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Kalisperati P, Spanou E, Pateras IS, Evangelou K, Thymara I, Korkolopoulou P, Kotsinas A, Vlachoyiannopoulos PG, Tzioufas AG, Kanellopoulos C, Gorgoulis VG, Sougioultzis S. Helicobacter pylori Eradication Reverses DNA Damage Response Pathway but Not Senescence in Human Gastric Epithelium. Int J Mol Sci 2024; 25:3888. [PMID: 38612698 PMCID: PMC11011975 DOI: 10.3390/ijms25073888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Helicobacter pylori (H. pylori) infection induces DNA Double-Strand Breaks (DSBs) and consequently activates the DNA Damage Response pathway (DDR) and senescence in gastric epithelium. We studied DDR activation and senescence before and after the eradication of the pathogen. Gastric antral and corpus biopsies of 61 patients with H. pylori infection, prior to and after eradication treatment, were analyzed by means of immunohistochemistry/immunofluorescence for DDR marker (γH2AΧ, phosporylated ataxia telangiectasia-mutated (pATM), p53-binding protein (53BP1) and p53) expression. Samples were also evaluated for Ki67 (proliferation index), cleaved caspase-3 (apoptotic index) and GL13 staining (cellular senescence). Ten H. pylori (-) dyspeptic patients served as controls. All patients were re-endoscoped in 72-1361 days (mean value 434 days), and tissue samples were processed in the same manner. The eradication of the microorganism, in human gastric mucosa, downregulates γH2AΧ expression in both the antrum and corpus (p = 0.00019 and p = 0.00081 respectively). The expression of pATM, p53 and 53BP1 is also reduced after eradication. Proliferation and apoptotic indices were reduced, albeit not significantly, after pathogen clearance. Moreover, cellular senescence is increased in H. pylori-infected mucosa and remains unaffected after eradication. Interestingly, senescence was statistically increased in areas of intestinal metaplasia (IM) compared with adjacent non-metaplastic mucosa (p < 0.001). In conclusion, H. pylori infection triggers DSBs, DDR and senescence in the gastric epithelium. Pathogen eradication reverses the DDR activation but not senescence. Increased senescent cells may favor IM persistence, thus potentially contributing to gastric carcinogenesis.
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Affiliation(s)
- Polyxeni Kalisperati
- Gastroenterology Unit, Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, 11527 Athens, Greece;
| | - Evangelia Spanou
- Gastroenterology Unit, Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, 11527 Athens, Greece;
| | - Ioannis S. Pateras
- 2nd Department of Pathology, “Attikon” University Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, 12462 Athens, Greece;
| | - Konstantinos Evangelou
- Molecular Carcinogenesis Group, Department of Histology and Embryology, Faculty of Medicine, National Kapodistrian University of Athens, Mikras Asias 75, 11527 Athens, Greece; (K.E.); (A.K.); (V.G.G.)
| | - Irene Thymara
- 1st Department of Pathology, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, 11527 Athens, Greece; (I.T.); (P.K.)
| | - Penelope Korkolopoulou
- 1st Department of Pathology, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, 11527 Athens, Greece; (I.T.); (P.K.)
| | - Athanassios Kotsinas
- Molecular Carcinogenesis Group, Department of Histology and Embryology, Faculty of Medicine, National Kapodistrian University of Athens, Mikras Asias 75, 11527 Athens, Greece; (K.E.); (A.K.); (V.G.G.)
| | - Panayiotis G. Vlachoyiannopoulos
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, 11527 Athens, Greece; (P.G.V.); (A.G.T.)
| | - Athanasios G. Tzioufas
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, 11527 Athens, Greece; (P.G.V.); (A.G.T.)
| | - Christos Kanellopoulos
- Faculty of Geology and Geoenvironment, National and Kapodistrian University of Athens, 15771 Athens, Greece;
| | - Vassilis G. Gorgoulis
- Molecular Carcinogenesis Group, Department of Histology and Embryology, Faculty of Medicine, National Kapodistrian University of Athens, Mikras Asias 75, 11527 Athens, Greece; (K.E.); (A.K.); (V.G.G.)
- Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 4HN, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK
- Faculty of Health and Medical Sciences, University of Surrey, 30 Priestley Road, Surrey Research Park, Guildford, Surrey GU2 7YH, UK
| | - Stavros Sougioultzis
- Gastroenterology Unit, Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, 11527 Athens, Greece;
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Venetsanopoulou AI, Goules AV, Vlachoyiannopoulos PG, Drosos AA, Tzioufas AG, Voulgari PV. The Role of Nailfold Capillaroscopy in Evaluating Patients with Interstitial Lung Disease Related to Connective Tissue Disease. Mediterr J Rheumatol 2023; 34:588-591. [PMID: 38282947 PMCID: PMC10815530 DOI: 10.31138/mjr.20230804.tr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 01/30/2024] Open
Abstract
Capillaroscopy is a non-invasive and safe imaging method that allows the evaluation of the microcirculation of the small vessels of the skin. The method's main advantage is the early detection of microvascular changes that may occur in certain connective tissue diseases (CTDs). Today, the presence of specific autoantibodies and capillaroscopic findings are generally accepted and emerge as a powerful diagnostic tool for detecting underlying CTDs in patients with Raynaud's phenomenon. The role of capillaroscopy has also been investigated in patients with CTD and interstitial lung disease (ILD). In these patients, lung involvement is considered one of the most severe complications, potentially leading to significant morbidity and mortality. So far, studies have shown an association of the scleroderma pattern in capillaroscopy with lung involvement in Scleroderma patients. Although there are studies on the association of capillary findings in patients with other CTDs, further efforts are needed to evaluate this technique and produce high-performance algorithms in the early detection of involvement and the progression of (CTD) related ILD (CTD-ILD). The present study aims to perform capillaroscopy in CTDILD patients with different imaging patterns and to correlate the method's findings with those found in high-resolution computed tomography, pulmonary tests, and the immunological profile of patients. Furthermore, the impact of ILD treatment on the capillaroscopic findings will be evaluated.
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Affiliation(s)
- Aliki I. Venetsanopoulou
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Greece
| | - Andreas V. Goules
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Panayiotis G. Vlachoyiannopoulos
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Greece; Institute for Autoimmune Systemic and Neurologic Diseases, Athens, Greece
| | - Alexandros A. Drosos
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Greece
| | - Athanasios G. Tzioufas
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Paraskevi V. Voulgari
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Greece
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Iliou A, Argyropoulou OD, Palamidas DA, Karagiannakou M, Benaki D, Tsezou K, Vlachoyiannopoulos PG, Mikros E, Tzioufas AG. NMR-based metabolomics in giant cell arteritis and polymyalgia rheumatica sequential sera differentiates active and inactive disease. Rheumatology (Oxford) 2023:kead590. [PMID: 37935429 DOI: 10.1093/rheumatology/kead590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 09/28/2023] [Accepted: 10/24/2023] [Indexed: 11/09/2023] Open
Abstract
OBJECTIVES Giant Cell Arteritis-(GCA) is an inflammatory disease following a chronic, relapsing course. The metabolic alterations related to the intense inflammatory process during the active phase and to the rapid impact of steroid treatment, remain unknown. The study aims to investigate the serum metabolome in active and inactive disease state. METHODS 110 serum samples from 50 patients [33-GCA and 17-Polymyalgia rheumatica-(PMR)] at 3 time points, 0-(V1: active disease), 1 and 6 months-(V2 and V3: remission) of treatment with glucocorticosteroids (GCs), were subjected to Nuclear Magnetic Resonance (NMR)-based metabolomic analysis. Multi- and univariate statistical analyses were utilized to unveil metabolome alterations following treatment. RESULTS Distinct metabolic profiles were identified between activity and remission, independently to disease type. N-acetylglycoproteins and cholines of bound phospholipids, emerged as predictive markers of disease activity. Altered levels of 4 out of the 21 small molecules were also observed, including increased levels of phenylalanine, and decreased of glutamine, alanine, and creatinine in active disease. Metabolic fingerprinting discriminated GCA from PMR in remission. GCA and PMR patients exhibited characteristic lipid alterations as a response and/or adverse effect of GCs treatment. Correlation analysis showed that several identified biomarkers were further associated with acute phase reactants, C-Reactive Protein and Erythrocyte Sedimentation Rate. CONCLUSION The NMR profile of serum metabolome could identify and propose sensitive biomarkers of inflammation. Metabolome alterations, following GCs treatment, could provide predictors for future steroid-induced side effects.
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Affiliation(s)
- Aikaterini Iliou
- Department of Pharmaceutical Chemistry, School of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Ourania D Argyropoulou
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Marianna Karagiannakou
- Department of Pharmaceutical Chemistry, School of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitra Benaki
- Department of Pharmaceutical Chemistry, School of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantina Tsezou
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Pharmagnose S.A, Inofyta, Greece
| | - Panayiotis G Vlachoyiannopoulos
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Research Institute for Systemic Autoimmune Rheumatic Diseases (RISARD), Athens, Greece
| | - Emmanuel Mikros
- Department of Pharmaceutical Chemistry, School of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
- Athena Research and Innovation Center in Information Communication & Knowledge Technologies, Marousi, Greece
- Pharmagnose S.A, Inofyta, Greece
| | - Athanasios G Tzioufas
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Center of New Biotechnologies and Precision Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Research Institute for Systemic Autoimmune Rheumatic Diseases (RISARD), Athens, Greece
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Solomonidi N, Vlachoyiannopoulos PG, Pappa M, Liantinioti G, Ktena S, Theotikos E, Elezoglou A, Netea MG, Giamarellos-Bourboulis EJ. A randomized clinical trial of bermekimab treatment for clinical improvement of systemic sclerosis. iScience 2023; 26:107670. [PMID: 37680472 PMCID: PMC10481358 DOI: 10.1016/j.isci.2023.107670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/11/2023] [Accepted: 08/16/2023] [Indexed: 09/09/2023] Open
Abstract
Increased concentrations of interleukin (IL)-1α have been recently described in tissues of patients with systemic sclerosis (SSc) suggesting that IL-1α inhibition may be a target for treatment. We conducted a double-blind, placebo-controlled study to assess the safety and efficacy of the fully humanized IL-1α blocking monoclonal antibody bermekimab in SSc. To evaluate response to treatment, we developed the score of inhibition of progression of SSc which was validated using the CRISS index and the modified CRISS index. The primary endpoint was met in 80% of bermekimab-treated patients vs. 20% of placebo-treated patients (p: 0.023). Most of efficacy was found for increase of carbon monoxide lung diffusion capacity. Production of IL-1α and TNF by circulating mononuclear cells was decreased and the absolute count of CD42/Cd62-platelets was decreased. Results suggest that bermekimab is a promising treatment for SSc.
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Affiliation(s)
- Nicky Solomonidi
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - Maria Pappa
- Department of Pathophysiology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Georgia Liantinioti
- Department of Pathophysiology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Sofia Ktena
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Evangelos Theotikos
- Department of Rheumatology, Asklepieion General Hospital of Voula, Athens, Greece
| | - Antonia Elezoglou
- Department of Rheumatology, Asklepieion General Hospital of Voula, Athens, Greece
| | - Mihai G. Netea
- Department of Internal Medicine and Center for Infectious Diseases, Radboud University, Nijmegen 6500, the Netherlands
- Department of Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
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Boutzios G, Chatzi S, Goules AV, Mina A, Charonis GC, Vlachoyiannopoulos PG, Tzioufas AG. Tocilizumab improves clinical outcome in patients with active corticosteroid-resistant moderate-to-severe Graves' orbitopathy: an observational study. Front Endocrinol (Lausanne) 2023; 14:1186105. [PMID: 37424868 PMCID: PMC10327634 DOI: 10.3389/fendo.2023.1186105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/30/2023] [Indexed: 07/11/2023] Open
Abstract
Background Graves' orbitopathy (GO) is an autoimmune disorder affecting the orbital fat and muscles. A significant role of IL-6 in the pathogenesis of GO has been described and tocilizumab (TCZ), an IL-6 inhibitor targeting IL-6R has been given in some patients. The aim of our case study was to evaluate the therapeutic outcome of TCZ in non-responders to first line treatments with corticosteroids. Methods We conducted an observational study of patients with moderate to severe GO. Twelve patients received TCZ in intravenous infusions at a dose of 8mg/kg every 28 days for 4 months and followed up for additionally 6 weeks. The primary outcome was improvement in CAS by at least 2 points, 6 weeks after the last dose of TCZ. Secondary outcomes included CAS <3 (inactive disease) 6 weeks after TCZ last dose, reduced TSI levels, proptosis reduction by > 2mm and diplopia response. Results The primary outcome, was achieved in all patients 6 weeks after treatment course. Furthermore all patients had inactive disease 6 weeks after treatment cessation. Treatment with TCZ reduced significantly median CAS by 3 units (p=0.002), TSI levels by 11.02 IU/L (p=0.006), Hertel score on the right eye by 2.3 mm (p=0.003), Hertel score on the left eye by 1.6 mm (p=0.002), while diplopia persisted in fewer patients (25%) after treatment with TCZ (not statistically significant, p=0.250). After treatment with TCZ, there was a radiological improvement in 75% of patients, while 16.7% showed no response, and in 8.3% of patients deterioration was established. Conclusion Tocilizumab appears to be a safe and cost effective therapeutic option for patients with active, corticosteroid-resistant, moderate to severe Graves' orbitopathy.
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Patsouras M, Alexopoulou E, Foutadakis S, Tsiki E, Karagianni P, Agelopoulos M, Vlachoyiannopoulos PG. Antiphospholipid antibodies induce proinflammatory and procoagulant pathways in endothelial cells. J Transl Autoimmun 2023; 6:100202. [PMID: 37216142 PMCID: PMC10197110 DOI: 10.1016/j.jtauto.2023.100202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 03/01/2023] [Accepted: 04/30/2023] [Indexed: 05/24/2023] Open
Abstract
Antiphospholipid syndrome (APS) is an autoimmune thrombophilia characterized by recurrent thrombotic events and/or pregnancy morbidity in the presence of antiphospholipid antibodies detected either as anti-cardiolipin, anti-β2 Glycoprotein I (anti-β2GPI) or Lupus anticoagulant (LA). Endothelial deregulation characterizes the syndrome. To address gene expression changes accompanying the development of autoimmune phenotype in endothelial cells in the context of APS, we performed transcriptomics analysis in Human Umbilical Vein Endothelial Cells (HUVECs) stimulated with IgG from APS patients and β2GPI, followed by intersection of RNA-seq data with published microarray and ChIP-seq results (Chromatin Immunoprecipitation). Our strategy revealed that during HUVEC activation diverse signaling pathways such as TNF-α, TGF-β, MAPK38, and Hippo are triggered as indicated by Gene Ontology (GO) classification and pathway analysis. Finally, cell biology approaches performed side-by-side in naïve and stimulated cultured HUVECs, as well as, in placenta specimens derived from Healthy donors (HDs) and APS-patients verified the evolution of an APS-characteristic gene expression program in endothelial cells during the initial stages of the disease's development.
