Drug-eluting balloons and drug-eluting stents in the treatment of small vessel coronary artery disease: a systematic review and metanalysis of long-term clinical and angiographic outcomes

Introduction

Coronary artery disease is a leading cause of mortality and morbidity worldwide. For those undergoing PCI, there are 20–30% with disease of the small coronary arteries on presentation [1]. Small coronary artery disease asserts a significant risk factor for adverse events. It is often diffuse and multi-vessel on presentation and confers higher rates of major adverse cardiac events, (MACE) and target lesion failure after intervention [2,3]. Best practice guidelines on the management of SvCAD interventions remain limited.

Drug-eluting balloons are a novel therapy, which has shown promise in treating in-stent restenosis (ISR), however their use in small coronary arteries when compared to drug-eluting stents remains unclear.

Purpose

This systematic review and meta-analysis compare long-term outcomes (>1 year), of drug-eluting balloons (DEB), vs. drug-eluting stents (DES), in the treatment of small coronary artery disease (<3mm).

Methods

A systematic review was completed within PRISMA guidelines. The primary outcome was non-inferiority of DEB Vs. DES in major adverse cardiac events (MACE). Secondary outcomes include all-cause mortality, MI, vessel thrombosis, major bleeding and target vessel revascularization at one, two and three years follow-up. Two independent reviewers extracted data. All outcomes used the Mantel-Haenszel and Random effect model. Odds ratios (OR), were presented with a 95% confidence interval (CI).

Result

Of 4661 articles, four RCTs were included (1414 patients). DEB demonstrated reduced rates of non-fatal MI at one year, OR 0.44 (95% CI 0.2, 0.94) and Basket-2 small reported a significant reduction in two-year bleeding rates OR 0.3 (95% CI 0.1, 0.91). DEBs were non-inferior to DES for all other outcomes.

Conclusion

Long duration follow-up of DEB and DES use in small coronary arteries demonstrates DEB to be non-inferior to DES in all outcomes across all years of follow-up. There was a significant reduction in rates of non-fatal MI at one year in the DEB arm and a reduction in major bleeding episodes at two years in the Basket Small 2 trial. These data highlight the potential utility and long-term safety of novel DEBs in small coronary artery disease revascularization.

Funding Acknowledgement

Type of funding sources: None.

The role of ILR monitoring in patients with a family history of SADS, a view from real clinical practice

Background/Introduction

Implantable Loop Recorder (ILR) device monitoring is an established method for long term heart rhythm monitoring in patients with inherited cardiac conditions. Many present with a family history of Sudden Arrhythmic Death Syndrome (SADS). The value of ILR findings in the investigation of SADS relatives has not been well documented.

Purpose

We aimed to evaluate the impact of ILR monitoring on the management plans of patients with a family history of SADS.

Methods

We performed a retrospective analysis of the ILR reports and electronic patient records of all patients at the inherited cardiac disease clinic with a family history of SADS and an ILR implanted. Patient demographics, ILR implant indication and specific changes to management plans were recorded and analysed using descriptive statistics.

Results

All 135 patients with ILR monitoring at the inherited cardiac disease clinic were screened and 87 patients (57.6% female, 41.7±14.0 years) with SADS relatives were included in the study. The mean follow up period was 657.9±392.3 days from ILR implant. Indications for ILR implantation included syncope (n=31, 15.7%), presyncope (45, 22.7%), palpitations (44, 22.2%), chest pain (9, 4.5%), short term heart rhythm monitor findings (6, 3.0%), ECG findings (6, 3.0%), asymptomatic indications (10, (5.1%) including patients with more than one relative with SADS, a family history of conduction disease or family history of long QT syndrome), and atypical symptoms (2 (1%) including seizures and sleep paralysis). Some patients had more than one indication for ILR at the time of implant. As a direct result of ILR monitoring, 43 (49.4%) patients had a change to their management plan. 6 specific definitions for management changes were used: Permanent pacemaker implantation (2, 2.3%), subsequent electrophysiology study (3, 3.5%), medication change (7, 8.1%), arrhythmia excluded as a cause for patient symptoms (26, 29.9%), prompted ILR implant in first degree relative (11, 12.6%) and ILR re-implant for further monitoring for premature conduction disease (1, 1.2%). Patients whose indication for ILR implant was palpitations had the highest likelihood for change of management with 27 changes associated with this indication, of which exclusion of arrhythmia as a cause for symptoms (15) was the most frequent outcome. The indications, syncope and presyncope both yield 21 management changes each.

Conclusion

The use of ILR devices in family relatives of patients with SADS provides information that may directly impact on patient management, with syncope providing the highest yield and reassurance the most common outcome in our cohort. ILR monitoring helped guide a wide range of other management strategies which included changes to medications and the need for further cardiac procedures. This data represented clinical practice in a niche patient cohort who are at risk for inherited cardiac conditions and associated arrhythmias.

