1
|
Moriya R, Kamihata N, Niwa Y, Kako H, Takahashi H, Kimura Y, Shigeyasu Y, Tsukamoto T, Hashimoto N, Imaizumi K. Autopsy case: Pathological complete response in an advanced lung cancer patient with severe immune related adverse events and COVID-19. Respir Investig 2024; 62:438-441. [PMID: 38518583 DOI: 10.1016/j.resinv.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/22/2024] [Accepted: 03/07/2024] [Indexed: 03/24/2024]
Abstract
A 51-year-old man with advanced lung cancer underwent chemotherapy including an immune checkpoint inhibitor (ICI). Subsequently, he developed ICI-related pneumonitis and colitis, followed by a ten-month treatment course of high doses of steroids. An infection with the SARS-CoV-2 Omicron BA.5 variant caused lethal respiratory failure. Autopsy examination revealed no evidence of viable lung cancer cells in the evaluated organs including the lungs, suggesting that pathological complete response (pCR) could be successfully achieved by ICI treatment in advanced lung cancer patients. Recognizing steroid-resistant ICI-related adverse events as critical factors in severe COVID-19 emphasizes the need for appropriate assessment of ICI-induced pCR.
Collapse
Affiliation(s)
- Ryoma Moriya
- Department of Respiratory Medicine, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Naoki Kamihata
- Department of Respiratory Medicine, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Yoshikazu Niwa
- Department of Respiratory Medicine, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Hisashi Kako
- Department of Respiratory Medicine, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Hideaki Takahashi
- Department of Respiratory Medicine, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Yutaro Kimura
- Department of Respiratory Medicine, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Yoshiko Shigeyasu
- Department of Respiratory Medicine, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Tetsuya Tsukamoto
- Department of Diagnostic Pathology, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Naozumi Hashimoto
- Department of Respiratory Medicine, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Kazuyoshi Imaizumi
- Department of Respiratory Medicine, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| |
Collapse
|
2
|
Suzuki A, Fukumitsu K, Fukihara J, Katano T, Kako H, Maeda Y, Ishii M, Niimi A, Imaizumi K, Yamaguchi E. Effectiveness of remdesivir-based therapy for moderate COVID-19: comparison of Omicron and other variant phases. J Chemother 2024; 36:127-132. [PMID: 38044564 DOI: 10.1080/1120009x.2023.2289268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 11/27/2023] [Indexed: 12/05/2023]
Abstract
Remdesivir is an antiviral drug for the treatment of coronavirus disease 2019 (COVID-19), and the sustained antiviral activity against Omicron variants of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been reported. In this single-center retrospective study, we first compared the clinical effectiveness of remdesivir-based therapy between Omicron and other variant phases of moderate COVID-19 in a real-world setting. Between Dec 2020 and July 2022, a total of 406 patients with COVID-19 pneumonia were treated with remdesivir-based therapy on admission. The oxygen deterioration rate after initiation of treatment significantly decreased in the Omicron variant phase compared to the alpha and delta variant phases. In an adjusted multivariate Cox proportional hazards model, Omicron variant phase was significantly associated with delayed oxygen deterioration and early recovery from hypoxia. These favorable outcomes during the Omicron variant phase, compared to previous variant phases, might be due to the attenuation and the popularization of vaccination.
Collapse
Affiliation(s)
- Atsushi Suzuki
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
- Department of Internal Medicine, Aichi Prefectural Hospital, Okazaki, Aichi, Japan
| | - Kensuke Fukumitsu
- Department of Internal Medicine, Aichi Prefectural Hospital, Okazaki, Aichi, Japan
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Jun Fukihara
- Department of Internal Medicine, Aichi Prefectural Hospital, Okazaki, Aichi, Japan
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Takuma Katano
- Department of Internal Medicine, Aichi Prefectural Hospital, Okazaki, Aichi, Japan
- Department of Respiratory Medicine and Allergology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Hisashi Kako
- Department of Internal Medicine, Aichi Prefectural Hospital, Okazaki, Aichi, Japan
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yuri Maeda
- Department of Internal Medicine, Aichi Prefectural Hospital, Okazaki, Aichi, Japan
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Makoto Ishii
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Akio Niimi
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Kazuyoshi Imaizumi
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Etsuro Yamaguchi
- Department of Internal Medicine, Aichi Prefectural Hospital, Okazaki, Aichi, Japan
- Department of Respiratory Medicine and Allergology, Aichi Medical University, Nagakute, Aichi, Japan
| |
Collapse
|
3
|
Yonezawa T, Suzuki A, Fukumitsu K, Katano T, Kako H, Ishii M, Niimi A, Imaizumi K, Sakamoto K, Omote N, Yamaguchi E. Acute exacerbation of rheumatoid arthritis-associated interstitial lung disease triggered by COVID-19: What is the best practice for treatment? Respir Med Case Rep 2023; 43:101857. [PMID: 37124053 PMCID: PMC10125217 DOI: 10.1016/j.rmcr.2023.101857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/23/2023] [Indexed: 05/02/2023] Open
Abstract
We present a case of 79-year-old female with rheumatoid arthritis-associated interstitial lung disease (RA-ILD) developed an acute exacerbation (AE) triggered by coronavirus disease 2019 (COVID-19). The patient was unresponsive to a combination therapy of remdesivir, dexamethasone, and tocilizumab. Given that a recent multicenter cohort study reported ILD as a poor prognostic contributor in patients with RA and COVID-19, there may be potentially a certain number of patients with AE of RA-ILD triggered by COVID-19. This case highlights the need for a discussion how to treat these patients in a daily clinical practice.
