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  • 1
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    American Society of Hematology ; 2009
    In:  Blood Vol. 114, No. 12 ( 2009-09-17), p. 2417-2426
    In: Blood, American Society of Hematology, Vol. 114, No. 12 ( 2009-09-17), p. 2417-2426
    Abstract: The administration of cytokines that modulate endogenous or transferred T-cell immunity could improve current approaches to clinical immunotherapy. Interleukin-2 (IL-2) is used most commonly for this purpose, but causes systemic toxicity and preferentially drives the expansion of CD4+CD25+Foxp3+ regulatory T cells, which can inhibit antitumor immunity. IL-15 belongs to the γc cytokine family and possesses similar properties to IL-2, including the ability to induce T-cell proliferation. Whereas IL-2 promotes apoptosis and limits the survival of CD8+ memory T cells, IL-15 is required for the establishment and maintenance of CD8+ T-cell memory. However, limited data are available to guide the clinical use of IL-15. Here, we demonstrate in nonhuman primates that IL-15 administration expands memory CD8+ and CD4+ T cells, and natural killer (NK) cells in the peripheral blood, with minimal increases in CD4+CD25+Foxp3+ regulatory T cells. Daily administration of IL-15 resulted in persistently elevated plasma IL-15 levels and transient toxicity. Intermittent administration of IL-15 allowed clearance of IL-15 between doses and was safe for more than 3 weeks. These findings demonstrate that IL-15 has profound immunomodulatory properties distinct from those described for IL-2, and suggest that intermittent administration of IL-15 should be considered in clinical studies.
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    Publication Date: 2009
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  • 2
    In: Blood, American Society of Hematology, Vol. 106, No. 11 ( 2005-11-16), p. 4308-4308
    Abstract: The rarity of adult bone marrow native mesenchymal stem/progenitor cells and the difficulty in characterizing them in fresh organs renders their amplification necessary before use. Little is known about NPM and the correlation between the properties of amplified cells and those of NPM remains unknown. To study the NPM, the sorted fresh CD45− CD14− CD73+ cell subsets (Boiret et al., Exp. Hematol. 2005) were seeded in a cloning assay. We studied the proliferation ability of mesenchymal cells (MC) from bone marrow (BM) grafts (n=35), filtered hematons (H) (n=10), and spongious bone from femoral head (FH) (n=131), until P2-3 (mean culture duration: 6 weeks in IMDM 10% FCS 1% L-Glutamin). The median age of patients was 38±3 years ranging from 21 to 75 years. Seeding of fresh FH CD45− CD14− CD73+ at very low densities showed that about 0.6% of these cells adhered with a fibroblast-like morphology. More than 60 % of them were NMP and capable of cloning, with a very heterogeneous proliferation amplitude. In the first 10 days, cell proliferation represented a mean of 3.8 doubling population (DP). Addition of EGF and PDGF accelerated this proliferation (6.4 DP) and increased the size of initial clones with no increase in the number of CFU-F. In BM, H and FH, the frequency of CD45− CD14− CD73+ cells in the mononuclear population was 0.02±0.004, 0.47±0.25 and 0.43±0.03%, respectively. That of mesenchymal progenitors (CFU-F) was 15.6±2.7 (BM), 85.18±17.3 (H) and 108.5±7.8 (FH)/106 initial cells, with a majority (60%) of large colonies ( & gt;50 cells). The frequency of CFU-F amongst native adherent cells (up to 60%) dramatically decreased since after P0 then appeared relatively stable (down to 7%) during passaging. In parallel, whatever the origin of the MC, the size of colonies decreased progressively, resulting in a majority of & lt;50 cell-colonies at P3. Similarly, we observed that primary culture (P0) showed an average of 15 DP until confluence. After the first trypsinization, cell amplification clearly decreased and remained stable with a mean of 3 DP for each following passage (P1, P2, and P3). Cell proliferation was definitely reduced after about 25 DP, associated with a decrease in colony size. In conclusion, the majority of native BM adherent cells were mesenchymal progenitors. Their in vitro expansion was associated with a clearly decrease in cloning efficiency amongst their progeny from the earliest culture period and with a gradual decrease in their individual proliferative ability, revealing a marked reduction in NMP proliferative potential in standard culture medium. Expanded cells may not be biologically identical to NMP. Therefore, we confirmed here that most NMP from BM collections were in hematons, tissue aggregates usually eliminated by BM filtration. It is necessary now to define other conditions of culture for NMP amplification.
