AB0763 IGG4-RELATED CORONARY PERIARTERITIS: SYSTEMATIC LITERATURE REVIEW WITH OUR CASE SERIES

Background:

Coronary periarteritis is one of the clinical manifestations of IgG4-related disease. It can cause serious conditions such as angina and ruptured aneurysms. Therefore, it is important to recognize the clinical and radiological characteristics, which was little known.

Objectives:

We report four patients with IgG4-related coronary periarteritis with a systematic literature review.

Methods:

We identified four patients with IgG4-related coronary periarteritis at the St. Luke’s International Hospital in Tokyo, Japan from 2014 to 2020. A systematic literature review was conducted for English articles on IgG4-related coronary periarteritis cases with a full text or abstract available. We summarized patient demographics, IgG and IgG4 titers, the site and morphological type of coronary lesion, and other organ involvements.

Results:

Our 4 cases and 38 cases identified by the literature review were assessed. Coronary artery lesions were detected by a coronary CT in all but two cases. Wall thickening was the most common type of the lesion. Moreover, there were 32 (76.1%) patients with other organ involvements. The commonest other lesion was peri-aortitis in 21 (50.0%) patients. In cases with peri-aortitis, IgG and IgG4 titers were significantly higher than those without peri-aortitis (IgG4; 1540 [705.0, 2570.0] vs 246.0 [160.0, 536.3]; p = 0.001, IgG; 3596.5 [2838.3, 4260.0] vs 1779.0 [1288.3, 1992.8]; p =0.040). In addition, 15 (71.4%) patients of them had three or more IgG4 related organ involvements.

Conclusion:

Coronary CT was a useful imaging modality for the diagnosis of IgG4-related coronary periarteritis, and wall thickening was the most common lesion. Moreover, about half cases coexisted with peri-aortitis. Peri-aortitis and other organ involvements should be screened in those with higher IgG and IgG4.

Table 1.

Characteristics of our cases and the literature review cases.

RCA: right coronary artery, LAD: left anterior descending artery, LCx: left circumflex artery

Disclosure of Interests:

None declared

FRI0535 NEWLY DETECTED HYPERTHYROIDISM WITH THERAPEUTIC INDICATIONS IN RHEUMATIC DISEASE PATIENTS AND HEALTHY CONTROLS IN JAPAN: A RETROSPECTIVE COHORT STUDY

Background:

Thyroid disorders are known as common comorbidities of rheumatic diseases(RD) [1]. However, data regarding prevalence of hyperthyroidism with treatment indication in RD patients are limited.

Objectives:

This study aims to reveal and compare the frequency of newly developed hyperthyroidism with treatment indication between RD patients and healthy controls (HC), and identify risk factors to identify patients whose thyroid function should be followed up carefully.

Methods:

We retrospectively reviewed charts of RD patients and HC who had thyroid stimulating hormone (TSH) measured at least once between 2004 and 2018 from immuno-rheumatology center and preventive medicine center in St. Luke’s International Hospital, Japan. We compared frequency of hyperthyroidism requiring treatment (TSH ≦ 0.1μU/mL or for which physicians started treatment) with Kaplan-Meier curve and log rank test. Cox regression multivariate analysis was performed to reveal risk factors for the new onset of hyperthyroidism with treatment indication in participants without treatment-indicated hyperthyroidism at initial assessments.

Results:

Overall, 2307 RD patients and 78251 HC were included. Newly detected hyperthyroidism with treatment indication were significantly more frequent in RD patients at initial assessment (1.3% vs 0.5 %, p < 0.001) and in total (2.9% vs 1.7%, p<0.001) (Table 1, Figure 1). Cox regression multivariate analysis revealed systemic lupus erythematosis (SLE), polymyositis dermatomyositis (PMDM), mixed connective tissue disease (MCTD) as significant risk factors of new developments of hyperthyroidism during follow up after adjusting confounders. (Table 2)

Table 1.

Patients characteristics and results of hyperthyroidism

Rheumatic Disease (n = 2307)Control (n = 78251)p.valueAge(yr)53.7 (16.2)46.1 (11.9)<0.001Female (%)1826 (79.2)38632 (49.4)<0.001 Rheumatoid arthritis (%)1091 (47.3)-NA Spondyloarthritis161 (7.0)-NA ANA associated disease (%)944 (40.9)-NA  SLE(%)363 (15.7)-NA  SS (%)396 (17.2)-NA  PMDM(%)104 (4.5)-NA  SSc (%)222 (9.6)-NA  MCTD (%)43 (1.9)-NA Vasculitis (%)202 (8.8)-NA Others (%)244 (10.6)-NATimes of TSH measurement2.0 [1.0, 5.0]5.0 [3.0, 9.0]<0.001Follow up of TSH (days)258.00 [0, 1315]1992 [958, 3632]<0.001Baseline TSH (μU/mL)2.28 (3.21)2.15 (4.07)0.137 ≦0.45 μU/mL (%)86 (3.7)1371 (1.8)<0.001 ≦0.1 μU/mL (%)29 (1.3)389 (0.5)<0.001Baseline FreeT4 (μU/mL)1.16 (0.24)1.30 (0.20)<0.001≧1.65 μU/mL (%)17 (0.8)2355 (3.0)<0.001TSH level in follow up ≦0.45 μU/mL (%)231 (0.0)3926 (5.0)<0.001 ≦0.1 μU/mL (%)84 (3.6)1388 (1.8)<0.001Newly detected hyperthyroidism with treatment indication (%)68 (2.9)1350 (1.7)<0.001 At initial assessment (%)29 (1.3)389 (0.5)<0.001 In follow up (%)39 (1.6)961 (1.2)<0.001Treatment for hyperthyroidism (%)21 (0.9)325 (0.4)0.002Figure 1.

