Hurdles of environmental risk assessment procedures for advanced therapy medicinal products: comparison between the European Union and the United States.

An environmental risk assessment (ERA) consists of an analysis of the risks to human health and the environment that a medicinal product may cause due to its release during clinical development or after entering the market. Regulators in European Union (EU) and the United States (US) require that advanced therapy medicinal products (ATMPs) that are also genetically modified organisms (GMOs) undergo an ERA in order to be approved for marketing authorization. This work aims to review the regulatory issues that need to be taken into consideration for carrying out an ERA, comparing the EU and the US. The European regulatory framework for environmental procedures and the dissimilarities in its implementation across the Member States and its implications at a logistical level are analyzed in detail. In addition, this review provides a brief insight into the non-clinical and clinical assessments that should be carried out during the development of the product in order to conduct a successful ERA, and thus facilitate its marketing authorization and post-marketing monitoring. Finally, the need for a European harmonization regarding environmental procedures for ATMPs is discussed.

Amyloid formation in human islets is enhanced by heparin and inhibited by heparinase.

Islet transplantation is a promising therapy for patients with diabetes, but its long-term success is limited by many factors, including the formation of islet amyloid deposits. Heparin is employed in clinical islet transplantation to reduce clotting but also promotes fibrillization of amyloidogenic proteins. We hypothesized that heparin treatment of islets during pre-transplant culture may enhance amyloid formation leading to beta cell loss and graft dysfunction. Heparin promoted the fibrillization of human islet amyloid polypeptide (IAPP) and enhanced its toxicity to INS-1 beta cells. Heparin increased amyloid deposition in cultured human islets, but surprisingly decreased islet cell apoptosis. Treatment of human islets with heparin prior to transplantation increased the likelihood of graft failure. Removal of islet heparan sulfate glycosaminoglycans, which localize with islet amyloid deposits in type 2 diabetes, by heparinase treatment decreased amyloid deposition and protected against islet cell death. These findings raise the possibility that pretransplant treatment of human islets with heparin could potentiate IAPP aggregation and amyloid formation and may be detrimental to subsequent graft function.

Metabolic stress, IAPP and islet amyloid.

Amyloid forms within pancreatic islets in type 2 diabetes from aggregates of the ß-cell peptide islet amyloid polypeptide (IAPP). These aggregates are toxic to ß-cells, inducing ß-cell death and dysfunction, as well as inciting islet inflammation. The ß-cell is subject to a number of other stressors, including insulin resistance and hyperglycaemia, that may contribute to amyloid formation by increasing IAPP production by the ß-cell. ß-Cell dysfunction, evident as impaired glucose-stimulated insulin secretion and defective prohormone processing and exacerbated by metabolic stress, is also a likely prerequisite for islet amyloid formation to occur in type 2 diabetes. Islet transplants in patients with type 1 diabetes face similar stressors, and are subject to rapid amyloid formation and impaired proinsulin processing associated with progressive loss of ß-cell function and mass. Declining ß-cell mass is predicted to increase metabolic demand on remaining ß-cells, promoting a feed-forward cycle of ß-cell decline.

Molecular signature of the immune and tissue response to non-coding plasmid DNA in skeletal muscle after electrotransfer.

Electrotransfer of plasmid DNA in skeletal muscle is a common non-viral delivery method for both therapeutic genes and DNA vaccines. Yet, despite the similar approaches, an immune response is detrimental in gene therapy, but desirable for vaccines. However, the full nature of the immune and tissue responses to nucleic acids and electrotransfer in skeletal muscle has not been addressed. Here we used microarray analysis, fluorescence-activated cell sorting and quantitative polymerase chain reaction to obtain the molecular and cellular signature of the tissue and immune response to electrotransfer of saline and non-coding plasmid DNA. Saline electrotransfer resulted in limited infiltration and induction of a moderate damage-repair gene expression pattern not involving innate immune activation. However, plasmid electrotransfer augmented expression of the same genes in addition to inducing a strong innate immune response associated with pro-inflammatory infiltration. In particular, the inflammasome, Toll-like receptor 9 and other pattern recognition receptors able to respond to cytoplasmic DNA were upregulated. Several key differences in the nature of the inflammatory infiltrate and the kinetics of gene expression were also identified when comparing electrotransfer of conventional and CpG-free plasmids. Our data provide insights into the mechanisms of DNA detection and response in muscle that has relevance for non-viral gene therapy and DNA vaccination.

High AAV vector purity results in serotype- and tissue-independent enhancement of transduction efficiency.