Funding Acknowledgement

Type of funding sources: None. Indication for ILR vs management changeIndications for ILR implant

The utility of the implantable loop recorder in patients with a diagnosis or family history of long QT syndrome

Background

There is limited published data on the use of implantable loop recorders (ILRs) in patients with long QT syndrome (LQTS).

Purpose

We sought to evaluate the utility of the ILR in patients who had a diagnosis of LQTS or who had a family history of LQTS.

Methods

We carried out a retrospective analysis of patients attending an Inherited Cardiac Conditions Clinic who had an active ILR and who had a diagnosis or family history of LQTS. Patient demographics, indications for ILR implantation and clinical outcomes were compiled.

Results

Nine patients with a diagnosis of LQTS and an active ILR were identified with an average age of 37 years. Genetic results were available for seven patients. Four patients had a confirmed pathogenic mutation (one KCNQ1 and three KCNH2), one patient had a variant of uncertain significance in SCN5A and two patients had negative genetic testing. Indications for implantation were syncope (n=4), recurrent altered consciousness episodes (n=1), assessment of occult arrhythmia or beta blocker complications (n=2), palpitations and dizziness (n=1) and nocturnal dyspnoea and palpitations (n=1). Mean follow-up was 706 days and average age at ILR implant was 35 years. The ILR for three patients was a second device, implanted after end of battery life of the initial ILR. ILR recordings led to a change in management in three patients: finding of paroxysmal atrial fibrillation (n=1), finding of nocturnal QTc of 511ms with a change in medications (n=1) and a pause leading to cessation of beta blocker (n=1).

Eleven patients with a family history of LQTS and active ILR were identified. Nine patients were female, and the average age was 44.4 years. Genetic test results were available for five patients. Three patients had a pathogenic mutation in SCN5A, and two patients had negative genetic testing for common LQTS genes. Indications for implantation included syncope (n=5), lightheaded episodes (n=3) and risk assessment in gene carriers (n=3). The mean duration of ILR follow-up was 680 days and average age at ILR implant was 42.5 years. Five patients had no arrhythmia detected during ILR recording, two patients had supraventricular tachycardia identified, in two patients ILR data outruled a sinister cause for a symptomatic episode, one patient had documentation of SVT and brief NSVT which led to referral for electrophysiology study and one patient had no recurrence of symptoms and a second ILR was implanted.

Conclusion

ILRs were inserted in selected patients with a diagnosis of LQTS or in patients with a family history of LQTS or who were gene carriers. Rationale for ILR implantation included risk stratification, monitoring for occult arrhythmia and rhythm-symptom correlation in symptomatic patients. The ILR impacted management in almost 50% of patients and is considered an important tool in selected patients attending Inherited Cardiac Condition Clinics.

Funding Acknowledgement

Type of funding sources: None. Table 1

Sarcoptes scabiei mites in humans are distributed into three genetically distinct clades

Scabies is an ectoparasitic infestation caused by the mite Sarcoptes scabiei. Currently, S. scabiei is taxonomically divided into different varieties on the basis of host origin. Genetics-based research on scabies has been conducted, but the data on genetic diversity of populations of this mite in humans in Europe are lacking. We evaluated the genetic diversity of populations of S. scabiei. A large series of mites obtained from humans in France and the data of mites from various hosts and geographical areas retrieved from GenBank were included to investigate whether mites are divided into distinct populations. The study of cytochrome c oxidase subunit 1 gene polymorphisms were found to be best suited for phylogenetic analysis. S. scabiei mites were distributed into three genetically distinct clades, with most mites clustering in clades B and C. The Fst value and the Nm value calculated for mites included in clades B and C indicated a strong population structure and a very low gene flow between mites of those clades. The results of the present study not only support the rejection of the hypothesis of panmixia for S. scabiei in humans but also suggest that mites belonging to different clades are genetically isolated. Moreover, the results suggest that the subdivision of S. scabies in varieties according to animal or human hosts is not warranted. In conclusion, S. scabiei mites in humans do not constitute a homogeneous population. Further investigations are now required to assess whether different clinical forms of scabies are associated with particular haplotypes or clades.

Infestation by pyrethroids resistant bed bugs in the suburb of Paris, France

Bed bugs are hematophagous insects responsible for a re-emerging and challenging indoor pest in many countries. Bed bugs infestations may have health consequences including nuisance biting, cutaneous and systemic reactions. This resurgence can probably be attributed to factors such as increased international travel and development of resistance against insecticides. Resistance against pyrethroids has been reported several times from the USA and rarely in Europe. In France, very few data on bed bugs are available. The present study aimed to assess the infestation by bed bugs of a complex of two high-rise apartment buildings in the suburb of Paris and to evaluate their susceptibility to pyrethroid insecticides. We inspected for bed bugs 192 out of 198 apartments units (97%) and interviewed their residents. 76 (39.6%) apartments were infested. Among the 97 residents living in infested apartments, 53 (54.6%) reported bed bug bites. A total of 564 bed bugs were collected in the infested units. Bioassays showed that 54 out of 143 bed bugs were resistant to pyrethroids (37.8%; 95% confidence interval: 29.9-45.7%). DNA sequencing showed that all bed bugs tested (n = 124) had homozygous L925I kdr-like gene mutation. The level of pyrethroid resistance found indicates that this phenomenon was already established in the site and prompts the need to reevaluate the wide use of pyrethroids to control bed bugs.

