Premier cas rapporté d’infection en dialyse péritonéale à lactobacillus gasseri : quand l’ami de l’organisme se retourne contre son hôte.

Summary We report a case of lactobacillus gasseri peritonitis in a patient treated by peritoneal dialysis. Streptococcus anginus and lactobacillus gasseri bacteria are commensal organisms of human oral, small intestinal, colic and vaginal mucous membranes. An infection with streptococcus anginosus during peritoneal dialysis, one responsible for an intra-abdominal abscess, has already been described, this type of streptococcus being widely associated with abscess formation. In contrast, no case of peritoneal infection with lactobacillus gasseri has ever been described. This bacterium is native to the mucous membranes, and colonizes the digestive tract of infants during childbirth, as they pass through the vaginal canal. It has local adaptation capacities, namely tolerance to acid pH, adhesion to the mucous membrane and resistance to bile salts. It is recognized as having an antimicrobial and probiotic function due to its production of bacteriocin, its local immunomodulatory role, its attenuation of the development of helicobacter pylori, its positive effect on the balance of the vaginal flora and its improvement of infectious diarrhea. This usually makes it an ally that contributes to our systemic balance but its irruption in the peritoneum has made it a pathogenic bacterium. The treatment of this peritoneal infection required a classic duration of treatment of organisms of digestive origin, i.e. 3 weeksRésumé Nous rapportons un cas de péritonite à lactobacillus gasseri chez une patiente traitée par dialyse péritonéale. Les bactéries streptococcus anginosus et lactobacillus gasseri sont des germes commensaux des muqueuses humaines : buccale, de l’intestin grêle, colique et vaginale. Il a déjà été décrit une infection en dialyse péritonéale à streptococcus anginosus responsable d’un abcès intra-abdominal, ce type de streptocoque étant largement associé à la formation d’abcès. En revanche, aucun cas d’infection péritonéale à lactobacillus gasseri n’a encore été décrit. Cette bactérie est un micro-organisme autochtone des muqueuses qui colonise le tube digestif du nourrisson à l’accouchement lors du passage dans la filière vaginale. Elle possède des capacités d’adaptation locales au tube digestif : tolérance au pH acide, adhésion à la muqueuse et résistance aux sels biliaires. On lui reconnait une activité antimicrobienne et probiotique du fait de la production de bactériocine, de son rôle immuno-modulateur local, de l’atténuation du développement de l’helicobacter pylori, de son effet positif sur l’équilibre de la flore vaginale et de l’amélioration des diarrhées infectieuses. Ceci en fait, ordinairement, un allié de notre équilibre mais son irruption dans le péritoine en a fait une bactérie pathogène dans le cas rapporté. Le traitement de cette péritonite a celui utilisé classiquement lorsque le germe a une origne digestive, c’est à dre 3 semaines. &nbsp

Présentation et mise en place du premier système de dialyse péritonéale automatisée connecté en France

The first system of connected automated peritoneal dialysis (APD) was set up in France in the CHSF. This system allows to collect and transmit the data of APD sessions via a modem and a platform towards the medical team and permits the remote adaptation of the treatments. This implementation required a number of steps on national and regional levels. We present the functioning and the expected benefits of such a system.Le premier système connecté de dialyse péritonéale automatisée (DPA) a été mis en place en France au CHSF. Il s’agit d’un système collectant les données des séances de DPA via un modem et une plateforme sécurisée puis les transmettant vers l’équipe médicale et permettant l’adaptation des traitements à distance. Cette mise en place a nécessité un certain nombre de démarches à l’échelle nationale et régionale. Nous en présentons le fonctionnement et les bénéfices attendus. Cette revue est mise à disposition selon les termes de la Licence Creative Commons Attribution 4.0 International

A 59-kd renal antigen as a new target for rapidly progressive glomerulonephritis

Anti-glomerular basement membrane (anti-GBM) antibodies are the hallmark of anti-GBM disease, which is characterized by rapidly progressive glomerulonephritis. We describe the case of a 58-year-old woman who presented with rapidly progressive glomerulonephritis with typical anti-GBM staining found by means of direct immunofluorescence microscopy, associated with linear immunoglobin G deposits on tubules. Serum analysis showed circulating anti-tubular basement membrane antibodies, but failed to detect anti-GBM antibodies. Immunoblotting showed that serum antibodies reacted with a 59-kd antigen found along both the GBM and tubular basement membrane

The unexpected structure of the designed protein Octarellin V.1 forms a challenge for protein structure prediction tools.

