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Bruniaux J, Allard-Vannier E, Aubrey N, Lakhrif Z, Ben Djemaa S, Eljack S, Marchais H, Hervé-Aubert K, Chourpa I, David S. Magnetic nanocarriers for the specific delivery of siRNA: Contribution of breast cancer cells active targeting for down-regulation efficiency. Int J Pharm 2019; 569:118572. [DOI: 10.1016/j.ijpharm.2019.118572] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 07/17/2019] [Accepted: 07/25/2019] [Indexed: 12/17/2022]
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Marchais H, Rebika S, Bonnin N, Kémény JL, Paulon C, Chiambaretta F. [Intracardiac tumor causing recurrent central retinal artery occlusions]. J Fr Ophtalmol 2017; 40:e353-e355. [PMID: 29037521 DOI: 10.1016/j.jfo.2016.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 09/26/2016] [Accepted: 10/10/2016] [Indexed: 11/28/2022]
Affiliation(s)
- H Marchais
- Service d'ophtalmologie, CHU de Clermont-Ferrand, 58, rue de Montalembert, 63000 Clermont-Ferrand, France.
| | - S Rebika
- Service d'ophtalmologie, CHU de Clermont-Ferrand, 58, rue de Montalembert, 63000 Clermont-Ferrand, France
| | - N Bonnin
- Service d'ophtalmologie, CHU de Clermont-Ferrand, 58, rue de Montalembert, 63000 Clermont-Ferrand, France
| | - J L Kémény
- Service d'anatomopathologie, CHU de Clermont-Ferrand, 58, rue de Montalembert, 63000 Clermont-Ferrand, France
| | - C Paulon
- Service d'ophtalmologie, CHU de Clermont-Ferrand, 58, rue de Montalembert, 63000 Clermont-Ferrand, France
| | - F Chiambaretta
- Service d'ophtalmologie, CHU de Clermont-Ferrand, 58, rue de Montalembert, 63000 Clermont-Ferrand, France
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Duclairoir C, Nakache E, Marchais H, Orecchioni AM. Formation of gliadin nanoparticles: Influence of the solubility parameter of the protein solvent. Colloid Polym Sci 2014. [DOI: 10.1007/s003960050246] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hervé K, Douziech-Eyrolles L, Munnier E, Cohen-Jonathan S, Soucé M, Marchais H, Limelette P, Warmont F, Saboungi ML, Dubois P, Chourpa I. The development of stable aqueous suspensions of PEGylated SPIONs for biomedical applications. Nanotechnology 2008; 19:465608. [PMID: 21836255 DOI: 10.1088/0957-4484/19/46/465608] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We report here the development of stable aqueous suspensions of biocompatible superparamagnetic iron oxide nanoparticles (SPIONs). These so-called ferrofluids are useful in a large spectrum of modern biomedical applications, including novel diagnostic tools and targeted therapeutics. In order to provide prolonged circulation times for the nanoparticles in vivo, the initial iron oxide nanoparticles were coated with a biocompatible polymer poly(ethylene glycol) (PEG). To permit covalent bonding of PEG to the SPION surface, the latter was functionalized with a coupling agent, 3-aminopropyltrimethoxysilane (APS). This novel method of SPION PEGylation has been reproduced in numerous independent preparations. At each preparation step, particular attention was paid to determine the physico-chemical characteristics of the samples using a number of analytical techniques such as atomic absorption, Fourier transform infrared (FT-IR) spectroscopy and Raman spectroscopy, transmission electron microscopy (TEM), photon correlation spectroscopy (PCS, used for hydrodynamic diameter and zeta potential measurements) and magnetization measurements. The results confirm that aqueous suspensions of PEGylated SPIONs are stabilized by steric hindrance over a wide pH range between pH 4 and 10. Furthermore, the fact that the nanoparticle surface is nearly neutral is in agreement with immunological stealthiness expected for the future biomedical applications in vivo.
