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Takahashi N, Ikoma T, Sakamoto A, Suwa K, Fujihiro M, Shimoyama K, Ohtani H, Baba S, Ogawa N, Maekawa Y. Ventricular Thrombus Formation Caused by Subendomyocardial Inflammation in Eosinophilic Granulomatosis With Polyangiitis. JACC Case Rep 2024; 29:102321. [PMID: 38601841 PMCID: PMC11002855 DOI: 10.1016/j.jaccas.2024.102321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 04/12/2024]
Abstract
Cardiac involvement of eosinophilic granulomatosis with polyangiitis is a rare but life-threatening complication. We present a case of eosinophilic granulomatosis with polyangiitis with moderately impaired ventricular function forming a ventricular thrombus. Pathological assessment of endomyocardial biopsy specimen revealed aggregated eosinophils in the subendocardium, suggesting ventricular endothelial damage leading to thrombus formation.
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Affiliation(s)
- Naoyuki Takahashi
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takenori Ikoma
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Atsushi Sakamoto
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kenichiro Suwa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Mayu Fujihiro
- Department of Diagnostic Pathology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kumiko Shimoyama
- Division of Rheumatology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hayato Ohtani
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Satoshi Baba
- Department of Diagnostic Pathology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Noriyoshi Ogawa
- Division of Rheumatology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Yukishima T, Furuhashi K, Shimoyama K, Taki T, Azuma C, Yamazaki K, Furukawa S, Fukami S, Nagura O, Katahashi K, Yamashita K, Maekawa M, Ogawa N. Detailed tracking of antigen and antibody levels during coronavirus disease 2019 treatment in an immunosuppressed patient with anti-neutrophil cytoplasmic autoantibody-associated vasculitis. J Infect Chemother 2024:S1341-321X(24)00034-5. [PMID: 38342142 DOI: 10.1016/j.jiac.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/09/2024] [Accepted: 02/04/2024] [Indexed: 02/13/2024]
Abstract
A 67-year-old woman with anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis was not vaccinated against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and was on multiple immunosuppressive drugs. She was hospitalized because of interstitial shadowing in the lungs and diagnosed with persistent coronavirus disease 2019 (COVID-19). Despite treatment with a recombinant monoclonal antibody and antivirals, her symptoms persisted and she lacked a specific antibody response. She tested negative for SARS-CoV-2 antigen after the second antiviral treatment, and a subsequent chest radiograph showed improvement. However, the antibody levels did not change. This case highlights the importance of careful monitoring of the SARS-CoV-2 antigen and antibody levels during COVID-19 treatment in patients with immunosuppression.
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Affiliation(s)
- Toshitaka Yukishima
- Division of Immunology and Rheumatology, Third Department of Internal Medicine, Hamamatsu University School of Medicine, Japan.
| | - Kazuki Furuhashi
- Infection Control and Prevention Center, Hamamatsu University Hospital, Japan.
| | - Kumiko Shimoyama
- Division of Immunology and Rheumatology, Third Department of Internal Medicine, Hamamatsu University School of Medicine, Japan.
| | - Takeru Taki
- Division of Immunology and Rheumatology, Third Department of Internal Medicine, Hamamatsu University School of Medicine, Japan.
| | - Chika Azuma
- Division of Immunology and Rheumatology, Third Department of Internal Medicine, Hamamatsu University School of Medicine, Japan.
| | - Kenji Yamazaki
- Division of Immunology and Rheumatology, Third Department of Internal Medicine, Hamamatsu University School of Medicine, Japan.
| | - Shogo Furukawa
- Division of Immunology and Rheumatology, Third Department of Internal Medicine, Hamamatsu University School of Medicine, Japan.
| | - Soma Fukami
- Division of Immunology and Rheumatology, Third Department of Internal Medicine, Hamamatsu University School of Medicine, Japan.
| | - Osanori Nagura
- Infection Control and Prevention Center, Hamamatsu University Hospital, Japan.
| | - Kazuto Katahashi
- Second Department of Surgery, Hamamatsu University School of Medicine, Japan.
| | - Keita Yamashita
- Department of Laboratory Medicine, Hamamatsu University School of Medicine, Japan.
| | - Masato Maekawa
- Department of Laboratory Medicine, Hamamatsu University School of Medicine, Japan.
| | - Noriyoshi Ogawa
- Division of Immunology and Rheumatology, Third Department of Internal Medicine, Hamamatsu University School of Medicine, Japan.
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Miyamoto T, Izawa K, Masui S, Yamazaki A, Yamasaki Y, Matsubayashi T, Shiraki M, Ohnishi H, Yasumura J, Kawabe T, Miyamae T, Matsubara T, Arakawa N, Ishige T, Takizawa T, Shimbo A, Shimizu M, Kimura N, Maeda Y, Maruyama Y, Shigemura T, Furuta J, Sato S, Tanaka H, Izumikawa M, Yamamura M, Hasegawa T, Kaneko H, Nakagishi Y, Nakano N, Iida Y, Nakamura T, Wakiguchi H, Hoshina T, Kawai T, Murakami K, Akizuki S, Morinobu A, Ohmura K, Eguchi K, Sonoda M, Ishimura M, Furuno K, Kashiwado M, Mori M, Kawahata K, Hayama K, Shimoyama K, Sasaki N, Ito T, Umebayashi H, Omori T, Nakamichi S, Dohmoto T, Hasegawa Y, Kawashima H, Watanabe S, Taguchi Y, Nakaseko H, Iwata N, Kohno H, Ando T, Ito Y, Kataoka Y, Saeki T, Kaneko U, Murase A, Hattori S, Nozawa T, Nishimura K, Nakano R, Watanabe M, Yashiro M, Nakamura T, Komai T, Kato K, Honda Y, Hiejima E, Yonezawa A, Bessho K, Okada S, Ohara O, Takita J, Yasumi T, Nishikomori R. Clinical Characteristics of Cryopyrin-Associated Periodic Syndrome and Long-Term Real-World Efficacy and Tolerability of Canakinumab in Japan: Results of a Nationwide Survey. Arthritis Rheumatol 2024. [PMID: 38268504 DOI: 10.1002/art.42808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 01/09/2024] [Accepted: 01/22/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE We assess the clinical characteristics of patients with cryopyrin-associated periodic syndrome (CAPS) in Japan and evaluate the real-world efficacy and safety of interleukin-1 (IL-1) inhibitors, primarily canakinumab. METHODS Clinical information was collected retrospectively, and serum concentrations of canakinumab and cytokines were analyzed. RESULTS A total of 101 patients were included, with 86 and 15 carrying heterozygous germline and somatic mosaic mutations, respectively. We identified 39 mutation types, and the common CAPS-associated symptoms corresponded with those in previous reports. Six patients (5.9% of all patients) died, with four of the deaths caused by CAPS-associated symptoms. Notably, 73.7% of patients (100%, 79.6%, and 44.4% of familial cold autoinflammatory syndrome, Muckle-Wells syndrome, and chronic infantile neurological cutaneous articular syndrome/neonatal onset multisystem inflammatory disease, respectively) achieved complete remission with canakinumab, and early therapeutic intervention was associated with better auditory outcomes. In some patients, canakinumab treatment stabilized the progression of epiphysial overgrowth and improved height gain, visual acuity, and renal function. However, 23.7% of patients did not achieve inflammatory remission with crucial deterioration of organ damage, with two dying while receiving high-dose canakinumab treatment. Serological analysis of canakinumab and cytokine concentrations revealed that the poor response was not related to canakinumab shortage. Four inflammatory nonremitters developed inflammatory bowel disease (IBD)-unclassified during canakinumab treatment. Dual biologic therapy with canakinumab and anti-tumor necrosis factor-α agents was effective for IBD- and CAPS-associated symptoms not resolved by canakinumab monotherapy. CONCLUSION This study provides one of the largest epidemiologic data sets for CAPS. Although early initiation of anti-IL-1 treatment with canakinumab is beneficial for improving disease prognosis, some patients do not achieve remission despite a high serum concentration of canakinumab. Moreover, IBD may develop in CAPS after canakinumab treatment.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Tomoyo Matsubara
- Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | | | | | | | - Asami Shimbo
- Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Naoki Kimura
- Tokyo Medical and Dental University, Tokyo, Japan
| | | | | | | | | | - Satoshi Sato
- Saitama Children's Medical Center, Saitama, Japan
| | | | | | | | | | - Hiroshi Kaneko
- National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Naoko Nakano
- Ehime Prefectural Central Hospital, Matsuyama, Japan
| | | | | | | | - Takayuki Hoshina
- University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Toshinao Kawai
- National Center for Child Health and Development, Tokyo, Japan
| | | | | | | | | | | | | | | | | | | | - Masaaki Mori
- Tokyo Medical and Dental University, Tokyo, Japan, and St. Marianna University School of Medicine, Kawasaki, Japan
| | | | | | | | - Natsuko Sasaki
- University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Taisuke Ito
- Hamamatsu University School of Medicine, Hamamatsu, Japan
| | | | - Tae Omori
- Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | | | | | | | | | | | - Yuichiro Taguchi
- Department of Rheumatology, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | | | - Naomi Iwata
- Aichi Children's Health and Medical Center, Obu, Japan
| | - Hiroki Kohno
- Tokyo Women's Medical University Hospital, Tokyo, Japan
| | | | - Yasuhiko Ito
- Nagoya City University West Medical Center, Nagoya, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Osamu Ohara
- Kazusa DNA Research Institute, Kisarazu, Japan
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Mochizuki T, Shibata K, Naito T, Shimoyama K, Ogawa N, Maekawa M, Kawakami J. LC-MS/MS method for the quantitation of serum tocilizumab in rheumatoid arthritis patients using rapid tryptic digestion without IgG purification. J Pharm Anal 2022; 12:852-859. [PMID: 36605577 PMCID: PMC9805942 DOI: 10.1016/j.jpha.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/15/2022] [Accepted: 08/29/2022] [Indexed: 01/09/2023] Open
Abstract
The quantitation of serum tocilizumab using liquid chromatography tandem-mass spectrometry (LC-MS/MS) method has not been widely applied in clinical settings because of its time-consuming and costly sample pretreatments. The present study aimed to develop a validated LC-MS/MS method for detecting serum tocilizumab by utilizing immobilized trypsin without an immunoglobulin G purification step and evaluate its applicability in the treatment of rheumatoid arthritis (RA) patients administered intravenously or subcutaneously with tocilizumab. The tocilizumab-derived signature peptide was deciphered using a nano-LC system coupled to a hybrid quadrupole-orbitrap mass spectrometer. The serum tocilizumab was rapidly digested by immobilized trypsin for 30 min. The chromatographic peak of the signature peptide and that of the internal standard were separated from the serum digests for a total run time of 15 min. The calibration curve of serum tocilizumab concentration was linear with a range of 2-200 μg/mL. The intra- and inter-day accuracy and relative standard deviation (RSD) were 90.7%-109.4% and <10%, respectively. The serum tocilizumab concentrations in the RA patients receiving intravenous and subcutaneous injections were 5.8-28.9 and 2.4-63.5 μg/mL, respectively. The serum tocilizumab concentrations using the current method positively correlated with those using the enzyme-linked immunosorbent assay, although a systematic error was observed between these methods. In conclusion, a validated LC-MS/MS method with minimal sample pretreatments for monitoring serum tocilizumab concentrations in RA patients was developed.
