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Okazawa Y, Kamigaki T, Sugimoto K, Yamada T, Yoshida Y, Okada S, Ibe H, Oguma E, Iwai T, Matsuda A, Yamada T, Hasegawa S, Goto S, Takimoto R, Sakamoto K. A pilot study on the safety and efficacy of neoadjuvant chemo‑adoptive immunotherapy for locally advanced rectal cancer. Oncol Lett 2024; 27:101. [PMID: 38298433 PMCID: PMC10829080 DOI: 10.3892/ol.2024.14234] [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: 02/28/2023] [Accepted: 11/30/2023] [Indexed: 02/02/2024] Open
Abstract
The safety and efficacy of combination therapy of immune cell therapy and chemotherapy [chemo-adoptive immunotherapy (CAIT)] for patients with stage IV or recurrent colorectal cancer have been reported. In the present study, the safety and efficacy of neoadjuvant CAIT were investigated for preoperative therapy of locally advanced rectal cancer. The study included patients with cT3/T4 or cN (+) rectal adenocarcinoma scheduled for curative surgery. Six patients who consented to participate in the current study were selected as subjects. Neoadjuvant CAIT involves administration of activated autologous lymphocytes, αβ T cells, and mFOLFOX6 every 2 weeks for six courses, followed by surgery 4-6 weeks thereafter. Common Terminology Criteria for Adverse Events grade 3 neutropenia was observed in one patient. Neoadjuvant CAIT and curative surgery were performed on all the patients. The confirmed response rate was 67%. Downstaging was confirmed in five patients (83%). Regarding histological effects, two patients were grade 1a and four were grade 2. Regarding immunological reactions, both CD4+ and CD8+ T cell infiltration rates increased after treatment in three patients on tumor-infiltrating lymphocyte (TIL) analysis. In peripheral blood analysis, the total lymphocyte count was maintained in all patients, and the CD8+ T cell count increased by ≥3 times on the pretreatment count in two patients but may not be associated with changes in TILs. During the median postoperative follow-up duration of 24 months, liver and lung metastases occurred in one patient, but all patients survived. In conclusion, neoadjuvant CAIT (αβ T cells + mFOLFOX6) can be safely administered for the treatment of advanced rectal cancer. Verification of the efficacy of comprehensive immune cell therapy, especially the induction of antitumor immunity for the prevention of recurrence, will be maintained. The current study is registered with the Japan Registry of Clinical Trials (jRCT; ID, jRCTc030190248; January 21, 2019).
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Affiliation(s)
- Yu Okazawa
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo 113-8421, Japan
| | - Takashi Kamigaki
- Department of Next-Generation Cell and Immune Therapy, Faculty of Medicine, Juntendo University, Tokyo 113-8421, Japan
- Seta Clinic Tokyo, Seta Clinic Group, Tokyo 101-0062, Japan
| | - Kiichi Sugimoto
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo 113-8421, Japan
| | - Takeshi Yamada
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo 113-8603, Japan
| | - Yoichiro Yoshida
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka 814-0180, Japan
| | - Sachiko Okada
- Department of Next-Generation Cell and Immune Therapy, Faculty of Medicine, Juntendo University, Tokyo 113-8421, Japan
- Seta Clinic Tokyo, Seta Clinic Group, Tokyo 101-0062, Japan
| | - Hiroshi Ibe
- Department of Next-Generation Cell and Immune Therapy, Faculty of Medicine, Juntendo University, Tokyo 113-8421, Japan
- Seta Clinic Tokyo, Seta Clinic Group, Tokyo 101-0062, Japan
| | - Eri Oguma
- Department of Next-Generation Cell and Immune Therapy, Faculty of Medicine, Juntendo University, Tokyo 113-8421, Japan
- Seta Clinic Tokyo, Seta Clinic Group, Tokyo 101-0062, Japan
| | - Takuma Iwai
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo 113-8603, Japan
| | - Akihisa Matsuda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo 113-8603, Japan
| | - Teppei Yamada
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka 814-0180, Japan
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka 814-0180, Japan
| | - Shigenori Goto
- Department of Next-Generation Cell and Immune Therapy, Faculty of Medicine, Juntendo University, Tokyo 113-8421, Japan
- Seta Clinic Tokyo, Seta Clinic Group, Tokyo 101-0062, Japan
| | - Rishu Takimoto
- Department of Next-Generation Cell and Immune Therapy, Faculty of Medicine, Juntendo University, Tokyo 113-8421, Japan
- Seta Clinic Tokyo, Seta Clinic Group, Tokyo 101-0062, Japan
| | - Kazuhiro Sakamoto
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo 113-8421, Japan
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Kuraoka T, Goto S, Kanno M, Díaz-Tendero S, Reino-González J, Trinter F, Pier A, Sommerlad L, Melzer N, McGinnis OD, Kruse J, Wenzel T, Jahnke T, Xue H, Kishimoto N, Yoshikawa K, Tamura Y, Ota F, Hatada K, Ueda K, Martín F. Tracing Photoinduced Hydrogen Migration in Alcohol Dications from Time-Resolved Molecular-Frame Photoelectron Angular Distributions. J Phys Chem A 2024; 128:1241-1249. [PMID: 38324399 PMCID: PMC10895665 DOI: 10.1021/acs.jpca.3c07640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 02/09/2024]
Abstract
The recent implementation of attosecond and few-femtosecond X-ray pump/X-ray probe schemes in large-scale free-electron laser facilities has opened the way to visualize fast nuclear dynamics in molecules with unprecedented temporal and spatial resolution. Here, we present the results of theoretical calculations showing how polarization-averaged molecular-frame photoelectron angular distributions (PA-MFPADs) can be used to visualize the dynamics of hydrogen migration in methanol, ethanol, propanol, and isopropyl alcohol dications generated by X-ray irradiation of the corresponding neutral species. We show that changes in the PA-MFPADs with the pump-probe delay as a result of intramolecular photoelectron diffraction carry information on the dynamics of hydrogen migration in real space. Although visualization of this dynamics is more straightforward in the smaller systems, methanol and ethanol, one can still recognize the signature of that motion in propanol and isopropyl alcohol and assign a tentative path to it. A possible pathway for a corresponding experiment requires an angularly resolved detection of photoelectrons in coincidence with molecular fragment ions used to define a molecular frame of reference. Such studies have become, in principle, possible since the first XFELs with sufficiently high repetition rates have emerged. To further support our findings, we provide experimental evidence of H migration in ethanol-OD from ion-ion coincidence measurements performed with synchrotron radiation.
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Affiliation(s)
- T. Kuraoka
- Department
of Physics, University of Toyama, Gofuku 3190, Toyama 930-8555, Japan
| | - S. Goto
- Department
of Physics, University of Toyama, Gofuku 3190, Toyama 930-8555, Japan
| | - M. Kanno
- Department
of Chemistry, Tohoku University, 6-3 Aramaki Aza-Aoba, Aoba-ku, Sendai 980-8578, Japan
| | - S. Díaz-Tendero
- Departamento
de Química, Universidad Autónoma
de Madrid, Madrid 28049, Spain
- Condensed
Matter Physics Center (IFIMAC), Universidad
Autónoma de Madrid, Madrid 28049, Spain
- Institute
for Advanced Research in Chemical Sciences (IAdChem), Universidad Autónoma de Madrid, Madrid 28049, Spain
| | - J. Reino-González
- Instituto
Madrileño de Estudios Avanzados en Nanociencia (IMDEA-Nano), Campus de Cantoblanco, Madrid 28049, Spain
| | - F. Trinter
- Molecular
Physics, Fritz-Haber-Institut der Max-Planck-Gesellschaft, Faradayweg 4-6, Berlin 14195, Germany
| | - A. Pier
- Institut
für Kernphysik, Goethe-Universität
Frankfurt, Max-von-Laue-Straβe 1, Frankfurt am
Main 60438, Germany
| | - L. Sommerlad
- Institut
für Kernphysik, Goethe-Universität
Frankfurt, Max-von-Laue-Straβe 1, Frankfurt am
Main 60438, Germany
| | - N. Melzer
- Institut
für Kernphysik, Goethe-Universität
Frankfurt, Max-von-Laue-Straβe 1, Frankfurt am
Main 60438, Germany
| | - O. D. McGinnis
- Institut
für Kernphysik, Goethe-Universität
Frankfurt, Max-von-Laue-Straβe 1, Frankfurt am
Main 60438, Germany
| | - J. Kruse
- Institut
für Kernphysik, Goethe-Universität
Frankfurt, Max-von-Laue-Straβe 1, Frankfurt am
Main 60438, Germany
| | - T. Wenzel
- Institut
für Kernphysik, Goethe-Universität
Frankfurt, Max-von-Laue-Straβe 1, Frankfurt am
Main 60438, Germany
| | - T. Jahnke
- Max-Planck-Institut
für Kernphysik, Saupfercheckweg 1, Heidelberg 69117, Germany
- European
XFEL, Holzkoppel
4, Schenefeld 22869, Germany
| | - H. Xue
- Department
of Chemistry, Tohoku University, 6-3 Aramaki Aza-Aoba, Aoba-ku, Sendai 980-8578, Japan
| | - N. Kishimoto
- Department
of Chemistry, Tohoku University, 6-3 Aramaki Aza-Aoba, Aoba-ku, Sendai 980-8578, Japan
| | - K. Yoshikawa
- Department
of Physics, University of Toyama, Gofuku 3190, Toyama 930-8555, Japan
| | - Y. Tamura
- Department
of Physics, University of Toyama, Gofuku 3190, Toyama 930-8555, Japan
| | - F. Ota
- Department
of Physics, University of Toyama, Gofuku 3190, Toyama 930-8555, Japan
| | - K. Hatada
- Department
of Physics, University of Toyama, Gofuku 3190, Toyama 930-8555, Japan
| | - K. Ueda
- Department
of Chemistry, Tohoku University, 6-3 Aramaki Aza-Aoba, Aoba-ku, Sendai 980-8578, Japan
| | - F. Martín
- Departamento
de Química, Universidad Autónoma
de Madrid, Madrid 28049, Spain
- Instituto
Madrileño de Estudios Avanzados en Nanociencia (IMDEA-Nano), Campus de Cantoblanco, Madrid 28049, Spain
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Kida A, Mizukoshi E, Kitahara M, Miyashita T, Goto S, Kamigaki T, Takimoto R, Asai J, Kakinoki K, Urabe T, Tomita K, Kaneko S. Effects of adoptive T-cell immunotherapy on immune cell profiles and prognosis of patients with unresectable or recurrent cholangiocarcinoma. Int J Cancer 2024; 154:738-747. [PMID: 37676069 DOI: 10.1002/ijc.34716] [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: 02/06/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 09/08/2023]
Abstract
The identification of immune cell profiles (ICP) involved in anti-tumor immunity is crucial for immunotherapy. Therefore, we herein investigated cholangiocarcinoma patients (CCA) who received adoptive T-cell immunotherapy (ATI). Eighteen unresectable or recurrent CCA received ATI of αβ T cells alone or combined with chemotherapy. ICP were evaluated by flow cytometry. There were 14 patients with intrahepatic cholangiocarcinoma (iCCA) and four with distal cholangiocarcinoma (dCCA). After one course of treatment, nine iCCA and four dCCA had progressive disease (PD), while five iCCA had stable disease (SD). Median overall survival (OS) was prolonged to 21.9 months. No significant differences were observed in OS between the PD and SD groups of iCCA. The frequency of helper T cells (HT) in iCCA decreased from 70.3% to 65.5% (P = .008), while that of killer T cells (KT) increased from 27.0% to 30.6% (P = .005). dCCA showed no significant changes of immune cells. OS was prolonged in iCCA with increased frequencies of CD3+ T cells (CD3) (P = .039) and αβ T cells (αβ) (P = .039). dCCA showed no immune cells associated with OS. The frequencies of CD3+ T cells and αβ T cells in the PD group for iCCA decreased from 63.5% to 53% (P = .038) and from 61.6% to 52.2% (P = .028), respectively. In the SD group, the frequency of HT decreased from 65.8% to 56.9% (P = .043), whereas that of KT increased from 30.1% to 38.3% (P = .043). In conclusions, ATI affected ICP and prolonged OS. Immune cells involved in treatment effects differed according to the site of cholangiocarcinoma.
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Affiliation(s)
- Akihiko Kida
- Department of Gastroenterology, Public Central Hospital of Matto Ishikawa, Hakusan, Japan
| | - Eishiro Mizukoshi
- Innovative Clinical Research Center, Kanazawa University, Kanazawa, Japan
| | - Masaaki Kitahara
- Department of Internal Medicine, Komatsu Sophia Hospital, Komatsu, Japan
| | - Tomoharu Miyashita
- Department of Surgical Oncology, Kanazawa Medical University, Kahoku-gun, Japan
| | - Shigenori Goto
- Seta Clinic Group, Department of Next-Generation Cell and Immune Therapy, Juntendo University School of Medicine, Tokyo, Japan
| | - Takashi Kamigaki
- Seta Clinic Group, Department of Next-Generation Cell and Immune Therapy, Juntendo University School of Medicine, Tokyo, Japan
| | - Rishu Takimoto
- Seta Clinic Group, Department of Next-Generation Cell and Immune Therapy, Juntendo University School of Medicine, Tokyo, Japan
| | - Jun Asai
- Department of Gastroenterology, Public Central Hospital of Matto Ishikawa, Hakusan, Japan
| | - Kaheita Kakinoki
- Department of Gastroenterology, Public Central Hospital of Matto Ishikawa, Hakusan, Japan
| | - Takeshi Urabe
- Department of Gastroenterology, Public Central Hospital of Matto Ishikawa, Hakusan, Japan
| | | | - Shuichi Kaneko
- Department of Information-Based Medicine Development, Graduate School of Medicine, Kanazawa University, Kanazawa, Japan
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Staplin N, Haynes R, Judge PK, Wanner C, Green JB, Emberson J, Preiss D, Mayne KJ, Ng SYA, Sammons E, Zhu D, Hill M, Stevens W, Wallendszus K, Brenner S, Cheung AK, Liu ZH, Li J, Hooi LS, Liu WJ, Kadowaki T, Nangaku M, Levin A, Cherney D, Maggioni AP, Pontremoli R, Deo R, Goto S, Rossello X, Tuttle KR, Steubl D, Petrini M, Seidi S, Landray MJ, Baigent C, Herrington WG, Abat S, Abd Rahman R, Abdul Cader R, Abdul Hafidz MI, Abdul Wahab MZ, Abdullah NK, Abdul-Samad T, Abe M, Abraham N, Acheampong S, Achiri P, Acosta JA, Adeleke A, Adell V, Adewuyi-Dalton R, Adnan N, Africano A, Agharazii M, Aguilar F, Aguilera A, Ahmad M, Ahmad MK, Ahmad NA, Ahmad NH, Ahmad NI, Ahmad Miswan N, Ahmad Rosdi H, Ahmed I, Ahmed S, Ahmed S, Aiello J, Aitken A, AitSadi R, Aker S, Akimoto S, Akinfolarin A, Akram S, Alberici F, Albert C, Aldrich L, Alegata M, Alexander L, Alfaress S, Alhadj Ali M, Ali A, Ali A, Alicic R, Aliu A, Almaraz R, Almasarwah R, Almeida J, Aloisi A, Al-Rabadi L, Alscher D, Alvarez P, Al-Zeer B, Amat M, Ambrose C, Ammar H, An Y, Andriaccio L, Ansu K, Apostolidi A, Arai N, Araki H, Araki S, Arbi A, Arechiga O, Armstrong S, Arnold T, Aronoff S, Arriaga W, Arroyo J, Arteaga D, Asahara S, Asai A, Asai N, Asano S, Asawa M, Asmee MF, Aucella F, Augustin M, Avery A, Awad A, Awang IY, Awazawa M, Axler A, Ayub W, Azhari Z, Baccaro R, Badin C, Bagwell B, Bahlmann-Kroll E, Bahtar AZ, Baigent C, Bains D, Bajaj H, Baker R, Baldini E, Banas B, Banerjee D, Banno S, Bansal S, Barberi S, Barnes S, Barnini C, Barot C, Barrett K, Barrios R, Bartolomei Mecatti B, Barton I, Barton J, Basily W, Bavanandan S, Baxter A, Becker L, Beddhu S, Beige J, Beigh S, Bell S, Benck U, Beneat A, Bennett A, Bennett D, Benyon S, Berdeprado J, Bergler T, Bergner A, Berry M, Bevilacqua M, Bhairoo J, Bhandari S, Bhandary N, Bhatt A, Bhattarai M, Bhavsar M, Bian W, Bianchini F, Bianco S, Bilous R, Bilton J, Bilucaglia D, Bird C, Birudaraju D, Biscoveanu M, Blake C, Bleakley N, Bocchicchia K, Bodine S, Bodington R, Boedecker S, Bolduc M, Bolton S, Bond C, Boreky F, Boren K, Bouchi R, Bough L, Bovan D, Bowler C, Bowman L, Brar N, Braun C, Breach A, Breitenfeldt M, Brenner S, Brettschneider B, Brewer A, Brewer G, Brindle V, Brioni E, Brown C, Brown H, Brown L, Brown R, Brown S, Browne D, Bruce K, Brueckmann M, Brunskill N, Bryant M, Brzoska M, Bu Y, Buckman C, Budoff M, Bullen M, Burke A, Burnette S, Burston C, Busch M, Bushnell J, Butler S, Büttner C, Byrne C, Caamano A, Cadorna J, Cafiero C, Cagle M, Cai J, Calabrese K, Calvi C, Camilleri B, Camp S, Campbell D, Campbell R, Cao H, Capelli I, Caple M, Caplin B, Cardone A, Carle J, Carnall V, Caroppo M, Carr S, Carraro G, Carson M, Casares P, Castillo C, Castro C, Caudill B, Cejka V, Ceseri M, Cham L, Chamberlain A, Chambers J, Chan CBT, Chan JYM, Chan YC, Chang E, Chang E, Chant T, Chavagnon T, Chellamuthu P, Chen F, Chen J, Chen P, Chen TM, Chen Y, Chen Y, Cheng C, Cheng H, Cheng MC, Cherney D, Cheung AK, Ching CH, Chitalia N, Choksi R, Chukwu C, Chung K, Cianciolo G, Cipressa L, Clark S, Clarke H, Clarke