Nrf2-dependent persistent oxidative stress results in stress-induced vulnerability to depression.

Stressful life events produce a state of vulnerability to depression in some individuals. The mechanisms that contribute to vulnerability to depression remain poorly understood. A rat model of intense stress (social defeat (SD), first hit) produced vulnerability to depression in 40% of animals. Only vulnerable animals developed a depression-like phenotype after a second stressful hit (chronic mild stress). We found that this vulnerability to depression resulted from a persistent state of oxidative stress, which was reversed by treatment with antioxidants. This persistent state of oxidative stress was due to low brain-derived neurotrophic factor (BDNF) levels, which characterized the vulnerable animals. We found that BDNF constitutively controlled the nuclear translocation of the master redox-sensitive transcription factor Nrf2, which activates antioxidant defenses. Low BDNF levels in vulnerable animals prevented Nrf2 translocation and consequently prevented the activation of detoxifying/antioxidant enzymes, ultimately resulting in the generation of sustained oxidative stress. Activating Nrf2 translocation restored redox homeostasis and reversed vulnerability to depression. This mechanism was confirmed in Nrf2-null mice. The mice displayed high levels of oxidative stress and were inherently vulnerable to depression, but this phenotype was reversed by treatment with antioxidants. Our data reveal a novel role for BDNF in controlling redox homeostasis and provide a mechanistic explanation for post-stress vulnerability to depression while suggesting ways to reverse it. Because numerous enzymatic reactions produce reactive oxygen species that must then be cleared, the finding that BDNF controls endogenous redox homeostasis opens new avenues for investigation.

Nrf2-dependent persistent oxidative stress results in stress-induced vulnerability to depression.

This corrects the article DOI: 10.1038/mp.2016.144.

Long-term safety and efficacy of lentiviral hematopoietic stem/progenitor cell gene therapy for Wiskott-Aldrich syndrome.

Patients with Wiskott-Aldrich syndrome (WAS) lacking a human leukocyte antigen-matched donor may benefit from gene therapy through the provision of gene-corrected, autologous hematopoietic stem/progenitor cells. Here, we present comprehensive, long-term follow-up results (median follow-up, 7.6 years) (phase I/II trial no. NCT02333760 ) for eight patients with WAS having undergone phase I/II lentiviral vector-based gene therapy trials (nos. NCT01347346 and NCT01347242 ), with a focus on thrombocytopenia and autoimmunity. Primary outcomes of the long-term study were to establish clinical and biological safety, efficacy and tolerability by evaluating the incidence and type of serious adverse events and clinical status and biological parameters including lentiviral genomic integration sites in different cell subpopulations from 3 years to 15 years after gene therapy. Secondary outcomes included monitoring the need for additional treatment and T cell repertoire diversity. An interim analysis shows that the study meets the primary outcome criteria tested given that the gene-corrected cells engrafted stably, and no serious treatment-associated adverse events occurred. Overall, severe infections and eczema resolved. Autoimmune disorders and bleeding episodes were significantly less frequent, despite only partial correction of the platelet compartment. The results suggest that lentiviral gene therapy provides sustained clinical benefits for patients with WAS.

Repeated social defeat-induced depression-like behavioral and biological alterations in rats: involvement of cholecystokinin.

Cholecystokinin (CCK) involvement in depression-like disorders is poorly documented. Here, we investigated whether CCKergic neurotransmission is relevant to depressive-like symptoms and antidepressant therapy using a novel preclinical model based on repeated social defeat over 4 weeks in rats. Repeated social defeat triggers changes that could be considered as behavioral and biological correlates of depressive symptoms in humans, such as a hyperactivity of hypothalamic-pituitary-adrenal (HPA) axis (increase of serum corticosterone levels and of adrenal gland weight), increased immobility time in the forced swimming test (FST), decrease of body weight and of sweet water consumption and reduction of hippocampal volume associated with a decreased cell proliferation in the dentate gyrus. In addition, in vivo microdialysis showed that cortical CCK release was tonically increased in defeated rats. Chronic imipramine treatment (16 mg kg(-1) per day for 25 days) prevented both the repeated social defeat-induced alterations of biological and behavioral parameters and the associated increase of cortical CCK release. Chronic blockade of CCK2 receptors by the specific antagonist CI-988 (1 mg kg(-1) per day for 25 days) also normalized immobility time in the FST and prevented HPA axis hyperactivity, reduction of hippocampal volume and cell proliferation and decreased sweet water intake normally evoked by repeated social defeat. These data showed that the repeated social-defeat paradigm can be considered as a suitable model of 'depression' in rats. The causal link between social defeat-evoked (1) increase in cortical CCKergic neurotransmission and (2) depression-like symptoms that we highlighted here strongly suggests that CCKergic systems may be a relevant target for novel antidepressant therapy.

