Fatal primary infection due to human herpesvirus 6 variant A in a renal transplant recipient

We describe a fatal primary human herpesvirus 6 (HHV-6) variant A infection in a kidney transplanted adult woman. On day 20 post transplantation (TX), after rejection therapy, the patient presented an acute hemophagocytic syndrome with hepatitis and central nervous system involvement. HHV-6 IgG and IgM antibodies seroconversion was demonstrated. HHV-6 variant A was the sole pathogen detected by nested PCR and/or culture in blood, bone marrow aspiration, liver biopsy, cerebrospinal fluid and bronchoalveolar lavage. The graft was HHV-6 seropositive and the patient was not transfused before day 28 post TX, suggesting that the virus was transmitted by the graft. Despite immunoglobulins, ganciclovir and foscarnet therapy, the HHV-6 infection progressed and led to severe aplasia. The patient developed Aspergillus fumigatus pneumonia and died from fulminant candidemia. This case demonstrated for the first time that HHV-6 variant A primary infection can cause life-threatening disseminated infection in immunosuppressed patients.

Male recipients of kidneys from female donors are at increased risk of graft loss from both rejection and technical failure

The aim of the present retrospective study was to uncover the factor(s) responsible for the poor outcome of cadaver kidney grafts from female donors in male recipients. The 741 transplantations performed at our center from August 1983 to September 1997 were distributed into four groups according to recipient and donor gender: female donor to female recipient (F to F: n = 117), male donor to female recipient (M to F: n = 172), female donor to male recipient (F to M: n = 170), and male donor to male recipient (M to M: n = 282). All the patients received immunosuppressive therapy based on corticosteroids and cyclosporine, associated or not with either azathioprine or prophylactic anti-lymphocyte globulin. Overall graft survival was lower in the F to M group than in the three other groups (p = 0.009). Failures due to rejection were more frequent during the 1st post-transplant trimester in female than in male donor grafts, irrespective of recipient gender (p = 0.025). All failures due to technical problems occurred during the first 3 months post-transplantation: they were more frequent in the F to M group than in the three other groups (p = 0.040): this could be related to the older age of the donors in the former group. After the first post-transplant year, failures due to causes other than rejection remained low in the F to F group but increased steadily in the three other groups (p = 0.007). Specific survival rates were not correlated with the time-evolution of mean serum creatinine values, daily doses and trough levels of cyclosporine in the four groups of grafts. In conclusion, the poor outcome of F to M grafts results from combined immunologic and technical factors exerting their effects early in the course of transplantation.

A role for Th2 cytokines in the suppression of CD8+ T cell-mediated graft rejection

A major histocompatibility complex (MHC) class I-specific T cell receptor (TCR)-transgenic mouse was used to study classical-type transplantation tolerance in the adult. Engraftment of MHC class I-incompatible bone marrow and tolerance to donor-type skin grafts were obtained using dimethylmyeleran (DMM) as a myeloablative agent and a non-depleting anti-CD8 monoclonal antibody (mAb) as the sole immunosuppressant. Surprisingly, bone marrow engraftment was facilitated by host CD4+ T cells, a subset normally considered unable to reject class I MHC-incompatible grafts. A combination of mAb to interleukins (IL)-4 and -10 antagonized the "permissive" effects of host CD4+ T cells, indicating a possible role for Th2-type immunoregulation that can act on CD8+ T cells in this form of transplantation tolerance. The fate of graft-reactive T cells was monitored using anti-clonotypic antibodies. It was observed that bone marrow engraftment then led to peripheral deletion of mAb-blockaded, clonotype+ CD8+ T cells.

The induction of human T cell unresponsiveness by soluble anti-CD3 mAb requires T cell activation

In order to obtain an in vitro model of human T cell unresponsiveness induced by soluble anti-CD3 mAb in the presence of accessory cells, T cells purified from peripheral blood of healthy volunteers were cultured for 4 days with irradiated accessory cells and OKT3. After a 48 h resting period allowing TCR-CD3 complex re-expression, T cells were rechallenged with plastic-immobilized OKT3, and their proliferative response as well as their secretion of IL-2, IFN-gamma and IL-10 measured. Primary culture with OKT3 induced a state of unresponsiveness characterized by defective responses to OKT3 rechallenge but normal or enhanced responses to PMA and A23187 calcium ionophore, indicating a defect in the early steps of TCR-CD3-mediated signal transduction. Indeed, we found that unresponsive T cells displayed an impaired mobilization of intracellular calcium stores upon TCR-CD3 ligation. In order to determine whether the development of unresponsiveness depends on the initial T cell activation triggered by OKT3, we compared several versions of OKT3 differing in their ability to bind Fc receptors. We found that only the activating antibodies that bind Fc receptors on accessory cells induced T cell unresponsiveness. We conclude that human resting T cells can be rendered unresponsive by anti-CD3 mAb in soluble form provided that they trigger T cell activation.

