Long-term tolerance and efficacy of siltuximab (anti-IL-6) in a young adult with idiopathic multicentric Castleman disease during COVID-19

Background: Castleman disease (CD) is a rare lymphoproliferative disorder with various subtypes, including the HHV-8-negative/idiopathic multicentric CD (iMCD). The diagnosis of iMCD remains challenging due to its non-specific presentation, in the form of generalised lymphadenopathies and inflammation. Two clinical presentations have been recently defined: a severe form iMCD-TAFRO and a milder form of iMCD not otherwise specified (iMCD-NOS). identification of interleukin-6 (IL-6) as a major culprit of inflammatory symptoms led to the development of anti-IL-6 therapies, with siltuximab being the approved first-line treatment. Case description: A 16-year-old male presented with recurrent fever, night sweats and several other non-specific symptoms. After extensive evaluations, an excisional lymph node biopsy confirmed the iMCD-NOS diagnosis. The patient received high-dose steroid therapy followed by siltuximab for four years. This treatment was well tolerated with only mild neutropenia not leading to dose adjustment. On siltuximab, the patient developed two mild COVID-19 episodes. His response to siltuximab remained effective throughout four years. Discussion: The absence of biomarker or causal agent identification poses a diagnostic challenge requiring lymph node histopathology for a definitive diagnosis of iMCD. Anti-IL 6 (siltuximab) is the recommended frontline therapy, suppressing inflammation and halting disease progression. Intravenous administration every 3 to 6 weeks can impact patient quality of life, prompting further research for alternative treatments. High-dose steroids, rituximab, cyclosporine, tacrolimus, lenalidomide or combined chemotherapy such as rituximab-bortezomib-dexamethasone are among the considered options according to disease severity. Conclusion: Overall, long-term siltuximab effectively controlled iMCD symptoms and was well tolerated by this young adult, who endured two mild COVID-19 episodes

257 A novel polysaccharide-based porous scaffold for cell delivery into the infarcted heart

BackgroundCellular cardiomyoplasty has been proposed as an attractive strategy to repair myocardial damage. One of the crucial point is the optimal delivery strategy. In the present study, we examined the use of an implantable porous scaffold for promoting bone marrow-derived mesenchymal stem cells (MSCs) survival and functions in a rat model of acute myocardial infarction.Methods and ResultsCardiac patch was based on biodegradable polysaccharides porous scaffold. After ligation of the left anterior coronary artery, the fate of 1x106 GFP+ MSC administered either using cellularized scaffold implantation or direct injection was examined at 1 and 2 months. The number of residual GFP+ cells in the sample studied was estimated on the basis of the fluorescence emitted by a defined number of GFP+ cells used for calibration. Cellularized scaffold allowed a more efficient delivery and the difference with direct injection was significant at 2 months, with respectively 2100±1300×103 and 215±85x103 residual GFP+ cells (p<0.03). Cardiac tissue levels of matrix metalloproteinase-2 and -9 mRNA were similar whatever the administration conditions but a slight increase in the local production of vascular endothelial growth factor was observed at 2 months after patch implantation in comparison to direct injection (p<0.05). In animals having received MSC implemented on scaffold, clusters of GFP+ cells, mainly phenotypically consistent with immature MSC cells, were detected in the peri-infarct area. The increased survival using scaffold was not translated in an improved myocardial remodelling and functions with no significant difference in the LVEDD, LVESD, and FS between the 2 groups as in comparison with animals implanted with non cellularized scaffold.ConclusionsThese findings demonstrate that the implantation of cellularized grafts is safe and effective for delivering mesenchymal stem cells into damaged myocardium, and results in a better cellular engraftment compared to direct injection

Circulating LPS and (1→3)-β-D-Glucan: A Folie à Deux Contributing to HIV-Associated Immune Activation

Immune activation is the driving force behind the occurrence of AIDS and non-AIDS events, and is only partially reduced by antiretroviral therapy (ART). Soon after HIV infection, intestinal CD4+ T cells are depleted leading to epithelial gut damage and subsequent translocation of microbes and/or their products into systemic circulation. Bacteria and fungi are the two most abundant populations of the gut microbiome. Circulating lipopolysaccharide (LPS) and (1→3)-β-D-Glucan (βDG), major components of bacterial and fungal cell walls respectively, are measured as markers of microbial translocation in the context of compromised gut barriers. While LPS is a well-known inducer of innate immune activation, βDG is emerging as a significant source of monocyte and NK cell activation that contributes to immune dysfunction. Herein, we critically evaluated recent literature to untangle the respective roles of LPS and βDG in HIV-associated immune dysfunction. Furthermore, we appraised the relevance of LPS and βDG as biomarkers of disease progression and immune activation on ART. Understanding the consequences of elevated LPS and βDG on immune activation will provide insight into novel therapeutic strategies against the occurrence of AIDS and non-AIDS events

CXCL13 as a Biomarker of Immune Activation During Early and Chronic HIV Infection

