1
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Huang Q, Wu Y, Li H. Signal detection of adverse reactions for bendamustine based on FDA adverse event reporting system. Expert Opin Drug Saf 2024:1-11. [PMID: 38682580 DOI: 10.1080/14740338.2024.2348573] [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: 11/20/2023] [Accepted: 03/28/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND This study aimed to analyze the adverse events to bendamustine using data obtained from the Food and Drug Administration open public data project (openFDA) and to provide a reference for its use in clinical practice. RESEARCH DESIGN AND METHODS Adverse events (AEs) due to bendamustine usage reported from 1 January 2008 to 31 March 2023 were collected from the FDA Adverse Event Reporting System (FAERS). The reporting odds ratio (ROR), proportional reporting ratio (PRR), Bayesian plausible propagation neural network (BCPNN), and multinomial gamma-Poisson distribution shrinking (MGPS) algorithms were used to identify signs of adverse reactions caused by bendamustine. RESULTS A total of 4214 AE reports where bendamustine was considered as the first suspected drug were obtained from FAERS. The analysis revealed 214 AE risk signals, among which 141 met the criteria but they were not listed as possible side effects on the drug information sheet provided in the package. CONCLUSION Our findings identified numerous common AEs with previously reported clinical observations. We also identified some signs of potential new AEs, indicating the need of careful clinical monitoring of patients treated with bendamustine and further risk identification research about this drug.
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Affiliation(s)
- Qing Huang
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, FengTai District, Beijing, China
| | - Yuanbin Wu
- Department of Emergency Medicine, The Seventh Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Huimin Li
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, FengTai District, Beijing, China
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2
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Park E, Barclay WE, Barrera A, Liao TC, Salzler HR, Reddy TE, Shinohara ML, Ciofani M. Integrin α3 promotes T H17 cell polarization and extravasation during autoimmune neuroinflammation. Sci Immunol 2023; 8:eadg7597. [PMID: 37831759 PMCID: PMC10821720 DOI: 10.1126/sciimmunol.adg7597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023]
Abstract
Multiple sclerosis (MS) is an autoimmune disease of the central nervous system (CNS) caused by CNS-infiltrating leukocytes, including TH17 cells that are critical mediators of disease pathogenesis. Although targeting leukocyte trafficking is effective in treating autoimmunity, there are currently no therapeutic interventions that specifically block encephalitogenic TH17 cell migration. Here, we report integrin α3 as a TH17 cell-selective determinant of pathogenicity in experimental autoimmune encephalomyelitis. CNS-infiltrating TH17 cells express high integrin α3, and its deletion in CD4+ T cells or Il17a fate-mapped cells attenuated disease severity. Mechanistically, integrin α3 enhanced the immunological synapse formation to promote the polarization and proliferation of TH17 cells. Moreover, the transmigration of TH17 cells into the CNS was dependent on integrin α3, and integrin α3 deficiency enhanced the retention of CD4+ T cells in the perivascular space of the blood-brain barrier. Integrin α3-dependent interactions continuously maintain TH17 cell identity and effector function. The requirement of integrin α3 in TH17 cell pathogenicity suggests integrin α3 as a therapeutic target for MS treatment.
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Affiliation(s)
- Eunchong Park
- Department of Integrative Immunobiology, Duke University Medical Center, Durham, NC, USA
- Center for Advanced Genomic Technologies, Duke University, Durham, NC, USA
| | - William E. Barclay
- Department of Integrative Immunobiology, Duke University Medical Center, Durham, NC, USA
| | - Alejandro Barrera
- Center for Advanced Genomic Technologies, Duke University, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical School, Durham, NC, USA
| | - Tzu-Chieh Liao
- Department of Integrative Immunobiology, Duke University Medical Center, Durham, NC, USA
- Center for Advanced Genomic Technologies, Duke University, Durham, NC, USA
| | - Harmony R. Salzler
- Department of Integrative Immunobiology, Duke University Medical Center, Durham, NC, USA
| | - Timothy E. Reddy
- Center for Advanced Genomic Technologies, Duke University, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical School, Durham, NC, USA
| | - Mari L. Shinohara
- Department of Integrative Immunobiology, Duke University Medical Center, Durham, NC, USA
- Department of Molecular Genetics and Microbiology, Duke University Medical Center, Durham, NC, USA
| | - Maria Ciofani
- Department of Integrative Immunobiology, Duke University Medical Center, Durham, NC, USA
- Center for Advanced Genomic Technologies, Duke University, Durham, NC, USA
- Department of Molecular Genetics and Microbiology, Duke University Medical Center, Durham, NC, USA
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3
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Born T, Vassallo P, Golshayan D, Di Liberto G, Brouland JP, Egervari K, Merkler D, Du Pasquier RA, Bernard-Valnet R. Bridging the Gap: Immunotherapy in Progressive Multifocal Leukoencephalopathy: A New Hope? Neurology 2023; 101:e1382-e1386. [PMID: 37407265 PMCID: PMC10558171 DOI: 10.1212/wnl.0000000000207533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 05/04/2023] [Indexed: 07/07/2023] Open
Abstract
Progressive multifocal leukoencephalopathy (PML) is a severe infection of the CNS occurring in immunocompromised individuals in which large demyelinating lesions are induced by polyomavirus JC (JCV). In the absence of effective antiviral treatment, control of the infection relies on restoring anti-JCV immunity. Thus, particularly in long-standing immunocompromising conditions such as organ transplantation, lymphoproliferative disorders, or idiopathic lymphopenia, new strategies to boost anti-JCV immune responses are needed. Here, we report the case of a patient developing PML in the context of kidney transplantation who received recombinant human interleukin 7 to foster immune responses against JCV. We give an overview of the immunologic mechanisms underlying the development of PML and immune restoration within the CNS after JCV infection. Immunotherapeutic strategies developed based on current understanding of the disease hold promise in managing patients with PML.
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Affiliation(s)
- Tristan Born
- From the Neurology Service (T.B., P.V., G.D.L., R.A.D.P., R.B.-V.), Department of Clinical Neurosciences, Transplantation Center (D.G.), Department of Medicine, and Pathology Department (J.-P.B.), Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois) and the University of Lausanne; and Service of Clinical Pathology (K.E., D.M.), Department of Pathology and Immunology and Diagnostic Department, University Hospitals of Geneva, Switzerland
| | - Paola Vassallo
- From the Neurology Service (T.B., P.V., G.D.L., R.A.D.P., R.B.-V.), Department of Clinical Neurosciences, Transplantation Center (D.G.), Department of Medicine, and Pathology Department (J.-P.B.), Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois) and the University of Lausanne; and Service of Clinical Pathology (K.E., D.M.), Department of Pathology and Immunology and Diagnostic Department, University Hospitals of Geneva, Switzerland
| | - Dela Golshayan
- From the Neurology Service (T.B., P.V., G.D.L., R.A.D.P., R.B.-V.), Department of Clinical Neurosciences, Transplantation Center (D.G.), Department of Medicine, and Pathology Department (J.-P.B.), Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois) and the University of Lausanne; and Service of Clinical Pathology (K.E., D.M.), Department of Pathology and Immunology and Diagnostic Department, University Hospitals of Geneva, Switzerland
| | - Giovanni Di Liberto
- From the Neurology Service (T.B., P.V., G.D.L., R.A.D.P., R.B.-V.), Department of Clinical Neurosciences, Transplantation Center (D.G.), Department of Medicine, and Pathology Department (J.-P.B.), Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois) and the University of Lausanne; and Service of Clinical Pathology (K.E., D.M.), Department of Pathology and Immunology and Diagnostic Department, University Hospitals of Geneva, Switzerland
| | - Jean-Philippe Brouland
- From the Neurology Service (T.B., P.V., G.D.L., R.A.D.P., R.B.-V.), Department of Clinical Neurosciences, Transplantation Center (D.G.), Department of Medicine, and Pathology Department (J.-P.B.), Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois) and the University of Lausanne; and Service of Clinical Pathology (K.E., D.M.), Department of Pathology and Immunology and Diagnostic Department, University Hospitals of Geneva, Switzerland
| | - Kristof Egervari
- From the Neurology Service (T.B., P.V., G.D.L., R.A.D.P., R.B.-V.), Department of Clinical Neurosciences, Transplantation Center (D.G.), Department of Medicine, and Pathology Department (J.-P.B.), Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois) and the University of Lausanne; and Service of Clinical Pathology (K.E., D.M.), Department of Pathology and Immunology and Diagnostic Department, University Hospitals of Geneva, Switzerland
| | - Doron Merkler
- From the Neurology Service (T.B., P.V., G.D.L., R.A.D.P., R.B.-V.), Department of Clinical Neurosciences, Transplantation Center (D.G.), Department of Medicine, and Pathology Department (J.-P.B.), Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois) and the University of Lausanne; and Service of Clinical Pathology (K.E., D.M.), Department of Pathology and Immunology and Diagnostic Department, University Hospitals of Geneva, Switzerland
| | - Renaud A Du Pasquier
- From the Neurology Service (T.B., P.V., G.D.L., R.A.D.P., R.B.-V.), Department of Clinical Neurosciences, Transplantation Center (D.G.), Department of Medicine, and Pathology Department (J.-P.B.), Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois) and the University of Lausanne; and Service of Clinical Pathology (K.E., D.M.), Department of Pathology and Immunology and Diagnostic Department, University Hospitals of Geneva, Switzerland
| | - Raphael Bernard-Valnet
- From the Neurology Service (T.B., P.V., G.D.L., R.A.D.P., R.B.-V.), Department of Clinical Neurosciences, Transplantation Center (D.G.), Department of Medicine, and Pathology Department (J.-P.B.), Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois) and the University of Lausanne; and Service of Clinical Pathology (K.E., D.M.), Department of Pathology and Immunology and Diagnostic Department, University Hospitals of Geneva, Switzerland.
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4
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Boumaza X, Bonneau B, Roos-Weil D, Pinnetti C, Rauer S, Nitsch L, Del Bello A, Jelcic I, Sühs KW, Gasnault J, Goreci Y, Grauer O, Gnanapavan S, Wicklein R, Lambert N, Perpoint T, Beudel M, Clifford D, Sommet A, Cortese I, Martin-Blondel G. Progressive Multifocal Leukoencephalopathy Treated by Immune Checkpoint Inhibitors. Ann Neurol 2023; 93:257-270. [PMID: 36151879 PMCID: PMC10092874 DOI: 10.1002/ana.26512] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 09/01/2022] [Accepted: 09/16/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Our aim was to assess the real-world effectiveness of immune checkpoint inhibitors for treatment of patients with progressive multifocal leukoencephalopathy (PML). METHODS We conducted a multicenter survey compiling retrospective data from 79 PML patients, including 38 published cases and 41 unpublished cases, who received immune checkpoint inhibitors as add-on to standard of care. One-year follow-up data were analyzed to determine clinical outcomes and safety profile. Logistic regression was used to identify variables associated with 1-year survival. RESULTS Predisposing conditions included hematological malignancy (n = 38, 48.1%), primary immunodeficiency (n = 14, 17.7%), human immunodeficiency virus/acquired immunodeficiency syndrome (n = 12, 15.2%), inflammatory disease (n = 8, 10.1%), neoplasm (n = 5, 6.3%), and transplantation (n = 2, 2.5%). Pembrolizumab was most commonly used (n = 53, 67.1%). One-year survival was 51.9% (41/79). PML-immune reconstitution inflammatory syndrome (IRIS) was reported in 15 of 79 patients (19%). Pretreatment expression of programmed cell death-1 on circulating T cells did not differ between survivors and nonsurvivors. Development of contrast enhancement on follow-up magnetic resonance imaging at least once during follow-up (OR = 3.16, 95% confidence interval = 1.20-8.72, p = 0.02) was associated with 1-year survival. Cerebrospinal fluid JC polyomavirus DNA load decreased significantly by 1-month follow-up in survivors compared to nonsurvivors (p < 0.0001). Thirty-two adverse events occurred among 24 of 79 patients (30.4%), and led to treatment discontinuation in 7 of 24 patients (29.1%). INTERPRETATION In this noncontrolled retrospective study of patients with PML who were treated with immune checkpoint inhibitors, mortality remains high. Development of inflammatory features or overt PML-IRIS was commonly observed. This study highlights that use of immune checkpoint inhibitors should be strictly personalized toward characteristics of the individual PML patient. ANN NEUROL 2023;93:257-270.
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Affiliation(s)
- Xavier Boumaza
- Department of Infectious and Tropical Diseases, Toulouse University Hospital, Toulouse, France
| | - Baptiste Bonneau
- Department of Medical Pharmacology, CIC 1436, Toulouse University Hospital, Toulouse, France
| | - Damien Roos-Weil
- Department of Hematology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Carmela Pinnetti
- HIV/AIDS Clinical Unit, National Institute for Infectious Disease "L. Spallanzani", Rome, Italy
| | - Sebastian Rauer
- Department of Neurology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Louisa Nitsch
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Arnaud Del Bello
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.,Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), INSERM UMR1291, CNRS UMR5051, Toulouse III University, Toulouse, France
| | - Ilijas Jelcic
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Kurt-Wolfram Sühs
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Jacques Gasnault
- Unit of Rehabilitation of Neuroviral Diseases, Bicêtre Hospital, APHP, Le Kremlin-Bicêtre, France.,INSERM U1186, Paul Brousse Hospital, Paris Saclay University, Villejuif, France
| | - Yasemin Goreci
- Department of Neurology, University Hospital of Cologne, Cologne, Germany
| | - Oliver Grauer
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Sharmilee Gnanapavan
- Department of Neurology, Barts Health NHS Trust and Queen Mary University of London, London, UK
| | - Rebecca Wicklein
- Department of Neurology, Technical University of Munich, Munich, Germany
| | - Nicolas Lambert
- Department of Neurology, University Hospital of Liège, Liège, Belgium
| | - Thomas Perpoint
- Department of Infectious and Tropical Diseases, Lyon University Hospital, Lyon, France
| | - Martijn Beudel
- Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Department of Neuroscience, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - David Clifford
- Department of Neurology, Washington University in St Louis, St Louis, MO, USA
| | - Agnès Sommet
- Department of Medical Pharmacology, CIC 1436, Toulouse University Hospital, Toulouse, France
| | - Irene Cortese
- Experimental Immunotherapeutics Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - Guillaume Martin-Blondel
- Department of Infectious and Tropical Diseases, Toulouse University Hospital, Toulouse, France.,Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), INSERM UMR1291, CNRS UMR5051, Toulouse III University, Toulouse, France.,European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group on Infections of the Brain (ESGIB), Basel, Switzerland
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5
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Mayr P, Lutz M, Schmutz M, Hoeppner J, Liesche-Starnecker F, Schlegel J, Gaedcke J, Claus R. Progressive multifocal leukoencephalopathy associated with chemotherapy induced lymphocytopenia in solid tumors – case report of an underestimated complication. Front Oncol 2022; 12:905103. [PMID: 36003787 PMCID: PMC9394442 DOI: 10.3389/fonc.2022.905103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/24/2022] [Indexed: 11/19/2022] Open
Abstract
Background JC virus reactivation causing progressive multifocal leukoencephalopathy (PML) occurs preferentially in human immunodeficiency virus (HIV) positive individuals or patients suffering from hematologic neoplasms due to impaired viral control. Reactivation in patients suffering from solid malignancies is rarely described in published literature. Case Presentation Here we describe a case of PML in a male patient suffering from esophageal cancer who underwent neoadjuvant radiochemotherapy and surgical resection in curative intent resulting in complete tumor remission. The radiochemotherapy regimen contained carboplatin and paclitaxel (CROSS protocol). Since therapy onset, the patient presented with persistent and progredient leukopenia and lymphopenia in absence of otherwise known risk factors for PML. Symptom onset, which comprised aphasia, word finding disorder, and paresis, was apparent 7 months after therapy initiation. There was no relief in symptoms despite standard of care PML directed supportive therapy. The patient died two months after therapy onset. Conclusion PML is a very rare event in solid tumors without obvious states of immununosuppression and thus harbors the risk of unawareness. The reported patient suffered from lymphopenia, associated with systemic therapy, but was an otherwise immunocompetent individual. In case of neurologic impairment in patients suffering from leukopenia, PML must be considered – even in the absence of hematologic neoplasia or HIV infection.
