Intraperitoneal clearance as a potential biomarker of cisplatin after intraperitoneal perioperative chemotherapy: a population pharmacokinetic study.

BACKGROUND: Intraperitoneal (IP) perioperative chemotherapy with cisplatin is an interesting option in ovarian cancer treatment. A combination of cisplatin with IP epinephrine (already shown to improve IP and decrease systemic platinum (Pt) exposure) was evaluated using a population pharmacokinetic analysis. METHODS: Data from 55 patients treated with cisplatin-based IP perioperative chemotherapy with (n=26) or without (n=29) epinephrine were analysed using NONMEM. RESULTS: Epinephrine halves clearance between peritoneum and serum (IPCL) and increases the Pt central volume of distribution, IP exposure and penetration in tissue. IPCL has a better predictive value than any other parameter with respect to renal toxicity. CONCLUSION: This confirms that IPCL could be useful in assessing renal toxicity. As IPCL is also linked to tissue penetration and IP exposure, it may be proposed as biomarker. In addition to a Bayesian estimation, we propose a single-sample calculation-way to assess it. Prospective studies are needed to validate IPCL as a biomarker in this context.

Delayed 24 hours Nomega-nitro-L-arginine methyl ester injection induces pharmacological cardioprotection against reperfusion injury.

Previous studies indicate that adenosine supplementation or nitric oxide synthase (NOS) inhibition during reperfusion exert protective effects against myocardial ischemia-reperfusion (I/R) injury. We wanted to test the hypothesis that NOS inhibition before I/R also protects the myocardium against further injury and aimed to determine the involvement of adenosine receptors in a perfused rat heart model. Rats were injected with 10 mg/kg of L-NAME (N(omega)-nitro-L-arginine methyl ester) or L-NAME + SPT (8-(p-sulfophenyl)-theophylline)--an adenosine antagonist - at 2 x 25 mg/kg or with a saline buffer, 24 hrs prior to heart excision. The hearts, perfused retrogradely were subjected to 60 min of global ischemia followed by 120 min reperfusion. L-NAME decreased NOx (nitrite and nitrate) production (16.2 +/- 3.2 vs. 7.0 +/- 1.8 micromol/L; P<0.05) in vivo and increased the release of troponin I (0.04 +/- 0.01 vs. 0.02 +/- 0.01 microg/L; P<0.05) in the plasma, compared to controls. After 120 min of reperfusion, there was a higher release of adenosine (26.1 +/- 2.2 vs. 2.4 +/- 1.2 nmol/min; P<0.01) and a decrease in troponin I levels (0.19 +/-0.07 vs. 0.59 +/- 0.16 ng/min; P<0.05) in the L-NAME group compared to controls. These results were accompanied by a higher proportion of recovery of left ventricular developed pressure (72.0 +/- 4.0 vs. 60.0 +/- 4.0%; P<0.05) and coronary flow (72.0 +/- 5.0 vs. 51.0 +/- 4.0%; P<0.05) in the L-NAME group. These beneficial effects were not blocked by the adenosine receptor antagonist. The present study reveals that L-NAME protects against I/R injury when the inhibitor is administered 24 hrs before ischemia. The beneficial effects observed in this model appear to be independent of adenosine receptor stimulation.

Physical training decreases total plasma homocysteine and cysteine in middle-aged subjects.

AIMS: The aim of this study was to evaluate whether endurance exercise in middle-aged men induces changes in plasma total homocysteine (tHcy) and total cysteine (tCys), and whether these changes depend on the diet especially on vitamin B(6), folic acid and vitamin B(12) intakes. METHODS: Twelve trained subjects (52.33 +/- 2.4 years) and twelve untrained subjects (56.23 +/- 0.9 years) volunteered for the present study. tHcy and tCys were measured with high-pressure liquid chromatography at rest in both groups and during an incremental exercise performed on a cycle ergometer until exhaustion in the trained subjects. RESULTS: At baseline homocysteinemia and cysteinemia were lower in trained subjects (7.48 +/- 0.4 and 183.45 +/- 13.6 micromol/l) compared with untrained subjects (9.79 +/- 0.4 micromol/l, p < 0.001; 229.01 +/-14.7 micromol/l, p < 0.05, respectively). Incremental exercise also induced a decrease in tHcy and tCys concentrations. Moreover, tHcy concentration was negatively related to the folic acid and B(12) intakes in untrained (r = -0.589, p < 0.05; r = -0.580, p < 0.05, respectively) as well as in trained groups (r = -0.709, p < 0.01; r = -0.731, p < 0.01, respectively) whereas no correlation between tCys and vitamin in the diet was observed. CONCLUSION: This study demonstrates that the combined effects of a chronic physical exercise and a high folate and vitamin B(12) intake could be responsible for the reduction of plasma tHcy and tCys concentrations that might be a key for the prevention of many diseases.