R, Clarke S, Cleveland B, Cole E, Coles H, Condurache L, Connor A, Convery K, Cooper A, Cooper N, Cooper Z, Cooperman L, Cosgrove L, Coutts P, Cowley A, Craik R, Cui G, Cummins T, Dahl N, Dai H, Dajani L, D'Amelio A, Damian E, Damianik K, Danel L, Daniels C, Daniels T, Darbeau S, Darius H, Dasgupta T, Davies J, Davies L, Davis A, Davis J, Davis L, Dayanandan R, Dayi S, Dayrell R, De Nicola L, Debnath S, Deeb W, Degenhardt S, DeGoursey K, Delaney M, Deo R, DeRaad R, Derebail V, Dev D, Devaux M, Dhall P, Dhillon G, Dienes J, Dobre M, Doctolero E, Dodds V, Domingo D, Donaldson D, Donaldson P, Donhauser C, Donley V, Dorestin S, Dorey S, Doulton T, Draganova D, Draxlbauer K, Driver F, Du H, Dube F, Duck T, Dugal T, Dugas J, Dukka H, Dumann H, Durham W, Dursch M, Dykas R, Easow R, Eckrich E, Eden G, Edmerson E, Edwards H, Ee LW, Eguchi J, Ehrl Y, Eichstadt K, Eid W, Eilerman B, Ejima Y, Eldon H, Ellam T, Elliott L, Ellison R, Emberson J, Epp R, Er A, Espino-Obrero M, Estcourt S, Estienne L, Evans G, Evans J, Evans S, Fabbri G, Fajardo-Moser M, Falcone C, Fani F, Faria-Shayler P, Farnia F, Farrugia D, Fechter M, Fellowes D, Feng F, Fernandez J, Ferraro P, Field A, Fikry S, Finch J, Finn H, Fioretto P, Fish R, Fleischer A, Fleming-Brown D, Fletcher L, Flora R, Foellinger C, Foligno N, Forest S, Forghani Z, Forsyth K, Fottrell-Gould D, Fox P, Frankel A, Fraser D, Frazier R, Frederick K, Freking N, French H, Froment A, Fuchs B, Fuessl L, Fujii H, Fujimoto A, Fujita A, Fujita K, Fujita Y, Fukagawa M, Fukao Y, Fukasawa A, Fuller T, Funayama T, Fung E, Furukawa M, Furukawa Y, Furusho M, Gabel S, Gaidu J, Gaiser S, Gallo K, Galloway C, Gambaro G, Gan CC, Gangemi C, Gao M, Garcia K, Garcia M, Garofalo C, Garrity M, Garza A, Gasko S, Gavrila M, Gebeyehu B, Geddes A, Gentile G, George A, George J, Gesualdo L, Ghalli F, Ghanem A, Ghate T, Ghavampour S, Ghazi A, Gherman A, Giebeln-Hudnell U, Gill B, Gillham S, Girakossyan I, Girndt M, Giuffrida A, Glenwright M, Glider T, Gloria R, Glowski D, Goh BL, Goh CB, Gohda T, Goldenberg R, Goldfaden R, Goldsmith C, Golson B, Gonce V, Gong Q, Goodenough B, Goodwin N, Goonasekera M, Gordon A, Gordon J, Gore A, Goto H, Goto S, Goto S, Gowen D, Grace A, Graham J, Grandaliano G, Gray M, Green JB, Greene T, Greenwood G, Grewal B, Grifa R, Griffin D, Griffin S, Grimmer P, Grobovaite E, Grotjahn S, Guerini A, Guest C, Gunda S, Guo B, Guo Q, Haack S, Haase M, Haaser K, Habuki K, Hadley A, Hagan S, Hagge S, Haller H, Ham S, Hamal S, Hamamoto Y, Hamano N, Hamm M, Hanburry A, Haneda M, Hanf C, Hanif W, Hansen J, Hanson L, Hantel S, Haraguchi T, Harding E, Harding T, Hardy C, Hartner C, Harun Z, Harvill L, Hasan A, Hase H, Hasegawa F, Hasegawa T, Hashimoto A, Hashimoto C, Hashimoto M, Hashimoto S, Haskett S, Hauske SJ, Hawfield A, Hayami T, Hayashi M, Hayashi S, Haynes R, Hazara A, Healy C, Hecktman J, Heine G, Henderson H, Henschel R, Hepditch A, Herfurth K, Hernandez G, Hernandez Pena A, Hernandez-Cassis C, Herrington WG, Herzog C, Hewins S, Hewitt D, Hichkad L, Higashi S, Higuchi C, Hill C, Hill L, Hill M, Himeno T, Hing A, Hirakawa Y, Hirata K, Hirota Y, Hisatake T, Hitchcock S, Hodakowski A, Hodge W, Hogan R, Hohenstatt U, Hohenstein B, Hooi L, Hope S, Hopley M, Horikawa S, Hosein D, Hosooka T, Hou L, Hou W, Howie L, Howson A, Hozak M, Htet Z, Hu X, Hu Y, Huang J, Huda N, Hudig L, Hudson A, Hugo C, Hull R, Hume L, Hundei W, Hunt N, Hunter A, Hurley S, Hurst A, Hutchinson C, Hyo T, Ibrahim FH, Ibrahim S, Ihana N, Ikeda T, Imai A, Imamine R, Inamori A, Inazawa H, Ingell J, Inomata K, Inukai Y, Ioka M, Irtiza-Ali A, Isakova T, Isari W, Iselt M, Ishiguro A, Ishihara K, Ishikawa T, Ishimoto T, Ishizuka K, Ismail R, Itano S, Ito H, Ito K, Ito M, Ito Y, Iwagaitsu S, Iwaita Y, Iwakura T, Iwamoto M, Iwasa M, Iwasaki H, Iwasaki S, Izumi K, Izumi K, Izumi T, Jaafar SM, Jackson C, Jackson Y, Jafari G, Jahangiriesmaili M, Jain N, Jansson K, Jasim H, Jeffers L, Jenkins A, Jesky M, Jesus-Silva J, Jeyarajah D, Jiang Y, Jiao X, Jimenez G, Jin B, Jin Q, Jochims J, Johns B, Johnson C, Johnson T, Jolly S, Jones L, Jones L, Jones S, Jones T, Jones V, Joseph M, Joshi S, Judge P, Junejo N, Junus S, Kachele M, Kadowaki T, Kadoya H, Kaga H, Kai H, Kajio H, Kaluza-Schilling W, Kamaruzaman L, Kamarzarian A, Kamimura Y, Kamiya H, Kamundi C, Kan T, Kanaguchi Y, Kanazawa A, Kanda E, Kanegae S, Kaneko K, Kaneko K, Kang HY, Kano T, Karim M, Karounos D, Karsan W, Kasagi R, Kashihara N, Katagiri H, Katanosaka A, Katayama A, Katayama M, Katiman E, Kato K, Kato M, Kato N, Kato S, Kato T, Kato Y, Katsuda Y, Katsuno T, Kaufeld J, Kavak Y, Kawai I, Kawai M, Kawai M, Kawase A, Kawashima S, Kazory A, Kearney J, Keith B, Kellett J, Kelley S, Kershaw M, Ketteler M, Khai Q, Khairullah Q, Khandwala H, Khoo KKL, Khwaja A, Kidokoro K, Kielstein J, Kihara M, Kimber C, Kimura S, Kinashi H, Kingston H, Kinomura M, Kinsella-Perks E, Kitagawa M, Kitajima M, Kitamura S, Kiyosue A, Kiyota M, Klauser F, Klausmann G, Kmietschak W, Knapp K, Knight C, Knoppe A, Knott C, Kobayashi M, Kobayashi R, Kobayashi T, Koch M, Kodama S, Kodani N, Kogure E, Koizumi M, Kojima H, Kojo T, Kolhe N, Komaba H, Komiya T, Komori H, Kon SP, Kondo M, Kondo M, Kong W, Konishi M, Kono K, Koshino M, Kosugi T, Kothapalli B, Kozlowski T, Kraemer B, Kraemer-Guth A, Krappe J, Kraus D, Kriatselis C, Krieger C, Krish P, Kruger B, Ku Md Razi KR, Kuan Y, Kubota S, Kuhn S, Kumar P, Kume S, Kummer I, Kumuji R, Küpper A, Kuramae T, Kurian L, Kuribayashi C, Kurien R, Kuroda E, Kurose T, Kutschat A, Kuwabara N, Kuwata H, La Manna G, Lacey M, Lafferty K, LaFleur P, Lai V, Laity E, Lambert A, Landray MJ, Langlois M, Latif F, Latore E, Laundy E, Laurienti D, Lawson A, Lay M, Leal I, Leal I, Lee AK, Lee J, Lee KQ, Lee R, Lee SA, Lee YY, Lee-Barkey Y, Leonard N, Leoncini G, Leong CM, Lerario S, Leslie A, Levin A, Lewington A, Li J, Li N, Li X, Li Y, Liberti L, Liberti ME, Liew A, Liew YF, 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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Takimoto R, Kamigaki T, Ito H, Saito M, Takizawa K, Soejima K, Yasuda H, Ohgino K, Terai H, Tomita K, Miura M, Mizukoshi E, Miyashita T, Nakamoto Y, Hayashi K, Miwa S, Kitahara M, Takeuchi A, Kimura H, Mochizuki T, Sugie H, Seino KI, Yamada T, Takeuchi S, Makita K, Naitoh K, Yasumoto K, Yoshida Y, Inoue H, Kotake K, Ohshima K, Noda SE, Okamoto M, Yoshimoto Y, Okada S, Ibe H, Oguma E, Goto S. Safety evaluation of immune-cell therapy for malignant tumor in the Cancer Immune-cell Therapy Evaluation Group (CITEG). Cytotherapy 2023; 25:1229-1235. [PMID: 37486281 DOI: 10.1016/j.jcyt.2023.06.007] [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: 03/15/2023] [Revised: 06/10/2023] [Accepted: 06/22/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND AIMS With the aim of strengthening the scientific evidence of immune-cell therapy for cancer and further examining its safety, in October 2015, our hospital jointly established the Cancer Immune-Cell Therapy Evaluation Group (CITEG) with 39 medical facilities nationwide. METHODS Medical information, such as patients' background characteristics, clinical efficacy and therapeutic cell types obtained from each facility, has been accumulated, analyzed and evaluated by CITEG. In this prospective study, we analyzed the adverse events associated with immune-cell therapy until the end of September 2022, and we presented our interim safety evaluation. RESULTS A total of 3839 patients with malignant tumor were treated with immune-cell therapy, with a median age of 64 years (range, 13-97 years) and a male-to-female ratio of 1:1.08 (1846:1993). Most patients' performance status was 0 or 1 (86.8%) at the first visit, and 3234 cases (84.2%) were advanced or recurrent cases, which accounted for the majority. The total number of administrations reported in CITEG was 31890, of which 960 (3.0%) showed adverse events. The numbers of adverse events caused by treatment were 363 (1.8%) of 19661 administrations of αβT cell therapy, 9 of 845 administrations of γδT-cell therapy (1.1%) and 10 of 626 administrations of natural killer cell therapy (1.6%). The number of adverse events caused by dendritic cell (DC) vaccine therapy was 578 of 10748 administrations (5.4%), which was significantly larger than those for other treatments. Multivariate analysis revealed that αβT cell therapy had a significantly greater risk of adverse events at performance status 1 or higher, and patients younger than 64 years, women or adjuvant immune-cell therapy had a greater risk of adverse events in DC vaccine therapy. Injection-site reactions were the most frequently reported adverse events, with 449 events, the majority of which were associated with DC vaccine therapy. Among all other adverse events, fever (228 events), fatigue (141 events) and itching (131 events) were frequently reported. In contrast, three patients had adverse events (fever, abdominal pain and interstitial pneumonia) that required hospitalization, although they were weakly related to this therapy; rather, it was considered to be the effect of treatment for the primary disease. CONCLUSIONS Immune-cell therapy for cancer was considered to be a safe treatment without serious adverse events.
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Affiliation(s)
- Rishu Takimoto
- Seta Clinic Group, Tokyo, Japan; Next Generation Cell and Immunotherapy, Advanced Research Institute for Health Science, Juntendo University, Tokyo, Japan; LSI Sapporo Clinic, Sapporo, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan.
| | - Takashi Kamigaki
- Seta Clinic Group, Tokyo, Japan; Next Generation Cell and Immunotherapy, Advanced Research Institute for Health Science, Juntendo University, Tokyo, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Hisao Ito
- Seta Clinic Group, Tokyo, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Masashi Saito
- Seta Clinic Group, Tokyo, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Ken Takizawa
- Seta Clinic Group, Tokyo, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Kenzo Soejima
- Seta Clinic Group, Tokyo, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Hiroyuki Yasuda
- Seta Clinic Group, Tokyo, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Keiko Ohgino
- Seta Clinic Group, Tokyo, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Hideki Terai
- Seta Clinic Group, Tokyo, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Katsuro Tomita
- Kanazawa Advanced Medical Center, Kanazawa City, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Miyabi Miura
- Kanazawa Advanced Medical Center, Kanazawa City, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Eishiro Mizukoshi
- Kanazawa Advanced Medical Center, Kanazawa City, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Tomoharu Miyashita
- Kanazawa Advanced Medical Center, Kanazawa City, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Yasunari Nakamoto
- Kanazawa Advanced Medical Center, Kanazawa City, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Katsuhiro Hayashi
- Kanazawa Advanced Medical Center, Kanazawa City, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Shinji Miwa
- Kanazawa Advanced Medical Center, Kanazawa City, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Masaaki Kitahara
- Kanazawa Advanced Medical Center, Kanazawa City, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Akihiko Takeuchi
- Kanazawa Advanced Medical Center, Kanazawa City, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Hiroaki Kimura
- Kanazawa Advanced Medical Center, Kanazawa City, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Takafumi Mochizuki
- Kanazawa Advanced Medical Center, Kanazawa City, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Hiroki Sugie
- LSI Sapporo Clinic, Sapporo, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Ken-Ichiro Seino
- LSI Sapporo Clinic, Sapporo, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Tomonori Yamada
- LSI Sapporo Clinic, Sapporo, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Syuhei Takeuchi
- LSI Sapporo Clinic, Sapporo, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Kaori Makita
- Kitaosaka Medical Clinic, Suita City, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Keiko Naitoh
- Fukuoka Medical Clinic, Fukuoka City, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Kosei Yasumoto
- Fukuoka Medical Clinic, Fukuoka City, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Yoichiro Yoshida
- Fukuoka Medical Clinic, Fukuoka City, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Hiroyuki Inoue
- Fukuoka Medical Clinic, Fukuoka City, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Katsuhiro Kotake
- Masuko Memorial Hospital, Nagoya City, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Kihachi Ohshima
- Heisei-Hidaka Clinic, Gunma, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Shin-Ei Noda
- Heisei-Hidaka Clinic, Gunma, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Masahiko Okamoto
- Heisei-Hidaka Clinic, Gunma, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Yuya Yoshimoto
- Heisei-Hidaka Clinic, Gunma, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
| | - Sachiko Okada
- Seta Clinic Group, Tokyo, Japan; Next Generation Cell and Immunotherapy, Advanced Research Institute for Health Science, Juntendo University, Tokyo, Japan
| | - Hiroshi Ibe
- Seta Clinic Group, Tokyo, Japan; Next Generation Cell and Immunotherapy, Advanced Research Institute for Health Science, Juntendo University, Tokyo, Japan
| | - Eri Oguma
- Seta Clinic Group, Tokyo, Japan; Next Generation Cell and Immunotherapy, Advanced Research Institute for Health Science, Juntendo University, Tokyo, Japan
| | - Shigenori Goto
- Seta Clinic Group, Tokyo, Japan; Next Generation Cell and Immunotherapy, Advanced Research Institute for Health Science, Juntendo University, Tokyo, Japan; Cancer Immune-cell Therapy Evaluation Group (CITEG), Tokyo, Japan
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Nonami A, Matsuo R, Funakoshi K, Nakayama T, Goto S, Iino T, Takaishi S, Mizuno S, Akashi K, Eto M. Prospective study of adoptive activated αβT lymphocyte immunotherapy for refractory cancers: development and validation of a response scoring system. Cytotherapy 2023; 25:76-81. [PMID: 36253253 DOI: 10.1016/j.jcyt.2022.09.007] [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: 03/24/2022] [Revised: 09/03/2022] [Accepted: 09/25/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND AIMS This prospective clinical study aimed to determine the efficacy and prognostic factors of adoptive activated αβT lymphocyte immunotherapy for various refractory cancers. The primary endpoint was overall survival (OS), and the secondary endpoint was radiological response. METHODS The authors treated 96 patients. Activated αβT lymphocytes were infused every 2 weeks for a total of six times. Prognostic factors were identified by analyzing clinical and laboratory data obtained before therapy. RESULTS Median survival time (MST) was 150 days (95% confidence interval, 105-191), and approximately 20% of patients achieved disease control (complete response + partial response + stable disease). According to the multivariate Cox proportional hazards model with Akaike information criterion-best subset selection, sex, concurrent therapy, neutrophil/lymphocyte ratio, albumin, lactate dehydrogenase, CD4:CD8 ratio and T helper (Th)1:Th2 ratio were strong prognostic factors. Using parameter estimates of the Cox analysis, the authors developed a response scoring system. The authors then determined the threshold of the response score between responders and non-responders. This threshold was able to significantly differentiate OS of responders from that of non-responders. MST of responders was longer than that of non-responders (317.5 days versus 74 days). The validity of this response scoring system was then confirmed by internal validation. CONCLUSIONS Adoptive activated αβT lymphocyte immunotherapy has clinical efficacy in certain patients. The authors' scoring system is the first prognostic model reported for this therapy, and it is useful for selecting patients who might obtain a better prognosis through this modality.
