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Imbert S, Revers M, Enaud R, Orieux A, Camino A, Massri A, Villeneuve L, Carrié C, Petit L, Boyer A, Berger P, Gruson D, Delhaes L, Prével R. Lower airway microbiota compositions differ between influenza, COVID-19 and bacteria-related acute respiratory distress syndromes. Crit Care 2024; 28:133. [PMID: 38649970 PMCID: PMC11036773 DOI: 10.1186/s13054-024-04922-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/17/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) is responsible for 400,000 deaths annually worldwide. Few improvements have been made despite five decades of research, partially because ARDS is a highly heterogeneous syndrome including various types of aetiologies. Lower airway microbiota is involved in chronic inflammatory diseases and recent data suggest that it could also play a role in ARDS. Nevertheless, whether the lower airway microbiota composition varies between the aetiologies of ARDS remain unknown. The aim of this study is to compare lower airway microbiota composition between ARDS aetiologies, i.e. pulmonary ARDS due to influenza, SARS-CoV-2 or bacterial infection. METHODS Consecutive ARDS patients according to Berlin's classification requiring invasive ventilation with PCR-confirmed influenza or SARS-CoV-2 infections and bacterial infections (> 105 CFU/mL on endotracheal aspirate) were included. Endotracheal aspirate was collected at admission, V3-V4 and ITS2 regions amplified by PCR, deep-sequencing performed on MiSeq sequencer (Illumina®) and data analysed using DADA2 pipeline. RESULTS Fifty-three patients were included, 24 COVID-19, 18 influenza, and 11 bacterial CAP-related ARDS. The lower airway bacteriobiota and mycobiota compositions (β-diversity) were dissimilar between the three groups (p = 0.05 and p = 0.01, respectively). The bacterial α-diversity was significantly lower in the bacterial CAP-related ARDS group compared to the COVID-19 ARDS group (p = 0.04). In contrast, influenza-related ARDS patients had higher lung mycobiota α-diversity than the COVID-19-related ARDS (p = 0 < 01). CONCLUSION Composition of lower airway microbiota (both microbiota and mycobiota) differs between influenza, COVID-19 and bacterial CAP-related ARDS. Future studies investigating the role of lung microbiota in ARDS pathophysiology should take aetiology into account.
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Affiliation(s)
- Sébastien Imbert
- HU Bordeaux, Mycology-Parasitology Department, CIC 1401, 33000, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, Inserm UMR 1045, Univ Bordeaux, 33000, Bordeaux, France
| | - Mathilde Revers
- HU Bordeaux, Mycology-Parasitology Department, CIC 1401, 33000, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, Inserm UMR 1045, Univ Bordeaux, 33000, Bordeaux, France
| | - Raphaël Enaud
- Centre de Recherche Cardio-Thoracique de Bordeaux, Inserm UMR 1045, Univ Bordeaux, 33000, Bordeaux, France
- CHU Bordeaux, CRCM Pédiatrique, CIC 1401, 33000, Bordeaux, France
| | - Arthur Orieux
- CHU Bordeaux, Medical Intensive Care Unit, 33000, Bordeaux, France
| | - Adrian Camino
- Centre de Recherche Cardio-Thoracique de Bordeaux, Inserm UMR 1045, Univ Bordeaux, 33000, Bordeaux, France
| | | | | | - Cédric Carrié
- d CHU Bordeaux, Surgical Intensive Care Unit, 33000, Bordeaux, France
| | - Laurent Petit
- d CHU Bordeaux, Surgical Intensive Care Unit, 33000, Bordeaux, France
| | - Alexandre Boyer
- Centre de Recherche Cardio-Thoracique de Bordeaux, Inserm UMR 1045, Univ Bordeaux, 33000, Bordeaux, France
- CHU Bordeaux, Medical Intensive Care Unit, 33000, Bordeaux, France
| | - Patrick Berger
- Centre de Recherche Cardio-Thoracique de Bordeaux, Inserm UMR 1045, Univ Bordeaux, 33000, Bordeaux, France
| | - Didier Gruson
- Centre de Recherche Cardio-Thoracique de Bordeaux, Inserm UMR 1045, Univ Bordeaux, 33000, Bordeaux, France
- CHU Bordeaux, Medical Intensive Care Unit, 33000, Bordeaux, France
| | - Laurence Delhaes
- HU Bordeaux, Mycology-Parasitology Department, CIC 1401, 33000, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, Inserm UMR 1045, Univ Bordeaux, 33000, Bordeaux, France
| | - Renaud Prével
- Centre de Recherche Cardio-Thoracique de Bordeaux, Inserm UMR 1045, Univ Bordeaux, 33000, Bordeaux, France.
