Monitorage de l'infection active a CMV par deux methodes : antigenemie PP65 et PCR qualitative sur plasma

Au cours de ce travail nous avons evalue deux methodes diagnostiques de l'infection active a CMV (antigenemie pp65 CMV et PCR qualitative) quant a leur utilite dans le monitorage de cette infection. Notre travail a porte sur 31 patients allogreffes de moelle osseuse dont 22 ont developpe une infection active a CMV. Le pourcentage des antigenemies positives etait de 59contre 28PCR positives. En mediane; les PCR se sont positivees 14 jours apres l'antigenemie. La duree de positivite de l'antigenemie etait de 5 semaines contre une semaine pour la PCR et la positivite de la PCR n'etait jamais isolee. Le taux de concordance de 61;5entre les deux techniques et le coefficient ( = 0.50) modere temoignerait d'un degre moyen de precision des resultats. La PCR sur plasma a presente une association plus importante avec la maladie a CMV (p= 0;014). La GVHD etait le seul facteur favorisant l'infection active a CMV (p=0;02). Cette derniere (p= 0;001) et la maladie a CMV (p= 0;04) ont presente des facteurs de mauvais pronostic chez nos patients. L'antigenemie constitue une methode de choix pour le diagnostic et le monitorage de l'infection active a CMV. Alors que la PCR qualitative sur plasma ne presente pas d'interet dans ce contexte

[HLA-G: an immunoregulatory non classical class I HLA molecule]. / HLA-G: une molécule HLA de classe I non classique à pouvoir immunorégulateur.

HLA-G is a particular non classical HLA class I molecule. Despite its tissue-restricted expression and low polymorphism, this molecule plays an important role in innate and adaptative immunity. The tolerogenic propriety of HLA-G makes it an immunomodulatory molecule acting in the early phases of conception, protecting fetal tissues from the maternal immune system. Immunomodulatory functions of HLA-G and the associations of this molecule with some pathological states are reported in this review. So, little amounts of soluble HLA-G or particular allelic expression of this molecule are associated with some pregnancy complications. HLA-G expression on tumor cells by preventing antitumor responses via a trogocytosis mechanism and regulatory T cells induction is associated with invasiveness and clinical evolution of some tumor types. HLA-G is also involved in the protection of the transplanted tissues from rejection. Revealing of new more functional homomultimeric isoforms of this molecule offers new insight in a better understanding of clinical and biological role of HLA-G.

[Antiphospholipid syndrome: pathophysiology and clinicobiological aspects]. / Le syndrome des anti-phospholipides: physiopathologie et aspects clinico-biologiques.

Due to its heterogeneity and pathogenesis diversity, antiphospholipid syndrom remains a challenge for researchers more than a century after first antibody, the anticardiolipin antibody for syphilis diagnosis was discovered. After a review of the etiology and epitopic specificities of antiphospholipid antibodies, we propose a detailed overview of mechanisms and clinical aspects of antiphospholipid syndrome. We emphasize on the role of innate immunity and the involvement of endothelial cells Toll like receptors in the transduction signal of anti-beta2-glycoprotein I antibodies fixation, which induce a thrombogenic state. The thrombogenic role of the anti-beta2GPI antibodies direct against beta2GPI domain I in the clinical onset of this syndrome is also evoked. Diagnosis problems and clinicobiological manifestations in the light of the last international consensus statement of the classification criteria for antiphospholipid syndrome end this review.

Analysis of cytomegalovirus (CMV) viremia using the pp65 antigenemia assay, the amplicor CMV test, and a semi-quantitative polymerase chain reaction test after allogeneic marrow transplantation.

A pp65 antigenemia assay for polymorphonuclear leukocytes (PMNLs) (CINAkit Rapid Antigenemia), and a qualitative polymerase chain reaction (PCR) test for plasma 'PCR-P qual' (Amplicor cytomegalovirus [CMV] test) were performed for 126 samples (blood and plasma) obtained from 18 bone marrow transplant patients, over a 9-month surveillance period. Among those samples, 92 were assayed with a semi-quantitative PCR test for PMNLs 'PCR-L quant.' The number of samples with a positive CMV test for antigenemia and PCR-P qual assays was 20.63% and 12.7%, respectively, whereas the PCR-L quant assay was positive in 48 of the 92 samples assayed (52.17%). The rates of concordance of the results of PCR-P qual and antigenemia, PCR-P qual and PCR-L quant, antigenemia and PCR-L quant were 92%, 65.2% and 66.8%, respectively. The analysis of the results for the 92 specimens tested by all 3 methods showed a rate of concordance of 63% among all methods. Good agreement (kappa=0.72) was found only between pp65 Ag and PCR-P qual assays. Clinical disease correlates with an antigenemia high viral load. Three patients had CMV disease despite preemptive therapy, and all of them had graft-versus-host-disease (GVHD). PMNLs-based assays are more efficient in monitoring CMV reactivation, but for high-risk patients with GVHD, more sensitive assays (real-time PCR) must be done.

