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Bodinier M, Monneret G, Casimir M, Fleurie A, Conti F, Venet F, Cazalis MA, Cerrato E, Peronnet E, Rimmelé T, Lukaszewicz AC, Brengel-Pesce K, Llitjos JF. Identification of a sub-group of critically ill patients with high risk of intensive care unit-acquired infections and poor clinical course using a transcriptomic score. Crit Care 2023; 27:158. [PMID: 37085849 PMCID: PMC10119529 DOI: 10.1186/s13054-023-04436-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 01/23/2023] [Accepted: 04/08/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND The development of stratification tools based on the assessment of circulating mRNA of genes involved in the immune response is constrained by the heterogeneity of septic patients. The aim of this study is to develop a transcriptomic score based on a pragmatic combination of immune-related genes detected with a prototype multiplex PCR tool. METHODS As training cohort, we used the gene expression dataset obtained from 176 critically ill patients enrolled in the REALISM study (NCT02638779) with various etiologies and still hospitalized in intensive care unit (ICU) at day 5-7. Based on the performances of each gene taken independently to identify patients developing ICU-acquired infections (ICU-AI) after day 5-7, we built an unweighted score assuming the independence of each gene. We then determined the performances of this score to identify a subgroup of patients at high risk to develop ICU-AI, and both longer ICU length of stay and mortality of this high-risk group were assessed. Finally, we validated the effectiveness of this score in a retrospective cohort of 257 septic patients. RESULTS This transcriptomic score (TScore) enabled the identification of a high-risk group of patients (49%) with an increased rate of ICU-AI when compared to the low-risk group (49% vs. 4%, respectively), with longer ICU length of stay (13 days [95% CI 8-30] vs. 7 days [95% CI 6-9], p < 0.001) and higher ICU mortality (15% vs. 2%). High-risk patients exhibited biological features of immune suppression with low monocytic HLA-DR levels, higher immature neutrophils rates and higher IL10 concentrations. Using the TScore, we identified 160 high-risk patients (62%) in the validation cohort, with 30% of ICU-AI (vs. 18% in the low-risk group, p = 0.06), and significantly higher mortality and longer ICU length of stay. CONCLUSIONS The transcriptomic score provides a useful and reliable companion diagnostic tool to further develop immune modulating drugs in sepsis in the context of personalized medicine.
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Affiliation(s)
- Maxime Bodinier
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon, bioMérieux), Lyon, France
- Open Innovation and Partnerships (OI&P), bioMérieux S.A., Marcy L'Etoile, France
| | - Guillaume Monneret
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon, bioMérieux), Lyon, France
- Immunology Laboratory, Edouard Herriot Hospital - Hospices Civils de Lyon, Lyon, France
| | - Marie Casimir
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon, bioMérieux), Lyon, France
- Open Innovation and Partnerships (OI&P), bioMérieux S.A., Marcy L'Etoile, France
| | - Aurore Fleurie
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon, bioMérieux), Lyon, France
- Open Innovation and Partnerships (OI&P), bioMérieux S.A., Marcy L'Etoile, France
| | - Filippo Conti
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon, bioMérieux), Lyon, France
| | - Fabienne Venet
- Immunology Laboratory, Edouard Herriot Hospital - Hospices Civils de Lyon, Lyon, France
- Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard-Lyon 1, Lyon, France
| | - Marie-Angélique Cazalis
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon, bioMérieux), Lyon, France
- Open Innovation and Partnerships (OI&P), bioMérieux S.A., Marcy L'Etoile, France
| | - Elisabeth Cerrato
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon, bioMérieux), Lyon, France
- Open Innovation and Partnerships (OI&P), bioMérieux S.A., Marcy L'Etoile, France
| | - Estelle Peronnet
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon, bioMérieux), Lyon, France
- Open Innovation and Partnerships (OI&P), bioMérieux S.A., Marcy L'Etoile, France
| | - Thomas Rimmelé
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon, bioMérieux), Lyon, France
- Anaesthesia and Critical Care Medicine Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Anne-Claire Lukaszewicz
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon, bioMérieux), Lyon, France
- Anaesthesia and Critical Care Medicine Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Karen Brengel-Pesce
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon, bioMérieux), Lyon, France
| | - Jean-François Llitjos
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon, bioMérieux), Lyon, France.
- Open Innovation and Partnerships (OI&P), bioMérieux S.A., Marcy L'Etoile, France.
- Anaesthesia and Critical Care Medicine Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France.
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Venet F, Gossez M, Bidar F, Bodinier M, Coudereau R, Lukaszewicz AC, Tardiveau C, Brengel-Pesce K, Cheynet V, Cazalis MA, Pescarmona R, Garnier L, Ortillon M, Buisson M, Bouscambert-Duchamp M, Morfin-Sherpa F, Casalegno JS, Conti F, Rimmelé T, Argaud L, Cour M, Saadatian-Elahi M, Henaff L, Vanhems P, Monneret G. T cell response against SARS-CoV-2 persists after one year in patients surviving severe COVID-19. EBioMedicine 2022; 78:103967. [PMID: 35349827 PMCID: PMC8957405 DOI: 10.1016/j.ebiom.2022.103967] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 12/28/2021] [Revised: 03/10/2022] [Accepted: 03/10/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In critically ill COVID-19 patients, the initial response to SARS-CoV-2 infection is characterized by major immune dysfunctions. The capacity of these severe patients to mount a robust and persistent SARS-CoV-2 specific T cell response despite the presence of severe immune alterations during the ICU stay is unknown. METHODS Critically ill COVID-19 patients were sampled five times during the ICU stay and 9 and 13 months afterwards. Immune monitoring included counts of lymphocyte subpopulations, HLA-DR expression on monocytes, plasma IL-6 and IL-10 concentrations, anti-SARS-CoV-2 IgG levels and T cell proliferation in response to three SARS-CoV-2 antigens. FINDINGS Despite the presence of major lymphopenia and decreased monocyte HLA-DR expression during the ICU stay, convalescent critically ill COVID-19 patients consistently generated adaptive and humoral immune responses against SARS-CoV-2 maintained for more than one year after hospital discharge. Patients with long hospital stays presented with stronger anti-SARS-CoV-2 specific T cell response but no difference in anti-SARS-CoV2 IgG levels. INTERPRETATION Convalescent critically ill COVID-19 patients consistently generated a memory immune response against SARS-CoV-2 maintained for more than one year after hospital discharge. In recovered individuals, the intensity of SARS-CoV-2 specific T cell response was dependent on length of hospital stay. FUNDING This observational study was supported by funds from the Hospices Civils de Lyon, Fondation HCL, Claude Bernard Lyon 1 University and Région Auvergne Rhône-Alpes and by partial funding by REACTing (Research and ACTion targeting emerging infectious diseases) INSERM, France and a donation from Fondation AnBer (http://fondationanber.fr/).
