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Biomedical subjects

B Charpentier

Publications and source records attributed to B Charpentier.

At least 127 records · Page 7Linked to original sources

Induction of peripheral T cell tolerance and allo/xenoimmunity.

It is theoretically impossible or at least difficult to tolerize animals in xenogeneic situation, particularly in non-concordant species. Both humoral defense and several cellular components (T and non T) are offensive weapons which can be directed at myriad of self-antigens in a normal situation, at allo-antigens in abnormal situations, at xeno-antigens in exceptional situations. In either cases, the fine epitopic definition of allo/xeno antigens seen by the TCR is far from being totally known. From recent studies showing the precise requirement of peptides assembly composition in the MHC class I and II groove it should be theoretically possible to tolerize any group of peptides if they are presented, some other, because not presented, may remain ignored, thus apparently tolerized. It is also know, that transplantation tolerance is not a law of "either nothing or all" but a multiple process depending of both the affinity of the TCR and the nature/compositions of the target. In view of the complex array of factors influencing the pathway of T cell activation, three forms of T cell non responsiveness may be suggested in the context of xenogeneic recognition: physical deletion of potentially reactive T cells occurring predominantly in the thymus, non reactivity of T cells resulting from their failure to be influenced by antigens, and anergy possibly due to inappropriate signals from non professional antigen presenting cells. Future investigations must elucidate the requirements for inducing these events in a purpose of xenogeneic organ transplantation.

Clonal Anergy↗

[The reaction of rejection. Elements of diagnosis, surveillance, therapeutic attitude in cases of kidney grafts].

Allograft rejection reaction must be integrated within the general framework of alloreactivity, i.e. involving a huge T cell repertoire with a high number of alloreactive precursors. This reaction is modulated by the particular immunological state induced by chronic renal insufficiency, haemodialysis and primary kidney disease. The inefficiency of current immunosuppressive drugs is illustrated by the tendency towards chronic rejection, involving many growth factors. It must be noted that allo-stimulating cells are different from target cells. Therapeutical armamentarium currently involves corticosteroids and serotherapy, but it is hoped that new immunosuppressive drugs will increase the efficiency of rejection crisis treatment.

Acute Disease↗

Apoptosis of activated CD8+/CD57+ T cells is induced by some combinations of anti-CD2 mAb.

Peripheral blood CD8+/CD57+ T cells display poor proliferative responses when stimulated with CD3 or CD2 in vitro, but can be induced to proliferate in the presence of exogenous IL-2. Although GT2+T11(1), a mitogenic anti-CD2 mAb pair, could synergize with IL-2 to induce sustained cell divisions in this population (as did immobilized OKT3), D66+T11(1), another anti-CD2 mAb pair, could only induce a small abortive proliferative response. All these antibodies were in contrast strongly mitogenic for CD8+/CD57- T cells. Assuming that D66+T11(1) were exerting inhibitory effects on CD8+/CD57+ T cells, we indeed found that such antibodies profoundly suppressed the anti-CD3 and IL-2-induced proliferation of those cells, but not that of CD8+/CD57- cells. CD2-mediated growth arrest was correlated with rapid cell death occurring within 2 h, once the cells had been submitted to D66+T11(1), and cells susceptible to the death signal were large cells committed in the cell cycle. D66+T11(1)-treated cells had the well-known ultrastructural form of apoptosis, and the DNA extracted from these cells showed the typical ladder pattern of DNA fragmentation accompanying this process. For apoptosis to occur, two anti-CD2 mAb had to be applied to the cells, one of them being D66, suggesting that the corresponding anti-CD2 mAb pairs were imposing on the CD2 molecule a particular conformational change appropriate to transduce a death signal. Notably, CD8+/CD57- T cells were largely resistant to apoptosis in the conditions just described. When exposed to anti-CD3 and IL-2 in primary and secondary cultures, CD8+/CD57+ T cells retained high viability, whereas in contrast, when exposed to D66+T11(1), important cell loss occurred, concomitant with apoptosis, illustrating the specificity of the CD2-derived death signal. Our results suggest that the expansion of CD8+/CD57+ T cells is critically dependent on the CD2 pathway which, according to the conformational change of the CD2 molecule and the activation state of the cells, will direct them either towards proliferation or towards cell death.

