Carboxy-terminal fragment of fibroblast growth factor 23 induces heart hypertrophy in sickle cell disease

International audienc

Sex differences in post-acute neurological sequelae of SARS-CoV-2 and symptom resolution in adults after COVID-19 hospitalization: an international multicenter prospective observational study

Although it is known that coronavirus disease 2019 can present with a range of neurological manifestations and in-hospital complications, sparse data exist on whether these initial neurological symptoms of coronavirus disease 2019 are closely associated with post-acute neurological sequelae of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2; PANSC) and whether female versus male sex impacts symptom resolution. In this international, multi-centre, prospective, observational study across 407 sites from 15 countries (30 January 2020 to 30 April 2022), we report the prevalence and risk factors of PANSC among hospitalized adults and investigate the differences between males and females on neurological symptom resolution over time. PANSC symptoms included altered consciousness/confusion, fatigue/malaise, anosmia, dysgeusia and muscle ache/joint pain, on which information was collected at index hospitalization and during follow-up assessments. The analysis considered a time to the resolution of individual and all neurological symptoms. The resulting times were modelled by Weibull regression, assuming mixed-case interval censoring, with sex and age included as covariates. The model results were summarized as cumulative probability functions and age-adjusted and sex-adjusted median times to resolution. We included 6862 hospitalized adults with coronavirus disease 2019, who had follow-up assessments. The median age of the participants was 57 years (39.2% females). Males and females had similar baseline characteristics, except that more males (versus females) were admitted to the intensive care unit (30.5 versus 20.3%) and received mechanical ventilation (17.2 versus 11.8%). Approximately 70% of patients had multiple neurological symptoms at the first follow-up (median = 102 days). Fatigue (49.9%) and myalgia/arthralgia (45.2%) were the most prevalent symptoms of PANSC at the initial follow-up. The reported prevalence in females was generally higher (versus males) for all symptoms. At 12 months, anosmia and dysgeusia were resolved in most patients, although fatigue, altered consciousness and myalgia remained unresolved in >10% of the cohort. Females had a longer time to the resolution (5.2 versus 3.4 months) of neurological symptoms at follow-up for those with more than one neurological symptom. In the multivariable analysis, males were associated with a shorter time to the resolution of symptoms (hazard ratio = 1.53; 95% confidence interval = 1.39–1.69). Intensive care unit admission was associated with a longer time to the resolution of symptoms (hazard ratio = 0.68; 95% confidence interval = 0.60–0.77). Post-discharge stroke was uncommon (0.3% in females and 0.5% in males). Despite the methodological challenges involved in the collection of survey data, this international multi-centre prospective cohort study demonstrated that PANSC following index hospitalization was high. Symptom prevalence was higher and took longer to resolve in females than in males. This supported the fact that while males were sicker during acute illness, females were disproportionately affected by PANSC

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 < 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

Rôle de la chaperonne HSP 70 dans l'éythropoïèse inefficace des béta-thalassémies majeures