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Affiliation(s)
- Takashi Mochizuki
- Department of Hospital Pharmacy, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan
| | - Kaito Shibata
- Department of Hospital Pharmacy, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan,Department of Pharmacy, Shinshu University Hospital, Matsumoto, Nagano, 390-8621, Japan
| | - Takafumi Naito
- Department of Hospital Pharmacy, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan,Department of Pharmacy, Shinshu University Hospital, Matsumoto, Nagano, 390-8621, Japan,Corresponding author. Department of Pharmacy, Shinshu University Hospital, Matsumoto, Nagano, 390-8621, Japan.
| | - Kumiko Shimoyama
- Third Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan
| | - Noriyoshi Ogawa
- Third Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan
| | - Masato Maekawa
- Department of Laboratory Medicine, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan
| | - Junichi Kawakami
- Department of Hospital Pharmacy, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan
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Shimoyama K, Niwa T, Furukawa S, Morishita N, Nagakura Y, Yonezawa H, Hatakeyama M, Okubo Y, Suzuki D, Kosugi I, Shiogama K, Ogawa N. Behçet's Disease with Bilateral Renal Infarction Due to Mucormycosis. Intern Med 2022; 61:1077-1083. [PMID: 34544946 PMCID: PMC9038466 DOI: 10.2169/internalmedicine.7462-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a case of Behçet's disease with renal infarction due to mucormycosis. A 76-year-old man with entero-Behçet's disease had been treated with glucocorticoid and tumor necrosis factor (TNF) inhibitors. His entero-Behçet's disease was refractory to these treatments, and ileocecal resection was performed. After the operation, renal infarction that was unresponsive to anticoagulation therapy developed. He ultimately died of renal failure due to renal infarction. At the autopsy, histopathology of abundant hyphae in the renal vessel wall revealed mucormycosis. Renal mucormycosis is an important cause of renal failure with renal infarction in immunocompromised patients.
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Affiliation(s)
- Kumiko Shimoyama
- Internal Medicine 3, Hamamatsu University School of Medicine, Japan
| | - Tomoyuki Niwa
- Internal Medicine 1, Hamamatsu University School of Medicine, Japan
| | - Shogo Furukawa
- Internal Medicine 3, Hamamatsu University School of Medicine, Japan
| | | | - Yuka Nagakura
- Diagnostic Pathology, Hamamatsu University School of Medicine, Japan
| | - Haruka Yonezawa
- Internal Medicine 3, Hamamatsu University School of Medicine, Japan
| | | | - Yusuke Okubo
- Internal Medicine 3, Hamamatsu University School of Medicine, Japan
| | | | - Isao Kosugi
- Regenerative & Infectious Pathology, Hamamatsu University School of Medicine, Japan
| | - Kazuya Shiogama
- Faculty of Medical Technology, Fujita Health University, Japan
| | - Noriyoshi Ogawa
- Internal Medicine 3, Hamamatsu University School of Medicine, Japan
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Ogawa N, Ohashi H, Ota Y, Kobori K, Suzuki M, Tsuboi S, Hayakawa M, Goto Y, Karahashi T, Kimoto O, Miyamoto T, Furukawa S, Shimoyama K, Suzuki D, Maekawa Y. Multicenter, observational clinical study of abatacept in Japanese patients with rheumatoid arthritis. Immunol Med 2019; 42:29-38. [PMID: 31067155 DOI: 10.1080/25785826.2019.1605036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The aim of this study was to assess abatacept in rheumatoid arthritis (RA) patient. Patients (20 men, 89 women, aged 61.9 ± 10.4 y) who responded inadequately to conventional synthetic disease-modifying anti-rheumatic drug were treated with abatacept for 24-months. Disease activity score in 28 joints (DAS28-CRP) was evaluated. Of 109 patients, 82 (75.2%) were on methotrexate (MTX; mean dosage 9.0 ± 2.7 mg/week); 48 (44.0%) were naive to biologics and 61 (56.0%) had failed biologics. The 1- and 2-year retention rates were 77% and 53%, respectively. At 24-months, the DAS28-CRP remission rates were 54.5% in the biologic-naïve patients, and 28.2% in the biologic-failure patients (p < .01), while the structural remission rates were 83.9% and 73.1%, respectively (p = .461). Abatacept was equally effective in RA patients who were and were not on concomitant MTX. Biologic-naïve was associated with better clinical outcome. Abatacept was effective in patients who showed decreasing anti-CCP antibody titers or serum MMP-3 levels during treatment. Infection was the most frequent adverse effect of abatacept therapy. In conclusion, abatacept is more effective in biologic-naïve than in biologic-failure RA patients with or without concomitant use of MTX. Abatacept is more effective in RA patients with than without decreasing serum MMP-3 or anti-CCP antibody titers during treatment.
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Affiliation(s)
- Noriyoshi Ogawa
- a Division of Immunology and Rheumatology, Department of Internal Medicine 3 , Hamamatsu University School of Medicine , Hamamatsu-City , Japan
| | - Hiroyuki Ohashi
- b Department of Rheumatology, Omaezaki Municipal Hospital , Omaezaki-City , Japan
| | | | - Kaori Kobori
- d Kobori Orthopedic Clinic , Hamamatsu-City , Japan
| | - Motohiro Suzuki
- e Department of Orthopedic Surgery , Hamamatsu University School of Medicine , Hamamatsu , Japan
| | - Seiji Tsuboi
- f Department of Rheumatology, Shizuoka Kosei Hospital , Shizuoka-City , Japan
| | | | | | - Taro Karahashi
- i Department of Rheumatology, Fujieda Municipal Hospital , Fujieda , Japan
| | | | - Toshiaki Miyamoto
- k Department of Rheumatology, Seirei Hamamatsu General Hospital , Hamamatsu , Japan
| | - Shogo Furukawa
- a Division of Immunology and Rheumatology, Department of Internal Medicine 3 , Hamamatsu University School of Medicine , Hamamatsu-City , Japan
| | - Kumiko Shimoyama
- a Division of Immunology and Rheumatology, Department of Internal Medicine 3 , Hamamatsu University School of Medicine , Hamamatsu-City , Japan
| | - Daisuke Suzuki
- a Division of Immunology and Rheumatology, Department of Internal Medicine 3 , Hamamatsu University School of Medicine , Hamamatsu-City , Japan
| | - Yuichiro Maekawa
- a Division of Immunology and Rheumatology, Department of Internal Medicine 3 , Hamamatsu University School of Medicine , Hamamatsu-City , Japan
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Mitachi S, Satoh K, Shimoyama K, Satoh M. Compact optical fiber-type sleep apnea syndrome sensor. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.661] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mino Y, Naito T, Shimoyama K, Ogawa N, Kawakami J. Mycophenolic acid exposure and complement fraction C3 influence inosine 5'-monophosphate dehydrogenase activity in systemic lupus erythematosus. Ann Clin Biochem 2016; 54:490-494. [PMID: 27538768 DOI: 10.1177/0004563216667753] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Mycophenolate mofetil has recently been reported to be effective against systemic lupus erythematosus. The influence of the pharmacokinetics of mycophenolic acid, the active form of mycophenolate mofetil and the major inactive mycophenolic acid phenolic glucuronide on the activity of the target enzyme inosine 5'-monophosphate dehydrogenase, is expected to be revealed. The aim of this study was to identify the factors associated with inosine 5'-monophosphate dehydrogenase activity in systemic lupus erythematosus patients. Methods Fifty systemic lupus erythematosus patients in remission maintenance phase (29 received mycophenolate mofetil [MMF+] and 21 did not [MMF-]) were enrolled. Median and interquartile range of dose of mycophenolate mofetil were 1500 and 1000-1500 mg/day, respectively. Stepwise multiple linear regression analysis was performed to assess the dependence between inosine 5'-monophosphate dehydrogenase activity and 25 predictor values including predose plasma concentrations of free mycophenolic acid and mycophenolic acid phenolic glucuronide. Results Median and interquartile range of predose total plasma concentrations of mycophenolic acid and mycophenolic acid phenolic glucuronide were 2.73 and 1.43-5.73 and 25.5 and 13.1-54.7 µg/mL, respectively. Predose inosine 5'-monophosphate dehydrogenase activity was significantly higher in MMF+ than MMF- patients (median 38.3 and 20.6 nmoL xanthosine 5'-monophosphate/g haemoglobin/h, P<0.01). The plasma concentration of free mycophenolic acid phenolic glucuronide, complement fraction C3 and body weight were significant predictors accounting for interindividual variability in the inosine 5'-monophosphate dehydrogenase activity (adjusted R2 = 0.52, P < 0.01) in a multivariate analysis. Conclusions Predose inosine 5'-monophosphate dehydrogenase activity was higher in systemic lupus erythematosus patients receiving mycophenolate mofetil therapy. Inosine 5'-monophosphate dehydrogenase activity may be determined by mycophenolic acid exposure and complement fraction C3 in systemic lupus erythematosus patients.
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Affiliation(s)
- Yasuaki Mino
- 1 Department of Hospital Pharmacy, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Takafumi Naito
- 1 Department of Hospital Pharmacy, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Kumiko Shimoyama
- 2 Department of Rheumatology, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Noriyoshi Ogawa
- 2 Department of Rheumatology, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Junichi Kawakami
- 1 Department of Hospital Pharmacy, Hamamatsu University School of Medicine, Shizuoka, Japan
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Tanaka N, Muro Y, Suzuki Y, Nishiyama S, Takada K, Sekiguchi M, Hashimoto N, Ohmura K, Shimoyama K, Saito I, Kawano M, Akiyama M. Anticentromere antibody-positive primary Sjögren's syndrome: Epitope analysis of a subset of anticentromere antibody-positive patients. Mod Rheumatol 2016; 27:115-121. [PMID: 27161330 DOI: 10.1080/14397595.2016.1176327] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Anticentromere antibody (ACA) is generally considered to be a serological marker for systemic sclerosis (SSc). ACA-positive patients with primary Sjögren's syndrome (pSS) have also been reported. ACA often recognizes centromere proteins (CENPs): CENP-A, CENP-B, and CENP-C, and sometimes reacts to heterochromatin protein 1 (HP1)α. We compared the reactivity against six different epitopes for three ACA-positive clinical subgroups: 29 patients with pSS, 36 SSc patients with sicca symptoms, and 28 SSc patients without sicca symptoms. METHODS We utilized enzyme-linked immunosorbent assays (ELISAs) with recombinant proteins covering six different epitope regions of ACA (the amino terminus (Nt) of CENP-A, CENP-B, and CENP-C, the carboxyl terminus (Ct) of CENP-B and CENP-C, and HP1α). RESULTS The patients with pSS were found to have IgG-class autoantibodies against CENP-C-Nt and HP1α, and IgA-class autoantibodies against CENP-C-Ct with significantly higher frequencies than the SSc patients with or without sicca symptoms. The positive predictive value and the negative predictive value of the combination of these three autoantibodies for pSS were 73% and 82%, respectively, for pSS. CONCLUSIONS Based on the result that reactivities against CENP-C and HP1α in patients with pSS differ from those in patients with SSc, we propose ACA-positive pSS as a clinical subset of SS that is independent of SSc.
