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Chapuis E, Bousquet E, Viallard JF, Terrier B, Amoura Z, Batani V, Brézin A, Cacoub P, Caminati M, Chazal T, Comarmond C, Durieu I, Ebbo M, Grall M, Ledoult E, Losappio L, Mattioli I, Mékinian A, Padoan R, Regola F, Schroeder J, Seluk L, Trefond L, Wechsler ME, Lefevre G, Kahn JE, Sève P, Groh M. Ophthalmic vascular manifestations in eosinophil-associated diseases: a comprehensive analysis of 57 patients from the CEREO and EESG networks and a literature review. Front Immunol 2024; 15:1379611. [PMID: 38720897 PMCID: PMC11078014 DOI: 10.3389/fimmu.2024.1379611] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/04/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Eosinophils have widespread procoagulant effects. In daily practice, eosinophil-related cardiovascular toxicity consists of endomyocardial damage, eosinophilic vasculitis and arterial or venous thrombosis. Here we aim to report on the clinical features and treatment outcomes of patients with unexplained ophthalmic vascular manifestations and eosinophilia. Methods We conducted a retrospective, multicenter, observational study and a literature review of patients with eosinophilia (≥0.5 x109/L) and concomitant ophthalmic vascular manifestations independent of the underlying eosinophilic disease but with no alternative cause for ophthalmic manifestations. Results Fifty-seven patients were included (20 from the observational study and 37 from the literature review). Ophthalmic vascular features were the initial manifestation of eosinophil-related disease in 34 (59%) patients and consisted of 29 central retinal artery occlusions, six branch retinal artery occlusions, five central retinal vein occlusions, two branch retinal vein occlusions, seven retinal vasculitides, two retinal vasospasms, 12 Purtscher's retinopathies, 13 anterior ischemic optic neuropathies and two posterior ischemic optic neuropathies. The median [IQR] absolute eosinophil count at onset of ophthalmic vascular manifestations was 3.5 [1.7-7.8] x109/L. Underlying eosinophil-related diseases included eosinophilic granulomatosis with polyangiitis (n=32), clonal hypereosinophilic syndrome (HES) (n=1), idiopathic HES (n=13), lymphocytic HES (n=2), adverse drug reactions (n=3), parasitosis (n=2), polyarteritis nodosa (n=1), IgG4-related disease (n=1), eosinophilic fasciitis (n=1) and primary sclerosing cholangitis (n=1). Other extra-ophthalmologic arterial or venous thromboses related to eosinophilia were reported in four (7%) and nine (16%) patients, respectively. Visual prognosis was poor: only eight (10%) patients achieved full recovery of ophthalmologic symptoms. After a median follow-up of 10.5 [1-18] months, one patient (3%) had a recurrence of an ophthalmic vascular manifestation, and three patients (10%) had a recurrence of other vascular symptoms (deep vein thrombosis in two and pulmonary embolism in one patient). At the time of recurrence, absolute eosinophil counts were above 0.5 x109/L in all cases (n=4). Discussion This study broadens the spectrum of vascular manifestations associated with hypereosinophilia by adding ophthalmic vascular manifestations. In patients with ophthalmological vascular manifestations and hypereosinophilia, aggressive treatment of the underlying pathology (and normalization of blood count) should be implemented.
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Affiliation(s)
- Elisa Chapuis
- National Reference Center for Hypereosinophilic Syndromes, CEREO, Suresnes, France
- Department of Internal Medicine, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Elodie Bousquet
- Department of Ophthalmology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-François Viallard
- National Reference Center for Hypereosinophilic Syndromes, CEREO, Suresnes, France
- Department of Internal Medicine, Bordeaux University Hospital, Bordeaux, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Zahir Amoura
- Department of Internal Medicine, Autoimmune and systemic diseases, La Pitié Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Veronica Batani
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Antoine Brézin
- Department of Ophthalmology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, La Pitié Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marco Caminati
- Asthma Center and Allergy Unit, Center for Hyper-Eosinophilic Dysimmune Conditions, Department of Medicine, University of Verona, Verona, Italy
| | - Thibaud Chazal
- Department of Internal Medicine, Hospital Fondation Adolphe de Rothschild, Paris, France
| | - Cloé Comarmond
- Department of Internal Medicine, Competence Center for Rare Autoimmune and Inflammatory Diseases, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Isabelle Durieu
- Department of Internal Medicine, Centre Hospitalier Universitaire Lyon Sud, Pierre-Bénite, France
| | - Mikael Ebbo
- National Reference Center for Hypereosinophilic Syndromes, CEREO, Suresnes, France
- Internal Medicine Department, Hopital La Timone, APHM, Aix Marseille University, Marseille, France
| | | | - Emmanuel Ledoult
- National Reference Center for Hypereosinophilic Syndromes, CEREO, Suresnes, France
- Department of Internal Medicine and Clinical Immunology, CHU Lille, Lille, France
| | - Laura Losappio
- Department of Clinical Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Irene Mattioli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Arsène Mékinian
- Department of Internal Medicine, St Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Roberto Padoan
- Unit of Rheumatology, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Francesca Regola
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Jan Schroeder
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lior Seluk
- Department of Medicine, National Jewish Health, Denver, CO, United States
| | - Ludovic Trefond
- National Reference Center for Hypereosinophilic Syndromes, CEREO, Suresnes, France
- Department of Internal Medicine, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | | | - Guillaume Lefevre
- National Reference Center for Hypereosinophilic Syndromes, CEREO, Suresnes, France
- Inserm, U1286 - INFINITE - Institute for Translational Research in Inflammation, University of Lille, CHU Lille, Lille, France
| | - Jean-Emmanuel Kahn
- National Reference Center for Hypereosinophilic Syndromes, CEREO, Suresnes, France
- Department of Internal Medicine, Ambroise Pare Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne, France
| | - Pascal Sève
- Department of Internal Medicine, Lyon University Hospital, Lyon, France
| | - Matthieu Groh
- National Reference Center for Hypereosinophilic Syndromes, CEREO, Suresnes, France
- Department of Internal Medicine, Foch Hospital, Suresnes, France
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Hassold N, Dusser P, Laurent A, Lemelle I, Pillet P, Comarmond C, Mekinian A, Lambert M, Mirault T, Benhamou Y, Belot A, Jeziorski E, Reumaux H, Sibilia J, Desdoits A, Espitia O, Faye A, Quartier P, Saadoun D, Koné-Paut I. Clinical spectrum and outcome of Takayasu's arteritis in children. Joint Bone Spine 2024; 91:105735. [PMID: 38631524 DOI: 10.1016/j.jbspin.2024.105735] [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: 03/20/2024] [Revised: 03/29/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES We aimed to compare clinical spectrum and outcome between adults and children with Takayasu's arteritis (TAK) in a European population. METHODS We made a nationwide retrospective observational study between 1988 and 2019. All adult patients met the ACR diagnostic criteria for TAK and all children met the EULAR/PRINTO/PRES criteria for paediatric TAK. RESULTS We identified 46 children and 389 adults with TAK. The male to female ratio was 34/46 (0.74) in the paediatric group compared to 241/274 (0.88) in the adult group (P<0.05). Children presented with significantly more systemic symptoms; i.e., fever (P<0.05), fatigue (P<0.001), weight loss (P<0.001), abdominal pain (P<0.05), and myalgia (P<0.05) while adults had more upper limb claudication (P<0.01). Topography of the lesions differed significantly between the two groups: adults had more damage at the cerebral vasculature (P<0.01), upper and lower limbs (P<0.001) while children had more kidney lesions (P<0.05). Children TAK had more frequent (P<0.01) and higher (P<0.001) biological inflammation than adults. Children received higher dose-weight of corticosteroids (P=0.001) and less biotherapy (P<0.010) at diagnosis. Relapses (P<0.05) and death (8.6% vs 4.9%) were more frequent in children TAK than in adults. CONCLUSION Paediatric TAK seems more severe than adult TAK. Therefore, paediatrics patients may require closer monitoring and systemic use of biological treatment.
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Affiliation(s)
- Nolan Hassold
- Department of paediatric rheumatology and CEREMAIA, Kremlin-Bicêtre Hospital, AP-HP, université de Paris Saclay, Kremlin-Bicêtre, France.
| | - Perrine Dusser
- Department of paediatric rheumatology and CEREMAIA, Kremlin-Bicêtre Hospital, AP-HP, université de Paris Saclay, Kremlin-Bicêtre, France
| | - Audrey Laurent
- Department of paediatric rheumatology, Femme-Mère-Enfant Hospital, HCL, Lyon, France
| | - Irene Lemelle
- Department of paediatric oncology, Hôpitaux de Brabois, CHU, Nancy, France
| | - Pascal Pillet
- Department of paediatrics, Pellegrin Hospital, CHU, Bordeaux, France
| | - Cloé Comarmond
- Department of internal medicine, Lariboisière Hospital, AP-HP, Paris, France
| | - Arsene Mekinian
- Department of internal medicine, Saint-Antoine Hospital, AP-HP, Sorbonne université, Paris, France
| | - Marc Lambert
- Department of internal medicine, Claude-Huriez Hospital, CHU, Lille, France
| | - Tristan Mirault
- Department of vascular medicine, George-Pompidou Hospital, AP-HP, Paris, France
| | - Ygal Benhamou
- Department of internal medicine, Charles-Nicolle Hospital, CHU, Rouen, France
| | - Alexandre Belot
- Department of paediatric rheumatology, Femme-Mère-Enfant Hospital, HCL, Lyon, France
| | - Eric Jeziorski
- Department of paediatrics, Arnaud-de-Villeneuve Hospital, CHU, Montpellier, France
| | - Héloïse Reumaux
- Department of paediatrics, Jeanne-de-Flandre Hospital, CHRU, Lille, France
| | - Jean Sibilia
- Department of rheumatology, Arlin d'Alsace Hospital, CHU, Strasbourg, France
| | - Alexandra Desdoits
- Department of paediatrics, Hôpital de la Côte-de-Nacre, CHU, Caen, France
| | - Olivier Espitia
- Nantes Université, CHU Nantes, Department of internal and vascular medicine, 44000 Nantes, France
| | - Albert Faye
- Department of general paediatrics, infectious diseases and internal medecine, Robert-Debré Hospital, AP-HP, Université Paris Cité, Paris, France
| | - Pierre Quartier
- Department of paediatric rheumatology, Necker Hospital, AP-HP, Paris, France
| | - David Saadoun
- Department of internal medicine, La Pitié-Salpétrière Hospital, AP-HP, Sorbonne université, Paris, France
| | - Isabelle Koné-Paut
- Department of paediatric rheumatology and CEREMAIA, Kremlin-Bicêtre Hospital, AP-HP, université de Paris Saclay, Kremlin-Bicêtre, France
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Goncalves L, Tran VT, Chauffier J, Bourdin V, Nassarmadji K, Vanjak A, Bigot W, Burlacu R, Champion K, Lopes A, Depont A, Borrero BA, Mangin O, Adle-Biassette H, Bonnin P, Boutigny A, Bonnin S, Neumann L, Mouly S, Sène D, Comarmond C. [Clinical characteristics and follow-up of 60 patients with recent diagnosis of giant cell arteritis, NEWTON study]. Rev Med Interne 2024:S0248-8663(23)01322-X. [PMID: 38216390 DOI: 10.1016/j.revmed.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/05/2023] [Accepted: 12/17/2023] [Indexed: 01/14/2024]
Abstract
INTRODUCTION The management of giant cell arteritis (GCA) has evolved with the arrival of tocilizumab (TCZ) and the use of PET/CT. Our objective is to describe the characteristics and followup of patients with recent diagnosis of GCA in current care. PATIENTS AND METHODS The NEWTON cohort is a monocentric retrospective cohort based on data collected from 60 GCA patients diagnosed between 2017 and 2022 according to the ACR/EULAR 2022 criteria. RESULTS The median age at diagnosis was 73 [68.75; 81] years old. At diagnosis, the main manifestations were unusual temporal headaches in 48 (80 %) and an inflammatory syndrome in 50 (83 %) patients. Temporal artery biopsy confirmed the diagnosis in 49/58 (84 %) patients. Doppler of the temporal arteries found a halo in 12/23 (52 %) patients. The PET/CT found hypermetabolism in 19/43 (44 %) patients. Prednisone was stopped in 17.5 [12.75; 24.25] months. During follow-up, 22 (37 %) patients received TCZ. At least one complication of corticosteroid therapy was observed in 22 (37 %) patients. After a median follow-up of 24 [12; 42] months, 25 (42 %) patients relapsed. At the end of the follow-up, 29 (48.3 %) patients were weaned from corticosteroid therapy and 15 (25 %) were on TCZ. CONCLUSION Despite the increasing use of TCZ in the therapeutic arsenal and of the PET/CT in the imaging tools of GCA patients, relapses and complications of corticosteroid therapy remain frequent, observed in more than a third of patients.
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Affiliation(s)
- L Goncalves
- Médecine interne, hôpital Lariboisière, université Paris Cité, Paris, France
| | - V-T Tran
- Centre d'épidémiologie clinique, hôpital Hôtel-Dieu, université Paris Cité, Paris, France
| | - J Chauffier
- Médecine interne, hôpital Lariboisière, université Paris Cité, Paris, France
| | - V Bourdin
- Médecine interne, hôpital Lariboisière, université Paris Cité, Paris, France
| | - K Nassarmadji
- Médecine interne, hôpital Lariboisière, université Paris Cité, Paris, France
| | - A Vanjak
- Médecine interne, hôpital Lariboisière, université Paris Cité, Paris, France
| | - W Bigot
- Médecine interne, hôpital Lariboisière, université Paris Cité, Paris, France
| | - R Burlacu
- Médecine interne, hôpital Lariboisière, université Paris Cité, Paris, France
| | - K Champion
- Médecine interne, hôpital Lariboisière, université Paris Cité, Paris, France
| | - A Lopes
- Médecine interne, hôpital Lariboisière, université Paris Cité, Paris, France
| | - A Depont
- Médecine interne, hôpital Lariboisière, université Paris Cité, Paris, France
| | - B A Borrero
- Médecine interne, hôpital Lariboisière, université Paris Cité, Paris, France
| | - O Mangin
- Médecine interne, hôpital Lariboisière, université Paris Cité, Paris, France
| | | | - P Bonnin
- Physiologie, hôpital Lariboisière, Paris, France
| | - A Boutigny
- Physiologie, hôpital Lariboisière, Paris, France
| | - S Bonnin
- Ophtalmologie, hôpital Lariboisière et Fondation Rothschild, Paris, France
| | - L Neumann
- Neurologie, hôpital Lariboisière, Paris, France
| | - S Mouly
- Médecine interne, hôpital Lariboisière, université Paris Cité, Paris, France
| | - D Sène
- Médecine interne, hôpital Lariboisière, université Paris Cité, Paris, France
| | - C Comarmond
- Médecine interne, hôpital Lariboisière, université Paris Cité, Paris, France.
