AB0401 THE BASELINE SERUM SOLUBLE TNF RECEPTOR LEVELS ARE ASSOCIATED WITH THE RESPONSE OF RHEUMATOID ARTHRITIS PATIENTS TO JAKinibs

Background

Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily affects the multiple joints.

The elucidation of the pathogenesis of RA has progressed dramatically in recent decades, and among the many cytokines involved in the pathogenesis of RA, interleukin (IL)-6 and TNF-α are known to be the major pro-inflammatory cytokines that are abundant in the bloodstream and synovial tissue. JAK inhibitors (JAKinibs) such as tofacitinib and baricitinib are used in the treatment of RA by inhibiting JAK, which in turn inhibits the signaling of various cytokines including IL-6. However, predictors of the response to JAKinibs are still required.

Objectives

We aimed to combine soluble TNF receptor (sTNFR) I, sTNFR II, IL-6, soluble IL-6R (sIL-6R) and soluble gp130 (sgp130) levels to identify groups of JAKinibs responses in RA patients.

Methods

This research is a retrospective study. We reviewed medical records of RA patients initiating JAKinibs between July 2013 and July 2021 in our hospital. The Simplified Disease Activity Index (SDAI) was evaluated at baseline and 3, 6 months after JAKinibs administration. Clinical remission was defined when SDAI decreased ≤ 3.3. Of the 125 patients treated with JAKinibs, 89 patients with 6 months follow-up, valid SDAI and serum available were enrolled. Serum samples were tested for IL-6 (Human IL-6 Quantikine ELISA Kit, R&D systems), sIL-6R (Human soluble IL-6R alpha Quantikine ELISA Kit, R&D systems) and sgp130 (Human soluble gp130 Quantikine ELISA Kit, R&D systems), sTNFR I (Human TNF RI/TNFRSF1A Quantikine ELISA Kit DRT100) and sTNFR II (Human sTNF RII/TNFRSF1B Quantikine ELISA Kit DRT200) using specific ELISAs according to the manufacturer’s instructions. The statistical analyses were performed with EZR 1.55, and p values less than 0.05 were considered significant.

Results

The median age of patients was 62 (IQR: 51 - 72) years and the median of disease duration was 6.0 (2.0 - 16.0) years. Twenty-seven (30.3%) patients were biologics and Jakinibs naive. The baseline SDAI was median 18.9 (12.7 - 27.9). When comparing SDAI-remission group (clinical remission: CR) and non-remission group, there were no significant differences in any of the baseline clinical parameters. There was no significant difference in the serum levels of IL-6, sIL-6R and sgp130 between the CR and non-CR groups, but the serum levels of sTNFR I and sTNFR II in the CR group were significantly lower than non-CR group. Univariate logistic regression analysis suggested Biologics and JAKinibs naive (odds ratio (OR) 3.58, p = 0.015), baseline Log sTNFR II levels (OR 0.013, P=0.034) as predictors of SDAI remission treated with JAKinibs at 6 months. Although not significant, Stage IV (OR 0.211, P=0.082) and baseline Log sTNFR I serum levels (OR 0.013, P=0.065) were associated with clinical remission.

Conclusion

RA patients could be easily stratified prior to JAKinibs intervention with serum sTNFR II and sTNFR I levels, not but IL-6 axis cytokines (IL-6, sIL-6R and sgp130).

Univariate logistic regression analysis for clinical remission in patients treated with JAKinibs.　Odds Ratio[95% C.I.]P ValueAge, year0.973[0.942 - 1.010]0.104Female (%)0.820[0.231 - 2.910]0.759BMI0.968[0.847 - 1.110]0.627Duration, year0.952[0.897 - 1.010]0.110StageIreferrenceII0.857[0.218 - 3.370]0.825III0.444[0.072 - 2.740]0.382IV0.211[0.036 - 1.220]0.082Biologic/JAKi naïve3.580[1.280 - 9.950]0.015JAKi Drug-Baricitinibreferrence-Tofacitinib1.780[0.659 - 4.800]0.256MTX use1.640[0.532 - 5.30]0.390PSL use0.476[0.176 - 1.290]0.143SASP use0.783[0.268 - 2.290]0.654IGU use0.328[0.039 - 2.750]0.304BUC use0.436[0.051 - 3.760]0.450TAC use0.233[0.029 - 1.910]0.1750W IL-6, pg/mL0.991[0.977 - 1.000]0.1980W sIL-6R, ng/mL0.983[0.947 - 1.02]0.3690W sgp130, ng/mL0.998[0.994 - 1.000]0.4440W sTNFR II/I ratio0.808[0.222 - 2.940]0.7460W Log sTNFR II, pg/mL0.002[0.0000653 - 0.634]0.0340W Log sTNFR I, pg/mL0.013[0.000126 - 1.300]0.065

Disclosure of Interests

None declared

AB0362 NEUTROPHIL COUNT REDUCTION 1 MONTH AFTER INITIATING SARILUMAB AND BASELINE SERUM SOLUBLE gp130 LEVELS CAN INDEPENDENTLY PREDICT CLINICAL REMISSION WITHIN 3 MONTH IN RHEUMATOID ARTHRITIS PATIENTS

Background

IL-6 contributes significantly to the chronic inflammatory process of rheumatoid arthritis (RA) and is elevated in serum and synovial fluid of RA patients.

Sarilumab (SRL), a human anti-human IL-6 receptor alpha monoclonal antibody that blocks the signaling originated by the IL-6/IL-6R complex like tocilizumab (TCZ),is an effective treatment. Recently, an association between the therapeutic effect of TCZ and neutropenia after TCZ initiation was reported[1]. Neutropenia is a common adverse event of SRL in patients with RA, but the relationship between reduced neutrophil count and clinical response to SRL is still inconclusive. In EULAR 2020, we reported the association between serum soluble gp130 levels before SRL treatment and the efficacy of SRL[2]. It is also unclear whether there is a relationship between IL-6 axis cytokines and SRL-induced neutropenia.

Objectives

The purpose of this study was to determine whether neutropenia at 1 month by SRL predicts clinical remission within 3 months and whether there is an association between IL-6 axis cytokines levels and SRL-induced neutropenia.

Methods

This research is a retrospective study. We reviewed medical records of RA patients initiating SRL between February 2018 and August 2021 in our hospital. The Clinical Disease Activity Index (CDAI) was evaluated at baseline (before initiating SRL) and 3 months after administration. Clinical remission was defined when CDAI decreased ≤ 2.8. Of the 66 patients treated with SRL, 42 patients with 3 months follow-up, valid CDAI and serum available were enrolled. The ratio of neutrophil counts 1 month after initiating SRL to those at baseline (neutrophil ratio) was also calculated. Serum samples were tested for IL-6 (Human IL-6 Quantikine ELISA Kit, R&D systems), sIL-6R (Human soluble IL-6R alpha Quantikine ELISA Kit, R&D systems) and sgp130 (Human soluble gp130 Quantikine ELISA Kit, R&D systems) using specific ELISAs according to the manufacturer’s instructions. The statistical analyses were performed with EZR 1.55, and p values less than 0.05 were considered significant.