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Affiliation(s)
- Markos Patsouras
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Greece
| | - Eirini Alexopoulou
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Greece
| | - Spyros Foutadakis
- Center of Basic Research, Biomedical Research Foundation, Academy of Athens, 4 Soranou Ephessiou Street, Athens, 11527, Greece
| | - Eirini Tsiki
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Greece
| | - Panagiota Karagianni
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Greece
| | - Marios Agelopoulos
- Center of Basic Research, Biomedical Research Foundation, Academy of Athens, 4 Soranou Ephessiou Street, Athens, 11527, Greece
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Kapsogeorgou EK, Stergiou IE, Chatzis L, Voulgarelis M, Vlachoyiannopoulos PG. The Role of the Akt Signaling Pathway in Sjögren's Syndrome. Mediterr J Rheumatol 2023; 34:113-116. [PMID: 37223600 PMCID: PMC10201088 DOI: 10.31138/mjr.34.1.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 12/08/2022] [Indexed: 05/25/2023] Open
Abstract
Primary Sjögren's syndrome (pSS) is a chronic autoimmune disorder with diverse clinical picture and high prevalence of B-cell non-Hodgkin lymphoma (NHL), that possibly raises from the chronic activation of B-cells. The mechanisms underlying the development of neoplasia in pSS remain elusive. Activated Akt/mTOR pathway is a uniform finding in cancer, whereas its significance in haematologic malignancies is highlighted by the plethora of inhibitors with promising therapeutic efficacy. PI3K-Akt activation has been involved in the TLR3-induced apoptosis of cultured salivary gland epithelial cells (SGECs), whereas upregulated expression of the phosphorylated ribosomal S6 protein (pS6), an end-result of PI3K signalling, has been detected in the infiltrating T and B lymphocytes at the MSG lesions of pSS patients; nevertheless, without specifying if this was mediated by the Akt/mTOR or Ras/ERK pathways. To this end, the role of Akt/mTOR pathway in pSS and associated lymphomagenesis, will be investigated by the immunohistochemical detection of the entire and phosphorylated protein forms of Akt kinase and two of its substrates, namely the FoxO1 transcription factor and the proline-rich Akt substrate of 40-kDa (PRAS40) in MSGs of pSS patients with variable histological and clinical phenotype, as well as sicca-complaining controls. Subsequently, the role of this pathway will be evaluated in in-vitro inhibition experiments, studying the effect of specific inhibitors in the phenotype, function, and interaction of SGECs and B cells. The current proposal is expected to promote the understanding of pSS pathogenesis, enlighten the mechanisms underlying related lymphomagenesis and possible therapeutic targets.
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Affiliation(s)
| | | | | | | | - Panayiotis G. Vlachoyiannopoulos
- Corresponding Author: Panayiotis G. Vlachoyiannopoulos, MD, Department of Pathophysiology, School of Medicine, National University of Athens, 75 Mikras Asias street, Athens 11527, Greece, Tel.: +30 210 7462513, Fax: +30 210 7462664, E-mail:
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Katsouli OK, Lainis VG, Kapellos GG, Vlachoyiannopoulos PG. Large Vessel Vasculitis After the Administration of Oxford-AstraZeneca COVID-19 Vaccine. Mediterr J Rheumatol 2023; 34:97-100. [PMID: 37223596 PMCID: PMC10201099 DOI: 10.31138/mjr.34.1.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/30/2023] [Accepted: 02/05/2023] [Indexed: 05/25/2023] Open
Abstract
We report a case of a 52-year-old female with Large Vessel Vasculitis (LVV) after vaccination with Oxford-AstraZeneca COVID-19 vaccine. She was presented with fever, started two weeks after the second dose of vaccine. Laboratory values, revealed elevated inflammatory markers and chronic disease anaemia. All the infectious causes were excluded, and immunology tests were negative. Computed Tomography (CT) demonstrated concentric wall thickening of ascending and descending aorta. Positron Emission Tomography (PET) scan showed increased vascular fluorodeoxyglucose (FDG), compatible with LVV. Within one month of treatment with high dose glucocorticoids and iv cyclophosphamide, laboratory findings normalised, and fever resolved.
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Affiliation(s)
- Olga K. Katsouli
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, and Institute for Autoimmune Systemic and Neurologic Diseases, Athens, Greece
| | - Vasileios G. Lainis
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, and Institute for Autoimmune Systemic and Neurologic Diseases, Athens, Greece
| | | | - Panayiotis G. Vlachoyiannopoulos
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, and Institute for Autoimmune Systemic and Neurologic Diseases, Athens, Greece
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Papakonstantinou E, Vlachakis D, Thireou T, Vlachoyiannopoulos PG, Eliopoulos E. Computational Methods for Anticancer Drug Discovery; The MCT4 Paradigm. Adv Exp Med Biol 2023; 1424:231. [PMID: 37486498 DOI: 10.1007/978-3-031-31982-2_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Modern anticancer research has employed advanced computational techniques and artificial intelligence methods for drug discovery and development, along with the massive amount of generated clinical and in silico data over the last decades. Diverse computational techniques and state-of-the-art algorithms are being developed to enhance traditional Rational Drug Design pipelines and achieve cost-efficient and successful anticancer candidates to promote human health. Towards this direction, we have developed a pharmacophore- based drug design approach against MCT4, a member of the monocarboxylate transporter family (MCT), which is the main carrier of lactate across the membrane and highly involved in cancer cell metabolism. Specifically, MCT4 is a promising target for therapeutic strategies as it overexpresses in glycolytic tumors, and its inhibition has shown promising anticancer effects. Due to the lack of experimentally determined structure, we have elucidated the key features of the protein through an in silico drug design strategy, including for molecular modelling, molecular dynamics, and pharmacophore elucidation, towards the identification of specific inhibitors as a novel anti-cancer strategy.
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Affiliation(s)
- Eleni Papakonstantinou
- Laboratory of Genetics, Department of Biotechnology, School of Applied Biology and Biotechnology, Agricultural University of Athens, Athens, Greece
| | - Dimitrios Vlachakis
- Laboratory of Genetics, Department of Biotechnology, School of Applied Biology and Biotechnology, Agricultural University of Athens, Athens, Greece
- University Research Institute of Maternal and Child Health & Precision Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
- Department of Informatics, Faculty of Natural and Mathematical Sciences, King's College London, London, UK
| | - Trias Thireou
- Laboratory of Genetics, Department of Biotechnology, School of Applied Biology and Biotechnology, Agricultural University of Athens, Athens, Greece
| | | | - Elias Eliopoulos
- Laboratory of Genetics, Department of Biotechnology, School of Applied Biology and Biotechnology, Agricultural University of Athens, Athens, Greece.
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Gerolymatou N, Bakasis AD, Voulgari PV, Vlachoyiannopoulos PG. Oral Antiviral Treatment for COVID-19 in Patients With Systemic Autoimmune Rheumatic Diseases. J Rheumatol Suppl 2022:jrheum.221014. [PMID: 36521909 DOI: 10.3899/jrheum.221014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe data on the safety and efficacy of molnupiravir (MP) and nirmatrelvir/ritonavir (NM/R) in patients with systemic autoimmune rheumatic diseases (SARDs). METHODS Among patients with SARD being followed in 2 tertiary outpatient rheumatology clinics, we retrospectively identified those infected with SARS-CoV-2 between February and August 2022 who received MP or NM/R. Patients' medical files were reviewed for demographics and disease-related characteristics, as well as coronavirus disease (COVID-19) characteristics, including vaccination status, antiviral treatment, side effects, and COVID-19 outcomes. RESULTS Seventy-four patients with SARD (52 females) were identified who had been infected with SARS-CoV-2 and received MP (n = 26, 35.1%) or NM/R (n = 48, 64.9%). Most patients were vaccinated against SARS-CoV-2 (n = 62, 83.8%). Among frequently used regimens were glucocorticoids (n = 43, 58.1%), mycophenolate mofetil (n = 26, 35.1%), tumor necrosis factor inhibitors (n = 14, 18.9%), methotrexate (n = 13, 17.6%), and rituximab (n = 12, 16.2%). Common adverse events were reported only by 4 patients receiving NM/R (metallic taste, gastrointestinal upset, hypertension), not leading to drug discontinuation. During follow-up, all but 2 patients (n = 72, 97.3%) recovered at home without COVID-19-related complications. Nonetheless, we describe 2 presumptive cases of COVID-19 rebound who progressed to severe COVID-19. CONCLUSION These data show a favorable outcome and acceptable safety profile of the 2 oral antiviral therapies MP and NM/R among a high-risk SARD population. However, cases of COVID-19 rebound are being increasingly identified. These findings call for continuous surveillance to capture the real-world efficacy and safety profiles in our subpopulations of interest.
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Affiliation(s)
- Nafsika Gerolymatou
- N. Gerolymatou, MD, PhD, P.V. Voulgari, MD, PhD, Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina. A.D. Bakasis, MD, P.G. Vlachoyiannopoulos, MD, PhD, Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. P.V. Voulgari, Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Stavros Niarchos Av., Ioannina, 45445, Greece. . Accepted for publication November 23, 2022
| | - Athanasios-Dimitrios Bakasis
- N. Gerolymatou, MD, PhD, P.V. Voulgari, MD, PhD, Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina. A.D. Bakasis, MD, P.G. Vlachoyiannopoulos, MD, PhD, Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. P.V. Voulgari, Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Stavros Niarchos Av., Ioannina, 45445, Greece. . Accepted for publication November 23, 2022
| | - Paraskevi V Voulgari
- N. Gerolymatou, MD, PhD, P.V. Voulgari, MD, PhD, Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina. A.D. Bakasis, MD, P.G. Vlachoyiannopoulos, MD, PhD, Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. P.V. Voulgari, Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Stavros Niarchos Av., Ioannina, 45445, Greece. . Accepted for publication November 23, 2022
| | - Panayiotis G Vlachoyiannopoulos
- N. Gerolymatou, MD, PhD, P.V. Voulgari, MD, PhD, Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina. A.D. Bakasis, MD, P.G. Vlachoyiannopoulos, MD, PhD, Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. P.V. Voulgari, Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Stavros Niarchos Av., Ioannina, 45445, Greece. . Accepted for publication November 23, 2022
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11
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Bakasis AD, Mavragani CP, Voulgari PV, Gerolymatou N, Argyropoulou OD, Vlachoyiannopoulos PG, Skopouli FN, Tzioufas AG, Moutsopoulos HM. COVID-19: Clinical features and outcomes in unvaccinated 2-dose and 3-dose vaccinated against SARS-CoV-2 patients with systemic autoimmune and autoinflammatory rheumatic diseases. J Autoimmun 2022; 131:102846. [PMID: 35717727 PMCID: PMC9181272 DOI: 10.1016/j.jaut.2022.102846] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/25/2022] [Accepted: 06/02/2022] [Indexed: 11/21/2022]
Abstract
Clinical data on vaccinated patients with coronavirus disease 2019 (COVID-19) who have systemic autoimmune and autoinflammatory rheumatic diseases (SAARD) are limited. This observational study aimed to report the clinical features and outcomes of COVID-19 among cases with SAARD that were unvaccinated or were 2- and 3-dose vaccinated against SARS-CoV-2 and were consecutively recorded by the treating physician. Unvaccinated and 2- and 3-dose vaccinated patients were compared in terms of COVID-19 symptomatology, hospitalizations, oxygen supplementation requirements, and death rates. From the beginning of the pandemic to February 15, 2022, 134 vaccine-naïve COVID-19 cases were recorded among our study cohort. From March 1, 2021 to February 15, 2022, 89 2-dose vaccinated and 105 3-dose vaccinated patients who were infected with SARS-CoV-2 ≥14 days after the second dose were included. The hospitalization rate was higher in the unvaccinated (n = 36, 26.9%) than in the 2-dose (n = 13, 14.6%, p = 0.03) or 3-dose (n = 5, 4.8%, p < 0.001) vaccinated patients. Severe/critical COVID-19 cases requiring oxygen supplementation were the least among 3-dose vaccinated (n = 4, 3.8%) compared to both 2-dose vaccinated (n = 12, 13.5%, p = 0.018) and unvaccinated (n = 25, 18.7%, p < 0.001) patients. ICU admission and death rates were similar among unvaccinated (n = 5, 3.7% and n = 3, 2.2%, respectively) and 2-dose vaccinated patients (n = 4, 4.5%; and n = 2, 2.2%, respectively), while no 3-dose vaccinated patients died or required ICU admission. Logistic regression analysis revealed a significant inverse association between 3-dose vaccination and severe/critical COVID-19 (OR = 0.078, 95% CI: 0.022–0.273, p < 0.001). In conclusion, these findings argue in favor of booster vaccination against SARS-CoV-2 in patients with SAARD.
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Affiliation(s)
- Athanasios-Dimitrios Bakasis
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; Institute for Autoimmune Systemic and Neurologic Diseases, Athens, Greece.
| | - Clio P Mavragani
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Paraskevi V Voulgari
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Nafsika Gerolymatou
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Ourania D Argyropoulou
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayiotis G Vlachoyiannopoulos
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; Institute for Autoimmune Systemic and Neurologic Diseases, Athens, Greece
| | - Fotini N Skopouli
- Department of Medicine and Clinical Immunology, Euroclinic of Athens, Athens, Greece
| | - Athanasios G Tzioufas
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; Institute for Autoimmune Systemic and Neurologic Diseases, Athens, Greece
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12
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Bakasis AD, Goules AV, Vlachoyiannopoulos PG, Bitzogli K, Tzioufas AG. Late and booster anti-SARS-CoV-2 humoral responses in nonresponder vaccinated patients with rheumatic diseases receiving mycophenolate or rituximab: comment on the article by XXX et al. ACR Open Rheumatol 2022; 4:645-646. [PMID: 35588445 PMCID: PMC9347727 DOI: 10.1002/acr2.11446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/18/2022] [Accepted: 04/05/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Athanasios-Dimitrios Bakasis
- Department of Pathophysiology and School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Institute for Autoimmune Systemic and Neurologic Diseases, Athens, Greece
| | - Andreas V Goules
- Department of Pathophysiology and School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Institute for Autoimmune Systemic and Neurologic Diseases, Athens, Greece
| | - Panayiotis G Vlachoyiannopoulos
- Department of Pathophysiology and School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Institute for Autoimmune Systemic and Neurologic Diseases, Athens, Greece
| | - Kleopatra Bitzogli
- Institute for Autoimmune Systemic and Neurologic Diseases, Athens, Greece
| | - Athanasios G Tzioufas
- Department of Pathophysiology and School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Institute for Autoimmune Systemic and Neurologic Diseases, Athens, Greece
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13
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Bitzogli K, Jahaj E, Bakasis AD, Kapsogeorgou EK, Goules AV, Stergiou I, Pezoulas V, Antoniadou C, Skendros P, Ritis K, Fotiadis DI, Kotanidou A, Tzioufas AG, Vlachoyiannopoulos PG. Incidence of autoantibodies related to systemic autoimmunity in patients with severe COVID-19 admitted to the intensive care unit. Clin Exp Rheumatol 2022; 41:1024-1033. [PMID: 36135957 DOI: 10.55563/clinexprheumatol/2remcx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To assess the prevalence of autoantibodies (AAbs) in mechanically ventilated COVID-19 patients and to investigate whether AAbs influence the clinical outcome. METHODS Serum samples were drawn within the first 48 hours upon admission to the intensive care unit (ICU) from 217 consecutive patients, from January 1st, 2021, to May 10th, 2021, and investigated for the presence of AAbs using conventional techniques. Serum samples (n=117) of age- and sex-matched healthy individuals collected before COVID-19 pandemic were used as controls. RESULTS COVID-19 patients in the ICU had more commonly AAbs compared to age- and sex-matched controls (174/217, 80.2% vs. 73/117, 62.4%, p<0.001). Patients expressed more frequently ANAs (48.4% vs. 21.4%, p<0.001), anti-dsDNA (5.1% vs. 0%, p=0.01), anti-CCP (8.3% vs. 1.7%, p=0.014) and anti-CL IgM AAbs (21.7% vs. 9.4%, p=0.005) than controls, respectively. Simultaneous reactivity against at least three autoantigens, occurred in 144 out of 174 (82.8%) patients. The two groups did not differ in terms of clinicoepidemiologic characteristics or the mortality ratio within the ICU. Patients who died compared to convalescents were older, had higher ferritin, D-dimers levels, APACHE II score, lower oxygen saturation, higher prevalence of comorbidities and cognitive dysfunction. However, AAbs were not found to correlate with the clinical outcome. CONCLUSIONS Patients with severe COVID-19 express AAbs more commonly compared to controls. No correlation was found between AAbs and disease outcome.