Antibodies, Monoclonal↗

[Role of cyclosporin in renal transplantation].

The cyclosporine era started 10 years ago in organ transplantation, especially in renal transplantation. Following the pioneering works showing the efficacy and its synergism with other immunosuppressors, a second step consisted in a better use by decreasing the induction dose and a closer definition of its side effects. A major improvement in the results (increase of 5 to 10% in patient survival and of 10 to 20% in graft survival), a decrease in the number of acute rejection episodes, in the cumulative doses of steroids, in the duration of hospitalization and in the total cost of transplantation made this drug as the worldwide used agent, now considered as the milestone in immunosuppression. Over all, organ transplantation is needing a more specific immunological agent, deprived if possible of major side effects. In these regards, each new agent should be considered only if compared to the "gold standard", namely cyclosporine.

Clinical Protocols↗

Gastrointestinal complications in renal transplantation.

One wonders whether the use of cyclosporin, histamine receptor antagonists, low doses of steroids, and early diagnosis and treatment actually modify the incidence, morbidity, and mortality of gastrointestinal (GI) and pancreatic complications in renal transplantation. To find out, we reviewed 614 kidney transplant recipients between January 1984 and December 1988. One hundred patients (16.2%) were found to have GI and/or pancreatic complications in the following distribution: 9.6% gastroduodenal, 1.3% pancreatic, 4% colonic, and 0.4% small bowel. None of the patients presenting a gastroduodenal ulcer had perforation or bleeding. Fifty-five percent of the patients with this complication had a past history of eso-gastroduodenal disease, compared to 19.6% in recipients without gastroduodenal complications. Some 4.4% of the patients had a small bowel or a colonic complication and four died of peritonitis due to bowel perforation. Mortality was 35% in those having intestinal resection and/or perforation with peritonitis. Sixteen percent of patients with colonic complications had a known history of diverticula, compared to 3% for those without colonic complications. The incidence of GI and/or pancreatic complications in renal transplant recipients remains high and has caused 1.1% of the deaths in our series. Mortality is essentially due to upper GI bleeding, peritonitis following perforation, and infectious colitis. Better detection of gastroduodenal and colonic disease before transplantation seems to be mandatory. Prevention with histamine H2 receptor antagonists and early surgical treatment of complicated colonic diverticula help to reduce the morbidity and mortality in kidney graft recipients.

Adult↗

Antibody response after influenza immunization with various vaccine doses: a double-blind, placebo-controlled, multi-centre, dose-response study in elderly nursing-home residents and young volunteers.

The dose effect (0, 10, 20 and 60 micrograms) of influenza subunit vaccine on the antibody response was investigated in nursing-home residents and young controls. The vaccine antigens were: A/Taiwan/1/86 (H1N1), A/Sichuan/2/87 (H3N2) and B/Beijing/1/87. For the influenza B antigen, the post-GMT and the 'percentage protective titre' increased significantly both in the young controls and nursing-home residents. No dose effect was observed for the A/Taiwan, and a minor dose effect for A/Sichuan. All vaccine doses were well tolerated by both groups. We conclude from our data that higher vaccine doses may result in a better antibody response against some antigens but not against others. Therefore, in general, increasing the vaccine dose is no adequate method to improve the antibody response.

Adolescent↗

Percutaneous antegrade dilation of ureteral strictures in kidney transplants.

Transplant ureteral stricture can be treated by either incisional surgery or percutaneous endoluminal dilation. We present 17 cases of percutaneous antegrade endoluminal dilation. The results of this procedure were satisfactory, with a 70% success rate that seems to be maintained during long-term followup. The results were better if dilation was done on a short and recent juxta-anastomotic stricture stented with a 10F Double-J* catheter for 2 months.