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Affiliation(s)
- Atsushi Nonami
- Center for Advanced Medical Innovation, Kyushu University, Fukuoka, Japan; Department of Medicine and Biosystemic Science, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Ryu Matsuo
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kouta Funakoshi
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Tomohiro Nakayama
- Department of Radiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Shigenori Goto
- Department of Next-Generation Cell and Immune Therapy, Juntendo University School of Medicine, Tokyo, Japan
| | - Tadafumi Iino
- Center for Advanced Medical Innovation, Kyushu University, Fukuoka, Japan
| | - Shigeo Takaishi
- Center for Advanced Medical Innovation, Kyushu University, Fukuoka, Japan
| | - Shinichi Mizuno
- Center for Advanced Medical Innovation, Kyushu University, Fukuoka, Japan; Division of Medical Sciences and Technology, Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koichi Akashi
- Center for Advanced Medical Innovation, Kyushu University, Fukuoka, Japan; Department of Medicine and Biosystemic Science, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masatoshi Eto
- Center for Advanced Medical Innovation, Kyushu University, Fukuoka, Japan; Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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8
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Yagi R, Goto S, MacRae CA, Deo RC. Expanded adaptation of an artificial intelligence model for predicting chemotherapy-induced cardiotoxicity using baseline electrocardiograms. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2577] [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
Introduction
While effective as chemotherapeutics, anthracyclines can cause cancer therapy-related cardiac dysfunction (CTRCD), which adversely affects the prognosis of patients with malignancies1–5. Despite guideline recommendations6–9, repeated echocardiograms are rarely performed10 with delayed diagnosis of CTRCD leading to unrecoverable cardiac dysfunction11. Recently, artificial intelligence (AI) was shown to be capable of detecting reduced left ventricular ejection fraction (LVEF) solely from electrocardiogram (ECG)12. Furthermore, this model was predictive of a future decrease in LVEF. Therefore, we hypothesized that an AI model detecting reduced LVEF (AI-EF model) could predict CTRCD from ECGs.
Purpose
To assess whether the AI-EF model could detect patients at a high risk of CTRCD by analyzing ECGs taken immediately prior to the initiation of cardiotoxic chemotherapy.
Methods
Among patients who received chemotherapy with a regimen including anthracyclines in two institutions between June 1st, 2015 and October 1st, 2020, those who underwent both an ECG and echocardiogram ≤90 days prior to initial treatment were selected. The ECGs were analyzed by the AI-EF model and patients were divided into two groups according to the scores from the model. CTRCD was defined as LVEF <53% and ≥10% decrease in LVEF from the baseline at any time after the start of chemotherapy13. The cumulative incidence of CTRCD was compared for the two groups using Kaplan-Meier curves, log-rank test, a univariate Cox proportional hazard model, and a multivariable Cox proportional hazard model adjusting for known risk factors for CTRCD. Finally, a prediction model for CTRCD using readily available clinical variables with the AI-EF score was compared with the model using the same variables without the AI-EF score.
Results
1,158 patients were included in this study. 99 of them developed CTRCD during follow-up. The AI-EF model displayed excellent risk stratification of developing CTRCD: while 7.1% in the low AI-EF score group developed CTRCD, 12.9% of the patients in the high AI-EF score group developed CTRCD (hazard ratio (HR), 2.14; 95% confidence interval (CI), 1.43–3.19; log-rank p<0.001; Figure 1). This finding was robust across subgroups such as cancer types, the initial dose of anthracycline and baseline LVEF, and consistent after adjusting for multiple risk factors (adjusted HR, 2.10; 95% CI, 1.37–3.22; p<0.001; Figure 2). Furthermore, the addition of the AI-EF score significantly improved the accuracy of predicting CTRCD compared to clinical features alone (time-dependent area under the received operating curve (AUROC) for 2 years, 77.1; 95% CI, 71.8–82.3 for the model with AI-EF score and AUROC 73.9; 95% CI, 69.0–80.1 for the model without AI-EF score; p=0.02).
Conclusion
The AI-EF model, by utilizing baseline ECG, could stratify patients according to the risk of CTRCD and robustly augmented CTRCD prediction.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): American Heart AssociationVerily
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Affiliation(s)
- R Yagi
- Brigham and Women'S Hospital, Harvard Medical School , Boston , United States of America
| | - S Goto
- Brigham and Women'S Hospital, Harvard Medical School , Boston , United States of America
| | - C A MacRae
- Brigham and Women'S Hospital, Harvard Medical School , Boston , United States of America
| | - R C Deo
- Brigham and Women'S Hospital, Harvard Medical School , Boston , United States of America
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Pope MK, Hall TS, Atar D, Virdone S, Pieper K, Jansky P, Steffel J, Haas S, Gersh BJ, Goto S, Panchenko E, Baron-Esquivias G, Angchaisuksiri P, Camm AJ, Kakkar AK. Rhythm versus rate control in patients with newly diagnosed atrial fibrillation: observations from the GARFIELD-AF registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2000] [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
Atrial fibrillation is associated with considerable morbidity and mortality. Real-world reports on the effect of early rhythm control on patient outcomes in patient with recent onset atrial fibrillation are limited.
Purpose
To assess the effect of early rhythm versus rate control on clinical outcomes in patients with newly diagnosed non-valvular atrial fibrillation.
Method
The Global Anticoagulant Registry in the FIELD-AF (GARFIELD-AF) is a non-interventional registry of adult (≥18 years) patients with newly diagnosed atrial fibrillation (≤ six weeks' duration) and at least one investigator determined risk factor for stroke. Patients were enrolled in 1317 participating sites in 35 countries between March 2010 and August 2016. Patients with permanent atrial fibrillation were excluded. Stratification to rhythm or rate control was based on treatment strategy initiated at baseline (≤48 days post enrolment). Rhythm control was defined as investigator reported initiation of rhythm control (antiarrhythmic drug(s), cardioversion, or ablation – alone or in combination with rate modifiers). Rate control was defined as investigator reported initiation of rate control and absence of rhythm control therapy. Overlap propensity weighting and Cox proportional-hazards models were used to evaluate effect on outcomes.
Results
Of 45,382 included patients, 23,858 (52.6%) received rhythm control and 21,524 (47.4%) rate control. Rates of rhythm control were similar throughout the study time period (52.7% in 2010/2011, 54.2% in 2015/2016). Patients in the rhythm control group were younger (median age (Q1; Q3) 68.0 (60.0; 76.0) versus 73.0 (65.0; 79.0)), had lower rates of prior stroke/transitory ischemic attack/systemic embolism (9.4% vs 13.0%), and a lower median GARFIELD death score (4.0 (2.3; 7.5) versus 5.1 (2.8; 9.2)). Median CHA2DS2-VASc Scores were 3.0 (2.0; 4.0) in both groups. Rate of anticoagulation treatment was similar in the rhythm and rate control group (66.0% versus 65.5%). After propensity score overlap weighting, patients of the two groups were well balanced on all observed characteristics.
Event rates per 100 person-years (95% confidence interval [CI]) over two years follow-up in the rhythm and rate control group were 2.94 (2.78–3.10) versus 4.43 (4.22–4.64) for mortality, 0.84 (0.75–0.92) versus 1.16 (1.05–1.27) for non-haemorrhagic stroke/systemic embolism and 0.84 (0.76–0.93) versus 1.16 (1.06–1.27) for major bleeding. Adjusted hazard ratios (95% CI) for the same time period were 0.85 (0.79–0.92), 0.84 (0.72–0.97) and 0.9 (0.78–1.04).
Conclusion
In this large, internation registry, a rhythm control strategy was initiated at baseline in about half of the patients with newly diagnosed non-valvular atrial fibrillation. After adjustment for confounding factors, a significantly lower risk of all-cause mortality and non-haemorrhagic stroke/systemic embolism were observed for patients that received an early rhythm control strategy.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This work was supported by the Thrombosis Research Institute (London, UK).
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Affiliation(s)
- M K Pope
- University of Oslo, Institute of Clinical Medicine , Oslo , Norway
| | - T S Hall
- Oslo University Hospital Ulleval, Department of Cardiology , Oslo , Norway
| | - D Atar
- Oslo University Hospital Ulleval, Department of Cardiology , Oslo , Norway
| | - S Virdone
- Thrombosis Research Institute , London , United Kingdom
| | - K Pieper
- Thrombosis Research Institute , London , United Kingdom
| | - P Jansky
- Motol University Hospital, Department of Cardiovascular Surgery , Prague , Czechia
| | - J Steffel
- University of Zurich , Zurich , Switzerland
| | - S Haas
- Technical University of Munich, Formerly Department of Medicine , Munich , Germany
| | - B J Gersh
- Mayo Clinic College of Medicine and Science, Department of Cardiovascular Medicine , Rochester , United States of America
| | - S Goto
- Tokai University School of Medicine , Kanagawa , Japan
| | - E Panchenko
- National Medical Research Center of Cardiology , Moscow , Russian Federation
| | | | - P Angchaisuksiri
- Ramathibodi Hospital, Department of Medicine , Mahidol University , Thailand
| | - A J Camm
- St George's University of London, Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute , London , United Kingdom
| | - A K Kakkar
- Thrombosis Research Institute , London , United Kingdom
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Takimoto R, Kamigaki T, Okada S, Ibe H, Oguma E, Goto S. Efficacy of Adjuvant Immune-cell Therapy Combined With Systemic Therapy for Solid Tumors. Anticancer Res 2022; 42:4179-4187. [PMID: 35896218 DOI: 10.21873/anticanres.15918] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/24/2022] [Accepted: 07/04/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The efficacy of adjuvant systemic therapy after surgical resection remains unsatisfactory; therefore, a new treatment strategy is required. We aimed to examine the efficacy of adjuvant immune-cell therapy using activated T lymphocytes with or without dendritic cell vaccination in combination with standard adjuvant systemic therapies in terms of the survival of patients with solid tumors, such as lung, gastric, pancreatic, colorectal, and breast cancers. PATIENTS AND METHODS A total of 141 patients with solid tumors were enrolled in this study. The correlation of overall survival and disease-free survival with various clinical factors such as age, sex, performance status score, clinical stage, treatment strategies, and vital status was investigated by univariate and multivariate analyses. RESULTS Multivariate analysis revealed that a performance status score of 0 was a favorable prognostic factor in the full analysis set of solid tumors (HR=0.209, 95%CI=0.065-0.676, p=0.0089) and might be the indication for immune-cell therapy in the adjuvant setting. CONCLUSION Adjuvant immune-cell therapy combined with other systemic therapies would potentially provide a survival benefit in patients with solid tumors.
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Affiliation(s)
- Rishu Takimoto
- Seta Clinic Group, Tokyo, Japan; .,Next Generation Cell and Immunotherapy, Advanced Research Institute for Health Science, Juntendo University, Tokyo, Japan.,LSI Sapporo Clinic, Sapporo, Japan
| | - Takashi Kamigaki
- Seta Clinic Group, Tokyo, Japan.,Next Generation Cell and Immunotherapy, Advanced Research Institute for Health Science, Juntendo University, Tokyo, Japan
| | | | | | | | - Shigenori Goto
- Seta Clinic Group, Tokyo, Japan.,Next Generation Cell and Immunotherapy, Advanced Research Institute for Health Science, Juntendo University, Tokyo, Japan
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Yoshihara H, Otani T, Nishiyama T, Omae Y, Tokunaga K, Fumiko O, Goto S, Kitaori T, Sugiura-Ogasawara M. O-301 Genome-wide association study identified meiotic variant associated with aneuploid pregnancy loss. Hum Reprod 2022. [DOI: 10.1093/humrep/deac106.094] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Which single nucleotide variant (SNVs) are associated with aneuploid pregnancy loss?
Summary answer
We identified a SNV on MEIG1 gene, which are associated with meiosis/spermiogenesis.
What is known already
Recurrent pregnancy loss (RPL) refers to the loss of two or more pregnancies, with a frequency of 5%. Chromosomal abnormalities in embryos are found in 80% of first trimester miscarriages, 86% of which are aneuploid. Recently, embryonic aneuploidy was found to be the most common cause of RPL, with a frequency of 40-50%. Most trisomy miscarriages are of maternal origin, with errors occurring during meiosis of the oocyte. Chromosome segregation abnormalities in oocytes are thought to be an event associated with increasing maternal age, but in addition, maternal genetic causes are thought to contribute.
Study design, size, duration
A Genome wide association study (GWAS) was performed on a clinically well characterized cohort of 189 women with RPL whose previous aborted conceptus was ascertained to be an aneuploid embryo. Samples were mainly collected from 2007 to 2018 mainly at Nagoya City University Hospital. For control samples, we used 1157 samples from the population-based prospective cohorts that included fertile women.
Participants/materials, setting, methods
All patients underwent a systematic examination. Patients with antiphospholipid syndrome, an abnormal chromosome in either partner, or uterine anomaly were excluded. Patients whose previously miscarried POC exhibited triploidy or 45, X were excluded. DNA was isolated from stored EDTA-blood samples and genotyped by Axiom Japonica-array v2659,503 SNVs). For the GWAS, a chi-squared test was applied to a two-by-two contingency table in allele frequency model.
Main results and the role of chance
The mean (SD) ages and number of previous miscarriages of the patients were 36.8 (4.3) and 3.09 (1.13). GWAS data revealed 5 SNVs with suggestive significance (p < 9.46e-06). The SNVs that showed the most significant associations (P = 1.06E-06, OR = 1.72) was located on meiosis/spermiogenesis associated 1 (MEIG1) gene under an allelic model after Bonferroni correction considering the number of analyzed SNVs. The SNV rs7908491 was reported as a splicing QTL in the MEIG1 gene, which is a meiosis/meiosis-associated factor and is plausibly associated with chromosome aneuploidy. This is the first GWAS in patients with RPL caused by aneuploidy.
Limitations, reasons for caution
Since this study was conducted in a single center and had a small sample size, it needs to be replicated in different centers with more subjects and on an international scale. Whole genome imputation analysis will be performed to detect SNVs with more significant associations.
Wider implications of the findings
Our findings demonstrate that a specific genotype of MEIG1 gene can be a risk factor for aneuploid pregnancy loss. The establishment of clinically applicable maternal germ cell markers could identify groups for whom PGT would be more useful or provide patients with counseling that provides prognostic information about pregnancy.
Trial registration number
not applicable
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Affiliation(s)
- H Yoshihara
- Nagoya City University Graduate School of Medical Sciences, Obstetrics and Gynecology , Nagoya, Japan
| | - T Otani
- Nagoya City University Graduate School of Medical Sciences , Public Health , Nagoya, Japan
| | - T Nishiyama
- Nagoya City University Graduate School of Medical Sciences , Public Health , Nagoya, Japan
| | - Y Omae
- National Center for Global Health and Medicine Genome Medical Science, Project-Toyama , Tokyo, Japan
| | - K Tokunaga
- National Center for Global Health and Medicine Genome Medical Science, Project-Toyama , Tokyo, Japan
| | - O Fumiko
- Nagoya City University Graduate School of Medical Sciences, Obstetrics and Gynecology , Nagoya, Japan
| | - S Goto
- Nagoya City University Graduate School of Medical Sciences, Obstetrics and Gynecology , Nagoya, Japan
| | - T Kitaori
- Nagoya City University Graduate School of Medical Sciences, Obstetrics and Gynecology , Nagoya, Japan
| | - M Sugiura-Ogasawara
- Nagoya City University Graduate School of Medical Sciences, Obstetrics and Gynecology , Nagoya, Japan
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12
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Sammons E, Hopewell JC, Chen F, Stevens W, Wallendszus K, Valdes-Marquez E, Dayanandan R, Knott C, Murphy K, Wincott E, Baxter A, Goodenough R, Lay M, Hill M, Macdonnell S, Fabbri G, Lucci D, Fajardo-Moser M, Brenner S, Hao D, Zhang H, Liu J, Wuhan B, Mosegaard S, Herrington W, Wanner C, Angermann C, Ertl G, Maggioni A, Barter P, Mihaylova B, Mitchel Y, Blaustein R, Goto S, Tobert J, DeLucca P, Chen Y, Chen Z, Gray A, Haynes R, Armitage J, Baigent C, Wiviott S, Cannon C, Braunwald E, Collins R, Bowman L, Landray M. Long-term safety and efficacy of anacetrapib in patients with atherosclerotic vascular disease. Eur Heart J 2022; 43:1416-1424. [PMID: 34910136 PMCID: PMC8986460 DOI: 10.1093/eurheartj/ehab863] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/30/2021] [Accepted: 12/02/2021] [Indexed: 01/04/2023] Open
Abstract
AIMS REVEAL was the first randomized controlled trial to demonstrate that adding cholesteryl ester transfer protein inhibitor therapy to intensive statin therapy reduced the risk of major coronary events. We now report results from extended follow-up beyond the scheduled study treatment period. METHODS AND RESULTS A total of 30 449 adults with prior atherosclerotic vascular disease were randomly allocated to anacetrapib 100 mg daily or matching placebo, in addition to open-label atorvastatin therapy. After stopping the randomly allocated treatment, 26 129 survivors entered a post-trial follow-up period, blind to their original treatment allocation. The primary outcome was first post-randomization major coronary event (i.e. coronary death, myocardial infarction, or coronary revascularization) during the in-trial and post-trial treatment periods, with analysis by intention-to-treat. Allocation to anacetrapib conferred a 9% [95% confidence interval (CI) 3-15%; P = 0.004] proportional reduction in the incidence of major coronary events during the study treatment period (median 4.1 years). During extended follow-up (median 2.2 years), there was a further 20% (95% CI 10-29%; P < 0.001) reduction. Overall, there was a 12% (95% CI 7-17%, P < 0.001) proportional reduction in major coronary events during the overall follow-up period (median 6.3 years), corresponding to a 1.8% (95% CI 1.0-2.6%) absolute reduction. There were no significant effects on non-vascular mortality, site-specific cancer, or other serious adverse events. Morbidity follow-up was obtained for 25 784 (99%) participants. CONCLUSION The beneficial effects of anacetrapib on major coronary events increased with longer follow-up, and no adverse effects emerged on non-vascular mortality or morbidity. These findings illustrate the importance of sufficiently long treatment and follow-up duration in randomized trials of lipid-modifying agents to assess their full benefits and potential harms. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number (ISRCTN) 48678192; ClinicalTrials.gov No. NCT01252953; EudraCT No. 2010-023467-18.
