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Donadeu L, Jouve T, Bin S, Hartzell S, Crespo E, Torija A, Jarque M, Kevella D, Zúñiga J, Zhang W, Sun Z, Verlato A, Martínez-Gallo M, Font-Miñarro C, Meneghini M, Toapanta N, Torres IB, Sellarés J, Perelló M, Kaminski H, Couzi L, Loupy A, La Manna G, Moreso F, Cravedi P, Bestard O. High-dimensional mass cytometry identified circulating natural killer T-cell subsets associated with protection from cytomegalovirus infection in kidney transplant recipients. Kidney Int 2024:S0085-2538(24)00310-7. [PMID: 38685562 DOI: 10.1016/j.kint.2024.03.027] [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: 09/14/2023] [Revised: 02/08/2024] [Accepted: 03/12/2024] [Indexed: 05/02/2024]
Abstract
Cytomegalovirus (CMV) infection is associated with poor kidney transplant outcomes. While innate and adaptive immune cells have been implicated in its prevention, an in-depth characterization of the in vivo kinetics of multiple cell subsets and their role in protecting against CMV infection has not been achieved. Here, we performed high-dimensional immune phenotyping by mass cytometry, and functional assays, on 112 serially collected samples from CMV seropositive kidney transplant recipients. Advanced unsupervised deep learning analysis was used to assess immune cell populations that significantly correlated with prevention against CMV infection and anti-viral immune function. Prior to infection, kidney transplant recipients who developed CMV infection showed significantly lower CMV-specific cell-mediated immune (CMI) frequencies than those that did not. A broad diversity of circulating cell subsets within innate and adaptive immune compartments were associated with CMV infection or protective CMV-specific CMI. While percentages of CMV (tetramer-stained)-specific T cells associated with high CMI responses and clinical protection, circulating CD3+CD8midCD56+ NK-T cells overall strongly associated with low CMI and subsequent infection. However, three NK-T cell subsets sharing the CD11b surface marker associated with CMV protection and correlated with strong anti-viral CMI frequencies in vitro. These data were validated in two external independent cohorts of kidney transplant recipients. Thus, we newly describe the kinetics of a novel NK-T cell subset that may have a protective role in post-transplantation CMV infection. Our findings pave the way to more mechanistic studies aimed at understanding the function of these cells in protection against CMV infection.
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Affiliation(s)
- Laura Donadeu
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Thomas Jouve
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; University Grenoble Alpes, Centre Hospitalier Universitaire Grenoble Alpes, Inserm 1209, Centre national de la recherche scientifique 5309, Institute for Advanced Biosciences, Grenoble, France
| | - Sofia Bin
- Translational Transplant Research Center (TTRC), Icahn School of Medicine at Mount Sinai, New York, New York, USA; Nephrology, Dialysis and Renal Transplant Unit, Istituto di Ricovero e Cura a Carattere Scientifico-Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Susan Hartzell
- Translational Transplant Research Center (TTRC), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Elena Crespo
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alba Torija
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Jarque
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Delphine Kevella
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Zúñiga
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Weijia Zhang
- Translational Transplant Research Center (TTRC), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zeguo Sun
- Translational Transplant Research Center (TTRC), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alberto Verlato
- Translational Transplant Research Center (TTRC), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mónica Martínez-Gallo
- Immunology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Font-Miñarro
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Meneghini
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nestor Toapanta
- Vall d'Hebron for Solid Organ Transplantation Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Irina B Torres
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joana Sellarés
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manel Perelló
- Vall d'Hebron for Solid Organ Transplantation Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Hannah Kaminski
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France; Unité Mixte de Recherche 5164-ImmunoConcEpT, University of Bordeaux, Centre national de la recherche scientifique, Bordeaux University, Bordeaux, France
| | - Lionel Couzi
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France; Unité Mixte de Recherche 5164-ImmunoConcEpT, University of Bordeaux, Centre national de la recherche scientifique, Bordeaux University, Bordeaux, France
| | - Alexandre Loupy
- Paris Translational Research Center for Organ Transplantation, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-S970, Université de Paris, Paris, France
| | - Gaetano La Manna
- Nephrology, Dialysis and Renal Transplant Unit, Istituto di Ricovero e Cura a Carattere Scientifico-Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesc Moreso
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paolo Cravedi
- Translational Transplant Research Center (TTRC), Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Oriol Bestard
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Riveiro-Barciela M, Roade L, Martínez-Camprecios J, Vidal-González J, Rodríguez-Diez B, Perelló M, Ortí G, Robles-Alonso V, Berastegui C, Navarro J, Martínez-Valle F, Bilbao I, Castells L, Ventura-Cots M, Llaneras J, Rando-Segura A, Forns X, Lens S, Prieto M, García-Eliz M, Imaz A, Rodríguez-Frías F, Buti M, Esteban R. mTOR inhibitors a potential predisposing factor for chronic hepatitis E: Results from the prospective collaborative CHES study (Chronic Hepatitis EScreening in patients with immune impairment and increased transaminases levels). Gastroenterol Hepatol 2023; 46:764-773. [PMID: 36731726 DOI: 10.1016/j.gastrohep.2023.01.010] [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] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 01/03/2023] [Accepted: 01/21/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Chronic hepatitis E virus (HEV) in persons with immune impairment has a progressive course leading to a rapid progression to liver cirrhosis. However, prospective data on chronic HEV is scarce. The aim of this study was to determine the prevalence and risk factors for chronic HEV infection in subjects with immune dysfunction and elevated liver enzymes. PATIENTS AND METHODS CHES is a multicenter prospective study that included adults with elevated transaminases values for at least 6 months and any of these conditions: transplant recipients, HIV infection, haemodialysis, liver cirrhosis, and immunosuppressant therapy. Anti-HEV IgG/IgM (Wantai ELISA) and HEV-RNA by an automated highly sensitive assay (Roche diagnostics) were performed in all subjects. In addition, all participants answered an epidemiological survey. RESULTS Three hundred and eighty-one patients were included: 131 transplant recipients, 115 cirrhosis, 51 HIV-infected subjects, 87 on immunosuppressants, 4 hemodialysis. Overall, 210 subjects were on immunosuppressants. Anti-HEV IgG was found in 94 (25.6%) subjects with similar rates regardless of the cause for immune impairment. HEV-RNA was positive in 6 (1.6%), all of them transplant recipients, yielding a rate of chronic HEV of 5.8% among solid-organ recipients. In the transplant population, only therapy with mTOR inhibitors was independently associated with risk of chronic HEV, whereas also ALT values impacted in the general model. CONCLUSIONS Despite previous abnormal transaminases values, chronic HEV was only observed among solid-organ recipients. In this population, the rate of chronic HEV was 5.8% and only therapy with mTOR inhibitors was independently associated with chronic hepatitis E.
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Affiliation(s)
- Mar Riveiro-Barciela
- Liver Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebrón, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
| | - Luisa Roade
- Liver Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebrón, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
| | - Joan Martínez-Camprecios
- Liver Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebrón, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
| | - Judit Vidal-González
- Liver Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebrón, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
| | - Basilio Rodríguez-Diez
- Rheumatology Department, Hospital Universitario Vall d'Hebrón, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Manel Perelló
- Nephrology Department, Hospital Universitario Vall d'Hebrón, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Guillermo Ortí
- Department of Hematology, Hospital Universitario Vall d'Hebrón, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Virginia Robles-Alonso
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Digestive System Research Unit, Hospital Universitario Vall d'Hebrón, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Cristina Berastegui
- Pneumology Department, Hospital Universitario Vall d'Hebrón, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Jordi Navarro
- Infectious Diseases Department, Hospital Universitario Vall d'Hebrón, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Fernando Martínez-Valle
- Systemic Autoimmune Diseases Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebrón, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
| | - Itxarone Bilbao
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Liver Transplant Unit, Hospital Universitario Vall d'Hebrón, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Lluis Castells
- Liver Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebrón, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
| | - Meritxell Ventura-Cots
- Liver Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebrón, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
| | - Jordi Llaneras
- Liver Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebrón, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
| | - Ariadna Rando-Segura
- Microbiology Department, Hospital Universitario Vall d'Hebrón, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Xavier Forns
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Hospital Clínic, Barcelona, IDIBAPS, Universidad de Barcelona, Spain
| | - Sabela Lens
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Hospital Clínic, Barcelona, IDIBAPS, Universidad de Barcelona, Spain
| | - Martín Prieto
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Liver Transplantation and Hepatology Unit, La Fe Hospital, Valencia, Spain
| | - María García-Eliz
- Liver Transplantation and Hepatology Unit, La Fe Hospital, Valencia, Spain
| | - Arkaitz Imaz
- Infectious Diseases Department, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francisco Rodríguez-Frías
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Liver Pathology Unit, Departments of Biochemistry and Microbiology, Clinical Laboratories, Vall d'Hebron University Hospital, Spain
| | - Maria Buti
- Liver Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebrón, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain.
