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Jalink M, Jacobs CF, Khwaja J, Evers D, Bruggeman C, Fattizzo B, Michel M, Crickx E, Hill QA, Jaeger U, Kater AP, Mäkelburg ABU, Breedijk A, Te Boekhorst PAW, Hoeks MPA, de Haas M, D'Sa SP, Vos JMI. Daratumumab monotherapy in refractory warm autoimmune hemolytic anemia and cold agglutinin disease. Blood Adv 2024:bloodadvances.2024012585. [PMID: 38507742 DOI: 10.1182/bloodadvances.2024012585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/07/2024] [Accepted: 02/28/2024] [Indexed: 03/22/2024] Open
Abstract
Autoimmune hemolytic anemia (AIHA) is a rare autoantibody-mediated disease. For steroid and/or rituximab-refractory AIHA, there is no consensus on optimal treatment. Daratumumab, a monoclonal antibody targeting CD38, could be beneficial by suppression of CD38+ plasmacells and thus autoantibody secretion. In addition, since CD38 is also expressed by activated T-cells, daratumumab may also act via immunomodulatory effects. We evaluated efficacy and safety of daratumumab monotherapy in an international retrospective study including 19 adult patients with heavily pretreated refractory AIHA. In warm AIHA (wAIHA, n=12), overall response was 50% with a median response duration of 5.5 months (range, 2-12 months) including ongoing response in 2 patients after 6 and 12 months. Of 6 non-responders, 4 had Evans syndrome. In cold AIHA (cAIHA, n=7) overall hemoglobin (Hb) response was 57%, with ongoing response in 3/7 patients. One additional non-anemic cAIHA patient was treated for severe acrocyanosis and reached a clinical acrocyanosis response as well as a Hb increase. Of 6 cAIHA patients with acrocyanosis, 4 had improved symptoms after daratumumab treatment. In two patients with wAIHA treated with daratumumab in whom we prospectively collected blood samples, we found complete CD38+ T cells depletion after daratumumab, as well as altered T-cell subset differentiation and a severely diminished capacity for cell activation and proliferation. Reappearance of CD38+ T-cells coincided with disease relapse in one patient. In conclusion, our data show that daratumumab therapy may be a treatment option for refractory AIHA. The observed immunomodulatory effects that may contribute to the clinical response deserve further exploration.
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Affiliation(s)
- Marit Jalink
- Center for Clinical Transfusion Research, Sanquin Research, Amsterdam, Netherlands
| | - Chaja F Jacobs
- Experimental Immunology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | | | - Dorothea Evers
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Coty Bruggeman
- Department of Hematology, Martini Ziekenhuis, Groningen, The Netherlands
| | - Bruno Fattizzo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marc Michel
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, Université Paris Est Créteil, 94000 Créteil
| | - Etienne Crickx
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, Université Paris Est Créteil, 94000 Créteil
| | | | - Ulrich Jaeger
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Arnon P Kater
- Experimental Immunology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Anja B U Mäkelburg
- Department of Hematology, University Medical Center Groningen, Groningen, Netherlands
| | - Anouk Breedijk
- Department of Internal Medicine, Deventer Ziekenhuis, Deventer, Netherlands
| | | | - Marlijn P A Hoeks
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Masja de Haas
- Department of Hematology, Leiden University Medical Center, Leiden, the Netherlands
| | - Shirley P D'Sa
- University College London Hospital, London, United Kingdom
| | - Josephine M I Vos
- Department of Hematology, Amsterdam University Medical Center, Amsterdam, the Netherlands
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2
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Crickx E, Mahévas M. B-cell responses to ITP treatments. Br J Haematol 2024; 204:397-398. [PMID: 38155442 DOI: 10.1111/bjh.19199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 12/30/2023]
Abstract
Deficiency in regulatory B cells has been suggested in immune thrombocytopenia. In this study, Stimpson et al. emphasize the importance of considering the treatments received for immunological analyses. Commentary on: Stimpson et al. Systemic immunosuppression depletes peripheral blood regulatory B cells in patients with immune thrombocytopenia. Br J Haematol 2024;204:644-648.
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Affiliation(s)
- Etienne Crickx
- Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Matthieu Mahévas
- Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
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3
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Huang F, Khellaf LR, Lefèvre G, Berti A, d'Humières T, Sionis A, Solé AA, Bello F, Bermeo Garrido JA, Crickx E, Delvino P, Emmi G, Gaillet A, Garcia G, Gavand PE, George JL, Gilles F, Golden C, de Groote P, Guffroy A, Martis N, Monti S, Mourlanette P, Pineton de Chambrun M, Prunier F, Regola F, Seret G, Terrier B, Tréfond L, Souteyrand G, Varenne O, Zilio F, Haziza F, Benamer H, Kahn JE, Vallée A, Groh M. Clinical picture, outcomes, and predictors of relapse in eosinophilia-associated coronary vasospasm: data from a European multicentric study. J Allergy Clin Immunol Pract 2024:S2213-2198(24)00138-7. [PMID: 38307204 DOI: 10.1016/j.jaip.2024.01.036] [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] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/04/2024]
Affiliation(s)
- Florent Huang
- ACTION Study Group, Department of Cardiology, Foch Hospital, Suresnes, France; French National Reference Center for Hypereosinophilic Syndromes, Department of Internal Medicine, Foch Hospital, Suresnes, France
| | - Lucas Rémi Khellaf
- French National Reference Center for Hypereosinophilic Syndromes, Department of Internal Medicine, Foch Hospital, Suresnes, France
| | - Guillaume Lefèvre
- French National Reference Center for Hypereosinophilic Syndromes, Department of Internal Medicine, Foch Hospital, Suresnes, France; Department of Internal Medicine and Clinical Immunology, University of Lille, CHU de Lille, Lille, France; Inserm U1286 Institute for Translational Research in Inflammation, University of Lille, CHU Lille, Lille, France
| | - Alvise Berti
- Center for Medical Sciences, Department of Cellular, Computational, and Integrative Biology, University of Trento, Trento, Italy; Rheumatology Unit, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari Trento, Trento, Italy
| | - Thomas d'Humières
- Physiology Department, CHU Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Albert Ariza Solé
- Intensive Cardiac Care Unit, Cardiology Department, Bellvitge University Hospital, Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Federica Bello
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy; Interdisciplinary Internal Medicine Unit, Behçet Centre and Lupus Clinic, AOU Careggi Hospital of Firenze, Firenze, Italy
| | - Juan Andres Bermeo Garrido
- Intensive Cardiac Care Unit, Cardiology Department, Bellvitge University Hospital, Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Etienne Crickx
- Internal Medicine Department, Centre National de Référence des Cytopénies Auto-immunes de l'Adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire Innovative Therapy for Immune Disorders, Assistance Publique Hôpitaux de Paris, Université Paris Est Créteil, Créteil, France
| | - Paolo Delvino
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy; Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy; Interdisciplinary Internal Medicine Unit, Behçet Centre and Lupus Clinic, AOU Careggi Hospital of Firenze, Firenze, Italy; Centre for Inflammatory Diseases, Department of Medicine, Monash Medical Centre, Monash University, Clayton, Victoria, Australia
| | - Antoine Gaillet
- French National Reference Center for Hypereosinophilic Syndromes, Department of Internal Medicine, Foch Hospital, Suresnes, France; Medical Intensive Care Unit, Hôpitaux Universitaires Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Gilles Garcia
- Department of Pulmonology, Antony Private Hospital, Antony, France
| | | | - Jean-Louis George
- Department of Cardiology, Centre Hospitalier de Versailles, André Mignot Hospital, Le Chesnay-Rocquencourt, France
| | - Floriane Gilles
- Department of Cardiology, Centre Hospitalier de Versailles, André Mignot Hospital, Le Chesnay-Rocquencourt, France
| | | | - Pascal de Groote
- French National Reference Center for Hypereosinophilic Syndromes, Department of Internal Medicine, Foch Hospital, Suresnes, France; CHU Lille, Service de Cardiologie, Lille, France; Inserm U1167, Institut Pasteur de Lille, Lille, France
| | - Aurélien Guffroy
- Department of Clinical Immunology and Internal Medicine, National Reference Center for Systemic Autoimmune Diseases (CNR RESO), Tertiary Center for Primary Immunodeficiencies, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Nihal Martis
- Internal Medicine Department, Hôpital de Larchet, University Hospital of Nice, Côte d'Azur University, Nice, France
| | - Sara Monti
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
| | | | - Marc Pineton de Chambrun
- Department of Intensive Care Medicine, APHP, Sorbonne Université, Pitié Salpétrière, Paris, France
| | - Fabrice Prunier
- Department of Cardiology, Universitary Hospital of Angers, Angers, France
| | - Francesca Regola
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Gabriel Seret
- Department of Cardiology, University of Sorbonne-Paris Cité, APHP, Cochin Hospital, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, Hôpital Cochin, APHP, Paris, France
| | - Ludovic Tréfond
- Internal Medicine, Gabriel Montpied Hospital, Clermond-Ferrand, France
| | - Géraud Souteyrand
- Department of Cardiology, Gabriel Montpied Hospital, Clermond-Ferrand, France
| | - Olivier Varenne
- Department of Cardiology, University of Sorbonne-Paris Cité, APHP, Cochin Hospital, Paris, France
| | - Filippo Zilio
- Department of Cardiology, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari Trento, Trento, Italy
| | - Franck Haziza
- ACTION Study Group, Department of Cardiology, Foch Hospital, Suresnes, France
| | - Hakim Benamer
- ACTION Study Group, Department of Cardiology, Foch Hospital, Suresnes, France
| | - Jean-Emmanuel Kahn
- French National Reference Center for Hypereosinophilic Syndromes, Department of Internal Medicine, Foch Hospital, Suresnes, France; Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Alexandre Vallée
- Department of Epidemiology and Public Health, Foch Hospital, Suresnes, France
| | - Matthieu Groh
- French National Reference Center for Hypereosinophilic Syndromes, Department of Internal Medicine, Foch Hospital, Suresnes, France.
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4
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Fischer M, Olbrich P, Hadjadj J, Aumann V, Bakhtiar S, Barlogis V, von Bismarck P, Bloomfield M, Booth C, Buddingh EP, Cagdas D, Castelle M, Chan AY, Chandrakasan S, Chetty K, Cougoul P, Crickx E, Dara J, Deyà-Martínez A, Farmand S, Formankova R, Gennery AR, Gonzalez-Granado LI, Hagin D, Hanitsch LG, Hanzlikovà J, Hauck F, Ivorra-Cortés J, Kisand K, Kiykim A, Körholz J, Leahy TR, van Montfrans J, Nademi Z, Nelken B, Parikh S, Plado S, Ramakers J, Redlich A, Rieux-Laucat F, Rivière JG, Rodina Y, Júnior PR, Salou S, Schuetz C, Shcherbina A, Slatter MA, Touzot F, Unal E, Lankester AC, Burns S, Seppänen MRJ, Neth O, Albert MH, Ehl S, Neven B, Speckmann C. JAK inhibitor treatment for inborn errors of JAK/STAT signaling: An ESID/EBMT-IEWP retrospective study. J Allergy Clin Immunol 2024; 153:275-286.e18. [PMID: 37935260 DOI: 10.1016/j.jaci.2023.10.018] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/21/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Inborn errors of immunity (IEI) with dysregulated JAK/STAT signaling present with variable manifestations of immune dysregulation and infections. Hematopoietic stem cell transplantation (HSCT) is potentially curative, but initially reported outcomes were poor. JAK inhibitors (JAKi) offer a targeted treatment option that may be an alternative or bridge to HSCT. However, data on their current use, treatment efficacy and adverse events are limited. OBJECTIVE We evaluated the current off-label JAKi treatment experience for JAK/STAT inborn errors of immunity (IEI) among European Society for Immunodeficiencies (ESID)/European Society for Blood and Marrow Transplantation (EBMT) Inborn Errors Working Party (IEWP) centers. METHODS We conducted a multicenter retrospective study on patients with a genetic disorder of hyperactive JAK/STAT signaling who received JAKi treatment for at least 3 months. RESULTS Sixty-nine patients (72% children) were evaluated (45 STAT1 gain of function [GOF], 21 STAT3-GOF, 1 STAT5B-GOF, 1 suppressor of cytokine signaling 1 [aka SOCS1] loss of function, 1 JAK1-GOF). Ruxolitinib was the predominantly prescribed JAKi (80%). Overall, treatment resulted in improvement (partial or complete remission) of clinical symptoms in 87% of STAT1-GOF and in 90% of STAT3-GOF patients. We documented highly heterogeneous dosing and monitoring regimens. The response rate and time to response varied across different diseases and manifestations. Adverse events including infection and weight gain were frequent (38% of patients) but were mild (grade I-II) and transient in most patients. At last follow-up, 52 (74%) of 69 patients were still receiving JAKi treatment, and 11 patients eventually underwent HSCT after receipt of previous JAKi bridging therapy, with 91% overall survival. CONCLUSIONS Our study suggests that JAKi may be highly effective to treat symptomatic JAK/STAT IEI patients. Prospective studies to define optimal JAKi dosing for the variable clinical presentations and age ranges should be pursued.
