SPTLC2 variants are associated with early-onset ALS and FTD due to aberrant sphingolipid synthesis

OBJECTIVE

Amyotrophic lateral sclerosis (ALS) is a devastating, incurable neurodegenerative disease. A subset of ALS patients manifests with early-onset and complex clinical phenotypes. We aimed to elucidate the genetic basis of these cases to enhance our understanding of disease etiology and facilitate the development of targeted therapies.

METHODS

Our research commenced with an in-depth genetic and biochemical investigation of two specific families, each with a member diagnosed with early-onset ALS (onset age of <40 years). This involved whole-exome sequencing, trio analysis, protein structure analysis, and sphingolipid measurements. Subsequently, we expanded our analysis to 62 probands with early-onset ALS and further included 440 patients with adult-onset ALS and 1163 healthy controls to assess the prevalence of identified genetic variants.

RESULTS

We identified heterozygous variants in the serine palmitoyltransferase long chain base subunit 2 (SPTLC2) gene in patients with early-onset ALS. These variants, located in a region closely adjacent to ORMDL3, bear similarities to SPTLC1 variants previously implicated in early-onset ALS. Patients with ALS carrying these SPTLC2 variants displayed elevated plasma ceramide levels, indicative of increased serine palmitoyltransferase (SPT) activity leading to sphingolipid overproduction.

INTERPRETATION

Our study revealed novel SPTLC2 variants in patients with early-onset ALS exhibiting frontotemporal dementia. The combination of genetic evidence and the observed elevation in plasma ceramide levels establishes a crucial link between dysregulated sphingolipid metabolism and ALS pathogenesis. These findings expand our understanding of ALS's genetic diversity and highlight the distinct roles of gene defects within SPT subunits in its development.

One-Year Outcome of Drug-Coated Balloon vs. Drug-Eluting Stent in Patients Undergoing Initial Percutaneous Coronary Intervention (PCI) for De Novo Lesion

BACKGROUND

Drug-eluting stents (DES) are the major treatment option in percutaneous coronary intervention (PCI). Recently, drug-coated balloon (DCB) utilization has been increasing globally, leading to the expected new strategy of "stent-less PCI." This study aimed to evaluate the one-year outcome of DCB compared to DES.

METHODS

Patients who underwent initial PCI for de novo lesions in our institution from January 2018 to December 2021 (n=337) were subjected to retrospective analysis. Among them, 75 patients were treated with DCB, while 262 patients were treated with DES. Target lesion failure (TLF) was evaluated during the follow-up period.

RESULTS

The proportion of PCIs for ACS was significantly lower in the DCB group (DCB, n=23, 30.7% vs. DES, n=143, 54.6%; p=0.001). The median device diameter and length in the DES group were larger than those in the DCB group (DCB, 2.60 mm vs. DES, 2.98 mm; p<0.001; DCB, 19.1 mm vs. DES, 25.2 mm; p<0.001). There was no significant difference between the DCB and DES groups in lesion calcification. The proportion of ostial lesions was significantly higher in the DCB group (DCB, n=13, 17.3% vs. DES, n=21, 8.0%; p=0.018). The cumulative rate of TLF (DCB, n=5, 6.7% vs. DES, n=18, 6.9%; p=0.951) did not significantly differ between the DCB and DES groups.

CONCLUSION

DCB may be as effective a strategy as DES in the patient who underwent initial PCI for a de novo lesion.

Evaluation of a simple activity measurement method in rats

[Purpose] Behavioral analysis is widely used in animal research. However, such analysis requires specialized equipment and can be difficult to perform. Therefore, this study aimed to explore and validate a simple behavioral analysis method. [Participants and Methods] For behavioral assessments, Wistar rats were placed in a rearing cage and videotaped from two directions: overhead and side view. The filmed videos were analyzed using ImageJ software to calculate the distance traveled and activity and inactivity times of the rats. Intraclass correlation coefficients 1 and 2 were calculated to examine the reliability of the behavioral analysis method. [Results] Intraclass correlation coefficients 1 and 2 for distance traveled and activity and inactivity times determined using the behavioral analysis method showed high reliability. [Conclusion] The behavioral analysis method validated in this study used inexpensive and easily accessible equipment and devices. The results show high correlation coefficients for the measurement of distance traveled and activity time performed by experimental animals, demonstrating the reliability of this simple method.

Glucose loading for heart failure protects the myocardium and improves physical function

[Purpose] The purpose of this study was to investigate the effects of glucose intake on physical function in a heart failure rat model. [Materials and Methods] Five-week-old male Wistar rats were used for this study. Monocrotalin (40 mg/kg) was administered intraperitoneally to rats to induce heart failure. The rats were divided into two groups, control and MCT; the MCT group was further classified according to glucose concentration (0%, 10%, and 50%). [Results] Glucose intake during heart failure prevented the loss of body weight, skeletal muscle, and fat mass. Myocardial metabolism in heart failure was enhanced by hypoxia, which in turn, enhanced the glycolytic system. [Conclusion] Glucose loading suppressed cardiac hypertrophy and improved physical function in the heart failure rat model.

Growth Differentiation Factor-15 and Clinical Outcomes in Japanese Patients With Ischemic Heart Disease

Background

Despite a reduction in the rate of thrombotic events, ischemic heart disease (IHD) remains a key medical problem associated with high major bleeding and mortality in Asian patients with IHD. Growth differentiation factor (GDF)-15, a stress-response cytokine belonging to the transforming growth factor beta superfamily, is reportedly associated with poor clinical outcomes in Western patients with IHD. However, the clinical significance of GDF-15 in Asian patients with IHD has not yet been fully elucidated.

Objectives

The aim of the present study was to examine the impact of serum GDF-15 on clinical outcomes in Japanese patients with IHD.

Methods

Serum GDF-15 levels were evaluated in 632 consecutive patients with IHD. All patients were followed up for a median period of 2.8 years. The primary endpoint was the all-cause mortality rate. Secondary endpoints were major adverse cardiovascular events (MACE), heart failure (HF)-related rehospitalization, bleeding, and thrombotic events.

Results

Serum GDF-15 levels were elevated in acute coronary syndrome, severe coronary artery disease, and the major Japanese version of the high bleeding risk criteria. Multivariate Cox proportional hazards regression analysis demonstrated that GDF-15 was an independent predictor of all-cause mortality, MACE, HF-related rehospitalizations, and bleeding events after adjusting for confounding risk factors but not for thrombotic events. Adding GDF-15 to risk factors significantly improved the net reclassification index and integrated discrimination improvement for all-cause deaths, MACE, HF-related rehospitalization, and bleeding events.

Conclusions

Serum GDF-15 could be a feasible marker for major bleeding and adverse clinical outcomes in Japanese patients with IHD.

Genome-wide association study identifies a new susceptibility locus in PLA2G4C for Multiple System Atrophy

To elucidate the molecular basis of multiple system atrophy (MSA), a neurodegenerative disease, we conducted a genome-wide association study (GWAS) in a Japanese MSA case/control series followed by replication studies in Japanese, Korean, Chinese, European and North American samples. In the GWAS stage rs2303744 on chromosome 19 showed a suggestive association ( P = 6.5 × 10 ^-7 ) that was replicated in additional Japanese samples ( P = 2.9 × 10 ^-6 . OR = 1.58; 95% confidence interval, 1.30 to 1.91), and then confirmed as highly significant in a meta-analysis of East Asian population data ( P = 5.0 × 10 ^-15 . Odds ratio= 1.49; 95% CI 1.35 to 1.72). The association of rs2303744 with MSA remained significant in combined European/North American samples ( P =0.023. Odds ratio=1.14; 95% CI 1.02 to 1.28) despite allele frequencies being quite different between these populations. rs2303744 leads to an amino acid substitution in PLA2G4C that encodes the cPLA2γ lysophospholipase/transacylase. The cPLA2γ-Ile143 isoform encoded by the MSA risk allele has significantly decreased transacylase activity compared with the alternate cPLA2γ-Val143 isoform that may perturb membrane phospholipids and α-synuclein biology.

