Adaptation posologique de la metformine chez le sujet insuffisant rénal chronique

L'insuffisance rénale chronique est une maladie grave et fréquente qui est d'autant plus élevée chez les patients diabétiques et notamment de type 2 parmi lesquels la moitié souffre d'une insuffisance rénale chronique (IRC) définie par un débit de filtration glomérulaire (DFG) inférieur à 60 ml/mi /1.73 m2 et/ou une microalbuminurie ≥ 30 mg/g. La metformine étant le traitement de première intention, son adaptation posologique à la fonction rénale est primordiale. Afin de définir un outil fiable pour les prescripteurs,nous avons évalué les recommandations des résumés des caractéristiques produit (RCP) de 46 spécialités et celles de 3 sociétés savantes internationales. Les RCP de 3 spécialités émettent des recommandations claires, 2 ne sont pas précisent et 41 recommandent une adaptation à la fonction rénale des patients âgés. Les sociétés savantes recommandent une utilisation de la metformine jusqu'à une valeur de DFG de 30 ml/min. Cette étude a montré que les RCP étaient peu fiables et que les prescripteurs devaient davantage se baser sur des recommandations d'experts validées. Un des rôles du pharmacien hospitalier est de diffuser les recommandations et d'aider le prescripteur dans le choix du meilleur traitement adapté à la fonction rénale des patients

In vitro antiproliferative effect and induction of apoptosis by Retama monosperma L. extract in human cervical cancer cells.

The antiproliferative effect of different extracts obtained from Retama monosperma L. was investigated on human SiHa and HeLa cervical cancer cell lines using a MTT colorimetric assay. The Retama monosperma L. dichloromethane fraction (Rm-DF) was the most active extract, exhibiting a significant cytotoxic activity on both cell lines in a dose-dependent manner, after 72 h of treatment. IC50 values obtained were 14.57 ± 4.15 µg/ml and 21.33 ± 7.88 µg/ml, for SiHa and HeLa cell lines respectively. The morphological features assessment of apoptosis in Rm-DF-treated cells showed a condensation of chromatin and apoptotic bodies, accompanied by a decrease in mitochondrial membrane potential (ΔΨm) and an increase in reactive oxygen species in both cell lines. The induction of apoptosis was further confirmed by Western blotting pro-caspase 3, Bcl2 and PARP; caspase 3 activity assay; and Annexin V labelling. Analysis of Rm-DF by CG/MS revealed the presence of five known quinolizidine alkaloids as well as, sparteine (10,97%), L-methyl cytisine (9.11%), 17-oxosparteine (3.49%), lupanine (0.93%) and anagyrine (39.63%). This study shows that Retama monosperma L. extract exhibits a potential anticancer activity against cervical cancer cell lines in vitro through the inhibition of proliferation and induction of apoptosis, which may involve a mitochondria-mediated signaling pathway.

FT-IR microspectroscopy for early identification of some clinically relevant pathogens.

AIMS: To investigate the potentials and limitations of Fourier transform-infrared (FT-IR) microspectroscopy as a tool to identify, at the level of microcolonies, pathogenic bacteria frequently isolated in the clinical environment. METHODS AND RESULTS: A total of 1570 FT-IR spectra from 164 gram-positive and gram-negative bacteria isolated from patients were recorded from 6 to 10-h old microcolonies of 50-150 microm size. A classification of 100% was obtained for the most frequent gram-positive bacteria, such as Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, and Enterococcus faecium at the species level. An average accuracy of about 80% was reached with Gram negative bacteria from the Enterobacteriaceae and Pseudomonaceae families; Enterobacter aerogenes, Enterobacter cloacae, Klebsiella spp., and Citrobacter koseri; and Proteus mirabilis and Escherichia coli. Results were comparable with FT-IR measurements on dried suspensions from 18-h cultures. CONCLUSIONS: Early identification of young microcolonies is feasible with FT-IR microscopy with a very high accuracy for gram-positive bacteria. Some improvement in the transfer of microcolonies is necessary to increase the accuracy for gram-negative bacteria. SIGNIFICANCE AND IMPACT OF THE STUDY: Combination of FT-IR microscopy and multivariate data analysis could be a complementary, rapid, and reliable tool for screening and discriminating, at species and subspecies level, micro-organisms of clinical, food-borne, or environmental origins.

