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Hatchwell E, Smith EB, Jalilzadeh S, Bruno CD, Taoufik Y, Hendel-Chavez H, Liblau R, Brassat D, Martin-Blondel G, Wiendl H, Schwab N, Cortese I, Monaco MC, Imberti L, Capra R, Oksenberg JR, Gasnault J, Stankoff B, Richmond TA, Rancour DM, Koralnik IJ, Hanson BA, Major EO, Chow CR, Eis PS. Progressive multifocal leukoencephalopathy genetic risk variants for pharmacovigilance of immunosuppressant therapies. Front Neurol 2022; 13:1016377. [PMID: 36588876 PMCID: PMC9795231 DOI: 10.3389/fneur.2022.1016377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/11/2022] [Indexed: 12/15/2022] Open
Abstract
Background Progressive multifocal leukoencephalopathy (PML) is a rare and often lethal brain disorder caused by the common, typically benign polyomavirus 2, also known as JC virus (JCV). In a small percentage of immunosuppressed individuals, JCV is reactivated and infects the brain, causing devastating neurological defects. A wide range of immunosuppressed groups can develop PML, such as patients with: HIV/AIDS, hematological malignancies (e.g., leukemias, lymphomas, and multiple myeloma), autoimmune disorders (e.g., psoriasis, rheumatoid arthritis, and systemic lupus erythematosus), and organ transplants. In some patients, iatrogenic (i.e., drug-induced) PML occurs as a serious adverse event from exposure to immunosuppressant therapies used to treat their disease (e.g., hematological malignancies and multiple sclerosis). While JCV infection and immunosuppression are necessary, they are not sufficient to cause PML. Methods We hypothesized that patients may also have a genetic susceptibility from the presence of rare deleterious genetic variants in immune-relevant genes (e.g., those that cause inborn errors of immunity). In our prior genetic study of 184 PML cases, we discovered 19 candidate PML risk variants. In the current study of another 152 cases, we validated 4 of 19 variants in both population controls (gnomAD 3.1) and matched controls (JCV+ multiple sclerosis patients on a PML-linked drug ≥ 2 years). Results The four variants, found in immune system genes with strong biological links, are: C8B, 1-57409459-C-A, rs139498867; LY9 (alias SLAMF3), 1-160769595-AG-A, rs763811636; FCN2, 9-137779251-G-A, rs76267164; STXBP2, 19-7712287-G-C, rs35490401. Carriers of any one of these variants are shown to be at high risk of PML when drug-exposed PML cases are compared to drug-exposed matched controls: P value = 3.50E-06, OR = 8.7 [3.7-20.6]. Measures of clinical validity and utility compare favorably to other genetic risk tests, such as BRCA1 and BRCA2 screening for breast cancer risk and HLA-B*15:02 pharmacogenetic screening for pharmacovigilance of carbamazepine to prevent Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Conclusion For the first time, a PML genetic risk test can be implemented for screening patients taking or considering treatment with a PML-linked drug in order to decrease the incidence of PML and enable safer use of highly effective therapies used to treat their underlying disease.
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Affiliation(s)
- Eli Hatchwell
- Population Bio UK, Inc., Oxfordshire, United Kingdom,*Correspondence: Eli Hatchwell
| | | | | | | | - Yassine Taoufik
- Department of Hematology and Immunology, Hôpitaux Universitaires Paris-Saclay and INSERM 1186, Institut Gustave Roussy, Villejuif, France
| | - Houria Hendel-Chavez
- Department of Hematology and Immunology, Hôpitaux Universitaires Paris-Saclay and INSERM 1186, Institut Gustave Roussy, Villejuif, France
| | - Roland Liblau
- Infinity, Université Toulouse, CNRS, INSERM, UPS, Toulouse, France,Department of Immunology, CHU Toulouse, Hôpital Purpan, Toulouse, France
| | - David Brassat
- Infinity, Université Toulouse, CNRS, INSERM, UPS, Toulouse, France,Department of Immunology, CHU Toulouse, Hôpital Purpan, Toulouse, France
| | - Guillaume Martin-Blondel
- Infinity, Université Toulouse, CNRS, INSERM, UPS, Toulouse, France,Department of Infectious and Tropical Diseases, Toulouse University Hospital Center, Toulouse, France
| | - Heinz Wiendl
- Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Nicholas Schwab
- Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Irene Cortese
- Experimental Immunotherapeutics Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Maria Chiara Monaco
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Luisa Imberti
- Centro di Ricerca Emato-Oncologica AIL (CREA) and Diagnostic Department, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Ruggero Capra
- Lombardia Multiple Sclerosis Network, Brescia, Italy
| | - Jorge R. Oksenberg
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Jacques Gasnault
- Department of Internal Medicine, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, France
| | - Bruno Stankoff
- Department of Neurology, Hôpital Saint-Antoine, Paris, France
| | | | | | - Igor J. Koralnik
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Barbara A. Hanson
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Eugene O. Major
- Laboratory of Molecular Medicine and Neuroscience, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | | | - Peggy S. Eis
- Population Bio, Inc., New York, NY, United States,Peggy S. Eis
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Dekeyser M, Herve MDGD, Hendel-Chavez H, Boutin E, Herr F, Lhotte R, Taupin J, Taoufik Y, Durrbach A. L’immunité CD4 hétérospécifique contribue à maintenir une réponse immunitaire efficace contre le BK-virus et à prévenir la néphropathie associée au BK-virus. Nephrol Ther 2022. [DOI: 10.1016/j.nephro.2022.07.274] [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: 10/14/2022]
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Lievin R, Hendel-Chavez H, Baldé A, Lancar R, Algarte-Génin M, Krzysiek R, Costagliola D, Assoumou L, Taoufik Y, Besson C. Increased Production of B-Cell Activating Cytokines and Altered Peripheral B-Cell Subset Distribution during HIV-Related Classical Hodgkin Lymphoma. Cancers (Basel) 2021; 14:cancers14010128. [PMID: 35008292 PMCID: PMC8750095 DOI: 10.3390/cancers14010128] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 12/03/2022] Open
Abstract
Simple Summary Patients with HIV are at high risk of developing Hodgkin’s lymphoma. This is potentially due to alterations in blood circulating B-lymphocytes and their activating cytokines. We analyzed the distribution of circulating B-lymphocytes and the level of the activating cytokines IL6, IL10 and BAFF in 38 patients with HIV-related Hodgkin’s lymphoma during a 2-year follow-up. We also compared their characteristics at diagnosis with (1) pre-diagnosis serum samples and (2) samples from control HIV-infected subjects without lymphoma. We found an increase in activating cytokines in cases compared to controls. The level of activating cytokines increased in advanced lymphoma. It decreased over time during follow-up. B-lymphocytic count was similar between patients and controls, but their subset distribution differed. There was an overrepresentation of naive B-lymphocytes over memory B-lymphocytes in HIV-associated Hodgkin lymphoma patients, more pronounced in those with advanced lymphoma. Follow-up showed an increase in B-lymphocytic count with an even greater proportion of naive B-cells. Together this suggests that in HIV-infected patients, Hodgkin lymphoma is associated with an altered blood distribution of B-lymphocytic subsets and an increased production of activating cytokines. This environment may contribute to the process of tumorigenesis. Abstract Classical Hodgkin Lymphoma incidence increases in HIV-1-infected patients (HIV-cHL). HIV infection is associated with higher B-cell activation. Here, in 38 HIV-cHL patients from the French cohort ANRS-CO16 Lymphovir, we examined longitudinally over 24 months the serum levels of the B-cell activating cytokines IL10, IL6, and BAFF, and blood distribution of B-cell subsets. Fourteen HIV-cHL patients were also compared to matched HIV-infected controls without cHL. IL10, IL6, and BAFF levels were higher in HIV-cHL patients than in controls (p < 0.0001, p = 0.002, and p < 0.0001, respectively). Cytokine levels increased in patients with advanced-stage lymphoma compared to those with limited-stage (p = 0.002, p = 0.03, and p = 0.01, respectively). Cytokine levels significantly decreased following HIV-cHL diagnosis and treatment. Blood counts of whole B-cells were similar in HIV-cHL patients and controls, but the distribution of B-cell subsets was different with higher ratios of naive B-cells over memory B-cells in HIV-cHL patients. Blood accumulation of naive B-cells was more marked in patients with advanced cHL stages (p = 0.06). During the follow-up, total B-cell counts increased (p < 0.0001), and the proportion of naive B-cells increased further (p = 0.04). Together the results suggest that in HIV-infected patients, cHL is associated with a particular B-cell-related environment that includes increased production of B-cell-activating cytokines and altered peripheral distribution of B-cell subsets. This B-cell-related environment may fuel the process of tumorigenesis.
