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Stergianou D, Micha S, Tzanetakou V, Kanni T, Gkavogianni T, Katoulis A, Giamarellos-Bourboulis EJ. Immune Classification of Hidradenitis Suppurativa: Modulation by Secukinumab. J Invest Dermatol 2023; 143:2518-2520.e3. [PMID: 37211202 DOI: 10.1016/j.jid.2023.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/19/2023] [Accepted: 04/29/2023] [Indexed: 05/23/2023]
Affiliation(s)
- Dimitra Stergianou
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Styliani Micha
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassiliki Tzanetakou
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodora Kanni
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theologia Gkavogianni
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Katoulis
- 2nd Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Renieris G, Foutadakis S, Andriopoulou T, Spanou VM, Droggiti DE, Kafousopoulos D, Gkavogianni T, Damoraki G, Vatsellas G, Giamarellos-Bourboulis EJ. Association of Vitamin D with Severity and Outcome of COVID-19: Clinical and Experimental Evidence. J Innate Immun 2023; 16:1-11. [PMID: 38008066 PMCID: PMC10764091 DOI: 10.1159/000535302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 11/13/2023] [Indexed: 11/28/2023] Open
Abstract
INTRODUCTION The role of vitamin in COVID-19 remains controversial. We investigated the association between endogenous vitamin D and the severity of COVID-19 as well as the mechanisms of action of vitamin D supplementation. METHODS 25(OH)D3 in serum was associated with disease severity and outcome in 190 COVID-19 patients. In a COVID-19 animal model using intravenous injection of plasma from patients with COVID-19 acute respiratory distress syndrome into C57/BL6 mice, mice were treated with 0.25 μg human 1,25(OH)D3 or vehicle. Mice were sacrificed on day 4. Cytokines and myeloperoxidase (MPO) in tissues were measured. Changes in gene expression after vitamin D supplementation were measured. RESULTS Vitamin D deficiency and insufficiency were associated with increased severity and unfavorable outcome after 28 days. Vitamin D levels were negatively associated with biomarkers of COVID-19 severity. Vitamin D supplementation after challenge of mice with COVID-19 plasma led to reduced levels of TNFα, IL-6, IFNγ, and MPO in the lung, as well as down-regulation of pro-inflammatory pathways. CONCLUSION Normal levels of endogenous vitamin D are associated with reduced severity and risk of unfavorable outcome in COVID-19, possibly through attenuation of tissue-specific hyperinflammation.
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Affiliation(s)
- Georgios Renieris
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyros Foutadakis
- Greek Genome Center, Biomedical Research Foundation (BRFAA) of the Academy of Athens, Athens, Greece
| | - Theano Andriopoulou
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Victoria-Marina Spanou
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dionyssia-Eirini Droggiti
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dionysios Kafousopoulos
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theologia Gkavogianni
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Damoraki
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Giannis Vatsellas
- Greek Genome Center, Biomedical Research Foundation (BRFAA) of the Academy of Athens, Athens, Greece
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Panagiotopoulos D, Andriopoulou T, Spanou VM, Droggiti DI, Gkavogianni T, Giamarellos-Bourboulis EJ, Panagopoulos P. Deficiency of hydrogen sulfide production and pregnancy rate in an experimental model: Association with preterm delivery. Am J Reprod Immunol 2023; 90:e13764. [PMID: 37641370 DOI: 10.1111/aji.13764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/31/2023] Open
Abstract
PROBLEM Pro-inflammatory phenomena drive preterm delivery (PTD). Hydrogen sulfide is a gasotransmitter with anti-inflammatory properties produced through the activity of the enzyme cystathionine-γ-lyase (CSE), and its impact was studied in models of normal delivery and PTD in mice. METHOD OF STUDY Female CSE+/+ and CSE-/- mice were mated with male CSE+/+ mice; mating was done with drinking water unsupplemented and supplemented with cysteine. The pregnancy rate was monitored. PTD was induced by the intraperitoneal injection of bacterial lipopolysaccharide (LPS) on day 14.5 of pregnancy. Mice were sacrificed for tissue collection and splenocyte isolation after 6 and 12 h. Isolated splenocytes were stimulated for the production of tumor necrosis factor-alpha (TNFα), interleukin (IL)-10 and interferon-gamma (IFNγ); TNFα and vascular endothelial growth factor (VEGF) were measured in the fetuses and the placenta. RESULTS The successful pregnancy rate was lower in CSE-/- mice and it was restored with cysteine supplementation. CSE deficiency was associated with higher tissue concentrations of TNFα in the fetuses, attenuated IL-10 responses and higher IFNγ production from splenocytes. CSE deficiency was not associated with PTD. Following PTD induction, CSE-/- mice did not show attenuated IL-10 responses but the production of TNFα and IFNγ was lowered over-time; placental VEGF was also increased over-time. CONCLUSIONS CSE deficiency has an unfavorable impact on pregnancy. H2 S deficiency through CSE does not drive PTD but mediates pro-inflammatory phenomena in fetuses.
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Affiliation(s)
- Dimitrios Panagiotopoulos
- 3rd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Theano Andriopoulou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Victoria-Marina Spanou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Dionysia-Irene Droggiti
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Theologia Gkavogianni
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - Periklis Panagopoulos
- 3rd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Ferreira AV, Kostidis S, Groh LA, Koeken VACM, Bruno M, Baydemir I, Kilic G, Bulut Ö, Andriopoulou T, Spanou V, Synodinou KD, Gkavogianni T, Moorlag SJCFM, Charlotte de Bree L, Mourits VP, Matzaraki V, Koopman WJH, van de Veerdonk FL, Renieris G, Giera M, Giamarellos-Bourboulis EJ, Novakovic B, Domínguez-Andrés J. Dimethyl itaconate induces long-term innate immune responses and confers protection against infection. Cell Rep 2023; 42:112658. [PMID: 37330914 DOI: 10.1016/j.celrep.2023.112658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 03/09/2023] [Accepted: 05/31/2023] [Indexed: 06/20/2023] Open
Abstract
Itaconate is an immunomodulatory metabolite produced by immune cells under microbial stimulation and certain pro-inflammatory conditions and triggers antioxidant and anti-inflammatory responses. We show that dimethyl itaconate, a derivative of itaconate previously linked to suppression of inflammation and widely employed as an alternative to the endogenous metabolite, can induce long-term transcriptional, epigenomic, and metabolic changes, characteristic of trained immunity. Dimethyl itaconate alters glycolytic and mitochondrial energetic metabolism, ultimately leading to increased responsiveness to microbial ligand stimulation. Subsequently, mice treated with dimethyl itaconate present increased survival to infection with Staphylococcus aureus. Additionally, itaconate levels in human plasma correlate with enhanced ex vivo pro-inflammatory cytokine production. Collectively, these findings demonstrate that dimethyl itaconate displays short-term anti-inflammatory characteristics and the capacity to induce long-term trained immunity. This pro-and anti-inflammatory dichotomy of dimethyl itaconate is likely to induce complex immune responses and should be contemplated when considering itaconate derivatives in a therapeutic context.
