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Georgopoulou GA, Papasotiriou M, Bosgana P, de Lastic AL, Koufou EE, Papachristou E, Goumenos DS, Davlouros P, Kourea E, Zolota V, Thomopoulos K, Mouzaki A, Assimakopoulos SF. Altered Expression of Intestinal Tight Junctions in Patients with Chronic Kidney Disease: A Pathogenetic Mechanism of Intestinal Hyperpermeability. Biomedicines 2024; 12:368. [PMID: 38397970 PMCID: PMC10887073 DOI: 10.3390/biomedicines12020368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Systemic inflammation in chronic kidney disease (CKD) is associated (as a cause or effect) with intestinal barrier dysfunction and increased gut permeability, with mechanisms not yet fully understood. This study investigated different parameters of the intestinal barrier in CKD patients, especially tight junction (TJ) proteins and their possible association with systemic endotoxemia and inflammation. METHODS Thirty-three patients with stage I-IV CKD (n = 17) or end-stage kidney disease (ESKD) (n = 16) and 11 healthy controls underwent duodenal biopsy. Samples were examined histologically, the presence of CD3+ T-lymphocytes and the expression of occludin and claudin-1 in the intestinal epithelium was evaluated by means of immunohistochemistry, circulating endotoxin concentrations were determined by means of ELISA and the concentrations of the cytokines IL-1β, IL-6, IL-8, IL-10 and TNF-α in serum were measured using flow cytometry. RESULTS Patients with stage I-IV CKD or ESKD had significantly higher serum endotoxin, IL-6, IL-8 and IL-10 levels compared to controls. Intestinal occludin and claudin-1 were significantly decreased, and their expression was inversely correlated with systemic endotoxemia. Regarding occludin, a specific expression pattern was observed, with a gradually increasing loss of its expression from the crypt to the tip of the villi. CONCLUSION The expression of occludin and claudin-1 in enterocytes is significantly reduced in patients with CKD, contributing to systemic endotoxemia and inflammatory responses in these patients.
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Affiliation(s)
- Georgia-Andriana Georgopoulou
- Division of Nephrology, Department of Internal Medicine, Medical School, University of Patras, 26504 Patras, Greece; (G.-A.G.); (M.P.); (E.P.); (D.S.G.)
| | - Marios Papasotiriou
- Division of Nephrology, Department of Internal Medicine, Medical School, University of Patras, 26504 Patras, Greece; (G.-A.G.); (M.P.); (E.P.); (D.S.G.)
| | - Pinelopi Bosgana
- Department of Pathology, Medical School, University of Patras, 26504 Patras, Greece; (P.B.); (E.K.); (V.Z.)
| | - Anne-Lise de Lastic
- Laboratory of Immunohematology, Division of Hematology, Department of Internal Medicine, Medical School, University of Patras, 26504 Patras, Greece; (A.-L.d.L.); (A.M.)
| | - Eleni-Evangelia Koufou
- Division of Cardiology, Department of Internal Medicine, Medical School, University of Patras, 26504 Patras, Greece; (E.-E.K.); (P.D.)
| | - Evangelos Papachristou
- Division of Nephrology, Department of Internal Medicine, Medical School, University of Patras, 26504 Patras, Greece; (G.-A.G.); (M.P.); (E.P.); (D.S.G.)
| | - Dimitrios S. Goumenos
- Division of Nephrology, Department of Internal Medicine, Medical School, University of Patras, 26504 Patras, Greece; (G.-A.G.); (M.P.); (E.P.); (D.S.G.)
| | - Periklis Davlouros
- Division of Cardiology, Department of Internal Medicine, Medical School, University of Patras, 26504 Patras, Greece; (E.-E.K.); (P.D.)
| | - Eleni Kourea
- Department of Pathology, Medical School, University of Patras, 26504 Patras, Greece; (P.B.); (E.K.); (V.Z.)
| | - Vasiliki Zolota
- Department of Pathology, Medical School, University of Patras, 26504 Patras, Greece; (P.B.); (E.K.); (V.Z.)
