1
|
Yamanouchi Y, Nakamura T, Ikeda T, Usuku K. An Alternative Application of Natural Language Processing to Express a Characteristic Feature of Diseases in Japanese Medical Records. Methods Inf Med 2023; 62:110-118. [PMID: 36809794 PMCID: PMC10462427 DOI: 10.1055/a-2039-3773] [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: 10/17/2021] [Accepted: 04/13/2022] [Indexed: 02/23/2023]
Abstract
BACKGROUND Owing to the linguistic situation, Japanese natural language processing (NLP) requires morphological analyses for word segmentation using dictionary techniques. OBJECTIVE We aimed to clarify whether it can be substituted with an open-end discovery-based NLP (OD-NLP), which does not use any dictionary techniques. METHODS Clinical texts at the first medical visit were collected for comparison of OD-NLP with word dictionary-based-NLP (WD-NLP). Topics were generated in each document using a topic model, which later corresponded to the respective diseases determined in International Statistical Classification of Diseases and Related Health Problems 10 revision. The prediction accuracy and expressivity of each disease were examined in equivalent number of entities/words after filtration with either term frequency and inverse document frequency (TF-IDF) or dominance value (DMV). RESULTS In documents from 10,520 observed patients, 169,913 entities and 44,758 words were segmented using OD-NLP and WD-NLP, simultaneously. Without filtering, accuracy and recall levels were low, and there was no difference in the harmonic mean of the F-measure between NLPs. However, physicians reported OD-NLP contained more meaningful words than WD-NLP. When datasets were created in an equivalent number of entities/words with TF-IDF, F-measure in OD-NLP was higher than WD-NLP at lower thresholds. When the threshold increased, the number of datasets created decreased, resulting in increased values of F-measure, although the differences disappeared. Two datasets near the maximum threshold showing differences in F-measure were examined whether their topics were associated with diseases. The results showed that more diseases were found in OD-NLP at lower thresholds, indicating that the topics described characteristics of diseases. The superiority remained as much as that of TF-IDF when filtration was changed to DMV. CONCLUSION The current findings prefer the use of OD-NLP to express characteristics of diseases from Japanese clinical texts and may help in the construction of document summaries and retrieval in clinical settings.
Collapse
Affiliation(s)
- Yoshinori Yamanouchi
- Department of Medical Information Science, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Taishi Nakamura
- Department of Medical Information Science, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Tokunori Ikeda
- Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Sojo University, Nishi-ku, Kumamoto, Japan
| | - Koichiro Usuku
- Department of Medical Information Science, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| |
Collapse
|
2
|
Okadome Y, Morinaga J, Yamanouchi Y, Matsunaga E, Fukami H, Kadomatsu T, Horiguchi H, Sato M, Sugizaki T, Hayata M, Sakaguchi T, Hirayama R, Ishimura T, Kuwabara T, Usuku K, Yamamoto T, Mukoyama M, Suzuki R, Fukui T, Oike Y. Increased numbers of pre-operative circulating monocytes predict risk of developing cardiac surgery-associated acute kidney injury in conditions requiring cardio pulmonary bypass. Clin Exp Nephrol 2023; 27:329-339. [PMID: 36576647 DOI: 10.1007/s10157-022-02313-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 12/15/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Evaluating patients' risk for acute kidney injury (AKI) is crucial for positive outcomes following cardiac surgery. Our aims were first to select candidate risk factors from pre- or intra-operative real-world parameters collected from routine medical care and then evaluate potential associations between those parameters and risk of onset of post-operative cardiac surgery-associated AKI (CSA-AKI). METHOD We conducted two cohort studies in Japan. The first was a single-center prospective cohort study (n = 145) to assess potential association between 115 clinical parameters collected from routine medical care and CSA-AKI (≥ Stage1) risk in the population of patients undergoing cardiac surgery involving cardiopulmonary bypass (CPB). To select candidate risk factors, we employed random forest analysis and applied survival analyses to evaluate association strength. In a second retrospective cohort study, we targeted patients undergoing cardiac surgery with CPB (n = 619) and evaluated potential positive associations between CSA-AKI incidence and risk factors suggested by the first cohort study. RESULTS Variable selection analysis revealed that parameters in clinical categories such as circulating inflammatory cells, CPB-related parameters, ventilation, or aging were potential CSA-AKI risk factors. Survival analyses revealed that increased counts of pre-operative circulating monocytes and neutrophils were associated with CSA-AKI incidence. Finally, in the second cohort study, we found that increased pre-operative circulating monocyte counts were associated with increased CSA-AKI incidence. CONCLUSIONS Circulating monocyte counts in the pre-operative state are associated with increased risk of CSA-AKI development. This finding may be useful in stratifying patients for risk of developing CSA-AKI in routine clinical practice.
Collapse
Affiliation(s)
- Yusuke Okadome
- Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
- Department of Clinical Engineering, Japanese Red Cross Kumamoto Hospital, 2-1-1, Nagamine-Minami, Higashi-ku, Kumamoto, 861-8520, Japan
| | - Jun Morinaga
- Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
- Department of Clinical Investigation, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
| | - Yoshinori Yamanouchi
- Department of Clinical Investigation, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Eiji Matsunaga
- Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Hirotaka Fukami
- Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Tsuyoshi Kadomatsu
- Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Haruki Horiguchi
- Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Michio Sato
- Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Taichi Sugizaki
- Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Manabu Hayata
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Takeshi Sakaguchi
- Department of Cardiovascular Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1, Nagamine-Minami, Higashi-ku, Kumamoto, 861-8520, Japan
| | - Ryo Hirayama
- Department of Cardiovascular Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1, Nagamine-Minami, Higashi-ku, Kumamoto, 861-8520, Japan
| | - Tatsuhiro Ishimura
- Department of Anesthesiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Takashige Kuwabara
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Koichiro Usuku
- Medical Information Science and Administration Planning, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Tatsuo Yamamoto
- Department of Anesthesiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Masashi Mukoyama
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Ryusuke Suzuki
- Department of Cardiovascular Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1, Nagamine-Minami, Higashi-ku, Kumamoto, 861-8520, Japan
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yuichi Oike
- Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
| |
Collapse
|
3
|
Segawa M, Iizuka N, Ogihara H, Tanaka K, Nakae H, Usuku K, Yamaguchi K, Wada K, Uchizono A, Nakamura Y, Nishida Y, Ueda T, Shiota A, Hasunuma N, Nakahara K, Hebiguchi M, Hamamoto Y. Objective evaluation of tongue diagnosis ability using a tongue diagnosis e-learning/e-assessment system based on a standardized tongue image database. Front Med Technol 2023; 5:1050909. [PMID: 36993786 PMCID: PMC10040798 DOI: 10.3389/fmedt.2023.1050909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/10/2023] [Indexed: 03/14/2023] Open
Abstract
BackgroundIn Kampo medicine, tongue examination is used to diagnose the pathological condition “Sho,” but an objective evaluation method for its diagnostic ability has not been established. We constructed a tongue diagnosis electronic learning and evaluation system based on a standardized tongue image database.PurposeThis study aims to verify the practicality of this assessment system by evaluating the tongue diagnosis ability of Kampo specialists (KSs), medical professionals, and students.MethodsIn the first study, we analyzed the answer data of 15 KSs in an 80-question tongue diagnosis test that assesses eight aspects of tongue findings and evaluated the (i) test score, (ii) test difficulty and discrimination index, (iii) diagnostic consistency, and (iv) diagnostic match rate between KSs. In the second study, we administered a 20-question common Kampo test and analyzed the answer data of 107 medical professionals and 56 students that assessed the tongue color discrimination ability and evaluated the (v) correct answer rate, (vi) test difficulty, and (vii) factors related to the correct answer rate.ResultIn the first study, the average test score was 62.2 ± 10.7 points. Twenty-eight questions were difficult (correct answer rate, <50%), 34 were moderate (50%–85%), and 18 were easy (≥85%). Regarding intrarater reliability, the average diagnostic match rate of five KSs involved in database construction was 0.66 ± 0.08, and as for interrater reliability, the diagnostic match rate between the 15 KSs was 0.52 (95% confidence interval, 0.38–0.65) for Gwet's agreement coefficient 1, and the degree of the match rate was moderate. In the second study, the difficulty level of questions was moderate, with a correct rate of 81.3% for medical professionals and 82.1% for students. The discrimination index was good for medical professionals (0.35) and poor for students (0.06). Among medical professionals, the correct answer group of this question had a significantly higher total score on the Kampo common test than the incorrect answer group (85.3 ± 8.4 points vs. 75.8 ± 11.8 points, p < 0.01).ConclusionThis system can objectively evaluate tongue diagnosis ability and has high practicality. Utilizing this system can be expected to contribute to improving learners’ tongue diagnosis ability and standardization of tongue diagnosis.
Collapse
Affiliation(s)
- Makoto Segawa
- Department of Kampo Medicine, Yamaguchi University Hospital, Ube, Japan
- Correspondence: Makoto Segawa
| | - Norio Iizuka
- Department of Kampo Medicine, Yamaguchi University Hospital, Ube, Japan
- Yamaguchi Health Examination Center, Ogori-shimogo, Japan
| | - Hiroyuki Ogihara
- Department of Computer Science and Electronic Engineering, National Institute of Technology, Tokuyama Collage, Shunan, Japan
| | - Koichiro Tanaka
- Department of Traditional Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Hajime Nakae
- Department of Emergency and Critical Care Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | | | - Kojiro Yamaguchi
- Outpatient of Dental Chronic Disease, TANAKA Orthodontic Clinic, Medical Corporation HAYANOKAI, Kagoshima, Japan
| | - Kentaro Wada
- Division of Nephrology and Dialysis, Department of Internal Medicine, Nippon Kokan Fukuyama Hospital, Hiroshima, Japan
| | | | | | - Yoshihiro Nishida
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan
| | | | - Atsuko Shiota
- Department of Health Sciences, Faculty of Medicine, Kagawa University, Kitagun, Japan
| | - Naoko Hasunuma
- Department of Medical Education, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | | | | | - Yoshihiko Hamamoto
- Division of Electrical, Electronic and Information Engineering, Graduate School of Sciences and Technology for Innovation, Yamaguchi University, Ube, Japan
| |
Collapse
|
4
|
Yamada K, Saiki Y, Komori K, Shiomi A, Ueno M, Ito M, Hida K, Yamamoto S, Shiozawa M, Ishihara S, Kanemitsu Y, Ueno H, Kinjo T, Maeda K, Kawamura J, Fujita F, Takahashi K, Mizushima T, Shimada Y, Sasaki S, Sunami E, Ishida F, Hirata K, Ohnuma S, Funahashi K, Watanabe J, Kinugasa Y, Yamaguchi S, Hashiguchi Y, Ikeda M, Sudo T, Komatsu Y, Koda K, Sakamoto K, Okajima M, Ishida H, Hisamatsu Y, Masuda T, Mori S, Minami K, Hasegawa S, Endo S, Iwashita A, Hamada M, Ajioka Y, Usuku K, Ikeda T, Sugihara K. Characteristics of anal canal cancer in Japan. Cancer Med 2022; 11:2735-2743. [PMID: 35274487 PMCID: PMC9302302 DOI: 10.1002/cam4.4631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/06/2021] [Revised: 01/07/2022] [Accepted: 01/20/2022] [Indexed: 01/06/2023] Open
Abstract
Anal canal cancer (ACC) has been reported to be an uncommon cancer in Japan, as in the USA, Europe, and Australia. This retrospective multi‐institutional study was conducted to clarify the characteristics of ACC in Japan. First, the histological ACC type cases treated between 1991 and 2015 were collected. A detailed analysis of the characteristics of anal canal squamous cell carcinoma (SCC) cases was then conducted. The results of the histological types revealed that of the 1781 ACC cases, 435 cases (24.4%) including seven cases of adenosquamous cell carcinomas were SCC and 1260 cases (70.7%) were adenocarcinoma. However, the most common histological type reported in the USA, Europe, and Australia is SCC. Most ACC cases are adenocarcinomas and there is a low incidence of SCC in Japan which is different from the above‐mentioned countries. Moreover, we reclassified T4 into the following two groups based on tumor size: T4a (tumor diameter of 5 cm or less) and T4b (tumor diameter of more than 5 cm). The results of the TNM classification of SCC revealed that the hazard ratio (HR) to T1 of T2, T3, T4a, and T4b was 2.45, 2.28, 2.89, and 4.97, respectively. As T4b cases had a worse prognosis than T4a cases, we propose that T4 for anal canal SCC in Japan be subclassified into T4a and T4b.
