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Bourdin V, Fossé Q, Lambotte O, Joly B, Coppo P, Anguel N, Labeyrie C. Alemtuzumab-induced immune-mediated thrombotic thrombocytopenic purpura: A newly described drug-related autoimmune disease. Br J Haematol 2024; 204:1459-1463. [PMID: 38112161 DOI: 10.1111/bjh.19263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/27/2023] [Accepted: 12/04/2023] [Indexed: 12/20/2023]
Abstract
Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare and life-threatening disease that may result from drug exposure. We report a case of iTTP occurring in a 39-year-old patient, 45 months following introduction of the anti-CD52 lymphoid cell depleting monoclonal antibody alemtuzumab, to treat a relapsing-remitting multiple sclerosis. Treatment consisted in plasma exchange, corticosteroids and caplacizumab, allowing clinical remission 3 months after the diagnosis, attested by the absence of thrombocytopenia and recovery of ADAMTS-13 activity. As other autoimmune disorders, iTTP may occur following alemtuzumab. This diagnosis should be suspected in patients with features of thrombotic microangiopathy following this treatment.
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Affiliation(s)
- V Bourdin
- Internal Medicine Department, Hôpital Bicêtre, APHP, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Q Fossé
- AP-HP, Intensive Care Unit, Hôpital Bicêtre, DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, Groupe de Recherche Clinique CARMAS, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - O Lambotte
- Internal Medicine Department, Hôpital Bicêtre, APHP, Université Paris Saclay, Le Kremlin-Bicêtre, France
- Université Paris Saclay, Inserm, CEA, UMR 1184 ImVA-HB, Le Kremlin Bicêtre, France
| | - B Joly
- Biologic Hematology Department, Hopital Lariboisière and EA3518, Institut de Recherche Saint-Louis, APHP.Nord, Université Paris-Cité, Paris, France
- French Reference Center for Thrombotic Microangiopathies (CNR-MAT), Saint Antoine University Hospital, APHP, Sorbonne University, Paris, France
| | - P Coppo
- French Reference Center for Thrombotic Microangiopathies (CNR-MAT), Saint Antoine University Hospital, APHP, Sorbonne University, Paris, France
- Hematology Department, Hopital Saint-Antoine, APHP, Sorbonne University, Paris, France
| | - N Anguel
- AP-HP, Intensive Care Unit, Hôpital Bicêtre, DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, Groupe de Recherche Clinique CARMAS, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - C Labeyrie
- Department of Neurology, Hopital Bicêtre, APHP, Université Paris Saclay, Le Kremlin-Bicêtre, France
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2
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Pellegrino F, Coppo P, Barisone E, Bertorello N, Spadea M, Fagioli F. A single scalp nodule as the first presentation of acute lymphoblastic leukemia ( KMT2A::MLLT3) in a healthy-appearing infant: a case report. Front Pediatr 2023; 11:1254274. [PMID: 38143534 PMCID: PMC10748424 DOI: 10.3389/fped.2023.1254274] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/21/2023] [Indexed: 12/26/2023] Open
Abstract
Background Infant leukemia is a rare form of acute leukemia diagnosed prior to the age of 1 and is characterized by an extremely poor prognosis due to its dismal response to current therapeutic approaches. It comprises about 4% of all childhood cases of acute lymphoblastic leukemia (ALL). Isolated initial cutaneous involvement in ALL is uncommon, and even more so in infant ALL. Case presentation Here, we present the case of a 2-month-old healthy-appearing infant, initially presenting with a single scalp nodule and subsequently diagnosed with an infant ALL. The leukemia was characterized by the most immature B-lineage immunophenotype [pro-B ALL/B-I, according to the European Group for the Immunological Characterization of Leukaemias (EGIL) classification] and chromosomal translocation t(9;11)(p22;q23), resulting in fusion gene KMTLA2::MLLT3, which is considered a negative prognostic factor. The patient underwent hematopoietic stem cell transplantation and is still in remission. Conclusions This case is peculiar because of the rare occurrence of isolated initial cutaneous involvement in ALL. Despite the healthy appearance of the patient, every suspicious symptom suggestive of malignancies should be further investigated to anticipate the diagnosis and start treatment early.
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Affiliation(s)
- Francesco Pellegrino
- Department of Pediatric and Public Health Sciences, Postgraduate School of Pediatrics, Regina Margherita Children Hospital, University of Turin, Turin, Italy
| | - Paola Coppo
- Pediatric Dermatology, Regina Margherita Children’s Hospital, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Elena Barisone
- Stem Cell Transplantation and Cellular Therapy Laboratory, Paediatric Onco-Haematology Division, Regina Margherita Children’s Hospital, City of Health and Science of Turin, Torino, Italy
| | - Nicoletta Bertorello
- Stem Cell Transplantation and Cellular Therapy Laboratory, Paediatric Onco-Haematology Division, Regina Margherita Children’s Hospital, City of Health and Science of Turin, Torino, Italy
| | - Manuela Spadea
- Stem Cell Transplantation and Cellular Therapy Laboratory, Paediatric Onco-Haematology Division, Regina Margherita Children’s Hospital, City of Health and Science of Turin, Torino, Italy
| | - Franca Fagioli
- Stem Cell Transplantation and Cellular Therapy Laboratory, Paediatric Onco-Haematology Division, Regina Margherita Children’s Hospital, City of Health and Science of Turin, Torino, Italy
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3
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Patruno C, Fabbrocini G, Lauletta G, Boccaletti V, Colonna C, Cavalli R, Neri I, Ortoncelli M, Schena D, Stingeni L, Hansel K, Piccolo V, Di Brizzi V, Potenza C, Tolino E, Bianchi L, Manti S, De Pasquale R, Di Lernia V, Caminiti L, Galli E, Coppo P, Chiricozzi A, De Simone C, Guerriero C, Amoruso FG, Provenzano E, Leonardi S, Licari A, Marseglia GL, Palermo A, Di Pillo S, Russo D, Moschese V, Patella V, Peduto T, Ferreli C, Zangari P, Veronese F, Berti SF, Gruber M, Pezzolo E, Termine S, Satta R, Dragoni F, Esposito M, Fargnoli MC, Chiodini P, Vallone Y, di Vico F, Picone V, Napolitano M. A 52-week multicenter retrospective real-world study on effectiveness and safety of dupilumab in children with atopic dermatitis aged from 6 to 11 years. J DERMATOL TREAT 2023; 34:2246602. [PMID: 37580895 DOI: 10.1080/09546634.2023.2246602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 07/21/2023] [Indexed: 08/16/2023]
Abstract
Background: Dupilumab has been shown to be a safe and effective drug for the treatment of atopic dermatitis (AD) in children from 6 months to 11 years in randomized clinical trials. Aim: The aim of this real-life study was to determine the effectiveness in disease control and safety of dupilumab at W52 in moderate-to-severe AD children aged 6-11 years.Methods: All data were collected from 36 Italian dermatological or paediatric referral centres. Dupilumab was administered at label dosage with an induction dose of 300 mg on day 1 (D1), followed by 300 mg on D15 and 300 mg every 4 weeks (Q4W). Treatment effect was determined as overall disease severity, using EASI, P-NRS, S-NRS and c-DLQI at baseline, W16, W24, and W52. Ninety-six AD children diagnosed with moderate-to-severe AD and treated with dupilumab were enrolled.Results: Ninety-one (94.8%) patients completed the 52-week treatment period and were included in the study. A significant improvement in EASI score, P-NRS, S-NRS and c-DLQI was observed from baseline to weeks 16, 24 and 52.Conclusions: Our real-life data seem to confirm dupilumab effectiveness and safety in paediatric patients. Moreover, our experience highlighted that patients achieving clinical improvement at W16 preserved this condition over time.
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Affiliation(s)
- Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Gabriella Fabbrocini
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Giuseppe Lauletta
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Valeria Boccaletti
- Department of Medicine, Section of Dermatology, University of Brescia, Brescia, Italy
| | - Cristiana Colonna
- Pediatric Dermatology Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Cavalli
- Pediatric Dermatology Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Iria Neri
- Unit of Dermatology, IRCCS AOU di Policlinico S Orsola, University of Bologna, Bologna, Italy
| | - Michela Ortoncelli
- Department of Medical Sciences, Division of Dermatology, University of Turin, Turin, Italy
| | - Donatella Schena
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - Luca Stingeni
- Department of Medicine and Surgery, Dermatology Section, University of Perugia, Perugia, Italy
| | - Katharina Hansel
- Department of Medicine and Surgery, Dermatology Section, University of Perugia, Perugia, Italy
| | - Vincenzo Piccolo
- Dermatology Unit, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Veronica Di Brizzi
- Dermatology Unit, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Concetta Potenza
- Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Polo Pontino, Latina, Italy
| | - Ersilia Tolino
- Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Polo Pontino, Latina, Italy
| | - Luca Bianchi
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy
| | - Sara Manti
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy
| | | | - Vito Di Lernia
- Dermatology Unit, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lucia Caminiti
- Policlinico Hospital-University of Messina, Messina, Italy
| | - Elena Galli
- UOS Immuno Allergologia dell'Età evolutiva, Ospedale San Pietro-Fatebenefratelli, Roma, Italy
| | - Paola Coppo
- Pediatric Endocrinology Unit, Regina Margherita Children's Hospital, Città Della Salute e Della Scienza di Torino, Torino, Italy
| | - Andrea Chiricozzi
- Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Clara De Simone
- Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cristina Guerriero
- Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | - Salvatore Leonardi
- Pediatric Respiratory Unit, Department of Clinical and Experimental Medicine, San Marco Hospital, University of Catania, Catania, Italy
| | - Amelia Licari
- Department of Pediatrics, Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | | | - Sabrina Di Pillo
- Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, Chieti, Italy
| | - Daniele Russo
- Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, Chieti, Italy
| | - Viviana Moschese
- Pediatric Allergology and Immunology Unit, University of Rome Tor Vergata, Policlinico Tor Vergata, Rome, Italy
| | - Vincenzo Patella
- Department of Medicine, Division of Allergy and Clinical Immunology, "Santa Maria della Speranza" Hospital, Battipaglia, SA, Italy
| | - Tiziana Peduto
- Department of Medicine, Division of Allergy and Clinical Immunology, "Santa Maria della Speranza" Hospital, Battipaglia, SA, Italy
| | - Caterina Ferreli
- Department of Medical Sciences, and Public Health, Dermatology Clinic, University of Cagliari, Cagliari, Italy
| | - Paola Zangari
- Research Unit of Clinical Immunology and Vaccinology, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Federica Veronese
- Dermatologic Clinic, AOU Maggiore della Carità Hospital, Novara, Italy
| | - Samantha Federica Berti
- Dermatology Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Michaela Gruber
- Department of Pediatrics, Central Hospital of Bolzano, Bolzano, Italy
| | - Elena Pezzolo
- Dermatology Unit, Ospedale San Bortolo, Vicenza, Italy
| | | | - Rosanna Satta
- Dipartimento Scienze Mediche, Chirurgiche e Sperimentali, Università di Sassari, Sassari, Italy
| | | | - Maria Esposito
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Maria Concetta Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Paolo Chiodini
- Dermatology Unit, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Ylenia Vallone
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Francesca di Vico
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Vincenzo Picone
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Maddalena Napolitano
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
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4
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Luca M, Piglionica M, Bagnulo R, Cardaropoli S, Carli D, Turchiano A, Coppo P, Pantaleo A, Iacoviello M, Ferrero GB, Mussa A, Resta N. The somatic p.T81dup variant in AKT3 gene underlies a mild cerebral phenotype and expands the spectrum including capillary malformation and lateralized overgrowth. Genes Chromosomes Cancer 2023; 62:703-709. [PMID: 37395289 DOI: 10.1002/gcc.23188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023] Open
Abstract
Heterozygous germline or somatic variants in AKT3 gene can cause isolated malformations of cortical development (MCDs) such as focal cortical dysplasia, megalencephaly (MEG), Hemimegalencephaly (HME), dysplastic megalencephaly, and syndromic forms like megalencephaly-polymicrogyria-polydactyly-hydrocephalus syndrome, and megalencephaly-capillary malformation syndrome. This report describes a new case of HME and capillary malformation caused by a somatic AKT3 variant that differs from the common p.E17K variant described in literature. The patient's skin biopsy from the angiomatous region revealed an heterozygous likely pathogenic variant AKT3:c.241_243dup, p.(T81dup) that may affect the binding domain and downstream pathways. Compared to previously reported cases with a common E17K mosaic variant, the phenotype is milder and patients showed segmental overgrowth, an uncommon characteristic in AKT3 variant cases. These findings suggest that the severity of the disease may be influenced not only by the level of mosaicism but also by the type of variant. This report expands the phenotypic spectrum associated with AKT3 variants and highlights the importance of genomic analysis in patients with capillary malformation and MCDs.