Hyperthyroidism with treatment indication in rheumatic patients and control

Table 2.

Risk factors for newly detected hyperthyroidism with treatment indication

Adjusted HRp valueAge0.99 (0.98-0.99)< 0.001Female2.68 (2.31-3.12)< 0.001BMI1.04 (1.02-1.06)< 0.001Baseline TSH ≦ 0.455.71 (4.47-7.30)< 0.001Baseline Free T4 ≧ 1.651.16 (0.79-1.69)0.45Rheumatoid arthritis1.05 (0.50-2.21)0.90ANA associated diseases-- SLE2.29 (1.11-4.71)0.025 SS1.91 (0.91-4.01)0.089 PMDM12.90 (5.50-30.22)< 0.001 SSc0.67 (0.18-2.43)0.541 MCTD8.02 (2.62-24.51)< 0.001Vasculitis1.44 (0.35-5.92)0.610Spondyloarthritis3.04 (0.74-12.52)0.120Others1.98 (0.67-5.81)0.214

Conclusion:

Hyperthyroidism with therapeutic indications are considerably more frequent in RD patients (particularly with SLE, PMDM and MCTD) both at initial assessment and during follow up. We recommend routine screening at initial assessment and careful follow up of thyroid function test in those patients.

References:

[1] Rev Bras Rheumatol 2012;52(3):417-430

Disclosure of Interests:

None declared

AB0533 ANTI-NEUTROPHIL CYTOPLASMIC ANTIBODY (ANCA) IN GENERAL POPULATION WITHOUT ANCA ASSOCIATED VASCULITIS

Background:

Currently it is hypothesized that many systemic autoimmune diseases occur due to environmental risk factors in addition to genetic risk factors. Anti-Neutrophil Cytoplasmic Antibody (ANCA) is mainly associated with three systemic autoimmune disease including granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), eosinophilic granulomatosis with polyangiitis (EGPA). It is known that ANCA can be positive before clinical symptoms in patients with known diagnosis of GPA and ANCA titers rise before clinical manifestations appear. However, prevalence of ANCA among general population is not well known. It has not been described as well how many of people with positive ANCA eventually develop clinical manifestations of ANCA associated Vasculitis.

Objectives:

This study aims to estimate prevalence of ANCA in general population without ANCA associated Vasculitis. It also describes natural disease course of people with positive ANCA without ANCA associated Vasculitis. Risk factors for positive ANCA are also analyzed.

Methods:

This is a single center retrospective study at Center for Preventive Medicine of St. Luke’s International Hospital in Tokyo. ANCA was checked among the patients who wished to between 2018 and 2019. St. Luke’s Health Check-up Database (SLHCD) was utilized to collect the data. The patients whose serum was measured for ANCA were identified. The data for basic demographics, social habits, dietary habits and laboratory data were extracted. The charts of the patients with positive ANCA were reviewed.

Results:

Sera of total 1204 people were checked for ANCA. Of these 1204 people, 587 (48.8%) are male and the mean age was 55.8 years (32.6 to 79). There were total 11 patients with positive ANCA. Myeloperoxidase ANCA (MPO-ANCA) was positive for 3 patients and proteinase 3 ANCA (PR3-ANCA) was positive for 8 patients. Of these 11 patients, 5 were male (45.5%) and the mean age was 54.6 years. Two patients had history of autoimmune disease (primary biliary cirrhosis and ulcerative colitis). Five patients were evaluated by rheumatologists with the median follow-up period of 274 days. None of them developed clinical signs and symptoms of ANCA associated Vasculitis. Four out of five patients had ANCA checked later, two of which turned negative. The prevalence of ANCA in this cohort was 0.9% (95% confidence interval [95% CI]: 0.5% to 1.6%). Univariate analysis was performed to identify risk factors of positive ANCA. The variables analyzed include age, gender, body mass index (BMI), smoking habits, alcohol intake, dietary habits (fruits, fish, red meat), hypertension, dyslipidemia, and laboratory data. None of these variables demonstrated statistically significant differences except for positive rheumatoid factor (ANCA positive group: 33 % vs ANCA negative group: 9.1%, p value = 0.044).

Conclusion:

The prevalence of ANCA in this cohort was 0.9% (95% CI: 0.5% to 1.6%). None of them who had a follow-up developed ANCA associated Vasculitis during the follow-up period. Longer follow-up and more patients are necessary to determine natural course of people with positive ANCA.

Disclosure of Interests:

None declared

SAT0525 EFFICACY AND SAFETY OF MZR FOR IgG4-RELATED DISEASE

Background:

IgG4-Related Disease (IgG4RD) is known to cause multiple organ lesions with infiltration of IgG4-positive plasma cells, and patients often have relapses with tapering treatments despite an initial good response to glucocorticoids therapy. Mizoribine (MZR) is an immunosuppressant working as an inhibitor of purine synthesis, which mechanism of action is similar to mycophenolate mofetil. Data regarding the efficacy and safety of MZR on IgG4RD is limited although some previous case reports1showed effectiveness for IgG4RD.

