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Gaumond L, Lamarche C, Beauchemin S, Henley N, Elftouh N, Gerarduzzi C, Laurin LP. Identification of inflammatory biomarkers in IgA nephropathy using the NanoString technology: a validation study in Caucasians. Inflamm Res 2024; 73:447-457. [PMID: 38291238 PMCID: PMC10894174 DOI: 10.1007/s00011-023-01848-3] [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: 10/13/2023] [Revised: 12/16/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVE AND DESIGN Immunoglobulin A nephropathy (IgAN) is a kidney disease characterized by the accumulation of IgA deposits in the glomeruli of the kidney, leading to inflammation and damage to the kidney. The inflammatory markers involved in IgAN remain to be defined. Gene expression analysis platforms, such as the NanoString nCounter system, are promising screening and diagnostic tools, especially in oncology. Still, their role as a diagnostic and prognostic tool in IgAN remains scarce. In this study, we aimed to validate the use of NanoString technology to identify potential inflammatory biomarkers involved in the progression of IgAN. SUBJECTS A total of 30 patients with biopsy-proven IgAN and 7 cases of antineutrophil cytoplasmic antibody (ANCA)-associated pauci-immune glomerulonephritis were included for gene expression measurement. For the immunofluorescence validation experiments, a total of 6 IgAN patients and 3 controls were included. METHODS Total RNA was extracted from formalin-fixed paraffin-embedded kidney biopsy specimens, and a customized 48-plex human gene CodeSet was used to study 29 genes implicated in different biological pathways. Comparisons in gene expression were made between IgAN and ANCA-associated pauci-immune glomerulonephritis patients to delineate an expression profile specific to IgAN. Gene expression was compared between patients with low and moderate risk of progression. Genes for which RNA expression was associated with disease progression were analyzed for protein expression by immunofluorescence and compared with controls. RESULTS IgAN patients had a distinct gene expression profile with decreased expression in genes IL-6, INFG, and C1QB compared to ANCA patients. C3 and TNFRSF1B were identified as potential biomarkers for IgAN progression in patients early in their disease course. Protein expression for those 2 candidate genes was upregulated in IgAN patients compared to controls. Expression of genes implicated in fibrosis (PTEN, CASPASE 3, TGM2, TGFB1, IL2, and TNFRSF1B) was more pronounced in IgAN patients with severe fibrosis compared to those with none. CONCLUSIONS Our findings validate our NanoString mRNA profiling by examining protein expression levels of two candidate genes, C3 and TNFRSF1B, in IgAN patients and controls. We also identified several upregulated mRNA transcripts implicated in the development of fibrosis that may be considered fibrotic markers within IgAN patients.
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Affiliation(s)
- Laurence Gaumond
- Division of Nephrology, Maisonneuve-Rosemont Hospital, 5415 Boulevard de l'Assomption, Montreal, QC, H1T 2M4, Canada
| | - Caroline Lamarche
- Division of Nephrology, Maisonneuve-Rosemont Hospital, 5415 Boulevard de l'Assomption, Montreal, QC, H1T 2M4, Canada
- Research Center, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
- Department of Medicine, University of Montreal, Montreal, QC, Canada
| | | | - Nathalie Henley
- Research Center, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Naoual Elftouh
- Research Center, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Casimiro Gerarduzzi
- Research Center, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada.
- Department of Medicine, University of Montreal, Montreal, QC, Canada.
| | - Louis-Philippe Laurin
- Division of Nephrology, Maisonneuve-Rosemont Hospital, 5415 Boulevard de l'Assomption, Montreal, QC, H1T 2M4, Canada.
- Research Center, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada.
- Department of Medicine, University of Montreal, Montreal, QC, Canada.
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Myette RL, Lamarche C, Odutayo A, Verdin N, Canney M. Cardiovascular Risk in Patients With Glomerular Disease: A Narrative Review of the Epidemiology, Mechanisms, Management, and Patient Priorities. Can J Kidney Health Dis 2024; 11:20543581241232472. [PMID: 38404647 PMCID: PMC10894549 DOI: 10.1177/20543581241232472] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 01/09/2024] [Indexed: 02/27/2024] Open
Abstract
Purpose of review Cardiovascular (CV) disease is a major cause of morbidity and mortality for patients with glomerular disease. Despite the fact that mechanisms underpinning CV disease risk in this population are likely distinct from other forms of kidney disease, treatment and preventive strategies tend to be extrapolated from studies of patients with undifferentiated chronic kidney disease (CKD). There is an unmet need to delineate the pathophysiology of CV disease in patients with glomerular disease, establish unique risk factors, and identify novel therapeutic targets for disease prevention. The aims of this narrative review are to summarize the existing knowledge regarding the epidemiology, molecular mechanisms, and management of CV disease in patients with common glomerular disease, highlight the patient perspective, and propose specific areas for future study. Sources of information The literature for this narrative review was accessed using common research search engines, including PubMed, PubMed Central, Medline, and Google Scholar. Information for the patient perspective section was collected through iterative discussions with a patient partner. Methods We reviewed the epidemiology, molecular mechanisms of disease, management approaches, and the patient perspective in relation to CV disease in patients with glomerulopathies. Throughout, we have highlighted the current knowledge and have discussed future research approaches, both clinical and translational, while integrating the patient perspective. Key findings Patients with glomerular disease have significant CV disease risk driven by multifactorial, molecular mechanisms originating from their glomerular disease but complicated by existing comorbidities, kidney disease, and medication side effects. The current approach to risk stratification and treatment relies heavily on existing data from CKD patients, but this may not always be appropriate given the unique pathophysiology and mechanisms associated with CV disease risk in patients with glomerular disease. We highlight the need for ongoing glomerular disease-focused studies aimed to better delineate CV disease risk, while integrating the patient perspective. Limitations This is a narrative review and does not represent a comprehensive and systematic review of the literature.
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Affiliation(s)
- Robert L. Myette
- Division of Nephrology, Children’s Hospital of Eastern Ontario, Ottawa, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Caroline Lamarche
- Hôpital Maisonneuve-Rosemont Research Center, Department of Medicine, Division of Nephrology, Université de Montréal, ON, Canada
| | - Ayodele Odutayo
- Division of Nephrology, University Health Network, Toronto, ON, Canada
| | | | - Mark Canney
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, ON, Canada
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3
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Requejo Cier CJ, Valentini N, Lamarche C. Unlocking the potential of Tregs: innovations in CAR technology. Front Mol Biosci 2023; 10:1267762. [PMID: 37900916 PMCID: PMC10602912 DOI: 10.3389/fmolb.2023.1267762] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/20/2023] [Indexed: 10/31/2023] Open
Abstract
Regulatory T cells (Tregs) adoptive immunotherapy is emerging as a viable treatment option for both autoimmune and alloimmune diseases. However, numerous challenges remain, including limitations related to cell number, availability of target-specific cells, stability, purity, homing ability, and safety concerns. To address these challenges, cell engineering strategies have emerged as promising solutions. Indeed, it has become feasible to increase Treg numbers or enhance their stability through Foxp3 overexpression, post-translational modifications, or demethylation of the Treg-specific demethylated region (TSDR). Specificity can be engineered by the addition of chimeric antigen receptors (CARs), with new techniques designed to fine-tune specificity (tandem chimeric antigen receptors, universal chimeric antigen receptors, synNotch chimeric antigen receptors). The introduction of B-cell targeting antibody receptor (BAR) Tregs has paved the way for effective regulation of B cells and plasma cells. In addition, other constructs have emerged to enhance Tregs activation and function, such as optimized chimeric antigen receptors constructs and the use of armour proteins. Chimeric antigen receptor expression can also be better regulated to limit tonic signaling. Furthermore, various opportunities exist for enhancing the homing capabilities of CAR-Tregs to improve therapy outcomes. Many of these genetic modifications have already been explored for conventional CAR-T therapy but need to be further considered for CAR-Tregs therapies. This review highlights innovative CAR-engineering strategies that have the potential to precisely and efficiently manage immune responses in autoimmune diseases and improve transplant outcomes. As these strategies are further explored and optimized, CAR-Treg therapies may emerge as powerful tools for immune intervention.
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Affiliation(s)
- Christopher J. Requejo Cier
- Department of Microbiology, Infectiology and Immunology, Hôpital Maisonneuve-Rosemont Research Institute, Université de Montréal, Montreal, QC, Canada
| | - Nicolas Valentini
- Department of Microbiology, Infectiology and Immunology, Hôpital Maisonneuve-Rosemont Research Institute, Université de Montréal, Montreal, QC, Canada
| | - Caroline Lamarche
- Department of Medicine, Hôpital Maisonneuve-Rosemont Research Institute, Université de Montréal, Montreal, QC, Canada
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4
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Valentini N, Requejo Cier CJ, Lamarche C. Regulatory T-cell dysfunction and its implication for cell therapy. Clin Exp Immunol 2023; 213:40-49. [PMID: 37158407 PMCID: PMC10324551 DOI: 10.1093/cei/uxad051] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/16/2022] [Revised: 03/04/2023] [Accepted: 05/05/2023] [Indexed: 05/10/2023] Open
Abstract
Regulatory T cells (Tregs) are a subtype of CD4+ T cells that can mediate immune tolerance by a multitude of immunomodulatory mechanisms. Treg-based adoptive immunotherapy is currently being tested in multiple phases I and II clinical trials in transplantation and autoimmune diseases. We have learned from the work done on conventional T cells that distinct mechanistic states can define their dysfunctions, such as exhaustion, senescence, and anergy. All three can negatively impact the therapeutic effectiveness of T-cell-based therapies. However, whether Tregs are susceptible to such dysfunctional states is not well studied, and results are sometimes found to be controversial. In addition, Treg instability and loss of FOXP3 expression is another Treg-specific dysfunction that can decreasein their suppressive potential. A better understanding of Treg biology and pathological states will be needed to compare and interpret the results of the different clinical and preclinical trials. We will review herein Tregs' mechanisms of action, describe different T-cell dysfunction subtypes and how and if they apply to Tregs (exhaustion, senescence, anergy, and instability), and finally how this knowledge should be taken into consideration when designing and interpreting Treg adoptive immunotherapy trials.
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Affiliation(s)
- Nicolas Valentini
- Medicine Department, Hôpital Maisonneuve-Rosemont Research Center, Montreal, QC, Canada
- Microbiology, Infectiology and Immunology Department, Université de Montréal, Montreal, QC, Canada
| | - Christopher J Requejo Cier
- Medicine Department, Hôpital Maisonneuve-Rosemont Research Center, Montreal, QC, Canada
- Microbiology, Infectiology and Immunology Department, Université de Montréal, Montreal, QC, Canada
| | - Caroline Lamarche
- Medicine Department, Hôpital Maisonneuve-Rosemont Research Center, Montreal, QC, Canada
- Medicine Department, Université de Montréal, Montreal, QC, Canada
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5
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Roy G, Iordachescu I, Royal V, Lamarche C, Ahmad I, Nadeau-Fredette AC, Laurin LP. Kidney Biopsy Findings Among Allogenic Hematopoietic Stem Cell Transplant Recipients With Kidney Injury: A Case Series. Kidney Med 2023; 5:100674. [PMID: 37492111 PMCID: PMC10363560 DOI: 10.1016/j.xkme.2023.100674] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
Rationale and Objective The incidence of kidney disease is high in patients after allogeneic hematopoietic cell transplantation (aHCT). Although rarely performed, kidney biopsy may be useful to make a precise diagnosis because several mechanisms and risk factors can be involved, and to adjust the treatment accordingly. This case series aimed to report the spectrum of biopsy findings from patients with kidney injury after aHCT. Study Design Single-center retrospective case series. Setting and Participants All individuals who underwent a native kidney biopsy, among all adult patients who received aHCT in a tertiary hospital in Montreal (Canada) from January 1, 2010, to December 31, 2020, were identified, and the clinical data were extracted from their medical records. Results A total of 17 patients were included. Indications for biopsy included acute kidney injury (n=6), chronic kidney disease (n=5), nephrotic syndrome (n=4), and subnephrotic proteinuria (n=2). Pathologic findings from the kidney biopsy were heterogenous: 10 patients showed evidence of thrombotic microangiopathy (TMA), 5 of acute tubular injury, and 4 of membranous nephropathy. Cases of acute interstitial nephritis, BK virus nephropathy, immune complex nephropathy, focal and segmental glomerulosclerosis, minimal change disease, and karyomegalic-like interstitial nephritis were also described. Limitations There was no systematic kidney biopsy performed for all patients with kidney injury after aHCT. Only a small proportion of patients with kidney damage underwent biopsy, making the results less generalizable. Conclusions Kidney biopsy is useful in patients with kidney disease after aHCT to make a precise diagnosis and tailor therapy accordingly. This series is one of the few published studies describing pathologic findings of biopsies performed after aHCT in the context of acute kidney injury and chronic kidney disease. TMA was widely present on biopsy even when there was no clinical suspicion of such a diagnosis, suggesting that the current clinical criteria for a diagnosis of TMA are not sensitive enough for kidney-limited TMA.
