A New Serum Biomarker Set to Detect Mild Cognitive Impairment and Alzheimer's Disease by Peptidome Technology

Background:

Because dementia is an emerging problem in the world, biochemical markers of cerebrospinal fluid (CSF) and radio-isotopic analyses are helpful for diagnosing Alzheimer’s disease (AD). Although blood sample is more feasible and plausible than CSF or radiological biomarkers for screening potential AD, measurements of serum amyloid- β (Aβ), plasma tau, and serum antibodies for Aβ_1 - 42 are not yet well established.

Objective:

We aimed to identify a new serum biomarker to detect mild cognitive impairment (MCI) and AD in comparison to cognitively healthy control by a new peptidome technology.

Methods:

With only 1.5μl of serum, we examined a new target plate “BLOTCHIP^®” plus a matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF/MS) to discriminate control (n = 100), MCI (n = 60), and AD (n = 99). In some subjects, cognitive Mini-Mental State Examination (MMSE) were compared to positron emission tomography (PET) with Pittsburgh compound B (PiB) and the serum probability of dementia (SPD). The mother proteins of candidate serum peptides were examined in autopsied AD brains.

Results:

Apart from Aβ or tau, the present study discovered a new diagnostic 4-peptides-set biomarker for discriminating control, MCI, and AD with 87% of sensitivity and 65% of specificity between control and AD (^***p < 0.001). MMSE score was well correlated to brain Aβ deposition and to SPD of AD. The mother proteins of the four peptides were upregulated for coagulation, complement, and plasticity (three proteins), and was downregulated for anti-inflammation (one protein) in AD brains.

Conclusion:

The present serum biomarker set provides a new, rapid, non-invasive, highly quantitative and low-cost clinical application for dementia screening, and also suggests an alternative pathomechanism of AD for neuroinflammation and neurovascular unit damage.

Two Cases of Probable Neuro-Behçet's Disease with Longitudinally Extensive Transverse Myelitis

We report 2 cases of probable neuro-Behçet's disease (NBD) with longitudinally extensive transverse myelitis (LETM). In both cases, the patients presented paraplegia, as well as sensory, bladder, and rectal disturbances. Magnetic resonance imaging (MRI) of patient 1 showed continuous high signal intensity extending from the midbrain to the entire spinal cord in the central part of the cord on T2-weighted imaging (T2WI). Spinal MRI of patient 2 revealed high signal intensity extending from Th2 to Th10 in the central part of the cord on T2WI. Both patients received high-dose methylprednisolone. A continuous lesion from the midbrain to the entire spinal cord as in patient 1 has not been previously reported. Patient 2 dramatically improved by infliximab therapy. The present cases suggest that NBD should be considered as a differential diagnosis in patients with LETM.

Clinical Benefits of Antioxidative Supplement Twendee X for Mild Cognitive Impairment: A Multicenter, Randomized, Double-Blind, and Placebo-Controlled Prospective Interventional Study

Oxidative stress is part of the entire pathological process that underlies the development of Alzheimer's disease (AD), including the mild cognitive impairment (MCI) stage. Twendee X (TwX) is a supplement containing a strong antioxidative mix of eight antioxidants, which has been shown to have a clinical and therapeutic benefit in AD model mice. Here, we conducted a multicenter, randomized, double-blind, and placebo-controlled prospective interventional study to evaluate the efficacy of TwX in mitigating MCI. The primary outcomes were differences in Mini-Mental State Examination (MMSE) and Hasegawa Dementia Scale-revised (HDS-R) scores between baseline and six months for placebo and TwX groups. Seventy-eight subjects with MCI were randomized into placebo (n = 37) and TwX (n = 41) groups. MMSE scores at six months differed significantly between the TwX and placebo groups (p = 0.018), and HDS-R scores for the TwX group exhibited a significant improvement at six months relative to baseline (p = 0.025). The TwX group did not show any change in affective or activities of daily living scores at six months. The present study indicates that strong antioxidative supplement TwX is clinical beneficial for cognitive function in subjects with MCI.

Clinical impact of triglyceride deposit cardiomyovasculopathy, coronary atherosclerosis with triglyceride deposition, on vascular failure after drug-eluting stent implantation

Background

Triglyceride deposit cardiomyovasculopathy (TGCV) is a novel cardiovascular disorder, encoded as orphan disease in Europe in 2019, characterized by excessive accumulation of triglyceride in vascular smooth muscle cells, leading to coronary artery disease (CAD). However, there is no data about impact of TGCV on vascular failure after coronary stent implantation.