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Affiliation(s)
- K Hervé
- 'Nanovecteurs Magnétiques pour la Chimiothérapie', EA 4244 'Physicochimie des Matériaux et des Biomolécules', Université F. Rabelais, Faculté de Pharmacie, 37200 Tours, France
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Munnier E, Cohen-Jonathan S, Linassier C, Douziech-Eyrolles L, Marchais H, Soucé M, Hervé K, Dubois P, Chourpa I. Novel method of doxorubicin-SPION reversible association for magnetic drug targeting. Int J Pharm 2008; 363:170-6. [PMID: 18687392 DOI: 10.1016/j.ijpharm.2008.07.006] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Revised: 07/07/2008] [Accepted: 07/08/2008] [Indexed: 11/28/2022]
Abstract
A new method of reversible association of doxorubicin (DOX) to superparamagnetic iron oxide nanoparticles (SPION) is developed for magnetically targeted chemotherapy. The efficacy of this approach is evaluated in terms of drug loading, delivery kinetics and cytotoxicity in vitro. Aqueous suspensions of SPION (ferrofluids) were prepared by coprecipitation of ferric and ferrous chlorides in alkaline medium followed by surface oxidation by ferric nitrate and surface treatment with citrate ions. The ferrofluids were loaded with DOX using a pre-formed DOX-Fe(2+) complex. The resulting drug loading was as high as 14% (w/w). This value exceeds the maximal loading known from literature up today. The release of DOX from the nanoparticles is strongly pH-dependent: at pH 7.4 the amount of drug released attains a plateau of approximately 85% after 1h, whereas at pH 4.0 the release is almost immediate. At both pH, the released drug is iron-free. The in vitro cytotoxicity of the DOX-loaded SPION on the MCF-7 breast cancer cell line is similar to that of DOX in solution or even higher, at low-drug concentrations. The present study demonstrates the potential of the novel method of pH-sensitive DOX-SPION association to design novel magnetic nanovectors for chemotherapy.
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Affiliation(s)
- E Munnier
- Université François-Rabelais, Faculté de Pharmacie, Focalisation magnétique d'agents anticancéreux, Tours, France
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Tewes F, Munnier E, Antoon B, Ngaboni Okassa L, Cohen-Jonathan S, Marchais H, Douziech-Eyrolles L, Soucé M, Dubois P, Chourpa I. Comparative study of doxorubicin-loaded poly(lactide-co-glycolide) nanoparticles prepared by single and double emulsion methods. Eur J Pharm Biopharm 2007; 66:488-92. [PMID: 17433641 DOI: 10.1016/j.ejpb.2007.02.016] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Revised: 02/13/2007] [Accepted: 02/21/2007] [Indexed: 10/23/2022]
Abstract
This study describes how the control of doxorubicin (DOX) polarity allows to encapsulate it inside poly(lactide-co-glycolide) (PLGA) nanoparticles formulated either by a single oil-in-water (O/W) or a double water-in-oil-in-water (W/O/W) emulsification method (SE and DE, respectively). DOX is commercially available as a water soluble hydrochloride salt, which is useful for DE. The main difficulty related to DE approach is that the low affinity of hydrophilic drugs to the polymer limits entrapment efficiency. Compared to DE method, SE protocol is easier and should provide an additional gain in entrapment efficiency. To be encapsulated by SE technique, DOX should be used in a more lipophilic molecular form. We evaluated the lipophilicity of DOX in terms of apparent partition coefficient (P) and modulated it by adjusting the pH of the aqueous phase. The highest P values were obtained at pH ranging from 8.6 to 9, i. e. between two DOX pK(a) values (8.2 and 9.6). The conditions favorable for the drug lipophilicity were then used to formulate DOX-loaded PLGA nanoparticles by SE method. DOX encapsulation efficiency as well as release profiles were evaluated for these nanoparticles and compared to those with nanoparticles formulated by DE. Our results indicate that the encapsulation of DOX in nanoparticles formulated by SE provides an increased drug entrapment efficiency and decreases the burst effect.
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Affiliation(s)
- F Tewes
- Université François-Rabelais, Faculté de Pharmacie Focalisation magnétique d'agents anticancéreux, IFR 135, Imagerie Fonctionnelle, Tours, France.
