Thierry Poynard

Assistance Publique – Hôpitaux de Paris, Lutetia Parisorum, Île-de-France, France

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Publications (638)4792.65 Total impact

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    ABSTRACT: Hepatitis B (HBV) virus infection is characterized by the overproduction of subviral particles (SVP) over infectious Dane particles (VP). Precise regulation of the ratio between these forms is unknown, but its fluctuation may have a clinical impact. An enrichment method was applied to assess the SVP/VP ratio in chronically infected patients (CHB) and to compare the sensitivity of HBs antigen (HBsAg) and DNA detection methods. Plasmas from 9 genotype A–D CHB patients were fractionated on Nycodenz® gradients, and both HBV DNA and HBsAg were quantified in each collected fraction using standardized techniques expressed in IU/mL. Infection of primary human hepatocytes (PHHs) was performed with crude or fractionated plasma. Independently of the genotype, all plasmas showed a similar rate-zonal separation profile characterized by a bottom DNA-enriched peak surmounted by HBsAg-enriched fractions. Inoculation of PHH with plasma-derived VP-enriched fractions led to long-lasting production of virus in cell supernatants with a SVP/VP ratio similar to that observed in patient plasmas. In the VP fraction, one IU of HBsAg corresponded to approximately 5 million IU of HBV DNA. Rate-zonal gradient separation directly applied on patient plasma allows a better insight into the distribution of VP in HBeAg-positive CHB carriers. This study highlights the sensitivity difference of the techniques classically used to monitor HBV infection and indicates that VP-associated HBsAg contributes modestly to the overall amount of total circulating HBsAg in CHB. Such a fractionation approach should help to understand the fine regulation of HBsAg production over replication at different stages of CHB.
    Journal of Viral Hepatitis 01/2015; · 3.08 Impact Factor
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    ABSTRACT: The association of NAFLD with chronic hepatitis C (CHC) has been extensively studied but little is known about its coexistence with chronic hepatitis B (CHB).
    European Journal of Internal Medicine 12/2014; 26(1). · 2.30 Impact Factor
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    ABSTRACT: All trials of severe alcoholic hepatitis (AH) have included patients with “pure” AH, i.e., without concomitant gastrointestinal bleeding (GIB). Severe AH is often suspected in cirrhotics with GIB.Aims1) assess the prevalence of AH in patients with GIB and Maddrey discriminant function (DF) ⩾32; 2) compare the outcome in AH patients with or without GIB (AH-GIB+, AH-GIB-); 3) assess the performance of the Lille model for survival in AH-GIB+ patients.Methods We retrospectively included all patients with alcoholic cirrhosis admitted between January 2005 and March 2011 with the following: 1) jaundice <3 months, 2) DF ⩾32 at admission, 3) bilirubin level >50 μmol/l, 4) active drinking. Exclusion criteria were advanced hepatocellular carcinoma, other etiology of cirrhosis, severe comorbidities and DF <32 after stabilization. In our centre, we systematically plan a liver biopsy for these patients. Patients with severe AH received prednisolone.ResultsWe screened 161 patients (86 GIB+, 75 GIB-), and analyzed data for 58 and 47 patients in each group, respectively. The 2 groups did not differ in prevalence of AH (77.3% vs 81%), demographic data, MELD/Child-Pugh score, or DF. The 2 groups were similar in 6-month probability of survival (73.9±6.0% vs 69.9±7%, p=0.49). The probability of developing infection was lower for AH-GIB+ patients (24.1% vs 44.7%, p=0.04). The AUC for the Lille model for predicting 6-month survival was 0.71±0.06 for all patients and 0.74±0.06 for AH-GIB+ patients (p>0.05).Conclusions Prevalence of AH is 80% for patients with cirrhosis and GIB, recent jaundice and DF>32. Infection was lower for AH-GIB+ patients, which suggests a beneficial role of antibiotic prophylaxis treatment. Survival among subjects with GIB was the same as among subjects without GIB.
    Journal of Hepatology 11/2014; · 10.40 Impact Factor
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    ABSTRACT: Chronic liver diseases are highly prevalent and require an accurate evaluation of liver fibrosis to determine patient management. Over the last decade, great effort has been made to develop non-invasive liver fibrosis tests. The ensuing increase of literature is however impaired by extensive heterogeneity in the quality of published reports. The Standards for Reporting of Diagnostic Accuracy Studies (STARD), first published in 2003, were developed to improve the quality of research reports on diagnostic studies. We aimed to evaluate STARD statements in the setting of diagnostic studies on non-invasive liver fibrosis tests, and to propose an extended version developed specifically for those studies.
