Politics of COVID-19 vaccination in Japan: how governing incumbents' representation affected regional rollout variation

BACKGROUND

Despite initial delay, Japan's COVID-19 vaccination accelerated remarkably from May to September 2021 under the leadership of Prime Minister Yoshihide Suga. His "campaign" for vaccination, however, did not yield uniform results nationwide.

METHODS

To highlight political determinants for the regional variation, we employ ordinary least squares regression analyses to investigate how the share/presence of incumbent politicians belonging to the governing parties, the Liberal Democratic Party and Komei Party, influenced the varying progress of rollouts across prefectures as well as across cities/towns/villages. The data on the vaccination rate for all 47 prefectures was obtained from Government Chief Information Officer (CIO)'s Portal, Japan (GCPJ) approximately one month prior to the anticipated general election, the national election for the more important House of Representatives of Japan's bicameral parliament (Diet). The data for lower administrative units, though its availability was limited to only three prefectures, was obtained from the respective governments of Kagawa and Ehime and from a local newspaper in Gifu.

RESULTS

The findings reveal that at both prefectural and sub-prefectural administrative levels, the share/presence of the governing parties' representation in the national parliament had a positive and statistically significant effect on the region's vaccination progress, after controlling for the local proliferation of COVID-19 and demographic characteristics.

CONCLUSION

Our findings contribute insights into the understudied area of the contemporary COVID-19 health environment, namely how the political dynamics of democracy affect the pattern of vaccine dissemination in Japan.

TRIAL REGISTRATION

Not applicable.

POS0875 LATENT TRAJECTORY MODELING OF PULMONARY ARTERY PRESSURE IN SYSTEMIC SCLEROSIS: A RETROSPECTIVE COHORT STUDY

Background

Systemic sclerosis (SSc) is an autoimmune disease that is characterized by systemic vasculopathy and fibrosis. Pulmonary hypertension (PH), defined as elevated pulmonary arterial pressure (PAP), is one of the leading causes of death of SSc1. In recent years, various therapies have been developed to target each of the pathogenesis of SSc – autoimmunity, vasculopathy, and fibrosis. Accordingly, treatment strategies based on risk stratification for PH progression are aspired; however, prediction of changes in PAP in diverse patients with SSc has not been established2.

Objectives

To visualize the patterns of PAP elevation in SSc and to identify the clinical characteristics of each trajectory, by applying latent trajectory modeling for PAP measured repeatedly by echocardiography.

Methods

This was a multicenter, retrospective cohort study conducted at four referral hospitals in Kyoto, Japan. Patients with SSc who visited the study site between April 2008 and March 2021 and had at least three echocardiographic measurements of systolic pulmonary arterial pressure (sPAP) were included in this study. Follow-up concluded in March 2021. A group-based trajectory model3 was applied to the change in sPAP over time, and individual patients were classified into distinct subgroups that followed similar trajectories. The number and shape of the trajectories were estimated based on adequacy, goodness of fit, parsimony, and interpretability of the model. Clinical plausibility was assessed by comparing PH-free survival, i.e., time to either PH or death, for each trajectory. Multinomial logistic regression analysis was performed for baseline clinical characteristics associated with trajectory assignment.

Results

A total of 236 patients with a total of 1097 sPAP measurements were included. We identified five trajectories following the quadratic function as “rapid progression (n=9, 3.8%)”, “early elevation (n=30, 12.7%)”, “mid elevation (n=54, 22.9%)”, “late elevation (n=24, 10.2%)”, and “low stable (n=119, 50.4%)”. Each trajectory, in this order, showed earlier elevation of sPAP and shorter PH-free survival (Figure 1). In the multinomial logistic regression (with the “low stable” as reference), cardiac involvement was associated with the “rapid progression” (adjusted odds ratio [OR] 28.9, 95% confidence interval [CI] 3.21–259.5), diffuse cutaneous SSc was associated with the “early elevation” (OR 4.08, 95% CI 1.27–13.1), anti-centromere antibody positive was associated with the “mid elevation” (OR 4.50, 95% CI 1.11–18.2), and older age of onset was associated with the above three trajectories.

