1
|
Kyriazopoulou E, Hasin-Brumshtein Y, Midic U, Poulakou G, Milionis H, Metallidis S, Astriti M, Fragkou A, Rapti A, Taddei E, Kalomenidis I, Chrysos G, Angheben A, Kainis I, Alexiou Z, Castelli F, Serino FS, Bakakos P, Nicastri E, Tzavara V, Ioannou S, Dagna L, Dimakou K, Tzatzagou G, Chini M, Bassetti M, Kotsis V, Tsoukalas DG, Selmi C, Konstantinou A, Samarkos M, Doumas M, Masgala A, Pagkratis K, Argyraki A, Akinosoglou K, Symbardi S, Netea MG, Panagopoulos P, Dalekos GN, Liesenfeld O, Sweeney TE, Khatri P, Giamarellos-Bourboulis EJ. Transitions of blood immune endotypes and improved outcome by anakinra in COVID-19 pneumonia: an analysis of the SAVE-MORE randomized controlled trial. Crit Care 2024; 28:73. [PMID: 38475786 PMCID: PMC10935809 DOI: 10.1186/s13054-024-04852-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Endotype classification may guide immunomodulatory management of patients with bacterial and viral sepsis. We aimed to identify immune endotypes and transitions associated with response to anakinra (human interleukin 1 receptor antagonist) in participants in the SAVE-MORE trial. METHODS Adult patients hospitalized with radiological findings of PCR-confirmed severe pneumonia caused by SARS-CoV-2 and plasma-soluble urokinase plasminogen activator receptor levels of ≥ 6 ng/ml in the SAVE-MORE trial (NCT04680949) were characterized at baseline and days 4 and 7 of treatment using a previously defined 33-messenger RNA classifier to assign an immunological endotype in blood. Endpoints were changes in endotypes and progression to severe respiratory failure (SRF) associated with anakinra treatment. RESULTS At baseline, 23.2% of 393 patients were designated as inflammopathic, 41.1% as adaptive, and 35.7% as coagulopathic. Only 23.9% were designated as the same endotype at days 4 and 7 compared to baseline, while all other patients transitioned between endotypes. Anakinra-treated patients were more likely to remain in the adaptive endotype during 7-day treatment (24.4% vs. 9.9%; p < 0.001). Anakinra also protected patients with coagulopathic endotype at day 7 against SRF compared to placebo (27.8% vs. 55.9%; p = 0.013). CONCLUSION We identify an association between endotypes defined using blood transcriptome and anakinra therapy for COVID-19 pneumonia, with anakinra-treated patients shifting toward endotypes associated with a better outcome, mainly the adaptive endotype. Trial registration ClinicalTrials.gov, NCT04680949, December 23, 2020.
Collapse
Affiliation(s)
- Evdoxia Kyriazopoulou
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Garyfallia Poulakou
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Haralampos Milionis
- 1st Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Simeon Metallidis
- 1st Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Myrto Astriti
- 1st Department of Internal Medicine, G. Gennimatas General Hospital of Athens, Athens, Greece
| | | | - Aggeliki Rapti
- 2nd Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Eleonora Taddei
- Dipartimento Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Ioannis Kalomenidis
- 1st Department of Critical Care and Pulmonary Medicine, Medical School, National and Kapodistrian University of Athens, Evangelismos General Hospital, Athens, Greece
| | - Georgios Chrysos
- 2nd Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Andrea Angheben
- Department of Infectious - Tropical Diseases and Microbiology, IRCSS Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Ilias Kainis
- 10th Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases of Athens, Athens, Greece
| | - Zoi Alexiou
- 2nd Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece
| | - Francesco Castelli
- Spedali Civili, Brescia ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | | | - Petros Bakakos
- 1st Department of Chest Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Emanuele Nicastri
- Department of Internal Medicine, Spallanzani Institute of Rome, Rome, Italy
| | - Vasiliki Tzavara
- 1st Department of Internal Medicine, Korgialeneion-Benakeion General Hospital, Athens, Greece
| | - Sofia Ioannou
- Department of Therapeutics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | - Katerina Dimakou
- 5th Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Athens, Greece
| | - Glykeria Tzatzagou
- 1st Department of Internal Medicine, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Maria Chini
- 3rd Department of Internal Medicine and Infectious Diseases Unit, Korgialeneion-Benakeion General Hospital, Athens, Greece
| | - Matteo Bassetti
- Infectious Diseases Clinic, Ospedale Policlinico San Martino IRCCS and Department of Health Sciences, University of Genova, Genova, Italy
| | - Vasileios Kotsis
- 3rd Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dionysios G Tsoukalas
- 4th Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Carlo Selmi
- Department of Biomedical Sciences, Humanitas University and IRCCS Humanitas Research Hospital, Milan, Italy
| | - Alexandra Konstantinou
- 1st Department of Internal Medicine, Asklepieio General Hospital of Voula, Voula, Greece
| | - Michael Samarkos
- 1st Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Doumas
- 2nd Department of Propedeutic Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aikaterini Masgala
- 2nd Department of Internal Medicine, Konstantopouleio General Hospital, Athens, Greece
| | | | - Aikaterini Argyraki
- Department of Internal Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | | | - Styliani Symbardi
- 1st Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece
| | - Mihai G Netea
- Department of Internal Medicine and Center for Infectious Diseases, Radboud University, Nijmegen, The Netherlands
- Department of Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Periklis Panagopoulos
- 2nd Department of Internal Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
| | | | | | - Purvesh Khatri
- Institute for Immunity, Transplantation and Infection, School of Medicine, Stanford University, Stanford, CA, USA
- Center for Biomedical Informatics Research, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Evangelos J Giamarellos-Bourboulis
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
- 4th Department of Internal Medicine, ATTIKON University Hospital, 1 Rimini Street, 124 62, Athens, Greece.
| |
Collapse
|
2
|
Engel JJ, van der Made CI, Keur N, Setiabudiawan T, Röring RJ, Damoraki G, Dijkstra H, Lemmers H, Ioannou S, Poulakou G, van der Meer JWM, Giamarellos-Bourboulis EJ, Kumar V, van de Veerdonk FL, Netea MG, Ziogas A. Dexamethasone attenuates interferon-related cytokine hyperresponsiveness in COVID-19 patients. Front Immunol 2023; 14:1233318. [PMID: 37614228 PMCID: PMC10442808 DOI: 10.3389/fimmu.2023.1233318] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/18/2023] [Indexed: 08/25/2023] Open
Abstract
Background Dexamethasone improves the survival of COVID-19 patients in need of supplemental oxygen therapy. Although its broad immunosuppressive effects are well-described, the immunological mechanisms modulated by dexamethasone in patients hospitalized with COVID-19 remain to be elucidated. Objective We combined functional immunological assays and an omics-based approach to investigate the in vitro and in vivo effects of dexamethasone in the plasma and peripheral blood mononuclear cells (PBMCs) of COVID-19 patients. Methods Hospitalized COVID-19 patients eligible for dexamethasone therapy were recruited from the general care ward between February and July, 2021. Whole blood transcriptomic and targeted plasma proteomic analyses were performed before and after starting dexamethasone treatment. PBMCs were isolated from healthy individuals and COVID-19 patients and stimulated with inactivated SARS-CoV-2 ex vivo in the presence or absence of dexamethasone and transcriptome and cytokine responses were assessed. Results Dexamethasone efficiently inhibited SARS-CoV-2-induced in vitro expression of chemokines and cytokines in PBMCs at the transcriptional and protein level. Dexamethasone treatment in COVID-19 patients resulted in down-regulation of genes related to type I and II interferon (IFN) signaling in whole blood immune cells. In addition, dexamethasone attenuated circulating concentrations of secreted interferon-stimulating gene 15 (ISG15) and pro-inflammatory cytokines and chemokines correlating with disease severity and lethal outcomes, such as tumor necrosis factor (TNF), interleukin-6 (IL-6), chemokine ligand 2 (CCL2), C-X-C motif ligand 8 (CXCL8), and C-X-C motif chemokine ligand 10 (CXCL10). In PBMCs from COVID-19 patients that were stimulated ex vivo with multiple pathogens or Toll-like receptor (TLR) ligands, dexamethasone efficiently inhibited cytokine responses. Conclusion We describe the anti-inflammatory impact of dexamethasone on the pathways contributing to cytokine hyperresponsiveness observed in severe manifestations of COVID-19, including type I/II IFN signaling. Dexamethasone could have adverse effects in COVID-19 patients with mild symptoms by inhibiting IFN responses in early stages of the disease, whereas it exhibits beneficial effects in patients with severe clinical phenotypes by efficiently diminishing cytokine hyperresponsiveness.