Results

The median age of patients was 69.0 (IQR: 59.3 - 73.8) years and the median of disease duration was 9.0 (3.0 - 16.0) years. Eighteen (42.9%) patients were biologics and Jakinibs naive. The baseline CDAI was median 16.7 (11.5 - 25.8). When comparing CDAI-remission group (clinical remission: CR) and non-CR group, Patients in the CR group had significantly shorter disease duration, were more Biologic and JAKinib naive, and had greater neutropenia 1 month after starting SRL (0.71 vs 0.94, P=0.0252). There was no significant difference in the baseline serum levels of IL-6, sIL-6R between the CR and non-CR groups, but baseline serum sgp130 levels in the CR group tended to be higher than in the non-CR group (264.9 vs 234.2 ng/mL, P=0.0592). Univariate logistic regression analysis suggested Biologics and JAKinibs naive (odds ratio (OR) 6.68, p = 0.0317), baseline serum sgp130 levels (OR 8.608, P=0.0312) as predictors of CDAI remission treated with SRL at 3 months. Although not significant, neutrophil ratio ≤ 0.8 was associated with achieving remission (OR 6.67, P=0.0537). Univariate logistic regression for neutrophil ratio ≤ 0.8 did not show any relevant factors, including higher baseline serum sgp130 levels (OR 1.25, P=0.782).

Conclusion

A 20% or greater decrease in neutrophil count after 1 month of SRL treatment and a high baseline serum sgp130 level independently predict clinical remission within 3 months.

References

[1]Nakajima T, Watanabe R, Hashimoto M, Murata K, Murakami K, Tanaka M, et al. Neutrophil count reduction 1 month after initiating tocilizumab can predict clinical remission within 1 year in rheumatoid arthritis patients. Rheumatol Int. 2021;1rin

[2]Yoshikawa T, Furukawa T, Tamura M, Hashimoto T, Morimoto M, Azuma N, et al. FRI0113 THE BASELINE SOLUBLE GP130 IS ASSOCIATED WITH THE RESPONSE OF RHEUMATOID ARTHRITIS PATIENTS TO SARILUMAB. Ann Rheum Dis. 2020;79(Suppl 1):637.1-637.

Disclosure of Interests

None declared

AB0422 SODIUM BICARBONATE MOUTH RINSE IS A USEFUL SELF-CARE METHOD FOR DRY MOUTH IN PATIENTS WITH SJÖGREN’S SYNDROME

Background

Patients with Sjögren’s syndrome (SS) present various symptoms related to dry mouth. While hyposalivation is believed to be the main cause, saliva has various beneficial physiological effects on the intraoral environment, and qualitative changes in its composition should also be considered as a cause of the refractory intraoral manifestations in SS. One of the physiological effects of saliva is buffering, and salivary bicarbonate (HCO3-) is the main determinant of salivary buffering capacity. Since salivary concentration of bicarbonate heavily depends on the rate of salivary secretion, salivary buffering capacity and oral pH decrease in patients with dry mouth; this is associated with the development of dental caries and oral candidiasis. It is considered that sodium bicarbonate mouth rinse is effective for suppressing these intraoral disorders. It is also a practical self-care method because it is inexpensive and can be made at home.

Objectives

To investigate the usability and changes in symptoms associated with dry mouth after use of sodium bicarbonate mouth rinse in SS patients.

Methods

The subjects were 27 SS patients (female: male =24:3, mean age 62.9 years, primary SS: secondary SS =24:3, mean disease duration 12.3 years) who had used sodium bicarbonate mouth rinse (dissolve about 5 g of commercially available baking soda in 500 cc of water in a plastic bottle. Put this sodium bicarbonate water in the mouth and rinse the mouth for 30 seconds to 1 minute so as to reach throughout the oral cavity). We investigated usage status, usability, and changes in subjective symptoms using a questionnaire. During their using the mouth rinse, medication and countermeasures against dry mouth in the daily life continued as usual.

Results

More than half of the patients had no knowledge of sodium bicarbonate mouth rinse (n=15; 55.6%). Highest frequency of use was twice a day (n=9; 33.3%), and common use situations were before bedtime (n=18; 66.7%), after meals (n=17; 63.0%), and at waking up (n=11; 40.7%). Twenty patients (74.1%) had “very good” or “good” sense of use. Eighteen patients (66.7%) had relief of symptoms related to dry mouth. Pros were “feeling refreshed in the mouth” (n=14; 51.9%), followed by “becomes less sticky” (n=8; 29.6%), “easy to make” (n=7; 25.9%), and “inexpensive” (n=6; 22.2%). Some respondents said they had less glossitis, stomatitis, and angular cheilitis (n=4; 14.8%). For cons “troublesome” was the highest (n=10; 37.0%), followed by responses regarding “taste” (n=6; 22.2%). There were also many responses to “none in particular” (n=7; 25.9%). No obvious accidents occurred, and 20 (74.1%) of them replied that they would like to continue to use the sodium bicarbonate mouth rinse.

Conclusion

In addition to the inhibition of dental caries and oral candidiasis, removal of tongue plaque and refreshing feeling in the mouth after rinsing due to its mucolytic effect, reduction of halitosis-causing volatile sulfur compounds, and improvement of gingivitis have been reported as effects of sodium bicarbonate. However, reports on the effects of sodium bicarbonate on dry mouth in SS patients are scarce. These results suggest that sodium bicarbonate mouth rinse is considered to be a useful self-care method that can compensate for the salivary buffering capacity that is impaired in SS patients and may reduce dry mouth symptoms. Since it is easy to continue and safe, it is worth actively incorporating it into the standard treatment for SS. Evaluation in more patients with objective indices is desired in the future.

References

[1]Gambino A, et al. Gerodontology. 34: 208-214, 2017.

Disclosure of Interests

None declared

AB0311 INCREASED LEVELS OF SERUM WISTERIA FLORIBUNDA AGGLUTININPOSITIVE MAC-2 BINDING PROTEIN IN RHEUMATIC DISEASES INCLUDING SLE

Background:

Mac-2 binding protein is a cell-adhesive glycoprotein of the extracellular matrix secreted as a ligand of galectin-3 (Mac-2). Recently, a Wisteria floribunda agglutinin positive-M2BP (M2BP) assay developed using a lectin-antibody sandwich immunoassay has shown promise as a new fibrotic marker in liver fibrosis and interstitial lung disease (ILD) to detect unique fibrosis-related glycoalteration.

Objectives:

The aim of this study is to evaluate the utility of serum Mac-2 binding protein glycosylation isomer (M2BPGi) levels in patients with rheumatic diseases (RD).

