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Hoffmann J, Rheude A, Neubauer A, Brendel C, Thrun MC. Development of an explainable AI system using routine clinical parameters for rapid differentiation of inflammatory conditions. Front Immunol 2024; 15:1364954. [PMID: 38510238 PMCID: PMC10950914 DOI: 10.3389/fimmu.2024.1364954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/22/2024] [Indexed: 03/22/2024] Open
Abstract
Introduction Inflammatory conditions in patients have various causes and require different treatments. Bacterial infections are treated with antibiotics, while these medications are ineffective against viral infections. Autoimmune diseases and graft-versus-host disease (GVHD) after allogeneic stem cell transplantation, require immunosuppressive therapies such as glucocorticoids, which may be contraindicated in other inflammatory states. In this study, we employ a combination of straightforward blood tests to devise an explainable artificial intelligence (XAI) for distinguishing between bacterial infections, viral infections, and autoimmune diseases/graft-versus-host disease. Patients and methods We analysed peripheral blood from 80 patients with inflammatory conditions and 38 controls. Complete blood count, CRP analysis, and a rapid flow cytometric test for myeloid activation markers CD169, CD64, and HLA-DR were utilized. A two-step XAI distinguished firstly with C5.0 rules pruned by ABC analysis between controls and inflammatory conditions and secondly between the types of inflammatory conditions with a new bivariate decision tree using the Simpson impurity function. Results Inflammatory conditions were distinguished using an XAI, achieving an overall accuracy of 81.0% (95%CI 72 - 87%). Bacterial infection (N = 30), viral infection (N = 26), and autoimmune diseases/GVHD (N = 24) were differentiated with accuracies of 90.3%, 80.0%, and 79.0%, respectively. The most critical parameter for distinguishing between controls and inflammatory conditions was the expression of CD64 on neutrophils. Monocyte count and expression of CD169 were most crucial for the classification within the inflammatory conditions. Conclusion Treatment decisions for inflammatory conditions can be effectively guided by XAI rules, straightforward to implement and based on promptly acquired blood parameters.
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Affiliation(s)
- Joerg Hoffmann
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
| | - Anne Rheude
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
| | - Andreas Neubauer
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
| | - Cornelia Brendel
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
| | - Michael C. Thrun
- Databionics, Mathematics and Computer Science, Philipps University Marburg, Marburg, Germany
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The Association of Low CD4 Expression on Monocytes and Low CD8+ T-Cell Count at Hospital Admission Predicts the Need for Mechanical Ventilation in Patients With COVID-19 Pneumonia: A Prospective Monocentric Cohort Study. Crit Care Explor 2022; 4:e0810. [PMID: 36518218 PMCID: PMC9742091 DOI: 10.1097/cce.0000000000000810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
To identify COVID-19-associated immunophenotyping patterns at hospital admission and to determine if some patterns could predict the need for mechanical ventilation (MV). DESIGN Prospective observational monocentric cohort study. SETTING A university-affiliated hospital in Marseille, France. PATIENTS Thirty patients presenting with laboratory-confirmed COVID-19 pneumonia were enrolled within the first 48 hours of hospital admission and compared with 18 healthy controls. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Whole-blood leukocytes were immunophenotyped with a rapid and simplified one-step flow cytometry method. Thirty-eight immune and five laboratory parameters were compared first between COVID-19 patients and controls and then between the COVID-19 patients who received or not MV during their stays. The variables that significantly discriminated MV from non-MV patients in univariate analysis were entered into a multiple stepwise logistic regression analysis. The COVID-19 patients were predominantly male (87%), aged 61 years (50-71 yr), and 93% received early corticosteroid therapy. Sixteen patients (53%) were managed with noninvasive respiratory support, and 14 (47%) required MV. Compared with controls, COVID-19 patients were characterized by an immune signature featuring: 1) decreased HLA-DR expression on monocytes; 2) reduced basophils, eosinophils, T-cells, NK cells, and nonclassical monocyte count; and 3) up regulation of CD169 on monocytes, CD64 on neutrophils, the adhesion/migration markers (CD62L and CD11b), and the checkpoint inhibitor CD274 on myeloid cells. Among the COVID-19 patients, those who received MV had lower level of CD4 and HLA-DR on monocytes, lower CD8+ T-cell count, and higher lactate dehydrogenase at hospital admission. In multivariate analysis, only CD4 on monocytes (p = 0.032) and CD8+ T-cell count (p = 0.026) were associated with MV requirement. The model combining these two variables provided an area under curve of 0.97 (95% CI, 0.83-0.99). CONCLUSIONS The association of low CD4 on monocytes and low CD8+ T-cell count at hospital admission was highly predictive of the need for MV in hospitalized patients with COVID-19 pneumonia.
