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Cosson C, Riou R, Patoli D, Niu T, Rey A, Groslambert M, De Rosny C, Chatre E, Allatif O, Henry T, Venet F, Milhavet F, Boursier G, Belot A, Jamilloux Y, Merlin E, Duquesne A, Grateau G, Savey L, Jacques Maria AT, Pagnier A, Poutrel S, Lambotte O, Mallebranche C, Ardois S, Richer O, Lemelle I, Rieux-Laucat F, Bader-Meunier B, Amoura Z, Melki I, Cuisset L, Touitou I, Geyer M, Georgin-Lavialle S, Py BF. Functional diversity of NLRP3 gain-of-function mutants associated with CAPS autoinflammation. J Exp Med 2024; 221:e20231200. [PMID: 38530241 DOI: 10.1084/jem.20231200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 12/22/2023] [Accepted: 02/27/2024] [Indexed: 03/27/2024] Open
Abstract
NLRP3-associated autoinflammatory disease is a heterogenous group of monogenic conditions caused by NLRP3 gain-of-function mutations. The poor functional characterization of most NLRP3 variants hinders diagnosis despite efficient anti-IL-1 treatments. Additionally, while NLRP3 is controlled by priming and activation signals, gain-of-functions have only been investigated in response to priming. Here, we characterize 34 NLRP3 variants in vitro, evaluating their activity upon induction, priming, and/or activation signals, and their sensitivity to four inhibitors. We highlight the functional diversity of the gain-of-function mutants and describe four groups based on the signals governing their activation, correlating partly with the symptom severity. We identify a new group of NLRP3 mutants responding to the activation signal without priming, associated with frequent misdiagnoses. Our results identify key NLRP3 residues controlling inflammasome activity and sensitivity to inhibitors, and antagonistic mechanisms with broader efficacy for therapeutic strategies. They provide new insights into NLRP3 activation, an explanatory mechanism for NLRP3-AID heterogeneity, and original tools for NLRP3-AID diagnosis and drug development.
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Affiliation(s)
- Camille Cosson
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308 , ENS de Lyon, Lyon, France
| | - Romane Riou
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308 , ENS de Lyon, Lyon, France
| | - Danish Patoli
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308 , ENS de Lyon, Lyon, France
| | - Tingting Niu
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308 , ENS de Lyon, Lyon, France
- Tongji University Cancer Center, Shanghai Tenth People's Hospital, School of Medicine, Tongji University , Shanghai, China
| | - Amaury Rey
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308 , ENS de Lyon, Lyon, France
| | - Marine Groslambert
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308 , ENS de Lyon, Lyon, France
| | - Charlotte De Rosny
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308 , ENS de Lyon, Lyon, France
| | - Elodie Chatre
- Univ Lyon, ENS de Lyon, Inserm, CNRS SFR Biosciences US8 UAR3444, Université Claude Bernard Lyon 1 , Lyon, France
| | - Omran Allatif
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308 , ENS de Lyon, Lyon, France
| | - Thomas Henry
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308 , ENS de Lyon, Lyon, France
| | - Fabienne Venet
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308 , ENS de Lyon, Lyon, France
| | - Florian Milhavet
- Institute for Regenerative Medicine and Biotherapy, Inserm, U1183, University of Montpellier , Montpellier, France
- Department of Molecular Genetics, Medical Genetics of Rare and Autoinflammatory Disease Unit, Montpellier University Hospital, Montpellier, France
- Centre de Référence des Maladies Autoinflammatoires et des Amyloses Inflammatoires, CEREMAIA , France
| | - Guilaine Boursier
- Institute for Regenerative Medicine and Biotherapy, Inserm, U1183, University of Montpellier , Montpellier, France
- Department of Molecular Genetics, Medical Genetics of Rare and Autoinflammatory Disease Unit, Montpellier University Hospital, Montpellier, France
- Centre de Référence des Maladies Autoinflammatoires et des Amyloses Inflammatoires, CEREMAIA , France
| | - Alexandre Belot
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308 , ENS de Lyon, Lyon, France
- Centre de Référence des Maladies Autoinflammatoires et des Amyloses Inflammatoires, CEREMAIA , France
- Pediatric Nephrology, Rheumatology, Dermatology Department, National Referee Centre for Rheumatic and Autoimmune Diseases in Children (RAISE), Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France
- Lyon Immunopathology Federation (LIFE), Université Claude Bernard Lyon 1 , Lyon, France
| | - Yvan Jamilloux
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308 , ENS de Lyon, Lyon, France
- Centre de Référence des Maladies Autoinflammatoires et des Amyloses Inflammatoires, CEREMAIA , France
- Lyon Immunopathology Federation (LIFE), Université Claude Bernard Lyon 1 , Lyon, France
- Service de Médecine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon , Lyon, France
| | - Etienne Merlin
- Department of Pediatrics, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Agnès Duquesne
- Centre de Référence des Maladies Autoinflammatoires et des Amyloses Inflammatoires, CEREMAIA , France
- Pediatric Nephrology, Rheumatology, Dermatology Department, National Referee Centre for Rheumatic and Autoimmune Diseases in Children (RAISE), Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France
| | - Gilles Grateau
- Centre de Référence des Maladies Autoinflammatoires et des Amyloses Inflammatoires, CEREMAIA , France
- Sorbonne Université, Department of Internal Medicine, National Reference Center for Autoinflammatory Diseases and AA Amyloidosis, Tenon Hospital, Assistance Publique-Hôpitaux de Paris , Paris, France
| | - Léa Savey
- Centre de Référence des Maladies Autoinflammatoires et des Amyloses Inflammatoires, CEREMAIA , France
- Sorbonne Université, Department of Internal Medicine, National Reference Center for Autoinflammatory Diseases and AA Amyloidosis, Tenon Hospital, Assistance Publique-Hôpitaux de Paris , Paris, France
| | - Alexandre Thibault Jacques Maria
- Internal Medicine and Onco-Immunology (MedI2O), Institute for Regenerative Medicine and Biotherapy (IRMB), Saint Eloi Hospital, Montpellier University , Montpellier, France
| | - Anne Pagnier
- Centre Hospitalier Universitaire Grenoble Alpes, Immunologie Clinique, Immuno-Hémato-Oncologie (IHO), Hôpital Couple-Enfant , Grenoble, France
| | - Solène Poutrel
- Service de Médecine Interne, Hospices Civils de Lyon, Edouard Herriot Hospital , Lyon, France
| | - Olivier Lambotte
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne et Immunologie Clinique, Groupe Hospitalier Universitaire Paris Saclay, Hôpital Bicêtre , Le Kremlin-Bicêtre, France
- Université Paris Saclay, Inserm UMR, 1184, CEA , Le Kremlin-Bicêtre, France
| | - Coralie Mallebranche
- Université d'Angers, Université de Nantes, Inserm, CNRS, CRCI2NA, SFR ICAT, Angers, France
- Centre Hospitalier Universitaire d'Angers, Pediatric Immuno-Hemato-Oncology Unit, France
| | - Samuel Ardois
- Médecine Interne et Immunologie Clinique , Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Olivier Richer
- Paediatric, Rheumatology and Paediatric Internal Medicine, Reference Center for Rheumatic, Autoimmune and Systemic Diseases in Children (RAISE), Children's Hospital , Bordeaux, France
| | - Irène Lemelle
- Department of Pediatric Onco-hematology, Children Hospital, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France
| | - Frédéric Rieux-Laucat
- Université Paris Cité, Institut Imagine, Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Inserm UMR 1163 , Paris, France
| | - Brigitte Bader-Meunier
- Université Paris Cité, Institut Imagine, Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Inserm UMR 1163 , Paris, France
- Pediatric Immunology, Hematology and Rheumatology Department, Hôpital Necker, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Zahir Amoura
- Assistance Publique-Hôpitaux de Paris (AP-HP)-Sorbonne Université, Hopital Pitié-Salpétrière, Institut E3M, Service de Médecine Interne 2, Centre National de Référence Lupus et Syndrome des Anticorps Antiphospholipides, Centre d'Immunologie et des Maladies Infectieuses (CIMI), Paris, France
| | - Isabelle Melki
- Paediatric, Rheumatology and Paediatric Internal Medicine, Reference Center for Rheumatic, Autoimmune and Systemic Diseases in Children (RAISE), Children's Hospital , Bordeaux, France
- General Pediatrics, Infectious Disease and Internal Medicine Department, Hôpital Robert Debre, Assistance Publique-Hôpitaux de Paris (AP-HP), Reference Center for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), Paris, France
- Laboratory of Neurogenetics and Neuroinflammation, Imagine Institute , Paris, France
| | - Laurence Cuisset
- Université Paris Cité, Service de Médecine Génomique des Maladies de Système et D'Organe, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris , Paris, France
| | - Isabelle Touitou
- Institute for Regenerative Medicine and Biotherapy, Inserm, U1183, University of Montpellier , Montpellier, France
- Department of Molecular Genetics, Medical Genetics of Rare and Autoinflammatory Disease Unit, Montpellier University Hospital, Montpellier, France
- Centre de Référence des Maladies Autoinflammatoires et des Amyloses Inflammatoires, CEREMAIA , France
| | - Matthias Geyer
- Institute of Structural Biology, University of Bonn , Bonn, Germany
| | - Sophie Georgin-Lavialle
- Centre de Référence des Maladies Autoinflammatoires et des Amyloses Inflammatoires, CEREMAIA , France
- Sorbonne Université, Department of Internal Medicine, National Reference Center for Autoinflammatory Diseases and AA Amyloidosis, Tenon Hospital, Assistance Publique-Hôpitaux de Paris , Paris, France
| | - Bénédicte F Py
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308 , ENS de Lyon, Lyon, France
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Plaçais M, Laparra A, Maria ATJ, Kramkimel N, Perret A, Manson G, Comont T, Coutte L, Nardin C, Ouali K, Danlos FX, Noël N, Messayke S, Michel M, Lambotte O, Michot JM. Drug-induced autoimmune hemolytic anemias related to immune checkpoint inhibitors, therapeutic management, and outcome. Am J Hematol 2024. [PMID: 38642007 DOI: 10.1002/ajh.27339] [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] [Received: 01/21/2024] [Revised: 03/17/2024] [Accepted: 03/26/2024] [Indexed: 04/22/2024]
Affiliation(s)
- Marion Plaçais
- Hôpital Bicêtre, Service de Médecine Interne-Immunologie Clinique, Assitance Publique-Hôpitaux de Paris-Université Paris-Saclay, Le Kremlin Bicêtre, France
| | - Ariane Laparra
- Département interdisciplinaire d'organisation des parcours patients, Gustave Roussy-Université Paris-Saclay, Villejuif, France
| | - Alexandre Thibault Jacques Maria
- Centre Hospitalier Universitaire de Montpellier, Service de Médecine interne & Immuno-Oncologie (MedI2O), Institute for Regenerative Medicine and Biotherapy (IRPB), Hôpital Saint Eloi, Université de Montpellier, Montpellier, France
| | - Nora Kramkimel
- Hôpital Cochin, Service de Dermatologie et Vénérologie, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Audrey Perret
- Département interdisciplinaire d'organisation des parcours patients, Gustave Roussy-Université Paris-Saclay, Villejuif, France
| | - Guillaume Manson
- Service d'Hématologie clinique, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Thibault Comont
- Centre Hospitalier Universitaire de Toulouse, Médecine Interne et Immunopathologie, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Laetitia Coutte
- Hôpital Ambroise Paré, Service de Médecine interne, Assistance Publique-Hôpitaux de Paris, Boulogne Billancourt, France
| | - Charlee Nardin
- Centre Hospitalier Régional Universitaire Jean Minjoz, Département de Dermatologie, INSERM, UMR RIGHT, Université de Franche-Comté, Besançon, France
| | - Kaissa Ouali
- Gustave Roussy, Département des Innovations Thérapeutiques et Essais Précoces, Université Paris-Saclay, Villejuif, France
| | - Francois-Xavier Danlos
- Gustave Roussy, Département des Innovations Thérapeutiques et Essais Précoces, Université Paris-Saclay, Villejuif, France
| | - Nicolas Noël
- Hôpital Bicêtre, Service de Médecine Interne-Immunologie Clinique, Assitance Publique-Hôpitaux de Paris-Université Paris-Saclay, Le Kremlin Bicêtre, France
- INSERM UMR1184, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial Diseases (IDMIT/IMVA-HB), Université Paris-Saclay, Le Kremlin Bicêtre, France
| | - Sabine Messayke
- Gustave Roussy, Unité de Pharmacovigilance, Université Paris-Saclay, Villejuif, France
| | - Marc Michel
- Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Service de Médecine Interne, Centre de Référence des Cytopénies Auto-Immunes de l'adulte, Université Paris-Est Créteil, Créteil, France
| | - Olivier Lambotte
- Hôpital Bicêtre, Service de Médecine Interne-Immunologie Clinique, Assitance Publique-Hôpitaux de Paris-Université Paris-Saclay, Le Kremlin Bicêtre, France
- INSERM UMR1184, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial Diseases (IDMIT/IMVA-HB), Université Paris-Saclay, Le Kremlin Bicêtre, France
| | - Jean-Marie Michot
- Gustave Roussy, Département des Innovations Thérapeutiques et Essais Précoces, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, INSERM U1170, Université Paris-Saclay, Villejuif, France
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Fusaro M, Coustal C, Barnabei L, Riller Q, Heller M, Ho Nhat D, Fourrage C, Rivière S, Rieux-Laucat F, Maria ATJ, Picard C. A large deletion in a non-coding regulatory region leads to NFKB1 haploinsufficiency in two adult siblings. Clin Immunol 2024; 261:110165. [PMID: 38423196 DOI: 10.1016/j.clim.2024.110165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/19/2024] [Accepted: 02/26/2024] [Indexed: 03/02/2024]
Abstract
Mutations in NFkB pathway genes can cause inborn errors of immunity (IEI), with NFKB1 haploinsufficiency being a significant etiology for common variable immunodeficiency (CVID). Indeed, mutations in NFKB1 are found in 4 to 5% of in European and United States CVID cohorts, respectively; CVID representing almost ¼ of IEI patients in European countries registries. This case study presents a 49-year-old patient with respiratory infections, chronic diarrhea, immune thrombocytopenia, hypogammaglobulinemia, and secondary lymphoma. Comprehensive genetic analysis, including high-throughput sequencing of 300 IEI-related genes and copy number variation analysis, identified a critical 2.6-kb deletion spanning the first untranslated exon and its upstream region. The region's importance was confirmed through genetic markers indicative of enhancers and promoters. The deletion was also found in the patient's brother, who displayed similar but milder symptoms. Functional analysis supported haploinsufficiency with reduced mRNA and protein expression in both patients. This case underscores the significance of copy number variation (CNV) analysis and targeting noncoding exons within custom gene panels, emphasizing the broader genomic approaches needed in medical genetics.