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    Publisher: American Society of Hematology
    Publication Date: 2005
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  • 3
    In: Blood, American Society of Hematology, Vol. 120, No. 21 ( 2012-11-16), p. 4425-4425
    Abstract: Abstract 4425 Introduction: Despite the major benefit of TKI in the treatment of Chronic Myeloid Leukemia (CML) chronic phase, some of patients are resistant or progress to blast phase (BP) becoming not very accessible to therapy. We have been interested in the Syk molecule as a potential marker for CML progression for several reasons: i) its potential interaction with Src kinases, activated by BCR-ABL, and tyrosine kinase receptors, ii) its involvement in the molecular complexes activating actin and the cytoskeleton and integrin signalling pathways, regulating cell adhesion, a property that is impaired in CML, iii) its interaction with the PI3K/Akt pathway, activated by BCR-ABL. Furthermore, resistance to nilotinib was recently showed dependent on Syk expression. Method: The amount of Syk transcript was analyzed in primary cells using the 2-ΔΔ Ct method and was normalized to the endogenous reference gene (β2-microglobuline) and K562 cells as the calibrator. Using flow cytometry, we evaluated the expression of Syk and pSyk348 in K562 cells and in polymorphonuclear cells from 3 healthy donors (HD-PMN), primitive CML cells from 15 patients in chronic phase (CP) (patients #1 to #15) at diagnosis, in the blast cells from 4 patients in accelerated phase (AP) (patient#16, #17, #18 and #19) and from 2 patients in blast crisis (BC) (patient#20, #21). The level of intracellular dasatinib (DAS) was evaluated by an original flow cytometry method (Bourgne et al. Cytometry Part A, in press). Results: We observed a significant over expression of Syk mRNA in BP-CML cells, whereas there is no difference between HD-PMN and CP-CML cells. At the protein level we detected a decrease (2 times; p 〈 0.001) in and a tendency to increase (1.5 times; p=0.5) in the expression of Syk in CP-CML cells and BP-CML cells respectively compared with HD-PMN cells. Interestingly, we did not observe any expression of pSyk348 in HD-PMN or in granulocytic cells from CP-CML (n=15) but we systematically detected pSyk348 expression in the blast cells of the 6 patients (positive/control ratio: 2.3 ± 0.3) in advanced phases of CML. Moreover we did not found Syk phosphorylation in CP cells from one patient resistant to imatinib, then nilotinib and dasatinib but we detected pSyk348 only when his CML progressed, strengthening the hypothesis of a link between Syk phosphorylation and BP of CML. We confirmed in vitro that Dasatinib was able to rapidly (15 min) inhibit Syk phosphorylation in K562 cells and in blast cells from patient #17. Then we could follow dasatinib uptake into target blast cells, and expression of pSyk348 before and 6, 12, 36, 60, 84 and 136 hours after the first dose of DAS. We observed a significant storage of DAS in blast cells reaching a plateau after the 4th dose even though analyses were done 12 hrs after each dose. However, after a slight fall of blood leukocytes and blast cells numbers corresponding to a sharp drop of pSyk348 we observed an increase of blood malignant cells in parallel of a strong recurrence of pSyk348 at H60. Discussion: We observed a constitutive expression of Syk348 only in blast cells from advanced phases of CML, including in one patient we could follow from the TKI resistant phases to blast phase, strongly suggesting that Syk activation could be a pertinent biomarker for CML progression and could represent a potential target for combinatory therapy. The fact that we observed in one patient a correlation between Syk348 expression and malignant cell resistance even though cells stored dasatinib suggests a BCR-ABL/Src kinases independent mechanism of Syk phosphorylation in blast cells. Targeting Syk in BP-CML should offer new therapeutic option to patients with disease progression. Disclosures: No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Publisher: American Society of Hematology
    Publication Date: 2012
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  • 4
    In: Blood, American Society of Hematology, Vol. 87, No. 10 ( 1996-05-15), p. 4433-4439