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Michel M, Malergue F, Ait Belkacem I, Bourgoin P, Morange PE, Arnoux I, Miloud T, Million M, Tissot-Dupont H, Mege JL, Vitte J, Busnel JM. A rapid, easy, and scalable whole blood monocyte CD169 assay for outpatient screening during SARS-CoV-2 outbreak, and potentially other emerging disease outbreaks. SAGE Open Med 2022; 10:20503121221115483. [PMID: 35959245 PMCID: PMC9358337 DOI: 10.1177/20503121221115483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 06/28/2022] [Indexed: 11/25/2022] Open
Abstract
Objective: The COVID-19 corona virus disease outbreak is globally challenging health
systems and societies. Its diagnosis relies on molecular methods, with
drawbacks revealed by mass screening. Upregulation of neutrophil CD64 or
monocyte CD169 has been abundantly reported as markers of bacterial or acute
viral infection, respectively. We evaluated the sensitivity of an easy,
one-step whole blood flow cytometry assay to measure these markers within
10 min, as a potential screening test for COVID-19 patients. Methods: Patients (n = 177) with confirmed severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2) infection were tested on 10 µL blood and
results were compared with reverse transcriptase-quantitative polymerase
chain reaction (RT-qPCR). Results: We observed 98% and 100% sensitivity in early-stage (n = 52)
and asymptomatic patients (n = 9), respectively. Late-stage
patients, who presented for a second control RT-qPCR, were negative for both
assays in most cases. Conversely, neutrophil CD64 expression was unchanged
in 75% of cases, without significant differences between groups. Conclusion: Monocyte CD169 evaluation was highly sensitive for detecting SARS-CoV-2
infection in first-presentation patients; and it returns to basal level upon
infection clearance. The potential ease of fingerprick collection, minimal
time-to-result, and low cost rank this biomarker measurement as a potential
viral disease screening tool, including COVID-19. When the virus prevalence
in the tested population is usually low (1%−10%), such an approach could
increase the testing capacity 10 to 100-fold, with the same limited
molecular testing resources, which could focus on confirmation purposes
only.
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Affiliation(s)
- Moïse Michel
- Aix-Marseille University, Marseille, France.,APHM Hôpitaux Universitaires de Marseille, Hôpital Timone, Marseille, France
| | | | | | | | | | - Isabelle Arnoux
- APHM Hôpitaux Universitaires de Marseille, Hôpital Timone, Marseille, France
| | | | - Matthieu Million
- APHM Hôpitaux Universitaires de Marseille, Hôpital Timone, Marseille, France.,IHU Méditerranée Infection, Marseille, France
| | - Hervé Tissot-Dupont
- APHM Hôpitaux Universitaires de Marseille, Hôpital Timone, Marseille, France.,IHU Méditerranée Infection, Marseille, France
| | - Jean-Louis Mege
- Aix-Marseille University, Marseille, France.,IHU Méditerranée Infection, Marseille, France
| | - Joana Vitte
- Aix-Marseille University, Marseille, France.,APHM Hôpitaux Universitaires de Marseille, Hôpital Timone, Marseille, France.,IHU Méditerranée Infection, Marseille, France
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4
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Ait Belkacem I, Mossadegh‐keller N, Bourgoin P, Arnoux I, Loosveld M, Morange P, Markarian T, Michelet P, Busnel JM, Roulland S, Galland F, Malergue F. Cell Analysis from Dried Blood Spots: New Opportunities in Immunology, Hematology, and Infectious Diseases. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:e2100323. [PMID: 34278739 PMCID: PMC8456206 DOI: 10.1002/advs.202100323] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/03/2021] [Indexed: 05/04/2023]
Abstract
Blood cell analysis is a major pillar of biomedical research and healthcare. These analyses are performed in central laboratories. Rapid shipment from collection site to the central laboratories is currently needed because cells and biomarkers degrade rapidly. The dried blood spot from a fingerstick allows the preservation of cellular molecules for months but entire cells are never recovered. Here leucocyte elution is optimized from dried blood spots. Flow cytometry and mRNA expression profiling are used to analyze the recovered cells. 50-70% of the leucocytes that are dried on a polyester solid support via elution after shaking the support with buffer are recovered. While red blood cells lyse upon drying, it is found that the majority of leucocytes are preserved. Leucocytes have an altered structure that is improved by adding fixative in the elution buffer. Leucocytes are permeabilized, allowing an easy staining of all cellular compartments. Common immunophenotyping and mRNAs are preserved. The ability of a new biomarker (CD169) to discriminate between patients with and without Severe Acute Respiratory Syndrome induced by Coronavirus 2 (SARS-CoV-2) infections is also preserved. Leucocytes from blood can be dried, shipped, and/or stored for at least 1 month, then recovered for a wide variety of analyses, potentially facilitating biomedical applications worldwide.