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Affiliation(s)
- Mathieu Fusaro
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), INSERM U1291, CNRS U5051, University Toulouse III, Toulouse, France; Université Paris Cité, INSERM UMR1163, Imagine Institute, Paris, France; Study Center for Primary Immunodeficiencies, Necker-Enfants Malades Hospital - Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
| | - Cyrille Coustal
- Internal Medicine and Multi-Organic Diseases Department, Hôpital Saint Éloi, CHU Montpellier, Montpellier, France
| | - Laura Barnabei
- Université Paris Cité, INSERM UMR1163, Imagine Institute, Paris, France; Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Institut Imagine, INSERM UMR 1163, F-75015 Paris, France
| | - Quentin Riller
- Université Paris Cité, INSERM UMR1163, Imagine Institute, Paris, France; Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Institut Imagine, INSERM UMR 1163, F-75015 Paris, France
| | - Marion Heller
- Study Center for Primary Immunodeficiencies, Necker-Enfants Malades Hospital - Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Duong Ho Nhat
- Université Paris Cité, INSERM UMR1163, Imagine Institute, Paris, France; Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Institut Imagine, INSERM UMR 1163, F-75015 Paris, France
| | - Cécile Fourrage
- INSERM-UMR 1163, Imagine Institute, Paris, France; Bioinformatics Core Facility, INSERM-UMR 1163, Imagine Institute, Paris, France; Centre National de la Recherche Scientifique, Unité Mixte de Service 3633, INSERM, University Paris Cité, Paris, France
| | - Sophie Rivière
- Internal Medicine and Multi-Organic Diseases Department, Hôpital Saint Éloi, CHU Montpellier, Montpellier, France
| | - Frédéric Rieux-Laucat
- Université Paris Cité, INSERM UMR1163, Imagine Institute, Paris, France; Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Institut Imagine, INSERM UMR 1163, F-75015 Paris, France
| | - Alexandre Thibault Jacques Maria
- Internal Medicine & Onco-Immunology (MedI2O), Institute for Regenerative Medicine and Biotherapy (IRMB), Montpellier University Hospital, Montpellier, France; IRMB, University of Montpellier, INSERM, CHU Montpellier, Montpellier, France
| | - Capucine Picard
- Université Paris Cité, INSERM UMR1163, Imagine Institute, Paris, France; Study Center for Primary Immunodeficiencies, Necker-Enfants Malades Hospital - Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Pediatric Immuno-Hematology and Rheumatology Unit, Necker Hospital for Sick Children - AP-HP, Paris, France; French National Reference Center for Primary Immune Deficiencies CEREDIH, Necker University, Hospital for Sick Children - AP-HP, Paris, France
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Witkowski Durand Viel P, Henry K, Morel J, Jacot W, Jorgensen C, Riviere S, Maria ATJ, Rigau V, Le Quellec A, Goulabchand R, Guilpain P. Chronological interplay, clinical features, and treatments among patients with cancer and primary Sjögren's syndrome. Cancer Immunol Immunother 2023; 72:4309-4322. [PMID: 37938369 DOI: 10.1007/s00262-023-03565-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/17/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVE While the incidence and type of blood malignancies are well documented amid primary Sjögren's syndrome patients (pSS), data focusing on solid neoplasms are more conflicting. We aimed to describe clinical, pathological, and immunological characteristics of pSS patients with cancers, along with the chronological interplay between the two conditions. METHODS Outcomes concerning both pSS and cancer were retrospectively collected from Montpellier University Hospital (tertiary center) between 2019 and 2020. pSS characteristics were compared to a control group of pSS patients without cancer. RESULTS A total of 165 patients with pSS were included: 55 patients with cancer (52 female, mean age 58.4 ± 10.4 years at pSS diagnosis; mean follow-up 10.5 ± 10.1 years, 12 patients had multiple cancers) and 110 controls without cancer. Characteristics of pSS patients with cancers were different from controls mostly for lymphoma prognosis factors. Among the 70 cancers, we recorded 55 solid neoplasms (whom 27 breast cancers and 8 lung cancers, and 82% of adenocarcinomas), with no evidence of disease at the end of follow-up in 85% of them. Among the 15 recorded blood malignancies, ten were lymphomas with an excellent prognosis. Regarding chronological interplay between cancer and pSS, most cancers (43%) were diagnosed close (± 5 years) to pSS diagnosis. Breast cancers were diagnosed before or close to pSS diagnosis (mean delay - 1.8 ± 13.0 years), at an early stage, with only two relapses (no cancer-related death), while lung cancers were diagnosed late after. CONCLUSIONS The tight chronological interplay between breast cancer and pSS and the intriguing pathological and immunological pattern of pSS in these patients suggest a hypothesis of immune control of cancer.
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Affiliation(s)
- Philine Witkowski Durand Viel
- Department of Internal Medicine - Multi-organ Diseases, St Eloi Hospital, Montpellier University Hospital, Univ Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, France
- Faculty of Medicine, University of Montpellier, Montpellier, France
| | - Kim Henry
- Department of Internal Medicine - Multi-organ Diseases, St Eloi Hospital, Montpellier University Hospital, Univ Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, France
| | - Jacques Morel
- Faculty of Medicine, University of Montpellier, Montpellier, France
- Department of Rheumatology, Montpellier University Hospital, IDESP, Montpellier, France
| | - William Jacot
- Faculty of Medicine, University of Montpellier, Montpellier, France
- Medical Oncology, Montpellier Cancer Institute (ICM) Val d'Aurelle, Montpellier, France
| | - Christian Jorgensen
- Faculty of Medicine, University of Montpellier, Montpellier, France
- Institute for Regenerative Medicine & Biotherapy, University of Montpellier, Montpellier, France
- Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Montpellier University Hospital, Montpellier, France
| | - Sophie Riviere
- Department of Internal Medicine - Multi-organ Diseases, St Eloi Hospital, Montpellier University Hospital, Univ Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, France
| | - Alexandre Thibault Jacques Maria
- Department of Internal Medicine - Multi-organ Diseases, St Eloi Hospital, Montpellier University Hospital, Univ Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, France
- Faculty of Medicine, University of Montpellier, Montpellier, France
- Institute for Regenerative Medicine & Biotherapy, University of Montpellier, Montpellier, France
| | - Valérie Rigau
- Faculty of Medicine, University of Montpellier, Montpellier, France
- Department of Biopathology, Biopathology Tumor Bank, Montpellier University Hospital, Montpellier, France
| | - Alain Le Quellec
- Department of Internal Medicine - Multi-organ Diseases, St Eloi Hospital, Montpellier University Hospital, Univ Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, France
- Faculty of Medicine, University of Montpellier, Montpellier, France
| | - Radjiv Goulabchand
- Faculty of Medicine, University of Montpellier, Montpellier, France
- Institute for Regenerative Medicine & Biotherapy, University of Montpellier, Montpellier, France
- IDESP, Univ Montpellier, INSERM, Montpellier, Nimes University Hospital, Nimes, France
- Department of Internal Medicine, University Hospital, Nimes, France
| | - Philippe Guilpain
- Department of Internal Medicine - Multi-organ Diseases, St Eloi Hospital, Montpellier University Hospital, Univ Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, France.
- Faculty of Medicine, University of Montpellier, Montpellier, France.
- Institute for Regenerative Medicine & Biotherapy, University of Montpellier, Montpellier, France.
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5
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Colard-Thomas J, Manceron C, Duflos C, Herman F, Simon M, Maria ATJ, Faillie JL, Viala M, Palassin P. Comparison of clinical safety between standard versus extended interval dosing of immune checkpoint inhibitors: a real-world retrospective cohort study. ESMO Open 2023; 8:102070. [PMID: 37988951 PMCID: PMC10774961 DOI: 10.1016/j.esmoop.2023.102070] [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: 06/13/2023] [Revised: 10/15/2023] [Accepted: 10/21/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Extended interval dosing (ED) for inhibitors of programmed cell death protein 1 (anti-PD-1) (nivolumab, pembrolizumab) or its ligand (anti-PD-L1) (durvalumab) were recently approved based on pharmacokinetic model results that predicted a benefit-risk profile comparable with the standard dosing (SD) regimen. However, safety data in real-world condition of use are lacking. The objective was to compare the incidence and the risk factors of serious immune-related adverse events (irAEs) and any-grade irAEs between the SD and ED regimens in patients treated with anti-PD-1 or anti-PD-L1. MATERIALS AND METHODS IrAEs were assessed from medical records in all new users of nivolumab, pembrolizumab, or durvalumab between 1 January 2019 and 31 December 2020 across two oncology centers in France. The incidence of irAEs was compared between both dosing regimens using Cox proportional hazards models adjusting for the main available confounders. RESULTS Among 686 patients included, 63% were new users of an SD regimen, 14% of ED regimen, and 23% started with SD and switched to ED regimen during follow-up. Overall, 34.6% of patients experienced at least one irAE of any grade and 11.4% presented at least one serious grade ≥3 irAE. No statistical difference was found between the SD and ED regimen on the risk of grade ≥3 irAEs [adjusted hazard ratio (HR) 1.40, 95% confidence interval (CI) 0.71-2.76] but our results suggest an increased risk of any-grade irAEs with the ED regimen (adjusted HR 1.46, 95% CI 1.00-2.12, P = 0.048). IrAEs resolved without sequelae in 46.4% of cases, and they were fatal for three patients (0.4%). Autoimmune pre-existing condition was confirmed as a risk factor for grade ≥3 irAEs (HR 2.56, 95% CI 1.53-4.27) and for all-grade irAEs (HR 1.60, 95% CI 1.17-2.20). CONCLUSIONS In a real-world setting, according to the regimen chosen by the oncologist based on clinical characteristics, we did not observe an increase in grade ≥3 irAE incidence between the SD and ED regimens.
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Affiliation(s)
- J Colard-Thomas
- Department of Medical Oncology, Montpellier Cancer Institute, Univ Montpellier, Montpellier, France.
| | - C Manceron
- Department of Medical Pharmacology and Toxicology, CHU Montpellier, University of Montpellier, Montpellier, France
| | - C Duflos
- Department of Medical Information, Public Health Unit, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - F Herman
- Department of Medical Information, Public Health Unit, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - M Simon
- Department of UPCO, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - A T J Maria
- Internal Medicine & Immuno-Oncology (MedI(2)O), Institute for Regenerative Medicine and Biotherapy (IRMB), Saint Eloi Hospital, Montpellier University Hospital, Montpellier, France; University of Montpellier, IRMB, Inserm U1183, Montpellier, France
| | - J-L Faillie
- Department of Medical Pharmacology and Toxicology, CHU Montpellier, University of Montpellier, Montpellier, France; University of Montpellier, IDESP INSERM, Montpellier, France
| | - M Viala
- Department of Medical Oncology, Montpellier Cancer Institute, Univ Montpellier, Montpellier, France
| | - P Palassin
- Department of Medical Pharmacology and Toxicology, CHU Montpellier, University of Montpellier, Montpellier, France
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6
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Hountondji L, Ferreira De Matos C, Lebossé F, Quantin X, Lesage C, Palassin P, Rivet V, Faure S, Pageaux GP, Assenat É, Alric L, Zahhaf A, Larrey D, Witkowski Durand Viel P, Riviere B, Janick S, Dalle S, Maria ATJ, Comont T, Meunier L. Clinical pattern of checkpoint inhibitor-induced liver injury in a multicentre cohort. JHEP Rep 2023; 5:100719. [PMID: 37138674 PMCID: PMC10149360 DOI: 10.1016/j.jhepr.2023.100719] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 01/10/2023] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 05/05/2023] Open
Abstract
Background & Aims Immune checkpoint inhibitors (ICIs) have changed the landscape of cancer therapy. Liver toxicity occurs in up to 25% of patients treated with ICIs. The aim of our study was to describe the different clinical patterns of ICI-induced hepatitis and to assess their outcome. Methods We conducted a retrospective observational study of patients with checkpoint inhibitor-induced liver injury (CHILI) discussed in multidisciplinary meetings between December 2018 and March 2022 in three French centres specialised in ICI toxicity management (Montpellier, Toulouse, Lyon). The hepatitis clinical pattern was analysed by the ratio of serum alanine aminotransferase (ALT) and alkaline phosphatase (ALP) (R value = (ALT/ULN)/(ALP/ULN)) for characterisation as cholestatic (R ≤2), hepatocellular (R ≥5), or mixed (2 <R <5). Results We included 117 patients with CHILI. The clinical pattern was hepatocellular in 38.5%, cholestatic in 36.8%, and mixed in 24.8% of patients. High-grade hepatitis severity (grade ≥3 according to the Common Terminology Criteria for Adverse Events system) was significantly associated with the hepatocellular hepatitis (p <0.05). No cases of severe acute hepatitis were reported. Liver biopsy was performed in 41.9% of patients: granulomatous lesions, endothelitis, or lymphocytic cholangitis were described. Biliary stenosis occurred in eight patients (6.8%) and was significantly more frequent in the cholestatic clinical pattern (p < 0.001). Steroids alone were mainly administered to patients with a hepatocellular clinical pattern (26.5%), and ursodeoxycholic acid was more frequently used in the cholestatic pattern (19.7%) than in the hepatocellular or mixed clinical pattern (p <0.001). Seventeen patients improved without any treatment. Among the 51 patients (43.6%) rechallenged with ICIs, 12 (23.5%) developed CHILI recurrence. Conclusions This large cohort indicates the different clinical patterns of ICI-induced liver injury and highlights that the cholestatic and hepatocellular patterns are the most frequent with different outcomes. Impact and Implications ICIs can induce hepatitis. In this retrospective series, we report 117 cases of ICI-induced hepatitis, mostly grades 3 and 4. We find a similar distribution of the different patterns of hepatitis. ICI could be resumed without systematic recurrence of hepatitis.
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Affiliation(s)
- Lina Hountondji
- Department of Liver Transplantation, Saint Eloi Hospital, Montpellier University Hospital, Montpellier, France
| | | | - Fanny Lebossé
- Department of Hepatology, Croix Rousse Hospital, Lyon Liver Institute, Hospices Civils of Lyon, Lyon, France
| | - Xavier Quantin
- Department of Medical Oncology, Montpellier Cancer Institute, Montpellier University Hospital, Montpellier, France
| | - Candice Lesage
- Department of Dermatology, Saint Eloi Hospital, Montpellier University Hospital, Montpellier, France
| | - Pascale Palassin
- Department of Medical Pharmacology and Toxicology, Lapeyronie Hospital, Montpellier University Hospital, Montpellier, France
| | - Valérian Rivet
- Department of Internal Medicine, IUCT-Oncopole, Toulouse University Hospital, Toulouse, France
| | - Stéphanie Faure
- Department of Liver Transplantation, Saint Eloi Hospital, Montpellier University Hospital, Montpellier, France
| | - Georges-Philippe Pageaux
- Department of Liver Transplantation, Saint Eloi Hospital, Montpellier University Hospital, Montpellier, France
| | - Éric Assenat
- Department of Oncology, Saint Eloi Hospital, Montpellier University Hospital, Montpellier, France
| | - Laurent Alric
- Department of Internal Medicine and Digestive Diseases, Purpan Hospital, Toulouse University Hospital, Toulouse, France
| | - Amel Zahhaf
- Department of Liver Transplantation, Saint Eloi Hospital, Montpellier University Hospital, REFHEPS, Montpellier, France
| | - Dominique Larrey
- Department of Liver Transplantation, Saint Eloi Hospital, Montpellier University Hospital, REFHEPS, Montpellier, France
| | | | - Benjamin Riviere
- Department of Pathology, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | | | - Stéphane Dalle
- Department of Dermatology, Lyon Sud Hospital, Lyon Cancer Institute, Hospices Civils of Lyon, Lyon, France
| | - Alexandre Thibault Jacques Maria
- Internal Medicine & Immuno-Oncology (MedI2O), Institute for Regenerative Medicine and Biotherapy (IRMB), Saint Eloi Hospital, Montpellier University Hospital, Montpellier, France
| | - Thibaut Comont
- Department of Internal Medicine, IUCT-Oncopole, Toulouse University Hospital, Toulouse, France
| | - Lucy Meunier
- Department of Liver Transplantation, Saint Eloi Hospital, Montpellier University Hospital, REFHEPS, Montpellier, France
- Corresponding author. Address: Department of Liver Transplantation, Saint Eloi Hospital, Montpellier University Hospital, REFHEPS, 80 avenue Augustin Fliche, 34090 Montpellier, France. Tel: +33 4 67 33 02 24, Fax: +33 4 67 33 69 42.
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7
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Coustal C, Vanoverschelde J, Quantin X, Lesage C, Michot JM, Lappara A, Ederhy S, Assenat E, Faure M, Issa N, Lambotte O, Puyade M, Dereure O, Tosi D, Rullier P, Serre I, Larcher R, Klouche K, Chanques G, Vernhet-Kovacsik H, Faillie JL, Agullo A, Roubille F, Guilpain P, Maria ATJ. Prognosis of immune checkpoint inhibitors-induced myocarditis: a case series. J Immunother Cancer 2023; 11:jitc-2022-004792. [PMID: 37258037 DOI: 10.1136/jitc-2022-004792] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICI) have transformed cancer treatment over the last decade. Alongside this therapeutic improvement, a new variety of side effects has emerged, called immune-related adverse events (irAEs), potentially affecting any organ. Among these irAEs, myocarditis is rare but life-threatening. METHODS We conducted a multicenter cross-sectional retrospective study with the aim of better characterizing ICI-related myocarditis. Myocarditis diagnosis was based on the recent consensus statement of the International Cardio-Oncology Society. RESULTS Twenty-nine patients were identified, from six different referral centers. Most patients (55%) were treated using anti-programmed-death 1, rather than ICI combination (35%) or anti-programmed-death-ligand 1 (10%). Transthoracic echocardiography was abnormal in 52% of them, and cardiac magnetic resonance showed abnormal features in 14/24 patients (58%). Eleven patients (38%) were classified as severe. Compared with other patients, they had more frequently pre-existing systemic autoimmune disease (45% vs 6%, p=0.018), higher troponin level on admission (42-fold the upper limit vs 3.55-fold, p=0.001), and exhibited anti-acetylcholine receptor autoantibodies (p=0.001). Seven patients (24%) had myocarditis-related death, and eight more patients died from cancer progression during follow-up. Twenty-eight patients received glucocorticoids, 10 underwent plasma exchanges, 8 received intravenous immunoglobulins, and 5 other immunosuppressants. ICI rechallenge was performed in six patients, with only one myocarditis relapse. DISCUSSION The management of ICI-related myocarditis may be challenging and requires a multidisciplinary approach. Prognostic features are herein described and may help to allow ICI rechallenge for some patients with smoldering presentation, after an accurate evaluation of benefit-risk balance.
