[After the COVID crisis, what solutions for the future nursing home?] / Rapport 22-02. Après la crise COVID, quelles solutions pour l'EHPAD de demain ?

The ageing of the population induces situations of large vulnerability and dependence. Home care usually remains the best response to comply with the person's wish, the family's desire, and the civil society's interest. However, there are circumstances where patient management in a nursing home (EHPAD) is the only solution. The present pandemic of coronavirus COVID-19 has highlighted the issue of EHPAD and their limitations to provide high quality care. To analyze the current position of EHPAD into the care chain and to understand difficulties to their functioning, it seems essential to seek out accelerated changes in the EHPAD since their establishment in 1999 and then in the light of the current crisis, propose possible solutions with a positive view of the role which each EHPAD will have to ensure for future.

[Pharmacology, an innovative factor in therapeutic research]. / La pharmacologie, facteur d'innovation en recherche thérapeutique.

As members of the pharmacology training group set up by the committee of pharmacological science of the French Academy of Pharmacy, we examine the situation of pharmacology in drug discovery. Today, it is obvious that by integrating genome sequencing, cellular and molecular biology, and bioinformatics, pharmacology has become a cross-disciplinary science. Pharmacologists must become knowledgeable in a wide range of domains, using the major points in each to direct them towards the discovery and development of new therapeutic agents. It is also clear that pharmacology remains a major factor in the different steps of drug discovery, from the molecular and cellular stages, to clinical and pharmaceutical developments.

[Versatility of differentiated functions of cultured joint chondrocytes. Eventual usefulness in treatment]. / La versatilité des fonctions différenciées du chondrocyte articulaire en culture. Intérêt éventuel en thérapeutique.

The chondrocyte is the unique cell type in articular cartilage. It is responsible for the extracellular matrix production which permits the cartilaginous tissue to compensate the skeletal pressures during movements. The regulation of the different extracellular matrix components (type II collagen and aggrecan) depends on the differentiated state of the chondrocyte. However, in vivo, such as during aging and osteoarthritis, as well as in vitro, in monolayer culture, chondrocytes lose their morphological and biochemical characteristics. This phenomenon has been particularly studied in culture. As soon as at passage 1, there is a gradual shift from the synthesis of type II collagen to type I and III collagens and from the synthesis of large aggregating proteoglycans (aggrecan) to low molecular weight proteoglycans. However, it has been shown that dedifferentiated chondrocytes can reexpress phenotypic markers of the articular chondrocyte. These conditions include tridimensional culture in gels of agarose, collagen and alginate. This can be also obtained after treatment of chondrocytes in monolayer by dihydrocytochalasin B or staurosporine. Although the mechanisms involved in restoration of the differentiated phenotype have not been elucidated yet, it has been shown that the synthesis of specific proteoglycans and type II collagen can be related to a modification of actin architecture. The restoration of the differentiated functions using tridimensional culture of chondrocytes has been used to perform autologous chondrocyte implantation in chondral defects. In the future, the grafts could be improved using chondrocytes treated with stimulating growth factors and synthetically derived matrices.

SV40 large T antigen expression driven by col2a1 regulatory sequences immortalizes articular chondrocytes but does not allow stabilization of type II collagen expression.

Immortalization of chondrocytes by SV40 T Ag has often been reported to trigger the loss of expression of type II collagen, one of the main differentiation markers, although some immortalized chondrocyte lines maintaining a differentiated phenotype have also been described. Here, we show using transient cotransfections in differentiated chondrocytes that, in contrast to c-src, neither SV40 T Ag, nor c-myc, decreases col2a1 transcriptional activity. Then, we report the possibility of immortalizing rabbit articular chondrocytes by expression of SV40 T Ag controlled by the col2a1 promoter and enhancer (pCol2SV). This strategy allows one to select within a population of differentiated chondrocytes those which are able to maintain functional regulation of the col2a1 gene through long-term culture. In precrisis pCol2SV-transfected chondrocytes, all-trans-retinoic acid, a down-regulator of col2a1 expression, induced apoptosis, strongly suggesting the strict control of T Ag expression by col2a1 regulatory sequences. Some pCol2SV-transfected chondrocytes were definitively immortalized, after a short crisis period. However, type II collagen synthesis was restricted to a small proportion of cells, which went on to decrease with subculture, while the proportion of cells expressing T Ag was not affected. In these postcrisis cells, T Ag remained at least partially under the control of functional col2a1 regulatory elements as assessed by all-trans-retinoic acid down-regulation.

