Assessment of CD8+ T-cell mediated immunity in an influenza A(H3N2) human challenge model in Belgium: a single centre, randomised, double-blind phase 2 study

BACKGROUND

Protection afforded by inactivated influenza vaccines can theoretically be improved by inducing T-cell responses to conserved internal influenza A antigens. We assessed whether, in an influenza controlled human infection challenge, susceptible individuals receiving a vaccine boosting T-cell responses would exhibit lower viral load and decreased symptoms compared with placebo recipients.

METHODS

In this single centre, randomised, double-blind phase 2 study, healthy adult (aged 18-55 years) volunteers with microneutralisation titres of less than 20 to the influenza A(H3N2) challenge strain were enrolled at an SGS quarantine facility in Antwerp, Belgium. Participants were randomly assigned double-blind using a permuted-block list with a 3:2 allocation ratio to receive 0·5 mL intramuscular injections of modified vaccinia Ankara (MVA) expressing H3N2 nucleoprotein (NP) and matrix protein 1 (M1) at 1·5 × 108 plaque forming units (4·3 × 108 50% tissue culture infectious dose [TCID50]; MVA-NP+M1 group) or saline placebo (placebo group). At least 6 weeks later, participants were challenged intranasally with 0·5 mL of a 1 × 106 TCID50/mL dose of influenza A/Belgium/4217/2015 (H3N2). Nasal swabs were collected twice daily from day 2 until day 11 for viral PCR, and symptoms of influenza were recorded from day 2 until day 11. The primary outcome was to determine the efficacy of MVA-NP+M1 vaccine to reduce the degree of nasopharyngeal viral shedding as measured by the cumulative viral area under the curve using a log-transformed quantitative PCR. This study is registered with ClinicalTrials.gov, NCT03883113.

FINDINGS

Between May 2 and Oct 24, 2019, 145 volunteers were enrolled and randomly assigned to the MVA-NP+M1 group (n=87) or the placebo group (n=58). Of these, 118 volunteers entered the challenge period (71 in the MVA-NP+M1 group and 47 in the placebo group) and 117 participants completed the study (71 in the MVA-NP+M1 group and 46 in the placebo group). 78 (54%) of the 145 volunteers were female and 67 (46%) were male. The primary outcome, overall viral load as determined by quantitative PCR, did not show a statistically significant difference between the MVA-NP+M1 (mean 649·7 [95% CI 552·7-746·7) and placebo groups (mean 726·1 [604·0-848·2]; p=0·17). All reported treatment emergent adverse events (TEAEs; 11 in the vaccination phase and 51 in the challenge phase) were grade 1 and 2, except for two grade 3 TEAEs in the placebo group in the challenge phase. A grade 4 second trimester fetal death, considered possibly related to the MVA-NP+M1 vaccination, and an acute psychosis reported in a placebo participant during the challenge phase were reported.

INTERPRETATION

The use of an MVA vaccine to expand CD4+ or CD8+ T cells to conserved influenza A antigens in peripheral blood did not affect nasopharyngeal viral load in an influenza H3N2 challenge model in seronegative, healthy adults.

FUNDING

Department of Health and Human Services; Administration for Strategic Preparedness and Response; Biomedical Advanced Research and Development Authority; and Barinthus Biotherapeutics.

Central activation of the fatty acid sensor GPR120 suppresses microglia reactivity and alleviates sickness- and anxiety-like behaviors

G protein-coupled receptor 120 (GPR120, Ffar4) is a sensor for long-chain fatty acids including omega-3 polyunsaturated fatty acids (n-3 PUFAs) known for beneficial effects on inflammation, metabolism, and mood. GPR120 mediates the anti-inflammatory and insulin-sensitizing effects of n-3 PUFAs in peripheral tissues. The aim of this study was to determine the impact of GPR120 stimulation on microglial reactivity, neuroinflammation and sickness- and anxiety-like behaviors by acute proinflammatory insults. We found GPR120 mRNA to be enriched in  both murine and human microglia, and in situ hybridization revealed GPR120 expression in microglia of the nucleus accumbens (NAc) in mice. In a manner similar to or exceeding n-3 PUFAs, GPR120 agonism (Compound A, CpdA) strongly attenuated lipopolysaccharide (LPS)-induced proinflammatory marker expression in primary mouse microglia, including tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β), and inhibited nuclear factor-ĸB translocation to the nucleus. Central administration of CpdA to adult mice blunted LPS-induced hypolocomotion and anxiety-like behavior and reduced TNF-α, IL-1β and IBA-1 (microglia marker) mRNA in the NAc, a brain region modulating anxiety and motivation and implicated in neuroinflammation-induced mood deficits. GPR120 agonist pre-treatment attenuated NAc microglia reactivity and alleviated sickness-like behaviors elicited by central injection TNF-α and IL-1β. These findings suggest that microglial GPR120 contributes to neuroimmune regulation and behavioral changes in response to acute infection and elevated brain cytokines. GPR120 may participate in the protective action of n-3 PUFAs at the neural and behavioral level and offers potential as treatment target for neuroinflammatory conditions.

