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Schwarz C, Georgin-Lavialle S, Lombardi Y, Marion O, Jambon F, Legendre C, Marx D, Levi C, Toure F, Le Quintrec M, Bobot M, Matignon M, Dujardin A, Maanaoui M, Cuozzo S, Jalal-Eddine A, Louis K, Mohamadou I, Brazier F, De Nattes T, Geneste C, Thervet E, Ducloux D, Mayet V, Kormann R, Lanot A, Duveau A, Zaidan M, Mesnard L, Ouali N, Rondeau E, Petit-Hoang C, Audard V, Deshayes A, Moktefi A, Rabant M, Buob D, François H, Luque Y. Kidney Transplantation in Patients With AA Amyloidosis: Outcomes in a French Multicenter Cohort. Am J Kidney Dis 2024; 83:329-339. [PMID: 37741608 DOI: 10.1053/j.ajkd.2023.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 06/26/2023] [Accepted: 07/24/2023] [Indexed: 09/25/2023]
Abstract
RATIONALE & OBJECTIVE Outcomes of kidney transplantation for patients with renal AA amyloidosis are uncertain, with reports of poor survival and high rates of disease recurrence. However, the data are inconclusive and mostly based on studies from the early 2000s and earlier. STUDY DESIGN Retrospective multicenter cohort study. SETTING & PARTICIPANTS We searched the French national transplant database to identify all patients with renal AA amyloidosis who underwent kidney transplantation between 2008 and 2018. EXPOSURES Age, cause of amyloidosis, use of biotherapies, and C-reactive protein levels. OUTCOMES Outcomes were all-cause mortality and allograft loss. We also reported amyloidosis allograft recurrence, occurrence of acute rejection episodes, as well as infectious, cardiovascular, and neoplastic disease events. ANALYTICAL APPROACH Kaplan-Meier estimator for mortality and cumulative incidence function method for allograft loss. Factors associated with patient and allograft survival were investigated using a Cox proportional hazards model and a cause-specific hazards model, respectively. RESULTS 86 patients who received kidney transplants for AA amyloidosis at 26 French centers were included. The median age was 49.4 years (IQR, 39.7-61.1). The main cause of amyloidosis was familial Mediterranean fever (37 cases; 43%). 16 (18.6%) patients received biotherapy after transplantation. Patient survival rates were 94.0% (95% CI, 89.1-99.2) at 1 year and 85.5% (77.8-94.0) at 5 years after transplantation. Cumulative incidences of allograft loss were 10.5% (4.0-17.0) at 1 year and 13.0% (5.8-20.1) at 5 years after transplantation. Histologically proven AA amyloidosis recurrence occurred in 5 transplants (5.8%). An infection requiring hospitalization developed in 55.8% of cases, and there was a 27.9% incidence of acute allograft rejection. Multivariable analysis showed that C-reactive protein concentration at the time of transplantation was associated with patient survival (HR, 1.01; 95% CI, 1.00-1.02; P=0.01) and allograft survival (HR, 1.68; 95% CI, 1.10-2.57; P=0.02). LIMITATIONS The study lacked a control group, and the effect of biotherapies on transplantation outcomes could not be explored. CONCLUSIONS This relatively contemporary cohort of patients who received a kidney transplant for AA amyloidosis experienced favorable rates of survival and lower recurrence rates than previously reported. These data support the practice of treating these patients with kidney transplantation for end-stage kidney disease. PLAIN-LANGUAGE SUMMARY AA amyloidosis is a severe and rare disease. Kidney involvement is frequent and leads to end-stage kidney disease. Because of the involvement of other organs, these patients are often frail, which has raised concerns about their suitability for kidney transplantation. We reviewed all patients with AA amyloidosis nephropathy who underwent kidney transplantation in France in the recent era (2008-2018) and found that the outcomes after kidney transplantation were favorable, with 85.5% of patients still alive 5 years after transplantation, a survival rate that is comparable to the outcomes of patients receiving a transplant for other forms of kidney diseases. Recurrence of amyloidosis in the transplanted kidney was infrequent (5.8%). These data support the practice of kidney transplantation for patients with AA amyloidosis who experience kidney failure.
