1
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Masson JD, Badran G, Gherardi RK, Authier FJ, Crépeaux G. Widespread Myalgia and Chronic Fatigue: Phagocytes from Macrophagic Myofasciitis Patients Exposed to Aluminum Oxyhydroxide-Adjuvanted Vaccine Exhibit Specific Inflammatory, Autophagic, and Mitochondrial Responses. TOXICS 2024; 12:491. [PMID: 39058143 PMCID: PMC11281175 DOI: 10.3390/toxics12070491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 06/29/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024]
Abstract
(1) Background: Macrophagic myofasciitis (MMF) is an inflammatory histopathological lesion demonstrating long-term biopersistence of vaccine-derived aluminum adjuvants within muscular phagocytic cells. Affected patients suffer from widespread myalgia and severe fatigue consistent with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a poorly understood disorder suspected to result from chronic immune stimulation by infectious and inorganic particles. (2) Methods: In this study we determined the immuno-metabolic properties of MMF phagocytic cells compared to controls, at rest and upon exposure to aluminum oxyhydroxide adjuvant, with or without adsorbed antigens, using protein quantification and an oxygen consumption assay. (3) Results: MMF and control cells similarly internalized the adjuvant and vaccine but MMF cells specifically expressed Rubicon and Nox2, two molecules unique to the LC3-associated phagocytosis (LAP) machinery, a non-canonical autophagic pathway able to downregulate canonical autophagy. MMF cells exhibited an altered inflammatory secretome, producing more pain-inducing CXC chemokines and less TNF-α than controls, consistent with chronic myalgia and exhaustion of the immune system previously documented in ME/CFS. MMF cells exhibited mitochondrial metabolism dysfunction, with exacerbated reaction to adjuvanted vaccine, contrasting with limited spare respiratory capacity and marked proton leak weakening energy production. (4) Conclusions: MMF phagocytes seemingly use LAP to handle aluminum oxyhydroxide vaccine particles, secrete pain-inducing molecules, and exhibit exacerbated metabolic reaction to the vaccine with limited capacity to respond to ongoing energetic requests.
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Affiliation(s)
- Jean-Daniel Masson
- Institut National de la Santé Et de la Recherche Médicale, Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, F-94010 Creteil, France
| | - Ghidaa Badran
- Institut National de la Santé Et de la Recherche Médicale, Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, F-94010 Creteil, France
| | - Romain K. Gherardi
- Institut National de la Santé Et de la Recherche Médicale, Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, F-94010 Creteil, France
- Hôpitaux Universitaires Henri Mondor, Service d’Histologie/Centre Expert de Pathologie Neuromusculaire, Assistance Publique-Hôpitaux de Paris, F-94010 Creteil, France
| | - François-Jérôme Authier
- Institut National de la Santé Et de la Recherche Médicale, Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, F-94010 Creteil, France
- Hôpitaux Universitaires Henri Mondor, Service d’Histologie/Centre Expert de Pathologie Neuromusculaire, Assistance Publique-Hôpitaux de Paris, F-94010 Creteil, France
| | - Guillemette Crépeaux
- Institut National de la Santé Et de la Recherche Médicale, Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, F-94010 Creteil, France
- Ecole Nationale Vétérinaire d’Alfort, Institut Mondor de Recherche Biomédicale, F-94700 Maisons Alfort, France
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2
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Le Quang M, Solé G, Martin-Négrier ML, Mathis S. Clinical and pathological aspects of toxic myopathies. J Neurol 2024:10.1007/s00415-024-12522-x. [PMID: 38907023 DOI: 10.1007/s00415-024-12522-x] [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: 04/17/2024] [Revised: 06/14/2024] [Accepted: 06/15/2024] [Indexed: 06/23/2024]
Abstract
As the most frequent cause of acquired myopathy, toxic myopathies are characterised by clinicopathological features that vary depending on the mode of action of the drugs or toxins involved. Although a large number of substances can induce myotoxicity, the main culprits are statins, alcohol, and corticosteroids. A rigorous, well-organised diagnostic approach is necessary to obtain a rapid diagnosis. For early diagnosis and management, it is important for clinicians to be aware that most toxic myopathies are potentially reversible, and the goal of treatment should be to avoid serious muscle damage.
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Affiliation(s)
- Mégane Le Quang
- Department of Pathology, University Hospital (CHU) of Bordeaux, Pellegrin Hospital, Place Amélie Raba Léon, 33000, Bordeaux, France
| | - Guilhem Solé
- Department of Neurology, Nerve-Muscle Unit, AOC Reference for Neuromuscular Disorders, University Hospital (CHU) of Bordeaux, Pellegrin Hospital, Place Amélie Raba Léon, 33000, Bordeaux, France
| | - Marie-Laure Martin-Négrier
- Department of Pathology, University Hospital (CHU) of Bordeaux, Pellegrin Hospital, Place Amélie Raba Léon, 33000, Bordeaux, France
| | - Stéphane Mathis
- Department of Neurology, Nerve-Muscle Unit, AOC Reference for Neuromuscular Disorders, University Hospital (CHU) of Bordeaux, Pellegrin Hospital, Place Amélie Raba Léon, 33000, Bordeaux, France.
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3
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Lequain H, Dégletagne C, Streichenberger N, Valantin J, Simonet T, Schaeffer L, Sève P, Leblanc P. Spatial Transcriptomics Reveals Signatures of Histopathological Changes in Muscular Sarcoidosis. Cells 2023; 12:2747. [PMID: 38067175 PMCID: PMC10706822 DOI: 10.3390/cells12232747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
Sarcoidosis is a multisystemic disease characterized by non-caseating granuloma infiltrating various organs. The form with symptomatic muscular involvement is called muscular sarcoidosis. The impact of immune cells composing the granuloma on the skeletal muscle is misunderstood. Here, we investigated the granuloma-skeletal muscle interactions through spatial transcriptomics on two patients affected by muscular sarcoidosis. Five major transcriptomic clusters corresponding to perigranuloma, granuloma, and three successive muscle tissue areas (proximal, intermediate, and distal) around the granuloma were identified. Analyses revealed upregulated pathways in the granuloma corresponding to the activation of T-lymphocytes and monocytes/macrophages cytokines, the upregulation of extracellular matrix signatures, and the induction of the TGF-β signaling in the perigranuloma. A comparison between the proximal and distal muscles to the granuloma revealed an inverse correlation between the distance to the granuloma and the upregulation of cellular response to interferon-γ/α, TNF-α, IL-1,4,6, fibroblast proliferation, epithelial to mesenchymal cell transition, and the downregulation of muscle gene expression. These data shed light on the intercommunications between granulomas and the muscle tissue and provide pathophysiological mechanisms by showing that granuloma immune cells have a direct impact on proximal muscle tissue by promoting its progressive replacement by fibrosis via the expression of pro-inflammatory and profibrosing signatures. These data could possibly explain the evolution towards a state of disability for some patients.
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Affiliation(s)
- Hippolyte Lequain
- Département de Médecine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France;
- Institut NeuroMyoGène INMG-PGNM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, Inserm U1315, Faculté de Médecine Rockefeller, Université Claude Bernard UCBL-Lyon 1, 69008 Lyon, France; (N.S.); (T.S.)
| | - Cyril Dégletagne
- CRCL Core Facilities, Centre de Recherche en Cancérologie de Lyon (CRCL) INSERM U1052-CNRS UMR5286, Université de Lyon, Université Claude Bernard Lyon1, Centre Léon Bérard, 69008 Lyon, France; (C.D.); (J.V.)
| | - Nathalie Streichenberger
- Institut NeuroMyoGène INMG-PGNM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, Inserm U1315, Faculté de Médecine Rockefeller, Université Claude Bernard UCBL-Lyon 1, 69008 Lyon, France; (N.S.); (T.S.)
- Service d’Anatomopathologie, Centre de Biologie et Pathologie Est (CBPE), Hospices Civils de Lyon, 69500 Bron, France
| | - Julie Valantin
- CRCL Core Facilities, Centre de Recherche en Cancérologie de Lyon (CRCL) INSERM U1052-CNRS UMR5286, Université de Lyon, Université Claude Bernard Lyon1, Centre Léon Bérard, 69008 Lyon, France; (C.D.); (J.V.)
| | - Thomas Simonet
- Institut NeuroMyoGène INMG-PGNM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, Inserm U1315, Faculté de Médecine Rockefeller, Université Claude Bernard UCBL-Lyon 1, 69008 Lyon, France; (N.S.); (T.S.)
| | - Laurent Schaeffer
- Institut NeuroMyoGène INMG-PGNM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, Inserm U1315, Faculté de Médecine Rockefeller, Université Claude Bernard UCBL-Lyon 1, 69008 Lyon, France; (N.S.); (T.S.)
- Centre de Biotechnologie Cellulaire, CHU de Lyon—HCL Groupement Est, 69677 Bron, France
| | - Pascal Sève
- Département de Médecine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France;
- Pôle IMER, HESPER EA 7425, 69002 Lyon, France
| | - Pascal Leblanc
- Institut NeuroMyoGène INMG-PGNM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, Inserm U1315, Faculté de Médecine Rockefeller, Université Claude Bernard UCBL-Lyon 1, 69008 Lyon, France; (N.S.); (T.S.)
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4
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Matsumura N, Shiro R, Tsunoda I. Critical evaluation on roles of macrophagic myofasciitis and aluminum adjuvants in HPV vaccine-induced adverse events. Cancer Sci 2023; 114:1218-1228. [PMID: 36601818 PMCID: PMC10067403 DOI: 10.1111/cas.15714] [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: 09/02/2022] [Revised: 11/29/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023] Open
Abstract
Cervical cancer is caused by human papillomavirus (HPV) infection, which is preventable by HPV vaccines. In Japan, the HPV vaccination rate has remained extremely low due to the concerns for alleged neuropsychological symptoms or "diverse symptoms" following injections of two HPV vaccines, Cervarix and Gardasil, in HPV vaccine lawsuits. In the lawsuits, the attorneys' group has used several manuscripts proposing that aluminum (Al) adjuvant contained in HPV vaccines causes an immune-mediated disease, called macrophagic myofasciitis (MMF), as well as pathology in the central nervous system (CNS). We scientifically evaluated these manuscripts describing the "Al adjuvant-induced pathologies," particularly MMF. Although MMF patients have been reported to develop clinical symptoms/signs in various organs, including the CNS, muscle biopsy of the patients and animal experiments demonstrated that MMF pathology was localized only at the injected muscle. No muscle pathology which characterizes MMF was observed in any other muscles; thus, the systemic and neurological signs of MMF cases were irrelevant to localized MMF pathology. We evaluated that MMF-like pathology was induced as a local inflammatory response following vaccinations; MMF pathology was not the cause of systemic inflammation or "diverse symptoms." Lastly, MMF cases have been reported after vaccinations with Al-hydroxide-containing vaccines exclusively. As Al-hydroxide is a component of Cervarix, but not Gardasil, "diverse symptoms" following two HPV vaccinations in Japan cannot be explained by MMF. Our evaluation would help readers understand the validity of the manuscripts on the role of Al adjuvants or MMF for the alleged "diverse symptoms."
