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Ozawa T, Kimura R, Terai H, Takemura R, Namkoong H, Kondo M, Fukuda K, Yagi K, Asakura T, Masaki K, Chubachi S, Miyata J, Ohgino K, Kawada I, Kagyo J, Odani T, Kuwahara N, Nakachi I, Ishii M, Sato Y, Fukunaga K. Calcium channel blockers may reduce the development of long COVID in females. Hypertens Res 2024; 47:934-943. [PMID: 37978232 DOI: 10.1038/s41440-023-01501-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/19/2023]
Abstract
With the rising numbers of patients infected with severe acute respiratory syndrome coronavirus 2, long coronavirus disease 2019 (COVID-19)-a sequelae of COVID-19-has become a major problem. Different sexes and age groups develop different long COVID symptoms, and the risk factors for long COVID remain unclear. Therefore, we performed subgroup analyses of patients with COVID-19, classifying them into different groups. In this multicenter cohort study, using an original questionnaire, we examined patients (≥18 years old) diagnosed with COVID-19 from November 2020 to March 2022 and hospitalized at participating medical facilities. In total, 1066 patients were registered (361 female, 620 male). Hypertension was the most common comorbidity (n = 344; 32.5%). Females with hypertension were significantly less likely to develop long COVID symptoms than those without hypertension (odds ratio [OR] 0.51, 95% confidence interval [CI] 0.27-0.98; p = 0.043). In females, Ca channel blocker administration, rather than having hypertension, was significantly associated with reductions in the frequency of alopecia (OR 0.14, 95% CI 0.03-0.67, p = 0.015), memory impairment (OR 0.14, 95% CI 0.02-0.82, p = 0.029), sleeping disorders (OR 0.17, 95% CI 0.04-0.67, p = 0.012), tinnitus (OR 0.23, 95% CI 0.05-0.98, p = 0.047), sputum (OR 0.31, 95% CI 0.10-0.92, p = 0.035), and fever (OR 0.33, 95% CI 0.12-0.93, p = 0.036). Several long COVID symptoms, including alopecia, were significantly negatively associated with Ca channel-blocker administration in female patients with long COVID. Calcium channel blockers may reduce the development of long COVID in females.
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Affiliation(s)
- Takuya Ozawa
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
- Pulmonary Division, Department Internal Medicine, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Ryusei Kimura
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Hideki Terai
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
- Keio Cancer Center, Keio University School of Medicine, Tokyo, Japan.
| | - Ryo Takemura
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan.
| | - Ho Namkoong
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Kondo
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Keitaro Fukuda
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuma Yagi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Internal Medicine, Keiyu Hospital, Yokohama, Kanagawa, Japan
| | - Takanori Asakura
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Respiratory Medicine, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Katsunori Masaki
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shotaro Chubachi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Jun Miyata
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Keiko Ohgino
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ichiro Kawada
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
- Research Centers and Institutes, Health Center, Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Junko Kagyo
- Department of Internal Medicine, Keiyu Hospital, Yokohama, Kanagawa, Japan
| | - Toshio Odani
- Department of Rheumatology, National Hospital Organization Hokkaido Medical Center, Hokkaido, Japan
| | - Naota Kuwahara
- Department of Medicine, Division of Allergology and Respiratory Medicine, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Ichiro Nakachi
- Pulmonary Division, Department Internal Medicine, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Makoto Ishii
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasunori Sato
- Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
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Sujino K, Tanese K, Saito Y, Kuramoto J, Iwazaki H, Ida T, Aiso S, Imanishi N, Kajita H, Fukuda K, Amagai M, Tanikawa A. Visualization of intradermal blood vessel structures by dual-wavelength photoacoustic microscopy and characterization of three-dimensional construction of livedo-racemosa in cutaneous polyarteritis nodosa. J Dermatol Sci 2024:S0923-1811(24)00056-2. [PMID: 38644095 DOI: 10.1016/j.jdermsci.2024.03.010] [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: 10/20/2023] [Revised: 02/26/2024] [Accepted: 03/21/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Photoacoustic microscopy is expected to have clinical applications as a noninvasive and three-dimensional (3D) method of observing intradermal structures. OBJECTIVE Investigate the applicability of a photoacoustic microscope equipped with two types of pulsed lasers that can simultaneously recognize hemoglobin and melanin. METHODS 16 skin lesions including erythema, pigmented lesions, vitiligo and purpura, were analyzed to visualize 3D structure of melanin granule distribution and dermal blood vessels. 13 cases of livedo racemosa in cutaneous polyarteritis nodosa (cPN) were further analyzed to visualize the 3D structure of dermal blood vessels in detail. Vascular structure was also analyzed in the biopsy specimens obtained from tender indurated erythema of cPN by CD34 immunostaining. RESULTS Hemoglobin-recognition signal clearly visualized the 3D structure of dermal blood vessels and melanin-recognition signal was consistently reduced in vitiligo. In livedo racemosa, the hemoglobin-recognition signal revealed a relatively thick and large reticular structure in the deeper layers that became denser and finer toward the upper layers. The numerical analysis revealed that the number of dermal blood vessels was 1.29-fold higher (p<0.05) in the deeper region of the lesion than that of normal skin. The CD34 immunohistochemical analysis in tender indurated erythema revealed an increased number of dermal vessels compared with normal skin in 88.9% (8/9) of the cases, suggesting that vascular network remodeling had occurred in cPN. CONCLUSION The photoacoustic system has an advantage in noninvasively detecting dermal blood vessel structures that are difficult to recognize by two-dimensional histopathology specimen examination and is worth evaluating in various skin diseases.
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Affiliation(s)
- Kazuyo Sujino
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Keiji Tanese
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan.
| | - Yasuko Saito
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Junko Kuramoto
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | | | | | - Sadakazu Aiso
- Department of Anatomy, Keio University School of Medicine, Tokyo, Japan
| | - Nobuaki Imanishi
- Department of Anatomy, Keio University School of Medicine, Tokyo, Japan
| | - Hiroki Kajita
- Department of Plastic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Keitaro Fukuda
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Masayuki Amagai
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Akiko Tanikawa
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
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Funakoshi T, Nakamura Y, Hirai I, Kobayashi K, Fukuda K, Iwata T. Proposal for the optimal staging of extramammary Paget's disease: A retrospective analysis of 57 cases with distant metastasis. Exp Dermatol 2024; 33:e15017. [PMID: 38361430 DOI: 10.1111/exd.15017] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/26/2023] [Accepted: 01/03/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Takeru Funakoshi
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshio Nakamura
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Ikuko Hirai
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Kenta Kobayashi
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Keitaro Fukuda
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Taku Iwata
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
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4
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Tahara U, Matsui T, Atsugi T, Fukuda K, Terooatea TW, Minoda A, Kubo A, Amagai M. Keratinocytes of the Upper Epidermis and Isthmus of Hair Follicles Express Hemoglobin mRNA and Protein. J Invest Dermatol 2023; 143:2346-2355.e10. [PMID: 37981423 DOI: 10.1016/j.jid.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 11/21/2023]
Abstract
The epidermis, the keratinized stratified squamous epithelium surrounding the body surface, offers a valuable framework to investigate how terrestrial animals overcome environmental stresses. However, the mechanisms underlying epidermal barrier function remain nebulous. In this study, we examined genes highly expressed in the human and mouse upper epidermis, the outer frontier that induces various barrier-related genes. Transcriptome analysis revealed that the messenger RNA level of hemoglobin α (HBA), an oxygen carrier in erythroid cells, was enriched in the upper epidermis compared with that in the whole epidermis. Immunostaining analysis confirmed HBA protein expression in human and mouse keratinocytes (KCs) of the stratum spinosum and stratum granulosum. HBA was also expressed in hair follicle KCs in the isthmus region; its expression levels were more prominent than those in interfollicular KCs. HBA expression was not observed in noncutaneous keratinized stratified squamous epithelia of mice, for example, the vagina, esophagus, and forestomach. HBA expression was upregulated in human epidermal KC cultures after UV irradiation, a major cause of skin-specific oxidative stress. Furthermore, HBA knockdown increased UV-induced production of ROS in primary KCs. Our findings suggest that epidermal HBA expression is induced by oxidative stress and acts as an antioxidant, contributing to skin barrier function.
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Affiliation(s)
- Umi Tahara
- Laboratory for Skin Homeostasis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan; Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Takeshi Matsui
- Laboratory for Skin Homeostasis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan; Department of Dermatology, Keio University School of Medicine, Tokyo, Japan; Laboratory for Evolutionary Cell Biology of the Skin, School of Bioscience and Biotechnology, Tokyo University of Technology, Hachioji, Japan
| | - Toru Atsugi
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Keitaro Fukuda
- Laboratory for Skin Homeostasis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan; Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Tommy W Terooatea
- Laboratory for Cellular Epigenomics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Aki Minoda
- Laboratory for Cellular Epigenomics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan; Department of Cell Biology, Faculty of Science, Radboud Institute for Molecular Life Sciences, Radboud University, Nijmegen, The Netherlands
| | - Akiharu Kubo
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan; Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masayuki Amagai
- Laboratory for Skin Homeostasis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan; Department of Dermatology, Keio University School of Medicine, Tokyo, Japan.
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5
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Terai H, Ishii M, Takemura R, Namkoong H, Shimamoto K, Masaki K, Tanosaki T, Chubachi S, Matsuyama E, Hayashi R, Shimada T, Shigematsu L, Ito F, Kaji M, Takaoka H, Kurihara M, Nakagawara K, Tomiyasu S, Sasahara K, Saito A, Otake S, Azekawa S, Okada M, Fukushima T, Morita A, Tanaka H, Sunata K, Asaoka M, Nishie M, Shinozaki T, Ebisudani T, Akiyama Y, Mitsuishi A, Nakayama S, Ogawa T, Sakurai K, Irie M, Yagi K, Ohgino K, Miyata J, Kabata H, Ikemura S, Kamata H, Yasuda H, Kawada I, Kimura R, Kondo M, Iwasaki T, Ishida N, Hiruma G, Miyazaki N, Ishibashi Y, Harada S, Fujita T, Ito D, Bun S, Tabuchi H, Kanzaki S, Shimizu E, Fukuda K, Yamagami J, Kobayashi K, Hirano T, Inoue T, Haraguchi M, Kagyo J, Shiomi T, Lee H, Sugihara K, Omori N, Sayama K, Otsuka K, Miyao N, Odani T, Watase M, Mochimaru T, Satomi R, Oyamada Y, Masuzawa K, Asakura T, Nakayama S, Suzuki Y, Baba R, Okamori S, Arai D, Nakachi I, Kuwahara N, Fujiwara A, Oakada T, Ishiguro T, Isosno T, Makino Y, Mashimo S, Kaido T, Minematsu N, Ueda S, Minami K, Hagiwara R, Manabe T, Fukui T, Funatsu Y, Koh H, Yoshiyama T, Kokuto H, Kusumoto T, Oashi A, Miyawaki M, Saito F, Tani T, Ishioka K, Takahashi S, Nakamura M, Harada N, Sasano H, Goto A, Kusaka Y, Ohba T, Nakano Y, Nishio K, Nakajima Y, Suzuki S, Yoshida S, Tateno H, Kodama N, Shunsuke M, Sakamoto S, Okamoto M, Nagasaki Y, Umeda A, Miyagawa K, Shimada H, Hagimura K, Nagashima K, Sato T, Sato Y, Hasegawa N, Takebayashi T, Nakahara J, Mimura M, Ogawa K, Shimmura S, Negishi K, Tsubota K, Amagai M, Goto R, Ibuka Y, Kitagawa Y, Kanai T, Fukunaga K. Comprehensive analysis of long COVID in a Japanese nationwide prospective cohort study. Respir Investig 2023; 61:802-814. [PMID: 37783167 DOI: 10.1016/j.resinv.2023.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/15/2023] [Accepted: 08/16/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly since 2019, and the number of reports regarding long COVID has increased. Although the distribution of long COVID depends on patient characteristics, epidemiological data on Japanese patients are limited. Hence, this study aimed to investigate the distribution of long COVID in Japanese patients. This study is the first nationwide Japanese prospective cohort study on long COVID. METHODS This multicenter, prospective cohort study enrolled hospitalized COVID-19 patients aged ≥18 years at 26 Japanese medical institutions. In total, 1200 patients were enrolled. Clinical information and patient-reported outcomes were collected from medical records, paper questionnaires, and smartphone applications. RESULTS We collected data from 1066 cases with both medical records and patient-reported outcomes. The proportion of patients with at least one symptom decreased chronologically from 93.9% (947/1009) during hospitalization to 46.3% (433/935), 40.5% (350/865), and 33.0% (239/724) at 3, 6, and 12 months, respectively. Patients with at least one long COVID symptom showed lower quality of life and scored higher on assessments for depression, anxiety, and fear of COVID-19. Female sex, middle age (41-64 years), oxygen requirement, and critical condition during hospitalization were risk factors for long COVID. CONCLUSIONS This study elucidated the symptom distribution and risks of long COVID in the Japanese population. This study provides reference data for future studies of long COVID in Japan.
