Rhodnius prolixus Hemolymph Immuno-Physiology: Deciphering the Systemic Immune Response Triggered by Trypanosoma cruzi Establishment in the Vector Using Quantitative Proteomics

Understanding the development of Trypanosoma cruzi within the triatomine vector at the molecular level should provide novel targets for interrupting parasitic life cycle and affect vectorial competence. The aim of the current study is to provide new insights into triatomines immunology through the characterization of the hemolymph proteome of Rhodnius prolixus, a major Chagas disease vector, in order to gain an overview of its immune physiology. Surprisingly, proteomics investigation of the immunomodulation of T. cruzi-infected blood reveals that the parasite triggers an early systemic response in the hemolymph. The analysis of the expression profiles of hemolymph proteins from 6 h to 24 h allowed the identification of a broad range of immune proteins expressed already in the early hours post-blood-feeding regardless of the presence of the parasite, ready to mount a rapid response exemplified by the significant phenol oxidase activation. Nevertheless, we have also observed a remarkable induction of the immune response triggered by an rpPGRP-LC and the overexpression of defensins 6 h post-T. cruzi infection. Moreover, we have identified novel proteins with immune properties such as the putative c1q-like protein and the immunoglobulin I-set domain-containing protein, which have never been described in triatomines and could play a role in T. cruzi recognition. Twelve proteins with unknown function are modulated by the presence of T. cruzi in the hemolymph. Determining the function of these parasite-induced proteins represents an exciting challenge for increasing our knowledge about the diversity of the immune response from the universal one studied in holometabolous insects. This will provide us with clear answers for misunderstood mechanisms in host-parasite interaction, leading to the development of new generation strategies to control vector populations and pathogen transmission.

HCV cure: an appropriate moment to reduce cannabis use in people living with HIV? (ANRS CO13 HEPAVIH data)

BACKGROUND

Thanks to direct-acting antivirals, hepatitis C virus (HCV) infection can be cured, with similar rates in HCV-infected and HIV-HCV co-infected patients. HCV cure is likely to foster behavioral changes in psychoactive substance use, which is highly prevalent in people living with HIV (PLWH). Cannabis is one substance that is very commonly used by PLWH, sometimes for therapeutic purposes. We aimed to identify correlates of cannabis use reduction following HCV cure in HIV-HCV co-infected cannabis users and to characterize persons who reduced their use.

METHODS

We used data collected on HCV-cured cannabis users in a cross-sectional survey nested in the ANRS CO13 HEPAVIH cohort of HIV-HCV co-infected patients, to perform logistic regression, with post-HCV cure cannabis reduction as the outcome, and socio-behavioral characteristics as potential correlates. We also characterized the study sample by comparing post-cure substance use behaviors between those who reduced their cannabis use and those who did not.

RESULTS

Among 140 HIV-infected cannabis users, 50 and 5 had reduced and increased their use, respectively, while 85 had not changed their use since HCV cure. Cannabis use reduction was significantly associated with tobacco use reduction, a decrease in fatigue level, paying more attention to one's dietary habits since HCV cure, and pre-HCV cure alcohol abstinence (p = 0.063 for alcohol use reduction).

CONCLUSIONS

Among PLWH using cannabis, post-HCV cure cannabis reduction was associated with tobacco use reduction, improved well-being, and adoption of healthy behaviors. The management of addictive behaviors should therefore be encouraged during HCV treatment.

Early Post-Prandial Regulation of Protein Expression in the Midgut of Chagas Disease Vector Rhodnius prolixus Highlights New Potential Targets for Vector Control Strategy

Chagas disease is a vector-borne parasitic disease caused by the flagellated protozoan Trypanosoma cruzi and transmitted to humans by a large group of bloodsucking triatomine bugs. Triatomine insects, such as Rhodnius prolixus, ingest a huge amount of blood in a single meal. Their midgut represents an important interface for triatomine–trypanosome interactions. Furthermore, the development of parasites and their vectorial transmission are closely linked to the blood feeding and digestion; thus, an understanding of their physiology is essential for the development of new strategies to control triatomines. In this study, we used label-free quantitative proteomics to identify and analyze the early effect of blood feeding on protein expression in the midgut of Rhodnius prolixus. We both identified and quantified 124 proteins in the anterior midgut (AM) and 40 in the posterior midgut (PM), which vary significantly 6 h after feeding. The detailed analysis of these proteins revealed their predominant involvement in the primary function of hematophagy, including proteases, proteases inhibitors, amino acids metabolism, primary metabolites processing, and protein folding. Interestingly, our proteomics data show a potential role of the AM in protein digestion. Moreover, proteins related to detoxification processes and innate immunity, which are largely accepted to be triggered by blood ingestion, were mildly modulated. Surprisingly, one third of blood-regulated proteins in the AM have unknown function. This work contributes to the improvement of knowledge on the digestive physiology of triatomines in the early hours post-feeding. It provides key information for selecting new putative targets for the development of triatomine control tools and their potential role in the vector competence, which could be applied to other vector species.

Influence of HLA-C environment on the spontaneous clearance of hepatitis C in European HIV-HCV co-infected individuals

Natural killer (NK) cell functions are regulated by diverse inhibitory and activating receptors, including killer cell immunoglobulin-like receptors (KIR), which interact with human leukocyte antigen (HLA) class I molecules. Some KIR/HLA genetic combinations were reported associated with spontaneous clearance (SC) of hepatitis C virus (HCV) but with discordant results, possibly reflecting KIR and/or HLA gene polymorphism according to populations. KIR/HLA genetic combinations associated with both an exhaustive NK and T cell repertoire were investigated in a cohort of HIV-HCV co-infected individuals with either SC (n = 68) or chronic infection (CI, n = 163) compared to uninfected blood donors [controls (Ctrl), n = 100]. Multivariate analysis showed that the HLA C2C2 environment was associated with SC only in European HIV-HCV co-infected individuals [odds ratio (OR) = 4·30, 95% confidence interval = 1·57-12·25, P = 0·005]. KIR2D⁺ NK cell repertoire and potential of degranulation of KIR2DL1/S1⁺ NK cells were similar in the SC European cohort compared to uninfected individuals. In contrast, decreased frequencies of KIR2DS1⁺ and KIR2DL2⁺ NK cells were detected in the CI group of Europeans compared to SC and a decreased frequency of KIR2DL1/S1⁺ NK cells compared to controls. Regarding T cells, higher frequencies of DNAX accessory molecule-1 (DNAM-1)⁺ and CD57⁺ T cells were observed in SC in comparison to controls. Interestingly, SC subjects emphasized increased frequencies of KIR2DL2/L3/S2⁺ T cells compared to CI subjects. Our study underlines that the C2 environment may activate efficient KIR2DL1⁺ NK cells in a viral context and maintain a KIR2DL2/L3/S2⁺ mature T cell response in the absence of KIR2DL2 engagement with its cognate ligands in SC group of HCV-HIV co-infected European patients.