Characterization of the skin-to-bone mechanical interaction on porcine scalp: A combined experimental and computational approach

Fasciae are soft tissues permitting a large but finite sliding between organs, but also between skin and its underlying elements. The contribution of fasciae has been seldomly reported in the literature, and is usually neglected or overly simplified within simulations. In the present contribution, we propose to use peeling tests in order to quantify the skin-to-bone interaction associated with a simple computational approach based on a geometrical modeling of the skin-to-bone interface. To this aim, a new experimental set up combined with a computational model to characterize the skin-to-bone interaction were proposed. The current work is devoted to the porcine scalp complex since it constitutes a common mechanical surrogate for the human scalp complex. The ad hoc computational approach and peeling set up were firstly evaluated on a validation material, before being used to characterize the skin-to-bone interaction within 6 porcine specimens harvested from the scalp. Our experimental setup allowed to measure the peeling response of porcine scalp, showing a three-regimes response including a plateau force. The computational approach satisfyingly reproduced the peeling response based uniquely on experimental-based parameters and on a discrete modeling of skin-to-bone interface. The presented methodology is a first attempt to propose a computationally efficient geometrically based model able to take into account the skin-to-bone interaction up to failure and corroborated by experimental data, and may be largely extended to the modeling of soft interactions between biological human tissues in the future.

A preliminary quantification of the clinical gesture during vacuum assisted delivery on a training dummy

BACKGROUND

The vacuum assisted delivery represents, in France, the most used operative vaginal delivery technique. The purpose was to provide a preliminar quantification of the operator's hand kinematics while performing a vacuum assisted delivery.

METHODS

A group of 21 participants composed of 12 trainees and 9 obstetricians were recorded performing a vacuum assisted delivery on a training dummy, the matching fetal presentation was a left occiput anterior position.

FINDINGS

The mean movement was composed of a first phase corresponding to a descendant pull, followed by an ascendant finish of the gesture. No significative difference were found between the trainees and the obstetricians' mean gesture.

INTERPRETATION

This is the first quantification of the clinical gesture associated with the vacuum assisted delivery.

Hepaticojejunostomy for bile duct injury: state of the art

BACKGROUND

Hepaticojejunostomy (HJ) is the gold standard procedure for the reconstruction of the bile duct in many benign and malignant situations. One of the major situation is the bile duct injury (BDI) after cholecystectomy, either for early or late repair. This procedure presents some specificities associated to a debated management of BDI.

PURPOSE

This article provides a state-of-the-art of the hepaticojejunostomy procedure focusing on bile duct injury including its indications and outcomes CONCLUSION: Performed at the right moment and respecting the technical rules, HJ provides a restoration of the biliary patency in the long term of 80 to 90%. It is the main surgical technique to repair BDI. Complications and failure of this procedure can be difficult to manage. That is why the primary repair requires an appropriate multidisciplinary approach associated with an expert high quality surgical technique.

Regression trees to identify combinations of farming practices that achieve the best overall intrinsic quality of milk

Many studies over the last 30 years have shown the effects of farming practices on milk compounds. Combinations of practices may have antagonistic or synergistic effects on milk compounds, but these combination effects remain underinvestigated. Research needs to focus on overall intrinsic milk quality (including sensory, technological, health, and nutritional dimensions) and identify the combinations that can optimize it. The aim of this study was to identify which combinations of farming practices achieved the best scores for sensory, technological, health, and nutritional dimensions and for overall intrinsic milk quality. Ninety-nine private farms were visited once each to sample their bulk tank milk and survey their farming practices. The surveyed practices concerned herd characteristics, feeding management, housing conditions, and milking and milk storage conditions on the day of test. Analyses of bulk tank milk were designed to evaluate the overall intrinsic quality of the milk for 2 target products: raw milk cheese and semi-skimmed UHT milk. Regression trees were then used to identify the combinations of farming practices that achieved the best scores on each dimension and on overall intrinsic quality of the milk. Breed and diet (type of forage) were the most influential factors for sensory and health dimensions and for technological and nutritional dimension scores, respectively, in the cheese assessment. Overall cheese quality was highly positively correlated with these 4 dimension scores. Therefore, breed and diet emerged as the most influential practices in the regression tree for overall cheese quality. However, the combinations of practices that resulted in the best quality scores differed according to dimension studied and product targeted. This suggests that advice on farming practices to improve intrinsic milk quality needs to be adapted according to the end-purpose of the collected milk. This innovative approach combining on-farm data and regression trees provides farm managers with a valuable and practical tool to prioritize practices in terms of their role in shaping milk quality, and to identify the combinations of practices that promote good milk quality and practice thresholds or modalities needed to achieve it.

