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Dudreuilh C, Jarvis P, Beadle N, Pilecka I, Shaw O, Gardner L, Scottà C, Mamode N, Game DS, Sanchez-Fueyo A, Lombardi G, Learoyd A, Douiri A, Dorling A. Can regulatory T cells improve outcomes of sensitised patients after HLA-Ab incompatible renal transplantation: study protocol for the Phase IIa GAMECHANgER-1 trial. BMC Nephrol 2023; 24:117. [PMID: 37118685 PMCID: PMC10140710 DOI: 10.1186/s12882-023-03157-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/06/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Kidney transplantation is the gold-standard treatment for patients with kidney failure. However, one-third of patients awaiting a kidney transplant are highly sensitized to human leukocyte antigens (HLA), resulting in an increased waiting time for a suitable kidney, more acute and chronic rejection, and a shorter graft survival compared to non-highly sensitised patients. Current standard immunosuppression protocols do not adequately suppress memory responses, and so alternative strategies are needed. Autologous polyclonally expanded regulatory T cells (Tregs) have been demonstrated to be safe in transplant settings and could be a potential alternative to modulate memory immune alloresponses. METHODS The aim of this trial is to determine whether adoptive transfer of autologous Tregs into HLA sensitised patients can suppress memory T and B cell responses against specific HLA antigens. This is a two-part, multi-centre, prospective clinical trial, comprising an observational phase (Part 1) aiming to identify patients with unregulated cellular memory responses to HLA (Pure HLA Proteins) followed by an interventional phase (Part 2). The first 9 patients identified as being eligible in Part 1 will undergo baseline immune monitoring for 2 months to inform statistical analysis of the primary endpoint. Part 2 is an adaptive, open labelled trial based on Simon's two-stage design, with 21 patients receiving Good Manufacturing Practice (GMP)-grade polyclonally expanded Tregs to a dose of 5-10 × 106 cells/kg body weight. The primary EP is suppression of in vitro memory responses for 2 months post-infusion. 12 patients will receive treatment in stage 1 of Part 2, and 9 patients will receive treatment in stage 2 of Part 2 if ≥ 50% patients pass the primary EP in stage 1. DISCUSSION This is a prospective study aiming to identify patients with unregulated cellular memory responses to Pure HLA Proteins and determine baseline variation in these patterns of response. Part 2 will be an adaptive phase IIa clinical trial with 21 patients receiving a single infusion of GMP-grade polyclonally expanded Tregs in two stages. It remains to be demonstrated that modulating memory alloresponses clinically using Treg therapy is achievable. TRIAL REGISTRATION EudraCT Number: 2021-001,664-23. REC Number: 21/SC/0253. Trial registration number ISRCTN14582152.
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Affiliation(s)
- C Dudreuilh
- Centre for Nephrology, Urology and Transplantation, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King's College London & NIHR Biomedical Research Centre-Transplant Theme, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK.
- Centre for Nephrology, Urology and Transplantation, School of Immunology and Microbial Sciences, King's College London, London, UK.
| | - P Jarvis
- Centre for Nephrology, Urology and Transplantation, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King's College London & NIHR Biomedical Research Centre-Transplant Theme, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK
- Centre for Nephrology, Urology and Transplantation, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - N Beadle
- Centre for Nephrology, Urology and Transplantation, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King's College London & NIHR Biomedical Research Centre-Transplant Theme, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK
- Centre for Nephrology, Urology and Transplantation, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - I Pilecka
- Centre for Nephrology, Urology and Transplantation, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King's College London & NIHR Biomedical Research Centre-Transplant Theme, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK
- Clinical Trials Unit, King's College London, London, UK
| | - O Shaw
- Guy's and St Thomas's Hospital Trust, London, UK
| | - L Gardner
- Centre for Nephrology, Urology and Transplantation, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King's College London & NIHR Biomedical Research Centre-Transplant Theme, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK
- Centre for Nephrology, Urology and Transplantation, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - C Scottà
- Peter Gorer Department of Immunobiology, King's College London, London, UK
| | - N Mamode
- Centre for Nephrology, Urology and Transplantation, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King's College London & NIHR Biomedical Research Centre-Transplant Theme, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK
- Centre for Nephrology, Urology and Transplantation, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - D S Game
- Department of Transplantation, Guys and St, Thomas's Hospital NHS Trust, London, UK
| | - A Sanchez-Fueyo
- Institute of Liver Studies, King's College London University and King's College Hospital, London, UK
| | - G Lombardi
- Peter Gorer Department of Immunobiology, King's College London, London, UK
| | - A Learoyd
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - A Douiri
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - A Dorling
- Centre for Nephrology, Urology and Transplantation, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King's College London & NIHR Biomedical Research Centre-Transplant Theme, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK
- Centre for Nephrology, Urology and Transplantation, School of Immunology and Microbial Sciences, King's College London, London, UK
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2
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Morel A, Hoisnard L, Dudreuilh C, Moktefi A, Kheav D, Pimentel A, Sakhi H, Mokrani D, Attias P, El Sakhawi K, Champy CM, Remy P, Sbidian E, Grimbert P, Matignon M. Three-Year Outcomes in Kidney Transplant Recipients Switched From Calcineurin Inhibitor-Based Regimens to Belatacept as a Rescue Therapy. Transpl Int 2022; 35:10228. [PMID: 35497889 PMCID: PMC9043102 DOI: 10.3389/ti.2022.10228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 03/18/2022] [Indexed: 01/05/2023]
Abstract
Background: The long-term benefits of conversion from calcineurin inhibitors (CNIs) to belatacept in kidney transplant recipients (KTr) are poorly documented. Methods: A single-center retrospective work to study first-time CNI to belatacept conversion as a rescue therapy [eGFR <30 ml/min/1.73 m2, chronic histological lesions, or CNI-induced thrombotic microangiopathy (TMA)]. Patient and kidney allograft survivals, eGFR, severe adverse events, donor-specific antibodies (DSA), and histological data were recorded over 36 months after conversion. Results: We included N = 115 KTr. The leading cause for switching was chronic histological lesions with non-optimal eGFR (56.5%). Three years after conversion, patient, and death-censored kidney allograft survivals were 88% and 92%, respectively, eGFR increased significantly from 31.5 ± 17.5 to 36.7 ± 15.7 ml/min/1.73 m2 (p < 0.01), the rejection rate was 10.4%, OI incidence was 5.2 (2.9–7.6) per 100 person-years. Older age was associated with death, eGFR was not associated with death nor allograft loss. No patient developed dnDSA at M36 after conversion. CNI-induced TMA disappeared in all cases without eculizumab use. Microvascular inflammation and chronic lesions remained stable. Conclusion: Post-KT conversion from CNIs to belatacept, as rescue therapy, is safe and beneficial irrespective of the switch timing and could represent a good compromise facing organ shortage. Age and eGFR at conversion should be considered in the decision whether to switch.