Β-TM is an inherited hemoglobinopathy caused by a quantitative defect in the synthesis of the β-globin chains of hemoglobin, leading to the accumulation of free α-globin chains that form toxic aggregates. Despite extensive knowledge on the molecular defects causing β-TM, little is known about the mechanisms responsible for ineffective erythropoiesis (IE), which is characterised by accelerated erythroid differentiation, maturation arrest and apoptosis at the polychromatophilic stage. We have previously demonstrated that normal human erythroid cell maturation requires a transient activation of caspase-3. Although GATA-1, the master transcriptional factor of erythropoiesis, is a caspase-3 target, we have shown that during human erythroid differentiation, it is protected from cleavage through its association with the chaperone Hsp70 in the nucleus. Hsp70 is constitutively highly expressed in normal human erythroid cells. The best-known role of this ubiquitous chaperone is to participate in proteins folding and refolding of proteins denatured by cytoplasmic stress, thus preventing their aggregation.In this study, we have evidenced that during the maturation of human β-TM erythroblasts, Hsp70 is sequestrated in the cytoplasm by the excess of free α-globin chains, resulting in nuclear GATA-1 cleavage and, in turn, end-stage maturation arrest and apoptosis. A molecular modeling shows that α-globin binds to a highly electronegative cavity formed by all Hsp70 domains. Additionally, the transduction of a nuclear-targeted Hsp70 mutant (Hsp70-S400A) or caspase-3 uncleavable GATA-1 mutant (µGATA-1) corrects β-TM ineffective erythropoiesis in human cultured β-TM cells. Our data indicate that cytosolic Hsp70 sequestration by α-globin chains prevents its nuclear localization and is a key mechanism of the β-TM IE. In order to increase nuclear Hsp70 translocation, developing small molecules that could increase Hsp70 expression or disrupt the Hsp70/α-globin complex could be a novel approach of targeted therapies to improve erythropoiesis in β-TM.L’érythropoïèse inefficace joue un rôle central dans la physiopathologie de l’anémie des β-TM. Ses caractéristiques sont triple: accélération de la différenciation érythroïde, arrêt de maturation au stade d’érythroblaste polychromatophile et mort par apoptose à ce stade de différenciation. Les mécanismes précis de cette apoptose et de l’arrêt de la maturation n’ont pas encore été élucidés. Il a été montré, au cours de l’érythropoïèse physiologique, que la protéine chaperonne Hsp70, en se localisant dans le noyau des érythroblastes en cours de différenciation, protège GATA-1 (facteur de transcription érythroïde majeur) de sa destruction par la caspase-3. Cette enzyme clé de l’apoptose est en effet activée physiologiquement au cours de la différenciation érythroïde et peut cliver GATA-1. Notre travail se base sur l’hypothèse suivante : Hsp70 pourrait, au cours de l’érythropoïèse des β-TM, être séquestrée dans le cytoplasme des érythroblastes matures (stade d’une intense hémoglobinisation) afin d’exercer son rôle de chaperonne des chaînes d’α-globine libres. Cela aurait comme conséquence néfaste l’absence de localisation nucléaire d’Hsp70 et, en conséquence, la destruction de GATA-1 à l’origine de l’arrêt de maturation et de la mort cellulaire. Nous avons montré dans ce travail qu’Hsp70 était localisée principalement dans le cytoplasme des érythroblastes matures dans la moelle de patients β-TM, avec un défaut d’expression nucléaire. Par ailleurs, GATA-1 n’est plus exprimé dans ces cellules. Nous avons confirmé ces résultats dans un système de culture cellulaire érythroïde humaine en milieu liquide reproduisant les étapes de la différenciation érythroïde terminale. Une intéraction physique directe entre Hsp70 et l’α-globine a été identifiée par techniques de microscopie confocale, d’immunoprécipitation et de double hybride. Enfin, la transduction dans les érythroblastes de β-TM d’un mutant d’Hsp70-S400A, principalement nucléaire, ou d’un mutant de GATA-1 non clivable par la caspase-3 corrige l’érythropoïèse inefficace.Une modélisation mathématique du complexe Hsp70/α-globine nous a permis de préciser les domaines impliqués dans l’intéraction, ce qui ouvre la voie à une possibilité de criblage de petites molécules permettant la rupture de ce complexe afin de ramener Hsp70 dans le noyau avec un espoir thérapeutique pour améliorer l’érythropoïèse inefficace des β-TM

Role of the chaperone Hsp70 in beta-thalassemia major (β-TM) ineffective erythropoiesis

