1
|
Ebihara T, Nagatomo T, Sugiyama Y, Tsuruoka T, Osone Y, Shimura M, Tajika M, Ichimoto K, Naruke Y, Akiyama N, Lim SC, Yatsuka Y, Nitta KR, Kishita Y, Fushimi T, Okazaki A, Ohtake A, Okazaki Y, Murayama K. Severe spinal cord hypoplasia due to a novel ATAD3A compound heterozygous deletion. Mol Genet Metab Rep 2022; 33:100912. [PMID: 36061954 PMCID: PMC9428837 DOI: 10.1016/j.ymgmr.2022.100912] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/13/2022] [Accepted: 08/13/2022] [Indexed: 11/03/2022] Open
Abstract
Biallelic deletions extending into the ATPase family AAA-domain containing protein 3A (ATAD3A) gene lead to infantile lethality with severe pontocerebellar hypoplasia (PCH). However, only 12 such cases have been reported worldwide to date, and the genotype–phenotype correlations are not well understood. We describe cases associated with the same novel biallelic deletions of the ATAD3A and ATAD3B/3A regions in Japanese siblings with severe spinal cord hypoplasia and multiple malformations, including PCH, leading to neonatal death. The ATAD3A protein is essential for normal interaction between mitochondria and endoplasmic reticulum and is important for mitochondrial biosynthesis. The cases were evaluated using whole-genome sequencing for genetic diagnosis of mitochondrial disease. Spinal cord lesions associated with biallelic compound heterozygous deletion extending into the ATAD3A gene have not been reported. In addition, the ATAD3A deletion was 19 base pairs long, which is short compared with those reported previously. This deletion introduced a frameshift, resulting in a premature termination codon, and was expected to be a null allele. The pathological findings of the atrophic spinal cord showed gliosis and tissue destruction of the gray and white matter. We describe spinal cord lesions as a new central nervous system phenotype associated with a biallelic compound heterozygous deletion extending into the ATAD3A gene. Biallelic ATAD3A deletions should be considered in cases of mitochondrial disease with spinal cord hypoplasia and PCH.
Collapse
|
2
|
Ebihara T, Nagatomo T, Sugiyama Y, Tsuruoka T, Osone Y, Shimura M, Tajika M, Matsuhashi T, Ichimoto K, Matsunaga A, Akiyama N, Ogawa-Tominaga M, Yatsuka Y, Nitta KR, Kishita Y, Fushimi T, Imai-Okazaki A, Ohtake A, Okazaki Y, Murayama K. Neonatal-onset mitochondrial disease: clinical features, molecular diagnosis and prognosis. Arch Dis Child Fetal Neonatal Ed 2022; 107:329-334. [PMID: 34625524 PMCID: PMC9046829 DOI: 10.1136/archdischild-2021-321633] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 09/14/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Neonatal-onset mitochondrial disease has not been fully characterised owing to its heterogeneity. We analysed neonatal-onset mitochondrial disease in Japan to clarify its clinical features, molecular diagnosis and prognosis. DESIGN Retrospective observational study from January 2004 to March 2020. SETTING Population based. PATIENTS Patients (281) with neonatal-onset mitochondrial disease diagnosed by biochemical and genetic approaches. INTERVENTIONS None. MAIN OUTCOME MEASURES Disease types, initial symptoms, biochemical findings, molecular diagnosis and prognosis. RESULTS Of the 281 patients, multisystem mitochondrial disease was found in 194, Leigh syndrome in 26, cardiomyopathy in 38 and hepatopathy in 23 patients. Of the 321 initial symptoms, 236 occurred within 2 days of birth. Using biochemical approaches, 182 patients were diagnosed by mitochondrial respiratory chain enzyme activity rate and 89 by oxygen consumption rate. The remaining 10 patients were diagnosed using a genetic approach. Genetic analysis revealed 69 patients had nuclear DNA variants in 36 genes, 11 of 15 patients had mitochondrial DNA variants in five genes and four patients had single large deletion. The Cox proportional hazards regression analysis showed the effects of Leigh syndrome (HR=0.15, 95% CI 0.04 to 0.63, p=0.010) and molecular diagnosis (HR=1.87, 95% CI 1.18 to 2.96, p=0.008) on survival. CONCLUSIONS Neonatal-onset mitochondrial disease has a heterogenous aetiology. The number of diagnoses can be increased, and clarity regarding prognosis can be achieved by comprehensive biochemical and molecular analyses using appropriate tissue samples.
Collapse
Affiliation(s)
- Tomohiro Ebihara
- Department of Neonatology, Chiba Children's Hospital, Chiba, Japan
| | - Taro Nagatomo
- Department of Pediatrics, Fukuoka Red Cross Hospital, Fukuoka, Japan
| | - Yohei Sugiyama
- Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Tomoko Tsuruoka
- Department of Neonatology, Chiba Children's Hospital, Chiba, Japan
| | - Yoshiteru Osone
- Department of Neonatology, Chiba University Hospital, Chiba, Japan
| | - Masaru Shimura
- Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Makiko Tajika
- Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | | | - Keiko Ichimoto
- Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Ayako Matsunaga
- Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Nana Akiyama
- Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | | | - Yukiko Yatsuka
- Department of Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Kazuhiro R Nitta
- Department of Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Yoshihito Kishita
- Department of Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan,Department of Life Science, Faculty of Science and Engineering, Kindai University, Higashiosaka, Osaka, Japan
| | - Takuya Fushimi
- Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Atsuko Imai-Okazaki
- Department of Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Akira Ohtake
- Department of Pediatrics and Clinical Genomics, Saitama Medical University, Moroyama, Saitama, Japan
| | - Yasushi Okazaki
- Department of Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Kei Murayama
- Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| |
Collapse
|
3
|
Sugiyama Y, Watanabe T, Tajika M, Matsuhashi T, Shimura M, Fushimi T, Ichimoto K, Matsunaga A, Ebihara T, Tsuruoka T, Akiyama T, Murayama K. A Japanese single-center experience of the efficacy and safety of asfotase alfa in pediatric-onset hypophosphatasia. Orphanet J Rare Dis 2022; 17:78. [PMID: 35197081 PMCID: PMC8867653 DOI: 10.1186/s13023-022-02230-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 02/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Hypophosphatasia (HPP) is a rare inherited metabolic disorder caused by mutations in the ALPL gene, which encodes tissue nonspecific alkaline phosphatase. The severity of HPP is widely diverse from the perinatal form to the adult mild form. The former represents the most severe form and was earlier associated with high mortality due to pneumonia which was caused by severe hypomineralization of the bones—such as chest deformity and fractured ribs—and muscle weakness. Enzyme replacement therapy using asfotase alfa (AA) was approved in 2015 in Japan for treating patients with HPP and has improved their pulmonary function and life prognosis. There are several practical and ethical challenges related to using orphan drugs for a rare disorder in a publicly funded healthcare system. Sharing experiences about their application is essential towards formulating guidelines to assist clinicians with decisions about their initiation and withdrawal. We report the details of AA experience in ten cases of pediatric-onset HPP in nine families from January 2015 to November 2019 (median [interquartile range] age 11.0 [7.6–12.5] years; 60% male). This is a study of a single-center cohort describing the clinical course of patients with HPP, mainly consisting of the mild childhood form of HPP, treated with AA in Japan. Results One case of perinatal form of HPP, two cases of benign prenatal form, and seven cases of childhood form were observed. The most common symptom at onset was pain. All patients had low serum alkaline phosphatase levels as compared to the age-matched reference range before the commencement of AA. All HPP patients seem to have responded to AA treatment, as evidenced by pain alleviation, increased height standard deviation, improvement in respiratory condition and 6-min walk test result improvement, disappearance of kidney calcification, alleviation of fatigue, and/or increases in bone mineralization. There were no serious adverse events, but all patients had an injection site reaction and skin changes at the injection sites. Genetic analysis showed that eight out of ten patients had compound heterozygosity. Conclusions AA may be effective in patients with mild to severe pediatric-onset forms of HPP. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02230-y.
Collapse
Affiliation(s)
- Yohei Sugiyama
- Center for Medical Genetics, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba City, Chiba Prefecture, 266-0007, Japan.,Department of Metabolism, Chiba Children's Hospital, Chiba, Japan.,Department of Neonatology, Chiba Children's Hospital, Chiba, Japan
| | - Taijiro Watanabe
- Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Makiko Tajika
- Center for Medical Genetics, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba City, Chiba Prefecture, 266-0007, Japan.,Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Tetsuro Matsuhashi
- Center for Medical Genetics, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba City, Chiba Prefecture, 266-0007, Japan.,Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Masaru Shimura
- Center for Medical Genetics, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba City, Chiba Prefecture, 266-0007, Japan.,Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Takuya Fushimi
- Center for Medical Genetics, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba City, Chiba Prefecture, 266-0007, Japan.,Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Keiko Ichimoto
- Center for Medical Genetics, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba City, Chiba Prefecture, 266-0007, Japan.,Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Ayako Matsunaga
- Center for Medical Genetics, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba City, Chiba Prefecture, 266-0007, Japan.,Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Tomohiro Ebihara
- Center for Medical Genetics, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba City, Chiba Prefecture, 266-0007, Japan.,Department of Neonatology, Chiba Children's Hospital, Chiba, Japan
| | - Tomoko Tsuruoka
- Center for Medical Genetics, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba City, Chiba Prefecture, 266-0007, Japan.,Department of Neonatology, Chiba Children's Hospital, Chiba, Japan
| | - Tomoyuki Akiyama
- Department of Child Neurology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama city, Okayama Prefecture, 700-8558, Japan
| | - Kei Murayama
- Center for Medical Genetics, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba City, Chiba Prefecture, 266-0007, Japan. .,Department of Metabolism, Chiba Children's Hospital, Chiba, Japan.
| |
Collapse
|
4
|
Shimura M, Onuki T, Sugiyama Y, Matsuhashi T, Ebihara T, Fushimi T, Tajika M, Ichimoto K, Matsunaga A, Tsuruoka T, Nitta KR, Imai-Okazaki A, Yatsuka Y, Kishita Y, Ohtake A, Okazaki Y, Murayama K. Development of Leigh syndrome with a high probability of cardiac manifestations in infantile-onset patients with m.14453G > A. Mitochondrion 2021; 63:1-8. [PMID: 34933128 DOI: 10.1016/j.mito.2021.12.005] [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: 08/17/2021] [Revised: 11/24/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
The m.14453G > A mutation in MT-ND6 has been described in a few patients with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes or Leigh syndrome.However, the clinical spectrum and molecular characteristics are unclear.Here, we present four infantile-onset patients with m.14453G > A-associated Leigh syndrome. All four patients had brainstem lesions with basal ganglia lesions, and two patients had cardiac manifestations. Decreased ND6 protein expression and immunoreactivity were observed in patient-derived samples. There was no clear correlation between heteroplasmy levels and onset age or between heteroplasmy levels and phenotype; however, infantile onset was associated with Leigh syndrome.