TYPES OF ATTENDEES IN COMMUNITY SPACE IN JAPAN: TOWARD DESIGNING AN ENVIRONMENT FOR SOCIAL PARTICIPATION

Introduction

Designing community space for social participation of older adults is essential for healthy aging. The behavioral characteristics of the attendees have much to offer as they relate to social settings designed in the space. This study aims to elucidate the basic typology of the attendees considering their motivation for attendance and state of social connection.

Methods

Semi-structured interviews targeting attendees of Chiiki-Katsudokan, a space designed for social participation in a larger aging estate in Japan, were conducted in December 2021 (N=16, 16% male). Attendees were asked about their reasons for attending events at Chiiki-Katsudokan, interaction levels with other attendees, and levels of social participation during the COVID-19 pandemic.

Results

Based on the interviews, attendees were classified into three types: Seeker, Hobbyist, and Socializer. First, Seekers (n=3) used Chiiki-Katsudokan as the primary means of preventing social isolation. Amongst the three types, the social interaction level of Seekers was the lightest, and the opportunity decreased when Chiiki-Katsudokan closed during the quarantine. Second, the main motivation for Hobbyists (n=5) was the event contents which matched their interests. Hobbyists were also likely to engage in hobby networks, which continued privately during the pandemic. Finally, Socializers (n=8) attended Chiiki-Katsudokan to communicate with friends. Many were initially socially active and engaged in social interaction outside Chiiki-Katsudokan, e.g., teatime with friends, during the quarantine.

Conclusion

This study suggested that designing community space for social participation requires defining the varying levels of engagement and expecting relationships outside the space based on the behavioral characteristics of the attendees.

SOCIAL INTERACTIONS OF COMMUNITY SPACE ATTENDEES AND ANTICIPATED FUNCTION OF THE SPACE AMID THE COVID-19 PANDEMIC

Introduction

A regional community space in Japan, Chiiki-Katsudokan, was founded to facilitate the social interactions of older adults through activities. Meanwhile, the COVID-19 pandemic occasionally forced this space to close or limited the volume of its participants. In this research, the operation of the space was reviewed by monitoring the changes in the social interactions of the attendees, and by investigating the anticipated function from the attendees' needs. Method: A semi-structured interview targeting the attendees of Chiiki-Katsudokan was conducted in December 2021 (N=19, main age:80s). The level of social interaction before and during the pandemic and the newly anticipated function of the space were examined.

Results

First, deep and light interactions were observed. Those with deep interactions initially had wide social connections and used Chiiki-Katsudokan to interact with friends. Meanwhile, those with light interactions only talked to other attendees while attending the space. During the quarantine, those with deep interactions stayed connected with others and met privately, while those with light interactions faced a higher risk of social isolation. Second, the most popular newly anticipated functions of the space were "Place to gather with friends (n=14)" and "Interaction with younger generation (n=14)." "Opportunity to learn about the new pandemic-lifestyle (n=11)" was also rated high, while need for "online events" was rated the lowest (n=7).

Conclusion

The pandemic re-emphasized older adults' need for direct interaction. Low interest in technology-based countermeasures suggested that community spaces should expand their operation method while considering offline methods (e.g., pen-pal system) that could enhance social interaction.

Expanded clinical spectrum of oculopharyngodistal myopathy type 1

INTRODUCTION/AIMS

Heterozygous CGG repeat expansions in low-density lipoprotein receptor-related protein 12 (LRP12) have recently been identified as a cause of oculopharyngodistal myopathy (OPDM), and the disease is designated as OPDM type 1 (OPDM1). In contrast to broadening of our knowledge on the genetic background of OPDM, what we know of the clinical phenotype of genetically confirmed OPDM1 remains limited.

METHODS

This investigation was a single-center case series study of OPDM consisting of ten patients from seven families. Repeat-primed polymerase chain reaction and Southern blot analyses were performed to confirm the CGG repeat expansions in LRP12. Clinical findings were retrospectively reviewed.

RESULTS

Seven patients from five families were identified as having CGG repeat expansions in LRP12. We found a high prevalence of axial muscle involvement, such as neck muscle weakness (6/7) and fatty infiltration in the rectus abdominis muscle, as revealed by computed tomography (5/5). We identified patients with very subtle oculopharyngeal symptoms, mimicking isolated distal myopathy. Muscle specimens were collected from the biceps brachii and tibialis anterior muscles of three patients. Myopathic changes were more severe with more atrophic fibers forming clusters in the tibialis anterior than the biceps brachii muscles of these three patients. No rimmed vacuoles were observed in the biceps brachii muscles in two of the three patients.

DISCUSSION

This study shows the expanded clinical spectrum of OPDM1, highlighting the importance of axial muscle evaluation in OPDM1. Considering patients with very subtle oculopharyngeal symptoms, genetic analysis of LRP12 should be considered in patients with isolated distal myopathy.

Functional capacity in community-dwelling older adults maintained by a higher friend network than family network: implications from a two-year longitudinal study

Objective

Maintaining a level of functional capacity is essential for healthy aging. In this research, the association between the change in the level of functional capacity and social network typology was explored over a two-year period. Participants were recruited from a community-based cohort study within Kashiwa City, Japan, and data from the years 2016 and 2018 were used. Cognitive functions, functional capacity, and social network typology were assessed using the Mini-Mental State Examination, the Japan Science and Technology Agency Index of Competence, and the Lubben Social Network Scale, respectively. Binomial logistic regression analysis was then conducted to evaluate the association of individuals’ personal network and their functional capacity.

Results

Results showed that, when compared to the group with both a high family and friend network, the group of community-dwelling older adults with both a low family and friend network (OR: 0.58, 95% CI: 0.34-1.00), and the group with a high family but low friend network demonstrated a lower functional capacity (OR:0.47, 95% CI: 0.26–0.85). Active social participation, facilitated by a friend network, could be a contributing factor to the maintenance of functional capacity.

Muscle transcriptomics shows overexpression of cadherin 1 in inclusion body myositis

Objective

This study aimed to elucidate the molecular features of inclusion body myositis (IBM).

Methods

We performed RNA sequencing analysis of muscle biopsy samples from 67 participants, consisting of 58 myositis patients with the pathological finding of CD8‐positive T cells invading non‐necrotic muscle fibers expressing major histocompatibility complex class I (43 IBM, 6 polymyositis, and 9 unclassifiable myositis), and 9 controls.

Results

Cluster analysis, principal component analysis, and pathway analysis showed that differentially expressed genes and pathways identified in IBM and polymyositis were mostly comparable. However, pathways related to cell adhesion molecules were upregulated in IBM as compared with polymyositis and controls (p < 0.01). Notably, CDH1, which encodes the epidermal cell junction protein cadherin 1, was overexpressed in the muscles of IBM, which was validated by another RNA sequencing dataset from previous publications. Western blotting confirmed the presence of mature cadherin 1 protein in the muscles of IBM. Immunohistochemical staining confirmed the positivity for anti‐cadherin 1 antibody in the muscles of IBM, whereas there was no muscle fiber positive for anti‐cadherin 1 antibody in immune‐mediated necrotizing myopathy, antisynthetase syndrome, and controls. The fibers stained with anti‐cadherin 1 antibody did not have rimmed vacuoles or abnormal protein accumulation. Experimental skeletal muscle regeneration and differentiation systems showed that CDH1 is expressed during skeletal muscle regeneration and differentiation.