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Affiliation(s)
- Marco Fischer
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Division of Immunology and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; Department of Immunology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Peter Olbrich
- Pediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, IBiS/ Universidad de Sevilla/CSIC, Red de Investigación Traslacional en Infectología Pediátrica RITIP, Seville, Spain; Departamento de Pediatría, Facultad de Medicina, Universidad de Sevilla, Seville, Spain
| | - Jérôme Hadjadj
- Sorbonne University, Department of Internal Medicine, APHP, Saint-Antoine Hospital, F-75012 Paris, France
| | - Volker Aumann
- Pediatric Oncology Department, Otto von Guericke University Children's Hospital Magdeburg, Magdeburg, Germany
| | - Shahrzad Bakhtiar
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents Medicine, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Vincent Barlogis
- Pediatric Hematology Unit, Latimone University Hospital, Marseille, France
| | - Philipp von Bismarck
- Clinic for General Pediatrics, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Markéta Bloomfield
- Department of Immunology, 2nd Faculty of Medicine, Charles University in Prague and University Hospital in Motol, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Claire Booth
- Department of Paediatric Immunology and Gene Therapy, Great Ormond Street Hospital London, London, England, United Kingdom
| | - Emmeline P Buddingh
- Willem-Alexander Children's Hospital, Department of Pediatrics, Pediatric Stem cell Transplantation program, Leiden University Medical Center, Leiden, The Netherlands
| | - Deniz Cagdas
- Department of Pediatric Immunology, Hacettepe University Medical School, Ankara, Turkey
| | - Martin Castelle
- Immuno-hematology and Rheumatology Unit, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, INSERM 1163, Institut Imagine, Paris, Île-de-France, France
| | - Alice Y Chan
- Division of Allergy, Immunology, Bone Marrow Transplantation, Department of Pediatrics, University of California, San Francisco, Calif
| | - Shanmuganathan Chandrakasan
- Aflac Cancer and Blood Disorder Center, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Kritika Chetty
- Department of Paediatric Immunology and Gene Therapy, Great Ormond Street Hospital London, London, England, United Kingdom
| | - Pierre Cougoul
- Oncopole, Institut Universitaire du cancer de toulouse, Toulouse, France
| | - Etienne Crickx
- Internal Medicine Department, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Jasmeen Dara
- Division of Allergy, Immunology, Bone Marrow Transplantation, Department of Pediatrics, University of California, San Francisco, Calif
| | - Angela Deyà-Martínez
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain; Universitat de Barcelona Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Susan Farmand
- Division of Pediatric Stem Cell Transplantation and Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Renata Formankova
- Department of Paediatric Haematology and Oncology, Motol University Hospital and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Andrew R Gennery
- Children's Hematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, England, United Kingdom
| | - Luis Ignacio Gonzalez-Granado
- Primary Immunodeficiencies Unit, Department of Pediatrics, Hospital 12 Octubre Research Institute, Hospital 12 Octubre (i+12) Complutense University School of Medicine, Madrid, Spain
| | - David Hagin
- Allergy and Clinical Immunology Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Leif Gunnar Hanitsch
- Institute of Medical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin and the Berlin Institute of Health (BIH), BIH Center for Regenerative Therapies, Berlin, Germany
| | - Jana Hanzlikovà
- Department of Immunology and Allergology, Faculty of Medicine and Faculty Hospital, Pilsen, Czech Republic
| | - Fabian Hauck
- Department of Pediatrics, Dr von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - José Ivorra-Cortés
- Rheumatology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Kai Kisand
- Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Ayca Kiykim
- Istanbul University-Cerrahpasa, Pediatric Immunology and Allergy, Istanbul, Turkey
| | - Julia Körholz
- Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Timothy Ronan Leahy
- Children's Health Ireland, Crumlin, Dublin, Ireland; University of Dublin, Trinity College, Dublin, Ireland
| | - Joris van Montfrans
- Department of Pediatric Immunology and Infectious Diseases, Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Zohreh Nademi
- Children's Hematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, England, United Kingdom
| | - Brigitte Nelken
- Pediatric Hematology Unit, Centre Hospitalier Universitaire Regional de Lille, Lille, France
| | - Suhag Parikh
- Aflac Cancer and Blood Disorder Center, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Silvi Plado
- Department of Pediatrics, Tallinn Children's Hospital, Tallinn, Estonia
| | - Jan Ramakers
- Department of Pediatrics. Hospital Universitari Son Espases, Palma, Spain; Multidisciplinary Group for Research in Pediatrics, Hospital Universtari Son Espases, Balearic Island Health Research Institute (IdISBa), Palma, Spain
| | - Antje Redlich
- Pediatric Oncology Department, Otto von Guericke University Children's Hospital Magdeburg, Magdeburg, Germany
| | - Frédéric Rieux-Laucat
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Institut Imagine, INSERM, UMR 1163, Paris, France
| | - Jacques G Rivière
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Yulia Rodina
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - Pérsio Roxo Júnior
- Division of Pediatric Immunology and Allergy, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Sarah Salou
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Catharina Schuetz
- Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Anna Shcherbina
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - Mary A Slatter
- Children's Hematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, England, United Kingdom
| | - Fabien Touzot
- Department of Pediatrics, CHU Ste-Justine, Université de Montréal, Montreal, Canada
| | - Ekrem Unal
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Arjan C Lankester
- Willem-Alexander Children's Hospital, Department of Pediatrics, Pediatric Stem cell Transplantation program, Leiden University Medical Center, Leiden, The Netherlands
| | - Siobhan Burns
- Institute of Immunity and Transplantation, University College London, London, England, United Kingdom
| | - Mikko R J Seppänen
- The Rare Disease and Pediatric Research Centers, Hospital for Children and Adolescents and Adult Immunodeficiency Unit, Inflammation Center, University of Helsinki and HUS Helsinki, University Hospital, Helsinki, Finland
| | - Olaf Neth
- Pediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, IBiS/ Universidad de Sevilla/CSIC, Red de Investigación Traslacional en Infectología Pediátrica RITIP, Seville, Spain
| | - Michael H Albert
- Department of Pediatrics, Dr von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Stephan Ehl
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bénédicte Neven
- Immuno-hematology and Rheumatology Unit, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, INSERM 1163, Institut Imagine, Paris, Île-de-France, France
| | - Carsten Speckmann
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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5
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de Cevins C, Delage L, Batignes M, Riller Q, Luka M, Remaury A, Sorin B, Fali T, Masson C, Hoareau B, Meunier C, Parisot M, Zarhrate M, Pérot BP, García-Paredes V, Carbone F, Galliot L, Nal B, Pierre P, Canard L, Boussard C, Crickx E, Guillemot JC, Bader-Meunier B, Bélot A, Quartier P, Frémond ML, Neven B, Boldina G, Augé F, Alain F, Didier M, Rieux-Laucat F, Ménager MM. Single-cell RNA-sequencing of PBMCs from SAVI patients reveals disease-associated monocytes with elevated integrated stress response. Cell Rep Med 2023; 4:101333. [PMID: 38118407 PMCID: PMC10772457 DOI: 10.1016/j.xcrm.2023.101333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/10/2023] [Accepted: 11/20/2023] [Indexed: 12/22/2023]
Abstract
Gain-of-function mutations in stimulator of interferon gene 1 (STING1) result in STING-associated vasculopathy with onset in infancy (SAVI), a severe autoinflammatory disease. Although elevated type I interferon (IFN) production is thought to be the leading cause of the symptoms observed in patients, STING can induce a set of pathways, which have roles in the onset and severity of SAVI and remain to be elucidated. To this end, we performed a multi-omics comparative analysis of peripheral blood mononuclear cells (PBMCs) and plasma from SAVI patients and healthy controls, combined with a dataset of healthy PBMCs treated with IFN-β. Our data reveal a subset of disease-associated monocyte, expressing elevated CCL3, CCL4, and IL-6, as well as a strong integrated stress response, which we suggest is the result of direct PERK activation by STING. Cell-to-cell communication inference indicates that these monocytes lead to T cell early activation, resulting in their senescence and apoptosis. Last, we propose a transcriptomic signature of STING activation, independent of type I IFN response.
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Affiliation(s)
- Camille de Cevins
- Université de Paris Cité, Imagine Institute, Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, INSERM UMR 1163, 75015 Paris, France; Sanofi R&D Data and Data Science, Artificial Intelligence & Deep Analytics, Omics Data Science, 1 Av Pierre Brossolette, 91385 Chilly-Mazarin, France
| | - Laure Delage
- Université de Paris Cité, Imagine Institute Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163, 75015 Paris, France; Checkpoint Immunology, Immunology and Inflammation Therapeutic Area, Sanofi, 94400 Vitry-sur-Seine, France
| | - Maxime Batignes
- Université de Paris Cité, Imagine Institute, Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, INSERM UMR 1163, 75015 Paris, France
| | - Quentin Riller
- Université de Paris Cité, Imagine Institute Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163, 75015 Paris, France
| | - Marine Luka
- Université de Paris Cité, Imagine Institute, Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, INSERM UMR 1163, 75015 Paris, France; Labtech Single-Cell@Imagine, Imagine Institute, INSERM UMR 1163, 75015 Paris, France
| | - Anne Remaury
- Genomics and Proteomics Groups, Translational Sciences, Sanofi R&D, 1 Av Pierre Brossolette, 91385 Chilly-Mazarin, France
| | - Boris Sorin
- Université de Paris Cité, Imagine Institute Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163, 75015 Paris, France
| | - Tinhinane Fali
- Université de Paris Cité, Imagine Institute, Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, INSERM UMR 1163, 75015 Paris, France
| | - Cécile Masson
- Bioinformatics Platform, Structure Fédérative de Recherche Necker, INSERM UMR1163, Université de Paris, Imagine Institute, Paris, France
| | - Bénédicte Hoareau
- Sorbonne Université, INSERM UMS037 PASS, Plateforme de Cytométrie (CyPS), Paris, France
| | - Catherine Meunier
- Genomics and Proteomics Groups, Translational Sciences, Sanofi R&D, 1 Av Pierre Brossolette, 91385 Chilly-Mazarin, France
| | - Mélanie Parisot
- Genomics Core Facility, Institut Imagine-Structure Fédérative de Recherche Necker, INSERM U1163 et INSERM US24/CNRS UAR3633, Paris Descartes Sorbonne Paris Cite University, Paris, France
| | - Mohammed Zarhrate
- Genomics Core Facility, Institut Imagine-Structure Fédérative de Recherche Necker, INSERM U1163 et INSERM US24/CNRS UAR3633, Paris Descartes Sorbonne Paris Cite University, Paris, France
| | - Brieuc P Pérot
- Université de Paris Cité, Imagine Institute, Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, INSERM UMR 1163, 75015 Paris, France
| | - Víctor García-Paredes
- Université de Paris Cité, Imagine Institute, Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, INSERM UMR 1163, 75015 Paris, France
| | - Francesco Carbone
- Université de Paris Cité, Imagine Institute, Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, INSERM UMR 1163, 75015 Paris, France; Labtech Single-Cell@Imagine, Imagine Institute, INSERM UMR 1163, 75015 Paris, France
| | - Lou Galliot
- Aix Marseille Université, CNRS, INSERM, CIML, 13288 Marseille Cedex 9, France
| | - Béatrice Nal
- Aix Marseille Université, CNRS, INSERM, CIML, 13288 Marseille Cedex 9, France
| | - Philippe Pierre
- Aix Marseille Université, CNRS, INSERM, CIML, 13288 Marseille Cedex 9, France; Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; Shanghai Institute of Immunology, Department of Microbiology and Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Luc Canard
- Genomics and Proteomics Groups, Translational Sciences, Sanofi R&D, 1 Av Pierre Brossolette, 91385 Chilly-Mazarin, France
| | - Charlotte Boussard
- Université de Paris Cité, Imagine Institute Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163, 75015 Paris, France
| | - Etienne Crickx
- Université de Paris Cité, Imagine Institute Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163, 75015 Paris, France; Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Jean-Claude Guillemot
- Genomics and Proteomics Groups, Translational Sciences, Sanofi R&D, 1 Av Pierre Brossolette, 91385 Chilly-Mazarin, France
| | - Brigitte Bader-Meunier
- Pediatric Immuno-hematology and Rheumatology Department, Hôpital Necker-Enfants Malades, AP-HP. Centre Université Paris Cité, 75015 Paris, France
| | - Alexandre Bélot
- International Center of Infectiology Research (CIRI), University of Lyon, INSERM U1111, Claude Bernard University, Lyon 1, CNRS, UMR5308, ENS of Lyon, Lyon, France; National Reference Center for Rheumatic, Autoimmune and Systemic Diseases in Children (RAISE), Pediatric Nephrology, Rheumatology, Dermatology Unit, Hospital of Mother and Child, Hospices Civils of Lyon, Lyon, France
| | - Pierre Quartier
- Pediatric Immuno-hematology and Rheumatology Department, Hôpital Necker-Enfants Malades, AP-HP. Centre Université Paris Cité, 75015 Paris, France
| | - Marie-Louise Frémond
- Pediatric Immuno-hematology and Rheumatology Department, Hôpital Necker-Enfants Malades, AP-HP. Centre Université Paris Cité, 75015 Paris, France; Université Paris Cité, Imagine Institute, Laboratory of Neurogenetics and Neuroinflammation, INSERM UMR 1163, 75015 Paris, France
| | - Bénédicte Neven
- Université de Paris Cité, Imagine Institute Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163, 75015 Paris, France; Pediatric Immuno-hematology and Rheumatology Department, Hôpital Necker-Enfants Malades, AP-HP. Centre Université Paris Cité, 75015 Paris, France
| | - Galina Boldina
- Sanofi R&D Data and Data Science, Artificial Intelligence & Deep Analytics, Omics Data Science, 1 Av Pierre Brossolette, 91385 Chilly-Mazarin, France
| | - Franck Augé
- Sanofi R&D Data and Data Science, Artificial Intelligence & Deep Analytics, Omics Data Science, 1 Av Pierre Brossolette, 91385 Chilly-Mazarin, France
| | - Fischer Alain
- Université de Paris, Imagine Institute, INSERM UMR 1163, 75015 Paris, France; Collège de France, Paris, France; Department of Paediatric Immuno-Haematology and Rheumatology, Reference Center for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris (AP-HP) 75015 Paris, France
| | - Michel Didier
- Genomics and Proteomics Groups, Translational Sciences, Sanofi R&D, 1 Av Pierre Brossolette, 91385 Chilly-Mazarin, France
| | - Frédéric Rieux-Laucat
- Université de Paris Cité, Imagine Institute Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163, 75015 Paris, France
| | - Mickaël M Ménager
- Université de Paris Cité, Imagine Institute, Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, INSERM UMR 1163, 75015 Paris, France; Labtech Single-Cell@Imagine, Imagine Institute, INSERM UMR 1163, 75015 Paris, France.
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6
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Sokal A, Barba-Spaeth G, Hunault L, Fernández I, Broketa M, Meola A, Fourati S, Azzaoui I, Vandenberghe A, Lagouge-Roussey P, Broutin M, Roeser A, Bouvier-Alias M, Crickx E, Languille L, Fournier M, Michel M, Godeau B, Gallien S, Melica G, Nguyen Y, Canoui-Poitrine F, Pirenne F, Megret J, Pawlotsky JM, Fillatreau S, Reynaud CA, Weill JC, Rey FA, Bruhns P, Mahévas M, Chappert P. SARS-CoV-2 Omicron BA.1 breakthrough infection drives late remodeling of the memory B cell repertoire in vaccinated individuals. Immunity 2023; 56:2137-2151.e7. [PMID: 37543032 DOI: 10.1016/j.immuni.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/12/2023] [Accepted: 07/06/2023] [Indexed: 08/07/2023]
Abstract
How infection by a viral variant showing antigenic drift impacts a preformed mature human memory B cell (MBC) repertoire remains an open question. Here, we studied the MBC response up to 6 months after SARS-CoV-2 Omicron BA.1 breakthrough infection in individuals previously vaccinated with three doses of the COVID-19 mRNA vaccine. Longitudinal analysis, using single-cell multi-omics and functional analysis of monoclonal antibodies from RBD-specific MBCs, revealed that a BA.1 breakthrough infection mostly recruited pre-existing cross-reactive MBCs with limited de novo response against BA.1-restricted epitopes. Reorganization of clonal hierarchy and new rounds of germinal center reactions, however, combined to maintain diversity and induce progressive maturation of the MBC repertoire against common Hu-1 and BA.1, but not BA.5-restricted, SARS-CoV-2 Spike RBD epitopes. Such remodeling was further associated with a marked improvement in overall neutralizing breadth and potency. These findings have fundamental implications for the design of future vaccination booster strategies.
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Affiliation(s)
- Aurélien Sokal
- Institut Necker Enfants Malades, INSERM U1151/CNRS UMR 8253, Action thématique incitative sur programme-Avenir Team, Auto-Immune and Immune B cells, Université Paris Cité, Université Paris Est-Créteil, Créteil, France; Service de Médecine interne, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris Cité, Clichy, France; Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Giovanna Barba-Spaeth
- Institut Pasteur, Université de Paris Cité, CNRS UMR 3569, Unité de Virologie Structurale, Paris, France
| | - Lise Hunault
- Institut Pasteur, Université de Paris Cité, INSERM UMR1222, Unit of Antibodies in Therapy and Pathology, Paris, France; Sorbonne University, ED394, Paris, France; Sorbonne Université, INSERM, CNRS, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), 75013 Paris, France
| | - Ignacio Fernández
- Institut Pasteur, Université de Paris Cité, CNRS UMR 3569, Unité de Virologie Structurale, Paris, France
| | - Matteo Broketa
- Institut Pasteur, Université de Paris Cité, INSERM UMR1222, Unit of Antibodies in Therapy and Pathology, Paris, France; Sorbonne University, ED394, Paris, France
| | - Annalisa Meola
- Institut Pasteur, Université de Paris Cité, CNRS UMR 3569, Unité de Virologie Structurale, Paris, France
| | - Slim Fourati
- Département de Virologie, Bactériologie, Hygiène et Mycologie-Parasitologie, Centre Hospitalier Universitaire Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France; INSERM U955, équipe 18. Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Imane Azzaoui
- Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France; INSERM U955, équipe 2. Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Alexis Vandenberghe
- Institut Necker Enfants Malades, INSERM U1151/CNRS UMR 8253, Action thématique incitative sur programme-Avenir Team, Auto-Immune and Immune B cells, Université Paris Cité, Université Paris Est-Créteil, Créteil, France; Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France; INSERM U955, équipe 2. Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Pauline Lagouge-Roussey
- Institut Necker Enfants Malades, INSERM U1151/CNRS UMR 8253, Action thématique incitative sur programme-Avenir Team, Auto-Immune and Immune B cells, Université Paris Cité, Université Paris Est-Créteil, Créteil, France; Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France; INSERM U955, équipe 2. Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Manon Broutin
- Institut Necker Enfants Malades, INSERM U1151/CNRS UMR 8253, Action thématique incitative sur programme-Avenir Team, Auto-Immune and Immune B cells, Université Paris Cité, Université Paris Est-Créteil, Créteil, France; INSERM U955, équipe 2. Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Anais Roeser
- Institut Necker Enfants Malades, INSERM U1151/CNRS UMR 8253, Action thématique incitative sur programme-Avenir Team, Auto-Immune and Immune B cells, Université Paris Cité, Université Paris Est-Créteil, Créteil, France; Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Magali Bouvier-Alias
- Département de Virologie, Bactériologie, Hygiène et Mycologie-Parasitologie, Centre Hospitalier Universitaire Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France; INSERM U955, équipe 18. Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Etienne Crickx
- Institut Necker Enfants Malades, INSERM U1151/CNRS UMR 8253, Action thématique incitative sur programme-Avenir Team, Auto-Immune and Immune B cells, Université Paris Cité, Université Paris Est-Créteil, Créteil, France; Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France; INSERM U955, équipe 2. Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Laetitia Languille
- Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Morgane Fournier
- Institut Necker Enfants Malades, INSERM U1151/CNRS UMR 8253, Action thématique incitative sur programme-Avenir Team, Auto-Immune and Immune B cells, Université Paris Cité, Université Paris Est-Créteil, Créteil, France; Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Marc Michel
- Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Bertrand Godeau
- Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Sébastien Gallien
- Service de Maladies Infectieuses, Centre Hospitalier Universitaire Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Giovanna Melica
- Service de Maladies Infectieuses, Centre Hospitalier Universitaire Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Yann Nguyen
- Service de Médecine Interne, Centre Hospitalier Universitaire Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Florence Canoui-Poitrine
- Département de Santé Publique, Unité de Recherche Clinique (URC), CEpiA (Clinical Epidemiology and Ageing), EA 7376- Institut Mondor de Recherche Biomédicale (IMRB), Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - France Pirenne
- INSERM U955, équipe 18. Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil (UPEC), Créteil, France; Etablissement Français du Sang (EFS) Ile de France, Créteil, France
| | - Jérôme Megret
- Plateforme de Cytométrie en Flux, Structure Fédérative de Recherche Necker, INSERM US24-CNRS UMS3633, Paris, France
| | - Jean-Michel Pawlotsky
- Département de Virologie, Bactériologie, Hygiène et Mycologie-Parasitologie, Centre Hospitalier Universitaire Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France; INSERM U955, équipe 18. Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Simon Fillatreau
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMR 8253, Université de Paris, Paris, France
| | - Claude-Agnès Reynaud
- Institut Necker Enfants Malades, INSERM U1151/CNRS UMR 8253, Action thématique incitative sur programme-Avenir Team, Auto-Immune and Immune B cells, Université Paris Cité, Université Paris Est-Créteil, Créteil, France
| | - Jean-Claude Weill
- Institut Necker Enfants Malades, INSERM U1151/CNRS UMR 8253, Action thématique incitative sur programme-Avenir Team, Auto-Immune and Immune B cells, Université Paris Cité, Université Paris Est-Créteil, Créteil, France
| | - Félix A Rey
- Institut Pasteur, Université de Paris Cité, CNRS UMR 3569, Unité de Virologie Structurale, Paris, France
| | - Pierre Bruhns
- Institut Pasteur, Université de Paris Cité, INSERM UMR1222, Unit of Antibodies in Therapy and Pathology, Paris, France
| | - Matthieu Mahévas
- Institut Necker Enfants Malades, INSERM U1151/CNRS UMR 8253, Action thématique incitative sur programme-Avenir Team, Auto-Immune and Immune B cells, Université Paris Cité, Université Paris Est-Créteil, Créteil, France; Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France; INSERM U955, équipe 2. Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil (UPEC), Créteil, France.
| | - Pascal Chappert
- Institut Necker Enfants Malades, INSERM U1151/CNRS UMR 8253, Action thématique incitative sur programme-Avenir Team, Auto-Immune and Immune B cells, Université Paris Cité, Université Paris Est-Créteil, Créteil, France; INSERM U955, équipe 2. Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil (UPEC), Créteil, France.
