1
|
Audemard-Verger A, Descloux E, Ponard D, Deroux A, Fantin B, Fieschi C, John M, Bouldouyre A, Karkowsi L, Moulis G, Auvinet H, Valla F, Lechiche C, Davido B, Martinot M, Biron C, Lucht F, Asseray N, Froissart A, Buzelé R, Perlat A, Boutboul D, Fremeaux-Bacchi V, Isnard S, Bienvenu B. Infections Revealing Complement Deficiency in Adults: A French Nationwide Study Enrolling 41 Patients. Medicine (Baltimore) 2016; 95:e3548. [PMID: 27175654 PMCID: PMC4902496 DOI: 10.1097/md.0000000000003548] [Citation(s) in RCA: 24] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Complement system is a part of innate immunity, its main function is to protect human from bacterial infection. As genetic disorders, complement deficiencies are often diagnosed in pediatric population. However, complement deficiencies can also be revealed in adults but have been poorly investigated. Herein, we describe a case series of infections revealing complement deficiency in adults to study clinical spectrum and management of complement deficiencies.A nationwide retrospective study was conducted in French university and general hospitals in departments of internal medicine, infectious diseases enrolling patients older than 15 years old who had presented at least one infection leading to a complement deficiency diagnosis.Forty-one patients included between 2002 and 2015 in 19 different departments were enrolled in this study. The male-to-female ratio was 1.3 and the mean age at diagnosis was 28 ± 14 (15-67) years. The main clinical feature was Neisseria meningitidis meningitis 75% (n = 31/41) often involving rare serotype: Y (n = 9) and W 135 (n = 7). The main complement deficiency observed was the common final pathway deficiency 83% (n = 34/41). Half of the cohort displayed severe sepsis or septic shock at diagnosis (n = 22/41) but no patient died. No patient had family history of complement deficiency. The mean follow-up was 1.15 ± 1.95 (0.1-10) years. Half of the patients had already suffered from at least one infection before diagnosis of complement deficiency: meningitis (n = 13), pneumonia (n = 4), fulminans purpura (n = 1), or recurrent otitis (n = 1). Near one-third (n = 10/39) had received prophylactic antibiotics (cotrimoxazole or penicillin) after diagnosis of complement deficiency. The vaccination coverage rate, at the end of the follow-up, for N meningitidis, Streptococcus pneumonia, and Haemophilius influenzae were, respectively, 90% (n = 33/37), 47% (n = 17/36), and 35% (n = 14/34).This large study emphasizes that complement deficiencies can be revealed in adults by infectious episodes. Most of them were meningococcal infections revealing common final pathway deficiency. To avoid undiagnosis or late diagnosis, adult displaying first episode of N meningitidis infection should be tested for complement deficiency.
Collapse
Affiliation(s)
- A Audemard-Verger
- From the CHU de Caen, Department of Internal Medicine, Caen (AA-V, BB), Department of Infectious Diseases, Nouvelle Calédonie University Hospital, Nouvelle Calédonie (ED, MJ), Laboratory of Immunology, Grenoble University Hospital, Grenoble (DP, AD), Department of Internal Medicine, Grenoble University Hospital, Grenoble, Department of Internal Medicine, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris (BF), Department of Clinical Immunology, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris (CF, DB), Department of Internal Medicine, Robert Ballanger General Hospital, Aulnay sous Bois (MAB), Department of Internal Medicine, Hôpital d'Instruction des Armées, Metz (LK), Department of Internal Medicine, Toulouse University Hospital, UMR 1027 INSERM University of Toulouse; CIC 1436, Toulouse (GM), Department of Internal Medicine, Brest University Hospital, Brest (HA), Department of Paediatric Intensive Care Unit, Lyon University Hospital, Lyon (FV), Department of Infectious Diseases, Nîmes University Hospital, Nîmes (CL), Department of Infectious Diseases, Raymond Poincaré University Hospital, Garches (BD), Department of Medicine, Colmar General Hospital, Colmar (MM), Department of Infectious Diseases, Nantes University Hospital, Nantes (CB, NA), Department of Infectious Diseases, Saint Etienne University Hospital, Saint Etienne (FL), Department of Internal Medicine, Créteil Hospital, Créteil (AF), Department of Infectious Diseases, Tours University Hospital, Tour (RB), Department of Internal Medicine, Rennes University Hospital, Rennes (AP), Laboratory of Immunology, Team Dentritic Cells Physiology, Cochin Institute (SI); and Laboratory of Immunology, Européen Georges Pompidou University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris (VF-B), France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Maciejewski M, Ponard D, Humeau H, Sarre M, Drouet C, Martin L. Devenir des patientes ayant présenté un angio-œdème bradykininique sous pilule estrogénique. Ann Dermatol Venereol 2015. [DOI: 10.1016/j.annder.2015.10.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
3
|
Ghannam A, Sellier P, Defendi F, Favier B, Charignon D, López-Lera A, López-Trascasa M, Ponard D, Drouet C. C1 inhibitor function using contact-phase proteases as target: evaluation of an innovative assay. Allergy 2015; 70:1103-11. [PMID: 26010015 DOI: 10.1111/all.12657] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Controlling prekallikrein activation by C1 inhibitor (C1Inh) represents the most essential mechanism for angioedema patient protection. C1Inh function in the plasma is usually measured based on the residual activity of the C1s protease not involved in the pathological process. We have hereby proposed an alternative enzymatic measurement of C1Inh function based on contact-phase activation and correlation with angioedema diagnostic requirements. METHODS The contact phase was reconstituted using the purified components, with C1Inh standard or plasma sample. The kinetics of the amidase activity were monitored using Pro-Phe-Arg-pNA, independently of alpha2-macroglobulin. We prevented any interference from a possible high plasma kininogenase activity by preincubating the samples with protease inhibitor. Receiver operating characteristics (ROC) were used to calculate the assay's diagnostic performance. RESULTS The calibration curve was built using C1Inh standard (threshold limit 0.10 × 10(-3) U, i.e., 0.2 pmol), and C1Inh function was quantified in the sample, with a reference interval established based on healthy individuals (n = 281; men: 0.61-1.10 U/ml, median: 0.85 U/ml; women: 0.42-1.08 U/ml, median: 0.74 U/ml). The median values of female donors were lower than those of the others due to estrogen, yet C1Inh function remained within the reference interval. The ROC curve calculation provided the following optimum diagnostic cutoff values: women 0.36 U/ml (area under curve [AUC]: 0.99; sensitivity: 93.48%; specificity: 99.37%); and men 0.61 U/ml (AUC: 1; sensitivity: 100.0%; specificity: 100.0%). CONCLUSION The performance outcome provided features suitable for angioedema diagnostic or follow-up. Established by means of the kinin formation process, this assay should be preferred over the method based on a C1s protease target.
