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Lévesque H, Viallard JF, Houivet E, Bonnotte B, Voisin S, Le Cam-Duchez V, Maillot F, Lambert M, Liozon E, Hervier B, Fain O, Guillet B, Schmidt J, Luca LE, Ebbo M, Ferreira-Maldent N, Babuty A, Sailler L, Duffau P, Barbay V, Audia S, Benichou J, Graveleau J, Benhamou Y. Cyclophosphamide vs rituximab for eradicating inhibitors in acquired hemophilia A: A randomized trial in 108 patients. Thromb Res 2024; 237:79-87. [PMID: 38555718 DOI: 10.1016/j.thromres.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/19/2024] [Accepted: 03/07/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Acquired hemophilia A (AHA) is a rare autoimmune disorder due to autoantibodies against Factor VIII, with a high mortality risk. Treatments aim to control bleeding and eradicate antibodies by immunosuppression. International recommendations rely on registers and international expert panels. METHODS CREHA, an open-label randomized trial, compared the efficacy and safety of cyclophosphamide and rituximab in association with steroids in patients with newly diagnosed AHA. Participants were treated with 1 mg/kg prednisone daily and randomly assigned to receive either 1.5-2 mg/kg/day cyclophosphamide orally for 6 weeks, or 375 mg/m2 rituximab once weekly for 4 weeks. The primary endpoint was complete remission over 18 months. Secondary endpoints included time to achieve complete remission, relapse occurrence, mortality, infections and bleeding, and severe adverse events. RESULTS Recruitment was interrupted because of new treatment recommendations after 108 patients included (58 cyclophosphamide, 50 rituximab). After 18 months, 39 cyclophosphamide patients (67.2 %) and 31 rituximab patients (62.0 %) were in complete remission (OR 1.26; 95 % CI, 0.57 to 2.78). In the poor prognosis group (FVIII < 1 IU/dL, inhibitor titer > 20 BU mL-1), significantly more remissions were observed with cyclophosphamide (22 patients, 78.6 %) than with rituximab (12 patients, 48.0 %; p = 0.02). Relapse rates, deaths, severe infections, and bleeding were similar in the 2 groups. In patients with severe infection, cumulative doses of steroids were significantly higher than in patients without infection (p = 0.03). CONCLUSION Cyclophosphamide and rituximab showed similar efficacy and safety. As first line, cyclophosphamide seems preferable, especially in poor prognosis patients, as administered orally and less expensive. FUNDING French Ministry of Health. CLINICALTRIALS gov number: NCT01808911.
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Affiliation(s)
- H Lévesque
- Normandie Univ, UNIROUEN, U 1096, CHU Rouen, Department of Internal Medicine, F-76000 Rouen, France.
| | - J F Viallard
- Service de Médecine Interne et Maladies Infectieuses Hôpital Haut-Lévêque, CHU Bordeaux, 5 avenue de Magellan, 33604 Pessac, France
| | - E Houivet
- Department of Biostatistics, CHU Rouen, F-76031 Rouen, France
| | - B Bonnotte
- Service de médecine interne et immunologie clinique, CHU Dijon-Bourgogne, Université de Dijon, F-21079 Dijon, France
| | - S Voisin
- Department of Internal Medicine, CHU Toulouse, F-31059 Toulouse. France
| | - V Le Cam-Duchez
- Normandie Univ, UNIROUEN, Hématologie biologique, F-76031 Rouen, France
| | - F Maillot
- Département de Médecine Interne et immunologie clinique, CHRU Tours, Université de Tours, F-37044 Tours, France
| | - M Lambert
- CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reerence Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), F-59000 Lille, France
| | - E Liozon
- Department of Internal Medicine, Dupuytren Hospital, F-87000 Limoges, France
| | - B Hervier
- Service de Médecine Interne, Hôpital Saint-Louis, APHP, 75010 Paris & INSERM UMR-S 976, Human Immunology, Pathophysiology, Immunotherapy, Saint-Louis Research Institute, F-75000 Paris, France
| | - O Fain
- Sorbonne Université, APHP, Service de Médecine Interne-DMU i3, Hôpital Saint-Antoine, Paris F-75000, France
| | - B Guillet
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR-S 1085, F-35000 Rennes, France
| | - J Schmidt
- Department of Internal Medicine, Amiens University Hospital, F-80000 Amiens, France
| | - L E Luca
- Department of Internal Medicine, Poitiers University Hospital, F-86000 Poitiers, France
| | - M Ebbo
- Service de Médecine Interne, Hôpital La Timone, CHU Marseille, Aix-Marseille Université, F-13000 Marseille, France
| | - N Ferreira-Maldent
- Département de Médecine Interne et immunologie clinique, CHRU Tours, Université de Tours, F-37044 Tours, France
| | - A Babuty
- Service d'Hématologie Biologique, CRC-MHC, CHU de Nantes, Nantes Cedex 1, France
| | - L Sailler
- Department of Internal Medicine, CHU Toulouse, F-31059 Toulouse. France
| | - P Duffau
- Service de Médecine Interne-Immunologie Clinique Hôpital Saint-André, CHU Bordeaux, 1 rue Jean Burguet, 33075 Bordeaux, France
| | - V Barbay
- Normandie Univ, UNIROUEN, Hématologie biologique, F-76031 Rouen, France
| | - S Audia
- Service de médecine interne et immunologie clinique, CHU Dijon-Bourgogne, Université de Dijon, F-21079 Dijon, France
| | - J Benichou
- Department of Biostatistics, CHU Rouen and CESP UMR 1018, University of Rouen and University Paris-Saclay, F-76031 Rouen, France
| | - J Graveleau
- Nantes Université, CHU Nantes, Service de Médecine Interne, Nantes, France
| | - Y Benhamou