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Affiliation(s)
- Noriomi Matsumura
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Reona Shiro
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Ikuo Tsunoda
- Department of Microbiology, Kindai University Faculty of Medicine, Osaka, Japan
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5
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Arakawa H, Yokoyama S, Ohira T, Kang D, Honda K, Ueda Y, Tojo A. Juvenile Membranous Nephropathy Developed after Human Papillomavirus (HPV) Vaccination. Vaccines (Basel) 2022; 10:vaccines10091442. [PMID: 36146521 PMCID: PMC9502366 DOI: 10.3390/vaccines10091442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 02/05/2023] Open
Abstract
A 16-year-old girl with no history of renal disease had a fever of 38 °C after her second HPV vaccination and was identified as positive for proteinuria. As she maintained urinary protein of 3.10 g/gCr and 5-9 urinary red blood cells/HPF, a renal biopsy was performed and small spikes on PAM staining with the granular deposition of IgG1++ and IgG3+ on the glomerular capillary wall were discovered by immunofluorescence, although PLA2R immunostaining was negative. Analysis by electron microscope showed electron density deposition in the form of fine particles under the epithelium. The diagnosis was secondary membranous nephropathy stage II. Immunostaining with the anti-p16 INK4a antibody was positive for glomerular cells, and Western blot analysis of urinary protein showed a positive band for p16 INK4a. However, laser-microdissection mass spectrometry analysis of a paraffin section of glomeruli failed to detect HPV proteins. It is possible that the patient was already infected with HPV and administration of the HPV vaccine may have caused secondary membranous nephropathy.
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Affiliation(s)
- Haruna Arakawa
- Department of Nephrology & Hypertension, Dokkyo Medical University, Mibu 321-0293, Japan
| | - Shohei Yokoyama
- Department of Nephrology & Hypertension, Dokkyo Medical University, Mibu 321-0293, Japan
| | - Takehiro Ohira
- Department of Nephrology & Hypertension, Dokkyo Medical University, Mibu 321-0293, Japan
| | - Dedong Kang
- Department of Anatomy, Showa University School of Medicine, Tokyo 142-8555, Japan
| | - Kazuho Honda
- Department of Anatomy, Showa University School of Medicine, Tokyo 142-8555, Japan
| | - Yoshihiko Ueda
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, Saitama 343-8555, Japan
| | - Akihiro Tojo
- Department of Nephrology & Hypertension, Dokkyo Medical University, Mibu 321-0293, Japan
- Correspondence: ; Tel.: +81-282-86-1111
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6
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Angrand L, Masson JD, Rubio-Casillas A, Nosten-Bertrand M, Crépeaux G. Inflammation and Autophagy: A Convergent Point between Autism Spectrum Disorder (ASD)-Related Genetic and Environmental Factors: Focus on Aluminum Adjuvants. TOXICS 2022; 10:toxics10090518. [PMID: 36136483 PMCID: PMC9502677 DOI: 10.3390/toxics10090518] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/19/2022] [Accepted: 08/25/2022] [Indexed: 05/10/2023]
Abstract
Autism spectrum disorder (ASD), schizophrenia, and bipolar disorder are genetically complex and heterogeneous neurodevelopmental disorders (NDDs) resulting from genetic factors and gene-environment (GxE) interactions for which onset occurs in early brain development. Recent progress highlights the link between ASD and (i) immunogenetics, neurodevelopment, and inflammation, and (ii) impairments of autophagy, a crucial neurodevelopmental process involved in synaptic pruning. Among various environmental factors causing risk for ASD, aluminum (Al)-containing vaccines injected during critical periods have received special attention and triggered relevant scientific questions. The aim of this review is to discuss the current knowledge on the role of early inflammation, immune and autophagy dysfunction in ASD as well as preclinical studies which question Al adjuvant impacts on brain and immune maturation. We highlight the most recent breakthroughs and the lack of epidemiological, pharmacokinetic and pharmacodynamic data constituting a "scientific gap". We propose additional research, such as genetic studies that could contribute to identify populations at genetic risk, improving diagnosis, and potentially the development of new therapeutic tools.
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Affiliation(s)
- Loïc Angrand
- Univ Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France; (L.A.); (J.-D.M.)
- Ecole Nationale Vétérinaire d’Alfort IMRB, F-94700 Maisons-Alfort, France
- INSERM UMR-S 1270, 75005 Paris, France;
- Sorbonne Université, Campus Pierre et Marie Curie, 75005 Paris, France
- Institut du Fer à Moulin, 75005 Paris, France
| | - Jean-Daniel Masson
- Univ Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France; (L.A.); (J.-D.M.)
- Ecole Nationale Vétérinaire d’Alfort IMRB, F-94700 Maisons-Alfort, France
| | - Alberto Rubio-Casillas
- Biology Laboratory, Autlán Regional Preparatory School, University of Guadalajara, Autlán 48900, Jalisco, Mexico;
- Autlán Regional Hospital, Health Secretariat, Autlán 48900, Jalisco, Mexico
| | - Marika Nosten-Bertrand
- INSERM UMR-S 1270, 75005 Paris, France;
- Sorbonne Université, Campus Pierre et Marie Curie, 75005 Paris, France
- Institut du Fer à Moulin, 75005 Paris, France
| | - Guillemette Crépeaux
- Univ Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France; (L.A.); (J.-D.M.)
- Ecole Nationale Vétérinaire d’Alfort IMRB, F-94700 Maisons-Alfort, France
- Correspondence:
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7
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Sasaki E, Furuhata K, Mizukami T, Hamaguchi I. An investigation and assessment of the muscle damage and inflammation at injection site of aluminum-adjuvanted vaccines in guinea pigs. J Toxicol Sci 2022; 47:439-451. [DOI: 10.2131/jts.47.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Eita Sasaki
- Department of Safety Research on Blood and Biological Products, National Institute of Infectious Diseases
| | - Keiko Furuhata
- Department of Safety Research on Blood and Biological Products, National Institute of Infectious Diseases
| | - Takuo Mizukami
- Department of Safety Research on Blood and Biological Products, National Institute of Infectious Diseases
| | - Isao Hamaguchi
- Department of Safety Research on Blood and Biological Products, National Institute of Infectious Diseases
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8
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Krnjak G, Vulin K, Pazanin L, Barisic I, Duranovic V. A case of macrophagic myofasciitis in a girl with developmental delay. Pediatr Int 2022; 64:e14930. [PMID: 35139249 DOI: 10.1111/ped.14930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/12/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Goran Krnjak
- Department of Pediatrics, Varazdin General Hospital, Varazdin, Croatia
| | - Katarina Vulin
- Department of Pediatric Neurology, Children's Hospital Zagreb, Zagreb, Croatia
| | - Leo Pazanin
- Ljudevit Jurak Division of Pathology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Ingeborg Barisic
- Department of Medical Genetics and Reproductive Health, Children's Hospital Zagreb, Zagreb, Croatia
| | - Vlasta Duranovic
- Department of Pediatric Neurology, Children's Hospital Zagreb, Zagreb, Croatia
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9
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Treatment and Management of Autoimmune Myopathies. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00022-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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10
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Trautmann A. [Mechanisms underlying chronic fatigue, a symptom too often overlooked]. Med Sci (Paris) 2021; 37:910-919. [PMID: 34647880 DOI: 10.1051/medsci/2021143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Acute fatigue after exertion, like acute inflammation after injury, is useful for our body. On the contrary, both chronic fatigue and chronic inflammation are deleterious, and they are associated in many diseases. In this first part, we will analyze different immune phenomena (bystander activation, memory of the innate immune system, link with the intestinal microbiota) involved in triggering chronic inflammation. This review aims at looking for links between different signs and symptoms associated with chronic fatigue, as well as between different diseases in which severe chronic fatigue can manifest. Possible underlying mechanisms for these phenomena are discussed. This is a proposal made by a researcher, with no clinical experience, to doctors confronted with an entity that is still largely mysterious. The link between chronic inflammation, neuroinflammation and fatigue will be examined in a second part.
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Affiliation(s)
- Alain Trautmann
- UMR CNRS 8104, Inserm 1016, université Paris Descartes, Institut Cochin, rue Méchain, 75014 Paris, France
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11
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Hwang W, Lei W, Katritsis NM, MacMahon M, Chapman K, Han N. Current and prospective computational approaches and challenges for developing COVID-19 vaccines. Adv Drug Deliv Rev 2021; 172:249-274. [PMID: 33561453 PMCID: PMC7871111 DOI: 10.1016/j.addr.2021.02.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 12/23/2022]
Abstract
SARS-CoV-2, which causes COVID-19, was first identified in humans in late 2019 and is a coronavirus which is zoonotic in origin. As it spread around the world there has been an unprecedented effort in developing effective vaccines. Computational methods can be used to speed up the long and costly process of vaccine development. Antigen selection, epitope prediction, and toxicity and allergenicity prediction are areas in which computational tools have already been applied as part of reverse vaccinology for SARS-CoV-2 vaccine development. However, there is potential for computational methods to assist further. We review approaches which have been used and highlight additional bioinformatic approaches and PK modelling as in silico methods which may be useful for SARS-CoV-2 vaccine design but remain currently unexplored. As more novel viruses with pandemic potential are expected to arise in future, these techniques are not limited to application to SARS-CoV-2 but also useful to rapidly respond to novel emerging viruses.
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Affiliation(s)
- Woochang Hwang
- Milner Therapeutics Institute, University of Cambridge, Cambridge, UK
| | - Winnie Lei
- Milner Therapeutics Institute, University of Cambridge, Cambridge, UK; Department of Surgery, University of Cambridge, Cambridge, UK
| | - Nicholas M Katritsis
- Milner Therapeutics Institute, University of Cambridge, Cambridge, UK; Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | - Méabh MacMahon
- Milner Therapeutics Institute, University of Cambridge, Cambridge, UK; Centre for Therapeutics Discovery, LifeArc, Stevenage, UK
| | - Kathryn Chapman
- Milner Therapeutics Institute, University of Cambridge, Cambridge, UK
| | - Namshik Han
- Milner Therapeutics Institute, University of Cambridge, Cambridge, UK.
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12
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Gowda VK, Srinivasan VM, Muthane Y, Narayanappa G. Macrophagic Myofasciitis: A Report of Two South Indian Infants. J Pediatr Neurosci 2021; 15:279-282. [PMID: 33531946 PMCID: PMC7847130 DOI: 10.4103/jpn.jpn_141_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/15/2020] [Accepted: 03/28/2020] [Indexed: 11/04/2022] Open
Abstract
Macrophagic myofasciitis is a rare inflammatory myopathy characterized by peri-fascicular macrophage infiltration without muscle necrosis. Here we report two children presented in the early infancy. Case 1: a 5-month-old girl presented with lack of neck control and floppiness. On examination, generalized hypotonia, absent deep tendon reflexes, and motor power of 2/5 (Medical Research Council grade) were observed. Case 2: a 17-day-old boy presented with poor feeding, tachypnea, and floppiness. On examination, decreased tone in all limbs and power of <2/5 in all limbs with absent reflexes were observed. Routine investigations including serum Creatine phosphokinase of both babies were normal. Muscle biopsy showed features of macrophagic myofasciitis in both infants. Any floppy infant of lower motor neuron type macrophagic myofasciitis should be considered in addition to inherited causes.