- CHU Bordeaux, Medical Intensive Care Unit, 33000, Bordeaux, France.
- Medical Intensive Care Unit, Pellegrin Hospital, Place Amélie Raba-Léon, 33076, Bordeaux, France.
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Augusto JF, Beauvillain C, Poli C, Paolini L, Tournier I, Pignon P, Blanchard S, Preisser L, Soleti R, Delépine C, Monnier M, Douchet I, Asfar P, Beloncle F, Guisset O, Prével R, Mercat A, Vinatier E, Goret J, Subra JF, Couez D, Wilson MR, Blanco P, Jeannin P, Delneste Y. Clusterin Neutralizes the Inflammatory and Cytotoxic Properties of Extracellular Histones in Sepsis. Am J Respir Crit Care Med 2023; 208:176-187. [PMID: 37141109 DOI: 10.1164/rccm.202207-1253oc] [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: 07/04/2022] [Accepted: 05/03/2023] [Indexed: 05/05/2023] Open
Abstract
Rationale: Extracellular histones, released into the surrounding environment during extensive cell death, promote inflammation and cell death, and these deleterious roles have been well documented in sepsis. Clusterin (CLU) is a ubiquitous extracellular protein that chaperones misfolded proteins and promotes their removal. Objectives: We investigated whether CLU could protect against the deleterious properties of histones. Methods: We assessed CLU and histone expression in patients with sepsis and evaluated the protective role of CLU against histones in in vitro assays and in vivo models of experimental sepsis. Measurements and Main Results: We show that CLU binds to circulating histones and reduces their inflammatory, thrombotic, and cytotoxic properties. We observed that plasma CLU levels decreased in patients with sepsis and that the decrease was greater and more durable in nonsurvivors than in survivors. Accordingly, CLU deficiency was associated with increased mortality in mouse models of sepsis and endotoxemia. Finally, CLU supplementation improved mouse survival in a sepsis model. Conclusions: This study identifies CLU as a central endogenous histone-neutralizing molecule and suggests that, in pathologies with extensive cell death, CLU supplementation may improve disease tolerance and host survival.
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Affiliation(s)
- Jean-François Augusto
- Univ Angers, Nantes Université, INSERM, CNRS, CRCI2ICAT, Angers, France
- Département de Néphrologie, Dialyse et Transplantation
| | - Céline Beauvillain
- Univ Angers, Nantes Université, INSERM, CNRS, CRCIICAT, Angers, France
- Laboratoire d'Immunologie et Allergologie, and
| | - Caroline Poli
- Univ Angers, Nantes Université, INSERM, CNRS, CRCIICAT, Angers, France
- Laboratoire d'Immunologie et Allergologie, and
| | - Léa Paolini
- Univ Angers, Nantes Université, INSERM, CNRS, CRCIICAT, Angers, France
| | - Isabelle Tournier
- Univ Angers, Nantes Université, INSERM, CNRS, CRCIICAT, Angers, France
- Institut de Cancérologie de l'Ouest, Angers, France
| | - Pascale Pignon
- Univ Angers, Nantes Université, INSERM, CNRS, CRCIICAT, Angers, France
| | - Simon Blanchard
- Univ Angers, Nantes Université, INSERM, CNRS, CRCIICAT, Angers, France
- Laboratoire d'Immunologie et Allergologie, and
| | - Laurence Preisser
- Univ Angers, Nantes Université, INSERM, CNRS, CRCIICAT, Angers, France
| | - Raffaella Soleti
- Univ Angers, Nantes Université, INSERM, CNRS, CRCIICAT, Angers, France
| | - Chloé Delépine
- Univ Angers, Nantes Université, INSERM, CNRS, CRCIICAT, Angers, France
| | - Marine Monnier
- Univ Angers, Nantes Université, INSERM, CNRS, CRCIICAT, Angers, France
| | - Isabelle Douchet
- UMR-CNRS, ImmunConcept, University of Bordeaux, Bordeaux, France
| | - Pierre Asfar
- Service de Médecine Intensive et Réanimation, CHU d'Angers, Angers, France
- Université de Angers, Inserm, CNRS, MITOVASC, SFR ICAT, Angers, France
