1
|
Lévesque H, Viallard JF, Houivet E, Bonnotte B, Voisin S, Le Cam-Duchez V, Maillot F, Lambert M, Liozon E, Hervier B, Fain O, Guillet B, Schmidt J, Luca LE, Ebbo M, Ferreira-Maldent N, Babuty A, Sailler L, Duffau P, Barbay V, Audia S, Benichou J, Graveleau J, Benhamou Y. Cyclophosphamide vs rituximab for eradicating inhibitors in acquired hemophilia A: A randomized trial in 108 patients. Thromb Res 2024; 237:79-87. [PMID: 38555718 DOI: 10.1016/j.thromres.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/19/2024] [Accepted: 03/07/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Acquired hemophilia A (AHA) is a rare autoimmune disorder due to autoantibodies against Factor VIII, with a high mortality risk. Treatments aim to control bleeding and eradicate antibodies by immunosuppression. International recommendations rely on registers and international expert panels. METHODS CREHA, an open-label randomized trial, compared the efficacy and safety of cyclophosphamide and rituximab in association with steroids in patients with newly diagnosed AHA. Participants were treated with 1 mg/kg prednisone daily and randomly assigned to receive either 1.5-2 mg/kg/day cyclophosphamide orally for 6 weeks, or 375 mg/m2 rituximab once weekly for 4 weeks. The primary endpoint was complete remission over 18 months. Secondary endpoints included time to achieve complete remission, relapse occurrence, mortality, infections and bleeding, and severe adverse events. RESULTS Recruitment was interrupted because of new treatment recommendations after 108 patients included (58 cyclophosphamide, 50 rituximab). After 18 months, 39 cyclophosphamide patients (67.2 %) and 31 rituximab patients (62.0 %) were in complete remission (OR 1.26; 95 % CI, 0.57 to 2.78). In the poor prognosis group (FVIII < 1 IU/dL, inhibitor titer > 20 BU mL-1), significantly more remissions were observed with cyclophosphamide (22 patients, 78.6 %) than with rituximab (12 patients, 48.0 %; p = 0.02). Relapse rates, deaths, severe infections, and bleeding were similar in the 2 groups. In patients with severe infection, cumulative doses of steroids were significantly higher than in patients without infection (p = 0.03). CONCLUSION Cyclophosphamide and rituximab showed similar efficacy and safety. As first line, cyclophosphamide seems preferable, especially in poor prognosis patients, as administered orally and less expensive. FUNDING French Ministry of Health. CLINICALTRIALS gov number: NCT01808911.
Collapse
Affiliation(s)
- H Lévesque
- Normandie Univ, UNIROUEN, U 1096, CHU Rouen, Department of Internal Medicine, F-76000 Rouen, France.
| | - J F Viallard
- Service de Médecine Interne et Maladies Infectieuses Hôpital Haut-Lévêque, CHU Bordeaux, 5 avenue de Magellan, 33604 Pessac, France
| | - E Houivet
- Department of Biostatistics, CHU Rouen, F-76031 Rouen, France
| | - B Bonnotte
- Service de médecine interne et immunologie clinique, CHU Dijon-Bourgogne, Université de Dijon, F-21079 Dijon, France
| | - S Voisin
- Department of Internal Medicine, CHU Toulouse, F-31059 Toulouse. France
| | - V Le Cam-Duchez
- Normandie Univ, UNIROUEN, Hématologie biologique, F-76031 Rouen, France
| | - F Maillot
- Département de Médecine Interne et immunologie clinique, CHRU Tours, Université de Tours, F-37044 Tours, France
| | - M Lambert
- CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reerence Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), F-59000 Lille, France
| | - E Liozon
- Department of Internal Medicine, Dupuytren Hospital, F-87000 Limoges, France
| | - B Hervier
- Service de Médecine Interne, Hôpital Saint-Louis, APHP, 75010 Paris & INSERM UMR-S 976, Human Immunology, Pathophysiology, Immunotherapy, Saint-Louis Research Institute, F-75000 Paris, France
| | - O Fain
- Sorbonne Université, APHP, Service de Médecine Interne-DMU i3, Hôpital Saint-Antoine, Paris F-75000, France
| | - B Guillet
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR-S 1085, F-35000 Rennes, France
| | - J Schmidt
- Department of Internal Medicine, Amiens University Hospital, F-80000 Amiens, France
| | - L E Luca
- Department of Internal Medicine, Poitiers University Hospital, F-86000 Poitiers, France
| | - M Ebbo
- Service de Médecine Interne, Hôpital La Timone, CHU Marseille, Aix-Marseille Université, F-13000 Marseille, France
| | - N Ferreira-Maldent
- Département de Médecine Interne et immunologie clinique, CHRU Tours, Université de Tours, F-37044 Tours, France
| | - A Babuty
- Service d'Hématologie Biologique, CRC-MHC, CHU de Nantes, Nantes Cedex 1, France
| | - L Sailler
- Department of Internal Medicine, CHU Toulouse, F-31059 Toulouse. France
| | - P Duffau
- Service de Médecine Interne-Immunologie Clinique Hôpital Saint-André, CHU Bordeaux, 1 rue Jean Burguet, 33075 Bordeaux, France
| | - V Barbay
- Normandie Univ, UNIROUEN, Hématologie biologique, F-76031 Rouen, France
| | - S Audia
- Service de médecine interne et immunologie clinique, CHU Dijon-Bourgogne, Université de Dijon, F-21079 Dijon, France
| | - J Benichou
- Department of Biostatistics, CHU Rouen and CESP UMR 1018, University of Rouen and University Paris-Saclay, F-76031 Rouen, France
| | - J Graveleau
- Nantes Université, CHU Nantes, Service de Médecine Interne, Nantes, France
| | - Y Benhamou
- Normandie Univ, UNIROUEN, U 1096, CHU Rouen, Department of Internal Medicine, F-76000 Rouen, France
| |
Collapse
|
2
|
Moulis G, Rueter M, Duvivier A, Mahévas M, Viallard JF, Comont T, Chèze S, Audia S, Ebbo M, Terriou L, Lega JC, Jeandel PY, Hemim I, Bozzi S, Daak A, Okada H, Bonnotte B, Michel M, Lapeyre-Mestre M, Godeau B. Difficult-to-treat primary immune thrombocytopenia in adults: Prevalence and burden. Results from the CARMEN-France registry. Br J Haematol 2024; 204:1476-1482. [PMID: 38267268 DOI: 10.1111/bjh.19288] [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: 07/15/2023] [Revised: 11/25/2023] [Accepted: 12/22/2023] [Indexed: 01/26/2024]
Abstract
The aim of this study was to assess the prevalence and the burden of difficult-to-treat primary ITP (pITP), defined by the need for another ITP treatment after romiplostim and eltrombopag. Adult patients were selected in the prospective, real-world CARMEN-France registry up to December 2021. Out of 821 adult patients with pITP, 29 had difficult-to-treat ITP (3.5%; 95% confidence interval [CI]: 2.3%-4.8% in total; 7.6%; 95% CI: 4.9%-10.2% of patients needing ≥2nd line treatment). The 3-year cumulative incidence of bleeding, infection and thrombosis was 100%, 24.1% and 13.8% respectively. The median cumulative duration of hospital stays was 31 days (median follow-up: 30.3 months).
Collapse
Affiliation(s)
- Guillaume Moulis
- Department of Internal Medicine, Toulouse University Hospital, Toulouse, France
- Clinical Investigation Center, Toulouse University Hospital, Toulouse, France
| | - Manuela Rueter
- Clinical Investigation Center, Toulouse University Hospital, Toulouse, France
| | | | - Matthieu Mahévas
- Department of Internal Medicine, National Referral Center for Autoimmune Cytopenias, Créteil University Hospital, Créteil, France
| | | | - Thibault Comont
- Department of Internal Medicine, Toulouse Cancer University Hospital, Toulouse, France
| | - Stéphane Chèze
- Department of Hematology, Caen University Hospital, Caen, France
| | - Sylvain Audia
- Department of Internal Medicine, Dijon University Hospital, Dijon, France
| | - Mikaël Ebbo
- Department of Internal Medicine, Marseille University Hospital, Marseille, France
| | - Louis Terriou
- Department of Internal Medicine, Lille University Hospital, Lille, France
| | | | | | | | | | | | | | - Bernard Bonnotte
- Department of Internal Medicine, Dijon University Hospital, Dijon, France
| | - Marc Michel
- Department of Internal Medicine, National Referral Center for Autoimmune Cytopenias, Créteil University Hospital, Créteil, France
| | - Maryse Lapeyre-Mestre
- Clinical Investigation Center, Toulouse University Hospital, Toulouse, France
- Department of Clinical Pharmacology, Toulouse University Hospital, Toulouse, France
| | - Bertrand Godeau
- Department of Internal Medicine, National Referral Center for Autoimmune Cytopenias, Créteil University Hospital, Créteil, France
| |
Collapse
|
3
|
Ciudad M, Ouandji S, Lamarthée B, Cladière C, Ghesquière T, Nivet M, Thébault M, Boidot R, Soudry-Faure A, Chevrier S, Richard C, Maillet T, Maurier F, Greigert H, Genet C, Ramon A, Trad M, Predan V, Saas P, Samson M, Bonnotte B, Audia S. Regulatory T-cell dysfunctions are associated with increase in tumor necrosis factor α in autoimmune hemolytic anemia and participate in Th17 polarization. Haematologica 2024; 109:444-457. [PMID: 37534543 PMCID: PMC10828774 DOI: 10.3324/haematol.2023.282859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/25/2023] [Indexed: 08/04/2023] Open
Abstract
Warm autoimmune hemolytic anemia (wAIHA) is a rare acquired autoimmune disease mediated by antibodies targeting red blood cells. The involvement of CD4 T-helper cells has been scarcely explored, with most findings extrapolated from animal models. Here, we performed quantification of both effector T lymphocytes (Teff) and regulatory T cells (Treg), associated with functional and transcriptomic analyses of Treg in human wAIHA. We observed a shift of Teff toward a Th17 polarization concordant with an increase in serum interleukin-17 concentration that correlates with red blood cell destruction parameters, namely lactate dehydrogenase and bilirubin levels. A decrease in circulating Treg, notably effector Treg, associated with a functional deficiency, as represented by their decrease capability to inhibit Teff proliferation, were also observed. Treg deficiency was associated with a reduced expression of Foxp3, the master transcription factor known to maintain the Treg phenotype stability and suppressive functions. Transcriptomic profiling of Treg revealed activation of the tumor necrosis facto (TNF)-α pathway, which was linked to increased serum TNF-α concentrations that were twice as high as in controls. Treg transcriptomic profiling also suggested that post-translational mechanisms possibly accounted for Foxp3 downregulation and Treg dysfunctions. Since TNF-α participates in the rupture of immune tolerance during wAIHA, its inhibition could be of interest. To this end, the effects of fostamatinib, a SYK inhibitor, were investigated in vitro, and we showed that besides the inhibition of erythrocyte phagocytosis by monocytes, fostamatinib is also able to dampen TNF-α production, thus appearing as a promising multitargeting therapy in wAIHA (clinicaltrials gov. Identifier: NCT02158195).
Collapse
Affiliation(s)
- Marion Ciudad
- Department of Internal Medicine and Clinical Immunology, Referral Center for adult autoimmune cytopenia (CeReCAI) - Dijon University Hospital - F-21000 Dijon, France; Université de Bourgogne, INSERM, UMR1098, RIGHT -F-21000 Dijon
| | - Sethi Ouandji
- Department of Internal Medicine and Clinical Immunology, Referral Center for adult autoimmune cytopenia (CeReCAI) - Dijon University Hospital - F-21000 Dijon, France; Université de Bourgogne, INSERM, UMR1098, RIGHT -F-21000 Dijon
| | | | - Claudie Cladière
- Department of Internal Medicine and Clinical Immunology, Referral Center for adult autoimmune cytopenia (CeReCAI) - Dijon University Hospital - F-21000 Dijon, France; Université de Bourgogne, INSERM, UMR1098, RIGHT -F-21000 Dijon
| | - Thibault Ghesquière
- Department of Internal Medicine and Clinical Immunology, Referral Center for adult autoimmune cytopenia (CeReCAI) - Dijon University Hospital - F-21000 Dijon, France; Université de Bourgogne, INSERM, UMR1098, RIGHT -F-21000 Dijon
| | - Martin Nivet
- Department of Internal Medicine and Clinical Immunology, Referral Center for adult autoimmune cytopenia (CeReCAI) - Dijon University Hospital - F-21000 Dijon, France; Université de Bourgogne, INSERM, UMR1098, RIGHT -F-21000 Dijon
| | - Marine Thébault
- Department of Internal Medicine and Clinical Immunology, Referral Center for adult autoimmune cytopenia (CeReCAI) - Dijon University Hospital - F-21000 Dijon, France; Université de Bourgogne, INSERM, UMR1098, RIGHT -F-21000 Dijon
| | - Romain Boidot
- Unit of Molecular Biology, Georges-François Leclerc Cancer Center - F-21000 Dijon
| | - Agnès Soudry-Faure
- Department of Clinical Research and Innovation (DRCI), Clinical Research Unit-Methodological Support Network (USMR), Dijon Bourgogne University Hospital, Dijon
| | - Sandy Chevrier
- Unit of Molecular Biology, Georges-François Leclerc Cancer Center - F-21000 Dijon
| | - Corentin Richard
- Unit of Molecular Biology, Georges-François Leclerc Cancer Center - F-21000 Dijon
| | - Thibault Maillet
- Department of Internal Medicine - Centre Hospitalier de Mâcon, Groupe Hospitalier Bourgogne Méridionale - F-71000 Macon
| | - François Maurier
- Department of Internal Medicine, Groupe Hospitalier UNEOS - F-57000 Metz
| | - Hélène Greigert
- Department of Internal Medicine and Clinical Immunology, Referral Center for adult autoimmune cytopenia (CeReCAI) - Dijon University Hospital - F-21000 Dijon, France; Université de Bourgogne, INSERM, UMR1098, RIGHT -F-21000 Dijon
| | - Coraline Genet
- Université de Bourgogne, INSERM, UMR1098, RIGHT -F-21000 Dijon
| | - André Ramon
- Université de Bourgogne, INSERM, UMR1098, RIGHT -F-21000 Dijon
| | - Malika Trad
- Université de Bourgogne, INSERM, UMR1098, RIGHT -F-21000 Dijon
| | - Valérie Predan
- Department of Internal Medicine and Clinical Immunology, Referral Center for adult autoimmune cytopenia (CeReCAI) - Dijon University Hospital - F-21000 Dijon
| | - Philippe Saas
- Université de Bourgogne, INSERM, UMR1098, RIGHT -F-21000 Dijon
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Referral Center for adult autoimmune cytopenia (CeReCAI) - Dijon University Hospital - F-21000 Dijon, France; Université de Bourgogne, INSERM, UMR1098, RIGHT -F-21000 Dijon
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, Referral Center for adult autoimmune cytopenia (CeReCAI) - Dijon University Hospital - F-21000 Dijon, France; Université de Bourgogne, INSERM, UMR1098, RIGHT -F-21000 Dijon
| | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology, Referral Center for adult autoimmune cytopenia (CeReCAI) - Dijon University Hospital - F-21000 Dijon, France; Université de Bourgogne, INSERM, UMR1098, RIGHT -F-21000 Dijon.
| |
Collapse
|
4
|
Greigert H, Ramon A, Genet C, Cladière C, Gerard C, Cuidad M, Corbera-Bellalta M, Alba-Rovira R, Arnould L, Creuzot-Garcher C, Martin L, Tarris G, Ghesquière T, Ouandji S, Audia S, Cid MC, Bonnotte B, Samson M. Neointimal myofibroblasts contribute to maintaining Th1/Tc1 and Th17/Tc17 inflammation in giant cell arteritis. J Autoimmun 2024; 142:103151. [PMID: 38039746 DOI: 10.1016/j.jaut.2023.103151] [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: 08/31/2023] [Revised: 10/23/2023] [Accepted: 11/20/2023] [Indexed: 12/03/2023]
Abstract
Vascular smooth muscle cells (VSMCs) have been shown to play a role in the pathogenesis of giant cell arteritis (GCA) through their capacity to produce chemokines recruiting T cells and monocytes in the arterial wall and their ability to migrate and proliferate in the neointima where they acquire a myofibroblast (MF) phenotype, leading to vascular stenosis. This study aimed to investigate if MFs could also impact T-cell polarization. Confocal microscopy was used to analyze fresh fragments of temporal artery biopsies (TABs). Healthy TAB sections were cultured to obtain MFs, which were then treated or not with interferon-gamma (IFN-γ) and tumor necrosis factor-alpha (TNF-α) and analyzed by immunofluorescence and RT-PCR. After peripheral blood mononuclear cells and MFs were co-cultured for seven days, T-cell polarization was analyzed by flow cytometry. In the neointima of GCA arteries, we observed a phenotypic heterogeneity among VSMCs that was consistent with a MF phenotype (α-SMA+CD90+desmin+MYH11+) with a high level of STAT1 phosphorylation. Co-culture experiments showed that MFs sustain Th1/Tc1 and Th17/Tc17 polarizations. The increased Th1 and Tc1 polarization was further enhanced following the stimulation of MFs with IFN-γ and TNF-α, which induced STAT1 phosphorylation in MFs. These findings correlated with increases in the production of IL-1β, IL-6, IL-12 and IL-23 by MFs. Our study showed that MFs play an additional role in the pathogenesis of GCA through their ability to maintain Th17/Tc17 and Th1/Tc1 polarizations, the latter being further enhanced in case of stimulation of MF with IFN-γ and TNF-α.
Collapse
Affiliation(s)
- Hélène Greigert
- Department of Internal Medicine and Clinical Immunology, Referral Center for Rare Autoimmune and Autoinflammatory Diseases (MAIS), Dijon University Hospital, Dijon, France; Department of Vascular Medicine, Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France
| | - André Ramon
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France; Department of Rheumatology, Dijon University Hospital, Dijon, France
| | - Coraline Genet
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France
| | - Claudie Cladière
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France
| | - Claire Gerard
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France
| | - Marion Cuidad
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France
| | - Marc Corbera-Bellalta
- Department of Autoimmune Diseases, Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Roser Alba-Rovira
- Department of Autoimmune Diseases, Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Louis Arnould
- Department of Ophthalmology, Dijon University Hospital, Dijon, France
| | | | - Laurent Martin
- Department of Pathology, Dijon University Hospital, Dijon, France
| | - Georges Tarris
- Department of Pathology, Dijon University Hospital, Dijon, France
| | - Thibault Ghesquière
- Department of Internal Medicine and Clinical Immunology, Referral Center for Rare Autoimmune and Autoinflammatory Diseases (MAIS), Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France
| | - Sethi Ouandji
- Department of Internal Medicine and Clinical Immunology, Referral Center for Rare Autoimmune and Autoinflammatory Diseases (MAIS), Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France
| | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology, Referral Center for Rare Autoimmune and Autoinflammatory Diseases (MAIS), Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France
| | - Maria C Cid
- Department of Autoimmune Diseases, Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, Referral Center for Rare Autoimmune and Autoinflammatory Diseases (MAIS), Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Referral Center for Rare Autoimmune and Autoinflammatory Diseases (MAIS), Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France.
| |
Collapse
|
5
|
Audia S, Bussel J. Improving the chances of response to splenectomy in immune thrombocytopenia. Br J Haematol 2024; 204:24-25. [PMID: 37939484 DOI: 10.1111/bjh.19174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 11/10/2023]
Abstract
Immune thrombocytopenia (ITP) is an autoimmune bleeding disorder characterized by isolated thrombocytopenia. Its pathogenesis is complex relying in large part on destruction of platelets recognized by autoantibodies within the spleen. However, other mechanisms, such as platelet desialylation, may play a role in platelet reduction by accelerating their clearance in the liver. In their study, Mendoza and colleagues reported on platelet scintigraphy performed in 51 ITP patients, showing a response in 87.5% when the sequestration occurred in the spleen versus 45% in case of non-splenic destruction. Platelet desialylation was also measured after splenectomy and found to be higher in non-responder patients. These latter results, while requiring confirmation prior to splenectomy, support platelet desialylation may also be a potential biomarker of non-response to splenectomy. Commentary on: Mendoza et al. Study of platelet kinetics in immune thrombocytopenia to predict splenectomy response. Br J Haematol 2024;204:315-323.
