Molecular Demonstration of a Pneumocystis Outbreak in Stem Cell Transplant Patients: Evidence for Transmission in the Daycare Center

Pneumocystis jirovecii pneumonia (PCP) is a life-threatening infection in hematology. Although occasionally reported, the role of interhuman transmission of P. jirovecii in PCP, compared to that of reactivation, remains an unresolved question; the recommendation to isolate PCP patients in the hematology ward are not well evidence-based. Following an unexpected increase in the number of febrile pneumonia patients with P. jirovecii DNA detected in respiratory samples in our hematology ward, we explored 12 consecutive patients from November 2015 to May 2016. Genotyping of P jirovecii was performed using microsatellite markers. The frequency of simultaneous occupancy of these 12 patients in the same unit on the same day from 4 months prior to the first diagnosis was recorded. In three patients, the P. jirovecii genotype could not be determined because DNA was insufficient. One rare single genotype (Gt2) was found in four of the other nine, all allogeneic stem cell transplant recipients. The transmission map showed that these 4 patients had multiple opportunities to meet on the same day (median, 6.5; range, 4–10) at the daycare center. It was much less among the eight non-Gt2 patients (median, 1; range, 0–9; P = 0.048). This study, based on modern molecular technics, strongly suggests that interhuman transmission of P. jirovecii between allogeneic stem cell transplant recipients is possible. P. jirovecii DNA detected in respiratory specimens supports that isolation and respiratory precautions be recommended in such cases in the hematology ward

A comprehensive assessment of demographic, environmental, and host genetic associations with gut microbiome diversity in healthy individuals.

BACKGROUND: The gut microbiome is an important determinant of human health. Its composition has been shown to be influenced by multiple environmental factors and likely by host genetic variation. In the framework of the Milieu Intérieur Consortium, a total of 1000 healthy individuals of western European ancestry, with a 1:1 sex ratio and evenly stratified across five decades of life (age 20-69), were recruited. We generated 16S ribosomal RNA profiles from stool samples for 858 participants. We investigated genetic and non-genetic factors that contribute to individual differences in fecal microbiome composition. RESULTS: Among 110 demographic, clinical, and environmental factors, 11 were identified as significantly correlated with α-diversity, ß-diversity, or abundance of specific microbial communities in multivariable models. Age and blood alanine aminotransferase levels showed the strongest associations with microbiome diversity. In total, all non-genetic factors explained 16.4% of the variance. We then searched for associations between > 5 million single nucleotide polymorphisms and the same indicators of fecal microbiome diversity, including the significant non-genetic factors as covariates. No genome-wide significant associations were identified after correction for multiple testing. A small fraction of previously reported associations between human genetic variants and specific taxa could be replicated in our cohort, while no replication was observed for any of the diversity metrics. CONCLUSION: In a well-characterized cohort of healthy individuals, we identified several non-genetic variables associated with fecal microbiome diversity. In contrast, host genetics only had a negligible influence. Demographic and environmental factors are thus the main contributors to fecal microbiome composition in healthy individuals. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT01699893

Human genetic variants and age are the strongest predictors of humoral immune responses to common pathogens and vaccines.

Humoral immune responses to infectious agents or vaccination vary substantially among individuals, and many of the factors responsible for this variability remain to be defined. Current evidence suggests that human genetic variation influences (i) serum immunoglobulin levels, (ii) seroconversion rates, and (iii) intensity of antigen-specific immune responses. Here, we evaluated the impact of intrinsic (age and sex), environmental, and genetic factors on the variability of humoral response to common pathogens and vaccines. We characterized the serological response to 15 antigens from common human pathogens or vaccines, in an age- and sex-stratified cohort of 1000 healthy individuals (Milieu Intérieur cohort). Using clinical-grade serological assays, we measured total IgA, IgE, IgG, and IgM levels, as well as qualitative (serostatus) and quantitative IgG responses to cytomegalovirus, Epstein-Barr virus, herpes simplex virus 1 and 2, varicella zoster virus, Helicobacter pylori, Toxoplasma gondii, influenza A virus, measles, mumps, rubella, and hepatitis B virus. Following genome-wide genotyping of single nucleotide polymorphisms and imputation, we examined associations between ~ 5 million genetic variants and antibody responses using single marker and gene burden tests. We identified age and sex as important determinants of humoral immunity, with older individuals and women having higher rates of seropositivity for most antigens. Genome-wide association studies revealed significant associations between variants in the human leukocyte antigen (HLA) class II region on chromosome 6 and anti-EBV and anti-rubella IgG levels. We used HLA imputation to fine map these associations to amino acid variants in the peptide-binding groove of HLA-DRβ1 and HLA-DPβ1, respectively. We also observed significant associations for total IgA levels with two loci on chromosome 2 and with specific KIR-HLA combinations. Using extensive serological testing and genome-wide association analyses in a well-characterized cohort of healthy individuals, we demonstrated that age, sex, and specific human genetic variants contribute to inter-individual variability in humoral immunity. By highlighting genes and pathways implicated in the normal antibody response to frequently encountered antigens, these findings provide a basis to better understand disease pathogenesis. ClinicalTrials.gov , NCT01699893