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Affiliation(s)
- Ines Ait Belkacem
- Department of Research and DevelopmentBeckman Coulter Life Sciences‐Immunotech130 Avenue de Lattre de TassignyMarseille13009France
- Aix Marseille UniversitéCNRSINSERMCIMLCentre d'Immunologie de Marseille‐LuminyMarseille13009France
| | | | - Penelope Bourgoin
- Department of Research and DevelopmentBeckman Coulter Life Sciences‐Immunotech130 Avenue de Lattre de TassignyMarseille13009France
| | - Isabelle Arnoux
- Department of Hematology LaboratoryTimone University HospitalAPHM264 Rue Saint‐PierreMarseille13005France
| | - Marie Loosveld
- Department of Hematology LaboratoryTimone University HospitalAPHM264 Rue Saint‐PierreMarseille13005France
| | - Pierre‐emmanuel Morange
- Department of Hematology LaboratoryTimone University HospitalAPHM264 Rue Saint‐PierreMarseille13005France
- Aix Marseille UniversitéINSERMINRAEC2VN, 27 Boulevard Jean MoulinMarseille13385France
| | - Thibaut Markarian
- Department of Hematology LaboratoryTimone University HospitalAPHM264 Rue Saint‐PierreMarseille13005France
- Aix Marseille UniversitéINSERMINRAEC2VN, 27 Boulevard Jean MoulinMarseille13385France
| | - Pierre Michelet
- Aix Marseille UniversitéINSERMINRAEC2VN, 27 Boulevard Jean MoulinMarseille13385France
- Department of Emergency Medicine and Intensive CareTimone University HospitalAPHM264 Rue Saint PierreMarseille13005France
| | - Jean Marc Busnel
- Department of Research and DevelopmentBeckman Coulter Life Sciences‐Immunotech130 Avenue de Lattre de TassignyMarseille13009France
| | - Sandrine Roulland
- Aix Marseille UniversitéCNRSINSERMCIMLCentre d'Immunologie de Marseille‐LuminyMarseille13009France
| | - Franck Galland
- Aix Marseille UniversitéCNRSINSERMCIMLCentre d'Immunologie de Marseille‐LuminyMarseille13009France
| | - Fabrice Malergue
- Department of Research and DevelopmentBeckman Coulter Life Sciences‐Immunotech130 Avenue de Lattre de TassignyMarseille13009France
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5
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Belkacem IA, Bourgoin P, Busnel JM, Galland F, Malergue F. One-step White Blood Cell Extracellular Staining Method for Flow Cytometry. Bio Protoc 2021; 11:e4135. [PMID: 34541052 PMCID: PMC8413609 DOI: 10.21769/bioprotoc.4135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/19/2021] [Accepted: 05/26/2021] [Indexed: 11/02/2022] Open
Abstract
Flow cytometry is a powerful analytical technique that is increasingly used in scientific investigations and healthcare; however, it requires time-consuming, multi-step sample procedures, which limits its use to specialized laboratories. In this study, we propose a new universal one-step method in which white blood cell staining and red blood cell lysis are carried out in a single step, using a gentle lysis solution mixed with fluorescent antibody conjugates or probes in a dry or liquid format. The blood sample may be obtained from a routine venipuncture or directly from a fingerprick, allowing for near-patient analysis. This procedure enables the analysis of common white blood cell markers as well as markers related to infections or sepsis. This simpler and faster protocol may help to democratize the use of flow cytometry in the research and medical fields. Graphic abstract: One-step White Blood Cell Extracellular Staining Method for Flow Cytometry.
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Affiliation(s)
- Ines Ait Belkacem
- Aix Marseille University, Centre d'Immunologie de Marseille-Luminy, Marseille, France
- Department of Research and Development, Beckman Coulter Life Sciences-Immunotech, Marseille, France
| | - Pénélope Bourgoin
- Department of Research and Development, Beckman Coulter Life Sciences-Immunotech, Marseille, France
| | - Jean Marc Busnel
- Department of Research and Development, Beckman Coulter Life Sciences-Immunotech, Marseille, France
| | - Franck Galland
- Aix Marseille University, Centre d'Immunologie de Marseille-Luminy, Marseille, France
| | - Fabrice Malergue
- Department of Research and Development, Beckman Coulter Life Sciences-Immunotech, Marseille, France
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Bourgoin P, Belkacem IA, Arnoux I, Morange PE, Malergue F. Direct freezing of whole blood enables analysis of leucocyte markers by flow cytometry: a proof-of-concept study. Future Microbiol 2021; 16:955-966. [PMID: 34406067 DOI: 10.2217/fmb-2021-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: A new one-step flow cytometry procedure has been recently demonstrated for identifying subjects with infections, but only for fresh whole blood samples. The goal of this study was to assess its applicability on frozen samples, by proposing a new method to perform the sample freezing directly and easily. Methods: Fresh blood was tested, then frozen either directly or with dimethylsulfoxide and serum. Common markers of white blood cells as well as infection-related biomarkers were tested. Results: All percentages of leucocyte subsets and levels of infection-related biomarkers were significantly correlated between frozen and fresh samples. Conclusion: The direct freezing method enables an accurate assessment of common cellular sub-populations and of levels of important infectious biomarkers via flow cytometry.