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7
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Sorin B, Gaigne L, Garzaro M, Moulis G, Mageau A, Lopez C, Roy-Peaud F, Jeandel PY, Crickx E, Dossier A, Gobert D, Hadjadj J, Puyade M, Languille L, Rasmussen C, Terrier B, Ebbo M, Bonnotte B, Audia S, Galicier L, Michel M, Mahevas M, Viallard JF, Godeau B. Severe SARS-CoV-2 infection in rituximab-treated patients with autoimmune cytopenia: A multicenter observational study. Am J Hematol 2023; 98:E259-E262. [PMID: 37410544 DOI: 10.1002/ajh.27016] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/17/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Boris Sorin
- Centre de Référence des Cytopénies Auto-Immunes de L'adulte, filière MARIH, Service de Médecine Interne, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Léa Gaigne
- Service de Médecine Interne, CHU La Timone, APHM, Marseille, France
| | - Margaux Garzaro
- Service d'Immunologie Clinique, Hôpital Saint-Louis, APHP, Paris, France
| | - Guillaume Moulis
- Service de Médecine Interne, CHU de Toulouse, France
- Center d'Investigation Clinique U1436, CHU de Toulouse, Toulouse, France
| | - Arthur Mageau
- Service de Médecine Interne, Hôpital Bichat-Claude-Bernard, APHP, Paris, France
| | - Carine Lopez
- Service de Médecine Interne et de Maladies Infectieuses, CHU de Bordeaux, GH Haut-Lévêque, Pessac, France
| | - Frédérique Roy-Peaud
- Service de Médecine Interne et de Maladies Infectieuses, CHU de Poitiers, Poitiers, France
| | | | - Etienne Crickx
- Centre de Référence des Cytopénies Auto-Immunes de L'adulte, filière MARIH, Service de Médecine Interne, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Antoine Dossier
- Service de Médecine Interne, Hôpital Bichat-Claude-Bernard, APHP, Paris, France
| | - Delphine Gobert
- Service de Médecine Interne, Hôpital Saint-Antoine, APHP, Paris, France
| | - Jérôme Hadjadj
- Service de Médecine Interne, Hôpital Saint-Antoine, APHP, Paris, France
| | - Mathieu Puyade
- Service de Médecine Interne, Hôpital Bichat-Claude-Bernard, APHP, Paris, France
- Service de Médecine Interne et de Maladies Infectieuses, CHU de Poitiers, Poitiers, France
| | - Laetitia Languille
- Centre de Référence des Cytopénies Auto-Immunes de L'adulte, filière MARIH, Service de Médecine Interne, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | | | - Benjamin Terrier
- Service de Médecine Interne, Hôpital Cochin, APHP, Paris, France
| | - Mikael Ebbo
- Service de Médecine Interne, CHU La Timone, APHM, Marseille, France
| | - Bernard Bonnotte
- Service de Médecine Interne et d'Immunologie Clinique, CHU Dijon, Dijon, France
| | - Sylvain Audia
- Service de Médecine Interne et d'Immunologie Clinique, CHU Dijon, Dijon, France
| | - Lionel Galicier
- Service d'Immunologie Clinique, Hôpital Saint-Louis, APHP, Paris, France
| | - Marc Michel
- Centre de Référence des Cytopénies Auto-Immunes de L'adulte, filière MARIH, Service de Médecine Interne, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Matthieu Mahevas
- Centre de Référence des Cytopénies Auto-Immunes de L'adulte, filière MARIH, Service de Médecine Interne, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Jean-François Viallard
- Service de Médecine Interne et de Maladies Infectieuses, CHU de Bordeaux, GH Haut-Lévêque, Pessac, France
| | - Bertrand Godeau
- Centre de Référence des Cytopénies Auto-Immunes de L'adulte, filière MARIH, Service de Médecine Interne, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
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8
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Crickx E, Ebbo M, Rivière E, Souchaud-Debouverie O, Terriou L, Audia S, Ruivard M, Asli B, Marolleau JP, Méaux-Ruault N, Gerfaud-Valentin M, Audeguy P, Hamidou M, Corm S, Delbrel X, Fontan J, Lebon D, Mausservey C, Moulis G, Limal N, Michel M, Godeau B, Mahévas M. Combining thrombopoietin receptor agonists with immunosuppressive drugs in adult patients with multirefractory immune thrombocytopenia, an update on the French experience. Br J Haematol 2023; 202:883-889. [PMID: 37247631 DOI: 10.1111/bjh.18893] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 05/31/2023]
Abstract
Combining drugs could be an effective option for treating multirefractory ITP, that is, patients not responding to rituximab, thrombopoietin receptor agonists (TPO-RA) and splenectomy. We conducted a retrospective, multicenter, observational study including multirefractory ITP patients who received a combination of a TPO-RA and an immunosuppressive drug. We included 39 patients (67% women, median age 59 years [range 21-96]), with a median ITP duration of 57 months [3-393] and a median platelet count at initiation of 10 × 109 /L [1-35]. The combination regimen was given for a median duration of 12 months [1-103] and included eltrombopag (51%) or romiplostim (49%), associated with mycophenolate mofetil (54%), azathioprine (36%), cyclophosphamide (5%), cyclosporin (3%) or everolimus (3%). Overall, 30 patients (77%) achieved at least a response (platelet count ≥30 × 109 /L and at least doubling baseline during at least 3 months), including 24 complete responses (platelet count >100 × 109 /L during at least 3 months) with a median time to response of 30 days [7-270] and a median duration of response of 15 months [4-63]. Severe adverse event related to ITP treatment was observed in 31%. In conclusion, this study confirms that some patients with multirefractory ITP can achieve long lasting response with this combination.
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Affiliation(s)
- Etienne Crickx
- Internal Medicine Department, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Imagine Institute, Université Paris Cité, INSERM UMR U1163, Paris, France
| | - Mikael Ebbo
- Internal Medicine Department, Hôpital la Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Etienne Rivière
- Internal Medicine and Infectious Diseases Unit, Haut-Leveque Hospital, University Hospital Centre of Bordeaux, Pessac, France
- INSERM U1034, Bordeaux University, Pessac Cedex, France
| | | | - Louis Terriou
- Internal Medicine and Clinical Immunology Department, Centre de référence des maladies auto-immunes systémiques rares du nord et nord-ouest de France (CeRAINO), LIRIC INSERM U995, CHU LILLE, Lille, France
| | - Sylvain Audia
- Internal Medicine and Clinical Immunology Department, Centre de référence constitutif des cytopénies auto-immunes, Hôpital François Mitterrand, Centre Hospitalier Universitaire (CHU) Dijon-Bourgogne, Dijon, France
| | - Marc Ruivard
- Internal Medicine Department, Estaing University Hospital, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, Institut Pascal, Clermont-Ferrand, France
| | - Bouchra Asli
- Internal Medicine Department, Sauvegarde Clinic, Lyon, France
| | - Jean-Pierre Marolleau
- Clinical Hematology and Cellular Therapy Department, CHU Amiens-Picardie, EA4666 Equipe Hematim - CURS - UPJV, Amiens, France
| | - Nadine Méaux-Ruault
- Internal Medicine Department, Centre Hospitalier Universitaire Jean-Minjoz, Besançon, France
| | - Mathieu Gerfaud-Valentin
- Internal Medicine Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard-Lyon1, Lyon, France
| | | | | | - Selim Corm
- Clinical Hematology Department, Médipole de Savoie, Challes-les-Eaux, France
| | - Xavier Delbrel
- Internal Medicine Department, Centre Hospitalier de Pau, Pau, France
| | - Jean Fontan
- Clinical Hematology Department, CHU Besançon, Besançon, France
| | - Delphine Lebon
- Clinical Hematology and Cellular Therapy Department, CHU Amiens-Picardie, EA4666 Equipe Hematim - CURS - UPJV, Amiens, France
| | - Christelle Mausservey
- Internal Medicine Department, Centre Hospitalier William-Morey, Chalon/Saône, France
| | - Guillaume Moulis
- Internal Medicine Department, CHU de Toulouse, Toulouse, France
- CIC 1436, équipe PEPSS, CHU de Toulouse, Toulouse, France
| | - Nicolas Limal
- Internal Medicine Department, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Marc Michel
- Internal Medicine Department, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Bertrand Godeau
- Internal Medicine Department, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Matthieu Mahévas
- Internal Medicine Department, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMS 8253, ATIP-Avenir Team AI2B, Université de Paris Cité, Université Paris-Est-Créteil, Créteil, France
- INSERM U955, équipe 2, Université Paris-Est Créteil (UPEC), Créteil, France
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9
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Guillet S, Crickx E, Azzaoui I, Chappert P, Boutin E, Viallard JF, Rivière E, Gobert D, Galicier L, Malphettes M, Cheze S, Lefrere F, Audia S, Bonnotte B, Lambotte O, Noel N, Fain O, Moulis G, Hamidou M, Gerfaud-Valentin M, Marolleau JP, Terriou L, Martis N, Morin AS, Perlat A, Le Gallou T, Roy-Peaud F, Robbins A, Lega JC, Puyade M, Comont T, Limal N, Languille L, Zarrour A, Luka M, Menager M, Belmondo T, Hue S, Canoui-Poitrine F, Michel M, Godeau B, Mahévas M. Prolonged response after TPO-RA discontinuation in primary ITP: results of a prospective multicenter study. Blood 2023; 141:2867-2877. [PMID: 36893453 DOI: 10.1182/blood.2022018665] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/30/2023] [Accepted: 02/18/2023] [Indexed: 03/11/2023] Open
Abstract
Sustained response off treatment (SROT) after thrombopoietin receptor agonist (TPO-RA) discontinuation has been reported in immune thrombocytopenia (ITP). This prospective multicenter interventional study enrolled adults with persistent or chronic primary ITP and complete response (CR) on TPO-RAs. The primary end point was the proportion of patients achieving SROT (platelet count >30 × 109/L and no bleeding) at week 24 (W24) with no other ITP-specific medications. Secondary end points included the proportion of sustained CR off-treatment (SCROT, platelet count >100 × 109/L and no bleeding) and SROT at W52, bleeding events, and pattern of response to a new course of TPO-RAs. We included 48 patients with a median age of 58.5 years; 30 of 48 had chronic ITP at TPO-RA initiation. In the intention-to-treat analysis, 27 of 48 achieved SROT, 15 of 48 achieved SCROT at W24; 25 of 48 achieved SROT, and 14 of 48 achieved SCROT at W52. No severe bleeding episode occurred in patients who relapsed. Among patients rechallenged with TPO-RA, 11 of 12 achieved CR. We found no significant clinical predictors of SROT at W24. Single-cell RNA sequencing revealed enrichment of a tumor necrosis factor α signaling via NF-κB signature in CD8+ T cells of patients with no sustained response after TPO-RA discontinuation, which was further confirmed by a significant overexpression of CD69 on CD8+ T cells at baseline in these patients as compared with those achieving SCROT/SROT. Our results strongly support a strategy based on progressive tapering and discontinuation of TPO-RAs for patients with chronic ITP who achieved a stable CR on treatment. This trial was registered at www.clinicaltrials.gov as #NCT03119974.
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Affiliation(s)
- Stéphanie Guillet
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Etienne Crickx
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
- INSERM U1151/CNRS UMS 8253, Institut Necker Enfants Malades, ATIP-Avenir Team AI2B, Université de Paris Cité, Université Paris-Est Créteil (UPEC), Créteil, France
- INSERM UMR U1163,Imagine Institute, Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Université de Paris Cité, Paris, France
| | - Imane Azzaoui
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
- INSERM U1151/CNRS UMS 8253, Institut Necker Enfants Malades, ATIP-Avenir Team AI2B, Université de Paris Cité, Université Paris-Est Créteil (UPEC), Créteil, France
- INSERM U955, Équipe 2, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Pascal Chappert
- INSERM U1151/CNRS UMS 8253, Institut Necker Enfants Malades, ATIP-Avenir Team AI2B, Université de Paris Cité, Université Paris-Est Créteil (UPEC), Créteil, France
- INSERM U955, Équipe 2, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Emmanuelle Boutin
- Unité de Recherche Clinique (Mondor), AP-HP, Henri Mondor Hôpitaux Universitaires, Créteil, France
- INSERM, Institut Mondor de Recherche Biomédicale, Équipe Clinical Epidemiology and Ageing, UPEC, Créteil, France
| | - Jean-François Viallard
- Service de Médecine Interne, Haut-Lévêque Hôpital, Université de Bordeaux, Bordeaux, France
| | - Etienne Rivière
- Service de Médecine Interne, Haut-Lévêque Hôpital, Université de Bordeaux, Bordeaux, France
| | - Delphine Gobert
- Service de Médecine Interne, Saint Antoine Hôpital, AP-HP, Sorbonne Université, Paris, France
| | - Lionel Galicier
- Service d'Immunologie Clinique, Saint Louis Hôpital, AP-HP, Université de Paris Cité, Paris, France
| | - Marion Malphettes
- Service d'Immunologie Clinique, Saint Louis Hôpital, AP-HP, Université de Paris Cité, Paris, France
| | - Stéphane Cheze
- Institut d'Hématologie de Basse-Normandie, Centre Hospitalier de Caen Normandie, Caen, France
| | | | - Sylvain Audia
- Service de Médecine Interne et d'Immunologie Clinique, Centre de Référence Constitutif des Cytopénies Auto-Immunes, Hôpital François Mitterrand, Centre Hospitalier Universitaire (CHU) Dijon-Bourgogne, Dijon, France
| | - Bernard Bonnotte
- Service de Médecine Interne et d'Immunologie Clinique, Centre de Référence Constitutif des Cytopénies Auto-Immunes, Hôpital François Mitterrand, Centre Hospitalier Universitaire (CHU) Dijon-Bourgogne, Dijon, France
| | - Olivier Lambotte
- Service de Médecine Interne et d'Immunologie Clinique, Hôpital Bicêtre, AP-HP, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Nicolas Noel
- Service de Médecine Interne et d'Immunologie Clinique, Hôpital Bicêtre, AP-HP, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Olivier Fain
- Service de Médecine Interne, Saint Antoine Hôpital, AP-HP, Sorbonne Université, Paris, France
| | - Guillaume Moulis
- Service de Médecine Interne, CHU de Toulouse, Toulouse, France
- CIC 1436, Équipe PEPSS, CHU de Toulouse, Toulouse, France
| | | | | | - Jean-Pierre Marolleau
- Service d'Hématologie Clinique et Thérapie Cellulaire, CHU Amiens-Picardie, Amiens, France
| | - Louis Terriou
- Service de Médecine Interne et d'Immunologie Clinique, CHU de Lille, Lille, France
| | - Nihal Martis
- Service de Médecine Interne et d'Immunologie Clinique, Hôpital de Nice, Nice, France
| | - Anne-Sophie Morin
- Service de Médecine Interne, Jean Verdier Hôpital, AP-HP, Bondy, France
| | - Antoinette Perlat
- Service de Médecine Interne et Immunologie Clinique, CHU de Rennes, Rennes, France
| | - Thomas Le Gallou
- Service de Médecine Interne et Immunologie Clinique, CHU de Rennes, Rennes, France
| | - Frédérique Roy-Peaud
- Service de Médecine Interne-Maladies Infectieuses et Tropicales, CHU de Poitiers, Poitiers, France
| | - Ailsa Robbins
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Robert Debré Hospital, Reims University Hospitals, Reims, France
| | - Jean-Christophe Lega
- Service de Médecine Interne, Hospices Civils de Lyon, Lyon Sud Hôpital, Pierre-Bénite, France
| | - Matthieu Puyade
- Service de Médecine Interne, CHU de Poitiers, Poitiers, France
| | - Thibault Comont
- Service de Médecine Interne, CHU de Toulouse (IUCT-Oncopole), Toulouse, France
| | - Nicolas Limal
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Laetitia Languille
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Anissa Zarrour
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Marine Luka
- Université Paris Cité, Institut Imagine, Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, INSERM UMR 1163, F-75015 Paris, France
| | - Mickael Menager
- Université Paris Cité, Institut Imagine, Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, INSERM UMR 1163, F-75015 Paris, France
| | - Thibault Belmondo
- Département Immunologie-Hématologie, Henri Mondor Hôpital, AP-HP, UPEC, Créteil, France
- UPEC, Faculté de Médecine, Créteil, France
- Service de Santé Publique, AP-HP, Henri Mondor Hôpitaux Universitaires, Créteil, France
| | - Sophie Hue
- Département Immunologie-Hématologie, Henri Mondor Hôpital, AP-HP, UPEC, Créteil, France
- UPEC, Faculté de Médecine, Créteil, France
- INSERM U955, Équipe 16, Institut Mondor de Recherche Biomédicale, UPEC, Créteil, France
| | - Florence Canoui-Poitrine
- Unité de Recherche Clinique (Mondor), AP-HP, Henri Mondor Hôpitaux Universitaires, Créteil, France
- Service de Santé Publique, AP-HP, Henri Mondor Hôpitaux Universitaires, Créteil, France
| | - Marc Michel
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Bertrand Godeau
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Matthieu Mahévas
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
- INSERM U1151/CNRS UMS 8253, Institut Necker Enfants Malades, ATIP-Avenir Team AI2B, Université de Paris Cité, Université Paris-Est Créteil (UPEC), Créteil, France
- INSERM U955, Équipe 2, Université Paris-Est Créteil (UPEC), Créteil, France
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10
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Crickx E. COVID-19 and splenectomy: Education matters. Br J Haematol 2023. [PMID: 36994879 DOI: 10.1111/bjh.18767] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/10/2023] [Accepted: 03/12/2023] [Indexed: 03/31/2023]
Abstract
Whether COVID-19-related morbidity and mortality are increased in splenectomized patients is unknown. The study by Bianchi et al. suggests increased hospitalizations and mortality rates in splenectomized patients, despite observing similar infection rates when compared to the general population. Commentary on: Bianchi et al. Burden of COVID19 disease and vaccine coverages in Apulian splenectomized patients. A retrospective observational study, Br J Haematol 2023. doi: 10.1111/bjh.18731.
