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Wang Z, Zhang W, Chen L, Lu X, Tu Y. Lymphopenia in sepsis: a narrative review. Crit Care 2024; 28:315. [PMID: 39304908 DOI: 10.1186/s13054-024-05099-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 09/14/2024] [Indexed: 09/22/2024] Open
Abstract
This narrative review provides an overview of the evolving significance of lymphopenia in sepsis, emphasizing its critical function in this complex and heterogeneous disease. We describe the causal relationship of lymphopenia with clinical outcomes, sustained immunosuppression, and its correlation with sepsis prediction markers and therapeutic targets. The primary mechanisms of septic lymphopenia are highlighted. In addition, the paper summarizes various attempts to treat lymphopenia and highlights the practical significance of promoting lymphocyte proliferation as the next research direction.
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Affiliation(s)
- Zhibin Wang
- Department of Critical Care Medicine, School of Anesthesiology, Naval Medical University, Shanghai, 200433, China.
| | - Wenzhao Zhang
- Department of Critical Care Medicine, School of Anesthesiology, Naval Medical University, Shanghai, 200433, China
| | - Linlin Chen
- Department of Critical Care Medicine, School of Anesthesiology, Naval Medical University, Shanghai, 200433, China
| | - Xin Lu
- Department of Critical Care Medicine, School of Anesthesiology, Naval Medical University, Shanghai, 200433, China
| | - Ye Tu
- Department of Pharmacy, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, China.
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2
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Baudemont G, Tardivon C, Monneret G, Cour M, Rimmelé T, Garnier L, Yonis H, Richard J, Coudereau R, Gossez M, Wallet F, Delignette M, Dailler F, Buisson M, Lukaszewicz A, Argaud L, Laouenan C, Bertrand J, Venet F. Joint modeling of monocyte HLA-DR expression trajectories predicts 28-day mortality in severe SARS-CoV-2 patients. CPT Pharmacometrics Syst Pharmacol 2024; 13:1130-1143. [PMID: 38837680 PMCID: PMC11247117 DOI: 10.1002/psp4.13145] [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: 10/27/2023] [Revised: 02/11/2024] [Accepted: 04/04/2024] [Indexed: 06/07/2024] Open
Abstract
The recent SarsCov2 pandemic has disrupted healthcare system notably impacting intensive care units (ICU). In severe cases, the immune system is dysregulated, associating signs of hyperinflammation and immunosuppression. In the present work, we investigated, using a joint modeling approach, whether the trajectories of cellular immunological parameters were associated with survival of COVID-19 ICU patients. This study is based on the REA-IMMUNO-COVID cohort including 538 COVID-19 patients admitted to ICU between March 2020 and May 2022. Measurements of monocyte HLA-DR expression (mHLA-DR), counts of neutrophils, of total lymphocytes, and of CD4+ and CD8+ subsets were performed five times during the first month after ICU admission. Univariate joint models combining survival at day 28 (D28), hospital discharge and longitudinal analysis of those biomarkers' kinetics with mixed-effects models were performed prior to the building of a multivariate joint model. We showed that a higher mHLA-DR value was associated with a lower risk of death. Predicted mHLA-DR nadir cutoff value that maximized the Youden index was 5414 Ab/C and led to an AUC = 0.70 confidence interval (95%CI) = [0.65; 0.75] regarding association with D28 mortality while dynamic predictions using mHLA-DR kinetics until D7, D12 and D20 showed AUCs of 0.82 [0.77; 0.87], 0.81 [0.75; 0.87] and 0.84 [0.75; 0.93]. Therefore, the final joint model provided adequate discrimination performances at D28 after collection of biomarker samples until D7, which improved as more samples were collected. After severe COVID-19, decreased mHLA-DR expression is associated with a greater risk of death at D28 independently of usual clinical confounders.