Background: CXCL13 is preferentially secreted by Follicular Helper T cells (TFH) to attract B cells to germinal centers. Plasma levels of CXCL13 have been reported to be elevated during chronic HIV-infection, however there is limited data on such elevation during early phases of infection and on the effect of ART. Moreover, the contribution of CXCL13 to disease progression and systemic immune activation have been partially defined. Herein, we assessed the relationship between plasma levels of CXCL13 and systemic immune activation.Methods: Study samples were collected in 114 people living with HIV (PLWH) who were in early (EHI) or chronic (CHI) HIV infection and 35 elite controllers (EC) compared to 17 uninfected controls (UC). A subgroup of 11 EHI who initiated ART and 14 who did not were followed prospectively. Plasma levels of CXCL13 were correlated with CD4 T cell count, CD4/CD8 ratio, plasma viral load (VL), markers of microbial translocation [LPS, sCD14, and (1→3)-β-D-Glucan], markers of B cell activation (total IgG, IgM, IgA, and IgG1-4), and inflammatory/activation markers like IL-6, IL-8, IL-1β, TNF-α, IDO-1 activity, and frequency of CD38+HLA-DR+ T cells on CD4+ and CD8+ T cells.Results: Plasma levels of CXCL13 were elevated in EHI (127.9 ± 64.9 pg/mL) and CHI (229.4 ± 28.5 pg/mL) compared to EC (71.3 ± 20.11 pg/mL), and UC (33.4 ± 14.9 pg/mL). Longitudinal analysis demonstrated that CXCL13 remains significantly elevated after 14 months without ART (p &lt; 0.001) and was reduced without normalization after 24 months on ART (p = 0.002). Correlations were observed with VL, CD4 T cell count, CD4/CD8 ratio, LPS, sCD14, (1→3)-β-D-Glucan, total IgG, TNF-α, Kynurenine/Tryptophan ratio, and frequency of CD38+HLA-DR+ CD4 and CD8 T cells. In addition, CMV+ PLWH presented with higher levels of plasma CXCL13 than CMV- PLWH (p = 0.005).Conclusion: Plasma CXCL13 levels increased with HIV disease progression. Early initiation of ART reduces plasma CXCL13 and B cell activation without normalization. CXCL13 represents a novel marker of systemic immune activation during early and chronic HIV infection and may be used to predict the development of non-AIDS events

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P &lt; 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Distinct Plasma Concentrations of Acyl-CoA-Binding Protein (ACBP) in HIV Progressors and Elite Controllers

HIV elite controllers (ECs) are characterized by the spontaneous control of viral replication, and by metabolic and autophagic profiles which favor anti-HIV CD4 and CD8 T-cell responses. Extracellular acyl coenzyme A binding protein (ACBP) acts as a feedback inhibitor of autophagy. Herein, we assessed the circulating ACBP levels in ECs, compared to people living with HIV (PLWH) receiving antiretroviral therapy (ART) or not. We found lower ACBP levels in ECs compared to ART-na&iuml;ve or ART-treated PLWH (p &lt; 0.01 for both comparisons), independently of age and sex. ACBP levels were similar in ECs and HIV-uninfected controls. The expression of the protective HLA alleles HLA-B*27, *57, or *58 did not influence ACBP levels in ECs. ACBP levels were not associated with CD4 or CD8 T-cell counts, CD4 loss over time, inflammatory cytokines, or anti-CMV IgG titers in ECs. In ART-treated PLWH, ACBP levels were correlated with interleukin (IL)-1&beta; levels, but not with other inflammatory cytokines such as IL-6, IL-8, IL-32, or TNF-&alpha;. In conclusion, ECs are characterized by low ACBP plasma levels compared to ART-na&iuml;ve or ART-treated PLWH. As autophagy is key to anti-HIV CD4 and CD8 T-cell responses, the ACBP pathway constitutes an interesting target in HIV cure strategies

Advancing wavefront shaping with resonant nonlocal metasurfaces: beyond the limitations of lookup tables

International audienceResonant metasurfaces are of paramount importance in addressing the growing demand for reduced thickness and complexity, while ensuring high optical efficiency. This becomes particularly crucial in overcoming fabrication challenges associated with high aspect ratio structures, thereby enabling seamless integration of metasurfaces with electronic components at an advanced level. However, traditional design approaches relying on lookup tables and local field approximations often fail to achieve optimal performance, especially for nonlocal resonant metasurfaces. In this study, we investigate the use of statistical learning optimization techniques for nonlocal resonant metasurfaces, with a specific emphasis on the role of near-field coupling in wavefront shaping beyond single unit cell simulations. Our study achieves significant advancements in the design of resonant metasurfaces. For transmission-based metasurfaces, a beam steering design outperforms the classical design by achieving an impressive efficiency of 80% compared to the previous 23%. Additionally, our optimized extended depth-of-focus (EDOF) metalens yields a remarkable five-fold increase in focal depth, a four-fold enhancement in focusing power compared to conventional designs and an optical resolution superior to 600 cycle/mm across the focus region. Moreover, our study demonstrates remarkable performance with a wavelength-selected beam steering metagrating in reflection, achieving exceptional efficiency surpassing 85%. This far outperforms classical gradient phase distribution approaches, emphasizing the immense potential for groundbreaking applications in the field of resonant metasurfaces

Advancing wavefront shaping with resonant metasurface

International audienceIn metasurface design, the use of look-up tables based on a local periodicity approximation have been tradi-tionally employed, but can result in sub-optimal designs due to lack of consideration of near-field couplingeffects, which are particularly important for resonant systems. This paper explores the benefits of taking intoaccount near-field coupling while optimizing non-local resonant metasurfaces to enhance their performance forwavefront shaping, including the state-of-the-art Huygens’s metasurface