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Jarrot PA, Mirouse A, Ottaviani S, Cadiou S, Salmon JH, Liozon E, Parreau S, Michaud M, Terrier B, Gavand PE, Trefond L, Lavoiepierre V, Keraen J, Rekassa D, Bouldoires B, Weitten T, Roche D, Poulet A, Charpin C, Grobost V, Hermet M, Pallure M, Wackenheim C, Karkowski L, Grumet P, Rogier T, Belkefi N, Pestre V, Broquet E, Leurs A, Gautier S, Gras V, Gilet P, Holubar J, Sivova N, Schleinitz N, Durand JM, Castel B, Petrier A, Arcani R, Gramont B, Guilpain P, Lepidi H, Weiller PJ, Micallef J, Saadoun D, Kaplanski G. Polymyalgia rheumatica and giant cell arteritis following COVID-19 vaccination: Results from a nationwide survey. Hum Vaccin Immunother 2024; 20:2334084. [PMID: 38563792 PMCID: PMC10989707 DOI: 10.1080/21645515.2024.2334084] [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: 01/17/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
We conducted a national in-depth analysis including pharmacovigilance reports and clinical study to assess the reporting rate (RR) and to determine the clinical profile of polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) in COVID-19-vaccinated individuals. First, based on the French pharmacovigilance database, we estimated the RR of PMR and GCA cases in individuals aged over 50 who developed their initial symptoms within one month of receiving the BNT162b2 mRNA, mRNA-1273, ChAdOx1 nCoV-19, and Ad26.COV2.S vaccines. We then conducted a nationwide survey to gather clinical profiles, therapeutic management, and follow-up data from individuals registered in the pharmacovigilance study. A total of 70 854 684 COVID-19 vaccine doses were administered to 25 260 485 adults, among which, 179 cases of PMR (RR 7. 1 cases/1 000 000 persons) and 54 cases of GCA (RR 2. 1 cases/1 000 000 persons) have been reported. The nationwide survey allowed the characterization of 60 PMR and 35 GCA cases. Median time to the onset of first symptoms was 10 (range 2-30) and 7 (range 2-25) days for PMR and GCA, respectively. Phenotype, GCA-related ischemic complications and -large vessel vasculitis as well as therapeutic management and follow-up seemed similar according to the number of vaccine shots received and when compared to the literature data of unvaccinated population. Although rare, the short time between immunization and the onset of first symptoms of PMR and GCA suggests a temporal association. Physician should be aware of this potential vaccine-related phenomenon.
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Affiliation(s)
- Pierre-André Jarrot
- Department of Internal Medicine and Clinical Immunology, Hôpital de La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Centre for Cardiovascular and Nutrition Research (C2VN), INRA 1260, INSERM UMR_S1263, Aix-Marseille University, Marseille, France
| | - Adrien Mirouse
- Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l’Amylose inflammatoire (CEREMAIA), Sorbonne Universités, Paris, France
- INSERM, UMR_S 959 Lab, Immunology, Immunotherapeutics, Paris, France
- DMU 3ID, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Sébastien Ottaviani
- Department of Rheumatology, DMU Locomotion, Hôpital Bichat-Claude Bernard, APHP, Université de Paris, Paris, France
| | - Simon Cadiou
- Department of Rheumatology, CHU de Rennes, Université de Rennes 1, Rennes, France
| | - Jean-Hugues Salmon
- Department of Rheumatology, Hôpital de La Maison Blanche, Université de Reims, Reims, France
| | - Eric Liozon
- Department of Internal Medicine, Hôpital Universitaire de Limoges, Limoges, France
| | - Simon Parreau
- Department of Internal Medicine, Hôpital Universitaire de Limoges, Limoges, France
| | - Martin Michaud
- Department of Internal Medicine, Clinique Saint-Exupery, Toulouse, France
| | - Benjamin Terrier
- National Referral Center for Rare Systemic Autoimmune Disease, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre, Université Paris Cité, Paris, France
| | | | - Ludovic Trefond
- Department of Internal Medicine, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Virginie Lavoiepierre
- Department of Internal Medicine and Clinical Immunology, Hôpital de La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Jeremy Keraen
- Department of Internal Medicine, Hôpital de Cornouaille, Quimper, France
| | - Daniel Rekassa
- Department of Rehabilitation, Centre Thermal, Greoux Les Bains, France
| | | | - Thierry Weitten
- Department of Internal Medicine, Hôpital des Alpes du Sud, Gap, France
| | - Damien Roche
- Department of Rheumatology, Hôpital Saint-Joseph, Marseille, France
| | - Antoine Poulet
- Department of Internal Medicine, Hôpital Saint-Joseph, Marseille, France
| | - Caroline Charpin
- Department of Rheumatology, Hôpital Saint-Joseph, Marseille, France
| | - Vincent Grobost
- Department of Internal Medicine, Hôpital Estaing, Clermont-Ferrand, France
| | - Marion Hermet
- Department of Internal Medicine, Hôpital de Vichy, Vichy, France
| | - Magali Pallure
- Department of Rheumatology, Hôpital de Cannes Simone Veil, Cannes, France
| | - Chloe Wackenheim
- Department of Internal Medicine, Medipole Hôpital Privé, Villeurbanne, France
| | - Ludovic Karkowski
- Department of Internal Medicine, Hôpital d’Instruction des Armées Sainte-Anne, Toulon, France
| | - Pierre Grumet
- Department of Internal Medicine, Hôpital des Alpes du Sud, Gap, France
| | - Thomas Rogier
- Department of Internal Medicine and Systemic Disease, Hôpital François Mitterand, Dijon, France
| | - Nabil Belkefi
- Department of Internal Medicine, CH de Melun, Melun, France
| | - Vincent Pestre
- Department of Internal Medicine and Infectious Disease, CH d’Avignon, Avignon, France
| | | | - Amélie Leurs
- Department of Internal Medicine and Infectious Disease, CH de Dunkerque, Dunkerque, France
| | - Sophie Gautier
- Department of Pharmacology, centre régional de pharmacovigilance Nord Pas de Calais, CHRU de Lille, Lille, France
| | - Valérie Gras
- Department of Clinical Pharmacology, Centre régional de pharmacovigilance, service de pharmacologie clinique, CHU Amiens-Picardie, Amiens, France
| | - Pierre Gilet
- Regional Center of Pharmacovigilance, CHRU de Nancy, Hôpital Central, Nancy, France
| | - Jan Holubar
- Department of Internal Medicine, CHU de Nîmes, Nîmes, France
| | - Nadia Sivova
- Department of Internal Medicine, CH de Tourcoing, Tourcoing, France
| | - Nicolas Schleinitz
- Department of Internal Medicine, Hôpital de La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Jean-Marc Durand
- Department of Internal Medicine, Hôpital de La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Brice Castel
- Department of Internal Medicine, CH de Tarbes, Tarbes, France
| | | | - Robin Arcani
- Department of Internal Medicine and Therapeutics Department, Hôpital de La Timone, Marseille, France
| | - Baptiste Gramont
- Department of Internal Medicine, CHU de Saint-Etienne, Saint-Etienne, France
| | - Philippe Guilpain
- Department of Internal Medicine, CHU Saint-Eloi, Montpellier, France
| | - Hubert Lepidi
- Pathological Laboratory, Hôpital de La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | | | - Joelle Micallef
- Department of Clinical Pharmacology and pharmacosurveillance, Regional Pharmacovigilance Center of Marseille, Hôpital de La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - David Saadoun
- Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l’Amylose inflammatoire (CEREMAIA), Sorbonne Universités, Paris, France
- INSERM, UMR_S 959 Lab, Immunology, Immunotherapeutics, Paris, France
- DMU 3ID, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Gilles Kaplanski
- Department of Internal Medicine and Clinical Immunology, Hôpital de La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Centre for Cardiovascular and Nutrition Research (C2VN), INRA 1260, INSERM UMR_S1263, Aix-Marseille University, Marseille, France
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Muller R, Cauchois R, Lagarde M, Roffino S, Genovesio C, Fernandez S, Hache G, Guillet B, Kara Y, Marlinge M, Lenting PJ, Poullin P, Dignat-George F, Tellier E, Kaplanski G. Mortality, cardiac and cerebral damages reduction by IL-1 inhibition in a murine model of TTP. Blood 2024:blood.2023021974. [PMID: 38598839 DOI: 10.1182/blood.2023021974] [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: 07/27/2023] [Revised: 02/09/2024] [Accepted: 03/09/2024] [Indexed: 04/12/2024] Open
Abstract
Thrombotic thrombocytopenic purpura (TTP), a rare but fatal disease if untreated, is due to alteration in Von Willebrand factor cleavage resulting in capillary microthrombi formation and ischemic organ damage. Interleukin-1 (IL-1), has been shown to drive sterile inflammation following ischemia and could play an essential contribution to post-ischemic organ damage in TTP. Our objectives were to evaluate IL-1 involvement during TTP and to test the efficacy of the recombinant IL-1 receptor antagonist, anakinra, in a murine TTP model. We retrospectively measured plasmatic IL-1 concentrations in TTP patients and controls. TTP patients exhibited elevated plasma IL-1α and β concentrations, which correlated with disease course and survival. In a TTP mouse model, we administered anakinra (IL-1 inhibitor) or placebo for 5 days and evaluated the efficacy of this treatment. Anakinra significantly reduced mortality of mice (P<0.001). Anakinra significantly decreased TTP-induced cardiac damages as assessed by blood troponin concentrations, evaluation of left ventricular function by echocardiography, [18F]FDG PET of myocardial glucose metabolism, and cardiac histology. Anakinra also significantly reduced brain TTP-induced damages, evaluated through blood PS100b concentrations, nuclear imaging and histology. We finally showed that IL-1α and β trigger endothelial degranulation in vitro, leading to the release of Von Willebrand factor. In conclusion, Anakinra significantly reduced TTP mortality in a pre-clinical model of the disease by inhibiting both endothelial degranulation and post-ischemic inflammation, supporting further evaluations in humans.
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Affiliation(s)
- Romain Muller
- French Reference Center for Thrombotic Microangiopathies, France
| | - Raphael Cauchois
- French Reference Center for Thrombotic Microangiopathies, France
| | - Marie Lagarde
- French Reference Center for Thrombotic Microangiopathies, France
| | - Sandrine Roffino
- Aix-Marseille University, CNRS, ISM Inst Movement Sci, Marseille, France, Marseille, France
| | | | | | - Guillaume Hache
- Aix-Marseille University, APHM, INSERM, INRAE, C2VN, CERIMED, CHU Timone, Biology department, Marseille, France, Marseille, France
| | | | - Yeter Kara
- Aix-Marseille University, INSERM, INRAE, C2VN, Marseille, France, Marseille, France
| | - Marion Marlinge
- Aix-Marseille University, APHM, INSERM, INRAE, C2VN, CERIMED, CHU Timone, Biology department, Marseille, France, Marseille, France
| | | | - Pascale Poullin
- 3. French Reference Center for Thrombotic Microangiopathies, France
| | | | - Edwige Tellier
- 2. French Reference Center for Thrombotic Microangiopathies, France
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Bonnez Q, Dekimpe C, Bekaert T, Tellier E, Kaplanski G, Joly BS, Veyradier A, Coppo P, Lammertyn J, Tersteeg C, De Meyer SF, Vanhoorelbeke K. Diagnosis of thrombotic thrombocytopenic purpura: Easy-to-use fiber-optic surface plasmon resonance immunoassays for automated ADAMTS13 antigen and conformation evaluation. J Thromb Haemost 2024:S1538-7836(24)00170-3. [PMID: 38554935 DOI: 10.1016/j.jtha.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/18/2024] [Accepted: 03/18/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Laboratory diagnosis of immune-mediated thrombotic thrombocytopenic purpura (iTTP) remains challenging when ADAMTS13 activity ranges between 10-20%. To prevent misdiagnosis, open ADAMTS13 conformation gained clinical attention as a novel biomarker especially to diagnose acute iTTP in patient with diagnostic undecisive ADAMTS13 activity. Plasma ADAMTS13 conformation analysis corrects for ADAMTS13 antigen with both parameters being characterized in enzyme-linked immunosorbent assay (ELISA)-based reference assays requiring expert technicians. OBJECTIVES To design ADAMTS13 antigen and conformation assays on automated, easy-to-use fiber-optic surface plasmon resonance (FO-SPR) technology to promote assay accessibility and diagnose challenging iTTP patients. PATIENTS/METHODS ADAMTS13 antigen and conformation assays were designed on FO-SPR technology. Plasma of twenty healthy donors and twenty acute iTTP patients were quantified and data from FO-SPR and ELISA reference assays were compared. RESULTS Following assay design, both antigen and conformation FO-SPR assays were optimized and characterized presenting strong analytical sensitivity (detection limit of 0.001 μg/mL) and repeatability (inter-assay variation of 14.4%). Comparative analysis suggests positive correlation (Spearman r of 0.92) and good agreement between FO-SPR and ELISA assays. As expected, FO-SPR assays showed a closed or open ADAMTS13 conformation in healthy donors and acute iTTP patients respectively. CONCLUSIONS Both ADAMTS13 antigen and conformation assays were transferred onto automated, easy-to-use FO-SPR technology displaying potent analytical sensitivity and reproducibility. ADAMTS13 antigen and conformation were determined for healthy donors and acute iTTP patients showing strong correlation with ELISA reference. Introducing FO-SPR technology in clinical context could support routine diagnosis of acute iTTP patients, notably when ADAMTS13 activity fluctuates between 10-20%.
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Affiliation(s)
- Quintijn Bonnez
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Charlotte Dekimpe
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Tim Bekaert
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Edwige Tellier
- Aix-Marseille University, Institut National de la Santé et de la Recherche Médicale, INRAE, C2VN, Marseille, France
| | - Gilles Kaplanski
- Aix-Marseille University, Institut National de la Santé et de la Recherche Médicale, INRAE, C2VN, Marseille, France; Service de Médecine Interne et Immunologie Clinique, CHU Conception, Aix-Marseille University, APHM, Marseille, France
| | - Bérangère S Joly
- Service d'Hématologie Biologique Hôpital Lariboisière, AP-HP and EA3518, IRSL, Université Paris Cité, Paris France
| | - Agnès Veyradier
- Service d'Hématologie Biologique Hôpital Lariboisière, AP-HP and EA3518, IRSL, Université Paris Cité, Paris France; Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT) AP-HP Paris France
| | - Paul Coppo
- Department of Hematology, Reference Center for Thrombotic Microangiopathies (CNR-MAT), Saint-Antoine University Hospital, AP-HP, Paris, France
| | - Jeroen Lammertyn
- Department of Biosystems, Biosensors Group, KU Leuven, Leuven, Belgium
| | - Claudia Tersteeg
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Simon F De Meyer
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium.
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Dol C, Granel B, Resseguier N, Kaplanski G, Reynaud-Gaubert M, Schleinitz N, Grob JJ, Delaporte E, Lafforgue P, Rossi P, Bardin N, Benyamine A. [High anti-topoisomerase-1 autoantibodies levels are associated with the extension of skin fibrosis and vascular progression in patients with systemic sclerosis]. Rev Med Interne 2024; 45:126-131. [PMID: 38355359 DOI: 10.1016/j.revmed.2023.11.006] [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: 03/15/2023] [Revised: 10/29/2023] [Accepted: 11/04/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Anti-centromere antibodies, anti-topoisomerase-1 antibodies (ATA), and anti-RNA-polymerase III antibodies are three Systemic Sclerosis (SSc)-specific autoantibodies. Their detection is helpful in determining the prognosis. We aimed to evaluate whether ATA levels were associated with disease severity at diagnosis or disease progression during follow-up in ATA positive patients. METHODS We conducted a single-centre French retrospective observational study, between 2014 and 2021. ATA positive patients fulfilling the ACR/EULAR 2013 classification criteria for SSc with a minimal follow-up of 1 year and 2 ATA dosages were included. SSc patients with high IgG ATA levels at baseline (>240IU/mL) were compared with SSc patients with low levels (≤240IU/mL), at inclusion and at 1 and 3 years. A variation of at least 30 % of ATA levels was considered significant. RESULTS Fifty-nine SSc patients were included and analysed. There was a predominance of women and of patients with diffuse interstitial lung disease. Patients with high ATA levels exhibited a higher skin sclerosis assessed by the modified Rodnan skin score (P=0.0480). They had a lower carbon monoxide transfer coefficient (P=0.0457), a lower forced vital capacity (FVC) (P=0.0427) and more frequently had a FVC under 80 %, when compared to patients with low ATA levels (P=0.0423). Initial high ATA levels were associated with vascular progression at one year (21.95 % vs. 0 %; P=0.0495). CONCLUSION ATA levels are associated with skin sclerosis and vascular progression in SSc. Beyond the detection of ATA, quantifying this autoantibody might be of interest in predicting disease severity and prognosis in SSc.
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Affiliation(s)
- C Dol
- Service de médecine interne, hôpital Nord, Marseille, Assistance publique des Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13015 Marseille, France
| | - B Granel
- Service de médecine interne, hôpital Nord, Marseille, Assistance publique des Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13015 Marseille, France; Inserm, INRA, C2VN, Aix-Marseille université (AMU), 13005 Marseille, France
| | - N Resseguier
- Épidémiologie et économie de la santé, hôpital de la Timone, AP-HM, Aix-Marseille université (AMU), 13005 Marseille, France
| | - G Kaplanski
- Inserm, INRA, C2VN, Aix-Marseille université (AMU), 13005 Marseille, France; Service de médecine interne et immunologie clinique, hôpital de la Conception, Assistance publique des Hôpitaux de Marseille (AP-HM), 13005 Marseille, France
| | - M Reynaud-Gaubert
- Service de pneumologie, équipe de transplantation pulmonaire, centre de compétences des maladies pulmonaires rares, hôpital Nord, Marseille, Assistance publique des Hôpitaux de Marseille (AP-HM), Aix-Marseille université (AMU), 13015 Marseille, France
| | - N Schleinitz
- Service de médecine interne, hôpital de la Timone, Assistance publique des Hôpitaux de Marseille (AP-HM), 13005 Marseille, France
| | - J-J Grob
- Service de dermatologie, hôpital de la Timone, Assistance publique des Hôpitaux de Marseille (AP-HM), 13005 Marseille, France
| | - E Delaporte
- Service de dermatologie, hôpital Nord, Marseille, Assistance publique des Hôpitaux de Marseille (AP-HM), 13015 Marseille, France
| | - P Lafforgue
- Service de rhumatologie, hôpital Sainte-Marguerite, Assistance publique des Hôpitaux de Marseille (AP-HM), 13009 Marseille, France
| | - P Rossi
- Service de médecine interne, hôpital Nord, Marseille, Assistance publique des Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13015 Marseille, France; Inserm, INRA, C2VN, Aix-Marseille université (AMU), 13005 Marseille, France
| | - N Bardin
- Inserm, INRA, C2VN, Aix-Marseille université (AMU), 13005 Marseille, France; Laboratoire d'immunologie, biogénopole, hôpital de la Timone, Assistance publique des Hôpitaux de Marseille (AP-HM), 13005 Marseille, France
| | - A Benyamine
- Service de médecine interne, hôpital Nord, Marseille, Assistance publique des Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13015 Marseille, France; Inserm, INRA, C2VN, Aix-Marseille université (AMU), 13005 Marseille, France.
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Benyamine A, Poulet A, Belenotti P, Nihous H, Ene N, Jarrot PA, Swiader L, Mancini J, Beaufils N, Essaydi A, Gabert J, Weiller PJ, Kaplanski G. Molecular B-cell clonality assay in minor salivary glands as a useful tool for the lymphoma risk assessment in Sjögren's syndrome. Joint Bone Spine 2023; 91:105686. [PMID: 38161050 DOI: 10.1016/j.jbspin.2023.105686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 11/17/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES Non-Hodgkin's lymphoma (NHL) risk assessment is crucial in Sjögren's syndrome (SS). We studied the prevalence of clonal immunoglobulin gene rearrangements in minor salivary glands (MSG) and their correlations with lymphoma occurrence and with previously established NHL predictors. METHODS Molecular B-cell expansion was studied in fresh-frozen MSG of 207 patients with either suspected SS or with suspected lymphoma during SS, using a standardised multiplex PCR assay combined with heteroduplex analysis by microcapillary electrophoresis. The assignation of clonal cases was based on EuroClonality consortium guidelines. RESULTS Among 207 studied patients, 31 (15%) had MSG monoclonal B-cell infiltration. Monoclonality was significantly more frequent in patients with SS (28/123, 22.8%) compared with patients without SS (3/84, 3.6%, P<0.001). Monoclonal B-cell infiltration in MSG of SS patients correlated significantly with ongoing salivary gland NHL, salivary gland swelling, CD4+ T-cell lymphopenia, rheumatoid factor (RF) activity, low complement levels and type 2 mixed cryoglobulinemia. The accumulation of biological risk factors was associated with a higher rate of MSG B-cell monoclonality given that patients with only positive RF had no probability of MSG B-cell monoclonality, RF-positive patients with 1 or 2 other risk factors had a 25.0% and 85.7% probability of MSG B-cell monoclonality, respectively. CONCLUSION The detection of MSG monoclonal B-cell expansion by this easy-to-perform molecular assay is useful, both at the time of diagnosis and during the course of SS. Monoclonal B-cell expansion is associated with a subset of SS patients presenting either ongoing lymphoma or other established lymphoma predictive factors.