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Affiliation(s)
- Gaelle Baudemont
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAMEParisFrance
| | - Coralie Tardivon
- Département d'Epidémiologie Biostatistique et Recherche CliniqueAP‐HP.Nord, Hôpital BichatParisFrance
- Centre d'Investigations Cliniques‐Epidémiologie Clinique 1425INSERM, Hôpital BichatParisFrance
| | - Guillaume Monneret
- Immunology LaboratoryHospices Civils de Lyon, Edouard Herriot HôpitalLyonFrance
- Joint Research Unit HCL‐bioMérieuxEA 7426 “Pathophysiology of Injury‐Induced Immunosuppression” (Université Claude Bernard Lyon 1 – Hospices Civils de Lyon – bioMérieux)LyonFrance
| | - Martin Cour
- Medical intensive Care DepartmentHospices Civils de Lyon, Edouard Herriot HospitalLyonFrance
| | - Thomas Rimmelé
- Joint Research Unit HCL‐bioMérieuxEA 7426 “Pathophysiology of Injury‐Induced Immunosuppression” (Université Claude Bernard Lyon 1 – Hospices Civils de Lyon – bioMérieux)LyonFrance
- Anesthesia and Critical Care Medicine DepartmentHospices Civils de Lyon, Edouard Herriot HospitalLyonFrance
| | - Lorna Garnier
- Immunology LaboratoryHospices Civils de Lyon, Lyon‐Sud University HospitalPierre BéniteFrance
| | - Hodane Yonis
- Medical intensive Care DepartmentHospices Civils de Lyon, Croix‐Rousse University HospitalLyonFrance
| | - Jean‐Christophe Richard
- Medical intensive Care DepartmentHospices Civils de Lyon, Croix‐Rousse University HospitalLyonFrance
| | - Remy Coudereau
- Immunology LaboratoryHospices Civils de Lyon, Edouard Herriot HôpitalLyonFrance
- Joint Research Unit HCL‐bioMérieuxEA 7426 “Pathophysiology of Injury‐Induced Immunosuppression” (Université Claude Bernard Lyon 1 – Hospices Civils de Lyon – bioMérieux)LyonFrance
| | - Morgane Gossez
- Immunology LaboratoryHospices Civils de Lyon, Edouard Herriot HôpitalLyonFrance
- Centre International de Recherche en Infectiologie (CIRI)Inserm U1111, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard‐Lyon 1LyonFrance
| | - Florent Wallet
- Intensive Care DepartmentHospices Civils de Lyon, Lyon‐Sud University HospitalPierre‐BéniteFrance
| | - Marie‐Charlotte Delignette
- Anesthesia and Critical Care Medicine DepartmentHospices Civils de Lyon, Croix‐Rousse University HospitalLyonFrance
| | - Frederic Dailler
- Neurological Anesthesiology and Intensive Care DepartmentHospices Civils de Lyon, Pierre Wertheimer HospitalLyonFrance
| | - Marielle Buisson
- Centre d'Investigation Clinique de Lyon (CIC 1407 Inserm)Hospices Civils de LyonLyonFrance
| | - Anne‐Claire Lukaszewicz
- Joint Research Unit HCL‐bioMérieuxEA 7426 “Pathophysiology of Injury‐Induced Immunosuppression” (Université Claude Bernard Lyon 1 – Hospices Civils de Lyon – bioMérieux)LyonFrance
- Anesthesia and Critical Care Medicine DepartmentHospices Civils de Lyon, Edouard Herriot HospitalLyonFrance
| | - Laurent Argaud
- Medical intensive Care DepartmentHospices Civils de Lyon, Edouard Herriot HospitalLyonFrance
| | - Cédric Laouenan
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAMEParisFrance
- Département d'Epidémiologie Biostatistique et Recherche CliniqueAP‐HP.Nord, Hôpital BichatParisFrance
| | - Julie Bertrand
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAMEParisFrance
| | - Fabienne Venet
- Immunology LaboratoryHospices Civils de Lyon, Edouard Herriot HôpitalLyonFrance
- Centre International de Recherche en Infectiologie (CIRI)Inserm U1111, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard‐Lyon 1LyonFrance