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Affiliation(s)
- Raphael Lievin
- Department of Hematology and Oncology, Hospital of Versailles, 78150 Le Chesnay, France;
| | - Houria Hendel-Chavez
- Service d’Hématologie et Immunologie Biologique, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, 94270 Le Kremlin-Bicêtre, France; (H.H.-C.); (R.K.); (Y.T.)
- INSERM 1186, Institut Gustave Roussy, 94805 Villejuif, France
| | - Aliou Baldé
- Institut Pierre Louis d’Epidémiologie et de Santé Publique, IPLESP, Sorbonne Université, INSERM UMR-S 1136, 75646 Paris, France; (A.B.); (R.L.); (M.A.-G.); (D.C.); (L.A.)
| | - Rémi Lancar
- Institut Pierre Louis d’Epidémiologie et de Santé Publique, IPLESP, Sorbonne Université, INSERM UMR-S 1136, 75646 Paris, France; (A.B.); (R.L.); (M.A.-G.); (D.C.); (L.A.)
| | - Michèle Algarte-Génin
- Institut Pierre Louis d’Epidémiologie et de Santé Publique, IPLESP, Sorbonne Université, INSERM UMR-S 1136, 75646 Paris, France; (A.B.); (R.L.); (M.A.-G.); (D.C.); (L.A.)
| | - Roman Krzysiek
- Service d’Hématologie et Immunologie Biologique, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, 94270 Le Kremlin-Bicêtre, France; (H.H.-C.); (R.K.); (Y.T.)
- INSERM 1186, Institut Gustave Roussy, 94805 Villejuif, France
| | - Dominique Costagliola
- Institut Pierre Louis d’Epidémiologie et de Santé Publique, IPLESP, Sorbonne Université, INSERM UMR-S 1136, 75646 Paris, France; (A.B.); (R.L.); (M.A.-G.); (D.C.); (L.A.)
| | - Lambert Assoumou
- Institut Pierre Louis d’Epidémiologie et de Santé Publique, IPLESP, Sorbonne Université, INSERM UMR-S 1136, 75646 Paris, France; (A.B.); (R.L.); (M.A.-G.); (D.C.); (L.A.)
| | - Yassine Taoufik
- Service d’Hématologie et Immunologie Biologique, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, 94270 Le Kremlin-Bicêtre, France; (H.H.-C.); (R.K.); (Y.T.)
- INSERM 1186, Institut Gustave Roussy, 94805 Villejuif, France
| | - Caroline Besson
- Department of Hematology and Oncology, Hospital of Versailles, 78150 Le Chesnay, France;
- Université Versailles Saint Quentin en Yvelines, Université Paris-Saclay, 78180 Montigny le Bretonneux, France
- Centre for Research in Epidemiology and Population Health, INSERM Unit 1018, 94800 Villejuif, France
- Correspondence:
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Hamdi L, Creidy R, Boudjemaa S, Hendel-Chavez H, Hugues P, Taoufik Y, Leblanc T, Coulomb A, Krzysiek R, Landman-Parker J, Besson C. Frequent altered distribution of peripheral B-lymphocyte subsets in pediatric and adolescent patients with classical Hodgkin lymphoma. Leuk Lymphoma 2020; 62:300-307. [PMID: 33095090 DOI: 10.1080/10428194.2020.1834090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Peripheral lymphopenia is a well-known negative prognostic marker in classical Hodgkin lymphoma (cHL). We characterized the peripheral B-cell compartment in a prospective cohort of 83 pediatric cHL patients. We observed significantly low total B-cell counts (<100 cells/µl) in 31 of 83 patients (37%). More specifically, there was a smaller peripheral IgDhighCD27- naïve B-cell pool among B-cell lymphopenic patients than for non-B-cell lymphopenic patients (p < 0.01). The B-cell count was lower in patients without in situ Epstein Barr Virus (EBV) expression than among those with in situ EBV expression (p = 0.03). Peripheral B-cell lymphopenia was associated with the presence of poor prognostic features, such as advanced lymphoma stage (p < 0.01) and the presence of B symptoms (p = 0.04). Of interest, B-cell lymphopenia resolved in all six studied patients in long-term remission. Our findings support that cHL tumor-associated factors interfere with the distribution of peripheral B-cell subsets.
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Affiliation(s)
| | - Rita Creidy
- Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Sabah Boudjemaa
- Service d'Anatomie et de Cytologie Pathologiques, Sorbonne Université, Hôpital Armand Trousseau, Paris, France
| | - Houria Hendel-Chavez
- Service d'Hématologie Biologique, Hôpital Bicêtre, Assistance Publique-Hôpitaux de, Le Kremlin-Bicêtre, Paris, France
| | - Patricia Hugues
- Universite Paris-Saclay, Communaute Paris-Saclay, Villejuif, France
| | - Yassine Taoufik
- Service d'Hématologie Biologique, Hôpital Bicêtre, Assistance Publique-Hôpitaux de, Le Kremlin-Bicêtre, Paris, France
| | - Thierry Leblanc
- Service d'hemato-immunologie; Pole de Pediatrie Medicale, CHU Paris-Hopital Robert Debre, Paris
| | - Aurore Coulomb
- Service d'Anatomie et de Cytologie Pathologiques, Sorbonne Université, Hôpital Armand Trousseau, Paris, France
| | - Roman Krzysiek
- Service d'Hématologie Biologique, Hôpital Bicêtre, Assistance Publique-Hôpitaux de, Le Kremlin-Bicêtre, Paris, France
| | - Judith Landman-Parker
- Service d'hematologie oncologie pediatrique, Sorbonne Universite, Hopital Armand-Trousseau APHP, Paris
| | - Caroline Besson
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe "Exposome et Hérédité", CESP, Villejuif, France.,Hematology-Oncology Unit, Centre Hospitalier de Versailles, Le Chesnay, France
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5
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Garcia J, Hendel-Chavez H, De-Goer MG, L'Honneur AS, Dubessy AL, Taoufik Y, Stankoff B. Progressive multifocal leukoencephalopathy on dimethyl fumarate with preserved lymphocyte count but deep T-cells exhaustion. Mult Scler 2020; 27:640-644. [PMID: 32686582 DOI: 10.1177/1352458520942201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Progressive multifocal leukoencephalopathy (PML) among multiple sclerosis (MS) patients receiving dimethyl fumarate (DMF) is associated with iatrogenic lymphopenia, predominating on CD8+ T-cells. OBJECTIVES AND METHODS We report an unusual case of DMF-related PML in a 66-year-old MS patient with preserved lymphocyte count (nadir: 810/mm3) and normal CD8+ T-cells count. RESULTS A massive overexpression of the inhibitory receptor Programmed Cell Death 1 (PD-1) on CD8+ and memory effector T-cells together with an impaired anti-JC virus (JCV) specific T-cells response were found, compatible with exhaustion. Following DMF withdrawal, PML progressively regressed, PD-1 was downregulated, and a functional anti-JCV response was established. CONCLUSION T-cells exhaustion may favor PML onset on DMF independently of lymphocyte count.
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Affiliation(s)
- Jeanne Garcia
- Saint Antoine Hospital, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
| | - Houria Hendel-Chavez
- Paris Sud Medecine University, INSERM U1184, Kremlin Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Marie-Ghislaine De-Goer
- Paris Sud Medecine University, INSERM U1184, Kremlin Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Anne Sophie L'Honneur
- Department of Virology, Cochin Hospital, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
| | - Anne Laure Dubessy
- Saint Antoine Hospital, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
| | - Yassine Taoufik
- Paris Sud Medecine University, INSERM U1184, Kremlin Bicêtre Hospital, Bicêtre, France/Hematology Department, Kremlin Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Bruno Stankoff
- Saint Antoine Hospital, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France/Sorbonne University, UPMC, Brain and Spinal Cord Institute (ICM), INSERM UMR-S 1127, CNRS UMR 7225, Paris, France
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6
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Eis PS, Bruno CD, Richmond TA, Koralnik IJ, Hanson BA, Major EO, Chow CR, Hendel-Chavez H, Stankoff B, Gasnault J, Taoufik Y, Hatchwell E. Germline Genetic Risk Variants for Progressive Multifocal Leukoencephalopathy. Front Neurol 2020; 11:186. [PMID: 32256442 PMCID: PMC7094807 DOI: 10.3389/fneur.2020.00186] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/27/2020] [Indexed: 12/18/2022] Open
Abstract
Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating disorder of the brain caused by reactivation of the JC virus (JCV), a polyomavirus that infects at least 60% of the population but is asymptomatic or results in benign symptoms in most people. PML occurs as a secondary disease in a variety of disorders or as a serious adverse event from immunosuppressant agents, but is mainly found in three groups: HIV-infected patients, patients with hematological malignancies, or multiple sclerosis (MS) patients on the immunosuppressant therapy natalizumab. It is severely debilitating and is deadly in ~50% HIV cases, ~90% of hematological malignancy cases, and ~24% of MS-natalizumab cases. A PML risk prediction test would have clinical utility in all at risk patient groups but would be particularly beneficial in patients considering therapy with immunosuppressant agents known to cause PML, such as natalizumab, rituximab, and others. While a JC antibody test is currently used in the clinical decision process for natalizumab, it is suboptimal because of its low specificity and requirement to periodically retest patients for seroconversion or to assess if a patient's JCV index has increased. Whereas a high specificity genetic risk prediction test comprising host genetic risk variants (i.e., germline variants occurring at higher frequency in PML patients compared to the general population) could be administered one time to provide clinicians with additional risk prediction information that is independent of JCV serostatus. Prior PML case reports support the hypothesis that PML risk is greater in patients with a genetically caused immunodeficiency disorder. To identify germline PML risk variants, we performed exome sequencing on 185 PML cases (70 in a discovery cohort and 115 in a replication cohort) and used the gnomAD variant database for interpretation. Our study yielded 19 rare variants (maximum allele frequency of 0.02 in gnomAD ethnically matched populations) that impact 17 immune function genes (10 are known to cause inborn errors of immunity). Modeling of these variants in a PML genetic risk test for MS patients considering natalizumab treatment indicates that at least a quarter of PML cases may be preventable.
