George N Dalekos

University of Thessaly, Iolcus, Thessaly, Greece

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Publications (171)722.85 Total impact

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    ABSTRACT: Background & AimsWe assessed predictors of response in HBeAg-negative chronic hepatitis B patients treated with peginterferonalfa-2a in routine clinical practice.Methods Ninety-five HBeAg-negative patients receivedpeginterferonalfa-2a for 48 weeks and were followed-up for 48 weeks post-treatment. Serum HBsAg and HBV DNA levels were monitored during and after therapy with valid commercial assays. Sustained response (SR) was defined as HBV DNA <2,000 IU/mL at study week 96.ResultsTwenty-two patients (23%) achieved SR and nine (9.5%) lost HBsAg. HBsAg decline was more profound in patients with SR. HBsAg decline ≥ 10% from baseline to week 24 was significantly associated with SR (81% [17/21] vs 37% [21/57]; Odds Ratio:7.286 [2.162–24.552], P=0.001). The PARC rule (no decrease in HBsAg and <2 log drop in HBV DNA at week 12) was evaluated in a subset of 47 patients. Among eight patients who fulfilled the PARC rule, none achieved SR. Of the 39 patients who did not fulfill the PARC rule, 24 (62%) had HBsAg decline of ≥10% at week 24 (12 achieved SR) and 15 (38%) had HBsAg decline of <10% (1 achieved SR; negative predictive value: 93%).Conclusions In HBeAg-negative chronic hepatitis B patients treated with peginterferon alfa-2a, HBsAg decline>10% at 24 weeks is significantly associated with SR. The combination of the PARC rule and week 24 decline in HBsAg can identify almost two-thirds of patients who are unlikely to achieve SR.This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 11/2014; · 3.87 Impact Factor
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    ABSTRACT: Background/Aims The risk of hepatocellular carcinoma (HCC) in Caucasian patients with chronic hepatitis B (CHB) treated with entecavir (ETV) or tenofovir (TDF) is unclear. We evaluated the incidence and predictors of HCC and the accuracy of existing HCC risk scores in Caucasian CHB patients receiving ETV/TDF. Methods This large, multicenter, retrospective cohort study included 1666 adult Caucasian CHB patients under ETV/TDF for 39 months. CHB without cirrhosis, compensated and decompensated cirrhosis were present in 67%, 39% and 3% of patients. The predictability of baseline parameters and three risk scores (GAG-HCC, CU-HCC and REACH-B) developed in Asians was assessed. Results The cumulative probability of HCC was 1.3%, 3.4% and 8.7% at year-1, year-3 and year-5 after ETV/TDF onset. Older age and lower platelets were strong independent HCC predictors in the total population and in the subgroups of cirrhotic and non-cirrhotic patients, while liver disease severity was an independent HCC predictor in the total population and the cirrhotics. GAG-HCC, CU-HCC and REACH-B risk scores were associated with HCC development only in the univariable but not in the multivariable analyses and offered poor to modest predictability. Conclusions HCC can still develop in Caucasian CHB patients treated with ETV/TDF. Besides the well known predictors of HCC, such as older age, male gender and more advanced liver disease, lower platelets represent an independent factor of higher HCC risk. The applicability and predictability of HCC risk scores developed in Asians are poor or modest in Caucasian CHB patients, for whom different risk scores are required.
    Journal of Hepatology 09/2014; · 9.86 Impact Factor
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    ABSTRACT: Objective To estimate oxidative stress and antioxidant components during different stages of autoimmune liver diseases and assess their possible implication on disease progression. Methods We determined several markers of oxidative injury (isoprostane, aldehydes, protein carbonyls, 3-nitrotyrosine, and myeloperoxidase) and antioxidant components (glutathione, glutathione peroxidase, glutathione reductase, superoxide dismutase, and catalase) in whole blood, serum, and urine in 49 patients with autoimmune cholestatic liver diseases (AC) and 36 patients with autoimmune hepatitis (AIH) and healthy subjects matched for sex and age. Results Both AC and AIH patients had increased levels of all lipid and protein oxidative injury products and significantly decreased whole blood glutathione levels compared to controls. AIH patients had significantly higher levels of aldehydes and glutathione peroxidase activity and significantly lower protein carbonyl levels compared to AC patients. Protein carbonyl and isoprostane levels increased and glutathione levels decreased gradually with progression from mild fibrosis to severe fibrosis and cirrhosis in both AC and AIH patients. In addition, both cirrhotic AC and AIH patients had significantly higher protein carbonyls compared to non-cirrhotics. Discussion We provide novel findings in support of a major contribution of oxidant/antioxidant imbalance in the progression of liver injury in AC and AIH.