Efficiency of amifostine as a protection against doxorubicin toxicity in rats during a 12-day treatment.

BACKGROUND: Our purpose was to determine the effects of amifostine, a cytoprotective agent, on doxorubicin tolerance and cardiotoxicity in rats. MATERIALS AND METHODS: Male Wistar rats were treated every other day with an intraperitoneal injection of amifostine or saline 30 minutes before intraperitoneal injection of doxorubicin or saline. Weight change was recorded, and contractile function was evaluated after 11 injections by means of the isolated heart. RESULTS: Weight evolution and cardiac function were significantly improved by 7 and 20 mg/kg amifostine (p < 0.001) but not by 50 mg/kg. The final weight were: controls 349 +/- 16 g; doxorubicin alone 258 +/- 54 g; with amifostine: 7 mg/kg 314 + 28 g; 20 mg/kg 312 +/- 32 g; 50 mg/kg 250 +/- 34 g. Left ventricular developed pressure were: controls 137 +/- 15 mmHg; doxorubicin alone 119 +/- 20 mmHg; with amifostine: 7 mg/kg 140 +/- 20 mmHg; 20 mg/kg 137 +/- 25 mmHg; 50 mg/kg 124 +/- 20 mmHg. CONCLUSION: Seven and 20 mg/kg amifostine protected rats from the toxicity of doxorubicin at the cumulative dose of 18 mg/kg during a 12-day treatment, with regard to weight loss and heart contraction.

[Myocardial microdialysis. Importance and potential in cardiovascular research]. / Microdialyse myocardique. Intérêt et potentiel en recherche cardio-vasculaire.

The microdialysis expanded mainly in the field of the neuro- and the dermopharmacology with the study of the transmitters released in the central nervous system and derm. Since ten years, this tool gained other disciplines such as cardiology and cardiovascular surgery. Indeed, the collection and the study of the molecules released in the myocardic interstitial fluid without deteriorating it functioning made microdialysis a powerful tool in the study of the extracellular environment of the cardiomyocyte. The purpose of this study is to point out the principle of the microdialysis and to show its various uses in the field of cardiovascular pharmacology.

Inhibition of IgE-induced activation of human mast cells by IL-10.

BACKGROUND: IL-10 exhibits anti-inflammatory effects on activated rodent mast cells (MC) in vitro and inhibits allergen-induced airway inflammation in vivo in murine models. The effects of IL-10 on the allergic activation of human MC are presently unknown. OBJECTIVE: In light of the well-known heterogeneity of mast cell reactivity between animal species, one cannot readily predict the response of human MC to IL-10. Moreover, the impact of IL-10 on MC-derived proinflammatory mediators is still unknown. Thus, the objective of this study was to investigate the effects of IL-10 on the release of inflammatory mediators by IgE/anti-IgE-challenged human cord blood-derived mast cells (CBMC), used as an in vitro model of MC phenotypically similar to human lung MC. MATERIALS AND METHODS: Highly purified human MC were obtained by a first step of long-term culture of cord blood mononuclear cells in the presence of human recombinant stem cell factor (rhSCF) and of human recombinant IL-6 (rhIL-6), followed by a second step of purification by depletion of contaminating cells with an immunomagnetic METHOD: The cells were treated with human IgE, then challenged with anti-human IgE, in the presence or the absence of recombinant rhIL-10 used at various concentrations. Histamine, tumour necrosis factor-alpha (TNF-alpha), IL-5 and IL-8 were measured in the various supernatants collected at different times after the beginning of the challenge. RESULTS: IL-10 inhibited the release of TNF-alpha and of IL-8, but not of IL-5, by activated CBMC. Interestingly, IL-10 also inhibited the release of histamine by activated CBMC, contrasting with data reported for rodent MC. CONCLUSIONS: These findings suggest that IL-10 might have anti-inflammatory effects on IgE/anti-IgE-challenged human MC by inhibiting their release of TNF-alpha, IL-8 and histamine. These data provide new insights into the control of human mast cell activation and might lead to a better knowledge of the cellular mechanisms controlling allergic reactions.