    Journal of Hepatology 11/2014; · 10.40 Impact Factor
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    ABSTRACT: & Aims: Many patients with alcohol-associated cirrhosis also have diabetes, obesity, or insulin resistance-mediated steatosis, but little is known about how these disorders affect the severity of the liver disease. We analyzed the prevalence and prognostic implications of metabolic risk factors (MRF) such as overweight, diabetes, dyslipidemia, and hypertension in patients with alcohol-associated cirrhosis awaiting liver transplants. We performed a retrospective study of 110 patients alcohol-associated cirrhosis (77% male; mean age, 55 years; 71% >6 months of abstinence) who received liver transplants at a single center in Paris, France from 2000 through 2013. We collected data on previous exposure to MRF, steatosis (>10% in the explant), and histologically confirmed hepatocellular carcinoma (HCC). HCC was detected in explants from 29 patients (26%). Steatosis was detected in explants from 47 patients (70% were abstinent for ≥6 months); 50% had a history of overweight or type 2 diabetes. Fifty-two patients (47%) had a history of MRF and were therefore at risk for nonalcoholic fatty liver disease (NAFLD). A higher proportion of patients with MRF had HCC than of those without MRF (46% vs 9%, P<.001). A previous history of overweight or type 2 diabetes significantly increased the risk for HCC (odds ratio=6.23; 95% confidence interval [CI], 2.47-15.76 and odds ratio=4.63; 95% CI, 1.87-11.47, respectively; P<.001). MRF, but not steatosis, was associated with development of HCC (OR=11.76, 95%CI, 2.60-53; P=.001), independent of age, sex, amount of alcohol intake, or severity of liver disease. Patients with alcohol-associated cirrhosis who received transplants frequently also have NAFLD. MRF, particularly overweight, obesity and type 2 diabetes, significantly increase the risk of HCC.Despite a period of abstinence that is variable but usually longer than 6 months, some patients transplanted for alcoholic liver disease (ALD) still have steatosis on the explanted liver. In the general population, a frequent cause of steatosis, unrelated to alcohol consumption, is nonalcoholic fatty liver disease (NAFLD). NAFLD is usually due to long-term exposure to obesity, diabetes or different features of the metabolic syndrome and therefore is currently a very prevalent chronic liver disease. Because both at-risk alcohol consumption and exposure to metabolic risk factors are frequent in the general population, theoretically ALD and NAFLD can coexist. Some studies have notably shown that this association can result in heightened liver damage(1).For instance, excessive drinkers that are obese have cirrhosis and alcoholic hepatitis more often than non-obese drinkers (2). Central obesity and high serum glucose are also associated with more severe fibrosis in a population of patients with ALD(3). On the other hand, the severity of steatosis has been identified as an independent predictor of fibrosis progression and development of cirrhosis (4). Carcinogenesis might also be modulated by the association of these comorbidities. For example, overweight and obesity increase the risk of hepatocellular carcinoma (HCC) (5), while diabetes increases both liver cancer incidenceand mortality due to liver cancer (6). Steatosis was also associated with a higher risk of HCC (7). As it becomes increasingly clear that the association between ALD and NAFLD is clinically relevant, a better understanding of the prevalence and prognostic implications of metabolic risk factors (MRF, i.e. components of the metabolic syndrome such as obesity, diabetes, dyslipidemia, arterial hypertension) in patients with ALD is useful. In this study we attempted to investigate the prevalence and consequences of steatosis and MRF in a cohort of patients that had undergone liver transplantation for ALD. We hypothesized that the presence of steatosis on the native liver reflects concurrent NAFLD and that patients with steatosis and MRF are at higher risk of developing HCC. Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.
    Clinical Gastroenterology and Hepatology 10/2014; · 6.53 Impact Factor
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    ABSTRACT: The natural course of chronic hepatitis C varies widely. To improve the profiling of patients at risk of developing advanced liver disease, we assessed the relative contribution of factors for liver fibrosis progression in hepatitis C.