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Affiliation(s)
- Antoine Morel
- Nephrology and Renal Transplantation Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Léa Hoisnard
- AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, Centre d'Investigation Clinique and Fédération Hospitalo-Universitaire TRUE (InnovaTive theRapy for immUne disordErs), Créteil, France.,Université Paris Est Créteil (UPEC), EpiDermE (Epidemiology in Dermatology and Evaluation of therapeutics), Créteil, France
| | - Caroline Dudreuilh
- Nephrology and Renal Transplantation Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Anissa Moktefi
- Groupe Hospitalier Henri-Mondor/Albert-Chenevier, Pathology Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Créteil, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil, Créteil, France
| | - David Kheav
- AP-HP (Assistance Publique-Hôpitaux de Paris), Laboratoire Régional d'histocompatibilité, Hôpital Saint Louis, Vellefaux, Paris
| | - Ana Pimentel
- Nephrology and Renal Transplantation Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Hamza Sakhi
- Nephrology and Renal Transplantation Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - David Mokrani
- Nephrology and Renal Transplantation Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Philippe Attias
- Nephrology and Renal Transplantation Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Karim El Sakhawi
- Nephrology and Renal Transplantation Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Cécile Maud Champy
- Groupe Hospitalier Henri-Mondor/Albert Chenevier, Urology department, AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Philippe Remy
- Nephrology and Renal Transplantation Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, Créteil, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil, Créteil, France
| | - Emilie Sbidian
- AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, Centre d'Investigation Clinique and Fédération Hospitalo-Universitaire TRUE (InnovaTive theRapy for immUne disordErs), Créteil, France.,Université Paris Est Créteil (UPEC), EpiDermE (Epidemiology in Dermatology and Evaluation of therapeutics), Créteil, France.,Department of Dermatology, AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, Créteil, France.,INSERM, Centre d'Investigation Clinique 1430, Créteil, France
| | - Philippe Grimbert
- Nephrology and Renal Transplantation Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, Centre d'Investigation Clinique and Fédération Hospitalo-Universitaire TRUE (InnovaTive theRapy for immUne disordErs), Créteil, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, CIC biotherapy, Créteil, France
| | - Marie Matignon
- Nephrology and Renal Transplantation Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, Créteil, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil, Créteil, France
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Mohseni YR, Saleem A, Tung SL, Dudreuilh C, Lang C, Peng Q, Volpe A, Adigbli G, Cross A, Hester J, Farzaneh F, Scotta C, Lechler RI, Issa F, Fruhwirth GO, Lombardi G. Chimeric antigen receptor-modified human regulatory T cells that constitutively express IL-10 maintain their phenotype and are potently suppressive. Eur J Immunol 2021; 51:2522-2530. [PMID: 34320225 PMCID: PMC8581768 DOI: 10.1002/eji.202048934] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 04/30/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022]
Abstract
Clinical trials of Treg therapy in transplantation are currently entering phases IIa and IIb, with the majority of these employing polyclonal Treg populations that harbor a broad specificity. Enhancing Treg specificity is possible with the use of chimeric antigen receptors (CARs), which can be customized to respond to a specific human leukocyte antigen (HLA). In this study, we build on our previous work in the development of HLA-A2 CAR-Tregs by further equipping cells with the constitutive expression of interleukin 10 (IL-10) and an imaging reporter as additional payloads. Cells were engineered to express combinations of these domains and assessed for phenotype and function. Cells expressing the full construct maintained a stable phenotype after transduction, were specifically activated by HLA-A2, and suppressed alloresponses potently. The addition of IL-10 provided an additional advantage to suppressive capacity. This study therefore provides an important proof-of-principle for this cell engineering approach for next-generation Treg therapy in transplantation.