Collapse
Affiliation(s)
- Toshiyuki Yonezawa
- Department of Respiratory Medicine and Allergology, Aichi Medical University, Nagakute, Aichi, Japan
- Department of Internal Medicine, Aichi Prefectural Hospital, Okazaki, Aichi, Japan
| | - Atsushi Suzuki
- Department of Internal Medicine, Aichi Prefectural Hospital, Okazaki, Aichi, Japan
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kensuke Fukumitsu
- Department of Internal Medicine, Aichi Prefectural Hospital, Okazaki, Aichi, Japan
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Takuma Katano
- Department of Respiratory Medicine and Allergology, Aichi Medical University, Nagakute, Aichi, Japan
- Department of Internal Medicine, Aichi Prefectural Hospital, Okazaki, Aichi, Japan
| | - Hisashi Kako
- Department of Internal Medicine, Aichi Prefectural Hospital, Okazaki, Aichi, Japan
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Makoto Ishii
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Akio Niimi
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Kazuyoshi Imaizumi
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Koji Sakamoto
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Norihito Omote
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Etsuro Yamaguchi
- Department of Respiratory Medicine and Allergology, Aichi Medical University, Nagakute, Aichi, Japan
- Department of Internal Medicine, Aichi Prefectural Hospital, Okazaki, Aichi, Japan
| |
Collapse
|
4
|
Mieno Y, Hayashi M, Hirochi M, Ikeda A, Kako H, Ina T, Maeda Y, Maeda S, Inoue T, Souma T, Watanabe T, Horiguchi T, Gotoh Y, Niwa Y, Yamatsuta K, Morikawa S, Sakakibara Y, Okamura T, Uozu S, Goto Y, Isogai S, Fujita S, Fukumoto J, Hosoda N, Imaizumi K. Availability of Home sleep apnea test equipment LS-140 on a comparison with Polysomnography. Fujita Med J 2022; 8:17-24. [PMID: 35233343 PMCID: PMC8874914 DOI: 10.20407/fmj.2020-014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 10/30/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The prevalence of obstructive sleep apnea (OSA) in Japan is 9% among males and 3% among females. Up to 2.5 million patients are estimated to suffer from the disease, but limited number of facilities are capable of carrying out polysomnography (PSG), leaving more than 80% of these individuals are undiagnosed. In recent years, the development of new portable sleep monitoring (PMs) devices has been remarkable. We evaluate the correlation between the results of the LS-140 PMs device (Fukuda Denshi Tech Co. Ltd.), released in 2017, and those of PSG. METHODS We obtained contemporaneous data from the same patients by equipping 58 patients with PMs (LS-140) devices while they underwent PSG. Our primary outcome was Case 2 of the intraclass correlation coefficient (ICC), i.e., the ICC (2.1). And we used a Bland-Altman analysis to compare the apnea-hypopnea index (AHI) given by PSG and the respiratory event index (REI) given by LS-140 and examined the sensitivity and specificity of the REI relative to the AHI in the diagnosis of OSA. We also carried out the same comparison but in terms of the presence or absence of periodic limb movements (PLMs). RESULTS The ICC (2.1) between The REI and the AHI was 0.944, a rather high value (p<0.0001). The mean difference between AHI and REI values was -3.6 (p<0.0001), indicating a negative fixed bias. Sensitivity may decrease in groups with PLMs. CONCLUSION The REI and the AHI are highly correlated, giving LS-140 sufficient diagnostic sensitivity and specificity to screen for OSA.