Collapse
Affiliation(s)
- Sylvain Audia
- Department of Internal Medicine and Clinical Immunology, Referral Center for Adult Autoimmune Cytopenia (CeReCAI), Dijon University Hospital, Dijon, France
| | - James Bussel
- Department of Pediatrics, Weill Cornell Medical College, New York, New York, USA
| |
Collapse
|
6
|
Maldiney T, Greigert H, Martin L, Benoit E, Creuzot-Garcher C, Gabrielle PH, Chassot JM, Boccara C, Balvay D, Tavitian B, Clément O, Audia S, Bonnotte B, Samson M. Correction: Full-field optical coherence tomography for the diagnosis of giant cell arteritis. PLoS One 2023; 18:e0296315. [PMID: 38113232 PMCID: PMC10729943 DOI: 10.1371/journal.pone.0296315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0234165.].
Collapse
|
7
|
Guilhem A, Ciudad M, Aubriot-Lorton MH, Greigert H, Cladière C, Leguy-Seguin V, Audia S, Samson M, Bonnotte B. Pro-angiogenic changes of T-helper lymphocytes in hereditary hemorrhagic telangiectasia. Front Immunol 2023; 14:1321182. [PMID: 38143764 PMCID: PMC10748412 DOI: 10.3389/fimmu.2023.1321182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/24/2023] [Indexed: 12/26/2023] Open
Abstract
Hereditary hemorrhagic telangiectasia (HHT) is a rare inherited disease due to heterozygous loss-of-function mutations on the BMP9/10 pathway (ENG, ACVRL1 or MADH4 mainly). HHT endothelial cells are prone to lose their quiescence, leading to progressive appearance of numerous telangiectases on skin and mucosa (complicated by epistaxis and anemia), and to larger arteriovenous malformations in lungs, liver and brain. HHT is also associated with T lymphocyte abnormalities, which are currently poorly understood. We quantified by flow-cytometry the main T lymphocyte circulating subsets in 40 HHT patients and 20 matched healthy controls. Immunostaining was done on 2 HHT skin telangiectases. Disruptions in T lymphocyte homeostasis was observed, characterized by increases in subsets known to promote angiogenesis: Th2 (1.38% vs 1.15%, p=0.021), Th17 (0.32% vs 0.22%, p=0.019 2) and Treg (4.94% vs 3.51%, p= 0.027). T angiogenic lymphocytes (Tang), defined as CD3+CD31+CXCR4+ T cells, were at similar levels in both groups, but the proportion of VEGF-A+ Tang after stimulation was higher in the HHT group compared to controls (68.2% vs 44.9%, p=0.012). The global HHT T lymphopenia predominantly affected the effector memory T-helper cells (200 vs 270 cells/mm3, p=0.017), and the lymphocytic infiltrate around HHT telangiectases consisted of memory T-helper cells. The Th17 circulating subset was positively correlated with the monthly epistaxis duration (r coefficient: +0,431, p=0.042), prospectively assessed. HHT T-helper lymphocytes are affected by several pro-angiogenic changes, potentially resulting from their recruitment by abnormal endothelial cells. They could constitute a biologically relevant source of VEGF-A and a valuable therapeutic target in HHT.
Collapse
Affiliation(s)
- Alexandre Guilhem
- Service de Médecine Interne et Immunologie Clinique, Centre de compétence maladie de Rendu-Osler, Centre Hospitalo-Universitaire Dijon Bourgogne, Dijon, France
- Université de Bourgogne, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Marion Ciudad
- Université de Bourgogne, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | | | - Hélène Greigert
- Service de Médecine Interne et Immunologie Clinique, Centre de compétence maladie de Rendu-Osler, Centre Hospitalo-Universitaire Dijon Bourgogne, Dijon, France
| | - Claudie Cladière
- Université de Bourgogne, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Vanessa Leguy-Seguin
- Service de Médecine Interne et Immunologie Clinique, Centre de compétence maladie de Rendu-Osler, Centre Hospitalo-Universitaire Dijon Bourgogne, Dijon, France
| | - Sylvain Audia
- Service de Médecine Interne et Immunologie Clinique, Centre de compétence maladie de Rendu-Osler, Centre Hospitalo-Universitaire Dijon Bourgogne, Dijon, France
- Université de Bourgogne, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Maxime Samson
- Service de Médecine Interne et Immunologie Clinique, Centre de compétence maladie de Rendu-Osler, Centre Hospitalo-Universitaire Dijon Bourgogne, Dijon, France
- Université de Bourgogne, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Bernard Bonnotte
- Service de Médecine Interne et Immunologie Clinique, Centre de compétence maladie de Rendu-Osler, Centre Hospitalo-Universitaire Dijon Bourgogne, Dijon, France
- Université de Bourgogne, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| |
Collapse
|
8
|
Mageau A, Bonnotte B, Ebbo M, Dossier A, Galicier L, Souchaud-Debouverie O, Orvain C, Gerfaud-Valentin M, Gobert D, Riviere E, Audia S, Mahevas M, Michel M, Viallard JF, Godeau B. Efficacy and safety of two rituximab biosimilars for treating immune thrombocytopenia: a reference-product matched study. Platelets 2023; 34:2200848. [PMID: 37128870 DOI: 10.1080/09537104.2023.2200848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The emergence of rituximab biosimilars offers the prospect of significant savings to the healthcare system. However, these drugs have never been evaluated for treating immune thrombocytopenia (ITP). This was an observational, matched study. We included adults who received a rituximab biosimilar for ITP. Each rituximab-naïve biosimilar patient was matched with two controls from the historic ITP-ritux registry. For non-naïve patients, we compared the response to the biosimilar with that observed with the reference product. Response status was defined according to international criteria. We included 107 patients; 55 receiving Rixathon™ and 52 Truxima™. Three months after the first infusion of rituximab biosimilars, the overall response rate was 47/74 (63.5%) versus 76/142 (53.5%) for the matched controls receiving the reference product (p = .13). The 3-month overall response rate was 76.5% for Rixathon™ versus 51.5% for the matched control group (p = .01) and 21/40 (52.5%) for Truxima™ versus 41/74 (55.4%) for the matched controls (p = .81). For non-naïve patients, the response pattern was similar to that observed previously with the reference product. Safety was analogous to that observed with the reference product. Rituximab biosimilars seemed safe and effective for ITP treatment.
Collapse
Affiliation(s)
- Arthur Mageau
- Centre de référence des cytopénies auto-immunes de l'adulte, Service de Médecine Interne, Hôpital Henri Mondor, APHP, UPEC, Créteil, France
| | - Bernard Bonnotte
- Service de Médecine Interne et d'Immunologie Clinique, CHU Dijon-Bourgogne, Dijon, France
| | - Mikael Ebbo
- Département de Médecine Interne, Aix Marseille Univ, APHM, Hôpital de la Timone, Marseille, France
| | - Antoine Dossier
- Service de Médecine Interne, Hôpital Bichat-Claude Bernard, APHP, Université de Paris, Paris, France
| | - Lionel Galicier
- Service d'Immunopathologie Clinique, Hôpital Saint-Louis, APHP, Université de Paris, Paris, France
| | - Odile Souchaud-Debouverie
- Service de Médecine Interne, Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Corentin Orvain
- Service des Maladies du Sang, Centre Hospitalier Universitaire (CHU) d'Angers, Angers, France
| | | | - Delphine Gobert
- Service de Médecine Interne, Hôpital Saint-Antoine, APHP, Université de Paris, Paris, France
| | - Etienne Riviere
- Service de médecine interne CHU Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Sylvain Audia
- Service de Médecine Interne et d'Immunologie Clinique, CHU Dijon-Bourgogne, Dijon, France
| | - Matthieu Mahevas
- Centre de référence des cytopénies auto-immunes de l'adulte, Service de Médecine Interne, Hôpital Henri Mondor, APHP, UPEC, Créteil, France
| | - Marc Michel
- Centre de référence des cytopénies auto-immunes de l'adulte, Service de Médecine Interne, Hôpital Henri Mondor, APHP, UPEC, Créteil, France
| | | | - Bertrand Godeau
- Centre de référence des cytopénies auto-immunes de l'adulte, Service de Médecine Interne, Hôpital Henri Mondor, APHP, UPEC, Créteil, France
| |
Collapse
|
9
|
Razanamahery J, Samson M, Guy J, Racine J, Row C, Greigert H, Nicolas B, Francois S, Emile JF, Cohen-Aubart F, Audia S, Haroche J, Bonnotte B. Specific blood monocyte distribution in histiocytoses correlates with vascular involvement and disease activity. Haematologica 2023; 108:3444-3448. [PMID: 37317872 PMCID: PMC10690905 DOI: 10.3324/haematol.2023.282739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/01/2023] [Indexed: 06/16/2023] Open
Abstract
Not available.
Collapse
Affiliation(s)
- Jerome Razanamahery
- Department of Internal Medicine and Clinical Immunology, Francois Mitterrand Hospital, Dijon University Hospital, Dijon, Bourgogne-Franche Comté.
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Francois Mitterrand Hospital, Dijon University Hospital, Dijon, Bourgogne-Franche Comté
| | - Julien Guy
- Hematology Laboratory. Dijon University Hospital, Dijon, Bourgogne-Franche Comté
| | - Jessica Racine
- Hematology Laboratory. Dijon University Hospital, Dijon, Bourgogne-Franche Comté
| | - Celine Row
- Hematology Laboratory. Dijon University Hospital, Dijon, Bourgogne-Franche Comté
| | - Hélène Greigert
- Department of Internal Medicine and Clinical Immunology, Francois Mitterrand Hospital, Dijon University Hospital, Dijon, Bourgogne-Franche Comté
| | - Barbara Nicolas
- Department of Internal Medicine and Clinical Immunology, Francois Mitterrand Hospital, Dijon University Hospital, Dijon, Bourgogne-Franche Comté
| | - Stephanie Francois
- Immunology Laboratory. Dijon University Hospital, Dijon, Bourgogne-Franche Comté
| | - Jean-François Emile
- Department of Pathology. Ambroise-Paré Hospital. Assistance-Publique Hopitaux de Paris. Paris
| | - Fleur Cohen-Aubart
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Internal Medicine Department 2, National reference center for histiocytosis, Paris
| | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology, Francois Mitterrand Hospital, Dijon University Hospital, Dijon, Bourgogne-Franche Comté
| | - Julien Haroche
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Internal Medicine Department 2, National reference center for histiocytosis, Paris
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, Francois Mitterrand Hospital, Dijon University Hospital, Dijon, Bourgogne-Franche Comté
| |
Collapse
|
10
|
Razanamahery J, Samson M, Idbaih A, Greigert H, Comby PO, Cohen Aubart F, Haroche J, Audia S, Bonnotte B. Increased neopterin in cerebrospinal fluid in active adult neurohistiocytosis. Hematol Oncol 2023; 41:762-767. [PMID: 37302122 DOI: 10.1002/hon.3189] [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: 11/29/2022] [Revised: 04/21/2023] [Accepted: 05/12/2023] [Indexed: 06/13/2023]
Abstract
Diagnosis of neuro-histiocytosis is challenging and relies on clinical presentation, imaging, and cerebrospinal fluid (CSF) analysis to exclude differential diagnoses. Brain biopsy remains the gold standard for accurate diagnosis, but it is rarely performed because of the risk of the procedure and the low rentability in neurodegenerative presentation. Therefore, there is an unmet need to identify a specific biomarker for diagnosing neurohistiocytosis in adults. Because microglia (brain macrophages) is involved in the pathogenesis of neurohistiocytosis and produces neopterin secondary to aggression, the purpose of our study was to evaluate the value of the CSF neopterin levels for the diagnosis of active neurohistiocytosis. Of the 21 adult patients with histiocytosis, four patients had clinical symptoms compatible with neurohistiocytosis. In the two patients with a confirmed diagnosis of neurohistiocytosis, CSF neopterin levels were elevated as well as IL-6 and IL-10 levels. In contrast, the two other patients in whom the diagnosis of neurohistiocytosis was infirmed and all other patients with histiocytosis without active neurological disease involvement had normal CSF neopterin levels. In summary, increased CSF neopterin concentration represented a valuable tool for diagnosing active neuro-histiocytosis in adults with histiocytic neoplasms in this preliminary study.
Collapse
Affiliation(s)
- Jerome Razanamahery
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Ahmed Idbaih
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital Universitaire La Pitié Salpêtrière, DMU Neurosciences, Paris, France
| | - Helene Greigert
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | | | - Fleur Cohen Aubart
- Department of Internal Medicine 2, National Reference Center for Histiocytosis, Pitié-Salpétrière Hospital, Paris, France
| | - Julien Haroche
- Department of Internal Medicine 2, National Reference Center for Histiocytosis, Pitié-Salpétrière Hospital, Paris, France
| | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| |
Collapse
|
11
|
Razanamahery J, Godot A, Leguy-Seguin V, Samson M, Audia S, Bonnotte B. Impact of BRAFV600E mutation on aggressiveness and outcomes in adult clonal histiocytosis. Front Immunol 2023; 14:1260193. [PMID: 37809108 PMCID: PMC10556468 DOI: 10.3389/fimmu.2023.1260193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Histiocytoses encompass a wide spectrum of diseases, all characterized by tissue infiltration by CD68+ histiocytes. Most adult histiocytoses are considered clonal diseases because they highlight recurrent somatic mutations in the MAP-kinase pathway gene, primarily BRAF. The presence of BRAF mutation is associated with widespread disease in children with Langerhans cell histiocytosis (LCH) or cardiovascular/neurological involvement in Erdheim-Chester disease (ECD). Nevertheless, few data are available on adult clonal histiocytosis. This is why we have conducted a retrospective study of all patients with clonal histiocytosis in our institution and present the data according to the presence of BRAF mutation. Among 27 adult patients (10 ECD, 10 LCH, 5 Rosai-Dorfman disease (RDD), and 3 mixed ECD/LCH), 11 (39%) have BRAF mutation with gain of function (n = 9) and deletion (n = 2). Those patients had frequent multicentric disease with risk organ involvement, especially the brain and cardiovascular system. They had frequent associated myeloid neoplasms (mostly chronic myelomonocytic leukemia) and received more frequently targeted therapy as the front-line therapy. Nevertheless, its presence did not affect the overall survival or relapse-free survival probably due to the emergence of efficient therapies. To conclude, rapid and accurate molecular establishment in adult clonal histiocytoses is crucial because BRAFV600E mutation correlates with multicentric disease with organ involvement and incomplete metabolic response.
Collapse
Affiliation(s)
- Jerome Razanamahery
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Amelie Godot
- Department of Internal Medicine, Besancon University Hospital, Besancon, France
| | - Vanessa Leguy-Seguin
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - M. Samson
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| |
Collapse
|
12
|
Ollier N, Piel-Julian ML, Mahévas M, Viallard JF, Comont T, Chèze S, Audia S, Ebbo M, Terriou L, Lega JC, Jeandel PY, Bonnotte B, Michel M, Lapeyre-Mestre M, Godeau B, Moulis G. Platelet count threshold for hemorrhage in patients with immune thrombocytopenia treated with antiplatelet agents. Blood 2023; 142:1099-1101. [PMID: 37478400 DOI: 10.1182/blood.2023020311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/02/2023] [Accepted: 06/21/2023] [Indexed: 07/23/2023] Open
Abstract
A significant proportion of older patients with immune thrombocytopenia (ITP) also have clinical indications for treatment of cardiovascular disease with antiplatelet agents. Ollier and colleagues sought to determine the frequency of bleeding in patients with ITP on aspirin therapy, finding that the pattern of bleeding, segregated by platelet count, is similar to that observed in other adults with ITP not on aspirin. They show that a platelet count of <20 × 109/L is associated with most bleeding in ITP patients on antiplatelet agents.
Collapse
Affiliation(s)
- Natasha Ollier
- Department of Internal Medicine, Toulouse University Hospital, France
| | | | - Matthieu Mahévas
- Department of Internal Medicine, National Referral Center for Adult's Immune Cytopenias, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, France
| | | | - Thibault Comont
- Department of Internal Medicine, Toulouse University Institute for Cancer, France
| | - Stéphane Chèze
- Department of Hematology, Caen University Hospital, France
| | - Sylvain Audia
- Department of Internal Medicine, Dijon University Hospital, France
| | - Mikaël Ebbo
- Department of Internal Medicine, Marseille University Hospital, Assistance Publique-Hôpitaux de Marseille, France
| | - Louis Terriou
- Department of Internal Medicine, Lille University Hospital, France
| | - Jean-Christophe Lega
- Department of Internal Medicine, Lyon University Hospital, Hôpitaux Civils de Lyon, France
| | | | - Bernard Bonnotte
- Department of Internal Medicine, Dijon University Hospital, France
| | - Marc Michel
- Department of Internal Medicine, National Referral Center for Adult's Immune Cytopenias, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, France
| | - Maryse Lapeyre-Mestre
- Clinical Investigation Center 1436, Team PEPSS (PharmacoEpidemiology, Populations, cohortS, biomarkerS), Toulouse University Hospital, France
- Department of Clinical Pharmacology, Toulouse University Hospital, France
| | - Bertrand Godeau
- Department of Internal Medicine, National Referral Center for Adult's Immune Cytopenias, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, France
| | - Guillaume Moulis
- Department of Internal Medicine, Toulouse University Hospital, France
- Clinical Investigation Center 1436, Team PEPSS (PharmacoEpidemiology, Populations, cohortS, biomarkerS), Toulouse University Hospital, France
| |
Collapse
|
13
|
Thibault T, Bourredjem A, Maurier F, Wahl D, Muller G, Aumaitre O, Sève P, Blaison G, Pennaforte JL, Martin T, Magy-Bertrand N, Audia S, Arnaud L, Amoura Z, Devilliers H. The mediating effect of fatigue in impaired quality of life in systemic lupus erythematosus: mediation analysis of the French EQUAL cohort. Rheumatology (Oxford) 2023; 62:3051-3058. [PMID: 36655762 DOI: 10.1093/rheumatology/kead020] [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: 09/13/2022] [Revised: 12/22/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Mediation analyses were conducted to measure the extent to which musculoskeletal (MSK) flares and depression affected physical health through excessive fatigue. METHODS Mediation analyses were performed in a large multicentre cohort of SLE patients. Domains of the LupusQoL and SLEQOL questionnaires were selected as outcomes, MSK flares according to the SELENA-SLEDAI flare index (SFI-R) score and depression defined by Center for Epidemiologic Studies-Depression scale (CES-D) scale as exposures and different fatigue domains from MFI-20 and LupusQoL questionnaires as mediators. For each model, total, direct, indirect effects and proportion of effect mediated by fatigue (i.e. proportion of change in health-related quality of life) were determined. RESULTS Of the 336 patients, 94 (28%) had MSK flares at inclusion and 99 (29.5%) were considered with depression. The proportion of the total effect of MSK flares on physical health impairment explained by fatigue ranged from 59.6% to 78% using the LupusQOL 'Physical health' domain and from 51.1% to 73.7% using the SLEQOL 'Physical functioning' domain, depending on the fatigue domain selected. The proportion of the total effect of depression on physical health impairment explained by fatigue ranged from 68.8% to 87.6% using the LupusQOL 'Physical health' domain and from 79.3% to 103.2% using the SLEQOL 'Physical functioning' domain, depending on the fatigue domain selected. CONCLUSIONS The effect of MSK flares and depression on physical health impairment is largely mediated by fatigue. Thus, the patient's perception of disease activity as measured by physical health is largely influenced by fatigue. In addition, fatigue has a significant negative impact on quality of lifeof SLE patients with depression. TRIAL REGISTRATION ClinicalTrials.gov, http://clinicaltrials.gov, NCT01904812.
