Evaluation of amorphous and lipid-based formulation strategies to increase the in vivo cannabidiol bioavailability in piglets

Cannabidiol (CBD) suffers from poor oral bioavailability due to poor aqueous solubility and high metabolism, and is generally administered in liquid lipid vehicles. Solid-state formulations of CBD have been developed, but their ability to increase the oral bioavailability has not yet been proven in vivo. Various approaches are investigated to increase this bioavailability. This study aimed to demonstrate the enhancement of the oral bioavailability of oral solid dosage forms of amorphous CBD and lipid-based CBD formulation compared to crystalline CBD. Six piglets received the three formulations, in a cross-over design. CBD and 7 - COOH - CBD, a secondary metabolite used as an indicator of hepatic degradation, were analyzed in plasma. A 10.9-fold and 6.8-fold increase in oral bioavailability was observed for the amorphous and lipid formulations, respectively. However, the lipid-based formulation allowed reducing the inter-variability when administered to fasted animals. An entero-hepatic cycle was confirmed for amorphous formulations. Finally, this study showed that the expected protective effect of lipids against hepatic degradation of the lipid-based formulation did not occur, since the ratio CBD/metabolite was higher than that of the amorphous one.

Interaction-Induced ac Stark Shift of Exciton-Polaron Resonances

Laser-induced shift of atomic states due to the ac Stark effect has played a central role in cold-atom physics and facilitated their emergence as analog quantum simulators. Here, we explore this phenomenon in an atomically thin layer of semiconductor MoSe_{2}, which we embedded in a heterostructure enabling charge tunability. Shining an intense pump laser with a small detuning from the material resonances, we generate a large population of virtual collective excitations and achieve a regime where interactions with this background population are the leading contribution to the ac Stark shift. Using this technique we study how itinerant charges modify-and dramatically enhance-the interactions between optical excitations. In particular, our experiments show that the interaction between attractive polarons could be more than an order of magnitude stronger than those between bare excitons.

Expression of the endocannabinoid system and response to cannabinoid components by the human fetal testis

BACKGROUND

Cannabis consumption by pregnant women continues to increase worldwide, raising concerns about adverse effects on fetal growth and deleterious impacts on the newborn, in connection with evidence of placental transfer of cannabis compound. Cannabis action is mediated by the endocannabinoid system (ECS), which expression is well established in the brain but unknown in the developing testis. The fetal testis, whose endocrine function orchestrates the masculinization of many distant organs, is particularly sensitive to disruption by xenobiotics. In this context, we aimed to determine whether cannabis exposure has the potential to directly impact the human fetal testis.

METHODS

We determined the expression of components of the ECS in the human fetal testis from 6 to 17 developmental weeks and assessed the direct effects of phytocannabinoids Δ9-trans-tetrahydrocannabinol (THC) and cannabidiol (CBD) on the testis morphology and cell functions ex vivo.

RESULTS

We demonstrate the presence in the human fetal testis of two key endocannabinoids, 2-arachidonylglycerol (2-AG) and to a lower level anandamide (AEA), as well as a range of enzymes and receptors for the ECS. Ex vivo exposure of first trimester testes to CBD, THC, or CBD/THC [ratio 1:1] at 10^-7 to 10^-5 M altered testosterone secretion by Leydig cells, AMH secretion by Sertoli cells, and impacted testicular cell proliferation and viability as early as 72 h post-exposure. Transcriptomic analysis on 72 h-exposed fetal testis explants revealed 187 differentially expressed genes (DEGs), including genes involved in steroid synthesis and toxic substance response. Depending on the molecules and testis age, highly deleterious effects of phytocannabinoid exposure were observed on testis tissue after 14 days, including Sertoli and germ cell death.

CONCLUSIONS

Our study is the first to evidence the presence of the ECS in the human fetal testis and to highlight the potential adverse effect of cannabis consumption by pregnant women onto the development of the male gonad.

3D printed, personalized sustained release cortisol for patients with adrenal insufficiency

The standard of care for patients with Adrenal Insufficiency (AI) is suboptimal. Administration of hydrocortisone three times a day produces plasma cortisol fluctuations associated with negative health outcomes. Furthermore, there is a high inter-individual variability in cortisol need, necessitating a personalized approach. It is hypothesized that a personalized, sustained release formulation would enhance the pharmacotherapy by mimicking the physiological cortisol plasma concentration at a higher level. Therefore, a novel 24 h sustained release 3D printed (3DP) hydrocortisone formulation has been developed (M3DICORT) by coupling hot-melt extrusion with fused deposition modeling. A uniform drug distribution in the 3DP tablets is demonstrated by a content of 101.66 ± 1.60 % with an acceptance value of 4.01. Furthermore, tablets had a stable 24 h dissolution profile where the intra-batch standard deviation was ± 2.8 % and the inter-batch standard deviation was ± 6.8 %. Tablet height and hydrocortisone content were correlated (R² = 0.996), providing a tool for easy dose personalization. Tablets maintained critical quality attributes, such as dissolution profile (f2 > 60) and content uniformity after process transfer from a single-screw extruder to a twin-screw extruder. Impurities were observed in the final product which should be mitigated before clinical assessment. To our knowledge, M3DICORT is the first 3DP hydrocortisone formulation specifically developed for AI.

Identification précoce des phénotypes cardiovasculaires chez les patients en insuffisance respiratoire aiguë au cours de la première pandémie Covid-19

Objectif : L'objectif principal était de comparer la prévalence de la dysfonction ventriculaire gauche (VG) et/ ou droite (VD) des patients admis au service d'urgence (SU) avec une insuffisance respiratoire aiguë (IRA) secondaire ou non à une pneumopathie à Covid-19.

Méthodes : Pendant un mois, nous avons inclus (24/7) de façon prospective les patients de l'unité de Covid-19 du SU qui présentaient une IRA. Pour chaque patient, un test RT-PCR, une tomodensitométrie thoracique et une échographie cardiaque de niveau 2 et pulmonaire étaient systématiquement réalisés avant toute intervention thérapeutique. Chaque patient était classé selon les phénotypes cardiovasculaires suivants : insuffisance VG, insuffisance VD, hypovolémie ± hyperkinésie et profil hémodynamique normal.

