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Thouault L, Leven C, Eveillard JR, Kerspern H, Plée-Gautier E, Ianotto JC, Carre JL, Capaldo C. Assessment of the lipemia index determined by the Atellica CH 930 analyzer for the detection of monoclonal immunoglobulins. Clin Chem Lab Med 2024; 62:e68-e71. [PMID: 37682288 DOI: 10.1515/cclm-2023-0872] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/01/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Luc Thouault
- Department of Biochemistry and Pharmaco-Toxicology, Brest University Hospital, Brest, France
| | - Cyril Leven
- Department of Biochemistry and Pharmaco-Toxicology, Brest University Hospital, Brest, France
- Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | | | - Hélène Kerspern
- Department of Biochemistry and Pharmaco-Toxicology, Brest University Hospital, Brest, France
- Univ Brest, LIEN, Brest, France
| | - Emmanuelle Plée-Gautier
- Department of Biochemistry and Pharmaco-Toxicology, Brest University Hospital, Brest, France
- Univ Brest, LIEN, Brest, France
| | - Jean-Christophe Ianotto
- Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
- Department of Hematology, Brest University Hospital, Brest, France
| | - Jean-Luc Carre
- Department of Biochemistry and Pharmaco-Toxicology, Brest University Hospital, Brest, France
- Univ Brest, LIEN, Brest, France
| | - Clément Capaldo
- Department of Biochemistry and Pharmaco-Toxicology, Brest University Hospital, Brest, France
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Hermouet S, Bigot-Corbel E, Harb J. Determination of the target of monoclonal immunoglobulins: a novel diagnostic tool for individualized MGUS therapy, and prevention and therapy of smoldering and multiple myeloma. Front Immunol 2023; 14:1253363. [PMID: 38022528 PMCID: PMC10644846 DOI: 10.3389/fimmu.2023.1253363] [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: 07/05/2023] [Accepted: 09/11/2023] [Indexed: 12/01/2023] Open
Abstract
Subsets of patients diagnosed with a monoclonal gammopathy of undetermined significance (MGUS), smoldering multiple myeloma (SMM) or multiple myeloma (MM), present with a monoclonal immunoglobulin (Ig) specific for an infectious pathogen, including hepatitis C and B viruses (HCV, HBV), Helicobacter pylori and several Herpesviruses. Such cases are likely initiated by infection, since in the context of HCV- or HBV-infected patients, antiviral therapy can lead to the disappearance of antigenic stimulation, control of clonal plasma cells, and reduced or suppressed monoclonal Ig production. Complete remission has been obtained with anti-HCV therapy in refractory MM with a HCV-specific monoclonal Ig, and antiviral treatments significantly improved the probability of survival of MM patients infected with HCV or HBV prior to the diagnosis of MM. Monoclonal Igs may also target glucolipids, particularly glucosylsphingosine (GlcSph), and GlcSph-reducing therapy can lead to complete remission in SMM and MM patients presenting with a GlcSph-specific monoclonal Ig. The present review describes the importance of determining the target of the monoclonal Ig of MGUS, SMM and MM patients, and discusses the efficacy of target-reducing treatments in the management of MGUS, SMM and MM cases who present with a monoclonal Ig reactive against a treatable infectious pathogen or GlcSph.
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Affiliation(s)
- Sylvie Hermouet
- Nantes Université, INSERM, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302, Nantes, France
- Laboratoire d’Hématologie, CHU Nantes, Nantes, France
| | - Edith Bigot-Corbel
- Nantes Université, INSERM, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302, Nantes, France
- Laboratoire de Biochimie, CHU Nantes, Nantes, France
| | - Jean Harb
- Laboratoire de Biochimie, CHU Nantes, Nantes, France
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Cox MC, Esposito F, Postorino M, Venditti A, Di Napoli A. Serum Paraprotein Is Associated with Adverse Prognostic Factors and Outcome, across Different Subtypes of Mature B-Cell Malignancies-A Systematic Review. Cancers (Basel) 2023; 15:4440. [PMID: 37760410 PMCID: PMC10527377 DOI: 10.3390/cancers15184440] [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: 07/20/2023] [Revised: 08/20/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
The presence of a serum paraprotein (PP) is usually associated with plasma-cell dyscrasias, Waldenstrom Macroglobulinemia/lymphoplasmacytic lymphoma, and cryoglobulinemia. However, PP is also often reported in other high- and low-grade B-cell malignancies. As these reports are sparse and heterogeneous, an overall view on this topic is lacking, Therefore, we carried out a complete literature review to detail the characteristics, and highlight differences and similarities among lymphoma entities associated with PP. In these settings, IgM and IgG are the prevalent PP subtypes, and their serum concentration is often low or even undetectable without immunofixation. The relevance of paraproteinemia and its prevalence, as well as the impact of IgG vs. IgM PP, seems to differ within B-NHL subtypes and CLL. Nonetheless, paraproteinemia is almost always associated with advanced disease, as well as with immunophenotypic, genetic, and clinical features, impacting prognosis. In fact, PP is reported as an independent prognostic marker of poor outcome. All the above call for implementing clinical practice, with the assessment of paraproteinemia, in patients' work-up. Indeed, more studies are needed to shed light on the biological mechanism causing more aggressive disease. Furthermore, the significance of paraproteinemia, in the era of targeted therapies, should be assessed in prospective trials.
