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Panagopoulos PK, Georgakopoulou VE, Pezoulas VC, Malagari K, Fotiadis DI, Goules AV, Vassilakopoulos T, Tzioufas AG. Comparison of pulmonary and small airways function between idiopathic inflammatory myopathies patients with and without interstitial lung disease. Clin Exp Rheumatol 2024; 42:337-343. [PMID: 37382448 DOI: 10.55563/clinexprheumatol/v22yge] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/12/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVES To evaluate pulmonary and small airway function in patients with idiopathic inflammatory myopathies (IIM) and make comparisons between patients with and without interstitial lung disease (ILD). METHODS Newly diagnosed IIM patients with and without ILD determined by high resolution computed tomography were included in the study. Pulmonary and small airway function was assessed by spirometry, diffusing capacity for carbon monoxide (DLCO), body plethysmography, single and multiple breath nitrogen washout, impulse oscillometry and measurement of respiratory resistance by the interrupter technique (Rint) using the Q-box system. We used discrepancies between lung volumes measured by multiple breath nitrogen washout and body plethysmography to evaluate for small airway dysfunction. RESULTS Study cohort comprised of 26 IIM patients, 13 with and 13 without ILD. IIM-ILD patients presented more frequently with dyspnoea, fever, arthralgias and positive anti-synthetase antibodies, compared to IIM patients without ILD. Classic spirometric parameters and most lung physiology parameters assessing small airway function did not differ between the two groups. Predicted total lung capacity and residual volume (TLCN2WO, RVN2WO) measured by multiple breath nitrogen washout and the TLCN2WO/TLCpleth ratio were significantly lower in IIM-ILD patients compared to those without ILD (mean: 111.1% vs. 153.4%, p=0.034, median: 171% vs. 210%, p=0.039 and median: 1.28 vs. 1.45, p=0.039, respectively). Rint tended to be higher among IIM-ILD patients (mean:100.5% vs. 76.6%, p=0.053). CONCLUSIONS Discrepancies between lung volumes measured by multiple breath nitrogen washout and body plethysmography in IIM-ILD patients indicate an early small airways dysfunction in these patients.
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Affiliation(s)
- Panagiotis K Panagopoulos
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Vasiliki E Georgakopoulou
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Vasileios C Pezoulas
- Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, Greece
| | - Katerina Malagari
- 2nd Department of Radiology, University of Athens, Attikon Hospital, Chaidari, Athens, Greece
| | - Dimitrios I Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, Greece
| | - Andreas V Goules
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Theodoros Vassilakopoulos
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Athanasios G Tzioufas
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Greece.
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Chatzikonstantinou T, Scarfò L, Karakatsoulis G, Minga E, Chamou D, Iacoboni G, Kotaskova J, Demosthenous C, Smolej L, Mulligan S, Alcoceba M, Al-Shemari S, Aurran-Schleinitz T, Bacchiarri F, Bellido M, Bijou F, Calleja A, Medina A, Khan MA, Cassin R, Chatzileontiadou S, Collado R, Christian A, Davis Z, Dimou M, Donaldson D, Santos GD, Dreta B, Efstathopoulou M, El-Ashwah S, Enrico A, Fresa A, Galimberti S, Galitzia A, García-Serra R, Gimeno E, González-Gascón-y-Marín I, Gozzetti A, Guarente V, Guieze R, Gogia A, Gupta R, Harrop S, Hatzimichael E, Herishanu Y, Hernández-Rivas JÁ, Inchiappa L, Jaksic O, Janssen S, Kalicińska E, Kamel L, Karakus V, Kater AP, Kho B, Kislova M, Konstantinou E, Koren-Michowitz M, Kotsianidis I, Kreitman RJ, Labrador J, Lad D, Levin MD, Levy I, Longval T, Lopez-Garcia A, Marquet J, Martin-Rodríguez L, Maynadié M, Maslejova S, Mayor-Bastida C, Mihaljevic B, Milosevic I, Miras F, Moia R, Morawska M, Murru R, Nath UK, Navarro-Bailón A, Oliveira AC, Olivieri J, Oscier D, Panovska-Stavridis I, Papaioannou M, Papajík T, Kubova Z, Phumphukhieo P, Pierie C, Puiggros A, Rani L, Reda G, Rigolin GM, Ruchlemer R, Daniel de Deus Santos M, Schipani M, Schiwitza A, Shen Y, Simkovic M, Smirnova S, Abdelrahman Soliman DS, Spacek M, Tadmor T, Tomic K, Tse E, Vassilakopoulos T, Visentin A, Vitale C, von Tresckow J, Vrachiolias G, Vukovic V, Walewska R, Wasik-Szczepanek E, Xu Z, Yagci M, Yañez L, Yassin M, Zuchnicka J, Angelopoulou M, Antic D, Biderman B, Catherwood M, Claus R, Coscia M, Cuneo A, Demirkan F, Espinet B, Gaidano G, Kalashnikova OB, Laurenti L, Nikitin E, Pangalis GA, Panagiotidis P, Popov VM, Pospisilova S, Sportoletti P, Stavroyianni N, Tam C, Trentin L, Chatzidimitriou A, Bosch F, Doubek M, Ghia P, Stamatopoulos K. Other malignancies in the history of CLL: an international multicenter study conducted by ERIC, the European Research Initiative on CLL, in HARMONY. EClinicalMedicine 2023; 65:102307. [PMID: 38033506 PMCID: PMC10685149 DOI: 10.1016/j.eclinm.2023.102307] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 12/02/2023] Open
Abstract
Background Patients with chronic lymphocytic leukemia (CLL) have a higher risk of developing other malignancies (OMs) compared to the general population. However, the impact of CLL-related risk factors and CLL-directed treatment is still unclear and represents the focus of this work. Methods We conducted a retrospective international multicenter study to assess the incidence of OMs and detect potential risk factors in 19,705 patients with CLL, small lymphocytic lymphoma, or high-count CLL-like monoclonal B-cell lymphocytosis, diagnosed between 2000 and 2016. Data collection took place between October 2020 and March 2022. Findings In 129,254 years of follow-up after CLL diagnosis, 3513 OMs were diagnosed (27.2 OMs/1000 person-years). The most common hematological OMs were Richter transformation, myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML). Non-melanoma skin (NMSC) and prostate cancers were the most common solid tumors (STs).The only predictor for MDS and AML development was treatment with fludarabine and cyclophosphamide with/without rituximab (FC ± R) (OR = 3.7; 95% CI = 2.79-4.91; p < 0.001). STs were more frequent in males and patients with unmutated immunoglobulin heavy variable genes (OR = 1.77; 95% CI = 1.49-2.11; p < 0.001/OR = 1.89; 95% CI = 1.6-2.24; p < 0.001).CLL-directed treatment was associated with non-melanoma skin and prostate cancers (OR = 1.8; 95% CI = 1.36-2.41; p < 0.001/OR = 2.11; 95% CI = 1.12-3.97; p = 0.021). In contrast, breast cancers were more frequent in untreated patients (OR = 0.17; 95% CI = 0.08-0.33; p < 0.001).Patients with CLL and an OM had inferior overall survival (OS) than those without. AML and MDS conferred the worst OS (p < 0.001). Interpretation OMs in CLL impact on OS. Treatment for CLL increased the risk for AML/MDS, prostate cancer, and NMSC. FCR was associated with increased risk for AML/MDS. Funding AbbVie, and EU/EFPIAInnovative Medicines Initiative Joint Undertaking HARMONY grant n° 116026.
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Affiliation(s)
| | - Lydia Scarfò
- Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - Georgios Karakatsoulis
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
- Department of Mathematics, University of Ioannina, Ioannina, Greece
| | - Eva Minga
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Dimitra Chamou
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Gloria Iacoboni
- Department of Haematology, University Hospital Vall d'Hebron, Autonomous University, Barcelona, Spain
| | - Jana Kotaskova
- Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | - Lukas Smolej
- 4th Department of Internal Medicine-Haematology, University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic
| | | | - Miguel Alcoceba
- Department of Haematology, University Hospital of Salamanca (HUS-IBSAL), CIBERONC (CB16/12/00233) and Cancer Research Centre (CIC-IBMCC, USAL-CSIC), Salamanca, Spain
| | - Salem Al-Shemari
- Faculty of Medicine, Department of Medicine, Kuwait University, Kuwait City, Kuwait
| | | | | | - Mar Bellido
- Hematology Department, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Anne Calleja
- Department of Hemato-Oncology, Institut Paoli Calmettes, Marseille, France
| | | | - Mehreen Ali Khan
- Department of Hematology and Stem Cell Transplant, Armed Forces Bone Marrow Transplant Center/National Institute of Blood and Marrow Transplant, Rawalpindi, Pakistan
| | - Ramona Cassin
- Hematology Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico of Milan, Milan, Italy
| | - Sofia Chatzileontiadou
- Hematology Unit, 1st Dept of Internal Medicine, AUTH, AHEPA Hospital, Thessaloniki, Greece
| | - Rosa Collado
- Servicio de Hematología, Consorcio Hospital General Universitario de Valencia, Fundación de Investigación Hospital General Universitario de Valencia, Valencia, Spain
| | - Amy Christian
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Zadie Davis
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Maria Dimou
- Department of Hematology and Bone Marrow Transplantation Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - David Donaldson
- Clinical Haematology, Belfast City Hospital, Belfast, United Kingdom
| | | | - Barbara Dreta
- Division of Hematology, Department of Internal Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Maria Efstathopoulou
- Department of Haematology, Athens Medical Center-Psychikon Branch, Athens, Greece
| | | | | | - Alberto Fresa
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Sara Galimberti
- Section of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Galitzia
- Hematology and Stem Cell Transplantation Unit, Ospedale Oncologico A. Businco, ARNAS "G. Brotzu", Cagliari, Italy
| | - Rocío García-Serra
- Servicio de Hematología, Consorcio Hospital General Universitario de Valencia, Fundación de Investigación Hospital General Universitario de Valencia, Valencia, Spain
| | - Eva Gimeno
- Department of Hematology, Hospital del Mar, Barcelona, Spain
| | | | | | - Valerio Guarente
- Institute of Hematology and Center for Hemato-Oncology Research, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Romain Guieze
- Department of Hematology and Cell Therapy, Estaing University Hospital, Clermont-Ferrand, France
| | - Ajay Gogia
- Laboratory Oncology Unit, Dr. B.R.A. IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ritu Gupta
- Laboratory Oncology Unit, Dr. B.R.A. IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sean Harrop
- Peter MacCallum Cancer Centre, St Vincent's Hospital, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Eleftheria Hatzimichael
- Faculty of Medicine, Department of Haematology, School of Health Sciences, University of Ioannina, Stavros Niarchos Avenue, Ioannina 45110, Greece
| | - Yair Herishanu
- Department of Hematology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Luca Inchiappa
- Department of Hemato-Oncology, Institut Paoli Calmettes, Marseille, France
| | - Ozren Jaksic
- Department of Hematology, University Hospital Dubrava, Zagreb, Croatia
| | - Susanne Janssen
- Dept of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Elżbieta Kalicińska
- Department and Clinic of Hematology, Blood Neoplasms and Bone Marrow Transplantation Wroclaw Medical University, Wroclaw, Poland
| | - Laribi Kamel
- Department of Hematology, Centre Hospitalier Le Mans, Le Mans, France
| | | | - Arnon P. Kater
- Dept of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Bonnie Kho
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong, China
| | - Maria Kislova
- Department of Hematology, Oncology, and Chemotherapy, S. P. Botkin's City Hospital, Moscow, Russia
| | | | - Maya Koren-Michowitz
- Department of Hematology, Shamir Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Ioannis Kotsianidis
- Department of Hematology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Robert J. Kreitman
- Laboratory of Molecular Biology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jorge Labrador
- Department of Hematology, Hospital Universitario de Burgos, Burgos, Spain
| | - Deepesh Lad
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Ilana Levy
- Hematology, Bnai-Zion Medical Center, Haifa, Israel
| | - Thomas Longval
- Service d'Hématologie Oncologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Alberto Lopez-Garcia
- Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain
| | - Juan Marquet
- Hematology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Lucia Martin-Rodríguez
- Department of Haematology, University Hospital Vall d'Hebron, Autonomous University, Barcelona, Spain
| | - Marc Maynadié
- Biological Haematology Department, Dijon Bourgogne University Hospital, Haematological Malignancies Registry, LNC UMR 1231, Dijon 21000, France
| | - Stanislava Maslejova
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | - Biljana Mihaljevic
- Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Milosevic
- Faculty of Medicine, Clinical Centre of Vojvodina, University of Novi Sad, Novi Sad, Serbia
| | - Fatima Miras
- Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Riccardo Moia
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Marta Morawska
- Experimental Hematooncology Department, Medical University of Lublin, Lublin, Poland
- Hematology Department, St. John's Cancer Center, Lublin, Poland
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale Oncologico A. Businco, ARNAS "G. Brotzu", Cagliari, Italy
| | - Uttam Kumar Nath
- Department of Medical Oncology & Hematology, All India Institute of Medical Sciences, Rishikesh, India
| | - Almudena Navarro-Bailón
- Department of Haematology, University Hospital of Salamanca (HUS-IBSAL), CIBERONC (CB16/12/00233) and Cancer Research Centre (CIC-IBMCC, USAL-CSIC), Salamanca, Spain
| | - Ana C. Oliveira
- Department of Clinical Hematology, ICO, Hospital Duran i Reynals, IDIBELL, Barcelona, Spain
| | | | - David Oscier
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Irina Panovska-Stavridis
- Medical Faculty, University Clinic of Hematology, University Ss. Cyril and Methodius, Skopje, North Macedonia
| | - Maria Papaioannou
- Hematology Unit, 1st Dept of Internal Medicine, AUTH, AHEPA Hospital, Thessaloniki, Greece
| | - Tomas Papajík
- Faculty of Medicine and Dentistry, Department of Hemato-Oncology, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Zuzana Kubova
- Faculty of Medicine and Dentistry, Department of Hemato-Oncology, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic
| | | | - Cheyenne Pierie
- Dept of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Anna Puiggros
- Molecular Cytogenetics Laboratory, Pathology Department, Hospital del Mar and Translational Research on Hematological Neoplasms Group, Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Lata Rani
- Laboratory Oncology Unit, Dr. B.R.A. IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Gianluigi Reda
- Hematology Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico of Milan, Milan, Italy
| | | | - Rosa Ruchlemer
- Department of Hematology, Shaare-Zedek Medical Center, Affiliated with the Hebrew University Medical School, Jerusalem, Israel
| | | | - Mattia Schipani
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Annett Schiwitza
- Hematology and Oncology, Faculty of Medicine, University of Augsburg, Stenglinstrasse 2, Augsburg 86156, Germany
| | - Yandong Shen
- Royal North Shore Hospital, Sydney, NSW, Australia
| | - Martin Simkovic
- 4th Department of Internal Medicine-Haematology, University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic
| | - Svetlana Smirnova
- Consultative Hematology Department with a Day Hospital for Intensive High-Dose Chemotherapy, National Medical Research Center for Hematology, Moscow, Russia
| | | | - Martin Spacek
- First Faculty of Medicine, 1st Department of Medicine - Hematology, Charles University and General Hospital in Prague, Czech Republic
| | - Tamar Tadmor
- Hematology, Bnai-Zion Medical Center, Haifa, Israel
| | - Kristina Tomic
- Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Eric Tse
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Candida Vitale
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Julia von Tresckow
- Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - George Vrachiolias
- Department of Hematology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Vojin Vukovic
- Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Renata Walewska
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Ewa Wasik-Szczepanek
- Dept. Hematooncology and Bone Marrow Transplantation, Medical University in Lublin, Lublin, Poland
| | - Zhenshu Xu
- Fujian Provincial Key Laboratory of Hematology, Fujian Institute of Hematology, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Munci Yagci
- Gazi University Medical Faculty, Ankara, Turkey
| | - Lucrecia Yañez
- Department of Hematology, University Hospital Marqués de Valdecilla, Santander, Spain
- Department of Hematological Malignancies and Stem Cell Transplantation, Research Institute of Marques de Valdecilla (IDIVAL), Santander, Spain
| | - Mohamed Yassin
- Hematology Section, Department of Medical Oncology, National Center for Cancer Care and Research, Doha, Qatar
| | - Jana Zuchnicka
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Maria Angelopoulou
- Haematology, University of Athens, Laikon General Hospital, Athens, Greece
| | - Darko Antic
- Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Bella Biderman
- Department of Molecular Hematology, National Medical Research Center for Hematology, Moscow, Russia
| | - Mark Catherwood
- Clinical Haematology, Belfast City Hospital, Belfast, United Kingdom
| | - Rainer Claus
- Pathology, Faculty of Medicine, University of Augsburg, Stenglinstrasse 2, Augsburg 86156, Germany
- Faculty of Medicine, Comprehensive Cancer Center Augsburg, University of Augsburg, Stenglinstrasse 2, Augsburg 86156, Germany
| | - Marta Coscia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | | | - Fatih Demirkan
- Division of Hematology, Dokuz Eylul University, Izmir, Turkey
| | - Blanca Espinet
- Molecular Cytogenetics Laboratory, Pathology Department, Hospital del Mar and Translational Research on Hematological Neoplasms Group, Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Olga B. Kalashnikova
- Federal State Budgetary Educational Institution of Higher Education Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia
| | - Luca Laurenti
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Eugene Nikitin
- Department of Hematology, Oncology, and Chemotherapy, S. P. Botkin's City Hospital, Moscow, Russia
| | | | - Panagiotis Panagiotidis
- Department of Hematology and Bone Marrow Transplantation Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Viola Maria Popov
- Hematology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Sarka Pospisilova
- Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Paolo Sportoletti
- Institute of Hematology and Center for Hemato-Oncology Research, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Niki Stavroyianni
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Constantine Tam
- Peter MacCallum Cancer Centre, St Vincent's Hospital, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padova, Italy
| | | | - Francesc Bosch
- Department of Haematology, University Hospital Vall d'Hebron, Autonomous University, Barcelona, Spain
| | - Michael Doubek
- Central European Institute of Technology (CEITEC), Masaryk University, Brno, Czech Republic
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
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Toumpanakis D, Glynos C, Schoini P, Vassilakopoulou V, Chatzianastasiou A, Dettoraki M, Mizi E, Tsoukalas D, Perlikos F, Magkou C, Papapetropoulos A, Vassilakopoulos T. Synergistic Effects of Resistive Breathing on Endotoxin-Induced Lung Injury in Mice. Int J Chron Obstruct Pulmon Dis 2023; 18:2321-2333. [PMID: 37876659 PMCID: PMC10591622 DOI: 10.2147/copd.s424560] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 10/16/2023] [Indexed: 10/26/2023] Open
Abstract
Introduction Resistive breathing (RB) is characterized by forceful contractions of the inspiratory muscles, mainly the diaphragm, resulting in large negative intrathoracic pressure and mechanical stress imposed on the lung. We have shown that RB induces lung injury in healthy animals. Whether RB exerts additional injurious effects when added to pulmonary or extrapulmonary lung injury is unknown. Our aim was to study the synergistic effect of RB on lipopolysaccharide (LPS)-induced lung injury. Methods C57BL/6 mice inhaled an LPS aerosol (10mg/3mL) or received an intraperitoneal injection of LPS (10 mg/kg). Mice were then anaesthetized, the trachea was surgically exposed, and a nylon band of a specified length was sutured around the trachea, to provoke a reduction of the surface area at 50%. RB through tracheal banding was applied for 24 hours. Respiratory system mechanics were measured, BAL was performed, and lung sections were evaluated for histological features of lung injury. Results LPS inhalation increased BAL cellularity, mainly neutrophils (p < 0.001 to ctr), total protein and IL-6 in BAL (p < 0.001 and p < 0.001, respectively) and increased the lung injury score (p = 0.001). Lung mechanics were not altered. Adding RB to inhaled LPS further increased BAL cellularity (p < 0.001 to LPS inh.), total protein (p = 0.016), lung injury score (p = 0.001) and increased TNFa levels in BAL (p = 0.011). Intraperitoneal LPS increased BAL cellularity, mainly macrophages (p < 0.001 to ctr.), total protein levels (p = 0.017), decreased static compliance (p = 0.004) and increased lung injury score (p < 0.001). Adding RB further increased histological features of lung injury (p = 0.022 to LPS ip). Conclusion Resistive breathing exerts synergistic injurious effects when combined with inhalational LPS-induced lung injury, while the additive effect on extrapulmonary lung injury is less prominent.
