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Wellford SA, Moseman EA. Olfactory immunology: the missing piece in airway and CNS defence. Nat Rev Immunol 2024; 24:381-398. [PMID: 38097777 DOI: 10.1038/s41577-023-00972-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 12/23/2023]
Abstract
The olfactory mucosa is a component of the nasal airway that mediates the sense of smell. Recent studies point to an important role for the olfactory mucosa as a barrier to both respiratory pathogens and to neuroinvasive pathogens that hijack the olfactory nerve and invade the CNS. In particular, the COVID-19 pandemic has demonstrated that the olfactory mucosa is an integral part of a heterogeneous nasal mucosal barrier critical to upper airway immunity. However, our insufficient knowledge of olfactory mucosal immunity hinders attempts to protect this tissue from infection and other diseases. This Review summarizes the state of olfactory immunology by highlighting the unique immunologically relevant anatomy of the olfactory mucosa, describing what is known of olfactory immune cells, and considering the impact of common infectious diseases and inflammatory disorders at this site. We will offer our perspective on the future of the field and the many unresolved questions pertaining to olfactory immunity.
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Affiliation(s)
- Sebastian A Wellford
- Department of Integrative Immunobiology, Duke University School of Medicine, Durham, NC, USA
| | - E Ashley Moseman
- Department of Integrative Immunobiology, Duke University School of Medicine, Durham, NC, USA.
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Salomè S, Corrado FR, Mazzarelli LL, Maruotti GM, Capasso L, Blazquez-Gamero D, Raimondi F. Congenital cytomegalovirus infection: the state of the art and future perspectives. Front Pediatr 2023; 11:1276912. [PMID: 38034830 PMCID: PMC10687293 DOI: 10.3389/fped.2023.1276912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/18/2023] [Indexed: 12/02/2023] Open
Abstract
Congenital cytomegalovirus (cCMV) infection is the most common congenital infection, with an estimated incidence of approximately one in 200 infants in high-income settings. Approximately one in four children may experience life-long consequences, including sensorineural hearing loss and neurodisability. Knowledge regarding prevention, diagnosis, and treatment increased in the recent years, but some challenges remain. In this review, we tried to summarize the current knowledge on both the obstetrical and pediatric areas, while also highlighting controversial aspects and future perspectives. There is a need to enhance awareness among the general population and pregnant women through specific information programs. Further research is needed to better define the classification of individuals at birth and to have a deeper understanding of the long-term outcomes for so defined children. Finally, the availability of valaciclovir medication throughout pregnancy, where appropriate, has prompted the assessment of a universal serological antenatal screening. It is recommended to establish a dedicated unit for better evaluation and management of both mothers and children.
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Affiliation(s)
- S. Salomè
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - F. R. Corrado
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - L. L. Mazzarelli
- Division of Obstetrician and Gynecologist, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - G. M. Maruotti
- Division of Obstetrician and Gynecologist, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - L. Capasso
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - D. Blazquez-Gamero
- Pediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (Imas12), Translational Research Network in Pediatric Infectious Diseases (RITIP), Universidad Complutense, Madrid, Spain
| | - F. Raimondi
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
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Trapp W, Heid A, Röder S, Wimmer F, Hajak G. "Mmm, Smells like Coffee!": How a Brief Odor Identification Test Could Help to Identify People with Mild Cognitive Impairment and Dementia. Brain Sci 2023; 13:1052. [PMID: 37508984 PMCID: PMC10377169 DOI: 10.3390/brainsci13071052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/26/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Dementia and mild cognitive impairment (MCI) are still underdiagnosed in the general population. Impaired odor identification has been identified as an early marker of MCI and dementia. We aimed to compare the additional diagnostic value of two odor identification tests to a cognitive screening test in detecting MCI or dementia. (2) Methods: The Sniffin' Sticks odor identification test (SS-OIT), a brief odor identification test (B-OIT) requiring the identification of coffee scent, and the Mini-Mental State Exam (MMSE) were administered to a consecutive series of 174 patients (93 with dementia, 42 with mild cognitive impairment, and 39 without cognitive impairment) referred for neuropsychological testing. (3) Results: Both participants with dementia and with MCI exhibited impairments in odor identification. The SS-OIT and the B-OIT were substantially correlated. Complementing MMSE scores with the SS-OIT or the B-OIT similarly improved the diagnostic accuracy of individuals with dementia and MCI. (4) Conclusions: People with suspected dementia or MCI may already benefit from brief odor identification tests. Although these tests require little additional time, they can notably increase sensitivity for dementia or MCI.