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Affiliation(s)
- Anaísa V Ferreira
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Nijmegen Medical Centre, 6500HB Nijmegen, the Netherlands; Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, 4050-313 Porto, Portugal.
| | - Sarantos Kostidis
- Center for Proteomics and Metabolomics, Leiden University Medical Center, 2333ZA Leiden, the Netherlands
| | - Laszlo A Groh
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Nijmegen Medical Centre, 6500HB Nijmegen, the Netherlands
| | - Valerie A C M Koeken
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Nijmegen Medical Centre, 6500HB Nijmegen, the Netherlands; TWINCORE, a Joint Venture Between the Helmholtz-Centre for Infection Research (HZI) and the Hannover Medical School (MHH), 30625 Hannover, Germany; Centre for Individualised Infection Medicine (CiiM), Department of Computational Biology for Individualised Infection Medicine, a Joint Venture Between the Helmholtz-Centre for Infection Research (HZI) and the Hannover Medical School (MHH), 30625 Hannover, Germany
| | - Mariolina Bruno
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Nijmegen Medical Centre, 6500HB Nijmegen, the Netherlands
| | - Ilayda Baydemir
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Nijmegen Medical Centre, 6500HB Nijmegen, the Netherlands
| | - Gizem Kilic
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Nijmegen Medical Centre, 6500HB Nijmegen, the Netherlands
| | - Özlem Bulut
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Nijmegen Medical Centre, 6500HB Nijmegen, the Netherlands
| | - Theano Andriopoulou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Victoria Spanou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Kalliopi D Synodinou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Theologia Gkavogianni
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Simone J C F M Moorlag
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Nijmegen Medical Centre, 6500HB Nijmegen, the Netherlands
| | - L Charlotte de Bree
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Nijmegen Medical Centre, 6500HB Nijmegen, the Netherlands
| | - Vera P Mourits
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Nijmegen Medical Centre, 6500HB Nijmegen, the Netherlands
| | - Vasiliki Matzaraki
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Nijmegen Medical Centre, 6500HB Nijmegen, the Netherlands
| | - Werner J H Koopman
- Department of Pediatrics, Amalia Children's Hospital, Radboud Center for Mitochondrial Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frank L van de Veerdonk
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Nijmegen Medical Centre, 6500HB Nijmegen, the Netherlands
| | - Georgios Renieris
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Martin Giera
- Center for Proteomics and Metabolomics, Leiden University Medical Center, 2333ZA Leiden, the Netherlands
| | | | - Boris Novakovic
- Murdoch Children's Research Institute, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Jorge Domínguez-Andrés
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Nijmegen Medical Centre, 6500HB Nijmegen, the Netherlands.
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Renieris G, Karakike E, Gkavogianni T, Droggiti DE, Stylianakis E, Andriopoulou T, Spanou VM, Kafousopoulos D, Netea MG, Eugen-Olsen J, Simard J, Giamarellos-Bourboulis EJ. IL-1 Mediates Tissue-Specific Inflammation and Severe Respiratory Failure in COVID-19. J Innate Immun 2022; 14:643-656. [PMID: 35545011 PMCID: PMC9801253 DOI: 10.1159/000524560] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 09/22/2021] [Accepted: 03/21/2022] [Indexed: 01/02/2023] Open
Abstract
Acute respiratory distress syndrome (ARDS) in COVID-19 has been associated with catastrophic inflammation. We present measurements in humans and a new animal model implicating a role in danger-associated molecular patterns. Calprotectin (S100A8/A9) and high-mobility group box 1 (HMGB1) were measured in patients without/with ARDS, and admission calprotectin was associated with soluble urokinase plasminogen activator receptor (suPAR). An animal model was developed by intravenous injection of plasma from healthy or patients with COVID-19 ARDS into C57/BL6 mice once daily for 3 consecutive days. Mice were treated with one anti-S100A8/A9 antibody, the IL-1 receptor antagonist anakinra or vehicle, and Flo1-2a anti-murine anti-IL-1α monoclonal antibody or the specific antihuman IL-1α antibody XB2001 or isotype controls. Cytokines and myeloperoxidase (MPO) were measured in tissues. Calprotectin, but not HMGB1, was elevated in ARDS. Higher suPAR indicated higher calprotectin. Animal challenge with COVID-19 plasma led to inflammatory reactions in murine lung and intestines as evidenced by increased levels of TNFα, IL-6, IFNγ, and MPO. Lung inflammation was attenuated with anti-S100A8/A9 pre-treatment. Anakinra treatment restored these levels. Similar decrease was found in mice treated with Flo1-2a but not with XB2001. Circulating alarmins, specifically calprotectin, of critically ill COVID-19 patients induces tissue-specific inflammatory responses through an IL-1-mediated mechanism. This could be attenuated through inhibition of IL-1 receptor or of IL-1α.
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Affiliation(s)
- Georgios Renieris
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Eleni Karakike
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Theologia Gkavogianni
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Dionysia-Eirini Droggiti
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Emmanouil Stylianakis
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Theano Andriopoulou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Victoria-Marina Spanou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Dionyssios Kafousopoulos
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Mihai G. Netea
- Immunology and Metabolism, Life & Medical Sciences Institute, University of Bonn, Bonn, Germany,Department of Internal Medicine and Center for Infectious Diseases, Radboud University, Nijmegen, The Netherlands
| | - Jesper Eugen-Olsen
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | | | - Evangelos J. Giamarellos-Bourboulis
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece,*Evangelos J. Giamarellos-Bourboulis,
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6
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Kassianidis G, Siampanos A, Poulakou G, Adamis G, Rapti A, Milionis H, Dalekos GN, Petrakis V, Sympardi S, Metallidis S, Alexiou Z, Gkavogianni T, Giamarellos-Bourboulis EJ, Theoharides TC. Calprotectin and Imbalances between Acute-Phase Mediators Are Associated with Critical Illness in COVID-19. Int J Mol Sci 2022; 23:ijms23094894. [PMID: 35563282 PMCID: PMC9099708 DOI: 10.3390/ijms23094894] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 12/13/2022] Open
Abstract
The trajectory from moderate and severe COVID-19 into acute respiratory distress syndrome (ARDS) necessitating mechanical ventilation (MV) is a field of active research. We determined serum levels within 24 h of presentation of 20 different sets of mediators (calprotectin, pro- and anti-inflammatory cytokines, interferons) of patients with COVID-19 at different stages of severity (asymptomatic, moderate, severe and ARDS/MV). The primary endpoint was to define associations with critical illness, and the secondary endpoint was to identify the pathways associated with mortality. Results were validated in serial measurements of mediators among participants of the SAVE-MORE trial. Levels of the proinflammatory interleukin (IL)-8, IL-18, matrix metalloproteinase-9, platelet-derived growth factor (PDGF)-B and calprotectin (S100A8/A9) were significantly higher in patients with ARDS and MV. Levels of the anti-inflammatory IL-1ra and IL-33r were also increased; IL-38 was increased only in asymptomatic patients but significantly decreased in the more severe cases. Multivariate ordinal regression showed that pathways of IL-6, IL-33 and calprotectin were associated with significant probability for worse outcome. Calprotectin was serially increased from baseline among patients who progressed to ARDS and MV. Further research is needed to decipher the significance of these findings compared to other acute-phase reactants, such as C-reactive protein (CRP) or ferritin, for the prognosis and development of effective treatments.
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Affiliation(s)
- Georgios Kassianidis
- Intensive Care Unit, Korgialeneion-Benakeion Athens General Hospital, 115 26 Athens, Greece;
| | - Athanasios Siampanos
- 4th Department of Internal Medicine, ATTIKON University General Hospital, Medical School, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62 Athens, Greece; (A.S.); (T.G.)
| | - Garyphalia Poulakou
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece;
| | - George Adamis
- 1st Department of Internal Medicine, G. Gennimatas General Hospital of Athens, 115 27 Athens, Greece;
| | - Aggeliki Rapti
- 2nd Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, 115 27 Athens, Greece;
| | - Haralampos Milionis
- 1st Department of Internal Medicine, Medical School, University of Ioannina, 455 00 Ioannina, Greece;
| | - George N. Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National and European Expertise Center in Autoimmune Liver Diseases, General University Hospital of Larissa, 412 21 Larissa, Greece;
| | - Vasileios Petrakis
- 2nd Department of Internal Medicine, Medical School, Democritus University of Thrace, 681 00 Alexandroupolis, Greece;
| | - Styliani Sympardi
- 1st Department of Internal Medicine, Thriasio General Hospital of Eleusis, 196 00 Magoula, Greece;
| | - Symeon Metallidis
- 1st Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, 546 21 Thessaloniki, Greece;
| | - Zoi Alexiou
- 2nd Department of Internal Medicine, Thriasio General Hospital of Eleusis, 196 00 Magoula, Greece;
| | - Theologia Gkavogianni
- 4th Department of Internal Medicine, ATTIKON University General Hospital, Medical School, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62 Athens, Greece; (A.S.); (T.G.)
| | - Evangelos J. Giamarellos-Bourboulis
- 4th Department of Internal Medicine, ATTIKON University General Hospital, Medical School, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62 Athens, Greece; (A.S.); (T.G.)
