Pub Date : 2024-10-18DOI: 10.1016/j.banm.2024.05.007
Antoine Magnan
L’immunisation contre les allergènes obtenue au cours de l’immunothérapie spécifique des allergènes (ISA) peut être considérée comme une vaccination puisqu’il s’agit d’induire une réponse immunitaire protectrice durable grâce à l’administration de l’agent pathogène. Ce traitement est efficace contre les allergies au venin d’hyménoptères, et contre la rhinite et l’asthme déclenchés par les pollens et les acariens. Son intérêt par voie orale augmente pour l’allergie alimentaire à l’arachide mais c’est dans ce domaine que le niveau de preuve est le plus faible. Ses mécanismes sont de mieux en mieux connus, avec une réorientation de la réponse immune vers celle des non allergiques. De plus, l’ISA est capable de modifier le cours de l’allergie, en étant efficace sur le long terme, mais aussi en prévenant de nouvelles sensibilisations et la survenue de l’asthme. Sa place dans l’arsenal thérapeutique récemment enrichi des anticorps monoclonaux doit maintenant être précisée, au regard de son intérêt possible en association avec les biothérapies dans les formes sévères d’asthme. C’est ainsi que l’allergie doit désormais être considérée comme une caractéristique traitable à part entière dans les maladies chroniques médiées par l’inflammation de type 2.
Allergen immunization obtained during allergen-specific immunotherapy (AIT) can be considered as vaccination since it aims to induce a lasting protective immune response by administering the pathogen. This treatment is effective against allergies to hymenoptera venom, as well as against pollen and dust mite-induced rhinitis and asthma. Its interest via oral route is increasing for peanut allergy, but this is in this area that the level of evidence is the weakest. Its mechanisms are better understood, with a shift of the immune response towards non-allergic pathways. Moreover, AIT can alter the course of allergy, being effective in the long term, and also in preventing new sensitizations and the onset of asthma in rhinitic patients. Its place in the recently enriched therapeutic arsenal of monoclonal antibodies must now be clarified, considering its potential benefit in combination with biologic therapies in severe forms of asthma. Thus, allergy must now be considered as a fully treatable trait in chronic diseases mediated by type 2 inflammation.
在过敏原特异性免疫疗法（ASI）中获得的过敏原免疫可被视为疫苗接种，因为其目的是通过注射病原体诱导持久的保护性免疫反应。这种治疗方法对膜翅目昆虫毒液过敏、花粉和室内尘螨引发的鼻炎和哮喘都很有效。越来越多的人通过口服这种药物来治疗对花生的食物过敏，但这方面的证据最薄弱。人们对 ISA 的作用机制有了更深入的了解，它能将免疫反应重新导向非过敏症患者的免疫反应。此外，ISA 还能改变过敏的进程，不仅长期有效，而且还能预防新的过敏反应和哮喘的发生。考虑到 ISA 与生物疗法结合治疗严重哮喘的可能价值，现在需要明确 ISA 在最近扩大的单克隆抗体治疗领域中的地位。在过敏原特异性免疫疗法（AIT）中获得的过敏原免疫可被视为疫苗接种，因为其目的是通过注射病原体诱导持久的保护性免疫反应。这种治疗方法对膜翅目昆虫毒液过敏、花粉和尘螨引起的鼻炎和哮喘都很有效。通过口服途径治疗花生过敏越来越受到关注，但这一领域的证据水平最弱。人们对 AIT 的作用机制有了更深入的了解，免疫反应转向了非过敏途径。此外，AIT 还能改变过敏症的病程，长期有效，还能预防新的过敏症和鼻病患者哮喘的发生。考虑到 AIT 与生物疗法联合治疗严重哮喘的潜在益处，现在必须明确 AIT 在最近丰富的单克隆抗体治疗药物库中的地位。因此，现在必须将过敏视为由 2 型炎症介导的慢性疾病中一种完全可治疗的特征。
{"title":"Vaccination contre les allergies : immunothérapie spécifique des allergènes","authors":"Antoine Magnan","doi":"10.1016/j.banm.2024.05.007","DOIUrl":"10.1016/j.banm.2024.05.007","url":null,"abstract":"<div><div>L’immunisation contre les allergènes obtenue au cours de l’immunothérapie spécifique des allergènes (ISA) peut être considérée comme une vaccination puisqu’il s’agit d’induire une réponse immunitaire protectrice durable grâce à l’administration de l’agent pathogène. Ce traitement est efficace contre les allergies au venin d’hyménoptères, et contre la rhinite et l’asthme déclenchés par les pollens et les acariens. Son intérêt par voie orale augmente pour l’allergie alimentaire à l’arachide mais c’est dans ce domaine que le niveau de preuve est le plus faible. Ses mécanismes sont de mieux en mieux connus, avec une réorientation de la réponse immune vers celle des non allergiques. De plus, l’ISA est capable de modifier le cours de l’allergie, en étant efficace sur le long terme, mais aussi en prévenant de nouvelles sensibilisations et la survenue de l’asthme. Sa place dans l’arsenal thérapeutique récemment enrichi des anticorps monoclonaux doit maintenant être précisée, au regard de son intérêt possible en association avec les biothérapies dans les formes sévères d’asthme. C’est ainsi que l’allergie doit désormais être considérée comme une caractéristique traitable à part entière dans les maladies chroniques médiées par l’inflammation de type 2.