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Affiliation(s)
- Fabienne Venet
- Immunology Laboratory, Hôpital E. Herriot - Hospices Civils de Lyon, 5 place d'Arsonval, Lyon 69437 CEDEX 03, France; Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard-Lyon 1, Lyon, France.
| | - Morgane Gossez
- Immunology Laboratory, Hôpital E. Herriot - Hospices Civils de Lyon, 5 place d'Arsonval, Lyon 69437 CEDEX 03, France; Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard-Lyon 1, Lyon, France
| | - Frank Bidar
- EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), Joint Research Unit HCL-bioMérieux, Lyon 69003, France; Anesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon 69437, France
| | - Maxime Bodinier
- EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), Joint Research Unit HCL-bioMérieux, Lyon 69003, France
| | - Rémy Coudereau
- Immunology Laboratory, Hôpital E. Herriot - Hospices Civils de Lyon, 5 place d'Arsonval, Lyon 69437 CEDEX 03, France; EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), Joint Research Unit HCL-bioMérieux, Lyon 69003, France
| | - Anne-Claire Lukaszewicz
- EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), Joint Research Unit HCL-bioMérieux, Lyon 69003, France; Anesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon 69437, France
| | - Claire Tardiveau
- EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), Joint Research Unit HCL-bioMérieux, Lyon 69003, France
| | - Karen Brengel-Pesce
- EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), Joint Research Unit HCL-bioMérieux, Lyon 69003, France
| | - Valérie Cheynet
- EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), Joint Research Unit HCL-bioMérieux, Lyon 69003, France
| | - Marie-Angélique Cazalis
- EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), Joint Research Unit HCL-bioMérieux, Lyon 69003, France
| | - Rémi Pescarmona
- Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard-Lyon 1, Lyon, France; Immunology Laboratory, Lyon-Sud University Hospital - Hospices Civils de Lyon, Pierre-Bénite, France
| | - Lorna Garnier
- Immunology Laboratory, Lyon-Sud University Hospital - Hospices Civils de Lyon, Pierre-Bénite, France
| | - Marine Ortillon
- Immunology Laboratory, Hôpital E. Herriot - Hospices Civils de Lyon, 5 place d'Arsonval, Lyon 69437 CEDEX 03, France
| | - Marielle Buisson
- Centre d'Investigation Clinique de Lyon (CIC 1407 Inserm), Hospices Civils de Lyon, Lyon F-69677, France
| | - Maude Bouscambert-Duchamp
- Virology Laboratory, CNR des virus des infections Respiratoires, Institut des Agents Infectieux, Hospices Civils de Lyon, Hôpital de la Croix Rousse, Lyon, France
| | - Florence Morfin-Sherpa
- Virology Laboratory, CNR des virus des infections Respiratoires, Institut des Agents Infectieux, Hospices Civils de Lyon, Hôpital de la Croix Rousse, Lyon, France
| | - Jean-Sébastien Casalegno
- Virology Laboratory, CNR des virus des infections Respiratoires, Institut des Agents Infectieux, Hospices Civils de Lyon, Hôpital de la Croix Rousse, Lyon, France
| | - Filippo Conti
- EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), Joint Research Unit HCL-bioMérieux, Lyon 69003, France
| | - Thomas Rimmelé
- EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), Joint Research Unit HCL-bioMérieux, Lyon 69003, France; Anesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon 69437, France
| | - Laurent Argaud
- Medical intensive Care Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon 69437, France
| | - Martin Cour
- Medical intensive Care Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon 69437, France
| | - Mitra Saadatian-Elahi
- Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard-Lyon 1, Lyon, France; Service Hygiène, Epidémiologie, Infectiovigilance et Prévention, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon 69437, France
| | - Laetitia Henaff
- Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard-Lyon 1, Lyon, France; Service Hygiène, Epidémiologie, Infectiovigilance et Prévention, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon 69437, France
| | - Philippe Vanhems
- Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard-Lyon 1, Lyon, France; Service Hygiène, Epidémiologie, Infectiovigilance et Prévention, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon 69437, France
| | - Guillaume Monneret
- Immunology Laboratory, Hôpital E. Herriot - Hospices Civils de Lyon, 5 place d'Arsonval, Lyon 69437 CEDEX 03, France; EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), Joint Research Unit HCL-bioMérieux, Lyon 69003, France
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Lafon T, Cazalis MA, Vallejo C, Tazarourte K, Blein S, Pachot A, Laterre PF, Laribi S, François B. Prognostic performance of endothelial biomarkers to early predict clinical deterioration of patients with suspected bacterial infection and sepsis admitted to the emergency department. Ann Intensive Care 2020; 10:113. [PMID: 32785865 PMCID: PMC7423829 DOI: 10.1186/s13613-020-00729-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 04/09/2020] [Accepted: 07/31/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The objective of this study was to evaluate the ability of endothelial biomarkers to early predict clinical deterioration of patients admitted to the emergency department (ED) with a suspected sepsis. This was a prospective, multicentre, international study conducted in EDs. Adult patients with suspected acute bacterial infection and sepsis were enrolled but only those with confirmed infection were analysed. The kinetics of biomarkers and organ dysfunction were collected at T0, T6 and T24 hours after ED admission to assess prognostic performances of sVEGFR2, suPAR and procalcitonin (PCT). The primary outcome was the deterioration within 72 h and was defined as a composite of relevant outcomes such as death, intensive care unit admission and/or SOFA score increase validated by an independent adjudication committee. RESULTS After adjudication of 602 patients, 462 were analysed including 124 who deteriorated (27%). On admission, those who deteriorated were significantly older (73 [60-82] vs 63 [45-78] y-o, p < 0.001) and presented significantly higher SOFA scores (2.15 ± 1.61 vs 1.56 ± 1.40, p = 0.003). At T0, sVEGFR2 (5794 [5026-6788] vs 6681 [5516-8059], p < 0.0001), suPAR (6.04 [4.42-8.85] vs 4.68 [3.50-6.43], p < 0.0001) and PCT (7.8 ± 25.0 vs 5.4 ± 17.9 ng/mL, p = 0.001) were associated with clinical deterioration. In multivariate analysis, low sVEGFR2 expression and high suPAR and PCT levels were significantly associated with early deterioration, independently of confounding parameters (sVEGFR2, OR = 1.53 [1.07-2.23], p < 0.001; suPAR, OR = 1.57 [1.21-2.07], p = 0.003; PCT, OR = 1.10 [1.04-1.17], p = 0.0019). Combination of sVEGFR2 and suPAR had the best prognostic performance (AUC = 0.7 [0.65-0.75]) compared to clinical or biological variables. CONCLUSIONS sVEGFR2, either alone or combined with suPAR, seems of interest to predict deterioration of patients with suspected bacterial acute infection upon ED admission and could help front-line physicians in the triage process.