- Normandie Univ, UNIROUEN, U 1096, CHU Rouen, Department of Internal Medicine, F-76000 Rouen, France
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Lévesque H, Guillet B, Benhamou Y. [Acquired hemophilia and pregnancy: A necessarily multidisciplinary approach]. Rev Med Interne 2022; 43:494-497. [PMID: 35637030 DOI: 10.1016/j.revmed.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/22/2022] [Accepted: 04/02/2022] [Indexed: 11/19/2022]
Abstract
The occurrence of acquired hemophilia during pregnancy or postpartum is rare (2 to 10 % in series). It is generally suspected in the presence of haemorrhagic manifestations (especially subcutataneous or mucosal bleeding) associated with an isolated prolongation of the activated partial thromboplastin time (APTT). The diagnosis is confirmed by the association of a low level of factor VIII (FVIII) and the presence of an anti-FVIII inhibitor. Postpartum management is similar to that of other acquired haemophilias: correction of a severe haemorrhagic syndrome by "bypassing" agents, eradication of the inhibitor by corticosteroids alone or in combination with another immunosuppressive agent depending on the residual level of FVIII and the titer of the inhibitor. Management of the forms occurring during pregnancy is based on rare experiences or expert opinions. The management of childbirth is particularly delicate in terms of haemorrhage, especially if the anti-FVIII inhibitor is still present, and must be prepared in a multidisciplinary manner. Finally, as with any acquired hemophilia, a relapse is possible, especially in the year following remission. During a subsequent pregnancy, the risk of recurrence is possible but should not be a contraindication to a new pregnancy.
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Affiliation(s)
- H Lévesque
- Service de médecine interne, Normandie université, UNIROUEN, Interne, 76031 Rouen, France.
| | - B Guillet
- Centre de traitement des maladies hémorragiques, CHU de Rennes, Rennes, France; Inserm, EHESP, IRSET (institut de recherche en santé, environnement et travail) - UMR_S 1085, Université Rennes, CHU de Rennes, 35000 Rennes, France
| | - Y Benhamou
- Service de médecine interne, Normandie université, UNIROUEN, Interne, 76031 Rouen, France
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Diop A, Diop A, Hak JF, Di Bisceglie M, Bartoli JM, Guillet B, Vidal V. Hemostatic embolization of renal artery pseudoaneurysm using absorbable surgical suture (FairEmbo concept). Diagn Interv Imaging 2020; 101:757-758. [DOI: 10.1016/j.diii.2020.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 12/25/2022]
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Di Bisceglie M, Hak J, Brige P, Tradi F, Bartoli J, Jacquier A, Moulin G, Guillet B, Vidal V. Abstract No. 404 Safety and efficacy of arterial embolization with permanent suture micro particles: the FAIR-Embo concept. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Bobot M, Hache G, Fernandez S, Balasse L, Brige P, Chopinet S, Thomas L, Mckay N, Burtey S, Guillet B. L’atteinte cognitive est associée à une rupture de la barrière hémato-encéphalique et aux concentrations d’indoxyl sulfate dans deux modèles de maladie rénale chronique chez le rat. Nephrol Ther 2019. [DOI: 10.1016/j.nephro.2019.07.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Vidal V, Hak JF, Brige P, Chopinet S, Tradi F, Bobot M, Gach P, Haffner A, Soulez G, Jacquier A, Moulin G, Bartoli JM, Guillet B. In Vivo Feasibility of Arterial Embolization with Permanent and Absorbable Suture: The FAIR-Embo Concept. Cardiovasc Intervent Radiol 2019; 42:1175-1182. [PMID: 31025052 DOI: 10.1007/s00270-019-02211-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 03/25/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Arterial embolization has been shown to be effective and safe for the management of bleeding, especially for postpartum and pelvic traumatic bleeding. We propose to evaluate the proof of concept of feasibility and effectiveness of arterial embolization with absorbable and non-absorbable sutures in a porcine model. MATERIALS AND METHODS In the acute setting (n = 1), several different arteries (mesenteric, splenic, pharyngeal, kidney) were embolized using non-absorbable sutures (NAS): Mersutures™ braided sutures (polyethylene terephthalate). In the chronic setting (n = 3), only lower pole renal arteries were embolized. On the right side, NAS was used, whereas on the left side embolization was realized with absorbable suture (AS): Vicryl® braided suture (polyglactin 910). The chronic group was followed for 3 months. The pigs received contrast-enhanced CT the day before embolization (D-1), after the embolization (D0), at 1 month and 3 months after embolization (M1 and M3); digital subtraction angiography (DSA) was done at D0 and M3 and histological analysis at M3. RESULTS All vascular targets were effectively embolized without any pre- or postoperative complications. Both DSAs and CTs at M3 showed a 100% recanalization rate for the AS embolization and a partial reversal rate for the NAS embolization. A renal hypotrophy in the embolized region was observed during both the M1 and M3 scans for both sutures (AS and NAS) with a clear hypotrophy for the NAS embolized kidney. CONCLUSION Embolization by AS and NAS (FAIR-Embo) is a feasible and effective treatment which opens up the possibility of global use of this inexpensive and widely available embolization agent.
