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Osawa K, Yamamoto S, Yamano Y, Kita A, Okamoto K, Kato N, Tatematsu Y, Kojima F, Ohya M, Hara S, Murata SI, Inoue N, Maruyama S, Araki SI. Overlapping Atypical Hemolytic Uremic Syndrome and C3 Glomerulopathy with Mutation in CFI in a Japanese Patient: A Case Report. Intern Med 2023:2713-23. [PMID: 37926536 DOI: 10.2169/internalmedicine.2713-23] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
A 34-year-old Japanese man presented with blurred vision, headache, nausea, anemia, thrombocytopenia, and severe renal dysfunction. Thrombotic microangiopathy was initially suspected to have been caused by malignant hypertension. Antihypertensive medications did not improve his thrombocytopenia or renal dysfunction, and other diseases causing thrombotic microangiopathy were ruled out. Therefore, the patient was diagnosed with atypical hemolytic uremic syndrome. A renal biopsy revealed an overlap of thrombotic microangiopathy and C3 glomerulopathy. Genetic testing revealed c.848A>G (p.Asp283Gly), a missense heterozygous variant in the gene encoding complement factor I. Overlapping atypical hemolytic uremic syndrome and C3 glomerulopathy with complement factor I mutation is very rare, especially in Japan.
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Affiliation(s)
- Kosuke Osawa
- Department of Nephrology, School of Medicine, Wakayama Medical University, Japan
| | - Shuto Yamamoto
- Department of Nephrology, School of Medicine, Wakayama Medical University, Japan
| | - Yukiko Yamano
- Department of Nephrology, School of Medicine, Wakayama Medical University, Japan
| | - Ayako Kita
- Department of Nephrology, School of Medicine, Wakayama Medical University, Japan
| | - Kota Okamoto
- Department of Nephrology, School of Medicine, Wakayama Medical University, Japan
| | - Noritoshi Kato
- Department of Nephrology, Graduate School of Medicine, Nagoya University, Japan
| | | | - Fumiyoshi Kojima
- Department of Human Pathology, School of Medicine, Wakayama Medical University, Japan
| | - Masaki Ohya
- Department of Nephrology, School of Medicine, Wakayama Medical University, Japan
| | - Shigeo Hara
- Department of Pathology, Kobe City Medical Center General Hospital, Japan
| | - Shin-Ichi Murata
- Department of Human Pathology, School of Medicine, Wakayama Medical University, Japan
| | - Norimitsu Inoue
- Department of Molecular Genetics, School of Medicine, Wakayama Medical University, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Graduate School of Medicine, Nagoya University, Japan
| | - Shin-Ichi Araki
- Department of Nephrology, School of Medicine, Wakayama Medical University, Japan
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Tane M, Kosako H, Hosoi H, Tabata K, Hiroi T, Osawa K, Iwamoto R, Murata S, Mushino T, Murata SI, Araki SI, Fujii T, Sonoki T. Severe systemic inflammation mimicking TAFRO syndrome following COVID-19. Int J Hematol 2023; 118:374-380. [PMID: 37000328 PMCID: PMC10063432 DOI: 10.1007/s12185-023-03589-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 04/01/2023]
Abstract
TAFRO syndrome is a rare systemic inflammatory disease. Its pathogenesis mainly involves excessive cytokine secretion and autoimmune dysfunction. Although its etiology is unclear, some viral infections have been reported to cause it. Here, we report a case of severe systemic inflammation mimicking TAFRO syndrome that arose after COVID-19. A 61-years-old woman suffered from a continuous fever, ascites, and edema after contracting COVID-19. She developed progressive thrombocytopenia, renal failure, and elevated C-reactive protein levels. She was tentatively diagnosed with multisystem inflammatory syndrome in adults (MIS-A) and received steroid pulse therapy. However, she exhibited worsening fluid retention and progressive renal failure, which are not typical of MIS-A. A bone marrow examination showed reticulin myelofibrosis and an increased number of megakaryocytes. Although a definitive diagnosis of TAFRO syndrome was not made according to current diagnostic criteria, we determined that her symptoms were clinically consistent with those of TAFRO syndrome. Combination therapy, including steroid pulse therapy, plasma exchange, rituximab, and cyclosporine, improved her symptoms. There are pathological similarities between hyperinflammation that arises after COVID-19 and TAFRO syndrome in terms of the associated cytokine storms. COVID-19 may have triggered the development of systemic inflammation mimicking TAFRO syndrome in this case.
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Affiliation(s)
- Misato Tane
- Department of Hematology/Oncology, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8510, Japan
| | - Hideki Kosako
- Department of Hematology/Oncology, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8510, Japan
| | - Hiroki Hosoi
- Department of Hematology/Oncology, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8510, Japan.
- Department of Internal Medicine, Kainan Municipal Medical Center, Wakayama, Japan.
| | - Kayoko Tabata
- Department of Rheumatology and Clinical Immunology, Wakayama Medical University, Wakayama, Japan
| | - Takayuki Hiroi
- Department of Internal Medicine, Kainan Municipal Medical Center, Wakayama, Japan
| | - Kosuke Osawa
- Department of Nephrology, Wakayama Medical University, Wakayama, Japan
| | - Ryuta Iwamoto
- Department of Human Pathology, Wakayama Medical University, Wakayama, Japan
| | - Shogo Murata
- Department of Hematology/Oncology, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8510, Japan
| | - Toshiki Mushino
- Department of Hematology/Oncology, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8510, Japan
| | - Shin-Ichi Murata
- Department of Human Pathology, Wakayama Medical University, Wakayama, Japan
| | - Shin-Ichi Araki
- Department of Nephrology, Wakayama Medical University, Wakayama, Japan
| | - Takao Fujii
- Department of Rheumatology and Clinical Immunology, Wakayama Medical University, Wakayama, Japan
| | - Takashi Sonoki
- Department of Hematology/Oncology, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8510, Japan
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Kawakami K, Ohya M, Yashiro M, Sonou T, Yamamoto S, Nakashima Y, Yano T, Tanaka Y, Ishida K, Kobashi S, Shigematsu T, Araki SI. Bisphosphonate FYB-931 Prevents High Phosphate-Induced Vascular Calcification in Rat Aortic Rings by Altering the Dynamics of the Transformation of Calciprotein Particles. Calcif Tissue Int 2023:10.1007/s00223-023-01086-z. [PMID: 37099142 DOI: 10.1007/s00223-023-01086-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/15/2023] [Indexed: 04/27/2023]
Abstract
Patients with chronic kidney disease develop vascular calcification, owing to impaired calcium and phosphate metabolism. The prevention of vascular calcification is important to improve the prognosis of such patients. In this study, we investigated whether treatment with FYB-931, a novel bisphosphonate compound, prevents vascular calcification in rat aortic rings cultured in high-phosphate medium for 9 days, assessed by measurement of the calcium content and the degree of calcium deposition, visualized using von Kossa staining. The effect on the transformation of calciprotein particles (CPPs) from primary to secondary CPPs was assessed using a fluorescent probe-based flow cytometric assay. FYB-931 dose-dependently prevented high phosphate-induced aortic calcification, but failed to rapidly cause the regression of high phosphate-induced vascular calcification once it had developed. Furthermore, the treatment dose-dependently inhibited the high phosphate-induced transformation from primary to secondary CPPs. In addition, the treatment with FYB-931 prevented the transformation from primary to secondary CPPs in vitamin D3-treated rats as a model of ectopic calcification, consistent with the results from rat aortic rings. In conclusion, treatment with FYB-931 prevents high phosphate-induced rat aortic vascular calcification by altering the dynamics of CPP transformation. This finding suggests that inhibition of the transformation from primary to secondary CPPs is an important target for the prevention of vascular calcification in patients with chronic kidney disease.
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Affiliation(s)
- Kazuki Kawakami
- Department of Nephrology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8509, Japan
| | - Masaki Ohya
- Department of Nephrology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8509, Japan.
| | - Mitsuru Yashiro
- Department of Nephrology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8509, Japan
| | - Tomohiro Sonou
- Department of Nephrology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8509, Japan
| | - Shuto Yamamoto
- Department of Nephrology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8509, Japan
| | - Yuri Nakashima
- Department of Nephrology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8509, Japan
| | - Takuro Yano
- Department of Nephrology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8509, Japan
| | - Yusuke Tanaka
- Department of Nephrology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8509, Japan
| | - Koichi Ishida
- Medical R&D Division, Fuji Yakuhin Co. Ltd, Laboratory 2, Iidashinden, Nishi-ku, Saitama, Saitama, 331-0068, Japan
| | - Seiichi Kobashi
- Medical R&D Division, Fuji Yakuhin Co. Ltd, Laboratory 1, Nishiomiya, Nishi-ku, Saitama, Saitama, 331-0078, Japan
| | - Takashi Shigematsu
- Department of Nephrology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8509, Japan
- Department of Nephrology, Rinku General Medical Center, Izumisano, Osaka, 598-8577, Japan
| | - Shin-Ichi Araki
- Department of Nephrology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8509, Japan
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Yokoyama H, Araki SI, Kawai K, Yamazaki K, Tomonaga O, Maeda H, Ohtaki M, Obata H, Sone H, Kabata D, Shintani A, Maegawa H. Reduced incidence of cardiovascular disease in patients with type 2 diabetes through the integrated improvement of diabetes care by comparing two prospective observational cohorts in real-world clinical practice (JDDM 72). Diabetes Res Clin Pract 2023:110674. [PMID: 37086752 DOI: 10.1016/j.diabres.2023.110674] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/04/2023] [Accepted: 04/17/2023] [Indexed: 04/24/2023]
Abstract
AIM To investigate whether any reduction in all-cause mortality and cardiovascular disease morbidity was found over the decade in type 2 diabetes on real-world practice. METHODS A prospective observational study was performed by following two independent cohorts recruited in 2004 (n=3286, Cohort 1) and 2014 (n=3919, Cohort 2). The primary outcome was a composite of onset of cardiovascular disease and death. Cox proportional hazards analysis was used to explore any difference between Cohort 2 and Cohort 1 for the composite endpoints and cardiovascular disease after adjustment for covariates and accumulation of five risks (smoking, HbA1c, blood pressure, lipids, and albuminuria) outside target ranges. RESULTS During the 8-year follow-up, 391 (11.9%) and 270 (6.9%) primary outcomes, and 270 (8.2%) and 161 (4.1%) cardiovascular diseases occurred in Cohort 1 and Cohort 2, respectively. Cohort 2 (vs. Cohort 1) exhibited a significant risk reduction for composite endpoints (HR 0.73, 95% CI 0.62 to 0.86) and cardiovascular disease (HR 0.64, 95% CI 0.52 to 0.79), and similarly exhibited a significant reduction independent of the accumulation of the five risks. CONCLUSIONS The significant reduction of Cohort 2 for cardiovascular disease independent of the baseline covariates suggests an integrated effect delivered by the recent treatment advances.