Molecular survey of knockdown resistance to pyrethroids in human scabies mites

There are growing concerns about the emergence of resistance of Sarcoptes scabiei to permethrin and other pyrethroid derivatives. Sarcoptes scabiei mites collected from 40 patients visiting two hospitals near Paris, France, were genotypically characterized considering two parts of their voltage-sensitive sodium channel gene. No nucleotide polymorphism resulting in a codon change at codon 733 or other positions associated with knockdown resistance in other arthropods has been identified. These data may establish a reference line for future surveys of the susceptibility of S. scabiei in the area.

Insecticide resistance in head lice: clinical, parasitological and genetic aspects

Insecticide treatment resistance is considered to be a major factor in the increasing number of infestations by head lice. The large insecticide selection pressure induced by conventional topical pediculicides has led to the emergence and spread of resistance in many parts of the world. Possible mechanisms of resistance include accelerated detoxification of insecticides by enzyme-mediated reduction, esterification, oxidation that may be overcome by synergistic agents such as piperonyl butoxide, alteration of the binding site, e.g. altered acetylcholinesterase or altered nerve voltage-gated sodium channel, and knockdown resistance (kdr). Clinical, parasitological and molecular data on resistance to conventional topical pediculicides show that treatments with neurotoxic insecticides have suffered considerable loss of activity worldwide. In particular, resistance to synthetic pyrethroids has become prominent, probably because of their extensive use. As other treatment options, including non-insecticidal pediculicides such as dimeticone, are now available, the use of older insecticides, such as lindane and carbaryl, should be minimized, owing to their loss of efficacy and safety concerns. The organophosphorus insecticide malathion remains effective, except in the UK, mostly in formulations that include terpineol.

Correlation of cytological and biochemical parameters with resistance and tolerance to Mycosphaerella graminicola in wheat

This study investigated the infection process of Mycosphaerella graminicola and enzyme activities related to reactive oxygen species (ROS) or oxylipin biosynthesis in four French wheat cultivars with variable resistance to M. graminicola infection. At field level, cultivars Caphorn, Maxyl and Gen11 were susceptible, whereas Capnor showed high levels of quantitative resistance. Moreover, Capnor and Gen11 were tolerant, i.e., their yield was less affected by infection compared to non-tolerant Maxyl and Caphorn. These four cultivars were inoculated under laboratory conditions with the M. graminicola IPO323 reference strain. Cytological and biochemical responses were studied on collected first plantlet leaves and several features discriminated between cultivars. However, resistance and tolerance had no impact on the fungal infection process. Levels of lipoxygenase (LOX), peroxidase (PO) and glutathione-S-transferase (GST) activities were also compared with regard to cultivar resistance or tolerance to M. graminicola. LOX, PO and GST activities did not discriminate resistance and tolerance profiles, although a low level of PO in inoculated and non-inoculated plants could be associated with tolerance. In addition, cell necrosis correlated positively with LOX in non-tolerant cultivars, while mycelia surrounding stomata were positively correlated with PO in the resistant cultivar. GST activity presented correlations between cytological and biochemical parameters only for susceptible cultivars. Stomatal and direct penetration were positively correlated with GST activity in the susceptible non-tolerant cultivars, while these correlations were negative in the tolerant cultivar. When combining cytological and biochemical observations with resistance and tolerance profiles, for each cultivar and at each time point, cultivars could be classified in tight accordance with their previous field characterisation. Moreover, tolerance allowed us to distinguish susceptible cultivars when both biochemical and cytological parameters were considered together.

[Resistance of Plasmodium falciparum to antimalarial drugs: impact on malaria pre-elimination in Madagascar]

The purpose of this review was to provide up-to-date information on the resistance of Plasmodium falciparum to the main antimalarials used in Madagascar and to assist implementation of the malaria control and elimination program. In 2006, the failure rate for chloroquine treatment was 44% (n = 300) and was comparable to the rate observed in continental Africa. Most treatment failures occurred after the first week of follow-up. P. falciparum resistance to chloroquine appeared to be special in Madagascar with only 3.2% of isolates showing in vitro resistance (n = 372, 7 sentinel sites) and less than 1% harbouring mutant parasites within the Pfcrt gene. Conversely, the Pfmdr1 N86Y point mutation was found in 64.3% (n = 174) of isolates in 2006 and in 51.7% (n = 343) in 2007. Failure of combined sulfadoxine-pyrimethamine therapy, i.e., the recommended intermittent preventive treatment for malaria during pregnancy, and in vitro resistance to pyrimethamine were rare. However, the Pfdhfr 51I/59R/108N allele showed consistently high prevalence levels reaching 33.3% in 2008. Moreover, the single Pfdhfr 164L mutant allele, a haplotype unique to Madagascar, was discovered in 2006 and showed prevalence rates up to 30% in some locations (southeast) in 2008. Up to now, the quadruple mutant allele Pfdhfr 51I/59R/108N/164L has not been observed. Susceptibility to the other antimalarials tested appeared excellent but the number of isolates showing in vitro susceptibility to artemisinin derivatives has been fallen in recent years and this decline may herald a decrease in the efficacy of these drugs.