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Affiliation(s)
- V Vidal
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone APHM, Marseille, France. .,LIIE, Aix Marseille Univ, Marseille, France. .,CERIMED, Aix Marseille Univ, Marseille, France.
| | - J F Hak
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone APHM, Marseille, France. .,LIIE, Aix Marseille Univ, Marseille, France. .,CERIMED, Aix Marseille Univ, Marseille, France.
| | - P Brige
- LIIE, Aix Marseille Univ, Marseille, France.,CERIMED, Aix Marseille Univ, Marseille, France
| | - S Chopinet
- LIIE, Aix Marseille Univ, Marseille, France.,CERIMED, Aix Marseille Univ, Marseille, France.,Department of Digestive Surgery, University Hospital Timone APHM, Marseille, France
| | - F Tradi
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone APHM, Marseille, France.,LIIE, Aix Marseille Univ, Marseille, France.,CERIMED, Aix Marseille Univ, Marseille, France
| | - M Bobot
- CERIMED, Aix Marseille Univ, Marseille, France.,Department of Nephrology, University Hospital Conception APHM, Marseille, France.,INSERM 1263, INRA 1260, C2VN, Aix Marseille Univ, Marseille, France
| | - P Gach
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone APHM, Marseille, France.,LIIE, Aix Marseille Univ, Marseille, France.,CERIMED, Aix Marseille Univ, Marseille, France
| | - A Haffner
- Department of Pathological Anatomy, University Hospital Timone APHM, Marseille, France
| | - G Soulez
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, 1560 Sherbrooke East, Montreal, H2L 4M1, Canada
| | - A Jacquier
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone APHM, Marseille, France
| | - G Moulin
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone APHM, Marseille, France
| | - J M Bartoli
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone APHM, Marseille, France
| | - B Guillet
- CERIMED, Aix Marseille Univ, Marseille, France.,INSERM 1263, INRA 1260, C2VN, Aix Marseille Univ, Marseille, France.,Department of Radiopharmacy, APHM, Marseille, France
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Bobot M, Hache G, Garrigue P, Brunet P, Burtey S, Guillet B. La scintigraphie rénale à l’acide dimercaptosuccinique 99mTc permet d’évaluer le développement de la fibrose interstitielle au cours d’un régime riche en adénine chez le rat. Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pinganaud C, Proulle V, Dreyfus M, Lambert T, Guillet B. Myocardial Infarction Occurring in a Case of Acquired Haemophilia During the Treatment Course with Recombinant Activated Factor VII. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1613284] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Liesner RJ, Abashidze M, Aleinikova O, Altisent C, Belletrutti MJ, Borel-Derlon A, Carcao M, Chambost H, Chan AKC, Dubey L, Ducore J, Fouzia NA, Gattens M, Gruel Y, Guillet B, Kavardakova N, El Khorassani M, Klukowska A, Lambert T, Lohade S, Sigaud M, Turea V, Wu JKM, Vdovin V, Pavlova A, Jansen M, Belyanskaya L, Walter O, Knaub S, Neufeld EJ. Immunogenicity, efficacy and safety of Nuwiq®
(human-cl rhFVIII) in previously untreated patients with severe haemophilia A-Interim results from the NuProtect Study. Haemophilia 2017; 24:211-220. [PMID: 28815880 DOI: 10.1111/hae.13320] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2017] [Indexed: 01/19/2023]
Affiliation(s)
- R. J. Liesner
- Great Ormond Hospital for Children NHS Trust Haemophilia Centre; London UK
| | - M. Abashidze
- JSC Institute of Haematology and Transfusiology; Tbilisi Georgia
| | - O. Aleinikova
- Republican Scientific and Practical Centre of Children Oncology, Hematology and Immunology; Minsk Belarus
| | - C. Altisent
- Unitat d'Hemofilia; Hospital Vall D'Hebron; Barcelona Spain
| | - M. J. Belletrutti
- Pediatric Hematology; Department of Pediatrics; University of Alberta; Edmonton AB Canada
| | | | - M. Carcao
- Hospital for Sick Children; Toronto ON Canada
| | - H. Chambost
- Department of Pediatric Hematology Oncology; Children Hospital La Timone; APHM and Inserm; UMR 1062; Aix Marseille University; Marseille France
| | - A. K. C. Chan
- Division of Pediatric Hematology/Oncology; McMaster University; Hamilton ON Canada
| | - L. Dubey
