Oncological monitoring after transanal total mesorectal excision (TaTME) for rectal neoplasia.

BACKGROUND: The surgical treatment of choice for rectal neoplasia is total mesorectal excision (TME). The transanal approach enables a better approach in male and obese patients and/or those with a narrow pelvis and in patients with small tumors. Short-term results are comparable with those for laparoscopy or the open approach, but the medium- and long-term oncological data are sparse. The aim of the present study was to evaluate our early experience with transanal TME (TaTME). METHODS: This was a retrospective study conducted on patients who underwent TaTME at our center between August 2013 and April 2017 with a follow-up ≥ 3 years. Histopathology, complications, mortality, neoplastic recurrence and disease-free survival were analyzed. RESULTS: One hundred patients (68 men and 32 women,, median age 66.8 years [range 29.6-91.2 years]) were included. There were 67 T3 cases (67%) with 74 N0 cases (74%), the mesorectal quality was graded optimal for 87.6% and only 2 cases of radial margin involvement were detected (2%). The median follow-up period was 47.6 months (range 11.8-78.9 months). Eighteen cases of recurrence were diagnosed, of which 3 (3%) recurred locally with an average disease-free period of 43.1 months. Overall survival was 80% and mortality due to progression of disease was 13%. CONCLUSIONS: TaTME is a safe surgical procedure with surgical, anatomopathological and oncological results at 3 years (medium-term) comparable with those for the laparoscopic and open approaches. Better monitoring is required with studies of the long-term functional and quality of life outcomes, i.e., at 5 or 10 years.

Resolution of major protein kinase substrates in neutrophil cytosol in response to DAG/PS and arachidonic acid stimulation and the selective action of various protein kinase inhibitors.

Stimulation of human neutrophils induces phosphorylation of several cellular proteins. Human neutrophils possess calcium-dependent protein kinase C (PKC) alpha and beta isoforms and calcium-independent n isoforms. Little is known, however, of the physiological substrates of each isoform. In this study, we characterized the substrates of calcium-dependent and -independent PKC isoforms and the substrate of PKC activated by arachidonic acid. Furthermore, we found that the PKC inhibitor H-7 failed to inhibit phosphorylation of endogenous substrates of calcium-independent PKC activity. These results may help to understand the role of PKC in neutrophil activation and shed light on the different responses elicited by H-7 in intact cells.

Accumulation of azithromycin and roxithromycin in tracheal epithelial fetal cell lines expressing wild type or mutated cystic fibrosis transmembrane conductance regulator protein (CFTR).

Macrolides are accumulated in phagocytes, partially via an active transport system; the membrane carrier is not identified but many data indicate a link with the P-glycoprotein family which includes the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) protein. We have used two epithelial cell lines which express either wild-type (N cells) or mutated (homozygous deltaF508) (F cells) CFTR to study the cellular accumulation of two macrolides (azithromycin and roxithromycin). Adherent cells were incubated with the radiolabeled drugs before extensive washings and counting. Azithromycin was better (about 2-fold) accumulated in F cells up to 60 min but then plateaued, whereas accumulation continued without saturation over 3 hours in N cells. Roxithromycin was also better (1.5-fold) accumulated in F cells at 15 and 30 min, but there were no differences at further incubation times. Macrolide efflux from loaded N and F cells, and the susceptibilities of the carrier systems (entry and efflux) to various pharmacologic agents were similar to those previously observed with phagocytes. These data suggest that the macrolide carriers (for entry and efflux) are not strictly specific for phagocytes and that the CFTR protein plays a role in macrolide uptake.

Inhibition of human neutrophil protein kinase C activity by the antimalarial drug mefloquine.

Mefloquine (alpha-(2-piperidyl)-2,8-bis(trifluoromethyl)-4-quinolinemethanol) , an antimalarial drug, has been shown to inhibit human neutrophil functions, particularly oxygen-dependent bactericidal activity. Since calcium- and phospholipid-dependent protein kinase C (PKC) has a central role in the regulation of this function, we hypothesized that its activity might be altered by mefloquine. We found that mefloquine directly inhibited PKC in a dose-dependent manner, with an IC50 of 45 microM. This inhibition appeared to be non-competitive with respect to ATP, histone and phosphatidylserine. In addition, mefloquine inhibited the binding of [3H]phorbol 12,13 dibutyrate to PKC, indicating that it interacts with the regulatory domain of PKC. By contrast, mefloquine had little or no effect on neutrophil cAMP-dependent protein kinase or its catalytic subunit. Phorbol myristate acetate-induced protein phosphorylation in intact neutrophils was also inhibited by preincubation with mefloquine at concentrations similar to those inhibiting superoxide anion production. These data suggest that inhibition of neutrophil functions by mefloquine may be due to the inhibition of cellular PKC and that mefloquine could have further biological effects in situations in which PKC is involved.