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4
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Bigot W, Forzy L, Nassarmadji K, Champion K, Asesio N, Mouly S, Sène D, Comarmond C, Brenac G, Chaudot F, Gasparini S, Leghima L. Une anémie dans les chaussettes mon cher Michel. Rev Med Interne 2023; 44:676-678. [PMID: 37419730 DOI: 10.1016/j.revmed.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 07/09/2023]
Affiliation(s)
- W Bigot
- Département de médecine interne et immunologie clinique, hôpital Lariboisière, AP-HP, université Paris Citém, Paris, France.
| | - L Forzy
- Département de médecine interne et immunologie clinique, hôpital Lariboisière, AP-HP, université Paris Citém, Paris, France
| | - K Nassarmadji
- Département de médecine interne et immunologie clinique, hôpital Lariboisière, AP-HP, université Paris Citém, Paris, France
| | - K Champion
- Département de médecine interne et immunologie clinique, hôpital Lariboisière, AP-HP, université Paris Citém, Paris, France
| | - N Asesio
- Service de gastro-entérologie, GH Lariboisière - St Louis, AP-HP, université Paris Cité, Paris, France
| | - S Mouly
- Département de médecine interne et immunologie clinique, hôpital Lariboisière, AP-HP, université Paris Citém, Paris, France
| | - D Sène
- Département de médecine interne et immunologie clinique, hôpital Lariboisière, AP-HP, université Paris Citém, Paris, France
| | - C Comarmond
- Département de médecine interne et immunologie clinique, hôpital Lariboisière, AP-HP, université Paris Citém, Paris, France
| | - G Brenac
- Service de médecine interne, CHU de Dijon, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon Cedex, France
| | - F Chaudot
- Service de médecine interne, Hospices Civils de Lyon, université Claude-Bernard Lyon 1, Lyon, France
| | - S Gasparini
- Service de médecine interne, CHU de Poitiers, CHU de Poitiers, 2 rue de la Milétrie, CS 90577, 86000 Poitiers, France
| | - L Leghima
- Service de médecine interne, CHU d'Amiens-Picardie, Site Sud, 1, rond-point du Professeur Christian Cabrol, 80054 Amiens Cedex 1, France
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5
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Bugaut H, Barete S, Bagot M, Bouaziz JD, Le Pelletier de Glatigny F, Gallien Y, Biard L, Domont F, Cacoub P, Saadoun D, Comarmond C. Neutrophilic dermatosis and hidradenitis suppurativa in patients with Behçet's disease: A neutrophilic disease in the spectrum of autoinflammatory syndromes. Semin Arthritis Rheum 2023; 61:152224. [PMID: 37207416 DOI: 10.1016/j.semarthrit.2023.152224] [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: 02/06/2023] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Association of neutrophilic dermatosis (ND), hidradenitis suppurativa (HS) and Behçet's disease (BD) and shared efficacy of TNFα axis blockade suggests common physiopathology. OBJECTIVES To investigate the clinical features and therapeutic response of ND and HS associated with BD. METHODS We identified 20 patients with ND or HS associated with BD among 1462 patients with BD. RESULTS We analysed 20 (1.4%) patients diagnosed with ND or HS associated with BD: 13 HS, 6 pyoderma gangrenosum (PG), and 1 SAPHO. Our 6 PG cases over 1462 BD patients accounts for 400/100 000 prevalence. Thirteen had bipolar aphthosis, 6 vascular, 5 neurologic, and 4 ocular involvements. All PG occurred on limbs and had typical histology with constant dermal neutrophilic infiltrate. All HS had the classical axillary-mammary phenotype. Sixty-nine percent (69%) of HS were Hurley 1 stage. Treatment consisted mainly in colchicine (n = 20), glucocorticoids (n = 12), and anti-TNFα (n = 9). Interesting results with complete or partial responses were obtained with anti-TNFα (9 cases), ustekinumab (3 cases) and tocilizumab (1 case) to treat refractory ND or HS associated with BD. CONCLUSION PG seems overrepresented in patients with BD. Biotherapies such as anti-TNFα, ustekinumab and tocilizumab appear to be promising to treat refractory ND or HS associated with BD.
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Affiliation(s)
- Hélène Bugaut
- Department of Internal Medicine and Clinical Immunology, Sorbonne University, Pitié-Salpêtrière Hospital, APHP, 75013 Paris France, Centre de référence Maladies Autoimmunes systémiques rares, Centre de référence Maladies Autoinflammatoires et amylose, 83 boulevard de l'hôpital, Paris 75013, France
| | - Stéphane Barete
- Unit of Dermatology, Pitié-Salpêtrière Hospital, APHP, DMU3ID, Sorbonne Université, Paris 75013, France
| | - Martine Bagot
- Dermatology, Saint-Louis Hospital, Université Paris Cité, Paris 75010, France
| | - Jean-David Bouaziz
- Dermatology, Saint-Louis Hospital, Université Paris Cité, Paris 75010, France
| | | | - Yves Gallien
- Biostatistic, Saint-Louis Hospital, Université Paris Cité, Paris 75010, France
| | - Lucie Biard
- Biostatistic, Saint-Louis Hospital, Université Paris Cité, Paris 75010, France
| | - Fanny Domont
- Department of Internal Medicine and Clinical Immunology, Sorbonne University, Pitié-Salpêtrière Hospital, APHP, 75013 Paris France, Centre de référence Maladies Autoimmunes systémiques rares, Centre de référence Maladies Autoinflammatoires et amylose, 83 boulevard de l'hôpital, Paris 75013, France
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Sorbonne University, Pitié-Salpêtrière Hospital, APHP, 75013 Paris France, Centre de référence Maladies Autoimmunes systémiques rares, Centre de référence Maladies Autoinflammatoires et amylose, 83 boulevard de l'hôpital, Paris 75013, France
| | - David Saadoun
- Department of Internal Medicine and Clinical Immunology, Sorbonne University, Pitié-Salpêtrière Hospital, APHP, 75013 Paris France, Centre de référence Maladies Autoimmunes systémiques rares, Centre de référence Maladies Autoinflammatoires et amylose, 83 boulevard de l'hôpital, Paris 75013, France.
| | - Cloé Comarmond
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université Paris Cité, Paris 75010, France
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6
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Comarmond C, Chimon A, Salfrant M, Sène D. Relapsing Polychondritis With Palmoplantar Pustulosis. J Rheumatol 2023:jrheum.2023-0003. [PMID: 37321639 DOI: 10.3899/jrheum.2023-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Palmoplantar pustulosis (PPP) is a very rare cutaneous manifestation observed during relapsing polychondritis (RP),1,2 not found in other conditions associated with saddle nose (eg, granulomatosis with polyangiitis, sarcoidosis, VEXAS [vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic] syndrome, congenital syphilis, leprosy, septal abscess).
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Affiliation(s)
- Cloé Comarmond
- Cloé Comarmond, MD, PhD, Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université Paris Cité
| | - Alice Chimon
- Alice Chimon, MD, MSc, Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université Paris Cité
| | - Maxime Salfrant
- Maxime Salfrant, MD, MSc, Department of Otorhinolaryngology, Lariboisière Hospital, Université Paris Cité
| | - Damien Sène
- Damien Sène, MD, PhD, Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université Paris Cité, Paris. France
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Leveque T, Pavlidi A, Lacoste-Palasset T, Cazes A, Messika J, Montravers P, Lortat-Jacob B, Castier YH, Bunel V, Borie R, Sène D, Allenbach Y, Mégarbane B, Comarmond C. A 24-Year-Old Woman With Cough, Arthralgia, and Skin Ulcerations. Chest 2023; 163:e223-e229. [PMID: 37164587 DOI: 10.1016/j.chest.2022.12.038] [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: 07/26/2022] [Revised: 10/27/2022] [Accepted: 12/07/2022] [Indexed: 05/12/2023] Open
Abstract
CASE PRESENTATION A 24-year-old Senegalese woman without remarkable history except anemia and iron deficiency related to excessive menstrual bleeding and sickle cell trait was admitted to our internal medicine department with 4-month fever, weight loss (-13 kg), dyspnea for limited efforts, intermittent productive cough, and bilateral metacarpophalangeal (MCP) and interphalangeal arthralgia. She was born and lived in France. She traveled previously to Senegal in 2015. She had no history of tobacco, alcohol, or drug use nor proximity with animals. She was taking no medication.
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Affiliation(s)
- Thibault Leveque
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Université Paris Cité, Paris, France
| | - Anastasia Pavlidi
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université Paris Cité, Paris, France
| | - Thomas Lacoste-Palasset
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Université Paris Cité, Paris, France
| | - Aurélie Cazes
- Department of Pathology, Lariboisière Hospital, Université Paris Cité, Paris, France
| | - Jonathan Messika
- Pulmonology B and Lung Transplantation Department, Bichat Claude Bernard Hospital, Université Paris Cité, Paris, France
| | - Philippe Montravers
- Department of Anaesthesiology and Critical Care Medicine, Bichat Claude Bernard Hospital, Université Paris Cité, Paris, France
| | - Brice Lortat-Jacob
- Department of Anaesthesiology and Critical Care Medicine, Bichat Claude Bernard Hospital, Université Paris Cité, Paris, France
| | - Yves-Hervé Castier
- Thoracic Surgery Department, Bichat Claude Bernard Hospital, Université Paris Cité, Paris, France
| | - Vincent Bunel
- Pulmonology B and Lung Transplantation Department, Bichat Claude Bernard Hospital, Université Paris Cité, Paris, France
| | - Raphaël Borie
- Pulmonology A Department, Bichat Claude Bernard Hospital, Université Paris Cité, Paris, France
| | - Damien Sène
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université Paris Cité, Paris, France
| | - Yves Allenbach
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Université Paris Cité, Paris, France
| | - Cloé Comarmond
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université Paris Cité, Paris, France.
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8
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Gautier F, Neumann L, Adle-Biassete H, Rubenstein E, Bernat AL, Chimon A, Mouly S, Sène D, Comarmond C. Pachymeningitis associated with IgG4-related disease and ANCA positivity: Case report and review of the literature. Autoimmun Rev 2023; 22:103285. [PMID: 36738953 DOI: 10.1016/j.autrev.2023.103285] [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: 01/09/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Hypertrophic pachymeningitis is a rare clinical disorder involving localized or diffuse thickening of the dura mater. Considering pachymeningitis is both in the clinical spectrum of IgG4-RD and ANCA vasculitis (specifically granulomatosis with polyangiitis), an overlap syndrome is discussed. METHODS We report a case of hypertrophic pachymeningitis revealed by headache and cranial nerve dysfunction, and coexistence of biopsy-proven IgG4-RD pachymeningitis and MPO-ANCA positivity. Furthermore, all cases previously reported in the literature of pachymeningitis with IgG4-RD and presence of ANCA were analyzed. RESULTS Thirteen patients with pachymeningitis, IgG4-RD and ANCA were analyzed. Patients with HP-related IgG4 and ANCA are mainly male (8, 62%). Median age at diagnosis was 64 years. Main clinical manifestations at diagnosis were localized to the head and neck with headaches (10, 77%), cranial nerve dysfunction (7, 54%), hearing impairment (6, 46%) and vertigo (4, 31%). Except 1 patient with diffuse aortitis, no other systemic manifestation was observed at diagnosis and during follow-up. Serum IgG4 was often elevated (11, 85%) and ANCA was mainly with myeloperoxidase specificity (11, 85%). Seven patients had cerebrospinal fluid analyse with lymphocytic pleocytosis in 5 cases (71%), elevated proteins in 4 cases (57%), positive oligoclonal bands in 3 cases (42%) and decreased glucose in one case (14%). On the MRI, the thickening of the dura mater concerned most often the posterior fossa, in 7 cases (54%). Among 10 cases with histological findings, all showed increased IgG4-positivity of plasma cells, 50% lymphocytic infiltrate but none presented the three major histological criteria of IgG4-related disease. Three (30%) showed histological signs of vasculitis with vascular wall damage and/or giant cells. Among the 12 patients treated with steroid therapy, a clinical improvement was noted in 11 cases (92%). Relapse occurred during tapering in 4 patients (33%). An immunosuppressive drug was added in 2nd line for 7 cases (54%), with a clinical improvement in all. CONCLUSION Pachymeningitis with IgG4 and ANCA seems a localized disease to the head and neck. Leptomeningeal biopsy commonly found IgG4 criteria and no vasculitis. All patients responded well to steroid therapy and immunosuppressive drugs, especially rituximab, with clinical and radiological improvement but relapse and/or sequelae are not uncommon.
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Affiliation(s)
- Félicien Gautier
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université Paris Cité, 75010 Paris, France
| | - Lisa Neumann
- Department of Neurology, Lariboisière Hospital, Université Paris Cité, 75010 Paris, France
| | - Homa Adle-Biassete
- Department of Pathology, Lariboisière Hospital, Université Paris Cité, 75010 Paris, France
| | - Emma Rubenstein
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université Paris Cité, 75010 Paris, France
| | - Anne-Laure Bernat
- Department of Neurosurgery, Lariboisière Hospital, Université Paris Cité, 75010 Paris, France
| | - Alice Chimon
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université Paris Cité, 75010 Paris, France
| | - Stéphane Mouly
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université Paris Cité, 75010 Paris, France
| | - Damien Sène
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université Paris Cité, 75010 Paris, France
| | - Cloé Comarmond
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université Paris Cité, 75010 Paris, France.
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9
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Comarmond C, Leclercq M, Leroux G, Marques C, Le Joncour A, Domont F, Hatte C, Toquet-Bouedec S, Guillaume-Jugnot P, Desbois AC, Vautier M, Rigolet A, Allenbach Y, Benveniste O, Saadoun D, Cacoub P. Correspondence on 'Impact of COVID-19 pandemic on patients with large-vessels vasculitis in Italy: a monocentric survey'. Ann Rheum Dis 2023; 82:e30. [PMID: 33184046 DOI: 10.1136/annrheumdis-2020-219407] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 01/26/2023]
Affiliation(s)
- Cloé Comarmond
- Internal Medicine and Clinical Immunology, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Paris, France .,Sorbonne Université, Paris, France
| | - Mathilde Leclercq
- Internal Medicine and Clinical Immunology, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Gaëlle Leroux
- Internal Medicine and Clinical Immunology, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Cindy Marques
- Internal Medicine and Clinical Immunology, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Paris, France.,DHU Inflammation, Immunopathologie, Biothérapie, Paris, France
| | - Alexandre Le Joncour
- Internal Medicine and Clinical Immunology, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Paris, France.,DHU Inflammation, Immunopathologie, Biothérapie, Paris, France
| | - Fanny Domont
- Internal Medicine and Clinical Immunology, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Céline Hatte
- Internal Medicine and Clinical Immunology, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Ségolène Toquet-Bouedec
- Internal Medicine and Clinical Immunology, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Paris, France.,Sorbonne Université, Paris, France
| | - Perrine Guillaume-Jugnot
- Internal Medicine and Clinical Immunology, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Anne-Claire Desbois
- Internal Medicine and Clinical Immunology, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Paris, France.,Sorbonne Université, Paris, France
| | - Mathieu Vautier
- Internal Medicine and Clinical Immunology, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Aude Rigolet
- Internal Medicine and Clinical Immunology, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Yves Allenbach
- Internal Medicine and Clinical Immunology, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Paris, France.,Sorbonne Université, Paris, France.,DHU Inflammation, Immunopathologie, Biothérapie, Paris, France
| | - Olivier Benveniste
- Internal Medicine and Clinical Immunology, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Paris, France.,Sorbonne Université, Paris, France.,DHU Inflammation, Immunopathologie, Biothérapie, Paris, France
| | - David Saadoun
- Internal Medicine and Clinical Immunology, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Paris, France.,Sorbonne Université, Paris, France.,DHU Inflammation, Immunopathologie, Biothérapie, Paris, France
| | - Patrice Cacoub
- Internal Medicine and Clinical Immunology, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Paris, France.,Sorbonne Université, Paris, France.,DHU Inflammation, Immunopathologie, Biothérapie, Paris, France
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10
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Nassarmadji K, Vanjak A, Bourdin V, Champion K, Burlacu R, Mouly S, Sène D, Comarmond C. 18-Fluorodeoxyglucose positron emission tomography/computed tomography for large vessel vasculitis in clinical practice. Front Med (Lausanne) 2023; 10:1103752. [PMID: 36744139 PMCID: PMC9892645 DOI: 10.3389/fmed.2023.1103752] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023] Open
Abstract
Diagnosis, prognostic assessment, and monitoring disease activity in patients with large vessel vasculitis (LVV) can be challenging. Early recognition of LVV and treatment adaptation is essential because vascular complications (aneurysm, dilatations, ischemic complications) or treatment related side effects can occur frequently in these patients. 18-fluorodeoxyglucose positron emission tomography/computed tomography (2-[18F]FDG-PET/CT) is increasingly used to diagnose, follow, and evaluate treatment response in LVV. In this review, we aimed to summarize the current evidence on the value of 2-[18F]FDG-PET/CT for diagnosis, follow, and treatment monitoring in LVV.
