Étude structurale et fonctionnelle de la protéine Core du virus de l'hépatite C

Le virus de l’hépatite C (VHC) représente un problème majeur de santé publique avec au dessus de 120 millions de personnes infectées et à ce jour aucun traitement capable de contrer de manière efficace ce virus. Le VHC a été découvert en 1989, classé dans la famille des flaviviridae et est le seul représentant du genre hepacivirus. Il s’agit d’un virus enveloppé, formé donc d’une bicouche lipidique, d’une capside, et d’un acide nucléique (ARN). La capside virale est formée d’une seule et unique protéine appelée « Core ». Il s’agit d’une protéine de 177 acides aminés sous sa forme mature. Il a été démontré au sein du laboratoire du Professeur Denis Leclerc que la première moitié de la protéine (C82) était suffisante pour générer à la fois in vivo et in vitro la formation de la capside virale. Ayant comme objectif de comprendre les mécanismes régissant l’assemblage viral, nous avons étudié cette protéine d’un point de vue structural. Suite à la mise au point d’un protocole robuste d’expression, de marquage isotopique et de purification, nous avons étudié la Core C82 par dichroïsme circulaire et résonance magnétique nucléaire. Les données expérimentales obtenues suggèrent que la Core C82 est non structurée et flexible, confirmant ainsi l’analyse de la séquence primaire et les prédictions de structure secondaire de la Core. Nous avons ainsi mis en évidence que la moitié N-terminale de la Core du VHC appartenait à la famille des protéines intrinsèquement non structurées (IUP). Les IUPs sont des protéines peu ou très peu structurées et parfois capables de se structurer en liaison à un partenaire (protéine, acide nucléique, petite molécule). Nous avons donc, dans le but de structurer la Core C82, testé de multiples conditions de sel, détergent, agent lipomimétique et un partenaire protéique (protéine p53). Seul l’ajout d’un agent lipomimétique (2,2,2-trifluoroéthanol, TFE) à la Core C82 est venu modifier sa structure et sa dynamique. Nous avons ainsi pu démontrer que la Core C82 pouvait adopter une structure en hélice α. Nous avons, de plus, confirmé que ce repliement était également présent dans des versions tronquées plus longues de la Core (formes C124 et C170). Enfin, nous avons, parallèlement à son étude structurale, mis au point un test in vitro d’inhibition de l’assemblage. Cet outil nous a permis de découvrir plusieurs peptides dérivés de la séquence protéique de la Core et de la protéine NS5A du VHC, ayant un effet inhibiteur sur l’assemblage viral in vitro de la Core mature (C170). Ces travaux innovateurs représentent une avenue encourageante vers la découverte d’un moyen efficace de soigner l’infection au VHC. Au final, même si la structure 3D de la Core mature reste non déterminée, notre étude structurale de la Core C82 est la plus complète réalisée à ce jour à l’échelle atomique. Par ailleurs, nos travaux préliminaires sur la forme mature de la Core (C170) semblent être très prometteurs et permettraient de déterminer la structure 3D de la protéine Core mature.The hepatitis C virus (HCV) is a major public health problem with more than 120 million infected people, and to date no efficient treatment is available. HCV was discovered in 1989, classified in the flaviviridae family, and is the only member of the hepacivirus genus. It is an enveloped virus, consisting in a lipid bilayer, a capsid, and a ribonucleic acid (RNA). The viral capsid is composed by only one protein called “Core” protein. It is a 177 amino acid long protein in its mature form. It was demonstrated in our laboratory that the first half of this protein (C82) was sufficient to generate, both in vivo and in vitro, the assembly of the viral capsid. In order to understand the mechanism controlling the capsid assembly, we have studied the structural aspect of this protein. After developing robust protocols of overexpression, isotope labelling and purification of the protein C82, we studied this truncated form using circular dichroism and nuclear magnetic resonance. The experimental data obtained suggest that Core C82 is an unstructured and very flexible protein, thus confirming primary sequence analysis and secondary structure predictions. We established that the N-terminal half of the Core protein is a member of the intrinsically unstructured protein family (IUP). IUPs are proteins which are totally or partially unstructured, but can sometimes undergo a structural change induced by the binding of a partner (protein, nucleic acid, small molecule). In order to induce a structured form of the C82 protein, we have tested a large range of conditions of salt, detergent, lipomimetic solvent, as well as interaction with a proteic partner (p53). Only the addition of a lipomimetic agent (2,2,2-trifluoroethanol, TFE) to the Core C82 protein resulted in a structural and a dynamical change. In this special condition, we were able to demonstrate that the Core C82 can adopt an α-helix conformation. We have, moreover, confirmed that this conformation was also present in longer truncated form of the Core protein (C124 and C170). We also, along its structural analysis, developed an in vitro test to inhibit the assembly of the Core protein. This tool allowed us to discover several small peptides derived from the HCV Core and NS5A proteins amino acid sequences, with an inhibitory effect on the viral assembly of the mature Core protein (C170). This innovative work is potentially an interesting step towards the development of an efficient treatment against HCV. Ultimately, even if the 3D structure of the mature Core protein remains unsolved, our structural study of the C82 truncated form is the most comprehensive study to date at an atomic resolution. Moreover, our preliminary works on the mature form of the Core protein (C170) are very promising and should eventually lead to the three dimensional structure

