Paraskevi Katsaounou

Implication of Interleukin (IL)-18 in the pathogenesis of chronic obstructive pulmonary disease (COPD).

Interleukin (IL)-18 is a pro-inflammatory cytokine that was firstly described as an interferon (IFN)-γ-inducing factor. Similar to IL-1β, IL-18 is synthesized as an inactive precursor requiring processing by caspase-1 into an active cytokine. The platform for activating caspase-1 is known as the inflammasome, a multiple protein complex. Macrophages and dendritic cells are the primary sources for the release of active IL-18, whereas the inactive precursor remains in the intracellular compartment of mesenchymal cells. Finally, the IL-18 precursor is released from dying cells and processed extracellularly. IL-18 has crucial host defense and antitumor activities, and gene therapy to increase IL-18 levels in tissues protects experimental animals from infection and tumor growth and metastasis. Moreover, multiple studies in experimental animal models have shown that IL-18 over-expression results to emphysematous lesions in mice. The published data prompt to the hypothesis that IL-18 induces a broad spectrum of COPD-like inflammatory and remodeling responses in the murine lung and also induces a mixed type 1, type 2, and type 17 cytokine responses. The majority of studies identify IL-18 as a potential target for future COPD therapeutics to limit both the destructive and remodeling processes occurring in COPD lungs.

Acute effects of short term use of e-cigarettes on airways physiology and respiratory symptoms in smokers with and without airways obstructive diseases and in healthy non smokers

BACKGROUND Although the use of e-cigarettes is increasing worldwide, their short and long-term effects remain undefined. We aimed to study the acute effect of short-term use of e-cigarettes containing nicotine on lung function and respiratory symptoms in smokers with airways obstructive disease (COPD, asthma), “healthy” smokers, and healthy never smokers. METHODS Respiratory symptoms, vital signs, exhaled NO, airway temperature, airway resistance (Raw), specific airway conductance (sGaw) and single nitrogen breath test were assessed before and immediately after short term use of an e-cigarette containing 11mg of nicotine among adults with COPD, asthma, “healthy” smokers, and never-smokers. The effect of the use of nicotine-free e-cigarettes among “healthy” never smokers was also studied. RESULTS The majority of participants reported acute cough. Short term use of nicotine e-cigarettes was associated: a) with increased heart rate in all subjects except in the COPD group, b) decreased oxygen saturation in “healthy” and COPD smokers, c) increased Raw in asthmatic smokers, “healthy” smokers, and healthy never smokers, d) decreased sGaw in healthy subjects, and e) changed slope of phase III curve in asthmatic smokers. Short-term use of nicotine-free e-cigarettes increased Raw and decreased sGaw among healthy never smokers. CONCLUSIONS Short-term use of an e-cigarette has acute effects on airways physiology and respiratory symptoms in COPD smokers, asthmatic smokers, “healthy” smokers and healthy never smokers. E-cigarette use was associated with effects in “healthy” never smokers irrespectively of nicotine concentration. More studies are needed to investigate both short and long-term effects of e-cigarette use

Antioxidant Supplementation Alters Cytokine Production From Monocytes

We studied in 10 healthy subjects the effect of chronic enteral supplementation of antioxidants (vitamins E, C, A, allopurinol, and N-acetylcysteine) on cytokine production by monocytes at rest, end exercise (60-min cycling at 60% of maximum oxygen consumption), and 60 min post-exercise (recovery). The percentage and the mean fluorescent intensity (MFI) of both unstimulated and lipopolysaccharide (LPS)-stimulated tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, and IL-6-producing monocytes were detected using flow cytometry. Antioxidants decreased the percentage of unstimulated IL-6-producing monocytes following exercise, while their MFI increased at rest. The percentage of LPS-stimulated monocytes increased after exercise and they produced more IL-6 both at rest and following exercise. The percentage of unstimulated and LPS-stimulated IL-1beta-producing monocytes was not affected by antioxidants. The MFI of IL-1beta-produced unstimulated monocytes was increased after antioxidants both at rest and following exercise. After antioxidants, LPS-stimulated monocytes produced more IL-1beta following exercise. Antioxidants decreased the percentage of TNF-alpha spontaneously-produced monocytes following exercise, which produced more TNF-alpha at recovery. Antioxidants did not affect the percentage of LPS-stimulated monocytes producing TNF-alpha, while LPS-stimulated production of TNF-alpha increased both at rest and following exercise. Antioxidants differentially affect TNF-alpha, IL-1beta, and IL-6 production by monocytes, with a general tendency of augmenting cytokine production.

