1
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Cullen JK, Yap PY, Ferguson B, Bruce ZC, Koyama M, Handoko H, Hendrawan K, Simmons JL, Brooks KM, Johns J, Wilson ES, de Souza MMA, Broit N, Stewart P, Shelley D, McMahon T, Ogbourne SM, Nguyen TH, Lim YC, Pagani A, Appendino G, Gordon VA, Reddell PW, Boyle GM, Parsons PG. Tigilanol tiglate is an oncolytic small molecule that induces immunogenic cell death and enhances the response of both target and non-injected tumors to immune checkpoint blockade. J Immunother Cancer 2024; 12:e006602. [PMID: 38658031 PMCID: PMC11043783 DOI: 10.1136/jitc-2022-006602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Tigilanol tiglate (TT) is a protein kinase C (PKC)/C1 domain activator currently being developed as an intralesional agent for the treatment of various (sub)cutaneous malignancies. Previous work has shown that intratumoral (I.T.) injection of TT causes vascular disruption with concomitant tumor ablation in several preclinical models of cancer, in addition to various (sub)cutaneous tumors presenting in the veterinary clinic. TT has completed Phase I dose escalation trials, with some patients showing signs of abscopal effects. However, the exact molecular details underpinning its mechanism of action (MoA), together with its immunotherapeutic potential in oncology remain unclear. METHODS A combination of microscopy, luciferase assays, immunofluorescence, immunoblotting, subcellular fractionation, intracellular ATP assays, phagocytosis assays and mixed lymphocyte reactions were used to probe the MoA of TT in vitro. In vivo studies with TT used MM649 xenograft, CT-26 and immune checkpoint inhibitor refractory B16-F10-OVA tumor bearing mice, the latter with or without anti-programmed cell death 1 (PD-1)/anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) mAb treatment. The effect of TT at injected and non-injected tumors was also assessed. RESULTS Here, we show that TT induces the death of endothelial and cancer cells at therapeutically relevant concentrations via a caspase/gasdermin E-dependent pyroptopic pathway. At therapeutic doses, our data demonstrate that TT acts as a lipotoxin, binding to and promoting mitochondrial/endoplasmic reticulum (ER) dysfunction (leading to unfolded protein responsemt/ER upregulation) with subsequent ATP depletion, organelle swelling, caspase activation, gasdermin E cleavage and induction of terminal necrosis. Consistent with binding to ER membranes, we found that TT treatment promoted activation of the integrated stress response together with the release/externalization of damage-associated molecular patterns (HMGB1, ATP, calreticulin) from cancer cells in vitro and in vivo, characteristics indicative of immunogenic cell death (ICD). Confirmation of ICD in vivo was obtained through vaccination and rechallenge experiments using CT-26 colon carcinoma tumor bearing mice. Furthermore, TT also reduced tumor volume, induced immune cell infiltration, as well as improved survival in B16-F10-OVA tumor bearing mice when combined with immune checkpoint blockade. CONCLUSIONS These data demonstrate that TT is an oncolytic small molecule with multiple targets and confirms that cell death induced by this compound has the potential to augment antitumor responses to immunotherapy.
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Affiliation(s)
- Jason K Cullen
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
- QBiotics Group Limited, Brisbane, Queensland, Australia
| | - Pei-Yi Yap
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Blake Ferguson
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Zara C Bruce
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Motoko Koyama
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Herlina Handoko
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Kevin Hendrawan
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Jacinta L Simmons
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Kelly M Brooks
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Jenny Johns
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Emily S Wilson
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | | | - Natasa Broit
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Praphaporn Stewart
- University of the Sunshine Coast, Maroochydore DC, Queensland, Australia
| | - Daniel Shelley
- University of the Sunshine Coast, Maroochydore DC, Queensland, Australia
| | - Tracey McMahon
- University of the Sunshine Coast, Maroochydore DC, Queensland, Australia
| | - Steven M Ogbourne
- QBiotics Group Limited, Brisbane, Queensland, Australia
- University of the Sunshine Coast, Maroochydore DC, Queensland, Australia
| | - Tam Hong Nguyen
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Yi Chieh Lim
- Danish Cancer Society Research Centre, Copenhagen DK, Denmark
| | - Alberto Pagani
- Dipartimento di Scienze del Farmaco, Università Degli Studi del Piemonte Orientale, Novara, Italy
| | - Giovanni Appendino
- Dipartimento di Scienze del Farmaco, Università Degli Studi del Piemonte Orientale, Novara, Italy
| | | | | | - Glen M Boyle
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Peter G Parsons
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- QBiotics Group Limited, Brisbane, Queensland, Australia
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2
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Minnie SA, Waltner OG, Zhang P, Takahashi S, Nemychenkov NS, Ensbey KS, Schmidt CR, Legg SRW, Comstock M, Boiko JR, Nelson E, Bhise SS, Wilkens AB, Koyama M, Dhodapkar MV, Chesi M, Riddell SR, Green DJ, Spencer A, Furlan SN, Hill GR. TIM-3 + CD8 T cells with a terminally exhausted phenotype retain functional capacity in hematological malignancies. Sci Immunol 2024; 9:eadg1094. [PMID: 38640253 DOI: 10.1126/sciimmunol.adg1094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/27/2024] [Indexed: 04/21/2024]
Abstract
Chronic antigen stimulation is thought to generate dysfunctional CD8 T cells. Here, we identify a CD8 T cell subset in the bone marrow tumor microenvironment that, despite an apparent terminally exhausted phenotype (TPHEX), expressed granzymes, perforin, and IFN-γ. Concurrent gene expression and DNA accessibility revealed that genes encoding these functional proteins correlated with BATF expression and motif accessibility. IFN-γ+ TPHEX effectively killed myeloma with comparable efficacy to transitory effectors, and disease progression correlated with numerical deficits in IFN-γ+ TPHEX. We also observed IFN-γ+ TPHEX within CD19-targeted chimeric antigen receptor T cells, which killed CD19+ leukemia cells. An IFN-γ+ TPHEX gene signature was recapitulated in TEX cells from human cancers, including myeloma and lymphoma. Here, we characterize a TEX subset in hematological malignancies that paradoxically retains function and is distinct from dysfunctional TEX found in chronic viral infections. Thus, IFN-γ+ TPHEX represent a potential target for immunotherapy of blood cancers.
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Affiliation(s)
- Simone A Minnie
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Olivia G Waltner
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Ping Zhang
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Shuichiro Takahashi
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Nicole S Nemychenkov
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Kathleen S Ensbey
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Christine R Schmidt
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Samuel R W Legg
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Melissa Comstock
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Julie R Boiko
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Ethan Nelson
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Shruti S Bhise
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Alec B Wilkens
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Motoko Koyama
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Madhav V Dhodapkar
- Department of Hematology/Medical Oncology, Emory University, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Marta Chesi
- Department of Medicine, Division of Hematology/Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - Stanley R Riddell
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Division of Medical Oncology, University of Washington, Seattle, WA, USA
| | - Damian J Green
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Division of Medical Oncology, University of Washington, Seattle, WA, USA
| | - Andrew Spencer
- Australian Center for Blood Diseases, Monash University/Alfred Hospital, Melbourne, VIC, Australia
- Department of Clinical Haematology, Monash University, Melbourne, VIC, Australia
- Malignant Haematology and Stem Cell Transplantation, Alfred Hospital, Melbourne, VIC, Australia
| | - Scott N Furlan
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Geoffrey R Hill
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Division of Medical Oncology, University of Washington, Seattle, WA, USA
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3
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Takahashi S, Minnie SA, Ensbey KS, Schmidt CR, Sekiguchi T, Legg SRW, Zhang P, Koyama M, Olver SD, Collinge AD, Keshmiri S, Comstock ML, Varelias A, Green DJ, Hill GR. Regulatory T cells suppress myeloma-specific immunity during autologous stem cell mobilization and transplantation. Blood 2024; 143:1656-1669. [PMID: 38295333 DOI: 10.1182/blood.2023022000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 01/22/2024] [Accepted: 01/22/2024] [Indexed: 02/02/2024] Open
Abstract
ABSTRACT Autologous stem cell transplantation (ASCT) is the standard of care consolidation therapy for eligible patients with myeloma but most patients eventually progress, an event associated with features of immune escape. Novel approaches to enhance antimyeloma immunity after ASCT represent a major unmet need. Here, we demonstrate that patient-mobilized stem cell grafts contain high numbers of effector CD8 T cells and immunosuppressive regulatory T cells (Tregs). We showed that bone marrow (BM)-residing T cells are efficiently mobilized during stem cell mobilization (SCM) and hypothesized that mobilized and highly suppressive BM-derived Tregs might limit antimyeloma immunity during SCM. Thus, we performed ASCT in a preclinical myeloma model with or without stringent Treg depletion during SCM. Treg depletion generated SCM grafts containing polyfunctional CD8 T effector memory cells, which dramatically enhanced myeloma control after ASCT. Thus, we explored clinically tractable translational approaches to mimic this scenario. Antibody-based approaches resulted in only partial Treg depletion and were inadequate to recapitulate this effect. In contrast, a synthetic interleukin-2 (IL-2)/IL-15 mimetic that stimulates the IL-2 receptor on CD8 T cells without binding to the high-affinity IL-2Ra used by Tregs efficiently expanded polyfunctional CD8 T cells in mobilized grafts and protected recipients from myeloma progression after ASCT. We confirmed that Treg depletion during stem cell mobilization can mitigate constraints on tumor immunity and result in profound myeloma control after ASCT. Direct and selective cytokine signaling of CD8 T cells can recapitulate this effect and represent a clinically testable strategy to improve responses after ASCT.
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Affiliation(s)
- Shuichiro Takahashi
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Simone A Minnie
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Kathleen S Ensbey
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Christine R Schmidt
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Tomoko Sekiguchi
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Samuel R W Legg
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Ping Zhang
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Motoko Koyama
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Stuart D Olver
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Alika D Collinge
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Sara Keshmiri
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Melissa L Comstock
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Antiopi Varelias
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
- Faculty of Medicine, University of Queensland, St Lucia, QLD, Australia
| | - Damian J Green
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Geoffrey R Hill
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
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4
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Zhang P, Fleming P, Andoniou CE, Waltner OG, Bhise SS, Martins JP, McEnroe BA, Voigt V, Daly S, Kuns RD, Ekwe AP, Henden AS, Saldan A, Olver S, Varelias A, Smith C, Schmidt CR, Ensbey KS, Legg SR, Sekiguchi T, Minnie SA, Gradwell M, Wagenaar I, Clouston AD, Koyama M, Furlan SN, Kennedy GA, Ward ES, Degli-Esposti MA, Hill GR, Tey SK. IL-6-mediated endothelial injury impairs antiviral humoral immunity after bone marrow transplantation. J Clin Invest 2024; 134:e174184. [PMID: 38557487 PMCID: PMC10977988 DOI: 10.1172/jci174184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 02/09/2024] [Indexed: 04/04/2024] Open
Abstract
Endothelial function and integrity are compromised after allogeneic bone marrow transplantation (BMT), but how this affects immune responses broadly remains unknown. Using a preclinical model of CMV reactivation after BMT, we found compromised antiviral humoral responses induced by IL-6 signaling. IL-6 signaling in T cells maintained Th1 cells, resulting in sustained IFN-γ secretion, which promoted endothelial cell (EC) injury, loss of the neonatal Fc receptor (FcRn) responsible for IgG recycling, and rapid IgG loss. T cell-specific deletion of IL-6R led to persistence of recipient-derived, CMV-specific IgG and inhibited CMV reactivation. Deletion of IFN-γ in donor T cells also eliminated EC injury and FcRn loss. In a phase III clinical trial, blockade of IL-6R with tocilizumab promoted CMV-specific IgG persistence and significantly attenuated early HCMV reactivation. In sum, IL-6 invoked IFN-γ-dependent EC injury and consequent IgG loss, leading to CMV reactivation. Hence, cytokine inhibition represents a logical strategy to prevent endothelial injury, thereby preserving humoral immunity after immunotherapy.
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Affiliation(s)
- Ping Zhang
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Peter Fleming
- Infection and Immunity Program and Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
- Centre for Experimental Immunology, Lions Eye Institute, Nedlands, Western Australia, Australia
| | - Christopher E. Andoniou
- Infection and Immunity Program and Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
- Centre for Experimental Immunology, Lions Eye Institute, Nedlands, Western Australia, Australia
| | - Olivia G. Waltner
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Shruti S. Bhise
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Jose Paulo Martins
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | | | - Valentina Voigt
- Centre for Experimental Immunology, Lions Eye Institute, Nedlands, Western Australia, Australia
| | - Sheridan Daly
- Centre for Experimental Immunology, Lions Eye Institute, Nedlands, Western Australia, Australia
| | - Rachel D. Kuns
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Adaeze P. Ekwe
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Andrea S. Henden
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- University of Queensland, St Lucia, Queensland, Australia
- Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia
| | - Alda Saldan
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- University of Queensland, St Lucia, Queensland, Australia
| | - Stuart Olver
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Antiopi Varelias
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- University of Queensland, St Lucia, Queensland, Australia
| | - Corey Smith
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Christine R. Schmidt
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Kathleen S. Ensbey
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Samuel R.W. Legg
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Tomoko Sekiguchi
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Simone A. Minnie
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Mark Gradwell
- Cancer Sciences Unit, Centre for Cancer Immunology, University of Southampton, Southampton, United Kingdom
| | - Irma Wagenaar
- Cancer Sciences Unit, Centre for Cancer Immunology, University of Southampton, Southampton, United Kingdom
| | | | - Motoko Koyama
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Scott N. Furlan
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Pediatrics and
| | - Glen A. Kennedy
- University of Queensland, St Lucia, Queensland, Australia
- Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia
| | - E Sally Ward
- Cancer Sciences Unit, Centre for Cancer Immunology, University of Southampton, Southampton, United Kingdom
| | - Mariapia A. Degli-Esposti
- Infection and Immunity Program and Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
- Centre for Experimental Immunology, Lions Eye Institute, Nedlands, Western Australia, Australia
| | - Geoffrey R. Hill
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Division of Medical Oncology, University of Washington, Seattle, Washington, USA
| | - Siok-Keen Tey
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- University of Queensland, St Lucia, Queensland, Australia
- Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia
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5
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Koyama M. A potential tissue-based biomarker in gut GVHD. Blood 2023; 142:1768-1769. [PMID: 37995106 DOI: 10.1182/blood.2023022229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023] Open
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6
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Schuster IS, Sng XYX, Lau CM, Powell DR, Weizman OE, Fleming P, Neate GEG, Voigt V, Sheppard S, Maraskovsky AI, Daly S, Koyama M, Hill GR, Turner SJ, O'Sullivan TE, Sun JC, Andoniou CE, Degli-Esposti MA. Infection induces tissue-resident memory NK cells that safeguard tissue health. Immunity 2023; 56:2173-2174. [PMID: 37703831 DOI: 10.1016/j.immuni.2023.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
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7
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Koyama M, Hippe DS, Srinivasan S, Proll SC, Miltiadous O, Li N, Zhang P, Ensbey KS, Hoffman NG, Schmidt CR, Yeh AC, Minnie SA, Strenk SM, Fiedler TL, Hattangady N, Kowalsky J, Grady WM, Degli-Esposti MA, Varelias A, Clouston AD, van den Brink MRM, Dey N, Randolph TW, Markey KA, Fredricks DN, Hill GR. Intestinal microbiota controls graft-versus-host disease independent of donor-host genetic disparity. Immunity 2023; 56:1876-1893.e8. [PMID: 37480848 PMCID: PMC10530372 DOI: 10.1016/j.immuni.2023.06.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 04/11/2023] [Accepted: 06/28/2023] [Indexed: 07/24/2023]
Abstract
Acute graft-versus-host disease (aGVHD) remains a major limitation of allogeneic stem cell transplantation (SCT), and severe intestinal manifestation is the major cause of early mortality. Intestinal microbiota control MHC class II (MHC-II) expression by ileal intestinal epithelial cells (IECs) that promote GVHD. Here, we demonstrated that genetically identical mice of differing vendor origins had markedly different intestinal microbiota and ileal MHC-II expression, resulting in discordant GVHD severity. We utilized cohousing and antibiotic treatment to characterize the bacterial taxa positively and negatively associated with MHC-II expression. A large proportion of bacterial MHC-II inducers were vancomycin sensitive, and peri-transplant oral vancomycin administration attenuated CD4+ T cell-mediated GVHD. We identified a similar relationship between pre-transplant microbes, HLA class II expression, and both GVHD and mortality in a large clinical SCT cohort. These data highlight therapeutically tractable mechanisms by which pre-transplant microbial taxa contribute to GVHD independently of genetic disparity.