Hepatic MR imaging: comparison of RARE derived sequences with conventional sequences for detection and characterization of focal liver lesions

BACKGROUND

We compared two T2-weighted turbo spin echo (TSE) sequences with a T2-weighted conventional SE (CSE) sequence to determine whether sequences derived from rapid acquisition with relaxation enhancement such as TSE could replace CSE for the detection and subsequent characterization of focal liver lesions.

METHODS

A total of 55 consecutive patients with 107 liver lesions underwent magnetic resonance imaging examinations at 1.5 Tesla, with a constant imaging protocol. TSE pulse sequences were acquired with eight echo trains (repetition time [TR], 4718 ms; echo time [TE], 90 ms; acquisition time [TA], 4.03 min; and a symmetric k-space ordering scheme) and 11 echo trains (TR, 4200 ms; TE, 140 ms; TA, 4.40 min; and an asymmetric k-space ordering scheme) and compared with CSE (TR, 2300 ms; TE, 45/90 ms; TA, 9.53 min). Images were analyzed qualitatively by scoring image quality and artifacts and counting focal liver lesions by independent reading with consensus obtained for discrepancies. Quantitative analysis was performed by measuring signal-to-noise (S/N), contrast-to-noise (C/N), and tumor-liver signal intensity (T/L) ratios.

RESULTS

T2-weighted TSE sequences provided better subjective image quality and reduced artifacts as compared with the T2-weighted CSE sequence. CSE and TSE sequences exhibited no statistically significant differences in liver S/N, lesion-liver C/N (CSE TE, 90 ms: 18.6 +/- 14.0; TSE TE, 90 ms: 16.5 +/- 12.9) and the detectability of focal liver lesions. Heavily T2-weighted TSE with a TE of 140 ms allowed correct characterization of focal liver lesions based on a T/L ratio of 3.0 in 84% of patients.

CONCLUSIONS

T2-weighted TSE sequences are as suited as CSE for the detection (TE, 90 ms), and appear to be superior for the characterization (TE, 140 ms), of focal hepatic lesions. Whether a single sequence, such as a double-echo TSE or a single-echo TSE sequence with a TE between 110 and 120 ms, might perform both functions as well or better than CSE is unknown. However, because of time savings, TSE eventually may be preferred over CSE.

Men sexually abused in childhood. Sequelae and implications for the family physician

Although the majority of childhood sexual abuse victims are women, male children are also at risk for sexual assault and consequent long-term effects including major psychiatric disorders, substance abuse, sexual dysfunction, and somatization syndromes. Male patients sexually abused in childhood or adolescence may present to the primary-care physician with specific interpersonal or developmental crises or with persistent depression, anxiety, or somatic complaints. The physician can serve a therapeutic role by validating the patient's experience and can provide the patient with information on the prevalence and consequences of male sexual abuse. Assessment of the impact of sexual abuse will rely on the sensitive and systematic evaluation of critical variables related to the abuse. More severely traumatized patients will require assessment for suicide potential and referral for mental health services.

IFN-gamma, IL-4, IL-10 and IL-12 gene expression in BCG-Leishmania vaccination of Trypanosoma cruzi-infected mice