Collapse
Affiliation(s)
- Job J. Engel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Caspar I. van der Made
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Nick Keur
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Todia Setiabudiawan
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rutger J. Röring
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Georgia Damoraki
- Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Helga Dijkstra
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Heidi Lemmers
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Sofia Ioannou
- Department of Therapeutics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Garyfallia Poulakou
- Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Jos W. M. van der Meer
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Vinod Kumar
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Genetics, University Medical Center Groningen, Groningen, Netherlands
| | - Frank L. van de Veerdonk
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Mihai G. Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Immunology and Metabolism, Life & Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Athanasios Ziogas
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| |
Collapse
|
3
|
Marinaki S, Vittoraki A, Tsiakas S, Kofotolios I, Darema M, Ioannou S, Vallianou K, Boletis J. Clinical Outcome of Kidney Transplant Recipients with C1q-Binding De Novo Donor Specific Antibodies: A Single-Center Experience. J Clin Med 2023; 12:4475. [PMID: 37445510 DOI: 10.3390/jcm12134475] [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: 02/19/2023] [Revised: 07/01/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023] Open
Abstract
Complement activation by HLA antibodies is a key component of immune-mediated graft injury. We examined the clinical outcomes of kidney transplant recipients with complement-fixing de novo donor-specific antibodies (dnDSA) who were followed in our center. The C1q-binding ability was retrospectively assessed in 69 patients with dnDSA and mean fluorescence intensity (MFI) values > 2000 out of the 1325 kidney transplant recipients who were screened for DSA between 2015 and 2019. Luminex IgG single antigen beads (SAB)and C1q-SAB assays (One Lambda) were used. C1q-binding dnDSA was identified in 32/69 (46.4%) of the patients. Significantly higher MFI values were observed in C1q-positive DSA (18,978 versus 5840, p < 0.001). Renal graft biopsies were performed in 43 of the kidney transplant recipients (62.3%) with allograft dysfunction. Antibody-mediated rejection (ABMR) was detected in 29/43 (67.4%) of the patients. The incidence of ABMR was similar among patients with C1q-binding and non-C1q-binding DSA (51.7% vs. 48.3%, p = 0.523). Graft loss occurred in 30/69 (43.5%) of the patients at a median time of 82.5 months (IQR 45-135) from DSA detection. C1q-binding DSA was present in more patients who experienced graft loss (53.1% vs. 35.1%, p = 0.152). Higher MFI values and inferior clinical outcomes occurred in most of the kidney transplant recipients with C1q-binding dnDSA.
Collapse
Affiliation(s)
- Smaragdi Marinaki
- Clinic of Nephrology and Renal Transplantation, National and Kapodistrian University of Athens Medical School, Laiko Hospital, 11527 Athens, Greece
| | - Angeliki Vittoraki
- Immunology Department, National Tissue Typing Center, General Hospital of Athens "G. Gennimatas", 11527 Athens, Greece
| | - Stathis Tsiakas
- Clinic of Nephrology and Renal Transplantation, National and Kapodistrian University of Athens Medical School, Laiko Hospital, 11527 Athens, Greece
| | - Ioannis Kofotolios
- Clinic of Nephrology and Renal Transplantation, National and Kapodistrian University of Athens Medical School, Laiko Hospital, 11527 Athens, Greece
| | - Maria Darema
- Clinic of Nephrology and Renal Transplantation, National and Kapodistrian University of Athens Medical School, Laiko Hospital, 11527 Athens, Greece
| | - Sofia Ioannou
- Immunology Department, National Tissue Typing Center, General Hospital of Athens "G. Gennimatas", 11527 Athens, Greece
| | - Kalliopi Vallianou
- Clinic of Nephrology and Renal Transplantation, National and Kapodistrian University of Athens Medical School, Laiko Hospital, 11527 Athens, Greece
| | - John Boletis
- Clinic of Nephrology and Renal Transplantation, National and Kapodistrian University of Athens Medical School, Laiko Hospital, 11527 Athens, Greece
| |
Collapse
|
4
|
Akinosoglou K, Kotsaki A, Gounaridi IM, Christaki E, Metallidis S, Adamis G, Fragkou A, Fantoni M, Rapti A, Kalomenidis I, Chrysos G, Boni G, Kainis I, Alexiou Z, Castelli F, Serino FS, Bakakos P, Nicastri E, Tzavara V, Safarika A, Ioannou S, Dagna L, Dimakou K, Tzatzagou G, Chini M, Bassetti M, Kotsis V, Angheben A, Tsoukalas G, Selmi C, Spiropoulou OM, Samarkos M, Doumas M, Damoraki G, Masgala A, Papanikolaou I, Argyraki A, Negri M, Leventogiannis K, Sympardi S, Gatselis NK, Petrakis V, Netea MG, Panagopoulos P, Sakka V, Milionis H, Dalekos GN, Giamarellos-Bourboulis EJ. Efficacy and safety of early soluble urokinase plasminogen receptor plasma-guided anakinra treatment of COVID-19 pneumonia: A subgroup analysis of the SAVE-MORE randomised trial. EClinicalMedicine 2023; 56:101785. [PMID: 36590789 PMCID: PMC9791950 DOI: 10.1016/j.eclinm.2022.101785] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The SAVE-MORE trial demonstrated that anakinra treatment in COVID-19 pneumonia with plasma soluble urokinase plasminogen activator (suPAR) levels of 6 ng/mL or more was associated with 0.36 odds for a worse outcome compared to placebo when expressed by the WHO-Clinical Progression Scale (CPS) at day 28. Herein, we report the results of subgroup analyses and long-term outcomes. METHODS This prospective, double-blind, randomised clinical trial, recruited patients with a confirmed SARS-CoV-2 infection, in need of hospitalisation, lower respiratory tract infection and plasma suPAR ≥6 ng/mL from 37 academic and community hospitals in Greece and Italy. Patients were 1:2 randomised to subcutaneous treatment with placebo or anakinra (100 mg) once daily for 10 days. Pre-defined subgroups of Charlson's comorbidity index (CCI), sex, age, level of suPAR, and time from symptom onset were analysed for the primary endpoint (overall comparison of distribution of frequencies of the scores from the WHO-CPS between treatments on day 28), by multivariable ordinal regression analysis in the intention to treat (ITT) population. This trial is registered with the EU Clinical Trials Register (2020-005828-11) and ClinicalTrials.gov (NCT04680949). FINDINGS Patients were enrolled between 23 December 2020 and 31 March 2021; 189 patients in the placebo arm and 405 patients in the anakinra arm were the ITT population. Multivariable analysis showed that anakinra treatment was accompanied by significantly lower odds for worse outcome compared to placebo at day 28 for all studied subgroups (CCI ≥ 2, OR: 0.34, 95% confidence intervals [CI] 0.22-0.50; CCI < 2, OR: 0.38, 95% CI 0.21-0.68; suPAR > 9 ng/mL, OR: 0.35, 95% CI 0.19-0.66; suPAR 6-9 ng/mL, OR: 0.35, 95% CI 0.24-0.52; patients ≥65 years, OR: 0.41, 95% CI 0.25-0.66; and patients <65 years, OR: 0.29, 95% CI 0.19-0.45). The benefit was uniform, irrespective of the time from start of symptoms until the start of the study drug. At days 60 and 90, anakinra treatment had odds of 0.40 (95% CI 0.28-0.57) and 0.46 (95% CI 0.32-0.67) respectively, for a worse outcome compared to placebo. The costs of general ward stay, ICU stay, and drugs were lower with anakinra treatment. INTERPRETATION Anakinra represents an important therapeutic tool in the management of COVID-19 that may be administered in all subgroups of patients; benefits are maintained until day 90. FUNDING Hellenic Institute for the Study of Sepsis; Swedish Orphan Biovitrum AB.
