Medical biology in France: evolution and issues / Rapport des Académies nationales de médecine et de pharmacie. La biologie médicale en France : évolutions et enjeux

Medical biology is an essential part of patient care, both for the diagnosis and monitoring of diseases and for certain therapeutic advances. However, in recent years, it has been confronted with fundamental questions concerning its future. This report is the follow-up to the one published in 2018 by the National Academies of Medicine and Pharmacy and unfortunately only confirms a strong deterioration at all levels. The public authorities do not assume their role of regulator, thus allowing the excessive financialization of Medical Biology to grow considerably and lead to disproportionate groupings of Medical Biology Laboratories (MBL), destructive and sources of health risks. The result is that the Medical Biology Laboratories in towns, which are already known to be poorly distributed, are gradually becoming simple sampling sites, with patients finding themselves alone, often anxious, with their results sent to them by Internet without interpretation. Moreover, although progress in the field of Medical Biology is incredible and should constitute a major pole of attraction for young people, the disaffection of the discipline is total and worrying. Finally, innovation, in the context of current technological progress: connected devices, artificial intelligence and big data, represents a major challenge for the future. Here again, little or nothing is being done, even though the challenges are immense. After these alarming observations, the report will end with a series of recommendations aimed at optimizing the entry of MBL into a new era.

La biologie médicale est un maillon essentiel de la prise en charge des patients, tant pour le diagnostic et le suivi des maladies que pour certaines avancées thérapeutiques. Elle est toutefois, depuis quelques années, confrontée à des questions fondamentales concernant son avenir. Le présent rapport s'inscrit dans le prolongement de celui publié en 2018 par les Académies nationales de médecine et de pharmacie et ne fait malheureusement que conforter une forte dégradation à tous les niveaux. Les pouvoirs publics n'assument pas leur rôle de régulateur, permettant ainsi que la financiarisation à outrance de la biologie médicale s'amplifie considérablement et conduise à des regroupements démesurés des laboratoires de biologie médicale (LBM), destructeurs et sources de risques sanitaires. Le résultat est que les LBM de ville, dont on connaît déjà la mauvaise répartition territoriale, deviennent progressivement de simples sites de prélèvements, les patients se retrouvant alors seuls, souvent angoissés, avec leurs résultats transmis par Internet sans interprétation. Par ailleurs, bien que les progrès dans le domaine de la biologie médicale soient incroyables et devraient constituer un pôle d'attractivité majeur pour les jeunes, la désaffection de la discipline est totale et inquiétante. Enfin, l'innovation, dans le cadre des progrès technologiques actuels : dispositifs connectés, intelligence artificielle et mégadonnées (big data), représente un enjeu majeur pour l'avenir. Là encore rien n'est fait, ou presque, alors que les chantiers sont immenses. Après ces constatations alarmantes, le rapport se terminera par une série de recommandations visant à optimiser l'entrée des LBM dans une nouvelle ère.

[Medical biology in the face of the evolution of health care needs]. / Rapport des Académies nationales de médecine et de pharmacie sur la biologie médicale La biologie médicale face aux défis de l'évolution des besoins de santé.

Since the publication of the ordinance of January 13th 2010, ratified by the law of May 30th 2013, medical biology in France has undergone a massive restructuration with the emergence of groups of several hundred laboratories. This evolution, which leads to a considerable reduction in the number of structures, causes numerous problems related to increased industrialization and financialization, difficulties of accreditation and disappearance of the proximity link between the biologist and the prescriber or the patient. It also leads to a clear disaffection of students, especially medical students, for this specialty whose medical character has been clearly affirmed by the law. This report takes stock of the current situation of medical biology and makes recommendations to strengthen the role of the medical biologist in the health system and patients' care.

In Situ Microparticles Loaded with S-Nitrosoglutathione Protect from Stroke.