Résultats : Parmi les 517 patients admis pendant la période d'étude, 78 présentaient une IRA (15 %) et 62 ont bénéficié d'une échocardiographie de niveau 2 (âge : 73 ± 14 ans ; SpO2 : 90 ± 4 % ; lactate : 2,1 ± 1,3 mmol/l). Le diagnostic de la Covid-19 a été établi pour 22 patients (35 %). L'insuffisance VG (15 [38 %] vs 2 [9 %] ; p = 0,016) et celle VD (12 [30 %] vs 1 [5 %] ; p = 0,018) étaient plus souvent observées dans le groupe témoin que chez les patients ayant une pneumopathie à Covid-19. Inversement, les patients Covid-19 avaient plus fréquemment un profil hémodynamique normal ou une hypovolémie associée ou non à une vasoplégie (20 [91 %] vs 21 [53 %] ; p = 0,002). La mortalité intrahospitalière était de 18 % ( n = 11). Tous les patients atteints de la Covid-19 présentant une insuffisance VG et/ou VD précoce sont décédés pendant leur hospitalisation.

Conclusions : La dysfonction VG et celle VD étaient plus fréquentes chez les patients non atteints de la Covid-19, alors que les patients atteints de Covid-19 avaient un phénotype cardiovasculaire normal ou hypovolémique.

Influence of API physico-chemical properties on amorphization capacity of several mesoporous silica loading methods

The objective of this work was to evaluate the impact of physico-chemical properties of pharmaceutical drugs on the optimal mesoporous silica loading methods. Indeed, a good combination between drug and loading process has to be studied to promote the deepest penetration of the drug inside the mesopores, allowing high drug amorphization. Six molecules, namely lidocaine and its hydrochloride, ibuprofen, ketoprofen, artemether and miconazole, with different physico-chemical properties (the ionized character, the acid-base character, the HBDA number, the solubility in sc-CO₂ and the behavior under subcritical CO₂) were used to produce drug-silica formulations. Different impregnation processes (physical mixing, melting, wetting, sc-CO₂ and subcritical CO₂ impregnations) have been compared for each drug, in terms of drug recovery and crystallinity. Formulations showed drug percentage close to 100% except for supercritical soluble drug formulations impregnated by using sc-CO₂. However, the basic drug character provided less or no drug loss during impregnation. Processing insoluble sc-CO₂ molecule under supercritical conditions led to less crystallinity than the correspondent physical mixture suggesting an interesting repulsive effect that forces the drug penetration within the mesopores. Besides, it has been also highlighted that the HBDA number is not sufficient to predict the final drug loading. Melting methods have high interest considering the drugs tested and subcritical CO₂ could increase the loading, especially for drugs with high molten viscosity. This study showed that a plethora of loading methods can be used to provide high drug loaded MS formulations with a wide choice of equipment.

P–055 Methylation dynamics of the sperm epigenome after chemotherapy: a case study

Study question

What is the evolution of the sperm epigenome after chemotherapy in a patient with testicular cancer (TC)?

Summary answer

These new data on epigenetic recovery profil after TC are useful tools for counseling and reassuring these patients.

What is known already

An important issue for young men affected TC is how TC and its treatment will affect, transiently or permanently, their future reproductive health. The consequences of cancer treatment on the sperm epigenome during the recovery periods are topical issues of ascendant significance as epigenetic modifications to the paternal genome may have deleterious effects on the offspring.

Study design, size, duration

Here we report the epigenomic profiling of frozen sperm from a TC patient before and after the treatment at different time points (6, 9, 12 and 24 months) by using RRBS analysis (Reduced representation bisulfite sequencing method).

Participants/materials, setting, methods

A testicular tumor (testicular germ cell tumor) was diagnosed in a 30 years old patient. A cryopreservation of spermatozoa was proposed before treatment.Semen samples were obtained 2 times before treatment and 4 times after treatment (6, 9, 12 and 24 months following the initiation of treatment).

Main results and the role of chance

Upon collection, sampling after chemotherapy ranged from 0,6 to 4,2 million per sperm straw between 6 and 24 months after the treatment, always increasing.

In order to capture the direct effect of the treatment on the methylation changes, the DMR detection has been operated between pre-chemotherapy samples (pair-wise) and the time point of 6 months. Among the 179 hqDMRs, 74 are differentially methylated between the PreCT and PostCT6m samples (16 hyper- and 68 hypo-methylated) associated with 49 DMGs (15 hyper- and 34 hypo-methylated).

We further sub-clustered the 74 hqDMRs between PreCT and PostCT6m into 6 patterns, 3 hyper- and 3 hypo-methylated. Briefly, patterns P1 and P4 include hqDMRs that quickly get back to their pre-treatment methylation status just after 9th months onwards. Patterns P2 and P5 include hqDMRs that slowly get back to their pre-treatment methylation status between 12 and 24 months after treatment. Patterns P3 and P6 include hqDMRs that remain hyper- or hypo-methylated even after 24 months.

We have intersected the genes (DMGs) associated with the detected hqDMRs with those known to be important or expressed during embryogenesis. We thus detected that 7 hyper-methylated and 6 hypomethylated DMGs were involved (or expressed) during embryonic / fetal development.

Limitations, reasons for caution

This study involves a single patient. As the patient made no major changes in his personal way of life, we hypothesized that sperm parameter variations may be attributable to the BEP treatment.

Wider implications of the findings: The altered methylated status of those DMGs important for early development might modify their expression pattern and thus affect their function during key stages of embryogenesis leading to potential developmental disorders. It is important to notice that among the 110 DMGs none of them correspond to known imprinted genes.

Trial registration number

Not applicable

Systematic study of liposomes composition towards efficient delivery of plasmid DNA as potential application of dermal fibroblasts targeting

The use of non-viral DNA vectors to topically treat skin diseases has demonstrated a high potential. However, vectors applied on the skin face extracellular barriers including the stratum corneum and intracellular barriers such as the endosomal escape and the nuclear targeting of the plasmid DNA. The aim of this study was to develop a formulation suitable for dermal application and effective for delivering plasmid DNA into cells. Different formulations were prepared using different cationic lipids (DOTAP, DC-Chol, DOTMA) and co-lipids (DOPE, DSPE). Lipoplexes were produced by complexing liposomes with plasmid DNA at different pDNA/CL (w/w) ratios. Our results showed that appropriate pDNA/CL ratios allowing total complexation of plasmid DNA differed depending on the structure of the lipid used. The transfection rates showed that (i) higher rates were obtained with DOTMA lipoplexes, (ii) DC-Chol lipoplexes provided a transfection twice as important as DOTAP lipoplexes and (iii) when DSPE was added, the cytotoxicity decreased while transfection rates were similar. We found that formulations composed of DC-Chol:DOPE:DSPE or DOTMA:DOPE were appropriate to complex plasmid DNA and to transfect human primary dermal fibroblasts with efficacy and limited cytotoxicity. Therefore, these formulations are highly promising in the context of gene therapy to treat skin diseases.

