The emerging global epidemic of paediatric inflammatory bowel disease--causes and consequences.

Two decades ago, paediatric inflammatory bowel disease (IBD) drew only modest interest from the international paediatric community. Since then, dramatically globally increasing incidence rates have made childhood-onset IBD a priority for most paediatric gastroenterologists. The emerging pandemia of paediatric IBD has fuelled a quest to identify the recent changes in early life exposures that could explain the increasing risk for IBD amongst today's children. Treatment of children with IBD should aim for symptom control but should also target restoration of growth and prevention of pubertal delay. The paediatric IBD phenotype seems to be characterized by more extensive disease location, and some comparative studies have suggested that childhood-onset IBD also represents a more severe phenotype than the adult-onset IBD form. In this review, we analyse recent global incidence trends of paediatric IBD. We present an update on the known and suggested risk factors that could explain the emerging global epidemia of paediatric IBD. We also draw attention to differences in treatment between children and adults with IBD. Finally, we highlight latest follow-up studies that question the proposed dynamic and aggressive nature of childhood-onset IBD.

Safety, healing, and efficacy of vascular prostheses coated with hydroxypropyl-ß-cyclodextrin polymer: experimental in vitro and animal studies.

OBJECTIVES: Polyester vascular prostheses (PVPs) coated with a polymer of hydroxypropyl-ß-cyclodextrin (HPßCD) have been designed to provide an in situ reservoir for the sustained delivery of one or more bioactive molecules. The goal of this study was to assess the efficacy, the safety and the healing properties of these prostheses. METHODS: Collagen-sealed PVPs were coated with the HPßCD-based-polymer (PVP-CD) using the pad-dry-cure textile finishing method and loaded with one or two antibiotics. Appropriate control and PVP-CD samples were tested in several in vitro and animal model conditions. The study end points included haemolysis, platelet aggregation, antibacterial efficacy, polymer biodegradation, acute toxicity and chronic tolerance. RESULTS: PVP-CD proved to be compatible with human blood, since it did not induce haemolysis nor influenced ADP-mediated platelet aggregation. Sustained antimicrobial efficacy was achieved up to 7 days against susceptible bacteria when PVP-CDs were loaded with the appropriate drugs. Analysis of harvested PVP-CD from the animal model revealed that the HPßCD-based coating was still present at 1 month but had completely disappeared 6 months after implantation. All grafts were patent, well encapsulated without healing abnormalities. Clinical data, blood-sample analysis and histological examination did not evidence any signs of acute or chronic, local or systemic toxicity in the animal models. CONCLUSION: PVP-CD was proved safe and demonstrated excellent biocompatibility, healing and degradation properties. Effective antimicrobial activity was achieved with PVP-CD in conditions consistent with a sustained-release mechanism.

[Bone substitutes: Classification and concerns]. / Les biomatériaux de substitution osseuse : classification et intérêt.

Autograft is considered as the "gold standard" for bone reconstruction. It provides osteoinductive factors, osteogenic cells, and appropriate osteoconductive scaffold. Donor site morbidity is the main limitation of autograft. Donor disease transmission limits the use of allograft. Synthetic bone substitutes still lack osteoinductive or osteogenic properties. Composite bone substitutes combining synthetic scaffold and biochemical substances initiating proliferation and cell differentiation, and possibly osteogenesis. Bone substitutes and grafts intended for clinical use are listed.

Chemical, biological and microbiological evaluation of cyclodextrin finished polyamide inguinal meshes.