Treatment of tobacco addiction using the Feeling-State Addiction Protocol (FSAP) of the Eye Movement Desensitization and Reprocessing (EMDR) treatment

Compulsions and cravings for smoking have been the subject of behavioural treatment. EMDR is an established, effective treatment of trauma-based disorders. Resent findings suggest that a modified form of EMDR can also be used efficiently in the treatment of behavioural and substance addictions (Ricci 2006). Merging the Feeling-State Theory of Compulsions and EMDR, the Eye Movement Compulsion Protocol (EMCP) was developed. EMCP is used for fading both feelings and un-wanted behaviour related to smoking. The FSAP hypothesizes that the pleasure during smoking is imprinted in the brain generating feelings like comfort, contentment and happiness. Thus, when craving resurges, the Feeling-State (FS) behaviour is re-enacted. The EMCP incorporates the standard eye movement technique of EMDR to reduce the FS associated with impulsion to smoke. This study aims to assess the efficacy of the FSAP in the treatment of tobacco addiction of relapsed smokers with persistent compulsions to smoke. We studied 2 groups (12 smokers in each), that relapsed (at least 1 m after smoking cessation). Smokers were matched for age, sex, Fagerstrom Test for Nicotine Dependence & pack/d. The FSAP although brief, results in profound changes in behaviour (Miller 2011). Consequently, the 1st group was administered 6 sessions of the FSAP protocol. The 2nd group had 6 sessions of Cognitive Behaviour Therapy. The 2 groups were compared for smoking cessation (self-reported questionnaire, CO-measurements). The 1st group had a succession rate of 50% vs the second that had only 25%. Thus, we conclude that EMDR could be a very helpful tool in managing smoking relapses.

Acute effect of smoking and smoking abstinence on energy intake and appetite-related hormones blood concentrations

The effect of smoking on energy balance and the underlying mechanisms are not fully understood. The aim of the present study is to examine the acute effect of smoking and its abstinence on energy intake, subjective feelings of appetite and related hormones. Fourteen healthy smokers participated in a randomized, crossover study consisting of two trials: the Cigarette trial (participants smoked two cigarettes of their brand within 15min) and the Sham trial (they were asked to hold the cigarette as smoking, but without lighting it). After 45min the participants were offered an ad libitum variety of snacks, and their intake was recorded. Blood samples were taken at fasting, before the ad libitum meal and 1h after and were analyzed for obestatin, ghrelin, glucagon-like peptide-1, cholecystokinin and insulin levels. Subjective feelings of hunger, satiety and desired to eat, as well as smoking craving were evaluated by visual analog scales. Mean energy intake at the ad libitum meal was 825±310kcal in the Sham trial and 673±245kcal in the Cigarette trial (p=0.010). No significant intervention effects were observed for the reported appetite feelings or the appetite-related hormones levels. In conclusion, smoking was found to have an acute effect on dietary intake; this was not explained by changes in the hormonal levels that were evaluated. More research is needed to confirm these results in more prolonged periods of abstinence and explore other pathways through which smoking and its abstinence affect energy balance.

Acute effects of smoke exposure on airway and systemic inflammation in forest firefighters

Introduction The aim of this study was to assess respiratory health and airway and systemic inflammation in professional forest firefighters post firefighting. Methods A total of 60 firefighters who participated in forest firefighting operations in Greece during 2008 were included in the study. A questionnaire consisting of symptoms and exposure, pulmonary function, atopy, bronchial hyperresponsiveness, and markers of inflammation in induced sputum, serum, and bronchoalveolar lavage (BAL) fluid was assessed. Results A measurable eosinophilic and neutrophilic inflammation was shown to be induced in the bronchial airways after acute exposure during forest firefighting. This was associated with increased respiratory symptoms from the upper and lower respiratory tract and pulmonary function impairment. Additionally, a measurable systemic inflammatory response was demonstrated. This study showed that acute exposure during forest firefighting significantly augments the intensity of airway and systemic inflammation in relation to the baseline inflammatory background due to chronic exposure. Conclusion The repeated acute exposures during firefighting augment the burden of chronic airway and systemic inflammation and may eventually lead to allergic sensitization of the airways and increased incidence of rhinitis and asthma after prolonged exposure.

