Petros Bakakos

National and Kapodistrian University of Athens, Athínai, Attica, Greece

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Publications (39)143.65 Total impact

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    ABSTRACT: Clara cell secretory protein (CC16) is associated with Th2 modulation. Surfactant protein-D (SPD) plays an important role in surfactant homeostasis and eosinophil chemotaxis. We measured CC16 and SPD in sputum supernatants of 84 asthmatic patients and 12 healthy controls. In 22 asthmatics we additionally measured CC16 and SPD levels in BAL and assessed smooth muscle area (SMA), reticular basement membrane (RBM) thickness, and epithelial detachment (ED) in bronchial biopsies. Induced sputum CC16 and SPD were significantly higher in patients with severe asthma (SRA) compared to mild-moderate and healthy controls. BAL CC16 and SPD levels were also higher in SRA compared to mild-moderate asthma. CC16 BAL levels correlated with ED while SPD BAL levels correlated with SMA and RBM. Severity represented a significant covariate for these associations. CC16 and SPD levels are upregulated in SRA and correlate with remodeling indices, suggesting a possible role of these biomarkers in the remodeling process. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Allergy 03/2015; DOI:10.1111/all.12603 · 6.00 Impact Factor
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    ABSTRACT: Background Angiopoietin-1 (Ang-1) is an essential mediator of angiogenesis by establishing vascular integrity, whereas angiopoietin-2 (Ang-2) acts as its natural inhibitor.Objective We aimed to determine the levels of angiopoietins in sputum supernatants of patients with optimally treated asthma and to investigate whether smoking represents a significant covariate on the above possible processes.Methods Eighty-seven patients with asthma (42 smokers) and 28 healthy subjects (14 smokers) were studied. All subjects underwent lung function tests, bronchial hyperresponsiveness assessment and sputum induction for cell count identification and measurement of Ang-1, Ang-2, VEGF, TGF-β1, MMP-2, IL-13, ECP, and IL-8 in supernatants. Airway vascular permeability (AVP) index was also assessed.ResultsAng-1 (ng/ml) levels were significantly higher in patients with asthma compared to normal subjects. Smoking significantly increased Ang-1 levels [median, interquartile ranges 24(13-37) in smoking asthmatics vs. 10 (7-14) in non smoking asthmatics vs. 5.3(3.7-6.5) and 4.6 (3.8-5.7) in healthy smokers and non smokers respectively, p<0.001]. Similar results were observed for Ang-2 (pg/ml) [168 (132-203) vs 124 (82-152) vs 94(78-113) vs 100 (96-108) respectively, p<0.001]. Regression analysis in the whole study population showed a significant negative association for Ang-1 with AVP index, and MMP-2. Smoking was a significant covariate for both Ang-1& Ang-2 in asthmatic patients.Conclusions Ang-1 & Ang-2 levels are up regulated in patients with optimally treated asthma. Our data support a possible role for smoking in the angiogenetic process in asthma.This article is protected by copyright. All rights reserved.
    European Journal of Clinical Investigation 11/2014; 45(1). DOI:10.1111/eci.12379 · 3.37 Impact Factor
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    ABSTRACT: ABSTRACT Osteopontin (OPN) is a phosphorylated acidic glycoprotein that can function both as an extracellular matrix molecule and a cytokine. Recently published data support that OPN is up-regulated in surgical lung tissue samples of COPD patients.The aim of this study was to determine the levels of OPN in sputum supernatants of COPD patients and to investigate possible associations with mediators and cells involved in the inflammatory and remodeling process, as well as with the extent of emphysema.Seventy-seven COPD patients and 40 healthy subjects (20 smokers) were studied. All subjects underwent lung function tests, sputum induction for cell count identification and OPN, TGF-β1, MMP-2, IL-8, LTB4 measurement in sputum supernatants. High resolution computed tomography (HRCT) of the chest was performed for quantification of emphysema.OPN levels (pg/ml) were significantly higher in COPD patients compared to healthy smokers and non-smokers [median (IQR) 1340 (601,6227) vs. 101(77,110) vs. 68 (50,89) respectively, p<0.001]. Regression analysis showed a significant association between OPN and sputum neutrophils, IL-8, MMP-2 and the extent of emphysema. The above associations were not observed in healthy subjects.OPN levels are higher in COPD patients compared to healthy subjects. OPN may play a role in the neutrophilic inflammation and in the pathogenesis of emphysema.