Collapse
Affiliation(s)
| | - Antigone Kotsaki
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Institute for the Study of Sepsis, Athens, Greece
| | - Ioanna-Maria Gounaridi
- Third Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eirini Christaki
- First Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Simeon Metallidis
- First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Adamis
- First Department of Internal Medicine, G. Gennimatas General Hospital of Athens, Athens, Greece
| | | | - Massimo Fantoni
- Dipartimento Scienze di Laboratorio e Infettivologiche - Fondazione Policlinico Gemelli IRCCS, Roma, Italy
| | - Aggeliki Rapti
- Second Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Ioannis Kalomenidis
- First Department of Critical Care and Pulmonary Medicine, Medical School, Evangelismos General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Chrysos
- Second Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Gloria Boni
- Hospital Pharmacy, IRCCS Hospital Sacro Cuore, Negrar di Valpolicella, Verona, Italy
- IRCSS Sacro Cuore Hospital, Negrar di Valpolicella, Verona, Italy
| | - Ilias Kainis
- Tenth Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases of Athens, Athens, Greece
| | - Zoi Alexiou
- Second Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece
| | - Francesco Castelli
- Spedali Civili, Brescia ASST Spedali Civili Hospital, University of Brescia, Italy
| | | | - Petros Bakakos
- First Department of Chest Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Emanuele Nicastri
- Department of Internal Medicine, Spallanzani Institute of Rome, Rome, Italy
| | - Vassiliki Tzavara
- First Department of Internal Medicine, Korgialeneion-Benakeion General Hospital, Athens, Greece
| | - Asimina Safarika
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Institute for the Study of Sepsis, Athens, Greece
| | - Sofia Ioannou
- Department of Therapeutics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS Ospedale San Raffaele & Vita-Salute San Raffaele University, Milan, Italy
| | - Katerina Dimakou
- Fifth Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Glykeria Tzatzagou
- First Department of Internal Medicine, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Maria Chini
- Third Department of Internal Medicine and Infectious Diseases Unit, Korgialeneion-Benakeion General Hospital, Athens, Greece
| | - Matteo Bassetti
- Infectious Diseases Clinic, Ospedale Policlinico San Martino IRCCS and Department of Health Sciences, University of Genova, Genoa, Italy
| | - Vasileios Kotsis
- Third Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andrea Angheben
- Department of Infectious – Tropical Diseases and Microbiology, IRCSS Sacro Cuore Hospital, Negrar di Valpolicella, Verona, Italy
| | - George Tsoukalas
- Fourth Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Carlo Selmi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20072, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan 20089, Italy
| | - Olga-Maria Spiropoulou
- First Department of Internal Medicine, Asklipieio General Hospital of Voula, Athens, Greece
| | - Michael Samarkos
- First Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Doumas
- Second Department of Propedeutic Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Damoraki
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Masgala
- Second Department of Internal Medicine, Konstantopouleio General Hospital, Athens, Greece
| | - Ilias Papanikolaou
- Department of Pulmonary Medicine, General Hospital of Kerkyra, Kerkyra, Greece
| | - Aikaterini Argyraki
- Department of Internal Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Marcantonio Negri
- Dipartimento Scienze Mediche e Chirurgiche - Fondazione Policlinico Gemelli IRCCS, Roma, Italy
| | - Konstantinos Leventogiannis
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Institute for the Study of Sepsis, Athens, Greece
| | - Styliani Sympardi
- First Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece
| | - Nikolaos K. Gatselis
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, Full Member of the European Reference Network on Hepatological Disases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa 41110, Greece
| | - Vasileios Petrakis
- Second Department of Internal Medicine, Medical School, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Mihai G. Netea
- Department of Internal Medicine and Center for Infectious Diseases, Radboud University, Nijmegen 6500, Netherlands
- Department of Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Periklis Panagopoulos
- Second Department of Internal Medicine, Medical School, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Vissaria Sakka
- Third Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Haralampos Milionis
- First Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - George N. Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, Full Member of the European Reference Network on Hepatological Disases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa 41110, Greece
| | - Evangelos J. Giamarellos-Bourboulis
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Institute for the Study of Sepsis, Athens, Greece
- Corresponding author. 4th Department of Internal Medicine, ATTIKON University Hospital, 1 Rimini Street, Athens 12462, Greece.
| |
Collapse
|
5
|
Simistiras A, Delialis D, Georgiopoulos G, Bampatsias D, Maneta E, Dimoula A, Petropoulos I, Neofytou O, Oikonomou E, Kontogiannis C, Ioannou S, Miliotou A, Kanakakis I, Evangelou E, Stamatelopoulos K. Lp(a) is not associated with arterial stiffness: a Mendelian randomization study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2310] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Deeper understanding of the potential causal relationship between Lp(a) and vascular injury will provide further insight to related pathways to be monitored and targeted by emerging treatments. Accumulating evidence supports the causal association of lipoprotein(a) [Lp(a)] with cardiovascular disease and calcific aortic valve disease (AVD). Arterial stiffening is mechanistically linked with cardiovascular disease and AVD severity. We hypothesized that Lp(a) may be causally associated with pulse-wave velocity (PWV) as the gold-standard marker of arterial stiffness.
Aim
To investigate the potential causal association of Lp(a) levels with PWV.
Methods
We performed a two sample Mendelian randomization (MR) analysis of LP(a) on PWV by combining the summary data of two independent Genetic-Wide Association Study (GWASs). Genetic variants associated with Lp(a) were retrieved from the UK Biobank (N=220,497). A GWAS based on a cohort in Germany (N=7,000) was used to obtain genetic associations for PWV index (outcome). We assessed two different measures of arterial stiffness, brachial ankle (baPWV) and carotid femoral pulse (cfPWV) wave velocity. In total, we used 170 SNPs as Instrument Variables (IV's) and applied a two sample MR with the main technique of Inverse Variance Weighting method (IVW). We conducted sensitivity analyses (MR-Egger and Median based) to detect pleiotropy of the causal variants and to test for robustness of our findings.
Results
Our analyses based on all 170 SNP's did not find evidence for causal relationship between Lp(a) and PWV for neither measurement [bivw (baPWV) = −0.0005, CI (−0.0043, 0.0034), P=0.8 and bivw (cfPWV) = −0.006, CI (−0.013, 0.002), P=0.16 for brachial ankle and carotid-femoral PWV, respectively]. Sensitivity analyses, including weighted median and mode-based estimation, did not show significant association of Lp (a) with neither baPWV nor cfPWV.
Conclusions
Lp(a) is not causally associated with arterial stiffness. These findings suggest that arterial stiffening is not involved Lp(a)-mediated cardiovascular and aortic valve disease.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- A Simistiras
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - D Delialis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - G Georgiopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - D Bampatsias
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Maneta
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A Dimoula
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - I Petropoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - O Neofytou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Oikonomou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - C Kontogiannis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - S Ioannou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A Miliotou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - I Kanakakis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Evangelou
- University of Ioannina Medical School, Department of Hygiene and Epidemiology , Ioannina , Greece
| | - K Stamatelopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| |
Collapse
|
6
|
Delialis D, Georgiopoulos G, Aivalioti E, Mavraganis G, Dimopoulou AM, Sianis A, Aggelidakis L, Patras R, Petropoulos I, Ioannou S, Syrigou R, Chatzidou S, Kanakakis I, Stellos K, Stamatelopoulos K. Remnant cholesterol and atherosclerotic disease in high cardiovascular risk patients. Beyond LDL cholesterol and hypolipidemic treatment. Hellenic J Cardiol 2022; 66:26-31. [PMID: 35667617 DOI: 10.1016/j.hjc.2022.05.011] [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: 03/12/2022] [Revised: 05/03/2022] [Accepted: 05/29/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Remnant cholesterol (RC) is an emerging factor contributing to residual risk for the development of atherosclerotic cardiovascular disease (ASCVD). We aimed to investigate the association of RC with ASCVD in high ASCVD risk patients. METHODS RC was calculated in 906 participants (178 low/moderate-risk and 728 high-risk) consecutively recruited from a vascular registry. Subclinical carotid atherosclerosis was assessed by B-mode carotid ultrasonography. Maximal carotid wall thickness (maxWT) and carotid atherosclerotic burden (n≥2 atherosclerotic plaques) were set as the vascular outcomes. An independent cohort of 87 consecutively recruited high-risk patients who were followed for their lipid profile for 3 months, was also analyzed. RESULTS RC was increased in the high-risk group as compared to controls (26±17 vs. 21±11mg/dl, respectively, p<0.001). Increased RC levels were independently associated with increased maxWT and carotid atherosclerotic burden (p<0.05), after adjustment for traditional cardiovascular risk factors (TRF) and ASCVD. RC levels were associated with the presence of flow-limiting ASCVD and coronary artery disease (p<0.05), after adjustment for TRFs. These associations remained significant in those not receiving hypolipidemic treatment and in treated individuals achieving LDL-C<100 mg/dl. In the prospective cohort, there was no significant interaction between change in RC levels and hypolipidemic status, as contrasted to LDL-C levels (p <0.001). CONCLUSION In a high-risk population, RC was associated with subclinical and clinically overt ASCVD particularly in patients with the most adverse lipid phenotype (untreated) or in treated patients with low LDL-related risk profile. These findings support a residual pro-atherosclerotic role of RC in high-risk patients.
