Mécanismes de résistance aux inhibiteurs de CCR5

Le travail décrit dans ce manuscrit vise à caractériser les voies de résistance aux inhibiteurs de CCR5. Lors d’une première étape, nous avons développé un test phénotypique clonal nous permettant d’une part d’identifier le tropisme viral et d’autre part de mesurer la résistance aux inhibiteurs des CCR5. Des virus à tropisme R5 ou X4 représentant aussi peu que 0,4% d’un mélange de populations virales sont détectables par ce test, démontrant ainsi sa sensibilité. De plus, grâce à son approche clonale, cette technique permet de différencier les virus à tropisme double de populations virales mixtes. Par la suite, nous avons étudié l’impact des mutations dans les régions variables de la protéine gp120 de l’enveloppe du virus VIH-1 sur la résistance aux inhibiteurs de CCR5. Pour ce faire, nous avons généré des virus résistants par passage des isolats CC1/85 et BAL, en présence de concentrations sous-inhibitrices de maraviroc (MVC) et vicriviroc (VCV). Après quelques passages du virus CC1/85 en présence de MVC, certaines sont apparues dans differentes régions de la gp120. Par la suite, nous avons sélectionné trois mutations dans les domaines variables de la gp 120, V169M en V2, L317W en V3 et I408T en V4 pour construire des virus contenant des mutations simples, doubles et triples afin d’évaluer la contribution des mutations individuelles ou combinées au phénotype de résistance. Nous avons déterminé la sensibilité de chaque mutant à MVC et VCV, le pourcentage d’infectivité et le tropisme viral par rapport au phénotype sauvage. Tous les mutants ont conservé le tropisme R5 et ont montré une diminution d’infectivité par rapport au contrôle. Nos résultats ont montré que les mutants qui portent des mutations en V4 (I408T) ont eu le plus d'impact sur la susceptibilité au MVC. Finalement, nous avons voulu évaluer l’activité antivirale d’un nouvel inhibiteur de CCR5, VCH-286 avec d’autres inhibiteurs de CCR5 tels que MVC et VVC ainsi que ses interactions avec des médicaments représentatifs de différentes classes d’antirétroviraux ARV employés en clinique pour traiter le HIV/SIDA., afin d’évaluer si ces médicaments pourraient être utilisés dans un même régime thérapeutique. Nous avons tout d’abord évalué indépendamment l’activité antivirale des trois inhibiteurs de CCR5 : VCH-286, MVC et VVC. Par la suite nous avons évalué les interactions de VCH-286 avec MVC et VVC. Finalement nous avons évalué les interactions de VCH-286 avec d’autres médicaments antirétroviraux. Ces études ont montré que VCH-286 est un inhibiteur puissant de CCR5 avec une activité antivirale in vitro de l’ordre du nanomolaire et des interactions médicamenteuses favorables avec la majorité des ARV tels que les inhibiteurs de transcriptase inverse, de protéase, d’intégrase, et de fusion employés en clinique pour traiter le VIH/SIDA et des interactions allant de synergie à l'antagonisme avec les inhibiteurs de CCR5. Nos résultats montrent que la plasticité de l’enveloppe virale du VIH-1 a des répercussions sur la résistance aux inhibiteurs de CCR5, le tropisme et la possible utilisation de ces molécules en combinaison avec d’autres molécules appartenant à la même classe.The work described in this manuscript aimed to characterize the resistance pathways to CCR5 inhibitors. We first developed a phenotypic assay to identify viral tropism and to measure the resistance to CCR5 inhibitors. This assay detects R5 tropic viruses or X4 when they represent as little as 0.4% in a mixture of viral populations, demonstrating its robustness and sensitivity. Based on its clonal approach, this assay can differentiate the truly dual-tropic viruses from mixed viral populations. We then studied the impact of mutations in the variable regions of gp120 envelope protein of HIV-1 virus on resistance to CCR5 inhibitors. To do this, resistant viruses were generated by passage of CC1/85 and BAL isolates in the presence of sub-inhibitory concentrations of maraviroc (MVC) and vicriviroc (VCV). Following some passages of the CC1/85 virus in the presence of MVC, some mutations were identified in differents regions of the gp120. We further selected three mutations in the variable domains of gp120, V169M in V2, L317W in V3 and I408T in V4 to construct viruses containing single, double and triple mutations to assess the contribution of individual or combined mutations in the resistance phenotype to MVC and VCV. We determined the sensitivity of each mutant to MVC and VCV, the tropism and the percentage of infectivity compared to wild type. Our results showed that the sequences that carry mutations in the V4 domain I408T, had the most impact on susceptibility to MVC. Finally, we aimed to evaluate the antiviral activity of a new CCR5 inhibitor, VCH-286 and its interaction with representative drugs from different classes of antiretroviral (ARVs) such as reverse transcriptase inhibitors, protease inhibitors, integrase inhibitors and fusion inhibitors used in clinic to treat HIV/AIDS and other CCR5 inhibitors such as MVC and VVC to assess whether these drugs could be used together within the same treatment regimen. To answer this question, we first evaluated the antiviral activity of the three CCR5 inhibitors: VCH-286, MVC, and VVC. We then evaluated the interactions of VCH -286 with MVC VVC. We finally evaluated the interactions of VCH -286 with other ARV drugs These studies showed that VCH-286 is a potent inhibitor of R5 viruses with antiviral activity at the nanomolar range and favorable drug interactions with the majority of ARVs such as reverse transcriptase, protease, integrase and fusion inhibitors employed clinically to treat HIV/AIDS. The combinations of CCR5 inhibitors have interactions ranging from synergy to antagonism. Our results show that the plasticity of the viral envelope of HIV-1 affects resistance to CCR5 inhibitors, its tropism and the potential combination of these drugs

Sustained low functional impairment in axial spondyloarthritis (axSpA): which are the primary outcomes that should be targeted to achieve this?

