Intravacuolar Membranes Regulate CD8 T Cell Recognition of Membrane-Bound Toxoplasma gondii Protective Antigen

Apicomplexa parasites such as Toxoplasma gondii target effectors to and across the boundary of their parasitophorous vacuole (PV), resulting in host cell subversion and potential presentation by MHC class I molecules for CD8 T cell recognition. The host-parasite interface comprises the PV limiting membrane and a highly curved, membranous intravacuolar network (IVN) of uncertain function. Here, using a cell-free minimal system, we dissect how membrane tubules are shaped by the parasite effectors GRA2 and GRA6. We show that membrane association regulates access of the GRA6 protective antigen to the MHC I pathway in infected cells. Although insertion of GRA6 in the PV membrane is key for immunogenicity, association of GRA6 with the IVN limits presentation and curtails GRA6-specific CD8 responses in mice. Thus, membrane deformations of the PV regulate access of antigens to the MHC class I pathway, and the IVN may play a role in immune modulation

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Role and regulation of integrins and cadherins in the transdifferentiation MUSCLE/BONE induced by BMP-2 : biomimetic approach

Le muscle et l’os coopèrent mécaniquement mais aussi biochimiquement, via les facteurs de croissance et les cytokines. Suite à une lésion de l’os, les cellules souches sont recrutées et induites en différenciation osseuse grâce à la sécrétion de molécules bioactives telles que les facteurs de croissance. L’une des stratégies de l’ingénierie tissulaire de l’os est de combiner des matériaux avec des facteurs de croissance osseux. Les protéines morphogéniques osseuses (ou BMPs), pouvant être présentées aux cellules en solution ou enchâssées dans la matrice, appartiennent à la famille des facteurs de croissance basiques et jouent un rôle très important dans la formation de l’os. Les BMPs induisent non seulement une différenciation osseuse de progéniteurs osseux, mais induisent aussi la transdifférenciation de progéniteurs musculaires vers un phénotype ostéoblastique. L’obtention de la complexité de l’architecture tissulaire osseuse nécessite des interactions continues entre la cellule et son microenvironnement. Ces interactions sont médiées par les récepteurs cellule/matrice (intégrine) et cellule/cellule (cadhérines). Dans cette thèse, nous nous sommes intéressés au rôle du système adhésif dans la réponse à la BMP-2 lors de la transdifférenciation des myoblastes C2C12. Nous avons utilisé un film multicouche à base de hyaluronane et de poly(L-lysine) comme biomatériau pour présenter la BMP-2 par la matrice. A court terme, nous avons mis en évidence une coopération entre l’intégrine 3 et les récepteurs BMP dans l’induction d’un étalement cellulaire et d’une réponse précoce à la BMP-2, via la protéine GSK3. A plus long terme, nous avons montré un switch du répertoire adhésif en réponse à la BMP-2. Enfin, nos résultats suggèrent une coopération entre les intégrines β3 et β5 et les cadhérines N et 11 dans la transdifférenciation induite par la BMP-2.Muscle and bone cooperate both mechanically and biochemically, through growth factors and cytokines. Following a bone lesion, stem cells are recruited and their differentiation is induced via the secretion of bioactive molecules such as growth factors. One strategy in bone tissue engineering is to combine materials with bone growth factors. Bone Morphogenetic Proteins (BMPs), which can be presented to the cell either in solution or bound to the matrix, belong to the basic growth factor family and play a very important role in bone formation. BMPs induce not only the differentiation of bone progenitors, but also the transdifferentiation of muscle progenitors towards an osteoblastic phenotype. Obtaining the complexity of the bone tissue architecture requires continuous interactions between the cell and its microenvironment. These interactions are mediated by cell/matrix and cell/cell receptors (integrins and cadherins, respectively). In this thesis, we investigated the role of the adhesion system in the context of its response to BMP-2 during the transdifferentiation of C2C12 murine myoblasts. To do so, we used polelectrolyte multilayer films composed of hyaluronan and poly(L-lysine) as a biomaterial to present BMP-2 in a matrix-bound manner. Short term, we revealed a cooperation between the integrin 3 and BMP receptors in the induction of cell spreading and of an early response to BMP-2 via the protein GSK3. In a longer term, we showed a switch in the repertoire of adhesion receptors in response to BMP-2. Finally, our results suggest a cooperation between 3 and 5 integrins and cadherins N and 11 for the BMP-2-induced transdifferentiation