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Affiliation(s)
- Maria Christina Cox
- UOC Malattie Linfoproliferative, Fondazione Policlinico Tor Vergata, 00133 Roma, Italy
| | - Fabiana Esposito
- Ematologia, Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, 00133 Roma, Italy; (F.E.)
| | - Massimiliano Postorino
- Ematologia, Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, 00133 Roma, Italy; (F.E.)
| | - Adriano Venditti
- Ematologia, Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, 00133 Roma, Italy; (F.E.)
| | - Arianna Di Napoli
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University, 00189 Roma, Italy;
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Abstract
Pathogenic roles of monoclonal immunoglobulins in kidney disease have been attributed previously to malignant plasma cell and lymphoproliferative disorders such as multiple myeloma, lymphoplasmacytic lymphoma, chronic lymphocytic leukemia, or amyloid light chain amyloidosis. Improved technology, advancements in molecular diagnostics, and highly sensitive imaging techniques have established the need to redefine monoclonal gammopathies and the kidney disorders that are associated with monoclonal immunoglobulins regardless of tumor burden. This has led to the establishment of monoclonal gammopathy with renal significance (MGRS). MGRS was defined by the International Kidney and Monoclonal Gammopathy Research Group in 2012 as a clonal proliferative disorder that produces a nephrotoxic monoclonal immunoglobulin and does not meet previously defined hematological criteria for treatment of a specific malignancy. MGRS encompasses a wide array of pathologies with knowledge surrounding its incidence, prognosis, and management continuously increasing. This review examines the current evidence on the diagnosis, prognosis, pathogenesis, and therapy of plasma cell dyscrasias and related MGRS.
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Affiliation(s)
- Shonali Midha
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
| | - Omar Nadeem
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Umut Selamet
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA
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Hübnerová P, Karhanová M, Krhovská P, Minařík J, Mlčák P, Pašková B, Schreiberová Z, Šínová I, Zapletalová J, Šín M. Retinal oxygen saturation in monoclonal gammopathies patients: A pilot study. Acta Ophthalmol 2023; 101:e143-e153. [PMID: 36004612 DOI: 10.1111/aos.15239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 07/06/2022] [Accepted: 08/14/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this pilot study was to assess oxygen saturation in retinal blood vessels in patients with monoclonal gammopathies (MGs). METHODS Thirty-one patients with MGs (11 women and 20 men, mean age 65.9 ± 8.9 years) were enrolled during 2016-2020. The patients were diagnosed at the Haemato-Oncology Department and subsequently examined at the Ophthalmology Department before initiating systemic therapy. All patients were subjected to automatic retinal oximetry (Oxymap ehf.) and had their fundus photographed (Topcon TRC-50DX retinal camera). We assessed the association between retinal oxygen saturation (SatO2 ) - arterial SatO2 , venous SatO2 and arterio-venous (AV) difference-and MGs parameters: serum monoclonal immunoglobulin (M-protein) level and serum immunoglobulin-free light chains (FLC kappa and lambda), total protein, serum viscosity, haemoglobin, albumin, lactate dehydrogenase, C-reactive protein, creatinine and serum calcium level. Hyperviscosity-related retinopathy was also evaluated. RESULTS Statistical analysis showed a significant positive correlation (r = 0.462; p = 0.009) between the AV difference and the haemoglobin level. A significant, medium strong negative correlation was found between the AV difference and the serum levels of the monoclonal light lambda chains (r = -0.450; p = 0.011). Contrary to expectations, no statistically significant correlation was found between retinal oxygen saturation and the total protein or viscosity. CONCLUSION This study found correlation between retinal oxygen saturation and certain parameters in the blood of patients with MGs. Increasing levels of monoclonal immunoglobulin seem to reduce oxygen absorption in retinal arterioles, resulting in a lower AV difference, particularly in patients with a high free light chain level.
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Affiliation(s)
- Petra Hübnerová
- Department of Ophthalmology, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic.,Department of Physiology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic
| | - Marta Karhanová
- Department of Ophthalmology, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic
| | - Petra Krhovská
- Department of Haemato-oncology, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic
| | - Jiří Minařík
- Department of Haemato-oncology, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic
| | - Petr Mlčák
- Department of Ophthalmology, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic.,Department of Physiology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic
| | - Barbora Pašková
- Department of Ophthalmology, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic.,Department of Physiology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic
| | - Zuzana Schreiberová
- Department of Ophthalmology, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic
| | - Irena Šínová
- Department of Ophthalmology, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic
| | - Jana Zapletalová
- Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic
| | - Martin Šín
- Department of Ophthalmology, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic.,Department of Ophthalmology, 1st Faculty of Medicine, Military University Hospital Prague, Charles University, Prague, Czech Republic
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Gkalea V, Fotiou D, Dimopoulos MA, Kastritis E. Monoclonal Gammopathy of Thrombotic Significance. Cancers (Basel) 2023; 15:cancers15020480. [PMID: 36672429 PMCID: PMC9856365 DOI: 10.3390/cancers15020480] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/04/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
The current review provides an overview of the thrombotic risk observed in patients with MG who do not otherwise require treatment. We discuss clinical and biomarker studies that highlight the heterogenous hemostatic profile observed in these patients and how knowledge has evolved over the past 20 years. Biomarker studies suggest shared biologic features between multiple myeloma and monoclonal gammopathy of undetermined significance (MGUS), which involves both hypercoagulability and platelet activation. Hemostatic abnormalities identified in MGUS patients cannot be translated into clinical practice as they lack correlation to clinical events. The prothrombotic phenotype of MGUS patients has not been ascertained yet, but novel data on coagulation markers are promising. We also review rare conditions associated with the thrombogenic properties of the monoclonal protein that predispose to arterial, venous or microthrombotic events and demonstrate that the M-protein can be linked to clinically significant thrombotic events. Cryoglobulinemia, cryofibrinogenemia, cryo-crystaloglobulinemia and MG-related antiphospholipid syndrome are reviewed. We propose the new umbrella term "monoclonal gammopathy of thrombotic significance" (MGTS) to refer to significant, recurrent thrombotic events in patients with MGUS that provide a rationale for targeting the underlying plasma cell clone. Identifying MGUS patients at high risk for thrombotic events is currently a challenge.