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Affiliation(s)
- Hiroki Yokoyama
- Jiyugaoka Medical Clinic, Internal Medicine, Obihiro, Japan.
| | - Shin-Ichi Araki
- Division of Nephrology, Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | | | | | | | | | - Masafumi Ohtaki
- Department of Neurosurgery, Obihiro Kosei General Hospital, Obihiro, Japan
| | - Hiromi Obata
- Division of Cardiology, Department of Internal Medicine, National Obihiro Hospital, Obihiro, Japan
| | - Hirohito Sone
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - Daijiro Kabata
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hiroshi Maegawa
- Department of Medicine, Yasu City Hospital, Yasu, Shiga, Japan
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Miyazawa I, Yokoyama H, Yagi N, Araki SI, Morino K, Kume S, Shirabe S, Yamazaki K, Maegawa H. Annual trends in glycemic control and prescribing patterns in diabetic treatment according to age in Japanese patients with type 2 diabetes between 2012 and 2019 (JDDM 71). Diabetes Res Clin Pract 2023; 198:110599. [PMID: 36849048 DOI: 10.1016/j.diabres.2023.110599] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/12/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023]
Abstract
AIMS This study aimed to evaluate changes in glycemic control and diabetes treatment by age group in Japanese patients with type 2 diabetes. METHODS The study included the results of approximately 40,000 patients/year using cross-sectional and retrospective analyses from 2012 to 2019. RESULTS There was little change in the glycemic control status in all age groups during the study period. However, by age group, patients aged ≤ 44 years continued to have the highest glycated hemoglobinA1c (HbA1c) values during the study period (7.4 % ± 1.7 % in 2012 and 7.4 % ± 1.5 % in 2019), especially in insulin-treated patients (8.3 % ± 1.9 % in 2012 and 8.4 % ± 1.8 % in 2019). Biguanides and dipeptidyl peptidase-4 inhibitors were widely prescribed. Sulfonylurea and insulin use showed a decreasing trend, but older patients had a higher percentage of prescriptions. Sodium glucose transporter 2 inhibitors were prescribed rapidly, especially in younger patients. CONCLUSIONS There were no obvious changes in glycemic control over time in the study period. The mean HbA1c level was higher in younger patients, which suggested that improvement is required. In older patients, there was a trend toward greater emphasis on management to avoid hypoglycemia. Different treatment strategies based on age showed different drug choices.
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Affiliation(s)
- Itsuko Miyazawa
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan; Education Center for Medicine and Nursing, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan.
| | - Hiroki Yokoyama
- Internal Medicine, Jiyugaoka Medical Clinic, Hokkaido Obihiro, Hokkaido 080-0016, Japan
| | | | - Shin-Ichi Araki
- Department of Internal Medicine, Division of Nephrology, Wakayama Medical University, Wakayama, Wakayama 641-8509, Japan
| | - Katsutaro Morino
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan; Institutional Research Office, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Shinji Kume
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | | | | | - Hiroshi Maegawa
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan; Yasu City Hospital, Yasu, Shiga 520-2331, Japan
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Yokoyama H, Araki SI, Yamazaki K, Kawai K, Shirabe SI, Oishi M, Kanatsuka A, Yagi N, Kabata D, Shintani A, Maegawa H. Trends in glycemic control in patients with insulin therapy compared with non-insulin or no drugs in type 2 diabetes in Japan: a long-term view of real-world treatment between 2002 and 2018 (JDDM 66). BMJ Open Diabetes Res Care 2022; 10:10/3/e002727. [PMID: 35504696 PMCID: PMC9066475 DOI: 10.1136/bmjdrc-2021-002727] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/06/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION We investigated trends in the proportion of diabetes treatment and glycemic control, which may be altered by recent advances in insulin and non-insulin drugs, in Japanese patients with type 2 diabetes. RESEARCH DESIGN AND METHODS A serial cross-sectional study was performed using a multicenter large-population database from the Japan Diabetes Clinical Data Management study group. Patients with type 2 diabetes who attended clinics belonging to the study group between 2002 and 2018 were included to examine trends in glycated hemoglobin A1c (HbA1c) by treatment group using multivariable non-linear regression model. RESULTS The proportion of patients with insulin only decreased from 15.0% to 3.6%, patients with insulin+non-insulin drugs increased from 8.1% to 15.1%, patients with non-insulin drugs increased from 50.8% to 67.0%, and those with no drugs decreased from 26.1% to 14.4% from 2002 to 2018, respectively. The HbA1c levels of each group, except for no drugs, continued to decrease until 2014 (unadjusted mean HbA1c (%) from 2002 to 2014: from 7.89 to 7.45 for insulin only, from 8.09 to 7.63 for insulin+non-insulin, and from 7.51 to 6.98 for non-insulin) and remained unchanged thereafter. Among insulin-treated patients, use of human insulin decreased, use of long-acting analog insulin increased, and concomitant use of non-insulin drugs increased (from 35.1% in 2002 to 80.9% in 2018), which included increased use of dipeptidyl peptidase 4 inhibitors, sodium-glucose cotransporter 2 inhibitors, and glucagon-like peptide 1 receptor agonists, and the persistently high use of metformin. CONCLUSIONS During the past two decades, combined use of insulin and non-insulin drugs increased and glycemic control improved and leveled off after 2014 in Japanese patients with type 2 diabetes. Further studies of the trend in association with age and factors related to metabolic syndrome are necessary to investigate strategies aiming at personalized medicine in diabetes care.
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Affiliation(s)
| | - Shin-Ichi Araki
- Department of Internal Medicine, Division of Nephrology, Wakayama Medical University, Wakayama, Japan
| | | | | | | | | | | | | | - Daijiro Kabata
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Maegawa
- Department of Medicine, Shiga University of Medical Science, Otsu, Japan
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Nakazawa J, Yamanaka S, Yoshida S, Yoshibayashi M, Yoshioka M, Ito T, Araki SI, Kume S, Maegawa H. A Long-term Estimated Glomerular Filtration Rate Plot Analysis Permits the Accurate Assessment of a Decline in the Renal Function by Minimizing the Influence of Estimated Glomerular Filtration Rate Fluctuations. Intern Med 2022; 61:1823-1833. [PMID: 35705311 PMCID: PMC9259813 DOI: 10.2169/internalmedicine.8298-21] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Evaluating the rate of decline in the estimated glomerular filtration rate (eGFR) may help identify patients with occult chronic kidney disease (CKD). We herein report that eGFR fluctuation complicates the assessment of the rate of decline and propose a long-term eGFR plot analysis as a solution. Methods In 142 patients with persistent eGFR decline in a single hospital, we evaluated the factors influencing the rate of eGFR decline, calculated over the long term (≥3 years) and short term (<3 years) using eGFR plots, taking into account eGFR fluctuation between visits. Results The difference between the rate of eGFR decline calculated using short- and long-term plots increased as the time period considered in the short-term plots became shorter. A regression analysis revealed that eGFR fluctuation was the only factor that explained the difference and that the fluctuation exceeded the annual eGFR decline in all participants. Furthermore, the larger the eGFR fluctuation, the more difficult it became to detect eGFR decline using a short-term eGFR analysis. Obesity, a high eGFR at baseline, and faster eGFR decline were associated with larger eGFR fluctuations. To circumvent the issue of eGFR fluctuation in the assessment of the rate of eGFR decline, we developed a system that generates a long-term eGFR plot using all eGFR values for a participant, which enabled the detection of occult CKD, facilitating early therapeutic intervention. Conclusion The construction of long-term eGFR plots is useful for identifying patients with progressive eGFR decline, as it minimizes the effect of eGFR fluctuation.
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Affiliation(s)
- Jun Nakazawa
- Division of Nephrology, Department of Internal Medicine, Otsu City Hospital, Japan
- Department of Medicine, Shiga University of Medical Science, Japan
| | | | - Shohei Yoshida
- Division of Nephrology, Department of Internal Medicine, Otsu City Hospital, Japan
| | - Mamoru Yoshibayashi
- Division of Nephrology, Department of Internal Medicine, Otsu City Hospital, Japan
| | - Miho Yoshioka
- Division of Nephrology, Department of Internal Medicine, Otsu City Hospital, Japan
| | - Takamasa Ito
- Department of Infectious Diseases, Kyoto Prefectural University of Medicine, Japan
| | - Shin-Ichi Araki
- Department of Medicine, Shiga University of Medical Science, Japan
| | - Shinji Kume
- Department of Medicine, Shiga University of Medical Science, Japan
| | - Hiroshi Maegawa
- Department of Medicine, Shiga University of Medical Science, Japan
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Oshima M, Toyama T, Hara A, Shimizu M, Kitajima S, Iwata Y, Sakai N, Furuichi K, Haneda M, Babazono T, Yokoyama H, Iseki K, Araki SI, Ninomiya T, Hara S, Suzuki Y, Iwano M, Kusano E, Moriya T, Satoh H, Nakamura H, Makino H, Wada T. Combined changes in albuminuria and kidney function and subsequent risk for kidney failure in type 2 diabetes. BMJ Open Diabetes Res Care 2021; 9:9/1/e002311. [PMID: 34193460 PMCID: PMC8246293 DOI: 10.1136/bmjdrc-2021-002311] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/29/2021] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Changes in albuminuria or estimated glomerular filtration rate (eGFR) can be used as a surrogate endpoint of end-stage kidney disease (ESKD) in people with type 2 diabetes. We investigated whether the combined changes in albuminuria and eGFR are more strongly associated with future risk of ESKD. RESEARCH DESIGN AND METHODS Using data from a multicenter observational cohort study of people with type 2 diabetes, we evaluated the association of percentage change in urine albumin to creatinine ratio (UACR) and/or annual change in eGFR over 2 years with subsequent ESKD risk. RESULTS Among 1417 patients with repeated albuminuria and eGFR over 2 years, 129 (9.1%) developed ESKD. Patients with >30% UACR decline had lower ESKD risk (HR 0.47; 95% CI 0.29 to 0.77), whereas those with >30% UACR increase had higher ESKD risk (HR 2.31; 95% CI 1.52 to 3.51), compared with those with minor UACR change. Patients with greater eGFR decline had an increased ESKD risk than those with minor eGFR change (a decline of <2.5 mL/min/1.73 m2/year): HR 4.19 (95% CI 1.87 to 9.38) and 2.89 (95% CI 1.32 to 6.33) for those with a decline of >5 and 2.5-5 mL/min/1.73 m2/year, respectively. When the combined changes in UACR and eGFR were used, the highest ESKD risk (HR 5.60; 95% CI 2.08 to 15.09) was observed among patients with >30% UACR increase and an eGFR decline of >5 mL/min/1.73 m2/year compared with those with a minor change in UACR and eGFR. CONCLUSIONS Combined changes in albuminuria and eGFR over 2 years were strongly associated with future risk of kidney failure in patients with type 2 diabetes.