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Affiliation(s)
- Noriyo Tanaka
- a Department of Dermatology , Nagoya University Graduate School of Medicine , Nagoya , Aichi , Japan
| | - Yoshinao Muro
- a Department of Dermatology , Nagoya University Graduate School of Medicine , Nagoya , Aichi , Japan
| | - Yasunori Suzuki
- b Division of Rheumatology , Kanazawa University Hospital , Kanazawa , Ishikawa , Japan
| | - Susumu Nishiyama
- c Rheumatic Disease Center, Kurashiki Medical Center , Kurashiki, Okayama , Japan
| | - Kunio Takada
- d Division of Environmental Medicine , National Defense Medical College Research Institute , Saitama , Japan
| | - Masahiro Sekiguchi
- e Division of Rheumatology, Department of Internal Medicine , Hyogo College of Medicine , Nishinomiya , Hyogo , Japan
| | - Naoaki Hashimoto
- e Division of Rheumatology, Department of Internal Medicine , Hyogo College of Medicine , Nishinomiya , Hyogo , Japan
| | - Koichiro Ohmura
- f Department of Rheumatology and Clinical Immunology , Kyoto University Graduate School of Medicine , Kyoto , Japan
| | - Kumiko Shimoyama
- g Division of Immunology and Rheumatology, Department of Medicine 3 , Hamamatsu University School of Medicine , Hamamatsu , Shizuoka , Japan , and
| | - Ichiro Saito
- h Department of Pathology , Tsurumi University School of Dental Medicine , Yokohama , Kanagawa , Japan
| | - Mitsuhiro Kawano
- b Division of Rheumatology , Kanazawa University Hospital , Kanazawa , Ishikawa , Japan
| | - Masashi Akiyama
- a Department of Dermatology , Nagoya University Graduate School of Medicine , Nagoya , Aichi , Japan
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Naito T, Mino Y, Aoki Y, Hirano K, Shimoyama K, Ogawa N, Kagawa Y, Kawakami J. ABCB1 genetic variant and its associated tacrolimus pharmacokinetics affect renal function in patients with rheumatoid arthritis. Clin Chim Acta 2015; 445:79-84. [PMID: 25817604 DOI: 10.1016/j.cca.2015.03.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 03/18/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND This study aimed to evaluate the blood exposure of and clinical responses to tacrolimus based on genetic variants of CYP3A5 and ABCB1 in patients with rheumatoid arthritis. METHODS Seventy rheumatoid arthritis patients treated with oral tacrolimus once daily were enrolled. Blood concentrations of tacrolimus and its major metabolite 13-O-demethylate at 12h after dosing were determined. The relationships between the tacrolimus pharmacokinetics and efficacy, renal function, and CYP3A5 and ABCB1 genotypes were evaluated. RESULTS Dose-normalized blood concentration of tacrolimus was significantly higher in the CYP3A5*3/*3 group than in the *1 allele carrier group. A lower metabolic ratio of 13-O-demethylate to tacrolimus was observed in the CYP3A5*3/*3 group. The ABCB1 3435TT group had higher dose-normalized blood concentrations of tacrolimus and 13-O-demethylate. The blood tacrolimus concentration was inversely correlated with the estimated glomerular filtration rate (eGFR). ABCB1 C3435T but not CYP3A5 genotype had decreased eGFR. Patients lacking the CYP3A5*3 allele had a higher incidence of tacrolimus withdrawal. CONCLUSION CYP3A5*3 increased the blood exposure of tacrolimus through its metabolic reduction. ABCB1 C3435T led to a higher blood exposure of tacrolimus and its major metabolite. The ABCB1 genetic variant and its associated tacrolimus pharmacokinetics affected renal function in rheumatoid arthritis patients.
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Affiliation(s)
- Takafumi Naito
- Department of Hospital Pharmacy, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
| | - Yasuaki Mino
- Department of Hospital Pharmacy, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yuki Aoki
- Department of Hospital Pharmacy, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan; Department of Clinical Pharmaceutics and Pharmacy Practice, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Shizuoka, Japan
| | - Kumi Hirano
- Department of Hospital Pharmacy, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Kumiko Shimoyama
- Department of Rheumatology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Noriyoshi Ogawa
- Department of Rheumatology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yoshiyuki Kagawa
- Department of Clinical Pharmaceutics and Pharmacy Practice, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Shizuoka, Japan
| | - Junichi Kawakami
- Department of Hospital Pharmacy, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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Sano M, Satoh H, Suwa K, Nobuhara M, Saitoh T, Saotome M, Urushida T, Katoh H, Shimoyama K, Suzuki D, Ogawa N, Takehara Y, Sakahara H, Hayashi H. Characteristics and clinical relevance of late gadolinium enhancement in cardiac magnetic resonance in patients with systemic sclerosis. Heart Vessels 2014; 30:779-88. [PMID: 24996373 PMCID: PMC4648959 DOI: 10.1007/s00380-014-0539-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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: 02/16/2014] [Accepted: 06/13/2014] [Indexed: 01/14/2023]
Abstract
Cardiac involvement in systemic sclerosis (SSc) is considerably frequent in autopsy, but the early identification is clinically difficult. Recent advantages in cardiac magnetic resonance (CMR) enabled to detect myocardial fibrotic scar as late gadolinium enhancement (LGE). We aimed to examine the prevalence and distribution of LGE in patients with SSc, and associate them with clinical features, electrocardiographic abnormalities and cardiac function. Forty patients with SSc (58 ± 14 years-old, 35 females, limited/diffuse 25/15, disease duration 106 ± 113 months) underwent serological tests, 12-lead electrocardiogram (ECG) and CMR. Seven patients (17.5 %) showed LGE in 26 segments of left ventricle (LV). LGE distributed mainly in the basal to mid inter-ventricular septum and the right ventricular (RV) insertion points, but involved all the myocardial regions. More patients with LGE showed NYHA functional class II and more (71 vs. 21 %, p < 0.05), bundle branch blocks (57 vs. 6 %, p < 0.05), LV ejection fraction (LVEF) < 50 % (72 vs. 6 %, p < 0.01), LV asynergy (43 vs. 0 %, p < 0.01) and RVEF < 40 % (100 vs. 39 %, p < 0.01). There was no difference in disease duration, disease types, or prevalence of positive autoimmune antibodies or high serum NT-proBNP level (>125 pg/ml). When cardiac involvement of SSc was defined as low LVEF, ECG abnormalities or high NT-proBNP, the sensitivity, specificity positive and negative predictive values of LGE were 36, 92, 71 and 72 %, respectively. We could clarify the prevalence and distribution of LGE in Japanese patients with SSc. The presence of LGE was associated with cardiac symptom, conduction disturbance and impaired LV/RV contraction.
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Affiliation(s)
- Makoto Sano
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
| | - Hiroshi Satoh
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan.
| | - Kenichiro Suwa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
| | - Mamoru Nobuhara
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
| | - Takeji Saitoh
- Department of Emergency Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masao Saotome
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
| | - Tsuyoshi Urushida
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
| | - Hideki Katoh
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
| | - Kumiko Shimoyama
- Division of Immunology and Rheumatology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Daisuke Suzuki
- Division of Immunology and Rheumatology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Noriyoshi Ogawa
- Division of Immunology and Rheumatology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yasuo Takehara
- Department of Radiology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Harumi Sakahara
- Department of Radiology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideharu Hayashi
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
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12
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Saito M, Ota Y, Ohashi H, Dei Y, Shimoyama K, Suzuki D, Hayashi H, Ogawa N. CD40-CD40 ligand signal induces the intercellular adhesion molecule-1 expression through nuclear factor-kappa B p50 in cultured salivary gland epithelial cells from patients with Sjögren's syndrome. Mod Rheumatol 2014. [DOI: 10.3109/s10165-006-0538-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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13
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Shimoyama K, Ogawa N, Dei Y, Suzuki D, Saito M, Hayashi H. A case of proteinase 3-antineutrophil cytoplasmic antibody-positive Sjögren's syndrome complicated with interstitial nephritis. Mod Rheumatol 2014. [DOI: 10.3109/s10165-007-0621-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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14
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Shimoyama K, Ogawa N, Sawaki T, Karasawa H, Masaki Y, Kawabata H, Fukushima T, Wano Y, Hirose Y, Umehara H. A case of Mikulicz’s disease complicated with interstitial nephritis successfully treated by high-dose corticosteroid. Mod Rheumatol 2014. [DOI: 10.3109/s10165-006-0478-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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15
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Nakagawa K, Gonzalez-Roca E, Souto A, Kawai T, Umebayashi H, Campistol JM, Cañellas J, Takei S, Kobayashi N, Callejas-Rubio JL, Ortego-Centeno N, Ruiz-Ortiz E, Rius F, Anton J, Iglesias E, Jimenez-Treviño S, Vargas C, Fernandez-Martin J, Calvo I, Hernández-Rodríguez J, Mendez M, Dordal MT, Basagaña M, Bujan S, Yashiro M, Kubota T, Koike R, Akuta N, Shimoyama K, Iwata N, Saito MK, Ohara O, Kambe N, Yasumi T, Izawa K, Kawai T, Heike T, Yagüe J, Nishikomori R, Aróstegui JI. Somatic NLRP3 mosaicism in Muckle-Wells syndrome. A genetic mechanism shared by different phenotypes of cryopyrin-associated periodic syndromes. Ann Rheum Dis 2013; 74:603-10. [PMID: 24326009 DOI: 10.1136/annrheumdis-2013-204361] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
UNLABELLED : Familial cold autoinflammatory syndrome, Muckle-Wells syndrome (MWS), and chronic, infantile, neurological, cutaneous and articular (CINCA) syndrome are dominantly inherited autoinflammatory diseases associated to gain-of-function NLRP3 mutations and included in the cryopyrin-associated periodic syndromes (CAPS). A variable degree of somatic NLRP3 mosaicism has been detected in ≈35% of patients with CINCA. However, no data are currently available regarding the relevance of this mechanism in other CAPS phenotypes. OBJECTIVE To evaluate somatic NLRP3 mosaicism as the disease-causing mechanism in patients with clinical CAPS phenotypes other than CINCA and NLRP3 mutation-negative. METHODS NLRP3 analyses were performed by Sanger sequencing and by massively parallel sequencing. Apoptosis-associated Speck-like protein containing a CARD (ASC)-dependent nuclear factor kappa-light chain-enhancer of activated B cells (NF-κB) activation and transfection-induced THP-1 cell death assays determined the functional consequences of the detected variants. RESULTS A variable degree (5.5-34.9%) of somatic NLRP3 mosaicism was detected in 12.5% of enrolled patients, all of them with a MWS phenotype. Six different missense variants, three novel (p.D303A, p.K355T and p.L411F), were identified. Bioinformatics and functional analyses confirmed that they were disease-causing, gain-of-function NLRP3 mutations. All patients treated with anti-interleukin1 drugs showed long-lasting positive responses. CONCLUSIONS We herein show somatic NLRP3 mosaicism underlying MWS, probably representing a shared genetic mechanism in CAPS not restricted to CINCA syndrome. The data here described allowed definitive diagnoses of these patients, which had serious implications for gaining access to anti-interleukin 1 treatments under legal indication and for genetic counselling. The detection of somatic mosaicism is difficult when using conventional methods. Potential candidates should benefit from the use of modern genetic tools.