Collapse
Affiliation(s)
- Kazutaka Yamada
- Department of Surgery, Coloproctology Center Takano Hospital, Kumamoto, Japan
| | - Yasumitsu Saiki
- Department of Surgery, Coloproctology Center Takano Hospital, Kumamoto, Japan
| | - Koji Komori
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Aichi, Japan
| | - Akio Shiomi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Masashi Ueno
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masaaki Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Koya Hida
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Seiichiro Yamamoto
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Manabu Shiozawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Kanagawa, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Tatsuya Kinjo
- Department of Digestive and General Surgery, Graduate School of Medicine, University of Ryukyus, Okinawa, Japan
| | - Kotaro Maeda
- International Medical Center, Fujita Health University Hospital, Aichi, Japan
| | - Junichiro Kawamura
- Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Fumihiko Fujita
- Department of Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Keiichi Takahashi
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Tsunekazu Mizushima
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yasuhiro Shimada
- Department of Clinical Oncology, Kochi Health Sciences Center, Kochi, Japan
| | - Shin Sasaki
- Department of Coloproctological Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Eiji Sunami
- Department of Surgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Fumio Ishida
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Keiji Hirata
- Department of Surgery1, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Shinobu Ohnuma
- Department of Surgery, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kimihiko Funahashi
- Department of Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Jun Watanabe
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Kanagawa, Japan
| | - Yusuke Kinugasa
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shigeki Yamaguchi
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yojiro Hashiguchi
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Masataka Ikeda
- Division of Lower Gastrointestinal Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Takeshi Sudo
- Department of Gastroenterological Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Yoshito Komatsu
- Department of Cancer Center, Hokkaido University Hospital, Hokkaido, Japan
| | - Keiji Koda
- Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Kazuhiro Sakamoto
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Masazumi Okajima
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Hideyuki Ishida
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Yuichi Hisamatsu
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Taiki Masuda
- Department of Surgery, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Shinichiro Mori
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medicine and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Kazuhito Minami
- Department of Surgery, Matsuyama Red Cross Hospital, Ehime, Japan
| | - Seiji Hasegawa
- Department of Surgery, Saiseikai Yokohamashi Nanbu Hospital, Kanagawa, Japan
| | - Shungo Endo
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Akinori Iwashita
- Department of Pathology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Madoka Hamada
- Division of Gastrointestinal Surgery, Kansai Medical University Hospital, Osaka, Japan
| | - Yoichi Ajioka
- Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Koichiro Usuku
- Department of Medical Information Sciences and Administration Planning, Kumamoto University Hospital, Kumamoto, Japan
| | - Tokunori Ikeda
- Department of Medical Information Sciences and Administration Planning, Kumamoto University Hospital, Kumamoto, Japan
| | | |
Collapse
|
5
|
Segawa M, Iizuka N, Ogihara H, Tanaka K, Nakae H, Usuku K, Hamamoto Y. Construction of a Standardized Tongue Image Database for Diagnostic Education: Development of a Tongue Diagnosis e-Learning System. Front Med Technol 2022; 3:760542. [PMID: 35047962 PMCID: PMC8757883 DOI: 10.3389/fmedt.2021.760542] [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: 10/28/2021] [Accepted: 11/26/2021] [Indexed: 11/13/2022] Open
Abstract
Tongue examination is an important diagnostic method for judging pathological conditions in Kampo (traditional Japanese medicine), but it is not easy for beginners to learn the diagnostic technique. One reason is that there are few objective diagnostic criteria for tongue examination findings, and the educational method for tongue examination is not standardized in Japan, warranting the need for a tongue image database for e-learning systems that could dramatically improve the efficiency of education. Therefore, we constructed a database comprising tongue images whose findings were determined on the basis of votes given by five Kampo medicine specialists (KMSs) and confirmed the educational usefulness of the database for tongue diagnosis e-learning systems. The study was conducted in the following five steps: development of a tongue imaging collection system, collection of tongue images, evaluation and annotation of tongue images, development of a tongue diagnosis e-learning system, and verification of the educational usefulness of this system. Five KMSs evaluated the tongue images obtained from 125 participants in the following eight aspects: (i) tongue body size, (ii) tongue body color, (iii) tongue body dryness and wetness, (iv) tooth marks on the edge of the tongue, (v) cracks on the surface of the tongue, (vi) thickness of tongue coating, (vii) color of tongue coating, and (viii) dryness and wetness of tongue coating. Medical students (MSs) were given a tongue diagnosis test using an e-learning system after a lecture on tongue diagnosis. The cumulative and individual match rates (%) (individual match rates of 100% (5/5), 80% (4/5), and 60% (3/5) are shown in parentheses, respectively) were as follows: (i) tongue body size: 92.8 (26.4/26.4/40.0); (ii) tongue body color: 83.2 (10.4/20.8/52.0); (iii) tongue body dryness and wetness: 88.8 (13.6/34.4/40.8); (iv) tooth marks on the edge of the tongue: 88.8 (6.4/35.2/47.2); (v) cracks on the surface of the tongue: 96.8 (24.0/35.2/37.6); (vi) thickness of tongue coating: 84.8 (7.2/21.6/56.0); (vii) color of tongue coating: 88.0 (15.2/37.6/35.2); and (viii) dryness and wetness of tongue coating: 74.4 (4.8/19.2/50.4). The test showed that the tongue diagnosis ability of MSs who attended a lecture on tongue diagnosis was almost the same as that of KMSs. We successfully constructed a tongue image database standardized for training specialists on tongue diagnosis and confirmed the educational usefulness of the e-learning system using a database. This database will contribute to the standardization and popularization of Kampo education.
Collapse
Affiliation(s)
- Makoto Segawa
- Department of Kampo Medicine, Yamaguchi University Hospital, Ube, Japan
| | - Norio Iizuka
- Department of Kampo Medicine, Yamaguchi University Hospital, Ube, Japan.,Yamaguchi Health Examination Center, Yamaguchi, Japan
| | - Hiroyuki Ogihara
- Division of Electrical, Electronic and Information Engineering, Graduate School of Sciences and Technology for Innovation, Yamaguchi University, Ube, Japan
| | - Koichiro Tanaka
- Department of Traditional Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Hajime Nakae
- Department of Emergency and Critical Care Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Koichiro Usuku
- Department of Medical Information Science and Administrative Planning, Kumamoto University Hospital, Kumamoto, Japan
| | - Yoshihiko Hamamoto
- Division of Electrical, Electronic and Information Engineering, Graduate School of Sciences and Technology for Innovation, Yamaguchi University, Ube, Japan
| |
Collapse
|
6
|
Maki Y, Sueta D, Ishii M, Yamanouchi Y, Fujisue K, Yamanaga K, Nakamura T, Tabata N, Arima Y, Araki S, Yamamoto E, Kaikita K, Chikamoto A, Matsushita K, Matsuoka M, Usuku K, Tsujita K. Associations of cardiovascular risk factors with survival outcomes in a cancer registration: Findings from the KUMAMON registry. Medicine (Baltimore) 2021; 100:e27921. [PMID: 34964764 PMCID: PMC8615348 DOI: 10.1097/md.0000000000027921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 11/08/2021] [Indexed: 01/05/2023] Open
Abstract
Although the relationship between cardiovascular diseases and malignant diseases has recently attracted attention, the associations of cardiovascular risk factors and clinical outcomes in cancer patients remain to be elucidated. We performed a retrospective, observational study that explored the clinical outcomes of patients with cancer or with a history of cancer.We enrolled 30,706 consecutive adult cancer patients from Kumamoto University Hospital. We investigated mortality and morbidity, including cardiovascular conditions (dyslipidemia [DL]/diabetes mellitus [DM]/hypertension [HT]). The primary endpoint was all-cause mortality.Of the enrolled patients, 9032 patients (29.4%) died within the follow-up period. The Kaplan-Meier analysis demonstrated that in the groups classified according to the number of DL/DM/HT (LDH) factors, the LDH1 and LDH2 groups had a significantly higher probability of the primary endpoint than the LDH0 group (P < .001 and P < .001, respectively), whereas there were no significant differences between the LDH0 group and LDH3 group (P = .963). Univariate Cox proportional hazards regression analyses of mortality complemented by the multiple imputation method including various factors demonstrated that the presence of DL in cancer patients was a significant negative predictor of mortality (hazard ratio = 0.79, P < .01).The all-cause mortality rate did not always increase as the number of LDH factors increased. The present study revealed that the presence of DL is a negative risk factor for all-cause mortality in cancer patients.
Collapse
Affiliation(s)
- Yuji Maki
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan
| | - Daisuke Sueta
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan
| | - Masanobu Ishii
- Department of Cardiology, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan
| | - Yoshinori Yamanouchi
- Department of Department of Clinical Investigation, Kumamoto University Hospital, Kumamoto, Japan
| | - Koichiro Fujisue
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan
- Medical Quality and Safety Management, Kumamoto University Hospital, Kumamoto, Japan
| | - Kenshi Yamanaga
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan
| | - Taishi Nakamura
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan
- Medical Information Science and Administration Planning, Kumamoto University Hospital, Kumamoto, Japan
| | - Noriaki Tabata
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan
| | - Yuichiro Arima
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan
| | - Satoshi Araki
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan
| | - Eiichiro Yamamoto
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan
| | - Akira Chikamoto
- Medical Quality and Safety Management, Kumamoto University Hospital, Kumamoto, Japan
- Gastroenterological Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Kenichi Matsushita
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan
- Division of Advanced Cardiovascular Therapeutics, Kumamoto University Hospital, Kumamoto, Japan
| | - Masao Matsuoka
- Hematology, Rheumatology, and Infectious Diseases, Kumamoto University School of Medicine, Kumamoto Japan
| | - Koichiro Usuku
- Medical Information Science and Administration Planning, Kumamoto University Hospital, Kumamoto, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan
| |
Collapse
|
7
|
Oba Y, Kohro T, Sato H, Nochioka K, Nakayama M, Fujita H, Mizuno Y, Kiyosue A, Iwanaga Y, Miyamoto Y, Matoba T, Tsutsui H, Nakamura T, Usuku K, Nagai R. The relationships among the pulse rate, use of beta-blockers, and prognosis in patients with ischemic heart disease in a real-world database using a storage system. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The use of β-blockers has the effect of improving the prognosis of patients with ischemic heart disease (IHD). One of the underlying mechanisms is a decrease in the cardiac load due to a reduction in the heart rate.
Purpose
To clarify the relationships among the pulse rate, the use of β-blockers, and the prognosis in patients with IHD in a multicenter study using a storage system.
Methods
The Clinical Deep Data Accumulation System (CLIDAS) collects (1) basic patient information, prescriptions, and laboratory data from electronic medical records from the Standardized Structured Medical Information eXchange (SS-MIX2) standard storage, and (2) the results of physiological tests, cardiac catheterization, and cardiac catheter intervention reports from the SS-MIX2 extended storage. 8540 cases who underwent cardiac catheterization from 6 university hospitals and the national cardiovascular center in Japan were registered (male: 77%, average age: 70.2 years). We evaluated these patients' pulse rate at admission and at the discharge of cardiac catheterization in 6,598 patients. We divided the pulse rates at discharge into quartiles (Q1: <60, Q2: 60–66, Q3: 67–75, Q4: ≥76 bpm), and we analyzed the relationship between the pulse rate and the prognosis by dividing the patients into the stable angina group (n=2,631) and the acute coronary syndrome (ACS) group (n=2,394). Regarding the use of β-blockers, we compared the pulse rates of the patients taking carvedilol (n=1,728) and those taking bisoprolol (n=2,761) at admission and discharge. Major adverse cardiovascular events (MACE) were defined as cardiovascular death, non-fatal myocardial infarction, unstable angina, heart failure, stroke, and other hospitalized cardiovascular events.
Results
A total of 600 MACEs occurred during an average observation period of 890 days. The incidence of cardiovascular events was significantly higher in the Q4 patients in the stable angina group (hazard ratio 1.79, 95% confidence interval 1.32–2.41, but there was no significant difference among the four pulse rate subgroups in the ACS group. The bisoprolol-treated patients had lower pulse rates at discharge (67.4±12.2 vs. 68.8±11.8 bpm, p<0.001) and a lower percentage of patients in the Q4 group (21.2 vs. 24.9%, p=0.005) compared to the carvedilol-treated patients. The pulse rate at admission was similar in the bisoprolol- and carvedilol-treated patients (74.3±19.3 vs. 73.2±29.5 bpm, p=0.328).
Conclusion
In a real-world database using a storage system, a pulse rate of ≤75 bpm was associated with a good prognosis in patients with ACS. Compared to carvedilol, bisoprolol was associated with a decreased pulse rate at discharge.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Kowa Company, Ltd.
Collapse
Affiliation(s)
- Y Oba
- Jichi Medical University, Department of Internal Medicine, Tochigi, Japan
| | - T Kohro
- Jichi Medical University, Department of Internal Medicine, Tochigi, Japan
| | - H Sato
- Precision Inc., Tokyo, Japan
| | | | | | - H Fujita
- Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Y Mizuno
- University of Tokyo, Tokyo, Japan
| | | | - Y Iwanaga
- National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - Y Miyamoto
- National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - T Matoba
- Kyushu University, Fukuoka, Japan
| | | | | | - K Usuku
- Kumamoto University, Kumamoto, Japan
| | - R Nagai
- Jichi Medical University, Department of Internal Medicine, Tochigi, Japan
| |
Collapse
|
8
|
Nakanishi T, Ikeda T, Nakamura T, Yamanouchi Y, Chikamoto A, Usuku K. Author Correction: Development of an algorithm for assessing fall risk in a Japanese inpatient population. Sci Rep 2021; 11:18895. [PMID: 34535741 PMCID: PMC8448764 DOI: 10.1038/s41598-021-98621-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Tomoko Nakanishi
- Department of Medical Information Science, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuou-ku, Kumamoto, 860-8556, Japan. .,Department of Nursing, Kumamoto University Hospital, Kumamoto, Japan.
| | - Tokunori Ikeda
- Department of Medical Information Sciences and Administration Planning, Kumamoto University Hospital, Kumamoto, Japan. .,Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Sojo University, 4-22-1, Ikeda, Nishi-ku, Kumamoto, 860-8556, Japan.
| | - Taishi Nakamura
- Department of Medical Information Science, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuou-ku, Kumamoto, 860-8556, Japan.,Department of Medical Information Sciences and Administration Planning, Kumamoto University Hospital, Kumamoto, Japan
| | - Yoshinori Yamanouchi
- Department of Medical Information Science, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuou-ku, Kumamoto, 860-8556, Japan
| | - Akira Chikamoto
- Department of Medical Quality and Safety Management, Kumamoto University Hospital, Kumamoto, Japan
| | - Koichiro Usuku
- Department of Medical Information Science, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuou-ku, Kumamoto, 860-8556, Japan.,Department of Medical Information Sciences and Administration Planning, Kumamoto University Hospital, Kumamoto, Japan
| |
Collapse
|
9
|
Nakanishi T, Ikeda T, Nakamura T, Yamanouchi Y, Chikamoto A, Usuku K. Development of an algorithm for assessing fall risk in a Japanese inpatient population. Sci Rep 2021; 11:17993. [PMID: 34504235 PMCID: PMC8429765 DOI: 10.1038/s41598-021-97483-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 08/26/2021] [Indexed: 11/10/2022] Open
Abstract
Falling is a representative incident in hospitalization and can cause serious complications. In this study, we constructed an algorithm that nurses can use to easily recognize essential fall risk factors and appropriately perform an assessment. A total of 56,911 inpatients (non-fall, 56,673; fall; 238) hospitalized between October 2017 and September 2018 were used for the training dataset. Correlation coefficients, multivariable logistic regression analysis, and decision tree analysis were performed using 36 fall risk factors identified from inpatients. An algorithm was generated combining nine essential fall risk factors (delirium, fall history, use of a walking aid, stagger, impaired judgment/comprehension, muscle weakness of the lower limbs, night urination, use of sleeping drug, and presence of infusion route/tube). Moreover, fall risk level was conveniently classified into four groups (extra-high, high, moderate, and low) according to the priority of fall risk. Finally, we confirmed the reliability of the algorithm using a validation dataset that comprised 57,929 inpatients (non-fall, 57,695; fall, 234) hospitalized between October 2018 and September 2019. Using the newly created algorithm, clinical staff including nurses may be able to appropriately evaluate fall risk level and provide preventive interventions for individual inpatients.