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Affiliation(s)
- Audrey Benyamine
- Service de médecine interne, Aix-Marseille université, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France.
| | - Antoine Poulet
- Service de médecine interne et immunologie clinique, Aix-Marseille université, hôpital de la Conception, AP-HM, 13005 Marseille, France
| | - Pauline Belenotti
- Consultations de médecine interne, hôpital privé Clairval, 13009 Marseille, France
| | - Hugo Nihous
- Laboratoire d'anatomo-cyto-pathologie et de neuropathologie, Aix-Marseille université, hôpital de La Timone, AP-HM, 13005 Marseille, France
| | - Nicoleta Ene
- Département de médecine interne, Aix-Marseille université, hôpital de La Timone, AP-HM, 13005 Marseille, France
| | - Pierre André Jarrot
- Service de médecine interne et immunologie clinique, Aix-Marseille université, hôpital de la Conception, AP-HM, 13005 Marseille, France
| | - Laure Swiader
- Département de médecine interne, Aix-Marseille université, hôpital de La Timone, AP-HM, 13005 Marseille, France
| | - Julien Mancini
- Département de biostatistique et technologies de l'information et de la communication (BioSTIC), Aix-Marseille université, hôpital de La Timone, AP-HM, Inserm, IRD, SESSTIM, 13005 Marseille, France
| | - Nathalie Beaufils
- Laboratoire de biochimie et biologie moléculaire, Aix-Marseille université, hôpital Nord, AP-HM, 13015 Marseille, France
| | - Arnaud Essaydi
- Laboratoire d'histocompatibilité, établissement français du sang Grand Est, Strasbourg, France
| | - Jean Gabert
- Laboratoire de biochimie et biologie moléculaire, Aix-Marseille université, hôpital Nord, AP-HM, 13015 Marseille, France
| | - Pierre Jean Weiller
- Département d'onco-hématologie, institut Paoli-Calmettes, 13009 Marseille, France
| | - Gilles Kaplanski
- Service de médecine interne et immunologie clinique, Aix-Marseille université, hôpital de la Conception, AP-HM, 13005 Marseille, France
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Cambon A, Rebelle C, Bachelier R, Arnaud L, Robert S, Lagarde M, Muller R, Tellier E, Kara Y, Leroyer A, Farnarier C, Vallier L, Chareyre C, Retornaz K, Jurquet AL, Tran TA, Lacroix R, Dignat-George F, Kaplanski G. Macrophage IL-1β-positive microvesicles exhibit thrombo-inflammatory properties and are detectable in patients with active juvenile idiopathic arthritis. Front Immunol 2023; 14:1228122. [PMID: 38077384 PMCID: PMC10703381 DOI: 10.3389/fimmu.2023.1228122] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/27/2023] [Indexed: 12/18/2023] Open
Abstract
Objective IL-1β is a leaderless cytokine with poorly known secretory mechanisms that is barely detectable in serum of patients, including those with an IL-1β-mediated disease such as systemic juvenile idiopathic arthritis (sJIA). Leukocyte microvesicles (MVs) may be a mechanism of IL-1β secretion. The first objective of our study was to characterize IL-1β-positive MVs obtained from macrophage cell culture supernatants and to investigate their biological functions in vitro and in vivo. The second objective was to detect circulating IL-1β-positive MVs in JIA patients. Methods MVs were purified by serial centrifugations from PBMCs, or THP-1 differentiated into macrophages, then stimulated with LPS ± ATP. MV content was analyzed for the presence of IL-1β, NLRP3 inflammasome, caspase-1, P2X7 receptor, and tissue factor (TF) using ELISA, Western blot, or flow cytometry. MV biological properties were studied in vitro by measuring VCAM-1, ICAM-1, and E-selectin expression after HUVEC co-culture and factor-Xa generation test was realized. In vivo, MVs' ability to recruit leukocytes in a murine model of peritonitis was evaluated. Plasmatic IL-1β-positive MVs were studied ex vivo in 10 active JIA patients using flow cytometry. Results THP-1-derived macrophages stimulated with LPS and ATP released MVs, which contained NLRP3, caspase-1, and the 33-kDa precursor and 17-kDa mature forms of IL-1β and bioactive TF. IL-1β-positive MVs expressed P2X7 receptor and released soluble IL-1β in response to ATP stimulation in vitro. In mice, MVs induced a leukocyte peritoneal infiltrate, which was reduced by treatment with the IL-1 receptor antagonist. Finally, IL-1β-positive MVs were detectable in plasma from 10 active JIA patients. Conclusion MVs shed from activated macrophages contain IL-1β, NLRP3 inflammasome components, and TF, and constitute thrombo-inflammatory vectors that can be detected in the plasma from active JIA patients.
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Affiliation(s)
- Audrey Cambon
- Aix-Marseille University, Institut National de la Santé Et de la Recherche Médicale (INSERM), Institut National de la Recherche pour l’Agriculture et l’Environnement (INRAE), Centre de Recherche en CardioVasculaire et Nutrition (C2VN), Marseille, France
- Service de Médecine interne et d’Infectiologie, Hôpital d’Instruction des Armées (HIA) Sainte-Anne, Service de Santé des Armées (SSA), Toulon, France
| | - Charlotte Rebelle
- Aix-Marseille University, Institut National de la Santé Et de la Recherche Médicale (INSERM), Institut National de la Recherche pour l’Agriculture et l’Environnement (INRAE), Centre de Recherche en CardioVasculaire et Nutrition (C2VN), Marseille, France
- Service de Pédiatrie, Assistance Publique des Hôpitaux de Marseille (AP-HM), Hôpital Nord, Marseille, France
| | - Richard Bachelier
- Aix-Marseille University, Institut National de la Santé Et de la Recherche Médicale (INSERM), Institut National de la Recherche pour l’Agriculture et l’Environnement (INRAE), Centre de Recherche en CardioVasculaire et Nutrition (C2VN), Marseille, France
| | - Laurent Arnaud
- Laboratoire d’Hématologie, Assistance Publique des Hôpitaux de Marseille (AP-HM), La Timone, Marseille, France
| | - Stéphane Robert
- Aix-Marseille University, Institut National de la Santé Et de la Recherche Médicale (INSERM), Institut National de la Recherche pour l’Agriculture et l’Environnement (INRAE), Centre de Recherche en CardioVasculaire et Nutrition (C2VN), Marseille, France
| | - Marie Lagarde
- Aix-Marseille University, Institut National de la Santé Et de la Recherche Médicale (INSERM), Institut National de la Recherche pour l’Agriculture et l’Environnement (INRAE), Centre de Recherche en CardioVasculaire et Nutrition (C2VN), Marseille, France
| | - Romain Muller
- Aix-Marseille University, Institut National de la Santé Et de la Recherche Médicale (INSERM), Institut National de la Recherche pour l’Agriculture et l’Environnement (INRAE), Centre de Recherche en CardioVasculaire et Nutrition (C2VN), Marseille, France
- Service de Médecine interne et d’Immunologie clinique, Assistance Publique des Hôpitaux de Marseille (AP-HM), La Conception, Marseille, France
| | - Edwige Tellier
- Aix-Marseille University, Institut National de la Santé Et de la Recherche Médicale (INSERM), Institut National de la Recherche pour l’Agriculture et l’Environnement (INRAE), Centre de Recherche en CardioVasculaire et Nutrition (C2VN), Marseille, France
| | - Yéter Kara
- Aix-Marseille University, Institut National de la Santé Et de la Recherche Médicale (INSERM), Institut National de la Recherche pour l’Agriculture et l’Environnement (INRAE), Centre de Recherche en CardioVasculaire et Nutrition (C2VN), Marseille, France
| | - Aurélie Leroyer
- Aix-Marseille University, Institut National de la Santé Et de la Recherche Médicale (INSERM), Institut National de la Recherche pour l’Agriculture et l’Environnement (INRAE), Centre de Recherche en CardioVasculaire et Nutrition (C2VN), Marseille, France
| | - Catherine Farnarier
- Laboratoire d’Immunologie, Assistance Publique des Hôpitaux de Marseille (AP-HM), La Conception, Marseille, France
| | - Loris Vallier
- Aix-Marseille University, Institut National de la Santé Et de la Recherche Médicale (INSERM), Institut National de la Recherche pour l’Agriculture et l’Environnement (INRAE), Centre de Recherche en CardioVasculaire et Nutrition (C2VN), Marseille, France
| | - Corinne Chareyre
- Aix-Marseille University, Institut National de la Santé Et de la Recherche Médicale (INSERM), Institut National de la Recherche pour l’Agriculture et l’Environnement (INRAE), Centre de Recherche en CardioVasculaire et Nutrition (C2VN), Marseille, France
| | - Karine Retornaz
- Service de Pédiatrie, Assistance Publique des Hôpitaux de Marseille (AP-HM), Hôpital Nord, Marseille, France
| | - Anne-Laure Jurquet
- Service de Pédiatrie, Assistance Publique des Hôpitaux de Marseille (AP-HM), Hôpital Nord, Marseille, France
| | - Tu-Anh Tran
- Service de Pédiatrie, Centre Hospitalo-Universitaire (CHU) Nîmes, Hôpital Carémeau, Nîmes, France
| | - Romaric Lacroix
- Aix-Marseille University, Institut National de la Santé Et de la Recherche Médicale (INSERM), Institut National de la Recherche pour l’Agriculture et l’Environnement (INRAE), Centre de Recherche en CardioVasculaire et Nutrition (C2VN), Marseille, France
- Laboratoire d’Hématologie, Assistance Publique des Hôpitaux de Marseille (AP-HM), La Timone, Marseille, France
| | - Françoise Dignat-George
- Aix-Marseille University, Institut National de la Santé Et de la Recherche Médicale (INSERM), Institut National de la Recherche pour l’Agriculture et l’Environnement (INRAE), Centre de Recherche en CardioVasculaire et Nutrition (C2VN), Marseille, France
- Laboratoire d’Hématologie, Assistance Publique des Hôpitaux de Marseille (AP-HM), La Timone, Marseille, France
| | - Gilles Kaplanski
- Aix-Marseille University, Institut National de la Santé Et de la Recherche Médicale (INSERM), Institut National de la Recherche pour l’Agriculture et l’Environnement (INRAE), Centre de Recherche en CardioVasculaire et Nutrition (C2VN), Marseille, France
- Service de Médecine interne et d’Immunologie clinique, Assistance Publique des Hôpitaux de Marseille (AP-HM), La Conception, Marseille, France
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Potere N, Garrad E, Kanthi Y, Di Nisio M, Kaplanski G, Bonaventura A, Connors JM, De Caterina R, Abbate A. NLRP3 inflammasome and interleukin-1 contributions to COVID-19-associated coagulopathy and immunothrombosis. Cardiovasc Res 2023; 119:2046-2060. [PMID: 37253117 PMCID: PMC10893977 DOI: 10.1093/cvr/cvad084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 01/30/2023] [Accepted: 02/21/2023] [Indexed: 06/01/2023] Open
Abstract
Immunothrombosis-immune-mediated activation of coagulation-is protective against pathogens, but excessive immunothrombosis can result in pathological thrombosis and multiorgan damage, as in severe coronavirus disease 2019 (COVID-19). The NACHT-, LRR-, and pyrin domain-containing protein 3 (NLRP3) inflammasome produces major proinflammatory cytokines of the interleukin (IL)-1 family, IL-1β and IL-18, and induces pyroptotic cell death. Activation of the NLRP3 inflammasome pathway also promotes immunothrombotic programs including release of neutrophil extracellular traps and tissue factor by leukocytes, and prothrombotic responses by platelets and the vascular endothelium. NLRP3 inflammasome activation occurs in patients with COVID-19 pneumonia. In preclinical models, NLRP3 inflammasome pathway blockade restrains COVID-19-like hyperinflammation and pathology. Anakinra, recombinant human IL-1 receptor antagonist, showed safety and efficacy and is approved for the treatment of hypoxaemic COVID-19 patients with early signs of hyperinflammation. The non-selective NLRP3 inhibitor colchicine reduced hospitalization and death in a subgroup of COVID-19 outpatients but is not approved for the treatment of COVID-19. Additional COVID-19 trials testing NLRP3 inflammasome pathway blockers are inconclusive or ongoing. We herein outline the contribution of immunothrombosis to COVID-19-associated coagulopathy, and review preclinical and clinical evidence suggesting an engagement of the NLRP3 inflammasome pathway in the immunothrombotic pathogenesis of COVID-19. We also summarize current efforts to target the NLRP3 inflammasome pathway in COVID-19, and discuss challenges, unmet gaps, and the therapeutic potential that inflammasome-targeted strategies may provide for inflammation-driven thrombotic disorders including COVID-19.
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Affiliation(s)
- Nicola Potere
- Department of Medicine and Ageing Sciences, ‘G. d’Annunzio’ University, Via Luigi Polacchi 11, Chieti 66100, Italy
| | - Evan Garrad
- Laboratory of Vascular Thrombosis and Inflammation, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
- University of Missouri School of Medicine, Columbia, MO, USA
| | - Yogendra Kanthi
- Laboratory of Vascular Thrombosis and Inflammation, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marcello Di Nisio
- Department of Medicine and Ageing Sciences, ‘G. d’Annunzio’ University, Via Luigi Polacchi 11, Chieti 66100, Italy
| | - Gilles Kaplanski
- Aix-Marseille Université, INSERM, INRAE, Marseille, France
- Division of Internal Medicine and Clinical Immunology, Assistance Publique - Hôpitaux de Marseille, Hôpital Conception, Aix-Marseille Université, Marseille, France
| | - Aldo Bonaventura
- Department of Internal Medicine, Medicina Generale 1, Medical Center, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | - Jean Marie Connors
- Division of Hematology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Raffaele De Caterina
- University Cardiology Division, Pisa University Hospital, Pisa, Italy
- Chair and Postgraduate School of Cardiology, University of Pisa, Pisa, Italy
- Fondazione Villa Serena per la Ricerca, Città Sant’Angelo, Pescara, Italy
| | - Antonio Abbate
- Robert M. Berne Cardiovascular Research Center, Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, 415 Lane Rd (MR5), PO Box 801394, Charlottesville, VA 22903, USA
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8
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Bonnez Q, Dekimpe C, Tellier E, Kaplanski G, Verhamme P, Tersteeg C, De Meyer SF, Lammertyn J, Joly B, Coppo P, Veyradier A, Vanhoorelbeke K. Measuring ADAMTS-13 activity to diagnose thrombotic thrombocytopenic purpura: a novel, fast fiber-optic surface plasmon resonance immunoassay. Res Pract Thromb Haemost 2023; 7:102171. [PMID: 37711907 PMCID: PMC10497779 DOI: 10.1016/j.rpth.2023.102171] [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: 06/15/2023] [Revised: 07/16/2023] [Accepted: 07/20/2023] [Indexed: 09/16/2023] Open
Abstract
Background Thrombotic thrombocytopenic purpura (TTP) is characterized by severe ADAMTS-13 activity deficiency (<10%). Diagnostic testing is challenging because of unavailability, high cost, and expert technician requirement of ADAMTS-13 enzyme assays. Cost-effective, automated fiber-optic surface plasmon resonance (FO-SPR) platforms show potential for developing diagnostic tests. Yet, FO-SPR has never been explored to measure enzymatic activities. Objectives To develop an easy-to-use ADAMTS-13 activity assay utilizing optical fibers to rapidly diagnose TTP. Methods The ADAMTS-13 activity assay was designed and optimized using FO-SPR technology based on a previously described enzyme-linked immunosorbent assay setup. A calibration curve was generated to quantify ADAMTS-13 activity in plasma of healthy donors and patients with acute immune-mediated TTP (iTTP), hemolytic uremic syndrome, or sepsis. ADAMTS-13 activity data from FO-SPR and fluorescence resonance energy transfer-based strategies (FRETS)-VWF73 reference assays were compared. Results After initial assay development, optimization improved read-out magnitude and signal-to-noise ratio and reduced variation. Further characterization demonstrated a detection limit (6.8%) and inter-assay variation (Coefficient of variation, 7.2%) that showed good analytical sensitivity and repeatability. From diverse plasma samples, only plasma from patients with acute iTTP showed ADAMTS-13 activities below 10%. Strong Pearson correlation (r = 0.854) between FO-SPR and reference FRETS-VWF73 assays were observed for all measured samples. Conclusions A fast ADAMTS-13 activity assay was designed onto automated FO-SPR technology. Optimization resulted in sensitive ADAMTS-13 activity measurements with a detection limit enabling clinical diagnosis of TTP within 3 hours. The FO-SPR assay proved strong correlation with the reference FRETS-VWF73 assay. For the first time, this assay demonstrated the capacity of FO-SPR technology to measure enzymatic activity in pre-clinical context.
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Affiliation(s)
- Quintijn Bonnez
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Charlotte Dekimpe
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Edwige Tellier
- Aix-Marseille University, Institut National de la Santé et de la Recherche Médicale, INRAE, C2VN, Marseille, France
| | - Gilles Kaplanski
- Aix-Marseille University, Institut National de la Santé et de la Recherche Médicale, INRAE, C2VN, Marseille, France
- Service de Médecine Interne et Immunologie Clinique, CHU Conception, Aix-Marseille University, APHM, Marseille, France
| | - Peter Verhamme
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Claudia Tersteeg
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Simon F. De Meyer
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Jeroen Lammertyn
- Department of Biosystems, Biosensors Group, KU Leuven, Leuven, Belgium
| | - Bérangère Joly
- Service d'Hématologie Biologique Hôpital Lariboisière, AP-HP and EA3518, IRSL, Université Paris Cité, Paris France
| | - Paul Coppo
- Department of Hematology, Reference Center for Thrombotic Microangiopathies (CNR-MAT), Saint-Antoine University Hospital, AP-HP, Paris, France
| | - Agnès Veyradier
- Service d'Hématologie Biologique Hôpital Lariboisière, AP-HP and EA3518, IRSL, Université Paris Cité, Paris France
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT) AP-HP Paris France
| | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
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9
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Arcani R, Rey L, Mazziotto A, Bertin D, Kaplanski G, Jarrot PA, Lafforgue P, Venton G, Heim X, Villani P, Mège JL, Brodovitch A, Bardin N. Anti-Jo-1 autoantibodies: biomarkers of severity and evolution of the disease in antisynthetase syndrome. Arthritis Res Ther 2023; 25:125. [PMID: 37481643 PMCID: PMC10362709 DOI: 10.1186/s13075-023-03116-5] [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: 05/14/2023] [Accepted: 07/12/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND Anti-Jo-1 autoantibodies represent essential markers in the diagnosis of antisynthetase syndrome (ASS). In this retrospective study, we aimed to investigate whether their concentrations and fluctuations could both respectively reflect the severity and evolution of ASS. METHODS Between 2015 and 2020, clinical and biological features of ASS patients with at least one positive measure of anti-Jo-1 autoantibody were collected. At each serum sampling, we assessed myositis activity by using the Myositis Intention to Treat Activities Index (MITAX) and compared anti-Jo-1 concentrations with ASS severity, anti-Jo-1 concentrations between patients with and without active disease, and changes in anti-Jo-1 concentrations with disease activity. RESULTS Forty-eight patients with ASS had at least one positive determination of anti-Jo-1 concentration. Among them, twenty-nine patients had at least two determinations of anti-Jo-1 autoantibody in their follow-up. We showed that these autoantibody concentrations were significantly correlated with MITAX (r = 0.4, p = 0.03) and creatine kinase concentration (r = 0.34, p = 0.002) and that they were significantly higher in patients with active disease than in those with inactive disease (91.7 IU/L vs 44.4 IU/L, p = 0.016). During follow-up, we found a significant correlation between fluctuations of anti-Jo-1 autoantibody concentrations and MITAX score (r = 0.7, p < 0.0001). CONCLUSION Our results suggest that anti-Jo-1 autoantibody concentration could be a predictive marker of the severity and evolution of ASS and show that their quantification could represent a precious tool for disease monitoring and for improving the therapeutic management of ASS patients.
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Affiliation(s)
- Robin Arcani
- Internal Medicine and Therapeutics Department, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), 264 Rue Saint-Pierre, 13005, Marseille, France.
