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Lovey J, Molnar A, Banky B. Long-term nutrition in patients candidate to neoadjuvant and adjuvant treatments. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:106850. [PMID: 36841694 DOI: 10.1016/j.ejso.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/14/2023] [Indexed: 02/19/2023]
Abstract
To improve outcomes, to decrease the rate of local recurrence and development of distant metastases neoadjuvant and adjuvant therapies are employed in cancer patients in forms of radiation, chemo-, endocrine-, targeted-, and immunotherapy or their combination. Nutrition therapy plays important role in all phases of the cancer journey. From neoadjuvant therapy to prehabilitation, early postoperative nutrition, and long-term nutrition care during the adjuvant phase and survivorship determines the survival and quality of life of cancer patients. During the neoadjuvant phase patients may be in poor nutritional condition which can be aggravated by the applied oncological treatment. Beside this apparent threat this period also gives an excellent opportunity to maintain or even improve the nutritional status of the patients by nutrition therapy. After surgery the burdening effects of the operation may jeopardize the execution of adjuvant therapy. After early postoperative feeding a long-term nutrition strategy should be developed for cancer patients in order to avoid nutritional deterioration during the usually lengthy postoperative therapy. In this narrative review we discuss how preoperative nutritional status and medical nutrition therapy influence the results of surgery and after the operation what is the available evidence about nutritional status and outcome and the potentials to influence them by nutrition therapy.
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Affiliation(s)
- Jozsef Lovey
- National Tumorbiology Laboratory, National Institute of Oncology, Budapest, Hungary; Chair of Oncology, Semmelweis University, Budapest, Hungary.
| | - Andrea Molnar
- Scientific Committee, National Association of Hungarian Dietitians, Budapest, Hungary
| | - Balazs Banky
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
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Sarcopenia remaining after intensive nutritional feeding support could be a criterion for the selection of patients for surgery for oesogastric junction adenocarcinoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:384-391. [PMID: 36372618 DOI: 10.1016/j.ejso.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/19/2022] [Accepted: 11/04/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Sarcopenia is recognized as a negative prognostic factor in several cancers. The aim of this study was to investigate the impact of nutritional support with feeding jejunostomy (FJ) on the occurrence of sarcopenia and how it may affect postoperative short-term outcomes and long-term survival outcomes in patients undergoing esophagectomy for oesogastric junction adenocarcinoma (OJA). METHODS Patients with OJA were included. The presence of sarcopenia was determined using cutoff values of the total cross-sectional muscle tissue measured on CT scan. We analyzed risk factors for sarcopenia occurrence and the impact of preoperative sarcopenia on postoperative results, overall survival and disease-free survival. RESULTS A total of 124 patients were eligible for analysis. Ninety-one patients underwent surgery after chemotherapy, and 72 of them received preoperative FJ. Among the 91 patients, 21 patients (23.0%) were sarcopenic after preoperative chemotherapy. Multivariate analysis showed that FJ is a protective factor against sarcopenia occurrence. Overall survival was significantly different between sarcopenic and nonsarcopenic patients (median survival = 33.7 vs. 58.6 months, respectively, p = 0.04), and sarcopenia occurrence was an independent risk factor for overall survival in patients who underwent surgery (HR = 3.02; CI 95% 1.55-5.9; p < 0.005). Subgroup analyses showed no differences in overall survival between patients who presented sarcopenia despite nutritional prehabilitation with a FJ and patients excluded from surgery in palliative situations (median survival = 21.9 vs. 17.2 months, respectively, p = 0.46). CONCLUSION The persistence of sarcopenia after preoperative chemotherapy despite renutrition with FJ could be a selection factor to propose curative surgery for OJA.