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11
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Comarmond C, Drumez E, Labreuche J, Hachulla E, Thomas T, Flipo RM, Seror R, Avouac J, Balandraud N, Desbarbieux R, Felten R, Gilson M, Guyot MH, Hittinger-Roux A, Pham T, Renard M, Roux N, Sobanski V, Tournadre A, Richez C, Cacoub P. COVID-19 presentation and outcomes in patients with inflammatory rheumatic and musculoskeletal diseases receiving IL6-receptor antagonists prior to SARS-CoV-2 infection. J Transl Autoimmun 2023; 6:100190. [PMID: 36684808 PMCID: PMC9839461 DOI: 10.1016/j.jtauto.2023.100190] [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: 01/06/2023] [Accepted: 01/12/2023] [Indexed: 01/15/2023] Open
Abstract
Objective COVID-19 outcome may be less favourable in patients with inflammatory rheumatic and musculoskeletal diseases (RMD) receiving immunosuppressive therapy. We aimed to investigate whether RMD patients on anti-IL6 therapy prior to SARS-CoV-2 infection have less severe disease and better outcomes of COVID-19. Methods We conducted a retrospective national, multicentre cohort study using data from the French RMD COVID-19 cohort. We compared the severity and outcome of highly suspected or confirmed COVID-19 infection in RMD patients previously treated with tocilizumab or sarilumab (anti-IL6 group) with patients who did not receive anti-IL6 therapy (no anti-IL6 group). Results Data were collected for 1883 patients with mean age of 55.2 years [SD 16.7] and 1256 (66.7%) female. Two hundred ten (11.1%) developed severe COVID-19 and 115 (6.4%) died. After adjusting for potential confounding factors, severe COVID-19 was less frequent in the anti-IL6 group compared with the no anti-IL6 group (aOR for moderate vs. mild severity, 0.23 [95% CI, 0.10 to 0.54], p ≤ 0.01 and aOR for severe vs. mild, 0.29 [95% CI, 0.10 to 0.81], p ≤ 0.01). No significant differences were found for the evolution of COVID-19 between the anti-IL6 group and the no anti-IL6 group (aOR for recovery with sequelae vs recovery without sequelae, 0.78 [95% CI, 0.41 to 1.48] and aOR for death vs recovery without sequelae, 0.29 [95% CI, 0.07 to 1.30]). Conclusion RMD patients receiving anti-IL6 therapy prior to SARS-CoV-2 infection have less severe forms of COVID-19. No difference was observed in COVID-19 evolution, i.e., sequelae or death, between the groups.
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Affiliation(s)
- Cloé Comarmond
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université de Paris, 75010, Paris, France,Corresponding author.
| | - Elodie Drumez
- ULR 2694 METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Université de Lille, CHU Lille, Lille, France
| | - Julien Labreuche
- ULR 2694 METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Université de Lille, CHU Lille, Lille, France
| | - Eric Hachulla
- Université de Lille, INSERM, CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Autoimmunes Systémiques Rares Du Nord et Nord-Ouest de France, U1286—INFINITE: Institute for Translational Research in Inflammation, France
| | - Thierry Thomas
- Rheumatology, CHU de Saint-Etienne - Hôpital Nord, France
| | | | - Raphaëlle Seror
- Rheumatology, APHP - Hôpital Bicêtre, Kremlin-Bicêtre, France
| | - Jérôme Avouac
- Rheumatology, APHP - Hôpital Cochin, Université de, Paris, France
| | | | | | - Renaud Felten
- Rheumatology, CHRU de Strasbourg - Hôpital de Hautepierre, France
| | | | | | | | - Thao Pham
- Rheumatology, APHM - Hôpital Sainte-Marguerite, Marseille, France
| | - Myriam Renard
- Rheumatology, CH Métropole-Savoie - Hôpital Reine Hortense, France
| | - Nicolas Roux
- Rheumatology, Hôpitaux Privés de Metz - Hôpital Belle-Isle, France
| | - Vincent Sobanski
- Université de Lille, INSERM, CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Autoimmunes Systémiques Rares Du Nord et Nord-Ouest de France, U1286—INFINITE: Institute for Translational Research in Inflammation, France
| | - Anne Tournadre
- Rheumatology, CHU de Clermont-Ferrand - Hôpital Gabriel Montpied, France
| | | | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière Hospital, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Sorbonne Université, UMR 959, 75013, Paris, France,Corresponding author.
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12
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Gautier F, Neumann L, Rubenstein E, Bernat A, Adle-Biasette H, Nassarmadji K, Bigot W, Mouly S, Sene D, Comarmond C. Une pachyméningite révélatrice d’une maladie associée aux IgG4 et à la présence d’ANCA anti-MPO : à propos d’un cas et revue de la littérature. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.212] [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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13
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Vieira M, Comarmond C, Labreuche J, Mirouse A, Saadoun D, Richez C, Flipo RM, Hachulla E, Drumez E, Cacoub P. COVID-19 outcomes in giant cell arteritis and polymyalgia rheumatica versus rheumatoid arthritis: A national, multicenter, cohort study. J Autoimmun 2022; 132:102868. [PMID: 35926375 PMCID: PMC9296684 DOI: 10.1016/j.jaut.2022.102868] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 11/10/2022]
Abstract
Objectives To determine whether giant cell arteritis and polymyalgia rheumatica (GCA/PMR) represent independent risk factors for worse outcomes in COVID-19. Methods Observational, national, French, multicenter cohort (NCT04353609) comprising patients aged ≥18 years with confirmed diagnoses of either GCA, PMR or rheumatoid arthritis (RA) having presented COVID-19; those under rituximab were excluded. Primary endpoint was COVID-19 severity in GCA/PMR patients as compared to RA. We also aimed to describe the evolution of GCA/PMR patients following COVID-19. Multinomial logistic regression models were performed, with and without adjustment on pre-specified confounding factors (i.e., age, sex, body mass index, arterial hypertension, diabetes and cardiovascular disease). Unadjusted and adjusted multinomial odds-ratio (OR/aOR) and their 95% confidence intervals (CIs) were calculated as effect size using RA as reference group. Results Between April 15, 2020, and August 20, 2021, 674 patients [45 (6.6%) GCA, 47 (7.0%) PMR, 582 (86.4%) RA; 62.8 years, 73.2% female] were included. Compared to RA patients, those with GCA/PMR were older and more frequently presented hypertension, diabetes and cardiovascular disease. Severe COVID-19 and death occurred in 24 (26.1%) and 16 (17.8%) patients with GCA/PMR, respectively. Unadjusted analyses revealed higher odds of severe COVID-19 [OR = 3.32 (95% CI 1.89–5.83; p < 0.001)] and death [OR = 3.20 (95%CI 1.67–6.13; p < 0.001)] for GCA/PMR compared to RA. After model adjustment, these odds were attenuated. Conclusion Patients with GCA/PMR were more likely to have severe COVID-19 and higher mortality compared to those with RA. This worse prognosis is mostly due to well known risk factors for the general population rather than vasculitis per se.
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14
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Comarmond C, Leroux G, Frances C, Barete S, Saadoun D, Cacoub P. [Cutaneous hyperpigmentation, flexion of interphalangeal joints and hallux valgus in a 42 year-old patient]. Rev Med Interne 2022; 43:452-454. [PMID: 35811111 DOI: 10.1016/j.revmed.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 11/28/2022]
Affiliation(s)
- C Comarmond
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université Paris Cité, 75010 Paris, France.
| | - G Leroux
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière Hospital, Sorbonne Université, 75013 Paris, France
| | - C Frances
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière Hospital, Sorbonne Université, 75013 Paris, France
| | - S Barete
- Dermatology, Pitié-Salpêtrière Hospital, Sorbonne Université, 75013 Paris, France
| | - D Saadoun
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière Hospital, Sorbonne Université, 75013 Paris, France
| | - P Cacoub
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière Hospital, Sorbonne Université, 75013 Paris, France
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15
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Ben Hamou D, Bigot W, Comarmond C, Kladoum N, Burlacu R, Vanjak A, Lopes A, Champion K, Mouly S, Sene D. Vascularite cérébrale post-infectieuse corticodépendante traitée par cyclophosphamide : à propos d’un cas. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.224] [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: 10/18/2022]
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16
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Mirouse A, Deltour S, Leclerc D, Pouchelon C, Comarmond C, Kahn J, Benhamou Y, Mirault T, Mekinian A, Lambert M, Cacoub P, Biard L, Saadoun D. Accidents cérébraux ischémiques au cours de la maladie de Takayasu. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.322] [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: 11/25/2022]
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17
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Legendre P, Couture P, Ponsoye M, Marroun I, Ackermann F, Comarmond C. [Weakness and weight loss in a 62 year-old patient]. Rev Med Interne 2022; 43:444-447. [PMID: 35606201 DOI: 10.1016/j.revmed.2022.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 11/17/2022]
Affiliation(s)
- P Legendre
- Service de médecine interne, hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
| | - P Couture
- Service de médecine interne, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - M Ponsoye
- Service de médecine interne, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - I Marroun
- Service de médecine interne, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - F Ackermann
- Service de médecine interne, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - C Comarmond
- Service de médecine interne, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
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18
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Comarmond C, Mégarbane B. Extracorporeal life support as a bridge to lung transplantation strategy in anti-MDA5+ rapidly progressive interstitial lung disease is life-saving but with persistent difficulties at the bedside. Eur Respir J 2022; 60:13993003.00817-2022. [PMID: 35595311 DOI: 10.1183/13993003.00817-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 04/28/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Cloé Comarmond
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université de Paris Cité, Paris, France
| | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Université de Paris Cité, INSERM UMRS-1144, Paris, France
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19
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Mirouse A, Deltour S, Leclercq D, Squara PA, Pouchelon C, Comarmond C, Kahn JE, Benhamou Y, Mirault T, Mekinian A, Lambert M, Chiche L, Koskas F, Cluzel P, Redheuil A, Cacoub P, Biard L, Saadoun D. Cerebrovascular Ischemic Events in Patients With Takayasu Arteritis. Stroke 2022; 53:1550-1557. [PMID: 35354303 DOI: 10.1161/strokeaha.121.034445] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Takayasu arteritis (TA) is a large vessel vasculitis that may complicate with cerebrovascular ischemic events. The objective was to describe clinical and vascular features of TA patients with cerebrovascular ischemic events and to identify risk factors for these events. METHODS We analyzed the prevalence and type of stroke/transient ischemic attack (TIA), factors associated with cerebrovascular ischemic events, and stroke-free survival in a large cohort fulfilling the American College of Rheumatology or Ishikawa criteria of TA. RESULTS Among 320 patients with TA (median age at diagnosis, 36 [25-47] years; 261 [86%] women), 63 (20%) had a stroke (n=41; 65%) or TIA (n=22; 35%). Ischemic event localized in the carotid territory for 55 (87%) patients and the vertebral artery territory in 8 (13%) patients. Multiple stenosis were observed in 33 (52%) patients with a median number of stenosis of 2 (minimum, 0 to maximum, 11), and aneurysms were observed in 10 (16%) patients. A history of stroke or TIA before TA diagnosis (hazard ratio [HR], 4.50 [2.45-8.17]; P<0.0001), smoking (HR, 1.75 [1.01-3.02]; P=0.05), myocardial infarction history (HR, 0.21 [0.05-0.89]; P=0.039), thoracic aorta involvement (HR, 2.05 [1.30-3.75]; P=0.023), time from first symptoms to diagnosis >1 year (HR, 2.22 [1.30-3.80]; P=0.005), and aspirin treatment (HR, 1.82 [1.04-3.19]; P=0.035) were associated with cerebrovascular ischemic event. In multivariate analysis, time from first symptoms to TA diagnosis >1 year (HR, 2.16 [1.27-3.70]; P=0.007) was independently associated with cerebrovascular ischemic events in patients with TA. The HR for cerebrovascular ischemic event in patients who already experienced a stroke/TIA was 5.11 (2.91-8.99; P<0.0001), compared with those who had not. CONCLUSIONS Carotid stroke/TIA is frequent in TA. We identified factors associated with cerebrovascular ischemic events.
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Affiliation(s)
- Adrien Mirouse
- Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, APHP, Paris, France. (A. Mirouse, C.P., P. Cacoub, D.S.).,Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy, Paris, France (A. Mirouse, C.P., P. Cacoub, D.S.).,Sorbonne Université, Paris, France (A. Mirouse, A. Mekinian, F.K., P. Cluzel, A.R., P. Cacoub, D.S.)
| | - Sandrine Deltour
- Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, APHP, Paris, France. (A. Mirouse, C.P., P. Cacoub, D.S.).,Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy, Paris, France (A. Mirouse, C.P., P. Cacoub, D.S.).,Service de Neurologie, Hôpital Raymond Poincaré, APHP, Université Versailles Saint Quentin en Yvelines, Garches, France (S.D.)
| | - Delphine Leclercq
- Service de Neuro-Radiologie, Hôpital Pitié-Salpêtrière, APHP, Paris, France. (D.L.)
| | - Pierre-Alexandre Squara
- AP-HP, Hôpital Saint Louis, Service de Biostatistique et Information Médicale (DMU PRISME), INSERM U1153 Team ECSTRRA, Université de Paris, France (P.-A.S., L.B.)
| | - Clara Pouchelon
- Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, APHP, Paris, France. (A. Mirouse, C.P., P. Cacoub, D.S.).,Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy, Paris, France (A. Mirouse, C.P., P. Cacoub, D.S.)
| | - Cloé Comarmond
- Département de Médecine Interne et Immunologie Clinique, Hôpital Lariboisière APHP, Paris, France. (C.C.)
| | - Jean-Emmanuel Kahn
- Service de Médecine Interne, Hôpital Ambroise Paré, APHP, Boulogne, France (J.-E.K.)
| | - Ygal Benhamou
- Service de Médecine Interne, Vasculaire et Thrombose, CHU de Rouen, France (Y.B.)
| | - Tristan Mirault
- Service de Médecine Interne, Hôpital Européen Georges Pompidou, APHP, Paris, France. (T.M.)
| | - Arsène Mekinian
- Service de Médecine Interne, Hôpital Saint-Antoine, APHP, Paris, France. (A. Mekinian).,Sorbonne Université, Paris, France (A. Mirouse, A. Mekinian, F.K., P. Cluzel, A.R., P. Cacoub, D.S.)
| | - Marc Lambert
- Service de Médecine Interne, CHRU de Lille, France (M.L.)
| | - Laurent Chiche
- Service de Chirurgie Vasculaire, Hôpital Pitié-Salpêtrière, APHP, Paris, France. (L.C., F.K.)
| | - Fabien Koskas
- Service de Chirurgie Vasculaire, Hôpital Pitié-Salpêtrière, APHP, Paris, France. (L.C., F.K.).,Sorbonne Université, Paris, France (A. Mirouse, A. Mekinian, F.K., P. Cluzel, A.R., P. Cacoub, D.S.)
| | - Philippe Cluzel
- Service de Radiologie Interventionnelle, Hôpital Pitié-Salpêtrière, APHP, Paris, France. (P. Cluzel).,Sorbonne Université, Paris, France (A. Mirouse, A. Mekinian, F.K., P. Cluzel, A.R., P. Cacoub, D.S.)
| | - Alban Redheuil
- Service de Radiologie et Imagerie Cardio-Vasculaire, Hôpital Pitié-Salpêtrière, APHP, Paris, France. (A.R.).,Sorbonne Université, Paris, France (A. Mirouse, A. Mekinian, F.K., P. Cluzel, A.R., P. Cacoub, D.S.)
| | - Patrice Cacoub
- Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, APHP, Paris, France. (A. Mirouse, C.P., P. Cacoub, D.S.).,Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy, Paris, France (A. Mirouse, C.P., P. Cacoub, D.S.).,Sorbonne Université, Paris, France (A. Mirouse, A. Mekinian, F.K., P. Cluzel, A.R., P. Cacoub, D.S.)
| | - Lucie Biard
- AP-HP, Hôpital Saint Louis, Service de Biostatistique et Information Médicale (DMU PRISME), INSERM U1153 Team ECSTRRA, Université de Paris, France (P.-A.S., L.B.)
| | - David Saadoun
- Sorbonne Université, Paris, France (A. Mirouse, A. Mekinian, F.K., P. Cluzel, A.R., P. Cacoub, D.S.)