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6
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Biotypes of HIV-associated neurocognitive disorders based on viral and immune pathogenesis. Curr Opin Infect Dis 2022; 35:223-230. [PMID: 35665716 PMCID: PMC9179892 DOI: 10.1097/qco.0000000000000825] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW HIV-associated neurocognitive disorders (HAND) continues to be prevalent in people living with HIV despite antiretroviral therapy. However, understanding disease mechanisms and identifying therapeutic avenues has been challenging. One of the challenges is that HAND is a heterogeneous disease and that patients identified with similar impairments phenotypically may have very different underlying disease processes. As the NeuroAIDS field is re-evaluating the approaches used to identify patients with HIV-associated neurological impairments, we propose the subtyping of patients into biotypes based on viral and immune pathogenesis. RECENT FINDINGS Here we review the evidence supporting subtyping patients with HIV-associated neurological complications into four biotypes: macrophage-mediated HIV encephalitis, CNS viral escape, T-cell-mediated HIV encephalitis, and HIV protein-associated encephalopathy. SUMMARY Subtyping patients into subgroups based on biotypes has emerged as a useful approach for studying heterogeneous diseases. Understanding biotypes of HIV-associated neurocognitive impairments may therefore enable better understanding of disease mechanisms, allow for the development of prognostic and diagnostic markers, and could ultimately guide therapeutic decisions.
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7
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Charabati M, Grasmuck C, Ghannam S, Bourbonnière L, Fournier AP, Lécuyer MA, Tastet O, Kebir H, Rébillard RM, Hoornaert C, Gowing E, Larouche S, Fortin O, Pittet C, Filali-Mouhim A, Lahav B, Moumdjian R, Bouthillier A, Girard M, Duquette P, Cayrol R, Peelen E, Quintana FJ, Antel JP, Flügel A, Larochelle C, Arbour N, Zandee S, Prat A. DICAM promotes T H17 lymphocyte trafficking across the blood-brain barrier during autoimmune neuroinflammation. Sci Transl Med 2022; 14:eabj0473. [PMID: 34985970 DOI: 10.1126/scitranslmed.abj0473] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Marc Charabati
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada.,Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec H3T 1J4, Canada
| | - Camille Grasmuck
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada.,Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec H3T 1J4, Canada
| | - Soufiane Ghannam
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada.,Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec H3T 1J4, Canada
| | - Lyne Bourbonnière
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada
| | - Antoine P Fournier
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada.,Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec H3T 1J4, Canada
| | - Marc-André Lécuyer
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada.,Department of Microbiology, Infectious Diseases and Immunology, Faculty of Medicine, Université de Montréal, Montreal, Quebec H3T 1J4, Canada.,Institute for Neuroimmunology and Multiple Sclerosis Research, University Medical Center Göttingen, Göttingen D-37073, Germany
| | - Olivier Tastet
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada
| | - Hania Kebir
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada.,Department of Microbiology, Infectious Diseases and Immunology, Faculty of Medicine, Université de Montréal, Montreal, Quebec H3T 1J4, Canada
| | - Rose-Marie Rébillard
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada.,Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec H3T 1J4, Canada
| | - Chloé Hoornaert
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada.,Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec H3T 1J4, Canada
| | - Elizabeth Gowing
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada.,Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec H3T 1J4, Canada
| | - Sandra Larouche
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada
| | - Olivier Fortin
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada
| | - Camille Pittet
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada
| | - Ali Filali-Mouhim
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada
| | - Boaz Lahav
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada.,Multiple Sclerosis Clinic, Division of Neurology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec H2L 4M1, Canada
| | - Robert Moumdjian
- Division of Neurosurgery, Université de Montréal and CHUM, Montreal, Quebec H2L 4M1, Canada
| | - Alain Bouthillier
- Division of Neurosurgery, Université de Montréal and CHUM, Montreal, Quebec H2L 4M1, Canada
| | - Marc Girard
- Multiple Sclerosis Clinic, Division of Neurology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec H2L 4M1, Canada
| | - Pierre Duquette
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada.,Multiple Sclerosis Clinic, Division of Neurology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec H2L 4M1, Canada
| | - Romain Cayrol
- Department of Pathology, Université de Montréal and CHUM, Montreal, Quebec H2L 4M1, Canada
| | - Evelyn Peelen
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada.,Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec H3T 1J4, Canada
| | - Francisco J Quintana
- Ann Romney Carter for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.,Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Jack P Antel
- Neuroimmunology Unit, Montreal Neurological Institute and Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec H3A 2B4, Canada
| | - Alexander Flügel
- Institute for Neuroimmunology and Multiple Sclerosis Research, University Medical Center Göttingen, Göttingen D-37073, Germany
| | - Catherine Larochelle
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada.,Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec H3T 1J4, Canada.,Multiple Sclerosis Clinic, Division of Neurology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec H2L 4M1, Canada
| | - Nathalie Arbour
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada.,Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec H3T 1J4, Canada
| | - Stephanie Zandee
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada.,Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec H3T 1J4, Canada
| | - Alexandre Prat
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada.,Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec H3T 1J4, Canada.,Multiple Sclerosis Clinic, Division of Neurology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec H2L 4M1, Canada
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8
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Zeiner PS, Mann L, Filipski K, Starzetz T, Forster MT, Ronellenfitsch MW, Steinbach JP, Mittelbronn M, Wagner M, Harter PN. Immune profile and radiological characteristics of progressive multifocal leukoencephalopathy. Eur J Neurol 2021; 29:543-554. [PMID: 34644450 DOI: 10.1111/ene.15140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE Progressive multifocal leukoencephalopathy (PML) constitutes a severe disease with increasing incidence, mostly in the context of immunosuppressive therapies. A detailed understanding of immune response in PML appears critical for the treatment strategy. The aim was a comprehensive immunoprofiling and radiological characterization of magnetic resonance imaging (MRI) defined PML variants. METHODS All biopsy-confirmed PML patients (n = 15) treated in our department between January 2004 and July 2019 were retrospectively analysed. Data from MRI, histology as well as detailed clinical and outcome data were collected. The MRI-defined variants of classical (cPML) and inflammatory (iPML) PML were discriminated based on the intensity of gadolinium enhancement. In these PML variants, intensity and localization (perivascular vs. parenchymal) of inflammation in MRI and histology as well as the cellular composition by immunohistochemistry were assessed. The size of the demyelinating lesions was correlated with immune cell infiltration. RESULTS Patients with MRI-defined iPML showed a stronger intensity of inflammation with an increased lymphocyte infiltration on histological level. Also, iPML was characterized by a predominantly perivascular inflammation. However, cPML patients also demonstrated certain inflammatory tissue alterations. Infiltration of CD163-positive microglia and macrophage (M/M) subtypes correlated with PML lesion size. CONCLUSIONS The non-invasive MRI-based discrimination of PML variants allows for an estimation of inflammatory tissue alterations, although exhibiting limitations in MRI-defined cPML. The association of a distinct phagocytic M/M subtype with the extent of demyelination might reflect disease progression.
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Affiliation(s)
- Pia S Zeiner
- Dr Senckenberg Institute of Neurooncology, University Hospital, Frankfurt am Main, Germany.,Department of Neurology, University Hospital, Frankfurt am Main, Germany.,Frankfurt Cancer Institute (FCI), Frankfurt am Main, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Leonhard Mann
- Department of Neurology, University Hospital, Frankfurt am Main, Germany.,Neurological Institute (Edinger Institute), University Hospital, Frankfurt am Main, Germany.,Institute of Neuroradiology, Goethe University, Frankfurt am Main, Germany
| | - Katharina Filipski
- Frankfurt Cancer Institute (FCI), Frankfurt am Main, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Neurological Institute (Edinger Institute), University Hospital, Frankfurt am Main, Germany
| | - Tatjana Starzetz
- Neurological Institute (Edinger Institute), University Hospital, Frankfurt am Main, Germany
| | | | - Michael W Ronellenfitsch
- Dr Senckenberg Institute of Neurooncology, University Hospital, Frankfurt am Main, Germany.,Frankfurt Cancer Institute (FCI), Frankfurt am Main, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Joachim P Steinbach
- Dr Senckenberg Institute of Neurooncology, University Hospital, Frankfurt am Main, Germany.,Frankfurt Cancer Institute (FCI), Frankfurt am Main, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michel Mittelbronn
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg.,Department of Oncology (DONC), Luxembourg Institute of Health (LIH), Strassen, Luxembourg.,Faculty of Science, Technology and Medicine (FSTM), University of Luxembourg, Esch-sur-Alzette, Luxembourg.,Department of Life Sciences and Medicine (DLSM), University of Luxembourg, Esch-sur-Alzette, Luxembourg.,Laboratoire national de santé (LNS), Dudelange, Luxembourg.,Luxembourg Centre of Neuropathology (LCNP), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Marlies Wagner
- Frankfurt Cancer Institute (FCI), Frankfurt am Main, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Institute of Neuroradiology, Goethe University, Frankfurt am Main, Germany
| | - Patrick N Harter
- Frankfurt Cancer Institute (FCI), Frankfurt am Main, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Neurological Institute (Edinger Institute), University Hospital, Frankfurt am Main, Germany
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9
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Bernard-Valnet R, Koralnik IJ, Du Pasquier R. Advances in Treatment of Progressive Multifocal Leukoencephalopathy. Ann Neurol 2021; 90:865-873. [PMID: 34405435 PMCID: PMC9291129 DOI: 10.1002/ana.26198] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 12/19/2022]
Abstract
Progressive multifocal encephalopathy (PML) is a severe demyelinating disease of the central nervous system (CNS) caused by JC virus (JCV), which occurs in immunocompromised individuals. Management of PML relies on restoration of immunity within the CNS. However, when this restoration cannot be readily achieved, PML has a grim prognosis. Innovative strategies have shown promise in promoting anti‐JCV immune responses, and include T‐cell adoptive transfer or immune checkpoint inhibitor therapies. Conversely, management of immune reconstitution inflammatory syndrome, particularly in iatrogenic PML, remains a major challenge. In this paper, we review recent development in the treatment of PML. ANN NEUROL 2021;90:865–873
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Affiliation(s)
- Raphaël Bernard-Valnet
- Service of Neurology, Department of Clinical Neurosciences, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Igor J Koralnik
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Renaud Du Pasquier
- Service of Neurology, Department of Clinical Neurosciences, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
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10
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Interleukin-15 superagonist (N-803) treatment of PML and JCV in a post-allogeneic hematopoietic stem cell transplant patient. Blood Adv 2021; 4:2387-2391. [PMID: 32484854 DOI: 10.1182/bloodadvances.2019000664] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 04/02/2020] [Indexed: 12/24/2022] Open
Abstract
Key Points
Therapy with an IL-15 superagonist resulted in immune and clinical responses in a transplant recipient with PML.
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11
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Manouchehri N, Steinman L, Stuve O. Biological Significance of Anti-SARS-CoV-2 Antibodies: Lessons Learned From Progressive Multifocal Leukoencephalopathy. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:e935. [PMID: 33361386 PMCID: PMC7768959 DOI: 10.1212/nxi.0000000000000935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/09/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To discuss the pathogenic and diagnostic relevance of cellular and humoral immune responses against severe acute respiratory syndrome novel coronavirus (SARS-COV-2) and pertinent observations made in progressive multifocal leukoencephalopathy (PML). METHODS Review of pertinent literature. RESULTS: There is at least 1 precedent for an antibody response against a viral pathogen that fails to provide host protection in the absence of immune-competent CD4+ T cells. PML is an infection of the CNS caused by JC virus (JCV), which commonly occurs during treatment with the therapeutic monoclonal antibody natalizumab. In this context, the humoral immune response fails to prevent JCV reactivation, and elevated anti-JCV serum indices are associated with a higher PML incidence. The more relevant immune-competent cells in host defense against JCV appear to be T cells. T cell-mediated responses are also detectable in convalescing patients with SARS-COV-2 irrespective of the humoral immune response. CONCLUSION Based on pathogenic lessons learned from PML under natalizumab therapy, we suggest the incorporation of functional assays that determine neutralizing properties of SARS-CoV-2-specific antibodies. In addition, we outline the potential role of T-cell detection assays in determining herd immunity in a given population or in studying therapeutic responses to vaccines.