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Affiliation(s)
- Kenji Nakagawa
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Eva Gonzalez-Roca
- Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Alejandro Souto
- Department of Rheumatology, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Toshinao Kawai
- Department of Human Genetics, National Center for Child Health and Development, Tokyo, Japan
| | - Hiroaki Umebayashi
- Department of General Pediatrics, Miyagi Children's Hospital, Sendai, Japan
| | | | - Jeronima Cañellas
- Department of Rheumatology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Syuji Takei
- Faculty of Medicine, School of Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Norimoto Kobayashi
- Department of Pediatrics, School of Medicine, Shinshu University, Matsumoto, Japan
| | | | | | | | - Fina Rius
- Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Jordi Anton
- Department of Pediatric Rheumatology, Hospital Sant Joan de Deu, Esplugues, Spain
| | - Estibaliz Iglesias
- Department of Pediatric Rheumatology, Hospital Sant Joan de Deu, Esplugues, Spain
| | | | - Carmen Vargas
- Department of Rheumatology, Hospital Virgen de la Macarena, Sevilla, Spain
| | | | - Inmaculada Calvo
- Department of Pediatric Rheumatology, Hospital Universitario La Fe, Valencia, Spain
| | | | - María Mendez
- Department of Pediatrics, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Maria Basagaña
- Allergy Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Segundo Bujan
- Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain
| | - Masato Yashiro
- Department of Pediatrics, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Tetsuo Kubota
- Department of Medicine and Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryuji Koike
- Department of Medicine and Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoko Akuta
- Department of Pediatrics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kumiko Shimoyama
- Third Internal Medicine Department, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naomi Iwata
- Department of Infection and Immunology, Aichi Children's Health and Medical Centre, Obu, Japan
| | - Megumu K Saito
- Department of Clinical Application, Center for iPS cell research and application, Kyoto University, Kyoto, Japan
| | - Osamu Ohara
- Department of Human Genome Research, Kazusa DNA Research Institute, Kisarazu, Japan
| | - Naotomo Kambe
- Department of Dermatology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takahiro Yasumi
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazushi Izawa
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomoki Kawai
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshio Heike
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Jordi Yagüe
- Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Ryuta Nishikomori
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Juan I Aróstegui
- Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Barcelona, Spain
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Suzuki D, Kimoto O, Sawada J, Shimoyama K, Kawashima M, Mukai T, Ohashi H, Yamamura M, Ogawa N. [Efficacy and safety of combination therapy with mizoribine and methotrexate for rheumatoid arthritis resistant with methotrexate]. ACTA ACUST UNITED AC 2011; 34:149-53. [PMID: 21720103 DOI: 10.2177/jsci.34.149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. MZB is a purine analog, and is used as a disease modifying anti-rheumatic drug (DMARD). We conducted an open label uncontrolled clinical trial to evaluate the efficacy and safety of combination therapy with methotrexate (MTX) and mizoribine (MZB). Methods. Thirty one RA patients (9 males, 22 females, 68±12 year-old) who fulfilled ACR criteria of RA and did not show sufficient clinical response to MTX were included. MZB (150 mg/day, once a day) were added to MTX. DAS28-CRP was measured at day 0 and 1, 3, 6, and 12 months after the treatment. Adverse events were recorded. Results. Overall DAS28-CRP was significantly decreased from 4.4±1.0 to 3.1±1.3 at 3 months (p<0.01), 2.7±0.68 at 6 months (p<0.01), 2.4±1.4 at 12 months (p<0.01). Seventeen patients (55%) achieved significant improvement of DAS28-CRP. Number of swollen joints of responders before the treatment was significantly fewer than that of non-responders. Improvement of DAS28-CRP was significantly different between the responders (0.91±0.74) and non-responders (0.18±0.66) at 1 month (p<0.01). Nine patients (29%) could achieve remission Four patients experienced adverse events. Conclusions. MTX and MZB combination therapy was effective and relatively safety.
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Affiliation(s)
- Daisuke Suzuki
- Department of Rheumatology, Hamamatsu University School of Medicine, Japan
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Mino Y, Naito T, Shimoyama K, Ogawa N, Kawakami J. Pharmacokinetic variability of mycophenolic acid and its glucuronide in systemic lupus erythematosus patients in remission maintenance phase. Biol Pharm Bull 2011; 34:755-9. [PMID: 21532168 DOI: 10.1248/bpb.34.755] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of this study was to identify factors affecting the pharmacokinetics of mycophenolic acid (MPA) and its 7-O-glucuronide (MPAG) in systemic lupus erythematosus (SLE) patients. Thirty-one SLE patients in remission maintenance phase treated with mycophenolate mofetil (median 1500 mg/d) and prednisolone and followed-up for up to 56 months (median 13 months) were enrolled. Creatinine clearance and metal medication were significant predictors accounting for interindividual variability in the dose-normalized predose plasma concentration (C₀) of MPA (adjusted R²=0.305, p=0.01) in a multivariate analysis. Dose-normalized MPAG C₀ was significantly correlated with only creatinine clearance (adjusted R²=0.135, p=0.03). The free fraction of MPA was significantly correlated with only serum albumin (adjusted R²=0.700, p<0.01). The free fraction of MPAG was significantly correlated with serum albumin, metal medication, and age (adjusted R²=0.598, p=0.02). In conclusion, renal function and co-administered metal influenced the pharmacokinetics of MPA and MPAG in SLE patients in remission maintenance phase.
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Affiliation(s)
- Yasuaki Mino
- Department of Hospital Pharmacy, Hamamatsu University School of Medicine, Japan
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Mino Y, Naito T, Shimoyama K, Ogawa N, Kawakami J. Effective plasma concentrations of mycophenolic acid and its glucuronide in systemic lupus erythematosus patients in the remission-maintenance phase. J Clin Pharm Ther 2011; 37:217-20. [DOI: 10.1111/j.1365-2710.2011.01269.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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19
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Kimoto O, Sawada J, Shimoyama K, Suzuki D, Nakamura S, Hayashi H, Ogawa N. Activation of the interferon pathway in peripheral blood of patients with Sjogren's syndrome. J Rheumatol 2010; 38:310-6. [PMID: 21078725 DOI: 10.3899/jrheum.100486] [Citation(s) in RCA: 41] [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: 01/01/2023]
Abstract
OBJECTIVE DNA microarray analysis and quantitative real-time polymerase chain reaction (PCR) were performed to identify key target genes in peripheral blood from patients with Sjögren's syndrome (SS). METHODS DNA microarray analysis was performed in 19 patients with SS (all women) and 10 healthy controls (5 men and 5 women) using a low-density DNA microarray system with 778 genes. For confirmation, the expression of upregulated genes was analyzed by quantitative real-time PCR in another 37 SS patients (35 women and 2 men) and 9 healthy controls (8 women and 1 man). Relationships between gene signatures and various clinical measures, such as disease duration, symptoms and signs, complications, immunological findings, and salivary and lacrimal functions, were analyzed. RESULTS Interferon-α (IFN-α)-inducible protein 27 (IFI27) showed the most significant difference between SS patients and controls in the microarray screening. We performed quantitative RT-PCR for IFI27. IFI27 gene expression level was increased in patients with SS compared with controls (p < 0.01) by real-time PCR, supporting our observations from the microarray data. The level of IFI27 was significantly correlated with serum IgG levels (r = 0.462, p < 0.01) and ß(2)-microglobulin (r = 0.385, p < 0.05), soluble interleukin 2 receptor (r = 0.473, p < 0.01), erythrocyte sedimentation rate (r = 0.333, p < 0.05), and antinuclear antibody titer (speckled pattern; r = 0.445, p < 0.01). CONCLUSION Our results suggest that upregulation of IFN-inducible genes in SS patients is a systemic phenomenon, and IFN may play an important role in the pathogenesis of SS. The expression level of IFI27 could be an effective and specific biomarker associated with SS.
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Affiliation(s)
- Osamu Kimoto
- Third Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu 431-3192, Japan.
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Suzuki D, Ogawa N, Sawada J, Kimoto O, Shimoyama K, Hayashi H. [The efficacy of mycophenolate mofetil for systemic lupus erythematosus]. Nihon Rinsho Meneki Gakkai Kaishi 2009; 32:263-268. [PMID: 19721347 DOI: 10.2177/jsci.32.263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Systemic lupus erythematosus (SLE) is usually treated with corticosteroids and immunosuppressive agents. However, some patients are refractory to these agents, others show adverse effects. Usefulness of mycophenolate mofetil (MMF) in SLE has been reported in several studies. In this study, we evaluated the clinical efficacy and adverse effects of MMF in SLE. Sixteen cases which were difficult to reduce the dose of corticosteroid, resistant to immunosuppressive agents or could not use them for adverse effects were treated with MMF. Thirteen cases were females and three were males. Mean age was 44.4+/-9.2 year-old. Mean duration of SLE was 12.5+/-6.9 years. Mean observational duration was 12.0+/-5.5 months. Mean maintenance dose of MMF was 1.95+/-0.61 g/day. Good clinical response was obtained in 69% of total cases. In laboratory data, serum IgG (p<0.05) decreased and the levels of serum albumin (p<0.01) and complement (p<0.05) increased significantly. Adverse effects, mainly infections, were observed, but severe infection was not experienced. This study suggests that MMF is effective and relatively safe for SLE.
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Affiliation(s)
- Daisuke Suzuki
- Hamamatsu University School of Medicine, Internal Medicine III
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21
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Shimoyama K, Yasuda K, Kawano M, Satoh M. [The effectiveness of measurement of nasal resistance in patients with sleep disordered breathing]. Nihon Kokyuki Gakkai Zasshi 2009; 47:449-454. [PMID: 19601517] [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: 05/28/2023]
Abstract
Nasal breathing disorder has been associated with the condition and treatment of sleep disordered breathing (SDB). In the current study, we investigated the utility of measurement of nasal resistance in patients with SDB. We examined the relationship between nasal symptoms and nasal resistance in 219 patients, and how the results affected the administration of nasal continuous positive airway pressure (nCPAP) in 34 SDB patients. Total nasal resistance was not significantly different between patients who were divided into two groups: those with nasal symptoms, and those without. The left-right ratio of nasal flow in the group with nasal symptoms was higher than in the group without nasal symptoms (p < 0.01). The mean percentage of nCPAP use was not significantly different between two groups divided by total nasal resistance. The mean percentage of nCPAP use > or = 4 hours was lower in the group in which total nasal resistance was more than 0.25Pa/cm3/sec (p < 0.05). The left-right ratio of nasal flow does not affect nCPAP use. We conclude that measurement of nasal resistance for confirming nasal breathing disorder is effective in patients with SDB, whether a patient complains of nasal symptoms or not.