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Affiliation(s)
- Thomas Lafon
- Emergency Department, Dupuytren University Hospital, Limoges, France.,Inserm CIC 1435, Dupuytren University Hospital, Limoges, France
| | | | - Christine Vallejo
- Emergency Department, Dupuytren University Hospital, Limoges, France.,Inserm CIC 1435, Dupuytren University Hospital, Limoges, France
| | - Karim Tazarourte
- Emergency Department, University Hospital Edouard Herriot - HCL, Lyon, France
| | - Sophie Blein
- Medical Diagnostic Discovery Department MD3, bioMerieux SA, Marcy L'Etoile, France
| | - Alexandre Pachot
- Medical Diagnostic Discovery Department MD3, bioMerieux SA, Marcy L'Etoile, France
| | - Pierre-François Laterre
- Departments of Emergency and Intensive Care, Cliniques Universitaires Saint Luc, UCL, Brussels, Belgium
| | - Said Laribi
- School of Medicine and Tours University Hospital, Emergency Medicine Department, Tours University, Tours, France
| | - Bruno François
- Inserm CIC 1435, Dupuytren University Hospital, Limoges, France. .,Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, Limoges, France. .,UMR 1092, University of Limoges, Limoges, France.
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Plassais J, Venet F, Cazalis MA, Le Quang D, Pachot A, Monneret G, Tissot S, Textoris J. Transcriptome modulation by hydrocortisone in severe burn shock: ancillary analysis of a prospective randomized trial. Crit Care 2017. [PMID: 28623938 PMCID: PMC5473974 DOI: 10.1186/s13054-017-1743-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background Despite shortening vasopressor use in shock, hydrocortisone administration remains controversial, with potential harm to the immune system. Few studies have assessed the impact of hydrocortisone on the transcriptional response in shock, and we are lacking data on burn shock. Our objective was to assess the hydrocortisone-induced transcriptional modulation in severe burn shock, particularly modulation of the immune response. Methods We collected whole blood samples during a randomized controlled trial assessing the efficacy of hydrocortisone administration in burn shock. Using whole genome microarrays, we first compared burn patients (n = 32) from the placebo group to healthy volunteers to describe the transcriptional modulation induced by burn shock over the first week. Then we compared burn patients randomized for either hydrocortisone administration or placebo, to assess hydrocortisone-induced modulation. Results Study groups were similar in terms of severity and major outcomes, but shock duration was significantly reduced in the hydrocortisone group. Many genes (n = 1687) were differentially expressed between burn patients and healthy volunteers, with 85% of them exhibiting a profound and persistent modulation over seven days. Interestingly, we showed that hydrocortisone enhanced the shock-associated repression of adaptive, but also innate immunity. Conclusions We found that the initial host response to burn shock encompasses wide and persistent modulation of gene expression, with profound modulation of pathways associated with metabolism and immunity. Importantly, hydrocortisone administration may worsen the immunosuppression associated with severe injury. These data should be taken into account in the risk ratio of hydrocortisone administration in patients with inflammatory shock. Trial registration ClinicalTrials.gov, NCT00149123. Registered on 6 September 2005. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1743-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jonathan Plassais
- EA7426, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, bioMérieux ; "Pathophysiology of injury induced immunosuppression (PI3)", hôpital E. Herriot, 5 place d'Arsonval, 69437, Lyon, France
| | - Fabienne Venet
- EA7426, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, bioMérieux ; "Pathophysiology of injury induced immunosuppression (PI3)", hôpital E. Herriot, 5 place d'Arsonval, 69437, Lyon, France.,Hospices Civils de Lyon, Immunology laboratory, hôpital E. Herriot, 5 place d'Arsonval, 69437, Lyon, France
| | - Marie-Angélique Cazalis
- EA7426, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, bioMérieux ; "Pathophysiology of injury induced immunosuppression (PI3)", hôpital E. Herriot, 5 place d'Arsonval, 69437, Lyon, France
| | - Diane Le Quang
- Hospices Civils de Lyon, Burn ICU, Anesthesia and Critical Care Medicine department, hôpital E. Herriot, 5 place d'Arsonval, 69437, Lyon, France
| | - Alexandre Pachot
- EA7426, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, bioMérieux ; "Pathophysiology of injury induced immunosuppression (PI3)", hôpital E. Herriot, 5 place d'Arsonval, 69437, Lyon, France
| | - Guillaume Monneret
- EA7426, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, bioMérieux ; "Pathophysiology of injury induced immunosuppression (PI3)", hôpital E. Herriot, 5 place d'Arsonval, 69437, Lyon, France.,Hospices Civils de Lyon, Immunology laboratory, hôpital E. Herriot, 5 place d'Arsonval, 69437, Lyon, France
| | - Sylvie Tissot
- Hospices Civils de Lyon, Burn ICU, Anesthesia and Critical Care Medicine department, hôpital E. Herriot, 5 place d'Arsonval, 69437, Lyon, France
| | - Julien Textoris
- EA7426, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, bioMérieux ; "Pathophysiology of injury induced immunosuppression (PI3)", hôpital E. Herriot, 5 place d'Arsonval, 69437, Lyon, France. .,Hospices Civils de Lyon, Burn ICU, Anesthesia and Critical Care Medicine department, hôpital E. Herriot, 5 place d'Arsonval, 69437, Lyon, France.