    Redox report: communications in free radical research 08/2014; · 1.51 Impact Factor
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    ABSTRACT: Background Antibodies (Abs) to soluble liver antigen/liver pancreas (anti-SLA/LP) are considered markers of worse prognosis and outcome in patients with autoimmune hepatitis (AIH) although this assumption has recently been attributed to their frequent co-expression with Abs against Ro52 (anti-Ro52).AimsTo assess the clinical significance of anti-SLA/LP Abs alone or in combination with anti-Ro52 in AIH patients and determine the immunodominant Ro52 epitopes according to the anti-SLA/LP status.Methods23 anti-SLA/LP-positive and 106 anti-SLA/LP-negative AIH patients were included. Anti-SLA/LP were determined by ELISA using recombinant antigen, and confirmed by immunoblot using cytosolic rat liver fraction or HuH-7 extract. Anti-Ro52 Abs were determined by ELISA using recombinant antigen. Epitope mapping was assessed by ELISA using overlapping peptides covering the whole Ro52 protein in 26 AIH patients and 12 patients with Sjögren's syndrome.ResultsAnti-SLA/LP positivity was not associated with the clinical, laboratory or histological characteristics of AIH patients. Treatment response, corticosteroid withdrawal, relapse after stopping treatment and outcome, were not associated with the presence of anti-SLA/LP, anti-Ro52 or double reactivity. Moreover, Ro52 epitope mapping revealed new epitopes unique for AIH and independent from anti-SLA/LP positivity.Conclusions Neither anti-SLA/LP nor anti-Ro52 Abs or their combination could specify a distinct group of AIH patients in terms of clinical characteristics, treatment response and outcome. Further studies are needed in order to clarify whether the newly discovered immunodominant epitopes of Ro52 antigen which were associated specifically with AIH have any clinical or pathogenetic significance in AIH.This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 08/2014; · 3.87 Impact Factor
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    ABSTRACT: Hepatocellular carcinoma (HCC) may still develop in chronic hepatitis B (CHB) patients treated with lamivudine. Whether HCC rates are comparable in patients treated with the current first-line antivirals remains uncertain. We estimated the incidence and evaluated predictors of HCC in a large nationwide prospective cohort (HepNet.Greece) of HBeAg-negative CHB patients treated with entecavir. HBeAg-negative CHB patients from the same cohort who were initially treated with lamivudine were used as controls. We included 321 patients treated with entecavir for a median of 40 months and 818 patients treated initially with lamivudine for a median of 60 months. In the entecavir group, HCC developed in 4 of 321 (1.2%) patients at a median of 1.5 (range: 1.0–4.5) years, while the cumulative HCC incidence was significantly higher in cirrhotics than noncirrhotics (1, 3, 5 years: 0%, 3%, 9% vs 1%, 1%, 1%; P = 0.024) and in older patients (P = 0.026). Entecavir compared with lamivudine group patients had lower HCC incidence (1, 3, 5 years: 0.3%, 1.2%, 2.8% vs 0.7%, 3.8%, 5.6%; P = 0.024). However, in multivariable Cox regression analysis, the HCC risk was independently associated with older age (P < 0.001), male gender (P = 0.011) and cirrhosis (P = 0.025), but not with the initial agent. In conclusion, our large nationwide study indicates that the HCC risk remains increased in entecavir-treated HBeAg-negative CHB patients with cirrhosis, particularly of older age, at least for the first 5 years. The HCC risk does not seem to be significantly reduced with entecavir compared with antiviral therapy starting with lamivudine.