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Affiliation(s)
- Megumi Oshima
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan
| | - Tadashi Toyama
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan
- Innovative Clinical Research Center, Kanazawa University, Kanazawa, Japan
| | - Akinori Hara
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan
- Department of Environmental and Preventive Medicine, Kanazawa University, Kanazawa, Japan
| | - Miho Shimizu
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan
| | - Shinji Kitajima
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan
| | - Yasunori Iwata
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan
| | - Norihiko Sakai
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan
| | - Kengo Furuichi
- Nephrology, Kanazawa Medical University, Kahoku-gun, Japan
| | - Masakazu Haneda
- Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Tetsuya Babazono
- Diabetes Center, Tokyo Women's Medical University, Shinjuku-ku, Japan
| | | | | | - Shin-Ichi Araki
- Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Kyushu University, Fukuoka, Japan
| | - Shigeko Hara
- Okinaka Memorial Institute for Medical Research, Minato-ku, Japan
- Center of Health Management, Toranomon Hospital, Minato-ku, Japan
| | - Yoshiki Suzuki
- Health Administration Center, Niigata University, Niigata, Japan
| | - Masayuki Iwano
- Division of Nephrology, University of Fukui, Fukui, Japan
| | - Eiji Kusano
- Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Tatsumi Moriya
- Health Care Center, Kitasato University, Minato-ku, Japan
| | - Hiroaki Satoh
- Department of Metabolism and Endocrinology, Juntendo University School of Medicine Graduate School of Medicine, Bunkyo-ku, Japan
| | - Hiroyuki Nakamura
- Department of Environmental and Preventive Medicine, Kanazawa University, Kanazawa, Japan
| | | | - Takashi Wada
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan
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Imamura M, Takahashi A, Matsunami M, Horikoshi M, Iwata M, Araki SI, Toyoda M, Susarla G, Ahn J, Park KH, Kong J, Moon S, Sobrin L, Yamauchi T, Tobe K, Maegawa H, Kadowaki T, Maeda S. Genome-wide association studies identify two novel loci conferring susceptibility to diabetic retinopathy in Japanese patients with type 2 diabetes. Hum Mol Genet 2021; 30:716-726. [PMID: 33607655 DOI: 10.1093/hmg/ddab044] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 01/14/2021] [Accepted: 02/03/2021] [Indexed: 12/21/2022] Open
Abstract
Several reports have suggested that genetic susceptibility contributes to the development and progression of diabetic retinopathy. We aimed to identify genetic loci that confer susceptibility to diabetic retinopathy in Japanese patients with type 2 diabetes. We analysed 5 790 508 single nucleotide polymorphisms (SNPs) in 8880 Japanese patients with type 2 diabetes, 4839 retinopathy cases and 4041 controls, as well as 2217 independent Japanese patients with type 2 diabetes, 693 retinopathy cases and 1524 controls. The results of these two genome-wide association studies (GWAS) were combined with an inverse variance meta-analysis (Stage-1), followed by de novo genotyping for the candidate SNP loci (P < 1.0 × 10-4) in an independent case-control study (Stage-2, 2260 cases and 723 controls). After combining the association data (Stages 1 and 2) using meta-analysis, the associations of two loci reached a genome-wide significance level: rs12630354 near STT3B on chromosome 3, P = 1.62 × 10-9, odds ratio (OR) = 1.17, 95% confidence interval (CI) 1.11-1.23, and rs140508424 within PALM2 on chromosome 9, P = 4.19 × 10-8, OR = 1.61, 95% CI 1.36-1.91. However, the association of these two loci was not replicated in Korean, European or African American populations. Gene-based analysis using Stage-1 GWAS data identified a gene-level association of EHD3 with susceptibility to diabetic retinopathy (P = 2.17 × 10-6). In conclusion, we identified two novel SNP loci, STT3B and PALM2, and a novel gene, EHD3, that confers susceptibility to diabetic retinopathy; however, further replication studies are required to validate these associations.
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Affiliation(s)
- Minako Imamura
- Department of Advanced Genomic and Laboratory Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan.,Division of Clinical Laboratory and Blood Transfusion, University of the Ryukyus Hospital, Okinawa 903-0215, Japan.,Laboratory for Genomics of Diabetes and Metabolism, RIKEN Center for Integrative Medical Sciences, Yokohama, Kanagawa 230-0045, Japan
| | - Atsushi Takahashi
- Department of Genomic Medicine, Research Institute, National Cerebral and Cardiovascular Center, Osaka 564-8565, Japan.,Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Kanagawa 230-0045, Japan
| | - Masatoshi Matsunami
- Department of Advanced Genomic and Laboratory Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan.,Laboratory for Genomics of Diabetes and Metabolism, RIKEN Center for Integrative Medical Sciences, Yokohama, Kanagawa 230-0045, Japan
| | - Momoko Horikoshi
- Laboratory for Genomics of Diabetes and Metabolism, RIKEN Center for Integrative Medical Sciences, Yokohama, Kanagawa 230-0045, Japan
| | - Minoru Iwata
- First Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan.,Itoigawa Community Medical Unit, Toyama University Hospital, Toyama 930-0194, Japan
| | - Shin-Ichi Araki
- Department of Medicine, Shiga University of Medical Science, Shiga 520-2192, Japan
| | - Masao Toyoda
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa 259-1193, Japan
| | - Gayatri Susarla
- Massachusetts Eye and Ear Department of Ophthalmology, Harvard Medical School, Boston, MA 02114, USA
| | - Jeeyun Ahn
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul Municipal Government Seoul National University Boramae Medical Center, Seoul 07061, Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Jinhwa Kong
- Division of Genome Research, Center for Genome Science, Korea National Institute of Health, Chungcheongbuk-do 28159, Korea
| | - Sanghoon Moon
- Division of Genome Research, Center for Genome Science, Korea National Institute of Health, Chungcheongbuk-do 28159, Korea
| | - Lucia Sobrin
- Massachusetts Eye and Ear Department of Ophthalmology, Harvard Medical School, Boston, MA 02114, USA
| | | | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Kazuyuki Tobe
- First Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Hiroshi Maegawa
- Department of Medicine, Shiga University of Medical Science, Shiga 520-2192, Japan
| | - Takashi Kadowaki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan.,Toranomon Hospital, Tokyo 105-8470, Japan.,Okinaka Memorial Institute for Medical Research, Tokyo 105-8470, Japan
| | - Shiro Maeda
- Department of Advanced Genomic and Laboratory Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan.,Division of Clinical Laboratory and Blood Transfusion, University of the Ryukyus Hospital, Okinawa 903-0215, Japan.,Laboratory for Genomics of Diabetes and Metabolism, RIKEN Center for Integrative Medical Sciences, Yokohama, Kanagawa 230-0045, Japan
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10
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Yokoyama H, Shiraiwa T, Takahara M, Iwamoto M, Kuribayashi N, Nomura T, Yamada M, Sone H, Araki SI. Applications of physical performance measures to routine diabetes care for frailty prevention concept: fundamental data with grip strength, gait speed, timed chair stand speed, standing balance, and knee extension strength. BMJ Open Diabetes Res Care 2020; 8:8/1/e001562. [PMID: 32948539 PMCID: PMC7511604 DOI: 10.1136/bmjdrc-2020-001562] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Progression of muscle strength weakening will lead to a poor physical performance and disability. While this is particularly important in patients with diabetes, the associations of reduced muscle strength measured by grip strength with clinical features and physical performance remain unclear. We investigated clinical features and physical performance measures in association with grip strength in elderly people with diabetes in a primary care setting. RESEARCH DESIGN AND METHODS A cross-sectional study was conducted enrolling 634 male and 323 female Japanese patients with type 2 diabetes aged 60 years or older. First, grip strength was measured and the associations of gender-specific grip strength with clinical features were evaluated. Second, in patients with a grip strength below the gender-specific median, physical performance measures, including gait speed, timed chair stand speed, knee extension strength, standing balance, and short physical performance battery scores, were investigated. Patients with and without a low performance defined by Asian Working Group for Sarcopenia were compared in terms of clinical features and physical performance measures. RESULTS Grip strength decreased according to aging and longer duration of diabetes and was independently related to body mass index, glycated hemoglobin A1c (HbA1c), serum albumin, albuminuria, neuropathy, and stroke in male patients, and to body mass index and albuminuria in female patients. The physical performance measures became worse proportionally to a decrease in the grip strength. Patients with a low performance exhibited a significantly older age, lower grip strength and serum albumin, higher albuminuria, and poorer physical performance measures than those without. CONCLUSIONS Reduced grip strength was associated with glycemic exposure indicators of age-related duration, HbA1c, and vascular complications. The physical performance measures became worse with decreasing grip strength. Measurements of grip strength and physical performance in patients with diabetes may help promote intervention to prevent frailty in future studies.
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Affiliation(s)
- Hiroki Yokoyama
- Department of Internal Medicine, Jiyugaoka Medical Clinic, Obihiro, Japan
| | | | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masahiro Iwamoto
- Department of Internal Medicine, Iwamoto Medical Clinic, Zentsuji, Japan
| | | | - Takuo Nomura
- Department of Rehabilitation Sciences, Kansai University of Welfare Sciences, Kashiwara, Osaka, Japan
| | - Minoru Yamada
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hirohito Sone
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - Shin-Ichi Araki
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
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11
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Yokoyama H, Araki SI, Kawai K, Yamazaki K, Shirabe SI, Sugimoto H, Minami M, Miyazawa I, Maegawa H. The Prognosis of Patients With Type 2 Diabetes and Nonalbuminuric Diabetic Kidney Disease Is Not Always Poor: Implication of the Effects of Coexisting Macrovascular Complications (JDDM 54). Diabetes Care 2020; 43:1102-1110. [PMID: 32144168 DOI: 10.2337/dc19-2049] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [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] [Received: 10/15/2019] [Accepted: 01/25/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Nonalbuminuric diabetic kidney disease (DKD) has become the prevailing phenotype in patients with type 2 diabetes. However, it remains unclear whether its prognosis is poorer than that of other DKD phenotypes. RESEARCH DESIGN AND METHODS A total of 2,953 Japanese patients with type 2 diabetes and estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m2, enrolled in an observational cohort study in 2004, were followed until 2015. On the basis of albuminuria (>30 mg/g creatinine) and reduced eGFR (<60 mL/min/1.73 m2) at baseline, participants were classified into the four DKD phenotypes-no-DKD, albuminuric DKD without reduced eGFR, nonalbuminuric DKD with reduced eGFR, and albuminuric DKD with reduced eGFR-to assess the risks of mortality, cardiovascular disease (CVD), and renal function decline. RESULTS During the mean follow-up of 9.7 years, 113 patients died and 263 developed CVD. In nonalbuminuric DKD, the risks of death or CVD were not higher than those in no-DKD (adjusted hazard ratio 1.02 [95% CI 0.66, 1.60]) and the annual decline in eGFR was slower than in other DKD phenotypes. The risks of death or CVD in nonalbuminuric DKD without prior CVD were similar to those in no-DKD without prior CVD, whereas the risks in nonalbuminuric DKD with prior CVD as well as other DKD phenotypes were higher. CONCLUSIONS Nonalbuminuric DKD did not have a higher risk of mortality, CVD events, or renal function decline than the other DKD phenotypes. In nonalbuminuric DKD, the presence of macrovascular complications may be a main determinant of prognosis rather than the renal phenotype.
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Affiliation(s)
| | - Shin-Ichi Araki
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | | | | | | | | | | | - Itsuko Miyazawa
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
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12
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Yoshibayashi M, Kume S, Yasuda-Yamahara M, Yamahara K, Takeda N, Osawa N, Chin-Kanasaki M, Nakae Y, Yokoi H, Mukoyama M, Asanuma K, Maegawa H, Araki SI. Protective role of podocyte autophagy against glomerular endothelial dysfunction in diabetes. Biochem Biophys Res Commun 2020; 525:319-325. [PMID: 32089264 DOI: 10.1016/j.bbrc.2020.02.088] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 01/14/2020] [Accepted: 02/11/2020] [Indexed: 02/07/2023]
Abstract
To examine the cell-protective role of podocyte autophagy against glomerular endothelial dysfunction in diabetes, we analyzed the renal phenotype of tamoxifen (TM)-inducible podocyte-specific Atg5-deficient (iPodo-Atg5-/-) mice with experimental endothelial dysfunction. In both control and iPodo-Atg5-/- mice, high fat diet (HFD) feeding induced glomerular endothelial damage characterized by decreased urinary nitric oxide (NO) excretion, collapsed endothelial fenestrae, and reduced endothelial glycocalyx. HFD-fed control mice showed slight albuminuria and nearly normal podocyte morphology. In contrast, HFD-fed iPodo-Atg5-/- mice developed massive albuminuria accompanied by severe podocyte injury that was observed predominantly in podocytes adjacent to damaged endothelial cells by scanning electron microscopy. Although podocyte-specific autophagy deficiency did not affect endothelial NO synthase deficiency-associated albuminuria, it markedly exacerbated albuminuria and severe podocyte morphological damage when the damage was induced by intravenous neuraminidase injection to remove glycocalyx from the endothelial surface. Furthermore, endoplasmic reticulum stress was accelerated in podocytes of iPodo-Atg5-/- mice stimulated with neuraminidase, and treatment with molecular chaperone tauroursodeoxycholic acid improved neuraminidase-induced severe albuminuria and podocyte injury. In conclusion, podocyte autophagy plays a renoprotective role against diabetes-related structural endothelial damage, providing an additional insight into the pathogenesis of massive proteinuria in diabetic nephropathy.