Cervical spondylitis and spinal abscess due to Actinomyces meyeri

AbstractHuman actinomycosis with involvement of the spine is a rare condition although it has been first described a long time ago. It is probably underrecognized since its clinical presentation is often misleading and accurate bacteriological diagnosis is challenging. We herein report a rare case of cervical actinomycosis with paravertebral abscess and spondylitis imputed to an infection by Actinomyces meyeri in a 52-year-old immunocompetent Caucasian man. A. meyeri should be considered as a potential cause for subacute or chronic spondylitis, even in immunocompetent subjects. Modern diagnostic tools such as Matrix-Assisted Laser Desorption–Ionization Time of Flight mass spectrometry and 16S rRNA sequencing are efficient for accurate microbiological identification

Can haematological changes constitute a surrogate diagnostic parameter to detect schistosomiasis in migrants and travellers? - A retrospective analysis

Full blood count; Schistosomiasis; TravelHemograma completo; Esquistosomiasis; ViajarHemograma complet; Esquistosomiasi; ViatjarBackground Earlier studies found characteristic haematological changes in African patients with active schistosomiasis. If consistently present, full blood counts (FBC) may be helpful to diagnose schistosomiasis also in migrants and returning travellers. Methods A retrospective patient record review was conducted on data from seven European travel clinics, comparing FBC of Schistosoma egg-positive travellers and migrants to reference values. Sub-analyses were performed for children, returned travellers, migrants and different Schistosoma species. Results Data analysis included 382 subjects (median age 21.0 years [range 2–73]). In returned travellers, decreases in means of haemoglobin particularly in females (β = −0.82 g/dL, p = 0.005), MCV (β = −1.6 fL, p = 0.009), basophils, neutrophils, lymphocytes and monocytes (β = −0.07, p < 0.001; −0.57, p = 0.012; −0.57, p < 0.001 and −0.13 103/μL, p < 0.001, respectively) were observed. As expected, eosinophils were increased (β = +0.45 103/μL, p < 0.001). In migrants, a similar FBC profile was observed, yet thrombocytes and leukocytes were significantly lower in migrants (β = −48 103/μL p < 0.001 and β = −2.35 103/μL, p < 0.001, respectively). Conclusions Active egg-producing Schistosoma infections are associated with haematological alterations in returned travellers and migrants. However, these differences are discrete and seem to vary among disease stage and Schistosoma species. Therefore, the FBC is unsuitable as a surrogate diagnostic parameter to detect schistosomiasis

The antigen presenting potential of Vγ9Vδ2 T-cells during Plasmodium falciparum blood-stage infection.

During Plasmodium falciparum infections, erythrocyte-stage parasites inhibit dendritic cell maturation and function; compromising development of effective anti-malarial adaptive immunity. Human Vγ9Vδ2 T-cells can act in vitro as APCs and induce αβ T-cell activation. However, the relevance of this activity in pathophysiological contexts in vivo has remained elusive. Since Vγ9Vδ2 T-cells are activated during the early immune response against P.falciparum infection, we investigated whether they could contribute to the instruction of adaptive immune responses toward malaria parasites. In P.falciparum-infected patients,Vγ9Vδ2 T-cells presented an increased surface expression of APC-associated markers HLA-DR and CD86. In response to infected red blood cells in vitro, Vγ9Vδ2 T-cells readily up-regulated surface expression of HLA-DR, HLA-ABC, CD40, CD80, CD83 and CD86, induced naive αβ T-cell responses, and cross-presented soluble prototypical protein to antigen-specific CD8+ T-cells. Our findings indicate that P. falciparum parasites induce genuine APC properties in Vγ9Vδ2 T-cells and qualify this subset as an alternative professional APC in malaria patients, which could be harnessed for therapeutic interventions and vaccine design