Effects of L-arginine administration before cardioplegic arrest on ischemia-reperfusion injury.

BACKGROUND: Administration of L-arginine during reperfusion or its addition to cardioplegic solution has been shown to protect myocardium against ischemia-reperfusion injury. This study aimed at evaluating the role of L-arginine in ischemia-reperfusion injury when administered intraperitoneally 24 hours before cardioplegic arrest. METHODS: Two groups of Sprague-Dawley rats (control, n = 10; and L-arginine, n = 10) were studied in an isolated buffer-perfused heart model. Both groups were injected intraperitoneally 24 hours before ischemia. Before experimentation blood samples were collected for cardiac troponin I and cGMP analysis. In the coronary effluents, cardiac troponin I, adenosine, cyclic guanosine monophosphate, and nitric oxide metabolites were assayed. RESULTS: Before heart excision, serum cardiac troponin I concentrations were higher in the L-arginine than in the control group (0.037 +/- 0.01 versus 0.02 +/- 0.05 microg x L(-1); p < 0.05). During reperfusion, cardiac troponin I release was lower in the L-arginine than in the control group (0.04 +/- 0.01 versus 0.19 +/- 0.03 ng x min(-1); p < 0.05). The coronary flow as well as the left ventricular developed pressure were higher in the L-arginine than in the control group before ischemia and remained so throughout the experimentation. CONCLUSIONS: These results indicate that L-arginine administered intraperitoneally 24 hours before cardioplegic arrest reduced myocardial cell injury and seems to protect myocardium against ischemia-reperfusion injury.

Myocardial fixation of anticardiac troponin I antibody and cardiac troponin I release.

BACKGROUND: The threefold aim of this experimental study was to test the correlation of cardiac troponin I released to myocardial infarction size and myocardial fixation of anticardiac troponin I antibody and to determine how long after myocardial infarction the measure of cardiac troponin I concentration can evaluate myocardial infarction size. METHODS: Forty rabbits were assigned either to a control group or to an experimental preconditioned group. Infarction was obtained by tightening a snare around the left anterior descending artery. Serial venous blood samples were drawn for measurement of cardiac troponin I. The rabbits were sacrificed at 72 hours and a histological study was performed to determine the infarct size and the size of the area void of fixation of anticardiac troponin I antibody. RESULTS: There was a linear correlation between the total amount of CTn I released and both infarct size (r=0.45, p<0.02) and the size of the area void of anti-cardiac troponin I antibody (r=0.47, p<0.02). These two sizes were strongly correlated (r=0.95, p<0.02). The hour 9 CTn I sample was the best correlated with both the infarct size (r=0.47, p<0.02) and the size of area void of anticardiac troponin I antibody (r=0.45, p<0.02). CONCLUSIONS: Our study shows that: 1) cardiac troponin I release is correlated to both myocardial infarction size and the size of area void of fixation of anticardiac troponin I antibody, 2) the area void of anticardiac troponin I antibody fixation includes the whole ischemic area, and 3) evaluation of myocardial infarction size can be obtained by CTn I concentration as early as the ninth hour.

Effects of myocardial ischemia on the release of cardiac troponin I in isolated rat hearts.

