Non-Financial Conflicts of Interest in Academic Grant Evaluation: A Qualitative Study of Multiple Stakeholders in France

International audienceBACKGROUND: Peer review is the most widely used method for evaluating grant applications in clinical research. Criticisms of peer review include lack of equity, suspicion of biases, and conflicts of interest (CoI). CoIs raise questions of fairness, transparency, and trust in grant allocation. Few observational studies have assessed these issues. We report the results of a qualitative study on reviewers' and applicants' perceptions and experiences of CoIs in reviews of French academic grant applications. METHODOLOGY AND PRINCIPAL FINDINGS: We designed a qualitative study using semi-structured interviews and direct observation. We asked members of assessment panels, external reviewers, and applicants to participate in semi-structured interviews. Two independent researchers conducted in-depth reviews and line-by-line coding of all transcribed interviews, which were also subjected to Tropes® software text analysis, to detect and qualify themes associated with CoIs. Most participants (73/98) spontaneously reported that non-financial CoIs predominated over financial CoIs. Non-financial CoIs mainly involved rivalry among disciplines, cronyism, and geographic and academic biases. However, none of the participants challenged the validity of peer review. Reviewers who felt they might be affected by CoIs said they reacted in a variety of ways: routine refusal to review, routine attempt to conduct an impartial review, or decision on a case-by-case basis. Multiple means of managing non-financial CoIs were suggested, including increased transparency throughout the review process, with public disclosure of non-financial CoIs, and careful selection of independent reviewers, including foreign experts and methodologists. CONCLUSIONS: Our study underscores the importance of considering non-financial CoIs when reviewing research grant applications, in addition to financial CoIs. Specific measures are needed to prevent a negative impact of non-financial CoIs on the fairness of resource allocation. Whether and how public disclosure of non-financial CoIs should be accomplished remains debatable

Effect of methotrexate and anti-TNF on Epstein-Barr virus T-cell response and viral load in patients with rheumatoid arthritis or spondylarthropathies

INTRODUCTION: There is a suspicion of increased risk of Epstein-Barr virus (EBV)-associated lymphoproliferations in patients with inflammatory arthritides receiving immunosuppressive drugs. We investigated the EBV load and EBV-specific T-cell response in patients treated with methotrexate (MTX) or anti-TNF therapy. METHODS: Data for patients with rheumatoid arthritis (RA) (n = 58) or spondylarthropathy (SpA) (n = 28) were analyzed at baseline in comparison with controls (n = 22) and after 3 months of MTX or anti-TNF therapy for EBV load and EBV-specific IFNγ-producing T cells in response to EBV latent-cycle and lytic-cycle peptides. RESULTS: The EBV load and the number of IFNγ-producing T-cells after peptide stimulation were not significantly different between groups at baseline (P = 0.61 and P = 0.89, respectively). The EBV load was not significantly modified by treatment, for RA with MTX (P = 0.74) or anti-TNF therapy (P = 0.94) or for SpA with anti-TNF therapy (P = 1.00). The number of EBV-specific T cells was not significantly modified by treatment, for RA with MTX (P = 0.58) or anti-TNF drugs (P = 0.19) or for SpA with anti-TNF therapy (P = 0.39). For all patients, the EBV load and EBV-specific T cells were significantly correlated (P = 0.017; R = 0.21). For most patients, short-term exposure (3 months) to MTX or anti-TNF did not alter the EBV load or EBV-specific T-cell response but two patients had discordant evolution. CONCLUSIONS: These data are reassuring and suggest there is no short-term defect in EBV-immune surveillance in patients receiving MTX or anti-TNF drugs. However, in these patients, long term follow-up of EBV-specific T-cell response is necessary and the role of non-EBV-related mechanisms of lymphomagenesis is not excluded

Modalités de recrutement des sujets dans la recherche en pédiatrie : étude prospective multicentrique