Objectives:

This study aims to assess the efficacy and safety of MZR in patients with IgG4RD.

Methods:

We retrospectively reviewed charts of IgG4RD patients who used MZR between January 2004 and December 2019 at Immuno-Rheumatology Center in St. Luke’s International Hospital, Tokyo, Japan. We investigated basic demographics, involved organs, results of blood tests including IgG and IgG4 titer, and medications used including glucocorticoid and other immunosuppressants (IS). We followed IgG4 titer, dose of glucocorticoid, flare of disease and retention of MZR at the beginning, 6 and 12months after starting MZR. We compared changes in PSL (prednisolone) doses and IgG4 titers over time using Friedman test with Bonferroni correction. We also checked adverse events during follow up.

Results:

Twenty-two patients with IgG4RD who used MZR were included. Median age was 62 years old, and 15 (68.2%) patients are male. Lacrimal and salivary glands, pancreatitis and retroperitoneal fibrosis were common lesions. All patients were initially treated with glucocorticoids. Flare was observed in 5 (22.7 %) patients before initiation of MZR. The number of patients who continued MZR without flare are 19 (86.4 %) at 6 months, and 14 (73.7 %) at 12 months. IgG4 titer significantly declined at 6 and 12 months from baseline although significant consecutive decrease in PSL dose (Figure 1, 2). Liver dysfunctions are commonest adverse events (n=16, 72.7%) but mild (grade1; n=15, 68.2%) and most cases are apparently due to other reasons. Serious infection (SI) occurred in 3 (13.6%) patients in total follow up, however no SI were observed during 1 year after MZR treatment.

Conclusion:

MZR can be safely used in patients of IgG4RD with high retention rate, and seemed to have steroid-sparing effect. Prospective comparative studies are needed.

References:

[1]Nanke Y, Kobashigawa T, Yago T, Kamatani N, Kotake S. A case of Mikulicz’s disease, IgG4-related plasmacytic syndrome, successfully treated by corticosteroid and mizoribine, and then by mizoribine alone. Intern Med 49: 1449-1453, 2010.

Table 1.

Patient characteristics

    Table 2.

Disease and treatment status before and after initiation of MZR

    Figure 1.

Serum IgG4 level changes

Figure 2.

Changes in the PSL dose over time

Disclosure of Interests:

None declared

AB0198 SMOKING AND POSITIVITY OF RHEUMATOID FACTOR AND ANTI-CYCLIC CITRULLINATED PEPTIDE ANTIBODY IN THE GENERAL POPULATION

Background:

It is well known that rheumatoid arthritis (RA) occurs due to environmental risk factors in addition to genetic risk factors. Rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (ACPA) are strongly associated with RA, and these biomarkers could turn to be positive before development of clinical symptoms. While smoking, particularly Brinkman index (BI) is well known as a risk factor for RA and ACPA positivity, it is still unclear whether smoking intensity or smoking duration contribute more to positive RF and ACPA.

Objectives:

This study aims to evaluate risk factors for RF and ACPA positivity in the general population. It also describes whether smoking intensity, duration, and BI are significant.

Methods:

This is a cross-sectional, observational, single center study. We reviewed the baseline characteristics of the general population who checked RF and ACPA at Preventive Medicine Center in St. Luke’s International Hospital, Tokyo, Japan from January 2004 to December 2018.

The data for basic demographics, dietary habit, smoking intensity, smoking duration, BI, and blood tests including RF and ACPA were extracted. The data was analyzed statistically.

Results:

A total of 127472 people who checked RF are included. Of these 127472 people, 64504 (50.6%) are male and the mean age was 44.9 years. RF was positive in 11477 people (9.0%). Among these, 1667 (1.2%) were checked for ACPA, and 21 people (1.3%) had positive ACPA. None of variables demonstrated significant association with RF positivity. In contrast, BI and smoking duration was significantly associated with an increased risk of ACPA positivity (13.3 years vs 7.49 years, p value = 0.023), although the number of cigarettes smoked was not. The smoking duration for 10 years or more was associated with an increased risk of ACPA positivity even after adjusted for age and sex (adjusted hazard ratio: 2.47 [95% confidence interval: 1.04-5.87]; p=0.04).

Conclusion:

In this study, no significant risk factor for positive RF was found. Even smoking was not associated with RF positivity. On the other hand, smoking duration, not smoking intensity was significantly associated with an increased risk of ACPA positivity.

References:

[1]Verpoort KN. Association of smoking with the constitution of the anti-cyclic citrullinated peptide response in the absence of HLA-DRB1 shared epitope alleles. Arthritis Rheum 2007;56:29138.

Table 1.