Évaluation hémodynamique précoce par échocardiographie ciblée des patients en sepsis ou choc septique (Sepsis-3) au service d’urgence

Introduction : L’identification du profil hémodynamique des patients septiques au service d’urgence (SU) pourrait permettre d’adapter individuellement les recommandations de la Surviving Sepsis Campaign (SSC). L’objectif de cette étude était de décrire le profil hémodynamique précoce par échocardiographie ciblée chez les patients en sepsis et leur impact thérapeutique.

Méthode : Étude prospective monocentrique incluant les patients septiques (score qSOFA [quick Sepsis-related Organ Failure Assessment] ≥ 2) sur une période de 30 mois. L’échocardiographie était réalisée par des médecins urgentistes de niveau échographie clinique en médecine d’urgence 1 afin de déterminer le profil hémodynamique (hypovolémie, vasoplégie avec hyperkinésie, insuffisance ventriculaire ou profil « normal ») dès le sepsis identifié au SU. L’impact thérapeutique était défini par le nombre de patients pour lesquels l’échocardiographie modifiait le traitement de la SSC.

Résultats : Quatre-vingt-un patients (44 sepsis, 37 chocs septiques) ont été étudiés (âge moyen : 70 ± 15 ans ; hommes [n = 47, 58 %] ; SOFA = 5,3 ± 2,9 ; lactates = 4,6 ± 4,2 mmol/l ; admission en réanimation [n = 30, 37 %] ; mortalité j28 [n = 28, 35 %]) après un remplissage vasculaire médian de 500 ml (écart interquartile : 250–1 500 ml). Les profils hémodynamiques dominants étaient l’hypovolémie (n = 54, 66 %), parfois associée à une vasoplégie (n = 26, 32 %) et l’insuffisance ventriculaire (n = 21, 26 %). L’impact thérapeutique concernait 21 patients (26 %), dont un arrêt précoce du remplissage vasculaire après un volume de 850 ± 740 ml chez huit patients.

Conclusion : La dysfonction ventriculaire précoce est présente chez plus de 20 % des patients septiques. L’impact pronostique d’une évaluation échocardiographique dès l’identification du sepsis au SU reste à déterminer.

RNA profiling of human testicular cells identifies syntenic lncRNAs associated with spermatogenesis

STUDY QUESTION

Is the noncoding transcriptional landscape during spermatogenesis conserved between human and rodents?

SUMMARY ANSWER

We identified a core group of 113 long noncoding RNAs (lncRNAs) and 20 novel genes dynamically and syntenically transcribed during spermatogenesis.

WHAT IS KNOWN ALREADY

Spermatogenesis is a complex differentiation process driven by a tightly regulated and highly specific gene expression program. Recently, several studies in various species have established that a large proportion of known lncRNAs are preferentially expressed during meiosis and spermiogenesis in a testis-specific manner.

STUDY DESIGN, SIZE, DURATION

To further investigate lncRNA expression in human spermatogenesis, we carried out a cross-species RNA profiling study using isolated testicular cells.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Human testes were obtained from post-mortem donors (N = 8, 51 years old on average) or from prostate cancer patients with no hormonal treatment (N = 9, 80 years old on average) and only patients with full spermatogenesis were used to prepare enriched populations of spermatocytes, spermatids, Leydig cells, peritubular cells and Sertoli cells. To minimize potential biases linked to inter-patient variations, RNAs from two or three donors were pooled prior to RNA-sequencing (paired-end, strand-specific). Resulting reads were mapped to the human genome, allowing for assembly and quantification of corresponding transcripts.

MAIN RESULTS AND THE ROLE OF CHANCE

Our RNA-sequencing analysis of pools of isolated human testicular cells enabled us to reconstruct over 25 000 transcripts. Among them we identified thousands of lncRNAs, as well as many previously unidentified genes (novel unannotated transcripts) that share many properties of lncRNAs. Of note is that although noncoding genes showed much lower synteny than protein-coding ones, a significant fraction of syntenic lncRNAs displayed conserved expression during spermatogenesis.

LARGE SCALE DATA

Raw data files (fastq) and a searchable table (.xlss) containing information on genomic features and expression data for all refined transcripts have been submitted to the NCBI Gene Expression Omnibus under accession number GSE74896.

LIMITATIONS, REASONS FOR CAUTION

Isolation procedures may alter the physiological state of testicular cells, especially for somatic cells, leading to substantial changes at the transcriptome level. We therefore cross-validated our findings with three previously published transcriptomic analyses of human spermatogenesis. Despite the use of stringent filtration criteria, i.e. expression cut-off of at least three fragments per kilobase of exon model per million reads mapped, fold-change of at least three and false discovery rate adjusted P-values of less than <1%, the possibility of assembly artifacts and false-positive transcripts cannot be fully ruled out.

WIDER IMPLICATIONS OF THE FINDINGS

For the first time, this study has led to the identification of a large number of conserved germline-associated lncRNAs that are potentially important for spermatogenesis and sexual reproduction. In addition to further substantiating the basis of the human testicular physiology, our study provides new candidate genes for male infertility of genetic origin. This is likely to be relevant for identifying interesting diagnostic and prognostic biomarkers and also potential novel therapeutic targets for male contraception.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by l'Institut national de la santé et de la recherche médicale (Inserm); l'Université de Rennes 1; l'Ecole des hautes études en santé publique (EHESP); INERIS-STORM to B.J. [N 10028NN]; Rennes Métropole 'Défis scientifiques émergents' to F.C (2011) and A.D.R (2013). The authors have no competing financial interests.

Impregnation of mesoporous silica with poor aqueous soluble molecule using pressurized carbon dioxide: Is the solubility in the supercritical and subcritical phase a critical parameter?

Recently, mesoporous silica (MS) has been used as a material able to maintain amorphous state of active compounds and therefore, enhance the oral bioavailability of BCSII drugs. Among impregnation methods of MS, techniques using supercritical carbon dioxide (Sc-CO₂) are promising tools. Solubility of compounds in Sc-CO₂ is reported as one of the most critical parameters, which usually limits its use in drug formulation. Indeed, most of compounds have poor solubility in Sc-CO₂. The aim of this work is to compare different MS and to study alternative processes using pressurized CO₂ for insoluble molecule in Sc-CO₂. By using high pressure reactor, DSC, HPLC and in vitro dissolution tests, the crystallinity and dissolution profiles of MS with different pore size (6.6 nm, 25.0 nm and 2.5 nm) impregnated with fenofibrate (FF) under Sc-CO₂ were compared to select the most appropriate carrier. Then, the selected MS has been impregnated under supercritical, subcritical and atmospheric conditions. We have shown that the MS pore size of 6.6 nm provides the higher amorphous drug loading capacity as well as the faster and higher drug dissolution. In addition, FF-MS formulations produced with pressurized CO₂ as fusion medium, both in subcritical and supercritical conditions; give similar crystallinity and dissolution results compared to those produced with supercritical fluids as solvent. Through this study, we show new possibilities of using CO₂ for insoluble compounds in this fluid.

