Impairment of anti-viral T cell memory and viral infectious diseases in kidney transplantation

Les réactivations à Polyomavirus, BK-virus (BKv) et JC-virus (JCv), sont des complications majeures en transplantation rénale, responsables de néphropathie à BKv (Nx BKv) et de leuco-encéphalopathie multifocale progressive (LEMP). Sans thérapeutique antivirale spécifique, ces infections virales menent à la perte du rein transplanté ou au décès du patient. Notre groupe a conduit une étude observationnelle incluant 100 patients transplantés rénaux avec différents niveaux de réactivation BKv (Etude MelTyK). Nous avons mis en évidence une altération progressive de la fonctionnalité des lymphocytes T spécifiques du BKv, associée à une corrélation inverse entre la polyfonctionnalité lymphocytaire ou le nombre d’incompatibilités HLA et la charge virale BKv plasmatique. Cette altération de la fonctionnalité suggérait un état d’épuisement des lymphocytes T spécifiques du BKv en fonction du niveau de réactivation BKv. Ces données nous ont conduit à élaborer une méthode biologique non-invasive d’évaluation du risque individuel de Nx BKv (brevet FR1855342). Cette méthode a pour objectif d’aider au diagnostic de Nx BKv sans avoir recours à la biopsie du greffon rénal et de stratifier le risque de développer cette complication. Par ailleurs, nous avons décrit un cas fatal de LEMP associé à un état d’anergie des lymphocytes T spécifiques du JCv. L’étude de la fonctionnalité des lymphocytes T spécifiques des Polyomavirus pourrait ouvrir de futures pistes diagnostiques et/ou thérapeutiques. Elle pourrait permettre de dépister les patients à risques de Nx BKv et pourrait contribuer au développement d’immunothérapies innovantes. La restauration de la fonctionalité des lymphocytes T spécifiques des Polyomavirus pourrait ainsi fournir une piste thérapeutique prometteuse afin de contrôler ces réactivations virales sans majorer le risque de rejet allogénique.Polyomavirus reactivations, BK-virus (BKv) and JC-virus (JCv), are major complications in kidney transplantation, responsable of BKv associated nephropathy (BKvAN) and progressive multifocal leukoencephalopathy (PML). Without antiviral treatment, these viral reactivations lead to kidney transplant loss or patient death. Our group has headed an observational study including 100 kidney transplant recipients with different BKv reactivation levels (the MelTyK study). We were able to highlight a gradual loss of functional BKv-specific T cells, associated with an inverse correlation between lymphocyte functionality or HLA mismatches and plasmatic BKv viral load. This functional impairment suggested an exhaustion of BKv-specific T cells according to BKv reactivation levels. These data have led us to develop a non-invasive biological method to assess the individual BKvAN risk (patent FR1855342). This method is intended to help the BKvAN diagnosis, without renal graft biopsy and to stratify the risk to develop this complication. Moreover, we have described a fatal case of PML associated with a anergy state of the JCv-specific T cells. Functional assessment of Polyomavirus-specific T cells could help to propose new diagnostic assays and immunotherapy approaches. Functional restauration of Polyomavirus-specific T cells could provide a promising therapeutic approache to control viral reactivations without increase of allogenic rejection risk

Anomalies de la mémoire lymphocytaire T antivirale et infections virales en transplantation rénale