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Affiliation(s)
- Pénélope Bourgoin
- Department of Research & Development, Beckman Coulter Life Sciences-Immunotech, 130 Avenue de Lattre de Tassigny, Marseille, 13009, France.,C2VN INSERM-INRAE, Aix-Marseille University, 27 Boulevard Jean Moulin, Marseille, 13385, France
| | - Inès Ait Belkacem
- Department of Research & Development, Beckman Coulter Life Sciences-Immunotech, 130 Avenue de Lattre de Tassigny, Marseille, 13009, France.,UMR 7280, Marseille-Luminy Immunology Center (CIML), Marseille, 13009, France
| | - Isabelle Arnoux
- Laboratory of Hematology, La Timone Hospital, 264 Rue Saint-Pierre, Marseille, 13385, France
| | - Pierre-Emmanuel Morange
- C2VN INSERM-INRAE, Aix-Marseille University, 27 Boulevard Jean Moulin, Marseille, 13385, France.,Laboratory of Hematology, La Timone Hospital, 264 Rue Saint-Pierre, Marseille, 13385, France
| | - Fabrice Malergue
- Department of Research & Development, Beckman Coulter Life Sciences-Immunotech, 130 Avenue de Lattre de Tassigny, Marseille, 13009, France
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7
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Bourgoin P, Soliveres T, Barbaresi A, Loundou A, Belkacem IA, Arnoux I, Bernot D, Loosveld M, Morange PE, Michelet P, Malergue F, Markarian T. CD169 and CD64 could help differentiate bacterial from CoVID-19 or other viral infections in the Emergency Department. Cytometry A 2021; 99:435-445. [PMID: 33491921 PMCID: PMC8014466 DOI: 10.1002/cyto.a.24314] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 01/16/2023]
Abstract
The identification of a bacterial, viral, or even noninfectious cause is essential in the management of febrile syndrome in the emergency department (ED), especially in epidemic contexts such as flu or CoVID-19. The aim was to assess discriminative performances of two biomarkers, CD64 on neutrophils (nCD64) and CD169 on monocytes (mCD169), using a new flow cytometry procedure, in patients presenting with fever to the ED during epidemics. Eighty five adult patients presenting with potential infection were included during the 2019 flu season in the ED of La Timone Hospital. They were divided into four diagnostic outcomes according to their clinical records: no-infection, bacterial infection, viral infection and co-infection. Seventy six patients with confirmed SARS-CoV-2 infection were also compared to 48 healthy volunteers. For the first cohort, 38 (45%) patients were diagnosed with bacterial infections, 11 (13%) with viral infections and 29 (34%) with co-infections. mCD169 was elevated in patients with viral infections, with a majority of Flu A virus or Respiratory Syncytial Virus, while nCD64 was elevated in subjects with bacterial infections, with a majority of Streptococcus pneumoniae and Escherichia coli. nCD64 and mCD169 showed 90% and 80% sensitivity, and 78% and 91% specificity, respectively, for identifying patients with bacterial or viral infections. When studied in a second cohort, mCD169 was elevated in 95% of patients with SARS-CoV-2 infections and remained at normal level in 100% of healthy volunteers. nCD64 and mCD169 have potential for accurately distinguishing bacterial and acute viral infections. Combined in an easy and rapid flow cytometry procedure, they constitute a potential improvement for infection management in the ED, and could even help for triage of patients during emerging epidemics.
