Multicellular tumor spheroids: a relevant 3D model for the in vitro preclinical investigation of polymer nanomedicines

International audienceThe application of nanotechnology to medicine, usually termed nanomedicine, has given a crucial impulse to the design of various drug-loaded nanocarriers driven by the aim to overcome the limits associated with traditional drug delivery modalities, in particular, in the field of cancer treatment. However, an appropriate preclinical evaluation of the real therapeutic potential of nanomedicines suffers from the lack of relevant models that are well representative of the human disease and good predictors of the therapeutic response in patients. In this context, great emphasis has been directed toward 3D tumor models aiming to surmount the insufficient predictive power of traditional 2D monolayer cultures of cancer cells. This review focuses on multicellular tumor spheroids (MCTS), which are currently the most widely employed 3D tumor model in preclinical studies. After a brief discussion on spheroid construction strategies and analytical/imaging techniques employed in experimental settings, the application of 3D MCTS to the evaluation of nanomedicines displaying various physico-chemical properties is reviewed. Finally, relevant examples of scaffold and microfluidic systems in which MCTS have been included are described

Estimating the value of carbon sequestration ecosystem services in the Mediterranean Sea: An ecological economics approach

n/

The Copernicus Marine Service ocean forecasting system for the Mediterranean Sea

The Mediterranean Monitoring and Forecasting Center (MED-MFC) is part of the Copernicus Marine Environment and Monitoring Service (CMEMS) and provides regular and systematic information on the time-evolving Mediterranean Sea physical (including waves) and biogeochemical state. The systems consist of 3 components: 1) Med-Physics, a numerical ocean prediction systems, based on NEMO model, that operationally produces analyses, reanalysis and short term forecasts of the main physical parameters; 2) Med-Biogeochemistry, a biogeochemical analysis, reanalysis and forecasting system based on the Biogeochemical Flux Model (BFM) which provides information on chlorophyll, phosphate, nitrate, primary productivity, oxygen, phytoplankton biomass, pH and pCO2; 3) Med-Waves based on WAM model and providing analysis, forecast and reanalysis products for waves. The systems have been recently upgraded at a resolution of 1/24 degree in the horizontal and 141 vertical levels. The Med-Physics analysis and forecasting system is composed by the hydrodynamic model NEMO 2-way coupled with the third-generation wave model WaveWatchIII and forced by ECMWF atmospheric fields. The model solutions are corrected by the 3DVAR data assimilation system (3D variational scheme adapted to the oceanic assimilation problem) with a daily assimilation cycle of sea level anomaly and vertical profiles of temperature and salinity. The model has a non-linear explicit free surface and it is forced by surface pressure, interactive heat, momentum and water fluxes at the air-sea interface. The biogeochemical analysis and forecasts are produced by means of the MedBFM v2.1 modeling system (i.e. the physical-biogeochemical OGSTM-BFM model coupled with the 3DVARBIO assimilation scheme) forced by the outputs of the Med-Physics product. Seven days of analysis/hindcast and ten days of forecast are bi-weekly produced on Wednesday and on Saturday, with the assimilation of surface chlorophyll concentration from satellite observations. In-situ data are mainly used to estimate model uncertainty at different spatial scales. The Med-Waves modelling system is based on the WAM Cycle 4.5.4 wave model code. It consists of a wave model grid covering the Mediterranean Sea at a 1/24° horizontal resolution, nested to a North Atlantic grid at a 1/6° resolution. The system is forced by ECMWF winds at 1/8°. Refraction due to surface currents is accounted by the system which assimilates altimeter along-track significant wave height observations. On a daily basis, it provides 1-day analysis and 5-day forecast hourly wave parameters. Currently, wave buoy observations of significant wave height and mean wave period along with satellite observations are used to calibrate and validate the Med-waves modelling system.PublishedHalifax, Nova Scotia, Canada4A. Oceanografia e clim

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Disease-specific and general health-related quality of life in newly diagnosed prostate cancer patients: The Pros-IT CNR study

