Vertically Oriented Metallic Heterodimer Array Semiembedded in Flat Conductive Carbon Film for Electrochemical Application

General synthesis of a highly oriented metallic heterodimer array based on a selective electrodeposition technique onto a metal nanoparticle-embedded carbon film is proposed, which enables the preparation of heterodimers with a wide variety of metal combinations. This method requires no surfactant, capping agent, organic solvent, or heat treatment. As a representative metal combination, a nickel (Ni)/palladium (Pd) heterodimer array was prepared by selective electrodeposition of Ni nanoparticles (Ni NPs) on top of partially exposed Pd NPs embedded in carbon film electrodes fabricated by a cosputtering technique. Such a selective electrodeposition becomes possible by utilizing the difference in electrodeposition overpotentials between carbon and Pd NP surfaces. X-ray photoelectron spectroscopy revealed a charge transfer from Ni NPs to Pd NPs, implying that the catalytic and optical properties can be expected to be controllable. The formed heterodimer array structure was mechanically stable against ultrasonication in ethanol for over 1 h because most parts of the Pd NPs were tightly embedded in the carbon film. After conversion from Ni to nickel hydroxide (Ni(OH)₂), the electrode showed high electrocatalytic activity toward glucose oxidation, with a higher turnover rate and lower overpotential compared to Ni(OH)₂ electrodeposited on pure carbon film electrodes.

A Highly Sensitive Ammonia Gas Sensor Using Micrometer-Sized Core-Shell-Type Spherical Polyaniline Particles

A highly sensitive NH₃ gas sensor based on micrometer-sized polyaniline (PANI) spheres was successfully fabricated. The PANI microspheres were prepared via a facile in situ chemical oxidation polymerization in a polystyrene microsphere dispersion solution, resulting in a core–shell structure. The sensor response increased as the diameter of the microspheres increased. The PSt@PANI(4.5) sensor, which had microspheres with a 4.5 μm average diameter, showed the largest response value of 77 for 100 ppm dry NH₃ gas at 30 °C, which was 20 times that of the PANI-deposited film-based sensor. Even considering measurement error, the calculated detection limit was 46 ppb. A possible reason for why high sensitivity was achieved is simply the use of micrometer-sized PANI spherical particles. This research succeeded in providing a new and simple technology for developing a high-sensitivity NH₃ gas sensor that operates at room temperature.

Hepatic Adenosine Triphosphate Reduction Through the Short-Chain Fatty Acids-Peroxisome Proliferator-Activated Receptor γ-Uncoupling Protein 2 Axis Alleviates Immune-Mediated Acute Hepatitis in Inulin-Supplemented Mice

How liver tolerance is disrupted in immune-mediated liver injury is currently unclear. There is also insufficient information available regarding susceptibility, precipitation, escalation, and perpetuation of autoimmune hepatitis. To explore how dietary fiber influences hepatic damage, we applied the concanavalin A (ConA)-induced acute immune-mediated liver injury model in mice fed a diet supplemented with 6.8% inulin, a water-soluble fermentable fiber. Twelve hours after ConA administration, inulin-supplemented diet-fed mice demonstrated significantly alleviated hepatic damage histologically and serologically, with down-regulation of hepatic interferon-γ and tumor necrosis factor and reduced myeloperoxidase (MPO)-producing neutrophil infiltration. Preconditioning with an inulin-supplemented diet for 2 weeks significantly reduced hepatic adenosine triphosphate (ATP) content; suramin, a purinergic P2 receptor antagonist, abolished the protective effect. Of note, the portal plasma derived from mice fed the inulin-supplemented diet significantly alleviated ConA-induced immune-mediated liver injury. Mechanistically, increased portal short-chain fatty acid (SCFA) levels, such as those of acetate and butyrate, by inulin supplementation leads to up-regulation of hepatic γ-type peroxisome proliferator-activated receptor (Pparg) and uncoupling protein 2 (Ucp2), which uncouples mitochondrial ATP synthesis downstream of PPARγ. Pparg down-regulating small interfering RNA cancelled the protective effect of inulin supplementation against MPO-producing neutrophil infiltration and the subsequent immune-mediated liver injury, suggesting that the SCFA-PPARγ-UCP2 axis plays a key role in the protective effect by inulin supplementation. Moreover, significant changes in the gut microbiota, including increased operational taxonomic units in genera Akkermansia and Allobaculum, also characterized the protective effect of the inulin-supplemented diet. Conclusion: There is a possible unraveled etiopathophysiological link between the maintenance of liver tolerance and dietary fiber. The SCFA-PPARγ-UCP2 axis may provide therapeutic targets for immune-mediated liver injury in the future.

Supporting effects of a N-doped carbon film electrode on an electrodeposited Ni@Ni(OH)2 core-shell nanocatalyst in accelerating electrocatalytic oxidation of oligosaccharides

The supporting effect of a N-doped carbon film induced superior crystallinity in electrodeposited Ni@Ni(OH)2 core-shell nanoparticles. This improvement resulted in a much higher regeneration rate of catalytic sites (NiOOH), leading to higher oxidation currents of sugars. Also, the overpotential of the maltopentaose (G5) oxidation reaction decreased significantly, probably due to the effect of the electrostatic interaction between NPs and G5.