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Affiliation(s)
- Motoko Koyama
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center (FHCC), Seattle, WA 98109, USA.
| | - Daniel S Hippe
- Clinical Research Division, FHCC, Seattle, WA 98109, USA
| | | | - Sean C Proll
- Vaccine and Infectious Disease Division, FHCC, Seattle, WA 98109, USA
| | - Oriana Miltiadous
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Naisi Li
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center (FHCC), Seattle, WA 98109, USA
| | - Ping Zhang
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center (FHCC), Seattle, WA 98109, USA
| | - Kathleen S Ensbey
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center (FHCC), Seattle, WA 98109, USA
| | - Noah G Hoffman
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98195, USA
| | - Christine R Schmidt
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center (FHCC), Seattle, WA 98109, USA
| | - Albert C Yeh
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center (FHCC), Seattle, WA 98109, USA; Department of Medicine, University of Washington, Seattle, WA 98109, USA
| | - Simone A Minnie
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center (FHCC), Seattle, WA 98109, USA
| | - Susan M Strenk
- Vaccine and Infectious Disease Division, FHCC, Seattle, WA 98109, USA
| | - Tina L Fiedler
- Vaccine and Infectious Disease Division, FHCC, Seattle, WA 98109, USA
| | - Namita Hattangady
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center (FHCC), Seattle, WA 98109, USA
| | - Jacob Kowalsky
- Vaccine and Infectious Disease Division, FHCC, Seattle, WA 98109, USA
| | - Willian M Grady
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center (FHCC), Seattle, WA 98109, USA; Department of Medicine, University of Washington, Seattle, WA 98109, USA
| | - Mariapia A Degli-Esposti
- Infection and Immunity Program and Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC 3800, Australia; Centre for Experimental Immunology, Lions Eye Institute, Nedlands, WA 6009, Australia
| | - Antiopi Varelias
- Transplantation Immunology Laboratory, Cancer Research Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia; Faculty of Medicine, University of Queensland, St Lucia, QLD 4067, Australia
| | - Andrew D Clouston
- Molecular and Cellular Pathology, University of Queensland, Brisbane, QLD 4006, Australia
| | - Marcel R M van den Brink
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA; Department of Immunology, Sloan Kettering Institute, New York, NY 10065, USA
| | - Neelendu Dey
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center (FHCC), Seattle, WA 98109, USA; Department of Medicine, University of Washington, Seattle, WA 98109, USA
| | - Timothy W Randolph
- Clinical Research Division, FHCC, Seattle, WA 98109, USA; Public Health Sciences Division, FHCC, WA 98109, USA
| | - Kate A Markey
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center (FHCC), Seattle, WA 98109, USA; Department of Medicine, University of Washington, Seattle, WA 98109, USA; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA
| | - David N Fredricks
- Vaccine and Infectious Disease Division, FHCC, Seattle, WA 98109, USA; Department of Medicine, University of Washington, Seattle, WA 98109, USA
| | - Geoffrey R Hill
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center (FHCC), Seattle, WA 98109, USA; Department of Medicine, University of Washington, Seattle, WA 98109, USA.
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8
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Schuster IS, Sng XYX, Lau CM, Powell DR, Weizman OE, Fleming P, Neate GEG, Voigt V, Sheppard S, Maraskovsky AI, Daly S, Koyama M, Hill GR, Turner SJ, O'Sullivan TE, Sun JC, Andoniou CE, Degli-Esposti MA. Infection induces tissue-resident memory NK cells that safeguard tissue health. Immunity 2023; 56:531-546.e6. [PMID: 36773607 PMCID: PMC10360410 DOI: 10.1016/j.immuni.2023.01.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 10/17/2022] [Accepted: 01/17/2023] [Indexed: 02/12/2023]
Abstract
Tissue health is dictated by the capacity to respond to perturbations and then return to homeostasis. Mechanisms that initiate, maintain, and regulate immune responses in tissues are therefore essential. Adaptive immunity plays a key role in these responses, with memory and tissue residency being cardinal features. A corresponding role for innate cells is unknown. Here, we have identified a population of innate lymphocytes that we term tissue-resident memory-like natural killer (NKRM) cells. In response to murine cytomegalovirus infection, we show that circulating NK cells were recruited in a CX3CR1-dependent manner to the salivary glands where they formed NKRM cells, a long-lived, tissue-resident population that prevented autoimmunity via TRAIL-dependent elimination of CD4+ T cells. Thus, NK cells develop adaptive-like features, including long-term residency in non-lymphoid tissues, to modulate inflammation, restore immune equilibrium, and preserve tissue health. Modulating the functions of NKRM cells may provide additional strategies to treat inflammatory and autoimmune diseases.
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Affiliation(s)
- Iona S Schuster
- Infection and Immunity Program and Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia; Centre for Experimental Immunology, Lions Eye Institute, Nedlands, WA, Australia.
| | - Xavier Y X Sng
- Infection and Immunity Program and Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Colleen M Lau
- Immunology Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David R Powell
- Monash Bioinformatics Platform, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Orr-El Weizman
- Immunology Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter Fleming
- Infection and Immunity Program and Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia; Centre for Experimental Immunology, Lions Eye Institute, Nedlands, WA, Australia
| | - Georgia E G Neate
- Infection and Immunity Program and Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Valentina Voigt
- Infection and Immunity Program and Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia; Centre for Experimental Immunology, Lions Eye Institute, Nedlands, WA, Australia
| | - Sam Sheppard
- Immunology Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andreas I Maraskovsky
- Infection and Immunity Program and Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia; Centre for Experimental Immunology, Lions Eye Institute, Nedlands, WA, Australia
| | - Sheridan Daly
- Centre for Experimental Immunology, Lions Eye Institute, Nedlands, WA, Australia
| | - Motoko Koyama
- Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Geoffrey R Hill
- Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Stephen J Turner
- Infection and Immunity Program and Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Timothy E O'Sullivan
- Department of Microbiology, Immunology and Molecular Genetics, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Joseph C Sun
- Immunology Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christopher E Andoniou
- Infection and Immunity Program and Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia; Centre for Experimental Immunology, Lions Eye Institute, Nedlands, WA, Australia
| | - Mariapia A Degli-Esposti
- Infection and Immunity Program and Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia; Centre for Experimental Immunology, Lions Eye Institute, Nedlands, WA, Australia.
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9
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10
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Rashidi A, Koyama M, Dey N, McLean JS, Hill GR. Colonization resistance is dispensable for segregation of oral and gut microbiota. BMC Med Genomics 2023; 16:31. [PMID: 36814251 PMCID: PMC9948407 DOI: 10.1186/s12920-023-01449-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/31/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND The oral and colonic microbiota are distinct in healthy individuals. However, this distinction is diminished in common diseases such as colon cancer and inflammatory bowel disease, suggesting a potential pathogenic role for oral bacteria when ectopically colonized in the gut. A key mechanism for the segregation of oral and colonic microbiota niches is thought to be microbiota-mediated colonization resistance whereby the commensal gut microbiota outcompete and eliminate the ingested oral bacteria. METHODS We tested this theory by analyzing exact amplicon sequence variants generated from concurrent fecal and oral samples from healthy volunteers exposed to a brief course of a single antibiotic (cohort 1), acute leukemia patients (cohort 2), and stem cell transplant recipients (cohort 3). Cohorts 2 and 3 represent extreme clinical scenarios with respect to antibiotic pressure and severity of gut microbiota injury. RESULTS While mild antibiotic exposure in cohort 1 was not sufficient for colonization of any oral bacteria in the gut, even with extreme antibiotic pressure and severe gut microbiota disruptions in cohorts 2 and 3, only one oral species in each cohort colonized the gut. CONCLUSIONS Colonization resistance is dispensable for segregation of oral and colonic microbiota in humans. This finding implies that the presence of oral bacteria in the distal gut in diseases such as colon cancer and inflammatory bowel disease is not driven by impaired colonization resistance.
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Affiliation(s)
- Armin Rashidi
- Fred Hutchinson Cancer Center, 1100 Fairview Ave N, D1-100, Seattle, WA, 98109, USA. .,Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, USA.
| | - Motoko Koyama
- grid.270240.30000 0001 2180 1622Fred Hutchinson Cancer Center, 1100 Fairview Ave N, D1-100, Seattle, WA 98109 USA
| | - Neelendu Dey
- grid.270240.30000 0001 2180 1622Fred Hutchinson Cancer Center, 1100 Fairview Ave N, D1-100, Seattle, WA 98109 USA ,grid.34477.330000000122986657Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA USA
| | - Jeffrey S. McLean
- grid.34477.330000000122986657School of Dentistry, University of Washington, Seattle, WA USA
| | - Geoffrey R. Hill
- grid.270240.30000 0001 2180 1622Fred Hutchinson Cancer Center, 1100 Fairview Ave N, D1-100, Seattle, WA 98109 USA ,grid.34477.330000000122986657Division of Oncology, Department of Medicine, University of Washington, Seattle, WA USA
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11
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Minnie SA, Waltner OG, Ensbey KS, Olver SD, Collinge AD, Sester DP, Schmidt CR, Legg SR, Takahashi S, Nemychenkov NS, Sekiguchi T, Driessens G, Zhang P, Koyama M, Spencer A, Holmberg LA, Furlan SN, Varelias A, Hill GR. TIGIT inhibition and lenalidomide synergistically promote antimyeloma immune responses after stem cell transplantation in mice. J Clin Invest 2023; 133:e157907. [PMID: 36512425 PMCID: PMC9927935 DOI: 10.1172/jci157907] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 12/08/2022] [Indexed: 12/15/2022] Open
Abstract
Autologous stem cell transplantation (ASCT) with subsequent lenalidomide maintenance is standard consolidation therapy for multiple myeloma, and a subset of patients achieve durable progression-free survival that is suggestive of long-term immune control. Nonetheless, most patients ultimately relapse, suggesting immune escape. TIGIT appears to be a potent inhibitor of myeloma-specific immunity and represents a promising new checkpoint target. Here we demonstrate high expression of TIGIT on activated CD8+ T cells in mobilized peripheral blood stem cell grafts from patients with myeloma. To guide clinical application of TIGIT inhibition, we evaluated identical anti-TIGIT antibodies that do or do not engage FcγR and demonstrated that anti-TIGIT activity is dependent on FcγR binding. We subsequently used CRBN mice to investigate the efficacy of anti-TIGIT in combination with lenalidomide maintenance after transplantation. Notably, the combination of anti-TIGIT with lenalidomide provided synergistic, CD8+ T cell-dependent, antimyeloma efficacy. Analysis of bone marrow (BM) CD8+ T cells demonstrated that combination therapy suppressed T cell exhaustion, enhanced effector function, and expanded central memory subsets. Importantly, these immune phenotypes were specific to the BM tumor microenvironment. Collectively, these data provide a logical rationale for combining TIGIT inhibition with immunomodulatory drugs to prevent myeloma progression after ASCT.
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Affiliation(s)
- Simone A. Minnie
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Olivia G. Waltner
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Kathleen S. Ensbey
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Stuart D. Olver
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Alika D. Collinge
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - David P. Sester
- Translational Research Institute, Woolloongabba, Queensland, Australia
- Hugh Green Cytometry Centre, Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Christine R. Schmidt
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Samuel R.W. Legg
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Shuichiro Takahashi
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | | | - Tomoko Sekiguchi
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | | | - Ping Zhang
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Motoko Koyama
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Andrew Spencer
- Australian Center for Blood Diseases, Monash University and
- Malignant Haematology and Stem Cell Transplantation, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of Clinical Haematology, Monash University, Melbourne, Victoria, Australia
| | - Leona A. Holmberg
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Division of Medical Oncology and
| | - Scott N. Furlan
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Antiopi Varelias
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, St. Lucia, Queensland, Australia
| | - Geoffrey R. Hill
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Division of Medical Oncology and
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12
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Koyama M, Samson L, Ensbey KS, Takahashi S, Clouston AD, Martin PJ, Hill GR. Lithium attenuates graft-versus-host disease via effects on the intestinal stem cell niche. Blood 2023; 141:315-319. [PMID: 36201741 PMCID: PMC10163278 DOI: 10.1182/blood.2022015808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 09/01/2022] [Accepted: 09/21/2022] [Indexed: 01/24/2023] Open
Affiliation(s)
- Motoko Koyama
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Luke Samson
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Kathleen S. Ensbey
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Shuichiro Takahashi
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Paul J. Martin
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
- Envoi Specialist Pathologists, Brisbane, QLD, Australia
| | - Geoffrey R. Hill
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
- Envoi Specialist Pathologists, Brisbane, QLD, Australia
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13
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Minnie SA, Waltner OG, Ensbey KS, Nemychenkov NS, Schmidt CR, Bhise SS, Legg SRW, Campoy G, Samson LD, Kuns RD, Zhou T, Huck JD, Vuckovic S, Zamora D, Yeh A, Spencer A, Koyama M, Markey KA, Lane SW, Boeckh M, Ring AM, Furlan SN, Hill GR. Depletion of exhausted alloreactive T cells enables targeting of stem-like memory T cells to generate tumor-specific immunity. Sci Immunol 2022; 7:eabo3420. [PMID: 36240285 PMCID: PMC10184646 DOI: 10.1126/sciimmunol.abo3420] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Some hematological malignancies such as multiple myeloma are inherently resistant to immune-mediated antitumor responses, the cause of which remains unknown. Allogeneic bone marrow transplantation (alloBMT) is the only curative immunotherapy for hematological malignancies due to profound graft-versus-tumor (GVT) effects, but relapse remains the major cause of death. We developed murine models of alloBMT where the hematological malignancy is either sensitive [acute myeloid leukemia (AML)] or resistant (myeloma) to GVT effects. We found that CD8+ T cell exhaustion in bone marrow was primarily alloantigen-driven, with expression of inhibitory ligands present on myeloma but not AML. Because of this tumor-independent exhaustion signature, immune checkpoint inhibition (ICI) in myeloma exacerbated graft-versus-host disease (GVHD) without promoting GVT effects. Administration of post-transplant cyclophosphamide (PT-Cy) depleted donor T cells with an exhausted phenotype and spared T cells displaying a stem-like memory phenotype with chromatin accessibility present in cytokine signaling genes, including the interleukin-18 (IL-18) receptor. Whereas ICI with anti-PD-1 or anti-TIM-3 remained ineffective after PT-Cy, administration of a decoy-resistant IL-18 (DR-18) strongly enhanced GVT effects in both myeloma and leukemia models, without exacerbation of GVHD. We thus defined mechanisms of resistance to T cell-mediated antitumor effects after alloBMT and described an immunotherapy approach targeting stem-like memory T cells to enhance antitumor immunity.
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Affiliation(s)
- Simone A. Minnie
- Clinical Research Division, Fred Hutchinson Cancer Center; Seattle, WA, 98109, UNITED STATES
| | - Olivia G. Waltner
- Clinical Research Division, Fred Hutchinson Cancer Center; Seattle, WA, 98109, UNITED STATES
| | - Kathleen S. Ensbey
- Clinical Research Division, Fred Hutchinson Cancer Center; Seattle, WA, 98109, UNITED STATES
| | - Nicole S. Nemychenkov
- Clinical Research Division, Fred Hutchinson Cancer Center; Seattle, WA, 98109, UNITED STATES
| | - Christine R. Schmidt
- Clinical Research Division, Fred Hutchinson Cancer Center; Seattle, WA, 98109, UNITED STATES
| | - Shruti S. Bhise
- Clinical Research Division, Fred Hutchinson Cancer Center; Seattle, WA, 98109, UNITED STATES
| | - Samuel RW. Legg
- Clinical Research Division, Fred Hutchinson Cancer Center; Seattle, WA, 98109, UNITED STATES
| | - Gabriela Campoy
- Clinical Research Division, Fred Hutchinson Cancer Center; Seattle, WA, 98109, UNITED STATES
| | - Luke D. Samson
- Clinical Research Division, Fred Hutchinson Cancer Center; Seattle, WA, 98109, UNITED STATES
| | - Rachel D. Kuns
- QIMR Berghofer Medical Research Institute; Brisbane, QLD, 4006, AUSTRALIA
| | - Ting Zhou
- Department of Immunobiology, Yale School of Medicine; New Haven, CT, 06519, UNITED STATES
| | - John D. Huck
- Department of Immunobiology, Yale School of Medicine; New Haven, CT, 06519, UNITED STATES
| | - Slavica Vuckovic
- QIMR Berghofer Medical Research Institute; Brisbane, QLD, 4006, AUSTRALIA
| | - Danniel Zamora
- Department of Medicine, University of Washington; Seattle, WA, 98109, UNITED STATES
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center; Seattle, WA, 98109, UNITED STATES
| | - Albert Yeh
- Clinical Research Division, Fred Hutchinson Cancer Center; Seattle, WA, 98109, UNITED STATES
- Department of Medicine, University of Washington; Seattle, WA, 98109, UNITED STATES
| | - Andrew Spencer
- Australian Center for Blood Diseases, Monash University/The Alfred Hospital; Melbourne, VIC, 3004, AUSTRALIA
- Malignant Haematology and Stem Cell Transplantation, The Alfred Hospital; Melbourne, VIC, 3004, AUSTRALIA
- Department of Clinical Haematology, Monash University; Melbourne, VIC, 3800, AUSTRALIA
| | - Motoko Koyama
- Clinical Research Division, Fred Hutchinson Cancer Center; Seattle, WA, 98109, UNITED STATES
| | - Kate A. Markey
- Clinical Research Division, Fred Hutchinson Cancer Center; Seattle, WA, 98109, UNITED STATES
- Department of Medicine, University of Washington; Seattle, WA, 98109, UNITED STATES
| | - Steven W. Lane
- QIMR Berghofer Medical Research Institute; Brisbane, QLD, 4006, AUSTRALIA
| | - Michael Boeckh
- Clinical Research Division, Fred Hutchinson Cancer Center; Seattle, WA, 98109, UNITED STATES
- Department of Medicine, University of Washington; Seattle, WA, 98109, UNITED STATES
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center; Seattle, WA, 98109, UNITED STATES
| | - Aaron M. Ring
- Department of Immunobiology, Yale School of Medicine; New Haven, CT, 06519, UNITED STATES
| | - Scott N. Furlan
- Clinical Research Division, Fred Hutchinson Cancer Center; Seattle, WA, 98109, UNITED STATES
- Department of Pediatrics, University of Washington; WA, 98105, UNITED STATES
| | - Geoffrey R. Hill
- Clinical Research Division, Fred Hutchinson Cancer Center; Seattle, WA, 98109, UNITED STATES
- Department of Medicine, University of Washington; Seattle, WA, 98109, UNITED STATES
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14
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Katano S, Watanabe A, Nagaoka R, Numazawa R, Honma S, Ohori K, Kouzu H, Fujito T, Nishikawa R, Ohwada R, Nagano N, Koyama M, Katayose M, Hashimoto A, Yano T. Loss of social role awareness, a subdomain of social frailty, is an independent predictor of future adverse events in hospitalized older patients with heart failure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Frailty is a complex syndrome characterized by a decline in functional reserve, and associated with aging and chronic diseases including heart failure (HF). The impact of physical frailty on prognosis and the effect of cardiac rehabilitation in HF patients have been well established. However, the data on the prognostic impact of social frailty (SF) in HF patients is limited.