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Affiliation(s)
- Kleopatra Bitzogli
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, and Institute for Autoimmune Systemic and Neurologic Diseases, Athens, Greece
| | - Edison Jahaj
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evaggelismos Hospital, Athens, Greece
| | - Athanasios-Dimitrios Bakasis
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, and Institute for Autoimmune Systemic and Neurologic Diseases, Athens, Greece
| | - Efstathia K. Kapsogeorgou
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Andreas V. Goules
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens; Institute for Autoimmune Systemic and Neurologic Diseases, Athens, and Joint Academic Rheumatology Program, Medical School of the National and Kapodistrian University of Athens, Greece
| | - Ioanna Stergiou
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Vasilis Pezoulas
- Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, and Biomedical Research Section, Institute FORTH, Ioannina, Greece
| | - Christina Antoniadou
- Laboratory of Molecular Haematology, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Panagiotis Skendros
- Laboratory of Molecular Haematology, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Konstantinos Ritis
- Laboratory of Molecular Haematology, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitrios I. Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, and Biomedical Research Section, Institute FORTH, Ioannina, Greece
| | - Anastasia Kotanidou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evaggelismos Hospital, Athens, Greece
| | - Athanasios G. Tzioufas
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens; Institute for Autoimmune Systemic and Neurologic Diseases, Athens, and Joint Academic Rheumatology Program, Medical School of the National and Kapodistrian University of Athens, Greece
| | - Panayiotis G. Vlachoyiannopoulos
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens; Institute for Autoimmune Systemic and Neurologic Diseases, Athens, and Joint Academic Rheumatology Program, Medical School of the National and Kapodistrian University of Athens, Greece.
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14
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Vlachoyiannopoulos PG, Chatzis LG, Goules AV, Argyropoulou OD, Englezopoulou A, Stergiou I, Voulgarelis M, Tsanakas P, Exarchos T, Gorgoulis VV, Fotiadis DI, Tzioufas AG. Patient-centered approaches for patients with systemic autoimmune rheumatic diseases: development and evolution. Expert Rev Clin Immunol 2022; 18:125-133. [DOI: 10.1080/1744666x.2022.2022477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Loukas G Chatzis
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas V Goules
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ourania D Argyropoulou
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Ioanna Stergiou
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Michalis Voulgarelis
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayiotis Tsanakas
- School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | | | - Vassilis V Gorgoulis
- Laboratory of Histology-Embryology Molecular Carcinogenesis Group, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios I Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, Ioannina, Greece
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology, Ioannina, Greece
| | - Athanasios G Tzioufas
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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15
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Calina D, Hernández AF, Hartung T, Egorov AM, Izotov BN, Nikolouzakis TK, Tsatsakis A, Vlachoyiannopoulos PG, Docea AO. Challenges and Scientific Prospects of the Newest Generation of mRNA-Based Vaccines against SARS-CoV-2. Life (Basel) 2021; 11:life11090907. [PMID: 34575056 PMCID: PMC8467884 DOI: 10.3390/life11090907] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/26/2021] [Accepted: 08/28/2021] [Indexed: 02/07/2023] Open
Abstract
In the context of the current COVID-19 pandemic, traditional, complex and lengthy methods of vaccine development and production would not have been able to ensure proper management of this global public health crisis. Hence, a number of technologies have been developed for obtaining a vaccine quickly and ensuring a large scale production, such as mRNA-based vaccine platforms. The use of mRNA is not a new concept in vaccine development but has leveraged on previous knowledge and technology. The great number of human resources and capital investements for mRNA vaccine development, along with the experience gained from previous studies on infectious diseases, allowed COVID-19 mRNA vaccines to be developed, conditionally approved and commercialy available in less than one year, thanks to decades of basic research. This review critically presents and discusses the COVID-19 mRNA vaccine-induced immunity, and it summarizes the most common anaphylactic and autoimmune adverse effects that have been identified until now after massive vaccination campaigns.
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Affiliation(s)
- Daniela Calina
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Correspondence: (D.C.); (A.O.D.)
| | - Antonio F. Hernández
- Department of Legal Medicine and Toxicology, School of Medicine, University of Granada, 18016 Granada, Spain;
- Biomedical Research Institute of Granada ibs.GRANADA, Avda. de las Fuerzas Armadas, 2, 18014 Granada, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública), CIBERESP, Instituto de Salud Carlos III, Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - Thomas Hartung
- CAAT-Europe, University of Konstanz, 78464 Konstanz, Germany;
- CAAT, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Alexey M. Egorov
- Chumakov Federal Scientific Center for Research and Development of Immune and Biological Products, Russian Academy of Sciences, 108819 Moscow, Russia;
- Division of Medical Sciences, Russian Academy of Sciences, 119991 Moscow, Russia
| | - Boris Nikolaevich Izotov
- Department of Analytical and Forensic Medical Toxicology, Sechenov University, 119991 Moscow, Russia; (B.N.I.); (A.T.)
| | | | - Aristidis Tsatsakis
- Department of Analytical and Forensic Medical Toxicology, Sechenov University, 119991 Moscow, Russia; (B.N.I.); (A.T.)
- Laboratory of Toxicology, Medical School, University of Crete, 70013 Heraklion, Greece;
| | | | - Anca Oana Docea
- Department of Toxicology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Correspondence: (D.C.); (A.O.D.)
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16
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Kaklamanos A, Belogiannis K, Skendros P, Gorgoulis VG, Vlachoyiannopoulos PG, Tzioufas AG. COVID-19 Immunobiology: Lessons Learned, New Questions Arise. Front Immunol 2021; 12:719023. [PMID: 34512643 PMCID: PMC8427766 DOI: 10.3389/fimmu.2021.719023] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/09/2021] [Indexed: 12/17/2022] Open
Abstract
There is strong evidence that COVID-19 pathophysiology is mainly driven by a spatiotemporal immune deregulation. Both its phenotypic heterogeneity, spanning from asymptomatic to severe disease/death, and its associated mortality, are dictated by and linked to maladaptive innate and adaptive immune responses against SARS-CoV-2, the etiologic factor of the disease. Deregulated interferon and cytokine responses, with the contribution of immune and cellular stress-response mediators (like cellular senescence or uncontrolled inflammatory cell death), result in innate and adaptive immune system malfunction, endothelial activation and inflammation (endothelitis), as well as immunothrombosis (with enhanced platelet activation, NET production/release and complement hyper-activation). All these factors play key roles in the development of severe COVID-19. Interestingly, another consequence of this immune deregulation, is the production of autoantibodies and the subsequent development of autoimmune phenomena observed in some COVID-19 patients with severe disease. These new aspects of the disease that are now emerging (like autoimmunity and cellular senescence), could offer us new opportunities in the field of disease prevention and treatment. Simultaneously, lessons already learned from the immunobiology of COVID-19 could offer new insights, not only for this disease, but also for a variety of chronic inflammatory responses observed in autoimmune and (auto)inflammatory diseases.
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Affiliation(s)
- Aimilios Kaklamanos
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Institute for Autoimmune Systemic and Neurological Diseases, Athens, Greece
| | - Konstantinos Belogiannis
- Molecular Carcinogenesis Group, Department of Histology and Embryology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Skendros
- First Department of Internal Medicine and Laboratory of Molecular Hematology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Vassilis G. Gorgoulis
- Molecular Carcinogenesis Group, Department of Histology and Embryology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Faculty Institute for Cancer Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
- Basic Research Center, Biomedical Research Foundation of the Academy of Athens (BRFAA), Athens, Greece
- Center for New Biotechnologies and Precision Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayiotis G. Vlachoyiannopoulos
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Institute for Autoimmune Systemic and Neurological Diseases, Athens, Greece
| | - Athanasios G. Tzioufas
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Institute for Autoimmune Systemic and Neurological Diseases, Athens, Greece
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17
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Argyropoulou OD, Goules AV, Boutzios G, Tsirogianni A, Sfontouris C, Manoussakis MN, Vlachoyiannopoulos PG, Tzioufas AG, Kapsogeorgou EK. Occurrence and Antigenic Specificity of Perinuclear Anti-Neutrophil Cytoplasmic Antibodies (P-ANCA) in Systemic Autoimmune Diseases. Cells 2021; 10:cells10082128. [PMID: 34440897 PMCID: PMC8393570 DOI: 10.3390/cells10082128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/12/2021] [Accepted: 08/17/2021] [Indexed: 11/26/2022] Open
Abstract
Perinuclear anti-neutrophilic cytoplasmic antibodies (P-ANCA) recognize heterogeneous antigens, including myeloperoxidase (MPO), lactoferrin, elastase, cathepsin-G and bactericidal/permeability-increasing protein. Although P-ANCA have diagnostic utility in vasculitides, they may also be found in patients with various other systemic autoimmune rheumatic diseases (SARDs). Nevertheless, the clinical significance and the targets recognized by P-ANCA in such patients remain unclear. For this purpose, herein we investigated the occurrence of ANCA-related antigenic specificities in 82 P-ANCA-positive sera by multiplex ELISA, as well as their association with other autoantibodies. The P-ANCA-positive sera corresponded to patients with vasculitides (n = 24), systemic lupus erythematosus (n = 28), antiphospholipid syndrome (n = 5), Sjögren’s syndrome (n = 7), rheumatoid arthritis (n = 3), systemic scleroderma (n = 1), sarcoidosis (n = 1) and Hashimoto′s thyroiditis (n = 13). In most P-ANCA-positive patients studied (51/82, 62.3%), these autoantibodies occurred in high titers (>1:160). The analysis of P-ANCA-positive sera revealed reactivity to MPO in only 50% of patients with vasculitides, whereas it was infrequent in the other disease groups studied. Reactivity to other P-ANCA-related autoantigens was also rarely detected. Our findings support that high P-ANCA titers occur in SARD. The P-ANCA-positive staining pattern is associated with MPO specificity in vasculitides, while in other autoimmune diseases, it mostly involves unknown autoantigens.
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Affiliation(s)
- Ourania D. Argyropoulou
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (O.D.A.); (G.B.); (M.N.M.); (P.G.V.); (A.G.T.); (E.K.K.)
- Joint Rheumatology Academic Program, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Andreas V. Goules
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (O.D.A.); (G.B.); (M.N.M.); (P.G.V.); (A.G.T.); (E.K.K.)
- Joint Rheumatology Academic Program, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Correspondence: ; Tel.: +30-210-7462-513
| | - Georgios Boutzios
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (O.D.A.); (G.B.); (M.N.M.); (P.G.V.); (A.G.T.); (E.K.K.)
| | - Alexandra Tsirogianni
- Department of Immunology and Histocompatibility, Evangelismos General Hospital, 10676 Athens, Greece;
| | | | - Menelaos N. Manoussakis
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (O.D.A.); (G.B.); (M.N.M.); (P.G.V.); (A.G.T.); (E.K.K.)
- Joint Rheumatology Academic Program, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Panayiotis G. Vlachoyiannopoulos
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (O.D.A.); (G.B.); (M.N.M.); (P.G.V.); (A.G.T.); (E.K.K.)
- Joint Rheumatology Academic Program, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Athanasios G. Tzioufas
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (O.D.A.); (G.B.); (M.N.M.); (P.G.V.); (A.G.T.); (E.K.K.)
- Joint Rheumatology Academic Program, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Efstathia K. Kapsogeorgou
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (O.D.A.); (G.B.); (M.N.M.); (P.G.V.); (A.G.T.); (E.K.K.)
- Joint Rheumatology Academic Program, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
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18
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Bakasis AD, Mavragani CP, Boki KA, Tzioufas AG, Vlachoyiannopoulos PG, Stergiou IE, Skopouli FN, Moutsopoulos HM. COVID-19 infection among autoimmune rheumatic disease patients: Data from an observational study and literature review. J Autoimmun 2021; 123:102687. [PMID: 34311142 PMCID: PMC8282479 DOI: 10.1016/j.jaut.2021.102687] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 12/13/2022]
Abstract
The impact of SARS-CoV-2 infection in patients with autoimmune/auto-inflammatory rheumatic diseases (AARD) under immunomodulatory treatment has been a focus of interest during the COVID-19 pandemic. In this observational study, demographic data, disease related features and comorbidities, COVID-19 manifestations and outcome as well as antibody responses to SARS-CoV-2 were recorded among 77 consecutive patients with underlying AARD infected by SARS-CoV-2. Analysis of data was performed using univariate and multivariate models. Most patients (68.8%) had a mild COVID-19 course. The predominant clinical manifestations were fatigue (58.4%), low grade fever (45.4%) and upper respiratory tract symptoms (68.8%). About a quarter of patients required hospitalization (23.3%) and the mortality rate was 1.3%. Regarding COVID-19 severity, prior treatment with corticosteroids, mycophenolate mofetil or rituximab was more common in patients who developed a more serious disease course (60.0 vs 29.9%, p = 0.003, 40.0 vs 7.5%, p = 0.003, 10.0 vs 0.0%, p = 0.009, respectively). When disease related features and comorbidities were considered in multivariate models, older age and lung disease in the context of the AARD were found to be independent predictive factors for hospitalization (OR [95%]: 1.09 [1.03-1.15] and 6.43 [1.11-37.19]). Among COVID-19 related features, patients with shortness of breath and high-grade fever were more likely to get hospitalized (OR [95%]: 7.06 [1.36-36.57], 12.04 [2.96-48.86]), while anosmia was independently associated with lower hospitalization risk (OR [95%]: 0.09 [0.01-0.99]). Though the majority of AARD patients displayed a mild COVID-19 course, certain underlying disease features and COVID-19 related manifestations should prompt alertness for the physician to identify patients with AARD at high risk for severe COVID-19 and need for hospitalization.