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Yao S, Wang S, Yi R, Ran L, Zhang C. A Case of Multiple Myeloma-Associated Systemic Amyloidosis with Multiple Skin Manifestations as the First Symptom. Clin Cosmet Investig Dermatol 2023; 16:987-993. [PMID: 37065789 PMCID: PMC10101219 DOI: 10.2147/ccid.s405330] [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: 01/18/2023] [Accepted: 03/30/2023] [Indexed: 04/18/2023]
Abstract
An 81-year-old woman presented with purpura, petechiae, ecchymoses, flesh or brown-colored waxy, smooth, papules, warty plaque, nail dystrophy and palmodigital erythematous swelling for more than 6 years. She was diagnosed as multiple myeloma-associated systemic amyloidosis after skin subcutaneous histopathological examinations and relevant examinations such as blood and bone marrow. Systemic amyloidosis is closely related with multiple myeloma (MM). Multiple and pleomorphic skin lesions are not usual among patients with multiple myeloma or systemic amyloidosis.
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Affiliation(s)
- Shunyu Yao
- Chinese Traditional Medicine, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Department of Dermatology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People’s Republic of China
| | - Suxia Wang
- Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Beijing, People’s Republic of China
| | - Runxi Yi
- Chinese Traditional Medicine, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Department of Oncology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People’s Republic of China
| | - Liwei Ran
- Department of Dermatology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
- Correspondence: Liwei Ran, Department of Dermatology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, People’s Republic of China, Tel +86 010 85231374, Email
| | - Cang Zhang
- Department of Dermatology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People’s Republic of China
- Cang Zhang, Department of Dermatology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, 23 Back Street of Art Gallery, Dongcheng District, Beijing, 100010, People’s Republic of China, Tel +86 13693219292, Email
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Sarthou A, Bouchet-Seraphin C, Hurtado-Nedelec MM, Peoc’h K. [Lower-back pain and weight loss in a 75-year-old man]. Ann Biol Clin (Paris) 2022; 80:541-3. [PMID: 36696553 DOI: 10.1684/abc.2022.1768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A 75-year-old men is adressed in rheumatology for lower back pain, asthenia, and recent weight loss. Myeloma is suspected. Anemia, hyperproteinemia as well as a monoclonal IgG kappa with serum protein immunofixation are discovered. The diagnosis is confirmed by the myelogram with 14% of medullar plasmocytes. Osteolytic lesions are also found on the scanner.
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Martins M, Bridoux F, Goujon JM, Meuleman MS, Ribes D, Rondeau E, Guerry MJ, Delmas Y, Levy B, Ducloux D, Kandel-Aznar C, Le Fur A, Garrouste C, Provot F, Gibier JB, Thervet E, Bruneval P, Rabant M, Karras A, Dragon Durey MA, Fremeaux-Bacchi V, Chauvet S. Complement Activation and Thrombotic Microangiopathy Associated With Monoclonal Gammopathy: A National French Case Series. Am J Kidney Dis 2022; 80:341-352. [PMID: 35217094 DOI: 10.1053/j.ajkd.2021.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 06/28/2021] [Accepted: 12/19/2021] [Indexed: 01/27/2023]
Abstract
RATIONALE & OBJECTIVE Hemolytic uremic syndrome (HUS), a thrombotic microangiopathy (TMA) with kidney involvement, is a rare condition in patients with monoclonal gammopathy. In the absence of known causes of TMA, the role of complement activation in endothelial injury in patients with monoclonal gammopathy remains unknown and was the focus of this investigation. STUDY DESIGN Case series. SETTING & PARTICIPANTS We studied the 24 patients in the French national registry of HUS between 2000 and 2020 who had monoclonal gammopathy without other causes of secondary TMA. We provide the clinical histories and complement studies of these patients. FINDINGS Monoclonal gammopathy-associated TMA with kidney involvement is estimated to be 10 times less frequent than adult atypical HUS (aHUS) in the French national registry. It is characterized by severe clinical features, with 17 of 24 patients requiring dialysis at disease onset, and with median renal survival of only 20 months. TMA-mediated extrarenal manifestations, particularly cutaneous and neurological involvement, were common and associated with poor overall prognosis. Complement studies identified low C3, normal C4, and high soluble C5b-9 levels in 33%, 100%, and 77% of tested patients, respectively, indicating a contribution of the alternative and terminal complement pathways in the pathophysiology of the disease. Genetic abnormalities in complement genes known to be associated with aHUS were found in only 3 of 17 (17%) who were tested. LIMITATIONS Retrospective study without comparison group; limited number of patients, limited available blood samples. CONCLUSIONS Within the spectrum of TMA, TMA associated with monoclonal gammopathy represents a distinct subset. Our findings suggest that HUS associated with monoclonal immunoglobulin is a complement-mediated disease akin to aHUS.
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Affiliation(s)
- Manon Martins
- Institut National de la Santé et de la Recherche Médicale Team 1138, Cordelier Research Center, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris; Departments of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris
| | - Frank Bridoux
- Departments of Nephrology, Centre Hospitalier Universitaire de Poitiers; Centre National de Référence Maladies Rares: Amylose AL et Autres Maladies à; Dépôts d'Immunoglobulines Monoclonales; Université de Poitiers, Poitiers
| | - Jean Michel Goujon
- Departments of Nephrology and Pathology, Centre Hospitalier Universitaire de Poitiers; Centre National de Référence Maladies Rares: Amylose AL et Autres Maladies à; Dépôts d'Immunoglobulines Monoclonales
| | - Marie Sophie Meuleman
- Institut National de la Santé et de la Recherche Médicale Team 1138, Cordelier Research Center, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris
| | - David Ribes
- Department of Nephrology, Centre Hospitalier Universitaire de Toulouse, Toulouse
| | - Eric Rondeau
- Department of Nephrology, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris
| | - Mary-Jane Guerry
- Department of Nephrology, Centre Hospitalier de Valenciennes, Valenciennes
| | - Yahsou Delmas
- Department of Nephrology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux
| | - Bénédicte Levy
- Department of Nephrology, Centre Hospitalier de Troyes, Troyes
| | - Didier Ducloux
- Department of Nephrology, Centre Hospitalier Universitaire de Besançon, Besançon
| | | | - Awena Le Fur
- Department of Nephrology, Centre Hospitalier Departemental de La Roche-sur-Yon, La Roche-sur-Yon
| | - Cyril Garrouste
- Department of Nephrology, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand
| | - François Provot
- Department of Nephrology, Centre Hospitalier Universitaire de Lille, Lille
| | | | - Eric Thervet
- Departments of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris; Université de Paris, Paris
| | - Patrick Bruneval
- Departments of Nephrology Pathology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris
| | - Marion Rabant
- Department of Pathology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris
| | - Alexandre Karras
- Departments of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris
| | - Marie Agnès Dragon Durey
- Departments of Nephrology Pathology, and Immunology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris
| | - Veronique Fremeaux-Bacchi
- Departments of Nephrology Pathology, and Immunology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris
| | - Sophie Chauvet
- Institut National de la Santé et de la Recherche Médicale Team 1138, Cordelier Research Center, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris; Departments of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris; Université de Paris, Paris.