Collapse
Affiliation(s)
- Masaru Shimura
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan
| | - Takanori Onuki
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan
| | - Yohei Sugiyama
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan
| | - Tetsuro Matsuhashi
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan
| | - Tomohiro Ebihara
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan
| | - Takuya Fushimi
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan
| | - Makiko Tajika
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan
| | - Keiko Ichimoto
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan
| | - Ayako Matsunaga
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan
| | - Tomoko Tsuruoka
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan
| | - Kazuhiro R Nitta
- Diagnostics and Therapeutic of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Hongo 2-1-1 Bunkyo-ku, Tokyo 113-8421, Japan
| | - Atsuko Imai-Okazaki
- Diagnostics and Therapeutic of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Hongo 2-1-1 Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yukiko Yatsuka
- Diagnostics and Therapeutic of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Hongo 2-1-1 Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yoshihito Kishita
- Diagnostics and Therapeutic of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Hongo 2-1-1 Bunkyo-ku, Tokyo 113-8421, Japan; Department of Life Science, Faculty of Science and Engineering, Kindai University, 3-4-1 Kowakae, Higashiosaka, Osaka 577-8502, Japan
| | - Akira Ohtake
- Department of Pediatrics & Clinical Genomics, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama, Saitama 350-0495, Japan
| | - Yasushi Okazaki
- Diagnostics and Therapeutic of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Hongo 2-1-1 Bunkyo-ku, Tokyo 113-8421, Japan
| | - Kei Murayama
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan; Diagnostics and Therapeutic of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Hongo 2-1-1 Bunkyo-ku, Tokyo 113-8421, Japan.
| |
Collapse
|
5
|
Ogata T, Narita Y, Kumanishi R, Nakazawa T, Matsubara Y, Kodama H, Nakata A, Honda K, Masuishi T, Bando H, Kadowaki S, Ando M, Ito S, Tajika M, Muro K. 1418P Chronological improvement in the survival of advanced gastric cancer patients in the past 15 years. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1527] [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: 10/20/2022] Open
|
6
|
Imai-Okazaki A, Matsunaga A, Yatsuka Y, Nitta KR, Kishita Y, Sugiura A, Sugiyama Y, Fushimi T, Shimura M, Ichimoto K, Tajika M, Tominaga M, Ebihara T, Matsuhashi T, Tsuruoka T, Kohda M, Hirata T, Harashima H, Nojiri S, Takeda A, Nakaya A, Kogaki S, Sakata Y, Ohtake A, Murayama K, Okazaki Y. Long-term prognosis and genetic background of cardiomyopathy in 223 pediatric mitochondrial disease patients. Int J Cardiol 2021; 341:48-55. [PMID: 34298071 DOI: 10.1016/j.ijcard.2021.06.042] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/18/2021] [Accepted: 06/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cardiomyopathy is a risk factor for poor prognosis in pediatric patients with mitochondrial disease. However, other risk factors including genetic factors related to poor prognosis in mitochondrial disease has yet to be fully elucidated. METHODS AND RESULTS Between January 2004 and September 2019, we enrolled 223 consecutive pediatric mitochondrial disease patients aged <18 years with a confirmed genetic diagnosis, including 114 with nuclear gene mutations, 89 patients with mitochondrial DNA (mtDNA) point mutations, 11 with mtDNA single large-scale deletions and 9 with chromosomal aberrations. Cardiomyopathy at baseline was observed in 46 patients (22%). Hazard ratios (HR) and 95% confidence intervals (CI) were calculated for all-cause mortality. Over a median follow-up of 36 months (12-77), there were 85 deaths (38%). The overall survival rate was significantly lower in patients with cardiomyopathy than in those without (p < 0.001, log-rank test). By multivariable analysis, left ventricular (LV) hypertrophy (HR = 4.6; 95% CI: 2.8-7.3), neonatal onset (HR = 2.9; 95% CI: 1.8-4.5) and chromosomal aberrations (HR = 2.9; 95% CI: 1.3-6.5) were independent predictors of all-cause mortality. Patients with LV hypertrophy with neonatal onset and/or chromosomal aberrations had higher mortality (100% in 21 patients) than those with LV hypertrophy alone (71% in 14 patients). CONCLUSION In pediatric patients with mitochondrial disease, cardiomyopathy was common (22%) and was associated with increased mortality. LV hypertrophy, neonatal onset and chromosomal aberrations were independent predictors of all-cause mortality. Prognosis is particularly unfavourable if LV hypertrophy is combined with neonatal onset and/or chromosomal aberrations.
Collapse
Affiliation(s)
- Atsuko Imai-Okazaki
- Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Centre, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Ayako Matsunaga
- Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Yukiko Yatsuka
- Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Centre, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Kazuhiro R Nitta
- Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Centre, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Yoshihito Kishita
- Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Centre, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Ayumu Sugiura
- Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Centre, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Yohei Sugiyama
- Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Takuya Fushimi
- Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Masaru Shimura
- Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Keiko Ichimoto
- Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Makiko Tajika
- Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Minako Tominaga
- Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Tomohiro Ebihara
- Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | | | - Tomoko Tsuruoka
- Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Masakazu Kohda
- Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Centre, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Tomoko Hirata
- Laboratory for Comprehensive Genomic Analysis, RIKEN Centre for Integrative Medical Sciences, Kanagawa, Japan
| | - Hiroko Harashima
- Department of Paediatrics & Clinical Genomics, Saitama Medical University, Saitama, Japan; Centre for Intractable Diseases, Saitama Medical University Hospital, Saitama, Japan
| | - Shuko Nojiri
- Clinical Research and Trial Centre, Juntendo University, Japan
| | - Atsuhito Takeda
- Department of Paediatrics, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Akihiro Nakaya
- Department of Genome Data Science, Graduate School of Frontier Sciences, The University of Tokyo, Chiba, Japan
| | - Shigetoyo Kogaki
- Department of Paediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Akira Ohtake
- Department of Paediatrics & Clinical Genomics, Saitama Medical University, Saitama, Japan; Centre for Intractable Diseases, Saitama Medical University Hospital, Saitama, Japan
| | - Kei Murayama
- Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Yasushi Okazaki
- Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Centre, Graduate School of Medicine, Juntendo University, Tokyo, Japan; Laboratory for Comprehensive Genomic Analysis, RIKEN Centre for Integrative Medical Sciences, Kanagawa, Japan.
| |
Collapse
|
7
|
Kato K, Masuishi T, Fushiki K, Nakano S, Kawamoto Y, Narita Y, Tsushima T, Harada K, Kadowaki S, Todaka A, Yuki S, Tajika M, Machida N, Komatsu Y, Yasui H, Muro K, Kawakami T. Impact of tumor growth rate during preceding treatment on tumor response to nivolumab or irinotecan in advanced gastric cancer. ESMO Open 2021; 6:100179. [PMID: 34119801 PMCID: PMC8209093 DOI: 10.1016/j.esmoop.2021.100179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/12/2021] [Accepted: 05/16/2021] [Indexed: 11/28/2022] Open
Abstract
Background Nivolumab (NIVO) and irinotecan (IRI) are standard treatments for refractory advanced gastric cancer (AGC); however, it is unclear which drug should be administered first or in which cases. The tumor growth rate (TGR) during preceding treatment is reported to be associated with tumor response in metastatic colorectal cancer patients treated with regorafenib or trifluridine/tipiracil, suggesting that TGR may be useful for drug selection. Therefore, we evaluated the association between TGR during preceding treatment and the tumor response to NIVO or IRI. Patients and methods We retrospectively evaluated consecutive AGC patients treated with NIVO or IRI and divided them into slow-growing (Slow) and rapid-growing (Rapid) groups according to TGR and the presence or absence of new lesions (NL+/NL−, respectively) during preceding treatment (Slow group: NL− with low TGR <0.30%/day; Rapid group: NL+ or high TGR ≥0.30%/day). Results A total of 117 patients (Rapid/Slow groups, 72/45; NIVO/IRI groups, 32/85) were eligible. All baseline characteristics except peritoneal metastases were similar between patients treated with NIVO and IRI in the Rapid and Slow groups. The response rate was significantly higher in patients treated with NIVO compared with IRI [31%/3%; odds ratio (OR), 13.8; P = 0.01; adjusted OR, 52; P = 0.002] in the Slow group, but there was no difference between patients treated with NIVO and IRI (5%/8%; OR, 0.68; P = 0.73; adjusted OR, 0.94; P = 0.96) in the Rapid group. Disease control rate, progression-free survival, and overall survival were consistent with these results. Conclusions Our findings suggest that NIVO treatment is a more favorable option for patients with slow-growing tumors, and NIVO and IRI are similarly recommended for patients with rapid-growing tumors in refractory AGC. TGR and NL emergence during preceding treatment may be helpful for drug selection and warrant further investigation. NIVO and IRI are standard treatments for refractory AGC, although it is unclear which should be administered first. TGR may be useful for drug selection, therefore we evaluated the association between TGR and the tumor response to NIVO or IRI. In the Slow group, the response rate (RR) was significantly higher in patients treated with NIVO compared with IRI. In the Rapid group, there was no significant difference in RR between the NIVO and IRI groups. TGR and NL emergence during preceding treatment may be useful for drug selection.
Collapse
Affiliation(s)
- K Kato
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - T Masuishi
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan.
| | - K Fushiki
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - S Nakano
- Cancer Center, Hokkaido University Hospital, Sapporo, Japan
| | - Y Kawamoto
- Cancer Center, Hokkaido University Hospital, Sapporo, Japan
| | - Y Narita
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - T Tsushima
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - K Harada
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan
| | - S Kadowaki
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - A Todaka
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - S Yuki
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan
| | - M Tajika
- Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan
| | - N Machida
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Y Komatsu
- Cancer Center, Hokkaido University Hospital, Sapporo, Japan
| | - H Yasui
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - K Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - T Kawakami
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| |
Collapse
|
8
|
Morizane C, Ueno M, Ioka T, Tajika M, Ikeda M, Yamaguchi K, Hara H, Yabusaki H, Miyamoto A, Iwasa S, Muto M, Takashima T, Minashi K, Komatsu Y, Nishina T, Nakajima T, Sahara T, Funasaka S, Yashiro M, Furuse J. 128P Clinical update with plasma and tumour-based genomic analyses in expansion part of phase I study of selective FGFR inhibitor E7090. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.149] [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: 11/16/2022] Open
|
9
|
Sugiyama Y, Shimura M, Ogawa-Tominaga M, Ebihara T, Kinouchi Y, Isozaki K, Matsuhashi T, Tajika M, Fushimi T, Ichimoto K, Matsunaga A, Ishida T, Mizutani K, Tsuruoka T, Murayama K. Therapeutic effect of N-carbamylglutamate in CPS1 deficiency. Mol Genet Metab Rep 2020; 24:100622. [PMID: 32670798 PMCID: PMC7347628 DOI: 10.1016/j.ymgmr.2020.100622] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/24/2020] [Accepted: 06/24/2020] [Indexed: 12/12/2022] Open
Abstract
The detoxification of ammonia to urea requires a functional hepatic urea cycle, which consists of six enzymes and two mitochondrial membrane transporters. The initial step of the urea cycle is catalyzed by carbamyl phosphate synthetase 1 (CPS1). CPS1 deficiency (CPS1D) is a rare autosomal recessive disorder. N-Carbamylglutamate (NCG), a deacylase-resistant analogue of N-acetylglutamate, can activate CPS1. We describe the therapeutic course of a patient suffering from neonatal onset CPS1D with compound heterozygosity for the c.2359C > T (p.Arg787*) and c.3559G > T (p.Val1187Phe) variants in CPS1, treated with NCG. She presented with hyperammonemia, which reached 944 μmol/L at the age of 2 days. The ammonia concentration decreased after treatment with continuous hemodiafiltration, NCG, sodium benzoate, sodium phenylbutyrate, L-arginine, vitamin cocktail (vitamin B1, vitamin B12, vitamin C, vitamin E, biotin), l-carnitine, coenzyme Q10, and parenteral nutrition. Her ammonia and glutamine levels remained low; thus, protein intake was increased to 1.2 g/kg/day. Furthermore, the amount of sodium benzoate and sodium phenylbutyrate were reduced. She remained metabolically stable and experienced no metabolic crisis following treatment with oral NCG, sodium benzoate, sodium phenylbutyrate, citrulline, vitamin cocktail, l-carnitine, and coenzyme Q10 until she underwent liver transplantation at 207 days of age. She had no neurological complications at the age of 15 months. Ammonia and glutamine levels of the patient were successfully maintained at a low level via NCG treatment with increased protein intake, which led to normal neurological development. Thus, undiagnosed urea cycle disorders should be treated rapidly with acute therapy including NCG, which should be maintained until a genetic diagnosis is reached. It is essential to prevent metabolic crises in patients with CPS1D until liver transplantation to improve their prognoses.