IgG4 subclass in malignant melanoma.

Three hundred and ninety-seven sera from 185 melanoma patients were studied. These sera were classified into three groups according to stage of disease. An alteration in the level of the IgG4 subclass was found. It was related to the dissemination of disease. The percentage of abnormalities (either increased or decreased levels of IgG4) was more frequent in patients with stage II and III diseases (55 and 53%, respectively) than in patients with stage I(19%). The higher frequencies of high titers of IgG4 were essentially detected in advanced disease. The biologic significance of the increase of IgG4 in melanoma remains obscure. The increase may be related to the development of facilitating antibodies of the IgG4 subclass.

A redox function for the Calpha2 domain of IgA immunoglobulin.

IgA1 populations were reduced over a range of dithiothreitol concentrations and the products were examined by sodium dodecyl sulfate polyacrylamide gel electrophoresis and peptide mapping. The study showed that IgA was more resistant to reduction than other immunoglobulin classes (IgG, IgM). SDS-polyacrylamide gel electrophoresis showed that intersubunit bond and H-L bond were the most labile disulfide in polymeric and monomeric IgA, respectively. Peptide mapping revealed that the itrachain disulfide of the C alpha 2 domain was more or equally sensitive to the reduction than H-L and intersubunit bonds. Electrochemical experiments demonstrated that this bond had redox properties and the possibility involving disulfide exchange is discussed.

[Low doses ketamine: antihyperalgesic drug, non-analgesic]. / Kétamine à faibles doses: antihyperalgésique, non analgésique.

Recent data in animal experiments as in clinical trials have clearly reported that pain modulation is related to an equilibrium between antinociceptive and pronociceptive systems. Therefore, the apparent pain level could not only be a consequence of a nociceptive input increase but could also result from a pain sensitization process. Glutamate, via NMDA receptors, plays a major role in the development of such a neuronal plasticity in the central nervous system, leading to a pain hypersensitivity that could facilitate chronic pain development. By an action on NMDA receptors opioids also induce, in a dose dependent manner, an enhancement of this postoperative hypersensitivity. "Antihyperalgesic" doses of ketamine, an NMDA receptor antagonist, were able to decrease this central sensitization not only in painful animal but also in human volunteers exposed to different pain models, or in the postoperative period. Many studies have reported that ketamine effects are elicited when this drug is administered the following manner: peroperative bolus (0.1 to 0.5 mg/kg), followed by a constant infusion rate (1 to 2 microg/kg per min) during the peroperative period and for 48 to 72 hours after anaesthesia. Those ketamine doses improved postoperative pain management by reducing hyperalgesia due to both surgical trauma and high peroperative opioid doses. This antihyperalgesic action of ketamine also limited the postoperative morphine tolerance leading to a decrease in analgesic consumption and an increase in the analgesia quality.

[Kinetic study of human immunoglobulin G fragmentation by pepsin]. / Etude cinétique de la fragmentation des immunoglobulines G humaines par la pepsine

The rate of pepsin hydrolysis of the four subclasses of human IgG has been studied. The levels of undegraded IgG and of pep-F'c fragments have been determined by radial immunodiffusion using specific antisera against Cgamma2 and Cgamma3 domain antigenic determinants. This study shows that the four IgG subclasses have different susceptibilities to pepsin hydrolysis and defines the optimum conditions (times of hydrolysis) for the preparation of maximum yields of F (ab)'2 fragments and/or pep-F'c fragments.

An improved three-step method for the purification of the third component of human complement.

This paper describes a three-step purification method for the third component of human complement (C3) from plasma. The method consists of PEG precipitation, DEAE-cellulose chromatography and preparative isofocusing in a granulated dextran gel, with pH range 5--8. From this last step, a highly purified form of native C3 was obtained as indicated by immunoelectrophoresis and polyacrylamide gel electrophoresis analysis. The average final recovery was 20%.

Monoclonal antibodies against human plasma protein C and their uses for immunoaffinity chromatography.