Adult↗

A possible role for specific "anergy" in immunologic hyporeactivity to donor stimulation in human kidney allograft recipients.

The low immunological reactivity toward donor cells usually observed in transplant recipients has been linked to clonal deletion or suppression of alloreactive cells. However, the anergy of donor-specific reactive cells is another possibility not extensively tested until now in humans. In this case, donor-specific reactive cells would be present and eventually be activated without becoming effector cells (i.e., without secreting IL-2 or becoming cytotoxic) after donor-specific stimulation. We studied 8 patients under low-dose immunosuppressive drugs who displayed hyporeactivity toward donor stimulation. IL-2 production, proliferative response, and cytotoxic activity toward donor cell stimulation was decreased (respectively 22, 53, and 19% of response toward third-party stimulation). In order to evidence anergy, we studied two activation markers (cell size increase and expression of IL-2 receptor [CD25]) in allografted recipient T cells after autologous (background), donor (experimental), and third-party cell stimulation (positive control). We showed that the percentage of CD25+ cells and the cell size increase were similar after donor or third-party cell stimulation and clearly above the background as early as days 1-2 after the beginning of the mixed lymphocyte culture. Moreover, CD4+ and CD8+ cells similarly expressed CD25 after donor or third-party stimulation. Thus, donor-specific reactive cells not only were present but could be activated without becoming effector cells. These data suggest that anergy may be an important phenomenon in allograft tolerance.

Humans↗

A versatile ELISA-PCR assay for mRNA quantitation from a few cells.

Gene expression studies require a sensitive and quantitative assay of mRNA amounts present in small samples. We describe a general method of quantifying specific mRNA quickly and easily from purified RNA or directly from a few cells by PCR and enzyme-linked immunosorbent assay (ELISA) revelation of the resulting products (sensitivity of the last step: < 0.1 fmol). Cells are digested and the total cellular RNA is reverse-transcribed and then amplified with 5' and 3' primers; the former being 5' biotinylated. The amplification product is captured on avidin-coated microplates and quantified by hybridization with a digoxigenin-labeled internal oligonucleotide probe. After revelation with an anti-digoxigenin alkaline phosphatase coupled antibody (anti-DIG-AP1), the amount of hybridized probe is determined by optical reading. The results can be easily converted to absolute values by comparison with an external DNA standard curve. An internal DNA or RNA standard can also be used. The method we describe can be adapted to any cellular or viral gene of known sequence in a matter of days. Since it uses nonradioactive probes, commercially available reagents and standard microplate readers, it is inexpensive and could be automated easily. In this study, interleukin-2 mRNA expression could be studied in as few as 40 Jurkat cells. It was also possible to quantify human immunodeficiency virus (HIV) DNA from 1500 to 1.5 copies out of 1.5 x 10(5) human genomic DNA copies.

Avidin↗

[Current concepts on the alloreactive response].

Many new data have been obtained in the last 4 years about the structure and the functions of Major Histocompatibility Complex (MHC) molecules. Structural data are summarized and the functions of MHC molecules in the presentation of peptides to T cells is described. The high selectivity of peptides binding to MHC molecules is explained. The negative and positive selection of T cells in the thymus is described and the notion of repertoire introduced. The consequences of these new data on the understanding of H2 restriction and alloreactivity are explained. The 4 potential types of alloreactivity are defined: 1) House keeping gene (HKG) peptides bound to allogenic MHC molecules, 2) allogenic peptides (derived from allogenic MHC molecules) bound to allogenic MHC molecules, 3) empty allogenic MHC molecules, 4) allogenic peptides bound to autologous MHC molecules. In fact, the allogenic response is mostly directed toward HKG peptides bound to the allogenic MHC molecules of the graft cells (type 1). The potential role of type 4 alloreactivity in rejection is discussed.

Animals↗