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Affiliation(s)
- Pénélope Bourgoin
- Department of Research and Development, Beckman Coulter Life Sciences-Immunotech, Marseille, France.,Aix Marseille University, INSERM, INRAE, Marseille, France
| | - Thomas Soliveres
- Department of Emergency Medicine and Intensive Care, Timone University Hospital, APHM, Marseille, France
| | - Alexandra Barbaresi
- Department of Emergency Medicine and Intensive Care, Timone University Hospital, APHM, Marseille, France
| | - Anderson Loundou
- Department of Public Health, EA3279 Self-Perceived Health Assessment Research Unit, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Inès Ait Belkacem
- Department of Research and Development, Beckman Coulter Life Sciences-Immunotech, Marseille, France.,UMR 7280, Marseille-Luminy Immunology Center (CIML), Marseille, France
| | - Isabelle Arnoux
- Department of Hematology Laboratory, Timone University Hospital, APHM, Marseille, France
| | - Denis Bernot
- Department of Hematology Laboratory, Timone University Hospital, APHM, Marseille, France
| | - Marie Loosveld
- Department of Hematology Laboratory, Timone University Hospital, APHM, Marseille, France
| | - Pierre-Emmanuel Morange
- Aix Marseille University, INSERM, INRAE, Marseille, France.,Department of Hematology Laboratory, Timone University Hospital, APHM, Marseille, France
| | - Pierre Michelet
- Aix Marseille University, INSERM, INRAE, Marseille, France.,Department of Emergency Medicine and Intensive Care, Timone University Hospital, APHM, Marseille, France
| | - Fabrice Malergue
- Department of Research and Development, Beckman Coulter Life Sciences-Immunotech, Marseille, France
| | - Thibaut Markarian
- Aix Marseille University, INSERM, INRAE, Marseille, France.,Department of Emergency Medicine and Intensive Care, Timone University Hospital, APHM, Marseille, France
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Ortillon M, Coudereau R, Cour M, Rimmelé T, Godignon M, Gossez M, Yonis H, Argaud L, Lukaszewicz AC, Venet F, Monneret G. Monocyte CD169 expression in COVID-19 patients upon intensive care unit admission. Cytometry A 2021; 99:466-471. [PMID: 33547747 PMCID: PMC8014094 DOI: 10.1002/cyto.a.24315] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 12/11/2022]
Abstract
During the second surge of COVID‐19 in France (fall 2020), we assessed the expression of monocyte CD169 (i.e., Siglec‐1, one of the numerous IFN‐stimulated genes) upon admission to intensive care units of 45 patients with RT‐PCR‐confirmed SARS‐CoV2 pulmonary infection. Overall, CD169 expression was strongly induced on circulating monocytes of COVID‐19 patients compared with healthy donors and patients with bacterial sepsis. Beyond its contribution at the emergency department, CD169 testing may be also helpful for patients' triage at the ICU to rapidly reinforce suspicion of COVID‐19 etiology in patients with acute respiratory failure awaiting for PCR results for definitive diagnosis.
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Affiliation(s)
- Marine Ortillon
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Laboratoire d'Immunologie, Lyon, France
| | - Remy Coudereau
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Laboratoire d'Immunologie, Lyon, France.,EA 7426 Pathophysiology of Injury-Induced Immunosuppression, (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Hôpital Edouard Herriot, Lyon, France
| | - Martin Cour
- Hospices Civils de Lyon, Hôpital Edouard Herriot, service de Médecine intensive-réanimation, Lyon, France
| | - Thomas Rimmelé
- EA 7426 Pathophysiology of Injury-Induced Immunosuppression, (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Hôpital Edouard Herriot, Lyon, France.,Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'anesthésie-réanimation, Lyon, France
| | - Marine Godignon
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Laboratoire d'Immunologie, Lyon, France
| | - Morgane Gossez
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Laboratoire d'Immunologie, Lyon, France.,EA 7426 Pathophysiology of Injury-Induced Immunosuppression, (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Hôpital Edouard Herriot, Lyon, France
| | - Hodane Yonis
- Hospices Civils de Lyon, Croix-Rousse University Hospital, Medical intensive Care Department, Lyon, France
| | - Laurent Argaud
- Hospices Civils de Lyon, Hôpital Edouard Herriot, service de Médecine intensive-réanimation, Lyon, France
| | - Anne-Claire Lukaszewicz
- EA 7426 Pathophysiology of Injury-Induced Immunosuppression, (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Hôpital Edouard Herriot, Lyon, France.,Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'anesthésie-réanimation, Lyon, France
| | - Fabienne Venet
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Laboratoire d'Immunologie, Lyon, France.,EA 7426 Pathophysiology of Injury-Induced Immunosuppression, (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Hôpital Edouard Herriot, Lyon, France.,Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard-Lyon 1, Lyon, France
| | - Guillaume Monneret
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Laboratoire d'Immunologie, Lyon, France.,EA 7426 Pathophysiology of Injury-Induced Immunosuppression, (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Hôpital Edouard Herriot, Lyon, France
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9
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Vitte J, Diallo AB, Boumaza A, Lopez A, Michel M, Allardet-Servent J, Mezouar S, Sereme Y, Busnel JM, Miloud T, Malergue F, Morange PE, Halfon P, Olive D, Leone M, Mege JL. A Granulocytic Signature Identifies COVID-19 and Its Severity. J Infect Dis 2020; 222:1985-1996. [PMID: 32941618 PMCID: PMC7543529 DOI: 10.1093/infdis/jiaa591] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/15/2020] [Indexed: 01/02/2023] Open
Abstract
Background An unbiased approach of SARS-CoV-2-induced immune dysregulation has not been undertaken so far. We aimed to identify previously unreported immune markers able to discriminate COVID-19 patients from healthy controls and to predict mild and severe disease. Methods An observational, prospective, multicentric study was conducted in patients with confirmed COVID-19: mild/moderate (n=7) and severe (n=19). Immunophenotyping of whole blood leukocytes was performed in patients upon hospital ward or intensive care unit admission and in healthy controls (n=25). Clinically relevant associations were identified through unsupervised analysis. Results Granulocytic (neutrophil, eosinophil and basophil) markers were enriched during COVID-19 and discriminated between mild and severe patients. Increased counts of CD15 +CD16 + neutrophils, decreased granulocytic expression of integrin CD11b, and Th2-related CRTH2 downregulation in eosinophils and basophils established a COVID-19 signature. Severity was associated with the emergence of PDL1 checkpoint expression in basophils and eosinophils. This granulocytic signature was accompanied by monocyte and lymphocyte immunoparalysis. Correlation with validated clinical scores supported pathophysiological relevance. Conclusion Phenotypic markers of circulating granulocytes are strong discriminators between infected and uninfected individuals as well as between severity stages. COVID-19 alters the frequency and functional phenotypes of granulocyte subsets with the emergence of CRTH2 as a disease biomarker.