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Affiliation(s)
- Etienne Crickx
- Internal Medicine Department, Centre National de Référence des Cytopénies Auto-Immunes de l'adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
- Université de Paris Cité, Imagine Institute, Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR U1163, Paris, France
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11
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Crickx E, Mahévas M, Michel M, Godeau B. Older Adults and Immune Thrombocytopenia: Considerations for the Clinician. Clin Interv Aging 2023; 18:115-130. [PMID: 36726813 PMCID: PMC9885884 DOI: 10.2147/cia.s369574] [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: 10/26/2022] [Accepted: 01/10/2023] [Indexed: 01/28/2023] Open
Abstract
Many epidemiological studies have shown that the incidence of immune thrombocytopenia (ITP) increases after age 60 years and peaks in patients over age 80 years. Therefore, ITP is a concern for physicians taking care of older patients, especially regarding its diagnosis and management. The diagnostic work-up should exclude other causes of thrombocytopenia and secondary ITP, including myelodysplastic syndrome and drug-induced ITP. The treatment decision is influenced by an increased risk of bleeding, infectious diseases and thrombosis in this population and should take into account comorbidities and concomitant medications such as anticoagulant drugs. First-line treatment is based on short corticosteroids courses and intravenous immunoglobulin, which should be reserved for patients with more severe bleeding complications, with their higher risk of toxic effects as compared with younger patients. Second-line treatment should be tailored to the patient's history, comorbidities and preferences. Preferred second-line treatments are thrombopoietin receptor agonists for most groups and guidelines given their good efficacy/tolerance ratio, but the thrombotic risk is increased in older people. Other second-line options that can be good alternatives depending on the clinical context include rituximab, dapsone, fostamatinib or immunosuppressive drugs. Splenectomy is less often performed but remains an option for fit patients with chronic refractory disease. Emerging treatments such as Syk or Bruton tyrosine kinase inhibitors and FcRn antagonists are becoming available for ITP and may modify the treatment algorithm in the near future. The aim of this review is to describe the particularities of the diagnosis and treatment of ITP in older people, including the response and tolerance to the currently available drugs. We also discuss some situations related to co-morbidities that can frequently lead to adapt the management strategy in older patients.
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Affiliation(s)
- Etienne Crickx
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France,Université de Paris, Imagine Institute, Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Paris, F-75015, France
| | - Matthieu Mahévas
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France,Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMS 8253, ATIP-Avenir Team AI2B, Université de Paris, Université Paris-Est-Créteil, Paris, France,INSERM U955, équipe 2, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Marc Michel
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Bertrand Godeau
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France,Correspondence: Bertrand Godeau, Service de Médecine Interne, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), 51 avenue du maréchal de Lattre de Tassigny, Créteil, 94000, France, Tel +331 49 81 29 05, Fax +331 49 81 29 02, Email
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12
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Chappert P, Huetz F, Espinasse MA, Chatonnet F, Pannetier L, Da Silva L, Goetz C, Mégret J, Sokal A, Crickx E, Nemazanyy I, Jung V, Guerrera C, Storck S, Mahévas M, Cosma A, Revy P, Fest T, Reynaud CA, Weill JC. Human anti-smallpox long-lived memory B cells are defined by dynamic interactions in the splenic niche and long-lasting germinal center imprinting. Immunity 2022; 55:1872-1890.e9. [PMID: 36130603 PMCID: PMC7613742 DOI: 10.1016/j.immuni.2022.08.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 04/01/2022] [Revised: 06/22/2022] [Accepted: 08/26/2022] [Indexed: 12/31/2022]
Abstract
Memory B cells (MBCs) can persist for a lifetime, but the mechanisms that allow their long-term survival remain poorly understood. Here, we isolated and analyzed human splenic smallpox/vaccinia protein B5-specific MBCs in individuals who were vaccinated more than 40 years ago. Only a handful of clones persisted over such an extended period, and they displayed limited intra-clonal diversity with signs of extensive affinity-based selection. These long-lived MBCs appeared enriched in a CD21hiCD20hi IgG+ splenic B cell subset displaying a marginal-zone-like NOTCH/MYC-driven signature, but they did not harbor a unique longevity-associated transcriptional or metabolic profile. Finally, the telomeres of B5-specific, long-lived MBCs were longer than those in patient-paired naive B cells in all the samples analyzed. Overall, these results imply that separate mechanisms such as early telomere elongation, affinity selection during the contraction phase, and access to a specific niche contribute to ensuring the functional longevity of MBCs.
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Affiliation(s)
- Pascal Chappert
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMR 8253, Université Paris Cité, Paris, France; Inovarion, Paris, France; Institut Mondor de Recherche Biomédicale (IMRB), INSERM U955, équipe 2, Université Paris-Est Créteil (UPEC), Créteil, France.
| | - François Huetz
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMR 8253, Université Paris Cité, Paris, France; Institut Pasteur, Université Paris Cité, Unité Anticorps en thérapie et pathologie, UMR 1222 INSERM, Paris, France
| | - Marie-Alix Espinasse
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMR 8253, Université Paris Cité, Paris, France
| | - Fabrice Chatonnet
- Université de Rennes 1, INSERM, Établissement Français du Sang de Bretagne, UMR_S1236, Rennes, France; Laboratoire d'Hématologie, Pôle de Biologie, Centre Hospitalier Universitaire, Rennes, France
| | - Louise Pannetier
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMR 8253, Université Paris Cité, Paris, France
| | - Lucie Da Silva
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMR 8253, Université Paris Cité, Paris, France
| | - Clara Goetz
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMR 8253, Université Paris Cité, Paris, France
| | - Jérome Mégret
- Structure Fédérative de Recherche Necker, INSERM US24-CNRS UAR3633, Paris, France
| | - Aurélien Sokal
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMR 8253, Université Paris Cité, Paris, France
| | - Etienne Crickx
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMR 8253, Université Paris Cité, Paris, France; Service de Médecine Interne, Centre Hospitalier Universitaire Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Ivan Nemazanyy
- Structure Fédérative de Recherche Necker, INSERM US24-CNRS UAR3633, Paris, France
| | - Vincent Jung
- Structure Fédérative de Recherche Necker, INSERM US24-CNRS UAR3633, Paris, France
| | - Chiara Guerrera
- Structure Fédérative de Recherche Necker, INSERM US24-CNRS UAR3633, Paris, France
| | - Sébastien Storck
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMR 8253, Université Paris Cité, Paris, France
| | - Matthieu Mahévas
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMR 8253, Université Paris Cité, Paris, France; Institut Mondor de Recherche Biomédicale (IMRB), INSERM U955, équipe 2, Université Paris-Est Créteil (UPEC), Créteil, France; Service de Médecine Interne, Centre Hospitalier Universitaire Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Antonio Cosma
- Translational Medicine Operations Hub, National Cytometry Platform, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Patrick Revy
- INSERM UMR 1163, Laboratory of Genome Dynamics in the Immune System, Labellisé Ligue Nationale contre le Cancer, Imagine Institute, Université Paris Cité, Paris, France
| | - Thierry Fest
- Université de Rennes 1, INSERM, Établissement Français du Sang de Bretagne, UMR_S1236, Rennes, France; Laboratoire d'Hématologie, Pôle de Biologie, Centre Hospitalier Universitaire, Rennes, France
| | - Claude-Agnès Reynaud
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMR 8253, Université Paris Cité, Paris, France.
| | - Jean-Claude Weill
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMR 8253, Université Paris Cité, Paris, France.
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Bontoux C, Badaoui B, Abermil N, Tarfi S, Guermouche H, Dubois S, Roy L, Xuan JV, Quang VT, Wang L, Favre L, Poullot E, Michel M, Sloma I, Crickx E, Pécriaux A. La néoplasie myéloïde associée à un réarrangement de PDGFRB : une pathologie rare de diagnostic difficile. Ann Pathol 2022; 42:481-487. [DOI: 10.1016/j.annpat.2022.03.005] [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] [Received: 01/10/2022] [Revised: 03/04/2022] [Accepted: 03/15/2022] [Indexed: 11/17/2022]
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14
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Canales-Herrerias P, Crickx E, Broketa M, Sokal A, Chenon G, Azzaoui I, Vandenberghe A, Perima A, Iannascoli B, Richard-Le Goff O, Castrillon C, Mottet G, Sterlin D, Robbins A, Michel M, England P, Millot GA, Eyer K, Baudry J, Mahevas M, Bruhns P. High-affinity autoreactive plasma cells disseminate through multiple organs in patients with immune thrombocytopenic purpura. J Clin Invest 2022; 132:153580. [PMID: 35503254 PMCID: PMC9197514 DOI: 10.1172/jci153580] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 07/27/2021] [Accepted: 04/28/2022] [Indexed: 11/17/2022] Open
Abstract
The major therapeutic goal for immune thrombocytopenic purpura (ITP) is to restore normal platelet counts using drugs to promote platelet production or by interfering with mechanisms responsible for platelet destruction. Eighty percent of patients with ITP possess anti–integrin αIIbβ3 IgG autoantibodies that cause platelet opsonization and phagocytosis. The spleen is considered the primary site of autoantibody production by autoreactive B cells and platelet destruction. The immediate failure in approximately 50% of patients to recover a normal platelet count after anti-CD20 rituximab-mediated B cell depletion and splenectomy suggests that autoreactive, rituximab-resistant, IgG-secreting B cells (IgG-SCs) reside in other anatomical compartments. We analyzed more than 3,300 single IgG-SCs from spleen, bone marrow, and/or blood of 27 patients with ITP, revealing high interindividual variability in affinity for αIIbβ3, with variations over 3 logs. IgG-SC dissemination and range of affinities were, however, similar for each patient. Longitudinal analysis of autoreactive IgG-SCs upon treatment with the anti-CD38 mAb daratumumab demonstrated variable outcomes, from complete remission to failure with persistence of high-affinity anti–αIIbβ3 IgG-SCs in the bone marrow. This study demonstrates the existence and dissemination of high-affinity autoreactive plasma cells in multiple anatomical compartments of patients with ITP that may cause the failure of current therapies.
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Affiliation(s)
| | - Etienne Crickx
- INSERM U1151/CNRS UMS8253, Institut Necker-Enfants Malades, Paris, France
| | - Matteo Broketa
- Department of Immunology, Institut Pasteur, Paris, France
| | - Aurélien Sokal
- INSERM U1151/CNRS UMS8253, Institut Necker-Enfants Malades, Paris, France
| | - Guilhem Chenon
- Laboratoire Colloïdes et Matériaux Divisés (LCMD), ESPCI, Paris, France
| | - Imane Azzaoui
- Service de Médecine Interne, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Paris, France
| | - Alexis Vandenberghe
- Service de Médecine Interne, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Paris, France
| | - Angga Perima
- Department of Immunology, Institut Pasteur, Paris, France
| | | | | | | | | | | | - Ailsa Robbins
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunolo, Robert Debré Hospital, Reims University Hospitals, Reims, France
| | - Marc Michel
- Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Créteil, France
| | - Patrick England
- Plateforme de Biophysique Moléculaire, Institut Pasteur, Paris, France
| | - Gael A Millot
- Hub Bioinformatique et Biostatistique, Institut Pasteur, Paris, France
| | - Klaus Eyer
- Laboratory for Functional Immune Repertoire Analysis, ETH Zurich, Zurich, Switzerland
| | - Jean Baudry
- Laboratoire Colloïdes et Matériaux Divisés (LCMD), ESPCI, Paris, France
| | - Matthieu Mahevas
- INSERM U1151/CNRS UMS8253, Institut Necker-Enfants Malades, Paris, France
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Sokal A, Broketa M, Barba-Spaeth G, Meola A, Fernández I, Fourati S, Azzaoui I, de La Selle A, Vandenberghe A, Roeser A, Bouvier-Alias M, Crickx E, Languille L, Michel M, Godeau B, Gallien S, Melica G, Nguyen Y, Zarrouk V, Canoui-Poitrine F, Noizat-Pirenne F, Megret J, Pawlotsky JM, Fillatreau S, Simon-Lorière E, Weill JC, Reynaud CA, Rey FA, Bruhns P, Chappert P, Mahévas M. Analysis of mRNA vaccination-elicited RBD-specific memory B cells reveals strong but incomplete immune escape of the SARS-CoV-2 Omicron variant. Immunity 2022; 55:1096-1104.e4. [PMID: 35483354 PMCID: PMC8986479 DOI: 10.1016/j.immuni.2022.04.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/16/2022] [Accepted: 04/04/2022] [Indexed: 11/05/2022]
Abstract
The SARS-CoV-2 Omicron variant can escape neutralization by vaccine-elicited and convalescent antibodies. Memory B cells (MBCs) represent another layer of protection against SARS-CoV-2, as they persist after infection and vaccination and improve their affinity. Whether MBCs elicited by mRNA vaccines can recognize the Omicron variant remains unclear. We assessed the affinity and neutralization potency against the Omicron variant of several hundred naturally expressed MBC-derived monoclonal IgG antibodies from vaccinated COVID-19-recovered and -naive individuals. Compared with other variants of concern, Omicron evaded recognition by a larger proportion of MBC-derived antibodies, with only 30% retaining high affinity against the Omicron RBD, and the reduction in neutralization potency was even more pronounced. Nonetheless, neutralizing MBC clones could be found in all the analyzed individuals. Therefore, despite the strong immune escape potential of the Omicron variant, these results suggest that the MBC repertoire generated by mRNA vaccines still provides some protection against the Omicron variant in vaccinated individuals.
