Double-blind, parallel group, placebo-controlled study of Kjellmaniella crassifolia Miyabe (Gagome) in human: The potential of Gagome to activate the immune system

Background: Marine brown algae, Kjellmaniella crassifolia Miyabe (Gagome) is extensively harvested in Northern Japan and is known to help improve the immune system and prevent lifestyle diseases by its functional constituents, particularly the polysaccharide fucoidan. However, since most scientific findings come from animal studies, we examined its potential effectiveness in humans to raise immune functions, using small amounts of Gagome to avoid overconsumption of iodide. Methods: We set up a double-blind, placebo-controlled clinical trial (n=30 subjects for Gagome consumption; n=30 for placebo), in which 0.8 gram/day of Gagome containing 200 mg as dietary fiber (ca. 80 mg as fucoidan) was ingested for 8 weeks. The primary end-point was natural killer (NK) cell activity while other immune-related biomarkers, such as immunoglobulins (IgM and IgA) and cytokines (IL-12 and IFN-g) were secondary end-points.Results: No adverse effects were observed during the course of the clinical trial. We found that 8-week daily Gagome intake raised NK cell activities for the group with a relatively higher baseline number of NK cells (p=0.03). We also demonstrated that Gagome intake exerted a tendency to stimulate IgA secretion. These results indicate the possibility that Gagome intake may potentiate host defense systems in human as seen in animal studies.Conclusion: In this study, we used small amounts of Gagome (0.8 g daily) as an active test sample to avoid overconsumption of iodide, and found that this amount could enhance NK cell activities, particularly in the subclass with initially higher NK cell numbers. We also found an appreciable increment of IgA. With all of these facts, it seems that Gagome intake activates immune responses that contribute to the promotion of health through stimulation of the immune system.Keywords: clinical trial, dietary fiber, fucoidan, Gagome, natural killer cells

A randomized, double-blind, placebo-controlled study to examine the effects of high-isoflavone soybeans “Yukipirika” in climacteric women

Background: Soy isoflavones belong to a class of plant-based compounds known as phytoestrogens and effect menopausal symptoms and bone metabolism. We evaluated the effects of high-isoflavone soybeans (“Yukipirika”) in climacteric women.Methods: In this randomized, double-blind, placebo-controlled study, we randomly selected 64 female subjects (aged 46–60 years) to consume products made from high-isoflavone soybeans (active test), low-isoflavone soybeans (Placebo 2), or wheat (Placebo 1). The simplified menopausal index (SMI) test, visual analog scale (VAS) of skin and hair conditions, joints functions, and bowel movements, hematological analysis, and urinalysis were performed at weeks 0, 4, and 8 during the study period. Results: Intake of high-isoflavone soybeans did not change bone metabolism parameters. However, a subsection of the SMI score was improved in the active test food group compared to the Placebo 2 food group. Additionally, VAS of skin conditions, joints functions, and bowel movements improved in the active test group compared to the Placebo 1 or Placebo 2 groups. Conclusion: These results suggest that the ingestion of high-isoflavone soybeans can improve skin conditions, joints functions, and bowel movements, in addition to menopausal symptoms.Keywords: bone metabolism; clinical trial; isoflavone; soybeans; menopausal symptoms; Yukipirika

Impact of the Clinical Frailty Scale on Outcomes After Transcatheter Aortic Valve Replacement

Background:

The semiquantitative Clinical Frailty Scale (CFS) is a simple tool to assess patients’ frailty and has been shown to correlate with mortality in elderly patients even when evaluated by nongeriatricians. The aim of the current study was to determine the prognostic value of CFS in patients who underwent transcatheter aortic valve replacement.

Methods:

We utilized the OCEAN (Optimized Catheter Valvular Intervention) Japanese multicenter registry to review data of 1215 patients who underwent transcatheter aortic valve replacement. Patients were categorized into 5 groups based on the CFS stages: CFS 1-3, CFS 4, CFS 5, CFS 6, and CFS ≥7. We subsequently evaluated the relationship between CFS grading and other indicators of frailty, including body mass index, serum albumin, gait speed, and mean hand grip. We also assessed differences in baseline characteristics, procedural outcomes, and early and midterm mortality among the 5 groups.