Chemokinetic activity of N-formyl-methionyl-leucyl-phenylalanine on human neutrophils, and its modulation by phenylbutazone.

Phenylbutazone (PBZ) is known to inhibit the oriented migration of human polymorphonuclear leukocytes (PMNs) induced by formyl-methionyl-leucyl-phenylalanine (FMLP), and to protect these cells against the deactivation caused by their prior incubation with FMLP. To gain insight into the mechanism of these effects, we measured the oriented PMN migration under agarose induced, in the presence and absence of PBZ, by FMLP, zymosan-activated serum and Klebsiella pneumoniae culture supernatant. The two components of this migration, i.e. the speed (chemokinesis), and direction of locomotion (chemotaxis), were also assessed. At concentrations ranging from 10(-8) to 10(-5) M, FMLP displayed similar chemotactic activity but the speed of PMN locomotion was maximal for 10(-7) M, and lower for concentrations above and below this level. Oriented migration was proportional to the mean cell locomotion speed during the experiments. PBZ inhibited both the oriented migration and locomotion speed induced by 10(-7) M FMLP, but did not affect its chemotactic activity. At concentrations of 10(-6) and 10(-5) M, PBZ increased oriented migration and locomotion speed, again without influencing FMLP chemotactic activity. Oriented migration induced by zymosan-activated serum was not affected by PBZ but the migration induced by Klebsiella pneumoniae culture supernatant diminished slightly. These results demonstrate that PBZ modulates the chemokinetic effect of FMLP on PMNs and thus alters oriented PMN migration.

Interactions between antimicrobial drugs and phagocytes: an overview.

The problems of microbial resistance and the increasing numbers of immunocompromised individuals have strengthened interest in new therapeutic strategies, including immunomodulation. Since phagocytes play both positive and deleterious roles in infectious diseases, they may be criticl targets in the study of drug-induced immunomodulation. Antimicrobial agents can modify phagocyte numbers] and functions in many ways. The main data and the implications of such interferences are reviewed in this paper.

Antibacterial agents--phagocytes: new concepts for old in immunomodulation.

The possibility that antibacterial agents, primarily directed against microorganisms, also modify host functions is widely recognized. While a knowledge of these non-antimicrobial effects of antibiotics, sometimes considered as 'side-effects', is necessary to prevent antibiotic-associated toxicity, the development of drugs derived from antibacterial agents for use in non-infectious diseases (e.g. motilins and antidiabetic drugs) is a new field of therapeutic research. Interactions between antibacterial drugs and the immune system may contribute to therapeutic efficacy in infectious diseases [1,2]. The immune system itself is a complex pyramid of redundant cellular factors/humoral effectors/mediators, whose fine regulation is just beginning to be unraveled. Phagocytes, ubiquitous and multifaceted cells are key components of cellular immunity, being involved both in immediate defences against non-self targets (pathogens, tumour cells, exogenous molecules, etc.) and in the regulation and triggering of specific immune responses. They are thus, prime targets of immune response modifiers. This review reconsiders the widely explored problem of interactions between antibacterial agents and phagocytes, focusing on future prospects in both infectious and non-infectious diseases.

Antilymphocyte antibodies in progressive systemic sclerosis.

Sera from 19 patients with scleroderma were tested for antilymphocyte antibodies (ALA) by indirect immunofluorescence assay. ALA were found in 47% of the cases when tested at 0 degrees, and in 27% at 25 degrees C. Anti-T cell specificity was shown after separation of B and T cells. The heterogeneity of the ALA detected was clear both among different patients and in serum from the same patient. A monoclonal antibody (UCHT1) inhibited ALA binding to T cells completely in one case, and partially in another three, implying that with these 4 sera, the lymphocyte receptors for ALA were either identical or very close to the UCHT1 receptor. This study defines another immunological abnormality in scleroderma: the presence of cold-reactive anti-T cell specific ALA. Their pathogenicity requires further investigation.

Inhibitory effect of K-562 malignant cells on locomotion of human neutrophils.

