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Lafarge JC, Aron-Wisnewsky J, Pattou F, Cucherat M, Blondet E, Lascols S, Le Guludec D, David DJ, Carbonneil C. French National Authority for Health assessment of metabolic surgery for type 2 diabetes remission-A meta-analysis in patients with class I to III obesity. Diabetes Metab 2024; 50:101495. [PMID: 38000504 DOI: 10.1016/j.diabet.2023.101495] [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] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVE Randomized controlled trials (RCTs) have demonstrated the superiority of metabolic surgery (MS) over medical therapy (MT) in patients with obesity and type 2 diabetes, leading, to a joint statement in 2016 proposing MS to patients with class I obesity and uncontrolled glycemia. Yet, these RCTs included few patients with class I obesity (body mass index 30-35 kg/m2) and even fewer patients with overweight. Our aim was to provide an updated systematic review (SR) with meta-analysis (MA) of RCTs reporting diabetes remission (DR) after MS in these patients. RESEARCH DESIGN AND METHODS We included in the SR with MA only RCTs with at least 24-month follow-up found in Medline, Cochrane Library, Embase, and LiSSA between January 2008 and September 2022 comparing DR post-MT versus post-MS. We calculated relative risk (RR) and 95 % confidence intervals (CIs) using the Mantel-Haenszel random-effects approach to examine differences in DR between patients allocated to MS versus MT. RESULTS DR was significantly higher in MS versus MT after 36 months' follow-up in patients with obesity (RR = 6.65 [95 %CI 2.24;19.79]; I² = 27 %; 5 trials, 404 patients), but also specifically in patients with class I obesity (RR = 5.27 [1.31;21.23]; I² = 0 %; 4 trials, 80 patients). Furthermore, and in line with previous results, all additional MAs performed in patients with obesity in this work favor MS (specifically Roux-en-Y gastric bypass) over MT at 24, 36 (only) and 60 months of follow-up. CONCLUSIONS Although the data available in patients with class I obesity and type 2 diabetes remains limited, MA shows higher rates of DR after MS compared with MT after 36 months' follow-up in these patients. Consequently, the French National Authority for Health French (HAS) recommends MS for these patients.
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Affiliation(s)
- Jean-Charles Lafarge
- Health Technology Assessment Department, Haute Autorité de Santé, La Plaine Saint-Denis, France.
| | - Judith Aron-Wisnewsky
- Assistance Publique-Hôpitaux de Paris, AP-HP, Pitié-Salpêtrière, Department of Nutrition, 75013 Paris, France; Sorbonne Université, INSERM, Nutrition and Obesity: Systemic Approaches, NutriOmics, 75013 Paris, France
| | - François Pattou
- Université Lille, Inserm, CHU Lille, Institut Pasteur de Lille, Translational research in diabetes, Lille, France
| | - Michel Cucherat
- Service Hospitalo Universitaire de Pharmaco-Toxicologie, Hospices Civils de Lyon, Lyon, France
| | - Emmanuelle Blondet
- Health Technology Assessment Department, Haute Autorité de Santé, La Plaine Saint-Denis, France
| | - Sylvie Lascols
- Health Technology Assessment Department, Haute Autorité de Santé, La Plaine Saint-Denis, France
| | - Dominique Le Guludec
- Health Technology Assessment Department, Haute Autorité de Santé, La Plaine Saint-Denis, France
| | - Denis-Jean David
- Health Technology Assessment Department, Haute Autorité de Santé, La Plaine Saint-Denis, France
| | - Cédric Carbonneil
- Health Technology Assessment Department, Haute Autorité de Santé, La Plaine Saint-Denis, France
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Carbonneil C. New French Coverage with Evidence Development for Innovative Medical Devices: Improvements and Unresolved Issues. Value Health 2017; 20:178-179. [PMID: 28212960 DOI: 10.1016/j.jval.2016.09.2400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 08/29/2016] [Accepted: 09/12/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Cédric Carbonneil
- French Ministry of Health, General Directorate for Provision of Healthcare (DGOS), Paris, France
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Roussel C, Carbonneil C, Audry A. Organisational impact: Definition and assessment methods for medical devices. Therapie 2016; 71:69-96. [PMID: 27080633 DOI: 10.1016/j.therap.2016.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 01/04/2016] [Accepted: 01/05/2016] [Indexed: 10/22/2022]
Abstract
Health technology assessment (HTA) is a rapidly developing area and the value of taking non-clinical fields into consideration is growing. Although the health-economic aspect is commonly recognised, evaluating organisational impact has not been studied nearly as much. The goal of this work was to provide a definition of organisational impact in the sector of medical devices by defining its contours and exploring the evaluation methods specific to this field. Following an analysis of the literature concerning the impact of technologies on organisations as well as the medical literature, and also after reviewing the regulatory texts in this respect, the group of experts identified 12 types of organisational impact. A number of medical devices were carefully screened using the criteria grid, which proved to be operational and to differentiate properly. From the analysis of the practice and of the methods described, the group was then able to derive a few guidelines to successfully evaluate organisational impact. This work shows that taking organisational impact into consideration may be critical alongside of the other criteria currently in favour (clinically and economically). What remains is to confer a role in the decision-making process on this factor and one that meets the economic efficiency principle.