Interpretation

CDH1 was detected as a differentially expressed gene, and immunohistochemistry showed that cadherin 1 exists in the muscles of IBM, whereas it was rarely seen in those of other idiopathic inflammatory myopathies. Cadherin 1 upregulation in muscle could provide a valuable clue to the pathological mechanisms of IBM. ANN NEUROL 2022;91:317–328

Environmental Features Supporting Non-transportation Walking in Older Dwellers in a Hilly Neighbourhood

Walking is the basic mode of transportation; however, it is also considered as a recreational and physical activity. For elderly people, non-transportation walking (NTW) is necessary to maintain a good health; thus, irrespective of topography, living in an environment conducive to NTW is essential for the ageing community. This case study explores the features of the physical environment supporting NTW in older people, living in a hilly Japanese neighbourhood. We conducted semi-structured interviews with 23 older participants, with 6 being in their seventies, 13 in their eighties, and 4 in their nineties. We investigated the destinations and routes of their outings for a week, as well as their perception of walkability. Thereafter, we analysed the location of the NTW and the rationale behind the location choice. Consequently, four groups of people were identified based on their walking location: those who walked within a 1 km radius zone (N=6), those who walked outside the zone (N=8), those who walked both within and outside the zone (N=3), and those who did not walk (N=6). Moreover, each group had varied expectations regarding the physical environment, which is determined by their motivations and physical conditions, relating to the land use of the location of NTW. This implies the necessity of target identification and a suitable environmental approach for the target to promote NTW among older people in a hilly residential neighbourhood, such as improving comfort and connectedness by installing rest spots for the within-and-outside the zone walking group.

Development of Online Child Support Activities by Older Adults; An Action Research During the COVID-19 Pandemic

Japanese communities have been attempting a novel type of childcare support, wherein community-dwelling older adults form a specialized group (support group) that aims to provide child support activities. Before the COVID-19 pandemic, the group gathered children and mothers in community spaces and conducted events. However, on-site support had to be halted due to the pandemic. In this study, we report a case of action research aimed at shifting the activities online. First, a suitable online support plan was explored by hosting several discussions with child-rearing mothers. A questionnaire survey was then conducted to determine the most-sought intervention contents (N=19). Finally, based on the results, an intervention was conducted. As a result of the discussions, the hosting of online programs was set as the main goal. Out of the ten activities studied, the three most popular activities were programming (n=17), English conversation (n=16), and science workshop (n=15). Based on the results, an online science workshop that built a Bottleium, a small aquarium using a bottle, was hosted. Eight children participated in the event. A post-activity survey revealed that all participants attended the online activity for the first time, and the parents were happy to have joined the activity that entertained their child during the quarantine period. Furthermore, focus group interviews were conducted with the support group; they reported being satisfied with the outcome and recognized the importance of their role as member of support group. The results suggest the positive effect of this project on both older adults and the children.

Low Friend Connection Leads to Low Functional Capacity of Older Adults: Findings From a 2-year Longitudinal Study

Maintaining personal connections in geriatric years is important to sustain the functional capacity of older adults. In this study, we define the term functional capacity as the ability to perform tasks and activities necessary for one’s independent life. Meanwhile, the type of personal connection and its effect on functional capacity remain unclear. We classified personal connections into connections with family or friends and examined their association with the functional capacity of independently living Japanese older adults. A two-year longitudinal study (2016 and 2018) was conducted using data from the Kashiwa Cohort Study. The amount of personal connections was determined using the Lubben Social Network Scale. The Japan Science and Technology Agency Index of Competence was used to assess participants’ functional capacity. The change in functional capacity was analyzed by binomial logistic regression analysis (N=638, reference: group with high family and friend connection). The results showed a decline in the functional capacity of the group with low friend and family connections (odds ratio (OR): 0.48, 95%CI: 0.29–0.82). This trend was also seen for the group with a high family connection but low friend connection (OR: 0.43, 95%CI: 0.24–0.78). Meanwhile, there was no significant difference between the reference group and the group with low family but high friend connection (OR: 0.85, 95%CI: 0.47–1.56). The results imply the importance of having a friend for sustainable functional capacity in old age. Interventions that facilitate friend-to-friend interactions or promote new friendships among older adults can be considered as support strategies.

Alanine transaminase is predominantly increased in the active phase of anti-HMGCR myopathy

Autoantibodies against 3‑hydroxy-3-methylglutaryl-CoA reductase (HMGCR) and the signal recognition particle (SRP) are representative antibodies causing immune-mediated necrotizing myopathies (IMNM), called as anti-HMGCR and anti-SRP myopathies, respectively. Here, we analyzed the differences in routine blood test results between 56 anti-HMGCR and 77 anti-SRP myopathy patients. A higher alanine transaminase (ALT) level and a lower aspartate transaminase (AST)/ALT ratio were observed in anti-HMGCR myopathy patients [ALT, 265.7 ± 213.3 U/L (mean ± standard deviation); AST/ALT ratio, 0.88 ± 0.32] than in anti-SRP-myopathy patients (ALT, 179.3 ± 111.2 U/L, p < 0.05; AST/ALT ratio, 1.28 ± 0.40, p < 0.01). In the active phase, anti-HMGCR myopathy often showed ALT predominance, whereas anti-SRP myopathy often showed AST predominance. In addition, there were differences in erythrocyte sedimentation rate (ESR), total cholesterol (TChol) level, and high-density lipoprotein (HDL) level between anti-HMGCR and anti-SRP myopathies (ESR: HMGCR, 24.4 ± 20.8 mm/1 h; SRP, 35.7 ± 26.7 mm/1 h, p = 0.0334; TChol: HMGCR, 226.7 ± 36.6 mg/dL; SRP, 207.6 ± 40.8 mg/dL, p = 0.0163; HDL: HMGCR, 58.4 ± 13.9 mg/dL; SRP, 46.2 ± 17.3 mg/dL, p < 0.01). Additional studies on the differences in routine blood test results may further reveal the pathomechanisms of IMNM.

Anti-LGI1 Encephalitis Developing Immunoglobulin Responsive Orthostatic Hypotension after Remission

Anti-leucine-rich glioma-inactivated 1 (LGI1) antibody is associated with limbic encephalitis. We herein report a patient with anti-LGI1 encephalitis who developed severe orthostatic hypotension (OH) responsive to immunoglobulin therapy five years after developing symptoms of encephalitis. A 71-year-old man presented with amnesia caused by limbic encephalitis. The symptoms of encephalitis improved partially without any immunotherapy. Five years later, he developed severe OH, and anti-LGI1 antibody was positive. The catecholamine dynamics indicated that the central autonomic nervous system was the lesion of his OH. Intravenous immunoglobulin therapy improved the OH. This case suggests that anti-LGI1 antibody can be associated with severe OH.

Association between thrombolysis in myocardial infarction grade and clinical outcome after emergent percutaneous coronary intervention in patients with acute myocardial infarction who have suffered out-of-hospital cardiac arrest: the Yamagata AMI registry

Despite improvements in the survival rate of acute myocardial infarction (AMI), out-of-hospital cardiac arrest (OHCA) due to AMI is still a devastating condition. Thrombolysis in myocardial infarction (TIMI) grade is used to classify coronary reperfusion after percutaneous coronary intervention (PCI), but it remains unclear whether TIMI grade after emergent PCI is associated with short-term mortality in patients with AMI who have suffered OHCA. We analyzed data collected from 2012 to 2017 and recorded in the Yamagata AMI registry, which is a multicenter surveillance conducted in all institutions in Yamagata prefecture. Among 3332 patients with AMI, 254 had suffered OHCA. There were 564 deaths during the 30 days after the onset of AMI. The survival rate was lower in patients who had suffered OHCA than in those who had not (40% vs. 87%; P < 0.0001). Patients with AMI who had suffered OHCA were divided into three groups based on TIMI grade (TIMI III group, n = 70; TIMI ≤ II group, n = 21; and no coronary angiography [non-CAG] group, n = 163). The survival rates in the TIMI III, TIMI ≤ II, and non-CAG groups were 87%, 38%, and 5%, respectively. Kaplan-Meier analysis demonstrated that the survival rate was highest in the TIMI III group. Multivariate Cox proportional hazard regression analysis demonstrated that TIMI III was closely associated with survival after adjustment for confounding factors. Achieving TIMI grade III during emergent PCI is crucial to improve survival in patients with AMI who have suffered OHCA.

