Immune Dysregulation in the Oral Cavity during Early SARS-CoV-2 Infection

Tissue-specific immune responses are critical determinants of health-maintaining homeostasis and disease-related dysbiosis. In the context of COVID-19, oral immune responses reflect local host-pathogen dynamics near the site of infection and serve as important "windows to the body," reflecting systemic responses to the invading SARS-CoV-2 virus. This study leveraged multiplex technology to characterize the salivary SARS-CoV-2-specific immunological landscape (37 cytokines/chemokines and 11 antibodies) during early infection. Cytokine/immune profiling was performed on unstimulated cleared whole saliva collected from 227 adult SARS-CoV-2+ participants and 37 controls. Statistical analysis and modeling revealed significant differential abundance of 25 cytokines (16 downregulated, 9 upregulated). Pathway analysis demonstrated early SARS-CoV-2 infection is associated with local suppression of oral type I/III interferon and blunted natural killer-/T-cell responses, reflecting a potential novel immune-evasion strategy enabling infection. This virus-associated immune suppression occurred concomitantly with significant upregulation of proinflammatory pathways including marked increases in the acute phase proteins pentraxin-3 and chitinase-3-like-1. Irrespective of SARS-CoV-2 infection, prior vaccination was associated with increased total α-SARS-CoV-2-spike (trimer), -S1 protein, -RBD, and -nucleocapsid salivary antibodies, highlighting the importance of COVID-19 vaccination in eliciting mucosal responses. Altogether, our findings highlight saliva as a stable and accessible biofluid for monitoring host responses to SARS-CoV-2 over time and suggest that oral-mucosal immune dysregulation is a hallmark of early SARS-CoV-2 infection, with possible implications for viral evasion mechanisms.

POS0551 MEDICAL COSTS FOR PATIENTS STARTING TREATMENT FOR RHEUMATOID ARTHRITIS WHO HAVE COMORBID DIABETES MELLITUS IN JAPAN

Background:

Rheumatoid arthritis (RA) patients can experience various comorbidities1. The incidence of diabetes mellitus (DM) is reported higher in patients with RA2 and comorbid DM is likely to affect treatment outcomes3 and then healthcare resource uses, however, no previous study has not focused on it.

Objectives:

To evaluate medical costs and resource use in patients starting treatment for RA with and without DM using a large claims database in Japan.

Methods:

We used a large Japanese administrative claims database constructed by the Japan Medical Data Center (JMDC)4. Patients with the International Classification of Diseases 10th revision (ICD-10) codes for RA who started medication with disease-modifying antirheumatic drugs (DMARDs) after 6 months without them in the period from 1/1/2012 to 12/31/2017 and who were observable for 12 months as a follow-up period were enrolled. These patients were categorized as DM or non-DM group with ICD-10 codes for DM plus use of antidiabetic drugs in 6 months before starting DMARDs (baseline period). To adjust baseline characteristics between the 2 groups, they were matched by sex, age, Charlson Comorbidity Index (CCI) except for DM, months from the first RA codes to starting DMARDs, and medications. The primary endpoint was mean medical cost per patient in the 12-month follow-up period. Costs in JPY were converted into EUR (1 EUR = 125 JPY in 2020). Costs for drugs, treatments, and materials and their subcategories were evaluated both with and without DM-specific costs. The secondary endpoints were the proportions of patients using the subcategories of each resource.

Results:

Patients of 161 for the DM group and 2,974 for the non-DM group were eligible, and 109 patients were matched from each group. The medians of age and CCI were 59 years and 2.0 in both groups and no significant difference was observed in all baseline characteristics used for matching between the groups. Total mean costs were significantly higher in the DM group (DM, 5,331 EUR, non-DM 3,200 EUR; P< 0.05). After excluding DM-specific costs, drug costs were significantly higher in the DM group than in the non-DM group (DM 1,883 EUR, non-DM 896 EUR; P < 0.05), especially costs for biological DMARDs (DM 1,156 EUR, non-DM 292 EUR; P < 0.05), mainly because a higher proportion of patients used these drugs in the DM group (Table 1). Treatment costs (DM 2,380 EUR, non-DM 2,133 EUR) and material costs (DM 74 EUR, non-DM 149 EUR) were not different between the groups, but only costs for examinations were significantly higher in the DM group (DM 970 EUR, non-DM 779 EUR; P < 0.05).

Table 1.

Number and proportion of patients who used drugs

Type of drugDrug use, n (%)DM (N = 109)Non-DM (N = 109)P-valuecsDMARDsTotal109 (100.0)109 (100.0)1.000Methotrexate101 (92.7)102 (93.6)1.000Others46 (42.2)51 (46.8)0.583bDMARDsTotal16 (14.7)6 (5.5)0.041TNFi11 (10.1)4 (3.7)0.118IL6i6 (5.5)2 (1.8)0.219T-cell4 (3.7)0 (0.0)0.125tsDMARDs0 (0.0)0 (0.0)1.000CSs65 (59.6)62 (56.9)0.711AnalgesicsTotal103 (94.5)96 (88.1)0.167Acetaminophen24 (22.0)23 (21.1)1.000Acetaminophen /Opioids10 (9.2)6 (5.5)0.454NSAIDs102 (93.6)93 (85.3)0.093Opioids0 (0.0)4 (3.7)0.125Others25 (22.9)17 (15.6)0.185

bDMARDs=biological disease-modifying antirheumatic drugs; CSs=corticosteroids; csDMARDs=conventional synthetic disease-modifying antirheumatic drugs; DM=diabetes mellitus; IL6i=interleukin-6 inhibitor; NSAID=non-steroidal anti-inflammatory drug; T-cell=selective T-cell co-stimulation modulator; TNFi=tumor necrosis factor α inhibitor; tsDMARDs=targeted synthetic disease-modifying antirheumatic drugs; P-values were calculated using McNemar test

Conclusion:

Medical costs for RA were higher in the DM group than in the non-DM group because of more prevalent use of biological DMARDs in the DM group.

