A prospective, observational study of fidaxomicin use for Clostridioides difficile infection in France.

To describe the characteristics, management and outcomes of hospitalised patients with Clostridioides difficile infection (CDI) treated with and without fidaxomicin. This prospective, multicentre, observational study (DAFNE) enrolled hospitalised patients with CDI, including 294 patients treated with fidaxomicin (outcomes recorded over a 3-month period) and 150 patients treated with other CDI therapies during three 1-month periods. The primary endpoint was baseline and CDI characteristics of fidaxomicin-treated patients. At baseline, the fidaxomicin-treated population included immunocompromised patients (39.1%) and patients with severe (59.2%) and recurrent (36.4%) CDI. Fidaxomicin was associated with a high rate of clinical cure (92.2%) and low CDI recurrence (16.3% within 3 months). Clinical cure rates were ≥90% in patients aged ≥65 years, those receiving concomitant antibiotics and those with prior or severe CDI. There were 121/296 (40.9%) patients with adverse events (AEs), 5.4% with fidaxomicin-related AEs and 1.0% with serious fidaxomicin-related AEs. No fidaxomicin-related deaths were reported. Fidaxomicin is an effective and well-tolerated CDI treatment in a real-world setting in France, which included patients at high risk of adverse outcomes.Trial registration: Description of the use of fidaxomicin in hospitalised patients with documented Clostridium difficile infection and the management of these patients (DAFNE), NCT02214771, www.ClinicalTrials.gov

Functioning of the dimeric GABA(B) receptor extracellular domain revealed by glycan wedge scanning

The G-protein-coupled receptor (GPCR) activated by the neurotransmitter GABA is made up of two subunits, GABA(B1) and GABA(B2). GABA(B1) binds agonists, whereas GABA(B2) is required for trafficking GABA(B1) to the cell surface, increasing agonist affinity to GABA(B1), and activating associated G proteins. These subunits each comprise two domains, a Venus flytrap domain (VFT) and a heptahelical transmembrane domain (7TM). How agonist binding to the GABA(B1) VFT leads to GABA(B2) 7TM activation remains unknown. Here, we used a glycan wedge scanning approach to investigate how the GABA(B) VFT dimer controls receptor activity. We first identified the dimerization interface using a bioinformatics approach and then showed that introducing an N-glycan at this interface prevents the association of the two subunits and abolishes all activities of GABA(B2), including agonist activation of the G protein. We also identified a second region in the VFT where insertion of an N-glycan does not prevent dimerization, but blocks agonist activation of the receptor. These data provide new insight into the function of this prototypical GPCR and demonstrate that a change in the dimerization interface is required for receptor activation

Analyse de l'activation du récepteur GABA-B (une machinerie complexe de la transmission synaptique)