Collapse
Affiliation(s)
- Dimitrios Delialis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Evmorfia Aivalioti
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Georgios Mavraganis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Angeliki-Maria Dimopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Alexandros Sianis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Lasthenis Aggelidakis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Raphael Patras
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Ioannis Petropoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Sofia Ioannou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Rodanthi Syrigou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Sofia Chatzidou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Ioannis Kanakakis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Konstantinos Stellos
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK; Department of Cardiovascular Research, European Center for Angioscience (ECAS), Heidelberg University, Mannheim, Germany; German Centre for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung, DZHK), Heidelberg/Mannheim Partner Site, Mannheim, Germany
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece; Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK.
| |
Collapse
|
7
|
Ioannou A, Papaxoinis G, Gouveris P, Zouki D, Kardara V, Ioannou S, Exarchos K, Adamou V, Bitsas I, Karianakis G, Koronakis G, Stavrou N, Demiri S. P-142 Inflammatory biomarkers in patients with advanced pancreatic adenocarcinoma undergoing first-line chemotherapy with nab-paclitaxel and gemcitabine: A single-center study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
8
|
Ioannou S, Papaxoinis G, Korkolis D, Kypreos D, Gouveris P, Zouki D, Kardara V, Exarchos K, Karianakis G, Bitsas I, Adamou V, Koronakis G, Stavrou N, Demiri S. P-145 Modified FOLFIRINOX as neoadjuvant treatment in patients with borderline resectable and locally advanced pancreatic adenocarcinoma: A single-center study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
9
|
Giamarellos-Bourboulis EJ, Poulakou G, de Nooijer A, Milionis H, Metallidis S, Ploumidis M, Grigoropoulou P, Rapti A, Segala FV, Balis E, Giannitsioti E, Rodari P, Kainis I, Alexiou Z, Focà E, Lucio B, Rovina N, Scorzolini L, Dafni M, Ioannou S, Tomelleri A, Dimakou K, Tzatzagou G, Chini M, Bassetti M, Trakatelli C, Tsoukalas G, Selmi C, Samaras C, Saridaki M, Pyrpasopoulou A, Kaldara E, Papanikolaou I, Argyraki A, Akinosoglou K, Koupetori M, Panagopoulos P, Dalekos GN, Netea MG. Development and validation of SCOPE score: A clinical score to predict COVID-19 pneumonia progression to severe respiratory failure. Cell Rep Med 2022; 3:100560. [PMID: 35474750 PMCID: PMC8872836 DOI: 10.1016/j.xcrm.2022.100560] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 11/16/2021] [Revised: 01/07/2022] [Accepted: 02/15/2022] [Indexed: 01/08/2023]
Abstract
Most patients infected with SARS-CoV-2 (COVID-19) experience mild, non-specific symptoms, but many develop severe symptoms associated with an excessive inflammatory response. Elevated plasma concentrations of soluble urokinase plasminogen activator receptor (suPAR) provide early warning of progression to severe respiratory failure (SRF) or death, but access to suPAR testing may be limited. The Severe COvid Prediction Estimate (SCOPE) score, derived from circulating concentrations of C-reactive protein, D- dimers, interleukin-6, and ferritin among patients not receiving non-invasive or invasive mechanical ventilation during the SAVE-MORE study, offers predictive accuracy for progression to SRF or death within 14 days comparable to that of a suPAR concentration of ≥6 ng/mL (area under receiver operator characteristic curve 0.81 for both). The SCOPE score is validated in two similar independent cohorts. A SCOPE score of 6 or more is an alternative to suPAR for predicting progression to SRF or death within 14 days of hospital admission for pneumonia, and it can be used to guide treatment decisions. SCOPE score is composed of C-reactive protein, D dimers, ferritin, and interleukin-6 Values of 6 or more predict 6-fold risk for severe respiratory failure or death SCOPE score predicts risk for severe respiratory failure or death comparable to suPAR Anakinra treatment when SCOPE is 6 or more provides lower odds of poor outcome
Collapse
Affiliation(s)
- Evangelos J Giamarellos-Bourboulis
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, ATTIKON University General Hospital, 1 Rimini Street, 124 62 Athens, Greece.,Hellenic Institute for the Study of Sepsis, Athens, Greece
| | - Garyfallia Poulakou
- Third Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Aline de Nooijer
- Department of Internal Medicine and Center for Infectious Diseases, Radboud University, Nijmegen, the Netherlands
| | - Haralampos Milionis
- First Department of Internal Medicine, University of Ioannina, Medical School, Ioannina, Greece
| | - Simeon Metallidis
- First Department of Internal Medicine, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Michalis Ploumidis
- First Department of Internal Medicine, G. Gennimatas General Hospital of Athens, Athens, Greece
| | | | - Aggeliki Rapti
- Second Department of Pulmonary Medicine, Sotiria General Hospital for Chest Diseases, Athens, Greece
| | - Francesco Vladimiro Segala
- Dipartimento Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Gemelli IRCCS, Roma, Italy
| | - Evangelos Balis
- First Department of Critical Care and Pulmonary Medicine, Medical School, National and Kapodistrian University of Athens, Evangelismos General Hospital, Athens, Greece
| | - Efthymia Giannitsioti
- Second Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Paola Rodari
- Department of Infectious-Tropical Diseases and Microbiology, IRCSS Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Ilias Kainis
- Tenth Department of Pulmonary Medicine, Sotiria General Hospital for Chest Diseases, Athens, Greece
| | - Zoi Alexiou
- Second Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece
| | - Emanuele Focà
- Spedali Civili, Brescia ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Brollo Lucio
- Department of Internal Medicine, Hospital of Jesolo, Venice, Italy
| | - Nikoletta Rovina
- First Department of Chest Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Laura Scorzolini
- Department of Internal Medicine, Spallanzani Institute of Rome, Rome, Italy
| | - Maria Dafni
- First Department of Internal Medicine, Korgialeneion-Benakeion General Hospital, Athens, Greece
| | - Sofia Ioannou
- Department of Therapeutics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS Ospedale San Raffaele & Vita-Salute San Raffaele University, Milan, Italy
| | - Katerina Dimakou
- Fifth Department of Pulmonary Medicine, Sotiria General Hospital for Chest Diseases, Athens, Greece
| | - Glykeria Tzatzagou
- First Department of Internal Medicine, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Maria Chini
- Third Department of Internal Medicine and Infectious Diseases Unit, Korgialeneion-Benakeion General Hospital, Athens, Greece
| | - Matteo Bassetti
- Infectious Diseases Clinic, Ospedale Policlinico San Martino IRCCS and Department of Health Sciences, University of Genova, Genova, Italy
| | - Christina Trakatelli
- Third Department of Internal Medicine, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - George Tsoukalas
- Fourth Department of Pulmonary Medicine, Sotiria General Hospital for Chest Diseases, Athens, Greece
| | - Carlo Selmi
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, and IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Charilaos Samaras
- First Department of Internal Medicine, Asklipieio General Hospital of Voula, Voula, Greece
| | - Maria Saridaki
- First Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Athina Pyrpasopoulou
- Second Department of Propaedeutic Medicine, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Elisabeth Kaldara
- Second Department of Internal Medicine, Konstantopouleio General Hospital, Athens, Greece
| | - Ilias Papanikolaou
- Department of Pulmonary Medicine, General Hospital of Kerkyra, Kontokali, Greece
| | - Aikaterini Argyraki
- Department of Internal Medicine, Sotiria General Hospital for Chest Diseases, Athens, Greece
| | | | - Marina Koupetori
- First Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece
| | - Periklis Panagopoulos
- Second Department of Internal Medicine, Democritus University of Thrace, Medical School, 68100 Alexandroupolis, Greece
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, 41110 Larissa, Greece
| | - Mihai G Netea
- Department of Internal Medicine and Center for Infectious Diseases, Radboud University, Nijmegen, the Netherlands.,Department of Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| |
Collapse
|
10
|
Gouveris P, Georgakopoulou EA, Grigoraki A, Zouki D, Kardara V, Ioannou S, Tryfonopoulos D, Demiri S, Gkouveris I. Nivolumab‑induced lichenoid granulomatous stomatitis in a patient with advanced melanoma: A case report. Mol Clin Oncol 2022; 16:79. [PMID: 35251630 PMCID: PMC8892467 DOI: 10.3892/mco.2022.2512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 11/15/2021] [Accepted: 01/18/2022] [Indexed: 11/06/2022] Open
Abstract
Lichenoid granulomatous reactions (LGR) are granulomatous inflammations of the skin and oral mucosa, also sharing features of lichenoid lesions. Thus, the present study refers to lichenoid granulomatous dermatitis (LGD) and lichenoid granulomatous stomatitis (LGS). LGR is a condition that can be triggered by drugs, diseases or environmental causes. In the present case study, anti-PD1 (nivolumab) medication had a detrimental effect on the oral mucosa, which clinicaly and histologicaly proved to be LGS. Checkpoint inhibitors consitute a cornerstone in the current treatment of several types of cancer, of which cutaneous melanoma is the best example. Oral lichenoid responses following anti-PD-1 therapy have been recorded in few case reports and small case series. To the best of our knowledhe, this is the first case of LGS being reported as a side effect of immune checkpoint inhibitor treatment.