Collapse
Affiliation(s)
- Yuki Mieno
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Masamichi Hayashi
- Fujita Health University Okazaki Medical Center, Okazaki, Aichi, Japan
| | - Mariko Hirochi
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Aki Ikeda
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Hisashi Kako
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Takuma Ina
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Yuri Maeda
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Shingo Maeda
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Takahiro Inoue
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Tomohide Souma
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Toshikazu Watanabe
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Tomoya Horiguchi
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Yusuke Gotoh
- Fujita Health University Okazaki Medical Center, Okazaki, Aichi, Japan
| | - Yoshikazu Niwa
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Kumiko Yamatsuta
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Sayako Morikawa
- Fujita Health University Okazaki Medical Center, Okazaki, Aichi, Japan
| | - Yosuke Sakakibara
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Takuya Okamura
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Sakurako Uozu
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Yasuhiro Goto
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Sumito Isogai
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Shiho Fujita
- Fujita Health University Clinical Laboratory Center, Toyoake, Aichi, Japan
| | - Junichi Fukumoto
- Fujita Health University Clinical Laboratory Center, Toyoake, Aichi, Japan
| | - Nami Hosoda
- Fujita Health University Clinical Laboratory Center, Toyoake, Aichi, Japan
| | - Kazuyoshi Imaizumi
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| |
Collapse
|
5
|
Horiguchi T, Toyama Y, Sakakibara Y, Ikeda A, Kako H, Ina T, Okamura T, Uozu S, Goto Y, Yokoi K, Imaizumi K. Budd-Chiari syndrome caused by latent hepatic metastasis from a thymoma. Respir Med Case Rep 2021; 34:101492. [PMID: 34401316 PMCID: PMC8353463 DOI: 10.1016/j.rmcr.2021.101492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/09/2021] [Accepted: 08/02/2021] [Indexed: 10/26/2022] Open
Abstract
A 34-year-old woman visited our hospital because she had had abdominal bloating for 2 months. She had been diagnosed with invasive thymoma (WHO pathological type B2), for which she had undergone chemotherapy and total thymectomy 10 years previously. Six years previously, pleural dissemination was diagnosed and she had undergone right extra-pleural pneumonectomy. On presentation to our hospital, abdominal computed tomography and ultrasound scans revealed abundant ascites and a huge liver lesion, likely a metastasis from her thymoma, obstructing the inferior vena cava. The serum-ascites albumin gradient was high at 1.4 g/dL, which indicated portal hypertension. We diagnosed Budd-Chiari syndrome caused by liver metastasis from a previous thymoma. Steroid therapy resulted in shrinkage of her liver tumor and a marked decrease in her ascites. Although rare, Budd-Chiari syndrome caused by liver metastasis from a thymoma is a possible serious complication of advanced invasive thymoma.
Collapse
Affiliation(s)
- Tomoya Horiguchi
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yoko Toyama
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yosuke Sakakibara
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Aki Ikeda
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Hisashi Kako
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Takuma Ina
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Takuya Okamura
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Sakurako Uozu
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yasuhiro Goto
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Kohei Yokoi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Imaizumi
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| |
Collapse
|
6
|
Gotoh Y, Yamaguchi T, Yatsuya H, Ikeda A, Okamura T, Sakakibara Y, Ina T, Maeda Y, Hirochi M, Kako H, Goto Y, Isogai S, Yamamoto N, Kondo M, Imaizumi K. Predictive risk factors for pneumothorax after transbronchial biopsy using endobronchial ultrasonography with a guide sheath. BMC Pulm Med 2021; 21:181. [PMID: 34051763 PMCID: PMC8164257 DOI: 10.1186/s12890-021-01551-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/17/2021] [Indexed: 11/18/2022] Open
Abstract
Background Pneumothorax is one complication of transbronchial biopsy (TBB) using endobronchial ultrasonography with a guide sheath (EBUS-GS-TBB). We sought to clarify the risk factors for pneumothorax after EBUS-GS-TBB under fluoroscopic guidance. Methods We retrospectively reviewed data from 916 patients who underwent EBUS-GS-TBB at Fujita Health University Hospital. We evaluated the following risk factors for pneumothorax after EBUS-GS-TBB: patient characteristics (sex, age, and pulmonary comorbidities); lesion data (location, size, existence of ground-glass opacities [GGOs], pleural involvement, computed tomography [CT] bronchus sign, visibility on fluoroscopy, and EBUS findings); final diagnosis; years of bronchoscopist experience; and guide sheath size. Univariate and multivariate logistic regression analyses were performed. Results Among the 916 patients, 30 (3.28%) presented with pneumothorax. With a univariate analysis, factors that independently predisposed to pneumothorax included lesions containing GGOs, lesions in sagittal lung segments on fluoroscopy, lesions that were not visible on fluoroscopy, and infectious lesions. A univariate analysis also showed that lesions in the right upper lobe or left upper division, as well as malignant lesions, were less likely to lead to pneumothorax. Age, underlying pulmonary disease, CT bronchus sign, EBUS findings, bronchoscopist experience, and guide sheath size did not influence the incidence of pneumothorax. A multivariate analysis revealed that only lesions containing GGOs (odds ratio [OR] 6.47; 95% confidence interval [CI] 2.13–19.6, P = 0.001) and lesions in lung segments with a sagittal orientation on fluoroscopy (OR 2.47; 95% CI 1.09–5.58, P = 0.029) were significant risk factors for EBUS-GS-TBB-related pneumothorax. Conclusions EBUS-GS-TBB of lesions containing GGOs or lesions located in sagittal lung segments on fluoroscopy correlate with a higher pneumothorax risk.