Collapse
Affiliation(s)
- Thomas Thibault
- Internal Medicine and Systemic Diseases Unit, University Hospital Dijon-Burgundy, Dijon, France
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon-Burgundy, Dijon, France
| | - Abderrahmane Bourredjem
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon-Burgundy, Dijon, France
| | - François Maurier
- Department of Internal Medicine and Clinical Immunology, Hôpital Robert Schuman, Metz-Vantoux, France
| | - Denis Wahl
- Inserm UMR_S 1116, CHRU de Nancy, Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, University of Lorraine, Nancy, France
| | - Geraldine Muller
- Internal Medicine and Systemic Diseases Unit, University Hospital Dijon-Burgundy, Dijon, France
| | - Olivier Aumaitre
- Department of Internal Medicine, Centre Hospitalier Universitaire, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Pascal Sève
- Department of Internal Medicine, Lyon University Hospital, Hôpital Croix Rousse, Lyon, France
| | - Gilles Blaison
- Department of Internal Medicine, Hôpital Louis Pasteur, Colmar, Alsace, France
| | - Jean-Loup Pennaforte
- Department of Internal Medicine, Centre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, France
| | - Thierry Martin
- Internal Medicine and Clinical Immunology Department, Strasbourg University Hospital, Strasbourg, France
| | - Nadine Magy-Bertrand
- Department of Internal Medicine, University Hospital Jean Minjoz, Besançon, France
| | - Sylvain Audia
- Internal Medicine and Clinical Immunology Unit, University Hospital Dijon-Burgundy, Dijon, France
| | - Laurent Arnaud
- Department of Rheumatology, Centre National de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest (RESO), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- INSERM UMR-S 1109, Strasbourg, France
| | - Zahir Amoura
- Department of Internal Medicine, National Referral Center for Systemic Lupus Erythematosus and Anti-Phospholipid Syndrome, Pitié-Salpêtrière University Hospital, Paris, France
| | - Hervé Devilliers
- Internal Medicine and Systemic Diseases Unit, University Hospital Dijon-Burgundy, Dijon, France
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon-Burgundy, Dijon, France
| |
Collapse
|
14
|
Sorin B, Gaigne L, Garzaro M, Moulis G, Mageau A, Lopez C, Roy-Peaud F, Jeandel PY, Crickx E, Dossier A, Gobert D, Hadjadj J, Puyade M, Languille L, Rasmussen C, Terrier B, Ebbo M, Bonnotte B, Audia S, Galicier L, Michel M, Mahevas M, Viallard JF, Godeau B. Severe SARS-CoV-2 infection in rituximab-treated patients with autoimmune cytopenia: A multicenter observational study. Am J Hematol 2023; 98:E259-E262. [PMID: 37410544 DOI: 10.1002/ajh.27016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/17/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Boris Sorin
- Centre de Référence des Cytopénies Auto-Immunes de L'adulte, filière MARIH, Service de Médecine Interne, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Léa Gaigne
- Service de Médecine Interne, CHU La Timone, APHM, Marseille, France
| | - Margaux Garzaro
- Service d'Immunologie Clinique, Hôpital Saint-Louis, APHP, Paris, France
| | - Guillaume Moulis
- Service de Médecine Interne, CHU de Toulouse, France
- Center d'Investigation Clinique U1436, CHU de Toulouse, Toulouse, France
| | - Arthur Mageau
- Service de Médecine Interne, Hôpital Bichat-Claude-Bernard, APHP, Paris, France
| | - Carine Lopez
- Service de Médecine Interne et de Maladies Infectieuses, CHU de Bordeaux, GH Haut-Lévêque, Pessac, France
| | - Frédérique Roy-Peaud
- Service de Médecine Interne et de Maladies Infectieuses, CHU de Poitiers, Poitiers, France
| | | | - Etienne Crickx
- Centre de Référence des Cytopénies Auto-Immunes de L'adulte, filière MARIH, Service de Médecine Interne, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Antoine Dossier
- Service de Médecine Interne, Hôpital Bichat-Claude-Bernard, APHP, Paris, France
| | - Delphine Gobert
- Service de Médecine Interne, Hôpital Saint-Antoine, APHP, Paris, France
| | - Jérôme Hadjadj
- Service de Médecine Interne, Hôpital Saint-Antoine, APHP, Paris, France
| | - Mathieu Puyade
- Service de Médecine Interne, Hôpital Bichat-Claude-Bernard, APHP, Paris, France
- Service de Médecine Interne et de Maladies Infectieuses, CHU de Poitiers, Poitiers, France
| | - Laetitia Languille
- Centre de Référence des Cytopénies Auto-Immunes de L'adulte, filière MARIH, Service de Médecine Interne, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | | | - Benjamin Terrier
- Service de Médecine Interne, Hôpital Cochin, APHP, Paris, France
| | - Mikael Ebbo
- Service de Médecine Interne, CHU La Timone, APHM, Marseille, France
| | - Bernard Bonnotte
- Service de Médecine Interne et d'Immunologie Clinique, CHU Dijon, Dijon, France
| | - Sylvain Audia
- Service de Médecine Interne et d'Immunologie Clinique, CHU Dijon, Dijon, France
| | - Lionel Galicier
- Service d'Immunologie Clinique, Hôpital Saint-Louis, APHP, Paris, France
| | - Marc Michel
- Centre de Référence des Cytopénies Auto-Immunes de L'adulte, filière MARIH, Service de Médecine Interne, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Matthieu Mahevas
- Centre de Référence des Cytopénies Auto-Immunes de L'adulte, filière MARIH, Service de Médecine Interne, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Jean-François Viallard
- Service de Médecine Interne et de Maladies Infectieuses, CHU de Bordeaux, GH Haut-Lévêque, Pessac, France
| | - Bertrand Godeau
- Centre de Référence des Cytopénies Auto-Immunes de L'adulte, filière MARIH, Service de Médecine Interne, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| |
Collapse
|
15
|
Crickx E, Ebbo M, Rivière E, Souchaud-Debouverie O, Terriou L, Audia S, Ruivard M, Asli B, Marolleau JP, Méaux-Ruault N, Gerfaud-Valentin M, Audeguy P, Hamidou M, Corm S, Delbrel X, Fontan J, Lebon D, Mausservey C, Moulis G, Limal N, Michel M, Godeau B, Mahévas M. Combining thrombopoietin receptor agonists with immunosuppressive drugs in adult patients with multirefractory immune thrombocytopenia, an update on the French experience. Br J Haematol 2023; 202:883-889. [PMID: 37247631 DOI: 10.1111/bjh.18893] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 05/31/2023]
Abstract
Combining drugs could be an effective option for treating multirefractory ITP, that is, patients not responding to rituximab, thrombopoietin receptor agonists (TPO-RA) and splenectomy. We conducted a retrospective, multicenter, observational study including multirefractory ITP patients who received a combination of a TPO-RA and an immunosuppressive drug. We included 39 patients (67% women, median age 59 years [range 21-96]), with a median ITP duration of 57 months [3-393] and a median platelet count at initiation of 10 × 109 /L [1-35]. The combination regimen was given for a median duration of 12 months [1-103] and included eltrombopag (51%) or romiplostim (49%), associated with mycophenolate mofetil (54%), azathioprine (36%), cyclophosphamide (5%), cyclosporin (3%) or everolimus (3%). Overall, 30 patients (77%) achieved at least a response (platelet count ≥30 × 109 /L and at least doubling baseline during at least 3 months), including 24 complete responses (platelet count >100 × 109 /L during at least 3 months) with a median time to response of 30 days [7-270] and a median duration of response of 15 months [4-63]. Severe adverse event related to ITP treatment was observed in 31%. In conclusion, this study confirms that some patients with multirefractory ITP can achieve long lasting response with this combination.
Collapse
Affiliation(s)
- Etienne Crickx
- Internal Medicine Department, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Imagine Institute, Université Paris Cité, INSERM UMR U1163, Paris, France
| | - Mikael Ebbo
- Internal Medicine Department, Hôpital la Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Etienne Rivière
- Internal Medicine and Infectious Diseases Unit, Haut-Leveque Hospital, University Hospital Centre of Bordeaux, Pessac, France
- INSERM U1034, Bordeaux University, Pessac Cedex, France
| | | | - Louis Terriou
- Internal Medicine and Clinical Immunology Department, Centre de référence des maladies auto-immunes systémiques rares du nord et nord-ouest de France (CeRAINO), LIRIC INSERM U995, CHU LILLE, Lille, France
| | - Sylvain Audia
- Internal Medicine and Clinical Immunology Department, Centre de référence constitutif des cytopénies auto-immunes, Hôpital François Mitterrand, Centre Hospitalier Universitaire (CHU) Dijon-Bourgogne, Dijon, France
| | - Marc Ruivard
- Internal Medicine Department, Estaing University Hospital, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, Institut Pascal, Clermont-Ferrand, France
| | - Bouchra Asli
- Internal Medicine Department, Sauvegarde Clinic, Lyon, France
| | - Jean-Pierre Marolleau
- Clinical Hematology and Cellular Therapy Department, CHU Amiens-Picardie, EA4666 Equipe Hematim - CURS - UPJV, Amiens, France
| | - Nadine Méaux-Ruault
- Internal Medicine Department, Centre Hospitalier Universitaire Jean-Minjoz, Besançon, France
| | - Mathieu Gerfaud-Valentin
- Internal Medicine Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard-Lyon1, Lyon, France
| | | | | | - Selim Corm
- Clinical Hematology Department, Médipole de Savoie, Challes-les-Eaux, France
| | - Xavier Delbrel
- Internal Medicine Department, Centre Hospitalier de Pau, Pau, France
| | - Jean Fontan
- Clinical Hematology Department, CHU Besançon, Besançon, France
| | - Delphine Lebon
- Clinical Hematology and Cellular Therapy Department, CHU Amiens-Picardie, EA4666 Equipe Hematim - CURS - UPJV, Amiens, France
| | - Christelle Mausservey
- Internal Medicine Department, Centre Hospitalier William-Morey, Chalon/Saône, France
| | - Guillaume Moulis
- Internal Medicine Department, CHU de Toulouse, Toulouse, France
- CIC 1436, équipe PEPSS, CHU de Toulouse, Toulouse, France
| | - Nicolas Limal
- Internal Medicine Department, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Marc Michel
- Internal Medicine Department, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Bertrand Godeau
- Internal Medicine Department, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Matthieu Mahévas
- Internal Medicine Department, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMS 8253, ATIP-Avenir Team AI2B, Université de Paris Cité, Université Paris-Est-Créteil, Créteil, France
- INSERM U955, équipe 2, Université Paris-Est Créteil (UPEC), Créteil, France
| |
Collapse
|
16
|
Guillet S, Crickx E, Azzaoui I, Chappert P, Boutin E, Viallard JF, Rivière E, Gobert D, Galicier L, Malphettes M, Cheze S, Lefrere F, Audia S, Bonnotte B, Lambotte O, Noel N, Fain O, Moulis G, Hamidou M, Gerfaud-Valentin M, Marolleau JP, Terriou L, Martis N, Morin AS, Perlat A, Le Gallou T, Roy-Peaud F, Robbins A, Lega JC, Puyade M, Comont T, Limal N, Languille L, Zarrour A, Luka M, Menager M, Belmondo T, Hue S, Canoui-Poitrine F, Michel M, Godeau B, Mahévas M. Prolonged response after TPO-RA discontinuation in primary ITP: results of a prospective multicenter study. Blood 2023; 141:2867-2877. [PMID: 36893453 DOI: 10.1182/blood.2022018665] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/30/2023] [Accepted: 02/18/2023] [Indexed: 03/11/2023] Open
Abstract
Sustained response off treatment (SROT) after thrombopoietin receptor agonist (TPO-RA) discontinuation has been reported in immune thrombocytopenia (ITP). This prospective multicenter interventional study enrolled adults with persistent or chronic primary ITP and complete response (CR) on TPO-RAs. The primary end point was the proportion of patients achieving SROT (platelet count >30 × 109/L and no bleeding) at week 24 (W24) with no other ITP-specific medications. Secondary end points included the proportion of sustained CR off-treatment (SCROT, platelet count >100 × 109/L and no bleeding) and SROT at W52, bleeding events, and pattern of response to a new course of TPO-RAs. We included 48 patients with a median age of 58.5 years; 30 of 48 had chronic ITP at TPO-RA initiation. In the intention-to-treat analysis, 27 of 48 achieved SROT, 15 of 48 achieved SCROT at W24; 25 of 48 achieved SROT, and 14 of 48 achieved SCROT at W52. No severe bleeding episode occurred in patients who relapsed. Among patients rechallenged with TPO-RA, 11 of 12 achieved CR. We found no significant clinical predictors of SROT at W24. Single-cell RNA sequencing revealed enrichment of a tumor necrosis factor α signaling via NF-κB signature in CD8+ T cells of patients with no sustained response after TPO-RA discontinuation, which was further confirmed by a significant overexpression of CD69 on CD8+ T cells at baseline in these patients as compared with those achieving SCROT/SROT. Our results strongly support a strategy based on progressive tapering and discontinuation of TPO-RAs for patients with chronic ITP who achieved a stable CR on treatment. This trial was registered at www.clinicaltrials.gov as #NCT03119974.
Collapse
Affiliation(s)
- Stéphanie Guillet
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Etienne Crickx
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
- INSERM U1151/CNRS UMS 8253, Institut Necker Enfants Malades, ATIP-Avenir Team AI2B, Université de Paris Cité, Université Paris-Est Créteil (UPEC), Créteil, France
- INSERM UMR U1163,Imagine Institute, Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Université de Paris Cité, Paris, France
| | - Imane Azzaoui
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
- INSERM U1151/CNRS UMS 8253, Institut Necker Enfants Malades, ATIP-Avenir Team AI2B, Université de Paris Cité, Université Paris-Est Créteil (UPEC), Créteil, France
- INSERM U955, Équipe 2, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Pascal Chappert
- INSERM U1151/CNRS UMS 8253, Institut Necker Enfants Malades, ATIP-Avenir Team AI2B, Université de Paris Cité, Université Paris-Est Créteil (UPEC), Créteil, France
- INSERM U955, Équipe 2, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Emmanuelle Boutin
- Unité de Recherche Clinique (Mondor), AP-HP, Henri Mondor Hôpitaux Universitaires, Créteil, France
- INSERM, Institut Mondor de Recherche Biomédicale, Équipe Clinical Epidemiology and Ageing, UPEC, Créteil, France
| | - Jean-François Viallard
- Service de Médecine Interne, Haut-Lévêque Hôpital, Université de Bordeaux, Bordeaux, France
| | - Etienne Rivière
- Service de Médecine Interne, Haut-Lévêque Hôpital, Université de Bordeaux, Bordeaux, France
| | - Delphine Gobert
- Service de Médecine Interne, Saint Antoine Hôpital, AP-HP, Sorbonne Université, Paris, France
| | - Lionel Galicier
- Service d'Immunologie Clinique, Saint Louis Hôpital, AP-HP, Université de Paris Cité, Paris, France
| | - Marion Malphettes
- Service d'Immunologie Clinique, Saint Louis Hôpital, AP-HP, Université de Paris Cité, Paris, France
| | - Stéphane Cheze
- Institut d'Hématologie de Basse-Normandie, Centre Hospitalier de Caen Normandie, Caen, France
| | | | - Sylvain Audia
- Service de Médecine Interne et d'Immunologie Clinique, Centre de Référence Constitutif des Cytopénies Auto-Immunes, Hôpital François Mitterrand, Centre Hospitalier Universitaire (CHU) Dijon-Bourgogne, Dijon, France
| | - Bernard Bonnotte
- Service de Médecine Interne et d'Immunologie Clinique, Centre de Référence Constitutif des Cytopénies Auto-Immunes, Hôpital François Mitterrand, Centre Hospitalier Universitaire (CHU) Dijon-Bourgogne, Dijon, France
| | - Olivier Lambotte
- Service de Médecine Interne et d'Immunologie Clinique, Hôpital Bicêtre, AP-HP, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Nicolas Noel
- Service de Médecine Interne et d'Immunologie Clinique, Hôpital Bicêtre, AP-HP, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Olivier Fain
- Service de Médecine Interne, Saint Antoine Hôpital, AP-HP, Sorbonne Université, Paris, France
| | - Guillaume Moulis
- Service de Médecine Interne, CHU de Toulouse, Toulouse, France
- CIC 1436, Équipe PEPSS, CHU de Toulouse, Toulouse, France
| | | | | | - Jean-Pierre Marolleau
- Service d'Hématologie Clinique et Thérapie Cellulaire, CHU Amiens-Picardie, Amiens, France
| | - Louis Terriou
- Service de Médecine Interne et d'Immunologie Clinique, CHU de Lille, Lille, France
| | - Nihal Martis
- Service de Médecine Interne et d'Immunologie Clinique, Hôpital de Nice, Nice, France
| | - Anne-Sophie Morin
- Service de Médecine Interne, Jean Verdier Hôpital, AP-HP, Bondy, France
| | - Antoinette Perlat
- Service de Médecine Interne et Immunologie Clinique, CHU de Rennes, Rennes, France
| | - Thomas Le Gallou
- Service de Médecine Interne et Immunologie Clinique, CHU de Rennes, Rennes, France
| | - Frédérique Roy-Peaud
- Service de Médecine Interne-Maladies Infectieuses et Tropicales, CHU de Poitiers, Poitiers, France
| | - Ailsa Robbins
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Robert Debré Hospital, Reims University Hospitals, Reims, France
| | - Jean-Christophe Lega
- Service de Médecine Interne, Hospices Civils de Lyon, Lyon Sud Hôpital, Pierre-Bénite, France
| | - Matthieu Puyade
- Service de Médecine Interne, CHU de Poitiers, Poitiers, France
| | - Thibault Comont
- Service de Médecine Interne, CHU de Toulouse (IUCT-Oncopole), Toulouse, France
| | - Nicolas Limal
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Laetitia Languille
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Anissa Zarrour
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Marine Luka
- Université Paris Cité, Institut Imagine, Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, INSERM UMR 1163, F-75015 Paris, France
| | - Mickael Menager
- Université Paris Cité, Institut Imagine, Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, INSERM UMR 1163, F-75015 Paris, France
| | - Thibault Belmondo
- Département Immunologie-Hématologie, Henri Mondor Hôpital, AP-HP, UPEC, Créteil, France
- UPEC, Faculté de Médecine, Créteil, France
- Service de Santé Publique, AP-HP, Henri Mondor Hôpitaux Universitaires, Créteil, France
| | - Sophie Hue
- Département Immunologie-Hématologie, Henri Mondor Hôpital, AP-HP, UPEC, Créteil, France
- UPEC, Faculté de Médecine, Créteil, France
- INSERM U955, Équipe 16, Institut Mondor de Recherche Biomédicale, UPEC, Créteil, France
| | - Florence Canoui-Poitrine
- Unité de Recherche Clinique (Mondor), AP-HP, Henri Mondor Hôpitaux Universitaires, Créteil, France
- Service de Santé Publique, AP-HP, Henri Mondor Hôpitaux Universitaires, Créteil, France
| | - Marc Michel
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Bertrand Godeau
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Matthieu Mahévas
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
- INSERM U1151/CNRS UMS 8253, Institut Necker Enfants Malades, ATIP-Avenir Team AI2B, Université de Paris Cité, Université Paris-Est Créteil (UPEC), Créteil, France
- INSERM U955, Équipe 2, Université Paris-Est Créteil (UPEC), Créteil, France
| |
Collapse
|
17
|
Nguyen M, Beltramo G, Audia S, Devilliers H, Laurent A, Blot M. [Correlation between Objective structured clinical examinations (OSCE) and knowledge examination scores and analysis of factors associated with better OSCE success in fourth and fifth year medicine students at Dijon university hospital]. Rev Med Interne 2023:S0248-8663(23)00114-5. [PMID: 37024357 DOI: 10.1016/j.revmed.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 03/08/2023] [Accepted: 03/17/2023] [Indexed: 04/08/2023]
Abstract
RATIONALE Objective structured clinical examinations (OSCEs) were introduced to evaluate students not only on their knowledge, but also on their clinical skills and attitudes. The objectives were to study the correlation between OSCE scores and scores obtained to traditional knowledge examinations and to analyse factors associated with better OSCE performance in DFASM1 and 2 students at Dijon university hospital. METHODS This was a prospective observational study conducted among all fourth and fifth year medical students in Dijon. The scores on the OSCE elective tests (2022) and the average score on the knowledge tests (2021-2022) were collected and their correlation measured. A questionnaire asked students about their demographic characteristics, their investment in formative and practicum OSCEs, their level of empathy (Jefferson questionnaire) and their personality traits (NEO-Pi-R). RESULTS Of 549 students, 513 completed all tests. Scores on OSCE and faculty knowledge tests were correlated (r=0.39, P<0.001). Of these, 111 (20%) students responded to the questionnaire, and 97 were analized. We did not observe any significant difference between students who performed better on OSCEs than on knowledge tests and those who did not, regarding their age, their investment in formative tests, their personality traits or their level of empathy. CONCLUSION Our results underline the need to optimize the evaluation of empathy and clinical skills in OSCE tests, using new tools, in order to better discriminate between students on these skills.