This study describes the use of cyclodextrins (CDs) as a finishing agent of polyamide (PA) fibers used in order to obtain inguinal meshes with improved antibiotic delivery properties. The finishing process involved polymerization between citric acid and CDs, which yielded a cross-linked polymer that physically adhered to the surface of PA fibers. This permanent functionalization was characterized by evaluating the damping property with a polar liquid (glycerol) via the drop contact angle method for various rates of modification of the fabrics. The biological and microbiological effects of the PA, which were functionalized with hydroxypropylated derivate of gamma-CD (HP-gamma-CDs) and charged with ciprofloxacin (CFX), were evaluated by cell culture assays. We observed a good adhesion and proliferation of fibroblastic cells (NIH3T3) after 3 and 6 days and no detectable toxicity of the modified substrate. The in vitro antibacterial activity of the HP-gamma-CD grafted PA fabrics charged with CFX against the bacteria Staphylococcus aureus, Staphylococcus epidermidis and Escherichia coli was greatly superior to that of the virgin sample within a 24h batch experiment in human blood plasma medium. In conclusion, these results from our study offer an insight into the efficient performance of CDs as drug delivery systems for multiple applications in the fields of biomaterials and medical textiles.

Vascular prostheses with controlled release of antibiotics Part 2. In vitro biological evaluation of vascular prostheses treated by cyclodextrins.

Viability tests by the colony forming method show no toxicity for all CDs (beta-CD, gamma-CD, HPbeta-CD and HPgamma-CD) and their associated polymer. A survival rate of 100% is observed for all CDs at high concentration 400 ppm. Proliferation tests revealed a low proliferation of L132 cells on grafted vascular prostheses and untreated prostheses and good proliferation on Melinex (film form of PET). A proliferation of 17% is observed after 3 days of incubation and decrease at 4% after 6 days on prostheses. Melinex exhibits a proliferation rate as the controls. Vitality tests confirm proliferation tests and show a good vitality of cells even for low cell amounts. From these experiments it becomes obvious that the decreasing proliferation rate is not a cytotoxic effect but is due to the chemical and/or physical surface characteristics. A similar result is obtained for cell adhesion kinetics between grafted vascular prostheses and control. After 2 h adhesion, a lower adhesion is observed on untreated prostheses. Theses results were confirmed by immunochemistry and morphology tests. This cell adhesion inhibiting effect of the PET prostheses contributes to a better "survival" of vascular prostheses without secondary obstruction or stenosis.

Vascular prostheses with controlled release of antibiotics Part 1: Surface modification with cyclodextrins of PET prostheses.

Vascular prostheses were functionalised with the aim to obtain a slow release of antibiotics in order to reduce postoperative infections. The original process that we present in this paper is based on the use of a family of cage molecules named cyclodextrins (CD). These compounds have the ability to form reversible inclusion complexes with drugs such as antibiotics. The aim of this work was to graft CD onto the prosthesis, so that an antibiotic can be bound on it by this inclusion phenomenon, and then be progressively released over a prolonged period by a complex dissociation mechanism. This paper presents the first part of this research program and concerns mainly the study of the functionalization parameters. It presents surface characterization results of the modified prostheses. The PET prostheses were immersed into a solution containing a cross linking agent, cyclodextrins (beta-CD, gamma-CD, HP-beta-CD and HP-gamma-CD) and a catalyst and were padded. Grafting occurred by the mean of a thermofixation step at a temperature comprised between 140 and 180 degrees C. It was observed that the support was permanently modified when the CD polymer that coated the fibres resisted to the final washing process. Grafting rates of 12 wt% in CD polymer could be reached. It was also observed that the fibre coating reaction induced an increase of the permeability of the grafts.

Antibacterial activation of hydroxyapatite (HA) with controlled porosity by different antibiotics.

In order to prevent the increasing frequency of per-operative infections, bioceramics can be loaded with anti-bacterial agents, which will release with respect to their chemical characteristics. A novel hydroxyapatite (HA) was elaborated with specific internal porosities for using as a bone-bioactive antibiotic (ATB) carrier material. UV spectrophotometry and bacteria inhibition tests were performed for testing the ATB adsorption and the microbiological effectiveness after loading with different antibiotics. The impregnation time, ATB impregnating concentration, impregnation condition and other factors, which might influence the ATB loading effect, were studied by exposure to different releasing solvents and different pathogenic bacteria: Staphylococcus aureus, Staphylococcus epidermidis and Escherichia coli. It clearly showed that the facility of ATB loading on this porous HA is even possible just under simple non-vacuum impregnation conditions in a not-so-long impregnating interval. The results also showed that, for all three types of ATB (vancomycin, ciprofloxacin and gentamicin), adsorbed amount on the micro-porous HA were hugely higher than that on dense HA. The micro-porosity of test HA had also significantly prolonged the release time of antibiotics even under mimic physiological conditions. Furthermore, it also has primarily proved by a pilot test that the antibacterial efficiency of crude micro-porous HA could be further significantly improved by other methods of functionalization such as cold plasma technique.