Collapse
Affiliation(s)
- Tomoko Nakanishi
- Department of Medical Information Science, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuou-ku, Kumamoto, 860-8556, Japan. .,Department of Nursing, Kumamoto University Hospital, Kumamoto, Japan.
| | - Tokunori Ikeda
- Department of Medical Information Sciences and Administration Planning, Kumamoto University Hospital, Kumamoto, Japan. .,Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Sojo University, 4-22-1 Ikeda, Nishi-ku, Kumamoto, 860-0082, Japan.
| | - Taishi Nakamura
- Department of Medical Information Science, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuou-ku, Kumamoto, 860-8556, Japan.,Department of Medical Information Sciences and Administration Planning, Kumamoto University Hospital, Kumamoto, Japan
| | - Yoshinori Yamanouchi
- Department of Medical Information Science, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuou-ku, Kumamoto, 860-8556, Japan
| | - Akira Chikamoto
- Department of Medical Quality and Safety Management, Kumamoto University Hospital, Kumamoto, Japan
| | - Koichiro Usuku
- Department of Medical Information Science, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuou-ku, Kumamoto, 860-8556, Japan.,Department of Medical Information Sciences and Administration Planning, Kumamoto University Hospital, Kumamoto, Japan
| |
Collapse
|
10
|
Yamada K, Saiki Y, Takano S, Iwamoto K, Tanaka M, Fukunaga M, Noguchi T, Nakamura Y, Hisano S, Fukami K, Kuwahara D, Tsuji Y, Takano M, Usuku K, Ikeda T, Sugihara K. Long-term results of intersphincteric resection for low rectal cancer in Japan. Surg Today 2019; 49:275-285. [PMID: 30604217 DOI: 10.1007/s00595-018-1754-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/01/2018] [Indexed: 12/18/2022]
Abstract
Intersphincteric resection (ISR) is the ultimate sphincter-preserving procedure for low rectal cancer. A questionnaire about the standardization of ISR was given to 2125 patients who underwent curative ISR for low rectal cancer between 2005 and 2012 at 127 affiliated institutions of the Japanese Society for Cancer of the Colon and Rectum (JSCCR), and the results were compared with the results of a systematic review. The findings revealed that although mortality and morbidity were relatively low and the survival rate after ISR was good, the rates of local recurrence and postoperative fecal incontinence were relatively high. The radicality of ISR was compared with that of abdominoperineal resection and low anterior resection using the propensity score matching prognosis analysis of patients in the JSCCR nationwide registry. The local recurrence rate was significantly higher after ISR, and especially high in patients with T3 (invasion into the external anal sphincter) and T4 disease. These results provide evidence about the factors related to fecal incontinence after ISR. As measures for the standardization of ISR, it is important to reconfirm that ISR is not indicated for patients with cT3 and cT4 disease and those with poor preoperative defecatory function, based on the ISR indication criteria.
Collapse
Affiliation(s)
- Kazutaka Yamada
- Department of Surgery, Coloproctology Center Takano Hospital, 3-2-55 Oe, Chuo-ku, Kumamoto, 862-0971, Japan.
| | - Yasumitsu Saiki
- Department of Surgery, Coloproctology Center Takano Hospital, 3-2-55 Oe, Chuo-ku, Kumamoto, 862-0971, Japan
| | - Shota Takano
- Department of Surgery, Coloproctology Center Takano Hospital, 3-2-55 Oe, Chuo-ku, Kumamoto, 862-0971, Japan
| | - Kazutsugu Iwamoto
- Department of Surgery, Coloproctology Center Takano Hospital, 3-2-55 Oe, Chuo-ku, Kumamoto, 862-0971, Japan
| | - Masafumi Tanaka
- Department of Surgery, Coloproctology Center Takano Hospital, 3-2-55 Oe, Chuo-ku, Kumamoto, 862-0971, Japan
| | - Mitsuko Fukunaga
- Department of Surgery, Coloproctology Center Takano Hospital, 3-2-55 Oe, Chuo-ku, Kumamoto, 862-0971, Japan
| | - Tadaaki Noguchi
- Department of Surgery, Coloproctology Center Takano Hospital, 3-2-55 Oe, Chuo-ku, Kumamoto, 862-0971, Japan
| | - Yasushi Nakamura
- Department of Surgery, Coloproctology Center Takano Hospital, 3-2-55 Oe, Chuo-ku, Kumamoto, 862-0971, Japan
| | - Saburo Hisano
- Department of Surgery, Coloproctology Center Takano Hospital, 3-2-55 Oe, Chuo-ku, Kumamoto, 862-0971, Japan
| | - Kensaku Fukami
- Department of Surgery, Coloproctology Center Takano Hospital, 3-2-55 Oe, Chuo-ku, Kumamoto, 862-0971, Japan
| | - Daisaku Kuwahara
- Department of Surgery, Coloproctology Center Takano Hospital, 3-2-55 Oe, Chuo-ku, Kumamoto, 862-0971, Japan
| | - Yoriyuki Tsuji
- Department of Surgery, Coloproctology Center Takano Hospital, 3-2-55 Oe, Chuo-ku, Kumamoto, 862-0971, Japan
| | - Masahiro Takano
- Department of Surgery, Coloproctology Center Takano Hospital, 3-2-55 Oe, Chuo-ku, Kumamoto, 862-0971, Japan
| | - Koichiro Usuku
- Department of Medical Information Sciences and Administration Planning, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Tokunori Ikeda
- Department of Medical Information Sciences and Administration Planning, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Kenichi Sugihara
- The Japanese Society for Cancer of the Colon and Rectum, 2 Sanbancho, Chiyoda-ku, Tokyo, 102-0075, Japan
| |
Collapse
|
11
|
Hirose J, Nishioka H, Tsukano M, Matsubara S, Usuku K, Mizuta H. Matrix changes in articular cartilage in the knee of patients with rheumatoid arthritis after biological therapy: 1-year follow-up evaluation by T2 and T1ρ MRI quantification. Clin Radiol 2018; 73:984.e11-984.e18. [PMID: 30072032 DOI: 10.1016/j.crad.2018.06.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023]
Abstract
AIM To estimate the morphological changes in the articular cartilage of the knees of patients with rheumatoid arthritis treated with biological disease-modifying anti-rheumatic drugs (bDMARDs). MATERIALS AND METHODS Cartilage-specific magnetic resonance imaging (MRI) results, including T2 and T1ρ mapping of the femorotibial joint of 17 patients, were obtained before and 1 year after starting treatment with bDMARDs. Regions of interest were selected on the sagittal images of the cartilage of the medial and lateral femoral condyles (MFC, LFC) and the tibial plateau (MTP, LTP). Cartilage thickness, T2, and T1ρ were measured, and the correlations of their changes were evaluated. RESULTS The mean changes in cartilage thickness tended to decrease in all four condyles, and the rate was significant in the MFC. T2 and T1ρ tended to increase, and T2 in the MFC significantly increased. Changes in cartilage thickness after 1 year showed a moderate correlation with the baseline T2 in the MFC as well as changes in T2 in the MTP. CONCLUSIONS Decreasing cartilage thickness and matrix changes appeared in the MFC after 1 year of treatment with bDMARDs. Microstructural damage of the cartilage at baseline is a predictor for further cartilage damage in the knee joint, even if treatment with bDMARDs is effective.
Collapse
Affiliation(s)
- J Hirose
- Department of Orthopedic Surgery, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
| | - H Nishioka
- Department of Orthopedic Surgery, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - M Tsukano
- Department of Orthopaedic Surgery, Kumamoto Orthopaedic Hospital, 1-15-7 Kuhonji, Chuo-ku, Kumamoto 862-0976, Japan
| | - S Matsubara
- Center for Arthritis and Clinical Rheumatology, Matsubara Clinic, 5-3-15 Tsukide, Higashi-ku, Kumamoto 862-0920, Japan
| | - K Usuku
- Department of Medical Information Science and Administration Planning, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - H Mizuta
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| |
Collapse
|
12
|
Yoshida A, Jinnouchi H, Sugiyama S, Hirose J, Segata T, Furuta K, Katahira K, Kajiwara K, Hieshima K, Jinnouchi T, Usuku K. Combined arteriosclerotic assessment of ankle-brachial index and maximum intima-media thickness via CCTA is useful for predicting coronary artery stenosis in patients with type 2 diabetes. Diabetes Res Clin Pract 2016; 117:91-9. [PMID: 27329027 DOI: 10.1016/j.diabres.2016.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 03/24/2016] [Accepted: 04/15/2016] [Indexed: 10/21/2022]
Abstract
AIMS Patients with diabetes mellitus (DM) are likely to develop asymptomatic myocardial infarction as a complication. However, coronary artery lesions are difficult to assess in internal medicine. This study aimed to develop a prediction formula for coronary artery stenosis, as determined by coronary computed tomographic angiography (CCTA), by analyzing risk factors in patients with type 2 DM. METHODS A prediction formula was developed based on a multivariate analysis of common factors in patients with ⩾50% coronary artery stenosis in a cohort of 327 patients with type 2 DM who underwent CCTA between 2007 and 2009, and cutoff values were calculated (derivation study). The validity of the optimal cutoff value was confirmed in a separate cohort of 317 patients with type 2 DM who underwent CCTA between 2010 and 2011 (validation study). RESULTS In the derivation study, five predictive factors (presence/absence of hypertension, estimated glomerular filtration rate, maximum intima-media thickness [max-IMT], ankle-brachial index [ABI], and use/nonuse of diabetic medication) were used to develop a prediction formula. In the validation study, positive predictive value (PPV) and negative predictive value (NPV) of the cutoff value derived from the prediction formula were 53% and 73%, respectively. CONCLUSIONS We developed a novel formula to predict coronary artery stenosis using five predictive factors. This formula is useful for determining whether computed tomography (CT) examination is necessary, even in clinical settings without CCTA equipment. Early detection of coronary artery stenosis in patients with DM may also lead to better health outcomes.
Collapse
Affiliation(s)
- Akira Yoshida
- Jinnouchi Clinic, 6-2-3 Kuhonji, Chuo-ku, Kumamoto 862-0976, Japan; Department of Medical Information Sciences and Administration Planning, Kumamoto University Hospital, 1-1-1 honjo, Chuo-ku, 860-8556 Kumamoto, Japan.
| | | | - Seigo Sugiyama
- Jinnouchi Clinic, 6-2-3 Kuhonji, Chuo-ku, Kumamoto 862-0976, Japan
| | - Jun Hirose
- Department of Medical Information Sciences and Administration Planning, Kumamoto University Hospital, 1-1-1 honjo, Chuo-ku, 860-8556 Kumamoto, Japan
| | - Tateki Segata
- Department of Medical Information Sciences and Administration Planning, Kumamoto University Hospital, 1-1-1 honjo, Chuo-ku, 860-8556 Kumamoto, Japan
| | - Kazue Furuta
- Jinnouchi Clinic, 6-2-3 Kuhonji, Chuo-ku, Kumamoto 862-0976, Japan
| | - Kazuhiro Katahira
- Department of Diagnostic Radiology, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Minami-ku, Kumamoto 862-0965, Japan
| | - Keizo Kajiwara
- Jinnouchi Clinic, 6-2-3 Kuhonji, Chuo-ku, Kumamoto 862-0976, Japan
| | - Kunio Hieshima
- Jinnouchi Clinic, 6-2-3 Kuhonji, Chuo-ku, Kumamoto 862-0976, Japan
| | - Tomio Jinnouchi
- Jinnouchi Clinic, 6-2-3 Kuhonji, Chuo-ku, Kumamoto 862-0976, Japan
| | - Koichiro Usuku
- Department of Medical Information Sciences and Administration Planning, Kumamoto University Hospital, 1-1-1 honjo, Chuo-ku, 860-8556 Kumamoto, Japan
| |
Collapse
|
13
|
Hirose J, Taniwaki T, Fujimoto T, Okada T, Nakamura T, Okamoto N, Usuku K, Mizuta H. Predictive value of E-PASS and POSSUM systems for postoperative risk assessment of spinal surgery. J Neurosurg Spine 2014; 20:75-82. [DOI: 10.3171/2013.9.spine12671] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Object
The Estimation of Physiological Ability and Surgical Stress (E-PASS) and Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) systems are surgical risk scoring systems that take into account both the patient's preoperative condition and intraoperative variables. While they predict postoperative morbidity and mortality rates for several types of surgery, spinal surgeries are currently not included. The authors assessed the usefulness of E-PASS and POSSUM algorithms and compared the predictive ability of both systems in patients with spinal disorders considered for surgery.
Methods
The E-PASS system includes a preoperative risk score, a surgical stress score, and a comprehensive risk score that is determined by both the preoperative risk score and surgical stress score. The POSSUM system is composed of a physiological score and an operative severity score; its total score is based on both the physiological score and operative severity score. The authors calculated the E-PASS and POSSUM scores for 601 consecutive patients who had undergone spinal surgery and investigated the relationship between the individual scores of both systems and the incidence of postoperative complications. They also assessed the correctness of the predicted morbidity rate of both systems.
Results
Postoperative complications developed in 64 patients (10.6%); there were no in-hospital deaths. All EPASS scores (p ≤ 0.001) and the operative severity score and total score of the POSSUM (p < 0.03) were significantly higher in patients with postoperative complications than in those without postoperative complications. The morbidity rates correlated linearly and significantly with all E-PASS scores (p ≤ 0.001); their coefficients (preoperative risk score, ρ = 0.179; surgical stress score, ρ = 0.131; and comprehensive risk score, ρ = 0.198) were higher than those for the POSSUM scores (physiological score, ρ = 0.059; operative severity score, ρ = 0.111; and total score, ρ = 0.091). The area under the receiver operating characteristic curve for the predicted morbidity rate was 0.668 for the E-PASS and 0.588 for the POSSUM system.