Collapse
Affiliation(s)
- M Nguyen
- Service d'anesthésie et réanimation, centre hospitalo-universitaire de Dijon-Bourgogne, Dijon, France; UFR des sciences de santé, université de Bourgogne, 21000, Dijon, France.
| | - G Beltramo
- UFR des sciences de santé, université de Bourgogne, 21000, Dijon, France; Service de pneumologie et soins intensifs respiratoires, centre-hospitalo universitaire de Dijon-Bourgogne, Dijon, France
| | - S Audia
- UFR des sciences de santé, université de Bourgogne, 21000, Dijon, France; Service de médecine interne et immunologie cinique, centre-hospitalo universitaire de Dijon-Bourgogne, Dijon, France
| | - H Devilliers
- UFR des sciences de santé, université de Bourgogne, 21000, Dijon, France; Service de médecine interne et maladies systémiques, centre-hospitalo universitaire de Dijon-Bourgogne, Dijon, France; Inserm CIC-EC 1432, centre d'investigation clinique, Dijon, France
| | - A Laurent
- Service d'anesthésie et réanimation, centre hospitalo-universitaire de Dijon-Bourgogne, Dijon, France; UFR des sciences de santé, université de Bourgogne, 21000, Dijon, France; EA 7458, laboratoire psy-DREPI, université de Bourgogne Franche-Comté, Dijon, France
| | - M Blot
- UFR des sciences de santé, université de Bourgogne, 21000, Dijon, France; Inserm CIC-EC 1432, centre d'investigation clinique, Dijon, France; Département de maladies infectieuses, centre hospitalo-universitaire de Dijon-Bourgogne, Dijon, France
| |
Collapse
|
18
|
Zakine È, Papageorgiou L, Bourguiba R, Mekinian A, Terrier B, Kosmider O, Hirsch P, Jachiet M, Audia S, Ardois S, Adélaïde L, Bigot A, Duriez P, Emile JF, Lazaro E, Fayard D, Galland J, Hié M, Humbert S, Jean A, Kostine M, Lacombe V, Le Guenno G, Lobbes H, Magy-Bertrand N, Marianetti-Guingel P, Mathian A, Outh R, Saillard C, Samson M, Vial G, Bouaziz JD, Moguelet P, Chasset F. Clinical and pathological features of cutaneous manifestations in VEXAS syndrome: A multicenter retrospective study of 59 cases. J Am Acad Dermatol 2023; 88:917-920. [PMID: 36343774 DOI: 10.1016/j.jaad.2022.10.052] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/05/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Ève Zakine
- Dermatology Department, Paris University, Faculty of Medicine, AP-HP, Saint Louis University Hospital, Paris, France
| | - Loula Papageorgiou
- Hematology and Cytology Department, Sorbonne University, INSERM, Saint Antoine Research Center, AP-HP, Saint Antoine University Hospital, Paris, France
| | - Rim Bourguiba
- Internal Medicine Department, Sorbonne University, Faculty of Medicine, AP-HP, Tenon University Hospital, Paris, France
| | - Arsène Mekinian
- Internal Medicine Department, Sorbonne University, Faculty of Medicine, AP-HP, Saint Antoine University Hospital, Paris, France
| | - Benjamin Terrier
- Internal Medicine Department, Paris University, Faculty of Medicine, AP-HP, Cochin University Hospital, Paris, France
| | - Olivier Kosmider
- Hematology Department, Paris University, Faculty of Medicine, AP-HP, Cochin University Hospital, Paris, France
| | - Pierre Hirsch
- Hematology and Cytology Department, Sorbonne University, INSERM, Saint Antoine Research Center, AP-HP, Saint Antoine University Hospital, Paris, France
| | - Marie Jachiet
- Dermatology Department, Paris University, Faculty of Medicine, AP-HP, Saint Louis University Hospital, Paris, France
| | - Sylvain Audia
- Internal Medicine Department, Bourgogne University, Faculty of Medicine, Dijon University Hospital, Dijon, France
| | - Samuel Ardois
- Internal Medicine Department, Rennes University, Faculty of Medicine, Rennes University Hospital, Rennes, France
| | - Léopold Adélaïde
- Internal Medicine Department, Claude Bernard Lyon 1 University, Faculty of Medicine, Croix-Rousse Hospital, Lyon, France
| | - Adrien Bigot
- Internal Medicine Department, Tours University, Faculty of Medicine, Tours University Hospital, Tours, France
| | - Paul Duriez
- Pathology Department, Sorbonne University, Faculty of Medicine, AP-HP, Saint Antoine University Hospital, Paris, France
| | - Jean-François Emile
- Pathology Department, Versailles Saint Quentin University, Faculty of Medicine, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Estibaliz Lazaro
- Internal Medicine Department, Bordeaux University, Faculty of Medicine, Bordeaux University Hospital, Bordeaux, France
| | - Damien Fayard
- Internal Medicine Department, Clermont-Ferrand University, Faculty of Medicine, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Joris Galland
- Internal Medicine Department, Fleyriat Hospital, Bourg-en-Bresse, France
| | - Miguel Hié
- Internal Medicine Department, Sorbonne University, Faculty of Medicine, AP-HP, Pitié-Salpêtrière University Hospital, Paris, France
| | - Sébastien Humbert
- Internal Medicine Department, Besançon University, Faculty of Medicine, Besançon University Hospital, Paris, France
| | - Alexis Jean
- Internal Medicine Department, Bordeaux University, Faculty of Medicine, Bordeaux University Hospital, Bordeaux, France
| | - Marie Kostine
- Rheumatology Department, Bordeaux University, Faculty of Medicine, Bordeaux University Hospital, Bordeaux, France
| | - Valentin Lacombe
- Internal Medicine Department, Clermont-Ferrand University, Faculty of Medicine, Estaing University Hospital, Clermont-Ferrand, France
| | - Guillaume Le Guenno
- Internal Medicine and Clinical Immunology Department, Angers University, Faculty of Medicine, Angers University Hospital, Angers, France
| | - Hervé Lobbes
- Internal Medicine and Clinical Immunology Department, Angers University, Faculty of Medicine, Angers University Hospital, Angers, France
| | - Nadine Magy-Bertrand
- Internal Medicine Department, Besançon University, Faculty of Medicine, Besançon University Hospital, Paris, France
| | - Paola Marianetti-Guingel
- Internal Medicine Department, Reims University, Faculty of Medicine, Reims University Hospital, Reims, France
| | - Alexis Mathian
- Internal Medicine Department, Sorbonne University, Faculty of Medicine, AP-HP, Pitié-Salpêtrière University Hospital, Paris, France
| | - Rodérau Outh
- Internal Medicine Department, Perpignan Hospital Center, Perpignan, France
| | - Clémence Saillard
- Dermatology Department, Rennes University, Faculty of Medicine, Rennes University Hospital, Rennes, France
| | - Maxime Samson
- Internal Medicine Department, Bourgogne University, Faculty of Medicine, Dijon University Hospital, Dijon, France
| | - Guillaume Vial
- Internal Medicine Department, Bordeaux University, Faculty of Medicine, Bordeaux University Hospital, Bordeaux, France
| | - Jean-David Bouaziz
- Dermatology Department, Paris University, Faculty of Medicine, AP-HP, Saint Louis University Hospital, Paris, France
| | - Philippe Moguelet
- Pathology Department, Sorbonne University, Faculty of Medicine, AP-HP, Tenon University Hospital, Paris, France
| | - François Chasset
- Dermatology and Allergology Department, Sorbonne University, Faculty of Medicine, AP-HP, Tenon University Hospital, Paris, France.
| | | |
Collapse
|
19
|
Kapur R, Audia S. Secondary spleen in immune thrombocytopenia: Not so accessory after all…. Br J Haematol 2023. [DOI: 10.1111/bjh.18776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/15/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023]
|
20
|
Guillet S, Loustau V, Boutin E, Zarour A, Comont T, Souchaud-Debouverie O, Costedoat Chalumeau N, Pan-Petesch B, Gobert D, Cheze S, Viallard JF, Morin AS, Sauvetre G, Cliquennois M, Royer B, Masseau A, Terriou L, Fieschi C, Lambotte O, Girault S, Lioger B, Audia S, Sacre K, Lega JC, Langlois V, Benachi A, Orvain C, Devidas A, Humbert S, Gambier N, Ruivard M, Zarrouk V, Ebbo M, Willems L, Segaux L, Mahevas M, Haddad B, Michel M, Canoui-Poitrine F, Godeau B. Immune thrombocytopenia and pregnancy: an exposed/nonexposed cohort study. Blood 2023; 141:11-21. [PMID: 36054922 PMCID: PMC10644036 DOI: 10.1182/blood.2022017277] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/18/2022] [Accepted: 08/03/2022] [Indexed: 01/10/2023] Open
Abstract
The risk of immune thrombocytopenia (ITP) worsening during pregnancy and neonatal ITP (NITP) have never been prospectively studied. We included 180 pregnant and 168 nonpregnant women with ITP in a prospective, multicenter, observational cohort study. A total of 131 pregnant women with ITP were matched to 131 nonpregnant women with ITP by history of splenectomy, ITP status (no response, response, complete response), and duration. Groups were followed for 15 months. The primary outcome was the first occurrence of ITP worsening defined by a composite end point including bleeding events and/or severe thrombocytopenia (<30 × 109/L) and/or ITP treatment modification. We also studied the recurrence of ITP worsening and the incidence of NITP and risk factors. The first occurrence of ITP worsening did not differ between pregnant and nonpregnant women with ITP (53.4 per 100 person-years [95% confidence interval {CI}, 40.8-69.9] vs 37.1 [95% CI, 27.5-50.0]; hazard ratio {HR}, 1.35 [95% CI, 0.89-2.03], P = .16). Pregnant women with ITP were more likely to have recurrence of severe thrombocytopenia and treatment modification (HR, 2.71 [95% CI, 1.41-5.23], P = .003; HR, 2.01 [95% CI, 1.14-3.57], P = .017, respectively). However, recurrence of severe bleeding events was not different between groups (P = .4). Nineteen (14%) neonates showed NITP <50 × 109/L. By multivariable analysis, NITP was associated with a previous offspring with NITP and maternal platelet count <50 × 109/L within 3 months before delivery (adjusted odds ratio, 5.55 [95% CI, 1.72-17.89], P = .004 and 4.07 [95% CI, 1.41-11.73], P = .009). To conclude, women with ITP do not increase their risk of severe bleeding during pregnancy. NITP is associated with NITP history and the severity of maternal ITP during pregnancy. These results will be useful for counseling women with ITP.
Collapse
MESH Headings
- Infant, Newborn
- Female
- Humans
- Pregnancy
- Purpura, Thrombocytopenic, Idiopathic/epidemiology
- Purpura, Thrombocytopenic, Idiopathic/therapy
- Purpura, Thrombocytopenic, Idiopathic/complications
- Cohort Studies
- Prospective Studies
- Pregnancy Complications, Hematologic/epidemiology
- Pregnancy Complications, Hematologic/therapy
- Thrombocytopenia, Neonatal Alloimmune/therapy
- Retrospective Studies
Collapse
Affiliation(s)
- Stéphanie Guillet
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Valentine Loustau
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
- Service de Médecine Interne, Centre Hospitalier Alpes Léman, Contamine sur Arve, France
| | - Emmanuelle Boutin
- Unité de Recherche Clinique (URC Mondor), AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
- Univ Paris Est Créteil, INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), Créteil, France
| | - Anissa Zarour
- Unité de Recherche Clinique (URC Mondor), AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Thibault Comont
- Service de Médecine Interne et d’Immunopathologie–IUCT-Oncopole, CHU de Toulouse, Toulouse, France
| | | | - Nathalie Costedoat Chalumeau
- Service de Médecine Interne, Centre de Référence Maladies Auto-immunes et Systémiques Rares, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
- Centre for Clinical Epidemiology, Hôpital Hôtel-Dieu, AP-HP, Université de Paris, Centre of Research in Epidemiology and Statistics, Paris, France
| | | | - Delphine Gobert
- Service de Médecine Interne, Hôpital Saint Antoine, AP-HP, Sorbonne Université, Paris, France
| | - Stéphane Cheze
- Institut d’Hématologie de Basse-Normandie, Centre Hospitalier de Caen Normandie, Caen, France
| | | | - Anne-Sophie Morin
- Service de Médecine Interne, Hôpital Jean Verdier, AP-HP, Bondy, France
| | - Gaetan Sauvetre
- Service de Médecine Interne, Hôpital Charles Nicolle, Université de Rouen, Rouen, France
| | - Manuel Cliquennois
- Service d'Onco-hématologie Adulte, Hôpital Saint-Vincent de Paul, GH de l'institut Catholique de Lille, Lille, France
| | - Bruno Royer
- Service d’Immuno-hématologie, Hôpital Saint Louis, Paris, France
- Service d’Hématologie clinique, CHU d’Amiens, Amiens, France
| | - Agathe Masseau
- Service de Médecine Interne, CHU de Nantes, Nantes, France
| | - Louis Terriou
- Service de Médecine Interne et d’Immunologie Clinique, CHU Lille, Université de Lille, Lille, France
| | - Claire Fieschi
- Service d’Immunologie Clinique, Hôpital Saint Louis, AP-HP, Paris, France
| | - Olivier Lambotte
- Service de Médecine Interne et d’Immunologie Clinique, Hôpital Bicêtre, Université Paris Sacly, Le Kremlin-Bicêtre, France
| | - Stéphane Girault
- Service d’Hématologie Clinique et de Thérapie Cellulaire, CHU Dupuytren, Limoges, France
| | | | - Sylvain Audia
- Service de Médecine Interne et d’Immunologie Clinique, Centre de Référence Constitutif des Cytopénies Auto-Immunes, Hôpital François Mitterrand, CHU Dijon-Bourgogne, Dijon, France
| | - Karim Sacre
- Service de Médecine Interne, Hôpital Bichat, AP-HP, Paris, France et Université de Paris, Centre de Recherche sur l’Inflammation, INSERM UMR1149, CNRS ERL8252, Laboratoire d’Excellence Inflamex, Paris, France
| | - Jean Christophe Lega
- Service de Médecine Interne et Médecine Vasculaire, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Université de Lyon, Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, CNRS-UMR 5588, Université Lyon 1, Lyon, France
| | - Vincent Langlois
- Service de Médecine Interne, Hôpital Jacques Monod, Le Havre, France
| | - Alexandra Benachi
- Service d’Obstétrique et Gynécologie, Hôpital Antoine-Béclère, AP-HP, Université Paris-Saclay, Clamart, France
| | - Corentin Orvain
- Service d’Hématologie, Hôpital d’Anger, INSERM, CRCINA, Université d’Angers, Angers, France
| | - Alain Devidas
- Service d’Hématologie Clinique, CH Sud Francilien, Corbeil Essonnes, France
| | | | - Nicolas Gambier
- Service de Médecine Interne, CH Général Delafontaine, St Denis, France
| | - Marc Ruivard
- Service de Médecine Interne, CHU Estaing, Clermont-Ferrand, France
| | - Virginie Zarrouk
- Service de Médecine Interne, Hôpital Beaujon, AP-HP, Clichy, France
| | - Mikael Ebbo
- Service de Médecine Interne, Hôpital de la Conception, AP-HP, Université Aix-Marseille, Marseille, France
| | - Lise Willems
- Service d’Hématologie Clinique, Hôpital Cochin, Paris, France
| | - Lauriane Segaux
- Service de Santé Publique, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Matthieu Mahevas
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Bassam Haddad
- Centre Hospitalier Inter-Communal de Créteil, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Equipe Immunorégulation et Biothérapie (I-BIOT), Université Paris Est Créteil, Univ Paris Est Créteil, INSERM U955, Institut Mondor De Recherche Biomédicale (IMRB), Créteil, France
| | - Marc Michel
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Florence Canoui-Poitrine
- Unité de Recherche Clinique (URC Mondor), AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
- Service de Santé Publique, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Bertrand Godeau
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| |
Collapse
|
21
|
Samson M, Genet C, Corbera-Bellalta M, Greigert H, Espígol-Frigolé G, Gérard C, Cladière C, Alba-Rovira R, Ciudad M, Gabrielle PH, Creuzot-Garcher C, Tarris G, Martin L, Saas P, Audia S, Bonnotte B, Cid MC. Human monocyte-derived suppressive cells (HuMoSC) for cell therapy in giant cell arteritis. Front Immunol 2023; 14:1137794. [PMID: 36895571 PMCID: PMC9989212 DOI: 10.3389/fimmu.2023.1137794] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction The pathogenesis of Giant Cell Arteritis (GCA) relies on vascular inflammation and vascular remodeling, the latter being poorly controlled by current treatments. Methods This study aimed to evaluate the effect of a novel cell therapy, Human Monocyte-derived Suppressor Cells (HuMoSC), on inflammation and vascular remodeling to improve GCA treatment. Fragments of temporal arteries (TAs) from GCA patients were cultured alone or in the presence of HuMoSCs or their supernatant. After five days, mRNA expression was measured in the TAs and proteins were measured in culture supernatant. The proliferation and migration capacity of vascular smooth muscle cells (VSMCs) were also analyzed with or without HuMoSC supernatant. Results Transcripts of genes implicated in vascular inflammation (CCL2, CCR2, CXCR3, HLADR), vascular remodeling (PDGF, PDGFR), angiogenesis (VEGF) and extracellular matrix composition (COL1A1, COL3A1 and FN1) were decreased in arteries treated with HuMoSCs or their supernatant. Likewise, concentrations of collagen-1 and VEGF were lower in the supernatants of TAs cultivated with HuMoSCs. In the presence of PDGF, the proliferation and migration of VSMCs were both decreased after treatment with HuMoSC supernatant. Study of the PDGF pathway suggests that HuMoSCs act through inhibition of mTOR activity. Finally, we show that HuMoSCs could be recruited in the arterial wall through the implication of CCR5 and its ligands. Conclusion Altogether, our results suggest that HuMoSCs or their supernatant could be useful to decrease vascular in flammation and remodeling in GCA, the latter being an unmet need in GCA treatment.