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Cacoub P, Comarmond C, Vieira M, Régnier P, Saadoun D. HCV-related lymphoproliferative disorders in the direct-acting antiviral era: From mixed cryoglobulinaemia to B-cell lymphoma. J Hepatol 2022; 76:174-185. [PMID: 34600000 DOI: 10.1016/j.jhep.2021.09.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/31/2021] [Accepted: 09/14/2021] [Indexed: 02/06/2023]
Abstract
HCV has been shown to induce many B-cell lymphoproliferative disorders. B lymphocytes specialise in producing immunoglobulins and, during chronic HCV infection, they can cause manifestations ranging from polyclonal hypergammaglobulinaemia without clinical repercussions, through mixed cryoglobulinaemic vasculitis to B-cell non-Hodgkin lymphoma. This spectrum is supported by substantial epidemiological, pathophysiological and therapeutic data. Many, although not all, of the pathogenic pathways leading from one extreme to another have been decrypted. Chronic viral antigen stimulation of B lymphocytes has a central role until the final steps before overt malignancy. This has direct implications for treatment strategies, which always include the use of direct-acting antivirals sometimes alongside immunosuppressants. The role of direct-acting antivirals has been well established in patients with cryoglobulinaemia vasculitis. However, their positive impact on B-cell non-Hodgkin lymphoma needs to be confirmed in larger studies with longer follow-up.
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Affiliation(s)
- Patrice Cacoub
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France; Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, F-75013, Paris, France; Institut National de la Santé et de la Recherche Médicale, INSERM, UMR_S 959, F-75013, Paris, France; CNRS, FRE3632, F-75005, Paris, France; Sorbonne Université, UPMC Univ Paris 06, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), F-75005, Paris, France.
| | - Cloé Comarmond
- AP-HP, Lariboisière Hospital, Department of Internal Medicine and Clinical Immunology, Paris, France
| | - Matheus Vieira
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France; Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, F-75013, Paris, France; Institut National de la Santé et de la Recherche Médicale, INSERM, UMR_S 959, F-75013, Paris, France; CNRS, FRE3632, F-75005, Paris, France; Sorbonne Université, UPMC Univ Paris 06, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), F-75005, Paris, France
| | - Paul Régnier
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France; Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, F-75013, Paris, France; Institut National de la Santé et de la Recherche Médicale, INSERM, UMR_S 959, F-75013, Paris, France; CNRS, FRE3632, F-75005, Paris, France; Sorbonne Université, UPMC Univ Paris 06, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), F-75005, Paris, France
| | - David Saadoun
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France; Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, F-75013, Paris, France; Institut National de la Santé et de la Recherche Médicale, INSERM, UMR_S 959, F-75013, Paris, France; CNRS, FRE3632, F-75005, Paris, France; Sorbonne Université, UPMC Univ Paris 06, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), F-75005, Paris, France
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Mariette X, Hermine O, Tharaux PL, Resche-Rigon M, Porcher R, Ravaud P, Bureau S, Dougados M, Tibi A, Azoulay E, Cadranel J, Emmerich J, Fartoukh M, Guidet B, Humbert M, Lacombe K, Mahevas M, Pene F, Pourchet-Martinez V, Schlemmer F, Yazdanpanah Y, Baron G, Perrodeau E, Vanhoye D, Kedzia C, Demerville L, Gysembergh-Houal A, Bourgoin A, Dalibey S, Raked N, Mameri L, Alary S, Hamiria S, Bariz T, Semri H, Hai DM, Benafla M, Belloul M, Vauboin P, Flamand S, Pacheco C, Walter-Petrich A, Stan E, Benarab S, Nyanou C, Montlahuc C, Biard L, Charreteur R, Dupré C, Cardet K, Lehmann B, Baghli K, Madelaine C, D'Ortenzio E, Puéchal O, Semaille C, Savale L, Harrois A, Figueiredo S, Duranteau J, Anguel N, Pavot A, Monnet X, Richard C, Teboul JL, Durand P, Tissieres P, Jevnikar M, Montani D, Bulifon S, Jaïs X, Sitbon O, Pavy S, Noel N, Lambotte O, Escaut L, Jauréguiberry S, Baudry E, Verny C, Noaillon M, Lefèvre E, Zaidan M, Le Tiec CLT, Verstuyft C, Roques AM, Grimaldi L, Molinari D, Leprun G, Fourreau A, Cylly L, Virlouvet M, Meftali R, Fabre S, Licois M, Mamoune A, Boudali Y, Georgin-Lavialle S, Senet P, Pialoux G, Soria A, Parrot A, François H, Rozensztajn N, Blin E, Choinier P, Camuset J, Rech JS, Canellas A, Rolland-Debord C, Lemarié N, Belaube N, Nadal M, Siguier M, Petit-Hoang C, Chas J, Drouet E, Lemoine M, Phibel A, Aunay L, Bertrand E, Ravato S, Vayssettes M, Adda A, Wilpotte C, Thibaut P, Fillon J, Debrix I, Fellahi S, Bastard JP, Lefèvre G, Fallet V, Gottenberg JE, Hansmann Y, Andres E, Bayer S, Becker G, Blanc F, Brin S, Castelain V, Chatelus E, Chatron E, Collange O, Danion F, De Blay F, Demonsant E, Diemunsch P, Diemunsch S, Felten R, Goichot B, Greigert V, Guffroy A, Heger B, Hutt A, Kaeuffer C, Kassegne L, Korganow AS, Le Borgne P, Lefebvre N, Martin T, Mertes PM, Metzger C, Meyer N, Nisand G, Noll E, Oberlin M, Ohlmann-Caillard S, Poindron V, Pottecher J, Ruch Y, Sublon C, Tayebi H, Weill F, Mekinian A, Abisror N, Jachiet V, Chopin D, Fain O, Garnier M, Krause le Garrec J, Morgand M, Pacanowski J, Urbina T, McAvoy C, Pereira M, Aratus G, Berard L, Simon T, Daguenel-Nguyen A, Antignac M, Leplay C, Arlet JB, Diehl JL, Bellenfant F, Blanchard A, Buffet A, Cholley B, Fayol A, Flamarion E, Godier A, Gorget T, Hamada SR, Hauw-Berlemont C, Hulot JS, Lebeaux D, Livrozet M, Michon A, Neuschwander A, Penet MA, Planquette B, Ranque B, Sanchez O, Volle G, Briois S, Cornic M, Elisee V, Jesuthasan D, Djadi-Prat J, Jouany P, Junquera R, Henriques M, Kebir A, Lehir I, Meunier J, Patin F, Paquet V, Tréhan A, Vigna V, Sabatier B, Bergerot D, Jouve C, Knosp C, Lenoir O, Mahtal N, Resmini L, Lescure FX, Ghosn J, BACHELARD A, BIRONNE T, BORIE R, BOUNHIOL A, BOUSSARD C, CHAUFFiER J, CHALAL S, CHALAL L, CHANSOMBAT M, CRESPIN P, CRESTANI B, DACONCEICAO O, DECONINCK L, DIEUDE P, DOSSIER A, DUBERT M, DUCROCQ G, FUENTES A, GERVAIS A, GILBERT M, ISERNIA V, ISMAEL S, JOLY V, JULIA Z, LARIVEN S, LE GAC S, LE PLUART D, LOUNI F, NDIAYE A, PAPO T, PARISEY M, PHUNG B, POURBAIX A, RACHLINE A, RIOUX C, SAUTEREAU A, STEG G, TARHINI H, VALAYER S, VALLOIS D, VERMES P, VOLPE T, Nguyen Y, Honsel V, Weiss E, Codorniu A, Zarrouk V, De Lastours V, Uzzan M, Olivier O, Rossi G, Gamany N, Rahli R, Louis Z, Boutboul D, Galicier L, Amara Y, Archer G, Benattia A, Bergeron A, Bondeelle L, De Castro N, Clément M, Darmont M, Denis B, Dupin C, Feredj E, Feyeux D, Joseph A, Lengliné E, Le Guen P, Liégeon G, Lorillon G, Mabrouki A, Mariotte E, Martin de Frémont G, Mirouse A, Molina JM, Peffault de Latour R, Oksenhendler E, Saussereau J, Tazi A, Tudesq JJ, Zafrani L, Brindele I, Bugnet E, Celli Lebras K, Chabert J, Djaghout L, Fauvaux C, Jegu AL, Kozaliewicz E, Meunier M, Tremorin MT, Davoine C, Madeleine I, Caillat-Zucman S, Delaugerre C, Morin F, SENE D, BURLACU R, CHOUSTERMAN B, MEGARBANE B, RICHETTE P, RIVELINE JP, FRAZIER A, VICAUT E, BERTON L, HADJAM T, VASQUEZ-IBARRA MA, JOURDAINE C, JACOB A, SMATI J, RENAUD S, MANIVET P, PERNIN C, SUAREZ L, Semerano L, ABAD S, Benainous R, Bloch Queyrat C, Bonnet N, Brahmi S, Cailhol J, Cohen Y, Comparon C, Cordel H, Dhote R, Dournon N, Duchemann B, Ebstein N, Giroux-Leprieur B, Goupil de Bouille J, Jacolot A, Nunes H, Oziel J, Rathouin V, Rigal M, Roulot D, Tantet C, Uzunhan Y, COSTEDOAT-CHALUMEAU N, Ait Hamou Z, Benghanem S, BLANCHE P, CANOUI E, CARLIER N, CHAIGNE B, CONTEJEAN A, DUNOGUE B, DUPLAND P, DUREL - MAURISSE A, GAUZIT R, JAUBERT P, Joumaa H, Jozwiak M, KERNEIS S, LACHATRE M, Lafoeste H, LEGENDRE P, LUONG NGUYEN LB, MAREY J, MORBIEU C, MOUTHON L, NGUYEN L, Palmieri LJ, REGENT A, SZWEBEL TA, TERRIER B, GUERIN C, ZERBIT J, CHEREF K, CHITOUR K, CISSE MS, CLARKE A, CLAVERE G, DUSANTER I, GAUDEFROY C, JALLOULI M, KOLTA S, LE BOURLOUT C, MARIN N, MENAGE N, MOORES A, PEIGNEY I, PIERRON C, SALEH-MGHIR S, VALLET M, MICHEL M, MELICA G, LELIEVRE JD, FOIS E, LIM P, MATIGNON M, GUILLAUD C, THIEMELE A, SCHMITZ D, BOUHRIS M, BELAZOUZ S, LANGUILLE L, MEKONTSO-DESSAPS A, SADAOUI T, Mayaux J, Cacoub P, Corvol JC, Louapre C, Sambin S, Mariani LL, Karachi C, Tubach F, Estellat C, Gimeno L, Martin K, Bah A, Keo V, Ouamri S, Messaoudi Y, Yelles N, Faye P, Cavelot S, Larcheveque C, Annonay L, Benhida J, Zahrate-Ghoul A, Hammal S, Belilita R, Lecronier M, Beurton A, Haudebourg L, Deleris R, Le Marec J, Virolle S, Nemlaghi S, Bureau C, Mora P, De Sarcus M, Clovet O, Duceau B, Grisot PH, Pari MH, Arzoine J, Clarac U, Faure M, Delemazure J, Decavele M, Morawiec E, Demoule A, Dres M, Vautier M, Allenbach Y, Benveniste O, Leroux G, Rigolet A, Guillaume-Jugnot P, Domont F, Desbois AC, Comarmond C, Champtiaux N, Toquet S, Ghembaza A, Vieira M, Maalouf G, Boleto G, Ferfar Y, Charbonnier F, AGUILAR C, ALBY-LAURENT F, ALYANAKIAN MA, BAKOUBOULA P, BROISSAND C, BURGER C, CAMPOS-VEGA C, CHAVAROT N, CHOUPEAUX L, FOURNIER B, GRANVILLE S, ISSORAT E, ROUZAUD C, VIMPERE D, Geri G, Derridj N, Sguiouar N, Meddah H, Djadel M, Chambrin-Lauvray H, Duclos-Vallée JC, Saliba F, Sacleux SC, Koumis I, Michot JM, Stoclin A, Colomba E, Pommeret F, Willekens C, Sakkal M, Da Silva R, Dejean V, Mekid Y, Ben-Mabrouk I, Pradon C, Drouard L, Camara-Clayette V, Morel A, Garcia G, Mohebbi A, Berbour F, Dehais M, Pouliquen AL, Klasen A, Soyez-Herkert L, London J, Keroumi Y, Guillot E, Grailles G, El Amine Y, Defrancq F, Fodil H, Bouras C, Dautel D, Gambier N, Dieye T, Razurel A, Bienvenu B, Lancon V, Lecomte L, Beziriganyan K, Asselate B, Allanic L, Kiouris E, Legros MH, Lemagner C, Martel P, Provitolo V, Ackermann F, Le Marchand M, Clan Hew Wai A, Fremont D, Coupez E, Adda M, Duée F, Bernard L, Gros A, Henry E, Courtin C, Pattyn A, Guinot PG, Bardou M, Maurer A, Jambon J, Cransac A, Pernot C, Mourvillier B, Servettaz A, Deslée G, Wynckel A, Benoit P, Marquis E, Roux D, Gernez C, Yelnik C, Poissy J, Nizard M, Denies F, Gros H, Mourad JJ, Sacco E, Renet S. Sarilumab in adults hospitalised with moderate-to-severe COVID-19 pneumonia (CORIMUNO-SARI-1): An open-label randomised controlled trial. The Lancet Rheumatology 2022; 4:e24-e32. [PMID: 34812424 PMCID: PMC8598187 DOI: 10.1016/s2665-9913(21)00315-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Patients with COVID-19 pneumonia can have increased inflammation and elevated cytokines, including interleukin (IL)-6, which might be deleterious. Thus, sarilumab, a high-affinity anti-IL-6 receptor antibody, might improve the outcome of patients with moderate-to-severe COVID-19 pneumonia. Methods We did a multicentric, open-label, Bayesian randomised, adaptive, phase 2/3 clinical trial, nested within the CORIMUNO-19 cohort, to test a superiority hypothesis. Patients 18 years or older hospitalised with COVID-19 in six French centres, requiring at least 3L/min of oxygen but without ventilation assistance and a WHO Clinical Progression Scale [CPS] score of 5 were enrolled. Patients were randomly assigned (1:1) via a web-based system, according to a randomisation list stratified on centre and with blocks randomly selected among 2 and 4, to receive usual care plus 400 mg of sarilumab intravenously on day 1 and on day 3 if clinically indicated (sarilumab group) or usual care alone (usual care group). Primary outcomes were the proportion of patients with WHO-CPS scores greater than 5 on the 10-point scale on day 4 and survival without invasive or non-invasive ventilation at day 14. This completed trial is closed to new participants and is registered with ClinicalTrials.gov, NCT04324073. Findings 165 patients were recruited from March 27 to April 6, 2020, and 148 patients were randomised (68 patients to the sarilumab group and 80 to the usual care group) and followed up for 90 days. Median age was 61·7 years [IQR 53·0–71·1] in the sarilumab group and 62·8 years [56·0–71·7] in the usual care group. In the sarilumab group 49 (72%) of 68 were men and in the usual care group 59 (78%) of 76 were men. Four patients in the usual care group withdrew consent and were not analysed. 18 (26%) of 68 patients in the sarilumab group had a WHO-CPS score greater than 5 at day 4 versus 20 (26%) of 76 in the usual care group (median posterior absolute risk difference 0·2%; 90% credible interval [CrI] −11·7 to 12·2), with a posterior probability of absolute risk difference greater than 0 of 48·9%. At day 14, 25 (37%) patients in the sarilumab and 26 (34%) patients in the usual care group needed ventilation or died, (median posterior hazard ratio [HR] 1·10; 90% CrI 0·69–1·74) with a posterior probability HR greater than 1 of 37·4%. Serious adverse events occurred in 27 (40%) patients in the sarilumab group and 28 (37%) patients in the usual care group (p=0·73). Interpretation Sarilumab treatment did not improve early outcomes in patients with moderate-to-severe COVID-19 pneumonia. Further studies are warranted to evaluate the effect of sarilumab on long-term survival. Funding Assistance publique—Hôpitaux de Paris
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Le Joncour A, Desbois AC, Leroyer AS, Tellier E, Régnier P, Maciejewski-Duval A, Comarmond C, Barete S, Arock M, Bruneval P, Launay JM, Fouret P, Blank U, Rosenzwajg M, Klatzmann D, Jarraya M, Chiche L, Koskas F, Cacoub P, Kaplanski G, Saadoun D. Mast cells drive pathologic vascular lesions in Takayasu arteritis. J Allergy Clin Immunol 2022; 149:292-301.e3. [PMID: 33992671 DOI: 10.1016/j.jaci.2021.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 12/04/2020] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Takayasu arteritis (TAK) is a large vessel vasculitis resulting in artery wall remodeling with segmental stenosis and/or aneurysm formation. Mast cells (MCs) are instrumental in bridging cell injury and inflammatory response. OBJECTIVES This study sought to investigate the contribution of MCs on vessel permeability, angiogenesis, and fibrosis in patients with TAK. METHODS MC activation and their tissue expression were assessed in sera and in aorta from patients with TAK and from healthy donors (HDs). In vivo permeability was assessed using a modified Miles assay. Subconfluent cultured human umbilic vein endothelial cells and fibroblasts were used in vitro to investigate the effects of MC mediators on angiogenesis and fibrogenesis. RESULTS This study found increased levels of MC activation markers (histamine and indoleamine 2,3-dioxygenase) in sera of patients with TAK compared with in sera of HDs. Marked expression of MCs was shown in aortic lesions of patients with TAK compared with in those of noninflammatory aorta controls. Using Miles assay, this study showed that sera of patients with TAK significantly increased vascular permeability in vivo as compared with that of HDs. Vessel permeability was abrogated in MC-deficient mice. MCs stimulated by sera of patients with TAK supported neoangiogenesis (increased human umbilic vein endothelial cell proliferation and branches) and fibrosis by inducing increased production of fibronectin, type 1 collagen, and α-smooth muscle actin by fibroblasts as compared to MCs stimulated by sera of HD. CONCLUSIONS MCs are a key regulator of vascular lesions in patients with TAK and may represent a new therapeutic target in large vessel vasculitis.
