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Cattaneo V, Belkoniene M, Porret R, Harr T, Muller YD. [Understanding hypersensitivity reactions to monoclonal antibodies]. Rev Med Suisse 2024; 20:705-710. [PMID: 38568064 DOI: 10.53738/revmed.2024.20.868.705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Biologic drugs are complex molecules synthesized by a living organism. Their use is increasingly prevalent across all medical specialties, exposing a growing number of patients to potential adverse reactions. In this review, we discuss the new classification of hypersensitivity reactions, along with the specific characteristics of monoclonal antibodies. We also address the available diagnostic tools and discuss the management of those reactions, including for patients requiring the continuation of these biologic drugs.
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Affiliation(s)
- Viola Cattaneo
- Service d'immunologie et allergies, Département de médecine interne, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Mhedi Belkoniene
- Service d'immunologie et allergies, Département de médecine interne, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Raphaël Porret
- Service d'immunologie et allergies, Département de médecine interne, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Thomas Harr
- Service d'immunologie et allergologie, Département de médecine interne, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Yannick D Muller
- Service d'immunologie et allergies, Département de médecine interne, Centre hospitalier universitaire vaudois, 1011 Lausanne
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2
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Alcaraz-Serna A, Porret R, Trueb L, Ribi C, Seebach J, Muller YD. [CAR-T therapy for autoimmune diseases]. Rev Med Suisse 2024; 20:688-693. [PMID: 38568061 DOI: 10.53738/revmed.2024.20.868.688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Cellular therapy using genetically modified T lymphocytes expressing synthetic receptors, known as CAR (Chimeric Antigen Receptor), has revolutionized the treatment of certain hematologic malignancies. This success has led to exploring the same approach in the treatment of severe autoimmune diseases refractory to conventional therapies. Initial results in systemic lupus erythematosus have shown complete remissions that appear to persist over time. Consequently, there is a growing number of ongoing clinical trials. In this review, we discuss the rationale behind the use of CAR-T therapies, the targeted autoimmune diseases, and the associated risks.
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Affiliation(s)
- Ana Alcaraz-Serna
- Service d'immunologie et allergie, Département de médecine, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Raphael Porret
- Service d'immunologie et allergie, Département de médecine, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Lionel Trueb
- Service d'immuno-oncologie, Département d'oncologie, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Camillo Ribi
- Service d'immunologie et allergie, Département de médecine, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Jörg Seebach
- Division d'immunologie et d'allergologie, Service d'immunologie et d'allergologie, Hôpitaux universitaires de Genève et Faculté de médecine, Université de Genève, 1211 Genève 4
| | - Yannick D Muller
- Service d'immunologie et allergie, Département de médecine, Centre hospitalier universitaire vaudois, 1011 Lausanne
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3
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Ringwald M, Moi L, Wetzel A, Comte D, Muller YD, Ribi C. Risk factors for allergy documentation in electronic health record: A retrospective study in a tertiary health center in Switzerland. Allergol Int 2024; 73:143-150. [PMID: 37455165 DOI: 10.1016/j.alit.2023.06.006] [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: 03/02/2023] [Revised: 05/27/2023] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Most hospitals use electronic health records (EHR) to warn health care professionals of drug hypersensitivity (DH) and other allergies. Indiscriminate recording of patient self-reported allergies may bloat the alert system, leading to unjustified avoidances and increases in health costs. The aim of our study was to analyze hypersensitivities documented in EHR of patients at Lausanne University Hospital (CHUV). METHODS We conducted a retrospective study on patients admitted at least 24 h to CHUV between 2011 and 2021. After ethical clearance, we obtained anonymized data. Because culprit allergen could be either manually recorded or selected through a list, data was harmonized using a reference allergy database before undergoing statistical analysis. RESULTS Of 192,444 patients, 16% had at least one allergy referenced. DH constituted 60% of all allergy alerts, mainly beta-lactam antibiotics (BLA) (30%), NSAID (11%) and iodinated contrast media (ICM) (7%). Median age at first hospitalization and hospitalization length were higher in the allergy group. Female to male ratio was 2:1 in the allergic group. Reactions were limited to the skin in half of patients, and consistent with anaphylaxis in 6%. In those deemed allergic to BLA, culprit drug was specified in 19%, 'allergy to penicillin' otherwise. It was impossible to distinguish DH based on history alone or resulting from specialized work-up. CONCLUSIONS Older age, longer hospital stays, and female sex increase the odds of in-patient allergy documentation. Regarding DH, BLA were referenced in 4% of inpatient records. Specific delabeling programs should be implemented to increase data reliability and patient safety.
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Affiliation(s)
- Maxime Ringwald
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
| | - Laura Moi
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Alexandre Wetzel
- Data Science & Research, Direction of Informatics Systems, Department of Infrastructures, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Denis Comte
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Yannick D Muller
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Camillo Ribi
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
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Alcaraz-Serna A, Noto A, Ermellino L, Monzambani-Banderet V, Tommasini F, Stehlin F, Girard C, Perreau M, Muller YD. Basophil activation tests with cryopreserved mRNA-based COVID-19 vaccines. Allergol Int 2023; 72:600-603. [PMID: 37061390 PMCID: PMC10060195 DOI: 10.1016/j.alit.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/25/2023] [Accepted: 03/27/2023] [Indexed: 04/17/2023] Open
Affiliation(s)
- Ana Alcaraz-Serna
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alessandra Noto
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Laura Ermellino
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Véronique Monzambani-Banderet
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Francesco Tommasini
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Florian Stehlin
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Cedric Girard
- Pharmacy, University Hospital of Lausanne, Hospital and University of Lausanne, Lausanne, Switzerland
| | - Matthieu Perreau
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Yannick D Muller
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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5
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Fallet B, Foglierini M, Porret R, Alcaraz A, Sauvage C, Jenelten R, Caplanusi T, Gilliet M, Perez L, Fenwick C, Genolet R, Harari A, Bobisse S, Gotardo R, Pantaleo G, Muller YD. Intradermal skin test with mRNA vaccines as a surrogate marker of T cell immunity in immunocompromised patients. J Infect 2023:S0163-4453(23)00329-8. [PMID: 37321353 DOI: 10.1016/j.jinf.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Intradermal skin test (IDT) with mRNA vaccines may represent a simple, reliable, and affordable tool to measure T cell response in immunocompromised patients who failed to mount serological responses following vaccination with mRNA covid-19 vaccines. METHODS We compared anti-SARS-CoV-2 antibodies and cellular responses in vaccinated immunocompromised patients (n=58), healthy seronegative naive controls (NC, n=8), and healthy seropositive vaccinated controls (VC, n=32) by Luminex, spike-induced IFN-γ Elispot and an IDT. A skin biopsy 24h after IDT and single-cell RNAseq was performed in three vaccinated volunteers. RESULTS Twenty-five percent of seronegative NC had a positive Elispot (2/8) and IDT (1/4), compared to 95% (20/21) and 93% (28/30) in seropositive VC, respectively. Single-cell RNAseq data in the skin of VC showed a predominant mixed population of effector helper and cytotoxic T cells. The TCR repertoire revealed 18/1064 clonotypes with known specificities against SARS-CoV-2, among which six were spike-specific. Seronegative immunocompromised patients with positive Elispot and IDT were in 83% (5/6) treated with B cell-depleting reagents, while those with negative IDT were all transplant recipients. CONCLUSIONS Our results indicate that delayed local reaction to IDT reflects vaccine-induced T-cell immunity opening new perspectives to monitor seronegative patients and elderly populations with waning immunity.
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Affiliation(s)
- Benedict Fallet
- Division of Immunology and Allergy, University Hospital of Lausanne, Switzerland
| | - Mathilde Foglierini
- Division of Immunology and Allergy, University Hospital of Lausanne, Switzerland
| | - Raphael Porret
- Division of Immunology and Allergy, University Hospital of Lausanne, Switzerland
| | - Ana Alcaraz
- Division of Immunology and Allergy, University Hospital of Lausanne, Switzerland
| | - Christophe Sauvage
- Center for Cell Immunotherapy, Department of Oncology and Ludwig Institute for Cancer Research, Lausanne Branch, University of Lausanne, Lausanne CH-1066, Switzerland
| | - Raphael Jenelten
- Department of Dermatology and venereology, University Hospital of Lausanne, Switzerland
| | - Teofila Caplanusi
- Department of Dermatology and venereology, University Hospital of Lausanne, Switzerland
| | - Michel Gilliet
- Department of Dermatology and venereology, University Hospital of Lausanne, Switzerland; University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland
| | - Laurent Perez
- Division of Immunology and Allergy, University Hospital of Lausanne, Switzerland; University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland
| | - Craig Fenwick
- Division of Immunology and Allergy, University Hospital of Lausanne, Switzerland
| | - Raphael Genolet
- Center for Cell Immunotherapy, Department of Oncology and Ludwig Institute for Cancer Research, Lausanne Branch, University of Lausanne, Lausanne CH-1066, Switzerland
| | - Alexandre Harari
- Center for Cell Immunotherapy, Department of Oncology and Ludwig Institute for Cancer Research, Lausanne Branch, University of Lausanne, Lausanne CH-1066, Switzerland; University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland
| | - Sara Bobisse
- Center for Cell Immunotherapy, Department of Oncology and Ludwig Institute for Cancer Research, Lausanne Branch, University of Lausanne, Lausanne CH-1066, Switzerland
| | - Raphael Gotardo
- Biomedical Data Science Center, University Hospital of Lausanne, Switzerland; University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland; Swiss Institute for Bioinformatics, Lausanne, Switzerland
| | - Giuseppe Pantaleo
- Division of Immunology and Allergy, University Hospital of Lausanne, Switzerland; University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland
| | - Yannick D Muller
- Division of Immunology and Allergy, University Hospital of Lausanne, Switzerland; University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland.
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6
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Belkoniene M, Ringwald M, Leimgruber A, Muller YD. [Hymenoptera venom allergy: what's new in 2023]. Rev Med Suisse 2023; 19:663-667. [PMID: 37017347 DOI: 10.53738/revmed.2023.19.821.663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Hymenoptera venom allergy is a central thematic in allergology. The recent limitation in the obtention of certain venom products has forced Swiss centers to adapt their diagnostic and therapeutical approaches. In this review, we will discuss diagnostics tools using recombinants serologies, recent recommendations for the screening of indolent systemic mastocytosis and the different immunotherapy protocols available for venom desensitization using aqueous and aluminum hydroxide-adsorbed purified venoms.
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Affiliation(s)
- Mhedi Belkoniene
- Service d'immunologie et allergie, Département de médecine, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Maxime Ringwald
- Service d'immunologie et allergie, Département de médecine, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Annette Leimgruber
- Service d'immunologie et allergie, Département de médecine, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Yannick D Muller
- Service d'immunologie et allergie, Département de médecine, Centre hospitalier universitaire vaudois, 1011 Lausanne
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Abstract
This cohort study examines the association of the COVID-19 vaccine booster with chronic spontaneous urticaria in Swiss patients.
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Affiliation(s)
- Olivier Duperrex
- Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Francesco Tommasini
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Yannick D Muller
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Ballou C, Barton F, Payne EH, Berney T, Villard J, Meier RPH, Baidal D, Alejandro R, Robien M, Eggerman TL, Kamoun M, Muller YD. Matching for HLA-DR excluding diabetogenic HLA-DR3 and HLA-DR4 predicts insulin independence after pancreatic islet transplantation. Front Immunol 2023; 14:1110544. [PMID: 37026004 PMCID: PMC10070978 DOI: 10.3389/fimmu.2023.1110544] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/16/2023] [Indexed: 04/08/2023] Open
Abstract
Introduction In pancreatic islet transplantation, the exact contribution of human leukocyte antigen (HLA) matching to graft survival remains unclear. Islets may be exposed to allogenic rejection but also the recurrence of type 1 diabetes (T1D). We evaluated the HLA-DR matching, including the impact of diabetogenic HLA-DR3 or HLA-DR4 matches. Methods We retrospectively examined the HLA profile in 965 transplant recipients and 2327 islet donors. The study population was obtained from patients enrolled in the Collaborative Islet Transplant Registry. We then identified 87 recipients who received a single-islet infusion. Islet-kidney recipients, 2nd islet infusion, and patients with missing data were excluded from the analysis (n=878). Results HLA-DR3 and HLA-DR4 were present in 29.7% and 32.6% of T1D recipients and 11.6% and 15.8% of the donors, respectively. We identified 52 T1D islet recipients mismatched for HLA-DR (group A), 11 with 1 or 2 HLA-DR-matches but excluding HLA-DR3 and HLA- DR4 (group B), and 24 matched for HLA-DR3 or HLA-DR4 (group C). Insulin-independence was maintained in a significantly higher percentage of group B recipients from year one through five post-transplantation (p<0.01). At five-year post-transplantation, 78% of group B was insulin-independent compared to 24% (group A) and 35% (group C). Insulin-independence correlated with significantly better glycemic control (HbA1c <7%), fasting blood glucose, and reduced severe hypoglycemic events. Matching HLA-A-B-DR (≥3) independently of HLA- DR3 or HLA-DR4 matching did not improve graft survival. Conclusion This study suggests that matching HLA-DR but excluding the diabetogenic HLA-DR3 and/or 4 is a significant predictor for long-term islet survival.