    Abstract: We studied 20 individuals from 17 unrelated families with congenital dyserythropoietic anemia (type II; CDAII). The clinical phenotype was mild to moderate. The inheritance pattern was invariably recessive. Coomassie blue stained gels after sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) show that band 3 was thinner and migrated slightly faster than usual. In addition, staining showed two unknown minor bands (in the patients), but not in normal controls, the obligate carrier parents, or in patients with other anemic syndromes. These minor proteins were studied using partial digestion, amino acid sequencing, Western blotting, immunofluorescence, and immunogold electron microscopy. They were identified as the glucose-regulated protein GRP78 and calreticulin that are resident proteins of the endoplasmic reticulum (ER). Using specific antibody, we showed that protein disulfide isomerase (PDI), a third major protein of the ER, was also present on the SDS-PAGE of red blood cell (RBC) ghosts. Immunofluorescence colocalized PDI with the dense discontinuous ring decorating the RBC membrane. Immunogold electron microscopy showed that PDI was localized in the lumen of the cisternae, confirming that these originate from the smooth ER. From a practical point of view, screening the above minor proteins in RBC membranes appears to be a straightforward and reliable diagnostic test for CDAII.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Publisher: American Society of Hematology
    Publication Date: 1996
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  • 5
    In: Blood, American Society of Hematology, Vol. 124, No. 21 ( 2014-12-06), p. 4363-4363
    Abstract: Hematopoietic stem cell (HSC) function is critical in maintaining hematopoiesis continuously throughout the lifespan of an organism and any change in their ability to self-renew and/or to differentiate into blood cell lineages induces severe diseases. Postnatally, HSC are mainly located in bone marrow where their stem cell fate is regulated through a complex network of local influences, thought to be concentrated in the bone marrow (BM) niche. Despite more than 30 years of research, the precise location of the HSC niche in human BM remains unclear because most observations were obtained from mice models. BM harvesting collects macroscopic coherent tissue aggregates in a cell suspension variably diluted with blood. The qualitative interest of these tissue aggregates, termed hematons, was already reported (first by I. Blaszek's group (Blaszek et al., 1988, 1990) and by our group (Boiret et al., 2003)) yet they remain largely unknown. Should hematons really be seen as elementary BM units, they must accommodate hematopoietic niches and must be a complete ex vivo surrogate of BM tissue. In this study, we analyzed hematons as single tissue structures. Biological samples were collected from i) healthy donor bone marrow (n= 8); ii) either biological samples collected for routine analysis by selecting bone marrow with normal analysis results (n=5); or iii) from spongy bone collected from the femoral head during hip arthroplasty (n=4). After isolation of hematons, we worked at single level, we used immunohistochemistry techniques, scanning electronic microscopy, confocal microscopy, flow cytometry and cell culture. Each hematon constitutes a miniature BM structure organized in lobular form around the vascular tree. Hematons are organized structures, supported by a network of cells with numerous cytoplasmic expansions associated with an amorphous structure corresponding to the extracellular matrix. Most of the adipocytes are located on the periphery, and hematopoietic cells can be observed as retained within the mesenchymal network. Although there is a degree of inter-donor variability in the cellular contents of hematons (on average 73 +/- 10 x103 cells per hematon), we observed precursors of all cell lines in each structure. We detected a higher frequency of CD34+ cells than in filtered bone marrow, representing on average 3% and 1% respectively (p 〈 0.01). Also, each hematon contains CFU-GM, BFU-E, CFU-Mk and CFU-F cells. Mesenchymal cells are located mainly on the periphery and seem to participate in supporting the structure. The majority of mesenchymal cells isolated from hematons (21/24) sustain in vitro hematopoiesis. Interestingly, more than 90% of the hematons studied contained LTC-ICs. Furthermore, when studied using confocal microscopy, a co-localization of CD34+ cells with STRO1+ mesenchymal cells was frequently observed (75% under 10 µm of the nearest STRO-1+ cell, association statistically highly significant; p 〈 1.10-16). These results indicate the presence of one or several stem cell niches housing highly primitive progenitor cells. We are confirming these in vitro data with an in vivo xenotransplantation model. These structures represent the elementary functional units of adult hematopoietic tissue and are a particularly attractive model for studying homeostasis of the BM niche and the pathological changes occurring during disease. Disclosures No relevant conflicts of interest to declare.