Purpose

To assess impact of TGCV on the outcome following coronary stent implantation in CAD patients with diabetes mellitus (DM) as Study 1, and chronic hemodialysis as Study 2.

Methods

This is multicenter retrospective estimation consisting of two studies.

Study 1) Among 526 consecutive patients suspected of having CAD who underwent coronary angiography (CAG) and iodine-123-β-methyliodophenyl-pentadecanoic acid (BMIPP) scintigraphy, a tracer for the diagnosis of TGCV, data from 81 patients with DM were analyzed.

The patients were divided into two groups; TGCV (n=7) or non-TGCV (n=74). All patients were implanted with a second-generation DES and underwent follow-up CAG. Binary restenosis (ISR), defined as angiographic luminal diameter &gt;50% by quantitative coronary angiography, in-stent late loss were assessed in 15 stents of TGCV patients and 111 stents of non-TGCV patients.

Study 2) Similarly, among 88 chronic hemodialysis patients, ISR and in-stent late loss were assessed in 12 stents of 9 TGCV patients and 21 stents of 17 non-TGCV patients.

Results

Study 1) There were no significant differences in baseline characteristics between the two groups. In-stent late loss was greater in TGCV group than in non-TGCV group (0.91mm [0.27, 2.39] vs. 0.15mm [0.03, 0.35]; p&lt;0.001), resulting in greater incidence of ISR in TGCV group than in non-TGCV group (46.7% vs. 9.0%; p&lt;0.001). Multivariable logistic analysis revealed TGCV to be an independent predictor for vascular failure after DES implantation in patients with DM.

Study 2) Similarly, in-stent late loss and incidence of ISR were greater in TGCV group than in non-TGCV group (1.20±0.99mm vs. 0.50±0.70, p=0.02; 58.3% vs. 9.5%, p=0.002, respectively). TGCV was an independent predictor for vascular failure after DES implantation in chronic hemodialysis patients.

Conclusion

Apart from existing risk factors such as DM and hemodialysis, TGCV could contribute to a novel risk factor for vascular failure, even in the second-generation DES era.

Figure 1

Funding Acknowledgement

Type of funding source: None

Differential impact of target vessel on the diagnostic performance of resting full-cycle ratio as non-hyperemic physiological assessment

Background

Recently, wire-based resting indices have been recognized as gold standard for evaluating physiological lesion assessment. The resting full-cycle ratio (RFR) is a unique resting index which is calculated as the point of absolutely lowest distal pressure to aortic pressure during entire cardiac cycle. It is unclear whether the diagnostic performance of RFR for detecting functional coronary artery stenosis is similar in each coronary artery. The aim of this study is to compare the diagnostic performance of RFR based on target coronary vessel.

Method

This study was a prospectively enrolled observational study. A total of 156 consecutive patients with 220 intermediate lesions were enrolled in this study. The RFR was measured after adequately waiting for stable condition, while FFR was measured after intravenous administration of ATP (180mcg/kg/min). Lesions with FFR ≤0.80 were considered functionally significant coronary artery stenosis.

Results

In all lesions, reference diameter, diameter stenosis, lesion length, RFR, and FFR were 3.0±0.7mm, 45±13%, 13.0±8.8mm, 0.90±0.09, and 0.82±0.10, respectively. Functional significance was observed in 88 lesions (40%) of all lesions. RFR showed a significant correlation with FFR in overall lesions (r=0.774, p&lt;0.001). The ROC curve analysis of RFR showed good accuracy for predicting functional significance (AUC 0.87, diagnostic accuracy 81%) in all subjects. Regarding each target vessel, there were similar and significant positive correlation between RFR and FFR (LAD; r=0.733, p&lt;0.001, LCX; r=0.771, p&lt;0.001, RCA; r=0.769, p&lt;0.001, respectively). The prevalence of discordant between RFR and FFR was significantly different among 3 vessels (LAD 26%, LCX 12%, RCA 13%, respectively, p&lt;0.05 for among 3 groups). Regarding the comparison of ROC curves according to lesion location, AUC was significantly lower in LAD than in LCX and RCA (LAD 0.780, LCX 0.947, RCA 0.926, p&lt;0.01 for LAD compared to LCX, p&lt;0.01 for LAD compared to RCA, respectively). Furthermore, the diagnostic accuracy was significantly different according to target vessel (LAD 74%, LCX 88%, RCA 87%, respectively, p&lt;0.05 for among 3 vessels).

