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Mitamura M, Kase S, Suzuki Y, Sakaguchi T, Suimon Y, Sinohara T, Shimizu AI, Matsuno Y, Sakai H, Kase M, Ishida S. Diffuse large b-cell lymphoma of the ocular adnexa with flow cytometry analysis and review of the literature. Eur J Ophthalmol 2022; 33:11206721221127053. [PMID: 36114636 DOI: 10.1177/11206721221127053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
PURPOSE The aim of this study was to evaluate the clinicopathological features and flow cytometry (FCM) of tumor tissues in ocular adnexal diffuse large B-cell lymphoma (DLBCL). METHODS This retrospective, multicenter case study was designed to evaluate the clinical and immunohistochemical features of tumors. DLBCL was diagnosed based on histopathology, immunoglobulin (Ig) heavy chain gene rearrangement, and FCM in all surgically removed periocular tumor tissues. This study involved assessing percentages (%) of B-cell/T-cell markers, a natural killer cell marker, and cell-surface Ig kappa/lambda (κ/λ) expression measured by FCM analysis in tumor tissues. RESULTS Eleven DLBCL patients (4 men and 7 women) with 11 tumors were enrolled in this study. The median age at the time of initial presentation was 73 years. The tumor cells were immunohistochemically positive for cluster of differentiation (CD) 20, while CD5 was negative in all 8 cases tested. At the time of ophthalmic diagnosis, two cases already showed systemic dissemination of DLBCL throughout the body. FCM of tumor tissues detected a high percentage of B-cell markers including CD19 and CD20 in all 11 tumors. One case with high CD10 levels in FCM was histologic transformation from follicular lymphoma. One case with a relatively low CD20 population involved a history of systemic treatments including intravenous rituximab. CONCLUSION Although caution should be exercised when interpreting the data, FCM is useful for not only supportive diagnosis complementary to immunohistochemistry, but also facilitates a better understanding of immunopathology including histologic transformation of follicular lymphoma to DLBCL in the ocular adnexa.
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Affiliation(s)
- Mizuho Mitamura
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, 12810Hokkaido University, Sapporo, Japan
| | - Satoru Kase
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, 12810Hokkaido University, Sapporo, Japan
| | - Yasuo Suzuki
- Department of Ophthalmology, Orbital Disease & Neuro-Ophthalmology Center, 37009Teine Keijinkai Hospital, Sapporo, Japan
| | - Takatoshi Sakaguchi
- Department of Ophthalmology, Orbital Disease & Neuro-Ophthalmology Center, 37009Teine Keijinkai Hospital, Sapporo, Japan
| | - Yuka Suimon
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, 12810Hokkaido University, Sapporo, Japan
| | - Toshiya Sinohara
- Department of Pathology, 37009Teine Keijinkai Hospital, Sapporo, Japan
| | - A I Shimizu
- Department of Surgical Pathology, 12810Hokkaido University Hospital, Sapporo, Japan
| | - Yoshihiro Matsuno
- Department of Surgical Pathology, 12810Hokkaido University Hospital, Sapporo, Japan
| | - Hajime Sakai
- Department of Hematology, 37009Teine Keijinkai Hospital, Sapporo, Japan
| | - Manabu Kase
- Department of Ophthalmology, Orbital Disease & Neuro-Ophthalmology Center, 37009Teine Keijinkai Hospital, Sapporo, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, 12810Hokkaido University, Sapporo, Japan