In vitro study of cytotoxicity of quinolones on rabbit tenocytes.

Tendinitis and tendon rupture complicating fluoroquinolone therapy have been reported recently, especially affecting men over 60 years. These new quinolones are more potent antimicrobial agents than older nonfluorinated compounds like nalidixic acid. We compared the effects of one quinolone (nalidixic acid) and two fluoroquinolones (norfloxacin and pefloxacin) on cultured rabbit Achilles tendon cells. First, we examined their effects on cell viability, mitochondrial succinate dehydrogenase and global activity, mitochondrial activity using microtitration methods. Pefloxacin and norfloxacin were more cytotoxic than nalidixic acid according to IC50 values. These results confirm that mitochondria represent a biological target of fluoroquinolones. Moreover, the extracellular matrix was studied by molecular hybridization. After a 72 h treatment, the level of type I collagen transcripts was not modified with any of the three antimicrobial agents, whereas mRNA encoding decorin was decreased with 10(-4) mol/L pefloxacin only. The decrease of transcripts encoding decorin suggests that this matrix component is another target of pefloxacin and modification of decorin seems to be an early event (before mitochondrion alteration) which may contribute to the explanation of tendon rupture.

Dedifferentiated chondrocytes cultured in alginate beads: restoration of the differentiated phenotype and of the metabolic responses to interleukin-1beta.

Chondrocytes cultivated in monolayer rapidly divide and lose their morphological and biochemical characteristics, whereas they maintain their phenotype for long periods of time when they are cultivated in alginate beads. Because cartilage has a low cellularity and is difficult to obtain in large quantities, the number of available cells often becomes a limiting factor in studies of chondrocyte biology. Therefore, we explored the possibility of restoring the differentiated properties of chondrocytes by cultivating them in alginate beads after two multiplication passages in monolayer. This resulted in the reexpression of the two main markers of differentiated chondrocytes: Aggrecan and type II collagen gene expression was strongly reinduced from day 4 after alginate inclusion and paralleled protein expression. However, 2 weeks were necessary for total suppression of type I and III collagen synthesis, indicators of a modulated phenotype. Interleukin-1beta, a cytokine that is present in the synovial fluid of rheumatoid arthritis patients, induces many metabolic changes on the chondrocyte biology. Compared with cells in primary culture, the production of nitric oxide and 92-kDa gelatinase in response to interleukin-1beta was impaired in cells at passage 2 in monolayer but was fully recovered after their culture in alginate beads for 2 weeks. This suggests that the effects of interleukin-1beta on cartilage depend on the differentiation state of chondrocytes. This makes the culture in alginate beads a relevant model for the study of chondrocyte biology in the presence of interleukin-1beta and other mediators of cartilage destruction in rheumatoid arthritis and osteoarthrosis.

Effects of simulated solar radiation on type I and type III collagens, collagenase (MMP-1) and stromelysin (MMP-3) gene expression in human dermal fibroblasts cultured in collagen gels.