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Affiliation(s)
- Maria Luca
- Department of Medical Sciences, University of Torino, Torino, Italy
| | - Marilidia Piglionica
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Rosanna Bagnulo
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Simona Cardaropoli
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
| | - Diana Carli
- Department of Medical Sciences, University of Torino, Torino, Italy
| | - Antonella Turchiano
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Paola Coppo
- Pediatric Dermatology Unit, Regina Margherita Children's Hospital, Torino, Italy
| | - Antonino Pantaleo
- National Institute of Gastroenterology-IRCCS "Saverio de Bellis", Bari, Italy
| | - Matteo Iacoviello
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | | | - Alessandro Mussa
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
- Pediatric Clinical Genetics, Regina Margherita Children Hospital, Torino, Italy
| | - Nicoletta Resta
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
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5
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Reynolds G, Cardaropoli S, Carli D, Luca M, Gazzin A, Coppo P, La Selva R, Piglionica M, Bagnulo R, Turchiano A, Ranieri C, Resta N, Mussa A. Epidemiology of the disorders of the Pik3ca-related overgrowth spectrum (Pros). Eur J Hum Genet 2023; 31:1333-1336. [PMID: 37365400 PMCID: PMC10620148 DOI: 10.1038/s41431-023-01414-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/18/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023] Open
Abstract
PIK3CA pathogenic variants are responsible for a group of overgrowth syndromes, collectively known as PIK3CA-Related Overgrowth Spectrum (PROS). These gain-of-function variants arise postzygotically, and, according to time of onset, kind of embryonal tissue affected and regional body extension, give rise to heterogeneous phenotypes. PROS rarity and heterogeneity hamper the correct estimation of its epidemiology. Our work represents the first attempt to define the prevalence of PROS according to the established diagnostic criteria and molecular analysis and based on solid demographic data. We assessed the prevalence in Piedmont Region (Italy), including in the study all participants diagnosed with PROS born there from 1998 to 2021. The search identified 37 cases of PROS born across the 25-year period, providing a prevalence of 1:22,313 live births. Molecular analysis was positive in 81.0% of participants. Taking into account the cases with a detected variant in PIK3CA (n = 30), prevalence of molecularly positive PROS was 1:27,519.
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Affiliation(s)
- Giuseppe Reynolds
- Department of Public Health and Pediatric Sciences, School of Medicine, University of Torino, Torino, Italy
| | - Simona Cardaropoli
- Department of Public Health and Pediatric Sciences, School of Medicine, University of Torino, Torino, Italy
| | - Diana Carli
- Department of Medical Science, University of Torino, Torino, Italy
| | - Maria Luca
- Department of Medical Science, University of Torino, Torino, Italy
| | - Andrea Gazzin
- Department of Public Health and Pediatric Sciences, School of Medicine, University of Torino, Torino, Italy
| | - Paola Coppo
- Pediatric Dermatology, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Roberta La Selva
- Pediatric Dermatology, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Marilidia Piglionica
- Medical Genetics Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) University of Bari "Aldo Moro", 70124, Bari, Italy
| | - Rosanna Bagnulo
- Medical Genetics Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) University of Bari "Aldo Moro", 70124, Bari, Italy
| | - Antonella Turchiano
- Medical Genetics Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) University of Bari "Aldo Moro", 70124, Bari, Italy
| | | | - Nicoletta Resta
- Medical Genetics Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) University of Bari "Aldo Moro", 70124, Bari, Italy
| | - Alessandro Mussa
- Department of Public Health and Pediatric Sciences, School of Medicine, University of Torino, Torino, Italy.
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6
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Carli D, Cardaropoli S, Tessaris D, Coppo P, La Selva R, Cesario C, Lepri FR, Pullano V, Palumbo M, Ramenghi U, Brusco A, Medico E, De Sanctis L, Ferrero GB, Mussa A. Successful treatment with MEK-inhibitor in a patient with NRAS-related cutaneous skeletal hypophosphatemia syndrome. Genes Chromosomes Cancer 2022; 61:740-746. [PMID: 35999193 PMCID: PMC9826313 DOI: 10.1002/gcc.23092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/19/2022] [Accepted: 08/19/2022] [Indexed: 01/11/2023] Open
Abstract
Cutaneous skeletal hypophosphatemia syndrome (CSHS) is caused by somatic mosaic NRAS variants and characterized by melanocytic/sebaceous naevi, eye, and brain malformations, and FGF23-mediated hypophosphatemic rickets. The MEK inhibitor Trametinib, acting on the RAS/MAPK pathway, is a candidate for CSHS therapy. A 4-year-old boy with seborrheic nevus, eye choristoma, multiple hamartomas, brain malformation, pleural lymphangioma and chylothorax developed severe hypophosphatemic rickets unresponsive to phosphate supplementation. The c.182A > G;p.(Gln61Arg) somatic NRAS variant found in DNA from nevus biopsy allowed diagnosing CSHS. We administered Trametinib for 15 months investigating the transcriptional effects at different time points by whole blood RNA-seq. Treatment resulted in prompt normalization of phosphatemia and phosphaturia, catch-up growth, chylothorax regression, improvement of bone mineral density, reduction of epidermal nevus and hamartomas. Global RNA sequencing on peripheral blood mononucleate cells showed transcriptional changes under MEK inhibition consisting in a strong sustained downregulation of signatures related to RAS/MAPK, PI3 kinase, WNT and YAP/TAZ pathways, reverting previously defined transcriptomic signatures. CSHS was effectively treated with a MEK inhibitor with almost complete recovery of rickets and partial regression of the phenotype. We identified "core" genes modulated by MEK inhibition potentially serving as surrogate markers of Trametinib action.
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Affiliation(s)
- Diana Carli
- Department of Public Health and PediatricsUniversity of TorinoTorinoItaly,Pediatric Onco‐Hematology, Stem Cell Transplantation and Cell Therapy DivisionRegina Margherita Children's Hospital, Città Della Salute e Della Scienza di TorinoTorinoItaly
| | - Simona Cardaropoli
- Department of Public Health and PediatricsUniversity of TorinoTorinoItaly
| | - Daniele Tessaris
- Pediatric Endocrinology UnitRegina Margherita Children's Hospital, Città Della Salute e Della Scienza di TorinoTorinoItaly
| | - Paola Coppo
- Pediatric Endocrinology UnitRegina Margherita Children's Hospital, Città Della Salute e Della Scienza di TorinoTorinoItaly
| | - Roberta La Selva
- Pediatric Dermatology UnitRegina Margherita Children's Hospital, Città Della Salute e Della Scienza di TorinoTorinoItaly
| | - Claudia Cesario
- Translational Cytogenomics Research UnitBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Francesca Romana Lepri
- Translational Cytogenomics Research UnitBambino Gesù Children's Hospital, IRCCSRomeItaly
| | | | - Martina Palumbo
- Laboratory of OncogenomicsCandiolo Cancer Institute, FPO‐IRCCSCandioloItaly
| | - Ugo Ramenghi
- Department of Public Health and PediatricsUniversity of TorinoTorinoItaly
| | - Alfredo Brusco
- Department of Medical SciencesUniversity of TorinoTorinoItaly,Medical Genetics UnitCittà della Salute e della Scienza University HospitalTorinoItaly
| | - Enzo Medico
- Laboratory of OncogenomicsCandiolo Cancer Institute, FPO‐IRCCSCandioloItaly,Department of OncologyUniversity of TorinoTorinoItaly
| | - Luisa De Sanctis
- Department of Public Health and PediatricsUniversity of TorinoTorinoItaly,Pediatric Endocrinology UnitRegina Margherita Children's Hospital, Città Della Salute e Della Scienza di TorinoTorinoItaly
| | | | - Alessandro Mussa
- Department of Public Health and PediatricsUniversity of TorinoTorinoItaly,Pediatric Clinical Genetics UnitRegina Margherita Children HospitalTorinoItaly
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7
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Mussa A, Turchiano A, Cardaropoli S, Coppo P, Pantaleo A, Bagnulo R, Ranieri C, Iacoviello M, Garganese A, Stella A, Vallero SG, Bertin D, Santoro F, Carli D, Ferrero GB, Resta N. Lateralized overgrowth with vascular malformation caused by a somatic PTPN11 pathogenic variant: another piece added to the puzzle of mosaic RASopathies. Genes Chromosomes Cancer 2022; 61:689-695. [PMID: 35778969 PMCID: PMC9542063 DOI: 10.1002/gcc.23086] [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: 03/28/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 11/23/2022] Open
Abstract
Lateralized/segmental overgrowth disorders (LOs) encompass a heterogeneous group of congenital conditions with excessive body tissue growth. Documented molecular alterations in LOs mostly consist of somatic variants in genes of the PI3KCA/AKT/mTOR pathway or of chromosome band 11p15.5 imprinted region anomalies. In some cases, somatic pathogenic variants in genes of the RAS/MAPK pathway have been reported. We present the first case of a somatic pathogenic variant (T507K) in PTPN11 causing a LO phenotype characterized by severe lateralized overgrowth, vascular proliferation, and cerebral astrocytoma. The T507K variant was detected in DNA from overgrown tissue in a leg with capillary malformation. The astrocytoma tissue showed a higher PTPN11 variant allele frequency. A pathogenic variant in FGFR1 was also found in tumor tissue, representing a second hit on the RAS/MAPK pathway. These findings indicate that RAS/MAPK cascade overactivation can cause mosaic overgrowth phenotypes resembling PIK3CA‐related overgrowth disorders (PROS) with cancer predisposition and are consistent with the hypothesis that RAS/MAPK hyperactivation can be involved in the pathogenesis of astrocytoma. This observation raises the issue of cancer predisposition in patients with RAS/MAPK pathway gene variants and expands genotype spectrum of LOs and the treatment options for similar cases through inhibition of the RAS/MAPK oversignaling.