    Chest 06/2014; 146(4). DOI:10.1378/chest.13-2440 · 7.13 Impact Factor
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    ABSTRACT: To examine the clinical usefulness of heart rate recovery (HRR) post 6-minute walking test (6MWT) as a simple marker of cardiovascular risk in obstructive sleep apnea (OSA) patients in comparison to HRR post cycle ergometry, the validated and more sophisticated protocol. Seventy-four participants underwent full overnight polysomnography, cycle ergometry and 6MWT. The HRR at 1, 2 and 3 min (HRR-1, HRR-2 and HRR-3) 6MWT was compared to HRR at 1, 2, and 3 min post cycle ergometry in normal subjects and in moderate and severe OSA patients before and after 6-month CPAP treatment. The HRR-1, HRR-2 and HRR-3 in 6MWT were significantly different between normal, moderate and severe OSA patients with higher rates achieved in normal. The higher the severity of OSA the lower the HRR was. There were also no differences found between work rate and distance walked during cycle ergometry or 6MWT, respectively, concerning normal, moderate and severe OSA patients. Heart rate recovery was further associated with minimum saturation of oxygen during sleep independently of the duration of apnea episodes of BMI and ESS. The treatment with CPAP had a beneficial effect on HRR both post-6MWT and post cycle ergometry. Autonomic nervous system dysfunction in OSA can be found even with submaximal exertion. Heart rate recovery post-6MWT, such as HRR post cycle ergometry, was significantly impaired in OSA patients in comparison to normals and was favorably influenced from CPAP treatment. Furthermore, it was found to be more sensitive compared with distance walked in 6MWT in discriminating severity of OSA. The HRR post-6MWT was found to be an easily measured and reliable marker of OSA severity both before and after CPAP treatment.
    Clinical Research in Cardiology 05/2014; 103(10). DOI:10.1007/s00392-014-0721-3 · 4.17 Impact Factor
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    ABSTRACT: On 18 April 2014, a case of Middle East Respiratory Syndrome coronavirus (MERS-CoV) infection was laboratory confirmed in Athens, Greece in a patient returning from Jeddah, Saudi Arabia. Main symptoms upon initial presentation were protracted fever and diarrhoea, during hospitalisation he developed bilateral pneumonia and his condition worsened. During 14 days prior to onset of illness, he had extensive contact with the healthcare environment in Jeddah. Contact tracing revealed 73 contacts, no secondary cases had occurred by 22 April.
    Eurosurveillance: bulletin europeen sur les maladies transmissibles = European communicable disease bulletin 04/2014; Euro Surveill(19 (16)):20782. DOI:10.2807/1560-7917.ES2014.19.16.20782 · 4.66 Impact Factor
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    ABSTRACT: COPD PostersSESSION TYPE: Poster PresentationsPRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PMPURPOSE: Adherence to treatment is an important and critical issue in patients with COPD. The purpose of this study is to examine psychological dimensions and to describe the psychological profile of stable COPD patients who comply and of those who do not comply with treatment strategies. In a previous study of 100 stable COPD patients (79 males; age 62±9 years; FEV1 46±11 %pred), we attempted to prognosticate the individual patient's motivation and compliance to our 25-session 3-month pulmonary rehabilitation (PR) program, based on smoking history and addiction to nicotine for every single patient (Kosmas E et al. Am J Respir Crit Care Med 2013; 187: A5131). We found that, among the general group of COPD patients, there are 2 distinct subgroups of patients: 1) Highly motivated patients [HM group; 26 patients, heavy ex-smokers (>40 pack-years) who succeeded to quit smoking despite their severe addiction to nicotine (Fagerstrom scale FS 7-10) and who participated in 23±2 PR sessions], and 2) Less motivated patients [LM group; 29 patients, current smokers despite their non-severe addiction to nicotine (FS 0-6), who participated in only 13±3 PR sessions]. Using as an instrument the Symptom Checklist-90-R (SCL-90-R), a 90-item self-reported psychometric questionnaire, we attempted to desribe possibly different psychological profiles between HM group with high level of adherence and LM group with low level of adherence to PR program. We found that HM patients had significantly higher scoring, as compared to LM patients, in the following scales of SCL-90-R: somatization (0.92±0.11 vs 0.68±0.13 respectively; p<0.01), obsessive-compulsive (0.88±0.14 vs 0.71±0.12; p<0.01), anxiety (0.73±0.09 vs 0.43±0.10; p<0.001) and phobic anxiety (0.27±0.05 vs 0.20±0.04; p=0.04). On the other hand, the LM patients presented significantly higher scoring in depression (0.99±0.17 vs 0.55±0.11; p<0.001) and hostility (0.53±0.08 vs 0.31±0.07; p<0.001). There was not any difference regarding interpersonal sensitivity, paranoid ideation and psychoticism scale. The level of patients' motivation to battle against COPD and to comply or not to difficult therapeutic tasks, such as smoking cessation and pulmonary rehabilitation, is closely related to the psychological profile of patients. Psychometry and psychological evaluation of COPD patients is necessary in order to tailor our approach towards every individual patient's needs more effectively. The following authors have nothing to disclose: Epameinondas Kosmas, Athanassios Tselebis, Dionissios Bratis, Silvia Dumitru, Elpida Theodorakopoulou, Maria Harikiopoulou, Konstantinos Velentzas, Petros Bakakos, Nachman Alchanatis, Nikolaos KoulourisNo Product/Research Disclosure Information.