- Center for Cardiovascular and Nutrition Research (C2VN), INRA, 1260, INSERM UMR_S 1263, Aix-Marseille University, Marseille, France.
| | - Louise Rey
- Biogénopôle, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Alice Mazziotto
- Internal Medicine and Therapeutics Department, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), 264 Rue Saint-Pierre, 13005, Marseille, France
| | - Daniel Bertin
- Biogénopôle, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Gilles Kaplanski
- Center for Cardiovascular and Nutrition Research (C2VN), INRA, 1260, INSERM UMR_S 1263, Aix-Marseille University, Marseille, France
- Department of Internal Medicine and Clinical Immunology, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Pierre-André Jarrot
- Center for Cardiovascular and Nutrition Research (C2VN), INRA, 1260, INSERM UMR_S 1263, Aix-Marseille University, Marseille, France
- Department of Internal Medicine and Clinical Immunology, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Pierre Lafforgue
- Department of Rheumatology, CHU Sainte-Marguerite, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Geoffroy Venton
- Hematology and Cellular Therapy Department, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Xavier Heim
- Center for Cardiovascular and Nutrition Research (C2VN), INRA, 1260, INSERM UMR_S 1263, Aix-Marseille University, Marseille, France
- Biogénopôle, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Patrick Villani
- Internal Medicine and Therapeutics Department, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), 264 Rue Saint-Pierre, 13005, Marseille, France
| | - Jean-Louis Mège
- Biogénopôle, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Alexandre Brodovitch
- Biogénopôle, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Nathalie Bardin
- Center for Cardiovascular and Nutrition Research (C2VN), INRA, 1260, INSERM UMR_S 1263, Aix-Marseille University, Marseille, France
- Biogénopôle, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
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Gomes de Pinho Q, Daumas A, Benyamine A, Bertolino J, Ebbo M, Schleinitz N, Harlé JR, Jarrot PA, Kaplanski G, Berbis J, Boucekine M, Rossi P, Granel B. Predictors of Relapses or Recurrences in Patients With Giant Cell Arteritis: A Medical Records Review Study. J Clin Rheumatol 2023; 29:e25-e31. [PMID: 36727749 DOI: 10.1097/rhu.0000000000001942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Giant cell arteritis (GCA) is the most common systemic vasculitis in individuals aged ≥50 years. Its course is marked by a high relapse rate requiring long-term glucocorticoid use with its inherent adverse effects. We aimed to identify factors associated with relapses or recurrences in GCA at diagnosis. METHODS We reviewed the medical records of consecutive patients with GCA diagnosed between 2009 and 2019 and followed for at least 12 months. We recorded their characteristics at onset and during follow-up. Factors associated with relapses or recurrences were identified using multivariable analysis. RESULTS We included 153 patients, among whom 68% were female with a median age of 73 (47-98) years and a median follow-up of 32 (12-142) months. Seventy-four patients (48.4%) had at least 1 relapse or recurrence. Headache and polymyalgia rheumatica were the most frequent manifestations of relapses. The first relapse occurred at a median time of 13 months after the diagnosis, with a median dose of 5.5 (0-25) mg/d of glucocorticoids.In multivariable analysis, patients with relapses or recurrences had a higher frequency of cough and scalp tenderness at diagnosis (20.3% vs 5.1%; odds ratio [OR], 4.73; 95% confidence interval [CI], 1.25-17.94; p = 0.022; and 41.9% vs 29.1%; OR, 2.4; 95% CI, 1.07-5.39; p = 0.034, respectively). Patients with diabetes mellitus at diagnosis had fewer relapses or recurrences during follow-up (5.4% vs 19%; OR, 0.24; 95% CI, 0.07-0.83; p = 0.024). CONCLUSIONS Cough and scalp tenderness at diagnosis were associated with relapses or recurrences, whereas patients with diabetes experienced fewer relapses or recurrences.
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Affiliation(s)
- Quentin Gomes de Pinho
- From the Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Service de Médecine Interne
| | - Aurélie Daumas
- Assistance Publique des Hôpitaux de Marseille, Hôpital de la Timone, Service de Médecine Interne, Gériatrie et Thérapeutique
| | - Audrey Benyamine
- From the Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Service de Médecine Interne
| | - Julien Bertolino
- From the Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Service de Médecine Interne
| | - Mikaël Ebbo
- Assistance Publique des Hôpitaux de Marseille, Hôpital de la Timone, Service de Médecine Interne
| | - Nicolas Schleinitz
- Assistance Publique des Hôpitaux de Marseille, Hôpital de la Timone, Service de Médecine Interne
| | - Jean-Robert Harlé
- Assistance Publique des Hôpitaux de Marseille, Hôpital de la Timone, Service de Médecine Interne
| | - Pierre André Jarrot
- Assistance Publique des Hôpitaux de Marseille, Hôpital de la Conception, Service de Médecine Interne et Immunologie Clinique
| | - Gilles Kaplanski
- Assistance Publique des Hôpitaux de Marseille, Hôpital de la Conception, Service de Médecine Interne et Immunologie Clinique
| | - Julie Berbis
- Faculté de Médecine de la Timone, Laboratoire de Santé Publique, EA 3279, Centre d'Étude et de Recherche sur les Service de Santé et la Qualité de Vie, Aix-Marseille Université, Marseille, France
| | - Mohamed Boucekine
- Faculté de Médecine de la Timone, Laboratoire de Santé Publique, EA 3279, Centre d'Étude et de Recherche sur les Service de Santé et la Qualité de Vie, Aix-Marseille Université, Marseille, France
| | - Pascal Rossi
- From the Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Service de Médecine Interne
| | - Brigitte Granel
- From the Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Service de Médecine Interne
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11
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Arcani R, Correard F, Suchon P, Kaplanski G, Jean R, Cauchois R, Leprince M, Arcani V, Seguier J, De Sainte Marie B, Andre B, Koubi M, Rossi P, Gayet S, Gobin N, Garrido V, Weiland J, Jouve E, Couderc AL, Villani P, Daumas A. Tocilizumab versus anakinra in COVID-19: results from propensity score matching. Front Immunol 2023; 14:1185716. [PMID: 37304271 PMCID: PMC10250610 DOI: 10.3389/fimmu.2023.1185716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/15/2023] [Indexed: 06/13/2023] Open
Abstract
Background Tocilizumab and anakinra are anti-interleukin drugs to treat severe coronavirus disease 2019 (COVID-19) refractory to corticosteroids. However, no studies compared the efficacy of tocilizumab versus anakinra to guide the choice of the therapy in clinical practice. We aimed to compare the outcomes of COVID-19 patients treated with tocilizumab or anakinra. Methods Our retrospective study was conducted in three French university hospitals between February 2021 and February 2022 and included all the consecutive hospitalized patients with a laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection assessed by RT-PCR who were treated with tocilizumab or anakinra. A propensity score matching was performed to minimize confounding effects due to the non-random allocation. Results Among 235 patients (mean age, 72 years; 60.9% of male patients), the 28-day mortality (29.4% vs. 31.2%, p = 0.76), the in-hospital mortality (31.7% vs. 33.0%, p = 0.83), the high-flow oxygen requirement (17.5% vs. 18.3%, p = 0.86), the intensive care unit admission rate (30.8% vs. 22.2%, p = 0.30), and the mechanical ventilation rate (15.4% vs. 11.1%, p = 0.50) were similar in patients receiving tocilizumab and those receiving anakinra. After propensity score matching, the 28-day mortality (29.1% vs. 30.4%, p = 1) and the rate of high-flow oxygen requirement (10.1% vs. 21.5%, p = 0.081) did not differ between patients receiving tocilizumab or anakinra. Secondary infection rates were similar between the tocilizumab and anakinra groups (6.3% vs. 9.2%, p = 0.44). Conclusion Our study showed comparable efficacy and safety profiles of tocilizumab and anakinra to treat severe COVID-19.
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Affiliation(s)
- Robin Arcani
- Internal Medicine and Therapeutics Department, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Center for Cardiovascular and Nutrition Research (C2VN), INRA 1260, INSERM UMR_S 1263, Aix-Marseille University, Marseille, France
| | | | - Pierre Suchon
- Hematology Laboratory, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Gilles Kaplanski
- Center for Cardiovascular and Nutrition Research (C2VN), INRA 1260, INSERM UMR_S 1263, Aix-Marseille University, Marseille, France
- Internal Medicine and Clinical Immunology Department, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Rodolphe Jean
- Internal Medicine and Clinical Immunology Department, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Raphael Cauchois
- Center for Cardiovascular and Nutrition Research (C2VN), INRA 1260, INSERM UMR_S 1263, Aix-Marseille University, Marseille, France
- Internal Medicine and Clinical Immunology Department, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Marine Leprince
- Internal Medicine and Clinical Immunology Department, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Vincent Arcani
- Pharmacy Department, CHU La Timone, AP-HM, Marseille, France
| | - Julie Seguier
- Internal Medicine Department, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Benjamin De Sainte Marie
- Internal Medicine Department, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Baptiste Andre
- Internal Medicine Department, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Marie Koubi
- Department of Internal Medicine, CHU Nord, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Pascal Rossi
- Department of Internal Medicine, CHU Nord, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Stéphane Gayet
- Internal Medicine and Therapeutics Department, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Nirvina Gobin
- Internal Medicine and Therapeutics Department, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Victoria Garrido
- Internal Medicine and Therapeutics Department, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Joris Weiland
- Internal Medicine and Therapeutics Department, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Elisabeth Jouve
- Service Evaluation Médicale, CHU la Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Anne-Laure Couderc
- Internal Medicine, Geriatrics and Therapeutic Department, CHU Sainte-Marguerite, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Aix-Marseille University, CNRS, EFS, ADES, Marseille, France
| | - Patrick Villani
- Internal Medicine and Therapeutics Department, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Aix-Marseille University, CNRS, EFS, ADES, Marseille, France
| | - Aurélie Daumas
- Internal Medicine and Therapeutics Department, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Center for Cardiovascular and Nutrition Research (C2VN), INRA 1260, INSERM UMR_S 1263, Aix-Marseille University, Marseille, France
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12
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Quartier P, Saadoun D, Belot A, Errera MH, Kaplanski G, Kodjikian L, Kone-Paut I, Miceli-Richard C, Monnet D, Audouin-Pajot C, Seve P, Uettwiller F, Weber M, Bodaghi B. French recommendations for the management of non-infectious chronic uveitis. Rev Med Interne 2023; 44:227-252. [PMID: 37147233 DOI: 10.1016/j.revmed.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/31/2023] [Accepted: 04/02/2023] [Indexed: 05/07/2023]
Abstract
This French National Diagnostic and Care Protocol (NDPC) includes both pediatric and adult patients with non-infectious chronic uveitis (NICU) or non-infectious recurrent uveitis (NIRU). NICU is defined as uveitis that persists for at least 3 months or with frequent relapses occurring less than 3 months after cessation of treatment. NIRU is repeated episodes of uveitis separated by periods of inactivity of at least 3 months in the absence of treatment. Some of these NICU and NIRU are isolated. Others are associated with diseases that may affect various organs, such as uveitis associated with certain types of juvenile idiopathic arthritis, adult spondyloarthropathies or systemic diseases in children and adults such as Behçet's disease, granulomatoses or multiple sclerosis. The differential diagnoses of pseudo-uveitis, sometimes related to neoplasia, and uveitis of infectious origin are discussed, as well as the different forms of uveitis according to their main anatomical location (anterior, intermediate, posterior or panuveitis). We also describe the symptoms, known physiopathological mechanisms, useful complementary ophthalmological and extra-ophthalmological examinations, therapeutic management, monitoring and useful information on the risks associated with the disease or treatment. Finally, this protocol presents more general information on the care pathway, the professionals involved, patient associations, adaptations in the school or professional environment and other measures that may be implemented to manage the repercussions of these chronic diseases. Because local or systemic corticosteroids are usually necessary, these treatments and the risks associated with their prolonged use are the subject of particular attention and specific recommendations. The same information is provided for systemic immunomodulatory treatments, immunosuppressive drugs, sometimes including anti-TNFα antibodies or other biotherapies. Certain particularly important recommendations for patient management are highlighted in summary tables.
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Affiliation(s)
- P Quartier
- Pediatric Immunology, Hematology and Rheumatology Unit, Necker-Enfants Malades Hospital, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France.
| | - D Saadoun
- Department of Internal Medicine and Clinical Immunology, RHU IMAP, Sorbonne University, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
| | - A Belot
- Department of Pediatric Nephrology, Rheumatology, Dermatology, Mère-Enfant Hospital, Hospices Civils de Lyon, Université Claude Bernard-Lyon 1, 69500 Bron, France
| | - M-H Errera
- Department of Ophthalmology, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France
| | - G Kaplanski
- Department of Internal Medicine and Clinical Immunology, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - L Kodjikian
- Department of Ophthalmology, Hôpital universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - I Kone-Paut
- Department of Pediatric Rheumatology, CHU de Bicêtre, APHP, University of Paris Saclay, Le Kremlin Biĉetre, France
| | - C Miceli-Richard
- Departement of rhumatology, Hôpital Cochin, Université de Paris, Paris, France
| | - D Monnet
- Department of Ophthalmology, Université de Paris, Hôpital Cochin, Paris, France
| | - C Audouin-Pajot
- Departement of rhumatology, Toulouse University Hospital (CHU de Toulouse), 330 Avenue de Grande-Bretagne, 31300 Toulouse, France
| | - P Seve
- Department of Internal Medicine, Croix-Rousse University Hospital, Hospices Civils de Lyon, Université Claude Bernard-Lyon 1, 69004 Lyon, France
| | - F Uettwiller
- Paediatric Rheumatology Unit, Centre Hospitalier Universitaire de Clocheville, Tours, France
| | - M Weber
- Department of Ophthalmology, Centre Hospitalier Universitaire de Nantes, 44000 Nantes, France
| | - B Bodaghi
- Departement of Ophthalmology, IHU FOReSIGHT, Sorbonne University, APHP, Paris, France.
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13
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Hankard A, Puéchal X, Martin Silva N, Deshayes S, Lorcy N, Le Gallou T, Carron PL, Daugas E, Kaplanski G, Boutemy J, Maigné G, Galimard C, Terrier B, Aouba A, de Boysson H. Characteristics of ANCA-associated vasculitis with aneurysms: Case series and review of the literature. Autoimmun Rev 2023; 22:103293. [PMID: 36787809 DOI: 10.1016/j.autrev.2023.103293] [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: 01/23/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023]
Abstract
INTRODUCTION ANCA-associated vasculitis (AAV) is an exceptional cause of small and large vascular aneurysms. Here, we present the phenotypic characteristics of patients with AAV associated with the presence of aneurysms. METHODS We conducted a retrospective multicenter study and a systematic review of the literature. Only AAV patients with positive ANCA results and > 1 aneurysm(s) were enrolled. Patients were recruited through a call of observations among the French Vasculitis Study Group (FVSG) and the French Internal Medicine Network. Patients with aneurysm rupture were compared to those without. RESULTS We enrolled 51 patients in the cohort, including 31 (67%) with granulomatosis with polyangiitis. The median Birmingham Vasculitis Activity Score was 18 [6-41]. A total of 92 aneurysms were noted, 74% of which involved medium-sized arteries, particularly the renal artery. During a follow-up of 24 [6-56] months, 22 (43%) patients experienced aneurysmal rupture, 91% of which involved medium-sized vessels. Patients with aneurysmal rupture showed significantly more pulmonary infiltrates and higher creatinine levels at baseline than patients without rupture. Initial treatments did not differ between the two groups. Ten (20%) patients died during the follow-up, including three from an aneurysmal rupture. CONCLUSION Aneurysms were more frequently observed in GPA patients and predominantly affected medium-sized vessels, especially the renal arteries. The risk of rupture was high and occurred in >40% of patients. Because of their increased mortality, further studies are required to better manage this subset of patients.
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Affiliation(s)
- Antoine Hankard
- Department of Internal Medicine, Caen University Hospital, Basse Normandie University, Caen, France.
| | - Xavier Puéchal
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Centre, Université Paris Cité, Paris, France
| | - Nicolas Martin Silva
- Department of Internal Medicine, Caen University Hospital, Basse Normandie University, Caen, France
| | - Samuel Deshayes
- Department of Internal Medicine, Caen University Hospital, Basse Normandie University, Caen, France
| | - Nolwenn Lorcy
- Department of Nephrology, Rennes University Hospital, Rennes, France
| | - Thomas Le Gallou
- Department of Internal Medicine, Rennes University Hospital, South Hospital, Rennes, France
| | | | - Eric Daugas
- Department of Nephrology, Bichat-Claude-Bernard Hospital, University Hospital Center, APHP, Paris, France
| | - Gilles Kaplanski
- Department of Internal Medicine, La Conception Hospital, University Hospital Center, APHM, Marseille, France
| | - Jonathan Boutemy
- Department of Internal Medicine, Caen University Hospital, Basse Normandie University, Caen, France
| | - Gwénola Maigné
- Department of Internal Medicine, Caen University Hospital, Basse Normandie University, Caen, France
| | - Caroline Galimard
- Department of Infectious Disease Medicine, Caen University Hospital, Basse Normandie University, Caen, France
| | - Benjamin Terrier
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Centre, Université Paris Cité, Paris, France
| | - Achille Aouba
- Department of Internal Medicine, Caen University Hospital, Basse Normandie University, Caen, France; Université de Caen Normandie, Caen, France
| | - Hubert de Boysson
- Department of Internal Medicine, Caen University Hospital, Basse Normandie University, Caen, France; Université de Caen Normandie, Caen, France
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14
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Lavrard-Meyer P, Gomes De Pinho Q, Daumas A, Benyamine A, Ebbo M, Schleinitz N, Harlé J, Jarrot P, Kaplanski G, Berbis J, Granel B. Hospitalisation pour infection chez les patients suivis pour une artérite à cellules géantes : étude monocentrique rétrospective. Rev Med Interne 2023; 44:212-217. [PMID: 37029032 DOI: 10.1016/j.revmed.2023.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 04/08/2023]
Abstract
INTRODUCTION Infections are associated with morbimortality of patients with giant cell arteritis (GCA). The aim of this work was twofold: the identification of factors predisposing to the risk of infection and the description of patients hospitalized with an infection occurring during the treatment period of CAG. METHODS A monocentric retrospective study was conducted in GCA patients, comparing patients hospitalized for infection with patients without infection. The analysis included 21/144 (14.6%) patients with 26 infections (cases) and 42 control matched on sex, age, and diagnosis of GCA. RESULTS Both groups were similar except for a higher frequency of seritis in cases (15% vs. 0%, p=0.03). Relapses of GCA were less common in cases (23.8% vs 50.0%, p=0.041). Hypogammaglobulinemia was present during infection. More than half of the infections (53.8%) occurred in the first year of follow-up with an average dose of 15mg/day of corticosteroids. Infections were mainly pulmonary (46.2%) and cutaneous (26.9%). CONCLUSION Factors associated with infectious risk were identified. This preliminary monocentric work will continue with a national multicentre study.
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15
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Tsangaris I, Antonakos N, Fantoni M, Kaplanski G, Kyriazopoulou E, Veas F, Clemens M. BIOMARKERS: CAN THEY REALLY GUIDE OUR DAILY PRACTICE? Shock 2023; 59:16-20. [PMID: 36867757 DOI: 10.1097/shk.0000000000001957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
ABSTRACT Optimal management of septic patients requires accurate assessment of both current severity status and prognosis. Since the 1990s, substantial advances have been made in the use of circulating biomarkers for such assessments. This summary of the session on "Biomarkers: can they really use guide our daily practice?" presented at the 2021 WEB-CONFERENCE OF THE EUROPEAN SHOCK SOCIETY, 6 November 2021. These biomarkers include ultrasensitive detection of bacteremia, circulating soluble urokina-type plasminogen activator receptor (suPAR), C-reactive protein (CRP) and ferritin and procalcitonin. In addition, the potential application of novel multiwavelength optical biosensor technology allows noninvasive monitoring of multiple metabolites that can be used to assess severity and prognosis in septic patients. The application these biomarkers and improved technologies provide the potential for improved personalized management of septic patients.
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Affiliation(s)
- Iraklis Tsangaris
- 2nd Department of Critical Care Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Antonakos
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Gilles Kaplanski
- Division of Internal Medicine and Clinical Immunology, Hôpital de la Conception, C2VN-INSERM U1263, Aix-Marseille University, Marseille, France
| | - Evdoxia Kyriazopoulou
- 2nd Department of Critical Care Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Mark Clemens
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina
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16
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Arcani R, Cauchois R, Suchon P, Weber S, Jean R, Jarrot PA, Rey L, Venton G, Koubi M, Muller R, Bertin D, Mège JL, Kaplanski G, Bardin N. "True" Antiphospholipid Syndrome in COVID-19: Contribution of the Follow-up of Antiphospholipid Autoantibodies. Semin Thromb Hemost 2023; 49:97-102. [PMID: 36335917 DOI: 10.1055/s-0042-1758118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Robin Arcani
- Department of Internal Medicine and Clinical Immunology, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France.,Aix-Marseille University, INSERM, INRAE, C2VN, Marseille, France
| | - Raphaël Cauchois
- Department of Internal Medicine and Clinical Immunology, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France.,Aix-Marseille University, INSERM, INRAE, C2VN, Marseille, France
| | - Pierre Suchon
- Hematology Laboratory, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Samuel Weber
- Service d'Immunologie, Pôle de Biologie, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), France
| | - Rodolphe Jean
- Department of Internal Medicine and Clinical Immunology, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Pierre-André Jarrot
- Department of Internal Medicine and Clinical Immunology, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France.,Aix-Marseille University, INSERM, INRAE, C2VN, Marseille, France
| | - Louise Rey
- Service d'Immunologie, Pôle de Biologie, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), France
| | - Geoffroy Venton
- Department of Hematology and Cellular Therapy, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Marie Koubi
- Department of Internal Medicine and Clinical Immunology, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Romain Muller
- Department of Internal Medicine and Clinical Immunology, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France.,Aix-Marseille University, INSERM, INRAE, C2VN, Marseille, France
| | - Daniel Bertin
- Service d'Immunologie, Pôle de Biologie, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), France
| | - Jean-Louis Mège
- Service d'Immunologie, Pôle de Biologie, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), France.,Aix-Marseille University, IRD, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Gilles Kaplanski
- Department of Internal Medicine and Clinical Immunology, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France.,Aix-Marseille University, INSERM, INRAE, C2VN, Marseille, France
| | - Nathalie Bardin
- Aix-Marseille University, INSERM, INRAE, C2VN, Marseille, France.,Service d'Immunologie, Pôle de Biologie, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), France
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17
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Cauchois R, Muller R, Lagarde M, Dignat-George F, Tellier E, Kaplanski G. Is Endothelial Activation a Critical Event in Thrombotic Thrombocytopenic Purpura? J Clin Med 2023; 12:jcm12030758. [PMID: 36769407 PMCID: PMC9918301 DOI: 10.3390/jcm12030758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
Thrombotic thrombocytopenic purpura (TTP) is a severe thrombotic microangiopathy. The current pathophysiologic paradigm suggests that the ADAMTS13 deficiency leads to Ultra Large-Von Willebrand Factor multimers accumulation with generation of disseminated microthrombi. Nevertheless, the role of endothelial cells in this pathology remains an issue. In this review, we discuss the various clinical, in vitro and in vivo experimental data that support the important role of the endothelium in this pathology, suggesting that ADAMTS13 deficiency may be a necessary but not sufficient condition to induce TTP. The "second hit" model suggests that in TTP, in addition to ADAMTS13 deficiency, endogenous or exogenous factors induce endothelial activation affecting mainly microvascular cells. This leads to Weibel-Palade bodies degranulation, resulting in UL-VWF accumulation in microcirculation. This endothelial activation seems to be worsened by various amplification loops, such as the complement system, nucleosomes and free heme.