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Affiliation(s)
- Guillaume Roy
- Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Ilinca Iordachescu
- Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Virginie Royal
- Department of Pathology, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
- Department of Pathology and Cellular Biology, University of Montreal, Montreal, Quebec, Canada
| | - Caroline Lamarche
- Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Imran Ahmad
- Division of Hematology, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Annie-Claire Nadeau-Fredette
- Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Louis-Philippe Laurin
- Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
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6
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Lamarche C, Ward-Hartstonge K, Mi T, Lin DTS, Huang Q, Brown A, Edwards K, Novakovsky GE, Qi CN, Kobor MS, Zebley CC, Weber EW, Mackall CL, Levings MK. Tonic-signaling chimeric antigen receptors drive human regulatory T cell exhaustion. Proc Natl Acad Sci U S A 2023; 120:e2219086120. [PMID: 36972454 PMCID: PMC10083618 DOI: 10.1073/pnas.2219086120] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 11/11/2022] [Accepted: 02/24/2023] [Indexed: 03/29/2023] Open
Abstract
Regulatory T cell (Treg) therapy is a promising approach to improve outcomes in transplantation and autoimmunity. In conventional T cell therapy, chronic stimulation can result in poor in vivo function, a phenomenon termed exhaustion. Whether or not Tregs are also susceptible to exhaustion, and if so, if this would limit their therapeutic effect, was unknown. To "benchmark" exhaustion in human Tregs, we used a method known to induce exhaustion in conventional T cells: expression of a tonic-signaling chimeric antigen receptor (TS-CAR). We found that TS-CAR-expressing Tregs rapidly acquired a phenotype that resembled exhaustion and had major changes in their transcriptome, metabolism, and epigenome. Similar to conventional T cells, TS-CAR Tregs upregulated expression of inhibitory receptors and transcription factors such as PD-1, TIM3, TOX and BLIMP1, and displayed a global increase in chromatin accessibility-enriched AP-1 family transcription factor binding sites. However, they also displayed Treg-specific changes such as high expression of 4-1BB, LAP, and GARP. DNA methylation analysis and comparison to a CD8+ T cell-based multipotency index showed that Tregs naturally exist in a relatively differentiated state, with further TS-CAR-induced changes. Functionally, TS-CAR Tregs remained stable and suppressive in vitro but were nonfunctional in vivo, as tested in a model of xenogeneic graft-versus-host disease. These data are the first comprehensive investigation of exhaustion in Tregs and reveal key similarities and differences with exhausted conventional T cells. The finding that human Tregs are susceptible to chronic stimulation-driven dysfunction has important implications for the design of CAR Treg adoptive immunotherapy strategies.
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Affiliation(s)
- Caroline Lamarche
- Department of Surgery, University of British Columbia, VancouverV6T 1Z4, BC, Canada
- BC Children’s Hospital Research Institute, VancouverV5Z 4H4, BC, Canada
- Department of Medicine, Hôpital Maisonneuve-Rosemont Research Center, Université de Montréal, MontrealH1T 2M4, QC, Canada
| | - Kirsten Ward-Hartstonge
- Department of Surgery, University of British Columbia, VancouverV6T 1Z4, BC, Canada
- BC Children’s Hospital Research Institute, VancouverV5Z 4H4, BC, Canada
- Department of Microbiology and Immunology, University of Otago, Dunedin9016, New Zealand
| | - Tian Mi
- Department of Immunology, St. Jude Children’s Research Hospital, Memphis, TN38105
| | - David T. S. Lin
- BC Children’s Hospital Research Institute, VancouverV5Z 4H4, BC, Canada
- Department of Medical Genetics, University of British Columbia, VancouverV6T 1Z4, BC, Canada
| | - Qing Huang
- Department of Surgery, University of British Columbia, VancouverV6T 1Z4, BC, Canada
- BC Children’s Hospital Research Institute, VancouverV5Z 4H4, BC, Canada
| | - Andrew Brown
- BC Children’s Hospital Research Institute, VancouverV5Z 4H4, BC, Canada
- School of Biomedical Engineering, University of British Columbia, VancouverV6T 1Z4, BC, Canada
| | - Karlie Edwards
- BC Children’s Hospital Research Institute, VancouverV5Z 4H4, BC, Canada
- Department of Medical Genetics, University of British Columbia, VancouverV6T 1Z4, BC, Canada
| | - Gherman E. Novakovsky
- BC Children’s Hospital Research Institute, VancouverV5Z 4H4, BC, Canada
- Department of Medical Genetics, University of British Columbia, VancouverV6T 1Z4, BC, Canada
| | - Christopher N. Qi
- Department of Surgery, University of British Columbia, VancouverV6T 1Z4, BC, Canada
- BC Children’s Hospital Research Institute, VancouverV5Z 4H4, BC, Canada
| | - Michael S. Kobor
- BC Children’s Hospital Research Institute, VancouverV5Z 4H4, BC, Canada
- Department of Medical Genetics, University of British Columbia, VancouverV6T 1Z4, BC, Canada
| | - Caitlin C. Zebley
- Department of Immunology, St. Jude Children’s Research Hospital, Memphis, TN38105
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children’s Research Hospital, Memphis, TN38105
| | - Evan W. Weber
- Division of Oncology, Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA19104
| | - Crystal L. Mackall
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA94305
- Department of Medicine, Stanford University School of Medicine, Stanford, CA94305
| | - Megan K Levings
- Department of Surgery, University of British Columbia, VancouverV6T 1Z4, BC, Canada
- BC Children’s Hospital Research Institute, VancouverV5Z 4H4, BC, Canada
- School of Biomedical Engineering, University of British Columbia, VancouverV6T 1Z4, BC, Canada
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7
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Sannier G, Nicolas A, Dubé M, Marchitto L, Nayrac M, Tastet O, Chatterjee D, Tauzin A, Lima-Barbosa R, Laporte M, Cloutier R, Sreng Flores AM, Boutin M, Gong SY, Benlarbi M, Ding S, Bourassa C, Gendron-Lepage G, Medjahed H, Goyette G, Brassard N, Delgado GG, Niessl J, Gokool L, Morrisseau C, Arlotto P, Rios N, Tremblay C, Martel-Laferrière V, Prat A, Bélair J, Beaubien-Souligny W, Goupil R, Nadeau-Fredette AC, Lamarche C, Finzi A, Suri RS, Kaufmann DE. A third SARS-CoV-2 mRNA vaccine dose in people receiving hemodialysis overcomes B cell defects but elicits a skewed CD4 + T cell profile. Cell Rep Med 2023; 4:100955. [PMID: 36863335 PMCID: PMC9902290 DOI: 10.1016/j.xcrm.2023.100955] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/27/2022] [Accepted: 02/02/2023] [Indexed: 02/10/2023]
Abstract
Cellular immune defects associated with suboptimal responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccination in people receiving hemodialysis (HD) are poorly understood. We longitudinally analyze antibody, B cell, CD4+, and CD8+ T cell vaccine responses in 27 HD patients and 26 low-risk control individuals (CIs). The first two doses elicit weaker B cell and CD8+ T cell responses in HD than in CI, while CD4+ T cell responses are quantitatively similar. In HD, a third dose robustly boosts B cell responses, leads to convergent CD8+ T cell responses, and enhances comparatively more T helper (TH) immunity. Unsupervised clustering of single-cell features reveals phenotypic and functional shifts over time and between cohorts. The third dose attenuates some features of TH cells in HD (tumor necrosis factor alpha [TNFα]/interleukin [IL]-2 skewing), while others (CCR6, CXCR6, programmed cell death protein 1 [PD-1], and HLA-DR overexpression) persist. Therefore, a third vaccine dose is critical to achieving robust multifaceted immunity in hemodialysis patients, although some distinct TH characteristics endure.
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Affiliation(s)
- Gérémy Sannier
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Alexandre Nicolas
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Mathieu Dubé
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Lorie Marchitto
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Manon Nayrac
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Olivier Tastet
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Debashree Chatterjee
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Alexandra Tauzin
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | | | - Mélanie Laporte
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Rose Cloutier
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Alina M Sreng Flores
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Marianne Boutin
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Shang Yu Gong
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Department of Microbiology and Immunology, McGill University, Montreal, QC H3A 2B4, Canada
| | - Mehdi Benlarbi
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Shilei Ding
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Catherine Bourassa
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Gabrielle Gendron-Lepage
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Halima Medjahed
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Guillaume Goyette
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Nathalie Brassard
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Gloria-Gabrielle Delgado
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Julia Niessl
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Laurie Gokool
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Chantal Morrisseau
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Pascale Arlotto
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Norka Rios
- Research Institute of the McGill University Health Centre, Montreal, QC H3H 2L9, Canada
| | - Cécile Tremblay
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Valérie Martel-Laferrière
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Alexandre Prat
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Département de Neurosciences, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Justin Bélair
- Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - William Beaubien-Souligny
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Nephrology Division, Centre Hospitalier de l'Université de Montréal, Montreal, QC H3X 3E4, Canada
| | - Rémi Goupil
- Centre de Recherche of the Hôpital du Sacré-Cœur de Montréal, Montreal, QC H4J 1C5, Canada; Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Annie-Claire Nadeau-Fredette
- Nephrology Division, Centre Hospitalier de l'Université de Montréal, Montreal, QC H3X 3E4, Canada; Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada; Centre de Recherche of the Hôpital Maisonneuve-Rosemont, Montreal, QC H1T 2M4, Canada
| | - Caroline Lamarche
- Nephrology Division, Centre Hospitalier de l'Université de Montréal, Montreal, QC H3X 3E4, Canada; Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada; Centre de Recherche of the Hôpital Maisonneuve-Rosemont, Montreal, QC H1T 2M4, Canada
| | - Andrés Finzi
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada; Department of Microbiology and Immunology, McGill University, Montreal, QC H3A 2B4, Canada.
| | - Rita S Suri
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Research Institute of the McGill University Health Centre, Montreal, QC H3H 2L9, Canada; Division of Nephrology, Department of Medicine, McGill University, Montreal, QC H3G 2M1, Canada.
| | - Daniel E Kaufmann
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Département de Médecine, Université de Montréal, Montréal, QC H3T 1J4, Canada; Division of Infectious Diseases, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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Burger D, Abdelrasoul A, Alexander RT, Ballermann B, Bridgewater D, Chan JSD, Cunanan J, Cybulsky AV, Gerarduzzi C, Gunaratnam L, Hartwig S, Kapus A, Kennedy CRJ, Lamarche C, Myette RL, Nmecha IK, Stalker L, Szaszi K, Torban E, Zhang SL, Takano T. Advancing Discovery Research in Nephrology in Canada: A Conference Report From the 2021 Molecules and Mechanisms Mediating Kidney Health and Disease (M3K) Scientific Meeting and Investigator Summit. Can J Kidney Health Dis 2022; 9:20543581221144824. [PMID: 36545249 PMCID: PMC9761209 DOI: 10.1177/20543581221144824] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/03/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE OF CONFERENCE New discoveries arising from investigations into fundamental aspects of kidney development and function in health and disease are critical to advancing kidney care. Scientific meetings focused specifically on fundamental biology of the kidney can facilitate interactions, support the development of collaborative groups, and accelerate translation of key findings. The Canadian fundamental kidney researcher community has lacked such a forum. On December 3 to 4, 2021, the first Molecules and Mechanisms Mediating Kidney Health and Disease (M3K) Scientific Meeting and Investigator Summit was held to address this gap with the goal of advancing fundamental kidney research nationally. The meeting was held virtually and was supported by a planning and dissemination grant from the Canadian Institutes of Health Research. Attendees included PhD scientists, nephrology clinician scientists, engineers, industry representatives, graduate students, medical residents, and fellows. SOURCES OF INFORMATION This report was prepared from the scientific program, registration numbers, and details obtained from the online platform WHOVA, and summaries written by organizers and participants of the 2021 meeting. METHODS A 21-person team, consisting of the organizing committee members and participants from the meeting, was assembled. Key highlights of the meeting and future directions were identified and the team jointly assembled this report. KEY FINDINGS Participation in the meeting was strong, with more than 140 attendees across a range of disciplines. The program featured state-of-the-art presentations on diabetic nephropathy, the immune system, kidney development, and fibrosis, and was heavily focused on trainee presentations. The moderated "Investigator Summit" identified key barriers to research advancement and discussed strategies for overcoming them. These included establishment of a pan-Canadian fundamental kidney research network, development of key resources, cross-pollination with clinical nephrology, better reintegration into the Canadian Society of Nephrology, and further establishment of identity and knowledge translation. LIMITATIONS AND IMPLICATIONS The 2021 M3K meeting represented a key first step in uniting fundamental kidney researchers in Canada. However, it was universally agreed that regular meetings were necessary to sustain this momentum. The proceedings of this meeting and future actions to sustain the M3K Scientific Meeting and Investigator Summit are presented in this article.