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    ISSN: 0006-4971 , 1528-0020
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    Publisher: American Society of Hematology
    Publication Date: 2014
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  • 6
    In: Blood, American Society of Hematology, Vol. 108, No. 11 ( 2006-11-16), p. 4944-4944
    Abstract: Translocation t(14;19)(q32;q13) juxtaposing BCL3 in 19q13 with IGH in 14q32, is a rare recurrent event found in patients with B-cell malignancies. So far, a few cases of well-documented B-cell neoplasm have been reported. We analyzed 34 patients with t(14;19) and 1 patient with a variant t(2;19)(p11;q13) collected by the Groupe Francophone de Cytogenetique Hematologique on the basis of cytogenetic abnormality. Clinico-biological data, morphological review, immunophenotyping with Matutes’ score, conventional karyotype and FISH analysis with BCL3, IGH, CEP12, 13q14, ATM, TP53, 6q21 probes, and IgVH mutational status were recorded. The sex ratio was 22M/13F, the median age at diagnosis was 61 [39–89] , the lymphocyte count was & gt; 4×109/l in 96% of patients, and spleen enlargement was found in 47%. 31% (11/35) were morphologically classified CLL, 37% (13/35) atypical CLL, 20% (7/35) MZL; 79% had features of disease progression; 3 of the 4 latter were Diffuse Large B Cell Lymphoma, possibly transformed from MZL. 87% were CD5+, 72% had a Matutes’ score & lt; 3. The IgVH genes were unmutated in 9/11 cases. The time to treatment was & lt; 1 year in 68% of patients. The BCL3 locus involvement was confirmed by FISH analysis in all cases. 46% of cases showed complex karyotype. The chromosomal abnormalities associated with t(14;19) were +12 (57%), 6q- (27%), +3 (15%), 11q- (15%), 13q- (13%), 17p- (12%), +18 (12%), 7q- (12%). Comparison with published cytogenetic CLL data shows that deletion 6q was frequent and deletion 13q uncommon. Trisomies 3 and 18, and 7q deletion are less common than in published MZL. The independent analysis of our series of CLL/atypical CLL and MZL gave the same tendency. The chromosomal abnormalities associated with t(14;19) are not specific, but their frequencies are between those of typical CLL and MZL suggesting an intermediary status between the 2 malignancies. The t(14;19) identifies a subgroup of B-disorders CD5+ and Matutes’ score & lt; 3, which could be of poor prognosis, based on progressive disease and unmutated status.
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    Publication Date: 2006
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  • 7
    In: Blood, American Society of Hematology, Vol. 112, No. 11 ( 2008-11-16), p. 679-679
    Abstract: The adoptive transfer of antigen-specific CD8+ cytotoxic T lymphocytes (CTL) that have been expanded in vitro is a promising treatment for human malignancies and infections. Interleukin (IL)-2 is frequently administered to support the in vivo survival of transferred T cells, but causes systemic toxicity when given in high doses and promotes the expansion of CD4+ regulatory T cells, which can inhibit antitumor immunity. IL-15, like IL-2, belongs to the four α-helix bundle family of cytokines and shares functional activities with IL-2, including binding to the IL-2 receptor (R) β and γc signaling components and promoting the proliferation of activated T cells in vitro. Despite the similar structure and in vitro function of IL-2 and IL-15, mice deficient in IL-15 or IL-15Rα have a marked reduction in natural killer (NK) cells, NKT cells, and CD8+ memory cells, whereas mice deficient in IL-2 or IL-2Rα have lymphoid hyperplasia and autoimmunity. Because of its critical role in the maintenance of T cell memory, IL-15 is an attractive alternative to IL-2 for augmenting adoptively transferred T cell immunity in humans. We administered IL-15 subcutaneously to nonhuman primates and evaluated toxicity, immunological effects, and peak and trough plasma levels. After establishing a safe regimen of IL-15 dosing, we evaluated the ability of IL-15 to support the survival of adoptively transferred CD8+ effector T cell (TE) clones in vivo. Results: IL-15 was administered subcutaneously to five macaques at doses ranging from 2.5 – 15 μg/kg, given either daily or every 3 days, respectively. The animals were monitored for clinical toxicity and plasma levels. Peripheral blood T cell subsets were enumerated at intervals and evaluated for phenotype and expression of Ki-67, a nuclear antigen expressed by cells undergoing proliferation. Daily administration of high-dose IL-15 resulted in a pronounced increase in the absolute numbers and Ki-67-expression of CD8+ T cells and NK cells, respectively, and preferentially expanded CD8+CD95+CCR7− effector memory (TEM) and CD8+CD95+CCR7+ central memory T cells (TCM). However, daily IL-15 in doses of 5 – 15 μg/kg was associated with accumulation of IL-15 in serum, and caused toxicities that were reversible when IL-15 was discontinued. By contrast, intermittent IL-15 treatment every 3 days was safe and induced only a moderate increase in NK cells, CD8+ TEM and TCM, and enhanced expression of Ki-67 in these cell subsets. This coincided with an increase of the absolute number of cytomegalovirus (CMV)-specific CD8+ T cells in the peripheral blood, but total numbers of CD4+ FoxP3+ T cells were not increased with IL-15. We then examined the ability of IL-15 administered every 3 – 4 days for 3 weeks to support the in vivo persistence of TCM-derived CMV-specific CD8+ TE clones that were marked to express a truncated macaque CD19 surface molecule and transferred to the animals without prior lymphodepletion. As previously reported, CD8+ TE clones derived from TCM precursors survive in vitro in low-doses of IL-15 in the absence of T cell receptor stimulation, persist long term in vivo after transfer and revert to the memory pool (Berger et al, JCI2008, 118:294). In comparison with animals that received CD8+ T cells alone in which transferred T cells persisted at a stable level of 0.2 – 0.8% of circulating CD8+ cells, the administration of IL-15 after T cell transfer resulted in the establishment of a high-level T cell response (10 – 15% of CD8+ T cells; 〉 100 cells/μL) that persisted for 〉 6 months after IL-15 was discontinued. The CD19+CD8+ TE clones re-acquired a memory T cell phenotype in vivo and expressed bcl-2, bcl-xL and Ki-67 comparable to endogenous CD8+ T cells. The transferred cells were present in large numbers in bone marrow and lymph node samples obtained on day 14 and day 56 after infusion suggesting that they efficiently occupied niches of T cell memory. This data in a large animal model predictive of clinical translation demonstrates that IL-15 can be safely administered, exerts a profound immunologic effect, and dramatically augments the long-term survival of ex vivo expanded antigen-specific CD8+ CTL clones after adoptive transfer without promoting in vivo expansion of CD4+ Foxp3+ regulatory cells. Thus, IL-15 may be a safer and more effective alternative to IL-2 and/or lymphodepletion to support the in vivo persistence of adoptively transferred tumor or virus-specific T cells in human immunotherapy.
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    Publication Date: 2008
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  • 8
    In: Blood, American Society of Hematology, Vol. 118, No. 21 ( 2011-11-18), p. 1102-1102
    Abstract: Abstract 1102 Introduction: Gaucher disease (GD) is due to an inborn deficiency of glucocerebrosidase (GC), that leads to the accumulation of glucosylceramide in monocytes/macrophages, known as “Gaucher cells”, which are thought to be responsible for a wide range of symptoms. Imiglucerase (CEREZYME®, Genzyme Corporation) (IMI) is the first line treatment of type 1 GD patients. Two new biosimilar agents, velaglucerase-alfa (VPRIV®, Shire Human Genetic Therapies, Dublin, Ireland) (VEL) and taliglucerase-alfa (PROTALIX®, Biotherapeutics, Pfizer) (TAL), have been described as being similar to IMI but differing slightly in glycan structure which could have an impact on macrophage uptake and thus on therapeutic efficacy. However, the ability of native GD cells to capture recombinant enzymes (REs) remains unknown. We used blood monocytes (Mo) from GD patients and healthy donors (HD) as a model to compare the uptake of the three REs. Patients and methods: After informed consent was obtained, cells were obtained from healthy donor blood (n=34). The left over part of biological samples collected for routine analysis from Gaucher patients (n=6) could be used for research because patients had been informed and did not verbally express any disagreement. Mononuclear cells were incubated with three concentrations of each RE (0.1, 0.5 and 1 U/ml) at 37°C for 30 minutes and one hour and washed twice with PBS to eliminate exogenous RE before evaluation of intra-cellular GC activity by standardized flow cytometry as previously described (Berger J. et al., Br J Haematol 2010) Results: Firstly, we confirmed that GD Mo (n=6) showed a marked enzyme deficiency (about 7% of the normal endogenous activity) as compared to normal glucocerebrosidase activity (GCA) (n=34) Then we observed a dose-dependent in vitro uptake of IMI, TAL and VEL in Mo from 4 untreated GD patients. However, the intra-monocyte (IMo) GCA of TAL was systematically lower than that of IMI and VEL. Case analysis showed an inter-patient heterogeneity, with the highest increase of intra-monocyte enzyme activity for all REs in patient #2 and the lowest in patient #3; this observation was confirmed in vivo by analysis