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Within the group of antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitides, granulomatosis with polyangiitis (GPA) is the most frequent. The incidence is around 10 to 20 cases/million/year. Clinical manifestations are varied, with ENT, lungs and kidneys most frequently involved. ANCA are pathogenic by triggering neutrophil activation, which leads to vascular damage. Detection of ANCA is most helpful in establishing the diagnosis, but serology may be negative in GPA limited to the airways. Diagnostic work-up and therapy require a multidisciplinary approach. Treatment includes an induction and maintenance phase, combining corticosteroids and immunosuppressive drugs. It aims at limiting the risk of relapses, which is important in GPA, and at reducing corticosteroids toxicity.

Anti-glomerular basement membrane disease is a rare disease. In its classical presentation it associates rapidly progressive glomerulonephritis and diffuse alveolar hemorrhage, linked to the presence of antibodies targeting type IV collagen in the glomerular and alveolar basal membrane. Anti-GBM disease warrants prompt medical management to limit permanent kidney damage and mortality. Treatment includes plasma exchanges to quickly remove pathogenic antibodies and immunosuppressants to stop their production. This article reviews the pathogenesis and current treatments.

Heart transplantation remains the most durable treatment for patients with end-stage heart failure refractory to medical treatment. Central elements of the listing criteria for heart transplantation have remained largely unchanged in the last three decades whereas treatment of heart failure has significantly increased survival and reduced disease-related symptoms. It remains unknown whether the improvement of heart failure therapy changed the profile of heart transplantation candidates or affected post-transplant survival. The study investigated a total of 323 heart transplant recipients of the Lausanne University Hospital with 328 transplant operations between 1987 and 2018. Patients were separated into three groups on the basis of availability of heart failure therapy: period 1 (1987-1998; n = 115) when renin-angiotensin system blockade and diuretic treatment were available; period 2 (1999-2010; n = 106) marked by the addition of beta-blocker and mineralocorticoid receptor antagonist treatment in severe heart failure, and the establishment of cardiac defibrillator and resynchronisation therapy; period 3 (2011-2018; n = 107) characterised by the increasing use of ventricular assist devices for bridge to transplantation. The patient characteristics age (all: 53.4 years), male sex (all: 79%) and body mass index (all: 24.5 kg/m2) did not differ between periods. History of arterial hypertension was less prevalent in period 2 (period 1 vs 2 vs 3: 44 vs 28 vs 43%, p = 0.04) whereas other cardiovascular risk factors were equally distributed. Left ventricular ejection fraction, VO2max, and pulmonary vascular resistance were not different between the three periods. The prevalence of ischaemic cardiomyopathy was higher in periods 1 and 3; dilated non-ischaemic cardiomyopathy was more frequent in period 2. Post-transplant 1-year survival was highest in period 3 (1 vs 2 vs 3: 87.2 ± 3.2% vs 70.8 ± 4.4% vs 93.0 ± 2.6%, p always ≤0.02), and the Kaplan-Meier estimates of survivors of the first year post-transplant were not different between the three periods. In descriptive analysis, early mortality was not associated with acknowledged pretransplant predictors of post-transplant mortality. Availability of different medical heart failure treatments did not result in greatly different pretransplant characteristics of heart transplantation recipients across the three periods. This suggests that the maintained central criteria of listing for heart transplantation still identify end-stage heart failure patients with a similar profile. This finding can explain the unchanged overall mortality on condition of 1-year survival across the three periods, since pretransplant characteristics are relevant for long-term survival after heart transplantation.

Pulmonary tumor embolism is characterized by the occlusion of pulmonary vessels by tumor clots, which can be found in the proximal arteries (macro-embolism) or the small vessels (micro-embolism). The clinical presentation is mainly a progressive dyspnea associated with pulmonary hypertension and subacute cor pulmonale. The diagnosis is difficult, mostly made post-mortem. It is rarely obtained through a combination of multiple diagnostic tests (chest CT, ventilation-perfusion scanning, pulmonary artery cytology, biopsy). Treatment is based on the one of the underlying cancer. The prognosis is poor, and patients usually die within weeks to months. It is a rare cause of pulmonary hypertension that must be considered even without a prior oncological diagnosis.