The purity of adeno-associated virus (AAV) vector preparations has important implications for both safety and efficacy of clinical gene transfer. Early-stage screening of candidates for AAV-based therapeutics ideally requires a purification method that is flexible and also provides vectors comparable in purity and potency to the prospective investigational product manufactured for clinical studies. The use of cesium chloride (CsCl) gradient-based protocols provides the flexibility for purification of different serotypes; however, a commonly used first-generation CsCl-based protocol was found to result in AAV vectors containing large amounts of protein and DNA impurities and low transduction efficiency in vitro and in vivo. Here, we describe and characterize an optimized, second-generation CsCl protocol that incorporates differential precipitation of AAV particles by polyethylene glycol, resulting in higher yield and markedly higher vector purity that correlated with better transduction efficiency observed with several AAV serotypes in multiple tissues and species. Vectors purified by the optimized CsCl protocol were found to be comparable in purity and functional activity to those prepared by more scalable, but less flexible serotype-specific purification processes developed for manufacture of clinical vectors, and are therefore ideally suited for pre-clinical studies supporting translational research.

High seroprevalence of Neospora caninum in the red fox (Vulpes vulpes) in the Pyrenees (NE Spain).

Antibodies to Neospora caninum were determined in the red fox (Vulpes vulpes) in the Pyrenees, north-eastern Spain. Sera from 53 red foxes (29 male and 24 female) were tested using a Neospora agglutination test (NAT). Seroprevalence at dilutions of 1/40, 1/80 and 1/160 was 69.8%, 47.2% and 7.5%, respectively. Sex differences were significant only at a dilution of 1:40. The high seroprevalence observed in red fox suggests that this species is highly exposed to N. caninum in this area.

Effect of acepromazine on the signs of capture stress in captive and free-ranging roe deer (Capreolus capreolus).

The differences between the capture stress responses of captive and free-ranging roe deer (Capreolus capreolus) and their modulation by acepromazine, during a period of three hours' physical restraint after capture in drive-nets, were examined in 16 free-ranging and 16 captive roe deer. Eight of the free-ranging and eight of the captive animals received acepromazine intramuscularly, and the other eight free-ranging and eight captive deer received the same volume of saline. Heart rate, body temperature and haematological and serum biochemical parameters were analysed. In the groups treated with acepromazine, the heart rate stabilised sooner, and the red blood cell (RBC) count, haemoglobin concentration, packed-cell volume, the serum activities of creatine kinase (CK), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) and the concentrations of creatinine and lactate were significantly lower, and serum glucose started to decrease earlier, than in the untreated groups. Serum potassium levels decreased over time only in the untreated groups. The body temperature stabilised earlier, and the RBC count, haemoglobin concentration, serum CK, AST, ALT and LDH activities, and serum creatinine, lactate, cholesterol and glucose concentrations were significantly lower in the free-ranging roe deer than in the captive deer.

Haematological and serum biochemical values of southern chamois (Rupicapra pyrenaica).

Blood samples were taken from 75 free-ranging southern chamois (Rupicapra pyrenaica) captured in drive-nets in Catalonia, north-eastern Spain, and 20 haematological and 24 serum biochemical variables were analysed. The values were similar to those of other species of the Caprinae subfamily, except for cortisol, the concentration of which was higher. The red blood cell count (RBC), platelets and leucocytes, and the concentrations of cortisol, lactate, muscular enzymes and gamma-globulins were higher in summer than in spring, whereas the mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration, and the concentrations of cholesterol, total bilirubin and creatinine were lower. Adult males had higher RBCs and haemoglobin values than females in summer, and lower leucocyte, lymphocyte and neutrophil counts than females and yearling males. The concentrations of triglycerides, total bilirubin, lactate, creatinine, urea, chloride and alpha2-globulins were higher in adult males than yearling males. In summer the adult females had higher values for platelets, lymphocytes, cortisol, sodium and muscular enzymes.

Effects of acepromazine on capture stress in roe deer (Capreolus capreolus).