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Affiliation(s)
- Vykuntaraju K Gowda
- Department of Pediatric Neurology, Indira Gandhi institute of Child Health, Bangalore, Karnataka, India
| | - Varunvenkat M Srinivasan
- Department of Pediatric Neurology, Indira Gandhi institute of Child Health, Bangalore, Karnataka, India
| | - Yasha Muthane
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Gayathri Narayanappa
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
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13
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Gulf war illness, post-HPV vaccination syndrome, and Macrophagic Myofasciitis. Similar disabling conditions possibly linked to vaccine-induced autoimmune dysautonomia. Autoimmun Rev 2020; 19:102603. [DOI: 10.1016/j.autrev.2020.102603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 03/02/2020] [Indexed: 02/06/2023]
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14
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Macrophagic myofasciitis: an atypical presentation for a rare disease with a challenging approach. Reumatologia 2020; 58:167-172. [PMID: 32684650 PMCID: PMC7362278 DOI: 10.5114/reum.2020.96683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/29/2020] [Indexed: 01/08/2023] Open
Abstract
Macrophagic myofasciitis (MMF) is a rare immune-mediated myopathy that seems to be triggered by aluminium hydroxide adjuvant used in vaccines. Its presentation is relatively heterogeneous and treatment with steroids leads to improvement, although there is little evidence regarding the role of other immunosuppressants. The histological findings in MMF seem to be the result of an abnormal presence in the inoculation site of aluminium, which can induce an immune-mediated muscular disease in susceptible persons. The authors describe the case of a patient with an atypical presentation of macrophagic myofasciitis, with histological confirmation in a muscle biopsy distant from the inoculation site, and a good therapeutic response to tacrolimus and mycophenolate mofetil, as well as a discussion on the pathologic basis, controversies and emerging treatments for this condition.
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15
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Macrophagic myofasciitis and subcutaneous pseudolymphoma caused by aluminium adjuvants. Sci Rep 2020; 10:11834. [PMID: 32678281 PMCID: PMC7366910 DOI: 10.1038/s41598-020-68849-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 06/22/2020] [Indexed: 11/29/2022] Open
Abstract
Aluminium hydroxide is a well-known adjuvant used in vaccines. Although it can enhance an adaptive immune response to a co-administered antigen, it causes adverse effects, including macrophagic myofasciitis (MMF), subcutaneous pseudolymphoma, and drug hypersensitivity. The object of this study is to demonstrate pediatric cases of aluminium hydroxide-induced diseases focusing on its rarity, under-recognition, and distinctive pathology. Seven child patients with biopsy-proven MMF were retrieved from the Seoul National University Hospital (SNUH) pathology archives from 2015 to 2019. The medical records and immunisation history were reviewed, and a full pathological muscle examination was carried out. The mean age was 1.7 years (8.9–40 months), who had records of vaccination against hepatitis B, hepatitis A, and tetanus toxoid on the quadriceps muscle. The chief complaints were muscle weakness (n = 6), delayed motor milestones (n = 6), instability, dysarthria, and involuntary movement (n = 1), swallowing difficulty (n = 1), high myopia (n = 1), and palpable subcutaneous nodules with skin papules (n = 1). Muscle biopsy showed MMF (n = 6) and pseudolymphoma (n = 1) with pathognomic basophilic large macrophage infiltration, which had distinctive spiculated inclusions on electron microscopy. The intracytoplasmic aluminium was positive for PAS and Morin stains. Distinctive pathology and ultrastructure suggested an association with aluminium hydroxide-containing vaccines. To avoid misdiagnosis and mistreatment, we must further investigate this uncommon condition, and pharmaceutical companies should attempt to formulate better adjuvants that do not cause such adverse effects.
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Caudal H, Briend-Godet V, Caroff N, Moret L, Navas D, Huon JF. Vaccine distrust: Investigation of the views and attitudes of parents in regard to vaccination of their children. ANNALES PHARMACEUTIQUES FRANÇAISES 2020; 78:294-302. [PMID: 32434681 DOI: 10.1016/j.pharma.2020.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/11/2020] [Accepted: 03/23/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND In France, many parents have lost confidence in vaccinations, which has a direct impact on immunization coverage. Pharmacists, like other health professionals, often encounter parents exhibiting vaccine distrust. METHODS Using a survey distributed in a school and in a number of volunteering pharmacies, the objective of this study was to gain a better understanding of the views and the attitude of parents in regard to vaccination of their children. RESULTS Our results show that the main concerns were in regard to vaccine adjuvants, the risk of short- and long-term adverse effects, and the risk of developing a disease or a disability as a result of vaccination. The parents, although they tended to express a degree of reluctance and apprehension, in general, they were not opposed to vaccination, and they sought objective scientific information and full transparency regarding all aspects of vaccine composition, adverse effects, and effectiveness. Cooperation of all the parties involved in the health system on this subject is essential for a seamless chain of care and to improve vaccination coverage. CONCLUSION The information collected, combined with a review of the international literature, allow avenues for dialogue adapted to parents' opinions to be established and thus assist health professionals to communicate effectively regarding vaccines, which is a bona fide public health issue.
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Affiliation(s)
- H Caudal
- Clinical pharmacy unit, Nantes university hospital, 1, place Alexis-Ricordeau, Nantes, France
| | - V Briend-Godet
- Infectious disease department, Nantes university hospital, 1, place Alexis Ricordeau, Nantes, France
| | - N Caroff
- Laboratory of clinical and experimental therapeutics of infections, Nantes university, 22, boulevard Benoni-Goullin, Nantes, France
| | - L Moret
- Medical evaluation and epidemiology department, Nantes university hospital, 85, rue Saint-Jacques, Nantes, France; EA 4275 SPHERE: biostatistics, pharmacoepidemiology and human sciences research team, 22, boulevard Benoni-Goullin, Nantes, France
| | - D Navas
- Clinical pharmacy unit, Nantes university hospital, 1, place Alexis-Ricordeau, Nantes, France; Laboratory of clinical and experimental therapeutics of infections, Nantes university, 22, boulevard Benoni-Goullin, Nantes, France
| | - J F Huon
- Clinical pharmacy unit, Nantes university hospital, 1, place Alexis-Ricordeau, Nantes, France; Laboratory of clinical and experimental therapeutics of infections, Nantes university, 22, boulevard Benoni-Goullin, Nantes, France.
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Bragazzi NL, Hejly A, Watad A, Adawi M, Amital H, Shoenfeld Y. ASIA syndrome and endocrine autoimmune disorders. Best Pract Res Clin Endocrinol Metab 2020; 34:101412. [PMID: 32265102 DOI: 10.1016/j.beem.2020.101412] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
An adjuvant is an immunological or pharmacological substance or group of substances that can be added to a given agent to enhance its effect in terms of efficacy, effectiveness and potency. Different mechanisms have been hypothesized underlying the action of the adjuvant, including boosting immune (innate and adaptive) response: this generally results in sparing the necessary amount of the agent and can potentially reduce the frequency of the needed number of therapeutic interventions. Adjuvants can be commonly found in vaccines, immunization products, mineral oils, cosmetics, silicone breast implants and other therapeutic/medical devices, being usually safe and effective. However, in a fraction of genetically susceptible and predisposed subjects, the administration of adjuvants may lead to the insurgence of serious side-effects, called "autoimmune/inflammatory syndrome by adjuvants" (ASIA) or Shoenfeld's syndrome. The present review is aimed at focusing on the "endocrine pebbles" of the mosaic of autoimmunity and of the ASIA syndrome, collecting together 54 cases of sub-acute thyroiditis, 2 cases of Hashimoto's thyroiditis, 11 cases of primary ovarian failure/primary ovarian insufficiency, 13 cases of autoimmune diabetes type 1, and 1 case of autoimmune adrenal gland insufficiency occurred after exposure to adjuvants.
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Affiliation(s)
- Nicola Luigi Bragazzi
- Department of Mathematics and Statistics, Laboratory for Industrial and Applied Mathematics (LIAM), Toronto, Canada
| | - Ashraf Hejly
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Internal Medicine 'B', Sheba Medical Center, Ramat Gan, Israel
| | - Abdulla Watad
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Internal Medicine 'B', Sheba Medical Center, Ramat Gan, Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - Mohammed Adawi
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Howard Amital
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Internal Medicine 'B', Sheba Medical Center, Ramat Gan, Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel; Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia.
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Yang SH, Chang C, Lian ZX. Polymyositis and dermatomyositis - challenges in diagnosis and management. J Transl Autoimmun 2019; 2:100018. [PMID: 32743506 PMCID: PMC7388349 DOI: 10.1016/j.jtauto.2019.100018] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/04/2019] [Indexed: 02/06/2023] Open
Abstract
Polymyositis (PM) and dermatomyositis (DM) are different disease subtypes of idiopathic inflammatory myopathies (IIMs). The main clinical features of PM and DM include progressive symmetric, predominantly proximal muscle weakness. Laboratory findings include elevated creatine kinase (CK), autoantibodies in serum, and inflammatory infiltrates in muscle biopsy. Dermatomyositis can also involve a characteristic skin rash. Both polymyositis and dermatomyositis can present with extramuscular involvement. The causative factor is agnogenic activation of immune system, leading to immunologic attacks on muscle fibers and endomysial capillaries. The treatment of choice is immunosuppression. PM and DM can be distinguished from other IIMs and myopathies by thorough history, physical examinations and laboratory evaluation and adherence to specific and up-to-date diagnosis criteria and classification standards. Treatment is based on correct diagnosis of these conditions. Challenges of diagnosis and management influences the clinical research and practice of Polymyositis and dermatomyositis. Diagnostic criteria have been updated and novel therapies have been developed in PM/DM. Pathogenesis investigation and diagnosis precision improvement may help to guide future treatment strategies.
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Key Words
- APC, antigen presenting cell
- AZA, Azathioprine
- CAM, cancer associated myositis
- CK, creatine kinase
- DM, dermatomyositis
- Dermatomyositis
- Diagnosis criteria
- EMG, electromyography
- HLA, human leukocyte antigen
- IIM, idiopathic inflammatory myopathies
- ILD, interstitial lung disease
- IV, intravenous
- Idiopathic inflammatory myopathy
- JDM, juvenile dermatomyositis
- MAA, myositis associated antibody
- MAC, membrane attack complex
- MHC, major histocompatibility complex
- MMF, mycophenolate mofetil
- MRI, magnetic resonance imaging
- MSA, myositis specific antibody
- MTX, methotrexate
- MUAP, motor unit action potential
- NAM, necrotizing autoimmune myopathy
- PM, polymyositis
- Polymyositis
- TNF, tumor necrosis factor
- Treatment
- Treg, regulatory T cell
- UVR, ultraviolet radiation
- sIBM, sporadic inclusion body myositis
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Affiliation(s)
- Shu-Han Yang
- Chronic Disease Laboratory, Institutes for Life Sciences and School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Christopher Chang
- Division of Rheumatology, Allergy and Clinical Immunology, University of California, Davis, Davis, CA, USA.,Division of Pediatric Immunology and Allergy, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Zhe-Xiong Lian
- Chronic Disease Laboratory, Institutes for Life Sciences and School of Medicine, South China University of Technology, Guangzhou, 510006, China
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Myalgia and chronic fatigue syndrome following immunization: macrophagic myofasciitis and animal studies support linkage to aluminum adjuvant persistency and diffusion in the immune system. Autoimmun Rev 2019; 18:691-705. [PMID: 31059838 DOI: 10.1016/j.autrev.2019.05.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 01/31/2019] [Indexed: 01/04/2023]
Abstract
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a multifactorial and poorly undersood disabling disease. We present epidemiological, clinical and experimental evidence that ME/CFS constitutes a major type of adverse effect of vaccines, especially those containing poorly degradable particulate aluminum adjuvants. Evidence has emerged very slowly due to the multiplicity, lack of specificity, delayed onset, and frequent medical underestimation of ME/CFS symptoms. It was supported by an epidemiological study comparing vaccinated vs unvaccinated militaries that remained undeployed during Gulf War II. Affected patients suffer from cognitive dysfunction affecting attention, memory and inter-hemispheric connexions, well correlated to brain perfusion defects and associated with a stereotyped and distinctive pattern of cerebral glucose hypometabolism. Deltoid muscle biopsy performed to investigate myalgia typically yields macrophagic myofasciitis (MMF), a histological biomarker assessing longstanding persistency of aluminum agglomerates within innate immune cells at site of previous immunization. MMF is seemingly linked to altered mineral particle detoxification by the xeno/autophagy machinery. Comparing toxicology of different forms of aluminum and different types of exposure is misleading and inadequate and small animal experiments have turned old dogma upside down. Instead of being rapidly solubilized in the extracellular space, injected aluminum particles are quickly captured by immune cells and transported to distant organs and the brain where they elicit an inflammatory response and exert selective low dose long-term neurotoxicity. Clinical observations and experiments in sheep, a large animal like humans, confirmed both systemic diffusion and neurotoxic effects of aluminum adjuvants. Post-immunization ME/CFS represents the core manifestation of "autoimmune/inflammatory syndrome induced by adjuvants" (ASIA).