Evolution of Mycosphaerella graminicola at the wheat leaf level and at the field level

Evolution of M. graminicola wheat field populations from a given French county (Morbihan, 56) between years 2005 and 2006 was investigated for thirty seven strains using molecular fingerprinting by microsatellite markers (ST1A4, ST1E3, ST1E7, and ST1D7), and SSCP analysis study of partial actin and beta-tubulin encoding sequences. In addition, twenty nine strains collected from 3 distinct lesions on a same wheat leaf in 2006 in another French county (Nord, 59) were also investigated for genetic diversity. At the field level, we observed similar gene diversity in the 2005 and in the 2006 populations, with no common clones between the two years. This indicates frequent sexual recombination undergone by the fungus. When considering each marker independently and comparing genetic variability of the two populations, we noticed a decrease in genetic variability of the 2006 strains for three of them (ST1A4, ST1D7 and the partial sequence of actin) and an increase for ST1E3, ST1E7 and the partial sequence of beta-tubulin, revealing the importance of the chosen markers. At the lesion level, 69% of the studied strains were haplotypes with 31% of the clonal population found in 2 lesions out of 3. This suggests that at least parts of the lesions were formed after asexual reproduction and dissemination of pycnidiospores by splashing. We also confirmed the exploitative competition that exists between the strains at the lesion level.

Single strand conformation polymorphism is a sensitive method for screening nucleotide variations in Mycosphaerella graminicola

Single Strand Conformation Polymorphism (SSCP) and sequencing were performed in order to assess molecular polymorphism of mating type sequences in the heterothallic ascomycete Mycosphaerella graminicola, the causal agent of Septoria tritici blotch of wheat. The screening was undertaken on mat1-1 and mat1-2 partial sequences of 341 and 657 bp, respectively, amplified with multiplex PCR from 510 French single-conidial strains plus the two reference isolates IPO323 and IPO94269 from The Netherlands. After restriction with Taq1 in order to reduce the fragment sizes, all digested amplicons were subjected to SSCP. Sequencing was then performed when a SSCP pattern deviates from the most frequently occurring profile. Among the assessed strains, 228 ones plus IPO323 were MAT1-1 and 282 ones plus IPO94269 were MAT1-2. Among the MAT1-1 strains, only a single one exhibited a SSCP profile distinct to the other MAT1-1 strains, whereas 10 MAT1-2 strains (among which 2 and 4 with same profiles, respectively) showed a SSCP profile differing to the other MAT1-2 strains. Sequencing revealed that all polymorphisms observed on SSCP gels were single nucleotide variations and all strains displaying the same SSCP profiles showed identical nucleotide sequences. Among the seven disclosed nucleotide variations, only two were non-synonymous and both were non-conservative. This study reports a high sensitivity of SSCP allowing detection of single point mutations in M. graminicola, shows a conservation of mating type idiomorphs in the fungus at both sequence and population scales, but also suggests a difference in polymorphism level between the two mating type sequences.

Fenpropimorph slows down the sterol pathway and the development of the arbuscular mycorrhizal fungus Glomus intraradices

The direct impact of fenpropimorph on the sterol biosynthesis pathway of Glomus intraradices when extraradical mycelia alone are in contact with the fungicide was investigated using monoxenic cultures. Bi-compartmental Petri plates allowed culture of mycorrhizal chicory roots in a compartment without fenpropimorph and exposure of extraradical hyphae to the presence of increasing concentrations of fenpropimorph (0, 0.02, 0.2, 2, 20 mg l(-1)). In the fungal compartment, sporulation, hyphal growth, and fungal biomass were already reduced at the lowest fungicide concentration. A decrease in total sterols, in addition to an increase in the amount of squalene and no accumulation of abnormal sterols, suggests that the sterol pathway is severely slowed down or that squalene epoxidase was inhibited by fenpropimorph in G. intraradices. In the root compartment, neither extraradical and intraradical development of the arbuscular mycorrhizal (AM) fungus nor root growth was affected when they were not in direct contact with the fungicide; only hyphal length was significantly affected at 2 mg l(-1) of fenpropimorph. Our results clearly demonstrate a direct impact of fenpropimorph on the AM fungus by a perturbation of its sterol metabolism.