Aims
We aimed to get new insight into mechanisms of the association of SF with clinical outcomes in older hospitalized HF patients.
Methods
A single-center, retrospective cohort study was conducted using data from 308 HF patients aged ≥65 years (mean age of 78±8 years; 49% females) who were admitted to our institute for the management of HF. SF was assessed using the validated Makizako's five questions. The following responses were considered positive for SF: (1) going out less frequently compared with last year; (2) not visiting friends; (3) not talking with someone every day; (4) not feeling helpful toward friends or family; and (5) living alone. SF was defined as two or more positive responses. The primary outcome was composite events defined by all-cause death and cardiovascular events. The missing data were imputed using multiple imputation by chained -equations algorithm.
Results
Of 308 older HF patients, 189 patients (61%) were SF. Patients with SF were significantly older, had lower body mass index, and a higher percentage of patients with physical frailty and cognitive frailty than those without SF. Seventy-five patients (24%) experienced composite events during a median follow-up period of 1.55-years (interquartile range, 0.88–2.20 years). Kaplan-Meier curves showed a significantly higher composite event rate in patients with SF than those without SF. In multivariate Cox regression analyses, SF was independently associated with a higher composite event rate after adjusting for pre-existing risk factors [adjusted hazard ratio (HR), 1.91; 95% confidence interval (CI), 1.09–3.35; p=0.03] (Figure 1A). In addition, further analyses showed that only the positive response on the question corresponding to the social role – not feeling helpful toward friends or family – among the questionnaire was an independent predictor for the incidence of the composite event (adjusted HR, 2.10; 95% CI, 1.29–3.41; p<0.01, Figure 1B). Inclusion of the response to the question regarding the social role into the baseline prognostic model improved the accuracy of prediction of the composite event (continuous net reclassification improvement, 0.46; 95% CI, 0.21–0.71; p<0.01; integrated discrimination improvement, 0.025; 95% CI 0.004–0.047; p=0.02; Figure 2).
Conclusion
Loss of social role awareness was associated with increased composite event risk and provided additive prognostic information in older HF patients, suggesting the importance of healthcare professionals' decision-making on the prevention and management of SF.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Katano
- Sapporo Medical University Hospital , Sapporo , Japan
| | - A Watanabe
- Sapporo Medical University Hospital, Division of Nursing , Sapporo , Japan
| | - R Nagaoka
- Sapporo Medical University Hospital, Division of Rehabilitation , Sapporo , Japan
| | - R Numazawa
- Sapporo Medical University, Graduate School of Medicine , Sapporo , Japan
| | - S Honma
- Sapporo Cardiovascular Hospital, Department of Rehabilitation , Sapporo , Japan
| | - K Ohori
- Hokkaido Cardiovascular Hospital, Department of Cardiology , Sapporo , Japan
| | - H Kouzu
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine , Sapporo , Japan
| | - T Fujito
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine , Sapporo , Japan
| | - R Nishikawa
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine , Sapporo , Japan
| | - R Ohwada
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine , Sapporo , Japan
| | - N Nagano
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine , Sapporo , Japan
| | - M Koyama
- Sapporo Medical University, Department of Public Health , Sapporo , Japan
| | - M Katayose
- Sapporo Medical University, Second Division of Physical Therapy , Sapporo , Japan
| | - A Hashimoto
- Sapporo Medical University, Division of Health Care Administration and Management , Sapporo , Japan
| | - T Yano
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine , Sapporo , Japan
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15
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Numazawa R, Katano S, Nagaoka R, Honma S, Ohori K, Kouzu H, Watanabe A, Fujito T, Nishikawa R, Owada W, Nagano N, Koyama M, Katayose M, Hashimoto A, Yano T. Coexistence of sarcopenia and osteoporosis in patients with heart failure: prevalence and association with functional status. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Sarcopenia, the loss of muscle mass and function, and osteoporosis, a condition of low bone mass and micro-architectural deterioration of bone, frequently coexist and are associated with low functional status in heart failure (HF) patients.
Aims
We aimed to investigate the impact of coexistence of sarcopenia and osteoporosis on functional status in HF patients.
Methods
This cross-sectional study was conducted using data from patients who admitted to our institute for the diagnosis and management of HF from 1 November 2015 to 30 April 2021. All patients received the dual-energy X-ray absorptiometry (DEXA) method before discharge. The diagnosis of sarcopenia was made according to the criteria of Asia Working Group for Sarcopenia 2019 recommendation as follows: reduced skeletal muscle mass [appendicular skeletal muscle mass index (ASMI) by DEXA, <7.00 kg/m2 in males and <5.40 kg/m2 in females] plus lower muscle strength (handgrip strength, <28 kg in males and <18 kg in females) and/or poor physical performance (gait speed, <1.0 m/s; chair stand test time. ≥12 s; short physical performance battery ≤9 points). In addition, bone mineral densities (BMDs) at the lumbar spine, femoral neck, and total femur were measured by DEXA, and osteoporosis was diagnosed when BMDs at any of the three sites were less than 70% of Young Adult Mean (YAM). Functional status was assessed by the Barthel Index (BI) within three days before discharge, and patients with a BI score of <85 points was defined as having functional dependence (FD). The missing data were imputed using multiple imputation by chained -equations algorithm.
Results
Four hundred-thirty eight patients [median age of 74 years (interquartile range, 65–82 years), 37% females] were included in the analyses. Of these, percentage of HF patients with sarcopenia, osteoporosis, and sarcopenia and osteoporosis was 45%, 34%, and 20%, respectively (Figure 1A). The analysis of covariance showed a lower %YAM at any sites in patients with sarcopenia than those without sarcopenia (Figure 1B). When patients were divided into subgroups according to the presence or absence of sarcopenia and osteoporosis, the prevalence of FD was 32%, 34%, and 48% in patients with osteoporosis alone, sarcopenia alone, and sarcopenia and osteoporosis, respectively. Multivariate logistic regression analysis indicated that an increase in adjusted odds ratio (OR) for predicting FD was observed across subgroups in the following order: patients with osteoporosis alone [OR, 1.64; 95% confidence interval (CI), 0.63–4.24; p=0.31], those with sarcopenia alone (OR, 2.44; 95% CI, 1.13–5.25; p=0.02) and those with both conditions (OR, 3.34; 95% CI, 1.52–7.38; p<0.01) (Figure 2).
Conclusion
There was considerable overlap between sarcopenia and osteoporosis in HF patients, which appeared to be a risk factor for FD.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Numazawa
- Sapporo Medical University, Graduate School of Medicine , Sapporo , Japan
| | - S Katano
- Sapporo Medical University Hospital, Division of Rehabilitation , Sapporo , Japan
| | - R Nagaoka
- Sapporo Medical University Hospital, Division of Rehabilitation , Sapporo , Japan
| | - S Honma
- Sapporo Cardiovascular Hospital, Department of Rehabilitation , Sapporo , Japan
| | - K Ohori
- Hokkaido Cardiovascular Hospital, Department of Cardiology , Sapporo , Japan
| | - H Kouzu
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine , Sapporo , Japan
| | - A Watanabe
- Sapporo Medical University Hospital, Division of Nursing , Sapporo , Japan
| | - T Fujito
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine , Sapporo , Japan
| | - R Nishikawa
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine , Sapporo , Japan
| | - W Owada
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine , Sapporo , Japan
| | - N Nagano
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine , Sapporo , Japan
| | - M Koyama
- Sapporo Medical University School of Medicine, Department of Public Health , sapporo , Japan
| | - M Katayose
- Sapporo Medical University, Second Division of Physical Therapy, School of Health Sciences , Sapporo , Japan
| | - A Hashimoto
- Sapporo Medical University School of Medicine, Division of Health Care Administration and Management , sapporo , Japan
| | - T Yano
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine , Sapporo , Japan
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16
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Koyama M, Miyagawa Y, Kitazawa M, Tokumaru S, Nakamura S, Yamamoto Y, Ehara T, Hondo N, Soejima Y. Laparoscopic right hemicolectomy with a cranial-first approach for right-sided colon cancer. Tech Coloproctol 2022; 26:919-920. [PMID: 35676545 DOI: 10.1007/s10151-022-02641-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/16/2022] [Indexed: 11/26/2022]
Affiliation(s)
- M Koyama
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan.
| | - Y Miyagawa
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - M Kitazawa
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - S Tokumaru
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - S Nakamura
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Y Yamamoto
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - T Ehara
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - N Hondo
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Y Soejima
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
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Kanayama Y, Nagata A, Shimotake M, Miyachi F, Fujita K, Koyama M, Uno S. AB0363 COMPARING THE ULTRASONOGRAPHIC EVALUATION IN PATIENTS WITH JAPANESE RHEUMATOID ARTHRITIS BETWEEN JAK AND TNF INHIBITOR THERAPY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundJAK inhibitor (JAK) and TNF inhibitor (TNF) are the important therapeutic agent for the treatment of rheumatoid arthritis.However there is still few studies of improvement of ultrasonographic findings in RA treated comparison with JAK and TNF.ObjectivesTo evaluate the clinical efficacy of JAK and TNF therapy patients with rheumatoid arthritis (RA) using ultrasonography (US).MethodsParticipants comprised 32 and 39 Japanese RA patients who had recently received JAK (BAR23, PEF9) and TNF. All patients with a diagnosis of RA according to the 2010 ACR/EULAR criteria. Patients underwent clinical and laboratory assessments every 4 weeks from baseline to 24 weeks, and US assessments at baseline, 4, 12 and 24 weeks. Gray scale (GS) and power doppler (PD) signals were scored using a semi-quantitative scale from 0 to 3 at 26 (0-78) synovial sites (22 joints) in the following joints: bilateral first to fifth metacarpopharangeal (MCP) joints (dorsal recess); first interphalangeal (IP) and second to fifth proximal interphalangeal (PIP) (dorsal recess) joints; and the wrists (dorsal radial, median and ulnar). We evaluated the improvement of GS and PD score from baseline to week 24.ResultsIn the patients receiving JAK (n=32) and TNF (n=39), the mean age was 54.7 vs 55.1 years old (p=0.871), disease duration was 7.4 vs 6.1 years (p=0.290), the rate of MTX use was 75% vs 87% (p=0.187), the mean MTX dose was 9.9 vs 10.2 mg/w (p=0.813), the rate of ACPA positive was 94% vs 79% (p=0.086), DAS28-ESR was 4.79 vs 4.65 (p=0.435), CDAI was 22.4 vs 19.1 (p=0.239), GS score was 20.8 vs 18.3 (p=0.995) and PD score was 14.0 vs 11.0 (p=0.940). The degree of improvement respective changes in GS and PD score after 4, 12 and 24 weeks were as follows: GS: -5.1 vs -4.3 (p=0.817) and PD: -5.3 vs -2.7 (p=0.855) after 4 weeks, GS: -9.1 vs -6.6 (p=0.880) and PD: -7.9 vs -4.5 (p=0.476) after 12 weeks, GS: -10.4 vs -9.5 (p=0.463) and PD: -8.1 vs -6.7 (p=0.968) after 24 weeks between JAK and TNF (Figures 1 and 2). Next, The improvement rate of respective changes in GS and PD score after 4, 12 and 24 weeks were as follows: GS: -13.7% vs -18.3% (p=0.489) and PD: -20.4% vs -16.5% (p=0.777) after 4 weeks, GS: -29.7% vs -26.0% (p=0.922) and PD: -30.9% vs -30.8% (p=0.890) after 12 weeks, GS: -38.1% vs -36.4% (p=0.567) and PD: -33.4% vs -50.1% (p=0.977) after 24 weeks between JAK and TNF.ConclusionThe present study provides evidence supporting the JAK and TNF therapy improved similarly the inflammatory synovitis of US findings.Disclosure of InterestsNone declared
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18
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Nagaoka R, Katano S, Numazawa R, Kouzu H, Ohori K, Honma S, Kamoda T, Sato K, Nishikawa R, Owada W, Nagano N, Koyama M, Katayose M, Hashimoto A, Yano T. Does serum 25-hydroxyvitamin D levels have impacts on sarcopenia in patients with chronic heart failure? Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Sarcopenia is associated with poor functional status and clinical outcomes in heart failure (HF) patients. Although recent observational studies showed the relationship between lower serum vitamin D levels and the development of poor physical function in community-dwelling older adults, involvement of vitamin D status in the development of sarcopenia in HF patients remain unclear. This study aimed to investigate the impact of serum vitamin D concentrations on sarcopenia in patients with HF.
Methods
We retrospectively enrolled 269 consecutive patients [median age of 73 years (interquartile range 63-82 years); 35% female] admitted to our institute for diagnosis and management of HF, and received the dual-energy X-ray absorptiometry (DEXA) method during the period from 1 September 2018 to 30 September 2021. The 25-hydroxyvitamin D [25(OH)D] was detected by a chemiluminescence immunoassay (CLIA) technology. The diagnosis of sarcopenia was made according to the criteria of Asia Working Group for Sarcopenia incorporating reduced skeletal muscle mass (appendicular skeletal muscle index [ASMI], <7.00 kg/m2 in males and <5.40 kg/m2 in females), and lower muscle strength (handgrip strength, <28 kg in males and <18 kg in females) and/or poor physical performance (gait speed, <1.0 m/s; chair stand test time, ≥12 s; short physical performance battery, ≤9 points).
Results
Of 269 patients, 116 (43%) patients had sarcopenia. An adjusted logistic regression model with a restricted cubic spline function showed that the odds ratio (OR) for sarcopenia increased as the serum 25(OH)D levels decreased. When the value that corresponded to an upper limit of 95% confidence interval (CI) for an OR of 1.0 was defined as the cut-off value of 25(OH)D levels for predicting sarcopenia, it was 18 ng/mL (Figure 1A). A multivariate logistic regression model was fit to calculate the propensity score (PS) for the 25(OH)D levels being <18 ng/mL based on covariates such as age, sex, and N-terminal pro B-type natriuretic peptide. (C-statistics 0.761). The inverse probability of treatment weighting (IPTW) was computed using PS to minimize differences in potential confounding factors between patients with a low serum 25(OH)D levels (<18 ng/mL) and those with a high serum 25(OH)D levels (≥18 ng/mL, Figure 1B). Results of the multivariate logistic regression analysis in the IPTW-weighted patients showed that a low serum 25(OH)D was independently associated with presence of sarcopenia (adjusted OR 2.03, 95% CI 1.31-3.16, p<0.01). In addition, patients with a low serum 25(OH)D had a significantly lower muscle strength and poor physical performance, but not ASMI, than those with a high serum 25(OH)D (Figure 2).