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Al-Ghazzawi K, Baum SH, Pförtner R, Philipp S, Bechrakis N, Görtz G, Eckstein A, Mairinger FD, Oeverhaus M. Evaluation of Orbital Lymphoproliferative and Inflammatory Disorders by Gene Expression Analysis. Int J Mol Sci 2022; 23:ijms23158609. [PMID: 35955742 PMCID: PMC9369106 DOI: 10.3390/ijms23158609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/28/2022] [Accepted: 07/28/2022] [Indexed: 11/21/2022] Open
Abstract
Non-specific orbital inflammation (NSOI) and IgG4-related orbital disease (IgG4-ROD) are often challenging to differentiate. Furthermore, it is still uncertain how chronic inflammation, such as IgG4-ROD, can lead to mucosa-associated lymphoid tissue (MALT) lymphoma. Therefore, we aimed to evaluate the diagnostic value of gene expression analysis to differentiate orbital autoimmune diseases and elucidate genetic overlaps. First, we established a database of NSOI, relapsing NSOI, IgG4-ROD and MALT lymphoma patients of our orbital center (2000−2019). In a consensus process, three typical patients of the above mentioned three groups (mean age 56.4 ± 17 years) at similar locations were selected. Afterwards, RNA was isolated using the RNeasy FFPE kit (Qiagen) from archived paraffin-embedded tissues. The RNA of these 12 patients were then subjected to gene expression analysis (NanoString nCounter®), including a total of 1364 target genes. The most significantly upregulated and downregulated genes were used for a machine learning algorithm to distinguish entities. This was possible with a high probability (p < 0.0001). Interestingly, gene expression patterns showed a characteristic overlap of lymphoma with IgG4-ROD and NSOI. In contrast, IgG4-ROD shared only altered expression of one gene regarding NSOI. To validate our potential biomarker genes, we isolated the RNA of a further 48 patients (24 NSOI, 11 IgG4-ROD, 13 lymphoma patients). Then, gene expression pattern analysis of the 35 identified target genes was performed using a custom-designed CodeSet to assess the prediction accuracy of the multi-parameter scoring algorithms. They showed high accuracy and good performance (AUC ROC: IgG4-ROD 0.81, MALT 0.82, NSOI 0.67). To conclude, genetic expression analysis has the potential for faster and more secure differentiation between NSOI and IgG4-ROD. MALT-lymphoma and IgG4-ROD showed more genetic similarities, which points towards progression to lymphoma.
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Affiliation(s)
- Karim Al-Ghazzawi
- Department of Ophthalmology, University Hospital Essen, 45147 Essen, Germany; (K.A.-G.); (S.P.); (N.B.); (G.G.); (A.E.)
| | - Sven Holger Baum
- Department of Oral and Maxillofacial Surgery, University of Duisburg-Essen, Kliniken-Essen-Mitte, 45136 Essen, Germany; (S.H.B.); (R.P.)
| | - Roman Pförtner
- Department of Oral and Maxillofacial Surgery, University of Duisburg-Essen, Kliniken-Essen-Mitte, 45136 Essen, Germany; (S.H.B.); (R.P.)
| | - Svenja Philipp
- Department of Ophthalmology, University Hospital Essen, 45147 Essen, Germany; (K.A.-G.); (S.P.); (N.B.); (G.G.); (A.E.)
| | - Nikolaos Bechrakis
- Department of Ophthalmology, University Hospital Essen, 45147 Essen, Germany; (K.A.-G.); (S.P.); (N.B.); (G.G.); (A.E.)
| | - Gina Görtz
- Department of Ophthalmology, University Hospital Essen, 45147 Essen, Germany; (K.A.-G.); (S.P.); (N.B.); (G.G.); (A.E.)
| | - Anja Eckstein
- Department of Ophthalmology, University Hospital Essen, 45147 Essen, Germany; (K.A.-G.); (S.P.); (N.B.); (G.G.); (A.E.)
| | - Fabian D. Mairinger
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
- Correspondence: (F.D.M.); (M.O.)
| | - Michael Oeverhaus
- Department of Ophthalmology, University Hospital Essen, 45147 Essen, Germany; (K.A.-G.); (S.P.); (N.B.); (G.G.); (A.E.)
- Correspondence: (F.D.M.); (M.O.)