A qualitative study examining UK female genital mutilation health campaigns from the perspective of affected communities

OBJECTIVES

Female genital mutilation (FGM) is a worldwide problem associated with severe health risks. In the UK, preventative public health campaigns have been developed to eradicate FGM. The aim of the present study was to elicit the views about FGM public health campaigns from the perspective of a UK Somali community.

STUDY DESIGN

Three focus groups and one interview were conducted with 16 community members.

METHODS

Using posters and leaflets focused on UK FGM prevention, photo-elicitation was used to encourage participants to discuss the usefulness and implications for national public health messages aimed at eradicating FGM. Data were subjected to inductive thematic analysis.

RESULTS

Participants were positive about the aims of the campaigns presented within the research, believing such campaigns were necessary and increased awareness of FGM. However, participants felt the campaigns also carried risks of enhancing stereotypes in terms of ethnicity, gender and religion. For example, some images were perceived to suggest that FGM was only relevant to Sub-Saharan women, although it is also prevalent in other populations. Some fathers reported feeling unfairly targeted in campaigns that focused on the role of mothers in protecting daughters from FGM. Participants were also concerned that some poster images may suggest that FGM was associated with Islam and perceived as a religious issue, rather than a cultural one. Fears were identified that this could lead to stigmatisation and hostility towards those affected.

CONCLUSIONS

The research findings suggested that actively working with affected communities to develop messaging that counters negative stereotyping and associated hostility should be a priority.

Symptômes prolongés ou résurgents de COVID-19 : à propos de 26 cas virologiquement confirmés

Introduction

Les manifestations persistantes ou résurgentes de COVID-19 survenant plus de 2 à 3 semaines après un premier épisode sont extrêmement diverses et encore mal connues.

Matériels et méthodes

Une consultation post-COVID a été ouverte à l’Hôtel-Dieu depuis mai 2020 pour les patients (pts) souffrant de symptômes prolongés ou résurgents de COVID. Un recueil était fait selon un questionnaire préétabli, après obtention de l’accord oral des pts. Ils étaient inclus en cas de diagnostic d’infection confirmée à SARS-COV-2 et après exclusion d’un diagnostic différentiel. Le diagnostic de COVID était retenu devant : RT-PCR et/ou une sérologie positive et/ou scanner thoracique initial typique de COVID et/ou contact avec un cas confirmé par PCR associé à 2 signes majeurs (anosmie, toux, fièvre, dyspnée).

Résultats

Parmi les 58 pts vus en consultation entre le 20 mai et le 12 juin 2020, 26 avaient un diagnostic de COVID confirmé par RT-PCR (n = 15), sérologie (n = 8), scanner thoracique typique (n = 1) et/ou présence de deux signes majeurs avec contage (n = 2). Il s’agissait de 19 (73,1 %) femmes et 7 (26,9 %) hommes, d’âge moyen 46 ans (22–75). Quatre sur 23 (15,4 %) pts avaient un antécédent de pathologie auto-immune et 11 (42,3 %) un terrain d’allergie. Les symptômes initiaux les plus fréquemment retrouvés étaient : fièvre (n = 19, 73,1 %), toux (n = 18, 69,2 %), anosmie (n = 17, 65,4 %) et céphalées (n = 16, 61,5 %). Seuls 4/23 (17,4 %) pts ont été hospitalisés. Un intervalle libre entre le 1^er épisode et les épisodes suivants a été noté dans 11 cas avec une durée de 13 ± 10 jours, en moyenne. Lors du 2^e épisode une persistance des symptômes du premier épisode était notée dans 11 cas, une réapparition de ces mêmes symptômes dans 16 cas et l’apparition de symptômes différents dans 18 cas.

Lors des épisodes tardifs, les symptômes étaient intermittents dans 35 % des cas (n = 7/20). 22 patients (84,6 %) étaient apyrétiques. Les symptômes les plus fréquents rapportés étaient :

– au moins 1 symptôme neurologique (21 pts, 80,7 %) : psychocognitifs à type de troubles de la mémoire, de la concentration, de l’humeur, somnolence (n = 17) ; sensoriels à type de céphalées, trouble de l’équilibre, fourmillements, brûlure et douleur neurogène (n = 35) ; trouble de la déglutition et de l’élocution (n = 2) et dysrégulation thermique (n = 2) dont 4 ont eu une IRM cérébrale qui est redevenue normale ;

– des symptômes cardiovasculaires, pour 20 pts (76,9 %), à type d’oppression et douleurs thoraciques, palpitations, dyspnée d’effort et toux ayant conduit au diagnostic de péricardite et/ou myocardite (n = 5 cas) ;

– et une asthénie souvent majeure (16 cas, 61,5 %).

La PCR SARS-COV-2 était souvent négative (n = 14/21, 66,7 %) lors que la sérologie SARS-COV-2 était le plus souvent positive (15/23, 65,2 %).

Conclusion

Les myopéricardites évoquent un syndrome post infectieux de nature dysimmunitaire, tandis que des recherches approfondies doivent être menées sur les atteintes neurologiques pour lesquelles une atteinte virale directe ne peut être exclue.

Personnel asymptomatique pour le SARS-COV-2 en EHPAD : une source de contamination des résidents ?