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Affiliation(s)
- Alexandre Le Joncour
- Department of Immunology-Immunopathology-Immunotherapy, Université Pierre-et-Marie-Curie Université de Paris 06, Unite Mixte de Recherche (UMR)S959, Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Universités, Paris, France; Department of Biotherapy, Hôpital Pitié-Salpêtrière, Paris, France; Department of Internal Medicine and Clinical Immunology, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, Paris, France
| | - Anne-Claire Desbois
- Department of Immunology-Immunopathology-Immunotherapy, Université Pierre-et-Marie-Curie Université de Paris 06, Unite Mixte de Recherche (UMR)S959, Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Universités, Paris, France; Department of Biotherapy, Hôpital Pitié-Salpêtrière, Paris, France; Department of Internal Medicine and Clinical Immunology, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, Paris, France
| | - Aurélie S Leroyer
- Centre de Recherche en CardioVasculaire et Nutrition, INSERM U1263, Inrae 1260, Aix-Marseille Université, Marseille, France
| | - Edwige Tellier
- Centre de Recherche en CardioVasculaire et Nutrition, INSERM U1263, Inrae 1260, Aix-Marseille Université, Marseille, France
| | - Paul Régnier
- Department of Immunology-Immunopathology-Immunotherapy, Université Pierre-et-Marie-Curie Université de Paris 06, Unite Mixte de Recherche (UMR)S959, Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Universités, Paris, France; Department of Biotherapy, Hôpital Pitié-Salpêtrière, Paris, France
| | - Anna Maciejewski-Duval
- Department of Immunology-Immunopathology-Immunotherapy, Université Pierre-et-Marie-Curie Université de Paris 06, Unite Mixte de Recherche (UMR)S959, Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Universités, Paris, France; Department of Biotherapy, Hôpital Pitié-Salpêtrière, Paris, France
| | - Cloé Comarmond
- Department of Immunology-Immunopathology-Immunotherapy, Université Pierre-et-Marie-Curie Université de Paris 06, Unite Mixte de Recherche (UMR)S959, Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Universités, Paris, France; Department of Biotherapy, Hôpital Pitié-Salpêtrière, Paris, France; Department of Internal Medicine and Clinical Immunology, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, Paris, France
| | - Stéphane Barete
- Department of Internal Medicine and Clinical Immunology, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, Paris, France; Department of Dermatology DMU3ID, Unité Fonctionnelle de Dermatologie, Groupe Hospitalier Pitié-Salpêtrière-C. Foix, Paris, France
| | - Michel Arock
- Cell Death and Drug Resistance in Lymphoproliferative Disorders Team, INSERM UMRS1138, Centre de Recherche des Cordeliers, Paris, France; Laboratoire d'Hématologie Biologique, Hôpital Pitié-Salpêtrière, Paris, France
| | - Patrick Bruneval
- Laboratoire d'anatomopathologie, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Pierre Fouret
- Laboratoire d'Anatomopathologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Ulrich Blank
- Center of Research on Inflammation, INSERM UMR S1149 and Centre National de la Recherche Scientifique Experimental Research Laboratory 8252, Universite de Paris, Sorbonne Paris Cite, Laboratoire d'Excellence INFLAMEX, Paris, France
| | - Michelle Rosenzwajg
- Department of Immunology-Immunopathology-Immunotherapy, Université Pierre-et-Marie-Curie Université de Paris 06, Unite Mixte de Recherche (UMR)S959, Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Universités, Paris, France; Department of Biotherapy, Hôpital Pitié-Salpêtrière, Paris, France; Department of Internal Medicine and Clinical Immunology, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, Paris, France
| | - David Klatzmann
- Department of Immunology-Immunopathology-Immunotherapy, Université Pierre-et-Marie-Curie Université de Paris 06, Unite Mixte de Recherche (UMR)S959, Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Universités, Paris, France; Department of Biotherapy, Hôpital Pitié-Salpêtrière, Paris, France; Department of Internal Medicine and Clinical Immunology, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, Paris, France
| | - Mohamed Jarraya
- Banque des Tissus Humains, Hôpital Saint Louis, Paris, France
| | - Laurent Chiche
- Service de Chirurgie Vasculaire, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fabien Koskas
- Service de Chirurgie Vasculaire, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Patrice Cacoub
- Department of Immunology-Immunopathology-Immunotherapy, Université Pierre-et-Marie-Curie Université de Paris 06, Unite Mixte de Recherche (UMR)S959, Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Universités, Paris, France; Department of Biotherapy, Hôpital Pitié-Salpêtrière, Paris, France; Department of Internal Medicine and Clinical Immunology, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, Paris, France
| | - Gilles Kaplanski
- Centre de Recherche en CardioVasculaire et Nutrition, INSERM U1263, Inrae 1260, Aix-Marseille Université, Marseille, France; Service de Médecine Interne, Centre Hospitalier Universitaire Conception, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - David Saadoun
- Department of Immunology-Immunopathology-Immunotherapy, Université Pierre-et-Marie-Curie Université de Paris 06, Unite Mixte de Recherche (UMR)S959, Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Universités, Paris, France; Department of Biotherapy, Hôpital Pitié-Salpêtrière, Paris, France; Department of Internal Medicine and Clinical Immunology, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, Paris, France.
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Comarmond C, Bensalha S, Lopes A, Dor F, Brocheriou I, Mouly S, Sène D. Comment on: Significance of PR3-ANCA positivity in eosinophilic granulomatosis with polyangiitis (Churg-Strauss). Rheumatology (Oxford) 2021; 60:e297-e299. [PMID: 33682889 DOI: 10.1093/rheumatology/keab213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 02/20/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Comarmond
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université de Paris, Paris, France
| | - S Bensalha
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université de Paris, Paris, France
| | - A Lopes
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université de Paris, Paris, France
| | - F Dor
- Department of Pathology, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - I Brocheriou
- Department of Pathology, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - S Mouly
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université de Paris, Paris, France.,INSERM UMR S1144, Université de Paris, Paris, France
| | - D Sène
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université de Paris, Paris, France.,INSERM UMR-S976, Université de Paris, Paris, France
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Ferfar Y, Morinet S, Espitia O, Agard C, Vautier M, Comarmond C, Desbois AC, Domont F, Resche-Rigon M, Cacoub P, Biard L, Saadoun D. Spectrum and Outcome of Noninfectious Aortitis. J Rheumatol 2021; 48:1583-1588. [PMID: 34210830 DOI: 10.3899/jrheum.201274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the spectrum and long-term outcome of patients with noninfectious aortitis. METHODS We performed a retrospective multicenter study of 353 patients (median age at diagnosis was 62 [IQR 46-71] yrs and 242 [68.6%] patients were women) with noninfectious aortitis. Factors associated with vascular complications were assessed in multivariate analysis. RESULTS We included 136 patients with giant cell arteritis (GCA), 96 with Takayasu arteritis (TA), 73 with clinically isolated aortitis (CIA), and 48 with aortitis secondary to inflammatory diseases (including Behçet disease, relapsing polychondritis, IgG4-related disease, Cogan syndrome, ankylosing spondylitis). After a median follow-up of 52 months, vascular complications were observed in 32.3%, revascularizations in 30% of patients, and death in 7.6%. The 5-year cumulative incidence of vascular complications was 58% (95% CI 41-71), 20% (95% CI 13-29), and 19% (95% CI 11-28) in CIA, GCA, and TA, respectively. In multivariate analysis, male sex (HR 2.10, 95% CI 1.45-3.05, P < 0.0001) and CIA (HR 1.76, 95% CI 1.11-2.81, P = 0.02) were independently associated with vascular complications. CONCLUSION Noninfectious aortitis accounts for significant morbidity and mortality. CIA seems to carry the highest rate of vascular complications.
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Affiliation(s)
- Yasmina Ferfar
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Sarah Morinet
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Olivier Espitia
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Christian Agard
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Mathieu Vautier
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Cloé Comarmond
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Anne Claire Desbois
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Fanny Domont
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Matthieu Resche-Rigon
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Patrice Cacoub
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Lucie Biard
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
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Richier Q, Jachiet V, Bonnemains V, Plaçais L, Abisror N, Garnier M, Pacanowski J, Dhote R, Hinchschberger O, Michel M, Bienvenu B, Comarmond C, Lacombe K, Mekinian A. Tocilizumab and COVID-19: timing of administration assessment. Infect Dis Now 2021; 52:31-34. [PMID: 34198000 PMCID: PMC8239201 DOI: 10.1016/j.idnow.2021.06.304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/05/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022]
Abstract
Recent evidence showed greater efficacy of tocilizumab (TCZ) in the subgroups of COVID-19 patients who presented with symptoms for less than 7 days and in those only receiving oxygen. We retrospectively analyzed a compassionate use cohort to determine the best timing for TCZ injection. We showed no association between the timing of injection after symptom onset and the efficacy of TCZ on mortality. We then investigated whether the oxygen level at the time of TCZ injection impacted the mortality rate. Our study finally suggested that TCZ could be less effective when oxygen requirement is > 11 L/min and we hypothesized that earlier administration could be associated with better outcome. However, randomized clinical trials are required to confirm this hypothesis.
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Affiliation(s)
- Q Richier
- Sorbonne Université, Inserm IPLESP, Service de maladies infectieuses, hôpital Saint-Antoine, AP-HP, F-75012 Paris, France.
| | - V Jachiet
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), F-75012, Paris, France
| | - V Bonnemains
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), F-75012, Paris, France
| | - L Plaçais
- Service de médecine interne et immunologie clinique, hôpital Bicêtre, AP-HP, Paris, France
| | - N Abisror
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), F-75012, Paris, France
| | - M Garnier
- Service d'Anesthésie-réanimation et médecine péri-opératoire, hôpital Saint Antoine, AP-HP, Sorbonne Université, GRC 29, Paris, France
| | - J Pacanowski
- Sorbonne Université, Inserm IPLESP, Service de maladies infectieuses, hôpital Saint-Antoine, AP-HP, F-75012 Paris, France
| | - R Dhote
- Service de médecine interne, hôpital Avicenne, AP-HP, Paris, France
| | - O Hinchschberger
- Service de médecine interne, hôpital Emile Muller, Mulhouse, France
| | - M Michel
- Service de médecine interne, hôpital Henri Mondor, AP-HP, Paris, France
| | - B Bienvenu
- Service de Médecine Interne, hôpital Saint-Joseph, Marseille, France
| | - C Comarmond
- Service de médecine interne et immunologie clinique, hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - K Lacombe
- Sorbonne Université, Inserm IPLESP, Service de maladies infectieuses, hôpital Saint-Antoine, AP-HP, F-75012 Paris, France
| | - A Mekinian
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), F-75012, Paris, France
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Rubenstein E, Kante A, Ouakrat R, Amador-Borrero B, Lazureanu P, Kladoum N, Champion K, Lopes A, Comarmond C, Mouly S, Sene D. Intérêt du dosage du récepteur soluble de l’IL2 comme marqueur d’activité de la sarcoïdose. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.250] [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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Rubenstein E, Amador-Borrero B, Lazureanu P, Kladoum N, Lopes A, Champion K, Comarmond C, Mouly S, Sene D. Hypothermie paroxystique dans une forme pseudotumorale de neuro-Behçet. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.139] [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: 11/28/2022]
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Desbois AC, Régnier P, Quiniou V, Lejoncour A, Maciejewski-Duval A, Comarmond C, Vallet H, Rosenzwag M, Darrasse-Jèze G, Derian N, Pouchot J, Samson M, Bienvenu B, Fouret P, Koskas F, Garrido M, Sène D, Bruneval P, Cacoub P, Klatzmann D, Saadoun D. Specific Follicular Helper T Cell Signature in Takayasu Arteritis. Arthritis Rheumatol 2021; 73:1233-1243. [PMID: 33538119 DOI: 10.1002/art.41672] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/09/2020] [Accepted: 01/28/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Our aim was to compare transcriptome and phenotype profiles of CD4+ T cells and CD19+ B cells in patients with Takayasu arteritis (TAK), patients with giant cell arteritis (GCA), and healthy donors. METHODS Gene expression analyses, flow cytometry immunophenotyping, T cell receptor (TCR) gene sequencing, and functional assessments of cells from peripheral blood and arterial lesions from TAK patients, GCA patients, and healthy donors were performed. RESULTS Among the most significantly dysregulated genes in CD4+ T cells of TAK patients compared to GCA patients (n = 720 genes) and in CD4+ T cells of TAK patients compared to healthy donors (n = 1,447 genes), we identified a follicular helper T (Tfh) cell signature, which included CXCR5, CCR6, and CCL20 genes, that was transcriptionally up-regulated in TAK patients. Phenotypically, there was an increase in CD4+CXCR5+CCR6+CXCR3- Tfh17 cells in TAK patients that was associated with a significant enrichment of CD19+ B cell activation. Functionally, Tfh cells helped B cells to proliferate, differentiate into memory cells, and secrete IgG antibodies. Maturation of B cells was inhibited by JAK inhibitors. Locally, in areas of arterial inflammation, we found a higher proportion of tertiary lymphoid structures comprised CD4+, CXCR5+, programmed death 1+, and CD20+ cells in TAK patients compared to GCA patients. CD4+CXCR5+ T cells in the aortas of TAK patients had an oligoclonal α/β TCR repertoire. CONCLUSION We established the presence of a specific Tfh cell signature in both circulating and aorta-infiltrating CD4+ T cells from TAK patients. The cooperation of Tfh cells and B cells might be critical in the occurrence of vascular inflammation in patients with TAK.