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Dubois S, Layese R, Languille L, Limal N, guillet S, Crickx E, Guillaud C, Lascu-Dubos G, Khellaf M, Mahevas M, Kini Matondo W, Michel M, Audureau E, Godeau B. Evaluation de la pertinence de la prescription des immunoglobulines par voie intraveineuse dans le purpura thrombopénique immunologique de l’adulte: résultat d’une étude pilote monocentrique portant sur 264 traitements. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.266] [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: 11/29/2022]
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17
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Sokal A, Barba-Spaeth G, Fernandez I, Broketa M, Azzaoui I, De La Selle A, Vandenberghe A, Fourati S, Roeser A, Crickx E, Michel M, Godeau B, Nguyen Y, Zarrouk V, Bruhns P, Rey F, Weill J, Reynaud C, Chappert P, Mahevas M. La vaccination par ARNm des sujets naïfs ou convalescents de la COVID-19 permet la génération de lymphocytes B mémoires capables de reconnaître et de neutraliser les variants du SARS-CoV-2. Rev Med Interne 2021. [PMCID: PMC8610708 DOI: 10.1016/j.revmed.2021.10.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction La mémoire immunitaire est un mécanisme qui protège les individus contre la réinfection. Cette stratégie de défense de l’organisme, qui est à la base du succès des vaccins, comprend la production d’anticorps protecteurs dans le sang ainsi que la formation de cellules à mémoire, capables de se réactiver rapidement en cellules productrices d’anticorps lors d’une nouvelle infection. Les vaccins à ARNm, codant pour la protéine Spike du SARS-CoV-2, ont été rapidement déployés dans le monde entier, avec une grande efficacité clinique. Déterminer les caractéristiques de la réponse lymphocytaire B mémoire générée par ces vaccins est d’une importance majeure, notamment dans le contexte de circulation de variants du SARS-CoV-2, porteurs de mutations dans la protéine Spike. Nous avons étudié la dynamique, l’évolution clonale, et l’affinité des cellules B à mémoire chez des patients vaccinés par le vaccin à ARNm, ainsi que leur capacité à reconnaître et à neutraliser les variants du SARS-CoV-2 dans deux cohortes longitudinales de patients, l’une infectée lors de la première vague (convalescents-vaccinés), et l’autre n’ayant pas été infectée (naïfs-vaccinés). Patients et méthodes Les patients infectés lors de la première vague de la pandémie ont été inclus dans l’étude MEMO-CoV2. Une partie de ces patients avec une forme sévère hospitalisée, ou une forme modérée ambulatoire ont reçu une dose de vaccin à ANR messager (BNT162b2) un an après l’infection. De façon parallèle, une cohorte de soignants, naïfs de toute infection et avec une sérologie négative, ont été vaccinés avec deux doses de vaccin à ARNm. Ces deux cohortes ont été suivies et analysées (Sérologie, Cytométrie en flux des cellules B) longitudinalement jusqu’à 2 mois après le boost vaccinal (première injection pour les convalescents, deuxième injection pour les naïfs). Les cellules B mémoires spécifiques du domaine RBD de la protéine Spike ont été isolées, triées et cultivées en cellule unique. Pour chaque cellule anti-RBD mémoire, nous avons séquencé la chaîne lourde de l’immunoglobuline et nous avons déterminé l’affinité par Biolayer-interferometry des anticorps produits contre des variants préoccupants(α, β, γ et δ). Nous avons aussi déterminé pour certains clones leur capacité à neutraliser le virus D614G (dominant lors de la première vague) et β in vitro. Résultats La vaccination induisait une réponse sérologique IgG anti-RBD robuste chez tous les patients analysés (n = 47). L’activité neutralisante du sérum contre le virus D614G était excellente pour tous les patients. Néanmoins, la neutralisation sérique des variants β et δ était très nettement meilleure chez les patients déjà infectés, suggérant que les plasmocytes mobilisés lors du boost vaccinal proviennent de cellules mémoires matures. L’analyse en cytométrie en flux, a mis en évidence une expansion du pool mémoires chez les patients convalescents à un niveau supérieur à celui des naïfs. L’analyse de plus de 2400 séquences de la chaîne lourde de l’immunoglobuline provenant de cellules B mémoires anti-RBD cultivés en cellule unique, a révélé que la réponse vaccinale anti-RBD mobilise des cellules peu mutées, donc nouvellement générées, chez les individus naïfs. À l’inverse les cellules mémoires mobilisées après le boost chez patients convalescents arboraient de nombreuses mutations somatiques, témoignant de la mobilisation de mémoires préexistantes. L’analyse du répertoire des cellules B mémoires montrait que sa diversité était conservée après la vaccination malgré son expansion. Nous avons ensuite analysé l’affinité de 382 anticorps monoclonaux issus cellules B mémoires mobilisées par le boost vaccinal, contre le RBD de différent variants (α, β, γ, δ, κ). L’affinité des anticorps contre la RBD sauvage était plus forte chez les convalescents que chez les naïfs et corrélait avec le nombre de mutations somatiques dans la chaine lourde de l’immunoglobuline, reflétant le processus de maturation d’affinité. Des clones de très haute affinité contre tous les RBD variants étaient détectés chez tous les individus testés, y compris chez les naïfs, ainsi que des clones neutralisant le variant β, qui a la plus grande capacité à échapper à la réponse immune. Conclusion Chez les patients convalescents, la vaccination amplifie un large répertoire de cellules B mémoires matures et génère des plasmocytes neutralisant les variants. Chez les individus naïfs, la vaccination induit un pool de mémoire contenant des clones neutralisants puissants contre tous les variants préoccupants actuels, dont bêta et delta. Nos résultats suggèrent qu’une troisième dose chez les sujets naïfs permettrait de différentier en plasmocytes les lymphocytes B mémoires de grande qualité générés par le schéma vaccinal initial et ainsi d’augmenter l’activité neutralisante des sérums contre les variants du SARS-CoV-2.
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18
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Muller R, Crickx E. Actualités dans les vascularites. Rev Med Interne 2021; 42:10S17-10S18. [PMID: 34598745 DOI: 10.1016/s0248-8663(21)00660-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- R Muller
- Service de médecine interne et immunologie clinique, CHU Conception, Assistance publique - hôpitaux de Marseille, 147, boulevard Baille, 13005 Marseille, France
| | - E Crickx
- Service de médecine interne, CHU Henri-Mondor, Assistance publique - hôpitaux de Paris, 1, rue Gustave-Eiffel, 94000 Créteil, France.
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19
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Muller R, Crickx E. Actualités dans le lupus et le syndrome des anticorps antiphospholipides. Rev Med Interne 2021; 42:10S14-10S16. [PMID: 34598744 DOI: 10.1016/s0248-8663(21)00659-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- R Muller
- Service de médecine interne et immunologie clinique, CHU Conception, Assistance publique - hôpitaux de Marseille, 147, boulevard Baille, 13005 Marseille, France
| | - E Crickx
- Service de médecine interne, CHU Henri-Mondor, Assistance publique - hôpitaux de Paris, 1, rue Gustave-Eiffel, 94000 Créteil, France.
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Sokal A, Barba-Spaeth G, Fernández I, Broketa M, Azzaoui I, de La Selle A, Vandenberghe A, Fourati S, Roeser A, Meola A, Bouvier-Alias M, Crickx E, Languille L, Michel M, Godeau B, Gallien S, Melica G, Nguyen Y, Zarrouk V, Canoui-Poitrine F, Pirenne F, Mégret J, Pawlotsky JM, Fillatreau S, Bruhns P, Rey FA, Weill JC, Reynaud CA, Chappert P, Mahévas M. mRNA vaccination of naive and COVID-19-recovered individuals elicits potent memory B cells that recognize SARS-CoV-2 variants. Immunity 2021; 54:2893-2907.e5. [PMID: 34614412 PMCID: PMC8452492 DOI: 10.1016/j.immuni.2021.09.011] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [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: 06/17/2021] [Revised: 08/05/2021] [Accepted: 09/14/2021] [Indexed: 01/04/2023]
Abstract
In addition to serum immunoglobulins, memory B cell (MBC) generation against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is another layer of immune protection, but the quality of MBC responses in naive and coronavirus disease 2019 (COVID-19)-recovered individuals after vaccination remains ill defined. We studied longitudinal cohorts of naive and disease-recovered individuals for up to 2 months after SARS-CoV-2 mRNA vaccination. We assessed the quality of the memory response by analysis of antibody repertoires, affinity, and neutralization against variants of concern (VOCs) using unbiased cultures of 2,452 MBCs. Upon boosting, the MBC pool of recovered individuals expanded selectively, matured further, and harbored potent neutralizers against VOCs. Although naive individuals had weaker neutralizing serum responses, half of their RBD-specific MBCs displayed high affinity toward multiple VOCs, including delta (B.1.617.2), and one-third retained neutralizing potency against beta (B.1.351). Our data suggest that an additional challenge in naive vaccinees could recall such affinity-matured MBCs and allow them to respond efficiently to VOCs.
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Affiliation(s)
- Aurélien Sokal
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMS 8253, Université de Paris, Paris, France; Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Giovanna Barba-Spaeth
- Institut Pasteur, Université de Paris, Unité de Virologie Structurale, CNRS UMR 3569, Paris 75015, France
| | - Ignacio Fernández
- Institut Pasteur, Université de Paris, Unité de Virologie Structurale, CNRS UMR 3569, Paris 75015, France
| | - Matteo Broketa
- Institut Pasteur, Université de Paris, INSERM UMR 1222, Unit of Antibodies in Therapy and Pathology, Paris 75015, France; Sorbonne Université, Collège doctoral, Paris 75005, France
| | - Imane Azzaoui
- Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France; INSERM U955, Équipe 2, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Andréa de La Selle
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMS 8253, Université de Paris, Paris, France; Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Alexis Vandenberghe
- Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France; INSERM U955, Équipe 2, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Slim Fourati
- Département de Virologie, Bactériologie, Hygiène et Mycologie-Parasitologie, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France; INSERM U955, Équipe 18, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Anais Roeser
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMS 8253, Université de Paris, Paris, France; Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Annalisa Meola
- Institut Pasteur, Université de Paris, Unité de Virologie Structurale, CNRS UMR 3569, Paris 75015, France
| | - Magali Bouvier-Alias
- Département de Virologie, Bactériologie, Hygiène et Mycologie-Parasitologie, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France; INSERM U955, Équipe 18, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Etienne Crickx
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMS 8253, Université de Paris, Paris, France; Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Laetitia Languille
- Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Marc Michel
- Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Bertrand Godeau
- Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Sébastien Gallien
- Service de Maladies Infectieuses, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Giovanna Melica
- Service de Maladies Infectieuses, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Yann Nguyen
- Service de Médecine Interne, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France
| | - Virginie Zarrouk
- Service de Médecine Interne, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France
| | - Florence Canoui-Poitrine
- Département de Santé Publique, Unité de Recherche Clinique (URC), CEpiA (Clinical Epidemiology and Ageing), EA 7376, Institut Mondor de Recherche Biomédicale (IMRB), Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - France Pirenne
- INSERM U955, Équipe 2, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil (UPEC), Créteil, France; Etablissement Français du Sang (EFS) Ile de France, Créteil, France
| | - Jérôme Mégret
- Plateforme de Cytométrie en Flux, Structure Fédérative de Recherche Necker, INSERM US24-CNRS UMS3633, Paris, France
| | - Jean-Michel Pawlotsky
- Département de Virologie, Bactériologie, Hygiène et Mycologie-Parasitologie, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France; INSERM U955, Équipe 18, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Simon Fillatreau
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMS 8253, Université de Paris, Paris, France
| | - Pierre Bruhns
- Institut Pasteur, Université de Paris, INSERM UMR 1222, Unit of Antibodies in Therapy and Pathology, Paris 75015, France
| | - Felix A Rey
- Institut Pasteur, Université de Paris, Unité de Virologie Structurale, CNRS UMR 3569, Paris 75015, France
| | - Jean-Claude Weill
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMS 8253, Université de Paris, Paris, France.
| | - Claude-Agnès Reynaud
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMS 8253, Université de Paris, Paris, France.
| | - Pascal Chappert
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMS 8253, Université de Paris, Paris, France; Inovarion, Paris, France.
| | - Matthieu Mahévas
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMS 8253, Université de Paris, Paris, France; Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France; INSERM U955, Équipe 2, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil (UPEC), Créteil, France.
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21
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Crickx E, Moulis G, Ebbo M, Terriou L, Briantais A, Languille L, Limal N, Guillet S, Michel M, Mahevas M, Godeau B. Safety of anti-SARS-CoV-2 vaccination for patients with immune thrombocytopenia. Br J Haematol 2021; 195:703-705. [PMID: 34467525 PMCID: PMC8653340 DOI: 10.1111/bjh.17813] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 01/01/2023]
Affiliation(s)
- Etienne Crickx
- Department of Internal Medicine, National Referral Center for Adult's Immune Cytopenias, Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Guillaume Moulis
- Department of Internal Medicine, Toulouse University Hospital (CHU de Toulouse), Toulouse, France.,CIC 1436, Toulouse University Hospital (CHU de Toulouse), Toulouse, France.,UMR 1027 Inserm, University of Toulouse, Toulouse, France
| | - Mikael Ebbo
- Department of internal medicine, Hôpital la Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Louis Terriou
- Department of Internal Medecine and Immunology, Claude-Huriez University Hospital, Université Lille Nord de France, Lille, France
| | - Antoine Briantais
- Department of internal medicine, Hôpital la Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Laetitia Languille
- Department of Internal Medicine, National Referral Center for Adult's Immune Cytopenias, Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Nicolas Limal
- Department of Internal Medicine, National Referral Center for Adult's Immune Cytopenias, Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Stéphanie Guillet
- Department of Internal Medicine, National Referral Center for Adult's Immune Cytopenias, Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Marc Michel
- Department of Internal Medicine, National Referral Center for Adult's Immune Cytopenias, Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Matthieu Mahevas
- Department of Internal Medicine, National Referral Center for Adult's Immune Cytopenias, Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Bertrand Godeau
- Department of Internal Medicine, National Referral Center for Adult's Immune Cytopenias, Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
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Mahévas M, Azzaoui I, Crickx E, Canoui-Poitrine F, Gobert D, Languille L, Limal N, Guillaud C, Croisille L, Jeljeli M, Batteux F, Baloul S, Fain O, Pirenne F, Weill JC, Reynaud CA, Godeau B, Michel M. Efficacy, safety and immunological profile of combining rituximab with belimumab for adults with persistent or chronic immune thrombocytopenia: results from a prospective phase 2b trial. Haematologica 2021; 106:2449-2457. [PMID: 32817288 PMCID: PMC8409028 DOI: 10.3324/haematol.2020.259481] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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] [Received: 05/18/2020] [Indexed: 12/24/2022] Open
Abstract
B-cell activating factor may be involved in the failure of B-cell depleting therapy with rituximab in immune thrombocytopenia (ITP) by promoting the emergence of splenic long-lived plasma cells. From results obtained in mouse models, we hypothesized that combining rituximab with sequential injections of belimumab could increase the rate of response at one year in patients with persistent or chronic ITP by preventing the emergence of these long-lived plasma cells. The study was a single-center, single arm, prospective phase 2b trial (RITUX-PLUS, NCT03154385) investigating the safety and efficacy of rituximab given at a fixed dose of 1,000 mg, two weeks apart, combined with five infusions of belimumab, 10 mg/kg at week 0 (W0)+2 days, W2+2 days, W4, W8 and W12 for adults with primary persistent or chronic ITP. The primary endpoint was the total number of patients achieving an overall response (complete response + response) at W52 according to a standard definition. In total, 15 non-splenectomized adults, nine (60%) with persistent IPT and six (40%) with chronic ITP, were included. No severe adverse event, infection, or severe hypogammaglobulinemia was observed. Thirteen patients achieved an initial overall response. At W52, 12 (80%) patients achieved an overall response, including ten (66.7%) with complete response. When compared with a cohort of patients receiving rituximab alone, the kinetics of B-cell repopulation appeared similar, but the number of circulating T follicular helper cells was significantly decreased with belimumab combination therapy. Combining rituximab and belimumab seems a promising strategy in ITP, with high efficacy and acceptable safety.
