Immunogenicity of long-lasting recombinant factor VIII products

International audienceReplacement therapy for patients with hemophilia A using plasma-derived or recombinant factor VIII (FVIII) is complicated by the short half-life of the FVIII products and by the occurrence of neutralizing antibodies in a substantial number of patients. In the recent years, enormous efforts have been invested to develop new generations of coagulation factors with extended half-lives. Presumably, the use of long-lasting FVIII products should reduce the frequency of administration to the patients and drastically improve their quality of life. The question of their immunogenicity remains however unanswered as yet. The present review proposes a summary of the different strategies developed to enhance the half-life of FVIII, including fusion of FVIII to the Fc fragment of the human IgG1 or to human serum albumin, or attachment of polyethylene glycol. Based on the available literature, we hypothesize on the potential benefits or risks associated with each of the latter strategies in terms of immunogenicity of the newly derived hemostatic drugs

From diluted magnetic semiconductors to self-organized nanocolumns of GeMn in Germanium

While achieving high Curie temperatures (above room temperature) in diluted magnetic semiconductors remains a challenge in the case of well controlled homogeneous alloys, several systems characterized by a strongly inhomogeneous incorporation of the magnetic component appear as promising. Incorporation of manganese into germanium drastically alters the growth conditions, and in certain conditions of low temperature Molecular Beam Epitaxy it leads to the formation of well organized nanocolumns of a Mn-rich material, with a crystalline structure in epitaxial relationship with the Mn-poor germanium matrix. A strong interaction between the Mn atoms in these nanocolums is demonstrated by x-ray absorption spectroscopy, giving rise to a ferromagnetic character as observed through magnetometry and x-ray magnetic circular dichroism. Most interesting, intense magneto-transport features are observed on the whole structure, which strongly depend on the magnetic configuration of the nanocolumns.Comment: SPIE Optics & Photonics Symposium, San Diego : \'Etats-Unis d'Am\'erique (2008

Effects of resuscitation with crystalloid fluids on cardiac function in patients with severe sepsis

<p>Abstract</p> <p>Background</p> <p>The use of hypertonic crystalloid solutions, including sodium chloride and bicarbonate, for treating severe sepsis has been much debated in previous investigations. We have investigated the effects of three crystalloid solutions on fluid resuscitation in severe sepsis patients with hypotension.</p> <p>Methods</p> <p>Ninety-four severe sepsis patients with hypotension were randomly assigned to three groups. The patients received the following injections within 15 min at initial treatment: Ns group (n = 32), 5 ml/kg normal saline; Hs group (n = 30), with 5 ml/kg 3.5% sodium chloride; and Sb group (n = 32), 5 ml/kg 5% sodium bicarbonate. Cardiac output (CO), systolic blood pressure, mean arterial pressure (MAP), body temperature, heart rate, respiratory rate and blood gases were measured.</p> <p>Results</p> <p>There were no differences among the three groups in CO, MAP, heart rate or respiratory rate during the 120 min trial or the 8 hour follow-up, and no significant differences in observed mortality rate after 28 days. However, improvement of MAP and CO started earlier in the Sb group than in the Ns and Hs groups. Sodium bicarbonate increased the base excess but did not alter blood pH, lactic acid or [HCO₃]^-values; and neither 3.5% hypertonic saline nor 5% sodium bicarbonate altered the Na⁺, K⁺, Ca²⁺or Cl^-levels.</p> <p>Conclusion</p> <p>All three crystalloid solutions may be used for initial volume loading in severe sepsis, and sodium bicarbonate confers a limited benefit on humans with severe sepsis.</p> <p>Trial registration</p> <p>ISRCTN36748319.</p

Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

Immunogenicity of therapeutic factor VIII : importance of complement and factor VIII C domains for its uptake

La survenue d'anticorps neutralisant le facteur VIII de la coagulation (FVIII) chez les patients hémophiles A constitue un échec thérapeutique majeur. Si les étapes effectrices de la réponse immunitaire, la nature des cellules immunitaires impliquées et les propriétés des anticorps ont été largement documentées, les étapes précoces de la réponse immunitaire restent mal connues et constituent l'objet de ma thèse. La première partie de ma thèse aborde le rôle du microenvironnement rencontré par le FVIII une fois administré in vivo, notamment le rôle des molécules du complément. Acteur majeur de l'immunité innée, le système du complément participe également aux réponses immunitaires adaptatives et peut interagir avec la cascade de la coagulation. Alors que le complément est impliqué dans les réponses immunitaires contre des agents pathogènes, son implication dans les réponses immunitaires dirigées contre les protéines thérapeutiques n'a jamais été décrite jusqu'à présent. Je me suis donc intéressé au potentiel rôle des molécules du complément dans l'immunogénicité du FVIII thérapeutique.La seconde partie de ma thèse aborde l'implication de la structure du FVIII pour sa reconnaissance par le système immunitaire. Ainsi, a-t-il été démontré l'importance du domaine C1 du FVIII pour sa prise en charge par les cellules du système immunitaire in vitro et pour son immunogénicité in vivo. En raison des fortes homologies de structure entre les domaines C1 et C2, je me suis intéressé au rôle potentiel du domaine C2 dans la capture du FVIII par les cellules présentatrices d'antigènes et l'élaboration de la réponse immunitaire anti-FVIII.Occurrence of pro-coagulant factor VIII (FVIII) neutralizing antibodies in hemophilia A patients constitutes a major therapeutic failure. While the effector steps of the immune response, the nature of the involved immune cells and the antibodies properties have been well-reported, the early stages of the immune response are poorly described and constitute the topic of my PhD thesis. The first part of my thesis deals with the role of the microenvironment encountered by FVIII once administered in vivo, especially the role of complement system molecules. While complement system is a major actor of the innate immunity, it also participates to adaptive immune responses and can interact with the coagulation cascade. Though complement is involved in immune responses against pathogens, its contribution to immune responses against therapeutic proteins has never been reported so far. Therefore I have investigated the potential role of the complement system in the immunogenicity of therapeutic FVIII. The second part of my thesis focuses on the involvement of FVIII structure for its recognition by the immune system. It has been demonstrated that FVIII C1 domain plays a major role of its uptake by immune cells in vitro and its immunogenicity in vivo. Because of strong structural homologies between C1 and C2 domains, I investigated the potential role of FVIII C2 domain for its endocytosis by antigen presenting cells and the elicitation of the anti-FVIII immune response