We have previously shown that vaccination of BALB/c mice with a combination of BCG plus killed Leishmania promastigotes, applied by the i.p. route 10 and 3 days before Trypanosoma cruzi inoculation, prolonged their survival and decreased their parasitaemia. In the present study we show that the BCG-Leishmania vaccine induced higher levels of circulating IFN-gamma in acute and chronic infection of mice [on day 25 and 40 post-infection (p.i.) respectively], in comparison to unvaccinated animals (PBS-treated). Though the IFN-gamma mRNA content of spleen cells of vaccinated and infected mice (on day 25 p.i.) was similar to that of unvaccinated animals, the BCG-Leishmania vaccine enhanced significantly the production of IFN-gamma by spleen cells stimulated with T. cruzi antigens. This effect was observed to a lower extent in BCG- and Leishmania-treated mice. The BCG-Leishmania vaccine reduced the expression of the IL-10 mRNA of splenocytes as soon as day 12 p.i., before the peak parasitaemia. Such this effect was not observed in BCG- or Leishmania-treated animals. On day 25 p.i., the BCG plus Leishmania- or BCG-treatment of mice abolished the capacity of spleen cells to produce IL-10 in response to T. cruzi antigens. The levels of mIL-4 RNA and protein production were not modified in any group of mice. T. cruzi infection in BCG-Leishmania-vaccined mice stimulated an early and high production of IL-12 transcripts in spleen cells during the acute phase of the infection, that was prolonged during the chronic phase of infection. This effect was weaker or absent in BCG- and Leishmania-treated animals, respectively. These results indicate that the BCG-Leishmania vaccine stimulates the production of IL-12 and IFN-gamma, but inhibits that of IL-10 and is without effect on IL-4 when mice are infected with T. cruzi. This highlights the key role of endogenously produced IFN-gamma, IL-10 and IL-12 in the control of T. cruzi acute and chronic infection in mice and the favorable modulation of their balance by a vaccination combining BCG and Leishmania.

Susceptibility and resistance to autoimmunity following neonatal injection of semi-allogeneic spleen cells in rats

A model of neonatal allotolerance was developed in rats. Brown-Norway (BN) neonates injected with semi-allogeneic (BN x Lewis) F1 hybrid spleen cells express a long-lasting chimerism and exhibit polyclonal B cell activation demonstrated by hyperimmunoglobulinemia affecting mainly IgE and IgG1, anti-laminin and anti-DNA autoantibodies as well as glomerulonephritis and anti-hapten antibodies. These abnormalities are autoregulated although the chimerism persists. In contrast, Lewis (LEW) neonates injected with semi-allogeneic (BN x LEW) F1 hybrid spleen cells exhibit a very short-lasting chimerism and transient activation of B cells, as reflected by increased allo-class II antigen expression, but do not develop an autoimmune disease. The autoimmune syndrome observed in BN rats is similar to that reported in mice during host-versus-graft reaction. Similarities between the drug-induced models of autoimmunity and allogeneic reactions in BN rats are also striking. The susceptibility of BN rats and the resistance of LEW rats to these autoimmune diseases might respectively reflect the involvement of TH2-like or of TH1-like subsets.

[Mycophenolate mofetil]

Mycophenolate Mofetil (MMF) is a new immunosuppressive agent that selectively inhibits the proliferation of T and B lymphocytes. The use of MMF in renal transplantation significantly reduced the incidence of acute rejection episodes in the first year after transplantation. The main toxicities of MMF are the occurrence of diarrhea and leucopenia. This potent immunosuppressive agent is devoid of the nephrotoxicity of cyclosporin and of the multiple adverse effects of corticosteroids. Clinical trials are currently in progress to assess whether the use of MMF will allow the discontinuation of cyclosporine or corticosteroid therapy without leading to an increased risk of rejection. If results were positive, MMF would represent a significant advance in the field of renal transplantation.

[What degree of freedom is there for living donors?]

The shortage of cadaveric donors has induced a renewed interest in living kidney donation. This paper describes the legal, religious and ethical factors which ensure or restrict the autonomy of the potential donor. We conclude that it is possible with appropriate measures to protect his freedom of choice.

[Twenty-five years of calcineurin inhibitors use in kidney transplantation at Erasme Hospital]

The results and risk factors within a cohort of 1.380 renal allografts treated with a calcineurin inhibitor from 1983 to 2008 at Erasme Hospital were analyzed. Three groups corresponding to successive periods were compared: A, from 1983 to 1992 (n = 463); B, from 1993 to 2000 (n = 470); C, from 2001 to 2008 (n = 447). Patient's survival was lower during period C than during periods A and B (89 vs 85% at 8 years, P = 0,044), due to the recipients age. In contrast, graft survival raised gradually (64, 76 and 81% at 8 years for periods A, B and C respectively, P < 0,001). Several factors significantly influence graft survival: in decreasing order, they are the recipient's age (reduced risk of rejection with age), immunosuppressive protocol (superiority of mycophenolate mofetyl and induction with antibodies directed to the IL2 receptor), HLA sensitization, number of HLA-B+Dr mismatches between recipient and donor, and gender (opposite effects of recipient's and donor's gender). The permanent evaluation of results using multivariate analyses would allow to promptly adapt selection and therapeutic strategies within each transplantation center.

