Association between kinetic of Anti-Neutrophil Cytoplasmic Antibody (ANCA), renal survival and relapse risk in ANCA-glomerulonephritis

BACKGROUND

Anti-neutrophil cytoplasmic antibody (ANCA) kinetic in ANCA-associated vasculitis with glomerulonephritis (AAV-GN) has been suggested to be associated with AAV relapse. Few studies focused on its association with renal prognosis. Thus, we aimed to investigate the relationship between i) ANCA specificity and evolutive profile, and ii) renal outcomes.

METHODS

This multicentric retrospective study included patients diagnosed with ANCA-GN since 01/01/2000. Patients without ANCA at diagnosis and with fewer than 3 ANCA determinations during follow-up were excluded. We analyzed eGFR variation, renal-free and relapse-free survival according to three ANCA profiles (negative, recurrent, persistent) and to ANCA specificity (MPO or PR3).

RESULTS

Over a follow-up of 56 [34-101] months, a median of 19 [13-25] ANCA determinations were performed for the 134 included patients. Patients with a recurrent/persistent ANCA profile had a lower relapse-free (p = 0.019) survival and tended to have a lower renal survival (p = 0.053) compared to those with negative ANCA profile. Patients with a recurrent/persistent MPO-ANCA profile had the shortest renal survival (p = 0.015) and those with recurrent/persistent PR3-ANCA profile had the worst relapse-free survival (p = 0.013) compared to other profiles. The negative ANCA profile was associated with a greater eGFR recovery. In multivariate regression analysis, it was an independent predictor of a two-fold increase of eGFR at 2-year (OR = 6.79, 95% CI [1.78, 31.4], p = 0.008).

CONCLUSION

ANCA kinetic after ANCA-GN diagnosis is associated with outcomes. MPO-ANCA recurrence/persistence identifies patients with a lower potential of renal recovery and a higher risk of kidney failure, while PR3-ANCA recurrence/persistence identifies patients with a greater relapse risk. Thus, ANCA kinetic may help identify patients with a smoldering disease.

MO259LYMPHOPENIA AT ANCA-GLOMERULONEPHRITIS DIAGNOSIS IS CORRELATED WITH SEVERITY AND RENAL PROGNOSIS

Background and Aims

Lymphopenia is commonly observed in various autoimmune diseases, such as systemic lupus erythematosus, where it has been associated with disease activity or prognosis. However, in ANCA-associated vasculitis (AAV) only few, small-scale studies have been targeted to this issue. Research has not yet focused on ANCA-glomerulonephritis (ANCA-GN) patients. Thus, the aim of this study was to analyze the association between lymphocyte counts and outcomes in a large cohort of ANCA-GN patients.

Method

We used the Maine-Anjou AAV registry that retrospectively gathers data on consecutive patients affected by AAV in four French Nephrology Centers, recorded since January 2000. We analyzed clinical, biological, and histological data at diagnosis of ANCA-GN. Biological data, including lymphocyte counts, were collected before the administration of any immunosuppressive treatment. Risk factors for end-stage kidney disease (ESKD) were analyzed. Event-free survival was also assessed.

Results

Among the 145 patients included in the study, 53 (37%) patients presented with lymphopenia at ANCA-GN diagnosis. Lymphopenic patients were older (72 [63–79] vs 66 [56–73] years old, p = 0.010), had a lower renal function at baseline (eGFR 13 mL/min vs 26 mL/min, p = 0.002), and a higher proteinuria (1.86 [1.21–3.52] g/g vs 1.30 [0.75–2.65] g/g, p = 0.042). There was a trend for a higher BVAS (18 [14–22] vs 15 [12–20], p = 0.076) in lymphopenic patients. Therapeutic management between the two groups was similar. There was no difference in relapse rate between the two groups but lymphopenic patients were more likely to require kidney replacement therapy (51% vs 25%, p = 0.003) and were more likely to die (34% vs 17%, p = 0.039). Lymphopenia was correlated with histological lesions and especially with the percentage of sclerotic glomeruli (p = 0.0027). ESKD-free survival and overall survival were lower in lymphopenic patients (p < 0.0001 and 0.0051 respectively). In multivariate Cox analysis, lymphopenia, but not death, was an independent risk factor for ESKD (HR 4.47 (95% confidence interval: [2.06–9.72], p < 0.001).