Human protein C, isolated by conventional multistep methods, was used for immunization of mice. Monoclonal antibodies were prepared and screening of antibodies to human protein C was achieved using an immunoblotting technique. Five monoclonal anti-protein C antibodies were compared as affinity ligands. Different parameters were studied (adsorption capacity, specificity of adsorption, possibility of desorption under mild conditions) and two antibodies were selected. One antibody allows preparation of highly purified protein C in a single-step procedure from a fraction of plasma containing high levels of coagulation factors whereas the other can be used for preparation of protein C deficient plasma.

A potential new procedure for removing anti-factor VIII antibodies from hemophilic plasma.

A new approach for removing the anti-factor VIII antibodies in hemophilic patients by immunoadsorption is proposed. The method is based on the fact that the anti-factor VIII antibodies were predominantly of the IgG4 subclass; anti-human IgG4 antibodies were covalently linked to agarose and large amounts of anti-factor VIII antibodies can be eliminated. A study of 21 blood samples from hemophilic patients with anti-factor VIII antibodies allows us to confirm the large predominance of IgG4 in the anti-factor VIII population. In some samples, the presence of IgG3 related anti-VIII:C was checked by adsorption on an anti-IgG3 column. In a majority of cases, after IgG4 (or IgG4 + IgG3) immunoadsorption, the substitution therapy becomes possible or easier.

Specific removal of transthyretin from plasma of patients with familial amyloidotic polyneuropathy: optimization of an immunoadsorption procedure.

Familial amyloidotic polyneuropathy is characterized by the presence in patients plasma of a genetic variant of transthyretin. No specific treatment has been found and extracorporeal immunoadsorption on immobilized anti-transthyretin antibodies appears as a potentially attractive procedure. Parameters involved in specific immunoadsorption of transthyretin were studied and optimized. Several monoclonal anti-TTR antibodies were compared as affinity ligands and one of them was found to be suitable for such purposes. Optimum quantities of antibodies to be immobilized on the gel were determined. Three desorption agents were tested for regenerating immunoadsorbents and best results were obtained with basic variation of pH, allowing total desorption of TTR and possibility of multiple use without loss of adsorption capacity. Simulation of an immunoadsorption procedure in well-defined conditions showed efficiency and specificity of adsorption to remove TTR and the system thus should be subjected to clinical trials.

Study of parameters involved in specific immunoadsorption of apolipoprotein B.

A therapeutic immunoadsorption system on immobilized and anti-apolipoprotein B as a plasma cholesterol lowering procedure was optimized. Several antibodies were compared and highest adsorption capacity was obtained with goat polyclonal antibodies. Optimum quantities of antibodies to be immobilized on the gel and quantities of apo-B to be applied to columns were determined. The amount of antibodies released from immunoadsorbents can be minimized by treatment with a 0.005% glutaraldehyde solution with an acceptable reduction rate of adsorption capacity. Each phase, adsorption and desorption respectively, were well-defined and synchronized so two columns could be used in parallel in an automated procedure. In these conditions, the immunoadsorption system can efficiently, specifically and safely remove cholesterol and has to be subjected to clinical trials.

[Urinary evaluation of 5-S-cysteinyldopa and seric evaluation of IgG4 subclass during follow-up of 27 primitive malignant melanomas (author's transl)]. / Dosage urinaire de la 5-S-cystéinyldopa et dosage sérique de la sous-classe IgG4 au cours de la surveillance de 27 cas de mélanomes malins primitifs.

27 patients with SSM or NM level IV and V have been submitted to a monthly evaluation of their level of 5-S-cysteinyldopa in the urine and IgG4 subclass in their sera. For 5 patients who entered the stage II of their disease during the follow-up, 3 had elevation of the 5S and 5 had large variations of IgG4. On 21 patients in clinical remission, 10 had conjunctly an increase of 5S and variations of IgG4. The predictional value of these tests is discussed.

[IgG levels in the sera of melanoma patients (author's transl)]. / Etude des IgG dans les sérums des sujets porteurs de mélanomes.

397 sera from 185 melanoma patients have been tested. We classified our subjects into three groups, according to the stage of disease. An alteration of the level of IgG 4 sub-class was found and related to the extension of the disease. The percentage of abnormalities was more frequent in stage II and III (55 p. 100 and 53 p. 100) than in stage I (19 p. 100). High titers of IgG 4 subclass were essentially detected in advanced disease. The biological significance is discussed.