Introduction

Matériels et méthodes

Résultats

Conclusion

L’anosmie : critère spécifique de l’atteinte COVID-19 « Coranosmie1 »

Introduction

Depuis le mois d’avril, les publications médicales suggèrent que l’anosmie est un symptôme fréquent lors d’une infection liée au COVID-19. Notre objectif était de déterminer la valeur prédictive positive (VVP) et la spécificité (Sp) de l’anosmie et de décrire sa prévalence et ses caractéristiques chez les patients COVID-19.

Matériels et méthodes

Il s’agissait d’une étude prospective observationnelle longitudinale d’une cohorte multicentrique des patients consultants entre le 17 et le 24 mars 2020, pour anosmie depuis moins de 9 jours sans autres signes typiques d’infection à COVID-19. Les patients considérés comme COVID-19 positifs sont ceux ayant eu une RT-PCR COVID-19 positive sur les sécrétions nasopharyngées, ou ayant un contact documenté avec un patient COVID-19 positif. Sur 1824 patients, nous avons comparé la performance diagnostique de l’anosmie par rapport à celle des patients présentant une toux ou des céphalées. Comme pour l’anosmie, nous n’avons incus dans cette comparaison que les patients présentant des symptômes depuis moins de 9 jours.

Résultats

Parmi les 55 patients ayant consulté pour anosmie, 51 (IC92,7 % [82,4–97,9]) avait une RT-PCR positive. La charge virale était modérée pour les 51 patients avec un taux médian de CT à 28,83 (27,55–32,72). L’âge moyen des 55 patients était 35,7 ± 9,7 ans ; 56,4 % étaient des femmes. Dix-neuf patients (34,5 %) avaient des antécédents de rhinite allergique et 12 (21,8 %) étaient des fumeurs actifs. Aucun patient avait des antécédents de trouble de l’olfaction chronique. Une anosmie totale a été rapportée pour 47/55 patients (85,5 %) et une hyposmie pour 8 patients (14,5 %). L’anosmie était d’installation brutale dans 88,7 % des cas (n = 47/55) et associée à une dysgueusie dans 80 % des cas (n = 44/55). Une obstruction nasale était retrouvée chez seulement 2 patients. Les autres symptômes les plus fréquemment retrouvés étaient les céphalées (n = 37, 68,5 %), l’asthénie (n = 28, 57,1 %) et la toux (n = 22, 40,7 %). L’anosmie était inaugurale chez 16 patients (29,1 %). Pour les autres patients, elle a commencé 3 (2–4) jours après le début de l’infection. Aucun de nos patients a eu une évolution vers une forme grave. À j15, la majorité des patients (72,9 %) ont partiellement récupéré l’odorat. L’analyse effectuée sur 1824 avait démontré que la VVP (77,8 % [73,8–81,6]) de l’anosmie et sa Sp (90,2 %, [88,2–92,0]) étaient plus élevées que celles de la toux (VVP : 47,3 % [45,0–49,5], Sp : 34,3 % [32,2–36,4]) ou les céphalées (VVP : 47,9 % [45,7–50,1], Sp : 36,7 % [34,5–38,8]).

Conclusion

L’anosmie paraît un symptôme spécifique et a une VVP élevée par rapport aux autres symptômes classiques de l’infection COVID. Elle est dans la majorité des cas d’installation brutale, sans obstruction nasale, souvent associée à une dysgueusie, et d’évolution a priori favorable.

Récurrences symptomatiques de COVID-19 confirmées après guérison clinique d’un premier épisode : rechute, réinfection ou rebond inflammatoire ?

Introduction

Bien que, par analogie aux autres coronavirus, la maladie COVID-19 induite par SARS-CoV-2 ait été initialement supposée monophasique et transitoirement immunisante, de rares publications rapportent des patients avec 2^e épisode. L’objectif de cette étude est de décrire les caractéristiques cliniques, la séquence moléculaire de détection virale, et le devenir de patients présentant 2 épisodes distincts de COVID-19.

Matériels et méthodes

Une étude nationale multicentrique rétrospective observationnelle a recensé les patients présentant un 2^e épisode aigu symptomatique de COVID-19, défini par au moins un signe clinique majeur typique, et une PCR SARS-CoV-2 positive dans les voies aériennes, après :

– au moins 21 jours du début du 1^er épisode ;

– une phase de guérison clinique (retour à l’état antérieur, ou sortie de soins aigus sans oxygène), sans diagnostic différentiel infectieux, thromboembolique ou inflammatoire.

Résultats

Onze patients présentant un 2^e épisode de COVID-19 après une guérison clinique médiane [étendue] de 10 [3–27] jours ont été recensés, et 2 groupes ont été individualisés.

Dans le 1^er, 4 soignants sans comorbidités, d’âge médian 32,5 [19–43] ans, potentiellement re-exposés au SARS-CoV- (3 dans des unités de soins COVID, 1 au domicile), ont présenté aux 2 épisodes une maladie modérée suivie en ambulatoire.

Dans le 2^e groupe, 7 patients comorbides (dont 2 sous chimiothérapie), d’âges médian 73 [54–91] ans, ont été hospitalisés en soins aigus à chaque épisode. Au 1^er, 3 patients ont reçu des corticoïdes. Aucune réexposition au SARS-CoV-2 n’a été documentée, et 3 patients sont décédés, dont 2 de syndrome de détresse respiratoire aiguë sans autre cause que le SARS-CoV-2.

Au 2^e épisode, tous les scanners montraient des signes aigus de COVID-19, 4/9 PCR avaient des « cycle threshold » (CT) < 30, et 1 sur 2 cultures virales pratiquées était positive. La sérologie SARS-CoV-2 après j21 était positive pour 6 patients, et négative pour 3 (du 2^e groupe).