Role of CC chemokine receptor 9 in the progression of murine and human non-alcoholic steatohepatitis

BACKGROUND & AIMS

The number of patients with non-alcoholic steatohepatitis (NASH) is increasing globally. Recently, specific chemokine receptors have garnered interest as therapeutic targets in NASH. This is the first report to examine the role of the C-C chemokine receptor 9 (CCR9)/C-C chemokine receptor ligand 25 (CCL25) axis, and to reveal its therapeutic potential in NASH.

METHODS

Patients with biopsy-proven non-alcoholic liver disease (NAFLD) were recruited and their serum and hepatic chemokine expression was examined. Furthermore, wild-type (WT) and Ccr9^-/- mice were fed a high-fat high-cholesterol (HFHC) diet for 24 weeks to establish NASH.

RESULTS

Serum CCL25, and hepatic CCR9 and CCL25 expression levels were increased in patients with NASH compared to healthy volunteers. Furthermore, Ccr9^-/- mice were protected from HFHC diet-induced NASH progression both serologically and histologically. Flow cytometry and immunohistochemistry analysis showed that CCR9⁺CD11b⁺ inflammatory macrophages accumulated in the inflamed livers of HFHC diet-fed mice, while the number was reduced in Ccr9^-/- mice. Consistent with human NASH livers, CCR9 was also expressed on hepatic stellate cells (HSCs) in mice with NASH, while CCR9-deficient HSCs showed less fibrogenic potential in vitro. Administration of a CCR9 antagonist hampered further fibrosis progression in mice with NASH, supporting its potential clinical application. Finally, we showed that CCR9 blockade attenuated the development of NAFLD-related hepatocellular carcinoma in HF diet-fed mice injected with diethylnitrosamine.

CONCLUSIONS

These results highlight the role of the CCR9/CCL25 axis on macrophage recruitment and fibrosis formation in a murine NASH model, providing new insights into therapeutic strategies for NASH.

LAY SUMMARY

Herein, we show that a specific chemokine axis involving a receptor (CCR9) and its ligand (CCL25) contributes to the progression of non-alcoholic steatohepatitis and carcinogenesis in humans and mice. Furthermore, treatment with a CCR9 antagonist ameliorates the development of steatohepatitis and holds promise for the treatment of patients with non-alcoholic steatohepatitis.

C-C motif chemokine receptor 9 regulates obesity-induced insulin resistance via inflammation of the small intestine in mice

AIMS/HYPOTHESIS

Accumulation of adipose tissue macrophages is considered pivotal in the development of obesity-associated inflammation and insulin resistance. In addition, recent studies suggest an involvement of the intestine as the primary organ in inducing hyperglycaemia and insulin resistance. We have reported that the C-C motif chemokine receptor (CCR) CCR9 is associated with intestinal immunity and has a pathogenic role in various liver diseases. However, its contribution to type 2 diabetes is unknown. In the current study, we aimed to clarify the involvement of CCR9 in the pathology of type 2 diabetes and the potential underlying mechanisms.

METHODS

To elucidate how CCR9 affects the development of metabolic phenotypes, we examined the impact of CCR9 deficiency on the pathogenesis of type 2 diabetes using male C57BL/6J (wild-type [WT]) and CCR9-deficient (CCR9 knockout [KO]) mice fed a 60% high-fat diet (HFD) for 12 weeks.

RESULTS

WT and Ccr9KO mice fed an HFD exhibited a comparable weight gain; however, glucose tolerance and insulin resistance were significantly improved in Ccr9KO mice. Moreover, visceral adipose tissue (VAT) and the liver of Ccr9KO mice presented with less inflammation and increased expression of glucose metabolism-related genes than WT mice. Ccr9 and Ccl25 expression were specifically higher in the small intestine but was not altered by HFD feeding and type 2 diabetes development. Accumulation of IFN-γ-producing CD4+ T lymphocytes and increased intestinal permeability in the small intestine was observed in WT mice following HFD feeding, but these changes were suppressed in HFD-fed Ccr9KO mice. Adoptive transfer of gut-tropic CCR9-expressing T lymphocytes partially reversed the favourable glucose tolerance found in Ccr9KO mice via exacerbated inflammation in the small intestine and VAT.

CONCLUSIONS/INTERPRETATION

CCR9 plays a central role in the pathogenesis of type 2 diabetes by inducing an inflammatory shift in the small intestine. Our findings support CCR9 as a new therapeutic target for type 2 diabetes via the gut-VAT-liver axis.

Hybrid Carbon Film Electrodes for Electroanalysis

Carbon materials have been widely used for electrochemical analysis and include carbon nanotubes, graphene, and boron-doped diamond electrodes in addition to conventional carbon electrodes, such as those made of glassy carbon and graphite. Of the carbon-based electrodes, carbon film has advantages because it can be fabricated reproducibly and micro- or nanofabricated into electrodes with a wide range of shapes and sizes. Here, we report two categories of hybrid-type carbon film electrodes for mainly electroanalytical applications. The first category consists of carbon films doped or surface terminated with other atoms such as nitrogen, oxygen and fluorine, which can control surface hydrophilicity and lipophilicity or electrocatalytic performance, and are used to detect various electroactive biochemicals. The second category comprises metal nanoparticles embedded in carbon film electrodes fabricated by co-sputtering, which exhibits high electrocatalytic activity for environmental and biological samples including toxic heavy metal ions and clinical sugar markers, which are difficult to detect at pure carbon-based electrodes.

