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Biomedical subjects

M Moutschen

Publications and source records attributed to M Moutschen.

At least 19 recordsLinked to original sources

Quantification of T cell receptor rearrangement excision circles to estimate thymic function: an important new tool for endocrine-immune physiology.

Although the thymus constitutes a target organ for most protein and steroid hormones, it has been quite difficult to determine the precise control exerted in vivo by the endocrine system upon thymic function. The biological role of the thymus is to ensure the generation of a diversified population of peripheral T cells able to respond to non-self-antigens but nevertheless tolerant to self-antigens. For a long time, thymic function could not be monitored, as a consequence of the absence of adequate technology to differentiate recent thymic emigrants from naive T cells. The generation of T cell receptor (TCR) diversity occurs in the thymus through recombination of gene segments encoding the variable parts of the TCR alpha and beta chains. During these processes, by-products of the rearrangements are generated in the form of TCR excision circles (TRECs). As these molecules are lost upon further cell division, their quantification is actually considered as a very valuable tool to estimate thymic function. The most appropriate TREC is deltaRec-Psi(J)alpha TREC or signal joint TREC resulting from deltaRec-Psi(J)alpha rearrangement (TCRD deletion) that occurs late during thymopoiesis, before V(alpha)-J(alpha) rearrangement. Here we describe how TREC quantification is a powerful and reliable method to evaluate the impact of hormones and endocrine disorders upon thymic function.

Aged↗

[Alteration of bone metabolism in HIV-infected patients treated by HAART].

For several years already, a growing number of studies reports modifications in the bone metabolism among HIV-infected patients. Some of these studies, published even before the use of HAART, involved the infection itself. With the experience already available as concerns HAART, antiretroviral treatments (ART) seem however to be called into question. Data are divergent yet. Some studies tend to invalidate the collected data about the harmful role of HAART and prove the absence of effect or even the beneficial action of ART on bone. Moreover, the three important classes of ART are implied, even if the proteases inhibitors are most commonly charged. Pathogenic mechanism remain hypothetical. While the impact on morbidity seems to be weak for the time being, long-term repercussions are still unknown, in particular when children are concerned. In such conditions, it appears difficult to set up coherent politics of screening, prevention and treatment. Nevertheless beyond the divergences, the multifactorial character of alteration of HIV-infected patient's bone metabolism seems to be undeniable. The identification of the different parameters should in the future clarify the situation and enable the publishing of exact criteria of screening, prevention and treatment.

Antiretroviral Therapy, Highly Active↗

[Morphological and metabolic abnormalities related to antiretroviral therapy].

The long term use of antiretroviral therapy is associated with metabolic and morphological abnormalities named lipodystrophy. The understanding of its epidemiology is in progress. NRTIs and Pls are involved in the origin of these abnormalities. So, NRTIs inhibit mitochondrial gamma polymerase and induce body fat distribution disorders. PIs interfere with lipid metabolism, leading to hyperlipidaemia and insulin resistance symptomatology. The diagnosis is made by clinical (far wasting or accumulation, or mixed syndrome) and biological signs (hyperlipidaemia, hyperglycaemia, hyperlactacidaemia). Radiological exams can quantify morphological abnormalities. The management consists in drug substitution, diet and exercise, and corrective drugs. Plastic surgery can be useful.

Adipose Tissue↗

[Still's disease in the adult].

The Adult Onset Still's Disease (AOSD) is an entity of unknown origin characterised by fever, polyarthralgias or polyarthritis, a pharyngitis, a cutaneous eruption and elevation of leucocytes. We present observations of 17 patients diagnosed during the last thirteen years. Files of hospitalized patients with suspected AOSD have been examined in a retrospective study and Yamaguchi and Kahn's criterias applied in order to confirm the diagnosis. Treatments undertaken and the evolution have been noted. The sex ratio is 1.83; the middle age of intervening from 42 to 45 years. The middle delay for the diagnosis is 3 to 8 weeks. Fever, eruption and polyarthralgias are the most frequent clinical signs. Elevation of leucocytes, hepatic cytolysis and hyperferritinemia are usual. Constantly, inflammatory tests are increased and the rheumatoid factor and the antinuclear antibodies are negative. Yamaguchi's criterias have been met by all patients. The non steroïd anti-inflammatory drugs and corticoïds constituted the main treatment. In the evolutionary shield, 6 cases of remission have been noted. The other patients evolved toward the chronicity with either a systemic or an articular shape. In the two situations, a state of corticodependance got settled with necessity of association to immunosuppressive drugs. The diagnosis of AOSD is easily done on basis of Yamaguchi's criterias. Corticoïds can permit to control the bouts. There are 3 types of evolution: remission, chronic systemic or chronic articular shape.

Adolescent↗

[Management of HIV infected patients. Experience of the Liege University Hospital Center].