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Affiliation(s)
- Dimitrios Toumpanakis
- “Marianthi Simou” Applied Biomedical Research and Training Center, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Constantinos Glynos
- “Marianthi Simou” Applied Biomedical Research and Training Center, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Pinelopi Schoini
- 4th Respiratory Clinic, “Sotiria” General Hospital for Thoracic Diseases of Athens, Athens, Greece
| | - Vyronia Vassilakopoulou
- “Marianthi Simou” Applied Biomedical Research and Training Center, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Athanasia Chatzianastasiou
- “Marianthi Simou” Applied Biomedical Research and Training Center, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Maria Dettoraki
- “Marianthi Simou” Applied Biomedical Research and Training Center, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Eleftheria Mizi
- “Marianthi Simou” Applied Biomedical Research and Training Center, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Dionysios Tsoukalas
- “Marianthi Simou” Applied Biomedical Research and Training Center, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Fotis Perlikos
- “Marianthi Simou” Applied Biomedical Research and Training Center, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | | | - Andreas Papapetropoulos
- Biomedical Research Foundation of the Academy of Athens, Athens, Greece
- Division of Pharmaceutical Chemistry, Department of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Vassilakopoulos
- “Marianthi Simou” Applied Biomedical Research and Training Center, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Voudouris D, Horianopoulou M, Apostolopoulou Z, Chryssanthopoulos C, Bardopoulou M, Maridaki M, Vassilakopoulos T, Koutsilieris M, Philippou A. The Effects of a Short-Term Combined Exercise Program on Liver Steatosis Indices and the Lipidemic and Glycemic Profile in NAFLD Individuals: A Pilot Study. Metabolites 2023; 13:1074. [PMID: 37887399 PMCID: PMC10609218 DOI: 10.3390/metabo13101074] [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: 09/14/2023] [Revised: 10/04/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a very common liver disease associated with obesity, unhealthy diet, and lack of physical exercise. Short-term aerobic or resistance exercise has been shown to result in reduced liver fat in patients with NAFLD; however, the impact of the combination of these types of exercise has received less attention. This study investigated the effect of a short-term (7 days) concurrent exercise training program performed daily on liver steatosis indices, as well as the glycemic and lipidemic profile of overweight/obese sedentary volunteers. Twenty adult patients (age: 47.3 ± 12.3 yrs, body mass index: 32.4 ± 3.4 kg/m2) with NAFLD, detected by ultrasound and hematological indices, participated in the study. Pre- and post-exercise intervention assessment included body weight (BW), waist circumference (WC), hip/waist ratio (H/W), Homeostasis Model Assessment Insulin Resistance (HOMA-IR), blood lipids, and steatosis indices. Fatty Liver Index, Lipid Accumulation Index, WC, H/W, triglycerides, and total cholesterol were improved (p < 0.05) post-exercise, while no differences (p > 0.05) were observed in BW, HOMA-IR, HDL, LDL, Hepatic Steatosis Index, and Framingham Steatosis Index compared to pre-exercise values. It is concluded that a 7-day combined exercise program can have beneficial effects on hepatic steatosis and central adiposity indices, independently of weight loss, in patients with NAFLD.
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Affiliation(s)
- Dimitrios Voudouris
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Maria Horianopoulou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Zoi Apostolopoulou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Costas Chryssanthopoulos
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Mari Bardopoulou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Maria Maridaki
- Department of Physical Education and Sport Science, School of Physical Education and Sport Science, National and Kapodistrian University of Athens, 17237 Athens, Greece
| | - Theodoros Vassilakopoulos
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Michael Koutsilieris
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Anastassios Philippou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Diamantopoulos PT, Solomou E, Symeonidis A, Pappa V, Kotsianidis I, Galanopoulos A, Pontikoglou C, Anagnostopoulos A, Vassilopoulos G, Zikos P, Hatzimichael E, Papaioannou M, Megalakaki A, Vassilakopoulos T, Dimou M, Tsokanas D, Papoutselis MK, Papageorgiou S, Kourakli A, Papadaki H, Panayiotidis P, Viniou NA. The prognostic significance of macrocytosis in patients with myelodysplastic neoplasms. Am J Hematol 2023; 98:E119-E122. [PMID: 36808739 DOI: 10.1002/ajh.26886] [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] [Received: 01/16/2023] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/23/2023]
Affiliation(s)
- Panagiotis T Diamantopoulos
- Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Elena Solomou
- Department of Internal Medicine, University Hospital of Patras, Rio, Greece
| | - Argiris Symeonidis
- Hematology Division, Department of Internal Medicine, University of Patras Medical School-University Hospital, Patras, Greece
| | - Vasiliki Pappa
- Haematology Division, Second Department of Internal Medicine, Attikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Kotsianidis
- Department of Hematology, University Hospital of Alexandroupolis, Alexandroupoli, Greece
| | - Athanasios Galanopoulos
- Department of Clinical Hematology, 'G. Gennimatas' District General Hospital, Athens, Greece
| | | | - Achilles Anagnostopoulos
- Hematology Department, General Hospital of Thessaloniki "George Papanikolaou", Pilea Chortiatis, Greece
| | - George Vassilopoulos
- Department of Hematology, Larissa University Hospital, University of Thessalia, Larissa, Greece
| | - Panagiotis Zikos
- Department of Hematology, 'St Andrew' General Hospital, Patras, Greece
| | | | - Maria Papaioannou
- Hematology Department, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | | | - Theodoros Vassilakopoulos
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Maria Dimou
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Dimitrios Tsokanas
- Department of Clinical Hematology, 'G. Gennimatas' District General Hospital, Athens, Greece
| | | | - Sotirios Papageorgiou
- Haematology Division, Second Department of Internal Medicine, Attikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Kourakli
- Hematology Division, Department of Internal Medicine, University of Patras Medical School-University Hospital, Patras, Greece
| | - Helen Papadaki
- Haematology Laboratory, School of Medicine, University of Crete, Greece
| | - Panayiotis Panayiotidis
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Nora-Athina Viniou
- Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Dina E, Toumpanakis D, Cheilari A, Chatzianastasiou A, Salagiannis K, Papapetropoulos A, Vassilakopoulos T, Aligiannis N. ANASA - Development of bioactive herbal extracts to treat severe acute respiratory system diseases. Maced Pharm Bull 2022. [DOI: 10.33320/maced.pharm.bull.2022.68.04.075] [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: 01/23/2023] Open
Affiliation(s)
- Evanthia Dina
- Department of Pharmacognosy and Natural Products Chemistry, Faculty of Pharmacy, National and Kapodistrian University of Athens, Panepistimiopolis Zografou, 15771, Greece
| | - Dimitrios Toumpanakis
- “Marianthi Simou” Applied Biomedical Research and Training Center, Evangelismos Hospital Medical School, National and Kapodistrian University of Athens, Greece
| | - Antigoni Cheilari
- Department of Pharmacognosy and Natural Products Chemistry, Faculty of Pharmacy, National and Kapodistrian University of Athens, Panepistimiopolis Zografou, 15771, Greece
| | - Athanasia Chatzianastasiou
- “Marianthi Simou” Applied Biomedical Research and Training Center, Evangelismos Hospital Medical School, National and Kapodistrian University of Athens, Greece
| | - Konstantinos Salagiannis
- Clinical, Experimental Surgery and Translational Research Center, Biomedical Research Foundation of the Academy of Athens, Greece
| | - Andreas Papapetropoulos
- linical, Experimental Surgery and Translational Research Center, Biomedical Research Foundation of the Academy of Athens, Greece
| | - Theodoros Vassilakopoulos
- “Marianthi Simou” Applied Biomedical Research and Training Center, Evangelismos Hospital Medical School, National and Kapodistrian University of Athens, Greece
| | - Nektarios Aligiannis
- Department of Pharmacognosy and Natural Products Chemistry, Faculty of Pharmacy, National and Kapodistrian University of Athens, Panepistimiopolis Zografou, 15771, Greece
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Panagopoulos PK, Goules AV, Georgakopoulou VE, Kallianos A, Chatzinikita E, Pezoulas VC, Malagari K, Fotiadis DI, Vlachoyiannopoulos P, Vassilakopoulos T, Tzioufas AG. Small airways dysfunction in patients with systemic sclerosis and interstitial lung disease. Front Med (Lausanne) 2022; 9:1016898. [PMID: 36452897 PMCID: PMC9702077 DOI: 10.3389/fmed.2022.1016898] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/24/2022] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND A number of studies report small airways involvement in patients with systemic sclerosis (SSc). Furthermore, small airways dysfunction is increasingly recognized in patients with interstitial lung disease (ILD) of idiopathic or autoimmune etiology. The objectives of this study were to evaluate small airways function in SSc patients with ILD and explore the effect of treatment on small airways function by using conventional and contemporary pulmonary function tests (PFTs). METHODS This single-center, prospective, observational study included a total of 35 SSc patients, with and without ILD based on HRCT scan, evaluated by a special radiologist blindly. Clinical data were collected from all patients who were also assessed for HRCT findings of small airways disease. Small airways function was assessed by classic spirometry, measurement of diffusing capacity for carbon monoxide, body plethysmography, single breath nitrogen washout (N2SBW) and impulse oscillometry (IOS). The prevalence of small airways dysfunction according to R5-R20, phase III slopeN2SBW and CV/VC methodologies was calculated in the total SSc population. Pulmonary function tests were compared between: (a) SSc-ILD and non-ILD patients and (b) two time points (baseline and follow up visit) in a subset of SSc-ILD patients who received treatment for ILD and were re-evaluated at a follow up visit after 12 months. RESULTS Phase III slopeN2SBW and R5-R20 showed the highest diagnostic performance for detecting small airways dysfunction among SSc patients (61 and 37.5%, respectively). Twenty three SSc patients were found with ILD and 14 of them had a 12-month follow up visit. SSc-ILD patients compared to those without ILD exhibited increased phase III slopeN2SBW ≥120% (p = 0.04), R5-R20 ≥0.07 kPa/L/s (p = 0.025), airway resistance (Raw) (p = 0.011), and special airway resistance (sRaw) (p = 0.02), and decreased specific airway conductance (sGaw) (p = 0.022), suggesting impaired small airways function in the SSc-ILD group. Radiographic features of SAD on HRCT were observed in 22% of SSc-ILD patients and in none of SSc-non-ILD patients. Comparison of PFTs between baseline and follow-up visit after 12 months in the 14 SSc-ILD treated patients, showed improvement of phase III slopeN2SBW (p = 0.034), R5-R20 (p = 0.035) and Raw (p = 0.044) but not sRaw and sGaw parameters. CONCLUSION Phase III slopeN2SBW and R5-R20 may reveal small airways dysfunction in SSc associated ILD before structural damage and may be partially improved in a subset of patients receiving treatment for ILD.
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Affiliation(s)
- Panagiotis K. Panagopoulos
- 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
- Research Institute of Systemic Autoimmune Diseases, Athens, Greece
| | - Vasiliki E. Georgakopoulou
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios Kallianos
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eirini Chatzinikita
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasileios C. Pezoulas
- Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, Ioannina, Greece
| | - Katerina Malagari
- 2nd Department of Radiology, “Attikon” Hospital, University of Athens, Athens, Greece
| | - Dimitrios I. Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, Ioannina, Greece
| | - Panayiotis Vlachoyiannopoulos
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Research Institute of Systemic Autoimmune Diseases, Athens, Greece
| | - Theodoros Vassilakopoulos
- Department of Physiology, 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
- Research Institute of Systemic Autoimmune Diseases, Athens, Greece
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Horianopoulou M, Voudouris D, Apostolopoulou Z, Chryssanthopoulos C, Maridaki M, Vassilakopoulos T, Koutsilieris M, Philippou A. The Effects Of A Short-term Combined Exercise Program On Liver Steatosis Indices In Nafld Patients. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000882648.14748.7e] [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: 11/21/2022]
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9
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Chryssanthopoulos C, Horianopoulou M, Koromantzou M, Lambropoulos I, Zacharogiannis E, Dimitriadis G, Maridaki M, Vassilakopoulos T, Koutsilieris M, Philippou A. Acute Exercise Performed At Different Frequency And Times Of The Day In Type 2 Diabetics. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000875900.91423.9d] [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: 11/21/2022]
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Schuster M, Zijlstra J, Casasnovas RO, Vermaat JSP, Kalakonda N, Goy A, Choquet S, Neste EVD, Hill B, Thieblemont C, Cavallo F, De la Cruz F, Kuruvilla J, Hamad N, Jaeger U, Caimi P, Gurion R, Warzocha K, Bakhshi S, Sancho JM, Follows G, Egyed M, Offner F, Vassilakopoulos T, Samal P, Ku M, Ma X, Corona K, Chamoun K, Shah J, Shacham S, Kauffman MG, Canales M, Maerevoet M. Effect of Prior Therapy and Disease Refractoriness on the Efficacy and Safety of Oral Selinexor in Patients with Diffuse Large B-cell Lymphoma (DLBCL): A Post-hoc Analysis of the SADAL Study. Clin Lymphoma Myeloma Leuk 2022; 22:483-494. [PMID: 35078739 DOI: 10.1016/j.clml.2021.12.016] [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] [Received: 07/11/2021] [Revised: 12/07/2021] [Accepted: 12/18/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Despite a number of treatment options, patients with diffuse large B-cell lymphoma (DLBCL) whose disease has become refractory to treatment have a poor prognosis. Selinexor is a novel, oral drug that is approved to treat patients with relapsed/refractory DLBCL. In this post hoc analysis of the SADAL study, a multinational, open-label study, we evaluated subpopulations to determine if response to single agent selinexor is impacted by number of lines of prior treatment, autologous stem cell transplant (ASCT), response to first and most recent therapies, and time to progressive disease. PATIENTS Patients (n = 134) with DLBCL after 2-5 prior therapies were enrolled in SADAL and received 60mg selinexor twice weekly. RESULTS The median overall survival was 9.0 months and median progression free survival was 2.6 months. Patients who had the best overall response rate (ORR) and disease control rate were those who had prior ASCT (42.5% and 50.0%) or responded to last line of therapy (35.9% and 43.5%). Patients with primary refractory DLBCL also showed responses (ORR 21.8%). Adverse events between subgroups were similar to the overall study population, the most common being thrombocytopenia (29.1%), fatigue (7.5%), and nausea (6.0%). CONCLUSION Regardless of prior therapy and disease refractory status, selinexor treatment demonstrated results consistent with its novel mechanism of action and lack of cross-resistance. Thus, single agent oral selinexor can induce deep, durable, and tolerable responses in patients with DLBCL who have recurrent disease after several chemoimmunotherapy combination regimens.