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Affiliation(s)
- Peggy S Eis
- Population Bio, Inc., New York, NY, United States
| | | | - Todd A Richmond
- Richmond Bioinformatics Consulting, Seattle, WA, United States
| | - Igor J Koralnik
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Barbara A Hanson
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Eugene O Major
- Laboratory of Molecular Medicine and Neuroscience, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | | | - Houria Hendel-Chavez
- Department of Hematology and Immunology, Hôpitaux Universitaires Paris-Sud, INSERM 1184, Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre, France
| | - Bruno Stankoff
- Department of Neurology, Hôpital Saint-Antoine, Paris, France
| | - Jacques Gasnault
- Department of Internal Medicine, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, France
| | - Yassine Taoufik
- Department of Hematology and Immunology, Hôpitaux Universitaires Paris-Sud, INSERM 1184, Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre, France
| | - Eli Hatchwell
- Population Bio UK, Inc., Oxfordshire, United Kingdom
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7
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Dekeyser M, De Goër De Herve M, Hendel-Chavez H, Labeyrie C, Adams D, Adebs-Nasser G, Gasnault J, Taoufik Y, Durrbach A. Leuco-encéphalopathie multifocale progressive et anergie lymphocytaire réfractaire au traitement après thérapie d’inhibition du deuxième signal d’activation lymphocytaire (bêlatacept). Nephrol Ther 2017. [DOI: 10.1016/j.nephro.2017.08.029] [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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8
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Dekeyser M, de Goër de Herve MG, Hendel-Chavez H, Labeyrie C, Adams D, Nasser GA, Gasnault J, Durrbach A, Taoufik Y. Refractory T-Cell Anergy and Rapidly Fatal Progressive Multifocal Leukoencephalopathy After Prolonged CTLA4 Therapy. Open Forum Infect Dis 2017. [PMID: 28638849 PMCID: PMC5473436 DOI: 10.1093/ofid/ofx100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Progressive multifocal leukoencephalopathy (PML) is a deadly demyelinating disease due to central nervous system replication of the human polyomavirus JC virus (JCV) in immunosuppressed patients. The only effective therapeutic approach is to restore anti-JCV T-cell responses. In this study, we describe a case of rapidly fatal PML with JCV T-cell anergy in a renal transplant patient treated with CTLA4-Ig (belatacept, a CD28-B7 costimulation blocker and T-cell anergy inducer). T-cell anergy could not be reversed despite several therapeutic approaches. Progressive multifocal leukoencephalopathy secondary to biotherapy-induced T-cell anergy may thus represent a subset of PML with major resistance to anti-JCV immune recovery.
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Affiliation(s)
- Manon Dekeyser
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1184, Immunology of Viral Infection and Auto-immune Diseases, Normal and Pathological T Memory, Faculté de Médecine Paris-Sud, le Kremlin-Bicêtre.,Institut Francilien de Techerche en Néphrologie et Transplantation, Department of Nephrology and Transplantation, Hôpitaux Universitaires Paris-Sud, France; and
| | - Marie-Ghislaine de Goër de Herve
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1184, Immunology of Viral Infection and Auto-immune Diseases, Normal and Pathological T Memory, Faculté de Médecine Paris-Sud, le Kremlin-Bicêtre
| | - Houria Hendel-Chavez
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1184, Immunology of Viral Infection and Auto-immune Diseases, Normal and Pathological T Memory, Faculté de Médecine Paris-Sud, le Kremlin-Bicêtre
| | | | | | | | - Jacques Gasnault
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1184, Immunology of Viral Infection and Auto-immune Diseases, Normal and Pathological T Memory, Faculté de Médecine Paris-Sud, le Kremlin-Bicêtre.,Department of Internal Medicine, Unit of Neuro-Virological Diseases
| | - Antoine Durrbach
- Institut Francilien de Techerche en Néphrologie et Transplantation, Department of Nephrology and Transplantation, Hôpitaux Universitaires Paris-Sud, France; and.,INSERM UMR 1197, Interactions between stem cells and their niches in physiology, tumors and tissue repair - Stem cells, Transplantation, Immunoregulation, Hôpitaux Universitaires Paris-Sud, Villejuif, France
| | - Yassine Taoufik
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1184, Immunology of Viral Infection and Auto-immune Diseases, Normal and Pathological T Memory, Faculté de Médecine Paris-Sud, le Kremlin-Bicêtre
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9
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Seror R, Nocturne G, Lazure T, Hendel-Chavez H, Desmoulins F, Belkhir R, Ravaud P, Benbijja M, Poirier-Colame V, Taoufik Y, Mariette X. Low numbers of blood and salivary natural killer cells are associated with a better response to belimumab in primary Sjögren's syndrome: results of the BELISS study. Arthritis Res Ther 2015; 17:241. [PMID: 26336930 PMCID: PMC4559969 DOI: 10.1186/s13075-015-0750-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 08/10/2015] [Indexed: 11/21/2022] Open
Abstract
Introduction In this study, we sought to address changes in blood lymphocyte subpopulations and labial salivary gland (LSG) inflammation after belimumab treatment in patients with primary Sjögren’s syndrome (pSS) and to identify predictors of response to treatment. Methods Sequential blood lymphocyte subsets and LSG biopsies were analysed between week 0 (W0) and W28 in 15 patients with pSS treated with belimumab. Systemic response to treatment was defined as a decrease in the European League Against Rheumatism Sjögren’s Syndrome Disease Activity Index score of ≥3 points at W28. Results After belimumab, we observed a decrease in blood B lymphocytes primarily involving CD27-negative/immunoglobulin D–positive naïve B cells (p=0.008). Lymphocytic sialadenitis (focus score >1) that was present in 12 patients (80.0 %) before belimumab treatment became negative in 5 of them after treatment (p=0.03). The median (interquartile range) LSG B-cell/T-cell ratio decreased from 0.58 (0.5–0.67) to 0.50 (0.5–0.5) (p=0.06). B-cell activating factor (BAFF) staining was detected in 11 (78.6 %) of 14 patients before belimumab treatment compared with 7 (50.0 %) of 14 after belimumab therapy (p=0.10). The median percentage of BAFF-positive cells in foci significantly decreased from 27.5 % (10–40) to 5 % (0–20) (p=0.03). A systemic response was achieved in six patients (40 %). The only predictor of response was the presence of a low number of natural killer (NK) cells, both in blood (8.5 % [7–10] vs 11 % [9–21]; p=0.04) and in LSG (20.6/mm3 [20.0–21.4] vs 30.0/mm3 [25.0–100.0], p=0.003). Serum BAFF levels did not influence response to treatment. Conclusions Low blood and salivary NK cell numbers are associated with a better response to belimumab. This suggests that two distinct subsets of pSS may exist: one with a predominant type I interferon (IFN)–BAFF–B-cell axis, representing good responders to belimumab; and one with a predominant type II IFN–NK cell axis, representing non-responders. Trial registration ClinicalTrials.gov identifier: NCT01160666. Registered 9 July 2010.