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Venkatasamy A, Guerin E, Reichardt W, Devignot V, Chenard MP, Miguet L, Romain B, Jung AC, Gross I, Gaiddon C, Mellitzer G. Morpho-functional analysis of patient-derived xenografts reveals differential impact of gastric cancer and chemotherapy on the tumor ecosystem, affecting immune check point, metabolism, and sarcopenia. Gastric Cancer 2023; 26:220-233. [PMID: 36536236 PMCID: PMC9950243 DOI: 10.1007/s10120-022-01359-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Gastric cancer (GC) is an aggressive disease due to late diagnosis resulting from the lack of easy diagnostic tools, resistances toward immunotherapy (due to low PD-L1 expression), or chemotherapies (due to p53 mutations), and comorbidity factors, notably muscle atrophy. To improve our understanding of this complex pathology, we established patient-derived xenograft (PDX) models and characterized the tumor ecosystem using a morpho-functional approach combining high-resolution imaging with molecular analyses, regarding the expression of relevant therapeutic biomarkers and the presence of muscle atrophy. MATERIALS AND METHODS GC tissues samples were implanted in nude mice. Established PDX, treated with cisplatin or not, were imaged by magnetic resonance imaging (MRI) and analyzed for the expression of relevant biomarkers (p53, PD-L1, PD-1, HER-2, CDX2, CAIX, CD31, a-SAM) and by transcriptomics. RESULTS Three well-differentiated, one moderately and one poorly differentiated adenocarcinomas were established. All retained the architectural and histological features of their primary tumors. MRI allowed in-real-time evaluation of differences between PDX, in terms of substructure, post-therapeutic changes, and muscle atrophy. Immunohistochemistry showed differential expression of p53, HER-2, CDX2, a-SAM, PD-L1, PD-1, CAIX, and CD31 between models and upon cisplatin treatment. Transcriptomics revealed treatment-induced hypoxia and metabolic reprograming in the tumor microenvironment. CONCLUSION Our PDX models are representative for the heterogeneity and complexity of human tumors, with differences in structure, histology, muscle atrophy, and the different biomarkers making them valuable for the analyses of the impact of platinum drugs or new therapies on the tumor and its microenvironment.
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Affiliation(s)
- A Venkatasamy
- Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC, Interface Recherche Fondamental et Appliquée à la Cancérologie, 3 Avenue Molière, 67200, Strasbourg, France
- IHU-Strasbourg, Institute of Image-Guided Surgery, 67200, Strasbourg, France
- Medizin Physik, Universitätsklinikum Freiburg, Kilianstr. 5a, 70106, Freiburg, Germany
| | - E Guerin
- Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC, Interface Recherche Fondamental et Appliquée à la Cancérologie, 3 Avenue Molière, 67200, Strasbourg, France
| | - W Reichardt
- Medizin Physik, Universitätsklinikum Freiburg, Kilianstr. 5a, 70106, Freiburg, Germany
| | - V Devignot
- Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC, Interface Recherche Fondamental et Appliquée à la Cancérologie, 3 Avenue Molière, 67200, Strasbourg, France
| | - M P Chenard
- Pathology Department, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098, Strasbourg Cedex, France
| | - L Miguet
- Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC, Interface Recherche Fondamental et Appliquée à la Cancérologie, 3 Avenue Molière, 67200, Strasbourg, France
| | - B Romain
- Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC, Interface Recherche Fondamental et Appliquée à la Cancérologie, 3 Avenue Molière, 67200, Strasbourg, France
- Digestive Surgery Department, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098, Strasbourg Cedex, France
| | - A C Jung
- Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC, Interface Recherche Fondamental et Appliquée à la Cancérologie, 3 Avenue Molière, 67200, Strasbourg, France
- Laboratoire de Biologie Tumorale, Institut de Cancérologie Strasbourg Europe, 67200, Strasbourg, France
| | - I Gross
- Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC, Interface Recherche Fondamental et Appliquée à la Cancérologie, 3 Avenue Molière, 67200, Strasbourg, France
| | - C Gaiddon
- Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC, Interface Recherche Fondamental et Appliquée à la Cancérologie, 3 Avenue Molière, 67200, Strasbourg, France
| | - G Mellitzer
- Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC, Interface Recherche Fondamental et Appliquée à la Cancérologie, 3 Avenue Molière, 67200, Strasbourg, France.