In planta xylanase activity and pathogenicity on wheat-Mycosphaerella graminicola pathosystem

A total of twenty four French strains and two reference strains IPO323 and IPO94269 of the hemibiotrophic fungus Mycosphoerella graminicola were investigated in planta to examine the association of the cell-wall degrading enzyme endo-beta-1,4-xylanase (EC 3.2.1.8) with pathogenicity. The French strains were selected from a collection of 363 strains previously genotyped using microsatellites, actine and beta-tubutine markers. Disease level assessments as well as enzyme quantifications were carried out at 20 days post inoculation from the third leaves of inoculated whole plants of the susceptible wheat cv. Scorpion. Great variability of both pathogenicity levels and endo-beta-1,4-xylanase activity patterns was obtained among strains. Only 15 out of the 26 assessed strains including the reference strain IPO323 were able to induce lesions bearing pycnidia. The percentages of diseased leaf areas bearing pycnidia ranged from 6.2% to 77%, while amounts of endo-beta-1,4-xylanase activity ranged from 0 to 399.15 mU/microg of total proteins. A Pearson correlation test revealed very high linkage between endo-beta-1,4-xylanase activity level and lesions bearing pycnidia production within strains (r = 0.94). Additional cytological and enzymatic investigations on two strains exhibiting different pathogenicity levels highlighted that successful disease induction by M. graminicola is not explained by either spore germination or direct and stomatal penetration rates of the host, but by the ability of the fungus to colonize the mesophyll and to secrete the endo-beta-1,4-xylanase activity during necrotrophic phase. This study strongly suggests the importance of both mesophyll colonisation and endo-beta-1,4-xylanase activity during the infection process of M. graminicola.

Changes in C12:0, C18:1, C18:2 and C20:2 fatty acid content in wheat treated with resistance inducers and infected by powdery mildew

This work presents a global investigation of total fatty acid (FA) content in wheat in relation to treatment with four inducers of resistance and to powdery mildew infection. Linolenic acid (C18:3), linoleic acid (C18:2) and palmitic acid (16:0) were the most abundant FAs in wheat leaves. We investigated the effect of the following inducers of resistance: Iodus40, heptanoyl salicylic acid (HSA), Milsana and trehalose on FA accumulation. Previous studies established that lipid metabolism is altered by these compounds, and we therefore aimed to characterise their impact at the FA level. During a time course experiment, content (quantitative analysis) and percentage (qualitative analysis) of FAs were compared in treated plants and in controls, as well as in plants inoculated with Blumeria graminis f. sp. tritici (i) and non-inoculated (ni) plants. No change in C18:3 content was observed. C18:1 in Iodus 40-treated (ni) plants showed a quantitative 1.2-fold increase. Lauric acid (C12:0) content quantitatively increased after Iodus 40 (2.8-fold), Milsana (4.8-fold) and trehalose (4.0-fold) treatment in (i) plants. However, eicosadienoic acid (C20:2) quantitatively decreased in (ni) plants after Iodus 40 (1.5-fold) and Milsana (2.3-fold) treatment. The amount of C18:2 increased (1.6-fold) after HSA treatment in (i) plants. All these variations in FA content were correlated with variations in the corresponding relative percentages. Our work provides the first evidence for alterations in C12:0, C18:1, C18:2 and C20:2 FA content caused by four resistance inducers. We also compared the amount and percentage of each FA in untreated (i) and (ni) plants. In (i) plants, eicosadienoic acid (C20:2) increased and C18:2 decreased slightly. The potential involvement of these FAs during induced resistance and infection is discussed.

Oligogalacturonides induce resistance in wheat against powdery mildew

Biological activities, priming and protective effects of two oligogalacturonides fractions (OGAs) were assayed during a compatible wheat/Blumeria graminis f. sp. tritici interaction. These fractions were obtained from commercial polygalacturonic acid. They both consisted of oligogalacturonides with polymerisation degrees (DP) ranging from 2 to 25, and one of them was a 30% chemically acetylated fraction. A 5 g x L(-1) solution of each fraction was infiltrated in the first leave of ten-days-old plantlets, and activities of defence-related enzymes were measured 48H post-treatment. Among them, oxalate oxidase and peroxidase activities increased, suggesting an elicitation due to both fractions of oligogalacturonides. Some of the pre-treated plantlets were subsequently submitted to powdery mildew infection. As revealed by 3,3'-diaminobenzidine (DAB) staining, the accumulation of hydrogen peroxide (H2O2) at the penetration site of the fungus increased 21H after inoculation to the same extent in areas of plantlets infiltrated by both fractions. On the other hand, the intensity of fluorescence associated with papillae was higher when plantlets were pre-infiltrated with the acetylated fraction, whereas no difference was observed between control plantlets and those treated with the non-acetylated fraction. Moreover, microscopic assessment of the number of haustoria occurring 40H post-inoculation showed it was only reduced when acetylated fraction was used. Despite different modes of action of these molecules, a similar 45% protective effect occurred in both cases when the oligogalacturonides fractions were sprayed on ten-days-old plantlets.