- Western Ukrainian Specialized Children's Medical Centre; Lviv Ukraine
| | - J. Ducore
- Department of Pediatrics; UC Davis Medical Center; Sacramento CA USA
| | - N. A. Fouzia
- Christian Medical College Vellore; Vellore India
| | - M. Gattens
- Cambridge University Hospital NHS Foundation Trust; Cambridge UK
| | - Y. Gruel
- Hôpital Trousseau; Centre Régional de Traitement de l'Hémophilie; Tours France
| | - B. Guillet
- Haemophilia Treatment Centre of Rennes-Brittany; University Hospital of Rennes; Rennes France
| | - N. Kavardakova
- National Children's Specialized Clinic “OHMATDET”; Kiev Ukraine
| | - M. El Khorassani
- Centre de traitement de l'hémophilie; University Mohamed V; Rabat Morocco
| | | | - T. Lambert
- CRTH Hôpital Universitaire Bicêtre APHP; Le Kremlin Bicêtre France
| | - S. Lohade
- Sahyadri Speciality Hospital; Pune India
| | - M. Sigaud
- Centre Régional de Traitement de I'Hémophilie; University Hospital of Nantes; Nantes France
| | - V. Turea
- Scientific Research Institute of Mother and Child Health Care; Chişinău Moldova
| | - J. K. M. Wu
- B.C. Children's Hospital; Vancouver BC Canada
| | - V. Vdovin
- Morozovskaya Children's Hospital; Moscow Russia
| | - A. Pavlova
- Institute of Experimental Haematology and Transfusion Medicine; University Clinic Bonn; Bonn Germany
| | - M. Jansen
- Octapharma Pharmazeutika Produktionsges.mbH; Vienna Austria
| | | | | | - S. Knaub
- Octapharma AG; Lachen Switzerland
| | - E. J. Neufeld
- St. Jude Children’s Research Hospital; Memphis TN USA
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Aouba A, Villette B, Borg J, Guillet B, Borel-Derlon A, Schved J, Schneid H, Levesque H. Utilisation quotidienne du facteur VII activé recombinant dans les saignements aigus de l’hémophile acquise A : résultats d’ACQUI-7, une étude française prospective. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lagier D, Guillet B, Velly L, Bruder N, Alessi M. Efficacy of terutroban in preventing delayed cerebral ischemia after subarachnoid hemorrhage: a functional isotope imaging study on a rat model. Crit Care 2014. [PMCID: PMC4069419 DOI: 10.1186/cc13651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Borg JY, Guillet B, Le Cam-Duchez V, Goudemand J, Lévesque H. Outcome of acquired haemophilia in France: the prospective SACHA (Surveillance des Auto antiCorps au cours de l'Hémophilie Acquise) registry. Haemophilia 2013; 19:564-70. [PMID: 23574453 DOI: 10.1111/hae.12138] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2013] [Indexed: 01/24/2023]
Abstract
Although extremely rare, acquired haemophilia A (AHA) can cause severe bleeding, which may be fatal. The underlying causes of autoantibody development are not fully understood. Treatment goals are bleeding control and autoantibody eradication. At the time of our study, there was no consensus on a standard treatment strategy for AHA. Previous data were mainly retrospective or from single-centre cohorts. We conducted a prospective, controlled, registry-based study of patients with AHA in France. The prospective French registry (Surveillance des Auto antiCorps au cours de l'Hémophilie Acquise [SACHA]) collected data on prevalence, clinical course, disease associations and outcomes for haemostatic treatment and autoantibody eradication in 82 patients with a 1-year follow-up. Similar to earlier studies, the prevalence of AHA was higher in the elderly, with two thirds of patients aged >70 years. Around half of AHA cases were associated with underlying disease, most commonly autoimmune disease and cancer in younger and older patients respectively. Haemostatic treatment was initially administered to 46% of patients. Complete resolution or improvement of initial bleeding occurred in 22/27 (81%) rFVIIa-treated patients and in all six cases receiving pd-aPCC. The majority of patients (94%) received immunosuppressive therapy, with complete remission at 3 months in 61% (36/59) and in 98% (50/51) at 1 year. Overall mortality was 33%: secondary to bleeding in only three patients but to sepsis in 10. Bypassing agents were effective at controlling bleeding in patients with AHA. Immunosuppressive therapy should be used early but with caution, particularly in elderly patients.