Collapse
Affiliation(s)
- Yohei Sugiyama
- Center for Medical Genetics, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba city, Chiba 266-0007, Japan
- Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba city, Chiba 266-0007, Japan
- Department of Neonatology, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba city, Chiba 266-0007, Japan
| | - Masaru Shimura
- Center for Medical Genetics, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba city, Chiba 266-0007, Japan
- Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba city, Chiba 266-0007, Japan
| | - Minako Ogawa-Tominaga
- Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba city, Chiba 266-0007, Japan
| | - Tomohiro Ebihara
- Center for Medical Genetics, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba city, Chiba 266-0007, Japan
- Department of Neonatology, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba city, Chiba 266-0007, Japan
| | - Yoshina Kinouchi
- Center for Medical Genetics, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba city, Chiba 266-0007, Japan
- Department of Neonatology, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba city, Chiba 266-0007, Japan
| | - Keitaro Isozaki
- Center for Medical Genetics, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba city, Chiba 266-0007, Japan
- Department of Neonatology, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba city, Chiba 266-0007, Japan
| | - Tetsuro Matsuhashi
- Center for Medical Genetics, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba city, Chiba 266-0007, Japan
- Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba city, Chiba 266-0007, Japan
| | - Makiko Tajika
- Center for Medical Genetics, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba city, Chiba 266-0007, Japan
- Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba city, Chiba 266-0007, Japan
| | - Takuya Fushimi
- Center for Medical Genetics, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba city, Chiba 266-0007, Japan
- Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba city, Chiba 266-0007, Japan
| | - Keiko Ichimoto
- Center for Medical Genetics, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba city, Chiba 266-0007, Japan
- Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba city, Chiba 266-0007, Japan
| | - Ayako Matsunaga
- Center for Medical Genetics, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba city, Chiba 266-0007, Japan
- Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba city, Chiba 266-0007, Japan
| | - Tomoki Ishida
- Department of Neonatology, Kimitsu Chuo Hospital, 1010 sakurai, Kisarazu city, Chiba 292-8535, Japan
| | - Kayo Mizutani
- Department of Neonatology, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba 296-8602, Japan
| | - Tomoko Tsuruoka
- Center for Medical Genetics, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba city, Chiba 266-0007, Japan
- Department of Neonatology, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba city, Chiba 266-0007, Japan
| | - Kei Murayama
- Center for Medical Genetics, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba city, Chiba 266-0007, Japan
- Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba city, Chiba 266-0007, Japan
- Corresponding author at: Center for Medical Genetics, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba city, Chiba 266-0007, Japan.
| |
Collapse
|
10
|
Ogawa E, Fushimi T, Ogawa‐Tominaga M, Shimura M, Tajika M, Ichimoto K, Matsunaga A, Tsuruoka T, Ishige M, Fuchigami T, Yamazaki T, Kishita Y, Kohda M, Imai‐Okazaki A, Okazaki Y, Morioka I, Ohtake A, Murayama K. Mortality of Japanese patients with Leigh syndrome: Effects of age at onset and genetic diagnosis. J Inherit Metab Dis 2020; 43:819-826. [PMID: 31967322 PMCID: PMC7383885 DOI: 10.1002/jimd.12218] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 01/30/2023]
Abstract
Leigh syndrome is a major phenotype of mitochondrial diseases in children. With new therapeutic options being proposed, assessing the mortality and clinical condition of Leigh syndrome patients is crucial for evaluating therapeutics. As data are scarce in Japan, we analysed the mortality rate and clinical condition of Japanese Leigh syndrome patients that we diagnosed since 2007. Data from 166 Japanese patients diagnosed with Leigh syndrome from 2007 to 2017 were reviewed. Patients' present status, method of ventilation and feeding, and degree of disability as of April 2018 was analysed. Overall, 124 (74.7%) were living, 40 (24.1%) were deceased, and 2 (1.2%) were lost to follow-up. Median age of living patients was 8 years (1-39 years). Median length of disease course was 91 months for living patients and 23.5 months for deceased patients. Nearly 90% of deaths occurred by age 6. Mortality rate of patients with onset before 6 months of age was significantly higher than that of onset after 6 months. All patients with neonatal onset were either deceased or bedridden. MT-ATP6 deficiency caused by m.8993T>G mutation and MT-ND5 deficiency induced a severe form of Leigh syndrome. Patients with NDUFAF6, ECHS1, and SURF1 deficiency had relatively mild symptoms and better survival. The impact of onset age on prognosis varied across the genetic diagnoses. The clinical condition of many patients was poor; however, few did not require mechanical ventilation or tube-feeding and were not physically dependent. Early disease onset and genetic diagnosis may have prognostic value.
Collapse
Affiliation(s)
- Erika Ogawa
- Department of MetabolismChiba Children's HospitalChibaJapan
- Department of Pediatrics and Child HealthNihon University School of MedicineTokyoJapan
| | - Takuya Fushimi
- Department of MetabolismChiba Children's HospitalChibaJapan
| | | | - Masaru Shimura
- Department of MetabolismChiba Children's HospitalChibaJapan
| | - Makiko Tajika
- Department of MetabolismChiba Children's HospitalChibaJapan
| | - Keiko Ichimoto
- Department of MetabolismChiba Children's HospitalChibaJapan
| | | | | | - Mika Ishige
- Department of Pediatrics and Child HealthNihon University School of MedicineTokyoJapan
| | - Tatsuo Fuchigami
- Department of Pediatrics and Child HealthNihon University School of MedicineTokyoJapan
| | - Taro Yamazaki
- Department of PediatricsSaitama Medical UniversitySaitamaJapan
| | - Yoshihito Kishita
- Intractable Disease Research CenterGraduate School of Medicine, Juntendo UniversityTokyoJapan
| | - Masakazu Kohda
- Intractable Disease Research CenterGraduate School of Medicine, Juntendo UniversityTokyoJapan
| | - Atsuko Imai‐Okazaki
- Intractable Disease Research CenterGraduate School of Medicine, Juntendo UniversityTokyoJapan
| | - Yasushi Okazaki
- Intractable Disease Research CenterGraduate School of Medicine, Juntendo UniversityTokyoJapan
| | - Ichiro Morioka
- Department of Pediatrics and Child HealthNihon University School of MedicineTokyoJapan
| | - Akira Ohtake
- Department of PediatricsSaitama Medical UniversitySaitamaJapan
- Department of Clinical GenomicsSaitama Medical UniversitySaitamaJapan
| | - Kei Murayama
- Department of MetabolismChiba Children's HospitalChibaJapan
- Intractable Disease Research CenterGraduate School of Medicine, Juntendo UniversityTokyoJapan
| |
Collapse
|
11
|
Fujiyoshi T, Tajika M, Tanaka T, Ishihara M, Mizuno N, Hara K, Hijioka S, Imaoka H, Yatabe Y, Hirooka Y, Goto H, Yamao K, Niwa Y. Corrigendum to: Comparative evaluation of new and conventional classifications of magnifying endoscopy with narrow band imaging for invasion depth of superficial esophageal squamous cell carcinoma. Dis Esophagus 2020; 33:5827112. [PMID: 32352143 DOI: 10.1093/dote/doaa040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 12/11/2022]
Affiliation(s)
- T Fujiyoshi
- Departments of Gastroenterology.,Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | | | | | | | | | - K Hara
- Departments of Gastroenterology
| | | | | | - Y Yatabe
- Pathology and Molecular Diagnosis, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Y Hirooka
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | - H Goto
- Departments of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - K Yamao
- Departments of Gastroenterology
| | | |
Collapse
|
12
|
Ichimoto K, Fujisawa T, Shimura M, Fushimi T, Tajika M, Matsunaga A, Ogawa-Tominaga M, Akiyama N, Naruke Y, Horie H, Fukuda T, Sugie H, Inui A, Murayama K. Two cases of a non-progressive hepatic form of glycogen storage disease type IV with atypical liver pathology. Mol Genet Metab Rep 2020; 24:100601. [PMID: 32455116 PMCID: PMC7235638 DOI: 10.1016/j.ymgmr.2020.100601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/02/2020] [Accepted: 05/02/2020] [Indexed: 11/26/2022] Open
Abstract
Glycogen storage disease type IV (GSD IV) is a rare inborn metabolic disorder characterized by the accumulation of amylopectin-like glycogen in the liver or other organs. The hepatic subtype may appear normal at birth but rapidly develops to liver cirrhosis in infancy. Liver pathological findings help diagnose the hepatic form of the disease, supported by analyses of enzyme activity and GBE1 gene variants. Pathology usually shows periodic acid-Schiff (PAS) positive hepatocytes resistant to diastase. We report two cases of hepatic GSD IV with pathology showing PAS positive hepatocytes that were mostly digested by diastase, which differ from past cases. Gene analysis was critical for the diagnosis. Both cases were found to have the same variants c.288delA (p.Gly97GlufsTer46) and c.1825G > A (p.Glu609Lys). These findings suggest that c.1825G > A variant might be a common variant in the non-progressive hepatic form of GSD IV.