The aim of this study was to evaluate effect of a short-acting neuroleptic (acepromazine) on capture stress response in roe deer (Capreolus capreolus). Sixteen roe deer were captured by drive-nets in the winters of 1998, 1999, and 2001. Roe deer were divided into two groups: animals in the treatment group received an intramuscular injection of acepromazine (0.093 mg/kg +/- 0.003 SEM; n = 8) while animals in the control group (n = 8) did not receive tranquilizer. Heart rate and body temperature, as well as hematologic and biochemical indicators of stress, were used to evaluate effect of the neuroleptic over 3 hr. Heart rate decreased over time after capture in both groups (P < 0.05), but stabilized sooner in the treated roe deer (75 min after capture) than in the controls (105 min after capture). Body temperature decreased over 45 min and then stabilized in both groups (P < 0.05). Comparisons of blood parameters revealed significantly lower red blood cell count (RBC), lymphocyte count, hemoglobin concentration, packed cell volume (PCV), and serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatine kinase (CK), and lactate dehydrogenase (LDH) activities in tranquilized animals compared with controls (at least P < 0.05). A reduction in PCV, lymphocyte count, and serum cortisol concentrations (at least P < 0.05) and an increase in serum creatinine levels (P < 0.05) were recorded over time in control animals, while a reduction in RBC and hemoglobin concentration (at least P < 0.05) and an increase in serum urea concentrations (P < 0.05) over time were observed in the treated group. Finally, a decrease in serum lactate and potassium levels and an increase in CK, AST, ALT, and LDH activities were recorded over time in both groups. Results obtained showed the suitability of using acepromazine in capture operations in order to reduce stress response and prevent its adverse effects in roe deer. The beneficial effect was not only due to the sedative effect of acepromazine, but also to peripheral vasodilatation.

Delayed acute capture myopathy in three roe deer.

Delayed acute capture myopathy is the term used to describe the clinical syndrome observed in three roe deer captured by drive-nets and transported to an enclosure for scientific purposes. The animals died 48 h, 60 h and 8 days after being captured. The simultaneous deaths coincided with a previous episode of deliberate human disturbance. The histopathological findings were indicative of acute myopathy and myoglobinaemic nephrosis. These could be related to an ataxic myoglobinuric syndrome brought on by capture and transport operations. The lack of clinical signs and negative prognosis indicators in the period between capture and just before death. the absence of gross muscular lesions in the animal that died after 8 days post-capture, the simultaneous deaths of animals captured at different times and the evidence of deliberate human disturbance in the enclosure are suggestive of death triggered by a second stress episode.

Multiple bilateral fractures of the lumbar transverse processes in a roe deer (Capreolus capreolus).

Multiple bilateral fractures of the lumbar transverse processes were radiographically identified postmortem in a recently captured roe deer (Capreolus capreolus). These fractures were probably caused by an avulsion of the psoas major occurring during introduction into the transport box. The deer probably died from shock caused by the fractures, muscle damage, and subsequent hemorrhage. Although easily overlooked, fractured lumbar transverse processes may indicate inadequate postcapture management practices.

Electrophoretic patterns and immunoglobulin G levels in mouflon (Ovis orientalis musimon) and roe deer (Capreolus capreolus).

Serum protein and immunoglobulin G (IgG) levels were measured from 16 healthy mouflons (Ovis orientalis musimon) and from 28 roe deer (Capreolus capreolus) in French and Catalonian populations. Electrophoretic patterns were described for each species. The only significant gender-related difference was increased beta-globulins in French roe deer males. Significantly increased alpha1-globulin levels and decreased IgG levels occurred in the young Catalonian roe deer compared with adults from the same group. Values for total proteins, beta-globulins, gamma-globulin, and IgG were significantly higher in the French roe deer, while albumin and albumin/globulin ratio were higher in the Catalonian roe deer. Both populations had the same relative migration distances of the various protein fractions of the electrophoresis.

[An ovarian sex cord tumor with annular tubules secreting prolactin. Reality or fortunate coincidence?]. / Tumeur ovarienne des cordons sexuels avec tubes annelés productrice de prolactine. Réalité ou coïncidence fortuite?

In a 13-year old girl, an ovarian tumor was suspected of being responsible for causing amenorrhea-galatorrhea. In the absence of any abnormality of the medial umbilical folds, hormonal assessment indicated a high level of prolactin, which was restored to normal after exeresis of the mass. This was an ovarian tumor of the sexual cords with annelated tubules (SCTAT de Scully).

[Evolvements in the presentation of primary bronchial adenocarcinomas observed in a pneumology service over an 11-year period]. / Evolution de la présentation des adénocarcinomes bronchiques primitifs observés dans un service de pneumologie pendant 11 ans.

The evolution of the clinical presentation, endoscopy and radiology in a consecutive series of 121 cases of primary bronchial adenocarcinoma has been studied in a retrospective manner over a period of 11 years. The mean age was 60 +/- 12 and 16.5% of the patients were women. The frequency of smoking and the quantity smoked in packed years was significantly higher in men than in women. The frequency of the presenting signs and the endoscopic features did not change over the period. On the other hand, the peripheral and mediastinal-hilar forms were more frequent from 1990 in a significant manner so that the hilar form became rarer. The result seems to confirm an increase in the frequency of a new radio-clinical expression of primary bronchial adenocarcinoma. These mediastinal-hilar adenocarcinomas do not have specific characteristics but are associated with a higher mortality.