Collapse
Affiliation(s)
- A. Ghannam
- GREPI/AGIM CNRS FRE 3405; Université Joseph Fourier; Grenoble France
- KininX SAS; Grenoble France
| | - P. Sellier
- GREPI/AGIM CNRS FRE 3405; Université Joseph Fourier; Grenoble France
- KininX SAS; Grenoble France
| | - F. Defendi
- GREPI/AGIM CNRS FRE 3405; Université Joseph Fourier; Grenoble France
- Centre de Référence des Angioedèmes CREAK; CHU Grenoble; Grenoble France
| | - B. Favier
- GREPI/AGIM CNRS FRE 3405; Université Joseph Fourier; Grenoble France
| | - D. Charignon
- GREPI/AGIM CNRS FRE 3405; Université Joseph Fourier; Grenoble France
- Centre de Référence des Angioedèmes CREAK; CHU Grenoble; Grenoble France
| | - A. López-Lera
- Unidad de Inmunología; Hospital Universitario La Paz/IdiPAZ; Madrid Spain
- Centro de Investigación Biomédica en Red (CIBERER U-754); Madrid Spain
| | - M. López-Trascasa
- Unidad de Inmunología; Hospital Universitario La Paz/IdiPAZ; Madrid Spain
- Centro de Investigación Biomédica en Red (CIBERER U-754); Madrid Spain
| | - D. Ponard
- Centre de Référence des Angioedèmes CREAK; CHU Grenoble; Grenoble France
| | - C. Drouet
- GREPI/AGIM CNRS FRE 3405; Université Joseph Fourier; Grenoble France
- Centre de Référence des Angioedèmes CREAK; CHU Grenoble; Grenoble France
| |
Collapse
|
4
|
Rigault G, Franko B, Pinel N, Ponard D, Zaoui P. Efficacité des échanges plasmatiques et du mabthera dans la glomérulonéphrite membrano-proliférative par anticorps anti-facteur H. Nephrol Ther 2015. [DOI: 10.1016/j.nephro.2015.07.250] [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: 10/23/2022]
|
5
|
Audemard A, Descloux E, Deroux A, Fantin B, Fieschi C, Bouldouyre M, Karkowski L, Moulis G, Froissart A, Fremeaux-Bacchi V, Ponard D, Bienvenu B. Déficits en complément révélés à l’âge adulte par un épisode infectieux. Résultats des 41 patients inclus dans l’étude DECORAPI. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.03.326] [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: 10/23/2022]
|
6
|
Defendi F, Charignon D, Ghannam A, Ponard D, Drouet C. [Biological investigation of kinin-mediated angioedema]. Ann Dermatol Venereol 2015; 142:163-9. [PMID: 25683013 DOI: 10.1016/j.annder.2015.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 11/21/2014] [Accepted: 01/06/2015] [Indexed: 11/15/2022]
Abstract
Kinin-mediated angioedema results from accumulation of kinins, vasoactive and vasopermeant peptides, on the vascular endothelium. The disease is characterized by sudden episodes of swelling in the subcutaneous and submucosal tissues; the edema may occur spontaneously or it may be precipitated by triggering factors such as physical or emotional stress, or certain medicines. The characterization of kinin formation and catabolism systems helps improve knowledge of the aetiopathogenic mechanisms involved and provides the basis for classification of kinin-mediated angioedema conditions; thus, we may distinguish between angioedema with C1 inhibitor deficiency, whether inherited or acquired, and angioedema with normal C1 inhibitor activity, associated with increased kinin-forming activity or deficiency in kinin catabolism enzymes. In support of the clinical diagnosis, the physician may request laboratory investigation for a functional and molecular definition of the disease. Laboratory diagnosis is based on the characterization of: (1) kinin production control by C1 inhibitor investigation (function, antigen levels and circulating species); (2) kinin production (kininogenase activity, kininogen cleavage species); and (3) kinin catabolism enzymes (aminopeptidase P, carboxypeptidase N, angiotensin-I converting enzyme and dipeptidyl peptidase IV). An abnormal biological phenotype is supported by examination of susceptibility genes (SERPING1, F12 and XPNPEP2) and mutation segregation in the families.
Collapse
Affiliation(s)
- F Defendi
- Exploration fonctionnelle de l'angiœdème, CHU Grenoble, CS 10217, 38043 Grenoble, France; Université Joseph Fourier, GREPI/AGIM CNRS FRE 3405, 38043 Grenoble cedex 9, France.
| | - D Charignon
- Exploration fonctionnelle de l'angiœdème, CHU Grenoble, CS 10217, 38043 Grenoble, France; Université Joseph Fourier, GREPI/AGIM CNRS FRE 3405, 38043 Grenoble cedex 9, France
| | - A Ghannam
- Exploration fonctionnelle de l'angiœdème, CHU Grenoble, CS 10217, 38043 Grenoble, France; Université Joseph Fourier, GREPI/AGIM CNRS FRE 3405, 38043 Grenoble cedex 9, France
| | - D Ponard
- Laboratoire d'immunologie, CHU Grenoble, CS 10217, 38043 Grenoble, France
| | - C Drouet
- Exploration fonctionnelle de l'angiœdème, CHU Grenoble, CS 10217, 38043 Grenoble, France; Université Joseph Fourier, GREPI/AGIM CNRS FRE 3405, 38043 Grenoble cedex 9, France
| |
Collapse
|
7
|
Charignon D, Ghannam A, Defendi F, Ponard D, Monnier N, López Trascasa M, Launay D, Caballero T, Djenouhat K, Fain O, Cichon S, Martin L, Drouet C. Hereditary angioedema with F12 mutation: factors modifying the clinical phenotype. Allergy 2014; 69:1659-65. [PMID: 25134986 DOI: 10.1111/all.12515] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hereditary angioedema (HAE) with normal C1 inhibitor (C1Inh) associated with the c.983C>A and c.983C>G mutations of the F12 gene (FXII-HAE) is a rare condition, and presents with highly variable clinical expression. On the basis of data gathered from a large carrier cohort, we assessed the modifiers affecting the clinical phenotype. METHODS We analyzed clinical and biological data recorded from 118 mutation carriers (80 symptomatic and 38 asymptomatic), 58 noncarrier relatives from 40 families, and 200 healthy donors. Disease severity was scored in relation to frequency and location of edema, as well as age at disease onset. To predict FXII-HAE disease severity, we analyzed the biological phenotype [C1Inh, C4, spontaneous amidase, angiotensin-I-converting enzyme (ACE), aminopeptidase P (APP), and carboxypeptidase N/M (CPN)] by means of logistic regression (Akaike information criterion) and odds ratio (OR). RESULTS Meaningful variables contributed to FXII-HAE, with the kinin catabolism enzymes ACE and CPN exhibiting a significant inverse relationship with disease severity (OR = 0.36, 95% CI 0.23-0.59, P < 0.001; OR = 0.58, 95% CI 0.36-0.91, P < 0.05, respectively). CPN activities were 37.5 (28.5-41.3) nmol/ml/min and 38.5 (32.8-45.6) for FXII-HAE asymptomatic and symptomatic carriers, respectively, and 37.9 (30.5-43.7) nmol/ml/min for noncarriers. Angiotensin-I-converting enzyme activities were 58 (44-76) and 49 (35-59) nmol/ml/min for FXII-HAE asymptomatic and symptomatic carriers, respectively, and 56 (49-66) nmol/ml/min for noncarriers. CONCLUSIONS The FXII-HAE is associated with modifiers, for example kinin catabolism enzymes, ACE and CPN, different from those recognized in HAE with C1Inh deficiency.