Collapse
Key Words
- ALT, alanine aminotransferase
- AST, aspartate transaminase
- Andersen disease
- COI, cut-off index
- GBE, glycogen-branching enzyme
- GBE1
- GSD IV
- GSD IV, Glycogen storage disease type IV
- M2BPGi
- M2BPGi, Mac-2 binding protein glycosylation isomer
- Nutrition therapy
- PAS, periodic acid-Schiff
- PAS-D, periodic acid-Schiff-diastase
- SD, standard deviation
- γ-GTP, gamma-glutamyltransferase
Collapse
Affiliation(s)
- Keiko Ichimoto
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba 266-0007, Japan
| | - Tomoo Fujisawa
- Department of Pediatric Hepatology and Gastroenterology, Saiseikai Yokohama-shi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama 230-8765, Japan
| | - Masaru Shimura
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba 266-0007, Japan
| | - Takuya Fushimi
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba 266-0007, Japan
| | - Makiko Tajika
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba 266-0007, Japan
| | - Ayako Matsunaga
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba 266-0007, Japan
| | - Minako Ogawa-Tominaga
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba 266-0007, Japan
| | - Nana Akiyama
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba 266-0007, Japan
| | - Yuki Naruke
- Department of Pathology, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba 266-0007, Japan
| | - Hiroshi Horie
- Department of Pathology, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba 266-0007, Japan
| | - Tokiko Fukuda
- Department of Pediatrics, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu 431-3192, Japan
| | - Hideo Sugie
- Faculty of Health and Medical Sciences, Tokoha University, 1230 Miyakodachou, Kita-ku, Hamamatsu 431-2102, Japan
| | - Ayano Inui
- Department of Pediatric Hepatology and Gastroenterology, Saiseikai Yokohama-shi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama 230-8765, Japan
| | - Kei Murayama
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba 266-0007, Japan
| |
Collapse
|
13
|
Nihei K, Minashi K, Takizawa K, Ogawa G, Yano T, Ezoe Y, Tsuchida T, Ono H, Iizuka T, Hanaoka N, Oda I, Morita Y, Tajika M, Fujiwara J, Katada C, Hori S, Kadota T, Muto M. Regional Lymph-Node Failures after Diagnostic Endoscopic Resection Plus Selective Chemoradiotherapy for Clinical Stage I Esophageal Squamous Cell Carcinoma: A Multi-Institutional Phase II Study (JCOG0508). Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
Kuwajima M, Goto M, Kurane K, Shimbo H, Omika N, Jimbo EF, Muramatsu K, Tajika M, Shimura M, Murayama K, Kurosawa K, Yamagata T, Osaka H. MELAS syndrome with m.4450 G > A mutation in mitochondrial tRNA Met gene. Brain Dev 2019; 41:465-469. [PMID: 30739820 DOI: 10.1016/j.braindev.2019.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/02/2019] [Accepted: 01/22/2019] [Indexed: 10/27/2022]
Abstract
Mutations in the mitochondrial tRNAMet gene have been reported in only five patients to date, all of whom presented with muscle weakness and exercise intolerance as signs of myopathy. We herein report the case of a 12-year-old girl with focal epilepsy since the age of eight years. At age 11, the patient developed sudden visual disturbances and headaches accompanied by recurrent, stroke-like episodes with lactic acidosis (pH 7.279, lactic acid 11.6 mmol/L). The patient frequently developed a delirious state, exhibited regression of intellectual ability. Brain magnetic resonance imaging revealed high-intensity signals on T2-weighted images of the left occipital lobe. Mitochondrial gene analysis revealed a heteroplasmic m.4450G > A mutation in the mitochondrial tRNAMet. The heteroplasmic rate of the m.4450G > A mutation in blood, skin, urinary sediment, hair, saliva, and nail samples were 20, 38, 59, 41, 27, and 35%, respectively. The patient's fibroblast showed an approximately 53% reduction in the oxygen consumption rate, compared to a control, and decreased complex I and IV activities. Stroke-like episodes, lactic acidosis, encephalopathy with brain magnetic resonance imaging findings, and declined mitochondrial function were consistent with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome. To our knowledge, the findings associated with this first patient with MELAS syndrome harboring the m.4450G > A mutation in mitochondrial tRNAMet expand the phenotypic spectrum of tRNAMet gene.
Collapse
Affiliation(s)
- Mari Kuwajima
- Department of Pediatrics, Jichi Medical University, Japan
| | - Masahide Goto
- Department of Pediatrics, Jichi Medical University, Japan
| | - Koyuru Kurane
- Department of Pediatrics, Jichi Medical University, Japan
| | - Hiroko Shimbo
- Department of Genetics, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
| | - Narumi Omika
- Department of Pediatrics, Jichi Medical University, Japan
| | - Eriko F Jimbo
- Department of Pediatrics, Jichi Medical University, Japan
| | | | - Makiko Tajika
- Department of Metabolism, Chiba Children's Hospital, Japan
| | - Masaru Shimura
- Department of Metabolism, Chiba Children's Hospital, Japan
| | - Kei Murayama
- Department of Metabolism, Chiba Children's Hospital, Japan
| | - Kenji Kurosawa
- Department of Genetics, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
| | | | - Hitoshi Osaka
- Department of Pediatrics, Jichi Medical University, Japan.
| |
Collapse
|
15
|
Ikeda T, Osaka H, Shimbo H, Tajika M, Yamazaki M, Ueda A, Murayama K, Yamagata T. Mitochondrial DNA 3243A>T mutation in a patient with MELAS syndrome. Hum Genome Var 2018; 5:25. [PMID: 30210801 PMCID: PMC6123423 DOI: 10.1038/s41439-018-0026-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 04/08/2018] [Revised: 06/10/2018] [Accepted: 07/29/2018] [Indexed: 11/24/2022] Open
Abstract
Approximately 80% of cases of mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) harbor a heteroplasmic m.3243A>G transition in the tRNALeu (UUR) (MTTL1) gene. We report a MELAS case with a rare heteroplasmic m.3243A>T mutation found by direct sequencing of MTTL1. This mutation has been previously reported in 5 cases, of which 2 cases had the MELAS phenotype. Our case also strengthens the hypothesis that the m.3243A>T mutation can cause the MELAS phenotype.
Collapse
Affiliation(s)
- Takahiro Ikeda
- 1Division of Pediatrics, Jichi Medical University, Shimotsuke, Tochigi Japan
| | - Hitoshi Osaka
- 1Division of Pediatrics, Jichi Medical University, Shimotsuke, Tochigi Japan
| | - Hiroko Shimbo
- 2Department of Pediatric Neurology, Kanagawa Children's Medical Center, Yokohama, Kanagawa Japan
| | - Makiko Tajika
- 3Department of Metabolism, Chiba Children's Hospital, Chiba, Chiba, Japan
| | - Masayo Yamazaki
- 1Division of Pediatrics, Jichi Medical University, Shimotsuke, Tochigi Japan
| | - Ayako Ueda
- 1Division of Pediatrics, Jichi Medical University, Shimotsuke, Tochigi Japan
| | - Kei Murayama
- 3Department of Metabolism, Chiba Children's Hospital, Chiba, Chiba, Japan
| | - Takanori Yamagata
- 1Division of Pediatrics, Jichi Medical University, Shimotsuke, Tochigi Japan
| |
Collapse
|
16
|
Lim SC, Tajika M, Shimura M, Carey KT, Stroud DA, Murayama K, Ohtake A, McKenzie M. Loss of the Mitochondrial Fatty Acid β-Oxidation Protein Medium-Chain Acyl-Coenzyme A Dehydrogenase Disrupts Oxidative Phosphorylation Protein Complex Stability and Function. Sci Rep 2018; 8:153. [PMID: 29317722 PMCID: PMC5760697 DOI: 10.1038/s41598-017-18530-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [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: 04/13/2017] [Accepted: 12/13/2017] [Indexed: 12/30/2022] Open
Abstract
Medium-chain acyl-Coenzyme A dehydrogenase (MCAD) is involved in the initial step of mitochondrial fatty acid β-oxidation (FAO). Loss of function results in MCAD deficiency, a disorder that usually presents in childhood with hypoketotic hypoglycemia, vomiting and lethargy. While the disruption of mitochondrial fatty acid metabolism is the primary metabolic defect, secondary defects in mitochondrial oxidative phosphorylation (OXPHOS) may also contribute to disease pathogenesis. Therefore, we examined OXPHOS activity and stability in MCAD-deficient patient fibroblasts that have no detectable MCAD protein. We found a deficit in mitochondrial oxygen consumption, with reduced steady-state levels of OXPHOS complexes I, III and IV, as well as the OXPHOS supercomplex. To examine the mechanisms involved, we generated an MCAD knockout (KO) using human 143B osteosarcoma cells. These cells also exhibited defects in OXPHOS complex function and steady-state levels, as well as disrupted biogenesis of newly-translated OXPHOS subunits. Overall, our findings suggest that the loss of MCAD is associated with a reduction in steady-state OXPHOS complex levels, resulting in secondary defects in OXPHOS function which may contribute to the pathology of MCAD deficiency.
Collapse
Affiliation(s)
- Sze Chern Lim
- Centre for Genetic Diseases, Hudson Institute of Medical Research, 3168, Melbourne, Australia.,Department of Molecular and Translational Science, Monash University, 3168, Melbourne, Australia
| | - Makiko Tajika
- Department of Metabolism, Chiba Children's Hospital, 266-0007, Chiba, Japan
| | - Masaru Shimura
- Department of Metabolism, Chiba Children's Hospital, 266-0007, Chiba, Japan
| | - Kirstyn T Carey
- Centre for Cancer Research, Hudson Institute of Medical Research, 3168, Melbourne, Australia
| | - David A Stroud
- Department of Biochemistry and Molecular Biology, Monash Biomedicine Discovery Institute, Monash University, 3800, Melbourne, Australia
| | - Kei Murayama
- Department of Metabolism, Chiba Children's Hospital, 266-0007, Chiba, Japan
| | - Akira Ohtake
- Department of Pediatrics, Saitama Medical University, 350-0495, Saitama, Japan
| | - Matthew McKenzie
- Centre for Genetic Diseases, Hudson Institute of Medical Research, 3168, Melbourne, Australia. .,Department of Molecular and Translational Science, Monash University, 3168, Melbourne, Australia.
| |
Collapse
|
17
|
Fujiyoshi T, Tajika M, Tanaka T, Ishihara M, Mizuno N, Hara K, Hijioka S, Imaoka H, Yatabe Y, Hirooka Y, Goto H, Yamao K, Niwa Y. Comparative evaluation of new and conventional classifications of magnifying endoscopy with narrow band imaging for invasion depth of superficial esophageal squamous cell carcinoma. Dis Esophagus 2017; 30:1-8. [PMID: 28881897 DOI: 10.1093/dote/dox037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Indexed: 12/11/2022]
Abstract
A new classification of magnifying endoscopy with narrow band imaging (ME-NBI) for diagnosing and staging superficial esophageal squamous cell carcinoma (SESCC) was proposed by the Japan Esophageal Society in 2011. This study aimed to compare the new classification with the conventional classifications (Inoue's classification and Arima's classification). This was a prospective analysis of data from a single cancer center involving 151 consecutive patients with 156 SESCCs that were endoscopically or surgically resected. Initially, only ME-NBI images were selected and reviewed independently by three experienced endoscopists. White light imaging (WLI) was then evaluated separately after an interval. The diagnostic performance of each classification and interobserver agreement were assessed, and the WLI findings that affect the diagnosis by the new classification were identified. The specificity for classifying invasive depth as epithelium (EP)/lamina propria mucosae (LPM) confined was higher with the new classification than with Inoue's classification (0.512 vs. 0.349; P = 0.02) and Arima's classification (0.512 vs. 0.279; P < 0.01). However, the sensitivity was lower (0.902 vs. 1.000; P < 0.01) compared with Arima's classification. The concordance rates of three evaluators (κ values) were 0.52 for the new classification, 0.50 for Inoue's classification, and 0.23 for Arima's classification. On multivariate analysis, thickness on WLI independently affected the accuracy of diagnosis with the new classification (OR 3.23; 95%CI, 1.30-8.03). The new classification is superior to conventional classifications with respect to specificity for diagnosing SESCC with depth EP/LPM. Thickness on WLI was a factor negatively affecting the diagnostic performance of the new classification.
