Antithymocyte Globulin in Reduced-Intensity Conditioning Regimen Allows a High Disease-Free Survival Exempt of Long-Term Chronic Graft-versus-Host Disease

AbstractNonmyeloablative (NMA) regimens allow the use of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients considered unfit for standard myeloablative conditioning (MAC) regimens using high-dose alkylating agents with or without total body irradiation (TBI). Reduced-intensity conditioning (RIC) regimens, based on fludarabine (Flu), busulfan (Bu), and rabbit antithymocyte globulin (r-ATG), represent an intermediate alternative between NMA and MAC regimens. This platform was subsequently optimized by the introduction of i.v. Bu and the use of 5 mg/kg r-ATG, based on the hypothesis that these modifications would improve the safety of RIC allo-HSCT. Here we report a study conducted at our institution on 206 patients, median age 59 years, who underwent allo-HSCT after conditioning with Flu, 2 days of i.v. Bu, and 5 mg/kg r-ATG (FBx-ATG) between 2005 and 2012. The prevalence of grade III-IV acute graft-versus-host disease (GVHD) was 9%, and that of extensive chronic GVHD was 22%. Four-year nonrelapse mortality (NRM), relapse, and overall survival (OS) rates were 22%, 36%, and 54%, respectively. NRM tended to be influenced by comorbidities (hematopoietic cell transplantation–specific comorbidity index [HCT-CI] <3 versus HCT-CI ≥3: 18% versus 27%; P = .075), but not by age (<60 years, 20% versus ≥60 years, 25%; P = .142). Disease risk significantly influenced relapse (2 years: low, 8%, intermediate, 28%, high, 34%; very high, 63%; P = .017). Both disease risk (hazard ratio [95% confidence interval]: intermediate, 2.1 [0.8 to 5.2], P = .127; high, 3.4 [1.3 to 9.1], P = .013; very high, 4.0 [1.1 to 14], P = .029) and HCT-CI (hazard ratio [95% confidence interval]: HCT-CI ≥3, 1.7 (1.1 to 2.8), P = .018) influenced OS, but age and donor type did not. The FBx-ATG RIC regimen reported here is associated with low mortality and high long-term disease-free survival without persistent GVHD in both young and old patients. It represents a valuable platform for developing further post-transplantation strategies aimed at reducing the incidence of relapse, particularly in the setting of high-risk disease

Characterisation of Genome-Wide PLZF/RARA Target Genes

The PLZF/RARA fusion protein generated by the t(11;17)(q23;q21) translocation in acute promyelocytic leukaemia (APL) is believed to act as an oncogenic transcriptional regulator recruiting epigenetic factors to genes important for its transforming potential. However, molecular mechanisms associated with PLZF/RARA-dependent leukaemogenesis still remain unclear

Pathologies associées à des anomalies de la régulation post-transcriptionnelle

MONTPELLIER-BU Pharmacie (341722105) / SudocSudocFranceF

Facteurs associés à la survenue d'effets indésirables après greffe de cellules souches hématopoïétiques autologues

AIX-MARSEILLE2-BU Pharmacie (130552105) / SudocSudocFranceF

The Cleavage/Polyadenylation Activity Triggered by a U-rich Motif Sequence Is Differently Required Depending on the Poly(A) Site Location at Either the First or Last 3′-Terminal Exon of the 2′-5′ Oligo(A) Synthetase Gene