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Varela-Martínez E, Abendaño N, Asín J, Sistiaga-Poveda M, Pérez MM, Reina R, de Andrés D, Luján L, Jugo BM. Molecular Signature of Aluminum Hydroxide Adjuvant in Ovine PBMCs by Integrated mRNA and microRNA Transcriptome Sequencing. Front Immunol 2018; 9:2406. [PMID: 30405610 PMCID: PMC6206264 DOI: 10.3389/fimmu.2018.02406] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/28/2018] [Indexed: 11/17/2022] Open
Abstract
There have been few in vivo studies on the effect of aluminum hydroxide adjuvant and its influence on the immune response to vaccination. In this study, lambs received a parallel subcutaneous treatment with either commercial vaccines containing aluminum hydroxide or an equivalent dose of this compound only with the aim of identifying the activated molecular signature. Blood samples were taken from each animal at the beginning and at the end of the experiment and PBMCs isolated. Total RNA and miRNA libraries were prepared and sequenced. After alignment to the Oar3.1 reference genome and differential expression with 3 programs, gene enrichment modeling was performed. For miRNAs, miRBase and RNAcentral databases were used for detection and characterization. Three expression comparisons were made: vaccinated animals at the beginning and at the end of the treatment, adjuvanted animals at the same times, and animals of both treatments at the end of the experiment. After exposure to both treatments, a total of 2,473; 2,980 and 429 differentially expressed genes were identified in vaccinated animals, adjuvanted animals and animals at the end of both treatments, respectively. In both adjuvant and vaccine treated animals the NF-κB signaling pathway was enriched. On the other hand, it can be observed a downregulation of cytokines and cytokine receptors in the adjuvanted group compared to the vaccinated group at the final time, suggesting a milder induction of the immune response when the adjuvant is alone. As for the miRNA analysis, 95 miRNAs were detected: 64 previously annotated in Ovis aries, 11 annotated in Bos taurus and 20 newly described. Interestingly, 6 miRNAs were differentially expressed in adjuvant treated animals, and 3 and 1 in the other two comparisons. Lastly, an integrated miRNA-mRNA expression profile was developed, in which a miRNA-mediated regulation of genes related to DNA damage stimulus was observed. In brief, it seems that aluminum-containing adjuvants are not simple delivery vehicles for antigens, but also induce endogenous danger signals that can stimulate the immune system. Whether this contributes to long-lasting immune activation or to the overstimulation of the immune system remains to be elucidated.
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Affiliation(s)
- Endika Varela-Martínez
- Department of Genetics, Physical Anthropology and Animal Physiology, Faculty of Science and Technology, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - Naiara Abendaño
- Department of Genetics, Physical Anthropology and Animal Physiology, Faculty of Science and Technology, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - Javier Asín
- Department of Animal Pathology, Veterinary Faculty, University of Zaragoza, Zaragoza, Spain
| | - Maialen Sistiaga-Poveda
- Department of Genetics, Physical Anthropology and Animal Physiology, Faculty of Science and Technology, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - Marta Maria Pérez
- Department of Animal Pathology, Veterinary Faculty, University of Zaragoza, Zaragoza, Spain
| | - Ramsés Reina
- Institute of Agrobiotechnology (CSIC-UPNA-Government of Navarra), Navarra, Spain
| | - Damián de Andrés
- Institute of Agrobiotechnology (CSIC-UPNA-Government of Navarra), Navarra, Spain
| | - Lluís Luján
- Department of Animal Pathology, Veterinary Faculty, University of Zaragoza, Zaragoza, Spain
| | - Begoña M Jugo
- Department of Genetics, Physical Anthropology and Animal Physiology, Faculty of Science and Technology, University of the Basque Country (UPV/EHU), Bilbao, Spain
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Abstract
The development of autoimmune/inflammatory syndrome induced by adjuvants (ASIA) is associated with the hyperergic reaction of the human immune system. The development of autoimmune inflammation is preceded by contact with internal or external trigger factors (adjuvants) of immune disorders. ASIA is associated with an individual genetic predisposition that is probably associated with the carriage of HLA-DRB1*01 or HLA-DRB4. The paper presents five possible options for the impact of adjuvants in the pathogenesis of autoimmune disorders. It gives diagnostic criteria for the syndrome, as well as its clinical, laboratory and morphological manifestations. Emphasis is laid on the importance of morphological changes in the diagnosis of autoimmune disorders. The spectrum of morphological changes in ASIA is extensive. The tissues show signs of immune inflammation, such as lymphohistiocytic infiltration, granulomatous inflammation, and scleroderma-like changes. The characteristic feature is the regression of clinical, laboratory, and morphological manifestations after adjuvant removal.
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Affiliation(s)
- S G Radenska-Lopovok
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia; Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia, Moscow, Russia
| | - P Volkova
- N.I. Pirogov Russian National Research Medical University, Moscow, Russia
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22
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Aoun Sebaiti M, Abrivard M, Blanc-Durand P, Van Der Gucht A, Souvannanorath S, Kauv P, Gherardi RK, Itti E, Authier FJ. Macrophagic myofasciitis-associated dysfunctioning: An update of neuropsychological and neuroimaging features. Best Pract Res Clin Rheumatol 2018; 32:640-650. [DOI: 10.1016/j.berh.2019.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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23
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Kuznetsova TA, Persiyanova EV, Ermakova SP, Khotimchenko MY, Besednova NN. The Sulfated Polysaccharides of Brown Algae and Products of Their Enzymatic Transformation as Potential Vaccine Adjuvants. Nat Prod Commun 2018. [DOI: 10.1177/1934578x1801300837] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The review is devoted to critical analysis of literature data, deal with effects and mechanisms of action of sulfated polysaccharides (PSs) – fucoidans from brown algae and products of their enzymatic transformation as potential adjuvants for enhancement of anti-infective and antitumor immune response. Numerous experimental data indicate that sulfated PSs demonstrate properties of vaccine adjuvants. Application perspectiveness of fucoidans as vaccine adjuvants is defined by their high biocompatibility, low-toxicity, safety and good tolerance by macroorganism, and also mechanisms of their immunomodulatory action. In particular, fucoidans are agonists of receptors of innate immunity and strong inducers of cellular and humoral immune response. At presenting the data of structural - functional interrelations, attention focused to the defining role of degree of sulfation, uronic acids and polyphenols contents, and also molecular mass in actions of fucoidans to innate and adaptive immunity cells. Insufficiency of literary data on studying of correlation of structure – physicochemical characteristics with adjuvanticities of the sulfated PSs, and also the problem of standardization of their active fractions are noted. Special attention is paid to the analysis of immunomodulatory and adjuvant activity of fucoidan oligosaccharides. Presented here results of experimental trial indicate that, despite the difficulties due to preparation of highly purified structurally characterized fractions and complex structure of fucoidans, these substances can be used as safe and effective adjuvants in vaccines against various pathogens including viruses, and also in antitumor vaccines.
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Affiliation(s)
- Tatyana A. Kuznetsova
- Federal State Budgetary Scientific Institution «Research Somov Institute of Epidemiology and Microbiology», Sel'skaya street, 1, 690087, Vladivostok, Russian Federation
- Far Eastern Federal University, School of Biomedicine, bldg. M25 FEFU Campus, Ajax Bay, Russky Isl., 690922 Vladivostok, Russian Federation
| | - Elena V. Persiyanova
- Federal State Budgetary Scientific Institution «Research Somov Institute of Epidemiology and Microbiology», Sel'skaya street, 1, 690087, Vladivostok, Russian Federation
| | - Svetlana P. Ermakova
- G.B. Elyakov Pacific Institute of Bioorganic Chemistry, Far Eastern Branch of the Russian Academy of Sciences, Pr. 100-letya Vladivostoka 159, 690022, Vladivostok, Russian Federation
| | - Maxim Yu. Khotimchenko
- Far Eastern Federal University, School of Biomedicine, bldg. M25 FEFU Campus, Ajax Bay, Russky Isl., 690922 Vladivostok, Russian Federation
| | - Natalya N. Besednova
- Federal State Budgetary Scientific Institution «Research Somov Institute of Epidemiology and Microbiology», Sel'skaya street, 1, 690087, Vladivostok, Russian Federation
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24
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Ou H, Yao W, Wu N, Wang FXC, Weng T, Han C, Lu X, Yu D, Wu H, Cheng L, Chen H, Yao H, Li L. Preclinical evaluation of the safety and pathogenicity of a live attenuated recombinant influenza A/H7N9 seed strain and corresponding MF59-adjuvanted split vaccine. Oncotarget 2018; 7:81012-81025. [PMID: 27768591 PMCID: PMC5348373 DOI: 10.18632/oncotarget.12746] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 10/12/2016] [Indexed: 12/03/2022] Open
Abstract
Developing a safe and effective H7N9 influenza vaccine was initiated in early spring 2013, following human infections with a novel avian influenza A (H7N9) virus. In this study, a candidate H7N9 vaccine seed strain is produced using reverse genetics, with HA and NA derived from a human H7N9 virus and the remaining genes from the PR8 backbone virus which grows well in eggs. We verified that the virulence and transmissibility of the recombinant H7N9 vaccine seed strain were decreased as compared to wild-type H7N9 virus, to levels comparable with PR8. Using the seed virus, we produced a monovalent split influenza A (H7N9) MF59-adjuvanted vaccine that was immunogenic in mice. Our H7N9 vaccine is selected for clinical investigation and potential human use. To assess the safety of our H7N9 vaccine, we performed acute toxicity, repeated dose toxicity and active systemic anaphylaxis tests. Our results showed that, under the conditions used in this study, the NOEAL (no obvious adverse effect level) was 30 μg/0.5 mL.