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Affiliation(s)
- Raphaèle Seror
- Université Paris-Sud, Center of Research on Immunology of Viral and Autoimmune diseases (IMVA), INSERM U1184, Le Kremlin Bicêtre, France. .,Université Paris-Sud, Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Rhumatologie, Hôpitaux Universitaires Paris-Sud, Hôpital Bicêtre, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France.
| | - Gaétane Nocturne
- Université Paris-Sud, Center of Research on Immunology of Viral and Autoimmune diseases (IMVA), INSERM U1184, Le Kremlin Bicêtre, France.
| | - Thierry Lazure
- Université Paris-Sud, Assistance Publique-Hôpitaux de Paris (AP-HP), Service d'anatomopathologie, Hôpitaux Universitaires Paris-Sud, Le Kremlin Bicêtre, France.
| | - Houria Hendel-Chavez
- Université Paris-Sud, Center of Research on Immunology of Viral and Autoimmune diseases (IMVA), INSERM U1184, Le Kremlin Bicêtre, France. .,Université Paris-Sud, Assistance Publique-Hôpitaux de Paris (AP-HP), Laboratoire d'immunologie, Hôpitaux Universitaires Paris-Sud, Le Kremlin Bicêtre, France.
| | - Frédéric Desmoulins
- Université Paris-Sud, Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Rhumatologie, Hôpitaux Universitaires Paris-Sud, Hôpital Bicêtre, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France.
| | - Rakiba Belkhir
- Université Paris-Sud, Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Rhumatologie, Hôpitaux Universitaires Paris-Sud, Hôpital Bicêtre, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France.
| | - Philippe Ravaud
- Université Paris Descartes, AP-HP, Hôtel-Dieu Hospital, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS-UMR1153), Paris, France.
| | - Mohcine Benbijja
- Université Paris-Sud, Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Rhumatologie, Hôpitaux Universitaires Paris-Sud, Hôpital Bicêtre, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France.
| | - Vichnou Poirier-Colame
- Institut de Cancérologie Gustave Roussy Cancer Campus (GRCC), INSERM U1015, GRCC, 475 rur Edouard Vaillant, 94805, Villejuif, France.
| | - Yacine Taoufik
- Université Paris-Sud, Center of Research on Immunology of Viral and Autoimmune diseases (IMVA), INSERM U1184, Le Kremlin Bicêtre, France. .,Université Paris-Sud, Assistance Publique-Hôpitaux de Paris (AP-HP), Laboratoire d'immunologie, Hôpitaux Universitaires Paris-Sud, Le Kremlin Bicêtre, France.
| | - Xavier Mariette
- Université Paris-Sud, Center of Research on Immunology of Viral and Autoimmune diseases (IMVA), INSERM U1184, Le Kremlin Bicêtre, France. .,Université Paris-Sud, Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Rhumatologie, Hôpitaux Universitaires Paris-Sud, Hôpital Bicêtre, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France.
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10
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Besson C, Lancar R, Prevot S, Brice P, Meyohas MC, Marchou B, Gabarre J, Bonnet F, Goujard C, Lambotte O, Boué F, Mounier N, Partisani M, Raffi F, Costello R, Hendel-Chavez H, Algarte-Genin M, Trabelsi S, Marchand L, Raphael M, Taoufik Y, Costagliola D. High Risk Features Contrast With Favorable Outcomes in HIV-associated Hodgkin Lymphoma in the Modern cART Era, ANRS CO16 LYMPHOVIR Cohort. Clin Infect Dis 2015. [PMID: 26223997 DOI: 10.1093/cid/civ627] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 01/22/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection is associated with a high risk of classical Hodgkin's lymphoma (cHL) in the combined antiretroviral therapy (cART) era. METHODS We analyzed the characteristics and outcome of HIV-associated cHL diagnosed in the modern cART era. The French ANRS-CO16 Lymphovir cohort enrolled 159 HIV-positive patients with lymphoma, including 68 (43%) with cHL. HIV-HL patients were compared with a series of non-HV-infected patients consecutively diagnosed with HL. RESULTS Most patients (76%) had Ann-Arbor stages III-IV and 96% of patients were treated with ABVD. At diagnosis, median CD4 T-cell count was 387/µL and 94% of patients were treated with cART. All patients received cART after diagnosis. Five patients died from early progression (n = 2), sepsis (1) or after relapse (2). Two additional patients relapsed during follow-up. Two-year overall and progression free survivals (PFS) were 94% [95% CI, 89%, 100%] and 89% [82%, 97%], respectively. The only factor associated with progression or death was age with a relative risk of 8.1 [1.0; 67.0] above 45 years. The PFS of Lymphovir patients appeared similar to PFS of HIV-negative patients, 86% [82%, 90%], but patients with HIV infection displayed higher risk features than HIV-negative patients. CONCLUSIONS Although high-risk features still predominate in HIV-HL, the prognosis of these patients, treated with cART and mainly ABVD, has markedly improved in the modern cART era and is now similar to non-HIV-infected patients.
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Affiliation(s)
- Caroline Besson
- Université Paris Sud, Faculté de médecine Paris Sud, Le Kremlin-Bicêtre AP-HP, Hôpitaux Paris Sud, Service d'hématologie, Le Kremlin-Bicêtre
| | - Remi Lancar
- Sorbonne Universités, UPMC Univ Paris 06 INSERM, UMR_S 1136, Institut Pierre Louis d'épidémiologie et de Santé Publique, Paris
| | - Sophie Prevot
- Université Paris Sud, Faculté de médecine Paris Sud, Le Kremlin-Bicêtre AP-HP, Hôpitaux Paris Sud Site Béclère, Service d'anatomo-pathologie, Clamart
| | - Pauline Brice
- Department of Hemato-oncology, Hôpital Saint-Louis, AP-HP
| | | | | | - Jean Gabarre
- AP-HP, CHU Pitié-Salpétrière, Service d'hématologie, Paris
| | - Fabrice Bonnet
- CHU Bordeaux, Service de Médecine Interne et Maladies Infectieuses, and INSERM U593, Université de Bordeaux
| | - Cécile Goujard
- Université Paris Sud, Faculté de médecine Paris Sud, Le Kremlin-Bicêtre AP-HP, Hôpitaux Paris Sud, Service d'hématologie, Le Kremlin-Bicêtre
| | - Olivier Lambotte
- Université Paris Sud, Faculté de médecine Paris Sud, Le Kremlin-Bicêtre AP-HP, Hôpitaux Paris Sud, Service d'hématologie, Le Kremlin-Bicêtre
| | - François Boué
- Université Paris Sud, Faculté de médecine Paris Sud, Le Kremlin-Bicêtre AP-HP, Hôpitaux Paris Sud Site Béclère, Service d'immunologie clinique, Clamart
| | | | | | | | - Régis Costello
- Department of Hematology, Hôpital La Conception, Marseille
| | | | - Michele Algarte-Genin
- Sorbonne Universités, UPMC Univ Paris 06 INSERM, UMR_S 1136, Institut Pierre Louis d'épidémiologie et de Santé Publique, Paris
| | - Selma Trabelsi
- Sorbonne Universités, UPMC Univ Paris 06 INSERM, UMR_S 1136, Institut Pierre Louis d'épidémiologie et de Santé Publique, Paris
| | | | - Martine Raphael
- Université Paris Sud, Faculté de médecine Paris Sud, Le Kremlin-Bicêtre
| | - Yassine Taoufik
- Université Paris Sud, Faculté de médecine Paris Sud, Le Kremlin-Bicêtre AP-HP, Hôpitaux Paris Sud, Service d'imunologie biologique, Le Kremlin-Bicêtre, France
| | - Dominique Costagliola
- Sorbonne Universités, UPMC Univ Paris 06 INSERM, UMR_S 1136, Institut Pierre Louis d'épidémiologie et de Santé Publique, Paris
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11
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Seror R, Nocturne G, Lazure T, Hendel-Chavez H, Desmoulins F, Belkhir R, Ravaud P, Benbijja M, Taoufik Y, Mariette X. THU0395 Low Numbers of Blood and Salivary Natural Killer Cells are Associated with a Better Response to Belimumab in Primary Sjogren's Syndrome: Results of the Beliss Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5261] [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: 11/04/2022]
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12
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Tran TA, Ghosn J, Avettand-Fenoël V, Hendel-Chavez H, de Goër de Herve MG, Cohen-Codar I, Rouzioux C, Delfraissy JF, Taoufik Y. Residual HIV-1 replication may impact immune recovery in patients on first-line lopinavir/ritonavir monotherapy. J Antimicrob Chemother 2015; 70:2627-31. [PMID: 26023212 DOI: 10.1093/jac/dkv138] [Citation(s) in RCA: 3] [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: 01/09/2015] [Accepted: 04/24/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Antiretroviral combination therapy raises issues of long-term adherence and toxicity. Initial treatment simplification based on single-drug therapy was investigated in the MONARK trial, which compared first-line lopinavir/ritonavir monotherapy (arm A) with first-line lopinavir/ritonavir + zidovudine/lamivudine tritherapy (arm B). The MONARK trial is registered as a randomized trial at clinical trials.gov under identifier NCT 00234923. PATIENTS AND METHODS Immune recovery was compared in patients with undetectable plasma virus (<50 copies/mL) after 60 weeks of treatment (arm A, n = 21; arm B, n = 13). RESULTS The week 60 CD4 T cell count and CD4 T cell subset distribution did not differ significantly between the treatment arms. Memory CD4 T cell responses to HIV and recall antigens were better with triple therapy than with monotherapy. The frequencies of activated CD8 T cells and anti-HIV CD8 T cell effector responses were similar in the two arms. However, the repertoire of CD8 T cell effector responses was broader and persistent residual viraemia more frequent (by ultrasensitive PCR) in the monotherapy arm. CONCLUSIONS While viral control can be achieved with first-line lopinavir/ritonavir monotherapy, the quality of immune recovery is inferior to that obtained with triple therapy, possibly owing to a higher level of residual viral replication. Thus, the benefits of first-line lopinavir/ritonavir monotherapy in terms of toxicity and adherence might be offset by an increased risk of residual viral replication, which may also fuel latent viral reservoirs.