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Affiliation(s)
- J Y Borg
- Haematology Laboratory, Rouen University Hospital and INSERM CIC-CRB 0204, Rouen, France
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Pellegrini L, Bennis Y, Guillet B, Velly L, Bruder N, Pisano P. [Cell therapy for stroke: from myth to reality]. Rev Neurol (Paris) 2012; 169:291-306. [PMID: 23246427 DOI: 10.1016/j.neurol.2012.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 07/13/2012] [Accepted: 08/09/2012] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Stroke is one of the leading causes of death and disability worldwide. Intravenous recombinant tissue plasminogen activator is the only available therapy for acute ischemic stroke, but its use is limited by a narrow therapeutic window and cannot stimulate endogenous repair and regeneration of damaged brain tissue. Stem cell-based approaches hold much promise as potential novel treatments to restore neurological function after stroke. STATE OF THE ART In this review, we summarize data from preclinical and clinical studies to investigate the potential application of stem cell therapies for treatment of stroke. Stem cells have been proposed as a potential source of new cells to replace those lost due to central nervous system injury, as well as a source of trophic molecules to minimize damage and promote recovery. Various stem cells from multiple sources can generate neural cells that survive and form synaptic connections after transplantation in the stroke-injured brain. Stem cells also exhibit neurorevitalizing properties that may ameliorate neurological deficits through stimulation of neurogenesis, angiogenesis and inhibition of inflammation. PERSPECTIVES/CONCLUSION Performed in stroke, cell therapy would decrease brain damage and reduce functional deficits. After the damage has been done, it would still improve neurological functions by activating endogenous repair. Nevertheless, many questions raised by experimental studies particularly related to long-term safety and technical details of cell preparation and administration must be resolved before wider clinical use.
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Affiliation(s)
- L Pellegrini
- Service d'anesthésie-réanimation 1, CHU de la Timone, Assistance publique-Hôpitaux de Marseille, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
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Bennis Y, Sarlon-Bartoli G, Guillet B, Lucas L, Pellegrini L, Velly L, Blot-Chabaud M, Dignat-Georges F, Sabatier F, Pisano P. Priming of late endothelial progenitor cells with erythropoietin before transplantation requires the CD131 receptor subunit and enhances their angiogenic potential. J Thromb Haemost 2012; 10:1914-28. [PMID: 22738133 DOI: 10.1111/j.1538-7836.2012.04835.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Endothelial colony-forming cells (ECFCs) are promising candidates for cell therapy of ischemic diseases. Erythropoietin (EPO) is a cytokine that promotes angiogenesis after ischemic injury. EPO receptors (EPORs) classically include two EPOR subunits, but may also associate with the β-common chain (CD131) in a newly identified receptor involved in EPO cytoprotective effects. OBJECTIVE The aim was to take advantage of the proangiogenic properties of EPO to enhance ECFC graft efficiency. We postulated that priming ECFCs by adding epoietin α in culture medium prior to experiments might increase their angiogenic properties. We also explored the role of the CD131 subunit in EPO priming of ECFCs. METHODS AND RESULTS By western blotting on cord blood ECFC lysates, we showed that EPOR and CD131 expression increased significantly after EPO priming. These proteins coimmunoprecipitated and colocalized, suggesting that they are covalently bound in ECFCs. EPO at 5 IU mL(-1) significantly stimulated proliferation, wound healing, migration and tube formation of ECFCs. EPO priming also increased ECFC resistance to H2 O2-induced apoptosis and survival in vivo. Similarly, in vivo studies showed that, as compared with non-primed ECFC injection, 5 IU mL(-1) EPO-primed ECFCs, injected intravenously 24 h after hindlimb ischemia in athymic nude mice, increased the ischemic/non-ischemic ratios of hindlimb blood flow and capillary density. These effects were all prevented by CD131 small interfering RNA transfection, and involved the phosphoinositide 3-kinase-Akt pathway. CONCLUSION These results highlight the potential role of EPO-primed ECFCs for cell-based therapy in hindlimb ischemia, and underline the critical role of CD131 as an EPO coreceptor.
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Affiliation(s)
- Y Bennis
- Aix-Marseille Université, UMR INSERM1076, Faculté de Pharmacie, Marseille, France.
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Cabasse C, Franck N, Duval H, Roussel M, Guillet B. Detection and characterization of circulating endothelial cells in multiple myeloma versus monoclonal gammapathy of indeterminated signifiance. Bull Group Int Rech Sci Stomatol Odontol 2011; 50:18-20. [PMID: 22750701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 11/22/2011] [Indexed: 06/01/2023]
Affiliation(s)
- C Cabasse
- UFService hemostase, INSERM U917, Centre Hospitalier Universitaire, Rennes, France.
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16
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Velly L, Pellegrini L, Guillet B, Bruder N, Pisano P. Erythropoietin 2nd cerebral protection after acute injuries: a double-edged sword? Pharmacol Ther 2010; 128:445-59. [PMID: 20732352 DOI: 10.1016/j.pharmthera.2010.08.002] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 08/02/2010] [Indexed: 12/20/2022]
Abstract
Over the past 15 years, a large body of evidence has revealed that the cytokine erythropoietin exhibits non-erythropoietic functions, especially tissue-protective effects. The discovery of EPO and its receptors in the central nervous system and the evidence that EPO is made locally in response to injury as a protective factor in the brain have raised the possibility that recombinant human EPO (rhEPO) could be administered as a cytoprotective agent after acute brain injuries. This review highlights the potential applications of rhEPO as a neuroprotectant in experimental and clinical settings such as ischemia, traumatic brain injury, and subarachnoid and intracerebral hemorrhage. In preclinical studies, EPO prevented apoptosis, inflammation, and oxidative stress induced by injury and exhibited strong neuroprotective and neurorestorative properties. EPO stimulates vascular repair by facilitating endothelial progenitor cell migration into the brain and neovascularisation, and it promotes neurogenesis. In humans, small clinical trials have shown promising results but large prospective randomized studies failed to demonstrate a benefit of EPO for brain protection and showed unwanted side effects, especially thrombotic complications. Recently, regions have been identified within the EPO molecule that mediate tissue protection, allowing the development of non-erythropoietic EPO variants for neuroprotection conceptually devoid of side effects. The efficacy and the safety profile of these new compounds are still to be demonstrated to obtain, in patients, the benefits observed in experimental studies.