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Affiliation(s)
- Cyrille Coustal
- Department of Internal Medicine, CHRU de Montpellier, Montpellier, France
| | | | - Xavier Quantin
- Department of thoracic oncology, Regional Cancer Centre Val d'Aurelle - Paul Lamarque, Montpellier, France
| | - Candice Lesage
- Department of Dermatology, CHRU de Montpellier, Montpellier, France
| | | | | | - Stephane Ederhy
- Cardiology, Assistance Publique - Hopitaux de Paris, Paris, France
| | - Eric Assenat
- Department of Oncology, CHRU de Montpellier, Montpellier, France
| | - Maxime Faure
- Department of Interventional Cardiology, CHU de Bordeaux Hôpital Cardiologique, Pessac, France
| | - Nahema Issa
- Intensive Care Unit, CHU de Bordeaux, Bordeaux, France
| | - Olivier Lambotte
- Department of Internal Medicine, CHU Bicêtre, Le Kremlin-Bicetre, France
| | - Mathieu Puyade
- Medecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- CIC-1402, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Olivier Dereure
- Department of Dermatology, CHRU de Montpellier, Montpellier, France
| | - Diego Tosi
- Medical Oncology Department, Institut régional du Cancer de Montpellier, Montpellier, France
| | - Patricia Rullier
- Department of Internal Medicine, CHRU de Montpellier, Montpellier, France
| | - Isabelle Serre
- Department of Pathology, CHRU de Montpellier, Montpellier, France
| | - Romaric Larcher
- Department of Intensive Care Medicine, CHRU de Montpellier, Montpellier, France
| | - Kada Klouche
- Department of Intensive Care Medicine, CHRU de Montpellier, Montpellier, France
| | - Gérald Chanques
- Department of Anesthesiology and Critical Care Medicine, CHRU de Montpellier, Montpellier, France
| | | | - Jean-Luc Faillie
- Department of Medical Pharmacology and Toxicology, University Hospital Centre Montpellier, Montpellier, France
| | - Audrey Agullo
- Department of Cardiology, CHRU de Montpellier, Montpellier, France
| | | | - Philippe Guilpain
- Department of Internal Medicine, CHRU de Montpellier, Montpellier, France
- U1183, Institut national de la santé et de la recherche médicale, Paris, France
| | - Alexandre Thibault Jacques Maria
- Department of Internal Medicine, CHRU de Montpellier, Montpellier, France
- U1183, Institut national de la santé et de la recherche médicale, Paris, France
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8
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Diaz L, Jauzelon B, Dillies AC, Le Souder C, Faillie JL, Maria ATJ, Palassin P. Hemophagocytic Lymphohistiocytosis Associated with Immunological Checkpoint Inhibitors: A Pharmacovigilance Study. J Clin Med 2023; 12:jcm12051985. [PMID: 36902771 PMCID: PMC10004618 DOI: 10.3390/jcm12051985] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/16/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Acquired hemophagocytic lymphohistiocytosis (HLH) is a rare but potentially fatal condition characterized by hyperactivation of macrophages and cytotoxic lymphocytes, combining a series of non-specific clinical symptoms and laboratory disorders. Etiologies are multiple: infectious (mainly viral) but also oncologic, autoimmune or drug-induced. Immune checkpoint inhibitors (ICI) are recent anti-tumor agents associated with a novel profile of adverse events triggered by immune system over-activation. Here, we sought to provide a comprehensive description and analysis of HLH cases reported with ICI since 2014. METHODS Disproportionality analyses were performed in order to further explore the association between ICI therapy and HLH. We selected 190 cases, 177 from the World Health Organization pharmacovigilance database and 13 from the literature. Detailed clinical characteristics were retrieved from the literature and from the French pharmacovigilance database. RESULTS The cases of HLH reported with ICI concerned men in 65% of cases with a median age of 64 years. HLH occurred in an average of 102 days after the initiation of ICI treatment and mostly concerned nivolumab, pembrolizumab and nivolumab/ipilimumab combination. All cases were considered serious. Most cases presented a favorable outcome (58.4%); however, death was reported for 15.3% of patients. Disproportionality analyses showed that HLH was seven times more frequently reported with ICI therapy than with other drugs and three times more than with other antineoplastic agents. CONCLUSIONS Clinicians should be aware of the potential risk of ICI-related HLH to improve the early diagnosis of this rare immune-related adverse event.
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Affiliation(s)
- Laurine Diaz
- Department of Medical Pharmacology and Toxicology, CHU Montpellier, Montpellier University, 34000 Montpellier, France
| | - Benjamin Jauzelon
- Internal Medicine & Immuno-Oncology (MedI2O), CHU Montpellier, 34000 Montpellier, France
| | - Anne-Charlotte Dillies
- Department of Medical Pharmacology and Toxicology, CHU Montpellier, Montpellier University, 34000 Montpellier, France
| | - Cosette Le Souder
- Department of Medical Pharmacology and Toxicology, CHU Montpellier, Montpellier University, 34000 Montpellier, France
| | - Jean-Luc Faillie
- Department of Medical Pharmacology and Toxicology, CHU Montpellier, Montpellier University, 34000 Montpellier, France
- Desbrest Institute of Epidemiology and Public Health (IDESP), Montpellier University, INSERM, 34000 Montpellier, France
| | - Alexandre Thibault Jacques Maria
- Internal Medicine & Immuno-Oncology (MedI2O), CHU Montpellier, 34000 Montpellier, France
- Institute for Regenerative Medicine and Biotherapy (IRMB), Montpellier University, 34000 Montpellier, France
| | - Pascale Palassin
- Department of Medical Pharmacology and Toxicology, CHU Montpellier, Montpellier University, 34000 Montpellier, France
- Correspondence: ; Tel.: +33-4-67336756; Fax: +33-4-67336751
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9
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Suzon B, Rivière S, Schiffmann A, Rivet V, Flori N, Guilpain P, Maria ATJ. Long-term home parenteral nutrition in systemic sclerosis-related intestinal failure is feasible but unveils occult cardiac disease. Nutrition 2023; 110:112009. [PMID: 36965242 DOI: 10.1016/j.nut.2023.112009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/03/2023] [Accepted: 02/16/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVE The aim of this study was to compare safety and efficacy of long-term home parenteral nutrition between patients with systemic sclerosis and intestinal failure (IF) and controls with IF from another etiology. METHODS A retrospective study was conducted in a referral center for systemic sclerosis (SSc) in Montpellier, France. Patients followed between 1985 and 2020 with SSc-related IF were included and compared with control patients with IF from another etiology. The patients included had to be treated for ≥4 wk by home parenteral nutrition (HPN). Primary outcome was occurrence of HPN-related complications. Secondary outcomes included duration of parenteral nutrition, body mass index at 12 mo, and survival. RESULTS Cumulative duration of HPN was 23 397 catheter days. HPN resulted in body mass index increase in both groups. There was no statistical difference regarding catheter-related bloodstream infections and thrombosis between the groups, despite use of immunosuppressive drugs and autologous hematopoietic stem cell transplantation in patients with SSc. However, the patients with SSc had significantly more HPN-related cardiac overload than the controls (P < 0.0001). Overloads occurred in SSc patients with and without cardiac disease, arguing for comprehensive hemodynamic screening in this condition. CONCLUSION Long-term HPN in SSc-related IF is feasible but unveils occult cardiac disease.
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Affiliation(s)
- Benoit Suzon
- Department of Internal Medicine, Martinique University Hospital, Martinique, France; EpiCliV Research Unit, University of the French West Indies, Fort-de-France, Martinique, France
| | - Sophie Rivière
- Department of Internal Medicine and Multi-Organic Diseases, Montpellier University Hospital, Montpellier, France
| | - Auelie Schiffmann
- Department of Internal Medicine and Multi-Organic Diseases, Montpellier University Hospital, Montpellier, France
| | - Valérian Rivet
- Internal Medicine and Clinical Immunopathology, ICUT-Oncopôle, Toulouse, France
| | - Nicolas Flori
- Clinical Nutrition, Gastroenterology and Endoscopy, Montpellier Cancer Institute, Montpellier, France
| | - Philippe Guilpain
- Department of Internal Medicine and Multi-Organic Diseases, Montpellier University Hospital, Montpellier, France; Montpellier University, Medical School, Montpellier, France; Institute for Regenerative Medicine and Biotherapy (IRMB), Saint Eloi Hospital, Montpellier University Hospital, Montpellier, France
| | - Alexandre Thibault Jacques Maria
- Montpellier University, Medical School, Montpellier, France; Institute for Regenerative Medicine and Biotherapy (IRMB), Saint Eloi Hospital, Montpellier University Hospital, Montpellier, France; Internal Medicine & Immuno-Oncology (MedI2O), Montpellier University Hospital, Montpellier, France.
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10
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Maria ATJ, Campidelli A, Castilla-Llorente C, Lansiaux P, Marjanovic Z, Pugnet G, Torregrosa-Diaz JM, Terriou L, Algayres JP, Urbain F, Yakoub-Agha I, Farge D. [Vaccination before and after autologous hematopoietic cell transplantation for autoimmune diseases: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (MATHEC-SFGM-TC)]. Bull Cancer 2023; 110:S97-S107. [PMID: 36658011 DOI: 10.1016/j.bulcan.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/16/2022] [Accepted: 11/16/2022] [Indexed: 01/18/2023]
Abstract
The Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) organized the 12th workshop on hematopoietic stem cell transplantation clinical practices harmonization procedures on September 2021 in Lille, France. In the absence of specific national or international recommendation, the French working group for autologous stem Cell transplantation in Auto-immune Diseases (MATHEC) proposed guidances for vaccinations of patients undergoing autologous hematopoietic stem cell transplantation for autoimmune disease, including in the context of SARS-Cov-2 pandemic.
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Affiliation(s)
- Alexandre Thibault Jacques Maria
- Médecine Interne & Immuno-Oncologie (MedI2O), Institute for Regenerative Medicine & Biotherapy (IRMB), Hôpital Saint Eloi, CHU de Montpellier, 80 avenue Augustin Fliche, Montpellier, France; IRMB, Inserm U1183, Hôpital Saint-Eloi, CHU de Montpellier, 34295, Montpellier, France
| | - Arnaud Campidelli
- CHRU Nancy, Service Hématologie Adulte, 54500 Vandoeuvre-lès-Nancy, France
| | - Cristina Castilla-Llorente
- Gustave Roussy Cancer Campus, Département d́Hématologie, 114 rue Edouard Vaillant, 94800 Villejuif, France
| | - Pauline Lansiaux
- Centre de Référence des Maladies auto-immunes systémiques Rares d'Ile-de-France MATHEC (FAI2R), AP-HP, Hôpital St-Louis, Unité de Médecine Interne: Maladies Auto-immunes et Pathologie Vasculaire (UF 04), 75010 Paris, France; Université de Paris Cité, Institut de recherche Saint Louis, Recherche clinique appliquée à l'hématologie, EA3518, 75010 Paris, France
| | - Zora Marjanovic
- Hôpital Saint Antoine (APHP), Service d'Hématologie et Thérapie cellulaire, 184 rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - Grégory Pugnet
- CHU Rangueil, Service de Médecine Interne et Immunologie Clinique, 1 avenue du Pr Jean Poulhès, 31059 Toulouse Cedex 9, France
| | | | - Louis Terriou
- Hôpital Claude Huriez, CHRU Lille, Service de médecine interne et immunologie clinique, rue Michel Polonovski, 59000 Lille, France
| | - Jean-Pierre Algayres
- Centre de Référence des Maladies auto-immunes systémiques Rares d'Ile-de-France MATHEC (FAI2R), AP-HP, Hôpital St-Louis, Unité de Médecine Interne: Maladies Auto-immunes et Pathologie Vasculaire (UF 04), 75010 Paris, France
| | - Fanny Urbain
- Hôpital Bicêtre, Groupe Hospitalier Universitaire Paris Sud, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne et Immunologie Clinique, 94275 Le Kremlin-Bicêtre cedex, France; Université Paris Saclay, Faculté de Médecine, Le Kremlin Bicêtre, France
| | | | - Dominique Farge
- Centre de Référence des Maladies auto-immunes systémiques Rares d'Ile-de-France MATHEC (FAI2R), AP-HP, Hôpital St-Louis, Unité de Médecine Interne: Maladies Auto-immunes et Pathologie Vasculaire (UF 04), 75010 Paris, France; Université de Paris Cité, Institut de recherche Saint Louis, Recherche clinique appliquée à l'hématologie, EA3518, 75010 Paris, France; McGill University, Department of Medicine, H3A 1A1, Montreal, Canada.
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11
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Palassin P, Bres V, Hassan S, Alfonsi A, Massy N, Gras-Champel V, Maria ATJ, Faillie JL. Comprehensive description of adult-onset Still's disease after COVID-19 vaccination. J Autoimmun 2023; 134:102980. [PMID: 36592513 PMCID: PMC9755011 DOI: 10.1016/j.jaut.2022.102980] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/07/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
Cases of adult-onset Still's disease (AOSD) have been reported after COVID-19 vaccination. Here we provide a comprehensive description and analysis of all cases of AOSD reported in the literature and in pharmacovigilance databases through April 2022. Disproportionality analyses of pharmacovigilance data were performed in order to further explore the association between vaccination and AOSD. We included 159 patients, 144 from the World Health Organization pharmacovigilance database and 15 from the literature. Detailed clinical characteristics were described for the cases from the literature and from the French pharmacovigilance database (n = 9). The cases of AOSD after COVID-19 vaccination concerned women in 52.2% of cases. The median age was 43.4 years. More than 80% of AOSD reports occurred during the first three weeks and concerned mostly the BNT162b2 mRNA vaccine. We identified 14.5% of disease flare with a median time-to-onset of AOSD flare-up significantly shorter than for the new onset form. More than 90% patients received steroids. Although all cases were considered serious and required hospitalization, most cases presented a favorable outcome (67.1%) with a good response to corticosteroid therapy with a mean time to recovery of 7.2 days. Disproportionality analyses suggested that AOSD was associated with COVID-19 vaccines as well as other vaccines. AOSD was nearly five times more frequently reported with COVID-19 vaccines than with all other drugs. Clinicians should be informed about the potential risk of AOSD onset or flare following COVID vaccines and the importance of its early detection to optimize its management.
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Affiliation(s)
- Pascale Palassin
- Department of Medical Pharmacology and Toxicology, CHU Montpellier, Montpellier, France.
| | - Virginie Bres
- Department of Medical Pharmacology and Toxicology, CHU Montpellier, Montpellier, France
| | | | - Ange Alfonsi
- Department of Medical Pharmacology and Toxicology, CHU Montpellier, Montpellier, France
| | - Nathalie Massy
- Regional Pharmacovigilance Center, Department of Pharmacology, CHU Rouen, Rouen, France
| | - Valérie Gras-Champel
- Regional Pharmacovigilance Center, Department of Clinical Pharmacology, CHU Amiens-Picardie, Amiens, France
| | - Alexandre Thibault Jacques Maria
- Internal Medicine & Immuno-Oncology (MedI2O), Institute for Regenerative Medicine and Biotherapy (IRMB), Saint Eloi Hospital, Montpellier University Hospital, Montpellier, France,Univ Montpellier, IRMB, Montpellier, France
| | - Jean-Luc Faillie
- Department of Medical Pharmacology and Toxicology, CHU Montpellier, Montpellier, France,Univ Montpellier, IDESP INSERM, Montpellier, France
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12
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Hadjadj J, Canzian A, Karadag O, Contis A, Maurier F, Sanges S, Sartorelli S, Denis L, de Moreuil C, Durel CA, Durupt S, Jachiet M, Rouzaud D, Salvarani C, Padoan R, Dagna L, Bonnet F, Agard C, Moulinet T, Hermet M, Sterpu R, Maria ATJ, Keraen J, Guillevin L, Jayne D, Terrier B. Use of biologics to treat relapsing and/or refractory polyarteritis nodosa: data from a European collaborative study. Rheumatology (Oxford) 2022; 62:341-346. [PMID: 35686919 DOI: 10.1093/rheumatology/keac332] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/12/2022] [Accepted: 05/27/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To describe the effectiveness and safety of biologics for the treatment of relapsing and/or refractory polyarteritis nodosa (PAN). METHODS A retrospective European collaborative study was conducted in patients with PAN who received biologics for relapsing and/or refractory disease. RESULTS Forty-two patients with PAN received a total of 53 biologic courses, including TNF-α blockers in 15 cases, rituximab (RTX) in 18 cases, tocilizumab (TCZ) in 10 cases and other biologics in 10 cases. TNF-α blockers and TCZ were mainly used for refractory diseases whereas RTX was mainly initiated for relapsing disease. After a median follow-up of 29 (8-50) months, remission, partial response, treatment failure and treatment discontinuation due to severe adverse events occurred in, respectively, 40%, 13%, 40% and 7% of patients receiving TNF-α blockers, 50%, none, 30% and 20% of TCZ recipients, and 33%, 11%, 56% and none of the RTX recipients. No remission was noted in patients treated with other biologics. Severe adverse events were observed in 14 (28%) patients without significant differences between the three biologics, leading to early biologics discontinuation in only three cases. CONCLUSION These results suggest that TCZ may be effective in relapsing and/or refractory PAN. Our data warrant further study to confirm these findings.