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Affiliation(s)
- Alessandro Mussa
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy.,Pediatric Clinical Genetics Unit, Regina Margherita Children's Hospital, Città della Salute e della Scienza, Torino, Italy
| | - Antonella Turchiano
- Department of Biomedical Sciences and Human Oncology (DIMO), Division of Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Simona Cardaropoli
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
| | - Paola Coppo
- Pediatric Dermatology, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Antonino Pantaleo
- Department of Biomedical Sciences and Human Oncology (DIMO), Division of Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Rosanna Bagnulo
- Department of Biomedical Sciences and Human Oncology (DIMO), Division of Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Carlotta Ranieri
- Department of Biomedical Sciences and Human Oncology (DIMO), Division of Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Matteo Iacoviello
- Department of Biomedical Sciences and Human Oncology (DIMO), Division of Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Antonella Garganese
- Unit of Medical Genetics, Ospedale Consorziale Policlinico di Bari, Bari, Italy
| | - Alessandro Stella
- Department of Biomedical Sciences and Human Oncology (DIMO), Division of Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Stefano Gabriele Vallero
- Pediatric Onco-Hematology, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Daniele Bertin
- Pediatric Onco-Hematology, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Federica Santoro
- Pathology Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Diana Carli
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy.,Pediatric Onco-Hematology, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Torino, Italy
| | | | - Nicoletta Resta
- Department of Biomedical Sciences and Human Oncology (DIMO), Division of Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
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8
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Stillo F, Mattassi R, Diociaiuti A, Neri I, Baraldini V, Dalmonte P, Amato B, Ametrano O, Amico G, Bianchini G, Campisi C, Cattaneo E, Causin F, Cavalli R, Colletti G, Corbeddu M, Coppo P, DE Fiores A, DI Giuseppe P, El Hachem M, Esposito F, Fulcheri E, Gandolfo C, Grussu F, Guglielmo A, Leuzzi M, Manunza F, Moneghini L, Monzani N, Nicodemi E, Occella C, Orso M, Pagella F, Paolantonio G, Pasetti F, Rollo M, Ruggiero F, Santecchia L, Spaccini L, Taurino M, Vaghi M, Vercellio G, Zama M, Zocca A, Aguglia M, Castronovo EL, DE Lorenzi E, Fontana E, Gusson E, Lanza J, Lizzio R, Mancardi MM, Rosina E. Guidelines for Vascular Anomalies by the Italian Society for the study of Vascular Anomalies (SISAV). INT ANGIOL 2022; 41:1-130. [PMID: 35546136 DOI: 10.23736/s0392-9590.22.04902-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Francesco Stillo
- SISAV Past President, Service of Vascular Anomalies Surgery, Casa di Cura Guarnieri accreditata SSN, Rome, Italy
| | - Raul Mattassi
- Service of Vascular Surgery, Casa di cura Humanitas accreditata SSN, Varese, Italy
| | - Andrea Diociaiuti
- Unit of Dermatology, Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
- Associazione Italiana Sindrome di Sturge Weber, Vicenza, Italy
| | - Iria Neri
- Department of Dermatology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Vittoria Baraldini
- Unit of Vascular Malformation Surgery, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | | | - Bruno Amato
- Service of Vascular and General Surgery, Federico II University Hospital, Naples, Italy
| | - Orsola Ametrano
- Department of Pediatric Dermatology, Santobono Hospital, Naples, Italy
| | - Giulia Amico
- Department of Medical Genetics, IRCCS "G. Gaslini" Institute, Genoa, Italy
| | - Giuseppe Bianchini
- Department of Vascular Surgery, IRCCS - Istituto Dermopatico dell'Immacolata, Rome, Italy
| | - Corradino Campisi
- Department of Vascular and General Surgery, University of Genoa, Genoa, Italy
| | - Elisa Cattaneo
- Service of Medical Genetics, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Francesco Causin
- Unit of Neuroradiology, University Hospital of Padua, Padua, Italy
| | - Riccardo Cavalli
- Unit of Pediatric Dermatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo Colletti
- Private Practitioner in Maxillofacial Surgery, Associazione Italiana Sindrome di Sturge Weber, Milan, Italy
| | | | - Paola Coppo
- Unit of Pediatric Dermatology, Regina Margherita Children's Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Antonio DE Fiores
- Service of Diagnostic Imaging Ultrasound, Casa di Cura Guarnieri Accreditata SSN, Rome, Italy
| | | | - May El Hachem
- Unit of Pediatric Dermatology, Dipartimento Pediatrico Universitario-Ospedaliero (DPUO), Associazione Italiana Sindrome di Sturge Weber, Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesco Esposito
- Unit of Emergency Radiology, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | - Ezio Fulcheri
- Unit of Pathological Anatomy and Histology, University of Genoa, Genoa, Italy
| | - Carlo Gandolfo
- Unit of Radiology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesca Grussu
- Unit of Plastic Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Alba Guglielmo
- Department of Dermatology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Miriam Leuzzi
- Department of Dermatology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Laura Moneghini
- Unit of Anatomy, Pathology and Medical Genetics, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Nicola Monzani
- Pediatric Intensive Care Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - Massimiliano Orso
- Regione Umbria, Direzione regionale Salute e Welfare, Perugia, Italy
| | - Fabio Pagella
- ENT Department, IRCCS San Matteo Polyclinic Foundation, University of Pavia, Pavia, Italy
| | | | | | | | | | | | - Luigina Spaccini
- Service of Medical Genetics, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Maurizio Taurino
- Department of Vascular Surgery, Sant'Andrea Hospital, Rome, Italy
| | | | | | - Mario Zama
- Unit of Plastic Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Alfredo Zocca
- Unit of Internal Medicine, ASST Fatebenefratelli, Milan, Italy
| | - Maria Aguglia
- Unit of Clinical Pathology, PO "Vito Fazzi", Lecce, Italy
- Associazione HHT Onlus, Rome, Italy
| | - Enza L Castronovo
- Unit of Vascular Malformation Surgery, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Elena DE Lorenzi
- Unit of Vascular Malformation Surgery, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Elena Fontana
- Associazione Italiana Sindrome di Sturge Weber, Vicenza, Italy
- AOUI (Azienda Ospedaliera Universitaria Integrata) di Verona, Verona, Italy
| | - Elena Gusson
- Associazione Italiana Sindrome di Sturge Weber, Vicenza, Italy
- Unit of Ophthalmology, Women and Children Hospital AOUI, Verona, Italy
| | - Jessica Lanza
- Unit of Vascular Malformation Surgery, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Roberta Lizzio
- ENT Department, IRCCS San Matteo Polyclinic Foundation, University of Pavia, Pavia, Italy
- Associazione HHT Onlus, Rome, Italy
| | - Maria M Mancardi
- Associazione Italiana Sindrome di Sturge Weber, Vicenza, Italy
- Unit of Child Neuropsychiatry, Department of Neurosciences, IRCCS "G. Gaslini" Institute, Genoa, Italy
| | - Erica Rosina
- Service of Medical Genetics, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
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9
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Robert M, Rouzaud D, Goulenok T, Chezel J, Coppens A, Bouadma L, De Montmollin E, Coppo P, Sacré K, Papo T, Dossier A. Maladie sérique au Rituximab dans un contexte de purpura thrombotique thrombocytopénique auto-immun. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.131] [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]
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10
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Fage N, Orvain C, Henry N, Mellaza C, Beloncle F, Tuffigo M, Genevieve F, Coppo P, Augusto J. Les scores PLASMIC et French ont des performances diminuées pour prédire le diagnostic de purpura thrombotique thrombocytopénique lorsqu’ils sont appliqués à une cohorte de microangiopathies thrombotiques non biaisé. Nephrol Ther 2021. [DOI: 10.1016/j.nephro.2021.07.261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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11
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Carli D, Kalantari S, Manicone R, Coppo P, Francia di Celle P, La Selva R, Santoro F, Ranieri C, Cardaropoli S, Fagioli F, Ferrero GB, Resta N, Mussa A. Kaposiform hemangioendothelioma further broadens the phenotype of PIK3CA-related overgrowth spectrum. Clin Genet 2021; 100:624-627. [PMID: 34402524 DOI: 10.1111/cge.14047] [Citation(s) in RCA: 7] [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] [Received: 06/14/2021] [Revised: 07/25/2021] [Accepted: 08/13/2021] [Indexed: 12/12/2022]
Abstract
Kaposiform hemangioendothelioma (KHE) is a rare locally aggressive mixed vascular tumor, with typical onset in early childhood and characterized by progressive angio- and lymphangiogenesis. Its etiopathogenesis and molecular bases are still unclear. Here, we report the first case of congenital KHE harboring a PIK3CA mosaic pathogenic variant (c.323G > A, p.Arg108His) in a boy with very subtle PIK3CA-related overgrowth spectrum (PROS) features. This finding provides insights into the pathophysiology of KHE, offering targeted therapeutic options by inhibition of the PI3K/Akt/mTOR pathway. We propose the inclusion of this mixed lymphatic and vascular anomaly within the PROS.
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Affiliation(s)
- Diana Carli
- Pediatric Clinical Genetics Unit, Department of Public Health and Pediatric Sciences, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Pediatric Onco-Hematology, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Silvia Kalantari
- Immunogenetics and Transplant Biology Service, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Rosaria Manicone
- Pediatric Onco-Hematology, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Paola Coppo
- Pediatric Dermatology, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Paola Francia di Celle
- Molecular Pathology Laboratory, Pathology Division, Città della Salute e della Scienza University Hospital, Torino, Italy
| | - Roberta La Selva
- Pediatric Dermatology, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Federica Santoro
- Department of Medical Sciences, Pathology Unit, Città della Salute e della Scienza Hospital, University of Torino, Torino, Italy
| | - Carlotta Ranieri
- Department of Biomedical Sciences and Human Oncology (DIMO), Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Simona Cardaropoli
- Pediatric Clinical Genetics Unit, Department of Public Health and Pediatric Sciences, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Franca Fagioli
- Pediatric Onco-Hematology, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Giovanni Battista Ferrero
- Pediatric Clinical Genetics Unit, Department of Public Health and Pediatric Sciences, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Nicoletta Resta
- Department of Biomedical Sciences and Human Oncology (DIMO), Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Alessandro Mussa
- Pediatric Clinical Genetics Unit, Department of Public Health and Pediatric Sciences, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
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12
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Simon D, Veyradier A, Coppo P, Joly B, Malot S, Grange S, Benhamou Y. Profil évolutif du Purpura thrombotique thrombocytopénique acquis sans auto-anticorps : expérience du Centre de Référence Français des Microangiopathies Thrombotiques. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.264] [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]
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13
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Lerolle N, Laanani M, Galicier L, Rivière S, Meynard JL, Azoulay E, Jeblaoui A, Lalande V, Mougari F, Fardet L, Coppo P, Goujard C, Molina JM, Lambotte O. Factors associated with tuberculosis-associated haemophagocytic syndrome: a multicentre case-control study. Int J Tuberc Lung Dis 2021; 24:124-130. [PMID: 32005316 DOI: 10.5588/ijtld.19.0856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: Tuberculosis (TB) is a potential trigger of haemophagocytic syndrome (HS) but little is known about the features of TB-associated HS.OBJECTIVE: To assess the risk factors associated with HS in patients with TB.DESIGN: We performed a multicentre case-control study assessing the medical records of adult patients diagnosed with proven TB with (TB/HS+) or without (TB/HS-) associated HS.RESULTS: Twenty-one patients with TB/HS+ (24% women, median age, 37 years [IQR 30-48]) were included in the study. Eleven patients (52%) were infected with human immunodeficiency virus and seven patients (33%) were immunocompromised due to other reasons. TB was disseminated in 17 patients (81%). Compared with 50 control TB patients (TB/HS-), patients with TB/HS+ were more likely to be immunocompromised (86% vs. 18%; P < 0.001) and to present with disseminated TB (80% vs. 12%; P < 0.001). The outcome was poorer in patients with TB/HS+, with a higher admission rate to intensive care (71% vs. 0%; P < 0.001) and a higher risk of death (38% vs. 7%; P = 0.005).CONCLUSION: TB/HS+ occurred more likely in immunocompromised patients and severely impaired the prognosis of TB. Further studies are needed to devise therapeutic strategies for patients with TB/HS+.