Biological and physico-chemical assessment of hydroxyapatite (HA) with different porosity.

HA with specific internal porosities was loaded with different antibiotics (ATBs) and then tested on its microbiological effectiveness. The HA purity was controlled with X-ray diffraction, IR and Raman spectrometry. Varying the sintering temperature and/or adding graphite and PMMA as porogenous agents lead to obtained micro- and meso-porosities. The biological tests concerned cell viability, proliferation and morphology (SEM), and the cytochemical staining of actin and vinculin. The micro- and meso-porous HA samples had an internal pore size of 1-10 microm and 10-50 microm, respectively. X-ray diffraction and FTIR confirmed the high purity of the HA. The cell viability tests with L132 cells confirmed the excellent cytocompatibility of HA, the graphite powder and the ATB vancomycine. Proliferation rate was assessed with MC3T3-E1 osteoblasts. All HA samples produced a higher proliferation than the controls; the micro-porous HA inducing the highest cell growth. The ATB impregnated HA also stimulated cell proliferation but in lower extend. Cytochemical staining of osteoblasts revealed a well-developed cytoskeleton with strong stress fibres. Labelling of the focal adhesion contacts with anti-vinculin showed a less developed adhesion process in the cells on the different HA substrates. It was possible to realize a highly pure hydroxyapatite with different but controlled porosities by varying the sintering temperature and/or addition of a porogenous agents. This purity and the micro-porosity stimulate significantly cell growth.

Functionalization of PVDF membranes with carbohydrate derivates for the controlled delivery of chlorhexidin.

Maltodextrin (MX) was fixed onto PVDF membranes in order to create a drug delivery Guided Tissue Regeneration (GTR) device with controlled drug delivery properties. PVDF microporous membranes were treated by a mixture of MX and citric acid, resulting to an 18 wt% increase of the supports. MX grafted membrane could capture 103 mg/g chlorhexidin digluconate (DigCHX) instead of 1mg/g for a virgin membrane. A neutralization step was performed before the biological tests. Viability tests confirmed the non-toxicity of the MX polymer coating after neutralisation. In vitro release test in human plasma, and microbiological tests showed that membranes grafted with MX were more performing compared to virgin and beta-CD grafted membranes. The antimicrobial activity was effective during more than 72 h.

Adverse events leading to modification of therapy in a large cohort of patients with inflammatory bowel disease.

BACKGROUND: Adverse events leading to discontinuation or dose reduction of thiopurine therapy occur in 9-28% of patients with inflammatory bowel disease. AIMS: To evaluate the influence of thiopurine methyltransferase status and thiopurine metabolites in a large patient population for the risk of developing adverse event. METHODS: Three hundred and sixty-four patients with inflammatory bowel disease and present or previous thiopurine therapy were identified from a local database. RESULTS: The adverse event observed in 124 patients (34%) were more common in adults than children (40% vs. 15%; P < 0.001) and in low to intermediate (

Physico-chemical and biological evaluation of excimer laser irradiated polyethylene terephthalate (pet) surfaces.