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Affiliation(s)
- Navid Manouchehri
- From the Department of Neurology (N.M.), the University of Texas Southwestern Medical Center, Dallas; Departments of Pediatrics and Neurology and Neurological Sciences (L.S.), Stanford University, CA; and Neurology Section (O.S.), VA North Texas Health Care System, Medical Service Dallas, VA Medical Center
| | - Lawrence Steinman
- From the Department of Neurology (N.M.), the University of Texas Southwestern Medical Center, Dallas; Departments of Pediatrics and Neurology and Neurological Sciences (L.S.), Stanford University, CA; and Neurology Section (O.S.), VA North Texas Health Care System, Medical Service Dallas, VA Medical Center
| | - Olaf Stuve
- From the Department of Neurology (N.M.), the University of Texas Southwestern Medical Center, Dallas; Departments of Pediatrics and Neurology and Neurological Sciences (L.S.), Stanford University, CA; and Neurology Section (O.S.), VA North Texas Health Care System, Medical Service Dallas, VA Medical Center
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12
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Oh H, Leventhal O, Channappa D, Henderson VW, Wyss-Coray T, Lehallier B, Gate D. Methods to investigate intrathecal adaptive immunity in neurodegeneration. Mol Neurodegener 2021; 16:3. [PMID: 33482851 PMCID: PMC7824942 DOI: 10.1186/s13024-021-00423-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 01/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background Cerebrospinal fluid (CSF) provides basic mechanical and immunological protection to the brain. Historically, analysis of CSF has focused on protein changes, yet recent studies have shed light on cellular alterations. Evidence now exists for involvement of intrathecal T cells in the pathobiology of neurodegenerative diseases. However, a standardized method for long-term preservation of CSF immune cells is lacking. Further, the functional role of CSF T cells and their cognate antigens in neurodegenerative diseases are largely unknown. Results We present a method for long-term cryopreservation of CSF immune cells for downstream single cell RNA and T cell receptor sequencing (scRNA-TCRseq) analysis. We observe preservation of CSF immune cells, consisting primarily of memory CD4+ and CD8+ T cells. We then utilize unbiased bioinformatics approaches to quantify and visualize TCR sequence similarity within and between disease groups. By this method, we identify clusters of disease-associated, antigen-specific TCRs from clonally expanded CSF T cells of patients with neurodegenerative diseases. Conclusions Here, we provide a standardized approach for long-term storage of CSF immune cells. Additionally, we present unbiased bioinformatic approaches that will facilitate the discovery of target antigens of clonally expanded T cells in neurodegenerative diseases. These novel methods will help improve our understanding of adaptive immunity in the central nervous system. Supplementary Information The online version contains supplementary material available at 10.1186/s13024-021-00423-w.
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Affiliation(s)
- Hamilton Oh
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Olivia Leventhal
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Divya Channappa
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Victor W Henderson
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA.,Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Tony Wyss-Coray
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Benoit Lehallier
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - David Gate
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA.
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13
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Hilger C, Riedhammer C, Orsó E, Weissert R. Effects of Alemtuzumab on (Auto)antigen-Specific Immune Responses. Front Immunol 2020; 11:563645. [PMID: 33133074 PMCID: PMC7578345 DOI: 10.3389/fimmu.2020.563645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/21/2020] [Indexed: 11/13/2022] Open
Abstract
Alemtuzumab (anti-CD52 mAb) leads to a long-lasting disease activity suppression in patients with relapsing forms of multiple sclerosis (MS). In this study, we examined the change of the immune cell repertoire and the cellular reactivity after treatment with alemtuzumab. We analyzed the number of IFN-γ–secreting cells in presence of several peptides which had been eluted from the central nervous system (CNS) of MS patients and are possible targets of autoreactive T cells in MS. The patients showed a stabilized disease activity measured in clinical parameters and lesion formation after the treatment. We detected a reduction of the number of IFN-γ–secreting cells in the presence of every tested self-antigen. The number of IFN-γ–secreting cells was also reduced in the presence of non-self-antigens. We also found a clear change in the immune cell repertoire. After an almost complete depletion of all lymphocytes, the cell specificities showed different reconstitution patterns, resulting in different cell fractions. The percentage of CD4+ T cells was clearly reduced after therapy, whereas the fractions of B and NK cells were elevated. When we evaluated the number of IFN-γ–secreting cells in relation to the number of present CD4+ T cells, we still found a significant reduction. We conclude that the reduction of IFN-γ–secreting cells by alemtuzumab is not only due to a reduction of the CD4+ T cell fraction within the peripheral blood mononuclear cell (PBMC) compartment but might also be caused by functional changes or a shift in the distribution of different subtypes in the CD4+ T cell pool.
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Affiliation(s)
- Clara Hilger
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany
| | | | - Evelyn Orsó
- Institute for Clinical Chemistry and Laboratory Medicine, University Hospital of Regensburg, Regensburg, Germany
| | - Robert Weissert
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany
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14
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Fifty Years of JC Polyomavirus: A Brief Overview and Remaining Questions. Viruses 2020; 12:v12090969. [PMID: 32882975 PMCID: PMC7552028 DOI: 10.3390/v12090969] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 08/28/2020] [Accepted: 08/30/2020] [Indexed: 12/11/2022] Open
Abstract
In the fifty years since the discovery of JC polyomavirus (JCPyV), the body of research representing our collective knowledge on this virus has grown substantially. As the causative agent of progressive multifocal leukoencephalopathy (PML), an often fatal central nervous system disease, JCPyV remains enigmatic in its ability to live a dual lifestyle. In most individuals, JCPyV reproduces benignly in renal tissues, but in a subset of immunocompromised individuals, JCPyV undergoes rearrangement and begins lytic infection of the central nervous system, subsequently becoming highly debilitating-and in many cases, deadly. Understanding the mechanisms allowing this process to occur is vital to the development of new and more effective diagnosis and treatment options for those at risk of developing PML. Here, we discuss the current state of affairs with regards to JCPyV and PML; first summarizing the history of PML as a disease and then discussing current treatment options and the viral biology of JCPyV as we understand it. We highlight the foundational research published in recent years on PML and JCPyV and attempt to outline which next steps are most necessary to reduce the disease burden of PML in populations at risk.
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15
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Arif S, Gomez-Tourino I, Kamra Y, Pujol-Autonell I, Hanton E, Tree T, Melandri D, Hull C, Wherrett DK, Beam C, Roep BO, Lorenc A, Peakman M. GAD-alum immunotherapy in type 1 diabetes expands bifunctional Th1/Th2 autoreactive CD4 T cells. Diabetologia 2020; 63:1186-1198. [PMID: 32248243 PMCID: PMC7228993 DOI: 10.1007/s00125-020-05130-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 02/18/2020] [Indexed: 01/13/2023]
Abstract
AIMS/HYPOTHESIS Antigen-specific therapy aims to modify inflammatory T cell responses in type 1 diabetes and restore immune tolerance. One strategy employs GAD65 conjugated to aluminium hydroxide (GAD-alum) to take advantage of the T helper (Th)2-biasing adjuvant properties of alum and thereby regulate pathological Th1 autoimmunity. We explored the cellular and molecular mechanism of GAD-alum action in the setting of a previously reported randomised placebo-controlled clinical trial conducted by Type 1 Diabetes TrialNet. METHODS In the clinical trial conducted by Type 1 Diabetes TrialNet, participants were immunised with 20 μg GAD-alum (twice or three times) or alum alone and peripheral blood mononuclear cell samples were banked at baseline and post treatment. In the present study, GAD-specific T cell responses were measured in these samples and GAD-specific T cell lines and clones were generated, which were then further characterised. RESULTS At day 91 post immunisation, we detected GAD-specific IL-13+ CD4 T cell responses significantly more frequently in participants immunised with GAD-alum (71% and 94% treated twice or three times, respectively) compared with those immunised with alum alone (38%; p = 0.003 and p = 0.0002, respectively) accompanied by high secreted levels of IL-13, IL-4 and IL-5, confirming a GAD-specific, GAD-alum-induced Th2 response. Of note, GAD-specific, IL-13+ CD4 T cells observed after immunisation co-secreted IFN-γ, displaying a bifunctional Th1/Th2 phenotype. Single-cell transcriptome analysis identified IL13 and IFNG expression in concert with the canonical Th2 and Th1 transcription factor genes GATA3 and TBX21, respectively. T cell receptor β-chain (TCRB) CDR3 regions of GAD-specific bifunctional T cells were identified in circulating naive and central memory CD4 T cell pools of non-immunised participants with new-onset type 1 diabetes and healthy individuals, suggesting the potential for bifunctional responses to be generated de novo by GAD-alum immunisation or via expansion from an existing public repertoire. CONCLUSIONS/INTERPRETATION GAD-alum immunisation activates and propagates GAD-specific CD4 T cells with a distinctive bifunctional phenotype, the functional analysis of which might be important in understanding therapeutic responses.
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Affiliation(s)
- Sefina Arif
- Peter Gorer Department of Immunobiology, King's College London Faculty of Life Sciences and Medicine, 2nd Floor, Borough Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Iria Gomez-Tourino
- Peter Gorer Department of Immunobiology, King's College London Faculty of Life Sciences and Medicine, 2nd Floor, Borough Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Yogesh Kamra
- Peter Gorer Department of Immunobiology, King's College London Faculty of Life Sciences and Medicine, 2nd Floor, Borough Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Irma Pujol-Autonell
- Peter Gorer Department of Immunobiology, King's College London Faculty of Life Sciences and Medicine, 2nd Floor, Borough Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Emily Hanton
- Peter Gorer Department of Immunobiology, King's College London Faculty of Life Sciences and Medicine, 2nd Floor, Borough Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Timothy Tree
- Peter Gorer Department of Immunobiology, King's College London Faculty of Life Sciences and Medicine, 2nd Floor, Borough Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Daisy Melandri
- Peter Gorer Department of Immunobiology, King's College London Faculty of Life Sciences and Medicine, 2nd Floor, Borough Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Caroline Hull
- Peter Gorer Department of Immunobiology, King's College London Faculty of Life Sciences and Medicine, 2nd Floor, Borough Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Diane K Wherrett
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Craig Beam
- Homer Stryker MD School of Medicine, Western Michigan University, Kalamazoo, MI, USA
| | - Bart O Roep
- Diabetes and Metabolism Research Institute, City of Hope, Duarte, CA, USA
| | - Anna Lorenc
- Peter Gorer Department of Immunobiology, King's College London Faculty of Life Sciences and Medicine, 2nd Floor, Borough Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Mark Peakman
- Peter Gorer Department of Immunobiology, King's College London Faculty of Life Sciences and Medicine, 2nd Floor, Borough Wing, Guy's Hospital, London, SE1 9RT, UK.
- King's Health Partners Institute of Diabetes, Endocrinology and Obesity, King's College Hospital NHS Foundation Trust, London, UK.
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16
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Brief Report: Decreased JC Virus-Specific Antibody-Dependent Cellular Cytotoxicity in HIV-Seropositive PML Survivors. J Acquir Immune Defic Syndr 2020; 82:220-224. [PMID: 31513076 DOI: 10.1097/qai.0000000000002105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Progressive multifocal leukoencephalopathy (PML) is an often fatal disease caused by JC virus (JCV) in severely immunocompromised patients, including HIV patients. Development of therapeutics to prevent or treat PML is an urgent medical need. While JCV-specific T cells are crucial to control JCV and recover from PML, the role played by antibodies remains unclear. Anti-JCV antibodies, including potent neutralizing antibodies, can be detected in most infected adults, yet in PML patients, JCV seems to escape from neutralization. Whether antibodies can contribute to JCV control by eliciting Fc-mediated effector functions activity has not been evaluated. METHODS We measured the capacity of plasma anti-JCV VP1 antibodies to recruit Fc receptor (FcR)-bearing effector cell functions in 28 HIV patients, comparing subjects without PML with PML survivors (PML S) who were alive 1 year after disease onset or PML progressors (PML P) who succumbed within the first year. Antibody titers against JCV VP1 and HIV gp140 trimer were determined by end-point titer dilution ELISA. FcR-mediated natural killer cell degranulation and IFN-γ production were measured as surrogate for in vitro antibody-dependent cellular cytotoxicity (ADCC). RESULTS PML S had higher JCV antibody titers than PML P and patients without PML. However, anti-JCV antibodies had a higher ability to functionally engage FcR in PML P than PML S. Antibody titers and ADCC activity did not vary over time in PML S. Anti-HIV antibody titers and ADCC activity were similar among groups. CONCLUSIONS The ability of anti-JCV antibodies to stimulate FcR-bearing effector cell activity might contribute to the outcome of PML. Further studies are warranted to define Fc-mediated functions of anti-JCV antibodies and evaluate whether ADCC can contain JCV replication.
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Beck ES, Cortese I. Checkpoint inhibitors for the treatment of JC virus-related progressive multifocal leukoencephalopathy. Curr Opin Virol 2020; 40:19-27. [PMID: 32279025 DOI: 10.1016/j.coviro.2020.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/14/2020] [Accepted: 02/19/2020] [Indexed: 12/18/2022]
Abstract
Progressive multifocal leukoencephalopathy (PML) is a frequently fatal brain infection caused by the JC polyomavirus (JCV). PML occurs in people with impaired cellular immunity, and the only effective treatment is restoration of immune function. Infection in immunocompromised hosts is often associated with immune exhaustion, which is mediated by inhibitory cell surface receptors known as immune checkpoints, leading to loss of T cell effector function. Blockade of immune checkpoints can reinvigorate host responses to fight infection. Recently, there have been several reports of checkpoint blockade to treat PML in patients in whom immune reconstitution is otherwise not possible, with some evidence for positive response. Larger studies are needed to better understand efficacy of checkpoint blockade in PML and factors that determine response.