Mechanisms of resistance and tolerance to Mycosphaerella graminicola in wheat

The aim of this study was to investigate the infection process of M. graminicola and the defence mechanisms related to active oxygen species (AOS) in five French wheat cultivars. These cultivars exhibited various resistant levels to M. graminicola infection: Maxyl, Caphorn and Gen11 are susceptible cultivars, whereas Capnor and Gen23 show high levels of quantitative resistances. In addition, Capnor, Gen23 and Gen11 are tolerant cultivars, i.e., their yield performance was less affected by infection compared to non-tolerant cultivars. Cultivars were inoculated with the IPO323 reference M. graminicola strain. First wheat leaves were collected 3, 5, 7, 9, 11, 13, 15, 17, 19, and 21 days after inoculation. The cytological and antioxidant response of the cultivars were both studied over the whole time course. Although infection occurred mainly through stomata, direct penetration attempts were also scored. Moreover, papilla formation turned out to be very rare. Assays for changes in peroxydase (PO), glutathione-S-transferase (GST) and lipoxygenase (LOX) activities allowed us to compare their levels in the five French wheat cultivars regarding to their resistance and/or tolerance towards M. graminicola infection. PO and GST were correlated to necrosis probably as a consequence of detoxification and LOX was related to some of the germination process steps. We also showed that significant differences for several biochemical parameters exist between the studied cultivars in non inoculated conditions but these differences were less important in the presence of the fungus.

Effects of anthracene on development of an arbuscular mycorrhizal fungus and contribution of the symbiotic association to pollutant dissipation

The influence of anthracene, a low molecular weight polycyclic aromatic hydrocarbon (PAH), on chicory root colonization by Glomus intraradices and the effect of the root colonization on PAH degradation were investigated in vitro. The fungus presented a reduced development of extraradical mycelium and a decrease in sporulation, root colonization, and spore germination when exposed to anthracene. Mycorrhization improved the growth of the roots in the medium supplemented containing 140 mg l(-1) anthracene, suggesting a positive contribution of G. intraradices to the PAH tolerance of roots. Anthracene disappearance from the culture medium was quantified; results suggested that nonmycorrhizal chicory roots growing in vitro were able to contribute to anthracene dissipation, and in addition, that mycorrhization significantly enhanced anthracene dissipation. These monoxenic experiments demonstrated a positive contribution of the symbiotic association to anthracene dissipation in the absence of other microorganisms. In addition to anthracene dissipation, intracellular accumulation of anthracene was detected in lipid bodies of plant cells and fungal hyphae, indicating intracellular storage capacity of the pollutant by the roots and the mycorrhizal fungus.

24-Methyl/methylene sterols increase in monoxenic roots after colonization by arbuscular mycorrhizal fungi

•  Characteristic sterols of transformed carrot (Daucus carota) and chicory (Cichorium intybus) roots colonized by different strains of arbuscular mycorrhizal (AM) fungi were identified. •  Sterols were extracted, analysed and identified by gas chromatography/mass spectrometry (GC-MS) from monoxenic cultures of mycorrhizal and nonmycorrhizal roots. After colonization by Glomus intraradices, Glomus proliferum and Glomus sp., carrot and chicory roots exhibited a significantly higher 24-methyl/methylene sterol content. A correlation was established between the content of the sum of 24-methyl cholesterol, 24-methylene cholesterol and 24-methyl desmosterol. •  This study clearly established that the increment of these characteristic sterols is an appropriate indicator of colonization by AM fungi of transformed roots. •  Metabolic origin and specificity of these sterols in mycorrhizal roots was researched. The 24-methyl/methylene sterol increase was observed only when the interaction between fungus and plant was completely established and the fungus was present inside the roots.

[Imported malaria in 2000 in 2 northern Paris hospitals]

The number of travellers in malaria striken areas increases each year (2). The risk of infection is high in Sub-Saharan Africa, but appropriate chemoprophylaxis can reduce the morbidity and mortality rate of malaria. Half of the samples of malaria cases received by the National reference centre of malaria chemosensibility (CNRCP) for chemosensibility analysis came from two hospitals in the north of Paris: Bichat Claude Bernard in Paris and Delafontaine in Saint-Denis. In 2000, quite all the malaria cases (n = 387) observed at the Bichat and Delafontaine Hospitals came from Africa (99%). Plasmodium falciparum remains the most represented (87.6%) species, with an average parasitic density of 0.3%. Patients with P falciparum came for medical advice on the tenth day after return (median, extremes 0-174 days). More than half of the patients (58%) did not take any medication for chemoprophylaxis and even if they took some, it was irregular or inappropriate. The most used drug chemoprophylaxis is the association of chloroquine and proguanil or Savarine. In 15% of the cases, the travellers took chloroquine as a prophylaxis and 4% other medicine not recommended by the French authorities. An average of 43.7% of these travellers took inappropriate chemoprophylaxis. In total, 27 chemoprophylaxis failures are reported. Some patients (22%) have already taken self treatment which was readjusted during admission at hospital. The first treatment of malaria in 2000 was monotherapy with quinine (P. falciparum) and chloroquine (P. ovale, malariae, vivax). The treatment associations in case of suspicious resistance were quinine + doxycycline and atovaquone + proguanil. Treatment failure was infrequent and resulted above all from a bad observance. More information should be given to travellers as well as doctors about recommendations and treatments.

