Researcher Database

Tatsuya Atsumi
Faculty of Medicine Internal Medicine Internal Medicine

Researcher Profile and Settings


  • Faculty of Medicine Internal Medicine Internal Medicine

Job Title

  • Professor


  • MD PhD

J-Global ID

Research Interests

  • 臨床免疫学   臨床免疫学   血栓止血学   リウマチ膠原病学   内科学   

Research Areas

  • Life sciences / Allergies and connective tissue disease / Rheumatology

Academic & Professional Experience

  • 2013/04 - Today Hokkaido University Hokkaido University Hospital
  • 2015/04 - 2017/03 Hokkaido University Graduate School of Medicine
  • 2012 - 医学研究科 教授
  • 2012 - Professor
  • 2010 - 2011 医学研究科准教授 職員(教務系)
  • 2010 - 2011 School Affairs Staff


  • 1988/04 - 1992/03  北海道大学大学院
  • 1982/04 - 1988/03  Hokkaido University  School of Medicine

Association Memberships


Research Activities

Published Papers

  • Takahiro Takase, Akinobu Nakamura, Chiho Yamamoto, Hiroshi Nomoto, Aika Miya, Midori Dannoura, Kyu Yong Cho, Yoshio Kurihara, Naoki Manda, Shin Aoki, Tatsuya Atsumi, Hideaki Miyoshi
    Journal of diabetes investigation 10 (3) 699 - 705 2040-1116 2019/05 [Refereed][Not invited]
    AIMS/INTRODUCTION: We compared treatment satisfaction in type 2 diabetes patients taking daily and weekly glucagon-like peptide-1 receptor agonists. MATERIALS AND METHODS: The study was a 12-week, multicenter, open-label, prospective, randomized, parallel-group comparison trial. The participants were Japanese patients with type 2 diabetes being administered with the glucagon-like peptide-1 receptor agonist, liraglutide, daily for >3 months. Patients were randomly assigned to either continue taking liraglutide once daily (Lira group) or switch to dulaglutide once weekly (Dula group). The primary outcome was the change in the Diabetes Treatment Satisfaction Questionnaire score from baseline to week 12 in the two groups. The secondary outcomes comprised changes in the Diabetes Therapy-Related Quality of Life score, body mass and glycemic control. RESULTS: A total of 33 participants were initially enrolled in the trial, and 31 participants completed the protocol. The change in the Diabetes Treatment Satisfaction Questionnaire score in the Dula group was significantly greater than that in the Lira group (+0.1 ± 4.7 in the Lira group vs +4.9 ± 5.2 in the Dula group; P = 0.013). The change in Diabetes Therapy-Related Quality of Life score in the Dula group was significantly greater than that in the Lira group (-3.7 ± 6.9 vs +8.9 ± 15.1; P = 0.007). There were no significant differences between groups in the changes in body mass, plasma glucose or glycated hemoglobin. CONCLUSIONS: Weekly administration of dulaglutide was superior to liraglutide with regard to treatment satisfaction in patients with type 2 diabetes, in the absence of any negative effect on glycemic control.
  • Kazuno Omori, Hiroshi Nomoto, Akinobu Nakamura, Takahiro Takase, Kyu Yong Cho, Kota Ono, Naoki Manda, Yoshio Kurihara, Shin Aoki, Tatsuya Atsumi, Hideaki Miyoshi
    Journal of diabetes investigation 10 (2) 367 - 374 2040-1116 2019/03 [Refereed][Not invited]
    AIMS/INTRODUCTION: Glinides are antidiabetic drugs that enhance the early phase of insulin secretion, but have been considered to be less effective at lowering blood glucose than sulfonylureas. However, glinides show a lower risk of hypoglycemia and a greater effect on postprandial hyperglycemia, and are particularly recommended for use in elderly patients with type 2 diabetes. We investigated the efficacy and safety of repaglinide compared with sulfonylurea for the treatment of elderly patients. MATERIALS AND METHODS: In the present multicenter, prospective, randomized, open-label, controlled trial, 57 elderly lean patients with type 2 diabetes who were being treated with sulfonylureas were studied. They were either switched to repaglinide (Repa group) or continued a sulfonylurea (SU group) for 12 weeks. The primary outcome comprised the change in glycemic control, and among the secondary outcomes was the presence of hypoglycemia and drug compliance. RESULTS: Although glycated hemoglobin (HbA1c) was not significantly different between the two groups (SU +0.02% vs Repa -0.07%), greater improvements in the glycated albumin (GA) and GA to HbA1c ratio (GA/HbA1c) were observed in the Repa group (ΔGA, SU +0.12% vs Repa -1.15%; ΔGA/HbA1c, SU +0.01 vs Repa -0.13; each P < 0.01) without increasing hypoglycemia. When the Repa group was subdivided according to whether GA improved, the SU dose before switching to repaglinide was significantly smaller and the homeostatic model assessment of β-cell function was significantly higher in the GA improvement subgroup. CONCLUSIONS: Switching from SU to Repa improved GA and GA/HbA1c, and had favorable effects on glucose fluctuation in elderly patients with type 2 diabetes.
  • Kiyohiko Takahashi, Kyu Yong Cho, Akinobu Nakamura, Aika Miya, Arina Miyoshi, Chiho Yamamoto, Hiroshi Nomoto, Hirokatsu Niwa, Kiyohito Takahashi, Naoki Manda, Yoshio Kurihara, Shin Aoki, Yoichi M Ito, Tatsuya Atsumi, Hideaki Miyoshi
    Journal of diabetes investigation 10 (2) 429 - 438 2040-1116 2019/03 [Refereed][Not invited]
    AIMS/INTRODUCTION: We investigated the difference in efficacy and safety between discontinuation and maintaining of sulfonylurea when adding a sodium-glucose cotransporter 2 inhibitor. MATERIALS AND METHODS: In the present multicenter, prospective observational study, 200 patients with type 2 diabetes treated with sulfonylurea and with a need to add ipragliflozin were enrolled and divided into two groups: discontinued sulfonylurea (Discontinuation group) or maintained sulfonylurea, but at the lowest dose (Low-dose group) when adding ipragliflozin. We compared the two groups after 24 weeks using propensity score matching to adjust for differences between the groups. RESULTS: In the matched cohort (58 patients in each group), baseline characteristics of both groups were balanced. The primary outcome of the proportion of patients with non-exacerbation in glycated hemoglobin after 24 weeks was 91.4% in the Low-dose group and 75.9% in the Discontinuation group, a significant difference (P = 0.024). However, bodyweight was significantly decreased in the Discontinuation group compared with the Low-dose group (-4.4 ± 2.1 kg vs -2.9 ± 1.9 kg, P < 0.01). Similarly, liver enzyme improvement was more predominant in the Discontinuation group. A logistic regression analysis showed that high-density lipoprotein cholesterol, age and sulfonylurea dose were independent factors associated with non-exacerbation of glycated hemoglobin in the Discontinuation group. CONCLUSIONS: The purpose of using ipragliflozin should be considered when making the decision to discontinue or maintain sulfonylurea at the lowest dose. Furthermore, low high-density lipoprotein cholesterol level, low dose of sulfonylurea and younger age were possible markers to not show worsening of glycemic control by discontinuing sulfonylurea.
  • Nobuya Abe, Yuichiro Fujieda, Kentaro Nagaoka, Misako Ohkusu, Shinsuke Yasuda, Katsuhiko Kamei, Tatsuya Atsumi
    American journal of respiratory and critical care medicine 199 (2) 235 - 236 1073-449X 2019/01/15 [Refereed][Not invited]
  • Michihiro Kono, Takashi Kurita, Shinsuke Yasuda, Michihito Kono, Yuichiro Fujieda, Toshiyuki Bohgaki, Takayuki Katsuyama, George C Tsokos, Vaishali R Moulton, Tatsuya Atsumi
    Arthritis & rheumatology (Hoboken, N.J.) 70 (12) 2046 - 2056 2326-5191 2018/12 [Refereed][Not invited]
    OBJECTIVE: T cells from systemic lupus erythematosus (SLE) patients have reduced protein levels of RasGRP1, a guanine nucleotide exchange factor for Ras, and increased transcript of alternatively spliced (AS) forms lacking exon 11. Serine/arginine-rich splicing factor 1 (SRSF1) binds pre-messenger RNA (pre-mRNA) to regulate AS forms of several genes, including CD3ζ in SLE T cells. This study was undertaken to assess whether SRSF1 controls the expression of RasGRP1 in T cells from patients with SLE. METHODS: We studied T cells from 45 SLE patients and 18 healthy subjects. Expression levels of SRSF1, wild-type (WT) RasGRP1, and DNA methyltransferase 1 (DNMT1) were assessed by quantitative polymerase chain reaction. Direct binding of SRSF1 to exon 11 of RasGRP1 mRNA was evaluated with an oligonucleotide-protein pulldown assay. Healthy T cells and SLE T cells were treated with SRSF1-specific small interfering RNA or SRSF1 expression vector, respectively, and then evaluated for mRNA/protein expression. RESULTS: SRSF1 expression levels were significantly lower in T cells from SLE patients compared to those from healthy subjects, and correlated inversely with disease activity and positively with levels of RasGRP1-WT and DNMT1. SRSF1 bound directly to exon 11 of RasGRP1 mRNA. Silencing of SRSF1 in human T cells led to increased ratios of RasGRP1-AS to RasGRP1-WT and decreased levels of RasGRP1 protein, whereas overexpression of SRSF1 in SLE T cells caused recovery of RasGRP1, which in turn induced DNMT1/interleukin-2 expression. CONCLUSION: SRSF1 controls the alternative splicing of RasGRP1 and subsequent protein expression. Our findings extend evidence that alternative splicing plays a central role in the aberrant T cell function in patients with SLE by controlling the expression of multiple genes.
  • Hiroyuki Nakamura, Sanae Shimamura, Shinsuke Yasuda, Michihito Kono, Michihiro Kono, Yuichiro Fujieda, Masaru Kato, Kenji Oku, Toshiyuki Bohgaki, Tomohiro Shimizu, Norimasa Iwasaki, Tatsuya Atsumi
    Annals of the rheumatic diseases 77 (12) 1765 - 1772 0003-4967 2018/12 [Refereed][Not invited]
    OBJECTIVES: Rheumatoid arthritis (RA) is an autoimmune polyarthritis, in which fibroblast-like synoviocytes (FLS) play a key role in cartilage and bone destruction through tumour-like proliferation and invasiveness. Considering still unsatisfactory remission rate in RA even under treatment with biological disease-modifying antirheumatic drugs, novel therapeutic strategy for treatment-resistant RA is still awaited. In this study, we analysed the expression and function of Ras guanine nucleotide-releasing proteins (RASGRPs), guanine exchange factors for small GTPase Ras, in FLS as a potential therapeutic target for RA. METHODS: The expression of RASGRPs mRNA was quantified by a real-time PCR assay in FLS isolated from synovial tissue samples. RASGRP2 protein was also evaluated immunohistochemically. Then, we transiently transfected FLS with RASGRP2 expression vector and assessed their proliferation, adhesion, migration and invasion by cellular functional assays and downstream signalling activation using immunoblot. Finally, the therapeutic effect of RASGRP2 silencing was evaluated in type-II collagen-induced arthritis rats. RESULTS: RASGRP2 was abundantly expressed in FLS from RA synovium, whereas scarcely found in those from osteoarthritis. Expression of RASGRP2 in RA-FLS was enhanced by transforming growth factor-beta. RASGRP2 activated RAP-1, subsequently affecting nuclear factor kappa-light-chain-enhancer of activated B cells pathway and actin dynamics in FLS. RASGRP2-overexpressed FLS had increased abilities of adhesion, migration and interleukin (IL)-6 production. Silencing of RASGRP2 using the intra-articular injection of Rasgrp2-specific siRNAs dampened experimental arthritis in rats by inhibiting pannus formation. CONCLUSIONS: RASGRP2 was identified to be involved in the pathogenesis of RA by promoting adhesion, migration and IL-6 production from FLS, proposed as a potential novel non-immunosuppressive therapeutic target for RA.
  • Yusuke Nishioka, Takaomi Sonoda, Haruki Shida, Yoshihiro Kusunoki, Fumihiko Hattanda, Shun Tanimura, Ryo Uozumi, Mai Yamada, Yuka Nishibata, Sakiko Masuda, Daigo Nakazawa, Utano Tomaru, Tatsuya Atsumi, Akihiro Ishizu
    Cytometry. Part A : the journal of the International Society for Analytical Cytology 93 (11) 1157 - 1164 1552-4922 2018/11 [Refereed][Not invited]
    NKT cells are defined as T cells that recognize hydrophobic antigens presented by class I MHC-like molecules, including CD1d. Among CD1d-restricted NKT cells, type I and type II subsets have been noted. CD1d-restricted type I NKT cells are regarded as pro-inflammatory cells in general. On the contrary, accumulated evidence has demonstrated an anti-inflammatory property of CD1d-restricted type II NKT cells. In our earlier study using a rat model with vasculitis, we demonstrated the pro-inflammatory function of CD1d-restricted type II NKT cells and identified that one such cell recognized P518-532 of rat sterol carrier protein 2 (rSCP2518-532 ), which appeared on vascular endothelial cells presented by CD1d. Based on this evidence, we attempted to detect human CD1d-restricted type II NKT cells in peripheral blood using hSCP2518-532 , the human counterpart of rSCP2518-532, together with a CD1d tetramer in flow cytometry. First, we determined the binding of hSCP2518-532 to CD1d. Next, we detected CD3-positive hSCP2518-532 -loaded CD1d (hSCP2518-532 /CD1d) tetramer-binding cells in peripheral blood of healthy donors. The abundance of TGF-β-producing cells rather than TNF-α-producing cells in CD3-positive hSCP2518-532 /CD1d tetramer-binding cells suggests the anti-inflammatory property of SCP2-loaded CD1d (SCP2/CD1d) tetramer-binding type II NKT cells in healthy individuals. Furthermore, we compared cytokine profile between healthy individuals and patients with vasculitis in a pilot study. Interestingly, the percentage of TGF-β-producing cells in SCP2/CD1d tetramer-binding type II NKT cells in vasculitic patients was significantly lower than that in healthy controls despite the greater number of these cells. Although further studies to clarify the mechanism and significance of this phenomenon are needed, SCP2/CD1d tetramer-binding type II NKT cells in peripheral blood should be examined in more detail to understand the pathophysiology of vasculitides in humans. © 2018 International Society for Advancement of Cytometry.
  • Watanabe H, Sada KE, Matsumoto Y, Harigai M, Amano K, Dobashi H, Fujimoto S, Usui J, Yamagata K, Atsumi T, Banno S, Sugihara T, Arimura Y, Matsuo S, Makino H, Japan Research Committee of, the, Ministry of Health,Labour, d Welfare for Intractable Vasculitis, the Research Committee of, Intractable Renal, Disease of, the, Ministry of Health,Labour, Welfare of Japan
    Arthritis & rheumatology (Hoboken, N.J.) 70 (10) 1626 - 1633 2326-5191 2018/10 [Refereed][Not invited]
  • Yuto Kobayashi, Tamotsu Kamishima, Hiroyuki Sugimori, Shota Ichikawa, Atsushi Noguchi, Michihito Kono, Toshitake Iiyama, Kenneth Sutherland, Tatsuya Atsumi
    Journal of Magnetic Resonance Imaging 48 (3) 687 - 694 1053-1807 2018/09 [Refereed][Not invited]
    © 2018 International Society for Magnetic Resonance in Medicine Background: Synovitis, which is a hallmark of rheumatoid arthritis (RA), needs to be precisely quantified to determine the treatment plan. Time–intensity curve (TIC) shape analysis is an objective assessment method for characterizing the pixels as artery, inflamed synovium, or other tissues using dynamic contrast-enhanced MRI (DCE-MRI). Purpose/Hypothesis: To assess the feasibility of our original arterial mask subtraction method (AMSM) with mutual information (MI) for quantification of synovitis in RA. Study Type: Prospective study. Subjects: Ten RA patients (nine women and one man; mean age, 56.8 years; range, 38–67 years). Field Strength/Sequence: 3T/DCE-MRI. Assessment: After optimization of TIC shape analysis to the hand region, a combination of TIC shape analysis and AMSM was applied to synovial quantification. The MI between pre- and postcontrast images was utilized to determine the arterial mask phase objectively, which was compared with human subjective selection. The volume of objectively measured synovitis by software was compared with that of manual outlining by an experienced radiologist. Simple TIC shape analysis and TIC shape analysis combined with AMSM were compared in slices without synovitis according to subjective evaluation. Statistical Tests: Pearson's correlation coefficient, paired t-test and intraclass correlation coefficient (ICC). Results: TIC shape analysis was successfully optimized in the hand region with a correlation coefficient of 0.725 (P < 0.01) with the results of manual assessment regarded as ground truth. Objective selection utilizing MI had substantial agreement (ICC = 0.734) with subjective selection. Correlation of synovial volumetry in combination with TIC shape analysis and AMSM with manual assessment was excellent (r = 0.922, P < 0.01). In addition, negative predictive ability in slices without synovitis pixels was significantly increased (P < 0.01). Data Conclusions: The combination of TIC shape analysis and image subtraction reinforced with MI can accurately quantify synovitis of RA in the hand by eliminating arterial pixels. Level of Evidence: 2. Technical Efficacy: Stage 2. J. Magn. Reson. Imaging 2018;48:687–694.
  • Nakamura H, Fujieda Y, Yasuda S, Nakai M, Atsumi T
    Annals of internal medicine 169 (5) 352 - 353 0003-4819 2018/09 [Refereed][Not invited]
  • Shingo Yanagiya, Kyu Yong Cho, Akinobu Nakamura, Hiroshi Nomoto, Yasuyuki Kawamoto, Kazumichi Kawakubo, Yoshito Komatsu, Tomoko Mitsuhashi, Hideaki Miyoshi, Tatsuya Atsumi
    Internal medicine (Tokyo, Japan) 57 (17) 2527 - 2531 0918-2918 2018/09/01 [Refereed][Not invited]
    An 84-year-old Japanese woman with metastatic insulinoma suffered from frequent hypoglycemic events. Continuous glucose monitoring (CGM) confirmed severe and frequent symptomatic/asymptomatic hypoglycemia. After the initiation of everolimus treatment, the hypoglycemic events were rapidly eliminated. CGM revealed that her blood glucose levels were maintained without hypoglycemia throughout the day. Furthermore, everolimus reduced the duration of time above the upper limit (>180 mg/dL) along with the standard deviation and mean amplitude of glycemic excursions. This case shows the potential effects of everolimus on hypoglycemia and glycemic control in a patient with inoperable metastatic insulinoma evaluated by CGM.
  • Oku K, Atsumi T
    Modern rheumatology 28 (5) 758 - 765 1439-7595 2018/09 [Refereed][Not invited]
  • de Jesús GR, Sciascia S, Andrade D, Nascimento IS, Rosa R, Barbhaiya M, Tektonidou M, Banzato A, Pengo V, Ji L, Meroni PL, Ugarte A, Cohen H, Branch DW, Andreoli L, Belmont HM, Fortin PR, Petri M, Rodriguez E, Cervera R, Knight JS, Atsumi T, Willis R, Erkan D, Levy RA, APS ACTION
    BJOG : an international journal of obstetrics and gynaecology 1470-0328 2018/09 [Refereed][Not invited]
  • Akinobu Nakamura, Hideaki Miyoshi, Shigekazu Ukawa, Koshi Nakamura, Takafumi Nakagawa, Yasuo Terauchi, Akiko Tamakoshi, Tatsuya Atsumi
    Journal of diabetes investigation 9 (5) 1106 - 1109 2040-1116 2018/09 [Refereed][Not invited]
    We investigated the association between serum high molecular weight (HMW) adiponectin and insulin secretion in a population-based study, with or without adjustment for insulin sensitivity. A total of 488 participants (263 women) were included in the present study. Insulin secretion was estimated using the homeostasis model assessment of β-cell function ± adjustment for insulin resistance using the disposition index. Multivariate analysis showed that HMW adiponectin was significantly and inversely associated with homeostasis model assessment of β-cell function (partial regression coefficient -0.19, 95% confidence interval -0.28, -0.10, P < 0.0001). However, HMW adiponectin was significantly and positively associated with disposition index (partial regression coefficient 0.15, 95% confidence interval 0.06, 0.24, P = 0.0016). The present study showed that a positive association between HMW adiponectin levels and insulin secretion evaluated using an index incorporating adjustment for insulin resistance was identified, and vice versa using an index that did not adjust for insulin resistance.
  • Naoyuki Kitao, Akinobu Nakamura, Hideaki Miyoshi, Hiroshi Nomoto, Kiyohiko Takahashi, Kazuno Omori, Kohei Yamamoto, Kyu Yong Cho, Yasuo Terauchi, Tatsuya Atsumi
    Metabolism: clinical and experimental 85 48 - 58 0026-0495 2018/08 [Refereed][Not invited]
    OBJECTIVE: We investigated whether glucokinase and insulin receptor substrate-2 were required for beta cell proliferation induced by short-term high-fat (HF) diet feeding, as has been shown for long-term HF diet. METHODS: Eight-week-old C57BL/6J mice were exposed to either a standard chow (SC) or HF diet. After 1 week on the diet, histopathological beta cell proliferation and gene expression in isolated islets were examined. Additionally, 8-week-old beta cell-specific glucokinase haploinsufficient (Gck+/-) and Irs2 knockout (Irs2-/-) mice were exposed to either an SC or HF diet. RESULTS: Immunohistochemical analysis revealed that short-term HF diet feeding resulted in a significant increase in BrdU incorporation rate compared with SC consumption in wild-type mice. Western blot analysis demonstrated that Irs2 expression levels did not differ between the two diets. Moreover, there was a significant increase in the BrdU incorporation rate in the HF diet group compared with the SC group in both Gck+/- and Irs2-/- mice. Gene expression profiling of isolated islets from mice fed an HF diet for 1 week revealed that the expression levels of downstream genes of Foxm1 were coordinately upregulated. One week of HF diet feeding stimulated beta cell proliferation with Foxm1 upregulation in 48-week-old mice as well as in 8-week-old. CONCLUSIONS: The mechanism of pancreatic beta cell proliferation induced by short-term HF diet feeding in mice could involve a glucokinase- and Irs2-independent pathway. Our results suggest that the pathways that induce beta cell proliferation in response to short-term HF diet feeding may differ from those in response to sustained HF diet feeding.
  • Kato M, Yasuda S, Atsumi T
    Rheumatology international 38 (8) 1333 - 1338 0172-8172 2018/08 [Refereed][Not invited]
  • Kohei Yamamoto, Hideaki Miyoshi, Kyu Yong Cho, Akinobu Nakamura, Andrew S Greenberg, Tatsuya Atsumi
    Data in brief 19 179 - 182 2018/08 [Refereed][Not invited]
    The data presented here are related to the research article entitled "Overexpression of Perilipin1 protects against atheroma progression in apolipoprotein E knockout mice" [1]. This paper describes data that were obtained from perilipin 1 (PLIN1) transgenic mice (Plin1Tg) regarding atherosclerosis. The main aim of collecting the data was to clarify the role of PLIN1 in the pathophysiology of atherosclerosis. The data were collected from C57BL/6J mice, apolipoprotein E knockout mice (ApoeKO) and Plin1Tg/ApoeKO. The atherosclerotic lesion areas of aorta were 3.3 ± 1.2% in C57BL/6J mice, 14.2 ± 3.2% in ApoeKO, and 5.6 ± 1.9% in Plin1Tg/ApoeKO. Body weight, gonadal adipose mass and plasma triglyceride concentrations were comparable among the three groups [1]. Furthermore, PLIN1 overexpression did not affect the gene expressions related to cholesterol influx and efflux in macrophage.
  • Nomoto H, Miyoshi H, Sekizaki T, Atsumi T
    Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 24 (3) 165 - 166 1341-1098 2018/06 [Refereed][Not invited]
  • Takahiro Takase, Akinobu Nakamura, Chiho Yamamoto, Tatsuya Atsumi, Hideaki Miyoshi
    Expert Opinion on Pharmacotherapy 19 (7) 631 - 632 1744-7666 2018/05/03 [Refereed][Not invited]
  • Kiyohiko Takahashi, Akinobu Nakamura, Hideaki Miyoshi, Hiroshi Nomoto, Naoyuki Kitao, Kazuno Omori, Kohei Yamamoto, Kyu Yong Cho, Yasuo Terauchi, Tatsuya Atsumi
    Scientific reports 8 (1) 6864 - 6864 2018/05/01 [Refereed][Not invited]
    To examine the effects of luseogliflozin, a sodium-glucose cotransporter 2 inhibitor, on pancreatic beta cell mass in db/db mice of different ages. db/db mice aged 6, 10, 14 and 24 weeks old were fed either standard chow (control group) or standard chow containing 0.01% luseogliflozin (luseo group). After 4 weeks, immunohistochemistry and gene expression tests were conducted. In 6-week-old db/db mice, immunohistochemistry revealed a significant increase in beta cell mass in the luseo group compared with the control group after 4 weeks of treatment. Gene expression profiling of isolated islets showed upregulation Mafa, Pdx1, Ki67 and Ccnd2 in the luseo group. Beta cell mass decreased with age in db/db mice in the control group. Beta cell mass in the luseo group significantly increased compared with the control group regardless of age, although beta cell mass in the 28-week-old luseo group (4 weeks of treatment in 24-week-old db/db mice) was significantly lower than in the 10-week-old luseo group (4 weeks of treatment in 6-week-old db/db mice). Luseogliflozin preserved beta cell mass in db/db mice. The protective effect was more evident in the earlier phase of diabetes.
  • Kazumasa Ohmura, Masaru Kato, Toshiyuki Watanabe, Kenji Oku, Toshiyuki Bohgaki, Tetsuya Horita, Shinsuke Yasuda, Yoichi M Ito, Norihiro Sato, Tatsuya Atsumi
    Arthritis research & therapy 20 (1) 72 - 72 1478-6354 2018/04/17 [Refereed][Not invited]
    BACKGROUND: Premature atherosclerosis is one of the major complications of systemic lupus erythematosus (SLE). Recently, the biological linkage between atherosclerosis and osteoporosis has garnered much attention. The aim of this study is to explore correlation between the development of atherosclerosis and anti-osteoporotic treatment. METHODS: Consecutive patients with SLE (n = 117) who underwent carotid ultrasonography were retrospectively analyzed using propensity scoring. RESULTS: Of the 117 patients, 42 (36%), 27 (23%), and 30 (26%) were receiving bisphosphonates and vitamin D (BP + VD), bisphosphonates alone, or vitamin D alone, respectively. Low bone mineral density was more frequent, and carotid plaque was less prevalent in the BP + VD group compared with other treatment groups. Age (OR = 1.57) and BP + VD treatment (OR = 0.24) were shown by multivariate analysis to be associated with the presence of carotid plaque. In all strata divided using the propensity score, carotid plaque was statistically significantly less prevalent (p = 0.015, Mantel-Haenszel test) in the BP + VD group relative to the other treatment groups. CONCLUSION: Combined treatment with bisphosphonate and vitamin D may have a role in preventing atherosclerosis in patients with SLE.
