Anti-idiotypic antibodies to human anti-gp120 antibodies bind recombinant and cellular human CD4.

The presence of anti-CD4 antibodies in sera of human immunodeficiency virus (HIV)-seropositive individuals has been recently documented, but its origin remains unknown. To test the hypothesis that anti-idiotypic antibodies to gp120, the HIV envelope glycoprotein with high affinity for CD4, mimic the configuration of gp120 and bind CD4, we performed two sets of experiments. First, we tested the possibility that anti-CD4 antibodies present in sera of a proportion of HIV-positive individuals exhibit variable region complementarity to autologous anti-gp120 antibodies. We show here that affinity-purified human anti-gp160 antibodies recognize specifically autologous affinity-purified anti-CD4 antibodies. We also demonstrate that antibodies to CD4 competitively inhibit anti-gp160 autologous antibodies binding to gp160. This implies that at least some anti-CD4 antibodies are directed towards idiotypic motifs located on anti-gp120 antibodies and that they may result from an anti-idiotypic response to anti-gp120 antibodies. In a second set of experiments, we examined the effect of anti-idiotypic immunization of experimental animals against human anti-gp120 antibodies. We found that anti-idiotypic antibodies produced in a rabbit immunized against affinity-purified human anti-gp120 antibodies specifically recognize recombinant and cellular human CD4, and that this interaction is competitively inhibited by soluble CD4. The data support the concept of idiotypic mimicry whereby anti-idiotypic antibodies produced against anti-gp120 antibodies recognize CD4, the cellular receptor of HIV.     

Tracheal rupture initially masked by accidental bronchial intubation

We report a case of tracheal rupture complicating a blunt chest trauma. As the endotracheal tube had been inadvertently inserted into the right bronchus, tracheal rupture was only suspected when increasingly severe subcutaneous emphysema occurred after mobilization of the tube. Bronchoscopy confirmed the diagnosis. After surgical repair of the lesion the outcome was uneventful. Tracheal rupture is an uncommon lesion. All physical and radiological symptoms provide useful diagnostic orientation. In the patient of our case report, inadvertent bronchial intubation made artificial ventilation possible and probably prevented lethal outcome.     

Biopharmaceutics and pharmacokinetics of 5-phenyl-1, 2-dithiole-3-thione complexed with sulfobutyl ether-7-beta-cyclodextrin in rabbits.

The biopharmaceutics and pharmacokinetics of 5-phenyl-1, 2-dithiole-3-thione (5PDTT) were investigated in rabbits, after administration as a complex with sulfobutyl-ether-7-beta-cyclodextrin (SBE7-beta-CD) by intravenous and oral routes and as a micronized powder by oral route. 5PDTT had a rapid and large red blood cell partitioning that was not dependent on drug concentration either in vitro or ex vivo. The blood clearance was very high (354 +/- 131 mL/min) suggesting extrahepatic metabolism and/or nonrenal elimination and a significant volume of distribution (67 +/- 76 L). The renal clearance was 0.17% of total clearance. 5-phenyl-1,2-dithiol-3-one (5PDTO) was identified as a metabolite in blood and urine. The bioavailability of 5PDTT following administration of 5PDTT/SBE7-beta-CD complex was estimated to 41% while it was close to zero when 5PDTT was given as a micronized powder.     

Spray-dried redispersible oil-in-water emulsion to improve oral bioavailability of poorly soluble drugs.

A physically stabilized dry emulsion dosage form reforming the original emulsion after rehydration was developed by spray-drying a liquid oil-in-water emulsion containing maltodextrin as carrier and sodium caseinate as emulsifying agent. Several oil:water as well as maltodextrin:water ratios were tested, the homogenization and spray-drying processes and the reconstitution properties were investigated and an optimum formulation was selected for poorly soluble drug incorporation, having an identical oil:water and carrier:water ratio of 10% (w/w) and a load of solid material of 20% (w/w). Lipophilic 5-phenyl-1,2-dithiole-3-thione (5-PDTT) was selected as a model drug. 5-PDTT release from the solid state emulsion was studied using an in vitro two-phase stirred model and the relative bioavailability of 5-PDTT in the dry emulsion was obtained in the rabbit after oral administration of the reconstituted emulsion, compared to a 5-PDTT-sulfobutyl ether 7 beta-cyclodextrin complex in solution. Incorporation of 5-PDTT in the oil phase neither affects the surface morphology of the powder nor the reconstitution, the droplet size or the drug releasing properties and, furthermore, allows a 3-fold improvement of 5-PDTT relative bioavailability in rabbit after oral administration. These results indicate that dry emulsions may be considered as relevant dosage forms to improve bioavailability of poorly absorbable lipophilic drugs.     

An unusual cause of acute respiratory distress

A 54-year-old patient was admitted to our ICU for ketoacidosis with acute respiratory distress (ARD). The main and unusual cause of ARD was hypophosphataemia. Patient-related risk factors for chronic hypophosphataemia were malnutrition, chronic alcoholism, and diabetes mellitus. Correction of the metabolic acidosis by insulin therapy resulted in intracellular penetration of phosphate and potassium, causing severe hypophosphataemia and hypokaliaemia responsible for ARD. This case provides an opportunity for reviewing the main causes and consequences of hypophosphataemia, and for emphasising the value of monitoring serum phosphate levels and providing supplemental phosphate in ICU patients at risk for phosphate depletion.     

Tumeurs hamartomateuses et pluritissulaires

Hamartoma are defined by the benign proliferation of cells normally occurring in the affected tissue or organ. The structure of the hyperplasic region can greatly differ from the normal histology of the affected tissue, due to the quantity, the layout, or the maturation state of tumoral cells. Hamartoma of the maxilla and mandible are a heterogeneous group of diseases. They nevertheless share two major therapeutic characteristics: surgical treatment of the mass effect and the deformations induced by tumoral growth and mandatory screening for associated extra-facial tumors.