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Willrich MAV. Commentary on Significance of Monoclonal Band in Cerebral Spinal Fluid. Clin Chem 2022; 68:281. [PMID: 35104858 DOI: 10.1093/clinchem/hvab255] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/10/2021] [Indexed: 11/14/2022]
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Lin ZS, Yu XJ, Zhang X, Wang SX, Cen XN, Zhou FD, Zhao MH. Monoclonal Immunoglobulin-Associated Renal Lesions in Patients with Newly Diagnosed Multiple Myeloma: A Report from a Single Center. Cancer Manag Res 2021; 13:3879-3888. [PMID: 34017194 PMCID: PMC8129914 DOI: 10.2147/cmar.s301818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background Monoclonal immunoglobulin-associated renal lesions in patients with newly diagnosed myeloma vary. We aimed to determine the pathological spectrum and analyze associated prognostic factors. Methods Fifty-six patients with newly diagnosed multiple myeloma and biopsy-proven renal lesions were enrolled. Kidney biopsies were reanalyzed, and the baseline clinical characteristics, treatments and outcomes were recorded. Results Fifty-one patients had monoclonal immunoglobulin-associated renal lesions, with myeloma cast nephropathy (MCN) being the most common pattern. We divided our cohort into pure MCN, MCN+ other pathologies and non-MCN. Patients with MCN had more severe renal injury than those with non-MCN. In our cohort, none of the patients with pure MCN or MCN + other pathologies presented with nephrotic syndrome. Patients with non-MCN had better renal and overall survival than those with pure MCN but similar survivals to those with MCN + other pathologies. Number of myeloma casts (HR 1.08, p = 0.012) was the only independent prognostic factor for renal survival. Male sex (HR: 3.64; p = 0.015) and number of casts (HR: 1.17; p = 0.001) were independent prognostic factors for overall survival. Conclusion Patients with MCN had more severe renal injury than those with non-MCN. Patients with non-MCN had better renal and overall outcomes than those with pure MCN, but their outcomes were similar to those with MCN + other pathologies. The independent predictors of overall survival were male sex and number of myeloma casts.
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Affiliation(s)
- Zi-Shan Lin
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University, Renal Pathology Center, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, People's Republic of China
| | - Xiao-Juan Yu
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University, Renal Pathology Center, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, People's Republic of China
| | - Xu Zhang
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University, Renal Pathology Center, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, People's Republic of China.,Laboratory of Electron Microscopy, Pathological Centre, Peking University First Hospital, Beijing, People's Republic of China
| | - Su-Xia Wang
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University, Renal Pathology Center, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, People's Republic of China.,Laboratory of Electron Microscopy, Pathological Centre, Peking University First Hospital, Beijing, People's Republic of China
| | - Xi-Nan Cen
- Department of Hematology, Peking University First Hospital, Beijing, People's Republic of China
| | - Fu-De Zhou
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University, Renal Pathology Center, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, People's Republic of China
| | - Ming-Hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University, Renal Pathology Center, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, People's Republic of China.,Peking-Tsinghua Center for Life Sciences, Beijing, People's Republic of China
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Harb J, Mennesson N, Lepetit C, Fourny M, Louvois M, Bosseboeuf A, Allain-Maillet S, Decaux O, Moreau C, Tallet A, Piver E, Moreau P, Salle V, Bigot-Corbel E, Hermouet S. Comparison of Monoclonal Gammopathies Linked to Poliovirus or Coxsackievirus vs. Other Infectious Pathogens. Cells 2021; 10:438. [PMID: 33669483 DOI: 10.3390/cells10020438] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 01/04/2023] Open
Abstract
Chronic stimulation by infectious pathogens or self-antigen glucosylsphingosine (GlcSph) can lead to monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM). Novel assays such as the multiplex infectious antigen microarray (MIAA) and GlcSph assays, permit identification of targets for >60% purified monoclonal immunoglobulins (Igs). Searching for additional targets, we selected 28 purified monoclonal Igs whose antigen was not represented on the MIAA and GlcSph assays; their specificity of recognition was then analyzed using microarrays consisting of 3760 B-cell epitopes from 196 pathogens. The peptide sequences PALTAVETG and PALTAAETG of the VP1 coat proteins of human poliovirus 1/3 and coxsackievirus B1/B3, respectively, were specifically recognized by 6/28 monoclonal Igs. Re-analysis of patient cohorts showed that purified monoclonal Igs from 10/155 MGUS/SM (6.5%) and 3/147 MM (2.0%) bound to the PALTAVETG or PALTAAETG epitopes. Altogether, PALTAV/AETG-initiated MGUS are not rare and few seem to evolve toward myeloma.