| | - Rafael Esteban
- Liver Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebrón, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
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Chamoun B, Sánchez-Sancho P, Torres IB, Gabaldon A, Perelló M, Sellarés J, Moreso F, Serón D. Tocilizumab in the treatment of active chronic humoral rejection resistant to standard therapy. Nefrologia 2022; 42:578-584. [PMID: 36717307 DOI: 10.1016/j.nefroe.2021.06.010] [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: 01/29/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 06/18/2023] Open
Abstract
INTRODUCTION There is no consensus on the most appropriate treatment for chronic active antibody-mediated rejection (cAMR). Recent studies suggest that treatment with tocilizumab (TCZ) may stabilize graft function, decrease the intensity of donor-specific HLA antibodies (DSAs) and reduce inflammation of microcirculation. PATIENTS AND METHODS Observational study with renal allograft recipients diagnosed with cAMR (n = 5) who had not submitted a response to traditional treatment based on the combination of plasma replacements, immunoglobulins, and rituximab. Patients were told to be treated with TCZ as compassionate use in six doses per month (8 mg/kg/month). Renal function, proteinuria, and the intensity of DSAs were monitored during follow-up. RESULTS Five patients, average age 60 ± 13 years, three male and two retrasplants (cPRA average 55%) with preformed DSAs. Treatment with TCZ was initiated within 47 ± 52 days of biopsy. In two cases treatment was discontinued after the first dose, by severe bicitopenia with cytomegalovirus viremia and by graft failure, respectively. In the three patients who completed treatment, no stability of renal function (serum creatinine from 1.73 ± 0.70 to 2.04 ± 0.52 mg/dL, e-FGR 4 6 ± 15 to 36 ± 16 mL/min), showed increased proteinuria (3.2 ± 4.0 to 6.9 ± 11.0 g/g) and the intensity of DSAs maintain stable. No changes were observed in the degree of inflammation of microcirculation (g+pt 4.2 ± 0.8 vs. 4.3 ± 1.0) or in the degree of transplant glomerulopathy (cg 1.2 ± 0.4 vs. 1.8 ± 1.0). CONCLUSIONS TCZ therapy does not appear to be effective in modifying the natural history of chronic active antibody-mediated rejection, does not improve the degree of inflammation of microcirculation and does not reduces the intensity of DSAs.
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Affiliation(s)
- Betty Chamoun
- Servicio de Nefrología, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Pablo Sánchez-Sancho
- Servicio de Farmacia, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Irina B Torres
- Servicio de Nefrología, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Alejandra Gabaldon
- Servicio de Patología, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Manel Perelló
- Servicio de Nefrología, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Joana Sellarés
- Servicio de Nefrología, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Francesc Moreso
- Servicio de Nefrología, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Daniel Serón
- Servicio de Nefrología, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
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Chamoun B, Sánchez-Sancho P, Torres IB, Gabaldon A, Perelló M, Sellarés J, Moreso F, Serón D. Tocilizumab en el tratamiento del rechazo humoral crónico activo resistente a terapia estándar. Nefrologia 2022. [DOI: 10.1016/j.nefro.2021.06.009] [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: 10/20/2022] Open
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Verploegen MFA, Vargas-Poussou R, Walsh SB, Alpay H, Amouzegar A, Ariceta G, Atmis B, Bacchetta J, Bárány P, Baron S, Bayrakci US, Belge H, Besouw M, Blanchard A, Bökenkamp A, Boyer O, Burgmaier K, Calò LA, Decramer S, Devuyst O, van Dyck M, Ferraro PM, Fila M, Francisco T, Ghiggeri GM, Gondra L, Guarino S, Hooman N, Hoorn EJ, Houillier P, Kamperis K, Kari JA, Konrad M, Levtchenko E, Lucchetti L, Lugani F, Marzuillo P, Mohidin B, Neuhaus TJ, Osman A, Papizh S, Perelló M, Rookmaaker MB, Conti VS, Santos F, Sawaf G, Serdaroglu E, Szczepanska M, Taroni F, Topaloglu R, Trepiccione F, Vidal E, Wan ER, Weber L, Yildirim ZY, Yüksel S, Zlatanova G, Bockenhauer D, Emma F, Nijenhuis T. Parathyroid hormone and phosphate homeostasis in patients with Bartter and Gitelman syndrome: an international cross-sectional study. Nephrol Dial Transplant 2022; 37:2474-2486. [PMID: 35137195 PMCID: PMC9681919 DOI: 10.1093/ndt/gfac029] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 10/03/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Small cohort studies have reported high parathyroid hormone (PTH) levels in patients with Bartter syndrome and lower serum phosphate levels have anecdotally been reported in patients with Gitelman syndrome. In this cross-sectional study, we assessed PTH and phosphate homeostasis in a large cohort of patients with salt-losing tubulopathies. METHODS Clinical and laboratory data of 589 patients with Bartter and Gitelman syndrome were provided by members of the European Rare Kidney Diseases Reference Network (ERKNet) and the European Society for Paediatric Nephrology (ESPN). RESULTS A total of 285 patients with Bartter syndrome and 304 patients with Gitelman syndrome were included for analysis. Patients with Bartter syndrome type I and II had the highest median PTH level (7.5 pmol/L) and 56% had hyperparathyroidism (PTH >7.0 pmol/L). Serum calcium was slightly lower in Bartter syndrome type I and II patients with hyperparathyroidism (2.42 versus 2.49 mmol/L; P = .038) compared to those with normal PTH levels and correlated inversely with PTH (rs -0.253; P = .009). Serum phosphate and urinary phosphate excretion did not correlate with PTH. Overall, 22% of patients had low serum phosphate levels (phosphate-standard deviation score < -2), with the highest prevalence in patients with Bartter syndrome type III (32%). Serum phosphate correlated with tubular maximum reabsorption of phosphate/glomerular filtration rate (TmP/GFR) (rs 0.699; P < .001), suggesting renal phosphate wasting. CONCLUSIONS Hyperparathyroidism is frequent in patients with Bartter syndrome type I and II. Low serum phosphate is observed in a significant number of patients with Bartter and Gitelman syndrome and appears associated with renal phosphate wasting.