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Venet F, Schilling J, Cazalis MA, Demaret J, Poujol F, Girardot T, Rouget C, Pachot A, Lepape A, Friggeri A, Rimmelé T, Monneret G, Textoris J. Modulation of LILRB2 protein and mRNA expressions in septic shock patients and after ex vivo lipopolysaccharide stimulation. Hum Immunol 2017; 78:441-450. [PMID: 28341250 DOI: 10.1016/j.humimm.2017.03.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 10/21/2016] [Revised: 03/17/2017] [Accepted: 03/21/2017] [Indexed: 01/22/2023]
Abstract
Septic patients develop immune dysfunctions, the intensities and durations of which are associated with deleterious outcomes. LILRB2 (leukocyte immunoglobulin-like receptors subfamily B, member 2), an inhibitory member of the LILR family of receptors, is known for its immunoregulatory properties. In a microarray study, we identified LILRB2 as an upregulated gene in septic shock patients. On monocytes primed with LPS ex vivo, LILRB2 mRNA and protein expressions were dose-dependently downregulated and subsequently highly upregulated versus non-stimulated cells. This is concordant with clinical data, since both LILRB2 mRNA and protein expressions were significantly increased in septic shock patients at day 3. In a cohort of more than 700 patients, only after septic shock were LILRB2 mRNA levels increased compared with non-infected or less severely infected patients. This was preceded by a phase of downregulated mRNA expression during the first hours after septic shock. Interestingly, the intensity of this decrease was associated with increased risk of death after septic shock. LILRB2 protein and mRNA expressions are deregulated on monocytes after septic shock and this can be reproduced ex vivo after LPS challenge. Considering LILRB2 inhibitory properties, we can hypothesize that LILRB2 may participate in the altered immune response after septic shock.
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Affiliation(s)
- Fabienne Venet
- Hospices Civils de Lyon, Immunology Laboratory, Groupement Hospitalier Edouard Herriot, Lyon, France; EA 7426 Hospices Civils de Lyon - bioMérieux - UCBL1 "Pathophysiology of Injury-induced Immunosuppression", Joint Research Unit, Groupement Hospitalier Edouard Herriot, Lyon, France.
| | - Jeremy Schilling
- EA 7426 Hospices Civils de Lyon - bioMérieux - UCBL1 "Pathophysiology of Injury-induced Immunosuppression", Joint Research Unit, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - Marie-Angélique Cazalis
- EA 7426 Hospices Civils de Lyon - bioMérieux - UCBL1 "Pathophysiology of Injury-induced Immunosuppression", Joint Research Unit, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - Julie Demaret
- Hospices Civils de Lyon, Immunology Laboratory, Groupement Hospitalier Edouard Herriot, Lyon, France; EA 7426 Hospices Civils de Lyon - bioMérieux - UCBL1 "Pathophysiology of Injury-induced Immunosuppression", Joint Research Unit, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - Fanny Poujol
- EA 7426 Hospices Civils de Lyon - bioMérieux - UCBL1 "Pathophysiology of Injury-induced Immunosuppression", Joint Research Unit, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - Thibaut Girardot
- EA 7426 Hospices Civils de Lyon - bioMérieux - UCBL1 "Pathophysiology of Injury-induced Immunosuppression", Joint Research Unit, Groupement Hospitalier Edouard Herriot, Lyon, France; Hospices Civils de Lyon, Anesthesiology and Critical Care Medicine Department, Groupement Hospitalier Edouard Herriot, University Claude Bernard Lyon 1, Lyon, France
| | - Christelle Rouget
- EA 7426 Hospices Civils de Lyon - bioMérieux - UCBL1 "Pathophysiology of Injury-induced Immunosuppression", Joint Research Unit, Groupement Hospitalier Edouard Herriot, Lyon, France; Hospices Civils de Lyon, Anesthesiology and Critical Care Medicine Department, Groupement Hospitalier Edouard Herriot, University Claude Bernard Lyon 1, Lyon, France
| | - Alexandre Pachot
- EA 7426 Hospices Civils de Lyon - bioMérieux - UCBL1 "Pathophysiology of Injury-induced Immunosuppression", Joint Research Unit, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - Alain Lepape
- Hospices Civils de Lyon, Intensive Care Unit, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Arnaud Friggeri
- Hospices Civils de Lyon, Intensive Care Unit, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Thomas Rimmelé
- EA 7426 Hospices Civils de Lyon - bioMérieux - UCBL1 "Pathophysiology of Injury-induced Immunosuppression", Joint Research Unit, Groupement Hospitalier Edouard Herriot, Lyon, France; Hospices Civils de Lyon, Anesthesiology and Critical Care Medicine Department, Groupement Hospitalier Edouard Herriot, University Claude Bernard Lyon 1, Lyon, France
| | - Guillaume Monneret
- Hospices Civils de Lyon, Immunology Laboratory, Groupement Hospitalier Edouard Herriot, Lyon, France; EA 7426 Hospices Civils de Lyon - bioMérieux - UCBL1 "Pathophysiology of Injury-induced Immunosuppression", Joint Research Unit, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - Julien Textoris
- EA 7426 Hospices Civils de Lyon - bioMérieux - UCBL1 "Pathophysiology of Injury-induced Immunosuppression", Joint Research Unit, Groupement Hospitalier Edouard Herriot, Lyon, France; Hospices Civils de Lyon, Anesthesiology and Critical Care Medicine Department, Groupement Hospitalier Edouard Herriot, University Claude Bernard Lyon 1, Lyon, France
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Demaret J, Venet F, Plassais J, Cazalis MA, Vallin H, Friggeri A, Lepape A, Rimmelé T, Textoris J, Monneret G. Identification of CD177 as the most dysregulated parameter in a microarray study of purified neutrophils from septic shock patients. Immunol Lett 2016; 178:122-30. [DOI: 10.1016/j.imlet.2016.08.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/23/2016] [Accepted: 08/24/2016] [Indexed: 12/31/2022]
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Friggeri A, Cazalis MA, Pachot A, Cour M, Argaud L, Allaouchiche B, Floccard B, Schmitt Z, Martin O, Rimmelé T, Fontaine-Kesteloot O, Page M, Piriou V, Bohé J, Monneret G, Morisset S, Textoris J, Vallin H, Blein S, Maucort-Boulch D, Lepape A, Venet F. Decreased CX3CR1 messenger RNA expression is an independent molecular biomarker of early and late mortality in critically ill patients. Crit Care 2016; 20:204. [PMID: 27364780 PMCID: PMC4929760 DOI: 10.1186/s13054-016-1362-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/27/2016] [Indexed: 01/31/2023]