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Affiliation(s)
- Kumiko Shimoyama
- University of Tsukuba, Department of Sleep Medicine, Graduate School of Comprehensive Human Sciences
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Masaki Y, Dong L, Nakajima A, Iwao H, Miki M, Kurose N, Kinoshita E, Nojima T, Sawaki T, Kawanami T, Tanaka M, Shimoyama K, Kim C, Fukutoku M, Kawabata H, Fukushima T, Hirose Y, Takiguchi T, Konda S, Sugai S, Umehara H. Intravascular large B cell lymphoma: proposed of the strategy for early diagnosis and treatment of patients with rapid deteriorating condition. Int J Hematol 2009; 89:600-10. [PMID: 19363707 DOI: 10.1007/s12185-009-0304-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 03/10/2009] [Accepted: 03/15/2009] [Indexed: 12/14/2022]
Abstract
We summarize our experience and propose methods for early diagnosis and treatment of intravascular large B cell lymphoma (IVL). A total of 16 patients with IVL between 1994 and 2007 were included and analyzed in this study. Predicted survival durations were short until September 2003. However, there have been marked improvement since the introduction of rituximab, and all patients responded to treatment and survived for more than 1 year following diagnosis of IVL. We propose an early clinical diagnostic strategy for starting treatment for IVL patients with quite poor performance status (PS) and in whom time is a limiting factor: (1) age >40 years, (2) fever above 38 degrees C with poor PS (ECOG 2-4), (3) lactate dehydrogenase (LDH) more than twice the upper limit of the normal level and/or sIL2R >5,000 IU/ml in serum, (4) worsening PS and/or elevation of serum LDH on a daily basis, and (5) confirmation of pathological lymphoid cells in peripheral blood or bone marrow smear and/or flow cytometry. Although accurate pathological diagnosis is quite important, time is a limiting factor for most of IVL patients. In such cases, we can start chemotherapy based on early clinical diagnostic strategy with high sensitivity and obtain good clinical outcome.
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Affiliation(s)
- Yasufumi Masaki
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Ishikawa, Japan.
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Shimoyama K, Ogawa N, Sawada J, Kimoto O, Suzuki D, Hayashi H. [Study of procedure of labial salivary gland biopsy in Sjögren's syndrome]. ACTA ACUST UNITED AC 2009; 32:53-60. [PMID: 19252379 DOI: 10.2177/jsci.32.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Minor salivary gland biopsy is useful for diagnosis of Sjögren's Syndrome, because it has 87.4% of sensitivity, 87.3% of specificity and 87.4% of accuracy. However, SS cannot be diagnosed solely on focus score (FS). Moreover, FS is at most semi-quantitative. We questioned 30 registered facilities of Society of Japan Sjögren's Syndrome about the method and evaluation of minor salivary gland biopsy. As a result, it turned out that there were no standard methods in the procedure of salivary gland biopsy. The small salivary gland can be reached easily with little invasive method, however there are several problems, which include 1. necessity of a standard technique, 2. minimization of the pain and 3. establishment of proper evaluation system. It is thought that the establishment of a standard technique and evaluation method is necessary to minimize the pain and collect the sufficient amount of tissue. Here we report the analysis of the procedure of minor salivary gland biopsy performed in other institutions as well as in our hospital in order to propose a standardized procedure and evaluation system.
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Affiliation(s)
- Kumiko Shimoyama
- The Third Department of Internal Medicine, Hamamatsu University School of Medicine
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Yoshino H, Kachi E, Shimizu H, Taniuchi M, Yano K, Udagawa H, Kajiwara T, Shimoyama K, Ishikawa K. Severity of residual stenosis of infarct-related lesion and left ventricular function after single-vessel anterior wall myocardial infarction: implication of ST-segment elevation in lead aVL of the admission electrocardiograms. Clin Cardiol 2009; 23:175-80. [PMID: 10761805 PMCID: PMC6654902 DOI: 10.1002/clc.4960230309] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The relationship between the severity of chronic-phase stenosis of infarct-related lesions (IRLs) and chronic left ventricular function in anterior acute myocardial infarctions (AMI) has not been adequately investigated. HYPOTHESIS This study investigated whether ST elevation in lead aVL of admission electrocardiogram (ECG) would be a determinant factor of the relationship between the severity of stenosis of the IRL and chronic left ventricular function after anterior wall AMI. METHODS One month after AMI, the IRL was evaluated by coronary angiography in 98 patients with anterior AMI, and left ventricular ejection fraction (LVEF) was determined using multigated radionuclide angiocardiography. Patients were classified according to the severity of the IRL: patients with 100% occlusion (Group O), patients with 90 to 99% stenosis (Group H), and patients with < or =75% stenosis (Group L). Patients with ST elevation > or =0.1 mV in the aVL lead on their admission ECG were included in the ST-elevation group, and those with ST elevation <0.1 mV were included in the non-ST-elevation group. RESULTS The LVEF was greater in the non-ST-elevation group than in the ST-elevation group (p<0.0001), and the LVEF in a whole group as follows: Group L LVEF>Group H LVEF>Group O LVEF (p = 0.0160). In the ST-elevation group, LVEF was higher in Group L than in the other groups (p = 0.0251). There were three independent predictors of a reduced LVEF: ST-elevation in aVL [odds ratio (OR): 3.38, p = 0.0044], IRL stenosis > or =90% (OR: 2.90, p = 0.0044), and the IRL occurring in the left anterior descending artery proximal to the first diagonal branch (OR: 6.31, p = 0.0024). CONCLUSION Left ventricular function was preserved, regardless of the severity of residual stenosis, in patients without ST elevation in aVL if the IRL was not totally occluded. In patients with ST elevation in aVL, LVEF was lower in patients with more severe stenosis, even if the IRL was patent.
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Affiliation(s)
- H Yoshino
- Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan
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Shimoyama K, Ogawa N, Dei Y, Suzuki D, Saito M, Hayashi H. A case of proteinase 3-antineutrophil cytoplasmic antibody-positive Sjögren's syndrome complicated with interstitial nephritis. Mod Rheumatol 2007; 17:514-7. [PMID: 18084707 DOI: 10.1007/s10165-007-0621-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Accepted: 06/18/2007] [Indexed: 11/25/2022]
Abstract
A 65-year-old woman who had fever was admitted. Laboratory data showed renal tubular dysfunction, elevated C-reactive protein, soluble interleukin-2 receptor (sIL-2R), and IgG. Her blood showed proteinase 3-antineutrophil cytoplasmic antibody (PR3-ANCA) as well as antinuclear antibody and anti-Ro/SS-A antibody. Salivary gland and renal biopsy showed inflammatory infiltration of lymphocytes. A diagnosis of Sjögren's syndrome (SS) and interstitial nephritis was made. beta(2)-microglobulin, sIL-2R, IgG, and PR3-ANCA were decreased in response to medium-dose oral prednisolone. Antineutrophil cytoplasmic antibody could be a new marker for extraglandular features of SS. It would be beneficial for SS patients who have positive ANCA to investigate extraglandular lesions such as interstitial nephritis.
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Affiliation(s)
- Kumiko Shimoyama
- Third Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan.
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Shimoyama K, Ogawa N, Sakai T, Sawaki T, Kawanami T, Karasawa H, Masaki Y, Tanaka M, Fukushima T, Hirose Y, Umehara H. [Analysis of clinical significance of anti-cyclic citrullinated peptide antibody (anti-CCP antibody) in rheumatoid arthritis (RA)]. Nihon Rinsho Meneki Gakkai Kaishi 2007; 30:408-413. [PMID: 17984582 DOI: 10.2177/jsci.30.408] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To examine clinical significance of anti-cyclic citrullinated peptide antibody (anti-CCP antibody) in RA. METHODS Hundred fifteen patients with polyarthralgia (89 females, 26 males) were recruited, and subjected for the study. We studied anti-CCP antibody, ESR, CRP, IgM-RF, IgG-RF, RAPA, MMP-3, CARF, C1q-IC, Stage, Class, Joint score, Sharp score, KL-6, SP-D, chest CT. RESULTS Anti-CCP antibody test had high specificity (93.5%). In RA with positive anti-CCP antibody, Sharp score (10.9+/-22.4) was higher than those with negative anti-CCP (1.7+/-1.8), and may serve as a prognostic marker of joint destruction (P<0.05). Anti-CCP antibody in RA with interstitial pneumonia is higher (84.5+/-36.4 U/mL) than those without interstitial pneumonia (52.6+/-44.7 U/mL) (P<0.05). CONCLUSION Anti-CCP antibody is useful for diagnosis of RA, and could be a specific marker of joint destruction. Further investigation is necessary to clarify the relation of anti-CCP antibody with organ involvement and activity of RA.
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Affiliation(s)
- Kumiko Shimoyama
- The third Department of Internal Medicine, Hamamatsu University School of Medicine
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27
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Saito M, Ota Y, Ohashi H, Dei Y, Shimoyama K, Suzuki D, Hayashi H, Ogawa N. CD40-CD40 ligand signal induces the intercellular adhesion molecule-1 expression through nuclear factor-kappa B p50 in cultured salivary gland epithelial cells from patients with Sjögren's syndrome. Mod Rheumatol 2007; 17:45-53. [PMID: 17278022 DOI: 10.1007/s10165-006-0538-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Accepted: 10/23/2006] [Indexed: 10/23/2022]
Abstract
The purpose of this study is to clarify signal transduction of expression of the intercellular adhesion molecule-1 (ICAM-1) via CD40-CD40 ligand in salivary glands of patients with Sjögren's syndrome (SS). We used cultured salivary gland epithelial cells (SG cells) from 15 SS patients and 8 controls obtained by labial minor salivary gland biopsy. First, ICAM-1 expression was determined with reverse transcriptase-polymerase chain reaction and flow cytometry in the presence or absence of soluble CD40L (sCD40L). Next, SG cells were transfected with plasmids of pGL1.3-Luc inserted with promoter region of ICAM-1, pGL1.3kB(-)-Luc mutated in nuclear factor kappa-B (NF-kappaB) binding site of pGL1.3-Luc and pNF-kappaB-Luc by lipofection method. Luciferase activity of the cells was measured in the presence or absence of sCD40L or sCD40L and an NF-kappaB inhibitor, pyrrolidine dithiocarbamate (PDTC). Finally NF-kappaB family proteins of cell nuclear extracts were determined. ICAM-1 expression was significantly enhanced with sCD40L at the mRNA and protein level. Activity of pNF-kappaB-Luc and pGL1.3-Luc was significantly elevated by stimulation with sCD40L and suppressed by PDTC. NF-kappaB p50 protein level was elevated by stimulation with sCD40L and suppressed by PDTC. Our results suggest that sCD40L enhances the ICAM-1 expression by activation of NF-kappaB p50 in the SS SG cells.