Qualitative Research on the Primary Effect of Fish Pet Ownership Using the Bottleium, a Bottle-Type Aquarium, on Community-Dwelling Older Adults in Japan: A Potential Preventive Measure Towards Social Isolation

Aging increases the risk of social isolation, which could lead to conditions such as depressive mood. Pet ownership is known to reduce social isolation. However, previous studies have mainly focused on mammals as pets, which could be difficult at old age. A small ornamental fish is relatively easy to culture and might be a suitable alternative. In this research, we aimed to elucidate the possible effects of fish ownership on the psychological state of community-dwelling older adults in Japan. A Bottleium, a bottle-type aquarium, was selected to lower the burden of fish ownership. A workshop was hosted in 2019 and participants brought home their own Bottleium, with fish and water snail inside. Nineteen participants gave consent to the follow-up interview a month later. Five themes, "observation of fish and water snail," "interaction between the fish and the owner," "taking care of the fish as pet owner," "facilitation of interpersonal interaction," and "development of support system," emerged from thematic analysis. The promotion of animal-to-human, and human-to-human interaction and development of responsibility could relate to a sense of social inclusion and ikigai-kan, a purpose of life. Fish ownership, when using equipment that suits the physical capability of older adults, could act as a positive stimulus.

Enhancement of elastin expression by transdermal administration of sialidase isozyme Neu2

Reduction of elastin in the skin causes various skin diseases as well as wrinkles and sagging with aging. Sialidase is a hydrolase that cleaves a sialic acid residue from sialoglycoconjugate. Cleavage of sialic acid from microfibrils by the sialidase isozyme Neu1 facilitates elastic fiber assembly. In the present study, we showed that a lower layer of the dermis and muscle showed relatively intense sialidase activity. The sialidase activity in the skin decreased with aging. Choline and geranate (CAGE), one of the ionic liquids, can deliver the sialidase subcutaneously while maintaining the enzymatic activity. The elastin level in the dermis was increased by applying sialidase from Arthrobacter ureafaciens (AUSA) with CAGE on the skin for 5 days in rats and senescence-accelerated mice prone 1 and 8. Sialidase activity in the dermis was considered to be mainly due to Neu2 based on the expression level of sialidase isozyme mRNA. Transdermal administration of Neu2 with CAGE also increased the level of elastin in the dermis. Therefore, not only Neu1 but also Neu2 would be involved in elastic fiber assembly. Transdermal administration of sialidase is expected to be useful for improvement of wrinkles and skin disorders due to the loss of elastic fibers.

Cerebellar Ataxia as a Common Clinical Presentation Associated with DNMT1 p.Y511H and a Review of the Literature

The phenotypes of patients with disease-associated variants in DNMT1 have been classified into two syndromes: hereditary sensory and autonomic neuropathy type 1E (HSAN1E, MIM614116, https://www.omim.org/ ) and autosomal dominant cerebellar ataxia, deafness, and narcolepsy (ADCA-DN, MIM604121). The amino acid codon 511 is a hotspot, and p.Y511C is the most frequently observed disease-associated variant among those in HSAN1E patients, whereas there have been only a few reports on patients with p.Y511H. In this study, we report on the cases of a kindred carrying the DNMT1 variant NM_001130823.2:c.1531 T > C (p.Y511H) presenting with the ADCA-DN phenotype. The review of the literature further revealed that later ages at onset and the presence of cerebellar ataxia are the main characteristics of patients carrying the DNMT1 p.Y511H as compared with those carrying DNMT1 p.Y511C. Although HSAN1E and ADCA-DN are proposed to be called DNMT1-complex disorders owing to their overlapping symptoms, this finding suggests a distinct genotype-phenotype correlation regarding the DNMT1 p.Y511H and p.Y511C variants.

A Community Space With Diverse Activities Support Older Adults’ Social Participation and Sustain Social Connection

Active older adults in Japan participate in multiple social activities to be socially involved. However, physical limitation and decline in enthusiasm due to ageing decrease their participation. Diverse activities should be available at one place, close to older adult’s residence, to sustain social connections. A community space was launched at Toyoshikidai housing complex (Kashwia, Japan) in February 2018. The place offers about 25 activities per month. This research aimed to elucidate the relationship between activity type and motivation for participation, and study the effect of the community space on older adults’ social connection. A cross-sectional questionnaire survey was conducted targeting the attendees of community space (February 2020). Of attendees, 68% lived within 10-minutes walking distance to the community space (N=101). The activities were classified into craft, exercise, and music. The motivation for attending craft events were information exchange and relaxation, as was health maintenance for exercise events. Participating in group performance was the motivation to attend active music event, and casual gathering and network expansion was for passive music event. The frequency of social participation outside the community space was low in the group aged over 75 years. This group attended the activities at the community space more frequently than did the younger group. Differences in the number of social connections were not found. This result implies that older adults maintained their social connection by attending activities held at the community space. The diverse programs and close location of the community space might have contributed to the motivation of participation.

Differences in Characteristics Associated With Mobility in Older Dwellers of a Hillside Residential Community

In a super-ageing society, sustaining outings as an elderly person is necessary for maintaining good health and preventing frailty and social isolation. Avoiding driving cars and walking due to ageing are among factors that deter the elderly from going out. However, the characteristics associated with mobility on foot and by car in actual outings of the elderly have not been examined. To explore these characteristics, we conducted interviews with 23 elderly participants living in a suburban hillside residential community in Japan, and investigated the destinations, routes, and means of all their outings for a certain week. Then, spatial analysis was conducted to identify differences in behavioral characteristics associated with mobility on foot and by car/taxi among three age groups: 70–79, 80–84, and 85+. Consequently, two inclinations were identified. First, the older the group, the smaller the area of the outing on foot due to difficulties in walking on slopes for a long duration with luggage. Second, the use of a car/taxi varies among the three groups. While the 70–79 age group used cars/taxis for district-to-district trips, the 80–84 age group rarely used them, and further, the 85+ age group mainly travelled by them one-way or made back-and-forth trips. To summarize, for older suburban dwellers in a hillside residential community, mobility on foot is lowered by physical and mental weakness and the landscape. Therefore, even though mobility increases by using cars/taxis, willingness for outing has changed with ageing, and thus, they make limited use of opportunities.

The Factors Associated With Daily Life Support for Single Older Adults to Remain at Their Home

Japan aims to enable older adults to remain at home in their familiar environment. However, the factors associated with daily life support for older adults who require medical and nursing care to remain at home are unclear. This study aimed to clarify the factors associated with daily life support for single older adults needing medical and nursing care to remain at home. Our participants were single older adults aged 65-94 years receiving medical and nursing care and their care providers. First, we analyzed records, which were written by care providers, regarding ten older adults who received medical and nursing care from 2014 to 2018. We categorized occurrences which exert single older adults’ life on change into six factors, such as gradual frailty and loss of a loved one. Then, to consider how they experience these factors, we conducted semi-structured interviews with three additional older adults who were single and received home visiting nursing care service in 2020. During this process, four multidisciplinary researchers discussed the factors associated with daily life support for single older adults; finally, three factors were derived. The first one pertained to health conditions: receiving sufficient medical and nursing care maintain older adults’ physical condition. The second related to the environment: maintaining social interactions (neighbors and friends). The third pertained to older adults’ values and meanings to remain at home. This study suggests that care providers focus on these three factors to help older adults who received medical and nursing care to remain at their home.

