Alleles of the α1 immunoglobulin gene 3′ enhancer control evolution of IgA nephropathy toward renal failure

Alleles of the α1 immunoglobulin gene 3′ enhancer control evolution of IgA nephropathy toward renal failure.BackgroundIgA nephropathy is the most common glomerular disease. Mechanisms leading to its occurrence and controlling the evolution of the disease remain largely unknown. Various genetic factors have been found, mostly implicating immunologically relevant genes (IgH, TCR, human lymphocyte antigen, and complement loci). A regulatory region recently identified downstream, the α1 gene of the IgH locus, was a likely candidate for the control of IgA1 production in patients. Alleles of this region, differing by size, sequence, and orientation of the α1 hs1,2 transcriptional enhancer, were first identified through Southern blot hybridization.MethodsWe established a polymerase chain reaction (PCR) method suitable for routine testing that amplifies minisatellites within the α1 hs1,2 enhancer, with variable numbers of tandem repeats (VNTR) defining the two alleles. This assay allowed the typing of 104 patients with IgAN and 83 healthy volunteers. Results from typing of α1 hs1,2 alleles were compared with long-term clinical outcome in patients. Enhancer alleles were compared in a luciferase reporter gene assay.ResultsThe α1 hs1,2 alleles do not constitute a predictive factor for IgA nephropathy, since similar allelic frequencies were observed in healthy individuals and in unrelated European patients. In contrast, among patients, homozygosity for the weakest enhancer allele (AA genotype) was significantly correlated with a milder form of the disease, whereas the allele B was associated with severe evolution. The minisatellite region within the α1 hs1,2 enhancer carried potential transcription factor-binding sites, and its duplication increased the transcriptional strength of the α1 hs1,2 allele B over that of allele A.ConclusionAltogether, these alleles may constitute a risk factor for the prognosis of IgA nephropathy

Mechanism of Calcium Incorporation Inside Sol–Gel Silicate Bioactive Glass and the Advantage of Using Ca(OH)2 over Other Calcium Sources

Calcium is an essential component of osteogenesis and is often required for imparting significant bioactivity to synthetic bone substitutes and, in particular, silicate-based materials. However, the mechanism of calcium incorporation inside sol–gel silicates is poorly understood. In this work, we shed light on the determinant parameters for incorporation of calcium into acid–base-catalyzed sol–gel silicates at ambient temperature: increasing the pH above the isoelectric point of silicic acid and the nature of the calcium counterion in the calcium precursor are found to be the key. Based on our proposed reaction sequence, we were able to compare calcium precursors and select an ideal candidate compound for the synthesis of bioactive glasses (BG) and organic–inorganic hybrids at ambient temperature. Reproducible syntheses and gel times of SiO2–CaO BG were obtained using calcium hydroxide (CH), and we demonstrate its usability in the synthesis of promising BG–polycaprolactone hybrid scaffolds. BG and hybrids prepared with CH were able to form nanocrystalline nonstoichiometric apatite in simulated body fluid. The increased reliability of low-temperature syntheses associated with the use of a stable and inexpensive alkaline-earth precursor are major steps toward the translation of calcium silicate hybrids or other alkaline-earth silicates from bench to clinic

The modified star excursion balance test for the detection of the risk of injury in elite handball female players

Background: Elite handball female players are at high risk of injury to the lower limbs. The modified Star Excursion Balance Test (mSEBT) is efficient in detecting players with a risk of injury. However, performed once before the season, the mSEBT cannot determine with precision when the injury will occur. Purpose: The objective of the study was to investigate if a repeated measure of mSEBT across the season would help in identifying with precision the period at risk of injury for each player.Methods: Eleven elite female handball players took part in the study. The mSEBT was measured weekly for 25 weeks and the injuries were recorded. Composite Scores (CS) and distances on each axis were computed for both legs of each player. The 94% cut-off on the composite score and the 4 cm difference between the right and left leg on the anteroposterior axis (ANT) was investigated for each player.Results: Five players reported injury. The 94% cut-off on the CS and the 4 cm difference on ANT were not significant indicators of risk of injury in our study. However, for each injured player, a drop in the composite score was noticed the week before the injury.Conclusion: We propose the drop of CS as an indicator for the detection of the risk of injury in a follow-up of elite athletes using repeated mSEBT. This indicator allows the detection of injury a week before it occurs. Further work is needed to confirm, investigate and validate this indicator

Radiothérapie et athérome

L’optimisation constante des traitements du cancer par radiothérapie pose le problème du devenir à long terme des patients traités et guéris par les rayonnements ionisants, et de la survenue éventuelle de seconds cancers ou de complications non cancéreuses. Parmi ces dernières, les pathologies cardiovasculaires sont prédominantes et peuvent concerner jusqu’à 40 % des patients selon la localisation de l’irradiation. Les dernières études épidémiologiques montrent que ce problème est sous-estimé et n’a pas fait l’objet de réelles études prospectives. La prise en charge thérapeutique de ces patients à risque vasculaire, voire à très haut risque s’ils présentent des facteurs de risque cardiovasculaires traditionnels préexistants, reste à déterminer. Les mécanismes physiopathologiques de l’athérome radio-induit ne sont pas encore clarifiés. La surveillance vasculaire prolongée des patients à distance de leur traitement par radiothérapie doit désormais être intégrée dans les schémas de soins, d’autant plus que la mise en place d’un plateau technique de radiothérapie de plus en plus sophistiqué ne résoudra pas forcément le problème du risque cardiovasculaire après traitement

Analysis of three genetic markers in IgA nephropathy patients from a single region.