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Affiliation(s)
- Miwako Saito
- Third Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu 431-3192, Japan.
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Shimoyama K, Ogawa N, Sawaki T, Karasawa H, Masaki Y, Kawabata H, Fukushima T, Wano Y, Hirose Y, Umehara H. A case of Mikulicz's disease complicated with interstitial nephritis successfully treated by high-dose corticosteroid. Mod Rheumatol 2006; 16:176-82. [PMID: 16767558 DOI: 10.1007/s10165-006-0478-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2005] [Accepted: 03/27/2006] [Indexed: 11/24/2022]
Abstract
A 40-year-old woman who had bilateral swelling in the eyelids and submandibular region was admitted. Clinical findings suggested she had primary Sjögren's syndrome. Laboratory data showed glucosuria, positive CRP (0.50 mg/dl), liver dysfunction (AST 53 U/l, ALT 101 U/l, gamma-GTP 241 U/l, ALP 914 U/l, LAP 496 U/l), hyperglycemia, hypergammaglobulinemia (IgG 3450 mg/dl, IgA 91 mg/dl, IgM 80 mg/dl), hypocomplementemia (C3 73 mg/dl, C4 2 mg/dl, CH50 < 19.0 U/ml), renal tubular dysfunction (urine N-acetyl-beta-D: -glucosaminidase 8.6 U/l, urine (beta2)-microglobulin 83 microg/l), and urinary concentration defect. Ammonium chloride loading test was normal. Gallium-67 scintigram indicated abnormal uptake in bilateral lacrimal glands, submandibular glands, and kidneys. A diagnosis of Mikulicz's disease and interstitial nephritis was made, since biopsy specimens of her lacrimal gland and minor salivary gland showed diffuse infiltration of lymphocytes. Renal biopsy specimens also showed severe interstitial infiltration of lymphocytes. Symptoms and laboratory data normalized in response to methylprednisolone pulse therapy and prednisolone 60 mg/day. This case of Mikulicz's disease complicated with interstitial nephritis was successfully treated by high-dose corticosteroid.
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Affiliation(s)
- Kumiko Shimoyama
- Department of Hematology and Immunology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa, 920-0293, Japan.
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29
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Hirose Y, Masaki Y, Sawaki T, Shimoyama K, Karasawa H, Kawabata H, Fukushima T, Ogawa N, Wano Y, Umehara H. Association of Epstein-Barr virus with human immunodeficiency virus-negative peripheral T-cell lymphomas in Japan. Eur J Haematol 2006; 76:109-18. [PMID: 16405431 DOI: 10.1111/j.0902-4441.2005.00575.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The association of Epstein-Barr virus (EBV) with human immunodeficiency virus-negative T-cell lymphoma was examined in 68 patients using the polymerase chain reaction (PCR) with DNA obtained from formalin-fixed paraffin-embedded tissues and an in situ hybridization technique. EBV-encoded RNA (EBER) was detected in 43 of 68 cases (63%) of peripheral T-cell lymphoma: in 100% (11 of 11 cases) of NK/T-cell lymphomas, 70% (14 of 20 cases) of angioimmunoblastic T-cell lymphomas (AILT) and 49% (18 of 37 cases) of other types of peripheral T-cell lymphoma. A positive band was also detected at high incidence (36 of 65 cases; 55%) in a PCR analysis using primers to detect the Bam HI-W fragment of EBV. In the immunohistochemical analysis using a monoclonal antibody to latent membrane protein 1 (LMP-1) of EBV, one of the EBV-encoded latent gene products, LMP-1, was found to be expressed in 13 of 64 cases (20%), but EBNA-2 was not expressed in all the cases examined (0 of 59 cases; 0%). The 5-yr survival rate was 28% for peripheral T-cell lymphomas overall, 0% for NK/T-cell lymphomas, 38% for AILTs and 28% for other types of peripheral T-cell lymphoma. The difference in the overall survival rate between NK/T-cell lymphoma and non-NK/T-cell lymphoma was significant (P = 0.0498 by Log-rank test). Among peripheral T-cell lymphoma patients overall, the group severely infected with EBV (EBER-ISH ++) had a lower 5-yr survival rate (8%) than the group slightly (EBER-ISH +) or not infected (38%; P = 0.0013).
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Affiliation(s)
- Yuko Hirose
- Department of Hematology and Immunology, Kanazawa Medical University, Ishikawa, Japan.
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30
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Kawabata H, Sawaki T, Kawanami T, Shimoyama K, Karasawa H, Fukushima T, Masaki Y, Ogawa N, Hirose Y, Ozaki K, Shimanaka K, Takase S, Ueno H, Umehara H. Myelodysplastic syndrome complicated with inflammatory intestinal ulcers: significance of trisomy 8. Intern Med 2006; 45:1309-14. [PMID: 17170506 DOI: 10.2169/internalmedicine.45.1718] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Three cases of myelodysplastic syndrome (MDS) complicated with inflammatory intestinal ulcers all had cytogenetic abnormalities with trisomy 8. The first two patients were diagnosed with intestinal Behçets disease and were successfully treated with salazosulphapiridine, and the third patient died after leukemic transformation. We review the reported cases of MDS complicated with Behçets disease. Most of these cases are Japanese, having intestinal involvement as well as cytogenetic abnormalities with trisomy 8. We discuss the significance of trisomy 8 in intestinal involvement in MDS.
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Affiliation(s)
- Hiroshi Kawabata
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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31
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Wano Y, Kang Y, Masaki H, Kawabata H, Fukushima T, Shimoyama K, Satoh A, Miyairi Y, Kashiwaba M, Hirose Y. [Cyclosporine A as an effective treatment for a patient with acquired hemophilia A complicated with diabetes mellitus and ischemic heart disease]. Rinsho Ketsueki 2005; 46:1100-4. [PMID: 16440770] [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: 05/06/2023]
Abstract
Acquired hemophilia A (AHA) is a rare coagulation disorder due to the development of an autoantibody against and inhibitor of coagulation factor VIII. It has been reported that immunosuppressive therapy with corticosteroids, cyclophosphamide, azathioprine and vincristine are effective to decrease this inhibitor. When corticosteroids and cytotoxic drugs are ineffective, cyclosporine A (CyA) may be effective as a second-line salvage therapy. Except for postpartum conditions, AHA usually occurs in elderly patients who are often already suffering from diabetes mellitus, ischemic heart disease and/or hyperlipidemia. However, immunosuppressive and cytotoxic drugs may have adverse effects on these patients. We report on a 66-year-old man who developed AHA after colon cancer resection (factor VIII inhibitor: 61 Bethesda units/ml, aPTT : 97.9 s). Since he already had both diabetes mellitus and ischemic heart disease, we abandoned treatment with corticosteroids and oral cyclophosphamide was started, but was switched to CyA because of leukopenia. Within 3 months of starting the CyA treatment, aPTT levels returned to normal and 4 further months were required for complete eradication of the inhibitor. This case revealed that CyA is as effective as corticosteroids for AHA. For patients with AHA who have unfavorable complications due to corticosteroids and cytotoxic drugs, CyA could be a potential first-line drug.
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Affiliation(s)
- Yuji Wano
- Hematology Department, Iwate Prefectural Central Hospital
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32
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Masaki Y, Sawaki T, Shimoyama K, Karasawa H, Kawanami T, Fukushima T, Kawabata H, Ogawa N, Wano Y, Sugai S, Hirose Y, Umehara H. [Successful salvage therapy of continuous low-dose irinotecan for a patient with relapsed and refractory diffuse large B-cell lymphoma]. Rinsho Ketsueki 2005; 46:1074-7. [PMID: 16440768] [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: 05/06/2023]
Abstract
A 46-year-old man with relapsed and refractory diffuse large B-cell lymphoma after salvage therapy (EPOCH and ESHAP regimens) was treated with continuous low-dose CPT-11 (irinotecan hydrochloride) at 30 mg/day (20 mg/m2/day) for three consecutive days every week. The patient's general condition and both LDH and CRP, tumor related markers, improved dramatically. Complete remission was achieved after a 10-week cycle of therapy without severe adverse effects. Unfortunately, the lymphoma relapsed after allogeneic hematopoietic stem cell transplantation, low-dose CPT-11 therapy was used again to palliate tumor symptoms for 12 months. This therapy may be a useful salvage and palliative chemotherapy for relapsed and refractory lymphoma.
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Takahashi M, Shimoyama K, Kyotani C, Sato H, Ogino K. Separation of copolymers using high-performance liquid chromatography with polymeric stationary phase and liquefied carbon dioxide as adsorption promoting solvent. J Chromatogr A 2005; 1084:201-6. [PMID: 16114255 DOI: 10.1016/j.chroma.2005.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chromatographic separation of copolymers depending on the chemical composition was studied by a solvent gradient method using liquefied carbon dioxide (CO2) as an adsorption promoting solvent. As the high polar stationary phase, non-bonded silica gel, crosslinked acrylamide (AA) gel and crosslinked acrylonitrile (AN) gel were utilized. All columns showed the typical normal phase type of adsorption. Polymeric stationary phases showed the higher sample recovery for styrene-methyl methacrylate (St-MMAs) copolymers, indicating suitability for quantitative analyses. The separations of butyl methacrylate (BMA)-methyl methacrylate, and 2,2,3,3,4,4,4-heptafluorobutyl methacrylate (FBMA)-methy methacrylate copolymers were also carried out, and the latter copolymers were separated based on the CO2-philicity with acrylonitrile column.
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Affiliation(s)
- Makoto Takahashi
- Graduate School of Bio-Applications and Systems Engineering, Tokyo University of Agriculture and Technology, Koganei, Tokyo 184-8588, Japan
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Ogawa N, Shimoyama K, Kawanami T. [Clearance of apoptotic cells and autoimmunity]. Nihon Rinsho 2005; 63 Suppl 5:229-32. [PMID: 15954354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Noriyoshi Ogawa
- Department of Hematology and Immunology, Kanazawa Medical University
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Abstract
IFNgamma plays an important role to induce several functional molecules on salivary epithelial cells, including class II MHC, Fas and CD40 in salivary glands from patients with Sjogren's syndrome (SS). IFNgamma also contributes to the development of lymphocytic infiltrates by inducing T cell attracting chemokines in SS salivary epithelial cells, such as IP-10 (CXCL10), Mig (CXCL9), and I-TAC (CXCL11). IFNgamma dysregulation in SS salivary gland may attribute to the decreased production of TGFbeta from salivary epithelial cells in some patients. Expression of Fas and CD40 was significantly higher in SS salivary epithelial cells than in normal cells after IFNgamma stimulation. Although neither anti-Fas (CH11) nor anti-CD40 mAb alone could induce typical apoptosis, the two together and preincubation with IFNgamma efficiently induced apoptosis in SS salivary epithelial cells. This apoptosis was almost completely blocked by neutralizing anti-Fas mAb (ZB4). c-FLIP, an important inhibitory molecule in the Fas death pathway, was strongly expressed in SS salivary epithelial cells, but its expression was downregulated, at the protein level, by anti-CD40 mAb. CD40 signals promote Fas-dependent death of SS salivary epithelial cells by downregulating c-FLIP expression. The presence of c-FLIP in these cells may explain their resistance to undergo apoptosis in response to either anti-Fas or anti-CD40 mAb, despite their surface expression of both proteins. These findings suggest that SS salivary epithelial cell death requires the cooperation of Fas and CD40.