Methods:

We retrospectively measured serum M2BPGi levels in 68 patients with RD and 16 healthy controls (HC). There were no patients of cirrhosis and active hepatitis. Serum levels of M2BPGi were measured using HISCL M2BP glycosylation isomer Assay Kit. We examined the relationship between serum M2BPGi levels and clinical parameters in patients with RD.

Results:

In patients with RD, the median age was 62.0 years and 79.4% of them were female.

Serum M2BPGi levels were significantly higher in patients with RD than in HC (median 0.98 cutoff index [COI], 0.32 COI, respectively; P < 0.00001). Patients with SLE tended to have higher serum M2BPGi levels than other rheumatic diseases.

In patients with RD, a significant correlation was not found between serum M2BP levels and inflammation markers such as CRP or ferritin. However, serum M2BPGi levels were significantly correlated with B cell activation markers such as immunoglobulin free light chain and IgG (r = 0.588, 0.504) and T cell activation marker such as sIL-2R (r = 0.408).

Conclusion:

Most of the rheumatic diseases in this study were considered to be type I interferonopathy diseases such as rheumatoid arthritis, Sjogren’s syndrome, inflammatory myositis, scleroderma and SLE.

Serum M2BPGi was reported to have a significant correlation with SLE disease activity [SS Ahn et al. Lupus. 2018; 27: 771], and also to have a significant correlation with Gakectin-9, a novel biomarker for IFN signiture [Lucas L van den Hoogen et al. Ann Rheum Dis. 2018; 77: 1810].

So, it was suggested that serum M2BPGi may be a novel biomarker that indirectly indicates how much IFN is activated in rheumatic diseases.

Disclosure of Interests:

None declared

Nationwide study of surgery for primary infected abdominal aortic and common iliac artery aneurysms

BACKGROUND

Primary infected aneurysms of the abdominal aorta and iliac arteries are potentially life-threatening. However, because of the rarity of the disease, its pathogenesis and optimal treatment strategy remain poorly defined.

METHODS

A nationwide retrospective cohort study investigated patients who underwent surgical treatment for a primary infected abdominal aortic and/or common iliac artery (CIA) aneurysm between 2011 and 2017 using a Japanese clinical registry. The study evaluated the relationships between preoperative factors and postoperative outcomes including 90-day and 3-year mortality, and persistent or recurrent aneurysm-related infection. Propensity score matching was used to compare survival between patients who underwent in situ prosthetic grafting and those who had endovascular aneurysm repair (EVAR).

RESULTS

Some 862 patients were included in the analysis. Preceding infection was identified in 30.2 per cent of the patients. The median duration of postoperative follow-up was 639 days. Cumulative overall survival rates at 30 days, 90 days, 1 year, 3 years and 5 years were 94.0, 89.7, 82.6, 74.9 and 68.5 per cent respectively. Age, preoperative shock and hypoalbuminaemia were independently associated with short-term and late mortality. Compared with open repair, EVAR was more closely associated with persistent or recurrent aneurysm-related infection (odds ratio 2.76, 95 per cent c.i. 1.67 to 4.58; P < 0.001). Propensity score-matched analyses demonstrated no significant differences between EVAR and in situ graft replacement in terms of 3-year all-cause and aorta-related mortality rates (P = 0.093 and P =0.472 respectively).

CONCLUSION

In patients undergoing surgical intervention for primary infected abdominal aortic and CIA aneursyms, postoperative survival rates were encouraging. Eradication of infection following EVAR appeared less likely than with open repair, but survival rates were similar in matched patients between EVAR and in situ graft replacement.

FRI0227 A USABILITY SURVEY OF WRIST MOUNTED DISPOSABLE HEAT PAD ON RAYNAUD’S PHENOMENON IN PATIENTS WITH CONNECTIVE TISSUE DISEASES

Background:

For patients with connective tissue diseases (CTD), vasodilators are used to treat Raynaud’s phenomenon (RP), they are difficult to control only by medication. Although physicians recommend the use of a portable handwarmer or gloves to patients with CTD presenting with RP, sustained heat-retention effects cannot be obtained from them because the patients’ daily life-related activities prevent their continued use. Since the wrist mounted disposable heat pad maintains the degrees of freedom of the hands and fingers and can remain usable during the daily activities, we considered this heat pad as a useful and highly practical heating method for CTD patients presenting with RP.

Objectives:

To investigate the usability and changes in symptoms resulting from the use of the wrist mounted disposable heat pad in CTD patients presenting with RP.

Methods:

Subjects were 23 outpatients with CTD presenting with RP (23 females; mean age 62.6 years; mean duration following the onset of RP 10.3 years; 12 systemic sclerosis, 5 mixed connective tissue disease, 5 Sjögren’s syndrome, and 1 systemic lupus erythematosus) who had used the wrist mounted disposable heat pad (put the pad in a specifically designed holder and wrap it around wrist joint (max. temperature 42 degrees Celsius, heat-retention time 6 hours)). We investigated through interviews with them the use situations, usability, and changes in RP. During their using the heat pad, medication and daily life-related precautions against RP continued to be implemented as before.

Results:

Many patients had no knowledge of the heat pad (n=17, 73.9%). The most common wearing time of the heat pad was 5–6 hours (n=8, 34.8%). As for scenes of wearing the heat pad, patients who wore the pad when being out of the home accounted for the highest proportion (n=16, 69.6%), and as follows: at home (n=6, 26.1%), during kitchen work (n=3, 13.0%), and during housework (n=2, 8.7%). 17 patients (73.9%) replied that usability was “good”, and 18 (78.3%) replied that usability was “better” compared with conventional measures. Moreover, many patients (n=16, 69.6%) replied that RP and associated symptoms had become reduced or alleviated. No patients replied that RP and associated symptoms had become exacerbated or severer. In terms of advantages of using the heat pad, patients who replied that the site on which the pad was mounted was felt to be warm accounted for the highest proportion (n=8, 34.8%), and those who replied that sites other than where the pad was mounted (such as fingertips, hands, and arms) were also warmed accounted for virtually the same proportion (n=7, 30.4%). Over 60% of the patients (n=14, 60.9%) replied that symptoms associated with RP (skin color, cold sensation, and pain) had become reduced or disappeared. In terms of disadvantages of using the heat pad, patients who replied that it was bothersome to use the pad accounted for the highest proportion while other patients made replies referring to cost and bad appearance. No significant accident occurred and as many as 17 patients (73.9%) replied that they would like to continue to use the heat pad in the future.