Impacts of production conditions on goat milk vitamin, carotenoid contents and colour indices

The content, composition and variation of vitamin compounds in goat milk have been little studied. An experimental design was based on 28 commercial farms, selected considering the main feeding system (based on main forage and especially pasture access), goat breed (Alpine vs Saanen) and reproductive management (seasonal reproduction), in the main French goat milk production area. Each farm received two visits (spring and autumn) that included a survey on milk production conditions and bulk milk sampling. Milk vitamins (A, E, B₂, B₆, B₉, B₁₂) and carotenoid concentrations plus colour indices were evaluated. A stepwise approach determined the variables of milk production conditions that significantly altered milk indicators. The main forage in the diet was the major factor altering goat milk vitamin and carotenoid concentrations and colour indices. Bulk milk from goats eating fresh grass as forage was richer in α-tocopherol (+64%), pyridoxal (+35%) and total vitamin B₆ (+31%), and b* index (characterising milk yellowness in the CIELAB colour space) was also higher (+12%) than in milk from goats eating conserved forages. In milk from goats eating fresh grass, concentrations of pyridoxamine, lutein and total carotenoids were higher than in milk of goats fed corn silage (+24, +118 and +101%, respectively), and retinol and α-tocopherol concentrations were higher than in milk of goats fed partially dehydrated grass (+45 and +55%). Vitamin B₂ concentration was higher in milk of goats eating fresh grass than in milk of goats fed hay or corn silage as forage (+10%). However, bulk milk when goats had access to fresh grass was significantly poorer in vitamin B₁₂ than when fed corn silage (-46%) and in γ-tocopherol (-31%) than when fed conserved forage. Alpine goats produced milk with higher vitamin B₂ and folate concentrations than Saanen goats (+18 and +14%, respectively). Additionally, the milk colour index that discriminates milks based on their yellow pigment contents was 7% higher in milk from Alpine than Saanen herds, but milk from Saanen goats was richer in lutein (+46%). Goat milks were richer in vitamins B₂ and B₁₂ and folates, but poorer in vitamin B₆ in autumn than in spring (+12, +133, +15 and -13%, respectively). This work highlights that goat milk vitamin and carotenoid concentrations and colour indices vary mainly according to the main forage of the diet and secondly according to the breed and season.

Analysis of suction-based gripping strategies in wildlife towards future evolutions of the obstetrical suction cup

The design of obstetrical suction cups used for vacuum assisted delivery has not substantially evolved through history despite of its inherent limitations. The associated challenges concern both the decrease of risk of soft tissue damage and failure of instrumental delivery due to detachment of the cup. The present study firstly details some of the suction-based strategies that have been developed in wildlife in order to create and maintain an adhesive contact with potentially rough and uneven substratum in dry or wet environments. Such strategies have permitted the emergence of bioinspired suction-based devices in the fields of robotics or biomedical patches that are briefly reviewed. The objective is then to extend the observations of such suction-based strategies toward the development of innovative medical suction cups. We firstly conclude that the overall design, shape and materials of the suction cups could be largely improved. We also highlight that the addition of a patterned surface combined with a viscous fluid at the interface between the suction cup and scalp could significantly limit the detachment rate and the differential pressure required to exert a traction force. In the future, the development of a computational model including a detailed description of scalp properties should allow to experiment various designs of bioinspired suction cups.

Mammalian Brain Ca2+ Channel Activity Transplanted into Xenopus laevis Oocytes

Several mutations on neuronal voltage-gated Ca²⁺ channels (VGCC) have been shown to cause neurological disorders and contribute to the initiation of epileptic seizures, migraines, or cerebellar degeneration. Analysis of the functional consequences of these mutations mainly uses heterologously expressed mutated channels or transgenic mice which mimic these pathologies, since direct electrophysiological approaches on brain samples are not easily feasible. We demonstrate that mammalian voltage-gated Ca²⁺ channels from membrane preparation can be microtransplanted into Xenopus oocytes and can conserve their activity. This method, originally described to study the alteration of GABA receptors in human brain samples, allows the recording of the activity of membrane receptors and channels with their native post-translational processing, membrane environment, and regulatory subunits. The use of hippocampal, cerebellar, or cardiac membrane preparation displayed different efficacy for transplanted Ca²⁺ channel activity. This technique, now extended to the recording of Ca²⁺ channel activity, may therefore be useful in order to analyze the calcium signature of membrane preparations from unfixed human brain samples or normal and transgenic mice.