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Ngaboni Okassa L, Marchais H, Douziech-Eyrolles L, Cohen-Jonathan S, Soucé M, Dubois P, Chourpa I. Development and characterization of sub-micron poly(D,L-lactide-co-glycolide) particles loaded with magnetite/maghemite nanoparticles. Int J Pharm 2006; 302:187-96. [PMID: 16099119 DOI: 10.1016/j.ijpharm.2005.06.024] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2005] [Revised: 06/02/2005] [Accepted: 06/14/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE The objective of this study is to develop biodegradable sub-micron poly(lactide-co-glycolide) particles loaded with magnetite/maghemite nanoparticles for intravenous drug targeting. METHOD Sub-micron magnetite/PLGA particles (also called composite nanoparticles) were prepared by a modified double emulsion method (w/o/w) or by an emulsion-evaporation process (o/w). To optimize the composite nanoparticles formulation, the influence of some experimental parameters, such as types of magnetite/maghemite nanoparticles, volume of magnetite suspension and amount of polymer were investigated. The morphology, size and zeta potential of the magnetite/PLGA nanoparticles were determined. The magnetite entrapment efficiency and magnetite content were assessed by dosing iron in the composite nanoparticles. RESULTS TEM photomicrographs showed that the composite nanoparticles were almost spherical in shape with a rather monomodal distribution in size. All composite nanoparticle formulations were found to have the mean diameter within the range of 268-327 nm with polydispersity index within the range of 0.02-0.15. Magnetite nanoparticles coated with oleic acid showed more efficient entrapment (60%) as compared to uncoated magnetite nanoparticles (48%). In both cases, when the volume of magnetite suspension increased, the magnetite entrapment efficiency decreased but the magnetite content increased. In addition, the two-fold rise in the amount of polymer did not significantly affect the composite nanoparticle characteristics except the magnetite content. Finally, none modification of the mean diameter of the composite nanoparticles was observed after storage for 3 months at 4 degrees C. CONCLUSIONS Magnetite/PLGA nanoparticles were prepared and the influence of some process parameters have been assessed. Improvement of the magnetite entrapment efficiency are in progress and the magnetization properties of the composite nanoparticles will subsequently be tested.
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Affiliation(s)
- L Ngaboni Okassa
- Laboratoire de Pharmacie Galenique, U.F.R. des Sciences Pharmaceutiques, Université François Rabelais de Tours, 31 Avenue Monge, 37200 Tours, France
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Ferranti V, Chabenat C, Marchais H, Ménager S, Hue H, Orecchioni AM, Lafont O. Effects of encapsulation of primidone on its oxidative metabolism in rats. Drug Metabol Drug Interact 2002; 18:191-208. [PMID: 11791884 DOI: 10.1515/dmdi.2001.18.3-4.191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to evaluate the influence of primidone (PRM) nanoencapsulation on its metabolism. Suspensions of PRM powder and PRM-loaded poly-epsilon-caprolactone nanocapsules were administered orally in the same way to rats. Primidone-loaded poly-epsilon-caprolactone nanocapsules were prepared according to the interfacial deposition technique. Free PRM suspensions were obtained by addition of PRM powder to a suspension of 0.212% carboxymethylcellulose CMC 12H in water. The dose was 20 mg/kg, n = 6, for each experiment. Urinary and faecal levels of PRM and of its three major metabolites, phenylethylmalonamide (PEMA), phenobarbital (PB), and p-hydroxyphenobarbital (p-HO-PB), were determined. Concentrations were evaluated by high-performance liquid chromatography (HPLC) according to a validated analytical method. After PRM nanocapsule administration, non-metabolised PRM urinary levels were increased compared to those observed after administration of a suspension of primidone powder (43.7+/-8.8% after PRM-loaded nanocapsule and 37.7+/-8.1% after free PRM administration). For phenylethylmalonamide, no difference was observed in urinary excretion in the two cases. For two of the oxidised metabolites, PB and p-HO-PB, excretion was delayed and shortened. The amount of these oxidised metabolites was lowered from 0.95% after free PRM administration to 0.25% after PRM-loaded nanocapsule administration. No difference was noted in non-metabolised primidone excretion in faeces. These results suggest that primidone-loaded nanocapsules could be used as a vehicle for oral primidone administration in order to minimise the phenobarbital metabolic pathway.