Hydroxyethylstarch microcapsules: a preliminary study for tumor immunotherapy application.

The objective of this work was to prepare microcapsules which would allow protection and slow release of antigens used for melanoma immunotherapy treatment. Hydroxyethylstarch (HES) microcapsules were prepared using interfacial cross-linking with terephthaloyl chloride (TC). They were characterized with respect to morphology (microscopy) and size (in the 4-15 microm range). Bovine serum albumin (BSA) was used as model protein for loading and release studies. Microcapsules were loaded with solutions at different protein concentrations (0.5-5%). The maximum loading efficiency (20%) was observed with the concentration of 2.5%, which allowed a loading capacity near 100%. Confocal laser scanning microscopy (CLSM) visualization showed that BSA was entrapped within the microcapsules and not only associated to their outer surface. BSA-release studies showed a 20% BSA release within 30 min while 80% remained entrapped in the microcapsules for 4 days. Microcapsules were degraded by alpha-amylase and addition of esterase to alpha-amylase enhanced slightly their degradation. In vitro studies on melanoma cells showed that HES microcapsules were non-toxic. Preliminary in vivo studies demonstrated that microcapsules were biodegradable after intraperitoneal injection (i.p.). The observation of peritoneal wash showed a complete degradation within 7 days, indicating a possible application as an in vivo drug delivery system especially to enhance the presentation of antigens.

Inhibition of multidrug resistance by immunisation with synthetic P-glycoprotein-derived peptides.

Overexpression of the membrane glycoprotein (P170) represents the most common multidrug resistance (MDR) mechanism in cancer therapy. Specific auto-antibodies to extracellular loops 1, 2 and 4 of murine P170 were elicited in mice using palmitoylated synthetic peptides reconstituted in liposomes, with or without Lipid A, and resuspended in alum. IgM antibodies were detected 14 days following the first injection and IgG1 became predominant after the third challenge. Animals did not show any auto-immune symptoms or induced toxicity up to 18 months after the immunisation. Previous immunisations of mice using liposomes with MDR1 peptides increases the efficacy of chemotherapy treatments with doxorubicin and vinblastine against P388 R cells with increase of 77% in the survival half time in the immunised group. Sera from the immunised mice were also effective in reducing cellular resistance to vinblastine and doxorubicin in vitro. Taken together, these data suggest that this immunisation approach might have potential clinical applications.

Partial restoration of all trans retinoic acid (ATRA) sensitivity by compactin in ATRA-resistant leukemic cells (ATRA-R HL-60).

The resistance to all trans retinoic acid (ATRA) differentiating treatment is a consequence, in most of the cases, of either increased catabolism or down regulation of ATRA uptake. Recently, we have shown that ATRA efficiency to differentiate HL-60 cells was enhanced about 30 times after its incorporation into Low Density Lipoprotein (ATRA-LDL). Here, we attempted to differentiate the ATRA-resistant HL-60 cells by ATRA-LDL at high concentrations up to 10 microM. No significant differentiating effect was observed, although the LDL receptor sites were evidenced in these cells. To increase the number of LDL receptors, the cells were pre-incubated in lipoprotein-deprived serum medium and compactin (2 microM), both ATRA and ATRA-LDL induced gradual increase of cell differentiation (35%+/-1 and 51.5%+/-5 at 10 microM of ATRA and ATRA-LDL respectively). At 2 and 8 microM, the intracellular concentrations of ATRA were respectively three and four times higher when incorporated into LDL. In addition, ATRA-LDL, in the medium, was better protected against degradation than ATRA. The surprising restoration of free ATRA sensitivity after treatment with compactin suggested the implication of new mechanisms unrelated to the LDL-receptor endocytosis but involving the non-sterol pathway.

[Detection of metastatic activity of the MCF-7 multidrug resistant cell line cultured in spheroids]. / Mise en évidence d'une activité métastasiante dans la lignée MCF-7 multidrogue résistante cultivée en sphéroïdes.