Collapse
Affiliation(s)
- T Fujiyoshi
- Departments of Gastroenterology.,Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | | | | | | | | | - K Hara
- Departments of Gastroenterology
| | | | | | - Y Yatabe
- Pathology and Molecular Diagnosis, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Y Hirooka
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | - H Goto
- Departments of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - K Yamao
- Departments of Gastroenterology
| | | |
Collapse
|
18
|
Mitani S, Oze I, Kadowaki S, Masuishi T, Narita Y, Taniguchi H, Ura T, Ando M, Tajika M, Makita C, Kodaira T, Uemura N, Abe T, Muro K. Risk of second malignancies after definitive therapy for esophageal cancer: A competing risk analysis. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.018] [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: 11/14/2022] Open
|
19
|
Ogawa E, Shimura M, Fushimi T, Tajika M, Ichimoto K, Matsunaga A, Tsuruoka T, Ishige M, Fuchigami T, Yamazaki T, Mori M, Kohda M, Kishita Y, Okazaki Y, Takahashi S, Ohtake A, Murayama K. Clinical validity of biochemical and molecular analysis in diagnosing Leigh syndrome: a study of 106 Japanese patients. J Inherit Metab Dis 2017; 40:685-693. [PMID: 28429146 PMCID: PMC5579154 DOI: 10.1007/s10545-017-0042-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 03/01/2017] [Accepted: 03/24/2017] [Indexed: 01/30/2023]
Abstract
Leigh syndrome (LS) is a progressive neurodegenerative disorder of infancy and early childhood. It is clinically diagnosed by typical manifestations and characteristic computed tomography (CT) or magnetic resonance imaging (MRI) studies. Unravelling mitochondrial respiratory chain (MRC) dysfunction behind LS is essential for deeper understanding of the disease, which may lead to the development of new therapies and cure. The aim of this study was to evaluate the clinical validity of various diagnostic tools in confirming MRC disorder in LS and Leigh-like syndrome (LL). The results of enzyme assays, molecular analysis, and cellular oxygen consumption rate (OCR) measurements were examined. Of 106 patients, 41 were biochemically and genetically verified, and 34 had reduced MRC activity but no causative mutations. Seven patients with normal MRC complex activities had mutations in the MT-ATP6 gene. Five further patients with normal activity in MRC were identified with causative mutations. Conversely, 12 out of 60 enzyme assays performed for genetically verified patients returned normal results. No biochemical or genetic background was confirmed for 19 patients. OCR was reduced in ten out of 19 patients with negative enzyme assay results. Inconsistent enzyme assay results between fibroblast and skeletal muscle biopsy samples were observed in 33% of 37 simultaneously analyzed cases. These data suggest that highest diagnostic rate is reached using a combined enzymatic and genetic approach, analyzing more than one type of biological materials where suitable. Microscale oxygraphy detected MRC impairment in 50% cases with no defect in MRC complex activities.
Collapse
Affiliation(s)
- Erika Ogawa
- Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba, 266-0007, Japan
- Department of Pediatrics and Child Health, Nihon University School of Medicine, 30-1 Ohyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Masaru Shimura
- Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba, 266-0007, Japan
| | - Takuya Fushimi
- Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba, 266-0007, Japan
| | - Makiko Tajika
- Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba, 266-0007, Japan
| | - Keiko Ichimoto
- Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba, 266-0007, Japan
| | - Ayako Matsunaga
- Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba, 266-0007, Japan
| | - Tomoko Tsuruoka
- Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba, 266-0007, Japan
| | - Mika Ishige
- Department of Pediatrics and Child Health, Nihon University School of Medicine, 30-1 Ohyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Tatsuo Fuchigami
- Department of Pediatrics and Child Health, Nihon University School of Medicine, 30-1 Ohyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Taro Yamazaki
- Department of Pediatrics, Saitama Medical University, 38 Morohongo, Moroyama, Saitama, 350-0495, Japan
| | - Masato Mori
- Department of Pediatrics, Matsudo City Hospital, Matsudo, 4005 Kamihongo, Matsudo, Chiba, 271-8511, Japan
| | - Masakazu Kohda
- Division of Translational Research, Research Center for Genomic Medicine, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1241, Japan
| | - Yoshihito Kishita
- Division of Functional Genomics and Systems Medicine, Research Center for Genomic Medicine, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1241, Japan
| | - Yasushi Okazaki
- Division of Translational Research, Research Center for Genomic Medicine, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1241, Japan
- Division of Functional Genomics and Systems Medicine, Research Center for Genomic Medicine, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1241, Japan
| | - Shori Takahashi
- Department of Pediatrics and Child Health, Nihon University School of Medicine, 30-1 Ohyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Akira Ohtake
- Department of Pediatrics, Saitama Medical University, 38 Morohongo, Moroyama, Saitama, 350-0495, Japan.
| | - Kei Murayama
- Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba, 266-0007, Japan.
| |
Collapse
|
20
|
Narita Y, Sasaki E, Yatabe Y, Kato K, Okano H, Mitani S, Honda K, Masuishi T, Taniguchi H, Kadowaki S, Ura T, Ando M, Tajika M, Ito S, Muro K. PD-L1 immunohistochemistry (IHC) by three different assays and molecular profiling in tissue microarray (TMA) of gastric cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
21
|
Mitani S, Taniguchi H, Honda K, Masuishi T, Narita Y, Kadowaki S, Ura T, Ando M, Tajika M, Muro K. Analysis of efficacy and prognostic factors in second-line chemotherapy for BRAF V600E mutant metastatic colorectal cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
22
|
Matsuoka T, Miwa Y, Tajika M, Sawada M, Fujimaki K, Soga T, Tomita H, Uemura S, Nishino I, Fukuda T, Sugie H, Kosuga M, Okuyama T, Umeda Y. Divergent clinical outcomes of alpha-glucosidase enzyme replacement therapy in two siblings with infantile-onset Pompe disease treated in the symptomatic or pre-symptomatic state. Mol Genet Metab Rep 2016; 9:98-105. [PMID: 27896132 PMCID: PMC5121151 DOI: 10.1016/j.ymgmr.2016.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 09/09/2016] [Revised: 11/11/2016] [Accepted: 11/11/2016] [Indexed: 11/22/2022] Open
Abstract
Pompe disease is an autosomal recessive, lysosomal glycogen storage disease caused by acid α-glucosidase deficiency. Infantile-onset Pompe disease (IOPD) is the most severe form and is characterized by cardiomyopathy, respiratory distress, hepatomegaly, and skeletal muscle weakness. Untreated, IOPD generally results in death within the first year of life. Enzyme replacement therapy (ERT) with recombinant human acid alpha glucosidase (rhGAA) has been shown to markedly improve the life expectancy of patients with IOPD. However, the efficacy of ERT in patients with IOPD is affected by the presence of symptoms and cross-reactive immunologic material (CRIM) status. We have treated two siblings with IOPD with ERT at different ages: the first was symptomatic and the second was asymptomatic. The female proband (Patient 1) was diagnosed with IOPD and initiated ERT at 4 months of age. Her younger sister (Patient 2) was diagnosed with IOPD at 10 days of age and initiated ERT at Day 12. Patient 1, now 6 years old, is alive but bedridden, and requires 24-hour invasive ventilation due to gradually progressive muscle weakness. In Patient 2, typical symptoms of IOPD, including cardiac failure, respiratory distress, progressive muscle weakness, hepatomegaly and myopathic facial features were largely absent during the first 12 months of ERT. Her cardiac function and mobility were well-maintained for the first 3 years, and she had normal motor development. However, she developed progressive hearing impairment and muscle weakness after 3 years of ERT. Both siblings have had low anti-rhGAA immunoglobulin G (IgG) antibody titers during ERT and have tolerated the treatment well. These results suggest that initiation of ERT during the pre-symptomatic period can prevent and/or attenuate the progression of IOPD, including cardiomyopathy, respiratory distress, and muscle weakness for first several years of ERT. However, to improve the long-term efficacy of ERT for IOPD, new strategies for ERT for IOPD, e.g. modifying the enzyme to enhance uptake into skeletal muscle and/or to cross the blood brain barrier (BBB), will be required.
Collapse
Affiliation(s)
- Takashi Matsuoka
- Showa University Northern Yokohama Hospital, Children Medical Center, Yokohama, Kanagawa, Japan
| | - Yoshiyuki Miwa
- Showa University Northern Yokohama Hospital, Children Medical Center, Yokohama, Kanagawa, Japan
| | - Makiko Tajika
- Showa University Northern Yokohama Hospital, Children Medical Center, Yokohama, Kanagawa, Japan
| | - Madoka Sawada
- Showa University Northern Yokohama Hospital, Children Medical Center, Yokohama, Kanagawa, Japan
| | - Koichiro Fujimaki
- Showa University Northern Yokohama Hospital, Children Medical Center, Yokohama, Kanagawa, Japan
| | - Takashi Soga
- Showa University Northern Yokohama Hospital, Children Medical Center, Yokohama, Kanagawa, Japan
| | - Hideshi Tomita
- Showa University Northern Yokohama Hospital, Cardiovascular Center, Yokohama, Kanagawa, Japan
| | - Shigeru Uemura
- Showa University Northern Yokohama Hospital, Cardiovascular Center, Yokohama, Kanagawa, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Tokiko Fukuda
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Hideo Sugie
- Faculty of Health and Medical Sciences, Tokoha University, Hamamatsu, Shizuoka, Japan
| | - Motomichi Kosuga
- Division of Medical Genetics, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Torayuki Okuyama
- Department of Clinical Laboratory Medicine, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Yoh Umeda
- Showa University Northern Yokohama Hospital, Children Medical Center, Yokohama, Kanagawa, Japan
| |
Collapse
|
23
|
Ito M, Koide Y, Yoshida M, Kimura K, Makita C, Tomita N, Tachibana H, Kodaira T, Tajika M, Niwa Y, Abe T, Hasegawa Y, Muro K. Clinical Results of Definitive Chemoradiation Therapy for Cervical Esophageal Cancer: Comparison of Failure Pattern and Toxicities Between Intensity Modulated Radiation Therapy and 3-Dimensional Chemoradiation Therapy Group. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
24
|
Taniguchi H, Uehara K, Nakayama H, Nakayama G, Takahashi T, Nakano Y, Matsuoka H, Utsunomiya S, Sakamoto E, Mori Y, Komori K, Tajika M, Muro K, Yatabe Y. The location of colorectal cancer (right- vs. left-sided colon and rectum) affects the prevalence of BRAF V600E, non-V600E and PIK3CA mutations: a prospective registration study in the Aichi Cancer Network. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.117] [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: 11/14/2022] Open
|
25
|
Mitani S, Kadowaki S, Oze I, Masuishi T, Narita Y, Taniguchi H, Ura T, Ando M, Tajika M, Makita C, Kodaira T, Uemura N, Abe T, Muro K. Chemoradiotherapy versus surgery for clinical stage I esophageal squamous cell carcinoma: A long-term comparison. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw371.63] [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: 11/14/2022] Open
|
26
|
Narita Y, Kadowaki S, Oze I, Taniguchi H, Ura T, Ando M, Ito S, Yatabe Y, Tajika M, Muro K. 205P Development of nomograms including HER2 status for predicting survival in metastatic gastric cancer. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv523.66] [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: 11/13/2022] Open
|
27
|
Tanaka T, Niwa Y, Tajika M, Ishihara M, Imaoka H, Mizuno N, Hara K, Hijioka S, Hirooka Y, Goto H, Yamao K. Prospective evaluation of a transnasal endoscopy utilizing flexible spectral imaging color enhancement (FICE) with the Valsalva maneuver for detecting pharyngeal and esophageal cancer. Hepatogastroenterology 2014; 61:1627-1634. [PMID: 25436354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIMS This study evaluated the efficacy and safety of transnasal endoscopy (TNE) with flexible spectral imaging color enhancement (FICE) for detection of superficial cancer in the pharyngeal and esophageal regions for high-risk populations. METHODOLOGY Patients who previously had head and neck or esophageal squamous cell carcinoma were enrolled. Screening was conducted using TNE with conventional white-light endoscopy (WLE) followed by FICE chromoendoscopy. For observation of the pharyngeal region, the Valsalva maneuver was employed. RESULTS 99 patients were eligible. Six esophageal cancers were detected in four patients (4.0%). The sensitivity, specificity, and accuracy for the detection of cancer were 25.0% (95% CI, 3.4- 71.0), 97.8% (95% CI, 92.1-99.8), and 94.9 % (95% CI, 88.4-98.1), respectively for WLE; 100% (95% CI, 45.4%- 100%), 96.8% (95% CI, 90.7%-99.3%), and 96.9% (95% CI, 89.3%-99.1%), respectively for FICE chromoendoscopy. Pain in the nose and nasal hemorrhage were observed in 3 (3.0%) and 2 patients (2.0%), respectively. Following the Valsalva maneuver, endoscopic scores significantly increased from a mean of 1.1 (0.8-1.4) to 2.0 (1.3-2.6) (p<0.05). CONCLUSIONS TNE with the Valsalva maneuver is a promising screening method for the pharyngeal and esophageal regions. TNE with FICE chromoendoscopy for detecting pharyngeal and esophageal cancer was more sensitive than WLE.