Conclusion

The pattern of changes in pulmonary artery pressure over time in SSc can be classified into five distinct trajectories. Each trajectory differed in baseline clinical characteristics and outcomes.

References

[1]Pokeerbux MR, et al. Survival and prognosis factors in systemic sclerosis: data of a French multicenter cohort, systematic review, and meta-analysis of the literature. Arthritis Res Ther. 2019;21(1):86.

[2]Denton CP, et al. Systemic sclerosis. Lancet. 2017;390(10103):1685-1699.

[3]Nagin DS, et al. Group-based trajectory modeling in clinical research. Annu Rev Clin Psychol. 2010;6:109-38.

Disclosure of Interests

None declared

A Case of Primary Small Cell Carcinoma of the Cervical Esophagus with Long-term Survival following Concurrent Chemoradiotherapy: Case Report and Review of the Literature

The authors describe a case of small cell carcinoma of the esophagus that was treated by concurrent chemoradiotherapy. Both the esophageal tumor and the regional lymph node metastases disappeared after this treatment. The patient is alive and disease free after more than five years.

Primary small cell carcinoma of the esophagus is a rare and aggressive neoplasm with a very poor prognosis, and the treatment modality is controversial. This case illustrates the possibility of treating this tumor type with concurrent chemoradiotherapy.

Changes of superoxide dismutase activity and ascorbic acid in focal cerebral ischaemia in rats

Free radical reactions are supposed to cause ischaemic brain damage, and active oxygens can initiate these chains reaction. If active oxygens play important roles in ischaemic brain damage, the activity of superoxide dismutase, scavenger of superoxide anion, is supposed to decrease in ischaemic brain. The reduced form of ascorbic acid also scavenges superoxide anion. In rat middle cerebral artery focal ischaemia, we investigated the changes in superoxide dismutase activity and the concentration of reduced ascorbate up to 48 hours. Middle cerebral artery territory of each cerebral hemisphere was homogenized. The supernatant was divided into two aliquots; one was dialysed to remove ascorbate and the other was not. The enzyme activity of the dialysed specimen from the ischaemic hemisphere did not decrease within 4 h after the arterial occlusion. The activity of the dialysed specimen from the nonischaemic side remained unchanged during the examination. Reduced ascorbate levels in nondialysed samples showed similar changes to the superoxide dismutase activities in the dialysed samples. Our data suggest that ascorbic acid may exert the enzyme activity and that the enzyme activity remains at the normal level in the early phase of ischaemia despite the irreversible ischaemic changes that take place within 4 h after the onset of ischaemia.

Twenty-year trends in neonatal surgery based on a nationwide Japanese surveillance program

AIM

To discuss the chronological changes observed in a national survey of neonatal surgery in Japan performed every 5 years by the Committee in the Japanese Society of Pediatric Surgeons.

METHODS

We analyzed the data obtained for 20 years from 1993 to 2013 and herein report the chronological changes.

RESULTS

The number of summarized cases was least in 1993, with 2806 cases, and subsequently increased to 3753 cases in 2013. The mortality rate among the patients with maternal transport linearly decreased (p = 0.0386). Although the proportion of extremely low birth weight infants linearly increased (p = 0.0014), with an annual rate of +0.39 %, the mortality rate linearly decreased (p = 0.0010), with an annual rate of -1.68 %. Moreover, the overall mortality rate linearly decreased (p = 0.0002), with an annual rate of -0.26 %. Most diseases were observed to exhibit a decline in the mortality rate with the same trend as overall mortality. The decline in the mortality rate was most robust with respect to congenital diaphragmatic hernia (CDH). The mortality rates, except for that of CDH, omphalocele, esophageal atresia, and intestinal perforation, declined to 5 % or lower by 2013.