Patient characteristics with RF and ACPA positivity

RF positive (n=11477)RF negative (n=115995)p valueACPA positive (n=21)ACPA negative (n=1646)p valueAge44.86 (12.32)44.94 (12.47)0.5437.90 (9.07)45.26 (12.58)0.008Male (%)5659 (49.3)57309 (49.4)0.84511 (52.4)834 (50.7)1Body Mass Index22.33 (3.38)22.35 (3.40)0.52121.64 (3.28)22.34 (3.37)0.346Smoker, total (%)4509 (39.3)45738 (39.4)0.77212 (57.1)642 (39.0)0.115Current smoker (%)1959 (17.1)20483 (17.7)0.1148 (38.1)277 (16.8)0.017Previous smoker (%)2550 (22.2)25255 (21.8)0.2714 (19.0)365 (22.2)1Brinkman index144.8 (299.3)145.2 (313.8)0.897280.9 (409.7)145.3 (300.3)0.041Number of cigarettes (/day)17.7 (18.5)17.4 (13.3)0.16619.8 (12.0)17.4 (12.1)0.511Smoking Duration (years)7.43 (11.68)7.45 (11.66)0.85113.33 (14.11)7.49 (11.68)0.023Alcohol Drinker (%)6972 (60.7)70010 (60.4)0.41810 (47.6)1005 (61.1)0.261Alcohol Intake (g/day)13.67 (21.88)13.58 (21.32)0.67616.70 (26.89)14.06 (22.16)0.59Exercise ≧3 times/week (%)2792 (24.3)28293 (24.4)0.8825 (23.8)402 (24.4)1White blood cell (103/μL)5.32 (1.46)5.35 (1.50)0.135.59 (2.05)5.37 (1.54)0.52Hemoglobin (g/dL)13.82 (1.44)13.82 (1.45)0.75314.12 (1.03)13.83 (1.43)0.36Creatinine (mg/dL)0.73 (0.20)0.73 (0.25)0.1940.76 (0.16)0.73 (0.18)0.586AST (U/L)21.89 (9.39)21.93 (11.65)0.78220.95 (6.02)21.68 (8.29)0.69LDL cholesterol (mg/dL)115.41 (30.90)115.48 (30.77)0.815112.62 (33.26)115.36 (31.03)0.688Triglyceride (mg/dL)97.63 (78.46)97.70 (80.36)0.929100.57 (63.40)97.85 (78.37)0.874Uric Acid (mg/dL)5.32 (1.42)5.33 (1.42)0.6235.76 (1.34)5.34 (1.42)0.172

Disclosure of Interests:

None declared

Shochu slop is an excellent medium for Escherichia coli K-12

We found that shochu slop, the residue generated during the production of distilled shochu liquor, which must be treated as industrial waste, can be used as an excellent medium for Escherichia coli culture. LB medium is generally used in laboratories for culturing E. coli. However, it is not the optimal medium for E. coli culture because the bacterial cells cannot grow to very high densities in LB medium. On the other hand, E. coli can grow to higher densities in Terrific broth and this medium is used when researchers want to grow E. coli to high density or to obtain a protein with high yield. In this study, we removed solid matter from shochu slop, adjusted the pH of the mixture to 7 and subsequently used the slop for E. coli culture. The ability of shochu slop to support E. coli growth was compared with those of LB Miller medium and Terrific broth. The results indicate that sweet potato shochu slop as culture medium for E. coli is comparable to Terrific broth and much better than LB Miller medium in terms of supporting cell proliferation, and plasmid and enzyme production. SIGNIFICANCE AND IMPACT OF THE STUDY: Shochu manufacturers incur a cost to dispose shochu slop, which is recognized as food manufactural residues. Escherichia coli has been used in laboratories and in industry. However, culture media used in the laboratories are expensive and those used in industry are expensive because of their large scale. We found that sweet potato shochu slop is an excellent culture medium for E. coli. This finding is not only useful for laboratories and industry, but also beneficial to the effective utilization of this renewable resource to create a sustainable society.

Environmental Distribution and Drug Susceptibility of Achromobacter Xylosoxidans Isolated from Outdoor and Indoor Environments

Achromobacter xylosoxidans is an environmental bacterium with multi-drug resistance. We isolated Achromobacter xylosoxidans and investigated its susceptibility to 13 drugs. Seventy-eight water samples were collected from rivers and ponds, and 11 samples were swabbed from residential sinks and baths. Nine strains of Achromobacter xylosoxidans were isolated from the 89 samples. Five strains, including 2 that were sampled from residential homes, showed high resistance to multiple aminoglycosides. This indicated that Achromobacter xylosoxidans is widely distributed in various outdoor and indoor environments. Moreover, since these highly resistant bacteria were present in indoor environments, caution should be taken for elderly people living at home. Furthermore, a careful assessment should be made for diagnosing and treating compromised hosts.

Properties of Achromobacter xylosoxidans highly resistant to aminoglycoside antibiotics

We herein discovered a highly resistant clinical isolate of Pseudomonas aeruginosa with MICs to amikacin, gentamicin, and arbekacin of 128 μg/mL or higher in a drug sensitivity survey of 92 strains isolated from the specimens of Yoka hospital patients between January 2009 and October 2010, and Achromobacter xylosoxidans was separated from this P. aeruginosa isolate. The sensitivity of this bacterium to 29 antibiotics was investigated. The MICs of this A. xylosoxidans strain to 9 aminoglycoside antibiotics were: amikacin, gentamicin, arbekacin, streptomycin, kanamycin, neomycin, and spectinomycin, 1,024 μg/mL or ≥ 1,024 μg/mL; netilmicin, 512 μg/mL; and tobramycin, 256 μg/mL. This strain was also resistant to dibekacin. This aminoglycoside antibiotic resistant phenotype is very rare, and we are the first report the emergence of A. xylosoxidans with this characteristic.