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Affiliation(s)
- N Lerolle
- Service de médecine interne et d'immunologie clinique, Hôpital Bicêtre, Assistance publique-Hôpitaux de Paris (APHP), Le Kremlin-Bicêtre
| | - M Laanani
- Unité de Biostatistiques et Epidémiologie, Hôtel Dieu, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, Centre de recherche en Epidémiologie et Santé des Populations, Institut national de la santé et de la recherche médicale (INSERM) Unité 1018, Le Kremlin-Bicêtre
| | - L Galicier
- Service d'Immunopathologie Clinique, Hôpital Saint Louis, APHP, Université Paris Diderot, Paris
| | - S Rivière
- Service de Médecine interne, Hôpital Saint Antoine, APHP, Université Paris 6, Paris
| | - J-L Meynard
- Service de Maladies infectieuses, Hôpital Saint Antoine, APHP, Université Paris 6, Paris
| | - E Azoulay
- Service de réanimation médicale, Hôpital Saint Louis, APHP, Université Paris 6, Paris
| | - A Jeblaoui
- Service de Microbiologie, Hôpital Bicêtre, APHP, Université Paris Sud, Le Kremlin-Bicêtre
| | - V Lalande
- Service de Microbiologie, Hôpital Saint Antoine, APHP, Université Paris 6, Paris
| | - F Mougari
- Service de Microbiologie, Hôpital Lariboisière, APHP, Université Paris Diderot, Paris
| | - L Fardet
- Service de Dermatologie, Hôpital Henri Mondor, APHP, Université Paris 12, Créteil
| | - P Coppo
- Service d'hématologie, Hôpital Saint Antoine, APHP, Université Paris 6, Paris
| | - C Goujard
- Service de médecine interne et d'immunologie clinique, Hôpital Bicêtre, Assistance publique-Hôpitaux de Paris (APHP), Le Kremlin-Bicêtre, Centre de recherche en Epidémiologie et Santé des Populations, Institut national de la santé et de la recherche médicale (INSERM) Unité 1018, Le Kremlin-Bicêtre, Université Paris Sud, Le Kremlin-Bicêtre
| | - J-M Molina
- Service de maladies Infectieuses, Hôpital Saint Louis, APHP, Université Paris Diderot, Paris
| | - O Lambotte
- Service de médecine interne et d'immunologie clinique, Hôpital Bicêtre, Assistance publique-Hôpitaux de Paris (APHP), Le Kremlin-Bicêtre, Université Paris Sud, Le Kremlin-Bicêtre, Immunology of Viral Infections and Autoimmune Diseases, INSERM Unité 1184, Kremlin-Bicêtre, Life Sciences Division, Infectious Disease Models and Innovative Therapies, Commissariat à l'énergie atomique et aux énergies alternatives, Institute of Emerging Diseases and Innovative Therapies, Fontenay-aux-Roses, France
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14
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Carli D, Ferrero GB, Fusillo A, Coppo P, La Selva R, Zinali F, Cardaropoli S, Ranieri C, Iacoviello M, Resta N, Mussa A. A new case of Smith-Kingsmore syndrome with somatic MTOR pathogenic variant expands the phenotypic spectrum to lateralized overgrowth. Clin Genet 2021; 99:719-723. [PMID: 33506498 DOI: 10.1111/cge.13931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/08/2021] [Accepted: 01/25/2021] [Indexed: 12/13/2022]
Abstract
Smith-Kingsmore syndrome (SKS) is a rare autosomal dominant disorder caused by heterozygous germline activating pathogenic variants in mammalian target of rapamycin (MTOR) on chromosome 1p36. A few patients with disseminated mosaicism have been described so far and they seem to display a different phenotype when compared to germline cases. Here we report the sixth case with a disseminated mosaic MTOR pathogenic variant, a 7-year-old boy with hemimegalencephaly, epilepsy, developmental delay, hypomelanosis of Ito, and lateralized overgrowth. Genetic testing revealed a pathogenic variant (c.4448G > A, p.Cys1483Tyr) in MTOR with a frequency of 32% in the DNA extracted from a skin sample, 3% in saliva and 0.46% in blood. The clinical features observed in our patient further corroborate the existence of differences in phenotypic presentation of germline and mosaic SKS cases. Moreover, lateralized overgrowth, a finding never described so far in SKS, further expands the phenotypic spectrum of SKS and allows the inclusion of MTOR pathogenic variants among the several causes of asymmetric body overgrowth.
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Affiliation(s)
- Diana Carli
- Pediatric Clinical Genetics Unit, Department of Public Health and Pediatric Sciences, University of Torino and Regina Margherita Children's Hospital, Città della Salute e della Scienza, Torino, Italy
| | | | - Anna Fusillo
- Pediatric Clinical Genetics Unit, Department of Public Health and Pediatric Sciences, University of Torino and Regina Margherita Children's Hospital, Città della Salute e della Scienza, Torino, Italy
| | - Paola Coppo
- Pediatric Dermatology, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Roberta La Selva
- Pediatric Dermatology, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Federica Zinali
- Pediatric Clinical Genetics Unit, Department of Public Health and Pediatric Sciences, University of Torino and Regina Margherita Children's Hospital, Città della Salute e della Scienza, Torino, Italy
| | - Simona Cardaropoli
- Pediatric Clinical Genetics Unit, Department of Public Health and Pediatric Sciences, University of Torino and Regina Margherita Children's Hospital, Città della Salute e della Scienza, Torino, Italy
| | - Carlotta Ranieri
- Department of Biomedical Sciences and Human Oncology (DIMO), Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Matteo Iacoviello
- Department of Biomedical Sciences and Human Oncology (DIMO), Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Nicoletta Resta
- Department of Biomedical Sciences and Human Oncology (DIMO), Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Alessandro Mussa
- Pediatric Clinical Genetics Unit, Department of Public Health and Pediatric Sciences, University of Torino and Regina Margherita Children's Hospital, Città della Salute e della Scienza, Torino, Italy
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15
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Prevel R, Roubaud-Baudron C, Tellier E, Le Besnerais M, Kaplanski G, Veyradier A, Benhamou Y, Coppo P. [Endothelial dysfunction in thrombotic thrombocytopenic purpura: therapeutic perspectives]. Rev Med Interne 2021; 42:202-209. [PMID: 33455838 DOI: 10.1016/j.revmed.2020.12.011] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 11/19/2020] [Accepted: 12/26/2020] [Indexed: 01/05/2023]
Abstract
Immune Thrombotic Thrombocytopenic Purpura (iTTP) is a rare but severe disease with a mortality rate of almost 100 % in the absence of adequate treatment. iTTP is caused by a severe deficiency in ADAMTS13 activity due to the production of inhibitory antibodies. Age has been shown to be a major prognostic factor. iTTP patients in the elderly (60yo and over) have more frequent organ involvement, especially heart and kidney failures compared with younger patients. They also have non-specific neurologic symptoms leading to a delayed diagnosis. Factors influencing this impaired survival among older patients remain unknown so far. Alteration of the functional capacity of involved organs could be part of the explanation as could be the consequences of vascular aging. In fact, severe ADAMTS13 deficiency is necessary but likely not sufficient for iTTP physiopathology. A second hit leading to endothelial activation is thought to play a central role in iTTP. Interestingly, the mechanisms involved in endothelial activation may share common features with those involved in vascular aging, potentially leading to endothelial dysfunction. It could thus be interesting to better investigate the causes of mid- and long-term mortality among older iTTP patients to confirm whether inflammation and endothelial activation really impact vascular aging and long-term mortality in those patients, in addition to their presumed role at iTTP acute phase. If so, further insights into the mechanisms involved could lead to new therapeutic targets.
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Affiliation(s)
- R Prevel
- CHU Bordeaux, Pôle de Gérontologie Clinique, 33000 Bordeaux, France; CHU Bordeaux, FHU Acronim 33000 Bordeaux, France; University Bordeaux, INSERM 1045 CRCTB 33000 Bordeaux, France
| | - C Roubaud-Baudron
- CHU Bordeaux, Pôle de Gérontologie Clinique, 33000 Bordeaux, France; University Bordeaux, INSERM UMR 1053 Bariton 33000 Bordeaux, France
| | - E Tellier
- Vascular Research Center of Marseille, Inserm, UMRS_1076, Aix-Marseille Université, Marseille, France
| | - M Le Besnerais
- Service de Médecine Interne, CHU Charles Nicolle, Rouen, France; INSERM U1096, UFR médecine pharmacie Rouen, Rouen, France
| | - G Kaplanski
- Vascular Research Center of Marseille, Inserm, UMRS_1076, Aix-Marseille Université, Marseille, France; Aix-Marseille université, 13284, Service de médecine interne, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13385 Marseille cedex 05, France; Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT, www.cnr-mat.fr), Paris, France
| | - A Veyradier
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT, www.cnr-mat.fr), Paris, France; Hématologie biologique, Hôpital Lariboisière, AP-HP, Université Paris Diderot, Paris, France
| | - Y Benhamou
- Service de Médecine Interne, CHU Charles Nicolle, Rouen, France; INSERM U1096, UFR médecine pharmacie Rouen, Rouen, France; Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT, www.cnr-mat.fr), Paris, France
| | - P Coppo
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT, www.cnr-mat.fr), Paris, France; Service d'Hématologie, Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT, www.cnr-mat.fr), AP-HP.6, Paris, France.