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Affiliation(s)
- Tu-Anh Tran
- INSERM U-1184, Université Paris-Sud, Le Kremlin-Bicêtre, France Department of Pediatrics, Nimes University Hospital, Nimes, France
| | - Jade Ghosn
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, EA 7327 Paris, France APHP, UF de Thérapeutique en Immuno-Infectiologie, CHU Hotel Dieu, Paris, France
| | - Véronique Avettand-Fenoël
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, EA 7327 Paris, France APHP, Laboratoire de Virologie, Hôpital Necker-Enfants Malades, Paris, France
| | - Houria Hendel-Chavez
- INSERM U-1184, Université Paris-Sud, Le Kremlin-Bicêtre, France Laboratoire d'Immunologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Marie-Ghislaine de Goër de Herve
- INSERM U-1184, Université Paris-Sud, Le Kremlin-Bicêtre, France Laboratoire d'Immunologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | | | - Christine Rouzioux
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, EA 7327 Paris, France APHP, Laboratoire de Virologie, Hôpital Necker-Enfants Malades, Paris, France
| | - Jean-François Delfraissy
- INSERM U-1184, Université Paris-Sud, Le Kremlin-Bicêtre, France AP-HP, Department of Internal Medicine, Bicetre University Hospital, Le Kremlin-Bicetre, France
| | - Yassine Taoufik
- INSERM U-1184, Université Paris-Sud, Le Kremlin-Bicêtre, France Laboratoire d'Immunologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
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13
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Michot JM, Canioni D, Driss H, Alric L, Cacoub P, Suarez F, Sibon D, Thieblemont C, Dupuis J, Terrier B, Feray C, Tilly H, Pol S, Leblond V, Settegrana C, Rabiega P, Barthe Y, Hendel-Chavez H, Nguyen-Khac F, Merle-Béral H, Berger F, Molina T, Charlotte F, Carrat F, Davi F, Hermine O, Besson C. Antiviral therapy is associated with a better survival in patients with hepatitis C virus and B-cell non-Hodgkin lymphomas, ANRS HC-13 lympho-C study. Am J Hematol 2015; 90:197-203. [PMID: 25417909 DOI: 10.1002/ajh.23889] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 10/28/2014] [Accepted: 10/30/2014] [Indexed: 12/16/2022]
Abstract
Hepatitis C virus (HCV) infection increases the risk of B-cell non-Hodgkin lymphomas (B-NHL). Antiviral treatment (AT) can induce hematological responses in patients with marginal zone lymphomas (MZL). The ANRS HC-13 Lympho-C study aimed at a better understanding of the impact of AT on HCV associated B-NHL. This multicentric study enrolled 116 HCV-positive patients with B-NHL between 2006 and 2012. Cytological and histological samples were collected for centralized review. At lymphoma diagnosis, median age was 61 years and gender ratio M/F was 1. Cytohistological distribution was marginal zone lymphoma (MZL) n = 45 (39%), diffuse large B-cell lymphoma (DLBCL) n = 45 (39%), and other types n = 26 (22%). MZL patients had more frequent detection of rheumatoid factor (68% vs. 35%; P = 0.001) and more frequently mixed cryoglobulinemia (74% vs. 44%; P = 0.021) than patients with DLBCL. Among patients receiving AT, a sustained virologic response was achieved in 23 of 38 (61%) patients with MZL and in 9 of 17 (53%) with DLBCL (P = 0.42). Three-year overall survival (OS) and progression-free survival were 78% 95%CI [63-88] and 64% [48-76], respectively, without difference between cytohistological groups. Outcome analysis showed a favorable association between OS and AT in all patients (P = 0.05) and in the subgroup of MZL patients only (P = 0.04). Our data support that AT improves the outcomes of HCV-associated NHLs. The impact of new AT regimen with protease inhibitor needs to be investigated in this setting. [clinicalTrials.gov Identification number NCT01545544]
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Affiliation(s)
- Jean-Marie Michot
- Department of Internal Medicine and Clinical Immunology; Paris Sud University; AP-HP, Hôpital Bicêtre Le Kremlin-Bicêtre France
| | - Danielle Canioni
- Department of Pathology; Paris 5 Descartes University; AP-HP, Hôpital Necker Paris France
| | - Henda Driss
- Epidemiology of Infectious Diseases INSERM Unité 707; Paris 6 Pierre et Marie Curie University; Paris France
| | - Laurent Alric
- Department of Internal Medicine and Digestive Diseases; Toulouse 3 University; UMR 152 IRD, Hôpital Purpan Toulouse France
| | - Patrice Cacoub
- Department of Internal Medicine; APHP; Hôpital Pitié-Salpétrière; Paris 6 Pierre et Marie Curie University; UMR 7211, INSERM, UMR S 959, CNRS Paris France
| | - Felipe Suarez
- Department of Adult Hematology; Paris 5 Descartes University; AP-HP, Hôpital Necker Paris France
- Imagine Institute; Université Sorbonne Paris Cité; INSERM U 1163, CNRS ERL 8254 Paris France
| | - David Sibon
- Department of Adult Hematology; Paris 5 Descartes University; AP-HP, Hôpital Necker Paris France
- Imagine Institute; Université Sorbonne Paris Cité; INSERM U 1163, CNRS ERL 8254 Paris France
| | - Catherine Thieblemont
- Service d'hémato-oncologie; Université Paris Sorbonne P7; INSERM U728, AP-HP, Hôpital Saint-Louis Paris France
| | - Jehan Dupuis
- Department of Lymphoid Malignancies and Clinical Hematology; Paris 12 Est Créteil University; AP-HP, Hôpital Henri-Mondor Créteil France
| | - Benjamin Terrier
- Department of Internal Medicine; APHP; Hôpital Pitié-Salpétrière; Paris 6 Pierre et Marie Curie University; UMR 7211, INSERM, UMR S 959, CNRS Paris France
| | - Cyrille Feray
- Department of Hepatology; Nantes University; Hôpital de Nantes Nantes France
| | - Hervé Tilly
- Department of Hematology; Rouen University; Centre Henri Becquerel Rouen France
| | - Stanislas Pol
- Department of Hepatology; Paris 5 Descartes University; INSERM U-1016, AP-HP, Hôpital Cochin Paris France
| | - Véronique Leblond
- Department of Clinical Hematology; Paris 6 Pierre et Marie Curie University; AP-HP, Hôpital Pitié-Salpêtrière Paris France
| | - Catherine Settegrana
- Department of Biological Hematology and Cytogenetic; Paris 6 Pierre et Marie Curie University; AP-HP, Hôpital Pitié-Salpêtrière Paris France
| | - Pascaline Rabiega
- Epidemiology of Infectious Diseases INSERM Unité 707; Paris 6 Pierre et Marie Curie University; Paris France
| | - Yoann Barthe
- Epidemiology of Infectious Diseases INSERM Unité 707; Paris 6 Pierre et Marie Curie University; Paris France
| | - Houria Hendel-Chavez
- Department of Biological Immunology and Hematology; Paris 11 Sud University; AP-HP, Hôpital Bicêtre Le Kremlin-Bicêtre France
| | - Florence Nguyen-Khac
- Department of Biological Hematology and Cytogenetic; Paris 6 Pierre et Marie Curie University; AP-HP, Hôpital Pitié-Salpêtrière Paris France
| | - Hélène Merle-Béral
- Department of Biological Hematology and Cytogenetic; Paris 6 Pierre et Marie Curie University; AP-HP, Hôpital Pitié-Salpêtrière Paris France
| | - Françoise Berger
- Department of Pathology; Lyon Sud University, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud; Lyon France
| | - Thierry Molina
- Department of Pathology; Paris 5 Descartes University; AP-HP, Hôpital Necker Paris France
| | - Frédéric Charlotte
- Department of Pathology; Paris 6 Pierre et Marie Curie University; AP-HP, Hôpital Pitié-Salpêtrière Paris France
| | - Fabrice Carrat
- Epidemiology of Infectious Diseases INSERM Unité 707; Paris 6 Pierre et Marie Curie University; Paris France
| | - Frédéric Davi
- Department of Biological Hematology and Cytogenetic; Paris 6 Pierre et Marie Curie University; AP-HP, Hôpital Pitié-Salpêtrière Paris France
| | - Olivier Hermine
- Department of Adult Hematology; Paris 5 Descartes University; AP-HP, Hôpital Necker Paris France
- Imagine Institute; Université Sorbonne Paris Cité; INSERM U 1163, CNRS ERL 8254 Paris France
| | - Caroline Besson
- Department of Internal Medicine and Clinical Immunology; Paris Sud University; AP-HP, Hôpital Bicêtre Le Kremlin-Bicêtre France
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Gasnault J, de Goër de Herve MG, Michot JM, Hendel-Chavez H, Seta V, Mazet AA, Croughs T, Stankoff B, Bourhis JH, Lambotte O, Delfraissy JF, Taoufik Y. Efficacy of recombinant human interleukin 7 in a patient with severe lymphopenia-related progressive multifocal leukoencephalopathy. Open Forum Infect Dis 2014; 1:ofu074. [PMID: 25734144 PMCID: PMC4281783 DOI: 10.1093/ofid/ofu074] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 07/08/2014] [Indexed: 12/24/2022] Open
Abstract
In this study, we report the case of a patient with profound lymphopenia after allogenic bone marrow transplantation who developed severe progressive multifocal leukoencephalopathy. Single-agent recombinant human interleukin-7 therapy was associated with restoration of anti-John Cunningham polyomavirus (JCV) T-cell responses, JCV clearance from cerebrospinal fluid, and a dramatic clinical improvement.