Approximate Entropy of Respiratory Movements in Human Newborns during Different Sleep States

Previous studies have reported that the respiratory cycle of healthy newborns is more irregular during active sleep. This study aimed to apply non-linear analysis to examine the irregularity of respiratory movement in newborns at different sleep states. The respiratory movement signals from an abdominal band during quiet and active sleep were analyzed using approximate entropy (ApEn). The breathing interval of active sleep was significantly shorter than that of quiet sleep [1.30 (0.17) s vs. 1.58 (0.11) s; (P < 0.03)]. The ApEn of respiratory movements during active sleep were significantly larger than that during quiet sleep [0.785 (0.135) s vs. 0.678 (0.083) s; (P < 0.05)]. We found that the ApEn of respiratory movement in healthy newborns could detect irregularities in respiration during sleep.

Effect of electrical stimulation-induced muscle force and streptomycin treatment on muscle and trabecular bone mass in early-stage disuse musculoskeletal atrophy

OBJECTIVES

The aim was to determine whether daily muscle electrical stimulation (ES) and streptomycin treatment would have positive or negative effects on trabecular bone mass in disuse rats.

METHODS

Seven-week-old male F344 rats were randomly divided into five groups of eight animals each: an age-matched control group (CON); a sciatic denervation group (DN); a DN + direct electrical stimulation group (DN+ES); a DN + streptomycin treatment group (DN+SM); and a DN+ES+SM group. The tibialis anterior (TA) muscles in all ES groups were stimulated with 16mA at 10Hz for 30 min/day, six days/week, for one week. Bone volume and structure were evaluated using micro-CT, and histological examinations of the tibiae were performed.

RESULTS

Direct ES significantly reduced the disuse-induced trabecular bone loss. Osteoid thickness were also significantly greater in the ES groups than in the DN group. Micro CT and histomorphological parameters were significantly lower in the DN+ES+SM group than in the DN+ES group, while there were no significant differences between the DN and DN+SM groups.

CONCLUSIONS

These results suggest that ES-induced muscle force reduced trabecular bone loss, and streptomycin treatment did not induce bone loss, but attenuated the effects of ES-induced muscle force on reducing the loss of disused bone.

Electrical stimulation of denervated rat skeletal muscle retards trabecular bone loss in early stages of disuse musculoskeletal atrophy

OBJECTIVES

We aimed to determine the intensity of muscle stimulation required to prevent structural failure as well as bone and skeletal muscle loss after denervation-induced disuse.

METHODS

Seven-week-old rats (weight, 198-225 g) were randomly assigned to age-matched groups comprising control (CON), sciatic nerve denervation (DN) or direct electrical stimulation (ES) one day later [after denervation] with 4, 8 and 16 mA at 10 Hz for 30 min/day, six days/week, for one or three weeks. Bone architecture and mean osteoid thickness in histologically stained tibial sections and tension in tibialis anterior muscles were assessed at one and three weeks after denervation.

RESULTS

Direct ES with 16 mA generated 23-30% maximal contraction force. Denervation significantly decreased trabecular bone volume fraction, thickness and number, connectivity density and increased trabecular separation in the DN group at weeks one and three. Osteoid thickness was significantly greater in the ES16 group at week one than in the DN and other ES groups. Trabecular bone volume significantly correlated with muscle weight.

CONCLUSIONS

Relatively low-level muscle contraction induced by low-frequency, high-intensity electrical muscle stimulation delayed trabecular bone loss during the early stages (one week after DN) of musculoskeletal atrophy due to disuse.

Changes over time in structural plasticity of trabecular bone in rat tibiae immobilized by reversible sciatic denervation

OBJECTIVE

The present study aimed to clarify the structural recovery, and to compare the time course of morphological changes in trabeculae and the process of bone mass change in rat tibiae following temporary immobilization of hind limb by sciatic neurectomy or nerve freezing.

METHODS

In 11-week-old male Fischer 344 rats, 4-5 mm of the sciatic nerve was removed (neurectomy group) or frozen by 5-second application of a stainless steel rod immersed in liquid nitrogen (nerve-freezing group). Quantitative changes in cancellous bone were assessed by histomorphometry.

RESULTS

The results clarified that: trabecular bone volume (BV/TV) decreases until 3 weeks after denervation, and in the nerve-freezing group, it then increases from week 4, recovering to pre-surgery levels by week 10 (no recovery was seen in the neurectomy group); in the initial phase of bone atrophy, the decrease in BV/TV is more gradual in the nerve-freezing group than in the neurectomy group; and changes in trabecular architecture in the bone atrophy-recovery process are strongly associated with changes in trabecular thickness.

CONCLUSION

The findings suggested that after transient injury by nerve freezing and subsequent recovery of neuromuscular function, bone tissue undergoes recovery from bone loss, but that trabeculae may not show complete structural recovery.

Effects of aerobic exercise training on brain structure and psychological well-being in young adults

AIM

There is convergent evidence that exercise increases psychological well-being; however, the mechanism of this psychological effect of exercise is not yet completely understood. The purpose of this study was to examine the effects of aerobic exercise training on brain structure and psychological well-being in young adults.

METHODS

University students who had not regularly exercised were divided into training group (N.=15) and control group (N.=15). The training group performed a total 30 periods of aerobic exercise training, while the control group never performed. Whole-brain magnetic resonance imaging scans and mental health questionnaire examinations were performed before and after the exercise training period for all of the participants. A voxel-based morphometry (VBM) analysis was used to compare the changes in gray-matter volumes in the two groups. VBM is an objective whole-brain technique for characterization of regional cerebral volume and tissue concentration differences in structural magnetic resonance images.