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Affiliation(s)
- Wolfgang Trapp
- Department of Psychiatry, Sozialstiftung Bamberg, St.-Getreu-Straße 18, 96049 Bamberg, Germany
- Department of Physiological Psychology, Otto-Friedrich University Bamberg, Markusplatz 3, 96045 Bamberg, Germany
| | - Andreas Heid
- Department of Psychiatry, Sozialstiftung Bamberg, St.-Getreu-Straße 18, 96049 Bamberg, Germany
| | - Susanne Röder
- Department of Psychiatry, Sozialstiftung Bamberg, St.-Getreu-Straße 18, 96049 Bamberg, Germany
| | - Franziska Wimmer
- Department of Psychiatry, Sozialstiftung Bamberg, St.-Getreu-Straße 18, 96049 Bamberg, Germany
| | - Göran Hajak
- Department of Psychiatry, Sozialstiftung Bamberg, St.-Getreu-Straße 18, 96049 Bamberg, Germany
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Chebib E, Vauloup-Fellous C, Benoit C, Noël Petroff N, Van Den Abbeele T, Maudoux A, Teissier N. Is CMV PCR of inner ear fluid during cochlear implantation a way to diagnose CMV-related hearing loss? Eur J Pediatr 2023; 182:375-383. [PMID: 36369401 DOI: 10.1007/s00431-022-04691-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/13/2022]
Abstract
UNLABELLED To evaluate the diagnostic performance of cytomegalovirus (CMV) polymerase chain reaction (PCR) on inner ear fluid collected during cochlear implantation and to assess its interest in current practice. This monocentric prospective study included consecutive children presenting with severe to profound sensorineural hearing loss (SNHL) who were candidates for unilateral and/or bilateral cochlear implantation. The etiology of the SNHL was determined before cochlear implantation when possible. During the surgery, drop-like samples of inner ear fluid and blood were collected. CMV PCR was then performed on both samples. Between January 2017 and September 2021, 113 children with severe to profound SNHL underwent cochlear implantation with inner ear fluid collection. Among these children, 77 of them presented with a known cause of SNHL (68%) and 36 of them had an unknown cause of SNHL at the time of surgery (32%). Sensitivity and specificity of the CMV PCR on inner ear fluid were 60% (95% CI: [49-71]) and 98% (95% CI: [96-100]), respectively. Positive and negative predictive values were 90% (95% CI: [83-97]) and 92% (95% CI: [86-98]), respectively. A sensitivity analysis according to age at cochlear implantation showed a decrease with age. CONCLUSION Sampling of inner ear fluid during cochlear implant surgery is an interesting, simple and safe way to diagnose CMV-related hearing loss, especially when the diagnosis of congenital infection can no longer be confirmed. However, the sensitivity decreases with age. TRIAL REGISTRATION NCT04724265 What is Known: • Congenital cytomegalovirus infection is the leading infectious cause of neurological disabilities and sensorineural hearing loss in children. In the absence of systematic screening at birth, many cCMV infections go undetected and are often undiagnosed despite the development of sensorineural sequelae. • Nearly 40% of indications for cochlear implantation are of unknown etiology. WHAT IS NEW • Performing CMV PCR on inner ear fluid at the time of cochlear implantation is a safe way with high diagnostic performance (PPV = 90%, NPV = 92%) to detect a CMV-related hearing loss. • This sample may be interesting in cases of unknown cause of hearing loss in order to identify undiagnosed cCMV infections.
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Affiliation(s)
- Emilien Chebib
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP) and Université de Paris, 48 Boulevard Sérurier, 75019, Paris, France.