BACKGROUND: The twofold aim of this experimental study was (1) to verify the correlation between the duration of ischemia and concentration of cardiac troponin I and (2) to compare the release of cardiac troponin I with histologic findings. METHODS: Experiments were done on 18 rat hearts, which were perfused according to the Langendorff method, immediately after excision in group I (control group) and after immersion for 3 hours (group II) and 6 hours (group III) in St. Thomas' Hospital solution at 4 degrees C. During reperfusion, the release of cardiac troponin I, creatine kinase isoenzyme MB, and lactate dehydrogenase, the recovery of left ventricular pressure, and heart rates were compared among the three groups. After the experiment, three samples of myocardium (left ventricle, right ventricle, and septum) were taken for histologic examination. RESULTS: Cardiac troponin I concentration was significantly higher in group III than in groups I and II and in group II compared with group I. Cardiac troponin I concentration increased as the ischemic period increased. The relation between cardiac troponin I release and ischemic duration tended to be linear. Creatine kinase MB and lactate dehydrogenase concentrations did not differ from one group to the other. Left ventricular pressure was not significantly different among the groups. In the control group, no heart had more than 10% of the myocytes affected. One of six hearts in group II and three of six in group III had more than 10% of myocytes affected. CONCLUSION: This experimental study showed (1) that cardiac troponin I is an early marker of ischemic injury and (2) that cardiac troponin I concentration increases as the ischemic period increases. Early cardiac troponin I release appears to correlate with the extent of ischemic injury in rats undergoing buffer perfusion.

Effects of gallium chloride on changes in action potentials and contraction in guinea pig ventricular muscle.

The electrophysiological effects of gallium chloride (Ga ) and its activity on arrhythmias induced by digitalis were investigated in guinea pig papillary muscle. KCl microelectrodes were used to record transmembrane electrical activity from Purkinje cells from the papillary muscle of guinea pig hearts during superfusion and electrical stimulation in vitro at 37 degrees C. Myocardial contractility was continuously monitored. Ga was superfused alone in cumulative concentrations(4.5 . 10(-5) to 3.6 . 10(-4) M). Arrhythmias were induced by a superfusion of Digitoxin (7.5 . 10 (-7) M). A superfusion of Ga (4.5 . 10(-5), 9 . 10(-5), 1.8 . 10(-4) M and 3.6 . 10(-4) M) was started 20 min later and maintained for 70 min. Ga alone produced a dose dependent reduction of action potential duration and contractility. Ga potentiated the decrease in the amplitude and duration of the action potential induced by Digitoxin. The incidence of arrhythmias was immediately reduced by two concentrations of Ga (4.5 . 10(-5) and 9 . 10(-5) M) in the digitalized papillary muscles. It is concluded that Ga inhibits calcium movements and has negative inotropic and antidysrhythmic effects.

Use of cardiac troponin I as a marker of perioperative myocardial ischemia.

Troponin I is a contractile protein comprising three isoforms, two related to the skeletal muscle and one to the cardiac fibers. Cardiac troponin I (CTn I) is specific, without any cross-reactivity with the other two. Several studies have demonstrated its release after acute myocardial infarction. In contrast, CTn I never has been found in a healthy population, marathon runners, people with skeletal disease, or patients undergoing non-cardiac operations. Thus, CTn I is a more specific marker of cardiac damage than common serum enzymes. It is also more sensitive, allowing diagnosis of perioperative microinfarction and detection of acute myocardial infarction much earlier after the onset of ischemia (4 hours). Using a rapid one-step assay, we measured the release of CTn I in two groups of patients after operation: 20 with calcified aortic stenosis and normal coronary arteries (aortic valve replacement group and control group) and 20 undergoing coronary artery bypass grafting. In the overall population CTn I peaked at hour 6 and practically disappeared after day 5. Mean values were higher in the coronary artery bypass grafting group. In the aortic valve replacement group, a positive correlation was found between aortic cross-clamping time and CTn I, which is a reliable marker of cardiac ischemia during heart operations and can be used to evaluate cardioprotective procedures.

[Detection of cyclin A mRNA in intra-epithelial lesions of the anogenital tract induced by papillomavirus]. / Détection des ARNm de la cycline A dans les lésions intraépithéliales du tractus anogénital induites par les papillomavirus.