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Cao M, Wang G, Xie J. Immune dysregulation in sepsis: experiences, lessons and perspectives. Cell Death Discov 2023; 9:465. [PMID: 38114466 PMCID: PMC10730904 DOI: 10.1038/s41420-023-01766-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/03/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023] Open
Abstract
Sepsis is a life-threatening organ dysfunction syndrome caused by dysregulated host responses to infection. Not only does sepsis pose a serious hazard to human health, but it also imposes a substantial economic burden on the healthcare system. The cornerstones of current treatment for sepsis remain source control, fluid resuscitation, and rapid administration of antibiotics, etc. To date, no drugs have been approved for treating sepsis, and most clinical trials of potential therapies have failed to reduce mortality. The immune response caused by the pathogen is complex, resulting in a dysregulated innate and adaptive immune response that, if not promptly controlled, can lead to excessive inflammation, immunosuppression, and failure to re-establish immune homeostasis. The impaired immune response in patients with sepsis and the potential immunotherapy to modulate the immune response causing excessive inflammation or enhancing immunity suggest the importance of demonstrating individualized therapy. Here, we review the immune dysfunction caused by sepsis, where immune cell production, effector cell function, and survival are directly affected during sepsis. In addition, we discuss potential immunotherapy in septic patients and highlight the need for precise treatment according to clinical and immune stratification.
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Affiliation(s)
- Min Cao
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Guozheng Wang
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, L69 7BE, UK
- Coagulation, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| | - Jianfeng Xie
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
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Gusev A. Germline mechanisms of immunotherapy toxicities in the era of genome-wide association studies. Immunol Rev 2023; 318:138-156. [PMID: 37515388 DOI: 10.1111/imr.13253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023]
Abstract
Cancer immunotherapy has revolutionized the treatment of advanced cancers and is quickly becoming an option for early-stage disease. By reactivating the host immune system, immunotherapy harnesses patients' innate defenses to eradicate the tumor. By putatively similar mechanisms, immunotherapy can also substantially increase the risk of toxicities or immune-related adverse events (irAEs). Severe irAEs can lead to hospitalization, treatment discontinuation, lifelong immune complications, or even death. Many irAEs present with similar symptoms to heritable autoimmune diseases, suggesting that germline genetics may contribute to their onset. Recently, genome-wide association studies (GWAS) of irAEs have identified common germline associations and putative mechanisms, lending support to this hypothesis. A wide range of well-established GWAS methods can potentially be harnessed to understand the etiology of irAEs specifically and immunotherapy outcomes broadly. This review summarizes current findings regarding germline effects on immunotherapy outcomes and discusses opportunities and challenges for leveraging germline genetics to understand, predict, and treat irAEs.