| | - François Beloncle
- Service de Médecine Intensive et Réanimation, CHU d'Angers, Angers, France
| | | | | | - Alain Mercat
- UMR-CNRS, ImmunConcept, University of Bordeaux, Bordeaux, France
| | - Emeline Vinatier
- Univ Angers, Nantes Université, INSERM, CNRS, CRCIICAT, Angers, France
- Laboratoire d'Immunologie et Allergologie, and
| | - Julien Goret
- UMR-CNRS, ImmunConcept, University of Bordeaux, Bordeaux, France
- Department of Immunology and Immunogenetics, Bordeaux University Hospital, Bordeaux, France
| | - Jean-François Subra
- Univ Angers, Nantes Université, INSERM, CNRS, CRCIICAT, Angers, France
- Département de Néphrologie, Dialyse et Transplantation
| | - Dominique Couez
- Univ Angers, Nantes Université, INSERM, CNRS, CRCIICAT, Angers, France
| | - Mark R Wilson
- Molecular Horizons and School of Chemistry and Molecular Bioscience, University of Wollongong, Wollongong, New South Wales, Australia; and
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Patrick Blanco
- UMR-CNRS, ImmunConcept, University of Bordeaux, Bordeaux, France
- Department of Immunology and Immunogenetics, Bordeaux University Hospital, Bordeaux, France
| | - Pascale Jeannin
- Univ Angers, Nantes Université, INSERM, CNRS, CRCIICAT, Angers, France
- Laboratoire d'Immunologie et Allergologie, and
| | - Yves Delneste
- Univ Angers, Nantes Université, INSERM, CNRS, CRCIICAT, Angers, France
- Laboratoire d'Immunologie et Allergologie, and
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Prével R, Dupont A, Labrouche-Colomer S, Garcia G, Dewitte A, Rauch A, Goutay J, Caplan M, Jozefowicz E, Lanoix JP, Poissy J, Rivière E, Orieux A, Malvy D, Gruson D, Garçon L, Susen S, James C. Plasma Markers of Neutrophil Extracellular Trap Are Linked to Survival but Not to Pulmonary Embolism in COVID-19-Related ARDS Patients. Front Immunol 2022; 13:851497. [PMID: 35371025 PMCID: PMC8968169 DOI: 10.3389/fimmu.2022.851497] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 01/11/2022] [Accepted: 02/23/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Coronavirus disease 2019 (COVID-19) can cause life-threatening acute respiratory distress syndrome (ARDS). Recent data suggest a role for neutrophil extracellular traps (NETs) in COVID-19-related lung damage partly due to microthrombus formation. Besides, pulmonary embolism (PE) is frequent in severe COVID-19 patients, suggesting that immunothrombosis could also be responsible for increased PE occurrence in these patients. Here, we evaluate whether plasma levels of NET markers measured shorty after admission of hospitalized COVID-19 patients are associated with clinical outcomes in terms of clinical worsening, survival, and PE occurrence. Patients and Methods Ninety-six hospitalized COVID-19 patients were included, 50 with ARDS (severe disease) and 46 with moderate disease. We collected plasma early after admission and measured 3 NET markers: total DNA, myeloperoxidase (MPO)–DNA complexes, and citrullinated histone H3. Comparisons between survivors and non-survivors and patients developing PE and those not developing PE were assessed by Mann–Whitney test. Results Analysis in the whole population of hospitalized COVID-19 patients revealed increased circulating biomarkers of NETs in patients who will die from COVID-19 and in patients who will subsequently develop PE. Restriction of our analysis in the most severe patients, i.e., the ones who enter the hospital for COVID-19-related ARDS, confirmed the link between NET biomarker levels and survival but not PE occurrence. Conclusion Our results strongly reinforce the hypothesis that NETosis is an attractive therapeutic target to prevent COVID-19 progression but that it does not seem to be linked to PE occurrence in patients hospitalized with COVID-19.