Prediction of Cognitive Decline for Enrichment of Alzheimer's Disease Clinical Trials

BACKGROUND

A key issue to Alzheimer's disease clinical trial failures is poor participant selection. Participants have heterogeneous cognitive trajectories and many do not decline during trials, which reduces a study's power to detect treatment effects. Trials need enrichment strategies to enroll individuals who are more likely to decline.

OBJECTIVES

To develop machine learning models to predict cognitive trajectories in participants with early Alzheimer's disease and presymptomatic individuals over 24 and 48 months respectively.

DESIGN

Prognostic machine learning models were trained from a combination of demographics, cognitive tests, APOE genotype, and brain imaging data.

SETTING

Data from the Alzheimer's Disease Neuroimaging Initiative (ADNI), National Alzheimer's Coordinating Center (NACC), Open Access Series of Imaging Studies (OASIS-3), PharmaCog, and a Phase 3 clinical trial in early Alzheimer's disease were used for this study.

PARTICIPANTS

A total of 2098 participants who had demographics, cognitive tests, APOE genotype, and brain imaging data, as well as follow-up visits for 24-48 months were included.

MEASUREMENTS

Baseline magnetic resonance imaging, cognitive tests, demographics, and APOE genotype were used to separate decliners, defined as individuals whose CDR-Sum of Boxes scores increased during a predefined time window, from stable individuals. A prognostic model to predict decline at 24 months in early Alzheimer's disease was trained on 1151 individuals who had baseline diagnoses of mild cognitive impairment and Alzheimer's dementia from ADNI and NACC. This model was validated on 115 individuals from a placebo arm of a Phase 3 clinical trial and 76 individuals from the PharmaCog dataset. A second prognostic model to predict decline at 48 months in presymptomatic populations was trained on 628 individuals from ADNI and NACC who were cognitively unimpaired at baseline. This model was validated on 128 individuals from OASIS-3.

RESULTS

The models achieved up to 79% area under the curve (cross-validated and out-of-sample). Power analyses showed that using prognostic models to recruit enriched cohorts of predicted decliners can reduce clinical trial sample sizes by as much as 51% while maintaining the same detection power.

CONCLUSIONS

Prognostic tools for predicting cognitive decline and enriching clinical trials with participants at the highest risk of decline can improve trial quality, derisk endpoint failures, and accelerate therapeutic development in Alzheimer's disease.

[Acute macular neuroretinopathy: En face OCT description, case series]

Acute macular neuroretinopathy (AMN) is a rare disease characterized by involvement of the outer retinal layers of the macula. The diagnosis of AMN is based on multimodal imaging, combining infrared reflectance (IR) imaging and optical coherence tomography with B-scan analysis (OCT-B). The en face OCT is a tomographic image processing technique, integrating data from entire A-scans to create a frontal retinal image of the desired area. Structural en face OCT imaging appears to be effective in delineating AMN lesions, using segmentation between the outer plexiform line and the ellipsoid line. In the future, analysis of the various modalities of a single OCT acquisition may be sufficient to diagnose AMN.

The association of Greig syndrome and mastocytosis reveals the involvement of the hedgehog pathway in advanced mastocytosis

Mastocytosis is a heterogeneous disease characterized by an abnormal accumulation of mast cells (MCs) in 1 or several organs. Although a somatic KIT D816V mutation is detected in ∼85% of patients, attempts to demonstrate its oncogenic effect alone have repeatedly failed, suggesting that additional pathways are involved in MC transformation. From 3 children presenting with both Greig cephalopolysyndactyly syndrome (GCPS, Mendelian Inheritance in Man [175700]) and congenital mastocytosis, we demonstrated the involvement of the hedgehog (Hh) pathway in mastocytosis. GCPS is an extremely rare syndrome resulting from haploinsufficiency of GLI3, the major repressor of Hh family members. From these familial cases of mastocytosis, we demonstrate that the Hh pathway is barely active in normal primary MCs and is overactive in neoplastic MCs. GLI3 and KIT mutations had a synergistic, tumorigenic effect on the onset of mastocytosis in a GCPS mouse model. Finally, Hh inhibitors suppressed neoplastic MC proliferation in vitro and extend the survival time of mice with aggressive systemic mastocytosis (ASM). This work revealed, for the first time, the involvement of Hh signaling in the pathophysiology of mastocytosis and demonstrated the cooperative effects of the KIT and Hh oncogenic pathways in mice with ASM, leading to the identification of new promising therapeutic targets.