    Journal of Viral Hepatitis 07/2014; · 3.08 Impact Factor
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    ABSTRACT: Hepatitis C virus (HCV) infection is a global health problem that affects more than 170 million people worldwide. It is a major cause of cirrhosis and hepatocellular carcinoma, making the virus the most common cause of liver failure and transplantation. The standard-of-care treatment for chronic hepatitis C (CHC) has been changed during the last decade and direct acting antiviral drugs have already been used. Besides, understanding of the pathogenesis of CHC has evolved rapidly during the last years and now several host factors are known to affect the natural history and response to treatment. Recent genome-wide association studies have shown the important role of interleukin-28B and inosine triphosphatase in HCV infection. The present review article attempts to summarize the current knowledge on the role of host factors towards individualization of HCV treatment.
    World Journal of Gastroenterology 03/2014; 20(11):2839-2853. · 2.55 Impact Factor
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    ABSTRACT: Interferon alpha is the only treatment option for hepatitis delta. Trials investigating the efficacy of pegylated interferon alfa (PEG-IFNa) showed HDV RNA negativity rates of 25-30% 24 weeks after therapy. However, the clinical and virological long-term outcome of HDV-infected patients treated with PEG-IFNa is unknown. We performed a retrospective-prospective follow-up of 77 patients treated for 48 weeks with either PEG-alfa-2a and adefovir (ADV) or either drug alone in the HIDIT-1 trial. Long-term follow-up data was available for 58 out of 77 patients (75%) with a median time of follow-up of 4.5 (0.5-5.5) years and in median 3 visits per patient. Patients treated with ADV alone received re-treatment with PEG-IFNa (48% vs. 19%; p=0.02) more often. HBsAg became negative in 6 PEG-IFNa-treated patients until end of long-term follow-up (10%). 16 patients tested HDV RNA-negative 6 months after PEG-IFNa treatment entered the long-term follow-up study. Out of these, 9 individuals tested HDV RNA-positive at least once during further long-term follow-up with 7 patients being HDV RNA-positive at the most recent visit. Clinical endpoints (liver-related death, liver transplantation, hepatic decompensation, hepatocellular carcinoma) were observed in 3 PEG-IFNa-treated (8%) and 3 ADV-treated (14%) patients during post-treatment long-term follow-up with an overall annual event rate of 2.5% (4.9% in cirrhosis). Sequencing confirmed re-appearance of pre-treatment virus strains in all cases. Conclusions: Late HDV RNA relapses may occur after PEG-IFNa therapy of hepatitis delta and thus the term SVR should be avoided in HDV infection. The annual post-treatment rate of clinical events in hepatitis delta patients eligible for PEG-IFNa therapy is about 2.5% and 4.9% in patients with cirrhosis. (Hepatology 2014;)
    Hepatology 02/2014; · 12.00 Impact Factor
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    ABSTRACT: Background Fusarium spp. can cause disseminated infections, particularly in immunocompromised patients. Fusarium verticilliodes is a human pathogen, and sporadic cases of fusariosis have been reported. Aim To report a nosocomial cluster of F. verticilliodes bloodstream infections among seven immunocompetent inpatients following reconstruction works. Methods Identification was performed using macroscopic and microscopic morphology, and molecular assays (sequencing the nuclear ribosomal internal transcribed spacer region and translation elongation factor-1α gene). Susceptibility testing was performed in accordance with the guidelines of the Clinical and Laboratory Standards Institute. Environmental surveillance specimens were taken and cultured on Sabouraud dextrose agar plates. Findings In total, 16 blood cultures obtained from the seven patients were positive for F. verticillioides. All surveillance cultures were negative. Conclusions In order to prevent fungaemia, it is important to implement effective infection control measures, before, during and after demolition and construction activities in healthcare settings.