L’érythropoïèse inefficace joue un rôle central dans la physiopathologie de l’anémie des β-TM. Ses caractéristiques sont triple: accélération de la différenciation érythroïde, arrêt de maturation au stade d’érythroblaste polychromatophile et mort par apoptose à ce stade de différenciation. Les mécanismes précis de cette apoptose et de l’arrêt de la maturation n’ont pas encore été élucidés. Il a été montré, au cours de l’érythropoïèse physiologique, que la protéine chaperonne Hsp70, en se localisant dans le noyau des érythroblastes en cours de différenciation, protège GATA-1 (facteur de transcription érythroïde majeur) de sa destruction par la caspase-3. Cette enzyme clé de l’apoptose est en effet activée physiologiquement au cours de la différenciation érythroïde et peut cliver GATA-1. Notre travail se base sur l’hypothèse suivante : Hsp70 pourrait, au cours de l’érythropoïèse des β-TM, être séquestrée dans le cytoplasme des érythroblastes matures (stade d’une intense hémoglobinisation) afin d’exercer son rôle de chaperonne des chaînes d’α-globine libres. Cela aurait comme conséquence néfaste l’absence de localisation nucléaire d’Hsp70 et, en conséquence, la destruction de GATA-1 à l’origine de l’arrêt de maturation et de la mort cellulaire. Nous avons montré dans ce travail qu’Hsp70 était localisée principalement dans le cytoplasme des érythroblastes matures dans la moelle de patients β-TM, avec un défaut d’expression nucléaire. Par ailleurs, GATA-1 n’est plus exprimé dans ces cellules. Nous avons confirmé ces résultats dans un système de culture cellulaire érythroïde humaine en milieu liquide reproduisant les étapes de la différenciation érythroïde terminale. Une intéraction physique directe entre Hsp70 et l’α-globine a été identifiée par techniques de microscopie confocale, d’immunoprécipitation et de double hybride. Enfin, la transduction dans les érythroblastes de β-TM d’un mutant d’Hsp70-S400A, principalement nucléaire, ou d’un mutant de GATA-1 non clivable par la caspase-3 corrige l’érythropoïèse inefficace.Une modélisation mathématique du complexe Hsp70/α-globine nous a permis de préciser les domaines impliqués dans l’intéraction, ce qui ouvre la voie à une possibilité de criblage de petites molécules permettant la rupture de ce complexe afin de ramener Hsp70 dans le noyau avec un espoir thérapeutique pour améliorer l’érythropoïèse inefficace des β-TM.Β-TM is an inherited hemoglobinopathy caused by a quantitative defect in the synthesis of the β-globin chains of hemoglobin, leading to the accumulation of free α-globin chains that form toxic aggregates. Despite extensive knowledge on the molecular defects causing β-TM, little is known about the mechanisms responsible for ineffective erythropoiesis (IE), which is characterised by accelerated erythroid differentiation, maturation arrest and apoptosis at the polychromatophilic stage. We have previously demonstrated that normal human erythroid cell maturation requires a transient activation of caspase-3. Although GATA-1, the master transcriptional factor of erythropoiesis, is a caspase-3 target, we have shown that during human erythroid differentiation, it is protected from cleavage through its association with the chaperone Hsp70 in the nucleus. Hsp70 is constitutively highly expressed in normal human erythroid cells. The best-known role of this ubiquitous chaperone is to participate in proteins folding and refolding of proteins denatured by cytoplasmic stress, thus preventing their aggregation.In this study, we have evidenced that during the maturation of human β-TM erythroblasts, Hsp70 is sequestrated in the cytoplasm by the excess of free α-globin chains, resulting in nuclear GATA-1 cleavage and, in turn, end-stage maturation arrest and apoptosis. A molecular modeling shows that α-globin binds to a highly electronegative cavity formed by all Hsp70 domains. Additionally, the transduction of a nuclear-targeted Hsp70 mutant (Hsp70-S400A) or caspase-3 uncleavable GATA-1 mutant (µGATA-1) corrects β-TM ineffective erythropoiesis in human cultured β-TM cells. Our data indicate that cytosolic Hsp70 sequestration by α-globin chains prevents its nuclear localization and is a key mechanism of the β-TM IE. In order to increase nuclear Hsp70 translocation, developing small molecules that could increase Hsp70 expression or disrupt the Hsp70/α-globin complex could be a novel approach of targeted therapies to improve erythropoiesis in β-TM

Syndrome hémophagocytaire au cours de la maladie de Still de l'adulte

PARIS6-Bibl. St Antoine CHU (751122104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Rôle d’HSP70 dans l’érythropoïèse inefficace des β-thalassémies majeures