Collapse
Affiliation(s)
- Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France.,Université Bourgogne Franche-Comté, INSERM, Etablissement Français du Sang, Bourgogne Franche-Comté (EFS BFC), UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France.,Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Coraline Genet
- Université Bourgogne Franche-Comté, INSERM, Etablissement Français du Sang, Bourgogne Franche-Comté (EFS BFC), UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Marc Corbera-Bellalta
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Hélène Greigert
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France.,Université Bourgogne Franche-Comté, INSERM, Etablissement Français du Sang, Bourgogne Franche-Comté (EFS BFC), UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Georgina Espígol-Frigolé
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Claire Gérard
- Université Bourgogne Franche-Comté, INSERM, Etablissement Français du Sang, Bourgogne Franche-Comté (EFS BFC), UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Claudie Cladière
- Université Bourgogne Franche-Comté, INSERM, Etablissement Français du Sang, Bourgogne Franche-Comté (EFS BFC), UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Roser Alba-Rovira
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Marion Ciudad
- Université Bourgogne Franche-Comté, INSERM, Etablissement Français du Sang, Bourgogne Franche-Comté (EFS BFC), UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | | | | | - Georges Tarris
- Department of Pathology, Dijon University Hospital, Dijon, France
| | - Laurent Martin
- Department of Pathology, Dijon University Hospital, Dijon, France
| | - Philippe Saas
- Université Bourgogne Franche-Comté, INSERM, Etablissement Français du Sang, Bourgogne Franche-Comté (EFS BFC), UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France.,Centre d'investigation clinique (CIC)-1431, INSERM, Besançon University Hospital, Etablissement Français du Sang (EFS), Besançon, France
| | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France.,Université Bourgogne Franche-Comté, INSERM, Etablissement Français du Sang, Bourgogne Franche-Comté (EFS BFC), UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France.,Université Bourgogne Franche-Comté, INSERM, Etablissement Français du Sang, Bourgogne Franche-Comté (EFS BFC), UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Maria C Cid
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| |
Collapse
|
22
|
Suleiman M, Costedoat-Chalumeau N, Le Guern V, Morel N, Amoura Z, Espitia O, Martis N, Jeandel P, Audia S, Cormarmond C, Sève P, Sene D, Gerfaud-Valentin M, Goutte J, Lavigne C, Thomas G, Bourgarit A, Roblot P, Puyade M, Martin M. Syndrome des antiphospholipides et atteinte surrénalienne : étude cas-témoin nationale multicentrique. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
23
|
Thibault T, Bourredjem A, Maurier F, Wahl D, Muller G, Aumaître O, Blaison G, Pennaforte J, Martin T, Magy-Bertrand N, Audia S, Arnaud L, Amoura Z, Devilliers H. Effet médiateur de la fatigue entre les poussées articulaires et l’altération de la qualité de vie au cours du lupus systémique. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
24
|
Venticello L, Boulin M, Samson M, Bonnotte B, Audia S. Influence du traitement par immunoglobulines polyvalentes intraveineuses sur la réponse au rituximab au cours de la thrombopénie immunologique. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
25
|
Ollier N, Piel-Julian M, Mahevas M, Viallard J, comont T, Cheze S, Audia S, Ebbo M, Terriou L, Lega J, Jeandel P, Bonnotte B, Michel M, Lapeyre-Mestre M, Godeau B, Moulis G. Seuil de numération plaquettaire associé au saignement chez les patients atteints de purpura thrombopénique immunologique traités par antiagrégants plaquettaires. Résultats du registre CARMEN-France. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
26
|
Moulis G, Rueter M, Mahevas M, Viallard J, comont T, Cheze S, Audia S, Ebbo M, Terriou L, Lega J, Jeandel P, Bonnotte B, Michel M, Lapeyre-Mestre M, Godeau B. Purpura thrombopénique immunologique primaire multiréfractaire de l’adulte : prévalence et complications. Résultats du registre CARMEN-France. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
27
|
Pouchelon C, Lafont C, Lafarge A, Comont T, Riviere E, Boutboul D, Fieschi C, Dossier A, Audia S, Vaidie J, Ruivard M, Gobert D, Bonnard G, Graveleau J, Mahevas M, Godeau B, Michel M. Characteristics and outcome of adults with severe autoimmune hemolytic anemia admitted to the intensive care unit: Results from a large French observational study. Am J Hematol 2022; 97:E371-E373. [PMID: 35871779 DOI: 10.1002/ajh.26665] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/13/2022] [Accepted: 07/18/2022] [Indexed: 01/24/2023]
Affiliation(s)
- Clara Pouchelon
- Department of Internal Medicine, National Reference Center for Adult' Immune Cytopenias, Henri Mondor University Hospital, Université Paris-Est Créteil, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Charlotte Lafont
- Service de Santé Publique, Univ Paris Est Creteil, INSERM, IMRB, Creteil, France.,Service de Santé Publique, AP-HP, hôpital Henri-Mondor, Créteil, France
| | - Antoine Lafarge
- Intensive Care Unit, Saint Louis Hospital, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Thibault Comont
- Department of Internal Medicine and Clinical Immunology, Institut Universitaire du Cancer Toulouse - Oncopôle, Toulouse, France
| | - Etienne Riviere
- Department of Internal Medicine and Infectious diseases, Haut-Lévêque University Hospital, Bordeaux, France
| | - David Boutboul
- Departement of Clinical Immunology, Saint Louis Hospital, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Claire Fieschi
- Departement of Clinical Immunology, Saint Louis Hospital, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Antoine Dossier
- Department of Internal Medicine and Clinical Immunology, Bichat University Hospital, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology, Reference Center for Adult' Immune Cytopenias, Le Bocage Université Hospital, Dijon, France
| | - Julien Vaidie
- Department of Hematology, Dupuytren University Hospital, Limoges, France
| | - Marc Ruivard
- Department of Internal Medicine and Clinical Immunology, D'Estaing University Hospital, Clermont-Ferrand, France
| | - Delphine Gobert
- Department of Internal Medicine and Clinical Immunology, Saint Antoine University Hospital, Paris-Sorbonne Université, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Guillaume Bonnard
- Department of Internal Medicine and Clinical Immunology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Julie Graveleau
- Department of Internal Medicine and Clinical Immunology, Hôtel Dieu University Hospital, Nantes, France
| | - Matthieu Mahevas
- Department of Internal Medicine, National Reference Center for Adult' Immune Cytopenias, Henri Mondor University Hospital, Université Paris-Est Créteil, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Bertrand Godeau
- Department of Internal Medicine, National Reference Center for Adult' Immune Cytopenias, Henri Mondor University Hospital, Université Paris-Est Créteil, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Marc Michel
- Department of Internal Medicine, National Reference Center for Adult' Immune Cytopenias, Henri Mondor University Hospital, Université Paris-Est Créteil, Assistance Publique Hôpitaux de Paris, Créteil, France
| |
Collapse
|
28
|
Samson M, Nicolas B, Ciudad M, Greigert H, Guilhem A, Cladiere C, Straub C, Blot M, Piroth L, Rogier T, Devilliers H, Manckoundia P, Ghesquiere T, Francois S, Lakomy D, Audia S, Bonnotte B. T-cell immune response predicts the risk of critical SARS-Cov2 infection in hospitalized COVID-19 patients. Eur J Intern Med 2022; 102:104-109. [PMID: 35690570 PMCID: PMC9163020 DOI: 10.1016/j.ejim.2022.06.001] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 01/08/2023]
Abstract
INTRODUCTION This study aimed to identify markers of disease worsening in patients hospitalized for SARS-Cov2 infection. PATIENTS AND METHODS Patients hospitalized for severe recent-onset (<1 week) SARS-Cov2 infection were prospectively included. The percentage of T-cell subsets and plasma IL-6 at admission (before any steroid therapy) were compared between patients who progressed to a critical infection and those who did not. RESULTS Thirty-seven patients (18 men, 19 women) were included; 11 (30%) progressed to critical infection. At admission, the critical infection patients were older (P = 0.021), had higher creatinine levels (P = 0.003), and decreased percentages of circulating B cells (P = 0.04), T cells (P = 0.009), and CD4+ T cells (P = 0.004) than those with a favorable course. Among T cell subsets, there was no significant difference between the two groups except for the percentage of Th17 cells, which was two-fold higher in patients who progressed to critical infection (P = 0.028). Plasma IL-6 at admission was also higher in this group (P = 0.018). In multivariate analysis, the percentage of circulating Th17 cells at admission was the only variable associated with higher risk of progression to critical SARS-Cov2 infection (P = 0.021). CONCLUSION This study suggests that an elevated percentage of Th17 cells in patients hospitalized for SARS-Cov2 infection is associated with an increased risk of progression to critical disease. If these data are confirmed in a larger study, this marker could be used to better target the population of patients in whom tocilizumab could decrease the risk of progression to critical COVID-19.
Collapse
Affiliation(s)
- Maxime Samson
- Department of Internal Medicine and Clinical Immunology, University Hospital of Dijon; INSERM U1098, University of Bourgogne-Franche Comté, Dijon, France.
| | - Barbara Nicolas
- Department of Internal Medicine and Clinical Immunology, University Hospital of Dijon; INSERM U1098, University of Bourgogne-Franche Comté, Dijon, France
| | - Marion Ciudad
- Department of Internal Medicine and Clinical Immunology, University Hospital of Dijon; INSERM U1098, University of Bourgogne-Franche Comté, Dijon, France
| | - Hélène Greigert
- Department of Internal Medicine and Clinical Immunology, University Hospital of Dijon; INSERM U1098, University of Bourgogne-Franche Comté, Dijon, France
| | - Alexandre Guilhem
- Department of Internal Medicine and Clinical Immunology, University Hospital of Dijon; INSERM U1098, University of Bourgogne-Franche Comté, Dijon, France
| | - Claudie Cladiere
- Department of Internal Medicine and Clinical Immunology, University Hospital of Dijon; INSERM U1098, University of Bourgogne-Franche Comté, Dijon, France
| | - Cécile Straub
- Department of Internal Medicine and Clinical Immunology, University Hospital of Dijon; INSERM U1098, University of Bourgogne-Franche Comté, Dijon, France
| | - Mathieu Blot
- Department of Infectious diseases, University Hospital of DijonDijon, France
| | - Lionel Piroth
- Department of Infectious diseases, University Hospital of DijonDijon, France
| | - Thomas Rogier
- Department of internal medicine and systemic diseases, University Hospital of DijonDijon, France
| | - Hervé Devilliers
- Department of internal medicine and systemic diseases, University Hospital of DijonDijon, France
| | - Patrick Manckoundia
- Department of geriatric internal medicine, University Hospital of DijonDijon, France
| | - Thibault Ghesquiere
- Department of Internal Medicine and Clinical Immunology, University Hospital of Dijon; INSERM U1098, University of Bourgogne-Franche Comté, Dijon, France
| | | | - Daniela Lakomy
- Laboratory of immunology, University Hospital of DijonDijon, France
| | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology, University Hospital of Dijon; INSERM U1098, University of Bourgogne-Franche Comté, Dijon, France
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, University Hospital of Dijon; INSERM U1098, University of Bourgogne-Franche Comté, Dijon, France
| |
Collapse
|
29
|
Razanamahery J, Abdallahoui M, Chabridon G, Fromont A, Tarris G, Idbaih A, Comby PO, Godard F, Haroche J, Audia S, Bonnotte B. Dramatic Efficacy of Interferon and Vemurafenib on Psychiatric Symptoms Revealing BRAFV600E -Mutated Erdheim-Chester Disease: A Case Report. Front Immunol 2022; 13:918613. [PMID: 35874752 PMCID: PMC9299438 DOI: 10.3389/fimmu.2022.918613] [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: 05/11/2022] [Accepted: 06/08/2022] [Indexed: 12/02/2022] Open
Abstract
Erdheim–Chester disease (ECD) is a rare condition with underestimated neurological involvement. Mild psychiatric symptoms such as mood swings have been rarely described in the clinical spectrum of neuro-ECD. We here describe the first patient with psychiatric manifestations of delirium revealing ECD with neurological involvement with favorable evolution under interferon followed by BRAF inhibitor monotherapy. An 81-year-old woman was referred to the hospital because of delirium and severe cognitive impairment associated with a cerebellar syndrome. Brain magnetic resonance imaging showed “FLAIR-changes” lesions in the pons and upper cerebellum peduncles. Blood and cerebrospinal fluid (CSF) analyses showed normal results except for an elevated neopterin level in the CSF. Whole-body CT scan (18FDG-PET) showed peri-nephric fat infiltration and aorta adventitia sheathing with radiotracer uptake in the pons, vessels, peri-nephric fat, and bone lesions, which was characteristic of ECD. The diagnosis was confirmed on perirenal tissue biopsy, which also showed a BRAFV600E mutation. Treatment with interferon resulted in the resolution of delirium, and treatment with BRAF inhibitor subsequently resulted in a partial remission of all active sites. This case highlights that delirium can be the first manifestation of neurodegenerative ECD. ECD should be screened in unexplained psychiatric features as interferon and targeted therapy appear to be effective in this situation.
Collapse
Affiliation(s)
- Jérôme Razanamahery
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Maroua Abdallahoui
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | | | - Agnès Fromont
- Department of Neurology, Dijon University Hospital, Dijon, France
| | - Georges Tarris
- Department of Pathology, Dijon University Hospital, Dijon, France
| | - Ahmed Idbaih
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital Universitaire La Pitié Salpêtrière, DMU Neurosciences, Paris, France
| | | | - Francois Godard
- Nuclear Medicine Department, Centre Georges Francois Leclerc, Dijon, France
| | - Julien Haroche
- Department of Internal Medicine 2, National Reference Center for Histiocytosis, Pitié-Salpétrière Hospital, Paris, France
| | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| |
Collapse
|
30
|
Thibault T, Durand-Bailloud B, Soudry-Faure A, Greigert H, Drouet C, Devilliers H, Ramon A, Bejot Y, Martin L, Creuzot-Garcher C, Falvo N, Audia S, Cochet A, Bonnotte B, Alberini JL, Samson M. PET/CT of cranial arteries for a sensitive diagnosis of giant cell arteritis. Rheumatology (Oxford) 2022; 62:1568-1575. [PMID: 35866984 DOI: 10.1093/rheumatology/keac430] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/16/2022] [Accepted: 07/17/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To investigate the performance of cranial PET/CT for the diagnosis of giant cell arteritis (GCA). METHODS All patients with a suspected diagnosis of GCA were prospectively enrolled in this study and had a digital PET/CT with evaluation of cranial arteries if they had not started glucocorticoids more than 72 hours previously. The diagnosis of GCA was retained after at least 6 months of follow-up if no other diagnosis was considered by the clinician and the patient went into remission after at least 6 consecutive months of treatment. Cranial PET/CT was considered positive if at least one arterial segment showed hypermetabolism similar to or greater than liver uptake. RESULTS For cranial PET/CT, sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) were 73.3%, 97.2%, 91.7% and 89.7%, respectively. For extracranial PET/CT, diagnostic performance was lower (Se = 66.7%, Sp = 80.6%, PPV = 58.8%, NPV = 85.3%). The combination of cranial and extracranial PET/CT improved overall sensitivity (Se = 80%) and NPV (NPV = 90.3%) while decreasing overall specificity (Sp = 77.8%) and PPV (PPV = 60%). CONCLUSION Cranial PET/CT can be easily combined with extracranial PET/CT with a limited increase in examination time. Combined cranial and extracranial PET/CT showed very high diagnostic accuracy for the diagnosis of GCA. TRIAL REGISTRATION ClinicalTrials.gov, https://clinicaltrials.gov, NCT05246540.
Collapse
Affiliation(s)
- Thomas Thibault
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | | | - Agnès Soudry-Faure
- Direction of Clinical Research and Innovation (DRCI), Clinical Research Unit-Methodological Support Network (USMR), Dijon University Hospital, 21000 Dijon, France
| | - Hélène Greigert
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France.,Department of Vascular Medicine, Dijon University Hospital, Dijon, France.,Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000 Dijon, France
| | - Clément Drouet
- Department of Nuclear Medicine, Centre Georges François Leclerc, 21000 Dijon, France
| | - Hervé Devilliers
- Department of Internal Medicine and Systemic Diseases, Dijon University Hospital, Dijon, France 7 - Department of Rheumatology, Dijon University Hospital, Dijon, France
| | - André Ramon
- Department of Neurology, Dijon University Hospital, Dijon, France
| | - Yannick Bejot
- Department of Neurology, Dijon University Hospital, Dijon, France
| | - Laurent Martin
- Department of Pathology, Dijon University Hospital, Dijon, France
| | | | - Nicolas Falvo
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France.,Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000 Dijon, France
| | - Alexandre Cochet
- Department of Nuclear Medicine, Centre Georges François Leclerc, 21000 Dijon, France.,Department of Nuclear Medicine, Dijon University Hospital, Dijon, France.,ImViA EA 7535, Université Bourgogne Franche-Comté, F-21000 Dijon, France
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France.,Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000 Dijon, France
| | - Jean-Louis Alberini
- Department of Nuclear Medicine, Centre Georges François Leclerc, 21000 Dijon, France.,Department of Nuclear Medicine, Dijon University Hospital, Dijon, France.,ImViA EA 7535, Université Bourgogne Franche-Comté, F-21000 Dijon, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France.,Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000 Dijon, France
| |
Collapse
|
31
|
Khitri MY, Guedon AF, Georgin-Lavialle S, Terrier B, Saadoun D, Seguier J, le Besnerais M, De Moreuil C, Denis G, Gerfaud-Valentin M, Allain JS, Maria A, Bouillet L, Grobost V, Galland J, Kosmider O, Dumont A, Devaux M, Subran B, Schmidt J, Marianetti-Guingel P, Audia S, Palat S, Roux-Sauvat M, Jachiet V, Hirsch P, Fain O, Mekinian A. Comparison between idiopathic and VEXAS-relapsing polychondritis: analysis of a French case series of 95 patients. RMD Open 2022; 8:rmdopen-2022-002255. [PMID: 35868738 PMCID: PMC9315905 DOI: 10.1136/rmdopen-2022-002255] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [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: 02/11/2022] [Accepted: 04/25/2022] [Indexed: 12/02/2022] Open
Abstract
Objective A new adult-onset autoinflammatory syndrome has been described, named VEXAS (Vacuoles, E1 Enzyme, X-linked, Autoinflammatory, Somatic). We aimed to compare the clinical characteristics, the laboratory features and the outcomes between idiopathic-relapsing polychondritis (I-RP) and VEXAS-relapsing polychondritis (VEXAS-RP). Methods Patients from French retrospective multicentre cohort of RP were separated into two groups: a VEXAS-RP and an I-RP. Results Compared with patients with I-RP (n=40), patients with VEXAS-RP (n=55) were men (96% vs 30%, p<0.001) and were older at diagnosis (66 vs 44 years, p<0.001). They had a greater prevalence of fever (60% vs 10%, p<0.001), of skin lesions (82% vs 20%, p<0.001), of ocular involvement (57% vs 28%, p=0.01), of pulmonary infiltrates (46% vs 0%, p<0.001), of heart involvement (11% vs 0%, p=0.0336) and with higher median C-reactive protein levels (64 mg/L vs 10 mg/L, p<0.001). Seventy-five per cent of the patients with VEXAS-RP had myelodysplastic syndrome (MDS) versus none in I-RP group. The glucocorticoids use, and the number of steroid sparing agents were similar in both groups, but patients with VEXAS-RP had more frequent refractory disease (remission obtained in 27% vs 90%, p<0001). VEXAS-RP was associated with higher risk of death: six patients (11%) died in the VEXAS-RP group after a median follow-up of 37 months and none in the I-RP group after a median follow-up of 92 months (p<0.05). Conclusion We report the largest cohort of VEXAS-RP, characterised by high prevalence of male sex, fever, skin lesion, ocular involvement, pulmonary infiltration, heart involvement, older age and MDS association.
Collapse
Affiliation(s)
| | - Alexis F Guedon
- Pierre Louis Epidemiology and Public Health Research Institute, Paris, Île-de-France, France
| | | | | | - David Saadoun
- Hopital Universitaire Pitie Salpetriere, Paris, Île-de-France, France
| | - Julie Seguier
- Hospital Timone, Marseille, Provence-Alpes-Côte d'Azu, France
| | | | | | - Guillaume Denis
- Centre Hospitalier de Rochefort, Rochefort, Nouvelle-Aquitaine, France
| | | | | | | | - Laurence Bouillet
- Internal Medicine, Centre Hospitalier Universitaire Grenoble, Michallon Hospital, Grenoble, France
| | | | - Joris Galland
- Hospital Centre Fleyriat de Bourg-en-Bresse, Bourg-en-Bresse, Rhône-Alpes, France
| | - Olivier Kosmider
- Service d'Hématologie Biologique, DMU BioPhyGen, APHP, Paris, Île-de-France, France
| | | | - Mathilde Devaux
- Intermunicipal Hospital Centre Poissy-Saint-Germain-en-Laye Poissy Site, Poissy, Île-de-France, France
| | - Benjamin Subran
- Hôpital de la Croix Saint-Simon, Paris, Île-de-France, France
| | - Jean Schmidt
- Internal Medicine, Amiens University Hospital, Amiens, France
| | | | | | | | - Marielle Roux-Sauvat
- Service de médecine interne, Pierre Oudot Hospital of Bourgoin-Jallieu, Bourgoin-Jallieu, Rhône-Alpes, France
| | - Vincent Jachiet
- Hopital Saint-Antoine Service de Medecine Interne, Paris, Île-de-France, France
| | - Pierre Hirsch
- service d'hématologie biologique, Hôpital Saint-Antoine, Paris, Île-de-France, France
| | - Olivier Fain
- Hopital Saint-Antoine Service de Medecine Interne, Paris, Île-de-France, France
| | - Arsène Mekinian
- Service de Médecine Interne, DHUi2B, Hôpital Saint-Antoine, Paris, Île-de-France, France
| | | |
Collapse
|
32
|
Jacquier M, Binquet C, Manoha C, Audia S, Simonet-Lamm AL, Casenaz A, Sow AK, Piroth L, Blot M. Beyond QuantiFERON-TB Results, the Added Value of a Weak Mitogen Response. Front Med (Lausanne) 2022; 9:876864. [PMID: 35712107 PMCID: PMC9197320 DOI: 10.3389/fmed.2022.876864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/10/2022] [Indexed: 12/26/2022] Open
Abstract
Introduction While QuantiFERON-TB gold (QFT) is frequently used, little attention is paid to the mitogen response. How it could be impacted and associated with outcomes is poorly known. Methods Retrospective, case-control study in hospitalized patients who underwent QFT testing in two hospitals between 2016 and 2019. We defined two groups of cases with either negative [interferon (IFN)-γ ≤ 0.5 IU/ml, official threshold] or weak (0.5–2 IU/ml) mitogen response, and one group of controls with normal (>2 IU/ml) mitogen response. Results A total of 872 patients were included. An ongoing infection was independently associated with both a negative (RR = 4.34; 95% CI = 2.94–6.41) and a weak mitogen response (RR = 2.44; 95% CI = 1.66–3.58). Among tuberculosis patients, a weak mitogen response was associated with a false-negative QFT result (75%) compared to a normal response (20%). Decreasing mitogen response (normal, weak and negative, respectively) was associated with increasing length of hospital stay [median (interquartile range) 5 (3–13), 11 (5–21) and 15 (10–30) days; p < 0.001] and increasing hospital mortality (3, 7, and 15%; p < 0.001). Conclusion Clinicians should take notice of the mitogen response since IFN-γ concentrations lower than <2 IU/ml were associated with false-negative QFT results in tuberculosis patients, independently associated with ongoing infections, and could be associated with worse prognosis.