Abstract Background Among the different mechanisms involved in irritable bowel syndrome ( IBS ) physiopathology, visceral hypersensitivity seems to play a key role. It involves sensitization of the colonic primary afferent fibers, especially through an overexpression of ion channels. The aims of this translational study were to investigate the colonic expression of Ca v 3.2 calcium channels and their involvement in an animal model of colonic hypersensitivity, and to assess their expression in the colonic mucosa of symptomatic IBS patients. Methods This bench‐to‐bed study combined a preclinical experimental study on mice and a case–control clinical study. Preclinical studies were performed on wild‐type and Ca v 3.2‐ KO mice. Colonic sensitivity and Ca v 3.2 expression were studied after a low‐dose treatment of dextran sodium sulfate ( DSS 0.5%). Regarding the clinical study, colonic biopsies were performed in 14 IBS patients and 16 controls during a colonoscopy to analyze the mucosal Ca v 3.2 expression. Key results Wild‐type, but not Ca v 3.2‐ KO , mice developed visceral hypersensitivity without colonic inflammation, after 0.5% DSS treatment. A significant increase of Ca v 3.2 mRNA ( p = 0.04) was found in the colon of low‐dose DSS ‐treated wild‐type ( WT ) mice compared to their controls. In human colonic biopsies, the Ca v 3.2 mRNA level was significantly higher in the IBS group compared to the control group ( p = 0.01). The immunofluorescence staining revealed their protein expression in colonic mucosa, particularly in nerve fibers. Conclusions & inferences This translational study supports the involvement of the calcium channels Ca v 3.2 in abdominal pain, as observed in IBS patients. It opens new therapeutic perspectives based on molecules specifically blocking these channels

MANUFACTURING NATURAL KILLER CELLS AS MEDICINAL PRODUCTS

Natural Killer (NK) cells are Innate Lymphoid Cells (ILC) with cytotoxic and regulatory properties. Their functions are tightly regulated by an array of inhibitory and activating receptors, and their mechanisms of activation strongly differ from antigen recognition in the context of HLA presentation as needed for T-cell activation. NK cells thus offer unique opportunities for new and improved therapeutic manipulation, either in vivo or in vitro, in a variety of human diseases, including cancers. NK cell activity can possibly be modulated in vivo through direct or indirect actions exerted by small molecules or monoclonal antibodies. NK cells can also be adoptively transferred following more or less substantial modifications through cell and gene manufacturing, in order to empower them with new or improved functions and ensure their controlled persistence and activity in the recipient. In the present review, we will focus on the technological and regulatory challenges of NK cell manufacturing, and discuss conditions in which these innovative cellular therapies can be brought to the clinic

Manufacturing Natural Killer Cells as Medicinal Products

International audienceNatural Killer (NK) cells are innate lymphoid cells (ILC) with cytotoxic and regulatory properties. Their functions are tightly regulated by an array of inhibitory and activating receptors, and their mechanisms of activation strongly differ from antigen recognition in the context of human leukocyte antigen presentation as needed for T-cell activation. NK cells thus offer unique opportunities for new and improved therapeutic manipulation, either in vivo or in vitro, in a variety of human diseases, including cancers. NK cell activity can possibly be modulated in vivo through direct or indirect actions exerted by small molecules or monoclonal antibodies. NK cells can also be adoptively transferred following more or less substantial modifications through cell and gene manufacturing, in order to empower them with new or improved functions and ensure their controlled persistence and activity in the recipient. In the present review, we will focus on the technological and regulatory challenges of NK cell manufacturing and discuss conditions in which these innovative cellular therapies can be brought to the clinic

Les unités de thérapie cellulaire à l’épreuve de la réglementation sur les médicaments de thérapie innovante

Le règlement européen (CE) n° 1394/2007 crée une nouvelle classe de médicaments : les « médicaments de thérapie innovante » (MTI), issus de l’ingénierie cellulaire, tissulaire, de manipulations génétiques, et éventuellement combinés à des dispositifs médicaux. Les MTI font l’objet d’une autorisation de mise sur le marché (AMM) centralisée délivrée par la Commission européenne, après évaluation de l’Agence européenne des médicaments (EMA), et sont produits et distribués par des établissements pharmaceutiques. Sept ans après la publication du règlement, les AMM accordées sont peu nombreuses, et ne sont pas systématiquement accompagnées par un succès commercial, soulevant la question des spécificités et du modèle économique applicables aux MTI. Parallèlement, trois classes de produits thérapeutiques biologiquement et fonctionnellement proches coexistent : les MTI, les MTI préparés ponctuellement (MTI-PP, transcription française de l’« exemption hospitalière » prévue dans le règlement), et les préparations de thérapie cellulaire (PTC) (cette dernière catégorie est spécifique au droit français) utilisées principalement dans les greffes de cellules hématopoïétiques. La coexistence de trois jeux de règles distincts soulève pour les opérateurs historiques ou émergents de ces activités des difficultés qui sont exposées ci-après