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Choi S, Seo M, Park SH, Jo JC, Chae SW, Lee JH, Cha HJ. Clinicopathologic Characteristics Associated with Prognosis in Ocular Extranodal Marginal Zone B Cell Lymphoma. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:818. [PMID: 35744081 PMCID: PMC9229471 DOI: 10.3390/medicina58060818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 06/15/2023]
Abstract
Background and Objectives: Extranodal marginal zone lymphoma of the mucosa-associated lymphoid tissue (MALT) type is the most common subtype of the ocular adnexal lymphoma. Despite its excellent prognosis, some patients experience partial remission or progressive disease. We aimed to evaluate clinicopathologic differences in the treatment responder group by comparing complete remission (CR) and non-complete remission (non-CR). Materials and Methods: This study retrospectively reviewed 48 patients who were diagnosed with ocular adnexal MALT lymphoma at Ulsan University Hospital between March 2002 and August 2018. Patients who were followed up for less than 6 months were excluded. Histologic and clinical features were analyzed. The patients were divided into two groups: CR and non-CR. Results: Among the 48 patients, 33 achieved CR and 15 achieved non-CR during the median follow-up period of 40.00 months (range, 7-109 months). In univariable analysis, more patients tend to undergo treatment in the CR group, and post-radiotherapy (post-RT) SUVmax, PET and serum lactate dehydrogenase (LDH) levels were higher in the non-CR group (p = 0.043, p = 0.016, and p = 0.042, respectively). In a multivariable analysis, only application of treatment, including radiotherapy or chemotherapy with immunotherapy, was related to CR (odd ratio 7.301, 95% confidence interval 1.273-41.862, p = 0.026). In subgroup analysis according to the site of involvement, none of the variables were significant except for the post-RT SUVmax of PET and level of serum LDH in the non-conjunctiva group (p = 0.026, and p = 0.037, respectively). Seven (14.6%) patients had a recurrence, and those with a recurring site other than the primary site had a higher Ki-67 labeling index, although it was not statistically significant (9.56% vs. 18.00%, p = 0.095). Conclusions: Although belonging to the early stages, the non-CR rate was high in patients with high serum LDH levels, and recurred patients had higher Ki-67. Thus, considering active treatment is recommended in this group of patients.
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Affiliation(s)
- Soyeon Choi
- Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 05505, Korea;
| | - Minjung Seo
- Department of Nuclear Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 05505, Korea; (M.S.); (S.H.P.)
| | - Seol Hoon Park
- Department of Nuclear Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 05505, Korea; (M.S.); (S.H.P.)
| | - Jae-Cheol Jo
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 05505, Korea;
| | - Seoung Wan Chae
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea;
| | - Ju-Hyang Lee
- Department of Ophthalmology, Ajou University Medical Center, Suwon 16499, Korea
| | - Hee Jeong Cha
- Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 05505, Korea;
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Mitamura M, Kase S, Suzuki Y, Sakaguchi T, Suimon Y, Dong Y, Hatanaka KC, Sinohara T, Kase M, Ishida S. Follicular lymphoma of the ocular adnexa: Clinicopathological findings with flow cytometry analysis of eight cases. Eur J Ophthalmol 2021; 32:1760-1765. [PMID: 34082607 DOI: 10.1177/11206721211023309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE Flow cytometry (FCM) is used to evaluate cell surface markers of various leukocyte populations quantitatively. However, little is known about the usefulness of FCM in follicular lymphoma (FL) of the ocular adnexa. The aim of this study was to evaluate the clinicopathological features and FCM results in ocular adnexal FL. MATERIALS This is a retrospective multicenter case study on clinical and immunohistochemical features. All tumors, surgically excised, were diagnosed based on histopathology, immunoglobulin heavy chain gene rearrangement, and FCM. The percentages (%) of B-cell markers, T-cell markers, a natural killer cell marker, and cell surface kappa/lambda measured by FCM analysis in tumor tissues were searched based on medical records. RESULTS This study enrolled nine tumors in eight FL patients (three men and five women). The median age at the time of initial presentation was 74 years. All the tumors surgically excised histologically exhibited cluster of differentiation (CD)10, CD20, and BCL2-positive cells. At the time of ophthalmic diagnosis, lymphomas were already disseminated throughout the body in five cases. FCM demonstrated high percentage of B-cell markers including CD10, CD19, CD20, and CD23 in all nine tumors. CD10 population was 73.5% ± 11.9% in seven out of nine tumors, while that in the other two tumors was particularly low being 11.7% ± 1.13%, which showed the relatively high T-cell lineages compared to the other seven tumors. CONCLUSION For ophthalmologists involving managements of ocular adnexal tumors, FCM can provide useful information for complementing the diagnosis and understanding pathophysiology of FL.