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Affiliation(s)
- E Sammons
- REVEAL Central Coordinating Office, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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13
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Goto S, Tamada K, Eto M. IL-7 and CCL19 producing CAR-T cells enhance antitumor efficacy against solid cancer by preventing antigen-loss tumor relapse. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01189-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Virdone S, Himmelreich J, Pieper K, Camm A, Bassand JP, Fox K, Fitzmaurice D, Goldhaber S, Goto S, Haas S, Kayani G, Misselwitz F, Turpie A, Verheugt F, Kakkar A. Comparative effectiveness of NOAC vs VKA in patients representing common clinical challenges: results from the GARFIELD-AF registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0557] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Large phase III trials of non-valvular atrial fibrillation (AF) patients have shown a favourable risk-to-benefit ratio with Non-Vitamin K antagonist oral anticoagulants (NOAC) compared to Vitamin K antagonists (VKA). Although the results of these trials are directly applicable to many AF patients, important subsets of patients were under-represented. Thus, there remains uncertainty about the safety and effectiveness of NOAC therapy in common challenging scenarios.
Purpose
The main purpose of this study is to quantify and compare the impact of NOAC vs VKA in settings where clinical uncertainty still exists and represents a considerable proportion of AF patients in clinical practice.
Methods
The analysis was conducted in patients enrolled in the largest AF multinational prospective registry (the Global Anticoagulant Registry in the FIELD–Atrial Fibrillation, GARFIELD-AF). We evaluated the effectiveness and safety of NOAC compared to VKA in three groups of patients representing common clinical challenges (CCC): 1) elderly patients (i.e. age ≥75), 2) increased bleeding risk (i.e. HAS-BLED ≥3 or prior bleeding), and 3) renal impairment (i.e. CKD stages II to IV).
We applied a propensity score using an overlap weighting scheme to obtain unbiased estimates of the treatment effect within each CCC group. Weights were applied to Cox proportional hazards models to estimate the effects of the NOAC vs VKA comparison on the occurrence of death, non-haemorrhagic stroke/SE and major bleeding within 2 years of enrolment.
Results
Comparative effectiveness of NOAC vs VKA was assessed in 8607 elderly patients, 1711 with increased bleeding risk, and 4460 with renal impairment.
The proportion of anticoagulated patients was low in patients with increased bleeding risk (59%), while in the other two CCC groups the corresponding proportion was close to the one in the overall population (72%).
Among anticoagulated patients, NOAC were prescribed to 50–55% of patients in the CCC groups. Patients with a high risk of bleeding and impaired kidney function were less likely to be prescribed NOAC instead of VKA compared with the overall anticoagulated population (−5.4% and −4.7%, respectively).
Propensity-weighted hazard ratios for all-cause mortality favored NOAC (vs VKA) in all three CCC groups: 0.86 (95% CI: 0.74–0.99) for elderly patients, 0.73 (0.53–1.00) for patients with increased bleeding risk, and 0.80 (0.65–0.98) for patients with renal impairment (Figure).
Conclusion
In the selected common challenging scenarios of AF patients, there were significant mortality reductions in favor of NOACs compared to VKAs. These observations suggest that NOACs are safe and effective in patients who are elderly, at increased bleeding risk, or renally impaired.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This study was supported by an unrestricted research grant from Bayer AG, Berlin, Germany, to TRI, London, UK, which sponsors the GARFIELD-AF registry. The work is supported by KANTOR CHARITABLE FOUNDATION for the Kantor-Kakkar Global Centre for Thrombosis Science.
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Affiliation(s)
- S Virdone
- Thrombosis Research Institute, London, United Kingdom
| | - J.C.L Himmelreich
- Thrombosis Research Institute, London, UK and Amsterdam UMC, Department of General Practice, Amsterdam, Netherlands (The)
| | - K.S Pieper
- Thrombosis Research Institute, London, United Kingdom
| | - A.J Camm
- St George's University of London, Cardiology Clinical Academic Group Molecular & Clinical Sciences Research Institute, London, United Kingdom
| | - J.-P Bassand
- Thrombosis Research Institute, London, UK and University of Besançon, Besancon, France
| | - K.A.A Fox
- University of Edinburgh, Edinburgh, United Kingdom
| | | | - S.Z Goldhaber
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - S Goto
- Tokai University School of Medicine, Kanagawa, Japan
| | - S Haas
- Technical University of Munich, Munich, Germany
| | - G Kayani
- Thrombosis Research Institute, London, United Kingdom
| | | | | | - F.W.A Verheugt
- Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, Netherlands (The)
| | - A.K Kakkar
- Thrombosis Research Institute and University College London, London, United Kingdom
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15
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Himmelreich J, Virdone S, Camm A, Harskamp R, Pieper K, Fox K, Bassand JP, Fitzmaurice D, Goldhaber S, Goto S, Haas S, Misselwitz F, Turpie A, Verheugt F, Kakkar A. Safety and efficacy of apixaban and rivaroxaban versus warfarin in real-world atrial fibrillation patients are similar to their randomized trials: insights from GARFIELD-AF registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0559] [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
Introduction
Generalisability of patient selection in the landmark trials for the approval of apixaban (ARISTOTLE) and rivaroxaban (ROCKET AF) for use in non-valvular atrial fibrillation (AF) is limited. Although observational data have confirmed the safety and efficacy of these non-vitamin K oral anticoagulants (NOACs) in unselected AF populations, robust replication of randomized trials in observational studies is warranted.
Purpose
To investigate the proportion of real-world AF patients who would have been eligible for the landmark trials for ARISTOTLE and ROCKET AF, and to assess reproducibility of these landmark trials in the largest, worldwide, prospective registry of newly diagnosed AF patients.
Methods
We analysed data from the Global Anticoagulant Registry in the FIELD–Atrial Fibrillation (GARFIELD-AF) registry. We assessed the eligibility of AF patients treated with apixaban or vitamin K antagonist (VKA) for ARISTOTLE, and those treated with rivaroxaban or VKA for ROCKET AF, using the selection criteria of the original trials. We replicated the inclusion and exclusion criteria of ARISTOTLE and ROCKET AF by deriving the set of patients eligible for each trial and calculating the adjusted hazard ratios (HRs) for stroke or systemic embolism, major bleeding, and all-cause mortality within 2 years of enrolment, using a propensity score overlap weighted Cox model. We compared the results from observational data with those reported in the original ARISTOTLE and ROCKET AF publications.
Results
Among all patients enrolled in GARFIELD-AF, 67% were eligible for recruitment in ARISTOTLE and 37% in ROCKET AF. The corresponding proportions among anticoagulated patients were 70% and 39%, respectively. Among patients on apixaban and VKA, 2570/3615 (71%) and 8005/11718 (68%), respectively, were eligible for ARISTOTLE. Of patients using rivaroxaban and VKA, 2005/4914 (41%) and 4368/11721 (37%), respectively, were eligible for ROCKET AF. Annual eligibility rates among real-world NOAC users were stable over time (Figure 1). Registry participants on rivaroxaban or VKA eligible for ROCKET AF had a higher burden of cardiovascular co-morbidity than those on apixaban or VKA eligible for ARISTOTLE. The adjusted HRs in observational data were compatible with results of the original trials in all selected outcomes (Figure 2).
Conclusion
Representativeness of ARISTOTLE and ROCKET AF for real-world AF populations was limited, with ROCKET AF's criteria being more restrictive. Despite inclusion of only incident AF cases in GARFIELD-AF versus mostly prevalent AF cases in the original trials, the results were similar. Our work indicates that the results from ARISTOTLE and ROCKET AF appear robust and reproducible in real-world patients with newly diagnosed AF.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This work was supported by an unrestricted research grant from Bayer AG, Berlin, Germany, to TRI, London, UK, which sponsors the GARFIELD-AF registry. This work is supported by KANTOR CHARITABLE FOUNDATION for the Kantor-Kakkar Global Centre for Thrombosis Science.
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Affiliation(s)
- J.C.L Himmelreich
- Thrombosis Research Institute, London, UK and Amsterdam UMC, Department of General Practice, Amsterdam, Netherlands (The)
| | - S Virdone
- Thrombosis Research Institute, London, United Kingdom
| | - A.J Camm
- St George's University of London, Cardiology Clinical Academic Group Molecular & Clinical Sciences Research Institute, London, United Kingdom
| | - R.E Harskamp
- Amsterdam UMC Location AMC, Department of General Practice, Amsterdam Public Health, Amsterdam, Netherlands (The)
| | - K.S Pieper
- Thrombosis Research Institute, London, United Kingdom
| | - K.A.A Fox
- University of Edinburgh, Edinburgh, United Kingdom
| | - J.-P Bassand
- Thrombosis Research Institute, London, UK and University of Besançon, Besançon, France
| | | | - S.Z Goldhaber
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - S Goto
- Tokai University School of Medicine, Kanagawa, Japan
| | - S Haas
- Technical University of Munich, Munich, Germany
| | | | | | - F.W.A Verheugt
- Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, Netherlands (The)
| | - A.K Kakkar
- Thrombosis Research Institute and University College London, London, United Kingdom
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16
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Himmelreich J, Virdone S, Camm A, Harskamp R, Pieper K, Fox K, Bassand JP, Fitzmaurice D, Goldhaber S, Goto S, Haas S, Misselwitz F, Turpie A, Verheugt F, Kakkar A. Comparing rivaroxaban and apixaban in GARFIELD-AF according to ROCKET AF and ARISTOTLE trial selection criteria. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0560] [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
Introduction
There is debate on the extent to which differences in selection criteria and outcome definitions used for ARISTOTLE and ROCKET AF – the trials for the approval of apixaban and rivaroxaban, respectively, for non-valvular atrial fibrillation – influenced their differences in outcomes relative to vitamin K antagonists (VKAs). In absence of randomized trials comparing the two non-vitamin K oral antagonists (NOACs) directly, this question can be addressed using data from the Global Anticoagulant Registry in the FIELD–Atrial Fibrillation (GARFIELD-AF) registry, a large, high-quality prospective observational study of newly diagnosed AF patients.
Purpose
To assess the influence of the ARISTOTLE and ROCKET AF inclusion and exclusion criteria on results for safety and efficacy of apixaban and rivaroxaban versus VKA using uniform endpoints in GARFIELD-AF.
Methods
We selected patients treated with apixaban, rivaroxaban or VKA from GARFIELD-AF who were eligible for ARISTOTLE or ROCKET AF as per the original trial criteria. We replicated the inclusion criteria in the GARFIELD-AF population and derived those eligible for each trial. We calculated the adjusted hazard ratios (HRs) for stroke or systemic embolism, major bleeding and all-cause mortality within 2 years of enrolment for apixaban as well as rivaroxaban versus VKA (reference) in those eligible for each trial. We used a propensity score overlap weighted Cox model to emulate trial randomization between NOAC and VKA.
Results
Among patients on apixaban, rivaroxaban and VKA, 2570/3615 (71%), 3560/4914 (72%) and 8005/11734 (71%) were eligible for ARISTOTLE, respectively, and 1612/3615 (45%), 2005/4914 (41%) and 4368/11734 (37%), respectively, were eligible for ROCKET AF. Cardiovascular co-morbidity was greater in those eligible for ROCKET AF than in those eligible for ARISTOTLE. In patients selected using the more restrictive ROCKET AF criteria, apixaban and rivaroxaban users showed similar results when compared with VKA (see Figure). The two sets of comparisons remained non-significant in difference when applying the less restrictive ARISTOTLE criteria, but there were trends for less similarity.
Conclusion
Apixaban showed similar results to rivaroxaban when selecting for higher-risk patients using the ROCKET AF criteria. In patients selected using ARISTOTLE criteria the similarity was less pronounced. Our results underline the problems faced in comparing treatments across rather than within clinical trials. For instance, co-morbidities were substantially different for patients recruited into the original ARISTOTLE and ROCKET AF trials. The current work points to the need for high-quality observational data for assessment of relative drug performance in absence of direct drug comparisons through randomized trials.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This work was supported by an unrestricted research grant from Bayer AG, Berlin, Germany, to TRI, London, UK, which sponsors the GARFIELD-AF registry. This work is supported by KANTOR CHARITABLE FOUNDATION for the Kantor-Kakkar Global Centre for Thrombosis Science.
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Affiliation(s)
- J.C.L Himmelreich
- Thrombosis Research Institute, London, UK and Amsterdam UMC, Department of General Practice, Amsterdam, Netherlands (The)
| | - S Virdone
- Thrombosis Research Institute, London, United Kingdom
| | - A.J Camm
- St George's University of London, Cardiology Clinical Academic Group Molecular & Clinical Sciences Research Institute, London, United Kingdom
| | - R.E Harskamp
- Amsterdam UMC Location AMC, Department of General Practice, Amsterdam Public Health, Amsterdam, Netherlands (The)
| | - K.S Pieper
- Thrombosis Research Institute, London, United Kingdom
| | - K.A.A Fox
- University of Edinburgh, Edinburgh, United Kingdom
| | - J.-P Bassand
- Thrombosis Research Institute, London, UK and University of Besançon, Besançon, France
| | | | - S.Z Goldhaber
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - S Goto
- Tokai University School of Medicine, Kanagawa, Japan
| | - S Haas
- Technical University of Munich, Munich, Germany
| | | | | | - F.W.A Verheugt
- Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, Netherlands (The)
| | - A.K Kakkar
- Thrombosis Research Institute and University College London, lONDON, United Kingdom
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17
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Yoshihara H, Sugiura-Ogasawara M, Kitaori T, Goto S. P–377 Association between antinuclear antibodies and pregnancy prognosis in recurrent pregnancy loss patients. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.376] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Can antinuclear antibody (ANA) affect the subsequent live birth rate in patients with recurrent pregnancy loss (RPL) who have no antiphospholipid antibodies (aPLs)?
Summary answer
ANA did not affect the pregnancy prognosis of RPL women.
What is known already
The prevalence of ANA is well-known to be higher in RPL patients. Our previous study found no difference in the live birth rates of ANA-positive and -negative patients who had no aPLs. Higher miscarriage rates were also reported in ANA-positive patients compared to ANA-negative patients with RPL. The RPL guidelines of the ESHRE state that “ANA testing can be considered for explanatory purposes.” However, there have been a limited number of studies on this issue and sample sizes have been small, and the impact of ANA on the pregnancy prognosis is unclear.
Study design, size, duration
An observational cohort study was conducted at Nagoya City University Hospital between 2006 and 2019. The study included 1,108 patients with a history of 2 or more pregnancy losses.
Participants/materials, setting, methods
4D-Ultrasound, hysterosalpingography, chromosome analysis for both partners, aPLs and blood tests for ANA and diabetes mellitus were performed before a subsequent pregnancy. ANAs were measured by indirect immunofluorescence. The cutoff dilution used was 1:40. In addition, patients were classified according to the ANA pattern on immunofluorescence staining. Live birth rates were compared between ANA-positive and ANA-negative patients after excluding patients with antiphospholipid syndrome, an abnormal chromosome in either partner and a uterine anomaly.
Main results and the role of chance
The 994 patients were analyzed after excluding 40 with a uterine anomaly, 43 with a chromosome abnormality in either partner and 32 with APS. The rate of ANA-positive patients was 39.2% (390/994) when the 1: 40 dilution result was positive. With a 1:160 dilution, the rate of ANA-positive patients was 3.62% (36/994). The live birth rate was calculated for 798 patients, excluding 196 patients with unexplained RPL who had been treated with any medication.
With the use of the 1: 40 dilution, the subsequent live birth rates were 71.34% (219/307) for the ANA-positive group and 70.67% (347/491) for the ANA-negative group (OR, 95%CI; 0.968, 0.707–1.326). After excluding miscarriages with embryonic aneuploidy, chemical pregnancies and ectopic pregnancies, live birth rates were 92.41% (219/237) for the ANA-positive group and 92.04% (347/377) for the ANA-negative group (0.951, 0.517–1.747). Using the 1:160 dilution, the subsequent live birth rates were 84.62% (22/26) for the ANA-positive group, and 70.47% (544/772) for the ANA-negative group (0.434, 0.148–1.273).
Subgroup analyses were performed for each pattern on immunofluorescence staining, but there was no significant difference in the live birth rate between the two groups.
Limitations, reasons for caution
The effectiveness of immunotherapies could not be evaluated. However, the results of this study suggest that it is not necessary.
Wider implications of the findings: The measurement of ANA might not be necessary for the screening of patients with RPL who have no features of collagen disease.
Trial registration number
Not applicable
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Affiliation(s)
- H Yoshihara
- Nagoya City University Graduate School of Medical Sciences, Obstetrics and Gynecology, Nagoya, Japan
| | - M Sugiura-Ogasawara
- Nagoya City University Graduate School of Medical Sciences, Obstetrics and Gynecology, Nagoya, Japan
| | - T Kitaori
- Nagoya City University Graduate School of Medical Sciences, Obstetrics and Gynecology, Nagoya, Japan
| | - S Goto
- Nagoya City University Graduate School of Medical Sciences, Obstetrics and Gynecology, Nagoya, Japan
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18
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Yoshihara H, Sugiura-Ogasawara M, Kitaori T, Goto S. P-377 Association between antinuclear antibodies and pregnancy prognosis in recurrent pregnancy loss patients. Hum Reprod 2021. [DOI: 10.1093/humrep/deab127.069] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Can antinuclear antibody (ANA) affect the subsequent live birth rate in patients with recurrent pregnancy loss (RPL) who have no antiphospholipid antibodies (aPLs)?
Summary answer
ANA did not affect the pregnancy prognosis of RPL women.
What is known already
The prevalence of ANA is well-known to be higher in RPL patients. Our previous study found no difference in the live birth rates of ANA-positive and -negative patients who had no aPLs. Higher miscarriage rates were also reported in ANA-positive patients compared to ANA-negative patients with RPL. The RPL guidelines of the ESHRE state that “ANA testing can be considered for explanatory purposes.” However, there have been a limited number of studies on this issue and sample sizes have been small, and the impact of ANA on the pregnancy prognosis is unclear.
Study design, size, duration
An observational cohort study was conducted at Nagoya City University Hospital between 2006 and 2019. The study included 1,108 patients with a history of 2 or more pregnancy losses.