    Gut 09/2014; · 13.32 Impact Factor
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    ABSTRACT: Background The aspartate aminotransferase platelet ratio index (APRI) is a validated, non-patented blood test for diagnosing fibrosis or cirrhosis in patients with chronic hepatitis C. We assess the impact of two limitations, the variability of the upper limit of normal for aspartate aminotransferase (AST-ULN) and the risk of overestimating fibrosis stage due to necroinflammatory activity. Methods The variability of AST-ULN was assessed by an overview of the literature and an assessment of AST-ULN in 2 control populations 7521 healthy volunteers and 393 blood donors. We assessed the impact of AST-ULN variability on APRI performance for estimating fibrosis prevalence and on the Obuchowski measure using individual data of 1651 patients with APRI, FibroTest and biopsy. Results The overview, and the analysis of the control populations found that ULN-AST ranged from 26 to 49 IU/L according to gender, body mass index and serum cholesterol. When this AST-ULN variability was applied to the chronic hepatitis group, the prevalence of advanced fibrosis and cirrhosis as presumed by APRI varied (P < 0.001) from 34.7% to 68.5%, and from 11.4% to 32.3%, respectively. This spectrum effect induced variability in APRI performance, which could be similar 0.862 (if AST-ULN = 26 IU/L) or lower 0.820 (AST-ULN ≥ 30IU/L) than the stable FibroTest performance (0.867; P = 0.35 and P < 0.0001 respectively). When applied to 18 acute hepatitis C patients, the rate of false positives of APRI varied from 0% to 61% due to AST-ULN. Conclusion The AST-ULN variability is high highly associated with the variability of metabolic risk factors between the different control groups. This variability induces a spectrum effect, which could cause misleading interpretations of APRI performance for the staging of fibrosis, comparisons of APRI with other non-invasive tests, and estimates of false positive rate.
    Gastroentérologie Clinique et Biologique 09/2014; · 1.98 Impact Factor
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    ABSTRACT: Background In cardiometabolic disorders, non-alcoholic fatty liver disease is frequent and presumably associated with increased mortality and cardiovascular risk.AimTo evaluate the prognostic value of non-invasive biomarkers of liver fibrosis (FibroTest) and steatosis (SteatoTest) in patients with type-2 diabetes and/or dyslipidaemia.MethodsA total of 2312 patients with type-2 diabetes and/or dyslipidaemia were included and prospectively followed up for 5–15 years. The cardiovascular Framingham-risk score was calculated; advanced fibrosis and severe steatosis, were defined by FibroTest >0.48 and SteatoTest >0.69, respectively, as previously established.ResultsDuring a median follow-up of 12 years, 172 patients (7.4%) died. The leading causes of mortality were cancer (31%) and cardiovascular-related death (20%). The presence of advanced fibrosis [HR (95% CI)] [2.98 (95% CI 1.78–4.99); P < 0.0001] or severe steatosis [1.86 (1.34–2.58); P = 0.0002] was associated with an increased risk of mortality. In a multivariate Cox model adjusted for confounders: the presence of advanced fibrosis was associated with overall mortality [1.95 (1.12–3.41); P = 0.02]; advanced fibrosis at baseline [n = 50/677; 1.92 (1.04–3.55); P = 0.04] and progression to advanced fibrosis during follow-up [n = 16/127; 4.8 (1.5–14.9); P = 0.007] were predictors of cardiovascular events in patients with type-2 diabetes. In patients with a Framingham-risk score ≥20%, the presence of advanced fibrosis was predictive of cardiovascular events [2.24 (1.16–4.33); P < 0.05].Conclusions Liver biomarkers, such as FibroTest and SteatoTest, have prognostic values in patients with metabolic disorders. FibroTest has prognostic value for predicting overall survival in patients with type-2 diabetes and/or dyslipidaemia. In type-2 diabetes, FibroTest predicted cardiovascular events and improved the Framingham-risk score.