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Affiliation(s)
- Chloë Schwarz
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1155, Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France; Université de Paris, Service de Néphrologie-Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Sophie Georgin-Lavialle
- Sorbonne Université, Internal Medicine Department, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, National Reference Center for Autoinflammatory Diseases and Inflammatory Amyloidosis, Groupe de recherche clinique Amylose AA Sorbonne Université (GRAASU), Paris, France
| | - Yannis Lombardi
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1155, Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - Olivier Marion
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
| | - Frédéric Jambon
- Centre Hospitalier Universitaire de Bordeaux, Service de Néphrologie, Transplantation Dialyse, Aphérèses, Hôpital Pellegrin, Place Amélie Raba Léon, Bordeaux, France
| | | | - David Marx
- Department of Nephrology and Transplantation, Strasbourg University Hospital, Strasbourg, France
| | - Charlène Levi
- Service de Transplantation Rénale, Hôpitaux Civils, Lyon, France
| | - Fatouma Toure
- Department of Nephrology, Dialysis and Transplantation, Hospital University of Limoges, Limoges, France
| | - Moglie Le Quintrec
- Service de Transplantation Rénale, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - Mickael Bobot
- Centre de Néphrologie et Transplantation Rénale, Assistance Publique-Hôpitaux de Marseille, Hôpital de la Conception, Centre Hospitalier Universitaire de la Conception, Marseille, France
| | - Marie Matignon
- Nephrology and Renal Transplantation Department, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Creteil, France
| | - Amaury Dujardin
- Service de Néphrologie et Immunologie Clinique, Nantes Université, Centre Hospitalier Universitaire Nantes, Institut National de la Santé et de la Recherche Médicale, Centre de Recherche en Transplantation et Immunologie, Unité Mixte de Recherche 1064, Institut de Transplantation Urologie Néphrologie, Nantes, France
| | - Mehdi Maanaoui
- Nephrology Department, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Sébastien Cuozzo
- Department of Nephrology Dialysis and Transplantation, Pasteur 2 Hospital, Nice University Hospital, Nice, France
| | | | - Kévin Louis
- Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Nephrology and Transplantation Department, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Inna Mohamadou
- Kidney Transplantation Department, Hôpital Pitié-Salpétriêre, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - François Brazier
- Nephrology, Internal Medicine, Dialysis and Transplantation Department, Centre Hospitalier Universitaire Amiens, Amiens, France
| | - Tristan De Nattes
- Nephrology-Hemodialysis Department, Centre Hospitalier Universitaire Rouen, Rouen, France
| | - Claire Geneste
- Nephrology Department, Centre Hospitalier Universitaire Tours, Tours, France
| | - Eric Thervet
- Nephrology Department, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Didier Ducloux
- Nephrology Department, Centre Hospitalier Universitaire Besançon, Besançon, France
| | - Valentin Mayet
- Nephrology-Hemodialysis Department, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Raphaël Kormann
- Nephrology Department, Centre Hospitalier Universitaire Nancy, Nancy, France
| | - Antoine Lanot
- Nephrology-Dialysis-Kidney Transplantation Department, Centre Hospitalier Universitaire Caen, Caen, France
| | - Agnès Duveau
- Nephrology Department, Centre Hospitalier Universitaire Angers, Angers, France
| | - Mohamad Zaidan
- Université de Paris, Service de Néphrologie-Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Laurent Mesnard
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1155, Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - Nacera Ouali
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1155, Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - Eric Rondeau
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1155, Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - Camille Petit-Hoang
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1155, Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - Vincent Audard
- Nephrology and Renal Transplantation Department, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Creteil, France
| | | | - Anissa Moktefi
- Pathology Department, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | | | - David Buob
- Pathology Department, Sorbonne Université, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hélène François
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1155, Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - Yosu Luque
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1155, Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France.