Sotigalimab and/or nivolumab with chemotherapy in first-line metastatic pancreatic cancer: clinical and immunologic analyses from the randomized phase 2 PRINCE trial

Chemotherapy combined with immunotherapy has improved the treatment of certain solid tumors, but effective regimens remain elusive for pancreatic ductal adenocarcinoma (PDAC). We conducted a randomized phase 2 trial evaluating the efficacy of nivolumab (nivo; anti-PD-1) and/or sotigalimab (sotiga; CD40 agonistic antibody) with gemcitabine/nab-paclitaxel (chemotherapy) in patients with first-line metastatic PDAC (NCT03214250). In 105 patients analyzed for efficacy, the primary endpoint of 1-year overall survival (OS) was met for nivo/chemo (57.7%, P = 0.006 compared to historical 1-year OS of 35%, n = 34) but was not met for sotiga/chemo (48.1%, P = 0.062, n = 36) or sotiga/nivo/chemo (41.3%, P = 0.223, n = 35). Secondary endpoints were progression-free survival, objective response rate, disease control rate, duration of response and safety. Treatment-related adverse event rates were similar across arms. Multi-omic circulating and tumor biomarker analyses identified distinct immune signatures associated with survival for nivo/chemo and sotiga/chemo. Survival after nivo/chemo correlated with a less suppressive tumor microenvironment and higher numbers of activated, antigen-experienced circulating T cells at baseline. Survival after sotiga/chemo correlated with greater intratumoral CD4 T cell infiltration and circulating differentiated CD4 T cells and antigen-presenting cells. A patient subset benefitting from sotiga/nivo/chemo was not identified. Collectively, these analyses suggest potential treatment-specific correlates of efficacy and may enable biomarker-selected patient populations in subsequent PDAC chemoimmunotherapy trials

Modulation of Macrophage Activation State Protects Tissue from Necrosis during Critical Limb Ischemia in Thrombospondin-1-Deficient Mice

International audienceBACKGROUND: Macrophages, key regulators of healing/regeneration processes, strongly infiltrate ischemic tissues from patients suffering from critical limb ischemia (CLI). However pro-inflammatory markers correlate with disease progression and risk of amputation, suggesting that modulating macrophage activation state might be beneficial. We previously reported that thrombospondin-1 (TSP-1) is highly expressed in ischemic tissues during CLI in humans. TSP-1 is a matricellular protein that displays well-known angiostatic properties in cancer, and regulates inflammation in vivo and macrophages properties in vitro. We therefore sought to investigate its function in a mouse model of CLI. METHODS AND FINDINGS: Using a genetic model of tsp-1(-/-) mice subjected to femoral artery excision, we report that tsp-1(-/-) mice were clinically and histologically protected from necrosis compared to controls. Tissue protection was associated with increased postischemic angiogenesis and muscle regeneration. We next showed that macrophages present in ischemic tissues exhibited distinct phenotypes in tsp-1(-/-) and wt mice. A strong reduction of necrotic myofibers phagocytosis was observed in tsp-1(-/-) mice. We next demonstrated that phagocytosis of muscle cell debris is a potent pro-inflammatory signal for macrophages in vitro. Consistently with these findings, macrophages that infiltrated ischemic tissues exhibited a reduced postischemic pro-inflammatory activation state in tsp-1(-/-) mice, characterized by a reduced Ly-6C expression and a less pro-inflammatory cytokine expression profile. Finally, we showed that monocyte depletion reversed clinical and histological protection from necrosis observed in tsp-1(-/-) mice, thereby demonstrating that macrophages mediated tissue protection in these mice. CONCLUSION: This study defines targeting postischemic macrophage activation state as a new potential therapeutic approach to protect tissues from necrosis and promote tissue repair during CLI. Furthermore, our data suggest that phagocytosis plays a crucial role in promoting a deleterious intra-tissular pro-inflammatory macrophage activation state during critical injuries. Finally, our results describe TSP-1 as a new relevant physiological target during critical leg ischemia

Impact of chronic viral infection on the CD8 preimmune repertoire : when do we lose our naivety ?

