A change of osteocalcin (OC) and tartrate resistant acid phosphatase 5b (TRACP-5b) with the menstrual cycle

Bone metabolism markers associated with 4 menstrual cycle phases were evaluated in 14 healthy young females without menstrual disorder. Menstrual cycle phases were confirmed with basal body temperature for 3 months, luteinizing hormone kits, and sexual hormone concentrations of serum. The bone metabolism markers used were osteocalcin (OC), which was measured by immunoradiometric assay (IRMA), and tartrate resistant acid phosphatase 5b (TRACP-5b), which was measured by enzyme immunometric assay (EIA). The highest values of OC and TRACP-5b were observed in the ovulation phase, and TRACP-5b increased significantly when compared with levels in the menstrual phase (p<0.05). Furthermore, the changes in sex-hormone secretion involved in OC and TRACP-5b showed specific patterns during the menstrual cycle. In other words, TRACP-5b levels are influenced by sex hormones produced during the menstrual period and are based on the bone-formation status. Therefore, it is presumed that the TRACP-5b levels during ovulation play a central role in bone formation and bone metabolism.

Effect of platelet-rich plasma with fibrin matrix on healing of intrasynovial flexor tendons

PURPOSE

To investigate the effects of platelet-rich plasma (PRP) with fibrin matrix on the healing of intrasynovial flexor tendons in a rabbit model in vivo.

METHODS

We transected and repaired 156 toe flexors of 73 rabbits using the technique of Tsuge et al and a simple running epitendinous suture. We randomly assigned Repaired tendons to groups that recieved no additional treatment (control) or to which we applied PRP, fibrin (F), or PRP with fibrin matrix (PRP-F) at the repair site. We scored edema and adhesion at 2, 3, and 6 weeks after surgery, and linearly tested repaired tendons for load to failure. We also histologically evaluated tendons at 2 and 3 weeks.

RESULTS

Edema scores and adhesion scores did not significantly differ among the 4 groups at any time point. Mean load to failure in the PRP-F group (14.7 N) was the highest among the 4 groups at 2 weeks after surgery, and was significantly higher than in the control group (10.0 N). Median histological scores in the PRP-F group (3.3 points) were significantly higher than in the control group (1.0 point). Mean load to failure in the PRP-F group (16.1 N) was highest, and median histological scores in the PRP-F group (3.5 points) were higher than in the control group (2.4 points) at 3 weeks, although there were no significant differences at 3 or 6 weeks.

CONCLUSIONS

In a rabbit model of cut flexor tendons, PRP with fibrin matrix significantly increased healing strength within 2 weeks after surgery. Side effects such as increases in toe edema or adhesions around the tendons did not arise.

CLINICAL RELEVANCE

Platelet-rich plasma with fibrin matrix might help reduce the risk of repeated rupture after flexor tendon surgery, and lead to early rehabilitation.

Additive impact of alfacalcidol on bone mineral density and bone strength in alendronate treated postmenopausal women with reduced bone mass

OBJECTIVES

Assessment of additive impact of alfacalcidol 1 μg daily (Alfa) on bone mineral density (BMD) and on bone strength in postmenopausal women treated with alendronate 70 mg weekly + 500 mg calcium daily.

SUBJECTS AND METHODS

In a randomized, double-blind, placebo controlled study, 279 postmenopausal women with osteoporosis or osteopenia participated (intention to treat analysis [ITT]; aged 73.6∓4.7 years) and were treated with 70 mg alendronate (ALN) weekly and 500 mg calcium daily for 36 months. In addition, these patients received either 1 μg alfacalcidol (Alfa) or placebo (PLC) daily. BMD was measured with Dual-Energy-X-ray-Absorptiometry (DXA) at the lumbar spine and proximal femur and at forearm and tibia with peripheral quantitative computed tomography (pQCT) at regular intervals for 36 months.

RESULTS

DXA-BMD of lumbar spine (L1-4) increased after 36 months, by 6.65% (p<0.0001) in the Alfa/ALN group versus 4.17% (p<0.0001) in the PLC/ALN group. Group difference was significant after 3 years (p=0.026). At the end of the study, significant differences were found in favor of the Alfa/ALN group in trabecular density (tibia) (p=0.002), cortical density (midshaft tibia) (p=0.043), and bone strength (p=0.001). The remaining parameters showed no differences between the treatment arms, apart cortical bone density at midshaft radius.