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Affiliation(s)
| | - Rosa Vargas-Poussou
- Department of Genetics, Centre de Références MARHEA, Hôpital Européen Georges Pompidou Assistance Publique Hôpitaux de Paris, Paris, France
| | - Stephen B Walsh
- Department of Renal Medicine, University College London, London, UK
| | - Harika Alpay
- Division of Paediatric Nephrology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Atefeh Amouzegar
- Division of Nephrology, Department of Medicine, Firoozgar Clinical Research Development Center, Iran University of Medical Sciences, Tehran, Iran
| | - Gema Ariceta
- Paediatric Nephrology Department, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Bahriye Atmis
- Department of Paediatric Nephrology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Justine Bacchetta
- Department of Paediatric Nephrology, Rheumatology and Dermatology, Reference Centre for Rare Renal Diseases, Reference Centre for Rare Diseases of Calcium and Phosphate Metabolism. University Children's Hospital, Lyon, France
| | - Peter Bárány
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Stéphanie Baron
- Department of Physiology, Hôpital Européen Georges Pompidou Assistance Publique Hôpitaux de Paris, Paris, France
| | - Umut Selda Bayrakci
- Department of Paediatric Nephrology, Ankara City Hospital, Üniversiteler Mahallesi Bilkent Caddesi, Çankaya/Ankara, Turkey
| | - Hendrica Belge
- Center for Human Genetics, Institute of Pathology and Genetics, Gosselies, Belgium
| | - Martine Besouw
- Department of Paediatric Nephrology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Anne Blanchard
- Clinical Research Centre 1418, Centre de Références MARHEA, Hôpital Européen Georges Pompidou Assistance Publique Hôpitaux de Paris, Paris, France,Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Arend Bökenkamp
- Department of Paediatric Nephrology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Olivia Boyer
- Department of Paediatric Nephrology, Necker Hospital, APHP, MARHEA, Imagine Institute, Paris University, Paris, France
| | - Kathrin Burgmaier
- Faculty of Medicine, University Hospital of Cologne, Children's and Adolescents' Hospital, Paediatric Nephrology, University of Cologne, Cologne, Germany
| | - Lorenzo A Calò
- Department of Medicine (DIMED), Nephrology, Dialysis, Transplantation, University of Padova, Padova, Italy
| | - Stéphane Decramer
- Department of Paediatric Nephrology. Centre de Références SORARE, Toulouse University Hospital, Toulouse, France
| | - Olivier Devuyst
- Division of Nephrology, UCLouvain Medical School, Brussels, Belgium; Institute of Physiology, Mechanism of Inherited Kidney Disorders Group, University of Zurich, Zurich, Switzerland
| | - Maria van Dyck
- Department of Paediatric Nephrology, University Hospital Leuven, Leuven, Belgium
| | - Pietro Manuel Ferraro
- U.O.S. Terapia Conservativa della Malattia Renale Cronica, U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marc Fila
- Pediatric Nephrology, CHU Arnaud de Villeneuve, Montpellier University Hospital, Montpellier, France
| | - Telma Francisco
- Department of Paediatric Nephrology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Gian Marco Ghiggeri
- Division of Nephrology, Dialysis and Transplantation, Istituto Giannina Gaslini, IRCCS, Genoa, Italy
| | - Leire Gondra
- Pediatric Nephrology Department, Cruces University Hospital, Barakaldo, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Spain; Paediatric Department, University of the Basque Country UPV/EHU, Leioa, Spain
| | - Stefano Guarino
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Nakysa Hooman
- Ali-Asghar Clinical Research Development Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Ewout J Hoorn
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Centre, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Pascal Houillier
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France,Department of Physiology, Centre de Références MARHEA, Hôpital Européen Georges Pompidou Assistance Publique Hôpitaux de Paris, Paris, France
| | - Konstantinos Kamperis
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jameela A Kari
- Pediatric Nephrology Centre of Excellence and Paediatric Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Martin Konrad
- Department of General Paediatrics, Paediatric Nephrology, University Hospital Münster, Munster, Germany
| | - Elena Levtchenko
- Department of Paediatric Nephrology & Department of Development and Regeneration, University Hospital Leuven, KU Leuven, Leuven, Belgium
| | - Laura Lucchetti
- Department of Paediatric Subspecialties, Division of Nephrology, Bambino Gesù Children's Hospital – IRCCS, Rome, Italy
| | - Francesca Lugani
- Division of Nephrology, Dialysis and Transplantation, Istituto Giannina Gaslini, IRCCS, Genoa, Italy
| | - Pierluigi Marzuillo
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Barian Mohidin
- Department of Renal Medicine, University College London, London, UK
| | - Thomas J Neuhaus
- Department of Paediatrics, Children's Hospital of Lucerne, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Abdaldafae Osman
- Paediatric Nephrology Unit, Great Ormond Street Hospital, London, UK
| | - Svetlana Papizh
- Department of Hereditary and Acquired Kidney Diseases, Research and Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Manel Perelló
- Nephrology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maarten B Rookmaaker
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Fernando Santos
- Department of Paediatrics, Asturias Central University Hospital, University of Oviedo, Oviedo, Spain
| | - Ghalia Sawaf
- Department of Paediatric Nephrology, Damascus Hospital, Damascus, Syria
| | - Erkin Serdaroglu
- Department of Paediatric Nephrology, Dr Behçet Uz Children's Hospital, Izmir, Turkey
| | - Maria Szczepanska
- Department of Paediatrics, Faculty of Medical Sciences in Zabrze, SUM in Katowice, Katowice, Poland
| | - Francesca Taroni
- Paediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Rezan Topaloglu
- Department of Paediatric Nephrology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Francesco Trepiccione
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Enrico Vidal
- Division of Paediatrics, Department of Medicine, University of Udine, Udine, Italy
| | - Elizabeth R Wan
- Department of Renal Medicine, University College London, London, UK
| | - Lutz Weber
- Faculty of Medicine, University Hospital of Cologne, Children's and Adolescents' Hospital, Paediatric Nephrology, University of Cologne, Cologne, Germany
| | - Zeynep Yuruk Yildirim
- Department of Paediatrics, Division of Paediatric Nephrology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Selçuk Yüksel
- Department of Paediatric Nephrology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Galia Zlatanova
- University Children's Hospital Medical University, Sofia, Bulgaria
| | - Detlef Bockenhauer
- Department of Renal Medicine, University College London, London, UK,Paediatric Nephrology Unit, Great Ormond Street Hospital, London, UK
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6
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Fernandez Rivera C, Calvo Rodríguez M, Poveda JL, Pascual J, Crespo M, Gomez G, Cabello Pelegrin S, Paul J, Lauzurica R, Perez Mir M, Moreso F, Perelló M, Andres A, González E, Fernandez A, Mendiluce A, Fernández Carbajo B, Sanchez Fructuoso A, Calvo N, Suarez A, Bernal Blanco G, Osuna A, Ruiz-Fuentes MC, Melilli E, Montero Perez N, Ramos A, Fernández B, López V, Hernandez D. Bioavailability of once-daily tacrolimus formulations used in clinical practice in the management of De Novo kidney transplant recipients: the better study. Clin Transplant 2021; 36:e14550. [PMID: 34851532 PMCID: PMC9285676 DOI: 10.1111/ctr.14550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/23/2021] [Revised: 10/26/2021] [Accepted: 11/13/2021] [Indexed: 12/21/2022]
Abstract
Multicenter, prospective, observational study to compare the relative bioavailability of once‐daily tacrolimus formulations in de novo kidney transplant recipients. De novo kidney transplant recipients who started a tacrolimus‐based regimen were included 14 days post‐transplant and followed up for 6 months. Data from 218 participants were evaluated: 129 in the LCPT group (Envarsus) and 89 in the PR‐Tac (Advagraf) group. Patients in the LCPT group exhibited higher relative bioavailability (Cmin /total daily dose [TDD]) vs. PR‐Tac (61% increase; P < .001) with similar Cmin and 30% lower TDD levels (P < .0001). The incidence of treatment failure was 3.9% in the LCPT group and 9.0% in the PR‐Tac group (P = .117). Study discontinuation rates were 6.2% in the LCPT group and 12.4% in the PR‐Tac group (P = .113). Adverse events, renal function and other complications were comparable between groups. The median accumulated dose of tacrolimus in the LCPT group from day 14 to month 6 was 889 mg. Compared to PR‐Tac, LCPT showed higher relative bioavailability, similar effectiveness at preventing allograft rejection, comparable effect on renal function, safety, adherence, treatment failure and premature discontinuation rates.