Conclusion

RFR demonstrated better diagnostic accuracy for evaluating functional lesion severity. The diagnostic performance of RFR was different based on target vessel. RFR is a unique and useful resting index, and it may detect functionally significant coronary stenosis that cannot be detected with other resting indices in daily practice.

Funding Acknowledgement

Type of funding source: None

Impact of higher detection rate of residual pulmonary thromboemboli one-year after acute pulmonary embolism: modified CT scan imaging method with modified CT obstruction index

Background

Recently, post pulmonary embolism (PE) syndrome or chronic thromboembolic disease after acute PE, has been recognized as important long-term complications. Furthermore, patients may develop with chronic thromboembolic pulmonary hypertension.

Purpose

We aimed to evaluate the frequency of residual pulmonary thromboemboli after acute PE by using our “higher”-resolution CT scan imaging method to detect residual thromboemboli down to sub-segmental pulmonary arteries.

Methods

This study was a prospective multi-center observational study. We enrolled consecutive 34 patients with acute symptomatic PE whose informed consent was obtained, and followed up for one year. One year after the onset of acute PE, patients were referred to our hospital and multiple examination including CT scan, 6-minute walk test (6MWT), questionnaire of SF-36, echocardiography and laboratory testing were performed. Additionally, we have modified the CT obstruction index (CTOI) to quantitatively evaluate the thromboemboli down to sub-segmental pulmonary arteries.

Results

Mean age was 60.5±15.8 years, and 56% were male. No patient was categorized as low recurrent VTE risk which was caused by transient factors, one patient was associated with active cancer, and 12% had known thrombophilia. In 85% of the patients, this onset was the first obvious episode of PE. At diagnosis, elevated B-type natriuretic peptide (BNP) (≥100 pg/ml) or N-terminal (NT)-proBNP (≥500 pg/ml) was observed in 45% of the patients. Median tricuspid regurgitation peak gradient (TRPG) by echocardiography was 30.9 (19.3–50.1) mmHg. Among all, 35% of the patients received single-drug approach with DOACs. At discharge, all of the patients except two were treated with DOACs.

One year after the onset, 21% of the patient were in NYHA II and others were in NYHA I. It was notable that pulmonary thromboemboli was detected by our CT scan in 76% of the patients. Modified CTOI was median 11.9 (1.8–24.4) % as shown in the figure.

In multiple regression analysis, TRPG at diagnosis and BNP at one month were significantly associated with mCTOI (β=0.536, p=0.002 and β=−0.482, p=0.003, respectively). Additionally, lowest SpO2 during 6MWT after one year from the onset, tended to inversely associate with mCTOI (β=−0.341, p=0.052).

Conclusions

Using our modified CT scan imaging method and modified CTOI, residual pulmonary thromboemboli was able to be detected more frequently than the previous studies. Residual pulmonary thromboemboli could be one of the cause of the post PE syndrome and lead to exercise-induced desaturation.

Figures

Funding Acknowledgement

Type of funding source: None

Clinical course of pulmonary embolism patients treated with DOACs: comparing prognosis, recurrent thromboembolism, and major bleeding between patients with and without cancer

Background

Venous thromboembolism (VTE) is the third frequent acute cardiovascular syndrome in the Europe and Japan. Since direct oral anticoagulants (DOACs) are widely used now, the morbidity and mortality of pulmonary embolism (PE) patients especially associated with cancer needs to be re-evaluated.

Purpose

We evaluated the clinical course of patients with PE mainly treated with DOACs.

Methods

This retrospective observational study was conducted in a single center. The data were collected from the medical record of consecutive patients who received inpatient treatment of PE. In this study, we have compared PE patients with cancer (cancer PE) to those without cancer (non-cancer PE) and evaluated the mortality, recurrent of VTE and major bleedings.

Results

In total, 140 patients were enrolled: 94 patients were cancer-related, and 46 patients were without cancer (Table). The type of the tumor in cancer PE patients were as follows: gastric 8 (9%), esophageal 5 (5%), pancreatic 12 (13%), lung 14 (15%), lymphoma 2 (2%), gynecologic 17 (18%), renal 2 (2%), bile duct 8 (9%), colon 12 (13%), and others 17 (18%).