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Affiliation(s)
| | - Josée Zijlstra
- Amsterdam UMC, Vrije Universiteit, Cancer Center, Amsterdam, Netherlands
| | | | | | | | - Andre Goy
- Hackensack University Medical Center, Hackensack, NJ, United States
| | | | | | - Brian Hill
- Cleveland Clinic, Cleveland, OH, United States
| | - Catherine Thieblemont
- APHP, Saint-Louis Hospital, Hemato-oncology, Paris, France & Diderot University, Paris, France
| | | | | | | | - Nada Hamad
- St. Vincent's Hospital Sydney, Darlinghurst, Australia
| | | | - Paolo Caimi
- UH Seidman Cancer Center, Cleveland, OH, United States
| | | | | | - Sameer Bakhshi
- Dr. B. R. A. Institute Rotary Cancer Hospital, New Delhi, India
| | | | | | | | | | | | - Priyanka Samal
- Institute of Medical Sciences & SUM Hospital, Odisha, India
| | - Matthew Ku
- St.Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Xiwen Ma
- Karyopharm Therapeutics, Newton, MA, United States
| | - Kelly Corona
- Karyopharm Therapeutics, Newton, MA, United States
| | | | - Jatin Shah
- Karyopharm Therapeutics, Newton, MA, United States
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Panagopoulos P, Georgakopoulou VE, Pezoulas V, Goules A, Fotiadis DI, Vassilakopoulos T, Tzioufas A. POS0894 COMPARISON OF PULMONARY AND SMALL AIRWAYS FUNCTION BETWEEN IDIOPATHIC INFLAMMATORY MYOPATHIES PATIENTS WITH AND WITHOUT INTERSTITIAL LUNG DISEASE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPulmonary manifestations of idiopathic inflammatory myopathies (IIM) include interstitial lung disease (ILD) and respiratory muscle weakness, but function of small airways has not been studied in these patients (1). Spirometry, impulse oscillometry and measurement of respiratory resistance by the interrupter technique (Rocc) are tools to evaluate function of small airways. In addition, body plethysmography is the gold standard for measuring lung volumes, whereas nitrogen washout seems impaired, “underestimating” lung volumes in patients with small airways obstruction due to gas trapping (2). Thus, discrepancies between lung volumes measured by those two techniques may be an indication of early small airways dysfunction.ObjectivesTo compare pulmonary and small airways function between IIM patients with and without ILD.MethodsThis prospective observational study included 13 IIM patients with ILD (8 patients with dermatomyositis and 5 with polymyositis) and 13 IIM patients without ILD (9 patients with dermatomyositis and 4 with polymyositis) who were diagnosed and followed up in the outpatient rheumatology clinic of the Department of Pathophysiology between June and December 2021. All IIM patients fulfilled the 2017 EULAR/ACR classification criteria (3). The presence of ILD was determined by high resolution computed tomography of the lungs that was performed as baseline standard of care at the time of diagnosis and was evaluated by a special radiologist blindly, according to Fleischner Society definitions for ILD (4). Clinical, laboratory and immunological data were recorded at the time of diagnosis and pulmonary function was assessed by spirometry, body plethysmography, single and multiple breath nitrogen washout, impulse oscillometry and measurement of Rocc, diffusing capacity for carbon monoxide (DLco) and maximal inspiratory and expiratory pressures. Statistical analysis for categorical data was performed by Fisher exact test or χ2 square test accordingly and numerical data with Man-Whitney test or t test.ResultsIIM-ILD patients presented more frequently with dyspnea (53.8% vs 0%, p<0.01), fever (61.5% vs 7.7%, p<0.05) and arthralgias (76.9% vs 23%, p<0.05), compared to IIM patients without ILD. Inflammatory markers, serum muscle enzymes, myositis specific autoantibodies and classic spirometric parameters did not differ between the two groups. IIM-ILD patients had markedly lower predicted DLco compared to those without (mean: 56.3% vs 78.2%, p<0.01). Predicted total lung capacity and residual volume (TLCN2WO%, RVN2WO%) measured by nitrogen washout and the TLC nitrogen washout: TLC body plethysmography ratio (TLCN2WO/TLCpleth) were significantly lower in IIM-ILD patients compared to those without ILD (mean: 111.1% vs 153.4%, p<0.05, median: 171% vs 210%, p<0.05 and median: 1.28 vs 1.45, p<0.05, respectively). Similarly, ΔΝ2(%) was found significantly higher among non-ILD than ILD-IIM patients [5.4 vs 2.8%, p=0.013]. Predicted normal value of Rocc tended to be higher in IIM-ILD patients, although not statistically significantly.ConclusionAbnormal single breath nitrogen washout and discrepancies between lung volumes measured by body plethysmography and nitrogen washout in IIM-ILD patients, indicate an early small airways dysfunction in these patients.References[1]Selva-O’Callaghan et al. PMID 16130510[2]Bell et al. PMID 30022817[3]Lundberg et al. PMID 29079590[4]Hatabu et al. PMID 32649920Table 1.Comparison of pulmonary and small airways function variables between IIM patients with and without ILD.Pulmonary function variablesIIM-ILD patients (n=13)IIM patients without ILD (n=13)p valueFVC%88.2104.10.09FEV1%85.8101.90.07FEV1/FVC82.780.90.57FEF25-75%85.790.40.74TLCpleth%82.689.90.32RVpleth %83.976.10.40TLCN2WO%111.1153.40.03RVN2WO%1712100.039TLCN2WO/TLCpleth1.281.450.039DLco%56.378.20.005MEP%6962.40.57MIP%93.472.50.06ΔN2(%)2.85.40.013Rocc Exp %100.576.60.053R(20)%99.4123.40.09Disclosure of InterestsNone declared
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Toumpanakis D, Chatzianastasiou A, Vassilakopoulou V, Mizi E, Dettoraki M, Perlikos F, Giatra G, Mikos N, Theocharis S, Vassilakopoulos T. TRPV4 Inhibition Exerts Protective Effects Against Resistive Breathing Induced Lung Injury. Int J Chron Obstruct Pulmon Dis 2022; 17:343-353. [PMID: 35210764 PMCID: PMC8857953 DOI: 10.2147/copd.s336108] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 02/03/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction TRPV4 channels are calcium channels, activated by mechanical stress, that have been implicated in the pathogenesis of pulmonary inflammation. During resistive breathing (RB), increased mechanical stress is imposed on the lung, inducing lung injury. The role of TRPV4 channels in RB-induced lung injury is unknown. Materials and Methods Spontaneously breathing adult male C57BL/6 mice were subjected to RB by tracheal banding. Following anaesthesia, mice were placed under a surgical microscope, the surface area of the trachea was measured and a nylon band was sutured around the trachea to reduce area to half. The specific TRPV4 inhibitor, HC-067047 (10 mg/kg ip), was administered either prior to RB and at 12 hrs following initiation of RB (preventive) or only at 12 hrs after the initiation of RB (therapeutic protocol). Lung injury was assessed at 24 hrs of RB, by measuring lung mechanics, total protein, BAL total and differential cell count, KC and IL-6 levels in BAL fluid, surfactant Protein (Sp)D in plasma and a lung injury score by histology. Results RB decreased static compliance (Cst), increased total protein in BAL (p < 0.001), total cell count due to increased number of both macrophages and neutrophils, increased KC and IL-6 in BAL (p < 0.001 and p = 0.01, respectively) and plasma SpD (p < 0.0001). Increased lung injury score was detected. Both preventive and therapeutic HC-067047 administration restored Cst and inhibited the increase in total protein, KC and IL-6 levels in BAL fluid, compared to RB. Preventive TRPV4 inhibition ameliorated the increase in BAL cellularity, while therapeutic TRPV4 inhibition exerted a partial effect. TRPV4 inhibition blunted the increase in plasma SpD (p < 0.001) after RB and the increase in lung injury score was also inhibited. Conclusion TRPV4 inhibition exerts protective effects against RB-induced lung injury.
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Affiliation(s)
- Dimitrios Toumpanakis
- “Marianthi Simou” Applied Biomedical Research and Training Center, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Correspondence: Dimitrios Toumpanakis, Email
| | - Athanasia Chatzianastasiou
- “Marianthi Simou” Applied Biomedical Research and Training Center, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vyronia Vassilakopoulou
- “Marianthi Simou” Applied Biomedical Research and Training Center, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftheria Mizi
- “Marianthi Simou” Applied Biomedical Research and Training Center, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Dettoraki
- “Marianthi Simou” Applied Biomedical Research and Training Center, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Fotis Perlikos
- “Marianthi Simou” Applied Biomedical Research and Training Center, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Giatra
- “Marianthi Simou” Applied Biomedical Research and Training Center, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- 3 Department of Critical Care Medicine, Evgenideio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Mikos
- Allergology Department, Laiko General Hospital, Athens, Greece
| | - Stamatios Theocharis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Vassilakopoulos
- “Marianthi Simou” Applied Biomedical Research and Training Center, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- 3 Department of Critical Care Medicine, Evgenideio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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13
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Manali ED, Kannengiesser C, Borie R, Ba I, Bouros D, Markopoulou A, Antoniou K, Kolilekas L, Papaioannou AI, Tzilas V, Tzouvelekis A, Daniil Z, Fouka E, Papakosta D, Xyfteri A, Karakatsani A, Loukides S, Korbila I, Tomos IP, Konstantinidis AK, Gogali A, Steiropoulos P, Papanikolaou IC, Bazaka C, Haritou A, Vassilakopoulos T, Maniati M, Kagouridis K, Markozannes E, Bouros E, Rampiadou C, Kounti G, Trachalaki A, Dimeas I, Karampitsakos T, Lyberopoulos P, Malamadakis N, Spyropoulou S, Revy P, Lainey E, Dieudé P, Rebah K, Ménard C, Oudin C, Masson C, Plessier A, Legendre M, Nathan N, Coulomb-L'Hermine A, Clement A, Amselem S, Boileau C, Crestani B, Papiris S. Genotype-Phenotype Relationships in Inheritable Idiopathic Pulmonary Fibrosis: A Greek National Cohort Study. Respiration 2022; 101:531-543. [PMID: 35078193 DOI: 10.1159/000520657] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/27/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Monogenic and polygenic inheritances are evidenced for idiopathic pulmonary fibrosis (IPF). Pathogenic variations in surfactant protein-related genes, telomere-related genes (TRGs), and a single-nucleotide polymorphism in the promoter of MUC5B gene encoding mucin 5B (rs35705950 T risk allele) are reported. This French-Greek collaborative study, Gen-Phen-Re-GreekS in inheritable IPF (iIPF), aimed to investigate genetic components and patients' characteristics in the Greek national IPF cohort with suspected heritability. PATIENTS AND METHODS 150 patients with familial PF, personal-family extrapulmonary disease suggesting short telomere syndrome, and/or young age IPF were analyzed. RESULTS MUC5B rs35705950 T risk allele was detected in 103 patients (90 heterozygous, 13 homozygous, allelic frequency of 39%), monoallelic TRG pathogenic variations in 19 patients (8 TERT, 5 TERC, 2 RTEL1, 2 PARN, 1 NOP10, and 1 NHP2), and biallelic ABCA3 pathogenic variations in 3. Overlapping MUC5B rs35705950 T risk allele and TRG pathogenic variations were shown in 11 patients (5 TERT, 3 TERC, 1 PARN, 1 NOP10, and 1 NHP2), MUC5B rs35705950 T risk allele, and biallelic ABCA3 pathogenic variations in 2. In 38 patients, neither MUC5B rs35705950 T risk allele nor TRG pathogenic variations were detectable. Kaplan-Meier curves showed differences in time-to-death (p = 0.025) where patients with MUC5B rs35705950 T risk allele alone or in combination with TRG pathogenic variations presented better prognosis. CONCLUSION The Gen-Phen-Re-GreekS in iIPF identified multiple and overlapping genetic components including the rarest, underlying disease's genetic "richesse," complexity and heterogeneity. Time-to-death differences may relate to diverse IPF pathogenetic mechanisms implicating "personalized" medical care driven by genotypes in the near future.