Collapse
Affiliation(s)
- D. Charignon
- CREAK; Centre de Référence des Angioedèmes; Grenoble France
- GREPI/AGIM CNRS FRE 3405; Université Joseph Fourier; Grenoble France
| | - A. Ghannam
- CREAK; Centre de Référence des Angioedèmes; Grenoble France
- GREPI/AGIM CNRS FRE 3405; Université Joseph Fourier; Grenoble France
| | - F. Defendi
- CREAK; Centre de Référence des Angioedèmes; Grenoble France
- GREPI/AGIM CNRS FRE 3405; Université Joseph Fourier; Grenoble France
| | - D. Ponard
- CREAK; Centre de Référence des Angioedèmes; Grenoble France
| | - N. Monnier
- CREAK; Centre de Référence des Angioedèmes; Grenoble France
| | - M. López Trascasa
- Institute for Health Research (IdiPaz); Hospital Universitario La Paz; Madrid Spain
- Biomedical Research Network on Rare Diseases-U754 (CIBERER); Madrid Spain
| | - D. Launay
- CREAK; Centre de Référence des Angioedèmes; Grenoble France
- Département de Médecine Interne; Université du Droit et de la Santé Lille 2; Lille France
| | - T. Caballero
- Institute for Health Research (IdiPaz); Hospital Universitario La Paz; Madrid Spain
- Biomedical Research Network on Rare Diseases-U754 (CIBERER); Madrid Spain
| | - K. Djenouhat
- Département d'Immunologie; Institut Pasteur; Alger Algeria
| | - O. Fain
- CREAK; Centre de Référence des Angioedèmes; Grenoble France
- Département de Médecine Interne; Université Paris XIII; Bondy France
| | - S. Cichon
- Institute für Humangenetics; Universität Bonn; Bonn Germany
- Departement Biomedizin; Universität Basel; Basel Switzerland
| | - L. Martin
- CREAK; Centre de Référence des Angioedèmes; Grenoble France
- Département de Dermatologie; L'UNAM Université; Hôpital d'Angers; Angers France
| | - C. Drouet
- CREAK; Centre de Référence des Angioedèmes; Grenoble France
- GREPI/AGIM CNRS FRE 3405; Université Joseph Fourier; Grenoble France
| |
Collapse
|
8
|
Beaudouin E, Defendi F, Picaud J, Drouet C, Ponard D, Moneret-Vautrin DA. Iatrogenic angioedema associated with ACEi, sitagliptin, and deficiency of 3 enzymes catabolizing bradykinin. Eur Ann Allergy Clin Immunol 2014; 46:119-122. [PMID: 24853572] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
New concepts of idiopathic and iatrogenic angioedema underline the role of bradykinin, and the importance of catabolizing enzymes. A case is described of Angiotensin converting enzyme inhibitor (ACEi) and sitagliptin induced angioedema, where AO attacks decreased after the withdrawal of lisinopril but resolved only after the withdrawal of sitagliptin, an inhibitor of dipeptylpeptidase IV. ACE, aminopeptidase P and carboxypeptidase N were decreased down to 17%, 42%, 64% of median references values, and remained low one year after the interruption of these drugs: 56%, 28% and 50%, respectively. The combined deficiency of APP and CPN might enhance the inhibiting effect of the DPP IV inhibitor. The fact that this triple deficiency remained latent before and after the treatment indicates that searching for latent enzyme deficiencies should be carried out when there is intention to treat with a combination of drugs interfering with the bradykinin metabolism.
Collapse
Affiliation(s)
- E Beaudouin
- Service d'Allergologie, Centre Hospitalier E Durkheim, Epinal, France
| | - F Defendi
- French Reference Center for Angioedema, CREAK, Grenoble, France. Université Joseph Fourier, GREPI/AGIM CNRS FRE 3405, Grenoble, France
| | - J Picaud
- Service d'Allergologie, Centre Hospitalier E Durkheim, Epinal, France
| | - C Drouet
- French Reference Center for Angioedema, CREAK, Grenoble, France. Université Joseph Fourier, GREPI/AGIM CNRS FRE 3405, Grenoble, France
| | - D Ponard
- Laboratoire d'Immunologie IBP, Grenoble, France
| | - D A Moneret-Vautrin
- Service d'Allergologie, Centre Hospitalier E Durkheim, Epinal, France. Université de Lorraine Nancy, France
| |
Collapse
|
9
|
Defendi F, Charignon D, Ghannam A, Ponard D, Nicolie B, Fain O, Martin L, Drouet C. Intérêt de l’étude du métabolisme de la bradykinine (BK) pour la prise en charge des angioedèmes. Ann Dermatol Venereol 2013. [DOI: 10.1016/j.annder.2013.09.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
10
|
Dessart P, Humeau H, Nicolie B, Ponard D, Drouet C, Martin L. Proportion relative des différents types d’angio-oedemes bradykiniques (AOBK) dans une population consultant en centre de référence. Ann Dermatol Venereol 2013. [DOI: 10.1016/j.annder.2013.09.058] [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: 10/26/2022]
|
11
|
Sarre M, Dessart P, Humeau H, Nicolie B, Ponard D, Drouet C, Martin L. Proportion relative des différents types d’angio-œdèmes bradykiniques dans une population pédiatrique consultant en centre de référence. Ann Dermatol Venereol 2013. [DOI: 10.1016/j.annder.2013.09.153] [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: 11/26/2022]
|
12
|
Ghannam A, Defendi F, Favier B, Ponard D, Drouet C. C1 inhibitor function with kinin forming enzymes as target: Evaluation of a novel assay. Mol Immunol 2013. [DOI: 10.1016/j.molimm.2013.05.145] [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: 11/15/2022]
|
13
|
Cartier JC, Truche AS, Croze L, Brunelle C, Ponard D, Carron PL, Zaoui P. Activation de la voie alterne du complément au cours de la microangiopathie thrombotique associée à la maladie de Still de l’adulte. Nephrol Ther 2012. [DOI: 10.1016/j.nephro.2012.07.104] [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]
|
14
|
Giard C, Nicolie B, Drouet M, Lefebvre-Lacoeuille C, Le Sellin J, Bonneau JC, Maillard H, Rénier G, Cichon S, Ponard D, Drouet C, Martin L. Angio-oedema induced by oestrogen contraceptives is mediated by bradykinin and is frequently associated with urticaria. Dermatology 2012; 225:62-9. [PMID: 22922353 DOI: 10.1159/000340029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 06/04/2012] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Hereditary C1-inhibitor (C1-Inh) deficiency is associated with 'bradykinin-mediated angio-oedema' (BK-AO) and is believed not to be associated with urticaria. Acquired AO has been related to oestrogen contraceptives. OBJECTIVE To demonstrate that AO precipitated by oestrogens and characterized by nonfunctional C1-Inh is mediated by BK and to evaluate the occurrence of urticaria in these patients. METHODS A retrospective evaluation of patients referred for AO related to oestrogen was undertaken. Circulating C1-Inh, high molecular weight kininogen (HK) and enzymes involved in the metabolism of bradykinin were investigated. RESULTS Fifteen patients were included. HK cleavage concurrent to oestrogen intake was demonstrated in 10 patients with available plasma. Eight patients reported recurrent or chronic urticaria. Discontinuation of the contraceptive resulted in a return to native C1-Inh and HK in all cases studied and to normal kininogenase activity in all but one. The clinical manifestations completely disappeared in 6 patients and improved in 7 after the withdrawal of oestrogen. CONCLUSION Patients display extensive cleavage of HK in the plasma, which supports that AO precipitated by oestrogen contraception is BK-mediated. Recurrent urticaria may have been underestimated in this context. The presence of recurrent urticaria should not systematically rule out the diagnosis of BK-AO when the history is suggestive.