Collapse
Affiliation(s)
- Marine Jacquier
- Department of Infectious Diseases, Dijon-Bourgogne University Hospital, Dijon, France.,Department of Intensive Care, Dijon-Bourgogne University Hospital, Dijon, France.,Lipness Team, INSERM Research Centre LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France
| | - Christine Binquet
- CHU Dijon-Bourgogne, INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
| | - Catherine Manoha
- Department of Virology, Dijon-Bourgogne University Hospital, Dijon, France
| | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology, Dijon-Bourgogne University Hospital, Dijon, France
| | | | - Alice Casenaz
- Department of Virology, Dijon-Bourgogne University Hospital, Dijon, France
| | - Amadou-Khalilou Sow
- CHU Dijon-Bourgogne, INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
| | - Lionel Piroth
- Department of Infectious Diseases, Dijon-Bourgogne University Hospital, Dijon, France.,CHU Dijon-Bourgogne, INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
| | - Mathieu Blot
- Department of Infectious Diseases, Dijon-Bourgogne University Hospital, Dijon, France.,Lipness Team, INSERM Research Centre LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France.,CHU Dijon-Bourgogne, INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
| |
Collapse
|
33
|
Samson M, Nicolas B, Guilhem A, Greigert H, Ciudad M, Cladiere C, Straub C, Blot M, Piroth L, Rogier T, Devilliers H, Manckoundia P, Ghesquiere T, Francois S, Lakomy D, Audia S, Bonnotte B. L’augmentation du pourcentage de lymphocytes Th17 est associée à un risque d’évolution vers une forme grave d’infection à SARS-CoV-2. Rev Med Interne 2022. [PMCID: PMC9212761 DOI: 10.1016/j.revmed.2022.03.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction Depuis décembre 2019, plus de 20 millions de français ont été infectés par le SARS-CoV-2 et plus de 130 000 en sont décédés. La physiopathologie de cette infection n’est pas totalement élucidée. Il a été démontré qu’elle provoquait une importante sécrétion de cytokines pro-inflammatoires, en particulier d’interleukine-6 (IL-6) [1]. Lorsque les patients infectés sont hospitalisés, ils reçoivent généralement de la dexaméthasone et parfois un traitement anti-infectieux. Si la maladie s’aggrave, le tocilizumab peut être ajouté [2]. Actuellement, seule l’évolution clinique incite à débuter le tocilizumab, mais parfois trop tardivement. Il manque aux cliniciens un marqueur précoce leur permettant de prédire le risque d’aggravation de la maladie. Cette étude, menée chez des patients hospitalisés pour infection à SARS-CoV-2 pendant la 2e vague, avait pour objectif de rechercher un marqueur d’aggravation de la maladie en comparant la réponse lymphocytaire entre les patients évoluant vers une forme grave et les autres. Patients et méthodes Les patients hospitalisés pour infection à SARS-CoV-2 prouvée par RT-PCR datant de moins d’une semaine ont été inclus prospectivement dans cette étude monocentrique. Une infection grave était définie par un transfert en soins intensifs, en réanimation ou le décès. Des prélèvements sanguins ont été obtenus à l’admission à l’hôpital et avant de débuter la corticothérapie afin d’étudier les sous-populations lymphocytaires par cytométrie en flux et doser l’IL-6 plasmatique par immunofluorimétrie. Les données sont exprimées en nombre (%) ou médiane (espace inter-quartile). Résultats De septembre à décembre 2020, 37 patients (18 hommes, 19 femmes) hospitalisés pour infection à SARS-Cov2 ont été inclus : âge = 81,7 (70,3–87,5) ans, IMC = 25,7 (23,7–29) kg/m2, hypertension artérielle (54 %), diabète (24 %), dyslipidémie (35 %), tabagisme (24 %), cardiopathie ischémique (8 %), maladie cérébrovasculaire (11 %). La durée de suivi était de 10 (8–15) jours. Parmi les 37 patients inclus, 11 (30 %) ont présenté une infection à SARS-CoV-2 grave dont 4 transferts en réanimation et 8 décès. À l’admission, les patients ayant une infection évoluant vers une forme grave étaient plus âgés (p = 0,021), avaient une créatininémie plus élevée (p = 0,003) et une diminution du pourcentage de lymphocytes B (p = 0,04), de lymphocytes T (p = 0,009) et de lymphocytes T CD4+ (p = 0,004) circulants parmi les lymphocytes totaux comparativement aux patients dont l’évolution était favorable. Parmi les sous-populations lymphocytaires T étudiées (mémoires, naïfs, Th1, Th2, Th17, Treg, Tc1, Tc17, T CD8 cytotoxiques), il n’y avait pas de différence significative entre les deux groupes en dehors du pourcentage de lymphocytes Th17 à l’admission qui était deux fois plus élevé chez les patients dont l’infection évoluait vers une forme grave (0,44 vs 0,23 % des LT CD4 totaux ; p = 0,028). Chez les patients ayant une infection évoluant vers une forme grave, l’IL-6 plasmatique à l’admission était plus élevée (39 vs 13,1 pg/mL ; p = 0,018) et la CRP à l’admission avait tendance à être plus élevée sans atteindre le seuil de significativité (58 vs 18,5 mg/L ; p = 0,17). En analyse multivariée (régression logistique binaire comprenant les variables : âge, créatininémie, CRP, hémoglobine, lymphocytes T CD4, Th17, Treg activés (CD4 + CD45RA-FoxP3high), lymphocytes B, IL-6 sérique), la seule variable associée au risque d’évolution vers une forme grave de l’infection était le pourcentage de lymphocytes Th17 circulants (p = 0,034). L’aire sous la courbe de la courbe ROC évaluant la sensibilité et la spécificité du pourcentage de lymphocytes Th17 pour prédire une forme grave d’infection à SARS-CoV-2 chez un patient hospitalisé était de 0,75 (intervalle de confiance à 95 % : 0,56–0,95). Enfin, le fait d’avoir un pourcentage de lymphocytes Th17 > 0,435 % des lymphocytes T CD4 totaux au moment de l’admission en hospitalisation était associé à une moins bonne survie (p = 0,024). Conclusion Cette étude suggère qu’une élévation du pourcentage de lymphocytes Th17 chez des patients hospitalisés pour infection à SARS-CoV-2 augmente significativement le risque d’évolution vers une forme grave de la maladie. Ce résultat est cohérent avec le fait qu’il a été démontré que le tocilizumab, qui est efficace dans le traitement des formes graves de COVID-19 [2], inhibe la réponse lymphocytaire Th17 [3]. Ces données méritent d’être confirmées chez un plus grand nombre de patients afin de confirmer ce résultat car cette mesure pourrait permettre de mieux cibler la population de patients à qui proposer précocement un traitement par tocilizumab pour diminuer le risque d’évolution vers une forme grave d’infection à SARS-CoV-2.
Collapse
|
34
|
Samson M, Genet C, Corbera-Bellalta M, Greigert H, Ramon A, Gerard C, Cladiere C, Gabrielle P, Creuzot-Garcher C, Tarris G, Martin L, Audia S, Cid M, Bonnotte B. Une nouvelle thérapie pour l’artérite à cellules géantes : les cellules monocytaires immunosuppressives (HuMoSC). Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.289] [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]
|
35
|
Poisson C, Razanamahery J, Larsen K, Comby P, Daubail B, Mercier A, Fillebeen Y, Samson M, Ouandji S, Audia S, Bonnotte B. Un diagnostic à ne pas rater devant des paresthésies et une gammapathie monoclonale IgM. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.100] [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: 11/28/2022]
|
36
|
Godot A, Razanamahery J, Méaux-Ruault N, Emile J, Haroche J, Gil H, Audia S, Samson M, Bonnotte B, Leguy-Seguin V, Magy-Bertrand N. Évaluation des caractéristiques phénotypiques dans les histiocytoses des groupes L et R en fonction du statut mutationnel de BRAFV600E. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.287] [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]
|
37
|
Greigert H, Ramon A, Gerard C, Ciudad M, Cladiere C, Genet C, Arnould L, Creuzot-Garcher C, Martin L, Tarris G, Audia S, Cid MC, Bonnotte B, Samson M. POS0252 MYOFIBROBLASTS MAINTAIN Th1 and Tc1 POLARIZATIONS IN GIANT CELL ARTERITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundGiant cell arteritis (GCA) is a large-vessel vasculitis mainly involving the aorta and cranial arteries. It is the most frequent vasculitis in adults over 50 years. When they are stimulated by interferon-gamma (IFN-γ), vascular smooth muscle cells (VSMC) contribute to GCA pathogenesis by producing chemokines triggering the recruitment of pro-inflammatory T cells and monocytes (1).ObjectivesCurrent knowledge about the interaction between resident cells of the vascular wall (VSMC, myofibroblasts [MF]) and immune cells is limited. The aim of our research was to better characterize the interactions between VSMC, MF and T cells in GCA.MethodsFresh fragments of temporal artery biopsies (TAB) performed at Dijon university hospital (France) were prospectively sent to our research unit. Fresh sections of positive and negative TAB were fixed and embedded in optimal cutting temperature OCT and stored at -80°C. Then, cryostat sections were fixed, permeabilized, blocked and incubated with primary antibodies (anti-alpha smooth muscle actin [α-SMA], anti-myosin heavy chain 11 [MHC11], anti-Desmin, anti CD90, anti-CD45, anti-HLA-DR, anti-phospho STAT1 [pSTAT1] and anti-pSTAT3) and secondary antibodies for confocal microscopy analyses. Fresh sections of healthy TAB were embedded in MATRIGEL and covered by DMEM to obtain vascular cells in culture. Cells were treated with trypsina-EDTA between each passage. Vascular cells were used after 4-7 doubling passages. Cells were analyzed by immunofluorescence, flow cytometry and RT-PCR and their proliferation was evaluated by impedancemetry (iCELLigence system). Peripheral blood mononuclear cells (PBMC) and vascular cells thus obtained were co-cultured for 7 days in different conditions. Vascular cells were cultured in the presence or absence of IFN-γ and tumor necrosis factor alpha (TNF-α) or interleukin-6 (IL-6) and soluble receptor of IL-6 for 72 hours. When cells reached confluence, they were cultured alone or with allogenic PBMC activated with anti-CD3/CD28 microbeads. After 7 days of culture, cells were separated with a treatment with EDTA and studied by flow cytometry.ResultsConfocal microscopy analyses of GCA arteries showed that neointima was mainly composed of myofibroblasts (MF) (α-SMA+Desmin+MHC11lowCD90+) in contact with CD45+ cells and that MF expressed HLA-DR, the phosphorylated form of STAT1 (pSTAT1) and in a lesser extent pSTAT3, strongly suggesting the activation of the IFN-γ signaling pathway rather than the IL-6 pathway. The phenotype of cultured vascular cells isolated from fresh TAB was consistent with MF. When MF were exposed to IFN-γ and TNF-α in vitro, their proliferation capacity decreased and their levels of expression of HLA-DR and CD86 increased (median fluorescence intensity [MFI] from 0 to 57 [p=0.03] and from 34 to 103 [p=0.03], respectively). In addition, co-cultures of MF and activated PBMC revealed that MF maintained the polarization of T cells into Th1 and Tc1 cells (p≤0.001) and to a lesser extent into Th17 and Tc17 cells (p=0.03). This effect was even more significant when MF were previously exposed to IFN-γ and TNF-α but not when they were exposed to IL-6.ConclusionOur results show that myofibroblasts are present in the neointima of GCA patients and that these MF activate signaling pathways indicative of IFN-γ exposure. Moreover, these MF, especially when exposed to IFN-γ, maintain the polarization of T cells into Th1 and Tc1 cells, which contributes to amplify the production of IFN-γ and thus initiate a pro-inflammatory amplification loop that likely participates in vascular inflammation and remodelling.References[1]Corbera-Bellalta M, Planas-Rigol E, Lozano E, Terrades-Garcia N, Alba MA, Prieto-Gonzalez S, et al. Blocking interferon gamma reduces expression of chemokines CXCL9, CXCL10 and CXCL11 and decreases macrophage infiltration in ex vivo cultured arteries from patients with giant cell arteritis. Ann Rheum Dis 2016;75:1177-86.Disclosure of InterestsNone declared
Collapse
|
38
|
Gérard C, Thébault M, Lamarthée B, Genet C, Cattin F, Brazdova A, Janikashvili N, Cladière C, Ciudad M, Ouandji S, Ghesquière T, Greigert H, Tinel C, Adotevi O, Saas P, Samson M, Audia S, Bonnotte B. Human Monocyte-Derived Suppressor Cell Supernatant Induces Immunoregulatory Effects and Mitigates xenoGvHD. Front Immunol 2022; 13:827712. [PMID: 35345675 PMCID: PMC8957111 DOI: 10.3389/fimmu.2022.827712] [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: 12/03/2021] [Accepted: 02/11/2022] [Indexed: 12/03/2022] Open
Abstract
Recently developed cell-based therapies have shown potential for graft-versus-host disease (GvHD) mitigation. Our team previously developed a protocol to generate human monocyte-derived suppressor Cells (HuMoSC), a subpopulation of CD33+ suppressor cells of monocytic origin. CD33+HuMoSC successfully reduced xenoGvHD severity in NOD/SCID/IL-2Rγc-/- (NSG) mice. While CD33+ HuMoSC culture supernatant inhibits T cell activation and proliferation, the recovery of CD33+ HuMoSC immunosuppressive cells and the subsequent production of their supernatant is limited. An attractive solution would be to use both the CD33+ and the large number of CD14+ cells derived from our protocol. Here, we assessed the immunoregulatory properties of the CD14+HuMoSC supernatant and demonstrated that it inhibited both CD4 and CD8 T cell proliferation and decreased CD8 cytotoxicity. In vivo, injection of CD14+HuMoSC supernatant reduced xenoGvHD in NSG mice. Furthermore, CD14+HuMoSC supernatant maintained its immunoregulatory properties in an inflammatory environment. Proteomic and multiplex analyses revealed the presence of immunosuppressive proteins such as GPNMB, galectin-3 and IL-1R(A) Finally, CD14+HuMoSC supernatant can be produced using good manufacturing practices and be used as complement to current immunosuppressive drugs. CD14+HuMoSC supernatant is thus a promising therapy for preventing GvHD.
Collapse
Affiliation(s)
- Claire Gérard
- Université Bourgogne Franche-Comté (UBFC), Inserm, EFS BFC, UMR1098, Team « immunoregulation, immunopathology », RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France.,Department of Internal Medicine, Dijon University Hospital, Dijon, France
| | - Marine Thébault
- Université Bourgogne Franche-Comté (UBFC), Inserm, EFS BFC, UMR1098, Team « immunoregulation, immunopathology », RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Baptiste Lamarthée
- Université Bourgogne Franche-Comté (UBFC), Inserm, EFS BFC, UMR1098, Team « immunoregulation, immunopathology », RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Coraline Genet
- Université Bourgogne Franche-Comté (UBFC), Inserm, EFS BFC, UMR1098, Team « immunoregulation, immunopathology », RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Florine Cattin
- Université Bourgogne Franche-Comté (UBFC), Inserm, EFS BFC, UMR1098, Team « immunoregulation, immunopathology », RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Andréa Brazdova
- Université Bourgogne Franche-Comté (UBFC), Inserm, EFS BFC, UMR1098, Team « immunoregulation, immunopathology », RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France.,Institute of Organic Chemistry and Biochemistry of the Czech Academy of Sciences, Prague, Czechia
| | - Nona Janikashvili
- Université Bourgogne Franche-Comté (UBFC), Inserm, EFS BFC, UMR1098, Team « immunoregulation, immunopathology », RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France.,Department of Immunology, Faculty of Medicine, Tbilisi State Medical University (TSMU), Tbilisi, Georgia
| | - Claudie Cladière
- Université Bourgogne Franche-Comté (UBFC), Inserm, EFS BFC, UMR1098, Team « immunoregulation, immunopathology », RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Marion Ciudad
- Université Bourgogne Franche-Comté (UBFC), Inserm, EFS BFC, UMR1098, Team « immunoregulation, immunopathology », RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Séthi Ouandji
- Université Bourgogne Franche-Comté (UBFC), Inserm, EFS BFC, UMR1098, Team « immunoregulation, immunopathology », RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Thibault Ghesquière
- Université Bourgogne Franche-Comté (UBFC), Inserm, EFS BFC, UMR1098, Team « immunoregulation, immunopathology », RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France.,Department of Internal Medicine, Dijon University Hospital, Dijon, France
| | - Hélène Greigert
- Université Bourgogne Franche-Comté (UBFC), Inserm, EFS BFC, UMR1098, Team « immunoregulation, immunopathology », RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Claire Tinel
- Université Bourgogne Franche-Comté (UBFC), Inserm, EFS BFC, UMR1098, Team « immunoregulation, immunopathology », RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Olivier Adotevi
- UBFC, Inserm, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Philippe Saas
- UBFC, Inserm, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Maxime Samson
- Université Bourgogne Franche-Comté (UBFC), Inserm, EFS BFC, UMR1098, Team « immunoregulation, immunopathology », RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France.,Department of Internal Medicine, Dijon University Hospital, Dijon, France
| | - Sylvain Audia
- Université Bourgogne Franche-Comté (UBFC), Inserm, EFS BFC, UMR1098, Team « immunoregulation, immunopathology », RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France.,Department of Internal Medicine, Dijon University Hospital, Dijon, France
| | - Bernard Bonnotte
- Université Bourgogne Franche-Comté (UBFC), Inserm, EFS BFC, UMR1098, Team « immunoregulation, immunopathology », RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France.,Department of Internal Medicine, Dijon University Hospital, Dijon, France
| |
Collapse
|
39
|
Heitz J, Razanamahery J, Audia S, Bour JB, Guy J, Berthier S, Leguy V, Ghesquiere T, Nicolas B, Samson M, Bonnotte B. T-cell response to 3 doses of Sars-Cov2 BNT162b2 Pfizer vaccine in long term rituximab treated patients. Eur J Intern Med 2022; 99:104-105. [PMID: 35094894 PMCID: PMC8784462 DOI: 10.1016/j.ejim.2022.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Jade Heitz
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon 21000, France
| | - Jerome Razanamahery
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon 21000, France
| | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon 21000, France
| | | | - Julien Guy
- Laboratory of Hematology, Dijon University Hospital, Bourgogne-Franche Comté, Dijon, France
| | - Sabine Berthier
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon 21000, France
| | - Vanessa Leguy
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon 21000, France
| | - Thibault Ghesquiere
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon 21000, France
| | - Barbara Nicolas
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon 21000, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon 21000, France
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon 21000, France.