We present data from 112 patients followed in the Infectious Diseases Unit of the Liege University Hospital (CHU Sart-Tilman). The primary goal of this study was to evaluate the efficiency of highly active antiretroviral therapy (HAART) on surrogate immunological and virological parameters. The study also aimed at determining the prevalence of opportunistic infections and iatrogenic metabolical abnormalities in the era of HAART. Data from HIV infected patients under combined treatment were collected from March 1996 till July 1999. The follow-up focused on the variation of the CD4 cell counts and viral load, and the occurrence of opportunistic infections. The average age was 39 +/- 10 years and the sex ratio (M/F) was 2.3. At baseline, the CD4 count was 352 +/- 244/mm3 and the viral load was 4.1 +/- 1.2 log. After 12 months, the CD4 cells were at 540 +/- 374 and the viral load at 2.5 +/- 1.5 log. This favourable outcome was observed in 70% of patients (naive and experienced). Clinically, patients in therapeutic success presented few opportunistic infections, but many drugs related toxicity. Our data demonstrate the efficiency of combined treatment in the management of HIV infected patients. However, the apparition of toxicity problems could limit the benefit brought by these drugs.

Academic Medical Centers↗

HIV-associated hematologic disorders are correlated with plasma viral load and improve under highly active antiretroviral therapy.

The relationship between HIV-1 replication and hematologic parameters was examined in two separate studies. The first study was a cross-sectional evaluation of 207 untreated patients. In this study, the proportion of patients with hematologic disorders increased with disease progression. There was a significant inverse correlation between HIV-1 plasma viral load and all hematologic values (r = -0.266 to -0.331). The second study was a longitudinal evaluation of patients on combination antiretroviral therapy (HAART) with hematologic alterations before treatment ( N = 27 with platelets <150,000/microl, 24 with hemoglobin <12 g/dl, 36 with neutrophils <2000/microl and 29 with leukocytes <3000/microl). Samples were analyzed every 3 months for 2 years. At 2 years, >50% of patients experienced a sustained virologic response, with viral loads <500 RNA copies/ml. Hematologic reconstitution occurred progressively for all blood cell lineages and became statistically significant after the sixth month of therapy ( p <.001). Mean values increased from 110 to 180 x 10(3)/microl for platelets, from 10.7 to 12.3 g/dl for hemoglobin (stabilizing finally at 11.4 g/dl), from 1,260 to 2,240/microl for neutrophils, and from 2,260 to 3,600/microl for leukocytes. In conclusion, hematologic disorders are corrected by combination antiretroviral therapy. This suggests a causative role of HIV-1 in hematologic disorders.

Adult↗

[Autoimmune thyroiditis].

The continuum of clinical phenotype between different autoimmune thyroid diseases and mainly the common pathophysiological mechanisms have lead to a novel classification of these disorders into three types: (1) Type 1 autoimmune thyroiditis (euthyroidism associated with the presence of anti-thyroglobulin and anti-thyroperoxydase autoantibodies); (2) Type 2 autoimmune thyroiditis or Hashimoto's disease (hypothyroidism with anti-thyroglobulin and anti-thyroperoxydase autoantibodies). Postpartum thyroiditis falls into this category and is characterized by transient hyperthyroidism followed by hypothyroidism; and (3) Type 3 autoimmune thyroiditis or Graves-Basedow's disease (hyperthyroidism with anti-TSH receptor "stimulating" auto-antibodies, often associated with anti-thyroglobulin and anti-thyroperoxydase autoantibodies). Thyroid orbitopathy often complicates Type 3 autoimmune thyroiditis and is thought to result from an autoimmune response against an autoantigen common to thyroid and orbital fibroblasts/adipose cells. We present the actualized knowledge about the immunological parameters that can be detected and quantified in autoimmune thyroid diseases, about the pathophysiological mechanisms involved in these disorders, and about the options of their treatment that are currently offered to the medical community.

Biomarkers↗

[Pharma-clinics how I treat ... an HIV infection. IV. Protease inhibitors].

Protease inhibitors constitute the last class of antiretroviral drugs appeared on the market. They raised an enormous enthusiasm, reinforced by recent studies results. These molecules prevent the formation of infectious viral particles, while inhibiting a viral enzyme that plays a key role in the cycle of replication of the HIV. Their efficiency, especially in association, is recognized for all stages of the infection and the intervening of a resistance often requires many mutations. However, the unexpected adverse events such as lipodystrophy and some interactions can limit their utilization in first intention.

Cell Cycle↗

Antitumoral vaccination with granulocyte-macrophage colony-stimulating factor or interleukin-12-expressing DHD/K12 colon adenocarcinoma cells.

