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Kosmider O, Possémé C, Templé M, Corneau A, Carbone F, Duroyon E, Breillat P, Chirayath TW, Oules B, Sohier P, Luka M, Gobeaux C, Lazaro E, Outh R, Le Guenno G, Lifermann F, Berleur M, Le Mene M, Friedrich C, Lenormand C, Weitten T, Guillotin V, Burroni B, Boussier J, Willems L, Aractingi S, Dionet L, Tharaux PL, Vergier B, Raynaud P, Ea HK, Ménager M, Duffy D, Terrier B. VEXAS syndrome is characterized by inflammasome activation and monocyte dysregulation. Nat Commun 2024; 15:910. [PMID: 38291039 PMCID: PMC10828464 DOI: 10.1038/s41467-024-44811-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/02/2024] [Indexed: 02/01/2024] Open
Abstract
Acquired mutations in the UBA1 gene were recently identified in patients with severe adult-onset auto-inflammatory syndrome called VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic). However, the precise physiological and clinical impact of these mutations remains poorly defined. Here we study a unique prospective cohort of VEXAS patients. We show that monocytes from VEXAS are quantitatively and qualitatively impaired and display features of exhaustion with aberrant expression of chemokine receptors. In peripheral blood from VEXAS patients, we identify an increase in circulating levels of many proinflammatory cytokines, including IL-1β and IL-18 which reflect inflammasome activation and markers of myeloid cells dysregulation. Gene expression analysis of whole blood confirms these findings and also reveals a significant enrichment of TNF-α and NFκB signaling pathways that can mediate cell death and inflammation. This study suggests that the control of the nflammasome activation and inflammatory cell death could be therapeutic targets in VEXAS syndrome.
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Affiliation(s)
- Olivier Kosmider
- Université de Paris Cité, Institut Cochin, CNRS UMR8104, INSERM U1016, Paris, France.
- Hematology Laboratory, Assistance Publique-Hôpitaux de Paris, Centre-Université de Paris Cité, Cochin Hospital, Paris, France.
| | - Céline Possémé
- Institut Pasteur, Université de Paris Cité, Translational Immunology Unit, Paris, France
| | - Marie Templé
- Université de Paris Cité, Institut Cochin, CNRS UMR8104, INSERM U1016, Paris, France
- Hematology Laboratory, Assistance Publique-Hôpitaux de Paris, Centre-Université de Paris Cité, Cochin Hospital, Paris, France
| | - Aurélien Corneau
- Sorbonne Université, Faculté de Médecine, UMS037, PASS, Plateforme de Cytométrie de la Pitié-Salpêtrière CyPS, Paris, France
| | - Francesco Carbone
- Université de Paris Cité, Imagine Institute, Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, INSERM UMR 1163, Paris, France
- Labtech Single-Cell@Imagine, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Eugénie Duroyon
- Université de Paris Cité, Institut Cochin, CNRS UMR8104, INSERM U1016, Paris, France
- Hematology Laboratory, Assistance Publique-Hôpitaux de Paris, Centre-Université de Paris Cité, Cochin Hospital, Paris, France
| | - Paul Breillat
- Université de Paris Cité, INSERM, U970, PARCC, F-, Paris, France
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP, APHP-CUP, Hôpital Cochin, Paris, France
| | | | - Bénédicte Oules
- Department of Pathology, AP-HP, APHP-CUP, Hôpital Cochin, Paris, France
| | - Pierre Sohier
- Department of Pathology, AP-HP, APHP-CUP, Hôpital Cochin, Paris, France
| | - Marine Luka
- Université de Paris Cité, Imagine Institute, Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, INSERM UMR 1163, Paris, France
- Labtech Single-Cell@Imagine, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Camille Gobeaux
- Biochemistry Laboratory, Assistance Publique-Hôpitaux de Paris, Centre-Université de Paris Cité, Cochin Hospital, Paris, France
| | - Estibaliz Lazaro
- Department of Internal Medicine, Bordeaux University Hospital-Haut-Lévêque, Pessac, France
| | - Roderau Outh
- Department of Internal Medicine, Centre Hospitalier de Perpignan, Perpignan, France
| | - Guillaume Le Guenno
- Department of Internal Medicine, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | | | - Marie Berleur
- Department of Internal Medicine, AP-HP, APHP-NUP, Hôpital Bichat, Paris, France
| | - Melchior Le Mene
- Université de Paris Cité, Institut Cochin, CNRS UMR8104, INSERM U1016, Paris, France
- Hematology Laboratory, Assistance Publique-Hôpitaux de Paris, Centre-Université de Paris Cité, Cochin Hospital, Paris, France
| | - Chloé Friedrich
- Université de Paris Cité, Institut Cochin, CNRS UMR8104, INSERM U1016, Paris, France
- Hematology Laboratory, Assistance Publique-Hôpitaux de Paris, Centre-Université de Paris Cité, Cochin Hospital, Paris, France
| | - Cédric Lenormand
- Université de Strasbourg, Department of Dermatology, CHRU Strasbourg, Strasbourg, France
| | - Thierry Weitten
- Department of Internal Medicine, Centre Hospitalier (CHICAS), Gap, France
| | - Vivien Guillotin
- Department of Internal Medicine, Bordeaux University Hospital-Saint-André, Bordeaux, France
| | - Barbara Burroni
- Department of Pathology, AP-HP, APHP-CUP, Hôpital Cochin, Paris, France
| | - Jeremy Boussier
- Sorbonne University - 47-83 Boulevard de l'Hopital, Paris, France
| | - Lise Willems
- Université de Paris Cité, Institut Cochin, CNRS UMR8104, INSERM U1016, Paris, France
- Hematology Department, Assistance Publique-Hôpitaux de Paris, Centre-Université de Paris Cité, Cochin Hospital, Paris, France
| | - Selim Aractingi
- Dermatology Department, Assistance Publique-Hôpitaux de Paris, Centre-Université de Paris Cité, Cochin Hospital, Paris, France
| | - Léa Dionet
- Université de Paris Cité, INSERM, U970, PARCC, F-, Paris, France
| | | | - Béatrice Vergier
- Pathology Department, Bordeaux University Hospital-Haut-Lévêque, Pessac, France
| | - Pierre Raynaud
- Pathology Department, Centre Hospitalier de Perpignan, Perpignan, France
| | - Hang-Korng Ea
- Université de Paris Cité, INSERM, UMR-S 1132 BIOSCAR, Paris, France
- Rheumatology Department, AP- HP, Lariboisière Hospital, Paris, France
| | - Mickael Ménager
- Université de Paris Cité, Imagine Institute, Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, INSERM UMR 1163, Paris, France
- Labtech Single-Cell@Imagine, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Darragh Duffy
- Institut Pasteur, Université de Paris Cité, Translational Immunology Unit, Paris, France
| | - Benjamin Terrier
- Université de Paris Cité, INSERM, U970, PARCC, F-, Paris, France.
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP, APHP-CUP, Hôpital Cochin, Paris, France.
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Orieux A, Prevel R, Dumery M, Lascarrou JB, Zucman N, Reizine F, Fillatre P, Detollenaere C, Darreau C, Antier N, Saint-Léger M, Schnell G, La Combe B, Guesdon C, Bruna F, Guillon A, Varillon C, Lesieur O, Grand H, Bertrand B, Siami S, Oudeville P, Besnard C, Persichini R, Bauduin P, Thyrault M, Evrard M, Schnell D, Auchabie J, Auvet A, Rigaud JP, Beuret P, Leclerc M, Berger A, Ben Hadj Salem O, Lorber J, Stoclin A, Guisset O, Bientz L, Khan P, Guillotin V, Lacherade JC, Boyer A, Orieux A, Prevel R, Dumery M, Lascarrou JB, Zucman N, Reizine F, Fillatre P, Detollenaere C, Darreau C, Antier N, Saint-Léger M, Schnell G, La Combe B, Guesdon C, Bruna F, Guillon A, Varillon C, Lesieur O, Grand H, Bertrand B, Siami S, Oudeville P, Besnard C, Persichini R, Bauduin P, Thyrault M, Evrard M, Schnell D, Auchabie J, Auvet A, Rigaud JP, Beuret P, Leclerc M, Berger A, Ben Hadj Salem O, Lorber J, Stoclin A, Guisset O, Bientz L, Khan P, Guillotin V, Lacherade JC, Boyer A. Invasive group A streptococcal infections requiring admission to ICU: a nationwide, multicenter, retrospective study (ISTRE study). Crit Care 2024; 28:4. [PMID: 38167516 PMCID: PMC10759709 DOI: 10.1186/s13054-023-04774-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Group A Streptococcus is responsible for severe and potentially lethal invasive conditions requiring intensive care unit (ICU) admission, such as streptococcal toxic shock-like syndrome (STSS). A rebound of invasive group A streptococcal (iGAS) infection after COVID-19-associated barrier measures has been observed in children. Several intensivists of French adult ICUs have reported similar bedside impressions without objective data. We aimed to compare the incidence of iGAS infection before and after the COVID-19 pandemic, describe iGAS patients' characteristics, and determine ICU mortality associated factors. METHODS We performed a retrospective multicenter cohort study in 37 French ICUs, including all patients admitted for iGAS infections for two periods: two years before period (October 2018 to March 2019 and October 2019 to March 2020) and a one-year after period (October 2022 to March 2023) COVID-19 pandemic. iGAS infection was defined by Group A Streptococcus isolation from a normally sterile site. iGAS infections were identified using the International Classification of Diseases and confirmed with each center's microbiology laboratory databases. The incidence of iGAS infections was expressed in case rate. RESULTS Two hundred and twenty-two patients were admitted to ICU for iGAS infections: 73 before and 149 after COVID-19 pandemic. Their case rate during the period before and after COVID-19 pandemic was 205 and 949/100,000 ICU admissions, respectively (p < 0.001), with more frequent STSS after the COVID-19 pandemic (61% vs. 45%, p = 0.015). iGAS patients (n = 222) had a median SOFA score of 8 (5-13), invasive mechanical ventilation and norepinephrine in 61% and 74% of patients. ICU mortality in iGAS patients was 19% (14% before and 22% after COVID-19 pandemic; p = 0.135). In multivariate analysis, invasive mechanical ventilation (OR = 6.08 (1.71-21.60), p = 0.005), STSS (OR = 5.75 (1.71-19.22), p = 0.005), acute kidney injury (OR = 4.85 (1.05-22.42), p = 0.043), immunosuppression (OR = 4.02 (1.03-15.59), p = 0.044), and diabetes (OR = 3.92 (1.42-10.79), p = 0.008) were significantly associated with ICU mortality. CONCLUSION The incidence of iGAS infections requiring ICU admission increased by 4 to 5 after the COVID-19 pandemic. After the COVID-19 pandemic, the rate of STSS was higher, with no significant increase in ICU mortality rate.