The aim of this work was to investigate the consequences of excimer laser irradiation on the physico-chemical and biological properties of polyethylene terephthalate (PET) films, currently used for medical devices. Three PET films from different origins were studied in the present work, chosen with respect to their chemical and physical properties, which are of high importance for ulterior medical application as vascular prostheses. Multiple assays were carried out to characterize the physical and chemical effects of the laser irradiation: surface morphology tests (light microscopy, Dektak profilometer and confocal laser scanning microscopy) showed the strong transformation of the surface with the laser treatment. Contact angle measurements revealed a significant increase of the surface energy for each PET depending on the applied fluency. Finally XPS characterization of the surface demonstrated the appearance of new chemical species favorable for cell attachment. This aspect had to be strongly considered regarding to the multiple biological effects of laser irradiated surfaces on living cells. Different cell culture experiments were carried out with L132 human epithelial cells after 6-days culture: proliferation and vitality rate, cell adhesion and cell morphology. Results clearly revealed that laser treatment improved cell proliferation (up to 140% with respect to controls), vitality (10% higher than controls), morphology and adhesion kinetics (more than 16% of control). A significant correlation (R2=0.906) was also established on one PET between the fluencies of laser treatment and the cellular response. These results emphasized high importance of the choice of the PET material for a medical application: only one of the three considered PET films showed really improved cellular response.

Improved drug delivery properties of PVDF membranes functionalized with beta-cyclodextrin--application to guided tissue regeneration in periodontology.

The purpose of this study was to develop a membrane for guided tissue regeneration applicable in periodontology that could release antimicrobial agent during the healing period. Our strategy consisted to graft beta-cyclodextrin (beta-CD), a molecule that is known to form inclusion complexes with a large variety of drugs, onto PVDF membranes. Grafting occurred by using citric acid that provoked a crosslinking reaction of beta-CD, and the resulting polymer was imprisoned into the porous structure of the PVDF membrane. The reaction produced a weight increase of the membrane, the range of which depended on the temperature and on the time of curing applied in the process. The biological behavior of the membranes evaluated by proliferation and vitality tests showed good proliferation and improved activity of L132 epithelial cells on the raw and on the grafted membranes. Doxycyclin (DOX) and chlorhexidine (CHX) were used as antimicrobial agents. Their inclusion into the beta-CD cavity in aqueous solutions was confirmed by NMR spectroscopy. After the impregnation of the membranes with DOX and CHX, their release was studied in vitro in batch type experiments and measured by UV spectrophotometry. Low amounts of DOX and CHX were delivered from the raw membranes within the first few hours of tests. Grafted membranes, however, delivered DOX and CHX in larger quantities within 24 h and 10 days respectively.

[Biodegradation of synthetic bioglasses with different crystallinity in vitro].

SG600, SG900 and SG1100 were synthesized by the sol-gel method. Further treatments with increasing temperatures influenced and determined the crystallization degree of the material. Primary cultured osteoclasts were incubated for 4h and 48h on samples. Osteoclast actin labeling was examined by cytochemical staining. The concentrations of Ca and P in culture medium were quantified by colorimetric methods. SEM examined osteoclast morphology and resorption lacuna. Actin staining revealed on all three materials the typical adhesion contact ring. The Ca concentration in the culture medium of SG600 was significantly higher than that in control medium, SG900 and SG1100. Ca and P concentrations were always higher in culture media with the presence of osteoclasts. Morphological studies by scanning electron microsopy(SEM) showed a good adhesion behavior of osteoclasts on all three samples. Well-developed and deep resorption lacunae appearing after the osteoclastic resorption action were detected on all three samples. The synthetic bioglasses with different crystallizations caused different solubility, which seemed to have little effect on the osteoclast resorption behavior. The results of morphological studies on osteoclasts and resorption lacunae clearly demonstrate that the synthetic bioglasses are easily resorbed in vitro by osteoclasts.

Cylindrical laminated bodies in nickel-subsulphide-induced rhabdomyosarcoma in rabbits.

The induction of rabbit rhabdomyosarcoma was obtained after intramuscular implantation of a large quantity of very pure nickel subsulphide, though until the present time the rabbit was considered refractory to Ni3S2 tumorigenesis. These tumors are similar to those induced in rats under the same conditions. Four different cell types were observed: small polygonal cells, small elongated cells, giant cells, and mature myofibers. Electron microscopy reveals a complete disorientation of myofibrils in mature myoblasts. Giant cells appear by pluripolar endomitosis and always contain myofibrillar structures, but M-lines and Z-lines are not present in these cells. Cylindrical laminated bodies were observed very often in all four cell types. They are formed of 4 nm fibrils arranged in crossed position in each lamella. Some of these paracrystalline structures were also observed in nuclei. The laminated bodies are considered to be abnormal formations of contractile proteins produced during tumoral myofibrillar differentiation.