Collapse
Affiliation(s)
- Yusuke Gotoh
- Department of Respiratory Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Teppei Yamaguchi
- Department of Thoracic Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Japan
| | - Hiroshi Yatsuya
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho, Nagoya, Japan
| | - Aki Ikeda
- Department of Respiratory Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Takuya Okamura
- Department of Respiratory Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Yosuke Sakakibara
- Department of Respiratory Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Takuma Ina
- Department of Respiratory Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Yuri Maeda
- Department of Respiratory Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Mariko Hirochi
- Department of Respiratory Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Hisashi Kako
- Department of Respiratory Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Yasuhiro Goto
- Department of Respiratory Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Sumito Isogai
- Department of Respiratory Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Naoki Yamamoto
- Department of Ophthalmology, Kanazawa Medical University, Ishikawa, Japan
| | - Masashi Kondo
- Department of Respiratory Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Kazuyoshi Imaizumi
- Department of Respiratory Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| |
Collapse
|
7
|
Abstract
Neuraxial anesthesia combined with general anesthesia has become a widely accepted method of providing effective postoperative analgesia and decreasing intraoperative anesthetic needs in the pediatric population. In clinical practice, there still appears to be hesitancy for the use of a neuraxial technique (spinal or epidural) in patients at risk for bacteremia or with an on-going systemic infection. However, evidence-based medicine lacks any data to support an increase in the risk of infectious complications following neuraxial anesthesia. We present two pediatric patients with intra-abdominal infectious processes who received caudal epidural blockade for postoperative operative analgesia. The use of neuraxial techniques in patients at risk for bacteremia is reviewed, evidence-based medicine regarding the risks of infection discussed, and the potential favorable effects of neuraxial blockade on the neurohumoral response to sepsis and the systemic inflammatory responses presented.
Collapse
Affiliation(s)
- H Kako
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, Ohio, USA
| | - M Hakim
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - A Kundu
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, Ohio, USA
| | - T D Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
8
|
Marks M, Bottomley C, Tome H, Pitakaka R, Butcher R, Sokana O, Kako H, Solomon AW, Mabey DC. Mass drug administration of azithromycin for trachoma reduces the prevalence of genital Chlamydia trachomatis infection in the Solomon Islands. Sex Transm Infect 2016; 92:261-5. [PMID: 26888658 PMCID: PMC4893086 DOI: 10.1136/sextrans-2015-052439] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 01/23/2016] [Indexed: 11/30/2022] Open
Abstract
Objectives Chlamydia trachomatis is the most common bacterial sexually transmitted infection and is frequently asymptomatic; ocular C. trachomatis strains cause trachoma. Mass drug administration (MDA) of azithromycin for trachoma might also reduce the prevalence of genital C. trachomatis. In a survey conducted in the Solomon Islands in 2014, prior to MDA, the prevalence of genital C. trachomatis was 20.3% (95% CI 15.9% to 25.4%). We conducted a survey to establish the impact of MDA with azithromycin on genital C. trachomatis. Methods Women attending three community outpatient clinics, predominantly for antenatal care, 10 months after MDA with azithromycin given for trachoma elimination, were enrolled in this survey. Self-taken high vaginal swabs were for C. trachomatis and Neisseria gonorrhoeae using the BD Probetec strand displacement assay. Results 298 women were enrolled. C. trachomatis infection was diagnosed in 43 women (14.4%, 95% CI 10.6% to 18.9%) and N. gonorrhoeae in 9 (3%, 95% CI 1.4% to 5.7%). The age-adjusted OR for C. trachomatis infection was consistent with a significant decrease in the prevalence of C. trachomatis following MDA (OR 0.58, 95% CI 0.37 to 0.94, p=0.027). There was no change in the prevalence of N. gonorrhoeae between following MDA (OR 0.51, 95% CI 0.22 to 1.22, p=0.13). Conclusions This study demonstrated a 40% reduction in the age-adjusted prevalence of genital C. trachomatis infection following azithromycin MDA for trachoma elimination.
