La prévision des quantités d'hospitalisations de courte durée au Québec

Numéro de référence interne originel : a1.1 g 114

Assessing renal graft function in clinical trials: Can tests predicting glomerular filtration rate substitute for a reference method?

Assessing renal graft function in clinical trials: Can tests predicting glomerular filtration rate substitute for a reference method?BackgroundIn clinical trials, comparison of renal graft function needs a rigorous determination of glomerular filtration rate (GFR). Since reference methods to measure GFR cannot be easily implemented, a number of tests predicting GFR are usually used. However, little is known about their validity in renal transplant patients. We aimed to compare the performances of six GFR tests with inulin clearance in this population.MethodsFive hundred consecutive inulin clearances performed in 294 renal transplant recipients with stable renal function were retrospectively selected. For each of them, we computed six estimates: the 24-hour creatinine clearance, the Cockcroft-Gault, Walser, Jelliffe, Nankivell, and Levey formulas. Their respective performance was assessed by correlation (simple linear regression), accuracy (dispersion of true error), and agreement (Bland and Altman method).ResultsEach GFR test closely correlated with inulin clearance (P < 0.0001). Comparisons between pairs of GFR tests did not show any significant difference in accuracy between the Levey, Jelliffe, and Walser formulas. Conversely, each of these formulas demonstrated a significant lower dispersion (P < 0.005) than the others. Nevertheless, all GFR tests displayed considerable lack of agreement with limits of agreement over 40mL/min/1.73m2 apart. The proportion of predicted GFR differing from inulin clearance by ± 10mL/min/1.73m2, ranged from 34% for the Jelliffe formula to 53% for the Nankivell's one.ConclusionNone of these formulas seems to be able to safely substitute for inulin clearance. In clinical trials, renal graft function should be preferably assessed using a reference method of GFR measurement

Case report: Immune response characterization of a pseudoprogression in a PD-L1-negative, TMB-low, KEAP1/STK11 co-mutated metastatic NSCLC

A patient with a PD-L1-negative, TMB-low, KEAP1/STK11 co-mutated metastatic non-small cell lung cancer (NSCLC) experienced a multisite radiological progression at 3 months after initiation of chemoimmunotherapy as first-line treatment for metastatic disease. After the radiological progression, while she was not undergoing treatment, the patient had spontaneous lesions shrinkage and further achieved a prolonged complete response. Genomic and transcriptomic data collected at baseline and at the time of pseudoprogression allowed us to biologically characterize this rare response pattern. We observed the presence of a tumor-specific T-cell response against tumor-specific neoantigens (TNAs). Endogenous retroviruses (ERVs) expression following chemoimmunotherapy was also observed, concurrent with biological features of an anti-viral-like innate immune response with type I IFN signaling and production of CXCR3-associated chemokines. This is the first biological characterization of a NSCLC pseudoprogression under chemoimmunotherapy followed by a prolonged complete response in a PD-L1-negative, TMB-low, KEAP1/STK11 co-mutated NSCLC. These clinical and biological data underline that even patients with multiple factors of resistance to immune checkpoint inhibitors could trigger a tumor-specific immune response to tumor neoantigen, leading to complete eradication of the tumor and probably a vaccinal immune response

Geographic Differences in Genetic Susceptibility to IgA Nephropathy: GWAS Replication Study and Geospatial Risk Analysis

Peer reviewe

Ramipril and Risk of Hyperkalemia in Chronic Hemodialysis Patients

Angiotensin converting enzyme (ACE) inhibitors provide well known cardiorenal-protective benefits added to antihypertensive effects in chronic renal disease. These agents are underused in management of patients receiving hemodialysis (HD) because of common concern of hyperkalemia. However, few studies have investigated effect of renin angiotensin aldosterone system (RAAS) blockade on serum potassium in hemodialysis patients. We assessed the safety of ramipril in patients on maintenance HD. We enrolled 28 adult end stage renal disease (ESRD) patients treated by maintenance HD and prescribed them ramipril in doses of 1.25 to 5 mg per day. They underwent serum potassium concentration measurements before ramipril introduction and in 1 to 3 months afterwards. No significant increase in kalemia was found. Results of our study encourage the use of ACE inhibitors in chronically hemodialyzed patients, but close potassium monitoring is mandatory

Pronostic role of CD4 T lymphocyte infiltrates in breast cancers

L’échappement des tumeurs à la surveillance du système immunitaire est une des raisons pour lesquelles le cancer parvient à se développer. Un des objectifs de notre équipe consiste à étudier les lymphocytes T CD4+ et leurs rôles dans un contexte de cancer. Mon travail de thèse a eu pour objectif de déterminer si les résultats murins obtenus au laboratoire étaient transposables à l’Homme, et surtout dans le cancer du sein. Nous avons tout d’abord mis en évidence que les lymphocytes Th17 infiltrant les cancers du sein inhibent les fonctions effectrices des lymphocytes T cytotoxiques de manière dépendante des ectonucléotidases. Enfin, nous avons montré qu’une infiltration tumorale riche en cellules Th17 est associée à un moins bon pronostic clinique des patientes atteintes de cancer du sein. Nous avons ensuite eu pour objectif de tenter de limiter la différenciation de ces cellules Th17. Nous avons démontré que l’activation de SIRT1 diminue l’acétylation de STAT3 ce qui perturbe le programme de différenciation de ces cellules. L’activation de SIRT1 in vivo limite l’expansion des Th17 et conduit à un ralentissement de la croissance tumorale. Ce concept fut validé chez l’Homme et ouvre donc la possibilité d’association d’agonistes de SIRT1 avec la chimiothérapie. Le dernier projet porte sur les lymphocytes Th9 et leur rôle pronostique dans le cancer du sein. Nous avons mis en évidence que les propriétés effectrices des lymphocytes Th9 humains pouvaient être augmentées par l’IFNα via l’activation du facteur de transcription IRF1. Nous avons enfin démontré que l’infiltration tumorale de lymphocytes Th9 était associée au meilleur pronostic des patientes.Tumor escape to immune system surveillance is one of the reasons why human cancer achieves to grow. In my research team, we aim to study CD4 T cell populations and their functions in the context of cancer. My work was precisely to determine if the results obtained in mice could be transposable in humans, in the context of breast cancer. . We first unraveled that tumor infiltrating Th17 cells could inhibit effector and cytotoxic functions of Th1 and CD8 T cells in an ectonucleotidase-dependent manner. Finally, we showed that high tumor infiltration in IL-17+ cells were significantly associated with a worse clinical prognosis for breast cancer patients. Then, we aim to prevent Th17 cell differentiation. We first established that SIRT1 activation reduces STAT3 acetylation thus limiting Th17 cell differentiation. Activation of SIRT1 limits in vivo Th17 cell expansion and leads to the decrease of tumor growth. This concept has been validated in humans and gives the possibility to associate SIRT1 agonists with chemotherapy. The last project concerns the role and the prognosis impact of Th9 lymphocytes in breast cancer. We highlighted that the effector properties of human Th9 cells could be increased by IFNα via IRF1 activation. Finally, we attested that the tumor infiltration of Th9 lymphocytes was associated with a better prognosis for breast cancer patients