- Correspondence: (E.J.G.-B.); (T.C.T.); Tel.: +30-210-58-31-994 (E.J.G.-B.); Fax: +30-210-53-26446 (E.J.G.-B.)
| | - Theoharis C. Theoharides
- Laboratory of Molecular Immunopharmacology and Drug Discovery, Department of Immunology, Tufts University School of Medicine, Boston, MA 02111, USA
- School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, MA 02111, USA
- Department of Internal Medicine, Tufts University School of Medicine and Tufts Medical Center, Boston, MA 02111, USA
- Institute of Neuro-Immune Medicine, Nova Southeastern University, Clearwater, FL 33759, USA
- Correspondence: (E.J.G.-B.); (T.C.T.); Tel.: +30-210-58-31-994 (E.J.G.-B.); Fax: +30-210-53-26446 (E.J.G.-B.)
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7
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Katsaros K, Renieris G, Safarika A, Adami EM, Gkavogianni T, Giannikopoulos G, Solomonidi N, Halvatzis S, Koutelidakis IM, Tsokos N, Tritzali M, Koutoukas P, Avgoustou C, Vasishta A, Giamarellos-Bourboulis EJ. Heparin Binding Protein for the Early Diagnosis and Prognosis of Sepsis in the Emergency Department: The Prompt Multicenter Study. Shock 2022; 57:518-525. [PMID: 34907118 DOI: 10.1097/shk.0000000000001900] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The validation of new biomarkers for the diagnosis and risk stratification of patients with sepsis at an early point is essential for successful treatment. Recent publications prompted us to investigate of heparin binding protein (HBP) for the emergency department (ED) admissions. MATERIALS AND METHODS In this multicenter, cross-sectional study, HBP and procalcitonin (PCT) were measured within the first hour upon admission to the ED in plasma samples of 371 patients with signs of infection. Patients were classified into non-sepsis and sepsis by the Sepsis-3 definitions and were followed up for outcome. RESULTS HBP was significantly higher in patients with sepsis and was positively correlated to PCT and C-reactive protein, absolute neutrophil and monocyte counts, creatinine, bilirubin and lactate. Sensitivity, specificity, positive predictive value, and negative predictive value of HBP more than 19.8 ng/mL for the diagnosis of sepsis was 66.3%, 44.9%, 49.3%, and 62.2%, respectively; and for prediction of early death was 100%, 41.0%, 4.5%, and 100%, respectively. Single HBP and PCT could not predict 28-day mortality; this was performed with sensitivity, specificity, positive predictive value, and negative predictive value 44.8%, 81.8%, 17.3%, and 94.6% when used in combination. CONCLUSION Admission HBP can be used as a tool for the early diagnosis of sepsis and for the risk of early death in the ED.
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Affiliation(s)
| | - Georgios Renieris
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Asimina Safarika
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Evangelia-Maria Adami
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Theologia Gkavogianni
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - Nicky Solomonidi
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Stamatios Halvatzis
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Ioannis M Koutelidakis
- Second Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Tsokos
- Department of Internal Medicine, Chalkida General Hospital, Chalkida, Greece
| | - Maroula Tritzali
- Department of Internal Medicine, Syros General Hospital, Ermoupolis, Syros, Greece
| | - Pantelis Koutoukas
- Department of Internal Medicine, Sparti General Hospital, Sparti, Greece
| | - Cristina Avgoustou
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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8
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Tsiakos K, Tsakiris A, Tsibris G, Voutsinas PM, Panagopoulos P, Kosmidou M, Petrakis V, Gravvani A, Gkavogianni T, Klouras E, Katrini K, Koufargyris P, Rapti I, Karageorgos A, Vrentzos E, Damoulari C, Zarkada V, Sidiropoulou C, Artemi S, Ioannidis A, Papapostolou A, Michelakis E, Georgiopoulou M, Myrodia DM, Tsiamalos P, Syrigos K, Chrysos G, Nitsotolis T, Milionis H, Poulakou G, Giamarellos-Bourboulis EJ. Early Start of Oral Clarithromycin Is Associated with Better Outcome in COVID-19 of Moderate Severity: The ACHIEVE Open-Label Single-Arm Trial. Infect Dis Ther 2021; 10:2333-2351. [PMID: 34363189 PMCID: PMC8345236 DOI: 10.1007/s40121-021-00505-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/16/2021] [Indexed: 12/27/2022] Open
Abstract
Introduction The anti-inflammatory effect of macrolides prompted the study of oral clarithromycin in moderate COVID-19. Methods An open-label non-randomized trial in 90 patients with COVID-19 of moderate severity was conducted between May and October 2020. The primary endpoint was defined at the end of treatment (EOT) as no need for hospital re-admission and no progression into lower respiratory tract infection (LRTI) for patients with upper respiratory tract infection and as at least 50% decrease of the respiratory symptoms score without progression into severe respiratory failure (SRF) for patients with LRTI. Viral load, biomarkers, the function of mononuclear cells and safety were assessed. Results The primary endpoint was attained in 86.7% of patients treated with clarithromycin (95% CIs 78.1–92.2%); this was 91.7% and 81.4% among patients starting clarithromycin the first 5 days from symptoms onset or later (odds ratio after multivariate analysis 6.62; p 0.030). The responses were better for patients infected by non-B1.1 variants. Clarithromycin use was associated with decreases in circulating C-reactive protein, tumour necrosis factor-alpha and interleukin (IL)-6; by increase of production of interferon-gamma and decrease of production of interleukin-6 by mononuclear cells; and by suppression of SARS-CoV-2 viral load. No safety concerns were reported. Conclusions Early clarithromycin treatment provides most of the clinical improvement in moderate COVID-19. Trial Registration ClinicalTrials.gov, NCT04398004 Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00505-8.
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Affiliation(s)
- Konstantinos Tsiakos
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece
| | - Antonios Tsakiris
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Georgios Tsibris
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Pantazis-Michael Voutsinas
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Periklis Panagopoulos
- 2nd Department of Internal Medicine, Medical School, Democritus University of Thrace, 681 00, Alexandroupolis, Greece
| | - Maria Kosmidou
- 1st Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Ioannina, 455 00, Ioannina, Greece
| | - Vasileios Petrakis
- 2nd Department of Internal Medicine, Medical School, Democritus University of Thrace, 681 00, Alexandroupolis, Greece
| | - Areti Gravvani
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece
| | - Theologia Gkavogianni
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Eleftherios Klouras
- 1st Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Ioannina, 455 00, Ioannina, Greece
| | - Konstantina Katrini
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Panagiotis Koufargyris
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Iro Rapti
- 1st Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Ioannina, 455 00, Ioannina, Greece
| | - Athanassios Karageorgos
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Emmanouil Vrentzos
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Christina Damoulari
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Vagia Zarkada
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | | | - Sofia Artemi
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Anastasios Ioannidis
- Department of Nursing, Faculty of Health Sciences, University of Peloponnese, Tripoli, Greece
| | - Androniki Papapostolou
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Evangelos Michelakis
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Maria Georgiopoulou
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Dimitra-Melia Myrodia
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece
| | - Panteleimon Tsiamalos
- 2nd Department of Internal Medicine, Tzaneion General Hospital of Piraeus, Piraeus, Greece
| | - Konstantinos Syrigos
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece
| | - George Chrysos
- 2nd Department of Internal Medicine, Tzaneion General Hospital of Piraeus, Piraeus, Greece
| | - Thomas Nitsotolis
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece
| | - Haralampos Milionis
- 1st Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Ioannina, 455 00, Ioannina, Greece
| | - Garyphallia Poulakou
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece
| | - Evangelos J Giamarellos-Bourboulis
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece.