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Affiliation(s)
- V Ferranti
- Laboratoire de Pharmacochimie, Faculté de Médecine et de Pharmacie de Rouen, France
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Abstract
Ketoconazole is an imidazole antifungal agent. It has a wide antifungal spectrum and possesses some antibacterial activity. In inappropriate formulations, especially in aqueous media, ketoconazole molecules may be unsteady. The stability of ketoconazole in aqueous media was assessed as a function of pH, antioxidant and ketoconazole concentrations. It was found that ketoconazole was least stable at pH 1 among the pH values studied (pH 1-9). Since the major degradation pathway was specific acid catalysis, based upon the transition-state theory, the entropy (DeltaS) of the activation was calculated and found to be negative indicating that the activated complex was more constrained than the individual species. The free energy of activation (DeltaG) was estimated to be 30 kcal mol(-1). The viscosity of the formulation was found to be more stable at high pH because carbopol is stable at basic pH and protected ketoconazole. It appears that the amount of ketoconazole in the formulation has a low influence on the degradation mechanisms. The increase of the butylated hydroxytoluene antioxidant levels from 0.05 to 0.4%, adversely affected the stability of ketoconazole. In conclusion, the expected shelf life of the final ketoconazole formulation (pH 7, 0.1% butylated hydroxytoluene) was 15 months.
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Affiliation(s)
- M Skiba
- Laboratoire de Pharmacotechnie et Biopharmacie, Faculté de Médecine et de Pharmacie, Université de Rouen, 22 boulevard Gambetta, 76183, Rouen, France.
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Ferranti V, Marchais H, Chabenat C, Orecchioni AM, Lafont O. Primidone-loaded poly-epsilon-caprolactone nanocapsules: incorporation efficiency and in vitro release profiles. Int J Pharm 1999; 193:107-11. [PMID: 10581427 DOI: 10.1016/s0378-5173(99)00325-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This paper describes the preparation of primidone-loaded poly-epsilon-caprolactone nanocapsules according to the interfacial deposition technique. The colloidal suspension obtained showed a monomodal size distribution with a mean diameter ranging from 308 to 352 nm. By adjusting the process parameters, the encapsulation efficiency was about 74% with good reproducibility. Primidone release from the nanocapsules was found to be slower as compared to the oily control solution despite an important burst-effect. The release profile was not influenced by the pH of the release medium.
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Affiliation(s)
- V Ferranti
- Laboratoire de Pharmacochimie, U.F.R de Médecine-Pharmacie, 22 Boulevard Gambetta, 76183, Rouen Cedex, France
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Marchais H, Benali S, Irache JM, Tharasse-Bloch C, Lafont O, Orecchioni AM. Entrapment efficiency and initial release of phenylbutazone from nanocapsules prepared from different polyesters. Drug Dev Ind Pharm 1998; 24:883-8. [PMID: 9876542 DOI: 10.3109/03639049809088536] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Several formulations of poly(epsilon-caprolactone) (PCL), poly(lactic acid) (PLA), and poly(lactic-co-glycolic acid) (PLGA) nanocapsules containing phenylbutazone were prepared according to the interfacial deposition technique. These formulations differed in the type of polymer used to form the shell of the nanocapsules. Analysis of particle size distribution and encapsulation efficiency of the nanocapsules revealed that the type and molecular weight of polyester used were the main factors influencing these properties. PLA had the highest encapsulation efficiency with the best reproducibility. From in vitro release studies, a small amount of drug release was observed at pH 7.4. However, in the gastric medium, an important burst effect occurred and was highest with the PLGAs and lowest with PCL, suggesting that drug release from these systems is affected by the type of polymer and the environmental conditions. The two formulations of phenylbutazone-loaded nanocapsules should be evaluated based on PCL and PLA in vivo in order to determine to what extent they are able to reduce the local side effects of this drug.
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Affiliation(s)
- H Marchais
- Laboratoire de Pharmacochimie et Biopharmacie (EA DRED 1295), Université de Rouen, Saint Etienne du Rouvray, France.