INTRODUCTION: The recurrence rate of chronic osteomyelitis in adults is close to 30% [1]. Bacteria are known to migrate deeper into bone tissue through canaliculi and evade common systemic- and local-antibiotic therapies [2]. By fabricating antibiotic loaded poly(ϵ-caprolactone) (PCL) microspheres conjugated with the bone-chelator poly(aspartic acid) (PAA) we aim to prolong the microsphere residency near the site of infection, increasing bactericidal potential. METHODS: Hydrophobic Gentamicin-dioctyl sulfosuccinate (Gen-AOT) loaded PCL microspheres were made by oil/water emulsion methods. In vitro antimicrobial properties were tested by zone of inhibition (ZOI) in a serial plate transfer test with S. aureus. In vivo antimicrobial efficacy of 1 mg of microspheres was tested in a femoral defect in rats (n =5), infected with 2·106 colony forming units (CFU) of bioluminescent Xen-29 a week prior to treatment. In a 2nd study, the PCL microspheres underwent conjugation with PAA by carbodiimide chemistry. Interaction with bone mineral was assessed in the same model as above. IR780 iodide loaded PCL or PCL-PAA microspheres (1 mg) were injected in the bone defect and traced using an in vivo imaging system (IVIS Lumina III, Perkin Elmer). RESULTS & DISCUSSION: ZOI of Gen-AOT loaded PCL was measurable for 5 days, while a ZOI for bactericidal collagen-sheets was visible for 3 days. The Gen-AOT loaded PCL microspheres caused an 81% reduction in CFU compared to untreated control. In vivo, a brighter signal was measured for PCL-PAA compared to PCL microspheres, validating the hypothesis that PAA-grafted PCL resides longer in bone as control PCL. CONCLUSIONS: In the presented animal model, a monotreatment of 1 mg PCL microspheres caused an 81% CFU reduction. PCL-PAA microspheres enhance bone affinity by chelation of the PAA to bone mineral at the femoral defect. Further work is required to optimize the bone-targeted drug delivery system to bone.

Experimental Autoimmune Myocarditis (EAM) is a CD4+ T cell mediated model of human inflammatory dilated cardiomyopathies. Heart specific CD4+ T cell activation is dependent on autoantigens presented by MHC class II (MHCII) molecules expressed on professional APCs. In this study we addressed the role of inflammation induced MHCII expression by cardiac nonhematopoietic cells on EAM development. EAM was induced in susceptible mice lacking inducible expression of MHCII molecules on all nonhematopoietic cells (pIV / K14 CIITA Tg mice) by immunization with a myosin heavy chain peptide (a MyHC) in CFA. Lack of inducible nonhematopoietic MHCII expression in pIV / K14 CIITA Tg mice conferred EAM resistance. In contrast cardiac pathology was induced in WT and heterozygous mice and correlated with elevated cardiac endothelial MHCII expression. Control mice with myocarditis displayed an increase in infiltrating CD4+ T cells and in expression of IFN ? which is the major driver of nonhematopoietic MHCII expression. Mechanistically IFN ? neutralization in WT mice shortly before disease onset resulted in reduced cardiac MHCII expression and pathology. These findings reveal a previously overlooked contribution of IFN ? to induce endothelial MHCII expression in the heart and to progress cardiac pathology during myocarditis. This article is protected by copyright. All rights reserved.

La survenue de diarrhées chroniques impose une stratégie diagnostique rapide pour éviter les risques de malnutrition et un déséquilibre de l'homéostasie hydro-électrolytique. Deux situations cliniques différentes, à savoir une colite collagène et des diarrhées sécrétoires, illustrent l'approche diagnostique distincte d'un même symptôme. Cette revue non exhaustive devrait permettre d'établir une stratégie diagnostique des diarrhées chroniques.