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Murillo MI, Gaiddon C, Le Lagadec R. Targeting of the intracellular redox balance by metal complexes towards anticancer therapy. Front Chem 2022; 10:967337. [PMID: 36034648 PMCID: PMC9405673 DOI: 10.3389/fchem.2022.967337] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
The development of cancers is often linked to the alteration of essential redox processes, and therefore, oxidoreductases involved in such mechanisms can be considered as attractive molecular targets for the development of new therapeutic strategies. On the other hand, for more than two decades, transition metals derivatives have been leading the research on drugs as alternatives to platinum-based treatments. The success of such compounds is particularly due to their attractive redox kinetics properties, favorable oxidation states, as well as routes of action different to interactions with DNA, in which redox interactions are crucial. For instance, the activity of oxidoreductases such as PHD2 (prolyl hydroxylase domain-containing protein) which can regulate angiogenesis in tumors, LDH (lactate dehydrogenase) related to glycolysis, and enzymes, such as catalases, SOD (superoxide dismutase), TRX (thioredoxin) or GSH (glutathione) involved in controlling oxidative stress, can be altered by metal effectors. In this review, we wish to discuss recent results on how transition metal complexes have been rationally designed to impact on redox processes, in search for effective and more specific cancer treatments.
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Affiliation(s)
- María Isabel Murillo
- Instituto de Química, Universidad Nacional Autónoma de México, Ciudad Universitaria, Ciudad de México, Mexico
| | - Christian Gaiddon
- Strasbourg Université, Inserm UMR_S U1113, IRFAC, Strasbourg, France
| | - Ronan Le Lagadec
- Instituto de Química, Universidad Nacional Autónoma de México, Ciudad Universitaria, Ciudad de México, Mexico
- *Correspondence: Ronan Le Lagadec,
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Nagata T, Adachi Y, Taniguchi A, Kimura Y, Iitaka D, Iwata G, Yamaoka N. Impact of Preoperative Nutritional Indicator on Poor Postoperative Outcomes in Geriatric Patients with Colorectal Cancer. Nutr Cancer 2021; 74:1347-1355. [PMID: 34547938 DOI: 10.1080/01635581.2021.1952625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The present study aimed to analyze the association between preoperative nutritional assessment and poor postoperative outcomes in geriatric patients with colorectal cancer. This retrospective study included 138 patients aged ≥80 years with colorectal cancer who underwent surgery from January 2013 to December 2018. Patients were classified into two groups according to outcomes, poor group and normal group. Clinicopathological factors were compared between the groups, and the relationships of several nutritional indices were examined. There was no significant difference in sex, age, or preoperative comorbidities. There were significant differences in volume of blood loss and proportion of laparoscopic surgery. The group with poor outcomes had significantly higher neutrophil/lymphocyte ratio (NLR) and modified Glasgow prognostic score (mGPS) than the group with normal outcomes. Multivariate analysis revealed that open approach, high NLR, and category D mGPS were independent risk factors of poor postoperative outcomes in elderly patients with colorectal cancer. Our findings indicate that mGPS and NLR could be useful nutritional indicators of short-term outcomes of surgical treatment in geriatric patients with colorectal cancer. They can be evaluated based on albumin and C-reactive protein levels and blood count, which are inexpensive and beneficial to use in routine clinical practice.
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Affiliation(s)
- Tomoyuki Nagata
- Department of Surgery, Kyoto Chubu Medical Center, Nantan, Japan
| | - Yuki Adachi
- Department of Surgery, Kyoto Chubu Medical Center, Nantan, Japan
| | | | - Yu Kimura
- Department of Surgery, Kyoto Chubu Medical Center, Nantan, Japan
| | - Daisuke Iitaka
- Department of Surgery, Kyoto Chubu Medical Center, Nantan, Japan
| | - George Iwata
- Department of Surgery, Kyoto Chubu Medical Center, Nantan, Japan
| | - Nobuki Yamaoka
- Department of Surgery, Kyoto Chubu Medical Center, Nantan, Japan