Participants/materials, setting, methods
4D-Ultrasound, hysterosalpingography, chromosome analysis for both partners, aPLs and blood tests for ANA and diabetes mellitus were performed before a subsequent pregnancy. ANAs were measured by indirect immunofluorescence. The cutoff dilution used was 1:40. In addition, patients were classified according to the ANA pattern on immunofluorescence staining. Live birth rates were compared between ANA-positive and ANA-negative patients after excluding patients with antiphospholipid syndrome, an abnormal chromosome in either partner and a uterine anomaly.
Main results and the role of chance
The 994 patients were analyzed after excluding 40 with a uterine anomaly, 43 with a chromosome abnormality in either partner and 32 with APS. The rate of ANA-positive patients was 39.2 % (390/994) when the 1: 40 dilution result was positive. With a 1:160 dilution, the rate of ANA-positive patients was 3.62 % (36/994). The live birth rate was calculated for 798 patients, excluding 196 patients with unexplained RPL who had been treated with any medication.
With the use of the 1
40 dilution, the subsequent live birth rates were 71.34 % (219/307) for the ANA-positive group and 70.67 % (347/491) for the ANA-negative group (OR, 95%CI; 0.968, 0.707-1.326). After excluding miscarriages with embryonic aneuploidy, chemical pregnancies and ectopic pregnancies, live birth rates were 92.41 % (219/237) for the ANA-positive group and 92.04 % (347/377) for the ANA-negative group (0.951, 0.517-1.747).
Using the 1:160 dilution, the subsequent live birth rates were 84.62 % (22/26) for the ANA-positive group, and 70.47 % (544/772) for the ANA-negative group (0.434, 0.148-1.273).
Subgroup analyses were performed for each pattern on immunofluorescence staining, but there was no significant difference in the live birth rate between the two groups.
Limitations, reasons for caution
The effectiveness of immunotherapies could not be evaluated. However, the results of this study suggest that it is not necessary.
Wider implications of the findings
The measurement of ANA might not be necessary for the screening of patients with RPL who have no features of collagen disease.
Trial registration number
not applicable
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Affiliation(s)
- H Yoshihara
- Nagoya City University Graduate School of Medical Sciences, Obstetrics and Gynecology, Nagoya, Japan
| | - M Sugiura-Ogasawara
- Nagoya City University Graduate School of Medical Sciences, Obstetrics and Gynecology, Nagoya, Japan
| | - T Kitaori
- Nagoya City University Graduate School of Medical Sciences, Obstetrics and Gynecology, Nagoya, Japan
| | - S Goto
- Nagoya City University Graduate School of Medical Sciences, Obstetrics and Gynecology, Nagoya, Japan
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Takimoto R, Kamigaki T, Okada S, Ibe H, Oguma E, Goto S. Prognostic Factors for Advanced/Recurrent Breast Cancer Treated With Immune-cell Therapy. Anticancer Res 2021; 41:4133-4141. [PMID: 34281884 DOI: 10.21873/anticanres.15216] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Advanced/recurrent breast cancer (ARBC) still has a poor prognosis; therefore, new treatment strategies are required. In this retrospective study, we aimed to investigate the efficacy of immune-cell therapy using T lymphocytes activated in vitro with or without dendritic cell vaccination in combination with standard therapies in terms of the survival of patients with ARBC. PATIENTS AND METHODS A total of 127 patients with ARBC were enrolled in this study. The correlation between overall survival and various clinical factors of each ARBC subset was examined by univariate and multivariate analyses. RESULTS Multivariate analysis demonstrated that performance status (PS) 0, the absence of prior chemotherapy, liver/pleural metastasis, and the presence of combined surgery in ARBC and PS 0 or the absence of liver metastasis in the HR+/HER- subset are indications for immune-cell therapy. CONCLUSION A survival benefit could be potentially obtained by a combination of immune-cell therapy with other therapies in ARBC patients.
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Affiliation(s)
- Rishu Takimoto
- Seta Clinic Group, Tokyo, Japan .,Department of Next Generation Cell and Immune Therapy, Juntendo University, Tokyo, Japan.,LSI Sapporo Clinic, Sapporo, Japan
| | - Takashi Kamigaki
- Seta Clinic Group, Tokyo, Japan.,Department of Next Generation Cell and Immune Therapy, Juntendo University, Tokyo, Japan
| | | | | | | | - Shigenori Goto
- Seta Clinic Group, Tokyo, Japan.,Department of Next Generation Cell and Immune Therapy, Juntendo University, Tokyo, Japan
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20
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Goto S, Tamada K, Eto M. Anti-mesothelin human CAR-T cells producing IL-7 and CCL19 enhance antitumor efficacy against solid cancer in orthotopic and PDX mouse models. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00932-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Takimoto R, Kamigaki T, Gotoda T, Takahashi T, Okada S, Ibe H, Oguma E, Goto S. Esophageal cancer responsive to the combination of immune cell therapy and low-dose nivolumab: two case reports. J Med Case Rep 2021; 15:191. [PMID: 33827668 PMCID: PMC8028114 DOI: 10.1186/s13256-020-02634-z] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/14/2020] [Indexed: 02/05/2023] Open
Abstract
Background Blocking the programmed death 1 pathway by immune checkpoint inhibitors induces dramatic antitumor activity in patients with malignant tumors. However, the clinical response to immune checkpoint inhibitors remains limited owing to the patients’ immunological status, such as the number of lymphocytes, programmed death ligand 1 expression, and tumor mutation burden. In this study, we successfully treated two patients with advanced esophageal cancer who responded to the combination of adoptive immune cell therapy and a low-dose immune checkpoint inhibitor, nivolumab. Case presentation Two Asian (Japanese) patients with advanced esophageal cancer who were resistant to conventional chemoradiation therapy were referred to our hospital for immune therapy. Case 1 was a 66-year-old woman who was diagnosed as having esophageal cancer. She received concurrent chemoradiation therapy and then underwent subtotal esophagectomy, after which she became cancer free. However, she relapsed, and cancer cells were found in the lung and lymph nodes 6 months later. She enrolled in a clinical trial at our institution (clinical trial number UMIN000028756). She received adoptive immune cell therapy twice at a 2-week interval followed by low-dose nivolumab with adoptive immune cell therapy four times at 2-week intervals. A follow-up computed tomography scan showed partial response, with mass reduction of the metastatic lung and mediastinal lesions. Case 2 was a 77-year-old man. He received concurrent chemoradiation therapy with fluoropyrimidine/platinum, and gastroscopy revealed complete remission of esophageal cancer. He was disease free for 5 months, but routine computed tomography revealed multiple metastases in his lungs and lymph nodes. He visited our clinic to receive adoptive immune cell therapy and immune checkpoint inhibitor combination therapy. Radiographic evidence showed continuous improvement of lesions. There was no evidence of severe adverse events during the combination therapy. Conclusion The combination of adoptive immune cell therapy and an immune checkpoint inhibitor might be a possible treatment strategy for advanced esophageal cancer. Trial registration UMIN000028756. Registered 14 September 2017
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Affiliation(s)
- Rishu Takimoto
- Seta Clinic Group, New Surugadai Bldg. 3F, 2-1-45 Kandasurugadai, Chiyoda-ku, Tokyo, 101-0062, Japan. .,Department of Next-Generation Cell and Immune Therapy, Graduate School of Medicine, Juntendo University, Yamanoue Bldg. 7F, 3-2-6 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Takashi Kamigaki
- Seta Clinic Group, New Surugadai Bldg. 3F, 2-1-45 Kandasurugadai, Chiyoda-ku, Tokyo, 101-0062, Japan.,Department of Next-Generation Cell and Immune Therapy, Graduate School of Medicine, Juntendo University, Yamanoue Bldg. 7F, 3-2-6 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Nihon University, 1-6, Kandasurugadai, Chiyoda-ku, Tokyo, 101-8309, Japan
| | - Toshimi Takahashi
- Division of Gastroenterology and Hepatology, Nihon University, 1-6, Kandasurugadai, Chiyoda-ku, Tokyo, 101-8309, Japan
| | - Sachiko Okada
- Seta Clinic Group, New Surugadai Bldg. 3F, 2-1-45 Kandasurugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
| | - Hiroshi Ibe
- Seta Clinic Group, New Surugadai Bldg. 3F, 2-1-45 Kandasurugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
| | - Eri Oguma
- Seta Clinic Group, New Surugadai Bldg. 3F, 2-1-45 Kandasurugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
| | - Shigenori Goto
- Seta Clinic Group, New Surugadai Bldg. 3F, 2-1-45 Kandasurugadai, Chiyoda-ku, Tokyo, 101-0062, Japan.,Department of Next-Generation Cell and Immune Therapy, Graduate School of Medicine, Juntendo University, Yamanoue Bldg. 7F, 3-2-6 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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22
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Maeda A, Murakami M, Iwasaki R, Goto S, Kitagawa K, Sakai H, Mori T. Three-dimensional conformal radiation therapy for canine aortic body tumour: 6 cases (2014-2019). J Small Anim Pract 2020; 62:385-390. [PMID: 33300156 DOI: 10.1111/jsap.13241] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine the feasibility of three-dimensional conformal radiation therapy for canine aortic body tumours. MATERIALS AND METHODS Medical records of dogs that had undergone three-dimensional conformal radiation therapy with presumptive diagnosis of aortic body tumour were reviewed for clinical characteristics, treatment modality and outcomes. RESULTS Eight dogs were diagnosed with aortic body tumour and were treated with three-dimensional conformal radiation therapy. One dog had proliferation of a mass in the right atrium during treatment and died of respiratory distress. Another dog did not undergo follow-up CT to evaluate the treatment response due to the increased blood urea nitrogen values. The remaining 6 dogs were included in the case series. Radiotherapy was performed using a median dose per fraction of 7 Gy (3.3-7.14 Gy), a median of seven divided doses (7-15) and a total median dose of 49 Gy (45-50 Gy). The median number of CT scans during the follow-up period was 5 (range: 3-8 times). CT revealed acute side effects in four dogs-grade 1 effects related to the lung (n = 4) and skin (n = 2). Self-limiting or asymptomatic late side effects (grade 1 lung-related effect) were observed in three dogs. After therapy, one dog demonstrated a complete response, another demonstrated a partial response and the disease remained stable in four animals. The median follow-up period was 514.5 (235-1219) days. After three-dimensional conformal radiation therapy, the aortic body tumour reduced gradually over time without regrowth in all these 6 dogs. CLINICAL SIGNIFICANCE In this small case series, aortic body tumours responded to three-dimensional conformal radiation therapy. Transient and self-limiting side effects of the treatments were common. Further controlled studies are required to prove the effectiveness and the safety of this intervention.
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Affiliation(s)
- A Maeda
- Department of Veterinary Medicine, Faculty of Applied Biological Sciences, Gifu University, Gifu, Japan
| | - M Murakami
- Laboratory of Veterinary Clinical Oncology, Department of Veterinary Medicine, Gifu University, Gifu5011193, Japan
| | - R Iwasaki
- Animal Medical Center, Gifu University, Gifu5011193, Japan
| | - S Goto
- Animal Medical Center, Gifu University, Gifu5011193, Japan
| | - K Kitagawa
- Department of Small Animal Clinical Science, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, 48824, USA
| | - H Sakai
- Laboratory of Veterinary Pathology, Department of Veterinary Medicine, Gifu University, Gifu, 5011193, Japan
| | - T Mori
- Laboratory of Veterinary Clinical Oncology, Department of Veterinary Medicine, Gifu University, Gifu5011193, Japan.,Center for Highly Advanced Integration of Nano and Life Sciences, Gifu University (G-CHAIN), Gifu, Japan
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23
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Shinya Y, Hiraide T, Kataoka M, Momoi M, Goto S, Katsumata Y, Endo J, Sano M, Kosaki K, Fukuda K. A novel causative gene variant, TNFRSF13B p.Gly76Ser, in patients with pulmonary arterial hypertension. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2310] [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: 11/13/2022] Open
Abstract
Abstract
Background
Pulmonary artery hypertension (PAH) is a poor prognostic disease. Some causative genes were reported as the PAH-associated genes. However, the pathogenetic variants in PAH-associated genes have not been identified in majority of patients with idiopathic PAH.
Purpose
Our aim was to investigate the new causative gene variants associated with PAH.
Methods
We performed whole-exome sequencing in 272 patients with idiopathic/heritable PAH. Structural analysis simulation was performed to define how the candidate gene variant affected the structure of protein.
Results
We identified the heterozygous substitution change of c.226G>A (p.Gly76Ser, rs146436713) in tumor necrotic factor receptor superfamily 13B gene (TNFRSF13B) (NM_012452.2) in 6 (2.2%) patients with idiopathic/heritable PAH, although the allele frequency of this rare variant is 0% in Integrative Japanese Genome Variation Database (control population database). Two of the six cases were blood relatives, although they did not have the known causative gene variants of PAH. One of these two relatives died of right heart failure despite the combination medical therapy, and her pathological anatomy demonstrated intimal thickening and medial hypertrophy in the pulmonary arteries, formation of plexiform lesions (Heath-Edwards classification grade V). Time-lapse images from structural analysis simulation showed the instability of N-terminal in the protein, which regulates the vascular inflammation, synthesized from TNFRSF13B p.Gly76Ser variant (Figure), suggesting that p.Gly76Ser variant may be involved in the development of PAH via aberrant inflammation in pulmonary vessels.
Conclusions
TNFRSF13B p.Gly76Ser variant is a candidate of causative gene variant for PAH.
Structural analysis of proteins
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- Y Shinya
- Keio University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - T Hiraide
- Keio University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - M Kataoka
- Keio University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - M Momoi
- Keio University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - S Goto
- Keio University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - Y Katsumata
- Keio University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - J Endo
- Keio University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - M Sano
- Keio University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - K Kosaki
- Keio University School of Medicine, Center for Medical Genetics, Tokyo, Japan
| | - K Fukuda
- Keio University School of Medicine, Department of Cardiology, Tokyo, Japan
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24
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Camm C, Camm A, Virdone S, Bassand JP, Fitzmaurice D, Fox K, Goldhaber S, Goto S, Haas S, Turpie A, Verheugt F, Misselwitz F, Kayani G, Pieper K, Kakkar A. The effect of body mass index on clinical outcomes in patients with newly diagnosed atrial fibrillation in the GARFIELD-AF registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0490] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Higher body mass index (BMI) is associated with a higher risk of atrial fibrillation (AF). However, previous evidence has suggested an inverse association between BMI and risk of AF outcomes.
Purpose
To explore the association between BMI and outcomes in those with newly diagnosed AF in the GARFIELD-AF registry.
Methods
GARFIELD-AF is an international registry of consecutively recruited patients aged ≥18 years with newly diagnosed AF and ≥1 stroke risk factor. Data were collected prospectively on 52,080 patients. Participants with missing or extreme BMI values and those without two-year follow-up were excluded. Cox proportional hazard models were used to estimate the effect of BMI on the risk of outcomes. Models were adjusted for age, sex, ethnicity, smoking, alcohol, and ≥moderate chronic kidney disease. Where appropriate participants were divided into groups based on BMI. Restricted cubic splines were used to assess non-linear relationships.
Results
BMI and outcome data were available for 40,495 patients. Those with higher BMI were generally younger, and more likely to have pre-existing hypertension, diabetes, or vascular disease (Table). Underweight patients received anticoagulation less often than those in other groups (60.3% vs 67.9%, respectively). During follow-up, 2,801 participants (6.9%) died and 603 (1.5%) had new/worsening heart failure. Following adjustment for potential confounders, a U-shaped relationship was seen between BMI and all-cause mortality and new/worsening heart failure (Figure). For all-cause mortality, the lowest risk was at 30kg/m2. Below this level, there was an 8% higher risk of mortality (95% confidence interval (CI) 6 to 9%) per 1kg/m2 lower BMI. Above 30kg/m2, there was a 5% higher risk of mortality per 1kg/m2 higher BMI (95% CI 4 to 7%). For new/worsening heart failure, the lowest risk was at 25kg/m2. Above this level, 1kg/m2 higher BMI was associated with an 5% higher risk (95% CI 13 to 6%).
Conclusions
BMI was an important risk factor for both all-cause mortality and new/worsening heart failure in AF. Those at both extremes of BMI are at higher risk.
BMI and selected outcomes
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): The GARFIELD-AF registry is funded by an unrestricted research grant from Bayer AG.
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Affiliation(s)
- C.J.F Camm
- University of Oxford, Oxford, United Kingdom
| | - A.J Camm
- St George's University of London, Cardiology Clinical Academic Group Molecular & Clinical Sciences Research Institute,, London, United Kingdom
| | - S Virdone
- Thrombosis Research Institute, London, United Kingdom
| | - J.-P Bassand
- Thrombosis Research Institute, London, UK and University of Besançon, Besançon, France
| | | | - K.A.A Fox
- University of Edinburgh, Edinburgh, United Kingdom
| | - S.Z Goldhaber
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - S Goto
- Tokai University School of Medicine, Kanagawa, Japan
| | - S Haas
- Technical University of Munich, Formerly Department of Medicine, Munich, Germany
| | | | - F.W.A Verheugt
- Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, Netherlands (The)
| | | | - G Kayani
- Thrombosis Research Institute, London, United Kingdom
| | - K.S Pieper
- Thrombosis Research Institute, London, United Kingdom
| | - A.K Kakkar
- Thrombosis Research Institute and University College London, London, United Kingdom
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25
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Cools F, Johnson D, Pieper K, Camm A, Bassand JP, Fitzmaurice D, Fox K, Goldhaber S, Goto S, Haas S, Turpie A, Verheugt F, Misselwitz F, Kayani G, Kakkar A. Permanent discontinuation of different anticoagulants in patients with atrial fibrillation and the impact on clinical outcome: data from the GARFIELD-AF registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0639] [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: 11/13/2022] Open
Abstract
Abstract
Background
Non-Vitamin K Antagonists (NOAC) are replacing vitamin K Antagonists (VKA) as first line oral anticoagulant therapy (OAC) in patients with non-valvular atrial fibrillation (NVAF). Discontinuation of OAC might put patients at increased risk. It was anticipated that patients who were on NOAC would discontinue OAC less.
Purpose
We compare the rates and impact on outcome of the discontinuation of NOAC and VKA using data from the GARFIELD-AF registry.