The Association of Early-Morning Eating Habits With High Nutrient Intake by Older Japanese Adults Living Alone

The consumption of essential nutrition is fundamental to maintain the health of older adults. Conventional studies report that community dwelling older adults who live alone have the tendency to skip meals and result in low nutrition intake. However, the details regarding the dietary behavior and its association with the status of nutrition intake remain unclear. In this study, a cross-sectional analysis was conducted to explore the association between the time of meals and nutrition balance. In October 2019, questionnaire surveys were distributed to 184 participants of a lunch event dedicated to older adults living alone (Kashiwa, Japan). The time of meals, number of meals per day, consumption status of 10 food groups, and self-rated health were used for the analysis (N=165). As a result, older adults who usually ate their first meal between 5 to 8 A.M. ate three meals/day, while those who ate their first meal after 8 A.M. ate two meals/day. Those who ate their meal between 5 to 8 A.M., frequently consumed meat, fish and seafood, milk, and green and yellow vegetables compared to those who ate after 8 A.M. Self-rated health score was also high. The consumption of early-morning meals was associated with good dietary behaviors. The importance of eating breakfast has been emphasized, however, the time of the breakfast could vary among individuals. This study proposed the importance of considering the time of the meal. Development of intervention programs which encourage early-morning meal consumption might be helpful to form healthy dietary behaviors of older adults.

Unmet needs for emergency care and prevention of prehospital death in acute myocardial infarction

INTRODUCTION

Percutaneous coronary intervention (PCI) has successfully reduced the mortality of patients with acute myocardial infarction (AMI). However, patients with out-of-hospital cardiac arrest have high mortality, which is difficult to control by hospital staff. In this study, we investigated the prevalence of prehospital death (PHD) in patients with AMI. Furthermore, we investigated the risk factors associated with 30-day mortality in patients with AMI who survived PHD.

METHODS

We investigated the prevalence of PHD using data from the Yamagata AMI registry and from death certification of the entire Yamagata Prefecture in Japan between 2010 and 2015. Furthermore, we investigated the risk factors for 30-day mortality in patients who survived PHD, using data from the Yamagata AMI registry from 1993 to 2015. AMI was identified by the International Classification of Diseases, 10th revision code I21.

RESULTS

Out of the 6984 patients with AMI, 3771 patients had PHD. Patients with PHD were older and more likely to be women than those without PHD. More PHD occurred in winter and spring than in summer or autumn. Multivariate regression analysis showed that age, female sex, and winter onset were independently associated with PHD. We also investigated the risk factors associated with 30-day mortality in 9675 patients who survived PHD. The rate of PCI was remarkably lower in patients with acute death than in those without acute death. Multivariate regression analysis showed that age, anterior infarction, estimated glomerular filtration rate, Killip class, and PCI were independently associated with 30-day mortality after adjusting for confounding factors.

CONCLUSION

Approximately half of the patients with AMI died before they could reach the destination hospital. Although emergency PCI is the most important factor in reducing 30-day mortality in patients with AMI, attempts to reduce patient delay and system delay are possibly needed to further reduce PHD.

HECT (Homologous to the E6-AP Carboxyl Terminus)-Type Ubiquitin E3 Ligase ITCH Attenuates Cardiac Hypertrophy by Suppressing the Wnt/β-Catenin Signaling Pathway

The HECT (homologous to the E6-AP carboxyl terminus)-type ubiquitin E3 ligase ITCH is an enzyme that plays an important role in ubiquitin-proteasomal protein degradation. Disheveled proteins (Dvl1 [disheveled protein 1], Dvl2, and Dvl3) are the main components of the Wnt/β-catenin signaling pathway, which is involved in cardiac hypertrophy. The aim of this study was to examine the role of ITCH during development of cardiac hypertrophy. Thoracic transverse aortic constriction (TAC) was performed in transgenic mice with cardiac-specific overexpression of ITCH (ITCH-Tg) and wild-type mice. Cardiac hypertrophy after TAC was attenuated in ITCH-Tg mice, and the survival rate was higher for ITCH-Tg mice than for wild-type mice. Protein interaction between ITCH and Dvls was confirmed with immunoprecipitation in vivo and in vitro. Expression of key molecules of the Wnt/β-catenin signaling pathway (Dvl1, Dvl2, GSK3β [glycogen synthase kinase 3β], and β-catenin) was inhibited in ITCH-Tg mice compared with wild-type mice. Notably, the ubiquitination level of Dvl proteins increased in ITCH-Tg mice. Protein and mRNA expression levels of ITCH increased in response to Wnt3a stimulation in neonatal rat cardiomyocytes. Knockdown of ITCH using small-interfering RNA increased cardiomyocyte size and augmented protein expression levels of Dvl proteins, phospho-GSK3β, and β-catenin after Wnt3a stimulation in cardiomyocytes. Conversely, overexpression of ITCH attenuated cardiomyocyte hypertrophy and decreased protein expression levels of Dvl proteins, phospho-GSK3β and β-catenin. In conclusion, ITCH targets Dvl proteins for ubiquitin-proteasome degradation in cardiomyocytes and attenuates cardiac hypertrophy by suppressing the Wnt/β-catenin signaling pathway.

Impact of percutaneous coronary intervention on short and long-term prognosis of elderly patients with acute myocardial infarction from 2010 to 2017 in Japanese population

Background

Advances in therapies have successfully decreased short-term mortality in patients with acute myocardial infarction (AMI). Although aging population is recently increasing in developed countries, there are few reports about the association between prevalence of percutaneous coronary intervention (PCI) and long-term prognosis in elderly patients with AMI in Japan.

Purpose

The aim of this study was to clarify the prevalence of PCI and the impact of PCI on short and long-term prognosis of elderly patients with AMI.

Methods and results

We investigated the prevalence of PCI and short-term mortality in 4,109 patients with AMI who were registered in Yamagata AMI Registry from 2010 to 2017. Long-term mortality was investigated using data from death certification in July 2019. We divided patients with AMI into three age groups (group 1, &lt;65 years old; group 2, 65–79 years old; and group 3, ≥80 years old). Short-term mortality within 30 days was 6.5%, 12.1%, and 28.6%, respectively. Also, prevalence of PCI was 88.0%, 84.7%, and 62.7%, respectively. Multivariate analysis revealed that age, PCI, and severity of Killip classification were significantly associated with short-term mortality after adjustment for confound factors in group 3. Since the prevalence of PCI in group 3 was the lowest among three groups, the cause of PCI not being executed was investigated in 1,429 patients aged ≥80 years old. Elderly patients who didn't undergo PCI was older, more women, and had higher prevalence of chronic kidney disease, previous stroke, and severe Killip classification. Multivariate analysis revealed that age and Killip III/IV were significantly associated with non-executed PCI after adjustment for confound factors. Next, we investigated impact of PCI on long-term mortality in elderly patients who escaped acute death. Multivariate Cox hazard analysis revealed that PCI was associated with lower mortality after adjustment for confound factors (adjusted hazard ratio 2.47, 95% CI: 1.47–4.06; p=0.0008).

Conclusion

Lower prevalence of PCI and higher short-term mortality were observed in elderly patients with AMI aged ≥80 years old. PCI ameliorated long-term mortality as well as short-term mortality in elderly patients with AMI.

Funding Acknowledgement

Type of funding source: None

Therapeutic inhibition of microRNA-34a ameliorates aortic valve calcification via modulation of Notch1-Runx2 signalling

AIMS

Calcific aortic valve stenosis (CAVS) is the most common valvular heart disease and is increased with elderly population. However, effective drug therapy has not been established yet. This study aimed to investigate the role of microRNAs (miRs) in the development of CAVS.