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Affiliation(s)
- Matthieu Mahévas
- Centre Hospitalier Universitaire Henri-Mondor, Université Paris Est Creteil, Creteil, France
| | | | - Etienne Crickx
- Centre Hospitalier Universitaire Henri-Mondor, Université Paris Est Creteil, Creteil, France
| | - Florence Canoui-Poitrine
- University Paris-Est, Paris Est Creteil University, CEpiA, Henri-Mondor Hospital, Creteil, France
| | | | - Laetitia Languille
- Centre Hospitalier Universitaire Henri-Mondor, Université Paris Est Creteil, Creteil, France
| | - Nicolas Limal
- Centre Hospitalier Universitaire Henri-Mondor, Université Paris Est Creteil, Creteil, France
| | - Constance Guillaud
- Centre Hospitalier Universitaire Henri-Mondor, Université Paris Est Creteil, Creteil, France
| | - Laure Croisille
- Service d'immunologie plaquettaire, Hopital Henri Mondor, Creteil, France
| | - Mohamed Jeljeli
- Service d'Immunologie biologique, Hopital Cochin, Institut Cochin, Paris, France
| | - Fréderic Batteux
- Service d'Immunologie biologique, Hopital Cochin, Institut Cochin, Paris, France
| | - Samia Baloul
- University Paris-Est, Paris Est Creteil University, CEpiA, Henri-Mondor Hospital, Creteil, France
| | - Olivier Fain
- Sorbonne Université, Service de Medecine Interne, Hopital Saint-Antoine, Paris, France
| | | | - Jean-Claude Weill
- Institut Necker Enfants Malades, Université Paris Descartes, Paris, France
| | | | - Bertrand Godeau
- Centre Hospitalier Universitaire Henri-Mondor, Université Paris Est Creteil, Creteil, France
| | - Marc Michel
- Centre Hospitalier Universitaire Henri-Mondor, Université Paris Est Creteil, Creteil, France
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23
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Crickx E, Audia S, Robbins A, Boutboul D, Comont T, Cheminant M, Oksenhendler E, Godeau B, Michel M, Mahevas M. Daratumumab, an original approach for treating multi-refractory autoimmune cytopenia. Haematologica 2021; 106:3198-3201. [PMID: 34348453 PMCID: PMC8634173 DOI: 10.3324/haematol.2021.279232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
- Etienne Crickx
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, Assistance Publique Hôpitaux de Paris, Université Paris Est Créteil, 94000 Créteil
| | - Sylvain Audia
- Service de Médecine Interne et d'Immunologie Clinique, Centre constitutif de référence des cytopénies auto-immunes de l'adulte, Hôpital François Mitterrand, 14 rue Paul Gaffarel, BP 77908 21079 Dijon Cedex
| | - Ailsa Robbins
- Service de Médecine interne, maladies infectieuses, immunologie clinique, CHU Robert Debré, Reims
| | - David Boutboul
- Service d'Immunologie Clinique, Hôpital Saint Louis, 1 avenue Claude Vellefaux, 75010 Paris, and Paris Université
| | - Thibault Comont
- Service de Médecine Interne et Immunopathologie, Institut Universitaire du Cancer Toulouse - Oncopôle, 1 avenue Joliot-Curie, 31059 Toulouse Cedex 9
| | | | - Eric Oksenhendler
- Service d'Immunologie Clinique, Hôpital Saint Louis, 1 avenue Claude Vellefaux, 75010 Paris, and Paris Université
| | - Bertrand Godeau
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, Assistance Publique Hôpitaux de Paris, Université Paris Est Créteil, 94000 Créteil
| | - Marc Michel
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, Assistance Publique Hôpitaux de Paris, Université Paris Est Créteil, 94000 Créteil
| | - Matthieu Mahevas
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, Assistance Publique Hôpitaux de Paris, Université Paris Est Créteil, 94000 Créteil.
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24
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Crickx E, Chappert P, Sokal A, Weller S, Azzaoui I, Vandenberghe A, Bonnard G, Rossi G, Fadeev T, Storck S, Fadlallah J, Meignin V, Rivière E, Audia S, Godeau B, Michel M, Weill JC, Reynaud CA, Mahévas M. Rituximab-resistant splenic memory B cells and newly engaged naive B cells fuel relapses in patients with immune thrombocytopenia. Sci Transl Med 2021; 13:13/589/eabc3961. [PMID: 33853929 DOI: 10.1126/scitranslmed.abc3961] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 10/29/2020] [Accepted: 03/22/2021] [Indexed: 01/19/2023]
Abstract
Rituximab (RTX), an antibody targeting CD20, is widely used as a first-line therapeutic strategy in B cell-mediated autoimmune diseases. However, a large proportion of patients either do not respond to the treatment or relapse during B cell reconstitution. Here, we characterize the cellular basis responsible for disease relapse in secondary lymphoid organs in humans, taking advantage of the opportunity offered by therapeutic splenectomy in patients with relapsing immune thrombocytopenia. By analyzing the B and plasma cell immunoglobulin gene repertoire at bulk and antigen-specific single-cell level, we demonstrate that relapses are associated with two responses coexisting in germinal centers and involving preexisting mutated memory B cells that survived RTX treatment and naive B cells generated upon reconstitution of the B cell compartment. To identify distinctive characteristics of the memory B cells that escaped RTX-mediated depletion, we analyzed RTX refractory patients who did not respond to treatment at the time of B cell depletion. We identified, by single-cell RNA sequencing (scRNA-seq) analysis, a population of quiescent splenic memory B cells that present a unique, yet reversible, RTX-shaped phenotype characterized by down-modulation of B cell-specific factors and expression of prosurvival genes. Our results clearly demonstrate that these RTX-resistant autoreactive memory B cells reactivate as RTX is cleared and give rise to plasma cells and further germinal center reactions. Their continued surface expression of CD19 makes them efficient targets for current anti-CD19 therapies. This study thus identifies a pathogenic contributor to autoimmune diseases that can be targeted by available therapeutic agents.
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Affiliation(s)
- Etienne Crickx
- Institut Necker-Enfants Malades, INSERM U1151/CNRS UMS8253, Université Paris Descartes, Sorbonne Paris Cité, 75993 Paris Cedex 14, France.,Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, 94000 Créteil, France
| | - Pascal Chappert
- Institut Necker-Enfants Malades, INSERM U1151/CNRS UMS8253, Université Paris Descartes, Sorbonne Paris Cité, 75993 Paris Cedex 14, France.,Inovarion, 75005 Paris, France
| | - Aurélien Sokal
- Institut Necker-Enfants Malades, INSERM U1151/CNRS UMS8253, Université Paris Descartes, Sorbonne Paris Cité, 75993 Paris Cedex 14, France
| | - Sandra Weller
- Institut Necker-Enfants Malades, INSERM U1151/CNRS UMS8253, Université Paris Descartes, Sorbonne Paris Cité, 75993 Paris Cedex 14, France
| | - Imane Azzaoui
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, 94000 Créteil, France.,INSERM U955, Université Paris Est Créteil (UPEC), 94000 Créteil, France
| | - Alexis Vandenberghe
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, 94000 Créteil, France.,INSERM U955, Université Paris Est Créteil (UPEC), 94000 Créteil, France
| | - Guillaume Bonnard
- INSERM U955, Université Paris Est Créteil (UPEC), 94000 Créteil, France
| | - Geoffrey Rossi
- Institut Necker-Enfants Malades, INSERM U1151/CNRS UMS8253, Université Paris Descartes, Sorbonne Paris Cité, 75993 Paris Cedex 14, France
| | - Tatiana Fadeev
- Institut Necker-Enfants Malades, INSERM U1151/CNRS UMS8253, Université Paris Descartes, Sorbonne Paris Cité, 75993 Paris Cedex 14, France
| | - Sébastien Storck
- Institut Necker-Enfants Malades, INSERM U1151/CNRS UMS8253, Université Paris Descartes, Sorbonne Paris Cité, 75993 Paris Cedex 14, France
| | - Jehane Fadlallah
- Service d'immunologie clinique, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France
| | - Véronique Meignin
- Service d'anatomopathologie, Hôpital Saint-Louis (AP-HP), 75010 Paris, France
| | - Etienne Rivière
- Service de médecine interne, Hôpital Haut-Lévêque, 33604 Pessac, France
| | - Sylvain Audia
- Service de médecine interne, Hôpital du Bocage, 21000 Dijon, France
| | - Bertrand Godeau
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, 94000 Créteil, France
| | - Marc Michel
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, 94000 Créteil, France
| | - Jean-Claude Weill
- Institut Necker-Enfants Malades, INSERM U1151/CNRS UMS8253, Université Paris Descartes, Sorbonne Paris Cité, 75993 Paris Cedex 14, France
| | - Claude-Agnès Reynaud
- Institut Necker-Enfants Malades, INSERM U1151/CNRS UMS8253, Université Paris Descartes, Sorbonne Paris Cité, 75993 Paris Cedex 14, France
| | - Matthieu Mahévas
- Institut Necker-Enfants Malades, INSERM U1151/CNRS UMS8253, Université Paris Descartes, Sorbonne Paris Cité, 75993 Paris Cedex 14, France. .,Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, 94000 Créteil, France.,INSERM U955, Université Paris Est Créteil (UPEC), 94000 Créteil, France
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Crickx E, Audia S, Robbins A, Boutboul D, Comont T, Cheminant M, Oksenhendler E, Godeau B, Michel M, Mahévas M. Traitement de recours par le daratumumab dans les cytopénies autoimmunes réfractaires de l’adulte : premières données rétrospectives du centre national de référence. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sokal A, Chappert P, Barba-Spaeth G, Roeser A, Fourati S, Azzaoui I, Vandenberghe A, Fernandez I, Crickx E, Beldi-Ferchiou A, Hue S, Michel M, Godeau B, Noizat-Pirenne F, Ménager M, Fillatreau S, Rey F, Weill J, Reynaud C, Mahevas M. Maturation et persistance de la réponse lymphocytaire B mémoire anti-SARS-CoV-2. Rev Med Interne 2021. [PMCID: PMC8192033 DOI: 10.1016/j.revmed.2021.03.258] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Crickx E, Tamirou F, Huscenot T, Costedoat-Chalumeau N, Rabant M, Karras A, Robbins A, Fadeev T, Le Guern V, Remy P, Hummel A, Aydin S, Lauwerys B, Weill JC, Reynaud CA, Houssiau F, Mahévas M. Molecular Signatures of Kidney Antibody-Secreting Cells in Lupus Patients With Active Nephritis Upon Immunosuppressive Therapy. Arthritis Rheumatol 2021; 73:1461-1466. [PMID: 33645886 DOI: 10.1002/art.41703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/18/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This study was undertaken to characterize kidney and urine antibody-secreting cells (ASCs) from patients with active lupus nephritis, before and after induction therapy. METHODS We included patients with biopsy-proven active lupus nephritis and performed anti-CD138 staining of kidney biopsy samples to visualize ASCs. We performed single-cell gene expression profiling on sorted ASCs from fresh biopsy samples using multiplex reverse transcriptase-polymerase chain reaction. We used a gene set that allowed for the study of ASC maturation from plasmablasts to long-lived plasma cells. We quantified urine ASCs from untreated patients with lupus nephritis at diagnosis and after 6 months of prospective follow-up during induction therapy. RESULTS The number of kidney CD138+ ASCs in 46 untreated patients with lupus nephritis was correlated with a low estimated glomerular filtration rate and with tubulointerstitial damage. Most kidney ASCs from 3 untreated patients had a plasmablast molecular signature; in contrast, in 4 patients with refractory lupus nephritis, the kidney ASCs were mainly long-lived plasma cells, representing an ASC transcriptional profile similar to that in the bone marrow of 2 healthy donors. Some urine ASCs with a plasmablast signature were detected in patients with untreated active lupus nephritis. The presence of urine ASCs at 6 months was associated with treatment failure. CONCLUSION Our results suggest potential for ASC-directed therapy in refractory lupus nephritis.
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Affiliation(s)
- Etienne Crickx
- Institut Necker Enfants Malades, INSERM U1151, CNRS UMS 8253, Université Paris Descartes, Sorbonne Paris Cité, Paris, France, and AP-HP, Hôpital Henri-Mondor, Université Paris-Est, Créteil, France
| | - Farah Tamirou
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Tessa Huscenot
- Institut Necker Enfants Malades, INSERM U1151, CNRS UMS 8253, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | | | - Marion Rabant
- Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | | | - Ailsa Robbins
- Institut Necker Enfants Malades, INSERM U1151, CNRS UMS 8253, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Tatiana Fadeev
- Institut Necker Enfants Malades, INSERM U1151, CNRS UMS 8253, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | | | | | | | - Selda Aydin
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Bernard Lauwerys
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Jean-Claude Weill
- Institut Necker Enfants Malades, INSERM U1151, CNRS UMS 8253, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Claude-Agnès Reynaud
- Institut Necker Enfants Malades, INSERM U1151, CNRS UMS 8253, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Frédéric Houssiau
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Matthieu Mahévas
- Institut Necker Enfants Malades, INSERM U1151, CNRS UMS 8253, Université Paris Descartes, Sorbonne Paris Cité, Paris, France, and AP-HP, Hôpital Henri-Mondor, Université Paris-Est, INSERM U955, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil (UPEC), Créteil, France
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28
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Sokal A, Chappert P, Barba-Spaeth G, Roeser A, Fourati S, Azzaoui I, Vandenberghe A, Fernandez I, Meola A, Bouvier-Alias M, Crickx E, Beldi-Ferchiou A, Hue S, Languille L, Michel M, Baloul S, Noizat-Pirenne F, Luka M, Mégret J, Ménager M, Pawlotsky JM, Fillatreau S, Rey FA, Weill JC, Reynaud CA, Mahévas M. Maturation and persistence of the anti-SARS-CoV-2 memory B cell response. Cell 2021; 184:1201-1213.e14. [PMID: 33571429 PMCID: PMC7994111 DOI: 10.1016/j.cell.2021.01.050] [Citation(s) in RCA: 215] [Impact Index Per Article: 71.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/09/2021] [Accepted: 01/26/2021] [Indexed: 12/15/2022]
Abstract
Memory B cells play a fundamental role in host defenses against viruses, but to date, their role has been relatively unsettled in the context of SARS-CoV-2. We report here a longitudinal single-cell and repertoire profiling of the B cell response up to 6 months in mild and severe COVID-19 patients. Distinct SARS-CoV-2 spike-specific activated B cell clones fueled an early antibody-secreting cell burst as well as a durable synchronous germinal center response. While highly mutated memory B cells, including pre-existing cross-reactive seasonal Betacoronavirus-specific clones, were recruited early in the response, neutralizing SARS-CoV-2 RBD-specific clones accumulated with time and largely contributed to the late, remarkably stable, memory B cell pool. Highlighting germinal center maturation, these cells displayed clear accumulation of somatic mutations in their variable region genes over time. Overall, these findings demonstrate that an antigen-driven activation persisted and matured up to 6 months after SARS-CoV-2 infection and may provide long-term protection.
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Affiliation(s)
- Aurélien Sokal
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMS 8253, Université de Paris, Paris, France; Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Pascal Chappert
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMS 8253, Université de Paris, Paris, France; Inovarion, Paris, France
| | | | - Anais Roeser
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMS 8253, Université de Paris, Paris, France; Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Slim Fourati
- Département de Virologie, Bactériologie, Hygiène et Mycologie-Parasitologie, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France; INSERM U955, équipe 18, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Imane Azzaoui
- Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France; INSERM U955, équipe 2, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Alexis Vandenberghe
- Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France; INSERM U955, équipe 2, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Ignacio Fernandez
- Institut Pasteur, Unité de Virologie Structurale, CNRS UMR 3569, Paris, France
| | - Annalisa Meola
- Institut Pasteur, Unité de Virologie Structurale, CNRS UMR 3569, Paris, France
| | - Magali Bouvier-Alias
- Département de Virologie, Bactériologie, Hygiène et Mycologie-Parasitologie, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France; INSERM U955, équipe 18, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Etienne Crickx
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMS 8253, Université de Paris, Paris, France; Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Asma Beldi-Ferchiou
- Département Immunologie-Hématologie, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), 94000 Créteil, France; INSERM U955, équipe immunorégulation et biothérapie (I-BIOT), Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Sophie Hue
- Département Immunologie-Hématologie, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), 94000 Créteil, France; Institut de Recherche Vaccinale (VRI), Université Paris-Est Créteil (UPEC), Faculté de Médecine, Créteil, France; INSERM U955, équipe 16, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Laetitia Languille
- Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Marc Michel
- Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Samia Baloul
- Département de Santé Publique, Unité de Recherche Clinique (URC), CEpiA (Clinical Epidemiology and Ageing), EA 7376, Institut Mondor de Recherche Biomédicale (IMRB), Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - France Noizat-Pirenne
- Etablissement Français du Sang, INSERM U955, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Marine Luka
- Réponses inflammatoires et réseaux transcriptomiques dans les maladies, Institut Imagine, INSERM UMR1163, ATIP-Avenir Team, Université de Paris, Paris, France; Labtech Single-cell@Imagine, Institut Imagine, INSERM UMR 1163, Paris, France
| | - Jérôme Mégret
- Plateforme de Cytométrie en Flux, Structure Fédérative de Recherche Necker, INSERM US24-CNRS UMS3633, Paris, France
| | - Mickaël Ménager
- Réponses inflammatoires et réseaux transcriptomiques dans les maladies, Institut Imagine, INSERM UMR1163, ATIP-Avenir Team, Université de Paris, Paris, France; Labtech Single-cell@Imagine, Institut Imagine, INSERM UMR 1163, Paris, France
| | - Jean-Michel Pawlotsky
- Département de Virologie, Bactériologie, Hygiène et Mycologie-Parasitologie, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France; INSERM U955, équipe 18, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Simon Fillatreau
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMS 8253, Université de Paris, Paris, France
| | - Felix A Rey
- Institut Pasteur, Unité de Virologie Structurale, CNRS UMR 3569, Paris, France
| | - Jean-Claude Weill
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMS 8253, Université de Paris, Paris, France.
| | - Claude-Agnès Reynaud
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMS 8253, Université de Paris, Paris, France.
| | - Matthieu Mahévas
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMS 8253, Université de Paris, Paris, France; Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France; INSERM U955, équipe 2, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil (UPEC), Créteil, France.