Collapse
Affiliation(s)
- M Marks
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, UK
| | - C Bottomley
- Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - H Tome
- Nursing Division, Honiara City Council, Honiara, Solomon Islands
| | - R Pitakaka
- National Referral Hospital, Honiara, Solomon Islands
| | - R Butcher
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - O Sokana
- Eye Health Department, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - H Kako
- Department of STI and HIV Prevention, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - A W Solomon
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, UK
| | - D C Mabey
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, UK
| |
Collapse
|
9
|
Marks M, Kako H, Butcher R, Lauri B, Puiahi E, Pitakaka R, Sokana O, Kilua G, Roth A, Solomon AW, Mabey DC. Prevalence of sexually transmitted infections in female clinic attendees in Honiara, Solomon Islands. BMJ Open 2015; 5:e007276. [PMID: 25922103 PMCID: PMC4420977 DOI: 10.1136/bmjopen-2014-007276] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES This study sought to determine the prevalence of common bacterial sexually transmitted infections, including Chlamydia trachomatis and Neisseria gonorrhoeae, in women attending clinics in the Solomon Islands. METHODS We conducted a sexual health survey among women attending three nurse-led community outpatient clinics in August 2014, to establish the prevalence of bacterial sexually transmitted infections in female clinic attenders in Honiara, Solomon Islands. Vaginal swab samples were tested for infection with C. trachomatis and N. gonorrhoeae using a commercial strand displacement amplification assay. Serum samples were tested for syphilis. RESULTS We enrolled 296 women, aged 16-49, attending three clinics. Knowledge of safe sexual practices was high but reported condom usage was low. The prevalence of infection with C. trachomatis was 20%. The prevalence of infection with N. gonorrhoeae and syphilis were 5.1% and 4.1%, respectively. CONCLUSIONS Bacterial sexually transmitted infections are a major health problem in the Solomon Islands. Interventions are urgently needed.
Collapse
Affiliation(s)
- M Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, UK
| | - H Kako
- Department of STI and HIV Prevention, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - R Butcher
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - B Lauri
- National Referral Hospital, Honiara, Solomon Islands
| | - E Puiahi
- National Referral Hospital, Honiara, Solomon Islands
| | - R Pitakaka
- National Referral Hospital, Honiara, Solomon Islands
| | - O Sokana
- Eye Health Department, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - G Kilua
- World Health Organization Country Office, Honiara, Solomon Islands
| | - A Roth
- Secretariat of the Pacific Community, Noumea, New Caledonia
| | - A W Solomon
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, UK
| | - D C Mabey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, UK
| |
Collapse
|
10
|
Nakagawa K, Akagi J, Takai E, Tamori Y, Okino T, Kako H, Egami H, Ogawa M. Prognostic values of MUC-1 molecule expressing cytokine receptor-like epitope and DF3 in patients with gastric carcinoma. Int J Oncol 1999; 14:425-35. [PMID: 10024673 DOI: 10.3892/ijo.14.3.425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
As recently reported, DF3/MUC-1 molecules having cytokine receptor-like sequences (CRL) at the extracellular region, are likely to function in signal transduction pathways. To elucidate the functional significance of CRL expressed on the DF3/MUC1 molecule, immunohistochemical localization of CRL and/or DF3 was investigated in cases of 115 patients with gastric carcinomas, treated by surgical resection. CRL was detected in 65 of 115 patients (56.5%), DF3 in 85 (73.9%), and both DF3 and CRL in 52 (45.2%). The combined immunohistochemical analysis of CRL and/or DF3, revealed that simultaneous expression of DF3 and CRL (DF3+/CRL+) significantly correlated to lymph node metastasis and to blood vessel invasion, and that patients with DF3+/CRL+-tumors survived for a significantly shorter period after surgery than did the other three groups (DF3+/CRL-, DF3-/CRL+, and DF3-/CRL-). Multivariate analysis showed independent prognostic significance for DF3+/CRL+ expression (hazard ratio [HR]=2.733, P=0.0085), and surgical cure (HR=4.334, P=0.003). To investigate the biological role of the simultaneous expression of DF3 and CRL, we constructed DF3-/CRL+ (NR-MC-38) and DF3+/CRL+ (R-MC-38) cells by transducing a mouse colon adenocarcinoma cell line MC-38 expressing neither DF3 nor CRL with MUC-1 cDNA containing ten tandem repeats (R-MC-38) or MUC-1 cDNA devoid of tandem repeats (NR-MC-38). R-MC-38 (DF3+/CRL+) cells were more invasive than NR-MC-38 (DF3-/CRL+) and MC-38 (DF3-/CRL-) cells. When these transfectants were incubated with pAb CRL, the invasiveness of R-MC-38 (DF3+/CRL+) was strikingly elevated over the case with native MC-38 (DF3-/CRL-) and NR-MC-38 (DF3-/CRL+) cells. The pAb CRL-induced invasiveness of R-MC-38 cells was inhibited by adding mAb DF3 or CRL peptides together with pAb CRL. These results suggest that an expression of DF3/MUC1 is highly associated with cell-invasiveness, and the DF3/MUC1-associated invasiveness is amplified by CRL. Thus DF3+/CRL+-MUC-1 molecule seems to be closely involved in a poor prognosis for gastric cancer patients.