The occurrence of solid tumors spreading through the body is a major concern for the clinicians. Moreover, in numerous cases, metastases exhibit a multidrug resistant (MDR) pattern. This dual characteristic still remains supported by few biological explanations. The purpose of our study was to compare invasive properties of sensitive and MDR MCF-7 cells. Spheroids were chosen as experimental model since they exhibit a number of characteristics (i.e. tridimensional structure) close to the growth of an in vivo tumor. MDR spheroids formed more compact structures compared to sensitive ones. In every experiment, spheroids made from sensitive cells were more resistant to doxorubicin than the same cells grown as monolayers, a characteristic not observed with MDR cells. On an other hand, a form of multicellular resistance appeared in spheroids of sensitive cells, a fact which was not present in MDR spheroids. Incubation of MDR spheroids in Boyden's chambers put in evidence increased motility and invasive properties through Matrigel which were not present in sensitive MCF-7 cells. Zymograms of culture media and membrane extracts were performed in polyacrylamide gels. Two metalloproteases, progelatinases A et B were detected in culture media conditioned by monolayers and spheroids of both sensitive and resistant cells. In contrast, 2 unidentified serine proteases were detected only in media conditioned by spheroids of both cell types. An intense band of pro-MMP2 was present only in membrane extracts from MDR spheroids. Taken altogether, these results demonstrate that spheroids of MDR cells exhibit a number of properties which could lead to an increased ability to form metastases.

Effects of all-trans-retinoic acid incorporated into low-density lipoprotein on invasive properties of multidrug-resistant MCF-7 spheroids.

Cultured cells grown as spheroids provide an in vitro model that is closer to an in vivo tumour than conventional monolayer techniques. Previous work from our laboratory has demonstrated that spheroids formed from multidrug-resistant MCF-7 cells exhibit invasive characteristics which were not present in their sensitive counterparts. The treatment of these spheroids by all-trans-retinoic acid (ATRA), a potent inducer of in vitro and in vivo differentiation, decreases their proteolytic activity and ability to invade Matrigel-coated filters. The efficiency of ATRA is enhanced by its incorporation into low-density lipoprotein (LDL) (LDL-ATRA). Indeed, invasion through a reconstituted basement membrane was reduced by 73% with 10(-6) M ATRA and 3 x 10(-8) M LDL-ATRA. Furthermore, inhibition of invasion was correlated with a decrease in several factors: (1) secreted matrix metalloproteinase-9 and enzymes degrading type IV collagen and Matrigel films, and (2) tissue plasminogen activator. The results observed were found with a concentration of LDL-ATRA 30 times lower than that of ATRA. This could be due to the protective effect of LDL and to a better targeting of cancer cells through their LDL receptors. LDL-ATRA may therefore represent a new and potent inhibitor of invasion that could be developed for clinical trials.

Evidence for reduced drug influx in multidrug resistant CEM cells by a fluorescent dye.

Multidrug resistance (MDR) in cancer cells is commonly ascribed to a reduced drug accumulation mediated by an ATP dependent efflux pump. We have developed a new, rapid and quantitative method for measuring influx of BCECF-AM in sensitive (CEM) and MDR cells (CEM/VLB100). The fluorescence of intracellular accumulated BCECF after hydrolysis of BCECF-AM is rapidly visualized by spectrofluorometry. The rate of BCECF-AM entry into CEM/VLB100 cells is considerably lower than that found in CEM cells, similar to 10-fold after 10 min of incubation. This phenomenon is not in relation with a difference of esterase activities, it is not energy or intracellular pH-dependent, and BCECF efflux is negligible. CEM cells exhibited diffuse fluorescence within cytoplasm in contrast with numerous spots of intense labelling, related to the presence of the cytoplasmic vesicles in CEM/VLB100 cells demonstrated by Nomarski's microscopy. MDR modulators such as verapamil, sodium orthovanadate, chlorpromazine or trifluoperazine induce an enhanced influx in CEM/VLB100 cells (150+/-4%; 204+/-17%; 410+/-17% and 229+/-7% respectively) whereas no major differences were noted with the parental sensitive cells. Vinblastine (under conditions close to IC50) increases the influx only in MDR cells (481+/-6%) by a process that is not linked to competitive inhibition of the P170 efflux pump. These results suggest that reduced influx of drugs could be a major defect in MDR cells, a possible role for P170-membrane lipids interactions is discussed.