Conclusion:

There have been few reports evaluating the usefulness of a heat pad for RP. The wrist mounted disposable heat pad was thought to be a heating method having the potential to achieve high levels of usability and practicality on CTD patients presenting with RP. Given that the heat pad alleviated RP or caused sites other than where the pad was mounted to be felt warm even though it did not directly heat the hands and fingers, the pad seemed to have usefulness attributed to the heating of the wrist. Although the heat pad seems to be an excellent method for addressing RP in patients’ daily lives, we hope that this heat pad will be evaluated on a larger number of patients with the addition of objective indices.

References:

[1]Koscheyev VS, et al. Aviat Space Environ Med. 72: 713-719, 2001.

Disclosure of Interests:

Naoto Azuma: None declared, Tetsuya Furukawa: None declared, Yoshihito Shima Grant/research support from: Endowed chair funded by/accepted a researcher from Kirikai Chemical and Kobayashi Pharmaceutical., Kiyoshi Matsui Grant/research support from: Asahi Kasei Pharma, Astellas Pharma (research grants), Speakers bureau: Bristol-Myers Squibb (lecture fees)

FRI0113 THE BASELINE SOLUBLE GP130 IS ASSOCIATED WITH THE RESPONSE OF RHEUMATOID ARTHRITIS PATIENTS TO SARILUMAB

Background:

IL-6 contributes significantly to the chronic inflammatory process of rheumatoid arthritis (RA). Sarilumab (SRL), a human anti-human IL-6 receptor alpha monoclonal antibody that blocks the signaling originated by the IL-6/IL-6R complex like tocilizumab,is an effective treatment. However, predictors of the response to sarilumab are still required.

Objectives:

We aimed to combine IL-6, soluble IL-6R (sIL-6R) and gp130 (sgp130) levels to identify groups of sarilumab responses.

Methods:

This research is a retrospective study. a total of 32 RA patients with SRL therapy in our department from February 1 in 2018 to December 31 in 2019 were included. Serum and clinical data from 32 RA patients were collected before treatment and until the last visit. Follow-up period was up to one year after starting SRL treatment. Serum were tested for IL-6 (Human IL-6 Quantikine ELISA Kit, R&D systems), sIL-6R (Human soluble IL-6R alpha Quantikine ELISA Kit, R&D systems) and sgp130 (Human soluble gp130 Quantikine ELISA Kit, R&D systems), using specific ELISAs according to the manufacturer’s instructions. Hierarchical cluster analysis (JMP14.3.0) was used to establish the relationship between IL-6, sIL-6R and sgp130. We evaluated the efficacy of SRL treatment on the last visit using European League Against Rheumatism (EULAR) response criteria in the groups of patients. The other statistical analyses were performed with EZR 1.41, and p Values less than 0.05 were considered significant.

Results:

The median age of patients was 70.5 (IQR: 66.5-74.3) years and the median of disease duration was 7.3 (1.7-15.3) years. Nine (28.1%) patients were biologics and Jakinibs naive. the median follow-up periods were 24 (12-26) weeks. The baseline DAS28 was median 4.39 (3.77 - 5.43), and CDAI was 21.1 (11.7-29.5). When comparing responders and non-responders, there were no significant differences in any of the baseline parameters and cytokines. Four statistical significant clusters of RA patients (i.e., Group1, Group2, Group3 and tocilizumab use group before SRL) were defined by serum concentrations of IL-6, sIL-6R and spg130 at baseline. The levels of IL-6 expressed as median in Group1 patients were 25.6 (14.4–72.2) pg/ml, in Group2 5.9 (3.3–11.3) pg/ml, and in Group3 70.2 (45.4–86.1) pg/ml (p < 0.002, significant difference only between Group2 and Group3). The levels of sIL-6R expressed as median in Group1 patients were 38.7 (34.7-45.1) ng/ml, in Group2 35.1 (24.8-41.9) ng/ml, and in Group3 35.7 (34.2-39.8) ng/ml (p = 0.5477). The levels of sgp130 expressed as median in Group1 patients were 272.6 (263.0-277.2) ng/ml, in Group2 223.1 (221.0-228.0) ng/ml, and in Group3 204.6 (192.0-207.6) ng/ml (p < 0.00003, significant difference between the three groups respectively). There were no significant differences in any of the baseline clinical features and laboratory findings between the three groups. Out of the 8 patients in Group1 had a good or moderate response to SRL. Conversely, the percentage of patients with no response to SRL was higher in Group3 than in Group1 and Group2.

Conclusion:

RA patients could be easily stratified prior to the rapeutic intervention with sgp130 related to the IL-6 signal reguration. Group1 patients, who had the best response to SRL, had the highest level of sgp130.

Table 1.

Comparison of baseline serum IL-6, sIL-6R and sgp130 of each groups of patients

TCZ use before SRLGroup 1Group 2Group 3P valuen=3N=9N=8N=9IL-6,pg/mL69.8,77.6,592.6Median[IQR]25.6[14.4-72.2]5.9[3.3-11.3]70.2[45.4-86.1]<0.002csIL-6R,ng/mL390.5,413.2,481.7Median[IQR]38.7[34.7-45.1]35.1[24.8-41.9]35.7[34.2-39.8]0.547sgp130,ng/mL205.6,219.2,239.8Median[IQR]273[263-277]223[221-228]205[192-208]<0.001abc

*a, b and c mean that statically significant difference between subgroups as a: group1 vs. 2, b: group 1 vs. 3, c: group 2 vs. 3.

Disclosure of Interests:

Takahiro Yoshikawa: None declared, Tetsuya Furukawa: None declared, Masao Tamura: None declared, Teppei Hashimoto: None declared, Mai Morimoto: None declared, Naoto Azuma: None declared, Kiyoshi Matsui Grant/research support from: Asahi Kasei Pharma, Astellas Pharma (research grants), Speakers bureau: Bristol-Myers Squibb (lecture fees)

A New Treatment for Dialysis-Related Amyloidosis with β 2-Microglobulin Adsorbent Column

Dialysis-related amyloidosis (DRA) is characterized by the presence of β 2-microglobulin (β 2-m) in the plasma. In order to eliminate β 2-m from the circulating blood, the β 2-m selective adsorbent for direct hemoperfusion (DHP) was developed. A DHP column (BM-01), containing 350 ml of the adsorbent, was subjected to clinical trials. The column was connected with a PAN (AN69) membrane dialyzer in series and used 3 times a week for 1 week (11 patients), 4 weeks (5 patients), 6 months (1 patient) and 12 months (2 patients). The percent reduction (%) of β 2-m was for 16 patients (for 1 or 4 weeks), more than 65, and for 3 patients (for more than 6 months), 76.5 ± 4.9, 73.5 ± 5.7, 72.2 ± 6.2. At the end of each session, β 2-m plasma levels were found to be below 10 mg/L, with 3.4 mg/L being the lowest. The total amounts of β 2-m removed were 172.5 ± 22.3, 257.0 ± 75.6, 157.6 ± 32.2 and 429.8 mg/session at max. Two out of these three patients had a favorable effect on joint symptoms and ocular fundus. It can be concluded that this selective adsorption therapy may delay the progression of DRA, and is worth considering for wide application.