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Martis N, Jamme M, Malot S, Isnard-Bagnis C, Pouteil-Noble C, Presne C, Vigneau C, Grange S, Burtey S, Coindre J, Wynckel A, Hamidou M, Kanouni T, Azoulay E, Hie M, Chauveau D, Veyradier A, Rondeau E, Coppo P. Profils de syndromes hémolytique et urémique associés aux maladies systémiques auto-immunes : une analyse transversale du registre français du CNR-MAT. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.086] [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]
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Gobert D, Bouillet L, Armengol G, Coppo P, Defendi F, Du-Thanh A, Hardy G, Javaud N, Jeandel PY, Launay D, Panayotopoulos V, Pelletier F, Boccon-Gibod I, Fain O. Angiœdèmes par déficit acquis en C1-inhibiteur : recommandations du CREAK pour le diagnostic et la prise en charge. Rev Med Interne 2020; 41:838-842. [DOI: 10.1016/j.revmed.2020.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/04/2020] [Accepted: 06/20/2020] [Indexed: 11/29/2022]
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Benhamou Y, Azoulay E, Galicier L, Poullin P, Hamidou M, Deligny C, Veyradier A, Coppo P. Le traitement du purpura thrombotique thrombocytopénique auto-immun par caplacizumab prévient la survenue d’évolutions défavorables jusqu’à l’amélioration de l’activité ADAMTS13. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.089] [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]
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Benhamou Y, Sauvètre G, Grangé S, Veyradier A, Coppo P. La maladie thrombo-embolique veineuse au cours du purpura thrombotique thrombocytopénique autoimmun est associée à un traitement prolongé par échanges plasmatiques. Rev Med Interne 2020; 41:809-813. [DOI: 10.1016/j.revmed.2020.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/29/2020] [Accepted: 06/19/2020] [Indexed: 11/29/2022]
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Scully M, Rubia J, Peyvandi F, Cataland S, Coppo P, Hovinga J, Knoebl P, Pavenski K, Callewaert F, Edou J, Sousa R. OUTCOMES OF PATIENTS WITH WORSENING ACQUIRED THROMBOTIC THROMBOCYTOPENIC PURPURA (TTP) DESPITE DAILY THERAPEUTIC PLASMA EXCHANGE IN THE PHASE 3 HERCULES TRIAL. Hematol Transfus Cell Ther 2020. [DOI: 10.1016/j.htct.2020.10.161] [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] Open
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Kaynar L, Coppo P, Scully M, Rubia JDL, Peyvandi F, Cataland S, Hovinga JAK, Knoebl P, Pavenski K, Edou JMM, Callewaert F, Sousa RDP. Caplacizumab induces fast and durable platelet count responses with improved time to complete remission and recurrence-free survival in patients with acquired thrombotic thrombocytopenic purpura. Hematol Transfus Cell Ther 2020. [DOI: 10.1016/j.htct.2020.09.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Severyns T, Kirchgesner J, Lambert J, Thieblemont C, Amiot A, Abitbol V, Treton X, Cazals-Hatem D, Malamut G, Coppo P, Galicier L, Walter-Petrich A, Deau-Fischer B, Besson C, Aparicio T, Beaugerie L, Allez M, Gornet JM. Prognosis of Lymphoma in Patients With Known Inflammatory Bowel Disease: A French Multicentre Cohort Study. J Crohns Colitis 2020; 14:1222-1230. [PMID: 32161943 DOI: 10.1093/ecco-jcc/jjaa048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS The prognosis of lymphoma that occurs in patients with inflammatory bowel disease [IBD] is poorly known. METHODS A multicentre retrospective cohort analysis was done in seven French tertiary centres from 1999 to 2019. Only lymphoma occurring in patients with previous established diagnosis of IBD were analysed. The primary outcome was progression-free survival at 3 years. RESULTS A total of 52 patients [male 65%, Crohn's disease 79%, median age 48.3 years, median duration of IBD 10.1 years] were included, of whom 37 had been previously exposed to immunosuppressants and/or biologics for at least 3 months and 20 had primary intestinal lymphomas. The lymphoma histological types were: diffuse large B cell lymphomas [N = 17], Hodgkin lymphomas [N = 17], indolent B cell lymphomas [N = 12], and others including T cell lymphomas, mantle cell lymphomas, and unclassifiable B cell lymphoma [N = 6]. The median follow-up after lymphoma was 5.1 years (interquartile range [IQR] 4-7.8). Progression-free survival at 3 years was 85% in the overall population (95% confidence interval [CI] 75%-96%) with no significant difference between the exposed and unexposed group, 79% for patients exposed to immunosuppressants and/or biologics [95% CI 67%-94%], and 83% for patients diagnosed with primary intestinal lymphoma [95% CI 67%-100%]. No relapse of IBD has been observed during chemotherapy. The IBD relapse rate at the end of the last chemotherapy cycle was 23% at 3 years [95% CI 11%-39%] in the overall population. CONCLUSIONS In this large cohort, the prognosis for lymphomas occurring in IBD appears to be good and similar to what is expected, irrespective of the exposure to biologics and/or immunosuppressants.
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Affiliation(s)
- T Severyns
- Service de Gastroentérologie, Hôpital Saint Louis, Université de Paris, Paris, France
| | - J Kirchgesner
- Service de Gastroentérologie, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - J Lambert
- Service de Biostatistiques et Information Médicale, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - C Thieblemont
- Service d'Hémato-oncologie, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - A Amiot
- Service de Gastroentérologie, Hôpital Henri Mondor, UPEC, Créteil, France
| | - V Abitbol
- Service de Gastroentérologie, Hôpital Cochin, Université de Paris, Paris, France
| | - X Treton
- Service de Gastroentérologie, Hôpital Beaujon, Université de Paris, Clichy La Garenne, France
| | - D Cazals-Hatem
- Département de Pathologie, Hôpital Beaujon, Université de Paris, Clichy La Garenne. France
| | - G Malamut
- Service de Gastroentérologie, Hôpital Européen Georges Pompidou, Université de Paris, Paris, France
| | - P Coppo
- Service d'Hématologie, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - L Galicier
- Service d'Immunohématologie, Hôpital Saint Louis, Université de Paris, Paris, France
| | - A Walter-Petrich
- Service de Biostatistiques et Information Médicale, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - B Deau-Fischer
- Service d'Hématologie, Hôpital Cochin, Université de Paris, Paris, France
| | - C Besson
- Service d'Hématologie-Oncologie, Centre Hospitalier de Versailles, Université Versailles Saint Quentin en Yvelines, Université de Paris-Saclay, Le Chesnay, France
| | - T Aparicio
- Service de Gastroentérologie, Hôpital Saint Louis, Université de Paris, Paris, France
| | - L Beaugerie
- Service de Gastroentérologie, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - M Allez
- Service de Gastroentérologie, Hôpital Saint Louis, Université de Paris, Paris, France
| | - J M Gornet
- Service de Gastroentérologie, Hôpital Saint Louis, Université de Paris, Paris, France
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Denina M, Pellegrino F, Morotti F, Coppo P, Bonsignori IM, Garazzino S, Ravanini P, Avolio M, Cavallo R, Bertolotti L, Felici E, Acucella G, Montin D, Rabbone I, Licciardi F. All that glisters is not COVID: Low prevalence of seroconversion against SARS-CoV-2 in a pediatric cohort of patients with chilblain-like lesions. J Am Acad Dermatol 2020; 83:1751-1753. [PMID: 32781180 PMCID: PMC7414307 DOI: 10.1016/j.jaad.2020.08.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/30/2020] [Accepted: 08/04/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Marco Denina
- Department of Pediatrics and Public Health, University of Turin, Turin (TO), Italy
| | - Francesco Pellegrino
- Department of Pediatrics and Public Health, University of Turin, Turin (TO), Italy
| | - Francesco Morotti
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara (NO), Italy
| | - Paola Coppo
- Unit of Chirurgia Plastica Pediatrica-Dermatologia, Città della salute e della Scienza, Regina Margherita, Children's Hospital, Turin (TO), Italy
| | - Ilaria Maria Bonsignori
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara (NO), Italy
| | - Silvia Garazzino
- Department of Pediatrics and Public Health, University of Turin, Turin (TO), Italy
| | - Paolo Ravanini
- Laboratorio di Microbiologia e virologia-AOU Maggiore della Carità di Novara, Novara (NO), Italy
| | - Maria Avolio
- Department of Public Health and Pediatrics, Microbiology and Virology Unit, Città della salute e della Scienza, Molinette Hospital, University of Turin, Turin (TO), Italy
| | - Rossana Cavallo
- Department of Public Health and Pediatrics, Microbiology and Virology Unit, Città della salute e della Scienza, Molinette Hospital, University of Turin, Turin (TO), Italy
| | - Luigi Bertolotti
- Department of Veterinary Science, University of Turin, Turin (TO), Italy
| | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, Children's Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria (AL), Italy
| | | | - Davide Montin
- Department of Pediatrics and Public Health, University of Turin, Turin (TO), Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara (NO), Italy
| | - Francesco Licciardi
- Department of Pediatrics and Public Health, University of Turin, Turin (TO), Italy.
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Parodi E, Tirtei E, Bianchi M, Frigerio M, Morra I, Coppo P. Association of dystrophic epidermolysis bullosa and neuroblastoma in a newborn. Pediatr Neonatol 2020; 61:117-118. [PMID: 31806449 DOI: 10.1016/j.pedneo.2019.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 09/30/2019] [Accepted: 11/06/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Emilia Parodi
- Pediatric and Neonatology Unit, AO Ordine Mauriziano Hospital, Turin, Italy.
| | - Elisa Tirtei
- Oncology Department, Regina Margherita Children's Hospital, Citta' della Salute e della Scienza, Turin, Italy
| | - Maurizio Bianchi
- Oncology Department, Regina Margherita Children's Hospital, Citta' della Salute e della Scienza, Turin, Italy
| | - Mario Frigerio
- Pediatric and Neonatology Unit, AO Ordine Mauriziano Hospital, Turin, Italy
| | - Isabella Morra
- Pathology Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Paola Coppo
- Pediatric Department, Regina Margherita Children's Hospital, Citta' della Salute e della Scienza, Turin, Italy
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Abstract
Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare and life-threatening disease characterized by microangiopathic hemolytic anemia, thrombocytopenia and multiorgan failure, resulting from autoantibody-mediated severe A disintegrin and metalloproteinase with thrombospondin motifs 13 (ADAMTS13) deficiency. In spite of treatment with plasma exchange and immunosuppression, patients remain at risk of exacerbations, refractoriness and death. Caplacizumab (Cablivi; Ablynx, a Sanofi company), a nanobody targeting von Willebrand factor (vWF), has been recently approved in the E.U. and the U.S. as the first therapeutic specifically indicated for the treatment of adults experiencing an episode of iTTP. Caplacizumab blocks the interaction of all multimers with platelets and, therefore, has an immediate effect on platelet aggregation and the ensuing formation and accumulation of platelet-rich microthrombi. This immediate effect of caplacizumab has the potential to protect the patient from tissue ischemia and organ dysfunction while the underlying disease process resolves. We detail here the preclinical and clinical data on caplacizumab for iTTP, including the recent studies that led to approval by the U.S. Food and Drug Administration (FDA) in 2019.
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Affiliation(s)
- P Poullin
- Service d'Hémaphérèse, Hôpital de La Conception, Marseille, France; Centre de Référence des Microangiopathies Thrombotiques, Paris, France
| | - C Bornet
- Pharmacie Usage Intérieur, Hôpital de la Conception, Marseille, France
| | - A Veyradier
- Service d'Hématologie Biologique, Hôpital Lariboisière, Paris, France; Centre de Référence des Microangiopathies Thrombotiques, Paris, France
| | - P Coppo
- Service d'Hématologie, Hôpital Saint-Antoine, Paris, France; Centre de Référence des Microangiopathies Thrombotiques, Paris, France; Sorbonne Université, Paris, France.
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Coppo P, Maury E, Azoulay E, Augusto J, Dossier A, Halimi J, Barbet C, Seguin A, Hamidou M, Malot S, Veyradier A, Poullin P. PTT acquis : Premières données de vie réelle du traitement par caplacizumab de la cohorte française suivie par le centre national de référence (CNR-MAT). Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.03.053] [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]
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Cervera P, Dupeux M, Tran D, Scriva A, Gimenez de Mestral S, Fabiani B, Coppo P. MORPHOLOGICAL EVALUATION OF THE IMMUNE PROFILE IN A SERIES OF DIFFUSE LARGE B CELLS LYMPHOMA IN TISSUE MICROARRAYS: PRELIMINARY RESULTS. Hematol Oncol 2019. [DOI: 10.1002/hon.20_2631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- P. Cervera
- 75, APHP; Sorbonne University; Paris France
| | - M. Dupeux
- 75, APHP; Sorbonne University; Paris France
| | - D. Tran
- 75, APHP; Sorbonne University; Paris France
| | - A. Scriva
- 75, APHP; Sorbonne University; Paris France
| | | | - B. Fabiani
- 75, APHP; Sorbonne University; Paris France
| | - P. Coppo
- 75, APHP; Sorbonne University; Paris France
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Abstract
Plasma for direct therapeutic use is a fast-evolving blood component in terms of its production and presentation. More than a dozen forms are available worldwide, which is often overlooked since most countries apply policies making only one or very few forms available for treating patients in need. It is most often reserved for the same three clinical indications, i.e. overall clotting-factor deficiency, reversal of vitamin K antagonists in the context of active bleeding or prior to urgent surgery, and therapeutic plasma exchange. The level of evidence is often less robust than generally acknowledged for such major indications while novel indications are tending to emerge in medical and trauma settings. This short review explores classical views and new prospects opened up by novel presentations and statuses for therapeutic plasma.