RESULTS

The results of VBM analysis revealed no change in gray-matter volume in the training group, although the gray-matter volume of the left insula was significantly decreased in the control group after the exercise training period. The training group exhibited significant improvement in some scores on the mental health questionnaire after the exercise training period, compared with the control group.

CONCLUSIONS

These findings suggest that aerobic exercise training may inhibit gray-matter volume loss in the insula, and that a relationship may exist between preservation of insula gray-matter and improvement of psychological well-being by aerobic exercise training.

Long-term effect of tacrolimus therapy in patients with refractory ulcerative colitis

BACKGROUND

Little is known about long-term outcome of tacrolimus therapy for ulcerative colitis. Aim To evaluate long-term efficacy and safety of tacrolimus in Japanese patients with refractory ulcerative colitis.

METHODS

Twenty-seven patients with UC refractory to conventional therapy were administered tacrolimus with trough whole-blood levels of 10-15 ng/mL to induce remission and 5-10 ng/mL to maintain remission. Median treatment duration was 11 months (1-39 months) and median follow-up duration was 17 months (2-65 months). Evaluation of the clinical response was based on a modified Truelove-Witts severity index (MTWSI).

RESULTS

Tacrolimus produced a clinical response in 21 patients (77.8%), and remission was achieved in 19 of these 21 (70.4%) within 30 days. Overall cumulative colectomy-free survival was estimated as 62.3% at 65 months. In 18 of 19 patients treated with corticosteroids at the initiation of tacrolimus therapy, corticosteroids were discontinued or tapered. Adverse events were tremor (25.9%), renal function impairment (18.5%), infectious disease (14.8%), hot flashes (11.1%), hyperkalaemia (7.4%), headache (7.4%), epigastralgia (7.4%) and nausea (3.7%). No mortality occurred.

CONCLUSION

Long-term administration of tacrolimus appears to be an effective and well-tolerated treatment for Japanese patients with refractory ulcerative colitis.

Sequential expression of vascular endothelial growth factor, Flt-1, and KDR/Flk-1 in regenerating mouse skeletal muscle

We investigated the expression of vascular endothelial growth factor (VEGF) and its receptors (Flt-1 and KDR/Flk-1) during muscle regeneration by immunohistochemistry and real-time RT-PCR. On days 5 and 7 after the induction of injury, VEGF and Flt-1 were detected in the cytoplasm and KDR/Flk-1 in the cytoplasm and on cell membranes of the same regenerating muscle fibers. The levels of these proteins in the regenerating muscle fibers gradually decreased until day 20. In contrast, these proteins were not detected in the fibers of normal muscle. This suggests that regenerating muscle fibers express VEGF and its receptors in response to injury. In addition, we found that the VEGF mRNA transcript transiently increased after 12 h of muscle injury and then returned to the basal levels observed in normal muscles on day 1. The expression of Flt-1 and KDR/Flk-1 mRNA transcripts also peaked on day 3 and then returned to the basal levels observed in normal muscles on day 10. These findings suggest that regenerating muscle fibers are an important source of VEGF and that VEGF signaling through Flt-1 and KDR/Flk-1 may be involved in the process of muscle regeneration in vivo.

Gastric mucosal hyperplasia via upregulation of gastrin induced by persistent activation of gastric innate immunity in major histocompatibility complex class II deficient mice

BACKGROUND AND AIMS

Major histocompatibility complex class II deficient (Aalpha0/0) mice have decreased CD4+ T cells, making them immunologically similar to patients with acquired immunodeficiency syndrome (AIDS). Both patients with AIDS and Aalpha0/0 mice have hypertrophic gastric folds. To clarify the mechanism of gastric mucosal hyperplasia, we investigated the pathophysiology and the role of the innate immunity in the stomach of Aalpha0/0 mice.

METHODS

Stomachs from 1-6 month old Aalpha0/0 mice, kept under specific pathogen free conditions, were examined at 1 month intervals histologically and immunohistochemically. Gene expression of proinflammatory cytokines, Toll-like receptors (TLRs), cyclooxygenase (COX)-2, and myeloperoxidase (MPO) activity in the gastric mucosa was investigated. Serum gastrin levels and gastric acidity were measured. Bacterial culture of the stomach was performed. To clarify the roles of hypergastrinaemia in the gastric mucosa, a gastrin receptor antagonist (AG041R) was administered.

RESULTS

Aalpha0/0 mice had a diffusely thick corpus mucosa with infiltration of CD11b+ granulocytes and macrophages. Anti-Ki67 staining demonstrated expansion of the proliferating neck zone. Gene expression of interleukin 1beta, interferon gamma, TLR-2, TLR-4, and COX-2 were upregulated, and MPO activity was increased. Only a small amount of non-pathogenic bacteria was detected in the stomach. Serum gastrin levels and Reg-Ialpha positive cells in the gastric mucosa increased, despite normal gastric acidity. After treatment with AG041R, gastric mucosal thickness was significantly reduced.

CONCLUSION

Persistent activation of innate immunity in the stomach induced gastric mucosal hyperplasia through upregulation of gastrin synthesis in Aalpha0/0 mice, suggesting a pathophysiology similar to the gastric changes in patients with AIDS.