Collapse
Affiliation(s)
- C Giard
- Department of Dermatology, L’UNAM University, Angers Hospital, Angers, France
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Smets P, Guettrot-Imbert G, Hermet M, Delèvaux I, Ponard D, Ruivard M, Evrard B, Andre M, Tridon A, Aumaitre O. Profil clinique associé à la présence d’anticorps anti-C1q. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.03.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
16
|
Moreno A, Valle S, Franca A, Levy S, Ponard D, Monnier N, Lunardi J, Arruda L. Type III Hereditary Angioedema: First Description of a Mutation in Factor XII Gene and Clinical Features in a Brazilian Family. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
17
|
Bygum A, Fagerberg CR, Ponard D, Monnier N, Lunardi J, Drouet C. Mutational spectrum and phenotypes in Danish families with hereditary angioedema because of C1 inhibitor deficiency. Allergy 2011; 66:76-84. [PMID: 20804470 DOI: 10.1111/j.1398-9995.2010.02456.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hereditary angioedema (HAE), type I and II, is an autosomal dominant disease with deficiency of functional C1 inhibitor protein causing episodic swellings of skin, mucosa and viscera. HAE is a genetically heterogeneous disease with more than 200 different mutations in the SERPING1 gene. A genotype-phenotype relationship does not seem to exist in HAE, although the polymorphism c.-21T>C of exon 2 has been reported to be associated with a more severe phenotype. We aimed to establish the mutational spectrum of C1 inhibitor deficiency in Denmark and investigate the possible disease-aggravating effect of the c.-21T>C polymorphism. METHODS Hereditary angioedema was diagnosed based on clinical features and C1 inhibitor deficiency. A general severity score ranging from 0 to 10 was developed based on age at disease onset, clinical manifestations and treatment experiences. SERPING1 gene investigation was performed by exon sequencing followed by multiplex ligation-dependent probe amplification genomic rearrangement analysis in all known Danish HAE families. RESULTS Fifty-nine patients with HAE from 26 families were included in this study. The mean disease severity score was 7.12 [1-10], and the mean C1 inhibitor function was 26% [20-46%]. The sensitivity of the mutational screening was 96%, and 13 new mutations were found in this Danish patient cohort. Nine patients (15%) carried the c.-21T>C polymorphism, but they didn't have a more severe phenotype. CONCLUSION Thirteen new mutations were identified in the Danish HAE population. No correlation between the c.-21T>C polymorphism, the biochemical values of C1 inhibitor function and the clinical severity score was found.
Collapse
Affiliation(s)
- A Bygum
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.
| | | | | | | | | | | |
Collapse
|
18
|
Affo C, Ponard D, Gompel A, Coulibaly I, Medjkane A, Challal S, Sterpu R, Bosquet A, Mahé I. Un angiœdème de type III particulier. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.10.246] [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]
|
19
|
Ruiz S, Segonds C, Georges B, Puissant B, Ponard D, Fourcade O, Conil JM. [Fulminant pneumococcemia: bacteria and complement partners in crime]. ACTA ACUST UNITED AC 2010; 29:593-4. [PMID: 20598496 DOI: 10.1016/j.annfar.2010.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
20
|
Brannelec A, Ponard D, Blanchard Delaunay C, Ollivier Y, Amarger S, Stirnemann J, Oksenhendler E, Bouillet L, Fain O. Traitement par rituximab des angiœdèmes acquis : quatre observations. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.03.426] [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: 11/26/2022]
|
21
|
Bouillet L, Boccon-Gibod I, Ponard D, Drouet C, Cesbron JY, Dumestre-Perard C, Monnier N, Lunardi J, Massot C. Prise en charge des grossesses chez les femmes ayant un angiœdème héréditaire de type III. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.03.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
22
|
Bouillet L, Boccon-Gibod I, Ponard D, Drouet C, Cesbron JY, Dumestre-Perard C, Monnier N, Lunardi J, Massot C, Gompel A. L’icatibant (antagoniste des récepteurs B2 de la Bradykinine) est efficace dans le traitement des angioedèmes héréditaires de type III. Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.10.375] [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: 11/30/2022]
|
23
|
Otmani F, Ly KH, Jaccard A, Ponard D, Gondran G, Bézanahary H, Vidal-Cathala E. Déficit acquis en C1 inhibiteur associé à un myélome multiple. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.10.146] [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: 10/21/2022]
|
24
|
|
25
|
Bouillet L, Ponard D, Rousset H, Cichon S, Drouet C. A case of hereditary angio-oedema type III presenting with C1-inhibitor cleavage and a missense mutation in the F12 gene. Br J Dermatol 2007; 156:1063-5. [PMID: 17381464 DOI: 10.1111/j.1365-2133.2007.07778.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
26
|
Creidy R, Veit V, Berbis P, Ponard D, Desplat-Jégo S. Diagnostic de l'œdème angioneurotique : intérêt en anesthésie et outils biologiques disponibles. ACTA ACUST UNITED AC 2006; 25:904-6. [PMID: 16859883 DOI: 10.1016/j.annfar.2006.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Accepted: 05/18/2006] [Indexed: 11/29/2022]
|
27
|
Drouet C, Ponard D, Bouillet L. [Iatrogenic angioedema due to estrogen, angiotensin conversion enzyme inhibitors, angiotensin receptor antagonists and dialysis membranes]. Rev Med Interne 2006; 27 Suppl 2:S76-9. [PMID: 16697083 DOI: 10.1016/j.revmed.2006.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Accepted: 04/07/2006] [Indexed: 11/16/2022]
Affiliation(s)
- C Drouet
- Laboratoire d'immunologie et clinique de médecine interne, CHU de Grenoble, hôpital Sud, BP 338, 38434 Echirolles, France.