  • Hiroyuki Nakamura, Kenji Oku, Yusuke Ogata, Kazumasa Ohmura, Yoko Yoshida, Etsuko Kitano, Yuichiro Fujieda, Masaru Kato, Toshiyuki Bohgaki, Olga Amengual, Shinsuke Yasuda, Yoshihiro Fujimura, Tsukasa Seya, Tatsuya Atsumi
    Thrombosis research 164 63 - 68 0049-3848 2018/04 [Refereed][Not invited]
    INTRODUCTION: Although complement activation has been proposed as a possible thrombophilic mechanism in antiphospholipid syndrome (APS), the origin of complement activation in APS remains unclear. Here, we focused on complement regulatory factors (CRF), which control the complement system to prevent damage to host tissue. We evaluated the function of two major CRF, membrane cofactor protein (MCP) and factor H (FH), in APS patients. MATERIALS AND METHODS: In this study, we analyzed preserved serum samples from 27 patients with primary APS (PAPS), 20 with APS complicated with SLE (APS + SLE), 24 with SLE (SLE), and 25 with other connective tissue diseases (Other CTD). Serum MCP and FH levels were tested by ELISA. Autoantibodies against FH were determined by both ELISA and western-blotting. RESULTS: Serum complement levels of PAPS were lower than those of other CTD (median C3: 82 vs 112 mg/dL, p < 0.01, C4: 15 vs 22 mg/dL, p < 0.05). Serum MCP levels did not significantly differ among the groups. Serum FH levels were significantly lower in PAPS patients compared with SLE or other CTD (median 204, 1275, and 1220 μg/mL, respectively, p < 0.01). In PAPS patients, serum FH levels were positively correlated with serum C3 levels (p < 0.01, R = 0.55), but no correlation was found with serum C4 levels (p = 0.22, R = 0.33). Autoantibodies against FH were not detected in any of our patients. CONCLUSIONS: Activation of the alternative complement pathway due to low level of FH is one of the possible thrombophilic mechanisms in PAPS.
  • Mimori T, Harigai M, Atsumi T, Fujii T, Kuwana M, Matsuno H, Momohara S, Takei S, Tamura N, Takasaki Y, Yamamoto K, Ikeuchi S, Kushimoto S, Koike T
    Modern rheumatology 1 - 10 1439-7595 2018/04 [Refereed][Not invited]
  • Unlu O, Erkan D, Barbhaiya M, Andrade D, Nascimento I, Rosa R, Banzato A, Pengo V, Ugarte A, Gerosa M, Ji L, Efthymiou M, Branch DW, de Jesus GR, Tincani A, Belmont HM, Fortin PR, Petri M, Rodriguez E, Pons-Estel GJ, Knight JS, Atsumi T, Willis R, Zuily S, Tektonidou MG, TheBehalf of APS ACTION
    Arthritis care & research 2151-464X 2018/04 [Refereed][Not invited]
  • Hiroyuki Nakamura, Kenji Oku, Olga Amengual, Kazumasa Ohmura, Yuichiro Fujieda, Masaru Kato, Toshiyuki Bohgaki, Shinsuke Yasuda, Tatsuya Atsumi
    Arthritis care & research 70 (4) 627 - 634 2151-464X 2018/04 [Refereed][Not invited]
    OBJECTIVE: To assess the value of a combination of anti-β2 -glycoprotein I (anti-β2 GPI) domain I antibody and anti-phosphatidylserine/prothrombin complex (anti-PS/PT) antibody tests for the diagnosis of antiphospholipid syndrome (APS). METHODS: This cross-sectional study involved a cohort of the patients who visited our clinic from April 2005 to March 2013. Tests for anti-β2 GPI domain I antibodies, IgG anti-PS/PT antibodies, and IgM anti-PS/PT antibodies, together with tests for criteria-defined antiphospholipid antibodies (aPL), were performed in all patients. The total antiphospholipid score (aPL-S) was calculated for each patient according to titers of and positivity for aPL. RESULTS: The study enrolled 157 patients (51 patients with APS and 106 with non-APS autoimmune diseases). All 21 patients positive for both anti-β2 GPI domain I antibodies and IgG and/or IgM (IgG/IgM) anti-PS/PT antibodies had APS with a high total aPL-S (median 46, range 26-76), as did all of the 10 patients who were positive for anti-β2 GPI domain I antibodies but negative for IgG/IgM anti-PS/PT antibodies (median 22, range 4-39). Of the 14 patients who were positive for IgG/IgM anti-PS/PT antibodies but negative for anti-β2 GPI domain I antibodies, 11 (79%) had APS; these individuals also had high total aPL-S values (median 23, range 11-60). In contrast, only 9 of the 112 patients (8%) with none of these antibodies had APS. CONCLUSION: The combination of the IgG anti-β2 GPI domain I antibody and IgG/IgM anti-PS/PT antibody tests shows a high positive predictive value for the diagnosis of APS and a strong correlation with the aPL-S. This combination as the first-line test for aPL may contribute to the simple and definite identification of APS with a high risk of thrombosis in clinical practice.
  • Yuta Kochi, Yoichiro Kamatani, Yuya Kondo, Akari Suzuki, Eiryo Kawakami, Ryosuke Hiwa, Yukihide Momozawa, Manabu Fujimoto, Masatoshi Jinnin, Yoshiya Tanaka, Takashi Kanda, Robert G Cooper, Hector Chinoy, Simon Rothwell, Janine A Lamb, Jiří Vencovský, Heřman Mann, Koichiro Ohmura, Keiko Myouzen, Kazuyoshi Ishigaki, Ran Nakashima, Yuji Hosono, Hiroto Tsuboi, Hidenaga Kawasumi, Yukiko Iwasaki, Hiroshi Kajiyama, Tetsuya Horita, Mariko Ogawa-Momohara, Akito Takamura, Shinichiro Tsunoda, Jun Shimizu, Keishi Fujio, Hirofumi Amano, Akio Mimori, Atsushi Kawakami, Hisanori Umehara, Tsutomu Takeuchi, Hajime Sano, Yoshinao Muro, Tatsuya Atsumi, Toshihide Mimura, Yasushi Kawaguchi, Tsuneyo Mimori, Atsushi Takahashi, Michiaki Kubo, Hitoshi Kohsaka, Takayuki Sumida, Kazuhiko Yamamoto
    Annals of the rheumatic diseases 77 (4) 602 - 611 0003-4967 2018/04 [Refereed][Not invited]
    OBJECTIVES: Idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of rare autoimmune diseases in which both genetic and environmental factors play important roles. To identify genetic factors of IIM including polymyositis, dermatomyositis (DM) and clinically amyopathic DM (CADM), we performed the first genome-wide association study for IIM in an Asian population. METHODS: We genotyped and tested 496 819 single nucleotide polymorphism for association using 576 patients with IIM and 6270 control subjects. We also examined the causal mechanism of disease-associated variants by in silico analyses using publicly available data sets as well as by in in vitro analyses using reporter assays and apoptosis assays. RESULTS: We identified a variant in WDFY4 that was significantly associated with CADM (rs7919656; OR=3.87; P=1.5×10-8). This variant had a cis-splicing quantitative trait locus (QTL) effect for a truncated WDFY4isoform (tr-WDFY4), with higher expression in the risk allele. Transexpression QTL analysis of this variant showed a positive correlation with the expression of NF-κB associated genes. Furthermore, we demonstrated that both WDFY4 and tr-WDFY4 interacted with pattern recognition receptors such as TLR3, TLR4, TLR9 and MDA5 and augmented the NF-κB activation by these receptors. WDFY4 isoforms also enhanced MDA5-induced apoptosis to a greater extent in the tr-WDFY4-transfected cells. CONCLUSIONS: As CADM is characterised by the appearance of anti-MDA5 autoantibodies and severe lung inflammation, the WDFY4 variant may play a critical role in the pathogenesis of CADM.
  • Aika Miya, Akinobu Nakamura, Hideaki Miyoshi, Yoshinari Takano, Kana Sunagoya, Koji Hayasaka, Chikara Shimizu, Yasuo Terauchi, Tatsuya Atsumi
    Frontiers in Endocrinology 9 81  1664-2392 2018/03/20 [Refereed][Not invited]
    Objective: The aim of this study was to examine the fluctuations in CD4+ T cells, CD8+ T cells, and natural CD4+CD25+FoxP3+T-regulatory (Treg) cells following an oral glucose tolerance test (OGTT) in participants with and those without type 2 diabetes (T2DM). Methods: 19 Japanese participants with T2DM (DM group) and 21 participants without diabetes (non-DM group) were recruited and underwent a 75-g OGTT. The cell numbers of leukocytes, lymphocytes, and the T cell compartment, such as CD4+, CD8+, and Treg, were calculated for blood samples obtained after an overnight 12 h fast and during a 75-g OGTT at 60 and 120 min. Results: Before glucose loading, no differences in the cell numbers of leukocytes, lymphocytes, CD4+, CD8+, and Treg were observed between the DM group and the non-DM group. The proportion of CD8+ was significantly reduced, whereas the proportion of CD4+ was significantly increased, after 120 min of glucose loading in both groups. The proportion of Treg was not affected. Furthermore, a significant positive correlation was observed between the AUC0-120 min of CD8+ and the change in the free fatty acid level following the OGTT (ρ = 0.39, P < 0.05), but not that of glucose or insulin. Conclusion: The proportion of CD4+ T cells was increased and that of CD8+ T cells was reduced after glucose loading in both subjects with and without diabetes. These findings suggest that glucose loading dynamically affects the balance of the circulating T lymphocyte subset, regardless of glucose tolerance.
  • Mayuko Oita, Hideaki Miyoshi, Kota Ono, Akinobu Nakamura, Kyu Yong Cho, Hiroshi Nomoto, Kohei Yamamoto, Kazuno Omori, Naoki Manda, Yoshio Kurihara, Shin Aoki, Tatsuya Atsumi
    Endocrine journal 65 (2) 141 - 150 0918-8959 2018/02/26 [Refereed][Not invited]
    We compared treatment satisfaction between daily dipeptidyl peptidase-4 (DPP-4) inhibitors and a weekly DPP-4 inhibitor in patients with type 2 diabetes. The study was a 12-week, open-label, randomized, multicenter, controlled trial. Participants were Japanese patients with type 2 diabetes who had received daily DPP-4 inhibitors for more than 3 months. Patients were randomly assigned to a treatment cohort: (1) a group that continued taking daily DPP-4 inhibitors (daily group); or (2) a group that switched from daily DPP-4 inhibitors to a weekly DPP-4 inhibitor, trelagliptin (weekly group). The primary outcome was the change in treatment satisfaction levels from baseline to 12 weeks between the two groups, according to Diabetes Treatment Satisfaction Questionnaire (DTSQ) and Diabetes Therapy-Related Quality of Life (DTR-QOL) questionnaire scores. The changes in glycemic control and body weight were also assessed. Of 49 patients initially enrolled in the study, 47 completed the study. The change in DTSQ scores in the weekly group was not significantly different from that in the daily group. However, the improvements in total score and subscale domains 1 and 2 in the DTR-QOL analysis, which relate to burden on social/daily activities and anxiety/dissatisfaction with treatment, were significantly greater in the weekly group than the daily group (p = 0.048, 0.013 and 0.045, respectively). Mean changes in glycated hemoglobin levels and body weight were comparable between the groups. Switching from daily DPP-4 inhibitors to a weekly DPP-4 inhibitor, trelagliptin, could partially improve treatment satisfaction levels in patients with type 2 diabetes without affecting glycemic control.
  • Simone Mader, Venkatesh Jeganathan, Yoshiyuki Arinuma, Yuichiro Fujieda, Irena Dujmovic, Jelena Drulovic, Yuka Shimizu, Yuko Sakuma, Joel N. H. Stern, Cynthia Aranow, Meggan Mackay, Shinsuke Yasuda, Tatsuya Atsumi, Shunsei Hirohata, Betty Diamond
    Arthritis and Rheumatology 70 (2) 277 - 286 2326-5205 2018/02/01 [Refereed][Not invited]
    Objective: IgG anti-DWEYS antibodies cross-reactive with DNA and the N-methyl-d-aspartate receptor subunits GluN2A and GluN2B are known to be associated with neuropsychiatric systemic lupus erythematosus (NPSLE). IgG anti-DWEYS have not been investigated in demyelinating NPSLE or in another demyelinating disorder, neuromyelitis optica spectrum disorder (NMOSD), which is a disease also found mainly in young women and associated with aquaporin 4 (AQP-4) or myelin oligodendrocyte glycoprotein (MOG) antibodies. This study was undertaken to investigate the frequency of all of these brain-reactive antibodies in patients with NPSLE, those with demyelinating NPSLE, and those with NMOSD. Methods: Serum samples from patients with NPSLE (n = 108), patients with SLE without neuropsychiatric manifestations (n = 38), patients with NMOSD (n = 33), and healthy controls (n = 106) were assessed for the frequency of IgG anti-brain antibodies as well as IgG antibodies to AQP-4, MOG, GluN2A/GluN2B, and double-stranded DNA (dsDNA). Results: Sera were positive for IgG anti–AQP-4 antibodies in 27 (82%) of 33 patients with NMOSD and 3 (27%) of 11 patients with demyelinating NPSLE, whereas all sera from patients with non-demyelinating NPSLE, patients with SLE, and healthy controls were negative for IgG anti–AQP-4. IgG anti-MOG were detected at high titers in 3 (50%) of 6 patients with NMOSD who were negative for IgG anti–AQP-4, and at low titers in 2 (18%) of 11 patients with demyelinating NPSLE and 1 (1%) of 97 patients with non-demyelinating NPSLE. IgG antibodies to dsDNA were present in 11 (33%) of 33 patients with NMOSD. Only 4 (12%) of 33 patients with NMOSD were positive for IgG anti-DWEYS, compared to 11 (29%) of 38 patients with SLE and 59 (55%) of 108 patients with NPSLE. IgG anti-DWEYS antibodies were present in 56 (58%) of 97 patients with non-demyelinating NPSLE and 3 (27%) of 11 patients with demyelinating NPSLE. Serum IgG brain-reactive antibodies were present at a similar frequency in patients with non-demyelinating NPSLE (72 [75%] of 96), those with demyelinating NPSLE (9 [82%] of 11), and those with SLE (32 [84%] of 38), but were less frequent in patients with NMOSD (20 [61%] of 33). Conclusion: Patients with demyelinating NPSLE should be tested for IgG antibodies to AQP-4, MOG, and DWEYS. IgG anti–AQP-4 can be considered diagnostic for NMOSD, whereas none of these antibodies appear to be diagnostic for demyelinating NPSLE. Moreover, IgG anti-dsDNA are present in patients with NMOSD but are not cross-reactive with IgG anti-DWEYS, indicating that the antigenic stimulus and mechanisms of tissue damage are potentially different between demyelinating NPSLE and NMOSD.
  • Masaru Kato, Tatsuya Atsumi
    European Journal of Clinical Investigation 48 (2) 1365-2362 2018/02/01 [Refereed][Not invited]
    Recent studies have clarified that pulmonary arterial hypertension associated with connective tissue diseases (CTD-PAH) has some distinctive clinical aspects from other PAH, such as high prevalence, venous and cardiac involvement, less favourable outcome, helpfulness of detection algorithm, response to immunosuppression, pre-PAH conditions in borderline pulmonary arterial pressure and coexistence of interstitial lung disease. In this review, by focusing on these distinctive aspects, we discuss how to provide an efficacious and safe management of CTD-PAH and garner attention to areas where further evidence is desired.
  • Amengual O, Atsumi T
    Modern rheumatology 28 (3) 1 - 8 1439-7595 2018/02 [Refereed][Not invited]
  • Kohei Yamamoto, Hideaki Miyoshi, Kyu Yong Cho, Akinobu Nakamura, Andrew S Greenberg, Tatsuya Atsumi
    Atherosclerosis 269 192 - 196 0021-9150 2018/02 [Refereed][Not invited]
    BACKGROUND AND AIMS: Perilipin1 (PLIN1), a lipid droplet-associated protein, plays an important role in the regulation of lipolysis and lipid storage in adipocytes. PLIN1 has recently been reported to be expressed in macrophages within atheroma plaques, suggesting PLIN1 may play a role in the accumulation of lipids at the arterial wall and in the development of atherosclerosis. To clarify the role of PLIN1 in the pathophysiology of atherosclerosis, we assessed the progression of atherosclerosis in PLIN1 transgenic mice (Plin1Tg). METHODS: Plin1Tg were crossed with apolipoprotein E knockout mice (ApoeKO). C57BL/6J mice, ApoeKO and Plin1Tg/ApoeKO received a normal chow diet for 20 weeks. Body weight, gonadal fat mass and plasma lipid concentrations were measured. Aortas were collected for quantification of atheroma lesions and histological analysis by Oil Red O staining. RESULTS: Body weight, gonadal adipose mass and plasma triglyceride concentrations were not significantly different among the three groups. In contrast, the atherosclerotic lesion area was significantly increased in ApoeKO (14.2 ± 3.2%; p < .01) compared with C57BL/6J mice (3.3 ± 1.2%) and Plin1Tg/ApoeKO (5.6 ± 1.9%). CONCLUSIONS: Overexpressed PLIN1 in macrophages had a protected role against atheroma progression in ApoeKO in the absence of changes in gonadal fat mass or plasma lipid levels, presumably due to modification of the stability and/or inflammatory profile of macrophages.
  • Motoshi Fujimori, Tamotsu Kamishima, Masaru Kato, Yumika Seno, Kenneth Sutherland, Hiroyuki Sugimori, Mutsumi Nishida, Tatsuya Atsumi
    British Journal of Radiology 91 (1086) 20170748  0007-1285 2018 [Refereed][Not invited]
    © 2018 The Authors. Published by the British Institute of Radiology. Objective: Power Doppler ultrasonography (PDUS) and MRI are independently useful to predict structural damage in patients with rheumatoid arthritis (RA). We hypothesize that there is a complementary relationship between these modalities. The aim of this study is, therefore, to investigate the usefulness of the predictive value of composite assessment of PDUS and contrast-enhanced MRI in radiographic outcomes in patients with RA. Methods: 20 patients (17 females and 3 males) with RA on disease-modifying antirheumatic drugs underwent PDUS and MRI of both hands at baseline. Radiography of the bilateral hands was performed at baseline and at 1 year. Articular synovitis on PDUS was evaluated according to quantitative measurement. Synovitis, bone marrow edema and bone erosion were scored according to the RA MRI scoring method. The changes of joint space narrowing and bone erosion on radiograph were assessed by the Sharp/van der Heijde method. We applied t-statistics to combine the assessment of quantitative PDUS with semiquantitative MRI. Results: Structural damage progression for radiography was not correlated with any evaluations for MRI, while it showed significant correlation with synovitis on PDUS (rs = 0.597, p = 0.005). The composite assessment of both modalities (synovitis for PDUS and bone marrow edema for MRI) was correlated with structural damage progression on radiograph (rs = 0.792, p < 0.0001). Conclusion: Composite assessment of PDUS and MRI may have a stronger predictive value in radiographic progression than PDUS or MRI alone in RA. Advances in knowledge: Composite assessment of PDUS and MRI may be an effective predictor of structural damage in RA.
  • Aika Miya, Akinobu Nakamura, Hideaki Miyoshi, Kyu Yong Cho, So Nagai, Yoshio Kurihara, Shin Aoki, Masataka Taguri, Yasuo Terauchi, Tatsuya Atsumi
    Journal of diabetes investigation 9 (1) 119 - 126 2040-1116 2018/01 [Refereed][Not invited]
    AIMS/INTRODUCTION: We compared the satisfaction levels of patients with type 2 diabetes undergoing combination therapy with lixisenatide (LIX) and basal insulin with that of patients undergoing multiple daily insulin injection (MDI) therapy. MATERIALS AND METHODS: The study was a 12-week open-label, randomized, multicenter, controlled trial. Participants were Japanese patients with type 2 diabetes receiving MDI for >3 months. Patients were randomly assigned to each treatment cohort: (i) a group that continued MDI (MDI group); and (ii) a group that switched from MDI to combination therapy with LIX and basal insulin (LIX group). The primary outcome was change in Diabetes Treatment Satisfaction Questionnaire scores from baseline to 12 weeks between these two groups. Key secondary outcomes were glycated hemoglobin and body weight changes. RESULTS: A total of 31 patients were initially enrolled in the study, and 26 of them completed the study. The change in Diabetes Treatment Satisfaction Questionnaire scores in the LIX group was significantly greater compared with that in the MDI group. Mean changes in glycated hemoglobin levels were -0.05 ± 0.37% in the MDI group and 0.04 ± 0.38% in the LIX group (P = 0.36). Mean changes in body weight were +0.6 ± 1.8 kg in the MDI group and -2.5 ± 1.8 kg in the LIX group (P < 0.01). CONCLUSIONS: Switching from MDI to combination therapy with LIX and basal insulin improved satisfaction levels while maintaining glycemic control in Japanese patients with type 2 diabetes.
  • Hiroshi Nomoto, Hideaki Miyoshi, Akinobu Nakamura, So Nagai, Chikara Shimizu, Tatsuya Atsumi
    Internal Medicine 57 (3) 453  1349-7235 2018 [Refereed][Not invited]
  • Nakamura H, Odani T, Yasuda S, Noguchi A, Fujieda Y, Kato M, Oku K, Bohgaki T, Sugita J, Endo T, Teshima T, Atsumi T
    Modern rheumatology 28 (5) 1 - 6 1439-7595 2018/01 [Refereed][Not invited]
  • Atsumi T, Fujio K, Yamaoka K, Tomobe M, Kuroyanagi K, Kameda H
    Modern rheumatology 28 (5) 1 - 9 1439-7595 2018/01 [Refereed][Not invited]
  • Efficient detection of pulmonary arterial hypertension using serum haptoglobin level and cardiac MRI in patients with connective tissue diseases: A pilot study
    H. Nakamura, Masaru Kato, A. Noguchi, H. Ohira, I. Tsujino, T. Atsumi
    Clinical and Experimental Rheumatology 36 (2) 345 - 346 1593-098X 2018 [Refereed][Not invited]
  • Tanimura S, Fujieda Y, Kono M, Shibata Y, Hisada R, Sugawara E, Nakamura H, Ohmura K, Shimamura S, Mitani A, Shida H, Watanabe T, Kato M, Oku K, Bohgaki T, Amengual O, Yasuda S, Shimizu C, Atsumi T
    Modern rheumatology 28 (5) 1 - 7 1439-7595 2017/12 [Refereed][Not invited]
  • Oku K, Atsumi T, Akiyama Y, Amano H, Azuma N, Bohgaki T, Asanuma YF, Horita T, Hosoya T, Ichinose K, Kato M, Katsumata Y, Kawaguchi Y, Kawakami A, Koga T, Kohsaka H, Kondo Y, Kubo K, Kuwana M, Mimori A, Mimori T, Mimura T, Murakami K, Nakano K, Nakayamada S, Ogishima H, Ohmura K, Saito K, Sano H, Shibuya M, Takahashi Y, Takasaki Y, Takeuchi T, Tamura N, Tanaka Y, Tsuboi H, Tsunoda S, Yukawa N, Yamakawa N, Yamamoto K, Sumida T
    Modern rheumatology 28 (4) 1 - 7 1439-7595 2017/11 [Refereed][Not invited]
  • Tanaka Y, Atsumi T, Amano K, Harigai M, Ishii T, Kawaguchi O, Rooney TP, Akashi N, Takeuchi T
    Modern rheumatology 28 (4) 1 - 9 1439-7595 2017/11 [Refereed][Not invited]
  • Shimizu Y, Yasuda S, Kimura T, Nishio S, Kono M, Ohmura K, Shimamura S, Kono M, Fujieda Y, Kato M, Oku K, Bohgaki T, Fukasawa Y, Tanaka S, Atsumi T
    Modern rheumatology 28 (4) 1 - 9 1439-7595 2017/11 [Refereed][Not invited]
  • Ryosuke Sakano, Katsumi Saito, Tamotsu Kamishima, Mutsumi Nishida, Tatsunori Horie, Atsushi Noguchi, Michihito Kono, Kenneth Sutherland, Tatsuya Atsumi
    ACTA RADIOLOGICA 58 (10) 1238 - 1244 0284-1851 2017/10 [Refereed][Not invited]
    Background: Despite the advantages of ultrasound (US) in the management of rheumatoid arthritis (RA) patients, power Doppler (PD) US may be highly dependent on the type of US machine used. Purpose: To present a method to calibrate the PD signal of two models of US machines by use of a flow phantom and finger joints of patients with RA. Material and Methods: For the phantom study, the PD signal count was measured in the flow phantom perfusing blood mimicking fluid at various injection rates and pulse repetition frequencies (PRFs). The quantitative PD index was calculated with ImageJ. For the clinical study, the second and third metacarpophalangeal joints of five consecutive patients with RA were examined. The quantitative PD index was measured at various PRFs by use of two models of machine (the same models as the phantom study). Results: For the phantom and clinical studies, negative correlations were found between the PRF and the quantitative PD index when the flow velocity was constant and positive correlations between flow velocity and the quantitative PD index at constant PRF. There was a significant difference in the depiction performance of synovial blood flow between the two models, which can be calibrated by adjusting the PRF values derived from the phantom study in each model. Conclusion: Signal calibration of pannus vascularity between US machines may be possible by adjusting the PRF value according to flow phantom data. Different US machines can thus provide equivalent examination results concerning the pannus vascularity.
  • Ryosuke Hiwa, Koichiro Ohmura, Noriko Arase, Hui Jin, Kouyuki Hirayasu, Masako Kohyama, Tadahiro Suenaga, Fumiji Saito, Chikashi Terao, Tatsuya Atsumi, Hirotsugu Iwatani, Tsuneyo Mimori, Hisashi Arase
    Arthritis & rheumatology (Hoboken, N.J.) 69 (10) 2069 - 2080 2326-5191 2017/10 [Refereed][Not invited]
    OBJECTIVE: Autoantibodies against myeloperoxidase (MPO) that are expressed in neutrophils play an important role in the pathogenesis of microscopic polyangiitis (MPA). We recently observed that misfolded cellular proteins are transported to the cell surface by HLA class II molecules and are targeted by autoantibodies in patients with rheumatoid arthritis or antiphospholipid syndrome, suggesting that HLA class II molecules play an important role in autoantibody recognition. The aim of this study was to address the role of HLA class II molecules in the cell surface expression of MPO in patients with MPA. METHODS: The association of MPO with HLA-DR was analyzed using MPO and HLA-DR transfectants as well as neutrophils from healthy donors and patients with MPA. Autoantibody binding to the MPO/HLA-DR complex was analyzed by flow cytometry. The association of MPO with HLA-DR was assessed using the immunoprecipitation technique. The function of MPO-antineutrophil cytoplasmic antibody (ANCA) was assessed using a neutrophil-like cell line expressing HLA-DR and MPO. RESULTS: MPO protein was detected on the cell surface in the presence of HLA-DR, and the MPO/HLA-DR complex was recognized by MPO-ANCA. A competitive inhibition assay suggested that MPO associated with HLA-DR expresses cryptic autoantibody epitopes for MPO-ANCA. Autoantibody binding to the MPO/HLA-DR complex was correlated with disease susceptibility conferred by each HLA-DR allele, suggesting that the MPO/HLA-DR complex is involved in the pathogenicity of MPA. Indeed, MPO-HLA class II complexes were detected in neutrophils from a patient with MPA as well as in cytokine-stimulated neutrophils from healthy donors. Moreover, MPO-ANCA stimulated MPO/HLA-DR complex-expressing HL-60 cells. CONCLUSION: Our findings suggest that MPO complexed with HLA class II molecules is involved in the pathogenesis of MPA as a target for MPO-ANCA.
  • Naoyuki Kitao, Hideaki Miyoshi, Tomoo Furumoto, Kota Ono, Hiroshi Nomoto, Aika Miya, Chiho Yamamoto, Atsushi Inoue, Kenichi Tsuchida, Naoki Manda, Yoshio Kurihara, Shin Aoki, Akinobu Nakamura, Tatsuya Atsumi