    The Journal of hospital infection 01/2014; · 3.01 Impact Factor
  • Journal of Stroke and Cerebrovascular Diseases. 01/2014;
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    ABSTRACT: Immunohistochemical assessment of liver tissue in chronic delta hepatitis (CDH) is underinvestigated. Aim of the study was (i) to assess variables associated with hepatitis D antigen (HDAg), hepatitis B surface antigen (HBsAg) and hepatitis B core antigen (HBcAg) staining in the liver. Demographic, biochemical and virologic data collected from the HIDIT 1 study were used. HBsAg, HBcAg and HDAg immunohistochemical (IHC) staining was semiquantitatively assessed. Hepatitis D antigen immunohistochemical staining displayed positive correlations with age and alanine aminotransferase (ALT) and negative correlations with serum HBsAg (P = 0.01 for all). HBsAg IHC displayed a negative correlation with gamma glutamyl transferase and positive correlations with serum HBV DNA, serum HBsAg levels and HBeAg serology (P < 0.001, P = 0.02 and P = 0.007 respectively). HBcAg staining was mainly nuclear and displayed negative correlations with serum HBsAg and histologic activity (P = 0.002 and P = 0.02 respectively). Pegylated IFN based treatment led to a decline of all IHC markers, however, these markers had no impact on treatment outcome. These data suggest an association of liver injury with HDAg expression in CDH whereas the negative correlation between HBcAg expression and liver injury and the overall nuclear localization of HBcAg suggest that HBcAg does not contribute to liver injury in CDH. HDV cases with high level of HBV replication, high serum HBsAg levels, HBeAg positivity, that are probably in the earlier stages of disease (low gamma-glutamyl transferase), had a more intense HBsAg staining profile. Overall, the data enforce the importance of HDAg and HBsAg in different phases of CDH infection.
    Liver international: official journal of the International Association for the Study of the Liver 11/2013; · 3.87 Impact Factor
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    ABSTRACT: Background/Aims: HCC may still develop in patients under lamivudine (LAM) with or without adefovir rescue therapy, while the HCC risk under newer nucleos(t)ide analogues (NAs) is unclear, particularly in Caucasian patients. We evaluated the incidence and risk factors of HCC in a large, multicenter, cohort of predominantly Caucasian CHB patients treated with ETV or TDF. Methods: We included 1231 adult CHB patients (mean age 52±15 years, males 72%, Caucasians 98.5%) treated with ETV/TDF (ETV:530, TDF:369, TDF+LAM:307, TDF+ETV:25) for ≥12 months in 7 Hepatology centers. 664 (54%) were NAs naive [(Peg)IFN in the past:171], 433 (35%) had prior NAs resistance [(Peg)IFN:142) and 134 (11%) were NA(s) exposed without resistance [(Peg)IFN:16]. CHB without cirrhosis, compensated and decompensated cirrhosis were diagnosed in 780 (66%), 359 (30%) and 43 (4%) cases (disease severity unclassified:49). The predictability of baseline parameters and REACH-B (Lancet Oncol 2011;12:568–74) and GAG-HCC (J Hepatol 2009;50:80–8) scores was assessed. Mean follow-up was 39±17 months. Results: HCC developed in 52/1231 (4.2%) patients at a median of 17 (range:2-58) months after ETV/TDF onset. The cumulative 1-, 3-, 5-year HCC rates were higher in decompensated (11.6%, 23.8%, 29.7%) than compensated cirrhosis (2.5%, 5.8%, 20.9%) than CHB (0.8%, 1.2%, 2.5%) (log-rank: p<0.001 for all comparisons). In univariate analyses, the HCC risk was significantly associated with older age (HR/year: 1.07, p<0.001), lower platelets (HR/1000/mm3: 0.98, p<0.001), higher REACH-B (HR/unit: 1.13, p=0.022) or GAG-HCC score (HR/unit: 1.05, p<0.001) and relatively associated with male gender (HR: 2.05, p=0.062), higher BMI (HR/kg/m2: 1.07, p=0.052) and no history of (Peg)IFN (HR: 2.06, p=0.050), while it was not associated with country or center, past NAs exposure, prior resistance, baseline ALT, HBV DNA, HBeAg status, ETV or TDF, and on-therapy virological responses. HCC risk was associated with both REACH-B (p=0.030) and GAG-HCC score (p<0.001) in cirrhotics, but only with GAG-HCC score (p=0.035) in non-cirrhotics. In multivariate analyses, the HCC risk was independently associated only with lower platelets (HR/1000/mm3: 0.98, p=0.005) in non-cirrhotics and with older age (HR/year: 1.05, p=0.012), liver decompensation (HR: 2.78, p=0.019) and past NAs exposure (HR: 0.47, p=0.050) in cirrhotics. Conclusions: Data from this large mutlicenter study in predominantly Caucasian patients indicate that the HCC risk remains increased in ETV/TDF treated CHB patients, particularly those with advanced disease. The applicability of HCC risk scores developed in Asians seems to be modest in Caucasian CHB patients.