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Affiliation(s)
- A C Desbois
- Sorbonne Université, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, INSERM UMR 959, Groupe Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - P Régnier
- Sorbonne Université, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, INSERM UMR 959, Groupe Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - V Quiniou
- Sorbonne Université, INSERM UMR 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - A Lejoncour
- Sorbonne Université, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, INSERM UMR 959, Groupe Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - A Maciejewski-Duval
- Sorbonne Université, INSERM UMR 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - C Comarmond
- Sorbonne Université, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, INSERM UMR 959, Groupe Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - H Vallet
- Sorbonne Université, INSERM UMR 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - M Rosenzwag
- Sorbonne Université, INSERM UMR 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - G Darrasse-Jèze
- Sorbonne Université, INSERM UMR 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - N Derian
- Sorbonne Université, INSERM UMR 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - J Pouchot
- Hôpital Européen Georges-Pompidou, AP-HP, Université Paris Descartes, Paris, France
| | - M Samson
- Centre Hospitalier Universitaire Dijon Bourgogne, Université Bourgogne-Franche Comté, INSERM EFS Bourgogne-Franche Comté UMR1098, Dijon, France
| | - B Bienvenu
- Centre Hospitalier Universitaire Caen, Caen, France
| | - P Fouret
- Groupe Hospitalier Pitié-Salpétrière, Paris, France
| | - F Koskas
- Groupe Hospitalier Pitié-Salpétrière, Paris, France
| | - M Garrido
- Sorbonne Université, INSERM UMR 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - D Sène
- Hôpital Lariboisière, Paris, France
| | - P Bruneval
- Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - P Cacoub
- Sorbonne Université, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, INSERM UMR 959, Groupe Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - D Klatzmann
- Sorbonne Université, INSERM UMR 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - D Saadoun
- Sorbonne Université, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, INSERM UMR 959, Groupe Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
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Vieira M, Buffier S, Vautier M, Le Joncour A, Jamilloux Y, Gerfaud-Valentin M, Bouillet L, Lazaro E, Barete S, Misery L, Gobert D, Goulenok T, Fain O, Sacre K, Sève P, Cacoub P, Comarmond C, Saadoun D. Apremilast in Refractory Behçet's Syndrome: A Multicenter Observational Study. Front Immunol 2021; 11:626792. [PMID: 33613571 PMCID: PMC7889954 DOI: 10.3389/fimmu.2020.626792] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/16/2020] [Indexed: 12/17/2022] Open
Abstract
Objective Mucocutaneous and joint disorders are the most common manifestations in Behçet's syndrome (BS) and are frequently clustered in the so-called minor forms of BS. There remains a need for safe and effective treatment for joint lesions in BS. We report the long-term safety and effectiveness of apremilast in refractory joint and mucocutaneous manifestations of BS. Methods French nationwide multicenter study including 50 BS patients with either active joint and/or mucocutaneous manifestations resistant to colchicine and/or DMARDs. Patients received apremilast 30 mg twice a day. Primary effectiveness endpoint was the proportion of patients with complete response (CR) of articular symptoms at month 6 (M6), defined as resolution of inflammatory arthralgia and arthritis, with joint count equal to zero. Results At inclusion, the median tender and swollen joint count was of 4 [2-6] and 2 [1-2], respectively. The proportion of CR in joint disease at M6 was 65% (n = 15/23), and 17% (n = 4/23) were partial responders. CR of oral and genital ulcers, and pseudofolliculitis at M6 was 73% (n = 24/33), 94% (n = 16/17) and 71% (n = 10/14), respectively. The overall response at M6 was 74% for the entire cohort and 70% for the mucocutaneous-articular cluster (n = 27). The median Behçet's syndrome activity score significantly decreased during study period [50 (40-60) vs. 20 (0-40); p <0.0001]. After a median follow-up of 11 [6-13] months, 27 (54%) patients were still on apremilast. Reasons for apremilast withdrawal included adverse events (n = 15, 30%) and treatment failure (n = 8, 16%). Thirty-three (66%) patients experienced adverse events, mostly diarrhea (n = 19, 38%), nausea (n = 17, 34%) and headache (n = 16, 32%). Conclusion Apremilast seems effective in BS-related articular disease refractory to colchicine and DMARDs. Discontinuation rates were significantly higher than that reported in clinical trials.
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Affiliation(s)
- Matheus Vieira
- Sorbonne Universités AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, Paris, France.,Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Solène Buffier
- Sorbonne Universités AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, Paris, France.,Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Mathieu Vautier
- Sorbonne Universités AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, Paris, France.,Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Alexandre Le Joncour
- Sorbonne Universités AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, Paris, France.,Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Yvan Jamilloux
- Department of Internal Medicine, Hopital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Mathieu Gerfaud-Valentin
- Department of Internal Medicine, Hopital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Laurence Bouillet
- Service de Médecine Interne, CHUGA, Unité Inserm 1036, Université Grenoble Alpes (UGA), Grenoble, France.,Department of Internal Medicine, Centre de référence national des angioedèmes (CREAK), Grenoble, France
| | - Estibaliz Lazaro
- Department of Internal Medicine, Haut-Lévêque Hospital, Pessac, France
| | - Stéphane Barete
- Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DHU i2B), Sorbonne Universités, UPMC Université Paris 06, UMR 7211, Paris, France.,INSERM, UMR_S 959, Paris, France.,UF de Dermatologie, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France
| | - Laurent Misery
- Department of Dermatology, Brest University Hospital, Brest, France Univ Brest, Brest, France
| | - Delphine Gobert
- Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Faculté de Médecine Sorbonne Université, Hôpital Saint Antoine, Sorbonne Universités AP-HP, Paris, France
| | - Tiphaine Goulenok
- Département de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris (APHP), Institut national de la santé et de la recherche médicale (INSERM) U1149, Université de Paris, Paris, France
| | - Olivier Fain
- Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Faculté de Médecine Sorbonne Université, Hôpital Saint Antoine, Sorbonne Universités AP-HP, Paris, France
| | - Karim Sacre
- Département de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris (APHP), Institut national de la santé et de la recherche médicale (INSERM) U1149, Université de Paris, Paris, France
| | - Pascal Sève
- Department of Internal Medicine, Hopital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Patrice Cacoub
- Sorbonne Universités AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, Paris, France.,Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Cloé Comarmond
- Sorbonne Universités AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, Paris, France.,Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - David Saadoun
- Sorbonne Universités AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, Paris, France.,Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
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Le Joncour A, Desbois A, Regner P, Maciejewski-Duval A, Comarmond C, Barète S, Arock M, Fouret P, Rosenzwajg M, Bruneval P, Launay J, Koskas F, Klatzmann D, Cacoub P, Kaplanski G, Saadoun D. Rôle des mastocytes dans le remodelage vasculaire de la maladie de Takayasu. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.102] [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: 10/22/2022]
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Mekinian A, Cacoub P, Fain O, Saadoun D, Mekinian A, Lorenzo D, Resche-Rigon M, Galli E, Novikov P, Espita O, Sciscia S, Comarmond C, Michaud M, Lambert M, Hernandez Rodriguez J, Scheinlitz Masataka N. Efficacité et tolérance de TNFa et tocilizumab dans la maladie de TAKAYASU : étude multicentrique européenne de 203 patients. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.044] [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: 11/27/2022]
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Vieira M, Buffier S, Vautier M, Barète S, Misery L, Goulenok T, Sacré K, Fain O, Gobert D, Bouillet L, Lazaro E, Gerfaud-Valentin M, Jamilloux Y, Sève P, Cacoub P, Comarmond C, Saadoun D. Traitement par apremilast dans la maladie de Behçet: étude observationnelle multicentrique. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.117] [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: 10/22/2022]
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Le Joncour A, Regner P, Comarmond C, Maciejewski-Duval A, Fouret P, Belot A, Vallet H, Rosenzwajg M, Klatzmann D, Cacoub P, Saadoun D. Voie de signalisation NF-kB dans la maladie de Behçet: une nouvelle cible thérapeutique? Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.097] [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: 10/22/2022]
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Comarmond C, Cacoub P, Saadoun D. Treatment of chronic hepatitis C-associated cryoglobulinemia vasculitis at the era of direct-acting antivirals. Therap Adv Gastroenterol 2020; 13:1756284820942617. [PMID: 32782479 PMCID: PMC7383649 DOI: 10.1177/1756284820942617] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/12/2020] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) infection is responsible for both hepatic and extrahepatic manifestations. Before the era of direct-acting antivirals (DAA), cryoglobulinemia was related to HCV infection in 70-90% of cases. Observed in 30% to 40% of patients with hepatitis C, mixed cryoglobulinemia is mainly asymptomatic. Conversely, symptomatic cryoglobulinemia vasculitis (CV) can occur in 5-10% of patients with HCV-associated cryoglobulinemia. CV is a small-vessel systemic vasculitis, and organ damage results from circulation and precipitation of cryoglobulins and complement activation. A wide range of clinical symptoms can be observed during CV, and manifestations are potentially life-threatening. The most frequent manifestations occurring in CV are cutaneous, with recurrent purpura, articular with joint pains, neurologic with peripheric neuropathy, and renal with membranoproliferative glomerulonephritis. DAA have drastically changed chronic HCV therapy. DAA induce sustained virological response (SVR) rates greater than 95%, and also improve extrahepatic manifestations such as CV. We review recent studies investigating the clinical and immune effects of DAA therapy on HCV-CV.
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Affiliation(s)
- Cloé Comarmond
- Sorbonne Université, Département de Médecine Interne et Immunologie Clinique, Paris, France, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Centre National de Référence Maladies Auto-Immunes Systémiques Rares, Centre National de Référence Maladies Auto-Inflammatoires et Amylose Inflammatoire INSERM, UMR_S 959, Paris, France; CNRS, FRE3632, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière
| | - Patrice Cacoub
- Sorbonne Université, Département de Médecine Interne et Immunologie Clinique, Paris, France, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Centre National de Référence Maladies Auto-Immunes Systémiques Rares, Centre National de Référence Maladies Auto-Inflammatoires et Amylose Inflammatoire INSERM, UMR_S 959, Paris, France; CNRS, FRE3632, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière
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Vautier M, Dupont A, De Boysson H, Comarmond C, Mirault T, Mekinian A, Lambert M, Ferfar Y, Aouba A, Cacoub P, Resche-Rigon M, Saadoun D. SAT0244 PROGNOSIS OF LARGE VESSEL INVOLVEMENT IN LARGE VESSEL VASCULITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5252] [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: 11/03/2022]
Abstract
Background:Giant cell arteritis (GCA) and Takayasu arteritis (TAK) are the two main forms of large vessels vasculitis (LVV). Vessel inflammation leads to aneurysms, wall thickening, stenosis, and, in some cases, complete occlusion of the artery. Due to the wide variation in the course of LVV, predicting outcome is challenging. To our knowledge, data regarding prognosis factors of LVI in LVV patients and comparison of outcome of LVI in GCA and TAK are lacking. An early identification of patients with higher mortality could help to prevent deaths and vascular complications.Objectives:To assess prognosis factors and outcome of large vessel involvement (LVI) in large vessels vasculitis (LVV) patients.Methods:Retrospective multicenter study of characteristics and outcomes of 417 patients with LVI including 299 Takayasu arteritis (TAK) and 118 Giant cell arteritis (GCA-LVI) were analyzed. Logistic regression analysis assessed prognosis factors in LVV patients. Outcome of LVI among TAK and GCA-LVI patients (ischemic complications, aneurysms complications, relapses and revascularization) were assessed.Results:In multivariable analysis, stroke/transient ischemic attack [HR: 3.63 (1.46 - 9.04), p=0.006] was independently associated with vascular complications in LVV. The 10-years aneurysm free survival was significantly lower [67% (48 – 93) vs 89% (84 – 95), p=0.02] in GCA-LVI compare to TAK patients. The 5-years relapse free survival was significantly lower [47% (37 – 60) vs 69% (63 – 75), p<0.001,] in GCA-LVI compare to TAK patients. The 10-years revascularization free survival was significantly lower [55% (48 – 64) vs 76% (59 – 99), p<0.001] in TAK compare to GCA-LVI patients. After a median follow-up of 5 years, 16 (5.4%) TAK and 7 (5.9%) GCA-LVI patients died, mainly of aneurysm (26%) and ischemic complications (26%).Conclusion:This large nationwide cohort of LVI provided prognosis factors of vascular complications in LVV patients. TAK and GCA-LVI have different long-term outcome in term of aneurysm development, relapse and revascularization.Disclosure of Interests:None declared
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Régnier P, Le Joncour A, Maciejewski-Duval A, Desbois AC, Comarmond C, Rosenzwajg M, Klatzmann D, Cacoub P, Saadoun D. SAT0246 TARGETING JAK/STAT PATHWAY IN TAKAYASU’S ARTERITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4987] [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
Background:Takayasu’s arteritis (TAK) is a large vessel vasculitis (LVV) in which the aorta and its main branches are greatly inflamed, leading to wall thickening, fibrosis, stenosis and to artery occlusion(1). The disease is more common in women mostly between 20 and 30 years old. TAK has a high morbidity rate: 50% of patients will relapse within 10 years after diagnosis(2, 3). This inflammation is essentially mediated by infiltration with macrophages and pro-inflammatory Th1/Th17 effector subsets(4–8). But the mechanisms behind these phenomena are essentially unknown. TAK is mainly treated with non-specific steroids(1) which are associated with potential side effects when used for a long-time course.Objectives:Our work aims to explore the involvement of JAK/STAT signaling pathway and its downstream biological cascades in pro-inflammatory T cells differentiation and disease activity of TAK. Plus, our work allows to consider targeting the JAK/STAT pathway in TAK using JAK inhibitors (JAKinibs).Methods:We analyzed transcriptome of FACS-sorted CD4+ and CD8+ T cells from healthy donors (HD) and TAK, using differential gene, pathway and network analysis. Then, we assessed in vitro and in vivo effects of JAKinibs in TAK by flow cytometry (FC).Results:Transcriptome analysis showed hundreds of significantly dysregulated genes/pathways for CD4+ and CD8+ samples between HD and TAK. Among these, we noticed in TAK a great enrichment for pathways linked to type I and II interferons (IFN), JAK/STAT and cytokines/chemokines-related signaling. We confirmed by RT-qPCR the upregulation of a type I IFN-specific gene signature in TAK T cells as compared to HD. Using genes coming from the previous pathways, we constructed networks connecting them according to their respective protein interactions. This representation showed for both CD4+ and CD8+ T cells that JAK and STAT genes were densely connected, thus representing core genes/proteins in the TAK physiopathology.We then performed in vitro cell cultures of PBMCs from HD or TAK supplemented with Ruxolitinib (JAK1/2 inhibitor) or PBS. We observed by FC that JAKinibs significantly induced in TAK CD4+ and CD8+ T cells reduction of CD25 expression, decrease of Th1/Th17 pro-inflammatory cells and increase of Tregs.Next, we followed by FC 3 TAK (refractory to conventional treatments) treated with JAKinibs. We also observed in their PBMCs a reduction of CD25 expression by CD4+ T cells, a decrease of Th1 and Th17 cells and an increase of Tregs, accompanied by an increase of the Tregs/Teffs ratio. JAKinibs also decreased C-Reactive Protein level, NIH score and co-administered steroids doses (present before JAKinibs introduction) in these 3 in vivo-treated TAK.Conclusion:JAK/STAT signaling pathway is critical in the pathogenesis of TAK and JAKinibs may be promising in its treatment.References:[1]F. Numano, M. Okawara, H. Inomata, Y. Kobayashi, The Lancet. 356, 1023–1025 (2000).[2]C. Comarmond et al., Circulation. 136, 1114–1122 (2017).[3]A. Mirouse et al., J. Autoimmun. 96, 35–39 (2019).[4]C. M. Weyand, J. J. Goronzy, Nat. Rev. Rheumatol. 9, 731–740 (2013).[5]C. M. Weyand et al., Clin. Immunol. 206, 33–41 (2019).[6]D. Saadoun et al., Arthritis Rheumatol. 67, 1353–1360 (2015).[7]T. Mirault, H. Guillet, E. Messas, Presse Médicale. 46, e189–e196 (2017).[8]D. P. Misra, S. Chaurasia, R. Misra, Autoimmune Dis. 2016, 1–8 (2016).Disclosure of Interests:Paul Régnier: None declared, Alexandre Le Joncour: None declared, Anna Maciejewski-Duval: None declared, Anne-Claire DESBOIS: None declared, Cloé Comarmond: None declared, Michelle Rosenzwajg: None declared, David Klatzmann Consultant of: ILTOO Pharma, Patrice cacoub: None declared, David Saadoun: None declared
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Ferfar Y, Morinet S, Espitia O, Agard C, Vautier M, Comarmond C, Desbois AC, Domont F, Resche-Rigon M, Cacoub P, Biard L, Saadoun D. OP0146 LONG TERM OUTCOME AND PROGNOSIS FACTORS OF ISOLATED AORTITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5448] [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
Background:Aortitis is a group of disorders characterized by the inflammation of the aorta. The most common causes of aortitis are the large-vessel vasculitis i.e. giant cell arteritis (GCA) and Takayasu arteritis (TA). However, aortitis may be isolated. Because of the wide variation in the course of aortitis, predicting outcome is challenging. The optimal management strategy of isolated aortitis (IA) is still unclear as IA is poorly defined, with data consisting of small retrospective and case control studies.Objectives:To assess the long-term outcome and prognosis factors for vascular complications in patients with isolated aortitis.Methods:Retrospective multicenter study of 353 patients with non-infectious aortitis including 136 giant cell arteritis (GCA), 96 Takayasu arteritis (TA) and 73 isolated aortitis (IA). Factors associated with event-free survival, vascular event-free survival and revascularization-free survival were assessed. Risk factors for vascular complications were identified in multivariate analysis.Results:After a median follow up of 52 months, vascular complications were observed in 32.3 %, revascularization in 30 % and death in 7.6%. The 5-year cumulative incidence of vascular complications was 58% (41; 71), 20% (13; 29), and 19 % (11; 28) in IA, GCA and TA, respectively. In multivariate analysis, IA [HR, 1.85 (1.19 to 2.88), p=0.017] and male gender [1.77 (1.26 to 2.49), p<0.0001] were independently associated with vascular events. The 5-year surgery-free survival was 45% (31; 65), 71% (62; 81) and 76% (68; 86) in IA, TA and GCA, respectively.Conclusion:IA has a worse vascular prognosis than GCA and TA. Sixty percent of IA patients will experience a vascular complication within 5 years from diagnosis.Disclosure of Interests:None declared
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Desbois AC, Cacoub P, Leroyer AS, Tellier E, Garrido M, Maciejewski-Duval A, Comarmond C, Barete S, Arock M, Bruneval P, Launay JM, Fouret P, Blank U, Rosenzwajg M, Klatzmann D, Jarraya M, Cluzel P, Koskas F, Kaplanski G, Saadoun D. Immunomodulatory role of Interleukin-33 in large vessel vasculitis. Sci Rep 2020; 10:6405. [PMID: 32286393 PMCID: PMC7156501 DOI: 10.1038/s41598-020-63042-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 02/25/2020] [Indexed: 01/19/2023] Open
Abstract
The mechanisms regulating inflammation in large vessels vasculitis (LVV) are poorly understood. Interleukin 33 (IL-33) has been shown to license innate and adaptive immunity by enhancing Th2 cytokines production. We aimed to examine the role of IL-33 in the immunomodulation of T cell activation in LVV. T cell homeostasis and cytokines production were determined in peripheral blood from 52 patients with giant cell arteritis (GCA) and 50 healthy donors (HD), using Luminex assay, flow cytometry, quantitative RT-PCR and by immunofluorescence analysis in inflammatory aorta lesions. We found increased level of IL-33 and its receptor ST2/IL-1R4 in the serum of patient with LVV. Endothelial cells were the main source of IL-33, whereas Th2 cells, Tregs and mast cells (MC) express ST2 in LVV vessels. IL-33 had a direct immunomodulatory impact by increasing Th2 and Tregs. IL-33 and MC further enhanced Th2 and regulatory responses by inducing a 6.1 fold increased proportion of Tregs (p = 0.008). Stimulation of MC by IL-33 increased indoleamine 2 3-dioxygenase (IDO) activity and IL-2 secretion. IL-33 mRNA expression was significantly correlated with the expression of IL-10 and TGF-β within aorta inflammatory lesions. To conclude, our findings suggest that IL-33 may exert a critical immunoregulatory role in promoting Tregs and Th2 cells in LVV.