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Affiliation(s)
- Cassandra Ballou
- Collaborative Islet Transplant Registry Coordinating Center, The EMMES Company, LLC, Rockville, MD, United States
- *Correspondence: Yannick D. Muller, ; Cassandra Ballou,
| | - Franca Barton
- Collaborative Islet Transplant Registry Coordinating Center, The EMMES Company, LLC, Rockville, MD, United States
| | - Elizabeth H. Payne
- Collaborative Islet Transplant Registry Coordinating Center, The EMMES Company, LLC, Rockville, MD, United States
| | - Thierry Berney
- Division of Transplantation, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Jean Villard
- Department of Genetic, Laboratory and Pathology Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Raphael P. H. Meier
- Department of Surgery, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - David Baidal
- Department of Medicine and the Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Rodolfo Alejandro
- Department of Medicine and the Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Mark Robien
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Thomas L. Eggerman
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Malek Kamoun
- Immunology and Histocompatibility Testing Laboratory, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Yannick D. Muller
- Division of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
- *Correspondence: Yannick D. Muller, ; Cassandra Ballou,
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Stehlin F, Tommasini F, Monzambani-Banderet V, Girard C, Yerly D, Ribi C, Muller YD. Graded-dosing immunization in adults at risk for immediate-type reactions to mRNA SARS-CoV-2 vaccines. Allergol Int 2022; 72:332-334. [PMID: 36280516 PMCID: PMC9595453 DOI: 10.1016/j.alit.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/17/2022] [Accepted: 09/26/2022] [Indexed: 01/25/2023] Open
Affiliation(s)
- Florian Stehlin
- Division of Immunology and Allergy, University Hospital of Lausanne, Lausanne, Switzerland
| | - Francesco Tommasini
- Division of Immunology and Allergy, University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Cedric Girard
- Pharmacy, University Hospital of Lausanne, Hospital and University of Lausanne, Lausanne, Switzerland
| | - Daniel Yerly
- Adverse Drug Reactions - Analysis & Consulting (ADR-AC) GmbH, Bern, Switzerland
| | - Camillo Ribi
- Division of Immunology and Allergy, University Hospital of Lausanne, Lausanne, Switzerland
| | - Yannick D. Muller
- Division of Immunology and Allergy, University Hospital of Lausanne, Lausanne, Switzerland,Corresponding author. Service d'immunologie et d'allergie, Département de médecine, BH010-511. Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
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10
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Porret R, Meier RPH, Mikulic J, Pascual M, Aubert V, Harr T, Golshayan D, Muller YD. Atopy as an independent predictor for long-term patient and graft survival after kidney transplantation. Front Immunol 2022; 13:997364. [PMID: 36263051 PMCID: PMC9574189 DOI: 10.3389/fimmu.2022.997364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAtopy is a genetic condition predisposing individuals to develop immunoglobulin E (IgE) against common allergens through T-helper 2 (Th2) polarization mechanisms. The impact of atopy on graft survival in solid organ transplantation is unknown.MethodologyWe analyzed 268 renal allograft recipients from the Swiss Transplant Cohort Study, a prospective multicenter cohort studying patients after solid organ transplantation, with a 9-year median follow-up (IQR 3.0). We used the Phadiatop assay to measure IgE antibodies against a mixture of common inhaled allergens (grass, tree, herbs, spores, animals, and mites) to identify pre-transplantation atopic patients (>0.35 KU/L).ResultsOf 268 kidney transplant recipients, 66 individuals were atopic (24.6%). Atopic patients were significantly younger than non-atopic patients (49.6 vs 58.0 years old, P = 0.002). No significant difference was found for gender, cold/warm ischemia time, preformed donor-specific antibodies (DSA), HLA mismatches, induction and maintenance immunosuppressive therapy, CMV serostatus, or cause of kidney failure. Patient and graft survival at ten years of follow-up were significantly better in the atopic group, 95.2% versus 69.2% patient survival (P < 0.001), and 87.9% versus 60.8% graft survival (P < 0.001), respectively. A multivariate Cox analysis revealed that atopy predicted recipient and graft survival independently of age and living donor donation. Finally, we found similar rates of biopsy-proven acute cellular and antibody-mediated rejections between atopic and non-atopic recipients.ConclusionAtopy was associated with better long-term patient and graft survival, independently of age and living donor donation after kidney transplantation. Yet, atopy should not be used as a predictor for acute rejection.
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Affiliation(s)
- Raphaël Porret
- Division of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Raphaël P. H. Meier
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Josip Mikulic
- Transplantation Center, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Manuel Pascual
- Transplantation Center, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Vincent Aubert
- Division of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Thomas Harr
- Division of Immunology and Allergy, University Hospitals of Geneva, Geneva, Switzerland
| | - Déla Golshayan
- Transplantation Center, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Yannick D. Muller
- Division of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
- *Correspondence: Yannick D. Muller,
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11
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Pescosolido E, Muller YD, Sabaté‐Brescó M, Ferrer M, Yerly D, Caubet J, Lantin J, Ribi C, Bergmann MM. Clinical and immunological data from chronic urticaria onset after mRNA SARS-CoV-2 vaccines. Clin Exp Allergy 2022; 52:1343-1346. [PMID: 35962744 PMCID: PMC9539124 DOI: 10.1111/cea.14214] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/22/2022] [Accepted: 08/08/2022] [Indexed: 01/26/2023]
Affiliation(s)
| | | | - Marina Sabaté‐Brescó
- Allergy Department, Clínica Universidad de NavarraIdiSNA, Navarra Institute for Health ResearchPamplonaNavarraSpain
| | - Marta Ferrer
- Allergy Department, Clínica Universidad de NavarraIdiSNA, Navarra Institute for Health ResearchPamplonaNavarraSpain
| | - Daniel Yerly
- Adverse Drug Reactions – Analysis and ConsultingBernSwitzerland
| | - Jean‐Christoph Caubet
- Pediatric Allergy Unit, Department of Woman, Child and AdolescentUniversity Hospitals of GenevaGenevaSwitzerland
| | | | - Camillo Ribi
- Service d'Immunologie et Allergie, CHUVLausanneSwitzerland
| | - Marcel M. Bergmann
- Centro Pediatrico del MendrisiottoMendrisioSwitzerland,Pediatric Allergy Unit, Department of Woman, Child and AdolescentUniversity Hospitals of GenevaGenevaSwitzerland,Faculty of Biomedical ScienceUniversità della Svizzera Italiana (USI)LuganoSwitzerland
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12
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Carrier AN, Verma A, Mohiuddin M, Pascual M, Muller YD, Longchamp A, Bhati C, Buhler LH, Maluf DG, Meier RPH. Xenotransplantation: A New Era. Front Immunol 2022; 13:900594. [PMID: 35757701 PMCID: PMC9218200 DOI: 10.3389/fimmu.2022.900594] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 03/20/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Organ allotransplantation has now reached an impassable ceiling inherent to the limited supply of human donor organs. In the United States, there are currently over 100,000 individuals on the national transplant waiting list awaiting a kidney, heart, and/or liver transplant. This is in contrast with only a fraction of them receiving a living or deceased donor allograft. Given the morbidity, mortality, costs, or absence of supportive treatments, xenotransplant has the potential to address the critical shortage in organ grafts. Last decade research efforts focused on creation of donor organs from pigs with various genes edited out using CRISPR technologies and utilizing non-human primates for trial. Three groups in the United States have recently moved forward with trials in human subjects and obtained initial successful results with pig-to-human heart and kidney xenotransplantation. This review serves as a brief discussion of the recent progress in xenotransplantation research, particularly as it concerns utilization of porcine heart, renal, and liver xenografts in clinical practice.
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Affiliation(s)
- Amber N Carrier
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Anjali Verma
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Muhammad Mohiuddin
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Manuel Pascual
- Department of Vascular Surgery, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Yannick D Muller
- Division of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Alban Longchamp
- Department of Vascular Surgery, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Chandra Bhati
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Leo H Buhler
- Faculty of Science and Medicine, Section of Medicine, University of Fribourg, Fribourg, Switzerland
| | - Daniel G Maluf
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Raphael P H Meier
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, United States
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13
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Stehlin F, Mahdi-Aljedani R, Canton L, Monzambani-Banderet V, Miauton A, Girard C, Kammermann K, Meylan S, Ribi C, Harr T, Yerly D, Muller YD. Intradermal Testing With COVID-19 mRNA Vaccines Predicts Tolerance. Front Allergy 2022; 3:818049. [PMID: 36238929 PMCID: PMC9552867 DOI: 10.3389/falgy.2022.818049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/14/2022] [Indexed: 11/26/2022] Open
Abstract
Background The newly developed mRNA-based COVID-19 vaccines can provoke anaphylaxis, possibly induced by polyethylene glycol (PEG) contained in the vaccine. The management of persons with a history of PEG allergy or with a suspected allergic reaction after the first dose remains to be defined. Methods In this real-life study, we defined two cohorts of individuals: one pre-vaccination including 187 individuals with high-risk profiles for developing anaphylaxis and a second post-vaccination including 87 individuals with suspected allergic reactions after the COVID-19 mRNA vaccine. Upon negative skin test with an mRNA vaccine, a two-step (10–90%) vaccination protocol was performed. Positive skin tests were confirmed with the basophil activation test (BAT). Results Among 604,267 doses of vaccine, 87 suspected allergic reactions (5 after the booster) were reported to our division for further investigations: 18/87 (21%) were consistent with anaphylaxis, 78/87 (90%) were female, and 47/87 (54%) received the BNT162b2 mRNA vaccine. Vaccine skin tests were negative in 96% and 76% of the pre- and post-vaccination cohorts, respectively. A two-step vaccination was tolerated in 232/236 (98%) of individuals with negative tests. Four individuals experienced isolated asthmatic reactions during the two-step challenge. Vaccine-positive skin tests were consistently confirmed by BAT; CD63 and CD203c expression was selectively inhibited with ibrutinib, suggesting an IgE-dependent mechanism. Conclusion Sensitization to SARS-CoV-2 mRNA vaccines can be detected with intradermal testing. Significantly more individuals were sensitized to mRNA vaccines in the post-vaccination cohort. A two-step 10–90%-vaccination protocol can be safely administered upon negative skin testing.
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Affiliation(s)
- Florian Stehlin
- Division of Immunology and Allergy, University Hospital of Lausanne, Lausanne, Switzerland
| | - Rima Mahdi-Aljedani
- Division of Immunology and Allergy, University Hospital of Lausanne, Lausanne, Switzerland
| | - Loris Canton
- Division of Immunology and Allergy, University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Alix Miauton
- Tropical, Travel and Vaccination Clinic, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Cedric Girard
- Division of Pharmacy, University Hospital of Lausanne, Lausanne, Switzerland
| | - Kevin Kammermann
- Adverse Drug Reactions - Analysis & Consulting (ADR-AC) GmbH, Bern, Switzerland
| | - Sylvain Meylan
- Infectious Diseases Service, University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Camillo Ribi
- Division of Immunology and Allergy, University Hospital of Lausanne, Lausanne, Switzerland
| | - Thomas Harr
- Division of Immunology and Allergy, University Hospital of Geneva, Geneva, Switzerland
| | - Daniel Yerly
- Adverse Drug Reactions - Analysis & Consulting (ADR-AC) GmbH, Bern, Switzerland
| | - Yannick D. Muller
- Division of Immunology and Allergy, University Hospital of Lausanne, Lausanne, Switzerland
- *Correspondence: Yannick D. Muller
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14
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Iuliano S, Senn L, Moi L, Muller YD, Ribi C, Buss G, Comte D. Management of Beta-Lactam Antibiotics Allergy: A Real-Life Study. Front Allergy 2022; 3:853587. [PMID: 35769578 PMCID: PMC9234877 DOI: 10.3389/falgy.2022.853587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
Beta-lactam allergy is a common problem in everyday medical practice and is recognized as a major public health issue. Carrying this label frequently leads to the avoidance of all beta-lactam antibiotics, favoring the use of other less preferred classes of antibiotics, that are more expensive and associated with more side effects and increased antimicrobial resistance. Therefore, delabeling a beta-lactam allergy is part of antimicrobial stewardship programs. Herein, we retrospectively examined the clinical records of 576 patients who were referred to our center for a label of allergy to beta-lactam antibiotics and were systematically investigated following a standardized algorithm. Our main aim was to evaluate the frequency of confirmed immediate- and delayed-type allergy to commonly prescribed subclasses of beta-lactam antibiotics (penicillin and cephalosporin), as well as the negative predictive value (NPV) and the sensitivity of skin tests. Our secondary aims were to examine the safety of beta-lactam skin testing and drug challenge. We identified that 260 patients reported a history of immediate reactions, 131 of delayed reactions, and 114 of unknown timing or mechanism of reactions. Following assessment and testing, 86 (18.3%) patients had a confirmed allergy to any beta-lactam antibiotics; 63 (13.4%) with an immediate- and 23 (4.9%) with a delayed-type reaction. Most frequently identified confirmed allergy was to penicillins (65 patients), followed by cephalosporins (21 patients). When immediate-type reactions were examined, NPV of skin tests were 96.3% and 100% for penicillins and cephalosporins, respectively. When delayed reactions were considered, NPV were 91.9 and 87.5% for penicillins and cephalosporins, respectively. Evaluation of the safety of skin tests according to the standardized procedure showed that systemic allergic reactions occurred in only 0.7% of skin tests and in 3.1% of drug challenges. Overall, our data indicate that only 18.3% of patients with a beta-lactam allergy label have a confirmed allergy and non-allergic patients can be safely delabeled through allergic workup based on skin tests and drug challenge. This approach supports the policy of saving second-line antibiotics through a standardized allergy workup.
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Affiliation(s)
- Sarah Iuliano
- Service of Immunology and Allergy, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Laurence Senn
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Service of Hospital Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Laura Moi
- Service of Immunology and Allergy, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Yannick D. Muller
- Service of Immunology and Allergy, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Camillo Ribi
- Service of Immunology and Allergy, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Guillaume Buss
- Service of Immunology and Allergy, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Denis Comte
- Service of Immunology and Allergy, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- *Correspondence: Denis Comte
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15
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Abstract
Anisakis simplex is a parasitic worm. It infects marine mammals that feed on fish and cephalopods, its intermediary hosts. Human disease is caused by accidental ingestion of Anisakis larvae. Upon consumption of contaminated fish, cuttlefish or squid, human may develop two distinct clinical pictures: Anisakiasis is provoked by living larvae penetrating the digestive mucosa. Allergy is caused by IgE-mediate hypersensitivity to living or dead larvae in a previously sensitized individual. Anisakiasis may manifests with violent epi gastric pain, acute abdomen or eosinophilic gastroenteritis. The larvae may be visualized by endoscopy or histology. The main Anisakis allergens are not denaturated by heat or cold and resist to digestion. Allergy diagnosis relies on careful history and detection of specific IgE.