    CARDIOVASCULAR DIABETOLOGY 16 (1) 125  1475-2840 2017/10 [Refereed][Not invited]
    Background: Dipeptidyl peptidase-4 (DPP-4) inhibitors may have protective effects in the early stage of atherosclerosis in patients with type 2 diabetes, although similar effects in advanced atherosclerosis were not shown in recent randomized placebo-controlled studies. Therefore, we investigated the efficacy of DPP-4 inhibitor on endothelial function and glycemic metabolism compared with high-dose metformin. Methods: In this multicenter, open-labeled, prospective, randomized, parallel-group comparison study, patients with type 2 diabetes treated with low-dose metformin (500-750 mg/day) were enrolled and randomly assigned to a vildagliptin, a DPP-4 inhibitor, add-on group (Vilda) or a double dose of metformin group (high Met) for 12 weeks. Flow-mediated dilation (FMD) and serum metabolic markers were assessed before and after treatment. In addition, glycemic control and metabolic parameters were also assessed. Results: Ninety-seven subjects (aged 58.7 +/- 11.0 years; body mass index, 25.9 +/- 4.4 kg/m(2); HbA1c, 7.3 +/- 0.5%; FMD, 5.8 +/- 2.6%) were enrolled. Eight subjects dropped out by the end of the study. There were no significant differences between the two groups in baseline characteristics. After 12 weeks, HbA1c was significantly improved in the Vilda group compared with the high Met group (-0.80 +/- 0.38% vs. -0.40 +/- 0.47%, respectively; p < 0.01). However, there were no significant differences in FMD (-0.51 [-1.08-0.06]% vs. -0.58 [-1.20-0.04]%). Although the apolipoprotein B/apolipoprotein A1 ratio was significantly reduced in the Vilda group compared with baseline (0.66-0.62; p < 0.01), the change did not differ significantly between the two groups (-0.04 vs. 0.00; p = 0.27). Adiponectin levels were significantly increased in the Vilda group compared with the high Met group (0.75 mu g/mL vs. 0.01 mu g/mL; p < 0.01). Conclusions: Regardless of glycemic improvement, combination therapy of vildagliptin and metformin did not affect endothelial function but may exert favorable effects on adipokine levels and lipid profile in patients with type 2 diabetes without advanced atherosclerosis.
  • Kaneko K, Mishima S, Goto M, Mitsui M, Tanigaki S, Oku K, Ozawa N, Inoue E, Atsumi T, Sago H, Murashima A
    Modern rheumatology 28 (4) 1 - 6 1439-7595 2017/10 [Refereed][Not invited]
  • Hiroyuki Nakamura, Masaru Kato, Toshitaka Nakaya, Michihiro Kono, Shun Tanimura, Takahiro Sato, Yuichiro Fujieda, Kenji Oku, Hiroshi Ohira, Toshiyuki Bohgaki, Shinsuke Yasuda, Ichizo Tsujino, Masaharu Nishimura, Tatsuya Atsumi
    MEDICINE 96 (43) e8349  0025-7974 2017/10 [Refereed][Not invited]
    We investigated the serum haptoglobin levels in patients with pulmonary arterial hypertension (PAH) based on the hypothesis that haptoglobin levels would reflect subclinical hemolysis due to microangiopathy in pulmonary arterioles.This cross-sectional study included 3 groups of patients attending Hokkaido University Hospital: PAH, chronic thromboembolic pulmonary hypertension (CTEPH), and connective tissue diseases (CTD) without PAH (CTD-non-PAH) group. Serum haptoglobin levels were measured by standardized turbidimetric immunoassay in all patients. Demographic data, laboratory results, right heart catheter, and echocardiographic findings were extracted from the medical records. Decreased haptoglobin levels were defined as below 19mg/dL based on the 95th percentile of healthy controls.Thirty-five patients in PAH group including 11 with idiopathic PAH (IPAH) and 24 with CTD-associated PAH (CTD-PAH), 27 in CTEPH group, and 32 in CTD-non-PAH group were analyzed. Serum haptoglobin levels in PAH group (median 66mg/dL) were significantly lower than those in CTEPH group (median 94mg/dL, P=.03) and CTD-non-PAH group (median 79mg/dL, P=.03). The prevalence of decreased haptoglobin levels was 26% in PAH group, 15% in CTEPH group, and 6% in CTD-non-PAH group. Serum haptoglobin levels had a significant negative correlation (r=-0.66, P<.001) with mean pulmonary artery pressure in PAH group, particularly in CTD-PAH subgroup (r=-0.74, P<.001), but no correlation in IPAH subgroup (r=-0.52, P=.13) and in CTEPH group (r=-0.17, P=.41). Follow-up cases of CTD-PAH showed lowering pulmonary artery pressure led to normalizing serum haptoglobin levels.Serum haptoglobin levels decreased in PAH patients and inversely correlated with pulmonary artery pressure in CTD-PAH patients, suggesting their potential as a surrogate marker for CTD-PAH.
  • Mimori T, Harigai M, Atsumi T, Fujii T, Kuwana M, Matsuno H, Momohara S, Takei S, Tamura N, Takasaki Y, Ikeuchi S, Kushimoto S, Koike T
    Modern rheumatology 27 (5) 755 - 765 1439-7595 2017/09 [Refereed][Not invited]
  • Mayumi Sugiura-Ogasawara, Yosuke Omae, Minae Kawashima, Licht Toyo-Oka, Seik-Soon Khor, Hiromi Sawai, Tetsuya Horita, Tatsuya Atsumi, Atsuko Murashima, Daisuke Fujita, Tomio Fujita, Shinji Morimoto, Eriko Morishita, Shinji Katsuragi, Tamao Kitaori, Kinue Katano, Yasuhiko Ozaki, Katsushi Tokunaga
    JOURNAL OF HUMAN GENETICS 62 (9) 831 - 838 1434-5161 2017/09 [Refereed][Not invited]
    Antiphospholipid syndrome (APS) is the most important treatable cause of recurrent pregnancy loss. The live birth rate is limited to only 70-80% in patients with APS undergoing established anticoagulant therapy. Lupus anticoagulant (LA), but not anticardiolipin antibody (aCL), was found to predict adverse pregnancy outcome. Recent genome-wide association studies (GWAS) of APS focusing on aCL have shown that several molecules may be involved. This is the first GWAS for obstetric APS focusing on LA. A GWAS was performed to compare 115 Japanese patients with obstetric APS, diagnosed according to criteria of the International Congress on APS, and 419 healthy individuals. Allele or genotype frequencies were compared in a total of 426 344 single-nucleotide polymorphisms (SNPs). Imputation analyses were also performed for the candidate regions detected by the GWAS. One SNP (rs2288493) located on the 3'-UTR of TSHR showed an experiment-wide significant APS association (P=7.85E-08, OR=6.18) under a recessive model after Bonferroni correction considering the number of analyzed SNPs. Another SNP (rs79154414) located around the C1D showed a genome-wide significant APS association (P=4.84E-08, OR=6.20) under an allelic model after applying the SNP imputation. Our findings demonstrate that a specific genotype of TSHR and C1D genes can be a risk factor for obstetric APS.
  • Atsumi T, Ando Y, Matsuda S, Tomizawa S, Tanaka R, Takagi N, Nakasone A
    Modern rheumatology 28 (3) 1 - 9 1439-7595 2017/09 [Refereed][Not invited]
  • Hiroshi Nomoto, Hideaki Miyoshi, Akinobu Nakamura, So Nagai, Naoyuki Kitao, Chikara Shimizu, Tatsuya Atsumi
    MEDICINE 96 (39) e8147  0025-7974 2017/09 [Refereed][Not invited]
    Rationale: Saccharated ferric oxide has been shown to lead to elevation of fibroblast growth factor 23, hypophosphatemia, and, consequently, osteomalacia. Moreover, mineral imbalance is often observed in patients with short-bowel syndrome to some degree. Patient concerns: A 62-year-old woman with short-bowel syndrome related with multiple resections of small intestines due to Crohn disease received regular intravenous administration of saccharated ferric oxide. Over the course of treatment, she was diagnosed with tetany, which was attributed to hypocalcemia. Additional assessments of the patient revealed not only hypocalcemia, but also hypophosphatemia, hypomagnesemia, osteomalacia, and a high concentration of fibroblast growth factor 23 (314 pg/mL). Diagnoses: We diagnosed her with mineral imbalance-induced osteomalacia due to saccharated ferric oxide and short-bowel syndrome. Interventions: Magnesium replacement therapy and discontinuation of saccharated ferric oxide alone. Outcomes: These treatments were able to normalize her serum mineral levels and increase her bone mineral density. Lessons: This case suggests that adequate evaluation of serum minerals, including phosphate and magnesium, during saccharated ferric oxide administration may be necessary, especially in patients with short-bowel syndrome.
  • Tatsuya Atsumi, Yoshiya Tanaka, Kazuhiko Yamamoto, Tsutomu Takeuchi, Hisashi Yamanaka, Naoki Ishiguro, Katsumi Eguchi, Akira Watanabe, Hideki Origasa, Shinsuke Yasuda, Yuji Yamanishi, Yasuhiko Kita, Tsukasa Matsubara, Masahiro Iwamoto, Toshiharu Shoji, Osamu Togo, Toshiyuki Okada, Desiree van der Heijde, Nobuyuki Miyasaka, Takao Koike
    ANNALS OF THE RHEUMATIC DISEASES 76 (8) 1348 - 1356 0003-4967 2017/08 [Refereed][Not invited]
    Objectives To investigate the clinical impact of 1-year certolizumab pegol (CZP) therapy added to the first year of 2-year methotrexate (MTX) therapy, compared with 2-year therapy with MTX alone. Methods MTX-naive patients with early rheumatoid arthritis (RA) with poor prognostic factors were eligible to enter Certolizumab-Optimal Prevention of joint damage for Early RA (C-OPERA), a multicentre, randomised, controlled study, which consisted of a 52-week double-blind (DB) period and subsequent 52-week post treatment (PT) period. Patients were randomised to optimised MTX+CZP (n=159) or optimised MTX+placebo (PBO; n=157). Following the DB period, patients entered the PT period, receiving MTX alone (CZP+MTX -> MTX; n=108, PBO+MTX -> MTX; n=71). Patients who flared could receive rescue treatment with open-label CZP. Results 34 CZP+MTX -> MTX patients and 14 PBO+MTX -> MTX patients discontinued during the PT period. From week 52 through week 104, significant inhibition of total modified total Sharp score progression was observed for CZP+MTX versus PBO+MTX (week 104: 84.2% vs 67.5% (p<0.001)). Remission rates decreased after CZP discontinuation; however, higher rates were maintained through week 104 in CZP+MTX -> MTX versus PBO+MTX -> MTX (41.5% vs 29.3% (p=0.026), 34.6% vs 24.2% (p=0.049) and 41.5% vs 33.1% (p=0.132) at week 104 in SDAI, Boolean and DAS28(erythrocyte sedimentation rate) remission. CZP retreated patients due to flare (n=28) showed rapid clinical improvement. The incidence of overall adverse events was similar between groups. Conclusions In MTX-naive patients with early RA with poor prognostic factors, an initial 1 year of add-on CZP to 2-year optimised MTX therapy brings radiographic and clinical benefit through 2 years, even after stopping CZP.
  • Junya Yamamoto, Saori Nishio, Fumihiko Hattanda, Daigo Nakazawa, Toru Kimura, Michio Sata, Minoru Makita, Yasunobu Ishikawa, Tatsuya Atsumi
    KIDNEY INTERNATIONAL 92 (2) 377 - 387 0085-2538 2017/08 [Refereed][Not invited]
    Autosomal dominant polycystic kidney disease (ADPKD) is characterized by the progressive development of kidney and liver cysts. The mammalian target of rapamycin (mTOR) cascade is one of the important pathways regulating cyst growth in ADPKD. Branched-chain amino acids (BCAAs), including leucine, play a crucial role to activate mTOR pathway. Therefore, we administered BCAA dissolved in the drinking water to Pkd1(flox/flox): Mx1-Cre (cystic) mice from four to 22 weeks of age after polyinosinic-polycytidylic acid-induced conditional Pkd1 knockout at two weeks of age. The BCAA group showed significantly greater kidney/body weight ratio and higher cystic index in both the kidney and liver compared to the placebo-treated mice. We found that the L-type amino acid transporter 1 that facilitates BCAA entry into cells is strongly expressed in cells lining the cysts. We also found increased cyst-lining cell proliferation and upregulation of mTOR and mitogenactivated protein kinase/extracellular signal-regulated kinase (MAPK/ERK) pathways in the BCAA group. In vitro, we cultured renal epithelial cell lines from Pkd1 null mice with or without leucine. Leucine was found to stimulate cell proliferation, as well as activate mTOR and MAPK/ERK pathways in these cells. Thus, BCAA accelerated disease progression by mTOR and MAPK/ERK pathways. Hence, BCAA may be harmful to patients with ADPKD.
  • Sakiko Masuda, Sakika Shimizu, Junji Matsuo, Yuka Nishibata, Yoshihiro Kusunoki, Fumihiko Hattanda, Haruki Shida, Daigo Nakazawa, Utano Tomaru, Tatsuya Atsumi, Akihiro Ishizu
    CYTOMETRY PART A 91A (8) 822 - 829 1552-4922 2017/08 [Refereed][Not invited]
    Neutrophil extracellular traps (NETs) are extracellular chromatin fibers adorned with antimicrobial proteins, such as myeloperoxidase (MPO), which are extruded from activated neutrophils. NETosis is the metamorphosis of neutrophils with NET formation that follows decondensation of DNA and rupture of the plasma membrane. Although NETs play important roles in innate immunity, excessive formation of NETs can be harmful to the hosts. Until now, various methods for evaluation of NETs have been reported. Although each has a virtue, the gold standard has not been established. Here we demonstrate a simple, objective, and quantitative method to detect NETs using flow cytometry. This method uses a plasma membrane-impermeable DNA-binding dye, SYTOX Green. SYTOX Green-positive cells were detected in human peripheral polymorphonuclear cells exposed to a NET inducer, phorbol 12-myristate 13-acetate (PMA). The number of SYTOX Green-positive cells was increased depending on the exposure duration and concentrations of PMA. Furthermore, co-localization of MPO and plasma membrane-appendant DNA of SYTOX Green-positive cells was demonstrated. Moreover, a NET inhibitor, diphenylene iodonium, could significantly reduce the number of SYTOX Green-positive cells induced by PMA. The collective evidence suggests that SYTOX Green-positive cells include neutrophils that formed NETs. The established method could detect neutrophils that underwent NETosis but not early apoptosis with equivalence in quantification to another well-used image analysis, which is based on fluorescent staining. Additionally, NETs that were formed in vivo were also detectable by this method. It is conceivable that the established method will bring us better understanding of the relation between NETosis and human diseases. (c) 2017 The Authors. Cytometry Part A published by Wiley Periodicals, Inc. on behalf of ISAC.
  • Kenji Oku, Olga Amengual, Shinsuke Yasuda, Tatsuya Atsumi
    CURRENT RHEUMATOLOGY REPORTS 19 (8) 51  1523-3774 2017/08 [Refereed][Not invited]
    Purpose of Review Antiphospholipid syndrome (APS) is a clinical disorder characterised by thrombosis and/or pregnancy morbidity in the persistence of antiphospholipid (aPL) antibodies that are pathogenic and have procoagulant activities. Thrombosis in APS tends to recur and require prophylaxis; however, the stereotypical treatment for APS patients is inadequate and stratification of the thrombotic risks is important as aPL are prevalently observed in various diseases or elderly population. Recent Findings It is previously known that the multiple positive aPL or high titre aPL correlate to thrombotic events. To progress the stratification of thrombotic risks in APS patients and to quantitatively analyse those risks, antiphospholipid score (aPL-S) and the Global Antiphospholipid Syndrome Score (GAPSS) were defined. These scores were raised from the large patient cohort data and either aPL profile classified in detail (aPL-S) or simplified aPL profile with classical thrombotic risk factors (GAPSS) was put into a scoring system. Both the aPL-S and GAPSS have shown a degree of accuracy in identifying high-risk APS patients, especially those at a high risk of thrombosis. However, there are several areas requiring improvement, or at least that clinicians should be aware of, before these instruments are applied in clinical practice. One such issue is standardisation of the aPL tests, including general testing of phosphatidylserinedependent antiprothrombin antibodies (aPS/PT). Summary Additionally, clinicians may need to be aware of the patient's medical history, particularly with respect to the incidence of SLE, which influences the cutoff value for identifying high-risk patients.
  • Hiroshi Nomoto, Hideaki Miyoshi, Hajime Sugawara, Kota Ono, Shingo Yanagiya, Mayuko Oita, Akinobu Nakamura, Tatsuya Atsumi
    DIABETOLOGY & METABOLIC SYNDROME 9 54  1758-5996 2017/07 [Refereed][Not invited]
    Background: Dipeptidyl peptidase-4 (DPP-4) inhibitors and sodium-glucose co-transporter 2 (SGLT2) inhibitors improve hyperglycemia, and the usefulness of co-administration of DPP-4 inhibitors and insulin therapy has been well established. However, it has been still uncertain whether combination therapy of SGLT2 inhibitors and insulin is superior to that of DPP-4 inhibitors and the latter. Therefore, we investigated the superiority of dapagliflozin on glucose fluctuation compared with DPP-4 inhibitors in patients with type 2 diabetes mellitus (T2DM) on insulin using a continuous glucose monitoring (CGM) system. Methods: In this prospective, randomized, open-label controlled trial, 36 patients with T2DM and treated with DPP-4 inhibitors and insulin therapy, were enrolled and allocated into two groups. The patients either switched their DPP-4 inhibitors to dapagliflozin 5 mg for 12 weeks, or continued their DPP-4 inhibitors for the same period. CGM analyses and metabolic markers were assessed before and after treatment periods. Results: In total, data from 29 patients were analyzed. There were no significant differences in the mean amplitude of glycemic excursions and other CGM profiles in either group after treatment. Within the dapagliflozin treatment group, significant reductions of body mass index and albuminuria, and increases of HbA1c, hemoglobin and hematocrit were observed, but improvement of albuminuria was not significant if compared with the DPP-4 continuation group. Conclusions: Combination therapy of dapagliflozin and insulin was not superior in glucose fluctuation to DPP-4 inhibitors on insulin. However, dapagliflozin may in part provide favorable effects on metabolism in patients with T2DM treated with insulin therapy.
  • Chikashi Terao, Takahisa Kawaguchi, Philippe Dieude, John Varga, Masataka Kuwana, Marie Hudson, Yasushi Kawaguchi, Marco Matucci-Cerinic, Koichiro Ohmura, Gabriela Riemekasten, Aya Kawasaki, Paolo Airo, Tetsuya Horita, Akira Oka, Eric Hachulla, Hajime Yoshifuji, Paola Caramaschi, Nicolas Hunzelmann, Murray Baron, Tatsuya Atsumi, Paul Hassoun, Takeshi Torii, Meiko Takahashi, Yasuharu Tabara, Masakazu Shimizu, Akiko Tochimoto, Naho Ayuzawa, Hidetoshi Yanagida, Hiroshi Furukawa, Shigeto Tohma, Minoru Hasegawa, Manabu Fujimoto, Osamu Ishikawa, Toshiyuki Yamamoto, Daisuke Goto, Yoshihide Asano, Masatoshi Jinnin, Hirahito Endo, Hiroki Takahashi, Kazuhiko Takehara, Shinichi Sato, Hironobu Ihn, Soumya Raychaudhuri, Katherine Liao, Peter Gregersen, Naoyuki Tsuchiya, Valeria Riccieri, Inga Melchers, Gabriele Valentini, Anne Cauvet, Maria Martinez, Tsuneyo Mimori, Fumihiko Matsuda, Yannick Allanore
    Annals of the rheumatic diseases 76 (6) 1150 - 1158 0003-4967 2017/06 [Refereed][Not invited]
    OBJECTIVES: Systemic sclerosis (SSc) is an autoimmune disease characterised by skin and systemic fibrosis culminating in organ damage. Previous genetic studies including genome-wide association studies (GWAS) have identified 12 susceptibility loci satisfying genome-wide significance. Transethnic meta-analyses have successfully expanded the list of susceptibility genes and deepened biological insights for other autoimmune diseases. METHODS: We performed transethnic meta-analysis of GWAS in the Japanese and European populations, followed by a two-staged replication study comprising a total of 4436 cases and 14 751 controls. Associations between significant single nuclear polymorphisms (SNPs) and neighbouring genes were evaluated. Enrichment analysis of H3K4Me3, a representative histone mark for active promoter was conducted with an expanded list of SSc susceptibility genes. RESULTS: We identified two significant SNP in two loci, GSDMA and PRDM1, both of which are related to immune functions and associated with other autoimmune diseases (p=1.4×10-10 and 6.6×10-10, respectively). GSDMA also showed a significant association with limited cutaneous SSc. We also replicated the associations of previously reported loci including a non-GWAS locus, TNFAIP3. PRDM1 encodes BLIMP1, a transcription factor regulating T-cell proliferation and plasma cell differentiation. The top SNP in GSDMA was a missense variant and correlated with gene expression of neighbouring genes, and this could explain the association in this locus. We found different human leukocyte antigen (HLA) association patterns between the two populations. Enrichment analysis suggested the importance of CD4-naïve primary T cell. CONCLUSIONS: GSDMA and PRDM1 are associated with SSc. These findings provide enhanced insight into the genetic and biological basis of SSc.
  • Aki Kondo, Akinobu Nakamura, Jun Takeuchi, Hideaki Miyoshi, Tatsuya Atsumi
    DIABETES CARE 40 (6) E67 - E68 0149-5992 2017/06 [Refereed][Not invited]
  • Kiyohiko Takahashi, Akinobu Nakamura, Hideaki Miyoshi, Hiroshi Nomoto, Hiraku Kameda, Kyu Yong Cho, So Nagai, Chikara Shimizu, Masataka Taguri, Yasuo Terauchi, Tatsuya Atsumi
    ENDOCRINE JOURNAL 64 (4) 387 - 392 0918-8959 2017/04 [Refereed][Not invited]
    We attempted to identify the predictors of an inadequate hypoglycemia in insulin tolerance test (ITT), defined as a blood glucose level higher than 2.8 mmol/L after insulin injection, in Japanese patients with suspected or proven hypopituitarism. A total of 78 patients who had undergone ITT were divided into adequate and inadequate hypoglycemia groups. The relationships between the subjects' clinical parameters and inadequate hypoglycemia in ITT were analyzed. Stepwise logistic regression analysis identified high systolic blood pressure (SBP) and high homeostasis model assessment of insulin resistance (HOMA-IR) as being independent factors associated with inadequate hypoglycemia in ITT. Receiver operating characteristic (ROC) curve analysis revealed the cutoff value for inadequate hypoglycemia was 109 mmHg for SBP and 1.4 for HOMA-IR. The areas under ROC curve for SBP and HOMA-IR were 0.72 and 0.86, respectively. We confirmed that high values of SBP and HOMA-IR were associated with inadequate hypoglycemia in ITT, regardless of the degree of reduction of pituitary hormone levels. Furthermore, the strongest predictor of inadequate hypoglycemia was obtained by using the cutoff value of HOMA-IR. Our results suggest that HOMA-IR is a useful pre-screening tool for ITT in these populations.
  • Hiroshi Nomoto, Kimihiko Kimachi, Hideaki Miyoshi, Hiraku Kameda, Kyu Yong Cho, Akinobu Nakamura, So Nagai, Takuma Kondo, Tatsuya Atsumi
    ENDOCRINE JOURNAL 64 (4) 417 - 424 0918-8959 2017/04 [Refereed][Not invited]
    To date, several clinical trials have compared differences in glucose fluctuation observed with dipeptidyl peptidase-4 inhibitor treatment in patients with type 2 diabetes mellitus. However, most patients were assessed for limited periods or during hospitalization. The aim of the present study was to evaluate the effects of switching from sitagliptin to vildagliptin, or vice versa, on 12-week glucose fluctuations using self-monitoring of blood glucose in the standard care setting. We conducted a multicenter, prospective, open-label controlled trial in Japanese patients with type 2 diabetes. Thirty-two patients were treated with vildagliptin (50 mg) twice daily or sitagliptin (50 mg) once daily and were allocated to one of two groups: vildagliptin treatment for 12 weeks before switching to sitagliptin for 12 weeks, or vice versa. Daily profiles of blood glucose were assessed several times during each treatment period, and the mean amplitude of glycemic excursions and M-value were calculated. Metabolic biomarkers such as hemoglobin Alc (HbAlc), glycated albumin, and 1,5-anhydroglucitol were also assessed. With vildagliptin treatment, mean amplitude of glycemic excursions was significantly improved compared with sitagliptin treatment (57.9 +/- 22.2 vs. 68.9 +/- 33.0 mg/dL; p=0.0045). M-value (p=0.019) and mean blood glucose (p=0.0021) were also lower with vildagliptin, as were HbAlc, glycated albumin, and 1,5-anhydroglucitol. There were no significant differences in other metabolic parameters evaluated. Reduction of daily blood glucose profile fluctuations by vildagliptin was superior to that of sitagliptin in Japanese patients with type 2 diabetes.
  • [Programs for Continuing Medical Education 2016: A Session: 8. Recent Strategy to Treat Patients with Rheumatoid Arthritis].
    Atsumi T
    Nihon Naika Gakkai zasshi. The Journal of the Japanese Society of Internal Medicine 106 (3) 499 - 504 0021-5384 2017/03 [Refereed][Not invited]
  • Naoki Ishiguro, Tatsuya Atsumi, Masayoshi Harigai, Tsuneyo Mimori, Norihiro Nishimoto, Takayuki Sumida, Tsutomu Takeuchi, Yoshiya Tanaka, Ayako Nakasone, Nobuhiro Takagi, Hisashi Yamanaka
    MODERN RHEUMATOLOGY 27 (2) 217 - 226 1439-7595 2017/03 [Refereed][Not invited]
    Objective: To evaluate effectiveness and safety of tocilizumab (TCZ) in biologic-naive Japanese patients with rheumatoid arthritis (RA) in real-world settings, and to analyze the relationship between disease duration and clinical outcomes.Methods: The FIRST Bio study was a postmarketing surveillance study of intravenous TCZ in biologics-naive patients who had a prior inadequate response or were intolerant to 1 conventional synthetic disease-modifying antirheumatic drug (csDMARD). Effectiveness, safety, and concomitant csDMARD administration were assessed.Results: Of the 839 patients analyzed, 72.3% completed 52 weeks of treatment. The Clinical Disease Activity Index (CDAI) remission rate at week 52 was 36.8%. Contributing factors for CDAI remission were younger age, early disease stage, and no comorbidities. Health Assessment Questionnaire Disability Index 0.5 was achieved in 65.1% of patients, and was significantly associated with disease duration. Discontinuation of concomitant methotrexate (MTX) and glucocorticoids (GCs) was possible in 19.3% and 34.1% of patients, respectively, without decreasing remission rate. The incidence (events/100 patient-years) of serious adverse events was 18.09, the most common being infection.Conclusion: These data validate the importance of TCZ treatment in the early stages of RA in biologic-naive patients to achieve increased effectiveness. The safety profile of TCZ was reconfirmed. Furthermore, TCZ therapy may allow discontinuation of concomitant MTX and GCs without affecting remission.