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Hegazy MT, Fayed A, Nuzzolese R, Sota J, Ragab G. Autoinflammatory diseases and the kidney. Immunol Res 2023; 71:578-587. [PMID: 36991303 PMCID: PMC10425501 DOI: 10.1007/s12026-023-09375-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/16/2023] [Indexed: 03/31/2023]
Abstract
The kidney represents an important target of systemic inflammation. Its involvement in monogenic and multifactorial autoinflammatory diseases (AIDs) vary from peculiar and relatively frequent manifestations to some rare but severe features that may end up requiring transplantation. The pathogenetic background is also very heterogeneous ranging from amyloidosis to non-amyloid related damage rooted in inflammasome activation. Kidney involvement in monogenic and polygenic AIDs may present as renal amyloidosis, IgA nephropathy, and more rarely as various forms of glomerulonephritis (GN), namely segmental glomerulosclerosis, collapsing glomerulopathy, fibrillar, or membranoproliferative GN. Vascular disorders such as thrombosis or renal aneurysms and pseudoaneurysms may be encountered in patients with Behcet's disease. Patients with AIDs should be routinely assessed for renal involvement. Screening with urinalysis, serum creatinine, 24-h urinary protein, microhematuria, and imaging studies should be carried out for early diagnosis. Awareness of drug-induced nephrotoxicity, drug-drug interactions as well as addressing the issue of proper renal adjustment of drug doses deserve a special mention and should always be considered when dealing with patients affected by AIDs. Finally, we will explore the role of IL-1 inhibitors in AIDs patients with renal involvement. Targeting IL-1 may indeed have the potential to successfully manage kidney disease and improve long-term prognosis of AIDs patients.
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Affiliation(s)
- Mohamed Tharwat Hegazy
- Rheumatology and Clinical Immunology Unit, Internal Medicine Department, Cairo University, Cairo, Egypt
- School of Medicine, Newgiza University (NGU), Giza, Egypt
| | - Ahmed Fayed
- Nephrology Unit, Internal Medicine Department, Cairo University, Cairo, Egypt
| | - Rossana Nuzzolese
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Jurgen Sota
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Gaafar Ragab
- Rheumatology and Clinical Immunology Unit, Internal Medicine Department, Cairo University, Cairo, Egypt.
- School of Medicine, Newgiza University (NGU), Giza, Egypt.
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Coşkuner T, Çağlayan Ş, Akgün Ö, Torun R, Yayla ENS, Bagrul IL, Kılbaş G, Yener GO, Köse H, Öztürk K, Baba Ö, Çakan M, Demir F, Sönmez HE, Kalyoncu M, Kılıç SS, Yüksel S, Bağlan E, Bakkaloğlu SA, Ünsal E, Aktay Ayaz N, Sözeri B. The safety of canakinumab in systemic juvenile idiopathic arthritis and autoinflammatory diseases in pediatric patients: a multicenter study. Expert Opin Biol Ther 2023; 23:1299-1306. [PMID: 37970654 DOI: 10.1080/14712598.2023.2282133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/07/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVE To evaluate the safety of canakinumab using real-world data in patients with systemic juvenile idiopathic arthritis (sJIA) and autoinflammatory diseases (AID). RESEARCH DESIGN AND METHODS This was a cross-sectional observational, multicenter study. Patients diagnosed with AID and sJIA treated with canakinumab were included in the study. The participating 13 centers retrospectively collected their patients' data. RESULTS A total of 335 patients were involved in the study. Among these patients, 280 were in the AID group and 55 were in the sJIA group. Canakinumab was administered at a median dose of 3 (2.5-4) mg/kg. The median total exposure time to canakinumab was 1.9 (0.8-3.2) years, corresponding to 759.5 patient-years. Seven hundred and seventy-nine total adverse events (AE) were identified. The total incidence of AE, and serious adverse events (SAE) throughout the study period was 1.02 per patient-years. The upper respiratory tract infection rate was 0.7 per patient-years, while the other infection rate was 0.13 per patient-years. While no death was observed in any patient, SAE were observed in 8 patients. Interstitial lung disease, anaphylaxis, or anaphylactoid reactions were not observed in any patient. CONCLUSIONS Real-life data from a large cohort of patients suggests that canakinumab is as safe as claimed in clinical trials.