| | | | | |
Collapse
|
28
|
Abstract
INTRODUCTION Antimitochondrial type M5 antibodies (AMA-M5) are among the immunological abnormalities associated with Sneddon syndrome. CASE A 45 year-old woman, hospitalized for diplopia and with a 20-year history of obstetrical accidents, internuclear ophthalmoplegia and livedo, was diagnosed with Sneddon syndrome associated with primary antiphospholipid syndrome (APS) aggravated by the presence of AMA-M5. DISCUSSION AMA-M5 are immunological markers of APS to the same extent as antiphospholipid antibodies. This case demonstrates the interest of screening for AMA-M5 in cases of strong clinical suspicion of APS when the anticoagulant lupus test is normal and no anti-cardiolipin, anti-b2 glycoprotein I or antiprothrombin antibodies are found.
Collapse
Affiliation(s)
- C Seinturier
- Unité de médecine vasculaire 10 C, Département pluridisciplinaire de médecine, CHU de Grenoble, BP 217, 38043 La Tronche Cedex.
| | | | | | | | | |
Collapse
|
29
|
Bouillet L, Ponard D, Drouet C, Massot C. [Non-histaminic angiodema management: diagnostic and therapeutic interest of tranexamic acid]. Rev Med Interne 2005; 25:924-6. [PMID: 15582173 DOI: 10.1016/j.revmed.2004.07.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [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: 02/19/2004] [Accepted: 07/17/2004] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The diagnosis of chronic angioedema (localised and reversible oedema) is sometimes very difficult when there is no efficiency of anti-histaminics and corticosteroids. In these cases, bradykinin angioedema must be mentioned. Tranexamic acid is efficient and must be proposed. STUDY We reported seven patients who have a non-histaminergic angioedema since an average of 8 years. Corticosteroids and histamine-1 blockers were not efficient. Daily tranexamic acid treatment (1 g x 3 per day) controlled the disease. Three patients had no more attack. The C1Inh antigen and function levels were normal. No secondary effect was described and all patients are still being treated (average of 20 months). CONCLUSION When a non-histaminergic angioedema is suspected, tranexamic acid must be proposed as attack's treatment and as prophylactic treatment.
Collapse
Affiliation(s)
- L Bouillet
- Service de médecine interne, département pluridisciplinaire de médecine, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France.
| | | | | | | |
Collapse
|
30
|
Abstract
Human mannan binding lectin (MBL) is a member of the collectins, a group of proteins that contain a dual structure with a lectin and a collagenous moieties. The collectins are considered as major actors of innate immunity. We report the presence of low molecular weight intracellular MBL forms in human hepatocytic cell lysates, with binding capacities associated to its lectin and/or its collagen moiety. Competition with D-mannose and with antibodies directed against the lectin binding site of MBL indicate that the 60 kDa form represents an intracellular association of MBL through its lectin moiety. The effects of collagenase or MBL associated serine proteases (MASPs) from a MBL deficient plasma, gave evidence that the 60 KDa form contains also collagen and suggested the binding of a ligand to this collagen part. These results show that this intracellular form of MBL shares binding properties with circulating MBL. The binding potential of the lectin and the collagenous parts of precursor forms of intracellular MBL may suggest that they behave as molecular chaperone. The complexity of MBL structure and functions deserves further investigation on other intracellular forms of MBL.
Collapse
Affiliation(s)
- C Dumestre-perard
- Laboratoire d'Immunologie, Université Joseph Fourier JE 2236, Hôpital Sud, CHU Grenoble, Avenue de Kimberley, 38130 Echirolles, France.
| | | | | |
Collapse
|
31
|
Bouillet L, Drouet C, Ponard D, Massot C. Intérêt du test thérapeutique à l'acide tranexamique dans la prise en charge des angio-œdèmes non allergiques. Rev Med Interne 2003. [DOI: 10.1016/s0248-8663(03)80361-2] [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: 10/25/2022]
|
32
|
Sarrot-Reynauld F, Nissou M, Ponard D, Arvieux J, Dumestre-Pérard C, Massot C, Imbert B, Gaudin P, Drouet C. Intérêt clinique des anticorps anti-endothélium. Rev Med Interne 2003. [DOI: 10.1016/s0248-8663(03)80388-0] [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]
|
33
|
Bouillet L, Ponard D, Massot C. Lipodystrophie céphalothoracique et activation de la voie alterne du complément. Rev Med Interne 2003. [DOI: 10.1016/s0248-8663(03)80569-6] [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: 11/30/2022]
|
34
|
Koenig M, Drouet C, Ponard D, Sarrot-Reynaud F, Massot C, Carpentier P. Anticorps anti-endothélium, complément et collectines dans la sclérodermie systémique. Rev Med Interne 2003. [DOI: 10.1016/s0248-8663(03)80439-3] [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: 11/30/2022]
|
35
|
Abstract
BACKGROUND Oral contraceptives can precipitate attacks of hereditary angioedema (ANE) or induce acquired forms. OBJECTIVE We studied 5 patients who had an ANE which had begun under oral contraception and disappeared after stopping the pill. METHODS We explored the clinical and biological characteristics of these patients. RESULTS The symptoms developed during the first year or later after starting contraception; the patients reported relapsing swelling of the lips, hands, larynx and abdomen. All women had normal serum C4 and C1 inhibitor (C1Inh) antigen levels, but a lowered C1Inh activity, with a marked protein cleavage on the immunoblot. The suppression of the pill was associated with the regression of the edema and normalization of C1Inh function. CONCLUSION The mechanism of these ANE is unknown. The could be due to a modulation of C1Inh expression upon androgens or an imbalance between coagulation proteins favoring C1Inh cleavage by its target proteases.