References:

[1]Gabriel SE et al., Arthritis Res Ther. 2009;11(3):229.

[2]Giacomelli R et al., Expert Rev Clin Immunol. 2016;12(8):849-55.

[3]Crepaldi G et al., PLoS One. 2016;11(1):e0146991.

[4]JMDC claims database, Tokyo, Japan.

Disclosure of Interests:

Eiichi Tanaka Speakers bureau: AbbVie GK, Asahi Kasei Pharma Corporation, Astellas Pharma Inc, Ayumi Pharmaceutical Corporation, Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., GlaxoSmithKline K.K., Kyowa Pharma Chemical Co., Ltd., Janssen Pharmaceutical K.K., Mochida Pharmaceutical Co., Ltd., Pfizer, Takeda Pharmaceutical Co., Ltd, and Teijin Pharma Ltd., Eisuke Inoue Speakers bureau: Pfizer Japan, Bristol-Myers Squibb K.K., Ryoko Sakai Speakers bureau: Bristol Myers Squibb Co., Ltd., Grant/research support from: Tokyo Women’s Medical University (TWMU), particularly the Division of Multidisciplinary Management of Rheumatic Diseases, Department of Rheumatology, has received unrestricted research grants from Ayumi Pharmaceutical Co.; Chugai Pharmaceutical Co., Ltd.; Eisai Co., Ltd., Nippon Kayaku Co., Ltd.; Taisho Toyama Pharmaceutical Co., Ltd.; Takeda Pharmaceutical Co., Ltd.; Mitsubishi Tanabe Pharma Co.; and Teijin Pharma Ltd., with which TWMU paid the salaries of RS., Iwasaki Katsuhiko: None declared, Ayako Shoji: None declared, masayoshi harigai Speakers bureau: AbbVie GK, Ayumi Pharmaceutical Corporation, Bristol-Myers Squibb K.K., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., Pfizer Japan Inc., and Takeda Pharmaceutical Co., Ltd., Consultant of: AbbVie GK, Bristol-Myers Squibb K.K., Chugai Pharmaceutical Co., Ltd., Eli Lilly Japan K.K., and Gilead Sciences Inc., Grant/research support from: AbbVie GK, and Asahi Kasei Corp., Astellas Pharma Inc., Ayumi Pharmaceutical Corporation, Bristol-Myers Squibb K.K., Chugai Pharmaceutical Co., Ltd. Daiichi-Sankyo, Inc., Eisai Co., Ltd., Mitsubishi Tanabe Pharma Corporation., Nippon Kayaku Co., Ltd., Taisho Pharmaceutical Co., Ltd., and Takeda Pharmaceutical Co., Ltd.

POS0554 MEDICAL COST AND RESOURCE USE IN PATIENTS STARTING TREATMENT FOR RHEUMATOID ARTHRITIS TREATED WITH AND WITHOUT CORTICOSTEROIDS IN JAPAN

Background:

The 2019 update of the European League Against Rheumatism (EULAR) treatment recommendations strongly recommends co-administration of corticosteroids (CSs) with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) in patients with RA as bridging therapy to improve the success rate of the first-line treatment and to avoid disease flare-ups1; however, current treatment guidelines for RA in Japan do not clearly mention about their use. Poor disease management after the initial diagnosis can affect the overall use of health services and the economic burden on patients.

Objectives:

To describe medical costs and resource use in patients with early RA treated with and without oral or injectable corticosteroids (CSs) as part of their initial treatment with disease-modifying antirheumatic drugs (DMARDs) in Japan.

Methods:

We used a large Japanese administrative claims database constructed by the Japan Medical Data Center (JMDC)2. Patients with the International Classification of Diseases 10th revision (ICD-10) codes for RA were enrolled at the first DMARDs prescription after no DMARDs prescription period for 6-months (index date) in the period from 1/1/2012 to 12/31/2017. Patients who were observable for 12 months after the index date as a follow-up period were included. Patients treated with CSs within the follow-up period were compared with those without them (CS and non-CS group). The primary endpoint was mean medical cost per patient in the 12-month follow-up period. The secondary endpoints were costs for drugs, treatments, and materials and the proportions of patients using the subcategories of each resource. Drugs were divided into medications for RA or for comorbidities including adverse events (AEs). Costs in JPY were converted into EUR (1 EUR = 125 JPY in 2020).

Results:

Eligible patients of 1,670 and 1,487 were identified as the CS and non-CS group (median age: 51 years and 50 years). Total mean costs were significantly higher in the CS group (CS, 4,448 EUR, non-CS 3,208 EUR; P< 0.05). Drug, treatment, and material costs were significantly higher in the CS group than in the non-CS group (drug for RA and AEs, CS 2,367 EUR, non-CS 1,581 EUR, P < 0.05; drug for RA only, CS 2,265 EUR, non-CS 1,516 EUR, P < 0.05; treatment, CS 1,987 EUR, non-CS 1,562 EUR, P < 0.05; material, CS 94 EUR, non-CS 65 EUR; P < 0.05). The resource use in almost all drug subcategories were higher in the CS group (Table 1), as well as in all treatment and material subcategories.

Table 1.