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Affiliation(s)
- Athanasios-Dimitrios Bakasis
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Clio P Mavragani
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; Institute for Autoimmune Systemic and Neurologic Diseases, Athens, Greece.
| | - Kyriaki A Boki
- Rheumatology Unit, Sismanoglio General Hospital, Athens, Greece
| | - Athanasios G Tzioufas
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; Institute for Autoimmune Systemic and Neurologic Diseases, Athens, Greece
| | - Panayiotis G Vlachoyiannopoulos
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; Institute for Autoimmune Systemic and Neurologic Diseases, Athens, Greece
| | - Ioanna E Stergiou
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Fotini N Skopouli
- Department of Nutrition and Clinical Dietetics, Harokopio University of Athens, Athens, Greece; Department of Medicine and Clinical Immunology, Euroclinic of Athens, Athens, Greece
| | - Haralampos M Moutsopoulos
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; Medical Sciences/Immunology, Academy of Athens, Athens, Greece
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19
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Bournia VK, Kallianos A, Panopoulos S, Gialafos E, Velentza L, Vlachoyiannopoulos PG, Sfikakis PP, Trakada G. Cardiopulmonary exercise testing and prognosis in patients with systemic sclerosis without baseline pulmonary hypertension: a prospective cohort study. Rheumatol Int 2021; 42:303-309. [PMID: 34189602 DOI: 10.1007/s00296-021-04937-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/24/2021] [Indexed: 11/24/2022]
Abstract
Cardiopulmonary Exercise Testing (CPET) is a standardized, non-invasive procedure assessing pulmonary, cardiovascular, hematopoietic, and skeletal muscle functions during a symptom-limited test. Few studies have examined whether CPET is of prognostic value in Systemic Sclerosis (SSc), a disease characterized by highly increased cardiorespiratory morbidity and mortality. To examine the prognostic value of CPET in SSc patients without baseline pulmonary hypertension (PH). Sixty-two consecutive SSc patients underwent CPET, Pulmonary Function Tests (PFTs) and echocardiography at baseline. Four patients with Right Ventricular Systolic Pressure ≥ 40 mmHg, were excluded. Participants repeated PFTs approximately every 3 years. At the end of the follow-up period [median (IQR): 9.79 (2.78) years] patient vital status was recorded. Cox Regression analysis was used to identify predictors of deterioration of PFTs and 10-year survival. Median (IQR) age of 58 patients (90% women) at baseline was 54.0 (15.0) years, whereas 10-year survival was 88%. Baseline respiratory Oxygen uptake (VO2max) predicted PFT deterioration, defined either as a decline in FVC ≥ 10% or a combined decline in FVC 5%-9% plus DLCO ≥ 15%, during follow-up, after correction for age, gender and smoking status (HR: 0.874, 95%CI: 0.779-0.979, p = 0.021). In addition, lower baseline VO2max (HR = 0.861, 95%CI:0.739-1.003, p = 0.054) and DLCO (HR = 0.957, 95%CI: 0.910-1.006 p = 0.088), as well as male gender (HR = 5.68, 95%CI: 1.090-29.610 p = 0.039) and older age (HR = 1.069, 95%CI: 0.990-1.154, p = 0.086) were associated, after adjustment, with an increased risk for death. In the absence of baseline PH, CPET indices may predict pulmonary function deterioration and death in SSc patients during a nearly 10-year follow-up period.
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Affiliation(s)
| | - Anastasios Kallianos
- Division of Pulmonology, Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, 11528, Athens, Greece
| | - Stylianos Panopoulos
- Joint Rheumatology Program, National and Kapodistrian University of Athens, Athens, Greece
| | - Elias Gialafos
- Joint Rheumatology Program, National and Kapodistrian University of Athens, Athens, Greece
| | - Lemonia Velentza
- Division of Pulmonology, Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, 11528, Athens, Greece
| | | | - Petros P Sfikakis
- Joint Rheumatology Program, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Trakada
- Division of Pulmonology, Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, 11528, Athens, Greece.
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20
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Krilis M, Qi M, Ioannou Y, Zhang JY, Ahmadi Z, Wong JWH, Vlachoyiannopoulos PG, Moutsopoulos HM, Koike T, Sturgess AD, Chong BH, Krilis SA, Giannakopoulos B. Clinical relevance of nitrated beta 2-glycoprotein I in antiphospholipid syndrome: Implications for thrombosis risk. J Autoimmun 2021; 122:102675. [PMID: 34098405 DOI: 10.1016/j.jaut.2021.102675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/26/2021] [Accepted: 05/29/2021] [Indexed: 02/03/2023]
Abstract
Β2-Glycoprotein I (β2GPI) is an important anti-thrombotic protein and is the major auto-antigen in the antiphospholipid syndrome (APS). The clinical relevance of nitrosative stress in post translational modification of β2GPI was examined.The effects of nitrated (n)β2GPI on its anti-thrombotic properties and its plasma levels in primary and secondary APS were determined with appropriate clinical control groups. β2-glycoprotein I was nitrated at tyrosines 218, 275 and 309. β2-glycoprotein I binds to lipid peroxidation modified products through Domains IV and V. Nitrated β2GPI loses this binding (p < 0.05) and had diminished activity in inhibiting platelet adhesion to vWF under high shear flow (p < 0.01). Levels of nβ2GPI were increased in patients with primary APS compared to patients with either secondary APS (p < 0.05), autoimmune disease without APS (p < 0.05) or non-autoimmune patients with arterial thrombosis (p < 0.01) and healthy individuals (p < 0.05).In conclusion tyrosine nitration of plasma β2GPI is demonstrated and has important implications with regards to the pathophysiology of platelet mediated thrombosis in APS. Elevated plasma levels of nβ2GPI in primary APS may be a risk factor for thrombosis warranting further investigation.
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Affiliation(s)
- M Krilis
- Department of Infectious Disease, Immunology and Sexual Health, St George Hospital and Department of Medicine, St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia.
| | - M Qi
- Department of Infectious Disease, Immunology and Sexual Health, St George Hospital and Department of Medicine, St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia.
| | - Y Ioannou
- Department of Infectious Disease, Immunology and Sexual Health, St George Hospital and Department of Medicine, St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia; Division of Medicine, Centre for Rheumatology Research, University College London, London, UK.
| | - J Y Zhang
- Department of Infectious Disease, Immunology and Sexual Health, St George Hospital and Department of Medicine, St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia.
| | - Z Ahmadi
- Haematology Research Unit, St George and Sutherland Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - J W H Wong
- Prince of Wales Clinical School and Lowy Cancer Research Centre, University of New South Wales, Sydney, NSW, Australia.
| | - P G Vlachoyiannopoulos
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - H M Moutsopoulos
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - T Koike
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University School of Medicine, Sapporo, Japan.
| | - A D Sturgess
- Department of Rheumatology, St George Hospital, University of New South Wales, Sydney, NSW, Australia.
| | - B H Chong
- Haematology Research Unit, St George and Sutherland Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - S A Krilis
- Department of Infectious Disease, Immunology and Sexual Health, St George Hospital and Department of Medicine, St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia.
| | - B Giannakopoulos
- Department of Infectious Disease, Immunology and Sexual Health, St George Hospital and Department of Medicine, St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia; Department of Rheumatology, St George Hospital, University of New South Wales, Sydney, NSW, Australia.
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21
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Kaklamanos A, Karamichalos P, Vlachoyiannopoulos PG, Tzioufas AG. Correspondence on 'Historically controlled comparison of glucocorticoids with or without tocilizumab versus supportive care only in patients with COVID-19-associated cytokine storm syndrome: results of the CHIC study'. Ann Rheum Dis 2021; 82:e134. [PMID: 33903096 DOI: 10.1136/annrheumdis-2021-220411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 12/29/2022]
Affiliation(s)
- Aimilios Kaklamanos
- Department of Pathophyiology, National and Kapodistrian University of Athens Faculty of Medicine, Athens, Greece
| | - Panagiotis Karamichalos
- Department of Pathophyiology, National and Kapodistrian University of Athens Faculty of Medicine, Athens, Greece
| | | | - Athanasios G Tzioufas
- Department of Pathophyiology, National and Kapodistrian University of Athens Faculty of Medicine, Athens, Greece
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22
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Abstract
Introduction: Sjögren's syndrome is a unique systemic autoimmune disease, placed in the center of systemic autoimmunity and at the crossroads of autoimmunity and lymphoproliferation. The diverse clinical picture of the disease, the inefficacy of current biologic treatments, and the co-existence with lymphoma conferring to the patients' morbidity and mortality force the scientific community to review disease pathogenesis and reveal the major implicated cellular and molecular elements.Areas covered: Biomarkers for early diagnosis, prediction, stratification, monitoring, and targeted treatments can serve as a tool to interlink and switch from the clinical phenotyping of the disease into a more sophisticated classification based on the underlying critical molecular pathways and endotypes. Such a transition may define the establishment of the so-called precision medicine era in which patients' management will be based on grouping according to pathogenetically related biomarkers. In the current work, literature on Sjogren's syndrome covering several research fields including clinical, translational, and basic research has been reviewed.Expert opinion: The perspectives of clinical and translational research are anticipated to define phenotypic clustering of high-risk pSS patients and link the clinical picture of the disease with fundamental molecular mechanisms and molecules implicated in pathogenesis.
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Affiliation(s)
- Loukas Chatzis
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Athanasios G Tzioufas
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas V Goules
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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23
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Patsouras M, Tsiki E, Karagianni P, Vlachoyiannopoulos PG. The role of thrombospondin-1 in the pathogenesis of antiphospholipid syndrome. J Autoimmun 2020; 115:102527. [PMID: 32709480 DOI: 10.1016/j.jaut.2020.102527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Antiphospholipid syndrome (APS) is an acquired thrombophilia characterized by recurrent thrombosis and/or pregnancy morbidity, in the presence of antibodies to β2 glycoprotein-I (β2GPI), prothrombin or Lupus anticoagulant (LA). Anti-β2GPI antibodies recognize complexes of β2GPI dimers with CXCL4 chemokine and activate platelets. Thrombospondin 1 (TSP-1) is secreted by platelets and exhibits prothrombotic and proinflammatory properties. Therefore, we investigated its implication in APS. METHODS Plasma from APS patients (n = 100), Systemic Lupus Erythematosus (SLE) (n = 27) and healthy donors (HD) (n = 50) was analyzed for TSP-1, IL-1β, IL-17A and free active TGF-β1 by ELISA. Human Umbilical Vein Endothelial Cells (HUVECs) and HD monocytes were treated with total HD-IgG or anti-β2GPI, β2GPI and CXCL4 and CD4+ T-cells were stimulated by monocyte supernatants. TSP-1, IL-1β, IL-17A TGF-β1 levels were quantified by ELISA and Real-Time PCR. RESULTS Higher plasma levels of TSP-1 and TGF-β1, which positively correlated each other, were observed in APS but not HDs or SLE patients. Patients with arterial thrombotic events or those undergoing a clinical event had the highest TSP-1 levels. These patients also had detectable IL-1β, IL-17A in their plasma. HD-derived monocytes and HUVECs stimulated with anti-β2GPI-IgG-β2GPI-CXCL4 secreted the highest TSP-1 and IL-1β levels. Supernatants from anti-β2GPI-β2GPI-CXCL4 treated monocytes induced IL-17A expression from CD4+ T-cells. Transcript levels followed a similar pattern. CONCLUSIONS TSP-1 is probably implicated in the pathogenesis of APS. In vitro cell treatments along with high TSP-1 levels in plasma of APS patients suggest that high TSP-1 levels could mark a prothrombotic state and an underlying inflammatory process.
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Affiliation(s)
- M Patsouras
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Greece
| | - E Tsiki
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Greece
| | - P Karagianni
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Greece
| | - P G Vlachoyiannopoulos
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Greece.
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24
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Pitsilka DA, Kampolis CF, Rontogianni D, Zisis C, Loukeri AA, Vlachoyiannopoulos PG. Bronchocentric granulomatosis in rheumatoid arthritis: case report and literature review. Acta Reumatol Port 2020; 45:214-219. [PMID: 33139678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Bronchocentric granulomatosis (BcG) is characterized by granulomatous destruction of bronchial or bronchiolar walls and adjacent parenchyma, with debris and exudates filling the airway lumen. Approximately 50% of total cases have been associated with asthma and allergic bronchopulmonary aspergillosis, while it has been rarely reported in the context of rheumatoid arthritis (RA). We describe the case of a 69-year-old female RA patient with BcG presenting as a solitary cavitary pulmonary mass. In addition, we conducted a literature review about the clinical and imaging features of BcG in RA patients. A chronically immunosuppressed 69-year-old female patient with a 16-year history of RA presented with constitutional symptoms (low-grade fever, excessive sweating and malaise) and a sizeable cavitary lung lesion. Open lung biopsy was performed and histopathological findings were consistent with the diagnosis of BcG. Other seven cases of BcG have been previously reported in the context of RA, with clinical and laboratory characteristics described in five of them. Overall, pulmonary nodules or masses were the most frequent imaging finding of BcG, while no clear relationship with disease activity or previous treatment modalities could be established. Surgical resection followed by administration of oral steroids was effective for achieving complete remission of symptoms and radiological stability in most cases.
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25
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Vlachoyiannopoulos PG, Magira E, Alexopoulos H, Jahaj E, Theophilopoulou K, Kotanidou A, Tzioufas AG. Autoantibodies related to systemic autoimmune rheumatic diseases in severely ill patients with COVID-19. Ann Rheum Dis 2020; 79:1661-1663. [PMID: 32581086 DOI: 10.1136/annrheumdis-2020-218009] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 12/15/2022]
Affiliation(s)
| | - Eleni Magira
- 1st Department of Intensive Care Medicine, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Attica, Greece
| | - Haris Alexopoulos
- Department of Pathophysiology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Attica, Greece
| | - Edison Jahaj
- 1st Department of Intensive Care Medicine, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Attica, Greece
| | - Katerina Theophilopoulou
- Department of Pathophysiology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Attica, Greece
| | - Anastasia Kotanidou
- 1st Department of Intensive Care Medicine, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Attica, Greece
| | - Athanasios G Tzioufas
- Department of Pathophysiology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Attica, Greece
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26
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Bournia VK, Kottas K, Panopoulos S, Konstantonis G, Iliopoulos A, Tektonidou MG, Tzioufas AG, Sfikakis PP, Vlachoyiannopoulos PG. Differential performance of nailfold video capillaroscopic parameters in the diagnosis and prognosis of systemic sclerosis. Clin Exp Rheumatol 2020; 38 Suppl 125:29-39. [PMID: 31969216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/06/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The contribution of nailfold video capillaroscopy (NVC) in identifying patients with Raynaud's phenomenon (RP) at risk for systemic sclerosis (SSc) is well established. Herein we comparatively assess the performance of different capillaroscopic parameters in diagnosing SSc among patients with RP and evaluate the prognostic capacity of NVC in SSc. METHODS At baseline we clinically and capillaroscopically evaluated 242 consecutive patients referred to our department for NVC (138 with SSc); 175 were reevaluated after 3.38±1.47 years. Sixty-two healthy volunteers served as controls. Capillaroscopy pattern (normal/early/active/late) was qualitatively defined. Capillary loss, dilated, giant or ramified capillaries and micro-haemorrhages were scored semi-quantitatively. RESULTS Capillary loss score had the highest diagnostic accuracy at discriminating patients with an SSc-spectrum disorder from patients with RP of different etiology and controls, as defined by ROC curve analysis [AUC (95% CI)=0.905 (0.869-0.942)], followed by dilatation score [0.863 (0.818-0.907)] and giant score [0.835 (0.787-0.884)]. By contrast, micro-haemorrhages [0.720 (0.662-0.779)] and ramifications scores [0.604 (0.539-0.670)] performed worse. Multivariate analysis in 94 SSc patients indicated that active (OR=3.305, p=0.043) and late (OR=6.900, p=0.023) baseline capillaroscopy pattern predicted occurrence of a combined adverse disease outcome [forced vital capacity (FVC) deterioration>10% and/or DLCO deterioration>15% and/or mRSS deterioration>3.5 and/or first occurrence of digital ulcers and/or death)] at 3 year follow-up. CONCLUSIONS Dilatation score performs best of all semi-quantitative NVC parameters in diagnosing SSc. In addition, our study confirms earlier reports that worse capillaroscopy pattern at baseline correlates with higher likelihood for adverse prognosis.
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Affiliation(s)
- Vasiliki Kalliopi Bournia
- First Department of Propaedeutic and Internal Medicine and Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Konstantinos Kottas
- First Department of Propaedeutic and Internal Medicine and Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Stylianos Panopoulos
- First Department of Propaedeutic and Internal Medicine and Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - George Konstantonis
- First Department of Propaedeutic and Internal Medicine and Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Alexios Iliopoulos
- Department of Rheumatology, Veterans Administration Hospital (NIMTS), Medical School, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Maria G Tektonidou
- First Department of Propaedeutic and Internal Medicine and Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Athanasios G Tzioufas
- Department of Pathophysiology and Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic and Internal Medicine and Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Panayiotis G Vlachoyiannopoulos
- Department of Pathophysiology and Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece.