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9
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Karamouzos V, Giamarellos-Bourboulis EJ, Velissaris D, Gkavogianni T, Gogos C. Cytokine production and outcome in MDR versus non-MDR gram-negative bacteraemia and sepsis. Infect Dis (Lond) 2021; 53:764-771. [PMID: 34137348 DOI: 10.1080/23744235.2021.1925738] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Sepsis represents a life-threatening syndrome characterized by a cytokine storm. Whether cytokine levels are related to the susceptibility pattern of invasive micro-organism remains a matter of debate. The purpose of this study is to investigate the immune response in multidrug resistant (MDR) and non-MDR sepsis patients by measuring cytokine levels, compare the outcome and determine predictors of mortality. MATERIALS AND METHODS A total of 128 septic patients, treated in intensive care unit (ICU) were enrolled in the study. Epidemiological and ICU data were recorded. Plasma concentrations of angiopoietin-2 (Ang-2), interleukin (IL)-6, IL-10, tumour necrosis factor-α (TNF-α) and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) were measured on admission. RESULTS A total of 90 patients suffered from non-MDR and 38 from MDR gram-negative sepsis. Levels of TNF-α were significantly higher (p = .017) in non-MDR sepsis patients. All pro-inflammatory cytokines were significantly increased in severely ill patients compared to patients with lower acute physiology and chronic health evaluation (APACHE) II score. MDR positive patients had a significantly lower 28-d survival (p = .008). Factors that were independently associated with higher 28-d mortality were carbapenem resistance (OR 5.38 [1.032 - 28.12], p = .046), male gender (OR 2.76 [1.156 - 6.588], p = .022), APACHE II score (OR 1.126 [1.048 - 1.21], p = .001) and Ang-2 (OR 1.025 [1.001 - 20.1], p = .048). CONCLUSIONS Sepsis evolution and outcome are influenced by multiple factors. Although MDR pathogens induced a weaker immune response characterized by lower TNF-α levels this was not accompanied by better survival. Increased Ang-2 levels, APACHE II score and carbapenem resistance are important factors associated with higher mortality.
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Affiliation(s)
| | | | | | - Theologia Gkavogianni
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalambos Gogos
- Internal Medicine Department, University Hospital of Patras, Patras, Greece
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10
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Renieris G, Droggiti DE, Katrini K, Koufargyris P, Gkavogianni T, Karakike E, Antonakos N, Damoraki G, Karageorgos A, Sabracos L, Katsouda A, Jentho E, Weis S, Wang R, Bauer M, Szabo C, Platoni K, Kouloulias V, Papapetropoulos A, Giamarellos-Bourboulis EJ. Host cystathionine-γ lyase derived hydrogen sulfide protects against Pseudomonas aeruginosa sepsis. PLoS Pathog 2021; 17:e1009473. [PMID: 33770141 PMCID: PMC8051778 DOI: 10.1371/journal.ppat.1009473] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 10/22/2020] [Revised: 04/16/2021] [Accepted: 03/12/2021] [Indexed: 11/18/2022] Open
Abstract
Hydrogen sulfide (H2S) has recently been recognized as a novel gaseous transmitter with several anti-inflammatory properties. The role of host- derived H2S in infections by Pseudomonas aeruginosa was investigated in clinical and mouse models. H2S concentrations and survival was assessed in septic patients with lung infection. Animal experiments using a model of severe systemic multidrug-resistant P. aeruginosa infection were performed using mice with a constitutive knock-out of cystathionine-γ lyase (Cse) gene (Cse-/-) and wild-type mice with a physiological expression (Cse+/+). Experiments were repeated in mice after a) treatment with cyclophosphamide; b) bone marrow transplantation (BMT) from a Cse+/+ donor; c) treatment with H2S synthesis inhibitor aminooxyacetic acid (ΑΟΑΑ) or propargylglycine (PAG) and d) H2S donor sodium thiosulfate (STS) or GYY3147. Bacterial loads and myeloperoxidase activity were measured in tissue samples. The expression of quorum sensing genes (QS) was determined in vivo and in vitro. Cytokine concentration was measured in serum and incubated splenocytes. Patients survivors at day 28 had significantly higher serum H2S compared to non-survivors. A cut- off point of 5.3 μΜ discriminated survivors with sensitivity 92.3%. Mortality after 28 days was 30.9% and 93.7% in patients with H2S higher and less than 5.3 μΜ (p = 7 x 10-6). In mice expression of Cse and application of STS afforded protection against infection with multidrug-resistant P. aeruginosa. Cyclophosphamide pretreatment eliminated the survival benefit of Cse+/+ mice, whereas BMT increased the survival of Cse-/- mice. Cse-/- mice had increased pathogen loads compared to Cse+/+ mice. Phagocytic activity of leukocytes from Cse-/- mice was reduced but was restored after H2S supplementation. An H2S dependent down- regulation of quorum sensing genes of P.aeruginosa could be demonstrated in vivo and in vitro. Endogenous H2S is a potential independent parameter correlating with the outcome of P. aeruginosa. H2S provides resistance to infection by MDR bacterial pathogens.