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Affiliation(s)
- Dylan Burger
- Kidney Research Centre, Ottawa Hospital
Research Institute, Department of Cellular and Molecular Medicine, University of
Ottawa, ON, Canada,Dylan Burger, Kidney Research Centre,
Ottawa Hospital Research Institute, Department of Cellular and Molecular
Medicine, University of Ottawa, 2513-/451 Smyth Road, Ottawa, ON K1H 8M5,
Canada.
| | - Amira Abdelrasoul
- Division of Biomedical Engineering,
Department of Chemical and Biological Engineering, University of Saskatchewan,
Saskatoon, Canada
| | - R. Todd Alexander
- Departments of Physiology &
Pediatrics, University of Alberta, Edmonton, Canada
| | | | - Darren Bridgewater
- Department of Pathology and Molecular
Medicine, McMaster University, Hamilton, ON, Canada
| | - John S. D. Chan
- Département de Médecine, Centre de
recherche du Centre hospitalier de l’Université de Montréal, Université de Montréal,
QC, Canada
| | - Joanna Cunanan
- University Health Network, University
of Toronto, ON, Canada
| | - Andrey V. Cybulsky
- Department of Medicine, McGill
University Health Centre, McGill University, Montreal, QC, Canada
| | - Casimiro Gerarduzzi
- Division of Nephrology,
Maisonneuve-Rosemont Hospital, Department of Medicine, University of Montreal, QC,
Canada
| | - Lakshman Gunaratnam
- Division of Nephrology, Department of
Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON,
Canada
| | - Sunny Hartwig
- Department of Biomedical Sciences,
Atlantic Veterinary College, Charlottetown, PEI, Canada
| | - Andras Kapus
- Keenan Research Centre for Biomedical
Science of the St. Michael’s Hospital, Department of Surgery, University of Toronto,
ON, Canada
| | - Christopher R. J. Kennedy
- Kidney Research Centre, Ottawa Hospital
Research Institute, Department of Cellular and Molecular Medicine, University of
Ottawa, ON, Canada
| | - Caroline Lamarche
- Division of Nephrology,
Maisonneuve-Rosemont Hospital, Department of Medicine, University of Montreal, QC,
Canada
| | - Robert L. Myette
- Kidney Research Centre, Ottawa Hospital
Research Institute, Department of Cellular and Molecular Medicine, University of
Ottawa, ON, Canada
| | | | | | - Katalin Szaszi
- Keenan Research Centre for Biomedical
Science of the St. Michael’s Hospital, Department of Surgery, University of Toronto,
ON, Canada
| | - Elena Torban
- McGill University Health Center
Research Institute, Montreal, ON, Canada
| | - Shao Ling Zhang
- MeDiC Program, Division of
Nephrology, The Research Institute of the McGill University Health Centre, McGill
University, Montreal, ON, Canada
| | - Tomoko Takano
- MeDiC Program, Division of
Nephrology, The Research Institute of the McGill University Health Centre, McGill
University, Montreal, ON, Canada
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Hall VG, Solera JT, Al-Alahmadi G, Marinelli T, Cardinal H, Poirier C, Huard G, Prasad GR, De Serres SA, Isaac D, Mainra R, Lamarche C, Sapir-Pichhadze R, Gilmour S, Humar A, Kumar D. Gravité de la COVID-19 chez les receveurs d’une transplantation d’organe plein au Canada, 2020–2021 : étude de cohorte prospective multicentrique. CMAJ 2022; 194:E1578-E1586. [DOI: 10.1503/cmaj.220620-f] [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] [Accepted: 08/05/2022] [Indexed: 01/08/2023] Open
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Hall VG, Solera JT, Al-Alahmadi G, Marinelli T, Cardinal H, Poirier C, Huard G, Prasad GVR, De Serres SA, Isaac D, Mainra R, Lamarche C, Sapir-Pichhadze R, Gilmour S, Humar A, Kumar D. Severity of COVID-19 among solid organ transplant recipients in Canada, 2020–2021: a prospective, multicentre cohort study. CMAJ 2022; 194:E1155-E1163. [PMID: 36302101 PMCID: PMC9435532 DOI: 10.1503/cmaj.220620] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Accepted: 08/05/2022] [Indexed: 11/04/2022] Open
Abstract
Background: Severe COVID-19 appears to disproportionately affect people who are immunocompromised, although Canadian data in this context are limited. We sought to determine factors associated with severe COVID-19 outcomes among recipients of organ transplants across Canada. Methods: We performed a multicentre, prospective cohort study of all recipients of solid organ transplants from 9 transplant programs in Canada who received a diagnosis of COVID-19 from March 2020 to November 2021. Data were analyzed to determine risk factors for oxygen requirement and other metrics of disease severity. We compared outcomes by organ transplant type and examined changes in outcomes over time. We performed a multivariable analysis to determine variables associated with need for supplemental oxygen. Results: A total of 509 patients with solid organ transplants had confirmed COVID-19 during the study period. Risk factors associated with needing (n = 190), compared with not needing (n = 319), supplemental oxygen included age (median 62.6 yr, interquartile range [IQR] 52.5–69.5 yr v. median 55.5 yr, IQR 47.5–66.5; p < 0.001) and number of comorbidities (median 3, IQR 2–3 v. median 2, IQR 1–3; p < 0.001), as well as parameters associated with immunosuppression. Recipients of lung transplants (n = 48) were more likely to have severe disease with a high mortality rate (n = 15, 31.3%) compared with recipients of other organ transplants, including kidney (n = 48, 14.8%), heart (n = 1, 4.4%), liver (n = 9, 11.4%) and kidney–pancreas (n = 3, 12.0%) transplants (p = 0.02). Protective factors against needing supplemental oxygen included having had a liver transplant and receiving azathioprine. Having had 2 doses of SARS-CoV-2 vaccine did not have an appreciable influence on oxygen requirement. Multivariable analysis showed that older age (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.02–1.07) and number of comorbidities (OR 1.63, 95% CI 1.30–2.04), among other factors, were associated with the need for supplemental oxygen. Over time, disease severity did not decline significantly. Interpretation: Despite therapeutic advances and vaccination of recipients of solid organ transplants, evidence of increased severity of COVID-19, in particular among those with lung transplants, supports ongoing public health measures to protect these at-risk people, and early use of COVID-19 therapies for recipients of solid organ transplants.
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Affiliation(s)
- Victoria G Hall
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta
| | - Javier T Solera
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta
| | - Ghadeer Al-Alahmadi
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta
| | - Tina Marinelli
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta
| | - Heloise Cardinal
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta
| | - Charles Poirier
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta
| | - Geneviève Huard
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta
| | - G V Ramesh Prasad
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta
| | - Sacha A De Serres
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta
| | - Debra Isaac
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta
| | - Rahul Mainra
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta
| | - Caroline Lamarche
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta
| | - Ruth Sapir-Pichhadze
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta
| | - Susan Gilmour
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta
| | - Atul Humar
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta
| | - Deepali Kumar
- Transplant Infectious Diseases and Multi-Organ Transplant Program (Hall, Solera, Al-Alahmadi, Marinelli, Humar, Kumar), University Health Network, Toronto, Ont.; Sir Peter MacCallum Department of Oncology (Hall), University of Melbourne, Parkville, Australia; Department of Infectious Diseases and Microbiology (Marinelli), Royal Prince Alfred Hospital, Sydney, AU; Department of Medicine (Cardinal, Poirier, Huard), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Kidney Transplant Program (Prasad), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Transplantation Unit, Renal Division, Department of Medicine (De Serres), University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, Que.; Division of Transplant Medicine (Isaac), University of Calgary, Calgary, Alta.; Saskatchewan Transplant Program, Transplantation Unit, Renal Division (Mainra), Department of Medicine, University Health Centre of Saskatchewan, Saskatoon, Sask.; Hôpital Maisonneuve-Rosemont Research Institute (Lamarche), Université de Montréal, Montréal, Que.; Centre for Outcomes Research and Evaluation (Sapir-Pichhadze), Research Institute of McGill University Health Centre; Division of Nephrology, Department of Medicine (Sapir-Pichhadze), McGill University; Department of Epidemiology, Biostatistics, Occupational Health (Sapir-Pichhadze), McGill University, Montréal, Que.; Stollery Children's Hospital (Gilmour), University of Alberta, Edmonton, Alta.
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11
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Valentini N, Marchitto L, Raymond M, Goyette G, Kaufmann DE, Finzi A, Suri RS, Lamarche C. Innate Immunity and SARS-CoV-2 Vaccine Response in Hemodialysis Patients. Kidney360 2022; 3:1763-1768. [PMID: 36514720 PMCID: PMC9717667 DOI: 10.34067/kid.0002542022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/08/2022] [Indexed: 01/12/2023]
Abstract
Patients receiving hemodialysis (HD) have more inflammatory monocytes and less plasmacytoid dendritic cells (DCs) compared with healthy controls.Patients on HD who have a poor antibody response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine had fewer monocyte-derived DCs and conventional DCs compared with good responders.The defects in antigen presentation might be possible therapeutic targets to increase vaccine efficacy in HD patients.
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Affiliation(s)
- Nicolas Valentini
- Hôpital Maisonneuve-Rosemont Research Institute, Montreal, Quebec, Canada,Department of Pharmacology and Physiology, University of Montreal, Montreal, Quebec, Canada
| | - Lorie Marchitto
- Centre Hospitalier Universitaire de Montreal (CHUM) Research Institute, Montreal, Quebec, Canada,Department of Microbiology, Infectiology and Immunology, University of Montreal, Montreal, Quebec, Canada
| | - Maxime Raymond
- Hôpital Maisonneuve-Rosemont Research Institute, Montreal, Quebec, Canada
| | - Guillaume Goyette
- Centre Hospitalier Universitaire de Montreal (CHUM) Research Institute, Montreal, Quebec, Canada
| | - Daniel E. Kaufmann
- Centre Hospitalier Universitaire de Montreal (CHUM) Research Institute, Montreal, Quebec, Canada,Departement of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Andrés Finzi
- Centre Hospitalier Universitaire de Montreal (CHUM) Research Institute, Montreal, Quebec, Canada,Department of Microbiology, Infectiology and Immunology, University of Montreal, Montreal, Quebec, Canada
| | - Rita S. Suri
- Research Institute of the McGill University Health Center, Montreal, Quebec, Canada,Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Caroline Lamarche
- Hôpital Maisonneuve-Rosemont Research Institute, Montreal, Quebec, Canada,Departement of Medicine, University of Montreal, Montreal, Quebec, Canada
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12
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Hall VG, Al-Alahmadi G, Solera JT, Marinelli T, Cardinal H, Prasad GVR, De Serres SA, Isaac D, Mainra R, Lamarche C, Sapir-Pichhadze R, Gilmour S, Matelski J, Humar A, Kumar D. Outcomes of SARS-CoV-2 Infection in Unvaccinated Compared With Vaccinated Solid Organ Transplant Recipients: A Propensity Matched Cohort Study. Transplantation 2022; 106:1622-1628. [PMID: 35502801 PMCID: PMC9311277 DOI: 10.1097/tp.0000000000004178] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/17/2022] [Accepted: 04/01/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Solid organ transplant (SOT) recipients are at high risk for complications from coronavirus disease 2019 (COVID-19). Vaccination may mitigate this risk; however, immunogenicity appears to be significantly impaired, with reports of increased risk of breakthrough infection. It is unknown if vaccine breakthrough infections are milder or as severe as infections in unvaccinated patients. METHODS We performed a multicenter matched cohort study between March 2020 and September 2021 to assess influence of COVID-19 vaccination on outcomes of COVID-19 infection. Treatment characteristics and disease severity outcomes were compared on the basis of vaccine status; breakthrough infections versus unvaccinated infections. Variable ratio propensity score matching based on age, sex, transplant type, and number of comorbidities, was used to develop the analytic cohort. Logistic regression was used to assess the influence of vaccination status on the selected outcomes. RESULTS From a cohort of 511 SOT patients with COVID-19, we matched 77 partially or fully vaccinated patients with 220 unvaccinated patients. Treatment characteristics including use of dexamethasone, remdesivir, and antibiotics did not differ. Vaccinated participants were more likely to receive tocilizumab, 15 of 77 (19.5%) versus 5 of 220 (2.3%), P < 0.001. Disease severity outcomes including oxygen requirement, mechanical ventilation, and mortality were similar among medically attended vaccine breakthroughs compared with unvaccinated patients. CONCLUSIONS SOT recipients who develop medically attended COVID-19 following 1- or 2-dose vaccination seem to have similar disease severity to unvaccinated patients who develop infection. This is consistent with the requirement that SOT recipients need 3 or more vaccine doses and emphasizes the importance of alternate strategies for this population.