CONCLUSIONS

Alfacalcidol significantly increases the efficacy of alendronate treatment in osteopenic/osteoporotic postmenopausal women on spinal DXA-BMD, cortical and trabecular BMD of the tibia and also bending stiffness of the tibia.

Incidence and risk factors for cholangitis during systemic chemotherapy among patients with advanced biliary tract cancer

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Background: Patients with biliary tract cancer (BTC) have a high risk of developing cholangitis. In patients with advanced BTC receiving systemic chemotherapy, cholangitis might interfere with the execution of the treatment. Furthermore, cholangitis during severe immunosuppression might develop into lethal complications such as sepsis or shock. Purpose: To determine the incidence of cholangitis among patients with advanced BTC undergoing systemic chemotherapy and to identify risk factors for the development of cholangitis.

Methods: We reviewed the records of 301 patients with advanced BTC who received systemic chemotherapy at our hospital between February 2002 and July 2009. The clinical data of patients treated with gemcitabine monotherapy (GEM) as a first-line chemotherapy was retrieved.

Results: One hundred and thirty-one patients were successfully followed up throughout the entire GEM treatment. Forty-three patients had intrahepatic BTC (32.8%), 28 had extrahepatic BTC (21.4%), 11 had hilar BTC (8.4%), 7 had ampullary cancer (5.3%), and 42 had gallbladder cancer (32.1%). Interventional radiological treatment or biliary reconstruction for biliary obstruction was performed in 50 patients (37.9%) prior to the start of chemotherapy. The median time to GEM treatment failure was 126 days. Cholangitis developed in 30 patients (22.9%) during GEM, and severe cholangitis developed in 10 patients (7.6%). The median time to the first episode of cholangitis from the start of chemotherapy was 65 days. Chemotherapy was discontinued because of cholangitis in 4 patients (3.1%), but no deaths as a result of cholangitis occurred. A multivariate analysis using a logistic regression model demonstrated that the presence of hilar obstruction (p=0.0002, OR: 10.748), the loss of sphincter of Oddi function (p=0.0005,OR: 8.960), and the presence of internal biliary drainage (p=0.007, OR: 4.472) were independent risk factors of cholangitis.

Conclusions: The incidence of cholangitis during GEM treatment was 22.9% among the advanced BTC patients in this study. Hilar obstruction, the loss of sphincter of Oddi function, and internal biliary drainage may be risk factors of cholangitis.

No significant financial relationships to disclose.

Feasibility study of two schedules of sunitinib in combination with pemetrexed in patients with advanced solid tumors

Background Sunitinib is an oral multitargeted tyrosine kinase inhibitor of vascular endothelial growth factor and platelet-derived growth factor receptors, as well as of other receptor types. We have performed a feasibility study to investigate the safety of sunitinib in combination with pemetrexed for treatment of advanced refractory solid tumors. Methods Sunitinib was administered once daily on a continuous daily dosing (CDD) schedule (37.5 mg/day) or a 2-weeks-on, 1-week-off treatment schedule (50 mg/day, Schedule 2/1) in combination with pemetrexed at 500 mg/m² on day 1 of repeated 21-day cycles. Results Twelve patients were enrolled in the study: six on the CDD schedule and six on Schedule 2/1. None of the treated patients experienced a dose-limiting toxicity. Toxicities were manageable and similar in type to those observed in monotherapy studies of sunitinib and pemetrexed. Pharmacokinetic analysis did not reveal any substantial drug–drug interaction. One patient with squamous cell lung cancer showed a partial response and five patients had stable disease. Conclusions Combination therapy with sunitinib administered on Schedule 2/1 (50 mg/day) or a CDD schedule (37.5 mg/day) together with standard-dose pemetrexed (500 mg/m²) was well tolerated in previously treated patients with advanced solid tumors.