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Affiliation(s)
- Yasmin R. Mohseni
- MRC Centre for Transplantation ImmunologySchool of Immunology and Microbial Sciences, King's College LondonLondonUK
| | - Adeel Saleem
- MRC Centre for Transplantation ImmunologySchool of Immunology and Microbial Sciences, King's College LondonLondonUK
- Imaging Therapies and Cancer GroupComprehensive Cancer Centre, School of Cancer and Pharmaceutical Studies, King's College LondonLondonUK
- Department of Haematology and Precision MedicineKings College HospitalLondonUK
| | - Sim L. Tung
- MRC Centre for Transplantation ImmunologySchool of Immunology and Microbial Sciences, King's College LondonLondonUK
| | - Caroline Dudreuilh
- MRC Centre for Transplantation ImmunologySchool of Immunology and Microbial Sciences, King's College LondonLondonUK
| | - Cameron Lang
- Imaging Therapies and Cancer GroupComprehensive Cancer Centre, School of Cancer and Pharmaceutical Studies, King's College LondonLondonUK
| | - Qi Peng
- MRC Centre for Transplantation ImmunologySchool of Immunology and Microbial Sciences, King's College LondonLondonUK
| | - Alessia Volpe
- Imaging Therapies and Cancer GroupComprehensive Cancer Centre, School of Cancer and Pharmaceutical Studies, King's College LondonLondonUK
| | - George Adigbli
- Transplantation Research & Immunology Group, Nuffield Department of Surgical SciencesUniversity of Oxford, Oxford, UK
| | - Amy Cross
- Transplantation Research & Immunology Group, Nuffield Department of Surgical SciencesUniversity of Oxford, Oxford, UK
| | - Joanna Hester
- Transplantation Research & Immunology Group, Nuffield Department of Surgical SciencesUniversity of Oxford, Oxford, UK
| | - Farzin Farzaneh
- Department of Haematological MedicineSchool of Cancer and Pharmaceutical Studies, King's College LondonLondonUK
| | - Cristiano Scotta
- MRC Centre for Transplantation ImmunologySchool of Immunology and Microbial Sciences, King's College LondonLondonUK
| | - Robert I. Lechler
- MRC Centre for Transplantation ImmunologySchool of Immunology and Microbial Sciences, King's College LondonLondonUK
| | - Fadi Issa
- Transplantation Research & Immunology Group, Nuffield Department of Surgical SciencesUniversity of Oxford, Oxford, UK
| | - Gilbert O. Fruhwirth
- Imaging Therapies and Cancer GroupComprehensive Cancer Centre, School of Cancer and Pharmaceutical Studies, King's College LondonLondonUK
| | - Giovanna Lombardi
- MRC Centre for Transplantation ImmunologySchool of Immunology and Microbial Sciences, King's College LondonLondonUK
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4
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Morel A, Hoisnard L, Dudreuilh C, Moktefi A, Kheav D, Attias P, Champy C, Remy P, Grimbert P, Matignon M. Conséquences à 3 ans de la conversion des inhibiteurs de la calcineurine au belatacept en thérapie de sauvetage chez les patients transplantés rénaux : une étude de cohorte retrospective. Nephrol Ther 2021. [DOI: 10.1016/j.nephro.2021.07.109] [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: 10/20/2022]
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5
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Dudreuilh C, Roper T, Breen C, Chowdhury P, Douthwaite S, Kumar N, Moutzouris DA. IgG SARS-CoV-2 Antibodies Persist at Least for 10 Months in Patients on Hemodialysis. Kidney Int Rep 2021; 6:1961-1964. [PMID: 33851068 PMCID: PMC8028697 DOI: 10.1016/j.ekir.2021.03.900] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Caroline Dudreuilh
- Renal & Transplant Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Tayeba Roper
- Renal & Transplant Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Cormac Breen
- Renal & Transplant Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Paramit Chowdhury
- Renal & Transplant Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Sam Douthwaite
- Department of Infectious Diseases, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Nicola Kumar
- Renal & Transplant Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK
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Dudreuilh C, Basu S, Scottà C, Dorling A, Lombardi G. Potential Application of T-Follicular Regulatory Cell Therapy in Transplantation. Front Immunol 2021; 11:612848. [PMID: 33603742 PMCID: PMC7884443 DOI: 10.3389/fimmu.2020.612848] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/14/2020] [Indexed: 12/18/2022] Open
Abstract
Regulatory T cells (Tregs) constitute a small proportion of circulating CD4+ T cells that function to maintain homeostasis and prevent autoimmunity. In light of their powerful immunosuppressive and tolerance-promoting properties, Tregs have become an interesting potential candidate for therapeutic use in conditions such as solid organ transplant or to treat autoimmune and inflammatory conditions. Clinical studies have demonstrated the safety of polyclonally expanded Tregs in graft-versus-host disease, type 1 diabetes, and more recently in renal and liver transplantation. However, Tregs are heterogenous. Recent insights indicate that only a small proportion of Tregs, called T follicular regulatory cells (Tfr) regulate interactions between B cells and T follicular helper (Tfh) cells within the germinal center. Tfr have been mainly described in mouse models due to the challenges of sampling secondary lymphoid organs in humans. However, emerging human studies, characterize Tfr as being CD4+CD25+FOXP3+CXCR5+ cells with different levels of PD-1 and ICOS expression depending on their localization, in the blood or the germinal center. The exact role they play in transplantation remains to be elucidated. However, given the potential ability of these cells to modulate antibody responses to allo-antigens, there is great interest in exploring translational applications in situations where B cell responses need to be regulated. Here, we review the current knowledge of Tfr and the role they play focusing on human diseases and transplantation. We also discuss the potential future applications of Tfr therapy in transplantation and examine the evidence for a role of Tfr in antibody production, acute and chronic rejection and tertiary lymphoid organs. Furthermore, the potential impact of immunosuppression on Tfr will be explored. Based on preclinical research, we will analyse the rationale of Tfr therapy in solid organ transplantation and summarize the different challenges to be overcome before Tfr therapy can be implemented into clinical practice.