Kaplan-Meier curve showed that the cumulative all-cause mortality was significantly higher in the cancer PE group (35/94 (37%) vs. 2/46 (4%), P&lt;0.001 (log rank), HR 10.3 [95% CI:2.5–43.3]). The cumulative incidence of recurrent VTE was significantly higher in the cancer PE group (7/94 (7%) vs. 0/46, P=0.03 (log rank)). There was no significant difference in the cumulative incidence of major bleeding between the cancer PE group and the non-cancer PE group (8/94 (9%) vs. 5/46 (11%)).

Conclusions

The risk of recurrent VTE was still higher in cancer PE patients compared to non-cancer PE patients, although DOACs were used. Meanwhile the incidence of major bleeding was comparable in both groups, the risk of bleeding might be acceptable with using DOACs especially in cancer PE patients.

Figure 1

Funding Acknowledgement

Type of funding source: None

Discordance predictor between fractional flow reserve and resting full-cycle ratio in clinical characteristics

Introduction

Fractional flow reserve (FFR) is a gold standard method to evaluate functional lesion severity in daily clinical practice. Recently, the resting full-cycle ratio (RFR) which was newly developed resting indices was launched. Unlike other resting indices evaluated in diastolic phase, RFR is evaluated during entire cardiac phase. Previous studies showed discordance predictors between FFR and instantaneous wave-free ratio. However, it is previously unreported what predictor cause discordant outcome between FFR and RFR.

Purpose

The purpose of this study was to evaluate clinical predictors of discordance between FFR and RFR.

Methods

A total of 156 patients with 220 lesions were prospectively enrolled in this study. RFR was evaluated before inducing hyperemia. FFR was measured after intravenous adenosine triphosphate administration (180 mcg/kg/min). According to FFR and RFR values, the patients and lesions were classified into 4 groups: Concordant negative (Group-1 [n=114]: FFR &gt;0.80, RFR &gt;0.89); negative FFR and positive RFR (Group-2 [n=18]: FFR &gt;0.80, RFR ≤0.89); positive FFR and negative RFR (Group-3 [n=25]: FFR ≤0.80, RFR &gt;0.89); Concordant positive (Group-4 [n=63]: FFR ≤0.80, RFR ≤0.89). Among them, discordance predictors with clinical characteristics between RFR and FFR were compared using by two separate logistic regression analyses. (Group-1 vs. Group-2, Group-3 vs. Group-4, respectively). Age, sex and those predictors with a p value ≤0.10 were included in a multivariate regression analysis using by forward stepwise selection to identify independent predictors of discordance.

Results

On multiple regression analysis, hemodialysis (HD) (OR:6.072 [1.090–33.836]), peripheral artery disease (PAD) (OR:9.053 [1.776–46.162]) and left anterior descending artery (LAD) (OR:9.264 [2.092–41.031]) were significantly associated with positive RFR among negative FFR groups (Groupe 2 discordance). Conversely, diabetes mellitus (DM) (OR:0.212 [0.062–0.721]) and Hb (OR:1.480 [1.102–1.987]) were significantly associated with negative RFR among positive FFR groups (Groupe 3 discordance)

Conclusions

Since the clinical characteristics with HD, PAD, LAD, DM and Hb may influence concordant with FFR during RFR evaluation, it should be considered when interpreting RFR.

Distribution and independent predictors

Funding Acknowledgement

Type of funding source: None

Diagnostic feasibility of resting full-cycle ratio between systole and diastole to assess functional lesion severity of intermediate coronary artery stenosis

Background

Recently, non-hyperemic physiologic indices have become widespread for evaluating physiological lesion assessment. The resting full-cycle ratio (RFR) is a unique non-hyperemic index which is calculated as the point of absolutely lowest distal pressure to aortic pressure during entire cardiac cycle. It is unclear whether RFR may detect functionally significant coronary stenosis that cannot be detected with other resting indices due to differences in the cardiac cycle. The aim of this study is to compare the diagnostic performance of RFR based on cardiac cycle.

Method

This study was a prospectively enrolled observational study. A total of 156 consecutive patients with 220 intermediate lesions were enrolled in this study. The RFR was measured after adequately waiting for stable condition, while FFR was measured after intravenous administration of ATP (180mcg/kg/min). Lesions with FFR ≤0.80 were considered functionally significant coronary artery stenosis.

