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Fischer K, Lassila R, Peyvandi F, Gatt A, Hollingsworth R, Lambert T, Kaczmarek R, Bettle A, Samji N, Rivard GÉ, Carcao M, Iorio A, Makris M. Inhibitor development according to concentrate in severe hemophilia: reporting on 1392 Previously Untreated Patients from Europe and Canada. Res Pract Thromb Haemost 2023; 7:102265. [PMID: 38193044 PMCID: PMC10772871 DOI: 10.1016/j.rpth.2023.102265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/01/2023] [Accepted: 10/09/2023] [Indexed: 01/10/2024] Open
Abstract
Background Clotting factor concentrates have been the mainstay of severe hemophilia treatment over the last 50 years. Differences in risk of neutralizing antibody (inhibitor) formation according to concentrate used remain clinically relevant. Objectives To assess inhibitor development according to type of clotting factor concentrate in previously untreated patients (PUPs) with severe hemophilia A and B. Methods The European Haemophilia Safety Surveillance (EUHASS) and Canadian Bleeding Disorders Registry (CBDR) have been monitoring adverse events overall and according to concentrate for 11 and 8 years, respectively. Inhibitors were reported quarterly, and PUPs completed 50 exposure days without inhibitor development annually. Cumulative inhibitor incidences and 95% confidence intervals (CIs) were compared without adjustment for other risk factors. Results Fifty-six European and 23 Canadian centers reported inhibitor development in 312 of 1219 (26%; CI, 23%-28%) PUPs with severe hemophilia A and 14 of 173 (8%; CI, 5%-13%) PUPs with severe hemophilia B. Inhibitor development was lower on plasma-derived factor (F)VIII (pdFVIII, 20%; CI, 14%-26%) than on standard half-life recombinant FVIII (SHL-rFVIII, 27%; CI, 24%-30% and odds ratio, 0.67; CI, 0.45%-0.98%; P = .04). Extended half-life recombinant FVIII (EHL-rFVIII, 22%; CI, 12%-36%) showed an intermediate inhibitor rate, while inhibitor rates for Advate (26%; CI, 22%-31%) and Kogenate/Helixate (30%; CI, 24%-36%) overlapped. For other SHL-rFVIII concentrates, inhibitor rates varied from 3% to 43%. Inhibitor development was similar for pdFIX (11%; CI, 3%-25%), SHL-rFIX (8%; CI, 3%-15%), and EHL-rFIX (7%; CI, 1%-22%). Conclusion While confirming expected rates of inhibitors in PUPs, inhibitor development was lower in pdFVIII than in SHL-rFVIII. Preliminary data suggest variation in inhibitor development among different SHL-rFVIII and EHL-rFVIII concentrates.
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Affiliation(s)
- Kathelijn Fischer
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Riitta Lassila
- Department of Hematology, Unit of Coagulation Disorders, Helsinki University Central Hospital, Helsinki, Finland
| | - Flora Peyvandi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Centre, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | | | | | | - Radek Kaczmarek
- Coagulation Products Safety Supply and Access Committee, World Federation of Hemophilia, Montreal, Quebec, Canada
- Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Nasrin Samji
- Department of Pediatrics, Division of Hematology-Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Georges-Étienne Rivard
- Department of Pediatrics, Division of Hematology-Oncology, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Manuel Carcao
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alfonso Iorio
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Toronto, Ontario, Canada
| | - Mike Makris
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - EUHASS and CHESS participants
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
- Department of Hematology, Unit of Coagulation Disorders, Helsinki University Central Hospital, Helsinki, Finland
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Centre, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Mater Dei Hospital, Tal-QRoqq, Msida, Malta
- MDSAS, Manchester, United Kingdom
- Hopital Bicetre, Paris, France
- Coagulation Products Safety Supply and Access Committee, World Federation of Hemophilia, Montreal, Quebec, Canada
- Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana, USA