Treatment of stroke, especially during the first hours or days, is still lacking. S-nitrosoglutathione (GSNO), a cerebroprotective agent with short life time, may help if administered early with a sustain delivery while avoiding intensive reduction in blood pressure. We developed in situ forming implants (biocompatible biodegradable copolymer) and microparticles (same polymer and solvent emulsified with an external oily phase) of GSNO to lengthen its effects and allow cerebroprotection after a single subcutaneous administration to Wistar rats. Arterial pressure was recorded for 3 days (telemetry, n = 14), whole-blood platelet aggregation up to 13 days (aggregometry, n = 58), and neurological score, cerebral infarct size and edema volume for 2 days after obstruction of the middle cerebral artery by autologous blood clots (n = 30). GSNO-loaded formulations (30 mg/kg) induced a slighter and longer hypotension (-10 vs. -56 ± 6 mmHg mean arterial pressure, 18 h vs. 40 min) than free GSNO at the same dose. The change in pulse pressure (-50%) lasted even up to 42 h for microparticles. GSNO-loaded formulations (30 mg/kg) prevented the transient 24 h hyper-aggregability observed with free GSNO and 7.5 mg/kg-loaded formulations. When injected 2 h after stroke, GSNO-loaded microparticles (30 mg/kg) reduced neurological score at 24 (-62%) and 48 h (-75%) vs. empty microparticles and free GSNO 7.5 mg/kg and, compared to free GSNO, divided infarct size by 10 and edema volume by 8 at 48 h. Corresponding implants reduced infarct size and edema volume by 2.5 to 3 times. The longer (at least 2 days) but slight effects on arterial pressures show sustained delivery of GSNO-loaded formulations (30 mg/kg), which prevent transient platelet hyper-responsiveness and afford cerebroprotection against the consequences of stroke. In conclusion, in situ GSNO-loaded formulations are promising candidates for the treatment of stroke.

Abdominal obesity and gestational diabetes: the interactive role of magnesium.

AIMS: Magnesium is a cofactor for numerous metabolic enzymatic reactions. It is required for glucose utilization and insulin signaling. We compared plasma magnesium concentrations in pregnant women with and without abdominal obesity, and investigated the interactive roles of magnesium and obesity in the development of gestational diabetes mellitus (GDM). METHODS: Pregnant women with and without abdominal obesity (n = 40 in each group) were followed during gestation. Oral glucose tolerance tests (OGTT) were performed at 24-28 weeks of pregnancy to diagnose GDM. Plasma glucose, insulin, triglycerides, high-sensitive C-reactive protein (hs-CRP), and malondialdehyde (MDA) were measured. The obesity-GDM relationship was investigated prospectively, and the magnesium-GDM relationship was analyzed on a cross-sectional basis. RESULTS: Sixteen patients in the obese group and one in the control developed GDM. There were no differences in plasma magnesium levels between obese and control groups (p-value = 0.14), but significant differences between diabetic and non-diabetic patients (p-value = 0.05). Fourteen out of 17 diabetic patients had magnesium concentrations below the median. Increases in insulin, homeostatic model for insulin resistance, triglycerides, hs-CRP, MDA and second-hour blood glucose were more pronounced in those with both abdominal obesity and low-normal magnesium concentrations. In the Poisson regression model, obesity (relative risk = 20.6, p-value = 0.002), low-normal magnesium level (relative risk = 4.2, p-value = 0.009), and their interaction (p-value<0.001) were significant. CONCLUSION: Abdominally obese patients with lower plasma magnesium are more likely to show abnormal OGTT results. Insulin resistance, inflammatory response and oxidative stress are exaggerated in these patients.

The degree of resistance of erythrocyte membrane cytoskeletal proteins to supra-physiologic concentrations of calcium: an in vitro study.

Calcium is a key regulator of cell dynamics. Dysregulation of its cytosolic concentration is implicated in the pathophysiology of several diseases. This study aimed to assess the effects of calcium on the network of membrane cytoskeletal proteins. Erythrocyte membranes were obtained from eight healthy donors and incubated with 250 µM and 1.25 mM calcium solutions. Membrane cytoskeletal proteins were quantified using SDS-PAGE at baseline and after 3 and 5 days of incubation. Supra-physiologic concentrations of calcium (1.25 mM) induced a significant proteolysis in membrane cytoskeletal proteins, compared with magnesium (p < 0.001). Actin exhibited the highest sensitivity to calcium-induced proteolysis (6.8 ± 0.3 vs. 5.3 ± 0.6, p < 0.001), while spectrin (39.9 ± 1.0 vs. 40.3 ± 2.0, p = 0.393) and band-6 (6.3 ± 0.3 vs. 6.8 ± 0.8, p = 0.191) were more resistant to proteolysis after incubation with calcium in the range of endoplasmic reticulum concentrations (250 µM). Aggregation of membrane cytoskeletal proteins was determined after centrifugation and was significantly higher after incubation with calcium ions compared with control, EDTA and magnesium solutions (p < 0.001). In a supra-physiologic range of 1.25-10 mM of calcium ions, there was a nearly perfect linear relationship between calcium concentration and aggregation of erythrocyte membrane cytoskeletal proteins (R(2) = 0.971, p < 0.001). Our observation suggests a strong interaction between calcium ions and membrane cytoskeletal network. Cumulative effects of disrupted calcium homeostasis on cytoskeletal proteins need to be further investigated at extended periods of time in disease states.