Number and proportion of patients who used drugs

Type of drugDrug use, n (%)CS (N = 1,670)Non-CS (N = 1,487)P-valuecsDMARDsTotal1,635 (97.9)1,447 (97.3)0.328 Methotrexate1,481 (88.7)1,315 (88.4)0.870 Others790 (47.3)551 (37.1)< 0.001bDMARDsTotal342 (20.5)181 (12.2)< 0.001 TNFi252 (15.1)129 (8.7)< 0.001 IL6i93 (5.6)40 (2.7)< 0.001 T-cell40 (2.4)17 (1.1)0.012AnalgesicsTotal1,512 (90.5)1,274 (85.7)< 0.001 Acetaminophen379 (22.7)273 (18.4)0.003 Acetaminophen / Opioids84 (5.0)37 (2.5)< 0.001 NSAIDs1,459 (87.4)1,214 (81.6)< 0.001 Opioids16 (1.0)10 (0.7)0.491 Others198 (11.9)101 (6.8)< 0.001AntibioticsTotal1,086 (65.0)873 (58.7)< 0.001 Antibacterial drugs1,022 (61.2)800 (53.8)< 0.001 Antifungal drugs133 (8.0)86 (5.8)0.019 Antiviral drugs172 (10.3)129 (8.7)0.136 Antiparasitic drugs5 (0.3)8 (0.5)0.443Anti-osteoporotic drugs341 (20.4)95 (6.4)< 0.001

bDMARDs=biological disease-modifying antirheumatic drugs; CSs=corticosteroids; csDMARDs=conventional synthetic disease-modifying antirheumatic drugs; IL6i=interleukin-6 inhibitor; NSAID=non-steroidal anti-inflammatory drug; T-cell=selective T-cell co-stimulation modulator; TNFi=tumor necrosis factor α inhibitor; P-values were calculated using Chi-square test

Conclusion:

Patients with early RA treated with CSs in the first year after starting DMARDs tended to use more resources and have higher medical costs than patients not treated with CSs.

References:

[1]Smolen JS et al., Ann Rheum Dis. 2020;79(6):685-699.

[2]JMDC claims database, Tokyo, Japan.

Disclosure of Interests:

Eiichi Tanaka Speakers bureau: AbbVie GK, Asahi Kasei Pharma Corporation, Astellas Pharma Inc, Ayumi Pharmaceutical Corporation, Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., GlaxoSmithKline K.K., Kyowa Pharma Chemical Co., Ltd., Janssen Pharmaceutical K.K., Mochida Pharmaceutical Co., Ltd., Pfizer, Takeda Pharmaceutical Co., Ltd, and Teijin Pharma Ltd., Eisuke Inoue Speakers bureau: Pfizer Japan, Bristol-Myers Squibb K.K., Ryoko Sakai Speakers bureau: Bristol Myers Squibb Co., Ltd., Grant/research support from: Tokyo Women’s Medical University (TWMU), particularly the Division of Multidisciplinary Management of Rheumatic Diseases, Department of Rheumatology, has received unrestricted research grants from Ayumi Pharmaceutical Co.; Chugai Pharmaceutical Co., Ltd.; Eisai Co., Ltd., Nippon Kayaku Co., Ltd.; Taisho Toyama Pharmaceutical Co., Ltd.; Takeda Pharmaceutical Co., Ltd.; Mitsubishi Tanabe Pharma Co.; and Teijin Pharma Ltd., with which TWMU paid the salaries of RS., Iwasaki Katsuhiko: None declared, Ayako Shoji: None declared, masayoshi harigai Speakers bureau: AbbVie GK, Ayumi Pharmaceutical Corporation, Bristol-Myers Squibb K.K., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., Pfizer Japan Inc., and Takeda Pharmaceutical Co., Ltd., Consultant of: AbbVie GK, Bristol-Myers Squibb K.K., Chugai Pharmaceutical Co., Ltd., Eli Lilly Japan K.K., and Gilead Sciences Inc., Grant/research support from: AbbVie GK, and Asahi Kasei Corp., Astellas Pharma Inc., Ayumi Pharmaceutical Corporation, Bristol-Myers Squibb K.K., Chugai Pharmaceutical Co., Ltd. Daiichi-Sankyo, Inc., Eisai Co., Ltd., Mitsubishi Tanabe Pharma Corporation., Nippon Kayaku Co., Ltd., Taisho Pharmaceutical Co., Ltd., and Takeda Pharmaceutical Co., Ltd.

AB1199 COST-EFFECTIVENESS OF EARLY INITIATION OF ABATACEPT ON JAPANESE RHEUMATOID ARTHRITIS PATIENTS BASED ON THE AMPLE STUDY, USING IORRA REAL WORLD DATA

Background:

Rheumatoid arthritis (RA) is a chronic inflammatory disorder leading to disability and reduced quality of life. Effective treatment with biologic disease-modifying antirheumatic drugs (bDMARD) poses a significant economic burden. The abatacept (ABT) versus adalimumab comparison in biologic-naive RA subjects with background methotrexate (AMPLE) trial1was a head-to-head randomized study.

Objectives:

To assess the cost-effectiveness (CE) of early initiation of ABT on Japanese RA patients with data from the IORRA database (ID).2

Methods:

A model based on the AMPLE study was used to estimate the CE of ABT 1stversus ABT 2ndlines in a cohort of 1000 patients based on responses on ACR20/50/70, HAQ-DI, CDAI and SDAI estimated from the real-clinical data of the ID. Unit costs for direct medical costs of adverse events (AEs), proportions of patients with concomitant medications or outpatient/inpatient visits; doses and duration of concomitant medications were taken from the JMDC claims database.3Uncertainty was assessed in sensitivity analyses (SA) where cost parameters were tested on their ±30% levels. Results were compared between subgroups using cut-offs of 65-years of age and 1.5 of HAQ, or 5-years of treatment duration. The study used a Japanese healthcare payers’ perspective over a 2-year time horizon.

Results:

Incremental costs were all in favor of ABT 2ndline with 137 MJPY (1.1 M€, 120 JPY=1 €), 6 MJPY (0.05 M€), 41 MJPY (0.3 M€), 8 MJPY (0.07 M€) and 2.2 MJPY (0.02 M€) for bDMARDs, concomitant medication, AEs, serious AE, and hospitalizations due to infections, respectively. In total, the incremental costs were expected to be 195 MJPY (1.6 M€) higher for ABT as 1stline treatment, but the cost per responding patient and per patient in remission favored ABT 1stline across most response outcomes (Table 1).