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Affiliation(s)
- Hideki Terai
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan; Keio Cancer Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Makoto Ishii
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan; Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Furocho, Chikusa Ward, Nagoya, Aichi, 466-8550, Japan
| | - Ryo Takemura
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Ho Namkoong
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan; Department of Infectious Diseases, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kyoko Shimamoto
- Keio Global Research Institute, Keio University, 2-15-45 Mita, Minato-ku, Tokyo, 108-8345, Japan
| | - Katsunori Masaki
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takae Tanosaki
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shotaro Chubachi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Emiko Matsuyama
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Reina Hayashi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takashi Shimada
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Lisa Shigematsu
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Fumimaro Ito
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masanori Kaji
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hatsuyo Takaoka
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Momoko Kurihara
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kensuke Nakagawara
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Saki Tomiyasu
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kotaro Sasahara
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Ayaka Saito
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shiro Otake
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shuhei Azekawa
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masahiko Okada
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takahiro Fukushima
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Atsuho Morita
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiromu Tanaka
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Keeya Sunata
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masato Asaoka
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Miyuki Nishie
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Taro Shinozaki
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Toshiki Ebisudani
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuto Akiyama
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Akifumi Mitsuishi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shingo Nakayama
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takunori Ogawa
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kaori Sakurai
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Misato Irie
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazuma Yagi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Keiko Ohgino
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Jun Miyata
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroki Kabata
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shinnosuke Ikemura
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hirofumi Kamata
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroyuki Yasuda
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Ichiro Kawada
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Ryusei Kimura
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masahiro Kondo
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Toshiki Iwasaki
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Noriyuki Ishida
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Gaku Hiruma
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Naoki Miyazaki
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yoshiki Ishibashi
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Sei Harada
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takanori Fujita
- Department of Health Policy and Management, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Daisuke Ito
- Department of Physiology/Memory Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shogyoku Bun
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hajime Tabuchi
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Sho Kanzaki
- Department of Otolaryngology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Eisuke Shimizu
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Keitaro Fukuda
- Department of Dermatology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Jun Yamagami
- Department of Dermatology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Keigo Kobayashi
- Department of Internal Medicine, Sano Kosei General Hospital, 1728 Horigomecho, Sano, Tochigi, 327-8511, Japan
| | - Toshiyuki Hirano
- Department of Internal Medicine, Sano Kosei General Hospital, 1728 Horigomecho, Sano, Tochigi, 327-8511, Japan
| | - Takashi Inoue
- Department of Internal Medicine, Sano Kosei General Hospital, 1728 Horigomecho, Sano, Tochigi, 327-8511, Japan
| | - Mizuha Haraguchi
- Department of Internal Medicine, Keiyu Hospital, Kanagawa, 3-7-3 Minatomirai, Nishi-ku, Yokohama, Kanagawa, 220-0012, Japan
| | - Junko Kagyo
- Department of Internal Medicine, Keiyu Hospital, Kanagawa, 3-7-3 Minatomirai, Nishi-ku, Yokohama, Kanagawa, 220-0012, Japan
| | - Tetsuya Shiomi
- Department of Internal Medicine, Keiyu Hospital, Kanagawa, 3-7-3 Minatomirai, Nishi-ku, Yokohama, Kanagawa, 220-0012, Japan
| | - Ho Lee
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan; Division of Pulmonary Medicine, Kawasaki Municipal Hospital, 12-1 Shinkawadori, Kawasaki-ku, Kawasaki, Kanagawa, 210-0013, Japan
| | - Kai Sugihara
- Division of Pulmonary Medicine, Kawasaki Municipal Hospital, 12-1 Shinkawadori, Kawasaki-ku, Kawasaki, Kanagawa, 210-0013, Japan
| | - Nao Omori
- Division of Pulmonary Medicine, Kawasaki Municipal Hospital, 12-1 Shinkawadori, Kawasaki-ku, Kawasaki, Kanagawa, 210-0013, Japan
| | - Koichi Sayama
- Division of Pulmonary Medicine, Kawasaki Municipal Hospital, 12-1 Shinkawadori, Kawasaki-ku, Kawasaki, Kanagawa, 210-0013, Japan
| | - Kengo Otsuka
- Department of Internal Medicine, Nihon Koukan Hospital, 1-2-1 Kokandori, Kawasaki-ku, Kawasaki, Kanagawa, 210-0852, Japan
| | - Naoki Miyao
- Department of Internal Medicine, Nihon Koukan Hospital, 1-2-1 Kokandori, Kawasaki-ku, Kawasaki, Kanagawa, 210-0852, Japan
| | - Toshio Odani
- Department of Rheumatology, National Hospital Organization Hokkaido Medical Center, 7-1-1 Yamanote 5 Jo, Nishi-ku, Sapporo, Hokkaido, 063-0005, Japan
| | - Mayuko Watase
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan; Department of Respiratory Medicine, National Hospital Organisation Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
| | - Takao Mochimaru
- Department of Respiratory Medicine, National Hospital Organisation Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
| | - Ryosuke Satomi
- Department of Respiratory Medicine, National Hospital Organisation Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
| | - Yoshitaka Oyamada
- Department of Respiratory Medicine, National Hospital Organisation Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
| | - Keita Masuzawa
- Department of Respiratory Medicine, Kitasato University Kitasato Institute Hospital, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8642, Japan
| | - Takanori Asakura
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan; Department of Respiratory Medicine, Kitasato University Kitasato Institute Hospital, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8642, Japan
| | - Sohei Nakayama
- Department of Respiratory Medicine, Kitasato University Kitasato Institute Hospital, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8642, Japan
| | - Yusuke Suzuki
- Department of Respiratory Medicine, Kitasato University Kitasato Institute Hospital, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8642, Japan
| | - Rie Baba
- Pulmonary Division, Department Internal Medicine, Saiseikai Utsunomiya Hospital, 911-1 Takebayashimachi, Utsunomiya, Tochigi, 321-0974, Japan
| | - Satoshi Okamori
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan; Pulmonary Division, Department Internal Medicine, Saiseikai Utsunomiya Hospital, 911-1 Takebayashimachi, Utsunomiya, Tochigi, 321-0974, Japan
| | - Daisuke Arai
- Pulmonary Division, Department Internal Medicine, Saiseikai Utsunomiya Hospital, 911-1 Takebayashimachi, Utsunomiya, Tochigi, 321-0974, Japan
| | - Ichiro Nakachi
- Pulmonary Division, Department Internal Medicine, Saiseikai Utsunomiya Hospital, 911-1 Takebayashimachi, Utsunomiya, Tochigi, 321-0974, Japan
| | - Naota Kuwahara
- Department of Medicine, Division of Allergology and Respiratory Medicine, Showa University Koto Toyosu Hospital, 5-1-38 Toyosu, Koto-ku, Tokyo, 135-8577, Japan
| | - Akiko Fujiwara
- Department of Medicine, Division of Allergology and Respiratory Medicine, Showa University Koto Toyosu Hospital, 5-1-38 Toyosu, Koto-ku, Tokyo, 135-8577, Japan
| | - Takenori Oakada
- Department of Medicine, Division of Allergology and Respiratory Medicine, Showa University Koto Toyosu Hospital, 5-1-38 Toyosu, Koto-ku, Tokyo, 135-8577, Japan
| | - Takashi Ishiguro
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, 1696 Itai, Kumagaya, Saitama, 360-0197, Japan
| | - Taisuke Isosno
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, 1696 Itai, Kumagaya, Saitama, 360-0197, Japan
| | - Yasushi Makino
- Department of Respiratory Medicine, Toyohashi Municipal Hospital, 50 Hachikennishi, Aotakecho, Toyohashi, Aichi, 441-8570, Japan
| | - Shuko Mashimo
- Department of Respiratory Medicine, Toyohashi Municipal Hospital, 50 Hachikennishi, Aotakecho, Toyohashi, Aichi, 441-8570, Japan
| | - Tatsuya Kaido
- Department of Respiratory Medicine, Toyohashi Municipal Hospital, 50 Hachikennishi, Aotakecho, Toyohashi, Aichi, 441-8570, Japan
| | - Naoto Minematsu
- Department of Internal Medicine, Hino Municipal Hospital, 4-3-1, Tamadaira, Hino-city, Tokyo, 191-0062, Japan
| | - Soichiro Ueda
- Department of Internal Medicine, Saitama Medical Center, 1981 Kamoda, Kawagoeshi, Saitama, 350-8550, Japan
| | - Kazuhiro Minami
- Department of Internal Medicine, Saitama Medical Center, 1981 Kamoda, Kawagoeshi, Saitama, 350-8550, Japan
| | - Rie Hagiwara
- Department of Internal Medicine, Saitama Medical Center, 1981 Kamoda, Kawagoeshi, Saitama, 350-8550, Japan
| | - Tadashi Manabe
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan; Division of Pulmonary Medicine, Department of Internal Medicine, Tachikawa Hospital, 4-2-22 Nishikicho, Tachikawa, Tokyo, 190-8531, Japan
| | - Takahiro Fukui
- Division of Pulmonary Medicine, Department of Internal Medicine, Tachikawa Hospital, 4-2-22 Nishikicho, Tachikawa, Tokyo, 190-8531, Japan
| | - Yohei Funatsu
- Division of Pulmonary Medicine, Department of Internal Medicine, Tachikawa Hospital, 4-2-22 Nishikicho, Tachikawa, Tokyo, 190-8531, Japan
| | - Hidefumi Koh
- Division of Pulmonary Medicine, Department of Internal Medicine, Tachikawa Hospital, 4-2-22 Nishikicho, Tachikawa, Tokyo, 190-8531, Japan
| | - Takashi Yoshiyama
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, 3-1-24 Matsuyama, Kiyose, Tokyo, 204-8522, Japan
| | - Hiroyuki Kokuto
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, 3-1-24 Matsuyama, Kiyose, Tokyo, 204-8522, Japan
| | - Tatsuya Kusumoto
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan; Department of Pulmonary Medicine, Eiju General Hospital, 2-23-16 Higashiueno, Taito-ku, Tokyo, 110-8645, Japan
| | - Ayano Oashi
- Department of Pulmonary Medicine, Eiju General Hospital, 2-23-16 Higashiueno, Taito-ku, Tokyo, 110-8645, Japan
| | - Masayoshi Miyawaki
- Department of Pulmonary Medicine, Eiju General Hospital, 2-23-16 Higashiueno, Taito-ku, Tokyo, 110-8645, Japan
| | - Fumitake Saito
- Department of Pulmonary Medicine, Eiju General Hospital, 2-23-16 Higashiueno, Taito-ku, Tokyo, 110-8645, Japan
| | - Tetsuo Tani
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan; Department of Pulmonary Medicine, Tokyo Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo, 108-0073, Japan
| | - Kota Ishioka
- Department of Pulmonary Medicine, Tokyo Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo, 108-0073, Japan
| | - Saeko Takahashi
- Department of Pulmonary Medicine, Tokyo Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo, 108-0073, Japan
| | - Morio Nakamura
- Department of Pulmonary Medicine, Tokyo Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo, 108-0073, Japan
| | - Norihiro Harada
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hitoshi Sasano
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Ai Goto
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yu Kusaka
- Department of Respiratory Medicine, Ome Municipal General Hospital, 4-16-5, Higashiome, Ome, Tokyo, 198-0042, Japan
| | - Takehiko Ohba
- Department of Respiratory Medicine, Ome Municipal General Hospital, 4-16-5, Higashiome, Ome, Tokyo, 198-0042, Japan
| | - Yasushi Nakano
- Department of Pulmonary Medicine, Kawasaki Municipal Ida Hospital, 2-27-1 Ida, Nakahara-ku, Kawasaki-shi, Kanagawa, 211-0035, Japan
| | - Kazumi Nishio
- Department of Pulmonary Medicine, Kawasaki Municipal Ida Hospital, 2-27-1 Ida, Nakahara-ku, Kawasaki-shi, Kanagawa, 211-0035, Japan
| | - Yukiko Nakajima
- Department of Infectious Disease, Kawasaki Municipal Ida Hospital, 2-27-1 Ida, Nakahara-ku, Kawasaki-shi, Kanagawa, 211-0035, Japan
| | - Shoji Suzuki
- Department of Pulmonary Medicine, Saitama City Hospital, 2460 Mimuro, Midori-ku, Saitama, 336-8522, Japan
| | - Shuichi Yoshida
- Department of Pulmonary Medicine, Saitama City Hospital, 2460 Mimuro, Midori-ku, Saitama, 336-8522, Japan
| | - Hiroki Tateno
- Department of Pulmonary Medicine, Saitama City Hospital, 2460 Mimuro, Midori-ku, Saitama, 336-8522, Japan
| | - Nobuhiro Kodama
- Department of General Internal Medicine, Fukuoka Tokushukai Hospital, 4-5 Sugukita, Kasuga, Fukuoka, 816-0864, Japan
| | - Maeda Shunsuke
- Department of General Internal Medicine, Fukuoka Tokushukai Hospital, 4-5 Sugukita, Kasuga, Fukuoka, 816-0864, Japan
| | - Satoshi Sakamoto
- Department of Internal Medicine, Division of Respirology, Neurology, and Rheumatology, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Masaki Okamoto
- Department of Internal Medicine, Division of Respirology, Neurology, and Rheumatology, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan; Department of Respirology, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Yoji Nagasaki
- Department of Infectious Disease and Clinical Research Center, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Akira Umeda
- Department of Respiratory Medicine, International University of Health and Welfare Shioya Hospital, 2600-1 Kitakanemaru, Otawara, Tochigi, 324-8501, Japan
| | - Kazuya Miyagawa
- Department of Pharmacology, School of Pharmacy, International University of Health and Welfare, 2600-1 Kitakanemaru, Otawara, Tochigi, 324-8501, Japan
| | - Hisato Shimada
- Department of Pharmacology, School of Pharmacy, International University of Health and Welfare, 2600-1 Kitakanemaru, Otawara, Tochigi, 324-8501, Japan
| | - Kazuto Hagimura
- Clinical and Translational Research Center, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kengo Nagashima
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Toshiro Sato
- Department of Organoid Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yasunori Sato
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan; Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Naoki Hasegawa
- Department of Infectious Diseases, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Toru Takebayashi
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Jin Nakahara
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kaoru Ogawa
- Department of Otolaryngology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shigeto Shimmura
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masayuki Amagai
- Department of Dermatology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Rei Goto
- Graduate School of Business Administration, Keio University, 4-1-1 Hiyoshi Kohoku-ku, Yokohama, Kanagawa, 223-8526, Japan
| | - Yoko Ibuka
- Faculty of Economics, Keio University, 2-15-45 Mita, Minato-ku, Tokyo, 108-8345, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
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Murakami K, Saito Y, Takeuchi S, Sujino K, Tanikawa A, Tanese K, Fukuda K. Successful management of severe alopecia areata and vitiligo using topical delgocitinib and a 308-nm excimer laser. Eur J Dermatol 2023; 33:428-430. [PMID: 37823495 DOI: 10.1684/ejd.2023.4513] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Affiliation(s)
- Kaori Murakami
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Yasuko Saito
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Sakiko Takeuchi
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Kasuyu Sujino
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Akiko Tanikawa
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Kenji Tanese
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Keitaro Fukuda
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan, Laboratory for Skin Homeostasis, RIKEN Center for Integrative Medical Sciences, Kanagawa, Japan
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Nakayama I, Takahari D, Chin K, Wakatsuki T, Takamatsu M, Yamamoto N, Ogura M, Ooki A, Fukuda K, Osumi H, Fukuoka S, Shinozaki E, Yamaguchi K. Incidence, clinicopathological features, and clinical outcomes of low HER2 expressed, inoperable, advanced, or recurrent gastric/gastroesophageal junction adenocarcinoma. ESMO Open 2023; 8:101582. [PMID: 37348349 PMCID: PMC10485394 DOI: 10.1016/j.esmoop.2023.101582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND According to the DESTINY-Breast04 trial, treating patients with breast cancer and low human epidermal growth factor receptor 2 expressions (HER2-low) varies from that of those with no HER2 expression. However, it is interesting to know if HER2-low indicates for anti-HER2 therapy in the gastric or gastroesophageal junction (G/GEJ) adenocarcinoma. Hence we conducted this study to assess the incidence, clinicopathological features, and treatment outcomes of patients with HER2-low G/GEJ adenocarcinoma. PATIENTS AND METHODS This was a single-center, retrospective observational study. Patients with previously untreated G/GEJ adenocarcinoma were classified based on their HER2 status using immunohistochemistry (IHC) with or without in situ hybridization (ISH) as follows: HER2 negative (IHC 0), HER2-low (IHC 1+ or 2+/ISH-), and HER2-positive (IHC2+/ISH+ or 3+). RESULTS In total, 734 patients with G/GEJ adenocarcinoma were divided into three groups (HER2-negative, n = 410; HER2-low, n = 154, and HER2-positive, n = 170). The intestinal-type histology, peritoneal metastasis, and higher serum carcinoembryonic antigen (CEA) levels differed significantly among patients with negative, low, and positive HER2 statuses: intestinal-type histology (21.0%, 44.2%, and 59.8%, respectively), peritoneal metastasis (56.3%, 44.8%, and 21.8%, respectively), and higher serum CEA level (32.2%, 41.6%, and 56.5%, respectively). Improved survival was observed in the HER2-positive group than in the HER2-negative G/GEJ adenocarcinoma group [hazard ratio (HR) = 0.73, 95% confidence interval (CI) 0.59-0.89; P = 0.002]. However, the prognoses of the HER2-low and HER2-negative groups were similar (HR = 1.01, 95% CI 0.82-1.23; P = 0.843). CONCLUSIONS Patients with HER2-low G/GEJ adenocarcinoma exhibited intermediate and distinct characteristics than those in the HER2-negative group. Similarly, the HER2-low group's prognosis was worse than that of the HER2-positive group. Therefore developing novel therapeutic strategies targeting HER2-low G/GEJ adenocarcinoma is required.
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Affiliation(s)
- I Nakayama
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo
| | - D Takahari
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo.
| | - K Chin
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo
| | - T Wakatsuki
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo
| | - M Takamatsu
- Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, , Tokyo, Japan
| | - N Yamamoto
- Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, , Tokyo, Japan
| | - M Ogura
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo
| | - A Ooki
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo
| | - K Fukuda
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo
| | - H Osumi
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo
| | - S Fukuoka
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo
| | - E Shinozaki
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo
| | - K Yamaguchi
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Koto-ku, Tokyo
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Fukuda K. IFNγ score-based neoadjuvant immunotherapy for stage III melanoma. J Exp Med 2023; 220:e20230160. [PMID: 36920330 PMCID: PMC10035434 DOI: 10.1084/jem.20230160] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
In this issue of JEM, Reijers et al. (2023. J. Exp. Med.https://doi.org/10.1084/jem.20221952) demonstrate that pre- and post-treatment IFNγ-related gene expression scores are promising markers for choosing neoadjuvant immunotherapy for stage III melanoma.
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Affiliation(s)
- Keitaro Fukuda
- Laboratory for Skin Homeostasis, RIKEN Center for Integrative Medical Sciences, Kanagawa, Japan
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
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Fukuda K. Immune Regulation by Cytosolic DNA Sensors in the Tumor Microenvironment. Cancers (Basel) 2023; 15:cancers15072114. [PMID: 37046775 PMCID: PMC10093344 DOI: 10.3390/cancers15072114] [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] [Received: 02/28/2023] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
cGAS and AIM2 are CDSs that are activated in the presence of cytosolic dsDNA and are expressed in various cell types, including immune and tumor cells. The recognition of tumor-derived dsDNA by CDSs in the cytosol of tumor-infiltrating dendritic cells (TIDCs) activates the innate and acquired immunity, thereby enhancing anti-tumor immune responses. STING is the downstream signaling effector of cGAS that induces type I interferon (IFN) signaling. Owing to their ability to activate TIDCs, STING agonists have been intratumorally injected in several clinical trials to enhance the anti-tumor immune response elicited by immune checkpoint antibodies. However, they have shown minimal effect, suggesting the importance of optimizing the dose and route of administration for STING agonists and deciphering other immune pathways that contribute to anti-tumor immune responses. Recent studies have revealed that AIM2 activity induces pro-tumor growth through multiple parallel pathways, including inhibition of STING-type I IFN signaling. Thus, AIM2 could be a potential molecular target for cancer immunotherapies. This review summarizes the current research on the roles of cGAS, STING, and AIM2 in immune cells and tumor cells in the tumor microenvironment and discusses the future prospects of anti-tumor treatment approaches based on these molecules.