</div></div><div><div>Allergen immunization obtained during allergen-specific immunotherapy (AIT) can be considered as vaccination since it aims to induce a lasting protective immune response by administering the pathogen. This treatment is effective against allergies to hymenoptera venom, as well as against pollen and dust mite-induced rhinitis and asthma. Its interest via oral route is increasing for peanut allergy, but this is in this area that the level of evidence is the weakest. Its mechanisms are better understood, with a shift of the immune response towards non-allergic pathways. Moreover, AIT can alter the course of allergy, being effective in the long term, and also in preventing new sensitizations and the onset of asthma in rhinitic patients. Its place in the recently enriched therapeutic arsenal of monoclonal antibodies must now be clarified, considering its potential benefit in combination with biologic therapies in severe forms of asthma. Thus, allergy must now be considered as a fully treatable trait in chronic diseases mediated by type 2 inflammation.</div></div>","PeriodicalId":55317,"journal":{"name":"Bulletin De L Academie Nationale De Medecine","volume":"208 9","pages":"Pages 1279-1287"},"PeriodicalIF":0.3,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142655807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-09DOI: 10.1016/j.banm.2024.10.017
Hugues Duffau
{"title":"Discussion suite à la communication « Vers un modèle en méta-réseau du fonctionnement cérébral : contribution de la chirurgie éveillée des gliomes de bas grade et implications thérapeutiques »","authors":"Hugues Duffau","doi":"10.1016/j.banm.2024.10.017","DOIUrl":"10.1016/j.banm.2024.10.017","url":null,"abstract":"","PeriodicalId":55317,"journal":{"name":"Bulletin De L Academie Nationale De Medecine","volume":"208 9","pages":"Pages 1349-1350"},"PeriodicalIF":0.3,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142650828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-09DOI: 10.1016/j.banm.2024.10.016
Jean-Louis Beaudeux
{"title":"Discussion suite à la communication « La protéine S100B, premier marqueur pour le diagnostic biologique du traumatisme crânien léger »","authors":"Jean-Louis Beaudeux","doi":"10.1016/j.banm.2024.10.016","DOIUrl":"10.1016/j.banm.2024.10.016","url":null,"abstract":"","PeriodicalId":55317,"journal":{"name":"Bulletin De L Academie Nationale De Medecine","volume":"208 9","pages":"Pages 1347-1348"},"PeriodicalIF":0.3,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142655365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-09DOI: 10.1016/j.banm.2024.07.020
Sophia Melo de Sousa, Luis Fernando Viana Furtado
Delay or refusal to vaccinate refers to the hesitation or resistance of individuals to receive vaccines, whether by postponing, selectively choosing certain vaccines, or outright rejecting immunization. This issue has been studied due to its significant implications for public health and infectious disease control. The phenomenon is influenced by each individual's personal context, their social circle, and specific aspects of a vaccine or the act of vaccination. Trust in vaccines and the healthcare system is crucial for achieving satisfactory vaccination coverage, thereby protecting the population from preventable diseases and their consequences. This work consists of a narrative literature review, where scientific articles and reports related to vaccine hesitancy in Brazil were analyzed, using keywords such as “vaccine hesitancy,” “vaccination coverage,” “National Immunization Program (NIP),” among others. In Brazil, the National Immunization Program (NIP) has been effectively coordinating immunization for 50 years. However, it has faced difficulties in recent years. In addition to convenience-related issues, such as availability and cost, vaccine hesitancy has been on the rise worldwide, alongside the activities of anti-vaccine movements. There has recently been a decrease in vaccination coverage in Brazil, leading to outbreaks of vaccine-preventable diseases. Undoubtedly, there is a correlation between lower economic power and the incidence of these diseases. This study highlights the importance of promoting trust in vaccines, addressing misinformation, and developing effective strategies to ensure immunization acceptance.