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Affiliation(s)
- Caroline Dudreuilh
- Department of Inflammation Biology, King's College London (KCL), Guy's Hospital, London, United Kingdom.,Centre for Nephrology, Urology and Transplantation, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom.,NIHR Biomedical Research Centre-Transplant Theme, Guy's Hospital, London, United Kingdom
| | - Sumoyee Basu
- Department of Inflammation Biology, King's College London (KCL), Guy's Hospital, London, United Kingdom.,Centre for Nephrology, Urology and Transplantation, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom.,NIHR Biomedical Research Centre-Transplant Theme, Guy's Hospital, London, United Kingdom
| | - Cristiano Scottà
- Centre for Nephrology, Urology and Transplantation, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom.,NIHR Biomedical Research Centre-Transplant Theme, Guy's Hospital, London, United Kingdom.,Peter Gorer Department of Immunobiology, School of Immunology and Microbial Science, King's College London (KCL), Guy's Hospital, London, United Kingdom
| | - Anthony Dorling
- Department of Inflammation Biology, King's College London (KCL), Guy's Hospital, London, United Kingdom.,Centre for Nephrology, Urology and Transplantation, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom.,NIHR Biomedical Research Centre-Transplant Theme, Guy's Hospital, London, United Kingdom
| | - Giovanna Lombardi
- Centre for Nephrology, Urology and Transplantation, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom.,NIHR Biomedical Research Centre-Transplant Theme, Guy's Hospital, London, United Kingdom.,Peter Gorer Department of Immunobiology, School of Immunology and Microbial Science, King's College London (KCL), Guy's Hospital, London, United Kingdom
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Dudreuilh C, Barbet C, Gatault P, Ferlicot S, Lebranchu Y, Rabot N, Beaudreuil S, Dürrbach A, Büchler M. Response to plasma exchange and graft survival in recurrent focal and segmental glomerulosclerosis after transplantation: does the time of recurrence matter? A retrospective study. Transpl Int 2020; 34:302-312. [PMID: 33275815 DOI: 10.1111/tri.13796] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/10/2020] [Accepted: 11/30/2020] [Indexed: 11/29/2022]
Abstract
Recurrence of primary focal and segmental glomerulosclerosis following kidney transplantation (rFSGS) is a frequent and severe disease. We studied the time to recurrence of FSGS and its impact on the response to plasma exchange (PE) and graft survival. Between 1990 and 2013, 2730 kidney transplants were performed, including 52 patients with a primary diagnosis of FSGS. Of these patients with primary FSGS, 34 (67%) developed rFSGS. We retrospectively divided these patients into two groups depending on the time to recurrence: early (up to three months after transplantation, n = 26) or late (more than three months after transplantation, n = 8). Survival did not significantly differ between the two groups. In cases of late recurrence, PE was started later and was performed less frequently, and remission was achieved after more PE sessions and longer PE treatment than for the early group (P = 0.01). In early recurrence, resistance to PE at 40 days was associated with no long-term response to PE. PE should be performed as soon as possible after rFSGS. Patients with late rFSGS need to be offered the same treatment regime as those with early rFSGS.
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Affiliation(s)
- Caroline Dudreuilh
- Department of Nephrology - Hypertension, Dialysis, Transplantation, CHRU, Tours, France.,EA4245 Dendritic Cells, Immunomodulation and Grafts, François-Rabelais University, Tours, France
| | - Christelle Barbet
- Department of Nephrology - Hypertension, Dialysis, Transplantation, CHRU, Tours, France.,EA4245 Dendritic Cells, Immunomodulation and Grafts, François-Rabelais University, Tours, France
| | - Philippe Gatault
- Department of Nephrology - Hypertension, Dialysis, Transplantation, CHRU, Tours, France.,EA4245 Dendritic Cells, Immunomodulation and Grafts, François-Rabelais University, Tours, France
| | - Sophie Ferlicot
- Department of Pathology, Bicetre University Hospital, Le Kremlin Bicêtre, France
| | - Yvon Lebranchu
- Department of Nephrology - Hypertension, Dialysis, Transplantation, CHRU, Tours, France.,EA4245 Dendritic Cells, Immunomodulation and Grafts, François-Rabelais University, Tours, France
| | - Nolwenn Rabot
- Department of Nephrology - Hypertension, Dialysis, Transplantation, CHRU, Tours, France.,EA4245 Dendritic Cells, Immunomodulation and Grafts, François-Rabelais University, Tours, France
| | - Severine Beaudreuil
- Nephrology Department, Hopitaux Universitaires Paris-Sud, APHP, Le Kremlin-Bicetre, France.,UMR 1197, University Paris Sud, INSERM, Paris-Saclay University, Villejuif, France
| | - Antoine Dürrbach
- Nephrology Department, Hopitaux Universitaires Paris-Sud, APHP, Le Kremlin-Bicetre, France.,UMR 1197, University Paris Sud, INSERM, Paris-Saclay University, Villejuif, France
| | - Matthias Büchler
- Department of Nephrology - Hypertension, Dialysis, Transplantation, CHRU, Tours, France.,EA4245 Dendritic Cells, Immunomodulation and Grafts, François-Rabelais University, Tours, France
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8
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Mohseni YR, Tung SL, Dudreuilh C, Lechler RI, Fruhwirth GO, Lombardi G. The Future of Regulatory T Cell Therapy: Promises and Challenges of Implementing CAR Technology. Front Immunol 2020; 11:1608. [PMID: 32793236 PMCID: PMC7393941 DOI: 10.3389/fimmu.2020.01608] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/16/2020] [Indexed: 12/18/2022] Open
Abstract
Cell therapy with polyclonal regulatory T cells (Tregs) has been translated into the clinic and is currently being tested in transplant recipients and patients suffering from autoimmune diseases. Moreover, building on animal models, it has been widely reported that antigen-specific Tregs are functionally superior to polyclonal Tregs. Among various options to confer target specificity to Tregs, genetic engineering is a particularly timely one as has been demonstrated in the treatment of hematological malignancies where it is in routine clinical use. Genetic engineering can be exploited to express chimeric antigen receptors (CAR) in Tregs, and this has been successfully demonstrated to be robust in preclinical studies across various animal disease models. However, there are several caveats and a number of strategies should be considered to further improve on targeting, efficacy and to understand the in vivo distribution and fate of CAR-Tregs. Here, we review the differing approaches to confer antigen specificity to Tregs with emphasis on CAR-Tregs. This includes an overview and discussion of the various approaches to improve CAR-Treg specificity and therapeutic efficacy as well as addressing potential safety concerns. We also discuss different imaging approaches to understand the in vivo biodistribution of administered Tregs. Preclinical research as well as suitability of methodologies for clinical translation are discussed.