Impairment of host resistance to helminthes with age in murine small intestine

Age-associated alterations of Th2 immune responses against nematode parasites are largely unknown. We investigated primary and memory responses against two types of gastrointestinal nematode parasites, Heligmosomoides polygyrus (Hp) and Nippostrongylus brasiliensis (Nb), in aged mice. The small intestinal gene expression of Th2 cytokines was almost unchanged after primary (Nb and Hp) and secondary infection (Hp) in aged mice in contrast to strongly increased small intestinal gene expression of Th2 cytokines in young (3-month-old) mice. Mucus production decreased (Nb), and worm expulsion was impaired (Nb and Hp) compared with the young mice. Immunofluorescent staining revealed that after Hp infection, the number of alternatively activated macrophages, which are induced by Th2 cytokines, was lower in the aged mice. On the other hand, the number of CD4(+) T cells recruited to the worm cysts was normal compared with the young mice. These results suggest that migration of CD4(+) T cells to the host-parasite interface is not affected by ageing. Alterations in Th2 immune responses in aged mice might be due to inappropriate or insufficient activation of CD4(+) T cells in the submucosa.

Factors related to postoperative delirium in patients with lower limb ischaemia: a prospective cohort study

OBJECTIVES

To preoperatively determine candidates at definitive risk of postoperative delirium (POD), we identified relevant factors in patients with arteriosclerosis obliterans who underwent bypass surgery.

DESIGN

A prospective cohort study.

PATIENTS AND METHODS

299 patients (age ≥ 60 years) who underwent bypasses in 1995-2006 were enrolled. Cognitive impairment was assessed by the Revised Hasegawa Dementia Scale, the Confusion Assessment Method was also used, and severity was graded as Grade I-III (mild to severe) based on the Delirium Rating Scale. All patients were followed for 3 years.

RESULTS

POD occurred in 88 patients (29%), with a median age of 75 (10) years (IQR). Onset was 2 (1) days postoperatively, and a duration of 2 (2) days was observed. POD was hyperactive in 89% and was Grade I, II, and III in 11%, 68%, and 21% respectively. Multiple logistic regression analysis identified the following risk factors for POD: age ≥ 72 years (<0.0001), end-stage renal failure (0.001), multiple occlusive lesions (<0.0001), cognitive impairment (0.003), and critical limb ischaemia (0.034). The 3-year survival rate was similar when comparing POD and non-POD patients (84% vs. 88%, NS).

CONCLUSIONS

This study identified 5 risk factors for POD in patients undergoing bypasses for limb ischaemia. Long-term outcomes were similar when comparing the patients who experienced POD with those who did not.

Isolation and characterization of polymorphic microsatellite markers in the red snow crab (Chionoecetes japonicus)

A total of 12 polymorphic microsatellite DNA loci were isolated from the red snow crab, Chionoecetes japonicus (Brachyura: Majidae), one of important fisheries resources in the Far East. The number of alleles observed at each locus ranged from two to 19, with the observed and expected heterozygosities of 0.125-0.875 and 0.156-0.949, respectively, suggesting these loci to be a useful molecular marker for population analysis in this species. Of the 12 loci, seven also were available for genotyping of the snow crab, Chionoecetes opilio, implying these loci as a useful molecular marker in the genus Chionoecetes.

[Vacuum-assisted wound closure in the management of deep sternal wound infection]

We herein present a case who underwent vacuum-assisted wound closure (VAC) therapy for post-sternotomy mediastinitis. A 71-year-old female with chronic renal failure on dialysis underwent a graft replacement of the ascending aortic aorta for the treatment of an acute aortic dissection. After she was discharged from the hospital, a purulent discharge was noted to occur from the median sternal wound. The wound was therefore reopened and all sternal wires were removed. Thereafter, polyurethane foam which was shaped to fit the defect was placed within the cavity. The area was covered with adhesive drape and suction drainage was carried out at -100 mmHg. The polyurethane foam was replaced every few days. The wound was finally closed using a muscle flap at 49 days after surgery. VAC therapy is therefore considered to be a useful treatment modality for deep sternal wound infections.

Effect on vein graft intimal hyperplasia of nuclear factor-kB decoy transfection using the second generation of HVJ vector

AIM

Vein graft stenosis due to intimal hyperplasia (IH) is the main cause of graft failure. We examined possibilities of nuclear factor-kB (NF-kB) expression in vein grafts, and inhibitive effects of NF-kB decoy on the gene expression and subsequent vein graft IH.

METHODS

Fifteen mongrel dogs underwent femoral artery replacement with autogenous vein grafts. Group I: grafts were retrieved at a predetermined time and subjected to NF-kB binding activity assay; Groups II and III: grafts were transfected with scrambled (II-a, III-a) or NF-kB (II-b, III-b) decoy using hemagglutinating virus of Japan envelope before implantation. Grafts were retrieved 7 days after implantation for evaluation of intercellular adhesion molecule-1 (ICAM-1) mRNA expression (Group II) and 4 weeks after implantation for comparison of IH by morphometric analysis (Group III).

RESULTS

NF-kB binding activity was increased in a time-dependent manner, with a peak 2 days after implantation. The ratio between ICAM-1 and glyceraldehyde-3-phosphate dehydrogenase mRNA expression in II-b was significantly lower than that in II-a (0.347 +/- 0.07 versus 0.612+/-0.08; P = 0.047). The ratio of intimal cross-section area to luminal cross-section area of III-b was significantly lower than that of the III-a (0.096+/-0.03 versus 0.461+/-0.11; P = 0.048).

CONCLUSION

NF-kB binding activity in vein grafts increases after implantation, and transfection of NF-kB decoy before implantation may reduce IH through the inhibition of ICAM-1 expression.

Effect of paroxetine on marble-burying behavior in mice

The present study was undertaken to investigate the effect of paroxetine, a selective serotonin reuptake inhibitor (SSRI), on marble-burying behavior in mice in comparison with those of fluvoxamine and clomipramine. Marble-burying test is extensively used as an animal model for obsessive/compulsive disorder. A significant inhibition in marble-burying behavior was observed with paroxetine, at a dose of 10 mg/kg. The earlier SSRI, fluvoxamine, also significantly inhibited marble-burying behavior at a dose of 30 mg/kg. Although clomipramine, a tricyclic antidepressant, caused an inhibition in marble-burying behavior, a high dose of 100 mg/kg was needed to show a significant effect. On the other hand, all the drugs used in the present study showed no significant changes in spontaneous locomotor activity at doses inhibiting marble-burying behavior. In conclusion, it was confirmed that paroxetine has a potent inhibitory effect on marble-burying behavior in mice, and could have a similar antiobsessive/anticompulsive activity in human beings.