| | - Konstantinos Thomopoulos
- Division of Gastroenterology, Department of Internal Medicine, Medical School, University of Patras, 26504 Patras, Greece;
| | - Athanasia Mouzaki
- Laboratory of Immunohematology, Division of Hematology, Department of Internal Medicine, Medical School, University of Patras, 26504 Patras, Greece; (A.-L.d.L.); (A.M.)
| | - Stelios F. Assimakopoulos
- Division of Infectious Diseases, Department of Internal Medicine, Medical School, University of Patras, 26504 Patras, Greece
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2
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Koufou EE, Assimakopoulos SF, Bosgana P, de Lastic AL, Grypari IM, Georgopoulou GA, Antonopoulou S, Mouzaki A, Kourea HP, Thomopoulos K, Davlouros P. Altered Expression of Intestinal Tight Junction Proteins in Heart Failure Patients with Reduced or Preserved Ejection Fraction: A Pathogenetic Mechanism of Intestinal Hyperpermeability. Biomedicines 2024; 12:160. [PMID: 38255265 PMCID: PMC10813326 DOI: 10.3390/biomedicines12010160] [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: 12/19/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Although intestinal microbiota alterations (dysbiosis) have been described in heart failure (HF) patients, the possible mechanisms of intestinal barrier dysfunction leading to endotoxemia and systemic inflammation are not fully understood. In this study, we investigated the expression of the intestinal tight junction (TJ) proteins occludin and claudin-1 in patients with HF with reduced (HFrEF) or preserved ejection fraction (HFpEF) and their possible association with systemic endotoxemia and inflammation. Ten healthy controls and twenty-eight patients with HF (HFrEF (n = 14), HFpEF (n = 14)) underwent duodenal biopsy. Histological parameters were recorded, intraepithelial CD3+ T-cells and the expression of occludin and claudin-1 in enterocytes were examined using immunohistochemistry, circulating endotoxin concentrations were determined using ELISA, and concentrations of cytokines were determined using flow cytometry. Patients with HFrEF or HFpEF had significantly higher serum endotoxin concentrations (p < 0.001), a significantly decreased intestinal occludin and claudin-1 expression (in HfrEF p < 0.01 for occludin, p < 0.05 for claudin-1, in HfpEF p < 0.01 occludin and claudin-1), and significantly increased serum concentrations of IL-6, IL-8, and IL-10 (for IL-6 and IL-10, p < 0.05 for HFrEF and p < 0.001 for HFpEF; and for IL-8, p < 0.05 for both groups) compared to controls. Occludin and claudin-1 expression inversely correlated with systemic endotoxemia (p < 0.05 and p < 0.01, respectively). Heart failure, regardless of the type of ejection fraction, results in a significant decrease in enterocytic occludin and claudin-1 expression, which may represent an important cellular mechanism for the intestinal barrier dysfunction causing systemic endotoxemia and inflammatory response.
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Affiliation(s)
| | - Stelios F. Assimakopoulos
- Department of Internal Medicine and Division of Infectious Diseases, University of Patras Medical School, 26504 Patras, Greece;
| | - Pinelopi Bosgana
- Department of Pathology, Medical School of Patras, 26504 Patras, Greece; (P.B.); (H.P.K.)
| | - Anne-Lise de Lastic
- Laboratory of Immunohematology, Division of Hematology, Department of Internal Medicine, Medical School, University of Patras, 26504 Patras, Greece; (A.-L.d.L.); (A.M.)
| | - Ioanna-Maria Grypari
- Cytology Department, Aretaieion University Hospital, National Kapodistrian University of Athens, 11528 Athens, Greece;
| | | | | | - Athanasia Mouzaki
- Laboratory of Immunohematology, Division of Hematology, Department of Internal Medicine, Medical School, University of Patras, 26504 Patras, Greece; (A.-L.d.L.); (A.M.)
| | - Helen P. Kourea
- Department of Pathology, Medical School of Patras, 26504 Patras, Greece; (P.B.); (H.P.K.)