    Alimentary Pharmacology & Therapeutics 09/2014; · 4.55 Impact Factor
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    ABSTRACT: Background Early-TIPSS (transjugular intrahepatic portosystemic shunt) placement may improve rebleeding and reduce 1-year mortality, compared to standard management in high-risk patients with cirrhosis and variceal bleeding.AimTo obtain external validation of this therapeutic approach.Methods We performed a prospective study including all consecutive patients with Child–Pugh C 10–13 cirrhosis or Child–Pugh B with active bleeding at endoscopy admitted to our ICU between March 2011 and February 2013 for variceal bleeding. TIPSS were placed within 72 h after stabilisation. Patients were matched for gender, age, Child–Pugh score, MELD score and to patients from a historical cohort hospitalised before March 2011.Results31/128 patients with cirrhosis (77.4% men, mean age 53.2 ± 9.0 years old, MELD score 20.9 ± 6.9, Child–Pugh C: 77.4%) admitted for acute variceal bleeding between March 2011 and February 2013 (TIPSS+ group) were matched to 31 historical patients (TIPSS− group). Uncontrolled bleeding occurred in 1/31 patients in the TIPSS+ group vs. 2/31 patients in TIPSS− group (P = 0.55). The 1-year probability of being free of rebleeding was higher in the TIPSS+ group (97% vs. 51%, P < 0.001). Actuarial 1-year survival was not different between the two groups (66.8 ± 9.4% vs. 74.2 ± 7.8%, P = 0.78). Acute cardiac failure occurred more frequently in the TIPSS+ group (25.8% vs. 6.4%, P = 0.03).Conclusions Early-TIPSS placement effectively prevents rebleeding in high-risk patients with variceal bleeding but does not significantly improve survival. This might be due to the high proportion of patients with Child–Pugh C cirrhosis in our series. Cardiac failure may play a role and must be investigated before the procedure, when possible.
    Alimentary Pharmacology & Therapeutics 09/2014; · 4.55 Impact Factor
  • Mona Munteanu, Marion Houot, Yen Ngo, Thierry Poynard
    The American Journal of Gastroenterology 08/2014; 109(8):1287-8. · 9.21 Impact Factor
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    ABSTRACT: & Aims: Transient elastometry is a non-invasive procedure used to measure fibrosis when patients are diagnosed with liver disease; it might be used to monitor changes over time. We investigated whether there are short-term variations in stiffness measurements not attributable to changes in fibrosis by studying patients with stable liver disease.
    Clinical Gastroenterology and Hepatology 07/2014; · 6.53 Impact Factor
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    ABSTRACT: The first aim was to extend the validation of FibroTest (FT) and transient elastography (TE) as markers of occurrence of cirrhosis without complications (F4.1), esophageal varices (F4.2), and severe complications (F4.3) in patients with chronic hepatitis B (CHB). The second aim was to validate a previous definition of inactive carrier based on normal FT and ActiTest (normal-FTAT). The third aim was to assess the long-term dynamics of fibrosis in patients with sustained virological response.
    Journal of Hepatology 07/2014; 61(5). · 10.40 Impact Factor
  • Mona Munteanu, Marion Houot, Yen Ngo, Thierry Poynard
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    ABSTRACT: We read with interest the comprehensive review article debating about the diagnostic accuracy of non-invasive markers for the prediction of hepatitis B-related fibrosis. [1] The author must be congratulated for the effort to review respective advantages and disadvantages of currently available non-invasive methods, such as serum biomarkers and TE. Even we acknowledge that the author deplored the lack of meta-analyses of data from individual patients, the review did not underlined few other important methodological limitations.This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 05/2014; · 4.41 Impact Factor
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    ABSTRACT: The development of esophageal varices is a late complication of chronic liver disease in children. The diagnosis is currently limited to invasive procedures such as endoscopy. Noninvasive tools to diagnose presence and degree of esophageal varices would potentially alter management decisions and support indications for invasive procedures in affected children. AIM:: To test the feasibility of spleen stiffness measurement (SSM) by transient elastography (Fibroscan) in children and compare data on its potential diagnostic use with established markers of liver fibrosis and parameters of portal hypertension. 99 children (62 with chronic liver disease, 6 after LTx, 31 controls) underwent SSM by transient elastography. Fibrotest was determined in 37 children, 45 children had an additional liver stiffness measurement and 19 underwent upper endoscopy. Spleen stiffness measurement by Fibroscan is feasible. Spleen size significantly determined success rate (90.5% in patients with splenomegaly vs. 70.2% in patients without, p = 0.02). Spleen stiffness was significantly higher in patients with splenomegaly (62.96kPa vs. 18.4kPa, p < 0.001), in patients with varices (75kPa vs. 24kPa, p < 0.01) and in patients with a history of variceal haemorrhage (75kPa vs. 50.25kPa, p < 0.05). Variceal haemorrhage did not occur in patients with SSM results below 60 kPa. Spleen stiffness decreased after liver transplantation, but remained elevated compared to controls (27.5 kPa vs. 16.3 kPa). Liver stiffness measurements and Fibrotest did not reflect presence or degree of esophageal varices. Spleen stiffness measurement by transient elastography is feasible in children and results reflect the degree and occurrence of complications. A prospective follow-up study with larger patient numbers and performance of screening endoscopies appears justified and desirable.