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13
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Clavijo A, Ryan N, Xu H, Singh G. Measurement of Monoclonal Immunoglobulin Protein Concentration in Serum Protein Electrophoresis: Comparison of Automated vs Manual/Human Readings. Lab Med 2020; 51:252-258. [PMID: 32374393 DOI: 10.1093/labmed/lmz055] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Protein concentration of monoclonal immunoglobulin in plasma-cell myeloma/multiple myeloma provides an estimate of the tumor mass and allows for monitoring of the response to treatment. Accurate and reproducible estimates of the monoclonal immunoglobulin concentration are important for patient care. OBJECTIVE To address the optimum method for estimation of the concentration of monoclonal immunoglobulins. METHODS Serum protein electrophoresis and immunofixation electrophoresis were conducted by using the Helena SPIFE Touch instrument. Estimation of the protein concentration of monoclonal immunoglobulin in the gamma region by computer-assisted reading was compared with the reading by technologists and pathology residents, in 300 gels. The data were compared using t-testing and analysis of variance. RESULTS Computer-generated readings had a consistent positive bias. The correlation coefficient of the average reading by technologists and residents with the computer generated value was 0.997. The average positive bias by the computer reading was 0.29 g per dL. The intercept on the regression analysis was 0.22 g per dL. The reading by the computer was significantly higher than each of the human-interpreted readings. The readings by the 3 human groups were not significantly different amongst them. The main reason for the higher reading by the computer was inclusion of a greater area on the anodal size of the peak on the densitometric scan. CONCLUSIONS Human- and computer-interpreted readings of the protein concentration of monoclonal immunoglobulin have a high degree of correlation. The consistent positive bias by the computer reading occurred due to inclusion of a greater area of the densitometric scan on the anodal side of the peak. We suggest that vendors should adjust such computer programs to provide readings comparable to those generated by expert humans. We recommend manual delineation of the monoclonal peaks for measuring the concentration of monoclonal immunoglobulins.
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Affiliation(s)
- Alex Clavijo
- Department of Pathology, Medical College of Georgia at Augusta University, Augusta, GA
| | - Nathan Ryan
- Department of Pathology, Medical College of Georgia at Augusta University, Augusta, GA
| | - Hongyan Xu
- Department of Epidemiology and Bio-Statistics, Medical College of Georgia at Augusta University, Augusta, GA
| | - Gurmukh Singh
- Department of Pathology, Medical College of Georgia at Augusta University, Augusta, GA.,Division of Clinical Pathology, Medical College of Georgia at Augusta University, Augusta, GA
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14
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Bosseboeuf A, Mennesson N, Allain-Maillet S, Tallet A, Piver E, Decaux O, Moreau C, Moreau P, Lehours P, Mégraud F, Salle V, Bigot-Corbel E, Harb J, Hermouet S. Characteristics of MGUS and Multiple Myeloma According to the Target of Monoclonal Immunoglobulins, Glucosylsphingosine, or Epstein-Barr Virus EBNA-1. Cancers (Basel) 2020; 12:cancers12051254. [PMID: 32429322 PMCID: PMC7281552 DOI: 10.3390/cancers12051254] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 12/21/2022] Open
Abstract
Chronic stimulation by infectious or self-antigens initiates subsets of monoclonal gammopathies of undetermined significance (MGUS), smoldering multiple myeloma (SMM), or multiple myeloma (MM). Recently, glucosylsphingosine (GlcSph) was reported to be the target of one third of monoclonal immunoglobulins (Igs). In this study of 233 patients (137 MGUS, 6 SMM, 90 MM), we analyzed the GlcSph-reactivity of monoclonal Igs and non-clonal Igs. The presence of GlcSph-reactive Igs in serum was unexpectedly frequent, detected for 103/233 (44.2%) patients. However, GlcSph was targeted by the patient’s monoclonal Ig for only 37 patients (15.9%); for other patients (44 MGUS, 22 MM), the GlcSph-reactive Igs were non-clonal. Then, the characteristics of patients were examined: compared to MM with an Epstein-Barr virus EBNA-1-reactive monoclonal Ig, MM patients with a GlcSph-reactive monoclonal Ig had a mild presentation. The inflammation profiles of patients were similar except for moderately elevated levels of 4 cytokines for patients with GlcSph-reactive Igs. In summary, our study highlights the importance of analyzing clonal Igs separately from non-clonal Igs and shows that, if autoimmune responses to GlcSph are frequent in MGUS/SMM and MM, GlcSph presumably represents the initial pathogenic event for ~16% cases. Importantly, GlcSph-initiated MM appears to be a mild form of MM disease.
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Affiliation(s)
- Adrien Bosseboeuf
- Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Inserm, Université de Nantes, Université d’Angers, 44000 Nantes, France; (A.B.); (N.M.); (S.A.-M.); (E.B.-C.); (J.H.)
| | - Nicolas Mennesson
- Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Inserm, Université de Nantes, Université d’Angers, 44000 Nantes, France; (A.B.); (N.M.); (S.A.-M.); (E.B.-C.); (J.H.)
| | - Sophie Allain-Maillet
- Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Inserm, Université de Nantes, Université d’Angers, 44000 Nantes, France; (A.B.); (N.M.); (S.A.-M.); (E.B.-C.); (J.H.)
| | - Anne Tallet
- Laboratoire de Biochimie, Centre Hospitalier Universitaire (CHU) Tours, 37000 Tours, France; (A.T.); (E.P.)
| | - Eric Piver
- Laboratoire de Biochimie, Centre Hospitalier Universitaire (CHU) Tours, 37000 Tours, France; (A.T.); (E.P.)
- Inserm UMR966, 37000 Tours, France
| | | | | | | | - Philippe Lehours
- Laboratoire de Bactériologie, CHU Bordeaux, 33000 Bordeaux, France; (P.L.); (F.M.)
- Inserm U1053, Université de Bordeaux, 33000 Bordeaux, France
| | - Francis Mégraud
- Laboratoire de Bactériologie, CHU Bordeaux, 33000 Bordeaux, France; (P.L.); (F.M.)