CONCLUSIONS

The present findings may be the result of remarkable progress in perinatal management.

Periostin levels correlate with disease severity and chronicity in patients with atopic dermatitis

BACKGROUND

Recent findings indicate that periostin, an extracellular matrix protein induced by T helper 2 cytokines, plays a critical role in the pathogenesis of atopic dermatitis (AD).

OBJECTIVES

To determine whether serum periostin level is associated with clinical phenotype in adult patients with AD.

METHODS

An enzyme-linked immunosorbent assay was performed to determine serum periostin levels in 257 adult patients with AD, 66 patients with psoriasis vulgaris (PV) as a disease control and 25 healthy controls. Serum periostin levels were analysed together with clinical characteristics and laboratory parameters, including thymus and activation-regulated chemokine (TARC), lactate dehydrogenase (LDH), blood eosinophil count and total IgE. Immunohistochemical analysis evaluated the expression of periostin in association with various clinical phenotypes of AD. The effect of treatment on serum periostin level was also assessed.

RESULTS

Serum periostin was significantly higher in patients with AD than in patients with PV and healthy controls. Periostin level was found to be positively correlated with disease severity, TARC level, LDH level and eosinophil count, but not with IgE level. Higher serum periostin level was observed in patients with extrinsic AD compared with patients with intrinsic AD; the positive correlation of disease severity disappeared in patients with intrinsic AD. Robust expression of periostin was detected in the dermis of patients with AD with erythroderma, lichenification and, to a lesser extent, scaly erythema. Serial measurement of serum periostin revealed decreased levels of periostin after treatment for AD.

CONCLUSIONS

Periostin may play a critical role in disease severity and chronicity in the pathogenesis of AD.

Cloning and Sequence Analysis of cDNA encodingRhizopus niveusLipase

Complementary DNA encoding Rhizopus niveus lipase (RNL) was isolated from the R. niveus IF04759 cDNA library using a synthetic oligonucleotide corresponding to the amino acid sequence of the enzyme. A clone, which had an insert of 1.0 kilobase pairs, was found to contain the coding region of the enzyme. The lipase gene was expressed in Escherichia coli as a lacZ fusion protein. The mature RNL consisted of 297 amino acid residues with a molecular mass of 32 kDa. The RNL sequence showed significant overall homology to Rhizomucor miehei lipase and the putative active site residues were strictly conserved.

ACTH expression in synovium of patients with rheumatoid arthritis and Lewis rats with adjuvant arthritis

Abstract Adrenocorticotropic hormone (ACTH) and another pro-opiomelanocortin-derived neuropeptide, β-endorphin (β-End), are stimulated by corticotropin-releasing hormone (CRH) at the anterior pituitary. CRH and β-End have predominantly proinflammatory effects in peripheral inflammatory sites. We have supposed that inflammatory stimuli develop ACTH as well as β-End. In this study, we investigated the expression of ACTH in inflamed synovial tissue from patients with rheumatoid arthritis (RA) and osteoarthritis (OA), and at inflammatory joints with adjuvant-induced arthritis (AA) in female Lewis (LEW/N) rats. The expression of ACTH immunostaining was significantly greater in synovium of RA patients than in that of OA patients (P < 0.0001), and correlated with the extent of inflammatory mononuclear cell infiltration. Extensive and intense intracellular ACTH immunostaining, which correlated with the advance in arthritis score, was observed in the synovial lining layer, inflammatory mononuclear cells, and fibroblast-like cells of synovium and chondrocytes in LEW/N rats with AA. In addition, we performed double immunostaining of the same sections from arthritic joints in rats with anti-ACTH and anti-CRH antibodies. ACTH and CRH colocalized in inflammatory mononuclear cells and fibroblast-like cells. ACTH may play a role in the pathogenesis of RA as well as CRH.