Table 1.

Total costs per responder and patient in remission per 2-year

Difference in cost per health gain(ABT first line - ABT second line)Cost per responding patient (kJPY)ACR20-2,927 (-24 k€)ACR50-6,406 (-53 k€)ACR70-10,822 (-90 k€)HAQ-DI-5,120 (-43 k€)Cost per patient in remission (kJPY)DAS28828 (7 k€)CDAI-7,019 (-58 k€)SDAI-5,584 (-47 k€)

ABT=abatacept; ACR20/50/70= 20/50/70% improvement of the American college of rheumatology criteria; HAQ-DI=health assessment questionnaire disability index; DAS28=disease activity score; CDAI=clinical disease activity index; SDAI=simplified disease activity index

SA showed that the cost for bDMARDs drives the difference in healthcare costs between the cohorts (-685 MJPY to 1,074 MJPY). For sub-groups of patients ≥65 years, <65 years, HAQ≥1.5, HAQ <1.5, treatment duration ≥5 years, <5 years the total 2-yearly costs per responder (SDAI remission) were 106 kJPY (0.9 k€), 321 kJPY (2.7 k€), 1,353 kJPY (11.3 k€), 106 kJPY (0.9 k€), 231 kJPY (1.9 k€) and 178 kJPY (1.5 k€) lower for ABT 1stline, respectively.

Conclusion:

Savings per responding patient are expected if ABT are prescribed as 1stline versus 2ndor 3rdline treatment, irrespective of age, disease duration and functional impairment level.

References:

[1]Sokolove J MS et al.,Anna rheum dis.2015;74(Suppl 2)

[2]IORRA cohort database, Tokyo Women’s Medical University, Tokyo, Japan

[3]JMDC claims database, Tokyo, Japan

Disclosure of Interests:

Eiichi Tanaka Consultant of: ET has received lecture fees or consulting fees from Abbvie, Asahi Kasei pharma co., Bristol Myers Squibb, Chugai Pharmaceutical, Daiichi Sankyo Co., Eisai Pharmaceutical, Janssen Pharmaceutical K.K., Nippon Kayaku, Pfizer, Takeda Pharmaceutical, Taisho Toyama Pharmaceutical Co., and UCB Pharma., Speakers bureau: ET has received lecture fees or consulting fees from Abbvie, Asahi Kasei pharma co., Bristol Myers Squibb, Chugai Pharmaceutical, Daiichi Sankyo Co., Eisai Pharmaceutical, Janssen Pharmaceutical K.K., Nippon Kayaku, Pfizer, Takeda Pharmaceutical, Taisho Toyama Pharmaceutical Co., and UCB Pharma., Eisuke Inoue Speakers bureau: EI has received speaker fee from Bristol-Meyers, Pfizer, Merck serono., Ayako Shoji Consultant of: To conduct this work, Jonas Nilsson Consultant of: To conduct this study, Christos Papagiannopoulos Consultant of: To conduct this study, Dhanda Devender Shareholder of: BMS, Employee of: BMS, Yoshio Anazawa Shareholder of: BMS, Employee of: BMS, Yuri Yoshizawa Shareholder of: BMS, Employee of: BMS, masayoshi harigai Grant/research support from: AbbVie Japan GK, Ayumi Pharmaceutical Co., Bristol Myers Squibb Co., Ltd., Eisai Co., Ltd., Mitsubishi Tanabe Pharma Co., Nippon Kayaku Co., Ltd., and Teijin Pharma Ltd. MH has received speaker’s fee from AbbVie Japan GK, Ayumi Pharmaceutical Co., Boehringer Ingelheim Japan, Inc., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., GlaxoSmithKline K.K., Kissei Pharmaceutical Co., Ltd., Oxford Immuotec, Pfizer Japan Inc., and Teijin Pharma Ltd. MH is a consultant for AbbVie, Boehringer-ingelheim, Kissei Pharmaceutical Co., Ltd. and Teijin Pharma.

Biotransport of metallic trace elements from marine to terrestrial ecosystems by seabirds

Physical systems, such as currents and winds, have traditionally been considered responsible for transporting contaminants. Although evidence is mounting that animals play a role in this process through their movements, we still know little about how such contaminant biotransport occurs and the extent of effects at deposition sites. In the present study, we address this question by studying how rhinoceros auklets (Cerorhinca monocerata), a seabird that occurs in immense colonies (∼300 000 pairs at our study site, Teuri Island), affect contaminant levels at their colony and at nearby sites. More specifically, we hypothesize that contaminants are transported and deposited by seabirds at their colony and that these contaminants are passed on locally to the terrestrial ecosystem. To test this hypothesis, we analyzed the concentration of 9 heavy metal and metalloids, as well as δ¹³ C and δ¹⁵ N stable isotopes, in bird tissues, plants, and soil, both within and outside of the colony. The results show that rhinoceros auklets transport marine-derived mercury (Hg), possibly from their wintering location, and deposit Hg via their feces at their breeding site, thereby contaminating plants and soils within the breeding colony. The present study confirms not only that animals can transport contaminants from marine to terrestrial ecosystems, potentially over unexpectedly long distances, but also that bird tissues contribute locally to plant contamination. Environ Toxicol Chem 2019;38:106-114. © 2018 SETAC.

Breeding phenology and winter activity predict subsequent breeding success in a trans-global migratory seabird

Inter-seasonal events are believed to connect and affect reproductive performance (RP) in animals. However, much remains unknown about such carry-over effects (COEs), in particular how behaviour patterns during highly mobile life-history stages, such as migration, affect RP. To address this question, we measured at-sea behaviour in a long-lived migratory seabird, the Manx shearwater (Puffinus puffinus) and obtained data for individual migration cycles over 5 years, by tracking with geolocator/immersion loggers, along with 6 years of RP data. We found that individual breeding and non-breeding phenology correlated with subsequent RP, with birds hyperactive during winter more likely to fail to reproduce. Furthermore, parental investment during one year influenced breeding success during the next, a COE reflecting the trade-off between current and future RP. Our results suggest that different life-history stages interact to influence RP in the next breeding season, so that behaviour patterns during winter may be important determinants of variation in subsequent fitness among individuals.