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Affiliation(s)
- Jérome Hadjadj
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP, APHP-CUP, Hôpital Cochin, Paris, France
| | - Alice Canzian
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP, APHP-CUP, Hôpital Cochin, Paris, France
| | - Omer Karadag
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Vasculitis Research Centre, Hacettepe University, Ankara, Turkey
| | - Anne Contis
- Department of Internal Medicine and Clinical Immunology, Saint Andre Hospital, University Hospital Centre of Bordeaux, Bordeaux
| | - François Maurier
- Department of Internal Medicine and Immunology, Groupe Hospitalier UNEOS, Metz-Vantoux
| | - Sébastien Sanges
- Univ. Lille, Inserm, CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), U1286 - INFINITE-Institute for Translational Research in Inflammation, Lille, France
| | - Silvia Sartorelli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Cécile-Audrey Durel
- Department of Internal Medicine, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon
| | - Stéphane Durupt
- Department of Internal Medicine, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon.,Service de Médecine Interne, Centre Hospitalier Universitaire Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite
| | | | - Diane Rouzaud
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Carlo Salvarani
- Rheumatology Unit, Dipartimento Medicina Interna e Specialità Mediche, Azienda Unità Sanitaria Locale di Reggio Emilia-Istituto di Ricerca e Cura a Carattere Scientifico, Reggio Emilia
| | - Roberto Padoan
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Fabrice Bonnet
- Department of Internal Medicine and Infectious Diseases, Bordeaux University Hospital, Saint André Hospital, Bordeaux
| | - Christian Agard
- Internal Medicine Department, Nantes Université, CHU Nantes, Nantes
| | - Thomas Moulinet
- Department of Internal Medicine and Clinical Immunology, Center de Compétence des Maladies Autoimmunes Systémiques Rares, CHU Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France; UMR 7365, IMoPA, University of Lorraine, CNRS, Nancy
| | - Marion Hermet
- Service de Médecine Interne, Centre Hospitalier, Vichy
| | - Raluca Sterpu
- Service de Médecine Interne, Immunologie Clinique, Médecine Aigüe Polyvalente, Hôpital Antoine-Béclère-AP-HP, Clamart
| | - Alexandre Thibault Jacques Maria
- Department of Internal Medicine and Multiorgan Diseases, Referral Center for Auto-immune Diseases, Saint-Eloi Hospital Montpellier University, Montpellier
| | - Jérémy Keraen
- Service de Médecine Interne, Centre Hospitalier Cornouaille, Quimper, France
| | - Loic Guillevin
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP, APHP-CUP, Hôpital Cochin, Paris, France
| | - David Jayne
- Service de Médecine Interne, Centre Hospitalier Cornouaille, Quimper, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP, APHP-CUP, Hôpital Cochin, Paris, France
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13
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Jachiet V, Ricard L, Hirsch P, Malard F, Pascal L, Beyne-Rauzy O, Peterlin P, Maria ATJ, Vey N, D'Aveni M, Gourin MP, Dimicoli-Salazar S, Banos A, Wickenhauser S, Terriou L, De Renzis B, Durot E, Natarajan-Ame S, Vekhoff A, Voillat L, Park S, Vinit J, Dieval C, Dellal A, Grobost V, Willems L, Rossignol J, Solary E, Kosmider O, Dulphy N, Zhao LP, Adès L, Fenaux P, Fain O, Mohty M, Gaugler B, Mekinian A. Reduced peripheral blood dendritic cell and monocyte subsets in MDS patients with systemic inflammatory or dysimmune diseases. Clin Exp Med 2022:10.1007/s10238-022-00866-5. [PMID: 35953763 DOI: 10.1007/s10238-022-00866-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Systemic inflammatory and autoimmune diseases (SIADs) occur in 10-20% of patients with myelodysplastic syndrome (MDS). Recently identified VEXAS (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) syndrome, associated with somatic mutations in UBA1 (Ubiquitin-like modifier-activating enzyme 1), encompasses a range of severe inflammatory conditions along with hematological abnormalities, including MDS. The pathophysiological mechanisms underlying the association between MDS and SIADs remain largely unknown, especially the roles of different myeloid immune cell subsets. The aim of this study was to quantitatively evaluate peripheral blood myeloid immune cells (dendritic cells (DC) and monocytes) by flow cytometry in MDS patients with associated SIAD (n = 14, most often including relapsing polychondritis or neutrophilic dermatoses) and to compare their distribution in MDS patients without SIAD (n = 23) and healthy controls (n = 7). Most MDS and MDS/SIAD patients had low-risk MDS. Eight of 14 (57%) MDS/SIAD patients carried UBA1 somatic mutations, defining VEXAS syndrome.Compared with MDS patients, most DC and monocyte subsets were significantly decreased in MDS/SIAD patients, especially in MDS patients with VEXAS syndrome. Our study provides the first overview of the peripheral blood immune myeloid cell distribution in MDS patients with associated SIADs and raises several hypotheses: possible redistribution to inflammation sites, increased apoptosis, or impaired development in the bone marrow.
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Affiliation(s)
- Vincent Jachiet
- Sorbonne Université, INSERM UMR938, Centre de Recherche Saint-Antoine (CRSA), 75012, Paris, France. .,Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France.
| | - Laure Ricard
- Sorbonne Université, INSERM UMR938, Centre de Recherche Saint-Antoine (CRSA), 75012, Paris, France.,Service d'Hématologie Clinique et de Thérapie Cellulaire, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Pierre Hirsch
- Service d'Hématologie Biologique, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Florent Malard
- Sorbonne Université, INSERM UMR938, Centre de Recherche Saint-Antoine (CRSA), 75012, Paris, France.,Service d'Hématologie Clinique et de Thérapie Cellulaire, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Laurent Pascal
- Service d'Oncologie et d'Hématologie, Hôpital Saint Vincent de Paul, Université Catholique de Lille, Lille, France
| | - Odile Beyne-Rauzy
- Service de Médecine Interne, CHU de Toulouse, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Pierre Peterlin
- Service d'Hématologie Clinique, CHU de Nantes, Nantes, France
| | - Alexandre Thibault Jacques Maria
- Service de Médecine Interne, maladies multi-organiques de l'adulte, Hôpital Saint-Éloi, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Norbert Vey
- Institut Paoli-Calmettes, CRCM, Aix-Marseille Univ, Inserm, CNRS, Marseille, France
| | - Maud D'Aveni
- Service d'Hématologie et de Médecine Interne, Hôpital Brabois, CHRU Nancy, Nancy, France
| | - Marie-Pierre Gourin
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Dupuytren, CHU de Limoges, Limoges, France
| | | | - Anne Banos
- Service d'Hématologie Clinique, Centre Hospitalier Côte Basque, Bayonne, France
| | - Stefan Wickenhauser
- Service d'Hématologie Clinique, Hôpital Universitaire Carémeau, Institut de Cancérologie du Gard, Nîmes, France
| | - Louis Terriou
- Service de Médecine Interne et Immunologie Clinique, CHU Lille, 59000, Lille, France
| | - Benoit De Renzis
- Service d'Hématologie Clinique, Hôpital Estaing, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Eric Durot
- Service d'Hématologie Clinique, Hôpital Robert Debré, CHU de Reims, Reims, France
| | - Shanti Natarajan-Ame
- Service d'Hématologie, Institut de Cancérologie Strasbourg Europe (ICANS), 17 rue Albert Calmette, Strasbourg, France
| | - Anne Vekhoff
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Laurent Voillat
- Service d'Hématologie et Oncologie, CH William Morey, Chalon sur Saône, France
| | - Sophie Park
- Service d'Hématologie, Université Grenoble Alpes Et CHU Grenoble Alpes, Grenoble, France
| | - Julien Vinit
- Service de Médecine Interne, CH William Morey, Chalon sur Saône, France
| | - Céline Dieval
- Service de Médecine Interne et Hématologie, GHLA, CH de Rochefort, Rochefort, France
| | - Azeddine Dellal
- Service de Rhumatologie, Hôpital Montfermeil, Montfermeil, France
| | - Vincent Grobost
- Service de Médecine Interne, CHU Estaing, Clermont-Ferrand, France
| | - Lise Willems
- Service d'Hématologie, AP-HP, Hôpital Cochin, Paris, France
| | - Julien Rossignol
- Service d'Hématologie Adultes, AP-HP, Hôpital Necker-Enfants Malades, 75015, Paris, France
| | - Eric Solary
- Département d'Hématologie, Institut Gustave Roussy, Villejuif, France
| | - Olivier Kosmider
- Service d'Hématologie Biologique, Université de Paris, AP-HP, Hôpital Cochin, 75014, Paris, France
| | - Nicolas Dulphy
- Institut de Recherche Saint Louis, Hôpital Saint Louis, Université de Paris, INSERM U1160, Paris, France
| | - Lin Pierre Zhao
- Département d'Hématologie, Université de Paris, AP-HP, Hôpital Saint Louis, 75010, Paris, France
| | - Lionel Adès
- Département d'Hématologie, Université de Paris, AP-HP, Hôpital Saint Louis, 75010, Paris, France
| | - Pierre Fenaux
- Département d'Hématologie, Université de Paris, AP-HP, Hôpital Saint Louis, 75010, Paris, France
| | - Olivier Fain
- Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Mohamad Mohty
- Sorbonne Université, INSERM UMR938, Centre de Recherche Saint-Antoine (CRSA), 75012, Paris, France.,Service d'Hématologie Clinique et de Thérapie Cellulaire, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Béatrice Gaugler
- Sorbonne Université, INSERM UMR938, Centre de Recherche Saint-Antoine (CRSA), 75012, Paris, France.,Service d'Hématologie Clinique et de Thérapie Cellulaire, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Arsène Mekinian
- Sorbonne Université, INSERM UMR938, Centre de Recherche Saint-Antoine (CRSA), 75012, Paris, France.,Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
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14
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Trefond L, Frances C, Costedoat-Chalumeau N, Piette JC, Haroche J, Sailler L, Assaad S, Viallard JF, Jego P, Hot A, Connault J, Galempoix JM, Aslangul E, Limal N, Bonnet F, Faguer S, Chosidow O, Deligny C, Lifermann F, Maria ATJ, Pereira B, Aumaitre O, André M. Aseptic Abscess Syndrome: Clinical Characteristics, Associated Diseases, and up to 30 Years’ Evolution Data on a 71-Patient Series. J Clin Med 2022; 11:jcm11133669. [PMID: 35806955 PMCID: PMC9267245 DOI: 10.3390/jcm11133669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 12/05/2022] Open
Abstract
Aseptic abscess (AA) syndrome is a rare type of inflammatory disorder involving polymorphonuclear neutrophils (PMNs), often associated with inflammatory bowel disease (IBD). This study sought to describe the clinical characteristics and evolution of this syndrome in a large cohort. We included all patients included in the French AA syndrome register from 1999 to 2020. All patients fulfilled the criteria outlined by André et al. in 2007. Seventy-one patients were included, 37 of which were men (52.1%), of a mean age of 34.5 ± 17 years. The abscesses were located in the spleen (71.8%), lymph nodes (50.7%), skin (29.5%), liver (28.1%), lung (22.5), and rarer locations (brain, genitals, kidneys, ENT, muscles, or breasts). Of all the patients, 59% presented with an associated disease, primarily IBD (42%). They were treated with colchicine (28.1%), corticosteroids (85.9%), immunosuppressants (61.9%), and biologics (32.3%). A relapse was observed in 62% of cases, mostly in the same organ. Upon multivariate analysis, factors associated with the risk of relapse were: prescription of colchicine (HR 0.52; 95% CI [0.28–0.97]; p = 0.042), associated IBD (HR 0.57; 95% CI [0.32–0.99]; p = 0.047), and hepatic or skin abscesses at diagnosis (HR 2.14; 95% CI [1.35–3.40]; p = 0.001 and HR 1.78; 95% CI [1.07–2.93]; p = 0.024, respectively). No deaths occurred related to this disease. This large retrospective cohort study with long follow up showed that AA syndrome is a relapsing systemic disease that can evolve on its own or be the precursor of an underlying disease, such as IBD. Of all the available treatments, colchicine appeared to be protective against relapse.
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Affiliation(s)
- Ludovic Trefond
- Médecine Interne, CHU Gabriel Montpied, 63000 Clermont-Ferrand, France; (O.A.); (M.A.)
- M2iSH, UMR 1071 Inserm, INRA USC 2018, University of Clermont Auvergne, 63000 Clermont-Ferrand, France
- Correspondence:
| | - Camille Frances
- Faculté de Médecine, AP-HP, Service de Dermatologie et Allergologie, Hôpital Tenon, Sorbonne Université, 75252 Paris, France;
| | - Nathalie Costedoat-Chalumeau
- APHP, Service de Médecine Interne, Centre de Référence des Maladies Auto-Immunes Systémiques Rares d’Ile de France, Hôpital Cochin, 27 rue du Faubourg St-Jacques, CEDEX 14, 75679 Paris, France;
- INSERM U 1153, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Université de Paris, 75006 Paris, France
| | - Jean-Charles Piette
- Service de Médecine Interne, AP-HP Groupe Hospitalier Pitié-Salpêtrière, 75013 Paris, France;
| | - Julien Haroche
- Assistance Publique–Hôpitaux de Paris (AP-HP), Groupement Hospitalier Pitié–Salpêtrière (GHPS), French National Reference Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Institut E3M, Sorbonne Université, 75252 Paris, France;
| | - Laurent Sailler
- Internal Medicine Department, CHU de Toulouse—Hôpital Purpan, 31300 Toulouse, France;
| | | | - Jean-François Viallard
- Hôpital Haut-Lévêque, CHU de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Université de BORDEAUX, 5 Avenue de Magellan, 33604 Pessac, France;
| | - Patrick Jego
- Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, Inserm, EHESP, University of Rennes, 35000 Rennes, France;
- Department of Internal Medicine, Rennes University Hospital, 35203 Rennes, France
| | - Arnaud Hot
- Service de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69437 Lyon, France;
| | - Jerome Connault
- Department of Internal and Vascular Medicine, CHU de Nantes, 44000 Nantes, France;
| | | | - Elisabeth Aslangul
- Service de Médecine Interne, Hôpital Louis-Mourier, Assistance Publique-Hôpitaux de Paris, 92701 Colombes, France;
- UPD5, Université Paris-Descartes, rue de l’École-de-Médecine, 75006 Paris, France
| | - Nicolas Limal
- Département de Médecine Interne, Hôpital Henri Mondor, APHP Université Paris-Est Créteil, 94010 Créteil, France;
| | - Fabrice Bonnet
- Department of Internal Medicine and Infectious Diseases, Bordeaux University Hospital, Saint André Hospital, 33000 Bordeaux, France;
| | - Stanislas Faguer
- Département de Néphrologie et Transplantation d’Organes, Centre de Référence des Maladies Rénales Rares, CHU de Toulouse, 31000 Toulouse, France;
| | - Olivier Chosidow
- Department of Dermatology, APHP, Hôpital Henri-Mondor, 94010 Créteil, France;
- Research Group Dynamic, EA7380, Faculté de Santé de Créteil, Ecole Nationale Vétérinaire d’Alfort, USC ANSES, Université Paris-Est Créteil, 94010 Créteil, France
| | - Christophe Deligny
- Service de Médecine Interne, CHU de Fort de France, 97200 Fort de France, France;
| | | | | | - Bruno Pereira
- Biostatistics Unit (DRCI), University Hospital Clermont-Ferrand, 63000 Clermont-Ferrand, France;
| | - Olivier Aumaitre
- Médecine Interne, CHU Gabriel Montpied, 63000 Clermont-Ferrand, France; (O.A.); (M.A.)
- M2iSH, UMR 1071 Inserm, INRA USC 2018, University of Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Marc André
- Médecine Interne, CHU Gabriel Montpied, 63000 Clermont-Ferrand, France; (O.A.); (M.A.)