- IWK Health Centre, Halifax, Nova Scotia, Canada
- Department of Pediatrics, Division of Hematology-Oncology, McMaster University, Hamilton, Ontario, Canada
- Department of Pediatrics, Division of Hematology-Oncology, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Toronto, Ontario, Canada
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
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2
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Dubé E, Merlen C, Bonnefoy A, Pilon J, Zourikian N, Gauthier J, St-Louis J, Rivard GÉ. Switching to emicizumab: A prospective surveillance study in haemophilia A subjects with inhibitors. Haemophilia 2023; 29:348-351. [PMID: 36315386 DOI: 10.1111/hae.14685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 11/04/2022]
Affiliation(s)
| | | | | | | | | | | | - Jean St-Louis
- CHU Sainte-Justine, Montréal, Canada.,Hôpital Maisonneuve-Rosemont, Montréal, Canada
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3
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Dubé E, Merlen C, Bonnefoy A, Gauthier J, Castilloux JF, Charlebois J, Cloutier S, Demers C, Sabapathy CA, St-Louis J, Vézina C, Warner M, Rivard GÉ. Evaluation of anti-factor VIII antibodies in haemophilia A subjects switching products following a provincial tender. Haemophilia 2021; 28:e1-e4. [PMID: 34766421 DOI: 10.1111/hae.14434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/21/2021] [Accepted: 09/30/2021] [Indexed: 12/23/2022]
Affiliation(s)
- Evemie Dubé
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, Canada
| | - Clémence Merlen
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, Canada
| | - Arnaud Bonnefoy
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, Canada
| | - Julie Gauthier
- Molecular Diagnostic Laboratory, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Canada.,Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Canada
| | | | - Janie Charlebois
- Centre Hospitalier Universitaire de Sherbrooke, Université Sherbrooke, Canada
| | - Stéphanie Cloutier
- Hôpital de l'Enfant Jésus, Centre Hospitalier Universitaire de Québec, Québec, Canada
| | - Christine Demers
- Hôpital de l'Enfant Jésus, Centre Hospitalier Universitaire de Québec, Québec, Canada
| | | | - Jean St-Louis
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, Canada.,Hôpital Maisonneuve-Rosemont, Montréal, Canada
| | - Catherine Vézina
- Montreal Children's Hospital, McGill University Health Center, Montréal, Canada
| | - Margaret Warner
- Montreal Children's Hospital, McGill University Health Center, Montréal, Canada
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4
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Amid A, Perkins H, Gauthier J, Bonnefoy A, Carcao M, Rivard GÉ, Klaassen RJ. Immune tolerance induction using Fc-fusion-protein recombinant factor IX in severe haemophilia B. Haemophilia 2021; 27:e776-e779. [PMID: 34599780 DOI: 10.1111/hae.14424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 09/08/2021] [Accepted: 09/19/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Ali Amid
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Heather Perkins
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Julie Gauthier
- Molecular Diagnostic Laboratory, CHU Sainte-Justine, Montreal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montreal, Québec, Canada
| | - Arnaud Bonnefoy
- Department of Pediatrics, Université de Montréal, Montreal, Québec, Canada.,Division of Hematology/Oncology, Montreal, Québec, Canada
| | - Manuel Carcao
- Division of Haematology/Oncology, Hospital for Sick Children (SickKids), Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Ontario, Canada
| | - Georges-Étienne Rivard
- Department of Pediatrics, Université de Montréal, Montreal, Québec, Canada.,Division of Hematology/Oncology, Montreal, Québec, Canada
| | - Robert J Klaassen
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
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5