An advanced method to design graded cylindrical scaffolds with versatile effective cross-sectional mechanical properties

The selection of the most-suited bone scaffold for a given clinical application is challenging, and has motivated numerous studies. They are mostly based on the characterization of cellular structures, generated from the three-dimensional repetition of a unit cell. However, the interest of circular graded bone scaffolds has been emphasized since they facilitate nutrient transport from the periphery to the core of the scaffold. In the present contribution, we present an advanced and versatile method to design graded circular porous 2D structures based on the conformal mapping of unit cells. We propose a method to generate 3D porous scaffolds by a multilayer repetition of the circular cross-section, resulting in tunable anisotropy depending on the clinical application. We then analyze the link between the porosities of the obtained structures and their effective elastic mechanical cross-sectional properties, making use of a novel and computationally efficient method allowing exhaustive parametric studies. The comparison of various conformal transformations and unit cell designs emphasizes the extent of mechanical properties and porosities that may be reached for a given constitutive material, including non-standard mechanical properties that open large perspectives towards the development of self-fitting scaffolds.

[Clinical and paraclinical examination of non-traumatic optic neuropathy in the adult population]

Optic neuropathies (ON) occur in a variety of clinical presentations depending on their pattern of occurrence, their topography and the amount of functional visual impairment. Management of an ON requires a sequence of steps: confirm its existence (positive diagnosis): the diagnosis of ON is usually clinical and must be considered in the case of decreased visual acuity, change in color vision, visual field defect, relative afferent pupillary defect (RAPD), and absence of macular pathology; rule out differential diagnoses: determine the cause; etiologic diagnosis is sometimes complex and takes shape from clinical and paraclinical building blocks. The etiology may be vascular, inflammatory or demyelinating, infectious, toxic, vitamin-deficient, compressive (neoplastic or non-neoplastic), hereditary, congenital, traumatic or even pressure-related (glaucoma or advanced intracranial hypertension). Cerebral and orbital imaging with fine cuts of the optic nerves is often a mandatory examination, which is sometimes useful to repeat; identify therapeutic emergencies.

[Ability of ophthalmic technicians to identify a normal ophthalmological examination]

INTRODUCTION

Ophthalmology care has been growing for several years. Since ophthalmic technicians have the opportunity to perform delegated procedures, it is important to evaluate their training.

OBJECTIVE

To evaluate the ability of 3rd year ophthalmic technician students and graduates to assess the normality of an ophthalmological examination and to determine a proposed time delay for seeing an ophthalmologist.

MATERIALS AND METHODS

One hundred records including ophthalmology examinations were shown to 8 ophthalmic technician students in their third year of study and to 3 graduated technicians. Three ophthalmologists determined the content of the files, the pathological nature or not of the case, as well as the proposed time for seeing an ophthalmologist. We calculated the sensitivity and specificity to recognize the normality of the case, as well as the concordance between the proposed time for seeing an ophthalmologist.

RESULTS

For recognition of a normal case, the sensitivity was 80%, and the specificity was 83% in the group of technician students, and 81% versus 80% respectively in the group of graduated technicians. For the proposed time of consultation for seeing an ophthalmologist, the kappa agreement coefficient was 0.30 in the group of students and 0.41 in the group of graduates (low and moderate agreement respectively).

CONCLUSION

The study showed a good ability of technicians to recognize the normality or not of clinical cases, but their ability to judge the appropriate timing of treatment by an ophthalmologist remains insufficient.

Co-construction of a method for evaluating the intrinsic quality of bovine milk in relation to its fate

There are time-tested assessments for the environmental and economic aspects of sustainability. Its societal aspect has mainly been approached through the assessment of animal welfare. However, the intrinsic quality of milk is seldom taken into account. We developed a participatory construction method for the overall assessment of intrinsic milk quality in its different dimensions (sensory, technological, nutritional and health), according to the fate of the raw milk. Two assessment models were developed, for semi-skimmed standardized ultra-high temperature (UHT) milk and for pressed uncooked non-standardized raw milk cheese. They were constructed by a participatory approach involving experts in the dairy sector with the aim to obtain a diagnostic tool that could be used in the field to help farmers to manage the quality of their milk (by prioritizing improvements on major problems). They were shaped from prerequisite specifications (limited costs and time of application, desire to obtain a transparent tool with all the steps kept visible) and current technical and scientific knowledge. They were based on indicators obtained from raw bulk tank milk analyses (30 for UHT milk and 50 for cheese assessments), which were then aggregated into criteria, principles, dimensions and overall intrinsic quality at farm level. The assessment models had parts in common, for example, same four dimensions, common indicators for health and nutritional dimensions. They also had process-specific features: units chosen, criteria, indicators and weightings in relation to the final product specifications. For instance, sensory and technological dimensions are more complex and preponderant in the cheese assessment (three principles for cheese vs one for UHT milk in both dimensions). Another example is the lack of microbial pathogens (as potential health risk for consumer) in the UHT milk assessment because of pasteurization. The assessment models then underwent a sensitivity analysis and an application in 30 farms in indoor and grazing periods to finally obtain overall UHT milk and cheese quality scores at a 1-year level. The tool was found to be applicable at farm level. However, we observed low overall quality scores with a narrow dispersion, characteristic of a severe evaluation. Even so, the assessment models showed up seasonal differences of the UHT milk and cheese quality at both overall and dimensional levels. In the light of new scientific knowledge and future quality objectives, these are adaptable to other dairy products allowing for their specific features.