  • Shinsuke Yasuda, Yuka Shimizu, Tatsuya Atsumi
    MODERN RHEUMATOLOGY 27 (2) 191 - 192 1439-7595 2017/03 [Refereed][Not invited]
  • Cho KY, Miyoshi H, Nakamura A, Kurita T, Atsumi T
    Endocrine journal 64 (2) 235 - 236 0918-8959 2017/02 [Refereed][Not invited]
  • Fukae J, Tanimura K, Isobe M, Kitano A, Henmi M, Nakai M, Aoki Y, Sakamoto F, Narita A, Ito T, Mitsuzaki A, Matsuhashi M, Shimizu M, Kamishima T, Atsumi T, Koike T
    International journal of rheumatic diseases 1756-1841 2017/02 [Refereed][Not invited]
  • Masakazu Washio, Hiroki Takahashi, Gen Kobashi, Chikako Kiyohara, Yoshifumi Tada, Toyoko Asami, Yuichiro Ide, Tatsuya Atsumi, Takahiko Horiuchi
    INTERNATIONAL JOURNAL OF RHEUMATIC DISEASES 20 (1) 76 - 83 1756-1841 2017/01 [Refereed][Not invited]
    Aim:The aim of the present study was to examine the influence of medical history and reproductive factors on the development of systemic lupus erythematosus (SLE) among Japanese females. Methods: One hundred and sixty female SLE patients and 660 female volunteers were studied in a case-control study. Unconditional logistic regression was used to compute odds ratios (OR) and 95% confidence intervals (CIs). Results: The present study demonstrated that medical histories of operations without blood transfusion (OR = 1.64, 95% CI = 1.10-2.44) and operations with blood transfusion (OR = 4.44, 95% CI = 1.93-10.23) increased the risk of SLE with adjustment for age, region, smoking and alcohol drinking. Among 91 SLE patients and 284 control subjects who had the experience of married life, nulliparity (OR = 2.29, 95% CI = 1.05-5.17), increased the risk of SLE, while the risk decreased according to the number of children (one to two vs. none, OR = 0.27, 95% CI = 0.10-0.73; three or more vs. none, OR = 0.14, 95% CI = 0.04-0.51; P for trend < 0.01). Conclusions: Several factors are suggested to be associated with the development of SLE among Japanese females.
  • Taro Sakashita, Tamotsu Kamishima, Hiroyuki Sugimori, Minghui Tang, Atsushi Noguchi, Michihito Kono, Kenneth Sutherland, Tatsuya Atsumi
    MAGNETIC RESONANCE IN MEDICAL SCIENCES 16 (1) 78 - 83 1347-3182 2017 [Refereed][Not invited]
    We examined the capability of a gray-scale arterial spin labeling blood flow pattern variation (BFPV) map with two different post labeling delay (PLD) times to discriminate pannus in patients with rheumatoid arthritis (RA) at 3T. There was a statistically significant difference in the BFPV values between artery, pannus, and surrounding tissue. Furthermore, the color-coded BFPV map was able to accurately distinguish pannus from other tissues. These results suggest this approach may be capable of identifying pannus noninvasively.
  • Atsushi Noguchi, Masaru Kato, Michihito Kono, Kazumasa Ohmura, Hiroshi Ohira, Ichizo Tsujino, Noriko Oyama-Manabe, Kenji Oku, Toshiyuki Bohgaki, Tetsuya Horita, Shinsuke Yasuda, Masaharu Nishimura, Tatsuya Atsumi
    MODERN RHEUMATOLOGY 27 (3) 481 - 488 1439-7595 2017 [Refereed][Not invited]
    Objectives: Pulmonary arterial hypertension (PAH) associated with systemic sclerosis (SSc) has a poor prognosis compared to PAH associated with other connective tissue diseases (CTD). The objective of this study was to examine the difference in hemodynamic state between SSc-PAH and other CTD-PAH by performing cardiac magnetic resonance (CMR) imaging.Methods: A single center retrospective analysis was conducted comprising 40 consecutive CTD patients who underwent right heart catheterization and CMR at the same period from January 2010 to October 2015.Results: Thirty-two patients had pre-capillary pulmonary hypertension. Of these, 15 had SSc and 17 had other CTD. CMR measurements, particularly the ratio of right to left end-diastolic volume (RVEDV/LVEDV), correlated well with mean pulmonary arterial pressure (mPAP). Conversely, RVEDV/LVEDV and mPAP correlated differently in SSc and non-SSc patients. In SSc patients, the ratio of RVEDV/LVEDV to mPAP was significantly higher compared to non-SSc patients. In the follow-up study, 2 SSc patients exhibited increased RVEDV/LVEDV in spite of decreased mPAP following treatment. Kaplan-Meier analysis revealed poor prognosis of patients with increased RVEDV/LVEDV following treatment.Conclusions: Our data indicated that altered bi-ventricular interplay detected at CMR may represent SSc-related cardiac involvement and reflect poor prognosis of SSc-PAH.
  • Takahiro Takase, Akinobu Nakamura, Hideaki Miyoshi, Chiho Yamamoto, Tatsuya Atsumi
    ENDOCRINE JOURNAL 64 (3) 363 - 367 0918-8959 2017 [Refereed][Not invited]
    In this study, we investigated the ameliorating effects of ipragliflozin on fatty liver in patients with type 2 diabetes. The factors that influenced the amelioration of fatty liver were also examined. Analysis included data of 21 Japanese patients with type 2 diabetes obtained from our prospective observational study. After obtaining patients' informed consent, once-daily ipragliflozin (50 mg/day) was given for 16 weeks. In addition to several clinical parameters, body composition was also compared before and after 16 weeks of treatment. The extent of fatty liver was estimated using a fatty liver index (FLI). After 16 weeks, FLI significantly decreased, from 70.1 +/- 19.4 to 60.3 +/- 25.5 (p = 0.0009) as well as levels of fasting plasma glucose (FPG), HbA1c, body weight, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and fat mass. To reveal the factors influencing the FLI changes observed on ipragliflozin treatment, correlations between changes in FLI and several other measured parameters were examined. Changes in FPG (correlation coefficient = 0.4683, p = 0.0323) and HbA1c (correlation coefficient = 0.4383, p = 0.0469) showed significant positive correlations with changes in FLI. On the other hand, no correlations of changes in FLI were observed with body weight, VAT, SAT nor fat mass. In conclusion, ipragliflozin ameliorated FLI in Japanese patients with type 2 diabetes. Improvement in FLI was associated with that of glucose intolerance.
  • Michihiro Kono, Shinsuke Yasuda, Tatsuya Atsumi
    JOURNAL OF RHEUMATOLOGY 44 (1) 125 - 126 0315-162X 2017/01 [Refereed][Not invited]
  • Subcutaneous panniculitis-like T-cell lymphoma with haemophagocytic syndrome during tocilizumab therapy for juvenile idiopathic arthritis.
    Nakamura H, Sugai T, Kato M, Hatanaka KC, Atsumi T
    Clinical and experimental rheumatology 35 (1) 174  0392-856X 2017/01 [Refereed][Not invited]
  • Michihito Kono, Tamotsu Kamishima, Shinsuke Yasuda, Keita Sakamoto, Sawako Abe, Atsushi Noguchi, Toshiyuki Watanabe, Yuka Shimizu, Kenji Oku, Toshiyuki Bohgaki, Olga Amengual, Tetsuya Horita, Tatsuya Atsumi
    MODERN RHEUMATOLOGY 27 (6) 953 - 960 1439-7595 2017 [Refereed][Not invited]
    Objectives: To evaluate the scoring of whole-body magnetic resonance imaging (WBMRI) for efficacy assessment in rheumatoid arthritis (RA) patients receiving biological disease-modifying anti-rheumatic drugs (bDMARDs).Methods: Thirty consecutive RA patients receiving bDMARDs were included in this retrospective study. Contrast WBMRI was performed before and 1 year after bDMARDs initiation.Results: At baseline, mean age was 57.1 years and mean disease duration was 3.0 years. Median disease activity score in 28 joints improved from 5.1 to 2.1. Treatment with bDMARDs improved mean whole-body synovitis score from 31.2 to 23.2 and median whole-body bone-edema score from 11 to 3. Whole-body bone-erosion score improved in seven patients and deteriorated in 17 patients. Logistic regression analysis identified whole-body synovitis score as a poor prognostic factor for whole-body bone-erosion progression. Bone-edema score in individual bones was identified as a poor prognostic factor for the progression of bone-erosion. Changes in hand synovitis score correlated with those of other joints, but neither changes in bone-edema nor erosion score of hands correlated with those of other joints in WBMRI.Conclusions: WBMRI scoring may be a novel useful tool to evaluate the efficacy of anti-rheumatic drugs, as well as a potential predictor of joint prognosis, in patients with RA.
  • Shinsuke Yasuda, Kazumasa Ohmura, Hiroshi Kanazawa, Takashi Kurita, Yujiro Kon, Tomonori Ishii, Yuichiro Fujieda, Satoshi Jodo, Kazuhide Tanimura, Michio Minami, Tomomasa Izumiyama, Takumi Matsumoto, Yoshiharu Amasaki, Yoko Suzuki, Hideki Kasahara, Naofumi Yamauchi, Masaru Kato, Tamotsu Kamishima, Akito Tsutsumi, Hiromitsu Takemori, Takao Koike, Tatsuya Atsumi
    MODERN RHEUMATOLOGY 27 (6) 930 - 937 1439-7595 2017 [Refereed][Not invited]
    Objectives: To preliminarily evaluate the feasibility of maintenance therapy with reduced dose of intravenous abatacept (ABT) to 250mg/body/month after achieving remission or low disease activity (LDA).Patients and methods: RA patients treated with ABT at 13 sites were enrolled in this prospective interventional pilot study during the period between March 2013 and March 2015. Inclusion criteria were (1) age at 20 years or older, (2) under treatment with monthly intravenous ABT at approved doses, (3) DAS28-CRP lower than 2.7 at least for 6 months, (4) agreed to join this trial with written informed consent and (5) body weight under 125kg. Enrolled patients were maintained with intravenous monthly ABT at a reduced dose of 250mg/body (MATADOR protocol). The primary end point was the proportion of the patients continued with MATADOR protocol at week 48. MATADOR protocol was discontinued upon disease flare or other reasons such as patients' request or severe adverse event (AE). Disease activities and structural changes were also evaluated.Results: Fifty-three patients fulfilled the entry criteria and were followed for 1-year. MATADOR protocol was continued for 1-year in 43 (81%) of the evaluated patients. Three patients experienced severe AEs. Mean DAS28-CRP and remission rate were 1.56 and 88% when ABT reduced and 1.80 and 81% at 1-year, respectively. Structural remission was achieved in 34 out of 42 evaluated patients.Conclusions: Reduced dose of intravenous ABT was proposed as a feasible choice for maintenance therapy for RA after achievement of remission/LDA, although further randomized trials would be awaited.
  • Eri Sugawara, Masaru Kato, Ryo Hisada, Kenji Oku, Toshiyuki Bohgaki, Tetsuya Horita, Shinsuke Yasuda, Tatsuya Atsumi
    INTERNAL MEDICINE 56 (4) 445 - 448 0918-2918 2017 [Refereed][Not invited]
    Pulmonary arterial hypertension (PAH) associated with systemic lupus erythematosus (SLE) or mixed connective tissue disease (MTCD), in contrast to other types of PAH, may respond to immunosuppressive therapy. Most PAH cases with an immunosuppressant response were in the early stages of the disease (WHO functional class III or less). The present case was a 34-year-old woman with MCTD-associated PAH (WHO functional class IV) who was resistant to a combination of three vasodilators. Afterwards, she was treated with glucocorticoid and cyclophosphamide. This case suggested the potential benefit of immunosuppressants in patients with severe MCTD-associated PAH.
  • Valderilio Azevedo, Brian Hassett, Joao Eurico Fonseca, Tatsuya Atsumi, Javier Coindreau, Ira Jacobs, Ehab Mahgoub, Julie O'Brien, Ena Singh, Steven Vicik, Brian Fitzpatrick
    CLINICAL RHEUMATOLOGY 35 (12) 2877 - 2886 0770-3198 2016/12 [Refereed][Not invited]
    The manufacture of biologics is a complex process involving numerous steps. Over time, differences may arise as a result of planned changes to the manufacturing processes of a biologic from the same manufacturer. Comparability is the regulatory process that outlines the scope of an assessment required of an already licensed biologic after a manufacturing process change made by the same manufacturer. The aim of a comparability assessment is to demonstrate that any pre-manufacturing and post-manufacturing changes have no adverse impact on quality, safety, and efficacy of the biologic. A comparability assessment is distinct from a biosimilarity assessment, which involves extensive assessment of a biologic that is highly similar to the originator (reference product) in terms of quality, safety, and efficacy. The US Food and Drug Administration, European Medicines Agency, and World Health Organization have applied the fundamental comparability concepts into their respective biosimilarity guidance documents. In this review, we examine the rationale behind the distinct, highly regulated approval processes governing changes that may occur over time to an originator biologic due to planned manufacturing changes (as described by a comparability exercise) and those that outline the approval of a proposed biosimilar drug, based on its relationship with the reference product (biosimilarity evaluations).
  • Haruki Shida, Daigo Nakazawa, Yu Tateyama, Arina Miyoshi, Yoshihiro Kusunoki, Fumihiko Hattanda, Sakiko Masuda, Utano Tomaru, Tamihiro Kawakami, Tatsuya Atsumi, Akihiro Ishizu
    FRONTIERS IN IMMUNOLOGY 7 636  1664-3224 2016/12 [Refereed][Not invited]
    Lactoferrin (Lf) is one of the antigens of antineutrophil cytoplasmic antibodies (ANCA) and functions as an endogenous suppressor of neutrophil extracellular trap (NET) formation. However, the prevalence and pathogenicity of anti-lactoferrin antibodies (aLf) in ANCA-associated vasculitis (AAV) remain unrevealed. This study aimed to examine the significance of aLf in AAV, initially. Sixty-five sera from AAV patients, including 41 microscopic polyangiitis, 5 granulomatosis with polyangiitis, and 19 eosinophilic granulomatosis with polyangiitis (EGPA) patients, were subjected to aLf detection using enzyme-linked immunosorbent assay. Clinical characteristics were compared between aLf-positive and aLf-negative patients. Neutrophils from healthy donors were exposed to suboptimal dose (10 nM) of phorbol myristate acetate (PMA) with aLf followed by evaluation of NET formation. Results demonstrated that 4 out of 65 AAV sera (6.2%) were positive for aLf. All of them were EGPA sera (4/19, 21.1%). In EGPA, the frequency of renal involvement, serum CRP levels, and Birmingham Vasculitis Activity Score (BVAS) in the aLf-positive patients was significantly higher than those in the aLf-negative patients, and the aLf titer correlated positively with the serum CRP level and BVAS. The NET formation was particularly enhanced by combined stimulation of 10 nM PMA and 1 mu g/mL aLf. IgG isolated from sera of the aLf-positive EGPA patients (250 mu g/mL) enhanced NET formation induced by 10 nM of PMA, and the effect was abolished completely by absorption of the aLf. This pilot study suggests that aLf enhance NET formation induced by PMA and are associated with disease activity of EGPA.
  • Yuko Kaneko, Tatsuya Atsumi, Yoshiya Tanaka, Masayuki Inoo, Hitomi Kobayashi-Haraoka, Koichi Amano, Masayuki Miyata, Yohko Murakawa, Hidekata Yasuoka, Shintaro Hirata, Hayato Nagasawa, Eiichi Tanaka, Nobuyuki Miyasaka, Hisashi Yamanaka, Kazuhiko Yamamoto, Tsutomu Takeuchi
    ANNALS OF THE RHEUMATIC DISEASES 75 (11) 1917 - 1923 0003-4967 2016/11 [Refereed][Not invited]
    Objective To compare the efficacy and safety between tocilizumab added to methotrexate and tocilizumab switched from methotrexate in patients with active rheumatoid arthritis (RA). Methods This is a 2-year randomised, controlled study. RA patients with moderate or high disease activity despite methotrexate were randomly assigned either to tocilizumab added to methotrexate (add-on) or tocilizumab switched from methotrexate (switch). The primary endpoint was the DAS28 remission rate at week 24. Secondary objectives included other clinical efficacy indices, radiological outcomes assessed with the van der Heijde-modified total Sharp scoring system (mTSS), and safety. Results Of 223 randomised patients, 83% completed 52 weeks. DAS28 remission rates at week 24 were 70% for add-on and 55% for switch (p=0.02), but they became comparable at week 52 (72% vs 70%, p=0.86). Structural remission rates (mTSS=0.5) at week 52 were not different (66% vs 64%, p=0.92). However, clinically relevant radiographic progression rates (CRRP; mTSS=3) tended to be higher with the switch than with the add-on (15% vs 7%, p=0.07). Radiographic progression in the CRRP patients was larger with the switch than with the add-on (9.0/year vs 5.0/year, p=0.04). The difference in the mean C-reactive protein of the CRRP patients was significant for the first 24 weeks (1.56 vs 0.49, p=0.001) but not for the following 28 weeks (0.10 vs 0.04, p=0.1). Overall safety was preferable in the switch group. Conclusions In RA patients with inadequate response to methotrexate, tocilizumab added to methotrexate more rapidly suppressed inflammation than tocilizumab switched from methotrexate, leading to superior clinical efficacy and prevention of joint destruction.
  • Yoshiya Tanaka, Hiroko Mori, Takatoshi Aoki, Tatsuya Atsumi, Yutaka Kawahito, Hisanori Nakayama, Shigeto Tohma, Yuji Yamanishi, Hitoshi Hasegawa, Kazuhide Tanimura, Nobuo Negoro, Yukitaka Ueki, Atsushi Kawakami, Katsumi Eguchi, Kazuyoshi Saito, Yosuke Okada
    JOURNAL OF BONE AND MINERAL METABOLISM 34 (6) 646 - 654 0914-8779 2016/11 [Refereed][Not invited]
    We conducted a prospective multicenter study to assess early changes in the dynamics of bone metabolism in patients with systemic connective tissue diseases following commencement of high-dose glucocorticoid therapy and the benefits of early treatment with bisphosphonate and vitamin D analogue. The subjects of this randomized controlled trial were 106 female patients with systemic connective tissue diseases treated for the first time with glucocorticoids at doses equivalent to prednisolone aeyen20 mg/day (age aeyen 18 years). One week after initiation of glucocorticoid therapy, patients were randomly assigned to treatment with alfacalcidol at 1 mu g/day (n = 33), alendronate 35 mg/week (n = 37), and alfacalcidol plus alendronate (n = 36). The primary endpoints were changes in lumbar spine bone density at 6 months of treatment and the frequency of bone fracture at 12 months. Commencement of glucocorticoid therapy was associated with a rapid and marked bone resorption within 1 week. The combination of alfacalcidol and alendronate administered after the first week of glucocorticoid therapy halted the pathological processes affecting bone metabolism, increased bone density, and reduced the incidence of bone fracture over a period of 12 months. Taken together, the use of the combination of alfacalcidol and alendronate improved bone metabolism, increased bone density, and significantly reduced the incidence of bone fracture during 1-year high-dose glucocorticoid therapy.
  • Kenji Oku, Hiroyuki Nakamura, Michihiro Kono, Kazumasa Ohmura, Masaru Kato, Toshiyuki Bohgaki, Tetsuya Horita, Shinsuke Yasuda, Olga Amengual, Tatsuya Atsumi
    AUTOIMMUNITY REVIEWS 15 (10) 1001 - 1004 1568-9972 2016/10 [Refereed][Not invited]
    The involvement of complement activation in the pathophysiology of antiphospholipid syndrome (APS) was first reported in murine models of antiphospholipid antibody (aPL)-related pregnancy morbidities. We previously reported that complement activation is prevalent and may function as a source of procoagulant cell activation in the sera of APS patients. Recently, autoantibodies against C1q, a component of complement 1, were reported to be correlated with complement activation in systemic lupus erythematosus. These antibodies target neoepitopes of deformed C1q bound to various molecules (i.e., anionic phospholipids) and induce accelerated complement activation. We found that anti-C1q antibodies are more frequently detected in primary APS patients than in control patients and in refractory APS patients with repeated thrombotic events. The titer of anti-C1q antibodies was significantly higher in refractory APS patients than in APS patients without flare. The binding of C1q to anionic phospholipids may be associated with the surge in complement activation in patients with anti-C1q antibodies when triggered by 'second-hit' biological stressors such as infection. Such stressors will induce overexpression of anionic phospholipids, with subsequent increases in deformed C1q that is targeted by anti-C1q antibodies. (C) 2016 Published by Elsevier B.V.
  • Kenji Oku, Olga Amengual, Masaru Kato, Toshiyuki Bohgaki, Tetsuya Horita, Shinsuke Yasuda, Naoya Sakamoto, Masahiro Ieko, Gary L. Norman, Tatsuya Atsumi
    THROMBOSIS RESEARCH 146 1 - 6 0049-3848 2016/10 [Refereed][Not invited]
    Antiphospholipid antibodies (aPLs) can vary both immunologically and funcLionally, thus i is important to effectively and correctly identify their presence when diagnosing antiphospholipid syndrome. Furthermore, since many immunologicallfunclional tests are necessary Lo measure aPLs, complete examinations are often no performed in many cases due o significath burden on the testing departments. To address this issue, we measured aPLs defined accordingio the classification criteria (anlicardiolipin araibody: aCL) IgG/IgM and anti-132 glycoprotein I antibody (a beta(2)GPI) (IgG/IgM) as well as non-criteria antibodies (aCL IgA, a beta(2)GPI IgA and a beta(2)GPI domain I), in a cohort 01 211 patients (61 APS, 140 disease controls and 10 healthy individuals). APLs were measured using a fully automated chemiluminescent immunoassay instrument (BIO-FLASH (R)/ACL AcuStara (R)) and with conventional ELISA tests. We demonstrated that both sensitivity and accuracy of diagnosis of aCL IgG and beta(2)GPI IgG were high, in agreement with the past reports. When multiple aPLs were examined, the accuracy of diagnosis increased. The proportion of APS patients that were positive for 2 Of more types of aPLs (47/61, 77%) was higher than that of patients with systemic lupus erythematosus (SLE)( 3/37, 9%), those with non-SLE connective tissues diseases (1/53,2%), those with other diseases or healthy volunteers. Based on these findings, it was concluded that the fully automated chemiluminescent immunoassay instrument, which allows the simultaneous evaluation of many types of aPLs, offers clear advantages for a more complete, more rapid and less labor-intensive alternative to running multiple ELISA and could help in better diagnosis for suspected APS patients. (C) 2016 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (thip://creativecommons.orglicenscs,thy-nc-nd/4.0,/).
  • Masaru Kato, Caroline Ospelt, Christoph Kolling, Tomohiro Shimizu, Michihito Kono, Shinsuke Yasuda, Beat A. Michel, Renate E. Gay, Steffen Gay, Kerstin Klein, Tatsuya Atsumi
    ONCOTARGET 7 (39) 64221 - 64232 1949-2553 2016/09 [Refereed][Not invited]
    Valosin containing protein (p97) is a chaperone implicated in a large number of biological processes including endoplasmic reticulum (ER)-associated protein degradation and autophagy. Silencing of p97 in rheumatoid arthritis (RA) synovial fibroblasts (RASFs) increased the amount of polyubiquitinated proteins, whereas silencing of its interaction partner histone deacetylase 6 (HDAC6) had no effect. Furthermore, silencing of p97 in RASFs increased not only rates of apoptotic cell death induced by TRAIL but also induced an autophagy-associated cell death during ER stress that was accompanied by the formation of polyubiquitinated protein aggregates and large vacuoles. Finally, we demonstrated an anti-arthritic effect of siRNAs targeting p97 in collagen-induced arthritis in rats. Our data indicate that p97 may be a new potential target in the treatment of RA.
  • Yuka Shimizu, Shinsuke Yasuda, Yuki Kako, Shin Nakagawa, Masatoshi Kanda, Ryo Hisada, Kazumasa Ohmura, Sanae Shimamura, Haruki Shida, Yuichiro Fujieda, Masaru Kato, Kenji Oku, Toshiyuki Bohgaki, Tetsuya Horita, Ichiro Kusumi, Tatsuya Atsumi
    AUTOIMMUNITY REVIEWS 15 (8) 786 - 794 1568-9972 2016/08 [Refereed][Not invited]
    In patients with systemic lupus erythematosus (SLE), neuropsychiatric (NP) symptoms sometimes occur after administration of corticosteroids, making differential diagnosis between NPSLE and steroid-induced psychosis challenging for clinicians. The aim of this study was to clarify the characteristics of post-steroid NP disease (PSNP) in patients with SLE. Clinical courses of 146 patients with SLE and 162 with other systemic autoimmune diseases, all in the absence of NP manifestations on admission, were retrospectively analyzed. Forty-three NPSLE patients on admission (de novo NPSLE) were also investigated. All patients were consecutively recruited and treated with 40 mg/day or more of prednisolone in Hokkaido University Hospital between April 2002 and March 2015. The prevalence of PSNP was strikingly higher in SLE patients than other systemic autoimmune diseases (24.7% vs. 7.4%, OR 4.09, 95% CI 2.04-8.22). As independent risk factors to develop PSNP in SLE patients, past history of mental disorder and the presence of antiphospholipid syndrome were identified using multiple logistic regression analysis. In patients with PSNP-SLE, mood disorder was significantly more frequent than in de novo NPSLE (47.2% vs. 20.9%, OR 3.38, 95% CI 126-9.04). Of PSNP-SLE patients, two-thirds were with one or more abnormal findings in cerebrospinal fluid, electroencephalogram, MRI or SPECT. Majority of our PSNP-SLE patients received intensified immunosuppressive treatments and experienced improvement in most cases. PSNP-SLE had better relapse-free survival than de novo NPSLE (p < 0.05, log rank test). In conclusion, PSNP frequently occurred in patients with SLE and treated successfully with immunosuppressive therapy, indicating that NPSLE is likely to harbor patients with PSNP-SLE. (C) 2016 Elsevier B.V. All rights reserved.
  • Kenji Oku, Olga Amengual, Ryo Hisada, Kazumasa Ohmura, Ikuma Nakagawa, Toshiyuki Watanabe, Toshiyuki Bohgaki, Tetsuya Horita, Shinsuke Yasuda, Tatsuya Atsumi
