Immune cell kinetics and antibody response in COVID-19 patients with low-count monoclonal B-cell lymphocytosis.

Low-count monoclonal B-cell lymphocytosis (MBLlo ) has been associated with an underlying immunodeficiency and has recently emerged as a new risk factor for severe COVID-19. Here, we investigated the kinetics of immune cell and antibody responses in blood during COVID-19 of MBLlo versus non-MBL patients. For this study, we analyzed the kinetics of immune cells in blood of 336 COVID-19 patients (74 MBLlo and 262 non-MBL), who had not been vaccinated against SARS-CoV-2, over a period of 43 weeks since the onset of infection, using high-sensitivity flow cytometry. Plasma levels of anti-SARS-CoV-2 antibodies were measured in parallel by ELISA. Overall, early after the onset of symptoms, MBLlo COVID-19 patients showed increased neutrophil, monocyte, and particularly, plasma cell (PC) counts, whereas eosinophil, dendritic cell, basophil, and lymphocyte counts were markedly decreased in blood of a variable percentage of samples, and with a tendency toward normal levels from week +5 of infection onward. Compared with non-MBL patients, MBLlo COVID-19 patients presented higher neutrophil counts, together with decreased pre-GC B-cell, dendritic cell, and innate-like T-cell counts. Higher PC levels, together with a delayed PC peak and greater plasma levels of anti-SARS-CoV-2-specific antibodies (at week +2 to week +4) were also observed in MBLlo patients. In summary, MBLlo COVID-19 patients share immune profiles previously described for patients with severe SARS-CoV-2 infection, associated with a delayed but more pronounced PC and antibody humoral response once compared with non-MBL patients.

High-Sensitive TRBC1-Based Flow Cytometric Assessment of T-Cell Clonality in Tαß-Large Granular Lymphocytic Leukemia.

Flow cytometric (FCM) analysis of the constant region 1 of the T-cell receptor ß chain (TRBC1) expression for assessing Tαß-cell clonality has been recently validated. However, its utility for the diagnosis of clonality of T-large granular lymphocytic leukemia (T-LGLL) needs to be confirmed, since more mature Tαß cells (i.e., T-LGL normal-counterpart) show broader TRBC1+/TRBC1- ratios vs. total Tαß cells. We compared the distribution and absolute counts of TRBC1+ and TRBC1- Tαß-LGL in blood containing polyclonal (n = 25) vs. clonal (n = 29) LGL. Overall, polyclonal TRBC1+ or TRBC1- Tαß-LGL ranged between 0.36 and 571 cells/µL (3.2-91% TRBC1+ cells), whereas the clonal LGL cases showed between 51 and 11,678 cells/µL (<0.9% or >96% TRBC1+ cells). Among the distinct TCRVß families, the CD28- effector-memory and terminal-effector polyclonal Tαß cells ranged between 0 and 25 TRBC1+ or TRBC1- cells/µL and between 0 and 100% TRBC1+ cells, while clonal LGL ranged between 32 and 5515 TRBC1+ or TRBC1- cells/µL, representing <1.6% or >98% TRBC1+ cells. Our data support the utility of the TRBC1-FCM assay for detecting T-cell clonality in expansions of Tαß-LGL suspected of T-LGLL based on altered percentages of TRBC1+ Tαß cells. However, in the absence of lymphocytosis or in the case of TαßCD4-LGL expansion, the detection of increased absolute cell counts by the TRBC1-FCM assay for more accurately defined subpopulations of Tαß-LGL-expressing individual TCRVß families, allows the detection of T-cell clonality, even in the absence of phenotypic aberrations.

Anti-TRBC1 Antibody-Based Flow Cytometric Detection of T-Cell Clonality: Standardization of Sample Preparation and Diagnostic Implementation.