- M2iSH, UMR 1071 Inserm, INRA USC 2018, University of Clermont Auvergne, 63000 Clermont-Ferrand, France
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15
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Farge D, Loisel S, Resche-Rigon M, Lansiaux P, Colmegna I, Langlais D, Charles C, Pugnet G, Maria ATJ, Chatelus E, Martin T, Hachulla E, Kheav VD, Lambert NC, Wang H, Michonneau D, Martinaud C, Sensebé L, Cras A, Tarte K. Safety and preliminary efficacy of allogeneic bone marrow-derived multipotent mesenchymal stromal cells for systemic sclerosis: a single-centre, open-label, dose-escalation, proof-of-concept, phase 1/2 study. The Lancet Rheumatology 2022. [DOI: 10.1016/s2665-9913(21)00326-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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16
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Rozier P, Maumus M, Maria ATJ, Toupet K, Jorgensen C, Guilpain P, Noël D. Lung Fibrosis Is Improved by Extracellular Vesicles from IFNγ-Primed Mesenchymal Stromal Cells in Murine Systemic Sclerosis. Cells 2021; 10:2727. [PMID: 34685707 PMCID: PMC8535048 DOI: 10.3390/cells10102727] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Systemic sclerosis (SSc) is a severe autoimmune disease for which mesenchymal stromal cells (MSCs)-based therapy was reported to reduce SSc-related symptoms in pre-clinical studies. Recently, extracellular vesicles released by MSCs (MSC-EVs) were shown to mediate most of their therapeutic effect. Here, we aimed at improving their efficacy by increasing the MSC-EV dose or by IFNγ-priming of MSCs. METHODS small size (ssEVs) and large size EVs (lsEVs) were recovered from murine MSCs that were pre-activated using 1 or 20 ng/mL of IFNγ. In the HOCl-induced model of SSc, mice were treated with EVs at day 21 and sacrificed at day 42. Lung and skin samples were collected for histological and molecular analyses. RESULTS increasing the dose of MSC-EVs did not add benefit to the dose previously reported to be efficient in SSc. By contrast, IFNγ pre-activation improved MSC-EVs-based treatment, essentially in the lungs. Low doses of IFNγ decreased the expression of fibrotic markers, while high doses improved remodeling and anti-inflammatory markers. IFNγ pre-activation upregulated iNos, IL1ra and Il6 in MSCs and ssEVs and the PGE2 protein in lsEVs. CONCLUSION IFNγ-pre-activation improved the therapeutic effect of MSC-EVs preferentially in the lungs of SSc mice by modulating anti-inflammatory and anti-fibrotic markers.
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Affiliation(s)
- Pauline Rozier
- IRMB, University of Montpellier, INSERM, 34295 Montpellier, France; (P.R.); (M.M.); (A.T.J.M.); (K.T.); (C.J.); (P.G.)
| | - Marie Maumus
- IRMB, University of Montpellier, INSERM, 34295 Montpellier, France; (P.R.); (M.M.); (A.T.J.M.); (K.T.); (C.J.); (P.G.)
| | - Alexandre Thibault Jacques Maria
- IRMB, University of Montpellier, INSERM, 34295 Montpellier, France; (P.R.); (M.M.); (A.T.J.M.); (K.T.); (C.J.); (P.G.)
- Department of Internal Medicine, Multi-Organic Diseases, CHU, 34295 Montpellier, France
| | - Karine Toupet
- IRMB, University of Montpellier, INSERM, 34295 Montpellier, France; (P.R.); (M.M.); (A.T.J.M.); (K.T.); (C.J.); (P.G.)
| | - Christian Jorgensen
- IRMB, University of Montpellier, INSERM, 34295 Montpellier, France; (P.R.); (M.M.); (A.T.J.M.); (K.T.); (C.J.); (P.G.)
- Clinical Immunology and Osteoarticular Disease Therapeutic Unit, Department of Rheumatology, CHU, 34295 Montpellier, France
| | - Philippe Guilpain
- IRMB, University of Montpellier, INSERM, 34295 Montpellier, France; (P.R.); (M.M.); (A.T.J.M.); (K.T.); (C.J.); (P.G.)
- Department of Internal Medicine, Multi-Organic Diseases, CHU, 34295 Montpellier, France
| | - Danièle Noël
- IRMB, University of Montpellier, INSERM, 34295 Montpellier, France; (P.R.); (M.M.); (A.T.J.M.); (K.T.); (C.J.); (P.G.)
- Clinical Immunology and Osteoarticular Disease Therapeutic Unit, Department of Rheumatology, CHU, 34295 Montpellier, France
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17
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Lansiaux P, Loisel S, Castilla-Llorente C, Fontenille C, Kabdani S, Marjanovic Z, Pugnet G, Puyade M, Robert E, Terriou L, Ait Abdallah N, Maria ATJ, Michel L, Tréton X, Yakoub-Agha I, Farge D. [Autologous hematopoietic cells for severe autoimmune diseases: Guidelines of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) for immune monitoring and biobanking]. Bull Cancer 2021; 108:S72-S81. [PMID: 34272057 DOI: 10.1016/j.bulcan.2021.03.020] [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: 02/04/2021] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 12/29/2022]
Abstract
Autologous hematopoietic cell transplantation (AHCT) is a new treatment option for patients with severe autoimmune diseases (AD), based on the use of intensive or myeloablative chemotherapy to eradicate the pathogenic autoreactive immune cells and to allow the installation of a new and tolerant immune system during immune reconstitution process. Immune reconstitution analysis after AHCT is required for patients clinical follow-up and to further identify biological and immunological markers of the clinical response to develop individualized AHCT protocols. These MATHEC-SFGM-TC good clinical practice guidelines were developed by a multidisciplinary group of experts including members of the french reference center for stem Cell Therapy in Auto-immune Diseases (MATHEC), hematologists from the French speaking Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) and experts in immune monitoring and biobanking. The objectives are to provide practical recommandations for immune monitoring and biobanking of samples in patients with AD undergoing AHCT, for routine care purposes and investigational studies.
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Affiliation(s)
- Pauline Lansiaux
- AP-HP, hôpital Saint-Louis, unité de médecine interne (UF 04): CRMR MATHEC, Maladies auto-immunes et thérapie cellulaire, Centre de Référence des Maladies auto-immunes systémiques Rares d'Ile-de-France MATHEC (FAI2R), 75010 Paris, France; Université de Paris, Institut de recherche Saint-Louis, recherche clinique appliquée à l'hématologie, EA3518, 75010 Paris, France
| | - Séverine Loisel
- CHU de Rennes, établissement français du sang Bretagne, SITI, 35000 Rennes, France
| | - Cristina Castilla-Llorente
- Gustave-Roussy Cancer Center, département d'hématologie, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - Claire Fontenille
- Institut Paoli-Calmettes, Association CRYOSTEM, 13009 Marseille, France
| | - Sarah Kabdani
- EFS HFNO site de Lille, unité de thérapie cellulaire, parc Eurasanté, 20, avenue Pierre-Mauroy, 59373 Loos, France
| | - Zora Marjanovic
- AP-HP, hôpital Saint-Antoine, service d'hématologie, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - Grégory Pugnet
- CHU de Rangueil, service de médecine interne et immunologie clinique, 1, avenue du Professeur Jean-Poulhès, 31059 Toulouse cedex 9, France
| | - Mathieu Puyade
- CHU de Poitiers, service de médecine interne, 2, rue de la Miletrie, 86021 Poitiers, France; CHU de Poitiers, CIC-1402, 2, rue de la Miletrie, 86021 Poitiers, France
| | - Emilie Robert
- Institut Paoli-Calmettes, Association CRYOSTEM, 13009 Marseille, France
| | - Louis Terriou
- Hôpital Claude-Huriez, CHRU Lille, service de médecine interne et immunologie clinique, rue Michel-Polonovski, 59000 Lille, France
| | - Nassim Ait Abdallah
- AP-HP, hôpital Saint-Louis, unité de médecine interne (UF 04): CRMR MATHEC, Maladies auto-immunes et thérapie cellulaire, Centre de Référence des Maladies auto-immunes systémiques Rares d'Ile-de-France MATHEC (FAI2R), 75010 Paris, France; Université de Paris, Institut de recherche Saint-Louis, recherche clinique appliquée à l'hématologie, EA3518, 75010 Paris, France
| | - Alexandre Thibault Jacques Maria
- CHRU de Montpellier, hôpital Saint-Éloi, médecine interne : maladies multi-organiques de l'adulte, Inserm U1183 IRMB, 34295 Montpellier cedex 5, France
| | - Laure Michel
- CHU de Rennes, seervice de neurologie, Rennes, France
| | - Xavier Tréton
- Hôpital Beaujon, université de Paris, service de gastro-entérologie, MICI et Assistance Nutritive, DMU DIGEST, 100, boulevard Leclerc, 92110 Clichy, France
| | | | - Dominique Farge
- AP-HP, hôpital Saint-Louis, unité de médecine interne (UF 04): CRMR MATHEC, Maladies auto-immunes et thérapie cellulaire, Centre de Référence des Maladies auto-immunes systémiques Rares d'Ile-de-France MATHEC (FAI2R), 75010 Paris, France; Université de Paris, Institut de recherche Saint-Louis, recherche clinique appliquée à l'hématologie, EA3518, 75010 Paris, France; McGill University, Department of Medicine, H3A 1A1, Montreal, Canada.
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Rozier P, Maumus M, Bony C, Maria ATJ, Sabatier F, Jorgensen C, Guilpain P, Noël D. Extracellular Vesicles Are More Potent Than Adipose Mesenchymal Stromal Cells to Exert an Anti-Fibrotic Effect in an In Vitro Model of Systemic Sclerosis. Int J Mol Sci 2021; 22:ijms22136837. [PMID: 34202139 PMCID: PMC8269376 DOI: 10.3390/ijms22136837] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 12/14/2022] Open
Abstract
Systemic sclerosis (SSc) is a complex disorder resulting from dysregulated interactions between the three main pathophysiological axes: fibrosis, immune dysfunction, and vasculopathy, with no specific treatment available to date. Adipose tissue-derived mesenchymal stromal cells (ASCs) and their extracellular vesicles (EVs) have proved efficacy in pre-clinical murine models of SSc. However, their precise action mechanism is still not fully understood. Because of the lack of availability of fibroblasts isolated from SSc patients (SSc-Fb), our aim was to determine whether a TGFβ1-induced model of human myofibroblasts (Tβ-Fb) could reproduce the characteristics of SSc-Fb and be used to evaluate the anti-fibrotic function of ASCs and their EVs. We found out that Tβ-Fb displayed the main morphological and molecular features of SSc-Fb, including the enlarged hypertrophic morphology and expression of several markers associated with the myofibroblastic phenotype. Using this model, we showed that ASCs were able to regulate the expression of most myofibroblastic markers on Tβ-Fb and SSc-Fb, but only when pre-stimulated with TGFβ1. Of interest, ASC-derived EVs were more effective than parental cells for improving the myofibroblastic phenotype. In conclusion, we provided evidence that Tβ-Fb are a relevant model to mimic the main characteristics of SSc fibroblasts and investigate the mechanism of action of ASCs. We further reported that ASC-EVs are more effective than parental cells suggesting that the TGFβ1-induced pro-fibrotic environment may alter the function of ASCs.
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Affiliation(s)
- Pauline Rozier
- INSERM U1183, Hôpital Saint-Eloi, IRMB, University of Montpellier, 80 Avenue Augustin Fliche, CEDEX 5, 34295 Montpellier, France; (P.R.); (M.M.); (C.B.); (C.J.); (P.G.)
| | - Marie Maumus
- INSERM U1183, Hôpital Saint-Eloi, IRMB, University of Montpellier, 80 Avenue Augustin Fliche, CEDEX 5, 34295 Montpellier, France; (P.R.); (M.M.); (C.B.); (C.J.); (P.G.)
| | - Claire Bony
- INSERM U1183, Hôpital Saint-Eloi, IRMB, University of Montpellier, 80 Avenue Augustin Fliche, CEDEX 5, 34295 Montpellier, France; (P.R.); (M.M.); (C.B.); (C.J.); (P.G.)
| | | | - Florence Sabatier
- INSERM, INRA, C2VN, Aix Marseille University, 13005 Marseille, France;
| | - Christian Jorgensen
- INSERM U1183, Hôpital Saint-Eloi, IRMB, University of Montpellier, 80 Avenue Augustin Fliche, CEDEX 5, 34295 Montpellier, France; (P.R.); (M.M.); (C.B.); (C.J.); (P.G.)
- Clinical Immunology and Osteoarticular Disease Therapeutic Unit, Department of Rheumatology, CHU, 34295 Montpellier, France
| | - Philippe Guilpain
- INSERM U1183, Hôpital Saint-Eloi, IRMB, University of Montpellier, 80 Avenue Augustin Fliche, CEDEX 5, 34295 Montpellier, France; (P.R.); (M.M.); (C.B.); (C.J.); (P.G.)
- Department of Internal Medicine, Multi-Organic Diseases, CHU, 34295 Montpellier, France;
| | - Danièle Noël
- INSERM U1183, Hôpital Saint-Eloi, IRMB, University of Montpellier, 80 Avenue Augustin Fliche, CEDEX 5, 34295 Montpellier, France; (P.R.); (M.M.); (C.B.); (C.J.); (P.G.)
- Clinical Immunology and Osteoarticular Disease Therapeutic Unit, Department of Rheumatology, CHU, 34295 Montpellier, France
- Correspondence: ; Tel.: +33-4-67-33-04-73; Fax: +33-4-67-33-01-13
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19
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Rozier P, Maumus M, Maria ATJ, Toupet K, Lai-Kee-Him J, Jorgensen C, Guilpain P, Noël D. Mesenchymal stromal cells-derived extracellular vesicles alleviate systemic sclerosis via miR-29a-3p. J Autoimmun 2021; 121:102660. [PMID: 34020253 DOI: 10.1016/j.jaut.2021.102660] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 04/16/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 12/16/2022]
Abstract
Systemic sclerosis (SSc) is a potentially lethal disease with no curative treatment. Mesenchymal stromal cells (MSCs) have proved efficacy in SSc but no data is available on MSC-derived extracellular vesicles (EVs) in this multi-organ fibrosis disease. Small size (ssEVs) and large size EVs (lsEVs) were isolated from murine MSCs or human adipose tissue-derived MSCs (ASCs). Control antagomiR (Ct) or antagomiR-29a-3p (A29a) were transfected in MSCs and ASCs before EV production. EVs were injected in the HOCl-induced SSc model at day 21 and euthanasized at day 42. We found that both ssEVs and lsEVs were effective to slow-down the course of the disease. All disease parameters improved in skin and lungs. Interestingly, down-regulating miR-29a-3p in MSCs totally abolished therapeutic efficacy. Besides, we demonstrated a similar efficacy of human ASC-EVs and importantly, EVs from A29a-transfected ASCs failed to improve skin fibrosis. We identified Dnmt3a, Pdgfrbb, Bcl2, Bcl-xl as target genes of miR-29a-3p whose regulation was associated with skin fibrosis improvement. Our study highlights the therapeutic role of miR-29a-3p in SSc and the importance of regulating methylation and apoptosis.
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Affiliation(s)
- Pauline Rozier
- IRMB, University of Montpellier, INSERM, Montpellier, France
| | - Marie Maumus
- IRMB, University of Montpellier, INSERM, Montpellier, France
| | - Alexandre Thibault Jacques Maria
- IRMB, University of Montpellier, INSERM, Montpellier, France; Department of Internal Medicine, Multi-organic Diseases, CHU, Montpellier, France
| | - Karine Toupet
- IRMB, University of Montpellier, INSERM, Montpellier, France
| | - Joséphine Lai-Kee-Him
- Centre de Biochimie Structurale (CBS), University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Christian Jorgensen
- IRMB, University of Montpellier, INSERM, Montpellier, France; Clinical Immunology and Osteoarticular Disease Therapeutic Unit, Department of Rheumatology, CHU, Montpellier, France
| | - Philippe Guilpain
- IRMB, University of Montpellier, INSERM, Montpellier, France; Department of Internal Medicine, Multi-organic Diseases, CHU, Montpellier, France
| | - Danièle Noël
- IRMB, University of Montpellier, INSERM, Montpellier, France; Clinical Immunology and Osteoarticular Disease Therapeutic Unit, Department of Rheumatology, CHU, Montpellier, France.