Background: The National Research Council (CNR) prostate cancer monitoring project in Italy (Pros-IT CNR) is an observational, prospective, ongoing, multicentre study aiming to monitor a sample of Italian males diagnosed as new cases of prostate cancer. The present study aims to present data on the quality of life at time prostate cancer is diagnosed. Methods: One thousand seven hundred five patients were enrolled. Quality of life is evaluated at the time cancer was diagnosed and at subsequent assessments via the Italian version of the University of California Los Angeles-Prostate Cancer Index (UCLA-PCI) and the Short Form Health Survey (SF-12). Results: At diagnosis, lower scores on the physical component of the SF-12 were associated to older ages, obesity and the presence of 3+ moderate/severe comorbidities. Lower scores on the mental component were associated to younger ages, the presence of 3+ moderate/severe comorbidities and a T-score higher than one. Urinary and bowel functions according to UCLA-PCI were generally good. Almost 5% of the sample reported using at least one safety pad daily to control urinary loss; less than 3% reported moderate/severe problems attributable to bowel functions, and sexual function was a moderate/severe problem for 26.7%. Diabetes, 3+ moderate/severe comorbidities, T2 or T3-T4 categories and a Gleason score of eight or more were significantly associated with lower sexual function scores at diagnosis. Conclusions: Data collected by the Pros-IT CNR study have clarified the baseline status of newly diagnosed prostate cancer patients. A comprehensive assessment of quality of life will allow to objectively evaluate outcomes of different profile of care

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Cellules tumorales et leur micro-environnement : développement de modèles 3D in vitro pour l’évaluation préclinique de nouveaux nanomédicaments