Abstract
Background Chemokine (C-X3-C motif) receptor 1 (CX3CR1) was identified as the most differentially expressed gene between survivors and non-survivors in two independent cohorts of septic shock patients and was proposed as a marker of sepsis-induced immunosuppression. Whether such a biomarker is associated with mortality in the heterogeneous group of critically ill patients is unknown. The primary objective of this study was to evaluate the association between CX3CR1 messenger RNA (mRNA) expression and mortality in intensive care unit (ICU) patients. The secondary objective was to evaluate similar endpoints in the subgroup of septic shock patients. Methods We performed a prospective, multicentre, non-interventional study in six ICUs of university hospitals in Lyon, France. Every consecutive adult patient with systemic inflammatory response syndrome and an expected length of stay in the ICU over 2 days was included. Whole-blood CX3CR1 mRNA expression was measured by quantitative real-time polymerase chain reaction at day 1 (D1) and D3 after inclusion. Results In ICU patients (n = 725), decreased CX3CR1 mRNA expression at D1 was associated with high D7 mortality (AUC 0.70, adjusted OR [aOR] 2.03, 95 % CI 1.19–3.46), while decreased expression at D3 was associated with increased D28 mortality (AUC 0.64, aOR 2.34, 95 % CI 1.45–3.77). In septic shock patients (n = 279), similar associations were observed between decreased D1 CX3CR1 mRNA expression and D7 mortality (AUC 0.69, aOR 2.76, 95 % CI 1.32–5.75) as well as decreased D3 expression and D28 mortality (AUC 0.72, aOR 3.98, 95 % CI 1.72–9.23). These associations were independent of lactacidaemia, Simplified Acute Physiology Score II, Sepsis-related Organ Failure Assessment score and Charlson comorbidity index. Conclusions This study represents the largest evaluation of such an mRNA marker in a heterogeneous cohort of severely injured patients. Our results show that decreased CX3CR1 mRNA expression is associated with increased mortality in ICU patients. This suggests a link between injury-induced immunosuppression and mortality in critically ill patients. In this context, the monitoring of such a host response molecular biomarker could prove very helpful for the identification of patients at high risk of death in the ICU. Electronic supplementary material The online version of this article (doi:10.1186/s13054-016-1362-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Arnaud Friggeri
- Hospices Civils de Lyon, Intensive Care Unit, Centre Hospitalier Lyon Sud, Pierre Bénite, France.,Hospices Civils de Lyon-bioMérieux Joint Research Unit, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - Marie-Angélique Cazalis
- Hospices Civils de Lyon-bioMérieux Joint Research Unit, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - Alexandre Pachot
- Hospices Civils de Lyon-bioMérieux Joint Research Unit, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - Martin Cour
- Hospices Civils de Lyon, Medical Intensive Care Unit, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - Laurent Argaud
- Hospices Civils de Lyon, Medical Intensive Care Unit, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - Bernard Allaouchiche
- Hospices Civils de Lyon, Intensive Care Unit, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Bernard Floccard
- Hospices Civils de Lyon, Department of Anaesthesiology and Critical Care Medicine, Groupement Hospitalier Edouard Herriot, University Claude Bernard Lyon 1, Lyon, France
| | - Zoé Schmitt
- Hospices Civils de Lyon, Intensive Care Unit, Hôpital de la Croix Rousse, Lyon, France
| | - Olivier Martin
- Hospices Civils de Lyon, Department of Anaesthesiology and Critical Care Medicine, Groupement Hospitalier Edouard Herriot, University Claude Bernard Lyon 1, Lyon, France
| | - Thomas Rimmelé
- Hospices Civils de Lyon-bioMérieux Joint Research Unit, Groupement Hospitalier Edouard Herriot, Lyon, France.,Hospices Civils de Lyon, Department of Anaesthesiology and Critical Care Medicine, Groupement Hospitalier Edouard Herriot, University Claude Bernard Lyon 1, Lyon, France
| | | | - Mathieu Page
- Hospices Civils de Lyon, Department of Anaesthesiology and Critical Care Medicine, Groupement Hospitalier Edouard Herriot, University Claude Bernard Lyon 1, Lyon, France
| | - Vincent Piriou
- Hospices Civils de Lyon, Intensive Care Unit, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Julien Bohé
- Hospices Civils de Lyon, Intensive Care Unit, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Guillaume Monneret
- Hospices Civils de Lyon-bioMérieux Joint Research Unit, Groupement Hospitalier Edouard Herriot, Lyon, France.,Hospices Civils de Lyon, Immunology Laboratory, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - Stéphane Morisset
- Hospices Civils de Lyon-bioMérieux Joint Research Unit, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - Julien Textoris
- Hospices Civils de Lyon-bioMérieux Joint Research Unit, Groupement Hospitalier Edouard Herriot, Lyon, France.,Hospices Civils de Lyon, Department of Anaesthesiology and Critical Care Medicine, Groupement Hospitalier Edouard Herriot, University Claude Bernard Lyon 1, Lyon, France
| | - Hélène Vallin
- Hospices Civils de Lyon, Intensive Care Unit, Centre Hospitalier Lyon Sud, Pierre Bénite, France.,Hospices Civils de Lyon-bioMérieux Joint Research Unit, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - Sophie Blein
- Hospices Civils de Lyon-bioMérieux Joint Research Unit, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - Delphine Maucort-Boulch
- Hospices Civils de Lyon, Université Lyon 1, CNRS, UMR5558, Service de Biostatistique et Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Lyon, France
| | - Alain Lepape
- Hospices Civils de Lyon, Intensive Care Unit, Centre Hospitalier Lyon Sud, Pierre Bénite, France.,Hospices Civils de Lyon-bioMérieux Joint Research Unit, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - Fabienne Venet
- Hospices Civils de Lyon-bioMérieux Joint Research Unit, Groupement Hospitalier Edouard Herriot, Lyon, France. .,Hospices Civils de Lyon, Immunology Laboratory, Groupement Hospitalier Edouard Herriot, Lyon, France. .,Immunology Laboratory, Hôpital E. Herriot - Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France.