Conclusion
Decreased serum 25(OH)D levels are associated with decline in muscle strength and physical performance in HF patients. Serum 25(OH)D levels of <18 ng/mL may be a novel risk factor of sarcopenia in HF patients.
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Affiliation(s)
- R Nagaoka
- Sapporo Medical University Hospital, Division of Rehabilitation, Sapporo, Japan
| | - S Katano
- Sapporo Medical University Hospital, Division of Rehabilitation, Sapporo, Japan
| | - R Numazawa
- Sapporo Medical University Hospital, Division of Rehabilitation, Sapporo, Japan
| | - H Kouzu
- Sapporo Medical University School of Medicine, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - K Ohori
- Hokkaido Cardiovascular Hospital, Department of Cardiology, Sapporo, Japan
| | - S Honma
- Sapporo Cardiovascular Hospital, Department of Rehabilitation, Sapporo, Japan
| | - T Kamoda
- Sapporo Medical University, Graduate School of Health Sciences, Sapporo, Japan
| | - K Sato
- Sapporo Medical University, Graduate School of Health Sciences, Sapporo, Japan
| | - R Nishikawa
- Sapporo Medical University School of Medicine, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - W Owada
- Sapporo Medical University School of Medicine, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - N Nagano
- Sapporo Medical University School of Medicine, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - M Koyama
- Sapporo Medical University School of Medicine, Department of Public Health, Sapporo, Japan
| | - M Katayose
- Sapporo Medical University School of Health Sciences, Second Division of Physical Therapy, Sapporo, Japan
| | - A Hashimoto
- Sapporo Medical University School of Medicine, Division of Health Care Administration and Management, Sapporo, Japan
| | - T Yano
- Sapporo Medical University School of Medicine, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
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19
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Honma S, Katano S, Nagaoka R, Numazawa R, Kouzu H, Ohori K, Nishikawa R, Ohwada W, Nagano N, Koyama M, Katayose M, Kobayashi C, Yoshioka N, Hashimoto A, Yano T. Novel equation for skeletal muscle mass estimation is useful for predicting mortality in patients with heart failure. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Skeletal muscle mass in heart failure (HF) patients is closely related to exercise tolerance and prognosis. Although the dual-energy X-ray absorptiometry (DEXA) method is a standard method for measuring skeletal muscle mass, it is not suitable in a daily clinical setting since it is a costly and hospital-based modality. We recently reported that an equation for appendicular skeletal muscle mass index (ASMI) estimation using anthropometric parameters predicted DEXA-measured ASMI in HF patients with reasonable accuracy. Here, we examined the prognostic impacts of ASMI predicted by the equation (predicted ASMI) in HF patients.
Methods
Data for 539 patients with HF ( 73 ± 14 years old, 43% female) who received the DEXA method and measurements of calf circumference (CC) and mid-arm circumference (MAC) between August 1, 2015, to August 31, 2020, were used for analyses. DEXA measured-appendicular skeletal muscle (ASM) was calculated as the sum of bone-free lean masses in the arms and legs, and ASMI was defined as ASM/height². Predicted ASMI was calculated as we previously reported: predicted ASMI (kg/m²) = [0.214 × weight (kg) + 0.217 × CC (cm) - 0.189 × MAC (cm) + 1.098 (male = 1, female = -1) + 0.576]/height² (m²). Low ASMI was defined as <7.0 kg/m² in males and <5.4 kg/m² in females, respectively. The primary endpoint was all-cause death. Multiple imputation using chained equations was used for the substitution of missing values.
Results
The median follow-up period was 1.75 years (interquartile range, 0.96 to 2.37 years), and 73 patients (15%) has died. Kaplan-Meier survival curves showed that patients with low DEXA measured-ASMI and patients with low predicted ASMI had significantly lower survival rates than those with high ASMI (Figure 1). In a multivariate Cox proportional hazard analyses adjusted for age, sex, logarithmic B-type natriuretic peptide, cystatin C based-estimated glomerular filtration rate, and gait speed, DEXA-measured ASMI [hazard ratio (HR), 0.982; 95% confidence interval (CI), 0.967 to 0.988; p<0.001] and predicted ASMI (HR, 0.979; 95% CI, 0.962 to 0.996; p=0.018) were independent predictors of all-cause mortality, respectively. Inclusion of predicted ASMI into the adjustment model improved the accuracy of prediction of the mortality after discharge [continuous net reclassification improvement, 0.338, p<0.01; integrated discrimination improvement, 0.020, p < 0.05] (Figure 2).
Conclusions
ASMI estimated by an equation using CC and MAC predicted the prognosis of HF patients at a similar level of accuracy to DEXA-measured ASMI, and it can be applied to the assessment of skeletal muscle mass in a daily clinical setting and in large population-based studies.
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Affiliation(s)
- S Honma
- Sapporo Cardiovascular Hospital, Department of Rehabilitation, Sapporo, Japan
| | - S Katano
- Sapporo Medical University Hospital, Division of Rehabilitation, Sapporo, Japan
| | - R Nagaoka
- Sapporo Medical University Hospital, Division of Rehabilitation, Sapporo, Japan
| | - R Numazawa
- Sapporo Medical University Hospital, Division of Rehabilitation, Sapporo, Japan
| | - H Kouzu
- Sapporo Medical University School of Medicine, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - K Ohori
- Hokkaido Cardiovascular Hospital, Department of Cardiology, Sapporo, Japan
| | - R Nishikawa
- Sapporo Medical University School of Medicine, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - W Ohwada
- Sapporo Medical University School of Medicine, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - N Nagano
- Sapporo Medical University School of Medicine, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - M Koyama
- Sapporo Medical University School of Medicine, Department of Public Health, Sapporo, Japan
| | - M Katayose
- Sapporo Medical University School of Medicine, Second Division of Physical Therapy, Sapporo, Japan
| | - C Kobayashi
- Sapporo Cardiovascular Hospital, Department of Cardiology, Sapporo, Japan
| | - N Yoshioka
- Sapporo Cardiovascular Hospital, Department of Cardiology, Sapporo, Japan
| | - A Hashimoto
- Sapporo Medical University School of Medicine, Division of Health Care Administration and Management, Sapporo, Japan
| | - T Yano
- Sapporo Medical University School of Medicine, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
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20
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Koyama M, Ishikawa M, Tajima K. Current status of countermeasures for ageing of nuclear power plants in Japan. KERNTECHNIK 2022. [DOI: 10.1515/kern-2002-0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
This paper summarizes ageing countermeasure program of the nuclear power plants performed by the Japanese Government and industries and related activities, and describes current research program and utilization of the research results for the aged nuclear power plants. Regulatory bodies (NISA of METI: Nuclear and Industrial Safety Agency of the Ministry of Economy, Trade and Industry') reviewed the ageing issues of nuclear power plants to enhance countermeasures for the aged plants. Nuclear Power Plant Life Engineering Center (PLEC) entrusted by NISA is carrying out the task relating to the aged plants.
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Affiliation(s)
- M. Koyama
- Nuclear Power Plant Life Engineering Center (PLEC), Japan Power Plant Life Engineering and Inspection Corporation (JAPEIC) , 5-11, Akasaka 1-chome, Minato-ku. Tokyo , 107-0052 Japan
| | - M. Ishikawa
- Nuclear Power Plant Life Engineering Center (PLEC), Japan Power Plant Life Engineering and Inspection Corporation (JAPEIC) , 5-11, Akasaka 1-chome, Minato-ku. Tokyo , 107-0052 Japan
| | - K. Tajima
- Nuclear Power Plant Life Engineering Center (PLEC), Japan Power Plant Life Engineering and Inspection Corporation (JAPEIC) , 5-11, Akasaka 1-chome, Minato-ku. Tokyo , 107-0052 Japan
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21
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Inoue T, Koyama M, Kaida K, Ikegame K, Ensbey KS, Samson L, Takahashi S, Zhang P, Minnie SA, Maruyama S, Ishii S, Daimon T, Fukuda T, Nakamae H, Ara T, Maruyama Y, Ishiyama K, Ichinohe T, Atsuta Y, Blazar BR, Furlan SN, Ogawa H, Hill GR. Peritransplant glucocorticoids redistribute donor T cells to the bone marrow and prevent relapse after haploidentical SCT. JCI Insight 2021; 6:e153551. [PMID: 34637399 PMCID: PMC8663779 DOI: 10.1172/jci.insight.153551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/08/2021] [Indexed: 02/02/2023] Open
Abstract
Patients with acute leukemia who are unable to achieve complete remission prior to allogeneic hematopoietic stem cell transplantation (SCT) have dismal outcomes, with relapse rates well in excess of 60%. Haplo-identical SCT (haplo-SCT) may allow enhanced graft-versus-leukemia (GVL) effects by virtue of HLA class I/II donor-host disparities, but it typically requires intensive immunosuppression with posttransplant cyclophosphamide (PT-Cy) to prevent lethal graft-versus-host disease (GVHD). Here, we demonstrate in preclinical models that glucocorticoid administration from days -1 to +5 inhibits alloantigen presentation by professional recipient antigen presenting cells in the gastrointestinal tract and prevents donor T cell priming and subsequent expansion therein. In contrast, direct glucocorticoid signaling of donor T cells promotes chemokine and integrin signatures permissive of preferential circulation and migration into the BM, promoting donor T cell residency. This results in significant reductions in GVHD while promoting potent GVL effects; relapse in recipients receiving glucocorticoids, vehicle, or PT-Cy was 12%, 56%, and 100%, respectively. Intriguingly, patients with acute myeloid leukemia not in remission who received unmanipulated haplo-SCT and peritransplant glucocorticoids also had an unexpectedly low relapse rate at 1 year (32%; 95% CI, 18%-47%) with high overall survival at 3 years (58%; 95% CI, 38%-74%). These data highlight a potentially simple and effective approach to prevent relapse in patients with otherwise incurable leukemia that could be studied in prospective randomized trials.
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Affiliation(s)
- Takayuki Inoue
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Motoko Koyama
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Katsuji Kaida
- Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Kazuhiro Ikegame
- Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Kathleen S. Ensbey
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Luke Samson
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Shuichiro Takahashi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Ping Zhang
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Simone A. Minnie
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Satoshi Maruyama
- Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
- Department of Hematology-Oncology, Chiba Cancer Center, Chiba, Japan
| | - Shinichi Ishii
- Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
- Division of Hematology, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Takashi Daimon
- Department of Biostatistics, Hyogo College of Medicine, Hyogo, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Hirohisa Nakamae
- Department of Hematology, Osaka City University Hospital, Osaka, Japan
| | - Takahide Ara
- Department of Hematology, Hokkaido University Hospital, Hokkaido, Japan
| | - Yumiko Maruyama
- Department of Hematology, University of Tsukuba Hospital, Ibaraki, Japan
| | - Ken Ishiyama
- Department of Hematology, Kanazawa University Hospital, Ishikawa, Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Tokyo, Japan
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Bruce R. Blazar
- Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Scott N. Furlan
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Hiroyasu Ogawa
- Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
- Department of Hematology, Osaka Gyoumeikan Hospital, Osaka, Japan
| | - Geoffrey R. Hill
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Division of Medical Oncology, University of Washington, Seattle, Washington, USA
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22
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Katano S, Yano T, Ohori K, Kouzu H, Nagaoka R, Honma S, Shimomura K, Numazawa R, Koyama M, Nagano N, Fujito T, Nishikawa R, Hashimoto A, Katayose M, Miura T. Barthel Index score predicts mortality in elderly heart failure: a goal of comprehensive cardiac rehabilitation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Accurate prediction of mortality in heart failure (HF) patients is crucial for decision-making regarding HF therapies, but a strategy for the prediction of mortality in elderly HF patients has not been established. In addition, although favorable effects of comprehensive cardiac rehabilitation (CR) on clinical outcomes and functional status in HF patients have been demonstrated, a goal of comprehensive CR during hospitalization for reducing mortality remains unclear.
Aims
We examined whether assessment of basic activities of daily living (ADL) by the Barthel Index (BI), the most widely used tool for assessment of basic ADL, is useful for predicting all-cause mortality in elderly HF patients who received comprehensive CR.
Methods
This study was a single-center, retrospective and observational study. We retrospectively examined 413 HF patients aged ≥65 years (mean age, 78±7 years; 50% female) who were admitted to our institute for management of HF and received comprehensive CR during hospitalization. Functional status for performing basic ADL ability was assessed by the BI within 3 days before discharge. The clinical endpoint was all-cause death during the follow-up period.
Results
Of 413 HF patients, 116 patients (28%) died during a follow-up period of median 1.90-years (interquartile range, 1.20–3.23 years). Results of an adjusted dose-dependent association analysis showed that the hazard ratio (HR) of mortality increases in an almost linear fashion as the BI score decreases and that the BI score corresponding the hazard ratio of 1.0 is 85 (Figure A). To minimize the differences in potential confounding factors between patient with low BI (<85) and patients with high BI (≥85), inverse probability treatment weighting (IPTW) was calculated using propensity score. Kaplan-Meier survival curves, in which selection bias was minimized by use of IPTW for confounders, showed that patients with low BI (<85) had a higher mortality rate than did patients with high BI (≥85) (Figure B). In multivariate Cox regression analyses, low BI was independently associated with higher mortality after adjustment for predictors including brain natriuretic peptide and prior HF hospitalization (IPTW-adjusted HR, 1.75 [95% confidence interval, 1.03–2.98], p<0.001). Inclusion of the BI into the adjustment model improved the accuracy of prediction of mortality (continuous net reclassification improvement, 0.292, p=0.008; integrated discrimination improvement, 0.017, p=0.022).
Conclusion
A BI score of <85 at the time of discharge is associated with increased mortality independently of known prognostic markers, and achievement of functional status of a BI score ≥85 by comprehensive CR during hospitalization may contribute to a favorable outcome in elderly HF patients.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): the Japan Society for the Promotion of Science
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Affiliation(s)
- S Katano
- Sapporo Medical University Hospital, Division of Rehabilitation, Sapporo, Japan
| | - T Yano
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - K Ohori
- Hokkaido Cardiovascular Hospital, Department of Cardiology, Sapporo, Japan
| | - H Kouzu
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - R Nagaoka
- Sapporo Medical University Hospital, Division of Rehabilitation, Sapporo, Japan
| | - S Honma
- Sapporo Cardiovascular Hospital, Department of Rehabilitation, Sapporo, Japan
| | - K Shimomura
- Hakodate Goryoukaku Hospital, Department of Rehabilitation, Hakodate, Japan
| | - R Numazawa
- Sapporo Medical University Hospital, Division of Rehabilitation, Sapporo, Japan
| | - M Koyama
- Sapporo Medical University, Department of Public Health, Sapporo, Japan
| | - N Nagano
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - T Fujito
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - R Nishikawa
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - A Hashimoto
- Sapporo Medical University, Division of Health Care Administration and Management, Sapporo, Japan
| | - M Katayose
- Sapporo Medical University, Second Division of Physical Therapy, Sapporo, Japan
| | - T Miura
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
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23
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Abstract
Allogeneic stem cell transplantation (alloSCT) is a curative therapy for hematopoietic malignancies. The therapeutic effect relies on donor T cells and NK cells to recognize and eliminate malignant cells, known as the graft-versus-leukemia (GVL) effect. However, off target immune pathology, known as graft-versus-host disease (GVHD) remains a major complication of alloSCT that limits the broad application of this therapy. The presentation of recipient-origin alloantigen to donor T cells is the primary process initiating GVHD and GVL. Therefore, the understanding of spatial and temporal characteristics of alloantigen presentation is pivotal to attempts to separate beneficial GVL effects from detrimental GVHD. In this review, we discuss mouse models and the tools therein, that permit the quantification of alloantigen presentation after alloSCT.