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Affiliation(s)
- Huilin Ou
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wei Yao
- Department of Pre-clinical Research and Development, Zhejiang Tianyuan Bio-Pharmaceutical Co., Ltd., Hangzhou, China
| | - Nanping Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Frederick X C Wang
- Department of Bioengineering, Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Texas, USA
| | - Tianhao Weng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chengcong Han
- Department of Pre-clinical Research and Development, Zhejiang Tianyuan Bio-Pharmaceutical Co., Ltd., Hangzhou, China
| | - Xiangyun Lu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Dongshan Yu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Haibo Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Linfang Cheng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Honglin Chen
- State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China
| | - Hangping Yao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lanjuan Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Khadilkar SV, Yadav RS, Patel BA. Idiopathic Inflammatory Myopathies. Neuromuscul Disord 2018. [DOI: 10.1007/978-981-10-5361-0_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Aoun Sebaiti M, Kauv P, Charles-Nelson A, Van Der Gucht A, Blanc-Durand P, Itti E, Gherardi RK, Bachoud-Levi AC, Authier FJ. Cognitive dysfunction associated with aluminum hydroxide-induced macrophagic myofasciitis: A reappraisal of neuropsychological profile. J Inorg Biochem 2017; 181:132-138. [PMID: 29079320 DOI: 10.1016/j.jinorgbio.2017.09.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/15/2017] [Accepted: 09/19/2017] [Indexed: 01/12/2023]
Abstract
Patients with macrophagic myofasciitis (MMF) present with diffuse arthromyalgias, chronic fatigue, and cognitive disorder. Representative features of MMF-associated cognitive dysfunction include attentional dysfunction, dysexecutive syndrome, visual memory deficit and left ear extinction. Our study aims to reevaluate the neuropsychological profile of MMF. 105 unselected consecutive MMF patients were subjected to a neuropsychological battery of screen short term and long-term memory, executive functions, attentional abilities, instrumental functions and dichotic listening. From these results, patients were classified in four different groups: Subsymptomatic patients (n=41) with performance above pathological threshold (-1.65 SD) in all tests; Fronto-subcortical patients (n=31) who showed pathological results at executive functions and selective attention tests; Papezian patients (n=24) who showed pathological results in storage, recognition and consolidation functions for episodic verbal memory, in addition to fronto-subcortical dysfunction; and Extinction patients (n=9) who had a left ear extinction at dichotic listening test in association to fronto-subcortical and papezian dysfunction. In addition, inter-test analysis showed that patients with apparently normal cognitive functions (Subsymptomatic group) performed significantly worse to attention tests compared to others. In conclusion, our study shows that (i) most patients have specific cognitive deficits; (ii) all patients with cognitive deficit have impairment of executive functions and selective attention; (iii) patients without measurable cognitive deficits display significant weakness in attention; (iv) episodic memory impairment affects verbal, but not visual, memory; (v) none of the patients show an instrumental dysfunction.
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Affiliation(s)
- Mehdi Aoun Sebaiti
- INSERM/UPEC U955 Team 10 'Biology of Neuromuscular System', Faculty of Médecine, 94000 Créteil, France; Department of Neurology, Henri Mondor University Hospital, 94000 Créteil, France
| | - Paul Kauv
- Neuroradiology, Henri Mondor University Hospital, 94000 Créteil, France
| | - Anaïs Charles-Nelson
- Cordeliers Research Center, UPMC, Team 'Information Sciences to Support Personalized Medicine', 75006 Paris, France
| | - Axel Van Der Gucht
- Nuclear Medicine, Henri Mondor University Hospital, 94000 Créteil, France
| | - Paul Blanc-Durand
- Nuclear Medicine, Henri Mondor University Hospital, 94000 Créteil, France
| | - Emmanuel Itti
- Nuclear Medicine, Henri Mondor University Hospital, 94000 Créteil, France
| | - Romain K Gherardi
- INSERM/UPEC U955 Team 10 'Biology of Neuromuscular System', Faculty of Médecine, 94000 Créteil, France; Expert Center for Neuromuscular Diseases, Department of Pathology, Henri Mondor University Hospital, 94000 Créteil, France
| | | | - François Jérôme Authier
- INSERM/UPEC U955 Team 10 'Biology of Neuromuscular System', Faculty of Médecine, 94000 Créteil, France; Expert Center for Neuromuscular Diseases, Department of Pathology, Henri Mondor University Hospital, 94000 Créteil, France.
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Van Der Gucht A, Abulizi M, Blanc-Durand P, Aoun-Sebaiti M, Emsen B, Gherardi RK, Verger A, Authier FJ, Itti E. Predictive value of brain 18F-FDG PET/CT in macrophagic myofasciitis?: A case report. Medicine (Baltimore) 2017; 96:e8134. [PMID: 28953647 PMCID: PMC5626290 DOI: 10.1097/md.0000000000008134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Although several functional studies have demonstrated that positron emission tomography/computed tomography with F-fluorodeoxyglucose (F-FDG PET/CT) appears to be efficient to identify a cerebral substrate in patients with known macrophagic myofasciitis (MMF), the predictive value of this imaging technique for MMF remains unclear. PATIENT CONCERNS We presented data and images of a 46-year-old woman. DIAGNOSES The patient was referred to our center for suspected MMF due to diffuse arthromyalgias and cognitive disorder (involving an impairment of visual selective attention and a weakness in executive functions revealed by neuropsychological assessment) which occurred few years after last vaccine injections. INTERVENTIONS After a first negative deltoid muscle biopsy, a brain F-FDG PET/CT was performed and revealed the known spatial pattern of a cerebral glucose hypometabolism involving occipital cortex, medial temporal areas, and cerebellum. OUTCOMES Given the clinical suspicion of MMF and brain F-FDG PET/CT findings, a 2nd deltoid muscle biopsy was performed and confirmed the diagnosis of MMF with typical histopathological features. LESSONS This case highlights the predictive value of brain F-FDG PET/CT as a noninvasive imaging tool for MMF diagnosis, even when muscle biopsy result comes back negative.
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Affiliation(s)
- Axel Van Der Gucht
- Department of Nuclear Medicine, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris/Paris-Est University
| | - Mukedaisi Abulizi
- Department of Nuclear Medicine, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris/Paris-Est University
| | - Paul Blanc-Durand
- Department of Nuclear Medicine, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris/Paris-Est University
| | | | - Berivan Emsen
- Department of Nuclear Medicine, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris/Paris-Est University
| | - Romain K. Gherardi
- INSERM U955-Team 10
- Department of Pathology, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris/Paris-Est University
- Reference Center for Neuromuscular Disorders, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil
| | - Antoine Verger
- CHU Nancy, Nuclear Medecine and Nancyclotep Experimental Imaging Platform, Nancy
| | - François-Jérôme Authier
- INSERM U955-Team 10
- Department of Pathology, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris/Paris-Est University
- Reference Center for Neuromuscular Disorders, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil
| | - Emmanuel Itti
- Department of Nuclear Medicine, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris/Paris-Est University
- INSERM U955-GRC Amyloid Research Institute, Créteil, France
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Chkheidze R, Burns DK, White CL, Castro D, Fuller J, Cai C. Morin Stain Detects Aluminum-Containing Macrophages in Macrophagic Myofasciitis and Vaccination Granuloma With High Sensitivity and Specificity. J Neuropathol Exp Neurol 2017; 76:323-331. [PMID: 28340105 PMCID: PMC5901095 DOI: 10.1093/jnen/nlx011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Macrophagic myofasciitis (MMF) is an inflammatory condition associated with the intramuscular (i.m.) injection of aluminum adjuvant-containing vaccines. It is clinically characterized by myalgia, weakness, and chronic fatigue and histologically by aggregates of cohesive macrophages with abundant basophilic, periodic acid-Schiff (PAS)-positive, diastase-resistant granules that percolate through the peri- and endomysium without eliciting substantial myofiber damage. The definitive diagnosis of MMF requires demonstration of aluminum within these macrophages. We evaluated the Morin stain, a simple, 2-step histochemical stain for aluminum, as a confirmatory diagnostic tool for MMF. Among 2270 muscle biopsies processed at UTSW between 2010 and 2015, a total of 12 MMF cases and 1 subcutaneous vaccination granuloma case were identified (11 pediatric, 2 adults). With the Morin stain, all 13 cases showed strong granular reactivity within the cytoplasm of macrophages but not in myofibers or connective tissue. Three cases of inflammatory myopathy with abundant macrophages (IMAM), 8 cases of granulomatous inflammation and 23 other deltoid muscle biopsies used as controls were all negative. Morin stain could be used in both formalin-fixed paraffin-embedded and cryostat sections. Thus, Morin stain detects aluminum with high sensitivity and specificity in human muscle and soft tissue and may improve the diagnostic yield of MMF and vaccination granuloma.
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Affiliation(s)
- Rati Chkheidze
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Dennis K Burns
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Charles L White
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Diana Castro
- Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Julie Fuller
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Chunyu Cai
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA
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Blanc-Durand P, Van Der Gucht A, Guedj E, Abulizi M, Aoun-Sebaiti M, Lerman L, Verger A, Authier FJ, Itti E. Cerebral 18F-FDG PET in macrophagic myofasciitis: An individual SVM-based approach. PLoS One 2017; 12:e0181152. [PMID: 28704562 PMCID: PMC5509294 DOI: 10.1371/journal.pone.0181152] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 06/27/2017] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Macrophagic myofasciitis (MMF) is an emerging condition with highly specific myopathological alterations. A peculiar spatial pattern of a cerebral glucose hypometabolism involving occipito-temporal cortex and cerebellum have been reported in patients with MMF; however, the full pattern is not systematically present in routine interpretation of scans, and with varying degrees of severity depending on the cognitive profile of patients. Aim was to generate and evaluate a support vector machine (SVM) procedure to classify patients between healthy or MMF 18F-FDG brain profiles. METHODS 18F-FDG PET brain images of 119 patients with MMF and 64 healthy subjects were retrospectively analyzed. The whole-population was divided into two groups; a training set (100 MMF, 44 healthy subjects) and a testing set (19 MMF, 20 healthy subjects). Dimensionality reduction was performed using a t-map from statistical parametric mapping (SPM) and a SVM with a linear kernel was trained on the training set. To evaluate the performance of the SVM classifier, values of sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and accuracy (Acc) were calculated. RESULTS The SPM12 analysis on the training set exhibited the already reported hypometabolism pattern involving occipito-temporal and fronto-parietal cortices, limbic system and cerebellum. The SVM procedure, based on the t-test mask generated from the training set, correctly classified MMF patients of the testing set with following Se, Sp, PPV, NPV and Acc: 89%, 85%, 85%, 89%, and 87%. CONCLUSION We developed an original and individual approach including a SVM to classify patients between healthy or MMF metabolic brain profiles using 18F-FDG-PET. Machine learning algorithms are promising for computer-aided diagnosis but will need further validation in prospective cohorts.