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Affiliation(s)
- Joana Vitte
- Aix-Marseille University, Institut de Recherche pour le Développement, APHM Hôpitaux Universitaires de Marseille, UMR-D258 Microbes, Évolution, Phylogénie et Infection, Marseille, France.,Institut Hospitalo-universitaire, Méditerranée Infection, Marseille, France
| | - Aïssatou Bailo Diallo
- Aix-Marseille University, Institut de Recherche pour le Développement, APHM Hôpitaux Universitaires de Marseille, UMR-D258 Microbes, Évolution, Phylogénie et Infection, Marseille, France.,Institut Hospitalo-universitaire, Méditerranée Infection, Marseille, France
| | - Asma Boumaza
- Aix-Marseille University, Institut de Recherche pour le Développement, APHM Hôpitaux Universitaires de Marseille, UMR-D258 Microbes, Évolution, Phylogénie et Infection, Marseille, France.,Institut Hospitalo-universitaire, Méditerranée Infection, Marseille, France
| | - Alexandre Lopez
- Aix-Marseille University, Institut de Recherche pour le Développement, APHM Hôpitaux Universitaires de Marseille, UMR-D258 Microbes, Évolution, Phylogénie et Infection, Marseille, France.,Institut Hospitalo-universitaire, Méditerranée Infection, Marseille, France.,Aix-Marseille University, APHM Hôpitaux Universitaires de Marseille, Hôpital Nord, Service d'Anesthésie et de Réanimation, Marseille, France
| | - Moïse Michel
- Aix-Marseille University, Institut de Recherche pour le Développement, APHM Hôpitaux Universitaires de Marseille, UMR-D258 Microbes, Évolution, Phylogénie et Infection, Marseille, France.,Institut Hospitalo-universitaire, Méditerranée Infection, Marseille, France
| | | | | | - Youssouf Sereme
- Aix-Marseille University, Institut de Recherche pour le Développement, APHM Hôpitaux Universitaires de Marseille, UMR-D258 Microbes, Évolution, Phylogénie et Infection, Marseille, France.,Institut Hospitalo-universitaire, Méditerranée Infection, Marseille, France
| | | | | | | | - Pierre-Emmanuel Morange
- Centre de Recherche en CardioVasculaire et Nutrition, Aix-Marseille University INSERM, INRAE, APHM Hôpitaux Universitaires de Marseille, Hôpital Timone, Service d'Hématologie, Marseille, France
| | - Philippe Halfon
- Internal Medicine and Infectious Diseases Department, Hôpital Européen-Laboratoire Alphabio, Marseille, France
| | - Daniel Olive
- Aix-Marseille University, Institut Paoli-Calmettes, Cancer Research Center of Marseille, INSERM U1068, CNRS U7258, Marseille, France
| | - Marc Leone
- Aix-Marseille University, Institut de Recherche pour le Développement, APHM Hôpitaux Universitaires de Marseille, UMR-D258 Microbes, Évolution, Phylogénie et Infection, Marseille, France.,Institut Hospitalo-universitaire, Méditerranée Infection, Marseille, France.,Aix-Marseille University, APHM Hôpitaux Universitaires de Marseille, Hôpital Nord, Service d'Anesthésie et de Réanimation, Marseille, France
| | - Jean-Louis Mege
- Aix-Marseille University, Institut de Recherche pour le Développement, APHM Hôpitaux Universitaires de Marseille, UMR-D258 Microbes, Évolution, Phylogénie et Infection, Marseille, France.,Institut Hospitalo-universitaire, Méditerranée Infection, Marseille, France.,Aix-Marseille University, APHM Hôpitaux Universitaires de Marseille, Hôpital de la Conception, Service d'Immunologie, Marseille, France
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10
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Abstract
OBJECTIVES Decreased expression of human leukocyte antigen-DR on monocytes (mHLA-DR) is recognized as the most appropriate marker for the monitoring of immune alterations in septic patients and critically ill subjects. Its measurement has been established for years by flow cytometry, but remains under-used due to pre-analytical constraints. The objectives of the present work were to develop a rapid and robust one-step protocol. METHODS A novel, simplified protocol has been developed to measure mHLA-DR in whole blood using flow cytometry. It is a one-step procedure that includes red cell lysis, antibodies, and fixative reagents. It has been compared to the standardized routine protocol in two consecutive cohorts of septic shock patients (n = 37). Finally, the protocol was applied to a few subjects in point-of-care settings, by collecting capillary blood from fingerpricks. RESULTS Strong correlation was observed between the one-step method and routine protocol in 24 patients. After testing several stabilizing agents, the procedure was further optimized by adding a low-dose formaldehyde to the stain and lyse solution. This improved method was tested in a second cohort of 13 patients, and again strongly correlated to the routine protocol. Finally, the fingerprick and venous puncture samples were shown to provide similar results. CONCLUSIONS The present work demonstrates the feasibility of a bedside protocol for flow cytometry measurement of mHLA-DR in critically ill subjects. This helps overcome pre-analytical constraints previously identified, which have limited wider use of this biomarker in intensive care units. In addition, preliminary results from fingerprick samples are promising.