Contexte. - Une enquête qualitative exploratoire a montré que le nombre de patients éligibles et sollicités dans les essais en pédiatrie était peu objectivé ainsi que les refus. Objectif. - Estimer le nombre de refus de participation des familles dans les essais en pédiatrie et lier le taux de refus aux caractéristiques protocole, investigateur et patients. Matériel et méthodes. - Étude prospective multicentrique inter-CIC (réseau pédiatrique) d'une cohorte de protocoles. Pour chaque sollicitation à participer, des fiches patient, investigateur et protocole étaient remplies. Résultats. - L'étude a été réalisée de décembre 2005 à septembre 2007 sur quatre centres et a inclus 45 protocoles : 32 à promotion industrielle, 36 multicentriques, 19 essais cliniques, 33 avec prises de sang et six avec examens invasifs, 26 avec des déplacements spécifiques et 14 des hospitalisations supplémentaires. Sur ces protocoles, 170 investigateurs étaient référencés comme recruteurs et 86 (51 %) ont répondu au questionnaire : âge médian 42 ans, sex-ratio de 1, 13 sont investigateurs principal, 32 responsables pour le CIC et 50 investigateurs associés, 20 percevaient une rétribution versée au service dans 80 % des cas. La charge de travail médiane par investigateur était d'une heure par inclusion et 67 (78 %) bénéficiaient d'une aide d'une TEC. Au total, 1022 sollicitations ont été réalisées sur 36 protocoles (neuf protocoles n'ayant eu aucune sollicitation) et 334 refus (33 %) ont été enregistrés soit une médiane de 12 % (Q1Q3 : 0-28 %) de refus par protocole. Parmi les 36 protocoles, 16 n'ont enregistré aucun refus, représentant 147 sollicitations et les 20 autres protocoles ont eu un taux moyen de 38 % de refus. L'analyse explicative est en cours. Conclusion. - Le taux de refus de 12 % n'est pas différent de celui des essais adultes et semble dépendant du type d'étude. L'absence de sollicitation concerne 20 % des études

High clustering of acute HCV infections and high rate of associated STIs among Parisian HIV-positive male patients.

BACKGROUND: Increasing incidence of hepatitis C virus (HCV) infection in human immunodeficiency virus (HIV)-positive men having sex with men (MSM) has been described in recent years. Phylogenetic analyses of acute HCV infections were undertaken to characterize the dynamics during the epidemic in Paris, and associated sexually transmitted infections (STIs) were evaluated. METHODS: Sanger sequencing of polymerase gene was performed. Maximum likelihood phylogenies were reconstructed using FastTree 2.1 under a GTR+CAT model. Transmission chains were defined as clades with a branch probability ≥0.80 and intraclade genetic distances <0.02 nucleotide substitutions per sites. STIs detected ≤1 month before HCV diagnosis were considered. RESULTS: Among the 85 studied patients, at least 81.2% were MSM. Respectively, 47.6%, 39.0%, 11.0% and 2.4% were infected with genotypes 1a, 4d, 3a and 2k. At least 91.8% were co-infected with HIV. HCV re-infection was evidenced for 24.7% of patients and STIs for 20.0% of patients. Twenty-two transmission chains were identified, including 52 acute hepatitis C (11 pairs and 11 clusters from three to seven patients). CONCLUSIONS: These results revealed strong clustering of acute HCV infections. Thus, rapid treatment of both chronic and acute infections is needed among this population to decrease the prevalence of HCV, in combination with preventive behavioural interventions

Clinical reappraisal of SHORT syndrome with PIK3R1 mutations: towards recommendation for molecular testing and management

International audienceSHORT syndrome has historically been defined by its acronym: short stature (S), hyperextensibility of joints and/or inguinal hernia (H), ocular depression (O), Rieger abnormality (R) and teething delay (T). More recently several research groups have identified PIK3R1 mutations as responsible for SHORT syndrome. Knowledge of the molecular etiology of SHORT syndrome has permitted a reassessment of the clinical phenotype. The detailed phenotypes of 32 individuals with SHORT syndrome and PIK3R1 mutation, including eight newly ascertained individuals, were studied to fully define the syndrome and the indications for PIK3R1 testing. The major features described in the SHORT acronym were not universally seen and only half (52%) had 4 or more of the classic features. The commonly observed clinical features of SHORT syndrome seen in the cohort included IUGR \textless 10(th) percentile, postnatal growth restriction, lipoatrophy and the characteristic facial gestalt. Anterior chamber defects and insulin resistance or diabetes were also observed but were not as prevalent. The less specific, or minor features of SHORT syndrome include teething delay, thin wrinkled skin, speech delay, sensorineural deafness, hyperextensibility of joints and inguinal hernia. Given the high risk of diabetes mellitus, regular monitoring of glucose metabolism is warranted. An echocardiogram, ophthalmological and hearing assessments are also recommended

Association of Killer Cell Immunoglobulin-Like Receptor Genes with Hodgkin's Lymphoma in a Familial Study