A single antibody (anti-TRBC1; JOVI-1 antibody clone) against one of the two mutually exclusive T-cell receptor ß-chain constant domains was identified as a potentially useful flow-cytometry (FCM) marker to assess Tαß-cell clonality. We optimized the TRBC1-FCM approach for detecting clonal Tαß-cells and validated the method in 211 normal, reactive and pathological samples. TRBC1 labeling significantly improved in the presence of CD3. Purified TRBC1+ and TRBC1- monoclonal and polyclonal Tαß-cells rearranged TRBJ1 in 44/47 (94%) and TRBJ1+TRBJ2 in 48 of 48 (100%) populations, respectively, which confirmed the high specificity of this assay. Additionally, TRBC1+/TRBC1- ratios within different Tαß-cell subsets are provided as reference for polyclonal cells, among which a bimodal pattern of TRBC1-expression profile was found for all TCRVß families, whereas highly-variable TRBC1+/TRBC1- ratios were observed in more mature vs. naïve Tαß-cell subsets (vs. total T-cells). In 112/117 (96%) samples containing clonal Tαß-cells in which the approach was validated, monotypic expression of TRBC1 was confirmed. Dilutional experiments showed a level of detection for detecting clonal Tαß-cells of ≤10-4 in seven out of eight pathological samples. These results support implementation of the optimized TRBC1-FCM approach as a fast, specific and accurate method for assessing T-cell clonality in diagnostic-FCM panels, and for minimal (residual) disease detection in mature Tαß+ leukemia/lymphoma patients.

Neuralgia del trigémino: estudio funcional mediante tensor de difusión de alta densidad como herramienta diagnóstica

Objetivo: El objetivo del presente artículo es demostrar la alteración de la fracción de anisotropía (FA) en la neuralgia esencial del trigémino (NET). Materiales y métodos: Se evaluaron 10 pacientes con diagnóstico de neuralgia esencial del trigémino mediante secuencias de tensor de difusión de alta densidad e imágenes anatómicas 3D en un resonador de alto campo 3 Tesla. En todos los casos se localizaron los nervios. Las imágenes obtenidas se posprocesaron para realizar la tractografía y medir la FA en 20 nervios. Resultados: Se correlacionaron los hallazgos patológicos entre la medición de la FA y la clínica de los pacientes. De los 10 casos, 6 presentaron compresión neurovascular de lado con neuralgia y un valor de FA descendido con respecto al contralateral en rango normal; mientras que 2 mostraron compresión neurovascular bilateral, pero solo descenso del valor de FA del lado afectado clínicamente. En los otros 2 pacientes no se determinó compresión neurovascular, aunque en el lado con manifestación clínica neurálgica la FA se encontraba descendida. Conclusión: La realización de la difusión anisotrópica de alta densidad y la medición de la FA pueden ser una herramienta en la evaluación de la neuralgia esencial del trigémino, ya que es un método reproducible y seguro que permite estudiar la función del nervio.(AU)

Objective: The objective of this article is to demonstrate the alteration of the anisotropy factor (FA) in essential trigeminal neuralgia. Materials and methods: Ten patients with essential trigeminal neuralgia were studied with sequences of high density diffusion tensor and anatomic 3D images with a high-field 3 Tesla resonator. The nerves were located in all cases studied. The obtained images were post-processed to perform tractography and FA was measured in 20 nerves. Results: There was correlation of pathological findings between measuring FA and clinical presentation of the patients. Six of the ten patients studied with neurovascular compression at the neuralgia side had decreased FA values compared to contralateral normal range. Two of the ten patients showed bilateral neurovascular compression, but only abnormal values of FA were found at the clinically affected side. In the remaining two patients no neurovascular compression was determined; however the FA was lower at the clinical manifestation neuralgic side. Conclusión: The performing of high density anisotropic diffusion and the measurement of the FA may be useful in the evaluation of Trigeminal neuralgia, since it is a safe and reproducible method that allows the study of nerve function.(AU)

Neuralgia del trigémino: estudio funcional mediante tensor de difusión de alta densidad como herramienta diagnóstica / Trigeminal Neuralgia: functional study using high density diffusion tensor imaging as a diagnostic tool