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Affiliation(s)
- Georgios Renieris
- 4 Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Dionysia-Eirini Droggiti
- 4 Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Konstantina Katrini
- 4 Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Panagiotis Koufargyris
- 4 Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Theologia Gkavogianni
- 4 Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Eleni Karakike
- 4 Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Nikolaos Antonakos
- 4 Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Georgia Damoraki
- 4 Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Athanasios Karageorgos
- 4 Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Labros Sabracos
- 4 Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Antonia Katsouda
- Center of Clinical, Experimental Surgery & Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Elisa Jentho
- Department of Anesthesiology and Intensive Care, Jena University Hospital, Jena, Germany
- Institute for Infectious Disease and Infection Control, Jena University Hospital, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - Sebastian Weis
- Department of Anesthesiology and Intensive Care, Jena University Hospital, Jena, Germany
- Institute for Infectious Disease and Infection Control, Jena University Hospital, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - Rui Wang
- Department of Biology, York University, Toronto, Canada
| | - Michael Bauer
- Department of Anesthesiology and Intensive Care, Jena University Hospital, Jena, Germany
| | - Csaba Szabo
- Department of Anaesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
- Chair of Pharmacology, Department of Medicine, University of Fribourg, Fribourg, Switzerland
| | - Kalliopi Platoni
- 2 Department of Radiology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Vasilios Kouloulias
- 2 Department of Radiology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Andreas Papapetropoulos
- Center of Clinical, Experimental Surgery & Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
- Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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11
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Kyriazopoulou E, Panagopoulos P, Metallidis S, Dalekos GN, Poulakou G, Gatselis N, Karakike E, Saridaki M, Loli G, Stefos A, Prasianaki D, Georgiadou S, Tsachouridou O, Petrakis V, Tsiakos K, Kosmidou M, Lygoura V, Dareioti M, Milionis H, Papanikolaou IC, Akinosoglou K, Myrodia DM, Gravvani A, Stamou A, Gkavogianni T, Katrini K, Marantos T, Trontzas IP, Syrigos K, Chatzis L, Chatzis S, Vechlidis N, Avgoustou C, Chalvatzis S, Kyprianou M, van der Meer JW, Eugen-Olsen J, Netea MG, Giamarellos-Bourboulis EJ. An open label trial of anakinra to prevent respiratory failure in COVID-19. eLife 2021; 10:66125. [PMID: 33682678 PMCID: PMC8034977 DOI: 10.7554/elife.66125] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [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: 12/29/2020] [Accepted: 03/04/2021] [Indexed: 01/08/2023] Open
Abstract
Background: It was studied if early suPAR-guided anakinra treatment can prevent severe respiratory failure (SRF) of COVID-19. Methods: A total of 130 patients with suPAR ≥6 ng/ml were assigned to subcutaneous anakinra 100 mg once daily for 10 days. Primary outcome was SRF incidence by day 14 defined as any respiratory ratio below 150 mmHg necessitating mechanical or non-invasive ventilation. Main secondary outcomes were 30-day mortality and inflammatory mediators; 28-day WHO-CPS was explored. Propensity-matched standard-of care comparators were studied. Results: 22.3% with anakinra treatment and 59.2% comparators (hazard ratio, 0.30; 95% CI, 0.20–0.46) progressed into SRF; 30-day mortality was 11.5% and 22.3% respectively (hazard ratio 0.49; 95% CI 0.25–0.97). Anakinra was associated with decrease in circulating interleukin (IL)−6, sCD163 and sIL2-R; IL-10/IL-6 ratio on day 7 was inversely associated with SOFA score; patients were allocated to less severe WHO-CPS strata. Conclusions: Early suPAR-guided anakinra decreased SRF and restored the pro-/anti-inflammatory balance. Funding: This study was funded by the Hellenic Institute for the Study of Sepsis, Technomar Shipping Inc, Swedish Orphan Biovitrum, and the Horizon 2020 Framework Programme. Clinical trial number: NCT04357366. People infected with the SARS-CoV-2 virus, which causes COVID-19, can develop severe respiratory failure and require a ventilator to keep breathing, but this does not happen to every infected individual. Measuring a blood protein called suPAR (soluble urokinase plasminogen activator receptor) may help identify patients at the greatest risk of developing severe respiratory failure and requiring a ventilator. Previous investigations have suggested that measuring suPAR can identify pneumonia patients at highest risk for developing respiratory failure. The protein can be measured by taking a blood sample, and its levels provide a snapshot of how the body’s immune system is reacting to infection, and of how it may respond to treatment. Anakinra is a drug that forms part of a class of medications called interleukin antagonists. It is commonly prescribed alone or in combination with other medications to reduce pain and swelling associated with rheumatoid arthritis. Kyriazopoulou et al. investigated whether treating COVID-19 patients who had developed pneumonia with anakinra could prevent the use of a ventilator and lower the risk of death. The findings show that treating COVID-19 patients with an injection of 100 milligrams of anakinra for ten days may be an effective approach because the drug combats inflammation. Kyriazopoulou et al. examined various markers of the immune response and discovered that anakinra was able to improve immune function, protecting a significant number of patients from going on a ventilator. The drug was also found to be safe and cause no significant adverse side effects. Administering anakinra decreased of the risk of progression into severe respiratory failure by 70%, and reduced death rates significantly. These results suggest that it may be beneficial to use suPAR as an early biomarker for identifying those individuals at highest risk for severe respiratory failure, and then treat them with anakinra. While the findings are promising, they must be validated in larger studies.
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Affiliation(s)
- Evdoxia Kyriazopoulou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Periklis Panagopoulos
- 2nd Department of Internal Medicine, Democritus University of Thrace, Medical School, Alexandroupolis, Greece
| | - Symeon Metallidis
- 1st Department of Internal Medicine, Aristotle University ofThessaloniki, Thessaloniki, Greece
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Garyphallia Poulakou
- 3rd Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Gatselis
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Eleni Karakike
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Saridaki
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Loli
- 1st Department of Internal Medicine, Aristotle University ofThessaloniki, Thessaloniki, Greece
| | - Aggelos Stefos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Danai Prasianaki
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Sarah Georgiadou
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Olga Tsachouridou
- 1st Department of Internal Medicine, Aristotle University ofThessaloniki, Thessaloniki, Greece
| | - Vasileios Petrakis
- 2nd Department of Internal Medicine, Democritus University of Thrace, Medical School, Alexandroupolis, Greece
| | - Konstantinos Tsiakos
- 3rd Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Kosmidou
- 1st Department of Internal Medicine,University of Ioannina, School of HealthSciences, Faculty of Medicine, Ioannina, Greece
| | - Vassiliki Lygoura
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Maria Dareioti
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Haralampos Milionis
- 1st Department of Internal Medicine,University of Ioannina, School of HealthSciences, Faculty of Medicine, Ioannina, Greece
| | | | - Karolina Akinosoglou
- Department of Internal Medicine, University of Patras, Medical School, Rion, Greece
| | - Dimitra-Melia Myrodia
- 3rd Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Areti Gravvani
- 3rd Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aliki Stamou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Theologia Gkavogianni
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantina Katrini
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Marantos
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis P Trontzas
- 3rd Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Syrigos
- 3rd Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Loukas Chatzis
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stamatios Chatzis
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Vechlidis
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Avgoustou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stamatios Chalvatzis
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Miltiades Kyprianou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Jos Wm van der Meer
- Department of Internal Medicine and Center for Infectious Diseases, Radboud University, Nijmegen, Netherlands
| | - Jesper Eugen-Olsen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Mihai G Netea
- Department of Internal Medicine and Center for Infectious Diseases, Radboud University, Nijmegen, Netherlands.,Immunology and Metabolism, Life & Medical Sciences Institute, University of Bonn, Bonn, Germany
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12
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Kyriazopoulou E, Liaskou-Antoniou L, Adamis G, Panagaki A, Melachroinopoulos N, Drakou E, Marousis K, Chrysos G, Spyrou A, Alexiou N, Symbardi S, Alexiou Z, Lagou S, Kolonia V, Gkavogianni T, Kyprianou M, Anagnostopoulos I, Poulakou G, Lada M, Makina A, Roulia E, Koupetori M, Apostolopoulos V, Petrou D, Nitsotolis T, Antoniadou A, Giamarellos-Bourboulis EJ. Procalcitonin to Reduce Long-Term Infection-associated Adverse Events in Sepsis. A Randomized Trial. Am J Respir Crit Care Med 2021; 203:202-210. [PMID: 32757963 PMCID: PMC7874409 DOI: 10.1164/rccm.202004-1201oc] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [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] [Indexed: 11/26/2022] Open
Abstract
Rationale: Although early antimicrobial discontinuation guided by procalcitonin (PCT) has shown decreased antibiotic consumption in lower respiratory tract infections, the outcomes in long-term sepsis sequelae remain unclear. Objectives: To investigate if PCT guidance may reduce the incidence of long-term infection-associated adverse events in sepsis. Methods: In this multicenter trial, 266 patients with sepsis (by Sepsis-3 definitions) with lower respiratory tract infections, acute pyelonephritis, or primary bloodstream infection were randomized (1:1) to receive either PCT-guided discontinuation of antimicrobials or standard of care. The discontinuation criterion was ≥80% reduction in PCT levels or any PCT ≤0.5 μg/L at Day 5 or later. The primary outcome was the rate of infection-associated adverse events at Day 180, a composite of the incidence of any new infection by Clostridioides difficile or multidrug-resistant organisms, or any death attributed to baseline C. difficile or multidrug-resistant organism infection. Secondary outcomes included 28-day mortality, length of antibiotic therapy, and cost of hospitalization. Measurements and Main Results: The rate of infection-associated adverse events was 7.2% (95% confidence interval [CI], 3.8–13.1%; 9/125) versus 15.3% (95% CI, 10.1–22.4%; 20/131) (hazard ratio, 0.45; 95% CI, 0.20–0.98; P = 0.045); 28-day mortality 15.2% (95% CI, 10–22.5%; 19/125) versus 28.2% (95% CI, 21.2–36.5%; 37/131) (hazard ratio, 0.51; 95% CI, 0.29–0.89; P = 0.02); and median length of antibiotic therapy 5 (range, 5–7) versus 10 (range, 7–15) days (P < 0.001) in the PCT and standard-of-care arms, respectively. The cost of hospitalization was also reduced in the PCT arm. Conclusions: In sepsis, PCT guidance was effective in reducing infection-associated adverse events, 28-day mortality, and cost of hospitalization. Clinical trial registered with www.clinicaltrials.gov (NCT03333304).