Au cours des dernières décennies, des systèmes de taille nanométrique chargés en principes actifs (nanomédicaments) et des nouvelles stratégies thérapeutiques ont été développés afin de surmonter les limitations liées à la chimiothérapie conventionnelle telles qu’une distribution non spécifique, une mauvaise accumulation dans les tissus cibles ainsi qu’une métabolisation rapide. Cependant, le succès des nouveaux médicaments en clinique reste encore limité et seulement un faible nombre de nanomédicaments est actuellement commercialisé.Une divergence entre les résultats précliniques in vitro et les performances obtenues in vivo est souvent observée dans la première étape du développement d'un médicament. Cet écart pourrait être attribué au manque de modèles pertinents, représentatifs de la pathologie observée chez l’Homme et qui soient de bons prédicteurs de la réponse thérapeutique chez les patients. En effet, les modèles utilisés aujourd’hui (généralement culture cellulaire en deux dimensions, 2D) ne reproduisent pas la structure complexe de la tumeur in vivo. Ainsi, ils ne permettent pas une évaluation fiable du potentiel thérapeutique réel des médicaments. Dans cette optique, les méthodologies de culture de cellules en trois dimensions (3D) sont extrêmement avantageuses. Ces méthodologies permettent, en effet, la construction de systèmes cellulaires pertinents qui reproduisent in vitro la relation entre les cellules cancéreuses et leur microenvironnement. Parmi ces modèles, l'assemblage de cellules sous forme de sphéroïdes multicellulaires a été largement exploré. Néanmoins, les sphéroïdes décrits jusqu'à présent correspondent à des nodules formés exclusivement de cellules cancéreuses, ce qui constitue une vraie limitation. En effet, ces sphéroïdes ne reproduisent pas l’organisation de la tumeur et l'hétérogénéité du microenvironnement, et par conséquent ils ne parviennent pas à mimer les multiples barrières biologiques que les médicaments doivent traverser pour atteindre les cellules cibles.Dans cet esprit, l'objectif de cette thèse de doctorat était de surmonter ces limitations et de construire des modèles pertinents qui reproduisent in vitro la relation entre les cellules cancéreuses et leur microenvironnement afin de i) mieux comprendre les mécanismes de passage des nanomédicaments et ii) mieux prédire l’efficacité des nouveaux traitements.Au cours de cette thèse nous nous sommes intéressés au cancer du pancréas qui est caractérisé par la présence d'un abondant stroma formant un bloc fibreux (réaction desmoplastique) qui limite la pénétration des médicaments et réduit ainsi leur efficacité. Cette tumeur représente donc un bon exemple de barrière biologique tumorale.La partie principale de ce travail de recherche repose sur la construction et la caractérisation complète d’un nouveau type de sphéroïde multicellulaire, capable de reproduire in vitro la relation entre les cellules cancéreuses et leur microenvironnement, grâce à la co-culture de cellules cancéreuses pancréatiques, de fibroblastes et de cellules endothéliales. Les études de cytotoxicité in vitro nous ont permis d’investiguer la capacité de ce modèle à reproduire la résistance des cellules cancéreuses aux traitements observés in vivo. Grâce à la Microscopie de Fluorescence à Feuillet de Lumière nous avons pu étudier la pénétration de la doxorubicine, soit en forme libre, soit encapsulée dans des nanoparticules, au sein des sphéroïdes. Ensuite, afin de mieux comprendre comment les médicaments et nanomédicaments interagissent avec la tumeur, nous avons cherché à combiner la culture 3D avec des conditions dynamiques contrôlées dans un dispositif microfluidique. Pour atteindre cet objectif, nous avons conçu et fabriqué une puce sur mesure, adaptée pour loger à la fois le sphéroïde et des canaux dans lesquels les cellules endothéliales pourront s’organiser sous forme de vaisseaux.In the last decades, various engineered systems for drug delivery (i.e., nanomedicines) have been developed with the aim to overcome the limits associated to conventional chemotherapy, such as non-specific drug distribution, poor delivery to the target tissue and rapid metabolism. However, the success of new therapeutic strategies in the clinic is still suboptimal and only a limited number is currently marketed.A discrepancy between promising preclinical in vitro results and the in vivo performances is often observed in the early stage of drug development and might be ascribed to the lack of capacity of the models commonly used for in vitro studies to faithfully reproduce the pathophysiology of solid tumors. These models mainly consist of cancer cells cultured as flat (two dimensional, 2D) monolayers or assembled to form three dimensional (3D) multicellular tumor spheroids (MCTS).However, being composed exclusively of one cell type, these models are too simplistic. They do not allow to reproduce the heterogeneous cellular composition, as well as, the complex architecture of the tumor and its surrounding microenvironment. Thus, they fail to replicate the multiple biological barriers that drugs and nanomecidines have to cross in order to reach the target cells.The aim of this PhD thesis was to overcome these limitations and construct a reliable tool for an appropriate in vitro evaluation of the therapeutic potential of nanomedicines and other chemotherapies. Attention has been focused on the pancreatic ductal adenocarcinoma (PDAC) whose strong fibrotic reaction represents a well-known example of a tumor biological barrier responsible of the limited efficacy of the treatments. The main part of this research work relies on the construction and complete characterization of novel hetero-type MCTS based on a triple co-culture of pancreatic cancer cells, fibroblasts and endothelial cells, and thus capable to integrate the cancerous component and the microenvironment of the tumor. The constructed 3D model has demonstrated the capacity to reproduce in vitro the influence of the microenvironment on the sensitivity of cancer cells to chemotherapy. In addition, by combining the 3D model and the innovative Light Sheet Fluorescence Microscopy (LSFM), we have been able to investigate the penetration of the anticancer drug doxorubicin (in a free form and loaded into nanoparticles (NPs)) in a high informative manner. Then, in order to acquire a better understanding on how nanomedicines and other anticancer chemotherapies interact with the tumor, we sought to combine the hetero-type 3D culture with controlled flow conditions in a microfluidic device. To reach this goal we have designed and fabricated a tailor-made chip suitable to host both a MCTS and a perfusable microvascular network (i.e., MCTS-on-a-chip)