Certain tumor cells generate factors that inhibit neutrophil chemotaxis. The present study was designed to explore, in K-562 malignant cells, the release of such factors that may alter the neutrophil locomotion. The supernatant, separated from the K-562 malignant cells cultured in vitro for 48 hours, was lyophilised and extracted with ethanol 80%. This ethanol extract (SE-K562) inhibited neutrophil locomotion. Both random and locomotion induced either by formyl-methionyl-leucyl-phenylalanine (FMLP) or serum were inhibited. SE-K562 was partially purified by Sephadex chromatography and the analysis of the eluted active fraction by SDS electrophoresis led one band of about 8 kd. No one inhibitory effect was observed with appropriate controls. In conclusion, K562 malignant cells in culture release a low molecular weight factor (8 kd) that inhibits all forms of PMN locomotion i.e. random locomotion and locomotion induced either by FMLP or serum.

Detection of antilymphocyte antibodies in patients with scleroderma using three different techniques.

The occurrence of antilymphocyte antibodies (AL-Ab) was investigated in the sera of 28 patients with scleroderma. By indirect immunofluorescence, we found these Ab in 53% of the sera. Inhibition of E rosette formation and lymphocytotoxicity revealed these Ab in 42% and 14% of the sera respectively. Most of the Ab (93%) reacted at 0 degrees C. These AL-Ab can be separated into several groups depending on their inhibitory activity on the lymphocyte membrane. In some cases, the receptor seems similar to that of sheep red blood cells. The study of the clinical features of the patients showed few differences between the groups with and those without Al-Ab. It must be noted that all the patients with the CREST syndrome (6 cases) possessed Al-Ab.

[Experimental evaluation of antibiotics as immunomodulators]. / Valutazione sperimentale di antibiotici come immunomodulatori.

Since the pioneer work by Metchnikoff, the goal of cooperation between therapeutics and the host defence system (HDS) has been sought after. This area of research received less attention after the introduction of antibiotics. Although, the predictive efficacy of antibacterial agents (ABA) is still evaluated in terms of MICs, MBCs, and pharmacokinetics, much evidence derived from clinical studies underlines the need for synergy between HDS and these drugs to obtain optimal therapeutic efficacy. The analysis of the immunomodifying properties of ABA has come under intense study. The majority of ABA does not substantially affect the functioning of the immune system at least in vivo, despite in-vitro observations of enhancement/inhibition of various immune parameters by some cephalosporins, macrolides, cyclins, aminoglycosides, etc. By contrast, chloramphenicol, sulphonamides and various beta-lactams may be responsible for drug-induced neutropenia whereas macrolides and quinolones, due to their high phagocytic uptake, synergize with phagocytes to destroy intracellular pathogens. Recently, the concept of Biological Response Modifier (BRM)-antibiotics has come under the limelight with the introduction of cefodizime, a new parenteral cephalosporin, which seems to be endowed with immunomodulating properties. This latter aspect has been demonstrated in vitro (potentiation of the phagocyte antimicrobial activity), ex vivo in immunocompromised animals and humans (restoration of various immune parameters) and in vivo (infection models using both sensitive and resistant species). Although the underlying mechanism has not been elucitated, the chemical structure responsible for this BRM activity has been recognized as the thio-thiazolyl moiety at C3 position of the cephem nucleus.(ABSTRACT TRUNCATED AT 250 WORDS)

The prohost effect of antimicrobial agents as a predictor of clinical outcome.

Apart from their direct antimicrobial activity, some antimicrobial agents may interfere in the complex host-microorganism interplay by modulating the natural response to invading pathogens. The three main aspects of this non-antibiotic effect (alteration of bacterial virulence, synergism with/impairment of the natural host response, impact on effector cell progenitors) will be briefly reviewed here, along with their potential incidence in the clinical outcome of infectious diseases.

Immunomodulation by macrolide antibiotics.

Macrolide antibiotics are strongly concentrated within host cells, a property that sustains their activity against intracellular pathogens and is likely responsible for the modulation of cell metabolism and function. There is extensive literature on the subject of macrolide-induced modulation of immune responses. Erythromycin A derivatives seem to display anti-inflammatory activity in vitro, in some animal models and in various clinical settings such as diffuse panbronchiolitis (DPB). The underlying mechanisms are not yet fully understood: inflammatory cytokine and oxidant production by phagocytes is down-regulated by these drugs, but other possible targets include bacterial virulence factors, bronchial and epithelial cells, etc. Also, a link has been suggested between the macrolide transmembrane carrier system and the P-glycoprotein family, which comprises MDR (multiple drug resistance) and CFTR (cystic fibrosis transmembrane conductance regulator), which are respectively involved in the chemotherapeutic resistance of cancer cells and in the genesis of cystic fibrosis.

Interaction of macrolides and ketolides with the phagocytic cell line PLB-985.