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Affiliation(s)
- Keitaro Fukuda
- RIKEN Center for Integrative Medical Sciences (IMS), Laboratory for Skin Homeostasis, Yokohama 230-0045, Japan
- Department of Dermatology, Keio University School of Medicine, Tokyo 160-8582, Japan
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Komeya M, Nara S, Young H, Kamei Y, Uchida H, Nagata T, Takahashi S, Kimura H, Fukuda K, Matsuzaki J, Makiyama K. The development of the novel simulation system that calculates the trajectories of 10000 stones in a short time. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00402-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Fukuda K, Lam T, Tun H, Peiris JSM, Cowling BJ, Zhang T. Surveillance of environmental contamination by antibiotics and antibiotic-resistant pathogens: abridged secondary publication. Hong Kong Med J 2023; 29 Suppl 1:32-33. [PMID: 36919217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Affiliation(s)
- K Fukuda
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - T Lam
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - H Tun
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - J S M Peiris
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - B J Cowling
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - T Zhang
- Department of Civil Engineering, The University of Hong Kong, Hong Kong SAR, China
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Tahara U, Matsui T, Atsugi T, Fukuda K, Kubo A, Amagai M. 532 Unexpected expression of hemoglobin α as an endogenous antioxidant in epidermal keratinocytes. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Takeuchi S, Fukuda K, Tanaka R, Funakoshi T, Takahashi H, Amagai M, Tanikawa A. Successful management of tumor necrosis factor‐α inhibitor‐induced erythema multiforme by switching to a Janus kinase inhibitor in a patient with rheumatoid arthritis and ulcerative colitis. J Dermatol 2022; 50:e117-e118. [PMID: 36412225 DOI: 10.1111/1346-8138.16643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/16/2022] [Accepted: 11/04/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Sakiko Takeuchi
- Department of Dermatology Keio University School of Medicine Tokyo Japan
| | - Keitaro Fukuda
- Department of Dermatology Keio University School of Medicine Tokyo Japan
- Laboratory for Skin Homeostasis RIKEN Center for Integrative Medical Sciences Kanagawa Japan
| | - Ryo Tanaka
- Department of Dermatology Keio University School of Medicine Tokyo Japan
| | - Takeru Funakoshi
- Department of Dermatology Keio University School of Medicine Tokyo Japan
| | - Hayato Takahashi
- Department of Dermatology Keio University School of Medicine Tokyo Japan
| | - Masayuki Amagai
- Department of Dermatology Keio University School of Medicine Tokyo Japan
- Laboratory for Skin Homeostasis RIKEN Center for Integrative Medical Sciences Kanagawa Japan
| | - Akiko Tanikawa
- Department of Dermatology Keio University School of Medicine Tokyo Japan
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14
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Tezuka Y, Akao M, Suzuki S, Yamashita T, Kodani E, Tsuda T, Hayashi K, Furusho H, Sawano M, Fukuda K, Nakai M, Sasahara Y, Miyamoto Y, Tomita H, Okumura K. Usefulness of echocardiographic parameters in predicting the incidence of ischemic stroke in Japanese patients with non-valvular atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) is a risk factor for ischemic stroke (IS). We developed a novel risk score of IS (HELT-E2S2 score) in non-valvular atrial fibrillation (NVAF) patients from the combined database of 5 major AF registries in Japan. However, this score does not include echocardiographic (Echo) parameters that have been reported to be risk factors of IS, such as left atrial diameter (LAD) enlargement or increased relative wall thickness (RWT) of left ventricle (LV).
Purpose
To investigate the predictive value of Echo parameters in Japanese patients with NVAF.
Methods
After excluding patients without the Echo data, 6,032 NVAF patients were analyzed in the present study. LAD was measured in the parasternal long axis view at the end-ventricular systole. RWT was calculated as (2x posterior wall thickness)/ LV end-diastolic dimension. We compared clinical characteristics and the incidence of IS between NVAF patients divided by LAD level (High/Low LAD group) and RWT level (High/Low RWT group). To balance the follow-up period among the registries, event data from individuals whose follow-up period exceeded 730 days were excluded from the analysis.
Results
The optimal cut-off value of LAD and RWT to predict the incidence of IS with the receiver operating characteristic analysis was 43.3 mm and 0.4167, respectively. Between the High/Low LAD groups (High LAD: n=2,640 vs. Low LAD: n=3,392), age (70.3±12.1 vs. 68.3±12.5 years; p<0.001), CHA2DS2-VASc score (3.02±1.84 vs. 2.57±1.78; p<0.001), HELT-E2S2 score (2.20±1.31 vs. 1.55±1.33; p<0.001), the prescription of oral anticoagulants (OACs) (69.5 vs. 51.5%; p<0.001), LV ejection fraction (60.4±13.4 vs. 64.4±10.7%; p<0.001) and RWT (0.401±0.091 vs. 0.396±0.082; p=0.02) were significantly different. Between the High/Low RWT groups (High RWT: n=2,293 vs. Low RWT: n=3,739), percentage of female (35.6 vs. 27.8%; p<0.001), age (71.2±12.1 vs. 68.0±12.4 years; p<0.001), CHA2DS2-VASc score (3.08±1.82 vs. 2.58±1.79; p<0.001), HELT-E2S2 score (2.10±1.39 vs. 1.67±1.31; p<0.001), the prescription of OACs (62.6 vs. 57.4%; p<0.001), LV ejection fraction (65.5±9.9 vs. 60.9±13.0%; p<0.001) and LAD (43.0±8.1 vs. 42.4±8.3; p=0.004) were significantly different. In Kaplan-Meier analysis, the incidence of IS was different between the groups during the median follow-up period of 730 days (High LAD vs. Low LAD; 1.82 vs. 1.00 per 100 person-years; p<0.001, by log-rank test, High RWT vs. Low RWT; 1.86 vs. 1.06; p<0.001) (Figure). Both High LAD (hazard ratio: 1.65, 95% CI: 1.12–2.46; p=0.01) and High RWT (hazard ratio: 1.43, 95% CI: 1.01–2.04; p=0.045) were independent predictors of the incidence of IS after adjustment by the components of the HELT-E2S2 score and other clinically relevant variables including co-existing diseases, gender, and the prescription of OACs (Table).
Conclusion
Echo parameters, LAD and RWT, were independently associated with the incidence of IS among Japanese patients with NVAF.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Japan Agency for Medical Research and Development
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Affiliation(s)
- Y Tezuka
- Mitsubishi Kyoto Hospital , Kyoto , Japan
| | - M Akao
- Kyoto Medical Center, Department of Cardiology , Kyoto , Japan
| | - S Suzuki
- Cardiovascular Institute, Department of Cardiovascular Medicine , Tokyo , Japan
| | - T Yamashita
- Cardiovascular Institute, Department of Cardiovascular Medicine , Tokyo , Japan
| | - E Kodani
- Nippon Medical School Hospital, Department of Internal Medicine and Cardiology , Tokyo , Japan
| | - T Tsuda
- Kanazawa University Graduate School of Medicine, Department of Cardiovascular Medicine , Kanazawa , Japan
| | - K Hayashi
- Kanazawa University Graduate School of Medicine, Department of Cardiovascular Medicine , Kanazawa , Japan
| | - H Furusho
- Kanazawa University, Department of Cardiovascular Medicine , Kanazawa , Japan
| | - M Sawano
- Keio University School of Medicine, Department of Cardiovascular Medicine , Tokyo , Japan
| | - K Fukuda
- Keio University School of Medicine, Department of Cardiovascular Medicine , Tokyo , Japan
| | - M Nakai
- National Cerebral & Cardiovascular Center, Center for Cerebral and Cardiovascular Disease Information , Suita , Japan
| | - Y Sasahara
- National Cerebral & Cardiovascular Center, Center for Cerebral and Cardiovascular Disease Information , Suita , Japan
| | - Y Miyamoto
- National Cerebral & Cardiovascular Center, Center for Cerebral and Cardiovascular Disease Information , Suita , Japan
| | - H Tomita
- Hirosaki University Graduate School of Medicine, Department of Cardiology , Hirosaki , Japan
| | - K Okumura
- Hirosaki University Graduate School of Medicine, Department of Cardiology , Hirosaki , Japan
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15
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Kaneko Y, Fukuda K, Irie T, Shimizu H, Tamura S, Kobari T, Hasegawa H, Nakajima T, Ishii H. Electrophysiological characteristics and catheter ablation of atypical fast-slow atrioventricular nodal reentrant tachycardia using an inferolateral left atrial slow pathway. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Understandings of subtypes of atypical atrioventricular nodal reentrant tachycardia (AVNRT) using variants of slow pathway (SP) are still growing. Inferolateral (inf-lat-) left atrial (LA) SP is a rare variant extending into an inf-lat-LA along the mitral annulus (MA).
Purpose
To characterize an unknown subtype of atypical fast-slow (F/S-) AVNRT using an inf-lat-LA-SP as a retrograde limb (inf-lat-LA-F/S-AVNRT).
Methods
This Japanese multicenter retrospective study enrolled 4 patients of inf-lat-LA-F/S-AVNRT that was characterized by the earliest site of atrial activation during tachycardia (EAA) between 3 and 6 o'clock along the MA. The diagnosis was made by an exclusion of AV reentrant tachycardia (AVRT) and atrial tachycardia (AT) according to the standard criteria and was confirmed by successful elimination of tachycardia and the inf-lat-LA-SP.
Results
Surface ECG during tachycardia revealed long RP appearance except one who had short RP due to a short conduction time across the inf-lat-LA-SP. During tachycardia, far-field LA activation preceding near-field activation of coronary sinus (CS) musculature was visible in the CS recording in 2. Retrograde conduction via the inf-lat-LA-SP with a decremental delay was consistently reproducible with ventricular stimulation in 2, 1 of whom had double atrial response, while it was always masked by the presence of a retrograde conduction via the fast pathway in 1 and a retrograde block at the lower common pathway in 1. An injection of a small dose of ATP transiently interrupted a retrograde conduction over the inf-lat-LA-SP, suggesting its ATP-sensitivity. Exclusion of AVRT was made by no resetting of tachycardia with left ventricular extrastimulus in 2 and VA dissociation during overdrive pacing of tachycardia in remaining 2. Exclusion of AT was made by V-A-V response after ventricular entrainment in 1 and termination without atrial capture by ventricular pacing in 2. Ablation of the right-sided SP was unsuccessful to eliminate the tachycardia, but ablation at or near the EAA by transseptal approach was successful to cure the tachycardia, associated with an elimination of a retrograde conduction over the inf-lat-LA-SP following a development of an accelerated junction rhythm in all. Low-frequency potentials preceding local atrial activation, consistent with a retrograde activation via the inf-lat-LA-SP were detected along the MA medial to the EAA in 1.
Conclusions
Differential diagnosis of tachycardia with the EAA in the inf-lat-LA and especially long RP appearance should include inf-lat-LA-F/S-AVNRT. Presumed arrhythmogenic substrate of the inf-lat-LA-SP seemed to be consistent with the remnant of embryogenic AV ring tissue in the electropharmacological and locational characteristics. Successful elimination of this AVNRT can be obtained by ablation of the inf-lat-LA-SP, but not of the right-sided SP.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- Y Kaneko
- Gunma University Graduate School of Medicine, Maebashi , Gunma , Japan
| | - K Fukuda
- International University of Health and Welfare Hospital, Department of Cardiology , Nasushiobara , Japan
| | - T Irie
- Saitama Sekishinkai Hospita, Department of Cardiology , Sayama , Japan
| | - H Shimizu
- Saiseikai Niigata Hospital, Department of Cardiology , Niigata , Japan
| | - S Tamura
- Gunma University Graduate School of Medicine, Maebashi , Gunma , Japan
| | - T Kobari
- Gunma University Graduate School of Medicine, Maebashi , Gunma , Japan
| | - H Hasegawa
- Gunma University Graduate School of Medicine, Maebashi , Gunma , Japan
| | - T Nakajima
- Gunma University Graduate School of Medicine, Maebashi , Gunma , Japan
| | - H Ishii
- Gunma University Graduate School of Medicine, Maebashi , Gunma , Japan
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16
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Hashimoto K, Miyama H, Seki Y, Ibe S, Yamashita T, Fujisawa T, Katsumata Y, Kimura T, Fukuda K, Takatsuki S. Advantage of POLARx over ARCTIC FRONT ADVANCE PRO during pulmonary vein isolation for paroxysmal atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
The electrical pulmonary vein (PV) isolation has been established as a curative therapy for paroxysmal atrial fibrillation (AF). Arctic Front™cryoballoon has been used worldwide for AF cryoablation. Recently, a new cryoballoon, POLARxTM CRYOABLATION system have been introduced, of which material of the balloon is softer and the N2O gas flow rate is higher.
Purpose
The aim was to investigate the procedural parameter and efficacy of POLARx comparing with Arctic Front.
Methods
This retrospective single center study included 101 consecutive patients who underwent paroxysmal AF ablation using cryoballoon at Keio University hospital from April 2021 to March 2022. The procedural data including the cryoballoon temperature and the number and duration of cryoablation were compared between POLARx (POLARx group) and ARCTIC FRONT ADVANCE PRO (AFA group). After the cryoablation, we added the radiofrequency application in order to maximize the isolated area when the voltage was remained inside PV (Figure 1). The necessities of the additional radiofrequency applications were also compared.
Results
In the present study, 64 patients in AFA group and 37 patients in POLARx group were analyzed. POLARx group included younger population and less females (62.8±9.9 vs 67.5±9.4 year of age, P=0.02; 13.5 vs 32.8%, P=0.04). There was no significant difference in comorbidities and examination data such as left atrium diameter or brain natriuretic peptide level. The minimal cryoballoon temperatures reached in POLARx group were lower than AFA group (−59.3±6.2 vs −47.7±7.5°C, P<0.01). No difference was found in the total number and duration of cryoablation and the time to isolate PV (6.1±2.1 vs 5.9±1.6, P=0.69; 790.2±256.1 vs 776.1±235.0 sec, P=0.69; 41.8±21.3 vs 47.1±29.6 sec, P=0.44, respectively). With regard to individual PVs, the total number and duration were tended to be larger at right superior PV in POLARx group (1.9±1.1 vs 1.4±0.7, P=0.01; 231.8±123.8 vs 193.2±83.0 sec, P=0.07), while there was no significant difference at the other PVs. The rate of successful PV isolation by a single cryo-application was not different between AFA and POLARx group (54.3 vs 61.4%, P=0.17). The additional radiofrequency applications were more frequent in AFA group (14.8 vs. 4.9%, P=0.003). There was a significant difference at right inferior PV (32.8 vs 8.1%, P=0.01), while not at left superior PV, left inferior PV and right superior PV (9.4 vs 2.9%, P=0.42; 9.4 vs 5.7%, P=0.71; 7.8 vs 2.7%, P=0.41). Phrenic nerve injury was occurred 1 case in both group and esophageal ulcer was occurred in 1 case in AFA group. No other complication including cardiac tamponade was occurred.
Conclusion
The total number and duration of cryoablation were not significantly different between AFA and POLARx group, except for right superior PV. There was an advantage in largely isolating right inferior PV in POLARx group comparing with AFA group.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Hashimoto
- Keio University School of Medicine, Department of Cardiology , Tokyo , Japan
| | - H Miyama
- Keio University School of Medicine, Department of Cardiology , Tokyo , Japan
| | - Y Seki
- Keio University School of Medicine, Department of Cardiology , Tokyo , Japan
| | - S Ibe
- Keio University School of Medicine, Department of Cardiology , Tokyo , Japan
| | - T Yamashita
- Keio University School of Medicine, Department of Cardiology , Tokyo , Japan
| | - T Fujisawa
- Keio University School of Medicine, Department of Cardiology , Tokyo , Japan
| | - Y Katsumata
- Keio University School of Medicine, Department of Cardiology , Tokyo , Japan
| | - T Kimura
- Keio University School of Medicine, Department of Cardiology , Tokyo , Japan
| | - K Fukuda
- Keio University School of Medicine, Department of Cardiology , Tokyo , Japan
| | - S Takatsuki
- Keio University School of Medicine, Department of Cardiology , Tokyo , Japan
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17
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Takamiya R, Fukuda K, Katsurada N, Kawa Y, Satouchi M, Kaneshiro K, Matsumoto M, Hatakeyama Y, Dokuni R, Matsumura K, Katsurada M, Nakata K, Yoshimura S, Tachihara M. EP14.05-022 The Drug Induced Interstitial Lung Disease in Chemoimmunotherapy for Extensive-Stage Small Cell Lung Cancer. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Matsui T, Urabe M, Fukuda K, Amagai M. 409 Corneoptosis, functional keratinocyte cell death, is tightly associated with spaciotemporal dynamics of epidermal tight junctions. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Nakamura Y, Tanese K, Kameyama K, Ota Y, Fusumae T, Hirai I, Fukuda K, Funakoshi T. Cutaneous eyelid melanoma with lacrimal sac metastasis: the potential role of lacrimal fluid as a metastatic pathway. Clin Exp Dermatol 2022; 47:2277-2280. [PMID: 35875892 DOI: 10.1111/ced.15339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Yoshio Nakamura
- Department of Dermatology, Keio University School of Medicine, Tokyo, JAPAN
| | - Keiji Tanese
- Department of Dermatology, Keio University School of Medicine, Tokyo, JAPAN
| | - Kaori Kameyama
- Department of Pathology, Keio University School of Medicine, Tokyo, JAPAN
| | - Yu Ota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, JAPAN
| | - Takaiyuki Fusumae
- Department of Dermatology, Keio University School of Medicine, Tokyo, JAPAN
| | - Ikuko Hirai
- Department of Dermatology, Keio University School of Medicine, Tokyo, JAPAN
| | - Keitaro Fukuda
- Department of Dermatology, Keio University School of Medicine, Tokyo, JAPAN
| | - Takeru Funakoshi
- Department of Dermatology, Keio University School of Medicine, Tokyo, JAPAN
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20
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Morimoto A, Fukuda K, Ito Y, Tahara U, Sasaki T, Shiohama A, Kawasaki H, Kawakami E, Naganuma T, Arita M, Sasaki H, Koseki H, Matsui T, Amagai M. Microbiota-Independent Spontaneous Dermatitis Associated With Increased Sebaceous Lipid Production in Tmem79-Deficient Mice. J Invest Dermatol 2022; 142:2864-2872.e6. [PMID: 35752300 DOI: 10.1016/j.jid.2022.06.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/28/2022] [Accepted: 06/07/2022] [Indexed: 11/19/2022]
Abstract
TMEM79 is a predisposing gene for atopic dermatitis (AD). Tmem79-deficient mice develop spontaneous dermatitis in a biphasic pattern. The 1st-phase dermatitis is unique, as it occurs independent of microbiota status, whereas the 2nd-phase dermatitis is microbiota-dependent. In this study, we sought to identify key factors mediating the development of 1st-phase dermatitis. Structural analysis showed that sebaceous gland hyperplasia started from 1st-phase dermatitis. Longitudinal RNA-sequencing analysis revealed significant activation of fatty acid lipid-metabolism pathways in 1st-phase dermatitis, whereas Th17-based immune response genes were highly expressed in 2nd-phase dermatitis. Quantitative reverse transcription-polymerase chain reaction analysis revealed that genes involved in fatty acid elongation and sebocyte differentiation were upregulated in 1st-phase dermatitis. The results of thin-layer chromatography supported these findings with an increased abundance of wax esters, cholesterol esters, and fatty alcohols in hair lipids. Further gas chromatography-tandem mass spectrometry analysis showed an increase in total fatty acid production, including that of elongated C20-24 saturated and C18-24 mono-unsaturated fatty acids. Collectively, these results suggest that aberrant production of sebaceous long-chain fatty acids is associated with microbiota-independent dermatitis. Further investigation of Tmem79-deficient mice may clarify the role of certain fatty acids in dermatitis.