Ribavarin for treating Lassa fever: A systematic review of pre-clinical studies and implications for human dosing

Ribavirin is currently the standard of care for treating Lassa fever. However, the human clinical trial data supporting its use suffer from several serious flaws that render the results and conclusions unreliable. We performed a systematic review of available pre-clinical data and human pharmacokinetic data on ribavirin in Lassa. In in-vitro studies, the EC50 of ribavirin ranged from 0.6 μg/ml to 21.72 μg/ml and the EC90 ranged from 1.5 μg/ml to 29 μg/ml. The mean EC50 was 7 μg/ml and the mean EC90 was 15 μg/ml. Human PK data in patients with Lassa fever was sparse and did not allow for estimation of concentration profiles or pharmacokinetic parameters. Pharmacokinetic modelling based on healthy human data suggests that the concentration profiles of current ribavirin regimes only exceed the mean EC50 for less than 20% of the time and the mean EC90 for less than 10% of the time, raising the possibility that the current ribavirin regimens in clinical use are unlikely to reliably achieve serum concentrations required to inhibit Lassa virus replication. The results of this review highlight serious issues with the evidence, which, by today standards, would be unlikely to support the transition of ribavirin from pre-clinical studies to human clinical trials. Additional pre-clinical studies are needed before embarking on expensive and challenging clinical trials of ribavirin in Lassa fever

High mean arterial pressure target to improve sepsis-associated acute kidney injury in patients with prior hypertension: a feasibility study

Background : The optimal mean arterial pressure (MAP) in cases of septic shock is still a matter of debate in patients with prior hypertension. An MAP between 75 and 85 mmHg can improve glomerular filtration rate (GFR) but its effect on tubular function is unknown. We assessed the effects of high MAP level on glomerular and tubular renal function in two intensive care units of a teaching hospital. Inclusion criteria were patients with a history of chronic hypertension and developing AKI in the first 24 h of septic shock. Data were collected during two 6 h periods of MAP regimen administered consecutively after haemodynamic stabilisation in an order depending on the patient's admission unit: a high-target period (80–85 mmHg) and a low-target period (65–70 mmHg). The primary endpoint was the creatinine clearance (CrCl) calculated from urine and serum samples at the end of each MAP period by the UV/P formula. Results : 26 patients were included. Higher urine output (+0.2 (95%:0, 0.4) mL/kg/h; P = 0.04), urine sodium (+6 (95% CI 0.2, 13) mmol/L; P = 0.04) and lower serum creatinine (− 10 (95% CI − 17, − 3) µmol/L; P = 0.03) were observed during the high-MAP period as compared to the low-MAP period, resulting in a higher CrCl (+25 (95% CI 11, 39) mL/mn; P = 0.002). The urine creatinine, urine–plasma creatinine ratio, urine osmolality, fractional excretion of sodium and urea showed no significant variation. The KDIGO stage at inclusion only interacted with serum creatinine variation and low level of sodium excretion at inclusion did not interact with these results. Conclusions : In the early stage of sepsis-associated AKI, a high-MAP target in patients with a history of hypertension was associated with a higher CrCl, but did not affect the kidneys' ability to concentrate urine, which may reflect no effect on tubular function