- Inserm U1053, Université de Bordeaux, 33000 Bordeaux, France
| | - Valéry Salle
- Médecine Interne et Maladies Systémiques, CHU Amiens, 80000 Amiens, France;
| | - Edith Bigot-Corbel
- Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Inserm, Université de Nantes, Université d’Angers, 44000 Nantes, France; (A.B.); (N.M.); (S.A.-M.); (E.B.-C.); (J.H.)
- Laboratoire de Biochimie, CHU Nantes, 44000 Nantes, France
| | - Jean Harb
- Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Inserm, Université de Nantes, Université d’Angers, 44000 Nantes, France; (A.B.); (N.M.); (S.A.-M.); (E.B.-C.); (J.H.)
- Laboratoire de Biochimie, CHU Nantes, 44000 Nantes, France
- Centre de Recherche en Transplantation et Immunologie (CRTI), UMR1064, Inserm, Université de Nantes, 44000 Nantes, France
| | - Sylvie Hermouet
- Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Inserm, Université de Nantes, Université d’Angers, 44000 Nantes, France; (A.B.); (N.M.); (S.A.-M.); (E.B.-C.); (J.H.)
- Laboratoire d’Hématologie, CHU Nantes, 44000 Nantes, France
- Correspondence: ; Tel.: +33-2-28-08-03-55
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15
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Abstract
Introduction: Hereditary angioedema due to C1 inhibitor deficiency (C1-INH-HAE) is a rare yet still probably underdiagnosed clinical condition. Recurrent episodes of subcutaneous and sub-mucosal swelling may involve the skin, the gastrointestinal tract or even the upper airways, exposing the patients to the risk of death. With the aim of improving patients' quality of life, the therapeutic scenario has expanded over the years.Areas covered: The focus of the present review is lanadelumab, a fully human, κ-light-chain, monoclonal immunoglobulin G1 against plasma kallikrein, currently approved for long-term prophylaxis of C1-INH-HAE attacks in the USA and Canada and designated as an orphan drug by the European Medicines Agency.Expert opinion: Lanadelumab is able to inhibit plasma kallikrein with high selectivity and affinity. The subsequent phases of drug development and the ongoing open-label trial have proven its safety and efficacy. It overcomes some of the limitations of other drugs available for long-term prophylaxis, given the easy route of administration, the simple administration schedule and the possibility to tailor the treatment to each patient. Further studies are needed to test its efficacy also in other types of angioedema for which a central role of plasma kallikrein is envisaged.
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Affiliation(s)
- Maddalena Alessandra Wu
- Division of Internal Medicine, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital - Polo Universitario - University of Milan, Milan, Italy
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16
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Jin J, Luo S, Ye X, Huang J. BCOR mutation and TLS-ERG expression in acute myeloid leukemia with monoclonal immunoglobulinemia. Onco Targets Ther 2019; 12:7123-7127. [PMID: 31564896 PMCID: PMC6730603 DOI: 10.2147/ott.s218805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 08/08/2019] [Indexed: 11/23/2022] Open
Abstract
Acute myeloid leukemia (AML) originates from the abnormal clonal proliferation of myeloblasts. Immunoglobulin is secreted by B cells. AML with monoclonal antibody often indicates a poor prognosis. Here we report a case of BCOR mutation and TLS-ERG expression in AML with monoclonal immunoglobulinemia. After chemotherapy, the patient achieved bone marrow complete remission. BCOR mutation and TLS-ERG fusion gene in patient's bone marrow were not detected, at the same time, peripheral blood monoclonal immunoglobulin also disappeared. BCOR mutation or TLS-ERG fusion gene expression is associated with poor prognosis, AML with monoclonal immunoglobulin may have the same prognostic significance.
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Affiliation(s)
- Jingxia Jin
- Department of Hematology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang 322000, People's Republic of China
| | - Shuna Luo
- Department of Hematology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang 322000, People's Republic of China
| | - XingNong Ye
- Department of Hematology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang 322000, People's Republic of China
| | - Jian Huang
- Department of Hematology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang 322000, People's Republic of China
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17
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Yu X, Lan P, Feng J, Feng X, Xie L. Renal amyloidosis complicated by light chain deposition nephropathy: a case report. Int J Clin Exp Pathol 2019; 12:2279-2283. [PMID: 31934052 PMCID: PMC6949640] [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] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 03/27/2019] [Indexed: 06/10/2023]
Abstract
Light chain amyloidosis (AL) and light chain deposition disease (LCDD) are systemic diseases caused by an abnormal production of monoclonal immunoglobulin light chains and their deposition in systemic tissue. We herein present a rare case of renal amyloidosis complicated with light chain deposition nephropathy. The patient presented with nephrotic syndrome and an increased serum creatinine. Laboratory studies showed the serum k light chain was decreased and the urine free λ light chain was positive. On a lighted microscopy examination of the renal cortical tissue, λ and κ light chain protein deposits were in the glomerular and renal tubular basement membranes and Congo red staining was positive. It was determined using electron microscopy that amyloid fibrils and continuous electron-dense granules were deposited in the glomerular basement membrane. Due to differences in the protein polymerization mechanisms, it is almost impossible for AL and LCDD to coexist. This rare case can help provide ideas for clinical diagnosis and for exploring new therapeutic targets.