{"title":"The price of doubt: Consequences of vaccine hesitancy on the incidence of infectious diseases in Brazil","authors":"Sophia Melo de Sousa, Luis Fernando Viana Furtado","doi":"10.1016/j.banm.2024.07.020","DOIUrl":"10.1016/j.banm.2024.07.020","url":null,"abstract":"<div><div>Delay or refusal to vaccinate refers to the hesitation or resistance of individuals to receive vaccines, whether by postponing, selectively choosing certain vaccines, or outright rejecting immunization. This issue has been studied due to its significant implications for public health and infectious disease control. The phenomenon is influenced by each individual's personal context, their social circle, and specific aspects of a vaccine or the act of vaccination. Trust in vaccines and the healthcare system is crucial for achieving satisfactory vaccination coverage, thereby protecting the population from preventable diseases and their consequences. This work consists of a narrative literature review, where scientific articles and reports related to vaccine hesitancy in Brazil were analyzed, using keywords such as “vaccine hesitancy,” “vaccination coverage,” “National Immunization Program (NIP),” among others. In Brazil, the National Immunization Program (NIP) has been effectively coordinating immunization for 50 years. However, it has faced difficulties in recent years. In addition to convenience-related issues, such as availability and cost, vaccine hesitancy has been on the rise worldwide, alongside the activities of anti-vaccine movements. There has recently been a decrease in vaccination coverage in Brazil, leading to outbreaks of vaccine-preventable diseases. Undoubtedly, there is a correlation between lower economic power and the incidence of these diseases. This study highlights the importance of promoting trust in vaccines, addressing misinformation, and developing effective strategies to ensure immunization acceptance.</div></div>","PeriodicalId":55317,"journal":{"name":"Bulletin De L Academie Nationale De Medecine","volume":"208 9","pages":"Pages 1324-1331"},"PeriodicalIF":0.3,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142655804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-09DOI: 10.1016/j.banm.2024.10.015
Bernard Lechevalier
{"title":"Éloge du Professeur Jean Cambier (1925–2022)","authors":"Bernard Lechevalier","doi":"10.1016/j.banm.2024.10.015","DOIUrl":"10.1016/j.banm.2024.10.015","url":null,"abstract":"","PeriodicalId":55317,"journal":{"name":"Bulletin De L Academie Nationale De Medecine","volume":"208 9","pages":"Pages 1354-1356"},"PeriodicalIF":0.3,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142650830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-05DOI: 10.1016/j.banm.2024.10.014
Michel Komajda
{"title":"Éloge du Professeur Yves Grosgogeat (1927–2023)","authors":"Michel Komajda","doi":"10.1016/j.banm.2024.10.014","DOIUrl":"10.1016/j.banm.2024.10.014","url":null,"abstract":"","PeriodicalId":55317,"journal":{"name":"Bulletin De L Academie Nationale De Medecine","volume":"208 9","pages":"Pages 1351-1353"},"PeriodicalIF":0.3,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142650829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-05DOI: 10.1016/j.banm.2024.10.006
Yvon Lebranchu
{"title":"Vaccins, facteurs de progrès médicaux et scientifiques","authors":"Yvon Lebranchu","doi":"10.1016/j.banm.2024.10.006","DOIUrl":"10.1016/j.banm.2024.10.006","url":null,"abstract":"","PeriodicalId":55317,"journal":{"name":"Bulletin De L Academie Nationale De Medecine","volume":"208 9","pages":"Pages 1251-1253"},"PeriodicalIF":0.3,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142655367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-05DOI: 10.1016/j.banm.2024.10.010
Jacques Battin
{"title":"","authors":"Jacques Battin","doi":"10.1016/j.banm.2024.10.010","DOIUrl":"10.1016/j.banm.2024.10.010","url":null,"abstract":"","PeriodicalId":55317,"journal":{"name":"Bulletin De L Academie Nationale De Medecine","volume":"208 9","pages":"Page 1340"},"PeriodicalIF":0.3,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142655361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-05DOI: 10.1016/j.banm.2024.10.009
Michel Sadelain , Isabelle Rivière