Le répertoire T CD8 préimmun correspond aux lymphocytes T spécifiques d'antigène circulant en périphérie, et n'ayant pas encore été activés. Ces cellules sont très rares, et de ce fait, n'ont jusqu'ici pas pu être étudiées de façon approfondie. Nous avons dans un premier temps développé un protocole d'enrichissement basé sur la technologie des tétramères. Nous avons pu détecter et énumérer des lymphocytes T CD8 naïfs spécifiques d'antigènes dans le sang de sujets sains. Nous avons ensuite utilisé cet outil pour évaluer le répertoire T préimmun de patients chroniquement infectés par le virus de l'hépatite C (cHCV). Nous avons démontré que celui-ci est significativement perturbé, avec des cellules hypersensibles à l'activation TCR et une proportion importante de lymphocytes T de phénotype mémoire alors qu'ils n'ont pourtant pas rencontré leur antigène cible. Ces anomalies disparaissent après résolution de l'infection, soulignant l'intérêt d'instaurer précocément un traitement antiviral chez ces patients. Enfin, nous avons observé dans un modèle de souris transgéniques (OTI) une proportion importante de T inexpérimentés de phénotype mémoire chez les animaux non-immunisés déficients en cxcr3. Nos travaux démontrent que les lymphocytes T inexpérimentés peuvent perdre leur naïveté dans différentes situations pathologiques. Ces résultats devraient être pris en considération pour l'optimisation de futures stratégies d'immunothérapie, notamment lorsque des patients dits "inflammatoires" sont la cible de vaccinations. Enfin, nos résultats soulignent la difficulté d'interpréter les données d'immunophénotypage en l'absence d'information sur la spécificité antigénique.The CD8 preimmune repertoire is defined as the set of circulating antigen-specific T CD8 lymphocytes that have not been activated yet by their cognate antigen. Because those cells are very rare, they have not been evaluated in humans. We developed a tetramer-based enrichment protocol that allowed for the first time direct detection and enumeration of those rare naive antigen-specific CD8 T cells in healthys. We then used this tool to characterize the CD8 preimmune repertoire in patients with chronic hepatitis C viral infection. We found that their naive CD8 T cells are dysregulated, being hypersensitive to TCR signals, and with increased proportions of memory-phenotype (MP) cells in inexperienced populations. These perturbations are reversible after viral clearance, highlighting the added benefit of early antiviral treatment. Finally, using a transgenic model (OTI), we observed high proportions of MP inexperienced T cells in the blood of cxcr3-deficient unimmunized mice. This suggests that CXCR3-dependent lymphocyte trafficking could account for some preimmune repertoire alterations. Altogether, our work demonstrates that inexperienced T cells can lose their naiveté in several pathological situations. The impact of these findings will need to be considered when designing future immunotherapeutic strategies - especially when « inflammatory » patients are being targeted. Additionally, we highlight the challenge of interpreting T-cell immunophenotyping studies without getting knowledge into antigen-specific populations

Impact d'une infection virale chronique sur le répertoire T CD8 préimmun : à quel moment perd-on sa naiveté?

The CD8 preimmune repertoire is defined as the set of circulating antigen-specific T CD8 lymphocytes that have not been activated yet by their cognate antigen. Because those cells are very rare, they have not been evaluated in humans. We developed a tetramer-based enrichment protocol that allowed for the first time direct detection and enumeration of those rare naive antigen-specific CD8 T cells in healthys. We then used this tool to characterize the CD8 preimmune repertoire in patients with chronic hepatitis C viral infection. We found that their naive CD8 T cells are dysregulated, being hypersensitive to TCR signals, and with increased proportions of memory-phenotype (MP) cells in inexperienced populations. These perturbations are reversible after viral clearance, highlighting the added benefit of early antiviral treatment. Finally, using a transgenic model (OTI), we observed high proportions of MP inexperienced T cells in the blood of cxcr3-deficient unimmunized mice. This suggests that CXCR3-dependent lymphocyte trafficking could account for some preimmune repertoire alterations. Altogether, our work demonstrates that inexperienced T cells can lose their naiveté in several pathological situations. The impact of these findings will need to be considered when designing future immunotherapeutic strategies - especially when « inflammatory » patients are being targeted. Additionally, we highlight the challenge of interpreting T-cell immunophenotyping studies without getting knowledge into antigen-specific populations.Le répertoire T CD8 préimmun correspond aux lymphocytes T spécifiques d'antigène circulant en périphérie, et n'ayant pas encore été activés. Ces cellules sont très rares, et de ce fait, n'ont jusqu'ici pas pu être étudiées de façon approfondie. Nous avons dans un premier temps développé un protocole d'enrichissement basé sur la technologie des tétramères. Nous avons pu détecter et énumérer des lymphocytes T CD8 naïfs spécifiques d'antigènes dans le sang de sujets sains. Nous avons ensuite utilisé cet outil pour évaluer le répertoire T préimmun de patients chroniquement infectés par le virus de l'hépatite C (cHCV). Nous avons démontré que celui-ci est significativement perturbé, avec des cellules hypersensibles à l'activation TCR et une proportion importante de lymphocytes T de phénotype mémoire alors qu'ils n'ont pourtant pas rencontré leur antigène cible. Ces anomalies disparaissent après résolution de l'infection, soulignant l'intérêt d'instaurer précocément un traitement antiviral chez ces patients. Enfin, nous avons observé dans un modèle de souris transgéniques (OTI) une proportion importante de T inexpérimentés de phénotype mémoire chez les animaux non-immunisés déficients en cxcr3. Nos travaux démontrent que les lymphocytes T inexpérimentés peuvent perdre leur naïveté dans différentes situations pathologiques. Ces résultats devraient être pris en considération pour l'optimisation de futures stratégies d'immunothérapie, notamment lorsque des patients dits "inflammatoires" sont la cible de vaccinations. Enfin, nos résultats soulignent la difficulté d'interpréter les données d'immunophénotypage en l'absence d'information sur la spécificité antigénique