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Affiliation(s)
- Erin S Beck
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Irene Cortese
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
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18
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Nishihara H, Soldati S, Mossu A, Rosito M, Rudolph H, Muller WA, Latorre D, Sallusto F, Sospedra M, Martin R, Ishikawa H, Tenenbaum T, Schroten H, Gosselet F, Engelhardt B. Human CD4 + T cell subsets differ in their abilities to cross endothelial and epithelial brain barriers in vitro. Fluids Barriers CNS 2020; 17:3. [PMID: 32008573 PMCID: PMC6996191 DOI: 10.1186/s12987-019-0165-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/19/2019] [Indexed: 12/11/2022] Open
Abstract
Background The brain barriers establish compartments in the central nervous system (CNS) that significantly differ in their communication with the peripheral immune system. In this function they strictly control T-cell entry into the CNS. T cells can reach the CNS by either crossing the endothelial blood–brain barrier (BBB) or the epithelial blood-cerebrospinal fluid barrier (BCSFB) of the choroid plexus (ChP). Objective Analysis of the cellular and molecular mechanisms involved in the migration of different human CD4+ T-cell subsets across the BBB versus the BCSFB. Methods Human in vitro models of the BBB and BCSFB were employed to study the migration of circulating and CNS-entry experienced CD4+ T helper cell subsets (Th1, Th1*, Th2, Th17) across the BBB and BCSFB under inflammatory and non-inflammatory conditions in vitro. Results While under non-inflammatory conditions Th1* and Th1 cells preferentially crossed the BBB, under inflammatory conditions the migration rate of all Th subsets across the BBB was comparable. The migration of all Th subsets across the BCSFB from the same donor was 10- to 20-fold lower when compared to their migration across the BBB. Interestingly, Th17 cells preferentially crossed the BCSFB under both, non-inflamed and inflamed conditions. Barrier-crossing experienced Th cells sorted from CSF of MS patients showed migratory characteristics indistinguishable from those of circulating Th cells of healthy donors. All Th cell subsets could additionally cross the BCSFB from the CSF to ChP stroma side. T-cell migration across the BCSFB involved epithelial ICAM-1 irrespective of the direction of migration. Conclusions Our observations underscore that different Th subsets may use different anatomical routes to enter the CNS during immune surveillance versus neuroinflammation with the BCSFB establishing a tighter barrier for T-cell entry into the CNS compared to the BBB. In addition, CNS-entry experienced Th cell subsets isolated from the CSF of MS patients do not show an increased ability to cross the brain barriers when compared to circulating Th cell subsets from healthy donors underscoring the active role of the brain barriers in controlling T-cell entry into the CNS. Also we identify ICAM-1 to mediate T cell migration across the BCSFB.
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Affiliation(s)
| | - Sasha Soldati
- Theodor Kocher Institute, University of Bern, Bern, Switzerland
| | - Adrien Mossu
- Theodor Kocher Institute, University of Bern, Bern, Switzerland.,Transcure Bioservices, Archamps, France
| | - Maria Rosito
- Theodor Kocher Institute, University of Bern, Bern, Switzerland.,Center for Life Nanoscience, Istituto Italiano di Tecnologia, Rome, Italy
| | - Henriette Rudolph
- Department of Pediatrics, Pediatric Infectious Diseases, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - William A Muller
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniela Latorre
- Institute for Research in Biomedicine, Università Della Svizzera Italiana, Bellinzona, Switzerland.,Institute for Microbiology, ETH Zurich, Zurich, Switzerland
| | - Federica Sallusto
- Institute for Research in Biomedicine, Università Della Svizzera Italiana, Bellinzona, Switzerland.,Institute for Microbiology, ETH Zurich, Zurich, Switzerland
| | - Mireia Sospedra
- Neuroimmunology and MS Research Section (NIMS), Neurology Clinic, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Roland Martin
- Neuroimmunology and MS Research Section (NIMS), Neurology Clinic, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Hiroshi Ishikawa
- Laboratory of Clinical Regenerative Medicine, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tobias Tenenbaum
- Department of Pediatrics, Pediatric Infectious Diseases, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Horst Schroten
- Department of Pediatrics, Pediatric Infectious Diseases, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Fabien Gosselet
- Blood Brain Barrier Laboratory, University of Artois, Lens, France
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Largey F, Jelcic I, Sospedra M, Heesen C, Martin R, Jelcic I. Effects of natalizumab therapy on intrathecal antiviral antibody responses in MS. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2019; 6:6/6/e621. [PMID: 31554671 PMCID: PMC6807967 DOI: 10.1212/nxi.0000000000000621] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 07/31/2019] [Indexed: 12/25/2022]
Abstract
Objective To investigate the effects of natalizumab (NAT) treatment on intrathecally produced antiviral antibodies in MS. Methods We performed a longitudinal, observational study analyzing both serum and CSF samples collected before and during NAT treatment for antibodies against measles, rubella, mumps, influenza, entero, herpes, and polyoma viruses, including JC polyomavirus (JCV) and its nearest homologue BK polyomavirus (BKV), and bacterial control antigens by ELISA to determine the antigen-specific CSF antibody index (CAI). CAI ≥1.5 indicated intrathecal synthesis of antigen-specific antibodies. Oligoclonal bands (OCBs) by isoelectric focusing and total IgG, IgM, and IgA by immunonephelometry were analyzed additionally. Results Intrathecal synthesis of JCV- and BKV-specific IgG was detected in 20% of patients with MS at baseline and was lost significantly more frequently during NAT treatment compared with other intrathecal antiviral and antibacterial antibody reactivities. Peripheral JCV- and BKV-specific antibody responses persisted, and no cross-reactivity between JCV- and BKV-specific CSF antibodies was found. Intrathecal production of antibodies against measles, rubella, and zoster antigens (MRZ reaction) was most prevalent and persisted (73.3% before vs 66.7% after 1 year of NAT therapy). CSF OCBs also persisted (93.3% vs 80.0%), but total CSF IgG and IgM levels declined significantly. Conclusions These data indicate that JCV-specific antibodies are produced intrathecally in a minority of patients with MS, and NAT treatment affects the intrathecal humoral immune response against JCV relatively specifically compared with other neurotropic viruses. Further studies are needed to determine whether this effect translates to higher risk of progressive multifocal leukoencephalopathy development.
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Affiliation(s)
- Fabienne Largey
- From the Neuroimmunology and Multiple Sclerosis Research Section (F.L., Ivan Jelcic, M.S., R.M., Ilijas Jelcic), Department of Neurology, University Hospital of Zurich, Switzerland; and Institute for Neuroimmunology and Multiple Sclerosis (inims) (C.H.), Center for Molecular Neurobiology (ZMNH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ivan Jelcic
- From the Neuroimmunology and Multiple Sclerosis Research Section (F.L., Ivan Jelcic, M.S., R.M., Ilijas Jelcic), Department of Neurology, University Hospital of Zurich, Switzerland; and Institute for Neuroimmunology and Multiple Sclerosis (inims) (C.H.), Center for Molecular Neurobiology (ZMNH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mireia Sospedra
- From the Neuroimmunology and Multiple Sclerosis Research Section (F.L., Ivan Jelcic, M.S., R.M., Ilijas Jelcic), Department of Neurology, University Hospital of Zurich, Switzerland; and Institute for Neuroimmunology and Multiple Sclerosis (inims) (C.H.), Center for Molecular Neurobiology (ZMNH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- From the Neuroimmunology and Multiple Sclerosis Research Section (F.L., Ivan Jelcic, M.S., R.M., Ilijas Jelcic), Department of Neurology, University Hospital of Zurich, Switzerland; and Institute for Neuroimmunology and Multiple Sclerosis (inims) (C.H.), Center for Molecular Neurobiology (ZMNH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Martin
- From the Neuroimmunology and Multiple Sclerosis Research Section (F.L., Ivan Jelcic, M.S., R.M., Ilijas Jelcic), Department of Neurology, University Hospital of Zurich, Switzerland; and Institute for Neuroimmunology and Multiple Sclerosis (inims) (C.H.), Center for Molecular Neurobiology (ZMNH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ilijas Jelcic
- From the Neuroimmunology and Multiple Sclerosis Research Section (F.L., Ivan Jelcic, M.S., R.M., Ilijas Jelcic), Department of Neurology, University Hospital of Zurich, Switzerland; and Institute for Neuroimmunology and Multiple Sclerosis (inims) (C.H.), Center for Molecular Neurobiology (ZMNH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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20
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Walter O, Treiner E, Bonneville F, Mengelle C, Vergez F, Lerebours F, Delobel P, Liblau R, Martin-Blondel G. Treatment of Progressive Multifocal Leukoencephalopathy with Nivolumab. N Engl J Med 2019; 380:1674-1676. [PMID: 30969500 DOI: 10.1056/nejmc1816198] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | | | | | | | - François Vergez
- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | | | | | - Roland Liblau
- Centre de Physiopathologie Toulouse-Purpan, Toulouse, France
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21
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Abstract
In this review article, typical imaging findings of diseases elicited by immunomodulatory drugs are presented. Progressive multifocal leucoencephalopathy (PML), a subacute infection due to reactivation of the JC virus, has a typical magnetic resonance imaging (MRI) pattern, which must be considered in the framework of immunomodulatory multiple sclerosis (MS) treatment with natalizumab, fingolimod, rituximab and fumarate and also in lymphoproliferative diseases or other forms of immunosuppression. Restoration of the immune system may result in an overlapping and overwhelming immune response in terms of an immune reconstitution inflammatory syndrome (IRIS). Further conditions with typical MRI patterns comprise methotrexate-associated leucoencephalopathy and posterior reversible encephalopathy syndrome (PRES). In immunotherapy with activation of T‑lymphocytes, attention should always be paid to the fact that the T‑lymphocytes activated by different processes not only target the diseased tissue but also normal brain tissue.
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Affiliation(s)
| | - H Urbach
- Klinik für Neuroradiologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland.
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22
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Planas R, Metz I, Martin R, Sospedra M. Detailed Characterization of T Cell Receptor Repertoires in Multiple Sclerosis Brain Lesions. Front Immunol 2018; 9:509. [PMID: 29616027 PMCID: PMC5867461 DOI: 10.3389/fimmu.2018.00509] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/26/2018] [Indexed: 12/21/2022] Open
Abstract
The antigen-specific activation of pathogenic T cells is considered essential in the initiation and maintenance of multiple sclerosis (MS). The site of activation, the differential involvement of CD4+, and CD8+ T cells, their functional phenotype, and specificity, are important aspects to understand MS pathogenesis. The analysis of clonal expansions of brain-infiltrating T cells may reveal local antigen-driven activation or specific brain homing and allow the identification of putatively pathogenic T cells. We used high-throughput T cell receptor β-chain variable gene (TRBV) sequencing (-seq) of genomic (g)DNA, which reflects the quantity and diversity of the TRBV repertoire, to characterize three white matter demyelinating lesions with different location and inflammatory activity, and paired peripheral blood memory CD4+ and CD8+ T cell pools from a secondary progressive (SP)MS patient. Our results revealed an important sharing of clonally expanded T cells with identical TRBV sequence (clonotypes) across MS lesions independently of their proximity or inflammatory activity. Comparison with circulating T cells showed that the most frequent brain-infiltrating CD8+, but not CD4+ clonotypes were also those with highest frequency in the peripheral blood, indicating clonal expansion inside the brain or specific brain homing of CD4+ but not CD8+ T cells. Parallel TRBV-seq of complementary (c)DNA that reflects the activation status of the cells, revealed differences between lesions regarding inflammatory activity and appears to facilitate the identification of putatively pathogenic T cells in active lesions. Approaches to identify pathogenic T cells in brain lesions using TRBV-seq may benefit from focusing on lesions with high inflammatory activity and from combining gDNA and cDNA sequencing.
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Affiliation(s)
- Raquel Planas
- Neuroimmunology and MS Research (nims), Department of Neurology, University Zurich, Zürich, Switzerland
| | - Imke Metz
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Roland Martin
- Neuroimmunology and MS Research (nims), Department of Neurology, University Zurich, Zürich, Switzerland
| | - Mireia Sospedra
- Neuroimmunology and MS Research (nims), Department of Neurology, University Zurich, Zürich, Switzerland
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23
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Ikegawa S, Fujii N, Tadokoro K, Sato K, Iwamoto M, Matsuda M, Inomata T, Sugiura H, Asano T, Yoshida S, Nishimori H, Matsuoka KI, Maeda Y. Progressive multifocal leukoencephalopathy after T-cell replete HLA-haploidentical transplantation with post-transplantation cyclophosphamide graft-versus-host disease prophylaxis. Transpl Infect Dis 2018; 20:e12850. [PMID: 29359846 DOI: 10.1111/tid.12850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 07/19/2017] [Accepted: 10/15/2017] [Indexed: 12/26/2022]
Abstract
A 52-year-old man suffered from progressive multifocal leukoencephalopathy (PML) after human leukocyte antigen (HLA)-haploidentical transplantation with post-transplantation cyclophosphamide (PTCY). Mirtazapine, mefloquine, and cytarabine failed to improve his symptoms, and he finally died 4.5 months after PML onset. This is the first case report of a patient with PML after HLA-haploidentical transplantation with PTCY. Although T-cell replete HLA-haploidentical transplantation with PTCY has enabled early immune reconstitution, PML should be considered if a patient's mental condition deteriorates.
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Affiliation(s)
- Shuntaro Ikegawa
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Nobuharu Fujii
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Koh Tadokoro
- Department of Neurology, Okayama University Hospital, Okayama, Japan
| | - Kota Sato
- Department of Neurology, Okayama University Hospital, Okayama, Japan
| | - Miki Iwamoto
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Masayuki Matsuda
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Tomoko Inomata
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Hiroyuki Sugiura
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Takeru Asano
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Shohei Yoshida
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Hisakazu Nishimori
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Ken-Ichi Matsuoka
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Yoshinobu Maeda
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
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24
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Mani J, Wang L, Hückelhoven AG, Schmitt A, Gedvilaite A, Jin N, Kleist C, Ho AD, Schmitt M. Definition and characterization of novel HLA-*A02-restricted CD8+ T cell epitopes derived from JCV polyomavirus with clinical relevance. Oncotarget 2018; 8:2485-2500. [PMID: 27705933 PMCID: PMC5356818 DOI: 10.18632/oncotarget.12387] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/19/2016] [Indexed: 11/25/2022] Open
Abstract
Human JC and BK polyomaviruses (JCV/BKV) can establish a latent infection without any clinical symptoms in healthy individuals. In immunocompromised hosts infection or reactivation of JCV and BKV can cause lethal progressive multifocal leukoencephalopathy (PML) and hemorrhagic cystitis, respectively. Vaccination with JCV/BKV derived antigen epitope peptides or adoptive transfer of virus-specific T cells would constitute an elegant approach to clear virus-infected cells. Furthermore, donor leukocyte infusion (DLI) is another therapeutic approach which could be helpful for patients with JCV/BKV infections.So far, only few immunodominant T cell epitopes of JCV and BKV have been described and therefore is a fervent need for the definition of novel epitopes. In this study, we identified novel T cell epitopes by screening libraries of overlapping peptides derived from the major capsid protein VP1 of JCV. Virus like particles (VLPs) were used to confirm naturally processing. Two human leucocyte antigen (HLA)-A*02-restricted epitopes were characterized by fine mapping with overlapping peptides and nonamer peptide sequences were identified. Cytokine release profile of the epitope-specific T cells was analyzed by enzyme-linked immunospot (ELISPOT) assays and by flow cytometry. We demonstrated that T cell responses were of polyfunctional nature with the potential of epitope-specific killing and cross-reactivity between JCV and BKV. These novel epitopes might constitute a new potential tool to design effective diagnostic and therapeutic approaches against both polyomaviruses.