Collapse
Affiliation(s)
- L Bouillet
- Département pluridisciplinaire de médecine, Service de médecine interne, Hôpital Sud, CHU de Grenoble, France.
| | | | | | | | | |
Collapse
|
36
|
Bouillet L, Ponard D, Drouet C, Massot C. Diagnostic et évolution de 17 patients atteints d'œdème angioneurotique acquis. Rev Med Interne 2002. [DOI: 10.1016/s0248-8663(02)80493-3] [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]
|
37
|
Abstract
The mannan binding lectin (MBL) plays a major role in innate immunity through its ability to activate complement upon binding to carbohydrate arrays on the surface of various microorganisms. The question of a possible association of the MBL structural gene polymorphism and the oligomeric state of MBL was poorly documented. For these reasons, it appears difficult to evaluate MBL in blood patients on the only basis of protein contents, even in combination with MBL genotyping. This study reports a method to calculate a specific activity for circulating MBL, that relies on: (i) the availability of purified MBL; and (ii) a simplified MBL activity assay based on complement activation. The three-step MBL purification from human plasma reported here is characterized by a highly purified MBL, that occurs in two different oligomeric forms. The results on the specific activity of these forms show that the higher oligomeric forms of MBL have the ability to induce C4 cleavage more efficiently than the corresponding lower oligomers. The usefulness of this approach is illustrated by its potential interest in the biological exploration of certain pathology, for example in the follow-up of chronic hepatitis C. Further investigation is needed to establish whether MBL specific activity (MBLsa) is correlated to the polymorphic state of the molecule. The relative simplicity of the test described here allows better investigation on the relationship between MBL biological activity and its genotype.
Collapse
Affiliation(s)
- C Dumestre-Perard
- Laboratoire d'Immunologie, Hôpital Sud, Université Joseph Fourier JE2236, Avenue de Kimberley, 38130 Echirolles, France.
| | | | | | | | | | | |
Collapse
|
38
|
Abstract
PURPOSE Nonallergic isolated angioedema is an uncommon clinical syndrome raising difficult diagnosis and therapeutic problems. Occurrences linked to a C1Inh are the predominant ones and have to be examined as a priority, taking into account the specificity of the associated follow-up. CURRENT KNOWLEDGE AND KEY POINTS Diseases with a clinical profile close to hereditary angioneurotic edema, but without C1Inh anomaly, have been described recently. It is in fact family cases, concerning only women, where estrogens seem to play a dominant role. Angioedema's secondary aspects are gathering various pathologies (vasculitis, Gleich's syndrome, angioedema initiated by physical agents). The role played by some drugs must not be forgotten, mainly angiotensin converting enzyme inhibitors, which are at the origin of angiodema in nearly 0.5% of users. FUTURE PROSPECT AND PROJECTS Uncontrolled activation of the contact system seems to play a major role in the main part of these angiodemas. The efficiency of the tranexaminic acid (which modulates its activation) is to be taken as evident. The key to the future seems to be the development of plasmin and bradykinin inhibitors.
Collapse
Affiliation(s)
- L Bouillet
- Service de médecine interne, pavillon Dominique-Villars, département pluridisciplinaire de médecine, CHU, BP 217, 38043 Grenoble, France.
| | | | | | | |
Collapse
|
39
|
Desauw C, Hachulla E, Boumbar Y, Bouroz-Joly J, Ponard D, Arvieux J, Dubucquoi S, Fauchais AL, Hatron PY, Devulder B. [Antiphospholipid syndrome with only antiphosphatidylethanolamine antibodies: report of 20 cases]. Rev Med Interne 2002; 23:357-63. [PMID: 11980311 DOI: 10.1016/s0248-8663(02)00570-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE The association of antiphosphatidylethanolamine antibodies (aPE) as the only antiphospholipid antibody with antiphospholipid syndrome (APS) is discussed. The aPE was described as the sole antibody in many cases suggesting APS. aPE was not included in the Sapporo criteria for the classification of APS. METHODS We investigated the clinical features of 20 patients with aPE only; 17 patients had symptoms potentially related to APS (group 1) and three had other manifestations (group 2). RESULTS There were 15 women and five men, mean age was 35 +/- 12 years at the beginning. In group 1 (n = 17), ten patients presented arterial thrombosis, nine venous thrombosis (five had both), and six microvascular thrombosis (livedo reticularis, lacunar pathology). The aPE positivity was persistent in 13 patients. A subgroup of four patients (three women) presented arteriosclerosis with peripheral arteriopathy which started before 45 years of age. They had another atherosclerosis risk factor associated with aPE persistence. In group 2 (n = 3), there was no thrombotic event, one demyelinating pathology, one microvascular pathology, and one arterial dysplasia. The aPE positivity was never confirmed. Finally, 13 patients presented an APS with aPE only, confirmed at least 8 weeks later. CONCLUSIONS Our study points out that testing for aPE would be of interest for patients when symptoms were potentially related to APS, particularly when other antiphospholipid antibodies were negative. This description questions the enlargement of the APS biological criteria defined in Sapporo. The role of aPE in atherosclerosis is considered.
Collapse
Affiliation(s)
- C Desauw
- Service de médecine interne, hôpital Claude-Huriez, CHRU, 59037 Lille, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Dumestre-Perard C, Ponard D, Drouet C, Leroy V, Zarski JP, Dutertre N, Colomb MG. Complement C4 monitoring in the follow-up of chronic hepatitis C treatment. Clin Exp Immunol 2002; 127:131-6. [PMID: 11882043 PMCID: PMC1906298 DOI: 10.1046/j.1365-2249.2002.01729.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [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] [Indexed: 02/05/2023] Open
Abstract
The overall role of complement in the host--pathogen relationship is now well understood. However, its involvement at a chronic stage of infection, such as chronic hepatitis C, is less well documented. Here, results are reported which point to the use of specific C4 monitoring in the follow-up of HCV patients. This study concerns 66 patients with chronic HCV infection, treated with interferon alpha 2b alone or with interferon alpha 2b + ribavirin, and 50 healthy adults as controls. Complement blood tests were performed to measure C1q, C3, C4, mannan binding lectin (MBL), C1s-C1 inhibitor complexes, total (CH50) and C4 (C4H) haemolytic activity; specific C4 activity was taken as the C4H/C4 protein ratio. Rheumatoid factor (RF) levels were also measured. A significant reduction in CH50 and specific C4 activity in HCV patients, compared with the healthy controls, was observed before the onset of treatment; the other parameters were not affected and no C1s-C1 inhibitor complexes were detected. At the same time, a significant reduction in specific C4 activity was observed in relapsers compared with sustained responders. These results point to a potential predictive function of C4 specific activity to monitor the response to therapy. Restoration of specific C4 activity at 6 months was better in responders than in non-responders. Complement activation in chronic hepatitis C does not seem to involve the C1 stage of the classical pathway. A negative correlation between specific C4 activity and RF titres suggests a possible involvement of RF in C4 activation, via the lectin pathway. Specific C4 monitoring appears to be a valuable tool for the follow-up of chronic hepatitis C treatment, together with the other conventional investigations.