Human papillomaviruses (HPVs) have been recognized as likely viral agents responsible for anogenital precancer lesions and squamous cell cancers in both men and women. Nevertheless their role in carcinogenesis is not entirely clear. There are many other agents, both viral and non-viral, which might act synergistically or separately with HPV in a multistep tumorigenic process. Among non-viral factors, protooncogene and tumor suppressor gene alterations may be a major step towards the malignant transformation of an HPV-infected cell. The induction of unscheduled DNA synthesis and cell proliferation by human papillomaviruses would provide the basis for the potential of these viruses to contribute to the formation of tumors in vivo. Thus, we studied by in situ hybridization (ISH) the cyclin A gene expression in HPV-induced condylomatous and dysplastic lesions of the anogenital tract, and in inflammatory squamous intraepithelial tissues. We observed a high level of cyclin A gene expression in low grade squamous intraepithelial lesions infected by HPV type 6/11. Cyclin A induction was surprisingly more important in the upper third layers of differentiated cells together with large amounts of HPV DNA, than in proliferating basal and parabasal cells. An identical pattern was also shown in some low grade squamous intraepithelial lesions infected with potential oncogenic HPV. In contrast, there was evidence of low abundance cyclin A mRNA in most high grade squamous intraepithelial lesions induced by high risk HPV. In the inflammatory tissues, an ISH signal was sometimes detected in the basal cells. As for proliferating cell nuclear antigen (PCNA), these results observed in vivo reveal that viral oncoproteins are able to reactivate cellular DNA replication machinery to support papillomavirus DNA replication in normally differentiated, non-cycling cells. The induction of cyclin A gene expression appears to correlate with the proliferative rather than the transforming properties of these cells.

Acute effects of gallium chloride on ventricular function and metabolism of the Langendorff perfused rat heart.

The effects of two concentrations of GaCl3 (1.79 microM and 7.17 microM) were studied on isolated perfused paced rat hearts. All hearts were submitted to an equilibration period of 20 minutes under normal conditions of oxygenation (95% O2, 5% CO2) and with 11 mM glucose in Krebs-Henseleit buffer. At the end of the perfusion (80 min) tissue Ga contents were 98.0 +/- 13.8 and 200.2 +/- 28.5 nM/g of wet weight for the lower and the higher Ga concentrations respectively. Left ventricular developed pressure (LVdp) as well as +LVdp/dt and -LVdp/dt were similar in control and Ga-treated groups during the 60 minutes following the equilibration period. At the same time mean coronary flow and oxygen consumption were lower (p < 0.05) in hearts perfused with 7.17 microM Ga than in the control group. Lactate production did not differ in the control and Ga-treated groups. Mean creatine kinase release was lower (p < 0.05) in the 7.17 microM Ga-treated group than in the 1.79 microM Ga-treated and control groups. Intratissular malondialdehyde as well as glycogen and ATP concentrations did not differ in all groups at the end of the experiment. Gallium chloride partially prevented the unavoidable oedema resulting from using saline Krebs-Henseleit solution. In conclusion, acute GaCl3 administration improves the functionality of the Langendorff-heart model.

Increased iron content in rat myocardium after 5-fluorouracil chronic administration.

The isovolumic perfused rat heart model according to Langendorff has been used in order to characterize the changes occurring in the heart following 5-Fluorouracil (5-FU) administration. Preliminary published data pointed out that perfusion of isolated heart with 1 mg/l 5-FU failed to show any differences in contractility and oxygen consumption in comparison with the control group. However, when Wistar rats received 5-FU once a day (50 mg/kg, I.P.) for five consecutive days a consistent increase in oxygen consumption throughout the 80 min of perfusion associated with a decrease in the fractional extraction of oxygen and a lowered + dP/dt max were observed, without any drug added during the in vitro perfusion. Further investigation has been performed for a better understanding of the results observed after 5-FU pretreatment. Magnesium, potassium, calcium, copper and iron contents in the myocardium (at 0 min of perfusion) were measured by flame atomic absorption spectrophotometry. Iron levels were 20% higher in the 5-FU pretreated group than in the control group, whereas as no differences were observed for the other elemental concentrations. Both initial glycogen and ATP contents were respectively 42% and 29% higher in the pretreated than in the control group and alpha-hydroxybutyrate dehydrogenase release was lower after 40 min of perfusion in the pretreated group. However, 5-FU pretreatment increased net tissue water gain after 80 min of perfusion. Increases in mean oxygen partial pressure in the myocardium and in oxygen consumption associated with increased iron level might be candidates responsible for 5-FU induced cardiotoxicity through an increased in oxygen derived free radicals. Sympathetic over-stimulation or calcium overload do not appear to be involved in 5-FU induced cardiotoxicity.