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Affiliation(s)
- Jiju Mani
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Lei Wang
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Angela G Hückelhoven
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Anita Schmitt
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Alma Gedvilaite
- Department of Eukaryote Genetic Engineering, Institute of Biotechnology, Vilnius University, Vilnius, Lithuania
| | - Nan Jin
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,Department of Hematology, ZhongDa Hospital, Southeast University, Nanjing, P. R. China
| | - Christian Kleist
- Department of Transplantation Immunology, Heidelberg University Hospital, Heidelberg, Germany.,Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Anthony D Ho
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Schmitt
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
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25
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To do or not to do? plasma exchange and timing of steroid administration in progressive multifocal leukoencephalopathy. Ann Neurol 2017; 82:697-705. [DOI: 10.1002/ana.25070] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 08/30/2017] [Accepted: 09/29/2017] [Indexed: 11/07/2022]
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26
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Recognition of viral and self-antigens by T H 1 and T H 1/T H 17 central memory cells in patients with multiple sclerosis reveals distinct roles in immune surveillance and relapses. J Allergy Clin Immunol 2017; 140:797-808. [DOI: 10.1016/j.jaci.2016.11.045] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 10/18/2016] [Accepted: 11/10/2016] [Indexed: 11/18/2022]
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27
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Martin R, Sospedra M, Rosito M, Engelhardt B. Current multiple sclerosis treatments have improved our understanding of MS autoimmune pathogenesis. Eur J Immunol 2017; 46:2078-90. [PMID: 27467894 DOI: 10.1002/eji.201646485] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 07/14/2016] [Accepted: 07/22/2016] [Indexed: 12/23/2022]
Abstract
Multiple sclerosis (MS) is the most common inflammatory disorder of the central nervous system (CNS) in young adults. When MS is not treated, it leads to irreversible and severe disability. The etiology of MS and its pathogenesis are not fully understood. The recent discovery that MS-associated genetic variants code for molecules related to the function of specific immune cell subsets is consistent with the concept of MS as a prototypic, T-cell-mediated autoimmune disease targeting the CNS. While the therapeutic efficacy of the currently available immunomodulatory therapies further strengthen this concept, differences observed in responses to MS treatment as well as additional clinical and imaging observations have also shown that the autoimmune pathogenesis underlying MS is much more complex than previously thought. There is therefore an unmet need for continued detailed phenotypic and functional analysis of disease-relevant adaptive immune cells and tissues directly derived from MS patients to unravel the immune etiology of MS in its entire complexity. In this review, we will discuss the currently available MS treatment options and approved drugs, including how they have contributed to the understanding of the immune pathology of this autoimmune disease.
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Affiliation(s)
- Roland Martin
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Mireia Sospedra
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Maria Rosito
- Theodor Kocher Institute, University of Bern, Bern, Switzerland
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28
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Belova AN, Rasteryaeva MV, Zhulina NI, Belova EM, Boyko AN. [Immune reconstitution inflammatory syndrome and rebound syndrome in multiple sclerosis patients who stopped disease modification therapy: current understanding and a case report]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:74-84. [PMID: 28617365 DOI: 10.17116/jnevro20171172274-84] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
More and more multiple sclerosis patients have been receiving treatment with new immunomodulatory drugs. Its discontinuation because of side-effects, lack of efficacy or pregnancy has been increasing as well. This paper reviews such severe complications of natalizumab and fingolimod cessation as immune reconstitution inflammatory syndrome (IRIS) and rebound. The short history, immunopathogenesis and diagnostic criteria of IRIS in individuals with human immunodeficiency virus infection are covered. Clinical and radiological presentations as well as possible pathogenic mechanisms of IRIS in patients treated with natalizumab and fingolimod are discussed. The authors also report the case of a woman with multiple sclerosis treated with fingolimod, who experienced a severe relapse when she stopped treatment. Diagnostic criteria and prognostic factors for IRIS and rebound are needed in patients with multiple sclerosis who discontinue the new disease modification therapy.
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Affiliation(s)
- A N Belova
- Privolzskyi Federal Medical Research Center, Nizhny Novgorod, Russia
| | - M V Rasteryaeva
- Privolzskyi Federal Medical Research Center, Nizhny Novgorod, Russia
| | - N I Zhulina
- Nizhny Novgorod State Medical Academy, Nizhny Novgorod, Russia
| | - E M Belova
- Nizhny Novgorod State Medical Academy, Nizhny Novgorod, Russia
| | - A N Boyko
- Pirogov National Russian Scientific Medical University, Moscow, Russia ,Center for demyelination diseases 'Neuroclinic', Moscow, Russia
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29
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Misbah SA. Progressive multi-focal leucoencephalopathy - driven from rarity to clinical mainstream by iatrogenic immunodeficiency. Clin Exp Immunol 2017; 188:342-352. [PMID: 28245526 PMCID: PMC5422720 DOI: 10.1111/cei.12948] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2017] [Indexed: 12/21/2022] Open
Abstract
Advances in immune-mediated targeted therapies have proved to be a double-edged sword for patients by highlighting the risk of iatrogenic infective complications. This has been exemplified by progressive multi-focal leucoencephalopathy (PML), a hitherto rare devastating viral infection of the brain caused by the neurotrophic JC polyoma virus. While PML achieved prominence during the first two decades of the HIV epidemic, effective anti-retroviral treatment and restitution of T cell function has led to PML being less prominent in this population. HIV infection as a predisposing factor has now been supplanted by T cell immunodeficiency induced by a range of immune-mediated therapies as a major cause of PML. This review focuses on PML in the context of therapeutic immunosuppression and encompasses therapeutic monoclonal antibodies, novel immunomodulatory agents such as Fingolimod and dimethyl fumarate, as well as emerging data on PML in primary immune deficiency.
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Affiliation(s)
- S A Misbah
- Department of Clinical Immunology, Oxford University Hospitals, John Radcliffe Hospital, Oxford, UK
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30
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The Enigmatic Role of Viruses in Multiple Sclerosis: Molecular Mimicry or Disturbed Immune Surveillance? Trends Immunol 2017; 38:498-512. [PMID: 28549714 PMCID: PMC7185415 DOI: 10.1016/j.it.2017.04.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/21/2017] [Accepted: 04/21/2017] [Indexed: 01/24/2023]
Abstract
Multiple sclerosis (MS) is a T cell driven autoimmune disease of the central nervous system (CNS). Despite its association with Epstein-Barr Virus (EBV), how viral infections promote MS remains unclear. However, there is increasing evidence that the CNS is continuously surveyed by virus-specific T cells, which protect against reactivating neurotropic viruses. Here, we discuss how viral infections could lead to the breakdown of self-tolerance in genetically predisposed individuals, and how the reactivations of viruses in the CNS could induce the recruitment of both autoaggressive and virus-specific T cell subsets, causing relapses and progressive disability. A disturbed immune surveillance in MS would explain several experimental findings, and has important implications for prognosis and therapy. A huge body of evidence suggests that viral infections promote MS; however, no single causal virus has been identified. Multiple viruses could promote MS via bystander effects. Molecular mimicry is an established pathogenic mechanism in selected autoimmune diseases. It is also well documented in MS, but its contribution to MS pathogenesis is still unclear. Bystander activation upon viral infection could be involved in the generation of the autoreactive and potentially encephalitogenic T helper (Th)-1/17 central memory (Th1/17CM) cells found in the circulation of patients with MS. Autoreactive Th1/17CM cells could expand at the cost of antiviral Th1CM cells in patients with MS, in particular in those undergoing natalizumab therapy, because these cells are expected to compete for the same homeostatic niche. Autoreactive Th1/17 cells and antiviral Th1 cells are recruited to the CSF of patients with MS following attacks, suggesting that viral reactivations in the CNS induce the recruitment of pathogenic Th1/17 cells. Autoreactive Th1/17 cells in the CNS might also induce de novo viral reactivations in a circuit of self-induced inflammation.
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31
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Fournier A, Martin-Blondel G, Lechapt-Zalcman E, Dina J, Kazemi A, Verdon R, Mortier E, de La Blanchardière A. Immune Reconstitution Inflammatory Syndrome Unmasking or Worsening AIDS-Related Progressive Multifocal Leukoencephalopathy: A Literature Review. Front Immunol 2017; 8:577. [PMID: 28588577 PMCID: PMC5440580 DOI: 10.3389/fimmu.2017.00577] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 05/01/2017] [Indexed: 12/26/2022] Open
Abstract
Incidence of progressive multifocal leukoencephalopathy (PML) in HIV-infected patients has declined in the combined antiretroviral therapy (cART) era although a growing number of acquired immunodeficiency syndrome (AIDS)-related PML-immune reconstitution inflammatory syndromes (PML-IRIS) have been published during the same period. Therapeutic management of PML-IRIS is not consensual and mainly relies on corticosteroids. Our main aim was, in addition to provide a thoughtful analysis of published PML-IRIS cases, to assess the benefit of corticosteroids in the management of PML-IRIS, focusing on confirmed cases. We performed a literature review of the 46 confirmed cases of PML-IRIS cases occurring in HIV-infected patients from 1998 to September 2016 (21 unmasking and 25 paradoxical PML-IRIS). AIDS-related PML-IRIS patients were mostly men (sex ratio 4/1) with a median age of 40.5 years (range 12-66). Median CD4 T cell count before cART and at PML-IRIS onset was 45/μl (0-301) and 101/μl (20-610), respectively. After cART initiation, PML-IRIS occurred within a median timescale of 38 days (18-120). Clinical signs were motor deficits (69%), speech disorders (36%), cognitive disorders (33%), cerebellar ataxia (28%), and visual disturbances (23%). Brain MRI revealed hyperintense areas on T2-weighted sequences and FLAIR images (76%) and suggestive contrast enhancement (87%). PCR for John Cunningham virus (JCV) in cerebrospinal fluid (CSF) was positive in only 84% of cases; however, when performed, brain biopsy confirmed diagnosis of PML in 90% of cases and demonstrated histological signs of IRIS in 95% of cases. Clinical worsening related to PML-IRIS and leading to death was observed in 28% of cases. Corticosteroids were prescribed in 63% of cases and maraviroc in one case. Statistical analysis failed to demonstrate significant benefit from steroid treatment, despite spectacular improvement in certain cases. Diagnosis of PML-IRIS should be considered in HIV-infected patients with worsening neurological symptoms after initiation or resumption of effective cART, independently of CD4 cell count prior to cART. If PCR for JCV is negative in CSF, brain biopsy should be discussed. Only large multicentric randomized trials could potentially demonstrate the possible efficacy of corticosteroids and/or CCR5 antagonists in the management of PML-IRIS.
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Affiliation(s)
- Anna Fournier
- Department of Infectious and Tropical Diseases, CHU Côte de Nacre, Caen, France
| | - Guillaume Martin-Blondel
- Department of Infectious and Tropical Diseases, CHU Toulouse, Toulouse, France.,INSERM U1043 - CNRS UMR 5282, Université Toulouse III, Centre de Physiopathologie Toulouse-Purpan, Toulouse, France
| | | | - Julia Dina
- Department of Virology, CHU Côte de Nacre, Caen, France
| | | | - Renaud Verdon
- Department of Infectious and Tropical Diseases, CHU Côte de Nacre, Caen, France
| | - Emmanuel Mortier
- Department of Internal Medicine, Hôpital Louis Mourier, Colombes, France
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32
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Scarpazza C, Prosperini L, Mancinelli CR, De Rossi N, Lugaresi A, Capobianco M, Moiola L, Naldi P, Imberti L, Gerevini S, Capra R. Is maraviroc useful in multiple sclerosis patients with natalizumab-related progressive multifocal leukoencephalopathy? J Neurol Sci 2017; 378:233-237. [PMID: 28566170 DOI: 10.1016/j.jns.2017.05.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/21/2017] [Accepted: 05/10/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite the recent advances in the understanding of natalizumab (NTZ) related progressive multifocal leukoencephalopathy (PML) and its associated immune reconstitution inflammatory syndrome (PML-IRIS), the therapeutic options are still under investigated. In this context, the beneficial use of maraviroc is still an anecdotal observation. OBJECTIVE To evaluate the impact of maraviroc in modifying the course of PML preventing IRIS or blunting IRIS manifestations. METHODS Three patients with NTZ PML included in the Italian dataset of PML were treated with maraviroc. Their longitudinal clinical and radiological course was described in detail. RESULTS The three patients were characterized by a steady clinical worsening not controlled by maraviroc. All the three patients manifested PML-IRIS, which emerged, respectively, at 62, 64 and 90days post NTZ withdrawal. This is in accordance with the data of the Italian dataset. Clinical and radiological stabilization of PML-IRIS occurred only after corticosteroids administration. CONCLUSION In these three cases, maraviroc did not show any clear effect in modulating the clinical course of PML preventing IRIS. Moreover, once PML-IRIS emerged, the clinical stabilization was achieved only with the use of corticosteroids. Thus, the use of maraviroc should be regarded with extreme caution due the potential adverse events associated with its use.
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Affiliation(s)
- Cristina Scarpazza
- Multiple Sclerosis Centre, Spedali Civili di Brescia, Via Ciotti 154, 25018 Montichiari, Brescia, Italy
| | - Luca Prosperini
- Department of Neurology and Psychiatry, Sapienza University, Viale Dell'Università, 30, 00185 Rome, Italy
| | - Chiara R Mancinelli
- Multiple Sclerosis Centre, Spedali Civili di Brescia, Via Ciotti 154, 25018 Montichiari, Brescia, Italy
| | - Nicola De Rossi
- Multiple Sclerosis Centre, Spedali Civili di Brescia, Via Ciotti 154, 25018 Montichiari, Brescia, Italy
| | - Alessandra Lugaresi
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), Alma Mater Studiorum, Università di Bologna, Italy; IRCCS Istituto delle Scienze, "UOSI Riabilitazione Sclerosi Multipla", Via Altura 3, 40138 Bologna, Italy
| | - Marco Capobianco
- SCDO Neurologia 2, Centro di Riferimento Regionale Sclerosi Multipla, AOU San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Torino, Italy
| | - Lucia Moiola
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 48, 20132 Milan, Italy
| | - Paola Naldi
- Multiple Sclerosis Centre, Clinica Neurologica, AOU "Maggiore della Carità" Novara, Corso Mazzini 18, 28100 Novara, Italy
| | - Luisa Imberti
- Centro Ricerca Emato-oncologia AIL (CREA), Diagnostics Department, Spedali Civili of Brescia, Piazzale Spedali Civili, 1, 25123 Brescia, Italy
| | - Simonetta Gerevini
- Department of Neuroradiology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy
| | - Ruggero Capra
- Multiple Sclerosis Centre, Spedali Civili di Brescia, Via Ciotti 154, 25018 Montichiari, Brescia, Italy.