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Dubé E, Merlen C, Bonnefoy A, Gauthier J, Castilloux JF, Cloutier S, Demers C, Sabapathy CA, St-Louis J, Vézina C, Warner M, Rivard GÉ. A prospective surveillance study in haemophilia B patients following a population switch to recombinant factor IX (nonacog gamma). Haemophilia 2021; 27:e530-e533. [PMID: 33555068 DOI: 10.1111/hae.14273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 01/08/2021] [Accepted: 01/27/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Evemie Dubé
- Division of Hematology-Oncology, Department of Pediatrics, CHU Sainte-Justine, Montréal, QC, Canada
| | - Clémence Merlen
- Division of Hematology-Oncology, Department of Pediatrics, CHU Sainte-Justine, Montréal, QC, Canada
| | - Arnaud Bonnefoy
- Division of Hematology-Oncology, Department of Pediatrics, CHU Sainte-Justine, Montréal, QC, Canada
| | - Julie Gauthier
- Molecular Diagnostic Laboratory, CHU Sainte-Justine, Montréal, QC, Canada.,Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | | | | | | | | | - Jean St-Louis
- Division of Hematology-Oncology, Department of Pediatrics, CHU Sainte-Justine, Montréal, QC, Canada.,Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada
| | - Catherine Vézina
- Montreal Children's Hospital, McGill University Health Center, Montréal, QC, Canada
| | - Margaret Warner
- Montreal Children's Hospital, McGill University Health Center, Montréal, QC, Canada
| | - Georges-Étienne Rivard
- Division of Hematology-Oncology, Department of Pediatrics, CHU Sainte-Justine, Montréal, QC, Canada
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Menkovic I, Boutin M, Alayoubi A, Mercier FE, Rivard GÉ, Auray-Blais C. Identification of a Reliable Biomarker Profile for the Diagnosis of Gaucher Disease Type 1 Patients Using a Mass Spectrometry-Based Metabolomic Approach. Int J Mol Sci 2020; 21:ijms21217869. [PMID: 33114153 PMCID: PMC7660648 DOI: 10.3390/ijms21217869] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/05/2020] [Accepted: 10/20/2020] [Indexed: 12/14/2022] Open
Abstract
Gaucher disease (GD) is a rare autosomal recessive multisystemic lysosomal storage disorder presenting a marked phenotypic and genotypic variability. GD is caused by a deficiency in the glucocerebrosidase enzyme. The diagnosis of GD remains challenging because of the large clinical spectrum associated with the disease. Moreover, GD biomarkers are often not sensitive enough and can be subject to polymorphic variations. The main objective of this study was to perform a metabolomic study using an ultra-performance liquid chromatography system coupled to a time-of-flight mass spectrometer to identify novel GD biomarkers. Following the analysis of plasma samples from patients with GD, and age- and gender-matched control samples, supervised statistical analyses were used to find the best molecules to differentiate the two groups. Targeted biomarkers were structurally elucidated using accurate mass measurements and tandem mass spectrometry. This metabolomic study was successful in highlighting seven biomarkers associated with GD. Fragmentation tests revealed that these latter biomarkers were lyso-Gb1 (glucosylsphingosine) and four related analogs (with the following modifications on the sphingosine moiety: -C2H4, -H2, -H2+O, and +H2O), sphingosylphosphorylcholine, and N-palmitoyl-O-phosphocholineserine. Based on the plasma biomarker distribution, we suggest the evaluation of this GD biomarker profile, which might facilitate early diagnosis, monitoring, and follow-up of patients.
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Affiliation(s)
- Iskren Menkovic
- Division of Medical Genetics, Department of Pediatrics, Centre de Recherche-CHUS, Faculty of Medicine and Health Sciences, Université de Sherbrooke, CIUSSS de l’Estrie-CHUS, 3001, 12th Avenue North, Sherbrooke, QC J1H 5N4, Canada; (I.M.); (M.B.)
| | - Michel Boutin
- Division of Medical Genetics, Department of Pediatrics, Centre de Recherche-CHUS, Faculty of Medicine and Health Sciences, Université de Sherbrooke, CIUSSS de l’Estrie-CHUS, 3001, 12th Avenue North, Sherbrooke, QC J1H 5N4, Canada; (I.M.); (M.B.)
| | - Abdulfatah Alayoubi
- Divisions of Experimental Medicine and Hematology, Department of Medicine, Faculty of Medicine, McGill University, Lady Davis Institute for Medical Research, Jewish General Hospital, 3755, Côte Sainte-Catherine, Montreal, QC H3T 1E2, Canada; (A.A.); (F.E.M.)