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Affiliation(s)
- Raphael Cauchois
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, INSERM, INRAE, C2VN, CHU Conception, Internal Medicine and Clinical Immunology, 13005 Marseille, France
- French Reference Center for Thrombotic Microangiopathies, 75571 Paris, France
- Correspondence:
| | - Romain Muller
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, INSERM, INRAE, C2VN, CHU Conception, Internal Medicine and Clinical Immunology, 13005 Marseille, France
| | - Marie Lagarde
- French Reference Center for Thrombotic Microangiopathies, 75571 Paris, France
- Aix Marseille University, INSERM, INRAE, C2VN, 13005 Marseille, France
| | - Françoise Dignat-George
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, INSERM, INRAE, C2VN, CHU Conception, Hematology Laboratory, 13005 Marseille, France
| | - Edwige Tellier
- French Reference Center for Thrombotic Microangiopathies, 75571 Paris, France
- Aix Marseille University, INSERM, INRAE, C2VN, 13005 Marseille, France
| | - Gilles Kaplanski
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, INSERM, INRAE, C2VN, CHU Conception, Internal Medicine and Clinical Immunology, 13005 Marseille, France
- French Reference Center for Thrombotic Microangiopathies, 75571 Paris, France
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18
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Tellier E, Widemann A, Cauchois R, Faccini J, Lagarde M, Brun M, Robert P, Robert S, Bachelier R, Poullin P, Roose E, Vanhoorelbeke K, Coppo P, Dignat-George F, Kaplanski G. Immune thrombotic thrombocytopenic purpura plasmas induce calcium- and IgG-dependent endothelial activation: correlations with disease severity. Haematologica 2022; 108:1127-1140. [PMID: 36453103 PMCID: PMC10071132 DOI: 10.3324/haematol.2022.280651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Indexed: 12/02/2022] Open
Abstract
Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is characterized by a severe ADAMTS13 deficiency due to the presence of anti-ADAMTS13 autoantibodies, with subsequent accumulation of circulating ultra-large von Willebrand Factor (VWF) multimers. The role of endothelial cell activation as a trigger of the disease has been suggested in animal models but remains to be demonstrated in humans.
We prospectively obtained plasma from the first plasma exchange of 25 patients during iTTP acute phase. iTTP but not control plasma, induced a rapid VWF release and P-selectin exposure on dermal human micro-vascular endothelial cell (HMVEC-d) surface, associated with angiopoietin-2 and endothelin-1 secretion, consistent with Weibel-Palade bodies exocytosis. Calcium (Ca2+) blockade significantly decreased VWF release, whereas iTTP plasma induced a rapid and sustained Ca2+ flux in HMVEC-d which correlated in retrospect, with disease severity and survival in 62 iTTP patients. F(ab)’2 fragments purified from the immunoglobulin G (IgG) fraction of iTTP plasma mainly induced endothelial cell (EC) activation with additional minor roles for circulating free heme and nucleosomes, but not for complement. Furthermore, two anti-ADAMTS13 monoclonal antibodies purified from iTTP patient B cells, but not serum from hereditary TTP, induced endothelial Ca2+ flux associated with Weibel-Palade bodies exocytosis in vitro, whereas inhibition of endothelial ADAMTS13 expression using small interference RNA, significantly decreased the stimulating effects of iTTP IgG.
In conclusion, Ca2+-mediated endothelial cell activation constitutes a second “hit” of iTTP, is correlated with the severity of the disease and may constitute a possible therapeutic target.
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Affiliation(s)
- Edwige Tellier
- Aix-Marseille Univ, INSERM, INRAE, C2VN, Marseille, France; French Reference Center for Thrombotic Microangiopathies.
| | | | - Raphaël Cauchois
- French Reference Center for Thrombotic Microangiopathies; Aix-Marseille Univ, APHM, INSERM, INRAE, C2VN, CHU Conception, Service de Médecine Interne et Immunologie Clinique, Marseille
| | - Julien Faccini
- Aix-Marseille Univ, INSERM, INRAE, C2VN, Marseille, France; French Reference Center for Thrombotic Microangiopathies
| | - Marie Lagarde
- Aix-Marseille Univ, INSERM, INRAE, C2VN, Marseille, France; French Reference Center for Thrombotic Microangiopathies
| | - Marion Brun
- Aix-Marseille Univ, APHM, INSERM, INRAE, C2VN, CHU Conception, Service de Médecine Interne et Immunologie Clinique, Marseille
| | - Philippe Robert
- Aix-Marseille Univ, APHM, CNRS, INSERM, CHU Conception, Laboratoire Immunologie, Marseille
| | | | | | - Pascale Poullin
- French Reference Center for Thrombotic Microangiopathies; APHM, Service d'Hémaphérèse, CHU Conception, Marseille
| | - Elien Roose
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk
| | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk
| | - Paul Coppo
- French Reference Center for Thrombotic Microangiopathies; Service d'Hématologie, Hôpital Saint-Antoine, APHP.6-SU, INSERM UMRS 1138, Centre de Recherche des Cordeliers, Paris
| | - Françoise Dignat-George
- Aix-Marseille Univ, INSERM, INRAE, C2VN, Marseille, France; Aix-Marseille Univ, APHM, INSERM, INRAE, C2VN, CHU Conception, Laboratoire d'Hématologie, Marseille
| | - Gilles Kaplanski
- French Reference Center for Thrombotic Microangiopathies; Aix-Marseille Univ, APHM, INSERM, INRAE, C2VN, CHU Conception, Service de Médecine Interne et Immunologie Clinique, Marseille
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Gomes de Pinho Q, Daumas A, Benyamine A, Koubi M, Devos M, Kaplanski G, Jarrot P, Schleinitz N, Ebbo M, Rossi P, Granel B. Effets indésirables associés aux traitements immunomodulateurs de l’artérite à cellules géantes : une étude monocentrique rétrospective. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.348] [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: 12/12/2022]
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Gomes de Pinho Q, Daumas A, Benyamine A, Bertolino J, Schleinitz N, Ebbo M, Harlé J, Jarrot P, Kaplanski G, Berbis J, Boucekine M, Rossi P, Granel B. Facteurs de risque de rechute au diagnostic d’une artérite à cellules géantes : une étude rétrospective. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.242] [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: 11/16/2022]
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Joseph A, Eloit M, Azoulay E, Kaplanski G, Provot F, Presne C, Wynckel A, Grangé S, Rondeau É, Pène F, Delmas Y, Lautrette A, Barbet C, Mousson C, Coindre J, Perez P, Jamme M, Augusto J, Poullin P, Jacobs F, El Karoui K, Vigneau C, Ulrich M, Kanouni T, Le Quintrec M, Hamidou M, Ville S, Charvet‐Rumpler A, Ojeda‐Uribe M, Godmer P, Fremeaux‐Bacchi V, Veyradier A, Halimi J, Coppo P. Immune‐mediated thrombotic thrombocytopenic purpura prognosis is affected by blood pressure. Res Pract Thromb Haemost 2022; 6:e12702. [PMID: 35599703 PMCID: PMC9115975 DOI: 10.1002/rth2.12702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/04/2022] [Accepted: 03/13/2022] [Indexed: 12/28/2022] Open
Abstract
Background The prevalence, prognostic role, and diagnostic value of blood pressure in immune-mediated thrombotic thrombocytopenic purpura (iTTP) and other thrombotic microangiopathies (TMAs) remain unclear. Methods Using a national cohort of iTTP (n = 368), Shigatoxin-induced hemolytic uremic syndrome (n = 86), atypical hemolytic uremic syndrome (n = 84), and hypertension-related thrombotic microangiopathy (n = 25), we sought to compare the cohort's blood pressure profile to assess its impact on prognosis and diagnostic performances. Results Patients with iTTP had lower blood pressure than patients with other TMAs, systolic (130 [interquartile range (IQR) 118-143] vs 161 [IQR 142-180] mmHg) and diastolic (76 [IQR 69-83] vs 92 [IQR 79-105] mmHg, both p < 0.001). The best threshold for iTTP diagnosis corresponded to a systolic blood pressure <150 mmHg. iTTP patients presenting with hypertension had a significantly poorer survival (hazard ratio 1.80, 95% confidence interval 1.07-3.04), and this effect remained significant after multivariable adjustment (hazard ratio = 1.14, 95% confidence interval 1.00-1.30). Addition of a blood pressure criterion modestly improved the French clinical score to predict a severe A disintegrin and metalloprotease with thrombospondin type 1 deficiency in patients with an intermediate score (i.e., either platelet count <30 × 109/L or serum creatinine <200 µM). Conclusions Elevated blood pressure at admission affects the prognosis of iTTP patients and may help discriminate them from other TMA patients. Particular attention should be paid to blood pressure and its management in these patients.
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Affiliation(s)
- Adrien Joseph
- INSERM, U1138, INSERM, Équipe 11 labellisée Ligue Nationale Contre le Cancer, Centre de Recherche des Cordeliers Paris France
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Médecine intensive réanimation Hôpital Saint Louis AP‐HP Paris France
| | - Martin Eloit
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service d’Hématologie et Thérapie Cellulaire CHRU de Tours Tours France
| | - Elie Azoulay
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Médecine intensive réanimation Hôpital Saint Louis AP‐HP Paris France
| | - Gilles Kaplanski
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Médecine Interne Hôpital la Conception Marseille France
| | - François Provot
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Néphrologie Hôpital Albert‐Calmette Lille France
| | - Claire Presne
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Néphrologie Hôpital Nord Amiens France
| | - Alain Wynckel
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Néphrologie Hôpital Maison Blanche Reims France
| | - Steven Grangé
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Réanimation Médicale CHU Charles Nicolle Rouen France
| | - Éric Rondeau
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Urgences Néphrologiques et Transplantation Rénale Hôpital Tenon Paris France
| | - Frédéric Pène
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Médecine Intensive–Réanimation Hôpital Cochin APHP Centre & Université de Paris Paris France
| | - Yahsou Delmas
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Néphrologie CHU de Bordeaux Bordeaux France
| | - Alexandre Lautrette
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Réanimation Médicale Hôpital Gabriel Montpied Clermont‐Ferrand France
| | - Christelle Barbet
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Néphrologie‐hypertension, Dialyses, Transplantation Rénale Hôpitaux Bretonneau et Clocheville Tours France
| | - Christiane Mousson
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Néphrologie CHU de Dijon Dijon France
| | - Jean‐Philippe Coindre
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Néphrologie CH Le Mans Le Mans France
| | - Pierre Perez
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Réanimation Polyvalente CHU de Nancy Nancy France
| | - Matthieu Jamme
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Réanimation Centre Hospitalier Intercommunal Poissy Saint‐Germain Poissy France
| | - Jean‐François Augusto
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Néphrologie Dialyse et Transplantation CHU Larrey Angers France
| | - Pascale Poullin
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service d’hémaphérèse et d’autotransfusion Hôpital la Conception Marseille France
| | - Frédéric Jacobs
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Réanimation Médicale Hôpital Antoine Béclère Clamart France
| | - Khalil El Karoui
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Néphrologie et Transplantation rénale Groupe Hospitalier Henri‐Mondor Créteil France
| | - Cécile Vigneau
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)–UMR_S 1085 Rennes France
| | - Marc Ulrich
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Néphrologie Hôpital Jean Bernard Valenciennes France
| | - Tarik Kanouni
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Unité d’Hémaphérèse Service d’Hématologie CHU de Montpellier Montpellier France
| | - Moglie Le Quintrec
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Néphrologie CHU de Montpellier Montpellier France
| | - Mohamed Hamidou
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Médecine Interne CHU de Nantes Nantes France
| | - Simon Ville
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Néphrologie CHU de Nantes Nantes France
| | - Anne Charvet‐Rumpler
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service d’Hématologie Centre Hospitalier Régional Universitaire Hôpital Jean Minjoz Besançon France
| | - Mario Ojeda‐Uribe
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service d’Hématologie et de Thérapie Cellulaire Groupe Hospitalier Region Mulhouse‐Sud‐Alsace (GHRMSA) Mulhouse France
| | - Pascal Godmer
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Médecine Interne Centre Hospitalier Bretagne Atlantique de Vannes Vannes France
| | - Véronique Fremeaux‐Bacchi
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service d’Immunologie Biologique Hôpital Européen Georges Pompidou, AP‐HP Paris France
| | - Agnès Veyradier
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service d’Hématologie Biologique Hôpital Lariboisière, AP‐HP Paris France
| | - Jean‐Michel Halimi
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Néphrologie‐hypertension, Dialyses, Transplantation Rénale Hôpitaux Bretonneau et Clocheville Tours France
| | - Paul Coppo
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service d’Hématologie Hôpital Saint‐Antoine AP‐HP Paris France
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Gomes de Pinho Q, Daumas A, Benyamine A, Bertolino J, Rossi P, Schleinitz N, Harlé JR, Jarrot PA, Kaplanski G, Berbis J, Granel B. Pericardial effusion in giant cell arteritis is associated with increased inflammatory markers: a retrospective cohort study. Rheumatol Int 2022; 42:2013-2018. [PMID: 35525874 DOI: 10.1007/s00296-022-05137-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/16/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Giant cell arteritis (GCA) is the most frequent vasculitis affecting adults aged > 50 years. Cardiac involvement in GCA is considered rare, and only a few cases of pericarditis have been reported. The aim of this study was to determine the characteristics and prognosis of GCA patients suffering from pericardial involvement at diagnosis. METHODS We conducted a single-centre, retrospective chart review of patients with GCA in internal medicine departments (from 2000 to 2020). Patients were identified through a centralized hospital database. We retrospectively collected demographic, clinicobiological, histological, imaging, treatment and outcome data. Patients with pericardial effusion, defined as an effusion visible on the CT-scan performed at GCA diagnosis were compared to those without pericardial involvement. RESULTS Among the 250 patients with GCA, 23 patients (9.2%) had pericardial effusion on CT-scan. The comparison between the groups revealed similar distribution of age, gender, cranial symptoms and ocular ischaemic complications. Patients with pericardial effusion had a higher frequency of weight loss. They also had lower haemoglobin levels and higher platelet levels (p = 0.006 and p = 0.002, respectively), and they more frequently had positive temporal artery biopsy. There were no differences concerning the treatment, relapses, follow-up duration or deaths. CONCLUSIONS This case series sheds light on GCA as a cause of unexplained pericardial effusion or symptomatic pericarditis among adults aged > 50 years and elevated inflammatory biological markers. Fortunately, pericardial involvement is a benign GCA manifestation. In that context, the search for constitutional symptoms, cranial symptoms and associated signs of polymyalgia rheumatica is crucial for rapidly guiding GCA diagnosis.
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Affiliation(s)
- Quentin Gomes de Pinho
- Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital Nord, Service de Médecine Interne, Aix-Marseille Université (AMU), Marseille, France.
| | - Aurélie Daumas
- Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital de la Timone, Service de Médecine Interne, Gériatrie et Thérapeutique, Aix-Marseille Université (AMU), Marseille, France
| | - Audrey Benyamine
- Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital Nord, Service de Médecine Interne, Aix-Marseille Université (AMU), Marseille, France
| | - Julien Bertolino
- Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital Nord, Service de Médecine Interne, Aix-Marseille Université (AMU), Marseille, France
| | - Pascal Rossi
- Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital Nord, Service de Médecine Interne, Aix-Marseille Université (AMU), Marseille, France
| | - Nicolas Schleinitz
- Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital de la Timone, Service de Médecine Interne, Aix-Marseille Université (AMU), Marseille, France
| | - Jean-Robert Harlé
- Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital de la Timone, Service de Médecine Interne, Aix-Marseille Université (AMU), Marseille, France
| | - Pierre André Jarrot
- Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital de la Conception, Service de Médecine Interne et Immunologie Clinique, Aix-Marseille Université (AMU), Marseille, France
| | - Gilles Kaplanski
- Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital de la Conception, Service de Médecine Interne et Immunologie Clinique, Aix-Marseille Université (AMU), Marseille, France
| | - Julie Berbis
- Faculté de Médecine de la Timone, Laboratoire de Santé Publique, EA 3279, Centre d'étude et de Recherche sur les Service de Santé et la Qualité de vie, Aix-Marseille Université (AMU), Marseille, France
| | - Brigitte Granel
- Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital Nord, Service de Médecine Interne, Aix-Marseille Université (AMU), Marseille, France
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Escoda T, George J, Jarrot PA, Jean R, Mazodier K, Sanderson F, Poullin P, Saby L, Jourde-Chiche N, Kaplanski G, Chiche L. Aortitis is an under-recognized manifestation of antiphospholipid syndrome: A case report and literature review. Lupus 2022; 31:744-753. [PMID: 35341372 DOI: 10.1177/09612033221091142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aortitis is a classic manifestation of large vessel vasculitis. Antiphospholipid syndrome (APS), sometimes known as Hughes syndrome, is an acquired autoimmune disorder that manifests clinically as recurrent venous or arterial thrombosis. Patients with APS may also suffer from various underlying diseases, most frequently systemic lupus erythematosus (SLE). Catastrophic antiphospholipid syndrome (CAPS) is a rare but serious complication of APS characterized by failure of several organs due to diffuse microcirculatory thrombi. Its main manifestations involve the kidneys, lungs, heart and central nervous system, and require early diagnosis and rapid therapeutic management. While APS can affect virtually any blood vessel, aortitis is not a known symptom of APS. We report the case of a 36-year-old patient with APS and SLE who presented with CAPS during pregnancy, with no concomitant SLE flare. The first manifestation of CAPS was aortitis, preceding renal, cardiac and haematological manifestations. The outcome was favourable with combined treatment including corticosteroids, anticoagulants, plasma exchange and rituximab. We then carried out a literature search for papers describing the presence of aortitis in APS and/or SLE. In the cases of aortic involvement identified in the literature, including another case of CAPS, the occurrence of aortitis in SLE, often associated with the presence of antiphospholipid antibodies/APS, suggests that aortitis should be considered as an under-recognized manifestation and potential non-criterion feature of APS.
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Affiliation(s)
- Thomas Escoda
- Service de Médecine Interne, 36900CHU Conception, Marseille, France.,Service de Médecine Interne, 36900Hôpital Européen, Marseille, France
| | - Julia George
- Service de Médecine Interne, 36900CHU Conception, Marseille, France
| | | | - Rodolphe Jean
- Service de Médecine Interne, 36900CHU Conception, Marseille, France
| | - Karin Mazodier
- Service de Médecine Interne, 36900CHU Conception, Marseille, France
| | | | - Pascale Poullin
- Service d'Hémaphérèse, 36900CHU Conception, Marseille France
| | - Ludivine Saby
- Service de Cardiologie, 36900Hôpital Européen, Marseille, France
| | | | - Gilles Kaplanski
- Service de Médecine Interne, 36900CHU Conception, Marseille, France
| | - Laurent Chiche
- Service de Médecine Interne, 36900Hôpital Européen, Marseille, France
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Arcani R, Cauchois R, Suchon P, Jean R, Jarrot P, Pinho QGD, Dalmas J, Jean E, Andre B, Veit V, Koubi M, Kaplanski G. Factors associated with dexamethasone efficacy in COVID‐19. A retrospective investigative cohort study. J Med Virol 2022; 94:3169-3175. [PMID: 35277862 PMCID: PMC9088322 DOI: 10.1002/jmv.27712] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/28/2022] [Accepted: 03/10/2022] [Indexed: 11/09/2022]
Abstract
Dexamethasone has demonstrated efficacy in reducing mortality in COVID‐19. However, its practical use is badly defined. We aimed to investigate factors associated with dexamethasone efficacy in real life. Our retrospective study was conducted in two university hospitals between September and November 2020 and included all the consecutive hospitalized patients with a laboratory‐confirmed SARS‐CoV‐2 infection assessed by RT‐PCR, treated with intravenous dexamethasone (6 mg/day). Among 111 patients, 10.6% necessitated a transfer into the intensive care unit (ICU) and the 28‐day mortality rate was 17.1%. The 28‐day mortality rate was significantly lower in patients who demonstrated improvement at 48 h (hazard ratio [HR]: 0.17, 95% confidence interval [CI]: 0.04–0.78, p = 0.02) and 96 h (HR: 0.07, 95% CI: 0.02–0.31, p = 0.0005) after dexamethasone initiation. Apart from well‐known risk factors (age, hypertension, active cancer, severe lesions on chest computed tomography [CT] scan), we found that a high viral load in nasopharyngeal swab (Cycle threshold <30) at dexamethasone initiation was associated with higher 28‐day mortality (66.6% vs. 36.7%, p = 0.03). Patients who did not receive antibiotics at dexamethasone initiation had a higher rate of transfer into the ICU (55.6% vs. 23.5%, p = 0.045) with a trend towards higher mortality in case of severe or critical lesions on CT scan (75.0% vs. 25.0%, p = 0.053). Patients who did not improve within 2–4 days after steroid initiation have a bad prognosis and should receive additional anti‐inflammatory drugs. Our data suggest better efficacy of dexamethasone in patients with a low or negative viral load, receiving broad‐spectrum antibiotics. At dexamethasone initiation, a high viral load was associated with higher mortality. Patients without antibiotics were more transferred into the ICU. Mortality was lower when improvement 48 h and 96 h after dexamethasone initiation.