TP53 mutations coincide with the ectopic expression of activation-induced cytidine deaminase in the fibroblast-like synoviocytes derived from a fraction of patients with rheumatoid arthritis

Main features of rheumatoid arthritis (RA), hyperplasia of fibroblast-like synoviocytes (FLS) and joint destruction are caused by inflammatory cytokines produced in chronic autoimmune inflammation. Cell-intrinsic acquisition of tumour-like phenotypes of RA-FLS could also be responsible for the aggressive proliferation and invasion, which are supported by the fact that in some cases RA-FLS has mutations of a tumour suppressor gene TP53. However, the underlying molecular mechanism for TP53 mutations in RA-FLS has not yet been clarified. Recently it has been reported that the non-lymphoid cells in the inflammatory tissues express ectopically the activation-induced cytidine deaminase (AID) gene that induces somatic hypermutations, not only at the immunoglobulin (Ig) gene variable regions in germinal centre B lymphocytes but also at coding regions in TP53. Real-time polymerase chain reaction (PCR) analyses revealed more than half (five of nine) of the RA-FLS lines we established showed the markedly increased expression of AID. AID transcription in RA-FLS was augmented by tumour necrosis factor (TNF)-alpha and even by physiological concentration of beta-oestradiol that could not induce AID transcription in osteoarthritis-FLS. Furthermore, AID-positive RA-FLS presented a higher frequency of somatic mutations in TP53. Cytological and immunohistochemical analyses demonstrated clearly the ectopic expression of AID in the FLS at the RA synovium. These data suggested strongly a novel consequence of RA; the ectopic expression of AID in RA-FLS causes the somatic mutations and dysfunction of TP53, leading to acquisition of tumour-like properties by RA-FLS.

Effect of axitinib (AG-013736) on fatigue, thyroid-stimulating hormone, and biomarkers: a phase I study in Japanese patients

Axitinib is an oral, potent, and selective inhibitor of vascular endothelial growth factor receptor (VEGFR) 1, 2, and 3. This phase I study evaluated the safety, pharmacokinetics, pharmacodynamics, antitumor activity, and recommended starting dose of axitinib in patients with advanced solid tumors. Twelve patients received single-dose axitinib 5 mg and were monitored for > or =48 h. Continuous 5 mg twice-daily dosing was then initiated. One patient had dose-limiting toxicity (grade 3 proteinuria and fatigue). Common treatment-related adverse events were anorexia, fatigue, and diarrhea. Grade 3 treatment-related adverse events were fatigue and hypertension. Maximum axitinib plasma concentration occurred 1-4 h after steady-state dosing. Eleven patients experienced thyroid-stimulating hormone elevation; time-course change and fatigue onset appeared to be related in some patients. Significant correlation was observed between thyroid-stimulating hormone change and area under the plasma concentration-time curve (AUC; r = 0.80, P = 0.005). Axitinib decreased plasma soluble vascular endothelial growth factor receptor 2 (s-VEGFR2), with significant correlation between change in s-VEGFR2 and AUC (r = -0.92, P < 0.0001). Fluorodeoxyglucose positron emission tomography revealed a substantial decrease in tumor metabolic activity associated with axitinib. Tumor size decreased in nine patients. The time-course of thyroid-stimulating hormone change appeared correlated with fatigue. There were significant correlations between thyroid-stimulating hormone or s-VEGFR2 and axitinib exposure. Axitinib 5 mg twice-daily is the recommended starting dose for Japanese patients. This trial is registered with ClinicalTrials.gov, identifier NCT00447005.

Phase I study of TLR9 agonist PF-3512676 in combination with carboplatin and paclitaxel in patients with advanced non-small-cell lung cancer

This phase I, open-label study investigated the Toll-like receptor 9 agonist, PF-3512676, in combination with carboplatin and paclitaxel in Japanese patients with advanced, non-small-cell lung cancer (NSCLC). Patients (n = 12) with treatment-naive stage IIIB or IV NSCLC received single-agent PF-3512676 subcutaneously once during the first 7 days (monotherapy phase) in three escalating dose levels (0.1, 0.2, and 0.4 mg/kg) followed by a combination phase during which patients received 0.1 or 0.2 mg/kg PF-3512676 subcutaneously on days 8 and 15 of each 3-week cycle of carboplatin (area under the curve, 6 mg x min/mL) and paclitaxel (200 mg/m(2)). Safety and pharmacokinetics of PF-3512676 were assessed during monotherapy and combination therapy phases. PF-3512676 was tolerable as monotherapy or in combination with chemotherapy in patients with NSCLC. Most common treatment-related, non-hematologic adverse events (AEs) throughout the study were injection-site reactions (n = 12, 100%) and flu-like symptoms (n = 11, 91.7%) that were each grade 1 or 2 in all but one patient. All patients experienced neutropenia and leukopenia (>or=grade 3 in 11 [91.7%] and seven [58.3%] patients, respectively). One patient in dose level 2 had a dose-limiting toxicity: grade 3 rash and grade 3 increase in gamma-glutamyltransferase during combination therapy. Mean PF-3512676 half-life ranged from 4.8 to 21.6 h (longer with higher doses). Four (33%) patients had objective responses (one complete response, three partial responses), and seven (58%) patients achieved stable disease. PF-3512676 as monotherapy and in combination with chemotherapy had an acceptable safety profile in Japanese patients with treatment-naive NSCLC.