Methods
Patients included in GARFIELD-AF, had a new diagnosis of NVAF and at least 1 stroke risk factor. In this analysis 26,299 patients (VKA: 13,012; NOAC: 13,287) that received OAC were included. Permanent discontinuation was defined as stopping OAC for at least 7 consecutive days (whether or not restarted during follow-up). Marginal structural Cox proportional hazards models estimated the effect of discontinuation on death, cardiovascular (CV) death, non-haemorrhagic stroke + systemic embolism (NHS+SE), myocardial infarction (MI), or combined endpoints. Adjustments were made for both baseline factors and time dependent variables.
Results
Of all patients, 15.6% discontinued OAC (VKA: 15.4%; NOAC: 15.8%) over a median follow-up of 181 days (IQR: 359). Most discontinued early (67.0% of patients on VKA and 47.1% of patients on NOAC ≤4 months). Significantly higher discontinuation risk was seen with worsening kidney function, coronary artery disease, history of bleeding (baseline factors), as well as with all types of bleeding (time dependent factors). Lower discontinuation rates were seen with history of stroke/TIA, hypertension, increasing age, permanent AF (all p<0.01).
Mean CHA2DS2-VASc score was 3 in all groups. Patients in both treatment arms who discontinued were at increased risk for death, NHS+SE, MI as well as combined endpoints of death/NHS+SE/MI, death/NHS+SE and a trend towards higher CV death (Figure 1). All interaction tests for the interaction of treatment and discontinuation had a p value >0.4. The association between discontinuation and outcomes did not change when a 30 day discontinuation window was used.
Conclusion
The rate of discontinuation in this study was 15.8% and comparable for VKA and NOAC over a 2-year follow-up. Discontinuation rates were the highest soon after the initiation of treatment. When VKA or NOAC was stopped for ≥7 consecutive days, the risk of NHS+SE, death, MI or any combined endpoints were significantly worse in both treatment arms. These data suggest that discontinuation of anticoagulant treatment with VKA or NOAC should be discouraged.
HR of patients who discontinued OAC
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): The GARFIELD-AF registry is funded by an unrestricted research grant from Bayer AG.
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Affiliation(s)
- F Cools
- General Hospital Klina, Brasschaat, Belgium
| | - D Johnson
- North Carolina State University, Department of Statistics, Raleigh, United States of America
| | - K.S Pieper
- Thrombosis Research Institute, London, United Kingdom
| | - A.J Camm
- St. George's University of London, Cardiology Clinical Academic Group Molecular & Clinical Sciences Research Institute, London, United Kingdom
| | - J.-P Bassand
- Thrombosis Research Institute, London, UK and University of Besançon, Besançon, France
| | | | - K.A.A Fox
- University of Edinburgh, Edinburgh, United Kingdom
| | - S.Z Goldhaber
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - S Goto
- Tokai University School of Medicine, Kanagawa, Japan
| | - S Haas
- Technical University of Munich, Formerly Department of Medicine, Munich, Germany
| | | | - F.W.A Verheugt
- Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, Netherlands (The)
| | | | - G Kayani
- Thrombosis Research Institute, London, United Kingdom
| | - A.K Kakkar
- Thrombosis Research Institute and University College London, London, UK, London, United Kingdom
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26
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Apenteng P, Fitzmaurice D, Virdone S, Camm A, Fox K, Bassand JP, Goldhaber S, Goto S, Haas S, Turpie A, Verheugt F, Misselwitz F, Kayani G, Pieper K, Kakkar A. Clinical outcomes of patients with newly diagnosed atrial fibrillation who refused anticoagulation: findings from the global GARFIELD-AF registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0517] [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
Introduction
Atrial fibrillation (AF) remains a common cause of stroke and anticoagulation (AC) treatment reduces the risk of stroke. Reasons for patients with AF not receiving anticoagulation are generally attributed to the clinician decision, however in reality a proportion of patients refuse anticoagulation. The aim of our study was to investigate the clinical outcomes of patients with AF who refused anticoagulation.
Methods
The Global Anticoagulant Registry in the FIELD (GARFIELD-AF) was an international prospective observational study of patients ≥18 years with newly diagnosed AF and ≥1 investigator determined risk factor for stroke. We analysed two-year outcomes (unadjusted) of non-haemorrhagic stroke/systemic embolism (stroke/SE), major bleeding and all-cause mortality in patients at high risk of stroke (men with CHA2DS2VASc≥2 and women with CHA2DS2VASc≥3) who did not received anticoagulation due to patient refusal, patients at high risk of stroke who received anticoagulation, and patients who were not on anticoagulation due to reasons other than patient refusal.
Results
Out of 43,154 patients, 13,283 (30.8%) are at the higher risk of stroke and did not received anticoagulation at baseline. The reason for not receiving anticoagulation was unavailable for 38.7% (5146/13283); of the patients with a known reason for not receiving anticoagulation, 12.5% (1014/8137) refused anticoagulation. Overall the study participants had a mean (SD) age of 72.2 (9.9) years and 50% were female. The median (Q1; Q3) CHA2DS2VASc score was 3.0 (3.0; 5.0) in patients who refused anticoagulation and 4.0 (3.0; 4.0) in patients who received anticoagulation. The median (Q1; Q3) HAS-BLED score was 1.0 (1.0; 2.0) in both groups. Of the patients who received anticoagulants, 59.7% received VKA and 40.3% received non-VKA oral anticoagulants. 79.4% of patients who refused anticoagulation were on antiplatelets. At two-year follow up the rate of events per 100 person-years (AC refused vs AC received) were: stroke/SE 1.42 vs 0.95 (p=0.04), major bleeding 0.62 vs 1.20 (p=0.02), and all-cause mortality 2.28 vs 3.90 (p=0.0004) (Figure). The event rates in patients who were not on anticoagulation for reasons other than patient refusal were stroke/SE 1.56, major bleeding 0.91, and all-cause mortality 5.49.
Conclusion
In this global real-world prospective study of patients with newly diagnosed AF, patients who refused anticoagulation had a higher rate of stroke/SE but lower rates of all-cause mortality and major bleeding than patients who received anticoagulation. While patient refusal of anticoagulation is an acceptable outcome of shared decision-making, clinically it is a missed opportunity to prevent AF related stroke. Patients' beliefs about AF related stroke and anticoagulation need to be explored. The difference in all-cause mortality warrants further investigation; further analysis will include adjusted results.
Event rates at two years of follow-up
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): The GARFIELD-AF registry is funded by an unrestricted research grant from Bayer AG.
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Affiliation(s)
- P Apenteng
- University of Warwick, Coventry, United Kingdom
| | | | - S Virdone
- Thrombosis Research Institute, London, United Kingdom
| | - A.J Camm
- St George's University of London, Cardiology Clinical Academic Group Molecular & Clinical Sciences Research Institute, London, United Kingdom
| | - K.A.A Fox
- University of Edinburgh, Edinburgh, United Kingdom
| | - J.-P Bassand
- Thrombosis Research Institute, London, UK and University of Besançon, Besançon, France
| | - S.Z Goldhaber
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - S Goto
- Tokai University School of Medicine, Kanagawa, Japan
| | - S Haas
- Technical University of Munich, Formerly Department of Medicine, Munich, Germany
| | | | - F.W.A Verheugt
- Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, Netherlands (The)
| | | | - G Kayani
- Thrombosis Research Institute, London, United Kingdom
| | - K.S Pieper
- Thrombosis Research Institute, London, United Kingdom
| | - A.K Kakkar
- Thrombosis Research Institute and University College London, London, United Kingdom
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27
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Camm A, Steffel J, Virdone S, Bassand JP, Fitzmaurice D, Fox K, Goldhaber S, Goto S, Haas S, Turpie A, Verheugt F, Misselwitz F, Kayani G, Pieper K, Kakkar A. Guideline-directed medical therapies for comorbidities among patients with atrial fibrillation: results from GARFIELD-AF. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0631] [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
Introduction
The GARFIELD-AF registry is a prospective, multicentre, observational study of adults with recently diagnosed non-valvular atrial fibrillation (AF) and at least one risk factor for stroke. In GARFIELD-AF the absolute risk reduction of mortality associated with anticoagulation is far greater than the apparent absolute risk reduction in (ischemic) stroke. One potential explanation is improved treatment, with the use of comprehensive guideline-directed medical therapies (GDMT), in patients with AF receiving oral anticoagulant (OAC) therapy. The objectives were to identify the potential relationships between anticoagulation status, GDMT use and clinical outcomes.
Methods
Use of GDMT was determined on the basis of published European Society for Cardiology guidelines operative between 2010 and 2016. We explored the use of GDMT in patients enrolled in GARFIELD-AF (March 2010-Aug 2016) with CHA2DS2-VASc ≥2 and with one or more of five comorbidities–coronary artery disease, diabetes mellitus, heart failure, hypertension and peripheral vascular disease. Association between GDMT use and clinical outcomes events was evaluated with Cox-proportional hazards models. The models included stratification by all possible combinations of the five comorbidities used to define GDMT eligibility.
Results
The study population comprised of 39,946 patients who had one or more comorbidities (3238 [8.1%] received none of the GDMT, 17,398 [43.6%] received some, and 19,310 [48.3%] received all of the GDMT for which they were eligible). Patients on OAC tended to receive all the GDMTs more frequently compared to patients on no OAC (50.2% vs 44.8%, respectively).
Comprehensive GDMT was associated with a lower risk of all-cause mortality (HR: 0.89 [0.80–0.99]) and non-cardiovascular mortality (0.80 [0.68–0.95]) compared to inadequate or no GDMT but was not associated with a lower risk of stroke (HR: 1.04 (0.88–1.24)] (Figure). The effect of OAC was beneficial for mortality and stroke risk whether receiving comprehensive GDMT or not.
Conclusion
OAC therapy is associated with a lower risk of all-cause mortality, non-cardiovascular mortality and stroke/SE in comparison with no OAC, irrespective of GDMT use in patients with CHA2DS2-VASc ≥2. Although the use of GDMT is associated with a significant reduction in mortality, there is little evidence that this explains the decrease in mortality with the use of OAC.
GDMT use at two years of follow-up
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): The GARFIELD-AF registry is funded by an unrestricted research grant from Bayer AG.
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Affiliation(s)
- A.J Camm
- St George's University of London, Cardiology Clinical Academic Group Molecular & Clinical Sciences Research Institute, London, United Kingdom
| | - J Steffel
- University Hospital Zurich, Zurich, Switzerland
| | - S Virdone
- Thrombosis Research Institute, London, United Kingdom
| | - J.-P Bassand
- Thrombosis Research Institute, London, UK and University of Besançon, Besançon, France
| | | | - K.A.A Fox
- University of Edinburgh, Edinburgh, United Kingdom
| | - S.Z Goldhaber
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - S Goto
- Tokai University School of Medicine, Kanagawa, Japan
| | - S Haas
- Technical University of Munich, Formerly Department of Medicine, Munich, Germany
| | | | - F.W.A Verheugt
- Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, Netherlands (The)
| | | | - G Kayani
- Thrombosis Research Institute, London, United Kingdom
| | - K.S Pieper
- Thrombosis Research Institute, London, United Kingdom
| | - A.K Kakkar
- Thrombosis Research Institute and University College London, London, United Kingdom
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28
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Kumai T, Mizukoshi E, Hashiba T, Nakagawa H, Kitahara M, Miyashita T, Mochizuki T, Goto S, Kamigaki T, Takimoto R, Yamashita T, Sakai Y, Yamashita T, Honda M, Tomita K, Kaneko S. Effect of adoptive T-cell immunotherapy on immunological parameters and prognosis in patients with advanced pancreatic cancer. Cytotherapy 2020; 23:137-145. [PMID: 32907781 DOI: 10.1016/j.jcyt.2020.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/27/2020] [Revised: 07/22/2020] [Accepted: 08/02/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND AIMS Immunotherapy is effective for many types of cancer, but its benefits in advanced pancreatic cancer, which has a poor prognosis, are not well established. In this study, the authors examined the effects of adoptive T-cell immunotherapy (ATI) on immune cell profiles and prognosis in patients with unresectable advanced pancreatic cancer. METHODS Seventy-seven patients with unresectable advanced pancreatic cancer were treated with six cycles of αβ T cells alone or in combination with chemotherapy or chemoradiation. Immune cell profiles in peripheral blood samples obtained before and after treatment were comprehensively evaluated by flow cytometry. Furthermore, associations between changes in immune cell frequencies and prognosis were determined. RESULTS ATI prolonged survival to 18.7 months compared with previous estimates of 6.2-11.1 months for patients treated with chemotherapy alone. ATI decreased CD3+CD4+CD8- T cell frequency in peripheral blood and increased CD3+CD4-CD8+ T cell frequency. An increase in CD3+ T cells and CD3+TCRγδ- T cells in peripheral blood after treatment was associated with a good prognosis. CONCLUSIONS ATI altered the immune profile in peripheral blood, including CD3+CD4-CD8+ T cells, and improved prognosis in pancreatic cancer.
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Affiliation(s)
- Tatsuo Kumai
- Department of Gastroenterology, Graduate School of Medicine, Kanazawa University, Kanazawa, Japan
| | - Eishiro Mizukoshi
- Department of Gastroenterology, Graduate School of Medicine, Kanazawa University, Kanazawa, Japan.
| | | | | | | | | | | | - Shigenori Goto
- Seta Clinic Group, Department of Next-Generation Cell and Immune Therapy, Juntendo University School of Medicine, Tokyo, Japan
| | - Takashi Kamigaki
- Seta Clinic Group, Department of Next-Generation Cell and Immune Therapy, Juntendo University School of Medicine, Tokyo, Japan
| | - Rishu Takimoto
- Seta Clinic Group, Department of Next-Generation Cell and Immune Therapy, Juntendo University School of Medicine, Tokyo, Japan
| | - Taro Yamashita
- Department of Gastroenterology, Graduate School of Medicine, Kanazawa University, Kanazawa, Japan
| | - Yoshio Sakai
- Department of Gastroenterology, Graduate School of Medicine, Kanazawa University, Kanazawa, Japan
| | - Tatsuya Yamashita
- Department of Gastroenterology, Graduate School of Medicine, Kanazawa University, Kanazawa, Japan
| | - Masao Honda
- Department of Gastroenterology, Graduate School of Medicine, Kanazawa University, Kanazawa, Japan
| | | | - Shuichi Kaneko
- Department of Gastroenterology, Graduate School of Medicine, Kanazawa University, Kanazawa, Japan
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29
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Goto S, Terao Y, Kamigaki T, Takimoto R, Naitoh K, Makita K, Yasumoto K, Okada S, Takizawa K, Yokomichi N, Suzuki N, Takeda S. Adoptive Immune-Cell Therapy for the Treatment of Neuroendocrine Carcinoma of the Uterine Cervix. Anticancer Res 2020; 40:4741-4748. [PMID: 32727800 DOI: 10.21873/anticanres.14475] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM We aimed to investigate the efficacy of immune-cell therapy in terms of the survival of patients with neuroendocrine carcinoma of the uterine cervix (NECC), which lacks standardized therapeutic approaches. PATIENTS AND METHODS We identified 17 patients who were diagnosed as having NECC and treated with immune-cell therapy. The clinical characteristics of these patients were extracted from their records and their overall survival was measured. RESULTS Of the 17 patients, two patients with early-stage NECC without recurrence and three patients with less than four treatments were excluded. The median survival times from the time of diagnosis and from the initial administration of immune-cell therapy were 49.7 and 24.4 months, respectively. The overall survival rates at 1, 2, and 5 years were 63.6%, 38.2%, and 25.5%, respectively. Long-term survival was observed in the patients with distant metastases. CONCLUSION The preliminary results of this retrospective study suggested the potential efficacy of immune-cell therapy for NECC.
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Affiliation(s)
- Shigenori Goto
- Seta Clinic, Tokyo, Japan .,Department of Next-Generation Cell and Immune Therapy, Juntendo University School of Medicine, Tokyo, Japan
| | - Yasuhisa Terao
- Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan
| | - Takashi Kamigaki
- Seta Clinic, Tokyo, Japan.,Department of Next-Generation Cell and Immune Therapy, Juntendo University School of Medicine, Tokyo, Japan
| | - Rishu Takimoto
- Seta Clinic, Tokyo, Japan.,Department of Next-Generation Cell and Immune Therapy, Juntendo University School of Medicine, Tokyo, Japan
| | | | | | | | - Sachiko Okada
- Seta Clinic, Tokyo, Japan.,Department of Next-Generation Cell and Immune Therapy, Juntendo University School of Medicine, Tokyo, Japan
| | | | - Noriyuki Yokomichi
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Nao Suzuki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan
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30
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Takimoto R, Kamigaki T, Okada S, Ibe H, Oguma E, Naitoh K, Makita K, Yasumoto K, Goto S. Prognostic Factors for Endometrial and Cervical Cancers of Uterus Treated With Immune-cell Therapy: A Retrospective Study. Anticancer Res 2020; 40:4729-4740. [PMID: 32727799 DOI: 10.21873/anticanres.14474] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM In this retrospective study, we aimed to investigate the efficacy of immune-cell therapy using T lymphocytes activated in vitro with or without dendritic cell vaccination in combination with standard therapies in terms of the survival of patients with advanced or recurrent endometrial and cervical cancers of the uterus. PATIENTS AND METHODS A total of 187 patients with advanced or recurrent uterine cancer were enrolled in this study. The correlation between overall survival and various clinical factors was examined by univariate and multivariate analyses. RESULTS Univariate analysis revealed that the prognosis was improved in uterine cancer patients who received immune-cell therapy without prior chemotherapy or without distant metastasis. Multivariate analysis demonstrated that the absence of prior chemotherapy for endometrial cancer and liver/lung metastasis of cervical cancer are indications for immune-cell therapy. CONCLUSION Survival benefit in uterine cancer patients could be potentially obtained by a combination of immune-cell therapy with other therapies.