Spontaneous formation and relaxation of spin domains in antiferromagnetic spin-1 condensates

Many-body systems at low temperatures generally organize themselves into ordered phases, whose nature and symmetries are captured by an order parameter. This order parameter is spatially uniform in the simplest cases, for example the macroscopic magnetization of a ferromagnetic material. Non-uniform situations also exist in nature, for instance in antiferromagnetic materials, where the magnetization alternates in space, or in the so-called stripe phases emerging for itinerant electrons in strongly correlated materials. Understanding such inhomogeneously ordered states is of central importance in many-body physics. Here we study experimentally the magnetic ordering of itinerant spin-1 bosons in inhomegeneous spin domains at nano-Kelvin temperatures. We demonstrate that spin domains form spontaneously, that is purely because of the antiferromagnetic interactions between the atoms and in the absence of external magnetic forces, after a phase separation transition. Furthermore, we explore how the equilibrium domain configuration emerges from an initial state prepared far from equilibrium.

Order parameter and phase characterization of multicomponent quantum system is of fundamental importance. Here the authors show the parameter control of the dynamics and relaxation of the magnetic ordering of the spin-1 Bose-Einstein condensates of sodium atoms in uniform magnetic field.

Peanut gastrointestinal delivery oral immunotherapy in adolescents: Results of the build-up phase of a randomized, double-blind, placebo-controlled trial (PITA study)

BACKGROUND

Oral immunotherapy to peanut is effective in desensitizing patients but has significant side effects including anaphylaxis and gastrointestinal symptoms. In most protocols, peanut is administered in a vehicle food.

OBJECTIVE

In an exclusively adolescent population, we tested a new approach using sealed capsules of peanut (gastrointestinal delivery oral immunotherapy or GIDOIT) to bypass the upper gastrointestinal tract. The primary aim was to assess the efficacy of the oral build-up phase of GIDOIT and the secondary aim to analyse its safety.

METHODS

Adolescents with a history of a clinical allergic reaction after peanut ingestion were included in a 2-armed, parallel-design, individually randomized, double-blind, placebo-controlled, multicentre trial after a positive double-blind placebo-controlled oral food challenge (DBPCFC1). A central randomization centre used computer-generated tables to allocate treatments. Peanut (or placebo) capsules were ingested daily over a period of 24 weeks with increments every 2 weeks from 2 to 400 mg of peanut protein (pp). Primary outcome was tolerance of 400 mg of pp at DBPCFC2.

RESULTS

Thirty patients were included between September 2013 and May 2014. At DBPCFC2, unresponsiveness to 400 mg of pp was achieved in 17/21 peanut group patients (2 withdrawn patients) and 1/9 in the placebo group (Intention-to-treat analysis, P < .001, absolute difference = 0.7, 95%IC 0.43 0.96). Oropharyngeal symptoms were equally frequent in both groups. No dysphagia or other signs of eosinophilic oesophagitis occurred. Digestive adverse events (AE) were more frequent in the treated group (P = .02), but mild and without compliance issues. Only one severe advent event led to withdrawal in a patient who ingested twice the investigated treatment. Peanut-specific humoral immune responses were modulated.

CONCLUSION

The GIDOIT protocol demonstrated clinical and immunological efficacy and had an acceptable level of safety with weak oropharyngeal symptoms, no dysphagia, mild digestive events and few severe systemic AE.

Short-term effect of outdoor mould spore exposure on prescribed allergy medication sales in Central France

BACKGROUND

Outdoor moulds are classically associated with exacerbations of asthma.

OBJECTIVE

The aim of this paper was to examine nasal allergy morbidity by studying the short-term relationship between mould spore exposure and daily sales of reimbursable anti-allergic treatment in central France.

METHODS

The relationship between daily changes in mould concentrations and daily sales obtained from the national healthcare database was analysed with generalized additive models, taking into account confounding factors such as air pollution, weather conditions, pollen counts, and days of the week.

RESULTS

During the study, the average total yearly number of treated people was around 10 000 over approximately 230 000 surveyed. The relative risk (95% CI confidence interval) of sales of oral antihistamines with topical treatment associated with an interquartile increase in mould concentration was significant for Cladosporium 1.079 [1.019-1.142] and Aspergillus-Penicillium (Asp-Pen) 1.051 [1.021-1.082] in the whole population. When the influence of age and sex was considered, the relationship was significant only in male children aged 0-12 years and those aged between 13 and 49 years for Cladosporium: 1.256 [1.081-1.460] and 1.151 [1.063-1.245], respectively. The relationship was also significant for Asp-Pen: 1.038 [1.003-1.075] for those aged between 13 and 49 years and 1.056 [1.007-1.108] for adults over 50 years of age.

CONCLUSION

The association between prescribed daily sales of oral antihistamines with topical treatment sales is associated with temporal changes to Cladosporium and Aspergillus-Penicillium in the whole population. When the influence of age and sex was considered, these two moulds contributed to prescribed medication sales only in the male general population.

An update on molecular cat allergens: Fel d 1 and what else? Chapter 1: Fel d 1, the major cat allergen

Background

Cats are the major source of indoor inhalant allergens after house dust mites. The global incidence of cat allergies is rising sharply, posing a major public health problem. Ten cat allergens have been identified. The major allergen responsible for symptoms is Fel d 1, a secretoglobin and not a lipocalin, making the cat a special case among mammals.

Main body

Given its clinical predominance, it is essential to have a good knowledge of this allergenic fraction, including its basic structure, to understand the new exciting diagnostic and therapeutic applications currently in development. The recent arrival of the component-resolved diagnosis, which uses molecular allergens, represents a unique opportunity to improve our understanding of the disease. Recombinant Fel d 1 is now available for in vitro diagnosis by the anti-Fel d 1 specific IgE assay. The first part of the review will seek to describe the recent advances related to Fel d 1 in terms of positive diagnosis and assessment of disease severity. In daily practice, anti-Fel d 1 IgE tend to replace those directed against the overall extract but is this attitude justified? We will look at the most recent arguments to try to answer this question. In parallel, a second revolution is taking place thanks to molecular engineering, which has allowed the development of various forms of recombinant Fel d 1 and which seeks to modify the immunomodulatory properties of the molecule and thus the clinical history of the disease via various modalities of anti-Fel d 1-specific immunotherapy. We will endeavor to give a clear and practical overview of all these trends.