Experimental transmission of AA amyloidosis by injecting the AA amyloid protein into interleukin-1 receptor antagonist knockout (IL-1raKO) mice

The incidence of AA amyloidosis is high in humans with rheumatoid arthritis and several animal species, including cats and cattle with prolonged inflammation. AA amyloidosis can be experimentally induced in mice using severe inflammatory stimuli and a coinjection of AA amyloid; however, difficulties have been associated with transmitting AA amyloidosis to a different animal species, and this has been attributed to the "species barrier." The interleukin-1 receptor antagonist knockout (IL-1raKO) mouse, a rodent model of human rheumatoid arthritis, has been used in the transmission of AA amyloid. When IL-1raKO and BALB/c mice were intraperitoneally injected with mouse AA amyloid together with a subcutaneous pretreatment of 2% AgNO3, all mice from both strains that were injected with crude or purified murine AA amyloid developed AA amyloidosis. However, the amyloid index, which was determined by the intensity of AA amyloid deposition, was significantly higher in IL-1raKO mice than in BALB/c mice. When IL-1raKO and BALB/c mice were injected with crude or purified bovine AA amyloid together with the pretreatment, 83% (5/6 cases) and 38% (3/8 cases) of IL-1raKO mice and 17% (1/6 cases) and 0% (0/6 cases) of BALB/c mice, respectively, developed AA amyloidosis. Similarly, when IL-1raKO and BALB/c mice were injected with crude or purified feline AA amyloid, 33% (2/6 cases) and 88% (7/8 cases) of IL-1raKO mice and 0% (0/6 cases) and 29% (2/6 cases) of BALB/c mice, respectively, developed AA amyloidosis. These results indicated that IL-1raKO mice are a useful animal model for investigating AA amyloidogenesis.

Ultraviolet B irradiation modulates susceptibility to tumour necrosis factor-alpha-induced apoptosis via induction of death receptors in murine fibroblasts

Ultraviolet B (UVB) irradiation causes cell death by apoptosis in murine fibroblast cells. Tumor necrosis factor-alpha (TNF-alpha) is also a well known inducer of apoptosis, although the physiological significance of this activity is poorly understood. We investigated the effects of pretreatment with UVB (312 nm) on TNF-alpha-induced apoptosis in murine fibroblast cells. UVB enhanced susceptibility to cell death by TNF-alpha in a dose-dependent manner. UVB but not TNF-alpha induced the expression of TNF receptor type-1 (TNFR-1) and type-2 (TNFR-2) in a dose-dependent manner. Expression of Fas (CD95) and Fas-ligand (Fas-L), and significant DNA fragmentation were observed in the cells that died. These results suggest that UVB irradiation modulates susceptibility to TNF-alpha-induced apoptosis through the induction of TNFRs, Fas, and Fas-L in murine fibroblasts.

Urokinase receptor and vascular endothelial growth factor are synergistically associated with the liver metastasis of colorectal cancer

Considering recent findings that the urokinase plasniinogen activation (PA) system is involved in invasion and vascular endothelial growth factor (VEGF) is involved in angiogenesis of colorectal cancer, we evaluated these factors in the liver metastasis of primary colorectal cancer. Cancer tissues from 71 colorectal cancer patients were assayed quantitatively for antigen levels of urokinase type plasminogen activator (uPA), uPA receptor (uPAR), and plasminogen activator inhibitor‐1 and ‐2 (PAI‐1, PAI‐2), and were also assayed immunohistochemically for expression of VEGF protein. Among the PA system factors, both the levels of uPAR and PAI‐1 were significantly higher in larger tumors than in smaller ones, and were also significantly higher in tumors that invaded subserosa, serosa or adjacent organs than in mucosal, submucosal tumors or in tumors that invaded the muscle layer. The uPAR levels were significantly higher in tumors with liver metastasis than in those without. VEGF overexpression was significantly more frequent in tumors with lymph node involvement or liver metastasis than in those without. Among the PA system factors, the uPAR levels were significantly higher in tumors with VEGF overexpression and a multivariate analysis revealed that high uPA level and VEGF overexpression were independent risk factors for liver metastasis. The combination of high uPAR level and overexpression of VEGF was associated with the worst prognosis in patients with colorectal cancer. These results suggest that uPAR and VEGF might contribute Synergistically to the liver metastasis of colorectal cancer.

Overexpression of vascular endothelial growth factor is responsible for the hematogenous recurrence of early-stage gastric carcinoma

Vascular endothelial growth factor (VEGF) is crucial for angiogenesis in various malignant tumors. However, it is still unclear whether VEGF is responsible for hematogenous metastasis after the curative resection of gastric carcinoma. In the present study, we evaluated the relevance of VEGF expression to the hematogenous recurrence of stage 1 or 2 primary gastric adenocarcinoma. Among 530 patients, 11 (2.1%) had hematogenous recurrence. Clinicopathological variables were compared between these 11 patients (group R) and 88 patients without intramucosal carcinoma who survived for more than 5 years (group S). Microvessel density (MVD) was assessed immunohistochemically along with VEGF protein expression in all patients from group R and 21 randomly selected patients from group S. There were significant differences in age, tumor size and VEGF expression in tumor tissue between the groups. Positive staining for VEGF protein was observed in all patients of group R, of whom 6 had strongly positive staining. On the other hand, 11 out of 21 patients in group S had positive staining and it was weak in all cases. Both the positive and strongly positive rate were significantly higher in group R than those in group S. There was no significant difference in MVD between the 2 groups (17.7 +/- 11.09/field in group R vs. 14.8 +/- 10. 27/field in group S) and no significant correlation between VEGF expression, MVD and venous invasion, though a weak correlation between the intensity of VEGF staining and MVD was observed (negative staining 12.1 +/- 10.51; weakly positive 16.67 +/- 10.41; strongly positive 19.7 +/- 9.97). Our results suggest that overexpression of VEGF, and not MVD or venous invasion, plays an important role in the hematogenous recurrence of curatively resected gastric carcinoma.