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Affiliation(s)
- Ari Morimoto
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan; Laboratory for Skin Homeostasis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Keitaro Fukuda
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan; Laboratory for Skin Homeostasis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Yoshihiro Ito
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan; Laboratory for Skin Homeostasis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Umi Tahara
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan; Laboratory for Skin Homeostasis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Takashi Sasaki
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Aiko Shiohama
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Kawasaki
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan; Laboratory for Skin Homeostasis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan; Laboratory for Developmental Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Eiryo Kawakami
- Advanced Data Science Project, RIKEN Information R&D and Strategy Headquarters, Yokohama, Japan; Artificial Intelligence Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tatsuro Naganuma
- Division of Physiological Chemistry and Metabolism, Faculty of Pharmacy, Keio University, Tokyo, Japan; Laboratory for Metabolomics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Makoto Arita
- Division of Physiological Chemistry and Metabolism, Faculty of Pharmacy, Keio University, Tokyo, Japan; Laboratory for Metabolomics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Hiroyuki Sasaki
- Department of Occupational Therapy, School of Rehabilitation, Tokyo Professional University of Health Sciences, Tokyo, Japan
| | - Haruhiko Koseki
- Laboratory for Developmental Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Takeshi Matsui
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan; Laboratory for Skin Homeostasis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan; Laboratory for Evolutionary Cell Biology of the Skin, School of Bioscience and Biotechnology, Tokyo University of Technology, Hachioji, Japan
| | - Masayuki Amagai
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan; Laboratory for Skin Homeostasis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan.
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21
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Fusumae T, Fukuda K, Hirai I, Nakamura Y, Kobayashi K, Tanese K, Matsumoto K, Iwata T, Funakoshi T. Management and outcomes of hydronephrosis in patients with metastatic extramammary Paget's disease: A retrospective analysis. J Dermatol 2022; 49:787-791. [PMID: 35466461 DOI: 10.1111/1346-8138.16407] [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: 01/31/2022] [Revised: 03/22/2022] [Accepted: 04/03/2022] [Indexed: 11/29/2022]
Abstract
Hydronephrosis in extramammary Paget's disease (EMPD) with distant metastasis (metastatic EMPD) has been observed in medical practice; however, its prognosis remains unclear. Retrospective analyses were performed to assess the management and outcomes of hydronephrosis in metastatic EMPD. During a follow-up of 44 patients with metastatic EMPD, 13 (30%) developed hydronephrosis. Ten (77%) of the 13 patients with hydronephrosis had impaired renal function (estimated glomerular filtration rate: <60 ml/min/1.73 m2 ), and ureteral stents were placed in every patient with impaired renal function. The stent was placed successfully in all 10 patients, and their renal function recovered within a median period of 7 days. Importantly, each of these patients continued chemotherapy, and none of them experienced stent failure. The median overall survival time (OS) in patients with metastatic EMPD and hydronephrosis (n = 13) was 7.8 months. Treatment for hydronephrosis was not a significant factor for OS, and median OS in patients who underwent ureteral stent replacement (n = 10) was 14.7 months. Collectively, our results indicate that hydronephrosis is relatively common, and ureteral stent placement should be considered in cases of metastatic EMPD with hydronephrosis to maintain renal function and continue chemotherapy toward a better prognosis.
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Affiliation(s)
- Takayuki Fusumae
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Keitaro Fukuda
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan.,Laboratory for Skin Homeostasis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Ikuko Hirai
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshio Nakamura
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Kenta Kobayashi
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Keiji Tanese
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | | | - Takashi Iwata
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Takeru Funakoshi
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
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22
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Abstract
Melanoma is an aggressive skin cancer derived from melanocyte, which shows high response rate to cancer immunotherapy, such as immune checkpoint inhibitors (ICIs). Vitiligo is an autoimmune skin disease resulting from the destruction of melanocytes by autoreactive CD8+ T cells. Vitiligo induced by cancer immunotherapy is a favorable prognostic factor in patients with melanoma, and growing evidence supports the fact that melanocyte/melanoma-shared antigen (MSA)-specific CD8+ T cells infiltrated in the tumor (melanoma) and skin (vitiligo) microenvironment play pivotal roles in the prognosis of both diseases. Thus, cellular communications that promote MSA-specific CD8+ T cells recruitment, proliferation, and effector functions are now seen as key targets to enhance the efficacy of current therapies for both diseases. Here, we discussed recent advancements in illustrating immune signaling pathways and immune cell types that regulate migration, proliferation, and function of MSA-specific CD8+ T cells in melanoma and vitiligo; and future immunotherapeutic approaches that may enhance clinical outcomes of both diseases.
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Affiliation(s)
- Keitaro Fukuda
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
- Laboratory for Skin Homeostasis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- *Correspondence: Keitaro Fukuda,
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23
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Hirai I, Tanese K, Fukuda K, Fusumae T, Nakamura Y, Sato Y, Amagai M, Funakoshi T. Imatinib mesylate in combination with pembrolizumab in patients with advanced KIT-mutant melanoma following progression on standard therapy: A phase I/II trial and study protocol. Medicine (Baltimore) 2021; 100:e27832. [PMID: 34889232 PMCID: PMC8663894 DOI: 10.1097/md.0000000000027832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 10/29/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Genetic alterations of KIT gene are known to be one of the major causes of melanoma. Those are more common in the mucous and acral subtypes and KIT is regarded as major oncogene in Asian melanomas, where the prevalence of these subtypes is high. Up to date, several clinical trials have been conducted to target KIT gene alterations in melanoma with unsatisfied efficacies. Imatinib mesylate, a small-molecule inhibitor of the KIT tyrosine kinase, provides a rapid but not durable clinical response in KIT-mutant melanoma. Meanwhile, recent basic and clinical evidence have revealed another aspect of KIT-targeted therapy, namely the enhancement of antitumor activity of immune checkpoint inhibitors. Herein, we designed clinical trial of co-administrating imatinib mesylate and pembrolizumab (anti-PD-1 antibody) to evaluate its safety and efficacy. METHODS AND ANALYSIS This is an open-label, single-arm, phase I/II clinical trial involving Japanese patients with metastatic KIT-mutant melanoma that are refractory to standard therapy including anti-PD-1 therapy. Phase I study is a dose-escalation study comprising two dose levels of imatinib mesylate (200 and 400 mg/day, respectively) with fixed dose of pembrolizumab (200 mg every 3 weeks) to evaluate safety and tolerability and determine recommended phase II dose. The primary endpoint of the phase II study is the objective response rate after 4 cycles (3 weeks/cycle) of pembrolizumab and imatinib mesylate at the dose determined in phase I, based on RECIST version 1.1. A Simon's minimax two-stage design is employed to test the null hypothesis of a 5% response rate vs 30% alternative, which will be rejected when a lower confidence limit of two-sided 90% confidence interval of true response rate is over than threshold response rate. The secondary endpoints include progression free survival, overall survival, best overall response and incidence of adverse events. Totally, a target size of 22 patients will be expected. DISCUSSION If this study shows efficacy and acceptable safety profile, it will contribute to the development of novel treatment option for patients with KIT-mutant melanoma that are refractory to standard therapy. TRIAL REGISTRATION NCT04546074. Date of Registration: September 11, 2020 (https://clinicaltrials.gov/ct2/show/NCT04546074). Date of First Participant Enrollment: December 23, 2020.
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Affiliation(s)
- Ikuko Hirai
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Keiji Tanese
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Keitaro Fukuda
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Takayuki Fusumae
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshio Nakamura
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Masayuki Amagai
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Takeru Funakoshi
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
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24
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Nakagawara K, Namkoong H, Terai H, Masaki K, Tanosaki T, Shimamoto K, Lee H, Tanaka H, Okamori S, Kabata H, Chubachi S, Ikemura S, Kamata H, Yasuda H, Kawada I, Ishii M, Ishibashi Y, Harada S, Fujita T, Ito D, Bun S, Tabuchi H, Kanzaki S, Shimizu E, Fukuda K, Yamagami J, Kobayashi K, Hirano T, Inoue T, Kagyo J, Shiomi T, Ohgino K, Sayama K, Otsuka K, Miyao N, Odani T, Oyamada Y, Masuzawa K, Nakayama S, Suzuki Y, Baba R, Nakachi I, Kuwahara N, Ishiguro T, Mashimo S, Minematsu N, Ueda S, Manabe T, Funatsu Y, Koh H, Yoshiyama T, Saito F, Ishioka K, Takahashi S, Nakamura M, Goto A, Harada N, Kusaka Y, Nakano Y, Nishio K, Tateno H, Edahiro R, Takeda Y, Kumanogoh A, Kodama N, Okamoto M, Umeda A, Hagimura K, Sato T, Miyazaki N, Takemura R, Sato Y, Takebayashi T, Nakahara J, Mimura M, Ogawa K, Shimmura S, Negishi K, Tsubota K, Amagai M, Goto R, Ibuka Y, Hasegawa N, Kitagawa Y, Kanai T, Fukunaga K. Comprehensive and long-term surveys of COVID-19 sequelae in Japan, an ambidirectional multicentre cohort study: study protocol. BMJ Open Respir Res 2021; 8:8/1/e001015. [PMID: 34836924 PMCID: PMC8628335 DOI: 10.1136/bmjresp-2021-001015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/02/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The rapid spread of COVID-19 posed a global burden. Substantial number of people died of the disease in the acute phase of infection. In addition, a significant proportion of patients have been reported to suffer from post-acute phase symptoms, sequelae of COVID-19, which may negatively influence the quality of daily living and/or socioeconomic circumstances of the patients. However, no previous study has comprehensively and objectively assessed the quality of life of patients by using existing international scales. Further, evidence of socioeconomic consequences among patients with COVID-19 is scarce. To address the multidimensional issues from sequelae of COVID-19, evidence from comprehensive surveys beyond clinical perspectives is critical that investigates health, and social determinants of disease progression as well as socioeconomic consequences at a large scale. METHODS AND ANALYSIS In this study, we plan to conduct a nationwide and comprehensive survey for the sequelae of COVID-19 in a total of 1000 patients diagnosed at 27 hospitals throughout Japan. This study will evaluate not only the health-related status of patients from clinical perspectives but also the Health-related Quality of Life (HRQoL) scores, socioeconomic status and consequences to discuss the sequelae of the disease and the related risk factors. The primary endpoint is the frequency of long-term complications of COVID-19 infection. The secondary endpoints are risk factors for progression to sequelae of COVID-19 infection. The study will provide robust and important evidence as a resource to tackle the issues from the sequelae of COVID-19 from the multi-dimensional perspectives. ETHICS AND DISSEMINATION This trial was approved by the Keio University School of Medicine Ethics Committee (20200243, UMIN000042299). The results of this study will be reported at a society meeting or published in a peer-reviewed journal.
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Affiliation(s)
- Kensuke Nakagawara
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ho Namkoong
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Hideki Terai
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Katsunori Masaki
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takae Tanosaki
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kyoko Shimamoto
- Keio Global Research Institute, Keio University, Tokyo, Japan
| | - Ho Lee
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiromu Tanaka
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Okamori
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiroki Kabata
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shotaro Chubachi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shinnosuke Ikemura
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hirofumi Kamata
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Yasuda
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ichiro Kawada
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Makoto Ishii
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yoshiki Ishibashi
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Sei Harada
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Takanori Fujita
- Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan
| | - Daisuke Ito
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Shogyoku Bun
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hajime Tabuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Sho Kanzaki
- Department of Otolaryngology, Keio University School of Medicine, Tokyo, Japan
| | - Eisuke Shimizu
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Keitaro Fukuda
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Jun Yamagami
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Keigo Kobayashi
- Department of Internal Medicine, Sano Kosei General Hospital, Tochigi, Japan
| | - Toshiyuki Hirano
- Department of Internal Medicine, Sano Kosei General Hospital, Tochigi, Japan
| | - Takashi Inoue
- Department of Internal Medicine, Sano Kosei General Hospital, Tochigi, Japan
| | - Junko Kagyo
- Department of Internal Medicine, Keiyu Hospital, Kanagawa, Japan
| | - Tetsuya Shiomi
- Department of Internal Medicine, Keiyu Hospital, Kanagawa, Japan
| | - Keiko Ohgino
- Division of Pulmonary Medicine, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Koichi Sayama
- Division of Pulmonary Medicine, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Kengo Otsuka
- Department of Internal Medicine, Nihon Koukan Hospital, Kanagawa, Japan
| | - Naoki Miyao
- Department of Internal Medicine, Nihon Koukan Hospital, Kanagawa, Japan
| | - Toshio Odani
- Department of Rheumatology, National Hospital Organization Hokkaido Medical Center, Hokkaido, Japan
| | - Yoshitaka Oyamada
- Department of Respiratory Medicine, National Hospital Organisation Tokyo Medical Center, Tokyo, Japan
| | - Keita Masuzawa
- Department of Respiratory Medicine, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Sohei Nakayama
- Department of Respiratory Medicine, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Yusuke Suzuki
- Department of Respiratory Medicine, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Rie Baba
- Pulmonary Division, Department Internal Medicine, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Ichiro Nakachi
- Pulmonary Division, Department Internal Medicine, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Naota Kuwahara
- Department of Medicine, Division of Allergology and Respiratory Medicine, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Takashi Ishiguro
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Saitama, Japan
| | - Shuko Mashimo
- Department of Respiratory Medicine, Toyohashi Municipal Hospital, Aichi, Japan
| | - Naoto Minematsu
- Department of Internal Medicine, Hino Municipal Hospital, Tokyo, Japan
| | - Soichiro Ueda
- Department of Internal Medicine, Saitama Medical Center, Saitama, Japan
| | - Tadashi Manabe
- Division of Pulmonary Medicine, Department of Internal Medicine, Tachikawa Hospital, Tokyo, Japan
| | - Yohei Funatsu
- Division of Pulmonary Medicine, Department of Internal Medicine, Tachikawa Hospital, Tokyo, Japan
| | - Hidefumi Koh
- Division of Pulmonary Medicine, Department of Internal Medicine, Tachikawa Hospital, Tokyo, Japan
| | - Takashi Yoshiyama
- Respiratory Disease Center, Fukujuji Hospital,Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Fumitake Saito
- Department of Pulmonary Medicine, Eiju General Hospital, Tokyo, Japan
| | - Kota Ishioka
- Department of Pulmonary Medicine, Saiseikai Central Hospital, Tokyo, Japan
| | - Saeko Takahashi
- Department of Pulmonary Medicine, Saiseikai Central Hospital, Tokyo, Japan
| | - Morio Nakamura
- Department of Pulmonary Medicine, Saiseikai Central Hospital, Tokyo, Japan
| | - Ai Goto
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Norihiro Harada
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Yu Kusaka
- Department of Respiratory Medicine, Ome Municipal General Hospital, Ome, Tokyo, Japan
| | - Yasushi Nakano
- Department of Pulmonary Medicine, Kawasaki Municipal Ida Hospital, Kanagawa, Japan
| | - Kazumi Nishio
- Department of Pulmonary Medicine, Kawasaki Municipal Ida Hospital, Kanagawa, Japan
| | - Hiroki Tateno
- Department of Pulmonary Medicine, Saitama City Hospital, Saitama, Japan
| | - Ryuya Edahiro
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshito Takeda
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Atsushi Kumanogoh
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Nobuhiro Kodama
- Department of General Internal Medicine, Fukuoka Tokushukai Hospitali, Fukuoka, Japan
| | - Masaki Okamoto
- Department of Internal Medicine, Division of Respirology, Neurology, and Rheumatology, Kurume University School of Medicine, Fukuoka, Japan
| | - Akira Umeda
- Department of Respiratory Medicine, International University of Health and Welfare Shioya Hospital, Tochigi, Japan
| | - Kazuto Hagimura
- Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Toshiro Sato
- Department of Organoid Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Naoki Miyazaki
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Ryo Takemura
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Yasunori Sato
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Toru Takebayashi
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Jin Nakahara
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Kaoru Ogawa
- Department of Otolaryngology, Keio University School of Medicine, Tokyo, Japan
| | - Shigeto Shimmura
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Masayuki Amagai
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Rei Goto
- Graduate School of Business Administration, Keio University, Tokyo, Japan
| | - Yoko Ibuka
- Faculty of Economics, Keio University, Tokyo, Japan
| | - Naoki Hasegawa
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
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25
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Inoue K, Shiozaki M, Sasaki S, Sasaki Y, Tamura H, Fukuda K, Kubota N, Hiki M, Funamizu T, Sumiyoshi M, Minamino T. Determination of physiological cardiac myosin-binging protein levels (cMyc) in healthy populations. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiac myosin–binding protein C (cMyC) is a cardiac-restricted protein that has more abundant, rapid release and clearance kinetics than cardiac troponin. The current ESC guideline suggests the cMyC may provide value as an alternative to cardiac troponin. The 99th percentile value is universally endorsed as the reference cut off to aid in the diagnosis of acute myocardial infarction (AMI), however, none of the report of healthy population of cMyC.