    RHEUMATOLOGY 55 (8) 1403 - 1411 1462-0324 2016/08 [Refereed][Not invited]
    Objective. To investigate the prevalence and significance of the autoantibodies against complement component 1 q subcomponent (C1q) in patients with APS. Methods. In all, 40 consecutive primary APS patients, 42 patients with non-SLE CTDs and 20 SLE patients negative for aPL were enrolled in this retrospective analysis. Refractory APS was defined as a clinical status of recurring thrombosis or pregnancy morbidity during adequate secondary prophylaxis. An ELISA was used to measure serum levels of anti-C1q antibodies and anaphylatoxins (C3a, C4a). Results. Anti-C1q antibodies were found in 36% (15/42) and 2.5% (1/40) of primary APS patients and controls, respectively. Among primary APS patients, anti-C1q antibody titres were significantly correlated with serum C4a levels (P = 0.013). Neither the prevalence nor the titre of anti-C1q antibodies was associated with any specific clinical manifestations of APS, nor titres of aPL. Refractory APS patients (n = 10) had a higher prevalence of anti-C1q antibodies (9/10 vs 6/32, P = 0.01) than APS patients without recurrence (n = 32). Conclusion. Anti-C1q antibodies are associated with complement activation in APS and may contribute to the pathogenesis, particularly in refractory cases.
  • Naohide Koyanagawa, Hideaki Miyoshi, Kota Ono, Akinobu Nakamura, Kyu Yong Cho, Kohei Yamamoto, Yoshinari Takano, Midori Dan-noura, Tatsuya Atsumi
    ENDOCRINE JOURNAL 63 (8) 747 - 753 0918-8959 2016/08 [Refereed][Not invited]
    The dipeptidyl peptidase-4 inhibitors vildagliptin and sitagliptin are effective in treating patients with type 2 diabetes mellitus. Patients receiving standard doses of sitagliptin plus insulin may require increased doses of sitagliptin or switching to vildagliptin to improve blood glucose control. This study compared the effects of increasing sitagliptin and switching to vildagliptin in type 2 diabetes patients receiving standard doses of sitagliptin plus insulin. This prospective, randomized, parallel-group comparison trial enrolled 33 type 2 diabetes patients receiving 50 mg sitagliptin once daily plus insulin. Seventeen patientg were randomized to 50 mg vildagliptin twice daily, and 16 to 100 mg sitagliptin once daily, and evaluated by continuous glucose monitoring at baseline and after 8 weeks. The primary end-point was the change in mean amplitude of glycemic excursions (MAGE). MAGE decreased from baseline in both the vildagliptin (-13.4 +/- 35.7 mg/dL) and sitagliptin (-8.4 +/- 24.3 mg/dL) groups, but neither within-nor between-group changes were statistically significant. Similarly, the areas under the curve for blood glucose levels >= 180 mg/dL and <70 mg/dL tended to improve in both groups, but these differences were not statistically significant. In contrast, HbAlc was significantly reduced only in the vildagliptin group, from 7.1 +/- 0.6% at baseline to 6.8 +/- 0.6% at 8 weeks (p=0.006). Increasing sitagliptin dose and switching to vildagliptin had limited effects in improving MAGE in type 2 diabetic patients treated with standard doses of sitagliptin.
  • Yuichiro Fujieda, Olga Amengual, Masaki Matsumoto, Kimiko Kuroki, Hidehisa Takahashi, Michihito Kono, Takashi Kurita, Kotaro Otomo, Masaru Kato, Kenji Oku, Toshiyuki Bohgaki, Tetsuya Horita, Shinsuke Yasuda, Katsumi Maenaka, Shigetsugu Hatakeyama, Keiichi I. Nakayama, Tatsuya Atsumi
    RHEUMATOLOGY 55 (6) 1117 - 1126 1462-0324 2016/06 [Refereed][Not invited]
    Objective. Phosphatidylserine-dependent, also called aPS-PT, recognizes the phosphati dylserine-prothrombin complex, which is associated with APS. We have previously reported that aPS-PT induces tissue factor (TF) expression on monocytes through the p38 mitogen-activated protein kinase pathway. However, the cell surface interaction between prothrombin and aPS-PT, which is involved in the activation of cell-signalling pathways, has remained unknown. The objective of this study was to identify membrane proteins involved in the binding of prothrombin and aPS-PT to monocyte surfaces as well as the induction of TF expression. Methods. RAW264.7 cells with FLAG-tagged prothrombin were incubated and separated using affinity chromatography with anti-FLAG antibody-conjugated Sepharose beads. Immunopurified proteins were then analysed by an online nano-liquid chromatography-tandem mass spectrometry. The binding between prothrombin and the identified protein, ribophorin II (RPN2), was analysed by ELISA and surface plasmon resonance. To elucidate the role of RPN2 in TF expression, the TF mRNA level in RAW264.7 cells treated with RPN2 small interfering RNA was determined by quantitative real-time PCR (qPCR). Results. RPN2 was identified as a candidate molecule involved in the binding of prothrombin to the cell surface. The binding between prothrombin and RPN2 was confirmed by ELISA and surface plasmon resonance. RAW264.7 cells treated with RPN2 small interfering RNA showed significant reduction of the TF expression mediated by prothrombin and a mouse monoclonal aPS-PT. Conclusion. We identified that RPN2 is one of the prothrombin-binding proteins on monocyte surfaces, suggesting that RPN2 is involved in the pathophysiology of thrombosis in patients with APS.
  • Chiho Yamamoto, Hideaki Miyoshi, Kota Ono, Hajime Sugawara, Reina Kameda, Mei Ichiyama, Kohei Yamamoto, Hiroshi Nomoto, Akinobu Nakamura, Tatsuya Atsumi
    ENDOCRINE JOURNAL 63 (6) 589 - 596 0918-8959 2016/06 [Refereed][Not invited]
    To investigate if ipraglifiozin, a novel sodium-glucose co-transporter 2 inhibitor, alters body composition and to identify variables associated with reductions in visceral adipose tissue in Japanese patients with type 2 diabetes mellitus. This prospective observational study enrolled Japanese participants with type 2 diabetes mellitus. Subjects were administered ipraglifiozin (50 mg/day) once daily for 16 weeks. Body composition, visceral adipose tissue volume and plasma variables were measured at 0, 8, and 16-weeks. The subjects' lifestyle habits including diet and exercise were evaluated at baseline and 16 weeks. The primary endpoint was defined as the decrease of visceral adipose tissue mass. Twenty-four of 26 enrolled participants completed the study. The visceral adipose tissue decreased significantly (110 +/- 33 to 101 +/- 36 cm(2), p = 0.005) as well as other parameters for metabolic insufficiency including hemoglobin A1c. Seventy-one % of the total body weight reduction (-2.49 kg) was estimated by a decrease in fat mass (-1.77 kg), and the remaining reduction (22%) by water volume (-0.55 kg). A minor but significant reduction in the skeletal muscle index was also observed. Correlation analyses were performed to identify variables associated with changes in visceral adipose tissue and the only significant variable identified was diet therapy (Spearman's r = -0.416, p = 0.043). Ipragliflozin significantly decreased visceral adipose tissue, and improved parametres for metabolic dysfunction. Adequate diet therapy would be necessary to induce and enhance the therapeutic merit.
  • Naonobu Sugiyama, Yutaka Kawahito, Takao Fujii, Tatsuya Atsumi, Tatsunori Murata, Yosuke Morishima, Yuri Fukuma
    CLINICAL THERAPEUTICS 38 (6) 1359 - 1375 0149-2918 2016/06 [Refereed][Not invited]
    Purpose: The aims of this article were to characterize the patterns of treating rheumatoid arthritis with biologics and to evaluate costs using claims data from the Japan Medical Data Center Co, Ltd. Methods: Patients aged 16 to <75 years who were diagnosed with rheumatoid arthritis and prescribed adalimumab (ADA), etanercept (ETN), infliximab (IFX), tocilizumab (TCZ), abatacept, certolizumab, or golimumab between January 2005 and August 2014 were included. For the cross-sectional analysis, the annual costs of ETN, IFX, ADA, and TCZ from 2009 to 2013 were assessed. For the longitudinal analysis, patients prescribed these biologics as the first line of biologics, from January 2005 to August 2014, were included. The cost of biologic treatment over 1, 2, and 3 years (including prescription of subsequent biologics) and direct medical costs (including treatment of comorbidities) were compared between groups. Discontinuation and switching rates in each group were estimated, and multivariate analyses were conducted to estimate an adjusted hazard ratio of discontinuation and switching rates among each group. The dose of each first-line biologic treatment until discontinuation was analyzed to calculate relative dose intensity. Findings: The cross-sectional annual biologic costs of ETN, IFX, ADA, and TCZ were similar to$8000 (2009 and 2013), $13,000 (2009) and $15,000 (2013), $10,000 (2009) and $11,000 (2013), and $9000 (2009) and $8000 (2013), respectively. In longitudinal analyses (n = 764), 276 (36%) initiated ETN; 242 (32%), IFX; 147 (19%), ADA; and 99 (13%), TCZ. The 1-year cumulative annual biologic costs per patient from the initial prescription of ETN, IFX, ADA, and TCZ as the first-line biologic treatment were similar to$11,000, $19,000, $16,000, and $12,000. The corresponding direct medical costs over 1 year from the initial prescription were similar to$17,000, $26,000, $22,000, and $22,000. Costs remained greatest in the IFX-initiation group at year 3. The discontinuation rates at 36 months with ETN, IFX, ADA, and TCZ were 37.7%, 52.3%, 55.8%, and 39.5%; the switching rates were 12.5%, 27.1%, 31.0%, and 16.7%. The mean (95% CI) relative dose intensities until discontinuation of ETN 25 mg, ETN 50 mg, IFX, ADA, and TCZ were 1.02 (0.95-1.10), 0.82 (0.79-0.85), 1.16 (1.12-1.20), 0.95 (0.90-0.99), and 0.96 (0.93-1.00). Implications: Considered costs and discontinuation and switching event rates were lowest with ETN versus IFX, ADA, or TCZ used as the first-line biologic. Despite limitations, these findings imply clinical cost-reductive benefits of ETN as the first line biologic treatment option for rheumatoid arthritis in Japan. (C) 2016 Elsevier HS Journals, Inc. All rights reserved.
  • Masatoshi Kanda, Hiroyuki Yamanaka, Satoshi Kojo, Yuu Usui, Hiroaki Honda, Yusuke Sotomaru, Michishige Harada, Masaru Taniguchi, Nao Suzuki, Tatsuya Atsumi, Haruka Wada, Muhammad Baghdadi, Ken-ichiro Seino
    PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA 113 (24) E3394 - E3402 0027-8424 2016/06 [Refereed][Not invited]
    Invariant natural killer T (iNKT) cells are a subset of innate-like T cells that act as important mediators of immune responses. In particular, iNKT cells have the ability to immediately produce large amounts of IFN-gamma upon activation and thus initiate immune responses in various pathological conditions. However, molecular mechanisms that control IFN-gamma production in iNKT cells are not fully understood. Here, we report that basic helix-loop-helix transcription factor family, member e40 (Bhlhe40), is an important regulator for IFN-gamma production in iNKT cells. Bhlhe40 is highly expressed in stage 3 thymic iNKT cells and iNKT1 subsets, and the level of Bhlhe40 mRNA expression is correlated with Ifng mRNA expression in the resting state. Although Bhlhe40-deficient mice show normal iNKT cell development, Bhlhe40-deficient iNKT cells show significant impairment of IFN-gamma production and antitumor effects. Bhlhe40 alone shows no significant effects on Ifng promoter activities but contributes to enhance T-box transcription factor Tbx21 (T-bet)-mediated Ifng promoter activation. Chromatin immunoprecipitation analysis revealed that Bhlhe40 accumulates in the T-box region of the Ifng locus and contributes to histone H3-lysine 9 acetylation of the Ifng locus, which is impaired without T-bet conditions. These results indicate that Bhlhe40 works as a cofactor of T-bet for enhancing IFN-gamma production in iNKT cells.
  • Masaru Kato, Tatsuya Atsumi
    RHEUMATOLOGY INTERNATIONAL 36 (5) 635 - 641 0172-8172 2016/05 [Refereed][Not invited]
    Over the past decade, reactivation of occult hepatitis B virus (HBV) infection has garnered much attention from rheumatologists owing to a number of reports which have indicated the potential risk of biologics in causing this previously ignored infectious complication. Hepatitis due to reactivation of occult HBV infection occurs only occasionally but with high mortality upon occurrence, placing us in a clinical dilemma "to address or not to address?" In this review, we discuss how biological and other immunosuppressive therapies increase the risk of developing reactivation of occult HBV infection and attempt to solve this clinical quandary.
  • Peng Zhang, James C. Weaver, Gang Chen, Julia Beretov, Tatsuya Atsumi, Miao Qi, Ravinay Bhindi, Jian C. Qi, Michele C. Madigan, Bill Giannakopoulos, Steven A. Krilis
    PLOS ONE 11 (3) e0152681  1932-6203 2016/03 [Refereed][Not invited]
    Reperfusion after a period of ischemia results in reperfusion injury (IRI) which involves activation of the inflammatory cascade. In cardiac IRI, IgM natural antibodies (NAb) play a prominent role through binding to altered neoepitopes expressed on damaged cells. Beta 2 Glycoprotein I (beta 2GPI) is a plasma protein that binds to neoepitopes on damaged cells including anionic phospholipids through its highly conserved Domain V. Domain I of beta 2GPI binds circulating IgM NAbs and may provide a link between the innate immune system, IgM NAb binding and cardiac IRI. This study was undertaken to investigate the role of beta 2GPI and its Domain V in cardiac IRI using wild-type (WT), Rag-1(-/-) and beta 2GPI deficient mice. Compared with control, treatment with Domain V prior to cardiac IRI prevented binding of endogenous beta 2GPI to post-ischemic myocardium and resulted in smaller myocardial infarction size in both WT and beta 2GPI deficient mice. Domain V treatment in WT mice also resulted in less neutrophil infiltration, less apoptosis and improved ejection fraction at 24 h. Rag-1-/- antibody deficient mice reconstituted with IgM NAbs confirmed that Domain V prevented IgM NAb induced cardiac IRI. Domain V remained equally effective when delivered at the time of reperfusion which has therapeutic clinical relevance. Based upon this study Domain V may function as a universal inhibitor of IgM NAb binding in the setting of cardiac IRI, which offers promise as a new therapeutic strategy in the treatment of cardiac IRI.
  • Daigo Nakazawa, Haruki Shida, Yoshihiro Kusunoki, Arina Miyoshi, Saori Nishio, Utano Tomaru, Tatsuya Atsumi, Akihiro Ishizu
    JOURNAL OF AUTOIMMUNITY 67 19 - 28 0896-8411 2016/02 [Refereed][Not invited]
    Neutrophil extracellular traps (NETs) are net-like chromatin fibers decorated with antimicrobial proteins, which are released from dying neutrophils. The death of neutrophils with NET formation is called NETosis. Although NETs play important roles in the innate immunity, especially in the elimination of microbes, the extracellular release of DNA and intra-cytoplasmic/nuclear proteins can, on the other hand, result in diverse adversities to the hosts. Therefore, NETosis is adequately regulated in vivo. Currently, two mechanisms, namely DNase I-dependent digestion and phagocytosis by macrophages, have been shown as such regulatory mechanisms. In this study, we focused on the interaction of macrophages and neutrophils that underwent NETosis. Results demonstrated that macrophages displayed a phenotype dependent response after degradation of NETs. Several hours after the interaction, M2 macrophages induced a pro-inflammatory response, while M1 macrophages underwent cell death with nuclear decondensation. This nuclear decondensation of M1 macrophages occurred in a peptidylarginine deiminase 4-dependent manner and resulted in a local release of extracellular DNA. Thereafter, M1 macrophages degraded DNA derived from themselves in a caspase-activated DNase-dependent manner resulting in the clearance of extracellular DNA within 24 h. This transient increase and subsequent clearance mechanism of extracellular DNA seems very reasonable in terms of the double-edged sword-like property of NETs. The collective findings demonstrate a novel phenotype- and time-dependent regulation of NETosis by macrophages. (C) 2015 The Authors. Published by Elsevier Ltd.
  • Akinobu Nakamura, Tomoko Mitsuhashi, Yoshinari Takano, Hideaki Miyoshi, Hiraku Kameda, Hiroshi Nomoto, So Nagai, Yutaka Hatanaka, Chikara Shimizu, Yasuo Terauchi, Tatsuya Atsumi
    ENDOCRINE JOURNAL 63 (2) 135 - 142 0918-8959 2016/02 [Refereed][Not invited]
    We investigated the relationship between the results of the octreotide test and somatostatin receptor (SSTR) 2 expression in insulinoma patients, to evaluate the usefulness of this test for predicting SSTR2 expression in insulinomas in Japanese patients. Five females and one male were included in the study. All patients underwent the octreotide test before the surgery carried out to resect the tumor, and histopathological examination of the resected tumor was performed by a single experienced pathologist. SSTR2 expression was evaluated by the SSTR2 immunohistochemistry scoring system. Insulinoma was clinically diagnosed and surgically resected in all six patients. In the octreotide test, suppression of insulin secretion was sufficient after loading in patients 1-4 and 6. In patient 5, however, the suppression of insulin secretion was insufficient, which resulted in severe hypoglycemia with endogenous relative hyperinsulinemia after the octreotide loading. The histopathological findings revealed SSTR2 expression in the insulinomas of patients 1-4 and 6, but not in the insulinoma of patient 5. In conclusion, improvement of hyperinsulinemic hypoglycemia by octreotide in Japanese insulinoma patients was associated with SSTR2 expression in the tumor. Our results suggest that the octreotide test could be useful for predicting SSTR2 expression in the tumor.
  • Tatsuya Atsumi, Kazuhiko Yamamoto, Tsutomu Takeuchi, Hisashi Yamanaka, Naoki Ishiguro, Yoshiya Tanaka, Katsumi Eguchi, Akira Watanabe, Hideki Origasa, Shinsuke Yasuda, Yuji Yamanishi, Yasuhiko Kita, Tsukasa Matsubara, Masahiro Iwamoto, Toshiharu Shoji, Toshiyuki Okada, Desiree van der Heijde, Nobuyuki Miyasaka, Takao Koike
    ANNALS OF THE RHEUMATIC DISEASES 75 (1) 75 - 83 0003-4967 2016/01 [Refereed][Not invited]
    Objectives To evaluate efficacy and safety of combination therapy using certolizumab pegol (CZP) and methotrexate (MTX) as first-line treatment for MTX-naive, early rheumatoid arthritis (RA) with poor prognostic factors, compared with MTX alone. Methods MTX-naive, early RA patients with <= 12 months persistent disease, high anti-cyclic citrullinated peptide, and either rheumatoid factor positive and/or presence of bone erosions were enrolled in this multicentre, double-blind, randomised placebo (PBO)-controlled study. Patients were randomised 1: 1 to CZP+MTX or PBO+MTX for 52 weeks. Primary endpoint was inhibition of radiographic progression (change from baseline in modified Total Sharp Score (mTSS CFB)) at week 52. Secondary endpoints were mTSS CFB at week 24, and clinical remission rates at weeks 24 and 52. Results 316 patients randomised to CZP+MTX (n=159) or PBO+MTX (n=157) had comparable baseline characteristics reflecting features of early RA (mean disease duration: 4.0 vs 4.3 months; Disease Activity Score 28-joint assessment (DAS28)) (erythrocyte sedimentation rate (ESR)): 5.4 vs 5.5; mTSS: 5.2 vs 6.0). CZP+MTX group showed significantly greater inhibition of radiographic progression relative to PBO+MTX at week 52 (mTSS CFB=0.36 vs 1.58; p<0.001) and week 24 (mTSS CFB=0.26 vs 0.86; p=0.003). Clinical remission rates (Simple Disease Activity Index, Boolean and DAS28 (ESR)) of the CZP+MTX group were significantly higher compared with those of the PBO +MTX group, at weeks 24 and 52. Safety results in both groups were similar, with no new safety signals observed with addition of CZP to MTX. Conclusions In MTX-naive early RA patients with poor prognostic factors, CZP+MTX significantly inhibited structural damage and reduced RA signs and symptoms, demonstrating the efficacy of CZP in these patients.
  • Chiho Yamamoto, Hideaki Miyoshi, Yutaka Fujiwara, Reina Kameda, Mei Ichiyama, Hiroshi Nomoto, Hiraku Kameda, Akinobu Nakamura, Tatsuya Atsumi
    ENDOCRINE JOURNAL 63 (1) 53 - 60 0918-8959 2016/01 [Refereed][Not invited]
    To investigate the differences in glycemic variability between the long-acting insulins glargine and degludec using continuous glucose monitoring, we conducted an open-label, multicenter, prospective, observational study that enrolled 21 participants with type 1 diabetes mellitus currently receiving basal-bolus insulin therapy with glargine. To avoid the potential influence of diet and exercise on glycemic control, all participants were housed and monitored within the hospital for the duration of the study. Once glycemic control was achieved with glargine, glycemic variability was evaluated using continuous glucose monitoring for 3 days. Glargine was then replaced by degludec and glycemic variability again assessed via continuous glucose monitoring. The primary outcome measure of mean amplitude of glycemic excursions was significantly reduced with degludec (p = 0.028), as was area under the curve for daily blood glucose level <70 mg/dL (p = 0.046). The required insulin dose was reduced up to 25% in the degludec group, although 24-h mean glucose concentrations were not different between groups. In conclusion, once or twice daily glargine was successfully replaced by a daily injection of degludec. When replacing glargine with degludec, a lower dose should be utilized to avoid hypoglycemia. Degludec is an effective and promising long-acting insulin that reduced hypoglycemia and daily blood glucose variability in participants with type 1 diabetes.
  • Ken-ei Sada, Masayoshi Harigai, Koichi Amano, Tatsuya Atsumi, Shouichi Fujimoto, Yukio Yuzawa, Yoshinari Takasaki, Shogo Banno, Takahiko Sugihara, Masaki Kobayashi, Joichi Usui, Kunihiro Yamagata, Sakae Homma, Hiroaki Dobashi, Naotake Tsuboi, Akihiro Ishizu, Hitoshi Sugiyama, Yasunori Okada, Yoshihiro Arimura, Seiichi Matsuo, Hirofumi Makino
    MODERN RHEUMATOLOGY 26 (5) 730 - 737 1439-7595 2016 [Refereed][Not invited]
    Objective: To compare disease severity classification systems for six-month outcome prediction in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Methods: Patients with newly diagnosed AAV from 53 tertiary institutions were enrolled. Six-month remission, overall survival, and end-stage renal disease (ESRD)-free survival were evaluated. Results: According to the European Vasculitis Study Group (EUVAS)-defined disease severity, the 321 enrolled patients were classified as follows: 14, localized; 71, early systemic; 170, generalized; and 66, severe disease. According to the rapidly progressive glomerulonephritis (RPGN) clinical grading system, the patients were divided as follows: 60, grade I; 178, grade II; 66, grade III; and 12, grade IV. According to the Five-Factor Score (FFS) 2009, 103, 109, and 109 patients had <= 1, 2, and >= 3 points, respectively. No significant difference in remission rates was found in any severity classification. The overall and ESRD-free survival rates significantly differed between grades I/II, III, and IV, regardless of renal involvement. Severe disease was a good predictor of six-month overall and ESRD-free survival. The FFS 2009 was useful to predict six-month ESRD-free survival but not overall survival. Conclusions: The RPGN grading system was more useful to predict six-month overall and ESRD-free survival than the EUVAS-defined severity or FFS 2009.
  • Taro Sakashita, Tamotsu Kamishima, Yuto Kobayashi, Hiroyuki Sugimori, Minghui Tang, Kenneth Sutherland, Atsushi Noguchi, Michihito Kono, Tatsuya Atsumi
    BRITISH JOURNAL OF RADIOLOGY 89 (1061) 20151000  0007-1285 2016 [Refereed][Not invited]
    Objective: To improve on the reproducibility and sensitivity of the assessment of patients with rheumatoid arthritis (RA), two semi-automated measurement methods of the area of enhancing pannus (AEP), based on thresholding (AEP_THRES) and pixel-by-pixel time-intensity curve analysis (AEP_TIC), were evaluated as an alternative for the gold-standard manual contouring method (AEP_MANUAL). Methods: 8 patients (7 females and 1 male) with RA of the wrist or finger joints participated in the study. A three-dimensional contrast-enhanced dynamic sequence was used at 3 T. After identifying the most relevant time-intensity curve (TIC) shape in terms of synovitis by comparing with the synovitis score using the RA-MRI scoring system, three different approaches for measuring the AEP were performed. Spearman's test of rank correlation was used to compare AEPs via two semi-automated methods (AEP_THRES and AEP_TIC) against manual segmentation (AEP_MANUAL) in the entire hand region as well as the wrist and the finger regions. Results: The TIC shape of "washout after fast initial enhancement" had excellent correlation with synovitis score (r = 0.809). The correlation coefficient between AEP_TIC and AEP_MANUAL was evaluated to be better than that of AEP_THRES and AEP_MANUAL in the wrist region (AEP_THRES: r = 0.716, AEP_TIC: r = 0.815), whereas these were of comparable accuracy for the entire hand and the finger regions. Conclusion: This study suggests that TIC analysis may be an alternative to manual contouring for pannus quantification and provides important clinical information of the extent of the disease in patients with RA. Advances in knowledge: TIC shape analysis can be applied for new quantitative assessment for RA synovitis in the wrist.
  • Shinsuke Yasuda, Michihito Kono, Sanae Shimamura, Takashi Kurita, Toshio Odani, Tatsuya Atsumi
    Japanese Journal of Clinical Immunology 39 (1) 8 - 17 1349-7413 2016 [Refereed][Not invited]