[Prognosis value of the pp65 antigenemia and semi-quantitative PCR in the detection of the CMV reactivation in bone marrow grafted patients]. / Valeur pronostique de l'antigénémie pp65 et de la PCR semi-quantitative dans la détection de la réacti- vation du CMV chez les greffés de moelle osseuse.

In this article a Cytomegalovirus (CMV) antigenemia and semiquantitative PCR retrospective evaluation of 26 bone marrow allo-grafted patients for different haematological disease is reported. Eighteen patients had a CMV reactivation despite a prophylactic treatment, seven of those patients had both positive antigenemia pp65 and positive semi-quantitative CMV PCR. During CMV reactivation, 3 patients developed a CMV disease despite a pre-emptive therapy. The follow up of the antigenemia was performed since D21 until D100 post transplantation, the antigenemia positivity occurred at D53 and was preceded about 7 days by CMV PCR positivity The CMV disease wasn't associated with a high viral load. All patients that had CMV reactivation had a positive CMV serology before the graft, whereas only 37.5% of the patients who did not reactivate had a positive CMV serology. Respectively half patients who reactivated and only 12.5% of those who didn't had a Graft versus host disease (GVHD), witch preceded the reactivation about 21 days in six of the formers. Clinical and biological signs presented by our patients in this cases report, seems to be associated more with the GVHD than with CMV reactivation.

[Immunoglobulin replacement therapy contribution in agammaglobulinemia: 10 case reports]. / Apport du traitement substitutif par les immunoglobulines au cours des agammaglobulinémies: à propos de 10 cas.

UNLABELLED: Intravenous immunoglobulin (Ig IV) has been used for many years in the treatment of primary antibody deficiencies. We performed a retrospective study of the clinical features and outcome of agammaglobulinemia children who received prolonged Ig IV infusions. PATIENTS AND METHODS: Ten children, 9 male et 1 female, with agammaglobulinemia diagnosis were studied for the clinical manifestations before and during the Ig IV replacement therapy. Serum Ig levels were quantified by nephelometry. Circulating B ant T cells were counted by immunofluorescence labeling by monoclonal antibodies. T-cell functions were assessed by using mitogen and antigen -induced T-cell proliferation assays in vitro. Patients clinical status was evaluated respectively, before initiation and at every moment (when patients had an infection) of the replacement therapy. RESULTS: Ig IV therapy was performed for 866 cumulated months, median 108 months. The median Ig IV doses administered to the 10 patients was 500 mg/kg/month. Residual serum IgG mean level was 3,9 g/L. All patients had 99 bacterial infections/year before Ig IV, mainly respiratory tract infections (48,5%), and 4 patients had bronchiectasis before Ig replacement therapy. The number of infection/year fall to 25 during IgIV replacement, and the infection/patient/year rate decreases significantly. One patient developed an Echovirus 27 meningoencephalitis during this treatment. CONCLUSION: Ig IV therapy with residual IgG mean level of 3,9 g/l reduced significantly the rate of bacterial infections. The use of specific antibiotherapy and respiratory kinesitherapy led to a lower rate of respiratory tract infections, and the stabilisation of the bronchiectasis. However this intravenous replacement therapy does not protect against viral meningoencephalitis.

[Value of the search for anticardiolipin antibodies during the course of systemic lupus erythematosus]. / Intérêt de la recherche des anti-cardiolipines au cours de l'évolution de la maladie lupique.

The anticardiolipin antibodies (aCL) are acquired inhibiting antibodies of the coagulation process. They interfere with the anionic phospholipids of the cellular membranous. These are frequently associated to the autoimmune diseases, especially the systemic lupus erythematosus (SLE), they expose the patient to thrombotic complications. In order to define the possible and prognostic predictive value of these aCL, a sequential research of these antibodies was performed on 12 patients suffering from SLE since 2 to 11 years. An average of one sample per year was drawn, either during an attack or in a routine control check. The detection of these IgG aCL did not appear to be related with be course of the disease. In fact, 3 of our patients, ill since respectively 2, 7 and 11 years, never showed any aCL. These aCL were positive during an attack in 80% of the cases. This positivity was associated to vascular thrombosis (2 cases), and cutaneous vascularity (6 cases) and, in one case, the presence of aCL was linked to inutero fetal death due to retruplacentary hematoma. This study confirms the association between aCL and thrombosis during systemic lupus erythematosus.