    AASLD 2013, Washington DC; 11/2013
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    ABSTRACT: To present the characteristics, management and outcome of patients with hepatitis B virus (HBV) or hepatitis C virus (HCV) infections concurrent with primary biliary cirrhosis (PBC). Since January 2001 to September 2009, we retrospectively evaluated the medical records of all HBV (n = 1493) and HCV patients (n = 526) who are followed in our center for the presence of concurrent PBC. Seventeen patients identified with concurrent viral hepatitis and PBC (8 HCV and PBC; follow-up: 61 ± 37 mo and 9 HBV and PBC; follow-up: 57 ± 38 mo). PBC diagnosis was established if the patients met at least two of the following criteria: positivity for antimitochondrial antibody, elevated cholestatic enzymes and histological lesions of PBC. HCV or HBV diagnosis preceded that of PBC in most patients by many years. PBC diagnosis was based on the presence of antimitochondrial antibody and elevated cholestatic enzymes in all 17 patients, while one third (5/17; 29.4%) experienced severe pruritus many years before diagnosis. Patients with PBC and HBV were significantly younger at diagnosis of PBC compared to patients with PBC and HCV (56.1 ± 11.2 vs 68.5 ± 10.3, respectively, P < 0.05). At initial clinical and histological assessment the majority of patients were cirrhotics (10/17; 58.8%) with the group of PBC and HCV carrying the highest frequency (87.5% vs 33.3% in PBC and HBV; P < 0.05). The patients with HBV and concomitant PBC seem to have better outcome compared to those with HCV and PBC since none of the 6 non-cirrhotics with HBV and PBC developed cirrhosis during follow-up. PBC diagnosis in HBV or HCV patients is very difficult and usually delayed. Therefore, in any case, cholestasis should alert physicians to further search for PBC.
    World journal of hepatology. 10/2013; 5(10):577-83.
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    ABSTRACT: Autoimmune hepatitis (AIH) is a disease of unknown aetiology characterised by interface hepatitis, hypergammaglobulinaemia, circulating autoantibodies and a favourable response to immunosuppression. To review recent advancements in understanding aetiopathogenesis, clinical, serological and histological features, diagnostic criteria and treatment strategies of AIH. Published studies on AIH extracted mainly from PubMed during the last 15 years. Autoimmune hepatitis has a global distribution affecting any age, both sexes and all ethnic groups. Clinical manifestations are variable ranging from no symptoms to severe acute hepatitis and only seldom to fulminant hepatic failure. Autoimmune attack is perpetuated, possibly via molecular mimicry mechanisms, and favoured by the impaired control of regulatory T-cells. A typical laboratory finding is hypergammaglobulinaemia with selective elevation of IgG, although in 15-25% of patients - particularly children, elderly and acute cases - IgG levels are normal. Liver histology and autoantibodies, although not pathognomonic, still remain the hallmark for diagnosis. Immunosuppressive treatment is mandatory and life-saving; however, to meet strict response criteria, the conventional therapy with prednisolone with or without azathioprine is far from ideal. Autoimmune hepatitis remains a major diagnostic and therapeutic challenge. The clinician, the hepato-pathologist and the laboratory personnel need to become more familiar with different expressions of the disease, interpretation of liver histology and autoimmune serology. According to the strict definition of treatment response issued by the 2010 AASLD guidelines, many patients are nonresponders to conventional treatment. Newer immunosuppressive agents targeting pathogenetic mechanisms can improve patient management, which needs to be tailored on a case-by-case basis.