    Treatment of organ involvements accompanied by systemic autoimmune diseases is still challenging for clinicians, reminding the existence of unmet needs. Among them, lupus nephritis (LN), neuropsychiatric lupus, interstitial lung diseases (ILD) complicated with polymyositis/dermatomyositis (PM/DM) or systemic sclerosis (SSc) are the most severe conditions with poor prognosis. Because of the rarity and severity of the disease status, and of variety in evaluation methods, randomized clinical trials tend to be difficult in recruiting patients, in designing protocols, and in meeting primary endpoints. In such tough conditions, superiority of IVCY over corticosteroids alone for LN has been established, which is now going to be replaced by mycophenolate mofetil (MMF). Moreover, non-inferiority of tacrolimus to MMF is reported and efficacy of biologics such as Rituximab and Abatacept for LN is under investigation. In contrast, PM/DM-ILD is not suitable for randomized controlled trial because of the severity/acute progression in some patients. Intensive immunosuppressive regimen is recommended for those with poor prognostic factor(s). Cyclophosphamide has limited efficacy in SSc-ILD. Hematopoietic stem cell transplantation elongated patient survival and improved ILD, but with high treatment-related mortality rate. Efficacy of rituximab and MMF has been reported in small-sized trials. In this review, previously established treatment as well as emerging immunotherapies for organ involvements will be discussed. Our experiences in autoimmune settings also will be introduced.
  • Arina Miyoshi, Mai Yamada, Haruki Shida, Daigo Nakazawa, Yoshihiro Kusunoki, Akinobu Nakamura, Hideaki Miyoshi, Utano Tomaru, Tatsuya Atsumi, Akihiro Ishizu
    PATHOBIOLOGY 83 (5) 243 - 251 1015-2008 2016 [Refereed][Not invited]
    Objectives: Although intensive therapy for type 2 diabetes (T2D) prevents microvascular complications, 10% of well-controlled T2D patients develop microangiopathy. Therefore, the identification of risk markers for microvascular complications in well-controlled T2D patients is important. Recent studies have demonstrated that high-dose glucose induces neutrophil extracellular trap (NET) formation, which can be a risk for microvascular disorders. Thus, we attempted to determine the correlation of circulating NET levels with clinical/laboratory parameters in well-controlled T2D patients and to reveal the mechanism of NET formation induced by high-dose glucose. Methods: Circulating NET levels represented by myeloperoxidase (MPO)-DNA complexes in the serum of 11 well-controlled T2D patients and 13 healthy volunteers were determined by enzyme-linked immunosorbent assay. The pathway involved in the NET formation induced by high-dose glucose was determined using specific inhibitors. Results: Serum MPO-DNA complex levels were significantly higher in some well-controlled T2D patients in correlation with the clinical/laboratory parameters which have been regarded as risk markers for microvascular complications. The aldose reductase inhibitor, ranirestat, could inhibit the NET formation induced by high-dose glucose. Conclusions: Elevated levels of circulating NETs can be a risk marker for microvascular complications in well-controlled T2D patients. The polyol pathway is involved in the NET formation induced by high-dose glucose. (C) 2016 The Author(s) Published by S. Karger AG, Basel
  • Kusunoki Y, Nakazawa D, Shida H, Hattanda F, Miyoshi A, Masuda S, Nishio S, Tomaru U, Atsumi T, Ishizu A
    Frontiers in immunology 7 227  2016 [Refereed][Not invited]
  • Hiroshi Nomoto, Hideaki Miyoshi, Tomoo Furumoto, Koji Oba, Hiroyuki Tsutsui, Atsushi Inoue, Tatsuya Atsumi, Naoki Manda, Yoshio Kurihara, Shin Aoki
    PloS one 11 (10) e0164255  2016 [Refereed][Not invited]
    OBJECTIVES: The DPP-4 inhibitors are incretin-related drugs that improve hyperglycemia in a glucose-dependent manner and have been reported to exert favorable effects on atherosclerosis. However, it has not been fully elucidated whether DPP-4 inhibitors are able to improve endothelial function in patients with type 2 diabetes. Therefore, we investigated the efficacy of sitagliptin, a DPP-4 inhibitor, on endothelial function and glycemic metabolism compared with that of the sulfonylurea glimepiride. MATERIALS AND METHODS: In this multicenter, prospective, randomized parallel-group comparison study, 103 outpatients with type 2 diabetes (aged 59.9 ± 9.9 years with HbA1c levels of 7.5 ± 0.4%) with dietary cure only and/or current metformin treatment were enrolled and randomly assigned to receive sitagliptin or glimepiride therapy once daily for 26 weeks. Flow-mediated dilation (FMD), a comprehensive panel of hemodynamic parameters (Task Force® Monitor), and serum metabolic markers were assessed before and after the treatment. RESULTS: During the study period, no statistically significant change in %FMD was seen in both groups (sitagliptin, 5.6 to 5.6%; glimepiride, 5.6 to 6.0%). Secretory units of islets in transplantation, TNF-α, adiponectin and biological antioxidant potential significantly improved in the sitagliptin group, and superoxide dismutase also tended to improve in the sitagliptin group, while improvements in HbA1c levels were similar between groups. Cardiac index, blood pressure and most other metabolic parameters were not different. CONCLUSIONS: Regardless of glycemic improvement, early sitagliptin therapy did not affect endothelial function but may provide favorable effects on beta-cell function and on inflammatory and oxidative stress in patients with type 2 diabetes without advanced atherosclerosis. TRIAL REGISTRATION: UMIN Clinical Trials Registry System UMIN 000004955.
  • [Biomarker of bone and cartilage destruction in rheumatoid arthritis].
    Tanimura S, Kato M, Atsumi T
    Clinical calcium 25 (12) 1769 - 1775 0917-5857 2015/12 [Refereed][Not invited]
  • Hiroshi Nomoto, Takuma Kondo, Hideaki Miyoshi, Akinobu Nakamura, Yoko Hida, Ken-ichiro Yamashita, Arun J. Sharma, Tatsuya Atsumi
    ENDOCRINOLOGY 156 (10) 3570 - 3580 0013-7227 2015/10 [Refereed][Not invited]
    The large-Maf transcription factor v-maf musculoaponeurotic fibrosarcoma oncogene homolog A (MafA) has been found to be crucial for insulin transcription and synthesis and for pancreatic beta-cell function and maturation. However, insights about the effects of small Maf factors on beta-cells are limited. Our goal was to elucidate the function of small-Maf factors on beta-cells using an animal model of endogenous small-Maf dysfunction. Transgenic (Tg) mice with beta-cell-specific expression of dominant-negative MafK (DN-MafK) experiments, which can suppress the function of all endogenous small-Mafs, were fed a high-fat diet, and their in vivo phenotypes were evaluated. Phenotypic analysis, glucose tolerance tests, morphologic examination of beta-cells, and islet experiments were performed. DN-MafK-expressed MIN6 cells were also used for in vitro analysis. The results showed that DN-MafK expression inhibited endogenous small-Maf binding to insulin promoter while increasing MafA binding. DN-MafK Tg mice under high-fat diet conditions showed improved glucose metabolism compared with control mice via incremental insulin secretion, without causing changes in insulin sensitivity or MafA expression. Moreover, up-regulation of insulin and glucokinase gene expression was observed both in vivo and in vitro under DN-MafK expression. We concluded that endogenous small-Maf factors negatively regulates beta-cell function by competing for MafA binding, and thus, the inhibition of small-Maf activity can improve beta-cell function.
  • Atsushi Ogata, Tatsuya Atsumi, Takaaki Fukuda, Yasuhiko Hirabayashi, Masaaki Inaba, Naoki Ishiguro, Motokazu Kai, Daisuke Kawabata, Daihei Kida, Hitoshi Kohsaka, Ryutaro Matsumura, Seiji Minota, Masaya Mukai, Takayuki Sumida, Kiyoshi Takasugi, Shigenori Tamaki, Tsutomu Takeuchi, Atsuhisa Ueda, Kazuhiko Yamamoto, Hisashi Yamanaka, Hajime Yoshifuji, Akira Nomura
    ARTHRITIS CARE & RESEARCH 67 (10) 1354 - 1362 2151-464X 2015/10 [Refereed][Not invited]
    Objective. To evaluate the efficacy and safety of switching from intravenous (IV) tocilizumab (TCZ) to subcutaneous (SC) TCZ monotherapy in rheumatoid arthritis patients. Methods. Patients who had completed 24 weeks of TCZ-SC (162 mg/2 weeks) or TCZ-IV (8 mg/kg/4 weeks) monotherapy in the double-blind period of the MUSASHI study were enrolled in an 84-week open-label extension period. All received TCZ-SC (162 mg/2 weeks) monotherapy. Effects of the IV to SC switch were evaluated at week 36 (12 weeks after switching). Results. Overall, 319 patients received >= 1 dose of TCZ-SC during the open-label extension period; 160 switched from TCZ-IV to TCZ-SC (TCZ IV/SC) and 159 continued TCZ-SC (TCZ SC/SC). Disease Activity Score in 28 joints using the erythrocyte sedimentation rate clinical remission rates were 62.5% (100 of 160) for TCZ IV/SC and 50.0% (79 of 158) for TCZ SC/SC at week 24, and were maintained at 62.5% (100 of 160) and 57.0% (90 of 158), respectively, at week 36. In the TCZ IV/SC group, 9% of patients (9 of 100) who had achieved remission at week 24 could not maintain remission at week 36. In TCZ IV/SC patients weighing >= 70 kg, the percentage with a sufficient serum TCZ concentration (>= 1 mu g/ml) decreased from 90.9% (10 of 11) at week 24 to 45.5% (5 of 11) at week 36. Overall safety profiles were similar in TCZ IV/SC and TCZ SC/SC except for mild injection site reactions in TCZ IV/SC. Conclusion. Efficacy is adequately maintained in most patients switching from TCZ-IV (8 mg/kg/4 weeks) to TCZ-SC (162 mg/2 weeks) monotherapy. Patients receiving TCZ-IV can switch to TCZ-SC without serious safety concerns. Clinical efficacy may be reduced after switching in some patients with high body weight.
  • Chikashi Terao, Takayoshi Matsumura, Hajime Yoshifuji, Yohei Kirino, Yasuhiro Maejima, Yoshikazu Nakaoka, Meiko Takahashi, Eisuke Amiya, Natsuko Tamura, Toshiki Nakajima, Tomoki Origuchi, Tetsuya Horita, Mitsuru Matsukura, Yuta Kochi, Akiyoshi Ogimoto, Motohisa Yamamoto, Hiroki Takahashi, Shingo Nakayamada, Kazuyoshi Saito, Yoko Wada, Ichiei Narita, Yasushi Kawaguchi, Hisashi Yamanaka, Koichiro Ohmura, Tatsuya Atsumi, Kazuo Tanemoto, Tetsuro Miyata, Masataka Kuwana, Issei Komuro, Yasuharu Tabara, Atsuhisa Ueda, Mitsuaki Isobe, Tsuneyo Mimori, Fumihiko Matsuda
    ARTHRITIS & RHEUMATOLOGY 67 (8) 2226 - 2232 2326-5191 2015/08 [Refereed][Not invited]
    Objective. Takayasu arteritis (TAK) is a systemic vasculitis affecting large arteries and large branches of the aorta. Ulcerative colitis (UC) is a prevalent autoimmune colitis. Since TAK and UC share HLA-B*52:01 and IL12B as genetic determinants, and since there are case reports of the co-occurrence of these diseases, we hypothesized that UC is a common complication of TAK. We undertook this study to perform a large-scale analysis of TAK, both to evaluate the prevalence of concurrent cases of TAK and UC and to identify and estimate susceptibility genes shared between the 2 diseases. Methods. We analyzed a total of 470 consecutive patients with TAK from 14 institutions. We characterized patients with TAK and UC by analyzing clinical manifestations and genetic components. Genetic overlapping of TAK and UC was evaluated with the use of UC susceptibility single-nucleotide polymorphisms by comparing risk directions and effect sizes between susceptibility to the 2 diseases. Results. Thirty of 470 patients with TAK had UC (6.4% [95% confidence interval 4.3-9.0]). This percentage was strikingly higher than that expected from the prevalence of UC in Japan. Patients with TAK complicated with UC developed TAK at an earlier stage of life (P=0.0070) and showed significant enrichment of HLA-B*52:01 compared to TAK patients without UC (P=1.0 x 10(-5)) (odds ratio 12.14 [95% confidence interval 2.96-107.23]). The 110 non-HLA markers of susceptibility to UC significantly displayed common risk directions with susceptibility to TAK (P=0.0054) and showed significant departure of permutation P values from expected P values (P < 1.0 x 10(-10)). Conclusion. UC is a major complication of TAK. These 2 diseases share a significant proportion of their genetic background, and HLA-B*52:01 may play a central role in their co-occurrence.
  • Michihito Kono, Shinsuke Yasuda, Toshiyuki Watanabe, Tatsuya Atsumi
    RHEUMATOLOGY 54 (8) 1530 - 1531 1462-0324 2015/08 [Refereed][Not invited]
  • Takashi Kurita, Shinsuke Yasuda, Koji Oba, Toshio Odani, Michihito Kono, Kotaro Otomo, Yuichiro Fujieda, Kenji Oku, Toshiyuki Bohgaki, Olga Amengual, Tetsuya Horita, Tatsuya Atsumi
    Rheumatology (Oxford, England) 54 (8) 1536 - 1536 1462-0324 2015/08 [Refereed][Not invited]
  • Hiroko Nagafuchi, Tatsuya Atsumi, Kazuhiro Hatta, Eri Muso, Mitsuhiro Takeno, Hidehiro Yamada, Shoichi Ozaki
    MODERN RHEUMATOLOGY 25 (4) 603 - 608 1439-7595 2015/07 [Refereed][Not invited]
    Objectives. The safety and efficacy of rituximab were examined in a multicenter open-label pilot study in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) in Japan. Methods. Patients with refractory AAV were administered a rituximab infusion at a weekly dose of 375 mg/m(2) for 4 weeks. All patients also received oral daily prednisolone. The primary outcome was complete remission, which was defined as a Birmingham Vasculitis Activity Score (BVAS) of 0 or 1. Results. The mean age of the 7 patients was 57 (range, 34-71) years. The mean follow-up period after rituximab treatment was 62.9 (range, 4.8-81) months. The mean BVAS at entry was 16.7 (range, 2-34). Complete remission occurred in all cases, except in 1 case in which the patient died, with a significant decline in BVAS from baseline at 12 months after initiation of rituximab. Rituximab reduced granulomatous orbital involvement in a patient with granulomatosis with polyangiitis. Relapse occurred in five patients. Adverse events included de novo hepatitis B in one patient, cancer (hepatocellular carcinoma and prostate cancer) in two patients, and transient visual disturbance, atypical mycobacterial infection, urinary tract infection, sepsis, and cytomegalovirus infection. Two patients died due to recurrent infections and airway obstruction, caused by an AAV lesion. Conclusions. Rituximab had a beneficial effect on refractory AAV in Japanese patients, but several adverse effects occurred during rituximab treatment.
  • Yasuhiko Ebina, Masahiro Ieko, Sumiyoshi Naito, Gen Kobashi, Masashi Deguchi, Hisanori Minakami, Tatsuya Atsumi, Hideto Yamada
    THROMBOSIS AND HAEMOSTASIS 114 (1) 65 - 69 0340-6245 2015/07 [Refereed][Not invited]
    It was the study objective to evaluate whether low levels of plasma protein S (PS) activity, free PS, protein C (PC) activity and coagulation factor XII (FXII) during early pregnancy are related to adverse pregnancy outcomes. Peripheral blood samples were obtained at 8-14 gestational weeks (GW) from a consecutive series of 1,220 women. The levels of plasma PS activity, free PS, PC activity, and FXII were measured. Cut-off values were defined as <1st, <5th, and <10th percentiles of values obtained from 933 women whose pregnancies ended in normal deliveries without complications. PS activity of <10th percentile yielded risks of pregnancy-induced hypertension (PIN) and severe PIH, while free PS level of <5th percentile yielded a risk of pre-eclampsia. FXII level of <1st percentile yielded a risk of premature delivery (PD) at <34 GW. None was associated with PD at <37 GW, fetal growth restriction or fetal loss. A multivariate analysis demonstrated that PS activity of <10th percentile (odds ratio 5.9, 95% confidence interval 1.7-18.1) and body mass index (BMI) >= 25 kg/m(2) (4.3, 1 1.1-13.3) were independent risk factors for severe PIN. Similarly, free PS level of <5th percentile (4.4, 1.0-14.3) and BMI >= 25 kg/m(2) (4.0, 1.3-10.9) were independent risk factors for pre-eclampsia. In conclusion, women with low levels of plasma PS activity and free PS during early pregnancy might have increased risks of PIN, severe PIN or pre-eclampsia. Women with low FXII level might have an increased risk of PD at <34 GW.
  • Shinsuke Yasuda, Takashi Kurita, Tetsuya Horita, Tatsuya Atsumi
    RHEUMATOLOGY 54 (6) 1129 - 1129 1462-0324 2015/06 [Refereed][Not invited]
  • Kenji Tanimura, Hui Jin, Tadahiro Suenaga, Satoko Morikami, Noriko Arase, Kazuki Kishida, Kouyuki Hirayasu, Masako Kohyama, Yasuhiko Ebina, Shinsuke Yasuda, Tetsuya Horita, Kiyoshi Takasugi, Koichiro Ohmura, Ken Yamamoto, Ichiro Katayama, Takehiko Sasazuki, Lewis L. Lanier, Tatsuya Atsumi, Hideto Yamada, Hisashi Arase
    BLOOD 125 (18) 2835 - 2844 0006-4971 2015/04 [Refereed][Not invited]
    Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by thrombosis and/or pregnancy complications. beta 2-glycoprotein I (beta 2GPI) complexed with phospholipid is recognized as a major target for autoantibodies in APS; however, less than half the patients with clinical manifestations of APS possess autoantibodies against the complexes. Therefore, the range of autoantigens involved in APS remains unclear. Recently, we found that human leukocyte antigen (HLA) class II molecules transport misfolded cellular proteins to the cell surface via association with their peptide-binding grooves. Furthermore, immunoglobulin G heavy chain/HLA class II complexes were specific targets for autoantibodies in rheumatoid arthritis. Here, we demonstrate that intact beta 2GPI, not peptide, forms a complex with HLA class II molecules. Strikingly, 100 (83.3%) of the 120 APS patients analyzed, including those whose antiphospholipid antibody titers were within normal range, possessed autoantibodies that recognize beta 2GPI/HLA class II complexes in the absence of phospholipids. In situ association between beta 2GPI and HLA class II was observed in placental tissues of APS patients but not in healthy controls. Furthermore, autoantibodies against beta 2GPI/HLA class II complexes mediated complement-dependent cytotoxicity against cells expressing the complexes. These data suggest that beta 2GPI/HLA class II complexes are a target in APS that might be involved in the pathogenesis.
  • [Programs for Continuing Medical Education: A session; 7. Antiphospholipid syndrome: diagnosis and treatment].
    Atsumi T
    Nihon Naika Gakkai zasshi. The Journal of the Japanese Society of Internal Medicine 104 (3) 513 - 518 0021-5384 2015/03 [Refereed][Not invited]
  • Yuko Matsuki, Tatsuya Atsumi, Koushi Yamaguchi, Michi Hisano, Naoko Arata, Kenji Oku, Noriyoshi Watanabe, Haruhiko Sago, Yoshinari Takasaki, Atsuko Murashima
    MODERN RHEUMATOLOGY 25 (2) 215 - 218 1439-7595 2015/03 [Refereed][Not invited]
    Objective. To clarify the clinical significance of antiphospholipid antibody (aPL) profile in patients with obstetric antiphospholipid syndrome (APS). Methods. Clinical records of 13 pregnant patients (15 pregnancies) with obstetrical APS were reviewed over 10 years. Patients who met the Sapporo Criteria fully were studied, whereas those with only early pregnancy loss were excluded. In addition to classical aPL: lupus anticoagulant (LA), anticardiolipin antibody (aCL), and anti-beta(2)-glycoprotein I (a beta 2GPI); phosphatidylserine-dependent anti-prothrombin antibody (aPS/PT) and kininogen-dependent anti-phosphatidylethanolamine antibody (aPE) were also examined in each case. Results. Cases were divided into two groups according to patient response to standard treatment: good and poor outcome groups. All cases with poor outcome presented LA, with IgG a beta 2GPI and IgG aPS/PT were also frequently observed. IgG aPE did not correlate with pregnancy outcome. Conclusion. aPL profile may predict pregnancy outcome in patients with this subset of obstetric APS.
  • Michihito Kono, Shinsuke Yasuda, Richard L. Stevens, Hideyuki Koide, Takashi Kurita, Yuka Shimizu, Yusaku Kanetsuka, Kenji Oku, Toshiyuki Bohgaki, Olga Amengual, Tetsuya Horita, Tomohiro Shimizu, Tokifumi Majima, Takao Koike, Tatsuya Atsumi
    ARTHRITIS & RHEUMATOLOGY 67 (2) 396 - 407 2326-5191 2015/02 [Refereed][Not invited]
    Objective. Ras guanine nucleotide-releasing protein 4 (RasGRP-4) is a calcium-regulated guanine nucleotide exchange factor and diacylglycerol/phorbol ester receptor not normally expressed in fibroblasts. While RasGRP-4-null mice are resistant to arthritis induced by anti-glucose-6-phosphate isomerase autoantibodies, the relevance of these findings to humans is unknown. We undertook this study to evaluate the importance of RasGRP-4 in the pathogenesis of human and rat arthritis. Methods. Synovial tissue from patients with rheumatoid arthritis (RA) and osteoarthritis (OA) were evaluated immunohistochemically for the presence of RasGRP-4 protein. Fibroblast-like synoviocytes (FLS) were isolated from synovial samples, and expression of RasGRP-4 was evaluated by real-time quantitative reverse transcription-polymerase chain reaction analyses. The proliferation potency of FLS was evaluated by exposing the cells to a RasGRP-4-specific small interfering RNA (siRNA). Finally, the ability of RasGRP-4-specific siRNAs to hinder type II collagen-induced arthritis in rats was evaluated to confirm the importance of the signaling protein in the disease. Results. Unexpectedly, RasGRP-4 protein was detected in the synovial hyperplastic lining, where proliferating FLS preferentially reside. FLS isolated from tissues obtained from a subpopulation of RA patients expressed much more RasGRP-4 than did FLS from examined OA patients. Moreover, the level of RasGRP-4 transcript was correlated with the FLS proliferation rate. The ability of cultured FLS to divide was diminished when they were treated with RasGRP-4-specific siRNAs. The intraarticular injection of RasGRP-4-specific siRNAs also dampened experimental arthritis in rats. Conclusion. RasGRP-4 is aberrantly expressed in FLS and helps regulate their growth. This intracellular signaling protein is therefore a candidate target for dampening proliferative synovitis and joint destruction.
  • Kanako Watanabe, Shinsuke Yasuda, Atsushi Noguchi, Tetsuya Horita, Tatsuya Atsumi
    ARTHRITIS & RHEUMATOLOGY 67 (2) 583 - 583 2326-5191 2015/02 [Refereed][Not invited]
  • Yuichiro Fujieda, Haruki Shida, Kenji Oku, Toshiyuki Bohgaki, Olga Amengual, Tetsuya Horita, Shinsuke Yasuda, Tatsuya Atsumi
    Japanese Journal of Clinical Immunology 37 (5) 430 - 436 1349-7413 2015/01/06 [Refereed][Not invited]
    Anticardiolipin antibodies (aCL-IgG/IgM) and anti-β2-glycoprotein I antibodies (aβ2GPI-IgG/IgM) are laboratory tests included in the current classification criteria for definite antiphospholipid syndrome (APS). However, not all of these assays have been commercially available in Japan. We investigated the efficacy of aCL-IgG/IgM and aβ2GPI-IgG/IgM assays using fluorescence enzyme immunoassay (Phadia:EliATM) for the diagnosis of APS in Japan. This study comprised 229 sera from patients (100 with APS and 129 without APS). The diagnosis of APS was made according to Sydney revised Sapporo criteria. EliATMCardiolipin and EliATMβ2-Glycoprotein (Phadia AB. Uppsala Sweden) were used to detect aCL IgG/M and aβ2GPI IgG/M, respectively. Sensitivity, specificity and area under the receiver operating characteristic curve (AUC) were as follows aCL-IgG (45%, 94%, 0.80), aCL-IgM (20%, 94%, 0.54), aβ2GPI-IgG (33%, 98%, 0.88) and aβ2GPI-IgM (16%, 99%, 0.64) respectively. aCL-IgM, aβ2GPI-IgG or aβ2GPI-IgM were detected in 10 patients (18%) with aCL-IgG negative. The use of Phadia:EliATMantiphospholipid antibodies assays improve the diagnostic yield of thrombotic risk in APS patients.
  • Hiroshi Kataoka, Shinsuke Yasuda, Shinji Fukaya, Kenji Oku, Tetsuya Horita, Tatsuya Atsumi, Takao Koike
    MODERN RHEUMATOLOGY 25 (1) 90 - 95 1439-7595 2015/01 [Refereed][Not invited]
    Objectives. To investigate the role of Foxp3(+)CD25(+)CD4(+) regulatory T cells (Treg) and their transcription factor, Runt-related transcription factor 1 (Runx1), in the pathogenesis and development of systemic sclerosis (SSc). Methods. We collected 23 blood samples from patients with SSc including 19 females and 4 males, 11 early-stage cases within 3 years from onset and 12 late-stage cases and 22 samples from age-matched healthy subjects (HS). Total CD4(+) T cells were assessed for the expression of Treg-related markers, CD25 and CD127, on their surface and intracellular Foxp3 using flow cytometry. Relative expression of Runx1 mRNA in magnetically purified Treg was analyzed using real-time PCR. Results. Proportion of Foxp3(+) cells in total CD4(+) T cells was decreased in patients with either early-or late-stage SSc compared with that in HS, and Runx1 mRNA expression in purified Treg was lower in patients with SSc than in HS. Runx1 mRNA expression level was related to the frequency of Treg in SSc. Conclusions. This is the first report on Runx1 expression in Treg of a human autoimmune disease. Low expression of Runx1 along with reduced proportion of Treg in CD4(+) T cells may be associated with development of SSc even in early disease.
  • Takashi Kurita, Shinsuke Yasuda, Koji Oba, Toshio Odani, Michihito Kono, Kotaro Otomo, Yuichiro Fujieda, Kenji Oku, Toshiyuki Bohgaki, Olga Amengual, Tetsuya Horita, Tatsuya Atsumi
    Rheumatology (Oxford, England) 54 (1) 39 - 44 1462-0324 2015/01 [Refereed][Not invited]
    OBJECTIVE: Interstitial lung diseases (ILDs) complicated with PM or DM are frequently aggressive and refractory to treatment. Recently some reports have suggested the potential benefit of tacrolimus for severe ILD complicated with PM/DM. However, little evidence has yet shown the efficacy of tacrolimus in these settings. The aim of this study was to evaluate the efficacy of tacrolimus as a treatment for PM-/DM-related ILD. METHODS: This retrospective study comprised 49 previously untreated patients diagnosed as PM-/DM-related ILD admitted to Hokkaido University Hospital from January 2000 to July 2013. These patients were treated with tacrolimus plus conventional therapy or only with conventional therapy (prednisolone, i.v. CYC and/or ciclosporin). The primary endpoint was defined as the time to relapse or death of respiratory cause or a serious adverse event. The secondary endpoint was defined as the time from the initiation of immunosuppressive treatment to relapse or death of respiratory cause. Endpoints were compared by adjusted Cox regression model by using inverse probability of treatment weighting in order to reduce the impact of these selection biases and potential confounding factors. RESULTS: After adjustment, the tacrolimus group (n = 25) had significantly longer event-free survival as compared with the conventional therapy group (n = 24). The weighted hazard ratio (HR) was 0.32 (95% CI 0.14, 0.75, P = 0.008). In addition, the tacrolimus group had significantly longer disease-free survival as compared with the conventional therapy group. The weighted HR was 0.25 (95% CI 0.10, 0.66, P = 0.005). CONCLUSION: The addition of tacrolimus to conventional therapy significantly improved the prognosis of patients with PM-/DM-related ILD.