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27
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Bournia VK, Tsangaris I, Rallidis L, Konstantonis D, Frantzeskaki F, Anthi A, Orfanos SE, Demerouti E, Karyofillis P, Voudris V, Laskari K, Panopoulos S, Vlachoyiannopoulos PG, Sfikakis PP. Cardiac Catheterization versus Echocardiography for Monitoring Pulmonary Pressure: A Prospective Study in Patients with Connective Tissue Disease-Associated Pulmonary Arterial Hypertension. Diagnostics (Basel) 2020; 10:E49. [PMID: 31963800 PMCID: PMC7168199 DOI: 10.3390/diagnostics10010049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 02/01/2023] Open
Abstract
Standard echocardiography is important for pulmonary arterial hypertension (PAH) screening in patients with connective tissue disease (CTD), but PAH diagnosis and monitoring require cardiac catheterization. Herein, using cardiac catheterization as reference, we tested the hypothesis that follow-up echocardiography is adequate for clinical decision-making in these patients. We prospectively studied 69 consecutive patients with CTD-associated PAH. Invasive baseline pulmonary artery systolic pressure (PASP) was 60.19 ± 16.33 mmHg (mean ± SD) and pulmonary vascular resistance (PVR) was 6.44 ± 2.95WU. All patients underwent hemodynamic and echocardiographic follow-up after 9.47 ± 7.29 months; 27 patients had a third follow-up after 17.2 ± 7.4 months from baseline. We examined whether clinically meaningful hemodynamic deterioration of follow-up catheterization-derived PASP (i.e., > 10% increase) could be predicted by simultaneous echocardiography. Echocardiography predicted hemodynamic PASP deterioration with 59% sensitivity, 85% specificity, and 63/83% positive/negative predictive value, respectively. In multivariate analysis, successful echocardiographic prediction correlated only with higher PVR in previous catheterization (p = 0.05, OR = 1.235). Notably, in patients having baseline PVR > 5.45 WU, echocardiography had both sensitivity and positive predictive values of 73%, and both specificity and negative predictive value of 91% for detecting hemodynamic PASP deterioration. In selected patients with CTD-PAH echocardiography can predict PASP deterioration with high specificity and negative predictive value. Additional prospective studies are needed to confirm that better patient selection can increase the ability of standard echocardiography to replace repeat catheterization.
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Affiliation(s)
- Vasiliki Kalliopi Bournia
- First Department of Propaedeutic Internal Medicine and Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece; (V.K.B.); (K.L.); (S.P.)
| | - Iraklis Tsangaris
- Pulmonary Hypertension Clinic, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece; (I.T.); (L.R.); (D.K.); (F.F.); (A.A.); (S.E.O.)
| | - Loukianos Rallidis
- Pulmonary Hypertension Clinic, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece; (I.T.); (L.R.); (D.K.); (F.F.); (A.A.); (S.E.O.)
| | - Dimitrios Konstantonis
- Pulmonary Hypertension Clinic, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece; (I.T.); (L.R.); (D.K.); (F.F.); (A.A.); (S.E.O.)
| | - Frantzeska Frantzeskaki
- Pulmonary Hypertension Clinic, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece; (I.T.); (L.R.); (D.K.); (F.F.); (A.A.); (S.E.O.)
| | - Anastasia Anthi
- Pulmonary Hypertension Clinic, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece; (I.T.); (L.R.); (D.K.); (F.F.); (A.A.); (S.E.O.)
| | - Stylianos E. Orfanos
- Pulmonary Hypertension Clinic, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece; (I.T.); (L.R.); (D.K.); (F.F.); (A.A.); (S.E.O.)
| | - Eftychia Demerouti
- Invasive Cardiology Department, Onassis Cardiac Surgery Center, 176 74 Kallithea, Greece; (E.D.); (P.K.); (V.V.)
| | - Panagiotis Karyofillis
- Invasive Cardiology Department, Onassis Cardiac Surgery Center, 176 74 Kallithea, Greece; (E.D.); (P.K.); (V.V.)
| | - Vassilis Voudris
- Invasive Cardiology Department, Onassis Cardiac Surgery Center, 176 74 Kallithea, Greece; (E.D.); (P.K.); (V.V.)
| | - Katerina Laskari
- First Department of Propaedeutic Internal Medicine and Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece; (V.K.B.); (K.L.); (S.P.)
| | - Stylianos Panopoulos
- First Department of Propaedeutic Internal Medicine and Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece; (V.K.B.); (K.L.); (S.P.)
| | - Panayiotis G. Vlachoyiannopoulos
- Department of Pathophysiology and Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece;
| | - Petros P. Sfikakis
- First Department of Propaedeutic Internal Medicine and Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece; (V.K.B.); (K.L.); (S.P.)
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Patsouras MD, Vlachoyiannopoulos PG. Evidence of epigenetic alterations in thrombosis and coagulation: A systematic review. J Autoimmun 2019; 104:102347. [PMID: 31607428 DOI: 10.1016/j.jaut.2019.102347] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 10/03/2019] [Indexed: 02/07/2023]
Abstract
Thrombosis in the context of Cardiovascular disease (CVD) affects mainly the blood vessels supplying the heart, brain and peripheries and it is the leading cause of death worldwide. The pathophysiological thrombotic mechanisms are largely unknown. Heritability contributes to a 30% of the incidence of CVD. The remaining variation can be explained by life style factors such as smoking, dietary and exercise habits, environmental exposure to toxins, and drug usage and other comorbidities. Epigenetic variation can be acquired or inherited and constitutes an interaction between genes and the environment. Epigenetics have been implicated in atherosclerosis, ischemia/reperfusion damage and the cardiovascular response to hypoxia. Epigenetic regulators of gene expression are mainly the methylation of CpG islands, histone post translational modifications (PTMs) and microRNAs (miRNAs). These epigenetic regulators control gene expression either through activation or silencing. Epigenetic control is mostly dynamic and can potentially be manipulated to prevent or reverse the uncontrolled expression of genes, a trait that renders them putative therapeutic targets. In the current review, we systematically studied and present available data on epigenetic alterations implicated in thrombosis derived from human studies. Evidence of epigenetic alterations is observed in several thrombotic diseases such as Coronary Artery Disease and Cerebrovascular Disease, Preeclampsia and Antiphospholipid Syndrome. Differential CpG methylation and specific histone PTMs that control transcription of prothrombotic and proinflammatory genes have also been associated with predisposing factors of thrombosis and CVD, such us smoking, air pollution, hypertriglyceridemia, occupational exposure to particulate matter and comorbidities including cancer, Chronic Obstructive Pulmonary Disease and Chronic Kidney Disease. These clinical observations are further supported by in vitro experiments and indicate that epigenetic regulation affects the pathophysiology of thrombotic disorders with potential diagnostic or therapeutic utility.
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Affiliation(s)
- M D Patsouras
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - P G Vlachoyiannopoulos
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Greece.
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29
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Affiliation(s)
- Christos F Kampolis
- Department of Pathophysiology, National and Kapodistrian University of Athens, Medical School, "Laiko" General Hospital, Athens, Greece.
| | - Panayiotis G Vlachoyiannopoulos
- Department of Pathophysiology, National and Kapodistrian University of Athens, Medical School, "Laiko" General Hospital, Athens, Greece
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30
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Zampeli E, Venetsanopoulou A, Argyropoulou OD, Mavragani CP, Tektonidou MG, Vlachoyiannopoulos PG, Tzioufas AG, Skopouli FN, Moutsopoulos HM. Myositis autoantibody profiles and their clinical associations in Greek patients with inflammatory myopathies. Clin Rheumatol 2018; 38:125-132. [DOI: 10.1007/s10067-018-4267-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/29/2018] [Accepted: 08/15/2018] [Indexed: 12/01/2022]
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31
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Vlachoyiannopoulos PG, Mavragani CP, Bourazopoulou E, Balitsari AV, Routsias JG. Anti-CD40 antibodies in antiphospholipid syndrome and systemic lupus erythematosus. Thromb Haemost 2017; 92:1303-11. [PMID: 15583738 DOI: 10.1160/th04-02-0135] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryAnti-β2glycoprotein I (anti-β2GPI) antibodies constitute the main autoantibody specificity in the sera of patients with antiphospholipid syndrome (APS). There is evidence that antiβ2GPI antibodies induce the precoagulant activity of the endothelium by cross-linking the β2 glycoprotein I (β2GPI) on the cell surface. Since β2GPI lacks intracellular domains, homology with other molecules such as CD40 that could initiate signaling, was extensively searched. A 86% homology between the amino acid position 239-245 of the CD40 and 7-13 of the β2glycoprotein was found. The CD40 peptide corresponding to amino acids 239-245 of the CD40 molecule was synthesized and coupled to a multiple antigenic peptide carrier. Antibodies to CD40 peptide were found in 61.5% APS patients (n=39), in 72.7% of systemic lupus erythematosus (SLE) positive for anti β2GPI antibodies (n=11) and 31.6% of SLE negative for antiβ2GPI antibodies (n=19), but not in rheumatoid arthritis patients (n=28) or controls (n=36). Antibodies to CD40 peptide were associated with arterial thrombosis and/or brain microinfarcts. Affinity purified anti-CD40 peptide antibodies as well as affinity purified anti-β2GPI antibodies recognized both, the β2GPI and the CD40 peptide. The specificity of this recognition was confirmed with homologous and heterologous inhibition experiments. Confocal microscopy experiments demonstrated this cross-recognition of CD40 and β2GPI molecules, by the purified anti-CD40 peptide antibodies, at the protein level. Thus, antibodies reacting with the β2GPI can react and potentially activate different cells which express CD40 molecules at their surface.
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MESH Headings
- Adult
- Antibodies/chemistry
- Antibodies, Antiphospholipid/immunology
- Antibodies, Monoclonal
- Antiphospholipid Syndrome/blood
- Antiphospholipid Syndrome/immunology
- Autoantibodies/immunology
- B-Lymphocytes/immunology
- CD40 Antigens/biosynthesis
- CD40 Antigens/immunology
- Cell Line, Transformed
- Cell Membrane/metabolism
- Chromatography
- Chromatography, Ion Exchange
- Endothelium, Vascular/immunology
- Enzyme-Linked Immunosorbent Assay
- Fluorescein-5-isothiocyanate/pharmacology
- Humans
- Lupus Erythematosus, Systemic/blood
- Lupus Erythematosus, Systemic/immunology
- Microscopy, Confocal
- Middle Aged
- Models, Biological
- Peptides/chemistry
- Protein Structure, Tertiary
- Sensitivity and Specificity
- Signal Transduction
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32
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Fragoulis GE, Lionaki S, Venetsanopoulou A, Vlachoyiannopoulos PG, Moutsopoulos HM, Tzioufas AG. Central nervous system involvement in patients with granulomatosis with polyangiitis: a single-center retrospective study. Clin Rheumatol 2017; 37:737-747. [DOI: 10.1007/s10067-017-3835-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/06/2017] [Accepted: 09/07/2017] [Indexed: 11/24/2022]
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33
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Elhai M, Meune C, Boubaya M, Avouac J, Hachulla E, Balbir-Gurman A, Riemekasten G, Airò P, Joven B, Vettori S, Cozzi F, Ullman S, Czirják L, Tikly M, Müller-Ladner U, Caramaschi P, Distler O, Iannone F, Ananieva LP, Hesselstrand R, Becvar R, Gabrielli A, Damjanov N, Salvador MJ, Riccieri V, Mihai C, Szücs G, Walker UA, Hunzelmann N, Martinovic D, Smith V, Müller CDS, Montecucco CM, Opris D, Ingegnoli F, Vlachoyiannopoulos PG, Stamenkovic B, Rosato E, Heitmann S, Distler JHW, Zenone T, Seidel M, Vacca A, Langhe ED, Novak S, Cutolo M, Mouthon L, Henes J, Chizzolini C, Mühlen CAV, Solanki K, Rednic S, Stamp L, Anic B, Santamaria VO, De Santis M, Yavuz S, Sifuentes-Giraldo WA, Chatelus E, Stork J, Laar JV, Loyo E, García de la Peña Lefebvre P, Eyerich K, Cosentino V, Alegre-Sancho JJ, Kowal-Bielecka O, Rey G, Matucci-Cerinic M, Allanore Y. Mapping and predicting mortality from systemic sclerosis. Ann Rheum Dis 2017; 76:1897-1905. [PMID: 28835464 DOI: 10.1136/annrheumdis-2017-211448] [Citation(s) in RCA: 343] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/21/2017] [Accepted: 07/18/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To determine the causes of death and risk factors in systemic sclerosis (SSc). METHODS Between 2000 and 2011, we examined the death certificates of all French patients with SSc to determine causes of death. Then we examined causes of death and developed a score associated with all-cause mortality from the international European Scleroderma Trials and Research (EUSTAR) database. Candidate prognostic factors were tested by Cox proportional hazards regression model by single variable analysis, followed by a multiple variable model stratified by centres. The bootstrapping technique was used for internal validation. RESULTS We identified 2719 French certificates of deaths related to SSc, mainly from cardiac (31%) and respiratory (18%) causes, and an increase in SSc-specific mortality over time. Over a median follow-up of 2.3 years, 1072 (9.6%) of 11 193 patients from the EUSTAR sample died, from cardiac disease in 27% and respiratory causes in 17%. By multiple variable analysis, a risk score was developed, which accurately predicted the 3-year mortality, with an area under the curve of 0.82. The 3-year survival of patients in the upper quartile was 53%, in contrast with 98% in the first quartile. CONCLUSION Combining two complementary and detailed databases enabled the collection of an unprecedented 3700 deaths, revealing the major contribution of the cardiopulmonary system to SSc mortality. We also developed a robust score to risk-stratify these patients and estimate their 3-year survival. With the emergence of new therapies, these important observations should help caregivers plan and refine the monitoring and management to prolong these patients' survival.