Objetivo: El objetivo del presente artículo es demostrar la alteración de la fracción de anisotropía (FA) en la neuralgia esencial del trigémino (NET). Materiales y métodos: Se evaluaron 10 pacientes con diagnóstico de neuralgia esencial del trigémino mediante secuencias de tensor de difusión de alta densidad e imágenes anatómicas 3D en un resonador de alto campo 3 Tesla. En todos los casos se localizaron los nervios. Las imágenes obtenidas se posprocesaron para realizar la tractografía y medir la FA en 20 nervios. Resultados: Se correlacionaron los hallazgos patológicos entre la medición de la FA y la clínica de los pacientes. De los 10 casos, 6 presentaron compresión neurovascular de lado con neuralgia y un valor de FA descendido con respecto al contralateral en rango normal; mientras que 2 mostraron compresión neurovascular bilateral, pero solo descenso del valor de FA del lado afectado clínicamente. En los otros 2 pacientes no se determinó compresión neurovascular, aunque en el lado con manifestación clínica neurálgica la FA se encontraba descendida. Conclusión: La realización de la difusión anisotrópica de alta densidad y la medición de la FA pueden ser una herramienta en la evaluación de la neuralgia esencial del trigémino, ya que es un método reproducible y seguro que permite estudiar la función del nervio.

Objective: The objective of this article is to demonstrate the alteration of the anisotropy factor (FA) in essential trigeminal neuralgia. Materials and methods: Ten patients with essential trigeminal neuralgia were studied with sequences of high density diffusion tensor and anatomic 3D images with a high-field 3 Tesla resonator. The nerves were located in all cases studied. The obtained images were post-processed to perform tractography and FA was measured in 20 nerves. Results: There was correlation of pathological findings between measuring FA and clinical presentation of the patients. Six of the ten patients studied with neurovascular compression at the neuralgia side had decreased FA values compared to contralateral normal range. Two of the ten patients showed bilateral neurovascular compression, but only abnormal values of FA were found at the clinically affected side. In the remaining two patients no neurovascular compression was determined; however the FA was lower at the clinical manifestation neuralgic side. Conclusión: The performing of high density anisotropic diffusion and the measurement of the FA may be useful in the evaluation of Trigeminal neuralgia, since it is a safe and reproducible method that allows the study of nerve function.

Overrepresentation of influenza A(H1N1)pdm09 virus among severe influenza cases in the 2011/12 season in four European countries.

In France, Ireland, Spain and the United Kingdom, the influenza season 2011/12 started in the final weeks of 2011 and has been dominated by influenza A(H3) viruses with minimal circulation of influenza A(H1N1) pdm09 and B viruses. A relatively greater proportion, however, of influenza A(H1N1)pdm09 viruses were reported in hospitalised laboratory-confirmed influenza cases in four countries. Compared to the season 2010/11, the proportion of subtype A(H3) among hospitalised cases has increased, associated with a larger proportion of cases in the youngest and oldest age groups.

Experience and lessons from surveillance and studies of the 2009 pandemic in Europe.

Surveillance and studies in a pandemic is a complex topic including four distinct components: (1) early detection and investigation; (2) comprehensive early assessment; (3) monitoring; and (4) rapid investigation of the effectiveness and impact of countermeasures, including monitoring the safety of pharmaceutical countermeasures. In the 2009 pandemic, the prime early detection and investigation took place in the Americas, but Europe needed to undertake the other three components while remaining vigilant to new phenomenon such as the emergence of antiviral resistance and important viral mutation. Laboratory-based surveillance was essential and also integral to epidemiological and clinical surveillance. Early assessment was especially vital because of the many important strategic parameters of the pandemic that could not be anticipated (the 'known unknowns'). Such assessment did not need to be undertaken in every country, and was done by the earliest affected European countries, particularly those with stronger surveillance. This was more successful than requiring countries to forward primary data for central analysis. However, it sometimes proved difficult to get even those analyses from European counties, and information from Southern hemisphere countries and North America proved equally valuable. These analyses informed which public health and clinical measures were most likely to be successful, and were summarized in a European risk assessment that was updated repeatedly. The estimate of the severity of the pandemic by the World Health Organization (WHO), and more detailed description by the European Centre for Disease Prevention and Control in the risk assessment along with revised planning assumptions were essential, as most national European plans envisaged triggering more disruptive interventions in the event of a severe pandemic. Setting up new surveillance systems in the midst of the pandemic and getting information from them was generally less successful. All European countries needed to perform monitoring (Component 3) for the proper management of their own healthcare systems and other services. The information that central authorities might like to have for monitoring was legion, and some countries found it difficult to limit this to what was essential for decisions and key communications. Monitoring should have been tested for feasibility in influenza seasons, but also needed to consider what surveillance systems will change or cease to deliver during a pandemic. International monitoring (reporting upwards to WHO and European authorities) had to be kept simple as many countries found it difficult to provide routine information to international bodies as well as undertaking internal processes. Investigation of the effectiveness of countermeasures (and the safety of pharmaceutical countermeasures) (Component 4) is another process that only needs to be undertaken in some countries. Safety monitoring proved especially important because of concerns over the safety of vaccines and antivirals. It is unlikely that it will become clear whether and which public health measures have been successful during the pandemic itself. Piloting of methods of estimating influenza vaccine effectiveness (part of Component 4) in Europe was underway in 2008. It was concluded that for future pandemics, authorities should plan how they will undertake Components 2-4, resourcing them realistically and devising new ways of sharing analyses.