Collapse
|
41
|
Martin L, Degenne D, Toutain A, Ponard D, Watier H. Hereditary angioedema type III: an additional French pedigree with autosomal dominant transmission. J Allergy Clin Immunol 2001; 107:747-8. [PMID: 11295676 DOI: 10.1067/mai.2001.114242] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
42
|
Brenier-Pinchart MP, Pinel C, Croisonnier A, Brion JP, Faure O, Ponard D, Ambroise-Thomas P. Diagnosis of malaria in non-endemic countries by the ParaSight-F test. Am J Trop Med Hyg 2000; 63:150-2. [PMID: 11388507 DOI: 10.4269/ajtmh.2000.63.150] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
QBC, examination of thin blood smears, and Parasight-F were performed for every case of malaria suspected between May 1997 and December 1998. Data from 310 patients were reported. Fifty had malaria infection diagnosed by QBC and thin blood film, among whom 39 had Plasmodium falciparum infection. Three of these 39 were negative with the Parasight-F test. Eleven patients had a positive ParaSight-F test but microscopic diagnosis methods were negative. Interpretation of these 11 positive ParaSight-F results is proposed to depend on clinical criteria.
Collapse
Affiliation(s)
- M P Brenier-Pinchart
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire, Grenoble, France
| | | | | | | | | | | | | |
Collapse
|
43
|
Bouillet L, Ponard D, Drouet C, Dumestre C, Pernollet M, Bonerandi JJ, Caillaud D, D'Incan M, Hacini M, Harle JR, de Wazières B, Colomb M, Massot C. [Acquired angioneurotic edema. Clinical and biological characteristics in 9 patients]. Presse Med 2000; 29:640-4. [PMID: 10780195] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE Angioneurotic edema (AE) is a rare but severe disease. Hereditary AE is the more well-known form. The acquired form is exceptional: the symptoms are the same but there are some biologic and treatment differences. We investigated the clinical and biochemical features in nine patients with acquired angioneurotic edema (AAE). PATIENTS AND METHODS Four of the patients with type I AAE presented an accelerated metabolism of C1Inh, associated with a hematology disease. Their C4, C1q and C1Inh plasma levels were low. Four patients had type II AAE associated with an autoantibody to C1Inh. Their C1Inh plasma levels were normal or low but the functional levels were low in all four. One patient had AAE induced by oral contraceptives. The C1Inh plasma level was normal but the functional level was very low; there were no autoantibodies. Symptoms resolved when oral contraceptives were withdrawn and the C1Inh level returned to normal. DISCUSSION Treatment of AAE is a difficult matter. For type I AAE, it consists in treating the associated disease. For type II AAE, the treatment goal is to lower the autoantibody level. Management of these diseases requires close collaboration between clinicians and biologists.
Collapse
Affiliation(s)
- L Bouillet
- Service de Médecine interne, Hôpital sud, CHU de Grenoble
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
D'Incan M, Tridon A, Ponard D, Dumestre-Pérard C, Ferrier-Le Bouedec M, Bétail G, Souteyrand P, Caillaud D. Acquired angioedema with C1 inhibitor deficiency: is the distinction between type I and type II still relevant? Dermatology 1999; 199:227-30. [PMID: 10592402 DOI: 10.1159/000018252] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acquired angioedemas are divided into type I associated with lymphoproliferation and type II caused by anti-C1-inhibitor antibodies. Recent reports have suggested that this distinction is not so clear-cut, mainly because of the presence of antibodies against the C1 inhibitor in some cases belonging to the type I group. We report herein 2 additional cases of acquired angioedema with anti-C1-inhibitor antibody. MATERIAL AND METHODS One man and 1 woman had had acquired angioedema for several years. In the man, a monoclonal component had been detected several years before the present study. In the second patient, a monoclonal component was detected during the study. The following data were studied on successive blood samples collected during angioedema manifestations: complement component levels, functional activity of the classical pathway, functional and antigenic C1 inhibitor doses, ELISA test to detect autoantibodies to C1 inhibitor and Western blot analysis of the C1 inhibitor. RESULTS In both patients, CH50 and C4 activities were decreased, and an autoantibody to C1 inhibitor was detected. In 1 case, the antibody appeared after the monoclonal component; in the second case, it appeared before and belonged to a different immunoglobulin class. CONCLUSION Our data suggest that the distinction between type I and type II acquired angioedema is no longer valid because of overlapping in some cases.
Collapse
Affiliation(s)
- M D'Incan
- Department of Dermatology, CHRU Hôtel-Dieu, Clermont-Ferrand, France.
| | | | | | | | | | | | | | | |
Collapse
|
45
|
|
46
|
Claveyrolas-Bouillet L, Ponard D, Jacquot C, Colomb M. L'œdème angioneurotique héréditaire et acquis: à propos d'une série de 26 patients. Rev Med Interne 1998. [DOI: 10.1016/s0248-8663(98)90022-4] [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: 11/30/2022]
|
47
|
Chevailler A, Arlaud G, Ponard D, Pernollet M, Carrère F, Renier G, Drouet M, Hurez D, Gardais J. C-1-inhibitor binding monoclonal immunoglobins in three patients with acquired angioneurotic edema. J Allergy Clin Immunol 1996; 97:998-1008. [PMID: 8655897 DOI: 10.1016/s0091-6749(96)80076-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The syndrome of acquired angioneurotic edema (AAE) is characterized by the adult onset of angioedema, the lack of evidence for inheritance of the disorder, and the frequent association of the C1-inhibitor (C1-INH) deficiency with lymphoproliferative or other malignant diseases. Recently, a new type of AAE (type II AAE) has been described. The two major biologic differences of this new syndrome compared with all other previously reported AAE cases (type I AAE) are the presence in patients' sera of both anti-C1-INH autoantibodies, often monoclonal, and a circulating low molecular weight (95 kd) C1-INH protein. From the clinical point of view, the absence of underlying lymphoproliferative disease is the hallmark of type II AAE compared with type I AAE. However, the distinction between type I and type II AAE may not be so clear-cut. We report three patients with monoclonal gammopathies and AAE for whom the initial diagnosis was type I AAE. The demonstration by ELISA of the C1-INH binding ability of their monoclonal immunoglobulins in addition to the presence of 95 kd C1-INH protein enables us to change the diagnosis to type II AAE. From the therapeutic point of view, it is crucial to detect the anti-C1-INH antibody and to analyze the C1-INH size to distinguish type I and type II AAE, especially if patients have a monoclonal gammopathy, to give the appropriate treatment (attenuated androgens vs immunosuppressive regimen, respectively) to prevent a fatal outcome.