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Affiliation(s)
- Victoria G. Hall
- Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Ghadeer Al-Alahmadi
- Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Javier T. Solera
- Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Tina Marinelli
- Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
- Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Heloise Cardinal
- Department of Medicine, University of Montreal, Montreal, QC, Canada
| | - G. V. Ramesh Prasad
- Kidney Transplant Program, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Sacha A. De Serres
- Transplantation Unit, Renal Division, Department of Medicine, University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Debra Isaac
- Division of Transplant Medicine, University of Calgary, Calgary, AB, Canada
| | - Rahul Mainra
- Saskatchewan Transplant Program, Transplantation Unit, Renal Division, Department of Medicine, University Health Center of Saskatchewan, Saskatoon, SK, Canada
| | - Caroline Lamarche
- Hôpital Maisonneuve-Rosemont Research Institute, Université de Montréal, Montréal, QC, Canada
| | - Ruth Sapir-Pichhadze
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Division of Nephrology, Department of Medicine, McGill University, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics, Occupational Health, McGill University, Montreal, QC, Canada
| | - Susan Gilmour
- Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada
| | - John Matelski
- Biostatistics Research Unit, University Health Network, Toronto, ON, Canada
| | - Atul Humar
- Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Deepali Kumar
- Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
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13
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Deneault-Marchand A, Cohade C, Lamarche C. Fluid Collection after Kidney Transplantation. Kidney360 2022; 3:1291-1292. [PMID: 35919536 PMCID: PMC9337908 DOI: 10.34067/kid.0001762022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/17/2022] [Indexed: 01/11/2023]
Affiliation(s)
| | - Christian Cohade
- Department of Radiology, Radio-oncology and Nuclear Medicine, Université de Montréal, Hôpital Maisonneuve Rosemont, Montreal, Canada
| | - Caroline Lamarche
- Department of Medicine, Université de Montréal, Montreal, Canada,Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Division of Nephrology, Department of Medicine, Université de Montréal, Montréal, Canada
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14
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Lamarche C, Maltzman JS. CAR Treg in transplantation: the future of cell therapy? Kidney Int Rep 2022; 7:1149-1152. [PMID: 35694556 PMCID: PMC9174038 DOI: 10.1016/j.ekir.2022.04.003] [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: 11/08/2022] Open
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15
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Leclerc S, Benkirane K, Nadeau-Fredette AC, Elftouh N, Lafrance JP, Pichette V, Royal V, Lamarche C, Laurin LP. Qualitative and Quantitative Dosage of the Anti M-Type Phospholipase A2 Receptor Autoantibody: One-Year Experience in Quebec's Reference Center. Can J Kidney Health Dis 2021; 8:20543581211052729. [PMID: 34721885 PMCID: PMC8552399 DOI: 10.1177/20543581211052729] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/23/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Quantification of the M-type phospholipase A2 receptor antibodies (anti-PLA2R) is now an essential tool for diagnosis and management of primary membranous nephropathy (MN). Since October 2018, Hôpital Maisonneuve-Rosemont (HMR) has been designated as Quebec’s reference center for serum anti-PLA2R antibody testing by the Institut National d’Excellence en Santé et Services Sociaux (INESSS), the regulatory body on drugs and tests usage in Quebec. Objectives: To describe the 2-step method of serum qualitative and quantitative anti-PLA2R antibody testing during its first year of use in Quebec and analyze its diagnostic value in the province’s population. Design: Retrospective cohort study. Setting: Single-center academic teaching hospital in Quebec, Canada. Patients: All patients who had a serum anti-PLA2R antibody test analyzed at HMR from October 1, 2018, to October 1, 2019, were included in the study. Measurements: Serum anti-PLA2R antibodies were screened by indirect immunofluorescence tests. If results were positive or undetermined, it was followed by a quantitative enzyme-linked immunosorbent assay (ELISA) test. Both tests were based on a commercial kit developed by the same company. Methods: We calculated sensitivity, specificity, predictive value, and likelihood ratio for both tests, using kidney biopsy findings performed at HMR as the gold standard. Results: In Quebec, a total of 1690 tests were performed among 1025 patients during the study year. A small proportion of these patients (8%) were followed at HMR. Patients tested at HMR and in the rest of Quebec had similar characteristics. Test validity was only characterized for patients tested at HMR. Sensitivity and specificity were, respectively, 58% and 100% for the qualitative test, and 71% and 100% for the quantitative test. The combined net sensitivity was 42% and the net specificity 100%. The net positive and negative predictive value were 100% and 84% respectively, whereas the net negative likelihood ratio was 0.58. Limitations: As the detailed analysis was only possible in the small proportion of patients clinically followed at HMR, there is a possible selection bias. Another potential selection bias was the focus on patients who were selected to have a kidney biopsy, probably because of more severe disease, higher probability of glomerulonephritis, or lesser number of comorbidities. Given the retrospective nature of this study, there was no systematic kidney biopsy or serum PLA2R antibody testing performed. Finally, we were unable to provide detailed information on the timing between immunosuppressive therapy and anti-PLA2R results. Conclusions: Serum anti-PLA2R antibody testing was widely used in Quebec during its first year of availability. A 2-step approach, using a qualitative test first, followed by a quantitative test if the results are positive or undetermined, appears efficient to avoid useless quantitative testing in negative patients and to better characterize undetermined results on immunofluorescence. Trial registration: Due to the retrospective nature of this study, no trial registration was performed.
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Affiliation(s)
- Simon Leclerc
- Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada
| | - Karim Benkirane
- Department of Medical Biochemistry, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada
| | - Annie-Claire Nadeau-Fredette
- Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada.,Research Center, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada.,Department of Medicine, University of Montreal, Montreal, QC, Canada
| | - Naoual Elftouh
- Research Center, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada
| | - Jean-Philippe Lafrance
- Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada.,Research Center, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada.,Department of Medicine, University of Montreal, Montreal, QC, Canada.,Department of Pharmacology and Physiology, University of Montreal, QC, Canada
| | - Vincent Pichette
- Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada.,Research Center, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada.,Department of Medicine, University of Montreal, Montreal, QC, Canada.,Department of Pharmacology and Physiology, University of Montreal, QC, Canada
| | - Virginie Royal
- Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada.,Department of Pathology, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada
| | - Caroline Lamarche
- Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada.,Research Center, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada.,Department of Medicine, University of Montreal, Montreal, QC, Canada
| | - Louis-Philippe Laurin
- Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada.,Research Center, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada.,Department of Medicine, University of Montreal, Montreal, QC, Canada
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Abstract
PURPOSE OF REVIEW Current immunosuppressive regimens used in kidney transplantation are sometimes ineffective and carry significant risks of morbidity and mortality. Cellular therapies are a promising alternative to prolong graft survival while minimizing treatment toxicity. We review the recently published breakthrough studies using cell therapies in kidney transplantation. RECENT FINDINGS The reviewed phase I and II trials showed that cell therapies are feasible and safe in kidney transplantation, sometimes associated with less infectious complications than traditional regimens. Regulatory T cells and macrophages were added to the induction regimen, allowing for lower immunosuppressive drug doses without higher rejection risk. Regulatory T cells are also a treatment for subclinical rejection on the 6 months biopsy. Other strategies, like bone marrow-derived mesenchymal cells, genetically modified regulatory T cells, and chimerism-based tolerance are also really promising. In addition, to improve graft tolerance, cell therapy could be used to prevent or treat viral infection after transplantation. SUMMARY Emerging data underline that cell therapy is a feasible and safe treatment in kidney transplantation. Although the evidence points to a benefit for transplant recipients, studies with standardized protocols, representative control groups, and longer follow-up are needed to answer the question definitively and guide future research.
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Affiliation(s)
- Simon Leclerc
- Centre de Recherche de l'Hôpital Maisonneuve-Rosemont
- Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Caroline Lamarche
- Centre de Recherche de l'Hôpital Maisonneuve-Rosemont
- Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
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17
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Leclerc S, Royal V, Lamarche C, Laurin LP. Minimal Change Disease With Severe Acute Kidney Injury Following the Oxford-AstraZeneca COVID-19 Vaccine: A Case Report. Am J Kidney Dis 2021; 78:607-610. [PMID: 34242687 PMCID: PMC8260495 DOI: 10.1053/j.ajkd.2021.06.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 05/26/2021] [Accepted: 06/25/2021] [Indexed: 11/22/2022]
Abstract
We report a case of minimal change disease (MCD) with severe acute kidney injury (AKI) following the first injection of the ChAdOx1 nCoV-19 (AZD1222) vaccine from Oxford-AstraZeneca against coronavirus disease 2019 (COVID-19). A 71-year-old man with a history of dyslipidemia and a baseline serum creatinine of 0.7 mg/dL presented with nephrotic syndrome, AKI, and severe hypertension 13 days after receiving the Oxford-AstraZeneca vaccine. Refractory hyperkalemia and hypervolemia with oligoanuria prompted initiation of hemodialysis. His serum albumin was 2.6 g/dL and his urinary protein-creatinine ratio was 2,321 mg/mmol. Given a high suspicion for rapidly progressive glomerulonephritis, empirical glucocorticoid treatment was initiated (3 methylprednisolone pulses followed by high-dose prednisone). A kidney biopsy showed MCD and acute tubular injury. Kidney function and proteinuria subsequently improved, and hemodialysis was discontinued 38 days after the start of therapy. This case describes de novo MCD after the Oxford-AstraZeneca vaccine. It adds to the few published case reports of MCD after the Pfizer-BioNTech COVID-19 vaccine. Further reports and studies will be needed to elucidate whether MCD is truly associated with COVID-19 vaccination.
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Affiliation(s)
- Simon Leclerc
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal
| | - Virginie Royal
- Department of Pathology, Maisonneuve-Rosemont Hospital, Montreal
| | - Caroline Lamarche
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal; Department of Medicine, University of Montreal, QC, Canada
| | - Louis-Philippe Laurin
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal; Department of Medicine, University of Montreal, QC, Canada.
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18
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Goupil R, Benlarbi M, Beaubien-Souligny W, Nadeau-Fredette AC, Chatterjee D, Goyette G, Gunaratnam L, Lamarche C, Tom A, Finzi A, Suri RS. Short-term antibody response after 1 dose of BNT162b2 vaccine in patients receiving hemodialysis. CMAJ 2021; 193:E793-E800. [PMID: 33980499 PMCID: PMC8177936 DOI: 10.1503/cmaj.210673] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND: Patients receiving in-centre hemodialysis are at high risk of exposure to SARS-CoV-2 and death if infected. One dose of the BNT162b2 SARS-CoV-2 vaccine is efficacious in the general population, but responses in patients receiving hemodialysis are uncertain. METHODS: We obtained serial plasma from patients receiving hemodialysis and health care worker controls before and after vaccination with 1 dose of the BNT162b2 mRNA vaccine, as well as convalescent plasma from patients receiving hemodialysis who survived COVID-19. We measured anti–receptor binding domain (RBD) immunoglobulin G (IgG) levels and stratified groups by evidence of previous SARS-CoV-2 infection. RESULTS: Our study included 154 patients receiving hemodialysis (135 without and 19 with previous SARS-CoV-2 infection), 40 controls (20 without and 20 with previous SARS-CoV-2 infection) and convalescent plasma from 16 patients. Among those without previous SARS-CoV-2 infection, anti-RBD IgG was undetectable at 4 weeks in 75 of 131 (57%, 95% confidence interval [CI] 47% to 65%) patients receiving hemodialysis, compared with 1 of 20 (5%, 95% CI 1% to 23%) controls (p < 0.001). No patient with nondetectable levels at 4 weeks developed anti-RBD IgG by 8 weeks. Results were similar in non-immunosuppressed and younger individuals. Three patients receiving hemodialysis developed severe COVID-19 after vaccination. Among those with previous SARS-CoV-2 infection, median anti-RBD IgG levels at 8 weeks in patients receiving hemodialysis were similar to controls at 3 weeks (p = 0.3) and to convalescent plasma (p = 0.8). INTERPRETATION: A single dose of BNT162b2 vaccine failed to elicit a humoral immune response in most patients receiving hemodialysis without previous SARS-CoV-2 infection, even after prolonged observation. In those with previous SARS-CoV-2 infection, the antibody response was delayed. We advise that patients receiving hemodialysis be prioritized for a second BNT162b2 dose at the recommended 3-week interval.