Results

In all lesions, reference diameter, diameter stenosis, lesion length, RFR, and FFR were 3.0±0.7mm, 45±13%, 13.0±8.8mm, 0.90±0.09, and 0.82±0.10, respectively. Functional significance was observed in 88 lesions (40%) of all lesions. RFR systole was observed in 24 lesions (10.9%). Regarding to the coronary lesions, RFR systole was more frequent in non-LAD (LAD; 4.2%, left circumflex artery (LCX); 9.8%, and right coronary artery (RCA); 30.4%, respectively, p&lt;0.018). RFR showed a significant correlation with FFR in both systole and diastole (R = 0.918, p&lt;0.001, R = 0.733, p&lt;0.001, respectively). The ROC curve analysis showed similar agreement in both systole and diastole (AUC: 0.881, p&lt;0.001, AUC: 0.864, p&lt;0.001, respectively). RFR provided a good diagnostic accuracy and no difference in both systole and diastole (79.6% and 87.5%, respectively, p=0.58).

Conclusion

RFR is feasible and reliable non-hyperemic index regardless of the difference of cardiac cycle to evaluate physiological lesion severity in daily practice.

Funding Acknowledgement

Type of funding source: None

Clinical and Pathological Benefits of Edaravone for Alzheimer's Disease with Chronic Cerebral Hypoperfusion in a Novel Mouse Model

Alzheimer's disease (AD) and chronic cerebral hypoperfusion (CCH) often coexist in dementia patients in aging societies. The hallmarks of AD including amyloid-β (Aβ)/phosphorylated tau (pTau) and pathology-related events such as neural oxidative stress and neuroinflammation play critical roles in pathogenesis of AD with CCH. A large number of lessons from failures of drugs targeting a single target or pathway on this so complicated disease indicate that disease-modifying therapies targeting multiple key pathways hold potent potential in therapy of the disease. In the present study, we used a novel mouse model of AD with CCH to investigate a potential therapeutic effect of a free radical scavenger, Edaravone (EDA) on AD with CCH via examining motor and cognitive capacity, AD hallmarks, neural oxidative stress, and neuroinflammation. Compared with AD with CCH mice at 12 months of age, EDA significantly improved motor and cognitive deficits, attenuated neuronal loss, reduced Aβ/pTau accumulation, and alleviated neural oxidative stress and neuroinflammation. These findings suggest that EDA possesses clinical and pathological benefits for AD with CCH in the present mouse model and has a potential as a therapeutic agent for AD with CCH via targeting multiple key pathways of the disease pathogenesis.

Improvement of a decreased anti-oxidative activity by edaravone in amyotrophic lateral sclerosis patients

BACKGROUND

The free radical scavenger edaravone is a proven neuroprotective drug for patients with amyotrophic lateral sclerosis (ALS). Our objective was to evaluate the therapeutic effects of edaravone for oxidative stress and anti-oxidative activity in ALS patients.

METHODS

Twenty-two ALS patients with a disease duration of 2 years, treated by edaravone, and 25 control participants were evaluated according to their clinical scores, including ALS functional rating scale-revised (ALSFRS-R), and serum and cerebrospinal fluid (CSF) markers of oxidative stress dROM and anti-oxidative activity OXY.

RESULTS

Serum and CSF markers of anti-oxidative activity OXY were significantly decreased in ALS patients at pre-treatment compared with controls (^##p < .01), which was improved in the course of edaravone treatment. Both serum and CSF OXY were significantly correlated with ALS clinical scores including ALSFRS-R (*p < .05, **p < .01, ***p < .001). Furthermore, serum OXY at pre-treatment was significantly correlated with a change in the ALSFRS-R score in the sixth cycle of edaravone treatment (*p < .05).

CONCLUSIONS

The present study suggests significant correlations between anti-oxidative activity and ALS clinical severity, and the therapeutic efficacy of edaravone for decreased anti-oxidative activity in ALS.

Systemic amyloid A (AA) amyloidosis in the Bengalese finch (Lonchura striata var. domestica)

The incidence of systemic amyloid A (AA) amyloidosis was high in Bengalese finches (Lonchura striata var. domestica), as 150 of 235 birds from 5 breeding colonies (63.8%) tested positive for it. The incidence was statistically significantly higher in one colony. The liver was the most frequently affected organ (150 cases), followed by the spleen and then the kidneys. The degree of amyloid deposition was high in the liver and spleen and low in the kidneys. The histological distribution of amyloid deposits was similar in all finch species. Species-specific or colony-specific predisposing factors for systemic AA amyloidosis in Bengalese finches remain to be elucidated. As far as we know, this is the first report of amyloidosis in Bengalese finches.