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MESH Headings
- Animals
- Antigens/immunology
- Bioengineering
- Humans
- Immunomodulation
- Immunotherapy, Adoptive/methods
- Receptors, Antigen, T-Cell/genetics
- Receptors, Antigen, T-Cell/immunology
- Receptors, Antigen, T-Cell/metabolism
- Receptors, Chimeric Antigen/genetics
- Receptors, Chimeric Antigen/immunology
- Receptors, Chimeric Antigen/metabolism
- T-Cell Antigen Receptor Specificity
- T-Lymphocytes, Regulatory/immunology
- T-Lymphocytes, Regulatory/metabolism
- Treatment Outcome
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Affiliation(s)
- Yasmin R. Mohseni
- Peter Gorer Department of Immunobiology, MRC Centre for Transplantation, School of Immunology and Microbial Science, King's College London (KCL), Guy's Hospital, London, United Kingdom
| | - Sim L. Tung
- Peter Gorer Department of Immunobiology, MRC Centre for Transplantation, School of Immunology and Microbial Science, King's College London (KCL), Guy's Hospital, London, United Kingdom
| | - Caroline Dudreuilh
- Peter Gorer Department of Immunobiology, MRC Centre for Transplantation, School of Immunology and Microbial Science, King's College London (KCL), Guy's Hospital, London, United Kingdom
| | - Robert I. Lechler
- Peter Gorer Department of Immunobiology, MRC Centre for Transplantation, School of Immunology and Microbial Science, King's College London (KCL), Guy's Hospital, London, United Kingdom
| | - Gilbert O. Fruhwirth
- Imaging Therapies and Cancer Group, Department of Imaging Chemistry and Biology, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Giovanna Lombardi
- Peter Gorer Department of Immunobiology, MRC Centre for Transplantation, School of Immunology and Microbial Science, King's College London (KCL), Guy's Hospital, London, United Kingdom
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9
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Dudreuilh C, Moutzouris DA. Is SARS-CoV-2 Serology Relevant for Hemodialysis Patients With COVID-19? Am J Kidney Dis 2020; 76:598. [PMID: 32603711 PMCID: PMC7320864 DOI: 10.1053/j.ajkd.2020.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/13/2020] [Indexed: 02/01/2023]
Affiliation(s)
- Caroline Dudreuilh
- Renal Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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10
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Affiliation(s)
- Caroline Dudreuilh
- Department of Inflammation Biology, School of Immunology and Microbial Sciences, King's College London, Guy's Hospital, London, UK
| | - Anthony Dorling
- Department of Inflammation Biology, School of Immunology and Microbial Sciences, King's College London, Guy's Hospital, London, UK
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11
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Dudreuilh C, Kumar N, Moxham V, Hemsley C, Goldenberg S, Moutzouris DA. De-isolation of COVID-19-positive hemodialysis patients in the outpatient setting: a single-center experience. Kidney Int 2020; 98:236-237. [PMID: 32471644 PMCID: PMC7206422 DOI: 10.1016/j.kint.2020.04.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 01/12/2023]
Affiliation(s)
| | - Nicola Kumar
- Renal Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Vicki Moxham
- Renal Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Carolyn Hemsley
- Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Simon Goldenberg
- Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
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12
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Dudreuilh C, Fakhouri F, Vigneau C, Augusto JF, Machet MC, Rabot N, Chapal M, Charpy V, Barbet C, Büchler M, Halimi JM, Gatault P. The Presence of Renal IgG Deposits in Necrotizing Crescentic Glomerulonephritis Associated with ANCA Is Not Related to Worse Renal Clinical Outcomes. Kidney Dis (Basel) 2019; 6:98-108. [PMID: 32309292 DOI: 10.1159/000503969] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 10/08/2019] [Indexed: 11/19/2022]
Abstract
Introduction Classical pauci-immune necrotizing crescentic glomerulonephritis (CGN) associated with antineutrophil cytoplasmic autoantibodies (ANCA) is characterized by the absence of renal immunoglobulin (Ig) deposits. However, IgG deposits can sometimes be present. We wanted to assess whether necrotizing CGN with IgG deposits is associated with a more severe presentation and outcome than necrotizing CGN without IgG deposits. Methods Between November 2008 and August 2013, we retrospectively identified 158 patients from four centers who had necrotizing CGN due to primary ANCA-associated systemic vasculitis. Glomerular IgG deposits were found in 18 (11%) patients (group 1). For each patient in group 1, we selected 2 patients with classical pauci-immune necrotizing CGN with the nearest date of diagnosis in the same center (group 2, n = 36). We assessed clinical, biological, and pathological characteristics in both groups. Results Baseline characteristics were similar in both groups, and most patients had ANCA-associated vasculitis with antibodies to myeloperoxidase (74%). Deposits displayed moderate to strong staining in 9 patients. As compared with group 2, group 1 exhibited a higher frequency of interstitial fibrosis/tubular atrophy lesions (p = 0.024) and lower frequency of acute tubular necrosis (p = 0.046). Nevertheless, after a mean follow-up of 30 and 26 months for group 1 and group 2, respectively, IgG deposits did not affect the renal prognosis or probability of relapse. Finally, the groups did not differ in renal or patient survival. Conclusions IgG deposits, detected in 11% of patients with ANCA-associated necrotizing CGN, did not affect renal or patient outcomes.