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Affiliation(s)
| | - Şengül Çağlayan
- Department of Pediatric Rheumatology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Özlem Akgün
- Department of Pediatric Rheumatology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Rüya Torun
- Department of Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Emine Nur Sunar Yayla
- Department of Pediatric Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - I Lknur Bagrul
- Department of Pediatric Rheumatology, University of Health Sciences Turkey, Ankara, Turkey
| | - Gülşah Kılbaş
- Department of Pediatric Rheumatology, School of Medicine, Pamukkale University, Denizli, Turkey
| | - Gülçin Otar Yener
- Department of Pediatric Rheumatology, Şanlıurfa Research and Training Hospital, Şanlıurfa, Turkey
| | - Hülya Köse
- Department of Pediatrics, Division of Immunology and Rheumatology, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Kübra Öztürk
- Department of Pediatric Rheumatology, Göztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Özge Baba
- Department of Pediatric Rheumatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Mustafa Çakan
- Department of Pediatric Rheumatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Ferhat Demir
- Department of Pediatric Rheumatology, Acıbadem University Faculty of Medicine, Istanbul, Turkey
| | - Hafize Emine Sönmez
- Department of Pediatric Rheumatology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Mukaddes Kalyoncu
- Department of Pediatric Rheumatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Sara Sebnem Kılıç
- Department of Pediatrics, Division of Immunology and Rheumatology, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Selçuk Yüksel
- Department of Pediatric Rheumatology, School of Medicine, Pamukkale University, Denizli, Turkey
| | - Esra Bağlan
- Department of Pediatric Rheumatology, University of Health Sciences Turkey, Ankara, Turkey
| | - Sevcan A Bakkaloğlu
- Department of Pediatric Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Erbil Ünsal
- Department of Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Nuray Aktay Ayaz
- Department of Pediatric Rheumatology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Betül Sözeri
- Department of Pediatric Rheumatology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Yazısız V, Yılmaz VT, Uçar İ, Dandin Ö, Aslan B, Erbasan F, Koçak H, Ender Terzioğlu M. The use of anti-interleukin-1 agents and tumor necrosis factor-alpha inhibitors in renal transplant recipients. Arch Rheumatol 2021; 36:366-374. [PMID: 34870168 PMCID: PMC8612503 DOI: 10.46497/archrheumatol.2021.8500] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 12/11/2020] [Indexed: 11/03/2022] Open
Abstract
Objectives The aim of this study was to investigate the efficacy and safety of anti-interleukin-1 (anti-IL-1) agents and tumor necrosis factor-alpha (TNF-α) inhibitors in renal transplant patients. Patients and methods Between February 2014 and February 2020, data of 12 renal transplant recipients (9 males, 3 females; median age: 51 years; range, 19 to 70 years) who received anti-IL-1 agents or TNF-α inhibitors for inflammatory diseases in the post-transplant time period and were followed in a single transplant center (n=12) were retrospectively analyzed. A total of 46 cases were reported in the literature, before the data were collected. The overall outcomes of all cases were analyzed in this study. Results Thirty-seven patients received anti-IL-1 agents in the post-transplant period. The main indications for anti-IL-1 agents were familial Mediterranean fever (FMF) and amyloidosis (75.7%). The continuation rate of colchicine treatment in patients with FMF was 85.7%. Anti-IL-1 agents prevented attacks completely in 89.3% of FMF patients. The number of cases used TNF-α inhibitors among renal transplant patients was lower (n=21). The TNF-α inhibitors were used mainly for inflammatory bowel diseases (57.1%) and ankylosing spondylitis (33.3%) and suppressed the disease activity in most of the patients with inflammatory diseases (72.7%). Death (n=3) and malignancies (n=3) were reported in patients who received TNF-α inhibitors, but not in patients who received anti-IL-1. The renal outcomes and graft survival rates were satisfactory in patients who received both anti-IL-1 agents and TNF-α inhibitors. Conclusion Our results support that anti-IL-1 agents can be used effectively and safely in renal transplant patients.