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Affiliation(s)
- Mizuho Mitamura
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.,Department of Ophthalmology, Orbital Disease and Neuro-Ophthalmology Center, Teine Keijinkai Hospital, Sapporo, Japan
| | - Satoru Kase
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yasuo Suzuki
- Department of Ophthalmology, Orbital Disease and Neuro-Ophthalmology Center, Teine Keijinkai Hospital, Sapporo, Japan
| | - Takatoshi Sakaguchi
- Department of Ophthalmology, Orbital Disease and Neuro-Ophthalmology Center, Teine Keijinkai Hospital, Sapporo, Japan
| | - Yuka Suimon
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yoko Dong
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kanako C Hatanaka
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan.,Clinical Biobank, Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan
| | - Toshiya Sinohara
- Department of Pathology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Manabu Kase
- Department of Ophthalmology, Orbital Disease and Neuro-Ophthalmology Center, Teine Keijinkai Hospital, Sapporo, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Asakage M, Usui Y, Nezu N, Shimizu H, Tsubota K, Umazume K, Yamakawa N, Umezu T, Suwanai H, Kuroda M, Goto H. Comprehensive Gene Analysis of IgG4-Related Ophthalmic Disease Using RNA Sequencing. J Clin Med 2020; 9:jcm9113458. [PMID: 33121169 PMCID: PMC7693346 DOI: 10.3390/jcm9113458] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/23/2020] [Accepted: 10/25/2020] [Indexed: 02/06/2023] Open
Abstract
High-throughput RNA sequencing (RNA-seq) uses massive parallel sequencing technology, allowing the unbiased analysis of genome-wide transcription levels and tumor mutation status. Immunoglobulin G4-related ophthalmic disease (IgG4-ROD) is a fibroinflammatory disease characterized by the enlargement of the ocular adnexal tissues. We analyzed RNA expression levels via RNA-seq in the biopsy specimens of three patients diagnosed with IgG4-ROD. Mucosa-associated lymphoid tissue (MALT) lymphoma, reactive lymphoid hyperplasia (RLH), normal lacrimal gland tissue, and adjacent adipose tissue were used as the controls (n = 3 each). RNA-seq was performed using the NextSeq 500 system, and genes with |fold change| ≥ 2 and p < 0.05 relative to the controls were defined as differentially expressed genes (DEGs) in IgG4-ROD. To validate the results of RNA-seq, real-time polymerase chain reaction (PCR) was performed in 30 IgG4-ROD and 30 orbital MALT lymphoma tissue samples. RNA-seq identified 35 up-regulated genes, including matrix metallopeptidase 12 (MMP12) and secreted phosphoprotein 1 (SPP1), in IgG4-ROD tissues when compared to all the controls. Many pathways related to the immune system were included when compared to all the controls. Expressions of MMP12 and SPP1 in IgG4-ROD tissues were confirmed by real-time PCR and immunohistochemistry. In conclusion, we identified novel DEGs, including those associated with extracellular matrix degradation, fibrosis, and inflammation, in IgG4-ROD biopsy specimens. These data provide new insights into molecular pathogenetic mechanisms and may contribute to the development of new biomarkers for diagnosis and molecular targeted drugs.
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Affiliation(s)
- Masaki Asakage
- Department of Ophthalmology, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan; (M.A.); (N.N.); (H.S.); (K.T.); (K.U.); (N.Y.); (H.G.)
| | - Yoshihiko Usui
- Department of Ophthalmology, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan; (M.A.); (N.N.); (H.S.); (K.T.); (K.U.); (N.Y.); (H.G.)
- Correspondence: ; Tel.: +81-3-3342-6111
| | - Naoya Nezu
- Department of Ophthalmology, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan; (M.A.); (N.N.); (H.S.); (K.T.); (K.U.); (N.Y.); (H.G.)
| | - Hiroyuki Shimizu
- Department of Ophthalmology, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan; (M.A.); (N.N.); (H.S.); (K.T.); (K.U.); (N.Y.); (H.G.)
| | - Kinya Tsubota
- Department of Ophthalmology, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan; (M.A.); (N.N.); (H.S.); (K.T.); (K.U.); (N.Y.); (H.G.)
| | - Kazuhiko Umazume
- Department of Ophthalmology, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan; (M.A.); (N.N.); (H.S.); (K.T.); (K.U.); (N.Y.); (H.G.)
| | - Naoyuki Yamakawa
- Department of Ophthalmology, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan; (M.A.); (N.N.); (H.S.); (K.T.); (K.U.); (N.Y.); (H.G.)
| | - Tomohiro Umezu
- Department of Molecular Pathology, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan; (T.U.); (M.K.)
| | - Hirotsugu Suwanai
- Department of Diabetes, Metabolism and Endocrinology, Tokyo Medical University, 6-7-1 Nishi-shinjuku Shinjuku-ku, Tokyo 160-0023, Japan;
| | - Masahiko Kuroda
- Department of Molecular Pathology, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan; (T.U.); (M.K.)
| | - Hiroshi Goto
- Department of Ophthalmology, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan; (M.A.); (N.N.); (H.S.); (K.T.); (K.U.); (N.Y.); (H.G.)