Collapse
Affiliation(s)
- K Nakagawa
- Department of Surgery II, Kumamoto University Medical School, Honjo, Kumamoto, Japan
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Inoue Y, Johno M, Kayashima K, Kako H, Ogawa M, Ono T. Metastatic skin cancer; a case with signet ring cell histology. Br J Dermatol 1996; 135:634-7. [PMID: 8915163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report a 64-year-old Japanese man who developed metastatic skin cancer, in the form of 1-3 cm diameter dome-shaped tumours on his face and head. Histopathological examination demonstrated diastase-resistant periodic acid--Schiff and Alcian blue-positive signet ring cells, suggesting gastric carcinoma. Immunohistochemical staining showed that these cells were positive for carbohydrate antigen CA19-9.
Collapse
Affiliation(s)
- Y Inoue
- Department of Dermatology, Kumamoto University School of Medicine, Japan
| | | | | | | | | | | |
Collapse
|
12
|
Nelson RL, Abcarian H, Nelson TM, Misumi A, Kako H, Rizk S, Sky-Peck H. The effect of dietary selenium deficiency on acute colorectal mucosal nucleotoxicity induced by several carcinogens in the rodent. Am J Surg 1996; 172:85-8. [PMID: 8686809 DOI: 10.1016/s0002-9610(96)00067-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Selenium (SE) has been inversely associated with colon cancer risk. Two potential mechanisms of this effect were examined in a rodent short-term carcinogenesis assay: whether dietary SE deficiency altered the initiation aspect of carcinogenesis in the colon, and whether SE altered carcinogen metabolism. SETTING Animal laboratory. SUBJECTS 52 Sprague-Dawley rats, divided into a SE diet deficient group (0.002 parts per million; ppm) and a SE sufficient (0.2 ppm) group. ENDPOINTS Weight, serum SE concentration, and karryorhectic index (KI), which is a measure of acute carcinogen induced nuclear toxicity in the colonic mucosa. METHODS After three weeks of acclimation to the diets, eight animals from each dietary group were injected with one of the following: dimethylhydrazine (DMH), a colon specific carcinogen, its metabolite, methylazoxymethanol (MAM), or 0.9% sodium chloride. Twenty-four hours after injection the colons were removed, blood drawn, and the stained colons assayed for nuclear aberrations. RESULTS No weight differences were generated by the dietary variations. Low-dietary SE resulted in serum SE declining markedly in the study period to 6 ng/ml versus 33 ng/ml in the SE sufficient group. Diet alone, and variations in weight gain, did not alter the KI. Both carcinogens greatly increased the KI in both the left and right colon. A SE-deficient diet was associated with a higher KI in both carcinogen groups in the right colon, with statistical significance for both the left and right colon in the MAM injection group. CONCLUSIONS Dietary SE deficiency is associated with increased KI of the colon in MAM treated rats. SE, therefore, has a protective effect in the initiation phase of carcinogenesis.