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Affiliation(s)
- Effrosyni D Manali
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Caroline Kannengiesser
- Département de Génétique, APHP Hôpital Bichat, Paris, France.,Université de Paris, Paris, France.,INSERM UMR 1152, Université de Paris, Paris, France
| | - Raphael Borie
- INSERM UMR 1152, Université de Paris, Paris, France.,APHP, Service de Pneumologie A, Centre de Référence des Maladies Pulmonaires Rares, FHU APOLLO, Hôpital Bichat, Paris, France
| | - Ibrahima Ba
- Département de Génétique, APHP Hôpital Bichat, Paris, France.,Université de Paris, Paris, France.,INSERM UMR 1152, Université de Paris, Paris, France
| | - Demosthenes Bouros
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria," Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Iatriko Medical Center, Athens, Greece
| | | | - Katerina Antoniou
- Laboratory of Molecular & Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | | | - Andriana I Papaioannou
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasileios Tzilas
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria," Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Iatriko Medical Center, Athens, Greece
| | - Argyrios Tzouvelekis
- Department of Respiratory Medicine, General Hospital of Patras, University of Patras, Patras, Greece
| | - Zoe Daniil
- Department of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Evangelia Fouka
- A Department of Pulmonary Medicine, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - Despoina Papakosta
- A Department of Pulmonary Medicine, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | | | - Anna Karakatsani
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stylianos Loukides
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Korbila
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis P Tomos
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Athina Gogali
- Department of Pneumonology, Medical School, University of Ioannina, Ioannina, Greece
| | - Paschalis Steiropoulos
- Department of Respiratory Medicine, University General Hospital Alexandroupolis, Medical School, Democritus University of Thrace, Thrace, Greece
| | | | | | | | - Theodoros Vassilakopoulos
- 3rd Department of Critical Care Medicine, Evgenideio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Maniati
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Kagouridis
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Markozannes
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Bouros
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Rampiadou
- Pulmonary Department, "G Papanikolaou" General Hospital, Thessaloniki, Greece
| | - Georgia Kounti
- Pulmonary Department, "G Papanikolaou" General Hospital, Thessaloniki, Greece
| | - Athina Trachalaki
- Laboratory of Molecular & Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Ilias Dimeas
- Department of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Theodoros Karampitsakos
- Department of Respiratory Medicine, General Hospital of Patras, University of Patras, Patras, Greece
| | - Panagiotis Lyberopoulos
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Malamadakis
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Patrick Revy
- Laboratory of Genome Dynamics in the Immune System, Imagine Institute, INSERM UMR 1163, Labellisé Ligue Contre Le Cancer, Université de Paris, Paris, France
| | - Elodie Lainey
- Service d'Hématologie Biologique, Hôpital Robert Debré, APHP, UMRS 1131, Institut Universitaire d'Hématologie, Paris, France
| | - Philippe Dieudé
- Department of Rheumatology, Hôpital Bichat-Claude Bernard, APHP, INSERM U1152, Université de Paris, Paris, France
| | - Khedidja Rebah
- Département de Génétique, APHP Hôpital Bichat, Paris, France.,Université de Paris, Paris, France
| | - Christelle Ménard
- Département de Génétique, APHP Hôpital Bichat, Paris, France.,Université de Paris, Paris, France
| | - Claire Oudin
- Département de Génétique, APHP Hôpital Bichat, Paris, France.,Université de Paris, Paris, France
| | - Cécile Masson
- Imagine Institute, Bioinformatics Platform, INSERM UMR 1163, Université de Paris, Paris, France
| | | | - Marie Legendre
- Sorbonne Université, INSERM UMR S933 Maladies Génétiques d'Expression Pédiatrique, and Assistance Publique Hôpitaux de Paris, U.F. de Génétique Moléculaire, Hôpital Armand Trousseau, Paris, France
| | - Nadia Nathan
- Sorbonne Université, INSERM UMR S933, France, Assistance Publique Hôpitaux de Paris, Service de Pneumologie Pédiatrique, Hôpital Armand Trousseau, Centre National de Référence des Maladies Respiratoires Rares RespiRare, Paris, France
| | - Aurore Coulomb-L'Hermine
- Service d'Anatomie et de Cytologie Pathologiques, Sorbonne Université, Hôpital d'Enfants Armand Trousseau, Paris, France
| | - Annick Clement
- Sorbonne Université, INSERM UMR S933, France, Assistance Publique Hôpitaux de Paris, Service de Pneumologie Pédiatrique, Hôpital Armand Trousseau, Centre National de Référence des Maladies Respiratoires Rares RespiRare, Paris, France
| | - Serge Amselem
- Sorbonne Université, INSERM UMR S933 Maladies Génétiques d'Expression Pédiatrique, and Assistance Publique Hôpitaux de Paris, U.F. de Génétique Moléculaire, Hôpital Armand Trousseau, Paris, France
| | - Catherine Boileau
- Département de Génétique, APHP Hôpital Bichat, Paris, France.,Université de Paris, Paris, France
| | - Bruno Crestani
- INSERM UMR 1152, Université de Paris, Paris, France.,APHP, Service de Pneumologie A, Centre de Référence des Maladies Pulmonaires Rares, FHU APOLLO, Hôpital Bichat, Paris, France
| | - Spyros Papiris
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
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14
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Vassilakopoulos T, Ferhanoglu B, Horowitz N, Mellios Z, Kaynar L, Zektser M, Symeonidis A, Piperidou A, Kalpadakis C, Akay OM, Atalar AC, Katodritou E, Leonidopoulou T, Papageorgiou S, Tadmor T, Gutwein O, Karakatsanis S, Ganzel C, Karianakis G, Isenberg G, Gainaru G, Vrakidou E, Palassopoulou M, Ozgur M, Siakantaris M, Paydas S, Tsirigotis P, Tsirogianni M, Hatzimichael E, Tuglular T, Chatzidimitriou C, Megalakaki E, Kanellias N, Zikos P, Koumarianou A, Gafter‐Gvili A, Angelopoulou M, Karmiris T, Gurion R. RITUXIMAB‐DOSE‐ADJUSTED EPOCH (R‐DA‐EPOCH) IN PRIMARY MEDIASTINAL LARGE B‐CELL LYMPHOMA (PMLBCL): REAL‐LIFE EXPERIENCE ON 190 PATIENTS FROM 3 MEDITERRANEAN COUNTRIES. Hematol Oncol 2021. [DOI: 10.1002/hon.76_2880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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15
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Toumpanakis D, Mizi E, Vassilakopoulou V, Dettoraki M, Chatzianastasiou A, Perlikos F, Giatra G, Moscholaki M, Theocharis S, Vassilakopoulos T. Spontaneous Breathing Through Increased Airway Resistance Augments Elastase-Induced Pulmonary Emphysema. Int J Chron Obstruct Pulmon Dis 2020; 15:1679-1688. [PMID: 32764913 PMCID: PMC7367735 DOI: 10.2147/copd.s256750] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/03/2020] [Accepted: 07/02/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Resistive breathing (RB), the pathophysiologic hallmark of chronic obstructive pulmonary disease (COPD), especially during exacerbations, is associated with significant inflammation and mechanical stress on the lung. Mechanical forces are implicated in the progression of emphysema that is a major pathologic feature of COPD. We hypothesized that resistive breathing exacerbates emphysema. Methods C57BL/6 mice were exposed to 0.75 units of pancreatic porcine elastase intratracheally to develop emphysema. Resistive breathing was applied by suturing a nylon band around the trachea to reduce surface area to half for the last 24 or 72 hours of a 21-day time period after elastase treatment in total. Following RB (24 or 72 hours), lung mechanics were measured and bronchoalveolar lavage (BAL) was performed. Emphysema was quantified by the mean linear intercept (Lm) and the destructive index (DI) in lung tissue sections. Results Following 21 days of intratracheal elastase exposure, Lm and DI increased in lung tissue sections [Lm (μm), control 39.09±0.76, elastase 62.05±2.19, p=0.003 and DI, ctr 30.95±2.75, elastase 73.12±1.75, p<0.001]. RB for 72 hours further increased Lm by 64% and DI by 19%, compared to elastase alone (p<0.001 and p=0.02, respectively). RB induced BAL neutrophilia in elastase-treated mice. Static compliance (Cst) increased in elastase-treated mice [Cst (mL/cmH2O), control 0.067±0.001, elastase 0.109±0.006, p<0.001], but superimposed RB decreased Cst, compared to elastase alone [Cst (mL/cmH2O), elastase+RB24h 0.090±0.004, p=0.006 to elastase, elastase+RB72h 0.090±0.005, p=0.006 to elastase]. Conclusion Resistive breathing augments pulmonary inflammation and emphysema in an elastase-induced emphysema mouse model.
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Affiliation(s)
- Dimitrios Toumpanakis
- "Marianthi Simou" Applied Biomedical Research and Training Center, Medical School, University of Athens, Evangelismos Hospital, Athens, Greece.,3rd Department of Critical Care Medicine, Evgenideio Hospital, Medical School, University of Athens, Athens, Greece
| | - Eleftheria Mizi
- "Marianthi Simou" Applied Biomedical Research and Training Center, Medical School, University of Athens, Evangelismos Hospital, Athens, Greece
| | - Vyronia Vassilakopoulou
- "Marianthi Simou" Applied Biomedical Research and Training Center, Medical School, University of Athens, Evangelismos Hospital, Athens, Greece
| | - Maria Dettoraki
- "Marianthi Simou" Applied Biomedical Research and Training Center, Medical School, University of Athens, Evangelismos Hospital, Athens, Greece
| | - Athanasia Chatzianastasiou
- "Marianthi Simou" Applied Biomedical Research and Training Center, Medical School, University of Athens, Evangelismos Hospital, Athens, Greece
| | - Fotis Perlikos
- "Marianthi Simou" Applied Biomedical Research and Training Center, Medical School, University of Athens, Evangelismos Hospital, Athens, Greece
| | - Georgia Giatra
- 3rd Department of Critical Care Medicine, Evgenideio Hospital, Medical School, University of Athens, Athens, Greece
| | - Marina Moscholaki
- "Marianthi Simou" Applied Biomedical Research and Training Center, Medical School, University of Athens, Evangelismos Hospital, Athens, Greece
| | | | - Theodoros Vassilakopoulos
- "Marianthi Simou" Applied Biomedical Research and Training Center, Medical School, University of Athens, Evangelismos Hospital, Athens, Greece.,3rd Department of Critical Care Medicine, Evgenideio Hospital, Medical School, University of Athens, Athens, Greece
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16
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Vassilakopoulos T, Toumpanakis D, Mancebo J. What's new about pulmonary hyperinflation in mechanically ventilated critical patients. Intensive Care Med 2020; 46:2381-2384. [PMID: 32472214 PMCID: PMC7256337 DOI: 10.1007/s00134-020-06105-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/20/2020] [Accepted: 05/11/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Theodoros Vassilakopoulos
- 3rd Department of Critical Care Medicine, Evgenideion Hospital, National & Kapodistrian University of Athens, Athens, Greece.
| | - Dimitrios Toumpanakis
- 3rd Department of Critical Care Medicine, Evgenideion Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Jordi Mancebo
- Intensive Care Medicine, Hospital de Sant Pau, Barcelona, Spain.
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17
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Moarbes V, Mayaki D, Huck L, Leblanc P, Vassilakopoulos T, Petrof BJ, Hussain SNA. Differential regulation of myofibrillar proteins in skeletal muscles of septic mice. Physiol Rep 2019; 7:e14248. [PMID: 31660704 PMCID: PMC6817996 DOI: 10.14814/phy2.14248] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/06/2019] [Accepted: 09/07/2019] [Indexed: 12/12/2022] Open
Abstract
Sepsis elicits skeletal muscle atrophy as a result of decreased total protein synthesis and/or increased total protein degradation. It is unknown how and whether sepsis differentially affects the expression of specific myofibrillar proteins in respiratory and limb muscles. In this study, we measured the effects of sepsis myofibrillar mRNAs and their corresponding protein levels in the diaphragm (DIA) and tibialis anterior (TA) muscles in a murine cecal ligation and perforation (CLP) model of sepsis. Male mice (C57/BL6j) underwent CLP-induced sepsis. Sham-operated mice were subjected to the same surgical procedures, except for CLP. Mice were euthanized 24, 48, or 96 h postsurgery. Transcript and protein levels of autophagy-related genes, ubiquitin E3 ligases, and several myofibrillar genes were quantified. Sepsis elicited transient fiber atrophy in the DIA and prolonged atrophy in the TA. Atrophy was coincident with increased autophagy and ubiquitin E3 ligase expression. Myosin heavy chain isoforms decreased at 24 h in the DIA and across the time-course in the TA, myosin light chain isoforms decreased across the time-course in both muscles, and troponins T and C as well as tropomyosin decreased after 24 and 48 h in both the DIA and TA. α-Actin and troponin I were unaffected by sepsis. Sepsis-induced decreases in myofibrillar protein levels coincided with decreased mRNA expressions of these proteins, suggesting that transcriptional inhibition is involved. We hypothesize that sepsis-induced muscle atrophy is mediated by decreased transcription and enhanced degradation of specific myofibrillar proteins, including myosin heavy and light chains, troponin C, troponin T, and tropomyosin.
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Affiliation(s)
- Vanessa Moarbes
- Meakins‐Christie Laboratories and Translational Research in Respiratory Diseases ProgramResearch Institute of the McGill University Health CentreMontréalQuébecCanada
- Department of Critical CareMcGill University Health CentreMontréalQuébecCanada
| | - Dominique Mayaki
- Meakins‐Christie Laboratories and Translational Research in Respiratory Diseases ProgramResearch Institute of the McGill University Health CentreMontréalQuébecCanada
- Department of Critical CareMcGill University Health CentreMontréalQuébecCanada
| | - Laurent Huck
- Meakins‐Christie Laboratories and Translational Research in Respiratory Diseases ProgramResearch Institute of the McGill University Health CentreMontréalQuébecCanada
- Department of Critical CareMcGill University Health CentreMontréalQuébecCanada
| | - Philippe Leblanc
- Meakins‐Christie Laboratories and Translational Research in Respiratory Diseases ProgramResearch Institute of the McGill University Health CentreMontréalQuébecCanada
- Department of Critical CareMcGill University Health CentreMontréalQuébecCanada
| | - Theodoros Vassilakopoulos
- Critical Care Department, National & Kapodistrian University of Athens, Medical School, Evgenideion HospitalAthensGreece
- Department of MedicineMcGill University Health CentreMontréalQuébecCanada
| | - Basil J. Petrof
- Meakins‐Christie Laboratories and Translational Research in Respiratory Diseases ProgramResearch Institute of the McGill University Health CentreMontréalQuébecCanada
- Department of Critical CareMcGill University Health CentreMontréalQuébecCanada
| | - Sabah N. A. Hussain
- Meakins‐Christie Laboratories and Translational Research in Respiratory Diseases ProgramResearch Institute of the McGill University Health CentreMontréalQuébecCanada
- Department of Critical CareMcGill University Health CentreMontréalQuébecCanada
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18
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Kalakonda N, Cavallo F, Follows G, Goy A, Vermaat JS, Casasnovas O, Lavee O, Maerevoet M, Zijlstra J, Bakhshi S, Bouabdallah R, Choquet S, Gurion R, Hill B, Jaeger U, Sancho JM, Schuster M, Thieblemont C, De la Cruz F, Egyed M, Mishra S, Offner F, Vassilakopoulos T, Warzocha K, McCarthy D, Ma X, Corona K, Saint-Martin JR, Joshi A, Shah J, Van Den Neste E, Canales M. A Phase 2b Study of Selinexor in Patients with Relapsed/Refractory (R/R) Diffuse Large B-Cell Lymphoma (DLBCL). Clinical Lymphoma Myeloma and Leukemia 2019. [DOI: 10.1016/j.clml.2019.07.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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19
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Kalakonda N, Cavallo F, Follows G, Goy A, Vermaat J, Casasnovas O, Lavee O, Maerevoet M, Zijlstra J, Bakshi S, Bouabdallah R, Choquet S, Gurion R, Hill B, Jaeger U, Sancho J, Schuster M, Thieblemont C, De la Cruz F, Egyed M, Mishra S, Offner F, Vassilakopoulos T, Warzocha K, Oluyadi A, McCarthy D, Ma X, Corona K, Shah J, Van Den Neste E, Canales M. A PHASE 2B STUDY OF SELINEXOR IN PATIENTS WITH RELAPSED/REFRACTORY (R/R) DIFFUSE LARGE B-CELL LYMPHOMA (DLBCL). Hematol Oncol 2019. [DOI: 10.1002/hon.31_2629] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- N. Kalakonda
- Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool United Kingdom
| | - F. Cavallo
- Molecular Biotechnology and Health Sciences; Aziena Ospedaliero - Universitaria Città della Salute e della Scienza di Torino; Turin Italy
| | - G. Follows
- Haematology; Cambridge University Hospitals NHS Foundation Trust Addenbrooke's Hospital; Cambridge United Kingdom
| | - A. Goy
- Oncology; Hackensack University Medical Center; Hackensack United States
| | - J. Vermaat
- Hematology; Leiden University Medical Center; Leiden Netherlands
| | | | - O. Lavee
- Hematology; St. Vincent's Hospital Sydney; Darlinghurst Australia
| | - M. Maerevoet
- Hematology; Service Hématologie, Institut Bordet; Bruxelles Belgium
| | - J. Zijlstra
- Hematology; Amsterdam UMC; Amsterdam Netherlands
| | - S. Bakshi
- Medical Oncology; Dr. B. R. A. Institute Rotary Cancer Hospital; New Delhi India
| | - R. Bouabdallah
- Oncology/Hematology; Institut Paoli-Calmettes; Marseille France
| | - S. Choquet
- Hematology; Hospital Pitie Salpetriere; Paris France
| | - R. Gurion
- Hematology; Rabin MC; Petah Tiqwa Israel
| | - B. Hill
- Hematology and Medical Oncology; Cleveland Clinic Main Campus; Cleveland United States
| | - U. Jaeger
- Medicine I; Medical University of Vienna; Vienna Austria
| | - J. Sancho
- Clinical Hematology; Hospital Germans Trias i Pujol; Barcelona Spain
| | - M. Schuster
- Medicine; Stony Brook University; Stony Brook United States
| | | | - F. De la Cruz
- Hematology; Hospital Universitario Virgen del Rocío; Sevilla Spain
| | - M. Egyed
- Hematology; Teaching Hospital Mór Kaposi; Kaposvár Hungary
| | - S. Mishra
- Medical Oncology; Institute of Medical Sciences & SUM Hospital; Bhubaneswar India
| | | | | | - K. Warzocha
- Hematology; Instytut Hematologii i Transfuzjologii; Warszawa Poland
| | - A. Oluyadi
- Clinical Development; Karyopharm Therapeutics Inc.; Newton United States
| | - D. McCarthy
- Clinical Operations; Karyopharm Therapeutics Inc.; Newton United States
| | - X. Ma
- Biostatistics; Karyopharm Therapeutics Inc.; Newton United States
| | - K. Corona
- Medical Affairs; Karyopharm Therapeutics Inc.; Newton United States
| | - J. Shah
- Clinical Development; Karyopharm Therapeutics Inc.; Newton United States
| | - E. Van Den Neste
- Hematology; Cliniques Universitaires Saint-Luc; Brussels Belgium
| | - M. Canales
- Medicine; Hospital Universitario La Paz; Madrid Spain
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20
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Giannakopoulou CE, Sotiriou A, Dettoraki M, Yang M, Perlikos F, Toumpanakis D, Prezerakos G, Koutsourelakis I, Kastis GA, Vassilakopoulou V, Mizi E, Papalois A, Greer JJ, Vassilakopoulos T. Regulation of breathing pattern by IL-10. Am J Physiol Regul Integr Comp Physiol 2019; 317:R190-R202. [PMID: 31091151 DOI: 10.1152/ajpregu.00065.2019] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Proinflammatory cytokines like interleukin-1β (IL-1β) affect the control of breathing. Our aim is to determine the effect of the anti-inflammatory cytokine IL-10 οn the control of breathing. IL-10 knockout mice (IL-10-/-, n = 10) and wild-type mice (IL-10+/+, n = 10) were exposed to the following test gases: hyperoxic hypercapnia 7% CO2-93% O2, normoxic hypercapnia 7% CO2-21% O2, hypoxic hypercapnia 7% CO2-10% O2, and hypoxic normocapnia 3% CO2-10% O2. The ventilatory function was assessed using whole body plethysmography. Recombinant mouse IL-10 (rIL-10; 10 μg/kg) was administered intraperitoneally to wild-type mice (n = 10) 30 min before the onset of gas challenge. IL-10 was administered in neonatal medullary slices (10-30 ng/ml, n = 8). We found that IL-10-/- mice exhibited consistently increased frequency and reduced tidal volume compared with IL-10+/+ mice during room air breathing and in all test gases (by 23.62 to 33.2%, P < 0.05 and -36.23 to -41.69%, P < 0.05, respectively). In all inspired gases, the minute ventilation of IL-10-/- mice was lower than IL-10+/+ (by -15.67 to -22.74%, P < 0.05). The rapid shallow breathing index was higher in IL-10-/- mice compared with IL-10+/+ mice in all inspired gases (by 50.25 to 57.5%, P < 0.05). The intraperitoneal injection of rIL-10 caused reduction of the respiratory rate and augmentation of the tidal volume in room air and also in all inspired gases (by -12.22 to -29.53 and 32.18 to 45.11%, P < 0.05, respectively). IL-10 administration in neonatal rat (n = 8) in vitro rhythmically active medullary slice preparations did not affect either rhythmicity or peak amplitude of hypoglossal nerve discharge. In conclusion, IL-10 may induce a slower and deeper pattern of breathing.