Collapse
Affiliation(s)
- P. Gouveris
- Second Department of Medical Oncology, Agios Savvas Cancer Hospital, 11522 Athens, Greece
| | - E. A. Georgakopoulou
- Laboratory of Histology‑Embryology Molecular Carcinogenesis Group, National and Kapodistrian University of Athens, Greece
| | - A. Grigoraki
- Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - D.N. Zouki
- Second Department of Medical Oncology, Agios Savvas Cancer Hospital, 11522 Athens, Greece
| | - V.E. Kardara
- Second Department of Medical Oncology, Agios Savvas Cancer Hospital, 11522 Athens, Greece
| | - S. Ioannou
- Second Department of Medical Oncology, Agios Savvas Cancer Hospital, 11522 Athens, Greece
| | - D. Tryfonopoulos
- Second Department of Medical Oncology, Agios Savvas Cancer Hospital, 11522 Athens, Greece
| | - S. Demiri
- Second Department of Medical Oncology, Agios Savvas Cancer Hospital, 11522 Athens, Greece
| | - I. Gkouveris
- Department of Oral and Maxillofacial Pathology and Medicine, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece
| |
Collapse
|
11
|
Delialis D, Aivalioti E, Mavraganis G, Dimopoulou AM, Sianis A, Angelidakis L, Patras R, Petropoulos I, Ioannou S, Syrigou R, Kanakakis J, Georgiopoulos G, Stellos K, Stamatelopoulos K. Remnant cholesterol is an independent determinant of the presence and extent of subclinical carotid atherosclerosis in statin-naive individuals. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2561] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Despite continuous improvements of diagnostic and therapeutic algorithms for cardiovascular disease (CVD), mortality from CVD remains high suggesting unaddressed residual risk. Remnant cholesterol (RC) consists the cholesterol content of triglyceride-rich lipoproteins, which along with LDL cholesterol infiltrate the arterial wall, accumulate and cause atherosclerosis. Increased remnant cholesterol (RC) levels have been previously associated with future adverse cardiac events despite hypolipidemic therapy. However, a mechanistic association of RC levels with human atherosclerosis in vivo has not been proven in a clinical setting.
Purpose
To evaluate the association of RC levels with the presence and extend of subclinical carotid atherosclerosis.
Methods
In this retrospective cohort study, 438 subjects from the Athens Vascular Registry without clinically overt CVD or treatment with statin were recruited. Atherosclerotic burden was assessed by B-mode carotid ultrasonography using: 1. Maximal carotid wall thickness [maxWT, the highest intima-media thickness (IMT) or highest atherosclerotic plaque thickness (PLQ) if present derived from all carotid sites], 2. Total thickness (sumWT, sum of maximal wall thickness), 3) high plaque burden (PLQ ≥2) and 4) average carotid IMT (avgIMT). RC was calculated using the formula RC=total cholesterol-LDL-C-HDL-C.
Results
Mean (SD) age was 54.8±12.4 years old with 41% being males. Subjects with RC>median (=18mg/dl) had higher sumWT (6.12±0.7 vs 5.57±1.7, p=0.002), maxWT (1.61±0.7 vs 1.43±0.7, p=0.008) and avgIMT (0.88±0.16 vs 0.83±0.16, p=0.003) vs RC<median.>median was associated with higher odds for increased sumWT (highest tertile, OR: 2.15 95% CI 1.26–3.66, p=0.006) and maxWT (OR: 2.15 95% CI: 1.38–3.33, p=0.001), and a higher plaque burden (≥2 plaques, OR: 2.1 95% CI 1.93–3.1, p<0.001) after adjustment for age, gender and systolic blood pressure, glomerular filtration rate, smoking, diabetes mellitus, body mass index and LDL-C
Conclusion
In a statin-naive population without clinically overt CVD, increased RC levels were associated with the presence and extend of subclinical carotid atherosclerosis. These findings provide novel mechanistic insight into mechanisms associated with increased CVD risk in individuals with high RC levels.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- D Delialis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - E Aivalioti
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - G Mavraganis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - A M Dimopoulou
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - A Sianis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - L Angelidakis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - R Patras
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - I Petropoulos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - S Ioannou
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - R Syrigou
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - J Kanakakis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - G Georgiopoulos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - K Stellos
- Newcastle University, Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle-Upon-Tyne, United Kingdom
| | | |
Collapse
|
12
|
Mavraganis G, Georgiopoulos G, Delialis D, Aivalioti E, Dimopoulou AM, Sianis A, Angelidakis L, Patras R, Petropoulos I, Ioannou S, Syrigou R, Kanakakis J, Stellos K, Stamatelopoulos K. Clinical utility of readily available novel markers of carotid atherosclerotic burden for reclassification and discrimination of very high cardiovascular risk. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2524] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Among high cardiovascular (CV) risk patients, there is emerging need to recognize those who will benefit from new treatments targeting residual risk. Readily available modalities providing reclassification value would be clinically useful in this setting. Preliminary data suggest that carotid ultrasonography using plaque burden but not intima-media thickness (IMT) is associated with very high risk.
Objectives
We aimed to assess the reclassification ability of two markers of carotid atherosclerosis in high-risk patients, reflecting total atherosclerotic burden and the most severe lesion and to compare them with the routinely used carotid indices IMT and number of carotid plaques.
Methods
In an ongoing registry of patients who visited a cardiovascular protection clinic for cardiovascular risk assessment, we enrolled 735 consecutively recruited patients (mean age 63.1 years, 68.8% male) classified as high or very-high CV risk according to 2019 European Society of Cardiology /European Atherosclerosis Society Guidelines. Sum of carotid wall thickness (sumWT) and maximal wall thickness (maxWT) using high-resolution ultrasonography at baseline were used to assess the total burden and the most severe carotid lesion, respectively. These markers integrate maximum plaque height or maximum IMT if no plaque is present. All patients were followed for a median of 41 months and the primary end-point consisted of CV mortality, acute myocardial infarction or coronary revascularization.
Results
After adjustment for traditional CV risk factors, maxWT and sumWT were associated with the primary end-point (hazard ratio [HR]=1.73 (95% confidence interval [CI]:1.39 to 2.17) and 1.19 (95% CI 1.10 to 1.30) respectively). Both markers were superior in terms of reclassification and discrimination to identify very high risk over validated CV risk scores including the Heartscore and the SMART score (net reclassification index [NRI]=0.624, p<0.0001, integrated discrimination index [IDI]=0.060, p<0.0001 and difference in the area under the curve (δAUC) = 0.136, p<0.001 for maxWT and NRI=0.497, p<0.0001, IDI=0.046, p<0.0001 and δAUC = 0.128, p<0.001 for sumWT), IMT (NRI=0.502, p<0.0001, IDI= 0.058, p=0.02 for maxWT and NRI=0.559, p<0.0001, IDI=0.051, p=0.016 for sumWT) and the number of carotid plaques (NRI=0.614, p<0.0001, IDI=0.038, p=0.001 for maxWT and NRI=0.292, p=0.019, IDI=0.022, p=0.009 for sumWT).