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11
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Bourgoin P, Lediagon G, Arnoux I, Bernot D, Morange PE, Michelet P, Malergue F, Markarian T. Flow cytometry evaluation of infection-related biomarkers in febrile subjects in the emergency department. Future Microbiol 2020; 15:189-201. [PMID: 32065550 DOI: 10.2217/fmb-2019-0256] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aim: In an Emergency Department (ED), the etiological identification of infected subjects is essential. 13 infection-related biomarkers were assessed using a new flow cytometry procedure. Materials & methods: If subjects presented with febrile symptoms at the ED, 13 biomarkers' levels, including CD64 on neutrophils (nCD64) and CD169 on monocytes (mCD169), were tested and compared with clinical records. Results: Among 50 subjects, 78% had bacterial infections and 8% had viral infections. nCD64 showed 82% sensitivity and 91% specificity for identifying subjects with bacterial infections. mCD169, HLA-ABC ratio and HLA-DR on monocytes had high values in subjects with viral infections. Conclusion: Biomarkers showed promising performances to improve the ED's infectious stratification.
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Affiliation(s)
- Pénélope Bourgoin
- Department of Research & Development, Beckman Coulter Life Sciences-Immunotech, 130 Avenue de Lattre de Tassigny, 13009 Marseille, France.,C2VN INSERM-INRA, Aix-Marseille University, 27 Boulevard Jean Moulin, 13385 Marseille, France
| | - Guillaume Lediagon
- Adult Emergency Unit, La Timone Hospital, APHM, 264 Rue Saint Pierre, 13385 Marseille, France
| | - Isabelle Arnoux
- Hematology Laboratory, La Timone Hospital, APHM, 264 Rue Saint Pierre, 13385 Marseille, France
| | - Denis Bernot
- Hematology Laboratory, La Timone Hospital, APHM, 264 Rue Saint Pierre, 13385 Marseille, France
| | - Pierre-Emmanuel Morange
- C2VN INSERM-INRA, Aix-Marseille University, 27 Boulevard Jean Moulin, 13385 Marseille, France.,Hematology Laboratory, La Timone Hospital, APHM, 264 Rue Saint Pierre, 13385 Marseille, France
| | - Pierre Michelet
- Adult Emergency Unit, La Timone Hospital, APHM, 264 Rue Saint Pierre, 13385 Marseille, France
| | - Fabrice Malergue
- Department of Research & Development, Beckman Coulter Life Sciences-Immunotech, 130 Avenue de Lattre de Tassigny, 13009 Marseille, France
| | - Thibaut Markarian
- Adult Emergency Unit, La Timone Hospital, APHM, 264 Rue Saint Pierre, 13385 Marseille, France
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12
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Bourgoin P, Biéchelé G, Ait Belkacem I, Morange PE, Malergue F. Role of the interferons in CD64 and CD169 expressions in whole blood: Relevance in the balance between viral- or bacterial-oriented immune responses. IMMUNITY INFLAMMATION AND DISEASE 2020; 8:106-123. [PMID: 32031762 PMCID: PMC7016842 DOI: 10.1002/iid3.289] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/13/2022]
Abstract
Introduction CD64 expression increases on neutrophils during bacterial infections. Recently an increase in CD169 expression has been discovered on monocytes during viral infections. Generally, interferons α (IFNsα) and IFNsγ are key drivers of the infectious host immune response. The purpose of this study was to explore if a link exists between these IFNs and both biomarkers. Methods Whole blood samples from healthy volunteers were stimulated with either IFNs, interleukins, or infectious extracts, to mimic an infectious state. Expressions of CD64 and CD169 were assessed in these samples by multiple flow cytometry methods, over precise kinetics. Results The expression of CD64 was statistically higher in samples stimulated with IFNγ, and CD169 in those stimulated with IFNα (and all other type I IFNs). Surface expressions are directly induced by their respective IFNs via Janus kinase/signal transducer and activator of transduction pathways within 6 to 8 hours of incubation. Mixing both types of IFNs seemed to indicate that they partially inhibit each other. Conclusions The induction of CD169 on monocytes and CD164 on neutrophils by type I and type II IFNs confirms the relevance of these markers for assessing between a viral‐ vs bacterial‐oriented immune response.