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Affiliation(s)
| | | | | | - Julio Pascual
- Nephrology Department, University Hospital del Mar, Barcelona, Spain
| | - Marta Crespo
- Nephrology Department, University Hospital del Mar, Barcelona, Spain
| | - Gonzalo Gomez
- Nephrology Department, University Hospital Son Espases, Palma de Mallorca, Spain
| | | | - Javier Paul
- Nephrology Department, Hospital Miguel Servet, Zaragoza, Spain
| | - Ricardo Lauzurica
- Nephrology Department, University Hospital Germans Trias y Pujol, Badalona, Spain
| | - Mònica Perez Mir
- Nephrology Department, University Hospital Germans Trias y Pujol, Badalona, Spain
| | - Francesc Moreso
- University Hospital Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Nephrology Department, Barcelona, Spain
| | - Manel Perelló
- University Hospital Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Nephrology Department, Barcelona, Spain
| | - Amado Andres
- Nephrology Department, University Hospital Doce de Octubre, Madrid, Spain
| | - Esther González
- Nephrology Department, University Hospital Doce de Octubre, Madrid, Spain
| | - Ana Fernandez
- Nephrology Department, University Hospital Ramón y Cajal, Madrid, Spain
| | - Alicia Mendiluce
- Nephrology Department, University Hospital Clínico de Valladolid, Valladolid, Spain
| | | | | | - Natividad Calvo
- Nephrology Department, University Hospital Clínico San Carlos, Madrid, Spain
| | - Alejandro Suarez
- Nephrology Department, University Hospital Virgen del Rocio, Sevilla, Spain
| | | | - Antonio Osuna
- Nephrology Department, University Hospital Virgen de las Nieves, Granada, Spain
| | | | - Edoardo Melilli
- Nephrology Department, University Hospital Bellvitge, Hospitalet de Llobregat, Spain
| | - Nuria Montero Perez
- Nephrology Department, University Hospital Bellvitge, Hospitalet de Llobregat, Spain
| | - Ana Ramos
- Nephrology Department, Fundación Jiménez Díaz, Madrid, Spain
| | | | - Verónica López
- University Hospital Regional, Málaga, IBIMA, University of Málaga, REDinREN (RED16/0009/0006), Nephrology Department, Spain
| | - Domingo Hernandez
- University Hospital Regional, Málaga, IBIMA, University of Málaga, REDinREN (RED16/0009/0006), Nephrology Department, Spain
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7
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Chamoun B, Torres IB, Gabaldón A, Sellarés J, Perelló M, Castellá E, Guri X, Salcedo M, Toapanta NG, Cidraque I, Moreso F, Seron D. Progression of Interstitial Fibrosis and Tubular Atrophy in Low Immunological Risk Renal Transplants Monitored by Sequential Surveillance Biopsies: The Influence of TAC Exposure and Metabolism. J Clin Med 2021; 10:jcm10010141. [PMID: 33406589 PMCID: PMC7796060 DOI: 10.3390/jcm10010141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/24/2020] [Revised: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 02/06/2023] Open
Abstract
The combination of tacrolimus (TAC) and mycophenolate is the most widely employed maintenance immunosuppression in renal transplants. Different surrogates of tacrolimus exposure or metabolism such as tacrolimus trough levels (TAC-C0), coefficient of variation of tacrolimus (CV-TAC-C0), time in therapeutic range (TTR), and tacrolimus concentration dose ratio (C/D) have been associated with graft outcomes. We explore in a cohort of low immunological risk renal transplants (n = 85) treated with TAC, mycophenolate mofetil (MMF), and steroids and then monitored by paired surveillance biopsies the association between histological lesions and TAC-C0 at the time of biopsy as well as CV-TAC-C0, TTR, and C/D during follow up. Interstitial inflammation (i-Banff score ≥ 1) in the first surveillance biopsy was associated with TAC-C0 (odds ratio (OR): 0.69, 95% confidence interval (CI): 0.50–0.96; p = 0.027). In the second surveillance biopsy, inflammation was associated with time below the therapeutic range (OR: 1.05 and 95% CI: 1.01–1.10; p = 0.023). Interstitial inflammation in scarred areas (i-IFTA score ≥ 1) was not associated with surrogates of TAC exposure/metabolism. Progression of interstitial fibrosis/tubular atrophy (IF/TA) was observed in 35 cases (41.2%). Multivariate regression logistic analysis showed that mean C/D (OR: 0.48; 95% CI: 0.25–0.92; p = 0.026) and IF/TA in the first biopsy (OR: 0.43, 95% CI: 0.24–0.77, p = 0.005) were associated with IF/TA progression between biopsies. A low C/D ratio is associated with IF/TA progression, suggesting that TAC nephrotoxicity may contribute to fibrosis progression in well immunosuppressed patients. Our data support that TAC exposure is associated with inflammation in healthy kidney areas but not in scarred tissue.
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Affiliation(s)
- Betty Chamoun
- Nephrology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (B.C.); (I.B.T.); (J.S.); (M.P.); (N.G.T.); (I.C.); (D.S.)
| | - Irina B. Torres
- Nephrology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (B.C.); (I.B.T.); (J.S.); (M.P.); (N.G.T.); (I.C.); (D.S.)
| | - Alejandra Gabaldón
- Pathology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (A.G.); (M.S.)
| | - Joana Sellarés
- Nephrology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (B.C.); (I.B.T.); (J.S.); (M.P.); (N.G.T.); (I.C.); (D.S.)
| | - Manel Perelló
- Nephrology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (B.C.); (I.B.T.); (J.S.); (M.P.); (N.G.T.); (I.C.); (D.S.)
| | - Eva Castellá
- Radiology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (E.C.); (X.G.)
| | - Xavier Guri
- Radiology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (E.C.); (X.G.)
| | - Maite Salcedo
- Pathology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (A.G.); (M.S.)
| | - Nestor G. Toapanta
- Nephrology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (B.C.); (I.B.T.); (J.S.); (M.P.); (N.G.T.); (I.C.); (D.S.)
| | - Ignacio Cidraque
- Nephrology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (B.C.); (I.B.T.); (J.S.); (M.P.); (N.G.T.); (I.C.); (D.S.)
| | - Francesc Moreso
- Nephrology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (B.C.); (I.B.T.); (J.S.); (M.P.); (N.G.T.); (I.C.); (D.S.)
- Department of Medicine, Autonomous University of Barcelona, 08035 Barcelona, Spain
- Correspondence: ; Tel.: +34-93-274-46-66
| | - Daniel Seron
- Nephrology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (B.C.); (I.B.T.); (J.S.); (M.P.); (N.G.T.); (I.C.); (D.S.)
- Department of Medicine, Autonomous University of Barcelona, 08035 Barcelona, Spain
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8
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Danés I, Pérez E, Pigrau C, Gracia RM, Perelló M, Sueiras M, Aguilera C, Agustí A. A case series of confusional states and other neurotoxic effects caused by ertapenem. Br J Clin Pharmacol 2020; 87:2140-2145. [PMID: 33010054 DOI: 10.1111/bcp.14582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/31/2020] [Accepted: 09/23/2020] [Indexed: 11/29/2022] Open
Abstract
Ten cases of ertapenem neurotoxicity, mainly confusional states, are described, some of them with fatal outcomes. The majority of patients (90%) had a creatinine clearance (CrCl) < 50 mL/min/1.73m2 at some point during treatment and hypoalbuminaemia was always present when ertapenem treatment was started. The pharmacokinetic and pharmacodynamic properties of this carbapenem could favour a different profile, and approved doses can be excessive in some patients with moderate renal failure (CrCl 31-59 mL/min/1.73 m2 ). It may be necessary to re-evaluate renal function during treatment and adjust doses or reconsider the adequacy of treatment based on clinical judgement, especially if relevant changes in the CrCl occur (i.e. a reduction to ≤30 mL/min/1.73 m2 ) or unexplained behavioural disorders are detected. The onset of the symptoms of ertapenem neurotoxicity can be insidious and go unnoticed, and so a knowledge and early suspicion of confusional states are important to improve the patient prognosis.
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Affiliation(s)
- Immaculada Danés
- Clinical Pharmacology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eulàlia Pérez
- Clinical Pharmacology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carles Pigrau
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Infectious Diseases Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Rosa M Gracia
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Intensive Care Medicine Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Manel Perelló
- Nephrology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Maria Sueiras
- Clinical Neurophysiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Cristina Aguilera
- Clinical Pharmacology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antònia Agustí
- Clinical Pharmacology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
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9
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Favà A, Cucchiari D, Montero N, Toapanta N, Centellas FJ, Vila-Santandreu A, Coloma A, Meneghini M, Manonelles A, Sellarés J, Torres I, Gelpi R, Lorenzo I, Ventura-Aguiar P, Cofan F, Torregrosa JV, Perelló M, Facundo C, Seron D, Oppenheimer F, Bestard O, Cruzado JM, Moreso F, Melilli E. Clinical characteristics and risk factors for severe COVID-19 in hospitalized kidney transplant recipients: A multicentric cohort study. Am J Transplant 2020; 20:3030-3041. [PMID: 32777153 PMCID: PMC7436908 DOI: 10.1111/ajt.16246] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/16/2020] [Accepted: 07/24/2020] [Indexed: 01/25/2023]
Abstract
Kidney transplant recipients might be at higher risk for severe coronavirus disease 2019 (COVID-19). However, risk factors for relevant outcomes remain uncertain in this population. This is a multicentric kidney transplant cohort including 104 hospitalized patients between March 4 and April 17, 2020. Risk factors for death and acute respiratory distress syndrome (ARDS) were investigated, and clinical and laboratory data were analyzed. The mean age was 60 years. Forty-seven patients (54.8%) developed ARDS. Obesity was associated to ARDS development (OR 2.63; P = .04). Significant age differences were not found among patients developing and not developing ARDS (61.3 vs 57.8 years, P = .16). Seventy-six (73%) patients were discharged, and 28 (27%) died. Death was more common among the elderly (55 and 70.8 years, P < .001) and those with preexisting pulmonary disease (OR 2.89, P = .009). At admission, higher baseline lactate dehydrogenase (257 vs 358 IU/mL, P = .001) or ARDS conferred higher risk of death (HR 2.09, P = .044). In our cohort, ARDS was equally present among young and old kidney recipients. However, the elderly might be at higher risk of death, along with those showing higher baseline LDH at admission.