Start of the influenza season 2008-9 in Europe - increasing influenza activity moving from West to East dominated by A(H3N2).

The influenza season 2008-9 started in week 49 of 2008 and is so far characterised by influenza virus type A subtype H3N2. Isolates of this subtype that were tested proved susceptible to neuraminidase inhibitors, but resistant to M2 inhibitors. The circulating A(H3N2) viruses are antigenically similar to the component in the current northern hemisphere influenza vaccine.

[Kawasaki disease: the echocardiographic diagnosis of coronary aneurysms. A report of 2 cases]. / Enfermedad de Kawasaki: diagnóstico ecocardiográfico de los aneurismas coronarios. Informe de dos casos.

We report two infants with Kawasaki disease and coronary aneurysms diagnosed by echocardiography. First case, a one year old male with abnormalities of left coronary artery, developed a myocardial infarction and died three weeks later. Second case a two months old male with aneurysm in the right coronary artery who doing well three months after the diagnosis was made. Echocardiography is the primary tool for evaluation and follow up of coronary abnormalities.

Cytotoxic T lymphocyte responses in the peripheral blood of children born to human immunodeficiency virus-1-infected mothers.

Cytotoxic T lymphocytes (CTL) are present at high activities in adult patients infected with the human immunodeficiency virus (HIV). In this report, CTL effectors were identified in peripheral blood mononuclear cells (PBMC) of children born to HIV-1-infected mothers. These CTL killed HLA-matched HIV-1-infected H9 target cells or doubly transfected P815-A2-env, gag or nef mouse tumor cells, which expressed the viral antigens in association with HLA-A1/A3 or HLA-A2, respectively. HIV-1-specific CTL were detected early after birth (less than 2 months) and remained present during the asymptomatic phase of the infection. As in HIV-1-infected adults, HIV-specific CTL declined with disease progression. Surprisingly, HIV-1-specific CTL were detected in the PBMC of three children who subsequently became seronegative.

HIV-1 env, nef, and gag-specific T-cell immunity in mice: conserved epitopes in nef p27 and gag p25 proteins.

Cellular immunogenicity of env gp160, nef p27, and gag p55 proteins of human immunodeficiency virus type 1 (HIV-1) was studied in mice immunized with vaccinia virus recombinants. Proliferative responses of spleen cells were comparable against env gp160, nef p27, and gag p25 recombinant proteins. No specific activity was observed against gag p18 protein. Env, nef, and gag-specific T-cell lines were generated by repeated stimulation of immune spleen cells with recombinant HIV-1 proteins. They were CD4 positive, proliferative, and also cytotoxic against HIV-transfected target cells. Specificity of the T-cell response against nef and gag protein was analyzed with synthetic peptides. Peptides nef 15, nef 16, and gag AM-30 were, respectively, reactive in nef- and gag-specific proliferative and cytolytic assays. The three peptides described have a relatively conserved amino acid sequence among HIV isolates and appear broadly immunoreactive among species.

Implications of HIV-specific cytotoxic T lymphocytes in AIDS.

The immune response to HIV in infected humans leads to the production of HIV-specific cytotoxic T lymphocytes (CTL) which circulate in high frequencies. The presence of these CTL and their eventual protective activities have been studied by various laboratories, and correlations have been made with certain immunopathological manifestations of HIV infections. It seems probable that HIV-immune CTL participate in the induction of certain disorders by initiating inflammatory reactions in the lungs, central nervous system, and lymph nodes. Various virus antigens recognized by HIV-immune CTL on the surface of the infected cell have been identified, and the molecular definition of the epitopes recognized is well under way. Likewise, numerous HLA transplantation antigens that regulate HIV antigen recognition by CTL have been identified. These data are discussed in view of the development of an eventual vaccine and of functional immunotherapies. They are compared with results obtained in animal experimental systems.