Pig cardiac myosin isoenzymes.

Pig heart myosins isolated from the free wall of the right ventricle and the free wall of the left ventricle were compared with respect to structural and enzymatic properties. The following parameters were studied (1) activation of myosin ATase by Ca2+ and K+j(2) molecular weight of the heavy and light chains of myosins as determined by electrophoretic migration in polyacrylamide sodium dodecyl sulfate (SDS) gels; (3) ability of the heavy chains to form aggregates at low ionic strength as revealed by electron microscopy; (4) sensitivity to the action of chymotrypsin. Differences were observed between left and right ventricular myosins (L-myosin and R-myosin) for all these parameters except for the molecular weight of heavy and light chains. The existence of large amounts of short synthetic filaments for R-myosin compared with L-myosin as revealed by the length repartition of the filaments, and the production of smaller quantities of HMM-S by chymotryptic digestion for R-myosin, strongly suggest the presence of different cardiac myosin heavy chain species.

Tumoral myosins of Ni3S2-induced rhabdomyosarcomas in rat and rabbit: comparative studies with adult and fetal myosins of skeletal muscle.

Tumoral myosins were isolated from rat and rabbit rhabdomyosarcomas and compared with normal adult and fetal skeletal myosins. The synthetic filaments, the light-chain composition and the Ca2+ ATP-ase activity were studied. In the presence of Mg2+, normal myosins precipitated as bipolar filaments (0.5 micrometer), fetal and tumoral myosins, however, precipitated as long fusiform filaments (1 to 10 micron). SDS-PAGE revealed that tumoral myosins contain the same light-chains as fetal myosin (25000 and 18000 daltons, L25-L18). The third light-chain of the normal muscle myosin (16000 daltons, L16) was absent. In addition, Urea-PAGE revealed the absence of the phosphorylated form of the L18 in fetal and tumoral myosins. Ca2+ ATPase activity measurements performed in function of the Ca2+ concentration showed similarities between fetal and adult muscle myosins. The Ca2+-ATPase activity of tumoral myosins, however, was very low and slightly activated by increasing the Ca2+ concentration (0.01 to 10 mM). The investigation has shown that fetal and tumoral myosins are identical concerning the ultrastructure of their synthetic filaments and their light-chain composition. This was not so in regard to the Ca2+ ATPase activity. This is probably the result of the expression of a new myosin- or of one of its polypeptides-, which has a different Ca2+-ATPase activity.

Evaluation of human recombinant bone morphogenetic protein-2-loaded tricalcium phosphate implants in rabbits' bone defects.

Porous beta-tricalcium phosphate (betaTCP) has osteoconductive properties. The adsorption of human recombinant bone morphogenetic protein-2 (rhBMP-2) onto TCP could realize an osteoinductive bone substitute. We evaluated it on an animal model using dual-energy X-ray absorptiometry (DEXA) and solid-state 31P nuclear magnetic resonance (NMR) spectroscopy. BetaTCP cylinders loaded with rhBMP-2 were implanted into rabbits' femoral condyle bone defects, and betaTCP alone as control into the contralateral femur. We studied two different doses of rhBMP-2 (10 and 40 microg) on two groups of four animals. Evaluation consisted in radiography, histology, and histomorphometry, DEXA, and NMR spectroscopy using an original method of quantification. With both doses of rhBMP-2, we observed on radiographs an increase of trabecular bone around implants. Histology showed resorption of the ceramic, trabecular bone with osteoblasts and osteoid substance around the implants, and colonization inside the porous betaTCP by new bone formed. Histomorphometry showed that the osteoid surface (OS/BS) was greatest with the high dose of rhBMP-2. The difference was slight between the low dose of rhBMP-2 and control. DEXA showed a dose-dependent increase of bone mineral density of rhBMP-2-loaded betaTCP vs. control. NMR spectroscopy confirmed that the amount of new bone formed in betaTCP was greater when betaTCP carried rhBMP-2, and increased with the dose of rhBMP-2 used. We showed that betaTCP was a good matrix for rhBMP-2, which gave it osteoinductive properties in an orthotopic site, in a dose-dependent manner. Thus, such composite biomaterial seems to be of great interest in reconstructive bone surgery. Further studies are needed in clinical practice to determine optimal doses.