Collapse
Affiliation(s)
- A Chevailler
- Laboratoire d'Immunopathologie, Centre Hospitalier Universitaire, Angers, France
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Mey A, Ponard D, Colomb M, Normier G, Binz H, Revillard JP. Acylation of the lipid A region of a Klebsiella pneumoniae LPS controls the alternative pathway activation of human complement. Mol Immunol 1994; 31:1239-46. [PMID: 7969185 DOI: 10.1016/0161-5890(94)90074-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Two mechanisms of direct activation of the complement system by LPS have been extensively documented: (i) activation of the alternative pathway (AP) by the polysaccharide region, and (ii) activation of the classical pathway (CP) by the lipid A region. Here we demonstrate that LPS from the Klebsiella pneumoniae I-145 strain activates the AP by a mechanism dependent on the acylation of the lipid A region. Cleavage of C3 by K. pneumoniae LPS in EGTA was blocked by polymyxin B. Two 34 kDa derivatives were prepared from a membrane extract of this K. pneumoniae strain: (i) an acyl-poly (1,3) galactoside containing two galactosamine-bound ester-linked and two amide-linked fatty acids (EFA-APG), and (ii) an acyl-poly (1,3) galactoside devoid of ester-linked fatty acids (APG). APG and EFA-APG share the structure of LPS molecules, with a long polysaccharidic chain, a core, and a lipid A region. The AP was activated by EFA-APG but not by APG nor by the isolated polygalactose chain GC-APG, indicating a critical role for ester-linked fatty acids in AP activation. Polymyxin B which binds to the lipid A region of LPS completely inhibited AP activation by EFA-APG. A small part of EFA-APG was shown to form aggregates in saline, but aggregation was not decreased by polymyxin B. Furthermore, APG formed aggregates of similar size although it was not able to activate AP. Therefore the role of lipid A acylation in triggering AP activation is not exclusively mediated by aggregation of the molecule. LPS from the rough strain of Salmonella minnesota (Sm Re LPS) directly activates the CP but not the AP. However, when mixed with the polygalactose chain GC-APG, Sm Re LPS activated the AP. The data demonstrate a cooperation between the lipid A region and the polysaccharidic chain in activation of the AP. Similar cooperation may occur with other LPS molecules.
Collapse
Affiliation(s)
- A Mey
- Laboratoire d'Immunologie INSERM U80 Lyon, France
| | | | | | | | | | | |
Collapse
|
49
|
Chevailler A, Drouet C, Ponard D, Alibeu C, Suraniti S, Carrère F, Renier G, Hurez D, Colomb MG. Non-coordinated biosynthesis of early complement components in a deficiency of complement proteins C1r and C1s. Scand J Immunol 1994; 40:383-8. [PMID: 7939409 DOI: 10.1111/j.1365-3083.1994.tb03478.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We report on a 60-year-old woman with systemic lupus erythematosus and a total (95%) C1r and a partial (36%) C1s deficiency. The patient complained about cutaneous lesions on forearms and legs without other systemic involvement. Elevated anti-nuclear, anti-native DNA and anti-SSA antibodies were present. The finding of persistently depressed levels of haemolytic complement activity (CH50) on both serum and plasma, associated with normal levels of C3, C4 and C2 components, and normal alternative pathway haemolytic activity showed a deficiency of an early component of the classical pathway. Indeed C1r component was below the limits of detection whereas C1s component was lowered (36%). The depressed CH50 was only corrected by purified C1r. Biosynthesis of C1r and C1s by patient's monocytes was spontaneously normal but not up-regulated by interferon-gamma for C1r alone, whereas the biosynthesis of C1s, but also of interleukin-6, was increased, indicating a specific disregulation of C1r. The deficiency was associated with a lupus syndrome and a fatal assumed septic shock. This is in agreement with other reported cases.
Collapse
Affiliation(s)
- A Chevailler
- Laboratoire d'Immunopathologie, CHU, Angers, France
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Abstract
The IgG subclass and light chain distribution of antiphospholipid antibodies (aPL) occurring in autoimmune patients were determined by means of two radioimmunoassays using either cardiolipin- or beta 2 glycoprotein 1 (beta 2GP1)-coated microtitre plates and mouse MoAbs. Of 50 sera selected for positivity of anticardiolipin antibodies (ACA) of the IgG isotype, 32 (64%) possessed anti-beta 2GP1 antibodies and their presence was closely associated with clinical features of the antiphospholipid syndrome. Good correlations were found between ACA and anti-beta 2GP1 antibodies when considering antibody level and patterns of light chain and IgG subclass, suggesting that, overall, the same antibodies were being measured. Light chain analysis showed the polyclonal origin of these antibodies and, in most sera, a trend towards use of lambda chain. Among sera positive for anti-beta 2GP1 antibodies, IgG2 was the major subclass reactive with beta 2GP1 and cardiolipin (87% and 74% of the IgG antibody activity, respectively). In contrast, in the group of 18 sera lacking anti-beta 2GP1 antibodies, ACA were largely restricted to IgG3, with a lesser contribution by IgG1. A few selected sera from the anti-beta 2GP1-positive group were shown to contain mixtures of antibodies that required beta 2GP1 (restricted to IgG2 present in large amounts) and did not require this cofactor (restricted to IgG3 and/or IgG1 present in low amounts) for their reactivity with cardiolipin. There was no contribution of glycosylation to the epitopes recognized by anti-beta 2GP1 antibodies, even though human anti-carbohydrate antibodies are restricted to the IgG2 subclass. These findings further emphasize the intra- and interindividual heterogeneity of aPL, and should help to discriminate clinically relevant specificies.
Collapse
Affiliation(s)
- J Arvieux
- Laboratoires d'Immunologie Centre de Transfusion, Sanguine, France
| | | | | | | |
Collapse
|