  • Oku K, Murashima A, Oomura K, Amengual O, Bohgaki T, Horita T, Yasuda S, Kaneko K, Nakanishi I, Nozawa K, Sugiura-Ogasawara M, Atsumi T
    Nihon Rinsho Men'eki Gakkai kaishi = Japanese journal of clinical immunology 38 (6) 457 - 465 0911-4300 2015 [Refereed][Not invited]
  • Oku K, Amengual O, Hisada R, Oomura K, Nakagawa I, Watanabe T, Bohgaki T, Horita T, Yasuda S, Atsumi T
    Nihon Rinsho Men'eki Gakkai kaishi = Japanese journal of clinical immunology 38 (3) 157 - 163 0911-4300 2015 [Refereed][Not invited]
  • Mayumi Sugiura-Ogasawara, Tatsuya Atsumi, Hideto Yamada, Tamao Kitaori, Yasuhiko Ozaki, Kinue Katano, Atsuko Murashima
    MODERN RHEUMATOLOGY 25 (6) 883 - 887 1439-7595 2015 [Refereed][Not invited]
    Objective. The international classification criteria (CC) for definite antiphospholipid syndrome (APS) recommend confirmation of the sustained presence, for at least 12 weeks, of both lupus anticoagulant (LA), as determined by aPTT and RVVT, and anti beta 2glycoprotein I (beta 2GPI) or anticardiolipin (aCL) IgG and/or IgM. However, it remains unclear whether obstetricians comply with the aforementioned CC for the diagnosis of APS in daily clinical practice. We performed a nationwide survey to examine the attitudes of Japanese obstetricians toward the use of assays for antiphospholipid antibodies (aPLs). Methods. A questionnaire was sent to 2,700 obstetric facilities where maternity checkups are car-ried out. The types of assays conducted for aPLs, ascertainment of persistence of the antibodies for at least 12 weeks, and the cutoff points used for the assays were examined. Results. Of the facilities surveyed, 61.5% carried out the assay(s) only once. In regard to the type of assay performed, 97.1% carried out the assay for aCL IgG and/or beta 2GPI-dependent aCL, while 67.9% performed the LA-aPTT and/or LA-RVVT assay. Only 8.8% carried out assays for both LA. As for the cutoff points used, 98% of the facilities used lower cutoff points described in the manufacturers' manuals rather than the cutoff values recommended in the CC. Conclusion. Thus, only a limited number of facilities adhered precisely to the CC for the diagnosis of APS. Inappropriate treatment and unnecessary expense are potentially major concerns when facilities overdiagnose APS using lower cutoff points or without ascertaining the persistence of the antibodies for at least 12 weeks. On the other hand, some patients miss the opportunity to be treated for APS because of the absence of testing for LA.
  • Shinsuke Yasuda, Tatsuya Atsumi, Sanae Shimamura, Kota Ono, Keiju Hiromura, Kenei Sada, Masaaki Mori, Syuji Takei, Yasushi Kawaguchi, Naoto Tamura, Yoshinari Takasaki
    MODERN RHEUMATOLOGY 25 (6) 854 - 857 1439-7595 2015 [Refereed][Not invited]
    Objectives. Mycophenolate mofetil (MMF) is used as one of the standard induction/maintenance protocols for lupus nephritis (LN). However, MMF has not been approved for treating LN in any country, resulting in worldwide off-label use of this immunosuppressant. In order to clarify the real-world use of MMF as a treatment for LN in Japan, Japan College of Rheumatology surveyed the use of MMF in daily clinical practice. Methods. Adult patients with LN who visited enrolled hospitals from October 2008 to September 2013 were surveyed for the initial, maximum, and maintenance doses of MMF. The safety and efficacy of MMF were retrospectively evaluated. Results. One hundred and thirty-seven LN patients including 116 females were enrolled. The median of initial, maximum, and maintenance doses of MMF were 1.0 g/day, 1.5 g/day, and 1.0 g/day, respectively. Sixty-one adverse events were reported in 39 patients during the follow-up period. Median urine protein level decreased from 1.89 g/gCr to 0.21 g/gCr, meanC3 level increased from 66.4 mg/dl to 80.3 mg/dl, and median anti-DNA antibody titer decreased from 40.6 IU/ml to 10.6 IU/ml. Conclusion. MMF was commonly used for the treatment of adult LN patients with acceptable efficacy and safety in Japan.
  • Ryoki Hara, Hirotaka Miyazawa, Kenichi Nishimura, Takahiro Momoi, Tomo Nozawa, Masako Kikuchi, Nodoka Sakurai, Toshitaka Kizawa, Sanae Shimamura, Shinsuke Yasuda, Keiju Hiromura, Ken-ei Sada, Yasushi Kawaguchi, Naoto Tamura, Syuji Takei, Yoshinari Takasaki, Tatsuya Atsumi, Masaaki Mori
    MODERN RHEUMATOLOGY 25 (6) 858 - 864 1439-7595 2015 [Refereed][Not invited]
    Purpose. To conduct a national survey of systemic lupus erythematosus (SLE) patients treated with mycophenolate mofetil (MMF). Based on current information on the use of MMF, we aimed to evaluate its efficacy and safety for childhood-onset (c-) SLE. Target. We evaluated 115 patients by questionnaire on MMF use for c-SLE in medical facilities specializing in pediatric rheumatic and renal diseases.Results. Average age at SLE onset was 10.6 (range, 2-15) years; average age at the time of starting MMF was 12.3 (range, 2-15) years. Average dose per body surface area was 1,059.3 mg/m2/ day. Corticosteroid dosing was 20.9 mg/day before treatment but 7.7 mg/day after treatment. Laboratory values before and after MMF treatment were as follows: C3 increased from 67.0 to 84.9 mg/dl (p < 0.001), C4 increased from 10.2 to 15.1 mg/dl (p < 0.001), and anti-DNA antibody decreased from 154.2 to 18.4 IU/ml (p < 0.001). 24 adverse events in 21 cases were reported, but MMF was not discontinued in any.Conclusions. The amount of MMF for c-SLE in Japan is similar to the standard dose in other countries. Reduction of corticosteroid dose and improvement of laboratory values represent efficacy of MMF. The side effects recorded here indicated tolerability of the drug.
  • Hiroshi Nomoto, Hideaki Miyoshi, Tomoo Furumoto, Koji Oba, Hiroyuki Tsutsui, Arina Miyoshi, Takuma Kondo, Kenichi Tsuchida, Tatsuya Atsumi, Naoki Manda, Yoshio Kurihara, Shin Aoki
    PloS one 10 (8) e0135854  2015 [Refereed][Not invited]
    OBJECTIVES: GLP-1 improves hyperglycemia, and it has been reported to have favorable effects on atherosclerosis. However, it has not been fully elucidated whether GLP-1 is able to improve endothelial function in patients with type 2 diabetes. Therefore, we investigated the efficacy of the GLP-1 analogue, liraglutide on endothelial function and glycemic metabolism compared with insulin glargine therapy. MATERIALS AND METHODS: In this multicenter, prospective randomized parallel-group comparison study, 31 diabetic outpatients (aged 60.3 ± 10.3 years with HbA1c levels of 8.6 ± 0.8%) with current metformin and/or sulfonylurea treatment were enrolled and randomly assigned to receive liraglutide or glargine therapy once daily for 14 weeks. Flow mediated dilation (FMD), a comprehensive panel of hemodynamic parameters (Task Force Monitor), and serum metabolic markers were assessed before and after the treatment period. RESULTS: A greater reduction (worsening) in %FMD was observed in the glargine group, although this change was not statistically different from the liraglutide group (liraglutide; 5.7 to 5.4%, glargine 6.7 to 5.7%). The augmentation index, C-peptide index, derivatives of reactive oxygen metabolites and BMI were significantly improved in the liraglutide group. Central systolic blood pressure and NT-proBNP also tended to be improved in the liraglutide-treated group, while improvements in HbA1c levels were similar between groups. Cardiac index, blood pressure and most other metabolic parameters were not different. CONCLUSIONS: Regardless of glycemic improvement, early liraglutide therapy did not affect endothelial function but may provide favorable effects on beta-cell function and cardioprotection in type 2 diabetics without advanced atherosclerosis. TRIAL REGISTRATION: UMIN Clinical Trials Registry System as trial ID UMIN000005331.
  • Yuki Matsui, Utano Tomaru, Arina Miyoshi, Tomoki Ito, Shinji Fukaya, Hideaki Miyoshi, Tatsuya Atsumi, Akihiro Ishizu
    EXPERIMENTAL AND MOLECULAR PATHOLOGY 97 (3) 354 - 358 0014-4800 2014/12 [Refereed][Not invited]
    Obesity is a state in which chronic low-grade inflammation persists in adipose tissues. Pro-inflammatory cytokines, including TNF-alpha, produced by adipose tissues have been implicated as active participants in the development of obesity-related diseases. Since TNF-alpha converting enzyme (TACE) is the major factor that induces soluble TNF-alpha, TACE has been noted as a pivotal regulator in this field. To reveal the role of TACE in adipose tissue inflammation, TACE-transgenic (TACE-Tg) and wild type (WT) mice were fed with high fat diet (HFD) or control diet for 16 weeks. At 13 weeks after the beginning of the diet, serum TNF-alpha and macrophage-related cytokine/chemokine levels were elevated in TACE-Tg mice fed with HFD (Tg-HFD mice), and the number of the so-called crown-like adipocyte was significantly increased in adipose tissues of Tg-HFD mice at the end of the experiment. Although macrophage infiltration was not detected in the adipose tissues at this time, fibrosis was observed around the crown-like adipocytes. These findings suggested that TACE overexpression induced macrophage infiltration and subsequent fibrosis in adipose tissues under HFD regimen. The collective evidence suggested that TACE could be a therapeutic target of HFD-induced obesity-related adipose tissue inflammation. (C) 2014 Elsevier Inc. All rights reserved.
  • Olga Amengual, Tetsuya Horita, Walter Binder, Gary L. Norman, Zakera Shums, Masaru Kato, Kotaro Otomo, Yuichiro Fujieda, Kenji Oku, Toshiyuki Bohgaki, Shinsuke Yasuda, Tatsuya Atsumi
    RHEUMATOLOGY INTERNATIONAL 34 (9) 1225 - 1230 0172-8172 2014/09 [Refereed][Not invited]
    Phosphatidylserine-dependent antiprothrombin antibodies (aPS/PT) were strongly correlated with the presence of lupus anticoagulant showing a high specificity for the diagnosis of antiphospholipid syndrome. However, the main criticism for the clinical applicability of aPS/PT testing is the lack of reproducibility of the results among laboratories. In this study, we measured IgG and IgM aPS/PT using our original in-house enzyme-linked immunosorbent assays (ELISA) and commercial ELISA kits to assess the assay performance and to evaluate the accuracy of aPS/PT results. The study included 111 plasma samples collected from patients and stored at our laboratory for aPS/PT assessment. Sixty-one samples were tested for IgG aPS/PT using two assays: (1) aPS/PT in-house ELISA and (2) QUANTA Lite (TM) aPS/PT IgG ELISA kit (INOVA Diagnostics, Inc., USA). Fifty samples were evaluated for IgM aPS/PT using two assays: (1) aPS/PT in-house ELISA and (2) QUANTA Lite (TM) aPS/PT IgM ELISA kit (INOVA Diagnostics). Ninety-eight percent of samples yielded concordant results for IgG aPS/PT and 82 % for IgM aPS/PT. There was an excellent agreement between the IgG aPS/PT assays (Cohen kappa = 0.962) and moderate agreement between the IgM aPS/PT assays (kappa = 0.597). Statistically significant correlations in the aPS/PT results were obtained from both IgG and IgM aPS/PT assays (r = 0.749, r = 0.622, p < 0.001, respectively). In conclusion, IgG and IgM detection by ELISA is accurate. The performance of aPS/PT is reliable, and concordant results can be obtained using different ELISA methods.
  • Jun Fukae, Masato Isobe, Akemi Kitano, Mihoko Henmi, Fumihiko Sakamoto, Akihiro Narita, Takeya Ito, Akio Mitsuzaki, Masato Shimizu, Kazuhide Tanimura, Megumi Matsuhashi, Tamotsu Kamishima, Tatsuya Atsumi, Takao Koike
    RHEUMATOLOGY 53 (9) 1608 - 1612 1462-0324 2014/09 [Refereed][Not invited]
    Objective. In this study we investigated the relationship between synovial vascularity (SV) and structural alteration of finger joints in patients with RA and long-term sustained clinical low disease activity (CLDA). Methods. RA patients with CLDA of >2 years (minimum 1 year of CLDA for study entry plus 1 year of observation) were analysed. Quantitative SV values were sequentially measured in each finger joint using power Doppler ultrasonography (0, 8, 20 and 52 weeks). Radiological progression of local finger joints was evaluated according to the Genant-modified Sharp score (0-52 weeks). Results. Of the 25 patients enrolled, 15 patients were finally analysed after excluding 10 patients who failed to maintain CLDA during the observational period. Changes in radiological progression of MCP and PIP joints with positive SV were significantly greater than those in joints with negative SV. Joint space narrowing (JSN) was strongly related to structural alteration of finger joints. In joints with positive SV, changes in structural alteration did not relate to total SV values, which reflect total exposure to inflammation in an observational period. Conclusion. Even in patients with a long period of CLDA, finger joints with positive SV showed structural alteration, especially in the progression of JSN.
  • Maria Laura Bertolaccini, Olga Amengual, Laura Andreoli, Tatsuya Atsumi, Cecilia B. Chighizola, Ricardo Forastiero, Philip De Groot, Gabriella Lakos, Marc Lambert, Pierluigi Meroni, Thomas L. Ortel, Michelle Petri, Anisur Rahman, Robert Roubey, Savino Sciascia, Melissa Snyder, Anne E. Tebo, Angela Tincani, Rohan Willis
    AUTOIMMUNITY REVIEWS 13 (9) 917 - 930 1568-9972 2014/09 [Refereed][Not invited]
    Current classification criteria for definite Antiphospholipid Syndrome CAPS) require the use of three laboratory assays to detect antiphospholipid antibodies (aCL, anti-beta 2GPI and LA) in the presence of at least one of the two major clinical manifestations (i.e. thrombosis or pregnancy morbidity) of the syndrome. However, several other autoantibodies shown to be directed to other proteins or their complex with phospholipids have been proposed to be relevant to APS but their clinical utility and their diagnostic value remains elusive. This report summarizes the findings, conclusions and recommendations of the "APS Task Force 3-Laboratory Diagnostics and Trends" meeting that took place during the 14th International Congress on Antiphospholipid Antibodies (APLA 2013, September 18-21, Rio de Janeiro, Rj, Brazil). (c) 2014 Elsevier B.V. All rights reserved.
  • [111th Scientific Meeting of the Japanese Society of Internal Medicine: Educationnal Lecture: 2. Systemic lupus erythematosus: Diagnosis and treatment].
    Atsumi T
    Nihon Naika Gakkai zasshi. The Journal of the Japanese Society of Internal Medicine 103 (9) 2236 - 2241 0021-5384 2014/09 [Refereed][Not invited]
  • Chikako Kiyohara, Masakazu Washio, Takahiko Horiuchi, Toyoko Asami, Saburo Ide, Tatsuya Atsumi, Gen Kobashi, Hiroki Takahashi, Yoshifumi Tada
    ARTHRITIS CARE & RESEARCH 66 (7) 1048 - 1056 2151-464X 2014/07 [Refereed][Not invited]
    Objective. N-acetyltransferase 2 (NAT2) is involved in the metabolism of various environmental substances, both with and without carcinogenic potential. Alcoholic and nonalcoholic caffeine-rich beverages may be associated with markers of inflammation. Systemic lupus erythematosus (SLE) is a chronic, multifaceted inflammatory disease. We investigated the effects of alcoholic and nonalcoholic caffeine-rich beverages on risk of SLE and determined whether the effects were modified by NAT2 status. Methods. The NAT2 polymorphism was genotyped in 152 SLE cases and 427 healthy controls, all women and Japanese. We assessed effect modification by testing an interaction term for the NAT2 polymorphism and consumption of beverages. Results. Consumption of black tea (odds ratio [OR] 1.88, 95% confidence interval [95% CI] 1.03-3.41) and coffee (OR 1.57, 95% CI 0.95-2.61), but not green tea, was associated with an increased risk of SLE, while alcohol use (OR 0.33, 95% CI 0.20-0.55) was associated with a decreased risk of SLE. There were significant interactions between the NAT2 polymorphism and either alcohol use (P-interaction = 0.026) or consumption of black tea (P-interaction = 0.048). Conclusion. The NAT2 polymorphism significantly modified the effects of alcohol use and black tea consumption on SLE, emphasizing the importance of incorporating genetic and metabolic information in studies on management of SLE. Additional studies are warranted to confirm the findings suggested in this study.
  • Hiraku Kameda, Hideaki Miyoshi, Chikara Shimizu, So Nagai, Akinobu Nakamura, Takuma Kondo, Dai Chida, Tatsuya Atsumi
    ENDOCRINOLOGY 155 (7) 2492 - 2499 0013-7227 2014/07 [Refereed][Not invited]
    The hypothalamic-pituitary-adrenal (HPA) axis is a major part of the neuroendocrine system that controls responses to stress, and has an important function in the regulation of various body processes. We previously created a mouse line deficient in the melanocortin 2 receptor (MC2R). MC2R-deficient mice (MC2R(-/-) mice) have high adrenocorticotropic hormone (ACTH) levels because of undetectable corticosterone levels. Increased neuromedin B (NMB) expression was recently reported in the pituitary gland of adrenalectomized mice, a model for acute adrenal insufficiency. To investigate gene expression in the pituitary gland under chronic adrenal deficiency, we examined the pituitary gland of MC2R(-/-) mice, a model of chronic adrenal insufficiency. To understand the molecular background of pituitary cells under chronic adrenal deficiency, we first performed DNA microarray analyses using the pituitary glands of the MC2R(-/-) mice. The DNA microarray analysis and real-time polymerase chain reaction showed that NMB expression was higher in the MC2R(-/-) than in the wild-type (WT) mice. We detected NMB expression in the MC2R(-/-) pituitary corticotrophs by immunohistochemistry using the specific antibodies for ACTH and NMB. In addition, the plasma NMB concentration was significantly higher in the MC2R(-/-) mice than in the WT mice. Subcutaneous implantation of a sustained-release corticosterone pellet decreased the expression of NMB mRNA as well as pituitary proopiomelanocortin mRNA. In isolated anterior pituitary cells, NMB mRNA expression was increased by the administration of corticotropin-releasing hormone (CRH) and was suppressed by dexamethasone treatment. In this study, we first demonstrate NMB expression in corticotrophs and its regulation by CRH and glucocorticoids. Furthermore, corticotrophs seemed to secrete NMB into the systemic circulation.
  • [Recent progress of diagnosis and treatment for immune-mediated hematological diseases. Topics: II. Differential diagnosis; 1. Idiopathic thrombocytopenic purpura and antiphospholipid syndrome].
    Atsumi T
    Nihon Naika Gakkai zasshi. The Journal of the Japanese Society of Internal Medicine 103 (7) 1580 - 1585 0021-5384 2014/07 [Refereed][Not invited]
  • [The pathogenesis, diagnosis and treatment of antiphospholipid syndrome].
    Ohmura K, Oku K, Atsumi T
    Nihon rinsho. Japanese journal of clinical medicine 72 (7) 1309 - 1313 0047-1852 2014/07 [Refereed][Not invited]
  • Hiroki Takahashi, Masakazu Washio, Chikako Kiyohara, Yoshifumi Tada, Toyoko Asami, Saburo Ide, Tatsuya Atsumi, Gen Kobashi, Motohisa Yamamoto, Takahiko Horiuchi
    MODERN RHEUMATOLOGY 24 (3) 448 - 452 1439-7595 2014/05 [Refereed][Not invited]
    Objectives. Daily psychological stress has been proposed as a risk factor for systemic lupus erythematosus (SLE) in Western countries. However, there is little information about the relationship between daily psychological stress and the risk of SLE in a Japanese population. We examined the association between SLE and daily psychological stress. Methods. A case-control study was conducted to examine the relationship between daily psychological stress and SLE in Japanese females. The participants were 160 female SLE patients and 660 female volunteers. Unconditional logistic regression was used to compute OR and 95% confi dence interval (CI), with adjustment for several covariates. Results. Smoking (OR = 2.59; 95% CI, 1.74-3.86), walking (OR = 1.75; 95% CI, 1.81-2.56) and daily psychological stress (OR = 1.88; 95% CI, 1.14-3.10) were increased in patients with SLE after adjusting for age, region and all factors. Smokers with daily psychological stress (OR = 4.70; 95% CI = 2.53-8.77) were more prevalent than nonsmokers without daily psychological stress in SLE. The multiplicative interaction measures between smoking status and daily psychological stress did not reach statistical significance. Conclusions. The present study suggests the possibility that daily psychological stress as well as smoking might be associated with an increased risk of SLE.
  • Daigo Nakazawa, Haruki Shida, Utano Tomaru, Masaharu Yoshida, Saori Nishio, Tatsuya Atsumi, Akihiro Ishizu
    JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY 25 (5) 990 - 997 1046-6673 2014/05 [Refereed][Not invited]
    AKI involves early Toll-like receptor (TLR)-driven immunopathology, and resolution of inflammation is needed for rapid regeneration of injured tubule cells. Notably, activation of TLRs also has been implicated in epithelial repair. We hypothesized that TLR signaling drives tubule regeneration after acute injury through the induction of certain ILs. Systematic screening in vitro identified IL-22 as a candidate proregeneratory factor in primary tubular cell recovery, and IL-22 deficiency or IL-22 blockade impaired post-ischemic tubular recovery after AKI in mice. Interstitial mononuclear cells, such as dendritic cells and macrophages, were the predominant source of IL-22 secretion, whereas IL-22 receptor was expressed by tubular epithelial cells exclusively. Depleting IL-22-producing cells during the healing phase impaired epithelial recovery, which could be rescued entirely by reconstituting mice with IL-22. In vitro, necrotic tubular cells and oxidative stress induced IL-22 secretion selectively through TLR4. Although TLR4 blockade during the early injury phase prevented tubular necrosis and AKI, TLR4 blockade during the healing phase suppressed IL-22 production and impaired kidney regeneration. Taken together, these results suggest that necrotic cell-derived TLR4 agonists activate intrarenal mononuclear cells to secrete IL-22, which accelerates tubular regeneration and recovery in AKI.
  • Jun Fukae, Kazuhide Tanimura, Tatsuya Atsumi, Takao Koike
    RHEUMATOLOGY 53 (4) 586 - 591 1462-0324 2014/04 [Refereed][Not invited]
    RA is a condition of multiple synovitis. Abnormal synovial vascularity (SV) is evident with the onset of joint inflammation. The idea of estimating the level of joint inflammation by sonographic SV was conceived with the advancement of US. The ideal treatment strategy, called treat to target (T2T), requires early diagnosis and assessment of RA. Detection of positive SV can be useful for proving the presence of synovitis and finally diagnosing RA. In the assessment of RA, US-based global scores aimed at assessing overall disease activity have the potential to be useful for the achievement of T2T because US can directly detect changes in synovitis. Remaining SV in local joints increases the risk of structural deterioration. RA requires both improvement of overall disease activity and the disappearance of local SV for remission. The evaluation of SV provides various information and contributes to the clinical treatment of RA.
  • Hui Jin, Noriko Arase, Kouyuki Hirayasu, Masako Kohyama, Tadahiro Suenaga, Fumiji Saito, Kenji Tanimura, Sumiko Matsuoka, Kosuke Ebina, Kenrin Shi, Noriko Toyama-Sorimachi, Shinsuke Yasuda, Tetsuya Horita, Ryosuke Hiwa, Kiyoshi Takasugi, Koichiro Ohmura, Hideki Yoshikawa, Takashi Saito, Tatsuya Atsumi, Takehiko Sasazuki, Ichiro Katayama, Lewis L Lanier, Hisashi Arase
    Proceedings of the National Academy of Sciences of the United States of America 111 (10) 3787 - 92 0027-8424 2014/03/11 [Refereed][Not invited]
    Specific HLA class II alleles are strongly associated with susceptibility to rheumatoid arthritis (RA); however, how HLA class II regulates susceptibility to RA has remained unclear. Recently, we found a unique function of HLA class II molecules: their ability to aberrantly transport cellular misfolded proteins to the cell surface without processing to peptides. Rheumatoid factor (RF) is an autoantibody that binds to denatured IgG or Fc fragments of IgG and is detected in 70-80% of RA patients but also in patients with other diseases. Here, we report that intact IgG heavy chain (IgGH) is transported to the cell surface by HLA class II via association with the peptide-binding groove and that IgGH/HLA class II complexes are specifically recognized by autoantibodies in RF-positive sera from RA patients. In contrast, autoantibodies in RF-positive sera from non-RA individuals did not bind to IgGH/HLA class II complexes. Of note, a strong correlation between autoantibody binding to IgG complexed with certain HLA-DR alleles and the odds ratio for that allele's association with RA was observed (r = 0.81; P = 4.6 × 10(-5)). Our findings suggest that IgGH complexed with certain HLA class II alleles is a target for autoantibodies in RA, which might explain why these HLA class II alleles confer susceptibility to RA.
  • [NETs in pathogenesis of vasculitis].
    Nakazawa D, Nishio S, Tomaru U, Atsumi T, Ishizu A
    Nihon Jinzo Gakkai shi 2 56 (2) 117 - 123 0385-2385 2014 [Refereed][Not invited]
  • Toshiyuki Bohgaki, Tatsuya Atsumi
    Japanese Journal of Clinical Immunology 37 (3) 125 - 132 1349-7413 2014 [Refereed][Not invited]
    Cell death process can be involved in the development, differentiation, inflammation, immunity and tumorigenesis. Molecular mechanism of apoptotic cell death has been unveiled while molecular mechanisms of the other programmed cell death, especially necroptosis and autophagy, also have been elucidated. Autophagy is a highly conserved lysosome-mediated catabolic process and a homeostatic process to degrade unnecessary or dysfunctional cellular organelles and to recycle nutrients. The relation between autophagy and human disease has been reported. Here, we describe about the role of autophagy in autoimmune disease. © 2014 The Japan Society for Clinical Immunology.