Interactions between antibacterial agents and polymorphonuclear neutrophils (PMNs) are a major focus of investigation. Owing to the variable drug susceptibility of PMNs from different individuals, in vitro studies require samples from large panels of healthy volunteers to reach statistical significance. Here, we used a phagocytic cell line, PLB-985, which can differentiate into mature PMNs in vitro, for the study of cellular interactions (drug uptake and antioxidant effects) of two macrolides (azithromycin and roxithromycin) and four ketolides [HMR 3004, HMR 3647 (telithromycin), HMR 3562 and HMR 3787]. The oxidative burst of differentiated (D) cells was inhibited by macrolides and ketolides. IC50% values (concentrations impairing the oxidative burst by 50%), determined after 30 min of incubation, were as follows for azithromycin, roxithromycin, HMR 3004, telithromycin, HMR 3562 and HMR 3787, respectively: 40, 39, 15, 23, 26, and 33 mg/l (fMLP stimulation) and 37, 86, 39, 43, 14, and 31 mg/l (PMA stimulation). These values were similar to those obtained with PMNs. Uptake of the two macrolides was significantly lower in non-differentiated (ND) cells than in D cells and PMNs. The cellular/extracellular (C/E) concentration ratios at 60 min for PMNs, D and ND PLB were respectively 67, 25 and 11 (roxithromycin) and 159, 137 and 48 (azithromycin). Ketolide uptake by ND-PLB was also significantly lower than that obtained with PMNs (C/E ratios at 60 min were about 75 versus 265 (HMR 3004), 36 vs 230 (telithromycin), 75 vs 235 (HMR 3562) and 20 vs 130 (HMR 3787). Although the active carrier system seemed to be present in ND cells, its activation pathway was not functional. Thus, the PLB-985 cell line is a good in vitro model for studying drug-PMN interactions. The use of ND and D cells may shed light on the nature and activation pathways of macrolide transport systems present on the PMN membrane.

Structure-activity relationships among 9-N-alkyl derivatives of erythromycylamine and their effect on the oxidative burst of human neutrophils in vitro.

Macrolide antibiotics have recently triggered much interest owing to the immunomodulatory potential of some derivatives, particularly in the field of inflammatory diseases. Among the possible mechanisms underlying these anti-inflammatory effects, macrolide-induced inhibition of oxidant production by phagocytes has attracted much attention. We and others have previously reported that erythromycin A-derived macrolides impair the phagocyte oxidative burst, a property linked to the presence of L-cladinose. However, we have also demonstrated that other substituents can be involved in the modulation of phagocyte function. Here we have extended the analysis of structure-activity relationships by studying the effects of five 9-N-alkyl derivatives of erythromycylamine on oxidant production by human neutrophils in vitro. LY211397 (2-methoxyethyl derivative) neither altered cell viability nor superoxide anion production. LY281389 (n-propyl derivative) did not alter cell viability and was slightly more inhibitory than erythromycylamine for the production of superoxide anion; its IC50 (concentration that inhibits 50% of the neutrophil response) was about 18 and 24 microM (versus 72 and 74 pM for erythromycylamine) after 60 min of incubation following fMLP and PMA stimulation, respectively. LY80576 (N-phenyl-3-indolylmethyl derivative), LY281981 (3-phenyl-n-propyl derivative) and LY57843 (benzyl derivative) all displayed cellular toxicity at high pharmacological concentrations after 30 to 60 min of incubation. Interestingly, these latter three drugs exhibited a rapid (5 min incubation) and strong inhibitory effect on the neutrophil oxidative burst from either stimulus, with IC50 values of 3 to 10 pM. Further in-vitro and in-vivo investigations are required to analyze the anti-inflammatory potential of these three derivatives.

[Role of Clostridium and its toxin in pseudo-membranous colitis (author's transl)]. / Rôle de Clostridium difficile et de sa toxine dans les colites pseudo-membraneuses.

At present many authors consider that pseudo-membranous colitis is of bacterial origin. The main pathogenic agent is Clostridium difficile. It is not easy to isolate this organism in the stool, selective media are under study. It liberates a lipo-glycoprotein exotoxin during lysis. It is only partially purified, its structure is not fully elucidated. Its molecular weight is not yet precisely determined. It consists of several polymerised polypeptide fragments of molecular weight 50 000. It is a thermolabile acid and alkaline sensitive cytotoxin which acts on the cell membranes and the ileo-caeco-colonic mucosa of man and animals. Clostridium difficile is transmissible by a small number of high risk carrier subjects who are potentially patients with pseudo-membranous colitis. Antibiotic therapy may lead to unbalance of the ecosystem represented by the bacterial flora of the digestive tract and favour the multiplication of a resistant strain to the administered antibiotic. The appearance of pseudo-membranous colitis requires the association of sufficient bacterial development (equal or greater than 10(7) germs per gram of stools) and the liberation of a cytotoxin. The pathogenic treatment consists of antibiotic therapy by Vancomycin or Metronidazole which seems, at present, the most active on the germs and a toxin absorbent, such as Cholestyramine, Coliptol hydrochloride or Heavy metals.