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Affiliation(s)
- Arthur Orieux
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France.
| | - Renaud Prevel
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
- Unité INSERM U1045, Université de Bordeaux, Bordeaux, France
| | - Margot Dumery
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
| | | | - Noémie Zucman
- Service de Réanimation Médico-Chirurgicale, CH Annecy Genevois, Epagny Metz-Tessy, France
| | - Florian Reizine
- Service de Réanimation Polyvalente, CH de Vannes, Vannes, France
| | - Pierre Fillatre
- Service de Réanimation Polyvalente, CH de Saint Brieuc, Saint Brieuc, France
| | - Charles Detollenaere
- Service de Réanimation - Unité de Soins Continus, CH de Boulogne Sur Mer, Boulogne, France
| | - Cédric Darreau
- Service de Réanimation Médico-Chirurgicale, CH Le Mans, Le Mans, France
| | | | | | - Guillaume Schnell
- Service de Réanimation Médico-Chirurgicale, Groupe Hospitalier du Havre, Le Havre, France
| | - Béatrice La Combe
- Service de Réanimation Polyvalente, Groupe Hospitalier Bretagne Sud, Lorient, France
| | - Charlotte Guesdon
- Service de Réanimation Polyvalente, Centre Hospitalier de Pau, Pau, France
| | - Franklin Bruna
- Service de Réanimation, CH Alpes Leman, Contamine Sur Arve, France
| | - Antoine Guillon
- Service de Médecine Intensive Réanimation, INSERM, Centre d'Étude des Pathologies Respiratoires (CEPR), UMR 1100, CHRU de Tours, Université de Tours, Tours, France
| | - Caroline Varillon
- Service de Médecine Intensive Réanimation, CH Dunkirk, Dunkirk, France
| | - Olivier Lesieur
- Service de Réanimation Médico-Chirurgical, CH La Rochelle, La Rochelle, France
| | - Hubert Grand
- Service de Réanimation Polyvalente, Hôpital Robert Boulin, Libourne, France
| | - Benjamin Bertrand
- Service de Réanimation Polyvalente, CH Intercommunal Toulon, La Seyne sur Mer (CHITS), Toulon, France
| | - Shidasp Siami
- Service de Réanimation Polyvalente, CH Sud Essonne, Étampes, France
| | - Pierre Oudeville
- Service de Réanimation Médicale, Groupe Hospitalier Régional Mulhouse Sud Alsace (GHRMSA), Mulhouse, France
| | - Céline Besnard
- Service de Médecine Intensive Réanimation, CH Régional de Orléans, Orléans, France
| | - Romain Persichini
- Service de Réanimation Et Soins Continus, CH de Saintonge, Saintes, France
| | - Pierrick Bauduin
- Service de Médecine Intensive Réanimation, CHU de Caen, Caen, France
| | - Martial Thyrault
- Service de Réanimation Polyvalente, Groupe Hospitalier Nord Essonne - site Longjumeau, Longjumeau, France
| | - Mathieu Evrard
- Service Réanimation Polyvalente et Surveillance Continue, CH de Lens, Lens, France
| | - David Schnell
- Service de Réanimation Polyvalente, CH d'Angoulême, Angoulême, France
| | - Johann Auchabie
- Service de Réanimation Polyvalente, CH de Cholet, Cholet, France
| | - Adrien Auvet
- Service de Réanimation Polyvalente, CH de Dax, Dax, France
| | | | - Pascal Beuret
- Service de Réanimation et Soins Continus, CH de Roanne, Roanne, France
| | - Maxime Leclerc
- Service de Réanimation et Soins Intensifs Polyvalents, CH Mémorial Saint-Lô, Saint-Lô, France
| | - Asaël Berger
- Service de Réanimation, CH de Haguenau, Haguenau, France
| | - Omar Ben Hadj Salem
- Service de Réanimation Médico-Chirurgicale, CHI Meulan - les Mureaux, Meulan en Yvelines, France
| | - Julien Lorber
- Service de Médecine Intensive Réanimation, CH de Saint Nazaire, Saint Nazaire, France
| | - Annabelle Stoclin
- Département Interdisciplinaire d'Organisation des Parcours Patients (DIOPP), Service de Réanimation, Gustave Roussy Cancer Campus, Villejuif, France
| | - Olivier Guisset
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
| | - Léa Bientz
- Laboratoire de Bactériologie, CHU de Bordeaux; Microbiologie Fondamentale et Pathogénicité UMR5234, Université de Bordeaux, Bordeaux, France
| | - Pierre Khan
- Département d'Anesthésie Réanimation Sud, Centre Médico-Chirurgical Magellan, Hôpital Haut Lévêque, CHU de Bordeaux, Pessac, France
| | - Vivien Guillotin
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
| | - Jean-Claude Lacherade
- Service de Médecine Intensive Réanimation, CH Départemental de la Vendée, La Roche-sur-Yon, France
| | - Alexandre Boyer
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
- Unité INSERM U1045, Université de Bordeaux, Bordeaux, France
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Borie R, Debray MP, Guedon AF, Mekinian A, Terriou L, Lacombe V, Lazaro E, Meyer A, Mathian A, Ardois S, Vial G, Moulinet T, Terrier B, Jamilloux Y, Heiblig M, Bouaziz JD, Zakine E, Outh R, Groslerons S, Bigot A, Flamarion E, Kostine M, Henneton P, Humbert S, Constantin A, Samson M, Bertrand NM, Biscay P, Dieval C, Lobbes H, Jeannel J, Servettaz A, Adelaide L, Graveleau J, de Sainte-Marie B, Galland J, Guillotin V, Duroyon E, Templé M, Bourguiba R, Georgin Lavialle S, Kosmider O, Audemard-Verger A, Pha M, Hie M, Meghit K, Rondeau-Lutz M, Weber JC. Pleuropulmonary Manifestations of Vacuoles, E1 Enzyme, X-Linked, Autoinflammatory, Somatic (VEXAS) Syndrome. Chest 2023; 163:575-585. [PMID: 36272567 DOI: 10.1016/j.chest.2022.10.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome is a newly identified autoinflammatory disorder related to somatic UBA1 mutations. Up to 72% of patients may show lung involvement. RESEARCH QUESTION What are the pleuropulmonary manifestations in VEXAS syndrome? STUDY DESIGN AND METHODS One hundred fourteen patients were included in the French cohort of VEXAS syndrome between November 2020 and May 2021. Each patient included in the study who had an available chest CT scan was discussed in an adjudication multidisciplinary team and classified as showing potentially pleuropulmonary-specific involvement of VEXAS syndrome or others. RESULTS Fifty-one patients had a CT scan available for review and 45 patients (39%) showed pleuropulmonary abnormalities on chest CT scan that were considered related to VEXAS syndrome after adjudication. Most patients were men (95%) with a median age 67.0 years at the onset of symptoms. Among these 45 patients, 44% reported dyspnea and 40% reported cough. All 45 patients showed lung opacities on chest CT scan (including ground-glass opacities [87%], consolidations [49%], reticulation [38%], and septal lines [51%]) and 53% of patients showed pleural effusion. Most patients showed improvement with prednisone, but usually required > 20 mg/d. The main clinical and biological features as well the median survival did not differ between the 45 patients with pleuropulmonary involvement and the rest of the cohort, suggesting that the prevalence of pleuropulmonary involvement might have been underdiagnosed in the rest of the cohort. INTERPRETATION Pulmonary manifestations are frequent in VEXAS syndrome, but rarely are at the forefront. The initial outcome is favorable with prednisone and does not seem to lead to pulmonary fibrosis.