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Affiliation(s)
- Anne-Claire Desbois
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR S 959, Immunology-Immunopathology- Immunotherapy (I3), F-75005, Paris, France
- Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hôpital Pitié-Salpêtrière, AP-HP, F-75651, Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, F-75013, Paris, France
- Centre national de références Maladies Autoimmunes et systémiques rares et Maladies Autoinflammatoires rares, Paris, France
| | - Patrice Cacoub
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR S 959, Immunology-Immunopathology- Immunotherapy (I3), F-75005, Paris, France
- Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hôpital Pitié-Salpêtrière, AP-HP, F-75651, Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, F-75013, Paris, France
- Centre national de références Maladies Autoimmunes et systémiques rares et Maladies Autoinflammatoires rares, Paris, France
| | - Aurélie S Leroyer
- Aix-Marseille Univ; INSERM, Vascular Research Center of Marseille, UMR-S 1076, 13385, Marseille, France
| | - Edwige Tellier
- Aix-Marseille Univ; INSERM, Vascular Research Center of Marseille, UMR-S 1076, 13385, Marseille, France
| | - Marlène Garrido
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR S 959, Immunology-Immunopathology- Immunotherapy (I3), F-75005, Paris, France
- Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hôpital Pitié-Salpêtrière, AP-HP, F-75651, Paris, France
| | - Anna Maciejewski-Duval
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR S 959, Immunology-Immunopathology- Immunotherapy (I3), F-75005, Paris, France
- Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hôpital Pitié-Salpêtrière, AP-HP, F-75651, Paris, France
| | - Cloé Comarmond
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR S 959, Immunology-Immunopathology- Immunotherapy (I3), F-75005, Paris, France
- Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hôpital Pitié-Salpêtrière, AP-HP, F-75651, Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, F-75013, Paris, France
- Centre national de références Maladies Autoimmunes et systémiques rares et Maladies Autoinflammatoires rares, Paris, France
| | - Stéphane Barete
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, F-75013, Paris, France
- Centre national de références Maladies Autoimmunes et systémiques rares et Maladies Autoinflammatoires rares, Paris, France
| | - Michel Arock
- Laboratoire de biotechnologies et pharmacologie génétique appliquée, CNRS UMR 8147, ENS - Ecole normale supérieure de Cachan, Cachan, France
- AP-HP, Hôpital Pitié-Salpétrière, Laboratoire d'Hématologie Biologique, Paris, France
| | - Patrick Bruneval
- Laboratoire d'anatomopathologie, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Pierre Fouret
- Laboratoire d'anatomopathologie; Groupe Hospitalier Pitié-Salpétrière, Paris, France
| | - Ulrich Blank
- Inserm U1149, CNRS ERL8252, Faculté de Médecine Site X. Bichat, Paris, France
| | - Michelle Rosenzwajg
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR S 959, Immunology-Immunopathology- Immunotherapy (I3), F-75005, Paris, France
- Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hôpital Pitié-Salpêtrière, AP-HP, F-75651, Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, F-75013, Paris, France
- Centre national de références Maladies Autoimmunes et systémiques rares et Maladies Autoinflammatoires rares, Paris, France
| | - David Klatzmann
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR S 959, Immunology-Immunopathology- Immunotherapy (I3), F-75005, Paris, France
- Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hôpital Pitié-Salpêtrière, AP-HP, F-75651, Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, F-75013, Paris, France
- Centre national de références Maladies Autoimmunes et systémiques rares et Maladies Autoinflammatoires rares, Paris, France
| | - Mohamed Jarraya
- Banque des tissus Humains, Hôpital saint Louis, Paris, France
| | - Philippe Cluzel
- Service de radiologie vasculaire, Groupe Hospitalier Pitié-Salpétrière, Paris, France
| | - Fabien Koskas
- Service de Chirurgie vasculaire, Groupe Hospitalier Pitié-Salpétrière, Paris, France
| | - Gilles Kaplanski
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, F-75013, Paris, France
- APHM, CHU Conception, Service de Médecine Interne, Marseille, France
| | - David Saadoun
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR S 959, Immunology-Immunopathology- Immunotherapy (I3), F-75005, Paris, France.
- Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hôpital Pitié-Salpêtrière, AP-HP, F-75651, Paris, France.
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, F-75013, Paris, France.
- Centre national de références Maladies Autoimmunes et systémiques rares et Maladies Autoinflammatoires rares, Paris, France.
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Régnier P, Le Joncour A, Maciejewski-Duval A, Desbois AC, Comarmond C, Rosenzwajg M, Klatzmann D, Cacoub P, Saadoun D. Targeting JAK/STAT pathway in Takayasu's arteritis. Ann Rheum Dis 2020; 79:951-959. [PMID: 32213496 DOI: 10.1136/annrheumdis-2019-216900] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [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: 12/25/2019] [Revised: 02/27/2020] [Accepted: 03/12/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Takayasu's arteritis (TAK) is a large vessel vasculitis with important infiltration of proinflammatory T cells in the aorta and its main branches, but its aetiology is still unknown. Our work aims to explore the involvement of Janus Kinase/Signal Transducers and Activators of Transcription (JAK/STAT) signalling pathway in proinflammatory T cells differentiation and disease activity of TAK. METHODS We analysed transcriptome and interferons gene signatures of fluorescence-activated cell sorting (FACS-sorted) CD4+ and CD8+ T cells from healthy donors (HD) and in 25 TAK (median age of 37.6 years including 21 active TAK with National Institutes of Health (NIH) score >1). Then we tested, in vitro and in vivo, the effects of JAK inhibitors (JAKinibs) in TAK. RESULTS Transcriptome analysis showed 248 and 432 significantly dysregulated genes for CD4+ and CD8+ samples between HD and TAK, respectively. Among dysregulated genes, we highlighted a great enrichment for pathways linked to type I and type II interferons, JAK/STAT and cytokines/chemokines-related signalling in TAK. We confirmed by Real Time Reverse Transcription Polymerase Chain Reaction (RT-qPCR) the upregulation of type I interferons gene signature in TAK as compared with HD. JAKinibs induced both in vitro and in vivo a significant reduction of CD25 expression by CD4+ and CD8+ T cells, a significant decrease of type 1 helper T cells (Th1) and Th17 cells and an increase of Tregs cells in TAK. JAKinibs also decreased C reactive protein level, NIH score and corticosteroid dose in TAK patients. CONCLUSIONS JAK/STAT signalling pathway is critical in the pathogenesis of TAK and JAKinibs may be a promising therapy.
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Affiliation(s)
- Paul Régnier
- UPMC Université Paris 6, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, Paris, France.,Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Groupe Hospitalier de la Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Alexandre Le Joncour
- UPMC Université Paris 6, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, Paris, France.,Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Groupe Hospitalier de la Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Paris, France.,Département de médecine interne et d'immunologie clinique, Centre national de référence Maladies Autoimmunes et Systémiques Rares et Centre national de référence Maladies Auto-inflammatoires, Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier de la Pitié-Salpêtrière, Paris, France
| | - Anna Maciejewski-Duval
- UPMC Université Paris 6, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, Paris, France.,Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Groupe Hospitalier de la Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Anne-Claire Desbois
- UPMC Université Paris 6, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, Paris, France.,Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Groupe Hospitalier de la Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Paris, France.,Département de médecine interne et d'immunologie clinique, Centre national de référence Maladies Autoimmunes et Systémiques Rares et Centre national de référence Maladies Auto-inflammatoires, Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier de la Pitié-Salpêtrière, Paris, France
| | - Cloé Comarmond
- UPMC Université Paris 6, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, Paris, France.,Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Groupe Hospitalier de la Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Paris, France.,Département de médecine interne et d'immunologie clinique, Centre national de référence Maladies Autoimmunes et Systémiques Rares et Centre national de référence Maladies Auto-inflammatoires, Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier de la Pitié-Salpêtrière, Paris, France
| | - Michelle Rosenzwajg
- UPMC Université Paris 6, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, Paris, France.,Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Groupe Hospitalier de la Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - David Klatzmann
- UPMC Université Paris 6, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, Paris, France.,Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Groupe Hospitalier de la Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Patrice Cacoub
- UPMC Université Paris 6, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, Paris, France.,Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Groupe Hospitalier de la Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Paris, France.,Département de médecine interne et d'immunologie clinique, Centre national de référence Maladies Autoimmunes et Systémiques Rares et Centre national de référence Maladies Auto-inflammatoires, Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier de la Pitié-Salpêtrière, Paris, France
| | - David Saadoun
- UPMC Université Paris 6, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, Paris, France .,Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Groupe Hospitalier de la Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Paris, France.,Département de médecine interne et d'immunologie clinique, Centre national de référence Maladies Autoimmunes et Systémiques Rares et Centre national de référence Maladies Auto-inflammatoires, Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier de la Pitié-Salpêtrière, Paris, France
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Vautier M, Dupont A, De Boysson H, Comarmond C, Mirault T, Mekinian A, Lambert M, Ferfar Y, Aouba A, Cacoub P, Resche-Rigon M, Saadoun D. Vascularite des gros vaisseaux : facteurs pronostics et comparaison de l’évolution à long terme de l’artérite gigantocellulaire et de la maladie de Takayasu. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.110] [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: 10/25/2022]
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Boleto G, Comarmond C, Ghillani-Dalbin P, Musset L, Biard L, Mulier G, Saadoun D, Cacoub P. Cryoglobulinémie mixte après l’ère de l’infection par le virus l’hépatite C. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.049] [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: 10/25/2022]
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Ben Hassine I, Rein C, Comarmond C, Glanowski C, Saidenberg-Kermanac’h N, Meunier B, Schleinitz N, Chanson N, Sacré K, Scherlinger M, Richez C, Hirschi S, Groh M, Devilliers H, Bielefeld P, Saadoun D, Chapelon-Abric C, Arnaud L, Cacoub P. Osseous sarcoidosis: A multicenter retrospective case-control study of 48 patients. Joint Bone Spine 2019; 86:789-793. [DOI: 10.1016/j.jbspin.2019.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
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Comarmond C, Lorin V, Marques C, Maciejewski-Duval A, Joher N, Planchais C, Touzot M, Biard L, Hieu T, Quiniou V, Desbois AC, Rosenzwajg M, Klatzmann D, Cacoub P, Mouquet H, Saadoun D. TLR9 signalling in HCV-associated atypical memory B cells triggers Th1 and rheumatoid factor autoantibody responses. J Hepatol 2019; 71:908-919. [PMID: 31279905 DOI: 10.1016/j.jhep.2019.06.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 06/24/2019] [Accepted: 06/27/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND & AIMS Hepatitis C virus (HCV) infection contributes to the development of autoimmune disorders such as cryoglobulinaemia vasculitis (CV). However, it remains unclear why only some individuals with HCV develop HCV-associated CV (HCV-CV). HCV-CV is characterized by the expansion of anergic CD19+CD27+CD21low/- atypical memory B cells (AtMs). Herein, we report the mechanisms by which AtMs participate in HCV-associated autoimmunity. METHODS The phenotype and function of peripheral AtMs were studied by multicolour flow cytometry and co-culture assays with effector T cells and regulatory T cells in 20 patients with HCV-CV, 10 chronicallyHCV-infected patients without CV and 8 healthy donors. We performed gene expression profile analysis of AtMs stimulated or not by TLR9. Immunoglobulin gene repertoire and antibody reactivity profiles of AtM-expressing IgM antibodies were analysed following single B cell FACS sorting and expression-cloning of monoclonal antibodies. RESULTS The Tbet+CD11c+CD27+CD21- AtM population is expanded in patients with HCV-CV compared to HCV controls without CV. TLR9 activation of AtMs induces a specific transcriptional signature centred on TNFα overexpression, and an enhanced secretion of TNFα and rheumatoid factor-type IgMs in patients with HCV-CV. AtMs stimulated through TLR9 promote type 1 effector T cell activation and reduce the proliferation of CD4+CD25hiCD127-/lowFoxP3+ regulatory T cells. AtM expansions display intraclonal diversity with immunoglobulin features of antigen-driven maturation. AtM-derived IgM monoclonal antibodies do not react against ubiquitous autoantigens or HCV antigens including NS3 and E2 proteins. Rather, AtM-derived antibodies possess rheumatoid factor activity and target unique epitopes on the human IgG-Fc region. CONCLUSION Our data strongly suggest a central role for TLR9 activation of AtMs in driving HCV-CV autoimmunity through rheumatoid factor production and type 1 T cell responses. LAY SUMMARY B cells are best known for their capacity to produce antibodies, which often play a deleterious role in the development of autoimmune diseases. During chronic hepatitis C, self-reactive B cells proliferate and can be responsible for autoimmune symptoms (arthritis, purpura, neuropathy, renal disease) and/or lymphoma. Direct-acting antiviral therapy clears the hepatitis C virus and eliminates deleterious B cells.