Potentialities of ultrasounds for the nondestructive evaluation of cell adhesion.

The aim of this paper is to present the potentialities of ultrasounds to investigate the mechanical properties of a cell/substrate interface. The adhesion process plays a major role in the development of osteoblastic cells on various substrates used in orthopedic applications such as metals, bioceramics, etc. Particularly, cell adherence appears to be a critical factor in the colonization process. High-frequency and low-power ultrasounds seem to be an appropriate tool for a nondestructive evaluation of interface properties. First, we present the results obtained with bulk longitudinal and shear waves under an arbitrary incidence over an aluminum-adhesive interface. This study was performed for an industrial application of bonding. The results clearly show the sensitivity of shear waves for the evaluation of the adhesion quality owing to the shear solicitations at the interface they induce. A model of ultrasound interactions with a boundary subject to varying degrees of adhesion has been developed and compared to the experiments. Second, we investigated osteoblastic cell cultures with a high-frequency acoustic microscope working at 50 MHz. The images obtained in the shear mode reveal a better contrast than those obtained in the longitudinal mode. For the time being, these results are qualitative, and theoretical models have to be developed according to the point of view of biologists.

[Preparation of highly purified microbules and evidence for a novel molecular arrangement at low temperatures]. / Préparation de microtubules hautement purifiés et mise en évidence d'un arrangement nouveau des molécules de tubuline à basse température.

Microtubules were prepared by in vitro polymerization-depolymerization cycles, 1.0 M NaCl which totally depolymerizes was then added to the preparation. After removal of NaCl new arrangements of tubulin were observed at 4 degrees C: simple and double rings as well as fibrils. At 37 degrees these structures disappeared and tubulin polymerized into microtubules. The highly microtubules contain tubulin, tubulin associated proteins of 300,000 and 330,000 molecular weight, minor proteins of low molecular weight and proteins similar to the Tau factors. This raises a question of the role played by low molecular weight polypeptides. Are they products of proteolysis of rather factors of polymerisation?

Immunolocalization of tenascin-C, alpha9 integrin subunit, and alphavbeta6 integrin during wound healing in human oral mucosa.

Tenascin-C (TN-C) and its isoforms are multidomain extracellular matrix (ECM) proteins that are believed to be involved in the regulation of stromal-epithelial interactions. Some of the interactions between TN-C and cells are mediated by integrins. In this study we analyzed the expression of TN-C and its large molecular weight splice isoform (TN-C(L)) and the putative TN-C-binding alpha9 and alphavbeta6 integrins during human wound repair. In 3-day-old oral mucosal wounds, immunoreactivity for alpha9 integrin localized abundantly at the migrating basal wound epithelial cells. TN-C and TN-C(L) were localized in the matrix between and underneath alpha9-expressing epithelial cells. In parallel with gradual downregulation of alpha9 integrin immunoreactivity in 7-day and older wounds, the expression of alphavbeta6 integrin was temporarily induced. Integrin alphavbeta6 co-localized in the same area as TN-C and TN-C(L) immunoreactivity at the cell-cell contacts of the basal and suprabasal cell layers of the wound epithelium. During granulation tissue formation and reorganization from 7 to 28 days after wounding, TN-C and TN-C(L) were abundantly localized in the granulation tissue. The findings show that TN-C(L) is expressed under the migrating epithelial front and in the granulation tissue during matrix deposition in wound repair. Preferential localization of alpha9 integrin in migrating epithelial cells and of alphavbeta6 integrin in epithelium after wound closure suggests different functions for these integrins in wound repair.