    Chest 03/2014; 145(3 Suppl):377A. DOI:10.1378/chest.1829814 · 7.13 Impact Factor
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    Eurosurveillance: bulletin europeen sur les maladies transmissibles = European communicable disease bulletin 01/2014; 19(16). · 4.66 Impact Factor
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    ABSTRACT: Abstract Background and Objective: Angiopoietin-2 (Ang-2) is an important mediator of angiogenesis and has been implicated in many inflammatory diseases. COPD is characterized by systemic inflammation, which is enhanced during exacerbations and may be assessed by measuring serum C-reactive protein (CRP). The aim of the study was to evaluate serum CRP and Ang-2 levels on the first (D1) and seventh day (D7) of hospitalization due to a COPD exacerbation and to examine possible associations of CRP and Ang-2 levels and kinetics with the length of hospital stay and outcome. Methods: We conducted a prospective study and evaluated 90 patients admitted to the hospital with a diagnosis of an acute exacerbation of COPD. A venous blood sample was obtained from all patients on D1 and D7 of hospitalization, for the measurement of Ang-2 and CRP. Results: Serum Ang-2 levels were significantly higher on D1 compared to D7 during the course of COPD exacerbation (p < 0.001). Serum CRP levels were also significantly higher on D1 compared to D7 (p < 0.001). Serum Ang-2 presented a significant positive correlation with CRP levels both on D1 and D7 (r = 0.315 and r = 0.228, respectively). Patients with unfavorable outcome had significantly higher Ang-2 levels both on D1 (p = 0.04) and D7 (p = 0.01). Conclusions: Serum Ang-2 levels are elevated at the onset of COPD exacerbations and are positively associated with CRP levels. Ang-2 levels decrease during the course of COPD exacerbations in patients with favorable outcome. Serum Ang-2 may serve as a biomarker that could predict the outcome of a COPD exacerbation.
    COPD Journal of Chronic Obstructive Pulmonary Disease 10/2013; DOI:10.3109/15412555.2013.829436 · 2.73 Impact Factor
  • COPD Journal of Chronic Obstructive Pulmonary Disease 10/2013; 10(5):557-9. DOI:10.3109/15412555.2013.832092 · 2.73 Impact Factor
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    ABSTRACT: Vascular endothelial growth factor (VEGF) is considered to be the most important angiogenic factor in asthma. Cysteinyl leukotrienes (Cyst-LTs) have been implicated in vascular permeability in asthma. Cyst-LTs receptor antagonists modulate vascular permeability by reducing VEGF expression. We aimed to determine the levels of VEGF and Cyst-LTs in sputum supernatants of patients with asthma and to investigate possible associations within them and with airway vascular permeability (AVP) index. Possible confounding factors were also assessed. One hundred twenty one patients with asthma (38 with severe refractory asthma, 41 smokers) and 30 healthy subjects (15 smokers) were studied. All subjects underwent lung function tests, and sputum induction for cell count identification and VEGF, Cyst-LTs, measurement in supernatants. AVP index was also assessed. Both VEGF & Cyst-LTs (pg/ml) levels were significantly elevated in patients with asthma compared to normal subjects (median, interquartile ranges 845 [487-1034] vs. 432 (327-654) and 209 [171-296] vs. 92 [75-114] respectively, p < 0.001 for both). Multivariate regression analysis in the whole group showed a significant association of Cyst-LTs levels in sputum supernatants with VEGF levels in sputum supernatants and AVP index. A similar positive association was observed between VEGF levels in sputum supernatants and AVP index. The presence of Severe asthma was a significant covariate for both associations. Our results indicate that Cyst-LTs may modulate vascular permeability by up-regulating VEGF expression. The above effect seems to be affected by asthma severity.