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Venkatasamy A, Guerin E, Blanchet A, Orvain C, Devignot V, Jung M, Jung AC, Chenard MP, Romain B, Gaiddon C, Mellitzer G. Ultrasound and Transcriptomics Identify a Differential Impact of Cisplatin and Histone Deacetylation on Tumor Structure and Microenvironment in a Patient-Derived In Vivo Model of Gastric Cancer. Pharmaceutics 2021; 13:pharmaceutics13091485. [PMID: 34575561 PMCID: PMC8467189 DOI: 10.3390/pharmaceutics13091485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 01/06/2023] Open
Abstract
The reasons behind the poor efficacy of transition metal-based chemotherapies (e.g., cisplatin) or targeted therapies (e.g., histone deacetylase inhibitors, HDACi) on gastric cancer (GC) remain elusive and recent studies suggested that the tumor microenvironment could contribute to the resistance. Hence, our objective was to gain information on the impact of cisplatin and the pan-HDACi SAHA (suberanilohydroxamic acid) on the tumor substructure and microenvironment of GC, by establishing patient-derived xenografts of GC and a combination of ultrasound, immunohistochemistry, and transcriptomics to analyze. The tumors responded partially to SAHA and cisplatin. An ultrasound gave more accurate tumor measures than a caliper. Importantly, an ultrasound allowed a noninvasive real-time access to the tumor substructure, showing differences between cisplatin and SAHA. These differences were confirmed by immunohistochemistry and transcriptomic analyses of the tumor microenvironment, identifying specific cell type signatures and transcription factor activation. For instance, cisplatin induced an "epithelial cell like" signature while SAHA favored a "mesenchymal cell like" one. Altogether, an ultrasound allowed a precise follow-up of the tumor progression while enabling a noninvasive real-time access to the tumor substructure. Combined with transcriptomics, our results underline the different intra-tumoral structural changes caused by both drugs that impact differently on the tumor microenvironment.
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Affiliation(s)
- Aina Venkatasamy
- Streinth Lab (Stress Response and Innovative Therapies), Strasbourg University, Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental et Appliquée à la Cancérologie), 67200 Strasbourg, France; (A.V.); (E.G.); (A.B.); (C.O.); (V.D.); (A.C.J.); (B.R.)
- IHU-Strasbourg (Institut Hospitalo-Universitaire), 67091 Strasbourg, France
| | - Eric Guerin
- Streinth Lab (Stress Response and Innovative Therapies), Strasbourg University, Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental et Appliquée à la Cancérologie), 67200 Strasbourg, France; (A.V.); (E.G.); (A.B.); (C.O.); (V.D.); (A.C.J.); (B.R.)
| | - Anais Blanchet
- Streinth Lab (Stress Response and Innovative Therapies), Strasbourg University, Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental et Appliquée à la Cancérologie), 67200 Strasbourg, France; (A.V.); (E.G.); (A.B.); (C.O.); (V.D.); (A.C.J.); (B.R.)
| | - Christophe Orvain
- Streinth Lab (Stress Response and Innovative Therapies), Strasbourg University, Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental et Appliquée à la Cancérologie), 67200 Strasbourg, France; (A.V.); (E.G.); (A.B.); (C.O.); (V.D.); (A.C.J.); (B.R.)
| | - Véronique Devignot
- Streinth Lab (Stress Response and Innovative Therapies), Strasbourg University, Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental et Appliquée à la Cancérologie), 67200 Strasbourg, France; (A.V.); (E.G.); (A.B.); (C.O.); (V.D.); (A.C.J.); (B.R.)
| | | | - Alain C. Jung
- Streinth Lab (Stress Response and Innovative Therapies), Strasbourg University, Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental et Appliquée à la Cancérologie), 67200 Strasbourg, France; (A.V.); (E.G.); (A.B.); (C.O.); (V.D.); (A.C.J.); (B.R.)
- Laboratoire de Biologie Tumorale, ICANS, 67200 Strasbourg, France
| | - Marie-Pierre Chenard
- Pathology Department, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France;
| | - Benoit Romain
- Streinth Lab (Stress Response and Innovative Therapies), Strasbourg University, Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental et Appliquée à la Cancérologie), 67200 Strasbourg, France; (A.V.); (E.G.); (A.B.); (C.O.); (V.D.); (A.C.J.); (B.R.)
- Digestive Surgery Department, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Christian Gaiddon
- Streinth Lab (Stress Response and Innovative Therapies), Strasbourg University, Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental et Appliquée à la Cancérologie), 67200 Strasbourg, France; (A.V.); (E.G.); (A.B.); (C.O.); (V.D.); (A.C.J.); (B.R.)