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Affiliation(s)
- Christophe Roussel
- 3M France, marchés de la santé, boulevard de l'Oise, 95006 Cergy-Pontoise, France.
| | - Cédric Carbonneil
- Ministère des affaires sociales, de la santé et des droits des femmes, direction générale de l'offre de soins, 75007 Paris, France
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Dervaux B, Szwarcensztein K, Josseran A, Barna A, Carbonneil C, Chevrie K, Debroucker F, Grumblat A, Grumel O, Massol J, Maugendre P, Méchin H, Orlikowski D, Roussel C, Rumeau-Pichon C, Sales JP, Vicaut E. Assessment and non-clinical impact of medical devices. Therapie 2015; 70:57-68. [PMID: 25747839 DOI: 10.2515/therapie/2015004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 01/13/2015] [Indexed: 11/20/2022]
Abstract
Medical devices (MDs) cover a wide variety of products. They accompany changes in medical practice in step with technology innovations. Innovations in the field of MDs can improve the conditions of use of health technology and/or modify the organisation of care beyond the strict diagnostic or therapeutic benefit for the patients. However, these non purely clinical criteria seem to be only rarely documented or taken into account in the assessment of MDs during reimbursement decisions at national level or for formulary listing by hospitals even though multidimensional models for the assessment of health technologies have been developed that take into account the views of all stakeholders in the healthcare system In this article, after summarising the background concerning the assessment of health technologies in France, a definition of non-clinical criteria for the assessment of MDs is proposed and a decision tree for the assessment of MDs is described. Future lines of approach are proposed as a conclusion.
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Affiliation(s)
| | | | | | | | | | - Cédric Carbonneil
- Direction Générale de l'Organisation des Soins, Ministère des Affaires Sociales, de la Santé et des Droits des Femmes, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | - Eric Vicaut
- Hôpitaux Universitaires Saint-Louis Lariboisière, Paris, France
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Dervaux B, Szwarcensztein K, Josseran A, Barna A, Carbonneil C, Chevrie K, Debroucker F, Grumblat A, Grumel O, Massol J, Maugendre P, Méchin H, Orlikowski D, Roussel C, Rumeau-Pichon C, Sales JP, Vicaut E. Evaluation et impact non clinique des dispositifs médicaux. Therapie 2015; 70:57-62. [DOI: 10.2515/therapie/2015002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 01/06/2015] [Indexed: 11/20/2022]
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Levesque K, Coqueblin C, Guillot B, Aubourg L, Avouac B, Carbonneil C, Cucherat M, Descamps-Mandine P, Hanoka S, Goldberg M, Josseran A, Parquin F, Pitel S, Ratignier C, Sechoy O, Szwarcenstein K, Tanti A, Teiger E, Thevenet N. Post-approval studies in France, challenges facing medical devices. Therapie 2014; 69:303-21. [PMID: 25230354 DOI: 10.2515/therapie/2014051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 06/12/2014] [Indexed: 11/20/2022]
Abstract
Medical devices are characterized notably by a wide heterogeneity (from tongue depressors to hip prostheses, and from non-implantable to invasive devices), a short life cycle with recurrent incremental innovations (from 18 months to 5 years), and an operator-dependent nature. The objective of the current round table was to develop proposals and recommendations concerning the prerequisites needed in order to meet the French health authorities expectations concerning requests for post-approval studies for medical devices, required in cases where short and long-term consequences are unknown. These studies, which are the responsibility of the manufacturer or the distributor of the medical device, are designed to confirm the role of the medical device in the therapeutic management strategy in a real-life setting. There are currently approximately 150 post-approval studies underway, mainly concerning class III devices, and the majority face difficulties implementing the study or meeting the study objectives. In light of this, the round table endeavored to clearly identify the conditions for implementation