Rôle et régulation des intégrines et des cadhérines dans la transdifférenciation MUSCLE/OS en réponse à la BMP-2 : approche biomimétique

Muscle and bone cooperate both mechanically and biochemically, through growth factors and cytokines. Following a bone lesion, stem cells are recruited and their differentiation is induced via the secretion of bioactive molecules such as growth factors. One strategy in bone tissue engineering is to combine materials with bone growth factors. Bone Morphogenetic Proteins (BMPs), which can be presented to the cell either in solution or bound to the matrix, belong to the basic growth factor family and play a very important role in bone formation. BMPs induce not only the differentiation of bone progenitors, but also the transdifferentiation of muscle progenitors towards an osteoblastic phenotype. Obtaining the complexity of the bone tissue architecture requires continuous interactions between the cell and its microenvironment. These interactions are mediated by cell/matrix and cell/cell receptors (integrins and cadherins, respectively). In this thesis, we investigated the role of the adhesion system in the context of its response to BMP-2 during the transdifferentiation of C2C12 murine myoblasts. To do so, we used polelectrolyte multilayer films composed of hyaluronan and poly(L-lysine) as a biomaterial to present BMP-2 in a matrix-bound manner. Short term, we revealed a cooperation between the integrin 3 and BMP receptors in the induction of cell spreading and of an early response to BMP-2 via the protein GSK3. In a longer term, we showed a switch in the repertoire of adhesion receptors in response to BMP-2. Finally, our results suggest a cooperation between 3 and 5 integrins and cadherins N and 11 for the BMP-2-induced transdifferentiation.Le muscle et l’os coopèrent mécaniquement mais aussi biochimiquement, via les facteurs de croissance et les cytokines. Suite à une lésion de l’os, les cellules souches sont recrutées et induites en différenciation osseuse grâce à la sécrétion de molécules bioactives telles que les facteurs de croissance. L’une des stratégies de l’ingénierie tissulaire de l’os est de combiner des matériaux avec des facteurs de croissance osseux. Les protéines morphogéniques osseuses (ou BMPs), pouvant être présentées aux cellules en solution ou enchâssées dans la matrice, appartiennent à la famille des facteurs de croissance basiques et jouent un rôle très important dans la formation de l’os. Les BMPs induisent non seulement une différenciation osseuse de progéniteurs osseux, mais induisent aussi la transdifférenciation de progéniteurs musculaires vers un phénotype ostéoblastique. L’obtention de la complexité de l’architecture tissulaire osseuse nécessite des interactions continues entre la cellule et son microenvironnement. Ces interactions sont médiées par les récepteurs cellule/matrice (intégrine) et cellule/cellule (cadhérines). Dans cette thèse, nous nous sommes intéressés au rôle du système adhésif dans la réponse à la BMP-2 lors de la transdifférenciation des myoblastes C2C12. Nous avons utilisé un film multicouche à base de hyaluronane et de poly(L-lysine) comme biomatériau pour présenter la BMP-2 par la matrice. A court terme, nous avons mis en évidence une coopération entre l’intégrine 3 et les récepteurs BMP dans l’induction d’un étalement cellulaire et d’une réponse précoce à la BMP-2, via la protéine GSK3. A plus long terme, nous avons montré un switch du répertoire adhésif en réponse à la BMP-2. Enfin, nos résultats suggèrent une coopération entre les intégrines β3 et β5 et les cadhérines N et 11 dans la transdifférenciation induite par la BMP-2

Ventriculomégalie cérébrale foetale (étiologies et devenir)

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Accouchement et déclenchement du travail pour interruption médicale de grossesse (analyse descriptive sur deux années (2001-2002))