Purpose
The aim of this study was to evaluate the distribution of cMyC values in healthy subjects.
Methods
We used two cohorts in this retrospective study. 1) Healthy subjects; a total of 500 subjects (250 men and 250 women) who had annual health examinations in 2012 in the area of Kamigoto, a suburb of Nagasaki city in Southern Japan were enrolled. All participants showed none of abnormal findings including cell blood counts, chemical analysis, liver function tests, general urine tests, occult blood tests of stool, barium swallow, mammography for women, abdominal ultrasound sonography, and electrocardiogram. All blood samples were obtained in a fasting state in the morning. 2) Chest pain subjects; we collected samples from 250 subjects including 50 with non-ST elevation myocardial infarction visited admitted to a university hospital for measurement of high-sensitivity troponin T and coronary artery assessment by coronary angiography. We measured cMyC level in both cohorts by HISCL™-800 system (Sysmex corporation, Japan). The assay has a limit of detection of 0.5 ng/L and a lower limit of quantification of 1.3 ng/L.
Result
In healthy subjects, median age (IQR) was 44 (20, 82) in men and 50 (23, 91) in women. The 99th percentile of cMyC was 27.3 ng/L, which was around one-third lower than that in previous report (87 ng/L). In chest pain subjects, the concentrations of cMyC at presentation were significantly higher in those with versus without AMI (median, 66 ng/L versus 10 ng/L, P<0.001). Discriminatory power for AMI, as quantified by the area under the receiver-operating characteristic curve (AUC), was comparable for cMyC (AUC, 0.85 (95% CI 0.79–0.91) and hs-cTnT (AUC, 0.81 (95% CI 0.76–0.88)).
Conclusion
We defined the normal range of cMyC in healthy Japanese subjects. The level of cMyC at presentation provides discriminatory power comparable to hs-cTnT in the diagnosis of AMI. To determine the physiological value of a biomarker may be necessary to evaluate enough information about their health status.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Grant-in-Aid for Scientific Research
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Affiliation(s)
- K Inoue
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - M Shiozaki
- Tokyo Metropolitan Tama Medical Center, Cardiology, Tokyo, Japan
| | - S Sasaki
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - Y Sasaki
- Sysmex R&D Center Europe GmbH, Hamburg, Germany
| | - H Tamura
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - K Fukuda
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - N Kubota
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - M Hiki
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - T Funamizu
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - M Sumiyoshi
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - T Minamino
- Juntendo University School of Medicine, Tokyo, Japan
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26
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Fukuda K, Okamura K, Riding RL, Fan X, Afshari K, Haddadi NS, McCauley SM, Guney MH, Luban J, Funakoshi T, Yaguchi T, Kawakami Y, Khvorova A, Fitzgerald KA, Harris JE. AIM2 regulates anti-tumor immunity and is a viable therapeutic target for melanoma. J Exp Med 2021; 218:212521. [PMID: 34325468 PMCID: PMC8329870 DOI: 10.1084/jem.20200962] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/24/2021] [Accepted: 07/09/2021] [Indexed: 12/14/2022] Open
Abstract
The STING and absent in melanoma 2 (AIM2) pathways are activated by the presence of cytosolic DNA, and STING agonists enhance immunotherapeutic responses. Here, we show that dendritic cell (DC) expression of AIM2 within human melanoma correlates with poor prognosis and, in contrast to STING, AIM2 exerts an immunosuppressive effect within the melanoma microenvironment. Vaccination with AIM2-deficient DCs improves the efficacy of both adoptive T cell therapy and anti–PD-1 immunotherapy for “cold tumors,” which exhibit poor therapeutic responses. This effect did not depend on prolonged survival of vaccinated DCs, but on tumor-derived DNA that activates STING-dependent type I IFN secretion and subsequent production of CXCL10 to recruit CD8+ T cells. Additionally, loss of AIM2-dependent IL-1β and IL-18 processing enhanced the treatment response further by limiting the recruitment of regulatory T cells. Finally, AIM2 siRNA-treated mouse DCs in vivo and human DCs in vitro enhanced similar anti-tumor immune responses. Thus, targeting AIM2 in tumor-infiltrating DCs is a promising new treatment strategy for melanoma.
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Affiliation(s)
- Keitaro Fukuda
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA.,Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Ken Okamura
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA
| | - Rebecca L Riding
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA
| | - Xueli Fan
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA
| | - Khashayar Afshari
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA
| | - Nazgol-Sadat Haddadi
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA
| | - Sean M McCauley
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Mehmet H Guney
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Jeremy Luban
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, MA.,Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, MA
| | - Takeru Funakoshi
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Tomonori Yaguchi
- Division of Cellular Signaling, Institute for Advanced Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Yutaka Kawakami
- Division of Cellular Signaling, Institute for Advanced Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Anastasia Khvorova
- RNA Therapeutics Institute, University of Massachusetts Medical School, Worcester, MA.,Department of Molecular Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Katherine A Fitzgerald
- Department of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, MA
| | - John E Harris
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA
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27
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Fukui S, Kawaai S, Tamaki H, Fukuda K, Okada M. A novel combination treatment with apremilast and tumor necrosis factor inhibitor for a patient with refractory intestinal Behcet's disease. Scand J Rheumatol 2021; 51:81-82. [PMID: 34232114 DOI: 10.1080/03009742.2021.1929458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- S Fukui
- Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan
| | - S Kawaai
- Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan
| | - H Tamaki
- Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan
| | - K Fukuda
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - M Okada
- Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan
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28
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Riding RL, Richmond JM, Fukuda K, Harris JE. Type I interferon signaling limits viral vector priming of CD8 + T cells during initiation of vitiligo and melanoma immunotherapy. Pigment Cell Melanoma Res 2021; 34:683-695. [PMID: 33040466 PMCID: PMC8035367 DOI: 10.1111/pcmr.12935] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 09/02/2020] [Accepted: 09/30/2020] [Indexed: 01/26/2023]
Abstract
Vitiligo is an autoimmune skin disease in which epidermal melanocytes are targeted for destruction by CD8+ T cells specific for melanocyte/melanoma-shared antigens. IFNγ is the central cytokine driving disease, but the role of type I IFN in vitiligo remains unclear. We investigated the functional role of type I IFN during vitiligo progression using two different mouse models: one induced with a vaccinia virus (VV) vaccine and one induced with dendritic cells to prime autoimmune T cells. Induction of vitiligo by VV in IFNaR-deficient mice led to the development of severe vitiligo compared with wild-type (WT) mice and was characterized by a significantly enhanced effector CD8+ T-cell response. Severe vitiligo in this model was a result of VV persistence, because exacerbation of disease in IFNaR-deficient mice was not observed when antigen-pulsed dendritic cells were used to induce vitiligo instead of virus. Treatment of B16F10 melanoma-inoculated mice with VV vaccine therapy also induced a significantly enhanced anti-tumor response in IFNaR-deficient mice compared with WT. These results not only help define the pathways responsible for vitiligo progression but also suggest that blockade of type I IFNs following administration of a VV vaccine may provide increased immunogenicity and efficacy for melanoma immunotherapy.
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Affiliation(s)
- Rebecca L Riding
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jillian M Richmond
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Keitaro Fukuda
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA
| | - John E Harris
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA
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29
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Hirai I, Funakoshi T, Kamijuku H, Fukuda K, Mori M, Sakurai M, Koda Y, Kato J, Mori T, Watanabe N, Noji S, Yaguchi T, Iwata T, Ohta S, Fujita T, Tanosaki R, Handa M, Okamoto S, Amagai M, Kawakami Y. Adoptive cell therapy using tumor-infiltrating lymphocytes for melanoma refractory to immune-checkpoint inhibitors. Cancer Sci 2021; 112:3163-3172. [PMID: 34101300 PMCID: PMC8353905 DOI: 10.1111/cas.15009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 02/03/2023] Open
Abstract
To evaluate the feasibility of adoptive cell therapy (ACT) using ex vivo‐expanded tumor‐infiltrating lymphocytes (TILs) in Japanese patients with melanoma who failed immune‐checkpoint inhibitor therapy, an open‐label, single‐arm, pilot study was conducted. We investigated the immunological and genetic factors of the pretreatment tumor and expanded TILs that may be associated with the clinical response. The treatment protocol comprised preparation of TIL culture, lympho‐depleting non‐myeloablative preconditioning with cyclophosphamide and fludarabine, TIL infusion, and intravenous administration of low‐dose IL‐2. Three patients of clinical subtypes mucosal, superficial spreading, and acral melanoma underwent TIL‐ACT. Most severe adverse events, including fever and leukopenia, were manageable with the supportive regimen specified in the protocol, suggesting that the TIL‐ACT regimen is suitable for Japanese patients with melanoma. One patient showed a short‐term partial response, one relatively long‐stable disease, and one experienced disease progression. Whole‐exome and transcriptional sequencing of isolated tumor cells and immunohistochemical analyses before TIL‐ACT revealed various immunostimulatory factors, including a high tumor mutation burden and immune cell‐recruiting chemokines, as well as various immunosuppressive factors including TGF‐β, VEGF, Wnt/β‐catenin, and MAPK signaling and epithelial‐to‐mesenchymal transition, which might influence the efficacy of TIL‐ACT. Our results imply mechanisms for the antitumor effect of and resistance to TIL‐ACT. Further studies of immune‐resistant mechanisms of TIL‐ACT are warranted. This study is registered with the UMIN Clinical Trial Registry (UMIN 000011431).
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Affiliation(s)
- Ikuko Hirai
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Takeru Funakoshi
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Hajime Kamijuku
- Institute for Advanced Medical Research, Division of Cellular Signaling, Keio University School of Medicine, Tokyo, Japan
| | - Keitaro Fukuda
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Mariko Mori
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Masatoshi Sakurai
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yuya Koda
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Jun Kato
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takehiko Mori
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Naohide Watanabe
- Center for Transfusion Medicine and Cell Therapy, Keio University School of Medicine, Tokyo, Japan
| | - Shinobu Noji
- Institute for Advanced Medical Research, Division of Cellular Signaling, Keio University School of Medicine, Tokyo, Japan
| | - Tomonori Yaguchi
- Institute for Advanced Medical Research, Division of Cellular Signaling, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Iwata
- Institute for Advanced Medical Research, Division of Cellular Signaling, Keio University School of Medicine, Tokyo, Japan.,Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Shigeki Ohta
- Institute for Advanced Medical Research, Division of Cellular Signaling, Keio University School of Medicine, Tokyo, Japan
| | - Tomonobu Fujita
- Institute for Advanced Medical Research, Division of Cellular Signaling, Keio University School of Medicine, Tokyo, Japan
| | - Ryuji Tanosaki
- Center for Transfusion Medicine and Cell Therapy, Keio University School of Medicine, Tokyo, Japan
| | - Makoto Handa
- Center for Transfusion Medicine and Cell Therapy, Keio University School of Medicine, Tokyo, Japan
| | - Shinichiro Okamoto
- Institute for Advanced Medical Research, Division of Cellular Signaling, Keio University School of Medicine, Tokyo, Japan
| | - Masayuki Amagai
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Yutaka Kawakami
- Institute for Advanced Medical Research, Division of Cellular Signaling, Keio University School of Medicine, Tokyo, Japan.,Department of Immunology, School of Medicine, International University of Health and Welfare, Chiba, Japan
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Komeya M, Nara S, Nagata T, Takahashi S, Uchida H, Kimura H, Fukuda K, Matsuzaki J, Yao M. Computational fluid dynamic modeling of renal stones in the renal calyx. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00599-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Asahina Y, Nakamura Y, Tanese K, Hirai I, Fukuda K, Amagai M, Funakoshi T. Metastatic Cutaneous Squamous Cell Carcinoma in Liver Successfully Treated With Partial Hepatectomy and Adjuvant Irinotecan Chemotherapy. In Vivo 2020; 34:825-828. [PMID: 32111790 DOI: 10.21873/invivo.11844] [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: 11/13/2019] [Revised: 11/29/2019] [Accepted: 12/03/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND The management of distant metastatic cutaneous squamous cell carcinoma (cSCC) relies mainly on chemotherapies and radiotherapy. Management of patients with cSCC with surgically resectable distant metastatic lesions is not clear. CASE REPORT A 59-year-old male had 4×10 cm-sized cSCC on the perianal skin with inguinal lymph node metastasis. Surgical resection was performed followed by radiation and adjuvant carboplatin and farmorubicin combination therapy. Six months later, 25 mm-sized solitary metastatic nodule arose on the liver. Base on his favorable overall condition fulfilling the criteria of tumor resectability for the treatment of tumors in liver and having good performance status, laparoscopic partial hepatectomy and six courses of adjuvant irinotecan therapy were performed. The surgical margin was negative and the patient has maintained complete remission for over 3 years. CONCLUSION The clinical course of the present case suggests that surgical approaches should also be considered as candidate additional therapy for resectable distant metastatic cSCC.
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Affiliation(s)
- Yasuhiko Asahina
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshio Nakamura
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Keiji Tanese
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Ikuko Hirai
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Keitaro Fukuda
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Masayuki Amagai
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Takeru Funakoshi
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
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Shinya Y, Kimura M, Kawakami T, Hiraide T, Moriyama H, Kataoka M, Endo J, Itabashi Y, Murata M, Kohno T, Fukuda K. Efficacy and outcomes of balloon pulmonary angioplasty in elderly vs non-elderly chronic thromboembolic pulmonary hypertension patients. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Balloon pulmonary angioplasty (BPA) has been reported as an effective and safe treatment for patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, its safety and efficacy in elderly patients remains unknown.
Purpose
We investigated the effect of BPA on hemodynamics and respiratory parameters, functional capacity, and short- and long-term outcome in elderly patients.
Methods
From November 2012 to May 2018, 141 consecutive CTEPH patients who underwent BPA in a single university hospital were enrolled (age: 65 [54.5–74] years old, WHO functional class [WHO-FC] II/III/IV; 35/96/10). Patients were divided into two groups according to the age; elderly (≥75 years, N=32) and young groups (<75 years, N=109). Hemodynamics (right-sided heart catheterization), biomarkers (brain natriuretic peptide), respiratory function (spirometry and diffusion capacity measurement), and functional capacity (6-minute walk distance [6MWD] and WHO-FC) were evaluated at baseline and 1-year post BPA. Procedure-related complications (in hospital death, use of percutaneous cardiopulmonary support [PCPS], and pulmonary injury) and all cause death during the follow up period were also assessed.
Results
At baseline, although elderly group had less severe hemodynamics (mPAP: 33.1±6.7 vs 39.0±11.8 mmHg, p<0.05), they had poor exercise capacity and reduced pulmonary diffusion capacity, compared with young group (6MWD: 264.6±101.3 vs 369.7±105.2 m, %DLco: 42.0±12.0 vs 50.2±12.7%, all p<0.05). BPA improved hemodynamics, biomarkers, exercise capacity, and pulmonary diffusion capacity in both elderly and young groups (all p<0.05). There was no in-hospital death or use of PCPS in both groups, although the incidence of pulmonary injury was higher in elderly group (14.3% vs 5.3%, p<0.01). Under the normalized hemodynamics 1-year after BPA in both groups, exercise capacity and pulmonary diffusion capacity were worse in the elderly group than young groups (p<0.01). The incidence of all-cause death in the follow up period was higher in elderly group, all of which were due to non-pulmonary hypertension (PH)-related death (p<0.01).
Conclusion
BPA was effective in improving hemodynamics and respiratory parameters and functional capacity, in associated with no critical complication, regardless of the age. Elderly patients who were treated with BPA were associated with higher incidence of non-PH-related death.