    Respiratory medicine 07/2013; DOI:10.1016/j.rmed.2013.06.014 · 2.33 Impact Factor
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    ABSTRACT: BACKGROUND: Smoking is associated with worse asthma outcomes and may modify airway inflammation. Such modification may be mediated through an effect on prostaglandin E2 (PGE2 ) and cysteinyl leukotrienes (Cyst-LTs). OBJECTIVE: We aimed to determine the levels of both PGE2 and Cyst-LTs in sputum supernatants of patients with asthma and to investigate the effect of smoking habit as well as their associations with inflammatory cells, bronchial hyperresponsiveness (BHR) and lung function. METHODS: Ninety-eight patients to asthma (47 smokers) and 40 healthy subjects (20 smokers) were studied. All subjects underwent sputum induction for cell count identification, PGE2 and Cyst-LTs levels measurement in supernatants, pulmonary function tests and BHR to methacholine. RESULTS: Patients with asthma had significantly higher levels of both Cyst-LTs and PGE2 in sputum supernatants compared to healthy subjects [median (interquartile ranges) 432 (287, 575) vs. 91.5 (73.5, 111) pg/mL and 654 (456,789) vs. 117.5 (92,157) pg/mL, respectively, P < 0.001 for both comparisons]. Smoking asthmatics had significantly higher Cyst-LTs and PGE2 levels compared to non-smoking asthmatics. Cyst-LTs levels in sputum supernatant of smoking asthmatics presented a significant positive association with sputum eosinophils, while PGE2 levels were positively associated with sputum neutrophils. CONCLUSIONS: The increased concentrations of PGE2 and Cyst-LTs in sputum supernatants of smoking asthma are consistent with an up-regulation of these two mediators in this specific phenotype of asthma. Furthermore, Cyst-LTs are associated with eosinophilic inflammation, while PGE2 is associated with the presence of neutrophilic inflammation in smoking asthma.
    Clinical & Experimental Allergy 06/2013; 43(6):616-624. DOI:10.1111/cea.12077 · 4.32 Impact Factor
  • Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 05/2013; 110(5):316-21. DOI:10.1016/j.anai.2012.12.026 · 2.75 Impact Factor
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    ABSTRACT: BACKGROUND: A variety of studies have demonstrated improvement in quality of life and depressive symptoms in obstructive sleep apnea (OSA) patients after continuous positive airway pressure (CPAP) treatment. However, very little is known about the effect of OSA treatment on physical activity and energy consumption. OBJECTIVES: The aim of this study was to evaluate the changes in depression, physical activity, energy expenditure, and quality of life (QoL) in OSA patients before and after CPAP therapy. METHODS: Forty-one patients with OSA as revealed by polysomnography, were included to the study. They responded to the generic World Health Organization Quality of Life (WHOQoL) questionnaire, to the specific-disease Quebec Sleep Questionnaire, and to Center for Epidemiologic Studies Depression Scale (CES-D) in order to evaluate QoL and the incidence of depression. In addition, all patients wore an accelerometer which measured physical activity and energy expenditure during a week. At least 6 months after initiation of CPAP treatment (mean time, 9 months) we re-examined 24 patients who met the compliance with the treatment criteria. RESULTS: Patients after CPAP therapy had significantly higher scores in all domains of the Quebec Sleep Questionnaire and in the domains of physical health/level of independence and psychological health/spirituality of the WHOQoL. Depression scores were also better in CES-D after treatment. However, despite the improvement in QoL and psychological status, CPAP therapy had no impact on physical activity and energy expenditure. CONCLUSIONS: CPAP therapy improves QoL and lessens depressive symptoms in our group of well-treated OSA patients. However, physical activity and energy expenditure did not present statistically significant improvement in the same group of OSA patients.