[Dioxins: current knowledge about health effects]

Dioxins are a family of chlorinated aromatic hydrocarbons that are produced during combustion processes in the presence of a chlorine donor and as by-products of the chlorine-processing chemical industries. Several dioxins are extremely stable compounds and persist for years in the environment. Exposure to dioxins occurs mainly via the ingestion of contaminated food. The lipophilic character of dioxins prevents their excretion in the urine and causes their accumulation in body fat. The mechanisms of dioxin action are similar to those of a hormone. Dioxins bind to a specific intracellular receptor and the complex acts as a transcription factor that induces the production of a great number of proteins. Certain dioxins, particularly 2,3,7,8-tetrachlorodibenzo-p-dioxin, are very toxic and able to induce numerous clinical conditions. The carcinogenicity of dioxins is well documented in animal models and has been described in humans after professional and accidental exposures. Recent experimental data also indicate that dioxins can cause dysfunction of the sexual and thyroid hormone systems and that the administration of dioxins induces several conditions related to hormonal dysfunction. Chronic exposure of female Rhesus monkeys increases the incidence and severity of endometriosis. The administration of dioxins during pregnancy and nursing causes altered development of the reproductive system, decreased spermatogenesis, hypothyroidism and disturbed psychomotor development in the offspring. The particular sensibility of the fetus and newborn is of concern because the exposition to dioxins is particularly important during those periods of life. In humans a series of conditions related to hormonal dysfunction as undescended testis, decreased spermatogenesis, testicular cancer and endometriosis have increased in incidence during the last decades. The chronological parallelism with the appearance of dioxins in the environment suggests that these might exert biological effects at the prevailing level of exposure. Nevertheless this hypothesis is currently unconfirmed by epidemiological studies. The implications of this scientific incertitude for the implementation of preventive measures are briefly discussed.

Modulation of murine host-versus-graft disease by anti-CD3 monoclonal antibody

BALB/c mice made tolerant to A/J alloantigens by neonatal injection of (A/J x BALB/c)F1 spleen cells develop a host-versus-graft (HVG) disease due to the activation of donor B cells by a subset of host alloreactive helper T cells. We have investigated the effects of a single neonatal injection of the 145-2C11 anti-mouse CD3 monoclonal antibody (MoAb) on the establishment of allotolerance and on the development of the immunopathological features of HVG disease. First, this treatment did not modify the specific anti-donor cytotoxic T lymphocyte (CTL) unresponsiveness or the persistence of circulating immunoglobulins bearing donor allotype. Second, the hyper IgE, the hyper IgG1 and the increased expression of Ia antigens on B cells found in untreated HVG mice were not observed after injection of the 145-2C11 MoAb. Likewise, treated mice displayed lower levels of anti-DNA IgG antibodies and less glomerular immune deposits as compared with untreated HVG mice. We conclude that the administration of the anti-CD3 MoAb did not interfere with the induction of allotolerance but exerts a pronounced inhibitory effect on the associated immunopathological syndrome.

Critical role of interleukin 4 in the induction of neonatal transplantation tolerance

Neonatal injection of semiallogeneic cells is known to promote differentiation of donor-specific CD4+ T cells into TH2-like cells in the peripheral lymphoid organs. We reasoned that the propensity of neonatal T cells to synthesize high levels of IL-4 might be involved in this polarization of the alloreactive response and thereby in the development of neonatal transplantation tolerance. First, analysis of cytokine gene expression in lymph nodes after neonatal injection of 10(7) (A/J x BALB/c)F1 cells in BALB/c mice indicated that IL-4 but not IL-2 is rapidly produced by CD4+ cells after allogeneic challenge in vivo. To determine whether the early production of IL-4 was involved in the establishment of allotolerance, BALB/c mice neonatally injected with (A/J x BALB/c)F1 spleen cells received on days 1 and 3 after birth 1 mg of anti-IL-4 mAb (11B11) or the same amount of control mAb. When grafted with A/J skin at 4 weeks, 88% of mice treated with control mAb retained their graft for more than 50 days, whereas rejection occurred within 30 days in 93% of mice treated with anti-IL-4 mAb. Analysis of T cell functions after in vitro restimulation with A/J spleen cells indicated that early IL-4 neutralization did not prevent donor-specific CTL unresponsiveness but allowed the emergence of alloreactive T cells secreting increased levels of IL-2 and IFN-gamma. We conclude that early production of IL-4 is critical for the establishment of neonatal transplantation tolerance in this strain combination, which has disparities across the entire H-2 region.