Antiapoptotic function of 17AA(+)WT1 (Wilms' tumor gene) isoforms on the intrinsic apoptosis pathway

The WT1 gene is overexpressed in human primary leukemia and a wide variety of solid cancers. The WT1 gene is alternatively spliced at two sites, yielding four isoforms: 17AA(+)KTS(+), 17AA(+)KTS(-), 17AA(-)KTS(+), and 17AA(-)KTS(-). Here, we showed that 17AA(+)WT1-specific siRNA induced apoptosis in three WT1-expressing leukemia cell lines (K562, HL-60, and Kasumi-1), but not in WT1-non-expressing lymphoma cell line (Daudi). 17AA(+)WT1-specific siRNA activated caspase-3 and -9 in the intrinsic apoptosis pathway but not caspase-8 in the extrinsic one. On the other hand, 17AA(-)WT1-specific siRNA did not induce apoptosis in the three WT1-expressing cell lines. The apoptosis was associated with activation of proapoptotic Bax, which was activated upstream of the mitochondria. Constitutive expression of 17AA(+)WT1 isoforms inhibited apoptosis of K562 leukemia cells induced by apoptosis-inducing agents, etoposide and doxorubicin, through the protection of mitochondrial membrane damages, and DNA-binding zinc-finger region of 17AA(+)WT1 isoform was essential for the antiapoptotic functions. We further studied the gene(s) whose expression was altered by the expression of 17AA(+)WT1 isoforms and showed that the expression of proapoptotic Bak was decreased by the expression of 17AA(+)KTS(-)WT1 isoform. Taken together, these results indicated that 17AA(+)WT1 isoforms played antiapoptotic roles at some points upstream of the mitochondria in the intrinsic apoptosis pathway.

Cloning of a gene encoding a highly stable endo-beta-1,4-glucanase from Aspergillus niger and its expression in yeast

A gene encoding an endo-beta-1,4-glucanase, which is highly resistant to high temperature, protease and surfactant treatment, was isolated from Aspergillus niger IFO31125 and designated as eng1. The deduced amino acid sequence encoded by eng1 showed high homology with the sequence of a not-well-characterized cellulase encoded by eglB which has not yet been shown to be a stable enzyme. To confirm the sequence of the gene encoding the highly stable endo-beta-1,4-glucanase, the cloned gene was expressed in the yeast Saccharomyces cerevisiae, in which no cellulase activity was found, and the gene product was purified and subjected to enzymatic characterization. The enzyme retained 56% of the initial activity after 1 h of incubation at 80 degrees C and was stable in the range of pH 3.0-10.0. The optimal temperature for enzyme activity was 70 degrees C and the optimal pH was 6.0. The enzyme was highly protease-resistant and retained more than 80% of the initial activity after protease treatment for 3 d at 40 degrees C. The enzyme was also resistant to various surfactants. From these results, eng1 was confirmed to encode a very stable endo-beta-1,4-glucanase.

Capillary supply and gene expression of angiogenesis‐related factors in murine skeletal muscle following denervation

Capillary supply of skeletal muscle decreases during denervation. To gain insight into the regulation of this process, we investigated capillary supply and gene expression of angiogenesis-related factors in mouse gastrocnemius muscle following denervation for 4 months. Frozen transverse sections were stained for alkaline phosphatase to detect endogenous enzyme in the capillary endothelium. The mRNA for angiogenesis-related factors, including hypoxia inducible factor-1alpha (HIF-1alpha), vascular endothelial growth factor (VEGF), kinase insert domain-containing receptor/fetal liver kinase-1 (KDR/Flk-1), fms-like tyrosine kinase (Flt-1), angiopoietin-1 and tyrosine kinase with Ig and epidermal growth factor(EGF) homology domain 2 (Tie-2), was analysed using a semi-quantitative reverse transcriptase-polymerase chain reaction (RT-PCR). The fibre cross-sectional area after denervation was about 20% of the control value, and the capillary to fibre ratio was significantly lower in denervated than in control muscles. The number of capillaries around each fibre also decreased to about 40% of the control value. These observations suggest that muscle capillarity decreases in response to chronic denervation. RT-PCR analysis showed that the expression of VEGF mRNA was lower in denervated than in control muscles, while the expression of HIF-1alpha mRNA remained unchanged. The expression levels of the KDR/Flk-1 and Flt-1 genes were decreased in the denervated muscle. The expression levels of angiopoietin-1 but not Tie-2 genes were decreased in the denervated muscle. These findings indicate that reduction in the expression of mRNAs in the VEGF/KDR/Flk-1 and Flt-1 as well as angiopoietin-1/Tie-2 signal pathways might be one of the reasons for the capillary regression during chronic denervation.

Cloning of a gene encoding thermostable cellobiohydrolase from Thermoascus aurantiacus and its expression in yeast

A gene encoding a cellobiohydrolase (CBH) was isolated from Thermoascus aurantiacus IFO 9748 and designated as cbh1. The deduced amino acid sequence encoded by cbh1 showed high homology with the sequence of glycoside hydrolase family 7. To confirm the sequence of the gene encoding the CBH, the cloned gene was expressed in the yeast Saccharomyces cerevisiae, in which no cellulase activity was found, and the gene product was purified and subjected to enzymatic characterization. The recombinant enzyme was confirmed as a CBH by analysis of the reaction product and designated as CBHI. Recombinant CBHI retained more than 80% of its initial activity after 1 h of incubation at 65 degrees C and was stable in the pH range 3.0-9.0. The optimal temperature for enzyme activity was about 65 degrees C and the optimal pH was about 6.0. The recombinant enzyme was found to be highly glycosylated and this glycosylation was shown to contribute to the thermostability of the enzyme. CBHI expression was shown to be induced at higher temperature in T. aurantiacus.