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Affiliation(s)
- Charoula Eleni Giannakopoulou
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
| | - Adamantia Sotiriou
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
| | - Maria Dettoraki
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
| | - Michael Yang
- Experimental Research Center, ELPEN Pharmaceuticals, Attica, Greece
| | - Fotis Perlikos
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
| | - Dimitrios Toumpanakis
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
| | - Georgios Prezerakos
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
| | - Ioannis Koutsourelakis
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
| | - Georgios A Kastis
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
| | - Vyronia Vassilakopoulou
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
| | - Eleftheria Mizi
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
| | | | - John J Greer
- Department of Physiology, Neuroscience and Mental Health Institute, Women and Children's Health Research Institute, Faculty of Medicine and Dentistry, University of Alberta , Edmonton, Alberta , Canada
| | - Theodoros Vassilakopoulos
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
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Kourlaba G, Hillas G, Vassilakopoulos T, Maniadakis N. The Economic Burden of Chronic Obstructive Pulmonary Disease in Greece. Appl Health Econ Health Policy 2019; 17:111-121. [PMID: 30328016 DOI: 10.1007/s40258-018-0431-5] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a leading cause of disability and death worldwide, imposing a substantial socioeconomic burden on societies and patients due to the long-term management required. OBJECTIVE To assess the economic burden of COPD in Greece and its potential determinants. METHODS A population-based, random-digit dialled, telephone nationwide survey was conducted to recruit patients with COPD in Greece (N = 351). A structured questionnaire was used to collect data. The total annual cost per patient from a societal perspective was calculated. RESULTS The mean (95% CI) annual total cost per patient for the management of COPD from a societal perspective was €2150 (€1879-€2443). The total annual cost was mainly driven by the medication cost (36.1%), followed by the cost of hospitalizations (26.7%) and long-term oxygen therapy (13.8%). Multiple generalized linear model revealed that age, COPD Assessment Test (CAT) score and exacerbations were independently associated with the total annual cost. CONCLUSION Investment in interventions aiming at delaying progression of disease, preventing acute exacerbations, and managing chronic symptoms are required to reduce the overall economic burden of COPD in Greece.
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Affiliation(s)
| | - Georgios Hillas
- Department of Critical Care of Evangelismos Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Vassilakopoulos
- Department of Critical Care of Evangelismos Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Nikos Maniadakis
- Department οf Health Services Organization and Management, National School οf Public Health, Athens, Greece
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22
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Panagouli E, Dinou A, Mallis P, Michalopoulos E, Papassavas A, Spyropoulou-Vlachou M, Meletis J, Angelopoulou M, Konstantopoulos K, Vassilakopoulos T, Stavropoulos-Giokas C. Non-Inherited Maternal Antigens Identify Acceptable HLA Mismatches: A New Policy for the Hellenic Cord Blood Bank. Bioengineering (Basel) 2018; 5:E77. [PMID: 30248919 PMCID: PMC6316301 DOI: 10.3390/bioengineering5040077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 08/10/2018] [Revised: 09/13/2018] [Accepted: 09/19/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND During pregnancy, the maternal-fetal contact may lead to the development of tolerance against the maternal human leukocyte antigen (HLA) that is not inherited by the fetus. These non-inherited maternal antigens (NIMAs) define acceptable HLA mismatches; therefore, the number of HLA phenotypes that are suitable matches for patients who need a hematopoietic stem cell transplant could be increased. Cord blood unit (CBU) transplantations to patients mismatched for a HLA loci, but similar to the ΝΙΜAs of the CBU, have a prognosis similar to 6/6-matched ones. METHODS The Hellenic Cord Blood Bank (HCBB) identified the maternal HLA of 380 cord blood donors, specifying the NIMA haplotypes of the related cryostored CBUs. RESULTS The HCBB extended the pool of HLA phenotypes through the generation of unique virtual phenotypes (VPs). A "VP database" was set up, using Microsoft Office-Access™, in order to provide NIMA-matched CBUs for potential recipients. The effectiveness of VPs' matching was tested in 80 Greek patients. CONCLUSION This methodology may contribute to the increase of the number of available CBUs for patients, in the case where there is no available CBU, or in case an additional one is needed. Through this method, the CBUs could be used faster and more effectively, rather than being cryostored for long periods of time.
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Affiliation(s)
- Effrosyni Panagouli
- Hellenic Cord Blood Bank, Biomedical Research Foundation Academy of Athens, 4 Soranou Ephessiou Street, 11527 Athens, Greece.
| | - Amalia Dinou
- Hellenic Cord Blood Bank, Biomedical Research Foundation Academy of Athens, 4 Soranou Ephessiou Street, 11527 Athens, Greece.
| | - Panagiotis Mallis
- Hellenic Cord Blood Bank, Biomedical Research Foundation Academy of Athens, 4 Soranou Ephessiou Street, 11527 Athens, Greece.
| | - Efstathios Michalopoulos
- Hellenic Cord Blood Bank, Biomedical Research Foundation Academy of Athens, 4 Soranou Ephessiou Street, 11527 Athens, Greece.
| | - Andreas Papassavas
- Hellenic Cord Blood Bank, Biomedical Research Foundation Academy of Athens, 4 Soranou Ephessiou Street, 11527 Athens, Greece.
| | | | - John Meletis
- Department of Hematology and Bone Marrow Transplantation, School of Medicine, National and Kapodistrian University of Athens, 17, Agiou Thoma Street, 11527 Athens, Greece.
| | - Maria Angelopoulou
- Department of Hematology and Bone Marrow Transplantation, School of Medicine, National and Kapodistrian University of Athens, 17, Agiou Thoma Street, 11527 Athens, Greece.
| | - Kostas Konstantopoulos
- Department of Hematology and Bone Marrow Transplantation, School of Medicine, National and Kapodistrian University of Athens, 17, Agiou Thoma Street, 11527 Athens, Greece.
| | - Theodoros Vassilakopoulos
- Department of Hematology and Bone Marrow Transplantation, School of Medicine, National and Kapodistrian University of Athens, 17, Agiou Thoma Street, 11527 Athens, Greece.
| | - Catherine Stavropoulos-Giokas
- Hellenic Cord Blood Bank, Biomedical Research Foundation Academy of Athens, 4 Soranou Ephessiou Street, 11527 Athens, Greece.
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23
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Tsirkinidis P, Terpos E, Boutsikas G, Papatheodorou A, Anargyrou K, Lalou E, Dimitrakopoulou A, Kalpadakis C, Konstantopoulos K, Siakantaris M, Panayiotidis P, Pangalis G, Kyrtsonis MC, Vassilakopoulos T, Angelopoulou MK. Bone metabolism markers and angiogenic cytokines as regulators of human hematopoietic stem cell mobilization. J Bone Miner Metab 2018; 36:399-409. [PMID: 28660376 DOI: 10.1007/s00774-017-0853-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 06/06/2017] [Indexed: 10/19/2022]
Abstract
Hematopoietic stem cell (HSC) mobilization involves cleavage of ligands between HSC and niche components. However, there are scarce data regarding the role of bone cells in human HSC mobilization. We studied biochemical markers of bone metabolism and angiogenic cytokines during HSC mobilization in 46 patients' sera with lymphoma and multiple myeloma, by ELISA. Significant changes between pre-mobilization and collection samples were found: (1) Bone alkaline phosphatase (BALP) increased, indicating augmentation of bone formation; (2) Receptor activator of Nf-κB ligand/osteoprotegerin ratio (RANKL/OPG) increased, showing osteoclastic differentiation and survival; however, there was no evidence of increased osteoclastic activity; and (3) Angiopoietin-1/Angiopoietin-2 ratio (ANGP-1/ANGP-2) decreased, consistent with vessel destabilization. Poor mobilizers had significantly higher carboxy-terminal telopeptide of collagen type I (CTX) and lower ANGP-1 at pre-mobilization samples, compared to good ones. CTX, amino-terminal telopeptide of collagen type I (NTX) and ANGP-1 pre-mobilization levels correlated significantly with circulating CD34+ peak cell counts. Our results indicate that bone formation and vessel destabilization are the two major events during human HSC mobilization. Osteoblasts seem to be the orchestrating cells, while osteoclasts are stimulated but not fully active. Moreover, ANGP-1, CTX and NTX may serve as predictors of poor mobilization.
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Affiliation(s)
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Boutsikas
- Department of Hematology, 251 General Air Force Hospital, Athens, Greece
| | | | | | - Eleni Lalou
- Department of Hematology and Bone Marrow Transplantation, School of Medicine, National and Kapodistrian University of Athens, 17, Agiou Thoma Street, 11527, Athens, Greece
| | - Aglaia Dimitrakopoulou
- Department of Immunology Research and Flow Cytometry, 'Laiko' General Hospital of Athens, Athens, Greece
| | - Christina Kalpadakis
- Department of Hematology, School of Medicine, University of Crete, Herakleion, Greece
| | - Konstantinos Konstantopoulos
- Department of Hematology and Bone Marrow Transplantation, School of Medicine, National and Kapodistrian University of Athens, 17, Agiou Thoma Street, 11527, Athens, Greece
| | - Marina Siakantaris
- 1st Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayiotis Panayiotidis
- 1st Propedeutic Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Gerassimos Pangalis
- Department of Hematology, Psychicon Branch, Athens Medical Center, Athens, Greece
| | - Marie-Christine Kyrtsonis
- 1st Propedeutic Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Vassilakopoulos
- Department of Hematology and Bone Marrow Transplantation, School of Medicine, National and Kapodistrian University of Athens, 17, Agiou Thoma Street, 11527, Athens, Greece
| | - Maria K Angelopoulou
- Department of Hematology and Bone Marrow Transplantation, School of Medicine, National and Kapodistrian University of Athens, 17, Agiou Thoma Street, 11527, Athens, Greece.
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Tsirigotis P, Vassilakopoulos T, Batsis I, Bousiou Z, Gkirkas K, Sakellari I, Kaloyannidis P, Roussou P, Pangalis GA, Moschogiannis M, Vassilopoulos G, Repousis P, Megalakaki A, Michalis E, Kalpadakis C, Papadaki HA, Kotsianidis I, Hatzimichael E, Spyridonidis A, Anargyrou K, Poulakidas E, Giannoullia P, Apostolidis I, Stamouli M, Konstantopoulos K, Pappa V, Panayiotidis P, Harhalakis N, Anagnostopoulos A, Angelopoulou M. Positive impact of brentuximab vedotin on overall survival of patients with classical Hodgkin lymphoma who relapse or progress after autologous stem cell transplantation: A nationwide analysis. Hematol Oncol 2018; 36:645-650. [PMID: 29882363 DOI: 10.1002/hon.2521] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 01/30/2018] [Revised: 04/09/2018] [Accepted: 04/10/2018] [Indexed: 11/12/2022]
Abstract
The outcome of patients with relapsed/refractory classical Hodgkin lymphoma (R/R cHL) after autologous stem cell transplantation (auto-SCT) is poor. Recently, the anti-CD30 monoclonal antibody-drug conjugate, brentuximab vedotin (BV), has shown remarkable activity in the setting of R/R cHL. In the pivotal phase II study, BV produced an overall response rate of 75% and a median progression-free survival of 6.7 months. Although these results have been reproduced by large registry studies, the impact of BV on the overall survival (OS) of patients with R/R cHL has not been addressed so far. The aim of this study was to examine the impact of BV on OS in the setting of post auto-SCT R/R cHL. Analysis was performed in a group of patients with R/R cHL after a previous auto-SCT reported in the Greek registry during the last 2 decades. By using a multivariate model and censoring patients at the time of subsequent allo-SCT or treatment with immune checkpoint inhibitors, we showed that treatment with BV in the posttransplant relapse setting has a positive impact on the outcome and results in significant improvement of OS. To our knowledge, this the first published study, addressing the impact of BV on the OS in the setting of posttransplant relapse.
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Affiliation(s)
- Panagiotis Tsirigotis
- Second Dept of Internal Medicine Propaedeutic, ATTIKO General University Hospital, Athens, Greece
| | | | - Ioannis Batsis
- Dept of Hematology and BMT, PAPANIKOLAOU Hospital, Thessaloniki, Greece
| | - Zoi Bousiou
- Dept of Hematology and BMT, PAPANIKOLAOU Hospital, Thessaloniki, Greece
| | - Konstantinos Gkirkas
- Second Dept of Internal Medicine Propaedeutic, ATTIKO General University Hospital, Athens, Greece
| | - Ioanna Sakellari
- Dept of Hematology and BMT, PAPANIKOLAOU Hospital, Thessaloniki, Greece
| | | | | | | | | | | | | | | | | | | | - Helen A Papadaki
- Dept of Hematology, University Hospital of Crete, Heraklion, Greece
| | | | | | | | | | - Elias Poulakidas
- Dept of Hematology, 401 Military Hospital of Athens, Athens, Greece
| | | | | | - Maria Stamouli
- Second Dept of Internal Medicine Propaedeutic, ATTIKO General University Hospital, Athens, Greece
| | | | - Vassiliki Pappa
- Second Dept of Internal Medicine Propaedeutic, ATTIKO General University Hospital, Athens, Greece
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Gourzoulidis G, Kourlaba G, Kakisis J, Matsagkas M, Giannakoulas G, Gourgoulianis KI, Vassilakopoulos T, Maniadakis N. Cost-Effectiveness Analysis of Rivaroxaban for Treatment of Deep Vein Thrombosis and Pulmonary Embolism in Greece. Clin Drug Investig 2018; 37:833-844. [PMID: 28608312 DOI: 10.1007/s40261-017-0540-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVE Venous thromboembolism (VTE), comprising deep-vein thrombosis (DVT) and pulmonary embolism (PE), is a major healthcare concern that results in substantial morbidity and mortality with great economic burden for healthcare systems. Hence, the need for effective and efficient treatment of patients with VTE is important for both clinical and economic reasons. The objective of this study was to evaluate the cost effectiveness of rivaroxaban compared to standard of care (SoC) with enoxaparin followed by dose-adjusted vitamin-K antagonists for the treatment of DVT and PE in Greece. METHODS An existing Markov model was locally adapted from a third-party payer perspective to reflect the management and complications of DVT and PE in the course of 3-month cycles, up to death. The clinical inputs and utility values were extracted from published studies. Direct medical costs, obtained from local resources, were incorporated in the model and refer to year 2017. Both costs and outcomes were discounted at 3.5%. The incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained was calculated. Probabilistic sensitivity analysis (PSA) was carried out to deal with uncertainty. RESULTS The base-case analysis showed that rivaroxaban in 3- and 6-month treatment duration for DVT and PE, respectively, as this is the common clinical practice in Greece, was associated with a 0.02 and 0.01 increment in QALYs compared to SoC, respectively. Rivaroxaban was associated with a reduced total cost in DVT (€85) but with an additional total cost in PE (€2) compared to SoC. Therefore, rivaroxaban was a dominant (less costly, more effective) and cost-effective (ICER: €177) alternative over SoC for the management of DVT and PE, respectively. PSA revealed that the probability of rivaroxaban being cost effective at a threshold of €34,000 per QALY gained was 99% and 81% for DVT and PE, respectively. CONCLUSION Rivaroxaban may represent a cost-effective option relative to SoC for the management of DVT and PE in Greece.
