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  1. Article: Semaglutide for nonalcoholic steatohepatitis: closer to a solution?

    Liava, Christina / Sinakos, Emmanouil

    Hepatobiliary surgery and nutrition

    2021  Volume 10, Issue 4, Page(s) 541–544

    Language English
    Publishing date 2021-08-21
    Publishing country China (Republic : 1949- )
    Document type Editorial ; Comment
    ZDB-ID 2812398-0
    ISSN 2304-389X ; 2304-3881
    ISSN (online) 2304-389X
    ISSN 2304-3881
    DOI 10.21037/hbsn-21-231
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  2. Article ; Online: Efficacy of Newer Nucleos(t)ide Analogs After Hepatitis B Immunoglobulin Discontinuation Against Hepatitis B and D Recurrence in Liver Transplant Recipients.

    Cholongitas, Evangelos / Oikonomou, Theodora / Bafa, Konstantina / Sinakos, Emmanouil / Papatheodoridis, George V / Goulis, Ioannis

    Transplantation

    2024  

    Abstract: Background: The use of nucleos(t)ide analogs (NAs) with a high genetic barrier to resistance, namely entecavir and tenofovir, has improved the efficacy of antiviral prophylaxis against hepatitis B virus (HBV) recurrence after liver transplantation (LT). ...

    Abstract Background: The use of nucleos(t)ide analogs (NAs) with a high genetic barrier to resistance, namely entecavir and tenofovir, has improved the efficacy of antiviral prophylaxis against hepatitis B virus (HBV) recurrence after liver transplantation (LT). However, the optimal duration and dosage of hepatitis B immunoglobulin (HBIG) administration, particularly in patients transplanted for HBV and hepatitis D virus (HDV) coinfection, remains controversial.
    Methods: We evaluated 28 patients transplanted for HBV/HDV cirrhosis. After LT, each patient received a fixed scheme of low-dose HBIG plus NA for 6 mo post-LT and then continued with long-term NA prophylaxis (entecavir: 8, tenofovir: 20 patients).
    Results: During 72 mo of follow-up, reappearance of hepatitis B surface antigen at low titers was observed in 1 (3.6%) patient at 33 mo after HBIG discontinuation, which became negative after a single dose of HBIG 1000 IU/L, whereas both serum HBV DNA and HDV RNA remained persistently undetectable and without any clinical or biochemical evidence of HBV/HDV recurrence.
    Conclusions: We showed for the first time the efficacy of a short, fixed scheme of low-dose HBIG plus NA followed by long-term NA monoprophylaxis against HBV/HDV recurrence after LT, although careful follow-up is needed after HBIG discontinuation, whereas further larger studies are needed to confirm these findings.
    Language English
    Publishing date 2024-04-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 208424-7
    ISSN 1534-6080 ; 0041-1337
    ISSN (online) 1534-6080
    ISSN 0041-1337
    DOI 10.1097/TP.0000000000005027
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  3. Article ; Online: Primary hepatic neuroendocrine tumor treated with liver transplantation.

    Chatziioannou, Anthi / Georgopoulou, Vassiliki / Katsiki, Evangelia / Sinakos, Emmanouil

    Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver

    2022  Volume 54, Issue 10, Page(s) 1441–1443

    MeSH term(s) Hepatectomy ; Humans ; Liver Neoplasms/pathology ; Liver Transplantation ; Neuroendocrine Tumors/pathology
    Language English
    Publishing date 2022-02-12
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1459373-7
    ISSN 1878-3562 ; 1125-8055
    ISSN (online) 1878-3562
    ISSN 1125-8055
    DOI 10.1016/j.dld.2022.01.133
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  4. Article: Role of immunotherapy in downsizing hepatocellular carcinoma prior to liver transplantation.

    Ouranos, Konstantinos / Chatziioannou, Anthi / Goulis, Ioannis / Sinakos, Emmanouil

    World journal of transplantation

    2022  Volume 12, Issue 11, Page(s) 331–346

    Abstract: Hepatocellular carcinoma (HCC) is an aggressive primary liver neoplasm that, according to tumor stage, can be treated with resection, transplantation, locoregional treatment options, or systemic therapy. Although interventions only in early-stage disease ...