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Affiliation(s)
- O Garraud
- EA3064, university of Lyon, faculty of medicine, 42023 Saint-Étienne cedex 2, France; Institut national de la transfusion sanguine, 75039 Paris cedex 15, France.
| | - C Aubron
- Medical intensive care unit, centre hospitalier et universitaire de Brest, CHRU de Brest, boulevard Tanguy-Prigent, 29609 Brest, France; Université de Bretagne Occidentale, 29009 Brest, France
| | - Y Ozier
- Medical intensive care unit, centre hospitalier et universitaire de Brest, CHRU de Brest, boulevard Tanguy-Prigent, 29609 Brest, France; Université de Bretagne Occidentale, 29009 Brest, France
| | - P Coppo
- CNR-MAT, groupe hospitalier Cochin, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75571 Paris cedex, France; Université Paris Pierre-et-Marie-Curie, 75006 Paris, France; Faculté de médecine de Sorbonne université, 91-105, boulevard de l'Hôpital, 75013 Paris, France; Inserm_U1009, Institut Gustave Roussy, rue Edouard Vaillant, 94800 Villejuif, France
| | - J-D Tissot
- Faculté de Biologie et de Médecine de Lausanne, 1011 Lausanne, Switzerland
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Dellal A, Deligny C, Boffa J, Bally S, Rondeau E, Barclay F, Hatron P, Fain O, Coppo P, Mekinian A. Microangiopathies thrombotiques associée avec une vascularite systémique : étude rétrospective française et revue de la littérature. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.03.347] [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: 11/27/2022]
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Scully M, Cataland S, Peyvandi F, Coppo P, Knoebl P, Kremer Hovinga J, Metjian A, De La Rubia J, Pavenski K, Biswas D, De Winter H, Zeldin R. Résultats de l’essai de phase III HERCULES – Essai contrôlé randomisé en double aveugle du caplacizumab dans le traitement du purpura thrombotique thrombocytopénique acquis. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.03.283] [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: 11/27/2022]
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Roose E, Schelpe AS, Joly BS, Peetermans M, Verhamme P, Voorberg J, Greinacher A, Deckmyn H, De Meyer SF, Coppo P, Veyradier A, Vanhoorelbeke K. An open conformation of ADAMTS-13 is a hallmark of acute acquired thrombotic thrombocytopenic purpura. J Thromb Haemost 2018; 16:378-388. [PMID: 29222940 DOI: 10.1111/jth.13922] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [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] [Received: 07/27/2017] [Indexed: 12/20/2022]
Abstract
Essentials Conformational changes in ADAMTS-13 are part of its mode-of-action. The murine anti-ADAMTS-13 antibody 1C4 discriminates between folded and open ADAMTS-13. ADAMTS-13 conformation is open in acute acquired thrombotic thrombocytopenic purpura (TTP). Our study forms an important basis to fully elucidate the pathophysiology of TTP. SUMMARY Background Acquired thrombotic thrombocytopenic purpura (aTTP) is an autoimmune disorder characterized by absent ADAMTS-13 activity and the presence of anti-ADAMTS-13 autoantibodies. Recently, it was shown that ADAMTS-13 adopts a folded or an open conformation. Objectives As conformational changes in self-antigens play a role in the pathophysiology of different autoimmune diseases, we hypothesized that the conformation of ADAMTS-13 changes during acute aTTP. Methods Antibodies recognizing cryptic epitopes in the spacer domain were generated. Next, the conformation of ADAMTS-13 in 40 healthy donors (HDs), 99 aTTP patients (63 in the acute phase versus 36 in remission), 12 hemolytic-uremic syndrome (HUS) patients and 63 sepsis patients was determined with ELISA. Results The antibody 1C4 recognizes a cryptic epitope in ADAMTS-13. Therefore, we were able to discriminate between a folded and an open ADAMTS-13 conformation. We showed that ADAMTS-13 in HDs does not bind to 1C4, indicating that ADAMTS-13 circulates in a folded conformation. Similar results were obtained for HUS and sepsis patients. In contrast, ADAMTS-13 of acute aTTP patients bound to 1C4 in 92% of the cases, whereas, in most cases, this binding was abolished during remission, showing that the conformation of ADAMTS-13 is open during an acute aTTP episode. Conclusions Our study shows that, besides absent ADAMTS-13 activity and the presence of anti-ADAMTS-13 autoantibodies, an open ADAMTS-13 conformation is also a hallmark of acute aTTP. Demonstrating this altered ADAMTS-13 conformation in acute aTTP will help to further unravel the pathophysiology of aTTP and lead to improved therapy and diagnosis.
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Affiliation(s)
- E Roose
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - A S Schelpe
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - B S Joly
- Service d'Hématologie biologique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris and EA3518, Institut Universitaire d'Hématologie, Hôpital Saint Louis, Université Paris Diderot, Paris, France
| | - M Peetermans
- Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - P Verhamme
- Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - J Voorberg
- Department of Plasma Proteins, Sanquin-Academic Medical Center Landsteiner Laboratory, Amsterdam, the Netherlands
| | - A Greinacher
- Institute for Immunology and Transfusion Medicine, University Medical Center, Greifswald, Germany
| | - H Deckmyn
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - S F De Meyer
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - P Coppo
- Département d'hématologie clinique, Hôpital Saint Antoine, AP-HP and Université Pierre et Marie Curie, Paris, France
| | - A Veyradier
- Service d'Hématologie biologique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris and EA3518, Institut Universitaire d'Hématologie, Hôpital Saint Louis, Université Paris Diderot, Paris, France
| | - K Vanhoorelbeke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
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Bergallo M, Accorinti M, Galliano I, Coppo P, Montanari P, Quaglino P, Savino F. Expression of miRNA 155, FOXP3 and ROR gamma, in children with moderate and severe atopic dermatitis. GIORN ITAL DERMAT V 2017; 155:168-172. [PMID: 29249119 DOI: 10.23736/s0392-0488.17.05707-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Atopic dermatitis is a disease characterized by a chronic inflammatory process in the skin, but its link to miRNA 155 is less known. The aim of the study was to evaluate the expression of microRNA155, and T helper type 17 cells and Treg cells in children with atopic dermatitis. METHODS The study population consisted of: children seen for atopic dermatitis at the outpatient ambulatory of Dermatology at the Children Hospital Regina Margherita, Torino, Italy (N.=23); healthy control subjects (N.=23). Blood samples were taken during routine control analysis and the expression of miRNA 155 and the production of FOXP3 and RORγ was determined using PCR real time. RESULTS The analysis of miR-155 shows that the over-expression of miR-155 is statistically significant (P=0.0040) in the group of patients with atopic dermatitis compared to the healthy control group. Analysis of mRNAs of FOXP3 and RORγ shows a FOXP3 mRNA expression statistically higher in the group of patients (P=0.0057). The Th17 / Treg ratio is significantly smaller in patients with atopic dermatitis (P=0.0012). Also the ratio miR-155/Th17/Treg is larger in the group of patients with atopic dermatitis (P=0.0002). CONCLUSIONS Our results suggest that increased miR-155 and FOXP3 and RORγ responses may provide a link to immune dysregulation associated with atopic dermatitis. Although a point-by-point correlation between miR-155 and the ratio Th17/Treg is not demonstrated, our findings shows that these two elements do not appear to be completely unrelated to each other.
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Affiliation(s)
- Massimiliano Bergallo
- Department of Pediatrics, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy.,Dipartimento delle Scienze di Sanità Pubblica e Pediatriche, School of Medicine, University of Turin, Turin, Italy
| | - Martina Accorinti
- Department of Pediatrics, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Ilaria Galliano
- Department of Pediatrics, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy.,Dipartimento delle Scienze di Sanità Pubblica e Pediatriche, School of Medicine, University of Turin, Turin, Italy
| | - Paola Coppo
- Department of Pediatrics, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Paola Montanari
- Department of Pediatrics, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy.,Dipartimento delle Scienze di Sanità Pubblica e Pediatriche, School of Medicine, University of Turin, Turin, Italy
| | - Pietro Quaglino
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Francesco Savino
- Department of Pediatrics, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy -
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Rafat C, Coppo P, Fakhouri F, Frémeaux-Bacchi V, Loirat C, Zuber J, Rondeau E. Syndromes hémolytiques et urémiques (SHU) et syndromes de microangiopathie thrombotique apparentés : traitement et pronostic. Rev Med Interne 2017; 38:833-839. [DOI: 10.1016/j.revmed.2017.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/26/2017] [Accepted: 07/24/2017] [Indexed: 10/18/2022]
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Tersteeg C, Joly BS, Gils A, Lijnen R, Deckmyn H, Declerck PJ, Plaimauer B, Coppo P, Veyradier A, Maas C, De Meyer SF, Vanhoorelbeke K. Amplified endogenous plasmin activity resolves acute thrombotic thrombocytopenic purpura in mice. J Thromb Haemost 2017; 15:2432-2442. [PMID: 28981198 DOI: 10.1111/jth.13859] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Indexed: 11/28/2022]
Abstract
Essentials Plasmin is able to proteolyse von Willebrand factor. It was unclear if plasmin influences acute thrombotic thrombocytopenic purpura (TTP). Plasmin levels are increased during acute TTP though suppressed via plasmin(ogen) inhibitors. Allowing amplified endogenous plasmin activity in mice results in resolution of TTP signs. SUMMARY Background Thrombotic thrombocytopenic purpura (TTP) is an acute life-threatening pathology, caused by occlusive von Willebrand factor (VWF)-rich microthrombi that accumulate in the absence of ADAMTS-13. We previously demonstrated that plasmin can cleave VWF and that plasmin is generated in patients during acute TTP. However, the exact role of plasmin in TTP remains unclear. Objectives Investigate if endogenous plasmin-mediated proteolysis of VWF can influence acute TTP episodes. Results In mice with an acquired ADAMTS-13 deficiency, plasmin is generated during TTP as reflected by increased plasmin-α2-antiplasmin (PAP)-complex levels. However, mice still developed TTP, suggesting that this increase is not sufficient to control the pathology. As mice with TTP also had increased plasminogen activator inhibitor 1 (PAI-1) levels, we investigated whether blocking the plasmin(ogen) inhibitors would result in the generation of sufficient plasmin to influence TTP outcome in mice. Interestingly, when amplified plasmin activity was allowed (α2-antiplasmin-/- mice with inhibited PAI-1) in mice with an acquired ADAMTS-13 deficiency, a resolution of TTP signs was observed as a result of an increased proteolysis of VWF. In line with this, in patients with acute TTP, increased PAP-complex and PAI-1 levels were also observed. However, neither PAP-complex levels nor PAI-1 levels were related to TTP signs and outcome. Conclusions In conclusion, endogenous plasmin levels are increased during acute TTP, although limited via suppression through α2-antiplasmin and PAI-1. Only when amplified plasmin activity is allowed, plasmin can function as a back-up for ADAMTS-13 in mice and resolve TTP signs as a result of an increased proteolysis of VWF.