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Affiliation(s)
- Xiaoyang Yu
- Department of Nephrology, The First Affiliated Hospital of Xi'an Jiaotong University Xi'an, Shaanxi, China
| | - Ping Lan
- Department of Nephrology, The First Affiliated Hospital of Xi'an Jiaotong University Xi'an, Shaanxi, China
| | - Jie Feng
- Department of Nephrology, The First Affiliated Hospital of Xi'an Jiaotong University Xi'an, Shaanxi, China
| | - Xueliang Feng
- Department of Nephrology, The First Affiliated Hospital of Xi'an Jiaotong University Xi'an, Shaanxi, China
| | - Liyi Xie
- Department of Nephrology, The First Affiliated Hospital of Xi'an Jiaotong University Xi'an, Shaanxi, China
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18
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Kousios A, Duncan N, Charif R, Roufosse C. Smoldering Myeloma Presenting with Renal Histopathology of Monoclonal Gammopathy of Renal Significance: Adding to the Complexity. J Am Soc Nephrol 2018; 29:2901. [PMID: 30377233 DOI: 10.1681/asn.2018080864] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Neill Duncan
- Department of Nephrology, Renal and Transplant Centre and
| | - Rawya Charif
- Department of Nephrology, Renal and Transplant Centre and
| | - Candice Roufosse
- Department of Cellular Pathology, Hammersmith Hospital, Imperial College National Health Service Trust, London, United Kingdom
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19
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Debus J, Lemaire P, Alani M, Farhi J, Rose J, Cussac V, Defasque S, Denizon N, Ghnaya H, Besançon-Bergelin A, Laribi K, Pineau-Vincent F. [Lymphoplasmacytic lymphoma or multiple myeloma: immunoglobulins may lead to misdiagnosis]. Ann Biol Clin (Paris) 2018; 76:451-7. [PMID: 30078781 DOI: 10.1684/abc.2018.1357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report here a case of lymphoplasmacytic lymphoma with IgA paraproteinemia and a case of concomitant Waldenström macroglobulinemia and monoclonal gammapathy of unknown significance. These rare cases show that the isotype of a monoclonal immunoglobulin does not allow to foresee every time the underlying pathology. Clinical data and medical imaging are essential. From a biological point of view, additional analysis such as immunophenotyping, cytogenetics and molecular biology are required in addition to the cytological features in order to make an accurate differential diagnosis between lymphoid and plasma cell malignancy.
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20
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Bosseboeuf A, Allain-Maillet S, Mennesson N, Tallet A, Rossi C, Garderet L, Caillot D, Moreau P, Piver E, Girodon F, Perreault H, Brouard S, Nicot A, Bigot-Corbel E, Hermouet S, Harb J. Pro-inflammatory State in Monoclonal Gammopathy of Undetermined Significance and in Multiple Myeloma Is Characterized by Low Sialylation of Pathogen-Specific and Other Monoclonal Immunoglobulins. Front Immunol 2017; 8:1347. [PMID: 29098000 PMCID: PMC5653692 DOI: 10.3389/fimmu.2017.01347] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 10/03/2017] [Indexed: 12/21/2022] Open
Abstract
Multiple myeloma (MM) and its pre-cancerous stage monoclonal gammopathy of undetermined significance (MGUS) allow to study immune responses and the chronology of inflammation in the context of blood malignancies. Both diseases are characterized by the production of a monoclonal immunoglobulin (mc Ig) which for subsets of MGUS and MM patients targets pathogens known to cause latent infection, a major cause of inflammation. Inflammation may influence the structure of both polyclonal (pc) Ig and mc Ig produced by malignant plasma cells via the sialylation of Ig Fc fragment. Here, we characterized the sialylation of purified mc and pc IgGs from 148 MGUS and MM patients, in comparison to pc IgGs from 46 healthy volunteers. The inflammatory state of patients was assessed by the quantification in serum of 40 inflammation-linked cytokines, using Luminex technology. While pc IgGs from MGUS and MM patients showed heterogeneity in sialylation level, mc IgGs from both MGUS and MM patients exhibited a very low level of sialylation. Furthermore, mc IgGs from MM patients were less sialylated than mc IgGs from MGUS patients (p < 0.01), and mc IgGs found to target an infectious pathogen showed a lower level of sialylation than mc IgGs of undetermined specificity (p = 0.048). Regarding inflammation, 14 cytokines were similarly elevated with a p value < 0.0001 in MGUS and in MM compared to healthy controls. MM differed from MGUS by higher levels of HGF, IL-11, RANTES and SDF-1-α (p < 0.05). MGUS and MM patients presenting with hyposialylated pc IgGs had significantly higher levels of HGF, IL-6, tumor necrosis factor-α, TGF-β1, IL-17, and IL-33 compared to patients with hyper-sialylated pc IgGs (p < 0.05). In MGUS and in MM, the degree of sialylation of mc and pc IgGs and the levels of four cytokines important for the anti-microbial response were correlated, either positively (IFN-α2, IL-13) or negatively (IL-17, IL-33). Thus in MGUS as in MM, hyposialylation of mc IgGs is concomitant with increased levels of cytokines that play a major role in inflammation and anti-microbial response, which implies that infection, inflammation, and abnormal immune response contribute to the pathogenesis of MGUS and MM.