BACKGROUND: Epstein-Barr virus (EBV) is the major environmental factor associated with Hodgkin's lymphoma (HL), a common lymphoma in young adults. Natural killer (NK) cells are key actors of the innate immune response against viruses. The regulation of NK cell function involves activating and inhibitory Killer cell Immunoglobulin-like receptors (KIRs), which are expressed in variable numbers on NK cells. Various viral and virus-related malignant disorders have been associated with the presence/absence of certain KIR genes in case/control studies. We investigated the role of the KIR cluster in HL in a family-based association study. METHODOLOGY: We included 90 families with 90 HL index cases (age 16–35 years) and 255 first-degree relatives (parents and siblings). We developed a procedure for reconstructing full genotypic information (number of gene copies) at each KIR locus from the standard KIR gene content. Out of the 90 collected families, 84 were informative and suitable for further analysis. An association study was then carried out with specific family-based analysis methods on these 84 families. PRINCIPAL FINDINGS: Five KIR genes in strong linkage disequilibrium were found significantly associated with HL. Refined haplotype analysis showed that the association was supported by a dominant protective effect of KIR3DS1 and/or KIR2DS1, both of which are activating receptors. The odds ratios for developing HL in subjects with at least one copy of KIR3DS1 or KIR2DS1 with respect to subjects with neither of these genes were 0.44[95% confidence interval 0.23–0.85] and 0.42[0.21–0.85], respectively. No significant association was found in a tentative replication case/control study of 68 HL cases (age 18–71 years). In the familial study, the protective effect of KIR3DS1/KIR2DS1 tended to be stronger in HL patients with detectable EBV in blood or tumour cells. CONCLUSIONS: This work defines a template for family-based association studies based on full genotypic information for the KIR cluster, and provides the first evidence that activating KIRs can have a protective role in HL

A Solve-RD ClinVar-based reanalysis of 1522 index cases from ERN-ITHACA reveals common pitfalls and misinterpretations in exome sequencing

Purpose Within the Solve-RD project (https://solve-rd.eu/), the European Reference Network for Intellectual disability, TeleHealth, Autism and Congenital Anomalies aimed to investigate whether a reanalysis of exomes from unsolved cases based on ClinVar annotations could establish additional diagnoses. We present the results of the “ClinVar low-hanging fruit” reanalysis, reasons for the failure of previous analyses, and lessons learned. Methods Data from the first 3576 exomes (1522 probands and 2054 relatives) collected from European Reference Network for Intellectual disability, TeleHealth, Autism and Congenital Anomalies was reanalyzed by the Solve-RD consortium by evaluating for the presence of single-nucleotide variant, and small insertions and deletions already reported as (likely) pathogenic in ClinVar. Variants were filtered according to frequency, genotype, and mode of inheritance and reinterpreted. Results We identified causal variants in 59 cases (3.9%), 50 of them also raised by other approaches and 9 leading to new diagnoses, highlighting interpretation challenges: variants in genes not known to be involved in human disease at the time of the first analysis, misleading genotypes, or variants undetected by local pipelines (variants in off-target regions, low quality filters, low allelic balance, or high frequency). Conclusion The “ClinVar low-hanging fruit” analysis represents an effective, fast, and easy approach to recover causal variants from exome sequencing data, herewith contributing to the reduction of the diagnostic deadlock

Intérêts et limites de la charge virale EBV dans le LCR (l'exemple du lymphome cérébral primitif chez le patient infecté par le VIH)

PARIS-BIUP (751062107) / SudocSudocFranceF

Limites du traitement de l'infection liée au virus de l'immunodéficience humaine de type 1 (aspects immuno-virologiques)

Les antirétroviraux du VIH-1 ont apporté un bénéfice clinique certain, mais gardent leurs limites. La restauration immune reste partielle avec défaut de sécrétion d interleukine 2, de reconnaissance des antigènes de rappel et du VIH, déficit des lymphocytes T cytotoxiques anti-EBV. L immunothérapie pourrait faire appel à l IL-16 qui inhibe la transcription du VIH in vitro, ou au murabutide (immunomodulateur testé chez les patients en essai de phase I/IIa), qui améliore les réponses lymphoprolifératives aux antigènes du VIH. De plus, de nouveaux profils de mutations de résistance apparaissent dont l impact sur la résistance et la capacité réplicative du virus est inconnue. Nous avons étudié par mutagenèse dirigée une nouvelle insertion sur le gène de la transcriptase inverse, la mutation au codon 68 associée aux mutations K65R et Q151M, et l association T215F/K219E retrouvée chez les patients en échec virologique modéré sous analogues de la thymidine.Antiretroviral therapy in HIV-1 infection leads to a dramatic clinical benefit with persistent immunological and virological limits. Restoration of immunity is partial : deficit in IL-2 secretion, in the lymphoproliferative responses to recall and HIV antigens, in EBV-specific cellular immune control. Non specific immunotherapy of HIV-1 would be helpful. Interleukin-16 inhibits HIV viral transcription in endogenously infected cells; murabutide, a synthetic analogue of muramylpeptide improves surrogate markers of antiviral immunity in phase I/IIa clinical trialsResistance mutations are easily emerging with ARV and new profiles appear. Directed mutagenesis was used to evaluate the impact of new mutations on resistance and replicative capacity of HIV variants. We studied a new insertion on the reverse transcriptase gene, substitution at codon 68 (mostly associated with K65R and Q151M), the K219E mutation in association with T215F in patients with moderate virological escape.PARIS-BIUSJ-Thèses (751052125) / SudocPARIS-BIUSJ-Physique recherche (751052113) / SudocSudocFranceF