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Affiliation(s)
- Alexandre Favà
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - David Cucchiari
- Nephrology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Nuria Montero
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain,Correspondence Nuria Montero
| | - Nestor Toapanta
- Nephrology Department, Hospital de Vall d’ Hebron, Barcelona, Spain
| | | | | | - Ana Coloma
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - Maria Meneghini
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - Anna Manonelles
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - Joana Sellarés
- Nephrology Department, Hospital de Vall d’ Hebron, Barcelona, Spain
| | - Irina Torres
- Nephrology Department, Hospital de Vall d’ Hebron, Barcelona, Spain
| | - Rosana Gelpi
- Nephrology Department, Fundació Puigvert, Barcelona, Spain
| | | | | | - Frederic Cofan
- Nephrology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Manel Perelló
- Nephrology Department, Hospital de Vall d’ Hebron, Barcelona, Spain
| | - Carme Facundo
- Nephrology Department, Fundació Puigvert, Barcelona, Spain
| | - Daniel Seron
- Nephrology Department, Hospital de Vall d’ Hebron, Barcelona, Spain
| | | | - Oriol Bestard
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - Josep M. Cruzado
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain,Josep M. Cruzado
| | - Francesc Moreso
- Nephrology Department, Hospital de Vall d’ Hebron, Barcelona, Spain
| | - Edoardo Melilli
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
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10
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Álvarez-López P, Riveiro-Barciela M, Oleas-Vega D, Flores-Cortes C, Román A, Perelló M, Berastegui C, Castells L, Esteban R, Buti M. Anti-HBc impacts on the risk of hepatitis B reactivation but not on survival of solid-organ transplant recipients. Medicine (Baltimore) 2020; 99:e19407. [PMID: 32118794 PMCID: PMC7478413 DOI: 10.1097/md.0000000000019407] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Immunosuppression can lead to hepatitis B virus (HBV) reactivation in hepatitis B core antigen antibodies (anti-HBc) positive patients, especially those undergoing chemotherapy, although there is limited data on solid organ recipients, especially lung transplantation. Our aim was to analyze the risk of HBV reactivation and the potential impact of anti-HBc-positive status (both donors and recipients) on prognosis in a lung, kidney, and liver transplantation cohort.Retrospective analysis including data from all transplants in adults (2011-2012) in a tertiary hospital, with prospective HBV serology study to assess the risk of reactivation and its possible impact on survival.In total, 392 transplant recipients were included (196 kidney, 113 lung, 83 liver). Pre-transplantation anti-HBc screening was more frequent in liver recipients (P < .001) and donors (P < .001) than in kidney or lung. Fifty-five (14%) recipients were anti-HBc-positive and were not undergoing antiviral prophylaxis. Three (5.4%) cases of HBV reactivation occurred: 2 in pre-transplant anti-HBc-positive recipients and 1 with prior unknown anti-HBc status. All were HBeAg+ with HBV deoxyribonucleic acid (DNA) >10E8 IU/mL and only mild fibrosis. Baseline recipient anti-HBc positive status was the only factor associated with HBV reactivation. No reactivation cases occurred in lung or kidney recipients of anti-HBc positive grafts. Survival was lower in lung transplants, especially in human immunodeficiency virus-infected patients and those with prior immunosuppression.Anti-HBc positive status is a risk factor for HBV reactivation in solid organ recipients. Anti-HBc testing is highly recommended in solid-organ transplant recipients in order to identify those anti-HBc positive and therefore candidates for periodical hepatitis B surface antigen (HBsAg) and HBV DNA screening after transplant.
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Affiliation(s)
| | - Mar Riveiro-Barciela
- Liver Unit, Internal Medicine Department
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid
| | | | | | - Antonio Román
- Pulmonology Service, Lung Transplant Program Vall d’Hebron Hospital, Barcelona, Spain
| | | | - Cristina Berastegui
- Pulmonology Service, Lung Transplant Program Vall d’Hebron Hospital, Barcelona, Spain
| | - Lluis Castells
- Liver Unit, Internal Medicine Department
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid
| | - Rafael Esteban
- Liver Unit, Internal Medicine Department
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid
| | - María Buti
- Liver Unit, Internal Medicine Department
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid
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11
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Sánchez Fructuoso A, Ruiz JC, Franco A, Diekmann F, Redondo D, Calviño J, Serra N, Aladrén MJ, Cigarrán S, Manonelles A, Ramos A, Gómez G, González Posada JM, Andrés A, Beneyto I, Muñiz AL, Perelló M, Lauzurica R. Effectiveness and safety of the conversion to MeltDose ® extended-release tacrolimus from other formulations of tacrolimus in stable kidney transplant patients: A retrospective study. Clin Transplant 2019; 34:e13767. [PMID: 31815310 PMCID: PMC7050537 DOI: 10.1111/ctr.13767] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 05/28/2019] [Revised: 11/14/2019] [Accepted: 11/25/2019] [Indexed: 12/24/2022]
Abstract
Tacrolimus is the cornerstone of immunosuppressive therapy after kidney transplantation. Its narrow therapeutic window mandates serum level strict monitoring and dose adjustments to ensure the optimal risk‐benefit balance. This observational retrospective study analyzed the effectiveness and safety of conversion from twice‐daily immediate‐release tacrolimus (IR‐Tac) or once‐daily prolonged‐release tacrolimus (PR‐Tac) to the recent formulation once‐daily MeltDose® extended‐release tacrolimus (LCP‐Tac) in 365 stable kidney transplant recipients. We compared kidney function three months before and three months after the conversion. Three months after conversion, the total daily dose was reduced ~35% (P < .0001), and improved bioavailability and stable serum LCP‐Tac concentrations were observed. There was no increase in the number of patients requiring tacrolimus dose adjustments after conversion. Renal function was unaltered, and no cases of BPAR were reported. Reports of tremors, as collected in the clinical histories for each patient, decreased from pre‐conversion (20.8%) to post‐conversion (11.8%, P < .0001). LCP‐Tac generated a cost reduction of 63% compared with PR‐Tac. In conclusion, the conversion strategy to LCP‐Tac from other tacrolimus formulations in stable kidney transplant patients showed safety and effectiveness in a real‐world setting, confirming the data from RCTs. The specific pharmacokinetic properties of LCP‐Tac could be potentially advantageous in patients with tacrolimus‐related adverse events.
