[Intrauterin infection during the first trimester and on-going pregnancy]. / Cas clinique. Infection intra-utérine au premier trimestre d'une grossesse évolutive.

An intrauterine infection during the first trimester of pregnancy can rapidly lead to bacteremia, with severe consequences for the patient. While these infections are mainly found after a miscarriage or an abortion, the diagnosis is sometimes made while the pregnancy is still in progress. The clinical history and symptoms reported by the patient lead to the suspicion of such a complication. Treatment must be rapid and based on a broad-spectrum antibiotic regimen covering Gram-negative, Gram-positive, aerobic and anaerobic bacteria. As soon as the treatment has been initiated, uterine curettage should be performed to remove the infected material, whether or not foetal cardiac activity is present at the time of diagnosis.

Une infection intra-utérine durant le premier trimestre de la grossesse peut rapidement mener à une bactériémie et avoir des conséquences sévères pour la patiente. Alors que ces infections sont principalement retrouvées après une fausse couche ou une interruption volontaire de grossesse, le diagnostic est parfois posé alors que la grossesse est évolutive. L'histoire clinique et les symptômes rapportés par la patiente permettent de suspecter une telle complication. La prise en charge doit être rapide et repose sur un traitement antibiotique à large spectre couvrant les bactéries Gram négatif, Gram positif, les aérobies et les anaérobies. Dès le traitement instauré, un curetage utérin devra être réalisé afin d'éliminer le matériel infecté, que l'activité cardiaque fœtale soit présente ou non au moment du diagnostic.

P-glycoprotein modulates oleanolic acid effects in hepatocytes cancer cells and zebrafish embryos.

Oleanolic acid (OA) is a triterpenoid, widely found in plants and possesses antitumor activity in many cancer lines. However, cancer cells develop multidrug resistance (mdr) hindering the effect of anticancer drugs. P-glycoprotein (P-gp) is a major cause of mdr. Therefore, the cytotoxic effect of OA was evaluated on human breast cancer MDA-MB-231 and human liver cancer HepG2 with absence and presence of P-gp, respectively. OA reduced MDA-MB-231 viability in a dose dependent manner, whereas no remarkable effect was observed on HepG2 in the same range of concentrations (1-60 µM). Moreover, cytotoxicity studies were conducted in the presence of verapamil (20 mg/L), a P-gp inhibitor. OA exhibited the same effect on MDA-MB-231 in the absence and presence of verapamil. However, the cytotoxicity was greatly enhanced for HepG2 cells in the presence of verapamil (cell viability dropped from 63.7% to 25% after 72 h at 60 µM). The results were then confirmed in vivo on zebrafish embryos. Increased mortality and malformations were observed in verapamil pretreated group between 5 and 15 µM of OA compared to control; also, all embryos died at 20 µΜ OA and above. These results demonstrate that inhibiting P-gp enhances the chemotherapeutic activity of OA.