Conclusions
The use of two novel cumulative markers of atherosclerotic burden improves risk stratification and discriminates high from very high CV risk. Given that carotid ultrasonography is a readily available modality, its clinical application for risk refinement of high-risk patients to facilitate treatment decisions merits further investigation.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- G Mavraganis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - G Georgiopoulos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - D Delialis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - E Aivalioti
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - A M Dimopoulou
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - A Sianis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - L Angelidakis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - R Patras
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - I Petropoulos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - S Ioannou
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - R Syrigou
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - J Kanakakis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - K Stellos
- Newcastle University, Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle-Upon-Tyne, United Kingdom
| | | |
Collapse
|
13
|
Ioannou S, Braun C, Claus T, Hartrumpf M, Erb M, Kühnel RU, Loladze G, Ali V, Schröter F, Albes J. CALA: Cumulative Volume of Calcium Lesions of the Ascending Aorta and Aortic Arch Correlate with Early Mortality, Critical Illness Polyneuropathy/Myopathy, and Delirium but Not with Stroke. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725643] [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: 10/21/2022]
Affiliation(s)
| | | | | | | | - M. Erb
- Bernau bei Berlin, Deutschland
| | | | | | - V. Ali
- Bernau bei Berlin, Deutschland
| | | | | |
Collapse
|
14
|
Kuehnel RU, Schroeter F, Hartrumpf M, Ostovar R, Ioannou S, Braun C, Filip T, Mueller T, Erb M, Albes J. Valve Fracturing of Degenerated Stented Bioprosthesis during Valve-in-Valve Procedure Is a Myth. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705414] [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: 10/24/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - M. Erb
- Bernau bei Berlin, Germany
| | | |
Collapse
|
15
|
Kuehnel RU, Schroeter F, Michera L, Pallmann M, Paun A, Hartrumpf M, Ioannou S, Braun C, Loladze G, Albes J. Preoperative Decolonization Reduces Surgical-Site Infection of Heart Surgery Patients. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705441] [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: 10/24/2022]
|
16
|
Oldak S, Ioannou S, Kamath P, Huang M, Slomovitz B, Schlumbrecht M. Disparities in the evolution of polypharmacy among women with ovarian cancer. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.03.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
17
|
Ioannou S, Karadima D, Pneumaticos S, Athanasiou H, Pontikis J, Zormpala A, Sipsas NV. Efficacy of prolonged antimicrobial chemotherapy for brucellar spondylodiscitis. Clin Microbiol Infect 2011; 17:756-62. [PMID: 20518794 DOI: 10.1111/j.1469-0691.2010.03272.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The standard treatment of brucellar spondylitis with a combination of two antibiotics for 6-12 weeks is associated with high rates of treatment failure and relapse. The present study aimed to assess the safety and efficacy of a treatment strategy based on the prolonged administration of a triple combination of suitable antibiotics. Eighteen patients with brucellar spondylitis were treated with a combination of at least three suitable antibiotics (doxycycline, rifampin, plus intramuscular streptomycin or cotrimoxazole or ciprofloxacin) until the completion of at least 6 months of treatment, when clinical, radiological and serology re-evaluation was performed. If necessary, the treatment was continued with additional 6-month cycles, until resolution or significant improvement of clinical and radiological findings, or for a maximum of 18 months. At presentation, the median age was 66 years (range, 42-85 years) with male predominance. The median duration of therapy was 48 weeks (range 24-72 weeks). Treatment was discontinued early because of side-effects in only one patient. Surgical intervention was required for three patients. At the end of treatment all patients had a complete response. After completion of treatment, all patients were followed up with regular visits. During the follow-up period (duration 1-96 months, median 36.5 months), no relapses were observed. In conclusion, prolonged (at least 6 months) administration of a triple combination of suitable antibiotics appears to be an effective treatment for brucellar spondylitis.
Collapse
Affiliation(s)
- S Ioannou
- Pathophysiology Department, Laikon General Hospital, and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | | | | | | |
Collapse
|
18
|
Karasali H, Ioannou S. HPLC determination of mepiquat chloride in commercial pesticide formulations. Bull Environ Contam Toxicol 2009; 83:636-639. [PMID: 19479174 DOI: 10.1007/s00128-009-9788-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Accepted: 05/15/2009] [Indexed: 05/27/2023]
Abstract
A simple, fast and precise High Performance Liquid Chromatographic method with diode array detector was developed and single laboratory validated for the determination of mepiquat chloride in soluble concentrate pesticide formulations. From the results obtained, the repeatability of the method expressed as relative standard deviation (%RSD) was found to be 0.3%, and the limit of detection was 0.02 microg/mL. The accuracy of the whole procedure estimated by the comparison of the results obtained with the reference values, and was found to be acceptable as t(cal) < t(crit). The precision of the method also considered acceptable as the experimental repeatability relative standard deviation (RSD(r)) was lower than the interlaboratory relative standard deviation (RSD(R)), calculated by the Horwitz equation.
Collapse
Affiliation(s)
- H Karasali
- Benaki Phytopathological Institute, Laboratory of Chemical Control of Pesticides, 145 61 Kifissia, Athens, Greece.
| | | |
Collapse
|
19
|
Ioannou S, Dalamagkidis K, Valavanis KP, Stefanakos EK. Improving Endurance and Range of a UGV with Gimballed Landing Platform for Launching Small Unmanned Helicopters. J INTELL ROBOT SYST 2008. [DOI: 10.1007/s10846-008-9243-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
20
|
Piat M, Perreault M, Lacasse D, Ioannou S, Pawliuk N, Bloom D. Stakeholder perspectives on psychiatric foster homes: residents, families, caregivers, and professionals. Psychiatr Rehabil J 2004; 27:228-34. [PMID: 14982329 DOI: 10.2975/27.2004.228.234] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Eight focus groups were conducted with the stakeholders involved in psychiatric foster homes: people with psychiatric disabilities, families, caregivers, and professionals. Four content dimensions emerged as important: 1) foster home environment, 2) caregiver characteristics, 3) community integration, and 4) stakeholder relationships. Findings revealed different perspectives among stakeholders. Caregivers and professionals differed in their views on rehabilitation. Families wanted stricter controls within homes; residents appreciated more autonomy. While residents and caregivers focussed on integration within the foster home, professionals criticized the lack of community integration. These findings demonstrate the need to examine the perspectives of multiple stakeholders in order to present a complete view of psychiatric foster homes.
Collapse
Affiliation(s)
- Myra Piat
- Division of Specialized and Continuing Care for Adults, Douglas Hospital, Quebec, Canada.
| | | | | | | | | | | |
Collapse
|
21
|
Papassavas AC, Stavropoulos-Giokas C, Boletis J, Ioannou S, Iniotaki-Theodoraki A, Kostakis A. Definition of permissible and immunogenic HLA antigens based on epitope analysis of the HLA specific antibodies produced in sensitized patients. Eur J Immunogenet 2002; 29:401-7. [PMID: 12358849 DOI: 10.1046/j.1365-2370.2002.00341.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The goal of this study was to develop an accurate protocol whereby detection of acceptable HLA-A and -B mismatches is based on epitope analysis of HLA class I specific antibodies detected in the serum of highly sensitized patients awaiting a kidney retransplant. A total of 400 serum samples from 44 highly sensitized patients with panel reactive antibodies (PRA) of > or = 60% were collected during a 3-year follow-up period. All patients had been sensitized from a previous graft. In order to define the specificities of the HLA class I specific antibodies, two techniques were used in parallel: the antihuman globulin augmented complement-dependent cytotoxicity (CDC) technique and an enzyme-linked immunoabsorbent assay (ELISA) technique. Epitope identification was based on class I HLA antigen sequencing, where the unique epitope configuration on one HLA antigen represented the private epitope of the specific HLA antigen, and epitopes shared by more than one HLA antigen represented public determinants. The epitope prediction for the immunogenic HLA epitopes was based on an MHC database. For each highly sensitized patient, antibody specificities against actual and 'at risk' epitopes were defined. Following epitope analysis, all HLA antigens that did not express the actual and/or 'at risk' immunogenic epitopes were considered as acceptable mismatches of epitope analysis. The cytotoxicity of highly sensitized patients was determined using two different panels of selected, separated T lymphocytes. HLA class I specific IgG antibodies against 69 actual and 86 'at risk' epitopes were detected. In all patients, a large number of acceptable mismatches were defined. These included a large number of HLA antigens, corresponding to both HLA-A and -B loci. Our study introduces an accurate protocol for the detection of acceptable mismatches in highly sensitized patients. According to this protocol, the detailed description of immunogenic HLA specific epitope targets, against which HLA class I specific antibodies are directed, is a useful tool for the detection of acceptable mismatches in highly sensitized patients. This may lead to reduced production of HLA class I specific antibodies and, consequently, improved graft survival.