- Department of Biochemistry and Molecular Medicine, College of Medicine, Taibah University, University Road, Madinah 42353, Saudi Arabia
| | - François E. Mercier
- Divisions of Experimental Medicine and Hematology, Department of Medicine, Faculty of Medicine, McGill University, Lady Davis Institute for Medical Research, Jewish General Hospital, 3755, Côte Sainte-Catherine, Montreal, QC H3T 1E2, Canada; (A.A.); (F.E.M.)
| | - Georges-Étienne Rivard
- Division of Hemato-Oncology, Department of Pediatrics, Faculty of Medicine, Centre Hospitalier Universitaire Sainte-Justine, 3175, Côte Sainte-Catherine, Montreal, QC H3T 1C5, Canada;
| | - Christiane Auray-Blais
- Division of Medical Genetics, Department of Pediatrics, Centre de Recherche-CHUS, Faculty of Medicine and Health Sciences, Université de Sherbrooke, CIUSSS de l’Estrie-CHUS, 3001, 12th Avenue North, Sherbrooke, QC J1H 5N4, Canada; (I.M.); (M.B.)
- Correspondence:
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7
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Marceau F, Bachelard H, Rivard GÉ, Hébert J. Increased fibrinolysis-induced bradykinin formation in hereditary angioedema confirmed using stored plasma and biotechnological inhibitors. BMC Res Notes 2019; 12:291. [PMID: 31133046 PMCID: PMC6537381 DOI: 10.1186/s13104-019-4335-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/22/2019] [Indexed: 12/25/2022] Open
Abstract
Objective We recently investigated the pathways of immunoreactive bradykinin (iBK) formation in fresh blood of normal volunteers and of patients with hereditary angioedema due to C1-esterase inhibitor deficiency (HAE-1/-2). Herein, we adapted the techniques to small volumes (200 μl) of previously frozen citrated plasma and further analyzed the mechanisms of iBK formation with additional biotechnological inhibitors. Results Measurable iBK formation was observed under stimulation with tissue kallikrein (KLK-1, 10 nM), the particulate material Kontact-APTT (concentration reduced to 2% v/v) or recombinant tissue plasminogen activator (tPA, 169 nM), with little background in unstimulated plasma incubated for up to 2 h. Plasma samples from HAE-1/-2 patients responded earlier to tPA than those from controls, as previously reported with whole blood. Lanadelumab inhibited iBK formation induced by Kontact-APTT and tPA. A highly specific plasmin inhibitor, DX-1000, abolished tPA-induced iBK formation in plasma but had no effect against Kontact-APTT, confirming the role of fibrinolysis in tPA-induced kinin formation. The anti-lanadelumab neutralizing antibody M293-D02 reversed the inhibitory effects of lanadelumab. Frozen plasma is a suitable material for measuring iBK formation kinetics, with possible applications such as investigating the effect of rare disease states on the kallikrein–kinin system and monitoring the effect of HAE prophylactic treatments. Electronic supplementary material The online version of this article (10.1186/s13104-019-4335-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- François Marceau
- Axe Microbiologie-Infectiologie et Immunologie, CHU de Québec-Université Laval, Quebec, QC, G1V 4G2, Canada.
| | - Hélène Bachelard
- Axe Endocrinologie et Néphrologie, CHU de Québec-Université Laval, Quebec, QC, G1V 4G2, Canada
| | | | - Jacques Hébert
- Service d'allergie, CHU de Québec-Université Laval, Quebec, QC, G1V 4G2, Canada
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8
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Charest-Morin X, Betschel S, Borici-Mazi R, Kanani A, Lacuesta G, Rivard GÉ, Wagner E, Wasserman S, Yang B, Drouet C. The diagnosis of hereditary angioedema with C1 inhibitor deficiency: a survey of Canadian physicians and laboratories. Allergy Asthma Clin Immunol 2018; 14:83. [PMID: 30479631 PMCID: PMC6249925 DOI: 10.1186/s13223-018-0307-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 05/22/2018] [Accepted: 11/10/2018] [Indexed: 12/20/2022] Open
Abstract
Background Hereditary angioedema due to C1 inhibitor deficiency (C1-INH-HAE) is an autosomal dominant disease resulting in random and unpredictable attacks of swelling. The swelling in C1-INH-HAE is a result of impaired regulation of bradykinin production. The fact that the array of tests needed to diagnose HAE is not always available to the treating physicians is challenging for them and their patients. Methods The data for this article were extracted from two distinct surveys. The first survey was conducted among HAE treating physicians and aimed to determine the availability and utilization of the various assays performed to help the diagnosis of C1-INH-HAE. The second survey was conducted with the various laboratories across Canada that performs the assays used in the diagnosis of HAE. The aim of this survey was to determine the availability and profile of the various assays used in the diagnosis of C1-INH-HAE in Canada, thereby ultimately bringing a rational basis for the biological testing. Results C1-INH functional assay was widely available in Canada (93%), but was only offered by a small numbers of hospitals meaning that there could be longer delays in the analysis of these samples that may explain why the physicians expressed a lower level of confidence in this assay (59%). Antigenic C1-INH was available to the vast majority of the physicians treating C1-INH-HAE (93%) and was considered reliable by 96% of the respondents. Antigenic C4 was found available to all Canadian physicians and, although with limited specificity, was considered very reliable by all the participants. This study revealed that 81% of physicians were able to order the antigenic C1q and the confidence in this assay was moderate (70%). Concerning genetic testing, the survey revealed that most of the CHAEN members never had to or couldn't order this test. Conclusion This study highlights the need for improved education and knowledge exchange, about biological assays available to Canadian physicians and their performance in proper diagnosis of C1-INH-HAE to improve confidence and access to relevant tests.