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Affiliation(s)
- Robin Arcani
- Department of Internal Medicine and Clinical Immunology, CHU La ConceptionAssistance Publique‐Hôpitaux de Marseille (AP‐HM)147 Boulevard Baille13005MarseilleFrance
- Center for Cardiovascular and Nutrition research (C2VN), INRA 1260, INSERM UMR_S 1263Aix‐Marseille University27 Boulevard Jean Moulin13385MarseilleFrance
| | - Raphael Cauchois
- Department of Internal Medicine and Clinical Immunology, CHU La ConceptionAssistance Publique‐Hôpitaux de Marseille (AP‐HM)147 Boulevard Baille13005MarseilleFrance
- Center for Cardiovascular and Nutrition research (C2VN), INRA 1260, INSERM UMR_S 1263Aix‐Marseille University27 Boulevard Jean Moulin13385MarseilleFrance
| | - Pierre Suchon
- Hematology Laboratory, CHU La Timone, Assistance Publique‐Hôpitaux de Marseille (AP‐HM)264 Rue Saint‐Pierre13005MarseilleFrance
| | - Rodolphe Jean
- Department of Internal Medicine and Clinical Immunology, CHU La ConceptionAssistance Publique‐Hôpitaux de Marseille (AP‐HM)147 Boulevard Baille13005MarseilleFrance
| | - Pierre‐André Jarrot
- Department of Internal Medicine and Clinical Immunology, CHU La ConceptionAssistance Publique‐Hôpitaux de Marseille (AP‐HM)147 Boulevard Baille13005MarseilleFrance
- Center for Cardiovascular and Nutrition research (C2VN), INRA 1260, INSERM UMR_S 1263Aix‐Marseille University27 Boulevard Jean Moulin13385MarseilleFrance
| | - Quentin Gomes De Pinho
- Department of Internal Medicine and Clinical Immunology, CHU La ConceptionAssistance Publique‐Hôpitaux de Marseille (AP‐HM)147 Boulevard Baille13005MarseilleFrance
| | - Jean‐Baptiste Dalmas
- Department of Internal Medicine and Clinical Immunology, CHU La ConceptionAssistance Publique‐Hôpitaux de Marseille (AP‐HM)147 Boulevard Baille13005MarseilleFrance
| | - Estelle Jean
- Department of Internal Medicine, CHU La TimoneAssistance Publique‐Hôpitaux de Marseille (AP‐HM)264 Rue Saint‐Pierre13005MarseilleFrance
| | - Baptiste Andre
- Department of Internal Medicine, CHU La TimoneAssistance Publique‐Hôpitaux de Marseille (AP‐HM)264 Rue Saint‐Pierre13005MarseilleFrance
| | - Véronique Veit
- Department of Internal Medicine, CHU La TimoneAssistance Publique‐Hôpitaux de Marseille (AP‐HM)264 Rue Saint‐Pierre13005MarseilleFrance
| | - Marie Koubi
- Department of Internal Medicine and Clinical Immunology, CHU La ConceptionAssistance Publique‐Hôpitaux de Marseille (AP‐HM)147 Boulevard Baille13005MarseilleFrance
| | - Gilles Kaplanski
- Department of Internal Medicine and Clinical Immunology, CHU La ConceptionAssistance Publique‐Hôpitaux de Marseille (AP‐HM)147 Boulevard Baille13005MarseilleFrance
- Center for Cardiovascular and Nutrition research (C2VN), INRA 1260, INSERM UMR_S 1263Aix‐Marseille University27 Boulevard Jean Moulin13385MarseilleFrance
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Mulatero M, Boucekine M, Felician O, Boussen S, Kaplanski G, Rossi P, Parola P, Stein A, Brouqui P, Lagier JC, Leone M, Kaphan E. Herpetic encephalitis: which treatment for which body weight? J Neurol 2022; 269:3625-3635. [DOI: 10.1007/s00415-022-10981-8] [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: 06/29/2021] [Revised: 01/01/2022] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
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26
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Le Joncour A, Desbois AC, Leroyer AS, Tellier E, Régnier P, Maciejewski-Duval A, Comarmond C, Barete S, Arock M, Bruneval P, Launay JM, Fouret P, Blank U, Rosenzwajg M, Klatzmann D, Jarraya M, Chiche L, Koskas F, Cacoub P, Kaplanski G, Saadoun D. Mast cells drive pathologic vascular lesions in Takayasu arteritis. J Allergy Clin Immunol 2022; 149:292-301.e3. [PMID: 33992671 DOI: 10.1016/j.jaci.2021.05.003] [Citation(s) in RCA: 4] [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: 12/04/2020] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Takayasu arteritis (TAK) is a large vessel vasculitis resulting in artery wall remodeling with segmental stenosis and/or aneurysm formation. Mast cells (MCs) are instrumental in bridging cell injury and inflammatory response. OBJECTIVES This study sought to investigate the contribution of MCs on vessel permeability, angiogenesis, and fibrosis in patients with TAK. METHODS MC activation and their tissue expression were assessed in sera and in aorta from patients with TAK and from healthy donors (HDs). In vivo permeability was assessed using a modified Miles assay. Subconfluent cultured human umbilic vein endothelial cells and fibroblasts were used in vitro to investigate the effects of MC mediators on angiogenesis and fibrogenesis. RESULTS This study found increased levels of MC activation markers (histamine and indoleamine 2,3-dioxygenase) in sera of patients with TAK compared with in sera of HDs. Marked expression of MCs was shown in aortic lesions of patients with TAK compared with in those of noninflammatory aorta controls. Using Miles assay, this study showed that sera of patients with TAK significantly increased vascular permeability in vivo as compared with that of HDs. Vessel permeability was abrogated in MC-deficient mice. MCs stimulated by sera of patients with TAK supported neoangiogenesis (increased human umbilic vein endothelial cell proliferation and branches) and fibrosis by inducing increased production of fibronectin, type 1 collagen, and α-smooth muscle actin by fibroblasts as compared to MCs stimulated by sera of HD. CONCLUSIONS MCs are a key regulator of vascular lesions in patients with TAK and may represent a new therapeutic target in large vessel vasculitis.
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Affiliation(s)
- Alexandre Le Joncour
- Department of Immunology-Immunopathology-Immunotherapy, Université Pierre-et-Marie-Curie Université de Paris 06, Unite Mixte de Recherche (UMR)S959, Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Universités, Paris, France; Department of Biotherapy, Hôpital Pitié-Salpêtrière, Paris, France; Department of Internal Medicine and Clinical Immunology, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, Paris, France
| | - Anne-Claire Desbois
- Department of Immunology-Immunopathology-Immunotherapy, Université Pierre-et-Marie-Curie Université de Paris 06, Unite Mixte de Recherche (UMR)S959, Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Universités, Paris, France; Department of Biotherapy, Hôpital Pitié-Salpêtrière, Paris, France; Department of Internal Medicine and Clinical Immunology, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, Paris, France
| | - Aurélie S Leroyer
- Centre de Recherche en CardioVasculaire et Nutrition, INSERM U1263, Inrae 1260, Aix-Marseille Université, Marseille, France
| | - Edwige Tellier
- Centre de Recherche en CardioVasculaire et Nutrition, INSERM U1263, Inrae 1260, Aix-Marseille Université, Marseille, France
| | - Paul Régnier
- Department of Immunology-Immunopathology-Immunotherapy, Université Pierre-et-Marie-Curie Université de Paris 06, Unite Mixte de Recherche (UMR)S959, Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Universités, Paris, France; Department of Biotherapy, Hôpital Pitié-Salpêtrière, Paris, France
| | - Anna Maciejewski-Duval
- Department of Immunology-Immunopathology-Immunotherapy, Université Pierre-et-Marie-Curie Université de Paris 06, Unite Mixte de Recherche (UMR)S959, Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Universités, Paris, France; Department of Biotherapy, Hôpital Pitié-Salpêtrière, Paris, France
| | - Cloé Comarmond
- Department of Immunology-Immunopathology-Immunotherapy, Université Pierre-et-Marie-Curie Université de Paris 06, Unite Mixte de Recherche (UMR)S959, Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Universités, Paris, France; Department of Biotherapy, Hôpital Pitié-Salpêtrière, Paris, France; Department of Internal Medicine and Clinical Immunology, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, Paris, France
| | - Stéphane Barete
- Department of Internal Medicine and Clinical Immunology, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, Paris, France; Department of Dermatology DMU3ID, Unité Fonctionnelle de Dermatologie, Groupe Hospitalier Pitié-Salpêtrière-C. Foix, Paris, France
| | - Michel Arock
- Cell Death and Drug Resistance in Lymphoproliferative Disorders Team, INSERM UMRS1138, Centre de Recherche des Cordeliers, Paris, France; Laboratoire d'Hématologie Biologique, Hôpital Pitié-Salpêtrière, Paris, France
| | - Patrick Bruneval
- Laboratoire d'anatomopathologie, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Pierre Fouret
- Laboratoire d'Anatomopathologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Ulrich Blank
- Center of Research on Inflammation, INSERM UMR S1149 and Centre National de la Recherche Scientifique Experimental Research Laboratory 8252, Universite de Paris, Sorbonne Paris Cite, Laboratoire d'Excellence INFLAMEX, Paris, France
| | - Michelle Rosenzwajg
- Department of Immunology-Immunopathology-Immunotherapy, Université Pierre-et-Marie-Curie Université de Paris 06, Unite Mixte de Recherche (UMR)S959, Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Universités, Paris, France; Department of Biotherapy, Hôpital Pitié-Salpêtrière, Paris, France; Department of Internal Medicine and Clinical Immunology, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, Paris, France
| | - David Klatzmann
- Department of Immunology-Immunopathology-Immunotherapy, Université Pierre-et-Marie-Curie Université de Paris 06, Unite Mixte de Recherche (UMR)S959, Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Universités, Paris, France; Department of Biotherapy, Hôpital Pitié-Salpêtrière, Paris, France; Department of Internal Medicine and Clinical Immunology, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, Paris, France
| | - Mohamed Jarraya
- Banque des Tissus Humains, Hôpital Saint Louis, Paris, France
| | - Laurent Chiche
- Service de Chirurgie Vasculaire, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fabien Koskas
- Service de Chirurgie Vasculaire, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Patrice Cacoub
- Department of Immunology-Immunopathology-Immunotherapy, Université Pierre-et-Marie-Curie Université de Paris 06, Unite Mixte de Recherche (UMR)S959, Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Universités, Paris, France; Department of Biotherapy, Hôpital Pitié-Salpêtrière, Paris, France; Department of Internal Medicine and Clinical Immunology, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, Paris, France
| | - Gilles Kaplanski
- Centre de Recherche en CardioVasculaire et Nutrition, INSERM U1263, Inrae 1260, Aix-Marseille Université, Marseille, France; Service de Médecine Interne, Centre Hospitalier Universitaire Conception, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - David Saadoun
- Department of Immunology-Immunopathology-Immunotherapy, Université Pierre-et-Marie-Curie Université de Paris 06, Unite Mixte de Recherche (UMR)S959, Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Universités, Paris, France; Department of Biotherapy, Hôpital Pitié-Salpêtrière, Paris, France; Department of Internal Medicine and Clinical Immunology, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, Paris, France.
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Gomes de Pinho Q, Daumas A, Benyamine A, Ebbo M, Jarrot P, Kaplanski G, Schleinitz N, Rossi P, Bernard-Guervilly F, Harlé J, Berbis J, Granel B. Épanchement péricardique au diagnostic d’artérite à cellules géantes. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.152] [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: 10/19/2022]
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28
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Bichon A, Bourenne J, Allardet-Servent J, Papazian L, Hraiech S, Guervilly C, Pauly V, Kaplanski G, Mokart D, Gainnier M, Carvelli J. High Mortality of HLH in ICU Regardless Etiology or Treatment. Front Med (Lausanne) 2021; 8:735796. [PMID: 34692727 PMCID: PMC8526960 DOI: 10.3389/fmed.2021.735796] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/31/2021] [Indexed: 01/30/2023] Open
Abstract
Background: Adult hemophagocytic lymphohistiocytosis (HLH) is highly lethal in the ICU. The diagnostic and therapeutic emergency that HLH represents is compounded by its unknown pathophysiological mechanisms. Here, we report on a large cohort of adult HLH in the ICU (ICU-HLH). We analyzed prognostic factors associated with mortality to define the diagnostic and therapeutic challenges in this specific population. Methods: This retrospective study included adult patients diagnosed with HLH in four ICUs in Marseille, France between 2010 and 2020. Patients who fulfilled the HLH-2004 criteria (≥ 4/8) and/or had an HScore ≥ 169 were diagnosed with HLH. HLH was categorized into four groups according to etiology: sepsis-associated HLH, intracellular infection-associated HLH, malignancy-associated HLH, and idiopathic HLH. Results: Two hundred and sixty patients were included: 121 sepsis-associated HLH (47%), 84 intracellular infection-associated HLH (32%), 28 malignancy-associated HLH (11%), and 27 idiopathic HLH (10%). The ICU mortality rate reached 57% (n = 147/260) without a statistical difference between etiological groups. Independent factors associated with mortality in multivariate analysis included age (OR (5 years) = 1.31 [1.16-1.48], p < 0.0001), SOFA score at ICU admission (OR = 1.37 [1.21-1.56], p < 0.0001), degradation of the SOFA score between ICU arrival and HLH diagnosis (Delta SOFA) (OR = 1.47 [1.28-1.70], p < 0.0001), the presence of bone-marrow hemophagocytosis (OR = 5.27 [1.11-24.97], p = 0.04), highly severe anemia (OR = 1.44 [1.09-1.91], p = 0.01), and hypofibrinogenemia (OR = 1.21 [1.04-1.41], p = 0.02). Conclusions: In this large retrospective cohort study of critically ill patients, ICU-HLH in adults was associated with a 57% mortality rate, regardless of HLH etiology or specific treatment. Factors independently associated with prognosis included age, presence of hemophagocytosis in bone-marrow aspirates, organ failure at admission, and worsening organ failure during the ICU stay. Whether a rapid diagnosis and the efficacy of specific therapy improve outcome is yet to be prospectively investigated.
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Affiliation(s)
- Amandine Bichon
- APHM, University Timone Hospital, Réanimation des Urgences, Marseille, France
- Aix-Marseille University, Marseille, France
| | - Jérémy Bourenne
- APHM, University Timone Hospital, Réanimation des Urgences, Marseille, France
- Aix-Marseille University, Marseille, France
| | | | - Laurent Papazian
- Aix-Marseille University, Marseille, France
- Department of Respiratory and Infectious Intensive Care, APHM, University Nord Hospital, Marseille, France
| | - Sami Hraiech
- Aix-Marseille University, Marseille, France
- Department of Respiratory and Infectious Intensive Care, APHM, University Nord Hospital, Marseille, France
| | - Christophe Guervilly
- Aix-Marseille University, Marseille, France
- Department of Respiratory and Infectious Intensive Care, APHM, University Nord Hospital, Marseille, France
| | - Vanessa Pauly
- Department of Medical Information, CEReSS - Health Service Research and Quality of Life Center, APHM, Aix-Marseille University, Marseille, France
| | - Gilles Kaplanski
- Aix-Marseille University, Marseille, France
- Department of Internal Medicine and Clinical Immunology, APHM, University Conception Hospital, Marseille, France
| | - Djamel Mokart
- Department of Onco-Hematological Intensive Care, Paoli Calmette Institute, Marseille, France
| | - Marc Gainnier
- APHM, University Timone Hospital, Réanimation des Urgences, Marseille, France
- Aix-Marseille University, Marseille, France
| | - Julien Carvelli
- APHM, University Timone Hospital, Réanimation des Urgences, Marseille, France
- Aix-Marseille University, Marseille, France
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29
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Arcani R, Colle J, Cauchois R, Koubi M, Jarrot PA, Jean R, Boyer A, Lachamp J, Tichadou A, Couderc AL, Farnault L, Costello R, Venton G, Kaplanski G. Clinical characteristics and outcomes of patients with haematologic malignancies and COVID-19 suggest that prolonged SARS-CoV-2 carriage is an important issue. Ann Hematol 2021; 100:2799-2803. [PMID: 34518918 PMCID: PMC8437431 DOI: 10.1007/s00277-021-04656-z] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/25/2021] [Indexed: 12/23/2022]
Abstract
Specificities of COVID-19 disease course in patients with haematologic malignancies are still poorly studied. So, we aimed to compare patients with haematologic malignancies to patients without malignancies, matched by sex and age and hospitalised for COVID-19 at the same time and in the same centre. Among 25 patients with haematologic malignancies, we found that mortality (40% versus 4%, p < 0.01), number of days with RT-PCR positivity (21.2 ± 15.9 days [range, 3-57] versus 7.4 ± 5.6 days [range, 1-24], p < 0.01), maximal viral load (mean minimal Ct, 17.2 ± 5.2 [range, 10-30] versus 26.5 ± 5.1 [range, 15-33], p < 0.0001) and the delay between symptom onset and clinical worsening (mean time duration between symptom onset and first day of maximum requirement in inspired oxygen fraction, 14.3 ± 10.7 days versus 9.6 ± 3.7 days, p = 0.0485) were higher than in other patients. COVID-19 course in patients with haematologic malignancies has a delayed onset and is more severe with a higher mortality, and patients may be considered as super-spreaders. Clinicians and intensivists need to be trained to understand the specificity of COVID-19 courses in patients with haematological malignancies.
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Affiliation(s)
- Robin Arcani
- Department of Internal Medicine and Clinical Immunology, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), 145 Boulevard Baille, Marseille, 13005, France.
- Center for Cardiovascular and Nutrition Research (C2VN), INRA 1260, INSERM UMR_S 1263, Aix-Marseille University, Marseille, France.
| | - Julien Colle
- Hematology and Cellular Therapy Department, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Raphaël Cauchois
- Department of Internal Medicine and Clinical Immunology, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), 145 Boulevard Baille, Marseille, 13005, France
- Center for Cardiovascular and Nutrition Research (C2VN), INRA 1260, INSERM UMR_S 1263, Aix-Marseille University, Marseille, France
| | - Marie Koubi
- Department of Internal Medicine and Clinical Immunology, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), 145 Boulevard Baille, Marseille, 13005, France
| | - Pierre-André Jarrot
- Department of Internal Medicine and Clinical Immunology, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), 145 Boulevard Baille, Marseille, 13005, France
- Center for Cardiovascular and Nutrition Research (C2VN), INRA 1260, INSERM UMR_S 1263, Aix-Marseille University, Marseille, France
| | - Rodolphe Jean
- Department of Internal Medicine and Clinical Immunology, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), 145 Boulevard Baille, Marseille, 13005, France
| | - Arthur Boyer
- Réanimation Des Brûlés, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Julie Lachamp
- Réanimation Des Brûlés, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Antoine Tichadou
- Hematology and Cellular Therapy Department, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Anne-Laure Couderc
- Geriatric and Therapeutic Unit, Internal Medicine, CHU Sainte Marguerite, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Etablissement Français du Sang, Anthropologie, Droit, Ethique en Santé, Centre National de La Recherche Scientifique (CNRS), Marseille, France
| | - Laure Farnault
- Hematology and Cellular Therapy Department, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Regis Costello
- Hematology and Cellular Therapy Department, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Geoffroy Venton
- Hematology and Cellular Therapy Department, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Gilles Kaplanski
- Department of Internal Medicine and Clinical Immunology, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), 145 Boulevard Baille, Marseille, 13005, France
- Center for Cardiovascular and Nutrition Research (C2VN), INRA 1260, INSERM UMR_S 1263, Aix-Marseille University, Marseille, France
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Arcani R, Bertin D, Bardin N, Mazodier K, Jean R, Suchon P, Venton G, Daumas A, Jean E, Villani P, Kaplanski G, Jarrot PA. Anti-NuMA antibodies: clinical associations and significance in patients with primary Sjögren's syndrome or systemic lupus erythematosus. Rheumatology (Oxford) 2021; 60:4074-4084. [PMID: 33404653 DOI: 10.1093/rheumatology/keaa881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/05/2020] [Revised: 11/26/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To determine the clinical significance of anti-nuclear mitotic apparatus (NuMA) antibodies (AC-26 or AC-25) in patients with primary Sjögren's syndrome (pSS) and SLE. METHODS Between 2013 and 2018, clinical and immunological features of pSS and SLE patients with anti-NuMA antibodies were compared with anti-NuMA antibodies-negative pSS and SLE cohorts. RESULTS Among 31 284 sera positive for antinuclear antibodies, 90 patients (0.29%) had anti-AC-26 (anti-NuMA1) and AC-25 (anti-HsEg5) antibodies (73.3% and 26.7%, respectively). Autoimmune diseases, mainly consisting in pSS (28.9%) and SLE (21.1%), were found in 67.8%. Anti-NuMA antibodies represented the unique ANA in 60% and 50% of patients with pSS and SLE patients, respectively. Compared with 137 anti-NuMA-negative pSS patients, 20 anti-NuMA-positive pSS presented with less frequent ocular sicca syndrome (70.0% vs 89.1%, P=0.031), dryness complications (15.0% vs 39.4%, P=0.045), or detectable anti-SSa and/or anti-SSb antibodies (40.0% vs 66.4%, P=0.027). Compared with 80 anti-NuMA-negative SLE patients, 14 anti-NuMA-positive SLE patients had no lupus nephritis (0.0% vs 28.8%, P=0.049), less frequent dsDNA antibodies (42.9% vs 75.0%, P=0.025) and complement consumption (21.4% vs 53.8%, P=0.040). Anti-NuMA-positive pSS and SLE patients less frequently required treatments compared with anti-NuMA-negative patients. CONCLUSION Although rare, anti-NuMA antibodies are mainly associated with pSS and SLE and may be useful for diagnosis when other auto-antibodies are negative. PSS and SLE patients with anti-NuMA antibodies have less severe clinical and biological profiles, suggesting that anti-NuMA antibodies may constitute a good prognosis marker in both autoimmune diseases.