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Affiliation(s)
- Maxime Ringwald
- Service d'immunologie et allergie, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Yannick D Muller
- Service d'immunologie et allergie, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Camillo Ribi
- Service d'immunologie et allergie, Centre hospitalier universitaire vaudois, 1011 Lausanne
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16
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Moi L, Stehlin F, Desseauve D, Ribi C, Muller YD. [Hypersensitivity reactions to intravenous iron: an allergist' perspective]. Rev Med Suisse 2022; 18:639-645. [PMID: 35385614 DOI: 10.53738/revmed.2022.18.776.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Intravenous iron infusions rarely result in severe hypersensitivity reactions. The primary suspected hypersensitivity mechanism is an abnormal complement activation by non-IgE antibodies to the carbohydrate moieties stabilizing iron formulations. A major risk factor for hypersensitivity reactions is related to the infusion speed. Fishbane-like reactions usually resolve after pausing the infusion, which can be resumed under medical surveillance and at a lower infusion rate. Yet, anaphylactic reactions require emergency first aid and subsequent strict avoidance of intravenous iron. Desensitization protocols can be implemented in selected cases and under strict medical surveillance to reduce the risks of severe reactions upon re-exposure.
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Affiliation(s)
- Laura Moi
- Service d'immunologie et allergie, Département de médecine, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Florian Stehlin
- Service d'immunologie et allergie, Département de médecine, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - David Desseauve
- Service d'obstétrique, Département femme-mère-enfant, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Camillo Ribi
- Service d'immunologie et allergie, Département de médecine, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Yannick D Muller
- Service d'immunologie et allergie, Département de médecine, Centre hospitalier universitaire vaudois, 1011 Lausanne
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17
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Skartsis N, Peng Y, Ferreira LMR, Nguyen V, Ronin E, Muller YD, Vincenti F, Tang Q. IL-6 and TNFα Drive Extensive Proliferation of Human Tregs Without Compromising Their Lineage Stability or Function. Front Immunol 2022; 12:783282. [PMID: 35003100 PMCID: PMC8732758 DOI: 10.3389/fimmu.2021.783282] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [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: 09/25/2021] [Accepted: 11/29/2021] [Indexed: 01/09/2023] Open
Abstract
Treg therapies are being tested in clinical trials in transplantation and autoimmune diseases, however, the impact of inflammation on Tregs remains controversial. We challenged human Tregs ex-vivo with pro-inflammatory cytokines IL-6 and TNFα and observed greatly enhanced proliferation stimulated by anti-CD3 and anti-CD28 (aCD3/28) beads or CD28 superagonist (CD28SA). The cytokine-exposed Tregs maintained high expression of FOXP3 and HELIOS, demethylated FOXP3 enhancer, and low IFNγ, IL-4, and IL-17 secretion. Blocking TNF receptor using etanercept or deletion of TNF receptor 2 using CRISPR/Cas9 blunted Treg proliferation and attenuated FOXP3 and HELIOS expression. These results prompted us to consider using CD28SA together with IL-6 and TNFα without aCD3/28 beads (beadless) as an alternative protocol for therapeutic Treg manufacturing. Metabolomics profiling revealed more active glycolysis and oxidative phosphorylation, increased energy production, and higher antioxidant potential during beadless Treg expansion. Finally, beadless expanded Tregs maintained suppressive functions in vitro and in vivo. These results demonstrate that human Tregs positively respond to proinflammatory cytokines with enhanced proliferation without compromising their lineage identity or function. This property can be harnessed for therapeutic Treg manufacturing.
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Affiliation(s)
- Nikolaos Skartsis
- Department of Surgery, University of California San Francisco, San Francisco, CA, United States.,Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Yani Peng
- Department of Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Leonardo M R Ferreira
- Department of Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Vinh Nguyen
- Department of Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Emilie Ronin
- Department of Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Yannick D Muller
- Department of Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Flavio Vincenti
- Department of Surgery, University of California San Francisco, San Francisco, CA, United States.,Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Qizhi Tang
- Department of Surgery, University of California San Francisco, San Francisco, CA, United States.,Diabetes Center, University of California San Francisco, San Francisco, CA, United States
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18
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Affiliation(s)
- Leonardo M R Ferreira
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, United States.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Yannick D Muller
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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19
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Muller YD, Ferreira LMR, Ronin E, Ho P, Nguyen V, Faleo G, Zhou Y, Lee K, Leung KK, Skartsis N, Kaul AM, Mulder A, Claas FHJ, Wells JA, Bluestone JA, Tang Q. Precision Engineering of an Anti-HLA-A2 Chimeric Antigen Receptor in Regulatory T Cells for Transplant Immune Tolerance. Front Immunol 2021; 12:686439. [PMID: 34616392 PMCID: PMC8488356 DOI: 10.3389/fimmu.2021.686439] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [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: 03/26/2021] [Accepted: 08/26/2021] [Indexed: 11/22/2022] Open
Abstract
Infusion of regulatory T cells (Tregs) engineered with a chimeric antigen receptor (CAR) targeting donor-derived human leukocyte antigen (HLA) is a promising strategy to promote transplant tolerance. Here, we describe an anti-HLA-A2 CAR (A2-CAR) generated by grafting the complementarity-determining regions (CDRs) of a human monoclonal anti-HLA-A2 antibody into the framework regions of the Herceptin 4D5 single-chain variable fragment and fusing it with a CD28-ζ signaling domain. The CDR-grafted A2-CAR maintained the specificity of the original antibody. We then generated HLA-A2 mono-specific human CAR Tregs either by deleting the endogenous T-cell receptor (TCR) via CRISPR/Cas9 and introducing the A2-CAR using lentiviral transduction or by directly integrating the CAR construct into the TCR alpha constant locus using homology-directed repair. These A2-CAR+TCRdeficient human Tregs maintained both Treg phenotype and function in vitro. Moreover, they selectively accumulated in HLA-A2-expressing islets transplanted from either HLA-A2 transgenic mice or deceased human donors. A2-CAR+TCRdeficient Tregs did not impair the function of these HLA-A2+ islets, whereas similarly engineered A2-CAR+TCRdeficientCD4+ conventional T cells rejected the islets in less than 2 weeks. A2-CAR+TCRdeficient Tregs delayed graft-versus-host disease only in the presence of HLA-A2, expressed either by co-transferred peripheral blood mononuclear cells or by the recipient mice. Altogether, we demonstrate that genome-engineered mono-antigen-specific A2-CAR Tregs localize to HLA-A2-expressing grafts and exhibit antigen-dependent in vivo suppression, independent of TCR expression. These approaches may be applied towards developing precision Treg cell therapies for transplant tolerance.
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Affiliation(s)
- Yannick D Muller
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States.,Diabetes Center, University of California, San Francisco, San Francisco, CA, United States
| | - Leonardo M R Ferreira
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States.,Diabetes Center, University of California, San Francisco, San Francisco, CA, United States.,Sean N. Parker Autoimmune Research Laboratory, University of California, San Francisco, San Francisco, CA, United States
| | - Emilie Ronin
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States.,Diabetes Center, University of California, San Francisco, San Francisco, CA, United States
| | - Patrick Ho
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States.,Diabetes Center, University of California, San Francisco, San Francisco, CA, United States.,Sean N. Parker Autoimmune Research Laboratory, University of California, San Francisco, San Francisco, CA, United States
| | - Vinh Nguyen
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States.,Diabetes Center, University of California, San Francisco, San Francisco, CA, United States
| | - Gaetano Faleo
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States.,Diabetes Center, University of California, San Francisco, San Francisco, CA, United States
| | - Yu Zhou
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, United States
| | - Karim Lee
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Kevin K Leung
- Department of Pharmaceutical Chemistry, University of California, San Francisco, San Francisco, CA, United States
| | - Nikolaos Skartsis
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States.,Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Anupurna M Kaul
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Arend Mulder
- Department of Immunohaematology and Blood Transfusion, Leiden University Medical Center, Leiden, Netherlands
| | - Frans H J Claas
- Department of Immunohaematology and Blood Transfusion, Leiden University Medical Center, Leiden, Netherlands
| | - James A Wells
- Department of Pharmaceutical Chemistry, University of California, San Francisco, San Francisco, CA, United States
| | - Jeffrey A Bluestone
- Diabetes Center, University of California, San Francisco, San Francisco, CA, United States.,Sean N. Parker Autoimmune Research Laboratory, University of California, San Francisco, San Francisco, CA, United States
| | - Qizhi Tang
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States.,Diabetes Center, University of California, San Francisco, San Francisco, CA, United States
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20
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Ringwald M, Moi L, Muller YD, Ribi C. [An unusual allergy : cannabis-fruit and vegetable syndrome]. Rev Med Suisse 2021; 17:680-683. [PMID: 33830699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Cannabis-fruit and vegetable syndrome is of recent discovery and linked to lipid transfer protein (LTP) sensitization. It is thought that the primary sensitization originates from the cannabis LTP (Can s 3). Sensitized patients can cross-react to others LTP homologs such as peach LTP (Pru p 3). Diagnosis may be challenging, as consumption of cannabis is often omitted by the patient and needs to be specifically addressed during the interview. Thus, meticulous history taking is mandatory. Laboratory workup includes LTP-specific IgE and skin testing. Management relies on allergen eviction.
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Affiliation(s)
| | - Laura Moi
- Service d'immunologie et allergie, CHUV, 1011 Lausanne
| | | | - Camillo Ribi
- Service d'immunologie et allergie, CHUV, 1011 Lausanne
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21
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Fallet B, Miauton A, Comte D, Ribi C, Muller YD. [COVID-19 vaccines: vaccine targets, immunogenicity and allergic reactions]. Rev Med Suisse 2021; 17:690-696. [PMID: 33830701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Many vaccine strategies have been developed to control the COVID-19 pandemic. This article presents the mechanisms of action and the efficacy of different vaccines including mRNA- and adenovirus-based vaccines. We will discuss the different vaccine targets, immune responses and allergic reactions which have been reported during the vaccination campaigns. Finally, the latest recommendations for the prevention and management of severe allergic reactions will be summarized.
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Affiliation(s)
- Bénédict Fallet
- Service d'immunologie et d'allergie, Département de médecine, CHUV, 1011 Lausanne
| | - Alix Miauton
- Policlinique de médecine tropicale, voyages et vaccinations, Unisanté, 1015 Lausanne
| | - Denis Comte
- Service d'immunologie et d'allergie, Département de médecine, CHUV, 1011 Lausanne
| | - Camillo Ribi
- Service d'immunologie et d'allergie, Département de médecine, CHUV, 1011 Lausanne
| | - Yannick D Muller
- Service d'immunologie et d'allergie, Département de médecine, CHUV, 1011 Lausanne
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22
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Muller YD, Nguyen DP, Ferreira LMR, Ho P, Raffin C, Valencia RVB, Congrave-Wilson Z, Roth TL, Eyquem J, Van Gool F, Marson A, Perez L, Wells JA, Bluestone JA, Tang Q. The CD28-Transmembrane Domain Mediates Chimeric Antigen Receptor Heterodimerization With CD28. Front Immunol 2021; 12:639818. [PMID: 33833759 PMCID: PMC8021955 DOI: 10.3389/fimmu.2021.639818] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [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: 12/09/2020] [Accepted: 02/08/2021] [Indexed: 12/12/2022] Open
Abstract
Anti-CD19 chimeric antigen receptor (CD19-CAR)-engineered T cells are approved therapeutics for malignancies. The impact of the hinge domain (HD) and the transmembrane domain (TMD) between the extracellular antigen-targeting CARs and the intracellular signaling modalities of CARs has not been systemically studied. In this study, a series of 19-CARs differing only by their HD (CD8, CD28, or IgG4) and TMD (CD8 or CD28) was generated. CARs containing a CD28-TMD, but not a CD8-TMD, formed heterodimers with the endogenous CD28 in human T cells, as shown by co-immunoprecipitation and CAR-dependent proliferation of anti-CD28 stimulation. This dimerization was dependent on polar amino acids in the CD28-TMD and was more efficient with CARs containing CD28 or CD8 HD than IgG4-HD. The CD28-CAR heterodimers did not respond to CD80 and CD86 stimulation but had a significantly reduced CD28 cell-surface expression. These data unveiled a fundamental difference between CD28-TMD and CD8-TMD and indicated that CD28-TMD can modulate CAR T-cell activities by engaging endogenous partners.