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Warnke C, Wattjes MP, Adams O, Hartung HP, Martin R, Weber T, Stangel M. [Progressive multifocal leukoencephalopathy]. DER NERVENARZT 2016; 87:1300-1304. [PMID: 27730274 DOI: 10.1007/s00115-016-0225-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Progressive multifocal leukoencephalopathy (PML) is a disease of immunosuppressed patients caused by the JC polyomavirus (JCPyV). Due to the elevated risk in patients treated with natalizumab for multiple sclerosis (MS) and also treatment with other biologicals for different indications, the relevance of PML has increased in recent years. This article summarizes the published knowledge on the biology and pathogenesis of PML with a focus on the role of cerebrospinal fluid diagnostics in the work-up for PML and the current PML case definition. Current recommendations regarding risk management are discussed, as are possible therapies and prevention.
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Affiliation(s)
- C Warnke
- Klinik für Neurologie, Medizinische Fakultät, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland.
| | - M P Wattjes
- Abteilung für Radiologie und Nuklearmedizin, VU University Medical Center, Amsterdam, Niederlande
| | - O Adams
- Institut für Virologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - H-P Hartung
- Klinik für Neurologie, Medizinische Fakultät, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - R Martin
- Klinik für Neurologie, Universitätsspital Zürich, Zürich, Schweiz
| | - T Weber
- Klinik für Neurologie, Kath. Marienkrankenhaus, Hamburg, Deutschland
| | - M Stangel
- Klinik für Neurologie, Medizinische Hochschule Hannover, Hannover, Deutschland
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Increased immune reactivity to central nervous system-derived naturally presented peptides in patients with active multiple sclerosis. J Allergy Clin Immunol 2016; 139:694-696.e7. [PMID: 27639936 DOI: 10.1016/j.jaci.2016.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 08/01/2016] [Accepted: 08/08/2016] [Indexed: 12/21/2022]
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Du F, Garg AV, Kosar K, Majumder S, Kugler DG, Mir GH, Maggio M, Henkel M, Lacy-Hulbert A, McGeachy MJ. Inflammatory Th17 Cells Express Integrin αvβ3 for Pathogenic Function. Cell Rep 2016; 16:1339-1351. [PMID: 27452457 PMCID: PMC5627357 DOI: 10.1016/j.celrep.2016.06.065] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/31/2016] [Accepted: 06/15/2016] [Indexed: 12/31/2022] Open
Abstract
Interleukin-23 (IL-23) is required for inflammatory Th17 cell function in experimental autoimmune encephalomyelitis (EAE), and IL-23 blockade reduces the number of effector Th17 cells in the CNS. We report that pro-inflammatory Th17 cells express high integrin β3 that is IL-23 dependent. Integrin β3 was not upregulated on all activated T cells; rather, integrin β3 was upregulated along with its functional partner integrin αv on effector Th17 cells and "ex-Th17" cells, and αvβ3(hi) RORγt(+) cells expanded during EAE. Integrin αvβ3 inhibitors ameliorated clinical signs of EAE, and integrin β3 deficiency on CD4(+) T cells alone was sufficient to block EAE induction. Furthermore, integrin-β3-deficient Th17 cells, but not Th1 cells, were impaired in their ability to induce EAE. Integrin β3(-/-) T cells induced smaller demyelinated lesions and showed reduced spread and accumulation within the CNS, corresponding with impaired extracellular-matrix-mediated migration. Hence, integrin β3 is required for Th17 cell-mediated autoimmune CNS inflammation.
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Affiliation(s)
- Fang Du
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, 3500 Terrace Street, Pittsburgh, PA 15261, USA
| | - Abhishek V Garg
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, 3500 Terrace Street, Pittsburgh, PA 15261, USA
| | - Karis Kosar
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, 3500 Terrace Street, Pittsburgh, PA 15261, USA
| | - Saikat Majumder
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, 3500 Terrace Street, Pittsburgh, PA 15261, USA
| | | | - Gerard Hernandez Mir
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, 3500 Terrace Street, Pittsburgh, PA 15261, USA
| | - Maria Maggio
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, 3500 Terrace Street, Pittsburgh, PA 15261, USA
| | - Matthew Henkel
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, 3500 Terrace Street, Pittsburgh, PA 15261, USA
| | | | - Mandy J McGeachy
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, 3500 Terrace Street, Pittsburgh, PA 15261, USA.
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Jelcic I, Jelcic I, Kempf C, Largey F, Planas R, Schippling S, Budka H, Sospedra M, Martin R. Mechanisms of immune escape in central nervous system infection with neurotropic JC virus variant. Ann Neurol 2016; 79:404-18. [PMID: 26874214 DOI: 10.1002/ana.24574] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 10/20/2015] [Accepted: 11/28/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Symptomatic infections of the central nervous system (CNS) with JC polyomavirus (JCV) usually occur as a result of immunocompromise and manifest as progressive multifocal leukoencephalopathy (PML) or granule cell neuronopathy (GCN). After immune reconstitution, some of these cases may show long-term persistence of JCV and delayed clinical improvement despite inflammation. METHODS We followed 4 patients with multiple sclerosis, who developed natalizumab-associated PML or GCN with regard to JC viral load and JCV-specific T-cell responses in the CNS. All of them experienced immune reconstitution inflammatory syndrome (IRIS), but in 2 cases JCV persisted > 21 months after IRIS accompanied by delayed clinical improvement. RESULTS Persistence of JCV was associated with a lack of JCV VP1-specific T-cell responses during immune reconstitution in 1 of the patients. Detailed analysis of the brain infiltrate in another patient with neuronal persistence of JCV revealed strong infiltration of CD8(+) T cells and clonal expansion of activated CD8(+) effector T cells with a CD4(dim) CD8(+) phenotype, both exhibiting exquisite specificity for conserved epitopes of JCV large T antigen. However, clearance of JCV was not efficient, because mutations in the major capsid protein VP1 caused reduced CD4(+) T-cell responses against the identified JCV variant and subsequently resulted in a decline of CD8(+) T-cell responses after IRIS. INTERPRETATION Our findings suggest that efficient CD4(+) T-cell recognition of neurotropic JCV variants is crucial to support CD8(+) T cells in combating JCV infection of the CNS.
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Affiliation(s)
- Ivan Jelcic
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology University Hospital Zurich, Zurich, Switzerland
| | - Ilijas Jelcic
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology University Hospital Zurich, Zurich, Switzerland
| | - Christian Kempf
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology University Hospital Zurich, Zurich, Switzerland
| | - Fabienne Largey
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology University Hospital Zurich, Zurich, Switzerland
| | - Raquel Planas
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology University Hospital Zurich, Zurich, Switzerland
| | - Sven Schippling
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology University Hospital Zurich, Zurich, Switzerland
| | - Herbert Budka
- Institute of Neuropathology, University Hospital Zurich, Zurich, Switzerland
| | - Mireia Sospedra
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology University Hospital Zurich, Zurich, Switzerland
| | - Roland Martin
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology University Hospital Zurich, Zurich, Switzerland
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Loignon M, Toma E. Treatment options for progressive multifocal leukoencephalopathy in HIV-infected persons: current status and future directions. Expert Rev Anti Infect Ther 2016; 14:177-91. [PMID: 26655489 DOI: 10.1586/14787210.2016.1132162] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Progressive multifocal encephalopathy (PML) caused by JC virus was frequently encountered in AIDS patients before combination antiretroviral therapy (cART). Incidence decreased and the outcome improved with cART. The immune reconstitution with cART is beneficial for HIV-infected patients and is an effective treatment for PML. However, when it is excessive an inflammatory response immune syndrome might occur with deterioration of PML. So far, no specific therapy has proven efficacious in small clinical trials in spite of some optimistic case reports. Combination of drugs targeted at different stages of JC virus life cycle seems to have a better effect. Passive and active immune therapies, immune competence "boosters" appear promising. New future approaches such as gene editing are not far away.
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Affiliation(s)
- Maude Loignon
- a Department of Microbiology, Immunology and Infectious Diseases , University of Montreal, Succursale Centre Ville , Montreal , Quebec , Canada
| | - Emil Toma
- a Department of Microbiology, Immunology and Infectious Diseases , University of Montreal, Succursale Centre Ville , Montreal , Quebec , Canada.,b Département de microbiologie et maladies infectieuses , Hôtel-Dieu Hospital du Centre Hospitalier de l'Université de Montréal (CHUM) , Montreal , Quebec , Canada
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38
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Martin-Blondel G, Pignolet B, Tietz S, Yshii L, Gebauer C, Perinat T, Van Weddingen I, Blatti C, Engelhardt B, Liblau R. Migration of encephalitogenic CD8 T cells into the central nervous system is dependent on the α4β1-integrin. Eur J Immunol 2015; 45:3302-12. [PMID: 26358409 PMCID: PMC7163664 DOI: 10.1002/eji.201545632] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 08/21/2015] [Accepted: 09/07/2015] [Indexed: 12/16/2022]
Abstract
Although CD8 T cells are key players in neuroinflammation, little is known about their trafficking cues into the central nervous system (CNS). We used a murine model of CNS autoimmunity to define the molecules involved in cytotoxic CD8 T‐cell migration into the CNS. Using a panel of mAbs, we here show that the α4β1‐integrin is essential for CD8 T‐cell interaction with CNS endothelium. We also investigated which α4β1‐integrin ligands expressed by endothelial cells are implicated. The blockade of VCAM‐1 did not protect against autoimmune encephalomyelitis, and only partly decreased the CD8+ T‐cell infiltration into the CNS. In addition, inhibition of junctional adhesion molecule‐B expressed by CNS endothelial cells also decreases CD8 T‐cell infiltration. CD8 T cells may use additional and possibly unidentified adhesion molecules to gain access to the CNS.
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Affiliation(s)
- Guillaume Martin-Blondel
- Department of Infectious and Tropical Diseases, Toulouse University Hospital, Toulouse, France.,INSERM U1043 - CNRS UMR 5282, Centre de Physiopathologie de Toulouse Purpan (CPTP), Toulouse, France.,Université Toulouse III, Toulouse, France
| | - Béatrice Pignolet
- INSERM U1043 - CNRS UMR 5282, Centre de Physiopathologie de Toulouse Purpan (CPTP), Toulouse, France.,Université Toulouse III, Toulouse, France.,Department of Clinical Neurosciences, Toulouse University Hospital, Toulouse, France
| | - Silvia Tietz
- Theodor Kocher Institute, University of Bern, Bern, Switzerland
| | - Lidia Yshii
- INSERM U1043 - CNRS UMR 5282, Centre de Physiopathologie de Toulouse Purpan (CPTP), Toulouse, France.,Université Toulouse III, Toulouse, France
| | - Christina Gebauer
- INSERM U1043 - CNRS UMR 5282, Centre de Physiopathologie de Toulouse Purpan (CPTP), Toulouse, France.,Université Toulouse III, Toulouse, France
| | - Therese Perinat
- Theodor Kocher Institute, University of Bern, Bern, Switzerland
| | - Isabelle Van Weddingen
- INSERM U1043 - CNRS UMR 5282, Centre de Physiopathologie de Toulouse Purpan (CPTP), Toulouse, France
| | - Claudia Blatti
- Theodor Kocher Institute, University of Bern, Bern, Switzerland
| | | | - Roland Liblau
- INSERM U1043 - CNRS UMR 5282, Centre de Physiopathologie de Toulouse Purpan (CPTP), Toulouse, France.,Université Toulouse III, Toulouse, France
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Jelcic I, Combaluzier B, Jelcic I, Faigle W, Senn L, Reinhart BJ, Ströh L, Nitsch RM, Stehle T, Sospedra M, Grimm J, Martin R. Broadly neutralizing human monoclonal JC polyomavirus VP1-specific antibodies as candidate therapeutics for progressive multifocal leukoencephalopathy. Sci Transl Med 2015; 7:306ra150. [PMID: 26400911 DOI: 10.1126/scitranslmed.aac8691] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 08/27/2015] [Indexed: 12/15/2022]
Abstract
In immunocompromised individuals, JC polyomavirus (JCPyV) may mutate and gain access to the central nervous system resulting in progressive multifocal leukoencephalopathy (PML), an often fatal opportunistic infection for which no treatments are currently available. Despite recent progress, the contribution of JCPyV-specific humoral immunity to controlling asymptomatic infection throughout life and to eliminating JCPyV from the brain is poorly understood. We examined antibody responses against JCPyV major capsid protein VP1 (viral protein 1) variants in the serum and cerebrospinal fluid (CSF) of healthy donors (HDs), JCPyV-positive multiple sclerosis patients treated with the anti-VLA-4 monoclonal antibody natalizumab (NAT), and patients with NAT-associated PML. Before and during PML, CSF antibody responses against JCPyV VP1 variants show "recognition holes"; however, upon immune reconstitution, CSF antibody titers rise, then recognize PML-associated JCPyV VP1 variants, and may be involved in elimination of the virus. We therefore reasoned that the memory B cell repertoire of individuals who recovered from PML could be a source for the molecular cloning of broadly neutralizing antibodies for passive immunization. We generated a series of memory B cell-derived JCPyV VP1-specific human monoclonal antibodies from HDs and a patient with NAT-associated PML-immune reconstitution inflammatory syndrome (IRIS). These antibodies exhibited diverse binding affinity, cross-reactivity with the closely related BK polyomavirus, recognition of PML-causing VP1 variants, and JCPyV neutralization. Almost all antibodies with exquisite specificity for JCPyV, neutralizing activity, recognition of all tested JCPyV PML variants, and high affinity were derived from one patient who had recovered from PML. These antibodies are promising drug candidates for the development of a treatment of PML.