High-resolution record of Northern Hemisphere climate extending into the last interglacial period

Two deep ice cores from central Greenland, drilled in the 1990s, have played a key role in climate reconstructions of the Northern Hemisphere, but the oldest sections of the cores were disturbed in chronology owing to ice folding near the bedrock. Here we present an undisturbed climate record from a North Greenland ice core, which extends back to 123,000 years before the present, within the last interglacial period. The oxygen isotopes in the ice imply that climate was stable during the last interglacial period, with temperatures 5 degrees C warmer than today. We find unexpectedly large temperature differences between our new record from northern Greenland and the undisturbed sections of the cores from central Greenland, suggesting that the extent of ice in the Northern Hemisphere modulated the latitudinal temperature gradients in Greenland. This record shows a slow decline in temperatures that marked the initiation of the last glacial period. Our record reveals a hitherto unrecognized warm period initiated by an abrupt climate warming about 115,000 years ago, before glacial conditions were fully developed. This event does not appear to have an immediate Antarctic counterpart, suggesting that the climate see-saw between the hemispheres (which dominated the last glacial period) was not operating at this time.

Venous blood flow through vein grafts before harvesting minimizes endothelial cell desquamation immediately after implantation

AIM

The aim of this paper was to examine effectiveness of maintaining venous blood flow through dissected, but not harvested, grafts on prostaglandin I2 production and endothelial cell regeneration after implantation.

METHODS

Using 10 dogs, 8-cm-long bilateral jugular veins were dissected; 1 was harvested, and immersed in heparinized blood for 60 or 120 min. The other was left in situ with retained blood flow until harvest after 60 or 120 min. Two 1-cm-long specimens were obtained from these 4 graft types and subjected to PGI2 assay or silver nitrate staining for measurement of endothelial cell coverage area. The remaining 6-cm portions of the 120-min grafts were autogenously implanted into the abdominal aorta, retrieved after 7 days and assayed and measured.

RESULTS

Comparisons between groups suggested beneficial effects of preserving venous blood flow until implantation on endothelial coverage and PGI2 production (p<0.05).

CONCLUSION

Venous blood flow through dissected vein grafts effectively helps preserve PGI2 production.

Molecular Paramagnetic Semiconductor: Crystal Structures and Magnetic and Conducting Properties of the Ni(dmit)2 Salts of 6-Oxoverdazyl Radical Cations (dmit = 1,3-Dithiol-2-thione-4,5-dithiolate)

Four kinds of 1:1 and 1:3 salts of 3-[4-(trimethylammonio)phenyl]-1,5-diphenyl-6-oxoverdazyl radical cation ([1](+)) and its mono- and dimethyl derivatives ([2](+) and [3](+)) with Ni(dmit)(2) anions (dmit = 1,3-dithiol-2-thione-4,5-dithiolate) ([1](+)[Ni(dmit)(2)](-) (4), [2](+)[Ni(dmit)(2)](-) (5), [3](+)[Ni(dmit)(2)](-) (6), and [1](+)[Ni(dmit)(2)](3)(-) (7)) have been prepared, and the magnetic susceptibilities (chi(M)) have been measured between 1.8 and 300 K. The chi(M) values of salts 5 and 7 can be well reproduced by the sum of the contributions from (i). a Curie-Weiss system with a Curie constant of 0.376 (K emu)/mol and negative Weiss constants (THETAV;) of -0.4 and -1.7 K and (ii). a dimer system with strong negative exchange interactions of 2J/k(B) = -354 and -258 K, respectively. The dimer formations in Ni(dmit)(2) anions have been ascertained by the crystal structure analyses of salts 4-6. In salts 4 and 6, Ni(dmit)(2) dimer molecules are sandwiched between two verdazyl cations, indicating the formation of a linear tetramer in 4 and 6. The magnetic susceptibility data for salts 4 and 6 have been fitted to a linear tetramer model using an end exchange interaction of 2J(1)/k(B) = -600 K and a central interaction of 2J(2)/k(B) = -280 K for 4 and 2J(1)/k(B) = -30 K and 2J(2)/k(B) = -580 K for 6, respectively. The results of the temperature dependence of the g(T) value in salts 4-6 obtained by ESR measurement also support the above analyses. The 1:1 salts 4-6 are insulators. On the other hand, the conductivity of the 1:3 salt 7 at 20 degrees C was sigma = 0.10 S cm(-)(1) with an activation energy E(A) = 0.099 eV, showing the semiconductor property. Salt 7 is a new molecular paramagnetic semiconductor.

Activation mechanism and physiological roles of stress-activated protein kinase/c-Jun NH2-terminal kinase in mammalian cells

Stress-activated protein kinase/c-Jun NH2-terminal kinase (SAPK/JNK), which belongs to the family of mitogen-activated protein kinase (MAPK), is activated by many types of cellular stress or extracellular signals. Recent studies, including the analysis with knockout cells and mice, have led towards understanding the molecular mechanism of stress-induced SAPK/JNK activation and the physiological roles of SAPK/JNK in embryonic development and immune responses. Two SAPK/JNK activators, SEK1 and MKK7, are required for full activation of SAPK/JNK, which responds to various stimuli in an all-or-none manner in mouse embryonic stem (ES) cells. SAPK/JNK activation plays essential roles in organogenesis during mouse development by regulating cell proliferation, survival or apoptosis and in immune responses by regulating cytokine gene expression. Furthermore, SAPK/JNK is involved in regulation of mRNA stabilization, cell migration, and cytoskeletal integrity. Thus, SAPK/JNK has a wide range of functions in mammalian cells.

Development, principles, and applications of automated ice fabric analyzers

We review the recent development of automated techniques to determine the fabric and texture of polycrystalline ice. The motivation for the study of ice fabric is first outlined. After a brief introduction to the relevant optical concepts, the classic manual technique for fabric measurement is described, along with early attempts at partial automation. Then, the general principles behind fully automated techniques are discussed. We describe in some detail the similarities and differences of the three modern instruments recently developed for ice fabric studies. Next, we discuss briefly X-ray, radar, and acoustic techniques for ice fabric characterization. We also discuss the principles behind automated optical techniques to measure fabric in quartz rock samples. Finally, examples of new applications that have been facilitated by the development of the ice fabric instruments are presented.

[Acute pulmonary embolism performed embolectomy under percutaneous cardiopulmonary support successfully after lung cancer operation]

We have experienced a case of acute pulmonary embolism after lung cancer operation. The case was a 74-year-old male. He underwent left upper lobectomy due to squamous cell carcinoma. He fell into shock state suddenly on the 6th day postoperatively. We diagnosted acute pulmonary embolism, performed urgent embolectomy under percutaneous cardiopulmonary support (PCPS). Postoperative course was smooth, and he has returned to normal daily life. Urgent diagnosis and management are indispensable for acute pulmonary embolism after lung cancer operation from the aspect of residual among of pulmonary vascular bed.