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Affiliation(s)
- Caroline Dudreuilh
- Department of Nephrology - Hypertension, Dialysis, Transplantation, CHRU, Tours, France
| | - Fadi Fakhouri
- Department of Nephrology and Immunology and INSERM UMR S-1064, CHU, Nantes, France
| | - Cécile Vigneau
- Department of Nephrology, CHU Hôpital de Pontchaillou, Rennes, France
| | | | | | - Nolwenn Rabot
- Department of Nephrology - Hypertension, Dialysis, Transplantation, CHRU, Tours, France
| | - Marion Chapal
- Department of Nephrology and Immunology and INSERM UMR S-1064, CHU, Nantes, France
| | - Vianney Charpy
- Department of Nephrology and Immunology and INSERM UMR S-1064, CHU, Nantes, France
| | - Christelle Barbet
- Department of Nephrology - Hypertension, Dialysis, Transplantation, CHRU, Tours, France
| | - Matthias Büchler
- Department of Nephrology - Hypertension, Dialysis, Transplantation, CHRU, Tours, France
| | - Jean-Michel Halimi
- Department of Nephrology - Hypertension, Dialysis, Transplantation, CHRU, Tours, France
| | - Philippe Gatault
- Department of Nephrology - Hypertension, Dialysis, Transplantation, CHRU, Tours, France
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13
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Beaudreuil S, Zhang X, Herr F, Harper F, Candelier JJ, Fan Y, Yeter H, Dudreuilh C, Lecru L, Vazquez A, Charpentier B, Lorenzo HK, Durrbach A. Circulating CASK is associated with recurrent focal segmental glomerulosclerosis after transplantation. PLoS One 2019; 14:e0219353. [PMID: 31356645 PMCID: PMC6663006 DOI: 10.1371/journal.pone.0219353] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 06/21/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Focal and Segmental GlomeruloSclerosis (FSGS) can cause nephrotic syndrome with a risk of progression to end-stage renal disease. The idiopathic form has a high rate of recurrence after transplantation, suggesting the presence of a systemic circulating factor that causes glomerular permeability and can be removed by plasmapheresis or protein-A immunoadsorption. Results To identify this circulating factor, the eluate proteins bound on therapeutic immunoadsorption with protein-A columns were analyzed by comparative electrophoresis and mass spectrometry. A soluble form of calcium/calmodulin-dependent serine protein kinase (CASK) was identified. CASK was immunoprecipitated only in the sera of patients with recurrent FSGS after transplantation and not in control patients. Recombinant-CASK (rCASK) induced the reorganization of the actin cytoskeleton in immortalized podocytes, a redistribution of synaptopodin, ZO-1,vinculin and ENA. rCASK also induced alterations in the permeability of a monolayer of podocytes and increased the motility of pdodocytes in vitro. The extracellular domain of CD98, a transmembrane receptor expressed on renal epithelial cells, has been found to co-immunoprecipitated with rCASK. The invalidation of CD98 with siRNA avoided the structural changes of rCask treated cells suggesting its involvement in physiopathology of the disease. In mice, recombinant CASK induced proteinuria and foot process effacement in podocytes. Conclusion Our results suggest that CASK can induce the recurrence of FSGS after renal transplantation.
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Affiliation(s)
- Severine Beaudreuil
- IFRNT, Department of Nephrology, Bicêtre Hospital, University of Paris-Sud, Le Kremlin-Bicêtre, France
- INSERM U1197, Villejuif, France
| | | | | | - Francis Harper
- CNRS, UMR 8122, Institut Gustave Roussy, Villejuif, France
| | | | - Ye Fan
- INSERM U1197, Villejuif, France
| | | | - Caroline Dudreuilh
- IFRNT, Department of Nephrology, Bicêtre Hospital, University of Paris-Sud, Le Kremlin-Bicêtre, France
- INSERM U1197, Villejuif, France
| | | | | | - Bernard Charpentier
- IFRNT, Department of Nephrology, Bicêtre Hospital, University of Paris-Sud, Le Kremlin-Bicêtre, France
- INSERM U1197, Villejuif, France
| | - Hans K. Lorenzo
- IFRNT, Department of Nephrology, Bicêtre Hospital, University of Paris-Sud, Le Kremlin-Bicêtre, France
- INSERM U1197, Villejuif, France
- * E-mail: (AD); (HKL)
| | - Antoine Durrbach
- IFRNT, Department of Nephrology, Bicêtre Hospital, University of Paris-Sud, Le Kremlin-Bicêtre, France
- INSERM U1197, Villejuif, France
- * E-mail: (AD); (HKL)
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14
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Lesouhaitier M, Dudreuilh C, Tamain M, Kanaan N, Bailly E, Legoupil D, Deltombe C, Perrin P, Houot R, Vigneau C. Utilisation des inhibiteurs de checkpoints chez les greffés rénaux. Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.371] [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: 10/28/2022]
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15
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Lesouhaitier M, Dudreuilh C, Tamain M, Kanaan N, Bailly E, Legoupil D, Deltombe C, Perrin P, Manson G, Vigneau C, Houot R. Checkpoint blockade after kidney transplantation. Eur J Cancer 2018; 96:111-114. [PMID: 29705511 DOI: 10.1016/j.ejca.2018.03.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/17/2018] [Indexed: 12/11/2022]
Affiliation(s)
| | - Caroline Dudreuilh