The IL-27/IL-27R axis is altered in CD4+ and CD8+ T lymphocytes from multiple sclerosis patients

Objectives

Pro‐ and anti‐inflammatory properties have been attributed to interleukin‐27 (IL‐27). Nevertheless, the impact of this cytokine on chronic inflammatory diseases such as multiple sclerosis (MS) remains ill‐defined. We investigated the biology of IL‐27 and its specific receptor IL‐27Rα in MS patients.

Methods

Levels of IL‐27 and its natural antagonist (IL‐27‐Rα) were measured by ELISA in biological fluids. CD4⁺ and CD8⁺ T lymphocytes were isolated from untreated relapsing–remitting MS patients and healthy donors. Transcriptome‐wide analysis compared T‐cell subsets stimulated or not with IL‐27. Expression of the IL‐27Rα, key immune factors, STAT phosphorylation and cytokine production was assessed by flow cytometry.

Results

We observed elevated levels of IL‐27 in the serum and cerebrospinal fluid of MS patients compared with controls. Moreover, we show that specific IL‐27‐mediated effects on T lymphocytes are reduced in MS patients including the induction of PD‐L1. IL‐27‐triggered STAT3 signalling pathway is enhanced in CD4⁺ and CD8⁺ T lymphocytes from MS patients. Elevated IL‐27Rα levels in serum from MS patients are sufficient to impair the capacity of IL‐27 to act on immune cells. We demonstrate that shedding of IL‐27Rα by activated CD4⁺ T lymphocytes from MS patients contributes to the increased IL‐27Rα peripheral levels and consequently can dampen the IL‐27 responsiveness.

Conclusion

Our work identifies several mechanisms that are altered in the IL‐27/IL‐27R axis in MS patients, especially in T lymphocytes. Our results underline the importance of characterising the biology of cytokines in human patients prior to design new therapeutics.

Impact of early biochemical diagnosis of anastomotic leakage after rectal cancer surgery: long-term results from GRECCAR 5 trial

Elevated C-reactive protein, should be used to prompt early detection of AL prior to the development of clinical symptoms. Early biochemical diagnosis and intervention of AL mitigates the negative impact of AL on oncological outcomes in patients with rectal cancer.

Interleukin-15 enhances proinflammatory T-cell responses in patients with MS and EAE

Objective

We posit that interleukin-15 (IL-15) is a relevant contributor to MS pathobiology as this cytokine is elevated in the CNS and periphery of patients with MS. We aim to investigate (1) the impact of IL-15 on T lymphocytes from patients with MS and (2) the in vivo role of IL-15 using the experimental autoimmune encephalomyelitis (EAE) mouse model.

Methods

We compared the impact of IL-15 on T lymphocytes obtained from untreated patients with MS (relapsing-remitting, secondary progressive, and primary progressive) to cells from age/sex-matched healthy controls (HCs) using multiparametric flow cytometry and in vitro assays. We tested the effects of peripheral IL-15 administration after EAE disease onset in C57BL/6 mice.

Results

IL-15 triggered STAT5 signaling in an elevated proportion of T cells from patients with MS compared with HCs. This cytokine also enhanced the production of key proinflammatory cytokines (interferon γ, granulocyte-macrophage colony-stimulating factor [GM-CSF], IL-17, and tumor necrosis factor) by T cells from both MS and controls, but these effects were more robust for the production of IL-17 and GM-CSF in T-cell subsets from patients with MS. At the peak of EAE disease, the proportion of CD4⁺ and CD8⁺ T cells expressing CD122⁺, the key signaling IL-15 receptor chain, was enriched in the CNS compared with the spleen. Finally, peripheral administration of IL-15 into EAE mice after disease onset significantly aggravated clinical scores and increased the number of inflammatory CNS-infiltrating T cells long term after stopping IL-15 administration.

Conclusions

Our results underscore that IL-15 contributes to the amplification of T-cell inflammatory properties after disease onset in both MS and EAE.

Impact de la crise de la COVID-19 sur les internes de dermatologie français

Introduction

Lors de la crise de la COVID-19, les internes de dermatologie, comme les autres professionnels de santé, ont été en première ligne. Nous avons souhaité évaluer l’impact de cette pandémie sur leurs pratiques professionnelles, leurs conditions de travail, leur formation universitaire et leur santé mentale.

Matériel et méthodes

Un questionnaire en ligne disponible du 17 au 26 avril a été envoyé à tous les internes français en dermatologie par la mailing list de l’association Futurs dermato-venerologues de France. Le questionnaire comprenait 104 questions dont le questionnaire de burn-out de Maslach.