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Affiliation(s)
- Mamoru Yoshibayashi
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Shinji Kume
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan.
| | | | - Kosuke Yamahara
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Naoko Takeda
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Norihisa Osawa
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | | | - Yuki Nakae
- Departments of Stem Cell Biology and Regenerative Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Hideki Yokoi
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masashi Mukoyama
- Department of Nephrology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Katsuhiko Asanuma
- Department of Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroshi Maegawa
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Shin-Ichi Araki
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan.
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13
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Araki SI. Combined effect of sodium-glucose cotransporter 2 and dipeptidyl peptidase-4 inhibitors for diabetic kidney disease. J Diabetes Investig 2019; 11:22-24. [PMID: 31520446 PMCID: PMC6944829 DOI: 10.1111/jdi.13147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Shin-Ichi Araki
- Division of Diabetology, Endocrinology and Nephrology, Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
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14
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Tomita I, Kume S, Yamahara K, Yasuda-Yamahara M, Takeda N, Osawa N, Chin-Kanasaki M, Kaneko T, Pieper M, Araki SI, Maegawa H. FO053ROLE OF KETONE BODY METABOLISM IN SGLT2 INHIBITOR-MEDIATED RENOPROTECTION IN HIGH FAT DIET-FED APOE-KNOCKOUT MICE. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz096.fo053] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Issei Tomita
- Shiga University of Medical Science, Otsu, Japan
| | - Shinji Kume
- Shiga University of Medical Science, Otsu, Japan
| | | | | | - Naoko Takeda
- Shiga University of Medical Science, Otsu, Japan
| | | | | | - Tatsuroh Kaneko
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Michael Pieper
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
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15
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Kume S, Tomita I, Yamahara K, Yasuda-Yamahara M, Takeda N, Osawa N, Chin-Kanasaki M, Kaneko T, Pieper M, Araki SI, Maegawa H. SP430Potential role for ketone body metabolism in an SGLT2 inhibitor-mediated anti-albuminuric effect in type 2 diabetic db/db mice. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp430] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Shinji Kume
- Shiga University of Medical Science, Otsu, Japan
| | - Issei Tomita
- Shiga University of Medical Science, Otsu, Japan
| | | | | | - Naoko Takeda
- Shiga University of Medical Science, Otsu, Japan
| | | | | | - Tatsuroh Kaneko
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Michael Pieper
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
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16
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Sugahara S, Kume S, Chin-Kanasaki M, Tomita I, Yasuda-Yamahara M, Yamahara K, Takeda N, Osawa N, Yanagita M, Araki SI, Maegawa H. Protein O-GlcNAcylation Is Essential for the Maintenance of Renal Energy Homeostasis and Function via Lipolysis during Fasting and Diabetes. J Am Soc Nephrol 2019; 30:962-978. [PMID: 31043434 DOI: 10.1681/asn.2018090950] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 09/25/2018] [Accepted: 03/09/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Energy metabolism in proximal tubular epithelial cells (PTECs) is unique, because ATP production largely depends on lipolysis in both the fed and fasting states. Furthermore, disruption of renal lipolysis is involved in the pathogenesis of diabetic tubulopathy. Emerging evidence suggests that protein O-GlcNAcylation, an intracellular nutrient-sensing system, may regulate a number of metabolic pathways according to changes in nutritional status. Although O-GlcNAcylation in PTECs has been demonstrated experimentally, its precise role in lipolysis in PTECs is unclear. METHODS To investigate the mechanism of renal lipolysis in PTECs-specifically, the role played by protein O-GlcNAcylation-we generated mice with PTECs deficient in O-GlcNAc transferase (Ogt). We analyzed their renal phenotypes during ad libitum feeding, after prolonged fasting, and after mice were fed a high-fat diet for 16 weeks to induce obesity and diabetes. RESULTS Although PTEC-specific Ogt-deficient mice lacked a marked renal phenotype during ad libitum feeding, after fasting 48 hours, they developed Fanconi syndrome-like abnormalities, PTEC apoptosis, and lower rates of renal lipolysis and ATP production. Proteomic analysis suggested that farnesoid X receptor-dependent upregulation of carboxylesterase-1 is involved in O-GlcNAcylation's regulation of lipolysis in fasted PTECs. PTEC-specific Ogt-deficient mice with diabetes induced by a high-fat diet developed severe tubular cell damage and enhanced lipotoxicity. CONCLUSIONS Protein O-GlcNAcylation is essential for renal lipolysis during prolonged fasting and offers PTECs significant protection against lipotoxicity in diabetes.
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Affiliation(s)
- Sho Sugahara
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Shinji Kume
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan;
| | - Masami Chin-Kanasaki
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan.,Division of Blood Purification, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan; and
| | - Issei Tomita
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | | | - Kosuke Yamahara
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Naoko Takeda
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Norihisa Osawa
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Motoko Yanagita
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shin-Ichi Araki
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan.,Division of Blood Purification, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan; and
| | - Hiroshi Maegawa
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan;
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17
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Nobuta H, Katagi M, Kume S, Terashima T, Araki SI, Maegawa H, Kojima H, Nakagawa T. A role for bone marrow-derived cells in diabetic nephropathy. FASEB J 2018; 33:4067-4076. [PMID: 30496699 DOI: 10.1096/fj.201801825r] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Diabetes mellitus causes systemic disorders. We previously demonstrated that diabetic condition forced bone marrow-derived cells (BMDCs) to express TNF-α, leading to the development of diabetic neuropathy in mice. Here, we hypothesized that these abnormal BMDCs are also involved in diabetic nephropathy. To test our hypothesis, mice were irradiated to receive total bone marrow (BM) from the transgenic mice expressing green fluorescent protein before diabetes was induced by streptozotocin. Confocal microscopy showed that the diabetic glomerulus had more BMDCs compared with the nondiabetic glomerulus. Most of these cells exhibited endothelial phenotypes, being negative for several markers, including podocin (a maker of podocyte), α8 integrin (mesangial cell), CD68, and F4/80 (macrophage). Next, the total BM of diabetic mice was transplanted into nondiabetic mice to examine if diabetic BM per se could cause glomerular injury. The recipient mice exhibiting normal glycemia developed albuminuria and mesangial expansion with an increase in capillary area. The number of BMDCs increased in the glomerulus of the recipient mice. These cells were found to exhibit the endothelial phenotype and to express TNF-α. These data suggest that diabetic BMDCs per se could initiate glomerular disease. Finally, eNOS knockout mice were used to examine if residential endothelial injury could attract BMDCs into the glomerulus. However, endothelial dysfunction due to eNOS deficiency failed to attract BMDCs into the glomerulus. In summary, BMDCs may be involved in the development of diabetic nephropathy.-Nobuta, H., Katagi, M., Kume, S., Terashima, T., Araki, S., Maegawa, H., Kojima, H., Nakagawa, T. A role for bone marrow-derived cells in diabetic nephropathy.
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Affiliation(s)
- Hiroshi Nobuta
- Department of Medicine, Shiga University of Medical Science, Shiga, Japan.,Department of Stem Cell Biology and Regenerative Medicine, Shiga University of Medical Science, Shiga, Japan; and
| | - Miwako Katagi
- Department of Stem Cell Biology and Regenerative Medicine, Shiga University of Medical Science, Shiga, Japan; and
| | - Shinji Kume
- Department of Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Tomoya Terashima
- Department of Stem Cell Biology and Regenerative Medicine, Shiga University of Medical Science, Shiga, Japan; and
| | - Shin-Ichi Araki
- Department of Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Hiroshi Maegawa
- Department of Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Hideto Kojima
- Department of Stem Cell Biology and Regenerative Medicine, Shiga University of Medical Science, Shiga, Japan; and
| | - Takahiko Nakagawa
- Department of Future Basic Medicine, Nara Medical University, Nara, Japan
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18
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Tanaka Y, Kume S, Maeda S, Osawa N, Takeda N, Chin-Kanasaki M, Isshiki K, Ugi S, Oshima I, Uzu T, Maegawa H, Araki SI. Overexpression of acetyl CoA carboxylase β exacerbates podocyte injury in the kidney of streptozotocin-induced diabetic mice. Biochem Biophys Res Commun 2017; 495:1115-1121. [PMID: 29175208 DOI: 10.1016/j.bbrc.2017.11.145] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
Abstract
A single nucleotide polymorphism (SNP) within the acetyl CoA carboxylase (ACC) β gene (ACACB), rs2268388, has been shown to be associated with susceptibility to development of proteinuria in patients with type 2 diabetes. To investigate the biological roles of ACCβ in the pathogenesis of diabetic nephropathy, we examined the effects of overexpression of ACACB using podocyte-specific ACACB-transgenic mice or ACACB-overexpressing murine podocytes. Podocyte-specific ACACB-transgenic mice or littermate mice were treated with streptozotocin (STZ) to induce diabetes, and 12 weeks after induction of diabetes, we examined the expression of podocyte markers to evaluate the degree of podocyte injury in these mice. We also examined the effects of ACCβ on podocyte injury in ACACB- or LacZ-overexpressing murine podocytes. Podocyte-specific ACACB overexpression did not cause visible podocyte injury in non-diabetic mice. In STZ-induced diabetic mice, ACACB-transgenic mice showed a significant increase in urinary albumin excretion, accompanied by decreased synaptopodin expression and podocin mislocalization in podocytes, compared with wild-type mice. In cultured murine podocytes, overexpression of ACACB significantly decreased synaptopodin expression and reorganized stress fibers under high glucose conditions, but not in normal glucose conditions. The decrease of synaptopodin expression and reorganized stress fibers observed in ACACB overexpressing cells cultured under high glucose conditions was reversed by a treatment of 5-aminoimidazole-4-carboxamide-1-beta-4-ribofuranoside (AICAR), activator of AMP-activated protein kinase (AMPK). The excess of ACCβ might contribute to exacerbation of podocyte injury in the kidney of an animal model for diabetes mellitus, and the AMPK/ACCβ pathway may be a novel therapeutic target for the prevention of diabetes-related podocyte injury.