Association of (pro)renin receptor gene polymorphism with blood pressure in Japanese men: the Ohasama study

BACKGROUND

Recent studies have revealed that (pro)renin receptor ((P)RR), a newly identified member of the renin-angiotensin system (RAS), is associated with blood pressure regulation in animals. However, there is no information on (P)RR in humans. We investigated the association of (P)RR gene polymorphisms with blood pressure in a Japanese population.

METHODS

Subjects (n = 1,112) were recruited from participants in the Ohasama study, a Japanese cohort study. For the association study, we selected three polymorphisms: -782A>G (rs2968915), intervening sequence (IVS)5+169C>T (rs5918007), and +1513A>G (rs6609080). Because the (P)RR gene is on the X chromosome, men (n = 357) and women (n = 755) were analyzed separately.

RESULTS

In men, 24-h systolic blood pressure (SBP) and diastolic blood pressure (DBP) values, daytime SBP and DBP values, and nighttime SBP and DBP values were significantly higher in IVS5+169T allele carriers than C allele carriers. Multiple regression analysis showed that IVS5+169C>T was significantly and independently related to ambulatory blood pressure (ABP). IVS5+169C>T was not associated with casual blood pressure (CBP) in men. In women, there were no significant differences in blood pressure values among the three genotypes of IVS5+169C>T. This polymorphism had no significant association with any other clinical characteristic. -782A>G was weakly associated with ABP in men. +1513A>G was not associated with blood pressure values in either men or women.

CONCLUSIONS

We demonstrated for the first time that polymorphism of the (P)RR gene IVS5+169C>T is associated with ABP in Japanese men. This association suggests that (P)RR has a role in blood pressure regulation.

Comparison of human serum with fetal bovine serum for expansion and differentiation of human synovial MSC: potential feasibility for clinical applications

The aim of this study was to evaluate the effect of human serum (HS) on growth and differentiation capacity of human synovium-derived mesenchymal stem cells (MSC) in comparison to cells grown in fetal bovine serum (FBS). Human MSCs were isolated from the synovium of knee joints of three donors and the cells were cultured individually in varying concentrations of allogenic HS or FBS. Bovine MSCs were isolated from synovium and cultured in the same manner. Cell proliferation was assessed by the tetrazolium assay after passage 3. The capacity for chondrogenic and osteogenic differentiation was investigated in specific media followed by 1,9-dimethylmethylene blue assay and alcian blue staining, or by alizarin red staining, respectively. Human MSCs proliferated significantly more rapidly in the presence of HS than with equivalent levels of FBS. Chondrogenic or osteogenic differentiation occurred to nearly identical levels in HS or FBS. The results of this study indicate that HS is superior for the culture of human MSCs compared with FBS in terms of cellular expandability, without losing chondrogenic or osteogenic differentiation capacity. Coupled with the advantage in eliminating the potential risk accompanied with the use of xeno-derived materials, pooled, well-characterized HS could be a useful reagent to promote cellular expansion for clinical synovial stem cell-based therapy.

Large artery stiffening as a link between cerebral lacunar infarction and renal albuminuria

BACKGROUND

Stiffening of large arteries increases pulsatile pressure and flow stresses, which extend to the microcirculation in vasodilated organs such as the brain and kidneys. Subclinical cerebral lacunar infarction and albuminuria, both of which are early manifestations of microvascular damage, have been shown to be potentially interrelated in hypertension and with aging, but the underlying pathogenesis remains unknown.