    Journal of pediatric gastroenterology and nutrition 04/2014; · 2.18 Impact Factor
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    ABSTRACT: We investigated the effectiveness of the protease inhibitors peginterferon and ribavirin in treatment-experienced patients with hepatitis C virus (HCV) genotype 1 infection and cirrhosis. In the Compassionate Use of Protease Inhibitors in Viral C Cirrhosis study, 511 patients with HCV genotype 1 infection and compensated cirrhosis who did not respond to a prior course of peginterferon and ribavirin (44.3% relapsers or patients with viral breakthrough, 44.8% partial responders, and 8.0% null responders) were given either telaprevir (n=299) or boceprevir (n=212) for 48 weeks. We assessed percentages of patients with sustained viral responses 12 weeks after therapy (SVR12) and safety. This observational study did not allow for direct comparison of the 2 regimens. Among patients given telaprevir, 74.2% of relapsers, 40.0% of partial responders, and 19.4% of null responders achieved SVR12. Among those given boceprevir, 53.9% of relapsers, 38.3% of partial responders, and none of the null responders achieved SVR12. In multivariate analysis, factors associated with SVR12 included prior response to treatment response, no lead-in phase, HCV subtype 1b (vs 1a), and baseline platelet count >100,000/mm(3). Severe adverse events occurred in 49.9% of cases, including liver decompensation or severe infections in 10.4% and death in 2.2%. In multivariate analysis, baseline serum albumin <35 g/L and baseline platelet counts ≤100,000/mm(3) predicted severe side effects or death. Relatively high percentages of real-life, treatment-experienced, patients with HCV genotype 1 infection and cirrhosis respond to the combination of peginterferon and ribavirin with telaprevir or boceprevir. However, side effects are frequent and often severe side. Baseline levels of albumin and platelet counts can be used to guide treatment decisions. number, NCT01514890.
    Gastroenterology 04/2014; · 12.82 Impact Factor
  • Journal of Hepatology 04/2014; 60(1):S359. · 10.40 Impact Factor
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    ABSTRACT: A complex interaction among metabolic factors, adipose tissue lipolysis, oxidative stress, and insulin resistance results in a deleterious process that may link nonalcoholic fatty liver disease (NAFLD) with severe cardiovascular (CV) outcomes. Patients with NAFLD are at higher risk of atherosclerosis, new onset of CV events, and overall mortality. The strong association between NAFLD and CV disease should affect clinical practice, with screening and surveillance of patients with NAFLD. This review discusses the data linking these major diseases.
    Clinics in liver disease 02/2014; 18(1):233-48.
  • Journal of hepatology. Supplement / EASL 01/2014; 60(1):S348.
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    ABSTRACT: Emerging data indicate that all-oral antiviral treatments for chronic hepatitis C virus (HCV) will become a reality in the near future. In replacing interferon-based therapies, all-oral regimens are expected to be more tolerable, more effective, shorter in duration and simpler to administer. Coinciding with new treatment options are novel methodologies for disease screening and staging, which create the possibility of more timely care and treatment. Assessments of histologic damage typically are performed using liver biopsy, yet noninvasive assessments of histologic damage have become the norm in some European countries and are becoming more widespread in the United States. Also in place are new Centers for Disease Control and Prevention (CDC) initiatives to simplify testing, improve provider and patient awareness and expand recommendations for HCV screening beyond risk-based strategies. Issued in 2012, the CDC recommendations aim to increase HCV testing among those with the greatest HCV burden in the United States by recommending one-time testing for all persons born during 1945-1965. In 2013, the United States Preventive Services Task Force adopted similar recommendations for risk-based and birth-cohort-based testing. Taken together, the developments in screening, diagnosis and treatment will likely increase demand for therapy and stimulate a shift in delivery of care related to chronic HCV, with increased involvement of primary care and infectious disease specialists. Yet even in this new era of therapy, barriers to curing patients of HCV will exist. Overcoming such barriers will require novel, integrative strategies and investment of resources at local, regional and national levels.