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Affiliation(s)
- Rishu Takimoto
- Seta Clinic Group, Tokyo, Japan .,Department of Next Generation Cell and Immune Therapy, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Takashi Kamigaki
- Seta Clinic Group, Tokyo, Japan.,Department of Next Generation Cell and Immune Therapy, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | | | | | | | | | | | | | - Shigenori Goto
- Seta Clinic Group, Tokyo, Japan.,Department of Next Generation Cell and Immune Therapy, Graduate School of Medicine, Juntendo University, Tokyo, Japan
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31
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Yamada T, Yoshida Y, Maeda T, Yoshimatsu G, Aisu N, Yamashita K, Komono A, Kajitani R, Matsumoto Y, Nagano H, Naito K, Yasumoto K, Takimoto R, Kamigaki T, Goto S, Yoshimura F, Sakata N, Kodama S, Hasegawa S. Changes in Immunological Status in Patients With Metastatic Colorectal Cancer Treated With First-line Chemoimmunotherapy. Anticancer Res 2020; 40:4763-4771. [PMID: 32727803 DOI: 10.21873/anticanres.14478] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/21/2020] [Accepted: 06/22/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Chemoimmunotherapy is a promising treatment for various malignant diseases. In this study, we examined whether first-line chemoimmunotherapy using adoptive immune-cell therapy was effective for metastatic colorectal cancer (mCRC). PATIENTS AND METHODS The therapeutic efficacy and safety of the standard first-line chemoimmunotherapy with adoptive αβ T cell therapy and bevacizumab were assessed using thirty-two patients with mCRC in our hospital. Immunological status after this chemoimmunotherapy was also evaluated. RESULTS The response and disease control rates were 68.8% and 87.5%, respectively. Further, median progression-free and overall survival were 14.2 and 35.3 months. Immunotherapy-associated toxicity was minimal. Significant decrease in the change of monocyte number (p=0.006) and increase in the change of rate of lymphocyte-to-monocyte ratio (p=0.039) were seen in the complete response group. CONCLUSION First-line chemoimmunotherapy with adoptive αβ T cell therapy may be useful for mCRC.
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Affiliation(s)
- Teppei Yamada
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan .,Department of Regenerative Medicine & Transplantation, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Yoichiro Yoshida
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Toshiki Maeda
- Department of Preventive Medicine and Public Health, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Gumpei Yoshimatsu
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan.,Department of Regenerative Medicine & Transplantation, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Naoya Aisu
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Kanefumi Yamashita
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Akira Komono
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Ryuji Kajitani
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Yoshiko Matsumoto
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Hideki Nagano
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | | | | | - Rishu Takimoto
- Seta Clinic Group, Tokyo, Japan.,Department of Next Generation Cell and Immune Therapy, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Takashi Kamigaki
- Seta Clinic Group, Tokyo, Japan.,Department of Next Generation Cell and Immune Therapy, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Shigenori Goto
- Seta Clinic Group, Tokyo, Japan.,Department of Next Generation Cell and Immune Therapy, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Fumihiro Yoshimura
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Naoaki Sakata
- Department of Regenerative Medicine & Transplantation, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Shohta Kodama
- Department of Regenerative Medicine & Transplantation, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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32
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Miura M, Mizukoshi E, Hashiba T, Kitahara M, Miyashita T, Mochizuki T, Goto S, Kamigaki T, Takimoto R, Yamashita T, Sakai Y, Yamashita T, Honda M, Kaneko S. Effects of adaptive immune cell therapy on the immune cell profile in patients with advanced gastric cancer. Cancer Med 2020; 9:4907-4917. [PMID: 32529780 PMCID: PMC7367616 DOI: 10.1002/cam4.3152] [Citation(s) in RCA: 2] [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: 01/22/2020] [Revised: 04/29/2020] [Accepted: 05/06/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Immunotherapy for cancer patients has been the subject of attention in recent years. In this study, we investigated whether αβT-cell therapy causes changes in the host's immune cell profile, and if so, the effect of these changes on prognosis. METHODS Peripheral blood mononuclear cells (PBMCs) from 30 gastric cancer patients who had completed one course of αβT-cell therapy were analyzed. The peripheral blood immune cell profile was established using PBMCs by counting the frequency of CD4+ helper T cells, CD8+ killer T cells, regulatory T cells (Tregs), and myeloid-derived suppressor cells and measuring the expression of their surface markers. The changes after treatment and their association with response to treatment were investigated. RESULTS Immune cell profiles changed greatly after treatment. The frequency of CD4+ helper T cells decreased, but that of CD8+ killer T cells increased. The frequency of programmed cell death 1 (PD-1)+ effector Tregs increased significantly, but only in the non-progressive disease (non-PD) group, in which it was significantly higher compared with the PD group. Patients in whom the frequency of PD-1+ effector Tregs increased had a significantly better prognosis than those in whom it decreased. CONCLUSION Our results suggested that αβT-cell therapy changes the host's immune cell profile, and an increase in PD-1+ effector Tregs may help improve prognosis.
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Affiliation(s)
- Miyabi Miura
- Department of Gastroenterology, Graduate School of Medicine, Kanazawa University, Kanazawa City, Japan
| | - Eishiro Mizukoshi
- Department of Gastroenterology, Graduate School of Medicine, Kanazawa University, Kanazawa City, Japan
| | | | | | | | | | - Shigenori Goto
- Seta Clinic Group, Department of Next-Generation Cell and Immune Therapy, Juntendo University School of Medicine, Tokyo, Japan
| | - Takashi Kamigaki
- Seta Clinic Group, Department of Next-Generation Cell and Immune Therapy, Juntendo University School of Medicine, Tokyo, Japan
| | - Rishu Takimoto
- Seta Clinic Group, Department of Next-Generation Cell and Immune Therapy, Juntendo University School of Medicine, Tokyo, Japan
| | - Taro Yamashita
- Department of Gastroenterology, Graduate School of Medicine, Kanazawa University, Kanazawa City, Japan
| | - Yoshio Sakai
- Department of Gastroenterology, Graduate School of Medicine, Kanazawa University, Kanazawa City, Japan
| | - Tatsuya Yamashita
- Department of Gastroenterology, Graduate School of Medicine, Kanazawa University, Kanazawa City, Japan
| | - Masao Honda
- Department of Gastroenterology, Graduate School of Medicine, Kanazawa University, Kanazawa City, Japan
| | - Shuichi Kaneko
- Department of Gastroenterology, Graduate School of Medicine, Kanazawa University, Kanazawa City, Japan
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33
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Takimoto R, Miyashita T, Mizukoshi E, Kamigaki T, Okada S, Ibe H, Oguma E, Naitoh K, Yasumoto K, Makita K, Tomita K, Goto S. Identification of prognostic factors for γδT cell immunotherapy in patients with solid tumor. Cytotherapy 2020; 22:329-336. [PMID: 32303429 DOI: 10.1016/j.jcyt.2020.02.008] [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: 10/30/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND AIMS Activated γδT cells have been shown to exhibit cytotoxicity against tumor cells. However, the efficacy of γδT cell immunotherapy for a large number of patients with solid tumors remains unclear. In this study, we examined the efficacy of γδT cell immunotherapy using in vitro-activated γδT lymphocytes in combination with standard therapies in terms of the survival of patients with solid tumors, and determined prognostic factor for γδT cell immunotherapy. METHODS 131 patients enrolled in this study received γδT cell immunotherapy with or without standard therapies. Their overall survival was analyzed by the Kaplan-Meier with log-rank test and Cox regression methods. Immunological analysis was performed by flow cytometry (FCM) before and after six cycles of γδT cell immunotherapy. RESULTS Multivariable analysis revealed that patients who showed stable disease (SD) and partial response (PR) to γδT cell immunotherapy showed better prognosis than those with a progressive disease (PD) (P = 0.0269, hazard ratio [HR], 0.410, 95% confidence interval [CI], 0.190-0.901). Furthermore, when immunological parameters were examined by FCM, the high Vγ9/γδT ratio (i.e., the high purity of the Vγ9 cells within the adoptively transferred γδT cells) before treatment was found to be a good prognostic factor for γδT cell immunotherapy (P = 0.0142, HR, 0.328, 95% CI, 0.125-0.801). No serious adverse events were reported during γδT cell immunotherapy. CONCLUSION Thus, γδT cell immunotherapy might extend the survival of patients with solid tumors.
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Affiliation(s)
- Rishu Takimoto
- Seta Clinic Group, Tokyo, Japan; Department of Next-Generation Cell and Immune Therapy, Juntendo University School of Medicine, Tokyo, Japan.
| | | | - Eishiro Mizukoshi
- Department of Gastroenterology, Graduate School of Medicine, Kanazawa University, Kanazawa, Japan
| | - Takashi Kamigaki
- Seta Clinic Group, Tokyo, Japan; Department of Next-Generation Cell and Immune Therapy, Juntendo University School of Medicine, Tokyo, Japan
| | | | | | | | | | | | | | | | - Shigenori Goto
- Seta Clinic Group, Tokyo, Japan; Department of Next-Generation Cell and Immune Therapy, Juntendo University School of Medicine, Tokyo, Japan
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Hiraide T, Kataoka M, Suzuki H, Aimi Y, Chiba T, Isobe S, Katsumata Y, Goto S, Kanekura K, Satoh T, Sano M, Gamou S, Kosaki K, Fukuda K. P6009Poor outcomes in pulmonary arterial hypertension as a member of RNF213-associated vascular diseases. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0729] [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
A variant of c.14429G>A (p.Arg4810Lys, rs112735431) in the ring finger protein 213 gene (RNF213; NM_001256071.2) has been recently identified as a risk allele for pulmonary arterial hypertension (PAH), suggesting that PAH can be added as a new member of RNF213-associated vascular diseases including Moyamoya disease and peripheral pulmonary stenosis.
Purpose
Our aim was to identify the clinical features and outcomes of PAH patients with RNF213 p.Arg4810Lys variant.
Methods
Whole-exome sequencing was performed in 139 idiopathic (or possibly heritable) PAH patients. Hemodynamics and prognosis were evaluated in the patients with RNF213 p.Arg4810Lys variant and the patients with bone morphogenic protein receptor type 2 (BMPR2) mutations.
Results
The RNF213 p.Arg4810Lys variant was identified in a heterozygous state in 11 patients (7.9%). Time-course changes in hemodynamics after combination therapy in the patients with the RNF213 p.Arg4810Lys variant were significantly poorer compared with those in BMPR2 mutation carriers (n=36) (comparison of changes in mean pulmonary arterial pressure, P=0.007). The event-free rate of death or lung transplantation was significantly poorer in RNF213 p.Arg4810Lys variant carriers than in BMPR2 mutation carriers (5-year event-free rate since the introduction of prostaglandin I2 infusion, 0% vs. 93%, P<0.001) (Figure).
Time to death or lung transplantation
Conclusions
PAH patients with the RNF213 p.Arg4810Lys variant were associated with a poor reactivity to vasodilator drugs and poor clinical outcomes even in the recent era. Earlier consideration of lung transplantation might be required for RNF213 p.Arg4810Lys variant carriers developing PAH. Documentation of the RNF213 p.Arg4810Lys variant, as well as already known pathogenic genes, can provide clinically relevant information for therapeutic strategies, leading to a personalized approach for the treatment of PAH.
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Affiliation(s)
- T Hiraide
- Keio University School of Medicine, Cardiology, Tokyo, Japan
| | - M Kataoka
- Keio University School of Medicine, Cardiology, Tokyo, Japan
| | - H Suzuki
- Keio University School of Medicine, Center for Medical Genetics, Tokyo, Japan
| | - Y Aimi
- Kyorin University School of Medicine, Division of Cardiology, Second Department of Internal Medicine, Tokyo, Japan
| | - T Chiba
- Kyorin University School of Medicine, Department of Pathology, Tokyo, Japan
| | - S Isobe
- Keio University School of Medicine, Cardiology, Tokyo, Japan
| | - Y Katsumata
- Keio University School of Medicine, Cardiology, Tokyo, Japan
| | - S Goto
- Keio University School of Medicine, Cardiology, Tokyo, Japan
| | - K Kanekura
- Tokyo Medical University, Department of Molecular Pathology, Tokyo, Japan
| | - T Satoh
- Kyorin University School of Medicine, Division of Cardiology, Second Department of Internal Medicine, Tokyo, Japan
| | - M Sano
- Keio University School of Medicine, Cardiology, Tokyo, Japan
| | - S Gamou
- Keio University School of Medicine, Cardiology, Tokyo, Japan
| | - K Kosaki
- Keio University School of Medicine, Center for Medical Genetics, Tokyo, Japan
| | - K Fukuda
- Keio University School of Medicine, Cardiology, Tokyo, Japan
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35
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Takimoto R, Kamigaki T, Okada S, Matsuda E, Ibe H, Oguma E, Naitoh K, Makita K, Goto S. Prognostic Factors for Colorectal Cancer Patients Treated With Combination of Immune-cell Therapy and First-line Chemotherapy: A Retrospective Study. Anticancer Res 2019; 39:4525-4532. [PMID: 31366555 DOI: 10.21873/anticanres.13629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/23/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM In this retrospective study, we aimed to investigate the efficacy of immune-cell therapy using T lymphocytes activated in vitro with or without dendritic cells vaccination (DCs), in combination with 1st-line chemotherapies in terms of the survival of patients with advanced colorectal cancer (CRC). PATIENTS AND METHODS A total of 198 patients who were diagnosed with advanced CRC and administered 1st-line chemotherapies were enrolled in this study. The correlation between overall survival (OS) and various clinical factors was examined by univariate and multivariate analyses. RESULTS Univariate analyses revealed that the prognosis was improved in CRC patients who received immune-cell therapy with PS 0, bevacizumab (BV), and capecitabine-including regimens (Cap). Finally, multivariate analysis demonstrated that PS=0, and the combination of immune-cell therapy and Cap provided a survival benefit in patients with advanced CRC. CONCLUSION The survival benefit could be potentially obtained with better PS by the combination of immune-cell therapy and Cap as a 1st-line setting in patients with CRC.
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Affiliation(s)
- Rishu Takimoto
- Seta Clinic Group, Tokyo, Japan .,Department of Next Generation Cell and Immune Therapy, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Takashi Kamigaki
- Seta Clinic Group, Tokyo, Japan.,Department of Next Generation Cell and Immune Therapy, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | | | | | | | | | | | | | - Shigenori Goto
- Seta Clinic Group, Tokyo, Japan.,Department of Next Generation Cell and Immune Therapy, Graduate School of Medicine, Juntendo University, Tokyo, Japan
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36
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KONO K, Fujii H, Watanabe K, Watanabe S, Yamada N, Goto K, Goto S, Nishi S. SAT-275 DIAGNOSTIC VALUE OF B-TYPE NATRIURETIC PEPTIDES FOR SEVERE LEFT VENTRICULAR DIASTOLIC DYSFUNCTION IN ADVANCED CHRONIC KIDNEY DISEASE. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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37
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Okamoto K, Fujii H, Goto S, Watanabe K, Kono K, Nishi S. SUN-272 Changes in whole PTH/intact PTH ratio in patients with chronic kidney disease. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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38
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Li S, Ma J, Hong X, Zheng M, Goto S, Takimoto R, Kamigaki T, Zang L. Significant clinical response of advanced colorectal cancer to combination therapy involving capecitabine and adoptive cell transfer therapy: a case report. Transl Cancer Res 2019; 8:693-698. [PMID: 35116802 PMCID: PMC8798970 DOI: 10.21037/tcr.2019.02.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/13/2018] [Accepted: 01/28/2019] [Indexed: 11/23/2022]
Abstract
Significant clinical response was obtained in a patient with stage IV colorectal cancer (CRC) following combination therapy involving capecitabine and adoptive cell transfer therapy. She had laparoscopic lower anterior resection and left liver metastatic carcinoma resecting in 20th, February, 2017. Capecitabine was used to further treatment for an unresectable hepatic metastasis. The serum level of carcinoembryonic antigen (CEA) was increased significantly after dropped temporarily. Since then, the patient took the adoptive cell transfer therapy at the same time. αβT cells and NK cells were injected intravenously into the patient. After the first transfusion with αβT cells, the tumor biomarker, CEA, dropped obviously from 14.7 to 6.1 ng/mL. And it came to 1.9 ng/mL after four times treatment, which was back into normal range (<5 ng/mL). Flow cytometry (FCM) was used to reveal the detailed immunological status of this patient before and after adoptive cell transfer therapy. With 19-month follow-up, neither recurrence or complication was founded. Combination therapy involving adoptive immunotherapy and capecitabine may be the potential method for advanced CRC with less complication.
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Affiliation(s)
- Shuchun Li
- Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Shanghai Minimally Invasive Surgery Center, Shanghai 200025, China
| | - Junjun Ma
- Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Shanghai Minimally Invasive Surgery Center, Shanghai 200025, China
| | - Xizhou Hong
- Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Shanghai Minimally Invasive Surgery Center, Shanghai 200025, China
| | - Minhua Zheng
- Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Shanghai Minimally Invasive Surgery Center, Shanghai 200025, China
| | - Shigenori Goto
- Seta Clinic Group, Tokyo, Japan
- Department of Next Generation Cell and Immune Therapy, Juntendo University School of Medicine, Tokyo, Japan
| | - Rishu Takimoto
- Seta Clinic Group, Tokyo, Japan
- Department of Next Generation Cell and Immune Therapy, Juntendo University School of Medicine, Tokyo, Japan
| | - Takashi Kamigaki
- Seta Clinic Group, Tokyo, Japan
- Department of Next Generation Cell and Immune Therapy, Juntendo University School of Medicine, Tokyo, Japan
| | - Lu Zang
- Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Shanghai Minimally Invasive Surgery Center, Shanghai 200025, China
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39
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Edama M, Okuyama R, Goto S, Sasaki M. Influence of loading rate and limb position on patellar tendon mechanical properties in vivo. Clin Biomech (Bristol, Avon) 2019; 61:52-57. [PMID: 30471637 DOI: 10.1016/j.clinbiomech.2018.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Received: 02/17/2018] [Revised: 11/04/2018] [Accepted: 11/09/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aims of this study were to clarify the changes of patellar tendon length during isometric knee joint extension and the double leg squat position using ultrasonography. METHODS The left legs of 17 healthy adults were investigated. Isometric knee extension motion was performed at three positions of knee flexion 30° (knee 30°), knee flexion 60° (knee 60°), knee flexion 90° (knee 90°), and at each limb position, 0% (0% peak torque (PT)), 40% (40% PT), 50% (50% PT), and 60% (60% PT) of the maximum knee joint extension torque were executed at random. Both double leg squat motions were randomly performed in three positions: hip flexion 30°, knee flexion 30°, ankle dorsiflexion 10° (squat 30°); hip joint flexion 60°, knee joint flexion 60°, ankle dorsiflexion 20° (squat 60°); and hip joint flexion 90°, knee joint flexion 90°, ankle dorsiflexion 30° (squat 90°). Ultrasonography was used to measure patellar tendon length. FINDINGS There were no significant changes in patellar tendon length and strain between knee flexion angles of 30°, 60°, and 90° in isometric knee joint extension and the double leg squat limb position. INTERPRETATION The loading rate and limb position do not appear to affect the length and strain of the patellar tendon.