Cu-Zn superoxide dismutase inhibits lactate dehydrogenase release and protects against cell death in murine fibroblasts pretreated with ultraviolet radiation

The effects of adding Cu-Zn superoxide dismutase (Cu-Zn SOD) to culture medium of the murine fibroblast cell line, L-929, pretreated with UV-B (312 nm, 480 mJ/cm(2)) have been investigated. Cell injury was monitored by the release of lactate dehydrogenase (LDH) into the medium, and cell death by the trypan blue exclusion test. UV-B radiation induced cell death by apoptosis, as demonstrated by DNA fragmentation. Over the range 0.1-0.3 microm Cu-Zn SOD, a significant dose-dependent protection against cell death was obtained of the UV-B exposed cells. Cell death correlated with the amount of LDH released into the medium, and Cu-Zn SOD treatment inhibited this. Heat-denatured Cu-Zn SOD did not affect either cell viability or the release of LDH from the cells. Endogenous Cu-Zn SOD activity, monitored by chemiluminescence, decreased by 20% in UV-B-irradiated cells; the addition of 0.3 microm exogenous Cu-Zn SOD to the medium did not affect intracellular Cu-Zn SOD activity. These results establish that Cu-Zn SOD added to extracellular medium can protect cells against injury caused by UV-B exposure.

Volatile chemicals identified in extracts from leaves of Japanese mugwort (Artemisia princeps pamp.)

Extracts from leaves of Japanese mugwort (Artemisia princeps Pamp.) were obtained using two methods: steam distillation under reduced pressure followed by dichloromethane extraction (DRP) and simultaneous purging and extraction (SPSE). A total of 192 volatile chemicals were identified in the extracts obtained by both methods using gas chromatography (GC) and gas chromatography-mass spectrometry (GC-MS). They included 47 monoterpenoids (oxygenated monoterpenes), 26 aromatic compounds, 19 aliphatic esters, 18 aliphatic alcohols, 17 monoterpenes (hydrocarbon monoterpenes), 17 sesquiterpenes (hydrocarbon sesquiterpenes), 13 sesquiterpenoids (oxygenated sesquiterpenes), 12 aliphatic aldehydes, 8 aliphatic hydrocarbons, 7 aliphatic ketones, and 9 miscellaneous compounds. The major volatile constituents of the extract by DRP were borneol (10.27 ppm), alpha-thujone (3.49 ppm), artemisia alcohol (2.17 ppm), verbenone (1.85 ppm), yomogi alcohol (1.50 ppm), and germacren-4-ol (1.43 ppm). The major volatile constituents of the extract by SPSE were 1,8-cineole (8.12 ppm), artemisia acetate (4.22 ppm), alpha-thujone (3.20 ppm), beta-caryophyllene (2.39 ppm), bornyl acetate (2.05 ppm), borneol (1.80 ppm), and trans-beta-farnesene (1. 78 ppm).

A study of conformational stability of polyglycine and poly(L-alanine), and polyglycine/poly(L-alanine) blends in the solid state by (13)C cross-polarization/magic angle spinning NMR

13C Cross-Polarization/Magic Angle Spinning nmr and T(1rhoH) experiments of polyglycine (PG), poly(L-alanine) (PLA), and PG/PLA blends prepared from dichloroacetic acid solution have been carried out, in order to elucidate the conformational stability of these polypeptides in the solid state. From these experimental results, it was clarified that the conformations of PG and PLA in their blends are strongly influenced by intermolecular hydrogen-bonding interactions that cause their miscibility at the molecular level.

Detection of pulmonary metastasis of low-grade endometrial stromal sarcoma 25 years after hysterectomy

Endometrial stromal sarcoma (ESS) is a rare uterine sarcoma. Low-grade ESS occasionally recurs or metastasizes after long disease-free periods, a fact that may complicate the diagnosis. Here we report a case of multiple lung metastases in a 68-year-old woman who had been disease-free for 25 years after hysterectomy for a uterine tumor. Biopsy revealed that the tumor was composed of oval cells with slight nuclear atypism but without mitotic figures, suggesting a low-grade neoplasm. Immunostaining for intermediate filaments revealed strong positivity for vimentin and weak positivity for alpha-smooth muscle actin. In addition, immunostaining for estrogen and progesterone receptors, performed under suspicion of low-grade ESS, was positive. The uterine tumor resected many years before had shown a similar morphology. Thus, it was demonstrated that the lung neoplasm was a metastatic low-grade ESS that had appeared after many disease-free years. A review of the literature revealed that this case had the longest recorded interval between the occurrence of the initial ESS and the development of distant metastases. When low-grade sarcoma appears in the lungs of female patients, it is important to consider the possibility of low-grade ESS. Detailed information on the past clinical history, together with immunostaining for estrogen and progesterone receptors, are important diagnostic keys.