Moderate alcohol consumption is not associated with subclinical cardiovascular damage but with hepatic fibrosis in non-alcoholic fatty liver disease

BACKGROUND

Moderate alcohol consumption is believed to be associated with reduced mortality from cardiovascular disease (CVD) in the general population. This cross-sectional study aimed to comprehensively examine the association between alcohol consumption and subclinical cardiovascular damage or hepatic fibrosis in non-alcoholic fatty liver disease (NAFLD).

METHODS

Subjects with NAFLD without a history of heart disease were extracted from 977 consecutive examinees who completed health checkups and optional cardiovascular examinations. Subclinical cardiovascular damage was assessed by coronary artery calcification (CAC), carotid artery ultrasound, and brachial-ankle pulse wave velocity (ba-PWV). CAC scores were classified into three grades (0, ≤100, and >100) by Agatston's method. Alcohol consumption was divided into three groups [Non-drinking (G0); Light (G1), 0.1-6.9 drinks/week; Moderate (G2), 7-20.9 drinks/week for men and 7-13.9 drinks/week for women]. Noninvasive markers (FIB-4, Fibrosis-4; NFS, NAFLD fibrosis score) were calculated for assessment of hepatic fibrosis and classified into low and intermediate-high grade.

RESULTS

The overall mean age was 60.2 years and males were 200 (74.6%) among 268 subjects with NAFLD. Number (%) of G0, G1, and G2 were 102 (38.1%), 103 (38.4%), and 63 (23.5%). Binary logistic regression analysis showed no significant difference between G0 and G1, or G0 and G2 in any of the above subclinical cardiovascular damages (CAC score >0, or CAC score >100, carotid plaque +, intima-media thickness ≥1.1 mm, and ba-PWV >1400 cm/s). However, only G2 had a significant association with intermediate-high grade of FIB-4 or NFS [odds ratio (95% confidence intervals), p value: 1.871 (1.209-2.893), p = 0.005; 2.910 (1.715-4.939), p = 0.000], compared to G0.

CONCLUSIONS

Non-heavy drinking might not reduce the risk of CVD in NAFLD subjects. On the contrary, even moderate drinking could promote hepatic fibrosis. Thus, NAFLD drinkers should not be recommended for even a moderate amount of alcohol.

Clinical implications with tolvaptan on monitored bioimpedance-defined fluid status in patients with cirrhotic ascites: an observational study

Background

Prognostic value or clinical implications of fluid status monitoring in liver cirrhosis are not fully elucidated. Tolvaptan, an orally available, selective vasopressin V2-receptor antagonist approved for hyponatremia in the United States and European Union. It is also used for cirrhotic ascites at a relatively low dose (3.75 mg to 7.5 mg) in Japan, exerts its diuretic function by excreting electrolyte-free water. We hypothesized that bioimpedance-defined dynamic changes in fluid status allow prediction of response of V2 antagonism and survival in cirrhotic patients.

Methods

In this prospective observational study, 30 patients with decompensated liver cirrhosis who were unresponsive to conventional diuretics were enrolled. Detailed serial changes of body composition that were assessed by using non-invasive bioimpedance analysis (BIA) devices, along with biochemical studies, were monitored at 5 time points.

Results

Sixteen patients were classified as short-term responders (53%). Rapid and early decrease of BIA-defined intracellular water, as soon as 6 h after the first dose (ΔICW_BIA%-6 h), significantly discriminated responders from non-responders (AUC = 0.97, P < 0.0001). ΔICW_BIA%-6 h was highly correlated with the change of BIA-derived phase angle of trunk, e.g. reduced body reactance operated at 50 kHz after 24 h of the first dose of tolvaptan. Lower baseline blood urea nitrogen and lower serum aldosterone were predictive of a rapid and early decrease of ICW_BIA. A rapid and early decrease of ICW_BIA in response to tolvaptan was also predictive of a better transplant-free survival.

Conclusions

BIA-defined water compartment monitoring may help predict short-term efficacy and survival in decompensated cirrhotic patients treated with tolvaptan.

Humidity-Resistive Optical NO Gas Sensor Devices Based on Cobalt Tetraphenylporphyrin Dispersed in Hydrophobic Polymer Matrix

We report on an optical nitrogen oxide (NO) gas sensor device using cobalt tetraphenylporphyrin (CoTPP) dispersed in three kinds of hydrophobic polymer film matrix (polystyrene (PSt), ethylcellulose (EC), and polycyclohexyl methacrylate (PCHMA)) to improve humidity resistance. Our approach is very effective because it allows us to achieve not only high humidity resistance, but also a more than sixfold increase in sensitivity compared with CoTPP film due to the high dispersion of CoTPP in the polymer film. The limit of detection was calculated as 33 ppb for the CoTPP-dispersed EC film, which is lower than that of CoTPP film (92 ppb).

