De la greffe de moelle à la thérapie cellulaire : les trajectoires incertaines de la coopération médecine/industrie

Bone marrow transplantation to cell therapies: new forms of cooperation between medicine and industrial firms The article describes the rapid technical substitution, since 1990/1991, of peripheral blood progenitor stem cells (PBPSC) reinjection to bone marrow transplantation in oncology and hematology. It analyses the various strategies of the actors involved in such technical innovation in order to show how most important issues are indeed at stake. A first issue deals with the regulatory, economic and ethical status of new class of therapeutics, the so-classed cell therapies and their future potential development to gene therapies. A second issue concerns emerging new forms of cooperation and control between industrial firms, clinicians and hospitals and regulatory agencies, in the health care sector, with a potential major impact on the equilibrium between market forces and the public sector.Résumé. L'article décrit le processus qui a conduit à la substitution rapide, à partir de 1990/1991, des greffes de cellules souches du sang périphérique (CSSP) à la greffe de moelle comme traitement de support de l'intensification des chimiothérapies en cancérologie. À partir d'une analyse détaillée des stratégies des acteurs concernés, il s'efforce de montrer en quoi la diffusion de la greffe de CSSP a cristallisé des enjeux beaucoup plus considérables : d'une part, quant au statut juridique, économique et éthique d'une nouvelle classe de stratégies thérapeutiques regroupées sous le terme de thérapie cellulaire et préfigurant la future thérapie génique, d'autre part, quant à l'évolution des formes de coopération et de contrôle entre groupes industriels, laboratoires de recherche, établissements de santé et administrations de tutelle, évolution elle-même susceptible d'influencer l'architecture d'ensemble de notre système de santé.Del trasplante de médula a la terapia celular : la cooperación medicina/industria El artículo describe el proceso que conjudo a la rápida substitution, a partir de 1990/1991, de los injertos de celulas madrés de sangre periférica (CSSP) al transplante de médula en los tratamientos de soporte de las quimioterapias intensivas en cancerología. A partir de un análisis detallado de las estrategias de los actores implicados, el artículo trata de mostrar de que manera la difusíon del transplante de CSSP cristalizó situaciones mucho más importantes : por una parte, sobre el status jurídico, económico y ético de una nueva clase de estrategias terapéuticas regrupadas bajo el término de terapia celular que prefiguran la futura terapia génica ; por otra parte, sobre la evolución de las formas de cooperación y de control entre grupos industriales, laboratorios de investigación, establecimientos de salud y administraciones tutelares, evolución susceptible en sí misma de influir sobre la estructura de nuestro sistema de salud.Fortanier Cécile, Mannoni-Chaine Guénaelle, Moatti Jean-Paul. De la greffe de moelle à la thérapie cellulaire : les trajectoires incertaines de la coopération médecine/industrie. In: Sciences sociales et santé. Volume 15, n°2, 1997. pp. 7-34

Identification and control of an isolated, but intense focus of lymphatic filariasis on Satawal Island, Federated States of Micronesia, in 2003

Abstract Background There is very limited data available on the prevalence of Bancroftian filariasis in the Federated States of Micronesia (FSM). Considerable attempts to eliminate the disease had occurred in the Pacific region by the year 2003, and the prevalence in FSM was thought to be sufficiently low that the region was considered non-endemic. However, a survey conducted in 2003 on an isolated atoll of FSM, Satawal Island, challenged that assumption. Methods Participants on Satawal Island were recruited and their blood tested for Wuchereria bancrofti antigen by the filariasis immunochromatographic test (ICT) card and circulating microfilaria by Knott’s concentration technique. A survey for active cases of lymphoedema, elephantiasis and hydrocoele was performed and mosquitoes were trapped and dissected to detect larvae of W. bancrofti. Results A total of 104 males and 149 females from early teens to mid-80s were tested. Men had a significantly higher prevalence of infection than women in both the ICT test (53 vs 28%; p 25 years of age. All persons sampled were treated for LF. No cases of elephantiasis or hydrocoele were detected. No Aedes dissected were positive but three of nine culicine mosquitoes were positive for L1–3 larval stages of W. bancrofti by microscopy. In depth interviews were conducted with residents and chiefs. Conclusions This survey showed that even in regions thought to be close to elimination, isolated high intensity foci of lymphatic filariasis may occur. These need to be recognized and control measures instituted such as local MDA as in the current study

Nutritional, lifestyle and environmental factors in ocular hypertension and primary open-angle glaucoma: an exploratory case-control study

PURPOSE: To evaluate known and potential risk factors, including nutritional, lifestyle and environmental factors, differentiating patients with high-tension primary open-angle glaucoma (POAG) from control subjects with ocular hypertension (OHT). METHODS: In 2006-2007, 111 French ophthalmologists prospectively enrolled 339 cases of POAG and 339 age-matched controls with OHT. After a clinical examination with assessment of ocular risk factors, the ophthalmologist filled, during face-to-face interview, a detailed questionnaire developed by nutritionists and epidemiologist on lifestyle and environmental risk factors, including socio-demographic variables, dietary habits related to omega-3 fatty acids intake, smoking and alcohol drinking and professional exposure to pesticides and other chemicals. Associations of POAG with risk factors were estimated using conditional logistic regression, with adjustment for age, gender and duration of disease. RESULTS: In the final multivariate model, by comparison with OHT, POAG was significantly associated with more frequent use of pesticides during the professional life [OR = 2.65, 95% confidence interval (CI): 1.04-6.78, p = 0.04] and with low consumption of fatty fish (OR = 2.14, 95% CI: 1.10-4.17, p = 0.02) and walnuts (OR = 2.02, 95% CI: 1.18-3.47, p = 0.01). POAG was also associated with higher frequency of heavy smoking (40 pack-years or more, OR = 3.93, 95% CI: 1.12-13.80, p = 0.03) but not with moderate (20-40 pack-years) and light smoking (<20 pack-years). CONCLUSIONS: These exploratory observations suggest a protective effect of omega-3 fatty acids and a deleterious effect of heavy smoking and professional exposure to pesticides in POAG. This will need to be confirmed in future studies

Clutch-size variation in Western Palaearctic secondary hole-nesting passerine birds in relation to nest box design

Secondary hole-nesting birds that do not construct nest holes themselves and hence regularly breed in nest boxes constitute important model systems for field studies in many biological disciplines with hundreds of scientists and amateurs involved. Those research groups are spread over wide geographic areas that experience considerable variation in environmental conditions, and researchers provide nest boxes of varying designs that may inadvertently introduce spatial and temporal variation in reproductive parameters. We quantified the relationship between mean clutch size and nest box size and material after controlling for a range of environmental variables in four of the most widely used model species in the Western Palaearctic: great tit Parus major, blue tit Cyanistes caeruleus, pied flycatcher Ficedula hypoleuca and collared flycatcher F.albicollis from 365 populations and 79610 clutches. Nest floor area and nest box material varied non-randomly across latitudes and longitudes, showing that scientists did not adopt a random box design. Clutch size increased with nest floor area in great tits, but not in blue tits and flycatchers. Clutch size of blue tits was larger in wooden than in concrete nest boxes. These findings demonstrate that the size of nest boxes and material used to construct nest boxes can differentially affect clutch size in different species. The findings also suggest that the nest box design may affect not only focal species, but also indirectly other species through the effects of nest box design on productivity and therefore potentially population density and hence interspecific competition