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Affiliation(s)
- Veli Yazısız
- Department of Internal Medicine, Division of Rheumatology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Vural Taner Yılmaz
- Department of Nephrology, Akdeniz University School of Medicine, Antalya, Turkey
| | - İsmail Uçar
- Department of Internal Medicine, Division of Rheumatology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Özgür Dandin
- Department of General Surgery, Akdeniz University School of Medicine, Antalya, Turkey
| | - Bengisu Aslan
- Department of Internal Medicine, Division of Rheumatology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Funda Erbasan
- Department of Internal Medicine, Division of Rheumatology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Hüseyin Koçak
- Department of Nephrology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Mustafa Ender Terzioğlu
- Department of Internal Medicine, Division of Rheumatology, Akdeniz University School of Medicine, Antalya, Turkey
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Simsek C, Karatas M, Tatar E, Yildirim AM, Alkan FT, Uslu A. The efficacy of interleukin-1 antagonist drugs in combination with colchicine in patients with FMF-AA with colchicine resistance after kidney transplantation: A study with histopathologic evidence. Clin Transplant 2021; 35:e14309. [PMID: 33813772 DOI: 10.1111/ctr.14309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The efficacy of anti-interleukin-1 (IL-1) drugs in kidney transplant patients with FMF-AA who developed colchicine resistance has not been clearly demonstrated. METHOD Thirty nine kidney transplant recipients with FMF-AA were evaluated. Group 1 consisted of patients who were in remission after transplantation with colchine and Group 2 included those who developed colchicine resistance. RESULTS The mean follow-up of the patients was 88.5 ± 61.9 months. Following the treatment with IL-1 antagonists; serum Amyloid A (SAA) averages (79.4 ± 35.3 mg/L) as well as the average number of hospitalizations per month due to FMF episodes (1.4 ± 0.5 times/month) decreased significantly (26.6 ± 25.9 mg/L and 0.1 ± 0.3 times/month) (p < .001). Rates of death with a functional graft were 30% and 0% in group 1 and 2 (p = .086). Biopsy-proven AA amyloidosis recurrence in the allograft was observed in 11 of 19 (58%) and seven of nine (78%) patients in group 1 and 2, respectively. Interestingly, glomerular amyloid deposition was not present in the vast majority of biopsies. De novo vasculer amyloid deposition was observed during treatment. CONCLUSION IL-1 antagonist drug and colchicine combination almost completely prevented acute FMF attacks in kidney transplant patients with colchicine resistance. However, amyloid accumulation did not cease during IL-1 antagonist drug treatment.
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Affiliation(s)
- Cenk Simsek
- Department of General Surgery and Transplantation, Izmir Bozyaka Education and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Murat Karatas
- Department of General Surgery and Transplantation, Izmir Bozyaka Education and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Erhan Tatar
- Department of Nephrology and Transplantation, Izmir Bozyaka Education and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Ali Murat Yildirim
- Department of General Surgery and Transplantation, Izmir Bozyaka Education and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Funda Tasli Alkan
- Department of Pathology, Izmir Bozyaka Education and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Adam Uslu
- Department of General Surgery and Transplantation, Izmir Bozyaka Education and Research Hospital, University of Health Sciences, Izmir, Turkey
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Abstract
Gout, a debilitating inflammatory arthritis, currently affects more than 9 million Americans. Hyperuricemia, the laboratory abnormality associated with the development of gout, also occurs in a significant number of patients with chronic kidney disease (CKD), a condition that affects approximately 14% of the US population. Several recent studies have attempted to provide a definitive link between the presence of hyperuricemia and progression of CKD; however, the treatment of asymptomatic hyperuricemia in CKD is not supported by recent randomized controlled trials. The pharmacology of acute gout flares and urate lowering is complicated in patients who also have evidence of CKD, primarily because of an increased risk of medication toxicity. Recipients of kidney transplants are particularly at risk of debilitating gout and medication toxicity. We review the available data linking CKD, gout, and hyperuricemia, providing practice guidelines on managing gout in CKD patients and kidney transplant recipients. We advocate for much greater involvement of nephrologists in the management of gout in renal patients.
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Affiliation(s)
| | - David B Mount
- Renal Division, Brigham and Women's Hospital, Boston, MA; Renal Division, VA Boston Healthcare System, Harvard Medical School, Boston, MA.
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Egeli BH, Ugurlu S. Familial Mediterranean Fever: Clinical State Of The Art. QJM 2020; 115:hcaa291. [PMID: 33079202 DOI: 10.1093/qjmed/hcaa291] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 12/22/2022] Open
Abstract
As the inflammation research improves year by year, so does our understanding of the autoinflammatory conditions. Over the past years, the number of monogenic autoinflammatory conditions snowballed thanks to our understanding of basic immunology and genetics. Familial Mediterranean Fever (FMF), being the entrance to this fascinating world, still has clinical relevance as it enables us to understand our approach to these patients, treatment modalities, and pathological mechanisms. This review can be used as a tool for clinicians already working with FMF patients to update themselves on recent scientific literature.