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Affiliation(s)
- Motoko Koyama
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Geoffrey R Hill
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States.,Division of Medical Oncology, University of Washington, Seattle, WA, United States
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24
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Henden AS, Koyama M, Robb RJ, Forero A, Kuns RD, Chang K, Ensbey KS, Varelias A, Kazakoff SH, Waddell N, Clouston AD, Giri R, Begun J, Blazar BR, Degli-Esposti MA, Kotenko SV, Lane SW, Bowerman KL, Savan R, Hugenholtz P, Gartlan KH, Hill GR. IFN-λ therapy prevents severe gastrointestinal graft-versus-host disease. Blood 2021; 138:722-737. [PMID: 34436524 PMCID: PMC8667051 DOI: 10.1182/blood.2020006375] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Immunopathology and intestinal stem cell (ISC) loss in the gastrointestinal (GI) tract is the prima facie manifestation of graft-versus-host disease (GVHD) and is responsible for significant mortality after allogeneic bone marrow transplantation (BMT). Approaches to prevent GVHD to date focus on immune suppression. Here, we identify interferon-λ (IFN-λ; interleukin-28 [IL-28]/IL-29) as a key protector of GI GVHD immunopathology, notably within the ISC compartment. Ifnlr1-/- mice displayed exaggerated GI GVHD and mortality independent of Paneth cells and alterations to the microbiome. Ifnlr1-/- intestinal organoid growth was significantly impaired, and targeted Ifnlr1 deficiency exhibited effects intrinsic to recipient Lgr5+ ISCs and natural killer cells. PEGylated recombinant IL-29 (PEG-rIL-29) treatment of naive mice enhanced Lgr5+ ISC numbers and organoid growth independent of both IL-22 and type I IFN and modulated proliferative and apoptosis gene sets in Lgr5+ ISCs. PEG-rIL-29 treatment improved survival, reduced GVHD severity, and enhanced epithelial proliferation and ISC-derived organoid growth after BMT. The preservation of ISC numbers in response to PEG-rIL-29 after BMT occurred both in the presence and absence of IFN-λ-signaling in recipient natural killer cells. IFN-λ is therefore an attractive and rapidly testable approach to prevent ISC loss and immunopathology during GVHD.
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Affiliation(s)
- Andrea S Henden
- Bone Marrow Transplantation Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Department of Haematology and Bone Marrow Transplantation, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Motoko Koyama
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Renee J Robb
- Bone Marrow Transplantation Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Adriana Forero
- Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA
| | - Rachel D Kuns
- Bone Marrow Transplantation Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Karshing Chang
- Bone Marrow Transplantation Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Kathleen S Ensbey
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Antiopi Varelias
- Bone Marrow Transplantation Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Stephen H Kazakoff
- Genetics and Computational Biology Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Nicole Waddell
- Genetics and Computational Biology Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | | | - Rabina Giri
- Mater Research Institute, The University of Queensland-Translational Research Institute, Brisbane, QLD, Australia
| | - Jakob Begun
- Mater Research Institute, The University of Queensland-Translational Research Institute, Brisbane, QLD, Australia
| | - Bruce R Blazar
- Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Mariapia A Degli-Esposti
- Centre for Experimental Immunology, Lions Eye Institute, Perth, WA, Australia
- Infection and Immunity Program, Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Sergei V Kotenko
- Center for Immunity and Inflammation, New Jersey Medical School, and
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers Biomedical and Health Sciences (RBHS), Newark, NJ
| | - Steven W Lane
- Cancer Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Kate L Bowerman
- Australian Centre for Ecogenomics, School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia; and
| | - Ram Savan
- Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA
| | - Philip Hugenholtz
- Australian Centre for Ecogenomics, School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia; and
| | - Kate H Gartlan
- Bone Marrow Transplantation Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Geoffrey R Hill
- Bone Marrow Transplantation Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, The University of Washington, Seattle, WA
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Garcia S, Koyama M. P–719 Self-declared infertility and child desire among women of reproductive age in the National Survey of Demography and Health, Brazil. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.718] [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: 11/13/2022] Open
Abstract
Abstract
Study question
This article aims to characterize from a socio-demographic point of view, women of reproductive age who wish to have children, declared themselves infertile, and their search for treatments and outcomes.
Summary answer
It is essential to develop specific population surveys on infertility in Brazil to identify its magnitude and main economic and social components.
What is known already
Commonly neglected in developing countries where public policy is incipient, infertility brings social, economic and psychological consequences to couples. It is considered as a serious public health problem whose impact varies among different populations and acquires relevance for specific communities. In Brazil, there are no clinical or demographic data that point us to the magnitude of the problem, its social characteristics and impact. Taking into account the postponement of motherhood for after 30 years, there will probably be an increase in the number of women and couples who may resort to infertility treatments to fulfil the desire for procreation.
Study design, size, duration
The National Survey of Demography and Health of Women and Children (PNDS) is a cross-sectional study and a household complex probabilistic sampling. The sampling units were selected according to a stratified model of simple random conglomerates in two stages: lottery draw and household draw. The last survey was conducted between June 2006 and May 2007 in 14,617 households. In the selected households, interviews were conducted with 15,575 women of reproductive age.
Participants/materials, setting, methods
The participants consisted of 15.575 women between 15 and 49 years, representative of the five Brazilian macro-regions. The information was obtained through questionnaires, applied in person, raising information on fertility, fecundity, contraception, use of health services and socioeconomic profile. The interviewer’s team was formed by approximately 100 people and 27 supervisors, all-female, divided into nine regional teams. The system used for data entry was the Census and Survey Processing System - CSPro.
Main results and the role of chance
The survey results indicate that of women who wish to have children, 9.2% declared themselves infertile; 50,8% of them sought health services for treatment; non-black women had higher percentages of demand compared to black women (62.4% versus 41.3%). Also, there were higher percentages of seeking help from women belonging to classes A (61.2%), B (83.3%) and C (60.9%) compared to those belonging to classes D (30.4%) and E (7.8%) On the other side, almost half of women did not seek help to get pregnant (49,1%); this percentage is higher among black women (58%). Moreover, women in classes D and E had the highest percentages of non-demand, 69.6% and 92.2%, respectively. The reasons cited for those who do not seek help, are “I think there is no solution” (54,7%); “I don’t think I can get help” (17.3%), “financial reasons” (26.8%) or “I don’t know where to get it” (1,2%). Among those who sought help, 48,5% are under treatment, 24,4% said there is no solution; 15,8% are waiting for service and 11,3% have no money for treatment. Significance limit was established for values of p < 0.05. The analysis was performed in the programs Stata v.9 and/or SPSS v.14.
Limitations, reasons for caution
The limitations of the study are recognized. Firstly, opinions are restricted to the moment of the interview and, thus, the desire for children may change over time. Secondly, the statement of infertility is based on self-declaration, not on clinical diagnosis.
Wider implications of the findings: This is the first study based on PNDS 2006 data on infertility and demand for treatments in Brazil. It can contribute to providing insights, raising new questions and discovering relevant categories and dimensions of analysis to be taken into account in future studies and surveys.
Trial registration number
Not applicable
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Affiliation(s)
- S Garcia
- Brazilian Center for Analysis and Planning - CEBRAP, Population and Society, São Paulo, Brazil
| | - M Koyama
- Independent Consultant, Independent Consultant, São Paulo, Brazil
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Garcia S, Koyama M. P-719 Self-declared infertility and child desire among women of reproductive age in the National Survey of Demography and Health, Brazil. Hum Reprod 2021. [DOI: 10.1093/humrep/deab125.039] [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: 11/12/2022] Open
Abstract
Abstract
Study question
This article aims to characterize from a socio-demographic point of view, women of reproductive age who wish to have children, declared themselves infertile, and their search for treatments and outcomes.
Summary answer
It is essential to develop specific population surveys on infertility in Brazil to identify its magnitude and main economic and social components.
What is known already
Commonly neglected in developing countries where public policy is incipient, infertility brings social, economic and psychological consequences to couples. It is considered as a serious public health problem whose impact varies among different populations and acquires relevance for specific communities. In Brazil, there are no clinical or demographic data that point us to the magnitude of the problem, its social characteristics and impact. Taking into account the postponement of motherhood for after 30 years, there will probably be an increase in the number of women and couples who may resort to infertility treatments to fulfil the desire for procreation.
Study design, size, duration
The National Survey of Demography and Health of Women and Children (PNDS) is a cross-sectional study and a household complex probabilistic sampling. The sampling units were selected according to a stratified model of simple random conglomerates in two stages: lottery draw and household draw. The last survey was conducted between June 2006 and May 2007 in 14,617 households. In the selected households, interviews were conducted with 15,575 women of reproductive age.
Participants/materials, setting, methods
The participants consisted of 15.575 women between 15 and 49 years, representative of the five Brazilian macro-regions. The information was obtained through questionnaires, applied in person, raising information on fertility, fecundity, contraception, use of health services and socioeconomic profile. The interviewer’s team was formed by approximately 100 people and 27 supervisors, all-female, divided into nine regional teams. The system used for data entry was the Census and Survey Processing System - CSPro.
Main results and the role of chance
The survey results indicate that of women who wish to have children, 9.2% declared themselves infertile; 50,8% of them sought health services for treatment; non-black women had higher percentages of demand compared to black women (62.4% versus 41.3%). Also, there were higher percentages of seeking help from women belonging to classes A (61.2%), B (83.3%) and C (60.9%) compared to those belonging to classes D (30.4%) and E (7.8%) On the other side, almost half of women did not seek help to get pregnant (49,1%); this percentage is higher among black women (58%). Moreover, women in classes D and E had the highest percentages of non-demand, 69.6% and 92.2%, respectively. The reasons cited for those who do not seek help, are “I think there is no solution” (54,7%); “I don’t think I can get help” (17.3%), “financial reasons” (26.8%) or “I don’t know where to get it” (1,2%). Among those who sought help, 48,5% are under treatment, 24,4 % said there is no solution; 15,8% are waiting for service and 11,3% have no money for treatment. Significance limit was established for values of p < 0.05. The analysis was performed in the programs Stata v.9 and/or SPSS v.14.
Limitations, reasons for caution
The limitations of the study are recognized. Firstly, opinions are restricted to the moment of the interview and, thus, the desire for children may change over time. Secondly, the statement of infertility is based on self-declaration, not on clinical diagnosis.
Wider implications of the findings
This is the first study based on PNDS 2006 data on infertility and demand for treatments in Brazil. It can contribute to providing insights, raising new questions and discovering relevant categories and dimensions of analysis to be taken into account in future studies and surveys.
Trial registration number
not applicable
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Affiliation(s)
- S Garcia
- Brazilian Center for Analysis and Planning - CEBRAP, Population and Society, São Paulo, Brazil
| | - M Koyama
- Independent Consultant, Independent Consultant, São Paulo, Brazil
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Okumura M, Tachibana D, Fudaba M, Misugi T, Koyama M. Fused yolk sacs in a case of forked umbilical cord in monochorionic diamniotic twin pregnancy: sonoembryological implications. Ultrasound Obstet Gynecol 2021; 58:142-143. [PMID: 32621308 DOI: 10.1002/uog.22142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/20/2020] [Accepted: 06/26/2020] [Indexed: 06/11/2023]
Affiliation(s)
- M Okumura
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - D Tachibana
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - M Fudaba
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - T Misugi
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - M Koyama
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka, Japan
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Izumi K, Moriwaki D, Toda T, Higashida-Konishi M, Koyama M, Oshima H, Okano Y, Kaneko Y, Ko S, Takeuchi T. AB0145 SMARTPHONE- AND SMARTWATCH-ACQUIRED DAILY STEPS, ACTIVITY, AND BAROMETRIC PRESSURES ASSOCIATED WITH SUBJECTIVE MEASURES OF RHEUMATOID ARTHRITIS: A PROSPECTIVE STUDY FOR RA DIGITAL PHENOTYPING. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Symptoms in patients with rheumatoid arthritis (RA) are potentially influenced by exercise load and meteorological change, and often vary from day to day, especially in unstable condition of RA. Patients with RA not infrequently experience worsening of joint symptoms when the load on the joint, such as walking and doing housework, exceeds a moderate range. However, the worsening of joint symptoms is often not observed in the midst of the loading of the joint, but often becomes apparent after a few hours or days.Objectives:To elucidate the relationship between smartphone- and smartwatch-acquired daily objective data (barometric pressures, steps, and activity) and daily subjective patient reported outcomes of RA.Methods:A smartphone (iPhone 8) and a wristband-type smartwatch (Fitbit Versa 2) were lent to each patient for free. A mobile app was developed and installed into the smartphones to collect patients’ daily subjective RA symptoms including Pt-P-VAS (patient-pain-visual analogue scale), Pt-G-VAS (pt-general-VAS), PtTJCount(68)(patient self-determined tender joint count among 68 joints), PtTJCount(28), PtSJCount(66)(patient self-determined swollen joint count among 66 joints), PtSJCount(28). Also, the smartwatch data and physicians’ assessment were collected from the same subject. Physicians’ and patients’ assessment of TJC, SJC, and G-VAS was independently performed without seeing each other’s assessment.We conducted a simple linear regression analysis with outcome variables of Pt-P-VAS, Pt-G-VAS, PtTJCount(68), PtTJCount(28), PtSJCount(66), and PtSJCount(28). The independent variables included smartphone-acquired daily steps and barometric pressure of the reported day and the previous day, and smartwatch-acquired minutes of “lightly active (1-3 METs equivalent)”, “fairly active(3-6 METs equivalent)”, and “very active(>6 METs equivalent)” of the reported day and previous day. We defined low barometric pressure as below 1000 hPa. The level of activity was measured by the smartwatch. Patients were blinded to daily barometric pressure data and their daily active time when the patients answered daily symptom questions on the smartphones.Results:A total of five patients were enrolled. At baseline, mean (± standard deviation (SD)) age was 50.8±14.8 years; all patients were females; mean disease duration was 6.6±4.9 years; mean SDAI was 18.6±25.5; mean DAS28-CRP was 3.23±1.85; mean morning stiffness was 134±116 min; mean HAQ-DI was 0.7±0.9. Mean observation period was 77.8 days. Because of the missing data, the sample size (N) for the regression analysis varies with the outcomes: Pt-P-VAS and Pt-G-VAS are 250 while PtTJCount and PtSJCount are 260.The table 1 showed that the patients’ assessment of TJC, SCJ, and G-VAS was correlated well with the physicians’ assessment.Table 1.Evaluation itemCorrelation between physicians and patients (ρ)Tender Joint Count (68)0.909Tender Joint Count(28)0.913Swollen Joint Count(66)0.896Swollen Joint Count(28)0.890General VAS0.688The figure 1 showed the change associated with one SD increment in each independent variable with 90% confidence intervals. Low barometric pressure was associated with bad health conditions (high Pt-G-VAS, Pt-P-VAS, and SJCount). Moreover, longer very active time in the previous day (“veryactive_1” in the Figure 1) was associated with bad health condition (high SJCount). Many steps were associated with good health conditions (low Pt-G-VAS, Pt-P-VAS, and SJCount).Figure 1.Conclusion:High barometric pressure was associated with good health conditions, and longer very active time in the previous day was associated with bad health condition. Barometric pressure data and physical activity data acquired by mobile digital devices may predict the change in RA symptoms. Further investigation in larger patient numbers is warranted.Acknowledgements:The authors would like to thank Harumi Kondo for her assistance.Disclosure of Interests:Keisuke Izumi Speakers bureau: Abbvie, Asahi Kasei Pharma, Bristol Myers Squibb, Chugai Pharmaceutical, Eli-Lily, Mochida Pharmaceutical, Ono Pharmaceutical, Grant/research support from: Abbvie, Asahi Kasei Pharma, Daisuke Moriwaki Employee of: CyberAgent, Inc., Takamichi Toda Employee of: AI Shift, Inc., Misako Higashida-Konishi: None declared, Manami Koyama: None declared, Hisaji Oshima: None declared, yutaka okano Speakers bureau: Asahi Kasei Pharma, Yuko Kaneko Speakers bureau: AbbVie, Astellas, Ayumi, Bristol–Myers Squibb, Chugai, Eisai, Eli Lilly, Hisamitsu, Jansen, Kissei, Kirin, Novartis, Pfizer, Sanofi, Takeda, Taisho, Tanabe-Mitsubishi, and UCB, Shigeru Ko: None declared, Tsutomu Takeuchi Speakers bureau: Abbott Japan Co, Ltd, Bristol–Myers KK, Chugai Pharmaceutical Co, Ltd, Eisai Co, Ltd, Janssen Pharmaceutical KK, Mitsubishi Tanabe Pharma Co, Pfizer Japan Inc, Takeda Pharmaceutical Co, Ltd, Astellas Pharma and Daiichi Sankyo Co, Ltd., Consultant of: Astra Zeneca KK, Eli Lilly Japan KK, Novartis Pharma KK, Mitsubishi Tanabe Pharma Co, Asahi Kasei Medical KK, Abbvie GK and Daiichi Sankyo Co, Ltd., Grant/research support from: Abbott Japan Co, Ltd, Astellas Pharma, Bristol-Myers KK, Chugai Pharmaceutical Co, Ltd, Daiichi Sankyo Co, Ltd, Eisai Co, Ltd, Janssen Pharmaceutical KK, Mitsubishi Tanabe Pharma Co, Pfizer Japan Inc, Sanofi–Aventis KK, Santen Pharmaceutical Co, Ltd, Takeda Pharmaceutical Co, Ltd, Teijin Pharma Ltd, Abbvie GK, Asahikasei Pharma Corp and Taisho Toyama Pharmaceutical Co, Ltd.