Understanding the mechanisms responsible for photodamage to the skin is most important for dermatology. 3-D cultures have been used as tools to mimic the in vivo situation for several years. We irradiated such a system containing human dermal fibroblasts cultured in collagen gels, a well-known model considered to be a dermal equivalent, which reproduces the interaction between cells and the surrounding extracellular matrix. The effects of solar irradiation (315-800 nm) on the steady-state levels of the mRNAs of extracellular matrix components (type I and III collagens) and their degrading enzymes (interstitial collagenase, MMP-1 and stromelysin 1, MMP-3) were measured. Exposure to low levels of solar radiation (0-10 J cm-2 in the UVA, i.e. suberythemal UVA doses) caused a transient decrease in type I procollagen mRNA, an increase in MMP-mRNA, and no change in type III procollagen mRNA steady-state levels. These results describe the early changes in the connective tissue of the skin following exposure to low-level solar stimulation, and may help explain the long-term changes in photodamaged skin.

Detection and characterization, using fluoresceincadaverine, of amine acceptor protein substrates accessible to active transglutaminase expressed by rabbit articular chondrocytes.

The purpose of this study was to investigate the implication of transglutaminases in the biology of articular chondrocytes. Transglutaminase activity measurements performed on cell lysates showed that a transglutaminase was present in chondrocytes in primary culture and that it was strongly activated by limited proteolysis. In chondrocytes dedifferentiated by subculture or retinoic acid treatment, this transglutaminase appeared to be downregulated, while type II transglutaminase expression was induced. However, protein levels, mRNA steady-state levels or transglutaminase activity in whole-cell lysates do not necessarily reflect the activity present in living cells, as it is strongly regulated. Therefore, Fluoresceincadaverine, a fluorescent polyamine, was used for detecting amine acceptor protein substrates accessible to active transglutaminase in living cells. After incubation of chondrocytes with Fluoresceincadaverine, dedifferentiated cells exhibited an extracellular labelling, while chondrocytes in primary culture did not, unless thrombin was added to the culture medium. In contrast, Fluoresceincadaverine labelling was not detected in the cytosol, although the transglutaminases were also partly cytosolic. By confocal microscopy and Western blot analysis of labelled cells in culture, fibronectin was shown to be the main substrate for both transglutaminases. The transglutaminases present in articular chondrocytes may, therefore, contribute to the organization and the stabilization of their extracellular matrix.

Restoration of the differentiated functions of serially passaged chondrocytes using staurosporine.

Among the various directions explored in order to have a large number of differentiated articular chondrocytes easily available, the restoration of the differentiated properties after cell multiplication in monolayer has been proposed. It has been clearly shown that the synthesis of cartilage proteoglycans and type II collagen synthesis is coincident with the presence of a faint microfibrillar architecture but is absent in chondrocytes showing well-defined actin cables. Staurosporin, mainly described as a protein kinase C inhibitor, has also been shown to rapidly induce the disruption of the actin microfilaments. The purpose of this paper was to investigate whether properties of differentiated chondrocytes were reinitiated upon staurosporin treatment of serially passaged chondrocytes. Results showed, after staurosporine treatment of cells at Passage two for 5 d, complete suppression of type I and type III collagen synthesis and induction of type II collagen synthesis and of Alcian blue stainable matrix. Additionally, we showed that staurosporin restored metabolic responses that chondrocytes in primary culture exhibit upon interleukin-1 beta treatment (decrease of Alcian blue- positive cells, induction of expression of the 92 kDa gelatinase, nitric oxide production). We conclude that staurosporin is a potent redifferentiating agent of articular chondrocytes that have been subcultured up to Passage two for multiplication. Taking into account that the cellularity of cartilage is very low, staurosporine-treated chondrocytes could be useful as an alternative cellular model to evaluate pharmacotoxicological effects of drugs.

The use of Fluoresceincadaverine for detecting amine acceptor protein substrates accessible to active transglutaminase in living cells.