Des régressions logistiques multivariées ont été effectuées pour examiner les facteurs associés au maintien d’une activité de dermatologie, une moins bonne supervision, une dégradation de la formation et les causes rapportées, et l’impact psychologique via un score de burn-out.

Résultats

Les internes déclarant une moins bonne supervision étaient les internes les plus avancés dans le cursus (OR 3,24 IC [1,65 ; 6,65], p < 0,001) ou en stage en CH périphériques (OR 2,21 IC [1,14 ; 4,46], p = 0,022). Pour 181 (76 %) internes, la pandémie a eu un effet négatif sur leur formation. La cause principale rapportée par 175 (74 %) d’entre eux était l’annulation des cours et des congrès. Il n’y avait de différence significative, entre les internes des zones fortement touchées ou non concernant la dégradation de leur formation ou des causes possibles liées à cette dégradation. Aucun interne n’était exempt de symptômes de burn-out, cinq (2 %) présentaient des symptômes intermédiaires, 43 (18 %) étaient fortement touchés dans 1 dimension, 76 (32 %) dans 2 et 112 (47 %) dans 3, sans différence significative entre les zones fortement et moins touchées.

Discussion

La crise de la COVID-19 a mis en tension notre système de santé mais également notre capacité à maintenir des activités essentielles pour les internes comme l’enseignement. Ces difficultés n’ont pas été exclusivement du fait du changement d’activité ou de la submersion des services par des patients atteints de la COVID-19, puisque la dégradation de la formation n’était pas corrélée à la situation géographique. La mise en place d’outils dématérialisés pour maintenir un lien et une formation adéquate n’a pas pu être mis en œuvre rapidement et efficacement durant la crise. Des stratégies pour accroître l’utilisation des outils numériques de formation et la télé-dermatologie semblent être des armes essentielles pour lutter en temps de crise épidémique avec le moins de répercussions sur leur travail et leur formation. Ces outils sont également adaptés aux nouvelles générations et aux nouveaux modes d’organisation du travail dans la société, dépassant même le cadre de la médecine et de la dermatologie.

[Haemophilic ankle arthropathy : case reports and review of the literature]

Haemophilic arthropathy affects about half of the patients who suffer from haemophilia. Despite the fact that it's one of the main morbidity factors of haemophilia and that the pathophysiology of its mechanism is slowly better understood, its management is still under discussion. The cases of two men (53 and 54 years old) who suffer from ankle haemophilic arthropathy since several years are reported. For both cases, different aspects of the management are investigated, including a medicated and a physiotherapy approach, and an adequate orthotic. Other treatments are available and sometimes used, such as radio- or arthroscopic synovectomy, corticosteroids or platelet-rich plasma in?ltration or visco-supplementation.

Hyperexcitability and seizures in the THY-Tau22 mouse model of tauopathy

Epileptic seizures constitute a significant comorbidity of Alzheimer's disease (AD), which are recapitulated in transgenic mouse models of amyloidogenesis. Here, we sought to evaluate the potential role of tau pathology regarding seizure occurrence. To this end, we performed intra-hippocampal electroencephalogram (EEG) recordings and PTZ (pentylenetetrazol) seizure threshold tests in THY-Tau22 transgenic mice of AD-like tau pathology. We demonstrate that despite a lack of spontaneous epileptiform activity in Tau22 mice, the animals display increased PTZ-induced seizure susceptibility and mortality. The increased propensity for induced seizures in THY-Tau22 mutants correlates with astrogliosis and increased expression of adenosine kinase, consistent with increased network excitability. These data support an impact of tau pathology toward AD-associated seizures and suggest that tau pathology may contribute to seizure generation in AD independent of Aβ pathology.

THU0312 AUTOLOGOUS NON-MYELOABLATIVE HEMATOPOIETIC STEM CELL TRANSPLANTATION FOR REFRACTORY TAKAYASU ARTERITIS: A RETROSPECTIVE MULTICENTRE CASE-SERIES FROM THE AUTOIMMUNE DISEASES WORKING PARTY (ADWP) OF THE EUROPEAN SOCIETY FOR BLOOD AND MARROW TRANSPLANTATION (EBMT)

Background:

Takayasu arteritis (TAK) is a chronic granulomatous large-vessel vasculitis, characterized by arterial thickening and fibrosis leading to stenosis and vascular occlusions. More than 10-20% of patients are refractory to conventional immunosuppressive therapy. Autologous hematopoietic stem cell transplantation (AHSCT) has emerged as a promising treatment option in severely affected and refractory patients with various autoimmune diseases and vasculitis, particularly ANCA-positive vasculitis and Behçet’s disease.

Objectives:

This study,approved by the ADWP, aims to evaluate the use and outcome of AHSCT in adult TAK patients.

