Emmanouil Sinakos

Aristotle University of Thessaloniki

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Evangelos Akriviadis

Interbalkan Medical Center

Keith D. Lindor

Mayo Clinic in Arizona

Eleni Gigi

Aristotle University of Thessaloniki

Ioannis Goulis

Aristotle University of Thessaloniki

Prodromos Hytiroglou

Aristotle University of Thessaloniki

George Papatheodoridis

National and Kapodistrian University of Athens

Efthymia Vlachaki

Aristotle University of Thessaloniki

Christina Liava

Aristotle University of Thessaloniki

Lavrentios Papalavrentios

Aristotle University of Thessaloniki

M. Raptopoulou‐Gigi

Aristotle University of Thessaloniki

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Aristotle University of Thessaloniki

153

Hippocration General Hospital

Ippokrateio General Hospital of Thessaloniki

National and Kapodistrian University of Athens

AHEPA University Hospital

Mayo Clinic

Mayo Clinic in Arizona

Laiko General Hospital of Athens

Papageorgiou General Hospital

Interbalkan Medical Center

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Acknowledgement to Referees

Acta Haematologica (2011)

Mirela Cartoafa Carmen Kahatt Arturo Soto-Matos Elena Roy Pilar Lardelli

Acknowledgement

10.1159/000333480

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Emerging advances in the pharmacologic treatment of nonalcoholic steatohepatitis and related cirrhosis

Annals of Gastroenterology (2022)

Emmanouil Sinakos

The prevalence of nonalcoholic fatty liver disease (NAFLD) is rapidly growing throughout the world.Nonalcoholic steatohepatitis (NASH), the progressive form of NAFLD, is likely to become the leading cause of cirrhosis and etiology for liver transplantation in future decades in the Western World.Most patients with NAFLD have some components of metabolic syndrome, including obesity, insulin resistance, dyslipidemia, and hypertension.NAFLD encompasses a wide spectrum of liver damage, ranging from simple steatosis to NASH, that can progress to advanced liver disease, as well as hepatocellular carcinoma.Unfortunately, the options for the pharmacological treatment of NASH are still very limited.Nonetheless, several classes of therapies have shown promise, and are currently being evaluated in large phase 2b and phase 3 trials, creating some hope that selected agents will be approved in the coming years.As NASH is a heterogeneous disease, multiple mechanistic pathways are being targeted to achieve optimal treatment response.Combination therapy is also on the horizon, where 2 or more drugs targeting different mechanistic pathways are being used to boost the clinical response.In this review, we first present the current concept of the pathophysiology of NASH, focusing on the pathways currently targeted in clinical trials.We then present the pharmacological agents that are being evaluated in phase IIb of clinical development and beyond, using histological outcomes, and finally we present preliminary results from the combination trials that have already been initiated.

Dyslipidemia

Steatohepatitis

Nonalcoholic steatohepatitis

Liver disease

Chronic liver disease

10.20524/aog.2022.0704

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Citations (12)

The lipidomic signature of adult patients with non-alcoholic fatty liver disease. An interim analysis of a prospective study

Clinical Nutrition ESPEN (2023)

Georgios Kalopitas Thomai Mouskeftara Michail Chourdakis L. Kougias V. Rafailidis

Interim analysis

Interim

10.1016/j.clnesp.2023.09.512

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Peripheral endothelial and microvascular damage in liver cirrhosis: A systematic review and meta‐analysis

Microcirculation (2022)

Ioanna Papagiouvanni Marieta Theodorakopoulou Pantelis Sarafidis Emmanouil Sinakos Ioannis Goulis

This is the first systematic review and meta-analysis of studies using any available functional method to examine differences in peripheral endothelial function between cirrhotic and non-cirrhotic individuals.Literature search involved PubMed, Web-of-Science, and Scopus databases, as well as gray literature sources. We included studies in adult subjects evaluating endothelial function with any semi-invasive or non-invasive functional method in patients with and without liver cirrhosis.From 3378 records initially retrieved, 15 studies with a total of 570 participants were included in the final quantitative meta-analysis. In six studies examining endothelial function with flow-mediated-dilatation, no differences between patients with cirrhosis and controls were evident (WMD: 1.33, 95%CI [-2.87, 5.53], I2 = 97%, p < .00001). Among studies assessing differences in endothelial-dependent or endothelial-independent vasodilation with venous-occlusion-plethysmography, there were no significant differences between the two groups. When pooling all studies together, regardless of the technique used, no significant difference in endothelial function between cirrhotic patients and controls was observed(SMD: 0.79, 95%CI[-0.04, 1.63], I2 = 94%, p < .00001).No differences in peripheral endothelial function assessed with semi-invasive or non-invasive functional methods exist between cirrhotic and non-cirrhotic subjects. The increasing co-existence of cardiovascular risk factors leading to impaired vascular reactivity in cirrhotic patients may partly explain these findings.