Intratumoral gene expression of 5-fluorouracil pharmacokinetics related enzymes in stage I and II non-small cell lung cancer patients treated with uracil-tegaful after surgery

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Background: It is believed through meta-analysis that the adjuvant chemotherapy with oral administration of uracil-tegafur combination drug (manufactured as UFT) yielded better survival than surgery alone in early stage non-small cell lung cancer patients (NSCLC) in Japan. However, no promising bio-marker, which can predict the benefit of UFT use in NSCLC patients, has been found. This clinical trial was designed to evaluate the relationship between the intratumoral gene expression of the five-fluorouracil pharmacokinetics related enzymes such as thymidylate synthase (TS), dihydropyrimidine dehydrogenase (DPD), orate phosphoribosyltransferase (OPRT) and thymidine phosphorylase (TP), and clinical outcomes in patients to whom UFT was administered for 2 years after surgery. Methods: From June 2004 to September 2007, 236 NSCLC patients who underwent complete resection of a pathological stage IA (maximum diameter of 2cm or more), IB and II (according to the 1997 UICC TNM classification) were eligible in this study. Other inclusion criteria were age of 20 to 80 years, ECOG PS of 0 or 1 and feasible oral UFT administration within 8 weeks after surgery. Total RNA was extracted from formalin-fixed lung cancer cell sample obtained with micro-dissection method. Gene expression was examined using quantified fluorescence-based real time revers transcription-polymerase chain reaction assay. Results: 131 (63%) patients completed 2 year administration of UFT. 73 (31%) patients had recurrence during 5 years follow-up and 48 (73%) patients among them were treated with chemotherapy including platinum. The 5-year disease free survival (DFS) and overall survival (OS) rates in all patients were 66.7% and 83.7%, respectively. A cox multivariate analysis revealed pathological stage (HR: 0.4463; p=0.034), TS expression status (HR: 0.469; p=0.021) and DPD expression status (HR: 1.956; p=0.048) to be prognostic for DFS but no factors to be prognostic for OS. Conclusions: This study suggested that TS and DPD mRNA expression in the tumor were possible prognostic biomarkers for postoperative adjuvant chemotherapy with UFT in stage I-II NSCLC. Clinical trial information: 15-65-1.

Kosterlitz-Thouless-type transition in a charge ordered state of the layered organic conductor α-(BEDT-TTF)2I3

The current-voltage characteristics in the charge order state of the two-dimensional organic conductor α-(BEDT-TTF)(2)I(3) exhibit power law behavior at low temperatures. The power law is understood in terms of the electric-field-dependent potential between electrons and holes, which are thermally excited from the charge order state. The power law exponent steeply changes from 1 to 3 in the range from 30 to 45 K with decreasing temperature, thereby suggesting the occurrence of a Kosterlitz-Thouless-type transition; many (few) unbound electron-hole pairs are thermally excited above (below) the transition. The effects of the finite size and interlayer coupling on the power law behavior are discussed.

Early treatment with olmesartan prevents juxtamedullary glomerular podocyte injury and the onset of microalbuminuria in type 2 diabetic rats

BACKGROUND

Studies were performed to determine if early treatment with an angiotensin II (Ang II) receptor blocker (ARB), olmesartan, prevents the onset of microalbuminuria by attenuating glomerular podocyte injury in Otsuka Long-Evans Tokushima Fatty (OLETF) rats with type 2 diabetes mellitus.

METHODS

OLETF rats were treated with either a vehicle, olmesartan (10 mg/kg/day) or a combination of nonspecific vasodilators (hydralazine 15 mg/kg/day, hydrochlorothiazide 6 mg/kg/day, and reserpine 0.3 mg/kg/day; HHR) from the age of 7-25 weeks.