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Affiliation(s)
- Robin Arcani
- Department of Internal Medicine and Clinical Immunology, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM).,Center for Cardiovascular and Nutrition research (C2VN), INRA 1260, INSERM UMR_S 1263, Aix-Marseille University
| | - Daniel Bertin
- Department of Biological Immunology, CHU La Conception
| | - Nathalie Bardin
- Center for Cardiovascular and Nutrition research (C2VN), INRA 1260, INSERM UMR_S 1263, Aix-Marseille University.,Department of Biological Immunology, CHU La Conception
| | - Karin Mazodier
- Department of Internal Medicine and Clinical Immunology, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM)
| | - Rodolphe Jean
- Department of Internal Medicine and Clinical Immunology, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM)
| | | | - Geoffroy Venton
- Hematology and Cellular Therapy Department, CHU La Conception
| | - Aurélie Daumas
- Center for Cardiovascular and Nutrition research (C2VN), INRA 1260, INSERM UMR_S 1263, Aix-Marseille University.,Internal Medicine, Geriatrics and Therapeutics Department, CHU La Timone
| | - Estelle Jean
- Internal Medicine Department, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Patrick Villani
- Internal Medicine, Geriatrics and Therapeutics Department, CHU La Timone
| | - Gilles Kaplanski
- Department of Internal Medicine and Clinical Immunology, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM).,Center for Cardiovascular and Nutrition research (C2VN), INRA 1260, INSERM UMR_S 1263, Aix-Marseille University
| | - Pierre-André Jarrot
- Department of Internal Medicine and Clinical Immunology, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM).,Center for Cardiovascular and Nutrition research (C2VN), INRA 1260, INSERM UMR_S 1263, Aix-Marseille University
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31
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Dekimpe C, Roose E, Kangro K, Bonnez Q, Vandenbulcke A, Tellier E, Kaplanski G, Feys HB, Tersteeg C, Männik A, De Meyer SF, Vanhoorelbeke K. Determination of anti-ADAMTS-13 autoantibody titers in ELISA: Influence of ADAMTS-13 presentation and autoantibody detection. J Thromb Haemost 2021; 19:2248-2255. [PMID: 33728786 DOI: 10.1111/jth.15297] [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: 01/06/2021] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is caused by inhibitory and/or clearing anti-ADAMTS-13 (A Disintegrin and Metalloprotease with ThromboSpondin type 1 repeats, member 13) autoantibodies. To determine the presence and total level of anti-ADAMTS-13 autoantibodies, commercial and in-house developed ELISAs are performed. However, different ELISA methods vary in relation to the presentation of recombinant (r)ADAMTS-13 and the detection method of the anti-ADAMTS-13 autoantibodies. Currently, the influence of those different approaches on anti-ADAMTS-13 autoantibody titers is not known. OBJECTIVES To assess the influence of different ADAMTS-13 presentation- and autoantibody detection methods on anti-ADAMTS-13 autoantibody titers in ELISA. MATERIALS/METHODS Anti-ADAMTS-13 autoantibody titers from 18 iTTP patients were determined using four different set-ups of anti-ADAMTS-13 autoantibody ELISAs. The ELISAs varied in the used presentation of rADAMTS-13 (directly coated full-length rADAMTS-13, directly coated rMDTCS and rT2C2, or antibody-captured full-length rADAMTS-13) and the detection antibodies (polyclonal anti-human IgG or monoclonal anti-human IgG1-4 antibodies). RESULTS Strong correlations between the different anti-ADAMTS-13 autoantibody ELISA approaches were observed, when using polyclonal anti-human IgG detection antibodies recognizing all IgG subclasses similarly, independent of the method of rADAMTS-13 presentation. Anti-ADAMTS-13 autoantibody titers correlated less when using a mixture of monoclonal anti-human IgG1-4 , because not all IgG subclasses were recognized with similar affinities. CONCLUSION Anti-ADAMTS-13 autoantibody levels using different methods of rADAMTS-13 presentation strongly correlate. However, the levels of anti-ADAMTS-13 autoantibodies are highly dependent on the detection antibody used, which should detect all IgG subclasses (IgG1-4 ) equally well.
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Affiliation(s)
- Charlotte Dekimpe
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Elien Roose
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Kadri Kangro
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
- Icosagen Cell Factory OÜ, Kambja vald, Tartumaa, Estonia
| | - Quintijn Bonnez
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Aline Vandenbulcke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Edwige Tellier
- C2VN, INSERM, INRAE, Aix Marseille Universite, Marseille, France
| | - Gilles Kaplanski
- C2VN, INSERM, INRAE, Aix Marseille Universite, Marseille, France
- Hôpital de la Conception, Service de médecine interne, APHM, C2VN, INSERM, INRAE, Aix Marseille Universite, Marseille, France
| | - Hendrik B Feys
- Transfusion Research Center, Belgian Red Cross-Flanders, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Claudia Tersteeg
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Andres Männik
- Icosagen Cell Factory OÜ, Kambja vald, Tartumaa, Estonia
| | - Simon F De Meyer
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
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Kyriazopoulou E, Huet T, Cavalli G, Gori A, Kyprianou M, Pickkers P, Eugen-Olsen J, Clerici M, Veas F, Chatellier G, Kaplanski G, Netea MG, Pontali E, Gattorno M, Cauchois R, Kooistra E, Kox M, Bandera A, Beaussier H, Mangioni D, Dagna L, van der Meer JWM, Giamarellos-Bourboulis EJ, Hayem G. Effect of anakinra on mortality in patients with COVID-19: a systematic review and patient-level meta-analysis. Lancet Rheumatol 2021; 3:e690-e697. [PMID: 34396156 PMCID: PMC8352496 DOI: 10.1016/s2665-9913(21)00216-2] [Citation(s) in RCA: 102] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Anakinra might improve the prognosis of patients with moderate to severe COVID-19 (ie, patients requiring oxygen supplementation but not yet receiving organ support). We aimed to assess the effect of anakinra treatment on mortality in patients admitted to hospital with COVID-19. Methods For this systematic review and individual patient-level meta-analysis, a systematic literature search was done on Dec 28, 2020, in Medline (PubMed), Cochrane, medRxiv, bioRxiv, and the ClinicalTrials.gov databases for randomised trials, comparative studies, and observational studies of patients admitted to hospital with COVID-19, comparing administration of anakinra with standard of care, or placebo, or both. The search was repeated on Jan 22, 2021. Individual patient-level data were requested from investigators and corresponding authors of eligible studies; if individual patient-level data were not available, published data were extracted from the original reports. The primary endpoint was mortality after 28 days and the secondary endpoint was safety (eg, the risk of secondary infections). This study is registered on PROSPERO (CRD42020221491). Findings 209 articles were identified, of which 178 full-text articles fulfilled screening criteria and were assessed. Aggregate data on 1185 patients from nine studies were analysed, and individual patient-level data on 895 patients were provided from six of these studies. Eight studies were observational and one was a randomised controlled trial. Most studies used historical controls. In the individual patient-level meta-analysis, after adjusting for age, comorbidities, baseline ratio of the arterial partial oxygen pressure divided by the fraction of inspired oxygen (PaO2/FiO2), C-reactive protein (CRP) concentrations, and lymphopenia, mortality was significantly lower in patients treated with anakinra (38 [11%] of 342) than in those receiving standard of care with or without placebo (137 [25%] of 553; adjusted odds ratio [OR] 0·32 [95% CI 0·20-0·51]). The mortality benefit was similar across subgroups regardless of comorbidities (ie, diabetes), ferritin concentrations, or the baseline PaO2/FiO2. In a subgroup analysis, anakinra was more effective in lowering mortality in patients with CRP concentrations higher than 100 mg/L (OR 0·28 [95% CI 0·17-0·47]). Anakinra showed a significant survival benefit when given without dexamethasone (OR 0·23 [95% CI 0·12-0·43]), but not with dexamethasone co-administration (0·72 [95% CI 0·37-1·41]). Anakinra was not associated with a significantly increased risk of secondary infections when compared with standard of care (OR 1·35 [95% CI 0·59-3·10]). Interpretation Anakinra could be a safe, anti-inflammatory treatment option to reduce the mortality risk in patients admitted to hospital with moderate to severe COVID-19 pneumonia, especially in the presence of signs of hyperinflammation such as CRP concentrations higher than 100 mg/L. Funding Sobi.
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Affiliation(s)
- Evdoxia Kyriazopoulou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Thomas Huet
- Rheumatology Department, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Giulio Cavalli
- Unit of Immunology, Rheumatology, Allergy, and Rare Diseases, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Gori
- Infectious Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Miltiades Kyprianou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud University, Nijmegen, Netherlands
| | - Jesper Eugen-Olsen
- Department of Clinical Research, Copenhagen University Hospital, Hvidovre, Denmark
| | - Mario Clerici
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Don C Gnocchi Foundation, IRCCS, Milan, Italy
| | - Francisco Veas
- Montpellier University, French Research Institute for Development, UMR5151, Mitigation Strategies for Biosecurity Risks/MSBR, PHYSE, Faculty of Pharmacy, Montpellier, France
| | - Gilles Chatellier
- Rheumatology Department, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Gilles Kaplanski
- Assistance Publique - Hôpitaux de Marseille, Division of Internal Medicine and Clinical Immunology, Hôpital Conception, Aix-Marseille Université, Marseille, France
| | - Mihai G Netea
- Department of Internal Medicine and Center for Infectious Diseases, Radboud University, Nijmegen, Netherlands
| | | | - Marco Gattorno
- Center for Autoinflammatory diseases and Immunodeficiencies, IRCCS G Gaslini, Genova, Italy
| | - Raphael Cauchois
- Assistance Publique - Hôpitaux de Marseille, Division of Internal Medicine and Clinical Immunology, Hôpital Conception, Aix-Marseille Université, Marseille, France
| | - Emma Kooistra
- Department of Intensive Care Medicine, Radboud University, Nijmegen, Netherlands
| | - Matthijs Kox
- Department of Intensive Care Medicine, Radboud University, Nijmegen, Netherlands
| | - Alessandra Bandera
- Infectious Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Hélène Beaussier
- Rheumatology Department, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Davide Mangioni
- Infectious Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy, and Rare Diseases, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy
| | - Jos W M van der Meer
- Department of Internal Medicine and Center for Infectious Diseases, Radboud University, Nijmegen, Netherlands
| | | | - Gilles Hayem
- Rheumatology Department, Groupe Hospitalier Paris Saint-Joseph, Paris, France
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Briantais A, De Sainte Marie B, Campana-Salort E, Kaplanski G, Durand JM, Bertin D, Bardin N, Ebbo M, Schleinitz N. Considering the level of myositis-specific autoantibodies could improve the precision of multiplex assay : lesson from patients with multiple positive results. Semin Arthritis Rheum 2021; 52:151871. [PMID: 34404513 DOI: 10.1016/j.semarthrit.2021.06.011] [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: 06/11/2021] [Accepted: 06/21/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Antoine Briantais
- Department of Internal Medicine, Assistance Publique - Hôpitaux de Marseille, CHU La Timone, Aix Marseille University, Marseille, France.
| | - Benjamin De Sainte Marie
- Department of Internal Medicine, Assistance Publique - Hôpitaux de Marseille, CHU La Timone, Aix Marseille University, Marseille, France
| | - Emmanuelle Campana-Salort
- Department of Neurology, Neuromuscular and ALS Reference Center, Assistance Publique - Hôpitaux de Marseille, CHU La Timone, Aix Marseille University, Marseille, France
| | - Gilles Kaplanski
- Department of Internal Medicine and Clinical Immunology, Assistance Publique - Hôpitaux de Marseille, CHU La Conception, Aix Marseille University, Marseille, France
| | - Jean-Marc Durand
- Department of Internal Medicine, Assistance Publique - Hôpitaux de Marseille, CHU La Timone, Aix Marseille University, Marseille, France
| | - Daniel Bertin
- Department of Biological Immunology, Assistance Publique - Hôpitaux de Marseille, CHU La Conception, Aix Marseille University, Marseille, France
| | - Nathalie Bardin
- Department of Biological Immunology, Assistance Publique - Hôpitaux de Marseille, CHU La Conception, Aix Marseille University, Marseille, France
| | - Mikael Ebbo
- Department of Internal Medicine, Assistance Publique - Hôpitaux de Marseille, CHU La Timone, Aix Marseille University, Marseille, France
| | - Nicolas Schleinitz
- Department of Internal Medicine, Assistance Publique - Hôpitaux de Marseille, CHU La Timone, Aix Marseille University, Marseille, France
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34
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Benyamine A, Bertin D, Resseguier N, Heim X, Bermudez J, Launay D, Dubucquoi S, Hij A, Farge D, Lescoat A, Bahon-Riedinger I, Benmostefa N, Mouthon L, Harlé JR, Kaplanski G, Rossi P, Bardin N, Granel B. Quantification of Antifibrillarin (anti-U3 RNP) Antibodies: A New Insight for Patients with Systemic Sclerosis. Diagnostics (Basel) 2021; 11:diagnostics11061064. [PMID: 34207757 PMCID: PMC8226926 DOI: 10.3390/diagnostics11061064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/19/2021] [Accepted: 05/26/2021] [Indexed: 12/04/2022] Open
Abstract
Background: The detection of additional autoantibodies is of great concern in systemic sclerosis (SSc) when those included in the ACR/EULAR classification are negative. In this context, the interest of antifibrillarin (anti-U3RNP) autoantibodies (AFAs) in the routine evaluation of SSc remains unclear. We aimed to assess the relevance of AFAs and their clinical association in SSc patients. Methods: In a multicenter observational retrospective study, we collected immunological and clinical data associated with AFA positivity in SSc (n = 42) and non-SSc patients (n = 13). Patients with SSc negative for AFAs (n = 83) were considered as a control group. AFAs were detected by indirect immunofluorescence (IIF) using HEp-2 cells, EliA or immunoblot techniques. Results: We confirmed a typical nuclear IIF pattern and showed that AFAs are mostly exclusive towards SSc conventional autoantibodies. Although also observed in non-SSc patients, high levels of AFAs with the ELiA technique allowed the diagnosis of SSc. Compared to AFA-negative SSc patients, AFA-positive SSc patients more frequently exhibited visceral involvements. They more frequently suffered from the diffuse cutaneous form and had a higher global severity of the disease. Conclusions: We demonstrate the usefulness of quantifying AFAs in the immunological exploration of SSc, especially when patients are seronegative for SSc conventional autoantibodies and display a typical IIF pattern. AFAs might constitute an interesting marker of SSc severity.
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Affiliation(s)
- Audrey Benyamine
- Internal Medicine Department, North Hospital of Marseilles, Public Assistance Hospital of Marseilles (AP-HM), 13015 Marseilles, France; (P.R.); (B.G.)
- Aix Marseilles University (AMU), INSERM, INRA, C2VN, 13005 Marseilles, France; (X.H.); (J.B.); (G.K.); (N.B.)
- Correspondence: ; Tel.: +33-4-91-96-87-11; Fax: +33-4-91-96-80-80
| | - Daniel Bertin
- Immunology Laboratory, La Conception Hospital, Public Assistance Hospital of Marseilles (AP-HM), 13005 Marseilles, France;
| | - Noémie Resseguier
- Epidemiology and Health Economics, La Timone Hospital, AP-HM, Aix Marseilles University (AMU), 13005 Marseilles, France;
| | - Xavier Heim
- Aix Marseilles University (AMU), INSERM, INRA, C2VN, 13005 Marseilles, France; (X.H.); (J.B.); (G.K.); (N.B.)
- Immunology Laboratory, La Conception Hospital, Public Assistance Hospital of Marseilles (AP-HM), 13005 Marseilles, France;
| | - Julien Bermudez
- Aix Marseilles University (AMU), INSERM, INRA, C2VN, 13005 Marseilles, France; (X.H.); (J.B.); (G.K.); (N.B.)
| | - David Launay
- Univ. Lille, U1286-INFINITE—Institute for Translational Research in Inflammation, F-59000 Lille, France;
- Inserm, F-59000 Lille, France
- CHU Lille, Internal Medicine and Clinical Immunology Department, Center of Reference for Rare Autoimmune and Systemic Diseases of North and North-West France (CeRAINO), F-59000 Lille, France
| | - Sylvain Dubucquoi
- Immunology Institute, Hospital University Center of Lille, 59037 Lille, France;
| | - Adrian Hij
- Public Assistance Hospital of Paris, Saint-Louis Hospital, Autoimmune and Vascular Disease Unit, Internal Medicine (UF04), Center of reference for rare systemic autoimmune diseases (FAI2R), Université de Paris, EA 3518, Paris, France; (A.H.); (D.F.)
| | - Dominique Farge
- Public Assistance Hospital of Paris, Saint-Louis Hospital, Autoimmune and Vascular Disease Unit, Internal Medicine (UF04), Center of reference for rare systemic autoimmune diseases (FAI2R), Université de Paris, EA 3518, Paris, France; (A.H.); (D.F.)
- Department of Medicine, McGill University, Montreal, QC H3G 2M1, Canada
| | - Alain Lescoat
- Internal Medicine and Clinical Immunology Department, Hospital University Center of Rennes, 35000 Rennes, France;
| | | | - Nouria Benmostefa
- Internal Medicine Department, Center of reference for rare systemic autoimmune diseases of Ile de France, Cochin Hospital, Public Assistance Hospital of Paris (AP-HP), 75014 Paris, France; (N.B.); (L.M.)
| | - Luc Mouthon
- Internal Medicine Department, Center of reference for rare systemic autoimmune diseases of Ile de France, Cochin Hospital, Public Assistance Hospital of Paris (AP-HP), 75014 Paris, France; (N.B.); (L.M.)
| | - Jean-Robert Harlé
- Internal Medicine Department, La Timone Hospital, Public Assistance Hospital of Marseilles (AP-HM), 13005 Marseilles, France;
| | - Gilles Kaplanski
- Aix Marseilles University (AMU), INSERM, INRA, C2VN, 13005 Marseilles, France; (X.H.); (J.B.); (G.K.); (N.B.)
- Internal Medicine and Clinical Immunology Department, La Conception Hospital, Public Assistance Hospital of Marseilles (AP-HM), 13005 Marseilles, France
| | - Pascal Rossi
- Internal Medicine Department, North Hospital of Marseilles, Public Assistance Hospital of Marseilles (AP-HM), 13015 Marseilles, France; (P.R.); (B.G.)
- Aix Marseilles University (AMU), INSERM, INRA, C2VN, 13005 Marseilles, France; (X.H.); (J.B.); (G.K.); (N.B.)
| | - Nathalie Bardin
- Aix Marseilles University (AMU), INSERM, INRA, C2VN, 13005 Marseilles, France; (X.H.); (J.B.); (G.K.); (N.B.)
- Immunology Laboratory, La Conception Hospital, Public Assistance Hospital of Marseilles (AP-HM), 13005 Marseilles, France;
| | - Brigitte Granel
- Internal Medicine Department, North Hospital of Marseilles, Public Assistance Hospital of Marseilles (AP-HM), 13015 Marseilles, France; (P.R.); (B.G.)
- Aix Marseilles University (AMU), INSERM, INRA, C2VN, 13005 Marseilles, France; (X.H.); (J.B.); (G.K.); (N.B.)