Les récepteurs couplés aux protéines G (RCPG) constituent la plus grande famille de récepteurs membranaires et sont la cible de plus de 25% des médicaments. La compréhension des mécanismes moléculaires de l'activation de ces complexes oligomériques est cruciale pour le développement de drogues plus efficaces. Notre modèle d'étude, le récepteur métabotrope de l'acide g-amino-butyrique (GABA-B), le principal neurotransmetteur inhibiteur du système nerveux central, module la transmission synaptique et constitue une cible pharmacologique pour le traitement de nombreux troubles neurologiques et psychiatriques incluant l'anxiété, l'épilepsie ou l'addiction aux drogues. Le récepteur GABA-B est un hétérodimère obligatoire formé de deux sous-unités GB1 et GB2, composées chacune d'un domaine extracellulaire appelé Vénus flytrap (VFT) et d'un domaine à sept helices transmembranaires (7TM) commun à tous les RCPG. Le VFT de GB1 lie le GABA, tandis que le domaine 7TM de GB2 contient le site de liaison de modulateurs allostériques positifs et est responsable du couplage à la protéine G. Mon travail de thèse a eu deux objectifs : (i) au niveau fondamental, il a consisté à mieux comprendre le mécanisme moléculaire d'activation du récepteur GABA-B. Nous avons démontré l'importance du mouvement relatif des VFT de GB1 et GB2 pour l'activation du récepteur, en développant l'approche glycan wedge scanning . D'autre part, nous avons démontré que la transactivation directe entre les deux domaines 7TM de l'hétérodimère représente une étape clé dans l'activation du récepteur ; (ii) au niveau technologique, j'ai mis en place un système senseur de l'état d'activation du récepteur GABA-B exprimé à la surface de cellules vivantes en utilisant de nouvelles techniques de marquage en fluorescence, compatibles avec des mesures de FRET en temps résolu. Pour cela, j'ai développé une méthode de marquage orthogonal entre un ACP-tag inséré dans une sous-unité et un Snap-tag fusionné à l'autre sous-unité. La mise en place de ce senseur devrait conduire à un nouveau test de criblage de molécules spécifiques du GABA-B, à moyen ou haut débitG-protein coupled receptors (GPCRs) constitute the largest family of membrane receptors, and the target of more than 25% of drugs on the market. Understanding the molecular mechanisms of the activation of such oligomeric complexes is crucial to develop more potent drugs. The metabotropic g-aminobutyric acid receptor (GABA-B) is activated by the main inhibitory neurotransmitter of the central nervous system (GABA). It plays an important role in brain functions and as such, it is a potential therapeutic target for the treatment of various neurologic and psychiatric disorders (anxiety, epilepsy or drug addiction). The GABA-B receptor is an obligatory heterodimer composed of two subunits, GB1 and GB2, each of them possessing an extracellular domain called Venus flytrap (VFT) and a seven transmembrane domain (7TM) common to all GPCRs. The VFT of GB1 contains the GABA binding site whereas 7TM domain of GB2, where the positive allosteric modulators bind, is responsible for G-protein activation. My doctoral research project had two main objectives. The first one was to better understand the molecular mechanism underlying the activation of GABA-B receptor. We first demonstrated the importance of the relative movement of GB1 and GB2 VFT domains in the activation, using a glycan wedge scanning approach. In addition, we showed a direct transactivation between the two 7TM that is a key step in GABA-B activation. The second objective was the development of a sensor to monitor the GABA-B receptor activation at the cell surface of living cells. This sensor, based on GABA-B receptor conformational changes during activation used new fluorescent tools compatible with time-resolved FRET experiments. To this aim, we set up an orthogonal labelling between an ACP-tag inserted in a loop of one subunit and a Snap-tag fused to the other. This sensor of GABA-B activation should lead to the development of a medium or high throughput screening of specific GABA-B moleculesMONTPELLIER-BU Sciences (341722106) / SudocSudocFranceF

Biased signaling through G-protein-coupled PROKR2 receptors harboring missense mutations

International audienceVarious missense mutations in the gene coding for prokineticin receptor 2 (PROKR2), a G-protein-coupled receptor, have been identified in patients with Kallmann syndrome. However, the functional consequences of these mutations on the different signaling pathways of this receptor have not been studied. We first showed that the wild-type PROKR2 can activate different G-protein subtypes (Gq, Gs, and Gi/o) and recruit beta-arrestins in transfected HEK-293 cells. We then examined, for each of these signaling pathways, the effects of 9 mutations that did not significantly impair cell surface targeting or ligand binding of the receptor. Four mutant receptors showing defective Gq signaling (R85C, R85H, R164Q, and V331M) could still recruit beta-arrestins on ligand activation, which may cause biased signaling in vivo. Conversely, the R80C receptor could activate the 3 types of G proteins but could not recruit beta-arrestins. Finally, the R268C receptor could recruit beta-arrestins and activate the Gq and Gs signaling pathways but could not activate the Gi/o signaling pathway. Our results validate the concept that mutations in the genes encoding membrane receptors can bias downstream signaling in various ways, possibly leading to pathogenic and, perhaps in some cases, protective (e.g., R268C) effects