of post-approval studies specific to the characteristics of medical devices. Various areas of progress have been envisaged to improve the performance of these studies, and by consequence, the efficiency of reimbursement of medical devices by the national health insurance. These include providing manufacturers with the opportunity to better anticipate post-approval requirements, defining a study-specific primary objective, integrating a phase allowing dialogue between the manufacturer, the health authorities and the scientific committee, and increasing awareness and training of health professionals on the impact of post-approval clinical studies in terms of the reimbursement of medical devices by the national insurance.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Odile Sechoy
- Direction de la recherche et de l'innovation, Toulouse, France
| | | | - André Tanti
- Comité économique des produits de santé, Paris, France
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Levesque K, Coqueblin C, Guillot B, Aubourg L, Avouac B, Carbonneil C, Cucherat M, Descamps-Mandine P, Hanoka S, Goldberg M, Josseran A, Parquin F, Pitel S, Ratignier C, Sechoy O, Szwarcenstein K, Tanti A, Teiger E, Thevenet N. Les études post-inscriptions en France, quels enjeux pour les dispositifs médicaux. Therapie 2014; 69:303-12. [DOI: 10.2515/therapie/2014047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 06/12/2014] [Indexed: 11/20/2022]
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Gilard M, Debroucker F, Dubray C, Allioux Y, Aper E, Barat-Leonhardt V, Brami M, Carbonneil C, Chartier-Kastler E, Coqueblin C, Fare S, Giri I, Goehrs JM, Levesque K, Maugendre P, Parquin F, Sales JP, Szwarcensztein K. Évaluation scientifique et tarification des dispositifs médicaux et des actes associés en France. Therapie 2013; 68:193-200. [DOI: 10.2515/therapie/2013034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 05/07/2013] [Indexed: 11/20/2022]
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9
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Gilard M, Debroucker F, Dubray C, Allioux Y, Aper E, Barat-Leonhardt V, Brami M, Carbonneil C, Chartier-Kastler E, Coqueblin C, Fare S, Giri I, Goehrs JM, Levesque K, Maugendre P, Parquin F, Sales JP, Szwarcensztein K. Scientific Evaluation and Pricing of Medical Devices and Associated Procedures in France. Therapie 2013; 68:193-208. [DOI: 10.2515/therapie/2013036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 05/07/2013] [Indexed: 11/20/2022]
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Saïdi H, Carbonneil C, Magri G, Eslahpazir J, Sekaly RP, Bélec L. Differential modulation of CCR5-tropic human immunodeficiency virus–1 transfer from macrophages towards T cells under interleukin-4/interleukin-13 microenvironment. Hum Immunol 2010; 71:1-13. [DOI: 10.1016/j.humimm.2009.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 08/13/2009] [Accepted: 08/18/2009] [Indexed: 12/16/2022]
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Saïdi H, Magri G, Carbonneil C, Bouhlal H, Hocini H, Belec L. Apical interactions of HIV type 1 with polarized HEC-1 cell monolayer modulate R5-HIV type 1 spread by submucosal macrophages. AIDS Res Hum Retroviruses 2009; 25:497-509. [PMID: 19397398 DOI: 10.1089/aid.2008.0156] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The in vitro model of HIV-1 transcytosis through a monolayer of HEC-1 cells is thought to mimic the mucosal crossing of the virus that may occur in vivo. We evaluated whether the stimulation of HEC-1 by HIV may modulate HIV infection of macrophages. Thus, the ability to capture, produce, and transfer R5 viruses to T cells, attract T cells, and finally produce cytokines/chemokines, was compared between untreated macrophages (M0) and macrophages differentiated in the presence of medium collected at the basolateral pole of HEC-1, which were unstimulated [M(BL)] or stimulated with either R5-HIV-1Ba-L [M(BL-R5)] or X4-HIV-1NDK [M(BL-X4)]. M(BL-X4)-secreted CCR5-interacting chemokines integrated and replicated HIV less efficiently than did M(BL) and M(BL-R5). M(BL-R5) and M(BL-X4) similarly transmitted HIV to activated T cells. Interestingly, mannose-binding receptors and heparan sulfate proteoglycans were variously involved in