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Affiliation(s)
- Rémi Goupil
- Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal (Goupil); Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM) (Benlarbi, Chatterjee, Goyette, Finzi, Suri); Centre de recherche de l'Hôpital Maisonneuve-Rosemont (Nadeau-Fredette, Lamarche), Montréal, Que.; Department of Microbiology and Immunology and Division of Nephrology, Department of Medicine (Gunaratnam), Western University, London, Ont.; Research Institute of the McGill University Health Centre (Tom, Suri); Département de microbiologie, infectiologie et immunologie (Finzi), Université de Montréal; Department of Microbiology and Immunology (Finzi), McGill University; Division of Nephrology (Suri), Department of Medicine, McGill University, Montréal, Que
| | - Mehdi Benlarbi
- Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal (Goupil); Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM) (Benlarbi, Chatterjee, Goyette, Finzi, Suri); Centre de recherche de l'Hôpital Maisonneuve-Rosemont (Nadeau-Fredette, Lamarche), Montréal, Que.; Department of Microbiology and Immunology and Division of Nephrology, Department of Medicine (Gunaratnam), Western University, London, Ont.; Research Institute of the McGill University Health Centre (Tom, Suri); Département de microbiologie, infectiologie et immunologie (Finzi), Université de Montréal; Department of Microbiology and Immunology (Finzi), McGill University; Division of Nephrology (Suri), Department of Medicine, McGill University, Montréal, Que
| | - William Beaubien-Souligny
- Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal (Goupil); Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM) (Benlarbi, Chatterjee, Goyette, Finzi, Suri); Centre de recherche de l'Hôpital Maisonneuve-Rosemont (Nadeau-Fredette, Lamarche), Montréal, Que.; Department of Microbiology and Immunology and Division of Nephrology, Department of Medicine (Gunaratnam), Western University, London, Ont.; Research Institute of the McGill University Health Centre (Tom, Suri); Département de microbiologie, infectiologie et immunologie (Finzi), Université de Montréal; Department of Microbiology and Immunology (Finzi), McGill University; Division of Nephrology (Suri), Department of Medicine, McGill University, Montréal, Que
| | - Annie-Claire Nadeau-Fredette
- Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal (Goupil); Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM) (Benlarbi, Chatterjee, Goyette, Finzi, Suri); Centre de recherche de l'Hôpital Maisonneuve-Rosemont (Nadeau-Fredette, Lamarche), Montréal, Que.; Department of Microbiology and Immunology and Division of Nephrology, Department of Medicine (Gunaratnam), Western University, London, Ont.; Research Institute of the McGill University Health Centre (Tom, Suri); Département de microbiologie, infectiologie et immunologie (Finzi), Université de Montréal; Department of Microbiology and Immunology (Finzi), McGill University; Division of Nephrology (Suri), Department of Medicine, McGill University, Montréal, Que
| | - Debashree Chatterjee
- Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal (Goupil); Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM) (Benlarbi, Chatterjee, Goyette, Finzi, Suri); Centre de recherche de l'Hôpital Maisonneuve-Rosemont (Nadeau-Fredette, Lamarche), Montréal, Que.; Department of Microbiology and Immunology and Division of Nephrology, Department of Medicine (Gunaratnam), Western University, London, Ont.; Research Institute of the McGill University Health Centre (Tom, Suri); Département de microbiologie, infectiologie et immunologie (Finzi), Université de Montréal; Department of Microbiology and Immunology (Finzi), McGill University; Division of Nephrology (Suri), Department of Medicine, McGill University, Montréal, Que
| | - Guillaume Goyette
- Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal (Goupil); Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM) (Benlarbi, Chatterjee, Goyette, Finzi, Suri); Centre de recherche de l'Hôpital Maisonneuve-Rosemont (Nadeau-Fredette, Lamarche), Montréal, Que.; Department of Microbiology and Immunology and Division of Nephrology, Department of Medicine (Gunaratnam), Western University, London, Ont.; Research Institute of the McGill University Health Centre (Tom, Suri); Département de microbiologie, infectiologie et immunologie (Finzi), Université de Montréal; Department of Microbiology and Immunology (Finzi), McGill University; Division of Nephrology (Suri), Department of Medicine, McGill University, Montréal, Que
| | - Lakshman Gunaratnam
- Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal (Goupil); Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM) (Benlarbi, Chatterjee, Goyette, Finzi, Suri); Centre de recherche de l'Hôpital Maisonneuve-Rosemont (Nadeau-Fredette, Lamarche), Montréal, Que.; Department of Microbiology and Immunology and Division of Nephrology, Department of Medicine (Gunaratnam), Western University, London, Ont.; Research Institute of the McGill University Health Centre (Tom, Suri); Département de microbiologie, infectiologie et immunologie (Finzi), Université de Montréal; Department of Microbiology and Immunology (Finzi), McGill University; Division of Nephrology (Suri), Department of Medicine, McGill University, Montréal, Que
| | - Caroline Lamarche
- Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal (Goupil); Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM) (Benlarbi, Chatterjee, Goyette, Finzi, Suri); Centre de recherche de l'Hôpital Maisonneuve-Rosemont (Nadeau-Fredette, Lamarche), Montréal, Que.; Department of Microbiology and Immunology and Division of Nephrology, Department of Medicine (Gunaratnam), Western University, London, Ont.; Research Institute of the McGill University Health Centre (Tom, Suri); Département de microbiologie, infectiologie et immunologie (Finzi), Université de Montréal; Department of Microbiology and Immunology (Finzi), McGill University; Division of Nephrology (Suri), Department of Medicine, McGill University, Montréal, Que
| | - Alexander Tom
- Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal (Goupil); Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM) (Benlarbi, Chatterjee, Goyette, Finzi, Suri); Centre de recherche de l'Hôpital Maisonneuve-Rosemont (Nadeau-Fredette, Lamarche), Montréal, Que.; Department of Microbiology and Immunology and Division of Nephrology, Department of Medicine (Gunaratnam), Western University, London, Ont.; Research Institute of the McGill University Health Centre (Tom, Suri); Département de microbiologie, infectiologie et immunologie (Finzi), Université de Montréal; Department of Microbiology and Immunology (Finzi), McGill University; Division of Nephrology (Suri), Department of Medicine, McGill University, Montréal, Que
| | - Andrés Finzi
- Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal (Goupil); Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM) (Benlarbi, Chatterjee, Goyette, Finzi, Suri); Centre de recherche de l'Hôpital Maisonneuve-Rosemont (Nadeau-Fredette, Lamarche), Montréal, Que.; Department of Microbiology and Immunology and Division of Nephrology, Department of Medicine (Gunaratnam), Western University, London, Ont.; Research Institute of the McGill University Health Centre (Tom, Suri); Département de microbiologie, infectiologie et immunologie (Finzi), Université de Montréal; Department of Microbiology and Immunology (Finzi), McGill University; Division of Nephrology (Suri), Department of Medicine, McGill University, Montréal, Que
| | - Rita S Suri
- Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal (Goupil); Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM) (Benlarbi, Chatterjee, Goyette, Finzi, Suri); Centre de recherche de l'Hôpital Maisonneuve-Rosemont (Nadeau-Fredette, Lamarche), Montréal, Que.; Department of Microbiology and Immunology and Division of Nephrology, Department of Medicine (Gunaratnam), Western University, London, Ont.; Research Institute of the McGill University Health Centre (Tom, Suri); Département de microbiologie, infectiologie et immunologie (Finzi), Université de Montréal; Department of Microbiology and Immunology (Finzi), McGill University; Division of Nephrology (Suri), Department of Medicine, McGill University, Montréal, Que.
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19
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Lamarche C, Sharma AK, Goldberg A, Wang L, Blydt-Hansen TD. Biomarker implementation: Evaluation of the decision-making impact of CXCL10 testing in a pediatric cohort. Pediatr Transplant 2021; 25:e13908. [PMID: 33155737 DOI: 10.1111/petr.13908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/12/2020] [Revised: 09/13/2020] [Accepted: 10/07/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Children are at high risk for subclinical rejection, and kidney biopsy is currently used for surveillance. Our objective was to test how novel rejection biomarkers such as urinary CXCL10 may influence clinical decision-making to indicate need for a biopsy. METHODS A minimum dataset for standard decision-making to indicate a biopsy was established by an expert panel and used to design clinical vignettes for use in a survey. Pediatric nephrologists were recruited to review the vignettes and A) estimate rejection risk and B) decide whether to biopsy; first without and then with urinary CXCL10/Cr level. Accuracy of biopsy decisions was then tested against the biopsy results. IRA was assessed by Fleiss Kappa (κ) for binary choice and ICC for probabilities. RESULTS Eleven pediatric nephrologists reviewed 15 vignettes each. ICC of probability assessment for rejection improved from poor (0.28, P < .01) to fair (0.48, P < .01) with addition of CXCL10/Cr data. It did not, however, improve the IRA for decision to biopsy (K = 0.48 and K = 0.43, for the comparison). Change in clinician estimated probability of rejection with additional CXCL10/Cr data was correlated with CXCL10/Cr level (r2 = 0.7756, P < .0001). Decision accuracy went from 8/15 (53.3%) cases to 11/15 (73.3%) with CXCL10/Cr, although improvement did not achieve statistical significance. Using CXCL10/Cr alone would have been accurate in 12/15 cases (80%). CONCLUSION There is high variability in decision-making on biopsy indication. Urinary CXCL10/Cr improves probability estimates for risk of rejection. Training may be needed to assist nephrologists in better integrate biomarker information into clinical decision-making.
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Affiliation(s)
- Caroline Lamarche
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Atul K Sharma
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Aviva Goldberg
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Li Wang
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Tom D Blydt-Hansen
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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20
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Lamarche C, Maltzman JS. The ONE Study: One Small Step for Patient Care, a Giant Leap for Cell Therapy. Am J Kidney Dis 2020; 77:297-299. [PMID: 32763258 DOI: 10.1053/j.ajkd.2020.07.006] [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] [Received: 06/16/2020] [Accepted: 07/02/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Caroline Lamarche
- Division of Nephrology, Centre de Recherche de l'Hôpital Maisonneuve-Rosemont (CRHMR), Department of medicine, Université de Montréal, Montreal, Quebec, Canada.
| | - Jonathan S Maltzman
- Division of Nephrology, Department of Medicine, Stanford University, CA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.
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21
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Sicard A, Lamarche C, Speck M, Wong M, Rosado-Sánchez I, Blois M, Glaichenhaus N, Mojibian M, Levings MK. Donor-specific chimeric antigen receptor Tregs limit rejection in naive but not sensitized allograft recipients. Am J Transplant 2020; 20:1562-1573. [PMID: 31957209 DOI: 10.1111/ajt.15787] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [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: 06/08/2019] [Revised: 12/19/2019] [Accepted: 01/13/2020] [Indexed: 02/06/2023]
Abstract
Cell therapy with autologous donor-specific regulatory T cells (Tregs) is a promising strategy to minimize immunosuppression in transplant recipients. Chimeric antigen receptor (CAR) technology has recently been used successfully to generate donor-specific Tregs and overcome the limitations of enrichment protocols based on repetitive stimulations with alloantigens. However, the ability of CAR-Treg therapy to control alloreactivity in immunocompetent recipients is unknown. We first analyzed the effect of donor-specific CAR Tregs on alloreactivity in naive, immunocompetent mice receiving skin allografts. Tregs expressing an irrelevant or anti-HLA-A2-specific CAR were administered to Bl/6 mice at the time of transplanting an HLA-A2+ Bl/6 skin graft. Donor-specific CAR-Tregs, but not irrelevant-CAR Tregs, significantly delayed skin rejection and diminished donor-specific antibodies (DSAs) and frequencies of DSA-secreting B cells. Donor-specific CAR-Treg-treated mice also had a weaker recall DSA response, but normal responses to an irrelevant antigen, demonstrating antigen-specific suppression. When donor-specific CAR Tregs were tested in HLA-A2-sensitized mice, they were unable to delay allograft rejection or diminish DSAs. The finding that donor-specific CAR-Tregs restrain de novo but not memory alloreactivity has important implications for their use as an adoptive cell therapy in transplantation.