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Affiliation(s)
| | | | - George Adamis
- Third Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | | | - Elina Drakou
- Third Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Konstantinos Marousis
- Third Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Georgios Chrysos
- First Department of Internal Medicine, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Andronikos Spyrou
- Third Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Nikolaos Alexiou
- Second Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Styliani Symbardi
- Second Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Athens, Greece
| | | | - Styliani Lagou
- Second Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece; and
| | - Virginia Kolonia
- Second Department of Internal Medicine, Sismanogleio General Hospital of Athens, Athens, Greece
| | | | | | - Ioannis Anagnostopoulos
- Second Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece; and
| | - Garyfallia Poulakou
- Second Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece; and
| | - Malvina Lada
- Second Department of Internal Medicine, Sismanogleio General Hospital of Athens, Athens, Greece
| | | | | | - Marina Koupetori
- Second Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Athens, Greece
| | | | - Dimitra Petrou
- Second Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Thomas Nitsotolis
- First Department of Internal Medicine, G. Gennimatas General Hospital of Athens, Athens, Greece
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13
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Koliakos NN, Renieris G, Sotiropoulos D, Pavlou K, Droggiti DE, Gkavogianni T, Charalampopoulos A, Giamarellos-Bourboulis EJ. Immunomodulation Through Beta-D-glucan in Chemically-induced Necrotizing Pancreatitis. J Surg Res 2021; 261:74-84. [PMID: 33421796 DOI: 10.1016/j.jss.2020.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 11/19/2020] [Accepted: 12/07/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although the ability of β-D-glucan and monophosphoryl lipid A (MPLA) to modulate immune responses has been studied in human primary cells, their effect on sterile inflammation models such as necrotizing pancreatitis has never been investigated. MATERIALS AND METHODS 85 male New Zealand rabbits were assigned into following groups: A: control, B: pretreatment with β-D-glucan 3 d before pancreatitis, C: pretreatment with MPLA 3 d before pancreatitis, D: pretreatment with β-D-glucan and laminarin 3 d before pancreatitis, E: treatment with β-D-glucan 1 d after pancreatitis, and F: MPLA 1 d after pancreatitis. Pancreatitis was induced by sodium taurocholate injection into the pancreatic duct and parenchyma. Survival was recorded for 21 d. On days 1, 3, and 7, blood was collected for amylase measurement. Peripheral blood mononuclear cells were isolated and stimulated for tumor necrosis factor alpha and interleukin 10 production. Pancreatic necrosis and tissue bacterial load were assessed. RESULTS 21-d survival was prolonged after pretreatment or treatment with β-D-glucan; this benefit was lost with laminarin administration. At sacrifice, pancreatic inflammatory alterations were more prominent in the control group. Bacterial load was lower after pretreatment or treatment with β-D-glucan and MPLA. Tumor necrosis factor alpha production from stimulated peripheral blood mononuclear cells was significantly decreased, whereas interleukin 10 production remained unaltered after pretreatment or treatment with β-D- glucan. CONCLUSIONS β-D-glucan reduces mortality of experimental pancreatitis in vivo. This is mediated through attenuation of cytokine production and prevention of bacterial translocation.
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Affiliation(s)
- Nikolaos N Koliakos
- 3rd Department of Surgery, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Georgios Renieris
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
| | - Dimitrios Sotiropoulos
- 3rd Department of Surgery, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Kalliopi Pavlou
- Department of Pathology, Evangelismos Hospital, Athens, Greece
| | - Dionysia-Eirini Droggiti
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Theologia Gkavogianni
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Anestis Charalampopoulos
- 3rd Department of Surgery, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Giamarellos-Bourboulis EJ, Tsilika M, Moorlag S, Antonakos N, Kotsaki A, Domínguez-Andrés J, Kyriazopoulou E, Gkavogianni T, Adami ME, Damoraki G, Koufargyris P, Karageorgos A, Bolanou A, Koenen H, van Crevel R, Droggiti DI, Renieris G, Papadopoulos A, Netea MG. Activate: Randomized Clinical Trial of BCG Vaccination against Infection in the Elderly. Cell 2020; 183:315-323.e9. [PMID: 32941801 PMCID: PMC7462457 DOI: 10.1016/j.cell.2020.08.051] [Citation(s) in RCA: 228] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/10/2020] [Accepted: 08/27/2020] [Indexed: 01/08/2023]
Abstract
BCG vaccination in children protects against heterologous infections and improves survival independently of tuberculosis prevention. The phase III ACTIVATE trial assessed whether BCG has similar effects in the elderly. In this double-blind, randomized trial, elderly patients (n = 198) received BCG or placebo vaccine at hospital discharge and were followed for 12 months for new infections. At interim analysis, BCG vaccination significantly increased the time to first infection (median 16 weeks compared to 11 weeks after placebo). The incidence of new infections was 42.3% (95% CIs 31.9%–53.4%) after placebo vaccination and 25.0% (95% CIs 16.4%–36.1%) after BCG vaccination; most of the protection was against respiratory tract infections of probable viral origin (hazard ratio 0.21, p = 0.013). No difference in the frequency of adverse effects was found. Data show that BCG vaccination is safe and can protect the elderly against infections. Larger studies are needed to assess protection against respiratory infections, including COVID-19 (ClinicalTrials.gov NCT03296423). ACTIVATE is a prospective randomized trial of BCG vaccination in the elderly BCG increased the time to first infection and decreased the incidence of new infection Strongest protection was found against viral respiratory tract infections Epigenetic reprogramming and increased cytokine production was found in monocytes
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Affiliation(s)
| | - Maria Tsilika
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Simone Moorlag
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 Nijmegen, the Netherlands
| | - Nikolaos Antonakos
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Antigone Kotsaki
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Jorge Domínguez-Andrés
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 Nijmegen, the Netherlands
| | - Evdoxia Kyriazopoulou
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Theologia Gkavogianni
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Maria-Evangelia Adami
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Georgia Damoraki
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Panagiotis Koufargyris
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Athanassios Karageorgos
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Amalia Bolanou
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Hans Koenen
- Department of Laboratory Medicine, Radboud University Medical Center, 6500 Nijmegen, the Netherlands
| | - Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 Nijmegen, the Netherlands
| | - Dionyssia-Irene Droggiti
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - George Renieris
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Antonios Papadopoulos
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 Nijmegen, the Netherlands; Department of Immunology and Metabolism, Life & Medical Sciences Institute, University of Bonn, 53115 Bonn, Germany
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Tsilika M, Antonakos N, Gkavogianni T, Karageorgos A, Kyriazopoulou E, Netea MG, Giamarellos-Bourboulis EJ. Impact of comorbidities on the performance of interferon-gamma release assay in an elderly Greek population without overt immunodeficiency. Int J Antimicrob Agents 2020; 56:106073. [PMID: 32629117 DOI: 10.1016/j.ijantimicag.2020.106073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/09/2020] [Accepted: 06/28/2020] [Indexed: 12/13/2022]
Abstract
Background The prevalence of latent tuberculosis infection (LTBI) increases with age. Interferon-gamma release assay (IGRA) is a T-cell based assay widely used for the detection of LTBI. Objectives To identify the prevalence of LTBI among an elderly Greek population using IGRA and to evaluate comorbidities associated with LTBI. Methods Individuals aged at least 65 years who were non-immunocompromised and had no history of active tuberculosis infection (TBI) underwent IGRA to identify LTBI. Participant characteristics were compared between the LTBI and non-LTBI groups. Interferon-gamma (INFγ) levels were analysed in each group. Results A total of 130 (38.7%) participants with LTBI and 206 (61.3%) participants without LTBI were included. Multivariate logistic regression analysis identified the following features that were independently associated with a positive IGRA result: female sex (odds ratio [OR]: 0.45; 95% confidence interval [CI]: 0.28-0.72; P=0.001), chronic heart failure (OR: 0.41; 95% CI: 0.22-0.77; P=0.005), history of major surgery (OR: 0.55; 95% CI: 0.33-0.92; P=0.022) and Charlson Comorbidity Index >3 (OR: 3.06; 95% CI: 1.46-6.40; P=0.003). Production of stimulated INFγ was significantly lower in the non-LTBI group. Conclusions Female sex, history of chronic heart failure and history of any surgical intervention were independently associated with a negative IGRA result, and CCI >3 was associated with a positive IGRA result. These results indicate careful interpretation of IGRA is required among elderly individuals with these characteristics.