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Affiliation(s)
- Yannick D Muller
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States.,Diabetes Center, University of California, San Francisco, San Francisco, CA, United States.,Department of Medicine, Service Immunologie et Allergie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Duy P Nguyen
- Department of Pharmaceutical Chemistry, University of California, San Francisco, San Francisco, CA, United States
| | - Leonardo M R Ferreira
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States.,Diabetes Center, University of California, San Francisco, San Francisco, CA, United States.,Sean N. Parker Autoimmune Research Laboratory, University of California, San Francisco, San Francisco, CA, United States
| | - Patrick Ho
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States.,Diabetes Center, University of California, San Francisco, San Francisco, CA, United States.,Sean N. Parker Autoimmune Research Laboratory, University of California, San Francisco, San Francisco, CA, United States
| | - Caroline Raffin
- Diabetes Center, University of California, San Francisco, San Francisco, CA, United States.,Sean N. Parker Autoimmune Research Laboratory, University of California, San Francisco, San Francisco, CA, United States
| | | | - Zion Congrave-Wilson
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Theodore L Roth
- Diabetes Center, University of California, San Francisco, San Francisco, CA, United States.,Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Justin Eyquem
- Sean N. Parker Autoimmune Research Laboratory, University of California, San Francisco, San Francisco, CA, United States
| | - Frederic Van Gool
- Diabetes Center, University of California, San Francisco, San Francisco, CA, United States.,Sean N. Parker Autoimmune Research Laboratory, University of California, San Francisco, San Francisco, CA, United States
| | - Alexander Marson
- Diabetes Center, University of California, San Francisco, San Francisco, CA, United States.,Department of Medicine, University of California, San Francisco, San Francisco, CA, United States.,Gladstone-UCSF Institute of Genomic Immunology, Gladstone Institutes, San Francisco, CA, United States
| | - Laurent Perez
- Department of Medicine, Service Immunologie et Allergie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - James A Wells
- Department of Pharmaceutical Chemistry, University of California, San Francisco, San Francisco, CA, United States.,Department of Cellular and Molecular Pharmacology, University of California, San Francisco, San Francisco, CA, United States
| | - Jeffrey A Bluestone
- Diabetes Center, University of California, San Francisco, San Francisco, CA, United States.,Sean N. Parker Autoimmune Research Laboratory, University of California, San Francisco, San Francisco, CA, United States
| | - Qizhi Tang
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States.,Diabetes Center, University of California, San Francisco, San Francisco, CA, United States
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23
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Meier RPH, Longchamp A, Mohiuddin M, Manuel O, Vrakas G, Maluf DG, Buhler LH, Muller YD, Pascual M. Recent progress and remaining hurdles toward clinical xenotransplantation. Xenotransplantation 2021; 28:e12681. [PMID: 33759229 DOI: 10.1111/xen.12681] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/12/2021] [Accepted: 02/21/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Xenotransplantation has made tremendous progress over the last decade. METHODS We discuss kidney and heart xenotransplantation, which are nearing initial clinical trials. RESULTS Life sustaining genetically modified kidney xenografts can now last for approximately 500 days and orthotopic heart xenografts for 200 days in non-human primates. Anti-swine specific antibody screening, preemptive desensitization protocols, complement inhibition and targeted immunosuppression are currently being adapted to xenotransplantation with the hope to achieve better control of antibody-mediated rejection (AMR) and improve xenograft longevity. These newest advances could probably facilitate future clinical trials, a significant step for the medical community, given that dialysis remains difficult for many patients and can have prohibitive costs. Performing a successful pig-to-human clinical kidney xenograft, that could last for more than a year after transplant, seems feasible but it still has significant potential hurdles to overcome. The risk/benefit balance is progressively reaching an acceptable equilibrium for future human recipients, e.g. those with a life expectancy inferior to two years. The ultimate question at this stage would be to determine if a "proof of concept" in humans is desirable, or whether further experimental/pre-clinical advances are still needed to demonstrate longer xenograft survival in non-human primates. CONCLUSION In this review, we discuss the most recent advances in kidney and heart xenotransplantation, with a focus on the prevention and treatment of AMR and on the recipient's selection, two aspects that will likely be the major points of discussion in the first pig organ xenotransplantation clinical trials.
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Affiliation(s)
- Raphael P H Meier
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alban Longchamp
- Department of Vascular Surgery, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Muhammad Mohiuddin
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Oriol Manuel
- Transplantation Center, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Georgios Vrakas
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Daniel G Maluf
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Leo H Buhler
- Faculty of Science and Medicine, Section of Medicine, University of Fribourg, Fribourg, Switzerland
| | - Yannick D Muller
- Division of Immunology and Allergy, University Hospital of Lausanne, Lausanne, Switzerland
| | - Manuel Pascual
- Transplantation Center, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
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Abstract
PURPOSE OF REVIEW Cell-based immunotherapies have made enormous progress over the last decade with the approval of several anti-CD19-chimeric antigen receptor (CAR)-T cell therapies for haemato-oncological diseases. CARs are synthetic receptors comprising an antigen-specific extracellular domain fused to a hinge, transmembrane and intracellular signalling domains. The success obtained with CD19 CAR-T cells rekindled interest in using CAR-T cells to treat HIV seropositive patients. The purpose of this review is to discuss historical and recent developments of anti-HIV CARs. RECENT FINDINGS Since the first description of CD4+-based CARs in the early 90s, new generations of anti-HIV CARs were developed. They target the hetero-trimeric glycoprotein gp120/gp41 and consist of either a CD4+ extracellular domain or a VH/VL segment derived from broadly neutralizing antibodies. Recent efforts were employed in multiplexing CAR specificities, intracellular signalling domains and T cells resistance to HIV. SUMMARY Several new-anti HIV CAR-T cells were successfully tested in preclinical mice models and are now waiting to be evaluated in clinical trials. One of the key parameters to successfully using CAR-T cells in HIV treatment will depend on their capacity to control the HIV reservoir without causing off-targeting activities.
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Affiliation(s)
- Oscar Alfageme-Abello
- Lausanne University Hospital (CHUV), Department of Medicine, Division of Immunology and Allergy, Lausanne, Switzerland
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25
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Meier RP, Muller YD, Dietrich PY, Tille JC, Nikolaev S, Sartori A, Labidi-Galy I, Ernandez T, Kaur A, Hirsch HH, McKee TA, Toso C, Villard J, Berney T. Immunologic Clearance of a BK Virus-associated Metastatic Renal Allograft Carcinoma. Transplantation 2021; 105:423-429. [PMID: 32091486 PMCID: PMC7837753 DOI: 10.1097/tp.0000000000003193] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/01/2020] [Accepted: 02/06/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Metastatic carcinoma of a renal allograft is a rare but life threatening event with a difficult clinical management. Recent reports suggested a potential role of BK polyomavirus (BKPyV) in the development of urologic tract malignancies in kidney transplant recipients. METHODS We investigated a kidney-pancreas female recipient with an history of BKPyV nephritis who developed a rapidly progressive and widely metastatic donor-derived renal carcinoma 9 years after transplantation. RESULTS Histology and fluorescence in situ hybridization analysis revealed a donor-derived (XY tumor cells) collecting (Bellini) duct carcinoma. The presence of BKPyV oncogenic large tumor antigen was identified in large amount within the kidney tumor and the bowel metastases. Whole genome sequencing of the tumor confirmed multiple genome BKPyV integrations. The transplanted kidney was removed, immunosuppression was withdrawn, and recombinant interleukin-2 (IL-2) was administered for 3 months, inducing a complete tumor clearance, with no evidence of disease at 6-year follow-up. The immunological profiling during IL-2 therapy revealed the presence of donor-specific T cells and expanded cytokine-producing bright natural killer cells but no donor-specific antibodies. Finally, we found persistently elevated anti-BK virus IgG titers and a specific anti-BKPyV T cell response. CONCLUSIONS This investigation showed evidence for the potential oncogenic role of BKPyV in collecting duct carcinoma in renal allografts and demonstrated that immunosuppression withdrawal and IL-2 therapy can lead to an efficient antitumor cellular mediated rejection possibly via 3 distinct mechanisms including (1) host-versus-graft, (2) host-versus-tumor, and (3) anti-BKPyV responses.
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Affiliation(s)
- Raphael P.H. Meier
- Abdominal Transplant Surgery, Department of Surgery, Geneva University Hospital and University of Geneva Medical School, Geneva, Switzerland
- Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Yannick D. Muller
- Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA
- Immunology and Transplant Unit, Department Diagnostic, Geneva University Hospital and University of Geneva Medical School, Geneva, Switzerland
| | - Pierre-Yves Dietrich
- Department of Oncology, Geneva University Hospital and University of Geneva Medical School, Geneva, Switzerland
| | - Jean-Christophe Tille
- Diagnostic Department, Geneva University Hospital, and Department of Pathology and Immunology, University of Geneva Medical School, Geneva, Switzerland
| | - Sergey Nikolaev
- Department of Genetic Medicine and Development, Geneva University Hospital and University of Geneva Medical School, Geneva, Switzerland
| | - Ambra Sartori
- Department of Genetic Medicine and Development, Geneva University Hospital and University of Geneva Medical School, Geneva, Switzerland
| | - Intidhar Labidi-Galy
- Department of Oncology, Geneva University Hospital and University of Geneva Medical School, Geneva, Switzerland
| | - Thomas Ernandez
- Division of Nephrology, Department of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Amandeep Kaur
- Transplantation and Clinical Virology, Department Biomedicine, University of Basel, Basel, Switzerland
| | - Hans H. Hirsch
- Transplantation and Clinical Virology, Department Biomedicine, University of Basel, Basel, Switzerland
| | - Thomas A. McKee
- Diagnostic Department, Geneva University Hospital, and Department of Pathology and Immunology, University of Geneva Medical School, Geneva, Switzerland
| | - Christian Toso
- Abdominal Transplant Surgery, Department of Surgery, Geneva University Hospital and University of Geneva Medical School, Geneva, Switzerland
| | - Jean Villard
- Immunology and Transplant Unit, Department Diagnostic, Geneva University Hospital and University of Geneva Medical School, Geneva, Switzerland
- Division of Nephrology, Department of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Thierry Berney
- Abdominal Transplant Surgery, Department of Surgery, Geneva University Hospital and University of Geneva Medical School, Geneva, Switzerland
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26
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Meier RPH, Meyer J, Muller YD, Szot GL, Bédat B, Andres A, Massé N, Lablanche S, Puppa G, Bosco D, Berney T. Pancreas collagen digestion during islet of Langerhans isolation-a prospective study. Transpl Int 2020; 33:1516-1528. [PMID: 32852857 DOI: 10.1111/tri.13725] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/31/2020] [Revised: 07/03/2020] [Accepted: 08/20/2020] [Indexed: 12/12/2022]
Abstract
The success of pancreas islet isolation largely depends on donor characteristics, including extracellular matrix composition of which collagen is the main element. We hypothesized that isolation yields are proportional to collagen digestion percentage, and aimed to determine a threshold that predicts isolation success. The amount of pancreas collagen (I-V) was determined using colorimetry prior to and after the digestion process in 52 human islet isolations. Collagen I-V and VI were also assessed histologically. We identified a collagen digestion threshold of ≥ 60% as an independent factor beyond which an islet preparation has a ninefold increased odds of yielding ≥ 250 000 islet equivalents (IEQ) (P = 0.009) and a sixfold increased odds of being transplanted (P = 0.015). Preparations with ≥ 60% collagen digestion (n = 35) yielded 283 017 ± 164 214 IEQ versus 180 142 ± 85 397 in the < 60% collagen digestion group (n = 17) (P = 0.016); respectively 62.9% versus 29.4% of those were transplanted (P = 0.024). Common donor characteristics, initial collagen content, enzyme blend, and digestion times were not associated with collagen digestion percentage variations. Donor age positively correlated with the amount of collagen VI (P = 0.013). There was no difference in islet graft survival between high and low digestion groups. We determined that a 60% pancreas collagen digestion is the threshold beyond which an islet isolation is likely to be successful and transplanted.
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Affiliation(s)
- Raphael P H Meier
- Cell Isolation and Transplantation Center, Department of Surgery, University of Geneva Hospitals and School of Medicine, Geneva, Switzerland.,Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jeremy Meyer
- Cell Isolation and Transplantation Center, Department of Surgery, University of Geneva Hospitals and School of Medicine, Geneva, Switzerland
| | - Yannick D Muller
- Cell Isolation and Transplantation Center, Department of Surgery, University of Geneva Hospitals and School of Medicine, Geneva, Switzerland.,Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Gregory L Szot
- Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Benoît Bédat
- Cell Isolation and Transplantation Center, Department of Surgery, University of Geneva Hospitals and School of Medicine, Geneva, Switzerland
| | - Axel Andres
- Cell Isolation and Transplantation Center, Department of Surgery, University of Geneva Hospitals and School of Medicine, Geneva, Switzerland.,Division of Transplantation, Department of Surgery, University of Geneva Hospitals and School of Medicine, Geneva, Switzerland
| | - Nathalie Massé
- Division of Transplantation, Department of Surgery, University of Geneva Hospitals and School of Medicine, Geneva, Switzerland
| | - Sandrine Lablanche
- Grenoble Alpes University, Grenoble, France.,Laboratory of Fundamental and Applied Bioenergetics Grenoble, Inserm U1055, Grenoble, France
| | - Giacomo Puppa
- Diagnostic Department, Geneva University Hospital, Geneva, Switzerland.,Department of Pathology and Immunology, University of Geneva Medical School, Geneva, Switzerland
| | - Domenico Bosco
- Cell Isolation and Transplantation Center, Department of Surgery, University of Geneva Hospitals and School of Medicine, Geneva, Switzerland
| | - Thierry Berney
- Cell Isolation and Transplantation Center, Department of Surgery, University of Geneva Hospitals and School of Medicine, Geneva, Switzerland.,Division of Transplantation, Department of Surgery, University of Geneva Hospitals and School of Medicine, Geneva, Switzerland
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27
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Bernuy-Guevara C, Chehade H, Muller YD, Vionnet J, Cachat F, Guzzo G, Ochoa-Sangrador C, Álvarez FJ, Teta D, Martín-García D, Adler M, de Paz FJ, Lizaraso-Soto F, Pascual M, Herrera-Gómez F. The Inhibition of Complement System in Formal and Emerging Indications: Results from Parallel One-Stage Pairwise and Network Meta-Analyses of Clinical Trials and Real-Life Data Studies. Biomedicines 2020; 8:biomedicines8090355. [PMID: 32948059 PMCID: PMC7554929 DOI: 10.3390/biomedicines8090355] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 07/22/2020] [Revised: 09/12/2020] [Accepted: 09/13/2020] [Indexed: 12/15/2022] Open
Abstract
This manuscript presents quantitative findings on the actual effectiveness of terminal complement component 5 (C5) inhibitors and complement component 1 (C1) esterase inhibitors through their formal and common “off-label” (compassionate) indications. The results emanated from pairwise and network meta-analyses to present evidence until September 2019. Clinical trials (CT) and real-life non-randomized studies of the effects of interventions (NRSI) are consistent on the benefits of C5 inhibitors and of the absence of effects of C1 esterase inhibitors (n = 7484): Mathematically, eculizumab (surface under the cumulative ranking area (SUCRA) >0.6) and ravulizumab (SUCRA ≥ 0.7) were similar in terms of their protective effect on hemolysis in paroxysmal nocturnal hemoglobinuria (PNH), thrombotic microangiopathy (TMA) in atypical hemolytic uremic syndrome (aHUS), and acute kidney injury (AKI) in aHUS, in comparison to pre-/off-treatment state and/or placebo (SUCRA < 0.01), and eculizumab was efficacious on thrombotic events in PNH (odds ratio (OR)/95% confidence interval (95% CI) in CT and real-life NRSI, 0.07/0.03 to 0.19, 0.24/0.17 to 0.33) and chronic kidney disease (CKD) occurrence/progression in PNH (0.31/0.10 to 0.97, 0.66/0.44 to 0.98). In addition, meta-analysis on clinical trials shows that eculizumab mitigates a refractory generalized myasthenia gravis (rgMG) crisis (0.29/0.13 to 0.61) and prevents new acute antibody-mediated rejection (AMR) episodes in kidney transplant recipients (0.25/0.13 to 0.49). The update of findings from this meta-analysis will be useful to promote a better use of complement inhibitors, and to achieve personalization of treatments with this class of drugs.