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Boury F, Marchais H, Proust J, Benoit J. Bovine serum albumin release from poly(α-hydroxy acid) microspheres: effects of polymer molecular weight and surface properties. J Control Release 1997. [DOI: 10.1016/s0168-3659(96)01547-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Boury F, Marchais H, Benoit JP, Proust JE. Surface characterization of poly(alpha-hydroxy acid) microspheres prepared by a solvent evaporation/extraction process. Biomaterials 1997; 18:125-36. [PMID: 9022959 DOI: 10.1016/s0142-9612(96)00102-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This work constitutes the first attempt to characterize the wettability of poly(alpha-hydroxy acid) (PAHA) microspheres in situ, prepared according to a complex process involving emulsification, solvent evaporation, washing and freeze-drying. The analysis of the flotation profile of the microspheres has allowed us to determine both advancing and receding contact angles at the microsphere/air/water interface and furnished information on the organization of poly(vinyl alcohol) (PVA) and bovine serum albumin (BSA) at the surface of the PAHA coating. By the comparison of contact angles measured from model surfaces obtained by sampling pure PAHA, PVA, BSA and mixed PVA/PAHA monolayers on glass and poly(methyl methacrylate) (PMMA) substrates, it was concluded that the emulsifier (PVA or BSA) was strongly anchored to the surfaces of the microspheres. The use of BSA to formulate the microspheres from a single oil-in-water emulsion led to dry particles having a hydrophobic surface. The unfolding of the hydrophilic segments of the BSA embedded at the surface of the microspheres, following immersion in water, increased the wettability of the microspheres by water. The same qualitative results were obtained when PVA was used to stabilize single emulsions. On the other hand, microspheres formulated from a double water-in-oil-in-water emulsion displayed no modifications of their wettability when immersed in water. This can be explained by the absence of mobility of the hydrophilic segments of the emulsifier which are blocked in the surface or at the subsurface of the polymer matrix.
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Affiliation(s)
- F Boury
- Laboratoire de Pharmacie Galénique et Biophysique Pharmaceutique, Faculté de Pharmacie, Angers, France
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Damgé C, Aprahamian M, Marchais H, Benoit JP, Pinget M. Intestinal absorption of PLAGA microspheres in the rat. J Anat 1996; 189 ( Pt 3):491-501. [PMID: 8982822 PMCID: PMC1167689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Rhodamine B-labelled poly (DL-lactide-co-glycolide) (PLAGA) microspheres of 2 different sizes, 1-5 microns and 5-10 microns, were administered as a single dose (1.44 x 10(9) and 1.83 x 10(8) particles, respectively) into the ileal lumen of adult rats. The content of rhodamine in the mesenteric vein and ileal lumen was analysed periodically from 10 min to 48 h as well as the distribution of microspheres in the intestinal mucosa and various other tissues. The concentration of rhodamine decreased progressively in the intestinal lumen and was negligible after 24 h. The number of microspheres in the mesenteric vein increased rapidly and reached a maximum after 4 h whatever the size of the particles. It then decreased progressively, but more rapidly with microspheres > 5 microns than with microspheres < 5 microns. The absorption efficiency was low for the former batch (about 0.11% of the administered dose) and higher for the latter (about 12.7%). The intraileal administration of free rhodamine B was followed by intense labelling of the epithelial cells and basement membranes in mesenteric lymph nodes, spleen, kidney and liver. PLAGA microspheres mainly crossed the intestinal mucosa at the site of Peyer's patches where microspheres of < 5 microns appeared after 3 h. Microspheres > 5 microns were retained in the ileal lumen. A few small microspheres were occasionally observed in the epithelial cells. Only the smallest particles were recovered in the liver, lymph nodes and spleen while basement membranes were always labelled. It is concluded that PLAGA microspheres could be useful for the oral delivery of antigens if their size is between 1 and 5 microns.
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Affiliation(s)
- C Damgé
- CEED Hôpitaux Universitaires, Strasbourg, France
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Vincent-Ballereau F, Lafleuriel MT, Marchais H, Claudel-Daniel V. [Natural immunity to Haemophilus influenzae type b. ELISA study of the distribution of IgG, IgG1 and IgG2 in France and Africa]. Pathol Biol (Paris) 1991; 39:38-41. [PMID: 2011408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A Haemophilus influenzae type b capsular polysaccharide-tetanus toxoid conjugate vaccine will be released for use in infants in developing and industrialized countries in the near future. This prompted a comparative study of the natural immunity of mothers and passive immunity of their newborns in France and Africa. An ELISA method capable of discriminating immunoglobulin classes and subclasses was used. Monoclonal antibodies were used to determine titers of IgG1 and IgG2 antibodies. Because capsular polyribose ribitol phosphate does not bind readily to polystyrene, the plate was coated with streptavidine which bound to biotin linked to the antigen. Antibody titers were found to be identical in French and African study groups. Both IgG1 and IgG2 antibodies were found, often with higher titers for the latter. Both subclasses were found in cord blood of French and African children.
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Affiliation(s)
- F Vincent-Ballereau
- Groupe d'Etudes Epidémiologiques et Prophylactiques (GEEP), Hôtel-Dieu, CHRU, Nantes, France
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