Conclusion

Cette étude exploratoire confirme la possibilité de récurrences de symptômes après guérison clinique d’un premier épisode de COVID-19. La positivité des PCR aux 2^e épisodes (de plusieurs gènes ou avec CT bas) et au moins une culture virale positive, sans diagnostic différentiel identifié, sont en faveur d’une origine virale à ces récurrences. Les caractéristiques des 2 groupes de patients suggèrent soit des réinfections, soit des réactivations virales. Un déficit immunitaire relatif cellulaire ou humoral (par épuisement professionnel ou immuno-senescence, ou traitements immunosuppresseurs), pourraient entraver la clairance virale ou l’efficacité immunitaire antivirale contre les réinfections à SARS-CoV-2. De plus larges études épidémiologiques, et immuno-virologiques sont nécessaires pour comprendre la fréquence et le(s) mécanisme(s) de ces récurrences.

High-Throughput Identification of the Rhodnius prolixus Midgut Proteome Unravels a Sophisticated Hematophagic Machinery

Chagas disease is one of the most common parasitic infections in Latin America, which is transmitted by hematophagous triatomine bugs, of which Rhodnius prolixus is the vector prototype for the study of this disease. The protozoan parasite Trypanosoma cruzi, the etiologic agent of this disease, is transmitted by the vector to humans through the bite wound or mucosa. The passage of the parasite through the digestive tract of its vector constitutes a key step in its developmental cycle. Herewith, by a using high-throughput proteomic tool in order to characterize the midgut proteome of R. prolixus, we describe a set of functional groups of proteins, as well as the biological processes in which they are involved. This is the first proteomic analysis showing an elaborated hematophagy machinery involved in the digestion of blood, among which, several families of proteases have been characterized. The evaluation of the activity of cathepsin D proteases in the anterior part of the digestive tract of the insect suggested the existence of a proteolytic activity within this compartment, suggesting that digestion occurs early in this compartment. Moreover, several heat shock proteins, blood clotting inhibitors, and a powerful antioxidant enzyme machinery against reactive oxygen species (ROS) and cell detoxification have been identified. Highlighting the complexity and importance of the digestive physiology of insects could be a starting point for the selection of new targets for innovative control strategies of Chagas disease.

Nevirapine Use Is Associated with Higher Bone Mineral Density in HIV-1 Positive Subjects on Long-Term Antiretroviral Therapy

We assessed bone mineral density (BMD) in a cohort of human immunodeficiency virus (HIV)-positive patients after a median of 11 years of combination antiretroviral therapy (cART) and evaluated the respective role of HIV infection and antiretroviral drugs (ARVs). A cross-sectional study of 162 participants (131 male) from the ANRS-C08 cohort was performed with bone dual-energy X-ray absorptiometry (DXA) scans and renal assessment. The window of exposure to ARVs was defined as an exposure of more than six cumulative months during the last 3 years before the DXA evaluation to account for a cumulative exposure that could affect bone remodeling. The association with low BMD (Z-score < -2) was assessed by a multiple logistic regression model. The study population was 50 years (median), hepatitis C virus (HCV) (18%), and hepatitis B virus (HBV) (8%) coinfection with HIV-RNA <50 c/mL in 89%, median CD4 of 619/mm³. Prevalence of low BMD was 18% in males and 6% in females. The factors associated with a Z-score < -2 in males were uric acid renal loss [adjusted odds ratio (aOR): 6.1; 95% confidence interval (CI): 1.2-31.5; p = .03], HCV coinfection (aOR: 4.0; 95% CI: 1.3-12.2; p = .02), and less frequent window of exposure to nevirapine (NVP) (aOR: 0.1; 95% CI: 0.02-0.6; p = .01). For the full study sample, there was a strong positive association between duration of exposure to NVP and lumbar spine Z-score (p = .004). HIV-positive patients exposed to long-term cART have a high incidence of low BMD. Tenofovir disoproxil fumarate and ritonavir-boosted protease inhibitors did not seem to be associated with increased risk of low BMD, whereas NVP exposure appeared to have an independent positive association.

Subjective Cognitive Decline Predicts Concurrent Cognition in Hispanics, but not in Non-Hispanic Whites: A Pilot Study

Objective

Subjective cognitive decline (SCD) is prevalent among older adults and may be indicative of future cognitive decline. However, the expression of SCD may vary across ethnic groups due to factors such as educational level, awareness of decline, and depression. This study explored whether SCD scores predicted concurrent cognition in Hispanic and Non-Hispanic White older adults, after adjusting for variables known to affect this relationship.

Participants and Method

Twenty-two Hispanic (mostly Mexican-American) and 27 Non-Hispanic White older adults were recruited from ongoing studies at the University of California, San Diego. The “My Cognition” version of the Subjective Cognitive Decline Questionnaire (SCD-Q) developed in Spain measured SCD (modified to “Mexican” Spanish and administered in language of preference - 55% in Spanish). The Mattis Dementia Rating Scale (DRS) measured global cognition and the Geriatric Depression Scale (GDS) measured mood.

Results

A hierarchical regression examined if ethnic group moderated the association between SCD-Q total score and DRS total score after adjusting for age, gender, education, and GDS score. Ethnicity moderated the relationship between SCD and DRS (β = -1.071, p = .024). Higher SCD-Q scores significantly predicted lower DRS scores in Hispanics (β = -.97, p &lt; .01), but not in Non-Hispanic Whites (β = -.23, p = .33), after adjusting for co-variates. Education level was the only significant predictor of DRS scores in the Non-Hispanic group.

Conclusions

Preliminary findings indicate that the SCD-Q may be a sensitive predictor of concurrent cognitive function in Hispanics, compared to Non-Hispanic Whites, suggesting that the SCD-Q may be culturally sensitive. Future studies should replicate these findings and investigate ethnic differences in the correlates of SCD (i.e., education, acculturation, depression reporting), which may account for the current findings. Importantly, future research should investigate if SCD can predict future cognitive changes in Hispanics.

Diabetes and dyslipidaemia are associated with oxidative stress independently of inflammation in long-term antiretroviral-treated HIV-infected patients

AIM

Ageing HIV-infected patients controlled by antiretroviral therapy (ART) frequently present age-related comorbidities, such as cardiovascular (CV) events, diabetes, dyslipidaemia, hypertension and chronic kidney disease (CKD). The prevalence of these comorbidities was evaluated in a cohort of long-term-monitored ART-controlled HIV-infected patients, then followed by a search into whether oxidative stress, like inflammation, might be associated with metabolic parameters and/or comorbidities.