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Affiliation(s)
| | - Juan Carlos Ruiz
- Nephrology, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Antonio Franco
- Nephrology, University Hospital General, Alicante, Spain
| | - Fritz Diekmann
- Nephrology, University Hospital Clinic, Barcelona, Spain
| | | | | | - Nuria Serra
- Nephrology, Fundación Puigvert, Barcelona, Spain
| | | | | | - Ana Manonelles
- Nephrology, University Hospital Bellvitge, Hospitalet de Llobregat, Spain
| | - Ana Ramos
- Nephrology, Fundación Jiménez Díaz, Madrid, Spain
| | - Gonzalo Gómez
- Nephrology, University Hospital son Espases, Palma de Mallorca, Spain
| | | | - Amado Andrés
- Nephrology, University Hospital Doce de Octubre, Madrid, Spain
| | | | | | - Manel Perelló
- Nephrology, University Hospital Vall de Hebrón, Barcelona, Spain
| | - Ricardo Lauzurica
- Nephrology, University Hospital Germans Trias y Pujol, Badalona, Spain
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12
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Sabé N, Oriol I, Melilli E, Manonelles A, Bestard O, Polo C, Los Arcos I, Perelló M, Garcia D, Riera L, Tebé C, Len Ò, Moreso F, Cruzado JM, Carratalà J. Antibiotic Treatment Versus No Treatment for Asymptomatic Bacteriuria in Kidney Transplant Recipients: A Multicenter Randomized Trial. Open Forum Infect Dis 2019; 6:ofz243. [PMID: 31214630 PMCID: PMC6563942 DOI: 10.1093/ofid/ofz243] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/20/2019] [Indexed: 12/23/2022] Open
Abstract
Background Whether antibiotic treatment of asymptomatic bacteriuria (AB) can prevent acute graft pyelonephritis (AGP) in kidney transplant (KT) recipients has not been elucidated. Methods In this multicenter, open-label, nonblinded, prospective, noninferiority, randomized controlled trial, we compared antibiotic treatment with no treatment for AB in KT recipients in the first year after transplantation when urinary catheters had been removed. The primary endpoint was the occurrence of AGP. Secondary endpoints included bacteremic AGP, cystitis, susceptibility of urine isolates, graft rejection, graft function, graft loss, opportunistic infections, need for hospitalization, and mortality. Results We enrolled 205 KT recipients between 2013 and 2015. AB occurred in 41 (42.3%) and 46 (50.5%) patients in the treatment and no treatment groups, respectively. There were no differences in the primary endpoint in the intention-to-treat population (12.2% [5 of 41] in the treatment group vs 8.7% [4 of 46] in the no treatment group; risk ratio, 1.40; 95% confidence interval, 0.40–4.87) or the per-protocol population (13.8% [4 of 29] in the treatment group vs 6.7% [3 of 45] in the no treatment group; risk ratio, 2.07, 95% confidence interval, 0.50–8.58). No differences were found in secondary endpoints, except for antibiotic susceptibility. Fosfomycin (P = .030), amoxicillin-clavulanic (P < .001) resistance, and extended-spectrum β-lactamase production (P = .044) were more common in KT recipients receiving antibiotic treatment for AB. Conclusions Antibiotic treatment of AB was not useful to prevent AGP in KT recipients and may increase antibiotic resistance. However, our findings should be regarded with caution, due to the small sample size analyzed.
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Affiliation(s)
- Núria Sabé
- Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Spanish Network for Research in Infectious Diseases (REIPI), and Clinical Sciences Department, Faculty of Medicine, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Isabel Oriol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Spanish Network for Research in Infectious Diseases (REIPI), and Clinical Sciences Department, Faculty of Medicine, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Edoardo Melilli
- Department of Nephrology, Hospital Universitari de Bellvitge-IDIBELL, and Clinical Sciences Department, Faculty of Medicine, L´Hospitalet de Llobregat, Barcelona, Spain
| | - Anna Manonelles
- Department of Nephrology, Hospital Universitari de Bellvitge-IDIBELL, and Clinical Sciences Department, Faculty of Medicine, L´Hospitalet de Llobregat, Barcelona, Spain
| | - Oriol Bestard
- Department of Nephrology, Hospital Universitari de Bellvitge-IDIBELL, and Clinical Sciences Department, Faculty of Medicine, L´Hospitalet de Llobregat, Barcelona, Spain
| | - Carolina Polo
- Department of Nephrology, Hospital Universitari de Bellvitge-IDIBELL, and Clinical Sciences Department, Faculty of Medicine, L´Hospitalet de Llobregat, Barcelona, Spain
| | - Ibai Los Arcos
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron-VHIR, Spanish Network for Research in Infectious Diseases (REIPI), Barcelona, Spain
| | - Manel Perelló
- Department of Nephrology, Hospital Universitari Vall d'Hebron-VHIR, Barcelona, Spain
| | - Dolors Garcia
- Department of Microbiology, Hospital Universitari de Bellvitge-IDIBELL, L´Hospitalet de Llobregat, Barcelona, Spain
| | - Lluís Riera
- Department of Urology, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain
| | - Cristian Tebé
- Statistical Assessment Service at Bellvitge Biomedical Research Institute (IDIBELL) and Department of Basic Sciences, Universitat Rovira i Virgili, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Òscar Len
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron-VHIR, Spanish Network for Research in Infectious Diseases (REIPI), Barcelona, Spain
| | - Francesc Moreso
- Department of Nephrology, Hospital Universitari Vall d'Hebron-VHIR, Barcelona, Spain
| | - Josep M Cruzado
- Department of Nephrology, Hospital Universitari de Bellvitge-IDIBELL, and Clinical Sciences Department, Faculty of Medicine, L´Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Spanish Network for Research in Infectious Diseases (REIPI), and Clinical Sciences Department, Faculty of Medicine, University of Barcelona, L'Hospitalet de Llobregat, Spain
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Los-Arcos I, Royuela M, Martín-Gómez MT, Alastruey-Izquierdo A, Sellarès J, Perelló M, Castells L, Dopazo C, Gavaldà J, Len O. Phaeohyphomycosis caused by Medicopsis romeroi in solid organ transplant recipients: Report of two cases and comprehensive review of the literature. Transpl Infect Dis 2019; 21:e13072. [PMID: 30865352 DOI: 10.1111/tid.13072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 12/04/2018] [Revised: 02/11/2019] [Accepted: 03/03/2019] [Indexed: 11/28/2022]
Abstract
Medicopsis romeroi is a melanized coelomycetous fungus, mainly found in tropical and subtropical regions and an uncommon cause of infection in solid organ transplant (SOT) recipients. We describe two cases of SOT recipients diagnosed with phaeohyphomycosis due to M romeroi and provide a comprehensive literature review. These infections should be considered in patients native to tropical countries with a localized skin and soft tissue infection. Sequencing is needed for accurate identification of uncommon melanized fungi. Surgical treatment is recommended to cure the infection and co-adjunctive oral antifungals should be considered.
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Affiliation(s)
- Ibai Los-Arcos
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Departament of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Meritxell Royuela
- Internal Medicine Department, ALTHAIA Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | | | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Joana Sellarès
- Nephrology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Manel Perelló
- Nephrology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Lluís Castells
- Liver Unit, Internal Medicine Department, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, CIBERehd, Barcelona, Spain
| | - Cristina Dopazo
- Department of HPB Surgery and Transplants, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Joan Gavaldà
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Departament of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oscar Len
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Departament of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Moreso F, Crespo M, Ruiz JC, Torres A, Gutierrez-Dalmau A, Osuna A, Perelló M, Pascual J, Torres IB, Redondo-Pachón D, Rodrigo E, Lopez-Hoyos M, Seron D. Treatment of chronic antibody mediated rejection with intravenous immunoglobulins and rituximab: A multicenter, prospective, randomized, double-blind clinical trial. Am J Transplant 2018; 18:927-935. [PMID: 28949089 DOI: 10.1111/ajt.14520] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [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: 04/13/2017] [Revised: 09/13/2017] [Accepted: 09/18/2017] [Indexed: 02/06/2023]
Abstract
There are no approved treatments for chronic antibody mediated rejection (ABMR). We conducted a multicenter, prospective, randomized, placebo-controlled, double-blind clinical trial to evaluate efficacy and safety of intravenous immunoglobulins (IVIG) combined with rituximab (RTX) (EudraCT 2010-023746-67). Patients with transplant glomerulopathy and anti-HLA donor-specific antibodies (DSA) were eligible. Patients with estimated glomerular filtration rate (eGFR) <20 mL/min per 1.73m2 and/or severe interstitial fibrosis/tubular atrophy were excluded. Patients were randomized to receive IVIG (4 doses of 0.5 g/kg) and RTX (375 mg/m2 ) or a wrapped isovolumetric saline infusion. Primary efficacy variable was the decline of eGFR at one year. Secondary efficacy variables included evolution of proteinuria, renal lesions, and DSA at 1 year. The planned sample size was 25 patients per group. During 2012-2015, 25 patients were randomized (13 to the treatment and 12 to the placebo group). The planned patient enrollment was not achieved because of budgetary constraints and slow patient recruitment. There were no differences between the treatment and placebo groups in eGFR decline (-4.2 ± 14.4 vs. -6.6 ± 12.0 mL/min per 1.73 m2 , P-value = .475), increase of proteinuria (+0.9 ± 2.1 vs. +0.9 ± 2.1 g/day, P-value = .378), Banff scores at one year and MFI of the immunodominant DSA. Safety was similar between groups. These data suggest that the combination of IVIG and RTX is not useful in patients displaying transplant glomerulopathy and DSA.