Carcinogenicity test of polyoxyethylene(10) nonylphenyl ether (NP-10) in female B6C3F1 mice

A carcinogenicity study of polyoxyethylene(10)nonylphenyl ether (NP-10) to B6C3F1 mouse was performed using 50 females per group of 4 study groups, or 200 mice in total. Diets containing NP-10 at 0, 500, 1500 and 4500 ppm were prepared and orally administered to the animals repeatedly for 104 weeks, and observation of general conditions, body weight analysis, food consumption analysis, hematologic examination, organ weight analysis and pathological examination were performed. The results are summarized as follows. The mean intake of the test substance in the 500, 1500 and 4500 ppm groups for 104 weeks was 81.5, 254 and 873 mg/kg/day, respectively. There were no differences observed in mortality among the groups and the mortality did not exceed the background data in any groups. There were no signs attributable to the administration of the test substance, and various signs which increased in occurrence with aging were observed in all groups at a similar frequency. Body weight gain was suppressed only in the 4500 ppm group throughout the entire administration period. Food consumption was increased in all treated groups around the early stage of administration and, thereafter, in the 1500 and 4500 ppm groups until the mid-stage of administration. Decreased food efficiency was observed in the 4500 ppm group alone. As a result of the hematologic examination, no changes attributable to the administration of the test substance were observed in any groups. As a result of the organ weight analysis, lower absolute weights of the liver and kidney and higher relative weights of the brain, liver and kidney, which were considered to be changes accompanying the suppressed body weight gain, were observed in the 4500 ppm group. The pathological examination revealed no marked changes in the gross findings in the treated groups. As a result of the histological examination, there were no neoplastic or non-neoplastic lesions in the treated groups which were unequivocally observed to have increased in occurrence. As the above findings show, NP-10 did not cause any increase in the incidence of neoplastic lesions in the mouse by oral administration for 2 years at 873 mg/kg/day (4500 ppm) and was determined to have no carcinogenicity.

Oral chronic toxicity and carcinogenicity test of polyoxyethylene(10)nonylphenyl ether (NP-10) in female F344 rats

Chronic toxicity and carcinogenicity of polyoxyethylene(10)nonylphenyl ether (NP-10) to Fischer 344 rats were investigated using 70 females per group in 4 study groups, or 280 rats in total. Diets containing NP-10 at 0, 1000, 3000 and 9000 ppm were prepared and orally administered to the animals repeatedly for 52 weeks for a chronic toxicity study and for 104 weeks for a carcinogenicity study. Observations of general condition, body weight analysis, food consumption analysis, hematologic examination, blood chemistry examination (only at Week 52 of administration), urinalysis (only at Week 52), ophthalmologic examination (immediately prior to administration and at Week 52), organ weight analysis and pathological examination were performed. The results are summarized as follows. The mean intake of the test substance was 60.5, 182 and 559 mg/kg/day in the chronic toxicity study for 52 weeks and 55.2, 166 and 520 mg/kg/day in the carcinogenicity study for 104 weeks in the 1000, 3000 and 9000 ppm groups, respectively. Mortality decreased approximately in a dose-related manner, with 28% in the control group, 26% in the 1000 ppm group, and 14% each in the 3000 and 9000 ppm groups. In general condition, there were no signs attributed to the treatment with NP-10. Body weight gain was suppressed in the 9000 ppm group throughout the administration period and in the 3000 ppm group during Weeks 21-88. Food consumption decreased in the 9000 and 3000 ppm groups. Food efficiency was lower in the 9000 and 3000 ppm groups. As a result of the hematologic examination, hematocrit value, hemoglobin value, red blood cell count, platelet count and MCV were lower and MCH and MCHC higher in the 9000 ppm group at Week 52 of administration. At Week 104, the neutrophil ratio was higher and lymphocyte ratio lower in the 3000 and 9000 ppm groups, and furthermore, hematocrit value, hemoglobin value, MCV and MCH were slightly lower in the 9000 ppm group. In the blood coagulability tests, prothrombin time was slightly shortened in the 9000 ppm group at Week 52. As a result of the blood chemistry examination, total protein and albumin values were higher and total bilirubin, uric acid and trygliceride value lower in the 3000 ppm and higher dose groups. Furthermore, the free cholesterol value was higher and the values of potassium, cholesterol ester ratio, GOT, GPT, ALP and cholinesterase were lower in the 9000 ppm group. As a result of the urinalysis, the specific gravity of urine was higher and urine pH acidic in some animals. As a result of the ophthalmologic examination, no abnormal animals were found in the 9000 ppm group. As a result of the organ weight analysis, absolute and relative weights of the liver and adrenals were higher in the 3000 and/or 9000 ppm groups as changes which were considered attributable to the test substance and, in addition, organs with a lower absolute weight and higher relative weight with the suppressed body weight gain were observed in the 9000 ppm group. The histopathological examination revealed no marked findings in necropsy observation or histology in the treated groups in the animals killed at Weeks 52, 104 as well as those killed moribund and dead animals. In the histological findings, bile duct hyperplasia of liver in the animals killed at Week 52, proliferative duct of pancreas in the animals killed at Week 104, pigment of deposit in pituitary and angiectasis of adrenals in the animals killed at moribund and dead animals were observed in a slightly larger number in the treated groups, but none of these changes were different in degree from the control and were not considered to be specific lesions. As a result of the overall study of the neoplastic lesions of all animals killed on schedule and of moribund and dead animals, no tumors were found in the treated groups which had increased in occurrence. Based on the above findings, it was determined that the no-adverse-effect level in the chronic toxicity study was 1000 ppm (

Aroma chemicals isolated and identified from leaves of Aloe arborescens Mill. Var. Natalensis Berger

Extracts from leaves of aloe (Aloe arborescens Mill. var. natalensis Berger) were obtained using two methods: steam distillation under reduced pressure followed by dichloromethane extraction (DRP) and simultaneous purging and extraction (SPE). A total of 123 aroma chemicals were identified in the extracts obtained by both methods using gas chromatography and gas chromatography/mass spectrometry. There were 42 alcohols, 23 terpenoids, 21 aldehydes, 9 esters, 8 ketones, 6 acids, 5 phenols, and 9 miscellaneous compounds. The major aroma constituents of this extract by DRP were (Z)-3-hexenol (29.89%), (Z)-3-hexenal (18.86%), (E)-hexenal (7.31%), 4-methyl-3-pentenol (5.66%), and butanol (4.29%). The major aroma constituents of this extract by SPE were (E)-2-hexenal (45.46%), (Z)-3-hexenal (32.12%), hexanal (9.14%), (Z)-3-hexenol (1.60%), and 3-pentanone (1.41%). Terpenoids were also found as one of the major constituents. The fresh green note of aloe leaves is due to the presence of these C(6) alcohols and aldehydes as well as terpenoids.