Alterations of vinblastine influx in multidrug-resistant lymphoblastic leukaemic CEM cells.

Typical multidrug-resistant (MDR) CEM/VLB100 cells exhibited reduced uptake of vinblastine (VLB) compared to their sensitive CEM counterparts mean results were respectively, 3.19 and 35.4 pmol per 10(6) cells. In CEM cells, the efflux of drug reached a steady state after 10-15 min while in CEM/VLB100 cells, the typical P170-mediated efflux was still efficient after 40 min. Nevertheless, the most striking difference observed in CEM/VLB100 cells was a dramatic decrease in early (30 sec) influx of drug which was 10 times lower than in sensitive cells, a characteristic still observed in the presence of Na azide and absence of glucose. MDR cells without little or no effect on sensitive cells. The Q10 entry of VLB into sensitive cells was 1.2 while it was 2.2 in CEM, suggesting that the mode of entry of VLB into MDR cells differed from that of CEM cells. Verapamil or nigericin, which rapidly increased the accumulation of VLB raised the Q10 to >2. These results suggest that the primary defect in MDR cells would be an inhibition of influx, which might involve interactions with P170 through a reversible process.

Virulence factors (aerobactin and mucoid phenotype) in Klebsiella pneumoniae and Escherichia coli blood culture isolates.

We examined the presence of two virulence factors in 241 blood isolates of Klebsiella pneumoniae from patients hospitalized during 1989 and 1990 in 7 French hospitals, and 125 blood isolates of Escherichia coli from one hospital. Aerobactin was scored phenotypically and genotypically with an intragenic DNA probe of 2 kb. The mucoid phenotype was assessed by culture on trypticase soy agar and by genotypic analysis (intragenic DNA probe of 235 bp). Only 6% K. pneumoniae isolates were aerobactin-positive with no significant variation according to geographical location while 20% of K. pneumoniae isolates displayed the mucoid phenotype, with a significant variation according to hospital. Aerobactin was always associated with the mucoid phenotype. The frequency of aerobactin production but not mucoid phenotype (14%) was higher among E. coli isolates (48%). They harbored two types of large plasmids. Intraperitoneal injection into mice of 10(3) cfu of K. pneumoniae producing both virulence factors demonstrated that capsular serotype K2 was the more virulent K23 and K28.

Study of sodium orthovanadate as a reverser of multidrug resistance on lymphoblastic leukemic CEM/VLB100 cells.

The occurrence of multidrug resistance (MDR) is the major cause of failure of cancer chemotherapy. Finding a way to circumvent this problem is now a major challenge in oncology. Multidrug resistant CEM/VLB100 cells accumulate 10 times less vinblastine (VLB) after 30 min than their sensitive counterparts (CEM cells). At a non-cytotoxic concentration (1 mM) of sodium orthovanadate (OVN), uptake by CEM/VLB100 cells was increased 4 times while no effect was observed on CEM cells. The action on VLB uptake of OVN and verapamil (VPL), an usual MDR modulator, was additive. In CEM/VLB100 cells, OVN did not alter efflux. Its cellular mechanism of action could involve a transitory stimulation of VLB influx (x3). OVN uptake in CEM and CEM/VLB100 cells was not significantly different and reached saturation after 30 s (180 pmol/10(6) CEM cells and 150 pmol/10(6) CEM/VLB100 cells). This OVN uptake was concentration dependent. IC50 of VLB and doxorubicin were decreased by approximately 43 and 62% after 1 hour's exposure to OVN and 48 hours of culture. Under these conditions, OVN was more efficient than OVN.

Cytotoxicity of Pseudomonas aeruginosa internal lectin PA-I to respiratory epithelial cells in primary culture.