BACKGROUND: IgA nephropathy (IgA-N) is the most common glomerular disease. Various genetic factors have been suspected to influence the disease, but they never have been studied in the same cohort of patients. METHODS: In 125 IgA-N biopsy-proven cases, we studied by DNA techniques the allele distribution of 3 polymorphic loci: the angiotensin-converting enzyme (ACE) gene, the specific HLA-DQB1 gene and the hs1,2 enhancer of the alpha1 gene of the IgH locus. Patients were classified as progressive and non-progressive based on a creatininemia above 150 microl/ml or/and a deterioration of the clearance greater than 3 ml/min/year. We analyzed the influence of the polymorphism on the development and the progression of the disease. The control group consisted of 83 heathly subjects. RESULTS: The frequency of HLA-DQB1*0602 was decreased in IgA-N patients (3.6% vs 10.2%, Pc = 0.04, RR = 0.36), suggesting a protective effect of this allele for IgA-N. Kaplan-Meyer analysis with the Cox-proportional hazard model revealed a shorter time between diagnosis and renal failure in patients with the B allele for the al gene hs1,2 enhancer (p = 0.04). ACE polymorphism did not influence the development or the progression of the disease. CONCLUSION: Genes controlling the immune response, such as HLA DQB1 and the alpha1 transcriptional enhancer gene, may influence the development and/or the progression of IgA-N nephropathy. Patients who develop an IgA-N nephropathy have a higher risk of severe evolution if they have a profile of high IgA humoral responder

Hospital admissions for acute myocardial infarction before and after lockdown according to regional prevalence of COVID-19 and patient profile in France: a registry study

International audienceBackground: The COVID-19 pandemic has had a profound effect on general health care. We aimed to evaluate the effect of a nationwide lockdown in France on admissions to hospital for acute myocardial infarction, by patient characteristics and regional prevalence of the pandemic.Methods: In this registry study, we collected data from 21 centres participating in the ongoing French Cohort of Myocardial Infarction Evaluation (FRENCHIE) registry, which collects data from all patients admitted for ST segment elevation myocardial infarction (STEMI) or non-ST segment elevation myocardial infarction (NSTEMI) within 48 h of symptom onset. We analysed weekly hospital admissions over 8 weeks: the 4 weeks preceding the institution of the lockdown and the 4 weeks following lockdown. The primary outcome was the change in the number of hospital admissions for all types of acute myocardial infarction, NSTEMI, and STEMI between the 4 weeks before lockdown and the 4 weeks after lockdown. Comparisons between categorical variables were made using χ2 tests or Fisher's exact tests. Comparisons of continuous variables were made using Student's t tests or Mann-Whitney tests. Poisson regression was used to determine the significance of change in hospital admissions over the two periods, after verifying the absence of overdispersion. Age category, region, and type of acute myocardial infarction (STEMI or NSTEMI) were used as covariables. The FRENCHIE cohort is registered with ClinicalTrials.gov, NCT04050956.Findings: Between Feb 17 and April 12, 2020, 1167 patients were consecutively admitted within 48 h of acute myocardial infarction (583 with STEMI, 584 with NSTEMI) and were included in the study. Admissions for acute myocardial infarction decreased between the periods before and after lockdown was instituted, from 686 before to 481 after lockdown (30% decrease; incidence rate ratio 0·69 [95% CI 0·51-0·70]). Admissions for STEMI decreased from 331 to 252 (24%; 0·72 [0·62-0·85]), and admissions for NSTEMI decreased from 355 to 229 (35%; 0·64 [0·55-0·76]) following institution of the lockdown, with similar trends according to sex, risk factors, and regional prevalence of hospital admissions for COVID-19.Interpretation: A marked decrease in hospital admissions was observed following the lockdown, irrespective of patient characteristics and regional prevalence of COVID-19. Health authorities should be aware of these findings, in order to adapt their message if the COVID-19 pandemic persists or recurs, or in case of future major epidemics

PREPARTOI: Prévention et REcherche Pour l'Atténuation du Risque de Tsunami dans l'Océan Indien (Réunion-Mayotte)

Rapport

Treatment, outcome, and prognostic factors in non-metastatic anal cancer: The French nationwide cohort study FFCD-ANABASE

International audienceIntroduction: International guidelines regarding the treatment of squamous cell carcinoma of the anus (SCCA) recommend intensity-modulated radiotherapy (IMRT) combined with mitomycin-based chemotherapy (CT). The French FFCD-ANABASE cohort aimed at evaluating clinical practices, treatment, and outcomes of SCCA patients.Methods: This prospective multicentric observational cohort included all non-metastatic SCCA patients treated in 60 French centers from January 2015 to April 2020. Patients and treatment characteristics, colostomy-free survival (CFS), disease-free survival (DFS), overall survival (OS), and prognostic factors were analyzed.Results: Among 1015 patients (male: 24.4 %; female: 75.6 %; median age: 65 years), 43.3 %presented with early-stage(T1-2, N0) and 56.7 % with locally advanced stage (T3-4 or N + ) tumors. IMRT was used for 815 patients (80.3 %) and a concurrent CT was administered in 781 patients, consisting of mitomycin-based CT for 80 %. The median follow-up was 35.5 months. DFS, CFS, and OS at 3 years were 84.3 %, 85.6 %, and 91.7 % respectively in the early-stage group compared to 64.4 %, 66.9 %, and 78.2 % in the locally-advanced group (p < 0.001). In multivariate analyses, male gender, locally-advanced stage, and ECOG PS ≥ 1 were associated with poorer DFS, CFS, and OS. IMRT was significantly associated with a better CFS in the whole cohort and almost reached significance in the locally-advanced group.Conclusion: Treatment of SCCA patients showed good respect for current guidelines. Significant differences in outcomes advocate for personalized strategies by either de-escalation for early-stage tumors or treatment intensification for locally-advanced tumors