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Affiliation(s)
- Antoine Sicard
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Surgery, University of British Columbia, Vancouver, BC, Canada.,Department of Nephrology-Dialysis-Transplantation, Nice University Hospital, Clinical Research Unit of University of Côte d'Azur, Nice, France.,CNRS, Institute of Molecular and Cellular Pharmacology, UMR7275, Valbonne, France
| | - Caroline Lamarche
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Madeleine Speck
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - May Wong
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Isaac Rosado-Sánchez
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Surgery, University of British Columbia, Vancouver, BC, Canada.,School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Mathilde Blois
- Department of Nephrology-Dialysis-Transplantation, Nice University Hospital, Clinical Research Unit of University of Côte d'Azur, Nice, France.,CNRS, Institute of Molecular and Cellular Pharmacology, UMR7275, Valbonne, France
| | - Nicolas Glaichenhaus
- CNRS, Institute of Molecular and Cellular Pharmacology, UMR7275, Valbonne, France
| | - Majid Mojibian
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Megan K Levings
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Surgery, University of British Columbia, Vancouver, BC, Canada.,School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
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22
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Dahmani A, Janelle V, Carli C, Richaud M, Lamarche C, Khalili M, Goupil M, Bezverbnaya K, Bramson JL, Delisle JS. TGFβ Programs Central Memory Differentiation in Ex Vivo-Stimulated Human T Cells. Cancer Immunol Res 2019; 7:1426-1439. [PMID: 31308016 DOI: 10.1158/2326-6066.cir-18-0691] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 09/30/2018] [Revised: 03/27/2019] [Accepted: 07/09/2019] [Indexed: 11/16/2022]
Abstract
The adoptive transfer of ex vivo-expanded T cells is a promising approach to treat several malignancies. Several lines of evidence support that the infusion of T cells with early memory features, capable of expanding and persisting after transfer, are associated with better outcomes. We report herein that exposure to exogenous TGFβ during human T-cell stimulation ex vivo leads to the accumulation of early/central memory (Tcm) cells. Exposure to TGFβ suppressed the expression of BLIMP-1, a key orchestrator of effector T-cell differentiation, and led to the upregulation of the memory-associated transcription factor ID3. Accordingly, this was associated with an early memory transcriptional signature in both CD4+ and CD8+ T-cell subsets. The T cells stimulated in the presence of TGFβ expanded normally, and displayed polyfunctional features and no suppressive activity. The adoptive transfer of ex vivo-stimulated T cells into immunodeficient mice confirmed that TGFβ-conditioned cells had an enhanced capacity to persist and mediate xenogeneic graft-versus-host disease, as predicted by their early T-cell memory phenotype. Chimeric antigen receptor-expressing T cells generated in the presence of exogenous TGFβ were cytotoxic and more effective at controlling tumor growth in immunodeficient animals. This work unveils a new role for TGFβ in memory T-cell differentiation and indicates that TGFβ signaling may be harnessed to program Tcm differentiation in the context of ex vivo T-cell stimulation for adoptive immunotherapy in humans.
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Affiliation(s)
- Amina Dahmani
- Centre de Recherche de l'Hôpital Maisonneuve-Rosemont (CRHMR), Montreal, Quebec, Canada
| | - Valérie Janelle
- Centre de Recherche de l'Hôpital Maisonneuve-Rosemont (CRHMR), Montreal, Quebec, Canada
| | - Cédric Carli
- Centre de Recherche de l'Hôpital Maisonneuve-Rosemont (CRHMR), Montreal, Quebec, Canada
| | - Manon Richaud
- Centre de Recherche de l'Hôpital Maisonneuve-Rosemont (CRHMR), Montreal, Quebec, Canada
| | - Caroline Lamarche
- Centre de Recherche de l'Hôpital Maisonneuve-Rosemont (CRHMR), Montreal, Quebec, Canada
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Myriam Khalili
- Centre de Recherche de l'Hôpital Maisonneuve-Rosemont (CRHMR), Montreal, Quebec, Canada
| | - Mathieu Goupil
- Centre de Recherche de l'Hôpital Maisonneuve-Rosemont (CRHMR), Montreal, Quebec, Canada
| | - Ksenia Bezverbnaya
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jonathan L Bramson
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jean-Sébastien Delisle
- Centre de Recherche de l'Hôpital Maisonneuve-Rosemont (CRHMR), Montreal, Quebec, Canada.
- Département de Médecine, Université de Montréal, Montreal, Quebec, Canada
- Hematology-Oncology Division, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
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23
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Lamarche C, Iliuta IA, Kitzler T. Infectious Disease Risk in Dialysis Patients: A Transdisciplinary Approach. Can J Kidney Health Dis 2019; 6:2054358119839080. [PMID: 31065378 PMCID: PMC6488776 DOI: 10.1177/2054358119839080] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 10/19/2018] [Accepted: 02/25/2019] [Indexed: 01/14/2023] Open
Abstract
Purpose of review: Infections are a major contributor to morbidity and mortality in end-stage
renal disease (ESRD) patients. A better understanding of the interplay
between infectious processes and ESRD may eventually lead to the development
of targeted treatment strategies aimed at lowering overall disease morbidity
and mortality. Monogenic causes are a major contributor to the development
of adult chronic kidney disease (CKD). Recent studies identified a genetic
cause in 10% to 20% of adults with CKD. With the introduction of whole-exome
sequencing (WES) into clinical mainstay, this proportion is expected to
increase in the future. Once patients develop CKD/ESRD due to a genetic
cause, secondary changes, such as a compromised immune status, affect
overall disease progression and clinical outcomes. Stratification according
to genotype may enable us to study its effects on secondary disease
outcomes, such as infectious risk. Moreover, this knowledge will enable us
to better understand the molecular interplay between primary disease and
secondary disease outcomes. Sources of information: We conducted a literature review using search engines such as PubMed, PubMed
central, and Medline, as well as cumulative knowledge from our respective
areas of expertise. Methods: This is a transdisciplinary perspective on infectious complications in ESRD
due to monogenic causes, such as autosomal dominant polycystic kidney
disease (ADPKD), combining expertise in genomics and immunology. Key findings: In ADPKD, infection is a frequent complication manifesting primarily as lower
urinary tract infection and less frequently as renal infection. Infectious
episodes may be a direct consequence of a specific underlying structural
abnormality, for example the characteristic cysts, among others. However,
evidence suggests that infectious disease risk is also increased in ESRD due
to secondary not-well-understood disease mechanisms. These disease
mechanisms may vary depending on the underlying nature of the primary
disease. While the infectious disease risk is well documented in ADPKD,
there are currently insufficient data on the risk in other monogenic causes
of ESRD. WES in combination with novel technologies, such as RNA sequencing
and single-cell RNA sequencing, can provide insight into the molecular
mechanisms of disease progression in different monogenic causes of CKD/ESRD
and may lead to the development of novel risk-stratification profiles in the
future. Limitations: This is not a systematic review of the literature and the proposed
perspective is tainted by the authors’ point of view on the topic. Implications: WES in combination with novel technologies such as RNA sequencing may enable
us to fully unravel underlying disease mechanisms and secondary disease
outcomes in monogenic causes of CKD and better characterize individual risk
profiles. This understanding will hopefully facilitate the development of
novel targeted therapies.
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Affiliation(s)
- Caroline Lamarche
- Department of Surgery, The University of British Columbia, Vancouver, Canada.,BC Children's Hospital Research Institute, Vancouver, Canada
| | - Ioan-Andrei Iliuta
- Department of Medicine, Division of Nephrology, University of Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| | - Thomas Kitzler
- Department of Medicine, Division of Nephrology, Harvard Medical School, Boston, MA, USA.,Boston Children's Hospital, MA, USA
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24
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Dawson NA, Lamarche C, Hoeppli RE, Bergqvist P, Fung VC, McIver E, Huang Q, Gillies J, Speck M, Orban PC, Bush JW, Mojibian M, Levings MK. Systematic testing and specificity mapping of alloantigen-specific chimeric antigen receptors in regulatory T cells. JCI Insight 2019; 4:123672. [PMID: 30753169 DOI: 10.1172/jci.insight.123672] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [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: 07/18/2018] [Accepted: 02/05/2019] [Indexed: 12/19/2022] Open
Abstract
Chimeric antigen receptor (CAR) technology can be used to engineer the antigen specificity of regulatory T cells (Tregs) and improve their potency as an adoptive cell therapy in multiple disease models. As synthetic receptors, CARs carry the risk of immunogenicity, particularly when derived from nonhuman antibodies. Using an HLA-A*02:01-specific CAR (A2-CAR) encoding a single-chain variable fragment (Fv) derived from a mouse antibody, we developed a panel of 20 humanized A2-CARs (hA2-CARs). Systematic testing demonstrated variations in expression, and ability to bind HLA-A*02:01 and stimulate human Treg suppression in vitro. In addition, we developed a new method to comprehensively map the alloantigen specificity of CARs, revealing that humanization reduced HLA-A cross-reactivity. In vivo bioluminescence imaging showed rapid trafficking and persistence of hA2-CAR Tregs in A2-expressing allografts, with eventual migration to draining lymph nodes. Adoptive transfer of hA2-CAR Tregs suppressed HLA-A2+ cell-mediated xenogeneic graft-versus-host disease and diminished rejection of human HLA-A2+ skin allografts. These data provide a platform for systematic development and specificity testing of humanized alloantigen-specific CARs that can be used to engineer specificity and homing of therapeutic Tregs.
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Affiliation(s)
- Nicholas Aj Dawson
- Department of Medicine and.,BC Children's Hospital Research Institute (BCCHR), Vancouver, British Columbia, Canada
| | - Caroline Lamarche
- Department of Surgery, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute (BCCHR), Vancouver, British Columbia, Canada
| | - Romy E Hoeppli
- Department of Surgery, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute (BCCHR), Vancouver, British Columbia, Canada
| | - Peter Bergqvist
- Centre for Drug and Research and Development, Vancouver, British Columbia, Canada
| | - Vivian Cw Fung
- Department of Surgery, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute (BCCHR), Vancouver, British Columbia, Canada
| | - Emma McIver
- Department of Surgery, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute (BCCHR), Vancouver, British Columbia, Canada
| | - Qing Huang
- Department of Surgery, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute (BCCHR), Vancouver, British Columbia, Canada
| | - Jana Gillies
- Department of Surgery, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute (BCCHR), Vancouver, British Columbia, Canada
| | - Madeleine Speck
- Department of Surgery, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute (BCCHR), Vancouver, British Columbia, Canada
| | - Paul C Orban
- Department of Surgery, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute (BCCHR), Vancouver, British Columbia, Canada
| | - Jonathan W Bush
- BC Children's Hospital Research Institute (BCCHR), Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine and
| | - Majid Mojibian
- Department of Surgery, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute (BCCHR), Vancouver, British Columbia, Canada
| | - Megan K Levings
- Department of Surgery, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute (BCCHR), Vancouver, British Columbia, Canada.,School of Biomedical Engineering, UBC, Vancouver, British Columbia, Canada
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25
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Boudreau G, Carli C, Lamarche C, Rulleau C, Bonnaure G, Néron S, Delisle JS. Leukoreduction system chambers are a reliable cellular source for the manufacturing of T-cell therapeutics. Transfusion 2018; 59:1300-1311. [DOI: 10.1111/trf.15121] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/15/2018] [Accepted: 11/21/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Gabrielle Boudreau
- Centre de Recherche de l'Hôpital Maisonneuve-Rosemont; Montréal Québec Canada
| | - Cédric Carli
- Centre de Recherche de l'Hôpital Maisonneuve-Rosemont; Montréal Québec Canada
| | - Caroline Lamarche
- Centre de Recherche de l'Hôpital Maisonneuve-Rosemont; Montréal Québec Canada
| | - Caroline Rulleau
- Centre de Recherche de l'Hôpital Maisonneuve-Rosemont; Montréal Québec Canada
| | - Guillaume Bonnaure
- Centre de Recherche de l'Hôpital Maisonneuve-Rosemont; Montréal Québec Canada
- Medical Affairs and Innovation; Héma-Québec; Québec Québec Canada
| | - Sonia Néron
- Medical Affairs and Innovation; Héma-Québec; Québec Québec Canada
- Department of Biochemistry, Microbiology and Bio-informatics; Université Laval; Québec Québec Canada
| | - Jean-Sébastien Delisle
- Centre de Recherche de l'Hôpital Maisonneuve-Rosemont; Montréal Québec Canada
- Hematology-Oncology Division; Hôpital Maisonneuve-Rosemont; Montréal Québec Canada
- Department of Medicine; Université de Montréal; Montreal Québec Canada
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26
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Pineault J, Lamarche C, Bell R, Lafrance JP, Ouellet G, Leblanc M, Pichette V, Bezzaoucha S, Vallée M. Association of Neutrophil-to-Lymphocyte Ratio With Inflammation and Erythropoietin Resistance in Chronic Dialysis Patients. Can J Kidney Health Dis 2017; 4:2054358117735563. [PMID: 29147572 PMCID: PMC5673002 DOI: 10.1177/2054358117735563] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 08/24/2017] [Indexed: 12/27/2022] Open
Abstract
Background Neutrophil-to-lymphocyte ratio (NLR) was widely studied as a prognostic marker in various medical and surgical specialties, but its significance in nephrology is not yet established. Objective We evaluated its accuracy as an inflammation biomarker in a dialysis population. Design setting Single-center retrospective study. Patients The records of all 550 patients who were treated with hemodialysis (HD) or peritoneal dialysis (PD) from September 2008 to March 2011 were included. Measurements NLR was calculated from the monthly complete blood count. Methods Association between NLR and markers of inflammation (C-reactive protein [CRP], serum albumin, and erythropoietin resistance index [ERI]) was measured using Spearman coefficient. Results In total, 120 patients were eligible for the correlation analyses. We found a positive correlation between NLR and CRP (all patients: r = 0.45, P < .001; HD: r = 0.47, P < .001; PD: r = 0.48, P = .13). NLR and albumin were inversely correlated (r = -0.51, P < .001). Finally, high NLR was associated with a nonsignificant increased ERI, but we have not demonstrated a direct correlation. Limitations CRP and albumin are not measured routinely and were ordered for a specific clinical reason leading to an indication bias. Also, no relationship with clinical outcome was established. Conclusions NLR seems to be a good inflammatory biomarker in dialysis in addition to being easily available. However, controlled studies should be conducted to properly assess and validate NLR levels that would be clinically significant and relevant, as well as its prognostic significance and utility in a clinical setting.