HIV adsorption, whereas DC-SIGN mostly mediated the HIV transfer. Conversely to M(BL) and M(BL-X4), M(BL-R5) did not secrete eotaxin, GRO, ITAC, lymphotactin, MIP-1, MIP-3, and RANTES, which was associated with a weak capacity to recruit CD4(+)CXCR4(+)CCR5(+) T cells. In particular, M(BL-R5) specifically released soluble factors enhancing HIV production by recruited T cells. These submucosal-conditioned macrophages differentially captured, produced, and transferred R5-HIV-1 to T cells, according to the tropism of the virus deposited at the apical pole of HEC-1. These observations challenge the question of the in vivo involvement of HIV-1 as a supraepithelial stimulus that likely modulates the susceptibility for HIV-1 of submucosal target cells in favor of its transmission.
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Affiliation(s)
- Héla Saïdi
- Université Paris Descartes (Paris V), Unité INSERM U743 “Immunologie Humaine,” Equipe “Immunité et Biothérapie Muqueuse,” Centre de Recherches Biomédicales des Cordeliers, Paris, France
- Institut Pasteur, Antiviral Immunity, Biotherapy, and Vaccine Unit, Infection and Epidemiology Department, Paris, France
| | - Giuliana Magri
- Université Paris Descartes (Paris V), Unité INSERM U743 “Immunologie Humaine,” Equipe “Immunité et Biothérapie Muqueuse,” Centre de Recherches Biomédicales des Cordeliers, Paris, France
| | - Cédric Carbonneil
- Université Paris Descartes (Paris V), Unité INSERM U743 “Immunologie Humaine,” Equipe “Immunité et Biothérapie Muqueuse,” Centre de Recherches Biomédicales des Cordeliers, Paris, France
| | - Hicham Bouhlal
- Université Paris Descartes (Paris V), Unité INSERM U743 “Immunologie Humaine,” Equipe “Immunité et Biothérapie Muqueuse,” Centre de Recherches Biomédicales des Cordeliers, Paris, France
- Institut Pasteur, Antiviral Immunity, Biotherapy, and Vaccine Unit, Infection and Epidemiology Department, Paris, France
- Unité Inserm 4925, Laboratoire d'Immunologie, Université Picardie Jules Verne, Amiens, France
| | - Hakim Hocini
- Université Paris Descartes (Paris V), Unité INSERM U743 “Immunologie Humaine,” Equipe “Immunité et Biothérapie Muqueuse,” Centre de Recherches Biomédicales des Cordeliers, Paris, France
| | - Laurent Belec
- Université Paris Descartes (Paris V), Unité INSERM U743 “Immunologie Humaine,” Equipe “Immunité et Biothérapie Muqueuse,” Centre de Recherches Biomédicales des Cordeliers, Paris, France
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Saidi H, Eslahpazir J, Eslaphazir J, Carbonneil C, Carthagena L, Requena M, Nassreddine N, Belec L. Differential modulation of human lactoferrin activity against both R5 and X4-HIV-1 adsorption on epithelial cells and dendritic cells by natural antibodies. J Immunol 2007; 177:5540-9. [PMID: 17015741 DOI: 10.4049/jimmunol.177.8.5540] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Human lactoferrin (Lf) is an iron binding glycoprotein that is present in several mucosal secretions. Many biological functions have been ascribed to Lf. In the present study, we showed that Lf limited specifically adsorption of R5- and X4-HIV-1-free particles on endometrial epithelial HEC-1A cells, by inhibiting virus adsorption on heparan-sulfated proteoglycans. But, Lf did not interfere with both R5 and X4-HIV transcytosis. We showed also the efficacy of Lf in preventing R5 and X4-HIV capture by dendritic cells. Conversely, we demonstrated that Lf-reacting natural Abs (NAbs) present within i.v. Ig-enhanced HIV attachment on dendritic cells by forming HIV-Lf-NAbs. HIV particles were able to directly interact with Lf following its interaction with NAbs. We also found Lf-reacting natural Abs within cervicovaginal secretions, suggesting the existence of Lf-NAbs complexes in women genital tract in vivo. In conclusion, this study highlights Lf as a potent microbicides and reports new function for NAbs within the genital compartment that may compartment that may abolish the inhibitory activity of microbicide compounds. Thus, we proposed a model in which Lf would appear as a double-edged sword that could have beneficial or detrimental effects depending on both cellular and molecular environments. This study highlights the use of Lf derivates as microbicide candidates to limit such interferences.