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Affiliation(s)
- L Velly
- Laboratoire de Pharmacologie, INSERM UMR 608, Université de la Méditerranée, Faculté de Pharmacie, Marseille, France
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17
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Cosnefroy A, Brion F, Guillet B, Laville N, Porcher J, Balaguer P, Aït-Aïssa S. A stable fish reporter cell line to study estrogen receptor transactivation by environmental (xeno)estrogens. Toxicol In Vitro 2009; 23:1450-4. [DOI: 10.1016/j.tiv.2009.07.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2008] [Revised: 04/10/2009] [Accepted: 07/06/2009] [Indexed: 11/28/2022]
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Millet A, Decaux O, Bareau B, Guillet B, Cazalets C, Perlat A, Jego P, Grosbois B. Efficacité du rituximab dans les hémophilies acquises: à propos de deux cas et revue de la littérature. Rev Med Interne 2007; 28:862-5. [PMID: 17707554 DOI: 10.1016/j.revmed.2007.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Accepted: 06/25/2007] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Acquired hemophilia due to an inhibitor of factor VIII is a rare clinical situation. EXEGESIS Rituximab is now used in the treatment of acquired hemophilia. We report two cases of acquired hemophilia treated by rituximab with efficiency. CONCLUSION Rituximab appears to be a first line immunosuppressive therapy in acquired hemophilia, especially in post-partum hemophilia.
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Affiliation(s)
- A Millet
- Service de médecine interne, département de médecine de l'adulte, hôpital Sud, 16, boulevard de Bulgarie, 35203 Rennes cedex 02, France
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L'hostis‐Guidet A, Madigou T, Nicolle O, Guillet B, Tiaho F, Boujard D. [P74]: Xenopus transgenic embryos to study early neuronal differentiation. Int J Dev Neurosci 2006. [DOI: 10.1016/j.ijdevneu.2006.09.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - T. Madigou
- UMR 6026, CNRS, Université de Rennes1France
| | - O. Nicolle
- UMR 6626, CNRS, Université de Rennes1France
| | - B. Guillet
- UMR 6026, CNRS, Université de Rennes1France
| | - F. Tiaho
- UMR 6026, CNRS, Université de Rennes1France
| | - D. Boujard
- UMR 6026, CNRS, Université de Rennes1France
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Lévesque H, Borg JY, Goudemand J, Guillet B, Bossi P, Cabane J. Suivi évolutif des hémophilies acquises: étude SACHA. À propos de 82 cas. Rev Med Interne 2006. [DOI: 10.1016/j.revmed.2006.10.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Labrande C, Velly L, Canolle B, Guillet B, Masmejean F, Nieoullon A, Pisano P. Neuroprotective effects of tacrolimus (FK506) in a model of ischemic cortical cell cultures: role of glutamate uptake and FK506 binding protein 12 kDa. Neuroscience 2005; 137:231-9. [PMID: 16289353 DOI: 10.1016/j.neuroscience.2005.08.080] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2005] [Revised: 08/29/2005] [Accepted: 08/31/2005] [Indexed: 11/16/2022]
Abstract
BACKGROUND The mechanisms underlying the neuroprotective effects of the immunosuppressant tacrolimus, observed in vivo, remain unclear. Here we quantify these effects in vitro, and evaluate the potential involvement of the glutamate and/or immunophilin FK506 binding protein 12 kDa in tacrolimus-induced neuroprotection. METHODS Primary cultures of neurons and astrocytes from rat cerebral cortex were subjected to transient oxygen-glucose deprivation. Neuronal injury was evaluated by cell counting after immunostaining experiments, lactate dehydrogenase release and 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide reduction. The involvement of the immunophilin FK506 binding protein 12 kDa was explored using an anti-FK506 binding protein 12 kDa antibody, (3-3-pyridyl)-1-propyl(2 s)-1-(3,3-dimethyl-1,2-dioxopentyl)-2-pyrrolidine carboxylate and rapamycin. Extracellular glutamate and glutamate uptake were respectively measured by high performance liquid chromatography and l-[3H]glutamate incorporation. RESULTS When added during either oxygen-glucose deprivation or reoxygenation, FK506 (50-500 pM) offered significant neuroprotection. During oxygen-glucose deprivation, it was able to reverse the oxygen-glucose deprivation-induced increase in extracellular glutamate and decrease in glutamate uptake and this effect was reversed in the presence of threo-3-methyl glutamate, a specific inhibitor of glutamate transporter-1. Blocking FK506 binding protein 12 kDa inhibited the neuroprotection induced by tacrolimus added during either oxygen-glucose deprivation or reoxygenation. Tacrolimus-induced neuroprotection was also reversed in the presence of rapamycin, an immunosuppressant FK506 binding protein 12 kDa ligand devoid of neuroprotective properties and (3-3-pyridyl)-1-propyl(2 s)-1-(3,3-dimethyl-1,2-dioxopentyl)-2-pyrrolidine carboxylate, a non-immunosuppressant ligand of FK506 binding protein 12 kDa, exerteing neuroprotective effects. CONCLUSION The beneficial effects of tacrolimus during in vitro ischemia/reperfusion seem to indicate the restoration of a glutamate transporter-1-mediated activity and could be mediated by a FK506 binding protein 12 kDa pathway.