Polymorphonuclear neutrophils from JAK2(V617F) positive MPD patients do not support hypercoagulability: A study with calibrated automated thrombography (CAT).

Essential thrombocythemia and polycythemia vera are myeloproliferative disorders (MPD) with an elevated thrombotic risk. Leukocytosis has recently emerged as a new risk factor and there is increasing evidence that polymorphonuclear neutrophils (PMN) are involved. Procoagulant activity (PCA) of PMN in MPD has not yet been investigated. PCA of PMN from 22 patients with JAK2(V617F) positive MPD and 26 healthy subjects was studied using calibrated automated thrombography: in vitro thrombin generation induced with 1 pM tissue factor in the presence of added procoagulant phospholipids. There were no differences between patients and controls regarding the ability of PMN to increase thrombin generation. More surprisingly, basal thrombin generation in acellular MPD-plasma was found decreased for as yet unknown reasons. The presence of an active protein C pathway or platelets might provide a better insight into the coagulation phenotype in MPD.

Inter-individual variability of effect of 7 low molecular weight antithrombin-dependent anticoagulants studied in vitro with calibrated automated thrombography.

INTRODUCTION: Low-molecular-weight heparins (LMWHs) and fondaparinux are antithrombin dependent anticoagulant drugs considered to need no laboratory monitoring because of their reputedly predictable anticoagulant effect. However it has been suggested in the literature the existence of an inter-individual variability in response to LMWHs that would be not fully attributable to pharmacokinetics causes. MATERIAL AND METHODS: In order to separate pharmacokinetic from pharmacodynamics effects we studied in 12 platelet-depleted plasmas from normal donors the inhibitory effect on TG determined with the CAT of added UFH, 5 LMWHs and 2 oligosaccharides with anti-Xa activity only. RESULTS: A concentration-dependent inhibition of thrombin generation was found with all molecules tested. The concentration-response relation was very different when the concentrations were expressed in anti-Xa unit but became very similar when expressed in anti-thrombin units regarding LMWHs. Most importantly, we noticed a large inter-individual variability of the inhibitory effects with all molecules tested, UFH and LMWHs alike. The IC40 value varied at least twofold between the highest and the lowest responder. For any given anti-Xa level of any heparin and of pentasaccharide the inhibition of the ETP showed scattering of around 25%. CONCLUSION: In contrast to what is generally assumed the inter-individual variation of the in vitro pharmacodynamics response is equally high for UFH and any LMWH (~25%) and even for the synthetic pentasaccharide. This questions the rationale for standard dosage, the more so as in clinical practice pharmacokinetic variation (e.g. due to body weight) will add to this pharmacodynamic variability.

In vitro effects of human neutrophil cathepsin G on thrombin generation: Both acceleration and decreased potential.