RESULTS

OLETF rats were hypertensive and had microalbuminuria from 9 weeks of age. At 15 weeks, OLETF rats had higher Ang II levels in the kidney, larger glomerular desmin-staining areas (an index of podocyte injury), and lower gene expression of nephrin in juxtamedullary glomeruli, than nondiabetic Long-Evans Tokushima Otsuka (LETO) rats. At 25 weeks, OLETF rats showed overt albuminuria, and higher levels of Ang II in the kidney and larger glomerular desmin-staining areas in superficial and juxtamedullary glomeruli compared to LETO rats. Reductions in mRNA levels of nephrin were also observed in superficial and juxtamedullary glomeruli. Although olmesartan did not affect glucose metabolism, it decreased blood pressure and prevented the renal changes in OLETF rats. HHR treatment also reduced blood pressure, but did not affect the renal parameters.

CONCLUSIONS

This study demonstrated that podocyte injury occurs in juxtamedullary glomeruli prior to superficial glomeruli in type 2 diabetic rats with microalbuminuria. Early treatment with an ARB may prevent the onset of albuminuria through its protective effects on juxtamedullary glomerular podocytes.

Cross-linked poly(gamma-glutamic acid) attenuates pleural and chest wall adhesions in a mouse thoracotomy model

BACKGROUND

Cross-linked poly(gamma-glutamic acid) (XL) is derived from a naturally occurring biodegradable polymer produced by Bacillus subtilis. In the present study, we compared the efficacy of XL in preventing adhesion formation after thoracotomy in mice with Seprafilm (SEP), which is currently the most commonly applied adhesion prevention material.

METHODS

Left thoracotomy was done. Adhesion between the lung and the thoracotomy site (Lu groups), or between the thoracotomy site and the overlying chest muscles (Mu groups), was evaluated in separate groups of animals. In the Lu-XL group (n = 12) and the Mu-XL group (n = 12), approximately 20 mg of XL was applied as powder. In the Lu-SEP group (n = 12) and Mu-SEP group (n = 12), a 5 × 3 mm SEP sheet was applied. Nothing was applied in the Lu-NON group (n = 12) and the Mu-NON group (n = 12). After 7 and 14 days, the respective adhesions were scored and compared.

RESULTS

The adhesion score was significantly lower in the Lu-XL group (0.5 ± 0.9) in comparison to the Lu-NON group (3.8 ± 0.5) and the Lu-SEP group (2.2 ± 0.8; p < 0.002), and in the Mu-XL group (0.8 ± 0.7) in comparison to the Mu-NON group (3.8 ± 0.4) and the Mu-SEP group (2.5 ± 0.8; p < 0.001). These differences were similar also at 14 days.

CONCLUSION

It was suggested that the antiadhesive effect of XL was superior to SEP in this particular model of thoracotomy in mice.

Association between Cardiac Function and Pulmonary Function in Hypertensive Patients

OBJECTIVE: This study examined the association between cardiac function and pulmonary function in hypertensive patients. METHODS: Hypertensive patients without overt cardiovascular disease were enrolled ( n = 43; mean ± SD age 71 ± 9 years). Pulmonary function was measured by the percentage of predicted forced vital capacity (%FVC) and the ratio of 1 s forced expiratory volume (FEV1) to FVC (FEV1/FVC ratio). Left ventricular ejection fraction (LVEF) and the ratio of peak early diastolic transmitral flow (E) to peak early diastolic mitral annular velocity (e′) (E/e′ ratio) were assessed using echocardiography. RESULTS: Multiple linear regression analysis revealed that E/e′ was independently associated with %FVC and that LVEF was independently associated with FEV1/FVC ratio. Both LVEF and FEV1/FVC ratio were significantly lower in hypertensive former or current smokers than in hypertensive never smokers. CONCLUSIONS: Subclinical cardiac dysfunction was independently associated with reduced pulmonary function in hypertensive patients. Hypertensive patients with decreased pulmonary function may need preventive care to prevent the progression of heart failure.