Immunogénicité du facteur VIII thérapeutique : importance du complément et des domaines C du facteur VIII pour son endocytose

Occurrence of pro-coagulant factor VIII (FVIII) neutralizing antibodies in hemophilia A patients constitutes a major therapeutic failure. While the effector steps of the immune response, the nature of the involved immune cells and the antibodies properties have been well-reported, the early stages of the immune response are poorly described and constitute the topic of my PhD thesis. The first part of my thesis deals with the role of the microenvironment encountered by FVIII once administered in vivo, especially the role of complement system molecules. While complement system is a major actor of the innate immunity, it also participates to adaptive immune responses and can interact with the coagulation cascade. Though complement is involved in immune responses against pathogens, its contribution to immune responses against therapeutic proteins has never been reported so far. Therefore I have investigated the potential role of the complement system in the immunogenicity of therapeutic FVIII. The second part of my thesis focuses on the involvement of FVIII structure for its recognition by the immune system. It has been demonstrated that FVIII C1 domain plays a major role of its uptake by immune cells in vitro and its immunogenicity in vivo. Because of strong structural homologies between C1 and C2 domains, I investigated the potential role of FVIII C2 domain for its endocytosis by antigen presenting cells and the elicitation of the anti-FVIII immune response.La survenue d'anticorps neutralisant le facteur VIII de la coagulation (FVIII) chez les patients hémophiles A constitue un échec thérapeutique majeur. Si les étapes effectrices de la réponse immunitaire, la nature des cellules immunitaires impliquées et les propriétés des anticorps ont été largement documentées, les étapes précoces de la réponse immunitaire restent mal connues et constituent l'objet de ma thèse. La première partie de ma thèse aborde le rôle du microenvironnement rencontré par le FVIII une fois administré in vivo, notamment le rôle des molécules du complément. Acteur majeur de l'immunité innée, le système du complément participe également aux réponses immunitaires adaptatives et peut interagir avec la cascade de la coagulation. Alors que le complément est impliqué dans les réponses immunitaires contre des agents pathogènes, son implication dans les réponses immunitaires dirigées contre les protéines thérapeutiques n'a jamais été décrite jusqu'à présent. Je me suis donc intéressé au potentiel rôle des molécules du complément dans l'immunogénicité du FVIII thérapeutique.La seconde partie de ma thèse aborde l'implication de la structure du FVIII pour sa reconnaissance par le système immunitaire. Ainsi, a-t-il été démontré l'importance du domaine C1 du FVIII pour sa prise en charge par les cellules du système immunitaire in vitro et pour son immunogénicité in vivo. En raison des fortes homologies de structure entre les domaines C1 et C2, je me suis intéressé au rôle potentiel du domaine C2 dans la capture du FVIII par les cellules présentatrices d'antigènes et l'élaboration de la réponse immunitaire anti-FVIII

A severe case of rhabdomyolysis after Moderna mRNA anti‐COVID‐19 vaccine with a literature review

Abstract The identification of rhabdomyolysis as a potential fatal adverse reaction to recent COVID‐19 vaccines is essential. As the symptoms of rhabdomyolysis are not specific, the threshold to actively search for this complication should be low

The C1 and C2 domains of blood coagulation factor VIII mediate its endocytosis by dendritic cells

The development of inhibitory antibodies to therapeutic factor VIII is the major complication of replacement therapy in patients with hemophilia A. The first step in the initiation of the anti-factor VIII immune response is factor VIII interaction with receptor(s) on antigen-presenting cells, followed by endocytosis and presentation to naïve CD4(+) T cells. Recent studies indicate a role for the C1 domain in factor VIII uptake. We investigated whether charged residues in the C2 domain participate in immunogenic factor VIII uptake. Co-incubation of factor VIII with BO2C11, a monoclonal C2-specific immunoglobulin G, reduced factor VIII endocytosis by dendritic cells and presentation to CD4(+) T cells, and diminished factor VIII immunogenicity in factor VIII-deficient mice. The mutation of basic residues within the BO2C11 epitope of C2 replicated reduced in vitro immunogenic uptake, but failed to prevent factor VIII immunogenicity in mice. BO2C11 prevents factor VIII binding to von Willebrand factor, thus potentially biasing factor VIII immunogenicity by perturbing its half-life. Interestingly, a factor VIII(Y1680C) mutant, that does not bind von Willebrand factor, demonstrated unaltered endocytosis by dendritic cells as well as immunogenicity in factor VIII-deficient mice. Co-incubation of factor VIII(Y1680C) with BO2C11, however, resulted in decreased factor VIII immunogenicity in vivo. In addition, a previously described triple C1 mutant showed decreased uptake in vitro, and reduced immunogenicity in vivo, but only in the absence of endogenous von Willebrand factor. Taken together, the results indicate that residues in the C1 and/or C2 domains of factor VIII are implicated in immunogenic factor VIII uptake, at least in vitro. Conversely, in vivo, the binding to endogenous von Willebrand factor masks the reducing effect of mutations in the C domains on factor VIII immunogenicity