The use of Fluoresceincadaverine as a primary amine donor for detecting the endogenous substrates for active transglutaminase in living cells was studied. Fluoresceincadaverine was found to be suitable for labelling cells in culture as it did not induce cytotoxicity when used at 0.5 mM in culture media and diffused throughout the cell. After appropriate fixation using methanol, Fluoresceincadaverine-labelled cells were observed by direct fluorescence microscopy, allowing visualization of the substrates for active transglutaminase. Simultaneous detection of transglutaminase and of Fluoresceincadaverine incorporated into proteins strongly suggested that cytosolic transglutaminase was inactive in these living cells. However, transglutaminase co-distributed with Fluoresceincadaverine-labelled structures, which resembled a lattice. Fluoresceincadaverine-labelled proteins detected by Western blotting using an anti-Fluorescein antibody showed that, in living cells, the major transglutaminase substrate migrated at an apparent molecular weight of 220 kDa, as does fibronectin. Fibronectin was found to co-distribute with Fluoresceincadaverine-labelled lattice. This confirmed that these lattice structures were extracellular and, therefore, that transglutaminase is in an active form in this compartment. This opportunity to perform morphological and biochemical analyses in the search for transglutaminase substrates in living cells should help in determining the specific function of transglutaminases in a particular cell type as well as in universal cellular events, such as apoptosis or cell growth.

Limitations of alginate gels as a culture model for the study of the effects of UVA radiation on human dermal fibroblasts.

Several studies were undertaken to develop three-dimensional (3-D) cell culture models that allow conditions closer to the in vivo situation. To this end, alginate gels were tested as a 3-D cell culture model that might be useful in the study of the effects of UVA on human dermal fibroblasts. Cell culture in alginate gels and the irradiation conditions were optimized. Results showed that optimized cultures in alginate gels experienced considerable cell death on UVA irradiation compared to the classical monolayer cell culture. Viability tests (cell counting and neutral red assay) were performed to show that only UVA-irradiated alginate gels were responsible for this cytotoxicity. The implication of oxygen species in the phototoxicity induced by ultraviolet light has already been described; for this reason we investigated whether oxygen species were involved in the cytotoxicity induced by alginate upon UVA irradiation. It appeared that superoxide anion is not implicated.

Culture and characterization of juvenile rabbit tenocytes.

The culture of rabbit tenocytes could be a useful model in the study of the physiopathology and pharmacotoxicology of tendons. This work was undertaken to examine the in vitro behavior of tenocytes form juvenile rabbit Achilles tendons. We report observations of the morphological and biological characteristics of primary culture and subsequent passages of rabbit tendon cells cultured in monolayer. Data obtained by electron microscopy and growth curves were complementary. After 36 passages, the generation time of tenocytes did not change and no sign of senescence could be seen. Primary culture and the first passages retained the expression of tenocyte differentiated functions, synthesis of type I collagen and decorin. Cell growth behavior was not modified upon passaging. However, when subcultured, tenocytes displayed a modulated phenotype.

New orientations of in vitro models: why? How?

From the beginning of cell cultures, the aim of all researchers has been to perform culture of a pure population of a particular cell type. However, the monolayer culture (of one type of cell) rapidly showed its limits concerning growth capacity and especially maintenance of the differentiated functions. These findings led to the design of increasingly complex in vitro models. Among them we can distinguish culture onto cellular matrices and into cellular matrices, or tridimensional cell culture. Cocultures in two-compartment dishes or one-compartment dishes, heteroculture, and tissue slices in vitro are other approaches deserving mention. Several examples were reported. Finally, immortalized and transfected cell lines exhibit a different state of complexity.

Type II transglutaminase expression in rabbit articular chondrocytes in culture: relation with cell differentiation, cell growth, cell adhesion and cell apoptosis.