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35
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Arcani R, Bertin D, Bardin N, Jean R, Mazodier K, Jarrot P, Kaplanski G. Anticorps anti-NuMA : associations cliniques et impact sur le phénotype de patients atteints de syndrome de Sjögren primitif et de lupus érythémateux systémique. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.226] [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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36
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Kessel C, Vollenberg R, Masjosthusmann K, Hinze C, Wittkowski H, Debaugnies F, Nagant C, Corazza F, Vély F, Kaplanski G, Girard-Guyonvarc'h C, Gabay C, Schmidt H, Foell D, Tepasse PR. Discrimination of COVID-19 From Inflammation-Induced Cytokine Storm Syndromes Using Disease-Related Blood Biomarkers. Arthritis Rheumatol 2021; 73:1791-1799. [PMID: 33880885 PMCID: PMC8251089 DOI: 10.1002/art.41763] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 11/20/2020] [Accepted: 04/06/2021] [Indexed: 12/26/2022]
Abstract
Objective Infection with the novel coronavirus SARS–CoV‐2 triggers severe illness with high mortality in a subgroup of patients. Such a critical course of COVID‐19 is thought to be associated with the development of cytokine storm, a condition seen in macrophage activation syndrome (MAS) and secondary hemophagocytic lymphohistiocytosis (HLH). However, specific data demonstrating a clear association of cytokine storm with severe COVID‐19 are still lacking. The aim of this study was to directly address whether immune activation in COVID‐19 does indeed mimic the conditions found in these classic cytokine storm syndromes. Methods Levels of 22 biomarkers were quantified in serum samples from patients with COVID‐19 (n = 30 patients, n = 83 longitudinal samples in total), patients with secondary HLH/MAS (n = 50), and healthy controls (n = 9). Measurements were performed using bead array assays and single‐marker enzyme‐linked immunosorbent assay. Serum biomarker levels were assessed for correlations with disease outcome. Results In patients with secondary HLH/MAS, we observed pronounced activation of the interleukin‐18 (IL‐18)–interferon‐γ axis, increased serum levels of IL‐1 receptor antagonist, intercellular adhesion molecule 1, and IL‐8, and strongly reduced levels of soluble Fas ligand in the course of SARS–CoV‐2 infection. These observations appeared to discriminate immune dysregulation in critical COVID‐19 from the well‐recognized characteristics of other cytokine storm syndromes. Conclusion Serum biomarker profiles clearly separate COVID‐19 from MAS or secondary HLH in terms of distinguishing the severe systemic hyperinflammation that occurs following SARS–CoV‐2 infection. These findings could be useful in determining the efficacy of drugs targeting key molecules and pathways specifically associated with systemic cytokine storm conditions in the treatment of COVID‐19.
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Affiliation(s)
- Christoph Kessel
- Department of Pediatric Rheumatology and Immunology, University Children's Hospital Muenster, Muenster, Germany
| | - Richard Vollenberg
- Department of Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital Muenster, Muenster, Germany
| | - Katja Masjosthusmann
- Department of General Pediatrics, University Children's Hospital Muenster, Muenster, Germany
| | - Claas Hinze
- Department of Pediatric Rheumatology and Immunology, University Children's Hospital Muenster, Muenster, Germany
| | - Helmut Wittkowski
- Department of Pediatric Rheumatology and Immunology, University Children's Hospital Muenster, Muenster, Germany
| | - France Debaugnies
- Laboratory of Translational Research, Centre Hospitalier Universitaire Brugmann, Université Libre de Bruxelles, Brussels, Belgium and Medical Biology Department, Laboratoire National de Santé, Dudelange, Luxembourg
| | - Carole Nagant
- Immunology Department, LHUB-ULB, Université Libre de Bruxelles, Brussels, Belgium
| | - Francis Corazza
- Laboratory of Translational Research, Centre Hospitalier Universitaire Brugmann and Immunology Department, LHUB-ULB, Université Libre de Bruxelles, Brussels, Belgium
| | - Frédéric Vély
- Aix Marseille Université, CNRS, INSERM, CIML and Assistance Publique des Hôpitaux de Marseille, Hôpital de la Timone, Immunology, Marseille Immunopole, Marseilles, France
| | - Gilles Kaplanski
- Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire Conception, Service de Médecine Interne et Immunologie Clinique, Aix-Marseille Universitô and Center for Cardiovascular Research and Nutrition, Aix-Marseille Université, INSERM UMRS1263, Marseilles, France
| | - Charlotte Girard-Guyonvarc'h
- Division of Rheumatology, Department of Medicine, University Hospital of GenevaDepartment of Medicine, University Hospital of Geneva, University of Geneva, Geneva, Switzerland
| | - Cem Gabay
- Division of Rheumatology, Department of Medicine, University Hospital of GenevaDepartment of Medicine, University Hospital of Geneva, University of Geneva, Geneva, Switzerland
| | - Hartmut Schmidt
- Department of Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital Muenster, Muenster, Germany
| | - Dirk Foell
- Department of Pediatric Rheumatology and Immunology, University Children's Hospital Muenster, Muenster, Germany
| | - Phil-Robin Tepasse
- Department of Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital Muenster, Muenster, Germany
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Muller R, Jarrot PA, Kaplanski G. Hydroxychloroquine-related hyperpigmentation. Rheumatology (Oxford) 2021; 61:873. [PMID: 33871581 DOI: 10.1093/rheumatology/keab352] [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: 03/24/2021] [Revised: 04/09/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Romain Muller
- Aix Marseillle université, APHM, Hopital La Conception, clinical immunology department
| | - Pierre André Jarrot
- Aix Marseillle université, APHM, Hopital La Conception, clinical immunology department
| | - Gilles Kaplanski
- Aix Marseillle université, APHM, Hopital La Conception, clinical immunology department
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38
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Pietri L, Giorgi R, Bégu A, Lojou M, Koubi M, Cauchois R, Grangeot R, Dubois N, Kaplanski G, Valéro R, Béliard S. Excess body weight is an independent risk factor for severe forms of COVID-19. Metabolism 2021; 117:154703. [PMID: 33421506 PMCID: PMC7834365 DOI: 10.1016/j.metabol.2021.154703] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 08/06/2020] [Revised: 12/30/2020] [Accepted: 01/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Few studies distinguished the independent role of overweight/obesity or their associated-comorbidities in the evolution towards severe forms of COVID-19. Obesity as a unifying risk factor for severe COVID-19 is an emerging hypothesis. The aim of this study was to evaluate whether excessive body weight per se, was a risk factor for developing a severe form of COVID-19. PATIENTS AND METHODS We included 131 patients hospitalized for COVID-19 pneumonia in a single center of the internal medicine department in Marseille, France. We recorded anthropometric and metabolic parameters such as fasting glycaemia, insulinemia, HOMA-IR, lipids, and all clinical criteria linked to SARS-CoV-2 infection at the admission. Excess body weight was defined by a BMI ≥ 25 kg/m2. The occurrence of a serious event was defined as a high-debit oxygen requirement over 6 L/min, admission into the intensive care unit, or death. RESULTS Among 113 patients, two thirds (n = 76, 67%) had an excess body weight. The number of serious events was significantly higher in excess body weight patients compared to normal weight patients (respectively 25% vs 8%, p = 0.03) although excess body weight patients were younger (respectively 63.6 vs 70.3 years old, p = 0.01). In multivariate analyses, the excess body weight status was the only predictor for developing a serious event linked to SARS-CoV-2 infection, with an odds ratio at 5.6 (95% CI: 1.30-23.96; p = 0.02), independently of previous obesity associated comorbidities. There was a trend towards a positive association between the BMI (normal weight, overweight and obesity) and the risk of serious events linked to COVID-19, with a marked increase from 8.1% to 20% and 30.6% respectively (p = 0.05). CONCLUSION Excess body weight was significantly associated with severe forms of the disease, independently of its classical associated comorbidities. Physicians and specialists in Public Health must be sensitized to better protect people with an excess body weight against SARS-CoV-2 infection.
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Affiliation(s)
- Léa Pietri
- Aix Marseille Univ, APHM, INSERM, INRAE, C2VN, Marseille, France; APHM, Department of Nutrition, Metabolic Diseases, Endocrinology, University Hospital La Conception, Marseille, France
| | - Roch Giorgi
- Aix Marseille Univ, APHM, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Hop Timone, BioSTIC, Biostatistique et Technologies de l'Information et de la, Communication, Marseille, France
| | - Audrey Bégu
- APHM, Department of Nutrition, Metabolic Diseases, Endocrinology, University Hospital La Conception, Marseille, France
| | - Manon Lojou
- APHM, Department of Nutrition, Metabolic Diseases, Endocrinology, University Hospital La Conception, Marseille, France
| | - Marie Koubi
- Department of Internal Medicine and Clinical Immunology, La Conception Hospital, APHM, 147 Bd Baille, 13005 Marseille, France
| | - Raphael Cauchois
- Aix Marseille Univ, APHM, INSERM, INRAE, C2VN, Marseille, France; Department of Internal Medicine and Clinical Immunology, La Conception Hospital, APHM, 147 Bd Baille, 13005 Marseille, France
| | - Rachel Grangeot
- APHM, Department of Nutrition, Metabolic Diseases, Endocrinology, University Hospital La Conception, Marseille, France
| | - Noémie Dubois
- APHM, Department of Nutrition, Metabolic Diseases, Endocrinology, University Hospital La Conception, Marseille, France
| | - Gilles Kaplanski
- Department of Internal Medicine and Clinical Immunology, La Conception Hospital, APHM, 147 Bd Baille, 13005 Marseille, France
| | - René Valéro
- Aix Marseille Univ, APHM, INSERM, INRAE, C2VN, Marseille, France; APHM, Department of Nutrition, Metabolic Diseases, Endocrinology, University Hospital La Conception, Marseille, France
| | - Sophie Béliard
- Aix Marseille Univ, APHM, INSERM, INRAE, C2VN, Marseille, France; APHM, Department of Nutrition, Metabolic Diseases, Endocrinology, University Hospital La Conception, Marseille, France.
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39
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Kone-Paut I, Barete S, Bodaghi B, Deiva K, Desbois AC, Galeotti C, Gaudric J, Kaplanski G, Mahr A, Noel N, Piram M, Tran TA, Wechsler B, Saadoun D. French recommendations for the management of Behçet's disease. Orphanet J Rare Dis 2021; 16:352. [PMID: 33622338 PMCID: PMC7903591 DOI: 10.1186/s13023-020-01620-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Behçet's disease (BD) is a systemic variable vessel vasculitis that involves the skin, mucosa, joints, eyes, arteries, veins, nervous system and gastrointestinal system, presenting with remissions and exacerbations. It is a multifactorial disease, and several triggering factors including oral cavity infections and viruses may induce inflammatory attacks in genetically susceptible individuals. BD vasculitis involves different vessel types and sizes of the vascular tree with mixed-cellular perivascular infiltrates and is often complicated by recurrent thrombosis, particularly in the venous compartment. Several new therapeutic modalities with different mechanisms of action have been studied in patients with BD. A substantial amount of new data have been published on the management of BD, especially with biologics, over the last years. These important therapeutic advances in BD have led us to propose French recommendations for the management of Behçet's disease [Protocole National de Diagnostic et de Soins de la maladie de Behçet (PNDS)]. These recommendations are divided into two parts: (1) the diagnostic process and initial assessment; (2) the therapeutic management. Thirty key points summarize the essence of the recommendations. We highlighted the main differential diagnosis of BD according to the type of clinical involvement; the role of genetics is also discussed, and we indicate the clinical presentations that must lead to the search for a genetic cause.
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Affiliation(s)
- Isabelle Kone-Paut
- Pediatric Rheumatology and CEREMAIA, Bicêtre Hospital APHP, University of Paris Sud Saclay, Le Kremlin-Bicêtre, France.
| | - Stéphane Barete
- Unit of Dermatology, DMU3ID, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), INSERM-UMRS 959, Sorbonne Universités, Paris, France
| | - Bahram Bodaghi
- Department of Ophthalmology, CRMR OPHTARA, IHU FOReSIGHT, Pitié-Salpêtrière Hospital, APHP, Sorbonne University, Paris, France
| | - Kumaran Deiva
- Department of Pediatric Neurology, National Referral Center for Rare Inflammatory Brain and Spinal Diseases, Assistance Publique-Hopitaux de Paris, University Hospitals of Paris-Saclay, Bicêtre Hospital, Paris, France
- Inserm UMR1184, Immunology of Viral Infections and Autoimmune Diseases, University Paris Saclay, Le Kremlin-Bicêtre, France
| | - Anne-Claire Desbois
- UPMC Université Paris 06, Inserm UMR S 959, Immunology Immunopathology Immunotherapy (I3), Sorbonne Universités, 75005, Paris, France
- Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hôpital Pitié-Salpêtrière, AP-HP, 75651, Paris, France
- AP-HP groupe hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, centre national de référence maladies autoinflammatoires et amylose inflammatoire, centre national de références maladies autoimmunes systémiques rares, 75013, Paris, France
| | - Caroline Galeotti
- Pediatric Rheumatology and CEREMAIA, Bicêtre Hospital APHP, University of Paris Sud Saclay, Le Kremlin-Bicêtre, France
| | - Julien Gaudric
- Department of Vascular Surgery, Pitié-Salpétrière Hospital, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Gilles Kaplanski
- Internal Medicine and Clinical Immunology Department, Hôpital de la Conception, Aix-Marseille Université, Marseille, France
| | - Alfred Mahr
- Clinic for Rheumatology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Nicolas Noel
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne et Immunologie Clinique, CHU Bicêtre, Le Kremlin Bicêtre, France
- INSERM, UMR 1184, Immunologie des Maladies Virales et Autoimmunes, Université Paris Saclay, Le Kremlin Bicêtre, France
- CEA, DSV/iMETI, Division of Immuno-Virology, IDMIT, Fontenay aux Roses, France
| | - Maryam Piram
- Pediatric Rheumatology and CEREMAIA, Bicêtre Hospital APHP, University of Paris Sud Saclay, Le Kremlin-Bicêtre, France
- Pediatric Dermatology, CHU Sainte Justine Research Centre, CHU Sainte Justine, University of Montreal, Montreal, Canada
| | - Tu-Anh Tran
- Department of Pediatrics, Nîmes University Hospital, INSERM U1183, Montpellier-Nîmes University, Nîmes, France
| | - Bertrand Wechsler
- UPMC Université Paris 06, Inserm UMR S 959, Immunology Immunopathology Immunotherapy (I3), Sorbonne Universités, 75005, Paris, France
- Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hôpital Pitié-Salpêtrière, AP-HP, 75651, Paris, France
- AP-HP groupe hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, centre national de référence maladies autoinflammatoires et amylose inflammatoire, centre national de références maladies autoimmunes systémiques rares, 75013, Paris, France
| | - David Saadoun
- UPMC Université Paris 06, Inserm UMR S 959, Immunology Immunopathology Immunotherapy (I3), Sorbonne Universités, 75005, Paris, France.
- Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hôpital Pitié-Salpêtrière, AP-HP, 75651, Paris, France.
- AP-HP groupe hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, centre national de référence maladies autoinflammatoires et amylose inflammatoire, centre national de références maladies autoimmunes systémiques rares, 75013, Paris, France.
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Velásquez Pereira LC, Roose E, Graça NAG, Sinkovits G, Kangro K, Joly BS, Tellier E, Kaplanski G, Falter T, Von Auer C, Rossmann H, Feys HB, Reti M, Prohászka Z, Lämmle B, Voorberg J, Coppo P, Veyradier A, De Meyer SF, Männik A, Vanhoorelbeke K. Immunogenic hotspots in the spacer domain of ADAMTS13 in immune-mediated thrombotic thrombocytopenic purpura. J Thromb Haemost 2021; 19:478-488. [PMID: 33171004 DOI: 10.1111/jth.15170] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 07/16/2020] [Revised: 10/10/2020] [Accepted: 10/28/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is caused by anti-ADAMTS13 autoantibodies inducing a severe deficiency of ADAMTS13. Epitope mapping studies on samples obtained during acute iTTP episodes have shown that the iTTP immune response is polyclonal, with almost all patients having autoantibodies targeting the spacer domain of ADAMTS13. OBJECTIVES To identify the immunogenic hotspots in the spacer domain of ADAMTS13. PATIENTS/METHODS A library of 11 full-length ADAMTS13 spacer hybrids was created in which amino acid regions of the spacer domain of ADAMTS13 were exchanged by the corresponding region of the spacer domain of ADAMTS1. Next, the full-length ADAMTS13 spacer hybrids were used in enzyme-linked immunosorbent assay to epitope map anti-spacer autoantibodies in 138 samples from acute and remission iTTP patients. RESULTS Sixteen different anti-spacer autoantibody profiles were identified with a similar distribution in acute and remission patients. There was no association between the anti-spacer autoantibody profiles and disease severity. Almost all iTTP samples contained anti-spacer autoantibodies against the following three regions: amino acid residues 588-592, 602-610, and 657-666 (hybrids E, G, and M). Between 31% and 57% of the samples had anti-spacer autoantibodies against amino acid regions 572-579, 629-638, 667-676 (hybrids C, J, and N). In contrast, none of the samples had anti-spacer autoantibodies against amino acid regions 556-563, 564-571, 649-656, and 677-685 (hybrids A, B, L, and O). CONCLUSION We identified three hotspot regions (amino acid regions 588-592, 602-610, and 657-666) in the spacer domain of ADAMTS13 that are targeted by anti-spacer autoantibodies found in a large cohort of iTTP patients.
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Affiliation(s)
| | - Elien Roose
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Nuno A G Graça
- Department of Molecular and Cellular Hemostasis, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Icosagen Cell Factory OÜ, Kambia vald, Tartumaa, Estonia
| | - György Sinkovits
- Department of Internal Medicine and Hematology, and Research Group of Immunology and Hematology, Hungarian Academy of Sciences and Semmelweis University, Budapest, Hungary
| | - Kadri Kangro
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Bérangère S Joly
- Service d'Hématologie biologique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris and EA3518, Institut de Recherche Saint Louis, Université de Paris, Paris, France
| | - Edwige Tellier
- INSERM, INRAE, C2VN, Aix-Marseille Univ, Marseille, France
- APHM, INSERM, C2VN, CHU Conception, Service de Médecine Interne et Immunologie Clinique, Aix-Marseille Univ, Marseille, France
| | | | - Tanja Falter
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center, Johannes Gutenberg University, Mainz, Germany
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Charis Von Auer
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Department of Hematology, Oncology and Pneumology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Heidi Rossmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center, Johannes Gutenberg University, Mainz, Germany
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Hendrik B Feys
- Transfusion Research Center, Belgian Red Cross-Flanders, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Marienn Reti
- Department of Haematology and Stem Cell Transplantation, Central Hospital of Southern Pest, National Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | - Zoltán Prohászka
- Department of Internal Medicine and Hematology, and Research Group of Immunology and Hematology, Hungarian Academy of Sciences and Semmelweis University, Budapest, Hungary
| | - Bernhard Lämmle
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Haemostasis Research Unit, University College London, London, UK
| | - Jan Voorberg
- Department of Molecular and Cellular Hemostasis, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Paul Coppo
- Service d'hématologie, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris, Paris, France
- Université Sorbonne Paris Cité, Paris, France
| | - Agnès Veyradier
- Service d'Hématologie biologique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris and EA3518, Institut de Recherche Saint Louis, Université de Paris, Paris, France
| | - Simon F De Meyer
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Andres Männik
- Icosagen Cell Factory OÜ, Kambia vald, Tartumaa, Estonia
| | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
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41
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Prevel R, Roubaud-Baudron C, Tellier E, Le Besnerais M, Kaplanski G, Veyradier A, Benhamou Y, Coppo P. [Endothelial dysfunction in thrombotic thrombocytopenic purpura: therapeutic perspectives]. Rev Med Interne 2021; 42:202-209. [PMID: 33455838 DOI: 10.1016/j.revmed.2020.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 11/19/2020] [Accepted: 12/26/2020] [Indexed: 01/05/2023]
Abstract
Immune Thrombotic Thrombocytopenic Purpura (iTTP) is a rare but severe disease with a mortality rate of almost 100 % in the absence of adequate treatment. iTTP is caused by a severe deficiency in ADAMTS13 activity due to the production of inhibitory antibodies. Age has been shown to be a major prognostic factor. iTTP patients in the elderly (60yo and over) have more frequent organ involvement, especially heart and kidney failures compared with younger patients. They also have non-specific neurologic symptoms leading to a delayed diagnosis. Factors influencing this impaired survival among older patients remain unknown so far. Alteration of the functional capacity of involved organs could be part of the explanation as could be the consequences of vascular aging. In fact, severe ADAMTS13 deficiency is necessary but likely not sufficient for iTTP physiopathology. A second hit leading to endothelial activation is thought to play a central role in iTTP. Interestingly, the mechanisms involved in endothelial activation may share common features with those involved in vascular aging, potentially leading to endothelial dysfunction. It could thus be interesting to better investigate the causes of mid- and long-term mortality among older iTTP patients to confirm whether inflammation and endothelial activation really impact vascular aging and long-term mortality in those patients, in addition to their presumed role at iTTP acute phase. If so, further insights into the mechanisms involved could lead to new therapeutic targets.
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Affiliation(s)
- R Prevel
- CHU Bordeaux, Pôle de Gérontologie Clinique, 33000 Bordeaux, France; CHU Bordeaux, FHU Acronim 33000 Bordeaux, France; University Bordeaux, INSERM 1045 CRCTB 33000 Bordeaux, France
| | - C Roubaud-Baudron
- CHU Bordeaux, Pôle de Gérontologie Clinique, 33000 Bordeaux, France; University Bordeaux, INSERM UMR 1053 Bariton 33000 Bordeaux, France
| | - E Tellier
- Vascular Research Center of Marseille, Inserm, UMRS_1076, Aix-Marseille Université, Marseille, France
| | - M Le Besnerais
- Service de Médecine Interne, CHU Charles Nicolle, Rouen, France; INSERM U1096, UFR médecine pharmacie Rouen, Rouen, France
| | - G Kaplanski
- Vascular Research Center of Marseille, Inserm, UMRS_1076, Aix-Marseille Université, Marseille, France; Aix-Marseille université, 13284, Service de médecine interne, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13385 Marseille cedex 05, France; Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT, www.cnr-mat.fr), Paris, France
| | - A Veyradier
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT, www.cnr-mat.fr), Paris, France; Hématologie biologique, Hôpital Lariboisière, AP-HP, Université Paris Diderot, Paris, France
| | - Y Benhamou
- Service de Médecine Interne, CHU Charles Nicolle, Rouen, France; INSERM U1096, UFR médecine pharmacie Rouen, Rouen, France; Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT, www.cnr-mat.fr), Paris, France
| | - P Coppo
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT, www.cnr-mat.fr), Paris, France; Service d'Hématologie, Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT, www.cnr-mat.fr), AP-HP.6, Paris, France.