[IgG levels in the sera of melanoma patients (author's transl)]. / Etude des IgG dans les sérums de sujets porteurs de mélanomes.

397 sera from 185 melanoma patients have been tested. We classified our subjects into three groups, according to the stage of disease. An alteration of the level of IgG4 subclass was found and related to the extension of the disease. The percentage of abnormalities was more frequent in stage II and III (55 p. 100 and 53 p. 100) than in stage I (19 p. 100). High titers of IgG 4 subclass were essentially detected in advanced disease. The biological significance is discussed.

[Affinity chromatography for extracorporeal purification or for separation of molecules for biological use: technical and legal restraints]. / La chromatographie d'affinité en épuration extra-corporelle ou pour la séparation de molécules d'intérêt biologique: contraintes techniques et réglementaires.

Affinity and/or immunoaffinity chromatography is one of the less commonly method used for large scale separation purposes. As this technic is greatly selective and gives high yields, it allows in vivo removal, in an extracorporeal circulation, of harmful substances in patient plasma as well as purification of molecules for biological and therapeutic uses. Large development with increased safety of such a method is dependent on some economic, technical and legal requirements. Particular attention must be drawn to the following points. Possibility of multiple uses of affinity supports contributes to lowering the cost of the method. Desorption agents should be chosen according to the best compromise between total desorption and preservation of adsorption capacity over runs. It is likewise essential to store affinity supports in conditions allowing prevention from contamination without loss of adsorption capacity. In developing and optimizing an affinity chromatography procedure, it is important to minimize the amount of ligand released from the affinity support. Besides economic and technical aspects, it is necessary to take into account legal requirements, particularly those related to the preparation of the ligand especially if it is monoclonal or polyclonal antibodies. An important consideration for the therapeutic use of antibodies (either in the preparation of biological products or in an extracorporeal circulation procedure) is the possible presence of viruses and/or potentially oncogenic macromolecules. Source material should be shown to be free of viruses, the cell banks (for monoclonal antibodies) and the production of antibodies must be closely controlled, viral inactivation of antibodies should be performed and the inactivation process should be shown to be effective.

[Validation of the virus inactivation capacity of a procedure of human plasma albumin purification by chromatography]. / Validation des capacités d'inactivation des virus d'un procédé de purification de l'albumine plasmatique humaine par chromatographie.

Almost the whole of the human plasma albumin preparations intended for clinical or biological uses is at present fractionated by cold ethanol precipitation technics based on the Cohn method. However, ion-exchange chromatographic processes have been recently developed. The aim of this work was the evaluation of the viral inactivation efficacy of an automated industrial chromatographic process allowing fractionation of 350 to 400 l of plasma per cycle (one precipitation step, three ion-exchange chromatography steps using the Spherodex-Spherosil gels--Sepracor-IBF, Villeneuve la Garenne, France--and one pasteurization step. Three relevant viruses were selected for this validation study: the hepatitis B virus (HBV), the poliomyelitis virus and the human immunodeficiency virus (HIV). In order to comply with EEC and FDA regulatory documents, significant amounts of the tested viruses were spiked into the different fractions obtained during the various purification steps and their removal or inactivation during the subsequent step were determined. The validation study was performed under conditions which mimic the manufacturing process using fractions obtained during a semi-industrial fractionation. Moreover, residual viral infectivity was checked on after elution and washing of the columns for each chromatographic step. Results have pointed out: a) an overall reduction of 4.4 log 10 for HBV. Infectivity is judged by a combination of several markers and the DNA polymerase activity is the most affected particularly during the three ending purification steps; b) an overall reduction in virus titer > 10 log 10 for the poliomyelitis virus; c) an overall reduction in virus titer > 10 log 10 for HIV (four of the five steps have an important potential to inactivate this virus increasing the safety of the process). Moreover, no residual viral infectivities were detected after washing of the columns. In conclusion, this study showed the viral safety of human albumin purified using the chromatographic Spherodex-Spherosil process. As had been observed for fractionation by means of ethanol, the pasteurization step is necessary to ensure inactivation of two of the three viruses tested (HBV and poliomyelitis virus). This validation study allowed the preparation of a manufacturing and controls document for albumin and a marketing authorization has been issued by the "Laboratoire National de la Santé" (LNS, France).