Activation de la voie alterne du complément dans les formes sévères de COVID-19

Introduction

Le SARS-CoV-2 est désormais responsable de plus de 4 millions de décès dans le monde. Les formes sévères de COVID-19 sont caractérisées par un état d’hyperinflammation, et l’utilisation de la corticothérapie a réduit significativement la mortalité. Des thérapies complémentaires plus spécifiques pourraient permettre d’améliorer la prise en charge des patients présentant des formes sévères. Dans ce contexte, les voies de signalisation en lien avec le système du complément semblent etre une cible idéale : on retrouve une surreprésentation des voies du compléments dans les cellules épithéliales pulmonaires, une élévation des marqueurs d’activation de la cascade du complément dans le plasma des patients atteints de COVID-19, et des déficits congénitaux dans les protéines de régulation du complément ont été associées à des formes plus sévères de la maladie. Cependant, nos connaissances des voies spécifiques activées du complément et leur lien avec la sévérité de la maladie restent limitées.

Patients et méthodes

Durant la première vague épidémique en France, nous avons recueilli les prélèvements de 32 patients COVID-19 présentant des niveaux de sévérité différents de la maladie. Nous avons déterminé l’expression ARN de 28 gènes du système du complément et les concentrations sériques de 6 protéines, représentant les trois voies du complément.

Résultats

L’expression des gènes du complément étaient régulées de façon différentielle selon la gravité de la COVID-19 : alors que la voie classique était activée chez tous les patients infectés, la forme sévère de la maladie était associée à une suractivation de la voie de la lectine et de la voie alterne, dont l’expression corrélait avec les marqueurs de l’inflammation et de coagulation. De plus, la properdine, régulateur positif majeur de la voie alterne, était exprimé à des niveaux élevés (ARN) chez les patients les plus graves, tandis que leurs niveaux protéiques étaient diminués, suggérant une consommation importante et la déposition au niveau des sites de l’activation du complément. De façon intéressante, les concentrations sériques basses de properdine étaient significativement associées au recours à la ventilation mécanique.

Conclusion

Cette étude apporte un éclairage sur le rôle potentiel de la voie alterne du complément dans les formes graves de COVID-19. Bien que des études histologiques et mécanistiques ainsi qu’une confirmation de ces résultats sur une plus grande cohorte soient nécessaires, ces résultats sont en faveur d’essais ciblant la voie alterne du complément chez les patients présentant des formes sévères de COVID-19.

Type I interferon response and vascular alteration in chilblain-like lesions during the COVID-19 outbreak

Background

The outbreak of chilblain‐like lesions (CLL) during the COVID‐19 pandemic has been reported extensively, potentially related to SARS‐CoV‐2 infection, yet its underlying pathophysiology is unclear.

Objectives

To study skin and blood endothelial and immune system activation in CLL in comparison with healthy controls and seasonal chilblains (SC), defined as cold‐induced sporadic chilblains occurring during 2015 and 2019 with exclusion of chilblain lupus.

Methods

This observational study was conducted during 9–16 April 2020 at Saint‐Louis Hospital, Paris, France. All patients referred with CLL seen during this period of the COVID‐19 pandemic were included in this study. We excluded patients with a history of chilblains or chilblain lupus. Fifty patients were included.

Results

Histological patterns were similar and transcriptomic signatures overlapped in both the CLL and SC groups, with type I interferon polarization and a cytotoxic–natural killer gene signature. CLL were characterized by higher IgA tissue deposition and more significant transcriptomic activation of complement and angiogenesis factors compared with SC. We observed in CLL a systemic immune response associated with IgA antineutrophil cytoplasmic antibodies in 73% of patients, and elevated type I interferon blood signature in comparison with healthy controls. Finally, using blood biomarkers related to endothelial dysfunction and activation, and to angiogenesis or endothelial progenitor cell mobilization, we confirmed endothelial dysfunction in CLL.

Conclusions

Our findings support an activation loop in the skin in CLL associated with endothelial alteration and immune infiltration of cytotoxic and type I IFN‐polarized cells leading to clinical manifestations.

Activation endothéliale associée aux ANCA IgA au cours des lésions de lésions acrales pendant l’épidémie de COVID-19

Introduction

Matériel et méthodes

Résultats

Discussion

Trigeminocerebellar and trigemino-olivary projections in rats

Retrograde and anterograde neuronal tracers (HRP, biocytin, biotinylated dextran-amine) were used to study the organisation of trigeminocerebellar and trigemino-olivary connections, focusing on the connectivity between trigeminal nuclear regions and the sagittal zones of the rat cerebellar cortex. Trigeminocerebellar projections were bilateral, but mostly ipsilateral. Direct trigeminocerebellar fibres originated mostly in the principal trigeminal nucleus (VP) and pars oralis (Vo), pars interpolaris (Vi), and to a lesser extent in pars caudalis (Vc) of the spinal trigeminal nucleus. Consistent projections were found from the Vc to cerebellar lobules IX and X. The trigeminal fibres terminated in the cerebellum in an organised fashion. The ventral part of the VP, Vo and Vi projected to the medial A zone and the C3 and D2 subzones, whereas the dorsal part of the nuclei projected to the lateral A zone and the C2, D0 and D1 subzones. In lobules IX and X, the organisation was different. The medial half of the VP, Vo, Vi and Vc projected to the lateral aspects of these lobules whereas their lateral part projected to their medial aspects. Trigeminal projections to the deep cerebellar nuclei were also present. Projections to a given sagittal zone concomitantly reached its corresponding nuclear target. Trigemino-olivary projections were principally contralateral. The Vo, Vi and Vc projected to the rostromedial dorsal accessory olive, the adjacent dorsal leaf and the dorsomedial part of the ventral leaf of the principal olive, which are known to project subzones C3, D0 and D1 of the rat cerebellar cortex.