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42
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Velier M, Priet S, Appay R, Atieh T, Lepidi H, Kaplanski G, Jarrot PA, Koubi M, Costello R, Dignat-George F, de Lamballerie X, Tichadou A, Arcani R, Couderc AL, Touati J, Varoquaux A, Berda-Haddad Y, Venton G. Severe and Irreversible Pancytopenia Associated With SARS-CoV-2 Bone Marrow Infection in a Patient With Waldenstrom Macroglobulinemia. Clin Lymphoma Myeloma Leuk 2021; 21:e503-e505. [PMID: 33563581 PMCID: PMC7832621 DOI: 10.1016/j.clml.2021.01.005] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/09/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Mélanie Velier
- Laboratory of Hematology and Vascular biology, Conception University Hospital, Marseille, France; Center for Cardiovascular and Nutrition Research (C2VN), INRA 1260, INSERM 1263, Aix-Marseille University, Marseille, France.
| | - Stéphane Priet
- Unité des Virus Émergents (UVE), IRD 190, Inserm 1207, Aix-Marseille University, Marseille, France
| | - Romain Appay
- Pathology and Neuropathology Department, La Timone University Hospital, Marseille, France; CNRS, INP, Inst Neurophysiopathol, Aix-Marseille University, Marseille, France
| | - Thérèse Atieh
- Unité des Virus Émergents (UVE), IRD 190, Inserm 1207, Aix-Marseille University, Marseille, France
| | - Hubert Lepidi
- Pathology and Neuropathology Department, La Timone University Hospital, Marseille, France
| | - Gilles Kaplanski
- Center for Cardiovascular and Nutrition Research (C2VN), INRA 1260, INSERM 1263, Aix-Marseille University, Marseille, France; Internal Medical and Clinical Immunology, Conception University Hospital, Marseille, France
| | - Pierre André Jarrot
- Center for Cardiovascular and Nutrition Research (C2VN), INRA 1260, INSERM 1263, Aix-Marseille University, Marseille, France; Internal Medical and Clinical Immunology, Conception University Hospital, Marseille, France
| | - Marie Koubi
- Internal Medical and Clinical Immunology, Conception University Hospital, Marseille, France
| | - Régis Costello
- Hematology and Cellular Therapy Department, Conception University Hospital, Marseille, France; TAGC, INSERM, UMR1090, Aix-Marseille University, Marseille, France
| | - Françoise Dignat-George
- Laboratory of Hematology and Vascular biology, Conception University Hospital, Marseille, France; Center for Cardiovascular and Nutrition Research (C2VN), INRA 1260, INSERM 1263, Aix-Marseille University, Marseille, France
| | - Xavier de Lamballerie
- Unité des Virus Émergents (UVE), IRD 190, Inserm 1207, Aix-Marseille University, Marseille, France
| | - Antoine Tichadou
- Hematology and Cellular Therapy Department, Conception University Hospital, Marseille, France; TAGC, INSERM, UMR1090, Aix-Marseille University, Marseille, France; SMARTc Unit, Pharmacokinetics Laboratory, UMR_911 CRO2 Aix-Marseille University, Marseille, France
| | - Robin Arcani
- Center for Cardiovascular and Nutrition Research (C2VN), INRA 1260, INSERM 1263, Aix-Marseille University, Marseille, France; Internal Medicine, Geriatrics and Therapeutics Department and Coordination Unit for Geriatric Oncology (UCOG), La Timone University Hospital, Marseille, France
| | - Anne Laure Couderc
- Internal Medicine, Geriatrics and Therapeutics Department and Coordination Unit for Geriatric Oncology (UCOG), La Timone University Hospital, Marseille, France; CNRS, EFS, ADES, Aix-Marseille University, Marseille, France
| | - Julian Touati
- Department of Medical Imaging, Conception University Hospital, Marseille, France; Center for Magnetic Resonance in Biology and Medicine, UMR 7339, La Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Arthur Varoquaux
- Department of Medical Imaging, Conception University Hospital, Marseille, France; Center for Magnetic Resonance in Biology and Medicine, UMR 7339, La Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Yaël Berda-Haddad
- Laboratory of Hematology and Vascular biology, Conception University Hospital, Marseille, France
| | - Geoffroy Venton
- Hematology and Cellular Therapy Department, Conception University Hospital, Marseille, France; TAGC, INSERM, UMR1090, Aix-Marseille University, Marseille, France; SMARTc Unit, Pharmacokinetics Laboratory, UMR_911 CRO2 Aix-Marseille University, Marseille, France
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43
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Stolowy N, Zanin E, Comet A, Jurquet AL, Benso C, Matonti F, Retornaz K, Kaplanski G, Denis D. [Immunosuppressive therapy in severe or chronic pediatric uveitis: Review of the literature]. J Fr Ophtalmol 2021; 44:252-258. [PMID: 33423814 DOI: 10.1016/j.jfo.2020.08.003] [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: 07/27/2020] [Revised: 08/17/2020] [Accepted: 08/24/2020] [Indexed: 11/19/2022]
Abstract
Immunosuppressants are prescribed for pediatric uveitis in cases of severe involvement affecting the prognosis for vision or life, in cases of recurrent or chronic uveitis to achieve corticosteroid sparing, or in cases of corticosteroid resistance. Immunosuppressants used in children include antimetabolites (methotrexate, mycophenolate mofetil, azathioprine), cyclosporine, tacrolimus, and biologics, including infliximab, adalimumab, anakinra, canakinumab, and tocilizumab. The mechanisms of action and indications of the various immunosuppressants are described in this review.
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Affiliation(s)
- N Stolowy
- Service d'ophtalmologie, hôpital Nord, Marseille, France.
| | - E Zanin
- Service d'ophtalmologie, hôpital Nord, Marseille, France.
| | - A Comet
- Service d'ophtalmologie, hôpital Nord, Marseille, France.
| | - A-L Jurquet
- Service de pédiatrie, hôpital Nord, Marseille, France.
| | - C Benso
- Service d'ophtalmologie, hôpital Nord, Marseille, France.
| | - F Matonti
- Centre Monticelli Paradis d'Ophtalmologie, Marseille, France.
| | - K Retornaz
- Service de pédiatrie, hôpital Nord, Marseille, France.
| | - G Kaplanski
- Service de médecine interne, hôpital de la Conception, Marseille, France.
| | - D Denis
- Service d'ophtalmologie, hôpital Nord, Marseille, France.
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44
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Guervilly C, Burtey S, Sabatier F, Cauchois R, Lano G, Abdili E, Daviet F, Arnaud L, Brunet P, Hraiech S, Jourde-Chiche N, Koubi M, Lacroix R, Pietri L, Berda Y, Robert T, Degioanni C, Velier M, Papazian L, Kaplanski G, Dignat-George F. Circulating Endothelial Cells as a Marker of Endothelial Injury in Severe COVID -19. J Infect Dis 2020; 222:1789-1793. [PMID: 32812049 PMCID: PMC7454721 DOI: 10.1093/infdis/jiaa528] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/18/2020] [Indexed: 12/12/2022] Open
Abstract
Beside the commonly described pulmonary expression of the coronavirus disease 2019 (COVID-19), major vascular events have been reported. The objective of this study was to investigate whether increased levels of circulating endothelial cells (CEC) might be associated with severe forms of COVID-19. Ninety-nine patients with COVID-19 were enrolled in this retrospective study. Patients in the intensive care units (ICU) had significantly higher CEC counts than non-ICU patients and the extent of endothelial injury was correlated with putative markers of disease severity and inflammatory cytokines. Altogether, these data provide in vivo evidence that endothelial injury is a key feature of COVID-19.
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Affiliation(s)
- Christophe Guervilly
- Medical Intensive Care Unit, North Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Center for Studies and Research on Health Services and Quality of Life, Aix-Marseille University, Marseille, France
| | - Stephane Burtey
- Department of Nephrology and Renal Transplantation, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Aix-Marseille University, INSERM 1263, INRAE, C2VN, Marseille, France
| | - Florence Sabatier
- Aix-Marseille University, INSERM 1263, INRAE, C2VN, Marseille, France.,Laboratory of Hematology and Vascular Biology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Cell Therapy Unit, INSERM CBT1409, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Raphaël Cauchois
- Aix-Marseille University, INSERM 1263, INRAE, C2VN, Marseille, France.,Department of Internal Medicine and Clinical Immunology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Guillaume Lano
- Department of Nephrology and Renal Transplantation, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Aix-Marseille University, INSERM 1263, INRAE, C2VN, Marseille, France
| | - Evelyne Abdili
- Laboratory of Hematology and Vascular Biology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Florence Daviet
- Department of Nephrology and Renal Transplantation, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Laurent Arnaud
- Laboratory of Hematology and Vascular Biology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Philippe Brunet
- Department of Nephrology and Renal Transplantation, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Aix-Marseille University, INSERM 1263, INRAE, C2VN, Marseille, France
| | - Sami Hraiech
- Medical Intensive Care Unit, North Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Center for Studies and Research on Health Services and Quality of Life, Aix-Marseille University, Marseille, France
| | - Noémie Jourde-Chiche
- Department of Nephrology and Renal Transplantation, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Aix-Marseille University, INSERM 1263, INRAE, C2VN, Marseille, France
| | - Marie Koubi
- Department of Internal Medicine and Clinical Immunology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Romaric Lacroix
- Aix-Marseille University, INSERM 1263, INRAE, C2VN, Marseille, France.,Laboratory of Hematology and Vascular Biology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Léa Pietri
- Department of Nutrition, Metabolic Diseases, Endocrinology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Yaël Berda
- Laboratory of Hematology and Vascular Biology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Thomas Robert
- Department of Nephrology and Renal Transplantation, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Aix-Marseille University, INSERM 1263, INRAE, C2VN, Marseille, France
| | - Clara Degioanni
- Cell Therapy Unit, INSERM CBT1409, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Mélanie Velier
- Aix-Marseille University, INSERM 1263, INRAE, C2VN, Marseille, France.,Laboratory of Hematology and Vascular Biology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Laurent Papazian
- Medical Intensive Care Unit, North Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Center for Studies and Research on Health Services and Quality of Life, Aix-Marseille University, Marseille, France
| | - Gilles Kaplanski
- Aix-Marseille University, INSERM 1263, INRAE, C2VN, Marseille, France.,Department of Internal Medicine and Clinical Immunology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Françoise Dignat-George
- Aix-Marseille University, INSERM 1263, INRAE, C2VN, Marseille, France.,Laboratory of Hematology and Vascular Biology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
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45
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Carvelli J, Le Saux A, Bourenne J, Gainnier M, Kaplanski G. Evolution Toward Severe Covid-19 From Biological Monitoring to Therapeutic Considerations. Front Immunol 2020; 11:562038. [PMID: 33384683 PMCID: PMC7770161 DOI: 10.3389/fimmu.2020.562038] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 11/23/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Julien Carvelli
- Réanimation des Urgences, CHU Timone, AP-HM, Aix-Marseille Université, Marseille, France
- Marseille Immunopôle, CHU Timone, AP-HM, Marseille, France
| | - Audrey Le Saux
- Réanimation des Urgences, CHU Timone, AP-HM, Aix-Marseille Université, Marseille, France
| | - Jeremy Bourenne
- Réanimation des Urgences, CHU Timone, AP-HM, Aix-Marseille Université, Marseille, France
| | - Marc Gainnier
- Réanimation des Urgences, CHU Timone, AP-HM, Aix-Marseille Université, Marseille, France
| | - Gilles Kaplanski
- Médecine Interne et Immunologie clinique, CHU Conception, AP-HM, Aix-Marseille Université, Marseille, France
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46
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Kaplanski G, Bontemps D, Esnault P, Blasco V, Carvelli J, Delarbre D, Cauchois R, Forel JM, Papazian L. Combined Anakinra and Ruxolitinib treatment to rescue extremely ill COVID-19 patients: A pilot study. Autoimmun Rev 2020; 20:102726. [PMID: 33326855 PMCID: PMC7833642 DOI: 10.1016/j.autrev.2020.102726] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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] [Received: 10/11/2020] [Accepted: 10/17/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Gilles Kaplanski
- Assistance Publique - Hôpitaux de Marseille, Hôpital Conception, Médecine Interne et Immunologie Clinique, 13005 Marseille, France; Aix-Marseille Université, Faculté de médecine, C2VN, 13005 Marseille, France.
| | - Denis Bontemps
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; Aix-Marseille Université, Faculté de médecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, 13005 Marseille, France
| | - Pierre Esnault
- Hôpital d'Instruction des Armées Sainte-Anne, Réanimation, 83000 Toulon, France
| | - Valery Blasco
- Assistance Publique - Hôpitaux de Marseille, Hôpital Timone, Réanimation Polyvalente et des Pathologies du Foie, 13005 Marseille, France
| | - Julien Carvelli
- Assistance Publique - Hôpitaux de Marseille, Hôpital Timone, Réanimation des Urgences et Médicale, Aix-Marseille Université, 13005 Marseille, France
| | - David Delarbre
- Hôpital d'Instruction des Armées Sainte-Anne, Réanimation, 83000 Toulon, France
| | - Raphael Cauchois
- Assistance Publique - Hôpitaux de Marseille, Hôpital Conception, Médecine Interne et Immunologie Clinique, 13005 Marseille, France; Aix-Marseille Université, Faculté de médecine, C2VN, 13005 Marseille, France
| | - Jean-Marie Forel
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; Aix-Marseille Université, Faculté de médecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, 13005 Marseille, France
| | - Laurent Papazian
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; Aix-Marseille Université, Faculté de médecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, 13005 Marseille, France.
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47
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Le Joncour A, Desbois A, Regner P, Maciejewski-Duval A, Comarmond C, Barète S, Arock M, Fouret P, Rosenzwajg M, Bruneval P, Launay J, Koskas F, Klatzmann D, Cacoub P, Kaplanski G, Saadoun D. Rôle des mastocytes dans le remodelage vasculaire de la maladie de Takayasu. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.102] [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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48
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Briantais A, Seguier J, Meunier B, De Sainte Marie B, Salort-Campana E, Kaplanski G, Bardin N, Bertin D, Swiader L, Harlé J, Ebbo M, Schleinitz N, Durand J. Multipositivité des anticorps spécifiques des myosites recherchéspar immunoblot : séroprévalence et signification clinique. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.055] [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: 11/24/2022]
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49
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Horta S, Qu JH, Dekimpe C, Bonnez Q, Vandenbulcke A, Tellier E, Kaplanski G, Delport F, Geukens N, Lammertyn J, Vanhoorelbeke K. Co(III)-NTA Mediated Antigen Immobilization on a Fiber Optic-SPR Biosensor for Detection of Autoantibodies in Autoimmune Diseases: Application in Immune-Mediated Thrombotic Thrombocytopenic Purpura. Anal Chem 2020; 92:13880-13887. [DOI: 10.1021/acs.analchem.0c02586] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Sara Horta
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Etienne Sabbelaan 53, Kortrijk 8500, Belgium
- Department of Biosystems, Biosensors Group, KU Leuven, Willem De Croylaan 42, Heverlee B-3001, Belgium
| | - Jia-Huan Qu
- Department of Biosystems, Biosensors Group, KU Leuven, Willem De Croylaan 42, Heverlee B-3001, Belgium
| | - Charlotte Dekimpe
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Etienne Sabbelaan 53, Kortrijk 8500, Belgium
| | - Quintijn Bonnez
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Etienne Sabbelaan 53, Kortrijk 8500, Belgium
| | - Aline Vandenbulcke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Etienne Sabbelaan 53, Kortrijk 8500, Belgium
| | - Edwige Tellier
- INSERM, INRAE, C2VN, Jardin du Pharo, Aix Marseille Univ, 58 Boulevard Charles Livon, 13007 Marseille , France
| | - Gilles Kaplanski
- INSERM, INRAE, C2VN, Jardin du Pharo, Aix Marseille Univ, 58 Boulevard Charles Livon, 13007 Marseille , France
- APHM, INSERM, INRAE, C2VN, Hôpital de la Conception, Service de médecine interne, Aix Marseille Univ, 147 Boulevard Baille, 13005 Marseille, France
| | - Filip Delport
- FOx Biosystems NV, Bioville, Agoralaan Abis, Diepenbeek 3590, Belgium
| | - Nick Geukens
- PharmAbs, The KU Leuven Antibody Center, KU Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Jeroen Lammertyn
- Department of Biosystems, Biosensors Group, KU Leuven, Willem De Croylaan 42, Heverlee B-3001, Belgium
| | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Etienne Sabbelaan 53, Kortrijk 8500, Belgium
- PharmAbs, The KU Leuven Antibody Center, KU Leuven, Herestraat 49, Leuven 3000, Belgium
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50
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Jarrot PA, Arcani R, Darmon O, Roudier J, Cauchois R, Mazodier K, Jean R, Balandraud N, Kaplanski G. Axial Articular Manifestations in Primary Sjögren Syndrome: Association With Spondyloarthritis. J Rheumatol 2020; 48:1037-1046. [PMID: 32669446 DOI: 10.3899/jrheum.200189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the prevalence of axial articular manifestations (AAMs) in patients with primary Sjögren syndrome (pSS), to investigate whether these symptoms reveal an associated spondyloarthritis (SpA), and to assess their therapeutic management. METHODS Among 148 consecutive patients with pSS fulfilling European League Against Rheumatism (EULAR)/American College of Rheumatology 2019 classification criteria followed between 2010 and 2018, we selected those who presented with AAMs. The association with SpA was retained when patients fulfilled Assessment of SpA international Society criteria. RESULTS A total of 29 patients (20%, 28 women) with a median age of 43 years (range 15-65 yrs), were identified. The main extraglandular features were peripheral arthralgia and arthritis in 93% and 90% of patients, respectively. Positive anti-Ro/SSA (anti-SSA) antibody was reported in 62%. AAMs were inaugural in 7%, delayed from the diagnostic of pSS in 7%, and occurred concomitantly in 86% of patients. AAMs were not associated to multisystemic involvement of pSS. Radiographic sacroiliitis was mentioned in 65%, and HLA-B27 was positive in 13%. The diagnosis of SpA was retained in 23/29 patients (79%), among which 74% and 26% fulfilled psoriatic arthritis and ankylosing spondylitis criteria, respectively. There was no phenotypic difference according to the anti-SSA antibody status. With a median follow-up of 60 months (range: 5-96), 61% of patients with associated SpA required biotherapies, mainly of anti-tumor necrosis factor-α or anti-interleukin 17A molecules with a good clinical outcome in 64% and no effect on pSS. CONCLUSION AAMs are not uncommon in patients with pSS and may reveal an associated SpA. Treatment of AAMs, especially when clearly associated with SpA, may necessitate biologics, following SpA-management therapeutic guidelines.
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Affiliation(s)
- Pierre-André Jarrot
- P.A. Jarrot, MD, PhD, R. Cauchois, MD, G. Kaplanski, MD, PhD, Department of Internal Medicine and Clinical Immunology CHU Conception, AP-HM, and Center for Cardiovascular and Nutrition Research, INRA 1260, INSERM UMR_S1263, Aix-Marseille University;
| | - Robin Arcani
- R. Arcani, MD, O. Darmon, MD, K. Mazodier, MD, R. Jean, MD, Department of Internal Medicine and Clinical Immunology CHU Conception, AP-HM
| | - Olivier Darmon
- R. Arcani, MD, O. Darmon, MD, K. Mazodier, MD, R. Jean, MD, Department of Internal Medicine and Clinical Immunology CHU Conception, AP-HM
| | - Jean Roudier
- J. Roudier, MD, PhD, N. Balandraud, MD, PhD, Department of Rheumatology, Institut du Mouvement et de l'appareil Locomoteur, CHU Sainte-Marguerite, AP-HM, and INSERM UMRs1097, Aix-Marseille University, Marseille, France
| | - Raphael Cauchois
- P.A. Jarrot, MD, PhD, R. Cauchois, MD, G. Kaplanski, MD, PhD, Department of Internal Medicine and Clinical Immunology CHU Conception, AP-HM, and Center for Cardiovascular and Nutrition Research, INRA 1260, INSERM UMR_S1263, Aix-Marseille University
| | - Karin Mazodier
- R. Arcani, MD, O. Darmon, MD, K. Mazodier, MD, R. Jean, MD, Department of Internal Medicine and Clinical Immunology CHU Conception, AP-HM
| | - Rodolphe Jean
- R. Arcani, MD, O. Darmon, MD, K. Mazodier, MD, R. Jean, MD, Department of Internal Medicine and Clinical Immunology CHU Conception, AP-HM
| | - Nathalie Balandraud
- J. Roudier, MD, PhD, N. Balandraud, MD, PhD, Department of Rheumatology, Institut du Mouvement et de l'appareil Locomoteur, CHU Sainte-Marguerite, AP-HM, and INSERM UMRs1097, Aix-Marseille University, Marseille, France
| | - Gilles Kaplanski
- P.A. Jarrot, MD, PhD, R. Cauchois, MD, G. Kaplanski, MD, PhD, Department of Internal Medicine and Clinical Immunology CHU Conception, AP-HM, and Center for Cardiovascular and Nutrition Research, INRA 1260, INSERM UMR_S1263, Aix-Marseille University
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