Effects of [Arg8]-vasopressin on regional cerebral blood flow in spontaneously hypertensive rats

The effects of [Arg(8)]-vasopressin (AVP) and related compounds on regional cerebral blood flow (rCBF) in the hippocampus were studied using conscious spontaneously hypertensive rats (SHR). rCBF in the hippocampus decreased gradually with age in proportion to an increase in mean blood pressure. Subcutaneous injection of AVP caused a dose-dependent increase in rCBF in the hippocampus. The effects of the metabolic fragments AVP4-9 and AVP4-8 on rCBF were relatively weak. OPC-31260, a vasopressin V(2) antagonist, antagonized the AVP-induced increase in rCBF in the hippocampus. Furthermore, subcutaneous injection of DDAVP, a V(2) agonist, increased rCBF in the hippocampus. On the other hand, the AVP-induced increase in rCBF in the hippocampus was not antagonized by OPC-21268, a vasopressin V(1) antagonist. Intracerebroventricular injection of AVP caused no significant changes in rCBF in the hippocampus, even at a dose of 10 ng/site.

Phenotype of cytochrome P4501B1 gene (CYP1B1) mutations in Japanese patients with primary congenital glaucoma

AIM

To investigate the phenotypes associated with cytochrome P4501B1 gene (CYP1B1) mutations in Japanese patients with primary congenital glaucoma (PCG).

METHODS

66 Japanese patients with PCG were screened for sequence mutations in the CYP1B1 gene using single strand conformation polymorphism analysis followed by automated DNA sequencing. 11 cases had a CYP1B1 mutation in both alleles (the mutation group) and 21 cases did not have a CYP1B1 mutation (the "no mutation" group). The clinical features, such as age of onset, sex, intraocular pressure, and Descemet's membrane rupture, of the two groups were compared.

RESULTS

The clinical symptoms and signs did not differ for the two groups. The mean age at onset was 1.7 months in the mutation group and 3.1 months in the no mutation group, and the male:female ratio was 6:5 in the mutation group and 19:2 in the no mutation group. Both of these differences were statistically significant.

CONCLUSIONS

In clinically diagnosed cases of PCG, a subgroup shows a CYP1B1 gene mutation. Age at onset was earlier in PCG patients with CYP1B1 mutations than in patients without mutations. Women were more prevalent among patients with mutations than those without mutations.

Long-term normalization in the central nervous system, ocular manifestations, and skeletal deformities by a single systemic adenovirus injection into neonatal mice with mucopolysaccharidosis VII

Systemic injection of an adenovirus vector into adult mice resulted in pathological improvements in multiple visceral organs of mice with mucopolysaccharidosis VII; however, no therapeutic efficacy was observed for mental retardation, skeletal deformities, corneal clouding, and retinal degeneration. In this study, an adenovirus vector expressing human beta-glucuronidase was injected into mice with mucopolysaccharidosis VII within 24 h of birth, and therapeutic efficacy was evaluated. In the brains of the mice, more than 20% of GUSB activity was maintained for at least 20 weeks after birth, and histopathological analysis showed no obvious lysosomal storage. Furthermore, no vacuolated cells were detected in corneal stroma and retinal pigment epithelium in the eyes of the mice treated in the neonatal period, while pathological improvement was not observed in adult MPSVII mice that received similar treatments. The treated mice also lacked characteristic facial skeletal deformities, and radiographic analysis demonstrated that their facial and cranial bones were morphologically normal. These results indicate that a single systemic adenovirus injection in the neonatal period could prevent the progression of mental retardation, corneal clouding, retinal degeneration, and skeletal deformities, all of which are frequently observed clinical manifestations and difficult to treat in adulthood.

Magnetic semiconductor: structural, magnetic, and conducting properties of the salts of the 6-oxoverdazyl radical cation with M(dmit)(2) anions (M = Ni, Zn, Pd, and Pt, dmit = 1,3-dithiol-2-thione-4,5-dithiolate)

Five kinds of (1:1), (1:3), and (2:1) salts of 3-[4-(diethylmethylammonio)phenyl]-1,5-diphenyl-6-oxoverdazyl radical cation [V](+) with M(dmit)(2) anions (M = Ni, Zn, Pd, and Pt, dmit = 1,3-dithiol-2-thione-4,5-dithiolate) ([V](+)[Ni(dmit)(2)](-) (1), [V](+)[Ni(dmit)(2)](3)(-) (2), [V](+)(2)[Zn(dmit)(2)](2-) (3), [V](+)(2)[Pd(dmit)(2)](2-) (4), and [V](+)(2)[Pt(dmit)(2)](2-) (5)) and an iodide salt of [V](+) ([V](+)[I](-) (6)) have been prepared, and the magnetic susceptibilities (chi(M) values) have been measured between 1.8 and 300 K. The chi(M) of the (1:1) Ni salt (1) can be well reproduced by the sum of the contributions from (i) a Curie-Weiss system with a Curie constant (C) of 0.376 K emu/mol and a negative Weiss constant (theta) of -1.5 K and (ii) the one-dimensional Heisenberg antiferromagnetic alternating chain system with 2J(A-B)/k(B) = -274 K (alternation parameter alpha = J(A-C)/J(A-B) = 0.2). The chi(M) of the (1:3) Ni salt (2) can be well explained by the two-term contributions from (i) the Curie-Weiss system with C = 0.376 K emu/mol and theta = -5.0 K and (ii) the dimer system with 2J/k(B) = -258 K. The magnetic properties of 1 and 2 were discussed based on the results obtained by crystal structure analysis and ESR measurements of 1 and 2. The chi(M) values of the (2:1) Zn, Pd, Pt salts 3, 4, and 5 and [V](+)[I](-) salt 6 follow the Curie-Weiss law with C = 0.723, 0.713, 0.712, and 0.342 K emu/mol and theta = -2.8, -3.1, -2.6, and +0.02 K, respectively, indicating that only the spins of the verdazyl radical cation contribute to the magnetic property of these salts. The salts 1, 3, and 5 are insulators. On the other hand, the conductivity (sigma) of the Ni salt 2 and Pd salt 4 at 20 degrees C was sigma = 8.9 x 10(-2) and 1.3 x 10(-4) S cm(-)(1) with an activation energy E(A) = 0.11 and 0.40 eV, respectively. The salts 2 and 4 are new molecular magnetic semiconductors.

Clinical implications of leptin and its potential humoral regulators in long-term low-calorie diet therapy for obese humans

OBJECTIVE

To address the clinical implications of leptin and to re-examine the relationship between leptin and its potential humoral regulators such as insulin, nonesterified fatty acids (NEFA) and triiodothyronine (T3) in low-calorie diet (LCD) for obese humans.

DESIGN

Longitudinal study.

SETTING

University and foundation hospitals.