Collapse
|
28
|
Tajika M, Niwa Y, Tanaka T, Ishihara M, Mizuno N, Hara K, Hijioka S, Imaoka H, Yogi T, Tsutsumi H, Fujiyoshi T, Sato T, Yoshida T, Okuno N, Hieda N, Yatabe Y, Bhatia V, Yamao K. Management and Long-Term Clinical Outcome of Api2-Malt1 Positive Gastric Malt Lymphoma. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu339.23] [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: 11/14/2022] Open
|
29
|
Nomura M, Abe T, Kodaira T, Oze I, Komori A, Narita Y, Masuishi T, Taniguchi H, Kadowaki S, Takahari D, Ura T, Andoh M, Kawai R, Uemura N, Tomita N, Tachibana H, Tanaka T, Tajika M, Niwa Y, Muro K. Comparison of Surgery with Definitive Chemoradiotherapy for Potentially Resectable Esophageal Cancer: a Propensity-Score Analysis. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.18] [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: 11/13/2022] Open
|
30
|
Hara K, Yamao K, Hijioka S, Mizuno N, Imaoka H, Tajika M, Kondo S, Tanaka T, Haba S, Takeshi O, Nagashio Y, Obayashi T, Shinagawa A, Bhatia V, Shimizu Y, Goto H, Niwa Y. Prospective clinical study of endoscopic ultrasound-guided choledochoduodenostomy with direct metallic stent placement using a forward-viewing echoendoscope. Endoscopy 2014; 45:392-6. [PMID: 23338620 DOI: 10.1055/s-0032-1326076] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [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: 02/07/2023]
Abstract
A prospective clinical study was conducted to evaluate the safety, feasibility, and efficacy of endoscopic ultrasound (EUS)-guided choledochoduodenostomy (CDS) with direct metallic stent placement using a prototype forward-viewing echoendoscope. The indication for EUS - CDS in this study was lower biliary obstruction only, and not failed endoscopic biliary drainage, because the aim was to evaluate EUS - CDS for first-line biliary drainage therapy. The technical and functional success rates were 94 % (17 /18) and 94 % (16 /17), respectively. Early complications (focal peritonitis) were encountered in two patients (11 %). No patients developed late complications. EUS - CDS with direct metallic stent placement using a forward-viewing echoendoscope was generally feasible and effective for malignant distal biliary tract obstruction. The forward-viewing echoendoscope was useful, especially for deploying the metallic stent.
Collapse
Affiliation(s)
- K Hara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Ogura T, Tajika M, Hijioka S, Hara K, Haba S, Hosoda W, Yatabe Y, Asano S, Higuchi K, Yamao K, Niwa Y. First report of a mucosa-associated lymphoid tissue (MALT) lymphoma of the esophagus diagnosed by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). Endoscopy 2012; 44 Suppl 2 UCTN:E167-8. [PMID: 22622725 DOI: 10.1055/s-0031-1291758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- T Ogura
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Hijioka S, Matsuo K, Mizuno N, Hara K, Mekky MA, Vikram B, Hosoda W, Yatabe Y, Shimizu Y, Kondo S, Tajika M, Niwa Y, Tamada K, Yamao K. Role of endoscopic ultrasound and endoscopic ultrasound-guided fine-needle aspiration in diagnosing metastasis to the pancreas: a tertiary center experience. Pancreatology 2011; 11:390-8. [PMID: 21894056 DOI: 10.1159/000330536] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [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] [Received: 05/09/2011] [Accepted: 07/05/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND Metastasis to the pancreas (MP) is a rare entity that is difficult to identify by imaging alone. Few reports have described endoscopic ultrasound (EUS) and EUS-guided fine-needle aspiration (FNA) findings. Herein, we try to describe the EUS and EUS-FNA characteristics of MP. METHODS This retrospective study compared 28 patients with MP (13 males; mean age: 60.1 ± 12.6 years) and 60 control patients (30 males; 62.7 ± 11.5 years) with pancreatic ductal adenocarcinoma (PDAC). All lesions were characterized by EUS, and MP was diagnosed by EUS-FNA (n = 16), surgery (n = 6) or both (n = 6). RESULTS Multivariate logistic regression revealed that the presence of regular borders (p = 0.004; OR: 8.81, 95% CI: 1.97-39.4), the absence of retention cysts (p = 0.045; OR: 12.5, 95% CI: 1.06-147.0), and the absence of main pancreatic duct (MPD) dilation (p = 0.003; OR: 8.18, 95% CI: 2.04-32.8) were predictors of MP rather than PDAC. The EUS-FNA sampling adequacy was 95.4% (21/22), and the correct diagnosis was obtained in 95.2% (20/21) of cases when K-ras mutation analysis and/or immunostaining were added. CONCLUSION The presence of regular borders, the absence of retention cysts and the presence of nondilated MPD on EUS indicate MP rather than PDAC. This diagnosis can be accurately confirmed by EUS-FNA with immunostaining and/or K-ras analysis.
Collapse
Affiliation(s)
- S Hijioka
- Department of Tropical Medicine and Gastroenterology, Assiut University Hospital, Assiut, Egypt.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Yuki S, Shitara K, Yoshida M, Takahari D, Utsunomiya S, Yokota T, Sato Y, Tajika M, Muro K. Phase II study of combination chemotherapy with biweekly cetuximab and irinotecan for wild-type KRAS metastatic colorectal cancer refractory to irinotecan, oxaliplatin, and fluoropyrimidines. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
561 Background: Weekly cetuximab and irinotecan is a standard regimen in heavily pretreated patients with metastatic colorectal cancer (MCRC). The aim of this study was to prospectively evaluate the efficacy of combination chemotherapy with biweekly cetuximab and irinotecan in patients with pretreated MCRC harboring wild-type KRAS. Methods: Patients with wild- type KRAS MCRC that had progressed after chemotherapy with irinotecan, oxaliplatin, and fluoropyrimidine were included in this study. Cetuximab was administered at 500 mg/m2 biweekly with irinotecan. The primary endpoint was response rate. The secondary endpoints included adverse events, progression-free survival, and overall survival. The pharmacokinetics of cetuximab was also evaluated in five patients. Results: From May, 2009 to February, 2010, a total of 31 patients were enrolled from five institutions. One patient was not eligible. Among the 30 assessable patients, ECOG PS was 0 in 12, 1 in 16, and 2 in two patients. The objective response rate was 30.0% (95% confidence interval [CI], 14.7-49.4), and the disease control rate (complete response, partial response, or stable disease) was 76.7% (95%CI, 61.4-92.3). The median progression-free survival was 5.3 months (95%CI, 3.4-7.3). Grade 3 skin toxicity was observed in 3 patients (10%), and treatment related death due to pneumonia occurred in one patient. Conclusions: The efficacy data are similar to those of standard dose of cetuximab plus irinotecan. Combination chemotherapy with biweekly cetuximab and irinotecan is effective for pretreated metastatic wild-type KRAS MCRC. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- S. Yuki
- Department of Gastroenterology, Hokkaido University School of Medicine, Sapporo, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Osaka Medical College Hospital, Osaka, Japan; Nagoya Kyoritsu Hospital, Nagoya, Japan
| | - K. Shitara
- Department of Gastroenterology, Hokkaido University School of Medicine, Sapporo, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Osaka Medical College Hospital, Osaka, Japan; Nagoya Kyoritsu Hospital, Nagoya, Japan
| | - M. Yoshida
- Department of Gastroenterology, Hokkaido University School of Medicine, Sapporo, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Osaka Medical College Hospital, Osaka, Japan; Nagoya Kyoritsu Hospital, Nagoya, Japan
| | - D. Takahari
- Department of Gastroenterology, Hokkaido University School of Medicine, Sapporo, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Osaka Medical College Hospital, Osaka, Japan; Nagoya Kyoritsu Hospital, Nagoya, Japan
| | - S. Utsunomiya
- Department of Gastroenterology, Hokkaido University School of Medicine, Sapporo, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Osaka Medical College Hospital, Osaka, Japan; Nagoya Kyoritsu Hospital, Nagoya, Japan
| | - T. Yokota
- Department of Gastroenterology, Hokkaido University School of Medicine, Sapporo, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Osaka Medical College Hospital, Osaka, Japan; Nagoya Kyoritsu Hospital, Nagoya, Japan
| | - Y. Sato
- Department of Gastroenterology, Hokkaido University School of Medicine, Sapporo, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Osaka Medical College Hospital, Osaka, Japan; Nagoya Kyoritsu Hospital, Nagoya, Japan
| | - M. Tajika
- Department of Gastroenterology, Hokkaido University School of Medicine, Sapporo, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Osaka Medical College Hospital, Osaka, Japan; Nagoya Kyoritsu Hospital, Nagoya, Japan
| | - K. Muro
- Department of Gastroenterology, Hokkaido University School of Medicine, Sapporo, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Osaka Medical College Hospital, Osaka, Japan; Nagoya Kyoritsu Hospital, Nagoya, Japan
| |
Collapse
|
34
|
Sawai Y, Yamao K, Bhatia V, Chiba T, Mizuno N, Sawaki A, Takahashi K, Tajika M, Shimizu Y, Yatabe Y, Yanagisawa A. Development of pancreatic cancers during long-term follow-up of side-branch intraductal papillary mucinous neoplasms. Endoscopy 2010; 42:1077-84. [PMID: 21120776 DOI: 10.1055/s-0030-1255971] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [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: 12/13/2022]
Abstract
BACKGROUND AND STUDY AIMS Side-branch intraductal papillary mucinous neoplasms (SB-IPMNs), and associated synchronous and metachronous pancreatic cancers are increasingly detected as imaging modalities become more sensitive. We investigated the natural history of SB-IPMN, and the incidence and characteristics of pancreatic cancers among patients undergoing long-term follow-up. PATIENTS AND METHODS We reviewed the clinical, imaging, and pathological features in 103 patients, diagnosed at the Aichi Cancer Center between September 1988 and September 2006 as having SB-IPMN, and conservatively followed up for ≥ 2 years (median 59 months) based on an endoscopic ultrasonography (EUS) database. RESULTS 74 (71.8 %) patients had nonprogressive lesions. Overall, six patients (5.8 %) developed pancreatic cancers during follow-up, with intraductal papillary mucinous (IPM) carcinoma in four, and ductal carcinoma of pancreas that was not IPMN in two patients. Of the six pancreatic cancers, five were diagnosed at a resectable stage. The 5-year and 10-year actuarial rates of development of pancreatic cancer were 2.4 % and 20.0 %, respectively. Although, at the last follow-up, cyst size, main pancreatic duct (MPD) diameter, mural nodule size, and frequency of metachronous and/or synchronous cancers of other organs were significantly higher in patients who developed IPM carcinoma, resected SB-IPMNs without mural nodules and dilated MPDs had no IPM carcinomas. CONCLUSIONS The frequency of pancreatic cancers is high on long-term follow-up of SB-IPMN. Although conservative management is appropriate for selected patients, regular and long-term imaging, especially by EUS is essential, even if SB-IPMN remains unchanged for 2 years. Presence of mural nodule and dilated MPD seem to be more appropriate indicators for resection than cyst size alone for SB-IPMNs.