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Affiliation(s)
- Raphael Borie
- Service de Pneumologie A, Hôpital Bichat, APHP, Paris, France; INSERM, Unité 1152, Université de Paris, Paris, France.
| | - Marie Pierre Debray
- Service de Radiologie, Hôpital Bichat, APHP, Paris, France; INSERM, Unité 1152, Université de Paris, Paris, France
| | - Alexis F Guedon
- Service de Médecine Interne, Hôpital St. Antoine, APHP, Paris, France
| | - Arsene Mekinian
- Service de Médecine Interne, Hôpital St. Antoine, APHP, Paris, France
| | | | - Valentin Lacombe
- Service de Médecine Interne et Immunologie Clinique, CHU d'Angers, Angers, France
| | - Estibaliz Lazaro
- Médecine Interne et Maladies Infectieuses, Hôpital Haut l'Evêque, CHU de Bordeaux, Pessac, France
| | - Aurore Meyer
- Service d'Immunologie Clinique et Médecine Interne, Nouvel Hôpital Civil, CHU Strasbourg, Strasbourg, France
| | - Alexis Mathian
- Service de Médicine Interne 2, Hôpital de la Pitié Salpêtrière, APHP, Paris, France
| | - Samuel Ardois
- Service de Médecine Interne et Immunologie Clinique, Hôpital Pontchaillou, Renne, France
| | - Guillaume Vial
- Médecine Interne et Immunologie Clinique, Hôpital Saint André, CHU Bordeaux, Bordeaux, France
| | - Thomas Moulinet
- Département de Médecine Interne et Immunologie Clinique, CHU Nancy, UMR 7365, IMoPA, University of Lorraine, CNRS, Nancy, France
| | - Benjamin Terrier
- Service de Médecine Interne, Hôpital Cochin, APHP, Paris, France
| | - Yvan Jamilloux
- Service de Médecine Interne, Hôpital de la Croix Rousse, Hématologie, Centre Hospitalier de Lyon Sud, Pierre Bénite, Lyon, France
| | - Mael Heiblig
- Service de Médecine Interne, Hôpital de la Croix Rousse, Hématologie, Centre Hospitalier de Lyon Sud, Pierre Bénite, Lyon, France
| | | | - Eve Zakine
- Service de Dermatologie, Hopital St. Louis, APHP, Paris, France
| | - Roderau Outh
- Service de Médecine Interne, CHG Perpignan, Perpignan, France
| | | | - Adrien Bigot
- Service de Médecine Interne et Immunologie Clinique, CHU Bretonneau, Tours, France
| | - Edouard Flamarion
- Service de Médecine Interne, Hôpital Européen Georges Pompidou, APHP-Centre, Université de Paris Cité, Paris, France
| | - Marie Kostine
- Service de Rhumatologie, CHU Bordeaux, Bordeaux, France
| | - Pierrick Henneton
- Service de Médecine Vasculaire, CHU de Montpellier, Montpellier, France
| | | | - Arnaud Constantin
- Department of Rheumatology, Pierre-Paul Riquet University Hospital, and Toulouse III-Paul Sabatier University, Toulouse, France
| | - Maxime Samson
- Service de Médecine Interne et Immunologie Clinique, CHU de Dijon, Dijon, France
| | | | - Pascal Biscay
- Clinique Mutualiste Pessac Médecine Interne, Pessac, France
| | - Celine Dieval
- Service de Médecine Interne, CHU Rochefort, Rochefort, France
| | - Herve Lobbes
- Service de Médecine Interne, CHU de Clermont-Ferrand, Hôpital Estaing, Clermont-Ferrand, France
| | - Juliette Jeannel
- Service de Médecine Interne, Nouvel Hôpital Civil, CHU Strasbourg, Strasbourg, France
| | - Amelie Servettaz
- Service de Médecine Interne, Maladies Infectieuses, Immunologie Clinique, CHU de Reims, Reims, France
| | - Leo Adelaide
- Service de Médecine Interne, CHU Lucien Hussel, Vienne, France
| | - Julie Graveleau
- Service de Médecine Interne, CHU Saint-Nazaire, Saint-Nazaire, France
| | | | - Joris Galland
- Service de Médecine Interne, Centre Hospitalier de Bourg-en-Bresse, Bourg-en-Bresse, France
| | - Vivien Guillotin
- Médecine Interne et Maladies Infectieuses, Hôpital Haut l'Evêque, CHU de Bordeaux, Pessac, France
| | - Eugénie Duroyon
- Laboratoire d'Hématologie, Hôpital Cochin, APHP, Paris, France
| | - Marie Templé
- Laboratoire d'Hématologie, Hôpital Cochin, APHP, Paris, France
| | - Rim Bourguiba
- Service de Médecine Interne, Hôpital Tenon, APHP, Paris, France
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Terrier B, Posseme C, Temple M, Corneau A, Carbone F, Chenevier-Gobeaux C, Lazaro E, Outh R, Le Guenno G, Lifermann F, Berleur M, Weitten T, Guillotin V, Ménager M, Duffy D, Kosmider O. Le syndrome VEXAS se caractérise par une activation des voies de l’inflammasome dans le sang et les tissus et par une dérégulation du compartiment monocytaire. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Scherlinger M, Guillotin V, Vacher P, Douchet I, Lazaro E, Richez C, Blanco P. POS0141 PLATELET-SELECTIN PRIME LUPUS NEUTROPHILS TO PRODUCE MITOCHONDRIAL ROS AND PARTICIPATE IN SLE PATHOGENESIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundIn patients with active systemic lupus erythematosus (SLE), circulating platelets have an activated phenotype characterized by the expression of P-selectin (CD62P). We have shown that in human SLE, platelets interact with T regulatory cells and repress their immunosuppressive functions through a P-selectin/CD15s-dependent interaction (1). Preliminary results showed that neutrophils express high level of CD15s, predicting a possible platelet/neutrophil interaction in SLE.ObjectivesInvestigate platelet/neutrophils interaction in human SLE and evaluate its impact on neutrophil functions, and lupus pathogenesis.MethodsPatients with SLE responding to the 2019 ACR/EULAR criteria were recruited for blood sampling (n = 30). Disease activity was measured using SLE disease activity index (SLEDAI-2K), and patients were considered active if SLEDAI-2K ≥ 6. Platelet-neutrophils aggregates were identified as (platelet) CD61+ (neutrophil) CD66b+ cells using flow cytometry on fresh blood samples. Single-cell cytosolic calcium and ROS imaging was performed by incubating cell with either a fluorescent calcium dye (cali-520), or a mitochondrial specific dye (MitoSox). Coverslips were mounted in an Attofluor cell chamber positioned on the stage of an inverted epifluorescence microscope (Olympus, IX70). Mitochondrial polarization of human neutrophil was evaluated by incubating cells with TMRM (100 nM) for 30 minutes. Platelet-free plasma was isolated by two sequential centrifugations (3500xg) of EDTA-anticoagulated blood and stored for subsequent evaluation of soluble P-selectin (using ELISA) and (platelet-derived) microparticular P-selectin (using flow cytometry).ResultsIn healthy donors (HD) and patients with SLE, circulating neutrophils expressed significantly higher levels of the P-selectin ligand CD15s compared to lymphoid subsets (p < 0.001), predicting platelet/neutrophil interactions. In contrast to HD and patients with inactive SLE, those with active disease had a significant increase of circulating platelet-neutrophils aggregates (p < 0.05), and these aggregates correlated with the SLEDAI (r = 0.59, p < 0.001). The incubation of human neutrophils with recombinant P-selectin induced a strong intracellular calcium signaling which was inhibited by preincubating neutrophil with anti-PSGL1 antibody (blocking P-selectin/CD15s interaction) or with a Syk kinase inhibitor. Similarly, P-selectin induced a mitochondrial ROS release in a CD15s- and Syk-dependent manner. Interestingly, incubation of neutrophils with anti-dsDNA IgG and P-selectin induced mitochondrial depolarization, which was absent with either stimulus alone. Soluble and platelet-derived microparticular P-selectin levels were significantly increased in patients with active SLE compared to inactive patients or healthy donors (p < 0.05 and p < 0.001, respectively). In a longitudinal analysis of SLE patients, soluble and microparticular P-selectin levels closely followed clinical (SLEDAI) and biological (C3 levels) markers of SLE disease activity.ConclusionP-selectin levels are increased in active SLE and follow hallmark of disease activity. P-selectin induces calcium/mitochondrial ROS signaling in lupus neutrophils which are key players in SLE pathogenesis. We hypothesize that the inhibition of P-selectin pathway might be a promising target in SLE.References[1]Scherlinger M. et al. (2021), Science Translational Medicine, 13(600):eabi4994.Disclosure of InterestsNone declared