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Kanayama Y, Nagata A, Shimotake M, Miyachi F, Fujita K, Koyama M, Uno S. POS0635 COMPARING THE ULTRASONOGRAPHIC EVALUATION IN PATIENTS WITH JAPANESE RHEUMATOID ARTHRITIS BETWEEN BARICITINIB AND TNF ANTAGONIST THERAPY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Baricitinib (BAR) and TNF antagonist are the important therapeutic agent for the treatment of rheumatoid arthritis.However there is still few studies of improvement of ultrasonographic findings in RA treated comparison with BAR and TNF.Objectives:To evaluate the clinical efficacy of BAR and TNF therapy patients with rheumatoid arthritis (RA) using ultrasonography (US).Methods:Participants comprised 16 and 45 Japanese RA patients who had recently received BAR and TNF. All patients with a diagnosis of RA according to the 2010 ACR/EULAR criteria. Patients underwent clinical and laboratory assessments every 4 weeks from baseline to 24 weeks, and US assessments at baseline, 4, 12 and 24 weeks. Gray scale (GS) and power doppler (PD) signals were scored using a semi-quantitative scale from 0 to 3 at 26 (0-78) synovial sites (22 joints) in the following joints: bilateral first to fifth metacarpopharangeal (MCP) joints (dorsal recess); first interphalangeal (IP) and second to fifth proximal interphalangeal (PIP) (dorsal recess) joints; and the wrists (dorsal radial, median and ulnar). We evaluated the improvement of GS and PD score from baseline to week 24.Results:In the patients receiving BAR (n=16) and TNF (n=45), the mean age was 55.9 vs 54.6 years old (p=0.682), disease duration was 10.2 vs 6.1 years (p=0.094), the rate of MTX use was 75% vs 89% (p=346), the mean MTX dose was 9.3 vs 10.2 mg/w (p=0.443), the rate of ACPA positive was 94% vs 82% (p=0.476), DAS28-ESR was 4.25 vs 4.61 (p=0.289), CDAI was 15.8 vs 18.5 (p=0.210), GS score was 21.6 vs 16.3 (p=0.436) and PD score was 15.0 vs 9.5 (p=0.260). The degree of improvement respective changes in GS and PD score after 4, 12 and 24 weeks were as follows: GS: -7.2 vs -3.7 (p=0.268) and PD: -7.6 vs -2.3 (p=0.158) after 4 weeks, GS: -10.9 vs -5.0 (p=0.161) and PD: -9.2 vs -3.8 (p=0.049) after 12 weeks, GS: -12.9 vs -6.1 (p=0.485) and PD: -11.3 vs -5.7 (p=0.062) after 24 weeks between BAR and TNF (Fig.1, 2). Next, The improvement rate of respective changes in GS and PD score after 4, 12 and 24 weeks were as follows: GS: -23.8% vs -11.6% (p=0.580) and PD: -30.3% vs -16.5% (p=0.343) after 4 weeks, GS: -39.6% vs -15.6% (p=0.129) and PD: -47.1% vs -30.8% (p=0.210) after 12 weeks, GS: -52.2% vs -22.2% (p=0.248) and PD: -77.1% vs -50.1% (p=0.048) after 24 weeks between BAR and TNF.Conclusion:The present study provides evidence supporting both the BAR and TNF therapy showed improvement effect over time, but in a comparison between BAR and TNF, the PD score of BAR showed a siginificant improvement effect compared to TNF at 12 and 24 weeks. It was suggeted that BAR may improve inflammatory synovitis earlier compared to TNF.Disclosure of Interests:None declared
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Fukano Y, Soga M, Fukuda M, Takahashi Y, Koyama M, Arakawa Y, Miyano N, Akiba Y, Horiguchi M. Debut of an endangered bird in zoos raises public interest, awareness and conservation knowledge of the species. Anim Conserv 2021. [DOI: 10.1111/acv.12693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Y. Fukano
- Graduate School of Agricultural and Life Sciences The University of Tokyo Tokyo Japan
| | - M. Soga
- Graduate School of Agricultural and Life Sciences The University of Tokyo Tokyo Japan
| | - M. Fukuda
- Ministry of the Environment Government of Japan Tokyo Japan
| | - Y. Takahashi
- Tokyo Zoological Park Society Ueno Zoological Gardens Tokyo Japan
| | | | | | | | - Y. Akiba
- Toyama Municipal Family Park Zoo Toyama Japan
- Japanese Association of Zoos and Aquariums Tokyo Japan
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Katano S, Yano T, Tsukada T, Kouzu H, Honma S, Inoue T, Takamura Y, Nagaoka R, Ohori K, Koyama M, Nagano N, Nishikawa R, Hashimoto A, Katayose M, Miura T. Clinical determinants and prognostic impact of osteoporosis in patients with chronic heart failure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Despite accumulating evidence of a close association between orthopedic fractures and chronic heart failure (CHF), the clinical risk factors of osteoporosis, defined as reduction in bone mineral densities (BMDs), in CHF patients have not been systematically analyzed. In addition, the impact of osteoporosis on prognosis of CHF remains unclear.
Aims
We aimed to clarify the prevalence, clinical risk factors, and prognostic impact of osteoporosis in CHF patients.
Methods
We retrospectively examined 303 CHF patients (75 years, [interquartile range (IQR), 66–82 years]; 41% female). BMDs at the lumber spine, femoral neck, and total femur were measured by dual-energy X-ray absorptiometry (DEXA), and osteoporosis was diagnosed when BMD at any of the three sites was less than 70% of Young Adult Mean.
Results
The prevalence of osteoporosis in the CHF patients was 40%. Patients with osteoporosis were older (79 [IQR, 74–86] vs. 72 [IQR, 62–80] years), included a large percentage of females, had slower gait speed and had lower body mass index (BMI). Loop diuretics and warfarin were used more frequently and direct oral anticoagulants (DOACs) were used less frequently in patients with osteoporosis than in patients without osteoporosis. Multivariate logistic regression analysis indicated that sex (odds ratio [OR] 5.07, 95% Confidence Interval [CI] 2.68–9.61, p<0.01), BMI (OR, 0.83; 95% CI, 0.75–0.91; p<0.01), gait speed (OR, 0.80; 95% CI, 0.70–0.92; p<0.01), loop diuretics use (OR, 2.52; 95% CI, 1.20–5.27; p=0.01) and no DOACs use (OR, 0.43; 95% CI, 0.19–0.96; p=0.04) were independently associated with osteoporosis. During the mean follow-up period of 290±254 days, 92 patients (30.4%) had adverse events. When patients with osteoporosis were divided into subgroups according to the number of sites with BMD of an osteoporosis level, Kaplan-Meier survival curves showed that the rate of adverse events (death and cardiovascular events) was higher in patients with osteoporotic BMD at two or more sites than in patients without osteoporosis (51% vs. 23%, p=0.03) (Figure). In multivariate Cox regression analyses, osteoporotic BMD at two or more sites was an independent predictor of adverse events after adjustment for age, sex, and NT-proBNP level (Hazard ratio, 1.74; 95% CI, 1.01–2.99; p=0.04).
Conclusion
The risk of osteoporosis may be increased in users of loop diuretics and may be decreased in users of DOACs in CHF patients. Extent of osteoporosis is a novel predictor of adverse events in CHF patients.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Japan Society for the Promotion of Science KAKENHI
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Affiliation(s)
- S Katano
- Sapporo Medical University Hospital, Division of Rehabilitation, Sapporo, Japan
| | - T Yano
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - T Tsukada
- Social Welfare Corporation, Hokkaido Social Work Association Obihiro Hospital, Cardiac Rehabilitation Center, Obihiro, Japan
| | - H Kouzu
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - S Honma
- Sapporo Cardiovascular Hospital, Department of Rehabilitation, Sapporo, Japan
| | - T Inoue
- Sapporo Medical University Hospital, Division of Rehabilitation, Sapporo, Japan
| | - Y Takamura
- Sapporo Medical University Hospital, Division of Rehabilitation, Sapporo, Japan
| | - R Nagaoka
- Sapporo Medical University Hospital, Division of Rehabilitation, Sapporo, Japan
| | - K Ohori
- Hokkaido Cardiovascular Hospital, Department of Cardiology, Sapporo, Japan
| | - M Koyama
- Sapporo Medical University, Department of Public Health, Sapporo, Japan
| | - N Nagano
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - R Nishikawa
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - A Hashimoto
- Sapporo Medical University, Division of Health Care Administration and Management, Sapporo, Japan
| | - M Katayose
- Sapporo Medical University, Second Division of Physical Therapy, Sapporo, Japan
| | - T Miura
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
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Engel JA, Lee HJ, Williams CG, Kuns R, Olver S, Lansink LI, Soon MS, Andersen SB, Powell JE, Svensson V, Teichmann SA, Hill GR, Varelias A, Koyama M, Haque A. Single-cell transcriptomics of alloreactive CD4+ T cells over time reveals divergent fates during gut graft-versus-host disease. JCI Insight 2020; 5:137990. [PMID: 32484791 PMCID: PMC7406307 DOI: 10.1172/jci.insight.137990] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/21/2020] [Indexed: 08/05/2023] Open
Abstract
Acute gastrointestinal (GI) graft-versus-host disease (GVHD) is a primary determinant of mortality after allogeneic hematopoietic stem cell transplantation (alloSCT). The condition is mediated by alloreactive donor CD4+ T cells that differentiate into pathogenic subsets expressing IFN-γ, IL-17A, or GM-CSF and is regulated by subsets expressing IL-10 and/or Foxp3. Developmental relationships between Th cell states during priming in mesenteric lymph nodes (mLNs) and effector function in the GI tract remain undefined at genome scale. We applied scRNA-Seq and computational modeling to a mouse model of donor DC-mediated GVHD exacerbation, creating an atlas of putative CD4+ T cell differentiation pathways in vivo. Computational trajectory inference suggested emergence of pathogenic and regulatory states along a single developmental trajectory in mLNs. Importantly, we inferred an unexpected second trajectory, categorized by little proliferation or cytokine expression, reduced glycolysis, and high tcf7 expression. TCF1hi cells upregulated α4β7 before gut migration and failed to express cytokines. These cells exhibited recall potential and plasticity following secondary transplantation, including cytokine or Foxp3 expression, but reduced T cell factor 1 (TCF1). Thus, scRNA-Seq suggested divergence of alloreactive CD4+ T cells into quiescent and effector states during gut GVHD exacerbation by donor DC, reflecting putative heterogeneous priming in vivo. These findings, which are potentially the first at a single-cell level during GVHD over time, may assist in examination of T cell differentiation in patients undergoing alloSCT.
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Affiliation(s)
- Jessica A. Engel
- QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia
| | - Hyun Jae Lee
- QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia
| | - Cameron G. Williams
- QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia
| | - Rachel Kuns
- QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia
| | - Stuart Olver
- QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia
| | - Lianne I.M. Lansink
- QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia
| | - Megan S.F. Soon
- QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia
| | - Stacey B. Andersen
- Institute for Molecular Bioscience, University of Queensland, St. Lucia, Queensland, Australia
| | - Joseph E. Powell
- Garvan-Weizmann Centre for Cellular Genomics, Sydney, New South Wales, Australia
- UNSW Cellular Genomics Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Sarah A. Teichmann
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridgeshire, United Kingdom
| | - Geoffrey R. Hill
- QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Division of Medical Oncology, University of Washington, Seattle, Washington, USA
| | - Antiopi Varelias
- QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, St. Lucia, Queensland, Australia
| | - Motoko Koyama
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Ashraful Haque
- QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia
- Department of Microbiology and Immunology, University of Melbourne, located at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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33
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Cheong M, Gartlan KH, Lee JS, Tey SK, Zhang P, Kuns RD, Andoniou CE, Martins JP, Chang K, Sutton VR, Kelly G, Varelias A, Vuckovic S, Markey KA, Boyle GM, Smyth MJ, Engwerda CR, MacDonald KPA, Trapani JA, Degli-Esposti MA, Koyama M, Hill GR. ASC Modulates CTL Cytotoxicity and Transplant Outcome Independent of the Inflammasome. Cancer Immunol Res 2020; 8:1085-1098. [PMID: 32444423 DOI: 10.1158/2326-6066.cir-19-0653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 02/10/2020] [Accepted: 05/14/2020] [Indexed: 11/16/2022]
Abstract
The adaptor protein ASC (apoptosis-associated speck-like protein containing a CARD) is known to facilitate caspase-1 activation, which is essential for innate host immunity via the formation of the inflammasome complex, a multiprotein structure responsible for processing IL1β and IL18 into their active moieties. Here, we demonstrated that ASC-deficient CD8+ T cells failed to induce severe graft-versus-host disease (GVHD) and had impaired capacity for graft rejection and graft-versus-leukemia (GVL) activity. These effects were inflammasome independent because GVHD lethality was not altered in recipients of caspase-1/11-deficient T cells. We also demonstrated that ASC deficiency resulted in a decrease in cytolytic function, with a reduction in granzyme B secretion and CD107a expression by CD8+ T cells. Altogether, our findings highlight that ASC represents an attractive therapeutic target for improving outcomes of clinical transplantation.
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Affiliation(s)
- Melody Cheong
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,School of Natural Sciences, Griffith University, Nathan, Queensland, Australia
| | - Kate H Gartlan
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jason S Lee
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Siok-Keen Tey
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Ping Zhang
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Rachel D Kuns
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Christopher E Andoniou
- Centre for Experimental Immunology, Lions Eye Institute, Nedlands, Western Australia, Australia.,Infection and Immunity Program and Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Jose Paulo Martins
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Karshing Chang
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Vivien R Sutton
- Cancer Cell Death Laboratory, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia
| | - Greg Kelly
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Antiopi Varelias
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Slavica Vuckovic
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Institute of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kate A Markey
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Glen M Boyle
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Mark J Smyth
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | | | | | - Joseph A Trapani
- Cancer Cell Death Laboratory, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia
| | - Mariapia A Degli-Esposti
- Centre for Experimental Immunology, Lions Eye Institute, Nedlands, Western Australia, Australia.,Infection and Immunity Program and Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Motoko Koyama
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Geoffrey R Hill
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia. .,Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
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34
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Gartlan KH, Wilkinson A, Chang K, Kuns RD, Henden A, Minnie SA, Ensbey KS, Clouston A, Zhang P, Koyama M, Hidalgo J, Rose-John S, Varelias A, Vuckovic S, Hill GR. Diverse IL-6 signalling modalities drive pathogenic T cell differentiation and graft-versus-host-disease after allotransplantation. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.87.33] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Allogeneic stem cell transplantation (alloSCT) and graft-versus-host disease (GVHD) are characterized by systemic interleukin 6 (IL-6) dysregulation, which plays a significant role in shaping donor immune responses and T cell polarization. GVHD is a T cell-mediated disease and the severity and tissue distribution is heavily influenced by T cell-derived cytokines, therefore it is critical to understand the factors that drive T cell polarization in this context to inform therapeutic strategies. IL-6 has a unique receptor system composed of IL-6Ra and the signal transducing molecule gp130, in which signaling occurs via multiple pathways either directly (classical), indirectly via a soluble IL-6 receptor (trans), or presented via antigen presenting cells (cluster). We examined the influence of IL-6 signaling modalities on T cell polarization following allotransplantation, where we found specific targeting of these pathways modulates GVHD outcomes. Using donor grafts composed of IL-6Ra deficient T cells resulted in a profound loss of pathogenic Th17/Th22 differentiation and increased GVHD survival, demonstrating these populations are highly dependent upon classical IL-6 signaling post-transplant. Whilst targeting cluster signaling through IL-6Ra deficient DC had no effect on T cell cytokine responses, trans-signaling inhibition via soluble gp130-Fc resulted in severe skin GVHD. This effect was due to significant expansion of pathogenic donor Th22 and was prevented by donor IL-22 deficiency. These data demonstrate an important role for IL-6 trans signaling in regulating pathogenic T cell polarization pathways following allotransplantation and support IL-6 classical signaling as an important target for GVHD prevention.