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Affiliation(s)
- Héla Saidi
- Université René Descartes Paris V, Unité Institut National de la Recherche et de la Santé (INSERM) Internationale 743 d'Immunologie Humaine, Centres de Recherches Biomédicales des Cordeliers, Paris, France.
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Bélec L, Saïdi H, Carbonneil C. [Chemical barriers for the prevention of HIV and sexually transmitted infections: overview on microbicide development]. Med Mal Infect 2005; 35 Suppl 2:S105-7. [PMID: 15978362 DOI: 10.1016/s0399-077x(05)81236-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L Bélec
- Equipe Immunité et Biothérapie Muqueuse, Université René Descartes (Paris V) Centre de Recherches Biomédicales des Cordeliers, 15, rue de l'Ecole de Médecine, 75006 Paris, France
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Bayry J, Lacroix-Desmazes S, Donkova-Petrini V, Carbonneil C, Misra N, Lepelletier Y, Delignat S, Varambally S, Oksenhendler E, Lévy Y, Debré M, Kazatchkine MD, Hermine O, Kaveri SV. Natural antibodies sustain differentiation and maturation of human dendritic cells. Proc Natl Acad Sci U S A 2004; 101:14210-5. [PMID: 15381781 PMCID: PMC521138 DOI: 10.1073/pnas.0402183101] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The differentiation and maturation of dendritic cells (DCs) is governed by various signals in the microenvironment. Monocytes and DCs circulate in peripheral blood, which contains high levels of natural antibodies (NAbs). NAbs are germ-line-encoded and occur in the absence of deliberate immunization or microbial aggression. To assess the importance of NAbs in the milieu on DC development, we examined the status of DCs in patients with X-linked agammaglobulinemia, a disease characterized by paucity of B cells and circulating antibodies. We demonstrate that the in vitro differentiation of DCs is severely impaired in these patients, at least in part because of low levels of circulating NAbs. We identified NAbs reactive with the CD40 molecule as an important component that participates in the development of DCs. CD40-reactive NAbs restored normal phenotypes of DCs in patients. The maturation process induced by CD40-reactive NAbs was accompanied by an increased IL-10 and decreased IL-12 production. The transcription factor analysis revealed distinct signaling pathways operated by CD40-reactive NAbs compared to those by CD40 ligand. These results suggest that B cells promote bystander DC development through NAbs and the interaction between NAbs and DCs may play a role in steady-state migration of DCs.