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Prevel R, Guillotin V, Imbert S, Blanco P, Delhaes L, Duffau P. Central Nervous System Cryptococcosis in Patients With Sarcoidosis: Comparison With Non-sarcoidosis Patients and Review of Potential Pathophysiological Mechanisms. Front Med (Lausanne) 2022; 9:836886. [PMID: 35425769 PMCID: PMC9002233 DOI: 10.3389/fmed.2022.836886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Cryptococcus spp. infection of the central nervous system (CINS) is a devastating opportunistic infection that was historically described in patients with acquired immunodeficiency syndrome (AIDS). Cryptococcus spp. infections are also associated with sarcoidosis; the impairment of cell-mediated immunity and long-term corticosteroid therapy being evoked to explain this association. Nevertheless, this assertion is debated and the underlying pathophysiological mechanisms are still unknown. The aims of this study were (i) to describe the clinical and biological presentation, treatments, and outcomes of CINS patients with and without sarcoidosis and (ii) to review the pathophysiological evidence underlying this clinical association. Patients and Methods Every patient with positive cerebrospinal fluid (CSF) cryptococcal antigen testing, India ink preparation, and/or culture from January 2015 to December 2020 at a tertiary university hospital were included, and patients with sarcoidosis were compared with non-sarcoidosis patients. Quantitative variables are presented as mean ± SD and are compared using the Mann-Whitney Wilcoxon rank-sum test. Categorical variables are expressed as the number of patients (percentage) and compared using the χ2 or Fisher's tests. Results During the study period, 16 patients experienced CINS, of whom 5 (31%) were associated with sarcoidosis. CINS symptoms, biological, and CSF features were similar between CINS patients with and without sarcoidosis except regarding CD4 cells percentages and CD4/CD8 ratio that was higher in those with sarcoidosis (47 ± 12 vs. 22 ± 18, p = 0.02 and 2.24 ± 1.42 vs. 0.83 ± 1.10, p = 0.03, respectively). CINS patients with sarcoidosis had less often positive blood antigen testing than those without sarcoidosis (2/5 vs. 11/11, p = 0.02). CINS patients with and without sarcoidosis were treated with similar drugs, but patients with sarcoidosis had a shorter length of treatment. CD4 cell levels do not seem to explain the association between sarcoidosis and cryptococcosis. Conclusion Sarcoidosis was the most frequently associated condition with CINS in this study. CINS patients associated with sarcoidosis had overall similar clinical and biological presentation than CINS patients associated with other conditions but exhibited a lower rate of positive blood cryptococcal antigen testing and higher CD4/CD8 T cells ratio. Pathophysiological mechanisms underlying this association remain poorly understood but B-1 cell deficiency or lack of IgM could be a part of the explanation. Another plausible mechanism is the presence of anti-granulocyte-macrophage colony-stimulating factor (GM-CSF) antibodies in a subset of patients with sarcoidosis, which could impair macrophage phagocytic function. Further studies are strongly needed to better understand those mechanisms and to identify at-risk patients.
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Affiliation(s)
- Renaud Prevel
- CHU Bordeaux, Internal Medicine Department, Bordeaux, France.,Univ Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, Inserm UMR 1045, Bordeaux, France
| | | | - Sébastien Imbert
- Univ Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, Inserm UMR 1045, Bordeaux, France.,CHU Bordeaux, Mycology-Parasitology Department, CIC 1401, Bordeaux, France
| | - Patrick Blanco
- CHU Bordeaux, Immunology Department, Bordeaux, France.,Univ Bordeaux, CNRS ImmunoConcEpT UMR 5164, Bordeaux, France
| | - Laurence Delhaes
- Univ Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, Inserm UMR 1045, Bordeaux, France.,CHU Bordeaux, Mycology-Parasitology Department, CIC 1401, Bordeaux, France
| | - Pierre Duffau
- CHU Bordeaux, Internal Medicine Department, Bordeaux, France.,Univ Bordeaux, CNRS ImmunoConcEpT UMR 5164, Bordeaux, France
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Duffau P, Korbi S, Guillotin V, Talagrand-Reboul E, Ménard A, Peuchant O. An unexpected case of Borrelia garinii liver infection. Ann Clin Microbiol Antimicrob 2022; 21:15. [PMID: 35346214 PMCID: PMC8958789 DOI: 10.1186/s12941-022-00506-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/17/2022] [Indexed: 11/24/2022] Open
Abstract
Background Lyme borreliosis is the most prevalent arthropod-borne infection in the Northern Hemisphere. In Europe, Borrelia afzelii is predominantly involved in cutaneous manifestations, Borrelia garinii and Borrelia bavariensis in neurological manifestations, and Borrelia burgdorferi sensu stricto in articular ones. Liver impairement is not classical in Lyme borreliosis. Diagnosis is currently mainly based on serological testing, and is challenging in immunocompromised patients. Case presentation We report the first case of B. garinii infection revealed by liver involvement in an immunocompromised man. A 73-year-old man with marginal zone lymphoma, treated with bendamustine and rituximab, developed intermittent fever and inflammatory syndrome. Microbial investigations were all negative and FDG-PET showed complete remission of the lymphoma. Three months later, liver biopsy was performed and histology revealed spirochetes-like bacteria. Microbial diagnosis was performed by 16S rDNA sequencing, flagellin (flaB) gene sequencing and multi-locus sequence typing and identified B. garinii. The patient recovered successfully after a three weeks course of antibiotics. Diagnosis was challenging because Borrelia hepatic involvement is unusual and no erythema migrans nor tick bite were notified. Conclusion This case highlights that unexplained fever and inflammatory syndrome in immunocompromised patients warrants specific investigations to identify bacteria such as spirochetes.
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Prével R, Delmas Y, Guillotin V, Gruson D, Rivière E. Complement Blockade Is a Promising Therapeutic Approach in a Subset of Critically Ill Adult Patients with Complement-Mediated Hemolytic Uremic Syndromes. J Clin Med 2022; 11:jcm11030790. [PMID: 35160242 PMCID: PMC8837052 DOI: 10.3390/jcm11030790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 02/04/2023] Open
Abstract
Thrombotic microangiopathy (TMA) gathers consumptive thrombocytopenia, mechanical haemolytic anemia, and organ damage. Hemolytic uremic syndromes (HUS) are historically classified as primary or secondary to another disease once thrombotic thrombocytopenic purpura (TTP), Shiga-toxin HUS, and cobalamin C-related HUS have been ruled out. Complement genetics studies reinforced the link between complement dysregulation and primary HUS, contributing to reclassifying some pregnancy- and/or post-partum-associated HUS and to revealing complement involvement in severe and/or refractory hypertensive emergencies. By contrast, no firm evidence allows a plausible association to be drawn between complement dysregulation and Shiga-toxin HUS or other secondary HUS. Nevertheless, rare complement gene variants are prevalent in healthy individuals, thus providing an indication that an investigation into complement dysregulation should be carefully balanced and that the results should be cautiously interpreted with the help of a trained geneticist. Several authors have suggested reclassifying HUS in two entities, regardless of they are complement-mediated or not, since the use of eculizumab, an anti-C5 antibody, dramatically lowers the proportion of patients who die or suffer from end-stage renal disease within the year following diagnosis. Safety and the ideal timing of eculizumab discontinuation is currently under investigation, and the long-term consequences of HUS should be closely monitored over time once patients exit emergency departments.
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Affiliation(s)
- Renaud Prével
- CHU Bordeaux, Medical Intensive Care Unit, F-33000 Bordeaux, France; (V.G.); (D.G.)
- University Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, Inserm UMR 1045, F-33000 Bordeaux, France
- Correspondence: ; Tel.: +33-(0)5-56-79-55-17; Fax: +33-(0)5-56-79-54-18
| | - Yahsou Delmas
- CHU Bordeaux, Nephrology Transplantation Dialysis Apheresis Unit, F-33076 Bordeaux, France;
| | - Vivien Guillotin
- CHU Bordeaux, Medical Intensive Care Unit, F-33000 Bordeaux, France; (V.G.); (D.G.)
| | - Didier Gruson
- CHU Bordeaux, Medical Intensive Care Unit, F-33000 Bordeaux, France; (V.G.); (D.G.)