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Affiliation(s)
- Jérôme Pineault
- Department of Medicine, Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, Québec, Canada
| | - Caroline Lamarche
- Department of Medicine, Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, Québec, Canada
| | - Robert Bell
- Department of Medicine, Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, Québec, Canada
| | - Jean-Philippe Lafrance
- Department of Medicine, Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, Québec, Canada.,Department of Medicine, Université de Montréal, Québec, Canada.,Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Montreal, Québec, Canada
| | - Georges Ouellet
- Department of Medicine, Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, Québec, Canada.,Department of Medicine, Université de Montréal, Québec, Canada
| | - Martine Leblanc
- Department of Medicine, Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, Québec, Canada.,Department of Medicine, Université de Montréal, Québec, Canada.,Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Montreal, Québec, Canada
| | - Vincent Pichette
- Department of Medicine, Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, Québec, Canada.,Department of Medicine, Université de Montréal, Québec, Canada.,Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Montreal, Québec, Canada
| | - Sarah Bezzaoucha
- Department of Medicine, Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, Québec, Canada.,Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Montreal, Québec, Canada
| | - Michel Vallée
- Department of Medicine, Division of Nephrology, Hôpital Maisonneuve-Rosemont, Montreal, Québec, Canada.,Department of Medicine, Université de Montréal, Québec, Canada
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Lamarche C, Pichette M, Ouimet D, Vallée M, Bell R, Ouellet G, Stewart J, Pichette V. Pharmacokinetic and Dynamic of Furosemide in Peritoneal Dialysis Patients. Perit Dial Int 2016; 36:107-8. [PMID: 26838993 DOI: 10.3747/pdi.2014.00328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of our study was to evaluate the efficacy and bioavailibility of a commonly used oral furosemide dose (500 mg) compared to a 250 mg intravenous (IV) dose in PD patients with significant residual renal function (urine volume > 100 mL). We also evaluated the immediate blood pressure effect in these patients. The data were obtained from a study we performed for the homologation of a 500-mg dose of furosemide by Health Canada.
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Affiliation(s)
- Caroline Lamarche
- Department of nephrology, Maisonneuve-Rosemont Hospital, Montreal, Canada
| | - Maude Pichette
- Department of nephrology, Maisonneuve-Rosemont Hospital, Montreal, Canada
| | - Denis Ouimet
- Department of nephrology, Maisonneuve-Rosemont Hospital, Montreal, Canada
| | - Michel Vallée
- Department of nephrology, Maisonneuve-Rosemont Hospital, Montreal, Canada
| | - Robert Bell
- Department of nephrology, Maisonneuve-Rosemont Hospital, Montreal, Canada
| | - Georges Ouellet
- Department of nephrology, Maisonneuve-Rosemont Hospital, Montreal, Canada
| | | | - Vincent Pichette
- Department of nephrology, Maisonneuve-Rosemont Hospital, Montreal, Canada Maisonneuve-Rosemont Hospital Research Center, Montreal, Canada
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Rauscher S, Lafrance JP, Pichette V, Bell RZ, Desforges K, Lepage L, Ouellet G, Ouimet D, Leblanc M, Lamarche C, Bezzaoucha S, Vallee M. Conversion of oral alfacalcidol to oral calcitriol in the treatment of secondary hyperparathyroidism in chronic hemodialysis patients. Int Urol Nephrol 2016; 49:325-328. [DOI: 10.1007/s11255-016-1446-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/22/2016] [Indexed: 11/24/2022]
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Laroche AS, Bell RZ, Bezzaoucha S, Földes E, Lamarche C, Vallée M. Retroperitoneal fibrosis: retrospective descriptive study on clinical features and management. Res Rep Urol 2016; 8:175-179. [PMID: 27822461 PMCID: PMC5087765 DOI: 10.2147/rru.s115448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Retroperitoneal fibrosis (RPF) is a rare condition characterized by the presence of inflammatory and fibrous retroperitoneal tissue that often encases the ureters or abdominal organs. This study describes the clinical characteristics, diagnostic methods, and treatments and their effects on renal function. METHODS We conducted a retrospective analysis of patients diagnosed with RPF at Maisonneuve-Rosemont Hospital. RESULTS We identified 17 patients with RPF between 1998 and 2013. Eight patients were females (47%), and the mean age was 62±18 years. Eleven patients were idiopathic. Back pain was the most common symptom. All diagnoses were made based on the finding of a retroperitoneal mass on the computed tomography scan. Three patients had histological diagnosis of RPF and seven patients had unspecific changes on their biopsy. Twelve patients needed double-J stents, three patients had a temporary percutaneous nephrostomy, two patients had to have a nephrectomy for refractory ureteral obstruction, and one patient required hemodialysis. Ten patients with idiopathic RPF received medical treatment. In the treated group, only two patients had complete remission of the disease and five patients had improvement of their lesions. There were no deteriorations and only one relapse. Seven patients did not receive any treatment; two of them achieved complete remission, one of them deteriorated, and two of them had no changes. CONCLUSION Most of our cases of RPF were idiopathic. Almost all treated patients received prednisone and seemed to respond, at least partially. There was a lot of heterogeneity in patient management, which makes it difficult to compare treatment effects. However, treated patients seemed to have more favorable outcomes than those who were not.
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Affiliation(s)
| | | | | | - Eva Földes
- Section of Internal Medicine, Department of Medicine, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, QC, Canada
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Naud J, Harding J, Lamarche C, Beauchemin S, Leblond FA, Pichette V. Effects of Chronic Renal Failure on Brain Cytochrome P450 in Rats. Drug Metab Dispos 2016; 44:1174-9. [DOI: 10.1124/dmd.116.070052] [Citation(s) in RCA: 6] [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: 02/12/2016] [Accepted: 05/18/2016] [Indexed: 11/22/2022] Open
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Lamarche C, Boucher A, Dandavino R, Senécal L, Collette S, Tran D, Vallée M. Treatment of Polyomavirus-Associated Nephropathy With the Association of Sirolimus and Leflunomide. EXP CLIN TRANSPLANT 2015; 13:607-608. [PMID: 26643679] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Caroline Lamarche
- Department of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Canada
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Langevin C, Lamarche C, Bell RZ, Vallée M. Presumed paradoxical embolus in a patient with diabetic ketoacidosis. Int J Gen Med 2015; 8:297-301. [PMID: 26445558 PMCID: PMC4590547 DOI: 10.2147/ijgm.s87521] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Thrombotic complications figure among the most frequent causes of mortality in diabetic ketoacidosis (DKA) and hyperosmolar state. We report the case of a 55-year-old woman presenting with DKA whereby a newly discovered patent foramen ovale was found due in part to the observation of bilateral deep vein thrombosis in legs, bilateral multiple pulmonary embolisms, and left subclavian acute artery thrombosis. Diabetes is known as a hypercoagulability state, and DKA is rising as a risk factor for vascular events. The importance of prophylactic anticoagulation should be emphasized in this setting.
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Affiliation(s)
- Catherine Langevin
- Department of Nephrology, Maisonneuve-Rosement Hospital, Montreal, QC, Canada
| | - Caroline Lamarche
- Department of Nephrology, Maisonneuve-Rosement Hospital, Montreal, QC, Canada
| | - Robert Z Bell
- Department of Nephrology, Maisonneuve-Rosement Hospital, Montreal, QC, Canada
| | - Michel Vallée
- Department of Nephrology, Maisonneuve-Rosement Hospital, Montreal, QC, Canada
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Beaubien-Souligny W, Bezzaoucha S, Pichette V, Lafrance JP, Bell R, Lamarche C, Ouimet D, Vallee M. The effect of lanthanum carbonate on metabolic acidosis in patients with chronic kidney disease stage IV, V and V-D. Int Urol Nephrol 2015; 47:1165-71. [DOI: 10.1007/s11255-015-1003-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 05/03/2015] [Indexed: 11/30/2022]
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Sciancalepore AG, Sallustio F, Girardo S, Passione LG, Camposeo A, Mele E, Di Lorenzo M, Costantino V, Schena FP, Pisignano D, Casino FG, Mostacci SD, Di Carlo M, Sabato A, Procida C, Creput C, Vanholder R, Stolear JC, Lefrancois G, Hanoy M, Nortier J, Potier J, Sereni L, Ferraresi M, Pereno A, Nazha M, Barbero S, Piccoli GB, Ficheux A, Gayrard N, Duranton F, Guzman C, Szwarc I, Bismuth -Mondolfo J, Brunet P, Servel MF, Argiles A, Bernardo A, Demers J, Hutchcraft A, Marbury TC, Minkus M, Muller M, Stallard R, Culleton B, Krieter DH, Korner T, Devine E, Ruth M, Jankowski J, Wanner C, Lemke HD, Surace A, Rovatti P, Steckiph D, Mancini E, Santoro A, Leypoldt JK, Agar BU, Bernardo A, Culleton BF, Vankova S, Havlin J, Klomp DJ, Van Beijnum F, Day JPR, Wieringa FP, Kooman JP, Gremmels H, Hazenbrink DH, Simonis F, Otten ML, Wester M, Boer WH, Joles JA, Gerritsen KG, Umimoto K, Shimamoto Y, Mastushima K, Miyata M, Muller M, Naik A, Pokropinski S, Bairstow S, Svatek J, Young S, Johnson R, Bernardo A, Rikker C, Juhasz E, Gaspar R, Rosivall L, Rusu E, Zilisteanu D, Balanica S, Achim C, Atasie T, Carstea F, Voiculescu M, Monzon Vazquez T, Saiz Garcia S, Mathani V, Escamilla Cabrera B, Cornelis T, Van Der Sande FM, Eloot S, Cardinaels E, Bekers O, Damoiseaux J, Leunissen KM, Kooman J, Baamonde Laborda E, Bosch Benitez-Parodi E, Perez Suarez G, Anton Perez G, Batista Garcia F, Lago Alonso M, Garcia Canton C, Hashimoto S, Seki M, Tomochika M, Yamamoto R, Okamoto N, Nishikawa A, Koike T, Ravagli E, Maldini L, Badiali F, Perazzini C, Lanciotti G, Steckiph D, Surace A, Rovatti P, Severi S, Rigotti A, McFarlane P, Marticorena R, Dacouris N, Pauly R, Nikitin S, Amdahl M, Bernardo A, Culleton B, Calabrese G, Mancuso D, Mazzotta A, Vagelli G, Balenzano C, Steckiph D, Bertucci A, Della Volpe M, Gonella M, Uchida T, Ando K, Kofuji M, Higuchi T, Momose N, Ito K, Ueda Y, Miyazawa H, Kaku Y, Nabata A, Hoshino T, Mori H, Yoshida I, Ookawara S, Tabei K, Umimoto K, Suyama M, Shimamoto Y, Miyata M, Kamada A, Sakai R, Minakawa A, Fukudome K, Hisanaga S, Ishihara T, Yamada K, Fukunaga S, Inagaki H, Tanaka C, Sato Y, Fujimoto S, Potier J, Bouet J, Queffeulou G, Bell R, Nolin L, Pichette V, Provencher H, Lamarche C, Nadeau-Fredette AC, Ouellet G, Leblanc M, Bezzaoucha S, Kouidmir Y, Kassis J, Alonso ML, Lafrance JP, Vallee M, Fils J, Mailley P, Cantaluppi V, Medica D, Quercia AD, Dellepiane S, Ferrario S, Gai M, Leonardi G, Guarena C, Caiazzo M, Biancone L, Enos M, Culleton B, Wiebenson D, Potier J, Hanoy M, Duquennoy S, Tingli W, Ling Z, Yunying S, Ping F, Dolley-Hitze T, Hamel D, Lombart ML, Leypoldt JK, Bernardo A, Hutchcraft AM, Vanholder R, Culleton BF, Movilli E, Camerini C, Gaggia P, Zubani R, Feller P, Pola A, Carli O, Salviani C, Manenti C, Cancarini G, Bozzoli L, Colombini E, Ricchiuti G, Pisanu G, Gargani L, Donadio C, Sidoti A, Lusini ML, Biagioli M, Ghezzi PM, Sereni L, Caiazzo M, Palladino G, Tomo T, Ishida K, Nakata T, Hamel D, Dolley-Hitze T. HAEMODIALYSIS TECHNIQUES AND ADEQUACY 1. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu153] [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: 11/13/2022] Open
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Thomson NR, Fraser MJ, Lamarche C, Barker JF, Forsey SP. Rebound of a coal tar creosote plume following partial source zone treatment with permanganate. J Contam Hydrol 2008; 102:154-171. [PMID: 18757111 DOI: 10.1016/j.jconhyd.2008.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2007] [Revised: 06/05/2008] [Accepted: 07/02/2008] [Indexed: 05/26/2023]
Abstract