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Affiliation(s)
- Paul Blanc-Durand
- Department of Nuclear Medicine, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris/Paris-Est University, Créteil, France
| | - Axel Van Der Gucht
- Department of Nuclear Medicine, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris/Paris-Est University, Créteil, France
| | - Eric Guedj
- Department of Nuclear Medicine, La Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
- Aix-Marseille University, INT, CNRS UMR 7289, Marseille, France
- Aix-Marseille University, CERIMED, Marseille, France
| | - Mukedaisi Abulizi
- Department of Nuclear Medicine, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris/Paris-Est University, Créteil, France
| | - Mehdi Aoun-Sebaiti
- INSERM U955-Team 10, Créteil, France
- Department of Neurology, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris/Paris-Est University, Créteil, France
| | - Lionel Lerman
- Department of Nuclear Medicine, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris/Paris-Est University, Créteil, France
| | - Antoine Verger
- CHU Nancy, Nuclear Medecine & Nancyclotep Experimental Imaging Platform, Nancy, France
| | - François-Jérôme Authier
- INSERM U955-Team 10, Créteil, France
- Department of Pathology, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris/Paris-Est University, Créteil, France
- Reference Center for Neuromuscular Disorders, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Emmanuel Itti
- Department of Nuclear Medicine, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris/Paris-Est University, Créteil, France
- INSERM U955-GRC Amyloid Research Institute, Créteil, France
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Diagnostic confounders of chronic widespread pain: not always fibromyalgia. Pain Rep 2017; 2:e598. [PMID: 29392213 PMCID: PMC5741304 DOI: 10.1097/pr9.0000000000000598] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 03/13/2017] [Accepted: 03/17/2017] [Indexed: 12/11/2022] Open
Abstract
Although chronic widespread pain is the defining feature of fibromyalgia, a myriad of other conditions may present with similar pain complaint leading to misdiagnosis. Conditions that may mimic fibromyalgia may be categorized as musculoskeletal, neurological, endocrine/metabolic, psychiatric/psychological, and medication related. In this review, we examine these various conditions that should be considered in a differential diagnosis and provide direction that will help the clinician differentiate these conditions from fibromyalgia. Introduction: Chronic widespread pain (CWP) is the defining feature of fibromyalgia (FM), a worldwide prevalent condition. Chronic widespread pain is, however, not pathognomonic of FM, and other conditions may present similarly with CWP, requiring consideration of a differential diagnosis. Objectives: To conduct a literature search to identify medical conditions that may mimic FM and have highlighted features that may differentiate these various conditions from FM. Methods: A comprehensive literature search from 1990 through September 2016 was conducted to identify conditions characterized by CWP. Results: Conditions that may mimic FM may be categorized as musculoskeletal, neurological, endocrine/metabolic, psychiatric/psychological, and medication related. Characteristics pertaining to the most commonly identified confounding diagnoses within each category are discussed; clues to enable clinical differentiation from FM are presented; and steps towards a diagnostic algorithm for mimicking conditions are presented. Conclusion: Although the most likely reason for a complaint of CWP is FM, this pain complaint can be a harbinger of illness other than FM, prompting consideration of a differential diagnosis. This review should sensitize physicians to a broad spectrum of conditions that can mimic FM.
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Blanc-Durand P, Van Der Gucht A, Sebaiti MA, Abulizi M, Authier FJ, Itti E. Brain 18F-FDG PET Metabolic Abnormalities in Macrophagic Myofasciitis: Are They Stable? J Nucl Med 2017; 58:1532-1533. [DOI: 10.2967/jnumed.117.190876] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kakkar A, Rajeshwari M, Nalwa A, Suri V, Sarkar C, Chakrabarty B, Gulati S, Sharma MC. Childhood macrophagic myofasciitis: A series from the Indian subcontinent. Muscle Nerve 2017; 56:71-77. [PMID: 27859369 DOI: 10.1002/mus.25467] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 11/02/2016] [Accepted: 11/08/2016] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Macrophagic myofasciitis (MMF) is a rare disorder, reported mainly in European adults, with occasional childhood cases. We report a series of 6 patients with pediatric MMF from the Indian subcontinent. METHODS Clinical details, creatine kinase levels, and results of electromyography are described for patients diagnosed with MMF. Fresh-frozen and formalin-fixed muscle biopsies were evaluated by hematoxylin-eosin staining, histochemistry, immunohistochemistry, and electron microscopy. RESULTS Six of 2,218 muscle biopsies were diagnosed as MMF; patient charts were reviewed. The 6 patients were all children; all presented with hypotonia and/or motor delay. Mean age at diagnosis was 16.2 months. There were 4 boys and 2 girls. All had a history of hepatitis B vaccination. Histopathology revealed infiltration by sheets of large periodic acid-Schiff stain-positive histiocytes. Ultrastructural examination demonstrated needle-shaped crystals within histiocytes. One patient had a co-existent neuromuscular disorder, merosin-deficient congenital muscular dystrophy. CONCLUSIONS MMF is a rare inflammatory myopathy that should be considered in the differential diagnosis of congenital myopathies in children. Muscle Nerve 56: 71-77, 2017.
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Affiliation(s)
- Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Madhu Rajeshwari
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Aasma Nalwa
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Vaishali Suri
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Chitra Sarkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Biswaroop Chakrabarty
- Department Pediatrics (Division of Child Neurology), All India Institute of Medical Sciences, New Delhi, India
| | - Sheffali Gulati
- Department Pediatrics (Division of Child Neurology), All India Institute of Medical Sciences, New Delhi, India
| | - Mehar C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
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Abstract
Immunity to targeted infectious diseases may be conferred or enhanced by vaccines, which are manufactured from recombinant forms as well as inactivated or attenuated organisms. These vaccines have to meet requirements for safety, quality, and efficacy. In addition to antigenic components, various adjuvants may be included in vaccines to evoke an effective immune response. To ensure the safety of new vaccines, preclinical toxicology studies are conducted prior to the initiation of, and concurrently with, clinical studies. There are five different types of preclinical toxicology study in the evaluation of vaccine safety: single and/or repeat dose, reproductive and developmental, mutagenicity, carcinogenicity, and safety pharmacology. If any adverse effects are observed in the course of these studies, they should be fully evaluated and a final safety decision made accordingly. Successful preclinical toxicology studies depend on multiple factors including using the appropriate study designs, using the right animal model, and evoking an effective immune response. Additional in vivo and in vitro assays that establish the identity, purity, safety, and potency of the vaccine play a significant role in assessing critical characteristics of vaccine safety.
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Masson JD, Thibaudon M, Bélec L, Crépeaux G. Calcium phosphate: a substitute for aluminum adjuvants? Expert Rev Vaccines 2016; 16:289-299. [DOI: 10.1080/14760584.2017.1244484] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jean-Daniel Masson
- Association E3M (Entraide aux Malades de Myofasciite à Macrophages), Monprimblanc, France
| | - Michel Thibaudon
- Pharmacien « Service des Allergènes », de l’Institut Pasteur, Paris, France
| | - Laurent Bélec
- Laboratoire de Microbiologie, hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, & Faculté de Médecine Paris Descartes, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Guillemette Crépeaux
- École nationale vétérinaire d’Alfort, Maisons-Alfort, France
- Inserm U955 E10, Université Paris Est Créteil, Créteil, France
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Van Der Gucht A, Aoun Sebaiti M, Guedj E, Aouizerate J, Yara S, Gherardi RK, Evangelista E, Chalaye J, Cottereau AS, Verger A, Bachoud-Levi AC, Abulizi M, Itti E, Authier FJ. Brain 18F-FDG PET Metabolic Abnormalities in Patients with Long-Lasting Macrophagic Myofascitis. J Nucl Med 2016; 58:492-498. [DOI: 10.2967/jnumed.114.151878] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 09/19/2016] [Indexed: 11/16/2022] Open
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Strunecka A, Blaylock RL, Strunecky O. Fluoride, aluminum, and aluminofluoride complexes in pathogenesis of the autism spectrum disorders: A possible role of immunoexcitotoxicity. J Appl Biomed 2016. [DOI: 10.1016/j.jab.2016.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Gherardi RK, Aouizerate J, Cadusseau J, Yara S, Authier FJ. Aluminum adjuvants of vaccines injected into the muscle: Normal fate, pathology and associated disease. Morphologie 2016; 100:85-94. [PMID: 26948677 DOI: 10.1016/j.morpho.2016.01.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 01/12/2016] [Accepted: 01/16/2016] [Indexed: 02/08/2023]
Abstract
Aluminum oxyhydroxide (Alhydrogel(®)) is a nano-crystalline compound forming aggregates that has been introduced in vaccine for its immunologic adjuvant effect in 1926. It is the most commonly used adjuvant in human and veterinary vaccines but mechanisms by which it stimulates immune responses remain ill-defined. Although generally well tolerated on the short term, it has been suspected to occasionally cause delayed neurologic problems in susceptible individuals. In particular, the long-term persistence of aluminic granuloma also termed macrophagic myofasciitis is associated with chronic arthromyalgias and fatigue and cognitive dysfunction. Safety concerns largely depend on the long biopersistence time inherent to this adjuvant, which may be related to its quick withdrawal from the interstitial fluid by avid cellular uptake; and the capacity of adjuvant particles to migrate and slowly accumulate in lymphoid organs and the brain, a phenomenon documented in animal models and resulting from MCP1/CCL2-dependant translocation of adjuvant-loaded monocyte-lineage cells (Trojan horse phenomenon). These novel insights strongly suggest that serious re-evaluation of long-term aluminum adjuvant phamacokinetics and safety should be carried out.
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Affiliation(s)
- R K Gherardi
- Garches-Necker-Mondor-Hendaye Reference Centre for Neuromuscular Diseases, 94000 Créteil, France; Expert Centre for Neuromuscular Pathology, Henri-Mondor Hospital, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France; Inserm U955-Team 10 "Biology of Neuromuscular System" Paris Est-Créteil University, Créteil, France
| | - J Aouizerate
- Garches-Necker-Mondor-Hendaye Reference Centre for Neuromuscular Diseases, 94000 Créteil, France; Expert Centre for Neuromuscular Pathology, Henri-Mondor Hospital, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France; Inserm U955-Team 10 "Biology of Neuromuscular System" Paris Est-Créteil University, Créteil, France
| | - J Cadusseau
- Garches-Necker-Mondor-Hendaye Reference Centre for Neuromuscular Diseases, 94000 Créteil, France; Inserm U955-Team 10 "Biology of Neuromuscular System" Paris Est-Créteil University, Créteil, France
| | - S Yara
- Garches-Necker-Mondor-Hendaye Reference Centre for Neuromuscular Diseases, 94000 Créteil, France; Inserm U955-Team 10 "Biology of Neuromuscular System" Paris Est-Créteil University, Créteil, France
| | - F J Authier
- Garches-Necker-Mondor-Hendaye Reference Centre for Neuromuscular Diseases, 94000 Créteil, France; Expert Centre for Neuromuscular Pathology, Henri-Mondor Hospital, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France; Inserm U955-Team 10 "Biology of Neuromuscular System" Paris Est-Créteil University, Créteil, France.
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Highly delayed systemic translocation of aluminum-based adjuvant in CD1 mice following intramuscular injections. J Inorg Biochem 2015; 152:199-205. [DOI: 10.1016/j.jinorgbio.2015.07.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/08/2015] [Accepted: 07/09/2015] [Indexed: 12/14/2022]
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Van Der Gucht A, Aoun-Sebaiti M, Kauv P, Guedj E, Aouizerate J, Verger A, Gherardi RK, Bachoud-Levi AC, Authier FJ, Itti E. FDG-PET/CT Brain Findings in a Patient With Macrophagic Myofasciitis. Nucl Med Mol Imaging 2015; 50:80-4. [PMID: 26941864 DOI: 10.1007/s13139-015-0371-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 09/04/2015] [Accepted: 09/08/2015] [Indexed: 11/28/2022] Open
Abstract
Brain Positron Emission Tomography/Computed Tomography with (18)F-fluorodeoxyglucose (FDG PET/CT) was performed in a 44-year-old woman with marked cognitive impairment, diffuse myalgias, sensory, memory and visual disorders, and chronic fatigue, presenting with histopathological features of macrophagic myofasciitis (MMF) at deltoid muscle biopsy. Cerebromedullary Magnetic Resonance Imaging (MRI), electromyography, ophthalmic examination, and cerebrospinal fluid analysis were normal. Visual analysis of FDG PET/CT images showed an atypical pattern of hypometabolism, involving symmetrically the occipital cortex, temporal lobes, and limbic system (including in particular amygdalo-hippocampal complexes), and the cerebellum. Posterior cingulate cortex and parietal areas were preserved. This pattern was confirmed by a voxel-based procedure using Statistical Parametric Mapping (SPM12) that compared a patient's images to normal reference samples from six healthy subjects with adjustment to age obtained using the same PET/CT camera. These results provide a glucose metabolism substrate for cognitive complaints in patients with long-lasting aluminium hydroxide-induced MMF.