METHODS

Included were 352 long-term ART patients who started with protease inhibitors (PIs) in 1997-1999. They were evaluated at their final visit, 11 years later, for previous CV events, prevalence of diabetes, LDL-related and atherogenic (high TG/HDL) dyslipidaemias, hypertension and CKD. Also measured were circulating biomarkers to explore oxidative stress (Lp-PLA2, oxLDL, oxLDL/LDL ratio, paraoxonase and arylesterase activities), inflammation/immune activation (hsCRP, hsIL-6, D dimer, soluble CD14, β2 microglobulin, cystatin C), adipokines and insulin resistance. Levels were compared in patients with and without each comorbidity or condition using non-parametric correlation tests and multivariate adjusted analyses.

RESULTS

At the final visit, 81.5% of patients were male and were aged (median, IQR) 49 years (45-56); BMI was 23.0 kg/m² (21.1-25.4), CD4+ lymphocytes were 620 cells/mm³ (453-790) and 91.5% had undetectable HIV-1 viral loads. The prevalence of diabetes was 11%, and LDL-related dyslipidaemia 28%, atherogenic dyslipidaemia 9%, hypertension 28%, CKD 9% and previous CV events 9%. Diabetes and atherogenic dyslipidaemia were associated with increased oxidative stress and independently with inflammation. LDL-related dyslipidaemia and impaired fasting glucose were associated with increased oxidative stress. No association of these biomarkers was detected with hypertension, CKD and previous CV events.

CONCLUSION

In long-term-treated HIV-infected patients with frequent comorbid conditions, oxidative stress could be contributing to diabetes and LDL-related and atherogenic dyslipidaemias independently of inflammation.

Invasive cervical cancer in HIV-infected women: risk and survival relative to those of the general population in France. Results from the French Hospital Database on HIV (FHDH)-Agence Nationale de Recherches sur le SIDA et les Hépatites Virales (ANRS) CO4 cohort study

OBJECTIVES

We examined trends in the incidence rates of invasive cervical cancer (ICC) and in the rate of survival after ICC among women living with HIV (WLHIV) in France and compared them to those of the general population.

METHODS

Histologically validated incident cases of ICC in the period 1992-2009 from the French Hospital Database on HIV (FHDH-ANRS CO4) were included in the study. Age-standardized incidence rates were estimated for FHDH and the general population in France for 1992-1996 [pre-combination antiretroviral therapy (cART) period], 1997-2000 (early cART period), 2001-2004 (intermediate cART period), and 2005-2009 (late cART period). Age-standardized incidence ratios (SIRs) were calculated. Five-year survival was compared with that of the general population for ICC diagnosed in 2005-2009 after standardization for age.

RESULTS

Among 28 977 WLHIV, 60 incident ICCs were histologically validated. There was a nonsignificant decreasing trend for the incidence across the cART periods (P = 0.07), from 60 to 36/100 000 person-years. The risk of ICC was consistently significantly higher in WLHIV than in the general population; the SIR was 5.4 [95% confidence interval (CI) 3.0-8.9] during the pre-cART period and 3.3 (95% CI 2.2-4.7) in 2005-2009. Survival after ICC did not improve across periods (log-rank P = 0.14), with overall estimated 5-year survival of 78% (95% CI 0.67-0.89%). Five-year survival was similar for WLHIV and the general population for women diagnosed with ICC in 2005-2009, after standardization (P = 0.45).

CONCLUSIONS

ICC risk is still more than three times higher in WLHIV than in the general population. Survival after ICC did not improve over time and was similar to that of the general population during the most recent period. Such results call for promotion of the uptake of screening in WLHIV.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

BACKGROUND

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

METHODS

This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.

RESULTS

Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.

CONCLUSIONS

After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Potent immunosuppressive activity of a phosphodiesterase-4 inhibitor N-acylhydrazone in models of lipopolysaccharide-induced shock and delayed-type hypersensitivity reaction

Immunosuppressive drugs are widely used for the treatment of immune-mediated diseases and inflammation, but the toxicity and side effects of the available immunosuppressors make the search of new agents of great relevance. Here, we evaluated the immunomodulatory activity of an N-acylhydrazone derivative, (E)-N'-(3,4-dimethoxybenzylidene)-4-methoxybenzohydrazide (LASSBio-1386), a phosphodiesterase-4 (PDE-4) inhibitor. LASSBio-1386 inhibited lymphocyte activation in a concentration-dependent fashion, decreasing lymphoproliferation and IFN-γ and IL-2 production stimulated by anti-CD3/CD28 mAbs or concanavalin A (Con A) and inducing cell-cycle arrest in the G0/G1 phase. These effects were not blocked by RU486, a glucocorticoid receptor (GR) antagonist, indicating an effect independent of glucocorticoid receptor activation. Combination index-isobologram analysis indicates a synergistic effect between LASSBio-1386 and dexamethasone in lymphoproliferation inhibition. LASSBio-1386 presented immunomodulatory action in macrophage cultures, as observed by a significant and concentration-dependent decrease in NO and TNF-α production, an effect achieved by reducing IĸB expression and NF-κB activation. In the mouse model of endotoxic shock, LASSBio-1386 at 50 and 100 mg/kg protected 50 and 85% of mice against LPS-induced lethality, respectively. In agreement to its in vitro action, treatment with 100 mg/kg of LASSBio-1386 reduced TNF-α and IL-1β serum levels, while increased IL-6 and IL-10. Finally, LASSBio-1386 reduced the paw edema in a BSA-induced delayed-type hypersensitivity model. These findings demonstrate the immunomodulatory and immunosuppressant effects of LASSBio-1386 and indicate this molecule is a promising pharmacologic agent for immune-mediated diseases.