    Alimentary Pharmacology & Therapeutics 09/2013; · 4.55 Impact Factor
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    ABSTRACT: To present the characteristics and the course of a series of anti-hepatitis B virus core antibody (HBc) antibody positive patients, who experienced hepatitis B virus (HBV) reactivation after immunosuppression. We retrospectively evaluated in our tertiary centers the medical records of hepatitis B virus surface antigen (HBsAg) negative patients who suffered from HBV reactivation after chemotherapy or immunosuppression during a 3-year period (2009-2011). Accordingly, the clinical, laboratory and virological characteristics of 10 anti-HBc (+) anti-HBs (-)/HBsAg (-) and 4 anti-HBc (+)/antiHBs (+)/HBsAg (-) patients, who developed HBV reactivation after the initiation of chemotherapy or immunosuppressive treatment were analyzed. Quantitative determination of HBV DNA during reactivation was performed in all cases by a quantitative real time polymerase chain reaction kit (COBAS Taqman HBV Test; cut-off of detection: 6 IU/mL). Twelve out of 14 patients were males; median age 74.5 years. In 71.4% of them the primary diagnosis was hematologic malignancy; 78.6% had received rituximab (R) as part of the immunosuppressive regimen. The median time from last chemotherapy schedule till HBV reactivation for 10 out of 11 patients who received R was 3 (range 2-17) mo. Three patients (21.4%) deteriorated, manifesting ascites and hepatic encephalopathy and 2 (14.3%) of them died due to liver failure. HBsAg-negative anti-HBc antibody positive patients can develop HBV reactivation even 2 years after stopping immunosuppression, whereas prompt antiviral treatment on diagnosis of reactivation can be lifesaving.
    World journal of hepatology. 07/2013; 5(7):387-92.
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    ABSTRACT: Hepatitis D virus (HDV) has decreased in Europe, but recent reports indicate a rising trend. We report the epidemiological changes, clinical progress and effect of treatment on the natural course of HDV-infection in Greece during the last 13 years. Prospective data, extracted from the HepNet.Greece Cohort-Study. Since 1997, 4673 chronic HBV (CHB) cases (4527 adults, 146 children) have been followed prospectively. Two-thousand-one-hundred-thirty-seven patients were tested for anti-HDV [101 (4.7%) positive]. Anti-HDV testing in Greece decreased significantly (57.0% before 2003, 35.3% thereafter; P<0.001). Anti-HDV prevalence among HBsAg-positives was 4.2%; lower in native-Greeks (2.8%) than in immigrants (7.5%) or in children (15.3%; P<0.001). Within 2.3-years follow-up, HDV occurred in 11/2047 HBsAg-positive patients (2.2 new delta-infected adults and 8.7 children per 1000 HBsAg-positive annually). HDV-positive compared to CHB adults were younger (P=0.035) and had more active and advanced disease at baseline, as indicated by laboratory indices and the higher prevalence of cirrhosis at younger age. During 4.2 years median observation, significantly more anti-HDV-positive than CHB adults developed a liver-related first event (20.0% vs. 8.5%, Plog-rank=0.014).Treatment received by 46/90 (51.1%) patients, 40 of them interferon-based. In multivariable analysis, interferon significantly decreased disease progression in HDV-positive patients [HR=0.14 (95%CI: 0.02-0.86; P=0.033)]. In Greece, HDV-serology is currently tested in only one-third of HBsAg-positive patients. HDV prevalence is lower in native-Greeks compared to immigrants, who may contribute >50% of HDV infection burden in Greece. Data show that HDV infection is a rapidly progressive disease, but interferon-based treatment may alter its course.