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Affiliation(s)
- C Labrande
- Laboratoire de Pharmacodynamie, Faculté de Pharmacie, Université de la Méditerranée, Marseille, France
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Robelet S, Melon C, Guillet B, Salin P, Kerkerian-Le Goff L. Chronic L-DOPA treatment increases extracellular glutamate levels and GLT1 expression in the basal ganglia in a rat model of Parkinson's disease. Eur J Neurosci 2004; 20:1255-66. [PMID: 15341597 DOI: 10.1111/j.1460-9568.2004.03591.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There is growing experimental evidence for the implication of glutamate-mediated mechanisms both in the pathophysiology of Parkinson's disease and in the development of dyskinesias with long-term administration of L-3,4-dihydroxyphenylalanine (L-DOPA). However, the impact of this treatment on glutamate transmission in the basal ganglia has been poorly investigated. In this study, we examined the effects of 6-hydroxydopamine-induced lesion of nigral dopamine neurons with or without subsequent chronic L-DOPA treatment on several parameters of glutamate system function in the rat striatum and substantia nigra pars reticulata. All the lesioned animals treated with L-DOPA developed severe dyskinesias. Extracellular glutamate levels, measured by microdialysis in freely moving conditions, and gene expression of the glial glutamate transporter GLT1, assessed by in situ hybridization, were unaffected by dopamine lesion or L-DOPA treatment alone, but were both markedly increased on the lesion side of rats with subsequent L-DOPA treatment. No change in the expression of the vesicular glutamate transporters vGluT1 and vGluT2 was measured in striatum. These data show that chronic L-DOPA treatment leading to dyskinesias increases basal levels of glutamate function in basal ganglia. The L-DOPA-induced overexpression of GLT1 may represent a compensatory mechanism involving astrocytes to limit glutamate overactivity and subsequent toxic processes.
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Affiliation(s)
- S Robelet
- Interactions Cellulaires, Neurodégénérescence et Neuroplasticité, UMR 6186, 31 chemin Joseph Aiguier, 13402 Marseille cedex 20, France
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Guillet B, Pinganaud C, Proulle V, Dreyfus M, Lambert T. Myocardial infarction occurring in a case of acquired haemophilia during the treatment course with recombinant activated factor VII. Thromb Haemost 2002; 88:698-9. [PMID: 12362252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Guillet B, Lortet S, Masmejean F, Samuel D, Nieoullon A, Pisano P. Developmental expression and activity of high affinity glutamate transporters in rat cortical primary cultures. Neurochem Int 2002; 40:661-71. [PMID: 11900862 DOI: 10.1016/s0197-0186(01)00110-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The expression and activity of glutamate transporters (EAAC1, GLAST and GLT1) were examined during the development of cortical neuron-enriched cultures. Protein content and mitochondrial respiration both increased during the first 7 days, later stabilized and decreased from DIV14. Glutamate transport and extracellular concentration were relatively constant from DIV3 to 18. The kinetic parameters of glutamate transport were at DIV7: K(m)=19+/-3 microM and V(max)=1068+/-83 pmol/mg protein/min and at DIV14: K(m)=40.8+/-9.3 microM and V(max)=1060+/-235 pmol/mg protein/min. The shift in K(m) towards higher values suggest a more important participation of GLAST after DIV14. At DIV7 and 14, glutamate transport was poorly sensitive to dihydrokaïnate (DHK) suggesting a weak participation of GLT1 in glutamate transport. Western blot experiments and immunocytochemistry showed that EAAC1 was expressed by neurons whatever the stage of the culture. GLAST was found in astrocytes as soon as DIV3 and labeling increased during the development of the culture. There was little neuronal GLT1 immunoreactivity at DIV7, only detected by immunocytochemistry. From DIV10 to 18, an increasing astrocytic expression of GLT1 was observed, also detected by Western blotting. These results show that: (1) glutamate uptake remains stable all along the development of the cultures although the pattern of expression of the different transporters is changing, suggesting that glutamate transport is highly regulated; (2) neuronal EAAC1 may play a critical role during the early stages of the culture when it is expressed alone; and (3) the developmental expression pattern of glutamate transporters in cortical neuron-enriched cultures is quite similar to that observed in vivo during early postnatal development.