Cathepsin G (Cath G), a serine-protease found in neutrophils, has been reported to have effects that could either facilitate or impede coagulation. Thrombin generation (CAT method) was chosen to study its overall effect on the process, at a plasma concentration (240 nM) observed after neutrophil activation. Coagulation was triggered by tissue factor in the presence of platelets or phospholipid vesicles. To help identify potential targets of Cath G, plasma depleted of clotting factors or of inhibitors was used. Cath G induced a puzzling combination of two diverging effects of varying intensities depending on the phospholipid surface provided: accelerating the process under the three conditions (shortened clotting time by up to 30%), and impeding the process during the same thrombin generation time-course since thrombin peak and ETP (total thrombin potential) were decreased, up to 45% and 12%, respectively, suggestive of deficient prothrombinase. This is consistent with Cath G working on at least two targets in the coagulation cascade. Our data indicate that coagulation acceleration can be attributed neither to platelet activation and nor to activation of a clotting factor. When TFPI (tissue factor pathway inhibitor) was absent, no effect on lag time was observed and the anticoagulant activity of TFPI was decreased in the presence of Cath G. Consistent with the literature and the hypothesis of deficient prothrombinase, experiments using Russel's Viper Venom indicate that the anticoagulant effect can be attributed to a deleterious effect on factor V. The clinical relevance of these findings deserves to be studied.

Oral administration of a microencapsulated low-molecular-weight heparin to rabbits: anti-Xa and anti-IIa profiles.

The development of heparin oral form has been a subject of international research for a long time. Promising results have been obtained in vivo in terms of anti-Xa activity with different strategies and notably microparticles but studies concerning the anti-IIa activity and the anti-Xa/anti-IIa ratio have never been presented. Anti-Xa activities, anti-IIa activities and anti-Xa/anti-IIa ratios provided by nadroparin Eudragit RS and poly (D,L-lactic-co-glycolic acid) (PLGA) microparticles were determined in vitro and in vivo and an evaluation of their pharmacokinetic parameters compared to subcutaneous injection was performed. Nadroparin was encapsulated into microparticles prepared by the double emulsion method using Eudragit RS alone or in mixture with PLGA of two kinds, i.e. with (PLGA S) or without (PLGA H) esterification of the acid ending. Microparticles characterisation was performed (size, anti-Xa and anti-IIa activities entrapped and released) before their oral administration in rabbits. In vitro anti-Xa/anti-IIa ratios released from nadroparin microparticles were higher than the ratio of the commercial solution. After oral administration, whatever the formulation, sustained anti-Xa and anti-IIa activities were obtained compared to the subcutaneous injection with a peak concentration at 4 hours (up to 0.59 anti-Xa U/ml and 0.11 anti-IIa U/ml for PLGA S 50% / ERS 50% formulation). Anti-Xa and anti-IIa relative bioavailabilities were high, up to 40% (ERS 100% formulation). Anti-Xa/anti-IIa ratios were within range already obtained for subcutaneous injection, i.e. between 5 and 15. Nadroparin microparticles of nadroparin are promising oral dosage form performing sustained and well controlled anti-Xa, anti-IIa activities and anti-Xa/anti-IIa ratio.

Influence of polymorphonuclear leukocytes on the plasma clot formation as evaluated by thromboelastometry (ROTEM).

OBJECTIVE: It has been emphasized that polymorphonuclear leukocytes (PMN) participate in the regulation of coagulation. However, the mechanisms of action are not clear. Besides a procoagulant activity, anticoagulant or fibrinolytic properties are attributed to these cells. To explore their global effect, we have studied their involvement in the clot formation with thromboelastometry, which gives global view over the clotting process, in particular on the structure of the clot and on the kinetic of its formation. METHODS: PMN were isolated from healthy blood donors and resuspended into autologous platelet-free plasma. The ROTEM device was used. Coagulation was triggered only by adding calcium chloride. Thromboelastometric profiles of PMN-rich plasma (PMN-RP) were compared with autologous platelet-rich (PRP) and platelet-poor plasma (PPP). The inhibition of both tissue factor and intrinsic pathways was also studied. RESULTS AND CONCLUSIONS: The procoagulant activity of resting PMN was demonstrated as the initiation of fibrin formation with PMN-RP was significantly faster compared with both PRP and PPP. The kinetic of plasma clotting was remarkably improved with PMN-RP compared with PPP. However, the clot with PMN-RP had the same poor viscoelastical properties as PPP. Thromboelastometry gives a new point of view in the involvement of PMN in coagulation, in the absence of any PMN pre-activation. Their impact was centred on the kinetic and the facilitation of the clot formation.

Immunoadsorption of alloantibodies onto erythroid membrane antigens encapsulated into polymeric microparticles.