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Affiliation(s)
- Xavier Charest-Morin
- 1Department of Microbiology-Infectious Disease and Immunology, Laval University, Quebec, QC Canada
| | - Stephen Betschel
- 2Division of Clinical Immunology and Allergy, St. Michael's Hospital, University of Toronto, Toronto, ON Canada
| | - Rozita Borici-Mazi
- 3Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Canada
| | - Amin Kanani
- 4Division of Allergy and Immunology, Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Gina Lacuesta
- 5Department of Medicine, Dalhousie University, Halifax, NS Canada
| | - Georges-Étienne Rivard
- 6Hematology/Oncology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC Canada
| | - Eric Wagner
- 7Immunology and Histocompatibility Laboratory, CHU de Quebec, Laval University, Quebec, QC Canada
| | - Susan Wasserman
- 8Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Bill Yang
- 9University of Ottawa Medical School, Ottawa, ON Canada
| | - Christian Drouet
- 10GREPI EA7408, University Grenoble Alpes, Grenoble, France.,Filière de santé Maladies Rares Immuno-Hématologiques (MaRIH), CHU Grenoble Alpes, Grenoble, France.,12Present Address: INSERM U1016, Institut Cochin and Laboratoire d'Immunologie, Hôpital Cochin, AP-HP, Université Paris-Descartes, Paris, France
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9
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Abstract
Acquired hemophilia A (AHA) is a rare acquired bleeding disorder caused by autoantibodies against autologous factor VIII (FVIII). It is a disease that most commonly affects the elderly, but it has been described in children and during the post-partum period. It is idiopathic in 50% of cases and is associated with autoimmune disease, malignancy, pregnancy, infection or certain medications in the other 50%. The diagnosis should be suspected in patients with an isolated prolonged aPPT without previous personal or familial bleeding history. Treating the bleeding and eradication of the inhibitor is the mainstay of treatment. The first line of treatment for acute bleeding is the use of bypassing agents. The most commonly used method for eradicating the inhibitor is immunosuppression, namely corticosteroids alone or in combination with cyclophosphamide. This review summarises current knowledge and reviews management options and guidelines.
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Affiliation(s)
- Janie Charlebois
- Division of Hematology/Oncology, Centre Hospitalier Universitaire Sainte-Justine, Department of Pediatrics, Université de Montréal, Montréal, Qc, Canada
| | - Georges-Étienne Rivard
- Division of Hematology/Oncology, Centre Hospitalier Universitaire Sainte-Justine, Department of Pediatrics, Université de Montréal, Montréal, Qc, Canada
| | - Jean St-Louis
- Division of Hematology/Oncology, Hôpital Maisonneuve-Rosemont, Department of Medicine, Université de Montréal, Montréal, Qc, Canada.