Collapse
Affiliation(s)
- R L Nelson
- Department of Surgery, University of Illinois College of Medicine at Chicago, USA
| | | | | | | | | | | | | |
Collapse
|
13
|
Fujita H, Kako H, Misumi A, Harada K, Ishimaru Y, Ogawa M. [A resected case of esophageal neurofibroma, and review of the Japanese literature]. Nihon Shokakibyo Gakkai Zasshi 1993; 90:795-9. [PMID: 8492471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- H Fujita
- 2nd Department of Surgery, Kumamoto University Medical School
| | | | | | | | | | | |
Collapse
|
14
|
Kiyohara H, Egami H, Kako H, Shibata Y, Murata K, Ohshima S, Sei K, Suko S, Kurano R, Ogawa M. Immunohistochemical localization of group II phospholipase A2 in human pancreatic carcinomas. Int J Pancreatol 1993; 13:49-57. [PMID: 8384235 DOI: 10.1007/bf02795199] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The immunohistochemical localization of group II phospholipase A2 (PLA2) in normal fetal and adult human pancreases, 5 chronic pancreatitis, and 30 pancreatic ductal carcinomas was investigated. Furthermore, pancreatic carcinoma cases were correlated with histologic type, tumor size, vascular involvement, lymphatic involvement, perineural invasion, lymph node metastasis, amount of interstitial tissue in the tumor, growth pattern of the tumor, and clinical stage. In the normal pancreases, almost all of acinar cells and a few cells of small and large ducts were immunoreactive in a supranuclear pattern. In chronic pancreatitis, immunoreactivity was retained in several acini, islet cells, and ductal cells, but the staining was diminished in acinal cells of atrophic lobules. A strong immunoreactivity was found in the cells of hyperplastic ducts. In pancreatic ductal carcinomas, the immunoreactivity was observed in 25 cases (83%). Eighteen of 25 (72%) immunoreactive cases showed a cytoplasmic granular or luminal surface pattern, both of which were not observed in the normal pancreas. Among the clinicopathological parameters of pancreatic cancer, the incidence of expression of this enzyme was significantly higher in infiltrative type cancers than in expansive and localized tumors. Furthermore, the expression of group II PLA2 was significantly higher in the tumor with larger amount of interstitial tissue than in that with smaller amounts of interstitial tissue. These results suggest that expression of group II PLA2 in human pancreatic ductal carcinomas is possibly involved in the proliferation of interstitial tissue directly or indirectly through prostaglandin production.
Collapse
Affiliation(s)
- H Kiyohara
- Department of Surgery II, Kumanoto University Medical School, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Chikazawa H, Shibata J, Murata H, Yoshida K, Fujiyama S, Satoh T, Kako H, Takano S, Misumi A, Akagi M. [A case of multiple tumors]. Gan No Rinsho 1990; 36:758-62. [PMID: 2161471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A 54-year-old man was admitted to our clinic for a further examination of rectal and liver tumors, after which a rectal cancer, a hepatocellular carcinoma (HCC), a hemangioma of the liver a retroperitoneal cyst, and a submucosal tumor of the stomach (SMT) were diagnosed by means of a colonoscopy, a gastroscopy, and US, CT, and angiography, these tests also revealing elevated CEA and AFP levels. A hepatic subsegmentectomy and a Miles's operation, as well as an enucleation of other liver tumors and an SMT, were performed and a retroperitoneal cyst was removed. The histopathological finding of the rectal cancer was a moderately differentiated adenocarcinoma, while the liver tumors were determined as being an HCC of the trabecular type, adenomatas revealing hyperplasia, a hemangioma, and the SMT showing a benign leiomyoblastoma.
Collapse
Affiliation(s)
- H Chikazawa
- 3rd Dept. of Int. Med., Kumamoto Univ. Med. School
| | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Yamashita S, Matsuzawa Y, Okazaki M, Kako H, Yasugi T, Akioka H, Hirano K, Tarui S. Small polydisperse low density lipoproteins in familial hyperalphalipoproteinemia with complete deficiency of cholesteryl ester transfer activity. Atherosclerosis 1988; 70:7-12. [PMID: 3355618 DOI: 10.1016/0021-9150(88)90094-9] [Citation(s) in RCA: 101] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Lipoprotein abnormalities were analyzed in 3 cases of marked hyperalphalipoproteinemia caused by complete deficiency of cholesteryl ester transfer activity. The probands were all men, aged 34, 43 and 48 years, respectively. The serum high density lipoprotein (HDL)-cholesterol levels of these patients were higher than 150 mg/dl (157-254 mg/dl), while serum total cholesterol levels ranged from 227 to 360 mg/dl. Sequential flotation-ultracentrifugation analysis disclosed that low density lipoprotein (LDL)-cholesterol was slightly decreased and that cholesteryl ester accumulated solely in the HDL2 fraction, which was also enriched with apolipoprotein E. Cholesteryl ester transfer activity was completely absent in all of these cases. High-performance liquid chromatography showed a decrease of LDL particle size in combination with a marked enlargement of HDL particle size. Analytical ultracentrifugation disclosed heterogeneity of LDL with the presence of small LDL subpopulations. We conclude that hyperalphalipoproteinemia due to complete deficiency of cholesteryl ester transfer activity is characterized by the presence of both small polydisperse LDL and markedly large HDL enriched with cholesteryl ester and apolipoprotein E.