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Affiliation(s)
- Noriyoshi Ogawa
- Department of Hematology and Immunology, Kanazawa Medical University, Japan
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36
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Fukushima T, Sawaki T, Shimoyama K, Karasawa H, Masaki Y, Kawabata H, Ogawa N, Wano Y, Hirose Y, Sugai S, Sutoh H, Itoh H, Kojima Y. [Successful treatment with etoposide by oral administration for recurrence of gastric diffuse large B-cell lymphoma after surgical resection--a case report]. Gan To Kagaku Ryoho 2005; 32:251-3. [PMID: 15751644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
A 64-year-old woman, who had been treated for gastric diffuse large B-cell lymphoma (DLBCL) by total gastrectomy and received 3 courses of CHOP therapy at 61 years of age, was diagnosed with recurrence of DLBCL in the small intestine. After the small intestinal tumor was resected, multiple metastases were found in the liver. Because intensive chemotherapy was difficult for her poor performance status, 50 mg of etoposide daily by oral was administered for 21 consecutive days. After one course of chemotherapy, liver metastases and lymph node swelling almost disappeared without severe adverse effects, and after five courses she achieved complete remission. Though DLBCL invaded the central nervous system, the abdominal regions had been free from recurrence for 12 months. This case report suggests that oral etoposide therapy is useful for gastrointestinal DLBCL which has metastasized to the liver.
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Ogawa N, Shimoyama K, Karasawa H, Fukushima T, Masaki Y, Wano Y, Hirose Y, Sugai S. [Clinical significance of cevimeline hydrochloride in the treatment of dry mouth in patients with Sjögren's syndrome]. ACTA ACUST UNITED AC 2005; 27:330-7. [PMID: 15559322 DOI: 10.2177/jsci.27.330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To evaluate the efficacy and safety of cevimeline hydrochloride for the treatment of dry mouth in patients with Sjögren's syndrome (SS), eight SS patients received 30 mg of cevimeline twice or three times daily for 24 weeks. Six out of the eight patients had improvement in dry mouth. Five patients had more than 20% increase in saliva secretion. In the assessment of salivary gland scintigraphy, three patients showed improvement. There was a significant negative correlation between the improvement of saliva secretion and the severity of tissue damage assessed by MR sialography (r= - 0.754, p<0.05). One patient stopped cevimeline at 4 weeks because of headache and nausea. There was no significant change in laboratory data. Cevimeline is safe and effective medicine for dry mouth in patients with SS, in particular, with less severe salivary gland destruction.
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Affiliation(s)
- Noriyoshi Ogawa
- Division of Hematology & Immunology, Department of Internal Medicine, Kanazawa Medical University
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38
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Shimoyama K, Ogawa N. [Salivary gland examinations in patients with rheumatoid arthritis]. Nihon Rinsho 2005; 63 Suppl 1:386-9. [PMID: 15799384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Kumiko Shimoyama
- Division of Hematology and Immunology, Department of Internal Medicine, Kanazawa Medical University
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Hirose Y, Masaki Y, Karasawa H, Shimoyama K, Fukushima T, Kawabata H, Ogawa N, Wano Y, Ozaki M. Incidence of Diffuse Large B-Cell Lymphoma of Germinal Center B-Cell Origin in Whole Diffuse Large B-Cell Lymphoma: Tissue Fluorescence In Situ Hybridization Using t(14;18) Compared with Immunohistochemistry. Int J Hematol 2005; 81:48-57. [PMID: 15717689 DOI: 10.1532/ijh97.04102] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) can be divided into prognostically important categories such as germinal center B (GCB)-like and non-GCB-like groups. The t(14;18)(q32;q21) translocation defines a unique subset of DLBCL cases with a GCB gene expression profile. Two-color fluorescence in situ hybridization (FISH) analysis was applied to detect t(14;18) (q32;q21) in the nuclei of paraffin-embedded tissue sections from 61 patients with de novo DLBCL. Nine (15%) of 61 cases had a positive pattern. Fifty-seven cases were subclassified in an immunohistochemical study with anti-CD10, anti-bcl-6, and anti-MUM1 antibodies. In this classification, 21 cases (37%) were placed in the GCB group, and 36 (63%) were placed in the non-GCB group. There was a discrepancy between t(14;18) occurrence and bcl-2 protein expression. Bcl-2 protein expression was positive in 40 (67%) of 60 cases. The expression of bcl-2 protein in the GCB and non-GCB groups was not significantly different: 15 (71%) of 21 cases in the GCB group and 24 (67%) of 36 cases in the non-GCB group tested positive. We found no difference between the FISH-positive and FISH-negative groups in overall survival time (P = .6019, log-rank test). The overall survival rates of GCB and non-GCB groups did not differ significantly by immunohistochemical classification (P = .5399, log-rank test). Overall survival was significantly longer in the group with a low International Prognostic Index (IPI) score than in the group with a high IPI score (P = .0002, log-rank test). Our results suggest that immunohistochemical study and cytogenetic study with t(14;18) FISH cannot predict the clinical outcomes of DLBCL patients. A study with a larger number of patients may show a difference in clinical outcomes between FISH-positive and FISH-negative groups and between GCB and non-GCB groups.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Chromosomes, Human, Pair 14
- Chromosomes, Human, Pair 18
- Female
- Germinal Center/pathology
- Humans
- Immunohistochemistry
- In Situ Hybridization, Fluorescence
- Incidence
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/mortality
- Lymphoma, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Translocation, Genetic
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Affiliation(s)
- Yuko Hirose
- Department of Hematology and Immunology, Kanazawa Medical University, Ishikawa, Japan.
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40
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Ogawa N, Kawanami T, Shimoyama K, Ping L, Sugai S. Expression of interferon-inducible T cell α chemoattractant (CXCL11) in the salivary glands of patients with Sjögren's syndrome. Clin Immunol 2004; 112:235-8. [PMID: 15308116 DOI: 10.1016/j.clim.2004.03.008] [Citation(s) in RCA: 31] [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: 01/28/2004] [Revised: 03/10/2004] [Accepted: 03/11/2004] [Indexed: 11/30/2022]
Abstract
To investigate the possible involvement of interferon-inducible T cell alpha chemoattractant (I-TAC or CXCL11) in the salivary gland lesions of Sjögren's syndrome (SS), I-TAC mRNA expression was assayed in cultured salivary epithelial cells by reverse transcriptase-polymerase chain reaction (RT-PCR). This transcript was not expressed by SS salivary epithelial cells in the absence of IFNgamma, but was expressed after cells were stimulated with IFNgamma. We found that IFNgamma was the only cytokine that induced I-TAC mRNA expression. I-TAC proteins were shown by ELISA to be secreted into the culture supernatants of SS salivary epithelial cells following IFNgamma stimulation. Moreover, immunohistochemical assays of minor salivary glands (MSG) showed that I-TAC was predominantly located in the ductal epithelium adjacent to lymphoid infiltrates in the SS salivary gland, indicating that ductal epithelial cells produce I-TAC proteins in response to stimulation with IFNgamma secreted by lymphocytes that infiltrate into SS salivary glands. In contrast, I-TAC proteins were virtually absent from normal salivary glands. These findings suggest that I-TAC is involved in the development of salivary gland lesions observed in SS.
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Affiliation(s)
- Noriyoshi Ogawa
- Division of Hematology and Immunology, Department of Internal Medicine, Kanazawa Medical University, Kahoku-gun, Ishikawa-ken 920-0293, Japan.
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41
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Hirose Y, Fukushima T, Masaki Y, Shimoyama K, Karasawa H, Ogawa N, Wano Y. Epstein-Barr virus-associated composite lymphoma composed of peripheral T-cell lymphoma and an anaplastic variant of a diffuse large B-cell type of non-Hodgkin's lymphoma and strongly expressing p53 protein. Int J Hematol 2004; 79:260-5. [PMID: 15168595 DOI: 10.1532/ijh97.03156] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We report a case of composite lymphoma consisting of peripheral T-cell lymphoma and an anaplastic variant of diffuse large B-cell lymphoma (DLBCL) and associated with Epstein-Barr virus (EBV) infection and strong p53 expression. A 65-year-old Japanese woman developed fever and generalized lymphadenopathy. A biopsy of the cervical node revealed the morphology of malignant lymphoma with 2 kinds of lymphoma coexisting in 1 lymph node. One lymphoma type consisted of immunoblastic large cells with the T-cell marker phenotype CD3+, CD45RO/UCHL-1+, CD20/L26-, CD79-, CD10-, CD30-, and CD15-; the other type consisted of large cells with abundant cytoplasm and pleomorphic nuclei with the marker phenotype CD79+, CD20/L26+, CD45RO/UCHL-1-, CD3-, CD10-, CD30+, NPM/ALK-, and CD15-. Therefore, the diagnosis was composite lymphoma of peripheral T-cell lymphoma and an anaplastic variant of DLBCL, stage IVB, because the patient had bone marrow involvement with peripheral T-cell lymphoma. The biopsy led to findings of latent type II EBV-associated lymphoma in both the peripheral T-cell lymphoma and the anaplastic variant of DLBCL as the result of positive signals for EBV small RNAs by in situ hybridization, positive immunostaining results for EBV latent membrane protein 1 antibody, and negative immunostaining results for EBV nuclear antigen 2. Immunostaining of the mass with p53 antibody also yielded positive results for both types of lymphoma cells. This case suggests that the immunocompromised state of this patient with EBV-related peripheral T-cell lymphoma allowed the emergence of an EBV-related anaplastic variant of DLBCL and suggests a close relationship between p53 expression and latent EBV infection.