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10
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Charest-Morin X, Hébert J, Rivard GÉ, Bonnefoy A, Wagner E, Marceau F. Comparing Pathways of Bradykinin Formation in Whole Blood From Healthy Volunteers and Patients With Hereditary Angioedema Due to C1 Inhibitor Deficiency. Front Immunol 2018; 9:2183. [PMID: 30333824 PMCID: PMC6176197 DOI: 10.3389/fimmu.2018.02183] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 09/04/2018] [Indexed: 12/26/2022] Open
Abstract
Multiple pathways have been proposed to generate bradykinin (BK)-related peptides from blood. We applied various forms of activation to fresh blood obtained from 10 healthy subjects or 10 patients with hereditary angioedema (HAE-1 or −2 only) to investigate kinin formation. An enzyme immunoassay for BK was applied to extracts of citrated blood incubated at 37°C under gentle agitation for 0–2 h in the presence of activators and/or inhibitory agents. Biologically active kinins in extracts were corroborated by c-Fos accumulation in HEK 293a cells that express either recombinant human B2 or B1 receptors (B2R, B1R). Biological evidence of HAE diagnostic and blood cell activation was also obtained. The angiotensin converting enzyme inhibitor enalaprilat, without any effect per se, increased immunoreactive BK (iBK) concentration under active stimulation of blood. Tissue kallikrein (KLK-1) and Kontact-APTT, a particulate material that activates the contact system, rapidly (5 min) and intensely (>100 ng/mL) induced similar iBK generation in the blood of control or HAE subjects. Tissue plasminogen activator (tPA) slowly (≥1 h) induced iBK generation in control blood, but more rapidly and intensely so in that of HAE patients. Effects of biotechnological inhibitors indicate that tPA recruits factor XIIa (FXIIa) and plasma kallikrein to generate iBK. KLK-1, independent of the contact system, is the only stimulus leading to an inconsistent B1R stimulation. Stimulating neutrophils or platelets did not generate iBK. In the HAE patients observed during remission, iBK formation capability coupled to B2R stimulation appears largely intact. However, a selective hypersensitivity to tPA in the blood of HAE patients suggests a role of plasmin-activated FXIIa in the development of attacks. Proposed pathways of kinin formation dependent on blood cell activation were not corroborated.
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Affiliation(s)
- Xavier Charest-Morin
- Axe Microbiologie-Infectiologie et Immunologie, CHU de Québec-Université Laval, Québec, QC, Canada
| | - Jacques Hébert
- Service d'allergie, CHU de Québec-Université Laval, Québec, QC, Canada
| | | | - Arnaud Bonnefoy
- Division of Hematology/Oncology, CHU Sainte-Justine, Montréal, QC, Canada
| | - Eric Wagner
- Axe Microbiologie-Infectiologie et Immunologie, CHU de Québec-Université Laval, Québec, QC, Canada
| | - François Marceau
- Axe Microbiologie-Infectiologie et Immunologie, CHU de Québec-Université Laval, Québec, QC, Canada
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11
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Bitzan M, Hammad RM, Bonnefoy A, Al Dhaheri WS, Vézina C, Rivard GÉ. Acquired thrombotic thrombocytopenic purpura with isolated CFHR3/1 deletion-rapid remission following complement blockade. Pediatr Nephrol 2018; 33:1437-1442. [PMID: 29728803 PMCID: PMC6019431 DOI: 10.1007/s00467-018-3957-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/27/2018] [Accepted: 04/02/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Thrombotic thrombocytopenic purpura (TTP) is caused by the abundance of uncleaved ultralarge von Willebrand factor multimers (ULvWF) due to acquired (autoantibody-mediated) or congenital vWF protease ADAMTS13 deficiency. Current treatment recommendations include plasma exchange therapy and immunosuppression for the acquired form and (fresh) frozen plasma for congenital TTP. CASE-DIAGNOSIS/TREATMENT A previously healthy, 3-year-old boy presented with acute microangiopathic hemolytic anemia, thrombocytopenia, erythrocyturia and mild proteinuria, but normal renal function, and elevated circulating sC5b-9 levels indicating complement activation. He was diagnosed with atypical hemolytic uremic syndrome and treated with a single dose of eculizumab, followed by prompt resolution of all hematological parameters. However, undetectably low plasma ADAMTS13 activity in the pre-treatment sample, associated with inhibitory ADAMTS13 antibodies, subsequently changed the diagnosis to acquired TTP. vWF protease activity normalized within 15 months without further treatment, and the patient remained in long-term clinical and laboratory remission. Extensive laboratory workup revealed a homozygous deletion of CFHR3/1 negative for anti-CFH antibodies, but no mutations of ADAMTS13, (other) alternative pathway of complement regulators or coagulation factors. CONCLUSIONS This case, together with a previous report of a boy with congenital TTP (Pecoraro et al. Am J Kidney Dis 66:1067, 2015), strengthens evolving in-vitro and ex-vivo evidence that ULvWF interferes with complement regulation and contributes to the TTP phenotype. Comprehensive, prospective complement studies in patients with TTP may lead to a better pathophysiological understanding and novel treatment approaches for acquired or congenital forms.