Conclusion

Lymphopenia correlates with severity of ANCA-GN at diagnosis and predicts poor renal outcome. In this view, lymphopenia could be used as a simple and cost-effective biomarker to assess renal prognosis at ANCA-GN diagnosis.

Lymphopenia at diagnosis of ANCA-vasculitis with renal involvement is correlated with severity and renal prognosis

BACKGROUND

Lymphopenia is commonly observed in autoimmune diseases, where it has been associated with disease activity or prognosis. However, in ANCA-associated vasculitis (AAV) only few, small-scale studies have been targeted to this issue. Research has not yet focused on AAV with renal involvement (AAV-RI) patients. Thus, the aim of this study was to analyze the association between lymphocyte counts and outcomes in a large cohort of AAV-RI patients.

METHODS

We used the Maine-Anjou AAV registry that retrospectively gathers data on consecutive patients affected by AAV in four French Nephrology Centers, recorded since January 2000. We analyzed clinical, biological, and histological data at diagnosis of AAV-RI. Risk factors for end-stage kidney disease (ESKD) were analyzed. Event-free survival was also assessed.

RESULTS

Among the 145 patients included in the study, those with lymphopenia at diagnosis had a lower renal function at baseline (eGFR 13 mL/min vs 26 mL/min, p = 0.002) and were more likely to require kidney replacement therapy (51% vs 25%, p = 0.003). Lymphopenia was correlated with histological lesions and especially with the percentage of sclerotic glomeruli (p = 0.0027). ESKD-free survival was lower in lymphopenic patients (p < 0.0001). In multivariate Cox analysis, lymphopenia was an independent risk factor for ESKD (HR 4.47 (95% confidence interval: [2.06-9.72], p < 0.001).

CONCLUSION

Lymphopenia correlates with the severity of AAV glomerulonephritis at diagnosis and predicts poor renal outcome. In this view, lymphopenia could be used as a simple and cost-effective biomarker to assess renal prognosis at AAV-RI diagnosis.

Chimiothérapie néoadjuvante dans les astrocytomes fibrillaires de grade II symptomatiques non opérables de l’adulte

We collected 6 case-reports of symptomatric non removable low grade fibrillary astrocytoma of adults treated with a procarbazine-CCNU-vincristine chemotherapy regimen. All patients had drug-resistant epilepsy but brain imaging was stable. Total gross resection was rejected because of Volume or tumor location. After 4 to 7 cycles of chemotherapy, 2 patients had partial response and one minor response on brain MRI. All of them were seizure-free. Progression free survival was not reached at 5 Years. Up-front chemotherapy for low-grade astrocytomas may be useful and has to be prospectively evaluated.

Inhibition of graft-versus-host reaction by treatment of immature thymocytes with eicosanoids

A model of in vivo secondary graft-versus-host (GVH) was used to appraise the behaviour of allostimulated eicosanoid-treated thymocytes. During the first step of the experiment P1 immature parental thymocytes were preincubated in the presence of P2 allogenic mature lymphocytes and eicosanoids (either PGE2 or LTB4). During the second step, the preincubated cells were injected intravenously into P1xP2 F1 irradiated hybrids and the in vivo mixed lymphocyte reaction assessed by 3H-thymidine uptake by the cells harboured in the spleen of the host. We also investigated the production of cytotoxic cells. We observed that PGE2 and LTB4 both influence the behaviour of immature thymocytes and that, in the context of allostimulation such as GVH, they induce a state of tolerance. The data are in agreement with a model of involvement of eicosanoids in education of thymocytes within the thymic organ.

NZB/NZW F1 mouse nephritis and immune response are not changed by treatment with a 15-lipoxygenase derivative

15-HETE is an arachidonic acid derivative issued from the 15 lipoxygenase pathway. This fatty acid possesses immunomodulatory capabilities since it was reported that it generates CD8 + suppressor T-cells either in vitro or ex vivo. The aim of the present report was to study if the suppressive capabilities of 15-HETE were able to influence the onset of the NZB/NZW Fl auto-immune disease. For that purpose we produced 15-HETE and injected the eicosanoid twice a week to NZB/WFI mice for 40 weeks. During the 15-HETE treatment of the animals it was observed an augmentation of the proliferative response of lectin-stimulated splenocytes (at weeks 20 and 30) then the thymidine uptake decreased (at week 40). In fact we observed that among 15-HETE treated mice the evolution of the nephropathy was not changed, the 'glomerular activity score' remained the same for the treated animals compared to controls. On the contrary antinuclear antibodies occurred earlier even if in some experiments the generation of CD8 + cells was demonstrated.