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Affiliation(s)
- Francesc Moreso
- Nephrology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Crespo
- Nephrology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Juan C Ruiz
- Nephrology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Armando Torres
- Nephrology Department, Hospital Universitario de Canarias, La Laguna, Spain
| | | | - Antonio Osuna
- Nephrology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Manel Perelló
- Nephrology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julio Pascual
- Nephrology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Irina B Torres
- Nephrology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Emilio Rodrigo
- Nephrology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Marcos Lopez-Hoyos
- Immunology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Daniel Seron
- Nephrology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Gentil MA, González-Corvillo C, Perelló M, Zarraga S, Jiménez-Martín C, Lauzurica LR, Alonso A, Franco A, Hernández-Marrero D, Sánchez-Fructuoso A. Hepatitis C Treatment With Direct-Acting Antivirals in Kidney Transplant: Preliminary Results From a Multicenter Study. Transplant Proc 2017; 48:2944-2946. [PMID: 27932113 DOI: 10.1016/j.transproceed.2016.07.034] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 07/27/2016] [Indexed: 01/27/2023]
Abstract
Hepatitis C (HC) is a very relevant negative prognosis factor for graft and transplant recipient survival. New direct-acting antivirals (DAAs) allow us to solve this problem in an effective way. It is crucial to understand their real impact in our daily practice. We analyzed treatment results with DAA, free of interferon, in kidney transplant recipients (KTRs) from 15 Spanish hospitals (Grupo Español de Actualización en Trasplante), regarding effectiveness, tolerance, and impact on immunosuppression, renal function-proteinuria, and diabetes. One hundred nineteen KTRs were included (9 combined liver-kidney transplants). The main DAA used was sofobusvir (91%) combined with ledipasvir (55%), simeprevir (14%), or daclatasvir (13%); in 9 cases (7%), a paritaprevir-ritonavir-ombitasvir-dasabuvir combination (3D) was used; Ribavirin was used as a coadjuvant in 18%. Side effects were limited (23.5%) and without relevance in general, except in 7 patients for whom we needed to interrupt the treatment due to neurotoxicity (1) caused by drug interaction (3D and tacrolimus) or anemia (3) by Ribavirin or others. Ninety-four patients had completed the treatment when data were analyzed: virological response was seen in 97.8% % of cases. Liver function analysis improved: 84% normal versus 21% before starting the treatment (P < .001). Renal function and proteinuria did not change. Tacrolimus level at the end of DAA-treatment was significantly lower with respect to the beginning (5.8 ± 2.1 ng/mL vs. 7.4 ± 1.8 ng/mL, P = .03), despite a slight increase in the dose (2.6 mg/d vs. 2.3 mg/d, P = .17). DAA are highly effective in the treatment of hepatitis C in KTRs with good tolerance in general, making it possible to solve the problem and have a good chance to improve the prognosis in our transplantation patients. The use of these therapies in KTRs requires special control and coordination with digestive professionals, especially if 3D or Ribavirin is used.
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Affiliation(s)
- M A Gentil
- Department of Nephrology, Hospital Virgen Del Rocio, Sevilla, Spain
| | | | - M Perelló
- Department of Nephrology, Hospital Vall D'Hebron, Barcelona, Spain
| | - S Zarraga
- Department of Nephrology, Hospital De Cruces, Baracaldo, Spain
| | | | - L R Lauzurica
- Department of Nephrology, Hospital Germans Trias I Pujol, Badalona, Spain
| | - A Alonso
- Department of Nephrology, Complejo Hospitalario De A Coruña, A Coruña, Spain
| | - A Franco
- Department of Nephrology, Hospital San Juan, Alicante, Spain
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16
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García Carro C, Azancot MA, Arredondo K, Juliana J, Sellarés J, Perelló M, Cantarell C, Trilla E, Salcedo M, Moreso F, Serón D. FP895USEFULNESS OF KIDNEY PREIMPLANTATION BIOPSIES FROM DECEASED DONORS FOR KIDNEY TRANSPLANT ALLOCATION. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv185.84] [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: 11/13/2022] Open
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17
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Ariceta G, Camacho JA, Fernández-Obispo M, Fernández-Polo A, Gamez J, García-Villoria J, Lara Monteczuma E, Leyes P, Martín-Begué N, Oppenheimer F, Perelló M, Morell GP, Torra R, Santandreu AV, Güell A. Cystinosis in adult and adolescent patients: Recommendations for the comprehensive care of cystinosis. Nefrologia 2015; 35:304-321. [PMID: 26523297 DOI: 10.1016/j.nefroe.2015.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
INTRODUCTION Cystinosis is a rare lysosomal systemic disease that mainly affects the kidney and the eye. Patients with cystinosis begin renal replacement therapy during the first decade of life in absence of treatment. Prognosis of cystinosis depends on early diagnosis, and prompt starting and good compliance with cysteamine treatment. Kidney disease progression, extra-renal complications and shorter life expectancy are more pronounced in those patients that do not follow treatment. The objective of this work was to elaborate recommendations for the comprehensive care of cystinosis and the facilitation of patient transition from paediatric to adult treatment, based on clinical experience. The goal is to reduce the impact of the disease, and to improve patient quality of life and prognosis. METHODS Bibliographic research and consensus meetings among a multidisciplinary professional team of experts in the clinical practice, with cystinotic patients (T-CiS.bcn group) from 5 hospitals located in Barcelona. RESULTS This document gathers specific recommendations for diagnosis, treatment and multidisciplinary follow-up of cystinotic patients in the following areas: nephrology, dialysis,renal transplant, ophthalmology, endocrinology, neurology, laboratory, genetic counselling,nursing and pharmacy. CONCLUSIONS A reference document for the comprehensive care of cystinosis represents a support tool for health professionals who take care of these patients. It is based on the following main pillars: (a) a multi-disciplinary approach, (b) appropriate disease monitoring and control of intracellular cystine levels in leukocytes, (c) the importance of adherence to treatment with cysteamine, and (d) the promotion of patient self-care by means of disease education programmes. All these recommendations will lead us, in a second phase, to create a coordinated transition model between paediatric and adult care services which will contemplate the specific needs of cystinosis.
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Torres IB, Salcedo M, Moreso F, Sellarés J, Castellá E, Azancot MA, Perelló M, Cantarell C, Serón D. Comparing transplant glomerulopathy in the absence of C4d deposition and donor-specific antibodies to chronic antibody-mediated rejection. Clin Transplant 2014; 28:1148-54. [DOI: 10.1111/ctr.12433] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2014] [Indexed: 01/15/2023]
Affiliation(s)
- Irina B. Torres
- Department of Nephrology; Hospital Universitari Vall d'Hebron; Universitat Autònoma Barcelona; Barcelona Spain
| | - Maite Salcedo
- Department of Pathology; Hospital Universitari Vall d'Hebron; Universitat Autònoma Barcelona; Barcelona Spain
| | - Francesc Moreso
- Department of Nephrology; Hospital Universitari Vall d'Hebron; Universitat Autònoma Barcelona; Barcelona Spain
| | - Joana Sellarés
- Department of Nephrology; Hospital Universitari Vall d'Hebron; Universitat Autònoma Barcelona; Barcelona Spain
| | - Eva Castellá
- Department of Radiology; Hospital Universitari Vall d'Hebron; Universitat Autònoma Barcelona; Barcelona Spain
| | - M. Antonieta Azancot
- Department of Nephrology; Hospital Universitari Vall d'Hebron; Universitat Autònoma Barcelona; Barcelona Spain
| | - Manel Perelló
- Department of Nephrology; Hospital Universitari Vall d'Hebron; Universitat Autònoma Barcelona; Barcelona Spain
| | - Carme Cantarell
- Department of Nephrology; Hospital Universitari Vall d'Hebron; Universitat Autònoma Barcelona; Barcelona Spain
| | - Daniel Serón
- Department of Nephrology; Hospital Universitari Vall d'Hebron; Universitat Autònoma Barcelona; Barcelona Spain
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Moreso F, Torres IB, Martínez-Gallo M, Benlloch S, Cantarell C, Perelló M, Jimeno J, Pujol-Borrell R, Seron D. Gene expression signature of tolerance and lymphocyte subsets in stable renal transplants: Results of a cross-sectional study. Transpl Immunol 2014; 31:11-6. [DOI: 10.1016/j.trim.2014.04.008] [Citation(s) in RCA: 23] [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: 02/02/2014] [Revised: 04/12/2014] [Accepted: 04/23/2014] [Indexed: 10/25/2022]
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Azancot MA, Cantarell C, Perelló M, Torres IB, Serón D, Seron D, Moreso F, Arias M, Campistol JM, Curto J, Hernandez D, Morales JM, Sanchez-Fructuoso A, Abraira V. Estimation of renal allograft half-life: fact or fiction? Nephrol Dial Transplant 2011; 26:3013-8. [PMID: 21292814 DOI: 10.1093/ndt/gfq788] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Renal allograft half-life time (t½) is the most straightforward representation of long-term graft survival. Since some statistical models overestimate this parameter, we compare different approaches to evaluate t½. PATIENTS AND METHODS Patients with a 1-year functioning graft transplanted in Spain during 1990, 1994, 1998 and 2002 were included. Exponential, Weibull, gamma, lognormal and log-logistic models censoring the last year of follow-up were evaluated. The goodness of fit of these models was evaluated according to the Cox-Snell residuals and the Akaike's information criterion (AIC) was employed to compare these models. RESULTS We included 4842 patients. Real t½ in 1990 was 14.2 years. Median t½ (95% confidence interval) in 1990 and 2002 was 15.8 (14.2-17.5) versus 52.6 (35.6-69.5) according to the exponential model (P < 0.001). No differences between 1990 and 2002 were observed when t½ was estimated with the other models. In 1990 and 2002, t½ was 14.0 (13.1-15.0) versus 18.0 (13.7-22.4) according to Weibull, 15.5 (13.9-17.1) versus 19.1 (15.6-22.6) according to gamma, 14.4 (13.3-15.6) versus 18.3 (14.2-22.3) according to the log-logistic and 15.2 (13.8-16.6) versus 18.8 (15.3-22.3) according to the lognormal models. The AIC confirmed that the exponential model had the lowest goodness of fit, while the other models yielded a similar result. CONCLUSIONS The exponential model overestimates t½, especially in cohorts of patients with a short follow-up, while any of the other studied models allow a better estimation even in cohorts with short follow-up.
