[Regulation of clinical research in European countries].
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Under strict observation of the ethical guidelines of the 1975 Declaration of Helsinki Human Research Committee, primary hepatocyte cultures were prepared from second-trimester fetal liver specimens. We have shown for the first time that fetal hepatocytes have the capacity to produce an acute-phase response on treatment with inflammatory mediators. Addition of interleukin-6 to the cultures resulted in strong induction of C-reactive protein and alpha-1-antichymotrypsin expression, whereas albumin expression was repressed. In contrast to interleukin-6, transforming growth factor-beta did not induce C-reactive protein expression. However, as in adult hepatocytes, fetal cells responded to transforming growth factor-beta by reduced albumin synthesis. We were able to show by virtue of fluorescein excretion into sealed clefts that fetal hepatocytes have the functional capacity to form bile. Our findings indicate that second-trimester hepatocytes can be regarded as fairly mature liver cells.
The rapid expansion over the last decade in medical research, sponsored by rich countries but undertaken in developing countries, has led to several reports and guidelines, three of which are excerpted here.
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The authors studied the function of human fetal liver cell--on level of DNA and gene regulation--by methods of molecular biology. Experiments were done under strict observation of the ethical guidelines of the 1975 Declaration of Helsinki Human Research Committee. They conclude that human fetal liver culture may serve as a suitable in vitro modell for study of the liver specific gene expressions. They found that cultured human fetal liver cells from second trimester express albumin and AFP. They demonstrate that fetal hepatocytes--like adult hepatocytes--respond to the inflammatory mediators, IL-1, IL-6 and TNF, by induction of CRP and alpha-1-Ach expression and regression of albumin synthesis proving the ability of fetal hepatocytes to produce an acute phase response.
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Professional and drug development laws require that each project involving human research is submitted to a specially appointed independent committee (Ethics Committee) to ensure conformity with the ethical principles of the medical profession (Declaration of Helsinki). Today the public demands this prerequisite for clinical research. The main goal is to protect the patient or proband from unjustified risks. The interest of the subject must always prevail over the interests of science and society.
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Clinical research is indispensable for determining the safety and efficacy of drugs in human. It provides the scientific basis for rational drug usage. Methodology of clinical trials can raise some ethical issues. As an example the use of a placebo is described in this paper. Generally the ethical issues may be solved by the adequate information of every individual assigned to clinical investigation in agreement with the Declaration of Helsinki and the Huriet law. This information must be approved by an ethical committee. Finally an information about the general provisions of clinical trials must be destined to the general public.
Randomized clinical trials are an accepted form of experimentation on human subjects to determine the effectiveness of new treatment regimens or drugs. The Declaration of Helsinki, adopted by the World Medical Association, has established guidelines to safeguard humans used as subjects in medical experimentation. The ethical issues of informed consent, the physician-patient relationship and the potential for abuses in research must be considered prior to agreeing to participate in human experimentation.
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