    Journal of Hepatology 07/2013; · 9.86 Impact Factor
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    ABSTRACT: Abstract Primary biliary cirrhosis (PBC) is a chronic cholestatic disease characterized by the presence of antimitochondrial antibodies (AMA). PBC-specific antinuclear antibodies (ANA) have been characterized and associated with disease progression and outcome. We evaluated the clinical significance of the presence and serial changes in titers of AMA, PBC-specific ANA (anti-gp210, anti-sp100) and anti-chromatin antibodies. Over a median (IQR) period of 35 (36) months, 512 specimens were collected from 110 patients. Autoantibodies were detected by commercial ELISAs (INOVA Diagnostics). Biochemical, clinical, and histological status were included at initial presentation and during follow-up visits. The Mayo risk score was calculated as a prognostic index at each time point. Liver biopsy findings were classified according to Ludwig's classification and biochemical response to ursodeoxycholic acid was evaluated according to Pares. At baseline, AMA IgG and IgA, anti-gp210 IgG, anti-sp100 IgG and anti-chromatin IgG were detected in 92/110 (83.6%), 57/110 (51.8%), 5/110 (4.5%), 14/110 (12.7%), and 0/110 (0%) patients, respectively. Positivity for all autoantibodies apart from anti-chromatin, at baseline visit (n = 110 patients), in all tested sera (n = 512) as well as increased autoantibodies titers during follow-up were associated with biochemically and/or histologically advanced disease. A decrease of anti-sp100 titers but not of anti-gp210 titers during follow-up was associated with improvement of Mayo risk score (p = 0.025) and response to ursodeoxycholic acid (p = 0.016). These results suggest that detection of AMA and PBC-specific ANA was correlated with disease severity. Serial changes of anti-sp100 titers and not of anti-gp210 titers might prove useful for monitoring the disease course and treatment outcome.
    Autoimmunity 06/2013; · 2.77 Impact Factor
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    Journal of Hepatology 03/2013; · 9.86 Impact Factor
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    ABSTRACT: For many decades, adipose tissue was considered as an inactive body compartment that was only used as an energy store. During the recent years, an increasing amount of data has revealed that adipose tissue is a major endocrine and paracrine organ producing numerous enzymes, hormones and growth factors which are collectively termed as adipokines. Several experimental and clinical studies showed that adipokines modulate insulin sensitivity and have an influence on glucose/fat metabolism and obesity. Apart from these properties, recent research revealed several direct actions of adipokines on endothelial function, vascular homeostasis and atherogenesis which are independent of their effects on glucose and fat metabolism. The present review focuses on the direct effects of adipokines on vascular/endothelial function and atherosclerosis and summarizes the experimental and clinical data which suggest a role for these molecules as potential diagnostic and prognostic cardiovascular markers as well as potential therapeutic target to reduce cardiovascular risk.
    Atherosclerosis 01/2013; · 3.71 Impact Factor
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    ABSTRACT: Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome and can progress to cirrhosis, liver failure, and hepatocellular carcinoma. In the last two decades, the prevalence of NAFLD has been growing in most developed countries, mainly as a consequence of its close association with obesity and diabetes mellitus. The exact pathogenesis of NAFLD and especially the mechanisms leading to disease progression have not been completely understood. Adipocytes produce and secrete several bioactive substances known as adipocytokines which are implicated in the pathogenesis of the disease. Among them, adiponectin is an insulin-sensitizing adipocytokine possessing multiple beneficial effects on obesity-related medical complication. This review focuses on the role of adiponectin in NAFLD pathogenesis and its potential use as a diagnostic tool but also as therapeutic target for NAFLD management.
    Clinical and Experimental Medicine 01/2013; · 2.83 Impact Factor

Publication Stats

2k Citations
722.85 Total Impact Points


  • 2000–2014
    • University of Thessaly
      • School of Medicine
      Iolcus, Thessaly, Greece
  • 1999–2012
    • Hannover Medical School
      • Department of Gastroenterology, Hepatology and Endocrinology
      Hanover, Lower Saxony, Germany
  • 2011
    • Goethe-Universität Frankfurt am Main
      Frankfurt, Hesse, Germany
  • 2008–2011
    • Center for Research and Technology, Thessaly
      Iolcus, Thessaly, Greece
  • 2006
    • University of Leipzig
      Leipzig, Saxony, Germany
  • 2005
    • King's College London
      • Division of Transplantation Immunology and Mucosal Biology
      Londinium, England, United Kingdom
  • 1995–2005
    • University Hospital of Ioannina
      Yannina, Epirus, Greece
  • 1993–2001
    • University of Ioannina
      • Division of Internal Medicine II
      Ioánnina, Ipeiros, Greece