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Affiliation(s)
- Alexander Gusev
- Division of Population Sciences, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
- Division of Genetics, Brigham & Women's Hospital, Boston, Massachusetts, USA
- The Broad Institute, Cambridge, Massachusetts, USA
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Marton C, Minaud A, Coupet CA, Chauvin M, Dhiab J, Vallet H, Boddaert J, Kehrer N, Bastien B, Inchauspe G, Barraud L, Sauce D. IL-7 producing immunotherapy improves ex vivo T cell functions of immunosenescent patients, especially post hip fracture. Hum Vaccin Immunother 2023; 19:2232247. [PMID: 37417353 PMCID: PMC10332238 DOI: 10.1080/21645515.2023.2232247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 06/29/2023] [Indexed: 07/08/2023] Open
Abstract
Following acute stress such as trauma or sepsis, most of critically ill elderly patients become immunosuppressed and susceptible to secondary infections and enhanced mortality. We have developed a virus-based immunotherapy encoding human interleukin-7 (hIL-7) aiming at restoring both innate an adaptative immune homeostasis in these patients. We assessed the impact of this encoded hIL-7 on the ex vivo immune functions of T cells from PBMC of immunosenescent patients with or without hip fracture. T-cell ex vivo phenotyping was characterized in terms of senescence (CD57), IL-7 receptor (CD127) expression, and T cell differentiation profile. Then, post stimulation, activation status, and functionality (STAT5/STAT1 phosphorylation and T cell proliferation assays) were evaluated by flow cytometry. Our data show that T cells from both groups display immunosenescence features, express CD127 and are activated after stimulation by virotherapy-produced hIL-7-Fc. Interestingly, hip fracture patients exhibit a unique functional ability: An important T cell proliferation occurred compared to controls following stimulation with hIL-7-Fc. In addition, stimulation led to an increased naïve T cell as well as a decreased effector memory T cell proportions compared to controls. This preliminary study indicates that the produced hIL-7-Fc is well recognized by T cells and initiates IL-7 signaling through STAT5 and STAT1 phosphorylation. This signaling efficiently leads to T cell proliferation and activation and enables a T cell "rejuvenation." These results are in favor of the clinical development of the hIL-7-Fc expressing virotherapy to restore or induce immune T cell responses in immunosenescent hip fracture patients.
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Affiliation(s)
- Chrystel Marton
- Centre d’Immunologie et des Maladies Infectieuses, Sorbonne Université, Inserm, CIMI-Paris, Paris, France
- ImmmunResQ Department, Transgene, Lyon, France
| | - Alix Minaud
- Centre d’Immunologie et des Maladies Infectieuses, Sorbonne Université, Inserm, CIMI-Paris, Paris, France
| | | | - Manon Chauvin
- Centre d’Immunologie et des Maladies Infectieuses, Sorbonne Université, Inserm, CIMI-Paris, Paris, France
| | - Jamila Dhiab
- Centre d’Immunologie et des Maladies Infectieuses, Sorbonne Université, Inserm, CIMI-Paris, Paris, France
| | - Hélène Vallet
- Centre d’Immunologie et des Maladies Infectieuses, Sorbonne Université, Inserm, CIMI-Paris, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Unité de Gériatrie Aigue, Paris, France
| | - Jacques Boddaert
- Centre d’Immunologie et des Maladies Infectieuses, Sorbonne Université, Inserm, CIMI-Paris, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpétrière, Unité périopératoire gériatrique, Paris, France
| | | | | | | | - Luc Barraud
- ImmmunResQ Department, Transgene, Lyon, France
| | - Delphine Sauce
- Centre d’Immunologie et des Maladies Infectieuses, Sorbonne Université, Inserm, CIMI-Paris, Paris, France
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Giamarellos-Bourboulis EJ, Dimopoulos G, Flohé S, Kotsaki A, van der Poll T, Skirecki T, Torres A, Netea MG. THE EUROPEAN SHOCK SOCIETY MEETS THE IMMUNOSEP CONSORTIUM FOR PERSONALIZED SEPSIS TREATMENT. Shock 2023; 59:21-25. [PMID: 36867758 DOI: 10.1097/shk.0000000000001955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
ABSTRACT The unacceptable high mortality of severe infections and sepsis led over the years to understand the need for adjunctive immunotherapy to modulate the dysregulated host response of the host. However, not all patients should receive the same type of treatment. The immune function may largely differ from one patient to the other. The principles of precision medicine require that some biomarker is used to capture the immune function of the host and guide the best candidate therapy. This is the approach of the ImmunoSep randomized clinical trial (NCT04990232) where patients are allocated to treatment with anakinra or recombinant interferon gamma tailored to immune signs of macrophage activation-like syndrome and immunoparalysis respectively. ImmunoSep is a first-in-class paradigm of precision medicine for sepsis. Other approaches need to consider classification by sepsis endotypes, targeting T cell and application of stem cells. Basic principle for any trial to be successful is the delivery of appropriate antimicrobial therapy as standard-of-care taking into consideration not just the likelihood for resistant pathogens but also the pharmacokinetic/pharmacodynamic mode of action of the administered antimicrobial.