The benefits of hepatitis C virus cure: Every rose has thorns

To examine mid-term benefits on hepatic complications, extrahepatic clinical syndromes and quality of life associated with HCV cure; to review the few safety issues linked to oral direct-acting antivirals (DAAs); and to discuss the potential population benefits of reducing the burden of HCV infection. DAAs cure HCV infection in more than 95% of patients. The halting of liver inflammation and fibrosis progression translates into both hepatic and extrahepatic benefits and reduces the need for liver transplantation. A reduction in the frequency of extrahepatic manifestations such as mixed cryoglobulinaemia and vasculitis and improvements in quality of life and fatigue have also been described. A few safety issues linked to DAAs such as the potential recurrence of aggressive HCC, the flares of hepatitis B virus in patients with overt or occult HBV infection are been discussed. Curing HCV infection also has a high potential to reduce the burden of HCV infection at the population level. With widespread scaling up of HCV treatment, several modeling studies suggest that major reductions in HCV prevalence and incidence are possible, and that elimination of viral hepatitis is an achievable target by 2030.

Experimental Observation of Classical Dynamical Monodromy

A Hamiltonian system is said to have nontrivial monodromy if its fundamental action-angle loops do not return to their initial topological state at the end of a closed circuit in angular momentum-energy space. This process has been predicted to have consequences which can be seen in dynamical systems, called dynamical monodromy. Using an apparatus consisting of a spherical pendulum subject to magnetic potentials and torques, we observe nontrivial monodromy by the associated topological change in the evolution of a loop of trajectories.

Hospitalization of HIV positive patients: Significant demand affecting all hospital sectors

BACKGROUND

In a context of the evolution of severe morbidities in patients living with HIV (PLWH), the aim of this study was to describe reasons for hospitalization and the mode of care for the patients requiring hospitalization.

METHODS

All admissions (≥24h) of PLWH to 10 hospitals in the south of Paris (COREVIH Ile-de-France Sud) between 1/1/2011 and 12/31/2011 were identified. The hospital database and the file of patients followed in the HIV referral department of each hospital were matched. Detailed clinical and biological data were collected, by returning to the individual medical records, for a random sample (65% of hospitalized patients).

RESULTS

A total of 3013 hospitalizations (1489 patients) were recorded in 2011. The estimated rate of hospitalized patients was about 8% among the 10105 PLWH routinely managed in COREVIH Ile-de-France Sud in 2011. The majority (58.5%) of these hospitalizations occurred in a unit other than the HIV referral unit. Non-AIDS-defining infections were the main reason for admission (16.4%), followed by HIV-related diseases (15.6%), hepatic/gastrointestinal diseases (12.0%), and cardiovascular diseases (10.3%). The median length of stay was 5 days overall (IQR: 2-11), it was longer among patients admitted to a referral HIV care unit than to another ward. HIV infection had been diagnosed >10 years previously in 61.4% of these hospitalized patients. They often had associated comorbidities (coinfection HCV/HVB 40.5%, smoking 45.8%; hypertension 33.4%, dyslipidemia 28.8%, diabetes 14.8%). Subjects over 60 years old accounted for 15% of hospitalized patients, most of them were virologically controlled under HIV treatment, and cardiovascular diseases were their leading reason for admission.

CONCLUSION

Needs for hospitalization among PLWH remain important, with a wide variety in causes of admission, involving all hospital departments. It is essential to prevent comorbidities to reduce these hospitalizations, and to maintain a link between the management of PLWH, that becomes rightly, increasing ambulatory, and recourse to specialized inpatient services.

Identification and preliminary characterization of a putative C-type lectin receptor-like protein in the T. cruzi tomato lectin endocytic-enriched proteome

Trypanosoma cruzi, the etiological agent of the Chagas' disease in Latin America undergoes a complex life cycle involving two hosts, a mammalian host and a reduviid insect vector (triatomine). In the insect midgut the parasite multiplies as epimastigote forms, which rely on endocytosis for their energy requirement. We recently showed that posttranslational modification of endocytic N-glycoproteins by tomato lectin (TL) binding-N-glycans is crucial for receptor-mediated endocytosis (RME) in epimastigote forms. In an attempt to characterize the endocytic proteome we used a TL affinity chromatography, which significantly enriched glycoproteins of the trypanosomal endocytic pathway. In addition to various lysosomal hydrolases, we found an endosomal C-type lectin-like protein, which displays some structural and topological characteristics of the mammalian lectin receptor superfamily. This lectin encoding a large transmembrane protein of around 375kDa contained three putative extracellular N-terminal C-type lectin domains (CTLD) and located inside the flagellar pocket (FP)/cytostome and endosomal compartments of the insect stage of the parasite and on the surface of the plasma membrane of intracellular amastigote parasites. Noteworthy, this endogenous lectin displayed similar sugar-binding specificity to that of TL and therefore could be important in either the N-glycan mediated endocytosis or parasite adhesion to host cells. We postulated that during the evolution of trypanosomatids, genes encoding lectin harboring 3 CTDLs represent an old acquisition present in free-living, monoxenic and heteroxenic trypanosomatids, which would have been secondarily lost in extracellular parasites from the T. brucei clade.

Specific Endocytosis Blockade of Trypanosoma cruzi Exposed to a Poly-LAcNAc Binding Lectin Suggests that Lectin-Sugar Interactions Participate to Receptor-Mediated Endocytosis

Trypanosoma cruzi is a protozoan parasite transmitted by a triatomine insect, and causing human Chagas disease in South America. This parasite undergoes a complex life cycle alternating between non-proliferative and dividing forms. Owing to their high energy requirement, replicative epimastigotes of the insect midgut display high endocytic activity. This activity is mainly restricted to the cytostome, by which the cargo is taken up and sorted through the endosomal vesicular network to be delivered to reservosomes, the final lysosomal-like compartments. In African trypanosomes tomato lectin (TL) and ricin, respectively specific to poly-N-acetyllactosamine (poly-LacNAc) and β-D-galactose, allowed the identification of giant chains of poly-LacNAc in N-glycoproteins of the endocytic pathway. We show that in T. cruzi epimastigote forms also, glycoproteins of the endocytic pathway are characterized by the presence of N-linked glycans binding to both ricin and TL. Affinity chromatography using both TL and Griffonia simplicifolia lectin II (GSLII), specific to non-reducing terminal residue of N-acetylglucosamine (GlcNAc), led to an enrichment of glycoproteins of the trypanosomal endocytic pathway. Incubation of live parasites with TL, which selectively bound to the cytostome/cytopharynx, specifically inhibited endocytosis of transferrin (Tf) but not dextran, a marker of fluid endocytosis. Taken together, our data suggest that N-glycan modification of endocytic components plays a crucial role in receptor-mediated endocytosis of T. cruzi.