of Mo 15 min. after the end of the first IMI infusion (× 38 and × 9 endogeneous IMoGCA respectively) whereas patient #2 had received a lower dose of enzyme (45 U/kg/2 weeks vs 60 U/kg/2 weeks). Interestingly, patient #2 showed mild GD suffering only thrombocytopenia and asthenia while patient #3 had an aggressive form of GD, with bone disorders (aseptic osteonecrosis, bone infarction and pseudarthrosis after traumatic fracture). Patient #2 responded rapidly, with improved thrombocytopenia (68%) and increased hemoglobin level (+1.9g/dL) from M3 but hematological response for patient #3 could not be evaluated because initial parameters had been normal in this patient who had been splenectomized 20 years ago. Because of the chitotriosidase deficiency of patient #2, we used plasma CCL18 as a biomarker; its kinetic of decrease was clearly more rapid than for patient #3. Similarly, correction of glycosylated-ferritin was better than in patient #2. The two other patients with IMoGCA values close to that of patient #2 had non-progressive disease not requiring treatment (patient #1), or had thrombocytopenia that improved over the expected period of time (patient #4). Discussion: In conclusion, this study shows inter-patient variability in the ability of blood Mo to store recombinant enzymes which to our knowledge has not been previously reported. This was confirmed in vivo 15 min. after the start of the infusion. This variability could partially explain the heterogeneity of GD response to enzyme replacement therapy. In this small series, the least aggressive disease corresponded to the highest intra-monocyte GCA and the most aggressive disease to the least intra-monocyte GCA. Six-month follow-up showed differences in change in biological biomarkers suggesting a relationship between intra-monocyte GCA and disease response. Furthermore in this in vitro GD Mo model, all the compounds available are not similar, even if their chemical structures are only slightly different with no relationship with the expression of the CD206 (data not shown). Another RE influx mechanism could exist and influence enzyme replacement therapy. These findings could help in customizing replacement therapy. Disclosures: Belmatoug: Genzyme: Consultancy; Shire: Research Funding. Berger:Shire: Consultancy; Genzyme: Consultancy, Research Funding.
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    Publication Date: 2011
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  • 9
    In: Blood, American Society of Hematology, Vol. 124, No. 21 ( 2014-12-06), p. 1396-1396
    Abstract: GD is a genetic lysosomal disease characterized by deficiency in glucocerebrosidase (Glc) particularly affecting macrophage-like cells where glucocerebroside accumulates in the lysosomes. Alglucerase then imiglucerase (IMI, Genzyme-Sanofi Corporation), a recombinant human glucocerebrosidase, improved or reversed many type 1 GD symptoms; Two new biosimilar agents are now available: velaglucerase-alfa (Shire Human Genetic Therapies) and taliglucerase-alfa (Biotherapeutics, Pfizer). All three recombinant enzymes are administered with identical therapeutic regimens, i.e. one infusion (30-60 IU/kg) every two weeks. However, disease responses remain variable and there are no pharmacokinetic explanations justifying this dosage regimen since plasma half-life is estimated to be less than 10 min. in murine models and in humans We compared endogenous glucocerebrosidase (Glc) activity evaluated by flow cytometry in the blood monocyte (Mo) compartment of 20 patients with 71 healthy donors, and we then followed residual intra-Mo Glc activity in patients starting imiglucerase (n=8). By using the only technique able to identify blood leukocyte subsets, we confirmed the marked higher value in Mo (×43) as compared to lymphocytes and polymorphonuclear (PMN) cells. In the 20 type 1 GD patients, we confirmed that enzyme deficiency was clear in Mo (p = 10-11 compared to HD), residual Glc activity in Mo from type 1 GD representing only 10% of normal Glc activity. We then followed trough Glc activity in 8 patients starting imiglucerase treatment de novo (n=1) or restarting imiglucerase after shortage (n=7), at 40 (n=1) or 60 U (n=7) /Kg/2 weeks. We observed progressive uptake over 6 months and a significant cumulative persistence of enzyme activity in monocyte compartment even 14 days after infusion. The estimated increase of residual intra-monocyte enzyme activity at M6 was 1.4 of endogenous level (p=.04) leading to a steady state value. The estimated rate constant of increase corresponded to an initial half-life of 2.8 days. These results explain for the first time the clinical efficacy of the routine infusion regimen, since intra-cellular pharmacokinetics are longer than plasma pharmacokinetics. Furthermore, we