Preparation and characterization of siliceous material using liposomes as template

Material synthesis using unilamellar liposomes with a high sol-gel temperature transition phase as a template leads to a new silica material.

Molecular survey of Plasmodium falciparum resistance in south-eastern Iran

In south-eastern Iran, the sulfadoxine-pyrimethamine (SP) combination has been used to treat malaria caused by chloroquine-resistant Plasmodium falciparum. To explore the molecular basis of antimalarial resistance in this region, the dhfr, dhps and pfcrt genes of 50 clinical isolates of P. falciparum, collected from cases of uncomplicated malaria in 2000-2001, were checked for the point mutations that appear associated with SP or chloroquine (CQ) resistance. The results of the study, which was based on a PCR followed by DNA sequencing, indicated that all 50 isolates presented the DHFR S108N mutation associated with pyrimethamine resistance. Seven isolates (14%) had a triple DHFR mutation (S108N, N51I, C59R) and 32 (64%) had a double mutation in this domain. Thirty-nine isolates (78%) had the wild-type DHFR 51 codon but only 15 (30%) had the wild-type DHFR 59 codon. Eleven isolates (22%) only had the DHFR S108N mutation. All isolates had the wild-type DHPS 436 and 540 codons and all but two of the isolates had the wild-type DHPS 437 codon. All isolates but one had the PFCRT K76T mutation associated with CQ treatment failure. The results of this preliminary investigation indicate that SP may remain the treatment of choice for cases of uncomplicated malaria in south-eastern Iran.

High Plasmodium falciparum resistance to chloroquine and sulfadoxine-pyrimethamine in Harper, Liberia: results in vivo and analysis of point mutations

In Liberia, little information is available on the efficacy of antimalarials against Plasmodium falciparum malaria. We measured parasitological resistance to chloroquine and sulfadoxine-pyrimethamine (SP) in Harper, south-west Liberia in a 28-d study in vivo. A total of 50 patients completed follow-up in the chloroquine group, and 66 in the SP group. The chloroquine failure rate was 74.0% (95% confidence interval [95% CI] 59.7-85.4%) after 14 d of follow-up and 84.0% (95% CI 70.9-92.8%) after 28 d (no polymerase chain reaction [PCR] analysis was performed to detect reinfections in this group). In the SP group, the failure rate was 48.5% (95% CI 36.2-61.0%) after 14 d and 69.7% (95% CI 57.1-80.4%) after 28 d, readjusted to 51.5% (95% CI 38.9-64.0%) after taking into account reinfections detected by PCR. Genomic analysis of parasite isolates was also performed to look for point mutations associated with resistance. Genotyping of parasite isolates revealed that all carried chloroquine-resistant K-76T mutations at gene pfcrt, whereas the triple mutation (S108N, N511, C59R) at dhfr and the A437G mutation at dhps, both associated with resistance to SP, were present in 84% and 79% of pretreatment isolates respectively. These results seriously question the continued use of chloroquine and SP in Harper and highlight the urgency of making alternative antimalarial therapies available. Our study confirms that resistance to chloroquine may be high in Liberia and yields hitherto missing information on SP.

Removal of trivalent chromium from tannery waste waters using bone charcoal

The ability of bone charcoal to remove Cr(III) from aqueous solutions by adsorption has been investigated. The adsorbent used was first characterised and then the adsorption was studied as a function of time and amount of charcoal. Tests were carried out with synthetic solutions whose Cr concentrations (500 mg L(-1)) were similar to those found in some effluents of Moroccan tannery industries. Cr removal efficiencies higher than 90% were obtained at pH 3.5 using 3 g of bone charcoal and a stirring time of about 30 min. Results of Cr removal by all sieved fractions of bone charcoal had shown the same interesting capabilities for Cr(III) retention. The cross interference with other elements was also investigated. Pre-treatment of bone charcoal by nitric acid led to an increase in its specific surface area but induced a drastic reduction in its Cr elimination abilities. Adsorption tests were also carried out using calcinated bone charcoal. The results obtained showed a similar percentage of Cr retention to those found with untreated bone charcoal. On the other hand, a double treatment of bone charcoal with HCl and NaOH provided an enhancement of Cr(III) retention. The role played by the mineral fraction of the solid phase of bone was thus evidenced.

Profile and evolution of the chemosusceptibility of falciparum malaria imported into France in 2000

In 2000, the chemosusceptibility of imported malaria was stable in France. All countries of infection considered, the bi-resistance to chloroquine and cycloguanil has not changed from 1996 to 2000. The monotherapy using quinine or mefloquine remains the first-line treatment to falciparum malaria. Resistance to these two antimalarials is rare in Africa and has not evolved over the past 15 years.