METHODS

In a population of 351 general adults aged > or =50 years, urinary albumin/creatinine ratio (ACR), pulse wave velocity (PWV), and 24-h ambulatory blood pressure (BP) were measured, and cerebral lacunar lesions were assessed on magnetic resonance imaging (MRI).

RESULTS

Lacunar infarction was present in 86 subjects (25%). Subjects with lacunae had a higher median urinary ACR than those without (20.6 vs. 14.6 mg/g.Cr, P = 0.004). The positive association between the presence of lacunae and urinary ACR remained significant in a logistic model that adjusted for covariates including age, gender, and 24-h BP (P = 0.04); the odds ratio (OR) for lacunae was 1.32 for each 1 s.d. increase in urinary ACR. However, when PWV was added to this model, increased PWV but not urinary ACR was associated with lacunae. There was a significant interaction between urinary ACR and PWV with respect to lacunae; only subjects with a high PWV above the median showed an independent association between urinary ACR and the presence of lacunae (P = 0.03).

CONCLUSIONS

Microvascular damage in the brain (lacunar infarction) and kidney (albuminuria) appears to be interrelated in the general population. Large arterial stiffening may play a pivotal role in this cerebro-renal connection.

Laboratory and febrile features after joint surgery in patients with rheumatoid arthritis treated with tocilizumab

OBJECTIVES

To understand the acute phase responses to surgical intervention in patients with rheumatoid arthritis (RA) treated with the anti-interleukin (IL)6 receptor antibody, tocilizumab.

METHODS

In a retrospective 1:1 pair-matched case-control study, 22 tocilizumab-treated RA cases and 22 cases treated with conventional disease-modifying antirheumatic drugs (DMARDs) and matched for type of surgery, age and sex were evaluated for body temperature every day, and blood C-reactive protein (CRP) levels and white blood cell (WBC), neutrophil and lymphocyte counts on days -1, 1, 3 and weeks 1 and 2 after joint surgery. Safety issues were also monitored.

RESULTS

No complications of infection or delay of wound healing occurred in either patient group. Tocilizumab partially, but significantly, suppressed the increase in body temperature on postoperative days 1 and 2, compared with DMARDs (average (SD) maximum increase in temperature was 0.45 (0.1) degrees C in the tocilizumab group and 0.78 (0.1) degrees C in the DMARD group; p<0.01). Tocilizumab completely suppressed the increase in CRP after surgery, whereas all cases treated with DMARDs showed a significant increase of CRP at postoperative day 1 (5.5 (0.6) mg/dl; p<0.001). WBC, neutrophil and lymphocyte counts showed no remarkable change after surgery, and there was no significant difference in any cell counts between the patient groups.

CONCLUSIONS

Within this small number of cases, safe operations on patients were performed during tocilizumab treatment. Tocilizumab suppressed fever and increase of CRP after surgery, whereas there was no influence on the transition in number of leukocytes. This characteristic postoperative response should be considered during tocilizumab treatment.

Optimal cutoff point of waist circumference and use of home blood pressure as a definition of metabolic syndrome: the Ohasama study

BACKGROUND

Self-measured blood pressure (BP) at home (HBP) has a stronger predictive power for cardiovascular mortality and morbidity than casual-screening BP (CBP). No studies have evaluated the clinical significance of self-measured HBP for diagnosing metabolic syndrome (MS). Eight scientific associations recently defined MS for the Japanese population. However, this definition remains controversial, especially with respect to the cutoff value of waist circumference (WC) being higher in women than in men.

METHODS

The: participants of this population-based survey were the 395 residents (> or =35 years of age) of Ohasama, a rural Japanese community. They measured HBP and underwent the oral glucose tolerance test between the years 2000 and 2006. We calculated the optimal cutoff values of WC required to diagnose MS, and examined the association of HBP with metabolic risk-factor clustering using multivariate analyses.

RESULTS

Receiver operation characteristic analysis indicated that the optimal WC cutoff values for identifying clusters of metabolic risk factors were 87 and 80 cm in men and women, respectively. Elevated HBP was significantly associated with the clustering of metabolic risk factors but CBP was not.

CONCLUSION

The appropriate WC cutoff value in the current MS criteria for Japanese women would be 80 cm. We suggest that HBP would be useful when considering a diagnosis of MS. The association between MS determined using HBP and the prognosis of cardiovascular diseases (CVDs) requires further investigation.