Collapse
Affiliation(s)
- S Yamashita
- Second Department of Internal Medicine, Osaka University Medical School, Japan
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Abstract
Biopsy of the uterine cervix from a 46-year-old woman who suffered from epigastric pain and weight loss showed metastatic adenocarcinoma. The primary site of the tumor was the stomach. At laparotomy, disseminated adenocarcinoma on the peritoneum and Krukenberg's tumor in the right ovary were found. A palliative partial gastrectomy, resection of the right ovary, and postoperative chemotherapy were performed. The possible mechanism of metastasis of extragenital cancer to the uterus is discussed.
Collapse
|
18
|
Hayakawa S, Fujiwara T, Kako H. Microbiological degradation of bile acids. The conjugation of a certain cholic acid metabolite with amino acids in Corynebacterium equi. Biochem J 1976; 160:757-68. [PMID: 1016254 PMCID: PMC1164294 DOI: 10.1042/bj1600757] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
1. (4R)-4[4alpha-(2-Carboxyethyl)-3aalpha-hexahydro-7abeta-methyl-5-oxoindan-1beta-yl]valeric acid (II) could not be utilized by Arthrobacter simplex, even though the acid was one of the metabolites formed from cholic acid (I) by this organism. Therefore the further degradation of the acid (II) by Corynebacterium equi was investigated to identify the intermediates involved in the cholic acid degradation. 2. The organism, cultured in a medium containing the acid (II) as the sole source of carbon, produced unexpected metabolites, the conjugates of this original acid (II) with amino acids or their derivatives, although the yield was very low. These new metabolites were isolated and identified by chemical synthesis as the Na-((4R)-4-[4alpha-(2-carboxyethyl)-3a alpha-hexahydro-7a beta-methyl-5-oxoindan-1 beta-yl]-valeryl) derivatives of L-alanine, glutamic acid, O-acetylhomoserine and glutamine, i.e. compounds (IIIa), (IIIb), (IIId) respectively. 3. The possibility that the bacterial synthetic reaction observed in the acid (II) metabolism with C. equi is analogous to peptide conjugation known in both animals and higher plants is discussed. A possible mechanism for this bacterial conjugation is also considered.
Collapse
|
19
|
Hayakawa S, Kanematsu Y, Fujiwara T, Kako H. Microbiological degradation of bile acids. The preparation of some hypothetical metabolites involved in cholic acid degradation. Biochem J 1976; 154:577-87. [PMID: 942388 PMCID: PMC1172758 DOI: 10.1042/bj1540577] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
1. To identify the intermediates involved in the degradation of cholic acid, the further degradation of (4R)-4-[4alpha-(2-carboxyethyl)-3aalpha-hexahydro-7abeta-methyl-5-oxoindan-1beta-yl]valeric acid (IVa) by Arthrobacter simplex was attempted. The organism could not utilize this acid but some hypothetical intermediate metabolities of compound (IVa) were prepared for later use as reference compounds. 2. The nor homologue (IIIa) and the dinor homologue (IIIb) of compound (IVa) were prepared by exposure of 3-oxo-24-nor-5beta-cholan-23-oic acid (I) and (20S)-3beta-hydroxy-5-pregnene-20-carboxylic acid (II) to A. simplex respectively. These compounds correspond to the respective metabolites produced by the shortening of the valeric acid side chain of compound (IVa) in a manner analogous to the conventional fatty acid alpha- and beta-oxidation mechanisms. Their structures were confirmed by partial synthesis. 3. The following authentic samples of reduction products of the oxodicarboxylic acids (IIIa), (IIIb) and (IVa) were also synthesized as hypothetical metabolities: (4R)-4-[3aalpha-hexahydro-5alpha-hydroxy-4alpha-(3-hydroxypropyl)-7abeta-methylindan-1beta-yl]valeric acid (Vb) and its nor homologue (VIIa) and dinor homologue (IXa);(4R)-4-[3Aaalpha-hexahydro-5alpha-hydroxy-4alpha-(3-hydroxypropyl)-7abeta-methylindan-1beta-yl]-pentan-1-ol (Vc); and their respective 5beta epimers (Ve), (VIIc), (IXc) and (Vf). 4. In connexion with the non-utilization of compound (IVa) by A. simplex, the possibility that not all the metabolites formed from cholic acid by a certain micro-organism can be utilized by the same organism is considered.
Collapse
|