Plasmacytoid dendritic cells protect against immune-mediated acute liver injury via IL-35

Acute liver failure (ALF) is a life-threatening condition, and liver transplantation is the only therapeutic option. Although immune dysregulation is central to its pathogenesis, the precise mechanism remains unclear. Here, we show that the number of peripheral and hepatic plasmacytoid DCs (pDCs) decrease during acute liver injury in both humans and mice. Selective depletion of pDCs in Siglechdtr/+ mice exacerbated concanavalin A-induced acute liver injury. In contrast, adoptively transferred BM-derived pDCs preferentially accumulated in the inflamed liver and protected against liver injury. This protective effect was independent of TLR7 and TLR9 signaling, since a similar effect occurred following transfer of MyD88-deficient pDCs. Alternatively, we found an unexpected immunosuppressive role of pDCs in an IL-35-dependent manner. Both Il12a and Ebi3, heterodimeric components of IL-35, were highly expressed in transferred pDCs and CD4+CD25+ Tregs. However, the protective effect of pDC transfer was completely lost in mice depleted of Tregs by anti-CD25 antibody. Moreover, pDCs derived from IL-35-deficient mice had less of a protective effect both in vivo and in vitro even in the presence of Tregs. These results highlight a unique aspect of pDCs in association with Tregs, serving as a guide for immunotherapeutic options in ALF.

Increased electrode activity during geosmin oxidation provided by Pt nanoparticle-embedded nanocarbon film

The musty odor compound geosmin was electrochemically detected by using Pt nanoparticle (PtNP)-embedded nanocarbon (Pt-C) films formed with unbalanced magnetron (UBM) co-sputtering. The sputtered Pt components formed NPs (typically 1.53-4.75 nm in diameter) spontaneously in the carbon films, owing to the poor intermiscibility of Pt with carbon. The surface concentrations of PtNPs embedded in the nanocarbon film were widely controllable (Pt = 4.8-35.9 at%) by regulating the target powers of the Pt and carbon individually. The obtained film had a flat surface (Ra = 0.17-0.18 nm) despite the fact the PtNPs were partially exposed at the surface. Compared with a Pt film electrode, some Pt-C films exhibited higher electrode activity against geosmin although the surface Pt concentrations of these Pt-C films were much lower than that of the Pt film electrode, thanks to the wider potential window and lower background current that resulted from the ultraflat and stable carbon-based film prepared by UBM co-sputtering. Computational experiments revealed that the theoretical oxidation potential (Eox) value for geosmin was relatively similar to that obtained in electrochemical experiments using our Pt-C film electrode. Moreover, we also theoretically estimated the possible oxidation site of geosmin molecules and the advantage of the NP shape of the electroactive Pt parts as regards the electrochemical oxidation of geosmin. We successfully used the Pt-C film (10.6 at%) electrode to detect geosmin in combination with HPLC at a low detection limit of 100 ng L-1.

Abstract P2-14-22: Is sentinel lymph node biopsy necessary in breast cancer patients who were diagnosed as initially clinically node-negative before neoadjuvant chemotherapy?

Background

Neoadjuvant chemotherapy (NAC) is established for treatment of locally advanced disease and is being used increasingly for early-stage breast cancer. And sentinel lymph node biopsy (SLNB) for clinically node-negative breast cancer patients after NAC is performed as a daily procedure. The purpose of this study was to identify the group that can omit SLNB in patients with clinically node-negative breast cancer at diagnosis before NAC.

Materials and Methods

A single institutional retrospective analysis was performed. 126 patients were diagnosed as clinically node-negative before NAC and underwent SLNB between 2005 and 2017.

Before NAC, all patients underwent clinical assessment of lymph-node status by palpation and axillary ultrasound. We judged patients to be node-negative when palpation and ultrasound showed no suspicious nodes. If axillar lymph nodes were swelling, fine-needle aspiration cytology was performed. After NAC, clinical assessment of lymph-node status was performed, again.

119 patients received anthracycline-based (anthracycline alone: 11, anthracycline followed by taxane: 108) chemotherapy and 7 patients received taxane alone. Clinical complete response (cCR) was defined if there was no evidence of tumor in the breast and axillary lymph nodes by US and MRI. SLNB procedure was done after NAC in all patients. Lymphatic mapping was performed with radioactive colloid and/or lymphatic blue dye.

Results

Median follow-up time was 51.2months. cCR rate was 16.7% (21/126).

Success rate for the identification and removal of a SLN was 96.8% (122/126). The median number of SLNs removed was 1.9 (1-5).

15 patients (12.3%) represented SLN positive in patients who were diagnosed as clinically node-negative before NAC. They were performed axillar dissection and the SLNs were the only positive nodes in 9 patients.

No SLNs metastases were observed in 21 patients who were diagnosed as cCR by ultrasound and MRI. And 15 patients (14.9%) had positive SLN in the 101 patients who were diagnosed as clinical partial response or clinical stable disease (p=0.071).

Tumor size, Surgical procedures, hormone receptor status and HER2 status did not influence the positive rate of SLN metastases.

No axillar lymph node recurrence was observed within follow-up period.

Conclusion

Our results show that SLNB is necessary even in breast cancer patients who were diagnosed as initially clinically node-negative before NAC.

However, SLNB may be omitted in breast cancer patients who were diagnosed as clinically node-negative by palpation and axillary ultrasound before NAC and as cCR by ultrasound and MRI after NAC.

Citation Format: Fujita T, Sakuragi M, Miyazaki C, Shiba S, Tanaka Y, Nishida S. Is sentinel lymph node biopsy necessary in breast cancer patients who were diagnosed as initially clinically node-negative before neoadjuvant chemotherapy? [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-14-22.