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Affiliation(s)
- Adrien Bosseboeuf
- CRCINA, INSERM, Institut de Recherche en Santé 2 (IRS-2), Université de Nantes, Nantes, France
| | - Sophie Allain-Maillet
- CRCINA, INSERM, Institut de Recherche en Santé 2 (IRS-2), Université de Nantes, Nantes, France
| | - Nicolas Mennesson
- CRCINA, INSERM, Institut de Recherche en Santé 2 (IRS-2), Université de Nantes, Nantes, France
| | - Anne Tallet
- Laboratoire de Biochimie, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Cédric Rossi
- Clinical Hematology, Centre Hospitalier Universitaire De Dijon, Dijon, France
| | - Laurent Garderet
- UMRS938, INSERM Institut National de la Santé et de la Recherche Médicale, Paris, France.,Département d'Hématologie et de Thérapie Cellulaire, Hôpital Saint Antoine, Paris, France.,UPMC Université Paris 6, Sorbonne Universités, Paris, France
| | - Denis Caillot
- Clinical Hematology, Centre Hospitalier Universitaire De Dijon, Dijon, France
| | - Philippe Moreau
- Hematology Department, Centre Hospitalier Universitaire (CHU) de Nantes, Nantes, France
| | - Eric Piver
- Laboratoire de Biochimie, Centre Hospitalier Universitaire de Tours, Tours, France.,UMR966, INSERM Institut National de la Santé et de la Recherche Médicale, Tours, France
| | - François Girodon
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire De Dijon, Dijon, France
| | - Hélène Perreault
- Department of Chemistry, University of Manitoba, Winnipeg, MB, Canada
| | - Sophie Brouard
- Centre de Recherche en Transplantation et Immunologie UMR1064, INSERM Institut National de la Santé et de la Recherche Médicale, Université de Nantes, Nantes, France
| | - Arnaud Nicot
- Centre de Recherche en Transplantation et Immunologie UMR1064, INSERM Institut National de la Santé et de la Recherche Médicale, Université de Nantes, Nantes, France
| | - Edith Bigot-Corbel
- CRCINA, INSERM, Institut de Recherche en Santé 2 (IRS-2), Université de Nantes, Nantes, France.,Laboratoire de Biochimie, Centre Hospitalier Universitaire (CHU) de Nantes, Nantes, France.,Faculté de Pharmacie, Université de Nantes, Nantes, France
| | - Sylvie Hermouet
- CRCINA, INSERM, Institut de Recherche en Santé 2 (IRS-2), Université de Nantes, Nantes, France.,Faculté de Médecine, Université de Nantes, Nantes, France.,Laboratoire d'Hématologie, Centre Hospitalier Universitaire (CHU) de Nantes, Nantes, France
| | - Jean Harb
- CRCINA, INSERM, Institut de Recherche en Santé 2 (IRS-2), Université de Nantes, Nantes, France.,Centre de Recherche en Transplantation et Immunologie UMR1064, INSERM Institut National de la Santé et de la Recherche Médicale, Université de Nantes, Nantes, France.,Laboratoire de Biochimie, Centre Hospitalier Universitaire (CHU) de Nantes, Nantes, France.,Faculté de Médecine, Université de Nantes, Nantes, France
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21
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Takehara E, Mandai S, Shikuma S, Akita W, Chiga M, Mori T, Oda T, Kuwahara M, Uchida S. Post-infectious Proliferative Glomerulonephritis with Monoclonal Immunoglobulin G Deposits Associated with Complement Factor H Mutation. Intern Med 2017; 56:811-817. [PMID: 28381748 PMCID: PMC5457925 DOI: 10.2169/internalmedicine.56.7778] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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] [Indexed: 11/06/2022] Open
Abstract
A 55-year-old man developed rapidly progressive glomerulonephritis and nephrotic syndrome. A kidney biopsy specimen showed diffuse proliferative and crescentic glomerulonephritis with monoclonal IgG1κ, humps, and nephritis-associated plasmin receptor, indicating infection-associated proliferative glomerulonephritis with monoclonal immunoglobulin G deposits (PGNMID). Despite dialysis-dependent renal failure, symptomatic therapy resulted in spontaneous recovery of the renal function, mimicking post-infectious glomerulonephritis (PIGN). A heterozygous complement factor H mutation was detected by comprehensive genetic testing of alternative pathway regulatory genes, which might lead to persistent infection-triggered alternative pathway activation and account for severe glomerulonephritis. Post-infectious PGNMID and PIGN might share common clinical presentations and pathogenesis related to the complement pathway.
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Affiliation(s)
- Eriko Takehara
- Department of Nephrology, Shuuwa General Hospital, Japan
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22
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Szalat R, Pirault J, Fermand JP, Carrié A, Saint-Charles F, Olivier M, Robillard P, Frisdal E, Villard EF, Cathébras P, Bruckert E, Chapman MJ, Giral P, Guerin M, Lesnik P, Le Goff W. Physiopathology of necrobiotic xanthogranuloma with monoclonal gammopathy. J Intern Med 2014; 276:269-84. [PMID: 24428816 PMCID: PMC4279948 DOI: 10.1111/joim.12195] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
RATIONALE Xanthomatosis associated with monoclonal gammopathy includes hyperlipidaemic xanthoma (HX), normolipidaemic xanthoma (NX) and necrobiotic xanthogranuloma (NXG). All three pathologies are characterized by skin or visceral lesions related to cholesterol accumulation, monoclonal immunoglobulin (MIg) and hypocomplementemia. The pathophysiology underlying NXG remains unknown although the involvement of MIg is suspected. OBJECTIVE To provide further insights into the pathophysiology of NXG, we evaluated the plasma lipid phenotype, mechanisms involved in cellular cholesterol accumulation and role of MIg in an analysis of blood and plasma markers of inflammation in 16 patients with xanthomatosis [NXG (n = 8) and NX (n = 8)] associated with monoclonal IgG relative to the relevant controls. RESULTS The lipid profile of patients with NXG was characterized by a low HDL-C phenotype and an abnormal distribution of HDL particles. Sera from patients with NXG induced cholesterol accumulation in human macrophages. This accumulation was due in part to a significant reduction in the HDL capacity to promote cholesterol efflux from macrophages, which was not found in the case of NX. The MIg of NXG and NX patients was tested positively by ELISA to recognize a large spectrum of lipoproteins. High plasma levels of pro-inflammatory cytokines (TNFα and IL-6), soluble cytokine receptors (sIL-6R, sTNFRI and sTNFRII), adhesion molecules (VCAM-1 and ICAM-1) and chemokines (MCP-1, IL-8 and MIP-1α) were observed in both patients with NXG and NX, revealing a specific xanthoma inflammatory signature which was inversely correlated with plasma levels of anti-inflammatory HDL. However, patients with NXG were distinguished by elevated levels of IL-15 and a marked increase in the rate of intermediate CD14++CD16+ monocytes. CONCLUSION This study revealed that NXG is characterized by impaired macrophage lipid homeostasis associated with a systemic inflammatory profile that may result from the interaction of MIg and lipoproteins.
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Affiliation(s)
- R Szalat
- Département d'immunologie Clinique, Hôpital Saint Louis, Paris, France; EA3963, Université Paris 7 Denis Diderot, INSERM, IFR105, Institut Universitaire d'Hématologie, Paris, France
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