Polyomavirus reactivations, BK-virus (BKv) and JC-virus (JCv), are major complications in kidney transplantation, responsable of BKv associated nephropathy (BKvAN) and progressive multifocal leukoencephalopathy (PML). Without antiviral treatment, these viral reactivations lead to kidney transplant loss or patient death. Our group has headed an observational study including 100 kidney transplant recipients with different BKv reactivation levels (the MelTyK study). We were able to highlight a gradual loss of functional BKv-specific T cells, associated with an inverse correlation between lymphocyte functionality or HLA mismatches and plasmatic BKv viral load. This functional impairment suggested an exhaustion of BKv-specific T cells according to BKv reactivation levels. These data have led us to develop a non-invasive biological method to assess the individual BKvAN risk (patent FR1855342). This method is intended to help the BKvAN diagnosis, without renal graft biopsy and to stratify the risk to develop this complication. Moreover, we have described a fatal case of PML associated with a anergy state of the JCv-specific T cells. Functional assessment of Polyomavirus-specific T cells could help to propose new diagnostic assays and immunotherapy approaches. Functional restauration of Polyomavirus-specific T cells could provide a promising therapeutic approache to control viral reactivations without increase of allogenic rejection risk.Les réactivations à Polyomavirus, BK-virus (BKv) et JC-virus (JCv), sont des complications majeures en transplantation rénale, responsables de néphropathie à BKv (Nx BKv) et de leuco-encéphalopathie multifocale progressive (LEMP). Sans thérapeutique antivirale spécifique, ces infections virales menent à la perte du rein transplanté ou au décès du patient. Notre groupe a conduit une étude observationnelle incluant 100 patients transplantés rénaux avec différents niveaux de réactivation BKv (Etude MelTyK). Nous avons mis en évidence une altération progressive de la fonctionnalité des lymphocytes T spécifiques du BKv, associée à une corrélation inverse entre la polyfonctionnalité lymphocytaire ou le nombre d’incompatibilités HLA et la charge virale BKv plasmatique. Cette altération de la fonctionnalité suggérait un état d’épuisement des lymphocytes T spécifiques du BKv en fonction du niveau de réactivation BKv. Ces données nous ont conduit à élaborer une méthode biologique non-invasive d’évaluation du risque individuel de Nx BKv (brevet FR1855342). Cette méthode a pour objectif d’aider au diagnostic de Nx BKv sans avoir recours à la biopsie du greffon rénal et de stratifier le risque de développer cette complication. Par ailleurs, nous avons décrit un cas fatal de LEMP associé à un état d’anergie des lymphocytes T spécifiques du JCv. L’étude de la fonctionnalité des lymphocytes T spécifiques des Polyomavirus pourrait ouvrir de futures pistes diagnostiques et/ou thérapeutiques. Elle pourrait permettre de dépister les patients à risques de Nx BKv et pourrait contribuer au développement d’immunothérapies innovantes. La restauration de la fonctionalité des lymphocytes T spécifiques des Polyomavirus pourrait ainsi fournir une piste thérapeutique prometteuse afin de contrôler ces réactivations virales sans majorer le risque de rejet allogénique

Longitudinal evaluation of the impact of immunosuppressive regimen on immune responses to COVID-19 vaccination in kidney transplant recipients.

International audienceImmunocompromised patients have a high risk of death from SARS-CoV-2 infection. Vaccination with an mRNA vaccine may protect these patients against severe COVID-19. Several studies have evaluated the impact of immune-suppressive drug regimens on cellular and humoral responses to SARS-CoV-2 variants of concern in this context. We performed a prospective longitudinal study assessing specific humoral (binding and neutralizing antibodies against spike (S) and T-lymphocyte (cytokine secretion and polyfunctionality) immune responses to anti-COVID-19 vaccination with at least two doses of BNT162b2 mRNA vaccine in stable kidney transplant recipients (KTR) on calcineurin inhibitor (CNI)- or belatacept-based treatment regimens. Fifty-two KTR−31 receiving CNI and 21 receiving belatacept—were enrolled in this study. After two doses of vaccine, 46.9% of patients developed anti-S IgG. Anti-spike IgG antibodies were produced in only 21.4% of the patients in the belatacept group, vs. 83.3% of those in the CNI group. The Beta and Delta variants and, more importantly, the Omicron variant, were less well neutralized than the Wuhan strain. T-cell functions were also much weaker in the belatacept group than in the CNI group. Renal transplant patients have an impaired humoral response to BNT162b2 vaccination. Belatacept-based regimens severely weaken both humoral and cellular vaccine responses. Clinically, careful evaluations of at least binding IgG responses, and prophylactic or post-exposure strategies are strongly recommended for transplant recipients on belatacept-based regimens

mTOR Inhibition Impairs the Activation and Function of Belatacept-Resistant CD4+CD57+ T Cells In Vivo and In Vitro