Abstract Objectives To (i) determine whether sustained disease activity states, as measured by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS), impact function, and (ii) evaluate characteristics predicting sustained low functional impairment in a prospective axial spondyloarthritis (axSpA) cohort. Methods Biologic Treatment Registry Across Canada (BioTRAC) was a multi-center, prospective registry that collected real-world data on axSpA patients receiving infliximab or golimumab between 2006 and 2017. Generalized estimating equations (GEE) were used to test baseline characteristics, treatment, and duration (at 6 and 12 months vs. only at 6 or 12 months vs. neither) of low BASDAI (< 3), ASDAS-inactive disease (ID)(< 1.3), and ASDAS-low disease activity (LDA) in predicting sustained low Bath Ankylosing Spondylitis Functional Index (BASFI)(< 3) between 12 and 18 months. The adjusted impact of achieving low disease state at 6 and/or 12 months on BASFI at 18 months was analyzed by generalized linear models. Results Eight hundred ten patients were enrolled. 33.7%, 13.4%, and 24.7% achieved sustained low BASDAI, ASDAS-ID, and ASDAS-LDA, respectively. In univariable GEE of baseline variables, age and baseline BASDAI, BASFI, and ASDAS significantly predicted sustained low BASFI. In multivariable GEE, sustained low BASDAI (p < 0.001), low BASDAI only at 6 or 12 months (p = 0.001), and baseline BASFI (p < 0.001) were the only predictors of sustained low BASFI. Sustained ASDAS-ID (p = 0.040) and ASDAS-LDA (p < 0.001) were also predictors when forced into the model. Similar results were obtained when evaluating the BASFI score at 18 months. Conclusion Sustained BASDAI < 3 may be a valid and feasible target for a treat-to-target strategy in axSpA having function as treatment goal

Chronic Granulomatous Disease (CGD): Commonly Associated Pathogens, Diagnosis and Treatment

Chronic granulomatous disease (CGD) is a primary immunodeficiency caused by a defect in the phagocytic function of the innate immune system owing to mutations in genes encoding the five subunits of the nicotinamide adenine dinucleotide phosphatase (NADPH) oxidase enzyme complex. This review aimed to provide a comprehensive approach to the pathogens associated with chronic granulomatous disease (CGD) and its management. Patients with CGD, often children, have recurrent life-threatening infections and may develop infectious or inflammatory complications. The most common microorganisms observed in the patients with CGD are Staphylococcus aureus, Aspergillus spp., Candida spp., Nocardia spp., Burkholderia spp., Serratia spp., and Salmonella spp. Antibacterial prophylaxis with trimethoprim-sulfamethoxazole, antifungal prophylaxis usually with itraconazole, and interferon gamma immunotherapy have been successfully used in reducing infection in CGD. Haematopoietic stem cell transplantation (HCT) have been successfully proven to be the treatment of choice in patients with CGD

Additional file 1 of Sustained low functional impairment in axial spondyloarthritis (axSpA): which are the primary outcomes that should be targeted to achieve this?

Additional file 1: Supplementary Table 1. Predictors of Sustained Low BASFI (<3) Between 12 and 18 Months Using Non-Responder Imputation (Sensitivity Analysis). BASFI=Bath Ankylosing Spondylitis Functional Index; OR=Odds Ratio; CI=Confidence Interval; M=Month; BASDAI= Bath Ankylosing Spondylitis Disease Activity Index; ASDAS=Ankylosing Spondylitis Disease Activity Score; ID=Inactive Disease; LDA=Low Disease Activity. Bold P-values denote statistical significance. Multivariable Analysis 1: primary analysis; Multivariable Analysis 2: secondary analysis including ASDAS-LDA instead of ASDAS-ID

A Systematic Review of the Clinical Diagnosis of Transient Hypogammaglobulinemia of Infancy

Transient hypogammaglobulinemia of infancy (THI) is a primary immunodeficiency caused by a temporary decline in serum immunoglobulin G (IgG) levels greater than two standard deviations below the mean age-specific reference values in infants between 5 and 24 months of age. Preterm infants are particularly susceptible to THI, as IgG is only transferred across the placenta from mother to infant during the third trimester of pregnancy. This study aimed to conduct a systematic review of the diagnostic criteria for transient hypogammaglobulinemia of infancy. Systematic review: Three electronic databases (PubMed, MEDLINE, and Google Scholar) were manually searched from September 2021 to April 2022. Abstracts were screened to assess their fit to the inclusion criteria. Data were extracted from the selected studies using an adapted extraction tool (Cochrane). The studies were then assessed for bias using an assessment tool adapted from Cochrane. Of the 215 identified articles, 16 were eligible for examining the diagnostic criteria of THI. These studies were also assessed for bias in the six domains. A total of five studies (31%) had a low risk of bias, while four studies (25%) had a high risk of bias, and bias in the case of seven studies (44%) was unclear. We conclude that THI is only definitively diagnosed after abnormal IgG levels normalise. Hence, THI is not a benign condition, and monitoring for subsequent recurrent infections must be conducted. The diagnostic criteria should also include vaccine and isohaemagglutinin responses to differentiate THI from other immunological disorders in infants