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Demaret J, Venet F, Friggeri A, Cazalis MA, Plassais J, Jallades L, Malcus C, Poitevin-Later F, Textoris J, Lepape A, Monneret G. Marked alterations of neutrophil functions during sepsis-induced immunosuppression. J Leukoc Biol 2015. [DOI: 10.1189/jlb.4a0415-168rr] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Venet F, Plassais J, Textoris J, Cazalis MA, Pachot A, Bertin-Maghit M, Magnin C, Rimmelé T, Monneret G, Tissot S. Low-dose hydrocortisone reduces norepinephrine duration in severe burn patients: a randomized clinical trial. Crit Care 2015; 19:21. [PMID: 25619170 PMCID: PMC4347659 DOI: 10.1186/s13054-015-0740-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 01/14/2015] [Indexed: 11/30/2022]
Abstract
Introduction The aim of this study was to assess the effect of low-dose corticosteroid therapy in reducing shock duration after severe burn. Methods A placebo-controlled, double-blind, randomized clinical trial (RCT) was performed on two parallel groups in the burn intensive care unit (ICU). Patients were randomized to receive either low-dose corticosteroid therapy or placebo for seven days. A corticotropin test was performed at the time of randomization, before the administration of the treatment dose. Thirty-two severely burned patients with refractory shock (>0.5 μg/kg/min of norepinephrine) were prospectively included in the study. Results We included 12 patients in the hydrocortisone-treated group and 15 patients in the placebo group in the final analysis. Among these patients, 21 were nonresponders to the corticotropin test. Median norepinephrine treatment duration (primary objective) was significantly lower in the corticosteroid-treated versus the placebo group (57 hours versus 120 hours, P = 0.035). The number of patients without norepinephrine 72 hours after inclusion was significantly lower in the treated group (P = 0.003, log-rank test analysis). The total quantities of norepinephrine administered to patients were lower in the hydrocortisone-treated versus the placebo group (1,205 μg/kg (1,079 to 2,167) versus 1,971 μg/kg (1,535 to 3,893), P = 0.067). There was no difference in terms of ICU or hospital length of stay, sepsis incidence, cicatrization or mortality. Conclusions In this placebo-controlled, randomized, double-blind clinical trial, we show for the first time that the administration of low-dose hydrocortisone in burn patients with severe shock reduces vasopressor administration. Trial registration Clinicaltrial.gov NCT00149123. Registered 6 September 2005. Electronic supplementary material The online version of this article (doi:10.1186/s13054-015-0740-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fabienne Venet
- Hospices Civils de Lyon, Cellular Immunology Laboratory, Hôpital E Herriot, Pavillon E - 5 place d'Arsonval, Lyon, Cedex 03 69437, France. .,Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon EAM 4174, Lyon, 69008, France. .,Hospices Civils de Lyon-bioMérieux Joint Research Unit, Hôpital E Herriot, Pavillon P - 5 place d'Arsonval, Lyon, Cedex 03 69437, France.
| | - Jonathan Plassais
- Hospices Civils de Lyon-bioMérieux Joint Research Unit, Hôpital E Herriot, Pavillon P - 5 place d'Arsonval, Lyon, Cedex 03 69437, France.
| | - Julien Textoris
- Hospices Civils de Lyon-bioMérieux Joint Research Unit, Hôpital E Herriot, Pavillon P - 5 place d'Arsonval, Lyon, Cedex 03 69437, France. .,Hospices Civils de Lyon, Burn Ward, Intensive Care Unit, Hôpital E Herriot, Pavillon I - 5 place d'Arsonval, Lyon, Cedex 03 69437, France.
| | - Marie-Angélique Cazalis
- Hospices Civils de Lyon-bioMérieux Joint Research Unit, Hôpital E Herriot, Pavillon P - 5 place d'Arsonval, Lyon, Cedex 03 69437, France.
| | - Alexandre Pachot
- Hospices Civils de Lyon-bioMérieux Joint Research Unit, Hôpital E Herriot, Pavillon P - 5 place d'Arsonval, Lyon, Cedex 03 69437, France.
| | - Marc Bertin-Maghit
- Hospices Civils de Lyon, Burn Ward, Intensive Care Unit, Hôpital E Herriot, Pavillon I - 5 place d'Arsonval, Lyon, Cedex 03 69437, France.
| | - Christophe Magnin
- Hospices Civils de Lyon, Burn Ward, Intensive Care Unit, Hôpital E Herriot, Pavillon I - 5 place d'Arsonval, Lyon, Cedex 03 69437, France.
| | - Thomas Rimmelé
- Hospices Civils de Lyon, Burn Ward, Intensive Care Unit, Hôpital E Herriot, Pavillon I - 5 place d'Arsonval, Lyon, Cedex 03 69437, France.
| | - Guillaume Monneret
- Hospices Civils de Lyon, Cellular Immunology Laboratory, Hôpital E Herriot, Pavillon E - 5 place d'Arsonval, Lyon, Cedex 03 69437, France. .,Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon EAM 4174, Lyon, 69008, France. .,Hospices Civils de Lyon-bioMérieux Joint Research Unit, Hôpital E Herriot, Pavillon P - 5 place d'Arsonval, Lyon, Cedex 03 69437, France.
| | - Sylvie Tissot
- Hospices Civils de Lyon, Burn Ward, Intensive Care Unit, Hôpital E Herriot, Pavillon I - 5 place d'Arsonval, Lyon, Cedex 03 69437, France.
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Cazalis MA, Lepape A, Venet F, Frager F, Mougin B, Vallin H, Paye M, Pachot A, Monneret G. Early and dynamic changes in gene expression in septic shock patients: a genome-wide approach. Intensive Care Med Exp 2014. [PMID: 26215705 PMCID: PMC4512996 DOI: 10.1186/s40635-014-0020-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [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] [Indexed: 02/07/2023] Open
Abstract
Background As early and appropriate care of severe septic patients is associated with better outcome, understanding of the very first events in the disease process is needed. Pan-genomic analyses offer an interesting opportunity to study global genomic response within the very first hours after sepsis. The objective of this study was to investigate the systemic genomic response in severe intensive care unit (ICU) patients and determine whether patterns of gene expression could be associated with clinical severity evaluated by the severity score. Methods Twenty-eight ICU patients were enrolled at the onset of septic shock. Blood samples were collected within 30 min and 24 and 48 h after shock and genomic response was evaluated using microarrays. The genome-wide expression pattern of blood leukocytes was sequentially compared to healthy volunteers and after stratification based on Simplified Acute Physiology Score II (SAPSII) score to identify potential mechanisms of dysregulation. Results Septic shock induces a global reprogramming of the whole leukocyte transcriptome affecting multiple functions and pathways (>71% of the whole genome was modified). Most altered pathways were not significantly different between SAPSII-high and SAPSII-low groups of patients. However, the magnitude and the duration of these alterations were different between these two groups. Importantly, we observed that the more severe patients did not exhibit the strongest modulation. This indicates that some regulation mechanisms leading to recovery seem to take place at the early stage. Conclusions In conclusion, both pro- and anti-inflammatory processes, measured at the transcriptomic level, are induced within the very first hours after septic shock. Interestingly, the more severe patients did not exhibit the strongest modulation. This highlights that not only the responses mechanisms by themselves but mainly their early and appropriate regulation are crucial for patient recovery. This reinforces the idea that an immediate and tailored aggressive care of patients, aimed at restoring an appropriately regulated immune response, may have a beneficial impact on the outcome. Electronic supplementary material The online version of this article (doi:10.1186/s40635-014-0020-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marie-Angélique Cazalis