An update on molecular cat allergens: Fel d 1 and what else? Chapter 1: Fel d 1, the major cat allergen

Background

Cats are the major source of indoor inhalant allergens after house dust mites. The global incidence of cat allergies is rising sharply, posing a major public health problem. Ten cat allergens have been identified. The major allergen responsible for symptoms is Fel d 1, a secretoglobin and not a lipocalin, making the cat a special case among mammals.

Main body

Given its clinical predominance, it is essential to have a good knowledge of this allergenic fraction, including its basic structure, to understand the new exciting diagnostic and therapeutic applications currently in development. The recent arrival of the component-resolved diagnosis, which uses molecular allergens, represents a unique opportunity to improve our understanding of the disease. Recombinant Fel d 1 is now available for in vitro diagnosis by the anti-Fel d 1 specific IgE assay. The first part of the review will seek to describe the recent advances related to Fel d 1 in terms of positive diagnosis and assessment of disease severity. In daily practice, anti-Fel d 1 IgE tend to replace those directed against the overall extract but is this attitude justified? We will look at the most recent arguments to try to answer this question. In parallel, a second revolution is taking place thanks to molecular engineering, which has allowed the development of various forms of recombinant Fel d 1 and which seeks to modify the immunomodulatory properties of the molecule and thus the clinical history of the disease via various modalities of anti-Fel d 1-specific immunotherapy. We will endeavor to give a clear and practical overview of all these trends.

Global approach for the validation of an in-line Raman spectroscopic method to determine the API content in real-time during a hot-melt extrusion process

Since the Food and Drug Administration (FDA) published a guidance based on the Process Analytical Technology (PAT) approach, real-time analyses during manufacturing processes are in real expansion. In this study, in-line Raman spectroscopic analyses were performed during a Hot-Melt Extrusion (HME) process to determine the Active Pharmaceutical Ingredient (API) content in real-time. The method was validated based on a univariate and a multivariate approach and the analytical performances of the obtained models were compared. Moreover, on one hand, in-line data were correlated with the real API concentration present in the sample quantified by a previously validated off-line confocal Raman microspectroscopic method. On the other hand, in-line data were also treated in function of the concentration based on the weighing of the components in the prepared mixture. The importance of developing quantitative methods based on the use of a reference method was thus highlighted. The method was validated according to the total error approach fixing the acceptance limits at ±15% and the α risk at ±5%. This method reaches the requirements of the European Pharmacopeia norms for the uniformity of content of single-dose preparations. The validation proves that future results will be in the acceptance limits with a previously defined probability. Finally, the in-line validated method was compared with the off-line one to demonstrate its ability to be used in routine analyses.

Oral probiotic treatment of Lactobacillus rhamnosus Lcr35® prevents visceral hypersensitivity to a colonic inflammation and an acute psychological stress

AIMS

This study evaluated the efficacy of a repeated oral treatment with two active pharmaceutical ingredients (Lcr Lenio^® and Lcr Restituo^® ) derivated from the probiotic bacterial strain Lactobacillus rhamnosus Lcr35^® in two animal models mimicking different features of irritable bowel syndrome (IBS). IBS is characterized by visceral pain associated with alteration of bowel transit. IBS patients present visceral hypersensitivity with peripheral and central origins.

METHODS AND RESULTS

The injection of 2,4,6-trinitrobenzenesulfonic acid (TNBS) into the proximal colon as well as an acute partial restraint stress (PRS) produces colonic hypersensitivity measured in conscious rats by a decrease in pain threshold in response to distal colonic distension. Visceral hypersensitivity was produced by injection of TNBS 7 days before colonic distension or by acute PRS on testing day. Treatments were performed once a day during eight consecutive days.

CONCLUSIONS

This study indicates that an 8-day probiotic treatment (Lcr Lenio and Lcr Restituo) produces an antihypersensitivity activity in both TNBS and PRS visceral pain models. As this probiotic strain attenuates peripherally and centrally induced visceral hypersensitivity in rats, it may be active in treatment of IBS symptoms. An immunomodulatory effect of the probiotics was highlighted in the TNBS model on the IL-23 secretion, suggesting a mechanism of action involving a regulation of the local IL-23/Th17 immune activation.

SIGNIFICANCE AND IMPACT OF THE STUDY

Two formulas of Lcr35^® probiotic strain show very encouraging results for the treatment of IBS patients. Further studies are needed to better understand the role and mechanisms of probiotics on the pathogenesis of IBS.

A simple calibration approach based on film-casting for confocal Raman microscopy to support the development of a hot-melt extrusion process

When developing a new formulation, the development, calibration and validation steps of analytical methods based on vibrational spectroscopy are time-consuming. For each new formulation, real samples must be produced and a "reference method" must be used in order to determine the Active Pharmaceutical Ingredient (API) content of each sample. To circumvent this issue, the paper presents a simple approach based on the film-casting technique used as a calibration tool in the framework of hot-melt extrusion process. Confocal Raman microscopic method was successfully validated for the determination of itraconazole content in film-casting samples. Then, hot-melt extrusion was carried out to produce real samples in order to confront the results obtained with confocal Raman microscopy and Ultra High Performance Liquid Chromatography (UHPLC). The agreement between both methods was demonstrated using a comparison study based on the Bland and Altman's plot.

Binding Potency of Heparin Immobilized on Activated Charcoal for DNA Antibodies

In vitro experiments showed that heparin adsorbed on activated charcoal can bind antibodies raised against native and single-stranded DNA in a diluted sera pool with a high level of these DNA. Thus, heparin used as anticoagulant during hemosorption procedure can demonstrate supplementary therapeutic activity resulting from its interaction with various agents involved in acute and chronic inflammatory reactions such as DNA- and RNA-binding substances, proinflammatory cytokines, complement components, growth factors, etc. Research and development of heparin-containing carbonic adsorbents for the therapy of numerous inflammatory and autoimmune diseases seems to be a promising avenue in hematology.

Vibrational spectroscopy and microspectroscopy analyzing qualitatively and quantitatively pharmaceutical hot melt extrudates

Since the last decade, more and more Active Pharmaceutical Ingredient (API) candidates have poor water solubility inducing low bioavailability. These molecules belong to the Biopharmaceutical Classification System (BCS) classes II and IV. Thanks to Hot-Melt Extrusion (HME), it is possible to incorporate these candidates in pharmaceutical solid forms. Indeed, HME increases the solubility and the bioavailability of these drugs by encompassing them in a polymeric carrier and by forming solid dispersions. Moreover, in 2004, the FDA's guidance initiative promoted the usefulness of Process Analytical Technology (PAT) tools when developing a manufacturing process. Indeed, the main objective when developing a new pharmaceutical process is the product quality throughout the production chain. The trend is to follow this parameter in real-time in order to react immediately when there is a bias. Vibrational spectroscopic techniques, NIR and Raman, are useful to analyze processes in-line. Moreover, off-line Raman microspectroscopy is more and more used when developing new pharmaceutical processes or when analyzing optimized ones by combining the advantages of Raman spectroscopy and imaging. It is an interesting tool for homogeneity and spatial distribution studies. This review treats about spectroscopic techniques analyzing a HME process, as well off-line as in-line, presenting their advantages and their complementarities.