Abstract P6-02-16: The efficacy of preoperative pathological features to improve diagnosis accuracy in lymph node metastasis by axillary ultrasound

Purpose

Recently a sentinel lymph node biopsy has been a part of standard surgical procedure instead of an axillary dissection with a mastectomy for breast cancers. It is necessary to make an accurate diagnosis of lymph node metastasis for deciding surgical procedure either a sentinel lymph node biopsy or an axillary dissection. Preoperative ultrasound is one of widely used tools to make a diagnosis of sentinel lymph node. This study presents results regarding preoperative pathological features to improve diagnosis accuracy of sentinel lymph node by preoperative axillary ultrasound.

Materials and methods

One doctor performed preoperative ultrasound. He used HITACHI HI VISION Ascendus. Axillary lymph node metastasis was suspected when these findings were observed such as partial thickening of lymph node cortex, loss of lymph nodes' hilum, circular swelling shape change and difference compared to a contralateral axillary lymph node. When we suspected axillary lymph node metastasis, we performed fine needle aspiration cytology except other findings such as CT, MRI or physical appearance showed obvious axillary lymph node metastasis. Preoperative core needle biopsies were performed to determine pathologic types and hormone characters. Clinical cases such that ductal carcinoma in situ, lobular carcinoma and ones with primary systemic treatment (neoadjuvant therapy) were excluded from statistical analysis.

Results

During a study period between April 2015 and December 2017, altogether 662 patients were participated in this study. 304 cases were analyzed by statistical analysis. 268 cases were diagnosed as negative and 36 case as positive in axillary lymph node metastasis by preoperative ultrasound. In the 268 cases 225 cases were diagnosed as negative by sentinel lymph node biopsy during operations (84.0%) but 43 cases were diagnosed as positive (16.0%). 23% cases included less than 20mm micro metastasis (10/43). To investigate correlation between false negative ratio of axillary lymph node metastasis diagnosed by an ultrasound and preoperative pathological features such as hormone receptor, HER2, Ki-67, nuclear grade and subtypes (Luminal, Her2 and triple negative). The false negative ratio was 17.0% vs 11.1% in hormone receptor (positive vs negative, p = 0.434), 14.5% vs 16.0% in HER2 (positive vs negative, p = 0.887), 15.4% vs 19.1% in Ki-67 (&lt;20% vs ≥20%, p = 0.441), 18.4% vs 9.38% in nuclear grade (1 vs 2 and 3, p = 0.997), 11.3% vs 23.8% vs 16.7% vs 16.7% (Luminal A vs Luminal B vs Her2 vs triple negative, p&gt;0.05).

Conclusion

There were no statistical significant difference between the axillary lymph node metastasis diagnosed by an ultrasound and the preoperative pathological features. However cases categorized in Luminal B by preoperative pathology had relatively high false negative ratio of axillary lymph node metastasis diagnosed by an ultrasound. It is necessary to investigate a way to improve diagnosis accuracy of sentinel lymph node by a preoperative axillary ultrasound.

Citation Format: Koike R, Fujita T, Sata N, Shiozawa M, Miyazaki C, Sakuragi M, Shiba S, Tanaka Y. The efficacy of preoperative pathological features to improve diagnosis accuracy in lymph node metastasis by axillary ultrasound [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-02-16.

Liver Fibrosis Markers Improve Prediction of Outcome in Non-Acetaminophen-Associated Acute Liver Failure

A prognostic system for acute liver failure (ALF) with a higher predictive value is urgently needed. The role of extracellular matrix (ECM) remodeling in ALF has not been fully elucidated. We hypothesized that serologic fibrosis markers, which reflect ECM remodeling, are predictive of ALF outcome at first presentation. This observational study included 110 patients with acute liver dysfunction, of which 73 had non-acetaminophen-associated ALF (NAA-ALF). We evaluated serum levels of hyaluronic acid, 7S domain of type IV collagen (4COL7S), and Wisteria floribunda agglutinin-positive Mac-2-binding protein at first presentation to a tertiary center. Serologic fibrosis markers were significantly higher in NAA-ALF compared with acute hepatitis. Elevated hyaluronic acid and 4COL7S levels at first presentation correlated significantly with worse clinical outcomes. 4COL7S, along with age, ammonia, and the Model for End-Stage Liver Disease (MELD) score, was a significant prognostic factor in multivariate analysis; 4COL7S correlated significantly with coagulopathy, decreased hepatic synthetic functions, advanced hepatic encephalopathy, and liver atrophy and also predicted 180-day transplant-free survival. Cox regression models incorporating 4COL7S with the MELD system had profoundly improved predictive values that significantly surpassed the MELD system alone. Conclusion: Elevation of serologic fibrosis markers reflecting ECM remodeling in NAA-ALF predicted a worse clinical outcome. Incorporation of 4COL7S at first presentation to a transplant center improves the specificity while retaining the sensitivity of the MELD system. External validation of a fibrosis marker as part of a clinical prediction tool in ALF warrants further investigation.