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Nezu N, Usui Y, Asakage M, Shimizu H, Tsubota K, Narimatsu A, Umazume K, Yamakawa N, Ohno SI, Takanashi M, Kuroda M, Goto H. Distinctive Tissue and Serum MicroRNA Profile of IgG4-Related Ophthalmic Disease and MALT Lymphoma. J Clin Med 2020; 9:jcm9082530. [PMID: 32764512 PMCID: PMC7464164 DOI: 10.3390/jcm9082530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/23/2020] [Accepted: 07/31/2020] [Indexed: 12/24/2022] Open
Abstract
The molecular pathogenesis of orbital lymphoproliferative disorders, such as immunoglobulin G4-related ophthalmic disease (IgG4-ROD) and orbital mucosa-associated lymphoid tissue (MALT) lymphoma, remains essentially unknown. Differentiation between the two disorders, which is important since the work-up and treatment can vary greatly, is often challenging due to the lack of specific biomarkers. Although miRNAs play an important role in the regulation of carcinogenesis and inflammation, the relationship between miRNA and orbital lymphoproliferative diseases remains unknown. We performed a comprehensive analysis of 2565 miRNAs from biopsy and serum specimens of 17 cases with IgG4-ROD, where 21 cases with orbital MALT lymphoma were performed. We identified specific miRNA signatures and their miRNA target pathways, as well as the network analysis for IgG4-ROD and orbital MALT lymphoma. Machine-learning analysis identified miR-202-3p and miR-7112-3p as the best discriminators of IgG4-ROD and orbital MALT lymphoma, respectively. Enrichment analyses of biological pathways showed that the longevity-regulating pathway in IgG4-ROD and the mitogen-activated protein kinase (MAPK) signaling pathway in orbital MALT lymphoma was most enriched by target genes of downregulated miRNAs. This is the first evidence of miRNA profiles of biopsy and serum specimens of patients with IgG4-ROD and orbital MALT lymphoma. These data will be useful for developing diagnostic and therapeutic interventions, as well as elucidating the pathogenesis of these disorders.
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Affiliation(s)
- Naoya Nezu
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (N.N.); (M.A.); (H.S.); (K.T.); (A.N.); (K.U.); (N.Y.); (H.G.)
| | - Yoshihiko Usui
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (N.N.); (M.A.); (H.S.); (K.T.); (A.N.); (K.U.); (N.Y.); (H.G.)
- Correspondence: ; Tel.: +81-3-3342-6111
| | - Masaki Asakage
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (N.N.); (M.A.); (H.S.); (K.T.); (A.N.); (K.U.); (N.Y.); (H.G.)
| | - Hiroyuki Shimizu
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (N.N.); (M.A.); (H.S.); (K.T.); (A.N.); (K.U.); (N.Y.); (H.G.)
| | - Kinya Tsubota
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (N.N.); (M.A.); (H.S.); (K.T.); (A.N.); (K.U.); (N.Y.); (H.G.)
| | - Akitomo Narimatsu
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (N.N.); (M.A.); (H.S.); (K.T.); (A.N.); (K.U.); (N.Y.); (H.G.)
| | - Kazuhiko Umazume
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (N.N.); (M.A.); (H.S.); (K.T.); (A.N.); (K.U.); (N.Y.); (H.G.)
| | - Naoyuki Yamakawa
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (N.N.); (M.A.); (H.S.); (K.T.); (A.N.); (K.U.); (N.Y.); (H.G.)
| | - Shin-ichiro Ohno
- Department of Molecular Pathology, Tokyo Medical University, Tokyo 160-8402, Japan; (S.-i.O.); (M.T.); (M.K.)
| | - Masakatsu Takanashi
- Department of Molecular Pathology, Tokyo Medical University, Tokyo 160-8402, Japan; (S.-i.O.); (M.T.); (M.K.)
| | - Masahiko Kuroda
- Department of Molecular Pathology, Tokyo Medical University, Tokyo 160-8402, Japan; (S.-i.O.); (M.T.); (M.K.)
| | - Hiroshi Goto
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (N.N.); (M.A.); (H.S.); (K.T.); (A.N.); (K.U.); (N.Y.); (H.G.)
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