PURPOSE: Classical immunoadsorbents used for the removal of deleterious molecules in blood such as auto-antibodies are prepared by covalent coupling of antigens onto previously chemically activated supports. Such a chemical treatment may induce a potential toxicity which can be reduced if new immunoadsorbents are prepared by encapsulating erythrocytes-ghosts carrying antigens inside polymeric and porous microparticles. MATERIALS AND METHODS: Erythrocyte-ghosts obtained by hemolysis in hypotonic buffer were encapsulated into ethylcellulose microparticles by w/o/w emulsification. The porosity of microparticles was evaluated by mercury porosimetry. The adsorption ability of encapsulated antigens was evaluated by hemagglutination after contact in tube or elution in column with polyclonal antibody solutions or human blood-plasma. RESULTS: The encapsulation process did not significantly alter the evaluated antigens since a significant decrease in anti-A (from 256 to 4) as well as anti-Kell (from 64 to 2) antibody titer has been observed in column after eight chromatographic runs (2 h). The higher the ghost concentration (total protein content of 6 mg/ml), the higher the adsorption capacity. CONCLUSION: Encapsulation, currently used for drug delivery purposes, may consequently also be applied to the design of new immunoadsorbents as biomaterials.

A comparison of epinephrine only, arginine vasopressin only, and epinephrine followed by arginine vasopressin on the survival rate in a rat model of anaphylactic shock.

BACKGROUND: Epinephrine and more recently arginine vasopressin (AVP) alone or in combination have been proposed in patients with anaphylactic shock, but few experimental data exist. The authors investigated the effects of epinephrine only, AVP only, or epinephrine followed by AVP in a model of anaphylactic shock. METHODS: Ovalbumin-sensitized Brown Norway rats were anesthetized, intubated, and shock induced with ovalbumin. Rats (n = 6/group) were randomly allocated to receive 5 min after shock onset: (1) saline (no-treatment group); (2) two boluses of epinephrine followed by continuous infusion (epinephrine group); (3) AVP bolus followed by continuous infusion (AVP group); (4) epinephrine bolus followed by AVP continuous infusion (epinephrine + AVP group). Mean arterial pressure (MAP) and skeletal muscle oxygen pressure (PtiO2) were measured. Continuous infusion rates were titrated to reach MAP values of 60 mmHg. Survival was analyzed. RESULTS: Without treatment, MAP and PtiO2 decreased rapidly with 0% survival. In the epinephrine group, MAP and PtiO2 recovered after an initial decrease, with 84% survival. In the AVP group, MAP was partially restored and subsequently decreased; PtiO2 values decreased to values similar to those in the no-treatment group; survival was 0%. In the epinephrine + AVP group, MAP and PtiO2 values increased more slowly as compared with the epinephrine group; survival was 100%. CONCLUSIONS: In this model of anaphylactic shock, early treatment with epinephrine followed by continuous epinephrine or vasopressin infusion resulted in an excellent survival rate, whereas vasopressin only resulted in a 100% death rate. These experimental results suggest that epinephrine must still be considered as the first-line drug to treat anaphylactic shock.

Pharmacological and physicochemical factors in the pressor effects of conjugated haemoglobin-based oxygen carriers in vivo.

BACKGROUND: The hypertension induced by haemoglobin-based oxygen carriers could be a result of different pharmacological and physicochemical factors. OBJECTIVE: To investigate whether production of superoxide anion (O2*-) and release of endothelin could be the factors responsible. METHODS: We studied the variation in mean arterial pressure (MAP) in guinea pigs by carrying out a 50% isovolaemic exchange transfusion with conjugated oxyhaemoglobin (non-oxidized form) or conjugated methaemoglobin (fully oxidized form) in the presence or absence of BQ-788 (5 nmol/l), an endothelin receptor type B (ETR-B) antagonist. At key timepoints of variation in MAP, the plasma concentrations of O2*- were measured. The presence of conjugated oxyhaemoglobin and increases in ETR-B concentrations inside the vascular wall were investigated in different vessels, using western blotting. RESULTS: We found that the administration of conjugated oxyhaemoglobin induced a significant increase in MAP, whereas conjugated methaemoglobin had no significant haemodynamic effect. Pretreatment with BQ-788 attenuated the increase in MAP induced by conjugated oxyhaemoglobin. This haemoglobin induced the production of high concentrations of O2*- that declined towards control values after 120 min and decreased in the presence of BQ-788. Western blot analysis showed that the presence of conjugated oxyhaemoglobin inside the vascular wall was time-dependent and correlated with increased ETR-B. CONCLUSION: These results show that the release of O2*- during auto-oxidation of conjugated oxyhaemoglobin is associated with the observed increase in MAP, which may be a result of the vasoconstriction caused by an increase in activation of ETR-B. This activation may be caused by the massive release of endothelin induced by the production of O2*-.