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Affiliation(s)
| | - George Dimopoulos
- 3rd Department of Critical Care Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stefanie Flohé
- Department of Trauma Surgery, University Hospital Essen, Essen, Germany
| | - Antigoni Kotsaki
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Tom van der Poll
- Amsterdam University Medical Center, University of Amsterdam, the Netherlands
| | - Tomasz Skirecki
- Laboratory of Flow Cytometry, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Antoni Torres
- Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
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Melhorn J, Alamoudi A, Mentzer AJ, Fraser E, Fries A, Cassar MP, Kwok A, Knight JC, Raman B, Talbot NP, Petousi N. Persistence of inflammatory and vascular mediators 5 months after hospitalization with COVID-19 infection. Front Med (Lausanne) 2023; 10:1056506. [PMID: 36844209 PMCID: PMC9950100 DOI: 10.3389/fmed.2023.1056506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/09/2023] [Indexed: 02/12/2023] Open
Abstract
Background and aim In acute severe COVID-19, patients present with lung inflammation and vascular injury, accompanied by an exaggerated cytokine response. In this study, our aim was to describe the inflammatory and vascular mediator profiles in patients who were previously hospitalized with COVID-19 pneumonitis, months after their recovery, and compare them with those in patients recovering from severe sepsis and in healthy controls. Methods A total of 27 different cytokine, chemokine, vascular endothelial injury and angiogenic mediators were measured in the plasma of forty-nine patients 5.0 ± 1.9 (mean ± SD) months after they were hospitalized with COVID-19 pneumonia, eleven patients 5.4 ± 2.9 months after hospitalization with acute severe sepsis, and 18 healthy controls. Results Compared with healthy controls, IL-6, TNFα, SAA, CRP, Tie-2, Flt1, and PIGF were significantly increased in the post-COVID group, and IL-7 and bFGF were significantly reduced. While IL-6, PIGF, and CRP were also significantly elevated in post-Sepsis patients compared to controls, the observed differences in TNFα, Tie-2, Flt-1, IL-7 and bFGF were unique to the post-COVID group. TNFα levels significantly correlated with the severity of acute COVID-19 illness (spearman's r = 0.30, p < 0.05). Furthermore, in post-COVID patients, IL-6 and CRP were each strongly negatively correlated with gas transfer factor %predicted (spearman's r = -0.51 and r = -0.57, respectively, p < 0.002) and positively correlated with computed tomography (CT) abnormality scores at recovery (r = 0.28 and r = 0.46, p < 0.05, respectively). Conclusion A unique inflammatory and vascular endothelial damage mediator signature is found in plasma months following acute COVID-19 infection. Further research is required to determine its pathophysiological and clinical significance.