- University Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, Inserm UMR 1045, F-33000 Bordeaux, France
| | - Etienne Rivière
- CHU Bordeaux, Internal Medicine Department, F-33000 Bordeaux, France;
- University Bordeaux, Biology of Cardiovascular Diseases, InsermU1034, F-33604 Pessac, France
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Guillotin V, Mercie P, Duffau P. [Gynecologic vasculitis revealing a giant cell arteritis: A case report and literature review]. Rev Med Interne 2022; 43:181-184. [PMID: 35031140 DOI: 10.1016/j.revmed.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/30/2021] [Accepted: 12/23/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Genital vasculitis are uncommon. They may be localized or be a manifestation of a systemic vasculitis. We report a patient with a giant cell arteritis (GCA) involving uterine arteries and a literature review on genital vasculitis. CASE REPORT A 65-year-old woman was referred to a gynecologist for a cervical intraepithelial neoplasia (CIN) associated with an ovarian mass. An unexpected diagnosis of GCA involving small to medium sized uterine arteries was made through the anatomopathological analysis while the patient was asymptomatic. Two weeks later, she presented typical cranial symptoms of giant cell arteritis (GCA). PET-scanner confirmed the diagnosis of GCA with an involvement of the ascending aorta, and the axillary and the subclavian arteries. CONCLUSION Gynecologic vasculitis are rare and usually an asymptomatic manifestations of GCA.
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Affiliation(s)
- V Guillotin
- Service de médecine interne, hôpital Saint-André, centre hospitalier universitaire de Bordeaux, place Amélie Raba Léon, 33000 Bordeaux, France; Université de Bordeaux, 146, rue Léo-Saignat, 33076 Bordeaux, France.
| | - P Mercie
- Service de médecine interne, hôpital Saint-André, centre hospitalier universitaire de Bordeaux, place Amélie Raba Léon, 33000 Bordeaux, France; Université de Bordeaux, 146, rue Léo-Saignat, 33076 Bordeaux, France
| | - P Duffau
- Service de médecine interne, hôpital Saint-André, centre hospitalier universitaire de Bordeaux, place Amélie Raba Léon, 33000 Bordeaux, France; Université de Bordeaux, 146, rue Léo-Saignat, 33076 Bordeaux, France; CNRS-UMR 5164, ImmunoConcept, université de Bordeaux, 146, rue Léo-Saignat, 33076 Bordeaux, France
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Rescoussier G, Vial G, Guillotin V, Gensous N, Couffinhal T, Ribeiro E, Cremer A, Duffau P, Mercié P. La maladie de Takayasu : une vascularite aux multiples visages. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Georgin-Lavialle S, Terrier B, Guedon AF, Heiblig M, Comont T, Lazaro E, Lacombe V, Terriou L, Ardois S, Bouaziz JD, Mathian A, Le Guenno G, Aouba A, Outh R, Meyer A, Roux-Sauvat M, Ebbo M, Zhao LP, Bigot A, Jamilloux Y, Guillotin V, Flamarion E, Henneton P, Vial G, Jachiet V, Rossignol J, Vinzio S, Weitten T, Vinit J, Deligny C, Humbert S, Samson M, Magy-Bertrand N, Moulinet T, Bourguiba R, Hanslik T, Bachmeyer C, Sebert M, Kostine M, Bienvenu B, Biscay P, Liozon E, Sailler L, Chasset F, Audemard-Verger A, Duroyon E, Sarrabay G, Borlot F, Dieval C, Cluzeau T, Marianetti P, Lobbes H, Boursier G, Gerfaud-Valentin M, Jeannel J, Servettaz A, Audia S, Larue M, Henriot B, Faucher B, Graveleau J, de Sainte Marie B, Galland J, Bouillet L, Arnaud C, Ades L, Carrat F, Hirsch P, Fenaux P, Fain O, Sujobert P, Kosmider O, Mekinian A. Further characterization of clinical and laboratory features occurring in VEXAS syndrome in a large-scale analysis of multicenter case-series of 116 French patients. Br J Dermatol 2021; 186:564-574. [PMID: 34632574 DOI: 10.1111/bjd.20805] [Citation(s) in RCA: 142] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND A new autoinflammatory syndrome related to somatic mutations of UBA1 was recently described and called VEXAS syndrome. OBJECTIVE To describe clinical characteristics, laboratory findings and outcomes of VEXAS syndrome. DESIGN Case-series. SETTING Patients referred to a French multicenter registry between November 2020 and May 2021. PATIENTS 116 patients with VEXAS syndrome. MEASUREMENTS Frequency and median of parameters and vital status, from diagnosis to the end of the follow-up. RESULTS Main clinical features were skin lesions (83.5%), non-infectious fever (63.6%), weight loss (62%), lung involvement (49.6%), ocular symptoms (38.8%), relapsing chondritis (36.4%), venous thrombosis (34.7%), lymph nodes (33.9%), and arthralgia (27.3%). Hematological disease was present in 58 cases (50%), considered as myelodysplastic syndrome (MDS, n= 58) and monoclonal gammapathy of unknown significance (n=12).UBA1 mutations included p.M41T (44.8%), p.M41V (30.2%), p.M41L (18.1%), and splice mutations (6.9%). After a median follow-up of 3.0 years, 18 patients died (15.5%), from infectious origin (n=9) and MDS progression (n=3). Unsupervised analysis identified 3 clusters: cluster 1 (47%) with mild-to-moderate disease; cluster 2 (16%) with underlying MDS and higher mortality rates; cluster 3 (37%) with constitutional manifestations, higher C-reactive protein levels and less frequent chondritis. Five-year probability of survival was 84.2% in cluster 1, 50.5 % in cluster 2, and 89.6% in cluster 3. UBA1 p.Met41Leu mutation was associated with a better prognosis. CONCLUSION VEXAS syndrome displays a large spectrum of organ manifestations and shows different clinical and prognostic profiles. It also raises a potential impact of the identified UBA1 mutation.
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Affiliation(s)
- S Georgin-Lavialle
- Sorbonne Université, AP-HP, Hôpital Tenon, service de médecine interne, CEREMAIA, F-75020, Paris, France
| | - B Terrier
- University of Paris, AP-HP, Cochin Hospital, Department of Internal Medicine, F-75014, Paris, France
| | - A F Guedon
- Sorbonne Université, Inserm, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, Département de Santé Publique, Hôpital Saint-Antoine, APHP, Paris
| | | | - T Comont
- University Hospital of Toulouse, Department of Internal Medicine and Clinical Immunology, Toulouse, France
| | - E Lazaro
- Department of Internal Medicine and Infectious Diseases, Hôpital Haut-Lévêque, Bordeaux, France
| | - V Lacombe
- Department of Internal Medicine, Angers University Hospital, Angers, France
| | - L Terriou
- Department of Internal Medicine, Lille University Hospital, Lille, France
| | - S Ardois
- Service de médecine interne, CHU de Rennes, Rennes, France
| | - J-D Bouaziz
- Université de Paris, Service de dermatologie, Hôpital Saint Louis, APHP, INSERM U944, Paris, France
| | - A Mathian
- Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Institut E3M, Paris, France
| | - G Le Guenno
- University Hospital Centre of Bordeaux, Saint Andre Hospital, Department of Internal Medicine and Clinical Immunology, F-33000 Bordeaux, France, CHU de Clermont-Ferrand, Hôpital Estaing, service de médecine interne, Clermont-Ferrand, France
| | - A Aouba
- Caen Université, Hôpital de Caen, Department of Internal Medicine, Caen, France
| | - R Outh
- Service de médecine interne et générale, Centre Hospitalier de Perpignan, Perpignan, France
| | - A Meyer
- Service d'immunologie clinique et médecine interne, Nouvel Hôpital Civil, CHU Strasbourg
| | - M Roux-Sauvat
- GHND, Centre Hospitalier Pierre Oudot, 30 avenue du Médipôle, BP 40348, 38302 Bourgoin-Jallieu Cedex
| | - M Ebbo
- Aix Marseille Université, AP-HM, Hôpital de la Timone, Department of Internal Medicine, Marseille, France
| | - L P Zhao
- APHP, Hematology department, CHU of Saint Louis, Paris, France
| | - A Bigot
- 19University of Tours, Tours, France, Department of Internal Medicine and Clinical
| | - Y Jamilloux
- University Hospital of Lyon, Hospices Civils de Lyon, Department of Internal Medicine and Clinical Immunology, Lyon, France
| | - V Guillotin
- University Hospital Centre of Bordeaux, Saint Andre Hospital, Department of Internal Medicine and Clinical Immunology, F-33000 Bordeaux, France, CHU de Clermont-Ferrand, Hôpital Estaing, service de médecine interne, Clermont-Ferrand, France