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Affiliation(s)
- Axel Van Der Gucht
- Department of Nuclear Medicine, Hôpital Henri Mondor AP-HP, Paris-Est University, 51 Ave. du Mal de Lattre de Tassigny, F-94010 Créteil, France
| | - Mehdi Aoun-Sebaiti
- Deparment of Neurology, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris/Paris-Est University, Créteil, F-94010 France
| | - Paul Kauv
- Department of Radiology, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris/Paris-Est University, Créteil, F-94010 France
| | - Eric Guedj
- Department of Nuclear Medicine, Hospital "La Timone", Assistance Publique des Hôpitaux de Marseille, Marseille, F-13000 France
| | - Jessie Aouizerate
- Department of Pathology, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris/Paris-Est University, Créteil, F-94010 France ; Reference Center for Neuromuscular Disorders, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, F-94010 France ; INSERM U955-Team 10, Créteil, F-94010 France
| | - Antoine Verger
- CHU Nancy, Nuclear Medecine & Nancyclotep Experimental Imaging Platform, Nancy, F-54000 France
| | - Romain K Gherardi
- Department of Pathology, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris/Paris-Est University, Créteil, F-94010 France ; Reference Center for Neuromuscular Disorders, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, F-94010 France ; INSERM U955-Team 10, Créteil, F-94010 France
| | - Anne-Catherine Bachoud-Levi
- Deparment of Neurology, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris/Paris-Est University, Créteil, F-94010 France ; INSERM U955-Team 1, Créteil, F-94010 France
| | - François-Jérôme Authier
- Department of Pathology, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris/Paris-Est University, Créteil, F-94010 France ; Reference Center for Neuromuscular Disorders, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, F-94010 France ; INSERM U955-Team 10, Créteil, F-94010 France
| | - Emmanuel Itti
- Department of Nuclear Medicine, Hôpital Henri Mondor AP-HP, Paris-Est University, 51 Ave. du Mal de Lattre de Tassigny, F-94010 Créteil, France
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Hu J, Qiu L, Wang X, Zou X, Lu M, Yin J. Carbohydrate-based vaccine adjuvants - discovery and development. Expert Opin Drug Discov 2015; 10:1133-44. [PMID: 26372693 DOI: 10.1517/17460441.2015.1067198] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The addition of a suitable adjuvant to a vaccine can generate significant effective adaptive immune responses. There is an urgent need for the development of novel po7tent and safe adjuvants for human vaccines. Carbohydrate molecules are promising adjuvants for human vaccines due to their high biocompatibility and good tolerability in vivo. AREAS COVERED The present review covers a few promising carbohydrate-based adjuvants, lipopolysaccharide, trehalose-6,6'-dibehenate, QS-21 and inulin as examples, which have been extensively studied in human vaccines in a number of preclinical and clinical studies. The authors discuss the current status, applications and strategies of development of each adjuvant and different adjuvant formulation systems. This information gives insight regarding the exciting prospect in the field of carbohydrate-based adjuvant research. EXPERT OPINION Carbohydrate-based adjuvants are promising candidates as an alternative to the Alum salts for human vaccines development. Furthermore, combining two or more adjuvants in one formulation is one of the effective strategies in adjuvant development. However, further research efforts are needed to study and develop novel adjuvants systems, which can be more stable, potent and safe. The development of synthetic carbohydrate chemistry can improve the study of carbohydrate-based adjuvants.
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Affiliation(s)
- Jing Hu
- a 1 Jiangnan University, Wuxi Medical School , Lihu Avenue 1800, 214122, Wuxi, China
| | - Liying Qiu
- a 1 Jiangnan University, Wuxi Medical School , Lihu Avenue 1800, 214122, Wuxi, China
| | - Xiaoli Wang
- b 2 Jiangnan University, The Key Laboratory of Carbohydrate Chemistry and Biotechnology, Ministry of Education, School of Biotechnology , Lihu Avenue 1800, 214122, Wuxi, China +86 51 085 328 229 ; +86 51 085 328 229 ;
| | - Xiaopeng Zou
- b 2 Jiangnan University, The Key Laboratory of Carbohydrate Chemistry and Biotechnology, Ministry of Education, School of Biotechnology , Lihu Avenue 1800, 214122, Wuxi, China +86 51 085 328 229 ; +86 51 085 328 229 ;
| | - Mengji Lu
- c 3 University Hospital Essen, Institute of Virology , Hufelandstr, 55, 45122 Essen, Germany +49 2 017 233 530 ; +49 2 017 235 929 ;
| | - Jian Yin
- b 2 Jiangnan University, The Key Laboratory of Carbohydrate Chemistry and Biotechnology, Ministry of Education, School of Biotechnology , Lihu Avenue 1800, 214122, Wuxi, China +86 51 085 328 229 ; +86 51 085 328 229 ;
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Verger P, Fressard L, Collange F, Gautier A, Jestin C, Launay O, Raude J, Pulcini C, Peretti-Watel P. Vaccine Hesitancy Among General Practitioners and Its Determinants During Controversies: A National Cross-sectional Survey in France. EBioMedicine 2015; 2:891-7. [PMID: 26425696 PMCID: PMC4563133 DOI: 10.1016/j.ebiom.2015.06.018] [Citation(s) in RCA: 222] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 06/18/2015] [Accepted: 06/19/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study aimed to assess: 1) vaccine hesitancy (VH) prevalence among French general practitioners (GPs) through the frequency of their vaccine recommendations, and 2) the determinants of these recommendations. METHODS Cross-sectional observational study in 2014 nested in a national panel of 1712 randomly selected GPs in private practice in France. We constructed a score of self-reported recommendation frequency for 6 specific vaccines to target populations. RESULTS 16% to 43% of GPs sometimes or never recommended at least one specific vaccine to their target patients. Multivariable logistic regressions of the dichotomized score showed that GPs recommended vaccines frequently when they felt comfortable explaining their benefits and risks to patients (OR = 1.87; 1.35-2.59), or trusted official sources of information highly (OR = 1.40; 1.01-1.93). They recommended vaccines infrequently when they considered that adverse effects were likely (OR = 0.71; 0.52-0.96) or doubted the vaccine's utility (OR = 0.21; 0.15-0.29). INTERPRETATION Our findings show that after repeated vaccine controversies in France, some VH exists among French GPs, whose recommendation behaviors depend on their trust in authorities, their perception of the utility and risks of vaccines, and their comfort in explaining them. Further research is needed to confirm these results among health care workers in other countries.
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Affiliation(s)
- Pierre Verger
- INSERM, UMR912 “Economics and Social Sciences Applied to Health & Analysis of Medical Information” (SESSTIM), 23 rue Stanislas Torrents, 13006 Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, 23 rue Stanislas Torrents, 13006 Marseille, France
- Aix Marseille University, IRD, UMR-S912, 58 bd Charles Livon, 13284 Marseille Cedex 07, France
- INSERM, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), GH Cochin Broca Hôtel Dieu, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Lisa Fressard
- INSERM, UMR912 “Economics and Social Sciences Applied to Health & Analysis of Medical Information” (SESSTIM), 23 rue Stanislas Torrents, 13006 Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, 23 rue Stanislas Torrents, 13006 Marseille, France
- Aix Marseille University, IRD, UMR-S912, 58 bd Charles Livon, 13284 Marseille Cedex 07, France
| | - Fanny Collange
- INSERM, UMR912 “Economics and Social Sciences Applied to Health & Analysis of Medical Information” (SESSTIM), 23 rue Stanislas Torrents, 13006 Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, 23 rue Stanislas Torrents, 13006 Marseille, France
- Aix Marseille University, IRD, UMR-S912, 58 bd Charles Livon, 13284 Marseille Cedex 07, France
| | - Arnaud Gautier
- Institut national de prévention et d'éducation pour la santé, 42 boulevard de la Libération, 93203 Saint Denis Cedex, France
| | - Christine Jestin
- Institut national de prévention et d'éducation pour la santé, 42 boulevard de la Libération, 93203 Saint Denis Cedex, France
| | - Odile Launay
- INSERM, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), GH Cochin Broca Hôtel Dieu, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, INSERM CIC 1417, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Jocelyn Raude
- EHESP Rennes, Sorbonne Paris Cité, avenue du Professeur Léon-Bernard, 35043 Rennes, France
| | - Céline Pulcini
- Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC, 34 Cours Léopold, 54000 Nancy, France
- CHU de Nancy, Service de Maladies Infectieuses, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy cedex, France
| | - Patrick Peretti-Watel
- INSERM, UMR912 “Economics and Social Sciences Applied to Health & Analysis of Medical Information” (SESSTIM), 23 rue Stanislas Torrents, 13006 Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, 23 rue Stanislas Torrents, 13006 Marseille, France
- Aix Marseille University, IRD, UMR-S912, 58 bd Charles Livon, 13284 Marseille Cedex 07, France
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Leca M, Bornet C, Montana M, Curti C, Vanelle P. Meningococcal vaccines: Current state and future outlook. ACTA ACUST UNITED AC 2015; 63:144-51. [DOI: 10.1016/j.patbio.2015.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 04/17/2015] [Indexed: 10/23/2022]
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Neuropsychological Correlates of Brain Perfusion SPECT in Patients with Macrophagic Myofasciitis. PLoS One 2015; 10:e0128353. [PMID: 26030650 PMCID: PMC4451975 DOI: 10.1371/journal.pone.0128353] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 04/26/2015] [Indexed: 12/24/2022] Open
Abstract
Background Patients with aluminum hydroxide adjuvant-induced macrophagic myofasciitis (MMF) complain of arthromyalgias, chronic fatigue and cognitive deficits. This study aimed to characterize brain perfusion in these patients. Methods Brain perfusion SPECT was performed in 76 consecutive patients (aged 49±10 y) followed in the Garches-Necker-Mondor-Hendaye reference center for rare neuromuscular diseases. Images were acquired 30 min after intravenous injection of 925 MBq 99mTc-ethylcysteinate dimer (ECD) at rest. All patients also underwent a comprehensive battery of neuropsychological tests, within 1.3±5.5 mo from SPECT. Statistical parametric maps (SPM12) were obtained for each test using linear regressions between each performance score and brain perfusion, with adjustment for age, sex, socio-cultural level and time delay between brain SPECT and neuropsychological testing. Results SPM analysis revealed positive correlation between neuropsychological scores (mostly exploring executive functions) and brain perfusion in the posterior associative cortex, including cuneus/precuneus/occipital lingual areas, the periventricular white matter/corpus callosum, and the cerebellum, while negative correlation was found with amygdalo-hippocampal/entorhinal complexes. A positive correlation was also observed between brain perfusion and the posterior associative cortex when the time elapsed since last vaccine injection was investigated. Conclusions Brain perfusion SPECT showed a pattern of cortical and subcortical changes in accordance with the MMF-associated cognitive disorder previously described. These results provide a neurobiological substrate for brain dysfunction in aluminum hydroxide adjuvant-induced MMF patients.