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Affiliation(s)
- Cloé Comarmond
- Sorbonne Université, INSERM UMR_S 959, Immunologie-Immunopathologie-Immunotherapie, i3 and Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie, i2B, F-75651 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Biothérapie, F-75013 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013 Paris, France; Laboratory of Humoral Immunology, Department of Immunology, Institut Pasteur, Paris, France; INSERM U1222, Paris, France
| | - Valérie Lorin
- Laboratory of Humoral Immunology, Department of Immunology, Institut Pasteur, Paris, France; INSERM U1222, Paris, France
| | - Cindy Marques
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013 Paris, France; Laboratory of Humoral Immunology, Department of Immunology, Institut Pasteur, Paris, France; INSERM U1222, Paris, France
| | - Anna Maciejewski-Duval
- Sorbonne Université, INSERM UMR_S 959, Immunologie-Immunopathologie-Immunotherapie, i3 and Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie, i2B, F-75651 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Biothérapie, F-75013 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013 Paris, France
| | - Nizar Joher
- Laboratory of Humoral Immunology, Department of Immunology, Institut Pasteur, Paris, France; INSERM U1222, Paris, France
| | - Cyril Planchais
- Laboratory of Humoral Immunology, Department of Immunology, Institut Pasteur, Paris, France; INSERM U1222, Paris, France
| | - Maxime Touzot
- INSERM U932, 26 rue d'Ulm, 75005 Paris, France; Institut Curie, Section Recherche, 26 rue d'Ulm, 75005 Paris, France; Laboratoire d'Immunologie Clinique, Institut Curie, 26 rue d'Ulm, 75005 Paris, France
| | - Lucie Biard
- AP-HP, SBIM, Hôpital Saint-Louis, Université Paris Diderot, Paris 7, Paris, France; INSERM, ECSTRA Team, CRESS UMR-S 1153, 75010 Paris, France
| | - Thierry Hieu
- Laboratory of Humoral Immunology, Department of Immunology, Institut Pasteur, Paris, France; INSERM U1222, Paris, France
| | - Valentin Quiniou
- Sorbonne Université, INSERM UMR_S 959, Immunologie-Immunopathologie-Immunotherapie, i3 and Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie, i2B, F-75651 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Biothérapie, F-75013 Paris, France
| | - Anne-Claire Desbois
- Sorbonne Université, INSERM UMR_S 959, Immunologie-Immunopathologie-Immunotherapie, i3 and Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie, i2B, F-75651 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Biothérapie, F-75013 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013 Paris, France
| | - Michelle Rosenzwajg
- Sorbonne Université, INSERM UMR_S 959, Immunologie-Immunopathologie-Immunotherapie, i3 and Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie, i2B, F-75651 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Biothérapie, F-75013 Paris, France
| | - David Klatzmann
- Sorbonne Université, INSERM UMR_S 959, Immunologie-Immunopathologie-Immunotherapie, i3 and Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie, i2B, F-75651 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Biothérapie, F-75013 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013 Paris, France
| | - Patrice Cacoub
- Sorbonne Université, INSERM UMR_S 959, Immunologie-Immunopathologie-Immunotherapie, i3 and Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie, i2B, F-75651 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Biothérapie, F-75013 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013 Paris, France
| | - Hugo Mouquet
- Laboratory of Humoral Immunology, Department of Immunology, Institut Pasteur, Paris, France; INSERM U1222, Paris, France.
| | - David Saadoun
- Sorbonne Université, INSERM UMR_S 959, Immunologie-Immunopathologie-Immunotherapie, i3 and Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie, i2B, F-75651 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Biothérapie, F-75013 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013 Paris, France.
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Mirouse A, Barete S, Desbois AC, Comarmond C, Sène D, Domont F, Bodaghi B, Ferfar Y, Cacoub P, Saadoun D. Long-Term Outcome of Ustekinumab Therapy for Behçet's Disease. Arthritis Rheumatol 2019; 71:1727-1732. [PMID: 31008548 DOI: 10.1002/art.40912] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 04/16/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Oral ulcers, the hallmark lesion of Behçet's disease (BD), can be disabling and resistant to conventional treatment, and there is a need for safe and effective treatment. We undertook this study to investigate the long-term safety and efficacy of ustekinumab therapy for BD-related oral ulcers that are resistant to colchicine. METHODS This multicenter, prospective, open-label study included 30 patients who fulfilled the criteria of the International Study Group for BD and who were diagnosed as having active oral ulcers resistant to colchicine. Patients were treated subcutaneously with ustekinumab 90 mg at inclusion, at week 4, and then once every 12 weeks. Each patient was assessed longitudinally for the presence and number of oral ulcers, and median numbers of oral ulcers (with interquartile range [IQR]) were calculated. The primary efficacy end point was the proportion of patients at week 12 who experienced complete response, defined as having no oral ulcers. RESULTS The median number of oral ulcers per patient during ustekinumab therapy was significantly lower at week 12 compared to baseline (0 [IQR 0-1] versus 2 [IQR 2-3]; P < 0.0001). Complete response was achieved in 60.0% and 88.9% of patients at weeks 12 and 24, respectively. The median Behçet's Syndrome Activity Score (in which higher scores indicate more active disease) was significantly lower at weeks 12 and 24 (17.5 [IQR 10-42.5] and 10 [IQR 8-11], respectively) versus baseline (70 [IQR 50-70]; P < 0.0001). After a median follow-up of 12 months (IQR 6-16 months), 26 patients (86.7%) were still receiving ustekinumab treatment. Reasons for ustekinumab discontinuation included BD flare (n = 3) and side effects (n = 1). Seven patients (23.3%) experienced adverse events, including headaches (n = 4) and asthenia (n = 2), with no serious side effects. CONCLUSION Ustekinumab seems to be effective in treating BD-related oral ulcers that are resistant to treatment with colchicine.
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Affiliation(s)
- Adrien Mirouse
- Sorbonne Université, Centre National de Référence Maladies Auoimmunes Systémiques Rares, Centre National de Référence Maladies Autoinflammatoires et Amylose Inflammatoire, INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Stéphane Barete
- Groupe Hospitalier Pitié-Salpêtrière, AP-HP, and Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie, Paris, France
| | - Anne-Claire Desbois
- Sorbonne Université, Centre National de Référence Maladies Auoimmunes Systémiques Rares, Centre National de Référence Maladies Autoinflammatoires et Amylose Inflammatoire, INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Cloé Comarmond
- Sorbonne Université, Centre National de Référence Maladies Auoimmunes Systémiques Rares, Centre National de Référence Maladies Autoinflammatoires et Amylose Inflammatoire, INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | | | - Fanny Domont
- Sorbonne Université, Centre National de Référence Maladies Auoimmunes Systémiques Rares, Centre National de Référence Maladies Autoinflammatoires et Amylose Inflammatoire, INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Bahram Bodaghi
- Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Yasmina Ferfar
- Sorbonne Université, Centre National de Référence Maladies Auoimmunes Systémiques Rares, Centre National de Référence Maladies Autoinflammatoires et Amylose Inflammatoire, INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Patrice Cacoub
- Sorbonne Université, Centre National de Référence Maladies Auoimmunes Systémiques Rares, Centre National de Référence Maladies Autoinflammatoires et Amylose Inflammatoire, INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - David Saadoun
- Sorbonne Université, Centre National de Référence Maladies Auoimmunes Systémiques Rares, Centre National de Référence Maladies Autoinflammatoires et Amylose Inflammatoire, INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
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Mirouse A, Biard L, Comarmond C, Lambert M, Mekinian A, Ferfar Y, Kahn JE, Benhamou Y, Chiche L, Koskas F, Cluzel P, Hachulla E, Messas E, Cacoub P, Mirault T, Resche-Rigon M, Saadoun D. Overall survival and mortality risk factors in Takayasu's arteritis: A multicenter study of 318 patients. J Autoimmun 2019; 96:35-39. [DOI: 10.1016/j.jaut.2018.08.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022]
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Abstract
Hepatitis C virus (HCV) infection has been demonstrated to result in several adverse hepatic outcomes and has been associated with a number of important extrahepatic manifestations. The scope of extrahepatic clinical possibilities includes systemic diseases such as vasculitis and lymphoproliferative disorders, cardiovascular disease, myalgia, arthritis, and sicca syndrome. These end-organ effects of HCV may dominate the clinical course beyond the hepatic complications and significantly worsen the long-term prognosis of infected patients. Until several years ago, the standard of care for the treatment of HCV infection had been interferon-alpha-based regimens, which not only had limited effectiveness in achieving a cure but were often poorly tolerated, especially in patients with kidney disease. In those HCV-infected patients with significant systemic manifestations, the interferon-based regimens were problematic given their association with a wide variety of toxicities. The development of highly effective direct-acting antiviral agents to treat HCV infection presented an opportunity to improve the HCV care cascade with the eradication of HCV in most infected patients and by reducing the burden of both hepatic and extrahepatic complications.
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Affiliation(s)
- Patrice Cacoub
- UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universités, UPMC Univ Paris 06, Paris, France.,INSERM, UMR_S 959, Paris, France.,CNRS, FRE3632, Paris, France.,Department of Internal Medicine and Clinical Immunology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Cloé Comarmond
- UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universités, UPMC Univ Paris 06, Paris, France.,INSERM, UMR_S 959, Paris, France.,CNRS, FRE3632, Paris, France.,Department of Internal Medicine and Clinical Immunology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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Maciejewski-Duval A, Comarmond C, Leroyer A, Zaidan M, Le Joncour A, Desbois AC, Fouret JP, Koskas F, Cluzel P, Garrido M, Cacoub P, Saadoun D. mTOR pathway activation in large vessel vasculitis. J Autoimmun 2018; 94:99-109. [PMID: 30061014 DOI: 10.1016/j.jaut.2018.07.013] [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: 04/23/2018] [Revised: 07/18/2018] [Accepted: 07/18/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Mammalian target of rapamycin complex 1 (mTORC 1) drives the proinflammatory expansion of T helper (TH) type 1, TH17 cells and controls fibroblast proliferation, typical features of large vessel vasculitis (LVV) pathogenesis. Molecular pathways involved in arterial lesions of LVV are unknown. METHODS We evaluate mTORC pathway activation in vascular aorta lesions and in T cell homeostasis of patients with LVV. RESULTS Proliferation of both endothelial cells and vascular smooth-muscle cells was shown in vascular lesions in LVV. The vascular endothelium of proliferating aorta vessels from patients with LVV showed indications of activation of the mTORC1 pathway (S6RP phosphorylation). In cultured vascular endothelial cells, sera from patients with LVV stimulated mTORC1 through the phosphorylation of S6RP. mTORC1 activation was found also in Th1 and Th17 cells both systemically and in inflamed vessels. Patients with LVV exhibited a diminished S6RP phosphorylation in Tregs. Inhibition of mTORC1 pathway with rapamycin, increase Tregs and decrease effector CD4+IFNγ+, CD4+IL17+ and CD4+IL21+ T cells in patients with LVV. CONCLUSIONS We provided evidence that mTORC1 pathway has a central role in driving T cell inflammation and vascular lesions in LVV. Targeting mTORC pathway may represent a new therapeutic option in patients with LVV.
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Affiliation(s)
- A Maciejewski-Duval
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DHU i2B), F-75005, Paris, France; INSERM, UMR_S 959, F-75013, Paris, France; CNRS, FRE3632, F-75005, Paris, France
| | - C Comarmond
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DHU i2B), F-75005, Paris, France; INSERM, UMR_S 959, F-75013, Paris, France; CNRS, FRE3632, F-75005, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, National Center for Autoimmune and Systemic Rare Disease, National Center for Autoinflammatory Diseases and Amyloidosis, F-75013, Paris, France
| | - A Leroyer
- Aix-Marseille Université, INSERM, Vascular Research Center of Marseille, UMR-S 1076, Marseille, France
| | - M Zaidan
- AP-HP, Hôpital Necker-Enfants Malades, Département de Néphrologie, F-75015, Paris, France
| | - A Le Joncour
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DHU i2B), F-75005, Paris, France; INSERM, UMR_S 959, F-75013, Paris, France; CNRS, FRE3632, F-75005, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, National Center for Autoimmune and Systemic Rare Disease, National Center for Autoinflammatory Diseases and Amyloidosis, F-75013, Paris, France
| | - A C Desbois
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DHU i2B), F-75005, Paris, France; INSERM, UMR_S 959, F-75013, Paris, France; CNRS, FRE3632, F-75005, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, National Center for Autoimmune and Systemic Rare Disease, National Center for Autoinflammatory Diseases and Amyloidosis, F-75013, Paris, France
| | - J P Fouret
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Laboratoire d'anatomopathologie, F-75013, Paris, France
| | - F Koskas
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Chirurgie Vasculaire, UPMC-Paris VI, Paris, France
| | - P Cluzel
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département d'Imagerie CardioVasculaire et de Radiologie Interventionnelle, UPMC Paris VI, INSERM-CNRS-LIB, Paris, France
| | - M Garrido
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DHU i2B), F-75005, Paris, France; INSERM, UMR_S 959, F-75013, Paris, France; CNRS, FRE3632, F-75005, Paris, France
| | - P Cacoub
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DHU i2B), F-75005, Paris, France; INSERM, UMR_S 959, F-75013, Paris, France; CNRS, FRE3632, F-75005, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, National Center for Autoimmune and Systemic Rare Disease, National Center for Autoinflammatory Diseases and Amyloidosis, F-75013, Paris, France
| | - D Saadoun
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DHU i2B), F-75005, Paris, France; INSERM, UMR_S 959, F-75013, Paris, France; CNRS, FRE3632, F-75005, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, National Center for Autoimmune and Systemic Rare Disease, National Center for Autoinflammatory Diseases and Amyloidosis, F-75013, Paris, France.
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Ferfar Y, Savey L, Comarmond C, Sadaghianloo N, Garrido M, Domont F, Valantin MA, Pourcher-Martinez V, Cluzel P, Fouret P, Chiche L, Gaudric J, Koskas F, Cacoub P, Saadoun D. Large-vessel vasculitis in human immunodeficiency virus-infected patients. J Vasc Surg 2018; 67:1501-1511. [DOI: 10.1016/j.jvs.2017.08.099] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 08/19/2017] [Indexed: 11/24/2022]
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Desbois A, Cacoub P, Leroyer A, Tellier E, Maciejewsky A, Comarmond C, Barète S, Arock M, Bruneval P, Klatzmann D, Kaplanski G, Saadoun D. Effets immunomodulateurs de l’IL-33/ST2 et des mastocytes au cours des vascularites des gros vaisseaux. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.312] [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: 11/27/2022]
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Mirouse A, Barète S, Monfort J, Bouyer A, Comarmond C, Sene D, Domont F, Ferfar Y, Cacoub P, Saadoun D. L’ustekinumab dans la maladie de Behçet. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.376] [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: 11/25/2022]
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