Association of microalbuminuria with brachial-ankle pulse wave velocity: the Ohasama study

BACKGROUND

Microalbuminuria is recognized as a marker of generalized vascular dysfunction. However, the associations between microalbuminuria and pulse wave velocity (PWV), carotid intima-media thickness (IMT), and ambulatory blood pressure (ABP), respectively, have not been investigated.

METHODS

Brachial-ankle PWV (baPWV), IMT, and ABP were determined in 328 individuals (mean age, 65.7 +/- 6.4 years) from the general population of Ohasama, a rural Japanese community. The participants were assigned to groups with microalbuminuria and with normoalbuminuria, and their characteristics were compared. We also examined the association between microalbuminuria and baPWV, IMT, and ABP, respectively, using multivariate analyses.

RESULTS

Seventy-nine participants (24%) with microalbuminuria had significantly higher baPWV (P < 0.001) and 24-h systolic BP (SBP) (P = 0.006) than those with normoalbuminuria, although 24-h pulse pressure and mean IMT did not significantly differ between the groups. Multiple logistic regression analyses showed that baPWV, but not 24-h ABP, was independently associated with microalbuminuria (P = 0.002) when adjusted for various confounding factors. After further adjustment for 24-h SBP, the association between baPWV and microalbuminuria remained significant (P = 0.012). The trend was significant even when daytime or nighttime SBP was used instead of 24-hour SBP in this model.

CONCLUSIONS

Microalbuminuria appears to be associated with baPWV more closely than with IMT and ABP, and its association with baPWV is independent of ABP and other cardiovascular risk factors.

A three-dimensional quantitative analysis of carpal deformity in rheumatoid wrists

We have measured the three-dimensional patterns of carpal deformity in 20 wrists in 20 rheumatoid patients in which the carpal bones were shifted ulnarwards on plain radiography. Three-dimensional bone models of the carpus and radius were created by computerised tomography with the wrist in the neutral position. The location of the centroids and rotational angle of each carpal bone relative to the radius were calculated and compared with those of ten normal wrists. In the radiocarpal joint, the proximal row was flexed and the centroids of all carpal bones translocated in an ulnar, proximal and volar direction with loss of congruity. In the midcarpal joint, the distal row was extended and congruity generally well preserved. These findings may facilitate more positive use of radiocarpal fusion alone for the deformed rheumatoid wrist.

The immunosuppressant FK506 promotes development of the chondrogenic phenotype in human synovial stromal cells via modulation of the Smad signaling pathway

OBJECTIVE

To assess the effect of the immunosuppressant FK506 on chondrogenic differentiation of human synovial stromal cells (hSSCs).

METHODS

hSSCs were isolated from synovium of the knee joint and 2x10(5) cells were subjected to pellet culture in chondrogenic culture medium for 3 weeks with or without growth factors [bone morphogenetic protein 2 (BMP2) or transforming growth factor beta(1) (TGFbeta(1))] and +/- addition of FK506 in chondrogenic culture media was evaluated. Chondrogenesis was assessed by the size of the pellet, the production of proteoglycans, and messenger RNA (mRNA) levels for chondrogenic markers. Furthermore, levels and intracellular location of phosphorylated Smad proteins related to BMP signaling and TGFbeta signaling were evaluated following exposure to FK506.

RESULTS

FK506 enhanced the differentiation of hSSCs toward a chondrogenic phenotype in a dose-dependent manner associated with increases in glycosaminoglycan synthesis and increased mRNA levels for chondrogenic marker genes. Additionally, FK506 further enhanced chondrogenesis of synovial stromal cells (SSCs) induced by BMP2 and TGFbeta(1), also in a dose-dependent manner. Notably, phosphorylation of Smad1/5/8 and Smad3 was significantly increased by FK506. Also, the ratio of nuclear translocation to cytoplasmic levels of phosphorylated Smad1/5/8 and Smad3 were increased following exposure of SSCs to FK506. Moreover, inhibition of Smad signaling significantly abrogated FK506-induced chondrogenic differentiation of SSCs.

CONCLUSION

This study demonstrated that FK506 promotes chondrogenic differentiation of hSSCs likely via impact on Smad signaling pathways. With further optimization, FK506 could potentially be a unique therapeutic tool to promote cartilage repair in clinical situations, as well as enhance development of tissue engineered cartilage in vitro.