The importance of EN ISO 15189 accreditation of allergen-specific IgE determination for reliable in vitro allergy diagnosis

BACKGROUND

Allergen-specific serum immunoglobulin E detection and quantification have become an important step in allergy diagnosis and follow-up. In line with the current trend of laboratory test accreditation to international standards, we set out to design and assess an accreditation procedure for allergen-specific serum IgE.

METHODS

Method validation according to the accreditation procedure under the EN ISO 15189 standard was carried out for allergen-specific immunoglobulin E determination using the fluoroimmunoenzymatic method ImmunoCAP(®) (ThermoFisher). Data were produced by 25 hospital laboratories in France. A total of 29 allergen specificities including mixes, extracts, and molecular allergens were assayed. Allergen-specific serum immunoglobulin E concentrations ranged from 0.1 to 100 kUA /l.

RESULTS

Repeatability, reproducibility, and accuracy results fulfilled method validation criteria for automated laboratory tests and proved similar irrespective of the allergen specificity, allergen-specific serum immunoglobulin E concentration, or individual laboratory.

CONCLUSION

Allergen-specific serum immunoglobulin E determination with the fluoroimmunoenzymatic method ImmunoCAP(®) is a highly repeatable, reproducible, and accurate method which may be considered as a single analyte assay in view of the EN ISO 15189 accreditation procedure.

Airborne pollen levels and drug consumption for seasonal allergic rhinoconjunctivitis: a 10-year study in France

BACKGROUND

Few time-series studies, and none lasting longer than 4 years, have investigated the etiology of treated seasonal allergic rhinoconjunctivitis (SAR) on the basis of anti-allergic medication prescriptions. The aim of this article was to study the short-term relationship between pollen exposure and drug-treated SAR over 10 years in an urban area in central France.

METHODS

A SAR case was defined as the association between an oral antihistamine and a local anti-allergic drug on the same prescription. The relationship between daily changes in pollen concentrations and daily changes in the number of treated SAR cases was analysed using generalized additive models, taking into account confounding factors such as air pollution, weather and days of the week.

RESULTS

Between 2003 and 2012, the total yearly number of treated SAR cases rose from 7265 to 11 315. The relative risk of treated SAR associated with an interquartile increase in pollen concentration increased significantly for Fraxinus, Betula, Carpinus, Platanus, Poaceae and Urticaceae for the whole pollen season, and for Urticaceae in the first semester.

CONCLUSIONS

The prevalence of treated SAR cases rose by about 55% in 10 years. The study not only confirmed the highly allergenic role of Fraxinus, Betula and Poaceae pollens but also showed a relatively unknown association between treated SAR and Carpinus and Platanus pollens, despite their pollen counts being <1% of overall pollen concentration. It also showed robust correlations with Urticaceae pollens, especially during the first semester, suggesting a potential allergenic role of Parietaria pollination in this non-Mediterranean area.

A review of pharmaceutical extrusion: critical process parameters and scaling-up

Hot melt extrusion has been a widely used process in the pharmaceutical area for three decades. In this field, it is important to optimize the formulation in order to meet specific requirements. However, the process parameters of the extruder should be as much investigated as the formulation since they have a major impact on the final product characteristics. Moreover, a design space should be defined in order to obtain the expected product within the defined limits. This gives some freedom to operate as long as the processing parameters stay within the limits of the design space. Those limits can be investigated by varying randomly the process parameters but it is recommended to use design of experiments. An examination of the literature is reported in this review to summarize the impact of the variation of the process parameters on the final product properties. Indeed, the homogeneity of the mixing, the state of the drug (crystalline or amorphous), the dissolution rate, the residence time, can be influenced by variations in the process parameters. In particular, the impact of the following process parameters: temperature, screw design, screw speed and feeding, on the final product, has been reviewed.

[Self-medication of regular headache: a community pharmacy-based survey in Belgium]

AIM

This observational community pharmacy-based study aimed to investigate headache characteristics and medication use of persons with regular headache presenting for self-medication.

METHODS

Participants (n=1205) completed ii) a questionnaire to assess current headache medication and previous physician diagnosis, (ii) the ID Migraine Screener [ID-M] and (iii) the MIDAS questionnaire.

RESULTS

Forty-four % of the study population (n=528) did not have a physician diagnosis of their headache, and 225 of them (225/528, 42.6%) were found to be ID-M positive. The most commonly used acute headache drugs were paracetamol (used by 62% of the study population), NSAIDs (39%) and combination analgesics (36%). Only 12% of patients physician-diagnosed with migraine used prophylactic migraine medication, and 25% used triptans. About 24% of our sample (n=292) chronically overused acute medication, which was combination analgesic overuse (n=166), simple analgesic overuse (n=130), triptan overuse (n=19), ergot overuse (n=6) and opioid overuse (n=51). Only 14.5% was ever advised to limit intake frequency of acute headache treatments.

CONCLUSIONS

This study identified underdiagnosis of migraine, low use of migraine prophylaxis and triptans, and high prevalence of medication overuse among subjects seeking self-medication for regular headache. Community pharmacists have a strategic position in education and referral of these self-medicating headache patients.

Liposome surface charge influence on skin penetration behaviour

Vesicular systems have shown their ability to increase dermal and transdermal drug delivery. Their mechanism of drug transport into and through the skin has been investigated but remains a much debated question. Several researchers have outlined that drug penetration can be influenced by modifying the surface charge of liposomes. In the present work we study the influence of particle surface charge on skin penetration. The final purpose is the development of a carrier system which is able to enhance the skin delivery of two model drugs, betamethasone and betamethasone dipropionate. Liposomes were characterised by their size, morphology, zeta potential, encapsulation efficiency and stability. Ex vivo diffusion studies using Franz diffusion cells were performed. Confocal microscopy was performed to visualise the penetration of fluorescently labelled liposomes into the skin. This study showed the potential of negatively charged liposomes to enhance the skin penetration of betamethasone and betamethasone dipropionate.

[Role of indoor endotoxins in asthma symptoms]

INTRODUCTION

Endotoxin is a collective term designating a characteristic group of chemical constituents of the outer membrane of Gram negative bacteria, the lipopolysaccharides (LPS).