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Affiliation(s)
- Martin Bitzan
- Division of Nephrology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Room B RC.6651, Montreal, Québec, H4A 3J1, Canada.
| | - Rawan M Hammad
- Division of Nephrology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Room B RC.6651, Montreal, Québec, H4A 3J1, Canada
| | - Arnaud Bonnefoy
- Service d'hématologie-oncologie, CHU Sainte-Justine and Université de Montréal, Montréal, Canada
| | - Watfa Shahwan Al Dhaheri
- Division of Nephrology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Room B RC.6651, Montreal, Québec, H4A 3J1, Canada
- Department of Pediatric, Tawam Hospital, Al Ain, United Arab Emirates
| | - Catherine Vézina
- Division of Hematology/Oncology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada
| | - Georges-Étienne Rivard
- Service d'hématologie-oncologie, CHU Sainte-Justine and Université de Montréal, Montréal, Canada
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Bell AD, Hurtig MB, Quenneville E, Rivard GÉ, Hoemann CD. Effect of a Rapidly Degrading Presolidified 10 kDa Chitosan/Blood Implant and Subchondral Marrow Stimulation Surgical Approach on Cartilage Resurfacing in a Sheep Model. Cartilage 2017; 8:417-431. [PMID: 28934884 PMCID: PMC5613897 DOI: 10.1177/1947603516676872] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective This study tested the hypothesis that presolidified chitosan-blood implants are retained in subchondral bone channels perforated in critical-size sheep cartilage defects, and promote bone repair and hyaline-like cartilage resurfacing versus blood implant. Design Cartilage defects (10 × 10 mm) with 3 bone channels (1 drill, 2 Jamshidi biopsy, 2 mm diameter), and 6 small microfracture holes were created bilaterally in n = 11 sheep knee medial condyles. In one knee, 10 kDa chitosan-NaCl/blood implant (presolidified using recombinant factor VIIa or tissue factor), was inserted into each drill and Jamshidi hole. Contralateral knee defects received presolidified whole blood clot. Repair tissues were assessed histologically, biochemically, biomechanically, and by micro-computed tomography after 1 day ( n = 1) and 6 months ( n = 10). Results Day 1 defects showed a 60% loss of subchondral bone plate volume fraction along with extensive subchondral hematoma. Chitosan implant was resident at day 1, but had no effect on any subsequent repair parameter compared with blood implant controls. At 6 months, bone defects exhibited remodeling and hypomineralized bone repair and were partly resurfaced with tissues containing collagen type II and scant collagen type I, 2-fold lower glycosaminoglycan and fibril modulus, and 4.5-fold higher permeability compared with intact cartilage. Microdrill holes elicited higher histological ICRS-II overall assessment scores than Jamshidi holes (50% vs. 30%, P = 0.041). Jamshidi biopsy holes provoked sporadic osteonecrosis in n = 3 debrided condyles. Conclusions Ten kilodalton chitosan was insufficient to improve repair. Microdrilling is a feasible subchondral marrow stimulation surgical approach with the potential to elicit poroelastic tissues with at least half the compressive modulus as intact articular cartilage.