Pseudomonas aeruginosa is the most important bacterial pathogen associated with chronic airway infection, especially in cystic fibrosis. We addressed the question of whether the galactophilic internal lectin of P. aeruginosa (PA-I) could represent a virulence factor for the respiratory epithelium. PA-I lectin was localized in all the bacteria of P. aeruginosa ATCC 33347 as determined by immunofluorescence staining. We investigated the dose-dependent effect of P. aeruginosa PA-I lectin on the growth, the ciliary beating frequency, and the morphology of human respiratory cells in primary culture of nasal polyps collected from non-cystic fibrosis patients. PA-I lectin significantly (P < 0.01) inhibited the growth of respiratory cells at a concentration of > or = 10 micrograms/ml. The percentage of active ciliated cell surface of the cultures decreased significantly (P < 0.05) at a PA-I lectin concentration of 50 micrograms/ml. Exposed to a low concentration of PA-I lectin (10 micrograms/ml), respiratory epithelial cells showed intracytoplasmic vacuoles when examined by light and transmission electron microscopy. At a higher concentration of PA-I lectin (100 micrograms/ml), major cell damage and severe epithelial shedding occurred. These results demonstrate that the P. aeruginosa internal PA-I lectin has a dose-dependent cytotoxic effect on respiratory epithelial cells in vitro. The P. aeruginosa PA-I lectin may represent a virulence factor by contributing to the respiratory epithelial damage during P. aeruginosa respiratory infections.

[The multidrug resistance phenotype: some morphological and biological characteristics except efflux pump]. / Le phénotype de résistance multidrogue: quelques caractéristiques morphologiques et biologiques autres que la pompe à efflux.

Recent data from the literature together with personal results strongly suggest that multidrug resistance phenotype is overwhelming the sole expression of P170 glycoprotein efflux pump. Morphological alterations have been put in evidence in MDR cells after transmission and scanning electron microscopy. They include presence of osmiophilic vesicles and modifications of nuclear and nucleolar chromatin. Biological characteristics include the hypersecretory pattern of lysosomal enzymes from MDR cells. Such a fact could be more or less related to the increased occurrence of mdr1 RNA in metastasis, especially in breast cancers, compared to primary tumors. If the P170-mediated efflux is one of the key mechanism of MDR, a decreased influx of anticancer drugs cannot be excluded. Liposomes, for instance made of cardiolipin, are thus able to increase the intracellular drug uptake of vinblastine without any action upon efflux mechanism.

Incidence of two virulence factors (aerobactin and mucoid phenotype) among 190 clinical isolates of Klebsiella pneumoniae producing extended-spectrum beta-lactamase.

Because outbreaks of multiple-resistant Klebsiella pneumoniae isolates producing extended-spectrum beta-lactamases were recently observed in French hospitals, the presence of virulence factors was examined for (i) phenotype by bioassay for aerobactin production and by culture for the mucoid phenotype, and (ii) genotype using intragenic probes of respectively 2-kb BglII and 235-bp BamHI-BglII fragments and dot-blotting among 190 unreplicated K. pneumoniae clinical isolates issued from 25 French hospitals and producing different types of extended-spectrum beta-lactamases (TEM-related enzymes: TEM-3, TEM-4, CAZ-1, CAZ-2, TEM-8, or SHV-related enzymes: SHV-2, SHV-3, SHV-4). Only 3.7% and 7% of K. pneumoniae isolates produced aerobactin and mucoid phenotypes respectively, unrelated to type of beta-lactamase. Only 2% had both factors. No discordance was reported according to the detection method tested. The low prevalence of such virulence factors seems to indicate they were not involved in dissemination of nosocomial K. pneumoniae isolates producing an extended-spectrum beta-lactamase.

Inhibition of collagenolytic activity in human leukemic K562 cells by tamoxifen.