| |
Collapse
|
40
|
Billet AC, Chevallier O, Samson M, Petit JM, Bonnotte B, Audia S. Adrenal Insufficiency Revealing a Bilateral Adrenal Hemorrhage-Adrenal Infarction Related to Antiphospholipid Syndrome. Am J Med 2022; 135:194-195. [PMID: 34509446 DOI: 10.1016/j.amjmed.2021.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Anne-Claire Billet
- Department of Internal Medicine and Clinical Immunology, University Hospital, Dijon, France
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, University Hospital, Dijon, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, University Hospital, Dijon, France
| | - Jean-Michel Petit
- Department of Endocrinology, Diabetes and Metabolic Disorders, University Hospital, Dijon, France
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, University Hospital, Dijon, France
| | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology, University Hospital, Dijon, France.
| |
Collapse
|
41
|
Moulis G, Germain J, Rueter M, Lafaurie M, Aroichane M, Comont T, Mahévas M, Viallard J, Chèze S, Ebbo M, Audia S, Leclerc‐Teffahi S, Sommet A, Beyne‐Rauzy O, Michel M, Godeau B, Lapeyre‐Mestre M, ADOUE D, ALRIC L, ANDRE B, ARISTA S, BALARDY L, BONNET D, BONNOTTE B, BEYNE‐RAUZY O, BOREL C, BRECHEMIER D, BRIANTAIS A, BRUN N, CARREIRO M, CASTEL B, COMONT T, COUGOUL P, COURTAULT C, DANU A, DELAVIGNE K, DELBREL X, DESHAYES S, DINGREMONT C, DION J, DUFFAU P, DURAND J, ESTELLE J, FAUCHER B, GACHES F, GAUDIN C, GIRAUD P, GODEL‐LABOURET A, GRAVELEAU J, HADJ‐KHELIFA S, HARLE J, HEBRAUD B, HENNIQUE H, KHATIBI S, LAPEYREMESTRE M, LARIBI K, LEPLAY L, LEVENEUR Y, LIFERMANN F, LIMAL N, LIOGER B, OLLIER S, MACHELART I, MADAULE S, MAIGNE G, MARTEL C, MARTIN‐BLONDEL G, MICHAUD M, MOEGLIN J, MOIGNET‐AUTREL A, MOURGUET M, MONTANE DE LA ROQUE P, NUCCIO F, ORVAIN C, PRUDHOMME L, PUGNET G, RECHER C, REMY V, RISPAL P, ROY‐PEAUD F, SAILLER L, SAINT‐LEZER A, SAINTE MARIE B, SAUNIER A, SAUVETRE G, SCHLEINITZ N, SEGUIER J, SIRE S, SOUBRIER C, SWIADER L, TAVITIAN S, URBANSKI G, VAILLANT W, VEIT V. Eltrombopag in adult patients with immune thrombocytopenia in the real-world in France, including off-label use before 6 months of disease duration: The multicenter, prospective ELEXTRA study. Am J Hematol 2022; 97:E40-E44. [PMID: 34779031 PMCID: PMC9300059 DOI: 10.1002/ajh.26404] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Guillaume Moulis
- Department of Internal Medicine Toulouse University Hospital Toulouse France
- Clinical Investigation Center Toulouse University Hospital Toulouse France
| | - Johanne Germain
- Clinical Investigation Center Toulouse University Hospital Toulouse France
| | - Manuela Rueter
- Clinical Investigation Center Toulouse University Hospital Toulouse France
| | - Margaux Lafaurie
- Clinical Investigation Center Toulouse University Hospital Toulouse France
- Department of Clinical Pharmacology Toulouse University Hospital Toulouse France
| | | | - Thibault Comont
- Department of Internal Medicine Toulouse Cancer University Hospital Toulouse France
| | - Matthieu Mahévas
- Department of Internal Medicine National Referral Center for Autoimmune Cytopenias, Créteil University Hospital Créteil France
| | | | - Stéphane Chèze
- Department of Haematology Caen University Hospital Caen France
| | - Mikaël Ebbo
- Department of Internal Medicine Marseille University Hospital Marseille France
| | - Sylvain Audia
- Department of Internal Medicine Dijon University Hospital Dijon France
| | | | - Agnès Sommet
- Clinical Investigation Center Toulouse University Hospital Toulouse France
- Department of Clinical Pharmacology Toulouse University Hospital Toulouse France
| | | | - Marc Michel
- Department of Internal Medicine Toulouse Cancer University Hospital Toulouse France
| | - Bertrand Godeau
- Department of Internal Medicine Toulouse Cancer University Hospital Toulouse France
| | - Maryse Lapeyre‐Mestre
- Clinical Investigation Center Toulouse University Hospital Toulouse France
- Department of Clinical Pharmacology Toulouse University Hospital Toulouse France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Muller R, Habert P, Ebbo M, Graveleau J, Groh M, Launay D, Audia S, Pugnet G, Cohen F, Perlat A, Benyamine A, Bienvenu B, Gaigne L, Chanez P, Gaubert JY, Schleinitz N. Thoracic involvement and imaging patterns in IgG4-related disease. Eur Respir Rev 2021; 30:30/162/210078. [PMID: 34615698 DOI: 10.1183/16000617.0078-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/09/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Immunoglobulin G4-related disease (IgG4-RD) is a rare orphan disease. Lung, pleura, pericardium, mediastinum, aorta and lymph node involvement has been reported with variable frequency and mostly in Asian studies. The objective of this study was to describe thoracic involvement assessed by high-resolution thoracic computed tomography (CT) in Caucasian patients with IgG4-RD. METHODS Thoracic CT scans before treatment were retrospectively collected through the French case registry of IgG4-RD and a single tertiary referral centre. CT scans were reviewed by two experts in thoracic imagery blinded from clinical data. RESULTS 48 IgG4-RD patients with thoracic involvement were analysed. All had American College of Rheumatology/European League Against Rheumatism classification scores ≥20 and comprehensive diagnostic criteria for IgG4-RD. CT scan findings showed heterogeneous lesions. Seven patterns were observed: peribronchovascular involvement (56%), lymph node enlargement (31%), nodular disease (25%), interstitial disease (25%), ground-glass opacities (10%), pleural disease (8%) and retromediastinal fibrosis (4%). In 37% of cases two or more patterns were associated. Asthma was significantly associated with peribronchovascular involvement (p=0.04). Among eight patients evaluated by CT scan before and after treatments, only two patients with interstitial disease displayed no improvement. CONCLUSION Thoracic involvement of IgG4-RD is heterogeneous and likely underestimated. The main thoracic CT scan patterns are peribronchovascular thickening and thoracic lymph nodes.
Collapse
Affiliation(s)
- Romain Muller
- Dept of Internal Medicine, Aix Marseille University, APHM, CHU La Timone, Marseille, France.,These authors contributed equally to this work
| | - Paul Habert
- Dept of Radiology, Aix Marseille University, APHM, CHU La Timone, Marseille, France.,These authors contributed equally to this work
| | - Mikael Ebbo
- Dept of Internal Medicine, Aix Marseille University, APHM, CHU La Timone, Marseille, France
| | - Julie Graveleau
- Dept of Internal Medicine, CH Saint Nazaire, Saint Nazaire, France
| | - Mathieu Groh
- Dept of Internal Medicine, CH Foch, National Referral Center for Hypereosinophilic Syndromes (CEREO), Suresnes, France
| | - David Launay
- Univ. Lille, Inserm, CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | | | - Gregory Pugnet
- Dept of Internal Medicine and Clinical Immunology, CHU Toulouse, Toulouse, France
| | - Fleur Cohen
- Dept of Internal Medicine, APHP, CHU Pitié-Salpêtrière, Paris, France
| | | | - Audrey Benyamine
- Dept of Internal Medicine, Aix Marseille University, APHM, CHU Nord, Marseille, France
| | - Boris Bienvenu
- Dept of Internal Medicine, CH St Joseph, Marseille, Marseille, France
| | - Lea Gaigne
- Dept of Internal Medicine, Aix Marseille University, APHM, CHU La Timone, Marseille, France
| | - Pascal Chanez
- Dept of Pneumology, Aix Marseille University, APHM, CHU Nord, Marseille, France
| | - Jean Yves Gaubert
- Dept of Radiology, Aix Marseille University, APHM, CHU La Timone, Marseille, France
| | - Nicolas Schleinitz
- Dept of Internal Medicine, Aix Marseille University, APHM, CHU La Timone, Marseille, France
| |
Collapse
|
43
|
Roussotte M, Gerfaud-Valentin M, Hot A, Audia S, Bonnotte B, Thibault T, Lobbes H, Le Guenno G, Goulabchand R, Cathebras P, Varron L, Dufour JF, Deroux A, Compain C, Baudet A, Karkowski L, Pérard L, Ebbo M, Lega JC, Sève P. Immune thrombocytopenia with clinical significance in systemic lupus erythematosus: a retrospective cohort study of 90 patients. Rheumatology (Oxford) 2021; 61:3627-3639. [PMID: 34918048 DOI: 10.1093/rheumatology/keab925] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/07/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To describe the characteristics, treatment, and outcome of patients with immune thrombocytopenia with clinical significance (ITPCS) associated with systemic lupus erythematosus (SLE). METHODS This retrospective multicentre study included SLE patients who experienced ≥1 ITPCS (defined as ITP with attributable bleeding disorders and/or a platelet count <30 x109/L). Other causes of secondary thrombocytopenia were excluded. Major bleeding event (MBG) was defined as Khellaf score>8 and/or WHO score>2. RESULTS A total of 90 patients were included, the median (range) follow-up duration was 80 (6-446) months. ITP was diagnosed before SLE in 25 patients. They presented high rate of autoimmune haemolytic anaemia (15%), antiphospholipid antibody (62%), and antiphospholipid syndrome (19%). The 25 (28%) patients who experienced MBG had significantly more bleedings at ITP diagnosis and higher bleeding scores, and serositis and thrombosis during follow-up. They required significantly more treatment lines, transfusions, and hospitalizations. The 11 (12%) patients who experienced no bleeding event presented a significantly more restricted SLE phenotype (cutaneous and/or articular). Patients received a mean (range) of 4.2 (1-11) treatment lines. Corticosteroids and hydroxychloroquine allowed ITPCS overall response in one third of patients. The median relapse-free survival of rituximab (n = 34), azathioprine (n = 19), mycophenolate mofetil (n = 8), thrombopoietin-receptor agonists (n = 16), and splenectomy (n = 19) were 53, 31.5, 61, 24.5, and 78 months, respectively. Four patients experienced thrombotic events after splenectomy and one occurred under thrombopoietin-receptor agonist treatment. CONCLUSION SLE-ITCS patients displayed a high rate of haematological abnormalities and MBG patients exhibited higher morbidity. Management of thrombocytopenia was highly heterogeneous and many options seem viable.
Collapse
Affiliation(s)
| | | | - Arnaud Hot
- Department of Internal Medicine, Hospices Civils de Lyon, France
| | - Sylvain Audia
- Department of Internal Medicine, Centre Hospitalier Universitaire de Dijon, France
| | - Bernard Bonnotte
- Department of Internal Medicine, Centre Hospitalier Universitaire de Dijon, France
| | - Thomas Thibault
- Department of Internal Medicine, Centre Hospitalier Universitaire de Dijon, France
| | - Hervé Lobbes
- Department of Internal Medicine, Centre Hospitalier Universitaire de Clermont-Ferrand, France
| | - Guillaume Le Guenno
- Department of Internal Medicine, Centre Hospitalier Universitaire de Clermont-Ferrand, France
| | - Radjiv Goulabchand
- Department of Internal Medicine, Centre Hospitalier Universitaire de Montpellier, France
| | - Pascal Cathebras
- Department of Internal Medicine, Centre Hospitalier Universitaire de Saint Etienne, France
| | - Loig Varron
- Department of Internal Medicine, Centre Hospitalier de Montélimar, France
| | | | - Alban Deroux
- Department of Internal Medicine, Centre Hospitalier Universitaire de Grenoble, France
| | - Caroline Compain
- Department of Internal Medicine, Centre Hospitalier de Chambéry, France
| | - Antoine Baudet
- Department of Internal Medicine, Centre Hospitalier d'Annecy, France
| | - Ludovic Karkowski
- Department of Internal Medicine, Centre Hospitalier Militaire de Desgenettes, Lyon, France
| | - Laurent Pérard
- Department of Internal Medicine, Centre Hospitalier de St. Joseph St. Luc, Lyon, France
| | - Mikael Ebbo
- Department of Internal Medicine, Centre Hospitalier de La Timone, Marseille, France
| | | | - Pascal Sève
- Department of Internal Medicine, Hospices Civils de Lyon, France.,Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| |
Collapse
|
44
|
Razanamahery J, Samson M, Guy J, Francois S, Emile J, Cohen Aubart F, Papo M, Haroche J, Audia S, Bonnotte B. La répartition des sous-populations monocytaire dans l’histiocytose est proche de la leucémie myélomonocytaire chronique, est corrélée au phénotype et à l’activité de la maladie. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.289] [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]
|
45
|
Pouchelon C, Lafont C, Lafarge A, comont T, Riviere E, Boutboul D, Dossier A, Hamidou M, Graveleau J, Bonnard G, Audia S, Gobert D, Ruivard M, Vaidie J, Godeau B, Michel M. Caractéristiques et évolution des patients adultes atteints d’anémie hémolytique auto-immune sévère admis en réanimation : résultats d’une étude française observationnelle multicentrique. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
46
|
Georgin-Lavialle S, Terrier B, Guedon AF, Heiblig M, Comont T, Lazaro E, Lacombe V, Terriou L, Ardois S, Bouaziz JD, Mathian A, Le Guenno G, Aouba A, Outh R, Meyer A, Roux-Sauvat M, Ebbo M, Zhao LP, Bigot A, Jamilloux Y, Guillotin V, Flamarion E, Henneton P, Vial G, Jachiet V, Rossignol J, Vinzio S, Weitten T, Vinit J, Deligny C, Humbert S, Samson M, Magy-Bertrand N, Moulinet T, Bourguiba R, Hanslik T, Bachmeyer C, Sebert M, Kostine M, Bienvenu B, Biscay P, Liozon E, Sailler L, Chasset F, Audemard-Verger A, Duroyon E, Sarrabay G, Borlot F, Dieval C, Cluzeau T, Marianetti P, Lobbes H, Boursier G, Gerfaud-Valentin M, Jeannel J, Servettaz A, Audia S, Larue M, Henriot B, Faucher B, Graveleau J, de Sainte Marie B, Galland J, Bouillet L, Arnaud C, Ades L, Carrat F, Hirsch P, Fenaux P, Fain O, Sujobert P, Kosmider O, Mekinian A. Further characterization of clinical and laboratory features occurring in VEXAS syndrome in a large-scale analysis of multicenter case-series of 116 French patients. Br J Dermatol 2021; 186:564-574. [PMID: 34632574 DOI: 10.1111/bjd.20805] [Citation(s) in RCA: 142] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND A new autoinflammatory syndrome related to somatic mutations of UBA1 was recently described and called VEXAS syndrome. OBJECTIVE To describe clinical characteristics, laboratory findings and outcomes of VEXAS syndrome. DESIGN Case-series. SETTING Patients referred to a French multicenter registry between November 2020 and May 2021. PATIENTS 116 patients with VEXAS syndrome. MEASUREMENTS Frequency and median of parameters and vital status, from diagnosis to the end of the follow-up. RESULTS Main clinical features were skin lesions (83.5%), non-infectious fever (63.6%), weight loss (62%), lung involvement (49.6%), ocular symptoms (38.8%), relapsing chondritis (36.4%), venous thrombosis (34.7%), lymph nodes (33.9%), and arthralgia (27.3%). Hematological disease was present in 58 cases (50%), considered as myelodysplastic syndrome (MDS, n= 58) and monoclonal gammapathy of unknown significance (n=12).UBA1 mutations included p.M41T (44.8%), p.M41V (30.2%), p.M41L (18.1%), and splice mutations (6.9%). After a median follow-up of 3.0 years, 18 patients died (15.5%), from infectious origin (n=9) and MDS progression (n=3). Unsupervised analysis identified 3 clusters: cluster 1 (47%) with mild-to-moderate disease; cluster 2 (16%) with underlying MDS and higher mortality rates; cluster 3 (37%) with constitutional manifestations, higher C-reactive protein levels and less frequent chondritis. Five-year probability of survival was 84.2% in cluster 1, 50.5 % in cluster 2, and 89.6% in cluster 3. UBA1 p.Met41Leu mutation was associated with a better prognosis. CONCLUSION VEXAS syndrome displays a large spectrum of organ manifestations and shows different clinical and prognostic profiles. It also raises a potential impact of the identified UBA1 mutation.