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Dossou E, Jouenne R, Picard C, Neven B, Hadjadj J, Fayand A, Michel M, Crickx E. Survenue d’une prolifération LGL chez une patiente avec un DICV : une mutation gain de fonction de STAT3 en cause. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mahevas M, Azzaoui I, Crickx E, Canoui-Poitrine F, Gobert D, Languille L, Limal N, Croisille L, Batteux F, Baloul S, Fain O, Noizat-Pirenne F, Weill J, Reynaud C, Godeau B, Michel M. Efficacité et tolérance du traitement combinant rituximab et belimumab au cours de la thrombopénie immunologique persistante et chronique de l’adulte : résultats d’un essai de phase IIb. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Crickx E, Sokal A, Chappert P, Weller S, Azzaoui I, Vandenberghe A, Bonnard G, Geoffrey R, Fadeev T, Storck S, Fadlallah J, Meignin V, Riviere E, Godeau B, Michel M, Weill J, Reynaud C, Mahevas M. Un réservoir de lymphocytes B mémoires ayant résisté au rituximab participe aux rechutes à distance du traitement au cours de la thrombopénie immunologique de l’adulte. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mahévas M, Moulis G, Andres E, Riviere E, Garzaro M, Crickx E, Guillotin V, Malphettes M, Galicier L, Noel N, Darnige L, Terriou L, Guerveno C, Sanchis-Borja M, Moulinet T, Meunier B, Ebbo M, Michel M, Godeau B. Clinical characteristics, management and outcome of COVID-19-associated immune thrombocytopenia: a French multicentre series. Br J Haematol 2020; 190:e224-e229. [PMID: 32678953 PMCID: PMC7404899 DOI: 10.1111/bjh.17024] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Matthieu Mahévas
- Department of Internal Medicine, National Referral Center for Adult's Immune Cytopenias Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Guillaume Moulis
- Department of Internal Medicine, Toulouse University Hospital (CHU de Toulouse), Toulouse, France.,CIC 1436, Toulouse University Hospital (CHU de Toulouse), Toulouse, France.,UMR 1027 Inserm, University of Toulouse, Toulouse, France
| | - Emmanuel Andres
- Department of Internal Medicine, University Hospital of Strasbourg, Research Team EA, 3072 "Mitochondrie, Stress oxydant et Protection musculaire", University of Strasbourg, Strasbourg, France
| | - Etienne Riviere
- Department of Internal Medicine, Bordeaux University Hospital (CHU de Bordeaux), Bordeaux, France.,Inserm U1034-University of Bordeaux, Bordeaux, France
| | - Margaux Garzaro
- Department of Clinical Immunology, Saint Louis University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Etienne Crickx
- Department of Internal Medicine, National Referral Center for Adult's Immune Cytopenias Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Vivien Guillotin
- Department of Internal Medicine, University Hospital of Strasbourg, Research Team EA, 3072 "Mitochondrie, Stress oxydant et Protection musculaire", University of Strasbourg, Strasbourg, France
| | - Marion Malphettes
- Department of Clinical Immunology, Saint Louis University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Lionel Galicier
- Department of Clinical Immunology, Saint Louis University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Nicolas Noel
- Department of internal medicine, Kremlin-Bicêtre, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Luc Darnige
- Inserm UMR-S 1140, Service d'Hématologie Biologique, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Louis Terriou
- Department of Internal Medicine and Immunology, Claude-Huriez University Hospital, Université Lille Nord de France, Lille, France
| | - Claire Guerveno
- Department of Internal Medicine, Albi Hospital, Albi, France
| | - Mateo Sanchis-Borja
- Department of pneumology, Hôpital européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Thomas Moulinet
- Department of internal medicine, Nancy University Hospital (CHU de Nancy), University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Benoit Meunier
- Department of internal medicine, Hôpital la Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Mikael Ebbo
- Department of internal medicine, Hôpital la Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Marc Michel
- Department of Internal Medicine, National Referral Center for Adult's Immune Cytopenias Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Bertrand Godeau
- Department of Internal Medicine, National Referral Center for Adult's Immune Cytopenias Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
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Mahévas M, Tran VT, Roumier M, Chabrol A, Paule R, Guillaud C, Fois E, Lepeule R, Szwebel TA, Lescure FX, Schlemmer F, Matignon M, Khellaf M, Crickx E, Terrier B, Morbieu C, Legendre P, Dang J, Schoindre Y, Pawlotsky JM, Michel M, Perrodeau E, Carlier N, Roche N, de Lastours V, Ourghanlian C, Kerneis S, Ménager P, Mouthon L, Audureau E, Ravaud P, Godeau B, Gallien S, Costedoat-Chalumeau N. Clinical efficacy of hydroxychloroquine in patients with covid-19 pneumonia who require oxygen: observational comparative study using routine care data. BMJ 2020; 369:m1844. [PMID: 32409486 PMCID: PMC7221472 DOI: 10.1136/bmj.m1844] [Citation(s) in RCA: 268] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess the effectiveness of hydroxychloroquine in patients admitted to hospital with coronavirus disease 2019 (covid-19) pneumonia who require oxygen. DESIGN Comparative observational study using data collected from routine care. SETTING Four French tertiary care centres providing care to patients with covid-19 pneumonia between 12 March and 31 March 2020. PARTICIPANTS 181 patients aged 18-80 years with documented severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia who required oxygen but not intensive care. INTERVENTIONS Hydroxychloroquine at a dose of 600 mg/day within 48 hours of admission to hospital (treatment group) versus standard care without hydroxychloroquine (control group). MAIN OUTCOME MEASURES The primary outcome was survival without transfer to the intensive care unit at day 21. Secondary outcomes were overall survival, survival without acute respiratory distress syndrome, weaning from oxygen, and discharge from hospital to home or rehabilitation (all at day 21). Analyses were adjusted for confounding factors by inverse probability of treatment weighting. RESULTS In the main analysis, 84 patients who received hydroxychloroquine within 48 hours of admission to hospital (treatment group) were compared with 89 patients who did not receive hydroxychloroquine (control group). Eight additional patients received hydroxychloroquine more than 48 hours after admission. In the weighted analyses, the survival rate without transfer to the intensive care unit at day 21 was 76% in the treatment group and 75% in the control group (weighted hazard ratio 0.9, 95% confidence interval 0.4 to 2.1). Overall survival at day 21 was 89% in the treatment group and 91% in the control group (1.2, 0.4 to 3.3). Survival without acute respiratory distress syndrome at day 21 was 69% in the treatment group compared with 74% in the control group (1.3, 0.7 to 2.6). At day 21, 82% of patients in the treatment group had been weaned from oxygen compared with 76% in the control group (weighted risk ratio 1.1, 95% confidence interval 0.9 to 1.3). Eight patients in the treatment group (10%) experienced electrocardiographic modifications that required discontinuation of treatment. CONCLUSIONS Hydroxychloroquine has received worldwide attention as a potential treatment for covid-19 because of positive results from small studies. However, the results of this study do not support its use in patients admitted to hospital with covid-19 who require oxygen.
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Affiliation(s)
- Matthieu Mahévas
- Department of Internal Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Viet-Thi Tran
- Centre for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Centre of Research in Epidemiology and Statistics, Paris, France
| | - Mathilde Roumier
- Department of Internal Medicine, Foch Hospital, Suresnes, France
| | - Amélie Chabrol
- Department of Infectious Diseases, Sud Francilien Hospital, Corbeil-Essonnes, France
| | - Romain Paule
- Department of Internal Medicine, Foch Hospital, Suresnes, France
| | - Constance Guillaud
- Department of Internal Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Elena Fois
- Department of Internal Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Raphael Lepeule
- Transversal Infections Treatment Unit, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, Créteil, France
| | - Tali-Anne Szwebel
- Department of Internal Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | | | - Frédéric Schlemmer
- Pulmonology Unit, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, Créteil, France
| | - Marie Matignon
- Department of Nephrology, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, Créteil, France
| | - Mehdi Khellaf
- Department of Internal Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Etienne Crickx
- Department of Internal Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Benjamin Terrier
- Department of Internal Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Caroline Morbieu
- Department of Internal Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Paul Legendre
- Department of Internal Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Julien Dang
- Centre for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Centre of Research in Epidemiology and Statistics, Paris, France
| | - Yoland Schoindre
- Department of Internal Medicine, Foch Hospital, Suresnes, France
| | - Jean-Michel Pawlotsky
- Department of Virology, Bacteriology-Hygiene, and Mycology-Parasitology Centre, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marc Michel
- Department of Internal Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Elodie Perrodeau
- Centre for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Centre of Research in Epidemiology and Statistics, Paris, France
| | - Nicolas Carlier
- Department of Pulmonology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Nicolas Roche
- Department of Pulmonology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Victoire de Lastours
- Department of Internal Medicine, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Clément Ourghanlian
- Pharmacy, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, Créteil, France
| | - Solen Kerneis
- Mobile Infectious Disease Team, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Philippe Ménager
- Pulmonology Unit, Sud Francilien Hospital, Corbeil-Essonnes, France
| | - Luc Mouthon
- Department of Internal Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Etienne Audureau
- Clinical Epidemiology and Aging Team, Mondor Institute for Biomedical Research (INSERM U955), Public Health Services, Henri-Mondor Hosptial, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, Créteil, France
| | - Philippe Ravaud
- Centre for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Centre of Research in Epidemiology and Statistics, Paris, France
| | - Bertrand Godeau
- Department of Internal Medicine, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Sébastien Gallien
- Department of Infectious Diseases, Henri-Mondor Hospital, Assistance Publique-Hôpitaux de Pari, Paris-Est Créteil University, Créteil, France
| | - Nathalie Costedoat-Chalumeau
- Centre for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Centre of Research in Epidemiology and Statistics, Paris, France
- Department of Internal Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
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Fadlallah J, Michel M, Crickx E, Limal N, Costedoat N, Malphettes M, Fieschi C, Galicier L, Oksenhendler E, Godeau B, Audia S, Mahévas M. Bortezomib and dexamethasone, an original approach for treating multi‐refractory warm autoimmune haemolytic anaemia. Br J Haematol 2019; 187:124-128. [DOI: 10.1111/bjh.16009] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 03/25/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Jehane Fadlallah
- Service de Médecine Interne Centre national de référence des cytopénies auto‐immunes de l'adulte Hôpital Henri Mondor Assistance Publique Hôpitaux de Paris Université Paris Est Créteil Créteil France
- Service d'Immunologie Clinique Hôpital Saint Louis Paris France
| | - Marc Michel
- Service de Médecine Interne Centre national de référence des cytopénies auto‐immunes de l'adulte Hôpital Henri Mondor Assistance Publique Hôpitaux de Paris Université Paris Est Créteil Créteil France
| | - Etienne Crickx
- Service de Médecine Interne Centre national de référence des cytopénies auto‐immunes de l'adulte Hôpital Henri Mondor Assistance Publique Hôpitaux de Paris Université Paris Est Créteil Créteil France
| | - Nicolas Limal
- Service de Médecine Interne Centre national de référence des cytopénies auto‐immunes de l'adulte Hôpital Henri Mondor Assistance Publique Hôpitaux de Paris Université Paris Est Créteil Créteil France
| | | | | | - Claire Fieschi
- Service d'Immunologie Clinique Hôpital Saint Louis Paris France
| | - Lionel Galicier
- Service d'Immunologie Clinique Hôpital Saint Louis Paris France
| | | | - Bertrand Godeau
- Service de Médecine Interne Centre national de référence des cytopénies auto‐immunes de l'adulte Hôpital Henri Mondor Assistance Publique Hôpitaux de Paris Université Paris Est Créteil Créteil France
| | - Sylvain Audia
- Service de Médecine Interne et d'Immunologie Clinique Hôpital François Mitterrand Dijon France
| | - Matthieu Mahévas
- Service de Médecine Interne Centre national de référence des cytopénies auto‐immunes de l'adulte Hôpital Henri Mondor Assistance Publique Hôpitaux de Paris Université Paris Est Créteil Créteil France
- IMRB ‐ U955 ‐ Equipe n°2 “Transfusion et maladies du globule rouge” EFS Île‐de‐France Hôpital Henri‐Mondor AP‐HP Créteil France
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Crickx E, Huscenot T, Costedoat-Chalumeau N, Rabant M, Karras A, Robbins A, Le Guern V, Lauwerys B, Houssiau F, Reynaud C, Godeau B, Mahevas M. Évolution sous traitement immunosuppresseur de la signature moléculaire des cellules sécrétrices d’anticorps rénales chez des patients avec néphrite lupique active : étude plasmo-lup. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.03.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Crickx E, Poullot E, Moulis G, Goulabchand R, Fieschi C, Galicier L, Meignin V, Coppo P, Delarue R, Casasnovas O, Roos-Weil D, de Leval L, Parrens M, Michel M, Dupuis J, Le Bras F, Fataccioli V, Martin-Garcia N, Godeau B, Haïoun C, Gaulard P, Mahévas M. Clinical spectrum, evolution, and management of autoimmune cytopenias associated with angioimmunoblastic T-cell lymphoma. Eur J Haematol 2019; 103:35-42. [PMID: 30985955 DOI: 10.1111/ejh.13239] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 01/24/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Angioimmunoblastic T-cell lymphoma (AITL) is frequently associated with autoimmune cytopenia (AIC). Whether such patients have a particular phenotype and require particular management is unclear. METHOD Angioimmunoblastic T-cell lymphoma patients from the multicentric database of the Lymphoma Study Association presenting with AIC during disease course were included and matched to AITL patients without AIC (1/5 ratio). RESULTS At diagnosis, AIC patients (n = 28) had more spleen and bone marrow involvement (54% vs 19% and 71% vs 34%, P < 0.001), Epstein-Barr virus replication (89% vs 39%, P < 0.001), gamma globulin titers (median 23 vs 15 g/L, P = 0.002), and proliferating B cells and plasmablasts in biopsies, as compared to control patients (n = 136). The 28 AIC patients had 41 episodes of AIC, diagnosed concomitantly with AITL in 23 (82%) cases. After a median follow-up of 24 months (range 3-155), 10 patients relapsed, all associated with AITL relapse. CONCLUSION Our results provide new insight into AIC associated with AITL by highlighting the significant interplay between AITL and B-cell activation leading to subsequent autoimmunity.
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Affiliation(s)
- Etienne Crickx
- Service de médecine interne, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est, Créteil, France.,Institut Necker Enfants Malades, INSERM U1151/CNRS UMS 8253, Université Paris Descartes, Sorbonne Paris Cité, Paris Cedex, France
| | - Elsa Poullot
- Département de Pathologie, Hôpital Henri-Mondor (AP-HP), Créteil, France.,Faculté de Médecine, Université Paris-Est, Inserm U955, Créteil, France
| | - Guillaume Moulis
- Service de médecine Interne, CHU de Toulouse, Toulouse, France.,UMR 1027 Inserm-Université de Toulouse, Toulouse, France.,CIC 1436, CHU de Toulouse, Toulouse, France
| | - Radjiv Goulabchand
- Service de médecine interne, maladies multi-organiques, Hôpital Saint-Eloi, CHRU Montpellier, Montpellier, France
| | - Claire Fieschi
- Service d'immunologie clinique, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Lionel Galicier
- Service d'immunologie clinique, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Véronique Meignin
- Service d'anatomopathologie, Hôpital Saint-Louis (AP-HP), Paris, France
| | - Paul Coppo
- Service d'hématologie, Centre de référence des microangiopathies thrombotiques, Hôpital Saint-Antoine (AP-HP), Sorbonne Universités, Paris, France
| | - Richard Delarue
- Service d'hématologie, Hôpital Necker (AP-HP), Paris, France
| | - Olivier Casasnovas
- Service d'hématologie, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Damien Roos-Weil
- Sorbonne Universités, UPMC Université Paris 06, AP-HP, GRC-11, Groupe de recherche clinique sur les hémopathies lymphoïdes (GRECHY), Hôpital Pitié-Salpétrière (APHP), Paris, France
| | - Laurence de Leval
- Institut de Pathologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Marie Parrens
- Département de Pathologie, Hôpital Pessac, Bordeaux, France
| | - Marc Michel
- Service de médecine interne, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est, Créteil, France
| | - Jehan Dupuis
- Unité Hémopathies Lymphoïdes, Hôpital Henri-Mondor (AP-HP), Créteil, France
| | - Fabien Le Bras
- Unité Hémopathies Lymphoïdes, Hôpital Henri-Mondor (AP-HP), Créteil, France
| | - Virginie Fataccioli
- Département de Pathologie, Hôpital Henri-Mondor (AP-HP), Créteil, France.,Faculté de Médecine, Université Paris-Est, Inserm U955, Créteil, France
| | - Nadine Martin-Garcia
- Département de Pathologie, Hôpital Henri-Mondor (AP-HP), Créteil, France.,Faculté de Médecine, Université Paris-Est, Inserm U955, Créteil, France
| | - Bertrand Godeau
- Service de médecine interne, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est, Créteil, France
| | - Corinne Haïoun
- Unité Hémopathies Lymphoïdes, Hôpital Henri-Mondor (AP-HP), Créteil, France
| | - Philippe Gaulard
- Département de Pathologie, Hôpital Henri-Mondor (AP-HP), Créteil, France.,Faculté de Médecine, Université Paris-Est, Inserm U955, Créteil, France
| | - Matthieu Mahévas
- Service de médecine interne, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est, Créteil, France.,Institut Necker Enfants Malades, INSERM U1151/CNRS UMS 8253, Université Paris Descartes, Sorbonne Paris Cité, Paris Cedex, France.,Unité Inserm U955, équipe 2, Hôpital Henri-Mondor, Assistance publique-hôpitaux de Paris, Créteil, France
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Crickx E, Moulis G, Ruivard M, Asli B, Marolleau J, Michel M, Godeau B, Mahevas M. Utilisation des agonistes du récepteur à la thrombopoïétine (ARTPO) en association avec un immunosuppresseur au cours du PTI de l’adulte multiréfractaire. Etude rétrospective multicentrique du centre de référence des cytopénies auto-immunes de l’adulte. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.278] [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: 11/15/2022]
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Crickx E. [Management of hemorrhagic complications under anticoagulant treatment]. Rev Prat 2017; 67:e443-e444. [PMID: 30717582] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Etienne Crickx
- Développement du système immunitaire, Inserm U1151, faculté de médecine Paris-Descartes, 75993 Paris Cedex 14, France
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Crickx E. [Management of hemorrhagic complications under anticoagulant treatment]. Rev Prat 2017; 67:e443-e444. [PMID: 30717581] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Etienne Crickx
- Développement du système immunitaire, Inserm U1151, faculté de médecine Paris-Descartes, 75993 Paris Cedex 14, France
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Crickx E, Bouaziz JD, Lorillon G, de Menthon M, Cordoliani F, Bugnet E, Bagot M, Rybojad M, Mourah S, Tazi A. Clinical Spectrum, Quality of Life, BRAF Mutation Status and Treatment of Skin Involvement in Adult Langerhans Cell Histiocytosis. Acta Derm Venereol 2017; 97:838-842. [PMID: 28421232 DOI: 10.2340/00015555-2674] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Langerhans cell histiocytosis is a rare histiocytic disorder for which skin involvement and management are poorly described in adults. The aim of this retrospective monocentric study in a national reference centre is to describe the clinical characteristics, quality of life, BRAF mutation status and outcomes of skin involvement in adult patients with Langerhans cell histiocytosis. Twenty-five patients (14 females, mean age 47 years) were included, with a median follow-up of 33 months (range 4-420 months). Patients experienced poor dermatological quality of life despite low body surface involvement. BRAFV600 mutations were detected in 8 of the 18 patients analysed (45%). Eight patients had an associated malignancy. Several treatment options were used and consisted of surgery, topical steroids and carmustine, thalidomide, methotrexate, vinblastine and steroids and cladribine. This study highlights the need to evaluate quality of life and to screen for associated malignancy in adult patients with Langerhans cell histiocytosis.