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Les retards de croissance intra-utérins sévères non vasculaires (étiologies, pronostic et prise en charge (à propos de 97 cas nés à Jeanne de Flandre en 1998 et 1999))

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Évaluation de la prescription médicamenteuse en unité de long séjour

Les personnes vivant en institutions semblent consommer plus de médicaments que celles vivant au domicile. L objectif de ce travail est d évaluer l adéquation des prescriptions avec les données de la littérature chez des patients hospitalisés dans une unité de long séjour gériatrique. L hypothèse est que les prescriptions ne bénéficient pas d une réévaluation médicale régulière. Il s agit d une étude observationnelle prospective sur les prescriptions médicamenteuses qui a comporté trois phases. Cinq classes thérapeutiques ont été choisies : les antidépresseurs, les neuroleptiques, les anticholinestérasiques, les antiulcéreux et enfin les antihypertenseurs. L étape n1 a été le recueil des prescriptions médicamenteuses d une cohorte constituée de tous les patients d un service de long séjour au moyen d un questionnaire portant sur les modalités de prescription. L étape n2 a été de proposer une réévaluation thérapeutique par le médecin prescripteur (maintien, modification ou arrêt de certains médicaments) s appuyant sur les différentes revues de la littérature et les dernières conférences de consensus. L étape n3 fût un nouveau recueil des prescriptions, environ un an après la première, (à l aide du même questionnaire) afin d évaluer l impact de la réflexion médicale sur les modalités de prescription. Les résultats ont montré que, parmi les cinq classes thérapeutiques étudiées, il y a eu une diminution de prescription des antidépresseurs, des neuroleptiques et des IPP. En revanche la prescription d antihypertenseur et de médicament spécifiques de la démence est restée stable. Ces résultats encouragent à procéder à une réévaluation régulière des traitements prescrits au long cours afin de diminuer la iatrogénieElderly patients living in institutions seems to take more drugs than the others. The objective of this study is to evaluate the adequation between prescription and litterature in a geriatric institution. The assumption is that prescriptions are not regularly re-evaluated. This is a observational prospective study on the prescriptions, which included three phases. Five drug-classes have been chosen : anti-depressant, narcoleptics, anticholinesterasic, anti-ulcers drugs and hypotensive agents. The stage n1 was the collection of the drugs of all the patients in one institution. This was made with a questionnaire collecting the regulation methods. The stage n2 consisted in proposing a therapeutic re-evaluation by the prescribing doctor (maintenance, modification or stop of certain drugs), based on the various reviews of the litterature and the last conferences of consensus. The stage n3 was a new collection of the regulations, approximately a year after the first, (using the same questionnaire) in order to evaluate the impact of the medical reflexion on the regulation methods. The results showed that, among the five studied therapeutic classes, there was a reduction in regulation of the anti-depressants, nerve sedatives and IPP. On the other hand the regulation of specific hypotensive agents and anti-dementia drugs remained stable. These results encourage to carry out a frequent re-evaluation of the treatments prescribed on the long course in order to decrease the iatrogenyPARIS12-CRETEIL BU Médecine (940282101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Tuning cellular responses to BMP-2 with material surfaces

International audienceABSTRACT Bone morphogenetic protein 2 (BMP-2) has been known for decades as a strong osteoinductive factor and for clinical applications is combined solely with collagen as carrier material. The growing concerns regarding side effects and the importance of BMP-2 in several developmental and physiological processes have raised the need to improve the design of materials by controlling BMP-2 presentation. Inspired by the natural cell environment, new material surfaces have been engineered and tailored to provide both physical and chemical cues that regulate BMP-2 activity. Here we describe surfaces designed to present BMP-2 to cells in a spatially and temporally controlled manner. This is achieved by trapping BMP-2 using physicochemical interactions, either covalently grafted or combined with other extracellular matrix components. In the near future, we anticipate that material science and biology will integrate and further develop tools for in vitro studies and potentially bring some of them toward in vivo applications