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Affiliation(s)
- Bugra Han Egeli
- Medical Doctor; Cerrahpasa Medical Faculty, University of Istanbul-Cerrahpasa, Istanbul, Turkey
| | - Serdal Ugurlu
- Professor: Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, University of Istanbul-Cerrahpasa, Istanbul, Turkey
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa
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8
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Graňák K, Jeseňák M, Vnučák M, Skálová P, Laca Ľ, Mokáň M, Dedinská I. Kidney transplantation as a treatment of choice for AA amyloidosis due to periodic fever syndrome. Clin Rheumatol 2020; 40:763-768. [PMID: 32654081 DOI: 10.1007/s10067-020-05283-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/08/2020] [Accepted: 07/06/2020] [Indexed: 11/21/2022]
Abstract
Renal AA amyloidosis is the most serious complication of periodic fever syndrome, which, inadequate suppression, due to persistent inflammation, leads to nephrotic syndrome and renal failure over several years. In most cases, periodic fever syndromes begin to manifest clinically in early childhood. Occurrence in adulthood is considered rare and is associated with a poorer clinical course. Kidney transplantation (KT) is an effective and safe treatment for end-stage chronic kidney disease (CKD) based on AA amyloidosis. In this paper, we present cases of two patients after deceased donor KT, who have been diagnosed with adult periodic fever syndrome. In the first one, diagnosis and treatment began in advanced stage of CKD and therefore underwent KT with compensated disease, while in the second patient, the disease manifested and diagnosed in the post-KT period. Timely initiation of treatment ensured protection of the graft from amyloid deposition.
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Affiliation(s)
- K Graňák
- Department of Surgery and Transplantation Center, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Kollárova 2, 03601, Martin, Slovak Republic
| | - M Jeseňák
- Department of Children and Adolescents, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Kollárova 2, 03601, Martin, Slovak Republic
| | - Matej Vnučák
- Department of Surgery and Transplantation Center, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Kollárova 2, 03601, Martin, Slovak Republic.
| | - P Skálová
- Department of Surgery and Transplantation Center, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Kollárova 2, 03601, Martin, Slovak Republic
| | - Ľ Laca
- Department of Surgery and Transplantation Center, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Kollárova 2, 03601, Martin, Slovak Republic
| | - M Mokáň
- 1st Department of Internal Diseases, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Kollárova 2, 03601, Martin, Slovak Republic
| | - I Dedinská
- Department of Surgery and Transplantation Center, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Kollárova 2, 03601, Martin, Slovak Republic
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9
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Hentgen V, Vinit C, Fayand A, Georgin-Lavialle S. The Use of Interleukine-1 Inhibitors in Familial Mediterranean Fever Patients: A Narrative Review. Front Immunol 2020; 11:971. [PMID: 32670263 PMCID: PMC7326122 DOI: 10.3389/fimmu.2020.00971] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 04/24/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose: Familial Mediterranean fever (FMF) is the most common monogenic auto-inflammatory disease characterized by recurrent attacks of fever and serositis. It is associated with mutation in pyrin inflammasome leading to interleukin-1 (IL-1) over secretion. Although colchicine is the first line treatment in FMF, 5-10% of patients are reported in literature as non-responders. Colchicine is not always well-tolerated due either to its direct toxicity or to co-morbidities that preclude the administration of its proper dosage. For these patients an alternative or additional treatment to colchicine is necessary. This literature review reports the published data regarding the use of IL-1 inhibitors in Familial Mediterranean Fever. Results: There is no uniform definition of colchicine resistance, but the different studies of treatment with IL-1 inhibitors provide evidence of IL-1 pathogenic role in colchicine-resistant FMF. IL-1 inhibition is an efficacious option for controlling and preventing flares -at least at the short term- in FMF patients who are insufficiently controlled with colchicine alone. Although canakinumab is the only approved drug in Europe for colchicine resistant FMF treatment, experience with anakinra is also substantial. In the absence of comparative studies both treatments seem to be an equal option for the management of these patients. Overall the safety profile of IL-1 inhibitors seems not different in FMF patients than in the other diseases and can be considered as globally safe. The main side effects are local injection site reactions and infections. Conclusion: IL-1 inhibitors have the potential to improve patient outcome even in FMF patients with co-morbidities or severe complications in whom inflammation control is difficult to achieve with colchicine alone. Nevertheless, current data are limited and further evaluation of long-term efficacy and safety of IL-1 inhibitors are necessary, in order to provide robust evidence in this domain.