Monitoring of the Parasite Load in the Digestive Tract of Rhodnius prolixus by Combined qPCR Analysis and Imaging Techniques Provides New Insights into the Trypanosome Life Cycle

Background

Here we report the monitoring of the digestive tract colonization of Rhodnius prolixus by Trypanosoma cruzi using an accurate determination of the parasite load by qPCR coupled with fluorescence and bioluminescence imaging (BLI). These complementary methods revealed critical steps necessary for the parasite population to colonize the insect gut and establish vector infection.

Methodology/Principal Findings

qPCR analysis of the parasite load in the insect gut showed several limitations due mainly to the presence of digestive-derived products that are thought to degrade DNA and inhibit further the PCR reaction. We developed a real-time PCR strategy targeting the T. cruzi repetitive satellite DNA sequence using as internal standard for normalization, an exogenous heterologous DNA spiked into insect samples extract, to precisely quantify the parasite load in each segment of the insect gut (anterior midgut, AM, posterior midgut, PM, and hindgut, H). Using combined fluorescence microscopy and BLI imaging as well as qPCR analysis, we showed that during their journey through the insect digestive tract, most of the parasites are lysed in the AM during the first 24 hours independently of the gut microbiota. During this short period, live parasites move through the PM to establish the onset of infection. At days 3–4 post-infection (p.i.), the parasite population begins to colonize the H to reach a climax at day 7 p.i., which is maintained during the next two weeks. Remarkably, the fluctuation of the parasite number in H remains relatively stable over the two weeks after refeeding, while the populations residing in the AM and PM increases slightly and probably constitutes the reservoirs of dividing epimastigotes.

Conclusions/Significance

These data show that a tuned dynamic control of the population operates in the insect gut to maintain an equilibrium between non-dividing infective trypomastigote forms and dividing epimastigote forms of the parasite, which is crucial for vector competence.

Although the key aspects of the T. cruzi life cycle were described more than one century ago, the development and interactions of T. cruzi with its vector are poorly characterized. By dissection of different compartments of the triatomine gut (prototype Rhodnius prolixus) (i.e., AM, PM and H) at regular time intervals, we evaluated trypanosome development within the insect using an accurate qPCR assay. qPCR analysis of trypanosomal colonization and clearance dynamics in real-time were confirmed in vivo using both fluorescence and bioluminescence imaging, which revealed massive parasite lysis during the first 24 hours post-feeding (p.f.). After one week, the parasite succeeded in establishing a resident population in each compartment of the gut, albeit at varying levels. From one week after the onset of infection in the AM and PM, some resident forms agglomerated into rosettes, clustering in close association with the vector tissue and constituting potential parasite reservoirs of the bug. For the first time, we have described a methodology to accurately quantify parasites in the insect gut that would be a useful tool for evaluating the impact of RNAi silencing of insect genes during the course of infection by T. cruzi.

HCV viral load at baseline and at week 4 of telaprevir/boceprevir based triple therapies are associated with virological outcome in HIV/hepatitis C co-infected patients

BACKGROUND

As first generation HCV-specific protease inhibitors, boceprevir (BOC) or telaprevir (TVR) can achieve 60% to 70% sustained virological response (SVR) for HCV infected patients with genotype 1 infections, they could remain temporary a therapeutic option in patients living in resources limited countries with limited access to the new anti-HCV direct acting antiviral (DAA) drugs, such as sofosbuvir.

OBJECTIVES AND STUDY DESIGN

Here we evaluated in a routine practice setting, the treatment responses, tolerance and factors associated with SVR of a triple therapy with BOC or TVR, combined with pegylated interferon and ribavirin (PegIFN/RBV) in HIV/HCV co-infected patients, included in a large cohort of HIV/HCV coinfected patients (ANRS CO13-HEPAVIH).

RESULTS

Among the 89 HIV/HCV coinfected patients treated, 65% of whom were previous non-responders to PegIFN/RBV therapy, 65%, 55% and 41% had at baseline genotype 1a, a high baseline HCV-RNA (≥800,000 IU/ml) and a cirrhosis, respectively. The SVR12 rate was 63% overall, 53% for BOC-based regimen and 66% for TVR-based regimen. In multivariate analysis, two factors were significantly associated with HCV SVR: HCV viral load <800,000 IU/mL at treatment initiation versus ≥800,000 IU/mL (OR 4.403, 95% CI 1.29-15.04; p=0.018) and virological response at W4 (HCV-RNA undetectable after 4 weeks of triple therapy) (OR 3.35, 95% CI 1.07-10.48; p=0.038).

CONCLUSIONS

Overall SVR12 was 63% and our results suggest that HIV/HCV coinfected patients with low HCV viral load (<800,000 IU/mL) and undetectable HCV-RNA after 4 weeks of triple therapy with TVR or BOC-based regimen have a higher probability of treatment success.

Protein 2DE reference map of the anterior midgut of the blood-sucking bug Rhodnius prolixus

Rhodnius prolixus is an important vector of Trypanosoma cruzi, the causative agent of Chagas' disease, an illness that affects 20% of Latin America population. The obligatory course of the parasite in the vector digestive tract has made it an important target for investigation in order to control the parasite transmission and thus interrupt its biological cycle in the insect vector. Therefore, an insight into the vector midgut physiology is valuable for insect control as well as to provide potential novel targets for drugs and vaccines development and thus disease treatment. In this study, the first 2DE map of R. prolixus anterior midgut is described. Proteins were separated by 2DE and analyzed by nano-LC MS/MS. The results yielded 489 proteins from 475 spots. These proteins were classified into 28 functional groups and their physiological roles in the insect midgut are discussed. All MS data have been deposited in the ProteomeXchange with identifiers PXD001488 and PXD001489 (http://proteomecentral.proteomexchange.org/dataset/PXD001488, http://proteomecentral.proteomexchange.org/dataset/PXD001489).