Intestinal barrier regulates immune responses in the liver via IL-10-producing macrophages

The gut-liver axis is of clinical importance as a potential therapeutic target in a wide range of liver diseases; however, the mechanisms underlying interactions between microbial products and immune responses in the liver remain unknown. In this study, we demonstrated that IL-10-producing macrophages contribute to immune tolerance in the inflamed liver under intestinal barrier disruption in a murine tandem model of dextran sulfate sodium (DSS) colitis and concanavalin A (Con A) hepatitis. Intestinal barrier disruption protected mice from subsequent liver injury, and the severity of colitis directly affected susceptibility to such injury. The protective effect of DSS-Con A was canceled in gut-sterilized mice, suggesting that gut microbiota play a substantial role in this process. Altered gut microbiota and their metabolites, along with a disrupted intestinal barrier, directly gave rise to immunological permissiveness in the inflamed liver. We identified 1-methylnicotinamide (1-MNA) as a candidate metabolite capable of suppressing liver injury with the potential to induce IL-10-producing macrophages. Consistently, expression of nicotinamide N-methyltransferase, which converts nicotinamide to 1-MNA, was upregulated in the liver of DSS-Con A mice, and this effect was abrogated by gut sterilization. Collectively, our results provide a mechanistic insight into the regulation of immunological balance in the liver via the gut-liver axis.

Commensal Lactobacillus Controls Immune Tolerance during Acute Liver Injury in Mice

Gut-derived microbial antigens trigger the innate immune system during acute liver injury. During recovery, regulatory immunity plays a role in suppressing inflammation; however, the precise mechanism underlying this process remains obscure. Here, we find that recruitment of immune-regulatory classical dendritic cells (cDCs) is crucial for liver tolerance in concanavalin A-induced acute liver injury. Acute liver injury resulted in enrichment of commensal Lactobacillus in the gut. Notably, Lactobacillus activated IL-22 production by gut innate lymphoid cells and raised systemic IL-22 levels. Gut-derived IL-22 enhanced mucosal barrier function and promoted the recruitment of regulatory cDCs to the liver. These cDCs produced IL-10 and TGF-β through TLR9 activation, preventing further liver inflammation. Collectively, our results indicate that beneficial gut microbes influence tolerogenic immune responses in the liver. Therefore, modulation of the gut microbiota might be a potential option to regulate liver tolerance.

On-treatment decrease of NKG2D correlates to early emergence of clinically evident hepatocellular carcinoma after interferon-free therapy for chronic hepatitis C

Background and aims

Interferon (IFN)- free direct antiviral agents (DAAs) with rapid HCV eradication might evoke immunological reconstitutions, and some early recurrences of HCC after IFN-free DAAs have been reported. This study aimed to investigate whether natural killer group 2, member D (NKG2D) predicts early emergence of HCC after IFN-free DAAs.

Methods

We conducted a clinical practice-based observational study of 101 patients infected with genotype 1 HCV who received IFN-free (DAAs), and stratified them into those who did or did not develop early (i.e., during the 6-month surveillance period following treatment.) recurrence or occurrence of clinically evident HCC. We also analyzed the peripheral blood mononuclear cells, both before treatment and at end of treatment (EOT), of 24 of the patients who received IFN-free DAAs, and 16 who received IFN-combined protease inhibitor.

Results

We found early emergence of clinically evident HCC after IFN-free DAAs in 12 (12%) patients. Higher pre-treatment NKG2D expression, higher FIB-4 score, previous HCC history and failure to achieve sustained viral response were significant factors correlating to early HCC emergence. After IFN-free DAAs, a rapid decrease of NKG2D at EOT correlated with early HCC emergence in the IFN-free DAA-treated patients, but not in patients treated with the IFN-combined regimen. The decrease of NKG2D until EOT was predictive of early HCC emergence at a cut-off of -52% (AUC = 0.92).

Conclusions

On-treatment decrease of NKG2D may be a useful predictor of early emerging HCC in patients treated with IFN-free DAAs.

Recovery from anemia and leukocytopenia after abstinence in Japanese alcoholic men and their genetic polymorphisms of alcohol dehydrogenase-1B and aldehyde dehydrogenase-2

BACKGROUND

The combination of the fast-metabolizing alcohol dehydrogenase-1B (ADH1B*2 allele) and inactive heterozygous aldehyde dehydrogenase-2 (ALDH2*1/*2) increases susceptibility to macrocytic anemia and leukocytopenia in alcoholics due to severe acetaldehydemia. More than half of Japanese drinkers with esophageal cancer have this genotype combination.

METHODS

To assess the recovery of hematologic abnormalities after drinking cessation, changes in blood erythrocyte indices and leukocyte count during 8-week hospital stay were evaluated in 925 Japanese alcoholic men. We used four categories in ascending order for high blood acetaldehyde exposure from drinking: A, ADH1B*1/*1 plus ALDH2*1/*1; B, ADH1B*2 plus ALDH2*1/*1; C, ADH1B*1/*1 plus ALDH2*1/*2; and D, ADH1B*2 plus ALDH2*1/*2.

RESULTS

Mean values of hemoglobin and hematocrit were the lowest, and those of mean corpuscular volume (MCV) were markedly the highest in the D group on admission, and returning toward normal after abstinence, but the inter-group differences remained significant throughout the 8 weeks. The mean leukocyte count was the lowest in the D group on admission, but increased during 4-week abstinence when the inter-group differences were no longer significant. Frequencies of MCV ≥110 fl (50.5%), hemoglobin levels <11.5 g/dL (32.7%), hemoglobin levels <10.0 g/dL (9.9%) and leukocytopenia <4000/μL (22.8%) were the highest in the D group on the admission day and decreased at the 4-week abstinence (28.7%, 18.8%, 4.0% and 7.9%, respectively). The inter-group differences in frequencies of the severe anemia and leukocytopenia disappeared after 4-week abstinence.