| | - E Flamarion
- Université de Paris, Service de médecine interne, HEGP Paris, France
| | - P Henneton
- Service de Médecine Vasculaire, CHU Montpellier, 80 Av Augustin Fliche, Montpellier, 34090
| | - G Vial
- University Hospital Centre of Bordeaux, Saint Andre Hospital, Department of Internal Medicine and Clinical Immunology, F-33000 Bordeaux, France, CHU de Clermont-Ferrand, Hôpital Estaing, service de médecine interne, Clermont-Ferrand, France
| | - V Jachiet
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), F-75012, Paris, France
| | - J Rossignol
- Université de Paris, Service d'hématologie, Necker Enfants Malades, Paris, France
| | - S Vinzio
- Univ. Grenoble Alpes, Inserm, U1036, CHU Grenoble Alpes, CEA, IRIG-BCI, 38000, Grenoble, France
| | - T Weitten
- Service de médecine interne, Centre Hospitalier (CHICAS), GAP, France
| | - J Vinit
- Service de médecine interne, Centre Hospitalier, Chalons, France
| | - C Deligny
- Service de Rhumatologie - Médecine Interne 5D · CHU de Martinique - Hôpital P. Zobda-Quitman, France
| | - S Humbert
- CHU de Besançon, Service de Médecine Interne, Besançon, France
| | - M Samson
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - N Magy-Bertrand
- CHU de Besançon, Service de Médecine Interne, Besançon, France
| | - T Moulinet
- Department of Internal Medicine and Clinical Immunology, Regional Competence Center for Systemic and Autoimmune Rare Diseases, Nancy University Hospital, UMR 7365, IMoPA, Lorraine University, CNRS, Vandoeuvre-lès-Nancy, France
| | - R Bourguiba
- Sorbonne Université, AP-HP, Hôpital Tenon, service de médecine interne, CEREMAIA, F-75020, Paris, France
| | - T Hanslik
- AP-HP, Hôpital Ambroise Paris, service de médecine interne, Paris, France
| | - C Bachmeyer
- Sorbonne Université, AP-HP, Hôpital Tenon, service de médecine interne, CEREMAIA, F-75020, Paris, France
| | - M Sebert
- APHP, Hematology department, CHU of Saint Louis, Paris, France
| | - M Kostine
- Department of Rheumatology, Hôpital Haut-Lévesque, Bordeaux, France
| | - B Bienvenu
- Hôpital Saint Joseph, service de médecine interne, Marseille, France
| | - P Biscay
- Clinique Mutualiste Pessac Médecine Interne, Pessac, France
| | - E Liozon
- Service de Médecine Interne, CHU Dupuytren, Limoges, France
| | - L Sailler
- University Hospital of Toulouse, Department of Internal Medicine, Toulouse, France
| | - F Chasset
- Sorbonne Université, Hôpital Tenon, service de dermatologie et allergologie et Inflammation-Immunopathology-Biotherapy Department (DMU i3), F-75020, Paris, France
| | - A Audemard-Verger
- 19University of Tours, Tours, France, Department of Internal Medicine and Clinical
| | - E Duroyon
- Service d'Hématologie Biologique, DMU BioPhyGen GH AP-HP. Centre-University de Paris
| | - G Sarrabay
- Laboratory of Rare and Autoinflammatory Genetic Diseases and Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), CHU Montpellier, University of Montpellier, Montpellier, France
| | - F Borlot
- Service de médecine Interne, CH Béziers, France
| | - C Dieval
- Service de médecine interne et hématologie, CH régional, Rochefort, France
| | - T Cluzeau
- Hematology department, CHU of Nice, Cote d'Azur University, Nice, France
| | - P Marianetti
- CHU de REIMS, Service de médecine interne, maladies infectieuses, immunologie clinique
| | - H Lobbes
- University Hospital Centre of Bordeaux, Saint Andre Hospital, Department of Internal Medicine and Clinical Immunology, F-33000 Bordeaux, France, CHU de Clermont-Ferrand, Hôpital Estaing, service de médecine interne, Clermont-Ferrand, France
| | - G Boursier
- Laboratory of Rare and Autoinflammatory Genetic Diseases and Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), CHU Montpellier, University of Montpellier, Montpellier, France
| | - M Gerfaud-Valentin
- University Hospital of Lyon, Hospices Civils de Lyon, Department of Haematology, Lyon, France
| | - J Jeannel
- Université de Paris, Service de médecine interne, HEGP Paris, France
| | - A Servettaz
- CHU de REIMS, Service de médecine interne, maladies infectieuses, immunologie clinique
| | - S Audia
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - M Larue
- APHP, Service de rhumatologie, Hôpital Henri Mondor, Créteil, France
| | - B Henriot
- Service de médecine interne, Centre Hospitalier René Pleven, Dinan, France
| | - B Faucher
- Aix Marseille Université, AP-HM, Hôpital de la Timone, Department of Internal Medicine, Marseille, France
| | - J Graveleau
- CHU de Nantes Hôtel Dieu, Service de Médecine Interne, Nantes, France
| | - B de Sainte Marie
- University Hospital Centre of Bordeaux, Saint Andre Hospital, Department of Internal Medicine and Clinical Immunology, F-33000 Bordeaux, France, CHU de Clermont-Ferrand, Hôpital Estaing, service de médecine interne, Clermont-Ferrand, France
| | - J Galland
- Service de médecine interne, hôpital Fleyriat, Centre hospitalier Bourg-en-Bresse, France
| | - L Bouillet
- Univ. Grenoble Alpes, Inserm, U1036, CHU Grenoble Alpes, CEA, IRIG-BCI, 38000, Grenoble, France
| | - C Arnaud
- University Hospital of Toulouse, Department of Internal Medicine, Toulouse, France
| | - L Ades
- APHP, Hematology department, CHU of Saint Louis, Paris, France
| | - F Carrat
- Sorbonne Université, Inserm, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, Département de Santé Publique, Hôpital Saint-Antoine, APHP, Paris
| | - P Hirsch
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, service d'hématologie biologique, F-75012, Paris, France
| | - P Fenaux
- APHP, Hematology department, CHU of Saint Louis, Paris, France
| | - O Fain
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), F-75012, Paris, France
| | - P Sujobert
- CHU de Besançon, Service de Médecine Interne, Besançon, France
| | - O Kosmider
- Service d'Hématologie Biologique, DMU BioPhyGen GH AP-HP. Centre-University de Paris
| | - A Mekinian
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), F-75012, Paris, France
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12
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Scherlinger M, Guillotin V, Douchet I, Vacher P, Boizard-Moracchini A, Guegan JP, Garreau A, Merillon N, Vermorel A, Ribeiro E, Machelart I, Lazaro E, Couzi L, Duffau P, Barnetche T, Pellegrin JL, Viallard JF, Saleh M, Schaeverbeke T, Legembre P, Truchetet ME, Dumortier H, Contin-Bordes C, Sisirak V, Richez C, Blanco P. Selectins impair regulatory T cell function and contribute to systemic lupus erythematosus pathogenesis. Sci Transl Med 2021; 13:13/600/eabi4994. [PMID: 34193612 DOI: 10.1126/scitranslmed.abi4994] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/14/2021] [Accepted: 05/25/2021] [Indexed: 12/14/2022]
Abstract
Systemic lupus erythematosus (SLE) is a systemic autoimmune disease characterized by a loss of tolerance toward self-nucleic acids, autoantibody production, interferon expression and signaling, and a defect in the regulatory T (Treg) cell compartment. In this work, we identified that platelets from patients with active SLE preferentially interacted with Treg cells via the P-selectin/P-selectin glycoprotein ligand-1 (PSGL-1) axis. Selectin interaction with PSGL-1 blocked the regulatory and suppressive properties of Treg cells and particularly follicular Treg cells by triggering Syk phosphorylation and an increase in intracytosolic calcium. Mechanistically, P-selectin engagement on Treg cells induced a down-regulation of the transforming growth factor-β axis, altering the phenotype of Treg cells and limiting their immunosuppressive responses. In patients with SLE, we found an up-regulation of P- and E-selectin both on microparticles and in their soluble forms that correlated with disease activity. Last, blocking P-selectin in a mouse model of SLE improved cardinal features of the disease, such as anti-dsDNA antibody concentrations and kidney pathology. Overall, our results identify a P-selectin-dependent pathway that is active in patients with SLE and validate it as a potential therapeutic avenue.