Tracking antigen-specific CD8⁺ T cells using MHC class I multimers.

International audienceThe tracking of epitope-specific T cells is a useful approach for the study of adaptive immune responses. This protocol describes how Major Histocompatibility Complex Class I (MHC-I) multimers can be used to stain, enrich, and enumerate (rare) populations of CD8(+) T cells specific for a given antigen. It provides the detailed steps for multimer labeling, magnetic enrichment, and cytometric analysis. Additionally, it provides informations for multiplexing experiments in order to achieve simultaneous detection of multiple antigenic specificities, and strategies for coupling the protocol with functional assays (e.g., intracellular cytokine staining). Future developments in cytometric systems (e.g., mass spectroscopy-based cytometry) and gene expression studies (e.g., single cell PCR) will extend these approaches and provide an unprecedented assessment of the immune repertoire

Emerging mould infections: Get prepared to meet unexpected fungi in your patient

International audienceInvasive fungal diseases are increasing issues in modern medicine, where the human immunodeficiency virus (HIV) pandemic and the wider use of immunosuppressive drugs generate an ever-growing number of immunocompromised patients with an increased susceptibility to uncommon fungal pathogens. In the past decade, new species have been reported as being responsible for disseminated and invasive fungal diseases in humans. Among them, the following genera are rare but seem emerging issues: Scopulariopsis, Hormographiella, Emergomyces, Westerdykella, Trametes, Actinomucor, Saksenaea, Apophysomyces, and Rhytidhysteron. Delay in diagnosis, which is often the case in these infections, jeopardizes patients' prognosis and leads to increased mortality. Here we summarize the clinical and biological presentation and the key features to identify these emerging pathogens and we discuss the available antifungal classes to treat them. We focused on Pubmed to recover extensively reported human invasive cases and articles regarding the nine previously cited fungal organisms. Information concerning patient background, macroscopic and microscopic description and pictures of these fungal organisms, histological features in tissues, findings with commonly used antigen tests in practice, and hints on potential efficient antifungal classes were gathered. This review's purpose is to help clinical microbiologists and physicians to suspect, identify, diagnose, and treat newly encountered fungi in hospital settings

CXCR3/CXCL10 Axis Shapes Tissue Distribution of Memory Phenotype CD8 + T Cells in Nonimmunized Mice

International audienceThe preimmune repertoire consists of mature T lymphocytes that have not yet been stimulated in the periphery. Memory phenotype (MP) cells have been reported as part of the preimmune repertoire (i.e., T cells bearing memory markers despite lack of engagement with cognate Ag); however, little is known about their trafficking and function. In this study, we hypothesized that MP cells, naive to TCR stimulation, constitute a transient population that traffics to tissues during development. Using mutant and transgenic animals with a monospecific TCR, we discovered increased numbers of MP CD8+ T cells circulating in nonimmunized Cxcr3-/- and Cxcl10-/- mice compared with wild-type animals. Phenotypic differences included decreased numbers of preimmune MP Ag-specific T cells in the skin and thymus and a distinct pattern of activation upon TCR engagement. Our results show for the first time, to our knowledge, an important role for CXCR3 and CXCL10 in the tissue distribution of preimmune MP cells