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Affiliation(s)
- Yuki Tanaka
- Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Shinji Kume
- Department of Medicine, Shiga University of Medical Science, Otsu, Japan.
| | - Shiro Maeda
- Laboratory for Endocrinology and Metabolism, RIKEN Center for Genomic Medicine, Yokohama, Japan; Department of Advanced Genomic and Laboratory Medicine, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan; Division of Clinical Laboratory and Blood Transfusion, University of the Ryukyus, Nishihara, Japan
| | - Norihisa Osawa
- Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Naoko Takeda
- Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | | | - Keiji Isshiki
- Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Satoshi Ugi
- Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Itsuki Oshima
- Shionogi Pharmaceutical Research Center, Shionogi & Co., Ltd., Osaka, Japan
| | - Takashi Uzu
- Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Hiroshi Maegawa
- Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Shin-Ichi Araki
- Department of Medicine, Shiga University of Medical Science, Otsu, Japan.
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Iwai T, Kume S, Chin-Kanasaki M, Kuwagata S, Araki H, Takeda N, Sugaya T, Uzu T, Maegawa H, Araki SI. Stearoyl-CoA Desaturase-1 Protects Cells against Lipotoxicity-Mediated Apoptosis in Proximal Tubular Cells. Int J Mol Sci 2016; 17:ijms17111868. [PMID: 27834856 PMCID: PMC5133868 DOI: 10.3390/ijms17111868] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/31/2016] [Accepted: 11/03/2016] [Indexed: 01/13/2023] Open
Abstract
Saturated fatty acid (SFA)-related lipotoxicity is a pathogenesis of diabetes-related renal proximal tubular epithelial cell (PTEC) damage, closely associated with a progressive decline in renal function. This study was designed to identify a free fatty acid (FFA) metabolism-related enzyme that can protect PTECs from SFA-related lipotoxicity. Among several enzymes involved in FFA metabolism, we identified stearoyl-CoA desaturase-1 (SCD1), whose expression level significantly decreased in the kidneys of high-fat diet (HFD)-induced diabetic mice, compared with non-diabetic mice. SCD1 is an enzyme that desaturates SFAs, converting them to monounsaturated fatty acids (MUFAs), leading to the formation of neutral lipid droplets. In culture, retrovirus-mediated overexpression of SCD1 or MUFA treatment significantly ameliorated SFA-induced apoptosis in PTECs by enhancing intracellular lipid droplet formation. In contrast, siRNA against SCD1 exacerbated the apoptosis. Both overexpression of SCD1 and MUFA treatment reduced SFA-induced apoptosis via reducing endoplasmic reticulum stress in cultured PTECs. Thus, HFD-induced decrease in renal SCD1 expression may play a pathogenic role in lipotoxicity-induced renal injury, and enhancing SCD1-mediated desaturation of SFA and subsequent formation of neutral lipid droplets may become a promising therapeutic target to reduce SFA-induced lipotoxicity. The present study provides a novel insight into lipotoxicity in the pathogenesis of diabetic nephropathy.
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Affiliation(s)
- Tamaki Iwai
- Department of Medicine, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan.
| | - Shinji Kume
- Department of Medicine, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan.
| | - Masami Chin-Kanasaki
- Department of Medicine, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan.
| | - Shogo Kuwagata
- Department of Medicine, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan.
| | - Hisazumi Araki
- Department of Medicine, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan.
| | - Naoko Takeda
- Department of Medicine, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan.
| | - Takeshi Sugaya
- Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa 216-8511, Japan.
| | - Takashi Uzu
- Department of Medicine, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan.
| | - Hiroshi Maegawa
- Department of Medicine, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan.
| | - Shin-Ichi Araki
- Department of Medicine, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan.
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20
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Tagawa A, Yasuda M, Kume S, Yamahara K, Nakazawa J, Chin-Kanasaki M, Araki H, Araki SI, Koya D, Asanuma K, Kim EH, Haneda M, Kajiwara N, Hayashi K, Ohashi H, Ugi S, Maegawa H, Uzu T. Impaired Podocyte Autophagy Exacerbates Proteinuria in Diabetic Nephropathy. Diabetes 2016; 65:755-67. [PMID: 26384385 DOI: 10.2337/db15-0473] [Citation(s) in RCA: 221] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 09/14/2015] [Indexed: 11/13/2022]
Abstract
Overcoming refractory massive proteinuria remains a clinical and research issue in diabetic nephropathy. This study was designed to investigate the pathogenesis of massive proteinuria in diabetic nephropathy, with a special focus on podocyte autophagy, a system of intracellular degradation that maintains cell and organelle homeostasis, using human tissue samples and animal models. Insufficient podocyte autophagy was observed histologically in patients and rats with diabetes and massive proteinuria accompanied by podocyte loss, but not in those with no or minimal proteinuria. Podocyte-specific autophagy-deficient mice developed podocyte loss and massive proteinuria in a high-fat diet (HFD)-induced diabetic model for inducing minimal proteinuria. Interestingly, huge damaged lysosomes were found in the podocytes of diabetic rats with massive proteinuria and HFD-fed, podocyte-specific autophagy-deficient mice. Furthermore, stimulation of cultured podocytes with sera from patients and rats with diabetes and massive proteinuria impaired autophagy, resulting in lysosome dysfunction and apoptosis. These results suggest that autophagy plays a pivotal role in maintaining lysosome homeostasis in podocytes under diabetic conditions, and that its impairment is involved in the pathogenesis of podocyte loss, leading to massive proteinuria in diabetic nephropathy. These results may contribute to the development of a new therapeutic strategy for advanced diabetic nephropathy.
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MESH Headings
- Adult
- Aged
- Animals
- Apoptosis
- Autophagy
- Autophagy-Related Protein 5
- Autophagy-Related Protein 7
- Blotting, Western
- Cell Line
- Diabetes Mellitus, Experimental/complications
- Diabetes Mellitus, Experimental/metabolism
- Diabetes Mellitus, Experimental/pathology
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/metabolism
- Diabetes Mellitus, Type 2/pathology
- Diabetic Nephropathies/etiology
- Diabetic Nephropathies/metabolism
- Diabetic Nephropathies/pathology
- Diet, High-Fat
- Female
- Humans
- Intracellular Signaling Peptides and Proteins/metabolism
- Intravital Microscopy
- Kidney/metabolism
- Kidney/pathology
- Lysosomes/metabolism
- Lysosomes/pathology
- Male
- Membrane Proteins/metabolism
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Mice, Transgenic
- Microfilament Proteins/metabolism
- Microscopy, Electron, Scanning
- Microscopy, Electron, Transmission
- Microtubule-Associated Proteins/genetics
- Middle Aged
- Podocytes/metabolism
- Proteinuria/etiology
- Proteinuria/metabolism
- Proteinuria/pathology
- RNA-Binding Proteins/blood
- Rats
- Rats, Long-Evans
- Severity of Illness Index
- Young Adult
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Affiliation(s)
- Atsuko Tagawa
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Mako Yasuda
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Shinji Kume
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Kosuke Yamahara
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Jun Nakazawa
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | | | - Hisazumi Araki
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Shin-Ichi Araki
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Daisuke Koya
- Division of Diabetology and Endocrinology, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Katsuhiko Asanuma
- Laboratory for Kidney Research (TMK Project), Medical Innovation Center, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan Division of Nephrology, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Eun-Hee Kim
- Division of Nephrology, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan Osong Medical Innovation Foundation, Laboratory Animal Center, Cheongwon-gun, Chungbuk, Republic of Korea
| | - Masakazu Haneda
- Division of Metabolism and Biosystemic Science, Department of Internal Medicine, Asahikawa Medical University, Hokkaido, Japan
| | | | - Kazuyuki Hayashi
- Department of Nephrology, Ikeda City Hospital, Ikeda, Osaka, Japan
| | - Hiroshi Ohashi
- Department of Pathology, Ikeda City Hospital, Ikeda, Osaka, Japan
| | - Satoshi Ugi
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Hiroshi Maegawa
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Takashi Uzu
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
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21
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Uzu T, Araki SI, Araki H, Kume S, Maegawa H. Multiple osteoporotic fractures in a patient with CKD stage G3b. Kidney Int 2015; 87:1077. [DOI: 10.1038/ki.2013.232] [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: 11/09/2022]
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22
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Araki H, Tanaka Y, Yoshida S, Morita Y, Kume S, Isshiki K, Araki SI, Uzu T, Kashiwagi A, Maegawa H. Oral glucose-stimulated serum C-peptide predicts successful switching from insulin therapy to liraglutide monotherapy in Japanese patients with type 2 diabetes and renal impairment. J Diabetes Investig 2014; 5:435-41. [PMID: 25411603 PMCID: PMC4210066 DOI: 10.1111/jdi.12169] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 08/22/2013] [Accepted: 09/23/2013] [Indexed: 11/30/2022] Open
Abstract
Aims/Introduction In Japan, liraglutide was recently approved for patients with type 2 diabetes. To our knowledge, there are no markers predicting successful switching from insulin therapy to liraglutide monotherapy in Japanese patients with type 2 diabetes and renal impairment. We therefore assessed clinical characteristics predicting successful switching. Materials and Methods We analyzed 21 patients with type 2 diabetes and estimated glomerular filtration rates <60 mL/min/1.73 m2 receiving long‐term insulin in Shiga University of Medical Science Hospital, Otsu, Shiga, Japan. Their β‐cell function was assessed by measuring urinary C‐peptide and C‐peptide immunoreactivity (CPR) index, along with glucagon loading and oral glucose tolerance tests. Blood glucose concentration and blood pressure were measured daily before and after switching from insulin to liraglutide, and glycated hemoglobin (HbA1c; National Glycohemoglobin Standardization Program) was assessed 12 weeks after switching to liraglutide. Results Baseline HbA1c was significantly lower in successfully switched than in unsuccessfully switched patients. CPR index, urinary C‐peptide concentration and 6‐min post‐glucagon increment in CPR (ΔCPR) did not differ significantly in the two groups. ΔCPR 120 min after 75 g oral glucose was significantly higher in successfully than unsuccessfully switched patients. Mean blood glucose concentrations before breakfast, after breakfast, before lunch and after dinner were significantly lower in successfully switched patients. HbA1c did not change significantly in either group. Conclusions Measurement of oral glucose‐stimulated ΔCPR120 min is recommended when considering switching Japanese type 2 diabetes patients with renal impairment from insulin to liraglutide monotherapy.
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Affiliation(s)
- Hisazumi Araki
- Department of Medicine Shiga University of Medical Science Otsu Shiga Japan
| | - Yuki Tanaka
- Department of Medicine Shiga University of Medical Science Otsu Shiga Japan
| | - Syohei Yoshida
- Department of Medicine Shiga University of Medical Science Otsu Shiga Japan
| | - Yoshikata Morita
- Department of Medicine Shiga University of Medical Science Otsu Shiga Japan
| | - Shinji Kume
- Department of Medicine Shiga University of Medical Science Otsu Shiga Japan
| | - Keiji Isshiki
- Department of Medicine Shiga University of Medical Science Otsu Shiga Japan
| | - Shin-Ichi Araki
- Department of Medicine Shiga University of Medical Science Otsu Shiga Japan
| | - Takashi Uzu
- Department of Medicine Shiga University of Medical Science Otsu Shiga Japan
| | - Atsunori Kashiwagi
- Department of Medicine Shiga University of Medical Science Otsu Shiga Japan
| | - Hiroshi Maegawa
- Department of Medicine Shiga University of Medical Science Otsu Shiga Japan
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23
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Hayashida M, Souma K, Sugo K, Araki SI, Ishizaka F, Ueda M, Kasai T, Masuko T. Sex and age differences in meat composition of Yeso sika deer (Cervus nippon yesoensis) reared for a short period after capture in the wild. Anim Sci J 2014; 86:207-13. [PMID: 25186458 DOI: 10.1111/asj.12274] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 05/29/2014] [Indexed: 11/27/2022]
Abstract
Yeso sika deer captured in winter around Lake Akan in Hokkaido were reared for 8-10 months at Tokyo University of Agriculture in Abashiri. Six 1-year-old females and males and six 2-year-old or older (adult) females and males were slaughtered and their carcasses were processed. The chemical composition, mineral contents and fatty acid composition of the loin were measured. No marked influence of gender or age was noted in the chemical composition of loin. In the mineral contents, significant differences were noted. The potassium and sulfur contents were lower and the sodium content was higher in adult deer meat (P < 0.05, respectively) and the potassium content was higher in male deer meat (P < 0.05). Arsenic, cadmium or lead were not detected. In the unsaturated fatty acid, a significant interaction was detected (P < 0.05), and it was high in 1-year-old female deer meat and low in 1-year-old male deer meat. Significant gender or age differences were noted only in the mineral contents in the loin of deer reared for a short period after capture.