BACKGROUND

LPS provocation tests in healthy subjects (50 microg) induce asthma-like airflow obstruction with a neutrophilic inflammatory influx, similar to reactions observed in non-atopic asthma. Asthmatic subjects show the same reaction with smaller doses of LPS (20 microg), revealing higher sensitivity to LPS than normal subjects. Low levels (2 microg) of LPS do not induce either airflow obstruction or bronchial hyperreactivity. Among exposed workers, particularly in agriculture, endotoxin is the most significant component of the bioaerosol that is associated with airway disease. In clinical studies, exposure to LPS is associated with severe asthma. Conversely, epidemiological studies, in both urban and rural areas, assessing the relationship between exposure to LPS and asthma and asthma- related symptoms are inconsistent.

PERSPECTIVES

Longitudinal epidemiological studies, especially in farm children, may confirm the putative protective effects of LPS with respect to atopic asthma.

CONCLUSION

Exposure to indoor LPS is frequently associated with asthma and asthma-like symptoms in current studies. Their definitive role needs to be confirmed by birth cohort studies currently under way that should define the controversial protective effect of LPS with respect to atopic asthma in farming populations.

Development of pH-responsive nanocarriers using trimethylchitosans and methacrylic acid copolymer for siRNA delivery

RNA interference-based therapies are dependent on intracellular delivery of siRNA. The release of siRNA from the endosomal compartment may be a rate limiting step in the transfection process. The purpose of this study was to produce pH-responsive nanocarriers made of trimethylchitosan (TMC). To this end, pH-sensitive methacrylic acid (MAA) copolymer was added to TMC-siRNA formulations. Four different TMCs associated or not with MAA were evaluated as siRNA carriers. Nanoparticles were characterized in terms of size, surface charge, morphology and interaction with siRNA. A swelling behaviour due to a decrease in pH was observed and was found to be dependent on MAA content in the complexes. In vitro experiments aimed at evaluating how the capacity of the nanocarriers to transfect siRNA in L929 cells was affected by MAA content. Confocal microscopy experiments showed that fluorescent MAA-containing particles exhibit a different distribution pattern inside the cells comparing to their counterpart without this pH-sensitive polymer. Transfection efficiency was investigated by RhoA mRNA expression inhibition. MAA-TMC-siRNA complexes were able to transfect L929 cells with greater efficiency than corresponding TMC-siRNA complexes. This study gives an insight into the opportunity of pH-sensitive nanocarriers for siRNA delivery. Such formulations may represent an attractive strategy to improve endosomal escape of siRNA.

Development of a new topical system: drug-in-cyclodextrin-in-deformable liposome

A new delivery system for cutaneous administration combining the advantages of cyclodextrin inclusion complexes and those of deformable liposomes was developed, leading to a new concept: drug-in-cyclodextrin-in-deformable liposomes. Deformable liposomes made of soybean phosphatidylcholine (PC) or dimyristoylphosphatidylcholine (DMPC) and sodium deoxycholate as edge activator were compared to classical non-deformable liposomes. Liposomes were prepared by the film evaporation method. Betamethasone, chosen as the model drug, was encapsulated in the aqueous cavity of liposomes by the use of cyclodextrins. Cyclodextrins allow an increase in the aqueous solubility of betamethasone and thus, the encapsulation efficiency in liposome vesicles. Liposome size, deformability and encapsulation efficiency were calculated. The best results were obtained with deformable liposomes made of PC in comparison with DMPC. The stability of PC vesicles was evaluated by measuring the leakage of encapsulated calcein on the one hand and the leakage of encapsulated betamethasone on the other hand. In vitro diffusion studies were carried out on Franz type diffusion cells through polycarbonate membranes. In comparison with non-deformable liposomes, these new vesicles showed improved encapsulation efficiency, good stability and higher in vitro diffusion percentages of encapsulated drug. They are therefore promising for future use in ex vivo and in vivo experiments.

Controlled release of drugs from multi-component biomaterials

In order to control their release, drugs are encapsulated into systems which are expected to provide a certain site with a predetermined amount of drug over a well-defined period of time. Here we report on a multi-component drug delivery biomaterial that consists of a hydrogel matrix in which drug-loaded biodegradable microcarriers are dispersed, and whose potential applications could be found in the design of implantable devices with long-term activity, as required by contraceptive and hormone replacement treatments. The release profile of the drug can actually be tuned by the complex interplay of several release mechanisms, including the permeability and eventually the degradation rate of the microcarriers and the diffusion through the hydrogel. The hydrogel consisted of 2-hydroxyethyl methacrylate cross-linked by ethylene glycol dimethacrylate. The microcarriers were biodegradable poly-epsilon-caprolactone (PCL) microspheres in which active molecules, such as levonorgestrel (LNG), were encapsulated. The hydrogels were characterized by water swelling, thermal properties, LNG diffusion through drug-free and drug-depleted hydrogel membranes and LNG release from devices with drug dispersed in the hydrogel. The PCL microspheres were observed by scanning electron microscopy; their size distribution, LNG loading and release were also investigated. The hydrogel-microsphere assemblies were characterized in terms of the distribution of the microspheres within the hydrogel, water swelling and the release of the encapsulated molecules. The developed device, due to its composite structure, has the ability to combine several release mechanisms, leading to drug release obeying zero-order kinetics for most of the time.

Validation of manufacturing process of Diltiazem HCl tablets by NIR spectrophotometry (NIRS)

The goal of this study was to apply the Process Analytical Technology FDA's initiative in pharmaceutical tablets manufacturing. Near Infrared Spectrophotometry (NIRS) was used as a non-destructive, very fast technique requiring no sample preparation. Direct compression powder blends containing Diltiazem HCl as a model drug were pressed into tablets for the calibration and the validation steps. First, a partial least squares model was built to calibrate the NIR spectrometer. Then, this model was validated and compared with a validated UV spectrophotometry reference method. For this comparison, the Bland and Altman's statistical method was applied. The manufacturing process was validated by producing three batches at three different concentration levels. The NIR analysis of these batches was performed during 3 days. This study shows that NIRS can be used to validate the whole manufacturing process and not only as an analytical method for tablets assay. NIRS is an interesting tool to show possible variations during the manufacturing process which could lead the finished product to fall outside of specifications.

[Crozet protocol: does a lipid-rich meal interfere with cryoglobulinemia assay?]