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Affiliation(s)
- Maria Tsilika
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece
| | - Nikolaos Antonakos
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece
| | - Theologia Gkavogianni
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece
| | - Athanassios Karageorgos
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece
| | - Evdoxia Kyriazopoulou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece
| | - Mihai G Netea
- Department of Internal Medicine and Infectious Diseases, Radboud University Nijmegen, The Netherlands
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Giamarellos-Bourboulis EJ, Netea MG, Rovina N, Akinosoglou K, Antoniadou A, Antonakos N, Damoraki G, Gkavogianni T, Adami ME, Katsaounou P, Ntaganou M, Kyriakopoulou M, Dimopoulos G, Koutsodimitropoulos I, Velissaris D, Koufargyris P, Karageorgos A, Katrini K, Lekakis V, Lupse M, Kotsaki A, Renieris G, Theodoulou D, Panou V, Koukaki E, Koulouris N, Gogos C, Koutsoukou A. Complex Immune Dysregulation in COVID-19 Patients with Severe Respiratory Failure. Cell Host Microbe 2020; 27:992-1000.e3. [PMID: 32320677 PMCID: PMC7172841 DOI: 10.1016/j.chom.2020.04.009] [Citation(s) in RCA: 1435] [Impact Index Per Article: 358.8] [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: 03/19/2020] [Revised: 04/03/2020] [Accepted: 04/09/2020] [Indexed: 02/06/2023]
Abstract
Proper management of COVID-19 mandates better understanding of disease pathogenesis. The sudden clinical deterioration 7-8 days after initial symptom onset suggests that severe respiratory failure (SRF) in COVID-19 is driven by a unique pattern of immune dysfunction. We studied immune responses of 54 COVID-19 patients, 28 of whom had SRF. All patients with SRF displayed either macrophage activation syndrome (MAS) or very low human leukocyte antigen D related (HLA-DR) expression accompanied by profound depletion of CD4 lymphocytes, CD19 lymphocytes, and natural killer (NK) cells. Tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) production by circulating monocytes was sustained, a pattern distinct from bacterial sepsis or influenza. SARS-CoV-2 patient plasma inhibited HLA-DR expression, and this was partially restored by the IL-6 blocker Tocilizumab; off-label Tocilizumab treatment of patients was accompanied by increase in circulating lymphocytes. Thus, the unique pattern of immune dysregulation in severe COVID-19 is characterized by IL-6-mediated low HLA-DR expression and lymphopenia, associated with sustained cytokine production and hyper-inflammation.
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Affiliation(s)
| | - Mihai G Netea
- Immunology and Metabolism, Life & Medical Sciences Institute, University of Bonn, 53115 Bonn, Germany; Department of Internal Medicine and Center for Infectious Diseases, Radboud University, 6500 Nijmegen, the Netherlands
| | - Nikoletta Rovina
- 1(st) Department of Pulmonary Medicine and Intensive Care Unit, National and Kapodistrian University of Athens, Medical School, 115 27 Athens, Greece
| | - Karolina Akinosoglou
- Department of Internal Medicine, University of Patras, Medical School, 265 04 Rion, Greece
| | - Anastasia Antoniadou
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Nikolaos Antonakos
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Georgia Damoraki
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Theologia Gkavogianni
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Maria-Evangelia Adami
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Paraskevi Katsaounou
- 1(st) Department of Critical Care Medicine, National and Kapodistrian University of Athens, 106 76 Athens, Medical School, Greece
| | - Maria Ntaganou
- 1(st) Department of Pulmonary Medicine and Intensive Care Unit, National and Kapodistrian University of Athens, Medical School, 115 27 Athens, Greece
| | - Magdalini Kyriakopoulou
- 1(st) Department of Pulmonary Medicine and Intensive Care Unit, National and Kapodistrian University of Athens, Medical School, 115 27 Athens, Greece
| | - George Dimopoulos
- 2(nd) Department of Critical Care Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | | | - Dimitrios Velissaris
- Department of Internal Medicine, University of Patras, Medical School, 265 04 Rion, Greece
| | - Panagiotis Koufargyris
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Athanassios Karageorgos
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Konstantina Katrini
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Vasileios Lekakis
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Mihaela Lupse
- Department of Infectious Diseases, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Antigone Kotsaki
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - George Renieris
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Danai Theodoulou
- 1(st) Department of Pulmonary Medicine and Intensive Care Unit, National and Kapodistrian University of Athens, Medical School, 115 27 Athens, Greece
| | - Vassiliki Panou
- 1(st) Department of Pulmonary Medicine and Intensive Care Unit, National and Kapodistrian University of Athens, Medical School, 115 27 Athens, Greece
| | - Evangelia Koukaki
- 1(st) Department of Pulmonary Medicine and Intensive Care Unit, National and Kapodistrian University of Athens, Medical School, 115 27 Athens, Greece
| | - Nikolaos Koulouris
- 1(st) Department of Pulmonary Medicine and Intensive Care Unit, National and Kapodistrian University of Athens, Medical School, 115 27 Athens, Greece
| | - Charalambos Gogos
- Department of Internal Medicine, University of Patras, Medical School, 265 04 Rion, Greece
| | - Antonia Koutsoukou
- 1(st) Department of Pulmonary Medicine and Intensive Care Unit, National and Kapodistrian University of Athens, Medical School, 115 27 Athens, Greece
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Goumenos S, Savvidou O, Renieris G, Gkavogianni T, Papagelopoulos PJ, Giamarellos-Bourboulis EJ. Staphylococcus Aureus Osteomyelitis as an Inducer of Tolerance to Escherichia Coli Pyelonephritis: an Experimental Study. Sci Rep 2020; 10:1345. [PMID: 31992837 PMCID: PMC6987097 DOI: 10.1038/s41598-020-58420-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/31/2019] [Indexed: 11/16/2022] Open
Abstract
The high incidence of osteomyelitis in vulnerable populations like those with multiple injuries or elderly undergoing joint arthroplasties generates the question what may be their responses to subsequent infection by high virulent isolates. Rabbits were subject to two operations at three week intervals; sham osteomyelitis and sham pyelonephritis (group S); sham osteomyelitis and Escherichia coli pyelonephritis (group P); and Staphylococcus aureus osteomyelitis and E. coli pyelonephritis (group OP). Survival was recorded; cytokine stimulation of circulating mononuclear cells (PBMCs) and tissue myeloperoxidase (MPO) activity and bacterial growth were monitored. In some experiments, dalbavancin treatment was given before pyelonephritis. Healthy PBMCs were pre-treated with bone homogenate, S. aureus or both. Mortality of groups S, P and OP after induction of pyelonephritis was 0%, 50% and 8.3% respectively. Tumour necrosis factor-alpha (TNFα) production by PBMCs was significantly lower in the OP group at 48 hours. E. coli bacterial load was similar in groups P and OP at death or sacrifice whereas the MPO activity of group OP was decreased. Production of TNFα was further decreased among dalbavancin treated rabbits; in these rabbits tissue MPO was increased. TNFα production decreased when healthy PBMCs pre-treated with bone homogenate, S. aureus (HKSA) or both were stimulated with E. coli (HKEC); production was further decreased in the presence of anti-TLR4 and anti-TLR9. It is concluded that staphylococcal osteomyelitis modulated the innate immune responses of the host leading to protection from death by highly virulent E. coli. Tolerance to TLR ligands is the most likely mechanism of action.