- Department of Nephrology and Renal Transplantation, Institut Francilien de Recherche en Néphrologie et Transplantation (IFRNT), Groupe Hospitalier Henri-Mondor/Albert-Chenevier, AP-HP (Assistance Publique-Hôpitaux de Paris), Créteil, France; DHU (Département Hospitalo-Universitaire), VIC (Virus-Immunité-Cancer), Université Paris-Est-Créteil (UPEC), IMRB (Institut Mondor de Recherche Biomédicale), Equipe 21, INSERM U 955, Créteil, France
| | - Mathilde Tamain
- Division of Nephrology, CHU Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, Clermont-Ferrand, France
| | - Nada Kanaan
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Elodie Bailly
- Department of Nephrology and Kidney Transplantation, University Hospital of Tours, France; Université François Rabelais, Tours, France
| | | | - Clement Deltombe
- Institute for Transplantation, Urology and Nephrology (ITUN), Nantes University Hospital, Nantes, France
| | - Peggy Perrin
- Nephrology-Transplantation Department, University Hospital, Strasbourg, France
| | | | - Cécile Vigneau
- CHU Pontchaillou, Division of Nephrology, Rennes, France; Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR 1085, Rennes, France
| | - Roch Houot
- CHU Pontchaillou, Department of Hematology, Rennes, France; INSERM, U1236, Rennes, France.
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16
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Dudreuilh C, Aguiar R, Ostermann M. Acute kidney injury in kidney transplant patients. Acute Med 2018; 17:31-35. [PMID: 29589603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Managing kidney transplant patients in an acute medical unit can be challenging, as patients have a single functioning kidney, underlying chronic kidney disease, and are immunosuppressed. Transplant patients develop AKI for all usual reasons but the differential diagnosis is wider and includes specific problems, such as obstruction of a single functioning kidney, vascular thrombosis, rejection, drug toxicity and drug-induced thrombotic microangiopathy. Septic AKI is common but again, the differential diagnosis of sepsis is wider. Transplant patients are at higher risk of developing both community and opportunistic infections, especially in the first year after the transplant or after any increase in immunosuppressive medication. In addition, there is always a risk of rejection, especially in case of reduction of immunosuppressive medications. Therefore, any change in the immunosuppressive therapy should to be discussed with the transplant team to achieve an appropriate balance between avoiding rejection and preventing opportunistic infections.
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Affiliation(s)
- C Dudreuilh
- Senior Clinical Fellow in Transplantation and Renal Medicine Departments of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - R Aguiar
- Clinical Fellow in Transplantation and Renal Medicine Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Ostermann
- Consultant in Critical Care & Nephrology Guy's & St Thomas' Hospital London
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17
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Stehlé T, Bartolucci P, Bouanane M, Galacteros F, Dudreuilh C, Grimbert P, Deux J, Audard V. Reversible kidney iron accumulation in a patient with sickle cell disease treated with hydroxyurea. Am J Hematol 2016; 91:1283-1284. [PMID: 27570100 DOI: 10.1002/ajh.24544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/24/2016] [Accepted: 08/25/2016] [Indexed: 11/12/2022]
Affiliation(s)
- Thomas Stehlé
- AP‐HP (Assistance Publique‐Hôpitaux de Paris, Créteil), Service de Néphrologie et TransplantationInstitut Francilien de Recherche en Néphrologie et Transplantation (IFRNT), Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Groupe Hospitalier Henri Mondor‐Albert ChenevierCréteilF‐94010 France
- Université Paris‐Est‐Créteil, (UPEC), DHU (Département Hospitalo‐Universitaire) VIC (Virus‐Immunité‐Cancer), IMRB (Institut Mondor de Recherche Biomédicale), INSERM U 955CréteilF‐94000 France
| | - Pablo Bartolucci
- AP‐HP, Centre de Référence des Syndromes Drépanocytaires Majeurs, Groupe Hospitalier Henri Mondor‐Albert ChenevierCréteilF‐94010 France
- AP‐HP, Service de Médecine InterneGroupe Hospitalier Henri Mondor‐Albert ChenevierCréteilF‐94010 France
- UPEC, IMRB, INSERM 955CréteilF‐94010 France
| | - Mohamed Bouanane
- AP‐HP, Service d'Imagerie MédicaleUPEC, Groupe Hospitalier Henri Mondor‐Albert ChenevierCréteilF‐94010 France
| | - Frederic Galacteros
- AP‐HP, Centre de Référence des Syndromes Drépanocytaires Majeurs, Groupe Hospitalier Henri Mondor‐Albert ChenevierCréteilF‐94010 France
- AP‐HP, Service de Médecine InterneGroupe Hospitalier Henri Mondor‐Albert ChenevierCréteilF‐94010 France
- UPEC, IMRB, INSERM 955CréteilF‐94010 France
| | - Caroline Dudreuilh
- AP‐HP (Assistance Publique‐Hôpitaux de Paris, Créteil), Service de Néphrologie et TransplantationInstitut Francilien de Recherche en Néphrologie et Transplantation (IFRNT), Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Groupe Hospitalier Henri Mondor‐Albert ChenevierCréteilF‐94010 France