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Affiliation(s)
- Maki Hayashida
- Department of Bio-production Technology, Junior College of Tokyo University of Agriculture, Tokyo, Japan
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24
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Abstract
During the past 10 years, a global pandemic of end‐stage renal disease (ESRD) attributed to diabetes mellitus has changed the therapeutic strategies based on landmark trials that have shown that diabetic micro‐ and macrovascular complications might be preventable. However, the remaining risk of the progression of diabetic kidney disease to ESRD is still high, despite newly introduced anti‐diabetic, antihypertensive and dyslipidemic drugs in the 21st century. Here, we show the importance of targeting remission and regression of microalbuminuria in type 2 diabetic patients. To achieve the remission and regression of microalbuminuria, physicians have revised the management strategy of diabetic patients and have to act immediately. Early detection of microalbuminuria with continuous screening, the use of renin–angiotensin system blockades, and targets for HbA1c of <7.35% and systolic blood pressure of <130 mmHg are closely associated with the remission and regression of microalbuminuria, resulting in protection against the progression of diabetic kidney disease, as well as cardiovascular events. Our concept of the natural history of diabetic kidney disease has to be modified by our results and others. Reducing microalbuminuria is therefore considered to be an important therapeutic target and could be a pivotal biomarker of therapeutic success in diabetic patients. (J Diabetes Invest, doi:10.1111/j.2040‐1124.2011.00112.x, 2011)
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Affiliation(s)
- Daisuke Koya
- Division of Diabetes & Endocrinology, Kanazawa Medical University, Kahokugun, Ishikawa
| | - Shin-Ichi Araki
- Division of Nephrology & Diabetes, Shiga University of Medical Science, Otsu, Shiga
| | - Masakazu Haneda
- Division of Metabolism and Biosystemic Science, Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
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25
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Uzu T, Sakaguchi M, Tsuda A, Kadota A, Yokomaku Y, Kume S, Kanasaki M, Isshiki K, Araki SI, Sugiomoto T, Maegawa H, Kashiwagi A. Effects of blood pressure and the renin-angiotensin system on platelet activation in type 2 diabetes. J Diabetes Investig 2014; 1:196-201. [PMID: 24843432 PMCID: PMC4020721 DOI: 10.1111/j.2040-1124.2010.00048.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aims/Introduction: Platelet‐derived microparticles (PDMP) are released from the platelets either after activation or in response to physical stimulation in vivo. The present study examined the association between blood pressure and PDMP, and the effects of high‐dose angiotensin receptor blockers (ARB) on PDMP in patients with type 2 diabetes. Materials and Methods: The study subjects consisted of 28 type 2 diabetes patients with blood pressure ≥130/80 mmHg who were treated with valsartan (80 mg daily). The patients were randomly assigned to take either 80 mg of telmisartan (Tel group) or 160 mg of valsartan (Val group) and then were followed up for 24 weeks. Thereafter, the patients were switched to combination therapy (5 mg of amlodipine with 40 mg of telmisartan [Tel group] or 80 mg of valsartan [Val group]) for 12 weeks. Results: Although the ambulatory blood pressure did not change, the PDMP levels were significantly decreased from baseline to week 24 (high dose ARB). In contrast, combination therapy reduced both blood pressure and PDMP levels compared with the baseline. Although the PDMP level was significantly correlated with the morning BP elevation at baseline and week 36 (combination therapy), this same relationship was not found at week 24. There were no significant differences in the blood pressure and PDMP levels between the two groups. Conclusions: Patients with morning hypertension might be at risk for cardiovascular diseases. High‐dose renin‐angiotensin system inhibition and blood pressure control are both considered to reduce cardiovascular events in patients with type 2 diabetes. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2010.00048.x, 2010)
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Affiliation(s)
- Takashi Uzu
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Masayoshi Sakaguchi
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Atsuko Tsuda
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Aya Kadota
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yukiyo Yokomaku
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Shinji Kume
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Masami Kanasaki
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Keiji Isshiki
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Shin-Ichi Araki
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Toshiro Sugiomoto
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Hiroshi Maegawa
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Atsunori Kashiwagi
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
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26
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Kume S, Uzu T, Takagi C, Kondo M, Okabe T, Araki SI, Isshiki K, Takeda N, Kondo K, Haneda M, Koya D, Nishio Y, Kashiwagi A, Maegawa H. Efficacy and tolerability of vildagliptin in type 2 diabetic patients on hemodialysis. J Diabetes Investig 2014; 3:298-301. [PMID: 24843580 PMCID: PMC4014953 DOI: 10.1111/j.2040-1124.2011.00169.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Anti-diabetic agent-related hypoglycemia is a serious complication in type 2 diabetic patients on hemodialysis. Therefore, we assessed the efficacy and tolerability of 24 weeks of monotherapy with vildagliptin, a dipeptidyl peptidase four inhibitor, which is a new class of antidiabetic agent. This open-label, single-arm clinical trial was performed on 26 patients on hemodialysis. The primary assessments were changes in postprandial glucose level and glycated albumin (GA). During the study, three patients dropped out, and data from 23 patients were analyzed. Significant reductions were seen in postprandial glucose (-2.60 ± 3.80 mmol/L, P < 0.001) and GA (-2.59 ± 2.33%, P < 0.001) levels. No serious drug-related adverse events were observed. Vildagliptin monotherapy can be recommended for glycemic control in type 2 diabetic patients on hemodialysis. This trial was registered with the University Hospital Medical Information Network (no. UMIN000003661). (J Diabetes Invest, doi: 10.1111/j.2040-1124.2011.00169.x, 2011).
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Affiliation(s)
- Shinji Kume
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga
| | - Takashi Uzu
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga
| | | | | | - Tomoko Okabe
- Rakuwakai Otowa Memorial Hospital, Yamashina, Kyoto
| | - Shin-Ichi Araki
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga
| | - Keiji Isshiki
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga
| | - Naoko Takeda
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga
| | - Keiko Kondo
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga
| | - Masakazu Haneda
- Department of Medicine, Asahikawa Medical College, Asahikawa, Hokkaido
| | - Daisuke Koya
- Division of Diabetes & Endocrinology, Kanazawa Medical University, Kahoku-Gun, Ishikawa, Japan
| | - Yoshihiko Nishio
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga
| | - Atsunori Kashiwagi
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga
| | - Hiroshi Maegawa
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga
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27
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Araki SI. [Diabetic nephropathy]. Nihon Rinsho 2013; 71:2010-2014. [PMID: 24397175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The number of elderly diabetic patients who require chronic hemodialysis is progressively increasing in Japan. Thus, halting the progression of diabetic nephropathy in elderly diabetic patients is a clinically important issue. However, there is little information or evidence of this complication. Understanding the change of the kidney function with aging, the clinical characteristics and factors associated with the progression of diabetic nephropathy in this population should be useful for establishing effective therapeutic strategies to prevent this life threatening complication.
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28
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Aoyama M, Isshiki K, Kume S, Chin-Kanasaki M, Araki H, Araki SI, Koya D, Haneda M, Kashiwagi A, Maegawa H, Uzu T. Fructose induces tubulointerstitial injury in the kidney of mice. Biochem Biophys Res Commun 2012; 419:244-9. [PMID: 22342673 DOI: 10.1016/j.bbrc.2012.02.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 02/01/2012] [Indexed: 01/12/2023]
Abstract
Fructose induces several kinds of human metabolic disorders; however, information regarding fructose-induced kidney injury is still limited. This study examined fructose-induced kidney injury in mice and clarified the differential susceptibility of three mouse strains: C57Bl/6J, CBA/JN and DBA/2N. In this study all mice were fed with an equal calorie count for sixteen weeks to remove the influence of total energy intake from metabolic effects by fructose-feeding. Only DBA/2N mice, but not C57Bl/6J and CBA/JN mice, fed with fructose displayed tubulointerstitial fibrosis localized on the outer cortex of the kidney together with the increase of mRNA expression of Kim1 and Ngal in the absence of distinct glomerular lesions and albuminuria - decidedly different from diabetic nephropathy. In time-course study of DBA/2N mice fed with fructose diet, the inflammation and fibrosis in the outer cortex of the kidney were enhancing after eight weeks, in parallel with the accumulation of oxidative stress. This progression of renal damage in DBA/2N mice was accompanied with increasing mRNA expression of GLUT5. These results suggest that the responsiveness of GLUT5 expression to fructose at the kidney is one of pivotal roles for the progression of fructose-induced kidney injury.