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Affiliation(s)
- Etienne Crickx
- Assistance Publique- Hôpitaux de Paris, Département de Dermatologie, Hôpital Saint-Louis, Paris, France
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Crickx E, Goulabchand R, Fieschi C, Galicier L, Coppo P, Delarue R, Moulis G, Michel M, Haioun C, Godeau B, Gaulard P, Mahevas M. Caractéristiques cliniques, évolution et prise en charge des cytopénies auto-immunes associées aux lymphomes T de type LAI : une étude multicentrique rétrospective comparative. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.015] [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: 11/17/2022]
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Crickx E, Machelart I, Lazaro E, Kahn JE, Cohen-Aubart F, Martin T, Mania A, Hatron PY, Hayem G, Blanchard-Delaunay C, de Moreuil C, Le Guenno G, Vandergheynst F, Maurier F, Crestani B, Dhote R, Silva NM, Ollivier Y, Mehdaoui A, Godeau B, Mariette X, Cadranel J, Cohen P, Puéchal X, Le Jeunne C, Mouthon L, Guillevin L, Terrier B. Intravenous Immunoglobulin as an Immunomodulating Agent in Antineutrophil Cytoplasmic Antibody-Associated Vasculitides: A French Nationwide Study of Ninety-Two Patients. Arthritis Rheumatol 2016; 68:702-12. [PMID: 26473632 DOI: 10.1002/art.39472] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [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: 05/20/2015] [Accepted: 10/01/2015] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Intravenous immunoglobulin (IVIG) represents a therapeutic alternative in antineutrophil cytoplasmic antibody-associated vasculitides (AAV), but its efficacy has been evaluated in only 2 small prospective trials. The aim of this study was to evaluate the efficacy and safety of IVIG in patients with AAV. METHODS We conducted a nationwide retrospective study of patients who received IVIG as immunomodulatory therapy for AAV. RESULTS A total of 92 patients (mean age 51 years) presenting with either granulomatosis with polyangiitis (Wegener's) (68%), eosinophilic granulomatosis with polyangiitis (Churg-Strauss) (22%), or microscopic polyangiitis (10%) received at least 1 course of IVIG. Antineutrophil cytoplasmic antibodies were present in 72% during the flare that required IVIG, as determined by immunofluorescence assay. IVIG was initiated because of relapsing disease in 83% of cases. IVIG was given for a median of 6 months (range 1-156 months) and in combination with corticosteroids in 21% of the patients or with other immunosuppressive agents in 77%. Efficacy of IVIG was assessed in the entire population and in a subset of 34 patients with unmodified background therapy. Remission rates at 6 months were 56% in the entire population and 58% in the unmodified background therapy group. Refractory disease and treatment failure at 6 months were observed in 7% and 18% in the whole population and 3% and 21% in the unmodified background therapy group, respectively. Adverse events (AEs) occurred in 33%, including serious AEs in 12% and AEs leading to discontinuation of IVIG in 7%. CONCLUSION This large study shows the clinical benefit of IVIG as adjunctive therapy, with an acceptable tolerance profile, and thus supports its use in AAV patients with refractory or relapsing disease.
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Affiliation(s)
- Etienne Crickx
- National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, AP-HP, and Université Paris Descartes, Paris, France
| | - Irène Machelart
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Estibaliz Lazaro
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | | | - Fleur Cohen-Aubart
- Groupe Hospitalier Pitié Salpêtrière, AP-HP, and Université Pierre et Marie Curie, Paris, France
| | - Thierry Martin
- CHU de Strasbourg and National Referral Center for Rare Autoimmune and Systemic Diseases, Strasbourg, France
| | | | | | - Gilles Hayem
- Hôpital Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | | | | | | | | | | | | | | | | | | | - Anas Mehdaoui
- Centre Hospitalier Intercommunal Eure et Seine, Evreux, France
| | | | - Xavier Mariette
- Hôpitaux Universitaires Paris-Sud, AP-HP, Université Paris-Sud, Le Kremlin-Bicêtre, France
| | | | - Pascal Cohen
- National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, AP-HP, and Université Paris Descartes, Paris, France
| | - Xavier Puéchal
- National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, AP-HP, and Université Paris Descartes, Paris, France
| | - Claire Le Jeunne
- National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, AP-HP, and Université Paris Descartes, Paris, France
| | - Luc Mouthon
- National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, AP-HP, and Université Paris Descartes, Paris, France
| | - Loïc Guillevin
- National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, AP-HP, and Université Paris Descartes, Paris, France
| | - Benjamin Terrier
- National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, AP-HP, and Université Paris Descartes, Paris, France
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Regnier E, Grange PA, Ollagnier G, Crickx E, Elie L, Chouzenoux S, Weill B, Plainvert C, Poyart C, Batteux F, Dupin N. Superoxide anions produced by Streptococcus pyogenes group A-stimulated keratinocytes are responsible for cellular necrosis and bacterial growth inhibition. Innate Immun 2015; 22:113-23. [PMID: 26621818 DOI: 10.1177/1753425915619476] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 07/09/2015] [Accepted: 10/28/2015] [Indexed: 11/15/2022] Open
Abstract
Gram-positive Streptococcus pyogenes (group A Streptococcus or GAS) is a major skin pathogen and interacts with keratinocytes in cutaneous tissues. GAS can cause diverse suppurative and inflammatory infections, such as cellulitis, a common acute bacterial dermo-hypodermitis with a high morbidity. Bacterial isolation yields from the lesions are low despite the strong local inflammation observed, raising numerous questions about the pathogenesis of the infection. Using an in vitro model of GAS-infected keratinocytes, we show that the major ROS produced is the superoxide anion ([Formula: see text]), and that its production is time- and dose-dependent. Using specific modulators of ROS production, we show that [Formula: see text] is mainly synthesized by the cytoplasmic NADPH oxidase. Superoxide anion production leads to keratinocyte necrosis but incomplete inhibition of GAS growth, suggesting that GAS may be partially resistant to the oxidative burst. In conclusion, GAS-stimulated keratinocytes are able to develop an innate immune response based on the production of ROS. This local immune response limits GAS development and induces keratinocyte cell death, resulting in the skin lesions observed in patients with cellulitis.
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Affiliation(s)
- Elodie Regnier
- Institut Cochin, INSERM U1016, Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Philippe A Grange
- Institut Cochin, INSERM U1016, Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Guillaume Ollagnier
- Institut Cochin, INSERM U1016, Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Etienne Crickx
- Institut Cochin, INSERM U1016, Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Laetitia Elie
- Institut Cochin, INSERM U1016, Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Sandrine Chouzenoux
- Institut Cochin, INSERM U1016, Faculté de Médecine, Université Paris Descartes, Paris, France Service d'Immunologie Biologique, Hôpital Cochin-Pavillon Achard, Paris, France
| | - Bernard Weill
- Institut Cochin, INSERM U1016, Faculté de Médecine, Université Paris Descartes, Paris, France Service d'Immunologie Biologique, Hôpital Cochin-Pavillon Achard, Paris, France
| | - Céline Plainvert
- Institut Cochin, INSERM U1016, Faculté de Médecine, Université Paris Descartes, Paris, France Service de Bactériologie, Centre National de Référence des Streptocoques, Groupe Hospitalier Paris Centre Cochin-Hôtel Dieu-Broca, Paris, France
| | - Claire Poyart
- Institut Cochin, INSERM U1016, Faculté de Médecine, Université Paris Descartes, Paris, France Service de Bactériologie, Centre National de Référence des Streptocoques, Groupe Hospitalier Paris Centre Cochin-Hôtel Dieu-Broca, Paris, France
| | - Frédéric Batteux
- Institut Cochin, INSERM U1016, Faculté de Médecine, Université Paris Descartes, Paris, France Service d'Immunologie Biologique, Hôpital Cochin-Pavillon Achard, Paris, France
| | - Nicolas Dupin
- Institut Cochin, INSERM U1016, Faculté de Médecine, Université Paris Descartes, Paris, France Service de Dermatologie-Vénéréologie, Hôpital Cochin-Pavillon Tarnier, Paris, France
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Crickx E, Saussine A, Vignon-Pennamen MD, Cordoliani F, Mouly F, Bagot M, Rybojad M. Diffuse dermal angiomatosis associated with severe atherosclerosis: two cases and review of the literature. Clin Exp Dermatol 2015; 40:521-4. [DOI: 10.1111/ced.12565] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2014] [Indexed: 11/30/2022]
Affiliation(s)
- E. Crickx
- Department of Dermatology; Université Paris-Diderot; Assistance Publique-Hôpitaux de Paris; Hôpital Saint Louis; Paris France
| | - A. Saussine
- Department of Dermatology; Université Paris-Diderot; Assistance Publique-Hôpitaux de Paris; Hôpital Saint Louis; Paris France
| | - M. D. Vignon-Pennamen
- Department of Pathology; Université Paris-Diderot; Assistance Publique-Hôpitaux de Paris; Hôpital Saint Louis; Paris France
| | - F. Cordoliani
- Department of Dermatology; Université Paris-Diderot; Assistance Publique-Hôpitaux de Paris; Hôpital Saint Louis; Paris France
| | - F. Mouly
- Department of Dermatology; Université Paris-Diderot; Assistance Publique-Hôpitaux de Paris; Hôpital Saint Louis; Paris France
| | - M. Bagot
- Department of Dermatology; Université Paris-Diderot; Assistance Publique-Hôpitaux de Paris; Hôpital Saint Louis; Paris France
| | - M. Rybojad
- Department of Dermatology; Université Paris-Diderot; Assistance Publique-Hôpitaux de Paris; Hôpital Saint Louis; Paris France
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London J, Grados A, Fermé C, Charmillon A, Maurier F, Deau B, Crickx E, Brice P, Chapelon-Abric C, Haioun C, Burroni B, Alifano M, Le Jeunne C, Guillevin L, Costedoat-Chalumeau N, Schleinitz N, Mouthon L, Terrier B. Sarcoidosis occurring after lymphoma: report of 14 patients and review of the literature. Medicine (Baltimore) 2014; 93:e121. [PMID: 25380084 PMCID: PMC4616278 DOI: 10.1097/md.0000000000000121] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Sarcoidosis is a granulomatous disease that most frequently affects the lungs with pulmonary infiltrates and/or bilateral hilar and mediastinal lymphadenopathy. An association of sarcoidosis and lymphoproliferative disease has previously been reported as the sarcoidosis-lymphoma syndrome. Although this syndrome is characterized by sarcoidosis preceding lymphoma, very few cases of sarcoidosis following lymphoma have been reported. We describe the clinical, biological, and radiological characteristics and outcome of 39 patients presenting with sarcoidosis following lymphoproliferative disease, including 14 previously unreported cases and 25 additional patients, after performing a literature review. Hodgkin lymphoma and non-Hodgkin lymphoma were equally represented. The median delay between lymphoma and sarcoidosis was 18 months. Only 16 patients (41%) required treatment. Sarcoidosis was of mild intensity or self-healing in most cases, and overall clinical response to sarcoidosis was excellent with complete clinical response in 91% of patients. Sarcoidosis was identified after a follow-up computerized tomography scan (CT-scan) or fluorodeoxyglucose-positron emission tomography/computerized tomography (FDG-PET/CT) evaluation in 18/34 patients (53%). Sarcoidosis is therefore a differential diagnosis to consider when lymphoma relapse is suspected on a CT-scan or FDG-PET/CT, emphasizing the necessity to rely on histological confirmation of lymphoma relapse.
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Affiliation(s)
- Jonathan London
- Department of Internal Medicine (JL, CLL, LG, NC-C, LM, BT), National Referral Center for Rare Systemic and Autoimmune Diseases; Department of Hematology (BD), Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes; Department of Hematology (EC); Department of Internal Medicine (CC-A), Pitié-Salpêtrière Hospital, AP-HP; Department of Onco-Hematology (PB), Saint-Louis Hospital, AP-HP; Department of Pathology (BB), Hôtel-Dieu Hospital, AP-HP; Department of Thoracic Surgery (MA), Cochin Hospital, AP-HP, Paris; Department of Internal Medicine (AC, FM), Belle Isle Hospital, Metz; Department of Internal Medicine (AG, NS), CHU Conception, Assistance Publique-Hôpitaux de Marseille, Marseille; Department of Medicine (CF), Gustave Roussy, Villejuif; and Lymphoid Malignancies Unit (CH), Henri Mondor Hospital, AP-HP, Créteil, France
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Crickx E, Buffet P, Caumes E, Jaureguiberry S. A Mauritanian Woman With a Swollen Knee. Clin Infect Dis 2013. [DOI: 10.1093/cid/cit515] [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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Crickx E, Buffet P, Caumes É, Jauréguiberry S. Photo quiz. A Mauritanian woman with a swollen knee. Clin Infect Dis 2013; 57:1308, 1362. [PMID: 24106227 DOI: 10.1093/cid/cit519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Affiliation(s)
- Cecilia Szekeres
- AP-HP, Lariboisière Hosp, Department of Neurology, F-75475 Paris, France
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Crickx E, Wittnebel S, Pasquier F, Danu A, Bourhis JH, Ribrag V, Boué F, Miceli C, Mariette X, Moreau P, Botton SD, Ghez D. Dissociated responses to newer antimyeloma drugs identify a subset of refractory patients with an extremely poor prognosis. Eur J Cancer 2012; 49:411-5. [PMID: 22980726 DOI: 10.1016/j.ejca.2012.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 08/07/2012] [Accepted: 08/14/2012] [Indexed: 11/28/2022]
Abstract
We describe the striking and unexpected evolution of 10 patients with de novo multiple myeloma treated with novel-agent based induction therapy, who displayed a dissociated evolution characterised by an apparent good response contrasting with the concomitant development of aggressive non-secreting plasmocytomas immediately before, or just after, autologous stem cell transplantation. Patients did not respond to salvage therapies. Eight of them died from progression less than 12 months after diagnosis. This unusual evolution in the era of novel agents warrants further scrutiny.
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Affiliation(s)
- Etienne Crickx
- Rheumatology Department, Hôpital du Kremlin Bicetre, 94275 Le Kremlin-Bicêtre Cedex, France
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Crickx E, Veyrie C, Bouilloud F, Marroun I, Schoindre Y, Ackermann F, Piette AM, Bletry O, Kahn JE. Polyarthrite induite par les inhibiteurs de dipeptidylpeptidase 4 : à propos de trois cas. Rev Med Interne 2011. [DOI: 10.1016/j.revmed.2011.10.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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