METHODS AND RESULTS

We measured the expression of 10 miRs, which were reportedly involved in calcification by using human aortic valve tissue from patients who underwent aortic valve replacement with CAVS or aortic regurgitation (AR) and porcine aortic valve interstitial cells (AVICs) after treatment with osteogenic induction medium. We investigated whether a specific miR-inhibitor can suppress aortic valve calcification in wire injury CAVS mice model. Expression of miR-23a, miR-34a, miR-34c, miR-133a, miR-146a, and miR-155 was increased, and expression of miR-27a and miR-204 was decreased in valve tissues from CAVS compared with those from AR. Expression of Notch1 was decreased, and expression of Runt-related transcription factor 2 (Runx2) was increased in patients with CAVS compared with those with AR. We selected miR-34a among increased miRs in porcine AVICs after osteogenic treatment, which was consistent with results from patients with CAVS. MiR-34a increased calcium deposition in AVICs compared with miR-control. Notch1 expression was decreased, and Runx2 expression was increased in miR-34a transfected AVICs compared with that in miR-control. Conversely, inhibition of miR-34a significantly attenuated these calcification signals in AVICs compared with miR-control. RNA pull-down assay revealed that miR-34a directly targeted Notch1 expression by binding to Notch1 mRNA 3' untranslated region. In wire injury CAVS mice, locked nucleic acid miR-34a inhibitor suppressed aortic velocity, calcium deposition of aortic valves, and cardiac hypertrophy, which were involved in decreased Runx2 and increased Notch1 expressions.

CONCLUSION

miR-34a plays an important role in the development of CAVS via Notch1-Runx2 signalling pathway. Inhibition of miR-34a may be the therapeutic target for CAVS.

Splice-site mutations in KIF5A in the Japanese case series of amyotrophic lateral sclerosis

Our objective was to investigate the frequency of KIF5A variants in amyotrophic lateral sclerosis (ALS) and the clinical characteristics of familial ALS (FALS) associated with variants in KIF5A. Whole-exome sequence analysis was performed for a Japanese series of 43 families with FALS and 444 patients with sporadic ALS (SALS), in whom causative variants had not been identified. We compared the frequencies of rare variants (MAF < 0.01) in KIF5A, including missense and loss of function (LoF) variants, between ALS and control subjects (n = 1163). Clinical characteristics of patients with FALS carrying pathogenic variants in KIF5A were also described. LoF variants were identified only in the probands of two families with FALS, both of which were 3' splice-site variants leading to exon skipping and an altered C-terminal domain, located in the mutational hotspot causing FALS, and were considered to be pathogenic for FALS. Rare missense variants in KIF5A were identified in five patients with SALS (1.13%) and 11 control subjects (0.95%, carrier frequency), which were not significantly different. Consequently, the pathogenic LoF variants in KIF5A accounted for 2.1% of all FALS families in this study. These patients suffered from ALS characteristically associated with the predominant involvement of upper motor neuron. In conclusion, we identified two pathogenic splice-site variants in KIF5A in the probands in two Japanese families with FALS, which altered the C-terminal region of KIF5A. Our findings broaden the phenotype spectrum of ALS associated with variants in KIF5A in the Japanese series.

Clinical efficacy of haematopoietic stem cell transplantation for adult adrenoleukodystrophy

Accumulated experience supports the efficacy of allogenic haematopoietic stem cell transplantation in arresting the progression of childhood-onset cerebral form of adrenoleukodystrophy in early stages. For adulthood-onset cerebral form of adrenoleukodystrophy, however, there have been only a few reports on haematopoietic stem cell transplantation and the clinical efficacy and safety of that for adulthood-onset cerebral form of adrenoleukodystrophy remain to be established. To evaluate the clinical efficacy and safety of haematopoietic stem cell transplantation, we conducted haematopoietic stem cell transplantation on 12 patients with adolescent-/adult-onset cerebral form/cerebello-brainstem form of adrenoleukodystrophy in a single-institution-based prospective study. Through careful prospective follow-up of 45 male adrenoleukodystrophy patients, we aimed to enrol patients with adolescent-/adult-onset cerebral form/cerebello-brainstem form of adrenoleukodystrophy at early stages. Indications for haematopoietic stem cell transplantation included cerebral form of adrenoleukodystrophy or cerebello-brainstem form of adrenoleukodystrophy with Loes scores up to 13, the presence of progressively enlarging white matter lesions and/or lesions with gadolinium enhancement on brain MRI. Clinical outcomes of haematopoietic stem cell transplantation were evaluated by the survival rate as well as by serial evaluation of clinical rating scale scores and neurological and MRI findings. Clinical courses of eight patients who did not undergo haematopoietic stem cell transplantation were also evaluated for comparison of the survival rate. All the patients who underwent haematopoietic stem cell transplantation survived to date with a median follow-up period of 28.6 months (4.2–125.3 months) without fatality. Neurological findings attributable to cerebral/cerebellar/brainstem lesions became stable or partially improved in all the patients. Gadolinium-enhanced brain lesions disappeared or became obscure within 3.5 months and the white matter lesions of MRI became stable or small. The median Loes scores before haematopoietic stem cell transplantation and at the last follow-up visit were 6.0 and 5.25, respectively. Of the eight patients who did not undergo haematopoietic stem cell transplantation, six patients died 69.1 months (median period; range 16.0–104.1 months) after the onset of the cerebral/cerebellar/brainstem lesions, confirming that the survival probability was significantly higher in patients with haematopoietic stem cell transplantation compared with that in patients without haematopoietic stem cell transplantation (P = 0.0089). The present study showed that haematopoietic stem cell transplantation was conducted safely and arrested the inflammatory demyelination in all the patients with adolescent-/adult-onset cerebral form/cerebello-brainstem form of adrenoleukodystrophy when haematopoietic stem cell transplantation was conducted in the early stages. Further studies are warranted to optimize the procedures of haematopoietic stem cell transplantation for adolescent-/adult-onset cerebral form/cerebello-brainstem form of adrenoleukodystrophy.

INITIATION OF INTERACTION AS THE BEGINNING OF SOCIAL PARTICIPATION: CONVERSATION ANALYSIS OF A JAPANESE SENIOR CLUB

The rate of social participation of senior citizens in a senior club’s activities is not equal to the rate of desire for the said participation. Earlier studies mainly examined personal and social factors which influence the participation rate, overlooking the practical methods by which senior citizens can overcome barriers to participating in club activities. Our study aims to clarify the features of a club activity as a resource by analyzing the activity’s interactions. Our study is based on data extracted from videotaped recordings of a senior calligraphy club in Kanto, Japan. In September 2018, one lecturer and 11 participants were videotaped for 3 hours, and the video underwent conversation analysis, which elucidates how people organize activities under specific circumstances. We analyzed how a female newcomer to the activity initiated face-to-face interaction, which is considered the first step of social participation. She talked to other participants who were familiar with the exercise several times by inquiring how to read kanjis on teaching materials. These findings suggest that visualization of skill relative to the other creates an environment for initiating face-to-face interaction. In this case, the newcomer utilized the difference in skill denoted by teaching materials and was given the rational reason to talk to the others already engaging in the activity. Therefore, designing teaching materials that assign the learning level of each participant may be effective in promoting social participation in senior study clubs.

A COMPARATIVE ANALYSIS OF THE SOCIAL SUPPORT IN SOLITARY SENIORS WHO ATTEND CLUB ACTIVITY OR GO OUT TO SEE FRIENDS

The Toyoshiki-dai housing complex, constructed in 1960s, is located in one of the commuter towns in a metropolitan area of Japan. Those who moved to this area as youngsters are now aged over 75 and many live a solitary life; making social support vital to prevent social frailty. The municipalities and universities have been hosting interventions, e.g. club activities, to make social connection but the effects remain unclear. In this study, the relationship between activity participation and the size of social support was explored to develop an effective method to increase social connections. A cross-sectional study was conducted in October 2018 and 200 questionnaires were distributed at a lunch event at the housing complex. The participants were solitary and independent seniors over the age of 70 (M:F=14.4:67.5). The frequency of going out to participate in club activity, see friends, and the geriatric social support scale were used for analysis. As a result, compared to seniors who went out to see their friends, the size of social support was smaller in groups that remained isolated (N = 161, odds ratio = 0.26, 95% CI=0.11-0.60). On the contrary, seniors who joined club activities had similar size of social support despite the frequency of participation. Clubs in Japan are often closed groups with limited membership, which may have restricted the addition of new social connection. Future intervention researches should focus on modifying the membership system of clubs and opening of a public space where seniors can casually access and talk to acquaintances.