[Blood substitutes: state of the art and technical setbacks and why we are still disappointed]. / Les substituts érythrocytaires: état de l'art et raisons d'un espoir retardé.

Volume loading solutions used therapeutically (albumin, dextrans, modified gelatins and hydroxylstarches) are simple plasma substitutes and cannot ensure oxygen transport. The search for erythrocyte substitutes initially seemed utopian, but this goal is now within our reach, in the form of hemoglobin-based oxygen carriers (HBOC) for example. The clinical development of HBOC has been slowed by adverse effects, including an increase in arterial pressure due to the vasoconstrictive effect of cell-free hemoglobin in plasma, haemoprotein autoxidation leading to methemoglobin formation, and free radical generation that creates oxidative stress.

Hydroxyethylstarch 200 and 240 differently affect aortic distensibility but not viscosity and blood pressure upon acute isovolumic hemodilution.

OBJECTIVES: It has been shown that a hydroxyethylstarch solution significantly increases the aortic distensibility coefficient (ADC) as compared to other non-hydroxyethylstarch colloid solutions. In order to investigate whether the effect of hydroxyethylstarch on ADC is class-specific, we investigated the effect of two hydroxyethylstarch solutions (HES 200: Elohes and HES 240: Hesteril) on the ADC and compared them with two other colloid solutions: 5% albumin and fluid gelatin (Gelofusin) in a rabbit model of acute isovolumic hemodilution. METHODS: Twenty-eight male New Zealand white rabbits were anesthetized and randomly allocated to receive (n=7, each): albumin, hydroxyethylstarch-200, hydroxyethylstarch-240 and gelatin for acute isovolumic hemodilution by exchanging 13 ml.kg(-1) body weight of blood with an identical volume of the test solution. Blood viscosity, mean arterial pressure, aortic blood flow and heart rate were measured and ADC was calculated. RESULTS: All groups were comparable with respect to arterial pressure, heart rate and aortic blood flow velocity before and after isovolumic hemodilution. After hemodilution, ADC coefficient remained unchanged as compared with pre-hemodilution values with albumin, hydroxyethylstarch-240 and gelatin, whereas a sustained 3 fold increase was observed with hydroxyethylstarch-200. CONCLUSION: These results demonstrate that minor physicochemical differences between two hydroxyethylstarch solutions result in measurable differences in ADC and suggest that the clinical effects of colloids should probably be analyzed for each type of colloid and not for classes of colloids (e.g. hydroxyethylstarch or fluid gelatins).

Oral bioavailability of a low molecular weight heparin using a polymeric delivery system.

Low molecular weight heparins (LMWHs) are the standards of anticoagulant for the prevention of deep vein thrombosis (DVT) in patients undergoing arthroplasty and abdominal surgery. However, LMWHs are so far only administered by parenteral route. Thus, they are usually replaced by oral warfarin for outpatient therapy. Since warfarin has a slow onset and high incidence of drug-drug interaction, there is a great need for the development of an oral LMWH formulation. LMWH (tinzaparin)-loaded nanoparticles prepared with a blend of a polyester and a polycationic polymethacrylate by the double emulsion method were administered orally in fasted rabbits. The plasma tinzaparin concentration was measured by a chromogenic anti-factor Xa assay. After oral administration of two doses of tinzaparin-loaded nanoparticles (200 and 600 anti-Xa U/kg), the oral absorption was observed between 4 and 10 or 12 h, with a delayed onset of action ranging from 3 to 4 h. Mean absolute bioavailabilities were 51% and 59% for the two tested doses. We now report that the encapsulation of tinzaparin into nanoparticles is likely to contribute to its oral efficacy with an anticoagulant effect prolonged up to 8 h.