Effect of arachidonic acid metabolites on CR1 expression by B-lymphocytes

The effect of arachidonic acid metabolites on the expression of the receptor for the C3b/C4b fragment of complement (CR1) by human B-lymphocytes was investigated. Kinetic experiments to determine CR1 expression over time indicated that the maximal receptor number occurred at 2 h, followed by a return to baseline values. Addition of 10(-4) M puromycin to the cells suggested that the increase was due to the expression of an intracellular pool and not de novo synthesis of new receptor molecules. B-lymphocytes were incubated with arachidonic acid, 15-hydroxyeicosatetraenoic acid, leukotrienes B4 or C4 or prostaglandin E2 (PGE2). The quantity of membrane antigenic binding sites was determined before and after incubation. The lipoxygenase metabolites did not alter CR1 numbers. In contrast, PGE2 significantly decreased (P less than 0.05) the quantity of CR1 expressed. In kinetic experiments, PGE2 blocked the maximal expression of CR1 seen at 2 h, indicating that it prevents the appearance of an intracellular pool of receptor. These results show that CR1 number on B-lymphocytes can be altered by at least one arachidonic acid metabolite. This may offer a partial explanation for the inhibitory effects of PGE2 on B-cell proliferation and immunoglobulin secretion since CR1 is implicated in B-lymphocyte differentiation and specific antibody response.

Effect of PGE2 and LTB4 on vicia villosa binding lymphocytes

Since there is a good deal of evidence that vicia villosa lectin (VVA) binds to contrasuppressor cells, mouse splenocytes and thymocytes were sorted by binding to VVA-coated Petri dishes. It was observed that vicia villosa adherent cells (VVA(+)) did not proliferate when mitogens were added to cultures, but they did enhance the thymidine uptake of PHA or ConA stimulated vicia villosa non-adherent (VVA(-)) splenocytes. PGE2 treatment of VVA(+) splenocytes or VVA(+) immature thymocytes did not very much affect the VVA(+) cell behavior. On the other hand, LTB4 increased the enhancing capability of VVA(+) splenocytes. Therefore, investigations dealing with the effects of LTB4 on lymphocyte subsets which may include VVA(+) cells should take into consideration the possible presence of contrasuppressor cells.

[Arterial thrombosis induced by direct electric current. Clinical applications (author's transl)]

Authors have demonstrated that it is possible to induce arterial thrombosis by applying direct electric current (10 mA -V). By the use of this method several thromboses were formed in the rabbit. This technique is now well established and the first clinical applications on human arteries give rise to considerable hopes, since it is simple, reliable, and much less dangerous than other types of embolisation. Experiments are being done to apply this technique to aneurysms.

[Urethroperineal fistula in the left lateroposition (author's transl)]

The authors describe a case of urethroperineal fistula in the lateropostion. It is a rare malformation, with a varied symptomatology, which requires radiological investigations for its morphological and topographical study. Surgical treatment varies as a function of the site and size of the fistula. Basing their comments on the studies by STEPHENS [12], the authors try to give an embryological explanation of this affection.

[Radiological aspects of infections due to mycoplasma pneumoniae in children (author's transl)]

The authors review 69 cases of infections due to mycoplasma pneumoniae in children, including the clinical, biological, and radiological aspects, and compare their results with those in the published literature. Clinical and radiological signs and non-specific, and diagnosis is made exclusively by serological tests.

[Mesenteric lipomas in children: a report on one case (author's transl)]

A case of mesenteric lipoma presenting as an isolated abdominal masse in a boy of 20 months is reported. Diagnosis was made from the appearance of the fatty mass in a straight abdominal film. Radiological examination was completed by urography and echotomography. The analysis of 11 identical cases found in the literature enabled the principal clinical and radiological characterists of this affection to be defined and evoked the problems of differential diagnosis from other lipomatous abdominal masses and cystic lymphangioma.