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Affiliation(s)
- Muriel Elhai
- Rheumatology A department, Paris Descartes University, INSERM U1016, Sorbonne Paris Cité, Cochin Hospital, Paris, France
| | - Christophe Meune
- Department of Cardiology, Paris XIII University, INSERM UMR S-942, Bobigny Hospital, Paris, France
| | - Marouane Boubaya
- Unit of Clinical Research, Paris Seine Saint Denis University, Bobigny, France
| | - Jérôme Avouac
- Rheumatology A department, Paris Descartes University, INSERM U1016, Sorbonne Paris Cité, Cochin Hospital, Paris, France
| | - Eric Hachulla
- Department of Internal Medicine, Hôpital Claude Huriez, University Lille Nord-de-France, Lille Cedex, Lille, France
| | - Alexandra Balbir-Gurman
- B Shine Rheumatology Unit, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel
| | | | - Paolo Airò
- UO Reumatologia ed Immunologia Clinica Spedali Civili Brescia, Brescia, Italy
| | - Beatriz Joven
- Servicio de Reumatologia, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Serena Vettori
- Department of Clinical and Experimental Medicine, 'F-Magrassi' II, Naples, Italy
| | - Franco Cozzi
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Susanne Ullman
- Department of Dermatology, University Hospital of Copenhagen, Hospital Bispebjerg, Copenhagen, Denmark
| | - László Czirják
- Department of Immunology and Rheumatology, University of Pécs, Pécs, Hungary
| | - Mohammed Tikly
- Chris Hani Baragwanath Academic Hospital University of the Witwatersrand, Johannesburg, South Africa
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Paola Caramaschi
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Florenzo Iannone
- Interdisciplinary Department of Medicine-Rheumatology Unit, Policlinico, University of Bari, Bari, Italy
| | - Lidia P Ananieva
- VA Nasonova Institute of Rheumatology, Moscow, Russian Federation
| | - Roger Hesselstrand
- Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Radim Becvar
- Institute of Rheumatology, 1st Medical School, Charles University, Praha, Czech Republic
| | - Armando Gabrielli
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy
| | - Nemanja Damjanov
- Institute of Rheumatology, University of Belgrade Medical School, Belgrade, Serbia
| | - Maria J Salvador
- Rheumatology Department, Hospitais da Universidade, Coimbra, Portugal
| | - Valeria Riccieri
- Department of Internal Medicine and Medical Specialities, 'Sapienza', University of Rome, Italy, Rome, Italy
| | - Carina Mihai
- Department of Internal Medicine and Rheumatology Clinic, Ion Cantacuzino Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Gabriella Szücs
- Department of Internal Medicine, Division of Rheumatology, University of Debrecen, Debrecen, Hungary
| | - Ulrich A Walker
- Department of Rheumatology, Basel University, Unispital Basel, Basel, Switzerland
| | - Nicolas Hunzelmann
- Department of Dermatology, University Hospital Cologne, Cologne, Germany
| | - Duska Martinovic
- Department of Internal Medicine, Clinical Hospital of Split, Split, Croatia
| | - Vanessa Smith
- Department of Rheumatology, University of Ghent, Ghent, Belgium
| | | | | | - Daniela Opris
- Department of Rheumatology, St Maria Hospital, Carol Davila, University of Medicine and Pharmacy, Bucharest, Romania
| | - Francesca Ingegnoli
- Dipartimento e Cattedra di Reumatologia, Università degli Studi di Milano, Istituto Ortopedico 'Gaetano Pini', Milano, Italy
| | | | - Bojana Stamenkovic
- Institute for Prevention, Treatment and Rehabilitation of Rheumatic and Cardiovascular Diseases, Niska Banja, Serbia and Montenegro
| | - Edoardo Rosato
- Dipartimento di Medicina Clinica, Centro per la Sclerosi Sistemica, Università La Sapienza, Policlinico Umberto I, Roma, Italy
| | - Stefan Heitmann
- Department of Rheumatology, Marienhospital Stuttgart, Stuttgart, Germany
| | - Jörg H W Distler
- Department of Internal Medicine 3, University Hospital Erlangen, Erlangen, Germany
| | - Thierry Zenone
- Department of Medicine, Unit of Internal Medicine, Valence cedex, France
| | - Matthias Seidel
- Medizinische Klinik III, University Hospital of Bonn, Bonn, Germany
| | - Alessandra Vacca
- Rheumatology Unit, University Hospital of Cagliari, Monserrato, Italy
| | - Ellen De Langhe
- Division of Rheumatology and Department of Development and Regeneration, University Hospital Leuven and Laboratory Tissue Homeostasis and Disease, Leuven, Belgium
| | - Srdan Novak
- Department of Rheumatology and Clinical Immunology, Internal Medicine, KBC Rijeka, Rijeka, Croatia
| | - Maurizio Cutolo
- Research Laboratory and Division of Rheumatology Department of Internal Medicine, University of Genova, Genova, Italy
| | - Luc Mouthon
- Department of Internal Medicine, Hôpital Cochin, Paris, France
| | - Jörg Henes
- Medizinische Universitätsklinik, Abt II (Onkologie, Hämatologie, Rheumatologie, Immunologie, Pulmonologie), Tübingen, Germany
| | - Carlo Chizzolini
- Department of Immunology and Allergy, University Hospital, Geneva, Switzerland
| | | | - Kamal Solanki
- Rheumatology Unit, Waikato University Hospital, Hamilton City, Hamilton, New Zealand
| | - Simona Rednic
- Department of Rheumatology, University of Medicine and Pharmacy 'Iuliu Hatieganu' Cluj, Cluj-Napoca, Romania
| | - Lisa Stamp
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Branimir Anic
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Maria De Santis
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Sule Yavuz
- Department of Rheumatology, University of Marmara, Istanbul, Turkey
| | | | - Emmanuel Chatelus
- Department of Rheumatology, University Hospital of Strasbourg-, Hôpital de Hautepierre, Service de Rhumatologie, Strasbourg, France
| | - Jiri Stork
- Department of Dermatology, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jacob van Laar
- Department of Rheumatology and Clinical Immunology, James Cook University Hospital, Middlesbrough, UK
| | - Esthela Loyo
- Reumatologia e Inmunologia Clinica, Hospital Regional Universitario Jose Ma Cabral y Baez, Clinica Corominas, Santiago, Dominican Republic
| | | | - Kilian Eyerich
- Department of Dermatology and Allergy of the TU Munich, Munich, Germany
| | - Vanesa Cosentino
- Department of Rheumatology and Collagenopathies, Osteoarticular Diseases and Osteoporosis Centre, Pharmacology and Clinical Pharmacological Research Centre, School of Medicine-University of Buenos Aires, Ramos Mejía Hospital, Buenos Aires, Argentina
| | | | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Grégoire Rey
- INSERM, CépiDc, Le Kremlin- Bicêtre, Le Kremlin-Bicêtre, France
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Section of Internal Medicine and Division of Rheumatology, Azienda Ospedaliero-Universitaria Careggi (AOUC), University of Florence, Florence, Italy
| | - Yannick Allanore
- Rheumatology A department, Paris Descartes University, INSERM U1016, Sorbonne Paris Cité, Cochin Hospital, Paris, France
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Sfikakis PP, Bournia VK, Sidiropoulos P, Boumpas DT, Drosos AA, Kitas GD, Konstantonis G, Liossis SN, Manoussakis MN, Sakkas L, Tektonidou M, Tzioufas AG, Vlachoyiannopoulos PG, Kani C, Paterakis P, Litsa P, Vassilopoulos D. Biologic treatment for rheumatic disease: real-world big data analysis from the Greek country-wide prescription database. Clin Exp Rheumatol 2017; 35:579-585. [PMID: 28281458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 12/09/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To directly assess the prevalence of inflammatory rheumatic disease under treatment with biologic disease modifying anti-rheumatic drugs (b-DMARDs) and compare treatment patterns between rheumatoid arthritis (RA) and spondyloarthropathy (SpA), including psoriatic arthritis. METHODS The obligatory country-wide prescription electronic database covering 10.223.000 Greek citizens (95.1% of the population, 99.5% Caucasian), all of whom with fully reinbursed access to b-DMARDs, was used to retrospectively capture all patients under b-DMARDs for RA/SpA between June 2014-May 2015. Age, gender and medications for RA/SpA and co-morbid classical cardiovascular risk factors (hypertension, dyslipidaemia, diabetes) were retrieved and analysed. RESULTS A total of 9.824 RA (61.2±14.0 years, 79% women) and 9.279 SpA patients (51.4±13.1 years, 41% women) using pharmacy-dispensed prescriptions for b-DMARDs were identified (overall prevalence 0.19%). Tumour necrosis factor inhibitors were used in 73% and 99% of RA and SpA patients, respectively. B-DMARD monotherapy (RA: 18.71%, SpA: 52.11%), b-DMARD switching during 12 months (RA: 7.73%, SpA: 6.26%), and use of methotrexate (RA: 50.25%, SpA: 27.35%) and corticosteroids (RA: 55.8%, SpA: 23.63%) differed between the two patient subgroups. In both subgroups, women received more often than men methotrexate, leflunomide, hydroxychloroquine and corticosteroids, and less often b-DMARD monotherapy. After adjustments for age, gender and concomitant drugs, the probability for anti-hypertensive and lipid-lowering drug prescription was higher in SpA than RA [OR=1.41 (95%CI: 1.29-1.54) and 1.24 (1.14-1.36), respectively, p<0.001], whereas for anti-diabetics it was similar. CONCLUSIONS In the first country-wide study that examines the characteristics of rheumatic disease patients under b-DMARD we show that their exact prevalence is 0.19%, with RA patients being older by 10 years, only slightly more numerous, and less likely to receive treatment for hypertension and dyslipidaemia than their demographically matched SpA counterparts. Longitudinal studies should assess the implications of these novel findings on the differential financial burden of rheumatic diseases, as well as on cardiovascular morbidity and mortality of these patients.
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Affiliation(s)
- Petros P Sfikakis
- Rheumatology Unit, First Department of Propedeutic Internal Medicine; and Joint Rheumatology Program, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.
| | - Vasiliki-Kalliopi Bournia
- Rheumatology Unit, First Department of Propedeutic Internal Medicine; and Joint Rheumatology Program, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | | | - Dimitrios T Boumpas
- Joint Rheumatology Program, National and Kapodistrian University of Athens School of Medicine, Greece
| | | | - George D Kitas
- Rheumatology Unit, First Department of Propedeutic Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Greece
| | - George Konstantonis
- Rheumatology Unit, First Department of Propedeutic Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Greece
| | | | - Menelaos N Manoussakis
- Joint Rheumatology Program, National and Kapodistrian University of Athens School of Medicine, Greece
| | | | - Maria Tektonidou
- Rheumatology Unit, First Department of Propedeutic Internal Medicine; and Joint Rheumatology Program, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Athanasios G Tzioufas
- Joint Rheumatology Program, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | | | - Chara Kani
- Greek National Organisation for Provision of Healthcare Services (EOPYY)-Medicines Division, Athens, Greece
| | - Panayiotis Paterakis
- Greek National Organisation for Provision of Healthcare Services (EOPYY)-Medicines Division, Athens, Greece
| | - Panayiota Litsa
- Greek National Organisation for Provision of Healthcare Services (EOPYY)-Medicines Division, Athens, Greece
| | - Dimitrios Vassilopoulos
- Joint Rheumatology Program, National and Kapodistrian University of Athens School of Medicine, Greece
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Lampropoulos CE, Orfanos P, Manoussakis MN, Tzioufas AG, Moutsopoulos HM, Vlachoyiannopoulos PG. Treat-to-target biologic therapy in patients with rheumatoid arthritis is more efficacious and safe compared to delayed initiation of biologics: a real-world study. Clin Exp Rheumatol 2017; 35:192-200. [PMID: 28094760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 05/02/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Rheumatoid arthritis (RA) is a chronic, devastating disease. Treat-to-target strategy (T2T) more than the usual care, reduces disease activity by using aggressively all therapeutic options. The aim of the study was to evaluate our hypothesis that T2T strategy using biologic disease-modifying anti-rheumatic drugs (bDMARDs), when needed, is also safer than the usual care characterised by delayed initiation of bDMARDs. METHODS Disease activity was regularly measured by DAS-28 until the end of treatment with the first bDMARD. All adverse events (AEs) and their severity were recorded. Cox proportional-hazards models were performed examining the association of treatment groups, with the risk of first AE. RESULTS There were 113 patients in T2T and 250 patients in usual care group. The likelihood (adjusted hazard ratio, HR) of achieving remission or LDA was 71% higher in the T2T group than in the usual care group, as it has been already shown by others. The novel finding of our work was that AEs, including cancers, were less frequent in the T2T group with the corresponding HRs being less than 0.50 for serious AEs, infections and serious infections (significant or marginally non-significant results). There were 15 new cancer cases in usual care and 1 in T2T group (IR 1.99 vs. 0.4, p=0.027). CONCLUSIONS Treat-to-target treatment with bDMARDs offers a safer, rapid and better long-term outcome to patients with RA.
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Affiliation(s)
- Christos E Lampropoulos
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Greece
| | - Philippos Orfanos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece
| | - Menelaos N Manoussakis
- Department of Pathophysiology, and Academic Joint Rheumatology Programme, Medical School, National and Kapodistrian University of Athens, Greece
| | - Athanasios G Tzioufas
- Department of Pathophysiology, and Academic Joint Rheumatology Programme, Medical School, National and Kapodistrian University of Athens, Greece
| | - Haralampos M Moutsopoulos
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Greece
| | - Panayiotis G Vlachoyiannopoulos
- Department of Pathophysiology, and Academic Joint Rheumatology Programme, Medical School, National and Kapodistrian University of Athens, Greece.
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Kalisperati P, Spanou E, Pateras IS, Korkolopoulou P, Varvarigou A, Karavokyros I, Gorgoulis VG, Vlachoyiannopoulos PG, Sougioultzis S. Inflammation, DNA Damage, Helicobacter pylori and Gastric Tumorigenesis. Front Genet 2017; 8:20. [PMID: 28289428 PMCID: PMC5326759 DOI: 10.3389/fgene.2017.00020] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/08/2017] [Indexed: 12/13/2022] Open
Abstract
Helicobacter pylori (H. pylori) is a Gram negative bacterium that colonizes the stomach of almost half human population. It has evolved to escape immune surveillance, establishes lifelong inflammation, predisposing to genomic instability and DNA damage, notably double strand breaks. The epithelial host cell responds by activation of DNA damage repair (DDR) machinery that seems to be compromised by the infection. It is therefore now accepted that genetic damage is a major mechanism operating in cases of H. pylori induced carcinogenesis. Here, we review the data on the molecular pathways involved in DNA damage and DDR activation during H. pylori infection.
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Affiliation(s)
- Polyxeni Kalisperati
- Gastroenterology Unit, Department of Pathophysiology, School of Medicine, National and Kapodistrian University Athens, Greece
| | - Evangelia Spanou
- Gastroenterology Unit, Department of Pathophysiology, School of Medicine, National and Kapodistrian University Athens, Greece
| | - Ioannis S Pateras
- Department of Histology and Embryology, School of Medicine, National and Kapodistrian University Athens, Greece
| | - Penelope Korkolopoulou
- 1st Department of Pathology, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens Athens, Greece
| | | | - Ioannis Karavokyros
- 1st Department of Surgery, Laiko Hospital, University of Athens, School of Medicine Athens, Greece
| | - Vassilis G Gorgoulis
- Department of Histology and Embryology, School of Medicine, National and Kapodistrian UniversityAthens, Greece; Biomedical Research Foundation of the Academy of AthensAthens, Greece; Faculty of Biology, Medicine and Health Manchester Cancer Research Centre, Manchester Academic Health Sciences Centre, The University of ManchesterManchester, UK
| | | | - Stavros Sougioultzis
- Gastroenterology Unit, Department of Pathophysiology, School of Medicine, National and Kapodistrian University Athens, Greece
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Lampropoulos CE, Kalamara P, Konsta M, Papaioannou I, Papadima E, Antoniou Z, Andrianopoulou A, Vlachoyiannopoulos PG. Osteoporosis and vascular calcification in postmenopausal women: a cross-sectional study. Climacteric 2016; 19:303-7. [PMID: 27045323 DOI: 10.3109/13697137.2016.1164134] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objectives To estimate the correlation between osteoporosis and vascular calcification in postmenopausal women and the influence of calcium/vitamin D supplements on vascular calcification. Methods A cross-sectional study was performed including 29 women with osteoporosis (15 not taking supplements) and 18 age-matched, non-osteoporotic women. They were evaluated for cardiovascular risk factors and blood tests, lateral X-ray of lumbar spine (assessment of abdominal aorta calcification, AAC) and carotid ultrasound (increased intima media thickness (iIMT) or calcified plaques) were performed. Results In univariate analysis, osteoporotic women were 16 times more likely to develop AAC (odds ratio (OR) 15.8, 95% confidence interval (CI) 1.9-135.4) and seven times more likely to develop iIMT (OR 6.8, 95% CI 1.8-25.4) compared to normal individuals. The odds of developing AAC and iIMT were increased each year after menopause (OR 1.11, 95% CI 1.01-1.2 and OR 1.18, 95% CI 1.05-1.3, respectively) and with aging (OR 1.27, 95% CI 1.1-1.47 and OR = 1.17, 95% CI 1.04-1.3, respectively). Calcified plaques were significantly correlated with osteoporosis (p = 0.014). In multivariate analysis, osteoporosis was an independent risk factor for AAC (OR 13.3, 95% CI 1.3-134.4) and iIMT (OR 4.7, 95% CI 1.1-19.9). Low doses of supplements did not appear to affect vascular calcification (p = 0.6). Conclusions Osteoporosis is associated with increased calcification of the abdominal aorta and carotids. Low doses of supplements do not appear to cause any increase in vascular calcification in osteoporotic women.