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Affiliation(s)
- Angela D. Bell
- Department of Clinical Studies, University of Guelph, Guelph, Ontario, Canada
| | - Mark B. Hurtig
- Department of Clinical Studies, University of Guelph, Guelph, Ontario, Canada
| | | | | | - Caroline D. Hoemann
- Department of Chemical Engineering, Institute of Biomedical Engineering, Ecole Polytechnique, Montreal, Quebec, Canada,Caroline D. Hoemann, Department of Chemical Engineering, Institute of Biomedical Engineering, École Polytechnique, Montreal, Quebec, H3C 3A7, Canada.
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Jean M, Raghavan A, Charles ML, Robbins MS, Wagner E, Rivard GÉ, Charest-Morin X, Marceau F. The isolated human umbilical vein as a bioassay for kinin-generating proteases: An in vitro model for therapeutic angioedema agents. Life Sci 2016; 155:180-8. [PMID: 27165535 DOI: 10.1016/j.lfs.2016.05.010] [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: 12/15/2015] [Revised: 04/20/2016] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
Abstract
AIMS The isolated human umbilical vein is a robust contractile bioassay for ligands of the bradykinin (BK) B2 receptor (B2R), also extendable to B1 receptor (B1R) pharmacology. We hypothesized that, as a freshly isolated vessel, it also contains traces of plasma proteins that may confer responses to exogenous proteases via the formation of kinins. MAIN METHODS Rings of human umbilical veins were mounted in organ baths containing Krebs buffer maintained at 37°C and purified proteases were introduced in the bathing fluid along with additional drugs/proteins that permit mechanistic analysis of effects. KEY FINDINGS The previously described contractile response to human recombinant tissue kallikrein (KLK-1, 1-10nM) is not influenced by metabolic inhibitors, suggesting its dependence on a preexisting reservoir of low molecular weight-kininogen (LK). Active plasma kallikrein (apK, ≤5nM) was inactive in fresh tissues, unless high molecular weight-kininogen (HK, 39-197nM) replenishment was applied. The effects of KLK-1 and HK+apK are abolished by pretreating tissues with icatibant, but not with tranexamic acid. C1-esterase inhibitor inhibited only HK+apK. Purified plasmin and neutrophil proteinase-3 produced small contractions in the presence of HK only, and tissue plasminogen activator, none. B1R stimulation was pharmacologically evidenced in response to KLK-1 if LK was supplied. SIGNIFICANCE The pharmacology of KLK-1 and HK+apK in the human isolated umbilical vein is essentially based on the activity of locally generated kinins and this assay models the inhibitory action of some therapeutic agents active in angioedema states. Proteases that indirectly generate kinins have little activity in the system.
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Affiliation(s)
- Melissa Jean
- Axe Microbiologie-Infectiologie et Immunologie, CHU de Québec, Faculté de Médecine, Université Laval, Québec, QC G1V 4G2, Canada
| | | | | | - Mark S Robbins
- Tansna Therapeutics, St. Louis, MO 63108, USA; Kodiak Strategic Consultants, LLC, Minneapolis, MN, USA
| | - Eric Wagner
- Axe Microbiologie-Infectiologie et Immunologie, CHU de Québec, Faculté de Médecine, Université Laval, Québec, QC G1V 4G2, Canada
| | | | - Xavier Charest-Morin
- Axe Microbiologie-Infectiologie et Immunologie, CHU de Québec, Faculté de Médecine, Université Laval, Québec, QC G1V 4G2, Canada
| | - François Marceau
- Axe Microbiologie-Infectiologie et Immunologie, CHU de Québec, Faculté de Médecine, Université Laval, Québec, QC G1V 4G2, Canada.
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Provençal M, Berger-Thibault N, Labbé D, Veitch R, Boivin D, Rivard GÉ, Gingras D, Béliveau R. Tissue factor mediates the HGF/Met-induced anti-apoptotic pathway in DAOY medulloblastoma cells. J Neurooncol 2009; 97:365-72. [DOI: 10.1007/s11060-009-0041-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 10/26/2009] [Indexed: 01/05/2023]
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Caron N, Rivard GÉ, Michon N, Morin F, Pilon D, Moutquin JM, Rey É. Low-dose ASA Response Using the PFA-100 in Women With High-risk Pregnancy. Journal of Obstetrics and Gynaecology Canada 2009; 31:1022-1027. [DOI: 10.1016/s1701-2163(16)34346-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [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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