can hypothesize that intra-cellular pharmacokinetics after infusion may vary between patients, as suggested by the different peaks of activity and variable residual levels of enzyme activity observed in this study. In this limited series, we observed several profiles: i) Four patients ( #1,2,3, 8) of whom one received 40 U/kg/2 weeks, showed progressive Glc uptake correlated with improvement of clinical and biological parameters; this corresponds to patients with hematological phenotype only (Figure S1 A). ii) Other patients showed variability of Glc uptake (Figure S1 B); these patients were more heterogenous, with bone disease (n=2), splenectomy (n=2), or BM disorders (myelodysplasia, n=1). Consequently intra-Mo imiglucerase uptake appears to be variable, suggesting for the first time a possible relation between Glc activity in cell compartments, phenotype and clinical efficacy. In summary, the persistence of imiglucerase in monocyte compartments explains the efficacy of 2-week infusion rates and variability may be a factor of ERT efficiency Disclosures Stirnemann: Genzyme/Sanofi: Consultancy. Belmatoug:Genzyme/Sanofi and Shire: Consultancy, Membership on an entity's Board of Directors or advisory committees. Rose:Genzyme: Consultancy, Membership on an entity's Board of Directors or advisory committees. Berger:Genzyme/Sanofi and Shire: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding.
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    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2014
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  • 10
    In: Blood, American Society of Hematology, Vol. 110, No. 11 ( 2007-11-16), p. 1192-1192
    Abstract: Fludarabine phosphate (FDR) is considered the most effective drug for treating aggressive B-cell Chronic Lymphocytic Leukemia (B-CLL). Nevertheless, several groups have reported negative effects on BM HP mobilization by G-CSF alone after several months and sometimes correlated with the blood platelet count. As it was previously reported that in vivo FDR-induced cytopenia suggesting toxicity towards HP, we postulate that FDR could impair two major cell components of the bone marrow niche - mesenchymal (MP) and hematopoietic cells - and durably alter the HP egress process. We assessed the effects of increasing doses of FDR (for 5 days) on normal BM MP and HP biological properties, on HP adherence to fibronectin (Fn) or stromal cells and on SDF-1-induced in vitro migration. The expression of molecules involved in HP egress, i.e. CXCR4, CD49d and CD106, was evaluated by flow cytometry. As we demonstrated previously that all MP express CD73, an ecto-nucleotidase probably involved in FDR metabolism, we then tested the effect of a specific CD73 inhibitor (α, b methylene adenosine 5′-diphosphate (MADP)) on MP response to FDR treatment. In two independent series, we found a dose-dependent toxic effect of FDR on BM mononuclear cells, particularly on clonogenic mesenchymal progenitors (MP) (n=8) and hematopoietic progenitors (HP) (n=9). The most sensitive progenitors were MP, BFU-E and CFU-Mk (from 1mM dose) but other progenitors (CFU-GM, CFU-Mix), including the most primitive (LTC-IC) (n=3), were also dose-dependently sensitive. We found that toxicity of FDR on MP was CD73-independent since no improvement in cell survival was observed in presence of MADP (n=4). Interestingly, after expanding the surviving cells, we observed that FDR-induced impairment of the proliferative capacity of input MP was transmitted to cell progeny during the following passages. This means that progeny-derived cells, that have not been directly in contact with FDR, are still affected by the initial dose of FDR in a dose-dependent fashion. In the hematopoietic compartment, FDR had no effect on mononuclear cell adhesion, but there was an increase in the adhesion of HP colony-forming cells (CFC) which correlated with an inhibition of SDF-1 induced migration. However, FDR did not modify the expression of CXCR4, CD49d or CD106 on mesenchymal (CD45CD14) − /CD73+ cells or hematopoietic CD34+ cells. In conclusion, FDR appeared toxic towards clonogenic MP and HP, and profoundly impaired cell metabolism, since the effect persisted in cell progeny. The high sensitivity of the mesenchymal component suggests a possible impairment of BM stem cell niches. Although there was no modification of expression of molecules involved in egress, increased CFC adhesion and inhibition of HP migration suggest a FDR-induced retention of HSC in bone marrow. We are currently evaluating these parameters in MP and HP cells isolated from the bone marrow of CLL patients.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2007
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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