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Affiliation(s)
- C Tersteeg
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - B S Joly
- Hematology Laboratory, French Reference Center for Thrombotic Microangiopathies, Hôpital Lariboisière and EA3518 IUH Saint Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Paris, France
| | - A Gils
- Laboratory for Therapeutic and Diagnostic Antibodies, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - R Lijnen
- Center for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium
| | - H Deckmyn
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - P J Declerck
- Laboratory for Therapeutic and Diagnostic Antibodies, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | | | - P Coppo
- Department of Hematology, Hôpital Saint-Antoine, French Reference Center for Thrombotic Microangiopathies, AP-HP, Paris, France
| | - A Veyradier
- Hematology Laboratory, French Reference Center for Thrombotic Microangiopathies, Hôpital Lariboisière and EA3518 IUH Saint Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Paris, France
| | - C Maas
- Laboratory of Clinical Chemistry and Hematology, UMC Utrecht, Utrecht, the Netherlands
| | - S F De Meyer
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - K Vanhoorelbeke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
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Prével R, Roubaud-Baudron C, Jamme M, Benhamou Y, Galicier L, Poullin P, Hamidou M, Deligny C, Hie M, Veyradier A, Coppo P. Particularités gériatriques du purpura thrombotique thrombocytopénique acquis. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Tellier E, Widemann A, Brun M, Sanderson F, Poullin P, Coppo P, Dignat-George F, Kaplanski G. Facteurs impliqués dans l’activation endothéliale au cours du purpura thrombotique thrombocytopénique. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Guignier C, Benamara A, Oriol P, Coppo P, Mariat C, Garraud O. Amotosalen-inactivated plasma is as equally well tolerated as quarantine plasma in patients undergoing large volume therapeutic plasma exchange. Transfus Clin Biol 2017; 25:73-77. [PMID: 29102655 DOI: 10.1016/j.tracli.2017.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 12/21/2022]
Abstract
A retrospective - single center - survey compared tolerance of individual donor therapeutic plasma in a series of 88 patients principally presenting with thrombotic microangiopathy; all patients underwent therapeutic plasma exchange (TPE) performed with more than 90% of either of two types of plasma preparations. One plasma type used in TPE was prepared with pathogen reduction by amotosalen addition and UVA illumination, and the other one was non-manipulated (quarantine plasma). Both types of plasma were single donor. Occurrences of adverse reactions were equally low in either arm (amotosalen: 9 in 4689 bags of ∼200mL [0.019] versus quarantine: 2 in 828 bags [0.024]), confirming the safe use of amotosalen inactivated therapeutic plasma for TPE.
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Affiliation(s)
- C Guignier
- Department of Family Practice, Faculty of Medicine of Saint-Étienne, 42023 Saint-Étienne, France
| | - A Benamara
- Établissement français du sang Rhône-Alpes-Auvergne, 42023 Saint-Étienne, France
| | - P Oriol
- Hemovigilance Unit, University Hospital of Saint-Étienne, 42055 Saint-Étienne, France
| | - P Coppo
- National Registry of Microangiopathies, Department of Hematology, Saint-Antoine Hospital, 75011 Paris, France; Faculty of Medicine, University Paris-Pierre-et-Marie-Curie, 75012 Paris, France
| | - C Mariat
- Department of Nephrology, University Hospital of Saint-Étienne, 42055 Saint-Étienne, France; EA3064, Faculty of Medicine of Saint-Étienne, University of Lyon, 42023 Saint-Étienne, France
| | - O Garraud
- EA3064, Faculty of Medicine of Saint-Étienne, University of Lyon, 42023 Saint-Étienne, France; Institut national de la transfusion sanguine, 6, rue Alexandre-Cabanel, 75015 Paris, France.
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Abstract
Thrombotic microangiopathies (TMA) are termed secondary when associated to a specific context favouring their occurrence. They encompass mainly TMA associated with pregnancy, allogeneic hematopoietic stem cell transplantation, cancer, drugs, or HIV infection. Secondary TMA represent a heterogeneous group of diseases which clinical presentation largely depends on the associated context. It is therefore mandatory to recognize these conditions since they have a significant impact in TMA management and prognosis. A successful management still represents a challenge in secondary TMA. Significant progresses have been made in the understanding of pregnancy-associated TMA, allowing an improvement of prognosis; on the opposite, other forms of secondary TMA such as hematopoietic stem cell transplantation-associated TMA or TMA associated with chemotherapy remain of dismal prognosis. A better understanding of pathophysiology in these forms of TMA, in association with a more empirical approach through the use of new therapeutic agents that can also help in the understanding on new mechanisms a posteriori, should improve their prognosis. The preliminary encouraging results reported with complement blockers in this field could represent a convincing example.
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Affiliation(s)
- P Coppo
- Service d'hématologie, centre de référence des microangiopathies thrombotiques, hôpital Saint-Antoine, UPMC université Paris 6, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
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- Service d'hématologie, centre de référence des microangiopathies thrombotiques, hôpital Saint-Antoine, UPMC université Paris 6, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
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Rafat C, Coppo P, Fakhouri F, Frémeaux-Bacchi V, Loirat C, Zuber J, Rondeau E. [Hemolytic and uremic syndrome and related thrombotic microangiopathies: Epidemiology, pathophysiology and clinics]. Rev Med Interne 2017; 38:817-824. [PMID: 28711159 DOI: 10.1016/j.revmed.2017.06.004] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 06/01/2017] [Indexed: 01/25/2023]
Abstract
Thrombotic microangiopathies (TMA) represent an eclectic group of conditions, which share hemolytic anemia and thrombocytopenia as a common defining basis. Remarkable breakthroughs in the physiopathological setting have allowed for a thorough recomposition of the disparate syndromes, which form the constellation of TMA. In this view, clinicians now discriminate thrombocytopenic thrombotic purpura (TTP) defined by a severe deficiency in ADAMTS13, which is rarely associated with a severe renal involvement and the hemolytic and uremic syndrome (HUS) in which renal impairment is the most prominent clinical feature. HUS can result from toxins stemming from bacterial infections of the digestive tract, alternate complement pathway abnormalities, metabolic or coagulation disorders or, lastly, drug and various toxic compounds. The diverse forms of HUS reflect the insights gained in the understanding of the pathophysiological mechanisms underpinning TMA. In this first part, a broad overview of the epidemiological, physiopathological and clinical aspects of HUS and related TMA syndromes is presented.
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Affiliation(s)
- C Rafat
- Urgences néphrologiques et transplantation rénale, hôpital Tenon, Assistance publique des Hôpitaux de Paris, Paris, France; Centre national de référence des microangiopathies thrombotiques (CNR-MAT), AP-HP, Paris, France.
| | - P Coppo
- Centre national de référence des microangiopathies thrombotiques (CNR-MAT), AP-HP, Paris, France; Service d'hématologie, hôpital Saint-Antoine, Assistance publique des Hôpitaux de Paris, Paris, France; Unité Inserm UMR 1170, Villejuif, France
| | - F Fakhouri
- Centre national de référence des microangiopathies thrombotiques (CNR-MAT), AP-HP, Paris, France; Service de néphrologie et d'immunologie, unité Inserm UMR 643, centre hospitalo-universitaire de Nantes, Nantes, France
| | - V Frémeaux-Bacchi
- Centre national de référence des microangiopathies thrombotiques (CNR-MAT), AP-HP, Paris, France; Laboratoire d'immunologie, hôpital européen Georges-Pompidou, Assistance publique des Hôpitaux de Paris, Paris, France
| | - C Loirat
- Centre national de référence des microangiopathies thrombotiques (CNR-MAT), AP-HP, Paris, France; Service de néphrologie pédiatrique, hôpital Robert-Debré, Assistance publique des Hôpitaux de Paris, Paris, France
| | - J Zuber
- Centre national de référence des microangiopathies thrombotiques (CNR-MAT), AP-HP, Paris, France; Service de transplantation rénale, unité Inserm UMR_S1163, institut imagine, hôpital Necker, Assistance publique des Hôpitaux de Paris, Paris, France
| | - E Rondeau
- Centre national de référence des microangiopathies thrombotiques (CNR-MAT), AP-HP, Paris, France; Urgences néphrologiques et transplantation rénale, unité Inserm UMR 1155, hôpital Tenon, Assistance publique des Hôpitaux de Paris, Paris, France
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Abstract
Daily therapeutic plasma exchange (TPE) transformed the historically fatal prognosis of acquired, anti-ADAMTS13 antibody-mediated thrombotic thrombocytopenic purpura (TTP), leading to the current overall survival rates of >80%. However, relapses occur in up to 40% of patients and refractory disease with fatal outcomes still occurs, typically within the first days of management. In this context, the introduction of rituximab has been the second major breakthrough in TTP management. Rituximab is now routinely recommended during the acute phase, typically in patients with a suboptimal response to treatment, and increasingly as frontline therapy, with high response rates in the following weeks. In more severe patients, salvage strategies typically include twice daily TPE, pulses of cyclophosphamide, as well as splenectomy in the more desperate cases. In this life-threatening and debilitating disease, relapses can be efficiently prevented in patients with a severe acquired ADAMTS13 deficiency and otherwise in remission with the use of rituximab. In the coming years, the TTP therapeutic landscape should be enriched by original strategies stemming from clinical experience and new agents that are currently being evaluated in large, international, clinical trials. Promising agents under evaluation include caplacizumab (an inhibitor of the glycoprotein-Ib/IX-Von-Willebrand factor axis), N-acetylcysteine, recombinant ADAMTS13, and anti-plasmocyte compounds.
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Affiliation(s)
- P Coppo
- Service d'hématologie, hôpital Saint-Antoine, université Pierre-et-Marie-Curie, centre de référence des microangiopathies thrombotiques, AP - HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France; Service d'hématologie, hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France; Inserm U1170, institut Gustave-Roussy, Villejuif, France; Université Sorbonne-Paris-Pierre-et-Marie-Curie (Univ Paris 6), Paris, France.