International audienc

Impact of hospitalized vaso-occlusive crises in the previous calendar year on mortality and complications in adults with sickle cell disease: a French population-based studyResearch in context

Summary: Background: Historically, sickle cell disease (SCD) patients experiencing frequent hospitalized vaso-occlusive crises (HVOC) have been associated with increased mortality, yet recent data reflecting the widespread use of hydroxyurea and advancements in disease management remain limited. Our study aims to assess the association between HVOC and mortality or severe complications in patients with SCD in this new treatment landscape. Methods: This was a retrospective observational cohort study using the French national health data system. Between 01-01-2012 and 12-31-2018, all SCD patients ≥16 years old (ICD-10 codes D57.0–2) were included and followed until 12-31-2018. HVOC was defined as a hospitalization of ≥1 night with primary diagnosis of SCD with crisis, following an emergency room visit. The association between HVOC and severe complications was assessed with a Cox proportional hazards model. Findings: In total, 8018 patients (56.6% females; 4538/8018) were included. The 2018 SCD standardized one-year period prevalence was 17.9 cases/100,000 person-years [17.4; 18.3]. The mean rate was 0.84 (1.88) HVOC/person-year. In 2018, 70% (5323/7605), 22% (1671/7605), and 8% (611/7605) of patients experienced 0, 1–2, or 3+ HVOCs, respectively. The median survival time between HVOCs was 415 days [386; 439]. Overall, 312 patients died (3.9%) with a mean age of 49.8 (19.4). Compared to patients without HVOC, the hazard ratios of death in patients with 1–2 or 3+ HVOCs the year prior to death were 1.67 [1.21; 2.30] and 3.70 [2.30; 5.93], respectively. Incidence of acute chest syndrome, pulmonary embolism, osteonecrosis, and sepsis increased with the HVOCs category, but not stroke. In 2018, 29.5% (180/611) of patients with 3+ HVOCs did not take hydroxyurea. Interpretation: Patients must be closely monitored during their hospitalizations to intensify treatment and check treatment compliance. Innovative therapies are also required. Funding: The study was funded by Novartis

Comparison between Adult Patients with Sickle Cell Disease of Sub-Saharan African Origin Born in Metropolitan France and in Sub-Saharan Africa

Sickle cell disease (SCD) prevalence has increased rapidly in Europe as a result of an increase in the life expectancy of these patients and the arrival of SCD migrants from Africa. The aim of our study was to compare the phenotypes of adult patients born in Sub-Saharan Africa (SSA) who migrated to France with those of patients with the same origin who were born in France. This single-center observational study compared the demographic, clinical and biological characteristics of SCD adult patients of SSA origin who were born in France or SSA. Data were collected from computerized medical charts. Groups were compared using multivariate logistic regression with adjustment for age, gender and type of SCD. Of the 323 SCD patients followed in our center, 235 were enrolled, including 111 patients born in France and 124 patients born in SSA. SCD genotypes were balanced between groups. Patients born in Africa were older (median age 32.1 (24.4–39) vs. 25.6 (22.1–30.5) years, p < 0.001) and more often women (n = 75 (60.5%) vs. 48 (43.2%), p = 0.008). The median age at arrival in France was 18 years (13–23). The median height was lower among patients born in SSA (169 (163–175) vs. 174.5 cm (168–179), p < 0.001). Over their lifetimes, patients born in France had more acute chest syndromes (median number 2 (1–4) vs. 1 (0–3), p = 0.002), with the first episode occurring earlier (19 (11.6–22.3) vs. 24 (18.4–29.5) years, p < 0.007), and were admitted to intensive care units more often (53.3% vs. 34.9%, p = 0.006). This difference was more pronounced in the SS/Sβ0 population. Conversely, patients born in SSA had more skin ulcers (19.4% vs. 6.3%, p = 0.03). No significant differences were found in social and occupational insertion or other complications between the two groups. Patients born in SSA had a less severe disease phenotype regardless of their age than those born in France. This difference could be related to a survival bias occurring in Africa during childhood and migration to Europe that selected the least severe phenotypes