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Affiliation(s)
- Jagadeesh Bayry
- Institut National de la Santé et de la Recherche Médicale Unité 430 and Université Pierre et Marie Curie, Institut des Cordeliers, 75006 Paris, France
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Carbonneil C, Donkova-Petrini V, Aouba A, Weiss L. Defective dendritic cell function in HIV-infected patients receiving effective highly active antiretroviral therapy: neutralization of IL-10 production and depletion of CD4+CD25+ T cells restore high levels of HIV-specific CD4+ T cell responses induced by dendritic cells generated in the presence of IFN-alpha. J Immunol 2004; 172:7832-40. [PMID: 15187167 DOI: 10.4049/jimmunol.172.12.7832] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We previously demonstrated that GM-CSF/IFN-alpha combination allowed the differentiation of monocytes from HIV-infected patients into dendritic cells (DCs) exhibiting high CD8(+) T cell stimulating abilities. The present study was aimed at characterizing the ability of DCs generated in the presence of GM-CSF and IFN-alpha to induce CD4 T cell responses. DCs were generated from monocytes of HIV-infected patients in the presence of GM-CSF with either IFN-alpha (IFN-DCs) or IL-4 (IL-4-DCs) for 7 days. Eleven patients receiving highly active antiretroviral therapy and exhibiting CD4 cell counts above 400/mm(3) and plasma HIV-RNA <50 copies/ml for at least 1 year were included in the study. Both DC populations were found to be defective in inducing autologous (in response to tuberculin or HIV-p24) or allogeneic CD4 T cell proliferation. Neutralization of IL-10 during the differentiation of IFN-DCs, but not during the DC-T cell coculture, significantly increased their ability to stimulate autologous CD4 T cell proliferation in response to tuberculin and allogeneic CD4 T cell proliferation (4.1-fold and 3.0-fold increases, respectively, at the DC to T cell ratio of 1:10). Moreover, IL-10 neutralization and CD4(+)CD25(+) T cell depletion synergistically act to dramatically increase HIV-p24-specific CD4 T cell responses induced by IFN-DCs (31.7-fold increase) but not responses induced by IL-4-DCs. Taken together, our results indicate that IFN-DCs are more efficient than IL-4-DCs to stimulate CD4(+) T cell proliferation, further supporting their use for immune-based therapy in HIV infection.
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Affiliation(s)
- Cédric Carbonneil
- Institut National de la Santé et de la Recherche Médicale Unité 430, Institut des Cordeliers, Paris, France
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Weiss L, Donkova-Petrini V, Caccavelli L, Balbo M, Carbonneil C, Levy Y. Human immunodeficiency virus-driven expansion of CD4+CD25+ regulatory T cells, which suppress HIV-specific CD4 T-cell responses in HIV-infected patients. Blood 2004; 104:3249-56. [PMID: 15271794 DOI: 10.1182/blood-2004-01-0365] [Citation(s) in RCA: 324] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The present study demonstrates that CD4(+)CD25(+) T cells, expanded in peripheral blood of HIV-infected patients receiving highly active antiretroviral therapy (HAART), exhibit phenotypic, molecular, and functional characteristics of regulatory T cells. The majority of peripheral CD4(+)CD25(+) T cells from HIV-infected patients expressed a memory phenotype. They were found to constitutively express transcription factor forkhead box P3 (Foxp3) messengers. CD4(+)CD25(+) T cells weakly proliferated to immobilized anti-CD3 monoclonal antibody (mAb) and addition of soluble anti-CD28 mAb significantly increased proliferation. In contrast to CD4(+)CD25(-) T cells, CD4(+)CD25(+) T cells from HIV-infected patients did not proliferate in response to recall antigens and to p24 protein. The proliferative capacity of CD4 T cells to tuberculin, cytomegalovirus (CMV), and p24 significantly increased following depletion of CD4(+)CD25(+) T cells. Furthermore, addition of increasing numbers of CD4(+)CD25(+) T cells resulted in a dose-dependent inhibition of CD4(+)CD25(-) T-cell proliferation to tuberculin and p24. CD4(+)CD25(+) T cells responded specifically to p24 antigen stimulation by expressing transforming growth factor beta (TGF-beta) and interleukin 10 (IL-10), thus indicating the presence of p24-specific CD4(+) T cells among the CD4(+)CD25(+) T-cell subset. Suppressive activity was not dependent on the secretion of TGF-beta or IL-10. Taken together, our results suggest that persistence of HIV antigens might trigger the expansion of CD4(+)CD25(+) regulatory T cells, which might induce a tolerance to HIV in vivo.
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Affiliation(s)
- Laurence Weiss
- Institut National de la Santé et de la Recherche Médicale U430, University of Paris V, France.