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Grignano E, Mekinian A, Jachiet V, Coppo P, Fain O. Manifestations auto-immunes et inflammatoires des hémopathies lymphoïdes. Rev Med Interne 2017; 38:374-382. [DOI: 10.1016/j.revmed.2016.10.396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 10/03/2016] [Accepted: 10/27/2016] [Indexed: 10/20/2022]
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Laurent C, Gravelle P, Péricart S, Fabiani B, Coppo P, Brousset P, Tosolini M, Fournié J. EBV infection promotes tumor infiltrating leucocyte and immune escape in plasmablastic lymphoma according to gene expression profiling. Hematol Oncol 2017. [DOI: 10.1002/hon.2439_28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- C. Laurent
- Pathology; IUCT Oncopole CHU Toulouse; Toulouse France
| | - P. Gravelle
- Pathology; IUCT Oncopole CHU Toulouse; Toulouse France
| | - S. Péricart
- Pathology; IUCT Oncopole CHU Toulouse; Toulouse France
| | - B. Fabiani
- Département de Pathologie; Hopital Saint Antoine APHP; Paris France
| | - P. Coppo
- Hematology; Hopital Saint Antoine APHP; Paris France
| | - P. Brousset
- Pathology; IUCT Oncopole CHU Toulouse; Toulouse France
| | - M. Tosolini
- INSERM U1037; Centre de Recherche en Cancérologie de Toulouse-Purpan; Toulouse France
| | - J. Fournié
- INSERM U1037; Centre de Recherche en Cancérologie de Toulouse-Purpan; Toulouse France
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Couture P, Hie M, Pineton De Chambrun M, Galicier L, Boffa J, Mathian A, Kanouni T, Bige N, Cohen Aubart F, Deroux A, Coppo P, Amoura Z. Caractéristiques cliniques, pronostiques et traitement des syndromes de microangiopathie thrombotique au cours du lupus : une étude descriptive multicentrique. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.03.115] [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]
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Tchernonog E, Faurie P, Coppo P, Monjanel H, Bonnet A, Algarte Génin M, Mercier M, Dupuis J, Bijou F, Herbaux C, Delmer A, Fabiani B, Besson C, Le Gouill S, Gyan E, Laurent C, Ghesquieres H, Cartron G. Clinical characteristics and prognostic factors of plasmablastic lymphoma patients: analysis of 135 patients from the LYSA group. Ann Oncol 2017; 28:843-848. [PMID: 28031174 DOI: 10.1093/annonc/mdw684] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [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: 07/15/2016] [Indexed: 11/14/2022] Open
Abstract
Background Plasmablastic lymphoma (PBL), initially described in 1997 in the oral cavity of HIV positive patients, is now recognized as a distinct aggressive and rare entity of diffuse large B-cells lymphoma by the World Health Organization (WHO) classification. Since the original description, others cases have been reported. However, these are largely derived from case reports or small series limiting any definitive conclusions on clinical characteristics and outcome. Patients and methods The clinical, biological, pathological features and outcome of a cohort including 135 patients with PBL, from LYSA centers in France and Belgium, were reported and analyzed. Results The median age was 58 years, with a male predominance. The cohort was divided into 56 HIV-positive patients, 17 post-transplant patients and 62 HIV-negative/non-transplanted patients. Within HIV-negative/non-transplanted, a relative immunosuppression was found in most cases (systemic inflammatory disease, history of cancer, increased age associated with weakened immune system). We have also described a new subtype, PBL arising in a chronic localized inflammatory site, without any sign of immunosuppression. At presentation, 19% of patients showed oral involvement. Immunophenotype showed CD138 positivity in 88% of cases and CD20 negativity in 90% of cases. Chemotherapy was administered to 80% of patients, with a complete response (CR) rate of 55%. The median overall survival (OS) was 32 months. In univariate analysis, HIV positive status showed better OS when compared with HIV negative status. In multivariate analysis, International Prognostic Index score, chemotherapy and CR were associated with survival benefit. Conclusion(s) This cohort, the largest reported to date, increases the spectrum of knowledge on PBL, rarely described. However, specific guidelines to clarify treatment are lacking, and may improve the poor prognosis of this rare disease.
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Affiliation(s)
- E Tchernonog
- Department of Hematology, University Hospital of Montpellier, Montpellier, France
| | - P Faurie
- Department of Hematology, Léon Bérard Center, Lyon, France
| | - P Coppo
- Department of Hematology, Saint Antoine University Hospital, Paris, France
| | - H Monjanel
- Department of Hematology, University Hospital of Tours, Tours, France
| | - A Bonnet
- Department of Hematology, University Hospital of Nantes, Nantes, France
| | - M Algarte Génin
- Institute Pierre Louis of Epidemiology and Public Health, Paris, France
| | - M Mercier
- Department of Hematology, University Hospital of Angers, Angers, France
| | - J Dupuis
- Lymphoid Malignancies Unit University Hospital Henri Mondor, Créteil, France
| | - F Bijou
- Institute Bergonie, Bordeaux, France
| | - C Herbaux
- Department of Hematology, University Hospital of Lille, Lille, France
| | - A Delmer
- Department of Hematology, University Hospital of Reims, Reims, France
| | - B Fabiani
- Department of Biopathology, University Hospital Saint Antoine, Paris, France
| | - C Besson
- Department of Hematology, University Hospital Kremlin Bicêtre, Paris, France
| | - S Le Gouill
- Department of Hematology, University Hospital of Nantes, Nantes, France
| | - E Gyan
- Department of Hematology, University Hospital of Tours, Tours, France
| | - C Laurent
- Department of Biopathology, University Hospital of Toulouse, Toulouse, France
| | - H Ghesquieres
- Department of Hematology, University Hospital of Lyon Sud, Lyon, France, France
| | - G Cartron
- Department of Hematology, University Hospital of Montpellier, Montpellier, France
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Baroero L, Coppo P, Bertolino L, Maccario S, Savino F. Three case reports of post immunization and post viral Bullous Pemphigoid: looking for the right trigger. BMC Pediatr 2017; 17:60. [PMID: 28228112 PMCID: PMC5322655 DOI: 10.1186/s12887-017-0813-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 02/16/2017] [Indexed: 11/17/2022] Open
Abstract
Background Bullous pemphigoid (BP) is a blistering skin disorder infrequent in infancy and rarely reported in medical literature. Case Presentation Here we describe three cases of BP which were referred to our department in the last 15 years. Two of them developed an eruption of bullous lesions just a few days after vaccination for diphtheria, tetanus, pertussis, poliomyelitis, hepatitis B and Haemophilus influenzae B. The third patient developed the same blistering lesions shortly after herpetic stomatitis. In all three cases, clinical diagnosis was confirmed by histological examination which showed subepidermal bullae with a dermal inflammatory infiltrate, and direct immunofluorescence of perilesional skin showed linear IgG and C3 deposits along the basement membrane zone. Immunoblot assay was positive for BP antigen 180. Treatment with oral prednisone was instituted and the lesions resolved in two out of three patients; the third one was treated with an immunosuppressive agent (tacrolimus) and corticosteroid and subsequently with intravenous immunoglobulin and plasmapheresis, due to an underlying complex autoimmune disease. Conclusion Although the mechanism of induction of BP is still unclear, the close relationship between trigger events (immunization or viral infection) and onset of the disease arises a possible association.
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Affiliation(s)
- Luca Baroero
- Dipartimento di Pediatria 1, Ospedale Infantile Regina Margherita, Regina Margherita Children's Hospital, Citta' della Salute e della Scienza di Torino, Piazza Polonia 94, 10126, Turin, Italy
| | - Paola Coppo
- Dipartimento di Pediatria 1, Ospedale Infantile Regina Margherita, Regina Margherita Children's Hospital, Citta' della Salute e della Scienza di Torino, Piazza Polonia 94, 10126, Turin, Italy
| | - Laura Bertolino
- Dipartimento di scienze mediche, Università degli studi di Torino, Torino, Italy
| | - Stefano Maccario
- Pediatric Department, Chelsea and Westminster Hospital, London, UK
| | - Francesco Savino
- Dipartimento di Pediatria 1, Ospedale Infantile Regina Margherita, Regina Margherita Children's Hospital, Citta' della Salute e della Scienza di Torino, Piazza Polonia 94, 10126, Turin, Italy.
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Scully M, Cataland S, Coppo P, de la Rubia J, Friedman KD, Kremer Hovinga J, Lämmle B, Matsumoto M, Pavenski K, Sadler E, Sarode R, Wu H. Consensus on the standardization of terminology in thrombotic thrombocytopenic purpura and related thrombotic microangiopathies. J Thromb Haemost 2017; 15:312-322. [PMID: 27868334 DOI: 10.1111/jth.13571] [Citation(s) in RCA: 294] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Indexed: 12/11/2022]
Abstract
Essentials An international collaboration provides a consensus for clinical definitions. This concerns thrombotic microangiopathies and thrombotic thrombocytopenic purpura (TTP). The consensus defines diagnosis, disease monitoring and response to treatment. Requirements for ADAMTS-13 are given. SUMMARY Background Thrombotic thrombocytopenic purpura (TTP) and hemolytic-uremic syndrome (HUS) are two important acute conditions to diagnose. Thrombotic microangiopathy (TMA) is a broad pathophysiologic process that leads to microangiopathic hemolytic anemia and thrombocytopenia, and involves capillary and small-vessel platelet aggregates. The most common cause is disseminated intravascular coagulation, which may be differentiated by abnormal coagulation. Clinically, a number of conditions present with microangiopathic hemolytic anemia and thrombocytopenia, including cancer, infection, transplantation, drug use, autoimmune disease, and pre-eclampsia and hemolysis, elevated liver enzymes and low platelet count syndrome in pregnancy. Despite overlapping clinical presentations, TTP and HUS have distinct pathophysiologies and treatment pathways. Objectives To present a consensus document from an International Working Group on TTP and associated thrombotic microangiopathies (TMAs). Methods The International Working Group has proposed definitions and terminology based on published information and consensus-based recommendations. Conclusion The consensus aims to aid clinical decisions, but also future studies and trials, utilizing standardized definitions. It presents a classification of the causes of TMA, and criteria for clinical response, remission and relapse of congenital and immune-mediated TTP.
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Affiliation(s)
- M Scully
- Department of Haematology, UCLH, Cardiometabolic programme-NIHR UCLH/UCL BRC, London, UK
| | - S Cataland
- Department of Internal Medicine, Ohio State University Hospital, Columbus, OH, USA
| | - P Coppo
- Department of Hematology, Saint-Antoine University Hospital, Paris, France
| | - J de la Rubia
- Department of Hematology, University Hospital Dr Peset, Valencia, Spain
| | - K D Friedman
- Division of Benign Hematology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - J Kremer Hovinga
- Department of Hematology, Bern University Hospital, Bern, Switzerland
| | - B Lämmle
- Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany
| | - M Matsumoto
- Department of Blood Transfusion Medicine, Nara Medical University, Nara, Japan
| | - K Pavenski
- Department of Laboratory medicine, St Michael's Hospital/Research Institute, Toronto, Ontario, Canada
| | - E Sadler
- Department of Hematology, Washington University School of Medicine, St Louis, MO, USA
| | - R Sarode
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA
| | - H Wu
- Department of Pathology, Ohio State University Hospital, Columbus, OH, USA
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Grall M, Prôvot F, Coindre J, Pouteil-Noble C, Guerrot D, Benhamou Y, Veyradier A, Coppo P, Grange S. Efficacité de l’éculizumab dans les microangiopathies thrombotiques induites par la gemcitabine. Expérience du Centre de référence français des microangiopathies thrombotiques. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Crickx E, Goulabchand R, Fieschi C, Galicier L, Coppo P, Delarue R, Moulis G, Michel M, Haioun C, Godeau B, Gaulard P, Mahevas M. Caractéristiques cliniques, évolution et prise en charge des cytopénies auto-immunes associées aux lymphomes T de type LAI : une étude multicentrique rétrospective comparative. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.015] [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: 11/17/2022]
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Jachiet V, Mekinian A, Carrat F, Grignano E, Retbi A, Coppo P, Fain O. Manifestations auto-immunes et inflammatoires associées aux lymphomes : caractéristiques et pronostic d’une série rétrospective de 108 patients. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.103] [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: 10/20/2022]
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Gilardin L, Delignat S, Maillère B, Peyron I, Ing M, Veyradier A, Latouche J, Kaveri S, Coppo P, Lacroix-Desmazes S. Épitopes T d’ADAMTS13 chez les patients atteints de purpura thrombotique thrombocytopénique. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.030] [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]
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