Conclusions
As E-PASS predicted morbidity more correctly than POSSUM, it is useful for estimating the postoperative risk of patients considered for spinal surgery.
Collapse
Affiliation(s)
- Jun Hirose
- 1Departments of Orthopaedic Surgery and
- 2Medical Information Science and Administration Planning, Kumamoto University Hospital, Kumamoto, Japan
| | | | | | | | | | | | - Koichiro Usuku
- 2Medical Information Science and Administration Planning, Kumamoto University Hospital, Kumamoto, Japan
| | | |
Collapse
|
14
|
Hirose J, Nishioka H, Okamoto N, Oniki Y, Nakamura E, Yamashita Y, Usuku K, Mizuta H. Articular cartilage lesions increase early cartilage degeneration in knees treated by anterior cruciate ligament reconstruction: T1ρ mapping evaluation and 1-year follow-up. Am J Sports Med 2013; 41:2353-61. [PMID: 23925576 DOI: 10.1177/0363546513496048] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Articular cartilage degeneration can develop after anterior cruciate ligament reconstruction (ACLR). Although radiological studies have identified risk factors for the progression of degenerative cartilage changes in the long term, risk factors in the early postoperative period remain to be documented. HYPOTHESIS Cartilage lesions that are present at surgery progress to cartilage degeneration in the early phase after ACLR. STUDY DESIGN Case series; Level of evidence, 4. METHODS T1ρ is the spin-lattice relaxation in the rotating frame magnetic resonance imaging. Sagittal T1ρ maps of the femorotibial joint were obtained before and 1 year after ACLR in 23 patients with ACL injuries. Four regions of interest (ROIs) were placed on images of the cartilage in the medial and lateral femoral condyle (MFC, LFC) and the medial and lateral tibia plateau (MTP, LTP). Changes in the T1ρ value (milliseconds) of each ROI were recorded, and differences between patients with and without cartilage lesions were evaluated. The relationship between changes in the T1ρ value and meniscal tears was also studied. RESULTS Arthroscopy at ACLR detected cartilage lesions in 15 MFCs, 7 LFCs, and 2 LTPs. The baseline T1ρ value of the MFC and LFC was significantly higher in patients with cartilage lesions (MFC, 40.7 ms; LFC, 42.2 ms) than in patients without cartilage lesions (MFC, 38.0 ms, P = .025; LFC, 39.4 ms, P = .010). At 1-year follow-up, the T1ρ value of the MFC and LFC was also significantly higher in patients with lesions (MFC, 43.1 ms; LFC, 42.7 ms) than in patients without such lesions (MFC, 39.1 ms, P = .002; LFC, 40.4 ms, P = .023, respectively). In patients with cartilage injury, the T1ρ value of the MFC increased during the year after treatment (P = .002). There was no significant difference in the baseline and follow-up T1ρ value in patients with or without meniscal tears on each side although the T1ρ value of the MFC, MTP, and LFC increased during the first year after surgery regardless of the presence or absence of meniscal injuries. CONCLUSION Using T1ρ mapping to detect minimal changes, our study demonstrated that cartilage lesions are related to progressive degenerative cartilage changes during the early phase after ACLR.
Collapse
Affiliation(s)
- Jun Hirose
- Jun Hirose, Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Seich al Basatena NK, MacNamara A, Vine AM, Thio CL, Astemborski J, Usuku K, Osame M, Kirk GD, Donfield SM, Goedert JJ, Bangham CR, Carrington M, Khakoo SI, Asquith B. KIR2DL2 enhances protective and detrimental HLA class I-mediated immunity in chronic viral infection. PLoS Pathog 2011; 7:e1002270. [PMID: 22022261 PMCID: PMC3192839 DOI: 10.1371/journal.ppat.1002270] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 08/01/2011] [Indexed: 12/14/2022] Open
Abstract
Killer cell immunoglobulin-like receptors (KIRs) influence both innate and adaptive immunity. But while the role of KIRs in NK-mediated innate immunity is well-documented, the impact of KIRs on the T cell response in human disease is not known. Here we test the hypothesis that an individual's KIR genotype affects the efficiency of their HLA class I-mediated antiviral immune response and the outcome of viral infection. We show that, in two unrelated viral infections, hepatitis C virus and human T lymphotropic virus type 1, possession of the KIR2DL2 gene enhanced both protective and detrimental HLA class I-restricted anti-viral immunity. These results reveal a novel role for inhibitory KIRs. We conclude that inhibitory KIRs, in synergy with T cells, are a major determinant of the outcome of persistent viral infection. Hepatitis C virus (HCV) and human T-cell leukemia virus (HTLV-I) infect millions of people worldwide. Some HCV-infected individuals spontaneously clear the virus and many HTLV-1-infected people remain asymptomatic; however, in both cases the infection can lead to serious illness such as cancer. The factors which determine outcome are still elusive. We have found that a gene that encodes a receptor (KIR2DL2) enhances both protective and detrimental HLA class I-mediated immunity to HCV and HTLV-1. Strikingly, although KIRs are primarily associated with innate immunity, our observations suggest that they also have a major impact on the efficiency of the adaptive immune response. This work helps to explain why one individual infected with a virus remains healthy but another, infected with the same virus develops disease; it also helps to explain why particular HLA class I molecules do not always protect or cause susceptibility as expected. Interestingly, the impact of the KIR is entirely context dependent: if an HLA class I molecule is protective then protection is enhanced, but in the context of a detrimental HLA then susceptibility is enhanced. This study reveals a novel role for inhibitory KIRs in adaptive immunity.
Collapse
MESH Headings
- Female
- Genes, MHC Class I
- HTLV-I Infections/genetics
- HTLV-I Infections/immunology
- HTLV-I Infections/virology
- Hepacivirus/immunology
- Hepacivirus/physiology
- Hepatitis C, Chronic/genetics
- Hepatitis C, Chronic/immunology
- Hepatitis C, Chronic/virology
- Histocompatibility Antigens Class I/immunology
- Human T-lymphotropic virus 1/immunology
- Human T-lymphotropic virus 1/physiology
- Humans
- Killer Cells, Natural/immunology
- Killer Cells, Natural/metabolism
- Killer Cells, Natural/virology
- Male
- Receptors, KIR/immunology
- Receptors, KIR2DL2/genetics
- Receptors, KIR2DL2/metabolism
- T-Lymphocytes/immunology
- Viral Load
Collapse
Affiliation(s)
| | | | | | - Chloe L. Thio
- Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | | | | | - Gregory D. Kirk
- Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | - James J. Goedert
- National Cancer Institute, Rockville, Maryland, United States of America
| | | | - Mary Carrington
- Cancer and Inflammation Program, Laboratory of Experimental Immunology, SAIC-Frederick, Inc., NCI-Frederick, Frederick, Maryland, United States of America
- Ragon Institute of MGH, MIT and Harvard, Boston, Massachusetts, United States of America
| | | | | |
Collapse
|
16
|
Hirose J, Ide J, Yakushiji T, Abe Y, Nishida K, Maeda S, Anraku Y, Usuku K, Mizuta H. Prediction of postoperative ambulatory status 1 year after hip fracture surgery. Arch Phys Med Rehabil 2010; 91:67-72. [PMID: 20103398 DOI: 10.1016/j.apmr.2009.09.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 09/22/2009] [Accepted: 09/28/2009] [Indexed: 10/20/2022]
Abstract
UNLABELLED Hirose J, Ide J, Yakushiji T, Abe Y, Nishida K, Maeda S, Anraku Y, Usuku K, Mizuta H. Prediction of postoperative ambulatory status 1 year after hip fracture surgery. OBJECTIVES To assess the validity of Estimation of Physiologic Ability and Surgical Stress (E-PASS) for predicting the postoperative risk and ambulatory status long-term follow-up after hip fracture surgery and to establish an algorithm for predicting their ambulatory status. DESIGN Cohort study. SETTING Twelve hospitals belonging to the regional network for hip fracture in Japan. PARTICIPANTS The study population was composed of 421 patients; 268 underwent surgery between April 2004 and March 2006 (group A), and 153 were treated surgically between April 2006 and March 2007 (group B). All were operated at 3 surgical hospitals and, subsequently, transferred to 9 rehabilitation centers. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES We evaluated various factors, including their E-PASS scores to determine whether there was a correlation with the patients' mortality rate and their ability to walk at discharge and 1 year after surgery (group A). Using multiple regression analysis, we then developed algorithms to predict the ability of elderly patients to walk after hip fracture surgery. We applied the algorithms to group B patients and compared their actual and predicted ambulatory status. RESULTS In group A patients, the postoperative walking ability and mortality rate were highly correlated with their E-PASS scores and dementia status. In group B, our algorithms exhibited good correlations between the predicted and actual walking ability at both time points (rho=0.6, P<.001). CONCLUSIONS In candidates for hip fracture surgery, the E-PASS scores exhibited a good correlation with the patients' functional and survival prognoses, and the algorithm including E-PASS scores and dementia status can accurately estimate the ambulatory status at discharge and 1 year after surgery.
Collapse
Affiliation(s)
- Jun Hirose
- Department of Medical Information Science and Administration Planning, Kumamoto University, Kumamoto, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Saito M, Usuku K, Arimura K, Izumo S, Osame M, Ohara Y. Increased frequency of CD4+T cells expressing fractalkine receptor CX3CR1 in patients with HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP), but its AIDS susceptible polymorphisms are not associated with the disease. J Neurol Sci 2008; 266:13-9. [PMID: 17884099 DOI: 10.1016/j.jns.2007.08.022] [Citation(s) in RCA: 1] [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] [Received: 05/28/2007] [Revised: 08/09/2007] [Accepted: 08/14/2007] [Indexed: 10/22/2022]
Abstract
To investigate whether fractalkine receptor CX3CR1 polymorphisms that have been associated with rapid progression to AIDS among HIV-1 positive individuals also affects the risk of human T cell lymphotropic virus type 1 (HTLV-1) associated myelopathy/tropical spastic paraparesis (HAM/TSP), we compared the allele frequencies of V249I and T280M between 233 HAM/TSP patients and 213 HTLV-1 seropositive asymptomatic carriers (HCs). Although the frequency and absolute number of peripheral blood CX3CR1+CD4+T cells were significantly increased in HAM/TSP patients compared to HCs and uninfected controls independent of HTLV-1 trans-activator protein Tax, we could not observe any association between the two polymorphisms and the risk of HAM/TSP in our cohort.
Collapse
Affiliation(s)
- Mineki Saito
- Department of Microbiology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Ishikawa 920-0293, Japan.
| | | | | | | | | | | |
Collapse
|
18
|
Nose H, Kubota R, Seth NP, Goon PK, Tanaka Y, Izumo S, Usuku K, Ohara Y, Wucherpfennig KW, Bangham CRM, Osame M, Saito M. Ex vivo analysis of human T lymphotropic virus type 1-specific CD4+ cells by use of a major histocompatibility complex class II tetramer composed of a neurological disease-susceptibility allele and its immunodominant peptide. J Infect Dis 2008; 196:1761-72. [PMID: 18190256 DOI: 10.1086/522966] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
HLA-DRB1*0101 is associated with susceptibility to human T lymphotropic virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Here, we used a synthetic tetramer of DRB1*0101 and its epitope peptide to analyze HTLV-1-specific CD4(+) T cells ex vivo. The frequency of tetramer(+)CD4(+) T cells was significantly greater in patients with HAM/TSP than in healthy HTLV-1 carriers (HCs) at a given proviral load and correlated with HTLV-1 tax messenger RNA expression in HCs but not in patients with HAM/TSP. These cells displayed an early to intermediate effector memory phenotype and were preferentially infected by HTLV-1. T cell receptor gene analyses of 2 unrelated DRB1*0101-positive patients with HAM/TSP showed similar Vbeta repertoires and amino acid motifs in complementarity-determining region 3. Our data suggest that efficient clonal expansion of virus-specific CD4(+) T cells in patients with HAM/TSP does not simply reflect higher viral burden but rather reflects a rapid turnover caused by preferential infection and/or in vivo stimulation by major histocompatibility complex-peptide complexes.
Collapse
Affiliation(s)
- Hirohisa Nose
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Arimura K, Nakagawa M, Izumo S, Usuku K, Itoyama Y, Kira JI, Osame M. Safety and efficacy of interferon-α in 167 patients with human T-cell lymphotropic virus type 1–associated myelopathy. J Neurovirol 2007; 13:364-72. [PMID: 17849320 DOI: 10.1080/13550280701397627] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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: 10/22/2022]
Abstract
A postmarketing surveillance study was undertaken to investigate the safety and efficacy of interferon-alpha for human T-cell lymphotropic virus type 1 (HTLV-1)-associated myelopathy (HAM) under routine treatment conditions. A total of 273 cases from 91 medical institutions were registered into the survey. So far, 167 cases had been evaluated for safety and 152 for efficacy. The efficacy evaluation was rated based on clinical symptoms of HAM. Efficacy ratio (rate of patients assessed as "modest to markedly improved" and "mildly improved") at 4 weeks was 66.2%. Factors that significantly affected efficacy ratio at 4 weeks was initial Osame's motor disability score (OMDS) before interferon-alpha therapy and duration and stage of illness. Sustained improvement of OMDS for at least 5 months after stopping interferon-alpha was observed in 11 of 30 patients (36.7%). A total of 536 adverse drug reactions (ADRs) occurred in 146 patients, 46 of which were serious. Because some of these ADRs occurred late, it is necessary to watch out for them during long-term treatment.