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Affiliation(s)
- George Gourzoulidis
- Department of Health Services Organization and Management, National School of Public Health, 196 Alexandras Avenue, 11521, Athens, Greece.
| | - Georgia Kourlaba
- The Stavros Niarchos Foundation-Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - John Kakisis
- Department of Vascular Surgery, Attikon Hospital, Athens University Medical School, Athens, Greece
| | - Mitiadis Matsagkas
- Department of Surgery - Vascular Surgery Unit, School of Medicine, University of Ioannina, Ioannina, Greece
| | - George Giannakoulas
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | | | - Theodoros Vassilakopoulos
- Department of Critical Care and Pulmonary Services, Evangelismos Hospital, University of Athens Medical School, Athens, Greece
| | - Nikos Maniadakis
- Department of Health Services Organization and Management, National School of Public Health, 196 Alexandras Avenue, 11521, Athens, Greece
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26
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Huertas A, Guignabert C, Barberà JA, Bärtsch P, Bhattacharya J, Bhattacharya S, Bonsignore MR, Dewachter L, Dinh-Xuan AT, Dorfmüller P, Gladwin MT, Humbert M, Kotsimbos T, Vassilakopoulos T, Sanchez O, Savale L, Testa U, Wilkins MR. Pulmonary vascular endothelium: the orchestra conductor in respiratory diseases. Eur Respir J 2018; 51:13993003.00745-2017. [DOI: 10.1183/13993003.00745-2017] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 02/03/2018] [Indexed: 12/15/2022]
Abstract
The European Respiratory Society (ERS) Research Seminar entitled “Pulmonary vascular endothelium: orchestra conductor in respiratory diseases - highlights from basic research to therapy” brought together international experts in dysfunctional pulmonary endothelium, from basic science to translational medicine, to discuss several important aspects in acute and chronic lung diseases. This review will briefly sum up the different topics of discussion from this meeting which was held in Paris, France on October 27–28, 2016. It is important to consider that this paper does not address all aspects of endothelial dysfunction but focuses on specific themes such as: 1) the complex role of the pulmonary endothelium in orchestrating the host response in both health and disease (acute lung injury, chronic obstructive pulmonary disease, high-altitude pulmonary oedema and pulmonary hypertension); and 2) the potential value of dysfunctional pulmonary endothelium as a target for innovative therapies.
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27
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Asimakos A, Toumpanakis D, Karatza MH, Vasileiou S, Katsaounou P, Mastora Z, Vassilakopoulos T. Immune cell response to strenuous resistive breathing: comparison with whole body exercise and the effects of antioxidants. Int J Chron Obstruct Pulmon Dis 2018; 13:529-545. [PMID: 29445271 PMCID: PMC5808692 DOI: 10.2147/copd.s154533] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Indexed: 01/25/2023] Open
Abstract
Background/hypothesis Whole body exercise (WBE) changes lymphocyte subset percentages in peripheral blood. Resistive breathing, a hallmark of diseases of airway obstruction, is a form of exercise for the inspiratory muscles. Strenuous muscle contractions induce oxidative stress that may mediate immune alterations following exercise. We hypothesized that inspiratory resistive breathing (IRB) alters peripheral blood lymphocyte subsets and that oxidative stress mediates lymphocyte subpopulation alterations following both WBE and IRB. Patients and methods Six healthy nonathletes performed two WBE and two IRB sessions for 45 minutes at 70% of VO2 maximum and 70% of maximum inspiratory pressure (Pimax), respectively, before and after the administration of antioxidants (vitamins E, A, and C for 75 days, allopurinol for 30 days, and N-acetylcysteine for 3 days). Blood was drawn at baseline, at the end of each session, and 2 hours into recovery. Lymphocyte subsets were determined by flow cytometry. Results Before antioxidant supplementation at both WBE end and IRB end, the natural killer cell percentage increased, the T helper cell (CD3+ CD4+) percentage was reduced, and the CD4/CD8 ratio was depressed, a response which was abolished by antioxidants only after IRB. Furthermore, at IRB end, antioxidants promoted CD8+ CD38+ and blunted cytotoxic T-cell percentage increase. CD8+ CD45RA+ cell percentage changes were blunted after antioxidant supplementation in both WBE and IRB. Conclusion We conclude that IRB produces (as WBE) changes in peripheral blood lymphocyte subsets and that oxidative stress is a major stimulus predominantly for IRB-induced lymphocyte subset alterations.
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Affiliation(s)
- Andreas Asimakos
- GP Livanos and M Simou Laboratories, Thorax Foundation.,Critical Care Department and Pulmonary Unit, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens
| | - Dimitrios Toumpanakis
- GP Livanos and M Simou Laboratories, Thorax Foundation.,Critical Care Department and Pulmonary Unit, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens
| | | | | | - Paraskevi Katsaounou
- GP Livanos and M Simou Laboratories, Thorax Foundation.,Critical Care Department and Pulmonary Unit, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens
| | - Zafeiria Mastora
- GP Livanos and M Simou Laboratories, Thorax Foundation.,Critical Care Department and Pulmonary Unit, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens
| | - Theodoros Vassilakopoulos
- GP Livanos and M Simou Laboratories, Thorax Foundation.,Critical Care Department and Pulmonary Unit, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens.,3rd Department of Critical Care Medicine, Evgenideion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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28
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Toumpanakis D, Vassilakopoulou V, Sigala I, Zacharatos P, Vraila I, Karavana V, Theocharis S, Vassilakopoulos T. The role of Src & ERK1/2 kinases in inspiratory resistive breathing induced acute lung injury and inflammation. Respir Res 2017; 18:209. [PMID: 29237457 PMCID: PMC5729404 DOI: 10.1186/s12931-017-0694-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 10/18/2017] [Accepted: 12/05/2017] [Indexed: 01/08/2023] Open
Abstract
Background Inspiratory resistive breathing (IRB), a hallmark of obstructive airway diseases, is associated with large negative intrathoracic pressures, due to strenuous contractions of the inspiratory muscles. IRB is shown to induce lung injury in previously healthy animals. Src is a multifunctional kinase that is activated in the lung by mechanical stress. ERK1/2 kinase is a downstream target of Src. We hypothesized that Src is activated in the lung during IRB, mediates ERK1/2 activation and IRB-induced lung injury. Methods Anaesthetized, tracheostomized adult rats breathed spontaneously through a 2-way non-rebreathing valve. Resistance was added to the inspiratory port to provide a peak tidal inspiratory pressure of 50% of maximum (inspiratory resistive breathing). Activation of Src and ERK1/2 in the lung was estimated during IRB. Following 6 h of IRB, respiratory system mechanics were measured by the forced oscillation technique and bronchoalveolar lavage (BAL) was performed to measure total and differential cell count and total protein levels. IL-1b and MIP-2a protein levels were measured in lung tissue samples. Wet lung weight to total body weight was measured and Evans blue dye extravasation was estimated to measure lung permeability. Lung injury was evaluated by histology. The Src inhibitor, PP-2 or the inhibitor of ERK1/2 activation, PD98059 was administrated 30 min prior to IRB. Results Src kinase was activated 30 min after the initiation of IRB. Src inhibition ameliorated the increase in BAL cellularity after 6 h IRB, but not the increase of IL-1β and MIP-2a in the lung. The increase in BAL total protein and lung injury score were not affected. The increase in tissue elasticity was partly inhibited. Src inhibition blocked ERK1/2 activation at 3 but not at 6 h of IRB. ERK1/2 inhibition ameliorated the increase in BAL cellularity after 6 h of IRB, blocked the increase of IL-1β and returned Evans blue extravasation and wet lung weight to control values. BAL total protein and the increase in elasticity were partially affected. ERK1/2 inhibition did not significantly change total lung injury score compared to 6 h IRB. Conclusions Src and ERK1/2 are activated in the lung following IRB and participate in IRB-induced lung injury.
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Affiliation(s)
- Dimitrios Toumpanakis
- 1st Department of Critical Care and Pulmonary Medicine and "Marianthi Simou" Applied Biomedical Research and Training Center, Medical School, University of Athens, 45-47 Ispilandou str, 10676, Athens, Greece
| | - Vyronia Vassilakopoulou
- 1st Department of Critical Care and Pulmonary Medicine and "Marianthi Simou" Applied Biomedical Research and Training Center, Medical School, University of Athens, 45-47 Ispilandou str, 10676, Athens, Greece
| | - Ioanna Sigala
- 1st Department of Critical Care and Pulmonary Medicine and "Marianthi Simou" Applied Biomedical Research and Training Center, Medical School, University of Athens, 45-47 Ispilandou str, 10676, Athens, Greece
| | - Panagiotis Zacharatos
- 1st Department of Critical Care and Pulmonary Medicine and "Marianthi Simou" Applied Biomedical Research and Training Center, Medical School, University of Athens, 45-47 Ispilandou str, 10676, Athens, Greece
| | - Ioanna Vraila
- 1st Department of Critical Care and Pulmonary Medicine and "Marianthi Simou" Applied Biomedical Research and Training Center, Medical School, University of Athens, 45-47 Ispilandou str, 10676, Athens, Greece
| | - Vassiliki Karavana
- 1st Department of Critical Care and Pulmonary Medicine and "Marianthi Simou" Applied Biomedical Research and Training Center, Medical School, University of Athens, 45-47 Ispilandou str, 10676, Athens, Greece
| | | | - Theodoros Vassilakopoulos
- 1st Department of Critical Care and Pulmonary Medicine and "Marianthi Simou" Applied Biomedical Research and Training Center, Medical School, University of Athens, 45-47 Ispilandou str, 10676, Athens, Greece.
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Affiliation(s)
- Theodoros Vassilakopoulos
- 1 Evangelismos Hospital National and Kapodistrian University of Athens Medical School Athens, Greece.,4 Department of Medicine McGill University Montreal, Quebec, Canada
| | - Basil J Petrof
- 2 Meakins-Christie Laboratories McGill University Montreal, Quebec, Canada and.,3 Translational Research in Respiratory Diseases Program McGill University Health Centre Montreal, Quebec, Canada
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Rossi A, Butorac-Petanjek B, Chilosi M, Cosío BG, Flezar M, Koulouris N, Marin J, Miculinic N, Polese G, Samaržija M, Skrgat S, Vassilakopoulos T, Vukić-Dugac A, Zakynthinos S, Miravitlles M. Chronic obstructive pulmonary disease with mild airflow limitation: current knowledge and proposal for future research - a consensus document from six scientific societies. Int J Chron Obstruct Pulmon Dis 2017; 12:2593-2610. [PMID: 28919728 PMCID: PMC5587130 DOI: 10.2147/copd.s132236] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [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] [Indexed: 12/19/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity worldwide, with high and growing prevalence. Its underdiagnosis and hence under-treatment is a general feature across all countries. This is particularly true for the mild or early stages of the disease, when symptoms do not yet interfere with daily living activities and both patients and doctors are likely to underestimate the presence of the disease. A diagnosis of COPD requires spirometry in subjects with a history of exposure to known risk factors and symptoms. Postbronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity <0.7 or less than the lower limit of normal confirms the presence of airflow limitation, the severity of which can be measured by FEV1% predicted: stage 1 defines COPD with mild airflow limitation, which means postbronchodilator FEV1 ≥80% predicted. In recent years, an elegant series of studies has shown that "exclusive reliance on spirometry, in patients with mild airflow limitation, may result in underestimation of clinically important physiologic impairment". In fact, exercise tolerance, diffusing capacity, and gas exchange can be impaired in subjects at a mild stage of airflow limitation. Furthermore, growing evidence indicates that smokers without overt abnormal spirometry have respiratory symptoms and undergo therapy. This is an essential issue in COPD. In fact, on one hand, airflow limitation, even mild, can unduly limit the patient's physical activity, with deleterious consequences on quality of life and even survival; on the other hand, particularly in younger subjects, mild airflow limitation might coincide with the early stage of the disease. Therefore, we thought that it was worthwhile to analyze further and discuss this stage of "mild COPD". To this end, representatives of scientific societies from five European countries have met and developed this document to stimulate the attention of the scientific community on COPD with "mild" airflow limitation. The aim of this document is to highlight some key features of this important concept and help the practicing physician to understand better what is behind "mild" COPD. Future research should address two major issues: first, whether mild airflow limitation represents an early stage of COPD and what the mechanisms underlying the evolution to more severe stages of the disease are; and second, not far removed from the first, whether regular treatment should be considered for COPD patients with mild airflow limitation, either to prevent progression of the disease or to encourage and improve physical activity or both.
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Affiliation(s)
- Andrea Rossi
- Pulmonary Unit, University of Verona, Verona, Italy
| | | | | | - Borja G Cosío
- Department of Respiratory Medicine, Hospital Son Espases-IdISPa and CIBERES, Palma, Spain
| | - Matjaz Flezar
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - Nikolaos Koulouris
- First Department of Respiratory Medicine, Medical School of National and Kapodistrian University of Athens, Greece
| | - José Marin
- Respiratory Medicine, Hospital Universitario Miguel Servet, CIBERES & IISAragon, Zaragoza, Spain
| | - Neven Miculinic
- Respiratory Department, University Hospital Centre, Zagreb, Croatia
| | | | - Miroslav Samaržija
- Jordanovac Department for Respiratory Diseases, University of Zagreb School of Medicine, University Hospital Centre, Zagreb, Croatia
| | - Sabina Skrgat
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - Theodoros Vassilakopoulos
- First Department of Critical Care and Pulmonary Services, Evangelismos Hospital, University of Athens, Greece
| | - Andrea Vukić-Dugac
- Jordanovac Department for Respiratory Diseases, University of Zagreb School of Medicine, University Hospital Centre, Zagreb, Croatia
| | - Spyridon Zakynthinos
- First Department of Critical Care and Pulmonary Services, Evangelismos Hospital, University of Athens, Greece
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitary Vall d'Hebron, Barcelona, Spain
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Toumpanakis D, Loverdos K, Tzouda V, Vassilakopoulou V, Litsiou E, Magkou C, Karavana V, Pieper M, Vassilakopoulos T. Tiotropium bromide exerts anti-inflammatory effects during resistive breathing, an experimental model of severe airway obstruction. Int J Chron Obstruct Pulmon Dis 2017; 12:2207-2220. [PMID: 28814849 PMCID: PMC5546183 DOI: 10.2147/copd.s137587] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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] [Indexed: 11/23/2022] Open
Abstract
Introduction Resistive breathing (RB), a hallmark of obstructive airway diseases, is characterized by strenuous contractions of the inspiratory muscles that impose increased mechanical stress on the lung. RB is shown to induce pulmonary inflammation in previous healthy animals. Tiotropium bromide, an anticholinergic bronchodilator, is also shown to exert anti-inflammatory effects. The effect of tiotropium on RB-induced pulmonary inflammation is unknown. Methods Adult rats were anesthetized, tracheostomized and breathed spontaneously through a two-way non-rebreathing valve. Resistances were connected to the inspiratory and/or expiratory port, to produce inspiratory resistive breathing (IRB) of 40% or 50% Pi/Pi,max (40% and 50% IRB), expiratory resistive breathing (ERB) of 60% Pe/Pe,max (60% ERB) or combined resistive breathing (CRB) of both 40% Pi/Pi,max and 60% Pe/Pe,max (40%/60% CRB). Tiotropium aerosol was inhaled prior to RB. After 6 h of RB, mechanical parameters of the respiratory system were measured and bronchoalveolar lavage (BAL) was performed. IL-1β and IL-6 protein levels were measured in lung tissue. Lung injury was estimated histologically. Results In all, 40% and 50% IRB increased macrophage and neutrophil counts in BAL and raised IL-1β and IL-6 lung levels, tissue elasticity, BAL total protein levels and lung injury score. Tiotropium attenuated BAL neutrophil number, IL-1β, IL-6 levels and lung injury score increase at both 40% and 50% IRB. The increase in macrophage count and protein in BAL was only reversed at 40% IRB, while tissue elasticity was not affected. In all, 60% ERB raised BAL neutrophil count and total protein and reduced macrophage count. IL-1β and IL-6 levels and lung injury score were increased. Tiotropium attenuated these alterations, except for the decrease in macrophage count and the increase in total protein level. In all, 40%/60% CRB increased macrophage and neutrophil count in BAL, IL-1β and IL-6 levels, tissue elasticity, total protein in BAL and histological injury score. Tiotropium attenuated the aforementioned alterations. Conclusion Tiotropium inhalation attenuates RB-induced pulmonary inflammation.