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Affiliation(s)
- Coralina Bernuy-Guevara
- Pharmacological Big Data Laboratory, University of Valladolid, 47005 Valladolid, Spain; (C.B.-G.); (F.J.Á.); (F.J.d.P.); (F.L.-S.)
| | - Hassib Chehade
- Pediatric Nephrology Unit, Lausanne University Hospital and University of Lausanne, 1100 Lausanne, Switzerland; (H.C.); (F.C.)
| | - Yannick D. Muller
- Transplantation Center, Lausanne University Hospital and University of Lausanne, 1100 Lausanne, Switzerland; (Y.D.M.); (J.V.); (G.G.); (M.P.)
| | - Julien Vionnet
- Transplantation Center, Lausanne University Hospital and University of Lausanne, 1100 Lausanne, Switzerland; (Y.D.M.); (J.V.); (G.G.); (M.P.)
- King’s College London, London WC2R 2LS, UK
| | - François Cachat
- Pediatric Nephrology Unit, Lausanne University Hospital and University of Lausanne, 1100 Lausanne, Switzerland; (H.C.); (F.C.)
| | - Gabriella Guzzo
- Transplantation Center, Lausanne University Hospital and University of Lausanne, 1100 Lausanne, Switzerland; (Y.D.M.); (J.V.); (G.G.); (M.P.)
| | | | - F. Javier Álvarez
- Pharmacological Big Data Laboratory, University of Valladolid, 47005 Valladolid, Spain; (C.B.-G.); (F.J.Á.); (F.J.d.P.); (F.L.-S.)
- Ethics Committee of Drug Research–east Valladolid area, University Clinical Hospital of Valladolid, 47005 Valladolid, Spain
| | - Daniel Teta
- Department of Nephrology, Hôpital du Valais, 1950 Sion, Switzerland;
| | - Débora Martín-García
- Clinical Nephrology Unit, University Clinical Hospital of Valladolid, 47003 Valladolid, Spain;
| | - Marcel Adler
- Center for Medical Oncology & Hematology, Hospital Thun, 3600 Thun, Switzerland;
| | - Félix J. de Paz
- Pharmacological Big Data Laboratory, University of Valladolid, 47005 Valladolid, Spain; (C.B.-G.); (F.J.Á.); (F.J.d.P.); (F.L.-S.)
| | - Frank Lizaraso-Soto
- Pharmacological Big Data Laboratory, University of Valladolid, 47005 Valladolid, Spain; (C.B.-G.); (F.J.Á.); (F.J.d.P.); (F.L.-S.)
- Centro de Investigación en Salud Pública, Instituto de Investigación de la Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima 15024, Peru
| | - Manuel Pascual
- Transplantation Center, Lausanne University Hospital and University of Lausanne, 1100 Lausanne, Switzerland; (Y.D.M.); (J.V.); (G.G.); (M.P.)
| | - Francisco Herrera-Gómez
- Pharmacological Big Data Laboratory, University of Valladolid, 47005 Valladolid, Spain; (C.B.-G.); (F.J.Á.); (F.J.d.P.); (F.L.-S.)
- Transplantation Center, Lausanne University Hospital and University of Lausanne, 1100 Lausanne, Switzerland; (Y.D.M.); (J.V.); (G.G.); (M.P.)
- Centro de Investigación en Salud Pública, Instituto de Investigación de la Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima 15024, Peru
- Department of Nephrology, Hospital Virgen de la Concha, 49022 Zamora, Spain
- Castile and León’s Research Consolidated Unit n° 299, 47011 Valladolid, Spain
- Correspondence: ; Tel.: +34-983-423077
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28
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Ferreira L, Muller YD, Kaul AM, Shaikh H, Guerrero-Moreno R, Yao LE, Goodman DB, Bluestone JA, Tang Q. Chimeric antigen receptor signaling confers antitumor activity to human regulatory T cells. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.238.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Regulatory T cells (Tregs) are a subset of T cells dedicated to suppressing immune responses to ensure immune self tolerance. Treg therapy offers the opportunity to treat transplant rejection and autoimmunity without the toxicity associated with immunosuppressive regimens. Conferring antigen specificity to Tregs using a chimeric antigen receptor (CAR) dramatically expands what targets can be pursued using Treg therapies. However, the consequences of CAR-mediated signaling for human Treg biology remain poorly understood. To address this, we generated anti-CD19 CAR Tregs with a tandem CD28-TCRζ intracellular domain. Upon in vitro co-incubation with CD19-expressing cells, CAR Tregs upregulated activation markers, proliferated, secreted IL-10, and suppressed T cell proliferation, while maintaining high FOXP3 expression and a demethylated TSDR. In humanized mice harboring CD19+ tumor cells, CAR Tregs suppressed CAR T cell proliferation. Strikingly, CAR Tregs also suppressed tumor growth, even in the absence of CAR T cells. This phenomenon was observed across three tumor cell types (B-cell leukemia, myeloid leukemia, and epithelial carcinoma) and two routes of delivery (intravenous and subcutaneous). Real-time monitoring of tumor cell survival and proliferation in vitro confirmed that CAR Tregs suppress tumor cell growth. Interestingly, single-cell cytokine analysis revealed that CAR-mediated activation of Tregs leads to higher production of IFN-γ, TNF-α, perforin, and granzyme B than anti-CD3/28 stimulation. CRISPR/Cas9-mediated ablation of granzyme B in CAR Tregs diminished their antitumor activity in vivo. These results demonstrate that CAR Treg cytotoxicity is an important concern for safe clinical translation.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Qizhi Tang
- 1University of California San Francisco (UCSF)
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29
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Muller YD, Vionnet J, Beyeler F, Eigenmann P, Caubet J, Villard J, Berney T, Scherer K, Spertini F, Fricker MP, Lang C, Schmid‐Grendelmeier P, Benden C, Roux Lombard P, Aubert V, Immer F, Pascual M, Harr T. Management of allergy transfer upon solid organ transplantation. Am J Transplant 2020; 20:834-843. [PMID: 31535461 PMCID: PMC7065229 DOI: 10.1111/ajt.15601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/03/2019] [Revised: 09/03/2019] [Accepted: 09/07/2019] [Indexed: 01/25/2023]
Abstract
Allergy transfer upon solid organ transplantation has been reported in the literature, although only few data are available as to the frequency, significance, and management of these cases. Based on a review of 577 consecutive deceased donors from the Swisstransplant Donor-Registry, 3 cases (0.5%) of fatal anaphylaxis were identified, 2 because of peanut and 1 of wasp allergy. The sera of all 3 donors and their 10 paired recipients, prospectively collected before and after transplantation for the Swiss Transplant Cohort Study, were retrospectively processed using a commercial protein microarray fluorescent test. As early as 5 days posttransplantation, newly acquired peanut-specific IgE were transiently detected from 1 donor to 3 recipients, of whom 1 liver and lung recipients developed grade III anaphylaxis. Yet, to define how allergy testing should be performed in transplant recipients and to better understand the impact of immunosuppressive therapy on IgE sensitization, we prospectively studied 5 atopic living-donor kidney recipients. All pollen-specific IgE and >90% of skin prick tests remained positive 7 days and 3 months after transplantation, indicating that early diagnosis of donor-derived IgE sensitization is possible. Importantly, we propose recommendations with respect to safety for recipients undergoing solid-organ transplantation from donors with a history of fatal anaphylaxis.
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Affiliation(s)
- Yannick D. Muller
- Division of Immunology and AllergyDepartment of MedicineUniversity Hospitals and University of GenevaGenevaSwitzerland,Transplantation CenterLausanne University Hospital and University of LausanneLausanneSwitzerland,Department of SurgeryUniversity of CaliforniaSan FranciscoCalifornia
| | - Julien Vionnet
- Transplantation CenterLausanne University Hospital and University of LausanneLausanneSwitzerland,Department of Inflammation Biology, School of Immunology and Microbial SciencesKing's College LondonLondonUK
| | | | - Philippe Eigenmann
- Pediatric Allergy UnitDepartment of Women-Children-TeenagersPediatric Allergy UnitUniversity Hospitals of Geneva and University of GenevaGenevaSwitzerland
| | - Jean‐Christoph Caubet
- Pediatric Allergy UnitDepartment of Women-Children-TeenagersPediatric Allergy UnitUniversity Hospitals of Geneva and University of GenevaGenevaSwitzerland
| | - Jean Villard
- Department of Genetic, Laboratory and Pathology MedicineGeneva University HospitalsGenevaSwitzerland
| | - Thierry Berney
- Division of TransplantationDepartment of SurgeryGeneva University HospitalsGenevaSwitzerland
| | - Kathrin Scherer
- Division of Allergy and DermatologyUniversity Hospital BaselBaselSwitzerland
| | - Francois Spertini
- Service of Immunology and AllergyLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Michael P. Fricker
- Division of Rheumatology, Immunology and AllergyInselspitalBernSwitzerland
| | - Claudia Lang
- Allergy UnitDepartment of DermatologyUniversity Hospital of ZürichZürichSwitzerland
| | | | - Christian Benden
- Division of Pulmonary MedicineUniversity Hospital of ZürichZürichSwitzerland
| | - Pascale Roux Lombard
- Division of Immunology and AllergyDepartment of MedicineUniversity Hospitals and University of GenevaGenevaSwitzerland
| | - Vincent Aubert
- Service of Immunology and AllergyLausanne University Hospital and University of LausanneLausanneSwitzerland
| | | | - Manuel Pascual
- Transplantation CenterLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Thomas Harr
- Division of Immunology and AllergyDepartment of MedicineUniversity Hospitals and University of GenevaGenevaSwitzerland
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30
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Madelon N, Montanari E, Gruaz L, Pimenta J, Muller YD, Bühler LH, Puga Yung GL, Seebach JD. Prolongation of rat-to-mouse islets xenograft survival by co-transplantation of autologous IL-10 differentiated murine tolerogenic dendritic cells. Xenotransplantation 2020; 27:e12584. [PMID: 31984564 DOI: 10.1111/xen.12584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/06/2019] [Accepted: 01/05/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Tolerogenic dendritic cells (DCs) represent a promising approach to promote transplantation tolerance. In this study, the potential of autologous bone marrow (BM)-derived murine DC to protect rat-to-mouse islets xenografts was analyzed. METHODS Tolerogenic DCs were generated by differentiating BM cells in the presence of granulocyte-macrophage colony-stimulating factor and interleukin 10 (IL-10, IL-10 DC). The phenotype of IL-10 DC was characterized in vitro by expression of costimulatory/inhibitory molecules (flow cytometry) and cytokines (Luminex and ELISA), their function by phagocytosis and T-cell stimulation assays. To study transplant tolerance in vivo, rat islets were transplanted alone or in combination with autologous murine IL-10 DC under the kidney capsule of streptozotocin-induced diabetic C57BL/6 mice. Xenograft survival was evaluated by monitoring glycemia, cellular infiltration of xenografts by microscopy and flow cytometry 10 days post-transplantation. RESULTS Compared with control DC, IL-10 DC exhibited lower levels of major histocompatibility complex class II, costimulatory molecules (CD40, CD86, CD205), lower production of pro-inflammatory cytokines (IL-12p70, TNF, IL-6), and higher production of IL-10. Phagocytosis of xenogeneic rat splenocytes was not impaired in IL-10 DC, whereas stimulation of T-cell proliferation was reduced in the presence of IL-10 DC. Xenograft survival of rat islets in diabetic mice co-transplanted with autologous murine IL-10 DC was significantly prolonged from 12 to 21 days, without additional immunosuppressive treatment. Overall, infiltration of xenografts by T cells and myeloid cells was not different in IL-10 DC recipient mice, but enriched for CD8+ T cells and myeloid cells with suppressor-associated phenotype. CONCLUSIONS Autologous IL-10-differentiated DC with tolerogenic properties prolong rat-to-mouse islets xenograft survival, potentially by locally inducing immune regulatory cells, indicating their potential for regulatory immune cell therapy in xenotransplantation.