Methods:

This is a retrospective survey of patients reported to the EBMT registry between 1998 and 2019, who received AHSCT primarily for TAK. Clinical and laboratory data, including data on diagnosis, previous lines of therapy, transplant regimen, treatment-related mortality, as well as data regarding course of disease and treatment were recorded.

Results:

Data from six adult patients treated with AHSCT between 2003 and 2019 for refractory Takayasu have been identified. Median (ranges) follow-up was 9.9 (1-14) years. Five patients were female (83%), median age was 25 (9-39) years at diagnosis and 28 (22-41) years at HSCT. All patients were pretreated with a median of 6 (4-8) lines of therapy, including systemic steroids (6 patients), methotrexate (5 patients), cyclophosphamide, mycophenolate mofetil or infliximab (4 patients), tocilizumab or etanercept (2 patients), and other biologic or conventional-synthetic DMARDs. Conditioning included cyclophosphamide and rabbit anti-thymocyte globulin in all patients. At six months post-transplantation, remission was obtained in all cases, which persisted at 12 months in 5 cases. Four patients reactivated TAK at a median time of 27 (7-52) months after AHSCT, and 3 resumed disease-modifying therapy. At last follow-up, all patients were alive, 2 patients were in remission (off-therapy), 2 patients improved compared to baseline, and 2 patients were in complete and partial remission, respectively, under immunosuppressive treatment.

Conclusion:

This small retrospective series demonstrates that AHSCT has the potential to provide significant clinical responses in TAK patients who had been unresponsive to previous immunosuppressive therapy, with an acceptable safety profile.

Acknowledgments:

no

Disclosure of Interests:

CHARLOTTE LAURENT: None declared, ZORA MARJANOVIC: None declared, Jörg Henes Grant/research support from: Novartis, Roche-Chugai, Consultant of: Novartis, Roche, Celgene, Pfizer, Abbvie, Sanofi, Boehringer-Ingelheim,, DOMNIQUE FARGE: None declared, MANUELA BADOGLIO: None declared, John SNOWDEN: None declared, olivier fain: None declared, Tobias Alexander: None declared, Maria Carolina Oliveira: None declared, Arsene Mekinian: None declared

R-CHOP appears to be the best first-line treatment for second primary diffuse large B cell lymphoma: a cancer registry study

Second primary diffuse large B cell lymphoma (spDLBCL) is defined as a metachronous tumor occurring after a first primary cancer. To date, while R-CHOP is the standard first-line treatment for de novo DLBCL, no available data show that R-CHOP is the optimal treatment for spDLBCL. This exploratory study aimed to investigate treatment of spDLBCL. From 2008 to 2015, the Poitou-Charentes general cancer registry recorded 68 cases of spDLBCL ≤ 80 years old, having received a first-line treatment with either R-CHOP (78%) or other regimens (22%). Patients without R-CHOP have worse overall survival in univariate (HR 2.89 [1.33-6.24], P = 0.007) and multivariate (HR 2.98 [1.34-6.67], P = 0.008) analyses. Patients without R-CHOP more frequently had PS > 1 (67% vs. 28%, P = 0.007) and prior chemotherapy (60% vs. 26%, P = 0.02), which suggests that both of these factors influence a clinician's decision to not use R-CHOP. Prior chemotherapy had no prognostic impact in univariate and multivariate analyses; this result could call into question the risk-benefit balance of not using R-CHOP to prevent toxicity. In our study, one DLBCL out of ten occurred after a first primary cancer, and as regards de novo DLBCL, R-CHOP appeared to be the best first-line treatment. Larger series are needed to confirm these results.

Modern slavery and public health: a rapid evidence assessment and an emergent public health approach

OBJECTIVES

Modern slavery is a human rights violation and a global public health concern. To date, criminal justice approaches have dominated attempts to address it. Modern slavery has severe consequences for people's mental and physical health, and there is a pressing need to identify and implement effective preventative measures. As such, a public health approach to modern slavery requires elucidation. The objectives of this study were to explore the case for public health involvement in addressing modern slavery and the components of a public health approach and to develop a globally relevant framework for public health action.

STUDY DESIGN

A Rapid Evidence Assessment.

METHODS

This study is a rapid systematic review of published literature and stakeholder consultation.

RESULTS

The accounts of 32 consultees and evidence from 17 papers including reviews, commentaries and primary studies were included in the evidence assessment. A strong ethical rationale for public health engagement in addressing modern slavery was evident. Multilevel and multicomponent interventional strategies were identified across global, national, regional, local and service levels. Although public health could add value to existing approaches, multiple barriers and tensions exist.

CONCLUSION

Published literature and stakeholder opinion indicate an emergent public health approach to modern slavery. It involves intervention at multiple levels and is guided by a rights-based, survivor-centred and trauma-informed approach. This synthesis offers an important early step in the construction of a globally relevant public health approach to modern slavery.