Defective signaling through plexin-A1 compromises the development of the peripheral olfactory system and neuroendocrine reproductive axis in mice

The olfacto-genital syndrome (Kallmann syndrome) associates congenital hypogonadism due to gonadotropin-releasing hormone (GnRH) deficiency and anosmia. This is a genetically heterogeneous developmental disease with various modes of transmission, including oligogenic inheritance. Previous reports have involved defective cell signaling by semaphorin-3A in the disease pathogenesis. Here, we report that the embryonic phenotype of Plxna1-/- mutant mice lacking plexin-A1 (a major receptor of class 3 semaphorins), though not fully penetrant, resembles that of Kallmann syndrome fetuses. Pathohistological analysis indeed showed a strongly abnormal development of the peripheral olfactory system and defective embryonic migration of the neuroendocrine GnRH cells to the hypothalamic brain region in some of the mutant mice, which resulted in reduced fertility in adult males. We thus screened 250 patients for the presence of mutations in PLXNA1, and identified different nonsynonymous mutations (p.V349L, p.V437L, p.R528W, p.H684Y, p.G720E, p.R740H, p.R813H, p.R840Q, p.A854T, p.R897H, p.L1464V, p.K1618T, p.C1744F), all at heterozygous state, in 15 patients. Most of these mutations are predicted to affect plexin-A1 stability or signaling activity based on predictive algorithms and a structural model of the protein. Moreover, in vitro experiments allowed us to show the existence of deleterious effects of eight mutations (including a transcript splicing defect), none of which are expected to result in a complete loss of protein synthesis, targeting, or signaling activity, though. Our findings indicate that signaling insufficiency through plexin-A1 can contribute to the pathogenesis of Kallmann syndrome, and further substantiate the oligogenic pattern of inheritance in this developmental disorder

Impact of the beta-lacta test on the management of urinary tract infections at the emergency department

Introduction: Rapid detection of extended-spectrum β-lactamases is essential. In this study, we evaluated the potential impact of β-lacta test on both the times to appropriate antibiotic therapy and to the implementation of patient isolation measures.Patients and methods: We included prospectively all the patients admitted to the emergency department for clinical suspicion of urinary tract infection. Compared with physician's decision, we analysed the potential impact of β-lacta test on the initial antibiotic therapy and on the implementation of hygiene measures. This study has been registered under number NCT02897609.Results: We included 203 patients, 43% with acute pyelonephritis and 21% with acute prostatitis. The β-lacta test had a 95.2% sensitivity and a 99.5% specificity to detect extended-spectrum β-lactamases. Taking the β-lacta test results into account would have decreased significantly both the times to appropriate therapy and to isolation measures from 54 to 2.7 h and from 55.2 to 2.6 h, respectively.Conclusion: The β-lacta test could reduce significantly the times to appropriate therapy and implementation of isolations measure

FRET-Based Sensors Unravel Activation and Allosteric Modulation of the GABA B Receptor

International audienceThe main inhibitory neurotransmitter, γ-aminobutyric acid (GABA), modulates many synapses by activating the G protein-coupled receptor GABAB, which is a target for various therapeutic applications. It is an obligatory heterodimer made of GB1 and GB2 that can be regulated by positive allosteric modulators (PAMs). The molecular mechanism of activation of the GABAB receptor remains poorly understood. Here, we have developed FRET-based conformational GABAB sensors compatible with high-throughput screening. We identified conformational changes occurring within the extracellular and transmembrane domains upon receptor activation, which are smaller than those observed in the related metabotropic glutamate receptors. These sensors also allow discrimination between agonists of different efficacies and between PAMs that have different modes of action, which has not always been possible using conventional functional assays. Our study brings important new information on the activation mechanism of the GABAB receptor and should facilitate the screening and identification of new chemicals targeting this receptor