Enhancement of HIV-specific cytotoxic T lymphocyte responses by zidovudine (AZT) treatment.

Zidovudine or 3'-azido-2'-3'-dideoxy-thymidine (AZT) is an antiviral drug widely used to treat HIV-infected patients. Because cytotoxic T lymphocytes (CTL) are thought to contribute actively to resistance against HIV-induced disease, we studied sequentially 10 HIV-infected individuals under zidovudine treatment for a period of 6-12 months. For a given patient all lymphocyte suspensions corresponding to the complete zidovudine therapy period were tested on the same day and on the same target cells. Patients were selected for expression of HLA-A2 and/or HLA-A3 class I transplantation antigen. HLA-restricted cytotoxicity specific for env, gag and nef HIV proteins was quantified for each patient at 6 week intervals. The data clearly indicated that zidovudine has a beneficial effect on the CTL response during the first 6-12 weeks of treatment, inducing cytotoxicity levels up to 100-fold stronger than base line. This effect was usually short lived. However, patients who maintained strong levels of cytotoxicity had better clinical and survival outlook than patients who had lost all detectable cytotoxic lymphocytes. It is proposed that AZT, among other effects, delays the onset of disease in HIV-infected patients by contributing to the stimulation of the HIV-specific CTL response.

In vivo persistence of a HIV-1-encoded HLA-B27-restricted cytotoxic T lymphocyte epitope despite specific in vitro reactivity.

A large number of human immunodeficiency virus type 1 (HIV-1) specific HLA-restricted cytotoxic T cell (CTL) epitopes have been mapped, including an HLA-B27-restricted immunodominant epitope within p25gag. Accordingly, this segment of the HIV-1 provirus was amplified by the polymerase chain reaction from DNA derived from fresh uncultured peripheral blood mononuclear cells (PBMC) of four HLA-B27 HIV-1-infected individuals. In all cases the majority of infected PBMC bore sequences encoding the HLA-B27-restricted peptide. CTL escape mutants had not accumulated in vivo 8 and 14 months later despite demonstrable CTL activity in vitro. These data emphasize the importance of silently infected lymphocytes in evading immune surveillance.

Epitope recognition of conserved HIV envelope sequences by human cytotoxic T lymphocytes.

CTL constitute an essential part of the immune response against the HIV. CTL recognize peptides derived from viral proteins together with the MHC class I molecules on the surface of infected cells. The CTL response could be important in prevention or control of infection with HIV by destroying virus-producing cells. In this study we have attempted to identify peptide epitopes recognized by HIV-specific CTL. Using synthetic peptides, we have identified six conserved peptidic epitopes on the gp120 envelope glycoprotein recognized by polyclonal human CTL in association with HLA-A2 class I transplantation Ag. These results were confirmed by two approaches: i) blocking of CTL activities with antibodies specific for three of these conserved peptides; and ii) construction of doubly transfected P815-A2 target cells, using deletions of the HIV env gene. Vaccination or immunotherapy in HLA-A2 individuals can thus be considered using highly conserved HIV env peptidic sequences.

HIV-specific cytotoxic T lymphocytes against alveolar macrophages: specificities and downregulation.

To analyse the evolution of alveolar-lymphocyte-mediated cytotoxic activity directed against autologous alveolar macrophages (AM), cytotoxic assays against various HIV+ target cells were performed in a cohort of 75 patients with HIV-associated lymphoid interstitial pneumonitis (LIP) studied at distinct stages of HIV infection. Our data confirm that alveolar HIV-specific cytotoxic T lymphocytes (CTL) against AM were detectable before AIDS in patients with CD8+ LIP. Mild CD8+ lymphocytic alveolitis occurs silently in 62% of stage II and III patients with no respiratory symptoms. In these cases, the lack of spontaneous alveolar-lymphocyte-mediated cytotoxic activity against autologous AM may contrast with the detection of primary alveolar CTL specific for HIV proteins such as nef. In AIDS patients, the alveolar CTL lytic efficiency against both AM- and HIV-antigen-expressing cells can be inhibited by a suppressor factor produced by alveolar CD8+ CD57+ cells. Therefore, spontaneous CTL lysis of AM may be (1) limited to a subgroup of patients with active LIP and (2) controlled by distinct mechanisms, including suppressor phenomenons, and HIV replication levels in AM.