Pulmonary cryptococcosis associated with HIV-1 infection in Rwanda: a retrospective study of 37 cases.

OBJECTIVES: To study the demographic, clinical, radiographic and diagnostic features, the clinical course and therapeutic response of pulmonary cryptococcosis in HIV-1-infected patients. DESIGN: Retrospective review. SETTING: The Department of Medicine of an urban reference hospital in Central Africa. METHODS: All the records of HIV-1-infected patients with pulmonary cryptococcosis were reviewed retrospectively with regard to the parameters described above. RESULTS: Over a 3-year period, pulmonary cryptococcosis was diagnosed in 37 HIV-1-infected Rwandan patients (21 men, 16 women; mean age, 35 years; range, 26-55 years). Twenty-nine patients (78%) had primary pulmonary cryptococcosis. Cough (94%), weight loss (65%), fever (51%), dyspnoea (46%), thoracic pain (30%), headache (13%) and haemoptysis (8%) were the predominant clinical findings. A diffuse interstitial infiltrate on chest radiograph was observed in 76% of the patients, an alveolar pattern in 19%, mediastinal and/or hilar adenopathy in 11%, nodules and pleural effusion each in 5%. Bronchoalveolar lavage, with a yield of 82%, was found to be the most sensitive diagnostic procedure. Screening of cryptococcal antigen in the serum failed to detect cases of primary pulmonary cryptococcosis. Twelve patients with primary pulmonary cryptococcosis treated with itraconazole as acute and maintenance therapy were all protected against disseminated cryptococcal disease; seven out of 10 (70%) of those who did not receive a specific anticryptococcal drug developed disseminated cryptococcal disease. CONCLUSION: Pulmonary cryptococcosis is not a rare complication of HIV-1 infection in Rwanda. Its clinical and radiographic patterns are non-specific and bronchoalveolar lavage is the procedure of choice for its diagnosis. The natural history of untreated primary pulmonary cryptococcosis is disseminated cryptococcal disease. Itraconazole is highly effective in the prevention of disseminated cryptococcal disease in patients with primary pulmonary cryptococcosis.

[Rectal neoplasia during pregnancy and the puerperium: report of 3 cases and review of the literature]. / Néoplasie rectale et gravido-puerpéralité. Rapport de trois cas et revue de la littérature.

Three cases of rectal carcinoma associated with pregnancy led the authors to review the general literature. The lesion is most often an adenocarcinoma, diagnosed late at an advanced stage of progression in young women. Results of treatment are poor and the outcome fatal.

[Residual ovary after hysterectomy. Is castration at peri-menopause necessary to prevent ovarian cancer?]. / L'ovaire restant après hystérectomie. Faut-il, à la périménopause, une castration pour prévenir le cancer ovarien?

OBJECTIVE: Evaluation of the risk of ovarian carcinoma associated with uni or bilateral adnexal preservation following gynecological surgery for benign lesions. MATERIAL: Gynecological surgery history of 190 patients with a primary ovarian carcinoma diagnosed and/or treated in the Navarre Teaching Hospital Group between 1981 and 1991 inclusive. RESULTS: Two patients, i.e. 1%, had undergone conservative surgery prior to the diagnosis of ovarian neoplasia. CONCLUSION: Ovary left in place after conservative surgery undergoes malignant change less than in the population as a whole.

Multicentre study of a continent colostomy plug.

A multicentre clinical study was carried out to assess the performance of a new disposable device, the Conseal 1-Piece, for colostomy control and continence. Forty-three patients were studied; none had any complication at the stoma. The time elapsed since surgery and the condition of the stoma and surrounding skin were recorded. The new product was compared with the patients' usual colostomy bag, studying the following parameters: ease of application, reliability, leakage, confidence, ease of removal, adhesion and comfort. Thirty-seven patients completed the study. No complications arose, and complete faecal continence was obtained with 71.1 per cent of applications. The plug was kept in position for a mean of 11.5 h and a normal stoma bag was used for the remainder of the day. Of the 37 patients who completed the trial, 26 preferred the Conseal 1-Piece to a colostomy bag. In this preliminary study the device was easy to apply, involved no major complications and provided a high degree of continence. This product deserves further study because of its simplicity of use. However, research to improve the level of continence should continue.