The long-term management of dissolved plumes originating from a coal tar creosote source is a technical challenge. For some sites stabilization of the source may be the best practical solution to decrease the contaminant mass loading to the plume and associated off-site migration. At the bench-scale, the deposition of manganese oxides, a permanganate reaction byproduct, has been shown to cause pore plugging and the formation of a manganese oxide layer adjacent to the non-aqueous phase liquid creosote which reduces post-treatment mass transfer and hence mass loading from the source. The objective of this study was to investigate the potential of partial permanganate treatment to reduce the ability of a coal tar creosote source zone to generate a multi-component plume at the pilot-scale over both the short-term (weeks to months) and the long-term (years) at a site where there is >10 years of comprehensive synoptic plume baseline data available. A series of preliminary bench-scale experiments were conducted to support this pilot-scale investigation. The results from the bench-scale experiments indicated that if sufficient mass removal of the reactive compounds is achieved then the effective solubility, aqueous concentration and rate of mass removal of the more abundant non-reactive coal tar creosote compounds such as biphenyl and dibenzofuran can be increased. Manganese oxide formation and deposition caused an order-of-magnitude decrease in hydraulic conductivity. Approximately 125 kg of permanganate were delivered into the pilot-scale source zone over 35 days, and based on mass balance estimates <10% of the initial reactive coal tar creosote mass in the source zone was oxidized. Mass discharge estimated at a down-gradient fence line indicated >35% reduction for all monitored compounds except for biphenyl, dibenzofuran and fluoranthene 150 days after treatment, which is consistent with the bench-scale experimental results. Pre- and post-treatment soil core data indicated a highly variable and random spatial distribution of mass within the source zone and provided no insight into the mass removed of any of the monitored species. The down-gradient plume was monitored approximately 1, 2 and 4 years following treatment. The data collected at 1 and 2 years post-treatment showed a decrease in mass discharge (10 to 60%) and/or total plume mass (0 to 55%); however, by 4 years post-treatment there was a rebound in both mass discharge and total plume mass for all monitored compounds to pre-treatment values or higher. The variability of the data collected was too large to resolve subtle changes in plume morphology, particularly near the source zone, that would provide insight into the impact of the formation and deposition of manganese oxides that occurred during treatment on mass transfer and/or flow by-passing. Overall, the results from this pilot-scale investigation indicate that there was a significant but short-term (months) reduction of mass emanating from the source zone as a result of permanganate treatment but there was no long-term (years) impact on the ability of this coal tar creosote source zone to generate a multi-component plume.
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Affiliation(s)
- N R Thomson
- Department of Civil and Environmental Engineering, University of Waterloo, Waterloo ON, Canada N2L 3G1.
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Lévesque K, Lamarche C, Rompré PP. Evidence for a role of endogenous neurotensin in the development of sensitization to the locomotor stimulant effect of morphine. Eur J Pharmacol 2008; 594:132-8. [DOI: 10.1016/j.ejphar.2008.07.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Revised: 07/09/2008] [Accepted: 07/23/2008] [Indexed: 11/25/2022]
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Thery J, Picquenot J, Cornic M, Lamarche C, Raillot V, Laberge-Le-couteulx S, Veyret C, Basuyau J, Blot E. Comparison of HER2 extra cellular domain (ECD) serum level at the time of metastasis with HER2 status modification between primary breast cancers and their respective metastases. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.1030] [Citation(s) in RCA: 1] [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: 11/20/2022] Open
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Lamarche C, Lévy R, Felloni B, de Mouzon J, Denis-Belicard E, Huss M, Maubon I, Aknin I, Seffert P. Prise en charge en Assistance médicale à la procréation des femmes de 38 ans et plus: résultats d'une enquête à propos de 84 couples. ACTA ACUST UNITED AC 2007; 35:420-9. [PMID: 17459756 DOI: 10.1016/j.gyobfe.2007.02.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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: 10/23/2006] [Accepted: 02/28/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE More and more young women are delaying childbearing until the fourth decade of life: thus, Assisted Reproductive Techniques centres receive more and more requests from ageing women. The aim of the study is to analyse the purpose of these requests, the biological and clinical features of these patients and the results in our infertility centre. PATIENTS AND METHODS A retrospective study was carried out at the CHU of Saint-Etienne from 01.01.01 to 31.12.04. We analysed the social, clinical and biological features of 84 couples when the woman's age was equal or superior to 38 years, representing 218 cycles. A questionnaire was used to collect social data. RESULTS Several factors can explain the increasing number of ageing women consulting for infertility: extend university time and professional career, professional stability, contraception and late meeting of the partner, false reassuring information concerning progress in ART, second child desire after a late first pregnancy, but also second marital unions and child desire in the redefined couple. In our study, above 40 years old, the pregnancy (19.4 versus 10.5%) and delivery rates (16.7 versus 5.8%) clearly decreased in IUI. Thus, most of the clinicians propose, in first choice, an IVF cycle to a 40 year-old woman. The ultrasound measurement of antral follicle count can accurately evaluate the prognosis in terms of pregnancy (P<0.01) and delivery rate (P=0.03). For patients with unfavourable prognosis, oocyte donation, embryo donation, or adoption can be considered. DISCUSSION AND CONCLUSION ART cannot compensate for the natural decrease in pregnancy rates and the increase in early miscarriages in ageing women. Therefore, it is essential to inform young women of the negative effects of age on their potential fertility.
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Affiliation(s)
- C Lamarche
- Laboratoire de biologie de la reproduction, CHU de Saint-Etienne, Hôpital Nord, Saint-Etienne, France
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De Koninck GC, Hébert M, Carrier J, Lamarche C, Dufour S. Body temperature and the return of slow wave activity in extended sleep. Electroencephalogr Clin Neurophysiol 1996; 98:42-50. [PMID: 8689993 DOI: 10.1016/0013-4694(95)00215-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The time courses of slow wave sleep (SWS) and EEG slow wave activity (SWA) were examined in relation to core body temperature (CBT) during extended sleep periods of 15 h. Ten subjects (4 male, 6 female; aged 18-29 years) slept in the laboratory for 3 consecutive nights (2 of 8 h, and the last of 15 h). Bedtime was as close as possible to subjects' habitual bedtimes, but was always between 23.00 h and 1.00 h, and was the same on all nights. Standard polysomnographic measures as well as rectal temperature were collected continuously each night. Using 3 h blocks, SWS and SWA declined with time asleep, then showed a significant increase in the final 3 h. Using a more specific measure with 15 min means, 8 of the 10 subjects showed SWA returns late in sleep, that were not related to preceding amounts of waking after sleep onset (WASO), rapid eye movement sleep (REMS), or WASO+REMS. The timing and magnitude of the SWA return was significantly associated with the phase of CBT as indexed by delay from sleep onset to CBT minimum. The findings are consistent with a 12 h rhythm of SWS and SWA that is related to the phase of the CBT rhythm, with the minor pole of SWS/SWA occurring independently of WASO and/or REMS.
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Affiliation(s)
- G C De Koninck
- School of Psychology, University of Ottawa, Ontario, Canada
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Korczak B, Robson IB, Lamarche C, Bernstein A, Kerbel RS. Genetic tagging of tumor cells with retrovirus vectors: clonal analysis of tumor growth and metastasis in vivo. Mol Cell Biol 1988; 8:3143-9. [PMID: 3211140 PMCID: PMC363542 DOI: 10.1128/mcb.8.8.3143-3149.1988] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Retrovirus vector infection was used to introduce large numbers of unique genetic markers into tumor cell populations for the purpose of analyzing comparative changes in the clonal composition of metastatic versus that of nonmetastatic tumors during their progressive growth in vivo. The cell lines used were SP1, a nonmetastatic, aneuploid mouse mammary adenocarcinoma, and SP1HU9L, a metastatic variant of SP1. Cells were infected with delta e delta pMoTN, a replication-defective retrovirus vector which possesses the dominant selectable neo gene and crippled long terminal repeats. G418r colonies were obtained at a frequency of 4 x 10(-3). Southern blot analysis of a number of clones provided evidence of random and heritable integration of one or two copies of the proviral DNA. Clonal evolution of primary tumor growth and the nature of lineage relationships among spontaneous metastases and primary tumors were analyzed by subcutaneously injecting 10(5) cells from a pooled mixture of 3.6 x 10(2) G418r SP1HU9L or 10(4) G418r SP1 colonies into syngeneic CBA/J mice. The most striking finding was the relative clonal homogeneity of advanced primary tumors; they invariably consisted of a small number (less than 10) of distinct clones despite the fact that hundreds or thousands of uniquely marked clones had been injected. In the case of the metastatic SP1HU9L cells, the nature of these "dominant" clones varied from one tumor to another. Analysis of a number of lung metastases revealed that a proportion of them were derived from dominant primary tumor clones and were composed of one, and sometimes two, distinct progenitors. In some animals, all the lung metastases were derived from a common progenitor clone, whereas in others, each metastatic nodule had a different progenitor. The results show the following. (i) Retrovirus vector infection can be used to introduce large numbers of unique and stable clonal markers into tumor cell populations. (ii) The progeny of a very limited number of clones dominate in advanced primary tumors. (iii) Mammary carcinoma metastases are of mono- or biclonal origin. The significance of the results is discussed.
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Affiliation(s)
- B Korczak
- Division of Cancer and Cell Biology, Mount Sinai Hospital Research Institute, Toronto, Ontario, Canada
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Lamarche C, Valiquette R. [Occlusion in complete dentures. I]. J Dent Que 1985; 22:503-8. [PMID: 3912413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Brien N, Lamarche C, Tache R. [Multidirectional insertion paths: their application to butterfly bridges]. J Dent Que 1985; 22:69-76. [PMID: 3897313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Lamarche C. [Parents of a handicapped child (review of American literature).]. Sante Ment Que 1985; 10:36-45. [PMID: 17093832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The presence of an handicapped child is a cause of major stress in a family and the source of serious upheavals. For the parents, this occurence can promote personal growth or lead to dissatisfaction or an inadaptive process that will influence their life on many levels: personal, conjugal, familial and social. The handicapped child's birth itself affects the parents and triggers many emotions, feelings behaviors and attitudes. The parents find themselves in a complex and irreversible situation to which they have to adapt. They have to organize their life in order to provide favorable conditions for the development of the child while preserving their own and their family's integrity. This article presents the different stages the parents have to go through to achieve a certain peace of mind. It also describes the reactions of the handicapped children's siblings in terms of their feelings and needs and underlines the determining role of the parents towards them. The professionals involved in those situations have to understand the underlying family dynamics. Their objective is to help the parents provide a stimulating environment to the handicapped child while preserving harmony in their family.
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Kim HS, Lamarche C, Verdier A. Etude des interactions entre un polyelectrolyte cationique de type ammonium tertiaire et une suspension aqueuse de bentonite. Colloid Polym Sci 1983. [DOI: 10.1007/bf01411519] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [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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