Immunomodulating gene therapy for the treatment of malignant diseases is under extensive investigation. In this study, we induced an antitumoral immune response with murine interleukin-12 (mIL-12) and murine granulocyte-macrophage colony-stimulating factor (GM-CSF)-secreting tumor cells in a model of peritoneal carcinomatosis. Intraperitoneal injection of DHD/K12 tumoral cells engineered to produce IL-12 or GM-CSF did not generate any tumors, whereas untransduced DHD/K12 cells gave rise to peritoneal carcinomatosis. IL-12-expressing DHD/K12 cells also protected against tumors derived from coinjected parental cells. To test whether cytokine-producing cells could elicit a memory antitumoral immune response, animals received a challenge with parental DHD/K12 cells 35 days after the injection of proliferating or irradiated DHD/K12 engineered cells. Under our experimental conditions, irradiated tumor cells did not generate any antitumoral immunity. In contrast, tumor development was delayed and survival increased in the animals vaccinated with cytokine-secreting proliferating cells. A specific cytotoxic T-lymphocyte response against DHD/K12 parental cells was observed after vaccination with GM-CSF-expressing cells. Our results demonstrated that intraperitoneal vaccination with IL-12- or GM-CSF-expressing adenocarcinoma cells induced a systemic immune antitumoral response that may be useful as an adjuvant therapy after surgical resection of colorectal cancer.

Adenocarcinoma↗

[Guidelines for the management of patients with HIV infection. I. Adolescents and adults. Liege Working Group on HIV Infection].

The management of HIV infected patient requires an approach that must put in balance profits expected from a tritherapy (suppression of viral replication, immune reconstitution) and problems related to treatment (difficulty of adherence, side effects, long-term toxicity, resistance). Controversies appear currently on the institution of a precocious treatment, on the use of protease inhibitors at initiation, in order to preserve choices when a modification is necessary. Many concepts, in investigation, are described in the management of a therapeutic failure. Resistance testings progressively find their place in the follow-up. Modes of prophylaxis-interruption of opportunistic infections are established, as well as is the management of professional postexposure. The question remains on how best to advise seropositive couples, about conception, and to elaborate recommendations after non-professional postexposure.

Adolescent↗

[Hydroxyurea and HIV infection].

Hydroxyurea is an anticancerous product, used recently in the treatment of HIV-1 infection thanks to its inhibitory action in viral replication, potentialization of the nucleosides activity (particularly ddI or didanosine) and its cytostatic properties on CD4 and CD8 lymphocytes. Many studies showed its efficiency, as further drug, in initial regimen of a tritherapy (containing ddI) and salvage therapy. The dosage of 500 mg bid seems tolerated well by adults, and 20 mg/kg by children. Long-term tolerance remains unknown. With ddI, it could be proposed in developing countries.

Adult↗

[The Hemovigilance Commission of the University Hospital Center].

As suggested by the National Blood Council, a Hemovigilance Committee was set up in the University Hospital of Liège in 1995. A multidisciplinary discussion takes place on any action aiming at the improvement of transfusion safety, and the follow-up of its implementation. The first issue to be discussed was the set up of a detailed documentation of all blood transfusions. The data are now recorded on a single document allowing proper identification of people and products involved, and of the eventual incidents. This document has lead to a better transfusion safety and to an improved administrative management of blood transfusion. The Commission has been coordinating two multi-centric studies analyzing the consumption of fresh blood products and the incidence of transfusion reactions. Among blood-saving policies, autologous transfusion and volume reduction of samples drawn for laboratory purposes have been discussed. Other measures were taken to improve the labeling of samples for cross-mach and to actively follow-up transfusion reactions. By its actions and advises, the Commission aims to direct strategies towards a safe and rational use of blood products.

Belgium↗

Mice transgenic for a soluble form of murine cytotoxic T lymphocyte antigen 4 are refractory to murine acquired immune deficiency sydrome development.

Interactions between B and CD4+ T cells are central to the pathogenesis of retrovirus-induced murine acquired immune deficiency virus (MAIDS). Prompted by previous work showing that treatment with cytotoxic T lymphocyte antigen 4 immunoglobulin (CTLA4Ig) partly inhibited the disease, we studied the course of infection in mice deficient for CD28-B7 interactions (mCTLA4-Hgamma1 transgenic mice). Despite a relative viral load identical to that of non-transgenic mice, the transgenic mice did not develop any of the major MAIDS symptoms (i.e. lymphoproliferation and immune anergy). The mCTLA4-Hgamma1 did not however, completely inhibit B-cell activation as indicated by a slight hypergammaglobulinaemia and microscopic blastic transformation. Absence of MAIDS in transgenic mice was associated with much lower levels of both interleukin-4 and interferon-gamma transcripts following viral infection. These results support the theory that the CD28/B7 costimulatory pathway is a critical determinant to MAIDS development.

Abatacept↗

[Pharma-clinics. How I treat ... HIV infection. III. Non-nucleoside reverse transcriptase inhibitors].

Non nucleoside reverse transcriptase inhibitors (NNRTI) are a new arm in the treatment of the HIV infection. They inhibit the replication by direct non competitive binding to the enzyme, and do not require phosphorylation. The fast emergence of resistance in monotherapy obliges to use them in a triple association. The 103 mutation confers a cross-resistance. The most common adverse event is rash. Association with nucleoside analogues is additive or even synergistic. They are metabolized by the cytochrome P450. Within a combined therapy, their efficiency is comparable to protease inhibitors, notably in patients with low viral load.

Cytochrome P-450 Enzyme System↗