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Affiliation(s)
- Masahiro Aoyama
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
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29
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Sawaguchi M, Araki SI, Kobori H, Urushihara M, Haneda M, Koya D, Kashiwagi A, Uzu T, Maegawa H. Association between urinary angiotensinogen levels and renal and cardiovascular prognoses in patients with type 2 diabetes mellitus. J Diabetes Investig 2011; 3:318-324. [PMID: 22822420 PMCID: PMC4014956 DOI: 10.1111/j.2040-1124.2011.00172.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Aims/Introduction: Activation of the renin‐angiotensin system (RAS) in the kidney plays an important role in renal function. The aim of this study was to investigate whether plasma and urinary angiotensinogen levels were associated with renal and cardiovascular prognosis in type 2 diabetic patients. Materials and Methods: We measured plasma and urinary angiotensinogen levels in the observational follow‐up cohort of 234 Japanese type 2 diabetic patients (144 with normoalbuminuria, 90 with albuminuria) enrolled between 1998 and 1999 and followed them up until the end of 2008. The associations of these markers with the annual decline in the estimated glomerular filtration rate (eGFR) and incidence of renal and cardiovascular composite endpoints (chronic hemodialysis, myocardial infarction, angina pectoris, stroke and cerebral hemorrhage) were evaluated. Results: At baseline, urinary angiotensinogen levels correlated with urinary albumin‐creatinine ratio, urinary β2‐microglobulin and inversely with eGFR. In contrast, plasma angiotensinogen levels correlated neither with these renal factors nor with urinary angiotensinogen levels. In the follow‐up study (median duration: 9 years), urinary angiotensinogen, but not plasma angiotensinogen, correlated inversely with the annual change in eGFR (r = −0.51, P < 0.001). When patients were divided into four subgroups according to albuminuria and urinary angiotensinogen levels, patients with albuminuria and high urinary angiotensinogen levels showed a progressive decline of eGFR and a higher incidence of renal and cardiovascular composite endpoints. Conclusions: These results suggest that the higher level of urinary angiotensinogen in type 2 diabetic patients with albuminuria is a high risk factor for worsening renal and cardiovascular complications. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00172.x, 2011)
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Affiliation(s)
- Makoto Sawaguchi
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga
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30
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Nakazawa J, Isshiki K, Sugimoto T, Araki SI, Kume S, Yokomaku Y, Chin-Kanasaki M, Sakaguchi M, Koya D, Haneda M, Kashiwagi A, Uzu T. Renoprotective effects of asialoerythropoietin in diabetic mice against ischaemia-reperfusion-induced acute kidney injury. Nephrology (Carlton) 2010; 15:93-101. [PMID: 20377776 DOI: 10.1111/j.1440-1797.2009.01170.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIM Diabetic patients are at higher risk of failure to recover after acute kidney injury, however, the mechanism and therapeutic strategies remain unclear. Erythropoietin is cytoprotective in a variety of non-haematopoietic cells. The aim of the present study was to clarify the mechanism of diabetes-related acceleration of renal damage after ischaemia-reperfusion injury and to examine the therapeutic potential of asialoerythropoietin, a non-haematopoietic erythropoietin derivative, against ischaemia-reperfusion-induced acute kidney injury in diabetic mice. METHODS C57BL/6J mice with and without streptozotocin-induced diabetes were subjected to 30 min unilateral renal ischaemia-reperfusion injury at 1 week after induction of diabetes. They were divided into four group: (i) non-diabetic plus ischaemia-reperfusion injury; (ii) non-diabetic plus ischaemia-reperfusion injury plus asialoerythropoietin (3000 IU/kg bodyweight); (iii) diabetic plus ischaemia-reperfusion injury; and (iv) diabetic plus ischemia-reperfusion injury plus asialoerythropoietin. Experiments were conducted at the indicated time periods after ischaemia-reperfusion injury. RESULTS Ischaemia-reperfusion injury of diabetic kidney resulted in significantly low protein expression levels of bcl-2, an anti-apoptotic molecule, and bone morphogenetic protein-7 (BMP-7), an anti-fibrotic and pro-regenerative factor, compared with non-diabetic kidneys. Diabetic kidney subsequently showed severe damage including increased tubular cell apoptosis, tubulointerstitial fibrosis and decreased tubular proliferation, compared with non-diabetic kidney. Treatment with asialoerythropoietin induced bcl-2 and BMP-7 expression in diabetic kidney and decreased tubular cell apoptosis, tubulointerstitial fibrosis and accelerated tubular proliferation. CONCLUSION Reduced induction bcl-2 and BMP-7 may play a role in the acceleration of renal damage after ischaemia-reperfusion injury in diabetic kidney. The renoprotective effects of asialoerythropoietin on acute kidney injury may be mediated through the induction of bcl-2 and BMP-7.
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Affiliation(s)
- Jun Nakazawa
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
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Maeda S, Araki SI, Babazono T, Toyoda M, Umezono T, Kawai K, Imanishi M, Uzu T, Watada H, Suzuki D, Kashiwagi A, Iwamoto Y, Kaku K, Kawamori R, Nakamura Y. Replication study for the association between four Loci identified by a genome-wide association study on European American subjects with type 1 diabetes and susceptibility to diabetic nephropathy in Japanese subjects with type 2 diabetes. Diabetes 2010; 59:2075-9. [PMID: 20460425 PMCID: PMC2911071 DOI: 10.2337/db10-0067] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Genetic factors are believed to contribute to the development and progression of diabetic nephropathy. Recently, a genome-wide association study for diabetic nephropathy revealed four novel candidate loci in European American subjects with type 1 diabetes. In this study, we determined the association of the four loci with diabetic nephropathy in Japanese subjects with type 2 diabetes. RESEARCH DESIGN AND METHODS We genotyped 11 singlenucleotide polymorphisms (SNPs) in four distinct loci (rs39059 and rs39075 in the CPVL/CHN2, rs1888747 and rs10868025 in FRMD3, rs739401 and rs451041 in CARS, and rs1041466, rs1411766, rs6492208, rs7989848, and rs9521445 in a chromosome 13q locus) in four independent Japanese populations. RESULTS Six SNPs were nominally associated with diabetic nephropathy in one of the four Japanese populations (P < 0.05; rs451041 in study 1; rs39059 and rs1888747 in study 3; rs1411766 in studies 1 and 4; and rs7989848 and rs9521445 in study 4); however, no significant association was observed for any SNP after correction for multiple testing errors in the individual populations. Nevertheless, a meta-analysis performed for the data obtained from all four populations revealed that one SNP (rs1411766) in chromosome 13q was significantly associated with diabetic nephropathy in the Japanese populations (nominal P = 0.004, corrected P = 0.04, odds ratio 1.26 [95% CI = 1.07-1.47]). CONCLUSIONS Our results suggest that the rs1411766 locus may be commonly involved in conferring susceptibility to diabetic nephropathy among subjects with type 1 or type 2 diabetes across different ethnic groups.
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Affiliation(s)
- Shiro Maeda
- Laboratory for Endocrinology and Metabolism, RIKEN Center for Genomic Medicine, Yokohama, Japan.
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Kume S, Uzu T, Horiike K, Chin-Kanasaki M, Isshiki K, Araki SI, Sugimoto T, Haneda M, Kashiwagi A, Koya D. Calorie restriction enhances cell adaptation to hypoxia through Sirt1-dependent mitochondrial autophagy in mouse aged kidney. J Clin Invest 2010; 120:1043-55. [PMID: 20335657 DOI: 10.1172/jci41376] [Citation(s) in RCA: 467] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 01/20/2010] [Indexed: 12/20/2022] Open
Abstract
Mitochondrial oxidative damage is a basic mechanism of aging, and multiple studies demonstrate that this process is attenuated by calorie restriction (CR). However, the molecular mechanism that underlies the beneficial effect of CR on mitochondrial dysfunction is unclear. Here, we investigated in mice the mechanisms underlying CR-mediated protection against hypoxia in aged kidney, with a special focus on the role of the NAD-dependent deacetylase sirtuin 1 (Sirt1), which is linked to CR-related longevity in model organisms, on mitochondrial autophagy. Adult-onset and long-term CR in mice promoted increased Sirt1 expression in aged kidney and attenuated hypoxia-associated mitochondrial and renal damage by enhancing BCL2/adenovirus E1B 19-kDa interacting protein 3-dependent (Bnip3-dependent) autophagy. Culture of primary renal proximal tubular cells (PTCs) in serum from CR mice promoted Sirt1-mediated forkhead box O3 (Foxo3) deacetylation. This activity was essential for expression of Bnip3 and p27Kip1 and for subsequent autophagy and cell survival of PTCs under hypoxia. Furthermore, the kidneys of aged Sirt1+/- mice were resistant to CR-mediated improvement in the accumulation of damaged mitochondria under hypoxia. These data highlight the role of the Sirt1-Foxo3 axis in cellular adaptation to hypoxia, delineate a molecular mechanism of the CR-mediated antiaging effect, and could potentially direct the design of new therapies for age- and hypoxia-related tissue damage.
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Affiliation(s)
- Shinji Kume
- Department of Medicine, Shiga University of Medical Science, Japan
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Uzu T, Kida Y, Shirahashi N, Harada T, Yamauchi A, Nomura M, Isshiki K, Araki SI, Sugimoto T, Koya D, Haneda M, Kashiwagi A, Kikkawa R. Cerebral microvascular disease predicts renal failure in type 2 diabetes. J Am Soc Nephrol 2010; 21:520-6. [PMID: 20110380 DOI: 10.1681/asn.2009050558] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Abnormalities in small renal vessels may increase the risk of developing impaired renal function, but methods to assess these vessels are extremely limited. We hypothesized that the presence of small vessel disease in the brain, which manifests as silent cerebral infarction (SCI), may predict the progression of kidney disease in patients with type 2 diabetes. We recruited 608 patients with type 2 diabetes without apparent cerebrovascular or cardiovascular disease or overt nephropathy and followed them for a mean of 7.5 years. At baseline, 177 of 608 patients had SCI, diagnosed by cerebral magnetic resonance imaging. The risk for the primary outcome of ESRD or death was significantly higher for patients with SCI than for patients without SCI [hazard ratio, 2.44; 95% confidence interval (CI) 1.36 to 4.38]. The risk for the secondary renal end point of any dialysis or doubling of the serum creatinine concentration was also significantly higher for patients with SCI (hazard ratio, 4.79; 95% CI 2.72 to 8.46). The estimated GFR declined more in patients with SCI than in those without SCI; however, the presence of SCI did not increase the risk for progression of albuminuria. In conclusion, independent of microalbuminuria, cerebral microvascular disease predicted renal morbidity among patients with type 2 diabetes.
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Affiliation(s)
- Takashi Uzu
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan.
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Koya D, Haneda M, Inomata S, Suzuki Y, Suzuki D, Makino H, Shikata K, Murakami Y, Tomino Y, Yamada K, Araki SI, Kashiwagi A, Kikkawa R. Long-term effect of modification of dietary protein intake on the progression of diabetic nephropathy: a randomised controlled trial. Diabetologia 2009; 52:2037-45. [PMID: 19652945 PMCID: PMC2744830 DOI: 10.1007/s00125-009-1467-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2008] [Accepted: 06/15/2009] [Indexed: 12/23/2022]
Abstract
AIMS/HYPOTHESIS There is currently insufficient evidence to recommend a low-protein diet for type 2 diabetic patients with diabetic nephropathy. We assessed whether a low-protein diet could prevent the progression of diabetic nephropathy. METHODS This was a multi-site parallel randomised controlled trial for prevention of diabetic nephropathy progression among 112 Japanese type 2 diabetic patients with overt nephropathy. It was conducted in Japan from 1 December 1997 to 30 April 2006. The participants were randomly assigned using a central computer-generated schedule to either low-protein diet (0.8 g kg(-1) day(-1)) and normal-protein diet (1.2 g kg(-1) day(-1)), and were followed for 5 years. The participants and investigators were not blinded to the assignment. The primary outcomes were the annual change in estimated GFR and creatinine clearance, the incidence of doubling of serum creatinine and the time to doubling of baseline serum creatinine. RESULTS The study was completed by 47 (84%) of 56 participants in the low-protein diet group and 41 (73%) of 56 participants in the normal-diet group. During the study period, the difference in mean annual change in estimated GFR between the low-protein diet and the normal-protein diet groups was -0.3 ml min(-1) 1.73 m(-2) (95% CI -3.9, 4.4; p = 0.93). The difference in mean annual change in creatinine clearance between the low-protein diet and the normal-protein diet groups was -0.006 ml s(-1) 1.73 m(-2) (95% CI -0.089, 0.112; p = 0.80). A doubling of serum creatinine was reached in 16 patients of the low-protein group (34.0%), compared with 15 in the normal-protein group (36.6%), the difference between groups being -2.6% (95% CI -22.6, 17.5; p = 0.80). The time to doubling of serum creatinine was similar in both groups (p = 0.66). CONCLUSIONS/INTERPRETATION It is extremely difficult to get patients to follow a long-term low-protein diet. Although in the low-protein group overall protein intake was slightly (but not significantly) lower, it did not confer renoprotection. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT00448526. FUNDING Research grant from the Ministry of Health, Labour and Welfare of Japan.
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Affiliation(s)
- D Koya
- Kanazawa Medical University, Uchinadacho, Kahokugun, Ishikawa, Japan.