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Affiliation(s)
| | | | | | | | | | - Simone A Minnie
- 3Clinical Research Division, Fred Hutchinson Cancer Research Center
| | | | | | | | | | - Juan Hidalgo
- 6Campus de la Universitat Autònoma de Barcelona, Spain
| | | | | | | | - Geoffrey R Hill
- 3Clinical Research Division, Fred Hutchinson Cancer Research Center
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35
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Suekane T, Tachibana D, Pooh RK, Misugi T, Koyama M. Type-3 vasa previa: normal umbilical cord insertion cannot exclude vasa previa in cases with abnormal placental location. Ultrasound Obstet Gynecol 2020; 55:556-557. [PMID: 31115101 DOI: 10.1002/uog.20347] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/02/2019] [Accepted: 05/10/2019] [Indexed: 06/09/2023]
Affiliation(s)
- T Suekane
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - D Tachibana
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - R K Pooh
- CRIFM Clinical Research Institute of Fetal Medicine PMC, Osaka, Japan
| | - T Misugi
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - M Koyama
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka, Japan
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36
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Wilkinson AN, Chang K, Kuns RD, Henden AS, Minnie SA, Ensbey KS, Clouston AD, Zhang P, Koyama M, Hidalgo J, Rose-John S, Varelias A, Vuckovic S, Gartlan KH, Hill GR. IL-6 dysregulation originates in dendritic cells and mediates graft-versus-host disease via classical signaling. Blood 2019; 134:2092-2106. [PMID: 31578204 DOI: 10.1182/blood.2019000396] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 09/22/2019] [Indexed: 12/13/2022] Open
Abstract
Graft-versus-host disease (GVHD) after allogeneic stem cell transplantation (alloSCT) is characterized by interleukin-6 (IL-6) dysregulation. IL-6 can mediate effects via various pathways, including classical, trans, and cluster signaling. Given the recent availability of agents that differentially inhibit these discrete signaling cascades, understanding the source and signaling and cellular targets of this cytokine is paramount to inform the design of clinical studies. Here we demonstrate that IL-6 secretion from recipient dendritic cells (DCs) initiates the systemic dysregulation of this cytokine. Inhibition of DC-driven classical signaling after targeted IL-6 receptor (IL-6R) deletion in T cells eliminated pathogenic donor Th17/Th22 cell differentiation and resulted in long-term survival. After engraftment, donor DCs assume the same role, maintaining classical IL-6 signaling-dependent GVHD responses. Surprisingly, cluster signaling was not active after transplantation, whereas inhibition of trans signaling with soluble gp130Fc promoted severe, chronic cutaneous GVHD. The latter was a result of exaggerated polyfunctional Th22-cell expansion that was reversed by IL-22 deletion or IL-6R inhibition. Importantly, inhibition of IL-6 classical signaling did not impair the graft-versus-leukemia effect. Together, these data highlight IL-6 classical signaling and downstream Th17/Th22 differentiation as important therapeutic targets after alloSCT.
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Affiliation(s)
- Andrew N Wilkinson
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Karshing Chang
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Rachel D Kuns
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Andrea S Henden
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Simone A Minnie
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | | | | | - Ping Zhang
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Motoko Koyama
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Juan Hidalgo
- Animal Physiology Unit, Department of Cellular Biology, Physiology and Immunology, Faculty of Biosciences, and
- Institute of Neurosciences, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Stefan Rose-John
- Institute of Biochemistry, Christian-Albrechts-Universität zu Kiel, Kiel, Germany; and
| | - Antiopi Varelias
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Slavica Vuckovic
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Kate H Gartlan
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Geoffrey R Hill
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, University of Washington, Seattle, WA
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37
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Mashita M, Adachi H, Koyama M, Nonoue S, Mamiya Y, Shigedo Y, Sugita Y, Kyotani K, Kato T, Ikeda M. The feature of sleep stage sequence of nocturnal rem periods reflects the pathophysiology of narcolepsy. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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38
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Ohori K, Yano T, Katano S, Honma S, Shimomura K, Watanabe A, Ishigo T, Fujito T, Nagano N, Koyama M, Kouzu H, Hashimoto A, Miura T. P4537Impact of body composition analysis on prediction of short-term readmission events in heart failure: muscle wasting vs. obesity. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Obesity, defined as higher body mass index (BMI), is associated with better prognosis in patients with chronic heart failure (CHF), though the presence of obesity is a risk factor of development of CHF (Obesity paradox). On the other hand, muscle wasting, i.e. reduction in skeletal muscle mass, is frequently observed in CHF, leading to lower exercise capacity and poor cardiovascular outcome.
Purpose
The aim of this study was to examine whether analysis of body composition improves prediction of short-term readmission rates in patients with CHF.
Methods
We retrospectively analyzed data for 167 consecutive HF patients who were admitted to our institute for management of HF and received a Dual-energy X-ray absorptiometry (DEXA) scan. Muscle wasting was defined as DEXA-measured appendicular skeletal muscle mass index <7.0 kg/m2 in male and <5.4 kg/m2 in female according to the Asian Working Group for Sarcopenia criteria. Obesity was defined according to the criteria by the use of DEXA-measured percent body fat mass: >25% in male, >30% in female. The primary endpoint was readmission due to cardiac events including worsening heart failure, arrhythmia, and cardiopulmonary arrest during a 180-days follow-up period after discharge.
Results
The mean age of the patients was 74±13 years and 46% of them were male. The mean BMI was 21.8±3.8 kg/m2. Forty-seven percent of the patients were classified as NYHA functional class III. The most frequent etiology of HF was cardiomyopathy (30%), followed by ischemic heart disease (27%) and valvular heart disease (27%). The prevalence of muscle wasting and that of obesity were 69% and 59%, respectively. Patients with muscle wasting had lower BMI level, higher prevalence of NYHA functional class III and diabetes mellitus compared with those without muscle wasting. On the other hand, patients with obesity had higher prevalence of hypertension and dyslipidemia, higher level of BMI, fasting plasma insulin and triglyceride, and lower level of HDL-cholesterol compared with those without obesity. During the follow-up period, 34 patients (19%) were re-hospitalized due to cardiac events. Kaplan-Meier survival curves showed that patients with obesity had a significantly lower readmission rate during a 180-days follow-up period than did the patients without obesity (14.3% vs. 29.0%, Log-Rank test, p<0.01). There was no difference in readmission rates between patients with and without muscle wasting (20.0% vs. 21.2%, p=0.88). In multivariate Cox regression analyses adjusted for age, sex, diabetes, and renal function, obesity was independently associated with lower readmission rates (hazard ratio 0.45, 95% confidence interval 0.22–0.93). However, the association between obesity and readmission rate was lost after the adjustment for NT-proBNP levels.
Conclusion
Body composition analysis by DEXA enables to find CHF patients with increased fat mass who have lower risk of short-term readmission.
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Affiliation(s)
- K Ohori
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - T Yano
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - S Katano
- Sapporo Medical University, Division of Rehabilitation, Sapporo, Japan
| | - S Honma
- Sapporo Medical University, Division of Rehabilitation, Sapporo, Japan
| | - K Shimomura
- Sapporo Medical University, Division of Rehabilitation, Sapporo, Japan
| | - A Watanabe
- Sapporo Medical University, Division of Nursing, Sapporo, Japan
| | - T Ishigo
- Sapporo Medical University, Division of Hospital Pharmacy, Sapporo, Japan
| | - T Fujito
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - N Nagano
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - M Koyama
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - H Kouzu
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - A Hashimoto
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - T Miura
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
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Shimomura K, Katano S, Yano T, Ohori K, Honma S, Watanabe A, Ishigo T, Fujito T, Nagano N, Koyama M, Kouzu H, Hashimoto A, Miura T. P1538Low energy intake predicts readmission of elderly heart failure patients independently of nutritional status. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Malnutrition is frequently present and closely associated with poor clinical outcomes in elderly heart failure (HF) patients. Our previous study showed that low energy intake (EI) is associated with worse functional status in elderly HF inpatients after cardiac rehabilitation, but significance of EI in prediction of hospital readmission has not been elucidated fully.
Purpose
We examined whether low EI is a predictor of readmission for cardiac events in elderly HF patients.
Methods
We retrospectively retrieved data for 298 HF patients aged ≥65 years (median age of 77 years, interquartile range [IQR]: 71 - 82, female: 53%) who admitted to our institute for diagnosis and treatment of HF. Medical records were reviewed with regard to demography, medical history, comorbidities, medications, laboratory data, echocardiograms, functional status, nutritional status and total energy intake. Nutritional status was assessed using the Mini Nutritional Assessment Short Form (MNA-SF) and total EI per day were calculated at discharge by a registered dietitian and a trained physical therapist. The primary endpoint was readmission due to cardiovascular events including worsening HF, arrhythmia, angina pectoris and myocardial infarction during a 1-year follow-up period.
Results
The median period of follow-up was 235 days (IQR: 78–365 days). The 1-year readmission rate for cardiovascular events was 54.4%. The cutoff values of MNA-SF score and EI, calculated by ROC curve analysis to predict the primary endpoint, were 7 points (area under the curve [AUC]: 0.59, sensitivity: 0.65, specificity: 0.50) and 31.8 kcal/kg/day (AUC: 0.59, sensitivity: 0.83, specificity: 0.35), respectively. Patients with low MNF-SF score (≤7) or low EI (≤31.8 kcal/kg/day) had significantly higher readmission rate during a 1-year follow-up period than did the patients with high MNF-SF score or EI (MNA-SF: 60.7% vs. 45.6%, p<0.01, EI: 60.4% vs. 36.8%, p<0.01), respectively. When patients were classified into four groups using cutoff values of MNA-SF score and EI, 1-year readmission rate was significantly higher in patients with low EI than in those with high EI regardless of MNF-SF scores. In multivariate Cox proportional hazard analyses adjusted for known prognostic factors in addition to age and gender, hazard ratios (HR) were significantly higher in patients with high MNA-SF score and low EI (adjusted HR: 2.81, 95% confidential interval [CI]: 1.15 - 9.32, p=0.02) and low MNA-SF score (≤7) and low EI (adjusted HR: 4.16, 95% CI: 1.72 - 13.72, p<0.01) than those with high MNA-SF score and high EI.
Kaplan-Meier curves of readmission rates
Conclusions
Low energy intake is a nutritional status-independent predictor of 1-year readmission rate in elderly HF patients.
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Affiliation(s)
- K Shimomura
- Sapporo Medical University Hospital, Division of Rehabilitation, Sapporo, Japan
| | - S Katano
- Sapporo Medical University Hospital, Division of Rehabilitation, Sapporo, Japan
| | - T Yano
- Sapporo Medical University School of Medicine, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - K Ohori
- Hokkaido Cardiovascular Hospital, Department of Cardiology, Sapporo, Japan
| | - S Honma
- Sapporo Medical University Hospital, Division of Rehabilitation, Sapporo, Japan
| | - A Watanabe
- Sapporo Medical University Hospital, Division of Nursing, Sapporo, Japan
| | - T Ishigo
- Sapporo Medical University Hospital, Department of Hospital Pharmacy, Sapporo, Japan
| | - T Fujito
- Sapporo Medical University School of Medicine, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - N Nagano
- Sapporo Medical University School of Medicine, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - M Koyama
- Sapporo Medical University School of Medicine, Department of Public Health, Sapporo, Japan
| | - H Kouzu
- Sapporo Medical University School of Medicine, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - A Hashimoto
- Sapporo Medical University School of Medicine, Division of Health Care Administration and Management, Sapporo, Japan
| | - T Miura
- Sapporo Medical University School of Medicine, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
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40
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Fujita Y, Yano T, Abe K, Nagano N, Kamiyama N, Fujito T, Mochizuki A, Koyama M, Kouzu H, Muranaka A, Naganara D, Tanno M, Miki T, Miura T. P6453Activation of necroptotic pathway by downregulated caspase-8 expression is associated with progression of left ventricular remodeling in nonischemic dilated cardiomyopathy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Necroptosis, a form of programmed necrosis, has been suggested to be involved in the pathogenesis of various pathological conditions including heart failure. Protein expression of caspase-8, an endogenous inhibitor of necroptosis, is reported to be downregulated in human failing hearts, but its clinical significance remains unclear.
Methods
Endomyocardial biopsy specimens were obtained from patients with nonischemic dilated cardiomyopathy (n=57, 56.2±14.5 years old, 70% male). The area stained with antibodies against caspase-8 and phospho-MLKL-Ser358 was calculated using an image analyzer, and fibrotic and cardiomyocyte areas were determined by Masson's Trichrome staining. Using a level of median caspase-8 expression (6.04% of the area of the myocardium with caspase-8 signal), patients were classified into a high caspase-8 expression group (H-cas8) and a low caspase-8 expression group (L-cas8).
Results
Caspase-8 signals were detected in cytoplasm and intercalated disks of cardiomyocytes. Patients in the L-cas8 group was younger (51.3±13.1 vs. 61.2±14.3 years old) and had larger left ventricular end-diastolic volume (LVEDV: 174±49 vs. 131±41 ml), larger left ventricular end-systolic volume (LVESV: 123±51 vs. 87±39 ml), and higher ratio of mitral peak velocity of early filling to late diastolic filling (E/A: 1.94±1.48 vs. 1.12±0.66) compared with the H-cas8 group. Caspase-8 expression level was positively correlated with age (r=0.34, p=0.01) and negatively correlated with LVEDV (r=−0.47, p<0.01), LVESV (r=−0.40, p<0.01), and E/A (r=−0.39, p<0.01) in simple linear regression analysis. The extent of myocardial fibrosis was not correlated with caspase-8 expression level. Multiple regression analysis indicated that LVEDV, LVESV, and E/A were independent explanatory factors of caspase-8 expression level after adjusting age and sex. Phospho-MLKL signals, an index of activation of necroptotic pathway, were frequently observed in cytoplasm, intercalated disks, and nuclei in the L-cas8 group but not in the H-cas8 group.
Conclusion
Lower caspase-8 expression in cardiomyocytes was associated with increased phosphorylation of MLKL and larger left ventricular volume, suggesting that downregulated caspase-8 may contribute to progression of myocardial remodeling via activation of MLKL in human dilated cardiomyopathy.
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Affiliation(s)
- Y Fujita
- Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - T Yano
- Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - K Abe
- Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - N Nagano
- Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - N Kamiyama
- Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - T Fujito
- Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - A Mochizuki
- Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - M Koyama
- Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - H Kouzu
- Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - A Muranaka
- Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - D Naganara
- Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - M Tanno
- Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - T Miki
- Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - T Miura
- Sapporo Medical University School of Medicine, Hokkaido, Japan
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Koyama M, Mukhopadhyay P, Schuster IS, Henden AS, Hülsdünker J, Varelias A, Vetizou M, Kuns RD, Robb RJ, Zhang P, Blazar BR, Thomas R, Begun J, Waddell N, Trinchieri G, Zeiser R, Clouston AD, Degli-Esposti MA, Hill GR. MHC Class II Antigen Presentation by the Intestinal Epithelium Initiates Graft-versus-Host Disease and Is Influenced by the Microbiota. Immunity 2019; 51:885-898.e7. [PMID: 31542340 DOI: 10.1016/j.immuni.2019.08.011] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 05/15/2019] [Accepted: 08/13/2019] [Indexed: 12/30/2022]
Abstract
Graft-versus-host disease (GVHD) in the gastrointestinal (GI) tract is the principal determinant of lethality following allogeneic bone marrow transplantation (BMT). Here, we examined the mechanisms that initiate GVHD, including the relevant antigen-presenting cells. MHC class II was expressed on intestinal epithelial cells (IECs) within the ileum at steady state but was absent from the IECs of germ-free mice. IEC-specific deletion of MHC class II prevented the initiation of lethal GVHD in the GI tract. MHC class II expression on IECs was absent from mice deficient in the TLR adaptors MyD88 and TRIF and required IFNγ secretion by lamina propria lymphocytes. IFNγ responses are characteristically driven by IL-12 secretion from myeloid cells. Antibiotic-mediated depletion of the microbiota inhibited IL-12/23p40 production by ileal macrophages. IL-12/23p40 neutralization prevented MHC class II upregulation on IECs and initiation of lethal GVHD in the GI tract. Thus, MHC class II expression by IECs in the ileum initiates lethal GVHD, and blockade of IL-12/23p40 may represent a readily translatable therapeutic strategy.
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Affiliation(s)
- Motoko Koyama
- Bone Marrow Transplantation Laboratory, Immunology Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
| | - Pamela Mukhopadhyay
- Medical Genomics Laboratory, Genetics and Computational Biology Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia
| | - Iona S Schuster
- Immunology and Virology Program, Centre for Ophthalmology and Visual Science, The University of Western Australia, Crawley, WA 6009, Australia; Centre for Experimental Immunology, Lions Eye Institute, Nedlands, WA 6009, Australia; Infection and Immunity Program and Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC 3800, Australia
| | - Andrea S Henden
- Bone Marrow Transplantation Laboratory, Immunology Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia; Department of Haematology and Bone Marrow Transplantation, Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia
| | - Jan Hülsdünker
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Albert Ludwigs University Freiburg, Freiburg 79106, Germany; Spemann Graduate School of Biology and Medicine, University Freiburg, Freiburg 79085, Germany; Faculty of Biology, University Freiburg, Freiburg 79104, Germany
| | - Antiopi Varelias
- Bone Marrow Transplantation Laboratory, Immunology Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia
| | - Marie Vetizou
- Cancer and Inflammation Program, Center for Cancer Research, NCI, NIH, Bethesda, MD 20892, USA
| | - Rachel D Kuns
- Bone Marrow Transplantation Laboratory, Immunology Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia
| | - Renee J Robb
- Bone Marrow Transplantation Laboratory, Immunology Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia
| | - Ping Zhang
- Bone Marrow Transplantation Laboratory, Immunology Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia
| | - Bruce R Blazar
- Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA
| | - Ranjeny Thomas
- Diamantina Institute, Translational Research Institute, University of Queensland, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia
| | - Jakob Begun
- Mater Research Institute, University of Queensland, Translational Research Institute, Brisbane, QLD 4102, Australia
| | - Nicola Waddell
- Medical Genomics Laboratory, Genetics and Computational Biology Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia
| | - Giorgio Trinchieri
- Cancer and Inflammation Program, Center for Cancer Research, NCI, NIH, Bethesda, MD 20892, USA
| | - Robert Zeiser
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Albert Ludwigs University Freiburg, Freiburg 79106, Germany
| | | | - Mariapia A Degli-Esposti
- Immunology and Virology Program, Centre for Ophthalmology and Visual Science, The University of Western Australia, Crawley, WA 6009, Australia; Centre for Experimental Immunology, Lions Eye Institute, Nedlands, WA 6009, Australia; Infection and Immunity Program and Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC 3800, Australia
| | - Geoffrey R Hill
- Bone Marrow Transplantation Laboratory, Immunology Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia; Department of Haematology and Bone Marrow Transplantation, Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; Division of Medical Oncology, University of Washington, Seattle, WA 98109, USA.