Collapse
Affiliation(s)
- S Georgin-Lavialle
- Sorbonne Université, AP-HP, Hôpital Tenon, service de médecine interne, CEREMAIA, F-75020, Paris, France
| | - B Terrier
- University of Paris, AP-HP, Cochin Hospital, Department of Internal Medicine, F-75014, Paris, France
| | - A F Guedon
- Sorbonne Université, Inserm, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, Département de Santé Publique, Hôpital Saint-Antoine, APHP, Paris
| | | | - T Comont
- University Hospital of Toulouse, Department of Internal Medicine and Clinical Immunology, Toulouse, France
| | - E Lazaro
- Department of Internal Medicine and Infectious Diseases, Hôpital Haut-Lévêque, Bordeaux, France
| | - V Lacombe
- Department of Internal Medicine, Angers University Hospital, Angers, France
| | - L Terriou
- Department of Internal Medicine, Lille University Hospital, Lille, France
| | - S Ardois
- Service de médecine interne, CHU de Rennes, Rennes, France
| | - J-D Bouaziz
- Université de Paris, Service de dermatologie, Hôpital Saint Louis, APHP, INSERM U944, Paris, France
| | - A Mathian
- Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Institut E3M, Paris, France
| | - G Le Guenno
- University Hospital Centre of Bordeaux, Saint Andre Hospital, Department of Internal Medicine and Clinical Immunology, F-33000 Bordeaux, France, CHU de Clermont-Ferrand, Hôpital Estaing, service de médecine interne, Clermont-Ferrand, France
| | - A Aouba
- Caen Université, Hôpital de Caen, Department of Internal Medicine, Caen, France
| | - R Outh
- Service de médecine interne et générale, Centre Hospitalier de Perpignan, Perpignan, France
| | - A Meyer
- Service d'immunologie clinique et médecine interne, Nouvel Hôpital Civil, CHU Strasbourg
| | - M Roux-Sauvat
- GHND, Centre Hospitalier Pierre Oudot, 30 avenue du Médipôle, BP 40348, 38302 Bourgoin-Jallieu Cedex
| | - M Ebbo
- Aix Marseille Université, AP-HM, Hôpital de la Timone, Department of Internal Medicine, Marseille, France
| | - L P Zhao
- APHP, Hematology department, CHU of Saint Louis, Paris, France
| | - A Bigot
- 19University of Tours, Tours, France, Department of Internal Medicine and Clinical
| | - Y Jamilloux
- University Hospital of Lyon, Hospices Civils de Lyon, Department of Internal Medicine and Clinical Immunology, Lyon, France
| | - V Guillotin
- University Hospital Centre of Bordeaux, Saint Andre Hospital, Department of Internal Medicine and Clinical Immunology, F-33000 Bordeaux, France, CHU de Clermont-Ferrand, Hôpital Estaing, service de médecine interne, Clermont-Ferrand, France
| | - E Flamarion
- Université de Paris, Service de médecine interne, HEGP Paris, France
| | - P Henneton
- Service de Médecine Vasculaire, CHU Montpellier, 80 Av Augustin Fliche, Montpellier, 34090
| | - G Vial
- University Hospital Centre of Bordeaux, Saint Andre Hospital, Department of Internal Medicine and Clinical Immunology, F-33000 Bordeaux, France, CHU de Clermont-Ferrand, Hôpital Estaing, service de médecine interne, Clermont-Ferrand, France
| | - V Jachiet
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), F-75012, Paris, France
| | - J Rossignol
- Université de Paris, Service d'hématologie, Necker Enfants Malades, Paris, France
| | - S Vinzio
- Univ. Grenoble Alpes, Inserm, U1036, CHU Grenoble Alpes, CEA, IRIG-BCI, 38000, Grenoble, France
| | - T Weitten
- Service de médecine interne, Centre Hospitalier (CHICAS), GAP, France
| | - J Vinit
- Service de médecine interne, Centre Hospitalier, Chalons, France
| | - C Deligny
- Service de Rhumatologie - Médecine Interne 5D · CHU de Martinique - Hôpital P. Zobda-Quitman, France
| | - S Humbert
- CHU de Besançon, Service de Médecine Interne, Besançon, France
| | - M Samson
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - N Magy-Bertrand
- CHU de Besançon, Service de Médecine Interne, Besançon, France
| | - T Moulinet
- Department of Internal Medicine and Clinical Immunology, Regional Competence Center for Systemic and Autoimmune Rare Diseases, Nancy University Hospital, UMR 7365, IMoPA, Lorraine University, CNRS, Vandoeuvre-lès-Nancy, France
| | - R Bourguiba
- Sorbonne Université, AP-HP, Hôpital Tenon, service de médecine interne, CEREMAIA, F-75020, Paris, France
| | - T Hanslik
- AP-HP, Hôpital Ambroise Paris, service de médecine interne, Paris, France
| | - C Bachmeyer
- Sorbonne Université, AP-HP, Hôpital Tenon, service de médecine interne, CEREMAIA, F-75020, Paris, France
| | - M Sebert
- APHP, Hematology department, CHU of Saint Louis, Paris, France
| | - M Kostine
- Department of Rheumatology, Hôpital Haut-Lévesque, Bordeaux, France
| | - B Bienvenu
- Hôpital Saint Joseph, service de médecine interne, Marseille, France
| | - P Biscay
- Clinique Mutualiste Pessac Médecine Interne, Pessac, France
| | - E Liozon
- Service de Médecine Interne, CHU Dupuytren, Limoges, France
| | - L Sailler
- University Hospital of Toulouse, Department of Internal Medicine, Toulouse, France
| | - F Chasset
- Sorbonne Université, Hôpital Tenon, service de dermatologie et allergologie et Inflammation-Immunopathology-Biotherapy Department (DMU i3), F-75020, Paris, France
| | - A Audemard-Verger
- 19University of Tours, Tours, France, Department of Internal Medicine and Clinical
| | - E Duroyon
- Service d'Hématologie Biologique, DMU BioPhyGen GH AP-HP. Centre-University de Paris
| | - G Sarrabay
- Laboratory of Rare and Autoinflammatory Genetic Diseases and Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), CHU Montpellier, University of Montpellier, Montpellier, France
| | - F Borlot
- Service de médecine Interne, CH Béziers, France
| | - C Dieval
- Service de médecine interne et hématologie, CH régional, Rochefort, France
| | - T Cluzeau
- Hematology department, CHU of Nice, Cote d'Azur University, Nice, France
| | - P Marianetti
- CHU de REIMS, Service de médecine interne, maladies infectieuses, immunologie clinique
| | - H Lobbes
- University Hospital Centre of Bordeaux, Saint Andre Hospital, Department of Internal Medicine and Clinical Immunology, F-33000 Bordeaux, France, CHU de Clermont-Ferrand, Hôpital Estaing, service de médecine interne, Clermont-Ferrand, France
| | - G Boursier
- Laboratory of Rare and Autoinflammatory Genetic Diseases and Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), CHU Montpellier, University of Montpellier, Montpellier, France
| | - M Gerfaud-Valentin
- University Hospital of Lyon, Hospices Civils de Lyon, Department of Haematology, Lyon, France
| | - J Jeannel
- Université de Paris, Service de médecine interne, HEGP Paris, France
| | - A Servettaz
- CHU de REIMS, Service de médecine interne, maladies infectieuses, immunologie clinique
| | - S Audia
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - M Larue
- APHP, Service de rhumatologie, Hôpital Henri Mondor, Créteil, France
| | - B Henriot
- Service de médecine interne, Centre Hospitalier René Pleven, Dinan, France
| | - B Faucher
- Aix Marseille Université, AP-HM, Hôpital de la Timone, Department of Internal Medicine, Marseille, France
| | - J Graveleau
- CHU de Nantes Hôtel Dieu, Service de Médecine Interne, Nantes, France
| | - B de Sainte Marie
- University Hospital Centre of Bordeaux, Saint Andre Hospital, Department of Internal Medicine and Clinical Immunology, F-33000 Bordeaux, France, CHU de Clermont-Ferrand, Hôpital Estaing, service de médecine interne, Clermont-Ferrand, France
| | - J Galland
- Service de médecine interne, hôpital Fleyriat, Centre hospitalier Bourg-en-Bresse, France
| | - L Bouillet
- Univ. Grenoble Alpes, Inserm, U1036, CHU Grenoble Alpes, CEA, IRIG-BCI, 38000, Grenoble, France
| | - C Arnaud
- University Hospital of Toulouse, Department of Internal Medicine, Toulouse, France
| | - L Ades
- APHP, Hematology department, CHU of Saint Louis, Paris, France
| | - F Carrat
- Sorbonne Université, Inserm, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, Département de Santé Publique, Hôpital Saint-Antoine, APHP, Paris
| | - P Hirsch
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, service d'hématologie biologique, F-75012, Paris, France
| | - P Fenaux
- APHP, Hematology department, CHU of Saint Louis, Paris, France
| | - O Fain
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), F-75012, Paris, France
| | - P Sujobert
- CHU de Besançon, Service de Médecine Interne, Besançon, France
| | - O Kosmider
- Service d'Hématologie Biologique, DMU BioPhyGen GH AP-HP. Centre-University de Paris
| | - A Mekinian
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), F-75012, Paris, France
| | | |
Collapse
|
47
|
Samson M, Greigert H, Ciudad M, Gerard C, Ghesquière T, Trad M, Corbera-Bellalta M, Genet C, Ouandji S, Cladière C, Thebault M, Ly KH, Liozon E, Maurier F, Bienvenu B, Terrier B, Guillevin L, Charles P, Quipourt V, Devilliers H, Gabrielle PH, Creuzot-Garcher C, Tarris G, Martin L, Saas P, Audia S, Cid MC, Bonnotte B. Improvement of Treg immune response after treatment with tocilizumab in giant cell arteritis. Clin Transl Immunology 2021; 10:e1332. [PMID: 34532040 PMCID: PMC8435365 DOI: 10.1002/cti2.1332] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 01/25/2021] [Revised: 06/20/2021] [Accepted: 08/03/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives To study the percentage, suppressive function and plasticity of Treg in giant cell arteritis (GCA), and the effects of glucocorticoids and tocilizumab. Methods Blood samples were obtained from 40 controls and 43 GCA patients at baseline and after treatment with glucocorticoids + IV tocilizumab (n = 20) or glucocorticoids (n = 23). Treg percentage and phenotype were assessed by flow cytometry. Suppressive function of Treg was assessed by measuring their ability to inhibit effector T‐cell (Teff) proliferation and polarisation into Th1 and Th17 cells. Results Treg (CD4+CD25highFoxP3+) frequency in total CD4+ T cells was decreased in active GCA patients when compared to controls (2.5% vs. 4.7%, P < 0.001) and increased after treatment with tocilizumab but worsened after treatment with glucocorticoids alone. Treg lacking exon 2 of FoxP3 were increased in GCA patients when compared to controls (23% vs. 10% of total Treg, P = 0.0096) and normalised after treatment with tocilizumab + glucocorticoids but not glucocorticoids alone. In GCA patients, Treg were unable to control Teff proliferation and induced ˜50% increase in the amount of IL‐17+ Teff, which was improved after in vitro blockade of the IL‐6 pathway by tocilizumab. Conclusion This study reports quantitative and functional disruptions in the regulatory immune response of GCA patients and demonstrates that, unlike glucocorticoids, tocilizumab improves Treg immune response.
Collapse
Affiliation(s)
- Maxime Samson
- Department of Internal Medicine and Clinical Immunology Dijon University Hospital Dijon France.,Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Hélène Greigert
- Department of Internal Medicine and Clinical Immunology Dijon University Hospital Dijon France.,Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Marion Ciudad
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Claire Gerard
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Thibault Ghesquière
- Department of Internal Medicine and Clinical Immunology Dijon University Hospital Dijon France.,Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Malika Trad
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Marc Corbera-Bellalta
- Vasculitis Research Unit Department of Autoimmune Diseases Hospital Clinic University of Barcelona Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) CRB-CELLEX Barcelona Spain
| | - Coraline Genet
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Sethi Ouandji
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Claudie Cladière
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Marine Thebault
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Kim Heang Ly
- Department of Internal Medicine CHU de Limoges Limoges France
| | - Eric Liozon
- Department of Internal Medicine CHU de Limoges Limoges France
| | - François Maurier
- Department of Internal Medicine HP-Metz Site Belle Isle Metz France
| | - Boris Bienvenu
- Department of Internal Medicine Hôpital Saint-Joseph Marseille France
| | - Benjamin Terrier
- Department of Internal Medicine National Referral Center for Systemic and Rare Autoimmune Diseases Hôpital Cochin APHP Paris France
| | - Loïc Guillevin
- Department of Internal Medicine National Referral Center for Systemic and Rare Autoimmune Diseases Hôpital Cochin APHP Paris France
| | - Pierre Charles
- Department of Internal Medicine Institut Mutualiste Montsouris Paris France
| | - Valérie Quipourt
- Department of Geriatric Internal Medicine Dijon University Hospital Dijon France
| | - Hervé Devilliers
- Department of Internal Medicine and Systemic Diseases Dijon University Hospital Dijon France.,INSERM CIC 1432 Clinical Epidemiology Unit Dijon France
| | | | | | - Georges Tarris
- Department of Pathology Dijon University Hospital Dijon France
| | - Laurent Martin
- Department of Pathology Dijon University Hospital Dijon France
| | - Philippe Saas
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France.,CIC-1431 INSERM Besançon University Hospital EFS Besançon France
| | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology Dijon University Hospital Dijon France.,Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Maria Cinta Cid
- Vasculitis Research Unit Department of Autoimmune Diseases Hospital Clinic University of Barcelona Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) CRB-CELLEX Barcelona Spain
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology Dijon University Hospital Dijon France.,Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| |
Collapse
|
48
|
Crickx E, Audia S, Robbins A, Boutboul D, Comont T, Cheminant M, Oksenhendler E, Godeau B, Michel M, Mahevas M. Daratumumab, an original approach for treating multi-refractory autoimmune cytopenia. Haematologica 2021; 106:3198-3201. [PMID: 34348453 PMCID: PMC8634173 DOI: 10.3324/haematol.2021.279232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
- Etienne Crickx
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, Assistance Publique Hôpitaux de Paris, Université Paris Est Créteil, 94000 Créteil
| | - Sylvain Audia
- Service de Médecine Interne et d'Immunologie Clinique, Centre constitutif de référence des cytopénies auto-immunes de l'adulte, Hôpital François Mitterrand, 14 rue Paul Gaffarel, BP 77908 21079 Dijon Cedex
| | - Ailsa Robbins
- Service de Médecine interne, maladies infectieuses, immunologie clinique, CHU Robert Debré, Reims
| | - David Boutboul
- Service d'Immunologie Clinique, Hôpital Saint Louis, 1 avenue Claude Vellefaux, 75010 Paris, and Paris Université
| | - Thibault Comont
- Service de Médecine Interne et Immunopathologie, Institut Universitaire du Cancer Toulouse - Oncopôle, 1 avenue Joliot-Curie, 31059 Toulouse Cedex 9
| | | | - Eric Oksenhendler
- Service d'Immunologie Clinique, Hôpital Saint Louis, 1 avenue Claude Vellefaux, 75010 Paris, and Paris Université
| | - Bertrand Godeau
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, Assistance Publique Hôpitaux de Paris, Université Paris Est Créteil, 94000 Créteil
| | - Marc Michel
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, Assistance Publique Hôpitaux de Paris, Université Paris Est Créteil, 94000 Créteil
| | - Matthieu Mahevas
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, Assistance Publique Hôpitaux de Paris, Université Paris Est Créteil, 94000 Créteil.
| |
Collapse
|
49
|
Crickx E, Chappert P, Sokal A, Weller S, Azzaoui I, Vandenberghe A, Bonnard G, Rossi G, Fadeev T, Storck S, Fadlallah J, Meignin V, Rivière E, Audia S, Godeau B, Michel M, Weill JC, Reynaud CA, Mahévas M. Rituximab-resistant splenic memory B cells and newly engaged naive B cells fuel relapses in patients with immune thrombocytopenia. Sci Transl Med 2021; 13:13/589/eabc3961. [PMID: 33853929 DOI: 10.1126/scitranslmed.abc3961] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 10/29/2020] [Accepted: 03/22/2021] [Indexed: 01/19/2023]
Abstract
Rituximab (RTX), an antibody targeting CD20, is widely used as a first-line therapeutic strategy in B cell-mediated autoimmune diseases. However, a large proportion of patients either do not respond to the treatment or relapse during B cell reconstitution. Here, we characterize the cellular basis responsible for disease relapse in secondary lymphoid organs in humans, taking advantage of the opportunity offered by therapeutic splenectomy in patients with relapsing immune thrombocytopenia. By analyzing the B and plasma cell immunoglobulin gene repertoire at bulk and antigen-specific single-cell level, we demonstrate that relapses are associated with two responses coexisting in germinal centers and involving preexisting mutated memory B cells that survived RTX treatment and naive B cells generated upon reconstitution of the B cell compartment. To identify distinctive characteristics of the memory B cells that escaped RTX-mediated depletion, we analyzed RTX refractory patients who did not respond to treatment at the time of B cell depletion. We identified, by single-cell RNA sequencing (scRNA-seq) analysis, a population of quiescent splenic memory B cells that present a unique, yet reversible, RTX-shaped phenotype characterized by down-modulation of B cell-specific factors and expression of prosurvival genes. Our results clearly demonstrate that these RTX-resistant autoreactive memory B cells reactivate as RTX is cleared and give rise to plasma cells and further germinal center reactions. Their continued surface expression of CD19 makes them efficient targets for current anti-CD19 therapies. This study thus identifies a pathogenic contributor to autoimmune diseases that can be targeted by available therapeutic agents.
Collapse
Affiliation(s)
- Etienne Crickx
- Institut Necker-Enfants Malades, INSERM U1151/CNRS UMS8253, Université Paris Descartes, Sorbonne Paris Cité, 75993 Paris Cedex 14, France.,Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, 94000 Créteil, France
| | - Pascal Chappert
- Institut Necker-Enfants Malades, INSERM U1151/CNRS UMS8253, Université Paris Descartes, Sorbonne Paris Cité, 75993 Paris Cedex 14, France.,Inovarion, 75005 Paris, France
| | - Aurélien Sokal
- Institut Necker-Enfants Malades, INSERM U1151/CNRS UMS8253, Université Paris Descartes, Sorbonne Paris Cité, 75993 Paris Cedex 14, France
| | - Sandra Weller
- Institut Necker-Enfants Malades, INSERM U1151/CNRS UMS8253, Université Paris Descartes, Sorbonne Paris Cité, 75993 Paris Cedex 14, France
| | - Imane Azzaoui
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, 94000 Créteil, France.,INSERM U955, Université Paris Est Créteil (UPEC), 94000 Créteil, France
| | - Alexis Vandenberghe
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, 94000 Créteil, France.,INSERM U955, Université Paris Est Créteil (UPEC), 94000 Créteil, France
| | - Guillaume Bonnard
- INSERM U955, Université Paris Est Créteil (UPEC), 94000 Créteil, France
| | - Geoffrey Rossi
- Institut Necker-Enfants Malades, INSERM U1151/CNRS UMS8253, Université Paris Descartes, Sorbonne Paris Cité, 75993 Paris Cedex 14, France
| | - Tatiana Fadeev
- Institut Necker-Enfants Malades, INSERM U1151/CNRS UMS8253, Université Paris Descartes, Sorbonne Paris Cité, 75993 Paris Cedex 14, France
| | - Sébastien Storck
- Institut Necker-Enfants Malades, INSERM U1151/CNRS UMS8253, Université Paris Descartes, Sorbonne Paris Cité, 75993 Paris Cedex 14, France
| | - Jehane Fadlallah
- Service d'immunologie clinique, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France
| | - Véronique Meignin
- Service d'anatomopathologie, Hôpital Saint-Louis (AP-HP), 75010 Paris, France
| | - Etienne Rivière
- Service de médecine interne, Hôpital Haut-Lévêque, 33604 Pessac, France
| | - Sylvain Audia
- Service de médecine interne, Hôpital du Bocage, 21000 Dijon, France
| | - Bertrand Godeau
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, 94000 Créteil, France
| | - Marc Michel
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, 94000 Créteil, France
| | - Jean-Claude Weill
- Institut Necker-Enfants Malades, INSERM U1151/CNRS UMS8253, Université Paris Descartes, Sorbonne Paris Cité, 75993 Paris Cedex 14, France
| | - Claude-Agnès Reynaud
- Institut Necker-Enfants Malades, INSERM U1151/CNRS UMS8253, Université Paris Descartes, Sorbonne Paris Cité, 75993 Paris Cedex 14, France
| | - Matthieu Mahévas
- Institut Necker-Enfants Malades, INSERM U1151/CNRS UMS8253, Université Paris Descartes, Sorbonne Paris Cité, 75993 Paris Cedex 14, France. .,Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, 94000 Créteil, France.,INSERM U955, Université Paris Est Créteil (UPEC), 94000 Créteil, France
| |
Collapse
|
50
|
Greigert H, Zeller M, Putot A, Steinmetz E, Terriat B, Maza M, Falvo N, Muller G, Arnould L, Creuzot-Garcher C, Ramon A, Martin L, Tarris G, Ponnelle T, Audia S, Bonnotte B, Cottin Y, Samson M. Myocardial infarction during giant cell arteritis: A cohort study. Eur J Intern Med 2021; 89:30-38. [PMID: 33610415 DOI: 10.1016/j.ejim.2021.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cardiovascular risk is increased in giant cell arteritis (GCA). We aimed to characterize myocardial infarction (MI) in a GCA cohort, and to compare the GCA and non-GCA population affected by MI. METHODS In patients with a biopsy-proven diagnosis of GCA between 1 January 2001 and 31 December 2016 in Côte D'Or (France), we identified patients with MI by crossing data from the territorial myocardial infarction registry (Observatoire des Infarctus de Côte d'Or) database. Five controls (non-GCA + MI) were paired with one case (GCA + MI) after matching for age, sex, cardiovascular risk factors and prior cardiovascular disease. MI were characterized as type 1 MI (T1MI), resulting from thrombus formation due to atherothrombotic disease, or type 2 MI (T2MI), due to a myocardial supply/demand mismatch. GCA-related MI was defined as MI occurring within 3 months of a GCA flare (before or after). RESULTS Among 251 biopsy-proven GCA patients, 13 MI cases were identified and paired with 65 controls. MI was GCA-related in 6/13 cases, accounting for 2.4% (6/251) of our cohort. T2MI was more frequently GCA-related than GCA-unrelated (80% vs. 16.7%, p = 0.080), and GCA diagnosis was the only identified triggering factor in 75% of GCA-related T2MI. GCA-unrelated MI were more frequently T1MI and occurred in patients who had received a higher cumulative dose of prednisone (p = 0.032). GCA was not associated with poorer one-year survival. CONCLUSIONS GCA-related MI are mainly T2MI probably caused by systemic inflammation rather than coronaritis. GCA-unrelated MI are predominantly T1MI associated with atherothrombotic coronary artery disease.
Collapse
Affiliation(s)
- Hélène Greigert
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France; Department of Vascular Medicine, Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000 Dijon, France
| | | | - Alain Putot
- PEC2, EA 7460 Dijon, France; Department of Geriatric Internal Medicine, Dijon University Hospital, Dijon, France
| | - Eric Steinmetz
- Department of Cardiovascular and Thoracic Surgery, Dijon University Hospital, Dijon, France
| | - Béatrice Terriat
- Department of Vascular Medicine, Dijon University Hospital, Dijon, France
| | | | - Nicolas Falvo
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Géraldine Muller
- Department of Internal Medicine and Systemic Diseases, Dijon University Hospital, Dijon, France
| | - Louis Arnould
- Department of Ophthalmology, Dijon University Hospital, Dijon, France
| | | | - André Ramon
- Department of Rheumatology, Dijon University Hospital, Dijon, France
| | - Laurent Martin
- Department of Pathology, Dijon University Hospital, Dijon, France
| | - Georges Tarris
- Department of Pathology, Dijon University Hospital, Dijon, France
| | | | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000 Dijon, France
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000 Dijon, France
| | - Yves Cottin
- Cardiology Department, Dijon University Hospital, Dijon, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000 Dijon, France.
| |
Collapse
|