Depending on the cell type studied, the involvement of type II transglutaminase (TGase) has been proposed in almost any event of the cell life such as differentiation, apoptosis, growth, aging, cell morphology and adhesion, metastatic capacity or extracellular matrix stabilization. In order to define the field(s) where this enzyme may be implicated in chondrocytes, type II TGase expression was studied in chondrocytes at different passages which differentiated state was modulated by retinoic acid, dihydrocytochalasin B or staurosporin. Results showed that (i) type II TGase expression is not incompatible with type II collagen expression, a main marker of chondrocyte differentiation (ii) type II TGase expression is higher when cells are in the exponential phase of growth than when growth arrested (iii) a high type II TGase expression does not imply that cells are apoptotic although cell apoptosis correlates with increased type II TGase expression (iv) non-adherent cells do not express type II TGase whereas adherent cells do whatever their differentiation state as assessed by type II collagen synthesis. These results suggest that, in articular chondrocytes, type II TGase is specifically implicated in the cell adhesion capacity.

A new apparatus for studying the effect of hydrostatic pressure on cells in culture : application to osteoblastic cells ROS 17/2.8.

Although mechanical stresses have long been recognized as an important factor in the regulation of bone remodeling, the mechanism underlying this effect has remained obscure. A number of methods have been devised to apply forces to bone tissues and bone-derived cells in order to investigate the biochemical results of mechanical stimuli. In this paper we report a method for applying a well controlled cyclic hydrostatic pressure on cultured ROS 17/2.8 osteoblastic lineage cells. This technique allows the investigation of the true frequency response of cells. Hydrostatic pressure with a 1 Hz frequency decreases alkaline phosphatase activity of confluent osteoblastic-like cells (ROS 17/2.8).

[Alternative methods to animal experimentation. Scientific and ethical problems]. / Les méthodes dites alternatives à l'expérimentation animale. Problèmes scientifiques et éthiques.

The alternative methods include all the technologies able to replace animal experimentation. This denomination has been much debated and several researchers prefer the term of complementary methods. Alternative methods consist mainly of methods based on organ and cell culture but also includes cell organelles. These methods have been introduced gradually over the years particularly in toxicology but also in biology, physiology, pathology and pharmacology. The reasons for this development are from technological and ethical sources. This last point was due to the consciousness of industrial countries on the animal suffering which is at the origin of groups for animal welfare, able to influence european governments. The results of the development of the alternative methods are an increase in fundamental and applied research under the influence of various organisations such as in England: FRAME (Fund for the Replacement of Animals in Medical Experimentals), in USA: John Hopkins Center and in ECC: ECVAM (European Center for the Validation of Alternative Methods). This last Center is particularly devoted to validation which are defined as "the process whereby the reliability and relevance of a procedure are established for a particular purpose". This involves several stages. Some validations procedures are now in progress mainly in the aim of evaluating potential alternative methods to the Draize eye irritation test. Alternative methods are able to decrease the use of animal experiments and consequently improve animal ethics although they could not replace totally animal experiments. However they are complementary and very useful for the screening of drugs and mechanistic areas.

Transglutaminase activity in rabbit articular chondrocytes in culture.

In vivo, articular chondrocytes produce an important amount of extracellular matrix (cartilage) whose quality is impaired upon inflammation or aging leading to arthritis or arthrosis. Transglutaminases (EC 2.3.2.13) are a family of enzymes which have been shown to be involved in extracellular matrix stabilization, cell differentiation and possibly in initiation and propagation of inflammatory diseases. It is therefore of interest to study transglutaminase activity in chondrocytes. Transglutaminase activity was studied in rabbit articular chondrocytes in primary culture, where cells are in a well-differentiated state as assessed by collagen-type synthesis, as well as in subculture and in retinoic acid-treated cells, where cells are in a dedifferentiated state. Results showed that two different TGases activities are expressed in chondrocytes. One, down-regulated upon retinoic acid treatment of cells, preferentially membrane bound and strongly activated upon trypsin treatment of cell lysates, is expressed at a high level in primary culture. The other one is up-regulated upon retinoic acid treatment, preferentially cytosolic and inactivated upon trypsin treatment of cell lysates. The rate of expression of the TGase down-regulated by RA seems to correlate with the differentiation state of the chondrocyte. This suggests that this TGase activity may have a physiological role in cartilage and merits further study.