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Affiliation(s)
- James Melhorn
- Nuffield Department of Clinical Medicine (NDM), University of Oxford, Oxford, United Kingdom
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Asma Alamoudi
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| | - Alexander J. Mentzer
- Nuffield Department of Clinical Medicine (NDM), University of Oxford, Oxford, United Kingdom
- Wellcome Centre for Human Genetics, NDM, University of Oxford, Oxford, United Kingdom
| | - Emily Fraser
- Oxford University Hospitals (OUH) NHS Foundation Trust, Oxford, United Kingdom
| | - Anastasia Fries
- Nuffield Department of Clinical Medicine (NDM), University of Oxford, Oxford, United Kingdom
| | - Mark Philip Cassar
- Oxford University Hospitals (OUH) NHS Foundation Trust, Oxford, United Kingdom
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Andrew Kwok
- Nuffield Department of Clinical Medicine (NDM), University of Oxford, Oxford, United Kingdom
- Wellcome Centre for Human Genetics, NDM, University of Oxford, Oxford, United Kingdom
| | - Julian Charles Knight
- Nuffield Department of Clinical Medicine (NDM), University of Oxford, Oxford, United Kingdom
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for Human Genetics, NDM, University of Oxford, Oxford, United Kingdom
- Chinese Academy of Medical Sciences Oxford Institute, University of Oxford, Oxford, United Kingdom
| | - Betty Raman
- Oxford University Hospitals (OUH) NHS Foundation Trust, Oxford, United Kingdom
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Nick P Talbot
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
- Oxford University Hospitals (OUH) NHS Foundation Trust, Oxford, United Kingdom
| | - Nayia Petousi
- Nuffield Department of Clinical Medicine (NDM), University of Oxford, Oxford, United Kingdom
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
- Oxford University Hospitals (OUH) NHS Foundation Trust, Oxford, United Kingdom
- *Correspondence: Nayia Petousi,
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Fernandes MB, Barata JT. IL-7 and IL-7R in health and disease: An update through COVID times. Adv Biol Regul 2023; 87:100940. [PMID: 36503870 DOI: 10.1016/j.jbior.2022.100940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 11/24/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
The role of IL-7 and IL-7R for normal lymphoid development and an adequately functioning immune system has been recognized for long, with severe immune deficiency and lymphoid leukemia as extreme examples of the consequences of deregulation of the IL-7-IL-7R axis. In this review, we provide an update (focusing on the past couple of years) on IL-7 and IL-7R in health and disease. We highlight the findings on IL-7/IL-7R signaling mechanisms and the, sometimes controversial, impact of IL-7 and its receptor on leukocyte biology, COVID-19, acute lymphoblastic leukemia, and different solid tumors, as well as their relevance as therapeutic tools or targets.
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Affiliation(s)
- Marta B Fernandes
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, 1649-028, Lisbon, Portugal
| | - João T Barata
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, 1649-028, Lisbon, Portugal.
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Crausaz M, Monneret G, Conti F, Lukaszewicz AC, Marchand JB, Martin P, Inchauspé G, Venet F. A novel virotherapy encoding human interleukin-7 improves ex vivo T lymphocyte functions in immunosuppressed patients with septic shock and critically ill COVID-19. Front Immunol 2022; 13:939899. [PMID: 36045686 PMCID: PMC9422896 DOI: 10.3389/fimmu.2022.939899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/19/2022] [Indexed: 12/21/2022] Open
Abstract
A majority of patients with sepsis surviving the first days in intensive care units (ICU) enter a state of immunosuppression contributing to their worsening. A novel virotherapy based on the non-propagative Modified Virus Ankara (MVA) expressing the human interleukin-7 (hIL-7) cytokine fused to an Fc fragment, MVA-hIL-7-Fc, was developed and shown to enhance innate and adaptive immunity and confer survival advantages in murine sepsis models. Here, we assessed the capacity of hIL-7-Fc produced by the MVA-hIL-7-Fc to improve ex vivo T lymphocyte functions from ICU patients with sepsis. Primary hepatocytes were transduced with the MVA-hIL-7-Fc or an empty MVA, and cell supernatants containing the secreted hIL-7-Fc were harvested for in vitro and ex vivo studies. Whole blood from ICU patients [septic shock = 15, coronavirus disease 2019 (COVID-19) = 30] and healthy donors (n = 36) was collected. STAT5 phosphorylation, cytokine production, and cell proliferation were assessed upon T cell receptor (TCR) stimulation in presence of MVA-hIL-7-Fc-infected cell supernatants. Cells infected by MVA-hIL-7-Fc produced a dimeric, glycosylated, and biologically active hIL-7-Fc. Cell supernatants containing the expressed hIL-7-Fc triggered the IL-7 pathway in T lymphocytes as evidenced by the increased STAT5 phosphorylation in CD3+ cells from patients and healthy donors. The secreted hIL-7-Fc improved Interferon-γ (IFN-γ) and/or Tumor necrosis factor-α (TNF-α) productions and CD4+ and CD8+ T lymphocyte proliferation after TCR stimulation in patients with bacterial and viral sepsis. This study demonstrates the capacity of the novel MVA-hIL-7-Fc-based virotherapy to restore ex vivo T cells immune functions in ICU patients with sepsis and COVID-19, further supporting its clinical development.