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Affiliation(s)
- C E Lampropoulos
- a Department of Internal Medicine , General Hospital of Argolidos , Argos , Greece
| | - P Kalamara
- b Department of Radiology , General Hospital of Argolidos , Argos , Greece
| | - M Konsta
- a Department of Internal Medicine , General Hospital of Argolidos , Argos , Greece
| | - I Papaioannou
- a Department of Internal Medicine , General Hospital of Argolidos , Argos , Greece
| | - E Papadima
- b Department of Radiology , General Hospital of Argolidos , Argos , Greece
| | - Z Antoniou
- b Department of Radiology , General Hospital of Argolidos , Argos , Greece
| | - A Andrianopoulou
- b Department of Radiology , General Hospital of Argolidos , Argos , Greece
| | - P G Vlachoyiannopoulos
- c Department of Pathophysiology, School of Medicine , National University of Athens , Athens , Greece
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Zampeli E, Vlachoyiannopoulos PG, Tzioufas AG. Treatment of rheumatoid arthritis: Unraveling the conundrum. J Autoimmun 2015; 65:1-18. [PMID: 26515757 DOI: 10.1016/j.jaut.2015.10.003] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 10/09/2015] [Indexed: 11/28/2022]
Abstract
Rheumatoid arthritis (RA) is a heterogeneous disease with a complex and yet not fully understood pathophysiology, where numerous different cell-types contribute to a destructive process of the joints. This complexity results into a considerable interpatient variability in clinical course and severity, which may additionally involve genetics and/or environmental factors. After three decades of focused efforts scientists have now achieved to apply in clinical practice, for patients with RA, the "treat to target" approach with initiation of aggressive therapy soon after diagnosis and escalation of the therapy in pursuit of clinical remission. In addition to the conventional synthetic disease modifying anti-rheumatic drugs, biologics have greatly improved the management of RA, demonstrating efficacy and safety in alleviating symptoms, inhibiting bone erosion, and preventing loss of function. Nonetheless, despite the plethora of therapeutic options and their combinations, unmet therapeutic needs in RA remain, as current therapies sometimes fail or produce only partial responses and/or develop unwanted side-effects. Unfortunately the mechanisms of 'nonresponse' remain unknown and most probable lie in the unrevealed heterogeneity of the RA pathophysiology. In this review, through the effort of unraveling the complex pathophysiological pathways, we will depict drugs used throughout the years for the treatment of RA, the current and future biological therapies and their molecular or cellular targets and finally will suggest therapeutic algorithms for RA management. With multiple biologic options, there is still a need for strong predictive biomarkers to determine which drug is most likely to be effective, safe, and durable in a given individual. The fact that available biologics are not effective in all patients attests to the heterogeneity of RA, yet over the long term, as research and treatment become more aggressive, efficacy, toxicity, and costs must be balanced within the therapeutic equation to enhance the quality of life in patients with RA.
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Affiliation(s)
- Evangelia Zampeli
- Department of Pathophysiology, School of Medicine, University of Athens, Athens, Greece
| | | | - Athanasios G Tzioufas
- Department of Pathophysiology, School of Medicine, University of Athens, Athens, Greece.
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Patsouras MD, Sikara MP, Grika EP, Moutsopoulos HM, Tzioufas AG, Vlachoyiannopoulos PG. Elevated expression of platelet-derived chemokines in patients with antiphospholipid syndrome. J Autoimmun 2015; 65:30-7. [PMID: 26283469 DOI: 10.1016/j.jaut.2015.08.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 07/31/2015] [Accepted: 08/05/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Platelet factor 4 tetramers (CXCL4 chemokine) form complexes with β2glycoprotein I (β2GPI), recognized by anti-β2GPI antibodies leading to platelet activation in antiphospholipid syndrome (APS), either primary (PAPS) or secondary (SAPS). Increased plasma levels of CXCL4 may favor this process; therefore we measured plasma levels of CXCL4, a CXCL4 variant (CXCL4L1) and as controls, platelet-derived chemokines CXCL7 (NAP-2) and CCL5 (RANTES), in APS, and disease controls such as patients with systemic lupus erythematosus (SLE) coronary artery disease (CAD) and healthy donors (HDs). METHODS Plasma samples and platelets were isolated from patients with APS (n = 87), SLE (n = 29), CAD (n = 14) and 54 HDs. Plasma levels of CXCL4, CXCL4L1, CXCL7 and CCL5 as well as intracellular platelet CXCL4 and CXCL4L1 were measured using ELISA. Platelet CXCL4 and CXCL4L1 RNA levels were determined by RT-PCR. RESULTS CXCL4, CXCL7 (NAP-2) and CCL5 (RANTES) plasma levels were significantly higher in patients with APS compared to both control groups (SLE, CAD) and HDs. CXCL4L1 plasma levels were also significantly higher in APS than in SLE and HDs, but lower from that of CAD patients. Statistically significant concordance was detected between CXCL4 and CXCL7 (p < 0.0001) or CCL5 (p < 0.0001) plasma levels in patients with APS, either PAPS or SAPS. CXCL4L1 plasma levels were inversely correlated with CXCL4 (P = 0.0027), CXCL7 (p = 0.012) and CCL5 (p = 0.023) in PAPS and positively with CXCL4 (p = 0.0191), CCL5 (p < 0.0001) and CXCL7 (P < 0.0001), in SAPS. Levels of CXCL4, CXCL4L1, CXCL7 and CCL5 were divided in "high" (exceeding a level defined as the mean of HDs and 3 SD) and "low" (below this level); The "CXCL4L1 high" group was characterized by increased IgG aCL, (p = 0.0215), double antibody positivity (either aCL or anti-β2GPI plus LA), (p = 0.0277), triple antibody positivity (aCL plus anti-β2GPI plus LA), (p = 0.0073) and thrombocytopenia (p = 0.0061), as well as with at least 1 thrombotic event or the last 5 years (p = 0.0001), or more than 3 thrombotic events ever (p = 0.0151). CONCLUSIONS Chemokines associated with platelet activation and immune cell chemotaxis were found to be elevated in APS patients' plasma and may contribute to the pathogenesis of the syndrome. High CXCL4L1 plasma levels are associated with the clinical expression of APS and should be prospectively evaluated as a biomarker.
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Affiliation(s)
- Markos D Patsouras
- Department of Pathophysiology, School of Medicine, National University of Athens, Athens, Greece
| | - Marina P Sikara
- Department of Pathophysiology, School of Medicine, National University of Athens, Athens, Greece
| | - Eleftheria P Grika
- Department of Pathophysiology, School of Medicine, National University of Athens, Athens, Greece
| | | | - Athanasios G Tzioufas
- Department of Pathophysiology, School of Medicine, National University of Athens, Athens, Greece
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Lampropoulos CE, Orfanos P, Bournia VK, Karatsourakis T, Mavragani C, Pikazis D, Manoussakis MN, Tzioufas AG, Moutsopoulos HM, Vlachoyiannopoulos PG. Adverse events and infections in patients with rheumatoid arthritis treated with conventional drugs or biologic agents: a real world study. Clin Exp Rheumatol 2015; 33:216-224. [PMID: 25664400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 12/10/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Treatment of rheumatoid arthritis (RA) with disease-modifying anti-rheumatic drugs (DMARDs), either synthetic (sDMARDs) or biologic agents (bDMARDs) has significantly improved disease outcome. However, the impact of therapy-related adverse events (AEs), mild, moderate or serious, on disease outcome is under debate. The purpose of the study was to test the hypothesis that AEs, including infections, are rather common in patients receiving bDMARDs than in those receiving sDMARDs. METHODS Analysis of the medical records of patients followed in a single outpatient clinic was performed. In total, 1403 adults (295 men, 1108 women) were included in the analysis (969 treated with sDMARDs only, 434 with bDMARDs). All AEs and infections were recorded and their severity was graded according to international criteria. Incident rates were calculated and Kaplan-Meier plots as well as Cox proportional-hazards models were performed to examine the association of treatment groups with the risk of any AE. RESULTS The risk of any AE, irrespective of severity, was significantly higher in patients with bDMARDs with the adjusted hazard ratio being 1.98 (95% CI: 1.64 to 2.39). Patients in the biologic group treated initially with infliximab or adalimumab had a higher risk of AE compared to patients receiving etanercept or other biologic agents. Among patients treated with methotrexate, those receiving a dose below 10 mg had a higher risk of any AE when compared to those receiving higher doses. CONCLUSIONS The risk of any AE among RA patients treated with bDMARDs was significantly higher compared to those treated with sDMARDs.
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Affiliation(s)
| | - Philippos Orfanos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National University of Athens, Athens, Greece
| | | | | | - Clio Mavragani
- Department of Pathophysiology, Medical School, National University of Athens, Greece
| | - Dimitrios Pikazis
- Department of Pathophysiology, Medical School, National University of Athens, Greece
| | | | - Athanasios G Tzioufas
- Department of Pathophysiology, Medical School, National University of Athens, Greece
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Aissopou EK, Bournia VK, Protogerou AD, Panopoulos S, Papaioannou TG, Vlachoyiannopoulos PG, Matucci-Cerinic M, Sfikakis PP. Intact calibers of retinal vessels in patients with systemic sclerosis. J Rheumatol 2015; 42:608-13. [PMID: 25641886 DOI: 10.3899/jrheum.141425] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE A primary endothelial cell dysfunction is thought to be involved in systemic sclerosis (SSc)-associated fibroproliferative vasculopathy of the microcirculation and small arterioles, even in sites not affected by fibrosis. Because the role of fibroblasts in pathologic modifications and vascular wall remodeling is relatively unclear, and because the retina provides a unique opportunity to assess microcirculation in the absence of resident fibroblasts, we systematically evaluated retinal vessels in patients with SSc. METHODS Digital retinal images were obtained from both eyes of 93 consecutive patients with fully characterized SSc and 29 healthy controls matched 1:1 for age and sex with selected patients without diabetes, hypertension history, or antihypertensive treatment. Internal microvascular calibers (erythrocyte column width in μm) by central retinal arteriolar and venular equivalents and arteriolar to venular ratio were measured using validated software. RESULTS Arteriolar and venular calibers were similar in patients and their matched controls (mean ± SEM; 187 ± 2 vs 184 ± 3, p = 0.444, and 211 ± 2 vs 216 ± 3, p = 0.314, respectively). Both arteriolar and venular calibers and their ratio in patients with SSc were not associated with disease duration, extent of skin involvement, pulmonary fibrosis, digital ulcers or pitting scars, amputations, digital capillaroscopic findings, inflammatory indices, or autoantibodies. CONCLUSION The evidence that retinal microcirculation is spared in SSc suggests that fibroproliferative vasculopathy may depend on specific cellular or soluble factors not present in the retinal environment.
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Affiliation(s)
- Evaggelia K Aissopou
- From the Rheumatology Unit, First Department of Propedeutic and Internal Medicine, and the Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School, Athens, Greece; Department of Clinical and Experimental Medicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi (AOUC), University of Florence, Florence, Italy.E.K. Aissopou, MD; V-K. Bournia, MD; A.D. Protogerou, MD, PhD; S. Panopoulos, MD, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; T.G. Papaioannou, PhD, Assistant Professor in Biomedical Engineering, Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School; P.G. Vlachoyiannopoulos, MD, PhD, Professor of Medicine-Immunology, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; M. Matucci-Cerinic, MD, PhD, Professor of Rheumatology, Department of Clinical and Experimental Medicine, Division of Rheumatology, AOUC, University of Florence; P.P. Sfikakis, MD, PhD, Professor of Internal Medicine, Head of Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School.