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Deji N, Kume S, Araki SI, Soumura M, Sugimoto T, Isshiki K, Chin-Kanasaki M, Sakaguchi M, Koya D, Haneda M, Kashiwagi A, Uzu T. Structural and functional changes in the kidneys of high-fat diet-induced obese mice. Am J Physiol Renal Physiol 2008; 296:F118-26. [PMID: 18971213 DOI: 10.1152/ajprenal.00110.2008] [Citation(s) in RCA: 184] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Metabolic syndrome has been reported to be associated with chronic kidney disease, but the mechanisms remain unclear. Although feeding of a high-fat diet (HFD) to C57BL/6 mice is reported to induce systemic metabolic abnormalities and subsequent renal injuries, such as albuminuria, similar to human metabolic syndrome, alterations in HFD-induced renal injuries have not been fully elucidated in detail. We therefore investigated the structural and functional changes in the kidneys of C57BL/6 mice on a HFD. Six-week-old mice were fed a low-fat diet (LFD; 10% of total calories from fat) or a HFD (60% fat) for 12 wk. Mice fed a HFD showed significant increases in body weight, systolic blood pressure, plasma insulin, glucose, and triglycerides compared with those on a LFD. Accompanying these systemic changes, mice on a HFD showed albuminuria, an increase in glomerular tuft area, and mesangial expansion. These systemic and renal alterations in mice on a HFD were prevented by body weight control with the dietary restriction of feeding a HFD. Furthermore, mice on a HFD showed renal pathophysiological alterations including renal lipid accumulation, an increased accumulation of type IV collagen in glomeruli, an increase in macrophage infiltration in the renal medulla, an increase in urinary 8-hydroxy-2'-deoxyguanosine excretion, and impaired sodium handling. In conclusion, this study suggests that local metabolic alterations in the kidney play important roles in the development of renal injury associated with metabolic syndrome in addition to systemic metabolic changes and an increase in body weight.
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Affiliation(s)
- Naoko Deji
- Dept. of Medicine, Shiga Univ. of Medical Science, Seta, Otsu, Shiga 520-2192, Japan
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Osawa N, Koya D, Araki SI, Uzu T, Tsunoda T, Kashiwagi A, Nakamura Y, Maeda S. Combinational effect of genes for the renin-angiotensin system in conferring susceptibility to diabetic nephropathy. J Hum Genet 2006; 52:143-151. [PMID: 17143591 DOI: 10.1007/s10038-006-0090-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2006] [Accepted: 11/04/2006] [Indexed: 12/20/2022]
Abstract
To elucidate the role of the renin-angiotensin system (RAS) in diabetic nephropathy, we examined the association between diabetic nephropathy in a large cohort of Japanese type 2 diabetic patients and polymorphisms within the genes that encode angiotensin-converting enzyme (ACE), angiotensinogen (AGT) and angiotensin II receptor type 1 (AGTR1). Single nucleotide polymorphisms (SNPs) within these genes were genotyped using invader assay in 747 nephropathy cases and 557 control subjects. Eight SNPs within the ACE gene were significantly associated with diabetic nephropathy (P<0.05), including five SNPs in almost complete linkage disequilibrium to the insertion/deletion polymorphism in the 16th intron (P=0.01, odds ratio =1.34, 95% CI 1.07-1.69). Three SNPs within the AGT, including M235T and one SNP in the AGTR1, were also significantly associated with nephropathy (M235T P=0.01, odds ratio =0.74, 95% CI 0.59-0.94). In addition, we found that the allelic mRNA expression corresponding to the 235M allele was significantly higher than that for the 235T allele in normal kidney tissues. Furthermore, we found a significant additional effect of these three genes by a step-wise logistic regression analysis (final empirical P value =0.00005). We concluded that RAS gene polymorphisms may contribute to the susceptibility to diabetic nephropathy in type 2 diabetes.
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Affiliation(s)
- Norihisa Osawa
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
- Laboratory for Diabetic Nephropathy, SNP Research Center, The Institute of Physical and Chemical Research, 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama, Kanagawa, 230-0045, Japan
| | - Daisuke Koya
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
| | - Shin-Ichi Araki
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
| | - Takashi Uzu
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
| | - Tatsuhiko Tsunoda
- Laboratory for Medical Informatics, SNP Research Center, The Institute of Physical and Chemical Research, Yokohama, Kanagawa, 230-0045, Japan
| | - Atsunori Kashiwagi
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
| | - Yusuke Nakamura
- Laboratory of Molecular Medicine, Human Genome Center, The Institute of Medical Science, University of Tokyo, Tokyo, 108-8639, Japan
| | - Shiro Maeda
- Laboratory for Diabetic Nephropathy, SNP Research Center, The Institute of Physical and Chemical Research, 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama, Kanagawa, 230-0045, Japan.
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Araki SI, Koya D, Makiishi T, Sugimoto T, Isono M, Kikkawa R, Kashiwagi A, Haneda M. APOE polymorphism and the progression of diabetic nephropathy in Japanese subjects with type 2 diabetes: results of a prospective observational follow-up study. Diabetes Care 2003; 26:2416-20. [PMID: 12882872 DOI: 10.2337/diacare.26.8.2416] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study is to clarify the conflicting results of the epsilon2/epsilon3/epsilon4 APOE polymorphism as a risk factor on diabetic nephropathy by a cohort study. RESEARCH DESIGN AND METHODS A total of 429 Japanese subjects with type 2 diabetes and with normoalbuminuria (n = 299) or with microalbuminuria (n = 130) were enrolled in a prospective observational follow-up study during 1995-1998 and followed until 2001 (for at least 3 years). The endpoint was the occurrence of a renal event defined as the progression to a higher stage of diabetic nephropathy. RESULTS During the study (the mean follow-up period: 4.4 +/- 1.0 years), 31 of 429 subjects progressed: 21 from normoalbuminuria to microalbuminuria and 10 from microalbuminuria to overt proteinuria. The allele frequency of the APOE polymorphism was significantly different between the progressors and the nonprogressors. Eight of 42 epsilon2 carriers (19%) progressed, whereas 23 of 387 noncarriers (6%) progressed with a relative risk of 3.2 (95% CI 1.5-6.7). When subjects were stratified by renal status at baseline, each relative risk for the progression in the epsilon2 carriers was 2.7 (0.99-7.4) in those with normoalbuminuria and 4.2 (1.3-13.3) in those with microalbuminuria. Furthermore, when analyzed only in subjects with normoalbuminuria and short duration of diabetes (<15 years) at baseline, the risk in the epsilon2 carriers became higher to 3.2 (1.2-8.8). CONCLUSIONS Our follow-up study indicates that the epsilon2 allele of the APOE polymorphism is a prognostic risk factor for both the onset and the progression of diabetic nephropathy in Japanese type 2 diabetes.
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Affiliation(s)
- Shin-Ichi Araki
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, 520-2192, Japan
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Araki SI, Ng DPK, Krolewski B, Wyrwicz L, Rogus JJ, Canani L, Makita Y, Haneda M, Warram JH, Krolewski AS. Identification of a common risk haplotype for diabetic nephropathy at the protein kinase C-beta1 (PRKCB1) gene locus. J Am Soc Nephrol 2003; 14:2015-24. [PMID: 12874455 DOI: 10.1097/01.asn.0000077347.27669.5c] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Abnormal activation of protein kinase C-beta isoforms in the diabetic state has been implicated in the development of diabetic nephropathy. It is thus plausible that DNA sequence differences in the protein kinase C-beta1 gene (PRKCB1), which encodes both betaI and betaII isoforms, may influence susceptibility to nephropathy. Nine single-nucleotide polymorphisms (SNP) in PRKCB1 were tested for association with diabetic nephropathy in type I diabetes mellitus, by using both case-control and family-study designs. Allele and genotype distributions of two SNP in the promoter (--1504C/T and --546C/G) differed significantly between case patients and control patients (P < 0.05). These associations were particularly strong with diabetes mellitus duration of <24 yr (P = 0.002). The risk of diabetic nephropathy was higher among carriers of the T allele of the --1504C/T SNP, compared with noncarriers (odds ratio, 2.54; 95% confidence interval, 1.39 to 4.62), and among carriers of the G allele of the --546C/G SNP (odds ratio, 2.45; 95% confidence interval, 1.37 to 4.38). Among individuals with diabetes mellitus duration of >/==" BORDER="0">24 yr, these two SNP were not associated with diabetic nephropathy. These positive findings were confirmed by using the family-based transmission disequilibrium test. The T-G haplotype, with both risk alleles, was transmitted more frequently than expected from heterozygous parents to offspring who developed diabetic nephropathy during the first 24 yr of diabetes mellitus. It is concluded that DNA sequence differences in the promoter of PRKCB1 contribute to diabetic nephropathy susceptibility in type I diabetes mellitus.
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Affiliation(s)
- Shin-Ichi Araki
- Section on Genetics and Epidemiology, Research Division, Joslin Diabetes Center, Boston, Massachusetts, USA
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Kosuge K, Uematsu T, Araki SI, Matsuno H, Ohashi K, Nakashima M. Comparative dispositions of ofloxacin in human head, axillary, and pubic hairs. Antimicrob Agents Chemother 1998; 42:1298-302. [PMID: 9593174 PMCID: PMC105814 DOI: 10.1128/aac.42.5.1298] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The distribution of ofloxacin (OFLX) along the shaft of each of three hair types, i.e., head, axillary and pubic, was investigated and compared among five healthy male volunteers 1 to 4 months after ingestion of OFLX for 1 or 2 days (total dose, 200 or 600 mg). Five strands of each hair type were sectioned together into successive 0.5-cm lengths starting from the dermal end, over a length of < or = 6 cm, and the OFLX concentration in each hair section was measured by high-pressure liquid chromatography with fluorescence detection. The distribution of OFLX along the head hair shaft was narrow, having a single peak even 3 to 4 months after administration, suggesting a rather uniform growth rate among hair strands. On the other hand, the OFLX distribution along axillary or pubic hair shafts tended to be broad, even having two apparent peaks, and the growth rate did not seem uniform. Since axillary hair seemed to stop growing after having gained a length of < or = 4 to 5 cm, it was suggested to enter a resting stage after the growth of < or = 3 cm over the 2 to 4 months after OFLX incorporation. These findings indicate that head hair is the most suitable for analysis of individual drug use and the larger growth rate and cycle stage variabilities of strands of the other types of hair should be taken into account.
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Affiliation(s)
- K Kosuge
- Department of Clinical Pharmacology, Hamamatsu University School of Medicine, Japan
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Tatsumi T, Shimazaki C, Araki SI, Sudo Y, Yamagata N, Ashihara E, Goto H, Inaba T, Fujita N, Nakagawa M, Misawa SI, Imashuku S. Philadelphia chromosome-positive acute lymphoblastic leukemia after therapy for Langerhans cell histiocytosis. Am J Hematol 1997; 54:88. [PMID: 8980271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Tatsumi T, Shimazaki C, Araki SI, Sudo Y, Yamagata N, Ashihara E, Goto H, Inaba T, Fujita N, Nakagawa M, Misawa SI, Imashuku S. Philadelphia chromosome-positive acute lymphoblastic leukemia after therapy for langerhans cell histiocytosis. Am J Hematol 1997. [DOI: 10.1002/(sici)1096-8652(199701)54:1<88::aid-ajh17>3.0.co;2-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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