| | - Christelle Vauloup-Fellous
- AP-HP Université Paris-Saclay, Hôpital Paul-Brousse, Department of Virology, INSERM U1193, 94804, Villejuif, France.,Groupe de Recherche sur les Infections Pendant la Grossesse (GRIG), Paris, France
| | - Charlotte Benoit
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP) and Université de Paris, 48 Boulevard Sérurier, 75019, Paris, France
| | - Nathalie Noël Petroff
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP) and Université de Paris, 48 Boulevard Sérurier, 75019, Paris, France
| | - Thierry Van Den Abbeele
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP) and Université de Paris, 48 Boulevard Sérurier, 75019, Paris, France
| | - Audrey Maudoux
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP) and Université de Paris, 48 Boulevard Sérurier, 75019, Paris, France.,Center for Balance Evaluation in Children (EFEE), Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris University, Paris, France.,Unit Progressive Sensory Disorders, Pathophysiology and Therapy, Institut de L'Audition, Institut Pasteur, Université de Paris, INSERM-UMRS1120, 63 rue de Charenton, F-75012, Paris, France
| | - Natacha Teissier
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP) and Université de Paris, 48 Boulevard Sérurier, 75019, Paris, France.,Groupe de Recherche sur les Infections Pendant la Grossesse (GRIG), Paris, France
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Chebib E, Maudoux A, Benoit C, Bernard S, Belarbi N, Parodi M, Picone O, Van Den Abbeele T, Wiener Vacher SR, Teissier N. Predictors of cochleovestibular dysfunction in children with congenital cytomegalovirus infection. Eur J Pediatr 2022; 181:2909-2918. [PMID: 35551461 DOI: 10.1007/s00431-022-04495-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 11/30/2022]
Abstract
UNLABELLED The purpose of this study is to assess the predictive factors of both hearing and vestibular impairment in congenitally cytomegalovirus-infected children (cCMV) through a multivariate analysis of clinical and imaging characteristics collected during pregnancy and at birth. This retrospective study was conducted between March 2014 and March 2020, including confirmed congenitally CMV-infected children with a complete vestibular and hearing assessment. Data concerning pregnancy, date of infection, clinical characteristics, and symptomatology at birth were collected. In total, 130 children were included, with a median age of 21 months. Eighty-three children (64%) presented with an inner ear impairment (both cochlear and vestibular impairment). Sex, modality of maternal infection (seroconversion or reactivation), pregnancy term, weight and head circumference at birth, neonatal clinical signs of infection, and treatment were not significantly correlated with inner ear impairment. However, multivariate analysis confirmed that there are two independent predictive factors of inner ear impairment: antenatal imaging lesions (ORa = 8.02 [1.74; 60.27], p-value = 0.01) and infection during the first trimester (ORa = 4.47 [1.21; 19.22], p-value = 0.03). Conversely, infections occurring during the second trimester were rarely associated with inner ear impairment: 4/13 (31%) in our series, with vestibular impairment alone (4/4) and no hearing loss. None of the children infected during the third trimester developed inner ear dysfunction. CONCLUSION Besides the symptomatic status of the CMV infection at birth, we found that antenatal imaging brain damage and early infection (mainly during the first trimester) constitute the two best independent predictive factors of inner ear involvement in congenitally CMV-infected children. WHAT IS KNOWN • Congenital cytomegalovirus infection is the leading infectious cause of neurological disabilities and sensorineural hearing loss in children and responsible of vestibular disorders, which are probably underestimated. • No articles have yet defined the predictive factors of the entire inner ear impairment (vestibule and cochlea). WHAT IS NEW • The timing of the infection during pregnancy (first and second trimester, ORa=4.47) and antenatal imaging lesions (ORa=8.02) are independently predictive (in a multivariate analysis) of inner ear involvement. • The symptomatic status at birth is a poor predictor of inner ear impairment.
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Affiliation(s)
- Emilien Chebib
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris University, 48 boulevard Sérurier, 75019, Paris, France.
| | - Audrey Maudoux
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris University, 48 boulevard Sérurier, 75019, Paris, France.,Center for Balance Evaluation in Children (EFEE), Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris University, Paris, France
| | - Charlotte Benoit
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris University, 48 boulevard Sérurier, 75019, Paris, France.,Université de Paris, INSERM U1141 NeuroDiderot, Inserm, 75019, Paris, France
| | - Sophie Bernard
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris University, 48 boulevard Sérurier, 75019, Paris, France
| | - Nadia Belarbi
- Department of Pediatric Imaging, Hospital Robert Debré, Paris VII University, 48 Bd Serurier, 75019, Paris, France
| | - Marine Parodi
- Department of Otolaryngology, Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris University, Paris, France
| | - Olivier Picone
- Department of Gynecology-Obstetrics, Louis Mourier Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris University, Colombes, France.,Université de Paris, INSERM U1137, Inserm, 75018, Paris, France
| | - Thierry Van Den Abbeele