Changes of mean PAP in the two groups
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- Y Shinya
- Keio University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - M Kimura
- Keio University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - T Kawakami
- Keio University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - T Hiraide
- Keio University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - H Moriyama
- Keio University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - M Kataoka
- Keio University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - J Endo
- Keio University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - Y Itabashi
- Keio University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - M Murata
- Keio University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - T Kohno
- Kyorin University School of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
| | - K Fukuda
- Keio University School of Medicine, Department of Cardiology, Tokyo, Japan
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Shinya Y, Hiraide T, Kataoka M, Momoi M, Goto S, Katsumata Y, Endo J, Sano M, Kosaki K, Fukuda K. A novel causative gene variant, TNFRSF13B p.Gly76Ser, in patients with pulmonary arterial hypertension. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Pulmonary artery hypertension (PAH) is a poor prognostic disease. Some causative genes were reported as the PAH-associated genes. However, the pathogenetic variants in PAH-associated genes have not been identified in majority of patients with idiopathic PAH.
Purpose
Our aim was to investigate the new causative gene variants associated with PAH.
Methods
We performed whole-exome sequencing in 272 patients with idiopathic/heritable PAH. Structural analysis simulation was performed to define how the candidate gene variant affected the structure of protein.
Results
We identified the heterozygous substitution change of c.226G>A (p.Gly76Ser, rs146436713) in tumor necrotic factor receptor superfamily 13B gene (TNFRSF13B) (NM_012452.2) in 6 (2.2%) patients with idiopathic/heritable PAH, although the allele frequency of this rare variant is 0% in Integrative Japanese Genome Variation Database (control population database). Two of the six cases were blood relatives, although they did not have the known causative gene variants of PAH. One of these two relatives died of right heart failure despite the combination medical therapy, and her pathological anatomy demonstrated intimal thickening and medial hypertrophy in the pulmonary arteries, formation of plexiform lesions (Heath-Edwards classification grade V). Time-lapse images from structural analysis simulation showed the instability of N-terminal in the protein, which regulates the vascular inflammation, synthesized from TNFRSF13B p.Gly76Ser variant (Figure), suggesting that p.Gly76Ser variant may be involved in the development of PAH via aberrant inflammation in pulmonary vessels.
Conclusions
TNFRSF13B p.Gly76Ser variant is a candidate of causative gene variant for PAH.
Structural analysis of proteins
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- Y Shinya
- Keio University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - T Hiraide
- Keio University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - M Kataoka
- Keio University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - M Momoi
- Keio University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - S Goto
- Keio University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - Y Katsumata
- Keio University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - J Endo
- Keio University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - M Sano
- Keio University School of Medicine, Department of Cardiology, Tokyo, Japan
| | - K Kosaki
- Keio University School of Medicine, Center for Medical Genetics, Tokyo, Japan
| | - K Fukuda
- Keio University School of Medicine, Department of Cardiology, Tokyo, Japan
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Shiozaki M, Inoue K, Suwa S, Lee C, Chiang S, Fukuda K, Hiki M, Kubota N, Tamura H, Fujiwara Y, Miyazaki T, Hirano Y, Sumiyoshi M. One-year outcome of the rule-out group according to the 0-h /1-hour algorithm with suspected myocardial infarction in Asian countries. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction; A rapid rule-out or rule-in protocol based on the 0-h/1-hour algorithm using high-sensitivity cardiac troponin T (hs-cTnT) is recommended by the European Society of Cardiology (ESC). Around 40–50% were stratified into “rule-out” group, and their 30-days prognosis was excellent. However, the one-year prognosis is uncertain. We aimed to better characterize these patients.
Methods
This study was a prospective, multi-center, observational study of patients with suspected non-ST elevation acute coronary syndrome (NSTE-ACS) admitted to 5 hospitals in Japan and Taiwan from 2014 November to 2018 December, respectively.
All patients underwent a clinical assessment the included medical history, physical examination, 12-lead ECG, standard blood test, chest radiography. Exclusion criteria were ST elevated myocardial infarction, chronic kidney disease (serum creatinine more than 3 mg/dL) and congestive heart failure, arrhythmia, or infection disease. The patients were divided into three groups according to the algorithm; “rule-out”, “observe” and “rule-in”. The final diagnosis was then adjudicated by 2 independent cardiologists using all available information, including coronary angiography, coronary computed tomography, stress electrocardiography and follow-up data. The presence of acute myocardial infarction (AMI) was defined according to the Fourth Universal Definition of Myocardial Infarction. After hospital discharge patients were follow after one-year b telephone or in written form. Major adverse cardiovascular events (including death myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention (PCI)) were recorded by establishing contact with the patient and the family physicians. The primary prognosis end point was all-cause mortality.
Results
Of the 1,187 patients were analyzed after exclusion. The prevalence rate of AMI was 16.1%. According to the algorithm, 42% (n=493) of patients were assigned to “rule-out” group and had no AMI nor death. The most common final adjudicated diagnoses were atypical chest pain (80%), gallstone attack (3%) and vasospastic angina pectoris (2%). All patients with unstable angina (4.7%) underwent PCI.
Conclusion(s)
Our findings suggest that the “rule-out” group patients according to ESC 0-h/1-hour algorithm provides very high safety and efficacy for the triage toward AMI.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Shiozaki
- Juntendo University Nerima Hospital, Cardiology, Tokyo, Japan
| | - K Inoue
- Juntendo University Nerima Hospital, Cardiology, Tokyo, Japan
| | - S Suwa
- Juntendo University Shizuoka Hospital, Cardiology, Izunokuni, Japan
| | - C.C Lee
- National Taiwan University Hospital, Emergency Medicine, Taipei, Taiwan
| | - S.J Chiang
- Taipei City Hospital, Cardiology, Taipei, Taiwan
| | - K Fukuda
- Juntendo University Nerima Hospital, Cardiology, Tokyo, Japan
| | - M Hiki
- Juntendo University Nerima Hospital, Cardiology, Tokyo, Japan
| | - N Kubota
- Juntendo University Nerima Hospital, Cardiology, Tokyo, Japan
| | - H Tamura
- Juntendo University Nerima Hospital, Cardiology, Tokyo, Japan
| | - Y Fujiwara
- Juntendo University Nerima Hospital, Cardiology, Tokyo, Japan
| | - T Miyazaki
- Juntendo University Urayasu Hospital, Cardiology, Chiba, Japan
| | - Y Hirano
- Juntendo University Urayasu Hospital, Emergency and Critical Care Medicine, Chiba, Japan
| | - M Sumiyoshi
- Juntendo University Nerima Hospital, Cardiology, Tokyo, Japan
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Kimura M, Kohno T, Kawakami T, Shinya T, Hiraide T, Moriyama H, Kataoka M, Endo J, Itabash Y, Mitsushige M, Fukuda K. De-escalation/discontinuation of oxygen-therapy and medication is feasible and safe in chronic thromboembolic pulmonary hypertension patients treated with balloon pulmonary angioplasty. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
There has been increasing evidence of the efficacy of balloon pulmonary angioplasty (BPA) in improving the hemodynamics, exercise capacity, and biomarkers of patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, there is no consensus on the adjustment of home oxygen therapy (HOT) and pulmonary hypertension (PH)-specific medications after BPA in patients with CTEPH.
Purpose
We aimed to examine the current status of the de-escalation/discontinuation of HOT and PH-specific medications post-BPA, and clarify its effect on subsequent hemodynamics, biomarkers, and long-term clinical outcomes.
Methods and results
From November 2012 to July 2019, 134 consecutive CTEPH patients who underwent BPA at a single university hospital were enrolled (age; 63.6±13.4 years, female; n=87 [64.9%], WHO functional class [WHO-FC] II/III/IV; 33/92/9). Hemodynamic data, functional capacity (6-minute walk distance and WHO-FC), biomarkers (brain natriuretic peptide [BNP] and high-sensitivity troponin T [hs-TropT]), and respiratory function were evaluated at baseline, immediately and 1 year post-BPA. Clinical outcomes (all-cause death and heart failure [HF] admission) were also assessed during the follow up period. The total number of sessions was 6.3±2.0, and the number of target vessels was 14.3±2.0. Mean pulmonary arterial pressure decreased from 37.8±11.2 to 20.4±5.1 mmHg 1-year after BPA (p<0.01). The proportion of patients who required HOT (at rest or on exertion) and combination medical therapy (≥2 PH-specific medications) decreased 1 year post-BPA (from 59.0% to 7.5%, and from 41.8% to 10.4%, respectively; Figure). Among 79 patients who required HOT during daytime, 64 patients (81.0%) discontinued HOT just after BPA completion. Among 56 patients who required combination medical therapy, 29 (51.8%) discontinued combination therapy. Baseline factors influencing the continuation of HOT and combination medical therapy post-BPA were almost identical (i.e. lower exercise capacity and pulmonary diffusion capacity, and worse hemodynamics). Results showed that discontinuation of HOT and combination medical therapy did not affect the maintenance of improved hemodynamics and levels of BNP and hs-TropT, and no adverse clinical outcomes (all-cause death and HF hospitalization) were observed during 1 year post-BPA.
Conclusions
Most CTEPH patients discontinued HOT and PH-specific combination medical therapy after BPA, which was not associated with the deterioration of hemodynamics, functional capacity, or biomarkers. No adverse long-term outcomes were observed. De-escalation/discontinuation of HOT and PH-specific combination medical therapy after BPA is feasible and safe for patients with CTEPH.
De-escalation of HOT and medical therapy
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Kimura
- Keio University Hospital, Cardiology, Tokyo, Japan
| | - T Kohno
- Kyorin University School of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
| | - T Kawakami
- Keio University Hospital, Cardiology, Tokyo, Japan
| | - T Shinya
- Keio University Hospital, Cardiology, Tokyo, Japan
| | - T Hiraide
- Keio University Hospital, Cardiology, Tokyo, Japan
| | - H Moriyama
- Keio University Hospital, Cardiology, Tokyo, Japan
| | - M Kataoka
- Keio University Hospital, Cardiology, Tokyo, Japan
| | - J Endo
- Keio University Hospital, Cardiology, Tokyo, Japan
| | - Y Itabash
- Keio University Hospital, Cardiology, Tokyo, Japan
| | - M Mitsushige
- Keio University Hospital, Cardiology, Tokyo, Japan
| | - K Fukuda
- Keio University Hospital, Cardiology, Tokyo, Japan
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Miyama H, Takatsuki S, Hashimoto K, Yamashita T, Fujisawa T, Katsumata Y, Kimura T, Fukuda K. Change of the pulmonary vein anatomy after cryoballoon ablation reflecting left atrial reverse remodeling. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cryoballoon ablation (CBA) is a widely used procedure for atrial fibrillation (AF). However, the anatomical change of pulmonary veins (PVs) and the risk factors of PV stenosis is less clear. We aimed to decipher the prevalence and the predictive factors for PV stenosis after CBA.
Methods
We analyzed the data of 320 PVs from 80 patients who underwent CBA for AF (age: 62±10 years, 59 males, 75 paroxysmal AF). All patients underwent pre- and post-procedural cardiac computed tomography (mean 6.7±3.3 months after ablation). We defined the PV stenosis when the cross sectional area of PV was less than 50% compared with that of PV before the CBA.
Results
The average cross sectional PV area decreased significantly after CBA (pre- vs. post-CBA; 2.4±1.0cm2 vs. 2.3±1.1cm2, P<0.001), whereas the volume of left atrium (LA) also decreased significantly (pre- vs. post-CBA; 75.0±23.2cm3 vs. 70.7±21.9cm3, P<0.001). There was a weak but significant correlation between the reduction rate of PV area and that of LA volume (Pearson's correlation coefficient 0.411, p<0.001). Only 6 PV stenosis were revealed, in which area reduction of more than 75% and 50–75% were observed in 2 PVs and 4 PVs, respectively. The incidence of PV stenosis was greater in female (male vs. female; 0.8% vs. 4.8%, P=0.043) and tend to be frequent in left PVs (left PVs vs. right PVs; 3.1% vs. 0.6%: P=0.107). Moreover, patients who developed PV stenosis tended to have lower weight and shorter height (PV stenosis group vs. non-PV stenosis group; 58.2±12.4kg vs. 67.7±13.0kg: P=0.078, 161.2±9.1cm vs. 167.2±8.8cm: P=0.094). There were no significant differences in the number of freezing, minimum temperature and total freezing time between PV stenosis group and non-PV stenosis group.
Conclusions
The ostial PV area decreased significantly but little after CBA, possibly due to LA reverse remodeling. The PV stenosis was more common in women and tend to be frequent in left PVs, lower weight, and shorter height patients, though severe stenosis after CBA was not observed in this study.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- H Miyama
- Keio University School of Medicine, Tokyo, Japan
| | - S Takatsuki
- Keio University School of Medicine, Tokyo, Japan
| | - K Hashimoto
- Keio University School of Medicine, Tokyo, Japan
| | - T Yamashita
- Keio University School of Medicine, Tokyo, Japan
| | - T Fujisawa
- Keio University School of Medicine, Tokyo, Japan
| | - Y Katsumata
- Keio University School of Medicine, Tokyo, Japan
| | - T Kimura
- Keio University School of Medicine, Tokyo, Japan
| | - K Fukuda
- Keio University School of Medicine, Tokyo, Japan
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Ishii M, Hirai I, Tanese K, Fusumae T, Nakamura Y, Fukuda K, Uchi H, Kabashima K, Otsuka A, Yokota K, Yamazaki N, Namikawa K, Fujimura T, Takenouchi T, Yamamoto Y, Nishiguchi M, Sato Y, Amagai M, Funakoshi T. Anti-PD-1 antibody therapy for epithelial skin malignancies: An investigator-initiated, open-label, single-arm, multicenter, phase II clinical trial (NMSC-PD1 Study). Medicine (Baltimore) 2020; 99:e22913. [PMID: 33126349 PMCID: PMC7598805 DOI: 10.1097/md.0000000000022913] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Malignant cutaneous epithelial tumors comprise various skin malignancies originating from the cutaneous epithelium, including cutaneous squamous cell carcinoma, basal cell carcinoma, and malignant cutaneous adnexal tumors. Treatment options are limited, as the rarity of these tumors, especially among Asians, renders well-controlled clinical trials extremely challenging to conduct. Thus, we designed a clinical trial to evaluate the efficacy and safety of the anti-programmed cell death-1 (PD-1) monoclonal antibody nivolumab in patients with metastatic cutaneous squamous cell carcinomas and other rare metastatic cutaneous epithelial tumors. METHODS AND ANALYSIS This is an open-label, single-arm, multicenter, phase 2 clinical trial involving patients with metastatic malignant cutaneous epithelial tumors. Nivolumab (480 mg) will be administered intravenously every 4 weeks for a maximum of 26 doses. The primary outcome of the study will be the response rate based on response evaluation criteria in solid tumors, version 1.1. Assuming a null hypothesis of a response rate ≤5% and an alternative hypothesis of a 25% response rate, a minimum of 26 patients are required to achieve a 5% two-sided type I error and 80% power based on the exact binomial distribution. Finally, a target cohort size of 30 patients was determined as some patient dropout will be expected. DISCUSSION This is the first phase 2 clinical trial evaluating the efficacy and safety of the PD-1 inhibitor nivolumab in Asian patients with metastatic malignant cutaneous epithelial tumors. The findings of the study will contribute to the development of novel treatment approaches for patients with rare cutaneous malignancies, which remains an unmet clinical need. TRIAL REGISTRATION Registry number: jRCT 2031190048.