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Affiliation(s)
- Stavros Goumenos
- 1st Department of Orthopedics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Olga Savvidou
- 1st Department of Orthopedics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - George Renieris
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Theologia Gkavogianni
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Panayiotis J Papagelopoulos
- 1st Department of Orthopedics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Liassidou A, Renieris G, Droggiti DI, Gkavogianni T, Liassides C, Sabracos L, Giamarellos-Bourboulis EJ, Siristatidis CS. Association of modulation of pro-inflammatory responses by dectin-2 with preterm delivery: An experimental model. Am J Reprod Immunol 2020; 83:e13216. [PMID: 31814179 DOI: 10.1111/aji.13216] [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: 09/19/2019] [Revised: 11/29/2019] [Accepted: 12/03/2019] [Indexed: 11/29/2022] Open
Abstract
PROBLEM Pro-inflammatory responses of pathogen recognition receptors (PRR) are implicated in preterm delivery (PTD). Dectin-2 is one PRR recognizing unselective carbohydrate structures; its participation in PTD has never been studied before. METHOD OF STUDY In an experimental model, PTD was induced in female pregnant wild-type (WT) mice and mice with homologous deficiency for dectin-2 by the intraperitoneal injection of bacterial lipopolysaccharide (LPS) on day 14 of pregnancy. Time to delivery and fetal mortality were recorded. Challenged mice were killed for tissue collection and splenocyte isolation 6 hours later. Concentrations of tumour necrosis factor-alpha (TNFα), interleukin (IL)-1α, and IL-1β were measured. RESULTS Delivery was induced significantly earlier in WT than dectin-2-/- mice; however, fetal mortality was higher among dectin-2-/- mice. Candida albicans challenge could not lead to these changes. Sacrifice experiments showed that LPS challenge led to significant increase of TNFα, IL-1α, and IL-1β in maternal tissues of WT; this was further enhanced for TNFα and IL-1β in dectin-2-/- mice. Pre-treatment with the prostaglandin inhibitor diclofenac delayed time to delivery of WT mice, but not of dectin2-/- mice. TNFα stimulation of splenocytes of dectin2-/- mice was enhanced with the addition of anti-TLR4 and decreased in the presence of lipid A. CONCLUSIONS Dectin-2 delays LPS-induced PTD by enhancing the production of pro-inflammatory cytokines.
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Affiliation(s)
- Aspasia Liassidou
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Renieris
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dionysia-Irene Droggiti
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theologia Gkavogianni
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christakis Liassides
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Labros Sabracos
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Charalampos S Siristatidis
- 3rd Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Akinosoglou K, Theodoraki S, Gkavogianni T, Pistiki A, Giamarellos-Bourboulis E, Gogos CA. How well does qSOFA correspond to underlying systemic inflammatory response? Cytokine 2018; 110:288-290. [DOI: 10.1016/j.cyto.2018.01.019] [Citation(s) in RCA: 2] [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] [Received: 09/28/2017] [Revised: 11/14/2017] [Accepted: 01/21/2018] [Indexed: 01/10/2023]
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Kyriazopoulou E, Leventogiannis K, Norrby-Teglund A, Dimopoulos G, Pantazi A, Orfanos SE, Rovina N, Tsangaris I, Gkavogianni T, Botsa E, Chassiou E, Kotanidou A, Kontouli C, Chaloulis P, Velissaris D, Savva A, Cullberg JS, Akinosoglou K, Gogos C, Armaganidis A, Giamarellos-Bourboulis EJ. Macrophage activation-like syndrome: an immunological entity associated with rapid progression to death in sepsis. BMC Med 2017; 15:172. [PMID: 28918754 PMCID: PMC5603161 DOI: 10.1186/s12916-017-0930-5] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 08/10/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A subanalysis of a randomized clinical trial indicated sepsis survival benefit from interleukin (IL)-1 blockade in patients with features of the macrophage activation-like syndrome (MALS). This study aimed to investigate the frequency of MALS and to develop a biomarker of diagnosis and prognosis. METHODS Patients with infections and systemic inflammatory response syndrome were assigned to one test cohort (n = 3417) and a validation cohort (n = 1704). MALS was diagnosed for patients scoring positive either for the hemophagocytic syndrome score and/or having both hepatobiliary dysfunction and disseminated intravascular coagulation. Logistic regression analysis was used to estimate the predictive value of MALS for 10-day mortality in both cohorts. Ferritin, sCD163, IL-6, IL-10, IL-18, interferon gamma (IFN-γ), and tumor necrosis factor alpha (TNF-α) were measured in the blood the first 24 h; ferritin measurements were repeated in 747 patients on day 3. RESULTS The frequency of MALS was 3.7% and 4.3% in the test and the validation cohort, respectively. In both cohorts, MALS was an independent risk factor for 10-day mortality. A ferritin level above 4420 ng/ml was accompanied by 66.7% and 66% mortality after 28 days, respectively. Ferritin levels above 4420 ng/ml were associated with an increase of IL-6, IL-18, INF-γ, and sCD163 and a decreased IL-10/TNF-α ratio, indicating predominance of pro-inflammatory phenomena. Any less than 15% decrease of ferritin on day 3 was associated with more than 90% sensitivity for unfavorable outcome after 10 days. This high mortality risk was also validated in an independent Swedish cohort (n = 109). CONCLUSIONS MALS is an independent life-threatening entity in sepsis. Ferritin measurements can provide early diagnosis of MALS and may allow for specific treatment.
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Affiliation(s)
- Evdoxia Kyriazopoulou
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece
| | - Konstantinos Leventogiannis
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece
| | - Anna Norrby-Teglund
- Department for Infectious Diseases and Center for Infectious Medicine, Karolinska Institute, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Georgios Dimopoulos
- 2nd Department of Critical Care Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Pantazi
- 2nd Department of Internal Medicine, Thriasion Elefsis General Hospital, Elefsina, Greece
| | - Stylianos E Orfanos
- 2nd Department of Critical Care Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikoletta Rovina
- 1st Department of Pulmonary Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Iraklis Tsangaris
- 2nd Department of Critical Care Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Theologia Gkavogianni
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece
| | - Elektra Botsa
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece
| | | | - Anastasia Kotanidou
- 1st Department of Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Kontouli
- Intensive Care Unit, "Agios Dimitrios" General Hospital, Thessaloniki, Greece
| | | | - Dimitrios Velissaris
- Department of Internal Medicine, University of Patras, Medical School, Patras, Greece
| | - Athina Savva
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece
| | - Jonas-Sundén Cullberg
- Department for Infectious Diseases and Center for Infectious Medicine, Karolinska Institute, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Karolina Akinosoglou
- Department of Internal Medicine, University of Patras, Medical School, Patras, Greece
| | - Charalambos Gogos
- Department of Internal Medicine, University of Patras, Medical School, Patras, Greece
| | - Apostolos Armaganidis
- 2nd Department of Critical Care Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos J Giamarellos-Bourboulis
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece.
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