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Affiliation(s)
- M Antonieta Azancot
- Department of Nephrology, Hospital Universitari Vall d'Hebron, Barcelona, Spain. [corrected]
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Moreno G, Perelló M, Camihort G, Luna G, Console G, Gaillard RC, Spinedi E. Impact of transient correction of increased adrenocortical activity in hypothalamo-damaged, hyperadipose female rats. Int J Obes (Lond) 2005; 30:73-82. [PMID: 16231033 DOI: 10.1038/sj.ijo.0803109] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To explore the effects of transient correction of enhanced corticoadrenal activity in monosodium L-glutamate (MSG)-damaged female rats on peripheral insulin sensitivity and in vitro retroperitoneal (RP) adipocyte function. DESIGNS A dose of 4 mg/g body weight (BW) of MSG or vehicle (CTR) was i.p. injected, once every 2 days, between days 2 and 10 of age, in female rats. Intact and 21 day-operated (sham or adrenal enucleation (AE)) rats from both (CTR and MSG) groups were used for experimentation on day 120 of age. Circulating levels of several hormones, in basal and after i.v. high-glucose load conditions, and RP adiposity morphology and function were then evaluated. RESULTS MSG rats developed increased adrenocortical function, hyperadiposity, hyperleptinemia, hyperinsulinemia and decreased peripheral insulin sensitivity. These characteristics were fully reversed after transient correction of corticoadrenal hyperactivity induced by AE. In addition, in vitro experimentation with isolated RP adipocytes indicated that cells from intact MSG animals displayed decreased sensitivity to insulin and dexamethasone stimulation of leptin secretion. Interestingly, adipocyte dysfunction in MSG rats was fully abrogated after AE-induced transient correction of insulinemia, leptinemia and adrenocortical activity. Importantly, the reversion of these metabolic abnormalities, induced by AE for 21 days, in MSG animals did occur, despite no significant changes in BW values. CONCLUSION Our results support that the changes in adipocyte characteristics and peripheral insulin resistance, developed in this pseudo-obese female rat model, are mainly due to increased glucocorticoid production. Importantly, appropriate correction of the enhanced adrenocortical activity fully reversed these abnormal functions.
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Affiliation(s)
- G Moreno
- Neuroendocrine Unit, Multidisciplinary Institute on Cell Biology (CONICET-CICPBA), La Plata, Argentina
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Chisari AN, Giovambattista A, Perelló M, Gaillard RC, Spinedi ES. Maternal undernutrition induces neuroendocrine immune dysfunction in male pups at weaning. Neuroimmunomodulation 2001; 9:41-8. [PMID: 11435751 DOI: 10.1159/000049006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The present study was designed to assess the effect of maternal undernutrition, during gestation and lactation, on the neuroendocrine [hypothalamo-pituitary-adrenal (HPA)]-immune axis response to endotoxin (LPS) administration. For this purpose, 21-day-old male rats from both well-nourished (WN) and undernourished (UN) mothers were examined 2 h after injection (i.p.) of vehicle alone (VEH) or containing LPS (130 microg/kg BW). Circulating levels of glucose (GLU), ACTH, corticosterone (B), tumor necrosis factor-alpha (TNFalpha) and leptin were explored. The results indicate that: (a) mother body weight was significantly (p < 0.05) reduced, as a consequence of UN, at the second and third weeks of pregnancy; (b) no differences in basal glycemia were found in the two groups of pups, and LPS treatment did not induce hypoglycemia, in either group; (c) basal plasma ACTH, B and TNFalpha levels were similar in the two groups, and LPS-induced ACTH, B and TNFalpha secretions, although severalfold higher than respective VEH values (p < 0.05) in pups from WN mothers, were fully (ACTH and B) and partially (TNFalpha) abolished in products from UN mothers; (d) both mean body weights and basal plasma leptin levels were significantly (p < 0.05) lower in pups from UN than from WN mothers, and LPS administration did not modify plasma leptin values in products from both groups. In addition, results of dispersed total adrenal cells incubated in vitro indicate that: (a) both basal and ACTH (22 pM)-induced B secretion were significantly (p < 0.05) lower in cells from UN than WN pups, and (b) leptin (100 nM) was able to inhibit partially ACTH-stimulated B output by adrenal gland (AG) cells from WN pups; however, it failed to inhibit ACTH-stimulated glucocorticoid release by AG cells from UN pups. The present results indicate that undernutrition in mothers, during the very critical periods of gestation and lactation, induces in their male pups at weaning: (a) reduced circulating leptin levels and body weight values; (b) metabolic adaptation to normal carbohydrate metabolism; (c) hyporesponsiveness of the HPA and immune (TNFalpha) axes during endotoxemia, and (d) leptin resistance at the adrenocortical level. This study strongly supports that undernutrition of mothers results in neuroendocrine immune dysfunction of their pups; however, adrenal resistance to the inhibitory effect of leptin on glucocorticoid output is developed, probably as an adaptive mechanism to counteract unfavorable metabolic conditions.
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Affiliation(s)
- A N Chisari
- Neuroendocrine Unit, Multidisciplinary Institute on Cell Biology (CIC-CONICET), La Plata, Argentina
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Abstract
We describe structural studies carried out with some basic proteins found in association with DNA in the spermatozoa of molluscs and echinoderms. We have studied proteins related to histone H1 as well as protamines. Structural prediction methods show that these proteins have a strong helical potential and contain several turns, mainly of the SPKK type. No beta structures were found. Strong structural similarities have been detected between distantly related species. The presence of helical regions is confirmed by circular dichroism in trifluoroethanol solution. The influence of the SPKK turns is also evident in the CD spectra. In proteins which contain a high percentage of arginine we conclude that conventional prediction methods should be modified in order to allow for a higher helical potential for this amino acid residue. Synthetic peptides with a sequence present in the C-terminal region of histone H1 have also been studied. It was found that octapeptides may only acquire a small amount of structure, whereas hexadecapeptides are 50-60% helical. These studies strongly suggest that both protamines and proteins related to the C-terminal part of histone H1 interact with DNA mainly in the alpha-helical conformation.
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Affiliation(s)
- N Verdaguer
- Departament d'Enginyeria Química, ETSEIB, Universitat Politècnica de Catalunya, Barcelona, Spain
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