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Affiliation(s)
- Véronique Hentgen
- General Pediatric Department, French National Reference Center for Autoinflammatory Diseases (CEREMAIA), Versailles Hospital, Versailles, France
| | - Caroline Vinit
- General Pediatric Department, French National Reference Center for Autoinflammatory Diseases (CEREMAIA), Versailles Hospital, Versailles, France
| | - Antoine Fayand
- Internal Medicine Department, French National Reference Center for Autoinflammatory Diseases (CEREMAIA), Tenon Hospital, Sorbonne University, Paris, France
| | - Sophie Georgin-Lavialle
- Internal Medicine Department, French National Reference Center for Autoinflammatory Diseases (CEREMAIA), Tenon Hospital, Sorbonne University, Paris, France
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10
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Xie CB, Jane-Wit D, Pober JS. Complement Membrane Attack Complex: New Roles, Mechanisms of Action, and Therapeutic Targets. THE AMERICAN JOURNAL OF PATHOLOGY 2020; 190:1138-1150. [PMID: 32194049 DOI: 10.1016/j.ajpath.2020.02.006] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/24/2020] [Accepted: 02/03/2020] [Indexed: 12/11/2022]
Abstract
The complement membrane attack complex (MAC) is classically known as a cytolytic effector of innate and adaptive immunity that forms pores in the plasma membrane of pathogens or targeted cells, leading to osmolysis. Nucleated cells resist MAC-mediated cytolysis by expression of inhibitors that block MAC assembly or by rapid removal of MAC through endocytosis or shedding. In the absence of lysis, MAC may induce intracellular signaling and cell activation, responses implicated in a variety of autoimmune, inflammatory, and transplant disease settings. New discoveries into the structure and biophysical properties of MAC revealed heterogeneous MAC precursors and conformations that provide insights into MAC function. In addition, new mechanisms of MAC-mediated signaling and its contribution to disease pathogenesis have recently come to light. MAC-activated cells have been found to express proinflammatory proteins-often through NF-κB-dependent transcription, assemble inflammasomes, enabling processing, and facilitate secretion of IL-1β and IL-18, as well as other signaling pathways. These recent insights into the mechanisms of action of MAC provide an updated framework to therapeutic approaches that can target MAC assembly, signaling, and proinflammatory effects in various complement-mediated diseases.
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Affiliation(s)
- Catherine B Xie
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut
| | - Dan Jane-Wit
- Division of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jordan S Pober
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut.
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11
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Kacar M, Savic S, van der Hilst JCH. The Efficacy, Safety and Tolerability of Canakinumab in the Treatment of Familial Mediterranean Fever: A Systematic Review of the Literature. J Inflamm Res 2020; 13:141-149. [PMID: 32210604 PMCID: PMC7069573 DOI: 10.2147/jir.s206204] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/20/2020] [Indexed: 11/23/2022] Open
Abstract
Familial Mediterranean Fever (FMF) is the most prevalent genetic autoinflammatory disorder. In most patients, treatment with colchicine can prevent attacks of fever and inflammation. However, 5%-10% of patients are resistant to colchicine treatment, while a similar percentage cannot tolerate colchicine in doses needed to prevent attacks. For these patients, Canakinumab, a full human antibody against IL-1β, has been approved recently by the FDA and EMA. In this article, we present a systematic review of the long-term efficacy, safety, and tolerability of Canakinumab in FMF patients who cannot tolerate colchicine or who are resistant to colchicine treatment.
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Affiliation(s)
- Mark Kacar
- Department of Clinical Immunology and Allergy, St James´s University Hospital, Leeds, UK
| | - Sinisa Savic
- Department of Clinical Immunology and Allergy, St James´s University Hospital, Leeds, UK
| | - Jeroen C H van der Hilst
- Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium.,BIOMED Research Institute, University of Hasselt, Hasselt, Belgium
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