Collapse
Affiliation(s)
- A C Papassavas
- Department of Immunology and National Tissue Typing Center, General Hospital Georgios Gennimatas, Athens, Greece.
| | | | | | | | | | | |
Collapse
|
22
|
Papassavas AC, Stavropoulos-Giokas C, Boletis J, Iniotaki-Theodoraki A, Ioannou S, Stravoskoufi P, Kostakis A. Epitope analysis of the HLA class I specific antibodies: a useful tool for the detection of the acceptable mismatches for highly sensitized patients. Transplant Proc 2002; 34:2053-5. [PMID: 12270311 DOI: 10.1016/s0041-1345(02)02849-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- A C Papassavas
- General Hospital Georgios Gennimatas, Department of Immunology and National Tissue Typing Center, Athens, Greece.
| | | | | | | | | | | | | |
Collapse
|
23
|
Laverdière M, Rotstein C, Bow EJ, Roberts RS, Ioannou S, Carr D, Moghaddam N. Impact of fluconazole prophylaxis on fungal colonization and infection rates in neutropenic patients. The Canadian Fluconazole Study. J Antimicrob Chemother 2000; 46:1001-8. [PMID: 11102422 DOI: 10.1093/jac/46.6.1001] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.5] [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: 11/13/2022] Open
Abstract
Fungal colonization profiles from four different anatomical sites were evaluated in 266 neutropenic cancer patients receiving intensive cytotoxic therapy for acute leukaemia or for autologous marrow transplantation. At the beginning of chemotherapy patients were allocated randomly to receive oral fluconazole 400 mg daily or an identical placebo until prophylaxis failure or marrow recovery. Candida albicans colonization was reduced from 30 to 10% in the fluconazole recipients while it increased from 32 to 57% in the placebo patients (P<0.001). By the end of prophylaxis, colonization with non-albicans Candida species increased from 7 to 21% and 8 to 18% in the fluconazole and placebo patients, respectively (P = 0.396). Although Candida glabrata was isolated more frequently at the end of the prophylactic period in the fluconazole patients than in the placebo patients (16 versus 7%), only one definite invasive C. glabrata infection was noted. Overall, definite invasive fungal infections were documented in 26 patients [four fluconazole versus 22 placebo patients (P< or =0.001)]. In 23 (92%) patients the infections were caused by persistently colonizing or newly acquired organisms. While probable invasive fungal infections were noted in five fluconazole patients, 10 placebo patients were also affected (P = 0.19). An end-of-prophylaxis colonization index >0.25 was 76% sensitive but only 69% specific for invasive fungal infection. However, a colonization index < or =0.25 at baseline had a negative predictive value of 88% for development of invasive fungal infection. Fluconazole prophylaxis decreased colonization by fungi and subsequent invasive fungal infections in neutropenic cancer patients.
Collapse
Affiliation(s)
- M Laverdière
- Department of Microbiology and Infectious Diseases, Hôpital Maisonneuve-Rosemont, 5415 Boulevard l'Assomption, Montréal, Québec, Canada H1T 2M4.
| | | | | | | | | | | | | |
Collapse
|
24
|
Yamamura DL, Rotstein C, Nicolle LE, Ioannou S. Candidemia at selected Canadian sites: results from the Fungal Disease Registry, 1992-1994. Fungal Disease Registry of the Canadian Infectious Disease Society. CMAJ 1999; 160:493-9. [PMID: 10081465 PMCID: PMC1230074] [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] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Candida species are important bloodstream pathogens that are being isolated with increasing frequency. Despite the availability of effective antifungal therapy, the mortality rate associated with Candida infection remains high. With the objective of describing the epidemiology of candidemia, the Canadian Infectious Disease Society conducted a study of candidemia in Canada. METHODS Fourteen medical centres across Canada identified all patients with candidemia from March 1992 to February 1994 through blood culture surveillance for Candida spp. Patient-related data for invasive fungal infection were compiled retrospectively by chart review using a standardized data-recording form developed for the Fungal Disease Registry of the Canadian Infectious Disease Society. Cases of Candidemia were studied in relation to underlying medical conditions, predisposing factors, concurrent infection, antimicrobial agents, antifungal treatment and deaths. RESULTS In total, 415 cases of candidemia were identified, 48 (11.6%) in children and 367 (88.4%) in adults. The causative pathogens were C. albicans in 286 cases (68.9%), C. parapsilosis in 43 (10.4%), C. glabrata in 34 (8.2%), C. tropicalis in 27 (6.5%) and other Candida species in 18 (4.3%); polymicrobial candidemia occurred in 7 cases (1.7%). The overall mortality rate was 46%, and the rate of deaths clinically related to candidemia was 19%. However, only 13 (27%) of the children died. A univariate analysis indicated that significant risk factors for death were age greater than 60 years, therapy for concomitant bacterial infection, stay in an intensive care unit, concurrent malignant disease, cytotoxic chemotherapy and granulocytopenia, although only age and stay in an intensive care unit emerged as significant risk factors in the multivariate analysis. After adjustment for other predictors of death, only infection with C. parapsilosis was associated with a lower mortality rate than infection with C. albicans. Treatment was given in 352 (84.8%) of cases. Amphotericin B was the preferred agent in 244 cases (69.3% of those treated); fluconazole was used in 101 cases (28.7%) and ketoconazole in 5 cases (1.4%). INTERPRETATION Candidemia in Canada is caused predominantly by C. albicans. The mortality rate associated with candidemia is high, but it varies with the species of Candida and is lower in children than in adults. Age greater than 60 years and stay in an intensive care unit were the most significant risk factors for overall mortality.
Collapse
Affiliation(s)
- D L Yamamura
- Department of Medicine, McMaster University, Hamilton, Ont
| | | | | | | |
Collapse
|
25
|
Rotstein C, Bow EJ, Laverdiere M, Ioannou S, Carr D, Moghaddam N. Randomized placebo-controlled trial of fluconazole prophylaxis for neutropenic cancer patients: benefit based on purpose and intensity of cytotoxic therapy. The Canadian Fluconazole Prophylaxis Study Group. Clin Infect Dis 1999; 28:331-40. [PMID: 10064252 DOI: 10.1086/515128] [Citation(s) in RCA: 187] [Impact Index Per Article: 7.5] [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: 11/04/2022] Open
Abstract
A randomized, double-blind trial comparing oral fluconazole (400 mg daily) with placebo as prophylaxis for adult patients receiving intensive cytotoxic therapy for acute leukemia or autologous bone marrow transplantation was conducted in 14 Canadian university-affiliated hospitals. Although fluconazole prophylaxis did not obviate the need for parenteral antifungal therapy compared with placebo (81 [57%] of 141 vs. 67 [50%] of 133, respectively), its use resulted in fewer superficial fungal infections (10 [7%] of 141 vs. 23 [18%] of 131, respectively; P = .02) and fewer definite and probable invasive fungal infections (9 vs. 32, respectively; P = .0001). Fluconazole recipients had fewer deaths attributable to definite invasive fungal infection (1 of 15 vs. 6 of 15, respectively; P = .04) and achieved more frequent success without fungal colonization (52 [37%] of 141 vs. 27 [20%] of 133, respectively; P = .004; relative risk reduction, 85%) than did placebo recipients. Patients benefiting the most from fluconazole prophylaxis included those with acute myeloid leukemia who were undergoing induction therapy with cytarabine plus anthracycline-based regimens and those receiving marrow autografts not supported with hematopoietic growth factors. Fluconazole prophylaxis reduces the incidence of superficial fungal infection and invasive fungal infection and fungal infection-related mortality among patients who are receiving intensive cytotoxic chemotherapy for remission induction.