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Affiliation(s)
- Jacques Gasnault
- Department of Internal Medicine , Assistance Publique-Hôpitaux de Paris (AP -HP), Hôpital Bicêtre , Le Kremlin-Bicêtre , France ; Institut National de la Santé et de la Recherche Médicale (INSERM) U1012, Faculté de Médecine , Université Paris Sud , Le Kremlin-Bicêtre , France
| | - Marie-Ghislaine de Goër de Herve
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1012, Faculté de Médecine , Université Paris Sud , Le Kremlin-Bicêtre , France
| | - Jean-Marie Michot
- Department of Internal Medicine , Assistance Publique-Hôpitaux de Paris (AP -HP), Hôpital Bicêtre , Le Kremlin-Bicêtre , France ; Department of Haematology , Institut Gustave Roussy , Villejuif , France
| | - Houria Hendel-Chavez
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1012, Faculté de Médecine , Université Paris Sud , Le Kremlin-Bicêtre , France
| | - Vannina Seta
- Department of Internal Medicine , Assistance Publique-Hôpitaux de Paris (AP -HP), Hôpital Bicêtre , Le Kremlin-Bicêtre , France
| | - Anne-Aurélie Mazet
- Department of Virology , AP-HP, Hôpital Paul Brousse , Villejuif , France
| | - Thérèse Croughs
- INSERM-Agence Nationale pour la Recherche sur le SIDA , Paris , France
| | - Bruno Stankoff
- Department of Neurology , AP-HP, Hôpital Tenon , Paris , France
| | - Jean-Henri Bourhis
- Department of Haematology , Institut Gustave Roussy , Villejuif , France
| | - Olivier Lambotte
- Department of Internal Medicine , Assistance Publique-Hôpitaux de Paris (AP -HP), Hôpital Bicêtre , Le Kremlin-Bicêtre , France ; Institut National de la Santé et de la Recherche Médicale (INSERM) U1012, Faculté de Médecine , Université Paris Sud , Le Kremlin-Bicêtre , France
| | - Jean-François Delfraissy
- Department of Internal Medicine , Assistance Publique-Hôpitaux de Paris (AP -HP), Hôpital Bicêtre , Le Kremlin-Bicêtre , France ; Institut National de la Santé et de la Recherche Médicale (INSERM) U1012, Faculté de Médecine , Université Paris Sud , Le Kremlin-Bicêtre , France ; INSERM-Agence Nationale pour la Recherche sur le SIDA , Paris , France
| | - Yassine Taoufik
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1012, Faculté de Médecine , Université Paris Sud , Le Kremlin-Bicêtre , France
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15
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Sellam J, Marion-Thore S, Dumont F, Jacques S, Garchon HJ, Rouanet S, Taoufik Y, Hendel-Chavez H, Sibilia J, Tebib J, Le Loët X, Combe B, Dougados M, Mariette X, Chiocchia G. Use of Whole-Blood Transcriptomic Profiling to Highlight Several Pathophysiologic Pathways Associated With Response to Rituximab in Patients With Rheumatoid Arthritis: Data From a Randomized, Controlled, Open-Label Trial. Arthritis Rheumatol 2014; 66:2015-25. [DOI: 10.1002/art.38671] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 04/11/2014] [Indexed: 12/15/2022]
Affiliation(s)
- Jérémie Sellam
- Hôpital Saint-Antoine, AP-HP, DHU i2B, and Université Pierre et Marie Curie Paris 6; Paris France
| | - Sandrine Marion-Thore
- INSERM U987, Laboratoire d'Excellence INFLAMEX, and Université Versailles Saint Quentin, Versailles, France, and Université de Limoges; Limoges France
| | - Florent Dumont
- Institut Cochin, Université Paris Descartes, and INSERM U1016; Paris France
| | - Sébastien Jacques
- Institut Cochin, Université Paris Descartes, and INSERM U1016; Paris France
| | - Henri-Jean Garchon
- INSERM U987, Laboratoire d'Excellence INFLAMEX, and Université Versailles Saint Quentin, Versailles, France and UFR des Sciences de la Santé, Versailles Saint Quentin en Yvelines Université; Montigny-Le-Bretonneux France
| | | | - Yassine Taoufik
- Université Paris-Sud 11 and Hôpitaux Universitaires Paris-Sud, AP-HP; Le Kremlin Bicêtre France
| | - Houria Hendel-Chavez
- Université Paris-Sud 11 and Hôpitaux Universitaires Paris-Sud, AP-HP; Le Kremlin Bicêtre France
| | - Jean Sibilia
- EA 3432, Hôpitaux Universitaires de Strasbourg, and Université de Strasbourg; Strasbourg France
| | | | - Xavier Le Loët
- Centre Hospitalier Universitaire de Rouen and INSERM U905; Rouen France
| | - Bernard Combe
- Lapeyronie University Hospital, Université Montpellier I, and UMR 5535; Montpellier France
| | - Maxime Dougados
- Université Paris Descartes, UPRES-EA 4058, and Hôpital Cochin, AP-HP; Paris France
| | - Xavier Mariette
- Université Paris-Sud 11, Hôpitaux Universitaires Paris-Sud, AP-HP, and INSERM U1012; Le Kremlin Bicêtre France
| | - Gilles Chiocchia
- INSERM U987, Laboratoire d'Excellence INFLAMEX, and Université Versailles Saint Quentin, Versailles, France and UFR des Sciences de la Santé, Versailles Saint Quentin en Yvelines Université; Montigny-Le-Bretonneux France
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Sellam J, Rouanet S, Hendel-Chavez H, Miceli-Richard C, Combe B, Sibilia J, Le Loët X, Tebib J, Jourdan R, Dougados M, Taoufik Y, Mariette X. CCL19, a B cell chemokine, is related to the decrease of blood memory B cells and predicts the clinical response to rituximab in patients with rheumatoid arthritis. ACTA ACUST UNITED AC 2013; 65:2253-61. [PMID: 23740460 DOI: 10.1002/art.38023] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 05/14/2013] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Migration of B cells from peripheral blood to the synovium in patients with rheumatoid arthritis (RA) may predict clinical response to rituximab (RTX). We undertook this study to investigate whether serum levels of chemokines involved in B cell trafficking are correlated with blood levels of memory B cells or serum levels of B cell activation biomarkers before B cell depletion and whether chemokine levels predict RTX responsiveness. METHODS Blood B cell subsets were analyzed by flow cytometry (CD27, IgD), and serum B cell activation biomarkers (rheumatoid factor, anti-cyclic citrullinated peptide, free light chains, IgG, IgA, IgM, and BAFF) were measured in 208 RA patients and 70 control subjects. Serum CCL19, CXCL12, and CXCL13 chemokine levels in patients and controls were determined by enzyme-linked immunosorbent assay. The first course of RTX was administered to RA patients, and the response was evaluated at week 24 according to European League Against Rheumatism (EULAR) criteria. Results were expressed as the odds ratio (OR) and 95% confidence interval (95% CI). RESULTS Levels of all chemokines were increased in RA patients compared with controls, and levels were inversely correlated with CD27+ memory B cell frequency. CCL19 and CXCL13 levels correlated with levels of 6 serum B cell biomarkers and 4 serum B cell biomarkers, respectively. By univariate analysis, the CCL19 level was positively associated with EULAR response (OR 1.43 [95% CI 1.08-1.90], P = 0.01). By multivariate analysis, the CCL19 level was predictive of a response to RTX (OR 1.48 [95% CI 1.06-2.06], P = 0.02), but this did not persist after adjustment for autoantibody status. CONCLUSION CXCL13 and CCL19 reflect blood B cell disturbances and their levels correlate with those of other serum B cell biomarkers. CXCL13 and CCL19 are, therefore, surrogate measures for serum B cell biomarkers in RA. Serum CCL19 measurement is a new hallmark of the B cell-mediated RA subtype and may predict clinical response to RTX.