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MESH Headings
- Aged
- Antigens, CD/analysis
- Female
- Herpesvirus 4, Human
- Humans
- Immunophenotyping
- Lymph Nodes/pathology
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/metabolism
- Lymphoma, B-Cell/virology
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/virology
- Lymphoma, T-Cell, Peripheral/diagnosis
- Lymphoma, T-Cell, Peripheral/metabolism
- Lymphoma, T-Cell, Peripheral/virology
- Neoplasms, Second Primary/diagnosis
- Neoplasms, Second Primary/metabolism
- Neoplasms, Second Primary/virology
- Tumor Suppressor Protein p53/analysis
- Tumor Suppressor Protein p53/biosynthesis
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Affiliation(s)
- Yuko Hirose
- Division of Hematology and Immunology, Department of Internal Medicine, Kanazawa Medical University, 1-1, Daigaku, Uchinadamachi, Kahoku-gun, Ishikawa, Prefecture 920-0293, Japan
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42
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43
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Masaki Y, Li DL, Shimoyama K, Kawanami T, Fukushima T, Kawabata H, Ogawa N, Wano Y, Hirose Y, Sugai S. ['Reverse' variant of follicular lymphoma with monoclonality of the immunoglobulin heavy chain and T cell receptor gamma chain genes]. Rinsho Ketsueki 2003; 44:1074-9. [PMID: 14689870] [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: 04/27/2023]
Abstract
We report an unusual case of the 'reverse' variant of follicular lymphoma in which the nodules had central parts that stained dark and cuffs that stained pale. Because diagnosis was difficult relying only on formalin-fixed histopathology, we examined the cell surface markers and karyotype. The patient, a 65-year-old man, presented with multiple lymphadenopathy, low-grade fever, night sweats, anorexia, dry cough and sense of chest oppression. Cell surface marker analysis showed that pathologic lymphocytes were positive for CD 10, CD 19, CD 20, HLA-DR, IgM/IgD and kappa, and t (14; 18) (q 32; q 21) was detected by karyotypic analysis. The 'reverse' variant of follicular lymphoma, clinical stage IVB was diagnosed the rearrangement band was detected with PCR-based clonality analysis in not only the immunoglobulin heavy chain gene but also the T cell receptor gamma chain gene, thus confirming monoclonal proliferation of both B cells and T cells.
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44
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Hirose Y, Masaki Y, Shimoyama K, Fukushima T, Kawabata H, Ogawa N, Wano Y, Sugai S. Epstein-Barr virus-associated anaplastic large cell variant of diffuse large B-cell-type non-Hodgkin's lymphoma with concurrent p53 protein expression. Int J Hematol 2003; 77:499-502. [PMID: 12841389 DOI: 10.1007/bf02986619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In the new World Health Organization (WHO) classification of malignant lymphoma, anaplastic large cell lymphoma of B-cell phenotype is classified either as the anaplastic large cell variant of diffuse large B-cell lymphoma or as Hodgkin's lymphoma. A 71-year-old Japanese man developed fever and generalized lymphadenopathy. Biopsy of the right axillary node revealed morphology of malignant lymphoma in which large cells with abundant cytoplasm and pleomorphic nuclei were scattered among small lymphocytes. Immunostaining with various monoclonal antibodies revealed the large cells to be CD79+, CD20/L26+, CD45RO/UCHL-(1-), CD3-, CD10-, CD30+, NPM/ALK-, EMA-, CD15-, and bcl-(2-). Amplification of the J region of the immunoglobulin heavy chain by polymerase chain reaction revealed a single rearranged band. Therefore the diagnosis of anaplastic large cell variant of diffuse large B-cell lymphoma, stage IIIB, was made from the standpoint of the new WHO classification of malignant lymphoma. Biopsy led to findings of Epstein-Barr virus (EBV)-associated lymphoma with positive in situ hybridization results for EBV small RNAs, positive results of immunostaining with EBV latent membrane 1 antibody, and negative results of immunostaining with Epstein-Barr nuclear antigen 2. Results of immunostaining of the mass with p53 antibody also were positive for lymphoma cells. The findings in this case may suggest a close relationship between p53 expression and latent EBV infection.
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Affiliation(s)
- Yuko Hirose
- Division of Hematology and Immunology, Department of Internal Medicine, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
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45
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Hirose Y, Masaki Y, Shimoyama K, Fukushima T, Kawabata H, Ogawa N, Wano Y, Sugai S. Immunophenotypic analysis of various blastic crises in chronic myeloid leukemia: correlations between CD7 expression and response to chemotherapy. Int J Hematol 2003; 77:420-2. [PMID: 12774936 DOI: 10.1007/bf02982656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
MESH Headings
- Adult
- Aged
- Antigens, CD7/analysis
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/therapeutic use
- Blast Crisis/drug therapy
- Blast Crisis/immunology
- Blast Crisis/mortality
- Female
- Humans
- Immunophenotyping
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Male
- Middle Aged
- Survival Rate
- Treatment Outcome
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46
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Kawai E, Shimoyama K, Ogino K, Sato H. Chemical compositional separation of styrene-methyl methacrylate copolymers using high-performance liquid chromatography with liquefied carbon dioxide as eluent. J Chromatogr A 2003; 991:197-203. [PMID: 12741599 DOI: 10.1016/s0021-9673(03)00243-7] [Citation(s) in RCA: 6] [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: 10/27/2022]
Abstract
Chromatographic separation of styrene-methyl methacrylate (MMA) copolymers depending on the chemical composition was studied using liquefied carbon dioxide as an adsorption promoting solvent, and tetrahydrofuran, chloroform containing ethanol as a desorption promoting solvent in the mobile phase and the column packed non-bonded silica gel by a solvent gradient method. With the increase of MMA content, the elution was retarded indicating that the typical normal-phase type of adsorption occurred. The effects of type of desorption solvents, molecular mass of sample, and column temperature on the elution were investigated.
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Affiliation(s)
- Eiichi Kawai
- Graduate School of Bio-Applications and Systems Engineering, Tokyo University of Agriculture and Technology, Koganei, Tokyo 184-8588, Japan
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47
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Ogawa N, Shimoyama K, Kawabata H, Masaki Y, Wano Y, Sugai S. [Clinical significance of serum KL-6 and SP-D for the diagnosis and treatment of interstitial lung disease in patients with diffuse connective tissue disorders]. Ryumachi 2003; 43:19-28. [PMID: 12692986] [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: 03/01/2023]
Abstract
OBJECTIVE To elucidate the clinical significance of serum KL-6 and SP-D for the diagnosis and treatment of interstitial lung disease in connective tissue disorders. METHODS 139 patients with various connective tissue disorders were subjected for the study, which included 46 cases of rheumatoid arthritis, 43 cases of Sjögren's syndrome, 16 cases of SLE, 10 cases of systemic sclerosis, 9 cases of polymyositis/dermatomyositis, 6 cases of vasculitis syndrome, 5 cases of Behçet's disease and 4 cases of MCTD. Serum levels of KL-6 and SP-D were determined by enzyme-immunoassay. The sensitivity, specificity and accuracy of serum KL-6 and SP-D for the diagnosis of interstitial lung disease were compared with serum LDH. The relationship of serum KL-6 and SP-D levels with high resolution CT (HRCT) of the lung and Gallium scintigraphy findings was analyzed. In some cases, serum levels of the two markers were determined monthly in the course of the disease. RESULTS When the serum levels of KL-6 and SP-D were measured simultaneously, the sensitivity to diagnose interstitial lung disease was 67.7%, the specificity was 98.1%, and the accuracy was 91.4%, while those of serum LDH were 45.2%, 88.9%, 79.1% respectively. In the patients with interstitial lung disease, those who had elevated serum levels of both KL-6 and SP-D showed parenchymal collapse opacity-dominant pattern in HRCT. On the other hand, the patients with interstitial lung disease who had normal levels of serum KL-6 and SP-D or had elevation either in KL-6 or SP-D levels showed ground glass opacity-dominant pattern in HRCT. There was no significant correlation between serum marker levels and Gallium scintigraphy findings. When serum KL-6 and SP-D were measured monthly, the levels of both markers changed more specifically and sensitively to the lung disease activity compared with serum LDH. CONCLUSIONS Serum KL-6 and SP-D are more specific and useful markers for the diagnosis and evaluation of interstitial lung disease compared with serum LDH in connective tissue disorders.
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Affiliation(s)
- Noriyoshi Ogawa
- Division of Hematology and Immunology, Department of Internal Medicine, Kanazawa Medical University, Kahokugun, Ishikawa
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48
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49
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Hirose Y, Masaki Y, Shimoyama K, Sugai S, Nojima T. Granulocytic sarcoma of megakaryoblastic differentiation in the lymph nodes terminating as acute megakaryoblastic leukemia in a case of chronic idiopathic myelofibrosis persisting for 16 years. Eur J Haematol 2001; 67:194-8. [PMID: 11737254 DOI: 10.1046/j.0902-4441.2001.492umedoc.492.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 43-yr-old Japanese woman presented with mild anemia, leukocytosis and splenomegaly in May 1984. Splenomegaly and anemia gradually progressed. Sixteen years later, in October 2000, she developed inguinal lymphadenopathy. Biopsy of the lymph node revealed infiltration of blasts, megakaryocytes, fibroblasts and myeloid cells. Large blasts with basophilic cytoplasm with cytoplasmic projections appeared in the peripheral blood. These blasts were negative in peroxidase stain, positive in acid phosphatase and weakly positive in periodic acid-Schiff stain. Immunohistochemical staining with monoclonal antibodies revealed that these blasts were positive with anti-CD41 (glycoprotein IIb/IIIa) and negative with other monoclonal antibodies. So diagnosis of granulocytic sarcoma in megakaryoblastic transformation from chronic idiopathic myelofibrosis was made. A cytogenetic study revealed that bone marrow cells were 46,XX del(13)(q?) initially and additional abnormalities including der(5,5,11)(q11;q13)ins(5;?)(q11;?) were found when she developed megakaryoblastic transformation. Granulocytic sarcoma of megakaryoblastic transformation from chronic idiopathic myelofibrosis is a rare event. Immunophenotyping with monoclonal antibody for CD41(glycoprotein IIb/IIIa) confirmed the diagnosis.
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Affiliation(s)
- Y Hirose
- Division of Hematology and Immunology, Department of Internal Medicine, Kanazawa Medical University, Ishikawa, Japan
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50
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Nishimura T, Yanagisawa A, Sakata H, Sakata K, Shimoyama K, Ishihara T, Yoshino H, Ishikawa K. Thallium-201 single photon emission computed tomography (SPECT) in patients with duchenne's progressive muscular dystrophy: a histopathologic correlation study. Jpn Circ J 2001; 65:99-105. [PMID: 11216833 DOI: 10.1253/jcj.65.99] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The pathomorphologic mechanism responsible for abnormal perfusion imaging during thallium-201 myocardial single photon emission computed tomography (201Tl-SPECT) in patients with Duchenne's progressive muscular dystrophy (DMD) was investigated. Hearts from 7 patients with DMD were evaluated histopathologically at autopsy and the results correlated with findings on initial and delayed resting 201Tl-SPECT images. The location of segments with perfusion defects correlated with the histopathologically abnormal segments in the hearts. Both the extent and degree of myocardial fibrosis were severe, especially in the posterolateral segment of the left ventricle. Severe transmural fibrosis and severe fatty infiltration were common in segments with perfusion defects. In areas of redistribution, the degree of fibrosis appeared to be greater than in areas of normal perfusion; and intermuscular edema was prominent. Thus, the degree and extent of perfusion defects detected by 201Tl-SPECT were compatible with the histopathology. The presence of the redistribution phenomenon may indicate ongoing fibrosis. Initial and delayed resting 201Tl-SPECT images can predict the site and progress of myocardial degeneration in patients with DMD.
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Affiliation(s)
- T Nishimura
- Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
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