    Sleep And Breathing 02/2013; 17(4). DOI:10.1007/s11325-013-0815-6 · 2.26 Impact Factor
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    ABSTRACT: Chronic obstructive pulmonary disease (COPD) is a complex, multicomponent disease at the clinical, cellular, and molecular levels. Over the past few years there has been a growing interest in the field of biomarkers in COPD and a large number of studies have evaluated potential candidate molecules in different patient settings. Data on systemic biomarkers from large cohorts, including the well-characterized population of the ECLIPSE study, are now available and provide exciting information on the association of biomarkers with clinically important outcomes, including exacerbations, hospitalizations and mortality. Moreover, recent research has provided proof for the existence of distinct "systemic inflammatory" phenotypes. This review summarizes the currently available evidence on systemic biomarkers in COPD, providing clinically relevant information on the possible role of systemic biomarkers in the evaluation of disease activity and severity, phenotypes, outcomes, COPD exacerbations and treatment response and guidance. Despite the fact that no single biomarker is currently ready to characterize sufficiently the status of COPD patients, guide treatment options, and predict future events, our current knowledge is definitely more advanced than a few years ago and the future of biomarkers looks even more promising.
    Current drug targets 12/2012; DOI:10.2174/1389450111314020005 · 3.93 Impact Factor
  • Current drug targets 12/2012; · 3.93 Impact Factor
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    ABSTRACT: Smoking may modify the inflammatory pattern of the asthmatic airways. Osteopontin (OPN) has been associated with inflammation and fibrosis. In asthma, sputum levels of OPN are elevated and have been related to the underlying severity and to mediators expressing remodeling and inflammation. To evaluate the levels of OPN in sputum supernatants of asthmatic patients and to investigate the possible role of smoking as well as associations with mediators and cells involved in the inflammatory and remodeling process. We studied 103 asthma patients (49 smokers) and 40 healthy subjects (20 smokers) who underwent lung function tests, bronchial hyperresponsiveness to methacholine, and sputum induction for cell count identification and measurement of OPN, TGF-β1, IL-8, IL-13 and ECP in sputum supernatants. The concentrations of all mediators were measured using enzyme immunoassays. OPN levels (pg/ml) were significantly higher in smoking asthmatics compared to non-smoking asthmatics, and both non-smoking and smoking controls [median (interquartile ranges) 1120 (651,1817) vs. 197 (118,341) vs. 50 (42,70) vs. 102 (77,110)pg/ml, respectively; p<0.001]. Regression analysis provided significant associations between OPN and sputum neutrophils, IL-8 and TGF-β1, the most significant being the one with TGF-β1. These associations were present only in smoking asthmatics. Smoking habit significantly affects sputum OPN levels in asthma. The associations of OPN with sputum neutrophils, TGF-β1 and IL-8 in smoking asthmatics suggest a possible role for OPN in the neutrophilic inflammation and remodeling process in this phenotype of asthma.
    Cytokine 10/2012; DOI:10.1016/j.cyto.2012.10.002 · 2.87 Impact Factor
  • American Thoracic Society 2012 International Conference, May 18-23, 2012 • San Francisco, California; 05/2012
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    ABSTRACT: Pathological features of chronic obstructive pulmonary disease (COPD) include lung vascular remodeling and angiogenesis. Angiopoietin-1 (Ang-1), is an essential mediator of angiogenesis by establishing vascular integrity, whereas angiopoietin-2 (Ang-2) acts as its natural inhibitor. We determined the levels of angiopoietins in sputum supernatants of patients with COPD and investigated their possible association with mediators and cells involved in the inflammatory and remodeling process. Fifty-nine patients with COPD, 25 healthy smokers and 20 healthy non-smokers were studied. All subjects underwent lung function tests, sputum induction for cell count identification and Ang-1, Ang-2, VEGF, TGF-β1, MMP-2, LTB4, IL-8, albumin measurement in sputum supernatants. Airway vascular permeability (AVP) index was also assessed. Ang-2 levels were significantly higher in patients with COPD compared to healthy smokers and healthy non-smokers [median, interquartile ranges pg/ml, 267 (147-367) vs. 112 (67-171) and 98 (95-107), respectively; p<0.001]. Regression analysis showed a significant association between Ang-2 levels and AVP index, VEGF, IL-8 and MMP-2 levels in COPD, the strongest being with VEGF. Our results indicate that induced sputum Ang-2 levels are higher in COPD compared to healthy smokers and healthy non-smokers. Moreover, Ang-2 is associated with AVP, IL-8, MMP-2, and VEGF, indicating a possible role for Ang-2 in the pathogenesis of the disease.