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Affiliation(s)
- Pénélope Bourgoin
- Department of Research and Development, Immunotech-Beckman Coulter, Marseille, France.,C2VN INSERM-INRAE, Aix-Marseille University, Marseille, France
| | - Géraldine Biéchelé
- Department of Research and Development, Immunotech-Beckman Coulter, Marseille, France
| | - Inès Ait Belkacem
- Department of Research and Development, Immunotech-Beckman Coulter, Marseille, France.,UMR 7280, Center for Marseille-Luminy Immunology (CIML), Marseille, France
| | - Pierre-Emmanuel Morange
- C2VN INSERM-INRAE, Aix-Marseille University, Marseille, France.,Laboratory of Hematology, La Timone Hospital (AP-HM), Marseille, France
| | - Fabrice Malergue
- Department of Research and Development, Immunotech-Beckman Coulter, Marseille, France
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13
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Bourgoin P, Soliveres T, Ahriz D, Arnoux I, Meisel C, Unterwalder N, Morange PE, Michelet P, Malergue F, Markarian T. Clinical research assessment by flow cytometry of biomarkers for infectious stratification in an Emergency Department. Biomark Med 2019; 13:1373-1386. [PMID: 31617736 DOI: 10.2217/bmm-2019-0214] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Aim: Management of patients with infections within the Emergency Department (ED) is challenging for practitioners, as the identification of infectious causes remains difficult with current techniques. A new combination of two biomarkers was tested with a new rapid flow cytometry technique. Materials & methods: Subjects from the ED were tested for their CD64 on neutrophils (nCD64) and CD169 on monocytes (mCD169) levels and results were compared to their clinical records. Results: Among 139 patients, 29% had confirmed bacterial infections and 5% viral infections. nCD64 and mCD169 respectively showed 88 and 86% sensitivity and 90 and 100% specificity for identifying subjects in bacterial or viral conditions. Conclusion: This point-of-care technique could allow better management of patients in the ED.
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Affiliation(s)
- Pénélope Bourgoin
- Department of Research & Development, Beckman Coulter Life Sciences-Immunotech, 130 Avenue de Lattre de Tassigny, 13009 Marseille, France.,C2VN Department, INSERM-INRA, Aix-Marseille University, 27 Boulevard Jean Moulin, 13385 Marseille, France
| | - Thomas Soliveres
- Adult Emergency Department, La Timone Hospital, 264 Rue Saint Pierre, 13385 Marseille, France
| | - Dalia Ahriz
- Adult Emergency Department, La Timone Hospital, 264 Rue Saint Pierre, 13385 Marseille, France
| | - Isabelle Arnoux
- Hematology Laboratory Department, La Timone Hospital, 264 Rue Saint Pierre, 13385 Marseille, France
| | - Christian Meisel
- Department of Medical Immunology, Charité - University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.,Department of Immunology, Labor Berlin - Charité Vivantes GmbH, Sylter Strasse 2, 13353 Berlin, Germany
| | - Nadine Unterwalder
- Department of Immunology, Labor Berlin - Charité Vivantes GmbH, Sylter Strasse 2, 13353 Berlin, Germany
| | - Pierre-Emmanuel Morange
- C2VN Department, INSERM-INRA, Aix-Marseille University, 27 Boulevard Jean Moulin, 13385 Marseille, France.,Hematology Laboratory Department, La Timone Hospital, 264 Rue Saint Pierre, 13385 Marseille, France
| | - Pierre Michelet
- Adult Emergency Department, La Timone Hospital, 264 Rue Saint Pierre, 13385 Marseille, France
| | - Fabrice Malergue
- Department of Research & Development, Beckman Coulter Life Sciences-Immunotech, 130 Avenue de Lattre de Tassigny, 13009 Marseille, France
| | - Thibaut Markarian
- Adult Emergency Department, La Timone Hospital, 264 Rue Saint Pierre, 13385 Marseille, France
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