Correction to: Comprehensive genetic analyses using targeted next-generation sequencing and genotype-phenotype correlations in 53 Japanese patients with osteogenesis imperfecta

The original article has been corrected.

Neuroprotective effect of CuATSM in mice stroke model by ameliorating oxidative stress

Cu-diacetyl-bis (N4-methylthiosemicarbazone) (CuATSM) has both anti-oxidative and anti-inflammatory activities, but its therapeutic efficacy for oxidative stress has not been thoroughly investigated in acute ischemic stroke. Here, the present study was designed to assess the efficacies of CuATSM in acute ischemic stroke by comparing with the standard neuroprotective reagent edaravone. Mice were subjected to transient middle cerebral occlusion (tMCAO) for 60 min, and then intravenously administrated with CuATSM (1.5 mg/kg) or edaravone (3 mg/kg) just after the reperfusion, and examined at 1 and 3 d. Compared with the vehicle group, CuATSM treatment decreased infarct volumes and oxidative stress at 3d after tMCAO, which was further enhanced by combined CuATSM + edaravone treatment as compared with single CuATSM group, but not improve neurobehaviors. The present study demonstrated that CuATSM showed strong antioxidative and neuroprotective effects in acute ischemic stroke, which was enhanced by the combination with edaravone.

Electrochemical reduction of CO2 using Germanium-Sulfide-Indium amorphous glass structures

The research in electrochemical reduction of CO₂ is shifting towards the discovery of new and novel materials. This study shows a new class of material, that of Ge-S-In chalcogenide glass, to be active for reduction of CO₂ in aqueous solutions. Experiments were conducted with bulk and particle form of the material, yielding different product for each structural form. Faradaic efficiency of upto 15% was observed in bulk form for CO production while formic acid with up to 26.1 % faradaic efficiency was measured in powder form. Chalcogenide studies have focused primarily on the photoelectrochemical reduction however these results provide a strong merit for introducing metal in chalcogenide glass structures for electrochemical reduction of CO₂. The activity for CO₂ reduction and the change in product selectivity reflects that further efforts to improve the glass structures can be undertaken in order to increase the faradaic efficiency and selectivity of the products.

Bone Marrow Stromal Cell Transplantation Drives Molecular Switch from Autophagy to the Ubiquitin-Proteasome System in Ischemic Stroke Mice

BACKGROUND

Bone marrow stromal cell (BMSC) transplantation is a promising therapeutic approach for cerebral ischemia, as it elicits multiple neuroprotective effects. However, it remains unclear how BMSC transplantation modulates the ubiquitin-proteasome system (UPS) and autophagy under cerebral ischemia.

METHODS

In the present study, an intermediate level of cerebral ischemia (30 minutes) was chosen to examine the effect of BMSC transplantation on the molecular switch regulating UPS and autophagy. BMSC or vehicle was stereotactically injected into the penumbra 15 minutes after sham operation or transient middle cerebral artery occlusion (tMCAO).

RESULTS

Thirty minutes of tMCAO artery occlusion significantly increased TUNEL-, ubiquitin-, and p62-positive cells (which peaked at 72 hours, 2 hours, and 2 hours after reperfusion, respectively) and ratios of both BAG3/BAG1 and LC3-II/LC3-I at 24 hours after reperfusion. However, intracerebral injection of BMSCs significantly reduced infarct volume and numbers of TUNEL- and p62-positive cells, and improved BAG3/BAG1 and LC3-II/LC3-I ratios. In addition, observed increases in ubiquitin-positive cells 2 hours after reperfusion were slightly suppressed by BMSC transplantation.

CONCLUSIONS

These data suggest a protective role of BMSC transplantation, which drove the molecular switch from autophagy to UPS in a murine model of ischemic stroke.