<div><div>Les CARs (<em>chimeric antigen receptors</em>) sont des récepteurs synthétiques qui déterminent la spécificité des lymphocytes qui les expriment et en augmentent les fonctions. Leur domaine extracellulaire se lie à un antigène de surface sélectionné comme cible thérapeutique. À la suite à cette ligation, le CAR signale par son domaine intracellulaire au lymphocyte d’activer la cytotoxicité, la sécrétion de cytokines et la prolifération. Le CAR stimule ainsi les propriétés d’un médicament vivant programmé pour exercer une action anti-tumorale et immunorégulatrice. Ayant établi au début des années 1990 une méthode permettant d’intégrer des gènes exogènes dans les lymphocytes primaires, nous avons pu définir des modules de signalisation combinatoires capables de soutenir une réponse cellulaire prolongée (Maher et al., 2002), étape clé du développement du médicament vivant. Nous avons ensuite identifié CD19 comme une cible prometteuse, laquelle, au vu de résultats précliniques encourageants (Brentjens et al., 2003), a ouvert la voie aux essais cliniques. Les premiers essais dans le cadre de leucémies et lymphomes réfractaires exprimant CD19, fondés sur une production académique des CAR-T, obtinrent des réponses thérapeutiques remarquables, rapidement confirmées dans plusieurs centres (June et Sadelain, 2018). Les CAR-T anti-CD19 furent les premiers médicaments vivants approuvés aux États-Unis en 2017 et en Europe en 2018. Les CARs anti-CD19 ont ainsi engendré une nouvelle classe de médicaments et inspiré de nouvelles applications pour lutter contre le cancer et les maladies auto-immunes, justifiant des efforts soutenus pour en abaisser le coût afin d’en permettre une utilisation accrue et équitable.</div></div><div><div>Chimeric antigen receptors (CARs) are synthetic receptors that determine the specificity and functions of transduced T cells. They bind cell surface antigens through their extracellular domain and initiate via their intracellular domain cytolytic functions, cytokine secretion and proliferation. The CAR thus specifies the properties of a living drug that is programmed to exert anti-tumor and immunoregulatory effects. After establishing a method to stably integrate foreign genes in primary T lymphocytes in the early 1990s, we identified combinatorial signaling modules that could sustain a prolonged T cell function (Maher et al., 2002), which underpins an essential feature of a living drug. We further identified CD19 as a promising molecular target, which, based on encouraging preclinical results in mice (Brentjens et al., 2003), paved the way for clinical trials. The first clinical studies in patients with relapsed, refractory leukemias and lymphomas, which all made use of CAR T cells produced in the academic setting, yielded remarkable clinical response that were soon confirmed at several centers (June et Sadelain, 2018). CAR T cells targeting CD19 were the first living drugs to be approved by the US Food and Drug Administrat
CAR（嵌合抗原受体）是一种合成受体，可决定表达它们的淋巴细胞的特异性并增强其功能。它们的细胞外结构域与被选为治疗靶点的表面抗原结合。结合后，CAR 的胞内结构域向淋巴细胞发出信号，激活细胞毒性、细胞因子分泌和增殖。因此，CAR 能激发活体药物的特性，使其发挥抗肿瘤和免疫调节作用。20 世纪 90 年代初，我们建立了将外源基因整合到原始淋巴细胞中的方法，并确定了能够维持长时间细胞反应的组合信号模块（Maher 等人，2002 年），这是开发活体药物的关键一步。随后，我们发现 CD19 是一个很有前景的靶点，临床前研究结果令人鼓舞（Brentjens 等人，2003 年），这为临床试验铺平了道路。在学术界生产的 CAR-Ts 基础上，针对表达 CD19 的难治性白血病和淋巴瘤的首批试验取得了显著的治疗效果，并迅速在多个中心得到证实（June 和 Sadelain，2018 年）。抗 CD19 CAR-Ts 是 2017 年美国和 2018 年欧洲批准的首批活体药物。因此，抗CD19 CAR催生了一类新药，并激发了抗击癌症和自身免疫性疾病的新应用，证明了降低其成本的持续努力是有道理的，这样它们才能得到更广泛、更公平的应用。嵌合抗原受体（CAR）是一种合成受体，决定了转导T细胞的特异性和功能。它们通过胞外结构域与细胞表面抗原结合，并通过胞内结构域启动细胞溶解功能、细胞因子分泌和增殖。因此，CAR具有活体药物的特性，可通过编程发挥抗肿瘤和免疫调节作用。20 世纪 90 年代初，我们找到了一种在原代 T 淋巴细胞中稳定整合外来基因的方法，之后又发现了能维持 T 细胞长期功能的组合信号模块（Maher 等人，2002 年），这也是活体药物的一个基本特征。我们进一步发现 CD19 是一个很有前景的分子靶点，基于令人鼓舞的小鼠临床前研究结果（Brentjens 等人，2003 年），我们为临床试验铺平了道路。针对复发性、难治性白血病和淋巴瘤患者的首批临床研究均使用了在学术环境中产生的 CAR T 细胞，取得了显著的临床反应，并很快在多个中心得到证实（June et Sadelain，2018 年）。靶向 CD19 的 CAR T 细胞是 2017 年美国食品药品管理局和 2018 年欧洲药品管理局批准的首批活体药物。因此，CD19 CAR催生了一类新的药物，并激发了利用工程免疫细胞治疗癌症和自身免疫性疾病的新应用，这就需要持续努力降低其成本，并以公平的方式增加其可用性。
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Pub Date : 2024-10-05DOI: 10.1016/j.banm.2024.10.011
Emmanuel Alain Cabanis
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