In vitro metacyclogenesis of Trypanosoma cruzi induced by starvation correlates with a transient adenylyl cyclase stimulation as well as with a constitutive upregulation of adenylyl cyclase expression

The Trypanosoma cruzi adenylyl cyclase (AC) multigene family encodes different isoforms (around 15) sharing a variable large N-terminal domain, which is extracellular and receptor-like, followed by a transmembrane helix and a conserved C-terminal catalytic domain. It was proposed that these key enzymes in the cAMP signalling pathway allow the parasite to sense its changing extracellular milieu in order to rapidly adapt to its new environment, which is generally achieved through a differentiation process. One of the critical differentiation events the parasitic protozoan T. cruzi undergoes during its life cycle, known as metacyclogenesis, occurs in the digestive tract of the insect and corresponds to the differentiation from noninfective epimastigotes to infective metacyclic trypomastigote forms. By in vitro monitoring the activity of AC during metacyclogenesis, we showed that both the activity of AC and the intracellular cAMP content follow a similar pattern of transient stimulation in a two-step process, with a first activation peak occurring during the first hours of nutritional stress and a second peak between 6 and 48 h, corresponding to the cellular adhesion. During this differentiation process, a general mechanism of upregulation of AC expression of both mRNA and protein is triggered and in particular for a major subclass of these enzymes that are present in various gene copies commonly associated to the THT gene clusters. Although the scattered genome distribution of these gene copies is rather unusual in trypanosomatids and seems to be a recent acquisition in the evolution of the T. cruzi clade, their encoded product redistributed on the flagellum of the parasite upon differentiation could be important to sense the extracellular milieu.

Current knowledge and future perspectives on acute hepatitis C infection

Acute hepatitis C virus (HCV) infections are frequently seen worldwide in certain risk groups, with an annual incidence rate varying between 0.08% and 66%. Although this incidence is substantial, a delayed diagnosis during chronic infection is most often made in the absence of clinical symptoms in the acute phase of the infection. Currently used methods to diagnose acute HCV infection are IgG antibody seroconversion and repeated HCV RNA measurements, although no definitive diagnostic test is currently available. Progress in the field of adaptive and innate immune responses has aided both advances in the field of HCV vaccine development and a more basic understanding of viral persistence. The rapid changes in the treatment of chronic HCV infection will affect therapeutic regimens for acute HCV infection in the coming years, leading to shorter treatment courses and pegylated interferon-free modalities. This review gives an overview of the current knowledge and uncertainties, together with some future perspectives on acute hepatitis C epidemiology, virology, immunology, and treatment.

[Injectable hospital preparation of valine labeled with the carbon 13 and nitrogen 15 (5 mg/mL) for a clinical trial on the brain tumor metabolism: Pharmaceutical control of active pharmaceutical ingredient and stability study of the finished product]

INTRODUCTION

The L-Valine labeled (L-[U-(13)C,(15)N] Val) is a stable isotopic tracer administered by parenteral route within the framework of a new clinical research program concerning the brain tumor metabolism. To meet regulatory requirements and have ready to use solution with an expiration date, a pharmaceutical control of active pharmaceutical ingredient followed by stability study of hospital preparation were realised.

MATERIALS AND METHODS

After the pharmaceutical control of the L-[U-(13)C,(15)N] Val, the hospital preparation was prepared according to the good manufacturing preparation. Prepared bottles were stored at 5°C±3°C and 25°C±2°C for six months. The stability of the preparation was determined by physico-chemical controls (pH, osmolality, sub-visible particles, L-[U-(13)C,(15)N] Val concentration, sodium concentration, isotopic enrichment) and microbiological (bacterial endotoxin and sterility).

RESULTS

Concentrations of L-[U-(13)C, (15)N] Val and sodium does not significantly decrease during the stability study. In parallel, no change in pH and osmolality were highlighted. Isotopic enrichment higher than 99.9% reflected the stability of labeling of L-valine molecule. The sub-visible particles, the bacterial endotoxin and sterility were in accordance with the European Pharmacopoeia attesting limpidity, apyrogenicity and sterility of this injectable preparation.

DISCUSSION AND CONCLUSION

The stability of this hospital preparation of L-[U-(13)C, (15)N] Val has been demonstrated for six months at 5°C±3°C and 25°C±2°C, ensuring a parenteral administration as part of the clinical trial.

[Aseptic process validation and stability study of an injectable preparation of fructose (5%)-glycerol (10%) as part of a hospital clinical research program on endoscopic curative treatment for early epithelial neoplastic lesions of the gastrointestinal tract]

INTRODUCTION

As part of a hospital clinical research program on endoscopic curative treatment for early epithelial neoplastic lesions of the gastrointestinal tract, a new hospital sterile and non-pyrogenic preparation of fructose (5%)-glycerol (10%) was realized. Under pharmaceutical legislation, the provision of this hospital preparation involves of aseptic process validation and achieve a stability study.

MATERIALS AND METHODS

After the aseptic process validation with Mediafill Test, the preparation was made under aseptic conditions associated with a sterilizing filtration according to the good practices preparation. Prepared flexible bags (100mL of solution) were stored for one year in a climatic chamber (25±2°C). To assess stability, the physicochemical controls (fructose concentration, glycerol concentration, hydroxy-methyl-5 furfural [5-HMF] concentration, sodium concentration, pH measure, osmolality and sub-visible particles count) and microbiological (bioburden, bacterial endotoxin and sterility) were performed at regular intervals for one year.

RESULTS

Neither significant decrease of fructose concentration, glycerol concentration and sodium concentration nor pH, 5-HMF, osmolality variations out of specifications were observed for one year. The sub-visible particles count, the bacterial endotoxin and sterility were in accordance with the European pharmacopoeia attesting limpidity, apyrogenicity and sterility of this injectable preparation.

DISCUSSION AND CONCLUSION

The hospital preparation was stable over one year at 25±2°C, ensuring safe administration in humans within the framework of this clinical research.