| | - Konstantinos Thomopoulos
- Division of Gastroenterology, Department of Internal Medicine, Medical School, University of Patras, University Hospital of Patras, 26504 Patras, Greece;
| | - Periklis Davlouros
- Department of Cardiology, Patras University Hospital, 26504 Patras, Greece;
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3
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Leventopoulos G, Koros R, Travlos C, Perperis A, Chronopoulos P, Tsoni E, Koufou EE, Papageorgiou A, Apostolos A, Kaouris P, Davlouros P, Tsigkas G. Mechanisms of Atrial Fibrillation: How Our Knowledge Affects Clinical Practice. Life (Basel) 2023; 13:1260. [PMID: 37374043 DOI: 10.3390/life13061260] [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: 04/15/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
Atrial fibrillation (AF) is a very common arrhythmia that mainly affects older individuals. The mechanism of atrial fibrillation is complex and is related to the pathogenesis of trigger activation and the perpetuation of arrhythmia. The pulmonary veins in the left atrium arei confirm that onfirm the most common triggers due to their distinct anatomical and electrophysiological properties. As a result, their electrical isolation by ablation is the cornerstone of invasive AF treatment. Multiple factors and comorbidities affect the atrial tissue and lead to myocardial stretch. Several neurohormonal and structural changes occur, leading to inflammation and oxidative stress and, consequently, a fibrotic substrate created by myofibroblasts, which encourages AF perpetuation. Several mechanisms are implemented into daily clinical practice in both interventions in and the medical treatment of atrial fibrillation.
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Affiliation(s)
| | - Rafail Koros
- Cardiology Department, University Hospital of Patras, 26504 Patras, Greece
| | | | - Angelos Perperis
- Cardiology Department, University Hospital of Patras, 26504 Patras, Greece
| | | | - Evropi Tsoni
- Cardiology Department, University Hospital of Patras, 26504 Patras, Greece
| | | | | | | | - Panagiotis Kaouris
- Cardiology Department, University Hospital of Patras, 26504 Patras, Greece
| | - Periklis Davlouros
- Cardiology Department, University Hospital of Patras, 26504 Patras, Greece
| | - Grigorios Tsigkas
- Cardiology Department, University Hospital of Patras, 26504 Patras, Greece
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Tsigkas G, Vakka A, Apostolos A, Bousoula E, Vythoulkas-Biotis N, Koufou EE, Vasilagkos G, Tsiafoutis I, Hamilos M, Aminian A, Davlouros P. Dual Antiplatelet Therapy and Cancer; Balancing between Ischemic and Bleeding Risk: A Narrative Review. J Cardiovasc Dev Dis 2023; 10:jcdd10040135. [PMID: 37103014 PMCID: PMC10144375 DOI: 10.3390/jcdd10040135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/15/2023] [Accepted: 03/19/2023] [Indexed: 04/28/2023] Open
Abstract
Cardiovascular (CV) events in patients with cancer can be caused by concomitant CV risk factors, cancer itself, and anticancer therapy. Since malignancy can dysregulate the hemostatic system, predisposing cancer patients to both thrombosis and hemorrhage, the administration of dual antiplatelet therapy (DAPT) to patients with cancer who suffer from acute coronary syndrome (ACS) or undergo percutaneous coronary intervention (PCI) is a clinical challenge to cardiologists. Apart from PCI and ACS, other structural interventions, such as TAVR, PFO-ASD closure, and LAA occlusion, and non-cardiac diseases, such as PAD and CVAs, may require DAPT. The aim of the present review is to review the current literature on the optimal antiplatelet therapy and duration of DAPT for oncologic patients, in order to reduce both the ischemic and bleeding risk in this high-risk population.