Novel SLC20A2 variant in a Japanese patient with idiopathic basal ganglia calcification-1 (IBGC1) associated with dopa-responsive parkinsonism

Idiopathic basal ganglia calcification-1 (IBGC1) is an autosomal dominant disorder characterized by calcification in the basal ganglia, which can manifest a range of neuropsychiatric symptoms, including parkinsonism. We herein describe a 64-year-old Japanese IBGC1 patient with bilateral basal ganglia calcification carrying a novel SLC20A2 variant (p.Val322Glufs*92). The patient also presented with dopa-responsive parkinsonism with decreased dopamine transporter (DAT) density in the bilateral striatum and decreased cardiac ¹²³I-meta-iodobenzylguanidine uptake.

P1626MicroRNA-21 deteriorates left ventricular reverse remodeling by promoting cardiac fibrosis in non-ischemic cardiomyopathy

Background

Left ventricular reverse remodeling (LVRR) contributes to better outcomes in patients with non-ischemic cardiomyopathy (NICM). It is reported that LVRR is associated with progression of cardiac fibrosis. MicroRNAs (miRs) have emerged as powerful regulators of post-transcriptional gene expression. We focused on miR-21, which plays a key role in pathogenesis of fibrosis in multiple organs. The aim of this study was to clarify the effect of miR-21 on cardiac fibrosis and LVRR in patients with NICM.

Methods

We measured plasma miR-21 levels in 16 patients with NICM. LVRR was defined as increased LVEF by ≥10% and decreased LV end-diastolic diameter index by ≥10% from baseline data after optimal medication treatment at 1-year of follow-up. Further, we examined miR-21 expression and its potential role in cardiac fibrosis induced by transverse aortic constriction (TAC) in mice and angiotensin II (Ang II) stimulation in neonatal rat cardiomyocytes (NRCMs).

Results

There were 12 patients without LVRR and 4 patients with LVRR. Plasma miR-21 levels were significantly higher in patients without LVRR compared with those with LVRR. In TAC mice heart, miR-21 levels were significantly increased and programmed cell death 4 (PDCD4), a main target of miR-21, was decreased. In vitro, miR-21 levels were significantly increased and its upstream transcriptional factor, activator protein 1 (AP-1), was activated by Ang II stimulation in NRCMs. After transfection of miR-21 specific inhibitor, PDCD4 levels were upregulated. Furthermore, AP-1 activity, expression of collagen type I, and α-smooth muscle actin levels were significantly decreased after miR-21 inhibition.

Conclusions

These findings suggested that miR-21/PDCD4/AP-1 feedback loop pathway was involved in LVRR in patients with NICM by promoting cardiac fibrosis. MiR-21 can be the therapeutic target in NICM.

P3355Stress-induced left ventricular dyssynchrony predicts future cardiac events in patients with known or suspected coronary artery disease

Background

Prognostic value of stress induced left ventricular (LV) dyssynchrony has not been fully understood.

The aim of this study was to evaluate the possible impact between cardiovascular events and stress induced worsening LV dyssynchrony.

Methods and results

One hundred and eighty consecutive subjects with known or suspected coronary artery disease (CAD) (142 men, mean age 68±12 years) underwent both gated myocardial single photon emission computed tomography (SPECT) with 99mTc-sestamibi or tetrofosmin according to a standard same day stress-rest protocol and coronary angiography or coronary computed tomography. The summed difference score (SDS) was calculated in every subjects. LV ejection fraction (EF) and phase Entropy at after stress and rest were determined by cardioREPO software. We determined %ΔEntropy = (stress Entropy - rest Entropy)/rest Entropy x100, as an indicator of stress-induced LV dyssynchrony. In the study population, the mean SDS was 2.7±3.9 and LVEF was 58±16%, stress and rest Entropy were 0.62±0.15 and 0.57±0.13, respectively.

%ΔEntropy was higher in patients with CAD than in those without CAD (3.3±11.5 vs. 10.2±15.0, respectively). Moreover, there was a strict correlation between the presence of CAD and %ΔEntropy, indicator of stress induced LV dyssynchrony (non-CAD vs. CAD and/or 1 vessel disease vs. multivessel disease: 4.3±12.5 vs. 8.8±15.6 vs. 12.7±14.3, respectively. p<0.05)

We examined all study subjects and they were divided into 2 groups by cut off value of the %ΔEntropy constructed with receiver operating characteristic curve (=15.4). Kaplan-Meier analysis revealed that future cardiovascular event rate was significantly higher in %ΔEntropy >15.4 group (20/57) than in %ΔEntropy <15.4 group (24/123) (Log-rank p<0.01). On the other hand, summed stress score and SDS were no significant differences between 2 groups.

However, SDS was higher in patients with future cardiovascular event than in those without cardiovascular event (4.4±5.4 vs. 2.2±3.2, respectively. p=0.001).

Conclusion

In patients with known or suspected CAD, stress-induced worsening LV dyssynchrony may predict the presence of CAD and future cardiac events.

Acknowledgement/Funding

None

Prominent Spasticity and Hyperreflexia of the Legs in a Nepalese Patient with Friedreich Ataxia

Friedreich ataxia (FRDA) is an autosomal recessive spinocerebellar ataxia caused by mutations of FXN. Hypotonus and hyporeflexia of the lower extremities are observed in most FRDA patients. Patients with hyperreflexia, called Friedreich ataxia with retained reflexes (FARR), have also been identified. We herein report the case of a 16-year-old Nepalese boy presenting with early-onset ataxia with prominent spasticity and hyperreflexia of the legs. Mutational analyses established the diagnosis of FRDA presenting as FARR. A haplotype analysis revealed that expanded alleles of the patient shared a common haplotype with Indian and European FRDA patients, suggesting that the mutation descended from a common founder.

P1615HECT-Type Ubiquitin E3 Ligase ITCH attenuates cardiac hypertrophy by suppressing Wnt signaling pathway

Background

The homologous to the E6-AP carboxyl terminus (HECT)–type ubiquitin E3 ligase ITCH is an enzyme that plays an important role in ubiquitin proteasomal protein degradation. Dishevelled proteins (Dvl1, Dvl2 and Dvl3), which are involved in canonical Wnt/β catenin signaling pathway, play a role in cardiac hypertrophy.

Purpose

The aim of this study was to examine whether ITCH interacts with Dvls and prevents cardiac hypertrophy induced by pressure overload.

Methods and results

We confirmed the protein interaction between ITCH and Dvls in cardiomyocytes. Overexpression of ITCH decreased protein expression levels of Dvls, phospho-GSK3β and β-catenin. Conversely, knockdown of ITCH using small interfering RNA augmented canonical Wnt/β catenin signaling pathway. Thoracic transverse aortic constriction (TAC) was performed in transgenic mice with cardiac-specific overexpression of ITCH (ITCH-Tg) and wild-type (WT) mice. The canonical Wnt/β catenin signaling pathway was inhibited and cardiac hypertrophy was attenuated in ITCH-Tg mice compared with WT mice after TAC.

Overexpression of ITCH in cardiomyocytes

Conclusion

We demonstrated that ITCH targets Dvls for ubiquitin-proteasome degradation in cardiomyocytes and ameliorates cardiac hypertrophy by suppressing canonical Wnt/β catenin signaling pathway.