Nucleus medialis-nucleus interpositus interface: its olivary and cerebellocortical projections in the rat

The nuclear target of the X zone of the cerebellar cortex was identified in rats as clusters of neurons scattered at the interface between the nuclei medialis (NM) and interpositus (NI). In a previous study, we had outlined these target neurons and termed them "interstitial cell groups" (icg). In order to determine whether the icg should be considered as part of either the NM or the medial NI, we analyzed two efferent pathways from the icg: their nucleocortical and nucleoolivary projections. These were compared to their homologues from the NM and the NI. This analysis is based on mapping retrograde cell labeling and anterograde terminal labeling following microinjections of tracers in either the cerebellar cortex, the cerebellar nuclei, or the inferior olive. Nucleocortical projections originating from the icg are of the three types described previously: a "reciprocal" projection to the ipsilateral X zone, a "nonreciprocal" projection to the ipsilateral A zone, and a "symmetrical" projection to the contralateral X zone. These features can be considered as the summed characteristics of the nucleocortical projections from the NM and from the medial NI. Nucleoolivary projections from the icg target the lateral-rostral portion of the dorsal accessory olive as well as the centrocaudal part of the medial accessory olive. These pathways converge with the nucleoolivary projections from the medial NI and from the NM, respectively. The icg receives olivary afferents from both the regions of the dorsal and medial accessory olives to which it projects. On the basis of similarities shown here between the two types of efferents originating from the icg and those from the NM as well as the medial NI, the icg may be regarded as a "mosaic" of neuron clusters alternately belonging to the NM and the medial NI. Therefore, the icg would be reciprocally connected with the inferior olive.

Cerebellar afferences from the mesencephalic trigeminal nucleus in the rat

The aim of the present study was to test for and characterize the organization of a direct projection from neurones of the trigeminal mesencephalic nucleus (Vme) to the cerebellum. WGA-HRP was used as a retrograde tracer following injections in the cerebellar cortex. The extent of each injection site within the sagittal zones was determined according to corticonuclear and olivocortical connections. Retrogradely labelled neurons were observed in the caudal part of the ipsilateral Vme only following vermal injection. The Vme projections reached exclusively the ipsilateral sagittal zone X in the anterior lobe, lobule VI and lobule IX. This identification was confirmed by anterograde labelling of mossy fibre terminals following a biocytin injection restricted to the Vme.

On the caudal extension of the X zone in the cerebellar cortex of the rat

Following a selective injection of biotinylated dextran amine in the nuclear target (the interstitial cell groups, icg) of the X zone of the rat cerebellum, retrogradely labelled Purkinje cells (PCs) were found within a longitudinal strip of cortex, 250 microns in width, 1000 microns lateral to midline. This labelling delineates two compartments in the X zone, one rostral through lobules II-VI, and one caudal through lobules VIII-X. The whole rostrocaudal extent of the icg appears to be the target of PCs from both compartments without any apparent topographical organization.

The X zone and CX subzone of the cerebellum in the rat

The existence of an X zone (lateral to the A zone) and a CX subzone (lateral to the C1 subzone) was documented within the anterior lobe and lobule VI in cats and primates. On the basis of their respective efferent and climbing fibre (CF) afferent connections, delineation of these two cortical subdivisions has been investigated here, in the rat, using small injections of WGA-HRP in the cerebellar cortex. We observe that both X and CX are "fractured" into a rostral and a caudal compartment. The rostral compartment of the X zone extends over lobules IV, V and VI and its caudal compartment over lobules VIII, IX and X. The rostral compartment of the CX subzone seems to be restricted to lobules V and VI, its caudal compartment cannot be topographically distinguished, over lobules IX and X, from the caudal compartment of the X zone. The olivary afferents to the X zone and the CX subzone arise from the horizontal and vertical lamellae of the medial accessory olive: subnucleus a projects into the rostral compartment and lobule VIII of the X zone. Subnuclei b and c project into the rostral compartment of both X and CX. The dorsomedial cell column selectively projects onto the caudal compartment of both X and CX over the vestibulo-cerebellum. The corticonuclear projections of the X zone have been found within the junctional region between the nucleus medialis and the nucleus interpositus (NI), here defined as the interstitial cell groups (icg), the corticonuclear projections of the CX subzone within the medial NI. It is suggested that the icg correspond to clusters of neurones dissociated from the medial aspect of the NI. We therefore consider the X zone and CX subzone of the rat, on the basis of their corticonuclear efferents, as "medial C1" and "lateral C1" subzone, respectively, although both may be regarded as part of the A zone on the basis of their olivary afferents.

Extraction of physostigmine from biologic fluids and analysis by liquid chromatography with electrochemical detection

A rapid and simple method is described for the extraction of physostigmine (Phy) and its hydrolysis product, eseroline, from plasma, whole blood, and cerebrospinal fluid (CSF) and their subsequent quantitation by high-performance liquid chromatography (HPLC) with dual electrode electrochemical detection. Phy and eseroline were extracted from biologic fluids with cyano-phase columns eluted with 0.1 M citrate buffer, pH 4 containing 20% acetonitrile. Phy recovery from citrate buffer and CSF was nearly 100%. Phy recovery from plasma was 82% when methanol was used to precipitate proteins and 62% when HClO4 was used to precipitate proteins. Phy recovery from whole blood was only 17%. These results are discussed in the context of attempting to measure Phy in fluids of patients receiving this drug in clinical trials for the treatment of Alzheimer's disease.