    Cytokine 04/2012; 58(3):455-60. DOI:10.1016/j.cyto.2012.03.007 · 2.87 Impact Factor
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    ABSTRACT: Airway and vascular remodeling may play a prominent role in the clinical severity of severe refractory asthma (SRA). Angiopoietin-1 (Ang-1) is an essential mediator of angiogenesis by establishing vascular integrity, whereas angiopoietin-2 (Ang-2) acts as its natural inhibitor. We aimed to determine the levels of angiopoietins in sputum supernatants of patients with SRA and to investigate the possible associations with mediators and cells involved in both the inflammatory and the vascular remodeling processes. Thirty-eight patients with SRA, 35 patients with moderate asthma, and 20 healthy subjects were studied. All participants underwent lung function tests, bronchial hyperresponsiveness assessment and sputum induction for cell count identification and Ang-1, Ang-2, VEGF, TGF-β1, Cys-LTs, MMP-2, IL-13, ECP, and IL-8 measurement in supernatants. Airway vascular permeability (AVP) index was also assessed. Ang-1 (ng/ml) and Ang-2 (pg/ml) levels were significantly elevated in patients with SRA compared with patients with moderate asthma and control subjects [median, interquartile ranges: 30 (17-39) vs 7.5 (5-11) vs 4.7 (3.8-5.9) respectively, P < 0.001; and 506 (400-700) vs 190 (146-236) vs 96 (89-120) respectively, P < 0.001]. Regression analysis showed a significant positive association between Ang-2 and AVP index, MMP-2, Ang-1, and VEGF in SRA. A weak association was also observed between Ang-1 and sputum eosinophils% in SRA. Our results indicate that both angiopoietins levels are higher in SRA compared with moderate asthma and healthy subjects. In SRA, Ang-2 is associated with mediators involved in both the inflammatory and the vascular remodeling processes.
    Allergy 03/2012; 67(3):396-402. DOI:10.1111/j.1398-9995.2011.02768.x · 6.00 Impact Factor
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    ABSTRACT: COPD is a multicomponent disease and systemic inflammation represents one of the possible mechanisms responsible for its systemic manifestations, including skeletal muscle weakness and cachexia. Fat-free mass index (FFMI) that reflects the skeletal muscle mass, has been shown to be associated with both dyspnoea and exercise capacity. We hypothesized that the multidimensional BODE index, that reflects the multicomponent nature of COPD, might be related to biomarkers of systemic inflammation. We further evaluated associations between FFMI and systemic inflammation. BODE index and FFMI were calculated in 222 stable COPD patients and 132 smokers or ex-smokers with normal lung function. Systemic inflammation was evaluated with the measurement of leptin, adiponectin, CRP, IL-6, and TNF-α in serum samples of COPD patients. In patients with COPD, both BODE index and FFMI presented significant positive and negative associations respectively with leptin levels (R(2) 0.61 and 0.65, respectively), whereas FFMI presented an additional negative association with the levels of TNF-α (R(2) 0.38). No significant associations were observed in smokers or ex-smokers with normal lung function. Both BODE index and FFMI, are related to the circulating levels of leptin in patients with COPD, suggesting a possible role for leptin in the systemic component of COPD. The additional association of FFMI with TNF-α may further support a role of systemic inflammation in muscle wasting in COPD.
    COPD Journal of Chronic Obstructive Pulmonary Disease 12/2011; 8(6):408-13. DOI:10.3109/15412555.2011.619599 · 2.73 Impact Factor

Publication Stats

229 Citations
143.65 Total Impact Points

Institutions

  • 2011–2015
    • National and Kapodistrian University of Athens
      • Department of Medicine
      Athínai, Attica, Greece
    • University of Thessaly
      • Πνευμονολογική Κλινική
      Iolcus, Thessaly, Greece
  • 2008–2013
    • Νοσοκομείο Σωτηρία
      Athínai, Attica, Greece
  • 2010
    • Harokopion University of Athens
      Athínai, Attica, Greece