Collapse
Affiliation(s)
- Y Sawai
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Matsumoto K, Sawaki A, Mizuno N, Hara K, Hijioka S, Niwa Y, Tajika M, Kawai H, Kondo S, Yamao K. Clinical Efficacy and Safety of Sunitinib After Imatinib Failure in Japanese Patients with Gastrointestinal Stromal Tumor. Jpn J Clin Oncol 2010; 41:57-62. [DOI: 10.1093/jjco/hyq164] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
36
|
Tsuboi J, Tajika M, Nakamura T, Kawai H, Bhatia V, Takayama R, Kitamura J, Yatabe Y, Hatooka S, Shinoda M, Yamao K, Ogura Y. Endoscopic features of short-term progression of esophageal intramural pseudodiverticulosis. Endoscopy 2010; 42 Suppl 2:E92-3. [PMID: 20195983 DOI: 10.1055/s-0029-1243915] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- J Tsuboi
- Department of Gastroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Nagoya, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Shitara K, Matsuo K, Takahari D, Yokota T, Shibata T, Ura T, Ito S, Sawaki A, Tajika M, Kawai H, Muro K. Neutropenia as a prognostic factor in advanced gastric cancer patients undergoing second-line chemotherapy with weekly paclitaxel. Ann Oncol 2010; 21:2403-2409. [PMID: 20494962 DOI: 10.1093/annonc/mdq248] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Neutropenia during chemotherapy has been reported to be a predictor of better survival in patients with several types of cancers, although there are no reports in pretreated patients. METHODS We retrospectively analyzed 242 patients with advanced gastric cancer (AGC) who received weekly paclitaxel (Taxol) as second-line chemotherapy. Background characteristics and neutropenia as time-varying covariates (TVCs) were analyzed as prognostic factors. RESULTS Of the 242 patients, mild neutropenia (grades 1-2) occurred in 101 patients (41.7%) and severe neutropenia (grades 3-4) occurred in 63 patients (26.0%). The other 78 patients (32.2%) did not experience neutropenia. According to a multivariate Cox model with neutropenia as a TVC, hazard ratios of death were 0.61 [95% confidence interval (CI) 0.43-0.85; P = 0.004] for patients with mild neutropenia and 0.61 (95% CI 0.41-0.88; P = 0.009) for those with severe neutropenia. Among the patients in landmark analysis (landmark of 2.5 months; median time to treatment failure of paclitaxel), mild and severe neutropenia remained significant prognostic factors. CONCLUSIONS Our results indicate that neutropenia during chemotherapy is associated with improved survival in patients with AGC who received weekly paclitaxel as second-line chemotherapy. Prospective trials are required to assess whether dosing adjustments based on neutropenia may improve chemotherapy efficacy.
Collapse
Affiliation(s)
- K Shitara
- Department of Clinical Oncology, Aichi Cancer Center Hospital.
| | - K Matsuo
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute
| | - D Takahari
- Department of Clinical Oncology, Aichi Cancer Center Hospital
| | - T Yokota
- Department of Clinical Oncology, Aichi Cancer Center Hospital
| | - T Shibata
- Department of Clinical Oncology, Aichi Cancer Center Hospital
| | - T Ura
- Department of Clinical Oncology, Aichi Cancer Center Hospital
| | | | - A Sawaki
- Departments of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - M Tajika
- Departments of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - H Kawai
- Departments of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - K Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital
| |
Collapse
|
38
|
Matsumoto K, Hara K, Sawaki A, Mizuno N, Hijioka S, Imamura H, Niwa Y, Tajika M, Kawai H, Kondo S, Inaba Y, Yamao K. Ruptured pseudoaneurysm of the splenic artery complicating endoscopic ultrasound-guided fine-needle aspiration biopsy for pancreatic cancer. Endoscopy 2010; 42 Suppl 2:E27-8. [PMID: 20073006 DOI: 10.1055/s-0029-1215323] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- K Matsumoto
- Department of Gastroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Tajika M, Nakamura T, Tsuboi J, Bhatia V, Kawai H, Sawaki A, Mizuno N, Takagi T, Hara K, Sawai Y, Kobayashi Y, Matsumoto K, Sugimori S, Yamakita K, Yamao K. A case of syndrome of inappropriate secretion of antidiuretic hormone following endoscopic treatment. Endoscopy 2009; 41 Suppl 2:E101. [PMID: 19418420 DOI: 10.1055/s-0028-1119621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- M Tajika
- Department of Endoscopy, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya City 464-8681, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Sawaki A, Mizuno N, Takagi T, Hara K, Nakamura T, Tajika M, Kawai H, Matsumoto K, Kobayashi Y, Yamao K. Gastric submucosal tumors: Lessons learned from 10-year follow-up. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e15631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15631 Background: Gastric Submucosal tumors (SMTs) were incidentally discovered esophagogastroduodenoscopy (EGD). However, they have not been studied in detail of epidemiology. Furthermore, no treatment strategy for SMTs has been established with few studies looking into long-term outcomes. The aim of this study is to clarify the clinical features and long-term outcomes of gastric SMT at a single institute for 10-year period. Methods: We performed a total of 5307 EGDs and detected 188 gastric SMTs during 1998. All clinical data including incidence, size and location in stomach were analyzed for the medical records. A retrospective review was conducted for 10-year period for 109 patients and 79 patients were excluded because of simultaneous surgery (3), disappear in follow- up EGD (27), lost of follow-up (49). Results: Gastric SMTs were detected 188 (81 males, 107 females) of 5307 patients (3.5%). Majority size of SMTs was less than 1cm (64%) and SMTs<2cm were 91%. 56% of SMTs located middle one third of stomach, and half (22%) of the remaining SMTs were detected at upper and lower one third, respectively. In 10-year follow-up, 83 of 109 patients were alive at December 2008. One patient was dead of SMT and the remaining 25 patients were dead of other disease till December 2008. Enlargement of SMT was observed in 2 of 109 SMTs (1.8%). Both of them underwent surgical resection and diagnosed as gastrointestinal stromal tumors (GIST). One patient was annually monitored by endoscopy, from 0.6cm to 1.5cm during 4 years, without recurrence for 6 years after surgical intervention. Another didn't undergo regular endoscopy, from 1.8cm to 8cm during 2 years, with recurrence, and consequently died of SMT. Conclusions: The incidence of SMTs is 3.5%, majority (91%) is small (<2cm), and frequent location is middle one third of stomach. Most of SMTs might be managed conservatively, but regular endoscopy is required. No significant financial relationships to disclose.
Collapse
Affiliation(s)
| | | | | | - K. Hara
- Aichi Cancer Center, Nagoya, Japan
| | | | | | - H. Kawai
- Aichi Cancer Center, Nagoya, Japan
| | | | | | - K. Yamao
- Aichi Cancer Center, Nagoya, Japan
| |
Collapse
|
41
|
Sawaki A, Mizuno N, Hoki N, Takagi T, Nakamura T, Tajika M, Kawaki H, Takayama R, Takeda Y, Yamao K. Diagnosis of gastric submucosal tumors using endoscopic ultrasound guided fine needle aspiration. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4574] [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: 11/20/2022] Open
|
42
|
Yamao K, Bhatia V, Mizuno N, Sawaki A, Ishikawa H, Tajika M, Hoki N, Shimizu Y, Ashida R, Fukami N. EUS-guided choledochoduodenostomy for palliative biliary drainage in patients with malignant biliary obstruction: results of long-term follow-up. Endoscopy 2008; 40:340-2. [PMID: 18389451 DOI: 10.1055/s-2007-995485] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [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: 12/13/2022]
Abstract
Five patients with obstructive jaundice caused by malignant periampullary biliary stenosis underwent EUS-guided choledochoduodenostomy (EUS-CDS) from the first portion of the duodenum using a convex echoendoscope and a needle knife. All the steps of the procedure including passage dilatation and the plastic stent placement were performed through the accessory channel of the echoendoscope over the guide wire. Stent insertion was technically successful in all five patients. The procedure was also clinically effective in relieving jaundice in all cases. One patient developed pneumoperitoneum, which resolved with conservative management. Stent exchange was successful in seven of eight attempts in patients with stent occlusion. One failure was due to tumor invasion to the choledochoduodenal fistula. Stent patency was maintained in the remaining patients throughout their survival period. The average stent patency was 211.8 days. EUS-CDS from the first portion of the duodenum appears to be feasible and safe in cases of obstructive jaundice caused by distal bile duct obstruction.