Cryoglobulins are serum immunoglobulins that precipitate reversibly at low temperature. It is important to determine their presence, because they can be responsible for severe complications. They can also reveal underlying conditions, in particular hepatitis C and haematological diseases. Laboratory investigations of cryoglobulins are problematic and require adherence to strict preanalytical conditions. We decided to determine wether a patient really needs to be in a fasting state when a blood sample is taken. In practice, this requirement is difficult for us to meet, because of our large patient population (consultations in a teaching Hospital). We therefore devised a protocol, called the Crozet protocol based on the assay of cryoglobulinemia in healthy volunteers, before and after a meal rich in lipids. Ten patients were tested. Cryoglobulinemia assays were performed according to the technique of Hartree. Lipid profiles were measured on Modular P (Roche Diagnostics). Cryoglobulinemia assay does not seem to be unduly affected by a meal rich in lipids, in particular in triglycerides. Hence the patient does not necessarily have to be on an empty stomach at blood sampling. This study allowed us to modify our threshold of significance (from 15 to 30 microg/mL), which confirmed our view of the physiological character of a low cryoglobulinemia level. Studies involving a greater number of healthy subjects are needed to accurately establish a new threshold and to confirm our findings.

Study of the relationship between lipid binding properties of cyclodextrins and their effect on the integrity of liposomes

It is well known that cyclodextrins are able to extract lipids constituting membranes, increasing their fluidity and permeability. This behaviour towards biological membranes is directly linked to the toxicological effects of methylated cyclodextrins. However, confusion is currently made in the literature between the different methylated cyclodextrin derivatives. Moreover, a new methylated cyclodextrin derivative recently occurred in the market, the Crysmeb. We wanted to compare and understand the effect of the most currently used cyclodextrins on a model membrane. We studied the influence of natural cyclodextrins (betaCD and gammaCD), methylated derivatives (2,6-dimethyl-betaCD (Dimeb), 2,3,6-trimethyl-betaCD (Trimeb) and randomly methylated-betaCD (Rameb), as well as the new derivative Crysmeb), hydroxypropylated derivatives (HPbetaCD of different substitution degrees and HPgammaCD) and the sulfobutylated derivative (SBEbetaCD) on the release of a fluorescent marker encapsulated in the inner cavity of liposomes. It was shown that the observed effect on calcein release can be directly related to the affinity of cyclodextrins for both lipid components of liposomes, cholesterol and phosphatidylcholine. From this relationship, we were able to determine, for each cyclodextrin, a theoretical concentration giving rise to 50% or 100% calcein release. This theoretical concentration was confirmed experimentally. We have also showed that cyclodextrins which provoke calcein release also induce large structure modifications of liposomes.

[Evaluation of rapid, semi-quantitative assay of C-reactive protein in whole blood, Actim CRP]

We evaluated a rapid and semi-quantitative C-Reactive Protein test on whole blood, the Actim CRP (Fumouze). Based on immuno-chromatography technology, this test ranked the blood sample in four groups: < 10 mg/L, 10-40 mg/L, 40-80 mg/L and > 80 mg/L. This evaluation finds an excellent repeatability, the absence of hook-effect for high levels of CRP and an independence from classical biological interferences: haemolysis, turbidity and bilirubin. The correlation is excellent between the rapid test and classical immuno-turbidimetric plasmatic CRP assay. This test with established analytical properties could be placed as an interesting alternative to replace the classical assays realised on analysers, and more particularly in case of reduced sample volume. The use in "patient care" context had to follow rigorous manufacturer's recommendations to respect analytical specificities identified during our validation process.

Automated method for the determination of a new matrix metalloproteinase inhibitor in ovine plasma and serum by coupling of restricted access material for on-line sample clean-up to liquid chromatography

A fully automated liquid chromatographic method was developed for the determination of Ro 28-2653, a new synthetic inhibitor of matrix metalloproteinases (MMPs), in ovine serum and plasma. The method was based on the coupling of a pre-column packed with restricted access material, namely LiChrospher RP-8 ADS (alkyl diol silica), for sample clean-up to an analytical column containing octyl silica stationary phase. One hundred microl of biological sample, to which 2-propanol was automatically added, were injected onto the ADS pre-column, which was then washed with a washing liquid consisting of a mixture of 25 mM phosphate buffer (pH 7.0) and acetonitrile (90:10; v/v) for 10 min. By rotation of the switching valve, the analyte was then eluted in the back-flush mode with the LC mobile phase composed of a mixture of acetonitrile and 25 mM phosphate buffer (pH 7.0) (57:43; v/v). The UV detection was performed at 395 nm. The main parameters likely to influence the sample preparation technique were investigated. The method was then validated over a concentration range from 17.5 to 1950 ng/ml, the first concentration level corresponding to the lower limit of quantitation. At this concentration level, the mean bias and the R.S.D. value for intermediate precision were -2.4% and 4.2%, respectively.

Cyclodextrins as a potential carrier in drug nebulization

The inhalation route is widely studied for many drug applications focusing on either local or systemic distributions. One matter of concern is the solubilization of hydrophobic drugs. We have studied the feasibility of using different cyclodextrins (CDs) to elaborate pharmaceutical formulations for the inhalation route and tested the short-term toxicity of such formulations administered by inhalation to C57BL/6 mice. We have shown that HP-beta-CD, gamma-CD, as well as RAMEB aqueous solutions can undergo aerosolization and that the resulting droplet-size ranges are compatible with pulmonary deposition. In vivo, we have demonstrated that short-term exposure to inhaled HP-beta-CD, gamma-CD and RAMEB solutions are non-toxic after assessing bronchoalveolar lavage (BAL), lung and kidney histology, bronchial responsiveness to methacholine and blood urea. The only change noted is a slight increase in lymphocyte count in the BAL after HP-beta-CD and gamma-CD inhalation. We conclude that CDs are useful in significantly enhancing the solubility of apolar drugs with a view to inhalation therapy although an increase in lymphocyte counts in the BAL after CDs inhalations needs further investigations.

L’antibiothérapie prophylactique (amoxicilline + acide clavulanique) avant transfert pour fécondation in vitro est inutile

OBJECTIVES

We studied the implantation rate during IVF cycles according to the prescription or not of antibiotics.

MATERIALS AND METHODS

During a 5-month period all the patients aged less than 38 years were randomized into two groups according to an independent personal variable. In group 1 amoxicilline + clavulanic acid 1g/125 mg were administrated from the ovum pick-up day for 6 days. In the group 2 no antibiotic treatment was administered.

RESULTS

The two groups were identical for all the criteria (type of stimulation, IVF/ICSI report, indications, average age). The average number of collected oocytes, obtained embryos and transferred embryos was similar in the two groups. The implantation rate per transfer was similar in the two groups (36.9% versus 36.5%; p>0.95). The pregnancy loss rate (biological pregnancy, early and late miscarriages or extra uterine pregnancy) was increased in a non significant manner (p=0.15) in the group with antibiotic: 33.3% (16/48) versus 20.8% (11/53) in the group without antibiotic.

CONCLUSION

This prospective randomised study leads us not to recommend this antibiotic prescription at the time of the embryo transfer during in vitro fertilisation attempt.