Burden of rare variants in causative genes for amyotrophic lateral sclerosis (ALS) accelerates age at onset of ALS

OBJECTIVES

To evaluate the burden of rare variants in the causative genes for amyotrophic lateral sclerosis (ALS) on the age at onset of ALS in a Japanese case series.

METHODS

We conducted whole-exome sequencing analysis of 89 families with familial ALS (FALS) and 410 patients with sporadic ALS (SALS) to identify known pathogenic mutations or rare functionally predicted deleterious variants in the causative genes for ALS. Rare variants (minor allele frequency <1%) with scaled Combined Annotation-Dependent Depletion score >20 were defined as rare functionally predicted deleterious variants. The patients with ALS were classified on the basis of the number of pathogenic and/or rare functionally predicted deleterious variants, and the age at onset was compared among the classified groups.

RESULTS

Whole-exome sequencing analysis revealed known pathogenic mutations or rare functionally predicted deleterious variants in causative genes for ALS in 56 families with FALS (62.9%) and 87 patients with SALS (21.2%). Such variants in multiple genes were identified in seven probands with FALS and eight patients with SALS. The ages at onset in the patients with ALS with multiple variants were significantly earlier than those in other patients with ALS. Even when the patients with known pathogenic mutations were excluded, a significantly earlier onset of the disease was still observed in patients with multiple rare functionally predicted deleterious variants.

CONCLUSIONS

A substantial number of patients carried rare variants in multiple genes, and the burden of rare variants in the known causative genes for ALS affects the age at onset in the Japanese ALS series.

Association of ATXN2 intermediate-length CAG repeats with amyotrophic lateral sclerosis correlates with the distributions of normal CAG repeat alleles among individual ethnic populations

Intermediate-length CAG repeats in ATXN2 have been widely shown to be a risk factor for sporadic amyotrophic lateral sclerosis (SALS). To evaluate the association of ATXN2 intermediate-length CAG repeat alleles with an increased risk of SALS, we investigated distributions of CAG repeat alleles in 394 patients with SALS and 490 control individuals in the Japanese population. In the intermediate-length repeat units of 29 or more, we identified one SALS patient with 31 repeat units and two control individuals with 30 repeat units. Thus, no significant differences in the carrier frequency of intermediate-length CAG repeat alleles were detected between patients with SALS and control individuals. When we investigated the distribution of "large normal alleles" defined as ATXN2 CAG repeats ranging from 24 up to 33 in the Japanese population compared with those in other populations in previous studies, the frequency of large normal alleles was significantly higher in the European and North American series than in the Japanese series. Moreover, these frequencies in the Turkish, Chinese, Korean, and Brazilian (Latin American) series were also higher than that in the Japanese series. These results raise the possibility that the frequencies of large normal alleles in individual populations underlie the frequencies of ALS risk alleles in the corresponding populations.

Establishing extracorporeal membrane oxygenation team increased number of patients and improved data recording

Background

For patients treated with extracorporeal membrane oxygenation (ECMO), employing a well-coordinated, multidisciplinary team specializing in ECMO has reportedly been effective in delivering better clinical outcomes. This study aims to assess the impact of establishing such a specialized team for patients treated with ECMO.

Method

This retrospective cohort study was performed at a tertiary-care hospital in Japan. We reviewed medical records of all consecutive patients treated with ECMO during October 2010–September 2016. The results obtained in pre-ECMO team cases (PRE group; October 2011–September 2012) and post-ECMO team cases (POST group; October 2014–September 2015) were compared.

Results

The results obtained in pre-ECMO team cases (PRE group; October 2011–September 2012) and post-ECMO team cases (POST group; October 2014–September 2015) were compared. During the study period, 177 patients were treated with ECMO. Before the introduction of ECMO team, an average of 22.7 patients underwent ECMO treatment per year; after establishing ECMO team, this number increased to 36.3 patients per year. ECMO was applied mainly to cardiac arrest patients 52/69 (75%). The PRE (n = 27) and POST (n = 42) groups did not differ with regard to the survival rate to hospital discharge, ECMO duration, ventilator days, and length of hospital stay. However, PaO₂ and positive end-expiratory pressure were significantly higher in the POST group at 6 h after ECMO initiation than those in the PRE group [367 (186–490) vs. 239 (113–430) mmHg, p = 0.047 and 8 (5–10) vs. 7 (5–8) cmH₂O, p = 0.01, respectively]. In addition, data recording the detailed time points of ECMO initiation was conducted in significantly more cases in the POST group (28/126 (22%) than in the PRE group (6/81 (7%); p = 0.01).

Conclusions

Following the establishment of an ECMO team, the survival rate of patients treated with ECMO, ECMO duration, and length of hospital stay were not improved. However, the number of ECMO cases increased and the recording of clinical data was improved.

Associations among behavioral and psychological symptoms of dementia, care burden, and family-to-work conflict of employed family caregivers

AIM

The present study aimed to examine the associations among behavioral and psychological symptoms of dementia (BPSD) of persons with dementia (PWD), care burden and family-to-work conflict (FWC) of employed family caregivers.

METHOD

A cross-sectional study was carried out with employed adult daughter or son (or in-law) caregivers for PWD from two rural cities in Japan. FWC, care burden and the degree of BPSD were evaluated by the Survey Work-Home Interaction-NijmeGen, Zarit Burden Scale-Short Version and Dementia Behavior Disturbance Scale, respectively. Of the 200 questionnaires distributed, 130 were returned. A total of 53 respondents were not employed, and seven questionnaires had missing data for demographic variables, Survey Work-Home Interaction-NijmeGen, Zarit Burden Scale-Short Version or Dementia Behavior Disturbance Scale. Thus, complete data from 70 respondents were analyzed through structural equation modeling.

RESULTS

The mean age of employed family caregivers was 56 years, and 34 (48.5%) were men. The mean age of PWD was 84 years, and there were 68 (68.6%) men. The path model with a good fit was shown (root mean square error of approximation 0.136, comparative fit index 0.960 and goodness of fit index 0.965). The path model showed that BPSD affected FWC, and that the association was partially mediated by care burden.

CONCLUSIONS

The results show that a decrease in not only care burden, but also BPSD, of PWD is important for employed family caregivers to reduce their FWC and maintain their work-life balance. Geriatr Gerontol Int 2019; 19: 51-55.

Neuroimaging, genetic, and enzymatic study in a Japanese family with a GBA gross deletion

INTRODUCTION

Glucocerebrosidase gene (GBA) variants are associated with Parkinson's disease (PD) and dementia with Lewy bodies (DLB). The molecular mechanisms underlying these diseases with GBA variants, however, are not well understood. In order to determine the effect of a deletion mutation in GBA, we performed a neuroimaging, genetic, and enzymatic study in a Japanese family with a gross deletion of exons 3 to 11 in GBA.

METHODS

We performed [¹²³I] FP-CIT SPECT and [¹²³I] N-isopropyl-p-iodoamphetamine SPECT (IMP-SPECT), and determined GBA expression and glucocerebrosidase (GCase) activity in leukocytes in two GBA-associated PD patients and nine unaffected individuals (including four mutation carriers) in a Japanese family with a heterozygous gross deletion mutation in the GBA gene.

RESULTS

The two PD patients and two of the four clinically unaffected carriers showed decreased [¹²³I] FP-CIT uptake. IMP-SPECT showed a pattern like that in DLB in one patient. When we compared PD patients with GBA mutations with clinically unaffected carriers, there was a poor correlation between the development of PD and the expression level of GBA or GCase activity.

CONCLUSION

We confirmed the gross deletion mutation in the GBA gene, which appeared to be associated with the PD or reduced [¹²³I] FP-CIT in this family. However, since we cannot conclude whether a reduction of GCase activity is directly correlated with the pathogenesis of PD or not, longitudinal follow-up of this family is needed.