CONCLUSIONS

Drinking cessation before surgery and/or chemoradiation treatment for esophageal cancer may be effective for recovery from anemia and leukocytopenia in drinkers belonging to the D group.

Bone marrow-derived macrophages distinct from tissue-resident macrophages play a pivotal role in Concanavalin A-induced murine liver injury via CCR9 axis

The fundamental mechanism how heterogeneous hepatic macrophage (Mφ) subsets fulfill diverse functions in health and disease has not been elucidated. We recently reported that CCR9⁺ inflammatory Mφs play a critical role in the course of acute liver injury. To clarify the origin and differentiation of CCR9⁺Mφs, we used a unique partial bone marrow (BM) chimera model with liver shielding for maintaining hepatic resident Mφs. First, irradiated mice developed less liver injury with less Mφs accumulation by Concanavalin A (Con A) regardless of liver shielding. In mice receiving further BM transplantation, CD11b^lowF4/80^high hepatic-resident Mφs were not replaced by transplanted donors under steady state, while under inflammatory state by Con A, CCR9⁺Mφs were firmly replaced by donors, indicating that CCR9⁺Mφs originate from BM, but not from hepatic-resident cells. Regarding the mechanism of differentiation and proliferation, EdU⁺CCR9⁺Mφs with a proliferative potential were detected specifically in the inflamed liver, and in vitro study revealed that BM-derived CD11b⁺ cells co-cultured with hepatic stellate cells (HSCs) or stimulated with retinoic acids could acquire CCR9 with antigen-presenting ability. Collectively, our study demonstrates that inflammatory Mφs originate from BM and became locally differentiated and proliferated by interaction with HSCs via CCR9 axis during acute liver injury.

Co-sputter deposited nickel-copper bimetallic nanoalloy embedded carbon films for electrocatalytic biomarker detection

We report the fabrication of a nickel (Ni)-copper (Cu) bimetallic nanoalloy (∼3 nm) embedded carbon film electrode with the unbalanced magnetron (UBM) co-sputtering technique, which requires only a one-step process at room temperature. Most of each nanoalloy body was firmly embedded in a chemically stable carbon matrix with an atomically flat surface (Ra: 0.21 nm), suppressing the aggregation and/or detachment of the nanoalloy from the electrode surface. The nanoalloy size and composition can be controlled simply by individually controlling the target powers of carbon, Ni and Cu, which also makes it possible to localize the nanoalloys near the electrode surface. This electrode exhibited excellent electrocatalytic activity for d-mannitol, which should be detected with a low detection limit in urine samples for the diagnosis of severe intestinal diseases. With a Ni/Cu ratio of around 64/36, the electrocatalytic current per metal area was 3.4 times larger than that of an alloy film electrode with a similar composition (∼70/30). This improved electrocatalytic activity realized higher stability (n = 60, relative standard deviation (RSD): 4.6%) than the alloy film (RSD: 32.2%) as demonstrated by continuous measurements of d-mannitol.

Genotype-Associated Differential NKG2D Expression on CD56+CD3+ Lymphocytes Predicts Response to Pegylated-Interferon/Ribavirin Therapy in Chronic Hepatitis C

Hepatitis C virus (HCV) genotype 1 infections are significantly more difficult to eradicate with PEG-IFN/ribavirin therapy, compared to HCV genotype 2. The aim of this work is to investigate the difference of immunological impairments underlying this phenomenon. Pre-treatment NKG2D expression on peripheral CD56+CD3+ lymphocytes and CD56+CD3- NK cells from cases of chronic hepatitis C were analyzed and assessed by treatment effect. Two strains of HCV were used to co-incubate with immune cells in vitro. NKG2D expression on peripheral CD56+CD3+ lymphocytes, but not NK cells, was significantly impaired in genotype 1 infection, compared to genotype 2. When peripheral blood mononuclear cells from healthy donors were co-incubated with TNS2J1, a genotype 1b/2a chimera strain, or with JFH1, a genotype 2a strain, genotype-specific decrease of NKG2D on CD56+CD3+ lymphocytes, but not NK cells, was observed.　Pre-treatment NKG2D expression on peripheral CD56+CD3+ lymphocytes significantly correlated with reduction in serum HCV RNA levels from week 0 to week 4, and predicted treatment response. Ex vivo stimulation of peripheral CD56+CD3+ lymphocytes showed NKG2D expression-correlated IFN-γ production. In conclusion, Decreased NKG2D expression on CD56+CD3+ lymphocytes in chronic HCV genotype 1 infection predicts inferior treatment response to PEG-IFN/ribavirin therapy compared to genotype 2.

An aged male patient with autoimmune hepatitis complicated by hepatocellular carcinoma

An 82-year-old male patient was admitted for liver dysfunction. Laboratory test showed the following data; aspartate aminotransferase (AST) 79 IU/l, alanine aminotransferase (ALT) 28 IU/l, total bilirubin (T. Bil) 0.9 U, zinc sulfate turbidity test (ZTT) 48.9 U, gamma-globulin 4.9 g/dl, immunoglobulin G (IgG) 5,046 mg/dl, anti-nuclear antibodies x 320, anti-mitochondrial antibodies (-), hepatitis B virus surface antigen (HBsAg) (-), HBcAb (-), anti-hepatitis C virus (anti-HCV) (-), hepatitis C virus (HCV-RNA) (-), anti-hepatitis G virus (anti-HGV) (-), alpha-fetoprotein 306.8 ng/ml, carcinoembryonic antigen (CEA) 2.3 ng/ml, carbohydrate antigen (CA) 19-9 77.2 U/ml. Abdominal ultrasonography and computed tomography showed a large mass occupying most of the right lobe and portal thrombosis in the liver. Liver biopsy revealed cirrhosis with inactive hepatitis in the nontumorous lesion and well-differentiated hepatocellular carcinoma in the tumorous lesion. We report a rare case of an aged male patient with autoimmune hepatitis complicated by hepatocellular carcinoma.