Collapse
Affiliation(s)
- K Yamao
- Department of Gastroenterology, Aichi Cancer Center Hospital, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Sawaki A, Takayama R, Mizuno N, Tajika M, Hoki N, Sayed ZE, Matsuo K, Nakagawa H, Nakamura Y, Yamao K. Serum REG4 protein in pancreatic cancer as a tumor marker: A prospective study. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.15063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
15063 Background: Pancreatic cancer (PC) shows the worst mortality rate in common malignancies, with 5-year survival rate of 4%. The only way to cure the disease is surgical resection of early stage PC. Establishment of a screening strategy to detect early stage PC is eagerly expected. REG4, a member of the regenerating islet-derived (REG) family, are secreted proteins that play a role in tissue regeneration and inflammation in digestive organs. We reported overexpression of REG4 in PC cells and serum, and preliminary data of the serum REG4 level of pancreatic disease patients including PC patients. We conducted a prospective study to evaluate the role of serum REG4 in PC. Methods: The series included 57 patients diagnosed pathologically as PC between November 2004 and December 2005. Serum REG4 was quantified by standard sandwich ELISA (Enzyme Linked Immunosorbent Assay) using original kit (MBL116: provided by Medical and Biological Laboratories Co., LTD, Japan) before treatment. The upper limit of the test was set at 3.52ng/ml and was based on studies of serum from 48 healthy control subjects. Results: With a specificity of 100%, the diagnostic sensitivity and accuracy were 63.2% and 80.0%, respectively. The ROC (receiver operating characteristic) analysis showed that area under the curve was 0.91. REG4 levels were a significant differences between PC and control (p<0.001), between each T stage and control (T1,T2, T3 or T4 v control), and between each TMN stage and control (stage 1, stage 2, stage 3 or stage 4 v control), but were not a statistical significance with T stage (T1 v T2 v T3 v T4), M stage (M0 v M1) or TNM stage (stage 1 v stage 2 v stage 3 v stage 4) in PC patients. The diagnostic sensitivity of carcinoembryonic antigen (CEA>5.0ng/ml) and carbohydrate antigen19–9 (CA19–9>50U/ml) was 56.5% and 68.4%, respectively. No significant correlation was demonstrated between REG4 and CA19–9 (coefficient of correlation [rs]=0.45). Conclusions: This study shows the potential of serum REG4 as a screening test for PC, especially for early PC. REG4 is considered to be a more useful marker in combination with CA19- 9. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- A. Sawaki
- Aichi Cancer Center, Nagoya, Japan; Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - R. Takayama
- Aichi Cancer Center, Nagoya, Japan; Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - N. Mizuno
- Aichi Cancer Center, Nagoya, Japan; Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - M. Tajika
- Aichi Cancer Center, Nagoya, Japan; Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - N. Hoki
- Aichi Cancer Center, Nagoya, Japan; Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Z. E. Sayed
- Aichi Cancer Center, Nagoya, Japan; Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - K. Matsuo
- Aichi Cancer Center, Nagoya, Japan; Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - H. Nakagawa
- Aichi Cancer Center, Nagoya, Japan; Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Y. Nakamura
- Aichi Cancer Center, Nagoya, Japan; Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - K. Yamao
- Aichi Cancer Center, Nagoya, Japan; Institute of Medical Science, University of Tokyo, Tokyo, Japan
| |
Collapse
|
44
|
Isaka T, Nakamura T, Tajika M, Kawai H, Imaoka H, Okamoto Y, Aoki M, Inoue H, Takahashi K, Mizuno N, Sawaki A, Yamao K, Seto M, Yokoi T, Yatabe Y, Nakamura S. API2-MALT1chimeric transcript-positive gastroduodenal MALT lymphoma with subsequent development of adenocarcinoma as a collision tumour over a clinical course of 7 years. Histopathology 2007; 51:119-23. [PMID: 17542995 DOI: 10.1111/j.1365-2559.2007.02718.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
45
|
Mizoshita T, Tsukamoto T, Inada KI, Hirano N, Tajika M, Nakamura T, Ban H, Tatematsu M. Loss of MUC2 expression correlates with progression along the adenoma-carcinoma sequence pathway as well as de novo carcinogenesis in the colon. Histol Histopathol 2007; 22:251-60. [PMID: 17163399 DOI: 10.14670/hh-22.251] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIMS We have previously demonstrated links between clinicopathological findings and phenotypes using several gastric and intestinal phenotypic markers in stomach and pancreatic cancers. However, the clinicopathological significance of the phenotype and Cdx2 expression has hitherto remained unclear in colorectal carcinogenesis. METHODS AND RESULTS We examined the correlation between gastric and intestinal phenotypic expression in 91 primary early carcinomas of the colon. MUC2 expression demonstrated a significant decrease from tubular/tubulovillous adenomas with moderate atypia, through intramucosal carcinomas, to cancers with submucosal invasion (P<0.0001). Intramucosal de novo carcinomas (flat type carcinomas without adenomatous components) exhibited a greater decrease of MUC2 than intramucosal lesions with adenomatous components. Expression of MUC5AC also decreased significantly with progression according to the tubular/tubulovillous adenoma-carcinoma sequence, carcinomas with villous adenomatous components having a higher level compared with their tubular adenomatous counterparts, suggesting differences in the pathway of malignant transformation. Cdx2 nuclear expression was maintained in all of the adenomas and early carcinomas examined. CONCLUSIONS Our data suggest that the reduction of MUC2 expression may be associated with the occurrence and progression of colorectal carcinomas in both adenoma-carcinoma sequence pathway and de novo carcinogenesis. Tumor-suppressive effects of Cdx2 may be preserved during early stages of colorectal carcinogenesis.
Collapse
Affiliation(s)
- T Mizoshita
- Division of Oncological Pathology, Aichi Cancer Center Research Institute, Nagoya, Japan
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Sawaki A, Mizuno N, Takahashi K, Nakamura T, Tajika M, Kawai H, Inoue H, Masatoshi A, Ahmed Z, Yamao K. Recurrence after imatinib treatment for gastrointestinal stromal tumor: Japanese experience in a single institute. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.19504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
19504 Background: Although imatinib is the most effective agent for metastatic gastrointestinal stromal tumors (GISTs), resistance to imatinib develops in most patients. While the effectiveness of an oral multitageted tyrosine kinase inhibitor for intolerant GIST is already reported, many of imatinib resistant patients are not available. We report clinical results of first imatinib and post imatinib treatment in a patient with metastatic or unresectable GIST. Methods: A retrospective review was undertaken in patients with metastatic or unresectable GIST treated with imatinib at Aichi Cancer Center Hospital between June 2001 and December 2005. Treatment schedule was four or six 100-mg capsules of imatinib orally once daily. Patients were evaluated for treatment, recurrence, and survival. Results: Forty-five patients (26 males and 43 metastatic patients) were treated with imatinib at first. The median age was 58 years (range 25–79). Primary tumor sites were as follow; stomach was 13, duodenum 9, small intestine except for duodenum 18, and colorectum 5. Metastatic sites were liver (21 patients), peritoneum (11 patients), both of them (10 patients), and the other (1 patient). The response rate (by RECIST) and PFS was 71.1% (32/45) and 24 months, respectively. Imatinib was well tolerated; only two patients stopped treatment due to nausea and vomiting. Twenty-six patients with disease progression were treated by the combination of many methods, and the following methods underwent as the second therapy; 9 patients underwent surgical resection, 7 patients underwent transarterial chemoembolization (TACE) for liver metastases, 9 patients enrolled in a clinical trial, and 9 patients continued imatininb because of clinical benefit and no other therapeutic options. PFS of surgery and TACE were 6 and 7 months, respectively. Out of 16 patients treated with surgery or TACE, 2 patients were well controlled by TACE more than 1 year. One patient, however, was suffering from intractable liver abscess after TACE. Conclusions: The efficacy and safety of imatinib for GIST is almost the same as in U.S. reports. TACE may be an effective treatment for liver metastases if new agents are not available. No significant financial relationships to disclose.
Collapse
Affiliation(s)
| | | | | | | | | | - H. Kawai
- Aichi Cancer Center, Nagoya, Japan
| | - H. Inoue
- Aichi Cancer Center, Nagoya, Japan
| | | | - Z. Ahmed
- Aichi Cancer Center, Nagoya, Japan
| | - K. Yamao
- Aichi Cancer Center, Nagoya, Japan
| |
Collapse
|
47
|
Ashida R, Yamao K, Okubo K, Sawaki A, Mizuno N, Nakamura T, Tajika M, Kawai H, Shimizu Y. Indocyanine green is an ideal dye for endoscopic ultrasound-guided fine-needle tattooing of pancreatic tumors. Endoscopy 2006; 38:190-2. [PMID: 16479428 DOI: 10.1055/s-2005-870404] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Endoscopic ultrasound-guided fine-needle tattooing (EUS-FNT) is an ideal technique for preoperative marking of lesions detected on preoperative examination. Although India ink has been used for endoscopic tattooing, there have been numerous reports of complications associated with its use. This is the first report of EUS-FNT using indocyanine green (ICG) and describes its use for preoperative marking of a tumor in a 78-year-old man with multiple pancreatic tumors. There were no complications associated with the EUS-FNT procedure and it is suggested that ICG is a more suitable dye for tattooing of pancreatic lesions than India ink, being far less frequently associated with side effects.
Collapse
Affiliation(s)
- R Ashida
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Sawaki A, Mizuno N, Takahashi K, Nakamura T, Tajika M, Kawai H, Kanemitsu Y, Salem AAS, Yamao K. A prognositc index predicts outcome following gemcitabine for patients with metastatic pancreatic cancer. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.4119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A. Sawaki
- Aichi Cancer Ctr Hosp, Nagoya, Japan
| | - N. Mizuno
- Aichi Cancer Ctr Hosp, Nagoya, Japan
| | | | | | - M. Tajika
- Aichi Cancer Ctr Hosp, Nagoya, Japan
| | - H. Kawai
- Aichi Cancer Ctr Hosp, Nagoya, Japan
| | | | | | - K. Yamao
- Aichi Cancer Ctr Hosp, Nagoya, Japan
| |
Collapse
|
49
|
Sawaki A, Katsurahara M, Okubo K, Mizuno N, Nakamura T, Tajika M, Kawai H, Toyama T, Yamao K. Can decreasing the serum level of CA19–9 predict the survival benefit of gemcitabine for advanced pancreatic cancer? J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A. Sawaki
- Aichi Cancer Center Hospital, Nagoya, Japan
| | | | - K. Okubo
- Aichi Cancer Center Hospital, Nagoya, Japan
| | - N. Mizuno
- Aichi Cancer Center Hospital, Nagoya, Japan
| | | | - M. Tajika
- Aichi Cancer Center Hospital, Nagoya, Japan
| | - H. Kawai
- Aichi Cancer Center Hospital, Nagoya, Japan
| | - T. Toyama
- Aichi Cancer Center Hospital, Nagoya, Japan
| | - K. Yamao
- Aichi Cancer Center Hospital, Nagoya, Japan
| |
Collapse
|
50
|
Moriwaki H, Tajika M, Miwa Y, Kato M, Yasuda I, Shiratori Y, Okuno M, Kato T, Ohnishi H, Muto Y. Nutritional pharmacotherapy of chronic liver disease: from support of liver failure to prevention of liver cancer. J Gastroenterol 2000; 35 Suppl 12:13-7. [PMID: 10779208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Many patients with liver cirrhosis are in a state of protein and energy malnutrition and require careful nutritional support. Our research has revealed that approximately 30% of the patients have protein-energy malnutrition, 40% protein malnutrition, and 10% energy malnutrition; 20% are in a normal nutritional state. Supplementation with branched-chain amino acids alleviates chronic liver failure, improves the protein nutritional state, and subsequently prolongs survival. In contrast, therapeutic modalities for energy malnutrition have not yet been fully elucidated and await further studies. Improved survival of the cirrhotic patients essentially brings a higher incidence of hepatocellular carcinoma (HCC). A synthetic analogue of vitamin A (acyclic retinoid or 4,5-dehydrogeranyl geranoic acid) prevents at least the development of second primary tumors after curative treatment of preceding HCC. The mechanism of this cancer chemo-prevention is clonal deletion of premalignant and latent malignant cells by the retinoid. We describe our clinical experiences with these two nutritional pharmacotherapies of chronic liver diseases and review their basic mechanisms.
Collapse
Affiliation(s)
- H Moriwaki
- First Department of Internal Medicine, Gifu University School of Medicine, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|