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20
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Avouac J, Drumez E, Hachulla E, Seror R, Georgin-Lavialle S, El Mahou S, Pertuiset E, Pham T, Marotte H, Servettaz A, Domont F, Chazerain P, Devaux M, Claudepierre P, Langlois V, Mekinian A, Maria ATJ, Banneville B, Fautrel B, Pouchot J, Thomas T, Flipo RM, Richez C. COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases treated with rituximab: a cohort study. Lancet Rheumatol 2021; 3:e419-e426. [PMID: 33786454 PMCID: PMC7993930 DOI: 10.1016/s2665-9913(21)00059-x] [Citation(s) in RCA: 166] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Various observations have suggested that the course of COVID-19 might be less favourable in patients with inflammatory rheumatic and musculoskeletal diseases receiving rituximab compared with those not receiving rituximab. We aimed to investigate whether treatment with rituximab is associated with severe COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases. Methods In this cohort study, we analysed data from the French RMD COVID-19 cohort, which included patients aged 18 years or older with inflammatory rheumatic and musculoskeletal diseases and highly suspected or confirmed COVID-19. The primary endpoint was the severity of COVID-19 in patients treated with rituximab (rituximab group) compared with patients who did not receive rituximab (no rituximab group). Severe disease was defined as that requiring admission to an intensive care unit or leading to death. Secondary objectives were to analyse deaths and duration of hospital stay. The inverse probability of treatment weighting propensity score method was used to adjust for potential confounding factors (age, sex, arterial hypertension, diabetes, smoking status, body-mass index, interstitial lung disease, cardiovascular diseases, cancer, corticosteroid use, chronic renal failure, and the underlying disease [rheumatoid arthritis vs others]). Odds ratios and hazard ratios and their 95% CIs were calculated as effect size, by dividing the two population mean differences by their SD. This study is registered with ClinicalTrials.gov, NCT04353609. Findings Between April 15, 2020, and Nov 20, 2020, data were collected for 1090 patients (mean age 55·2 years [SD 16·4]); 734 (67%) were female and 356 (33%) were male. Of the 1090 patients, 137 (13%) developed severe COVID-19 and 89 (8%) died. After adjusting for potential confounding factors, severe disease was observed more frequently (effect size 3·26, 95% CI 1·66–6·40, p=0·0006) and the duration of hospital stay was markedly longer (0·62, 0·46–0·85, p=0·0024) in the 63 patients in the rituximab group than in the 1027 patients in the no rituximab group. 13 (21%) of 63 patients in the rituximab group died compared with 76 (7%) of 1027 patients in the no rituximab group, but the adjusted risk of death was not significantly increased in the rituximab group (effect size 1·32, 95% CI 0·55–3·19, p=0·53). Interpretation Rituximab therapy is associated with more severe COVID-19. Rituximab will have to be prescribed with particular caution in patients with inflammatory rheumatic and musculoskeletal diseases. Funding None.
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Affiliation(s)
- Jérôme Avouac
- Université de Paris, Service de Rhumatologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Centre Université de Paris, Paris, France
| | - Elodie Drumez
- ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Université de Lille, CHU Lille, Lille, France
| | - Eric Hachulla
- Université de Lille, INSERM, CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Autoimmunes Systémiques Rares Du Nord et Nord-Ouest de France, U1286-INFINITE: Institute for Translational Research in Inflammation, Le Kremlin-Bicêtre, France
| | - Raphaèle Seror
- Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Service de Rhumatologie, Centre de Référence des Maladies Autoimmunes Systémiques Rares, Hôpital Bicêtre, INSERM UMR 1184, Le Kremlin-Bicêtre, France
| | - Sophie Georgin-Lavialle
- Sorbonne Université, Service de Médecine Interne, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Soumaya El Mahou
- Service de Rhumatologie, Centre Hospitalier de Tourcoing, Tourcoing, France
| | - Edouard Pertuiset
- Service de Rhumatologie, Centre Hospitalier René Dubos, Pontoise, France
| | - Thao Pham
- Service de Rhumatologie, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Hubert Marotte
- INSERM 1059, Université de Lyon, Saint-Etienne, France.,Service de Rhumatologie and CIC-1408, CHU de Saint-Etienne, Saint-Etienne, France.,CHU de Saint-Etienne, Saint-Etienne, France
| | - Amélie Servettaz
- Service de Médecine Interne, Maladies Infectieuses et Immunologie Clinique, CHU Reims, Hôpital Robert Debré, Reims, France
| | - Fanny Domont
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Service de Médecine Interne et Immunologie Clinique, Paris, France
| | - Pascal Chazerain
- Service de Rhumatologie et Médecine Interne, Groupe Hospitalier Diaconesses-croix St-Simon, Paris, France
| | - Mathilde Devaux
- Service de Médecine Interne, CHI Poissy Saint Germain, Poissy, France
| | - Pascal Claudepierre
- EpiDermE, Université Paris Est Créteil, Service de Rhumatologie, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Vincent Langlois
- Service de Maladies Infectieuses et Médecine Interne, Groupe Hospitalier du Havre, Le Havre, France
| | - Arsène Mekinian
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Médecine Interne et Inflammation- (DMU i3), Paris, France
| | | | - Béatrice Banneville
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Rhumatologie, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Bruno Fautrel
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Rhumatologie, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Jacques Pouchot
- Hôpital Européen Georges-Pompidou, Médecine Interne, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Thierry Thomas
- Service de Rhumatologie, Hôpital Nord, CHU de Saint-Etienne, INSERM U1059, Université de Lyon-Université Jean Monnet, Saint Etienne, France
| | | | - Christophe Richez
- Service de Rhumatologie, Centre de Référence des Maladies Autoimmunes Systémiques Rares de l'Est et du Sud-Ouest de France, CHU de Bordeaux and UMR-CNRS 5164, Université de Bordeaux, Bordeaux, France
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21
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Padern G, Duflos C, Ferreira R, Assou S, Guilpain P, Maria ATJ, Goulabchand R, Galea P, Jurtela M, Jorgensen C, Pers YM. Identification of a Novel Serum Proteomic Signature for Primary Sjögren's Syndrome. Front Immunol 2021; 12:631539. [PMID: 33708222 PMCID: PMC7942395 DOI: 10.3389/fimmu.2021.631539] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/04/2021] [Indexed: 12/13/2022] Open
Abstract
Context Primary Sjögren's syndrome (pSS) is a complex heterogeneous autoimmune disease (AID) which can mimic rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE). Our exploratory study investigated serum biomarkers that may discriminate pSS from RA and SLE. Methods Serum concentrations of 63 biomarkers involved in immune cell trafficking, inflammatory response, cellular movement, and cell-to-cell signaling were measured in AID patients, included prospectively into the study at the Montpellier University Hospital. A multivariate analysis by multiple logistic regression was performed, and discriminative power assessed using logistic regression adjusted on significant demographic factors. Results Among the 95 patients enrolled, 42 suffered from pSS, 28 from RA, and 25 from SLE. Statistical analysis showed that concentrations of BDNF (OR = 0.493 with 95% CI [0.273-0.891]; p = 0.0193) and I-TAC/CXCL11 (OR = 1.344 with 95% CI [1.027-1.76]; p = 0.0314) can significantly discriminate pSS from RA. Similarly, greater concentrations of sCD163 (OR = 0.803 with 95% CI [0.649-0.994]; p = 0.0436), Fractalkine/CX3CL1 (OR = 0.534 with 95% CI [0.287-0. 991]; p = 0.0466), MCP-1/CCL2 (OR = 0.839 with 95% CI [0.732-0.962]; p = 0.0121), and TNFa (OR = 0.479 with 95% CI [0.247-0.928]; p = 0.0292) were associated with SLE diagnosis compared to pSS. In addition, the combination of low concentrations of BDNF and Fractalkine/CX3CL1 was highly specific for pSS (specificity 96.2%; positive predictive value 80%) compared to RA and SLE, as well as the combination of high concentrations of I-TAC/CXCL11 and low concentrations of sCD163 (specificity 98.1%; positive predictive value 75%). Conclusion Our study highlights biomarkers potentially involved in pSS, RA, and SLE pathophysiology that could be useful for developing a pSS-specific diagnostic tool.
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Affiliation(s)
- Guillaume Padern
- IRMB, University of Montpellier, INSERM, CHU Montpellier, Montpellier, France
| | - Claire Duflos
- Clinical Research and Epidemiology Unit, CHU Montpellier, Montpellier University, Montpellier, France
| | - Rosanna Ferreira
- IRMB, University of Montpellier, INSERM, CHU Montpellier, Montpellier, France
| | - Said Assou
- IRMB, University of Montpellier, INSERM, CHU Montpellier, Montpellier, France
| | - Philippe Guilpain
- IRMB, University of Montpellier, INSERM, CHU Montpellier, Montpellier, France
- Internal Medicine and Multi-Organic Diseases Department, Hôpital Saint Éloi, CHU Montpellier, Montpellier, France
| | - Alexandre Thibault Jacques Maria
- IRMB, University of Montpellier, INSERM, CHU Montpellier, Montpellier, France
- Internal Medicine and Multi-Organic Diseases Department, Hôpital Saint Éloi, CHU Montpellier, Montpellier, France
| | - Radjiv Goulabchand
- Internal Medicine Department, Caremeau University Hospital, Nîmes, France
| | - Pascale Galea
- BioRad Laboratory, Research and Development Department, Montpellier, France
| | - Maja Jurtela
- Clinical Research and Epidemiology Unit, CHU Montpellier, Montpellier University, Montpellier, France
| | - Christian Jorgensen
- IRMB, University of Montpellier, INSERM, CHU Montpellier, Montpellier, France
| | - Yves-Marie Pers
- IRMB, University of Montpellier, INSERM, CHU Montpellier, Montpellier, France
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22
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Rivet V, Quantin X, Faillie JL, Lesage C, Meunier L, Faure S, Hillaire-Buys D, Lesouder C, Fabre S, Assenat E, Rullier P, Guilpain P, Maria ATJ. [Management of immune-related toxicities associated with immune checkpoints inhibitors: Data from the multidisciplinary meeting « ToxImmun » in Eastern Occitania]. Rev Med Interne 2021; 42:310-319. [PMID: 33485701 DOI: 10.1016/j.revmed.2021.01.002] [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: 06/07/2020] [Revised: 12/06/2020] [Accepted: 01/01/2021] [Indexed: 10/22/2022]
Abstract
Immune checkpoint inhibitors (ICIs) can cause numerous and complex immune-related adverse events whose management need a multidisciplinary approach. Herein, we investigated 114 requests, mostly concerning patients suffering from lung cancer, that were submitted to the « ToxImmun » multidisciplinary meeting in Eastern Occitania between December the 17th 2018 and January the 20th 2020. The leading reasons for the request concerned the putative causal link between immunotherapy and immune-toxicity and its management, followed by possible retreatment after temporary withdrawn because of adverse event, and finally the possibility to initiate ICIs in patients with pre-existing autoimmunity. Colitis, hepatitis and myocarditis were the most frequent immune-related adverse events (IRAEs), both all grade and grade 3-4. Sicca syndrome (with or without Sjogren criteria) was also frequent (26% of cases) and seems to be associated with severe toxicity and multi-toxicity. The mean time to first IRAE was 3.8 months, a time shortened with the use of anti-PD-L1 agents or ICI combination. A majority of requests came from initial evaluation by the internist confirming the early and main role of this specialty in the management of immunotoxicity. Expansion of this regional multidisciplinary meeting, coordinated by internists and medical oncologists, could improve management of immune-related adverse events for the patients' benefits.
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Affiliation(s)
- V Rivet
- Service de médecine interne : maladies multi-organiques de l'adulte, hôpital Saint-Éloi, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France; Faculté de médecine, université de Montpellier, Montpellier, France
| | - X Quantin
- Faculté de médecine, université de Montpellier, Montpellier, France; Service d'oncologie médicale-oncologie thoracique, institut du cancer de Montpellier, Val d'Aurelle, Montpellier, France
| | - J L Faillie
- Faculté de médecine, université de Montpellier, Montpellier, France; Département de pharmacologie médicale et toxicologie, centre régional de pharmacovigilance, hôpital Lapeyronie, CHRU de Montpellier, Montpellier, France
| | - C Lesage
- Service de dermatologie clinique, hôpital Saint-Éloi, CHRU de Montpellier, Montpellier, France
| | - L Meunier
- Faculté de médecine, université de Montpellier, Montpellier, France; Service d'hépato-gastro-entérologie, hôpital Saint-Éloi, CHRU de Montpellier, Montpellier, France
| | - S Faure
- Service d'hépato-gastro-entérologie, hôpital Saint-Éloi, CHRU de Montpellier, Montpellier, France
| | - D Hillaire-Buys
- Faculté de médecine, université de Montpellier, Montpellier, France; Département de pharmacologie médicale et toxicologie, centre régional de pharmacovigilance, hôpital Lapeyronie, CHRU de Montpellier, Montpellier, France
| | - C Lesouder
- Département de pharmacologie médicale et toxicologie, centre régional de pharmacovigilance, hôpital Lapeyronie, CHRU de Montpellier, Montpellier, France
| | - S Fabre
- Service de médecine interne, clinique Beau-Soleil, Montpellier, France
| | - E Assenat
- Faculté de médecine, université de Montpellier, Montpellier, France; Service d'oncologie médicale, hôpital Saint-Éloi, CHRU de Montpellier, Montpellier, France
| | - P Rullier
- Service de médecine interne : maladies multi-organiques de l'adulte, hôpital Saint-Éloi, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| | - P Guilpain
- Service de médecine interne : maladies multi-organiques de l'adulte, hôpital Saint-Éloi, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France; Faculté de médecine, université de Montpellier, Montpellier, France; IRMB Institute for regenerative medicine and biotherapy, Inserm U1183, hôpital Saint-Éloi, Montpellier, France
| | - A T J Maria
- Service de médecine interne : maladies multi-organiques de l'adulte, hôpital Saint-Éloi, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France; Faculté de médecine, université de Montpellier, Montpellier, France; IRMB Institute for regenerative medicine and biotherapy, Inserm U1183, hôpital Saint-Éloi, Montpellier, France.
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Maria ATJ, Diaz-Cau I, Benejean JM, Nutz A, Schiffmann A, Biron-Andreani C, Guilpain P. Flare of Antiphospholipid Syndrome in the Course of COVID-19. TH Open 2020; 4:e207-e210. [PMID: 32935073 PMCID: PMC7486139 DOI: 10.1055/s-0040-1716735] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 08/12/2020] [Indexed: 12/20/2022] Open
Abstract
We report the case of a 48-year-old man followed since 2013 for primary antiphospholipid syndrome (APLS) revealed by venous thromboembolism in the presence of antiphospholipid antibodies (APL-Abs, anticardiolipin and anti-β-2-glycoprotein-1), who decompensated in the course of coronavirus disease (COVID-19). Despite efficient anticoagulation, he suffered bilateral adrenal glands hemorrhage and limb arterial ischemia. The tropism of severe acute respiratory syndrome coronavirus-2 for endothelium can lead to microangiopathy and increased risk for thrombosis. If APL-Abs positivity can be an epiphenomenon under inflammatory and prothrombotic conditions, COVID-19 was herein responsible for disseminated thrombosis and a threat of catastrophic APLS, despite efficient anticoagulation.
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Affiliation(s)
- Alexandre Thibault Jacques Maria
- Department of Internal Medicine-Multi-organ Diseases, Local Referral Center for Auto-immune Diseases, Montpellier School of Medicine, Saint-Eloi University Hospital, University of Montpellier, Montpellier, France.,IRMB, Inserm U1183, CHU Montpellier (Saint-Eloi University Hospital), University of Montpellier, Montpellier, France
| | - Isabelle Diaz-Cau
- Hemostasis Laboratory, Referral Center for Hemophilia, Montpellier University Hospital, Saint-Eloi University Hospital, Montpellier, France
| | | | - Anaïs Nutz
- Department of Medicine and Endocrinology, Narbonne Hospital, Narbonne, France
| | - Aurélie Schiffmann
- Department of Internal Medicine-Multi-organ Diseases, Local Referral Center for Auto-immune Diseases, Montpellier School of Medicine, Saint-Eloi University Hospital, University of Montpellier, Montpellier, France
| | - Christine Biron-Andreani
- Hemostasis Laboratory, Referral Center for Hemophilia, Montpellier University Hospital, Saint-Eloi University Hospital, Montpellier, France
| | - Philippe Guilpain
- Department of Internal Medicine-Multi-organ Diseases, Local Referral Center for Auto-immune Diseases, Montpellier School of Medicine, Saint-Eloi University Hospital, University of Montpellier, Montpellier, France.,IRMB, Inserm U1183, CHU Montpellier (Saint-Eloi University Hospital), University of Montpellier, Montpellier, France
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Villard O, Morquin D, Molinari N, Raingeard I, Nagot N, Cristol JP, Jung B, Roubille C, Foulongne V, Fesler P, Lamure S, Taourel P, Konate A, Maria ATJ, Makinson A, Bertchansky I, Larcher R, Klouche K, Le Moing V, Renard E, Guilpain P. The Plasmatic Aldosterone and C-Reactive Protein Levels, and the Severity of Covid-19: The Dyhor-19 Study. J Clin Med 2020; 9:jcm9072315. [PMID: 32708205 PMCID: PMC7408691 DOI: 10.3390/jcm9072315] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 01/08/2023] Open
Abstract
Background. The new coronavirus SARS-CoV-2, responsible for the Covid-19 pandemic, uses the angiotensin converting enzyme type 2 (ACE2), a physiological inhibitor of the renin angiotensin aldosterone system (RAAS), as a cellular receptor to infect cells. Since the RAAS can induce and modulate pro-inflammatory responses, it could play a key role in the pathophysiology of Covid-19. Thus, we aimed to determine the levels of plasma renin and aldosterone as indicators of RAAS activation in a series of consecutively admitted patients for Covid-19 in our clinic. Methods. Plasma renin and aldosterone levels were measured, among the miscellaneous investigations needed for Covid-19 management, early after admission in our clinic. Disease severity was assessed using a seven-category ordinal scale. Primary outcome of interest was the severity of patients’ clinical courses. Results. Forty-four patients were included. At inclusion, 12 patients had mild clinical status, 25 moderate clinical status and 7 severe clinical status. In univariate analyses, aldosterone and C-reactive protein (CRP) levels at inclusion were significantly higher in patients with severe clinical course as compared to those with mild or moderate course (p < 0.01 and p = 0.03, respectively). In multivariate analyses, only aldosterone and CRP levels remained positively associated with severity. We also observed a positive significant correlation between aldosterone and CRP levels among patients with an aldosterone level greater than 102.5 pmol/L. Conclusions. Both plasmatic aldosterone and CRP levels at inclusion are associated with the clinical course of Covid-19. Our findings may open new perspectives in the understanding of the possible role of RAAS for Covid-19 outcome.