International audienceCalcineurin inhibitors have improved graft survival in solid-organ transplantation but their use is limited by toxicity, requiring a switch to another immunosuppressor in some cases. Belatacept is one option that has been shown to improve graft and patient survival despite being associated with a higher risk of acute cellular rejection. This risk of acute cellular rejection is correlated with the presence of belatacept-resistant T cells. We performed a transcriptomic analysis of in vitro-activated cells to identify pathways affected by belatacept in belatacept-sensitive cells (CD4+CD57−) but not in belatacept-resistant CD4+CD57+ T cells. mTOR was significantly downregulated in belatacept-sensitive but not belatacept-resistant T cells. The inhibition of mTOR strongly decreases the activation and cytotoxicity of CD4+CD57+ cells. In humans, the use of a combination of mTOR inhibitor and belatacept prevents graft rejection and decreases the expression of activation markers on CD4 and CD8 T cells. mTOR inhibition decreases the functioning of belatacept-resistant CD4+CD57+ T cells in vitro and in vivo. It could potentially be used in association with belatacept to prevent acute cellular rejection in cases of calcineurin intolerance

Frequent detection of IFN-gamma -producing memory effector and effector T cells in patients with progressive multifocal leukoencephalopathy

IntroductionProgressive Multifocal Leukoencephalopathy (PML) is a rare and deadly demyelinating disease caused by JC virus (JCV) replication in the central nervous system. PML occurs exclusively in patients with severe underlying immune deficiencies, including AIDS and hematological malignancies. PML has also emerged as a significant threat to patients on potent new immunosuppressive biologics, including natalizumab in multiple sclerosis.MethodsHere, we developed an IFN-γ release assay (IGRA) that mainly detects JCV-specific effector memory T cells and effectors T cells in the blood.ResultsThis assay was frequently positive in patients with active PML (with a positive JCV PCR in CSF) of various underlying immunosuppression causes (84% sensitivity). Only 3% of healthy donors had a positive response (97% specificity). The frequency of positivity also increased in multiple sclerosis patients according to the time on natalizumab (up to 36% in patients treated for more than 48 months, who are considered at a higher risk of PML).DiscussionThe results show this assay’s frequent or increased positivity in patients with PML or an increased risk of PML, respectively. The assay may help to stratify the risk of PML

COVID-19 in Patients on Maintenance Dialysis in the Paris Region

International audienceIntroduction: Coronavirus disease 2019 (COVID-19) represents a serious threat to patients on maintenance dialysis. The clinical setting, mortality rate, and prognostic factors in these patients have not been well established. Methods: We included all dialyzed patients with COVID-19 referred to our dialysis center between March 11 and April 11, 2020. Data were obtained through the review of the medical records and were censored at the time of data cutoff, on May 11, 2020. Results: Forty-four patients on maintenance dialysis with COVID-19 were referred to our dialysis unit during the COVID-19 epidemic. Median age was 61 years (interquartile range [IQR]: 51.5–72.5); 65.9% were men. Comorbidities included hypertension (97.7%), diabetes mellitus (50%), and chronic cardiac (38.6%) and respiratory (27.3%) diseases. Initial symptoms were fever (79.5%), shortness of breath (29.5%), cough (43.2%), and diarrhea (13.6%). Three profiles of severity were distinguished based on the World Health Organization (WHO) progression scale. Forty-one (93.2%) were hospitalized and only 3 were maintained on outpatient hemodialysis. Thirty-three (75%) patients required oxygen therapy, including 15 (45.5%) who were referred to the intensive care unit. Overall, 27.3% of patients died, and 58.5% were discharged from hospital, including only 2 (13.3%) of those admitted to the intensive care unit. By multivariate analysis, cough, thrombopenia 175 mg/l were significantly associated with death. Conclusion: A major outbreak of COVID-19 occurred in the Paris region, and spread among dialyzed patients. Our study underscores the severity of COVID-19 in these patients and identified prognostic markers