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Affiliation(s)
- Grigorios Tsigkas
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
| | - Angeliki Vakka
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
| | - Anastasios Apostolos
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
- First Department of Cardiology, Hippocration General Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Eleni Bousoula
- Department of Cardiology, Tzaneio General Hospital, 185 36 Piraeus, Greece
| | | | | | - Georgios Vasilagkos
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
| | - Ioannis Tsiafoutis
- First Department of Cardiology, Red Cross Hospital, 115 26 Athens, Greece
| | - Michalis Hamilos
- Department of Cardiology, Heraklion University Hospital, 715 00 Heraklion, Crete, Greece
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, 6042 Charleroi, Belgium
| | - Periklis Davlouros
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
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Tsigkas G, Koufou EE, Katsanos K, Patrinos P, Moulias A, Miliordos I, Almpanis G, Christodoulou I, Papanikolaou F, Dimitroula T, Kivetos A, Vardas P, Davlouros P. Potential Relationship Between Lifestyle Changes and Incidence of Hospital Admissions for Acute Coronary Syndrome During the COVID-19 Lockdown. Front Cardiovasc Med 2021; 8:604374. [PMID: 33644128 PMCID: PMC7904890 DOI: 10.3389/fcvm.2021.604374] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 09/17/2020] [Accepted: 01/25/2021] [Indexed: 12/30/2022] Open
Abstract
Aims: To evaluate the impact of lockdown during the COVID-19 pandemic on lifestyle changes of the general population, and on admissions for acute coronary syndrome (ACS). Methods and Results: All ACS admissions during the COVID-19 lockdown (10 March to 4 May, 2020), in 3 municipalities (3 spoke, and 1 hub hospital), in Southwestern Greece (411,576 inhabitants), were prospectively recorded and compared to the equivalent periods during 2018, and 2019. A telephone survey of 1014 participants was conducted to explore the lifestyle habits of citizens aged ≥35-years-old before and during lockdown. The median ACS incidence rate decreased from 19.0 cases per week in 2018 and 21.5 in 2019 down to 13.0 in 2020 (RR: 0.66 during the Covid-19 lockdown; 95%CI: 0.53–0.82; P = 0.0002). This was driven by a significant reduction of admissions for Non-ST elevation myocardial infarction (NSTEMI) (RR: 0.68; 95%CI: 0.52–0.88; P = 0.0037), mainly in patients with a lower burden of cardiovascular risk factors, as we noticed an inverse association between the reduction of the incidence of ACS during the Covid-19 lockdown period and the number of registered patient risk factors. There was no difference in the rates of STEMI and population-based all-cause mortality across the examined time periods. The telephone survey demonstrated reduction of passive smoking, working hours, alcohol, junk food and salt consumption, and an increase in sleeping hours, mainly in participants with a lower burden of cardiovascular risk factors. Conclusions: A significant decline in ACS admissions during the COVID-19 lockdown was noted, affecting mainly NSTEMI patients with a lower burden of cardiovascular risk factors. This was accompanied by significant lifestyle changes. Thus, it is tempting to speculate that to some extend the latter might be associated with the observed decline in ACS admissions.
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Affiliation(s)
- Grigorios Tsigkas
- Department of Cardiology, Patras University Hospital, Patras, Greece
| | | | | | | | | | - Ioannis Miliordos
- Department of Cardiology, Patras University Hospital, Patras, Greece
| | - Georgios Almpanis
- Department of Cardiology, General Hospital of Agrinio, Agrinio, Greece
| | | | | | | | - Andreas Kivetos
- Department of Cardiology, General Hospital of Pyrgos, Pyrgos, Greece
| | - Panagiotis Vardas
- Department of Cardiology, University Hospital of Heraklion, Heraklion, Greece
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Tsigkas G, Apostolos A, Synetos A, Latsios G, Toutouzas K, Xenogiannis I, Hamilos M, Sianos G, Ziakas A, Tsiafoutis I, Koutouzis M, Toulgaridis F, Moulias A, Sideris A, Patsilinakos S, Kanakakis I, Zampakis P, Tsioufis K, Kochiadakis G, Alexopoulos D, Davlouros P, Kalogeropoulou C, Vasilagkos G, Koufou EE, Papanikolaou A, Spanou E, Gerakaris A, Chlorogiannis D, Spiropoulou P, Miliordos I, Benetos G, Pappas C, Argentos S, Skalidis E, Kladou E, Skiadas C, Karagiannidis E, Mylona S, Zacharoulis A, Pappas L, Mantis C, Fagrezos D, Manouvelou S, Sertedaki E. Computed tomoGRaphy guidEd invasivE Coronary angiography in patiEnts with a previous coronary artery bypass graft surgery trial (GREECE trial): Rationale and design of a multicenter, randomized control trial. Hellenic J Cardiol 2021; 62:470-472. [PMID: 33482363 DOI: 10.1016/j.hjc.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/12/2020] [Accepted: 01/05/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Grigorios Tsigkas
- Department of Cardiology, University Hospital of Patras, Patras, Greece.