Collapse
Affiliation(s)
- Kimiyoshi Arimura
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | | | | | | | | | | | | |
Collapse
|
20
|
Nose H, Saito M, Usuku K, Sabouri AH, Matsuzaki T, Kubota R, Eiraku N, Furukawa Y, Izumo S, Arimura K, Osame M. Clinical symptoms and the odds of human T-cell lymphotropic virus type 1-associated myelopathy/ tropical spastic paraparesis (HAM/TSP) in healthy virus carriers: application of best-fit logistic regression equation based on host genotype, age, and provirus load. J Neurovirol 2006; 12:171-7. [PMID: 16877298 DOI: 10.1080/13550280600827336] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 10/24/2022]
Abstract
The authors have previously developed a logistic regression equation to predict the odds that a human T-cell lymphotropic virus type 1 (HTLV-1)-infected individual of specified genotype, age, and provirus load has HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) in southern Japan. This study evaluated whether this equation is useful predictor for monitoring asymptomatic HTLV-1-seropositive carriers (HCs) in the same population. The authors genotyped 181 HCs for each HAM/TSP-associated gene (tumor necrosis factor [TNF]-alpha-863A/C, stromal cell-derived factor 1 (SDF-1) +801G/A, human leukocyte antigen [HLA]-A*02, HLA-Cw*08, HTLV-1 tax subgroup) and measured HTLV-1 provirus load in peripheral blood mononuclear cells using real-time polymerase chain reaction (PCR). Finally, the odds of HAM/TSP for each subject were calculated by using the equation and compared the results with clinical symptoms and laboratory findings. Although no clear difference was seen between the odds of HAM/TSP and either sex, family history of HAM/TSP or adult T-cell lenkemia (ATL), history of blood transfusion, it was found that brisk patellar deep tendon reflexes, which suggest latent central nervous system compromise, and flower cell-like abnormal lymphocytes, which is the morphological characteristic of ATL cells, were associated with a higher odds of HAM/TSP. The best-fit logistic regression equation may be useful for detecting subclinical abnormalities in HCs in southern Japan.
Collapse
Affiliation(s)
- Hirohisa Nose
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Taylor GP, Goon P, Furukawa Y, Green H, Barfield A, Mosley A, Nose H, Babiker A, Rudge P, Usuku K, Osame M, Bangham CRM, Weber JN. Zidovudine plus lamivudine in Human T-Lymphotropic Virus type-I-associated myelopathy: a randomised trial. Retrovirology 2006; 3:63. [PMID: 16984654 PMCID: PMC1590049 DOI: 10.1186/1742-4690-3-63] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Accepted: 09/19/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND No therapies have been proven to persistently improve the outcome of HTLV-I-associated myelopathy. Clinical benefit has been reported with zidovudine and with lamivudine in observational studies. We therefore conducted a randomised, double blind, placebo controlled study of six months combination therapy with these nucleoside analogues in sixteen patients. RESULTS Primary outcomes were change in HTLV-I proviral load in PBMCs and clinical measures. Secondary endpoints were changes in T-cell subsets and markers of activation and proliferation. Six patients discontinued zidovudine. No significant changes in pain, bladder function, disability score, gait, proviral load or markers of T-cell activation or proliferation were seen between the two arms. Active therapy was associated with an unexplained decrease in CD8 and non-T lymphocyte counts. CONCLUSION Failure to detect clinical improvement may have been due irreversible nerve damage in these patients with a long clinical history and future studies should target patients presenting earlier. The lack of virological effect but may reflect a lack of activity of these nucleoside analogues against HTLV-I RT in vivo, inadequate intracellular concentrations of the active moiety or the contribution of new cell infection to maintaining proviral load at this stage of infection may be relatively small masking the effects of RT inhibition.
Collapse
Affiliation(s)
- Graham P Taylor
- Department of GU Medicine and Communicable Diseases, Faculty of Medicine, Imperial College, London, UK
| | - Peter Goon
- Department of GU Medicine and Communicable Diseases, Faculty of Medicine, Imperial College, London, UK
- Department of Immunology, Faculty of Medicine, Imperial College, London, UK
| | - Yoshitaka Furukawa
- 3Department of Internal Medicine, University of Kagoshima, Kagoshima, Japan
| | - Hannah Green
- Clinical Trials Unit, Medical Research Council, London, UK
| | - Anna Barfield
- Department of GU Medicine and Communicable Diseases, Faculty of Medicine, Imperial College, London, UK
| | - Angelina Mosley
- Department of Immunology, Faculty of Medicine, Imperial College, London, UK
| | - Hirohisa Nose
- 3Department of Internal Medicine, University of Kagoshima, Kagoshima, Japan
| | - Abdel Babiker
- Clinical Trials Unit, Medical Research Council, London, UK
| | - Peter Rudge
- The National Hospital for Neurology and Neurosurgery, London, UK
| | - Koichiro Usuku
- 3Department of Internal Medicine, University of Kagoshima, Kagoshima, Japan
| | - Mitsuhiro Osame
- 3Department of Internal Medicine, University of Kagoshima, Kagoshima, Japan
| | - Charles RM Bangham
- Department of Immunology, Faculty of Medicine, Imperial College, London, UK
| | - Jonathan N Weber
- Department of GU Medicine and Communicable Diseases, Faculty of Medicine, Imperial College, London, UK
| |
Collapse
|
22
|
Saito M, Nose H, Usuku K, Sabouri AH, Matsuzaki T, Izumo S, Arimura K, Osame M. Flow cytometry evaluation of the T-cell receptor Vbeta repertoire among human T-cell lymphotropic virus type-1 (HTLV-1) infected individuals: effect of interferon alpha therapy in HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). J Neurol Sci 2006; 246:37-43. [PMID: 16545396 DOI: 10.1016/j.jns.2006.02.004] [Citation(s) in RCA: 2] [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] [Received: 09/30/2005] [Revised: 01/03/2006] [Accepted: 02/01/2006] [Indexed: 11/15/2022]
Abstract
Human T-cell lymphotropic virus type-1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is chronic inflammatory disease of the spinal cord characterized by perivascular lymphocytic cuffing and parenchymal lymphocytic infiltration. In this study using flow cytometry, we have investigated the T-cell receptor (TCR) Vbeta repertoire of peripheral blood T lymphocytes in 8 HAM/TSP patients, 10 HTLV-1 infected healthy carriers, and 11 uninfected healthy controls to determine if there is a biased usage of TCR Vbeta. We found that TCR Vbeta7.2 was under-utilized and Vbeta12 was over-utilized in CD4+ T cells of HTLV-1 infected individuals compared with healthy uninfected controls, whereas there were no such differences in CD8+ T cells. Comparison of Vbeta repertoire changes before and after interferon-alpha (IFN-alpha) treatment for HAM/TSP revealed that one out of five patients showed dramatic decrease of specific Vbeta in CD8+ T cells. Our results suggest that dominant Vbeta subpopulations in CD4+ T cells evolved associated with chronic HTLV-1 infection, and IFN-alpha treatment for HAM/TSP does not induce a specific pattern of TCR Vbeta changes.
Collapse
Affiliation(s)
- Mineki Saito
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Nobuhara Y, Usuku K, Saito M, Izumo S, Arimura K, Bangham CRM, Osame M. Genetic variability in the extracellular matrix protein as a determinant of risk for developing HTLV-I-associated neurological disease. Immunogenetics 2006; 57:944-52. [PMID: 16402214 DOI: 10.1007/s00251-005-0075-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Accepted: 12/04/2005] [Indexed: 10/25/2022]
Abstract
Aggrecan, which is a well-known proteoglycan in joint cartilage, also exists in the spinal cord and plays an important role in maintaining water content in the extracellular matrix structure. In this study, we first examined the variable number of tandem repeat (VNTR) polymorphism of the aggrecan gene in 227 HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP) patients, in 217 HTLV-I-infected healthy carriers (HCs), and in 85 normal controls. The VNTR allele 28 (1,630 bp) was more frequently observed in HAM/TSP patients than in HCs (chi2=12.02, p=0.0005, odds ratio 1.79, 95% C.I. 1.29-2.50) and in controls (chi2=13.43, p=0.0002, odds ratio 2.54, 95% C.I. 1.52-4.25), although this allele was not related to disease progression or to HTLV-I provirus load. We also found that the aggrecan concentration in cerebrospinal fluid (CSF) from rapidly progressive HAM/TSP patients was significantly higher than in slowly progressive patients (corrected p=0.0145) but not in infected non-inflammatory neurological other disease controls (OND) (corrected p=0.078). We then analyzed this aggrecan VNTR polymorphism in the different set of patients with HAM/TSP (n=58) and healthy carriers (n=70). This analysis, again, revealed that allele 28 was detected more frequently in HAM/TSP group than in HCs (chi2=11.03, p=0.0009, odd ratio 3.04, 95% C.I. 1.55-5.97). The reproducibility of our study was regarded as a second- or third-class association by comparing combined p values and the Better Associations for Disease and GEnes (BADGE) system. Our results suggest that aggrecan polymorphism can be a novel genetic risk factor for developing HAM/TSP.
Collapse
Affiliation(s)
- Yasuyuki Nobuhara
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | | | | | | | | | | | | |
Collapse
|
24
|
Matsuzaki T, Saito M, Usuku K, Nose H, Izumo S, Arimura K, Osame M. A prospective uncontrolled trial of fermented milk drink containing viable Lactobacillus casei strain Shirota in the treatment of HTLV-1 associated myelopathy/tropical spastic paraparesis. J Neurol Sci 2005; 237:75-81. [PMID: 15961107 DOI: 10.1016/j.jns.2005.05.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2004] [Revised: 05/20/2005] [Accepted: 05/23/2005] [Indexed: 10/25/2022]
Abstract
Ten patients with human T-cell lymphotropic virus type-1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) were treated in an uncontrolled preliminary trial by oral administration of viable Lactobacillus casei strain Shirota (LcS) containing fermented milk. HTLV-1 provirus load, motor function, neurological findings, and immunological parameters were evaluated after 4 weeks. Although LcS did not change the frequencies or absolute numbers of all the examined cell surface phenotypes of peripheral blood mononuclear cells, NK cell activity was significantly increased after 4 weeks of oral administration of LcS preparation. Improvements in spasticity (modified Ashworth Scale scores) and urinary symptoms were also seen after LcS treatment. No adverse effect was observed in all the 10 patients throughout the study period. Our results indicated that LcS may be a safe and beneficial agent for the treatment of HAM/TSP; therefore randomized controlled studies are warranted.
Collapse
Affiliation(s)
- Toshio Matsuzaki
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | | | | | | | | | | | | |
Collapse
|
25
|
Saito M, Eiraku N, Usuku K, Nobuhara Y, Matsumoto W, Kodama D, Sabouri AH, Izumo S, Arimura K, Osame M. ApaI polymorphism of vitamin D receptor gene is associated with susceptibility to HTLV-1-associated myelopathy/tropical spastic paraparesis in HTLV-1 infected individuals. J Neurol Sci 2005; 232:29-35. [PMID: 15850579 DOI: 10.1016/j.jns.2005.01.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2004] [Revised: 01/07/2005] [Accepted: 01/10/2005] [Indexed: 11/25/2022]
Abstract
HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is one outcome of human T-cell lymphotropic virus type-1 (HTLV-1) infection. It remains unknown why the majority of infected people remain healthy, whereas only approximately 2-3% of infected individuals develop the disease. The active form of vitamin D has immunomodulatory effects, and allelic variants of the vitamin D receptor (VDR) appear to be associated with differential susceptibility to several infectious diseases. To investigate whether VDR single nucleotide polymorphisms (SNPs) are associated with the development of HAM/TSP, we studied four VDR SNPs in a group of 207 HAM/TSP patients and 224 asymptomatic HTLV-1 seropositive carriers (HCs) in Kagoshima, Japan, by using PCR-RFLP analysis. We found that ApaI polymorphism of VDR is associated with the risk of HAM/TSP, although this polymorphism did not affect the provirus load of HTLV-1 in either HAM/TSP patients or HCs.
Collapse
Affiliation(s)
- Mineki Saito
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Sabouri AH, Saito M, Usuku K, Bajestan SN, Mahmoudi M, Forughipour M, Sabouri Z, Abbaspour Z, Goharjoo ME, Khayami E, Hasani A, Izumo S, Arimura K, Farid R, Osame M. Differences in viral and host genetic risk factors for development of human T-cell lymphotropic virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis between Iranian and Japanese HTLV-1-infected individuals. J Gen Virol 2005; 86:773-781. [PMID: 15722539 DOI: 10.1099/vir.0.80509-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [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: 11/18/2022] Open
Abstract
Human T-cell lymphotropic virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a neurological disease observed only in 1–2 % of infected individuals. HTLV-1 provirus load, certain HLA alleles and HTLV-1 tax subgroups are reported to be associated with different levels of risk for HAM/TSP in Kagoshima, Japan. Here, it was determined whether these risk factors were also valid for HTLV-1-infected individuals in Mashhad in northeastern Iran, another region of endemic HTLV-1 infection. In Iranian HTLV-1-infected individuals (n=132, 58 HAM/TSP patients and 74 seropositive asymptomatic carriers), although HLA-DRB1*0101 was associated with disease susceptibility in the absence of HLA-A*02 (P=0·038; odds ratio=2·71) as observed in Kagoshima, HLA-A*02 and HLA-Cw*08 had no effect on either the risk of developing HAM/TSP or HTLV-1 provirus load. All Iranian subjects possessed tax subgroup A sequences, and the protective effects of HLA-A*02 were observed only in Kagoshima subjects with tax subgroup B but not in those with tax subgroup A. Both the prevalence of HTLV-1 subgroups and the host genetic background may explain the different risks levels for HAM/TSP development in these two populations.