Hemoglobin-based oxygen carriers do not alter platelet functions: study of three chemically modified hemoglobin solutions.

OBJECTIVE: Chemically modified hemoglobins are being developed as potential oxygen-carrying blood substitutes (HBOCs). Clinical and preclinical data demonstrate the vasoactive properties of HBOCs by trapping of nitric oxide, which is also known to have platelet inhibitory activities properties. This study evaluated the effects of three structurally different HBOCs (Hb-Dex-BTC, alphaalpha-Hb, and o-raffinose-poly-Hb) on platelet functions in vitro to compare to those elicited by plasma substitutes, such as hydroxyethylstarch. DESIGN: Platelet activation state was assessed using platelet-rich plasma diluted to 20% (v/v) with the different solutions, by main measuring glycoproteins (GPIb, GPIIb/IIIa, and P-selectin) using flow cytometry. Aggregation was assessed by impedance aggregometry on whole blood hemodiluted to 20% (v/v) with the solutions. SETTING: Biological hematology department of the university hospital of Nancy-Brabois. PATIENTS AND PARTICIPANTS: Ten healthy volunteers consent and informed of the study who denied taking any drugs at the time of the experiment. MEASUREMENTS AND RESULTS: None of these solutions induced activation nor modified reactivity of platelets as measured by the surface expression of glycoproteins GPIb, GPIIb/IIIa, and P-selectin. Moreover, none of these solutions induced platelet aggregation when added alone, nor modified the aggregation patterns of platelets induced by collagen (0.5 microg/ml) and thrombin receptor agonist peptide (12.5 microM). CONCLUSIONS: The three tested structurally different HBOCs, as with hydroxyethylstarch, did not alter platelet functions in vitro.

A new method of implanting orthotopic rat bladder tumor for experimental therapies.

We developed a model of orthotopic transplantation of bladder tumor cells in female Fischer rats using a new reproducible technique. After first performing the mechanical abrasion of a portion of the bladder urothelium with an Abrader inserted transurethrally via a catheter, we administered a suspension of 5-40 x 10(6) viable AY-27 tumor cells in sterile phosphate-buffered saline to the bladder cavity. This rapidly led to a tumor growth incidence of approximately 100%. The induced bladder tumors grew expansively into the bladder cavity from the surface (mucosa) and gradually invaded the submucosa, muscles, serosa and surrounding tissue (high-stage invasive transitional cell carcinoma). Size and staging were related to the quantity of tumor cells instilled into the bladder cavity. This model matches the characteristics of human bladder tumor more closely than other bladder cancer models induced with tumor cells. Moreover, it presents many advantages: the method is reproducible, tumors grow rapidly, they are directly attached to the bladder surface and they are always located on the bladder wall, in line with the urethra. This proves especially helpful for evaluating chemotherapeutic agents by different means such as in vivo fluorescence spectroscopy, a noninvasive method used in photodynamic therapy, or other methods designed to detect and treat transitional cell carcinoma.

Determination of the maximal tumor:normal bladder ratio after i.p. or bladder administration of 5-aminolevulinic acid in Fischer 344 rats by fluorescence spectroscopy in situ.

The two major steps in our study on the treatment of bladder tumors by photodynamic therapy (PDT) were the development of a new bladder tumor model in Fischer rats by implantation of tumor cells and the use of fluorescence spectroscopy, a semi-quantitative and non-invasive method, in order to determine the time after general or local administration of a photosensitizer when the tumor:normal bladder ratio was at its highest. 5-Aminolevulinic acid (5-ALA) (250 mg/kg body weight) was injected i.p. or instilled directly into the bladder cavity for 1, 2 or 4 h and fluorescence was measured on normal and bladder tumor tissues every 30 min for 8-10 h after administration, with a special miniaturized optical-fiber captor. The better tumor:normal bladder ratios were 2.85+/-1.2 at 3.5 h after i.p. administration and 3.96+/-1.04 after bladder instillation for 4 h, respectively. These results were confirmed by fluorescence microscopy. PDT with the same dose of 5-ALA as in this pharmacokinetic study must also be carried out in order to compare the toxicity of the two administration routes of the photosensitizer and to determine which one is the better for this bladder tumor model.