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Martínez-Lavín M. Hypothesis: Human papillomavirus vaccination syndrome—small fiber neuropathy and dysautonomia could be its underlying pathogenesis. Clin Rheumatol 2015; 34:1165-9. [DOI: 10.1007/s10067-015-2969-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 05/05/2015] [Accepted: 05/05/2015] [Indexed: 01/10/2023]
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Preusse C, Goebel HH, Pehl D, Rinnenthal JL, Kley RA, Allenbach Y, Heppner FL, Vorgerd M, Authier FJ, Gherardi R, Stenzel W. Th2-M2 immunity in lesions of muscular sarcoidosis and macrophagic myofasciitis. Neuropathol Appl Neurobiol 2015; 41:952-63. [PMID: 25711697 DOI: 10.1111/nan.12231] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 02/15/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To analyse the paradox of a lack of giant cell formation and fibrosis in chronic lesions of macrophagic myofasciitis (MMF) in comparison with muscular sarcoidosis (MuS). METHODS Inflammatory lesions and contiguous muscle regions from biopsy samples of 10 patients with MuS and 10 patients with MMF were cut out by laser microdissection. Mediators of the T helper cell (Th)1 inducing classical macrophage activation (e.g. STAT1, IFNγ and CXCR3), and Th2 inducing alternative activation of macrophages (e.g. CD206/MRC1, STAT6, SOCS1), molecules involved in development of fibrosis (e.g. TGFβ) and giant cells (e.g. TYROBP), were assessed by immunohistochemistry and real-time polymerase chain reaction (PCR). RESULTS STAT6-induced Th2 immunity was associated with up-regulated gene expression of MRC1, SOCS1 and TGFB in inflammatory foci, in comparison with adjacent tissue. TYROBP and TREM2, genes regulating giant cell formation, were more strongly expressed in lesions of MuS patients than in those of MMF. TGFβ co-localized with CD206(+) macrophages in MuS but not in MMF. Conversely, Th1 immunity was illustrated by STAT1 staining both in macrophages and myofibres in MuS, but not in MMF. Also, STAT1-induced IFNG and CXCR3 expression in lesions and the surrounding tissue was elevated compared with normal controls, but without statistically significant differences. CONCLUSION Giant cell and typical granuloma formations, including fibrogenesis, is dependent on two main mechanisms, both involving specific macrophage activation: a strong Th2-M2 polarization and a significant expression of TYROBP and TGFβ in macrophages. The low-grade alternative activation of macrophages in MMF lesions and poor TYROBP and TGFβco-expression are obviously insufficient to produce giant cells.
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Affiliation(s)
- Corinna Preusse
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, Germany
| | - Hans-H Goebel
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, Germany.,Department of Neuropathology, University Medicine, Johannes Gutenberg University, Mainz, Germany
| | - Debora Pehl
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, Germany
| | - Jan L Rinnenthal
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, Germany
| | - Rudolf A Kley
- Department of Neurology, Neuromuscular Center Ruhrgebiet, University Hospital Bergmannsheil, Ruhr-Universität Bochum, Bochum, Germany
| | - Yves Allenbach
- Département de Médecine Interne et Immunologie Clinique, Centre de Référence Maladies Neuro-Musculaires Paris Est, Assistance Public - Hôpitaux de Paris (AP-HP), DHU I2B, Paris, France.,Université Pierre et Marie Curie (UPMC), INSERM UMRS 974, Hôpital Pitié-Salpêtrière, Paris, France
| | - Frank L Heppner
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, Germany
| | - Matthias Vorgerd
- Department of Neurology, Neuromuscular Center Ruhrgebiet, University Hospital Bergmannsheil, Ruhr-Universität Bochum, Bochum, Germany
| | - François Jerôme Authier
- Neuromuscular Pathology Expert Center, Henri Mondor Hospital, Creteil, and INSERM U955, Faculty of Medicine, Paris Est University, Creteil, France
| | - Romain Gherardi
- Neuromuscular Pathology Expert Center, Henri Mondor Hospital, Creteil, and INSERM U955, Faculty of Medicine, Paris Est University, Creteil, France
| | - Werner Stenzel
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, Germany
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Gherardi RK, Eidi H, Crépeaux G, Authier FJ, Cadusseau J. Biopersistence and brain translocation of aluminum adjuvants of vaccines. Front Neurol 2015; 6:4. [PMID: 25699008 PMCID: PMC4318414 DOI: 10.3389/fneur.2015.00004] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 01/08/2015] [Indexed: 02/06/2023] Open
Abstract
Aluminum oxyhydroxide (alum) is a crystalline compound widely used as an immunological adjuvant of vaccines. Concerns linked to the use of alum particles emerged following recognition of their causative role in the so-called macrophagic myofasciitis (MMF) lesion detected in patients with myalgic encephalomyelitis/chronic fatigue/syndrome. MMF revealed an unexpectedly long-lasting biopersistence of alum within immune cells in presumably susceptible individuals, stressing the previous fundamental misconception of its biodisposition. We previously showed that poorly biodegradable aluminum-coated particles injected into muscle are promptly phagocytosed in muscle and the draining lymph nodes, and can disseminate within phagocytic cells throughout the body and slowly accumulate in brain. This strongly suggests that long-term adjuvant biopersistence within phagocytic cells is a prerequisite for slow brain translocation and delayed neurotoxicity. The understanding of basic mechanisms of particle biopersistence and brain translocation represents a major health challenge, since it could help to define susceptibility factors to develop chronic neurotoxic damage. Biopersistence of alum may be linked to its lysosome-destabilizing effect, which is likely due to direct crystal-induced rupture of phagolysosomal membranes. Macrophages that continuously perceive foreign particles in their cytosol will likely reiterate, with variable interindividual efficiency, a dedicated form of autophagy (xenophagy) until they dispose of alien materials. Successful compartmentalization of particles within double membrane autophagosomes and subsequent fusion with repaired and re-acidified lysosomes will expose alum to lysosomal acidic pH, the sole factor that can solubilize alum particles. Brain translocation of alum particles is linked to a Trojan horse mechanism previously described for infectious particles (HIV, HCV), that obeys to CCL2, signaling the major inflammatory monocyte chemoattractant.
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Affiliation(s)
- Romain Kroum Gherardi
- Faculté de Médecine and Faculté des Sciences et Technologie, INSERM U955 Team 10, Université Paris Est-Créteil , Créteil , France
| | - Housam Eidi
- Faculté de Médecine and Faculté des Sciences et Technologie, INSERM U955 Team 10, Université Paris Est-Créteil , Créteil , France
| | - Guillemette Crépeaux
- Faculté de Médecine and Faculté des Sciences et Technologie, INSERM U955 Team 10, Université Paris Est-Créteil , Créteil , France
| | - François Jerome Authier
- Faculté de Médecine and Faculté des Sciences et Technologie, INSERM U955 Team 10, Université Paris Est-Créteil , Créteil , France
| | - Josette Cadusseau
- Faculté de Médecine and Faculté des Sciences et Technologie, INSERM U955 Team 10, Université Paris Est-Créteil , Créteil , France
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Dórea JG. Exposure to mercury and aluminum in early life: developmental vulnerability as a modifying factor in neurologic and immunologic effects. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:1295-313. [PMID: 25625408 PMCID: PMC4344667 DOI: 10.3390/ijerph120201295] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 01/20/2015] [Indexed: 01/15/2023]
Abstract
Currently, ethylmercury (EtHg) and adjuvant-Al are the dominating interventional exposures encountered by fetuses, newborns, and infants due to immunization with Thimerosal-containing vaccines (TCVs). Despite their long use as active agents of medicines and fungicides, the safety levels of these substances have never been determined, either for animals or for adult humans—much less for fetuses, newborns, infants, and children. I reviewed the literature for papers reporting on outcomes associated with (a) multiple exposures and metabolism of EtHg and Al during early life; (b) physiological and metabolic characteristics of newborns, neonates, and infants relevant to xenobiotic exposure and effects; (c) neurobehavioral, immunological, and inflammatory reactions to Thimerosal and Al-adjuvants resulting from TCV exposure in infancy. Immunological and neurobehavioral effects of Thimerosal-EtHg and Al-adjuvants are not extraordinary; rather, these effects are easily detected in high and low income countries, with co-exposure to methylmercury (MeHg) or other neurotoxicants. Rigorous and replicable studies (in different animal species) have shown evidence of EtHg and Al toxicities. More research attention has been given to EtHg and findings have showed a solid link with neurotoxic effects in humans; however, the potential synergic effect of both toxic agents has not been properly studied. Therefore, early life exposure to both EtHg and Al deserves due consideration.
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Affiliation(s)
- José G Dórea
- Department of Nutrition, Faculty of Health Sciences, Universidade de Brasilia, 70919-970 DF Brasilia, Brazil.
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He P, Zou Y, Hu Z. Advances in aluminum hydroxide-based adjuvant research and its mechanism. Hum Vaccin Immunother 2015; 11:477-88. [PMID: 25692535 PMCID: PMC4514166 DOI: 10.1080/21645515.2014.1004026] [Citation(s) in RCA: 244] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 10/11/2014] [Accepted: 10/23/2014] [Indexed: 12/21/2022] Open
Abstract
In the past few decades, hundreds of materials have been tried as adjuvant; however, only aluminum-based adjuvants continue to be used widely in the world. Aluminum hydroxide, aluminum phosphate and alum constitute the main forms of aluminum used as adjuvants. Among these, aluminum hydroxide is the most commonly used chemical as adjuvant. In spite of its wide spread use, surprisingly, the mechanism of how aluminum hydroxide-based adjuvants exert their beneficial effects is still not fully understood. Current explanations for the mode of action of aluminum hydroxide-based adjuvants include, among others, the repository effect, pro-phagocytic effect, and activation of the pro-inflammatory NLRP3 pathway. These collectively galvanize innate as well as acquired immune responses and activate the complement system. Factors that have a profound influence on responses evoked by aluminum hydroxide-based adjuvant applications include adsorption rate, strength of the adsorption, size and uniformity of aluminum hydroxide particles, dosage of adjuvant, and the nature of antigens. Although vaccines containing aluminum hydroxide-based adjuvants are beneficial, sometimes they cause adverse reactions. Further, these vaccines cannot be stored frozen. Until recently, aluminum hydroxide-based adjuvants were known to preferentially prime Th2-type immune responses. However, results of more recent studies show that depending on the vaccination route, aluminum hydroxide-based adjuvants can enhance both Th1 as well as Th2 cellular responses. Advances in systems biology have opened up new avenues for studying mechanisms of aluminum hydroxide-based adjuvants. These will assist in scaling new frontiers in aluminum hydroxide-based adjuvant research that include improvement of formulations, use of nanoparticles of aluminum hydroxide and development of composite adjuvants.
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Affiliation(s)
- Peng He
- Division of Hepatitis Virus Vaccines; National Institutes for Food and Drug Control; Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products; Beijing, PR China
| | - Yening Zou
- Sinovac Research & Development Co., Ltd.; Beijing, PR China
| | - Zhongyu Hu
- Division of Hepatitis Virus Vaccines; National Institutes for Food and Drug Control; Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products; Beijing, PR China
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