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Affiliation(s)
- Ivan Jelcic
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University of Zurich, University Hospital Zurich, 8091 Zurich, Switzerland
| | | | - Ilijas Jelcic
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University of Zurich, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Wolfgang Faigle
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University of Zurich, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Luzia Senn
- Neurimmune Holding AG, 8952 Schlieren, Switzerland
| | - Brenda J Reinhart
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University of Zurich, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Luisa Ströh
- Interfaculty Institute of Biochemistry, University of Tübingen, 72076 Tübingen, Germany
| | - Roger M Nitsch
- Neurimmune Holding AG, 8952 Schlieren, Switzerland. Division of Psychiatry Research, University of Zurich, 8952 Schlieren, Switzerland
| | - Thilo Stehle
- Interfaculty Institute of Biochemistry, University of Tübingen, 72076 Tübingen, Germany. Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Mireia Sospedra
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University of Zurich, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Jan Grimm
- Neurimmune Holding AG, 8952 Schlieren, Switzerland.
| | - Roland Martin
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University of Zurich, University Hospital Zurich, 8091 Zurich, Switzerland.
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Planas R, Metz I, Ortiz Y, Vilarrasa N, Jelčić I, Salinas-Riester G, Heesen C, Brück W, Martin R, Sospedra M. Central role of Th2/Tc2 lymphocytes in pattern II multiple sclerosis lesions. Ann Clin Transl Neurol 2015; 2:875-93. [PMID: 26401510 PMCID: PMC4574806 DOI: 10.1002/acn3.218] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 03/26/2015] [Accepted: 05/05/2015] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Multiple sclerosis (MS) is a disease of the central nervous system with marked heterogeneity in several aspects including pathological processes. Based on infiltrating immune cells, deposition of humoral factors and loss of oligodendrocytes and/or myelin proteins, four lesion patterns have been described. Pattern II is characterized by antibody and complement deposition in addition to T-cell infiltration. MS is considered a T-cell-mediated disease, but until now the study of pathogenic T cells has encountered major challenges, most importantly the limited access of brain-infiltrating T cells. Our objective was to identify, isolate, and characterize brain-infiltrating clonally expanded T cells in pattern II MS lesions. METHODS We used next-generation sequencing to identify clonally expanded T cells in demyelinating pattern II brain autopsy lesions, subsequently isolated these as T-cell clones from autologous cerebrospinal fluid and functionally characterized them. RESULTS We identified clonally expanded CD8(+) but also CD4(+) T cells in demyelinating pattern II lesions and for the first time were able to isolate these as live T-cell clones. The functional characterization shows that T cells releasing Th2 cytokines and able to provide B cell help dominate the T-cell infiltrate in pattern II brain lesions. INTERPRETATION Our data provide the first functional evidence for a putative role of Th2/Tc2 cells in pattern II MS supporting the existence of this pathogenic phenotype and questioning the protective role that is generally ascribed to Th2 cells. Our observations are important to consider for future treatments of pattern II MS patients.
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Affiliation(s)
- Raquel Planas
- Neuroimmunology and MS Research (nims), Department of Neurology, University ZurichFrauenklinikstrasse 26, 8091, Zürich, Switzerland
| | - Imke Metz
- Institute of Neuropathology, University Medical Center GöttingenGöttingen, Germany
| | - Yaneth Ortiz
- Neuroimmunology and MS Research (nims), Department of Neurology, University ZurichFrauenklinikstrasse 26, 8091, Zürich, Switzerland
| | - Nuria Vilarrasa
- Neuroimmunology and MS Research (nims), Department of Neurology, University ZurichFrauenklinikstrasse 26, 8091, Zürich, Switzerland
| | - Ilijas Jelčić
- Neuroimmunology and MS Research (nims), Department of Neurology, University ZurichFrauenklinikstrasse 26, 8091, Zürich, Switzerland
| | - Gabriela Salinas-Riester
- Department of Developmental Biochemistry, DNA Microarray and Deep-Sequencing Facility, Faculty of Medicine, University Medical Center GöttingenGöttingen, Germany
| | - Christoph Heesen
- Institute for Neuroimmunology and Clinical MS Research (inims), Center for Molecular Neurobiology (ZMNH), University Medical Center Hamburg-EppendorfFalkenried 94, 20251, Hamburg, Germany
| | - Wolfgang Brück
- Institute of Neuropathology, University Medical Center GöttingenGöttingen, Germany
| | - Roland Martin
- Neuroimmunology and MS Research (nims), Department of Neurology, University ZurichFrauenklinikstrasse 26, 8091, Zürich, Switzerland
| | - Mireia Sospedra
- Neuroimmunology and MS Research (nims), Department of Neurology, University ZurichFrauenklinikstrasse 26, 8091, Zürich, Switzerland
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Kardas P, Leboeuf C, Hirsch HH. Optimizing JC and BK polyomavirus IgG testing for seroepidemiology and patient counseling. J Clin Virol 2015; 71:28-33. [PMID: 26370311 DOI: 10.1016/j.jcv.2015.07.305] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/20/2015] [Accepted: 07/26/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Polyomavirus JC (JCPyV) and BK (BKPyV) can cause significant diseases in immunocompromised patients including nephropathy, hemorrhagic cystitis, and leukoencephalopathy. Recently, JCPyV and BKPyV IgG have been explored as risk predictors in multiple sclerosis and transplant patients, but sensitivity, specificity and quantification issues limit current performance. OBJECTIVE To improve JCPyV and BKPyV-specific antibody testing. STUDY DESIGN Healthy blood donor sera (N=400) were tested at dilutions 1:100, 1:200, and 1:400 for JCPyV- and BKPyV-specific IgG using VP1 virus-like particle (VLP)-based ELISAs normalized to a laboratory reference serum. Normalized optical density 492nm greater or equal 0.1 in all 3 dilutions was regarded as reactive. Sera with discordant reactivity in at least one dilution were retested after VLP preadsorption. RESULTS At dilutions 1:100, 1:200, and 1:400, IgG reactivity was 74%, 60% and 53% for JCPyV, and 93%, 86% and 74% for BKPyV, respectively. At these dilutions, JCPyV-VLP preadsorption identified 56, 4 and 0 false-positives and 0, 4 and 27 false-negatives, respectively. Dilution-dependent sensitivity was 100%, 98%, and 89%, and specificity 65, 98%, and 100%, respectively. For sera diluted 100-, 200-, and 400-fold, BKPyV-VLP preadsorption identified 28, 1 and 0 false-positives, and 0, 0 and 46 false-negatives, and sensitivity was 100%, 100%, 86%, and specificity 50%, 98%, 100%, respectively. CONCLUSION For seroepidemiology studies, normalized JCPyV and BKPyV IgG ELISA at 1:200 serum dilution provides optimal sensitivity and specificity with the lowest false-positive and false-negative rate. For individual risk assessment, dilutions of 100, 200, and 400 combined with preadsorption for low-reactive sera may be most appropriate.
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Affiliation(s)
- Piotr Kardas
- Transplantation & Clinical Virology, Department Biomedicine - Haus Petersplatz, University of Basel, Basel, Switzerland
| | - Céline Leboeuf
- Transplantation & Clinical Virology, Department Biomedicine - Haus Petersplatz, University of Basel, Basel, Switzerland
| | - Hans H Hirsch
- Transplantation & Clinical Virology, Department Biomedicine - Haus Petersplatz, University of Basel, Basel, Switzerland; Infection Diagnostics, Department Biomedicine - Haus Petersplatz, University of Basel, Basel, Switzerland; Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
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Durali D, de Goër de Herve MG, Gasnault J, Taoufik Y. B cells and progressive multifocal leukoencephalopathy: search for the missing link. Front Immunol 2015; 6:241. [PMID: 26042124 PMCID: PMC4437032 DOI: 10.3389/fimmu.2015.00241] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 05/05/2015] [Indexed: 12/23/2022] Open
Abstract
Progressive multifocal leukoencephalopathy (PML) is a deadly demyelinating disease due to JC virus (JCV) replication in the brain. PML classically occurs in patients with severe immunodepression, and cases have recently been linked to therapeutic monoclonal antibodies such as natalizumab and also rituximab, which depletes B cells. B cells appear to play a complex role in the pathogenesis of PML. They may act as a viral reservoir and as a vector for viral dissemination in the central nervous system. Anti-JCV antibody responses appear to have a limited effect on JCV replication in the brain. However, accumulating evidence suggests that B cells may considerably influence T cell responses through their cytokine secretion. This immunomodulatory function of B cells may play an important role in the control of JCV infection and in the pathogenesis of PML, including rituximab-induced PML.
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Affiliation(s)
- Deniz Durali
- Immunology Research Laboratory, Department of Medical Microbiology, School of Medicine, Istanbul Medipol University , Istanbul , Turkey
| | | | - Jacques Gasnault
- IMVA-INSERM U1184, Department of Immunology, Bicetre Hospital, University Paris-sud , Le Kremlin-Bicêtre , France
| | - Yassine Taoufik
- IMVA-INSERM U1184, Department of Immunology, Bicetre Hospital, University Paris-sud , Le Kremlin-Bicêtre , France
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Shishido-Hara Y. Progressive multifocal leukoencephalopathy: Dot-shaped inclusions and virus-host interactions. Neuropathology 2015; 35:487-96. [PMID: 25946231 DOI: 10.1111/neup.12203] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 01/29/2015] [Indexed: 12/16/2022]
Abstract
Progressive multifocal leukoencephalopathy (PML) is a fatal demyelinating disease caused by reactivation of the asymptomatic persistent pathogen human polyomavirus JC (JC virus). The pathology of affected brain tissues demonstrates oligodendroglia-like cells with viral inclusions in their enlarged nuclei, a diagnostic hallmark of this disease. Today, the pathological features of this disease are expanding, partly due to an unsteady balance between viral virulence and host immunity. Intranuclear viral inclusions were initially thought to be amphophilic materials comprising the entire enlarged nucleus, based on HE staining (full inclusions). Howevewr, recent immunohistochemical analyses detected the presence of intranuclear viral inclusions in dots (dot-shaped inclusions). The dot-shaped inclusions reflect clustered progeny virions at punctuated subnuclear domains called promyelocytic leukemia nuclear bodies, and are indicative of early-stage viral infection or suppressed viral proliferation. Second, the JC virus is usually reactivated in patients with impaired immunity, and therefore the inflammatory reactions are poor. However, the causes of immunosuppression are divergent, as seen with the frequent use of immunosuppressive drugs, including natalizumab. Therefore, the degree of host immunity is variable; some patients show marked anti-viral inflammatory reactions and a good prognosis, indicating that a strong resistance against viral infection remains. Recovery of the immune system may also induce paradoxical clinical worsening, known as immune reconstitution inflammatory syndrome, the mechanism of which has not been clarified. The virus-host interactions have increased in complexity, and the pathology of PML is diverging. In this review, the pathology of PML will be described, with a focus on the intranuclear target of JC virus infection and host inflammatory reactions.
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Affiliation(s)
- Yukiko Shishido-Hara
- Department of Pathology, School of Medicine, Kyorin University, Tokyo, Japan.,Laboratory of Structural Neuropathology, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
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Jelcic I, Jelcic I, Faigle W, Sospedra M, Martin R. Immunology of progressive multifocal leukoencephalopathy. J Neurovirol 2015; 21:614-22. [PMID: 25740538 DOI: 10.1007/s13365-014-0294-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/10/2014] [Accepted: 09/18/2014] [Indexed: 11/30/2022]
Abstract
The high prevalence of asymptomatic JC polyomavirus (JCV) infection in the general population indicates coexistence with the human host and efficient immune control in healthy individuals. For unknown reasons, kidney-resident archetypic JCV strains can turn into neurotropic JCV strains which in hereditary or acquired states of immunodeficiency cause opportunistic infection and cytolytic destruction of glial cells or granule cell neurons resulting in progressive multifocal demyelination in the central nervous system (CNS) or cerebellar atrophy, respectively. Immunomodulatory or immunosuppressive therapies with specific monoclonal antibodies including natalizumab, efalizumab, and rituximab have increased the risk of progressive multifocal leukoencephalopathy (PML) among treated patients, highlighting that symptomatic JCV infection of the CNS is associated with disturbances of adaptive immunity affecting B cells, antibodies, and CD4(+) and/or CD8(+) T cells. To date, no specific therapy to overcome PML is available and the only way to eliminate the virus from the CNS is to reconstitute global immune function. However, since the identification of JCV as the causative agent of PML 40 years ago, it is still not fully understood which components of the immune system prevent the development of PML and which immune mechanisms are involved in eliminating the virus from the CNS. This review gives an update about adaptive JCV-specific immune responses.
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Affiliation(s)
- Ivan Jelcic
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University Hospital Zurich, 8091, Zurich, Switzerland
| | - Ilijas Jelcic
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University Hospital Zurich, 8091, Zurich, Switzerland
| | - Wolfgang Faigle
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University Hospital Zurich, 8091, Zurich, Switzerland
| | - Mireia Sospedra
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University Hospital Zurich, 8091, Zurich, Switzerland
| | - Roland Martin
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University Hospital Zurich, 8091, Zurich, Switzerland.
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Evangelopoulos ME, Koutoulidis V, Kilidireas K, Evangelopoulos DS, Nakas G, Andreadou E, Moulopoulos LA. Immune reconstitution inflammatory syndrome mimicking progressive multifocal leucoencephalopathy in a multiple sclerosis patient treated with natalizumab: a case report and review of the literature. J Clin Med Res 2014; 7:65-8. [PMID: 25368707 PMCID: PMC4217759 DOI: 10.14740/jocmr1888w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2014] [Indexed: 11/11/2022] Open
Abstract
Natalizumab (NTM) represents an effective drug for the treatment of relapsing-remitting multiple sclerosis (RRMS). Progressive multifocal leucoencephalopathy (PML) is a potential life-threatening complication of NTM treatment. A close follow-up and MRI monitoring of patients under NTM are required to avoid such devastating complications. The case of a 47-year-old woman with RRMS (EDSS 1.5) treated with NTM for 44 months is reported. The patient had a relapse with mild cerebellar symptomatology and visual complaints. MRI revealed a new area of abnormal signal intensity in the subcortical white matter of the right parietal lobe with mild peripheral enhancement. Visual fields showed scotomata mostly of the left eye. NTM was discontinued. JC virus (JCV) polymerase chain reaction (PCR) in cerebrospinal fluid was negative. The patient received IV corticosteroids for 5 days and then monthly for 2 months with subsequent clinical and MRI improvement. On month 4, she presented with a new relapse with severe ataxia, mild behavioral change, increase of cerebellar symptoms and internuclear opthalmoplegia (EDSS 3.5). MRI showed reappearance of the right parietal lobe lesion, with decreased size and less pronounced contrast enhancement. A new 2-cm lesion was noted in the left cerebellar hemisphere with a speckled pattern of contrast enhancement. JCV PCR was negative and the patient was treated with IV corticosteroids. On month 12, she demonstrated clinical and MRI improvement. Although initially PML was highly suspected in this patient, the clinical and MRI findings were supportive of the presence of immune reconstitution inflammatory syndrome (IRIS).