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Affiliation(s)
- Dimitrios Toumpanakis
- First Critical Care Department, Pulmonary Unit, National and Kapodistrian University of Athens Medical School, Evangelismos General Hospital.,George P. Livanos and Marianthi Simou Laboratories, Thorax Foundation
| | - Konstantinos Loverdos
- First Critical Care Department, Pulmonary Unit, National and Kapodistrian University of Athens Medical School, Evangelismos General Hospital.,George P. Livanos and Marianthi Simou Laboratories, Thorax Foundation
| | - Vassiliki Tzouda
- First Critical Care Department, Pulmonary Unit, National and Kapodistrian University of Athens Medical School, Evangelismos General Hospital.,George P. Livanos and Marianthi Simou Laboratories, Thorax Foundation
| | - Vyronia Vassilakopoulou
- First Critical Care Department, Pulmonary Unit, National and Kapodistrian University of Athens Medical School, Evangelismos General Hospital.,George P. Livanos and Marianthi Simou Laboratories, Thorax Foundation
| | - Eleni Litsiou
- First Critical Care Department, Pulmonary Unit, National and Kapodistrian University of Athens Medical School, Evangelismos General Hospital.,George P. Livanos and Marianthi Simou Laboratories, Thorax Foundation
| | - Christina Magkou
- Department of Pathology, Evangelismos General Hospital, Athens, Greece
| | - Vassiliki Karavana
- First Critical Care Department, Pulmonary Unit, National and Kapodistrian University of Athens Medical School, Evangelismos General Hospital.,George P. Livanos and Marianthi Simou Laboratories, Thorax Foundation
| | - Michael Pieper
- Boehringer Ingelheim Pharma GmbH & Co. KG Div. Research Germany, Biberach, Germany
| | - Theodoros Vassilakopoulos
- First Critical Care Department, Pulmonary Unit, National and Kapodistrian University of Athens Medical School, Evangelismos General Hospital.,George P. Livanos and Marianthi Simou Laboratories, Thorax Foundation
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Souliotis K, Kousoulakou H, Hillas G, Tzanakis N, Toumbis M, Vassilakopoulos T. The direct and indirect costs of managing chronic obstructive pulmonary disease in Greece. Int J Chron Obstruct Pulmon Dis 2017; 12:1395-1400. [PMID: 28546747 PMCID: PMC5436756 DOI: 10.2147/copd.s132825] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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] [Indexed: 02/04/2023] Open
Abstract
Objective COPD is associated with significant economic burden. The objective of this study was to explore the direct and indirect costs associated with COPD and identify the key cost drivers of disease management in Greece. Methods A Delphi panel of Greek pulmonologists was conducted, which aimed at eliciting local COPD treatment patterns and resource use. Resource use was translated into costs using official health insurance tariffs and Diagnosis-Related Groups (DRGs). In addition, absenteeism and caregiver’s costs were recorded in order to quantify indirect COPD costs. Results The total costs of managing COPD per patient per year were estimated at €4,730, with direct (medical and nonmedical) and indirect costs accounting for 62.5% and 37.5%, respectively. COPD exacerbations were responsible for 32% of total costs (€1,512). Key exacerbation-related cost drivers were hospitalization (€830) and intensive care unit (ICU) admission costs (€454), jointly accounting for 85% of total exacerbation costs. Annual maintenance phase costs were estimated at €835, with pharmaceutical treatment accounting for 77% (€639.9). Patient time costs were estimated at €146 per year. The average number of sick days per year was estimated at 16.9, resulting in productivity losses of €968. Caregiver’s costs were estimated at €806 per year. Conclusion The management of COPD in Greece is associated with intensive resource use and significant economic burden. Exacerbations and productivity losses are the key cost drivers. Cost containment policies should focus on prioritizing treatments that increase patient compliance as these can lead to reduction of exacerbations, longer maintenance phases, and thus lower costs.
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Affiliation(s)
- Kyriakos Souliotis
- Department of Social and Educational Policy, University of Peloponnese, Corinth
| | - Hara Kousoulakou
- Department of Social and Educational Policy, University of Peloponnese, Corinth
| | - Georgios Hillas
- Department of Pulmonary and Critical Care Medicine, Evangelismos Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens
| | - Nikos Tzanakis
- Department of Thoracic Medicine, Medical School, University General Hospital of Heraklion, Heraklion, Crete
| | - Michalis Toumbis
- Sixth Pulmonary Department, "Sotiria" Hospital for Thoracic Diseases, Athens, Greece
| | - Theodoros Vassilakopoulos
- Department of Pulmonary and Critical Care Medicine, Evangelismos Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens
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Diamantopoulos PT, Samara S, Kollia P, Giannakopoulou N, Sofotasiou M, Kalala F, Kodandreopoulou E, Zervakis P, Vassilakopoulos T, Siakantaris M, Mantzourani M, Angelopoulou M, Kyrtshonis MC, Korkolopoulou P, Patsouris E, Viniou NA. Tumor Protein 53 Gene Mutations Without 17p13 Deletion Have No Significant Clinical Implications in Chronic Lymphocytic Leukemia. Detection of a New Mutation. Anticancer Res 2017; 37:2387-2391. [PMID: 28476805 DOI: 10.21873/anticanres.11577] [Citation(s) in RCA: 2] [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: 02/28/2017] [Revised: 03/19/2017] [Accepted: 03/21/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND The tumor protein p53 (TP53) gene may be inactivated through 17p13 deletion, somatic mutations, or both. In chronic lymphocytic leukemia (CLL) although 17p13 deletion is correlated with poor prognosis, the role of sole TP53 mutations remains controversial. MATERIALS AND METHODS We carried out a mutation analysis of TP53 gene in 72 patients with CLL. RESULTS Seventy-one (98.6%) patients carried the polymorphic site c.215C>G, p.Pro72Arg, but its presence was not correlated with overall survival (OS). Moreover, 19 (26.4%) patients carried a mutation of TP53. Among the eight detected mutations, to our knowledge, one (c.587G>A) has never been reported in the past. There was a correlation of the mutation burden with the stage of the disease (p=0.022), but not with OS. None of the detected mutations was individually correlated with OS. CONCLUSION The clinical significance of TP53 mutations is still a matter of debate and larger studies and meta-analyses are required to reach an unequivocal conclusion.
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Affiliation(s)
- Panagiotis T Diamantopoulos
- First Department of Internal Medicine, Hematology Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Stavroula Samara
- Department of Genetics & Biotechnology, Faculty of Biology, School of Physical Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagoula Kollia
- Department of Genetics & Biotechnology, Faculty of Biology, School of Physical Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Nefeli Giannakopoulou
- First Department of Internal Medicine, Hematology Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Maria Sofotasiou
- First Department of Internal Medicine, Hematology Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Fani Kalala
- First Department of Internal Medicine, Hematology Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Elina Kodandreopoulou
- First Department of Internal Medicine, Hematology Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Panagiotis Zervakis
- First Department of Internal Medicine, Hematology Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Theodoros Vassilakopoulos
- First Department of Internal Medicine, Hematology Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Marina Siakantaris
- First Department of Internal Medicine, Hematology Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Marina Mantzourani
- First Department of Internal Medicine, Hematology Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Maria Angelopoulou
- First Department of Internal Medicine, Hematology Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Marie-Christine Kyrtshonis
- First Department of Internal Medicine, Hematology Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | - Efstathios Patsouris
- Department of Pathology, National and Kapodistrian University of Athens, Athens, Greece
| | - Nora-Athina Viniou
- First Department of Internal Medicine, Hematology Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Souliotis K, Kousoulakou H, Hillas G, Bakakos P, Toumbis M, Loukides S, Vassilakopoulos T. Direct and Indirect Costs of Asthma Management in Greece: An Expert Panel Approach. Front Public Health 2017; 5:67. [PMID: 28424767 PMCID: PMC5380663 DOI: 10.3389/fpubh.2017.00067] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 02/04/2017] [Accepted: 03/20/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Asthma is a major cause of morbidity and mortality and is associated with significant economic burden worldwide. The objectives of this study were to map current resource use associated with the disease management and to estimate the annual direct and indirect costs per adult patient with asthma. METHODS A Delphi panel with seven leading pulmonologists was conducted. A semistructured questionnaire was developed to elicit data on resource use and treatment patterns. Unit costs from official, published sources were subsequently assigned to resource use to estimate direct medical costs. Indirect costs were estimated as number of work loss days. Cost base year was 2015, and the perspective adopted was that of the National Organization of Health Care Services Provision, as well as the societal. RESULTS Patients with asthma are mainly managed by pulmonologists (71.4%) and secondarily by general practitioners and internists (28.6%). The annual cost of managing exacerbations was estimated at €273.1, while maintenance costs were estimated at €1,100.2 per year. Total costs of managing asthma per patient per year were estimated at €2,281.8, 64.4% of which represented direct medical costs. Of the direct costs, pharmaceutical treatment was the key driver, accounting for 63.9 and 41.2% of direct and total costs, respectively. Direct non-medical costs (patient travel and waiting time) were estimated at €152.3. Indirect costs accounted for 28.9% of total costs. CONCLUSION Asthma is a chronic condition, the management of which constrains the already limited Greek health care resources. The increasing prevalence of the disease raises concerns as it could translate per patient costs into a significant burden for the Greek health care system. Thus, the prevention, self-management, and improved quality of care for asthma should find a place in the health policy agenda in Greece.
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Affiliation(s)
- Kyriakos Souliotis
- Department of Social and Educational Policy, University of Peloponnese, Corinth, Greece
| | - Hara Kousoulakou
- Department of Social and Educational Policy, University of Peloponnese, Corinth, Greece
| | - Georgios Hillas
- Department of Pulmonary and Critical Care Medicine, Medical School, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros Bakakos
- 1st Respiratory Medicine Department, “Sotiria” Hospital for Thoracic Diseases, University of Athens Medical School, Athens, Greece
| | - Michalis Toumbis
- 6th Pulmonary Department, “Sotiria” Hospital for Thoracic Diseases, Athens, Greece
| | - Stelios Loukides
- 2nd Respiratory Medicine Department, “Attikon” Hospital, University of Athens Medical School, Athens, Greece
| | - Theodoros Vassilakopoulos
- Department of Pulmonary and Critical Care Medicine, Medical School, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Diamantopoulos P, Zervakis K, Zervakis P, Sofotasiou M, Vassilakopoulos T, Kotsianidis I, Symeonidis A, Pappa V, Galanopoulos A, Solomou E, Kodandreopoulou E, Papadopoulou V, Korkolopoulou P, Mantzourani M, Kyriakakis G, Viniou NA. Poly (ADP-ribose) polymerase 1 mRNA levels strongly correlate with the prognosis of myelodysplastic syndromes. Blood Cancer J 2017; 7:e533. [PMID: 28212373 PMCID: PMC5533939 DOI: 10.1038/bcj.2016.127] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 12/06/2016] [Indexed: 12/20/2022] Open
Abstract
Poly (ADP-ribose) polymerase 1 (PARP-1) has a central role in the repair of DNA breaks and is a promising treatment target in malignancy. We measured PARP1 mRNA levels by a SYBR-green-based PCR in the bone marrow of 74 patients with myelodysplastic syndrome (MDS) and correlated them to their demographic, hematologic and prognostic characteristics. The median PARP1 mRNA levels were correlated to the type of MDS (2008/2016 WHO classification, P=0.005) and to the IPSS score (P=0.002). A correlation was also found with the IPSS-R score (P=0.011) and the cytogenetic risk (P=0.008). In all cases, higher PARP1 levels were correlated with a higher risk category. Moreover, we found a significant survival disadvantage for patients with high PARP1 levels (median survival of 37.4 months versus ‘not reached’ for low PARP1 levels, P=0.0001, and a 5-year survival rate of 29.8 versus 88.9%, respectively). PARP1 mRNA levels were found to be the stronger predictor of survival in multivariate analysis. These correlations have never been reported in the past and may render PARP1 a prognostic factor to be incorporated in the current prognostic systems for MDS, also laying the basis for clinical trials evaluating PARP1 inhibitors in higher-risk MDS.
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Affiliation(s)
- P Diamantopoulos
- Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - K Zervakis
- Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - P Zervakis
- Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - M Sofotasiou
- Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - T Vassilakopoulos
- Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - I Kotsianidis
- Department of Hematology, University Hospital of Alexandroupolis, Alexandroupoli , Greece
| | - A Symeonidis
- Department of Internal Medicine, University Hospital of Patras, Rio, Greece
| | - V Pappa
- Haematology Division, Second Department of Internal Medicine, Attikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - A Galanopoulos
- Department of Clinical Hematology, 'G. Gennimatas' District General Hospital, Athens, Greece
| | - E Solomou
- Department of Internal Medicine, University Hospital of Patras, Rio, Greece
| | - E Kodandreopoulou
- Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - V Papadopoulou
- Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - P Korkolopoulou
- Department of Pathology, National and Kapodistrian University of Athens, Athens, Greece
| | - M Mantzourani
- Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - G Kyriakakis
- Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - N-A Viniou
- Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Affiliation(s)
- Ioanna Sigala
- GP Livanos & M Simou Laboratories, Thorax Foundation, Department of Critical Care, Pulmonary Unit, Evangelismos Hospital, National & Kapodistrian University of Athens Medical School, Athens, Greece
| | - Theodoros Vassilakopoulos
- GP Livanos & M Simou Laboratories, Thorax Foundation, Department of Critical Care, Pulmonary Unit, Evangelismos Hospital, National & Kapodistrian University of Athens Medical School, Athens, Greece; ; Department of Medicine, McGill University, Montreal, Quebec, Canada
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Perlikos F, Koutsourelakis I, Detoraki M, Sotiriou A, Giannakopoulou HE, Papalois A, Vassilakopoulos T. Respiratory Rate Response to Hypercapnic and Hypoxic Stimuli in Mice via the Carotid Body Is Attenuated by IL6-Induced by Resistive Breathing but not by TNFa. Chest 2016. [DOI: 10.1016/j.chest.2016.08.940] [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: 12/01/2022] Open
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Abstract
In obstructive lung diseases, airway inflammation leads to bronchospasm and thus resistive breathing, especially during exacerbations. This commentary discusses experimental evidence that resistive breathing per se (the mechanical stimulus) in the absence of underlying airway inflammation leads to lung injury and inflammation (mechanotransduction). The potential implications of resistive breathing-induced mechanotrasduction in COPD exacerbations are presented along with the available clinical evidence.
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Affiliation(s)
- Theodoros Vassilakopoulos
- Pulmonary and Critical Care Medicine, Medical School, National and Kapodistrian University of Athens, Greece
| | - Dimitrios Toumpanakis
- Pulmonary and Critical Care Medicine, Medical School, National and Kapodistrian University of Athens, Greece
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Abstract
Background The objective of the study was to estimate the self-reported prevalence of chronic obstructive pulmonary disease (COPD) in Greece and to quantify its burden on patients’ daily activities, productivity, and psychological status. Methods A population-based, random digit-dialed telephone nationwide survey was conducted between July 10, 2015 and July 31, 2015 in order to recruit patients with COPD in Greece. Among the 11,471 persons contacted, 3,414 met the inclusion criterion of age ≥40 years and completed the screening questions regarding COPD. Of the 362 subjects who reported that they had been diagnosed with COPD, 351 completed the survey. Data on demographic and lifestyle characteristics, comorbidities, disease history, perceived disease severity, breathlessness severity, symptoms severity, limitations in daily activities, psychological distress, and productivity were collected. All data were collected through the telephone interview method using a structured questionnaire. Results The overall self-reported COPD prevalence was 10.6%. Among 351 participants, only 9% reported that they suffered from severe breathlessness. The mean COPD assessment test score was 19.0, with 84% of participants having a COPD assessment test score ≥10. As for the perceived severity of COPD, the majority of subjects considered that their respiratory condition was of moderate (34.2%) or mild severity (33.9%). Overall, the participants reported a significant impact of COPD on their daily life. For instance, 61.5% of them reported that their respiratory condition has affected their sports activities. Moreover, 73% of subjects considered that the health care system could do more for them than it actually does. Almost one-fourth of the participants reported that they had missed work during the past 12 months due to their respiratory symptoms, with the mean number of days lost being 10. Conclusion This survey provides insightful data regarding the impact of COPD on Greek patients’ everyday life, psychology, and productivity, revealing the increased individual morbidity and the significant burden of this condition on society.
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Affiliation(s)
| | - Georgios Hillas
- Department of Critical Care of Evangelismos Hospital, Medical School of National & Kapodistrian University of Athens
| | - Theodoros Vassilakopoulos
- Department of Critical Care of Evangelismos Hospital, Medical School of National & Kapodistrian University of Athens
| | - Nikos Maniadakis
- Department of Health Services Organization and Management, National School of Public Health, Athens, Greece
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Loverdos K, Toumpanakis D, Litsiou E, Karavana V, Glynos C, Magkou C, Theocharis S, Vassilakopoulos T. The differential effects of inspiratory, expiratory, and combined resistive breathing on healthy lung. Int J Chron Obstruct Pulmon Dis 2016; 11:1623-38. [PMID: 27499619 PMCID: PMC4959591 DOI: 10.2147/copd.s106337] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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] [Indexed: 01/19/2023] Open
Abstract
Combined resistive breathing (CRB) is the hallmark of obstructive airway disease pathophysiology. We have previously shown that severe inspiratory resistive breathing (IRB) induces acute lung injury in healthy rats. The role of expiratory resistance is unknown. The possibility of a load-dependent type of resistive breathing-induced lung injury also remains elusive. Our aim was to investigate the differential effects of IRB, expiratory resistive breathing (ERB), and CRB on healthy rat lung and establish the lowest loads required to induce injury. Anesthetized tracheostomized rats breathed through a two-way valve. Varying resistances were connected to the inspiratory, expiratory, or both ports, so that the peak inspiratory pressure (IRB) was 20%-40% or peak expiratory (ERB) was 40%-70% of maximum. CRB was assessed in inspiratory/expiratory pressures of 30%/50%, 40%/50%, and 40%/60% of maximum. Quietly breathing animals served as controls. At 6 hours, respiratory system mechanics were measured, and bronchoalveolar lavage was performed for measurement of cell and protein concentration. Lung tissue interleukin-6 and interleukin-1β levels were estimated, and a lung injury histological score was determined. ERB produced significant, load-independent neutrophilia, without mechanical or permeability derangements. IRB 30% was the lowest inspiratory load that provoked lung injury. CRB increased tissue elasticity, bronchoalveolar lavage total cell, macrophage and neutrophil counts, protein and cytokine levels, and lung injury score in a dose-dependent manner. In conclusion, CRB load dependently deranges mechanics, increases permeability, and induces inflammation in healthy rats. ERB is a putative inflammatory stimulus for the lung.