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Carbonneil C, Saidi H, Donkova-Petrini V, Weiss L. Dendritic cells generated in the presence of interferon- stimulate allogeneic CD4+ T-cell proliferation: modulation by autocrine IL-10, enhanced T-cell apoptosis and T regulatory type 1 cells. Int Immunol 2004; 16:1037-52. [PMID: 15184347 DOI: 10.1093/intimm/dxh106] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Dendritic cells (DCs) generated in the presence of IFN-alpha (IFN-DCs) exhibit high expression of major histocompatibility and co-stimulatory molecules and a potent ability to stimulate CD8(+) T-cell responses. Here, we found that IFN-DCs were more potent stimulators of bulk and purified CD8(+) T-cell proliferation, as compared with IL-4-DCs. In contrast, IFN-DCs were less efficient than IL-4-DCs in stimulating allogeneic CD4(+) T-cell proliferation, due to a weak induction of naive CD4(+)CD45RO(-) T-cell proliferation by these DCs. However, both DC populations induced similar levels of proliferation of memory CD4(+)CD45RO(+) T cells. IFN-DCs and IL-4-DCs exhibited a similar phenotype and production of IL-10 following maturation induced by CD40 ligation. In contrast, IFN-DCs produced higher levels of IL-10 during the first days of differentiation. In addition, neutralization of IL-10 during the differentiation of DCs increased the expression of DC-LAMP and MHC class II by IFN-DCs, and the ability of IFN-DCs to stimulate allogeneic CD4(+) T-cell proliferation at similar levels, than IL-4-DCs. Independently of IL-10 production, IFN-DCs were found to induce higher levels of CD4(+)T-cell apoptosis, this effect being more sticking on naive T cells. Finally, we demonstrated that IFN-DCs induced a differentiation bias of naive CD4(+) T cells towards Th1 and Tr1 cells, compared to IL-4-DCs. Taken together, these results indicate that, despite the induction of Tr1 cells and enhanced apoptosis of naive CD4(+) T cells, IFN-DCs are potent stimulators of CD8(+) and memory CD4(+) T cells, and induce a strong polarization of naive CD4(+) T cells towards Th1 cells, further supporting their use in immune-based therapy.
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Carbonneil C, Aouba A, Burgard M, Cardinaud S, Rouzioux C, Langlade-Demoyen P, Weiss L. Dendritic cells generated in the presence of granulocyte-macrophage colony-stimulating factor and IFN-alpha are potent inducers of HIV-specific CD8 T cells. AIDS 2003; 17:1731-40. [PMID: 12891059 DOI: 10.1097/00002030-200308150-00002] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the ability of granulocyte-macrophage colony-stimulating factor (GM-CSF) and IFN-alpha to induce the differentiation of peripheral monocytes into dendritic cells (DC) and their ability to trigger an HIV-specific CD8 T-cell response. METHODS Monocytes isolated from both seronegative controls and HIV-infected individuals were differentiated into DC using GM-CSF with either IL-4 or IFN-alpha for 7 days. We assessed the phenotypic characteristics and IL-12 production by flow cytometry. The ability of DC to trigger CD8 T-cell responses was assessed by means of ELISpot and cytotoxicity assays. In addition, HIV-1-RNA levels were measured in culture supernatants. RESULTS Compared with control DC generated in the presence of GM-CSF and IL-4, DC generated in the presence of GM-CSF and IFN-alpha expressed higher levels of MHC class I molecules and produced similar or higher levels of IL-12 after CD40 ligation or Staphyloccus aureus Cowan stimulation. GM-CSF/IFN-alpha DC expressed low levels of CD4, CXCR4 and DC-SIGN and did not produce detectable virus during the differentiation period. Pulsed GM-CSF/IFN-alpha DC were found to prime CD8 T cells from HIV-negative controls to exert cytotoxic activity against target cells expressing HIV antigens. HIV peptide-pulsed GM-CSF/IFN-alpha DC promote specific IFN-gamma production by autologous CD8 T cells from HIV-seronegative donors. Furthermore, GM-CSF/IFN-alpha DC from HIV-seropositive patients efficiently present HIV peptides to autologous CD8 T lymphocytes. CONCLUSION GM-CSF and IFN-alpha allow the generation of DC with high CD8 T-cell stimulating abilities. Therefore, this strategy may represent a novel approach to therapeutic vaccination in HIV disease.
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