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Affiliation(s)
| | - Vasilios Koutoulidis
- Department of Radiology, University of Athens, Areteion Hospital, Athens, Greece
| | - Kostas Kilidireas
- Demyelinating Diseases Unit, Department of Neurology, University of Athens, Eginition Hospital, Athens, Greece
| | | | - Georgios Nakas
- Demyelinating Diseases Unit, Department of Neurology, University of Athens, Eginition Hospital, Athens, Greece
| | - Elisabeth Andreadou
- Demyelinating Diseases Unit, Department of Neurology, University of Athens, Eginition Hospital, Athens, Greece
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Sospedra M, Schippling S, Yousef S, Jelcic I, Bofill-Mas S, Planas R, Stellmann JP, Demina V, Cinque P, Garcea R, Croughs T, Girones R, Martin R. Treating progressive multifocal leukoencephalopathy with interleukin 7 and vaccination with JC virus capsid protein VP1. Clin Infect Dis 2014; 59:1588-92. [PMID: 25214510 DOI: 10.1093/cid/ciu682] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Progressive multifocal leukoencephalopathy is a currently untreatable infection of the brain. Here, we demonstrate in 2 patients that treatment with interleukin 7, JC polyomavirus (JCV) capsid protein VP1, and a Toll-like receptor 7 agonist used as adjuvant, was well tolerated, and showed a very favorable safety profile and unexpected efficacy that warrant further investigation.
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Affiliation(s)
- Mireia Sospedra
- Institute for Neuroimmunology and Clinical MS Research, Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University of Zurich, Switzerland
| | - Sven Schippling
- Institute for Neuroimmunology and Clinical MS Research, Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University of Zurich, Switzerland
| | - Sara Yousef
- Institute for Neuroimmunology and Clinical MS Research, Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ilijas Jelcic
- Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University of Zurich, Switzerland
| | - Silvia Bofill-Mas
- Department of Microbiology, Faculty of Biology, University of Barcelona, Spain
| | - Raquel Planas
- Institute for Neuroimmunology and Clinical MS Research, Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University of Zurich, Switzerland
| | - Jan-Patrick Stellmann
- Institute for Neuroimmunology and Clinical MS Research, Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Paola Cinque
- Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Robert Garcea
- Department of Molecular, Cellular and Developmental Biology, University of Colorado Boulder
| | | | - Rosina Girones
- Department of Microbiology, Faculty of Biology, University of Barcelona, Spain
| | - Roland Martin
- Institute for Neuroimmunology and Clinical MS Research, Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University of Zurich, Switzerland
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Abramowski P, Ogrodowczyk C, Martin R, Pongs O. A truncation variant of the cation channel P2RX5 is upregulated during T cell activation. PLoS One 2014; 9:e104692. [PMID: 25181038 PMCID: PMC4152149 DOI: 10.1371/journal.pone.0104692] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 07/10/2014] [Indexed: 01/11/2023] Open
Abstract
Members of the P2X family of ligand-gated cation channels (P2RX) are expressed by various cell types including neurons, smooth- and cardiac muscle cells, and leukocytes. The channels mediate signalling in response to extracellular ATP. Seven subunit isoforms (P2RX1-P2RX7) have been identified and these can assemble as homo- and heterotrimeric molecules. In humans, P2RX5 exists as a natural deletion mutant lacking amino acids 328–349 of exon 10, which are part of transmembrane (TM) 2 and pre-TM2 regions in other organisms like rat, chicken and zebrafish. We show that P2RX5 gene expression of human T lymphocytes is upregulated during activation. P2RX5 is recruited to the cell surface. P2RX5-siRNA-transfected CD4+ T cells produced twofold more IL-10 than controls. Surface and intracellular P2RX5 expression was upregulated in activated antigen-specific CD4+ T cell clones. These data indicate a functional role of the human P2RX5 splice variant in T cell activation and immunoregulation.
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Affiliation(s)
- Pierre Abramowski
- Institute for Neuroimmunology and Clinical Multiple Sclerosis Research (inims), ZMNH, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Department Cell and Gene Therapy, Clinic for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Ogrodowczyk
- Institute for Neural Signaltransduction, ZMNH, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Martin
- Institute for Neuroimmunology and Clinical Multiple Sclerosis Research (inims), ZMNH, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Neuroimmunology and MS Research, Department of Neurology, University Hospital Zurich, Zurich, Switzerland
- * E-mail:
| | - Olaf Pongs
- Institute for Neural Signaltransduction, ZMNH, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Physiology, University Hospital Homburg, Homburg/Saar, Germany
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Agnihotri SP, Dang X, Carter JL, Fife TD, Bord E, Batson S, Koralnik IJ. JCV GCN in a natalizumab-treated MS patient is associated with mutations of the VP1 capsid gene. Neurology 2014; 83:727-32. [PMID: 25037207 DOI: 10.1212/wnl.0000000000000713] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To describe the clinical, neuroimaging, immunologic, and virologic characteristics of JC virus-associated granule cell neuronopathy (JCV GCN) in a natalizumab-treated patient with multiple sclerosis (MS) who developed immune reconstitution inflammatory syndrome (IRIS) after natalizumab withdrawal. METHODS We obtained longitudinal clinical data as well as MRI and proton magnetic resonance spectroscopy from this patient with MS. We measured JCV-specific cellular immune response in his peripheral blood by intracellular cytokine staining and sequenced a fragment of JCV VP1 capsid gene detected in his CSF. We contrast our findings with the first recently reported case. RESULTS This patient presented with worsening cerebellar symptoms and progressive cerebellar atrophy without new MS lesions on MRI after 63 months of natalizumab monotherapy. JCV DNA was detected in his CSF by PCR and harbored novel GCN-type mutations in the VP1 gene. He developed IRIS upon discontinuation of natalizumab and plasma exchange, which manifested itself by a worsening of clinical symptoms and contrast enhancement in the cerebellum on MRI. Treatment with corticosteroids resulted in resolution of IRIS, as demonstrated by proton magnetic resonance spectroscopy. The patient had a strong JCV-specific T-cell response in his peripheral blood and remains alive after 15 months from onset of symptoms, although with significant disability. He did not have MS relapse on glatiramer acetate. CONCLUSIONS JCV GCN should be considered in patients on natalizumab presenting with progressive cerebellar symptoms and cerebellar atrophy, and is associated with mutations in the JCV VP1 gene. Natalizumab withdrawal may be complicated by JCV GCN IRIS, and require treatment with corticosteroids.
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Affiliation(s)
- Shruti P Agnihotri
- From the Division of Neurovirology, Department of Neurology (S.P.A., X.D., E.B., S.B., I.J.K.), Center for Virology and Vaccine Research (S.P.A., X.D., E.B., S.B., I.J.K.), and Department of Medicine (I.J.K.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.L.C., T.D.F.), University of Arizona College of Medicine, Tucson; and Barrow Neurological Institute (T.D.F.), Phoenix, AZ
| | - Xin Dang
- From the Division of Neurovirology, Department of Neurology (S.P.A., X.D., E.B., S.B., I.J.K.), Center for Virology and Vaccine Research (S.P.A., X.D., E.B., S.B., I.J.K.), and Department of Medicine (I.J.K.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.L.C., T.D.F.), University of Arizona College of Medicine, Tucson; and Barrow Neurological Institute (T.D.F.), Phoenix, AZ
| | - Jonathan L Carter
- From the Division of Neurovirology, Department of Neurology (S.P.A., X.D., E.B., S.B., I.J.K.), Center for Virology and Vaccine Research (S.P.A., X.D., E.B., S.B., I.J.K.), and Department of Medicine (I.J.K.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.L.C., T.D.F.), University of Arizona College of Medicine, Tucson; and Barrow Neurological Institute (T.D.F.), Phoenix, AZ
| | - Terry D Fife
- From the Division of Neurovirology, Department of Neurology (S.P.A., X.D., E.B., S.B., I.J.K.), Center for Virology and Vaccine Research (S.P.A., X.D., E.B., S.B., I.J.K.), and Department of Medicine (I.J.K.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.L.C., T.D.F.), University of Arizona College of Medicine, Tucson; and Barrow Neurological Institute (T.D.F.), Phoenix, AZ
| | - Evelyn Bord
- From the Division of Neurovirology, Department of Neurology (S.P.A., X.D., E.B., S.B., I.J.K.), Center for Virology and Vaccine Research (S.P.A., X.D., E.B., S.B., I.J.K.), and Department of Medicine (I.J.K.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.L.C., T.D.F.), University of Arizona College of Medicine, Tucson; and Barrow Neurological Institute (T.D.F.), Phoenix, AZ
| | - Stephanie Batson
- From the Division of Neurovirology, Department of Neurology (S.P.A., X.D., E.B., S.B., I.J.K.), Center for Virology and Vaccine Research (S.P.A., X.D., E.B., S.B., I.J.K.), and Department of Medicine (I.J.K.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.L.C., T.D.F.), University of Arizona College of Medicine, Tucson; and Barrow Neurological Institute (T.D.F.), Phoenix, AZ
| | - Igor J Koralnik
- From the Division of Neurovirology, Department of Neurology (S.P.A., X.D., E.B., S.B., I.J.K.), Center for Virology and Vaccine Research (S.P.A., X.D., E.B., S.B., I.J.K.), and Department of Medicine (I.J.K.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.L.C., T.D.F.), University of Arizona College of Medicine, Tucson; and Barrow Neurological Institute (T.D.F.), Phoenix, AZ.
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Chalkias S, Dang X, Bord E, Stein MC, Kinkel RP, Sloane JA, Donnelly M, Ionete C, Houtchens MK, Buckle GJ, Batson S, Koralnik IJ. JC virus reactivation during prolonged natalizumab monotherapy for multiple sclerosis. Ann Neurol 2014; 75:925-34. [PMID: 24687904 DOI: 10.1002/ana.24148] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 03/18/2014] [Accepted: 03/22/2014] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To determine the prevalence of JC virus (JCV) reactivation and JCV-specific cellular immune response during prolonged natalizumab treatment for multiple sclerosis (MS). METHODS We enrolled 43 JCV-seropositive MS patients, including 32 on natalizumab monotherapy >18 months, 6 on interferon β-1a monotherapy >36 months, and 5 untreated controls. We performed quantitative real-time polymerase chain reaction in cerebrospinal fluid (CSF), blood, and urine for JCV DNA, and we determined JCV-specific T-cell responses using enzyme-linked immunosorbent spot (ELISpot) and intracellular cytokine staining (ICS) assays, ex vivo and after in vitro stimulation with JCV peptides. RESULTS JCV DNA was detected in the CSF of 2 of 27 (7.4%) natalizumab-treated MS patients who had no symptoms or magnetic resonance imaging-detected lesions consistent with progressive multifocal leukoencephalopathy. JCV DNA was detected in blood of 12 of 43 (27.9%) and in urine of 11 of 43 (25.6%) subjects without a difference between natalizumab-treated patients and controls. JC viral load was higher in CD34(+) cells and in monocytes compared to other subpopulations. ICS was more sensitive than ELISpot. JCV-specific T-cell responses, mediated by both CD4(+) and CD8(+) T lymphocytes, were detected more frequently after in vitro stimulation. JCV-specific CD4(+) T cells were detected ex vivo more frequently in MS patients with JCV DNA in CD34(+) (p = 0.05) and B cells (p = 0.03). INTERPRETATION Asymptomatic JCV reactivation may occur in CSF of natalizumab-treated MS patients. JCV DNA load is higher in circulating CD34(+) cells and monocytes compared to other mononuclear cells, and JCV in blood might trigger a JCV-specific CD4(+) T-cell response. JCV-specific cellular immune response is highly prevalent in all JCV-seropositive MS patients, regardless of treatment.
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Affiliation(s)
- Spyridon Chalkias
- Division of NeuroVirology, Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston; Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
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Warnke C, von Geldern G, Markwerth P, Dehmel T, Hoepner R, Gold R, Pawlita M, Kümpfel T, Mäurer M, Stangel M, Wegner F, Hohlfeld R, Straeten V, Limmroth V, Weber T, Hermsen D, Kleinschnitz C, Hartung HP, Wattjes MP, Svenningson A, Major E, Olsson T, Kieseier BC, Adams O. Cerebrospinal fluid JC virus antibody index for diagnosis of natalizumab-associated progressive multifocal leukoencephalopathy. Ann Neurol 2014; 76:792-801. [PMID: 24729444 DOI: 10.1002/ana.24153] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 03/16/2014] [Accepted: 03/27/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Progressive multifocal leukoencephalopathy (PML), caused by JC virus (JCV), can occur in patients receiving natalizumab for multiple sclerosis (MS). JCV detection by quantitative polymerase chain reaction (qPCR) in cerebrospinal fluid (CSF), or brain biopsy, is required for probable or definite diagnosis of PML. However, in some patients only low levels of JCV DNA (<100 copies/ml) are present in CSF, making the diagnosis challenging. Our objective was to assess the complementary value of a CSF JCV antibody index (AIJCV ) in the diagnosis of natalizumab-associated PML. METHODS AIJCV was assessed in 37 cases of natalizumab-associated PML and 89 MS-patients treated with natalizumab without PML. Sera and CSF were tested in a capture enzyme-linked immunosorbent assay, using JCV-VP1 fused to glutathione S-transferase as antigen. Albumin levels and total immunoglobulin G concentration were determined by immunonephelometry, and the AIJCV was calculated as published. RESULTS Twenty-six of 37 (70%) patients with natalizumab-associated PML exhibited an AIJCV > 1.5, whereas this was seen in none of the controls (p < 0.0001). At time of the first positive qPCR for JCV DNA, 11 of 20 (55%) patients with natalizumab-associated PML had an AIJCV > 1.5. JCV DNA levels of <100 copies/ml were seen in 14 (70%) of these 20 patients, of whom 8 (57%) demonstrated an AIJCV > 1.5. INTERPRETATION Determination of the AIJCV could be an added tool in the diagnostic workup for PML and should be included in the case definition of natalizumab-associated PML.
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Affiliation(s)
- Clemens Warnke
- Department of Neurology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
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