- Joint Unit "Sepsis" Hospices Civils de Lyon - bioMérieux, Hôpital Edouard Herriot, 69437, Lyon, France,
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Plassais J, Cazalis MA, Venet F, Monneret G, Pachot A, Tissot S. Effect of low-dose hydrocortisone on gene expression profiles after severe burn injury. Crit Care 2014. [PMCID: PMC4068751 DOI: 10.1186/cc13265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Cazalis MA, Friggeri A, Cavé L, Demaret J, Barbalat V, Cerrato E, Lepape A, Pachot A, Monneret G, Venet F. Decreased HLA-DR antigen-associated invariant chain (CD74) mRNA expression predicts mortality after septic shock. Crit Care 2013; 17:R287. [PMID: 24321376 PMCID: PMC4056003 DOI: 10.1186/cc13150] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 11/12/2013] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Septic syndromes remain the leading cause of mortality in intensive care units (ICU). Septic patients rapidly develop immune dysfunctions, the intensity and duration of which have been linked with deleterious outcomes. Decreased mRNA expressions of major histocompatibility complex (MHC) class II-related genes have been reported after sepsis. We investigated whether their mRNA levels in whole blood could predict mortality in septic shock patients. METHODS A total of 93 septic shock patients were included. On the third day after shock, the mRNA expressions of five MHC class II-related genes (CD74, HLA-DRA, HLA-DMB, HLA-DMA, CIITA) were measured by qRT-PCR and monocyte human leukocyte antigen-DR (mHLA-DR) by flow cytometry. RESULTS A significant correlation was found among MHC class II related gene expressions. Among mRNA markers, the best prognostic value was obtained for CD74 (HLA-DR antigen-associated invariant chain). For this parameter, the area under the receiver operating characteristic curve (AUC) was calculated (AUC = 0.67, 95% confidence interval (CI) = 0.55 to 0.79; P = 0.01) as well as the optimal cut-off value. After stratification based on this threshold, survival curves showed that a decreased CD74 mRNA level was associated with increased mortality after septic shock (Log rank test, P = 0.0043, Hazard Ratio = 3.0, 95% CI: 1.4 to 6.5). Importantly, this association remained significant after multivariate logistic regression analysis including usual clinical confounders (that is, severity scores, P = 0.026, Odds Ratio = 3.4, 95% CI: 1.2 to 9.8). CONCLUSION Decreased CD74 mRNA expression significantly predicts 28-day mortality after septic shock. After validation in a larger multicentric study, this biomarker could become a robust predictor of death in septic patients.
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Turrel-Davin F, Tournadre A, Pachot A, Arnaud B, Cazalis MA, Mougin B, Miossec P. FoxO3a involved in neutrophil and T cell survival is overexpressed in rheumatoid blood and synovial tissue. Ann Rheum Dis 2009; 69:755-60. [PMID: 19435720 DOI: 10.1136/ard.2009.109991] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE FoxO3a is a transcriptional factor implicated in cell cycle regulation and apoptosis. Since rheumatoid arthritis (RA) is associated with apoptosis defects, the expression level, regulation and phosphorylation status of FoxO3a was investigated in blood and synovium from patients with RA. METHODS In microarray experiments, an overexpression of FoxO3a mRNA was observed in blood from patients with RA compared with healthy controls. FoxO3a mRNA expression was quantified in polymorphonuclear cells (PMNs) and peripheral blood mononuclear cells from patients with RA by qRT-PCR. Total FoxO3a and phosphorylated FoxO3a (pFoxO3a) protein expression was analysed in blood leucocytes from patients with RA versus controls and in synovium from patients with RA versus patients with osteoarthritis (OA) by immunostaining. RESULTS FoxO3a mRNA and protein expression levels were increased in blood from patients with RA compared with controls. FoxO3a overexpression was primarily observed in PMNs. In synovium from patients with RA, both total and inactive phosphorylated FoxO3a proteins were detected. FoxO3a was detected primarily in the sublining T lymphocytes of synovium from patients with RA compared with the lining layer tissue from patients with RA and OA, underlying a role for FoxO3a proteins in inflammation in RA. CONCLUSION The overexpression of FoxO3a in blood from patients with RA, particularly in PMNs, suggests a potential role for this gene in the pathogenesis of RA through increased survival of blood PMNs. In synovium from patients with RA, FoxO3a mainly detected in inflammatory aggregates may also regulate the chronic survival of T lymphocytes.
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Affiliation(s)
- Fanny Turrel-Davin
- Clinical Immunology Unit, Department of Immunology and Rheumatology, Joint Unit Hospices Civils de Lyon-bioMérieux, Hôpital Edouard Herriot, 5 place d'Arsonval, Lyon, France
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Zrioual S, Ecochard R, Tournadre A, Lenief V, Cazalis MA, Miossec P. Genome-Wide Comparison between IL-17A- and IL-17F-Induced Effects in Human Rheumatoid Arthritis Synoviocytes. J Immunol 2009; 182:3112-20. [DOI: 10.4049/jimmunol.0801967] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Pachot A, Cazalis MA, Venet F, Turrel F, Faudot C, Voirin N, Diasparra J, Bourgoin N, Poitevin F, Mougin B, Lepape A, Monneret G. Decreased Expression of the Fractalkine Receptor CX3CR1 on Circulating Monocytes as New Feature of Sepsis-Induced Immunosuppression. J Immunol 2008; 180:6421-9. [DOI: 10.4049/jimmunol.180.9.6421] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Zrioual S, Toh ML, Tournadre A, Zhou Y, Cazalis MA, Pachot A, Miossec V, Miossec P. IL-17RA and IL-17RC Receptors Are Essential for IL-17A-Induced ELR+ CXC Chemokine Expression in Synoviocytes and Are Overexpressed in Rheumatoid Blood. J Immunol 2007; 180:655-63. [DOI: 10.4049/jimmunol.180.1.655] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Pachot A, Arnaud B, Marrote H, Cazalis MA, Diasparra J, Gouraud A, Mougin B, Miossec P. Increased tumor necrosis factor-alpha mRNA expression in whole blood from patients with rheumatoid arthritis: reduction after infliximab treatment does not predict response. J Rheumatol 2007; 34:2158-61. [PMID: 17896807] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE It has been suggested that patients with rheumatoid arthritis (RA) with abundant tumor necrosis factor-alpha (TNF-alpha) are more likely to respond to TNF-alpha inhibitors. We measured expression of TNF-alpha mRNA in peripheral blood of RA patients undergoing infliximab treatment in order to test its predictive value for treatment response. METHODS Forty-four RA patients showing persistent disease activity and 27 healthy controls were studied. Peripheral blood TNF-alpha mRNA levels were measured before and 4 hours after the first infliximab infusion and at Week 22 using quantitative RT-PCR. Results were correlated to the treatment response at Week 22 in the whole RA cohort and a subset of patients showing high TNF-alpha mRNA levels at baseline. RESULTS At baseline and at Week 22, TNF-alpha mRNA expression in RA patients was significantly increased compared to healthy controls. At both timepoints, no significant difference was observed between responders and nonresponders. Compared to baseline, infliximab treatment induced a decrease in TNF-alpha mRNA level at 4 hours and at Week 22, although this effect was significant only in patients with high TNF-alpha mRNA expression at baseline. Such variation compared to baseline was similar in responders and nonresponders. CONCLUSION Peripheral blood TNF-alpha mRNA expression is increased in RA, but its reduction with anti-TNF treatment is not associated with treatment response.