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Affiliation(s)
- Marc Scherlinger
- Department of Rheumatology, Pellegrin, Bordeaux University Hospital, 33076 Bordeaux, France.,Centre national de référence maladie auto-immune et systémique rares Est/Sud-Ouest (RESO), Bordeaux University Hospital, 33076 Bordeaux, France.,UMR-CNRS 5164, ImmunoConcept, University of Bordeaux, 33076 Bordeaux, France
| | - Vivien Guillotin
- Centre national de référence maladie auto-immune et systémique rares Est/Sud-Ouest (RESO), Bordeaux University Hospital, 33076 Bordeaux, France.,UMR-CNRS 5164, ImmunoConcept, University of Bordeaux, 33076 Bordeaux, France.,Department of Internal Medicine, Saint André, Bordeaux University Hospital, 33076 Bordeaux, France
| | - Isabelle Douchet
- UMR-CNRS 5164, ImmunoConcept, University of Bordeaux, 33076 Bordeaux, France
| | | | | | | | - Anne Garreau
- UMR-CNRS 5164, ImmunoConcept, University of Bordeaux, 33076 Bordeaux, France
| | - Nathalie Merillon
- UMR-CNRS 5164, ImmunoConcept, University of Bordeaux, 33076 Bordeaux, France
| | - Agathe Vermorel
- Nephrology Department, Bordeaux University Hospital, 33076 Bordeaux, France
| | - Emmanuel Ribeiro
- Department of Internal Medicine, Saint André, Bordeaux University Hospital, 33076 Bordeaux, France
| | - Irène Machelart
- Centre national de référence maladie auto-immune et systémique rares Est/Sud-Ouest (RESO), Bordeaux University Hospital, 33076 Bordeaux, France.,Department of Internal Medicine, Haut-Leveque, Bordeaux University Hospital, 33604, Pessac, France
| | - Estibaliz Lazaro
- Centre national de référence maladie auto-immune et systémique rares Est/Sud-Ouest (RESO), Bordeaux University Hospital, 33076 Bordeaux, France.,Department of Internal Medicine, Haut-Leveque, Bordeaux University Hospital, 33604, Pessac, France
| | - Lionel Couzi
- Nephrology Department, Bordeaux University Hospital, 33076 Bordeaux, France
| | - Pierre Duffau
- Department of Internal Medicine, Saint André, Bordeaux University Hospital, 33076 Bordeaux, France
| | - Thomas Barnetche
- Department of Rheumatology, Pellegrin, Bordeaux University Hospital, 33076 Bordeaux, France.,Centre national de référence maladie auto-immune et systémique rares Est/Sud-Ouest (RESO), Bordeaux University Hospital, 33076 Bordeaux, France
| | - Jean-Luc Pellegrin
- Centre national de référence maladie auto-immune et systémique rares Est/Sud-Ouest (RESO), Bordeaux University Hospital, 33076 Bordeaux, France.,Department of Internal Medicine, Haut-Leveque, Bordeaux University Hospital, 33604, Pessac, France
| | - Jean-François Viallard
- Centre national de référence maladie auto-immune et systémique rares Est/Sud-Ouest (RESO), Bordeaux University Hospital, 33076 Bordeaux, France.,Department of Internal Medicine, Haut-Leveque, Bordeaux University Hospital, 33604, Pessac, France
| | - Maya Saleh
- UMR-CNRS 5164, ImmunoConcept, University of Bordeaux, 33076 Bordeaux, France
| | - Thierry Schaeverbeke
- Department of Rheumatology, Pellegrin, Bordeaux University Hospital, 33076 Bordeaux, France.,Centre national de référence maladie auto-immune et systémique rares Est/Sud-Ouest (RESO), Bordeaux University Hospital, 33076 Bordeaux, France
| | - Patrick Legembre
- Contrôle de la Réponse Immune B et lymphoproliférations, CRIBL, UMR CNRS 7276, INSERM 1262, Limoges, France
| | - Marie-Elise Truchetet
- Department of Rheumatology, Pellegrin, Bordeaux University Hospital, 33076 Bordeaux, France.,Centre national de référence maladie auto-immune et systémique rares Est/Sud-Ouest (RESO), Bordeaux University Hospital, 33076 Bordeaux, France.,UMR-CNRS 5164, ImmunoConcept, University of Bordeaux, 33076 Bordeaux, France
| | | | - Cécile Contin-Bordes
- UMR-CNRS 5164, ImmunoConcept, University of Bordeaux, 33076 Bordeaux, France.,Department of Immunology and Immunogenetics, Bordeaux University Hospital, 33076 Bordeaux, France
| | - Vanja Sisirak
- UMR-CNRS 5164, ImmunoConcept, University of Bordeaux, 33076 Bordeaux, France
| | - Christophe Richez
- Department of Rheumatology, Pellegrin, Bordeaux University Hospital, 33076 Bordeaux, France. .,Centre national de référence maladie auto-immune et systémique rares Est/Sud-Ouest (RESO), Bordeaux University Hospital, 33076 Bordeaux, France.,UMR-CNRS 5164, ImmunoConcept, University of Bordeaux, 33076 Bordeaux, France
| | - Patrick Blanco
- Centre national de référence maladie auto-immune et systémique rares Est/Sud-Ouest (RESO), Bordeaux University Hospital, 33076 Bordeaux, France. .,UMR-CNRS 5164, ImmunoConcept, University of Bordeaux, 33076 Bordeaux, France.,Department of Immunology and Immunogenetics, Bordeaux University Hospital, 33076 Bordeaux, France
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13
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Guicheney M, Peuchant O, Guillotin V, Beylot-Barry M, Duffau P. Nocardiosis mycetoma in an immunocompetent patient. Int J Dermatol 2021; 61:e17-e19. [PMID: 34151452 DOI: 10.1111/ijd.15719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/29/2021] [Accepted: 05/25/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Marie Guicheney
- Department of Dermatology, University Hospital Center of Bordeaux, Bordeaux, France
| | - Olivia Peuchant
- Laboratory of Bacteriology, University Hospital Center of Bordeaux, Bordeaux, France
| | - Vivien Guillotin
- Department of Internal Medicine and Clinical Immunology, University Hospital Center of Bordeaux, Bordeaux, France
| | - Marie Beylot-Barry
- Department of Dermatology, University Hospital Center of Bordeaux, Bordeaux, France
| | - Pierre Duffau
- Department of Internal Medicine and Clinical Immunology, University Hospital Center of Bordeaux, Bordeaux, France
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14
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Sobczak T, Ribeiro E, Guillotin V, Duffau P, Mercié P, Vial G. La mutation BRAF dans la maladie d’Erdheim-Chester à l’origine de LMMC et de tumeurs coliques. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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Vial G, Duffau P, Guillotin V, Mercié P, Ribeiro E. Infection chronique active à EBV : entre lymphoprolifération et immunodéficience. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Mahévas M, Moulis G, Andres E, Riviere E, Garzaro M, Crickx E, Guillotin V, Malphettes M, Galicier L, Noel N, Darnige L, Terriou L, Guerveno C, Sanchis-Borja M, Moulinet T, Meunier B, Ebbo M, Michel M, Godeau B. Clinical characteristics, management and outcome of COVID-19-associated immune thrombocytopenia: a French multicentre series. Br J Haematol 2020; 190:e224-e229. [PMID: 32678953 PMCID: PMC7404899 DOI: 10.1111/bjh.17024] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Matthieu Mahévas
- Department of Internal Medicine, National Referral Center for Adult's Immune Cytopenias Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Guillaume Moulis
- Department of Internal Medicine, Toulouse University Hospital (CHU de Toulouse), Toulouse, France.,CIC 1436, Toulouse University Hospital (CHU de Toulouse), Toulouse, France.,UMR 1027 Inserm, University of Toulouse, Toulouse, France
| | - Emmanuel Andres
- Department of Internal Medicine, University Hospital of Strasbourg, Research Team EA, 3072 "Mitochondrie, Stress oxydant et Protection musculaire", University of Strasbourg, Strasbourg, France
| | - Etienne Riviere
- Department of Internal Medicine, Bordeaux University Hospital (CHU de Bordeaux), Bordeaux, France.,Inserm U1034-University of Bordeaux, Bordeaux, France
| | - Margaux Garzaro
- Department of Clinical Immunology, Saint Louis University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Etienne Crickx
- Department of Internal Medicine, National Referral Center for Adult's Immune Cytopenias Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Vivien Guillotin
- Department of Internal Medicine, University Hospital of Strasbourg, Research Team EA, 3072 "Mitochondrie, Stress oxydant et Protection musculaire", University of Strasbourg, Strasbourg, France
| | - Marion Malphettes
- Department of Clinical Immunology, Saint Louis University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Lionel Galicier
- Department of Clinical Immunology, Saint Louis University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Nicolas Noel
- Department of internal medicine, Kremlin-Bicêtre, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Luc Darnige
- Inserm UMR-S 1140, Service d'Hématologie Biologique, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Louis Terriou
- Department of Internal Medicine and Immunology, Claude-Huriez University Hospital, Université Lille Nord de France, Lille, France
| | - Claire Guerveno
- Department of Internal Medicine, Albi Hospital, Albi, France
| | - Mateo Sanchis-Borja
- Department of pneumology, Hôpital européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Thomas Moulinet
- Department of internal medicine, Nancy University Hospital (CHU de Nancy), University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Benoit Meunier
- Department of internal medicine, Hôpital la Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Mikael Ebbo
- Department of internal medicine, Hôpital la Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Marc Michel
- Department of Internal Medicine, National Referral Center for Adult's Immune Cytopenias Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Bertrand Godeau
- Department of Internal Medicine, National Referral Center for Adult's Immune Cytopenias Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
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Brilland B, Scherlinger M, Khoryati L, Goret J, Duffau P, Lazaro E, Charrier M, Guillotin V, Richez C, Blanco P. Platelets and IgE: Shaping the Innate Immune Response in Systemic Lupus Erythematosus. Clin Rev Allergy Immunol 2019; 58:194-212. [DOI: 10.1007/s12016-019-08744-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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18
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Guillotin V, De Guillebon S, Bui N, Sazio C, Boyer A. Herpes simplex virus: A rare but treatable cause of fulminant hepatitis. Anaesth Crit Care Pain Med 2019; 38:77-78. [DOI: 10.1016/j.accpm.2018.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 02/21/2018] [Accepted: 02/24/2018] [Indexed: 01/03/2023]
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Scherlinger M, Guillotin V, Truchetet ME, Contin-Bordes C, Sisirak V, Duffau P, Lazaro E, Richez C, Blanco P. Systemic lupus erythematosus and systemic sclerosis: All roads lead to platelets. Autoimmun Rev 2018; 17:625-635. [PMID: 29635077 DOI: 10.1016/j.autrev.2018.01.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 01/18/2018] [Indexed: 01/13/2023]
Abstract
Systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) are two phenotypically distincts inflammatory systemic diseases. However, SLE and SSc share pathogenic features such as interferon signature, loss of tolerance against self-nuclear antigens and increased tissue damage such as fibrosis. Recently, platelets have emerged as a major actor in immunity including auto-immune diseases. Both SLE and SSc are characterized by strong platelet system activation, which is likely to be both the witness and culprit in their pathogenesis. Platelet activation pathways are multiple and sometimes redundant. They include immune complexes, Toll-like receptors activation, antiphospholipid antibodies and ischemia-reperfusion associated with Raynaud phenomenon. Once activated, platelet promote immune dysregulation by priming interferon production by immune cells, providing CD40L supporting B lymphocyte functions and providing a source of autoantigens. Platelets are actively implicated in SLE and SSc end-organ damage such as cardiovascular and renal disease and in the promotion of tissue fibrosis. Finally, after understanding the main pathogenic implications of platelet activation in both diseases, we discuss potential therapeutics targeting platelets.