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Affiliation(s)
- Orianne Villard
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Endocrinology, Diabetes, Nutrition, and INSERM 1411 Clinical Investigation Centre, Montpellier University Hospital, INSERM, 34000 Montpellier, France;
- Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, 34000 Montpellier, France
| | - David Morquin
- Department of Infectious and Tropical Diseases, Montpellier University Hospital, 34000 Montpellier, France;
| | - Nicolas Molinari
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- IMAG, CNRS, University of Montpellier, Montpellier University Hospital, 34000 Montpellier, France
| | - Isabelle Raingeard
- Department of Endocrinology, Diabetes, Nutrition, and INSERM 1411 Clinical Investigation Centre, Montpellier University Hospital, INSERM, 34000 Montpellier, France;
| | - Nicolas Nagot
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- IMAG, CNRS, University of Montpellier, Montpellier University Hospital, 34000 Montpellier, France
| | - Jean-Paul Cristol
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Laboratory of Biochemistry, Montpellier University Hospital, 34000 Montpellier, France
| | - Boris Jung
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Intensive Care Medicine, Montpellier University Hospital, 34000 Montpellier, France
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34000 Montpellier, France
| | - Camille Roubille
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34000 Montpellier, France
| | - Vincent Foulongne
- Laboratory of Virology, Montpellier University Hospital, 34000 Montpellier, France;
| | - Pierre Fesler
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34000 Montpellier, France
| | - Sylvain Lamure
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Infectious and Tropical Diseases, Montpellier University Hospital, 34000 Montpellier, France;
| | - Patrice Taourel
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Radiology, Montpellier University Hospital, 34000 Montpellier, France
| | - Amadou Konate
- Department of Internal Medicine—Multi-Organ Diseases, Local Referral Center for Auto-Immune Diseases, Montpellier University Hospital, 34000 Montpellier, France; (A.K.); (I.B.)
- Department of Internal Medicine—‘DIAGORA Unit’, Montpellier University Hospital, 34000 Montpellier, France
| | - Alexandre Thibault Jacques Maria
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Internal Medicine—Multi-Organ Diseases, Local Referral Center for Auto-Immune Diseases, Montpellier University Hospital, 34000 Montpellier, France; (A.K.); (I.B.)
- IRMB, INSERM U1183, Montpellier University Hospital, 34000 Montpellier, France
| | - Alain Makinson
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Infectious and Tropical Diseases, Montpellier University Hospital, 34000 Montpellier, France;
| | - Ivan Bertchansky
- Department of Internal Medicine—Multi-Organ Diseases, Local Referral Center for Auto-Immune Diseases, Montpellier University Hospital, 34000 Montpellier, France; (A.K.); (I.B.)
- Department of Internal Medicine—‘DIAGORA Unit’, Montpellier University Hospital, 34000 Montpellier, France
| | - Romaric Larcher
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Intensive Care Medicine, Montpellier University Hospital, 34000 Montpellier, France
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34000 Montpellier, France
| | - Kada Klouche
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Intensive Care Medicine, Montpellier University Hospital, 34000 Montpellier, France
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34000 Montpellier, France
| | - Vincent Le Moing
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Infectious and Tropical Diseases, Montpellier University Hospital, 34000 Montpellier, France;
| | - Eric Renard
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Endocrinology, Diabetes, Nutrition, and INSERM 1411 Clinical Investigation Centre, Montpellier University Hospital, INSERM, 34000 Montpellier, France;
- Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, 34000 Montpellier, France
| | - Philippe Guilpain
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Internal Medicine—Multi-Organ Diseases, Local Referral Center for Auto-Immune Diseases, Montpellier University Hospital, 34000 Montpellier, France; (A.K.); (I.B.)
- IRMB, INSERM U1183, Montpellier University Hospital, 34000 Montpellier, France
- Correspondence: ; Tel.: +33-4-67-33-73-32; Fax: +33-4-67-33-72-91
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Guilpain P, Le Bihan C, Foulongne V, Taourel P, Pansu N, Maria ATJ, Jung B, Larcher R, Klouche K, Le Moing V. Response to: 'Severe COVID-19 associated pneumonia in 3 patients with systemic sclerosis treated with rituximab' by Avouac et al. Ann Rheum Dis 2020; 80:e38. [PMID: 32503848 DOI: 10.1136/annrheumdis-2020-217955] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Philippe Guilpain
- Internal Medicine: Multi-Organic Diseases, Local Referral Center for Systemic Autoimmune Diseases, Montpellier University Hospital, Universite Montpellier, Medical School, Montpellier Cedex 5, France.,IRMB, Universite Montpellier, INSERM, Montpellier, France
| | - Clément Le Bihan
- Tropical and Infectious Diseases, Hôpital Saint Eloi, CHRU de Montpellier, Montpellier Cedex 5, Hérault, France
| | - Vincent Foulongne
- Pathogenesis and Control of Chronic Infections, Inserm, Universite Montpellier 1 Faculte de Medecine Montpellier-Nimes, Montpellier, Languedoc-Roussillon, France
| | - Patrice Taourel
- Osteoarticular Medical Imaging Section, Department of Medical Imaging, University Hospital Centre Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Nathalie Pansu
- Tropical and Infectious Diseases, Hôpital Saint Eloi, CHRU de Montpellier, Montpellier Cedex 5, Hérault, France
| | - Alexandre Thibault Jacques Maria
- Internal Medicine: Multi-Organic Diseases, Local Referral Center for Systemic Autoimmune Diseases, Montpellier University Hospital, Universite Montpellier, Medical School, Montpellier Cedex 5, France .,IRMB, Universite Montpellier, INSERM, Montpellier, France
| | - Boris Jung
- Department of Intensive Care Medicine, Lapeyronie University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France.,Lapeyronie University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Romaric Larcher
- Department of Intensive Care Medicine, Lapeyronie University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France.,Lapeyronie University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Kada Klouche
- Department of Intensive Care Medicine, Lapeyronie University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France.,Lapeyronie University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Vincent Le Moing
- Tropical and Infectious Diseases, Hôpital Saint Eloi, CHRU de Montpellier, Montpellier Cedex 5, Hérault, France
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Guilpain P, Le Bihan C, Foulongne V, Taourel P, Pansu N, Maria ATJ, Jung B, Larcher R, Klouche K, Le Moing V. Rituximab for granulomatosis with polyangiitis in the pandemic of covid-19: lessons from a case with severe pneumonia. Ann Rheum Dis 2020; 80:e10. [PMID: 32312768 DOI: 10.1136/annrheumdis-2020-217549] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Philippe Guilpain
- Internal Medicine: Multi-Organic Diseases, Local Referral Center for systemic autoimmune diseases, Saint Eloi Hospital, Univ Montpellier, Medical School, Montpellier University Hospital, Montpellier cedex 5, France .,Univ Montpellier, IRMB, Univ Montpellier, INSERM, Montpellier, France
| | - Clément Le Bihan
- Tropical and Infectious Diseases, Saint Eloi Hospital, Univ Montpellier, Medical School, Montpellier University Hospital, Montpellier cedex 5, France
| | - Vincent Foulongne
- Pathogenesis and Control of Chronic Infections, Inserm, Universite Montpellier 1 Faculte de Medecine Montpellier-Nimes, Montpellier, Languedoc-Roussillon, France
| | - Patrice Taourel
- Osteoarticular Medical Imaging Section, Department of Medical Imaging, University Hospital Centre Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Nathalie Pansu
- Tropical and Infectious Diseases, Saint Eloi Hospital, Univ Montpellier, Medical School, Montpellier University Hospital, Montpellier cedex 5, France
| | - Alexandre Thibault Jacques Maria
- Internal Medicine: Multi-Organic Diseases, Local Referral Center for systemic autoimmune diseases, Saint Eloi Hospital, Univ Montpellier, Medical School, Montpellier University Hospital, Montpellier cedex 5, France .,Univ Montpellier, IRMB, Univ Montpellier, INSERM, Montpellier, France
| | - Boris Jung
- Department of Intensive Care Medicine, Lapeyronie Hospital, Univ Montpellier, Medical School, Montpellier University Hospital, Montpellier, France.,Inserm, CNRS, PhyMedExp, Univ Montpellier, Montpellier, France
| | - Romaric Larcher
- Department of Intensive Care Medicine, Lapeyronie Hospital, Univ Montpellier, Medical School, Montpellier University Hospital, Montpellier, France.,Inserm, CNRS, PhyMedExp, Univ Montpellier, Montpellier, France
| | - Kada Klouche
- Department of Intensive Care Medicine, Lapeyronie Hospital, Univ Montpellier, Medical School, Montpellier University Hospital, Montpellier, France.,Inserm, CNRS, PhyMedExp, Univ Montpellier, Montpellier, France
| | - Vincent Le Moing
- Tropical and Infectious Diseases, Saint Eloi Hospital, Univ Montpellier, Medical School, Montpellier University Hospital, Montpellier cedex 5, France
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Goulabchand R, Hafidi A, Van de Perre P, Millet I, Maria ATJ, Morel J, Le Quellec A, Perrochia H, Guilpain P. Mastitis in Autoimmune Diseases: Review of the Literature, Diagnostic Pathway, and Pathophysiological Key Players. J Clin Med 2020; 9:jcm9040958. [PMID: 32235676 PMCID: PMC7231219 DOI: 10.3390/jcm9040958] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 12/13/2022] Open
Abstract
Mastitis frequently affects women of childbearing age. Of all the pathological breast conditions requiring specific management, autoimmune mastitis is in the third position after infection and breast cancer. The aim of this literature review was to make a comprehensive description of autoimmune diseases targeting the mammary gland. Four main histological patterns of autoimmune mastitis are described: (i) lymphocytic infiltrates; (ii) ductal ectasia; (iii) granulomatous mastitis; and (iv) vasculitis. Our literature search found that all types of autoimmune disease may target the mammary gland: organ-specific diseases (diabetes, thyroiditis); connective tissue diseases (such as systemic erythematosus lupus or Sjögren’s syndrome); vasculitides (granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, giant cell arteritis, polyarteritis nodosa, Behçet’s disease); granulomatous diseases (sarcoidosis, Crohn’s disease); and IgG4-related disease. Cases of breast-specific autoimmune diseases have also been reported, including idiopathic granulomatous mastitis. These breast-limited inflammatory diseases are sometimes the first symptom of a systemic autoimmune disease. Although autoimmune mastitis is rare, it is probably underdiagnosed or misdiagnosed. Early diagnosis may allow us to detect systemic diseases at an earlier stage, which could help to initiate a prompt, appropriate therapeutic strategy. In case of suspected autoimmune mastitis, we hereby propose a diagnostic pathway and discuss the potential pathophysiological pathways leading to autoimmune breast damage.
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Affiliation(s)
- Radjiv Goulabchand
- St Eloi Hospital, Department of Internal Medicine and Multi-Organic Diseases, Local Referral Center for Systemic and Autoimmune Diseases, 80 Avenue Augustin Fliche, F-34295 Montpellier, France; (R.G.); (A.T.J.M.); (A.L.Q.)
- Internal Medicine Department, Caremeau University Hospital, 30029 Nimes, France
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
- Inserm U1183, Institute for Regenerative Medicine and Biotherapy, St Eloi Hospital, 80 Avenue Augustin Fliche, 34295 Montpellier, France
| | - Assia Hafidi
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
- Gui de Chauliac Hospital, Pathology Department, 80 Avenue Augustin Fliche, 34295 Montpellier, France
| | - Philippe Van de Perre
- Pathogenesis and Control of Chronic Infections, Univ Montpellier, INSERM, EFS, Montpellier University Hospital, 34394 Montpellier, France;
| | - Ingrid Millet
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
- Lapeyronie Hospital, Montpellier University, Medical Imaging Department, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Alexandre Thibault Jacques Maria
- St Eloi Hospital, Department of Internal Medicine and Multi-Organic Diseases, Local Referral Center for Systemic and Autoimmune Diseases, 80 Avenue Augustin Fliche, F-34295 Montpellier, France; (R.G.); (A.T.J.M.); (A.L.Q.)
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
- Inserm U1183, Institute for Regenerative Medicine and Biotherapy, St Eloi Hospital, 80 Avenue Augustin Fliche, 34295 Montpellier, France
| | - Jacques Morel
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
- Department of Rheumatology, CHU and University of Montpellier, 34295 Montpellier, France
| | - Alain Le Quellec
- St Eloi Hospital, Department of Internal Medicine and Multi-Organic Diseases, Local Referral Center for Systemic and Autoimmune Diseases, 80 Avenue Augustin Fliche, F-34295 Montpellier, France; (R.G.); (A.T.J.M.); (A.L.Q.)
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
| | - Hélène Perrochia
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
- Gui de Chauliac Hospital, Pathology Department, 80 Avenue Augustin Fliche, 34295 Montpellier, France
| | - Philippe Guilpain
- St Eloi Hospital, Department of Internal Medicine and Multi-Organic Diseases, Local Referral Center for Systemic and Autoimmune Diseases, 80 Avenue Augustin Fliche, F-34295 Montpellier, France; (R.G.); (A.T.J.M.); (A.L.Q.)
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
- Inserm U1183, Institute for Regenerative Medicine and Biotherapy, St Eloi Hospital, 80 Avenue Augustin Fliche, 34295 Montpellier, France
- Correspondence: ; Tel.: +33-467-337332
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Nguyễn T, Maria ATJ, Ladhari C, Palassin P, Quantin X, Lesage C, Taïeb G, Ayrignac X, Rullier P, Hillaire-Buys D, Lambotte O, Guilpain P, Faillie JL. Rheumatic disorders associated with immune checkpoint inhibitors: what about myositis? An analysis of the WHO’s adverse drug reactions database. Ann Rheum Dis 2020; 81:e32. [DOI: 10.1136/annrheumdis-2020-217018] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 01/22/2020] [Indexed: 12/31/2022]
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Maria ATJ, Bourgier C, Martinaud C, Borie R, Rozier P, Rivière S, Crestani B, Guilpain P. [From fibrogenesis towards fibrosis: Pathophysiological mechanisms and clinical presentations]. Rev Med Interne 2020; 41:325-329. [PMID: 32046868 DOI: 10.1016/j.revmed.2020.01.002] [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: 12/30/2019] [Accepted: 01/19/2020] [Indexed: 12/24/2022]
Abstract
Fibrogenesis is a universal and ubiquitous process associated with tissue healing. The impairment of tissue homeostasis resulting from the deregulation of numerous cellular actors, under the effect of specific cytokine and pro-oxidative environments can lead to extensive tissue fibrosis, organ dysfunction and significant morbidity and mortality. This situation is frequent in internal medicine, since fibrosis is associated with most organ insufficiencies (i.e. cardiac, renal, or hepatic chronic failures), but also with cancer, a condition with common pathophysiological mechanisms. Finally, fibrosis is a hallmark of numerous systemic autoimmune diseases such as connective tissue disorders (in particular systemic sclerosis), vasculitides, granulomatoses, histiocytoses, and IgG4-associated disease. Although the process leading to tissue fibrosis may be in part irreversible, new pharmacological approaches or cell therapies bring hope in the field of fibrotic conditions.