Collapse
Affiliation(s)
- C Rotstein
- Department of Medicine, Hamilton Health Sciences Corporation, McMaster University, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
26
|
Papassavas AC, Iniotaki-Theodoraki A, Stathakopoulou A, Ioannou S, Kostakis A, Stavropoulos-Giokas C. Evaluation of HLA-class I alloantibodies using PRA-STAT and complement-dependent cytotoxicity techniques. Transplant Proc 1998; 30:724-6. [PMID: 9595073 DOI: 10.1016/s0041-1345(98)00023-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- A C Papassavas
- Department of Immunology, General Hospital of Athens Georgios Gennimatas, Greece
| | | | | | | | | | | |
Collapse
|
27
|
Dranitsaris G, Phillips P, Rotstein C, Puodziunas A, Shafran S, Garber G, Smaill F, Salit I, Miller M, Williams K, Conly J, Singer J, Ioannou S. Economic analysis of fluconazole versus amphotericin B for the treatment of candidemia in non-neutropenic patients. Pharmacoeconomics 1998; 13:509-518. [PMID: 10180750 DOI: 10.2165/00019053-199813050-00004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Fluconazole (FLU) is an alternative to amphotericin B (AMB) for the treatment of candidemia in non-neutropenic patients. This agent has similar clinical efficacy but significantly reduced adverse effects compared with AMB. Using the database from a Canadian randomised multicentre comparative trial of FLU versus AMB in the treatment of non-neutropenic patients with candidemia, an economic analysis of antifungal therapy was conducted from a Canadian hospital perspective. Patient records were examined for information containing hospital resource consumption. This included the costs for primary intravenous therapy with either AMB or FLU, laboratory tests, patient clinical monitoring and adverse effects management. The robustness of the baseline results were then tested by a comprehensive sensitivity analysis. The mean duration of therapy in the AMB and FLU arms was 17.1 and 23.7 days, respectively (p < 0.001). Assuming that all of the FLU was administered intravenously, the outcomes of the baseline economic analysis revealed that the treatment cost for patients randomized to receive FLU was approximately 50% higher than that for patients treated with AMB [AMB: $Can2370 vs FLU: $Can3578; p = 0.001 ($Can = Canadian dollars)]. In the sensitivity analysis, substitution to oral FLU after 7 days of intravenous therapy produced economic differences that were no longer statistically significant (AMB: $Can2370 vs FLU: $Can2705; p = 0.10). These results suggest that the FLU administration regimen used in the Canadian randomized trial for the treatment of candidemia in non-neutropenic patients may result in increased hospital costs compared with AMB. However, comparable expenditures could be realized if FLU is administered intravenously for the first 7 days and then orally in patients whose condition allows for reliable oral therapy.
Collapse
Affiliation(s)
- G Dranitsaris
- Department of Pharmaceutical Services, Ontario Cancer Institute, Princess Margaret Hospital, Toronto, Canada.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Phillips P, Shafran S, Garber G, Rotstein C, Smaill F, Fong I, Salit I, Miller M, Williams K, Conly JM, Singer J, Ioannou S. Multicenter randomized trial of fluconazole versus amphotericin B for treatment of candidemia in non-neutropenic patients. Canadian Candidemia Study Group. Eur J Clin Microbiol Infect Dis 1997; 16:337-45. [PMID: 9228472 DOI: 10.1007/bf01726360] [Citation(s) in RCA: 155] [Impact Index Per Article: 5.7] [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: 02/04/2023]
Abstract
A randomized trial was conducted to compare the efficacy and safety of fluconazole versus that of amphotericin B in the treatment of candidemia in non-neutropenic adults. Enrollment was stratified by disease severity (APACHE II score). Patients were randomized (1:1) to receive amphotericin B 0.6 mg/kg/day (cumulative dose 8 mg/kg) or fluconazole 800 mg intravenous loading dose, then 400 mg daily for four weeks (intravenous for at least 10 days). Patients were monitored for six months. A total of 106 patients were enrolled. A protocol amendment implemented midway through the trial required patients to be removed from the study and treated with amphotericin B if species identification indicated candidemia due to Candida glabrata or Candida krusei. Baseline characteristics were similar for the two groups; 103 patients (fluconazole, 50; amphotericin B, 53) met the major enrollment criteria. The intention-to-treat analysis indicated successful therapy in 50% of fluconazole recipients compared to 58% of the amphotericin B group (p = 0.39; one-sided 95% CI, -8 to 24%). The efficacy analysis included 84 patients (fluconazole, 42; amphotericin B, 42); successful outcomes were observed in 57% and 62% of cases in the fluconazole and amphotericin B groups, respectively (p = 0.66: one-sided 95% CI, -12 to 22%). The mortality at day 14 for the fluconazole group was 26% and for the amphotericin B group 21% (p = 0.52; chi-square test) and remained similar throughout the course of follow-up, Drug-related adverse events were more frequent with amphotericin B than with fluconazole and prompted switching of therapy for two (4%) and zero cases, respectively. Fluconazole and amphotericin B were associated with similar clinical response rates and survival in the treatment of candidemia among non-neutropenic patients; however, drug-related adverse events were more frequent with amphotericin B.
Collapse
Affiliation(s)
- P Phillips
- Division of Infectious Diseases, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
|
30
|
Berenbaum MC, Akande SL, Bonnett R, Kaur H, Ioannou S, White RD, Winfield UJ. meso-Tetra(hydroxyphenyl)porphyrins, a new class of potent tumour photosensitisers with favourable selectivity. Br J Cancer 1986; 54:717-25. [PMID: 2948536 PMCID: PMC2001545 DOI: 10.1038/bjc.1986.232] [Citation(s) in RCA: 176] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
We compared para-, meta- and ortho-isomers of meso-tetra(hydroxyphenyl)porphyrin (p-, m- and o-THPP) and the potassium salt of the para compound (K-p-THPP) with haematoporphyrin derivative (HpD) and Photofrin II in their ability to sensitise tumours, skin and brain to light. HpD and Photofrin II induced modest tumour photosensitisation at the cost of substantial skin and brain sensitisation. At doses low enough to keep sensitisation of these normal tissues within acceptable limits, tumour sensitisation was sufficient to give necrosis only approximately 2 mm deep after exposure to 10 J cm-2 light. In contrast, doses of p-THPP, K-p-THPP and m-THPP that produced skin and brain sensitivity within acceptable limits sensitised tumours enough to give 4-9 mm necrosis after 10 J cm-2 light. m-THPP was, on a molar basis, about 25-30 times as potent as HpD and Photofrin II in sensitising tumours. o-THPP was also a potent tumour photosensitiser, but induced a prohibitive degree of skin photosensitivity even at low doses. It is unlikely that these differences in relative selectivity are due to differences in such photophysical parameters as optimum activating wavelength (which would affect tissue penetration by light), or light absorption, and physicochemical factors that determine tissue localisation may be involved. The high tumour sensitising potency and favourable tissue selectivity of m-THPP, p-THPP and K-p-THPP make them promising candidates for clinical tumour phototherapy.
Collapse
|
31
|
Ioannou S. Should boxing be banned? Can Med Assoc J 1984; 131:10. [PMID: 6733641 PMCID: PMC1483356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
|
32
|
Ioannou S. Battered wife syndrome. Can Med Assoc J 1984; 130:1526. [PMID: 6733623 PMCID: PMC1483385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
33
|
Abstract
An improved preparation of photobilirubin II in ammoniacal methanol is described. Evidence is presented which distinguishes between the two structures proposed earlier for photobilirubin II in favour of the cycloheptadienyl structure. Nuclear-Overhauser-enhancement measurements with bilirubin IX alpha and photobilirubin II in dimethyl sulphoxide are complicated by the occurrence of negative and zero effects. The partition coefficient of photobilirubin II between chloroform and phosphate buffer (pH 7.4) is 0.67.
Collapse
|
34
|
Ioannou S. Screening for aural problems in school children. J Sch Health 1983; 53:172-174. [PMID: 6552326 DOI: 10.1111/j.1746-1561.1983.tb07811.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
|