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Affiliation(s)
- Konstantinos Loverdos
- Department of Critical Care, Pulmonary Unit and Marianthi Simou Applied Biomedical Research and Training Center, Evangelismos General Hospital, University of Athens Medical School
| | - Dimitrios Toumpanakis
- Department of Critical Care, Pulmonary Unit and Marianthi Simou Applied Biomedical Research and Training Center, Evangelismos General Hospital, University of Athens Medical School
| | - Eleni Litsiou
- Department of Critical Care, Pulmonary Unit and Marianthi Simou Applied Biomedical Research and Training Center, Evangelismos General Hospital, University of Athens Medical School
| | - Vassiliki Karavana
- Department of Critical Care, Pulmonary Unit and Marianthi Simou Applied Biomedical Research and Training Center, Evangelismos General Hospital, University of Athens Medical School
| | - Constantinos Glynos
- Department of Critical Care, Pulmonary Unit and Marianthi Simou Applied Biomedical Research and Training Center, Evangelismos General Hospital, University of Athens Medical School
| | | | - Stamatios Theocharis
- 1st Department of Pathology, University of Athens Medical School, Athens, Greece
| | - Theodoros Vassilakopoulos
- Department of Critical Care, Pulmonary Unit and Marianthi Simou Applied Biomedical Research and Training Center, Evangelismos General Hospital, University of Athens Medical School
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Diamantopoulos PT, Sofotasiou M, Georgoussi Z, Giannakopoulou N, Papadopoulou V, Galanopoulos A, Kontandreopoulou E, Zervakis P, Pallaki P, Kalala F, Kyrtsonis MC, Dimitrakopoulou A, Vassilakopoulos T, Angelopoulou M, Spanakis N, Viniou NA. Prognostic significance of signal transducer and activator of transcription 5 and 5b expression in Epstein-Barr virus-positive patients with chronic lymphocytic leukemia. Cancer Med 2016; 5:2240-8. [PMID: 27367207 PMCID: PMC5055175 DOI: 10.1002/cam4.804] [Citation(s) in RCA: 6] [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: 03/31/2016] [Revised: 04/24/2016] [Accepted: 05/20/2016] [Indexed: 01/16/2023] Open
Abstract
Signal transducer and activator of transcription (STAT) proteins have been intensively studied in hematologic malignancies, and the efficacy of agents against STATs in lymphomas is already under research. We investigated the expression of total STAT5 and STAT5b in peripheral blood samples of patients with chronic lymphocytic leukemia (CLL) in correlation with the presence of Epstein-Barr Virus (EBV) and its major oncoprotein (latent membrane protein 1, LMP1). The EBV load was measured in the peripheral blood by real-time PCR for the BXLF1 gene and the levels of LMP1 by PCR and ELISA. Western blotting was performed for total STAT5 and STAT5b in protein extracts. STAT5b was only expressed in patients (not in healthy subjects) and STAT5 but particularly STAT5b expression was correlated with the presence of the virus (77.3% vs. 51.2%, P = 0.006 for STAT5b) and to the expression of LMP1 (58.3% vs. 21.6%, P = 0.011 for STAT5b). Moreover, the expression of STAT5b and the presence of EBV and LMP1 were strongly negatively correlated with the overall survival of the patients (log-rank test P = 0.011, 0.015, 0.006, respectively). Double positive (for EBV and STAT5b) patients had the lowest overall survival (log-rank test P = 0.013). This is the first report of a survival disadvantage of EBV+ patients with CLL, and the first time that STAT5b expression is correlated with survival. The correlation of STAT5 expression with the presence of the virus, along with our survival correlations defines a subgroup of patients with CLL that may benefit from anti-STAT agents.
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Affiliation(s)
- Panagiotis T Diamantopoulos
- First Department of Internal Medicine, Hematology Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.
| | - Maria Sofotasiou
- First Department of Internal Medicine, Hematology Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Zafiroula Georgoussi
- Laboratory of Cellular Signaling and Molecular Pharmacology, Institute of Biosciences and Applications, National Centre for Scientific Research "Demokritos", Athens, Greece
| | - Nefeli Giannakopoulou
- First Department of Internal Medicine, Hematology Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Vasiliki Papadopoulou
- First Department of Internal Medicine, Hematology Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | - Elina Kontandreopoulou
- First Department of Internal Medicine, Hematology Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Panagiotis Zervakis
- First Department of Internal Medicine, Hematology Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Paschalina Pallaki
- Laboratory of Cellular Signaling and Molecular Pharmacology, Institute of Biosciences and Applications, National Centre for Scientific Research "Demokritos", Athens, Greece
| | - Fani Kalala
- First Department of Internal Medicine, Hematology Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Marie-Christine Kyrtsonis
- First Department of Internal Medicine, Hematology Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Aglaia Dimitrakopoulou
- Department of Immunology and Histocompatibility, Laikon General Hospital, Athens, Greece
| | - Theodoros Vassilakopoulos
- First Department of Internal Medicine, Hematology Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Maria Angelopoulou
- First Department of Internal Medicine, Hematology Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Nikolaos Spanakis
- First Department of Internal Medicine, Hematology Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Nora-Athina Viniou
- First Department of Internal Medicine, Hematology Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Hillas G, Perlikos F, Toumpanakis D, Litsiou E, Nikolakopoulou S, Sagris K, Vassilakopoulos T. Controlled Mechanical Ventilation Attenuates the Systemic Inflammation of Severe Chronic Obstructive Pulmonary Disease Exacerbations. Am J Respir Crit Care Med 2016; 193:696-8. [DOI: 10.1164/rccm.201508-1700le] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lakiotaki E, Levidou G, Angelopoulou MK, Adamopoulos C, Pangalis G, Rassidakis G, Vassilakopoulos T, Gainaru G, Flevari P, Sachanas S, Saetta AA, Sepsa A, Moschogiannis M, Kalpadakis C, Tsesmetzis N, Milionis V, Chatziandreou I, Thymara I, Panayiotidis P, Dimopoulou M, Plata E, Konstantopoulos K, Patsouris E, Piperi C, Korkolopoulou P. Potential role of AKT/mTOR signalling proteins in hairy cell leukaemia: association with BRAF/ERK activation and clinical outcome. Sci Rep 2016; 6:21252. [PMID: 26893254 PMCID: PMC4759548 DOI: 10.1038/srep21252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 09/27/2015] [Accepted: 01/20/2016] [Indexed: 01/04/2023] Open
Abstract
The potential role of AKT/mTOR signalling proteins and its association with the Raf-MEK-ERK pathway was investigated in hairy cell leukaemia (HCL). BRAFV600E expression and activated forms of AKT, mTOR, ERK1/2, p70S6k and 4E-BP1 were immunohistochemically assessed in 77 BM biopsies of HCL patients and correlated with clinicopathological and BM microvascular characteristics, as well as with c-Caspase-3 levels in hairy cells. Additionally, we tested rapamycin treatment response of BONNA-12 wild-type cells or transfected with BRAFV600E. Most HCL cases expressed p-p70S6K and p-4E-BP1 but not p-mTOR, being accompanied by p-ERK1/2 and p-AKT. AKT/mTOR activation was evident in BONNA-12 cells irrespective of the presence of BRAFV600E mutation and was implicated in cell proliferation enhancement. In multivariate analysis p-AKT/p-mTOR/p-4E-BP1 overexpression was an adverse prognostic factor for time to next treatment conferring earlier relapse. When p-AKT, p-mTOR and p-4E-BP1 were examined separately only p-4E-BP1 remained significant. Our findings indicate that in HCL, critical proteins up- and downstream of mTOR are activated. Moreover, the strong associations with Raf-MEK-ERK signalling imply a possible biologic interaction between these pathways. Most importantly, expression of p-4E-BP1 alone or combined with p-AKT and p-mTOR is of prognostic value in patients with HCL.
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Affiliation(s)
| | - Georgia Levidou
- Department of Pathology, University of Athens, Medical School, Greece
| | - Maria K Angelopoulou
- Department of Haematology and Bone Marrow Transplantation, University of Athens, Medical School, Greece
| | - Christos Adamopoulos
- Department of Biological Chemistry, University of Athens, Medical School, Greece
| | | | - George Rassidakis
- Department of Pathology, University of Athens, Medical School, Greece.,Department of Oncology-Pathology, Cancer Centrum Karolinska, Karolinska Institutet, Stockholm, Sweden
| | - Theodoros Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, University of Athens, Medical School, Greece
| | - Gabriella Gainaru
- Department of Haematology and Bone Marrow Transplantation, University of Athens, Medical School, Greece
| | - Pagona Flevari
- Department of Haematology and Bone Marrow Transplantation, University of Athens, Medical School, Greece
| | - Sotirios Sachanas
- Department of Haematology, Athens Medical Centre, Psychikon Branch, Greece
| | - Angelica A Saetta
- Department of Pathology, University of Athens, Medical School, Greece
| | - Athanasia Sepsa
- Department of Pathology, University of Athens, Medical School, Greece
| | | | | | - Nikolaos Tsesmetzis
- Department of Oncology-Pathology, Cancer Centrum Karolinska, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Irene Thymara
- Department of Pathology, University of Athens, Medical School, Greece
| | - Panayiotis Panayiotidis
- 1st Department of Propaedeutic Internal Medicine, University of Athens, Medical School, Greece
| | - Maria Dimopoulou
- Department of Haematology and Bone Marrow Transplantation, University of Athens, Medical School, Greece
| | - Eleni Plata
- Department of Haematology and Bone Marrow Transplantation, University of Athens, Medical School, Greece
| | | | | | - Christina Piperi
- Department of Biological Chemistry, University of Athens, Medical School, Greece
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Toumpanakis D, Zacharatos P, Michailidou T, Tsoukalas G, Vassilakopoulos T. S65 The role of Src kinase in inspiratory resistive breathing-induced pulmonary inflammation. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.71] [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: 11/03/2022]
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Vassilakopoulos T. Ultrasonographic Monitoring of the Diaphragm during Mechanical Ventilation: The Vital Pump Is Vivid, Plastic, and Vulnerable. Am J Respir Crit Care Med 2015; 192:1030-2. [DOI: 10.1164/rccm.201507-1466ed] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Michalinos A, Vassilakopoulos T, Levidou G, Korkolopoulou P, Kontos M. Multifocal Bilateral Breast Cancer and Breast Follicular Lymphoma: A Simple Coincidence? J Breast Cancer 2015; 18:296-300. [PMID: 26472982 PMCID: PMC4600696 DOI: 10.4048/jbc.2015.18.3.296] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 03/10/2015] [Accepted: 07/05/2015] [Indexed: 11/30/2022] Open
Abstract
Breast cancer coexisting with lymphoma is a rare condition with various diagnostic and therapeutic implications. In this report, we describe the case of a 55-year-old Caucasian woman who presented with simultaneous ductal carcinoma in situ of the right breast, and follicular lymphoma involving an inguinal lymph node and the left breast. The patient underwent local excision and radiotherapy for the ductal carcinoma in situ, while a watch and wait strategy was adopted for the lymphoma. Two years later, the patient presented with multifocal ductal carcinoma of the left breast and reappearance of the lymphoma in the left axillary lymph nodes. She underwent bilateral mastectomy, left sentinel node biopsy, and chemotherapy. Synchronous follicular lymphoma and bilateral metachronous breast carcinoma has not been described previously. Diagnosis is based on tissue histology after excision or a needle biopsy. Treatment for these two diseases is distinct, and a multidisciplinary approach should be adopted.
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Affiliation(s)
| | | | - Georgia Levidou
- First Department of Pathology, University of Athens, Athens, Greece
| | | | - Michalis Kontos
- First Department of Surgery, Laiko Hospital, University of Athens, Athens, Greece
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Glynos C, Toumpanakis D, Loverdos K, Karavana V, Zhou Z, Magkou C, Dettoraki M, Perlikos F, Pavlidou A, Kotsikoris V, Topouzis S, Theocharis SE, Brouckaert P, Giannis A, Papapetropoulos A, Vassilakopoulos T. Guanylyl cyclase activation reverses resistive breathing-induced lung injury and inflammation. Am J Respir Cell Mol Biol 2015; 52:762-71. [PMID: 25353067 DOI: 10.1165/rcmb.2014-0092oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Inspiratory resistive breathing (RB), encountered in obstructive lung diseases, induces lung injury. The soluble guanylyl cyclase (sGC)/cyclic guanosine monophosphate (cGMP) pathway is down-regulated in chronic and acute animal models of RB, such as asthma, chronic obstructive pulmonary disease, and in endotoxin-induced acute lung injury. Our objectives were to: (1) characterize the effects of increased concurrent inspiratory and expiratory resistance in mice via tracheal banding; and (2) investigate the contribution of the sGC/cGMP pathway in RB-induced lung injury. Anesthetized C57BL/6 mice underwent RB achieved by restricting tracheal surface area to 50% (tracheal banding). RB for 24 hours resulted in increased bronchoalveolar lavage fluid cellularity and protein content, marked leukocyte infiltration in the lungs, and perturbed respiratory mechanics (increased tissue resistance and elasticity, shifted static pressure-volume curve right and downwards, decreased static compliance), consistent with the presence of acute lung injury. RB down-regulated sGC expression in the lung. All manifestations of lung injury caused by RB were exacerbated by the administration of the sGC inhibitor, 1H-[1,2,4]oxodiazolo[4,3-]quinoxalin-l-one, or when RB was performed using sGCα1 knockout mice. Conversely, restoration of sGC signaling by prior administration of the sGC activator BAY 58-2667 (Bayer, Leverkusen, Germany) prevented RB-induced lung injury. Strikingly, direct pharmacological activation of sGC with BAY 58-2667 24 hours after RB reversed, within 6 hours, the established lung injury. These findings raise the possibility that pharmacological targeting of the sGC-cGMP axis could be used to ameliorate lung dysfunction in obstructive lung diseases.
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Affiliation(s)
- Constantinos Glynos
- 1 George P. Livanos and Marianthi Simou Laboratories, Evangelismos Hospital, First Department of Pulmonary and Critical Care, and
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Chatziantoniou V, Alexia S, Konstantopoulos K, Repousis P, Megalakaki A, Kotsopoulou M, Kylidou P, Vassilakopoulos T, Angelopoulou MK. Significance of the detection of paroxysmal nocturnal hemoglobinuria clones in patients with multiple myeloma undergoing autologous stem cell transplantation. Hematol Oncol Stem Cell Ther 2015; 8:150-9. [PMID: 26183672 DOI: 10.1016/j.hemonc.2015.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 06/19/2015] [Accepted: 06/22/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE/BACKGROUND There are reports about the presence of paroxysmal nocturnal hemoglobinuria (PNH) clones in multiple myeloma (MM), but these have been demonstrated only in red blood cells (RBCs) and the previous reports utilized an obsolete diagnostic method. We carried out a study to identify the clones by flow cytometry (FC) and to understand their clinical significance. METHODS A prospective study on consecutive patients with newly diagnosed MM who were candidates for autologous stem cell transplantation (ASCT) from 2008 to 2012. We screened peripheral blood samples by FC for CD55- and/or CD59-deficient RBC, neutrophils, and monocytes. PNH testing was carried out at diagnosis, before ASCT and 3 months after ASCT, as well as sporadically during MM remission and at disease relapse. RESULTS A total of 31 patients were included in the study. PNH clones reaching a median size of 10.8% (range 4.0-18.7%) were found in 10 patients (32.3%). Clones were detected at diagnosis in nine patients and 3 months after ASCT in one patient. A correlation between the presence of the clones and subclinical hemolysis was observed. Nevertheless, the presence of the clones did not influence the overall management and prognosis of the patients. CONCLUSION We confirmed findings of previous reports with current diagnostic guidelines and showed that although the size of the clones may be relatively large, their presence is probably not detrimental. The clinical significance of these clones and the possible mechanisms underlying their expansion in MM must be a subject of further investigation.
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Affiliation(s)
| | - Stavroula Alexia
- Hematology and Flow Cytometry Laboratory, Metaxa Anticancer Hospital, Piraeus, Greece
| | | | | | | | - Maria Kotsopoulou
- Department of Hematology, Metaxa Anticancer Hospital, Piraeus, Greece
| | - Pavlina Kylidou
- Hematology and Flow Cytometry Laboratory, Metaxa Anticancer Hospital, Piraeus, Greece
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