Collapse
Affiliation(s)
- Amir H Sabouri
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Mineki Saito
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Koichiro Usuku
- Department of Medical Information Science, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Sepideh Naghibzadeh Bajestan
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Mahmoud Mahmoudi
- Department of Immunology and Immunology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Forughipour
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Sabouri
- Department of Immunology and Immunology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Abbaspour
- Department of Immunology and Immunology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad E Goharjoo
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Ali Hasani
- Khorasan Blood Transfusion Center, Mashhad, Iran
| | - Shuji Izumo
- Department of Molecular Pathology, Center for Chronic Viral Diseases, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Kimiyoshi Arimura
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Reza Farid
- Department of Immunology and Immunology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mitsuhiro Osame
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| |
Collapse
|
27
|
Mori S, Mizoguchi A, Kawabata M, Fukunaga H, Usuku K, Maruyama I, Osame M. Bronchoalveolar lymphocytosis correlates with human T lymphotropic virus type I (HTLV-I) proviral DNA load in HTLV-I carriers. Thorax 2005; 60:138-43. [PMID: 15681503 PMCID: PMC1747290 DOI: 10.1136/thx.2004.021667] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [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: 11/04/2022]
Abstract
BACKGROUND A study was undertaken to investigate the pathogenesis of pulmonary involvement in human T lymphotropic virus type I (HTLV-I) carriers. METHODS The bronchoalveolar lavage (BAL) cell profile of 30 HTLV-I carriers (15 asymptomatic HTLV-I carriers (AHCs) and 15 symptomatic HTLV-I carriers (SHCs)) with chronic inflammatory diseases of respiratory tract and eight patients with HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP) was investigated. The HTLV-I proviral deoxyribonucleic acid (DNA) load in peripheral blood mononuclear cells (PBMCs) and BAL fluid from HTLV-I carriers was estimated using the quantitative polymerase chain reaction method and the correlation between the lymphocyte number in BAL fluid and the HTLV-I proviral DNA load in PBMCs and BAL fluid was examined. RESULTS The percentage of lymphocytes in BAL fluid was increased (>18%) in 11 of 30 HTLV-I carriers although there was no significant difference compared with control subjects. In HTLV-I carriers the lymphocyte number in BAL fluid correlated well with the copy number of HTLV-I proviral DNA in PBMCs. In addition, the copy number of HTLV-I proviral DNA in BAL fluid correlated well with the number of lymphocytes (both CD4+ and CD8+ cells) in BAL fluid. CONCLUSIONS These findings suggest that pulmonary lymphocytosis can occur in a subset of HTLV-I carriers without HAM/TSP and that the increased HTLV-I proviral DNA load may be implicated in the pathogenesis of pulmonary involvement in HTLV-I carriers.
Collapse
Affiliation(s)
- S Mori
- Third Department of Internal Medicine, Kagoshima University School of Medicine, Kagoshima 890-8520, Japan.
| | | | | | | | | | | | | |
Collapse
|
28
|
Kodama D, Saito M, Matsumoto W, Sabouri AH, Izumo S, Arimura K, Usuku K, Bangham CRM, Osame M. Longer dinucleotide repeat polymorphism in matrix metalloproteinase-9 (MMP-9) gene promoter which correlates with higher HTLV-I Tax mediated transcriptional activity influences the risk of HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP). J Neuroimmunol 2004; 156:188-94. [PMID: 15465610 DOI: 10.1016/j.jneuroim.2004.07.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2004] [Revised: 07/07/2004] [Accepted: 07/16/2004] [Indexed: 11/23/2022]
Abstract
Matrix metalloproteinase-9 (MMP-9) has been reported to be expressed in various inflammatory disorders including human T cell lymphotropic virus type I (HTLV-I) associated myelopathy/tropical spastic paraparesis (HAM/TSP). HTLV-I-infected T-cells expressed high levels of MMP-9 via viral transactivator Tax mediated activation of the MMP-9 promoter. To investigate whether the d(CA) repeat polymorphism in MMP-9 promoter affects the risk of developing HAM/TSP, we compared the allele frequencies between 200 HAM/TSP patients and 200 HTLV-I seropositive asymptomatic carriers (HCs). The longer d(CA) repeat alleles of MMP-9 promoter, which was associated with higher Tax-mediated transcriptional activity, was more frequently observed in HAM/TSP patients than HCs (p<0.01 by Mann-Whitney U-test). The length alteration of this d(CA) repeat in the MMP-9 promoter may cause phenotypic differences among HTLV-I infected infiltrating cells and may thereby be in part responsible for the development of HAM/TSP.
Collapse
Affiliation(s)
- Daisuke Kodama
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Umehara F, Nagatomo S, Yoshishige K, Saito M, Furukawa Y, Usuku K, Osame M. Chronic progressive cervical myelopathy with HTLV-I infection: Variant form of HAM/TSP? Neurology 2004; 63:1276-80. [PMID: 15477551 DOI: 10.1212/01.wnl.0000140496.03342.bc] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [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: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the role of human T-lymphotrophic virus type I (HTLV-I) infection in four patients who developed slowly progressive myelopathy with abnormal MRI lesions in the cervical cord levels. METHODS Clinical and neuroradiologic examinations were performed, and the odds that an HTLV-I-infected individual of specified genotype, age, and provirus load had HTLV-I-associated myelopathy (HAM)/tropical spastic paraparesis (TSP) were calculated. RESULTS Anti-HTLV-I antibodies were positive in both the serum and the CSF in all of the patients. Biopsied sample from spinal cord lesions showed inflammatory changes in Patient 1. Patient 2 had a demyelinating type of sensorimotor polyneuropathy. Two of the three patients examined showed high risk of developing HAM/TSP in virologic and immunologic aspects. CONCLUSION These four cases may belong to a variant form of HAM/TSP, predominantly involving the cervical cord levels.
Collapse
Affiliation(s)
- F Umehara
- Department of Neurology, Graduate School of Kagoshima University, Sakuragaoka 8-35-1, Kagoshima 8900075, Japan.
| | | | | | | | | | | | | |
Collapse
|
30
|
Furukawa Y, Usuku K, Izumo S, Osame M. Human T cell lymphotropic virus type I (HTLV-I) p12I is dispensable for HTLV-I transmission and maintenance of infection in vivo. AIDS Res Hum Retroviruses 2004; 20:1092-9. [PMID: 15585100 DOI: 10.1089/aid.2004.20.1092] [Citation(s) in RCA: 16] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The function of the p12(I) protein of human T cell lymphotropic virus type I (HTLV-I) has been under debate. p12K (lysine) and p12R (arginine) variants of this protein at amino acid 88 and a shorter life of p12K had been reported by another group. Because HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) patients usually have a higher provirus load than asymptomatic HTLV-I carriers (ACs), and p12(I) had been suggested to confer a proliferative effect on HTLV-I-infected cells in vitro, it is possible that the relatively unstable p12K is less frequent in HAM/TSP patients than in ACs. To elucidate whether p12K and other alterations in the p12 gene were related to the outcome of HTLV-I infection, we sequenced the p12 gene in 144 HAM/TSP patients, 41 adult T cell leukemia (ATL) patients, and in 46 ACs. p12K was observed in only two HAM/TSP patients, but was not present in either ATL patients or ACs. Interestingly, a premature termination codon in the p12 was observed in 5.6% of HAM/TSP patients and in 4.9% of ATL patients but none was found in ACs. The p12 initiation codon was destroyed in one HAM/TSP patient. These HTLV-I variants with truncated p12 protein or with a destroyed initiation codon in the p12 gene appeared to have been transmitted in the subjects' families. These findings suggest that p12 is dispensable for the transmission and maintenance of HTLV-I infection, although it is premature to conclude that sequence varitation in the p12 gene is associated with differences in the outcome of HTLV-I infection.
Collapse
MESH Headings
- Adult
- Female
- Gene Products, tax/genetics
- Genes, pX/genetics
- Genetic Variation
- HTLV-I Infections/genetics
- HTLV-I Infections/physiopathology
- HTLV-I Infections/transmission
- HTLV-I Infections/virology
- Human T-lymphotropic virus 1/pathogenicity
- Humans
- Male
- Molecular Sequence Data
- Oncogene Proteins, Viral/chemistry
- Oncogene Proteins, Viral/genetics
- Oncogene Proteins, Viral/metabolism
- Paraparesis, Tropical Spastic/genetics
- Paraparesis, Tropical Spastic/physiopathology
- Paraparesis, Tropical Spastic/transmission
- Paraparesis, Tropical Spastic/virology
- Polymorphism, Restriction Fragment Length
- Proviruses
- Sequence Analysis, DNA
- Transcription Factors/chemistry
- Transcription Factors/genetics
- Transcription Factors/metabolism
- Viral Load
- Viral Regulatory and Accessory Proteins
Collapse
Affiliation(s)
- Yoshitaka Furukawa
- Division of Blood Transfusion Medicine and Cell Therapy, Kagoshima University Hospital, Kagoshima 890-8520, Japan.
| | | | | | | |
Collapse
|
31
|
Sabouri AH, Saito M, Lloyd AL, Vine AM, Witkover AW, Furukawa Y, Izumo S, Arimura K, Marshall SEF, Usuku K, Bangham CRM, Osame M. Polymorphism in the interleukin-10 promoter affects both provirus load and the risk of human T lymphotropic virus type I-associated myelopathy/tropical spastic paraparesis. J Infect Dis 2004; 190:1279-85. [PMID: 15346339 DOI: 10.1086/423942] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2004] [Accepted: 04/12/2004] [Indexed: 11/03/2022] Open
Abstract
To investigate non-human leukocyte antigen candidate genes that influence the outcome of human T cell lymphotropic virus (HTLV) type I infection, we analyzed 6 single-nucleotide polymorphisms in the interleukin (IL)-10 promoter region in 280 patients with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and 255 HTLV-I-seropositive asymptomatic carriers from an area where HTLV-I is endemic. The IL-10 -592 A allele, which shows lower HTLV-I Tax-induced transcriptional activity than the C allele in the Jurkat T cell line, was associated with a >2-fold reduction in the odds of developing HAM/TSP (P=.011; odds ratio [OR], 0.50 [95% confidence interval, 0.30-0.86]) by reducing the provirus load in the whole cohort (P=.009, analysis of variance). Given the OR and the observed frequency of IL-10 -592 A, we demonstrate that this allele prevents approximately 44.7% (standard deviation, +/-13.1%) of potential cases of HAM/TSP, which indicates that it defines one component of the genetic susceptibility to HAM/TSP in the cohort.
Collapse
Affiliation(s)
- Amir H Sabouri
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Saito M, Usuku K, Nobuhara Y, Matsumoto W, Kodama D, Sabouri AH, Izumo S, Arimura K, Osame M. Serum concentration and genetic polymorphism in the 5′-untraslated region of VEGF is not associated with susceptibility to HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP) in HTLV-I infected individuals. J Neurol Sci 2004; 219:157-61. [PMID: 15050452 DOI: 10.1016/j.jns.2004.01.009] [Citation(s) in RCA: 1] [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] [Received: 09/09/2003] [Revised: 12/03/2003] [Accepted: 01/21/2004] [Indexed: 01/22/2023]
Abstract
HTLV-I- associated myelopathy/tropical spastic paraparesis (HAM/TSP) is one outcome of human T-cell lymphotropic virus type I (HTLV-I) infection. It remains unknown why the majority of infected people remain healthy whereas only approximately 2-3% of infected individuals develop the disease. Recently, it has been reported that increased plasma concentrations of VEGF were significantly related to high ATL cell infiltration, and the viral transactivator Tax activates the VEGF promoter, linking the induction of angiogenesis to viral gene expression. To investigate whether VEGF promoter -634C/G single nucleotide polymorphism (SNP) and serum concentration of VEGF are associated with the development of HAM/TSP, we studied a group of 202 HAM/TSP patients, 202 asymptomatic HTLV-I seropositive carriers (HCs) and 108 seronegative healthy controls (NCs) in Kagoshima, Japan by using PCR-RFLP analysis. The serum concentration of VEGF was also compared among patients with HAM/TSP, ATL, HCs as well as with NCs. Our results indicate that both VEGF gene polymorphism and serum VEGF levels are not specifically associated with the risk of HAM/TSP in our cohort.
Collapse
Affiliation(s)
- Mineki Saito
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Saito M, Nakagawa M, Kaseda S, Matsuzaki T, Jonosono M, Eiraku N, Kubota R, Takenouchi N, Nagai M, Furukawa Y, Usuku K, Izumo S, Osame M. Decreased Human T Lymphotropic Virus Type I (HTLV‐I) Provirus Load and Alteration in T Cell Phenotype after Interferon‐α Therapy for HTLV‐I–Associated Myelopathy/Tropical Spastic Paraparesis. J Infect Dis 2004; 189:29-40. [PMID: 14702150 DOI: 10.1086/380101] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2003] [Accepted: 07/17/2003] [Indexed: 11/03/2022] Open
Abstract
To analyze the mechanism by which interferon (IFN)-alpha is effective against human T cell lymphotropic virus type I (HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP), we investigated the T cell phenotype and HTLV-I provirus load in peripheral blood mononuclear cells from 25 patients with HAM/TSP that were obtained before and after administration of IFN-alpha. The frequency of memory (CD45RA(-)CD27(+)) T cells that were CD8(high+), CXCR3(+) cell populations, and HTLV-I provirus loads were significantly decreased after treatment. The proportion of memory T cells in the CD8(high+) cell population correlated well with HTLV-I provirus load, whereas the proportion of effector (CD45RA(+)CD27(-)) cells in the CD8(high+) cell population was inversely correlated with provirus load. Interestingly, the frequency of perforin expression in CD8(high+) cells was significantly decreased after treatment in patients who experienced clinical improvement, whereas patients who did not experience clinical improvement showed an increased frequency of perforin expression. Our data suggest that fluctuations in these cell subsets are associated with both the immunomodulatory effect of IFN-alpha and the observed clinical benefit of IFN-alpha treatment in patients with HAM/TSP.
Collapse
Affiliation(s)
- Mineki Saito
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima University, Sakuragaoka, Kagoshima, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Sabouri AH, Saito M, Matsumoto W, Kodama D, Farid R, Izumo S, Usuku K, Osame M. A C77G point mutation in CD45 exon 4, which is associated with the development of multiple sclerosis and increased susceptibility to HIV-1 infection, is undetectable in Japanese population. Eur J Neurol 2003; 10:737-9. [PMID: 14641523 DOI: 10.1046/j.1468-1331.2003.00679.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 11/20/2022]
Abstract
HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) is one outcome of Human T-cell lymphotropic virus type 1 (HTLV-1) infection. It remains unknown why the majority of infected people remain healthy whereas only approximately 2-3% develop disease. Recently, heterozygous state of CD45 exon 4 mutation (C77C wild type and C77G mutant) was reported to be associated with development of multiple sclerosis in German patients and increased susceptibility to HIV-1 infection in the United Kingdom. To investigate whether this mutation is associated with the development of HAM/TSP, we studied a group of 164 HAM/TSP patients and 108 asymptomatic HTLV-1 carriers in Kagoshima (HTLV-1 endemic area in Southern Japan) by using PCR-RFLP and subsequent direct sequencing analysis. All 272 subjects showed homozygosity in the CD45 exon 4, suggesting that this mutation is absent or very rare in Japanese population.