    Abstract Hepatocellular carcinoma (HCC) is an aggressive primary liver neoplasm that, according to tumor stage, can be treated with resection, transplantation, locoregional treatment options, or systemic therapy. Although interventions only in early-stage disease can offer complete tumor regression, systemic therapy in advanced disease can significantly prolong overall survival, according to pub lished clinical trials. The emergence of immunotherapy in the field of cancer therapy has had a positive impact on patients with HCC, resulting in atezolizumab-bevacizumab currently being the first-line option for treatment of advanced HCC. In light of this, application of immunotherapy in the preoperative process could increase the number of patients fulfilling the criteria for liver transplantation (LT). Implementation of this approach is faced with challenges regarding the safety of immunotherapy and the possibly increased risk of re jection in the perioperative period. Case reports and clinical trials assessing the safety profile and effectiveness of neoadjuvant immunotherapy, highlight important aspects regarding this newly evolving approach to HCC management. More studies need to be conducted in order to reach a consensus regarding the optimal way to administer immunotherapy prior to LT. In this review, we sum marize the role, safety profile and future considerations regarding the use of neoadjuvant immunotherapy prior to LT in patients with HCC.
    Language English
    Publishing date 2022-11-17
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 2220-3230
    ISSN 2220-3230
    DOI 10.5500/wjt.v12.i11.331
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  5. Article: Emerging advances in the pharmacologic treatment of nonalcoholic steatohepatitis and related cirrhosis.

    Sinakos, Emmanouil / Liava, Christina / Loomba, Rohit

    Annals of gastroenterology

    2022  Volume 35, Issue 3, Page(s) 213–225

    Abstract: 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 ... ...

    Abstract 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.
    Language English
    Publishing date 2022-04-07
    Publishing country Greece
    Document type Journal Article ; Review
    ZDB-ID 2032850-3
    ISSN 1108-7471
    ISSN 1108-7471
    DOI 10.20524/aog.2022.0704
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  6. Article ; Online: Cost-effectiveness of switching from tenofovir disoproxil fumarate to tenofovir alafenamide versus entecavir for chronic hepatitis B patients in Greece.

    Sinakos, Emmanouil / Kachru, Nandita / Tsoulas, Christos / Jeyakumar, Sushanth / Smith, Nathaniel J / Yehoshua, Alon / Cholongitas, Evangelos

    Journal of comparative effectiveness research

    2024  Volume 13, Issue 4, Page(s) e230090

    Abstract: Aim: ...

    Abstract Aim:
    MeSH term(s) Humans ; Hepatitis B, Chronic/drug therapy ; Cost-Benefit Analysis ; Greece ; Tenofovir/therapeutic use ; Adenine ; Liver Neoplasms/drug therapy ; Liver Cirrhosis/drug therapy ; Antiviral Agents/therapeutic use ; Treatment Outcome ; Guanine/analogs & derivatives
    Chemical Substances entecavir (5968Y6H45M) ; Tenofovir (99YXE507IL) ; Adenine (JAC85A2161) ; Antiviral Agents ; Guanine (5Z93L87A1R)
    Language English
    Publishing date 2024-02-06
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2669725-7
    ISSN 2042-6313 ; 2042-6305
    ISSN (online) 2042-6313
    ISSN 2042-6305
    DOI 10.57264/cer-2023-0090
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  7. Article: Treating nonalcoholic steatohepatitis with antidiabetic drugs: Will GLP-1 agonists end the struggle?

    Kalogirou, Maria / Sinakos, Emmanouil

    World journal of hepatology

    2018  Volume 10, Issue 11, Page(s) 790–794

    Abstract: Nonalcoholic fatty liver disease (NAFLD) is highly associated with insulin resistance (IR), type 2 diabetes mellitus and metabolic syndrome, being characterized as the hepatic component of metabolic syndrome. Despite its high prevalence, no ... ...

    Abstract Nonalcoholic fatty liver disease (NAFLD) is highly associated with insulin resistance (IR), type 2 diabetes mellitus and metabolic syndrome, being characterized as the hepatic component of metabolic syndrome. Despite its high prevalence, no pharmacological treatment has been established, as of yet. A growing body of evidence, however, shows that reducing IR can result in improvement of the biochemical and histological features of nonalcoholic steatohepatitis (NASH)-the aggressive form of NAFLD that can lead to cirrhosis and hepatocellular carcinoma. Unfortunately, the several trials that have assessed the effect of various antidiabetic agents to date have failed to establish an effective and safe treatment regimen for patients with NAFLD. Glucagon-like peptide-1 (commonly known as GLP-1) agonists are a novel class of antidiabetic drugs that improve insulin sensitivity and promote weight loss. They also appear to have a direct effect on the lipid metabolism of hepatocytes, reducing hepatic steatosis. Several trials have demonstrated that GLP-1 agonists can reduce aminotransferase levels and improve liver histology in patients with NAFLD, suggesting that these agents could serve as an alternative treatment option for these patients. This manuscript discusses the role and potential mechanisms of GLP-1 agonists in the treatment of NASH.
    Language English
    Publishing date 2018-12-01
    Publishing country United States
    Document type Editorial
    ZDB-ID 2573703-X
    ISSN 1948-5182
    ISSN 1948-5182
    DOI 10.4254/wjh.v10.i11.790
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  8. Article: Treatment of alcoholic hepatitis: is this a "dead-end"?