Aortic root dilatation as a marker of subclinical left ventricular diastolic dysfunction in patients with cardiovascular risk factors

Consensus is lacking about the clinical importance of aortic root dilatation in assessment of the risk of cardiovascular disease. In this study, correlations between aortic root diameter and echocardiographic features of left ventricular (LV) diastolic function were investigated in 333 patients with at least one cardiovascular risk factor (hypertension, diabetes or dyslipidaemia) and preserved LV systolic function. Aortic root diameter was measured by M-mode echocardiography, and LV diastolic function was evaluated by measuring the peak velocity of early (E) and late (A) diastolic transmitral blood flow and peak early diastolic mitral annular velocity (E') by Doppler echocardiography. Linear regression analysis showed that, in men, age was not related to aortic root diameter but hypertension and LV hypertrophy were, whereas the converse was true in women. The parameters E, E/A ratio and E', were related to aortic root diameter in both sexes. Stepwise multiple regression analysis confirmed that E in women and E' in men were independently associated with aortic root diameter. It is concluded that aortic root dilatation might be a useful marker of subclinical LV diastolic dysfunction. Patients with preserved systolic function showing aortic root dilatation should, therefore, be given preventative therapy against LV diastolic heart failure.

Differences in Left Ventricular Diastolic Dysfunction between Eccentric and Concentric Left Ventricular Hypertrophy in Hypertensive Patients with Preserved Systolic Function

Left ventricular (LV) hypertrophy (LVH) may be eccentric or concentric (2 × LV posterior wall thickness relative to LV end-diastolic dimension ≤ 0.42 or > 0.42, respectively). The LV diastolic function between age-matched hypertensive patients with eccentric and concentric LVH was compared in the present study. Echocardiography was used to measure LV mass index (LV mass/body surface area; LVMI) as an index of LVH. LV diastolic function was assessed by measurements of peak early transmitral flow velocity ( E)/peak late transmitral flow velocity ( A) (the E/A ratio), peak early diastolic mitral annular velocity ( e′) and the E/e′ ratio. Although LVMI, E/A and e′ did not differ between the two groups, E/e′ was significantly higher (worse) in patients with concentric LVH (13.4 ± 5.4) than in those with eccentric LVH (11.1 ± 3.6). Among hypertensive patients with LVH, those with concentric LVH may, therefore, have more severe LV diastolic dysfunction than those with eccentric LVH even if their LVMIs, which reflect the degree of LVH, are similar.

Sentinel node microscopic metastasis detected after segmentectomy for lung cancer followed by completion lobectomy: two case reports

We performed sentinel node identification using radioisotopic and/or dye techniques to determine the final indication after segmentectomy in cases with non-small cell lung cancer. Sentinel nodes were examined using intraoperative frozen sections stained with hematoxylin and eosin. We present 2 cases with completion lobectomy performed 7 and 11 days after segmentectomy because immunohistochemical staining of the sentinel nodes showed the presence of microscopic metastases that were not detected by the examination of intraoperative frozen sections.

Mitigation of occult lung injury by pneumonectomy via minithoracotomy in mice

BACKGROUND

The systemic and pulmonary inflammatory response associated with pneumonectomy performed via minithoracotomy versus that after open posterolateral thoracotomy is uncertain.

METHODS

Groups consisting of 7 randomly assigned mice underwent a) minithoracotomy (with 5-mm long incisions and sparing of the muscles) alone, b) posterolateral thoracotomy (with 20-mm long incisions) alone, c) pneumonectomy via minithoracotomy, or d) pneumonectomy via posterolateral thoracotomy. The animals' daily food intake, body weight changes and spontaneous activity were monitored for 10 days, and lung water accumulation and vascular hyperpermeability in the remaining right lung were measured at 24 h after surgery. Concentrations of high mobility group box 1 protein (HMGB1), a mediator of inflammation and shock, were measured in the bronchoalveolar lavage fluid.