HIV-1 infection of lung alveolar fibroblasts and macrophages in humans.

We have studied the infected cell populations in the lungs of four human immunodeficiency virus type 1 (HIV-1) seropositive patients suffering from lymphocytic alveolitis or lymphocytic interstitial pneumonitis. Adherent cells were obtained by bronchoalveolar lavage (BAL) and were analyzed by various technical approaches. The cells considered here were alveolar macrophages and fibroblasts, and could be clearly identified morphologically and by the expression of specific cell-surface markers using monoclonal antibodies. The presence of HIV-1 in both of these cell types was established by serological, virological, and molecular procedures. Our results show that alveolar macrophages and fibroblasts are naturally infected in the lungs of HIV+ patients. Both cell types express the CD4 receptor molecule, in contrast to skin fibroblasts which are negative. Alveolar macrophages and fibroblasts thus may act as eventual HIV-1 reservoirs in vivo, and are probably involved in the induction of inflammatory reactions because they are targets for CD8 cytotoxic T lymphocytes (CTL).

Increased lung epithelial permeability in HIV-infected patients with isolated cytotoxic T-lymphocytic alveolitis.

HIV-related lymphocytic alveolitis is common in HIV-seropositive patients without lung infection or tumor. In some of them a fraction of alveolar lymphocytes are HIV-specific cytotoxic T-lymphocytes (CTL) bearing the CD8 and D44 cell surface markers and capable of killing HIV-infected alveolar macrophages. In order to evaluate the in vivo effect of these CTL on lung function, we measured the pulmonary clearance of aerosolized 99mTc-diethylene triamine penta-acetate (DTPA-CI) on 24 occasions in 22 patients with lymphocytic alveolitis. DTPA-CI has been selected as a highly sensitive test to detect injury of the lung epithelium. In 13 of the patients, we found a high DTPA-CI of 4.56 +/- 2.54%.min-1 (mean +/- SD), suggesting an increase of the epithelial permeability. The lymphocytic alveolitis was then characterized by a high cellularity, a high proportion of lymphocytes (59 +/- 18%), mainly composed of CD8+D44+ T-lymphocytes (149 +/- 109 cells/mm3), which spontaneously exhibited a cytolytic activity against the autologous alveolar macrophages in a standard 51Cr release assay. In the remaining 11 patients, DTPA-CI was normal (less than 1.78%.min-1), lymphocytic alveolitis being characterized by a low number or an absence of CD8+D44+ alveolar lymphocytes (9 +/- 13 cells/mm3) with no significant cytolytic activity. In the whole group, a significant correlation (r = 0.74, p = 0.0004) was found between the DTPA-CI and the number of CD8+D44+ lymphocytes and their cytotoxic activity against alveolar macrophages. Altogether, these results suggest that an injury of the lung epithelium could result from a HIV-specific CTL-induced immunologic conflict.

HIV-specific cytotoxic T lymphocytes directed against alveolar macrophages in HIV-infected patients.

A CD8+ lymphocytic infiltration of the lungs is frequently observed in HIV-infected patients, even prior to the onset of opportunistic infections. In such patients, we could demonstrate that most of these CD8+ alveolar T lymphocytes displayed the D44 marker and were functional cytolytic T lymphocytes directed against autologous HIV-infected alveolar macrophages. This primary cytolytic activity was HLA-restricted and, at least partially, specific for the HIV envelope protein, since HLA-A2 alveolar T lymphocytes could specifically lyse cell lines expressing both the HLA-A2 and Env antigens. In contrast to data obtained in peripheral blood, no ADCC activity was observed against the Env antigen. HIV-specific alveolar T-lymphocyte cytolytic activity decreased with progression towards AIDS as shown by studies of a series of 40 patients. Functional abnormalities of the lung epithelium could be associated with the specific lysis of alveolar macrophages, suggesting that local tissue injury could result from the in vivo immune conflict between alveolar HIV-specific CTL and HIV-infected macrophages.