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Affiliation(s)
- M Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City 950-3198, Japan.
| | - R Okuyama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City 950-3198, Japan
| | - S Goto
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City 950-3198, Japan
| | - M Sasaki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City 950-3198, Japan
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40
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Harada S, Segawa T, Sato T, Ehara S, Sera K, Goto S. Imaging of Primary and Metastatic Tumors and Their Treatment through Abscopal Effects and Cancer Immunotherapy Using Encapsulated, Radiation Therapy Directed Antigen-Capturing Nanoparticles. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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41
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Camm AJ, Cools F, Virdone S, Bassand JP, Fitzmaurice DA, Fox KAA, Goldhaber SZ, Goto S, Haas S, Mantovani LG, Pieper K, Turpie AGG, Verheugt FWA, Kakkar AK. 1354The effect of non-recommended dosing of non-vitamin K antagonist oral anticoagulants (NOACs) on 1-year mortality in patients with newly diagnosed AF? Results from the GARFIELD-AF registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A J Camm
- St. George's University of London and Imperial College, London, United Kingdom
| | - F Cools
- AZ KLINA Cardiology, Brasschaat, Belgium
| | - S Virdone
- Thrombosis Research Institute, London, United Kingdom
| | - J.-P Bassand
- Thrombosis Research Institute, London, UK and University of Besançon, Besançon, France
| | - D A Fitzmaurice
- University of Warwick Medical School, Coventry, United Kingdom
| | - K A A Fox
- University of Edinburgh, Edinburgh, United Kingdom
| | - S Z Goldhaber
- Brigham and Women's Hospital and Harvard Medical School, Boston, United States of America
| | - S Goto
- Tokai University School of Medicine, Kanagawa, Japan
| | - S Haas
- Formerly Department of Medicine, Technical University of Munich, Munich, Germany
| | | | - K Pieper
- Duke Clinical Research Institute, Durham, NC, USA & Thrombosis Research Institute, London, United Kingdom
| | | | - F W A Verheugt
- Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, Netherlands
| | - A K Kakkar
- Thrombosis Research Institute and University College London, London, United Kingdom
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42
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Lauri FM, Mejia-Renteria H, Lee JM, Van Der Hoeven N, De Waard G, Macaya F, Goto S, Liontou C, Koo BK, Van Royen N, Escaned J. P5511Improving the diagnostic accuracy of quantitative flow ratio (QFR): a proposal of QFR-fractional flow reserve (FFR) hybrid approach. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- F M Lauri
- Hospital Clínico San Carlos, Instituto de Investigaciόn Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - H Mejia-Renteria
- Hospital Clinic San Carlos, Interventional Cardiology Department, Madrid, Spain
| | - J M Lee
- Samsung Medical Center, Seoul, Korea Republic of
| | | | - G De Waard
- VU University Medical Center, Amsterdam, Netherlands
| | - F Macaya
- Hospital Clinic San Carlos, Interventional Cardiology Department, Madrid, Spain
| | - S Goto
- Hospital Clinic San Carlos, Interventional Cardiology Department, Madrid, Spain
| | - C Liontou
- Hospital Clinic San Carlos, Interventional Cardiology Department, Madrid, Spain
| | - B K Koo
- Seoul National University Hospital, Seoul, Korea Republic of
| | - N Van Royen
- VU University Medical Center, Amsterdam, Netherlands
| | - J Escaned
- Hospital Clinic San Carlos, Interventional Cardiology Department, Madrid, Spain
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43
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Fox KAA, Berchuck S, Camm AJ, Bassand JP, Fitzmaurice DA, Gersh BJ, Goldhaber SZ, Goto S, Haas S, Misselwitz F, Pieper K, Turpie AGG, Verheugt FWA, Kakkar AK. P2895Evaluation of the effect of oral anticoagulants on all-cause mortality within 3 months of the diagnosis of atrial fibrillation: results from the GARFIELD-AF prospective registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2895] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K A A Fox
- University of Edinburgh, Edinburgh, United Kingdom
| | - S Berchuck
- Duke Clinical Research Institute, Durham, United States of America
| | - A J Camm
- St. George's University of London and Imperial College, London, United Kingdom
| | - J.-P Bassand
- Thrombosis Research Institute, London, UK & University of Besançon, Besancon, France
| | - D A Fitzmaurice
- University of Warwick Medical School, Coventry, United Kingdom
| | - B J Gersh
- Mayo Clinic, Rochester, United States of America
| | - S Z Goldhaber
- Brigham and Women's Hospital and Harvard Medical School, Boston, United States of America
| | - S Goto
- Tokai University School of Medicine, Kanagawa, Japan
| | - S Haas
- Formerly Department of Medicine, Technical University of Munich, Munich, Germany
| | | | - K Pieper
- Duke Clinical Research Institute, Durham, NC, USA & Thrombosis Research Institute, London, United Kingdom
| | | | - F W A Verheugt
- Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, Netherlands
| | - A K Kakkar
- Thrombosis Research Institute & University College London, London, United Kingdom
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Schlotter F, Goettsch C, Rogers MA, Hutcheson JD, Blaser MC, Goto S, Lee LH, Delaughter DM, Merryman WD, Seidman JG, Jaffer FA, Body SC, Aikawa M, Singh SA, Aikawa E. P5090Sortilin is a key driver of fibrocalcific aortic valve disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5090] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F Schlotter
- Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America
| | - C Goettsch
- Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America
| | - M A Rogers
- Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America
| | - J D Hutcheson
- Florida International University, Department of Biomedical Engineering, Miami, United States of America
| | - M C Blaser
- Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America
| | - S Goto
- Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America
| | - L H Lee
- Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America
| | - D M Delaughter
- Harvard Medical School, Department of Genetics, Boston, United States of America
| | - W D Merryman
- Vanderbilt University, Department of Biomedical Engineering, Nashville, United States of America
| | - J G Seidman
- Harvard Medical School, Department of Genetics, Boston, United States of America
| | - F A Jaffer
- Cardiovascular Research Center and Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, United States of America
| | - S C Body
- Brigham and Women's Hospital, Harvard Medical School, Department of Anesthesiology, Boston, United States of America
| | - M Aikawa
- Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America
| | - S A Singh
- Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America
| | - E Aikawa
- Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America
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Kim Y, Kai T, Kawano K, Goto S, Kodama Y, Yasunaga F, Takeyama M, Akizuki S, Kamada N, Kobayashi M. Predictive value of liver tissue flow in assessment of the viability of liver grafts after extended preservation in pigs. Transpl Int 2018. [DOI: 10.1111/tri.1992.5.s1.382] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Goto S, Kim Y, Kawano K, Kai T, Kobayashi M. Efficacy of PGI2
analog in preventing ischemia reperfusion damage of liver grafts from living donors. Transpl Int 2018. [DOI: 10.1111/tri.1992.5.s1.366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Makita K, Kamigaki T, Okada S, Matsuda E, Ibe H, Oguma E, Naitoh K, Takimoto R, Goto S. Prognostic Factors for Pancreatic Cancer Patients Treated with Immune-cell Therapy. Anticancer Res 2018; 38:4353-4360. [PMID: 29970573 DOI: 10.21873/anticanres.12736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 04/11/2018] [Revised: 06/07/2018] [Accepted: 06/18/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The past 17 years, immune-cell therapy has been administered to 990 patients with advanced or recurrent pancreatic adenocarcinoma and 50 patients with curatively resected pancreatic adenocarcinoma. MATERIALS AND METHODS The correlation between overall survival (OS) and various factors including sex, age, performance status (PS), distant metastasis, chemotherapy, radiotherapy, and type of immune-cell therapy were evaluated by univariate and multivariate analyses. RESULTS The median OS of advanced or recurrent pancreatic cancer was 5.8 months, and the prognosis was improved in pancreatic cancer patients who received immune-cell therapy with PS scores of 0-1 [hazard risk (HR)=0.56; 95% confidence interval (CI)=0.46-0.68; p<0.0001], chemotherapy (HR=0.68; 95%CI=0.54-0.87; p=0.002), or radiotherapy (HR=0.76; 95%CI=0.63-0.93; p=0.006). Multivariate analysis demonstrated that distant metastasis indicated a poor prognosis for pancreatic cancer patients that were administered immune-cell therapy (HR=1.62; 95%CI=1.37-1.93; p<0.0001). Additionally, the combined immune-cell therapy with αβ T cell and dendritic cell (DC) vaccine provided a survival benefit in advanced or recurrent pancreatic cancer patients (HR=0.69; 95%CI=0.57-0.83; p<0.0001). CONCLUSION A survival benefit could be potentially obtained with better PS by the combination of αβ T cell therapy, DC vaccine therapy, and chemotherapy at an early stage in pancreatic cancer.
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Affiliation(s)
| | - Takashi Kamigaki
- Seta Clinic Group, Tokyo, Japan
- Department of Next Generation Cell and Immune therapy, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | | | | | | | | | | | - Rishu Takimoto
- Seta Clinic Group, Tokyo, Japan
- Department of Next Generation Cell and Immune therapy, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Shigenori Goto
- Seta Clinic Group, Tokyo, Japan
- Department of Next Generation Cell and Immune therapy, Graduate School of Medicine, Juntendo University, Tokyo, Japan
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Abstract
SummaryCurrently available clinical database was mostly developed in North America and Europe (Western Countries). Clinical database of Asian patients are still not large enough to develop Asian region specific clinical guidelines, although the population of patients in the majority of Asia countries are increasing rapidly. Marked ethnic and life-style heterogeneity within Asian region also makes it difficult to develop Asian region specific Evidence-based clinical practice guidelines. In general, there are certain differences in the background epidemiology of the athero-sclerotic and thrombotic diseases in Asia countries and Western ones such as Asian patients are more prone to cerebrovascular disease (CVD) than coronary artery disease (CAD). Accordingly, there also are marked differences in the use of antiplatelet agents in Asian patients underwent coronary intervention (such as frequent use of cilostazol) as compared to those living in the Western countries. Currently available database also suggests the difference in side effects of anti -platelet agents in Asian patients as compared to Western ones such as relatively high incidence of hepatic dysfunction with the use of thienopiridine. In the future, it would be important to clarify the detailed difference of Asian patients and Western ones in regards to the effects and side effects of antiplatelet therapy by the multi-national prospective observation registry and clinical trials including equal number of Asian and Western patients. It would also be important for Asian physician to develop scientifically valid methods to import the results of “Global Evidence” with appropriate modification for the clinical practice in patients living in the specific region of Asia.
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49
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Hirooka Y, Kawashima H, Ohno E, Ishikawa T, Kamigaki T, Goto S, Takahara M, Goto H. Comprehensive immunotherapy combined with intratumoral injection of zoledronate-pulsed dendritic cells, intravenous adoptive activated T lymphocyte and gemcitabine in unresectable locally advanced pancreatic carcinoma: a phase I/II trial. Oncotarget 2017; 9:2838-2847. [PMID: 29416816 PMCID: PMC5788684 DOI: 10.18632/oncotarget.22974] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 10/19/2017] [Accepted: 11/15/2017] [Indexed: 02/06/2023] Open
Abstract
Dendritic cell (DC)-based vaccines prepared using various antigen loading methods have been studied for cancer immunotherapy. The in vivo provocation of immunity by the direct injection of DCs without using tumor-specific antigens into tumors after apoptosis-inducing chemotherapy is more applicable. We previously reported that zoledronate-pulsed DCs (Zol-DCs) may induce tumor-antigen-specific CD8+ T cells by activating Vγ9γδT cells. In this report, we studied the feasibility, safety, and efficacy of a comprehensive immunotherapy involving the combined intratumoral injection of Zol-DC, gemcitabine (GEM) and αβT cells in locally advanced pancreatic carcinoma. Seven of 15 patients showed a stable disease (SD) and most of the patients showed long-term clinical responses. The FACT-BRM score was significantly higher in the patients with SD. Additionally the CD8+/Treg ratio significantly increased in SD patients after treatment. The median over-all survival and progression-free-survival of 15 patients were 12.0 months and 5.5 months, respectively. Patients with a pretreatment neutrophil/lymphocyte ratio (NLR) lower than 5.0 showed significantly longer survival. Even in an analysis limited to the patients with an NLR lower than 5.0, the patients whose CD8+/Treg ratio increased more than twofold tended to survive longer. In conclusion, the comprehensive immunotherapy using Zol-DCs, systemic αβT cells, and GEM may synergistically show a therapeutic effect on locally advanced pancreatic carcinoma. By using appropriate and precise biomarkers, such as NLR and CD8+/Treg ratio, the present comprehensive immunotherapy could be more beneficial for patients with pancreatic carcinoma.
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Affiliation(s)
- Yoshiki Hirooka
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Kamigaki
- Seta Clinic, Tokyo, Japan.,Department of Next Generation Cell and Immune Therapy, Juntendo University School of Medicine, Tokyo, Japan
| | | | | | - Hidemi Goto
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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50
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Hirose K, Nishio K, Tanaka S, Léguillon R, Makii H, Nishinaka I, Orlandi R, Tsukada K, Smallcombe J, Vermeulen MJ, Chiba S, Aritomo Y, Ohtsuki T, Nakano K, Araki S, Watanabe Y, Tatsuzawa R, Takaki N, Tamura N, Goto S, Tsekhanovich I, Andreyev AN. Role of Multichance Fission in the Description of Fission-Fragment Mass Distributions at High Energies. Phys Rev Lett 2017; 119:222501. [PMID: 29286806 DOI: 10.1103/physrevlett.119.222501] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Indexed: 06/07/2023]
Abstract
Fission-fragment mass distributions were measured for ^{237-240}U, ^{239-242}Np, and ^{241-244}Pu populated in the excitation-energy range from 10 to 60 MeV by multinucleon transfer channels in the reaction ^{18}O+^{238}U at the Japan Atomic Energy Agency tandem facility. Among them, the data for ^{240}U and ^{240,241,242}Np were observed for the first time. It was found that the mass distributions for all the studied nuclides maintain a double-humped shape up to the highest measured energy in contrast to expectations of predominantly symmetric fission due to the washing out of nuclear shell effects. From a comparison with the dynamical calculation based on the fluctuation-dissipation model, this behavior of the mass distributions was unambiguously attributed to the effect of multichance fission.
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Affiliation(s)
- K Hirose
- Advanced Science Research Center, Japan Atomic Energy Agency (JAEA), 2-4 Shirakata Shirane, Tokai, Ibaraki 319-1195 Japan
| | - K Nishio
- Advanced Science Research Center, Japan Atomic Energy Agency (JAEA), 2-4 Shirakata Shirane, Tokai, Ibaraki 319-1195 Japan
| | - S Tanaka
- Faculty of Science and Engineering, Kindai University, Higashi-Osaka 577-8502, Japan
| | - R Léguillon
- Advanced Science Research Center, Japan Atomic Energy Agency (JAEA), 2-4 Shirakata Shirane, Tokai, Ibaraki 319-1195 Japan
| | - H Makii
- Advanced Science Research Center, Japan Atomic Energy Agency (JAEA), 2-4 Shirakata Shirane, Tokai, Ibaraki 319-1195 Japan
| | - I Nishinaka
- Advanced Science Research Center, Japan Atomic Energy Agency (JAEA), 2-4 Shirakata Shirane, Tokai, Ibaraki 319-1195 Japan
| | - R Orlandi
- Advanced Science Research Center, Japan Atomic Energy Agency (JAEA), 2-4 Shirakata Shirane, Tokai, Ibaraki 319-1195 Japan
| | - K Tsukada
- Advanced Science Research Center, Japan Atomic Energy Agency (JAEA), 2-4 Shirakata Shirane, Tokai, Ibaraki 319-1195 Japan
| | - J Smallcombe
- Advanced Science Research Center, Japan Atomic Energy Agency (JAEA), 2-4 Shirakata Shirane, Tokai, Ibaraki 319-1195 Japan
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - M J Vermeulen
- Advanced Science Research Center, Japan Atomic Energy Agency (JAEA), 2-4 Shirakata Shirane, Tokai, Ibaraki 319-1195 Japan
| | - S Chiba
- Laboratory for Advanced Nuclear Energy, Institute for Innovative Research, Tokyo Institute of Technology, 2-12-1-N1-19, Ookayama, Meguro-ku, Tokyo 152-8550 Japan
| | - Y Aritomo
- Faculty of Science and Engineering, Kindai University, Higashi-Osaka 577-8502, Japan
| | - T Ohtsuki
- Research Reactor Institute, Kyoto University, Kumatori, Osaka 590-0494, Japan
| | - K Nakano
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Fukuoka 816-8580, Japan
| | - S Araki
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Fukuoka 816-8580, Japan
| | - Y Watanabe
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Fukuoka 816-8580, Japan
| | - R Tatsuzawa
- Graduate School of Engineering, Tokyo City University, Tokyo 158-8557, Japan
| | - N Takaki
- Graduate School of Engineering, Tokyo City University, Tokyo 158-8557, Japan
| | - N Tamura
- Graduate School of Science and Technology, Niigata University, Niigata 950-2181, Japan
| | - S Goto
- Graduate School of Science and Technology, Niigata University, Niigata 950-2181, Japan
| | - I Tsekhanovich
- University of Bordeaux, 351 Cours de la Libration, 33405 Talence Cedex, France
| | - A N Andreyev
- Advanced Science Research Center, Japan Atomic Energy Agency (JAEA), 2-4 Shirakata Shirane, Tokai, Ibaraki 319-1195 Japan
- Department of Physics, University of York, York YO10 5DD, United Kingdom
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