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Kinouchi M, Iwasaki T, Koyama M, Obata M, Homma M. Image Gallery: Cutaneous hydrophilic polymer emboli following thoracic endovascular aortic repair. Br J Dermatol 2019; 180:e182. [DOI: 10.1111/bjd.17758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M. Kinouchi
- Department of Dermatology Asahikawa Red Cross Hospital AsahikawaJapan
| | - T. Iwasaki
- Department of Dermatology Asahikawa Medical University Asahikawa Japan
| | - M. Koyama
- Department of Cardiovascular Surgery Asahikawa Red Cross Hospital AsahikawaJapan
| | - M. Obata
- Department of Diagnostic Pathology Asahikawa Red Cross Hospital Asahikawa Japan
| | - M. Homma
- Department of Dermatology Asahikawa Medical University Asahikawa Japan
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43
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Koyama M, Mukhopadhyay P, Schuster IS, Henden AS, Hülsdünker J, Varelias A, Vetizou M, Kuns RD, Robb RJ, Zhang P, Blazar BR, Thomas R, Begun J, Waddell N, Trinchieri G, Zeiser R, Clouston AD, Degli-Esposti MA, Hill GR. Immune responses to the microbiome tune MHC class II antigen presentation by the intestinal epithelium to control gut pathology. The Journal of Immunology 2019. [DOI: 10.4049/jimmunol.202.supp.69.38] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
The factors initiating pathology in the gastrointestinal (GI) tract are largely unknown. Graft-versus-host disease (GVHD) of the gastrointestinal (GI) tract is the principal determinant of lethality following allogeneic bone marrow transplantation (BMT). MHC class II-dependent GVHD is initiated by recipient alloantigens being presented to donor T cells that in turn undergo Th1 and Th17 differentiation to mediate pathology in the GI tract. Critically, the mechanisms that initiate disease, especially the relevant antigen presenting cells, remain unclear. Here, we identify the response of IL-12-secreting macrophages to the microbiome as the key driver of IFNγ secretion by mucosal type-1 innate lymphoid cells (ILC1). The latter controls MHC class II expression and antigen presentation by intestinal epithelial cells (IEC) specifically within the ileum. When these tightly regulated responses between microbiome and lamina propria lymphocytes are perturbed by inflammatory signals driven by pre-transplant conditioning, dramatic increases in antigen presentation by IEC occur in the ileum and lethal GVHD ensues. Conditional and Villin-specific deletion of MHC class II in IEC, or inhibition of IL-12 pre-transplant, completely prevent the initiation of lethal GVHD, identifying a readily translatable therapeutic strategy.
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Affiliation(s)
- Motoko Koyama
- 1Fred Hutchinson Cancer Res. Ctr
- 2QIMR Berghofer Med. Res. Inst., Australia
| | | | - Iona S Schuster
- 3Monash University, Australia, Australia
- 4University of Western Australia, Australia
- 5Lions Eye Inst., Australia
| | - Andrea S Henden
- 2QIMR Berghofer Med. Res. Inst., Australia
- 6Royal Brisbane and Women’s Hospital, Australia
| | - Jan Hülsdünker
- 7Freiburg University Medical Cente, Germany
- 8University Freiburg, Germany
| | | | | | | | | | - Ping Zhang
- 2QIMR Berghofer Med. Res. Inst., Australia
| | | | - Ranjeny Thomas
- 11School of Medicine, University of Queensland, Australia
| | - Jakob Begun
- 11School of Medicine, University of Queensland, Australia
| | | | | | | | | | - Mariapia A Degli-Esposti
- 3Monash University, Australia, Australia
- 4University of Western Australia, Australia
- 5Lions Eye Inst., Australia
| | - Geoffrey R. Hill
- 1Fred Hutchinson Cancer Res. Ctr
- 2QIMR Berghofer Med. Res. Inst., Australia
- 13University of Washington
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44
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Jigami H, Koyama M, Kato T, Wada T, Tamaki T, Ohuchi H, Kaneoka K. Relationship between ultrasound and manual evaluation findings and muscle strength of Masters swimmers’ shoulder. J Sci Med Sport 2018. [DOI: 10.1016/j.jsams.2018.09.216] [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: 10/28/2022]
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45
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Koyama M, Furuhashi M, Nagano N, Fujita Y, Moniwa N, Yano T, Doi T, Takahashi T, Ohnishi H, Miura T. P3508Cardiac iodine-123 metaiodobenzylguanidine imaging predicts frequent hypotension during hemodialysis in patients with end-stage renal disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3508] [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] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Koyama
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - M Furuhashi
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - N Nagano
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - Y Fujita
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - N Moniwa
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - T Yano
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - T Doi
- Teine Keijinkai Hospital, Division of Cardiology, Cardiovascular center, Sapporo, Japan
| | - T Takahashi
- Obihiro Kosei Hospital, Department of Cardiovascular Internal Medicine, Obihiro, Japan
| | - H Ohnishi
- Sapporo Medical University, Department of Public Health, Sapporo, Japan
| | - T Miura
- Sapporo Medical University, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
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46
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Varelias A, Bunting M, Ormerod K, Koyama M, Olver S, Straube J, Kuns R, Robb R, Henden A, Cooper L, Lachner N, Gartlan K, Lantz OJ, Kjer-Nielsen L, Mak J, Fairlie D, Clouston A, McCluskey J, Rossjohn J, Lane S, Hugenholtz P, Hill G. Recipient mucosal-associated invariant T cells control graft-versus-host-disease within the colon. The Journal of Immunology 2018. [DOI: 10.4049/jimmunol.200.supp.55.15] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Mucosal-associated invariant T (MAIT) cells are a unique innate-like T-cell subset that responds to a wide array of bacteria and yeast through recognition of riboflavin metabolites presented by the MHC I-like molecule, MR1. Here we demonstrate using MR1 tetramers that recipient MAIT cells are present in small but definable numbers in graft-versus-host disease (GVHD) target organs and protect from acute GVHD in the colon following bone marrow transplantation (BMT). Consistent with their preferential juxtaposition to microbial signals in the colon, recipient MAIT cells generate large amounts of IL-17A, promote gastrointestinal tract integrity, and limit the donor alloantigen presentation that in turn drives donor Th1 and Th17 expansion specifically in the colon after BMT. Allogeneic BMT recipients deficient in IL-17A also develop accelerated GVHD, suggesting MAIT cells regulate GVHD, at least in part, by the generation of this cytokine. Indeed, analysis of stool microbiota and colon tissue from IL-17A−/− and MR1−/− mice identified analogous shifts in microbiome operational taxonomic units (OTU) and mediators of barrier integrity which represent pathways controlled by similar, IL-17A-dependent mechanisms. Thus, MAIT cells act to control intestinal microbiota and barrier function to attenuate pathogenic T-cell responses in the colon, and given their very high frequency in humans, likely represent an important population in clinical BMT.
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Affiliation(s)
| | | | - Kate Ormerod
- 2Australian Centre for Ecogenomics, The University of Queensland, Australia
| | | | | | | | | | - Renee Robb
- 1QIMR Berghofer Med. Res. Inst., Australia
| | - Andrea Henden
- 1QIMR Berghofer Med. Res. Inst., Australia
- 3The Royal Brisbane and Women’s Hospital, Australia
| | | | - Nancy Lachner
- 2Australian Centre for Ecogenomics, The University of Queensland, Australia
| | | | | | | | - Jeffrey Mak
- 6Institute for Molecular Bioscience, The University of Queensland, Australia
| | - David Fairlie
- 6Institute for Molecular Bioscience, The University of Queensland, Australia
| | | | | | | | - Steven Lane
- 1QIMR Berghofer Med. Res. Inst., Australia
- 3The Royal Brisbane and Women’s Hospital, Australia
| | - Phil Hugenholtz
- 2Australian Centre for Ecogenomics, The University of Queensland, Australia
| | - Geoff Hill
- 1QIMR Berghofer Med. Res. Inst., Australia
- 3The Royal Brisbane and Women’s Hospital, Australia
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47
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Varelias A, Bunting MD, Ormerod KL, Koyama M, Olver SD, Straube J, Kuns RD, Robb RJ, Henden AS, Cooper L, Lachner N, Gartlan KH, Lantz O, Kjer-Nielsen L, Mak JY, Fairlie DP, Clouston AD, McCluskey J, Rossjohn J, Lane SW, Hugenholtz P, Hill GR. Recipient mucosal-associated invariant T cells control GVHD within the colon. J Clin Invest 2018; 128:1919-1936. [PMID: 29629900 DOI: 10.1172/jci91646] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/16/2018] [Indexed: 12/11/2022] Open
Abstract
Mucosal-associated invariant T (MAIT) cells are a unique innate-like T cell subset that responds to a wide array of bacteria and yeast through recognition of riboflavin metabolites presented by the MHC class I-like molecule MR1. Here, we demonstrate using MR1 tetramers that recipient MAIT cells are present in small but definable numbers in graft-versus-host disease (GVHD) target organs and protect from acute GVHD in the colon following bone marrow transplantation (BMT). Consistent with their preferential juxtaposition to microbial signals in the colon, recipient MAIT cells generate large amounts of IL-17A, promote gastrointestinal tract integrity, and limit the donor alloantigen presentation that in turn drives donor Th1 and Th17 expansion specifically in the colon after BMT. Allogeneic BMT recipients deficient in IL-17A also develop accelerated GVHD, suggesting MAIT cells likely regulate GVHD, at least in part, by the generation of this cytokine. Indeed, analysis of stool microbiota and colon tissue from IL-17A-/- and MR1-/- mice identified analogous shifts in microbiome operational taxonomic units (OTU) and mediators of barrier integrity that appear to represent pathways controlled by similar, IL-17A-dependent mechanisms. Thus, MAIT cells act to control barrier function to attenuate pathogenic T cell responses in the colon and, given their very high frequency in humans, likely represent an important population in clinical BMT.
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Affiliation(s)
- Antiopi Varelias
- Bone Marrow Transplantation Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Faculty of Medicine, and
| | - Mark D Bunting
- Bone Marrow Transplantation Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Kate L Ormerod
- Australian Centre for Ecogenomics, The University of Queensland, Brisbane, Australia
| | - Motoko Koyama
- Bone Marrow Transplantation Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Stuart D Olver
- Bone Marrow Transplantation Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Jasmin Straube
- Gordon and Jessie Gilmour Leukaemia Research Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Rachel D Kuns
- Bone Marrow Transplantation Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Renee J Robb
- Bone Marrow Transplantation Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Andrea S Henden
- Bone Marrow Transplantation Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,The Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Leanne Cooper
- Gordon and Jessie Gilmour Leukaemia Research Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Nancy Lachner
- Australian Centre for Ecogenomics, The University of Queensland, Brisbane, Australia
| | - Kate H Gartlan
- Bone Marrow Transplantation Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Faculty of Medicine, and
| | - Olivier Lantz
- INSERM U932 and Department de Biologie des Tumeurs, Institute Curie and Centre d'Investigation Clinique, CICBT507 IGR/Curie, Paris, France
| | - Lars Kjer-Nielsen
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, Australia
| | - Jeffrey Yw Mak
- Australian Research Council Centre of Excellence in Advanced Molecular Imaging, Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | - David P Fairlie
- Australian Research Council Centre of Excellence in Advanced Molecular Imaging, Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | | | - James McCluskey
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, Australia
| | - Jamie Rossjohn
- Infection and Immunity Program and The Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute Monash University, Clayton, Australia.,Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom.,Australian Research Council Centre of Excellence in Advanced Molecular Imaging, Monash University, Clayton, Australia
| | - Steven W Lane
- Faculty of Medicine, and.,Gordon and Jessie Gilmour Leukaemia Research Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,The Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Philip Hugenholtz
- Australian Centre for Ecogenomics, The University of Queensland, Brisbane, Australia
| | - Geoffrey R Hill
- Bone Marrow Transplantation Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Faculty of Medicine, and.,The Royal Brisbane and Women's Hospital, Brisbane, Australia
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48
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Markey KA, Kuns RD, Browne DJ, Gartlan KH, Robb RJ, Martins JP, Henden AS, Minnie SA, Cheong M, Koyama M, Smyth MJ, Steptoe RJ, Belz GT, Brocker T, Degli-Esposti MA, Lane SW, Hill GR. Flt-3L Expansion of Recipient CD8α + Dendritic Cells Deletes Alloreactive Donor T Cells and Represents an Alternative to Posttransplant Cyclophosphamide for the Prevention of GVHD. Clin Cancer Res 2018; 24:1604-1616. [PMID: 29367429 DOI: 10.1158/1078-0432.ccr-17-2148] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 11/01/2017] [Accepted: 01/08/2018] [Indexed: 11/16/2022]
Abstract
Purpose: Allogeneic bone marrow transplantation (BMT) provides curative therapy for leukemia via immunologic graft-versus-leukemia (GVL) effects. In practice, this must be balanced against life threatening pathology induced by graft-versus-host disease (GVHD). Recipient dendritic cells (DC) are thought to be important in the induction of GVL and GVHD.Experimental Design: We have utilized preclinical models of allogeneic BMT to dissect the role and modulation of recipient DCs in controlling donor T-cell-mediated GVHD and GVL.Results: We demonstrate that recipient CD8α+ DCs promote activation-induced clonal deletion of allospecific donor T cells after BMT. We compared pretransplant fms-like tyrosine kinase-3 ligand (Flt-3L) treatment to the current clinical strategy of posttransplant cyclophosphamide (PT-Cy) therapy. Our results demonstrate superior protection from GVHD with the immunomodulatory Flt-3L approach, and similar attenuation of GVL responses with both strategies. Strikingly, Flt-3L treatment permitted maintenance of the donor polyclonal T-cell pool, where PT-Cy did not.Conclusions: These data highlight pre-transplant Flt-3L therapy as a potent new therapeutic strategy to delete alloreactive T cells and prevent GVHD, which appears particularly well suited to haploidentical BMT where the control of infection and the prevention of GVHD are paramount. Clin Cancer Res; 24(7); 1604-16. ©2018 AACR.
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Affiliation(s)
- Kate A Markey
- QIMR Berghofer Medical Research Institute, Brisbane, Australia. .,Royal Brisbane and Women's Hospital, Brisbane, Australia.,School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Rachel D Kuns
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Daniel J Browne
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Kate H Gartlan
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Renee J Robb
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - J Paulo Martins
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Andrea S Henden
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Royal Brisbane and Women's Hospital, Brisbane, Australia.,School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Simone A Minnie
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Melody Cheong
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Motoko Koyama
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Mark J Smyth
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Raymond J Steptoe
- University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia
| | - Gabrielle T Belz
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Thomas Brocker
- Institute for Immunology, Ludwig-Maximilians Universitat, Munich, Germany
| | - Mariapia A Degli-Esposti
- Centre for Experimental Immunology, Lions Eye Institute, Nedlands, Western Australia.,Immunology and Virology Program, Centre for Ophthalmology and Visual Science, University of Western Australia, Crawley, Western Australia
| | - Steven W Lane
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Royal Brisbane and Women's Hospital, Brisbane, Australia.,School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Geoffrey R Hill
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Royal Brisbane and Women's Hospital, Brisbane, Australia
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49
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Jigami H, Wada T, Matsumoto T, Koyama M, Kato T, Ohuchi H, Kaneoka K. Characteristics of Masters swimmer's rotator cuff. J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2017.09.192] [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: 10/18/2022]
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50
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Kanazawa M, Miura M, Toriyabe M, Koyama M, Hatakeyama M, Ishikawa M, Nakajima T, Onodera O, Nishizawa M, Shimohata T. Preconditioned protective microglia by oxygen-glucose deprivation promote functional recovery in ischemic rats. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.3694] [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: 11/25/2022]
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