Fumagillin Shortage: How to Treat Enterocytozoon bieneusi Microsporidiosis in Solid Organ Transplant Recipients in 2024?

Autor:	Garrouste C; Service de Néphrologie, CHU Clermont-Ferrand, Clermont-Ferrand, France., Poirier P; Service de Parasitologie-Mycologie, 3IHP, Inserm U1071, M2iSH, USC-INRAE 1382, Université Clermont Auvergne, CHU Clermont-Ferrand, Clermont-Ferrand, France.; Centre National de Référence des Cryptosporidioses, Microsporidies et Autres Protozooses Digestives, Laboratoire Associé de Clermont-Ferrand, Clermont-Ferrand, France., Uro-Coste C; Service de Néphrologie, CHU Clermont-Ferrand, Clermont-Ferrand, France., Iriart X; Service de Parasitologie-Mycologie, Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), CNRS UMR5051, INSERM UMR1291, Université Toulouse III Paul Sabatier, CHU Toulouse, Toulouse, France., Kamar N; Service de Néphrologie, CHU Toulouse, Toulouse, France., Bonhomme J; Service de Parasitologie-Mycologie, ToxEMAC-ABTE, Université de Normandie Unicaen, CHU Caen, Caen, France., Calvar E; Service de Néphrologie, CHU Caen, Caen, France., Le Gal S; Service de Parasitologie-Mycologie, CHU Brest, Brest, France., Lanfranco L; Service de Néphrologie, CHU Brest, Brest, France., Autier B; Service de Parasitologie-Mycologie, CHU Rennes, Rennes, France., Rakoff L; Service de Néphrologie, CHU Rennes, Rennes, France., Durieux MF; Service de Parasitologie-Mycologie, CHU Limoges, Limoges, France., Danthu C; Service de Néphrologie, CHU Limoges, Limoges, France., Morio F; Cibles et Médicaments des Infections et de l'Immunité, Nantes Université, CHU Nantes, Nantes, France., Deltombe C; Service de Néphrologie, CHU Nantes, Nantes, France., Moreno-Sabater A; Service de Parasitologie-Mycologie, Centre d'Immunologie et de Maladies Infectieuses (Cimi-Paris), Inserm U1135, Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Paris, France., Ouali N; Service de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France., Costa D; Parasitology-Mycology laboratory, EA 7510 ESCAPE Epidemiosurveillance and Circulation of Parasites in the Environment, University of Rouen Normandie, University Hospital of Rouen, National Reference Center (NRC) for cryptosporidiosis, microsporidia and other digestive protozoa, Rouen, France., Bertrand D; Service de Néphrologie, CHU Rouen, Rouen, France., Chesnay A; Service de Parasitologie-Mycologie, CHU Tours, Tours, France., Gatault P; Service de Néphrologie, CHU Tours, Tours, France., Rabodonirina M; Service de Parasitologie-Mycologie, Hospices Civils de Lyon, Lyon, France., Morelon E; Service de Néphrologie, Hospices Civils de Lyon, Lyon, France., Dumortier J; Service d'Hépato-Gastroentérologie, Hospices Civils de Lyon, Hôpital Edouard Herriot, Université Claude Bernard Lyon 1, Lyon, France., Sitterlé E; Service de Parasitologie-Mycologie, Assistance Publique-Hôpitaux de Paris, Hôpital Necker, Paris, France., Scemla A; Service de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Necker, Paris, France., Hamane S; Service de Parasitologie-Mycologie, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France., Cachera L; Service de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France., Damiani C; Service de Parasitologie et Mycologie Médicales et Agents Infectieux, Résistance et Chimiothérapie (AGIR), UR 4294, CHU Amiens-Picardie, Université de Picardie Jules Verne, Amiens, France., Poulain C; Service de Néphrologie, CHU Amiens, Amiens, France., L'Ollivier C; Service de Parasitologie-Mycologie, Assistance Publique-Hôpitaux de Marseille, IHU Méditerranée Infection, Marseille, France., Moal V; Service de Néphrologie, Assistance Publique-Hôpitaux de Marseille, Paris, France., Delhaes L; Service de Parasitologie-Mycologie, CHU Bordeaux, Bordeaux, France., Kaminski H; Service de Néphrologie-Transplantation-Dialyse-Aphéréses, CHU Bordeaux, Bordeaux, France., Cateau E; Service de Parasitologie-Mycologie, CHU Poitiers, Poitiers, France., Ecotière L; Service de Néphrologie, CHU Poitiers, Poitiers, France., Brunet J; Service de Parasitologie-Mycologie, CHU Strasbourg, Strasbourg, France., Caillard S; Service de Néphrologie, CHU Strasbourg, Strasbourg, France., Valot S; Service de Parasitologie-Mycologie, CHU Dijon, Dijon, France., Tinel C; Service de Néphrologie, CHU Dijon, Dijon, France., Argy N; Service de Parasitologie-Mycologie, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France., Raimbourg