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Affiliation(s)
- Alexandre Pachot
- Joint Unit, Hospices Civils de Lyon-bioMérieux, Hôpital Edouard Herriot, Hôpital Edouard Herriot, 5 place d'Arsonval, Lyon, France
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Cimaz R, Cazalis MA, Reynaud C, Gerloni V, Zulian F, Biggioggero M, Martini G, Pontikaki I, Fantini F, Mougin B, Miossec P. IL1 and TNF gene polymorphisms in patients with juvenile idiopathic arthritis treated with TNF inhibitors. Ann Rheum Dis 2007; 66:900-4. [PMID: 17324969 PMCID: PMC1955102 DOI: 10.1136/ard.2006.067454] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [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: 11/03/2022]
Abstract
OBJECTIVE To investigate the genetic contribution of cytokine gene polymorphisms (interleukin 1 (IL1) and tumour necrosis factor alpha (TNFalpha)) on disease phenotype and on response to TNF-blocking agents in a population of patients with juvenile idiopathic arthritis (JIA). METHODS A cohort of 107 consecutive patients with JIA who were receiving treatment with anti-TNF agents was enrolled in this study. Analysis of genetic polymorphisms for IL1B +3954, IL1RA +2018, TNFalpha -238 and TNFalpha -308 was performed by enzyme-linked oligo sorbent assay, and compared with those obtained from 630 healthy Caucasians and 263 adult patients with rheumatoid arthritis. Relevant demographic, clinical and laboratory data were collected from clinical charts and entered into a customised database, and chi(2) analysis was performed to compare cytokine polymorphisms with disease type according to the International League of Associations for Rheumatology criteria, presence of uveitis, rheumatoid factor and anti-nuclear antibody positivity, erosive disease, frequency of adverse effects to anti-TNF and clinical response after 3 months. RESULTS The T/T genotype of the IL1B +3954 polymorphism was absent in patients with JIA and present in 5% of controls (p = 0.015). No significant correlation was found between the studied polymorphisms and clinical or laboratory variables considered. Clinical response to TNF inhibitors at 3 months was not associated with the genetic polymorphisms considered. CONCLUSION In our cohort, the absence of the rare IL1B +3954 gene polymorphism was associated with JIA, but without specificity to particular disease phenotypes. The TNF and IL1 gene polymorphism studied did not seem to be associated with response to anti-TNF treatment.
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Affiliation(s)
- Rolando Cimaz
- Unité Mixte Hospices Civils de Lyon-BioMérieux, Lyon, France.
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Marotte H, Pallot-Prades B, Grange L, Tebib J, Gaudin P, Alexandre C, Blond JL, Cazalis MA, Mougin B, Miossec P. The shared epitope is a marker of severity associated with selection for, but not with response to, infliximab in a large rheumatoid arthritis population. Ann Rheum Dis 2005; 65:342-7. [PMID: 16096333 PMCID: PMC1798045 DOI: 10.1136/ard.2005.037150] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [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: 11/03/2022]
Abstract
OBJECTIVE To determine whether joint destruction, indication for, and response to infliximab in rheumatoid arthritis are associated with the shared epitope (SE) or selected cytokine gene polymorphisms (interleukin (IL) 1B, IL1-RN, and tumour necrosis alpha). METHODS In a large rheumatoid arthritis population of 930 patients from the same area (Rhône-Alpes, France), patients with (n = 198) or without infliximab treatment (n = 732) were compared according to their genetic status. Clinical, biological, and radiological data were collected. Typing for SE status and cytokine polymorphisms was carried out using enzyme linked oligosorbent assay. Statistical analysis was by chi(2) testing and calculation of odds ratios (OR). RESULTS A dose relation was observed between the number of SE copies and joint damage in the whole rheumatoid population (OR, 1 v 0 SE copy = 2.38 (95% confidence interval, 1.77 to 3.19), p<0.001; OR 2 v 0 SE copy = 3.92 (2.65 to 5.80), p<0.001. The SE effect increased with disease duration but was not significant before two years. Selection for infliximab treatment (n = 198) was associated with increased disease activity, joint damage, and the presence of the SE with a dose effect. In all, 66.2% patients achieved an ACR20 improvement. No clinical or genetic factors were able to predict the clinical response to infliximab. CONCLUSIONS This post-marketing study in a large cohort of rheumatoid arthritis patients indicates a linkage between rheumatoid arthritis severity, selection for treatment with infliximab, and the presence and dose of the SE.
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Affiliation(s)
- H Marotte
- Clinical Immunology Unit, Departments of Immunology and Rheumatology, Hôpital Edouard Hérriot, 69437 Lyon Cedex 03, France
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Berard C, Cazalis MA, Leissner P, Mougin B. DNA nucleic acid sequence-based amplification-based genotyping for polymorphism analysis. Biotechniques 2004; 37:680-2, 684, 686. [PMID: 15517981 DOI: 10.2144/04374dd04] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 11/23/2022] Open
Abstract
Nucleic acid sequence-based amplification (NASBA) is a sensitive isothermal transcription-based amplification method known to be a suitable tool for RNA research. We demonstrate that NASBA technology can be applied to single nucleotide polymorphism (SNP) analysis using human genomic DNA as a template. Combination of DNA NASBA with multiplex hybridization of specific molecular beacons makes it possible to unambiguously discriminate the presence of the SNP of interest. This protocol is easy-to-use, robust, and makes it possible to rapidly detect single nucleotide substitutions in clinical or cell line DNA sequences using a large range of DNA input. Such a real-time genotyping DNA NASBA assay can find broad application in clinical diagnostics.
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