Endothelial Dysfunction

Liver function

10.1111/micc.12773

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PubMed (2010)

Emmanouil Sinakos Eleni Gigi T. Lalla Bellou Al Albana Sykja

Background - Aims: Chronic hepatitis C (CHC) can cause a series of neuropsychiatric symptoms, whereas the currently approved treatment for this disease often induces similar symptoms as well. The aim of the present study was to compare Greek CHC patients' health-related quality of life (HRQoL) with that of healthy controls, to identify any possible relationships between HRQoL and demographic and laboratory parameters and to study the fluctuation of HRQoL during therapy and follow-up.Ninty nine patients with CHC and 91 healthy controls were enrolled in the study. ALT, viral load, HCV genotype, fibrosis stage by liver biopsy and BMI, were determined at baseline. All patients completed the SF-36 quality of life questionnaire, which was self-administered, before treatment. They were treated with pegylated interferon alpha2-a or alpha-2b and ribavirin for 24 or 48 weeks and evaluated in the middle of therapy, at the end and six months after treatment cessation. SF-36 questionnaire was also completed in each evaluation.Patients' HRQoL was found to be below that of healthy controls in all SF-36 scales before treatment. There was a significant negative association between history of drug abuse and general health and a positive association between age and mental health. Multivariate analysis revealed that history of drug abuse seemed to play a significant role in bodily pain and general health of patients, as well as age did in vitality and mental health. The course of patients' HRQoL showed that in the middle of treatment values in all SF-36 scales were below those of baseline and they returned to pretreatment levels at the end of therapy. However, at the end of the six month follow-up period, an improvement in almost all scales compared to baseline was noted.Our results showed that a) Greek CHC patients' HRQoL was worse than that of healthy individuals and fluctuated significantly during treatment b) A history of drug abuse and age can independently affect HRQoL c) During treatment values of HRQoL are worsened possibly due to interferon-a treatment and d) In the long-term treatment results in improvement of HRQoL.

Pegylated interferon

Hepatitis C

Liver disease

Depression

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Assessment of histologic risk factors for hepatocellular carcinoma in patients with chronic hepatitis B of advanced stage

Pathology - Research and Practice (2023)

Pavlina Pantelidou Emmanouil Sinakos Georgios Germanidis Eirini Pagkalidou Anna‐Bettina Haidich

Immunostaining

Hepatitis B

10.1016/j.prp.2023.154741

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Citations (1)

Semaglutide for nonalcoholic steatohepatitis: closer to a solution?

HepatoBiliary Surgery and Nutrition (2021)

Christina Liava Emmanouil Sinakos

Nonalcoholic steatohepatitis

Semaglutide

10.21037/hbsn-21-231

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Citations (5)

Inflammatory Bowel Disease in Primary Sclerosing Cholangitis

Inflammatory Bowel Diseases (2013)

Emmanouil Sinakos Sunil Samuel Felicity Enders Edward V. Loftus William J. Sandborn

Primary sclerosing cholangitis (PSC) has a well-established association with inflammatory bowel disease (IBD) and may represent a distinctive phenotype. It is unknown whether changes in the clinical and endoscopic presentation of newly diagnosed IBD among patients with PSC might have occurred over time.Initial clinical and endoscopic presentations of IBD in PSC were studied for 2 different time periods: 1993 to 1997 (early cohort) compared with 2003 to 2007 (recent cohort).The baseline characteristics were similar in the 57 early cohort and 72 recent cohort patients. Compared with the recent cohort, alkaline phosphatase concentrations were higher in the early cohort (7.1 versus 2.6 × upper limit of normal, P = 0.0001). PSC was diagnosed before IBD in the recent cohort compared with the early cohort (50% versus 35%, P = 0.0009). The initial clinical and endoscopic presentations of IBD were similar in the 2 cohorts. The majority of patients had mild pancolitis, whereas rectal sparing and backwash ileitis were detected in one third and one fourth of patients, respectively. In addition, no differences in IBD outcomes or PSC characteristics were revealed. Immunomodulators and biological treatments were more commonly used in the recent cohort when compared with the early cohort (90% versus 56%, P = 0.03, and 13% versus 4%, P = 0.08, respectively).IBD in PSC has unique characteristics, and the clinical features of this unique presentation have remained stable over time. A shift in the timing of diagnosis of the 2 diseases has occurred in recent years, with PSC being more often diagnosed first.

Primary Sclerosing Cholangitis

Pancolitis

10.1097/mib.0b013e3182802893

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Citations (77)

Accuracy of Controlled Attenuation Parameter for Liver Steatosis in High-Risk Patients for MASLD Using MRI-Proton Density Fat Fraction as Reference Standard

Digestive Diseases and Sciences (2024)

Konstantinos Malandris Emmanouil Korakas Anna Sarakapina Georgios Kalopitas Fotini Iatridi

Steatosis

Interquartile range

10.1007/s10620-024-08799-7

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Treatment of intravenous drug users with chronic hepatitis C: treatment response, compliance and side effects.

PubMed (2007)

Eleni Gigi Emmanouil Sinakos T. Lalla Eleni Vrettou E. Orphanou

Although intravenous drug users (IVDUs) comprise the majority of patients with chronic hepatitis C, most of them are excluded from treatment because of concerns about adherence to treatment and side effects.In this study we retrospectively evaluated safety, compliance to treatment and efficacy of treatment in IVDUs with HCV infection in 163 former IVDUs with chronic hepatitis C, who were not in methadone substitution and were attending our clinics the period 1997-2004. All subjects were HCVRNA (+), had ALT levels>x1.5 UNL and were treated for their HCV infection. Treatment consisted of three different regimens: IFN-alpha monotherapy (39.8%), IFN-alpha/ribavirin combination therapy (30.1%) and pegylated IFN-alpha/ribavirin combination therapy.Eighty seven over 163 patients (53.3%) discontinued treatment early due to drug abuse relapse (62%), side effects (32.1%, 10% psychiatric) and 5,7% for other reasons. Eighty precent of those who discontinued treatment had pre-treatment drug abstinence/= 9 months.

Hepatitis C

Drug holiday

Pegylated interferon

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Citations (12)