| | | | - Andreas Synetos
- First Department of Cardiology, University of Athens, Hippokration General Hospital, Athens, Greece
| | - George Latsios
- First Department of Cardiology, University of Athens, Hippokration General Hospital, Athens, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, University of Athens, Hippokration General Hospital, Athens, Greece
| | - Iosif Xenogiannis
- Second Department of Cardiology, University of Athens, Attikon University Hospital, Athens, Greece
| | - Michalis Hamilos
- Department of Cardiology, University Hospital of Heraklion, Heraklion, Greece
| | - Georgios Sianos
- First Department of Cardiology, Aristotle University of Thessaloniki, AHEPA University Hospital, Greece
| | - Antonios Ziakas
- First Department of Cardiology, Aristotle University of Thessaloniki, AHEPA University Hospital, Greece
| | | | | | - Fotios Toulgaridis
- Second Department of Cardiology, Evaggelismos General Hospital, Athens, Greece
| | | | - Antonios Sideris
- Second Department of Cardiology, Evaggelismos General Hospital, Athens, Greece
| | | | - Ioannis Kanakakis
- Department of Clinical Therapeutics, University of Athens, Alexandra General Hospital, Athens, Greece
| | - Petros Zampakis
- Department of Radiology, University Hospital of Patras, Patras, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, University of Athens, Hippokration General Hospital, Athens, Greece
| | | | - Dimitrios Alexopoulos
- Second Department of Cardiology, University of Athens, Attikon University Hospital, Athens, Greece
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Koufou EE, Arfaras-Melainis A, Rawal S, Kalogeropoulos AP. Treatment of Heart Failure with Mid-Range Ejection Fraction: What Is the Evidence. J Clin Med 2021; 10:jcm10020203. [PMID: 33429888 PMCID: PMC7827304 DOI: 10.3390/jcm10020203] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/01/2021] [Accepted: 01/04/2021] [Indexed: 12/12/2022] Open
Abstract
In this review, we briefly outline our current knowledge on the epidemiology, outcomes, and pathophysiology of heart failure (HF) with mid-range ejection fraction (HFmrEF), and discuss in more depth the evidence on current treatment options for this group of patients. In most studies, the clinical background of patients with HFmrEF is intermediate between that of patients with HF and reduced ejection fraction (HFrEF) and patients with HF and preserved ejection fraction (HFpEF) in terms of demographics and comorbid conditions. However, the current evidence, stemming from observational studies and post hoc analyses of randomized controlled trials, suggests that patients with HFmrEF benefit from medications that target the neurohormonal axes, a pathophysiological behavior that resembles that of HFrEF. Use of β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists, and sacubitril/valsartan is reasonable in patients with HFmrEF, whereas evidence is currently scarce for other therapies. In clinical practice, patients with HFmrEF are treated more like HFrEF patients, potentially because of history of systolic dysfunction that has partially recovered. Assessment of left ventricular systolic function with contemporary noninvasive modalities, e.g., echocardiographic strain imaging, is promising for the selection of patients with HFmrEF who will benefit from neurohormonal antagonists and other HFrEF-targeted therapies.
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Affiliation(s)
| | - Angelos Arfaras-Melainis
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY 10461, USA;
| | - Sahil Rawal
- Department of Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY 11794, USA;
| | - Andreas P. Kalogeropoulos
- Division of Cardiology, Department of Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY 11794, USA
- Correspondence: ; Tel.: +1-631-638-0081
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