SUBJECTS

Ten obese men and 10 premenopausal obese women.

INTERVENTIONS

Five men and five women took 800 kcal/day LCD and another five men and five women took 1400 kcal/day balanced deficit diet (BDD) during 4 weeks.

RESULTS

Plasma leptin levels in the LCD group decreased more markedly (46.2+/-14.6 to 13.2+/-3.6 ng/ml) than that expected for the decrement in percentage fat (39.0+/-1.7 to 35.9+/-1.7%) and body mass index (BMI; 35.4+/-2.4 to 33.1+/-2.2 kg/m(2)), while that in the BDD group did not decrease significantly (14.9+/-3.5 to 13.4+/-2.8 ng/ml). The ratio of the decrease in leptin levels to that of BMI during the first week was significantly greater than that during the following 3 weeks (39.5+/-2.7 vs 29.3+/-2.1%, P=0.017). The plasma insulin and T3 levels also fell substantially in the first week and continued to decrease during the entire course. Plasma leptin levels measured weekly in each subject were correlated well with insulin (r=0.586, P=0.0003) and T3 (r=0.785, P=0.0004). Multiple regression analyses after adjustment for the time course and BMI revealed that serum levels of T3 were independently correlated with plasma leptin levels (r=0.928, P<0.0001). The plasma NEFA level was markedly elevated during the first 2 weeks and decreased thereafter.

CONCLUSIONS

A rapid fall in leptin during the first week of LCD, coordinated by insulin, T3 and NEFA, should be beneficial for responding to decreased energy intake. Inversely, in view of the powerful effect of leptin on energy dissipation, the present findings suggest the potential usefulness of leptin in combination with caloric restriction for the treatment of obesity.

SPONSORSHIP

The Ministry of Education, Culture, Sports, Science and Technology of Japan and the Ministry of Health, Labour and Welfare of Japan.

Isotype-specific selection of high affinity memory B cells in nasal-associated lymphoid tissue

Mucosal immunoglobulin (Ig)A dominance has been proposed to be associated with preferential class switch recombination (CSR) to the IgA heavy chain constant region, Calpha. Here, we report that B cell activation in nasal-associated lymphoid tissue (NALT) upon stimulation with the hapten (4-hydroxy-3-nitrophenyl)acetyl (NP) coupled to chicken gamma globulin caused an anti-NP memory response dominated by high affinity IgA antibodies. In the response, however, NP-specific IgG(+) B cells expanded and sustained their number as a major population in germinal centers (GCs), supporting the view that CSR to IgG heavy chain constant region, Cgamma, operated efficiently in NALT. Both IgG(+) and IgA(+) GC B cells accumulated somatic mutations, indicative of affinity maturation to a similar extent, suggesting that both types of cell were equally selected by antigen. Despite the selection in GCs, high affinity NP-specific B cells were barely detected in the IgG memory compartment, whereas such cells dominated the IgA memory compartment. Taken together with the analysis of the V(H) gene clonotype in GC and memory B cells, we propose that NALT is equipped with a unique machinery providing IgA-specific enrichment of high affinity cells into the memory compartment, facilitating immunity with high affinity and noninflammatory secretory antibodies.

Adenovirus-mediated gene therapy for corneal clouding in mice with mucopolysaccharidosis type VII

Recent advances in systemic treatments for mucopolysaccharidosis have led to therapies that improve the multiple somatic features of this disease, but the therapeutic effect on ocular manifestations such as corneal clouding is not satisfactory. Here, we administered an adenovirus expressing human beta-glucuronidase (AxCAhGUS) into the anterior chamber or intrastromal region of the cornea in mice with mucopolysaccharidosis type VII (B6/MPSVII), and successfully treated corneal clouding of MPSVII. When we injected AxCAhGUS into the anterior chamber of the eyes, cells expressing beta-glucuronidase (GUSB) were located mainly in the trabecular meshwork as well as in all corneal regions, and subsequent pathological corrections in the cornea were achieved. Widespread transgene expression was also observed when we administered AxCAhGUS inside the cornea after lamellar keratotomy, and rapid elimination of the lysosomal storage in the corneal keratocytes occurred. Furthermore, intrastromal vector administration did not generate significant levels of anti-adenovirus neutralizing antibodies, and secondary vector administration was effective. Based on these observations, we conclude that it is worth developing a treatment strategy for corneal clouding in mucopolysaccharidosis based on direct intraocular administration of adenoviral vectors.

Establishment of pulmonary alveolar type II cell line from p53-deficient mice

We obtained a pulmonary alveolar type II epithelial cell line, MAC7, derived from the lung of p53-deficient mice (p53 -/-). When this cell line was passaged for long periods of time, the epithelial cells grew at a high rate for over 50th passage and never entered the non-growing senescent phase characteristic of the normal cells (p53 +/+). Each pulmonary epithelial outgrowth was characterized morphologically and immunocytochemically, and the growth and viability of the outgrowths were examined by MTT assay. Expression of surfactant-associated protein, SP-B, was detected, and transmission electron microscopy demonstrated a type II phenotype containing lamellar bodies and phospholipids. These findings indicate that MAC7 cells retain the morphological and physiological properties of alveolar type II epithelial cells. This cell line should be useful in experimental systems for studying lung pathology.

Novel cytochrome P4501B1 (CYP1B1) gene mutations in Japanese patients with primary congenital glaucoma

PURPOSE

To investigate CYP1B1 gene mutations in Japanese patients with primary congenital glaucoma (PCG).

METHODS

Sixty-five unrelated Japanese patients with PCG were screened by PCR-single-strand conformational polymorphism (SSCP) analysis followed by direct sequencing. No patients were offspring of consanguineous marriages, a common occurrence among patients in previous reports. PCG haplotypes were constructed with intragenic polymorphisms in affected individuals. Three-dimensional atomic structures of human CYP1B1 and four mutant CYP1B1 sequences representing missense mutations were assembled using homology modeling and were regularized by an energy-minimization procedure.

RESULTS

Eleven novel mutations, including seven definite and four probable mutations, were detected in 13 (20%) of the 65 unrelated patients. Of the seven definite mutations, three were predicted to truncate the CYP1B1 open reading frame. The other four were missense mutations (Asp192Val, Ala330Phe, Val364Met, and Arg444Gln), all located in conserved core structures determining proper folding and heme-binding ability of cytochrome P450 molecules. Molecular modeling demonstrated that two of four mutations in positions 330 and 364 were structurally neutral, but Arg444Gln caused significant structural change. Of the four probable mutations, three were missense (Val198Ile, Val320Leu, and Glu499Gly); the other was a base substitution in the noncoding region of exon 1.

CONCLUSIONS

The 11 varied CYP1B1 mutations found in 13 unrelated Japanese patients with sporadic occurrence of PCG represent an allelic heterogeneity and may be unique to a specific population.