    Journal of Viral Hepatitis 11/2013; 20(11):745-60. · 3.08 Impact Factor
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    ABSTRACT: Saliva sampling may provide an easier access to hepatitis C virus (HCV) screening test. HIV infection influence on specific salivary antibody detection has not been extensively studied. An anti-HCV antibodies (HCV-Ab) test was adapted for saliva specimens and its performances were analysed according to the patients' HIV status and related factors such as CD4 cell counts and HIV viral load. Four patients groups were selected: (i) HCV and HIV negative volunteers (n=28); (ii) HCV positive and HIV negative patients (n=30); (iii) HCV negative and HIV positive patients (n=30); (iv) HCV and HIV co-infected patients (n=30). Saliva samples were collected (Salivette system, Sarstedt) and an in-house adapted HCV-Ab detection assay was performed (MONOLISA anti-HCV PLUS Version 2, Biorad). HIV viral load, CD4 cells counts and HCV viremic status were reported. Sensitivity and specificity of saliva anti-HCV antibody tests in the HIV negative groups were 90% and 100%, respectively, compared to 73% and 93%, respectively in the HIV infected population. Compared to the HIV negative population, HIV mono-infected patients presented higher absorbance values (p=0.01) and HIV/HCV co-infected population presented lower HCV-Ab absorbance values (p<0.001). Sensitivity decline was associated with HIV replication (p=0.02), HCV replication (p=0.16) but not with CD4 cell counts (p=0.64). Performances of salivary HCV antibodies testing are strongly deteriorated in the HIV positive population, especially for patients with residual HIV replication. This serious limitation should prompt careful testing of non-invasive screening tests for hepatitis C in HIV-infected patients before use in real screening conditions.
    Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 08/2013; · 3.12 Impact Factor

Publication Stats

34k Citations
4,792.65 Total Impact Points


  • 2008–2014
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France
    • BioPredictive
      Lutetia Parisorum, Île-de-France, France
    • Université de Vincennes - Paris 8
      Saint-Denis, Île-de-France, France
    • Hôpital d'Aix en Provence
      Aix, Provence-Alpes-Côte d'Azur, France
    • Alphabio
      Marsiglia, Provence-Alpes-Côte d'Azur, France
  • 2005–2014
    • Pierre and Marie Curie University - Paris 6
      Lutetia Parisorum, Île-de-France, France
  • 1994–2014
    • Hôpital La Pitié Salpêtrière (Groupe Hospitalier "La Pitié Salpêtrière - Charles Foix")
      • • Service d’Hépato - Gastro - Entérologie
      • • Service de Médecine Interne 1
      Lutetia Parisorum, Île-de-France, France
    • Centre Hospitalier Universitaire de Grenoble
      Grenoble, Rhône-Alpes, France
  • 2013
    • Hôpital Bichat - Claude-Bernard (Hôpitaux Universitaires Paris Nord Val de Seine)
      Lutetia Parisorum, Île-de-France, France
  • 2010–2013
    • Polytech Paris-UPMC
      Lutetia Parisorum, Île-de-France, France
  • 2011–2012
    • UPMC
      Pittsburgh, Pennsylvania, United States
    • Université de Cergy-Pontoise
      95001 CEDEX, Ile-de-France, France
    • IDIBAPS August Pi i Sunyer Biomedical Research Institute
      Barcino, Catalonia, Spain
  • 1994–2012
    • Hôpitaux Universitaires La Pitié salpêtrière - Charles Foix
      Lutetia Parisorum, Île-de-France, France
  • 1998–2010
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France
  • 2009
    • Goethe-Universität Frankfurt am Main
      • Zentrum der Inneren Medizin
      Frankfurt am Main, Hesse, Germany
  • 2007
    • Indian Broiler (IB) Group India
      Bhānpuri, Chhattisgarh, India
    • The University of Western Ontario
      • Division of Gastroenterology
      London, Ontario, Canada
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 1994–2006
    • French National Centre for Scientific Research
      Lutetia Parisorum, Île-de-France, France
  • 2004
    • The University of Hong Kong
      • Department of Medicine
      Hong Kong, Hong Kong
  • 2002
    • Duke University Medical Center
      • Duke Clinical Research Institute
      Durham, NC, United States
  • 2001–2002
    • Université René Descartes - Paris 5
      • Faculty of Pharmaceutical Sciences and biology
      Lutetia Parisorum, Île-de-France, France
  • 2000
    • Tufts University
      • Department of Medicine
      Boston, GA, United States
  • 1999
    • University of Angers
      Angers, Pays de la Loire, France
  • 1987–1996
    • Hôpital Antoine-Béclère – Hôpitaux universitaires Paris-Sud
      Clamart, Île-de-France, France
  • 1983–1993
    • Institut de Cancérologie Gustave Roussy
      • Department of Radiotherapy
      Île-de-France, France
  • 1989
    • National Institute of Immunology
      New Dilli, NCT, India
  • 1988
    • Harvard Medical School
      Boston, Massachusetts, United States