Collapse
Affiliation(s)
- A H Sabouri
- Third Department of Internal Medicine, Faculty of Medicine, Kagoshima University, Sakuragaoka, Kagoshima, Japan
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Osame M, Usuku K, Umehara F, Saito M, Furukawa Y, Kubota R, Nagai M, Higuchi I, Nakagawa M, Arimura K, Izumo S. [Physiopathology and treatment of HAM]. Nihon Naika Gakkai Zasshi 2003; 92:1673-82. [PMID: 14560601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
|
36
|
Saito M, Braud VM, Goon P, Hanon E, Taylor GP, Saito A, Eiraku N, Tanaka Y, Usuku K, Weber JN, Osame M, Bangham CRM. Low frequency of CD94/NKG2A+ T lymphocytes in patients with HTLV-1-associated myelopathy/tropical spastic paraparesis, but not in asymptomatic carriers. Blood 2003; 102:577-84. [PMID: 12560226 DOI: 10.1182/blood-2002-09-2855] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [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: 11/20/2022] Open
Abstract
Human natural killer (NK)-cell receptors are expressed by NK cells and some T cells, primarily TCR+CD8+ cytotoxic T lymphocytes (CTLs). Inhibitory NK cell receptors (iNKRs) can down-regulate antigen-mediated T-cell effector functions, including cytotoxic activity and cytokine release. In the present study we demonstrate that CD3+ T cells that bind tetramers of HLA-E and express its ligand, the NK-cell inhibitory receptor CD94/NKG2A, were significantly decreased in frequency in patients with human T-cell lymphotropic virus 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) but not in asymptomatic HTLV-1 carriers. These cells were either alphabeta or gammadelta T cells. T-cell receptor (TCR) Vbeta-specific reverse transcription-polymerase chain reaction and spectratyping analysis revealed that the TCR repertoire in directly isolated HLA-E tetramer-positive cells from peripheral blood mononuclear cells was skewed in both HTLV-1-infected and healthy individuals. However, oligoclonally or monoclonally expanded levels of TCR Vbetawere more frequently detected within HTLV-1-infected individuals than healthy controls. Importantly, HLA-E tetramer-positive or NKG2A+ T cells from HTLV-1 patients do not express Tax and display different TCR usage from the immunodominant Tax11-19-specific CD8+ T cells, suggesting that they do not encounter HTLV-1-infected cells. The expression of NK cell-associated receptors by clonally expanded CD8+ T cells during chronic viral infection suggests that these receptors play a role in regulating CD8+ T cell-mediated antiviral immune responses and that a decrease of this cell subset results in an increased risk of inflammatory diseases such as HAM/TSP.
Collapse
MESH Headings
- Antigens, CD/analysis
- CD8-Positive T-Lymphocytes/immunology
- Carrier State/immunology
- Clone Cells/immunology
- DNA, Viral/genetics
- Epitopes, T-Lymphocyte/immunology
- Gene Products, tax/analysis
- Gene Rearrangement, T-Lymphocyte
- Genes, T-Cell Receptor beta
- HLA Antigens/analysis
- HTLV-I Infections/immunology
- Histocompatibility Antigens Class I/analysis
- Human T-lymphotropic virus 1/genetics
- Humans
- Immunodominant Epitopes/immunology
- Japan
- Lectins, C-Type/analysis
- Lymphocyte Count
- NK Cell Lectin-Like Receptor Subfamily C
- NK Cell Lectin-Like Receptor Subfamily D
- Paraparesis, Tropical Spastic/immunology
- Proviruses/genetics
- Receptors, Antigen, T-Cell, alpha-beta/analysis
- Receptors, Antigen, T-Cell, gamma-delta/analysis
- Receptors, Immunologic/analysis
- Receptors, Natural Killer Cell
- T-Lymphocyte Subsets/immunology
- HLA-E Antigens
Collapse
Affiliation(s)
- Mineki Saito
- Department of Immunology, Imperial College London, St Mary's Campus, London, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Kubota R, Furukawa Y, Izumo S, Usuku K, Osame M. Degenerate specificity of HTLV-1-specific CD8+ T cells during viral replication in patients with HTLV-1-associated myelopathy (HAM/TSP). Blood 2003; 101:3074-81. [PMID: 12480698 DOI: 10.1182/blood-2002-08-2477] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [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: 11/20/2022] Open
Abstract
Human T-lymphotropic virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is an inflammatory neurologic disease caused by HTLV-1 infection, in which HTLV-1-infected CD4(+) T cells and HTLV-1-specific CD8(+) T cells may play a role in the disease pathogenesis. Patients with HAM/TSP have high proviral loads despite vigorous virus-specific CD8(+) T-cell responses; however, it is unknown whether the T cells are efficient in eliminating the virus in vivo. To define the dynamics of HTLV-1-specific CD8(+) T-cell responses, we investigated longitudinal alterations in HTLV-1 proviral load, amino acid changes in an immunodominant viral epitope, frequency of HTLV-1-specific T cells, and degeneracy of T-cell recognition in patients with HAM/TSP. We showed that the frequency and the degeneracy of the HTLV-1-specific CD8(+) T cells correlated well with proviral load in the longitudinal study. The proviral load was much higher in a patient with low degeneracy of HTLV-1-specific T cells compared to that in a patient with comparable frequency but higher degeneracy of the T cells. Furthermore, in a larger number of patients divided into 2 groups by the proviral load, those with high proviral load had lower degeneracy of T-cell recognition than those with low proviral load. Sequencing analysis revealed that epitope mutations were remarkably increased in a patient when the frequency and the degeneracy were at the lowest. These data suggest that HTLV-1-specific CD8(+) T cells with degenerate specificity are increased during viral replication and control the viral infection.
Collapse
Affiliation(s)
- Ryuji Kubota
- Third Department of Internal Medicine, Center for Chronic Viral Diseases, Kagoshima University, Kagoshima, Japan.
| | | | | | | | | |
Collapse
|
38
|
Furukawa Y, Saito M, Matsumoto W, Usuku K, Tanaka Y, Izumo S, Osame M. Different cytokine production in tax-expressing cells between patients with human T cell lymphotropic virus type I (HTLV-I)-associated myelopathy/tropical spastic paraparesis and asymptomatic HTLV-I carriers. J Infect Dis 2003; 187:1116-25. [PMID: 12660926 DOI: 10.1086/368379] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2002] [Accepted: 12/04/2002] [Indexed: 11/03/2022] Open
Abstract
Human T cell lymphotropic virus type I (HTLV-I) provirus load has been reported to be generally higher in patients with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) than in asymptomatic HTLV-I carriers (ACs). However, some ACs have a high HTLV-I provirus load comparable with that in patients with HAM/TSP. To examine whether other factors influence the outcome of HTLV-I infection in patients with HAM/TSP and ACs, we analyzed spontaneous Tax expression and cytokine production in peripheral blood mononuclear cells using flow cytometry. The Tax expression in HTLV-I-infected cells (percentage of Tax expressing cells/HTLV-I provirus load when assumed 1 copy/cell) and the intensity of Tax expression did not differ between these 2 groups. However, the production of interferon-gamma and tumor necrosis factor-alpha in Tax-expressing cells was significantly lower in ACs with high HTLV-I provirus load than in patients with HAM/TSP. This result suggests that the production of inflammatory cytokines in Tax-expressing cells is one of the factors that contribute to the development of HAM/TSP.
Collapse
Affiliation(s)
- Yoshitaka Furukawa
- Division of Blood Transfusion Medicine, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan.
| | | | | | | | | | | | | |
Collapse
|
39
|
Furukawa Y, Kubota R, Eiraku N, Nakagawa M, Usuku K, Izumo S, Osame M. Human T-cell lymphotropic virus type I (HTLV-I)-related clinical and laboratory findings for HTLV-I-infected blood donors. J Acquir Immune Defic Syndr 2003; 32:328-34. [PMID: 12626894 DOI: 10.1097/00126334-200303010-00013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [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: 11/25/2022]
Abstract
Clinical and laboratory findings were examined for 111 human T-cell lymphotropic virus type I (HTLV-I)-infected blood donors. HTLV-I provirus loads in subjects with a family history of adult T-cell leukemia (ATL) or HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) tended to be higher than those in subjects without a family history of these conditions. There were 3 asymptomatic patients with ATL, 4 with a history of uveitis, 7 with hyperreflexia in the lower limbs, and 3 with urinary frequency in the night. The mean CD4 cell/CD8 cell ratio +/- SD was significantly lower (p<.0001) in subjects with hyperreflexia in the lower limbs (1.3 +/- 0.2) than in subjects without any clinical abnormalities (1.7 +/- 0.6), suggesting that subjects with hyperreflexia in the lower limbs already have some immunologic abnormalities. The concordance of HTLV-I infection between husband and wife was lower in this study than in a previous study. HTLV-I-related inflammatory symptoms were more frequent (p =.021, Fisher exact test; OR = 9.5; 95% CI, 1.7-53.5) in HTLV-I tax A-infected donors (3 [50%] of 6 donors) than in HTLV-I tax B-infected donors (10 [9.5%] of 105 donors), suggesting different risks of HTLV-I-related symptoms according to the virus genotype.
Collapse
Affiliation(s)
- Yoshitaka Furukawa
- Third Department of Internal Medicine, Faculty of Medicine, Kagoshima University, Japan.
| | | | | | | | | | | | | |
Collapse
|
40
|
Takenouchi N, Yamano Y, Usuku K, Osame M, Izumo S. Usefulness of proviral load measurement for monitoring of disease activity in individual patients with human T-lymphotropic virus type I-associated myelopathy/tropical spastic paraparesis. J Neurovirol 2003; 9:29-35. [PMID: 12587066 DOI: 10.1080/13550280390173418] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2002] [Revised: 06/25/2002] [Accepted: 08/16/2002] [Indexed: 10/20/2022]
Abstract
High human T-lymphotropic virus type I (HTLV-I) proviral load in peripheral blood mononuclear cells (PBMCs) has been reported in patients with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and the proviral load has been reported to fluctuate in individual patients during the course of the disease. Clinical symptoms usually became stable after a prolonged period of symptom progression. However, the authors have experienced having some patients whose clinical manifestations suddenly became worse during the course of the disease. To clarify the role of high proviral load and its fluctuation in the pathogenesis of HAM/TSP, the authors measured the proviral load of serially taken PBMCs as well as of cerebrospinal fluid (CSF) cells from patients with HAM/TSP on long-term follow-up and compared these with their clinical manifestations. There was a wide distribution of proviral load, from 0.3 to 37.8 copies/100 PBMCs; however, the proviral load in individual patients was relatively stable during the course of the disease. Eighty-three percent of the patients with clinical worsening showed an increase in proviral load at the time point when clinical worsening was recorded, or at the preceding time point. The proviral loads in CSF cells were higher than those in PBMCs in individual patients. The ratio of proviral loads in CSF cells/in PBMCs, but not the absolute load, in either compartment, was significantly associated with clinically progressive disease and with recent onset of HAM/TSP. These findings indicate that clinical progression of HAM/TSP is associated with increased proliferation or immigration of HTLV-I-infected lymphocytes in the central nervous system.
Collapse
Affiliation(s)
- Norihiro Takenouchi
- Division of Molecular Pathology and Genetic Epidemiology, Center for Chronic Viral Diseases, Faculty of Medicine, Kagoshima University, Japan.
| | | | | | | | | |
Collapse
|
41
|
Saito M, Higuchi I, Saito A, Izumo S, Usuku K, Bangham CRM, Osame M. Molecular analysis of T cell clonotypes in muscle-infiltrating lymphocytes from patients with human T lymphotropic virus type 1 polymyositis. J Infect Dis 2002; 186:1231-41. [PMID: 12402192 DOI: 10.1086/344315] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2002] [Revised: 06/20/2002] [Indexed: 11/03/2022] Open
Abstract
Epidemiological studies have shown that a correlation may exist between human T cell lymphotropic virus type 1 (HTLV-1) infection and a form of polymyositis (PM). To characterize muscle-infiltrating lymphocytes (MILs) from patients with HTLV-1 PM, we examined the T cell receptor (TCR) beta-chain variable region repertoire and clonotype of MILs and peripheral blood mononuclear cells (PBMC) from 3 patients, using TCR complementarity-determining region 3 (CDR3) length spectratyping and DNA sequencing. Immunohistochemical studies showed that MILs from patients with HTLV-1 PM contain both CD4(+) and CD8(+) T cells. Although some clonotypes observed in PBMC were also found in MILs in all patients examined, MILs consisted predominantly of locally expanded clones. One clonotype in MILs was derived from human leukocyte antigen (HLA)-A*02/Tax11-19 tetramer-positive cells, the CDR3 motif of which contains amino acid residues for HLA-A*02/Tax peptide-TCR interaction. We conclude that certain T cell clones proliferate in the muscle lesions of HTLV-1 PM and may contribute to the pathogenesis of the disease.
Collapse
MESH Headings
- Aged
- Amino Acid Sequence
- CD4-Positive T-Lymphocytes/immunology
- CD4-Positive T-Lymphocytes/pathology
- CD8-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/pathology
- Female
- HTLV-I Infections/immunology
- Humans
- Male
- Middle Aged
- Molecular Sequence Data
- Muscle, Skeletal/pathology
- Muscle, Skeletal/virology
- Polymyositis/immunology
- Polymyositis/virology
- Receptor-CD3 Complex, Antigen, T-Cell/chemistry
- Receptor-CD3 Complex, Antigen, T-Cell/genetics
- Receptors, Antigen, T-Cell, alpha-beta/chemistry
- Receptors, Antigen, T-Cell, alpha-beta/genetics
- T-Lymphocytes/immunology
Collapse
Affiliation(s)
- Mineki Saito
- Third Department of Internal Medicine, Faculty of Medicine, Kagoshima University, Sakuragaoka, Kagoshima, Japan.
| | | | | | | | | | | | | |
Collapse
|
42
|
Vine AM, Witkover AD, Lloyd AL, Jeffery KJM, Siddiqui A, Marshall SEF, Bunce M, Eiraku N, Izumo S, Usuku K, Osame M, Bangham CRM. Polygenic control of human T lymphotropic virus type I (HTLV-I) provirus load and the risk of HTLV-I-associated myelopathy/tropical spastic paraparesis. J Infect Dis 2002; 186:932-9. [PMID: 12232833 DOI: 10.1086/342953] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2002] [Revised: 04/19/2002] [Indexed: 11/03/2022] Open
Abstract
Human T lymphotropic virus type I (HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is one outcome of infection with HTLV-I. A population association study of 229 patients with HAM/TSP and 202 healthy carriers of HTLV-I in southern Japan showed that this outcome of HTLV-I infection and the HTLV-I provirus load are under polygenic control. Of 58 polymorphic sites studied in 39 non-HLA candidate gene loci, 3 new host genetic factors that influenced the risk of HAM/TSP or the provirus load of HTLV-I were identified. The promoter TNF -863A allele predisposed to HAM/TSP, whereas SDF-1 +801A 3'UTR, and IL-15 191C alleles conferred protection. Knowledge of HTLV-I-infected individuals' ages, sex, provirus load, HTLV-I subgroup, and genotypes at the loci HLA-A, HLA-C, SDF-1, and TNF-alpha allowed for the correct identification of 88% of cases of HAM/TSP in this Japanese cohort.