Phorbol ester facilitates apoptosis in murine fibroblasts pretreated by mild ultraviolet radiation

Although phorbol 12-myristate 13-acetate (PMA) inhibits apoptosis and promotes the growth of some types of cells, it induces apoptosis in other cells. We evaluated the apoptotic effects of PMA on murine fibroblasts (L-929) that had been exposed to ultraviolet-B (UV-B) radiation at 312 nm, which promotes tumor cell growth. Exposure to PMA alone did not induce Fas, Fas-L, or apoptosis. Cells exposed to mild UV-B irradiation (80 J/m(2)) alone exhibited a slight expression of Fas and Fas-L 36 to 48 h after the exposure, and exhibited apoptosis as evidenced by DNA fragmentation 72 h after exposure. The addition of PMA (0.8 x 10(-5) to 3.2 x 10(-5) M) to the medium 24 h after the UV-B exposure markedly and dose-dependently enhanced these cell responses. Confluent untreated cells, cells cocultured with PMA, and cells cocultured with PMA for 24 h after the UV-B exposure consistently expressed mRNAs for wild-type p53, bcl-2, and ICE. Expression of c-myc mRNA was initially observed, but became undetectable in the cells cocultured for 24 h with a high concentration of PMA (3.2 x 10(-5) M) following UV-B exposure. Such cells subsequently exhibited the maximal apoptotic response. We conclude that mild exposure to UV-B altered murine fibroblast cells in such a way as to facilitate their death by apoptosis upon addition of PMA.

[Usefulness of bronchoscopy for the diagnosis of atypical pulmonary mycobacteriosis]

In 14 subjects whose chest radiographs showed abnormal shadows during the two years from January 1995 until December 1996, no definite diagnosis could be obtained because sputum, smears and cultures all gave negative results for mycobacteria. Bronchoscopy was therefore performed, revealing atypical mycobacteria in cultures of the bronchial washing fluid for mycobacteria, and the significance of bronchoscopic examinations in cases diagnosed an atypical pulmonary mycobacteriosis was investigated. Most of the subjects (9) were women. Nine subjects had been informed that they had abnormal chest shadows; five had subjective symptoms; bloody sputum, 3 and cough, 2. The characteristics of the shadows were as follows: in the plain radiographs, the main shadows had a mottled or granular appearance in the majority of the patients (9) and there were infiltrative shadows in 3 patients and nodular shadows in another 3. In computed tomograms, the shadows in the vicinity of the pleura appeared as micronodular conglomerates in 12 patients, in 11 of whom bronchiectasis was also present near the shadows. Alveolar infiltrative shadows were present in four cases, and a cavity was seen in only one. Smears of the bronchial washing fluid for mycobacteria were positive in 7 patients, and cultures of this fluid yielded at least 100 colonies in 8 of the 14 subjects for whom the results were positive. By culture, Mycobacterium avium complex (MAC) was identified in 13 patients, but eleven of these in whom the bronchial washing fluid was concurrently tested for MAC by the polymerase chain reaction, only four were MAC-positive. Transbronchial lung biopsies were performed in 11 cases, in which the histological findings of mycobacterial infections showed granuloma in four, and caseation in three. Bronchoscopy is making possible initial-stage diagnosis, which are normally difficult, among the recently growing number of cases of the bronchial form of atypical pulmonary mycobacteriosis and is also useful for reaching definite diagnosis in the early stage.

Insufficient effectiveness of 5-hydroxytryptamine-3 receptor antagonists due to oral morphine administration in patients with cisplatin-induced emesis

PURPOSE

To compare the effect of 5-hydroxytryptamine-3 (5HT(3)) receptor antagonists in cancer patients receiving chemotherapy including cisplatin (CDDP), with or without sustained-release oral morphine (MS Contin; Shionogi Co, Osaka, Japan).

PATIENTS AND METHODS

We retrospectively studied 58 lung cancer patients given chemotherapy including at least 50 mg/m(2) CDDP with 5-HT(3) receptor antagonists between January 1996 and December 1997. Number of vomiting episodes, average proportions of hospital-supplied meals consumed (0 to 100%, as an index of appetite), and nausea severity scores (0 to 2 points, subjective patient judgment) were compared between oral morphine-administered (+) and morphine-free (-) groups.

RESULTS

Sixteen morphine(+) and 42 morphine(-) cases were used. In cases of acute emesis (within 24 hours after CDDP injection), morphine(+) and morphine(-) groups were significantly different in number of vomiting episodes (1.25 and 0.14, respectively; P <.0001), appetite (58.13% and 90.24%; P <.0001), and nausea severity scores (1.63 and 0.62; P <.0001). In delayed-emesis cases (24 to 120 hours after CDDP), these groups differed significantly in number of vomiting episodes (1.94 and 0.43, respectively; P =.0001), appetite (23.13% and 52.08%; P <.0001), and nausea severity (1.38 and 0.91; P =.009). There were no significant differences in sex, age, anticancer drugs concurrent with CDDP, CDDP dose, corticosteroid administration, clinical stage, or type of 5-HT(3) antagonist.

CONCLUSIONS

These data suggest that morphine can markedly reduce the effectiveness of 5-HT(3) receptor antagonists in patients receiving chemotherapy that includes CDDP. These results require confirmation by reinvestigation of clinical data on the efficacy of 5-HT(3) receptor antagonists and by extensive prospective analyses.