- Université Paris‐Est‐Créteil, (UPEC), DHU (Département Hospitalo‐Universitaire) VIC (Virus‐Immunité‐Cancer), IMRB (Institut Mondor de Recherche Biomédicale), INSERM U 955CréteilF‐94000 France
| | - Philippe Grimbert
- AP‐HP (Assistance Publique‐Hôpitaux de Paris, Créteil), Service de Néphrologie et TransplantationInstitut Francilien de Recherche en Néphrologie et Transplantation (IFRNT), Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Groupe Hospitalier Henri Mondor‐Albert ChenevierCréteilF‐94010 France
- Université Paris‐Est‐Créteil, (UPEC), DHU (Département Hospitalo‐Universitaire) VIC (Virus‐Immunité‐Cancer), IMRB (Institut Mondor de Recherche Biomédicale), INSERM U 955CréteilF‐94000 France
| | - Jean‐François Deux
- AP‐HP, Service d'Imagerie MédicaleUPEC, Groupe Hospitalier Henri Mondor‐Albert ChenevierCréteilF‐94010 France
| | - Vincent Audard
- AP‐HP (Assistance Publique‐Hôpitaux de Paris, Créteil), Service de Néphrologie et TransplantationInstitut Francilien de Recherche en Néphrologie et Transplantation (IFRNT), Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Groupe Hospitalier Henri Mondor‐Albert ChenevierCréteilF‐94010 France
- Université Paris‐Est‐Créteil, (UPEC), DHU (Département Hospitalo‐Universitaire) VIC (Virus‐Immunité‐Cancer), IMRB (Institut Mondor de Recherche Biomédicale), INSERM U 955CréteilF‐94000 France
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Attias P, Moktefi A, Matignon M, Haioun C, Desvaux D, Goujon J, Debiais C, Moroch J, Dudreuilh C, Grimbert P, Lang P, Audard V. Néphrite interstitielle à plasmocytes chez un patient avec une gammapathie monoclonale d’allure bénigne. Nephrol Ther 2016. [DOI: 10.1016/j.nephro.2016.07.256] [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: 10/21/2022]
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19
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Arrestier R, Dudreuilh C, Remy P, Boulahia G, Bentaarit B, Leibler C, Adedjouma A, Kofman T, Matignon M, Sahali D, Dufresne R, Deux JF, Colin C, Grimbert P, Lang P, Bartolucci P, Maitre B, Tran Van Nhieu J, Audard V. Successful Treatment of Lung Calciphylaxis With Sodium Thiosulfate in a Patient With Sickle Cell Disease: A Case Report. Medicine (Baltimore) 2016; 95:e2768. [PMID: 26871829 PMCID: PMC4753925 DOI: 10.1097/md.0000000000002768] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Calciphylaxis is a small vessel vasculopathy, characterized by medial wall calcification that develops in a few patients with chronic renal failure. The prognosis of skin calciphylaxis has improved considerably since the introduction of sodium thiosulfate (STS), but it remains unclear whether this therapy is effective against organ lesions related to calciphylaxis. Pulmonary calciphylaxis is a usually fatal medical condition that may occur in association with skin involvement in patients with end-stage renal disease.We report here the case of a 49-year-old woman homozygous sickle cell disease patient on chronic hemodialysis with biopsy-proven systemic calciphylaxis involving the lungs and skin. On admission, ulcerative skin lesions on the lower limbs and bilateral pulmonary infiltrates on chest computerized tomography scan were the main clinical and radiological findings. Skin and bronchial biopsies demonstrated calciphylaxis lesions. The intravenous administration of STS in association with cinacalcet for 8 consecutive months led to a clear improvement in skin lesions and thoracic lesions on chest computerized tomography scan.This case suggests for the first time that organ lesions related to calciphylaxis, and particularly lung injury, are potentially reversible. This improvement probably resulted from the combination of 3 interventions (more frequent dialysis, cinacalcet, and STS), rather than the administration of STS alone.
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Affiliation(s)
- Romain Arrestier
- From the Service de Néphrologie et Transplantation, Hôpitaux Universitaires Henri Mondor, Centre de référence maladie rare Syndrome Néphrotique Idiopathique, Institut Francilien de recherche en Néphrologie et Transplantation (IFRNT), AP-HP (Assistance Publique-Hôpitaux de Paris), Créteil, France (RA, CD, PR, GB, BB, CL, AD, TK, MM, DS, PG, PL, VA); Equipe 21, INSERM Unité 955 (RA, CD, PR, GB, BB, CL, AD, TK, MM, DS, PG, PL, VA); Centre de Dialyse des Nouvelles Eaux Vives, 97100 Basse-Terre, Guadeloupe (RD); Service d'Imagerie Médicale, Hôpitaux Universitaires Henri Mondor, APHP, UPEC, Créteil, France (J-FD); Service de Pneumologie, Hôpitaux Universitaires Henri Mondor, APHP, UPEC, Créteil, France (CC, BM); Centre de Référence des Syndromes Drépanocytaires Majeurs, Hôpitaux Universitaires Henri Mondor, APHP, UPEC, Créteil, France (PB); and Département de Pathologie, Hôpitaux Universitaires Henri Mondor, APHP, UPEC, Créteil, France (J-TVN), Créteil, France
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Dudreuilh C, Fakhouri F, Vigneau C, Augusto JF, Machet MC, Rabot N, Halimi JM, Gatault P. SP152PRESENCE OF RENAL IMMUNOGLOBULIN G DEPOSITS IN NECROTIZING CRESCENTIC GLOMERULONEPHRITIS ASSOCIATED TO ANCA : A CLINICAL IMPACT ? Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv189.25] [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: 11/12/2022] Open
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