- Correspondence: (C.G.); (G.M.)
| | - Georg Mellitzer
- Streinth Lab (Stress Response and Innovative Therapies), Strasbourg University, Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental et Appliquée à la Cancérologie), 67200 Strasbourg, France; (A.V.); (E.G.); (A.B.); (C.O.); (V.D.); (A.C.J.); (B.R.)
- Correspondence: (C.G.); (G.M.)
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Gaiddon C, Gross I, Meng X, Sidhoum M, Mellitzer G, Romain B, Delhorme JB, Venkatasamy A, Jung AC, Pfeffer M. Bypassing the Resistance Mechanisms of the Tumor Ecosystem by Targeting the Endoplasmic Reticulum Stress Pathway Using Ruthenium- and Osmium-Based Organometallic Compounds: An Exciting Long-Term Collaboration with Dr. Michel Pfeffer. Molecules 2021; 26:molecules26175386. [PMID: 34500819 PMCID: PMC8434532 DOI: 10.3390/molecules26175386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 12/27/2022] Open
Abstract
Metal complexes have been used to treat cancer since the discovery of cisplatin and its interaction with DNA in the 1960’s. Facing the resistance mechanisms against platinum salts and their side effects, safer therapeutic approaches have been sought through other metals, including ruthenium. In the early 2000s, Michel Pfeffer and his collaborators started to investigate the biological activity of organo-ruthenium/osmium complexes, demonstrating their ability to interfere with the activity of purified redox enzymes. Then, they discovered that these organo-ruthenium/osmium complexes could act independently of DNA damage and bypass the requirement for the tumor suppressor gene TP53 to induce the endoplasmic reticulum (ER) stress pathway, which is an original cell death pathway. They showed that other types of ruthenium complexes—as well complexes with other metals (osmium, iron, platinum)—can induce this pathway as well. They also demonstrated that ruthenium complexes accumulate in the ER after entering the cell using passive and active mechanisms. These particular physico-chemical properties of the organometallic complexes designed by Dr. Pfeffer contribute to their ability to reduce tumor growth and angiogenesis. Taken together, the pioneering work of Dr. Michel Pfeffer over his career provides us with a legacy that we have yet to fully embrace.
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Affiliation(s)
- Christian Gaiddon
- Université de Strasbourg-Inserm, UMR_S 1113 IRFAC, 67200 Strasbourg, France; (I.G.); (G.M.); (B.R.); (J.-B.D.); (A.V.); (J.A.C.)
- Correspondence: ; Tel.: +33-6-8352-5356
| | - Isabelle Gross
- Université de Strasbourg-Inserm, UMR_S 1113 IRFAC, 67200 Strasbourg, France; (I.G.); (G.M.); (B.R.); (J.-B.D.); (A.V.); (J.A.C.)
| | - Xiangjun Meng
- Department of Gastro-Oncology, 7th Hospital, Shanghai 200137, China;
| | | | - Georg Mellitzer
- Université de Strasbourg-Inserm, UMR_S 1113 IRFAC, 67200 Strasbourg, France; (I.G.); (G.M.); (B.R.); (J.-B.D.); (A.V.); (J.A.C.)
| | - Benoit Romain
- Université de Strasbourg-Inserm, UMR_S 1113 IRFAC, 67200 Strasbourg, France; (I.G.); (G.M.); (B.R.); (J.-B.D.); (A.V.); (J.A.C.)
| | - Jean-Batiste Delhorme
- Université de Strasbourg-Inserm, UMR_S 1113 IRFAC, 67200 Strasbourg, France; (I.G.); (G.M.); (B.R.); (J.-B.D.); (A.V.); (J.A.C.)
| | - Aïna Venkatasamy
- Université de Strasbourg-Inserm, UMR_S 1113 IRFAC, 67200 Strasbourg, France; (I.G.); (G.M.); (B.R.); (J.-B.D.); (A.V.); (J.A.C.)
| | - Alain C. Jung
- Université de Strasbourg-Inserm, UMR_S 1113 IRFAC, 67200 Strasbourg, France; (I.G.); (G.M.); (B.R.); (J.-B.D.); (A.V.); (J.A.C.)
| | - Michel Pfeffer
- CNRS UMR 7177, Institute of Chemistry, 67000 Strasbourg, France;
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