Feasibility of an exercise program in endocrine-treated metastatic breast cancer patients with overweight: protocol for the FEMA study

BACKGROUND

Many patients with metastatic breast cancer can live relatively long lives but are challenged by treatment- and cancer-related side effects such as weight gain, physical deconditioning, and reduced quality of life, possibly affecting survival. In particular, endocrine treatments are associated with an increased risk of weight gain and adverse metabolic effects. There is a need for interventions to prevent side effects among patients with disseminated breast cancer. Exercise is found to be effective in improving quality of life, metabolic health, and body composition in the curative setting, yet evidence in the metastatic setting is sparse. The aim of this study is to assess feasibility of a 12-week exercise intervention for metastatic breast cancer patients with overweight receiving endocrine therapy and to explore potential effects on metabolic health, body composition, physical performance, obesity-related biomarkers, and patient-reported outcomes.

METHODS

The FEMA study is a randomized controlled feasibility trial in which 21 endocrine-treated patients with metastatic breast cancer and overweight will be randomly assigned in a 2:1 ratio to either a 12-week training program with three weekly training sessions (intervention), or usual care (control), which includes standard clinical follow-up and supportive care without structured exercise. Feasibility will be assessed based on recruitment rate, adherence, retention, and acceptability, employing both quantitative and qualitative approaches for data collection. Participants' experiences will be explored by interviews and analyzed based on content analysis. Data are collected from blood samples, bioelectrical impedance analysis, physical performance tests, blood pressure measurements, and validated questionnaires on health-related quality of life, self-efficacy for coping with cancer, and sleep quality for explorative analyses.

DISCUSSION

The planned study will allow us to determine whether this 12-week exercise intervention is feasible in endocrine-treated metastatic breast cancer patients with overweight and explore potential effects on metabolic health, body composition, physical performance, obesity-related biomarkers, and patient-reported outcomes. Information from feasibility outcomes will inform the design of a future definitive randomized controlled trial.

TRIAL REGISTRATION

Retrospectively registered on March 6, 2024, at ClinicalTrials.gov (NCT06343987).

Modulation of the release of cytokines and reduction of the shock syndrome induced by anti-CD3 monoclonal antibody in mice by interleukin-10

Since IL-10 was recently shown to inhibit several T cell functions in vitro, we investigated the effects of IL-10 on the cytokine release syndrome induced in mice by the 145-2C11 anti-CD3 mAb. As OKT3 in man, this mAb induces a massive polyclonal T cell activation before to induce immunosuppression. First, we found that administration of 1000 U of recombinant mouse IL-10 (mIL-10) 30 min before injection of 10 micrograms of the 145-2C11 antimouse CD3 mAb markedly reduced the systemic release of IFN-gamma and TNF. In contrast, IL-10 pretreatment did not significantly modify the release of IL-6. To determine the effect of IL-10 pretreatment on the endogenous secretion of IL-10 induced by the 145-2C11 mAb, mice were injected with human IL-10 (hIL-10) which does not cross-react in the ELISA for mIL-10 determination. While hIL-10 was as efficient as mIL-10 in reducing TNF and IFN-gamma release, it did not modify peak serum levels of IL-10. The modulation of cytokine production by mIL-10 was associated with a significant reduction of the toxicity of the 145-2C11 mAb, as assessed by the attenuation of hypothermia and by the reduced lethality in D-galactosamine-sensitize mice. We conclude that IL-10 differentially regulates the in vivo production of cytokines and decreases the systemic toxicity induced by the 145-2C11 mAb. These observations suggest potential therapeutic applications of IL-10 in organ transplantation, especially in association with anti-CD3 mAb.