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Affiliation(s)
- Jérémie Sellam
- Hôpital Saint-Antoine, AP-HP, and Université Pierre et Marie Curie Paris 06, Paris, France
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Sellam J, Rouanet S, Hendel-Chavez H, Abbed K, Combe B, Sibilia J, Le Loët X, Tebib J, Jourdan R, Dougados M, Taoufik Y, Mariette X. THU0107 CCL19, a chemokine involved in B-cell trafficking, is related to the decrease of blood memory B-cells and predicts the clinical response to rituximab in rheumatoid arthritis: Results from the smart study. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2072] [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: 11/04/2022]
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Sellam J, Rouanet S, Hendel-Chavez H, Abbed K, Sibilia J, Tebib J, Le Loët X, Combe B, Dougados M, Mariette X, Taoufik Y. Blood memory B cells are disturbed and predict the response to rituximab in patients with rheumatoid arthritis. ACTA ACUST UNITED AC 2012; 63:3692-701. [PMID: 22127692 DOI: 10.1002/art.30599] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To examine blood B cell subsets in patients with rheumatoid arthritis (RA) prior to B cell depletion therapy and to assess their potential as predictors of clinical response to rituximab (RTX). METHODS Blood B cell subsets were assessed by flow cytometry in 208 RA patients included in an RTX retreatment study (assessed prior to RTX treatment) and in 47 age-matched controls. Expression of BAFF receptor (BAFF-R) on B cells and serum B cell biomarkers was also measured. B cell subsets and BAFF-R expression were compared between RA patient and control populations. Univariate and multivariate analyses were performed to identify baseline factors associated with a European League Against Rheumatism response 24 weeks after 1 cycle of RTX. RESULTS Mean ± SD counts of both CD27- naive and CD27+ memory B cells were decreased in RA patients (188.6 ± 121.4/mm(3)) compared with controls (257.3 ± 154.1/mm(3)) (P = 0.001) and were partially restored in patients treated with methotrexate (MTX) plus anti-tumor necrosis factor compared with patients treated with MTX alone. Within the CD27+ memory B cells, the CD27+IgD- switched memory subtype was selectively decreased, irrespective of treatment. The frequency of CD27+ memory B cells correlated inversely with levels of several B cell activation biomarkers in RA. Serum BAFF level and BAFF-R expression was comparable in RA patients and controls. A low baseline CD27+ memory B cell frequency was associated with a greater clinical response to RTX (odds ratio 0.97 [95% confidence interval 0.95-0.99], P = 0.0015). CONCLUSION In B cell depletion therapy-naive RA patients, a low frequency of CD27+ memory B cells correlated with levels of serum B cell activation biomarkers and may predict response to RTX. These results suggest that low memory B cell frequency may be indicative of a B cell-driven RA subtype that is more sensitive to B cell depletion therapy.
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Affiliation(s)
- Jérémie Sellam
- Hôpital Bicêtre, AP-HP, INSERM U1012, and Université Paris-Sud 11, Le Kremlin Bicêtre, France.
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Gasnault J, Costagliola D, Hendel-Chavez H, Dulioust A, Pakianather S, Mazet AA, de Goer de Herve MG, Lancar R, Lascaux AS, Porte L, Delfraissy JF, Taoufik Y. Improved survival of HIV-1-infected patients with progressive multifocal leukoencephalopathy receiving early 5-drug combination antiretroviral therapy. PLoS One 2011; 6:e20967. [PMID: 21738597 PMCID: PMC3127950 DOI: 10.1371/journal.pone.0020967] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Accepted: 05/17/2011] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Progressive multifocal leukoencephalopathy (PML), a rare devastating demyelinating disease caused by the polyomavirus JC (JCV), occurs in severely immunocompromised patients, most of whom have advanced-stage HIV infection. Despite combination antiretroviral therapy (cART), 50% of patients die within 6 months of PML onset. We conducted a multicenter, open-label pilot trial evaluating the survival benefit of a five-drug cART designed to accelerate HIV replication decay and JCV-specific immune recovery. METHODS AND FINDINGS All the patients received an optimized cART with three or more drugs for 12 months, plus the fusion inhibitor enfuvirtide during the first 6 months. The main endpoint was the one-year survival rate. A total of 28 patients were enrolled. At entry, median CD4+ T-cell count was 53 per microliter and 86% of patients had detectable plasma HIV RNA and CSF JCV DNA levels. Seven patients died, all before month 4. The one-year survival estimate was 0.75 (95% confidence interval, 0.61 to 0.93). At month 6, JCV DNA was undetectable in the CSF of 81% of survivors. At month 12, 81% of patients had undetectable plasma HIV RNA, and the median CD4+ T-cell increment was 105 per microliter. In univariate analysis, higher total and naive CD4+ T-cell counts and lower CSF JCV DNA level at baseline were associated with better survival. JCV-specific functional memory CD4+ T-cell responses, based on a proliferation assay, were detected in 4% of patients at baseline and 43% at M12 (P = 0.008). CONCLUSIONS The early use of five-drug cART after PML diagnosis appears to improve survival. This is associated with recovery of anti-JCV T-cell responses and JCV clearance from CSF. A low CD4+ T-cell count (particularly naive subset) and high JCV DNA copies in CSF at PML diagnosis appear to be risk factors for death. TRIAL REGISTRATION ClinicalTrials.gov NCT00120367.
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Affiliation(s)
- Jacques Gasnault
- Service de Médecine Interne et de Maladies Infectieuses, Hôpital Universitaire de Bicêtre-Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France.
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Sellam J, Hendel-Chavez H, Rouanet S, Abbed K, Combe B, Le Loët X, Tebib J, Sibilia J, Taoufik Y, Dougados M, Mariette X. B cell activation biomarkers as predictive factors for the response to rituximab in rheumatoid arthritis: a six-month, national, multicenter, open-label study. ACTA ACUST UNITED AC 2011; 63:933-8. [PMID: 21225699 DOI: 10.1002/art.30233] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine whether serum B cell markers can predict response to rituximab, a B cell-depleting monoclonal antibody, in patients with refractory rheumatoid arthritis (RA). METHODS This rituximab re-treatment dose study (SMART [eSsai MAbthera sur la dose de Re-Traitement]) involved 208 patients with refractory RA. Serum markers of B cell activation (anti-cyclic citrullinated peptide [anti-CCP] antibodies, rheumatoid factor [RF], serum IgG, IgA, and IgM levels, serum κ and λ free light chains, and serum BAFF) were assessed before the first rituximab cycle (1,000 mg on days 1 and 15). Univariate and multivariate analyses were performed to identify factors associated with a European League Against Rheumatism (EULAR) response at 24 weeks. RESULTS There were 149 responders (72%). Two baseline factors were associated with a EULAR response at 24 weeks in multivariate analysis: the presence of anti-CCP antibodies or RF (odds ratio 3.5 [95% confidence interval 1.6-7.6]) and a serum IgG concentration above normal (odds ratio 2.11 [95% confidence interval 1.02-4.33]), with synergy between them (odds ratio 6.0 [95% confidence interval 2.2-16.2]). CONCLUSION The presence of RF or anti-CCP antibodies and elevated IgG are 2 simple biomarkers that can be used routinely before therapy to predict response to rituximab in patients with refractory RA.