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Affiliation(s)
- Maki Ishii
- Department of Dermatology, Keio University School of Medicine, Tokyo
| | - Ikuko Hirai
- Department of Dermatology, Keio University School of Medicine, Tokyo
| | - Keiji Tanese
- Department of Dermatology, Keio University School of Medicine, Tokyo
| | - Takayuki Fusumae
- Department of Dermatology, Keio University School of Medicine, Tokyo
| | - Yoshio Nakamura
- Department of Dermatology, Keio University School of Medicine, Tokyo
| | - Keitaro Fukuda
- Department of Dermatology, Keio University School of Medicine, Tokyo
| | - Hiroshi Uchi
- Department of Dermato-oncology, National Hospital Organization Kyushu Cancer Center
| | | | | | - Kenji Yokota
- Department of Dermatology, Nagoya University Hospital
| | - Naoya Yamazaki
- Department of Dermatologic oncology, National Cancer Center Hospital
| | - Kenjiro Namikawa
- Department of Dermatologic oncology, National Cancer Center Hospital
| | - Taku Fujimura
- Department of Dermatology, Tohoku University Graduate School of Medicine
| | | | - Yuki Yamamoto
- Department of Dermatology, Wakayama Medical University
| | | | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Masayuki Amagai
- Department of Dermatology, Keio University School of Medicine, Tokyo
| | - Takeru Funakoshi
- Department of Dermatology, Keio University School of Medicine, Tokyo
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Fujita M, Fukuda K, Hayashi S, Kikuchi K, Takashima Y, Kamenaga T, Maeda T, Matsubara T, Kuroda R. AB0089 THE ANALYSIS FOR THE INHIBITION OF ANGIOGENESIS BY JAK INHIBITOR. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Many blood vessels are generated in the hyperplastic synovial tissue of patients with rheumatoid arthritis (RA), and lead to chronic tissue inflammation and joint destruction [1]. Janus kinase (JAK) family consisting of JAK1, JAK2, JAK3 and tyrosine kinase 2 (TYK2) are chain receptors which phosphorylate signal transducers and activators of transcription (STAT) and mediate inflammatory diseases including RA [2]. Nowadays, several JAK inhibitors such as Tofacitinib (TOF), Baricitinib (BAR) and Peficitinib (PEF) have been developed and demonstrated to have the inhibitory effects on inflammatory arthritis [3-5]. However, there were few reports concerning their effects on angiogenesis in vitro.Objectives:The purpose of the present study is to investigate the influence of JAK inhibitors on angiogenesis of human umbilical vein endothelial cell (HUVEC) activated by vascular endothelial growth factor (VEGF).Methods:The cell line of HUVECs were used for this study. The activity of proliferation and tube formation were analyzed by counting assay and tube formation assay, respectively.In counting assay, HUVECs (5 × 104cells/ml) were seeded onto 96-well cell culture plate with 20 ng/ml VEGF including various doses (0.1µM, 1µM, 5µM) of TOF, BAR or PEF. After 48 hours incubation at 37°C in a humidified atmosphere containing 5% CO2, cell proliferation of each groups was assessed using cell counting kit. In tube formation assay, HUVECs (5 × 104cells/ml) were treated with 20ng/ml VEGF including various dose (0.1µM, 1µM, 5µM) of TOF, BAR or PEF for 00 hours, then seeded onto 48-well plate applied with Matrigel. After 24 hours incubation on Matrigel, the capillary-like tube formation of each well was photographed using phase contrast microscopy. Tube formation were quantitated by measurement of the length of branch.Results:HUVECs were activated in proliferation and tube formation by VEGF treatment. And, the proliferation and tube formation of HUVECs activated by VEGF were suppressed by All of TOF, BAR and PEF. In particular, TOF and PEF could suppress them highly.Conclusion:This study showed the inhibitory effect of JAK inhibitors on proliferation and tube formation of HUVECs activated by VEGF. In particular, the angiogenesis of HUVECs activated by VEGF was highly suppressed by TOF and PEF. VEGF is reported to regulate the angiogenesis through multi JAK-STAT signaling pathways [6]. The inhibitory effects on angiogenesis of TOF, BAR and PEF might depend on the differences in their affinity for JAKs. VEGF has been shown to a have a central involvement in the angiogenic process in RA [7]. JAK inhibitors might suppress the angiogenesis in RA synovial tissues by inhibiting VEGF signaling.References:[1]Scott DL, et al. Rheumatoid arthritis. Lancet. 2010.[2]Banerjee S, et al. JAK-STAT signaling as a target for inflammatory and autoimmune diseases: current and future prospects. Drugs. 2017.[3]William D, et al. JAK inhibitors in dermatology: the promise of a new drug class. Journal of the American Academy of Dermatology. 2017.[4]Dhillon S. Tofacitinib: A Review in Rheumatoid Arthritis. Drugs. 2017.[5]Markham A, et al. Peficitinib: First Global Approval. Drugs. 2019.[6]Zhang HY, et al. Three important components in the regeneration of the cavernous nerve: brain-derived neurotrophic factor, vascular endothelial growth factor and the JAK/STAT signaling pathway. Asian journal of andrology. 2011.[7]Paleolog EM. Angiogenesis in rheumatoid arthritis. Arthritis research. 2002.Acknowledgments:noneDisclosure of Interests:None declared
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Takashima Y, Fukuda K, Hayashi S, Kamenaga T, Fujita M, Kikuchi K, Kuroda R, Funahashi K, Matsubara T. SAT0019 HISTOPATHOLOGICAL CHANGES OF SYNOVIAL TISSUE IN RHEUMATOID ARTHRITIS PATIENTS TREATED WITH TNF INHIBITORS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by hyperplasia of synovial tissues [1]. Tumor necrosis factor (TNF)-α is one of the pro-inflammatory cytokines that play a crucial role in the pathogenesis of RA synovitis, and TNF inhibitors (TNFi) were reported to force the RA to go into remission or low disease activity and have brought revolutionary impacts on RA treatment [2]. TNFi have been shown to act on inflammatory cells and form the discoid fibrosis in the sublining layers [3,4]. However, the changes of synovial tissue and the cause of discoid fibrosis in RA patients treated with TNFi has not been determined in detail.Objectives:The purpose of this study is to demonstrate the histological changes and the types of cells around discoid fibrosis in RA synovium treated with TNFi.Methods:Synovial tissues were obtained from 30 patients with RA during joint surgeries. 6 patients were treated with TNFi (1 patient with golimumab, 3 patients with etanercept, 2 patients with infliximab). As a control, synovial tissues were obtained from 6 patients who were treated only with csDMARDs (6 patients with MTX). The frozen sections were stained by hematoxylin and eosin (HE). To detect the apoptosis, TdT-mediated dUTP nick end labeling (TUNEL) was performed. The immunohistochemical characterization of the synovial cells was performed by using following antibodies: CD20 and CD3 for detecting B and T lymphocytes respectively, CD163 and CD86 for detecting M1 and M2 macrophage respectively.Results:In the sections stained with HE, the formation of discoid fibrosis and the other characteristic changes including hydropic degeneration, vacuolation, sclerosis of small vasculature, and the number of multilayered synovial cells was decreased in synovium from RA patients treated with TNFi. In the sections with TUNEL stain, apoptosis of lining cells around the discoid fibrosis was detected in RA synovium treated with TNFi (Figure 1a, 1b). In the sections with immunohistochemistry stain, CD86 expression increased in lining layer of RA synovium treated with TNFi. CD163 positive cells showed diffuse expression in RA synovium treated with TNFi. In contrast, CD20 and CD3 positive cells decreased around discoid fibrosis compared to control sections. These results showed indicated that the types of cells in lining and sublining layers were mainly macrophages and that the apoptosis of macrophages might form the discoid fibrosis in lining layers.Conclusion:This study showed the apoptosis of lining cells derived from macrophages resulted in the formation of the discoid fibrosis. These findings indicated TNFi might induce apoptosis of macrophage leading to the suppression of RA synovitis.References:[1] Scott Dl, et al. Progression of radiological changes in rheumatoid arthritis. Ann Rheum Dis. 1984.[2]van der Heijde D,et al. Comparison of etanercept and methotrexate, alone and combined, in the treatment of rheumatoid arthritis: two-year clinical and radiographic results from the TEMPO study, a double-blind, randomized trial. Arthritis Rheum. 2006.[3] Hirohata S,et al. TNF inhibitors induce discoid fibrosis in the sublining layers of the synovium with degeneration of synoviocytes in rheumatoid arthritis. Rheumatol Int. 2013.[4] Yamanaka H,et al. Scoring evaluation for histopathological features of synovium in patients with rheumatoid arthritis during anti-tumor necrosis factor therapy. Rheumatol Int. 2010.Acknowledgments :This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.Disclosure of Interests:None declared
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Fukuda K, Miura Y, Hayashi S, Maeda T, Kuroda R. AB0090 DEATH RECEPTOR 3 REGULATES THE GENE EXPRESSIONS OF VARIOUS KEY MOLECULES IN RHEUMATOID SYNOVIAL FIBROBLASTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Rheumatoid arthritis (RA) is a chronic inflammatory disease that causes hyperplasia of synovial tissue. Death receptor 3 (DR3) is a tumor necrosis factor receptor and binds to TL1A, a member of the TNF family. DR3 is involved in the mechanism of cell proliferation and apoptosis through NF-κB signaling. Suppression of DR3 in rheumatoid synovial fibroblasts (RA-FLS) is associated with hyperplasia of rheumatoid synovial tissue [1]. We previously revealed the expression profiles regulated by TL1A, suggesting that TL1A might affect the pathogenesis of RA, including proliferation, regulation of B cells and T cells, inflammation, and cytokine processing [2].Objectives:In this study, we investigated the gene expression profiles regulated by DR3 in RA-FLS to reveal how DR3 is involved in the pathogenesis of RA.Methods:RA-FLS were from patients with RA. Four individual lines of primary cultured RA-FLS were incubated either with 1000 ng/ml of human DR3-Fc protein or 1000ng/ml of human IgG1 as a control for 12h. Gene expressions were detected by microarray assay.Results:Microarray data analysis revealed that DR3 up-regulated or down-regulated the expression of various genes in RA-FLS (Figure). The function of regulated genes included protein-L-isoaspartate (D-aspartate) O-methyltransferase activity, carboxyl-O-methyltransferase activity, protein carboxyl O-methyltransferase activity, regulation of cilium assembly, O-methyltransferase activity, regulation of plasma membrane bounded cell projection assembly, regulation of cell projection assembly, regulation of organelle assembly, protein methyltransferase activity, and S-adenosylmethionine-dependent methyltransferase activity. The most up-regulated 2 genes by DR3 were KIAA1109 (KIAA1109), and adhesion G protein-coupled receptor A3 (ADGRA3). The most down-regulated 2 genes by DR3 were RNA exonuclease 2 (REXO2), and family with sequence similarity 120A (FAM120A).Conclusion:In this study, we first revealed the expression profiles of genes regulated by DR3 in RA-FLS. KIAA1109/TENR/IL2/IL21 gene is strongly associated with RA in European descent populations [3]. ADGRA3 is a member of G protein-coupled receptors (GPCRs). GPCRs associates with the regulation of cytoskeletal organization, the cell adhesion and migration, cell proliferation and apoptosis, and cell differentiation [4]. Loss of REXO2 affects cell growth and morphology [5], and REXO2 was identified as a target gene for inflammatory bowel disease-associated variants [6]. FAM120A regulates activity of Src kinase to protect cells from oxidative stress-induced apoptosis [7]. DR3 regulates the gene expressions of various key molecules in RA-FLS and may affect the pathogenesis of RA by regulating gene expression of RA-FLS.References:[1]Takami N. et al., Arthritis Rheuma. 2006;54:779-787.[2]Fukuda K. et al., Biomed Rep. 2019;1:1-5.[3]Teixeira VH. et al., Arthritis Research & Therapy. 2009;11:R45.[4]Hamann J. et al., Pharmacol Rev. 2015;67:338-367.[5]Bruni F, et al., PLoS One. 2013;8:e64670.[6]Hulur I, et al., BMC Genomics. 2015;16:138.[7]Tanaka M. et al., Mol Cell Biol. 2009;29:402-413.Disclosure of Interests:None declared
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Fusumae T, Fukuda K, Hirai I, Nakamura Y, Tanese K, Iwata T, Funakoshi T. Outcomes in patients with extramammary Paget disease with brain metastasis: A retrospective analysis. J Am Acad Dermatol 2020; 83:1832-1834. [PMID: 32450098 DOI: 10.1016/j.jaad.2020.05.094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Takayuki Fusumae
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Keitaro Fukuda
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan.
| | - Ikuko Hirai
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshio Nakamura
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Keiji Tanese
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Iwata
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Takeru Funakoshi
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
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Yamamoto T, Fukuda K, Morita A, Kimura T, Morishima H, Goto R, Zheng R, Terui T. Efficacy of guselkumab in a subpopulation with pustulotic arthro-osteitis through week 52: an exploratory analysis of a phase 3, randomized, double-blind, placebo-controlled study in Japanese patients with palmoplantar pustulosis. J Eur Acad Dermatol Venereol 2020; 34:2318-2329. [PMID: 32173916 PMCID: PMC7586986 DOI: 10.1111/jdv.16355] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/18/2020] [Indexed: 12/11/2022]
Abstract
Background Previous studies of guselkumab have demonstrated clinical benefits in patients with plaque‐type psoriasis, generalized pustular psoriasis, erythrodermic psoriasis and palmoplantar pustulosis (PPP). Objective The aim of this exploratory analysis of a double‐blind, multicenter, placebo‐controlled, phase 3 study in Japanese patients with PPP was to evaluate the efficacy of guselkumab in the subset of patients with pustulotic arthro‐osteitis (PAO). Methods Patients were randomized to receive guselkumab 100 or 200 mg at weeks 0, 4, 12 and every 8 weeks, or placebo with cross‐over to guselkumab 100 or 200 mg at week 16 (placebo group). Efficacy endpoints were changes from baseline in magnetic resonance imaging (MRI) score, EuroQOL‐5 dimensions (EQ‐5D) index score, EQ‐5D pain/discomfort dimension score and C‐reactive protein (CRP, mg/L) level in all PAO patients through week 52. Data from both guselkumab groups were combined and presented as results for a single overall guselkumab group. Results Among 159 patients with PPP, 66 with PAO were randomized across treatment groups. For patients with MRI data for all regions assessed, the proportion of patients in the guselkumab group with PAO characterized as severe decreased from 23.8% (10/42) at baseline to 5.4% (2/42) at week 52. The mean (SD) change from baseline at week 52 in EQ‐5D index score was 0.20 (0.17) among PPP patients with PAO and 0.15 (0.17) among those without PAO in the guselkumab group. Among all PAO patients, the proportions with an EQ‐5D pain/discomfort dimension score of no or slight pain/discomfort in the guselkumab group increased from baseline to week 52 [33.3% (7/21) vs. 87.5% (35/40)]. The mean (SD) CRP levels decreased in all PAO patients in the guselkumab group at week 52 compared to baseline [−1.71 (8.16) mg/L]. Conclusion Guselkumab treatment showed beneficial outcomes for PAO signs and symptoms in Japanese patients with PPP.
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Affiliation(s)
- T Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - K Fukuda
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - A Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - T Kimura
- Janssen Pharmaceutical K.K, Tokyo, Japan
| | | | - R Goto
- Janssen Pharmaceutical K.K, Tokyo, Japan
| | - R Zheng
- Janssen Pharmaceutical K.K, Tokyo, Japan
| | - T Terui
- Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
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Matsuda S, Kawakubo H, Takeuchi H, Hayashi M, Mayanagi S, Takemura R, Irino T, Fukuda K, Nakamura R, Wada N, Kitagawa Y. Minimally invasive oesophagectomy with extended lymph node dissection and thoracic duct resection for early-stage oesophageal squamous cell carcinoma. Br J Surg 2020; 107:705-711. [PMID: 32077101 DOI: 10.1002/bjs.11487] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 10/05/2019] [Accepted: 12/02/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Oesophageal squamous cell carcinoma is an aggressive disease owing to early and widespread lymph node metastases. Multimodal therapy and radical surgery may improve prognosis. Few studies have investigated the efficacy of radical lymph node and thoracic duct resection. METHODS Patients with oesophageal squamous cell carcinoma who underwent transthoracic minimally invasive oesophagectomy (TMIE) for cancer at Keio University Hospital between January 2004 and December 2016 were selected. Between 2004 and 2008, TMIE was performed in the lateral decubitus position without thoracic duct resection (standard TMIE). From 2009 onwards, TMIE with extended lymph node and thoracic duct resection was introduced (extended TMIE). Demographics, co-morbidity, number of retrieved lymph nodes, pathology, postoperative complications and recurrence-free survival (RFS) were compared between groups. RESULTS Forty-four patients underwent standard TMIE and 191 extended TMIE. There were no significant differences in clinical and pathological tumour stage or postoperative complications. The extended-TMIE group had more lymph nodes removed at nodal stations 106recL and 112. Among patients with cT1 N0 disease, RFS was better in the extended-TMIE group (P < 0·001), whereas there was no difference in RFS between groups in patients with advanced disease. CONCLUSION Extended TMIE including thoracic duct resection increased the number of lymph nodes retrieved and was associated with improved survival in patients with cT1 N0 oesophageal squamous cell carcinoma.