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Affiliation(s)
- Natacha Madelon
- Laboratory of Translational Immunology, Division of Immunology and Allergology, Department of Medical Specialties, Medical Faculty, Geneva University Hospitals, Geneva, Switzerland
| | - Elisa Montanari
- Department of Surgery, Medical Faculty, Cell Isolation and Transplantation Center, Geneva University Hospitals, Geneva, Switzerland
| | - Lyssia Gruaz
- Laboratory of Translational Immunology, Division of Immunology and Allergology, Department of Medical Specialties, Medical Faculty, Geneva University Hospitals, Geneva, Switzerland
| | - Joel Pimenta
- Department of Surgery, Medical Faculty, Cell Isolation and Transplantation Center, Geneva University Hospitals, Geneva, Switzerland
| | - Yannick D Muller
- Laboratory of Translational Immunology, Division of Immunology and Allergology, Department of Medical Specialties, Medical Faculty, Geneva University Hospitals, Geneva, Switzerland
| | - Leo H Bühler
- Department of Surgery, Medical Faculty, Cell Isolation and Transplantation Center, Geneva University Hospitals, Geneva, Switzerland
| | - Gisella L Puga Yung
- Laboratory of Translational Immunology, Division of Immunology and Allergology, Department of Medical Specialties, Medical Faculty, Geneva University Hospitals, Geneva, Switzerland
| | - Jörg D Seebach
- Laboratory of Translational Immunology, Division of Immunology and Allergology, Department of Medical Specialties, Medical Faculty, Geneva University Hospitals, Geneva, Switzerland
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Abstract
Regulatory T cells (Treg cells) are a small subset of immune cells that are dedicated to curbing excessive immune activation and maintaining immune homeostasis. Accordingly, deficiencies in Treg cell development or function result in uncontrolled immune responses and tissue destruction and can lead to inflammatory disorders such as graft-versus-host disease, transplant rejection and autoimmune diseases. As Treg cells deploy more than a dozen molecular mechanisms to suppress immune responses, they have potential as multifaceted adaptable smart therapeutics for treating inflammatory disorders. Indeed, early-phase clinical trials of Treg cell therapy have shown feasibility, tolerability and potential efficacy in these disease settings. In the meantime, progress in the development of chimeric antigen receptors and in genome editing (including the application of CRISPR-Cas9) over the past two decades has facilitated the genetic optimization of primary T cell therapy for cancer. These technologies are now being used to enhance the specificity and functionality of Treg cells. In this Review, we describe the key advances and prospects in designing and implementing Treg cell-based therapy in autoimmunity and transplantation.
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Affiliation(s)
- Leonardo M R Ferreira
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA
- Sean N. Parker Autoimmune Research Laboratory, University of California, San Francisco, San Francisco, CA, USA
| | - Yannick D Muller
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Jeffrey A Bluestone
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA.
- Sean N. Parker Autoimmune Research Laboratory, University of California, San Francisco, San Francisco, CA, USA.
| | - Qizhi Tang
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA.
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA.
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32
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Meier RPH, Andrey DO, Sun P, Niclauss N, Bédat B, Demuylder-Mischler S, Borot S, Benhamou PY, Wojtusciszyn A, Buron F, Pernin N, Muller YD, Bosco D, van Delden C, Berney T. Pancreas preservation fluid microbial contamination is associated with poor islet isolation outcomes - a multi-centre cohort study. Transpl Int 2018; 31:917-929. [PMID: 29603452 DOI: 10.1111/tri.13159] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/09/2018] [Accepted: 03/21/2018] [Indexed: 12/15/2022]
Abstract
The microbiological safety of islet preparations is paramount. Preservation medium contamination is frequent, and its impact on islet yield and function remains unclear. Microbiological samples collected during islet isolations from 2006 to 2016 were analyzed and correlated to isolation and allo- and autotransplantation outcomes. Microbial contamination of preservation medium was found in 64.4% of processed donor pancreases (291/452). We identified 464 microorganisms including Staphylococcus (253/464, 54.5%), Streptococcus (31/464, 6.7%), and Candida species (25/464, 5.4%). Microbial contamination was associated with longer warm and cold ischemia times and lower numbers of postpurification islet equivalents, purity, transplant rate, and stimulation index (all P < 0.05). Six percent of the preparations accepted for transplantation showed microbial contamination after isolation (12/200); 9 of 12 were Candida species. Six patients were transplanted with a sample with late microbial growth discovered after the infusion. Insulin independence rate was not affected. This risk of transplanting a contaminated islets preparation was reduced by half following the implementation of an additional sampling after 24 h of islet culture. Pancreas preservation fluid microbial contamination is associated with lower transplant rate and poorer in vitro function, but not with changes in graft survival. Culture medium testing 1 day after isolation reduces the risk of incidental transplantation with contaminated islets.
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Affiliation(s)
- Raphael P H Meier
- Department of Surgery, Cell Isolation and Transplantation Center, Geneva University Hospital, University of Geneva Medical School, Geneva, Switzerland.,Visceral and Transplant Surgery, Department of Surgery, Geneva University Hospital, University of Geneva Medical School, Geneva, Switzerland.,Transplant Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Diego O Andrey
- Transplant Infectious Diseases Unit, Department of Medical Specialties, Geneva University Hospital, University of Geneva Medical School, Geneva, Switzerland
| | - Pamela Sun
- Visceral and Transplant Surgery, Department of Surgery, Geneva University Hospital, University of Geneva Medical School, Geneva, Switzerland
| | - Nadja Niclauss
- Department of Surgery, Cell Isolation and Transplantation Center, Geneva University Hospital, University of Geneva Medical School, Geneva, Switzerland.,Visceral and Transplant Surgery, Department of Surgery, Geneva University Hospital, University of Geneva Medical School, Geneva, Switzerland
| | - Benoît Bédat
- Department of Surgery, Cell Isolation and Transplantation Center, Geneva University Hospital, University of Geneva Medical School, Geneva, Switzerland
| | - Sandrine Demuylder-Mischler
- Department of Surgery, Cell Isolation and Transplantation Center, Geneva University Hospital, University of Geneva Medical School, Geneva, Switzerland
| | - Sophie Borot
- Department of Surgery, Cell Isolation and Transplantation Center, Geneva University Hospital, University of Geneva Medical School, Geneva, Switzerland.,Service d'Endocrinologie-Métabolisme et Diabétologie-Nutrition, Centre Hospitalier Universitaire Jean Minjoz, Besançon, France
| | - Pierre-Yves Benhamou
- Department of Endocrinology, Pôle DigiDune, Grenoble University Hospital, University Grenoble Alpes, Grenoble, France
| | - Anne Wojtusciszyn
- Laboratory of Cell Therapy for Diabetes, IRMB, Saint Eloi Hospital, Montpellier University Hospital, Montpellier, France.,Department of Endocrinology, Diabetes and Nutrition, Lapeyronie Hospital, Montpellier University Hospital, Montpellier, France
| | - Fanny Buron
- Nephrology Unit, Department of Transplantation, Edouard Herriot Hospital, Lyon, France
| | - Nadine Pernin
- Department of Surgery, Cell Isolation and Transplantation Center, Geneva University Hospital, University of Geneva Medical School, Geneva, Switzerland
| | - Yannick D Muller
- Transplant Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Domenico Bosco
- Department of Surgery, Cell Isolation and Transplantation Center, Geneva University Hospital, University of Geneva Medical School, Geneva, Switzerland
| | - Christian van Delden
- Visceral and Transplant Surgery, Department of Surgery, Geneva University Hospital, University of Geneva Medical School, Geneva, Switzerland.,Transplant Infectious Diseases Unit, Department of Medical Specialties, Geneva University Hospital, University of Geneva Medical School, Geneva, Switzerland
| | - Thierry Berney
- Department of Surgery, Cell Isolation and Transplantation Center, Geneva University Hospital, University of Geneva Medical School, Geneva, Switzerland.,Visceral and Transplant Surgery, Department of Surgery, Geneva University Hospital, University of Geneva Medical School, Geneva, Switzerland
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Affiliation(s)
- Yannick D Muller
- Division of Immunology and Allergy, Department of Medical Specialties, University Hospitals and Medical Faculty, Geneva CH-1211, Switzerland.
| | - Thomas Harr
- Division of Immunology and Allergy, Department of Medical Specialties, University Hospitals and Medical Faculty, Geneva CH-1211, Switzerland
| | - Eric Dayer
- Central Institute, Hospital of Valais, Sion, Switzerland
| | - Jörg D Seebach
- Division of Immunology and Allergy, Department of Medical Specialties, University Hospitals and Medical Faculty, Geneva CH-1211, Switzerland
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Anderson SJ, White MG, Armour SL, Maheshwari R, Tiniakos D, Muller YD, Berishvili E, Berney T, Shaw JAM. Loss of end-differentiated β-cell phenotype following pancreatic islet transplantation. Am J Transplant 2018; 18:750-755. [PMID: 28949067 DOI: 10.1111/ajt.14521] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 05/30/2017] [Revised: 09/15/2017] [Accepted: 09/16/2017] [Indexed: 01/25/2023]
Abstract
Replacement of pancreatic β-cells through deceased donor islet transplantation is a proven therapy for preventing recurrent life-threatening hypoglycemia in type 1 diabetes. Although near-normal glucose levels and insulin independence can be maintained for many years following successful islet transplantation, restoration of normal functional β-cell mass has remained elusive. It has recently been proposed that dedifferentiation/plasticity towards other endocrine phenotypes may play an important role in stress-induced β-cell dysfunction in type 2 diabetes. Here we report loss of end-differentiated β-cell phenotype in 2 intraportal islet allotransplant recipients. Despite excellent graft function and sustained insulin independence, all examined insulin-positive cells had lost expression of the end-differentiation marker, urocortin-3, or appeared to co-express the α-cell marker, glucagon. In contrast, no insulin+ /urocortin-3- cells were seen in nondiabetic deceased donor control pancreatic islets. Loss of end-differentiated phenotype may facilitate β-cell survival during the stresses associated with islet isolation and culture, in addition to sustained hypoxia following engraftment. As further refinements in islet isolation and culture are made in parallel with exploration of alternative β-cell sources, graft sites, and ultimately fully vascularized bioengineered insulin-secreting microtissues, differentiation status immunostaining provides a novel tool to assess whether fully mature β-cell phenotype has been maintained.
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Affiliation(s)
- S J Anderson
- Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - M G White
- Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - S L Armour
- Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - R Maheshwari
- Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - D Tiniakos
- Institute of Cellular Medicine, Newcastle University, Newcastle, UK.,Department of Pathology, Aretaieion Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Y D Muller
- Cell Isolation and Transplantation Center, Department of Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - E Berishvili
- Cell Isolation and Transplantation Center, Department of Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.,Institute of Medical Research, Ilia State University, Tbilisi, Georgia
| | - T Berney
- Cell Isolation and Transplantation Center, Department of Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - J A M Shaw
- Institute of Cellular Medicine, Newcastle University, Newcastle, UK
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Muller YD, Ghaleb N, Rotman S, Vionnet J, Halfon M, Catana E, Golshayan D, Venetz JP, Aubert V, Pascual M. Rituximab as monotherapy for the treatment of chronic active antibody-mediated rejection after kidney transplantation. Transpl Int 2018; 31:451-455. [DOI: 10.1111/tri.13111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Yannick D. Muller
- Transplantation Center; Lausanne University Hospital; University of Lausanne; Lausanne Switzerland
| | - Nseir Ghaleb
- Transplantation Center; Lausanne University Hospital; University of Lausanne; Lausanne Switzerland
| | - Samuel Rotman
- Service of Clinical Pathology; Lausanne University Hospital; University of Lausanne; Lausanne Switzerland
| | - Julien Vionnet
- Transplantation Center; Lausanne University Hospital; University of Lausanne; Lausanne Switzerland
| | - Matthieu Halfon
- Transplantation Center; Lausanne University Hospital; University of Lausanne; Lausanne Switzerland
| | - Emmanuelle Catana
- Transplantation Center; Lausanne University Hospital; University of Lausanne; Lausanne Switzerland
| | - Déla Golshayan
- Transplantation Center; Lausanne University Hospital; University of Lausanne; Lausanne Switzerland
| | - Jean-Pierre Venetz
- Transplantation Center; Lausanne University Hospital; University of Lausanne; Lausanne Switzerland
| | - Vincent Aubert
- Service of Immunology and Allergy; Lausanne University Hospital; University of Lausanne; Lausanne Switzerland
| | - Manuel Pascual
- Transplantation Center; Lausanne University Hospital; University of Lausanne; Lausanne Switzerland
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Meier RPH, Muller YD, Balaphas A, Morel P, Pascual M, Seebach JD, Buhler LH. Xenotransplantation: back to the future? Transpl Int 2018; 31:465-477. [PMID: 29210109 DOI: 10.1111/tri.13104] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/05/2017] [Accepted: 11/26/2017] [Indexed: 12/26/2022]
Abstract
The field of xenotransplantation has fluctuated between great optimism and doubts over the last 50 years. The initial clinical attempts were extremely ambitious but faced technical and ethical issues that prompted the research community to go back to preclinical studies. Important players left the field due to perceived xenozoonotic risks and the lack of progress in pig-to-nonhuman-primate transplant models. Initial apparently unsurmountable issues appear now to be possible to overcome due to progress of genetic engineering, allowing the generation of multiple-xenoantigen knockout pigs that express human transgenes and the genomewide inactivation of porcine endogenous retroviruses. These important steps forward were made possible by new genome editing technologies, such as CRISPR/Cas9, allowing researchers to precisely remove or insert genes anywhere in the genome. An additional emerging perspective is the possibility of growing humanized organs in pigs using blastocyst complementation. This article summarizes the current advances in xenotransplantation research in nonhuman primates, and it describes the newly developed genome editing technology tools and interspecific organ generation.