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Affiliation(s)
- Marc Scherlinger
- Service de Rhumatologie, FHU ACRONIM, Hôpital Pellegrin, Centre Hospitalier Universitaire, Place Amélie Raba Léon, 33076 Bordeaux, France; Université de Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux, France; CNRS-UMR 5164, ImmunoConcept, Université de Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux, France
| | - Vivien Guillotin
- Service de médecine interne, FHU ACRONIM, Hôpital Saint André, Centre Hospitalier Universitaire, 1 rue Jean Burguet, 33076 Bordeaux, France; Université de Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux, France; CNRS-UMR 5164, ImmunoConcept, Université de Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux, France
| | - Marie-Elise Truchetet
- Service de Rhumatologie, FHU ACRONIM, Hôpital Pellegrin, Centre Hospitalier Universitaire, Place Amélie Raba Léon, 33076 Bordeaux, France; Université de Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux, France; CNRS-UMR 5164, ImmunoConcept, Université de Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux, France
| | - Cécile Contin-Bordes
- Laboratoire d'Immunologie et Immunogénétique, FHU ACRONIM, Hôpital Pellegrin, Centre Hospitalier Universitaire, Place Amélie Raba Léon, 33076 Bordeaux, France; Université de Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux, France; CNRS-UMR 5164, ImmunoConcept, Université de Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux, France
| | - Vanja Sisirak
- Université de Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux, France; CNRS-UMR 5164, ImmunoConcept, Université de Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux, France
| | - Pierre Duffau
- Service de médecine interne, FHU ACRONIM, Hôpital Saint André, Centre Hospitalier Universitaire, 1 rue Jean Burguet, 33076 Bordeaux, France; Université de Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux, France; CNRS-UMR 5164, ImmunoConcept, Université de Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux, France
| | - Estibaliz Lazaro
- Laboratoire d'Immunologie et Immunogénétique, FHU ACRONIM, Hôpital Pellegrin, Centre Hospitalier Universitaire, Place Amélie Raba Léon, 33076 Bordeaux, France; Université de Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux, France; CNRS-UMR 5164, ImmunoConcept, Université de Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux, France
| | - Christophe Richez
- Service de Rhumatologie, FHU ACRONIM, Hôpital Pellegrin, Centre Hospitalier Universitaire, Place Amélie Raba Léon, 33076 Bordeaux, France; Université de Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux, France; CNRS-UMR 5164, ImmunoConcept, Université de Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux, France
| | - Patrick Blanco
- Laboratoire d'Immunologie et Immunogénétique, FHU ACRONIM, Hôpital Pellegrin, Centre Hospitalier Universitaire, Place Amélie Raba Léon, 33076 Bordeaux, France; Université de Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux, France; CNRS-UMR 5164, ImmunoConcept, Université de Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux, France.
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20
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Guillotin V, Bouhet A, Barnetche T, Richez C, Truchetet ME, Seneschal J, Duffau P, Lazaro E. Hydroxychloroquine for the prevention of fetal growth restriction and prematurity in lupus pregnancy: A systematic review and meta-analysis. Joint Bone Spine 2018; 85:663-668. [PMID: 29631068 DOI: 10.1016/j.jbspin.2018.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/01/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that primarily affects women of childbearing age. While the impact of hydroxychloroquine (HCQ) on SLE activity and neonatal lupus occurrence has been evaluated in several studies, its role on prematurity and intrauterine growth restriction (IUGR) remains uncertain. The aim of this study was to assess the impact of HCQ exposure on prematurity and IUGR during pregnancy in women with SLE. METHODS We conducted a systematic review and a meta-analysis comparing prematurity and IUGR in SLE pregnancies exposed or not exposed to HCQ. The odds ratio of IUGR and prematurity were calculated and compared between pregnancies in each group according HCQ treatment. RESULTS Six studies were included (3 descriptive cohort studies and 3 case series) totalling 870 pregnancies. Of the SLE pregnancies, 308 were exposed to HCQ and were compared to 562 not exposed to HCQ. There was no statistical difference for prematurity or IUGR between groups. CONCLUSION This meta-analysis failed to prove the efficacy of HCQ in the prevention of prematurity as well as IUGR during SLE pregnancies. Due to the heterogeneity of the studies, these results should be interpreted cautiously.
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Affiliation(s)
- Vivien Guillotin
- Division of Internal Medicine, Bordeaux University Hospital, 33000 Bordeaux, France
| | - Alice Bouhet
- Division of Rheumatology, Bordeaux University Hospital, 33000 Bordeaux, France
| | - Thomas Barnetche
- Division of Rheumatology, Bordeaux University Hospital, 33000 Bordeaux, France
| | - Christophe Richez
- Division of Rheumatology, Bordeaux University Hospital, 33000 Bordeaux, France
| | | | - Julien Seneschal
- Division of Dermatology, Bordeaux University Hospital, 33000 Bordeaux, France
| | - Pierre Duffau
- Division of Internal Medicine and Clinical Immunology, Saint-André Hospital, 33000 Bordeaux, France
| | - Estibaliz Lazaro
- Division of Internal Medicine and Infectious Diseases, Haut-Lévêque Hospital, 33604 Pessac, France.
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21
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Guillotin V, Galli G, Viallard JF. [Usefulness of thiopurine methyltransferase polymorphism study and metabolites measurement for patients treated by azathioprine]. Rev Med Interne 2018; 39:421-426. [PMID: 29370945 DOI: 10.1016/j.revmed.2017.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 12/18/2017] [Accepted: 12/28/2017] [Indexed: 11/18/2022]
Abstract
Azathioprine is widely used in internal medicine and frequently implicated in occurrence of adverse events. Among these adverse events the bone marrow suppression, a dose-related one, is the most serious because of is potential morbidity and mortality. Severe myelosuppression, associated with abnormal AZA metabolism, is linked to the thiopurine methyltransferase (TPMT) genetic polymorphism that results in a high variability of its activity with 89% of patients with a normal activity, 11% with an intermediate activity, and 0.3% with very low activity leading to a very high risk of bonne marrow suppression. TPMT status can be assessed prior to AZA treatment by measuring enzyme activity or genotyping techniques to identify patients for which the standard dose is not advisable. Furthermore, azathioprine metabolites monitoring is helpful for the follow up of patients, especially in therapeutic failure, to distinguish non-compliant patients from under-dosed, "shunters" or resistant patients.
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Affiliation(s)
- V Guillotin
- Laboratoire d'immunologie de l'hôpital Pellegrin, place Amélié-Raba-Léon, 33000 Bordeaux, France.
| | - G Galli
- Service de médecine interne et immunologie clinique, Hôpital Saint-André, rue Jean-Burguet, 33000 Bordeaux, France
| | - J-F Viallard
- Service de médecine interne, hôpital du Haut-Lévêque, avenue Magellan, 33604 Pessac, France
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22
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Guillotin V, Saint-Lézer A, Prevel R, Sahali D, Bouabdallah K, Dilhuydy M, Milpied N. Syndrome néphrotique paranéoplasique et maladie de Hodgkin : à propos de c-mip. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.10.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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