Early Emergence of Neuropsychiatric Symptoms in Cognitively Normal Subjects and Mild Cognitive Impairment

The world is rapidly aging and facing an increase in the number of dementia patients, so it is important to detect the preclinical stage of dementia in such countries. We examined both cognitive and affective functions among cognitively normal control (n = 218), mild cognitive impairment (MCI, n = 146), and Alzheimer's disease (AD, n = 305) subjects using two evaluation tools for behavioral and psychological symptoms of dementia (BPSD) [Abe's BPSD score (ABS) and mild behavioral impairment (MBI)]. BPSD were present in 12.4% (ABS) and 9.6% (MBI) of cognitively normal people, 34.9% and 32.2% in MCI subjects, and 66.2% and 51.1% in AD patients. Both ABS (§p<0.05) and MBI (§§p < 0.01) score showed worse score with cognitive decline of the Mini-Mental State Examination in the AD group in BPSD-positive participants. Similar correlations were found in all participants in AD group (||||p < 0.01 versus ABS and MBI). Among the subscales in BPSD-positive participants, an apathy/indifference score of ABS and a decreased motivation of MBI showed significant differences in AD patients compared to the control and MCI subjects (**p<0.01). In addition, subscale analyses further showed a downward trend from the control to MCI and AD subjects in four ABS subscales and three MBI subscales. The present study showed the preclinical presence of BPSD in cognitively normal people, more so in MCI subjects, and ABS detected BPSD more sensitively than MBI in all three groups.

Comprehensive genetic analyses using targeted next-generation sequencing and genotype-phenotype correlations in 53 Japanese patients with osteogenesis imperfecta

To elucidate mutation spectrum and genotype-phenotype correlations in Japanese patients with OI, we conducted comprehensive genetic analyses using NGS, as this had not been analyzed comprehensively in this patient population. Most mutations were located on COL1A1 and COL1A2. Glycine substitutions in COL1A1 resulted in the severe phenotype.

INTRODUCTION

Most cases of osteogenesis imperfecta (OI) are caused by mutations in COL1A1 or COL1A2, which encode α chains of type I collagen. However, mutations in at least 16 other genes also cause OI. The mutation spectrum in Japanese patients with OI has not been comprehensively analyzed, as it is difficult to identify using classical Sanger sequencing. In this study, we aimed to reveal the mutation spectrum and genotype-phenotype correlations in Japanese patients with OI using next-generation sequencing (NGS).

METHODS

We designed a capture panel for sequencing 15 candidate OI genes and 19 candidate genes that are associated with bone fragility or Wnt signaling. Using NGS, we examined 53 Japanese patients with OI from unrelated families.

RESULTS

Pathogenic mutations were detected in 43 out of 53 individuals. All mutations were heterozygous. Among the 43 individuals, 40 variants were identified including 15 novel mutations. We found these mutations in COL1A1 (n = 30, 69.8%), COL1A2 (n = 12, 27.9%), and IFITM5 (n = 1, 2.3%). Patients with glycine substitution on COL1A1 had a higher frequency of fractures and were more severely short-statured. Although no significant genotype-phenotype correlation was observed for bone mineral density, the trabecular bone score was significantly lower in patients with glycine substitutions.

CONCLUSION

We identified pathogenic mutations in 81% of our Japanese patients with OI. Most mutations were located on COL1A1 and COL1A2. This study revealed that glycine substitutions on COL1A1 resulted in the severe phenotype among Japanese patients with OI.

P3638Triglyceride deposite cardiomyovasculopathy latency in population with coronary artery disease

Background

Triglyceride deposit cardiomyovasculopathy (TGCV) is a novel clinical concept found among Japanese cardiac transplant recipients in 2008 that the abnormal intracellular triglyceride (TG) metabolism results in the ectopic accumulation of TG in vascular smooth muscle cells and cardiomyocytes, leading to diffuse narrowing coronary artery disease (CAD) and heart failure. TGCV is estimated to affect almost forty to fifty-thousand people in Japan, but there is no real-world date about the prevalence or latency.

Purpose

To evaluate TGCV latency in population with CAD, especially requiring urgent coronary angiography as Study 1, and chronic hemodialysis as Study 2.

Methods

This is multicenter retrospective estimation consisting of two studies.

Study 1) From 2012 to 2017, consecutive 400 patients of unstable angina or acute myocardial infarction who underwent urgent coronary angiography (CAG) and following iodine-123-β-methyliodophenyl-pentadecanoic acid (BMIPP) scintigraphy, a tracer for the diagnosis of TGCV, were enrolled.

Study 2) From 2011 to 2017, 88 chronic hemodialysis patients who underwent planed CAG and BMIPP scintigraphy for detection of ischemic heart disease were enrolled.