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris University, 48 boulevard Sérurier, 75019, Paris, France.,Université de Paris, INSERM U1141 NeuroDiderot, Inserm, 75019, Paris, France
| | - Sylvette R Wiener Vacher
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris University, 48 boulevard Sérurier, 75019, Paris, France.,Center for Balance Evaluation in Children (EFEE), Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris University, Paris, France.,Université de Paris, INSERM U1141 NeuroDiderot, Inserm, 75019, Paris, France
| | - Natacha Teissier
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris University, 48 boulevard Sérurier, 75019, Paris, France.,Université de Paris, INSERM U1141 NeuroDiderot, Inserm, 75019, Paris, France
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Lazarini F, Lannuzel A, Cabié A, Michel V, Madec Y, Chaumont H, Calmont I, Favrat M, Lazarini F, Lannuzel A, Cabié A, Calmont I, Abel S, Cabras O, Marquise A, Pircher M, Signate A, Celeste C, Chaumont H, Lackmy A, Lepage G, Lobjois Q, Petit A, Tressières B, Teissier N, Roze E, Buivan TP, Conquet L, Laude H, Lledo PM, Madec Y, Mottez E, Taieb F, Ungeheuer MN, Montagutelli X, Roze E, Lledo PM. Olfactory outcomes in Zika virus-associated Guillain-Barré syndrome. Eur J Neurol 2022; 29:2823-2831. [PMID: 35699338 DOI: 10.1111/ene.15444] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/02/2022] [Accepted: 06/09/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Zika Virus (ZIKV) infection has been associated with Guillain-Barré Syndrome (GBS). Yet, little is known about the consequence of ZIKV infection on olfaction in humans. METHODS Just right before the COVID-19 outbreak, we prospectively investigated the olfactory capacities of 19 patients with ZIKV-associated GBS from the French West Indies and compared them to 9 controls from the same population, with a GBS of similar severity but independent of Zika infection. To provide further evidence that ZIKV infection induces smell alteration, we investigated the consequences of ZIKV infection on olfactory abilities using a mouse model. RESULTS Patients with GBS-Zika+ had a poorer olfactory function than GBS-non-Zika, even one to two years after the acute phase. The proportion of patients with hyposmia was significantly higher in GBS-Zika+ than in GBS-non-Zika group (68.4% versus 22.2%, P=0.042). These deficits were characterized by lower threshold and identification scores and were independent from GBS severity. Additionally, ZIKV infection was found to impair olfaction in immunodeficient mice infected with ZIKV. High viral load was observed in their olfactory system and downstream brain structures. ZIKV promoted both cellular damages in the olfactory neuroepithelium and protracted inflammation of the olfactory bulb, likely accounting for smell alteration. CONCLUSIONS Patients with ZIKV-related GBS had a poorer long-term olfactory function than patients with GBS-non-Zika and ZIKV-infected mice are hyposmic. These observations suggest that ZIKV belongs to the list of viruses affecting the olfactory system. Clinical evaluation of the olfactory system should be considered for ZIKV-infected patients.
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Affiliation(s)
- Françoise Lazarini
- Institut Pasteur, Université Paris Cité, Perception and Memory Unit, Centre National de la Recherche Scientifique, Unité Mixte de Recherche, Paris, France
| | - Annie Lannuzel
- Service de Neurologie, Centre Hospitalier Universitaire de la Guadeloupe, Faculté de Médecine de l'Université des Antilles, Centre d'investigation Clinique Antilles Guyane, Inserm CIC 1424, Faculté de Médecine de Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, U 1127, CNRS, Unité Mixte de Recherche 7225, Institut du Cerveau, ICM, Paris, France
| | - André Cabié
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de la Martinique, Faculté de Médecine de l'Université des Antilles, Centre d'investigation Clinique Antilles Guyane, Inserm CIC 1424, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1058, Université de Montpellier, Université des Antilles, Établissement français du sang, Montpellier, France
| | - Vincent Michel
- Institut Pasteur, Université Paris Cité, Perception and Memory Unit, Centre National de la Recherche Scientifique, Unité Mixte de Recherche, Paris, France
| | - Yoann Madec
- Institut Pasteur, Université Paris Cité, Epidemiology of Emerging Diseases Unit, Paris, France
| | - Hugo Chaumont
- Service de Neurologie, Centre Hospitalier Universitaire de la Guadeloupe, Faculté de Médecine de l'Université des Antilles, Centre d'investigation Clinique Antilles Guyane, Inserm CIC 1424, Faculté de Médecine de Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, U 1127, CNRS, Unité Mixte de Recherche 7225, Institut du Cerveau, ICM, Paris, France
| | - Isabelle Calmont
- Centre d'investigation Clinique Antilles Guyane, Centre Hospitalier Universitaire de la Martinique, Inserm CIC, Fort-de-France, France
| | - Mathilde Favrat
- Institut Pasteur, Université Paris Cité, Perception and Memory Unit, Centre National de la Recherche Scientifique, Unité Mixte de Recherche, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Xavier Montagutelli
- Institut Pasteur, Université Paris Cité, Mouse Genetics Laboratory, Paris, France
| | - Emmanuel Roze
- AP-HP, Hôpital de la Pitié-Salpêtrière, Département de Neurologie, Faculté de Médecine de Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, U 1127, CNRS, Unité Mixte de Recherche 7225, Institut du Cerveau, Paris, France
| | - Pierre-Marie Lledo
- Institut Pasteur, Université Paris Cité, Perception and Memory Unit, Centre National de la Recherche Scientifique, Unité Mixte de Recherche, Paris, France
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