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Affiliation(s)
- Morgane Crausaz
- Department of Infectious Diseases, Transgene SA, Lyon, France
- EA 7426 Pathophysiology of injury-induced immunosuppression (PI3), Lyon 1 University/Hospices Civils de Lyon/bioMérieux, Hôpital Edouard Herriot, Lyon, France
| | - Guillaume Monneret
- EA 7426 Pathophysiology of injury-induced immunosuppression (PI3), Lyon 1 University/Hospices Civils de Lyon/bioMérieux, Hôpital Edouard Herriot, Lyon, France
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Laboratoire d'Immunologie, Lyon, France
| | - Filippo Conti
- EA 7426 Pathophysiology of injury-induced immunosuppression (PI3), Lyon 1 University/Hospices Civils de Lyon/bioMérieux, Hôpital Edouard Herriot, Lyon, France
| | - Anne-Claire Lukaszewicz
- EA 7426 Pathophysiology of injury-induced immunosuppression (PI3), Lyon 1 University/Hospices Civils de Lyon/bioMérieux, Hôpital Edouard Herriot, Lyon, France
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'anesthésie-réanimation, Lyon, France
| | | | - Perrine Martin
- Department of Infectious Diseases, Transgene SA, Lyon, France
| | | | - Fabienne Venet
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Laboratoire d'Immunologie, Lyon, France
- Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard-Lyon 1, Lyon, France
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10
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Rienzo M, Skirecki T, Monneret G, Timsit JF. Immune checkpoint inhibitors for the treatment of sepsis:insights from preclinical and clinical development. Expert Opin Investig Drugs 2022; 31:885-894. [PMID: 35944174 DOI: 10.1080/13543784.2022.2102477] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Sepsis represents one-fifth of all deaths worldwide and is associated with huge costs. Regarding disease progression, it is now well established that sepsis induces a state of acquired immunosuppression, with an increased risk of secondary infections that contributes to patients' worsening. Thus, tackling sepsis-induced immunosuppression represents a promising perspective. AREAS COVERED Of mechanisms responsible for sepsis-induced immunosuppression, the increased expression of co-inhibitory receptors (aka immune checkpoint) such as PD-1, CTLA4, TIM-3, LAG-3 or BTLA and their ligands recently received considerable interest since their inhibition, thanks to the so-called checkpoint inhibitors (CPI), provided astonishing results in cancer by rebooting immune functions. This review reports on the first landmarks of these molecules in sepsis. We introduce them in terms of basic immunology in line with sepsis pathophysiology both in experimental models and observational works and assess the first human clinical studies. EXPERT OPINION Preclinical results are positive and the first human clinical trials, although currently limited to the early phase, showed a beneficial effect on immunological functions and/or markers and suggested that tolerance of CPIs side effects, mainly auto-immune disorders, is acceptable in sepsis. Elsewhere, in some specific infections leading to ICU admission (or occurring during ICU stay), such as fungal infections, preliminary convincing case reports have been published. Overall, the first results regarding CPIs in sepsis appear encouraging. However, further efforts are warranted, especially in defining the right patients to be treated (i.e., in an individualized approach) and establishing the optimal time to start an immune restoration. Larger trials are now mandatory to confirm CPIs' potential in sepsis.