Trials

OBJECTIVES: To assess the efficacy of several repurposed drugs to prevent hospitalisation or death in patients aged 65 or more with recent symptomatic SARS-CoV-2 infection (COVID-19) and no criteria for hospitalisation. TRIAL DESIGN: Phase III, multi-arm (5) and multi-stage (MAMS), randomized, open-label controlled superiority trial. Participants will be randomly allocated 1:1:1:1:1 to the following strategies: Arm 1: Control arm Arms 2 to 5: Experimental treatment arms Planned interim analyses will be conducted at regular intervals. Their results will be reviewed by an Independent Data and Safety Monitoring Board. Experimental arms may be terminated for futility, efficacy or toxicity before the end of the trial. New experimental arms may be added if new evidence suggests that other treatments should be tested. A feasibility and acceptability substudy as well as an immunological substudy will be conducted alongside the trial. PARTICIPANTS: Inclusion criteria are: 65-year-old or more; Positive test for SARS-CoV-2 on a nasopharyngeal swab; Symptoms onset within 3 days before diagnosis; No hospitalisation criteria; Signed informed consent; Health insurance. Exclusion criteria are: Inability to make an informed decision to participate (e.g.: dementia, guardianship); Rockwood Clinical Frailty Scale ≥7; Long QT syndrome; QTc interval > 500 ms; Heart rate 5.5 mmol/L or <3.5 mmol/L; Ongoing treatment with piperaquine, halofantrine, dasatinib, nilotinib, hydroxyzine, domperidone, citalopram, escitalopram, potent inhibitors or inducers of cytochrome P450 CYP3A4 isoenzyme, repaglinide, azathioprine, 6-mercaptopurine, theophylline, pyrazinamide, warfarin; Known hypersensitivity to any of the trial drugs or to chloroquine and other 4-aminoquinolines, amodiaquine, mefloquine, glafenine, floctafenine, antrafenine, ARB; Hepatic porphyria; Liver failure (Child-Pugh stage ≥B); Stage 4 or 5 chronic kidney disease (GFR <30 mL/min/1.73 m²); Dialysis; Hypersentivity to lactose; Lactase deficiency; Abnormalities in galactose metabolism; Malabsorption syndrome; Glucose-6-phosphate dehydrogenase deficiency; Symptomatic hyperuricemia; Ileus; Colitis; Enterocolitis; Chronic hepatitis B virus disease. The trial is being conducted in France in the Bordeaux, Corse, Dijon, Nancy, Paris and Toulouse areas as well as in the Grand Duchy of Luxembourg. Participants are recruited either at home, nursing homes, general practices, primary care centres or hospital outpatient consultations. INTERVENTION AND COMPARATOR: The four experimental treatments planned in protocol version 1.2 (April 8(th), 2020) are: (1) Hydroxychloroquine 200 mg, 2 tablets BID on day 0, 2 tablets QD from day 1 to 9; (2) Imatinib 400 mg, 1 tablet QD from day 0 to 9; (3) Favipiravir 200 mg, 12 tablets BID on day 0, 6 tablets BID from day 1 to 9; (4) Telmisartan 20 mg, 1 tablet QD from day 0 to 9. The comparator is a complex of vitamins and trace elements (AZINC Forme et Vitalité®), 1 capsule BID for 10 days, for which there is no reason to believe that they are active on the virus. In protocol version 1.2 (April 8th, 2020): People in the control arm will receive a combination of vitamins and trace elements; people in the experimental arms will receive hydroxychloroquine, or favipiravir, or imatinib, or telmisartan. MAIN OUTCOME: The primary outcome is the proportion of participants with an incidence of hospitalisation and/or death between inclusion and day 14 in each arm. RANDOMISATION: Participants are randomized in a 1:1:1:1:1 ratio to each arm using a web-based randomisation tool. Participants not treated with an ARB or ACEI prior to enrolment are randomized to receive the comparator or one of the four experimental drugs. Participants already treated with an ARB or ACEI are randomized to receive the comparator or one of the experimental drugs except telmisartan (i.e.: hydroxychloroquine, imatinib, or favipiravir). Randomisation is stratified on ACEI or ARBs treatment at inclusion and on the type of residence (personal home vs. nursing home). BLINDING (MASKING): This is an open-label trial. Participants, caregivers, investigators and statisticians are not blinded to group assignment. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): A total of 1057 participants will be enrolled if all arms are maintained until the final analysis and no additional arm is added. Three successive futility interim analyses are planned, when the number of participants reaches 30, 60 and 102 in the control arm. Two efficacy analyses (interim n°3 and final) will be performed successively. TRIAL STATUS: This describes the Version 1.2 (April 8(th), 2020) of the COVERAGE protocol that was approved by the French regulatory authority and ethics committee. The trial was opened for enrolment on April 15(th), 2020 in the Nouvelle Aquitaine region (South-West France). Given the current decline of the COVID-19 pandemic in France and its unforeseeable dynamic in the coming months, new trial sites in 5 other French regions and in Luxembourg are currently being opened. A revised version of the protocol was submitted to the regulatory authority and ethics committee on June 15(th), 2020. It contains the following amendments: (i) Inclusion criteria: age ≥65 replaced by age ≥60; time since first symptoms <3 days replaced by time since first symptoms <5 days; (ii) Withdrawal of the hydroxychloroquine arm (due to external data); (iii) increase in the number of trial sites. TRIAL REGISTRATION: The trial was registered on Clinical Trials.gov on April 22(nd), 2020 (Identifier: NCT04356495): and on EudraCT on April 10(th), 2020 (Identifier: 2020-001435-27). FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest of expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2)