Collapse
Affiliation(s)
- Alison M Vine
- Department of Immunology, Imperial College Faculty of Medicine, St. Mary's Campus, London, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Abstract
HAM/TSP is a chronic inflammatory disease of the spinal cord. It is rather rare in HTLV-1-infected individuals. Immunogenetic factors of the HLA complex have been identified that support or prevent the development of the disease. In HAM/TSP patients a characteristic constellation of high proviral loads and increased cellular and humoral immune responses have been established. Immune dysfunction in HAM/TSP patients might be partly explained by HTLV-1 tax p40 transactivation of cellular genes in infected CD4+ T lymphocytes. The oligoclonal expansion of infected T lymphocytes, the variation of tax p40 within HTLV-1 carriers, and the regulation of proviral gene expression are possible determinants for disease development and need to be clarified in future studies.
Collapse
Affiliation(s)
- B Kitze
- Department of Neurology, Faculty of Medicine, University of Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | | |
Collapse
|
44
|
Wodarz D, Hall SE, Usuku K, Osame M, Ogg GS, McMichael AJ, Nowak MA, Bangham CR. Cytotoxic T-cell abundance and virus load in human immunodeficiency virus type 1 and human T-cell leukaemia virus type 1. Proc Biol Sci 2001; 268:1215-21. [PMID: 11410146 PMCID: PMC1088729 DOI: 10.1098/rspb.2001.1608] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [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: 11/12/2022] Open
Abstract
The correlation between virus load and specific cytotoxic T-lymphocyte (CTL) frequency during the chronic phase in human immunodeficiency virus type 1 (HIV-1) infection has been found to be negative in cross-sectional studies. We report here that, in infection with the related retrovirus human T-cell leukaemia virus type 1 (HTLV-1), the correlation is positive in asymptomatic carriers and zero in patients with the associated inflammatory disease HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). We demonstrate that the direction of the correlation may depend on the efficacy of the CTL response using mathematical models. We conclude that the CTL response is effective in asymptomatic carriers of HTLV-1, but ineffective in patients with HAM/TSP. Virus-mediated impairment of specific CTL production in HIV-1 infection can account for the negative correlation observed.
Collapse
Affiliation(s)
- D Wodarz
- Institute for Advanced Study, Einstein Drive, Princeton, NJ 08540, USA
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Matsuzaki T, Nakagawa M, Nagai M, Usuku K, Higuchi I, Arimura K, Kubota H, Izumo S, Akiba S, Osame M. HTLV-I proviral load correlates with progression of motor disability in HAM/TSP: analysis of 239 HAM/TSP patients including 64 patients followed up for 10 years. J Neurovirol 2001; 7:228-34. [PMID: 11517397 DOI: 10.1080/13550280152403272] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.9] [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: 10/16/2022]
Abstract
To clarify clinical and laboratory findings that may be related to the pathomechanism of HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP), we analyzed these findings in 239 patients with HAM/TSP, including 64 patients followed up for 10 years after their first examinations, with special interest in the HTLV-I proviral load in peripheral blood mononuclear cells (PBMCs). The proviral load in PBMCs did not differ in terms of modes of HTLV-I transmission. However, the proviral load in patients with age of disease onset greater than 65 years tended to be higher than those with a younger age of onset. In the 64 patients followed up for 10 years, the clinical symptoms deteriorated in 36 patients (56%), unchanged in 26 patients (41%), and improved in 2 patients (3%). HTLV-I proviral load also appeared to be related to the deterioration of motor disability in these patients. To our knowledge, the present study is the first longitudinal study concerning the relationship between the clinical course of HAM/TSP and HTLV-I proviral load. It is suggested that HTLV-I proviral load is related to the progression of motor disability and is an important factor to predict prognosis of patients with HAM/TSP.
Collapse
Affiliation(s)
- T Matsuzaki
- Third Department of Internal Medicine, Kagoshima University Faculty of Medicine, Sakuragaoka, Kagoshima City, Kagoshima, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Saito M, Taylor GP, Saito A, Furukawa Y, Usuku K, Weber JN, Osame M, Bangham CR. In vivo selection of T-cell receptor junctional region sequences by HLA-A2 human T-cell lymphotropic virus type 1 Tax11-19 peptide complexes. J Virol 2001; 75:1065-71. [PMID: 11134322 PMCID: PMC114005 DOI: 10.1128/jvi.75.2.1065-1071.2001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2000] [Accepted: 10/13/2000] [Indexed: 11/20/2022] Open
Abstract
Using HLA-peptide tetrameric complexes, we isolated human T-cell lymphotrophic virus type 1 Tax peptide-specific CD8(+) T cells ex vivo. Antigen-specific amino acid motifs were identified in the T-cell receptor Vbeta CDR3 region of clonally expanded CD8(+) T cells. This result directly confirms the importance of the CDR3 region in determining the antigen specificity in vivo.
Collapse
MESH Headings
- Amino Acid Motifs
- Amino Acid Sequence
- CD8-Positive T-Lymphocytes/immunology
- Complementarity Determining Regions/genetics
- Gene Products, tax/immunology
- Gene Products, tax/metabolism
- HLA-A2 Antigen/immunology
- HLA-A2 Antigen/metabolism
- HTLV-I Infections/immunology
- HTLV-I Infections/virology
- Human T-lymphotropic virus 1/immunology
- Humans
- Molecular Sequence Data
- Receptors, Antigen, T-Cell, alpha-beta/chemistry
- Receptors, Antigen, T-Cell, alpha-beta/genetics
- Receptors, Antigen, T-Cell, alpha-beta/metabolism
- Reverse Transcriptase Polymerase Chain Reaction
Collapse
Affiliation(s)
- M Saito
- Departments of Immunology, Imperial College School of Medicine, St. Mary's Campus, London W2 1PG, United Kingdom
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Jeffery KJ, Siddiqui AA, Bunce M, Lloyd AL, Vine AM, Witkover AD, Izumo S, Usuku K, Welsh KI, Osame M, Bangham CR. The influence of HLA class I alleles and heterozygosity on the outcome of human T cell lymphotropic virus type I infection. J Immunol 2000; 165:7278-84. [PMID: 11120862 DOI: 10.4049/jimmunol.165.12.7278] [Citation(s) in RCA: 162] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The inflammatory disease human T cell lymphotropic virus type I (HTLV-I)-associated myelopathy (HAM/TSP) occurs in only 1-2% of HTLV-I-infected individuals and is associated with a high provirus load of HTLV-I. We hypothesize that a person's risk of developing HAM/TSP depends upon the efficiency of their immune response to the virus, which differs between individuals because of polymorphism in genes that influence this response. Previously we showed that the possession of HLA-A*02 was associated with a lower risk of HAM/TSP, and with a lower provirus load in healthy carriers of HTLV-I. However, HLA-A*02 did not account for all the observed difference in the risk of HAM/TSP. Here we present evidence, in the same study population in Japan, that HLA-Cw*08 was also associated with disease protection (probability value, two-tailed test = 0.002) and with a lower proviral load in healthy carriers. Possession of the A*02 and/or Cw*08 genes prevented 36% of potential HAM/TSP cases. In contrast, HLA-B*5401 was associated with a higher susceptibility to HAM/TSP (probability value, two-tailed test = 0.0003) and with a higher provirus load in HAM/TSP patients. At a given provirus load, B*5401 appeared to increase the risk of disease. The fraction of HAM/TSP cases attributable to B*5401 was 17%. Furthermore, individuals who were heterozygous at all three HLA class I loci have a lower HTLV-I provirus load than those who were homozygous at one or more loci. These results are consistent with the proposal that a strong class I-restricted CTL response to HTLV-I reduces the proviral load and hence the risk of disease.
Collapse
Affiliation(s)
- K J Jeffery
- Department of Immunology, Imperial College School of Medicine, St. Mary's, London, United Kingdom
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Matsuzaki T, Nakagawa M, Nagai M, Nobuhara Y, Usuku K, Higuchi I, Takahashi K, Moritoyo T, Arimura K, Izumo S, Akiba S, Osame M. HTLV-I-associated myelopathy (HAM)/tropical spastic paraparesis (TSP) with amyotrophic lateral sclerosis-like manifestations. J Neurovirol 2000; 6:544-8. [PMID: 11175327 DOI: 10.3109/13550280009091955] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [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: 11/13/2022]
Abstract
To clarify the existence of HAM/TSP presenting amyotrophic lateral sclerosis (ALS)-like manifestations, we assayed HTLV-I proviral load in peripheral blood mononuclear cells (PBMC) in 15 patients with anti-HTLV-I antibody in serum and ALS-like manifestations (upper motor neuron involvement in at least one region and lower motor neuron involvement in at least two limbs) by quantitative PCR, and compared the proviral load with that of 233 HAM/TSP patients and of 213 HTLV-I carriers. Five of 15 patients with ALS-like manifestations had proviral loads as high as those in the 233 patients with HAM/TSP. Anti-HTLV-I antibody in cerebrospinal fluid (CSF) was present in all of five patients. The proviral load in the remaining 10 patients was similar to that in HTLV-I carriers. Four of five patients with a high proviral load met the diagnostic criterion of HAM/TSP except for lower motor neuron involvement. These four patients showed high neopterin levels in CSF. On the basis of HTLV-I proviral load in PBMC and the clinical symptoms, our tentative conclusion is that these four patients are HAM/TSP presenting ALS-like manifestations.
Collapse
Affiliation(s)
- T Matsuzaki
- Third Department of Internal Medicine, Kagoshima University Faculty of Medicine, Sakuragaoka 8-35-1, Kagoshima City, Kagoshima 890-8520, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Furukawa Y, Yamashita M, Usuku K, Izumo S, Nakagawa M, Osame M. Phylogenetic subgroups of human T cell lymphotropic virus (HTLV) type I in the tax gene and their association with different risks for HTLV-I-associated myelopathy/tropical spastic paraparesis. J Infect Dis 2000; 182:1343-9. [PMID: 11010842 DOI: 10.1086/315897] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2000] [Revised: 07/31/2000] [Indexed: 11/03/2022] Open
Abstract
The association between human T cell lymphotropic virus (HTLV) type I tax variation and disease outcome was studied. The tax gene was sequenced in 61 patients with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP), 55 patients with adult T cell leukemia, and 62 healthy carriers (HCs). Phylogenetic analysis revealed 2 tax gene subgroups that are related on the basis of the long terminal repeat sequence. Further analysis using restriction fragment length polymorphism in 192 patients with HAM/TSP and 200 HCs revealed a higher incidence of 1 tax subgroup (taxA) in HAM/TSP. taxA was present in 30 (15.5%) of 192 patients with HAM/TSP and in 14 (7%) of 200 HCs. The difference was significant (chi2=6.47; P=.014; odds ratio, 2.46; 95% confidence interval, 1.26-4.80). This effect was independent of HLA-A*02, which has been reported to prevent HAM/TSP development. These findings suggest that both host genetic factors and HTLV-I subgroup are associated with different risks for development of HAM/TSP.
Collapse
Affiliation(s)
- Y Furukawa
- Third Dept. of Internal Medicine, Faculty of Medicine, Kagoshima University, Kagoshima 890-8520, Japan.
| | | | | | | | | | | |
Collapse
|
50
|
Hanon E, Hall S, Taylor GP, Saito M, Davis R, Tanaka Y, Usuku K, Osame M, Weber JN, Bangham CR. Abundant tax protein expression in CD4+ T cells infected with human T-cell lymphotropic virus type I (HTLV-I) is prevented by cytotoxic T lymphocytes. Blood 2000; 95:1386-92. [PMID: 10666215] [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: 02/15/2023] Open
Abstract
The role of the cellular immune response in human T-cell leukemia virus type I (HTLV-I) infection is not fully understood. A persistently activated cytotoxic T lymphocyte (CTL) response to HTLV-I is found in the majority of infected individuals. However, it remains unclear whether this CTL response is protective or causes tissue damage. In addition, several observations paradoxically suggest that HTLV-I is transcriptionally silent in most infected cells and, therefore, not detectable by virus-specific CTLs. With the use of a new flow cytometric procedure, we show here that a high proportion of naturally infected CD4+ peripheral blood mononuclear cells (PBMC) (between 10% and 80%) are capable of expressing Tax, the immunodominant target antigen recognized by virus-specific CTLs. Furthermore, we provide direct evidence that autologous CD8+ T cells rapidly kill CD4+ cells naturally infected with HTLV-I and expressing Tax in vitro by a perforin-dependent mechanism. Consistent with these observations, we observed a significant negative correlation between the frequency of Tax(11-19)-specific CD8+ T cells and the percentage of CD4+ T cells in peripheral blood of patients infected with HTLV-I. Those results are in accordance with the view that virus-specific CTLs participate in a highly efficient immune surveillance mechanism that persistently destroys Tax-expressing HTLV-I-infected CD4+ T cells in vivo. (Blood. 2000;95:1386-1392)
Collapse
Affiliation(s)
- E Hanon
- Department of Immunology and Genito-Urinary Medicine and Communicable Diseases, Imperial College School of Medicine, St Mary's Campus, London, United Kingdom
| | | | | | | | | | | | | | | | | | | |
Collapse
|