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Affiliation(s)
- B Guillet
- Laboratoire de Neurobiologie Cellulaire et Fonctionnelle, UPR CNRS 9013, 31 chemin Joseph Aiguier, 13009 Marseille, France
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Guillet B, Kriaa F, Huysse MG, Proulle V, George C, Tchernia G, D'Oiron R, Laurian Y, Charpentier B, Lambert T, Dreyfus M. Protein A sepharose immunoadsorption: immunological and haemostatic effects in two cases of acquired haemophilia. Br J Haematol 2001; 114:837-44. [PMID: 11564072 DOI: 10.1046/j.1365-2141.2001.03022.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Acquired haemophilia is a life-threatening disorder caused by circulating auto-antibodies that inhibit factor VIII coagulant activity (FBIII:C). Immunoadsorption on protein A sepharose (IA-PA) was performed in two bleeding patients with acquired haemophilia: we observed a dramatic and quick decrease in the anti-FVIII:C inhibitor titre leading to a normal, albeit transient, haemostatic status. In one case, IA-PA was the only procedure which succeeded in stopping massive haemorrhage. In the second case, IA-PA reinforced the haemostatic effect of recombinant activated factor VII by increasing the endogenous plasma factor VIII level. The efficacy of IA-PA was sustained with immunosuppressive treatment introduced, respectively, 10 and 15 d before the IA-PA procedures. Our experience with IA-PA suggests that this extracorporeal anti-FVIII:C removal procedure is a valuable therapeutic tool for acquired haemophilia and can alleviate life-threatening haemorrhages.
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Affiliation(s)
- B Guillet
- Laboratoire d'Hématologie et Centre de Référence et de Traitement de l'Hémophilie, Hôpital Bicêtre, AP-HP et Faculté de Médecine Paris XI, 94275 Le Kremlin-Bicêtre, Paris, France
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Abstract
PURPOSE Acquired haemophilia is a rare disease, occurring most frequently in elderly patients, caused by the development of autoantibodies against factor VIII. CURRENT KNOWLEDGE AND KEY POINTS The disease is characterised by spontaneous haemorrhagic complications which can be fatal in 15-20% of the patients. However spontaneous remission is possible and in fact natural evolution and aetiology are still partly unknown. Acquired haemophilia may arise in association with auto-immune diseases, lymphoproliferative malignancy, pregnancy and also as a drug reaction. The aims of the treatment are first to treat the bleeding which is the most common cause of morbidity and mortality, and second to eliminate the inhibitor by immunosuppression. However no consensus exists for these two parts of the treatment. Bleeding may be controlled by prothrombin complex concentrates, recombinant factor VIIa or porcine factor VIII. The inhibitor is abolished in up 70% of patients using prednisone and cyclophosphamide. Other combinations of prednisone with azathioprine or with cyclophosphamide and vincristine or the use of high-dose immunoglobulin or double-filtration plasmapheresis have also proven effective in some patients. FUTURE AND PROJECTS The rare occurrence of the disease, the associated with various diseases, and lack of consensus about treatment, require multicentric prospective studies.
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Affiliation(s)
- H Lévesque
- Département de médecine interne, hôpital de Boisguillaume, CHU, 76031 Rouen, France.
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Pinganaud C, Guillet B, Khellaf M, Dreyfus M, Tchernia G, Delfraissy J, Goujard C. Cytopénies auto-immunes sévères et réfractaires : alternative thérapeutique. Rev Med Interne 2001. [DOI: 10.1016/s0248-8663(01)83472-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Guillet B, Tchernia G, Lambert T. [Hemophilia. Diagnosis, genetics, complications]. Rev Prat 2001; 51:433-6. [PMID: 11355609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Affiliation(s)
- B Guillet
- Centre de traitement des maladies hémorragiques, l'hôpital Bicêtre, faculté de médecine, Paris-XI
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Vincens A, Dubois MA, Guillet B, Achoundong G, Buchet G, Riera B. Pollen-rain-vegetation relationships along a forest-savanna transect in southeastern Cameroon. Rev Palaeobot Palynol 2000; 110:191-208. [PMID: 10930605 DOI: 10.1016/s0034-6667(00)00009-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Modern soil and litter samples from southeastern Cameroon, collected along a continuous forest-savanna transect were analysed for pollen content to define modern pollen-vegetation relationships. The pollen results, completed and compared with botanical inventories, leaf area index and basal area measurements performed in the same area, clearly registered the physiognomy, the main floristic composition and floral richness of the two sampled ecosystems. Distortions were observed between sampled vegetations and their pollen rain, related to important differences in pollen production and dispersal of plant species: this is a general feature in many tropical regions. The pollen data in the area studied reflected well the recent transgression of forest versus savanna. This permitted us to define inside the forest ecosystem more successional vegetation communities than the botanical surveys allowed.
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Affiliation(s)
- A Vincens
- CEREGE, CNRS, BP 80, 13545 cedex 04, Aix-en-Provence, France
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Guillet B, Rouiller J, Souchier B. Accumulations de fer (lepidocrocite) superposees a des encroutements ferri-manganiques dans des sols hydromorphes vosgiens. ACTA ACUST UNITED AC 1976. [DOI: 10.2113/gssgfbull.s7-xviii.1.55] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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