[Macrolides and immunity]. / Macrolides et immunité.

In order to counteract an ever increasing bacterial resistance, a new trend in antibiotic therapy is to try and obtain compounds with "immunostimulating" properties. Although the macrolides have been known for more than 30 years, their interaction with the host defence system has been poorly investigated. These drugs display an outstanding ability to penetrate and concentrate in phagocytes. Few depressive effects on phagocyte functions have been reported, while some macrolides have been shown to exert an immunostimulating effect in vitro and ex vivo. The data published on this subject are summarized in this review paper. Further studies would be required for a better understanding of structure-immunomodulating activity relationships.

[Interaction between anti-infective agents and phagocytes]. / Interaction entre les agents anti-infectieux et les phagocytes.

Metchnikoff was one of the first to suggest the need for cooperation between phagocytes and therapeutic agents for the benefit of health. After the hopes raised by the discovery and the tremendous development of antimicrobials, there is now a creeping pessimism faced with the parallel evolution of resistance strategies in the microbial world. Interest has now turned to the use of immunomodulatory drugs, alone or combined with anti-infectious agents. Another tendency is based on the possibility that antimicrobials directly interfere with the host-microbe interplay. This review is aimed at summarizing our knowledge of the interactions between antimicrobial agents and the phagocyte, still a cornerstone in the natural defence system. Despite the problems inherent in the analysis and clinical relevance of effects observed in the test tube this developing area of research could provide new therapeutic solutions beyond the year 2000.

[Intracellular penetration of macrolides]. / Pénétration intracellulaire des macrolides.

CELL PENETRATION: One of the main features of macrolides is their capacity to penetrate host cells. This property is the basis of their action against intercellular microorganisms and can explain characteristic pharmacokinetics as well as interference with cell metabolism. INTRACELLULAR CONCENTRATION: Erythromycin A derivatives with a single base group (roxithromycin) accumulate rapidly to a saturation point both the cytoplasm and in granulations. Intracellular concentrations of derivatives with two base groups do not reach saturation due to slow exflux. THERAPEUTIC ACTION: Because of their intracellular concentration, macrolides are indicated for the treatment of cell-associated pathogens. Exflux allows possible selective transfer into infected tissues. Macrolides also have an effect on functional activity of the host cells.

[Macrolides. New therapeutic prospects]. / Macrolides. Nouvelles perspectives thérapeutiques.

The aim of the development of semisynthetic derivatives was to overcome the problem of chemical stability of erythromycin A in acid medium, with less variability in gastro-intestinal absorption and leading to renewed interest in macrolides. The new macrolides have the same antibacterial spectrum as erythromycin A including Gram-positive and Gram-negative cocci, intracellular bacteria, mycoplasma, Campylobacter sp., Helicobacter pylori, mycobacteria spp., Gram-negative bacilli including Haemophilus influenzae, Bordetella pertussis, Pasteurella multocida, Gram-positive bacilli including Corynebacterium diphtheriae and anaerobic species. In vitro activity against Haemophilus influenzae is still a controversial subject. Macrolides are among the best tolerated antibacterial agents. Theoretically, macrolides could be given to a large range of patients even those suffering from underlying diseases. The new macrolides, roxithromycin, azithromycin, clarithromycin, dirithromycin, rokitamycin and miokamycin, are indicated for the treatment of upper respiratory tract infections and lower respiratory tract infections due to intracellular bacteria or Mycoplasma pneumoniae. Macrolides could be used as first line therapy for non-gonococcal urethritis, especially those due to Chlamydia trachomatis or Ureaplasma urealyticum. In pelvic inflammatory infections in which Chlamydia trachomatis is involved macrolides could also be used. Other non-conventional indications under discussion are H. pylori and Lyme's disease. Macrolides in combination with other antibacterials could be an alternative for Mycobacterium avium-intracellulare infections. The antiparasite effect of erythromycin has been known since the 1950s. Extensive experimental work is currently underway to determine the potential use of these drugs in this setting. Research during the 80s in the macrolide field, led to enhanced pharmacokinetic properties. Current research is focused on expanding the antibacterial spectrum and to overcome cross-resistance among 14-membered-ring macrolides.