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Affiliation(s)
- A T J Maria
- Service de médecine interne, maladies multi-organiques de l'adulte, hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier, France; Faculté de médecine, Université de Montpellier, 2, rue de l'École-de-Médecine, 34060 Montpellier cedex 2, France; Inserm U1183, IRMB, Inserm, université Montpellier, CHU de Montpellier, Montpellier, France
| | - C Bourgier
- Département de radiothérapie, ICM-Val d'Aurelle, Montpellier, France; Inserm U1194, IRCM, Montpellier, France
| | - C Martinaud
- Unité de médicaments de thérapie innovante, centre de transfusion sanguine des armées, 1, rue du lieutenant-Batany, 92140 Clamart, France
| | - R Borie
- Service de pneumologie A, centre de référence des maladies pulmonaires rares, hôpital Bichat, DHU Fire, AP-HP, Paris, France; Inserm U1152, Paris, France; Université Paris Diderot, Paris, France
| | - P Rozier
- Service de médecine interne, maladies multi-organiques de l'adulte, hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier, France; Faculté de médecine, Université de Montpellier, 2, rue de l'École-de-Médecine, 34060 Montpellier cedex 2, France; Inserm U1183, IRMB, Inserm, université Montpellier, CHU de Montpellier, Montpellier, France
| | - S Rivière
- Service de médecine interne, maladies multi-organiques de l'adulte, hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier, France
| | - B Crestani
- Service de pneumologie A, centre de référence des maladies pulmonaires rares, hôpital Bichat, DHU Fire, AP-HP, Paris, France; Inserm U1152, Paris, France; Université Paris Diderot, Paris, France
| | - P Guilpain
- Service de médecine interne, maladies multi-organiques de l'adulte, hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier, France; Faculté de médecine, Université de Montpellier, 2, rue de l'École-de-Médecine, 34060 Montpellier cedex 2, France; Inserm U1183, IRMB, Inserm, université Montpellier, CHU de Montpellier, Montpellier, France.
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30
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Manson G, Maria ATJ, Poizeau F, Danlos FX, Kostine M, Brosseau S, Aspeslagh S, Du Rusquec P, Roger M, Pallix-Guyot M, Ruivard M, Dousset L, Grignou L, Psimaras D, Pluvy J, Quéré G, Grados F, Duval F, Bourdain F, Maigne G, Perrin J, Godbert B, Taifas BI, Forestier A, Voisin AL, Martin-Romano P, Baldini C, Marabelle A, Massard C, Honnorat J, Lambotte O, Michot JM. Worsening and newly diagnosed paraneoplastic syndromes following anti-PD-1 or anti-PD-L1 immunotherapies, a descriptive study. J Immunother Cancer 2019; 7:337. [PMID: 31796119 PMCID: PMC6892018 DOI: 10.1186/s40425-019-0821-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/13/2019] [Indexed: 02/07/2023] Open
Abstract
Background Paraneoplastic syndromes (PNS) are autoimmune disorders specifically associated with cancer. There are few data on anti-PD-1 or anti-PD-L1 immunotherapy in patients with a PNS. Our objective was to describe the outcome for patients with a pre-existing or newly diagnosed PNS following the initiation of anti-PD-1 or anti-PD-L1 immunotherapy. Methods We included all adult patients (aged ≥18) treated with anti-PD-1 or anti-PD-L1 immunotherapy for a solid tumor, diagnosed with a PNS, and registered in French pharmacovigilance databases. Patients were allocated to cohorts 1 and 2 if the PNS had been diagnosed before vs. after the initiation of immunotherapy, respectively. Findings Of the 1304 adult patients screened between June 27th, 2014, and January 2nd, 2019, 32 (2.45%) had a PNS and were allocated to either cohort 1 (n = 16) or cohort 2 (n = 16). The median (range) age was 64 (45–88). The tumor types were non-small-cell lung cancer (n = 15, 47%), melanoma (n = 6, 19%), renal carcinoma (n = 3, 9%), and other malignancies (n = 8, 25%). Eleven (34%) patients presented with a neurologic PNS, nine (28%) had a rheumatologic PNS, eight (25%) had a connective tissue PNS, and four (13%) had other types of PNS. The highest severity grade for the PNS was 1–2 in 10 patients (31%) and ≥ 3 in 22 patients (69%). Four patients (13%) died as a result of the progression of a neurologic PNS (encephalitis in three cases, and Lambert-Eaton syndrome in one case). Following the initiation of immunotherapy, the PNS symptoms worsened in eight (50%) of the 16 patients in cohort 1. Interpretation Our results show that PNSs tend to be worsened or revealed by anti-PD-1 or anti-PD-L1 immunotherapy. Cases of paraneoplastic encephalitis are of notable concern, in view of their severity. When initiating immunotherapy, physicians should carefully monitor patients with a pre-existing PNS.
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Affiliation(s)
- Guillaume Manson
- Département d'Innovation Thérapeutique et d'Essais Précoces, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France.,Department of Hematology, University Hospital of Rennes, Rennes, France
| | - Alexandre Thibault Jacques Maria
- Department of Internal Medicine and Multiorgan Diseases, Referral Center for Auto-immune Diseases, Saint-Eloi Hospital Montpellier University, Montpellier, France
| | - Florence Poizeau
- Department of Dermatology, Rennes University Hospital, Rennes, France
| | - François-Xavier Danlos
- Département d'Innovation Thérapeutique et d'Essais Précoces, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Marie Kostine
- Rheumatology Department, Bordeaux University Hospital, Bordeaux, France
| | - Solenn Brosseau
- AP-HP, Hôpital Bichat-Claude Bernard, Centre Investigation Clinique 1425, Thoracic Oncology Department, University Paris-Diderot, Paris, France
| | - Sandrine Aspeslagh
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Pauline Du Rusquec
- Medical Oncology Department, Institut de Cancérologie de l'Ouest, Centre René Gauducheau, Saint-Herblain, France
| | - Maxime Roger
- Department of Pulmonology and Thoracic Oncology, Rouen University Hospital, Rouen, France
| | | | - Marc Ruivard
- Internal Medicine Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Léa Dousset
- Dermatology Department, Bordeaux University Hospital, Bordeaux, France
| | | | - Dimitri Psimaras
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2-Mazarin et Université Pierre et Marie Curie-Paris 6, Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Auto-immunes, Paris, France
| | - Johan Pluvy
- AP-HP, Hôpital Bichat-Claude Bernard, Centre Investigation Clinique 1425, Thoracic Oncology Department, University Paris-Diderot, Paris, France
| | - Gilles Quéré
- Oncology Departement, Brest Hôpital Morvan Centre Hospitalier Régional Universitaire, Brest, France
| | - Franck Grados
- Amiens University Hospital, Rheumatology Department, University of Picardie - Jules Verne, Amiens, France
| | - Fanny Duval
- Neurology Department, Bordeaux University Hospital, Bordeaux, France
| | - Frederic Bourdain
- Departement de Neurologie, Centre Hospitalier de la Côte Basque, Bayonne, France
| | - Gwenola Maigne
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Julie Perrin
- Pneumology Department, Metz Robert Schuman Hospital, Metz, France
| | - Benoit Godbert
- Pneumology Department, Metz Robert Schuman Hospital, Metz, France
| | | | | | - Anne-Laure Voisin
- Gustave Roussy, Université Paris-Saclay, Unité fonctionnelle de Pharmacovigilance, F-94805, Villejuif, France
| | - Patricia Martin-Romano
- Département d'Innovation Thérapeutique et d'Essais Précoces, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Capucine Baldini
- Département d'Innovation Thérapeutique et d'Essais Précoces, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Aurélien Marabelle
- Département d'Innovation Thérapeutique et d'Essais Précoces, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Christophe Massard
- Département d'Innovation Thérapeutique et d'Essais Précoces, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Jérôme Honnorat
- Hospices Civils de Lyon, French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, SynatAc Team, Institut NeuroMyoGène. INSERM U1217/CNRS UMR 5310, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Olivier Lambotte
- AP-HP, Hôpital Bicêtre, Service de Médecine Interne et Immunologie Clinique, Le Kremlin-Bicêtre, France.,Université Paris Sud, Centre de Recherche en Immunologie des Infections Virales et des Maladies Auto-Immunes, INSERM U1184, Le Kremlin-Bicêtre, France.,Division d'Immunovirologie, Commissariat à l'Energie Atomique et aux Energies Alternatives, Fontenay-aux- Roses, France
| | - Jean-Marie Michot
- Département d'Innovation Thérapeutique et d'Essais Précoces, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France.
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Maria ATJ, Partouche L, Goulabchand R, Rivière S, Rozier P, Bourgier C, Le Quellec A, Morel J, Noël D, Guilpain P. Intriguing Relationships Between Cancer and Systemic Sclerosis: Role of the Immune System and Other Contributors. Front Immunol 2019; 9:3112. [PMID: 30687318 PMCID: PMC6335319 DOI: 10.3389/fimmu.2018.03112] [Citation(s) in RCA: 50] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 12/17/2018] [Indexed: 01/09/2023] Open
Abstract
Systemic sclerosis (SSc) is an autoimmune connective tissue disorder, characterized by multisystem involvement, vasculopathy, and fibrosis. An increased risk of malignancy is observed in SSc (including breast and lung cancers), and in a subgroup of patients with specific autoantibodies (i.e., anti-RNA polymerase III and related autoantibodies), SSc could be a paraneoplastic syndrome and might be directly related to an immune response against cancer. Herein, we reviewed the literature, focusing on the most recent articles, and shed light onto the potential relationship between cancer and scleroderma regarding temporal and immunological dimensions.
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Affiliation(s)
- Alexandre Thibault Jacques Maria
- Medical School, Montpellier University, Montpellier, France.,Department of Internal Medicine-Multiorganic Diseases, Local Referral Center for Auto-immune Diseases, Saint-Eloi Hospital, Montpellier University, Montpellier, France.,IRMB, INSERM, CHU Montpellier, Montpellier University, Montpellier, France
| | - Léo Partouche
- Medical School, Montpellier University, Montpellier, France.,Department of Internal Medicine-Multiorganic Diseases, Local Referral Center for Auto-immune Diseases, Saint-Eloi Hospital, Montpellier University, Montpellier, France
| | - Radjiv Goulabchand
- Medical School, Montpellier University, Montpellier, France.,Department of Internal Medicine-Multiorganic Diseases, Local Referral Center for Auto-immune Diseases, Saint-Eloi Hospital, Montpellier University, Montpellier, France
| | - Sophie Rivière
- Department of Internal Medicine-Multiorganic Diseases, Local Referral Center for Auto-immune Diseases, Saint-Eloi Hospital, Montpellier University, Montpellier, France
| | - Pauline Rozier
- Medical School, Montpellier University, Montpellier, France.,Department of Internal Medicine-Multiorganic Diseases, Local Referral Center for Auto-immune Diseases, Saint-Eloi Hospital, Montpellier University, Montpellier, France.,IRMB, INSERM, CHU Montpellier, Montpellier University, Montpellier, France
| | - Céline Bourgier
- Medical School, Montpellier University, Montpellier, France.,Department of Radiation Oncology, INSERM U1194/IRCM, ICM-Val d'Aurelle, Montpellier, France
| | - Alain Le Quellec
- Medical School, Montpellier University, Montpellier, France.,Department of Internal Medicine-Multiorganic Diseases, Local Referral Center for Auto-immune Diseases, Saint-Eloi Hospital, Montpellier University, Montpellier, France
| | - Jacques Morel
- Medical School, Montpellier University, Montpellier, France.,Department of Rheumatology, Lapeyronie Hospital, Montpellier, France
| | - Danièle Noël
- IRMB, INSERM, CHU Montpellier, Montpellier University, Montpellier, France
| | - Philippe Guilpain
- Medical School, Montpellier University, Montpellier, France.,Department of Internal Medicine-Multiorganic Diseases, Local Referral Center for Auto-immune Diseases, Saint-Eloi Hospital, Montpellier University, Montpellier, France.,IRMB, INSERM, CHU Montpellier, Montpellier University, Montpellier, France
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Guilpain P, Le Quellec A, Maria ATJ. Therapeutic innovation in adult-onset Still's disease (and other rare inflammatory disorders): how to secure evidence-based medicine? Ann Rheum Dis 2018; 77:1699-1701. [PMID: 29860231 DOI: 10.1136/annrheumdis-2018-213106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/14/2018] [Accepted: 05/15/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Philippe Guilpain
- Medical School, Montpellier University, Montpellier, France.,Department of Internal Medicine - Multi-Organic Diseases, Local Referral Center for Autoimmune Diseases, University of Montpellier, Saint-Eloi Hospital, Montpellier, France.,Institute for Regenerative Medicine and Biotherapy (IRMB), Inserm, U1183, Saint-Eloi Hospital, Montpellier, France
| | - Alain Le Quellec
- Medical School, Montpellier University, Montpellier, France.,Department of Internal Medicine - Multi-Organic Diseases, Local Referral Center for Autoimmune Diseases, University of Montpellier, Saint-Eloi Hospital, Montpellier, France
| | - Alexandre Thibault Jacques Maria
- Medical School, Montpellier University, Montpellier, France.,Department of Internal Medicine - Multi-Organic Diseases, Local Referral Center for Autoimmune Diseases, University of Montpellier, Saint-Eloi Hospital, Montpellier, France.,Institute for Regenerative Medicine and Biotherapy (IRMB), Inserm, U1183, Saint-Eloi Hospital, Montpellier, France
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33
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Maria ATJ, Le Quellec A, Jorgensen C, Touitou I, Rivière S, Guilpain P. Adult onset Still's disease (AOSD) in the era of biologic therapies: dichotomous view for cytokine and clinical expressions. Autoimmun Rev 2014; 13:1149-59. [PMID: 25183244 DOI: 10.1016/j.autrev.2014.08.032] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [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: 05/24/2014] [Accepted: 06/03/2014] [Indexed: 01/10/2023]
Abstract
Adult onset Still's disease (AOSD) is a rare inflammatory disorder characterized by hectic spiking fever, evanescent rash and joint involvement. Prognosis is highly variable upon disease course and specific involvements, ranging from benign and limited outcome to chronic destructive polyarthritis and/or life-threatening events in case of visceral complications or reactive hemophagocytic lymphohistiocytosis (RHL). AOSD remains a debatable entity at the frontiers of autoimmune diseases and autoinflammatory disorders. The pivotal role of macrophage cell activation leading to a typical Th1 cytokine storm is now well established in AOSD, and confirmed by the benefits using treatments targeting TNF-α, IL-1β or IL-6 in refractory patients. However, it remains difficult to determine predictive factors of outcome and to draw guidelines for patient management. Herein, reviewing literature and relying on our experience in a series of 8 refractory AOSD patients, we question nosology and postulate that different cytokine patterns could underlie contrasting clinical expressions, as well as responses to targeted therapies. We therefore propose to dichotomize AOSD according to its clinical presentation. On the one hand, 'systemic AOSD' patients, exhibiting the highest inflammation process driven by excessive IL-18, IL-1β and IL-6 production, would be at risk of life-threatening complications (such as multivisceral involvements and RHL), and would preferentially respond to IL-1β and IL-6 antagonists. On the other hand, 'rheumatic AOSD' patients, exhibiting pre-eminence of joint involvement driven by IL-8 and IFN-γ production, would be at risk of articular destructions, and would preferentially respond to TNF-α blockers.
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Affiliation(s)
- Alexandre Thibault Jacques Maria
- Department of Internal Medicine-Multiorganic Diseases, Saint-Eloi Hospital, 80 Avenue Augustin Fliche, F-34295 Montpellier, France; Inserm, U 844, Saint-Eloi Hospital, 80 Avenue Augustin Fliche, Montpellier F-34295, France
| | - Alain Le Quellec
- Department of Internal Medicine-Multiorganic Diseases, Saint-Eloi Hospital, 80 Avenue Augustin Fliche, F-34295 Montpellier, France
| | - Christian Jorgensen
- Inserm, U 844, Saint-Eloi Hospital, 80 Avenue Augustin Fliche, Montpellier F-34295, France; Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Lapeyronie Hospital, 191 Avenue du Doyen Gaston Giraud, F-34295 Montpellier, France
| | - Isabelle Touitou
- Inserm, U 844, Saint-Eloi Hospital, 80 Avenue Augustin Fliche, Montpellier F-34295, France; Auto-Inflammatory Diseases Unit, Genetic Laboratory, Arnaud De Villeneuve Hospital, 191 Avenue du Doyen Gaston Giraud, F-34295 Montpellier, France
| | - Sophie Rivière
- Department of Internal Medicine-Multiorganic Diseases, Saint-Eloi Hospital, 80 Avenue Augustin Fliche, F-34295 Montpellier, France
| | - Philippe Guilpain
- Department of Internal Medicine-Multiorganic Diseases, Saint-Eloi Hospital, 80 Avenue Augustin Fliche, F-34295 Montpellier, France; Inserm, U 844, Saint-Eloi Hospital, 80 Avenue Augustin Fliche, Montpellier F-34295, France.
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