Molecular characterisation of airport malaria: four cases in France during summer 1999

Four airport malaria cases have been observed in the vicinity of the Roissy-Charles-de-Gaulle International Airport, Paris, France. These cases were geographically very close to each other and clustered in a short period of time during the summer of 1999. The phenotype and genotype of the Plasmodium falciparum isolates obtained from these patients were determined in order to know whether a single mosquito could have infected more than one subject. The genomic characterisation of isolates was performed using the polymorphic markers merozoite surface protein 1 (Msp 1) and merozoite surface protein 2 (Msp 2) genes, the kappa and omega repeats domains of cg2 and the dihydrofolate reductase (DHFR) genotypes. Results showed identical genotypes for isolates 1, 2 and 4 whereas the genotype of isolate 3 differed at one locus. The molecular analysis was consistent with the hypothesis that all patients could have been bitten by the same mosquito and that patient 3, may have received a different clone and an additional species. In vitro susceptibility data did not confirm or rule out this hypothesis because isolates had the same profile of susceptibility to the tested drugs.

Analysis of pfcrt point mutations and chloroquine susceptibility in isolates of Plasmodium falciparum

Recent transfection based studies demonstrated that cg2, a candidate gene for chloroquine resistance in Plasmodium falciparum, was not the resistance determinant. A further analysis of the initial 36 kb locus comprising the cg2 gene led to the discovery of another gene, pfcrt, which was absolutely associated with chloroquine resistance in forty parasite lines [Fidock DA, Nomura T, Talley AT, Su XZ, Cooper R, Dzekunov SM, Ferdig MT, Ursos LMB, Sidhu ABS, Naudé B, Deitsch KW, Su XZ, Wootton JC, Roepe PD, Wellems TE. Mutations in the P. falciparum digestive vacuole transmembrane protein PfCRT and evidence for their role in chloroquine resistance. Mol Cell 2000;6:861-71]. The aim of this study was to evaluate, in 146 unselected clinical isolates obtained mostly from non-immune travellers returning from various endemic countries to France in years 1995-1999, the association between in vitro chloroquine resistance and the sequence of a part of the pfcrt gene. For comparison, the determination of the cg2 kappa and the pfmdr1 codon 86 genotypes were also performed on the same isolates. As determined by an isotopic semi-microtest, 70 isolates were susceptible to chloroquine (50% inhibitory concentration<80 nM) and 76 were resistant. The amplification of a portion of the pfcrt gene spanning codons 72-76, followed by sequencing showed three distinct genotypes: one type associated with susceptible isolates, one type associated mostly with resistant isolates and one type found in a resistant isolate originating from South America. Three different zones could be defined according to the status of codon 76. For 50% inhibitory concentration values< or =40 nM (n=47), all isolates but one had K76 (wild type). For 50% inhibitory concentration values located between 40 and 60 nM, isolates had either K76 (n=5) or K76T (mutant type) (n=6). For 50% inhibitory concentration values>60 nM (n=88), all isolates had K76T. A lack of a strong association between the pfmdr1 N86Y mutation and in vitro chloroquine resistance was observed. Cg2 genotypes were less strongly linked than pfcrt genotypes with in vitro chloroquine susceptibility in isolates located below 40 and above 60 nM. Further studies are needed to determine the reliability of the pfcrt gene as a genetic marker for chloroquine resistance.

[Plasmodium falciparum: point mutations of pcfrt and chloroquine susceptibility]

Recent transfection based studies demonstrated that cg2, a candidate gene for chloroquine resistance in Plasmodium faiciparum, was not the resistance determinant. A further analysis of the initial 36 kb locus comprising the cg2 gene led to the discovery of another gene, pfcrt, which was absolutely associated with chloroquine resistance in forty parasite lines. The aim of this study was to evaluate, in 146 unselected clinical isolates obtained mostly from non-immune travellers returning from various endemic countries to France in years 1995-1999, the association between in vitro chloroquine resistance and the sequence of a part of the pfcrt gene. For comparison, the determination of the cg2 kappa and the pfmdr1 codon 86 genotypes were also performed on the same isolates. As determined by an isotopic semi-microtest, 70 isolates were susceptible to chloroquine (50% inhibitory concentration < 80 nM) and 76 were resistant. The amplification of a portion of the pfcrt gene spanning codons 72 to 76, followed by sequencing showed three distinct genotypes: one type associated with susceptible isolates, one type associated mostly with resistant isolates and one type found in a resistant isolate originating from South America. Three different zones could be defined according to the status of codon 76. For 50% inhibitory concentration values < or = 40 nM (n = 47), all isolates but one had K76 (wild type). For 50% inhibitory concentration values located between 40 and 60 nM, isolates had either K76 (n = 5) or K76T (mutant type) (n = 6). For 50% inhibitory concentration values > 60 nM (n = 88), all isolates had K76T. A lack of a strong association between the pfmdr1 N86Y mutation and in vitro chloroquine resistance was observed. Cg2 genotypes were less strongly linked than pfcrt genotypes with in vitro chloroquine susceptibility in isolates located below 40 nM and above 60 nM. Further studies are needed to determine the reliability of the pfcrt gene as a genetic marker for chloroquine resistance.