    Akriviadis, Evangelos / Sinakos, Emmanouil

    Annals of gastroenterology

    2016  Volume 29, Issue 2, Page(s) 236–237

    Language English
    Publishing date 2016-02-25
    Publishing country Greece
    Document type Journal Article
    ZDB-ID 2032850-3
    ISSN 1108-7471
    ISSN 1108-7471
    DOI 10.20524/aog.2016.0023
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  9. Article ; Online: Update on the association of hepatitis B with intrahepatic cholangiocarcinoma: Is there new evidence?

    Fragkou, Nikolaos / Sideras, Lazaros / Panas, Panteleimon / Emmanouilides, Christos / Sinakos, Emmanouil

    World journal of gastroenterology

    2021  Volume 27, Issue 27, Page(s) 4252–4275

    Abstract: Intrahepatic cholangiocarcinoma (iCCA) is a subgroup of cholangiocarcinoma that accounts for about 10%-20% of the total cases. Infection with hepatitis B virus (HBV) is one of the most important predisposing factors leading to the formation of iCCA. It ... ...

    Abstract Intrahepatic cholangiocarcinoma (iCCA) is a subgroup of cholangiocarcinoma that accounts for about 10%-20% of the total cases. Infection with hepatitis B virus (HBV) is one of the most important predisposing factors leading to the formation of iCCA. It has been recently estimated based on abundant epidemiological data that the association between HBV infection and iCCA is strong with an odds ratio of about 4.5. The HBV-associated mechanisms that lead to iCCA are under intense investigation. The diagnosis of iCCA in the context of chronic liver disease is challenging and often requires histological confirmation to distinguish from hepatocellular carcinoma. It is currently unclear whether antiviral treatment for HBV can decrease the incidence of iCCA. In terms of management, surgical resection remains the mainstay of treatment. There is a need for effective treatment modalities beyond resection in both first- and second-line treatment. In this review, we summarize the epidemiological evidence that links the two entities, discuss the pathogenesis of HBV-associated iCCA, and present the available data on the diagnosis and management of this cancer.
    MeSH term(s) Bile Duct Neoplasms/epidemiology ; Bile Ducts, Intrahepatic ; Cholangiocarcinoma/epidemiology ; Hepatitis B/complications ; Hepatitis B/diagnosis ; Hepatitis B/drug therapy ; Humans ; Liver Neoplasms/epidemiology
    Language English
    Publishing date 2021-06-16
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2185929-2
    ISSN 2219-2840 ; 1007-9327
    ISSN (online) 2219-2840
    ISSN 1007-9327
    DOI 10.3748/wjg.v27.i27.4252
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article: Endothelial and microvascular function in liver cirrhosis: an old concept that needs re-evaluation?

    Papagiouvanni, Ioanna / Sarafidis, Pantelis / Theodorakopoulou, Marieta P / Sinakos, Emmanouil / Goulis, Ioannis

    Annals of gastroenterology

    2022  Volume 35, Issue 5, Page(s) 471–482

    Abstract: Liver cirrhosis is characterized by significant circulatory dysregulation, related to an imbalance among several vasodilating agents, mainly nitric oxide. In contrast to portal vein and macrovascular hemodynamic alterations, which have been rather well ... ...

    Abstract Liver cirrhosis is characterized by significant circulatory dysregulation, related to an imbalance among several vasodilating agents, mainly nitric oxide. In contrast to portal vein and macrovascular hemodynamic alterations, which have been rather well described, the peripheral microcirculatory and endothelial structure and function in this population are less well studied. Endothelial dysfunction is characterized by an imbalance between endothelium-derived relaxing and contracting factors. A number of methods have been used to assess endothelial and microvascular function in human studies. Venous occlusion plethysmography was used for many years as the gold standard for evaluating endothelial function, but flow-mediated dilatation (FMD) of the forearm is currently the most frequently used method. In patients with cirrhosis, the few existing studies have mainly used FMD, but the relevant results are largely contradictory. In recent years, several noninvasive and easily applicable methods, such as near-infrared spectroscopy, laser speckle contrast imaging, peripheral arterial tonometry, optical coherence tomography and nailfold video-capillaroscopy, have been increasingly used to assess peripheral microvascular function and have demonstrated a number of advantages. In this review, we present functional methods to evaluate peripheral microvascular and endothelial function, and we discuss the existing evidence on circulatory dysfunction in patients with liver cirrhosis.
    Language English
    Publishing date 2022-07-15
    Publishing country Greece
    Document type Journal Article ; Review
    ZDB-ID 2032850-3
    ISSN 1108-7471
    ISSN 1108-7471
    DOI 10.20524/aog.2022.0734
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