Despite impressive successes in protein design, designing a well-folded protein of more 100 amino acids de novo remains a formidable challenge. Exploiting the promising biophysical features of the artificial protein Octarellin V, we improved this protein by directed evolution, thus creating a more stable and soluble protein: Octarellin V.1. Next, we obtained crystals of Octarellin V.1 in complex with crystallization chaperons and determined the tertiary structure. The experimental structure of Octarellin V.1 differs from its in silico design: the (alphabetaalpha) sandwich architecture bears some resemblance to a Rossman-like fold instead of the intended TIM-barrel fold. This surprising result gave us a unique and attractive opportunity to test the state of the art in protein structure prediction, using this artificial protein free of any natural selection. We tested 13 automated webservers for protein structure prediction and found none of them to predict the actual structure. More than 50% of them predicted a TIM-barrel fold, i.e. the structure we set out to design more than 10years ago. In addition, local software runs that are human operated can sample a structure similar to the experimental one but fail in selecting it, suggesting that the scoring and ranking functions should be improved. We propose that artificial proteins could be used as tools to test the accuracy of protein structure prediction algorithms, because their lack of evolutionary pressure and unique sequences features

Successful long-term outcome of the first combined heart and kidney transplant in a patient with systemic Al amyloidosis.

International audienceSimultaneous cardiac and renal involvement is associated with a particularly poor prognosis in patients with AL amyloidosis (AL-A). We report the first case of a successful long-term outcome of combined heart and kidney transplantation not followed by autologous stem cell transplantation in a patient with systemic AL-A. The recipient was a 46-year-old man with end-stage renal failure associated with serious cardiac involvement in the context of AL-A. Before transplantation, two courses of oral melphalan plus prednisone induced partial hematologic remission, as shown by the decrease in circulating free light chain with no improvement of renal or heart function. The patient underwent combined heart and kidney transplantation as a rescue treatment. During the follow-up period (36 months), plasma cell dyscrasia remains in complete remission, with normal free lambda light chain levels and no recurrence of amyloid deposition on heart and kidney grafts. This case report demonstrates that combined heart and kidney transplantation not systematically associated with stem cell transplantation may be considered an additional therapeutic option in AL-A patients with severe organ dysfunction and partial hematologic remission

Amyloid Goiter in Familial Mediterranean Fever: Description of 42 Cases from a French Cohort and from Literature Review

International audienceOur aim was to describe the main features of amyloid goiter in adults with amyloidosis secondary to familial Mediterranean fever. Therefore, we analyzed cases from a French cohort of familial Mediterranean fever patients with amyloidosis and from literature review. Forty-two cases were identified: 9 from the French cohort and 33 from literature review. Ninety percent of patients were on hemodialysis for renal amyloidosis before the development of goiter. The goiter grew up rapidly in 88% of cases; 75.6% of patients were euthyroid, 58% displayed dyspnea, and 44.8% dysphagia. Various features were seen on ultrasound, from diffuse to multinodular goiter. When it was performed, fine-needle aspiration biopsy almost always revealed amyloidosis. Thirty-one patients underwent thyroidectomy: to manage compressive symptoms (72%) or rule out malignancy (27%). Histology showed mature adipose tissue in 64% of cases and lymphocytic infiltration in 21.4%. In conclusion, amyloid goiter in familial Mediterranean fever preferentially occurs in patients with end stage renal failure. Fine-needle aspiration biopsy seems to be a sensitive exam for diagnosis, but thyroidectomy remains sometimes necessary to rule out malignancy or release compressive symptoms

Rituximab Treatment for Membranous Nephropathy: A French Clinical and Serological Retrospective Study of 28 Patients

The development of well-tolerated and effective therapies that target the pathogenesis of membranous nephropathy (MN) would be useful. Our objective was to evaluate the efficacy of rituximab in MN. We analyzed the outcome of 28 patients treated with rituximab for idiopathic MN. Anti-PLA2R antibodies in serum and PLA2R antigen in kidney biopsy were assessed in 10 and 9 patients, respectively. Proteinuria was significantly decreased by 56, 62 and 87% at 3, 6 and 12 months, respectively. At 6 months, 2 patients achieved complete remission (CR) and 12 partial remission (PR; overall renal response, 50%). At 12 months (n = 23), CR was achieved in 6 patients and PR in 13 patients (overall renal response, 82.6%). Three patients suffered a relapse of nephrotic proteinuria 27–50 months after treatment. Univariate analysis suggested that the degree of renal failure (MDRD estimated glomerular filtration rate 2) is an independent factor that predicts lack of response to rituximab. Anti-PLA2R antibodies were detected in the serum of 10 patients, and PLA2R antigen in immune deposits in 8 of 9 patients. Antibodies became negative in all 5 responsive patients with available follow-up sera. In this retrospective study, a high rate of remission was achieved 12 months after treatment