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Affiliation(s)
- Jérémie Sellam
- Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin Bicêtre, France.
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de Goër de Herve MG, Gonzales E, Hendel-Chavez H, Décline JL, Mourier O, Abbed K, Jacquemin E, Taoufik Y. CD25 appears non essential for human peripheral T(reg) maintenance in vivo. PLoS One 2010; 5:e11784. [PMID: 20689592 PMCID: PMC2912775 DOI: 10.1371/journal.pone.0011784] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Accepted: 07/01/2010] [Indexed: 12/02/2022] Open
Abstract
Background IL-2 has been reported to be critical for peripheral Treg survival in mouse models. Here, we examined Treg maintenance in a series of paediatric liver transplant recipients who received basiliximab, a therapeutic anti-CD25 monoclonal antibody. Methodology/Principal Findings FoxP3+ CD4 T cells were analyzed by flow cytometry before liver grafting and more than 9 months later. We found that in vivo CD25 blockade did not lead to Treg depletion: the proportion of FoxP3+ cells among CD4 T cells and the level of FoxP3 expression were both unchanged. IL-2Rβ expression was enhanced in FoxP3+ cells both before and after basiliximab treatment, while the level of IL-2Rγ expression was similar in Tregs and non-Tregs. No significant change in the weak or absent expression of IL-7Rα and IL-15Rα expression on FoxP3+ cells was observed. Although the proportion of FoxP3+ cells among CD4 T cells did not vary, food allergies occurred more rapidly after liver grafting in patients who received basiliximab, raising questions as to Treg functionality in vivo in the absence of functional CD25. Conclusions CD25 appears non essential for human Treg peripheral maintenance in vivo. However, our results raise questions as to Treg functionality after therapeutic CD25 targeting.
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Affiliation(s)
- Marie-Ghislaine de Goër de Herve
- Unité d'Immunologie Biologique, CHU Bicêtre, Le Kremlin-Bicêtre, France
- Faculté de Médecine, INSERM 10-12, Le Kremlin-Bicêtre, France
- Faculté de Médecine, Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - Emmanuel Gonzales
- Service d'Hépatologie Pédiatrique et Centre de Référence National de l'Atrésie des Voies Biliaires, CHU Bicêtre, Le Kremlin-Bicêtre, France
| | - Houria Hendel-Chavez
- Unité d'Immunologie Biologique, CHU Bicêtre, Le Kremlin-Bicêtre, France
- Faculté de Médecine, INSERM 10-12, Le Kremlin-Bicêtre, France
| | - Jean-Luc Décline
- Service d'Hépatologie Pédiatrique et Centre de Référence National de l'Atrésie des Voies Biliaires, CHU Bicêtre, Le Kremlin-Bicêtre, France
| | - Olivia Mourier
- Service d'Hépatologie Pédiatrique et Centre de Référence National de l'Atrésie des Voies Biliaires, CHU Bicêtre, Le Kremlin-Bicêtre, France
| | - Karim Abbed
- Unité d'Immunologie Biologique, CHU Bicêtre, Le Kremlin-Bicêtre, France
| | - Emmanuel Jacquemin
- Service d'Hépatologie Pédiatrique et Centre de Référence National de l'Atrésie des Voies Biliaires, CHU Bicêtre, Le Kremlin-Bicêtre, France
| | - Yassine Taoufik
- Unité d'Immunologie Biologique, CHU Bicêtre, Le Kremlin-Bicêtre, France
- Faculté de Médecine, INSERM 10-12, Le Kremlin-Bicêtre, France
- Faculté de Médecine, Université Paris-Sud, Le Kremlin-Bicêtre, France
- * E-mail:
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Tran TA, de Goër de Herve MG, Hendel-Chavez H, Dembele B, Le Névot E, Abbed K, Pallier C, Goujard C, Gasnault J, Delfraissy JF, Balazuc AM, Taoufik Y. Resting regulatory CD4 T cells: a site of HIV persistence in patients on long-term effective antiretroviral therapy. PLoS One 2008; 3:e3305. [PMID: 18827929 PMCID: PMC2551739 DOI: 10.1371/journal.pone.0003305] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 08/27/2008] [Indexed: 12/18/2022] Open
Abstract
Background In HIV-infected patients on long-term HAART, virus persistence in resting long-lived CD4 T cells is a major barrier to curing the infection. Cell quiescence, by favouring HIV latency, reduces the risk of recognition and cell destruction by cytotoxic lymphocytes. Several cell-activation-based approaches have been proposed to disrupt cell quiescence and then virus latency, but these approaches have not eradicated the virus. CD4+CD25+ regulatory T cells (Tregs) are a CD4+ T-cell subset with particular activation properties. We investigated the role of these cells in virus persistence in patients on long-term HAART. Methodology/Principal Findings We found evidence of infection of resting Tregs (HLADR−CD69−CD25hiFoxP3+CD4+ T cells) purified from patients on prolonged HAART. HIV DNA harbouring cells appear more abundant in the Treg subset than in non-Tregs. The half-life of the Treg reservoir was estimated at 20 months. Since Tregs from patients on prolonged HAART showed hyporesponsiveness to cell activation and inhibition of HIV-specific cytotoxic T lymphocyte-related functions upon activation, therapeutics targeting cell quiescence to induce virus expression may not be appropriate for purging the Treg reservoir. Conclusions Our results identify Tregs as a particular compartment within the latent reservoir that may require a specific approach for its purging.
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Affiliation(s)
- Tu-Anh Tran
- INSERM U802, Université Paris 11, Le Kremlin Bicêtre, France
| | | | - Houria Hendel-Chavez
- Unité d'Immunologie Biologique, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Bamory Dembele
- INSERM U802, Université Paris 11, Le Kremlin Bicêtre, France
| | - Emilie Le Névot
- Unité d'Immunologie Biologique, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Karim Abbed
- Unité d'Immunologie Biologique, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Coralie Pallier
- Laboratoire de Virologie, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Cécile Goujard
- INSERM U802, Université Paris 11, Le Kremlin Bicêtre, France
- Service de Médecine Interne, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Jacques Gasnault
- INSERM U802, Université Paris 11, Le Kremlin Bicêtre, France
- Service de Médecine Interne, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Jean-François Delfraissy
- INSERM U802, Université Paris 11, Le Kremlin Bicêtre, France
- Service de Médecine Interne, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | | | - Yassine Taoufik
- INSERM U802, Université Paris 11, Le Kremlin Bicêtre, France
- Unité d'Immunologie Biologique, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- * E-mail:
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Goujard C, Marcellin F, Hendel-Chavez H, Burgard M, Meiffrédy V, Venet A, Rouzioux C, Taoufik Y, El Habib R, Beumont-Mauviel M, Aboulker JP, Lévy Y, Delfraissy JF. Interruption of antiretroviral therapy initiated during primary HIV-1 infection: impact of a therapeutic vaccination strategy combined with interleukin (IL)-2 compared with IL-2 alone in the ANRS 095 Randomized Study. AIDS Res Hum Retroviruses 2007; 23:1105-13. [PMID: 17919105 DOI: 10.1089/aid.2007.0047] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
HIV-specific T cell responses play a critical role in the control of infection. We evaluated the impact of immune-based interventions in patients first treated during primary HIV-1 infection (PHI). Forty-three patients were randomized within three groups, to receive either interleukin-2 (IL-2 group), or boosts of ALVAC-HIV (vCP1433) and LIPO-6T followed by interleukin-2 (Vac-IL2 group), compared with no immune intervention (control group), and were monitored for T cell responses. Impact of strategies on viral replication was subsequently assessed during long-term treatment interruption. HIV-specific CD4(+) T cell responses did not change during the study period in immunized patients relative to controls, and vaccination had only a transient effect on interferon-gamma-producing CD8 responses. Viral rebound after treatment interruption was similar in immunized patients and controls. Forty percent of patients had HIV RNA values <10,000 copies/ml 12 weeks after interruption. The cumulative time off treatment represented almost half the total follow-up period. Immunological and virological status during PHI and HIV DNA load at interruption were predictive of the level of viral rebound after treatment interruption, whereas HIV RNA level during PHI and HIV DNA level at interruption were predictive of the time off treatment. Treatment interruption is safe in patients treated early after primary HIV infection. On the basis of this pilot study, HIV immunizations and interleukin-2 appear to have no supplementary benefit.
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Affiliation(s)
- Cécile Goujard
- Service de Médecine Interne, Bicêtre Hospital, AP-HP, Le Kremlin Bicêtre, Paris, France.
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