Q; Service de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France., Robert MG; Service de Parasitologie-Mycologie, Université Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France., Noble J; Service de Néphrologie, CHU Grenoble, Grenoble, France., Boignard A; Service de Cardiologie, CHU Grenoble, Grenoble, France., Botterel F; Service de Parasitologie-Mycologie, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Paris, France., Matignon M; Service de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Paris, France., Bellanger AP; Service de Parasitologie-Mycologie, CHU Besançon, Besançon, France., Crépin T; Service de Néphrologie, CHU Besançon, Besançon, France., Leroy J; Service de Parasitologie-Mycologie, CHU Lille, Lille, France., Lionet A; Service de Néphrologie, CHU Lille, Hôpital Huriez, Lille, France., Debourgogne A; Service de Parasitologie-Mycologie, CHU Nancy, Nancy, France., Nicolas M; Service de Parasitologie-Mycologie, CHU Pointe-à-Pitre, Guadeloupe, France., Claudéon J; Service de Néphrologie, CHU Pointe-à-Pitre, Guadeloupe, France., Moniot M; Service de Parasitologie-Mycologie, 3IHP, Inserm U1071, M2iSH, USC-INRAE 1382, Université Clermont Auvergne, CHU Clermont-Ferrand, Clermont-Ferrand, France.; Centre National de Référence des Cryptosporidioses, Microsporidies et Autres Protozooses Digestives, Laboratoire Associé de Clermont-Ferrand, Clermont-Ferrand, France., Lambert C; Unité de Biostatistiques, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France., Nourrisson C; Service de Parasitologie-Mycologie, 3IHP, Inserm U1071, M2iSH, USC-INRAE 1382, Université Clermont Auvergne, CHU Clermont-Ferrand, Clermont-Ferrand, France.; Centre National de Référence des Cryptosporidioses, Microsporidies et Autres Protozooses Digestives, Laboratoire Associé de Clermont-Ferrand, Clermont-Ferrand, France.
Jazyk:	angličtina
Zdroj:	Transplant international : official journal of the European Society for Organ Transplantation [Transpl Int] 2024 Dec 12; Vol. 37, pp. 13518. Date of Electronic Publication: 2024 Dec 12 (Print Publication: 2024).
DOI:	10.3389/ti.2024.13518
Abstrakt:	Intestinal microsporidiosis caused by Enterocytozoon bieneusi is an opportunistic infection that especially affects solid organ transplant (SOT) recipients. Management revolves around tapering the immunosuppressive regimen and/or using a specific anti-microsporidia treatment, but only fumagillin has demonstrated efficacy for treatment of this infection. Since fumagillin has been commercially discontinued, nitazoxanide is increasingly being used in this indication. We aimed to describe therapeutic management of E. bieneusi infections in this context. We conducted a French nationwide observational retrospective study on reported cases of E. bieneusi infections in SOT recipients. We identified 154 cases: 64 (41.6%) were managed by simply modifying the immunosuppressive regimen, 54 (35.1%) were given fumagillin, and 36 (23.4%) were given nitazoxanide. Clinical remission rate ranged from 77.8% to 90.7% and was not significantly different between therapeutic strategies but tended to be lower with nitazoxanide. Stool negativization rate was highest with fumagillin (91.7%) and lowest with nitazoxanide (28.6%). Relapses occurred in 6.9% of cases and were more frequent with nitazoxanide (14.3%). This study shows that tapering immunosuppression can result in a satisfactory remission rate but is sometimes accompanied by relapses. Nitazoxanide had limited effectiveness, whereas fumagillin had good results that provide a solid rationale for bringing fumagillin back to market. Trial Registration Number: ClinicalTrials.gov ID: NCT05417815. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2024 Garrouste, Poirier, Uro-Coste, Iriart, Kamar, Bonhomme, Calvar, Le Gal, Lanfranco, Autier, Rakoff, Durieux, Danthu, Morio, Deltombe, Moreno-Sabater, Ouali, Costa, Bertrand, Chesnay, Gatault, Rabodonirina, Morelon, Dumortier, Sitterlé, Scemla, Hamane, Cachera, Damiani, Poulain, L’Ollivier, Moal, Delhaes, Kaminski, Cateau, Ecotière, Brunet, Caillard, Valot, Tinel, Argy, Raimbourg, Robert, Noble, Boignard, Botterel, Matignon, Bellanger, Crépin, Leroy, Lionet, Debourgogne, Nicolas, Claudéon, Moniot, Lambert and Nourrisson.)
Databáze:	MEDLINE
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