Inhibitory effects of Helicobacter pylori infection on murine autoimmune gastritis

BACKGROUND AND AIM

Long term Helicobacter pylori infection leads to atrophic gastritis but the relation between H pylori infection and autoimmune related atrophic gastritis (AIG) remains unclear. We studied the effects of H pylori infection on the pathophysiology of AIG in mice.

MATERIALS AND METHODS

BALB/c nu/nu mice (n=40) with or without H pylori infection received splenocytes from neonatally thymectomised mice to induce AIG. Half of the mice were orally infected with H pylori prior to AIG induction. Histological findings, and local and systemic immune responses were serially evaluated.

RESULTS

Two and six months after transfer, parietal cells in uninfected mice were depleted while those in infected mice were well preserved. The degree of gland atrophy (p<0.01), hyperplasia (p<0.01), gastric pH (p<0.05), and serum gastrin levels of infected mice were significantly lower than those of uninfected mice. Serum antiparietal cell antibody levels gradually decreased in infected mice, and were significantly lower than those of uninfected mice at six months (p<0.05). Real time polymerase chain reaction studies revealed significantly higher interleukin 4 (p<0.05) and transforming growth factor beta (p<0.05) gene expression in the gastric mucosa in infected mice than in uninfected mice at both two and six months after AIG induction.

CONCLUSIONS

H pylori infection inhibited the development of AIG in mice. Th2-type immune responses and transforming growth factor beta in the gastric microenvironment might be involved in the inhibitory effects of H pylori infection on the development of AIG, in which Th1-type responses have an important role.

Successful treatment of refractory T-cell acute lymphoblastic leukemia by unmanipulated stem cell transplantation from an HLA 3-loci mismatched (haploidentical) sibling

We describe a patient with refractory T-cell acute lymphoblastic leukemia who successfully underwent unmanipulated stem cell transplantation from an HLA 3-loci mismatched (haploidentical) sibling. In order to avoid severe graft-versus-host disease (GVHD), we used intensified GVHD prophylaxis consisting of tacrolimus, a short course of methotrexate, methylprednisolone, and mycophenolate mofetil. Hematopoietic reconstitution was rapid, with neutrophil count >5 x 10(8)/l on day +16, and platelet count >2 x 10(10)/l on day +25. There was no evidence of clinical acute GVHD. Bacterial, fungal, and viral infections were well controlled with antibiotics. The patient is still in complete remission past day +400. We suggest that unmanipulated HLA-mismatched transplantation with intensified GVHD prophylaxis is an alternative option for patients who do not have an HLA-identical donor.

[A complete response persisting for twelve months with the use of TS-1 in a patient with paraaortic lymph node metastasis of gastric cancer]

A 74-year-old female patient underwent total gastrectomy, splenectomy and D2 lymph node dissection for gastric cancer with non-dissectible paraaortic lymph node metastasis. Pathological examination revealed a high level of metastasis of dissected lymph nodes. The patient received daily oral administration of 100 mg TS-1, a novel oral anticancer agent. Each treatment course consisted of a four-week administration followed by two drug-free weeks. A partial response was obtained after the second course and a complete response was observed in the middle of the fourth and after the sixth course. The treatment was stopped because of grade 2 anemia in the middle of the seventh course, but no other adverse effect was observed. Complete response of the treatment persisted for twelve months and the patient has now been in good health without a recurrence for twenty months after surgery. Although the prognosis of gastric cancer with a high level of lymph node metastasis is poor, TS-1 therapy may have a potent efficacy in gastric cancer patients with a high level of lymph node metastasis such as the current case.

Changes in Ca2+-dependent protein kinase C isoforms induced by chronic ethanol treatment in mice

Protein kinase C (PKC) has been shown to regulate ethanol sensitivity. The goal of the present study was to ascertain whether chronic in vivo ethanol treatment could affect PKC isoforms in the mouse brain. We measured the protein level of membrane-bound PKC isoforms following chronic ethanol treatment using Western blotting. The protein level of membrane-bound PKCalpha and PKCgamma isoforms, which are defined as Ca2+-dependent PKC isoforms (cPKC), in the limbic forebrain during chronic ethanol treatment was significantly increased, whereas the levels of both were significantly decreased in the frontal cortex. By contrast, there was no change in PKCepsilon, a Ca2+-independent PKC isoform, in both areas. These findings suggest that the change in membrane-bound cPKC in the limbic forebrain and frontal cortex may play substantial roles for the development of ethanol dependence.

Lethal adenovirus infection in a patient who had undergone nonmyeloablative stem cell transplantation

We present a case of adenovirus (ADV) infection in a patient who had undergone nonmyeloablative stem cell transplantation (NST). A 50-year-old man with chronic myelogenous leukemia in the second chronic phase underwent NST from an HLA 2-loci-mismatched sibling. ADV hemorrhagic cystitis developed and progressed to lethal pneumonia. ADV was isolated from urine, bronchoalveolar lavage fluid, and postmortem specimens of kidney and liver. Because there are few reports of lethal pneumonia associated with ADV in Japan, we present the case and discuss the cause of and therapy for the infection.