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Affiliation(s)
- Mario Rienzo
- AP-HP, Bichat Hospital, Medical and infectious diseases ICU (MI2), F-75018 Paris, France
| | - Tomasz Skirecki
- Laboratory of Flow Cytometry, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813 Warsaw, Poland
| | - Guillaume Monneret
- Immunology Laboratory, Hôpital E. Herriot, Hospices Civils de Lyon, Lyon, F-69003.,Université de Lyon, EA7426, Hôpital E. Herriot, Lyon, F-69003
| | - Jean-François Timsit
- AP-HP, Bichat Hospital, Medical and infectious diseases ICU (MI2), F-75018 Paris, France.,University of Paris, IAME, INSERM, F-75018 Paris, France
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Bidar F, Hamada S, Gossez M, Coudereau R, Lopez J, Cazalis MA, Tardiveau C, Brengel-Pesce K, Mommert M, Buisson M, Conti F, Rimmelé T, Lukaszewicz AC, Argaud L, Cour M, Monneret G, Venet F. Correction to: Recombinant human interleukin-7 reverses T cell exhaustion ex vivo in critically ill COVID-19 patients. Ann Intensive Care 2022; 12:30. [PMID: 35362873 PMCID: PMC8972669 DOI: 10.1186/s13613-022-01007-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Frank Bidar
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression", Université Claude Bernard Lyon, 1-Hospices Civils de Lyon-bioMérieux, 69003, Lyon, France.,Anesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437, Lyon, France.,Immunology Laboratory, Hôpital E. Herriot-Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France
| | - Sarah Hamada
- Immunology Laboratory, Hôpital E. Herriot-Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France
| | - Morgane Gossez
- Immunology Laboratory, Hôpital E. Herriot-Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France.,Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude, Bernard-Lyon 1, Lyon, France
| | - Remy Coudereau
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression", Université Claude Bernard Lyon, 1-Hospices Civils de Lyon-bioMérieux, 69003, Lyon, France.,Immunology Laboratory, Hôpital E. Herriot-Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France
| | - Jonathan Lopez
- Biochemistry and Molecular Biology Laboratory, Lyon-Sud University Hospital-Hospices Civils de Lyon, Chemin du Grand Revoyet, Pierre-Benite, France
| | - Marie-Angelique Cazalis
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression", Université Claude Bernard Lyon, 1-Hospices Civils de Lyon-bioMérieux, 69003, Lyon, France
| | - Claire Tardiveau
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression", Université Claude Bernard Lyon, 1-Hospices Civils de Lyon-bioMérieux, 69003, Lyon, France
| | - Karen Brengel-Pesce
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression", Université Claude Bernard Lyon, 1-Hospices Civils de Lyon-bioMérieux, 69003, Lyon, France
| | - Marine Mommert
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression", Université Claude Bernard Lyon, 1-Hospices Civils de Lyon-bioMérieux, 69003, Lyon, France
| | - Marielle Buisson
- Centre d'Investigation Clinique de Lyon (CIC 1407 Inserm), Hospices Civils de Lyon, 69677, Lyon, France
| | - Filippo Conti
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression", Université Claude Bernard Lyon, 1-Hospices Civils de Lyon-bioMérieux, 69003, Lyon, France
| | - Thomas Rimmelé
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression", Université Claude Bernard Lyon, 1-Hospices Civils de Lyon-bioMérieux, 69003, Lyon, France.,Anesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437, Lyon, France
| | - Anne-Claire Lukaszewicz
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression", Université Claude Bernard Lyon, 1-Hospices Civils de Lyon-bioMérieux, 69003, Lyon, France.,Anesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437, Lyon, France
| | - Laurent Argaud
- Medical Intensive Care Department, Hospices Civils de Lyon, Edouard Herriot Hospital, 69437, Lyon, France
| | - Martin Cour
- Medical Intensive Care Department, Hospices Civils de Lyon, Edouard Herriot Hospital, 69437, Lyon, France
| | - Guillaume Monneret
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression", Université Claude Bernard Lyon, 1-Hospices Civils de Lyon-bioMérieux, 69003, Lyon, France.,Immunology Laboratory, Hôpital E. Herriot-Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France
| | - Fabienne Venet
- Immunology Laboratory, Hôpital E. Herriot-Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France. .,Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude, Bernard-Lyon 1, Lyon, France.
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