TGCV was diagnosed based on the latest diagnostic criteria for TGCV. The criteria include two major items (2 points each: BMIPP scintigraphy Wash-Out Rare <10%, Diffuse narrowing coronary arteries) and two minor items (1 point each: Jordans' anomaly in peripheral blood smear, Diabetes). Four points or more and three points indicated definite and probable TGCV, respectively. Only Items other than Jordans' anomaly were available for the diagnosis of TGCV because of retrospective nature. We evaluated the latent rate of definite and probable TGCV.

Results

Study 1) Figure (left) demonstrates the result of Study 1. Definitive TGCV patients were 14 patients, accounting for 3.5% of total 400 patients, and probable TGCV patients were 39 patients, accounting for 9.8% of all. Total 53 definitive and probable TGCV patients accounted for 13.3% of all. Annual average latency were 3.6±1.7% as definitive, 10.0±5.5% as probable and 13.6±6.6% as definitive and probable TGCV, respectively.

Study 2) Figure (right) demonstrates the result of Study 2. Definitive TGCV patients were 17 patients, accounting for 19.3% of total 88 hemodialysis patients, and probable TGCV patients were 22 patients, accounting for 25.0% of all. Total 39 definitive and probable TGCV patients accounted for 44.3% of all. Annual average latency of definitive TGCV was 19.3±13.4%. Of the 17 definitive TGCV patients, 9 patients were hemodialysis patients with diabetes.

Figure 1

Conclusions

TGCV might be latent with a probability of 3.6±1.7% per year in patients with unstable angina or acute myocardial infarction, and with a probability of 19.3±13.4% per year in chronic hemodialysis patients suspected of ischemic heart disease.

P2688A novel risk factor of stent restenosis after drug-eluting stent implantation; Involvement of triglyceride deposit cardiomyovasculopathy, coronary atherosclerosis with triglyceride deposition

Background

Triglyceride deposit cardiomyovasculopathy (TGCV) is a novel disease concept characterized by the excessive accumulation of triglyceride in cardiomyocytes and vascular smooth muscle cells, leading to coronary artery disease (CAD), heart failure, and arrhythmia. However, it is rarely known whether TGCV contributes to the increased risk of vascular failure after drug eluting stent (DES) implantation.

Purpose

The aim of this study was to evaluate vascular failure after 2nd generation DES implantation in patients with TGCV.

Methods

Among 637 consecutive patients suspected of having CAD who underwent both coronary angiography and iodine-123-β-methyliodophenyl-pentadecanoic acid (BMIPP) scintigraphy between 2010 and 2018, we analyzed the data from 92 patients who met the inclusion criteria (shown in Table and Figure). Ninety-two patients were allocated to the presence (TGCV group, 11 patients) or absence (control group, 81 patients) of TGCV. All of 92 patients were implanted 2nd generation DES and underwent planned follow up coronary angiography. Control patients were diagnosed of diabetes mellitus. Binary restenosis (ISR), defined as angiographic luminal diameter ≥50% by quantitative coronary angiography, target lesion revascularization (TLR), In-stent late loss and restenosis morphology were assessed in 23 stents of TGCV group and 120 stents of control group.

Results

There were no significant differences in baseline characteristics between the two groups except for the prevalence of hypertension. In-stent late loss was greater in TGCV than in control (0.45 (−0.04 to 3.33) vs. 0.15 (−0.18 to 2.75), p=0.ehz748.10067), resulting in greater incidence of ISR and TLR in TGCV than in control (34.8% vs. 10.0%, p=0.0017; 21.7% vs. 6.7%, p=0.021, respectively). On multivariable logistic regression analysis, TGCV was found to be a significant and independent predictor for ISR after 2nd generation DES implantation. Regarding restenosis morphology, diffuse and occlusive pattern of ISR, were more frequently observed in TGCV than control (87.5% and 33.3%, Fisher's exact test p=0.028).

Table 1.The 4th edition diagnostic criteria for TGCV Items Clinical findings 2 points I) BMIPP scintigraphy Wash-Out Rare <10% II) Diffuse narrowng coronary arteries 1 point III) Jordans anomaly in peripheral blood smear IV) Diabetes Decision 4 points or more → Definite TGCV

Figure 1

Conclusion

Patients with TGCV showed the greater incidence of vascular failure even after 2nd generation DES implantation, contributing to the novel risk factor for coronary intervention even in the 2nd DES era.