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Affiliation(s)
- Raphael P H Meier
- Visceral and Transplant Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Yannick D Muller
- Division of Clinical Immunology and Allergy, Department of Medical Specialties, University Hospitals and Medical Faculty, Geneva, Switzerland.,Transplantation Center, Lausanne University Hospital, Lausanne, Switzerland
| | - Alexandre Balaphas
- Visceral and Transplant Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Philippe Morel
- Visceral and Transplant Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Manuel Pascual
- Transplantation Center, Lausanne University Hospital, Lausanne, Switzerland
| | - Jörg D Seebach
- Division of Clinical Immunology and Allergy, Department of Medical Specialties, University Hospitals and Medical Faculty, Geneva, Switzerland
| | - Leo H Buhler
- Visceral and Transplant Surgery, University Hospitals of Geneva, Geneva, Switzerland
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Louis C, Vijgen S, Samii K, Chalandon Y, Terriou L, Launay D, Fajgenbaum DC, Seebach JD, Muller YD. TAFRO Syndrome in Caucasians: A Case Report and Review of the Literature. Front Med (Lausanne) 2017; 4:149. [PMID: 29018798 PMCID: PMC5614916 DOI: 10.3389/fmed.2017.00149] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 08/31/2017] [Indexed: 12/30/2022] Open
Abstract
Background TAFRO syndrome has been reported in Japan among human herpesvirus 8 (HHV-8)-negative/idiopathic multicentric Castleman’s disease (iMCD) patients. To date, the majority of iMCD patients with TAFRO syndrome originate from Japan. Case presentation Herein, we report a 67-year-old HIV/HHV-8-negative Caucasian iMCD patient diagnosed with TAFRO. He presented with marked systemic inflammation, bicytopenia, terminal renal insufficiency, diffuse lymphadenopathies, and anasarca. Lymph node and bone marrow biopsies revealed atrophic germinal centers variably hyalinized and megakaryocytic hyperplasia with mild myelofibrosis. Several other biopsies performed in kidneys, liver, gastrointestinal tract, prostate, and lungs revealed unspecific chronic inflammation. The patient had a complete response to corticosteroids, tocilizumab, and rituximab. He relapsed twice following discontinuation of rituximab. When reviewing the literature, we found seven other Caucasian cases with TAFRO syndrome. There were no significant differences with those described by the Japanese cohort except for the higher frequency of kidney failure and auto-antibodies in Western patients. Conclusion This case illustrates that patients with TAFRO syndrome can develop non-specific inflammation in several tissue sites. Furthermore, this case and our review of the literature demonstrate that TAFRO syndrome can affect Caucasian and Japanese patients highlighting the importance of evaluating for this syndrome independently of ethnic background.
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Affiliation(s)
- Céline Louis
- Division of Hematology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Sandrine Vijgen
- Department of Pathology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Kaveh Samii
- Division of Hematology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Yves Chalandon
- Division of Hematology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Louis Terriou
- Department of Internal Medicine and Clinical Immunology CHU, University of Lille, U995, Lille Inflammation Research International Center, INSERM, Centre national de référence maladies systémiques et auto-immunes rares (sclérodermie systémique), Lille, France
| | - David Launay
- Department of Internal Medicine and Clinical Immunology CHU, University of Lille, U995, Lille Inflammation Research International Center, INSERM, Centre national de référence maladies systémiques et auto-immunes rares (sclérodermie systémique), Lille, France
| | - David C Fajgenbaum
- Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jörg D Seebach
- Division of Clinical Immunology and Allergy, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Yannick D Muller
- Division of Clinical Immunology and Allergy, Geneva University Hospital, University of Geneva, Geneva, Switzerland
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Muller YD, Oppliger R, Breguet R, Meyer P, Rubbia-Brandt L, Petignat PA, Harr T, Dayer E, Seebach JD. Hereditary haemorrhagic telangiectasia: to transplant or not to transplant - is there a right time for liver transplantation? Liver Int 2016; 36:1735-1740. [PMID: 27864873 DOI: 10.1111/liv.13187] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/08/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Hereditary haemorrhagic telangiectasia is characterized by arterio-venous malformations (AVM). It frequently involves the liver without clinical symptoms, but may lead to biliary ischaemia, portal hypertension, or fatal high-output heart failure. The indication of liver transplantation is controversial. METHODS Herein, we report the case of a 65-year-old female patient with a 'double Osler syndrome' consisting of hereditary haemorrhagic telangiectasia (HHT) and type I hereditary angioedema diagnosed at the age of 25 and 22 years respectively. RESULTS Hereditary angioedema was treated with danazol for several decades until multiple hypoechogenic liver masses were detected. Albeit danazol treatment was replaced by C1 esterase inhibitor infusions, hepatocellular carcinoma was diagnosed at the age of 64 and the patient was listed for liver transplantation. HHT was marked by recurrent epistaxis until the age of 63 when severe intestinal bleeding occurred. At the age of 65, severe dyspnoea (NYHA class IV) developed and rapidly progressive high-output cardiac failure was diagnosed. Despite argon plasma coagulation to control bleeding from intestinal angiodysplasia, and treatment with bevacizumab to inhibit angiogenesis, the patient died from severe gastrointestinal bleeding associated with cardiogenic shock at the age of 66 before being transplanted. CONCLUSION The indication to list this patient for liver transplantation was debated several times before the diagnosis of hepatocellular carcinoma because of good general condition and low MELD score. Precise guidelines for screening and management of patients with hepatic HHT need to be better defined.
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Affiliation(s)
- Yannick D Muller
- Division of Clinical Immunology and Allergology, Department of Medical Specialties, University Hospitals and Medical Faculty, Geneva, Switzerland
| | | | - Romain Breguet
- Department of Radiology, University Hospitals and Medical Faculty, Geneva, Switzerland
| | - Philippe Meyer
- Division of Cardiology, Department of Medical Specialties, University Hospitals and Medical Faculty, Geneva, Switzerland
| | - Laura Rubbia-Brandt
- Division of Clinical Pathology, Department of Pathology, University Hospitals and Medical Faculty, Geneva, Switzerland
| | | | - Thomas Harr
- Division of Clinical Immunology and Allergology, Department of Medical Specialties, University Hospitals and Medical Faculty, Geneva, Switzerland
| | | | - Jörg D Seebach
- Division of Clinical Immunology and Allergology, Department of Medical Specialties, University Hospitals and Medical Faculty, Geneva, Switzerland
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Giovannoni L, Muller YD, Lacotte S, Parnaud G, Borot S, Meier RP, Lavallard V, Bédat B, Toso C, Daubeuf B, Elson G, Shang L, Morel P, Kosco-Vilbois M, Bosco D, Berney T. Enhancement of Islet Engraftment and Achievement of Long-Term Islet Allograft Survival by Toll-Like Receptor 4 Blockade. Transplantation 2015; 99:29-35. [DOI: 10.1097/tp.0000000000000468] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Meier RPH, Sert I, Morel P, Muller YD, Borot S, Badet L, Toso C, Bosco D, Berney T. Islet of Langerhans isolation from pediatric and juvenile donor pancreases. Transpl Int 2014; 27:949-55. [PMID: 24890668 DOI: 10.1111/tri.12367] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 03/28/2014] [Accepted: 05/26/2014] [Indexed: 11/30/2022]
Abstract
Islet grafts isolated from young donors allow superior functional outcomes but are often associated with poor islet isolation yields. The objective of this study was to comparatively analyze the outcomes of islet isolation between young and older donors. We retrospectively analyzed 564 pancreas isolations performed at our institution. Isolation outcomes were compared between donors aged ≤20 years (n = 42, YD) and >20 years (n = 522, OD). Isolation procedure was identical in both groups. Prepurification percentage of embedded islets was higher in YD (44.3 ± 22.7% vs. 24.9 ± 20.9%, P < 0.001). This led to a lower recovery rate in YD (48% vs. 76%, P = 0.002) and hence lower postpurification IEQ/g pancreas in YD (2 412 ± 1 789 IEQ/g vs. 3 194 ± 1 892 IEQ/g, P = 0.01). Final yield was 180 982 ± 128 073 IEQ in YD and 244 167 ± 134 137 IEQ in OD, (P = 0.006). In vitro function was markedly, albeit nonsignificantly, higher in YD (SI: 4.5 ± 5.1 vs. 3.0 ± 5.7, P = 0.350). Proportion of transplanted preparations was similar in both groups, 38% (16/42) in YD vs. 43% (224/522) in OD, P = 0.628. In spite of isolation and purification difficulties, pancreases from young donors allowed similar islet transplantation rates as older donors. Efforts should be directed at improving islet extraction in these donors to realize their full potential for islet transplantation.
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Affiliation(s)
- Raphael P H Meier
- Department of Surgery, Cell Isolation and Transplantation Center, University of Geneva Hospitals and School of Medicine, Geneva, Switzerland
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Meier RPH, Muller YD, Gutzwiller EM, Spahr L, Negro F, Krause KH, Schaller K, Wandrey C, Sgroi A, Morel P, Bühler LH. [Cell transplantation: current treatments and future prospects]. Rev Med Suisse 2014; 10:1350-1355. [PMID: 25051598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Regenerative medicine aims to replace a body function or specific cell loss. It includes therapies at the forefront of modem medicine, issuing from translational biomedical research. Transplantation of organs and cells has revolutionized the management of patients for whom medical treatment is a failure. Unfortunately, organ shortage is limiting treatment possibility. As an example, among the 15,000 patients with type I diabetes in Switzerland, only approximately 30 can receive a pancreas or an islet transplant per year. Second example, 500 patients die each year in Switzerland from alcoholic cirrhosis because no treatment is available. Transplantation of islet cells, hepatocytes, mesenchymal stem cells or dopaminergic neurons represents hope fora therapy available for large populations of patients.
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Meier RPH, Seebach JD, Morel P, Mahou R, Borot S, Giovannoni L, Parnaud G, Montanari E, Bosco D, Wandrey C, Berney T, Bühler LH, Muller YD. Survival of free and encapsulated human and rat islet xenografts transplanted into the mouse bone marrow. PLoS One 2014; 9:e91268. [PMID: 24625569 PMCID: PMC3953382 DOI: 10.1371/journal.pone.0091268] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 02/10/2014] [Indexed: 01/19/2023] Open
Abstract
Bone marrow was recently proposed as an alternative and potentially immune-privileged site for pancreatic islet transplantation. The aim of the present study was to assess the survival and rejection mechanisms of free and encapsulated xenogeneic islets transplanted into the medullary cavity of the femur, or under the kidney capsule of streptozotocin-induced diabetic C57BL/6 mice. The median survival of free rat islets transplanted into the bone marrow or under the kidney capsule was 9 and 14 days, respectively, whereas that of free human islets was shorter, 7 days (bone marrow) and 10 days (kidney capsule). Infiltrating CD8+ T cells and redistributed CD4+ T cells, and macrophages were detected around the transplanted islets in bone sections. Recipient mouse splenocytes proliferated in response to donor rat stimulator cells. One month after transplantation under both kidney capsule or into bone marrow, encapsulated rat islets had induced a similar degree of fibrotic reaction and still contained insulin positive cells. In conclusion, we successfully established a small animal model for xenogeneic islet transplantation into the bone marrow. The rejection of xenogeneic islets was associated with local and systemic T cell responses and macrophage recruitment. Although there was no evidence for immune-privilege, the bone marrow may represent a feasible site for encapsulated xenogeneic islet transplantation.
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Affiliation(s)
- Raphael P. H. Meier
- Cell Isolation and Transplantation Center, Department of Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Jörg D. Seebach
- Division of Clinical Immunology and Allergology, Department of Internal Medicine, University Hospital and Medical Faculty, Geneva, Switzerland
| | - Philippe Morel
- Cell Isolation and Transplantation Center, Department of Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Redouan Mahou
- Institut d’Ingénierie Biologique et Institut des Sciences et Ingénierie Chimiques, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Sophie Borot
- Cell Isolation and Transplantation Center, Department of Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Laurianne Giovannoni
- Cell Isolation and Transplantation Center, Department of Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Geraldine Parnaud
- Cell Isolation and Transplantation Center, Department of Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Elisa Montanari
- Cell Isolation and Transplantation Center, Department of Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Domenico Bosco
- Cell Isolation and Transplantation Center, Department of Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Christine Wandrey
- Institut d’Ingénierie Biologique et Institut des Sciences et Ingénierie Chimiques, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Thierry Berney
- Cell Isolation and Transplantation Center, Department of Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Leo H. Bühler
- Cell Isolation and Transplantation Center, Department of Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Yannick D. Muller
- Cell Isolation and Transplantation Center, Department of Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Division of Clinical Immunology and Allergology, Department of Internal Medicine, University Hospital and Medical Faculty, Geneva, Switzerland
- * E-mail:
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Muller YD, Gupta S, Morel P, Borot S, Bettens F, Truchetet ME, Villard J, Seebach JD, Holmberg D, Toso C, Lobrinus JA, Bosco D, Berney T. Transplanted human pancreatic islets after long-term insulin independence. Am J Transplant 2013; 13:1093-1097. [PMID: 23398948 DOI: 10.1111/ajt.12138] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 11/22/2012] [Accepted: 12/10/2012] [Indexed: 01/25/2023]
Abstract
Long-term insulin independence after islets of Langerhans transplantation is rarely achieved. The aims of this study were to identify the histological and immunological features of islets transplanted in a type 1 diabetic patient who died of a cerebral hemorrhage after >13 years insulin independence. Islets were pooled from two donors with respectively one and five HLA mismatches. Insulin-positive islets were found throughout the right and left liver, and absent in the pancreas. Two- and three-dimensional analysis showed that islets lost their initial rounded and compact morphology, had a mean diameter of 136 μm and were constituted of an unfolded epithelial band of 39.1 μm. Leukocyte phenotyping showed no evidence of a tolerogenic environment in the islet-containing portal spaces. Finally, HLA typing of microdissected islets showed HLA from the best matched donor in all 23 microdissection samples, compared to 1/23 for the least matched donor. This case report demonstrates that allogeneic islets can survive over 13 years while maintaining insulin independence. Allogeneic islets had unique morphologic features and implanted in the liver regardless of their size. Finally, our results suggest that, in this case, rejection had been prevalent over autoimmunity, although this hypothesis warrants further investigation.