Presence of a collagenolytic activity has been demonstrated in the human leukemic cell line K562. Among various effectors studied, tamoxifen, a well-known antiestrogenic compound, exhibited a strong inhibitory effect. After 3 days of culture in the presence of 10(-7) M of tamoxifen, 75% of the collagenolytic activity was inhibited. Hydroxytamoxifen and N-desmethyltamoxifen were equally potent inhibitors though devoid of the direct cytotoxic effect. Cis-tamoxifen was less efficient. K562 cells have no binding sites for estrogens but they possess high affinity binding sites for 3H-tamoxifen (295 fmol/mg of proteins, KD = 0.25 x 10(-9) M). Tamoxifen had no effect on cellular differentiation or enzyme secretion. Anticollagenolytic activity of tamoxifen (10(-7)-10(-6) M) could be related to its inhibitory action on plasmin and plasminogen activator.

Red blood cells bearing CD4 bind to gp120 covered plates and aggregate with cells expressing gp120.

Full-length recombinant CD4 (rCD4) was bound to human red blood cell membranes using a low-pH incubation procedure. The red blood cells bearing recombinant CD4 (RBC-rCD4+) specifically bound to gp 120-covered plates. The binding showed a threshold effect at low rCD4 concentrations per RBC. The binding of RBC-rCD4+ to gp120 plates was not inhibited by plasma proteins (incubation in human blood plasma). Preincubation of the RBC-rCD4+ with monoclonal anti-CD4 antibodies blocked the binding to the gp120-covered plates. Incubation of chinese hamster ovary (CHO) fibroblasts, which constitutively express the HIV envelope protein gp120 with RBC-rCD4+, resulted in the formation of large cell aggregates. These in vitro data suggest that RBC-rCD4+ retain affinity for gp120 and thus could have potential therapeutical value in AIDS treatment.

Cell-surface expression and purification of human CD4 produced in baculovirus-infected insect cells.

CD4 is an integral membrane glycoprotein that acts as the cellular receptor for human immunodeficiency virus (HIV). A cDNA encoding full-length CD4 was inserted into the genome of Autographa californica nuclear polyhedrosis virus under transcriptional regulation of the viral polyhedrin gene promoter. The recombinant virus was used to infect insect cells, which resulted in the abundant expression of CD4 as evaluated by flow cytometry and immunoblot analysis. Recombinant CD4 expressed on the surface of infected insect cells was immunologically indistinguishable from human CD4 when using 11 different anti-CD4 monoclonal antibodies. The extraction of infected cells by phase-transition separation with Triton X-114 followed by immunoaffinity chromatography yielded a single protein detected by NaDodSO4/PAGE using silver staining. N-terminal sequence analysis of the purified recombinant protein showed that CD4 produced in Sf9 cells is efficiently cleaved from the precursor protein. Immunoblot analysis under nondenaturing conditions showed that the purified protein reacted with the anti-CD4 monoclonal antibody Leu-3a. The potential use of the recombinant membrane-associated CD4 in anti-HIV therapy is discussed.

Association of adriamycin-induced resistance to NK-mediated lysis with sialic acid level and immunological reactivity of transferrin receptors and glycophorin A.

Adriamycin (ADM) can increase sialic acid content in K 562 cells and reduce their susceptibility to NK-mediated lysis. In this report, hypothetical relationship between this resistance and augmentation in sialylation has been investigated. Variations in the time of exposure to ADM showed that 12 hours were sufficient to cause maximal recruitment of benzidine-positive cells, growth inhibition and resistance to NK-mediated lysis. On the contrary, the membrane sialic acid density seemed stable and 24 hours of drug exposure were necessary to observe a clear rise in sialic acid. Neuraminidase treatment of control and ADM-treated K 562 cells was associated with an obvious enhancement in their susceptibility to NK-mediated lysis which can be explained by an increase in the target-effector binding ability as assessed by a direct conjugate-forming cell assay. However, the neuraminidase treatment did not modify the sensitivity difference to lysis between untreated and ADM-treated cells. As compared to control the reactivity of ADM-treated cells was higher with an antiglycophorin A (GPA) MAb and lower with an antitransferrin receptor (TFR) MAb. Kinetic studies suggested that GPA expression is a better index of ADM-induced resistance to NK-mediated lysis than TFR expression. In addition, neuraminidase treatment showed that TFR and GPA modulations induced by ADM can be correlated with sialylation alterations.