Death activation does not stop tumor growth: quantitative evidence for concomitant activation of apoptosis in tumor growth in vitro

A protein-independent fibrosarcoma, Gc-4 PF, grows exponentially in a protein-free medium. The doubling time (approximately 26 h) was similar to that of the serum-dependent parental clone, Gc-4 SD cultivated in the presence of fetal calf serum (FCS). We demonstrated here that the protein-free cultivation of Gc-4 PF cells concomitantly activates apoptotic phenotypes (one third of total cell population), including typical morphology, high uptake of Hoechst 33342 dye, and cleavage of DNA to large fragments, as observed in protein-deprived Gc-4 SD cell previously. Gc-4 SD cells arrested in the G0/G1-phase in response to the protein-free condition. In contrast, Gc-4 PF cells did not reach G0/G1 arrest in the protein-free condition; instead the durations of both G0/G1 and G2-phases were markedly reduced. The estimation of one cell cycle duration revealed that the cell division cycle was accelerated to 1.7 (27 h/15.4 h)-fold. Then the growth kinetics was able to be verified quantitatively by both the cell division rate and apoptotic cell loss. Protein-free cultivation resulted in slight down-regulation of c-myc protein in both cell types, while the down-regulation of p34cdc2, shown clearly in Gc-4 SD cells, was avoided in Gc-4 PF cells. Interestingly, while the expression of p53 was not affected in Gc-4 SD cells in response to the protein-free condition, the suppressor gene product expression was suppressed markedly in Gc-4 PF cells. These results suggest that Gc-4 PF cells may have acquired an ability to accelerate cell division by shortening the cell cycle duration to maintain a proper growth rate in response to intrinsic apoptosis activation with, at least in part, a suppression of p53 expression as well as an escape of down-regulation of p34cdc2.

Hyponatremia with consciousness disturbance caused by omeprazole administration. A case report and literature review

A 68-year-old man developed severe consciousness disturbance after daily administration of 20 mg omeprazole for four days for the treatment of bleeding gastric ulcer. Systemic investigation revealed severe hyponatremia (111 meq/liter). Consciousness did not become clear until his sodium intake was increased to 480 meq/day, and his serum sodium concentrations reached 130 meq/liter. After the discontinuation of omeprazole, his serum sodium levels returned to the normal range with only minimum supplementation of sodium in the form of dietary sodium chloride intake of 10 g/day. Although the mechanism of hyponatremia induced by omeprazole is not clear, an excessive loss of urinary sodium appears to be more likely than water retention with an increase in fluid intake. The literature was also reviewed.

An analysis of the subjective experience of schizophrenia

To examine how varieties of the subjective experience of schizophrenia (SES) can be categorized, a self-report questionnaire consisting of 150 items from the SES in Japanese was administered to 237 Japanese schizophrenic inpatients, and the results were analyzed through a multivariate method. The first factor represents loss of focus and adequacy of thoughts, behavior, and interpersonal perception; it resembles negative symptoms and coincides with the basic symptoms of schizophrenia reported by anthropological psychiatrists. The second factor represents automatic and excessive thoughts and affective loading, and overlaps "the tremble" of Conrad and the mental automatism of de Clerambault. Both signify different combinations of experiences from conventional descriptive symptoms, and may represent more suitable ways to describe the SES.

Philadelphia-chromosome-positive, monosomy 7 biphenotypic acute mixed lineage leukemia in adults: a pluripotent stem cell disorder

Two adult patients with acute mixed lineage leukemia (AMLL) having combined Philadelphia chromosome (Ph1) positivity and monosomy 7 are presented. The phenotypes of leukemic blasts from both cases were almost same (early B-lymphoid lineage and myeloid lineage); CD10+, CD13+, CD19+. HLA-DR+, and dual-color analysis showed simultaneous expression of CD10 (CD19) and CD13 antigens in individual blasts (biphenotypic) in both cases. On molecular analysis, the leukemic blasts showed rearrangement in the first intron of the BCR gene with breakpoint just outside of 3' end of m-BCR-2 (bcr 3) in case 1, and in the M-BCR in case 2. Immunoglobulin heavy chain gene (IgH) rearrangement was noted in both cases, but rearrangement of the T-cell receptor beta-chain gene (TCR beta) was detected only in case 1. Clinically, both cases achieved complete remission by the combination chemotherapy consisting of L-asparaginase, doxorubicin, vincristine, and prednisolone (L-AdVP). In remission, all these molecular abnormalities disappeared in both patients. These results suggest that the Ph1-positive and monosomy 7 AMLL in adults is de novo acute leukemia with both early B-lymphoid and myeloid phenotypes and may arise from malignant transformation of pluripotent stem cell, and expresses a heterogenous rearrangement pattern of the BCR gene.