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Affiliation(s)
- Renaud Prével
- CHU Bordeaux, Medical Intensive Care Unit, Pessac, France.,Univ. Bordeaux, INSERM, U1045, Centre de Recherche Cardio-Thoracique de Bordeaux, Pessac, France
| | - Annabelle Dupont
- Univ. Lille, INSERM, CHU Lille, Department of Hematology and Transfusion, Pôle de Biologie Pathologie Génétique, Institut Pasteur de Lille, UMR1011-EGID, Lille, France
| | - Sylvie Labrouche-Colomer
- Univ. Bordeaux, INSERM, UMR1034, Biology of Cardiovascular Diseases, Pessac, France.,CHU Bordeaux, Laboratory of Hematology, Pessac, France
| | - Geoffrey Garcia
- Laboratoire d'Hématologie, CHU Amiens, EA4666 HEMATIM, UPJV, Amiens, France
| | - Antoine Dewitte
- CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Centre, Bordeaux, France.,Univ. Bordeaux, CNRS, UMR 5164, INSERM ERL1303, Immunology from Concept and Experiments to Translation (ImmunoConcEpT), Bordeaux, France
| | - Antoine Rauch
- Univ. Lille, INSERM, CHU Lille, Department of Hematology and Transfusion, Pôle de Biologie Pathologie Génétique, Institut Pasteur de Lille, UMR1011-EGID, Lille, France
| | - Julien Goutay
- Centre Hospitalier Universitaire Lille, Intensive Care Department, Pôle de Réanimation, Lille, France
| | - Morgan Caplan
- Centre Hospitalier Universitaire Lille, Intensive Care Department, Pôle de Réanimation, Lille, France
| | - Elsa Jozefowicz
- Centre Hospitalier Universitaire Lille, Surgical Critical Care, Department of Anesthesiology and Critical Care, Lille, France
| | - Jean-Philippe Lanoix
- CHU Amiens-Picardie, Infectious Diseases Department, Amiens, France.,EA4294, Université Picardie Jules Verne, Amiens, France
| | - Julien Poissy
- Univ. Lille, INSERM U1285, CHU Lille, Pôle de réanimation, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France
| | - Etienne Rivière
- Univ. Bordeaux, INSERM, UMR1034, Biology of Cardiovascular Diseases, Pessac, France.,CHU Bordeaux, Internal Medicine and Infectious Diseases Unit, Pessac, France
| | - Arthur Orieux
- CHU Bordeaux, Medical Intensive Care Unit, Pessac, France
| | - Denis Malvy
- Department for Infectious and Tropical diseases, University Hospital Centre and INSERM 1219, University of Bordeaux, Bordeaux, France
| | - Didier Gruson
- CHU Bordeaux, Medical Intensive Care Unit, Pessac, France.,Univ. Bordeaux, INSERM, U1045, Centre de Recherche Cardio-Thoracique de Bordeaux, Pessac, France
| | - Loic Garçon
- Laboratoire d'Hématologie, CHU Amiens, EA4666 HEMATIM, UPJV, Amiens, France
| | - Sophie Susen
- Univ. Lille, INSERM, CHU Lille, Department of Hematology and Transfusion, Pôle de Biologie Pathologie Génétique, Institut Pasteur de Lille, UMR1011-EGID, Lille, France
| | - Chloé James
- Univ. Bordeaux, INSERM, UMR1034, Biology of Cardiovascular Diseases, Pessac, France.,CHU Bordeaux, Laboratory of Hematology, Pessac, France
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Prével R, Delmas Y, Guillotin V, Gruson D, Rivière E. Complement Blockade Is a Promising Therapeutic Approach in a Subset of Critically Ill Adult Patients with Complement-Mediated Hemolytic Uremic Syndromes. J Clin Med 2022; 11:jcm11030790. [PMID: 35160242 PMCID: PMC8837052 DOI: 10.3390/jcm11030790] [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: 12/30/2021] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 02/04/2023] Open
Abstract
Thrombotic microangiopathy (TMA) gathers consumptive thrombocytopenia, mechanical haemolytic anemia, and organ damage. Hemolytic uremic syndromes (HUS) are historically classified as primary or secondary to another disease once thrombotic thrombocytopenic purpura (TTP), Shiga-toxin HUS, and cobalamin C-related HUS have been ruled out. Complement genetics studies reinforced the link between complement dysregulation and primary HUS, contributing to reclassifying some pregnancy- and/or post-partum-associated HUS and to revealing complement involvement in severe and/or refractory hypertensive emergencies. By contrast, no firm evidence allows a plausible association to be drawn between complement dysregulation and Shiga-toxin HUS or other secondary HUS. Nevertheless, rare complement gene variants are prevalent in healthy individuals, thus providing an indication that an investigation into complement dysregulation should be carefully balanced and that the results should be cautiously interpreted with the help of a trained geneticist. Several authors have suggested reclassifying HUS in two entities, regardless of they are complement-mediated or not, since the use of eculizumab, an anti-C5 antibody, dramatically lowers the proportion of patients who die or suffer from end-stage renal disease within the year following diagnosis. Safety and the ideal timing of eculizumab discontinuation is currently under investigation, and the long-term consequences of HUS should be closely monitored over time once patients exit emergency departments.