Results:

Patient distribution into the 5 CFS groups was as follows: 38.0% (CFS 1-3), 32.9% (CFS4), 15.1% (CFS 5), 10.0% (CFS 6), and 4.0% (CFS ≥7). The CFS grade showed significant correlation with body mass index (Spearman’s ρ=−0.077, P =0.007), albumin (ρ=−0.22, P <0.001), gait speed (ρ=−0.28, P <0.001), and grip strength (ρ=−0.26, P <0.001). Cumulative 1-year mortality increased with increasing CFS stage (7.2%, 8.6%. 15.7%, 16.9%, 44.1%, P <0.001). In a Cox regression multivariate analysis, the CFS (per 1 category increase) was an independent predictive factor of increased late cumulative mortality risk (hazard ratio, 1.28; 95% confidence interval, 1.10–1.49; P <0.001).

Conclusions:

In addition to reflecting the degree of frailty, the CFS was a useful marker for predicting late mortality in an elderly transcatheter aortic valve replacement cohort.

On-target sorafenib toxicity predicts improved survival in hepatocellular carcinoma: a multi-centre, prospective study

BACKGROUND

Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide and has high mortality despite treatment. While sorafenib has a survival benefit for patients with advanced HCC, clinical response is highly variable.

AIM

To determine whether development of sorafenib toxicity is a prognostic marker of survival in HCC.

METHODS

In this prospective multicentre cohort study, patients with advanced-stage HCC receiving sorafenib were recruited from five international specialist centres. Demographic and clinical data including development and grade of sorafenib toxicity during treatment, radiological response to sorafenib and survival time (months) were recorded prospectively.

RESULTS

A total of 634 patients with advanced-stage HCC receiving sorafenib were recruited to the study, with a median follow-up of 6692.3 person-months at risk. The majority of patients were male (81%) with Child-Pugh A stage liver disease (74%) and Barcelona Clinic Liver Cancer stage C HCC (64%). Median survival time was 8.1 months (IQR 3.8-18.6 months). 94% experienced at least one sorafenib-related toxicity: 34% diarrhoea, 16% hypertension and 37% hand-foot syndrome (HFS). Twenty-one per cent ceased sorafenib due to toxicity and 59% ceased treatment due to progressive disease or death. On multivariate analysis, sorafenib-related diarrhoea (HR 0.76, 95% CI 0.61-0.95, P = 0.017), hypertension (HR 0.531, 95% CI 0.37-0.76, P < 0.0001) and HFS (HR 0.65, 95% CI 0.51-0.81, P < 0.0001) were all significant independent predictors of overall survival after adjusting for age, severity of liver disease, tumour stage and sorafenib dose.

CONCLUSION

Development of sorafenib-related toxicity including diarrhoea, hypertension and hand-foot syndrome is associated with prolonged overall survival in patients with advanced-stage HCC on sorafenib.

The albumin-bilirubin grade improves hepatic reserve estimation post-sorafenib failure: implications for drug development

BACKGROUND

Drug development in hepatocellular carcinoma (HCC) is limited by disease heterogeneity, with hepatic reserve being a major source of variation in survival outcomes. The albumin-bilirubin (ALBI) grade is a validated index of liver function in patients with HCC.

AIM

To test the accuracy of the ALBI grade in predicting post-sorafenib overall survival (PSOS) in patients who permanently discontinued treatment.

METHODS

From a prospectively maintained international database of 447 consecutive referrals, we derived 386 eligible patients treated with sorafenib within Barcelona Clinic Liver Cancer C stage (62%), 75% of whom were of Child class A at initiation. Clinical variables at sorafenib discontinuation were analysed for their impact on post-sorafenib overall survival using uni- and multivariable analyses.

RESULTS

Median post-sorafenib overall survival of the 386 eligible patients was 3.4 months and median sorafenib duration was 2.9 months, with commonest causes of cessation being disease progression (68%) and toxicity (24%). At discontinuation, 92 patients (24%) progressed to terminal stage, due to worsening Child class to C in 40 (10%). Median post-sorafenib overall survival in patients eligible for second-line therapies (n = 294) was 17.5, 7.5 and 1.9 months according respectively to ALBI grade 1, 2 and 3 (P < 0.001).

CONCLUSIONS

The ALBI grade at sorafenib discontinuation identifies a subset of patients with prolonged stability of hepatic reserve and superior survival. This may allow improved patient selection for second-line therapies in advanced HCC.