Immune cell response to strenuous resistive breathing: comparison with whole body exercise and the effects of antioxidants

Background/hypothesis Whole body exercise (WBE) changes lymphocyte subset percentages in peripheral blood. Resistive breathing, a hallmark of diseases of airway obstruction, is a form of exercise for the inspiratory muscles. Strenuous muscle contractions induce oxidative stress that may mediate immune alterations following exercise. We hypothesized that inspiratory resistive breathing (IRB) alters peripheral blood lymphocyte subsets and that oxidative stress mediates lymphocyte subpopulation alterations following both WBE and IRB. Patients and methods Six healthy nonathletes performed two WBE and two IRB sessions for 45 minutes at 70% of VO2 maximum and 70% of maximum inspiratory pressure (Pimax), respectively, before and after the administration of antioxidants (vitamins E, A, and C for 75 days, allopurinol for 30 days, and N-acetylcysteine for 3 days). Blood was drawn at baseline, at the end of each session, and 2 hours into recovery. Lymphocyte subsets were determined by flow cytometry. Results Before antioxidant supplementation at both WBE end and IRB end, the natural killer cell percentage increased, the T helper cell (CD3+ CD4+) percentage was reduced, and the CD4/CD8 ratio was depressed, a response which was abolished by antioxidants only after IRB. Furthermore, at IRB end, antioxidants promoted CD8+ CD38+ and blunted cytotoxic T-cell percentage increase. CD8+ CD45RA+ cell percentage changes were blunted after antioxidant supplementation in both WBE and IRB. Conclusion We conclude that IRB produces (as WBE) changes in peripheral blood lymphocyte subsets and that oxidative stress is a major stimulus predominantly for IRB-induced lymphocyte subset alterations.

Physical characterization of the aerosol of an electronic cigarette: impact of refill liquids.

Abstract Electronic cigarettes are used to evaporate a mixture of solvents, nicotine and flavors. Liquid particles can be generated under these conditions due to evaporation/condensation. The objective of this work is to measure the physical characteristics of the aerosol emission of an e-cigarette using different refill liquids. The aerosol particle number and size are determined with a Scanning Mobility Particle Sizer. Seven liquids are used: propylene glycol (PG), glycerol (VG), a mixture 1:1 of PG/VG, the mixture with 2% or 5% of a commercial flavor, the mixture with 1.2% of nicotine and the mixture with 1.2% of nicotine and 2% of flavor. Particle concentrations of the aerosol emitted from the electronic cigarette are 300–3000 times higher than that of the ambient air. Propylene glycol emits several times more than glycerol. The addition of a flavor or nicotine has little effect on the emission of the total number emitted. The count median diameter of the electronic cigarette particles is 200–400 nm, depending on the liquid used. Count median diameter of emitted particles is affected by the liquid used.

The WHO–ERS Smoking Cessation Training Project: the first year of experience

Globally, >7 million people die each year from tobacco use [1]. If no urgent action is taken, ≥100 million people will die from tobacco in the next 15 years [2]. Between 2010 and 2025, if tobacco use has a 50% relative reduction, it will help almost reach the global target to reduce premature noncommunicable disease (NCD) mortality by 25% by 2025 [3]. The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) Article 14 emphasises supporting current tobacco users to quit as a key component of comprehensive tobacco control strategy to avert premature NCD deaths [4, 5]. Strategic @ERSTalk–@WHO alliance to address tobacco use by training health professionals on brief advice resulted in establishing smoking cessation in real care settings with quit rates higher than the literature and high propensity for wider dissemination http://ow.ly/lWDF30krq5V

The ERS–industry fellowship: a tale of two experiences

Over the past few years, early career members of the European Respiratory Society (ERS) have expressed an interest in gaining exposure to industry, to complement their experience in the academic sector as well as to widen their career perspectives. Recipients of the ERS Fellowship in Industry discuss their experiences http://ow.ly/1gcE30hMe89