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Affiliation(s)
- Y D Muller
- Cell Isolation and Transplantation Center, Department of Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.,Division of Clinical Immunology and Allergology, Department of Internal Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - S Gupta
- Centre for Infection and Inflammation Research, Faculty of Health, University of Copenhagen, Denmark
| | - P Morel
- Cell Isolation and Transplantation Center, Department of Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - S Borot
- Cell Isolation and Transplantation Center, Department of Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - F Bettens
- National Reference Laboratory for Histocompatibility, Department of Internal Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - M E Truchetet
- Division of Clinical Immunology and Allergology, Department of Internal Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - J Villard
- Division of Clinical Immunology and Allergology, Department of Internal Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - J D Seebach
- Division of Clinical Immunology and Allergology, Department of Internal Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - D Holmberg
- Centre for Infection and Inflammation Research, Faculty of Health, University of Copenhagen, Denmark
| | - C Toso
- Cell Isolation and Transplantation Center, Department of Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - J A Lobrinus
- Department of Pathology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - D Bosco
- Cell Isolation and Transplantation Center, Department of Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - T Berney
- Cell Isolation and Transplantation Center, Department of Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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Parnaud G, Gonelle-Gispert C, Morel P, Giovannoni L, Muller YD, Meier R, Borot S, Berney T, Bosco D. Cadherin engagement protects human β-cells from apoptosis. Endocrinology 2011; 152:4601-9. [PMID: 21990317 DOI: 10.1210/en.2011-1286] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [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: 12/18/2022]
Abstract
The aim of this study was to assess the expression of different types of cadherins in human islets and their role in human β-cell apoptosis. Expression of E-, N-, and P-cadherins was studied by immunofluorescence on pancreas sections and islet cells, and by Western blotting on protein extracts of isolated islets and islet cells. The effects of specific cadherins on cell adhesion and apoptosis were studied using chimeric proteins containing functional E-, N-, or P-cadherin ectodomains fused to Fc fragment of Ig (E-cad/Fc, N-cad/Fc, and P-cad/Fc) and immobilized on glass substrate. β-Cells were identified by immunofluorescence for insulin and apoptotic cells by terminal deoxynucleotide transferase-mediated 2'-deoxyuridine, 5'-triphosphate nick-end labeling. By immunofluorescence, we showed that E- and N-, and not P-, cadherins were expressed at the surface of islet cells. By triple staining, we showed that E-cadherin was expressed at similar extent in β- and α-cells, whereas N-cadherin was preferentially expressed in β-cells. These results were confirmed by Western blot analysis using protein extracts from fluorescence-activated cell sorting-sorted β- and non-β-cells. Adhesion tests showed that the affinity of islet cells for E-cad/Fc and N-cad/Fc and not for P-cad/Fc was increased compared with control. By terminal deoxynucleotide transferase-mediated 2'-deoxyuridine, 5'-triphosphate nick-end labeling, we showed that the percentage of apoptotic cells was lower in aggregated β-cells compared with single β-cells and that attachment to E-cad/Fc and N-cad/Fc and not to P-cad/Fc decreased apoptosis of single β-cells compared with control. Our results show that at least E- and N-cadherins are expressed at the surface of human β-cells and that these adhesion molecules are involved in the maintenance of β-cell viability.
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Affiliation(s)
- Géraldine Parnaud
- Cell Isolation and Transplantation Center, Department of Surgery, Geneva University Hospitals and University of Geneva, 1211 Geneva 4, Switzerland
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Ellingsgaard H, Hauselmann I, Schuler B, Habib AM, Baggio LL, Meier DT, Eppler E, Bouzakri K, Wueest S, Muller YD, Hansen AMK, Reinecke M, Konrad D, Gassmann M, Reimann F, Halban PA, Gromada J, Drucker DJ, Gribble FM, Ehses JA, Donath MY. Interleukin-6 enhances insulin secretion by increasing glucagon-like peptide-1 secretion from L cells and alpha cells. Nat Med 2011; 17:1481-9. [PMID: 22037645 PMCID: PMC4286294 DOI: 10.1038/nm.2513] [Citation(s) in RCA: 618] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 09/15/2011] [Indexed: 12/23/2022]
Abstract
Exercise, obesity and type 2 diabetes are associated with elevated plasma concentrations of interleukin-6 (IL-6). Glucagon-like peptide-1 (GLP-1) is a hormone that induces insulin secretion. Here we show that administration of IL-6 or elevated IL-6 concentrations in response to exercise stimulate GLP-1 secretion from intestinal L cells and pancreatic alpha cells, improving insulin secretion and glycemia. IL-6 increased GLP-1 production from alpha cells through increased proglucagon (which is encoded by GCG) and prohormone convertase 1/3 expression. In models of type 2 diabetes, the beneficial effects of IL-6 were maintained, and IL-6 neutralization resulted in further elevation of glycemia and reduced pancreatic GLP-1. Hence, IL-6 mediates crosstalk between insulin-sensitive tissues, intestinal L cells and pancreatic islets to adapt to changes in insulin demand. This previously unidentified endocrine loop implicates IL-6 in the regulation of insulin secretion and suggests that drugs modulating this loop may be useful in type 2 diabetes.
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Affiliation(s)
- Helga Ellingsgaard
- Clinic for Endocrinology, Diabetes & Metabolism and Department Biomedicine, University Hospital Basel, Basel, Switzerland.
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Muller YD, Golshayan D, Ehirchiou D, Wyss JC, Giovannoni L, Meier R, Serre-Beinier V, Puga Yung G, Morel P, Bühler LH, Seebach JD. Immunosuppressive effects of streptozotocin-induced diabetes result in absolute lymphopenia and a relative increase of T regulatory cells. Diabetes 2011; 60:2331-40. [PMID: 21752956 PMCID: PMC3161310 DOI: 10.2337/db11-0159] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Streptozotocin (STZ) is the most widely used diabetogenic agent in animal models of islet transplantation. However, the immunomodifying effects of STZ and the ensuing hyperglycemia on lymphocyte subsets, particularly on T regulatory cells (Tregs), remain poorly understood. RESEARCH DESIGN AND METHODS This study evaluated how STZ-induced diabetes affects adaptive immunity and the consequences thereof on allograft rejection in murine models of islet and skin transplantation. The respective toxicity of STZ and hyperglycemia on lymphocyte subsets was tested in vitro. The effect of hyperglycemia was assessed independently of STZ in vivo by the removal of transplanted syngeneic islets, using an insulin pump, and with rat insulin promoter diphtheria toxin receptor transgenic mice. RESULTS Early lymphopenia in both blood and spleen was demonstrated after STZ administration. Direct toxicity of STZ on lymphocytes, particularly on CD8(+) cells and B cells, was shown in vitro. Hyperglycemia also correlated with blood and spleen lymphopenia in vivo but was not lymphotoxic in vitro. Independently of hyperglycemia, STZ led to a relative increase of Tregs in vivo, with the latter retaining their suppressive capacity in vitro. The higher frequency of Tregs was associated with Treg proliferation in the blood, but not in the spleen, and higher blood levels of transforming growth factor-β. Finally, STZ administration delayed islet and skin allograft rejection compared with naive mice. CONCLUSIONS These data highlight the direct and indirect immunosuppressive effects of STZ and acute hyperglycemia, respectively. Thus, these results have important implications for the future development of tolerance-based protocols and their translation from the laboratory to the clinic.
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Affiliation(s)
- Yannick D Muller
- Department of Internal Medicine, Division of Clinical Immunology and Allergology, University Hospital and Medical Faculty, Geneva, Switzerland.
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Muller YD, Seebach JD, Bühler LH, Pascual M, Golshayan D. Transplantation tolerance: Clinical potential of regulatory T cells. Self Nonself 2011; 2:26-34. [PMID: 21776332 PMCID: PMC3136901 DOI: 10.4161/self.2.1.15422] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Accepted: 03/09/2011] [Indexed: 01/12/2023]
Abstract
The major challenge in transplantation medicine remains long-term allograft acceptance, with preserved allograft function under minimal chronic immunosuppression. To safely achieve the goal of sustained donor-specific T and B cell non-responsiveness, research efforts are now focusing on therapies based on cell subsets with regulatory properties. In particular the transfusion of human regulatory T cells (Treg) is currently being evaluated in phase I/II clinical trials for the treatment of graft versus host disease following hematopoietic stem cell transplantation, and is also under consideration for solid organ transplantation. The purpose of this review is to recapitulate current knowledge on naturally occurring as well as induced human Treg, with emphasis on their specific phenotype, suppressive function and how these cells can be manipulated in vitro and/or in vivo for therapeutic purposes in transplantation medicine. We highlight the potential but also possible limitations of Treg-based strategies to promote long-term allograft survival. It is evident that the bench-to-beside translation of these protocols still requires further understanding of Treg biology. Nevertheless, current data already suggest that Treg therapy alone will not be sufficient and needs to be combined with other immunomodulatory approaches in order to induce allograft tolerance.
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Affiliation(s)
- Yannick D Muller
- Surgical Research Unit; Department of Surgery; University Hospital Geneva
- Service of Clinical Immunology and Allergology; Department of Internal Medicine; University Hospital Geneva
| | - Jörg D Seebach
- Service of Clinical Immunology and Allergology; Department of Internal Medicine; University Hospital Geneva
| | - Leo H Bühler
- Surgical Research Unit; Department of Surgery; University Hospital Geneva
| | - Manuel Pascual
- Transplantation Centre and Transplantation Immunopathology Laboratory; Departments of Medicine and Surgery; Centre Hospitalier Universitaire Vaudois and University of Lausanne; Switzerland
| | - Dela Golshayan
- Transplantation Centre and Transplantation Immunopathology Laboratory; Departments of Medicine and Surgery; Centre Hospitalier Universitaire Vaudois and University of Lausanne; Switzerland
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Abstract
OBJECTIVE It is generally admitted that the endocrine cell organization in human islets is different from that of rodent islets. However, a clear description of human islet architecture has not yet been reported. The aim of this work was to describe our observations on the arrangement of human islet cells. RESEARCH DESIGN AND METHODS Human pancreas specimens and isolated islets were processed for histology. Sections were analyzed by fluorescence microscopy after immunostaining for islet hormones and endothelial cells. RESULTS In small human islets (40-60 mum in diameter), beta-cells had a core position, alpha-cells had a mantle position, and vessels laid at their periphery. In bigger islets, alpha-cells had a similar mantle position but were found also along vessels that penetrate and branch inside the islets. As a consequence of this organization, the ratio of beta-cells to alpha-cells was constantly higher in the core than in the mantle part of the islets, and decreased with increasing islet diameter. This core-mantle segregation of islet cells was also observed in type 2 diabetic donors but not in cultured isolated islets. Three-dimensional analysis revealed that islet cells were in fact organized into trilaminar epithelial plates, folded with different degrees of complexity and bordered by vessels on both sides. In epithelial plates, most beta-cells were located in a central position but frequently showed cytoplasmic extensions between outlying non-beta-cells. CONCLUSIONS Human islets have a unique architecture allowing all endocrine cells to be adjacent to blood vessels and favoring heterologous contacts between beta- and alpha-cells, while permitting homologous contacts between beta-cells.
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Affiliation(s)
- Domenico Bosco
- Cell Isolation and Transplantation Center, Department of Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
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Muller YD, Mai G, Morel P, Serre-Beinier V, Gonelle-Gispert C, Yung GP, Ehirchiou D, Wyss JC, Bigenzahn S, Irla M, Heusser C, Golshayan D, Seebach JD, Wekerle T, Bühler LH. Anti-CD154 mAb and rapamycin induce T regulatory cell mediated tolerance in rat-to-mouse islet transplantation. PLoS One 2010; 5:e10352. [PMID: 20436684 PMCID: PMC2859949 DOI: 10.1371/journal.pone.0010352] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 03/31/2010] [Indexed: 12/16/2022] Open
Abstract
Background Anti-CD154 (MR1) monoclonal antibody (mAb) and rapamycin (RAPA) treatment both improve survival of rat-to-mouse islet xenograft. The present study investigated the effect of combined RAPA/MR1 treatment on rat-to-mouse islet xenograft survival and analyzed the role of CD4+CD25+Foxp3+ T regulatory cells (Treg) in the induction and maintenance of the ensuing tolerance. Methodology/Principal Findings C57BL/6 mice were treated with MR1/RAPA and received additional monoclonal anti-IL2 mAb or anti CD25 mAb either early (0–28 d) or late (100–128 d) post-transplantation. Treg were characterised in the blood, spleen, draining lymph nodes and within the graft of tolerant and rejecting mice by flow cytometry and immunohistochemistry. Fourteen days of RAPA/MR1 combination therapy allowed indefinite islet graft survival in >80% of the mice. Additional administration of anti-IL-2 mAb or depleting anti-CD25 mAb at the time of transplantation resulted in rejection (100% and 89% respectively), whereas administration at 100 days post transplantation lead to lower rejection rates (25% and 40% respectively). Tolerant mice showed an increase of Treg within the graft and in draining lymph nodes early post transplantation, whereas 100 days post transplantation no significant increase of Treg was observed. Rejecting mice showed a transient increase of Treg in the xenograft and secondary lymphoid organs, which disappeared within 7 days after rejection. Conclusions/Significances These results suggest a critical role for Treg in the induction phase of tolerance early after islet xenotransplantation. These encouraging data support the need of developing further Treg therapy for overcoming the species barrier in xenotransplantation.
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Affiliation(s)
- Yannick D Muller
- Surgical Research Unit, Department of Surgery, University Hospital Geneva, Geneva, Switzerland.
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