RESULTS

Compared with posterolateral thoracotomy, pneumonectomy via minithoracotomy was associated with significantly less weight loss (p < 0.05), despite a similar daily food intake among the groups. Spontaneous activity after pneumonectomy via minithoracotomy returned earlier than after posterolateral thoracotomy. Pulmonary vascular hyperpermeability and water retention in the residual lung were significantly less prominent after pneumonectomy performed via minithoracotomy than after pneumonectomy via posterolateral thoracotomy (both comparisons p < 0.05). HMGB1 concentrations in the bronchoalveolar lavage fluid collected from the residual lung were significantly lower (p < 0.05) after minithoracotomy than after posterolateral thoracotomy.

CONCLUSIONS

Based on postoperative weight loss, spontaneous activity, and the degree of pulmonary capillary injury in the residual lung, pneumonectomy via minithoracotomy was less invasive than posterolateral thoracotomy. The lower increase in HMGB1 associated with minithoracotomy might result in lower pulmonary vascular hyperpermeability and reflect less surgical invasiveness.

Blockade of AT1 receptors protects the blood-brain barrier and improves cognition in Dahl salt-sensitive hypertensive rats

BACKGROUND

The present study tested the hypothesis that inappropriate activation of the brain renin-angiotensin system (RAS) contributes to the pathogenesis of blood-brain barrier (BBB) disruption and cognitive impairment during development of salt-dependent hypertension. Effects of an angiotensin II (AngII) type-1 receptor blocker (ARB), at a dose that did not reduce blood pressure, were also examined.

METHODS

Dahl salt-sensitive (DSS) rats at 6 weeks of age were assigned to three groups: low-salt diet (DSS/L; 0.3% NaCl), high-salt diet (DSS/H; 8% NaCl), and high-salt diet treated with ARB, olmesartan at 1 mg/kg.

RESULTS

DSS/H rats exhibited hypertension, leakage from brain microvessels in the hippocampus, and impaired cognitive functions, which were associated with increased brain AngII levels, as well as decreased mRNA levels of tight junctions (TJs) and collagen-IV in the hippocampus. In DSS/H rats, olmesartan treatment, at a dose that did not alter blood pressure, restored the cognitive decline, and ameliorated leakage from brain microvessels. Olmesartan also decreased brain AngII levels and restored mRNA expression of TJs and collagen-IV in DSS/H rats.

CONCLUSIONS

These results suggest that during development of salt-dependent hypertension, activation of the brain RAS contributes to BBB disruption and cognitive impairment. Treatment with an ARB could elicit neuroprotective effects in cognitive disorders by preventing BBB permeability, which is independent of blood pressure changes.

Expression of Tn and sialyl Tn antigens in synovial tissues in rheumatoid arthritis

OBJECTIVES

The carbohydrate chains represented by mucins (MUCs) are expressed by a variety of normal and malignant secretory epithelial cells and induce a variety of immunoreactions. Tn and sialyl Tn antigens are tumour-associated carbohydrate antigens which are borne on the core proteins of mucins. The purpose of this study is to investigate the existence of tumour-associated carbohydrate antigens in rheumatoid arthritis (RA).

METHODS

. We examined the expression of Tn and sialyl Tn antigens in synovial tissues from RA and osteoarthritis (OA) patients by immunohistochemistry. In addition, mucins from synovial fluid (SF) from RA patients are purified by gel filtration and density gradient ultracentrifugation and the existence of these antigens examined by dot and Western blotting.

RESULTS

We found that Tn and sialyl Tn antigens were strongly expressed in synovial cells and infiltrating mononuclear cells on the sublining layer and lymphoid follicles in synovial tissues in RA compared with those in osteoarthritis. Tn and sialyl Tn antigens were detected in purified mucins of SF from RA patients.

CONCLUSIONS

Tumour-like synovial hyperplasia cells expressed Tn and sialyl Tn antigens. This finding suggests that the mucins exhibiting with abnormal glycosylation may be in part responsible for synovial hyperplasia, leading to the joint destruction in the pathogenesis of RA.