| | - Vasiliki-Kalliopi Bournia
- From the Rheumatology Unit, First Department of Propedeutic and Internal Medicine, and the Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School, Athens, Greece; Department of Clinical and Experimental Medicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi (AOUC), University of Florence, Florence, Italy.E.K. Aissopou, MD; V-K. Bournia, MD; A.D. Protogerou, MD, PhD; S. Panopoulos, MD, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; T.G. Papaioannou, PhD, Assistant Professor in Biomedical Engineering, Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School; P.G. Vlachoyiannopoulos, MD, PhD, Professor of Medicine-Immunology, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; M. Matucci-Cerinic, MD, PhD, Professor of Rheumatology, Department of Clinical and Experimental Medicine, Division of Rheumatology, AOUC, University of Florence; P.P. Sfikakis, MD, PhD, Professor of Internal Medicine, Head of Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School
| | - Athanase D Protogerou
- From the Rheumatology Unit, First Department of Propedeutic and Internal Medicine, and the Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School, Athens, Greece; Department of Clinical and Experimental Medicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi (AOUC), University of Florence, Florence, Italy.E.K. Aissopou, MD; V-K. Bournia, MD; A.D. Protogerou, MD, PhD; S. Panopoulos, MD, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; T.G. Papaioannou, PhD, Assistant Professor in Biomedical Engineering, Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School; P.G. Vlachoyiannopoulos, MD, PhD, Professor of Medicine-Immunology, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; M. Matucci-Cerinic, MD, PhD, Professor of Rheumatology, Department of Clinical and Experimental Medicine, Division of Rheumatology, AOUC, University of Florence; P.P. Sfikakis, MD, PhD, Professor of Internal Medicine, Head of Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School
| | - Stylianos Panopoulos
- From the Rheumatology Unit, First Department of Propedeutic and Internal Medicine, and the Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School, Athens, Greece; Department of Clinical and Experimental Medicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi (AOUC), University of Florence, Florence, Italy.E.K. Aissopou, MD; V-K. Bournia, MD; A.D. Protogerou, MD, PhD; S. Panopoulos, MD, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; T.G. Papaioannou, PhD, Assistant Professor in Biomedical Engineering, Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School; P.G. Vlachoyiannopoulos, MD, PhD, Professor of Medicine-Immunology, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; M. Matucci-Cerinic, MD, PhD, Professor of Rheumatology, Department of Clinical and Experimental Medicine, Division of Rheumatology, AOUC, University of Florence; P.P. Sfikakis, MD, PhD, Professor of Internal Medicine, Head of Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School
| | - Theodoros G Papaioannou
- From the Rheumatology Unit, First Department of Propedeutic and Internal Medicine, and the Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School, Athens, Greece; Department of Clinical and Experimental Medicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi (AOUC), University of Florence, Florence, Italy.E.K. Aissopou, MD; V-K. Bournia, MD; A.D. Protogerou, MD, PhD; S. Panopoulos, MD, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; T.G. Papaioannou, PhD, Assistant Professor in Biomedical Engineering, Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School; P.G. Vlachoyiannopoulos, MD, PhD, Professor of Medicine-Immunology, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; M. Matucci-Cerinic, MD, PhD, Professor of Rheumatology, Department of Clinical and Experimental Medicine, Division of Rheumatology, AOUC, University of Florence; P.P. Sfikakis, MD, PhD, Professor of Internal Medicine, Head of Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School
| | - Panayiotis G Vlachoyiannopoulos
- From the Rheumatology Unit, First Department of Propedeutic and Internal Medicine, and the Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School, Athens, Greece; Department of Clinical and Experimental Medicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi (AOUC), University of Florence, Florence, Italy.E.K. Aissopou, MD; V-K. Bournia, MD; A.D. Protogerou, MD, PhD; S. Panopoulos, MD, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; T.G. Papaioannou, PhD, Assistant Professor in Biomedical Engineering, Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School; P.G. Vlachoyiannopoulos, MD, PhD, Professor of Medicine-Immunology, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; M. Matucci-Cerinic, MD, PhD, Professor of Rheumatology, Department of Clinical and Experimental Medicine, Division of Rheumatology, AOUC, University of Florence; P.P. Sfikakis, MD, PhD, Professor of Internal Medicine, Head of Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School
| | - Marco Matucci-Cerinic
- From the Rheumatology Unit, First Department of Propedeutic and Internal Medicine, and the Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School, Athens, Greece; Department of Clinical and Experimental Medicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi (AOUC), University of Florence, Florence, Italy.E.K. Aissopou, MD; V-K. Bournia, MD; A.D. Protogerou, MD, PhD; S. Panopoulos, MD, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; T.G. Papaioannou, PhD, Assistant Professor in Biomedical Engineering, Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School; P.G. Vlachoyiannopoulos, MD, PhD, Professor of Medicine-Immunology, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; M. Matucci-Cerinic, MD, PhD, Professor of Rheumatology, Department of Clinical and Experimental Medicine, Division of Rheumatology, AOUC, University of Florence; P.P. Sfikakis, MD, PhD, Professor of Internal Medicine, Head of Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School
| | - Petros P Sfikakis
- From the Rheumatology Unit, First Department of Propedeutic and Internal Medicine, and the Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School, Athens, Greece; Department of Clinical and Experimental Medicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi (AOUC), University of Florence, Florence, Italy.E.K. Aissopou, MD; V-K. Bournia, MD; A.D. Protogerou, MD, PhD; S. Panopoulos, MD, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; T.G. Papaioannou, PhD, Assistant Professor in Biomedical Engineering, Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, Athens University Medical School; P.G. Vlachoyiannopoulos, MD, PhD, Professor of Medicine-Immunology, Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School; M. Matucci-Cerinic, MD, PhD, Professor of Rheumatology, Department of Clinical and Experimental Medicine, Division of Rheumatology, AOUC, University of Florence; P.P. Sfikakis, MD, PhD, Professor of Internal Medicine, Head of Rheumatology Unit, First Department of Propedeutic and Internal Medicine, Athens University Medical School
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Kampolis C, Tektonidou M, Moyssakis I, Tzelepis GE, Moutsopoulos H, Vlachoyiannopoulos PG. Evolution of cardiac dysfunction in patients with antiphospholipid antibodies and/or antiphospholipid syndrome: A 10-year follow-up study. Semin Arthritis Rheum 2014; 43:558-65. [DOI: 10.1016/j.semarthrit.2013.07.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 07/30/2013] [Accepted: 07/31/2013] [Indexed: 11/27/2022]
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Kosmas C, Papachrysanthou T, Daladimos T, Athanasopoulos A, Tsavaris N, Vlachoyiannopoulos PG. Control of relapsed germ cell tumor and SLE nephritis by high-dose chemotherapy and autologous hematopoietic cell transplantation. Future Oncol 2013; 9:1401-6. [PMID: 23980687 DOI: 10.2217/fon.13.70] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
High-dose chemotherapy and hematopoietic stem cell support remains a curative treatment option for relapsed or nonresponsive germ cell tumors, and has been applied experimentally to control severe autoimmune diseases. In the present study, we report on a patient with systemic lupus erythematosus nephritis who developed a nonseminomatous germ cell tumor that relapsed after standard chemotherapy and surgery. The patient received high-dose chemotherapy supported by autologous hematopoietic cell transplantation based on its indication for relapsed germ cell tumors. Prolonged control of his relapsed germ cell tumor and systemic lupus erythematosus was attained with high-dose chemotherapy and hematopoietic stem cell support. An extensive literature review is provided alongside a detailed discussion of the aforementioned case.
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Affiliation(s)
- Christos Kosmas
- Department of Medicine, 2nd Division of Medical Oncology & Hematopoietic Cell Transplantation Program, Metaxa Cancer Hospital, 51 Botassi Street, Piraeus, Greece.
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Golemati CV, Moutsopoulos HM, Vlachoyiannopoulos PG. Psychological characteristics of systemic sclerosis patients and their correlation with major organ involvement and disease activity. Clin Exp Rheumatol 2013; 31:37-45. [PMID: 23910608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 02/05/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The aim of this paper is to assess the psychological characteristics of personality, depression, anxiety, social support and coping strategies of systemic sclerosis (SSc) patients, their inter-correlations and their association with clinical symptoms. METHODS Patients with SSc (n=85) were interviewed and compared to rheumatoid arthritis (RA) patients (n=120) and healthy controls (HCs [n=125]). Psychological characteristics were assessed by the following psychometric scales: centre of epidemiological studies of depression (CES-D), hospital anxiety and depression scale (HAD), Eysenck personality questionnaire (EPQ), short form of social support (SSq), life experiences survey (LES) and ways of coping (WoC). Clinical data were collected at the same time of the interview. Both control groups were matched to SSc patients in terms of gender, age and educational status. Data were analysed with SPSS software. RESULTS Compared to control groups, SSc patients expressed more symptoms of depression and anxiety, showed less extraversion and reported more negative life events. They coped less often with positive reappraisal, problem solving, seeking of support and assertiveness, while they sought more often divine help, and they expressed wishing and denial. Inactive disease was associated with a lower probability of reporting depressive symptoms and negative life events and with a higher probability of positively reevaluating a problem. Lung dysfunction, skin involvement, esophageal problems and oral aperture correlated with psychological features. CONCLUSIONS Complications in psychological well-being characterise patients with SSc. This finding, as well as that of psychological characteristics correlating with organic factors, is an indication for designing supportive psycho-educational programmes as complementary therapies.
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Affiliation(s)
- Christina V Golemati
- Department of Pathophysiology, Medical School, National University of Athens, Greece.
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Vlachoyiannopoulos PG, Moutsopoulos HM. Anticentromere (ACA)-positive Sjӧgren's syndrome: a disease entity? Clin Exp Rheumatol 2013; 31:163-164. [PMID: 23343831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 12/05/2012] [Indexed: 06/01/2023]
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Kampylafka EI, Alexopoulos H, Kosmidis ML, Panagiotakos DB, Vlachoyiannopoulos PG, Dalakas MC, Moutsopoulos HM, Tzioufas AG. Incidence and prevalence of major central nervous system involvement in systemic lupus erythematosus: a 3-year prospective study of 370 patients. PLoS One 2013; 8:e55843. [PMID: 23424638 PMCID: PMC3570560 DOI: 10.1371/journal.pone.0055843] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 01/02/2013] [Indexed: 11/18/2022] Open
Abstract
Background The incidence and prevalence of CNS involvement in SLE remains unclear owing to conflicting results in the published studies. The aim of the study was to evaluate the incidence and prevalence of major definite CNS events in SLE patients. Methods 370 SLE patients with no previous history of CNS involvement were prospectively evaluated in a tertiary hospital referral center for 3 years. Major CNS manifestations were codified according to ACR definitions, including chorea, aseptic meningitis, psychosis, seizures, myelopathy, demyelinating syndrome, acute confusional state and strokes. Minor CNS events were excluded. ECLAM and SLEDAI-SELENA Modification scores were used to evaluate disease activity and SLICC/ACR Damage Index was used to assess accumulated damage. Results 16/370 (4.3%) patients presented with a total of 23 major CNS events. These included seizures (35%), strokes (26%), myelopathy (22%), optic neuritis (8.7%), aseptic meningitis (4.3%) and acute psychosis (4.3%). Incidence was 7.8/100 person years. Among hospitalizations for SLE, 13% were due to CNS manifestations. Epileptic seizures were associated with high disease activity, while myelopathy correlated with lower disease activity and NMO-IgG antibodies (P≤0.05). Stroke incidence correlated with APS coexistence (P = 0.06). Overall, CNS involvement correlated with high ECLAM and SLEDAI scores (P<0.001). Conclusions Clinically severe CNS involvement is rare in SLE patients, accounting for 7.8/100 person years. CNS involvement correlates with high disease activity and coexistence of specific features that define the respective CNS syndromes.
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Affiliation(s)
- Eleni I Kampylafka
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Abstract
Sjögren Syndrome (SS) is a systemic, autoimmune disorder characterized by lymphocytic infiltration of the exocrine glands. Different clinical associations have been described for each of the diverse autoantibodies found in SS patients. Antibodies directed against the Ro/La ribonucleoprotein complexes have been correlated with younger age, more severe dysfunction of the exocrine glands and a higher prevalence of extraglandular manifestations. Anti-nuclear antibodies and rheumatoid factors have been associated to extraglandular manifestations and an active immunological profile, while cryoglobulins are markers of more severe disease and correlate to lymphoma development and death. Antibodies to cyclic citrullinated peptides are scarce in SS and have been linked in some cases to the development of non-erosive arthritis. Furthermore, the presence of anti-mitochondrial antibodies and anti-smooth muscle antibodies in the sera of primary SS patients is considered indicative of primary biliary cirrhosis and autoimmune hepatitis, respectively. In addition, anti-centromere antibodies have been associated with a clinical phenotype intermediate between primary SS and systemic sclerosis, while antibodies against carbonic anhydrase have been related to renal tubular acidosis. Finally, an association of anti-muscarinic antibodies with cytopenias and a higher disease activity has also been described in primary SS. In conclusion, although not all of the above mentioned antibodies are useful for predicting distinct patient subgroups in SS, knowledge of the clinical associations of the different autoantibody specificities encountered in SS can advance our understanding of the disease and improve patient management.
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Affiliation(s)
- Vasiliki-Kalliopi Bournia
- Department of Pathophysiology, Medical School, University of Athens, Mikras Asias 75, 115 27 Athens, Greece
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Giannakopoulos B, Gao L, Qi M, Wong JW, Yu DM, Vlachoyiannopoulos PG, Moutsopoulos HM, Atsumi T, Koike T, Hogg P, Qi JC, Krilis SA. Factor XI is a substrate for oxidoreductases: enhanced activation of reduced FXI and its role in antiphospholipid syndrome thrombosis. J Autoimmun 2012; 39:121-9. [PMID: 22704541 DOI: 10.1016/j.jaut.2012.05.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 05/17/2012] [Indexed: 01/06/2023]
Abstract
Factor XI (FXI), a disulfide-linked covalent homodimer, circulates in plasma, and upon activation initiates the intrinsic/consolidation phase of coagulation. We present evidence that disulfide bonds in FXI are reduced to free thiols by oxidoreductases thioredoxin-1 (TRX-1) and protein disulfide isomerase (PDI). We identified that Cys362-Cys482 and Cys118-Cys147 disulfide bonds are reduced by TRX-1. The activation of TRX-1-treated FXI by thrombin, FXIIa or FXIa was significantly increased compared to non-reduced FXI, indicating that the reduced factor is more efficiently activated than the oxidized protein. Using a novel ELISA system, we compared the amount of reduced FXI in antiphospholipid syndrome (APS) thrombosis patients with levels in healthy controls, and found that APS patients have higher levels of reduced FXI. This may have implication for understanding the contribution of FXI to APS thrombosis, and the predisposition to thrombosis in patients with elevated plasma levels of reduced FXI.
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Affiliation(s)
- Bill Giannakopoulos
- Department of Immunology, Allergy and Infectious Diseases, St. George Hospital, University of New South Wales, Sydney, Australia.
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Tzioufas AG, Vlachoyiannopoulos PG. Sjogren's syndrome: an update on clinical, basic and diagnostic therapeutic aspects. J Autoimmun 2012; 39:1-3. [PMID: 22361268 DOI: 10.1016/j.jaut.2012.01.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 01/07/2012] [Indexed: 01/30/2023]
Abstract
The 11th International Symposium for Sjogren's syndrome was held in Athens, Greece in September 2011. This symposia is part of a long series of meetings that have attempted to meet the needs of both scientists and physicians in improving the healthcare of their patients with Sjogren's syndrome. Sjogren's syndrome affects almost 0.5% of the general population and is second only to rheumatoid arthritis amongst the systemic autoimmune diseases. More importantly, it has daily implications for the millions of sufferers around the world. The goal of this meeting, which included nearly 200 abstracts and invited lectures, was to address the critical needs in the clinical practice of Sjogren's syndrome. This volume is a composite of select papers that were presented at this meeting and attempts to provide a critical overview of clinical and basic science. The volume includes a variety of themes and, importantly, raises issues that are still unresolved but which are important in our future diagnostic and therapeutic efforts.
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Affiliation(s)
- A G Tzioufas
- Department of Pathophysiology, Medical School, National University of Athens, 75 Mikras Asias Str, 11528 Athens, Greece.
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Ioannou Y, Zhang JY, Qi M, Gao L, Qi JC, Yu DM, Lau H, Sturgess AD, Vlachoyiannopoulos PG, Moutsopoulos HM, Rahman A, Pericleous C, Atsumi T, Koike T, Heritier S, Giannakopoulos B, Krilis SA. Novel assays of thrombogenic pathogenicity in the antiphospholipid syndrome based on the detection of molecular oxidative modification of the major autoantigen β2-glycoprotein I. ACTA ACUST UNITED AC 2011; 63:2774-82. [PMID: 21618459 PMCID: PMC3328749 DOI: 10.1002/art.30383] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objective Beta-2-glycoprotein I (β2GPI) constitutes the major autoantigen in the antiphospholipid syndrome (APS), a common acquired cause of arterial and venous thrombosis. We recently described the novel observation that β2GPI may exist in healthy individuals in a free thiol (biochemically reduced) form. The present study was undertaken to quantify the levels of total, reduced, and posttranslationally modified oxidized β2GPI in APS patients compared to various control groups. Methods In a retrospective multicenter analysis, the proportion of β2GPI with free thiols in serum from healthy volunteers was quantified. Assays for measurement of reduced as well as total circulating β2GPI were developed and tested in the following groups: APS (with thrombosis) (n = 139), autoimmune disease with or without persistent antiphospholipid antibodies (aPL) but without APS (n = 188), vascular thrombosis without APS or aPL (n = 38), and healthy volunteers (n = 91). Results Total β2GPI was significantly elevated in patients with APS (median 216.2 μg/ml [interquartile range 173.3–263.8]) as compared to healthy subjects (median 178.4 μg/ml [interquartile range 149.4–227.5] [P < 0.0002]) or control patients with autoimmune disease or vascular thrombosis (both P < 0.0001). The proportion of total β2GPI in an oxidized form (i.e., lacking free thiols) was significantly greater in the APS group than in each of the 3 control groups (all P < 0.0001). Conclusion This large retrospective multicenter study shows that posttranslational modification of β2GPI via thiol-exchange reactions is a highly specific phenomenon in the setting of APS thrombosis. Quantification of posttranslational modifications of β2GPI in conjunction with standard laboratory tests for APS may offer the potential to more accurately predict the risk of occurrence of a thrombotic event in the setting of APS.
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Affiliation(s)
- Yiannis Ioannou
- Department of Immunology, St. George Hospital and University of New South Wales, Sydney, New South Wales, Australia
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