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Affiliation(s)
- Renaud Prével
- CHU Bordeaux, Medical Intensive Care Unit, F-33000 Bordeaux, France; (V.G.); (D.G.)
- University Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, Inserm UMR 1045, F-33000 Bordeaux, France
- Correspondence: ; Tel.: +33-(0)5-56-79-55-17; Fax: +33-(0)5-56-79-54-18
| | - Yahsou Delmas
- CHU Bordeaux, Nephrology Transplantation Dialysis Apheresis Unit, F-33076 Bordeaux, France;
| | - Vivien Guillotin
- CHU Bordeaux, Medical Intensive Care Unit, F-33000 Bordeaux, France; (V.G.); (D.G.)
| | - Didier Gruson
- CHU Bordeaux, Medical Intensive Care Unit, F-33000 Bordeaux, France; (V.G.); (D.G.)
- University Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, Inserm UMR 1045, F-33000 Bordeaux, France
| | - Etienne Rivière
- CHU Bordeaux, Internal Medicine Department, F-33000 Bordeaux, France;
- University Bordeaux, Biology of Cardiovascular Diseases, InsermU1034, F-33604 Pessac, France
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Prével R, Coelho J, Orieux A, Philip P, Gruson D, Bioulac S. Psychological evaluation and support in COVID-19 critically ill patients: a feasibility study. Crit Care 2021; 25:218. [PMID: 34167549 PMCID: PMC8223189 DOI: 10.1186/s13054-021-03642-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/11/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Renaud Prével
- Medical Intensive Care Unit, CHU Bordeaux, 33000, Bordeaux, France. .,Inserm UMR 1045, Univ Bordeaux, 33000, Bordeaux, France.
| | - Julien Coelho
- Service Universitaire Médecine du Sommeil, CHU Bordeaux, 33000, Bordeaux, France
| | - Arthur Orieux
- Medical Intensive Care Unit, CHU Bordeaux, 33000, Bordeaux, France
| | - Pierre Philip
- Service Universitaire Médecine du Sommeil, CHU Bordeaux, 33000, Bordeaux, France.,CNRS SANPSY (Sommeil Addiction et Neuropsychiatrie), USR 3413, Univ. Bordeaux, 33000, Bordeaux, France
| | - Didier Gruson
- Medical Intensive Care Unit, CHU Bordeaux, 33000, Bordeaux, France.,Inserm UMR 1045, Univ Bordeaux, 33000, Bordeaux, France
| | - Stéphanie Bioulac
- Service Universitaire Médecine du Sommeil, CHU Bordeaux, 33000, Bordeaux, France.,CNRS SANPSY (Sommeil Addiction et Neuropsychiatrie), USR 3413, Univ. Bordeaux, 33000, Bordeaux, France
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Prével R, Roubaud-Baudron C, Jamme M, Benhamou Y, Galicier L, Poullin P, Hamidou M, Deligny C, Hie M, Veyradier A, Coppo P. Particularités gériatriques du purpura thrombotique thrombocytopénique acquis. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.336] [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: 10/18/2022]
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