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Affiliation(s)
- S Matsuda
- Department of Surgery, Keio University School of Medicine, Keio University Hospital, Tokyo, Japan
| | - H Kawakubo
- Department of Surgery, Keio University School of Medicine, Keio University Hospital, Tokyo, Japan
| | - H Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - M Hayashi
- Department of Surgery, Keio University School of Medicine, Keio University Hospital, Tokyo, Japan
| | - S Mayanagi
- Department of Surgery, Keio University School of Medicine, Keio University Hospital, Tokyo, Japan
| | - R Takemura
- Biostatistics Unit, Clinical and Translational Research Centre, Keio University Hospital, Tokyo, Japan
| | - T Irino
- Department of Surgery, Keio University School of Medicine, Keio University Hospital, Tokyo, Japan
| | - K Fukuda
- Department of Surgery, Keio University School of Medicine, Keio University Hospital, Tokyo, Japan
| | - R Nakamura
- Department of Surgery, Keio University School of Medicine, Keio University Hospital, Tokyo, Japan
| | - N Wada
- Department of Surgery, Keio University School of Medicine, Keio University Hospital, Tokyo, Japan
| | - Y Kitagawa
- Department of Surgery, Keio University School of Medicine, Keio University Hospital, Tokyo, Japan
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Nakamura Y, Tanese K, Hirai I, Fukuda K, Kawakami Y, Amagai M, Funakoshi T. Weekly docetaxel monotherapy for metastatic extramammary Paget's disease: Retrospective single-institute analysis. J Dermatol 2020; 47:418-422. [PMID: 32020662 DOI: 10.1111/1346-8138.15255] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 01/08/2020] [Indexed: 11/28/2022]
Abstract
Monthly docetaxel (DTX) monotherapy is the first-line regimen that is preferably used for metastatic extramammary Paget's disease (EMPD). However, the high-dose DTX regimen frequently causes severe hematological adverse events (AE). To overcome such safety concerns, a weekly low-dose DTX monotherapy has been proposed for use in the treatment of various cancer types. In this study, we aimed to evaluate the feasibility and efficacy of weekly DTX (25 mg/m2 ) monotherapy for metastatic EMPD by retrospectively analyzing the clinical courses of 14 patients treated with this regimen. Weekly DTX monotherapy was well tolerated and all patients completed the treatment schedule without treatment withdrawal, dose reduction or treatment-related death. While five cases (35.7%) experienced hematological AE, their severity was mild. The response rate was 35.7% (5/14 cases), which included five partial responses. The mean progression-free survival (PFS) and overall survival were 7.1 (95% confidence interval [CI], 5.1-9.1) and 26.4 months (95% CI, 16.7-36.1), respectively. Furthermore, the median PFS was 7.3 months (95% CI, 4.5-10.0) in patients aged 65 years and younger and 7.1 months (95% CI, 4.4-9.9) in patients older than 65 years. These results suggest that weekly DTX monotherapy may be a useful regimen that has a high treatment continuation rate with low levels of hematological toxicity, regardless of the patient's age for metastatic EMPD.
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Affiliation(s)
- Yoshio Nakamura
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Keiji Tanese
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Ikuko Hirai
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Keitaro Fukuda
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Yutaka Kawakami
- Division of Cellular Signaling, Institute for Advanced Medical Research, Keio University School of Medicine, Tokyo, Japan.,Department of Immunology, International University of Health and Welfare School of Medicine, Tokyo, Japan
| | - Masayuki Amagai
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Takeru Funakoshi
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
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Shinada K, Kohno T, Fukuda K, Higashitani M, Kawamatsu N, Kitai T, Shibata T, Takei M, Nochioka K, Nakazawa G, Shiomi H, Miyashita M, Mizuno A. 2206Prevalence and determinants of complicated grief in bereaved caregivers of patients admitted for cardiovascular diseases. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Few studies have examined complicated grief in bereaved caregivers of patients with cardiovascular diseases (CVD), in contrast with studies in caregivers of patients with cancers. We examined the prevalence and determinants of complicated grief among bereaved caregivers of patients with CVD.
Methods
We conducted a cross-sectional survey using a self-administered questionnaire for bereaved family members of CVD patients who had died in the cardiology departments of 9 tertiary care centers in Japan. We assessed bereaved caregiver grief status using the Brief Grief Questionnaire (BGQ), and its association with their depression (Patient Health Questionnaire-9 [PHQ-9]). Questionnaire also covered following associated factors: bereaved family member and patient characteristics, end-of-life care (Care Evaluation Scale [CES], a scale for assessment of the structure and process of care); and the quality of the deceased patients' death (Good Death Inventory [GDI]).
Results
A total of 269 bereaved caregivers (mean age, 64±12 years; 35% male) of patients with CVD (heart failure n=155 myocardial infarction n=32, cardiopulmonary arrest n=15, arrhythmia n=8, and others n=59) were enrolled in the study. Overall, 14.1% of the bereaved caregivers had complicated grief (BGQ≥8), 32.3% had subthreshold complicated grief (BGQ=5–7), and 13.3% had depression (PHQ-9≥10). Bereaved caregivers with complicated grief frequently developed depression (58% vs. 6%, p<0.001). Among the bereaved caregivers with complicated grief, the assessment of end-of-life care was worse (CES score: 28 [21–40] vs. 23 [19–39], p=0.04), and the assessment of the deceased patients' quality of death tended to be worse (GDI score: 4.0 [3.0–4.8] vs. 4.3 [3.7–4.9], p=0.05). The cause of admission as well as preferences of the patient and family (e.g., treatment [focusing on extending life vs. relieving discomfort], desire for information, place of end-of-life) were not associated with the prevalence of complicated grief. The prevalence of complicated grief was associated with loss of a spouse, poor psychological health during the deceased patients' admission, and poor preparation for the patient's imminent death (all p<0.05). Bereaved caregivers with complicated grief had experienced more decisional burdens regarding the deceased patients' treatment (55% vs. 25%, p=0.001). Notably, 64% of bereaved caregivers with complicated grief were not treated (i.e., neither routine follow-up by psychiatrists/psychotherapist nor prescription for anti-depressants/tranquilizers).
Conclusions
The prevalence of complicated grief of bereavement was 14.0%. When subthreshold complicated grief was included, the prevalence of complicated grief increased to include half of the caregivers; therefore, routine screening of the bereaved could be recommended. Clinicians should pay particular attention to bereaved families with high risk factors to identify those at risk for future development of complicated grief.
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Affiliation(s)
- K Shinada
- Keio University School of Medicine, Division of Cardiology, Department of Medicine, Tokyo, Japan
| | - T Kohno
- Keio University School of Medicine, Division of Cardiology, Department of Medicine, Tokyo, Japan
| | - K Fukuda
- Keio University School of Medicine, Division of Cardiology, Department of Medicine, Tokyo, Japan
| | - M Higashitani
- Tokyo Medical University Ibaraki Medical Center, Department of Cardiology, Ibaraki, Japan
| | - N Kawamatsu
- Mito Saiseikai General Hospital, Department of Cardiology, Ibaraki, Japan
| | - T Kitai
- Kobe City Medical Center General Hospital, Departments of 1) Cardiovascular Medicine and 2) Clinical Research Support, Kobe, Japan
| | - T Shibata
- Kurume University School of Medicine, Division of Cardiovascular Medicine, Department of Internal Medicine, Fukuoka, Japan
| | - M Takei
- Tokyo Saiseikai Central Hospital, Department of Cardiology, Tokyo, Japan
| | - K Nochioka
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - G Nakazawa
- Tokai University School of Medicine, Department of Cardiology, Kanagawa, Japan
| | - H Shiomi
- Kyoto University Graduate School of Medicine, Department of Cardiology, Kyoto, Japan
| | - M Miyashita
- Tohoku University Graduate School of Medicine, Division of Palliative Nursing, Health Sciences, Sendai, Japan
| | - A Mizuno
- St. Luke's International Hospital, Department of Cardiology, Tokyo, Japan
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Kitakata H, Kohno T, Kohsaka S, Fujisawa D, Nakano N, Shiraishi Y, Katsumata Y, Yuasa S, Fukuda K. P5411Prognostic communication with hospitalized heart failure patients; the patients' perspective. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Informing heart failure (HF) patients about their prognosis is an important part of clinical management, particularly at the time of hospitalization. Current European Society of Cardiology guidelines recommend communicating this information to HF patients at the time of hospitalization and with any change in clinical status. However, little is known about actual patient preferences, understanding, and attitudes towards prognostic communication with their treating physicians.
Methods
We surveyed 113 consecutive hospitalized HF patients in a single university hospital. We assessed patient understanding of prognosis (likelihood of survival beyond 2 years), and compared patient expectations to model predictions. Model-predicted 2-year survival rate was calculated by the Seattle Heart Failure Model (SHFM). We also assessed patient preferences for information disclosure using the Prognosis and Treatment Perception Questionnaire (PTPQ). The PTPQ assesses patient beliefs regarding 1) the importance of knowing about prognosis, 2) the importance of knowing about treatment option, and 3) frequency of having a conversation about prognosis during the hospital stay.
Results
Enrolled patients were predominantly male (65.5%), with a mean age of 73.6±9.6 years and mean left ventricular ejection fraction was 46.2±15.4%. Median SHFM-estimated 2-year survival rate was 89.2% (interquartile range: 83.8–92.9%). Overall, patient understanding about prognosis was suboptimal. Among patients with a guarded 2-year survival (SHFM <90%: N=60), 44% reported that their likelihood of 2-year survival was >90% (Figure; red box). However, among patients with favorable 2-year survival (>90%: N=53), 38% reported a likelihood of <90% (Figure; blue box). Regarding treatment options, most patients (98%) desired to learn as many details as possible. Responses varied with regard to information on individual prognosis; whereas 51% wanted to know more about prognosis than their present status alone, a significant number (28%) of subjects answered “never” or “less often” to a query on the frequency of discussion about prognosis. Patient preference for more information about prognosis was associated with female sex (odds ratio [OR]: 2.52; 95% confidence interval [CI]: 1.12–5.69), fewer symptoms of depression (1-point increase on Patient Health Questionnaire-2, OR: 0.66; 95% CI: 0.49–0.87), and previous stroke (OR: 2.92; 95% CI: 1.04–8.19), but not other social/demographic or clinical factors (e.g., age, education, caregiver support, HF phenotype and severity, and other comorbid conditions).
Figure 1
Conclusions
There were substantial discrepancies in patient understanding of prognosis and in desire for more information from physicians. Interventions to improve prognostic understanding are warranted for HF patients, and hospitalization for HF could represent an opportunity for optimization.
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Affiliation(s)
- H Kitakata
- Keio University School of Medicine, Tokyo, Japan
| | - T Kohno
- Keio University School of Medicine, Tokyo, Japan
| | - S Kohsaka
- Keio University School of Medicine, Tokyo, Japan
| | - D Fujisawa
- Keio University School of Medicine, Tokyo, Japan
| | - N Nakano
- Keio University School of Medicine, Tokyo, Japan
| | - Y Shiraishi
- Keio University School of Medicine, Tokyo, Japan
| | - Y Katsumata
- Keio University School of Medicine, Tokyo, Japan
| | - S Yuasa
- Keio University School of Medicine, Tokyo, Japan
| | - K Fukuda
- Keio University School of Medicine, Tokyo, Japan
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48
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Akao M, Ogawa H, Suzuki S, Yamashita T, Kodani E, Tsuda T, Hayashi K, Furusho H, Sawano M, Fukuda K, Nakai M, Miyamoto Y, Tomita H, Okumura K. P3755Left atrial enlargement as an independent risk factor for ischemic stroke in Japanese atrial fibrillation patients: pooled analysis of five major Japanese atrial fibrillation registries. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) increases the risk of ischemic stroke. It remains unknown whether left atrial diameter determined by routine trans-thoracic echocardiography is a risk factor for ischemic stroke in non-valvular AF (NVAF) patients.
Purpose
The aim of this study is to investigate the impact of left atrial enlargement (LAE) on the incidence of ischemic stroke in a large-scale cohort of Japanese NVAF patients.
Methods
We combined the data of 5 major AF registries in Japan, J-RHYTHM Registry, Fushimi AF Registry, Shinken Database, Keio interhospital Cardiovascular Studies, and Hokuriku AF Registry. After excluding patients without echocardiographic data, 7,672 NVAF patients were analyzed in the present study (mean age, 69.3±12.3 years; mean CHADS2 score, 1.6±1.3). We compared clinical characteristics and the incidence of ischemic stroke between NVAF patients with LAE (left atrial diameter >45 mm; LAE group) and those without (non-LAE group).
Results
The mean left atrial diameter was 43.1±8.6 mm, and the LAE group accounted for 40.0% (n=3,066) of the entire cohort. Compared with non-LAE group (60.0%, n=4,606), the LAE group was older (LAE vs. non-LAE; 70.3±12.0 vs. 68.0±12.5, p<0.01), more often non-paroxysmal type (73.7% vs. 32.1%, p<0.01), had higher CHADS2 (1.86±1.34 vs. 1.46±1.29, p<0.01) and CHA2DS2-VASc (3.02±1.83 vs. 2.53±1.78, p<0.01) scores, and more frequently received oral anticoagulant (72.9% vs. 55.0%, p<0.01).
During the median follow-up period of 774.5 days (interquartile range: 567–1466 days), ischemic stroke occurred in 241 patients (131 vs. 110 patients; 1.52 vs. 0.82 per 100 person-years). In Kaplan Meier analysis, LAE was associated with a higher incidence of ischemic stroke (unadjusted hazard ratio (HR): 1.83, 95% confidence interval (CI): 1.42–2.36; log rank p<0.01) (Figure). LAE was independently associated with increased risk of ischemic stroke (adjusted HR: 1.63, 95% CI: 1.25–2.11; p<0.01) after adjustment by the components of CHADS2 score and the use of oral anticoagulant, on multivariate Cox proportional hazard analysis.
Conclusion
In this large-scale cohort of Japanese patients with AF, LAE was an independent predictor of ischemic stroke, suggesting that this simple echocardiographic parameter could refine thromboembolic risk stratification of NVAF patients.
Acknowledgement/Funding
Japan Agency for Medical Research and Development, AMED
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Affiliation(s)
- M Akao
- Kyoto Medical Center, National Hospital Organization, Kyoto, Japan
| | - H Ogawa
- Kyoto Medical Center, National Hospital Organization, Kyoto, Japan
| | - S Suzuki
- Cardiovascular Institute, Tokyo, Japan
| | | | - E Kodani
- Nippon Medical School, Tama-Nagayama Hospital, Tama, Japan
| | - T Tsuda
- Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - K Hayashi
- Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - H Furusho
- Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | | | | | - M Nakai
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Y Miyamoto
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | - H Tomita
- Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - K Okumura
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
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49
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Hiraide T, Kataoka M, Suzuki H, Aimi Y, Chiba T, Isobe S, Katsumata Y, Goto S, Kanekura K, Satoh T, Sano M, Gamou S, Kosaki K, Fukuda K. P6009Poor outcomes in pulmonary arterial hypertension as a member of RNF213-associated vascular diseases. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
A variant of c.14429G>A (p.Arg4810Lys, rs112735431) in the ring finger protein 213 gene (RNF213; NM_001256071.2) has been recently identified as a risk allele for pulmonary arterial hypertension (PAH), suggesting that PAH can be added as a new member of RNF213-associated vascular diseases including Moyamoya disease and peripheral pulmonary stenosis.
Purpose
Our aim was to identify the clinical features and outcomes of PAH patients with RNF213 p.Arg4810Lys variant.
Methods
Whole-exome sequencing was performed in 139 idiopathic (or possibly heritable) PAH patients. Hemodynamics and prognosis were evaluated in the patients with RNF213 p.Arg4810Lys variant and the patients with bone morphogenic protein receptor type 2 (BMPR2) mutations.
Results
The RNF213 p.Arg4810Lys variant was identified in a heterozygous state in 11 patients (7.9%). Time-course changes in hemodynamics after combination therapy in the patients with the RNF213 p.Arg4810Lys variant were significantly poorer compared with those in BMPR2 mutation carriers (n=36) (comparison of changes in mean pulmonary arterial pressure, P=0.007). The event-free rate of death or lung transplantation was significantly poorer in RNF213 p.Arg4810Lys variant carriers than in BMPR2 mutation carriers (5-year event-free rate since the introduction of prostaglandin I2 infusion, 0% vs. 93%, P<0.001) (Figure).
Time to death or lung transplantation
Conclusions
PAH patients with the RNF213 p.Arg4810Lys variant were associated with a poor reactivity to vasodilator drugs and poor clinical outcomes even in the recent era. Earlier consideration of lung transplantation might be required for RNF213 p.Arg4810Lys variant carriers developing PAH. Documentation of the RNF213 p.Arg4810Lys variant, as well as already known pathogenic genes, can provide clinically relevant information for therapeutic strategies, leading to a personalized approach for the treatment of PAH.
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Affiliation(s)
- T Hiraide
- Keio University School of Medicine, Cardiology, Tokyo, Japan
| | - M Kataoka
- Keio University School of Medicine, Cardiology, Tokyo, Japan
| | - H Suzuki
- Keio University School of Medicine, Center for Medical Genetics, Tokyo, Japan
| | - Y Aimi
- Kyorin University School of Medicine, Division of Cardiology, Second Department of Internal Medicine, Tokyo, Japan
| | - T Chiba
- Kyorin University School of Medicine, Department of Pathology, Tokyo, Japan
| | - S Isobe
- Keio University School of Medicine, Cardiology, Tokyo, Japan
| | - Y Katsumata
- Keio University School of Medicine, Cardiology, Tokyo, Japan
| | - S Goto
- Keio University School of Medicine, Cardiology, Tokyo, Japan
| | - K Kanekura
- Tokyo Medical University, Department of Molecular Pathology, Tokyo, Japan
| | - T Satoh
- Kyorin University School of Medicine, Division of Cardiology, Second Department of Internal Medicine, Tokyo, Japan
| | - M Sano
- Keio University School of Medicine, Cardiology, Tokyo, Japan
| | - S Gamou
- Keio University School of Medicine, Cardiology, Tokyo, Japan
| | - K Kosaki
- Keio University School of Medicine, Center for Medical Genetics, Tokyo, Japan
| | - K Fukuda
- Keio University School of Medicine, Cardiology, Tokyo, Japan
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50
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Isono C, Hirano M, Fukuda K, Samukawa M, Saigoh K, Nakamura Y, Kusunoki S. Clinical features and progression of dysphagia in bulbar-onset or limb-onset amyotrophic lateral sclerosis between patients with genetic mutations and those without mutations. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.1213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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