[Value of sophisticated explorative techniques of the pulmonary function in the preoperative evaluation of respiratory risk]. / Intérêt des techniques sophistiquées d'exploration fonctionnelle pulmonaire dans l'évaluation préopératoire du risque respiratoire.

In order to estimate the preoperative evaluation of the respiratory risk, a well adapted clinical examination associated with a routine pulmonary function test (VC, FEV1) can be sufficient. Although some patients with cardiopulmonary disorders or candidates to lung resection need more complex assessments: the flow-volume loop to detect small airways obstruction (MEF 50%, MEF 25%), measure of bronchial hyperreactivity to predict bronchospasm during anaesthesia, residual volume for the diagnosis of emphysema, diffusing capacity (DCO) to discover lung fibrosis: these parameters disruption always make the pronostic worse. It is also useful to couple together preoperative function test and pulmonary scintigraphy to predict post-operative values after lung resection. But, these criteria for operability are not always a good indicator of post-operative complications. So it is possible to use in addition the results of exercise testing to determine cardio-respiratory performances and maximal oxygen consumption (VO2MAX) which seem better correlated with mortality and post-operative lung surgical complications. Preliminary results of our study concerning thirty patients hospitalized in Besancon-St-Jacques Hospital, agree with the hypothesis that exercise testing is an important criterion in the pre-operative evaluation and to predict post-operative mortality and morbidity of patients candidates to thoracic surgery.

[Pediatric anesthesia and pharmacokinetics of propofol administered at a constant rate]. / Anesthésie pédiatrique et pharmacocinétique du propofol administré a débit constant.

The pharmacokinetic properties of propofol given at a constant rate, were studied in 10 children. Propofol was administered at a dose according to I.C.I. Pharma advices. For minor surgery, a low quality of general anesthesia was observed in correlation with low plasma levels of propofol. An increase in dosage would be necessary in children above 8 years old.

[Pharmacokinetic study of a new benzyl-1 isoquinoline derivative (458 L) after oral administration in men]. / Etude pharmacocinétique d'un nouveau dérivé de la benzyl-1 isoquinoléine (458 L) après administration orale chez l'homme.

Pharmacokinetic study of 458 L. via oral route, was performed in twelve normal volunteers, in a randomized crossover design of three galenic forms. Plasma concentrations were determined, after extraction, by HPLC, with spectrofluorimetric detection. Plasmatic kinetics were fitted to a bi-exponential function with a distribution half-life of 1h and an elimination half-life of 11.5 to 14.7 h according to the form. Pharmacokinetic parameters evaluated as area under the curve (AUC), maximum plasma concentrations (Cmax), relative bioavailability (F'), have shown strong interindividual differences, specially in women group, and this with tobacco smoking.

Comparative bioavailability of S-carboxymethylcysteine from two dosage forms: hard gelatin capsule and syrup.

Measurement of plasma concentrations after the oral administration of S-carboxymethylcysteine in two different dosage forms, as a hard gelatin capsule and as a syrup, shows its relative bioavailability from the two formulations to be similar. With the exception of the time required to reach peak concentration, which shows a slight variation attributable to the time taken for the drug to be released from the capsule and to dissolve, parameters such as peak concentration, biological half-life and area under the serum-concentration curve whether from t = 0 to t = 8 h or from t = 0 to t = infinity, are not statistically different. The areas under the plasma-concentration curves between t = 0 and t = 8 h and between t = 0 and t = infinity shows that for a confidence limit of 95 per cent, the mean for the capsular form does not differ by more than 3.3-10.3 per cent from the mean for the syrup.