  • Kyu Yong Cho, Hideaki Miyoshi, Satoshi Kuroda, Hiroshi Yasuda, Kenji Kamiyama, Joji Nakagawara, Masayoshi Takigami, Takuma Kondo, Tatsuya Atsumi
    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 22 (7) 910 - 8 1052-3057 2013/10 [Refereed][Not invited]
    BACKGROUND: Proinflammatory (M1) macrophages and anti-inflammatory (M2) macrophages have been identified in atherosclerotic plaques. While these macrophages have been speculated to be related to plaque vulnerability, there are limited studies investigating this relationship. Therefore, we examined the association between macrophage phenotype (M1 versus M2) and plaque vulnerability and clinical events. METHODS: Patients undergoing carotid endarterectomy received an ultrasound of the carotid artery before surgery. Plaques were processed for analysis by immunohistochemistry, Western blotting, and real-time polymerase chain reaction studies. Medical history and clinical data were obtained from medical records. RESULTS: Patients were divided into 2 groups: those suffering from acute ischemic attack (symptomatic, n = 31) and those that did not present with symptoms (asymptomatic, n = 34). Ultrasound analysis revealed that plaque vulnerability was greater in the symptomatic group (P= .033; Chi-square test). Immunohistochemistry revealed that plaques from the symptomatic group had a greater concentration of M1 macrophages (CD68-, CD11c-positive) while plaques from the asymptomatic group had more M2 macrophages (CD163-positive). This observation was confirmed by Western blotting. Characterization by real-time polymerase chain reaction studies revealed that plaques from the symptomatic group had increased expression of the M1 markers CD68 and CD11c, as well as monocyte chemoattractive protein-1, interleukin-6, and matrix metalloproteinase-9. In addition, more M1 macrophages expressed in unstable plaques were defined by ultrasound analysis, while more M2 macrophages were expressed in stable plaques. CONCLUSIONS: Our data show that M1 macrophage content of atherosclerotic plaques is associated with clinical incidence of ischemic stroke and increased inflammation or fibrinolysis. We also show the benefits of using ultrasound to evaluate vulnerability in the plaques.
  • Kenji Oku, Olga Amengual, Polona Zigon, Tetsuya Horita, Shinsuke Yasuda, Tatsuya Atsumi
    RHEUMATOLOGY 52 (10) 1775 - 1784 1462-0324 2013/10 [Refereed][Not invited]
    Objective. The aim of this study was to investigate the effects of phosphatidylserine-dependent antiprothrombin antibody (aPS/PT) on the expression of tissue factor (TF) and the signal transduction pathway in procoagulant cells. Methods. Peripheral blood mononuclear cells (PBMCs) from a healthy donor, murine monocyte RAW264.7 cells and human umbilical vein endothelial cells (HUVECs) were treated with either IgG fractions obtained from APS patients who were positive for aPS/PT or a murine monoclonal aPS/PT antibody, 231D, in the presence of prothrombin. The levels of TF mRNA were measured using real-time PCR. TF function, as measured by procoagulant activity, was determined with a clotting assay. 231D binding on the surface of treated cells was determined by flow cytometric analysis. Screening for phosphorylation of intracellular signalling proteins was conducted using an array assay. Phosphorylation of p38 MAPK was quantitatively analysed with ELISA, and SB203580 was used as a specific inhibitor of p38 MAPK. Specific siRNA for p38 MAPK was used for the knockdown assay. Results. The IgG fractions from APS patients and 231D induced TF mRNA overexpression and shortening of coagulation time in cells in the presence of prothrombin. The 231D moiety induced phosphorylation of p38 MAPK after binding to the cell surface of RAW264.7 cells. SB203580 or p38 siRNA significantly hampered TF overexpression. Conclusion. Expression of TF in procoagulant cells was induced by aPS/PT via p38MAPK phosphorylation. This phenomenon may be correlated with the thrombogenicity of APS.
  • Akihiro Ishizu, Utano Tomaru, Taichi Murai, Tomohiro Yamamoto, Tatsuya Atsumi, Takashi Yoshiki, Wako Yumura, Kunihiro Yamagata, Hidehiro Yamada, Shunichi Kumagai, Manae S. Kurokawa, Machi Suka, Hirofumi Makino, Shoichi Ozaki
    PLOS ONE 8 (5) e63182  1932-6203 2013/05 [Refereed][Not invited]
    The JMAAV study was an open-labeled prospective clinical trial, which proposed severity-based treatment protocols for patients with microscopic polyangiitis (MPA). The results suggest that the proposed protocols are useful (remission rate: 89.4%), but are also indicative of relapse or patient demise regardless of the treatment (recurrence rate: 19.0%; mortality rate: 10.6%). The aim of this study is to develop the method to predict response to the treatment in patients with MPA. In the present study, transcriptome analysis was performed using peripheral blood from patients enrolled in the JMAAV study before and 1-week after the beginning of treatment. The gene expression profile before treatment was not directly related to the response to the treatment. However, when the samples from 9 patients with good response (persistent remission for 18 months) were examined, the expression of 88 genes was significantly altered by the treatment. Thirty statistically reliable genes were selected, and then the alteration of expression by the treatment was examined among 22 patients, including 17 with good response, which was defined as persistent remission for 18 months and 5 with poor response, which was defined as relapse after remission or no remission. Discrimination analysis between the alteration of expression of the 30 genes by the treatment and the response identified a combination of 16 genes as the most valuable gene set to predict the response to the treatment. This preliminary study identified IRF7, IFIT1, IFIT5, OASL, CLC, GBP-1, PSMB9, HERC5, CCR1, CD36, MS4A4A, BIRC4BP, PLSCR1, DEFA1/DEFA3, DEFA4, and COL9A2 as the important genes that can predict the response to the treatment in patients with MPA at an early point during the therapy.
  • [Case report; A case of familial focal segmental glomerulosclerosis with a mutation in the formin INF2].
    Yamamoto J, Nakazawa D, Tsukaguchi H, Toyoyama T, Sato A, Nakagaki T, Ishikawa Y, Shibazaki S, Nishio S, Atsumi T
    Nihon Naika Gakkai zasshi. The Journal of the Japanese Society of Internal Medicine 5 102 (5) 1220 - 1222 0021-5384 2013/05 [Refereed][Not invited]
  • Arina Miyoshi, So Nagai, Masamitsu Takeda, Takuma Kondo, Hiroshi Nomoto, Hiraku Kameda, Amiko Hirai, Kyuyong Cho, Kimihiko Kimachi, Chikara Shimizu, Tatsuya Atsumi, Hideaki Miyoshi
    Journal of Diabetes Investigation 4 (3) 326 - 329 2040-1116 2013/05 [Refereed][Not invited]
    Aims/Introduction: Polycystic ovary syndrome (PCOS) is a heterogeneous disorder including polycystic ovary morphology (PCOM), ovulatory dysfunction and hyperandrogenism. PCOS is frequently associated with type 2 diabetes mellitus however, it is unknown whether PCOM and PCOS are prevalent in Japanese patients with type 1 diabetes mellitus. The purpose of our study was to determine the frequency of PCOM and PCOS in women with type 1 diabetes mellitus. Materials and Methods: We evaluated clinical, hormonal and ovarian ultrasound data from 21 type 1 diabetes mellitus patients whose average glycated hemoglobin levels were 7.9 ± 1.5%. Results: Ultrasound identified PCOM in 11 patients (52.4%) and these patients also had higher levels of the androgen dehydroepiandrosterone sulfate (DHEA-S) than those without PCOM (P < 0.05). Of the patients with PCOM, five presented menstrual irregularities (45.5%) and three met the Japanese criteria for PCOS (27.2%) whereas all patients without PCOM had a normal menstrual cycle (P < 0.05). Conclusions: Japanese premenopausal women with type 1 diabetes mellitus had a high frequency of PCOM as well as PCOS. This is the first research of this area carried out in an Asian population. © 2013 Asian Association for the Study of Diabetes and Wiley Publishing Asia Pty Ltd.
  • Jun Fukae, Masato Isobe, Akemi Kitano, Mihoko Henmi, Fumihiko Sakamoto, Akihiro Narita, Takeya Ito, Akio Mitsuzaki, Masato Shimizu, Kazuhide Tanimura, Megumi Matsuhashi, Tamotsu Kamishima, Tatsuya Atsumi, Takao Koike
    RHEUMATOLOGY 52 (3) 523 - 528 1462-0324 2013/03 [Refereed][Not invited]
    Objective. To investigate the relationship between synovial vascularity and joint damage progression in each finger joint of patients with RA under low disease activity during treatment with biologic agents. Methods. We studied 310 MCP and 310 PIP joints of 31 patients with active RA who were administered adalimumab (ADA) or tocilizumab (TCZ). Patients were examined with clinical and laboratory assessments. Power Doppler sonography was performed at baseline and at weeks 8, 20 and 40. Synovial vascularity was evaluated according to quantitative measurement. Hand and foot radiography was performed at baseline and at week 50. Results. Composite scores of the DAS with 28 joints and the Simplified Disease Activity Index (SDAI) were significantly decreased from baseline to week 8, being sustained at a low level by biologic agents during the observational period. MCP and PIP joints with positive synovial vascularity after week 8 showed more subsequent joint damage progression than joints without synovial vascularity throughout the follow-up. The changes in radiographic progression in these joints were independent of the sum of synovial vascularity from baseline to week 40 or the occasional occurrence of positive synovial vascularity. Conclusion. Smouldering inflammation reflected by positive synovial vascularity under low disease activity was linked to joint damage. The damage progressed irrespective of the severity of positive synovial vascularity. Even with a favourable overall therapeutic response, monitoring of synovial vascularity has the potential to provide useful joint information to tailor treatment strategies. Trial registration. University Hospital Medical Information Network Clinical Trials Registry; ext-link-type="uri" xlink:href="" xmlns:xlink="">; UMIN000004476.
  • Akito Takamura, Shintaro Hirata, Hayato Nagasawa, Hideto Kameda, Yohei Seto, Tatsuya Atsumi, Makoto Dohi, Takao Koike, Nobuyuki Miyasaka, Masayoshi Harigai
    MODERN RHEUMATOLOGY 2 23 (2) 297 - 303 1439-7595 2013/03 [Refereed][Not invited]
    We investigated associations between treatment with methotrexate (MTX) or biological disease-modifying antirheumatic drugs (DMARDs) and elevation of serum Krebs von den Lungen-6 (KL-6) levels in Japanese patients with rheumatoid arthritis (RA). Using a standardized form, data were collected retrospectively from medical records and analyzed descriptively. Of a total of 198 RA patients with KL-6 serum levels measured at initiation of treatment (month 0) and two or more times by month 12, 27 (17.9 %) of 151 RA patients treated with biological DMARDs, including infliximab, etanercept, adalimumab, and tocilizumab (the biological DMARDs group), and 5 (10.6 %) of 47 patients treated without biological DMARDs but with MTX (MTX group), met criterion B (max. KL-6 a parts per thousand yen500 U/ml and > 1.5-fold from baseline) by 12 months. The majority of patients (n = 28) meeting criterion B had no apparent interstitial lung disease or malignancy. Of these 28 patients, 21 had serum KL-6 levels available after reaching their maximum level, and 13 (61.9 %) of the 21 then met criterion R [decrease to less than 500 U/ml or to less than (baseline + 0.5 x (maximum - baseline))] by month 12. Serum KL-6 levels may increase during treatment with MTX or these biological DMARDs without significant clinical events.
  • Masayoshi Harigai, Akito Takamura, Tatsuya Atsumi, Makoto Dohi, Shintaro Hirata, Hideto Kameda, Hayato Nagasawa, Yohei Seto, Takao Koike, Nobuyuki Miyasaka
    Modern Rheumatology 23 (2) 284 - 296 1439-7595 2013/03 [Refereed][Not invited]
    Objective: The associations between elevated levels of serum Krebs von den Lungen-6 (KL-6) and treatment of rheumatoid arthritis (RA) with tumor necrosis factor (TNF) inhibitors were investigated in five Japanese clinical trials. Methods: Percentages and incidence rates were calculated for elevated serum KL-6 levels. Adverse events associated with elevated levels of serum KL-6 were investigated. Results: In RISING, a clinical trial for infliximab, 15.6 % of the enrolled patients met criterion B (KL-6 ≥500 U/ml and < 1.5-fold increase over the baseline value) by week 54. In HIKARI, 7.8 % of the certolizumab pegol (CZP) group and 0 % of the placebo group met criterion B during the double-blind (DB) period (p = 0.003). In J-RAPID, 8.4 % of the methotrexate (MTX) + CZP and 3.9 % of the MTX + placebo groups met criterion B during the DB period. In GO-MONO, 1.8 % of the golimumab (GLM) and 1.3 % of the placebo groups met criterion B during the DB period. In GO-FORTH, 7.1 % of the MTX + GLM and 0 % of the MTX + placebo groups met criteron B during the DB period (p = 0.017). No adverse events accompanied the elevation of serum KL-6 levels in 95.7 % of these patients. Conclusion: Serum KL-6 levels may increase during anti- TNF therapy without significant clinical events. In these patients, continuing treatment with TNF inhibitors under careful observation is a reasonable option. © Japan College of Rheumatology 2012.
  • Hideto Kameda, Katsuaki Kanbe, Eri Sato, Yukitaka Ueki, Kazuyoshi Saito, Shouhei Nagaoka, Toshihiko Hidaka, Tatsuya Atsumi, Michishi Tsukano, Tsuyoshi Kasama, Shunichi Shiozawa, Yoshiya Tanaka, Hisashi Yamanaka, Tsutomu Takeuchi
    ANNALS OF THE RHEUMATIC DISEASES 72 (2) 310 - 312 0003-4967 2013/02 [Refereed][Not invited]
  • Oku K, Atsumi T
    [Rinsho ketsueki] The Japanese journal of clinical hematology 2 54 (2) 179 - 188 0485-1439 2013/02 [Refereed][Not invited]
  • Olga Amengual, Tatsuya Atsumi, Kenji Oku, Eriko Suzuki, Tetsuya Horita, Shinsuke Yasuda, Takao Koike
    Modern Rheumatology 23 (1) 81 - 88 1439-7595 2013/01 [Refereed][Not invited]
    Objective: Thrombus formation is the key event of vascular manifestations in antiphospholipid syndrome (APS). Phosphatidylserine (PS) is normally sequestered in the inner leaflet of cell membranes. Externalization of PS occurs during cell activation and is essential for promoting blood coagulation and for the binding of antiphospholipid antibodies (aPL) to cells. One of the molecules involved in PS externalization is phospholipid scramblase 1 (PLSCR1). We evaluated PLSCR1 expression on monocytes from APS patients and analyzed the in vitro effect of monoclonal aPL on PLSCR1 expression. Patients and methods: Forty patients with APS were investigated. In vitro experiments were performed in monocyte cell lines incubated with monoclonal aPL. PLSCR1 expression was determined by quantitative real-time polymerase chain reactions. PS exposure on CD14+ cell surface was analyzed by flow cytometry. Results: Levels of full-length PLSCR1 messenger RNA (mRNA) were significantly increased in APS patients compared with healthy controls (2.4 ± 1.2 vs. 1.3 ± 0.4, respectively, p < 0.001). In cultured monocytes, interferon alpha enhanced tissue-factor expression mediated by β2-glycoprotein-I-dependent monoclonal anticardiolipin antibody. Conclusions: Monocytes in APS patients had increased PLSCR1 mRNA expression. © 2012 Japan College of Rheumatology.
  • Contrast-enhanced whole body joint MR imaging in rheumatoid patients on tumour necrosis factor-alpha agents: a pilot study to evaluate novel scoring system for MR synovitis.
    Kamishima T, Kato M, Atsumi T, Koike T, Onodera Y, Terae S
    Clinical and experimental rheumatology 1 31 (1) 154  0392-856X 2013/01 [Refereed][Not invited]
  • Shinji Fukaya, Yuki Matsui, Utano Tomaru, Ai Kawakami, Sayuri Sogo, Toshiyuki Bohgaki, Tatsuya Atsumi, Takao Koike, Masanori Kasahara, Akihiro Ishizu
    LABORATORY INVESTIGATION 1 93 (1) 72 - 80 0023-6837 2013/01 [Refereed][Not invited]
    TNF-alpha-converting enzyme (TACE) can cleave transmembrane proteins, such as TNF-alpha, TNF receptors, and epidermal growth factor receptor (EGFR) ligands, to release the extracellular domains from the cell surface. Recent studies have suggested that overexpression of TACE may be associated with the pathogenesis of inflammation and fibrosis. To determine the roles of TACE in inflammation and fibrosis, TACE transgenic (TACE-Tg) mice, which overexpressed TACE systemically, were generated. As the transgene-derived TACE was expressed as an inactive form, no spontaneous phenotype developed in TACE-Tg mice. However, the transgene-derived TACE could be converted to an active form by furin in vitro and by phorbol myristate acetate (PMA) in vivo. Subcutaneous injection of PMA into mice induced inflammatory cell infiltration 1 day later and subsequent dermal fibrosis 7 days later. Interestingly, the degree of dermal fibrosis at day 7 was significantly higher in TACE-Tg mice than in wild-type mice. Correspondingly, PMA increased the expression of type I collagen in the primary culture of dermal fibroblasts derived from TACE-Tg mice. Furthermore, phosphorylated EGFR was increased in the fibroblasts by the PMA treatment. The collective findings suggest that TACE overexpression and activation in fibroblasts could shed off putative EGFR ligands. Subsequently, the soluble EGFR ligands could bind and activate EGFR on fibroblasts, and then increase the type I collagen expression resulting in induction of dermal fibrosis. These results also suggest that TACE and EGFR on fibroblasts may be novel therapeutic targets of dermal fibrosis, which is induced after diverse inflammatory disorders of the skin. Laboratory Investigation (2013) 93, 72-80; doi:10.1038/labinvest.2012.153; published online 12 November 2012
  • Kotaro Otomo, Tatsuya Atsumi
    Japanese Journal of Clinical Immunology 36 (2) 63 - 70 1349-7413 2013 [Refereed][Not invited]
    Antiphospholipid syndrome (APS) is an autoimmune disease defined by the presence of antiphospholipid antibodies (APL) in plasma of patients with thrombosis and/or pregnancy morbidity. In the classification criteria of APS, the presence of lupus anticoagulant (LA), anticardiolipin antibodies (aCL) or anti-β2-glycoprotein I antibodies (aβ2GPI) is necessary to diagnose APS. Recently, we defined "antiphospholipid score (aPL-S)" and evaluate the predictive value for thrombosis. In the study, aPL-S may be a predictive marker for developing thrombosis in patients with autoimmune diseases. In this article, we explain various APL assays for diagnosing APS in a clinical practice, introduce the study of "aPL-S", and discuss the significance of APL tests not only for a diagnosis of APS but also for a predictive marker of thrombosis in patients with autoimmune diseases. © 2013 The Japan Society for Clinical Immunology.
  • Kazuki Tajima, Jun Shirakawa, Yu Togashi, Hideaki Inoue, Koichiro Sato, Kazuki Orime, Yuzuru Ito, Mitsuyo Kaji, Eri Sakamoto, Akinobu Nakamura, Kazutaka Aoki, Yoshio Goshima, Tatsuya Atsumi, Yasuo Terauchi
    PloS one 8 (5) e64633  2013 [Refereed][Not invited]
    The precise role of AMP-activated protein kinase (AMPK), a target of metformin, in pancreatic β cells remains controversial, even though metformin was recently shown to enhance the expression of incretin receptors (GLP-1 and GIP receptors) in pancreatic β cells. In this study, we investigated the effect of AMPK in the regulation of incretin receptors expression in pancreatic islets. The phosphorylation of AMPK in the mouse islets was decreased by increasing glucose concentrations. We showed the expression of incretin receptors in bell-shaped response to glucose. Expression of the incretin receptors in the isolated islets showed higher levels under a medium glucose concentration (11.1 mM) than that under a low glucose concentration (2.8 mM), but was suppressed under a high glucose concentration (22.2 mM). Both treatment with an AMPK inhibitor and DN-AMPK expression produced a significant increase of the incretin receptors expression under a low glucose concentration. By contrast, in hyperglycemic db/db islets, the enhancing effect of the AMPK inhibitor on the expression of incretin receptors was diminished under a low glucose concentration. Taken together, AMPK is involved in the regulation of incretin receptors expression in pancreatic islets under a low glucose concentration.
  • Ryoko Sakai, Michi Tanaka, Toshihiro Nanki, Kaori Watanabe, Hayato Yamazaki, Ryuji Koike, Hayato Nagasawa, Koichi Amano, Kazuyoshi Saito, Yoshiya Tanaka, Satoshi Ito, Takayuki Sumida, Atsushi Ihata, Yoshiaki Ishigatsubo, Tatsuya Atsumi, Takao Koike, Atsuo Nakajima, Naoto Tamura, Takao Fujii, Hiroaki Dobashi, Shigeto Tohma, Takahiko Sugihara, Yukitaka Ueki, Akira Hashiramoto, Atsushi Kawakami, Noboru Hagino, Nobuyuki Miyasaka, Masayoshi Harigai
    ANNALS OF THE RHEUMATIC DISEASES 71 (11) 1820 - 1826 0003-4967 2012/11 [Refereed][Not invited]
    Objective To compare reasons for discontinuation and drug retention rates per reason among anticytokine therapies, infliximab, etanercept and tocilizumab, and the risk of discontinuation of biological agents due to adverse events (AE) in patients with rheumatoid arthritis (RA). Method This prospective cohort study included Japanese RA patients who started infliximab (n = 412, 636.0 patient-years (PY)), etanercept (n = 442, 765.3 PY), or tocilizumab (n = 168, 206.5 PY) as the first biological therapy after their enrolment in the Registry of Japanese Rheumatoid Arthritis Patients for Long-term Safety (REAL) database. Drug retention rates were calculated using the Kaplan-Meier method. To compare risks of drug discontinuation due to AE for patients treated with these biological agents, the Cox proportional hazard model was applied. Results The authors found significant differences among the three therapeutic groups in demography, clinical status, comorbidities and usage of concomitant drugs. Development of AE was the most frequent reason for discontinuation of biological agents in the etanercept and tocilizumab groups, and the second most frequent reason in the infliximab group. Discontinuation due to good control was observed most frequently in the infliximab group. Compared with etanercept, the use of infliximab (HR 1.69; 95% CI 1.14 to 2.51) and tocilizumab (HR 1.98; 95% CI 1.04 to 3.76) was significantly associated with a higher risk of discontinuation of biological agents due to AE. Conclusions Reasons for discontinuation are significantly different among biological agents. The use of infliximab and tocilizumab was significantly associated with treatment discontinuation due to AE compared with etanercept.
  • Toshio Odani, Shinsuke Yasuda, Yuko Ota, Yuichiro Fujieda, Yujiro Kon, Tetsuya Horita, Yasushi Kawaguchi, Tatsuya Atsumi, Hisashi Yamanaka, Takao Koike
    RHEUMATOLOGY 51 (10) 1765 - 1774 1462-0324 2012/10 [Refereed][Not invited]
    Objective. Interstitial lung disease (ILD) is a serious complication of SSc. We aimed to identify markers associated with SSc-related ILD. Methods. RNA was prepared from the peripheral blood mononuclear cells of 14 SSc patients, divided into four different RNA pools according to the presence or absence of ILD and to the treatment, and subjected to microarray analysis. Real-time quantitative PCR was used to confirm the microarray results in 43 SSc patients, 42 autoimmune controls and 10 healthy controls. Genomic DNA samples were collected from 149 patients with SSc (70 in Hokkaido and 79 in Tokyo) who underwent a high-resolution CT for the evaluation of ILD and from 230 healthy controls. Genotyping was performed using sequence-specific primers. Results. The microarray analysis revealed HLA-DRB5 to be the only gene commonly up-regulated in patients with ILD compared with those without ILD in both comparison groups. High expression levels of HLA-DRB5 in SSc patients with ILD were confirmed by real-time quantitative PCR. The prevalence of HLA-DRB5 gene carriers increased in the SSc patients with ILD relative to those without ILD or to healthy controls in both cohorts. Among the four detected alleles, the HLA-DRB5*01:05 allele was significantly more frequent in SSc patients with ILD than in SSc patients without ILD or in healthy controls. These associations were confirmed in the second cohort. Conclusion. HLA-DRB5 was highly expressed in PBMCs from patients with SSc-related ILD. The HLA-DRB5*01:05 allele is a risk factor for ILD in patients with SSc.
  • Kenji Oku, Olga Amengual, Tatsuya Atsumi
    EUROPEAN JOURNAL OF CLINICAL INVESTIGATION 42 (10) 1126 - 1135 0014-2972 2012/10 [Refereed][Not invited]
    Eur J Clin Invest 2012; 42 (10): 11261135 Abstract In patients with the antiphospholipid syndrome (APS), the presence of a group of pathogenic autoantibodies called antiphospholipid antibodies causes arteriovenous thrombosis and pregnancy complications. To date, the pathogenicity of the antiphospholipid antibodies has been the focus of analysis. Recently, the antibodies were reported to be capable of direct cell activation, and research on the underlying mechanism is ongoing. The antiphospholipid antibodies bind to the membranes of vascular endothelial cells, monocytes and platelets, provoking tissue factor expression and platelet aggregation. This activation functions as intracellular signalling, independent of the cell type, to activate p38MAPK and the transcription factor NF?B. Currently, there are multiple candidates for the membrane receptors of the antiphospholipid antibodies that are being tested for potential in specific therapy. Recently, APS was reported to have significant comorbidity with complement activation, and it was proposed that this results in placental damage and cell activation and, therefore, could be the primary factor for the onset of pregnancy complications and thrombosis. The detailed mechanism of complement activation remains unknown; however, an inflammation-inducing substance called anaphylatoxin, which appears during the activation process of the classical complement pathway, is thought to be a key molecule. Complement activation occurs in tandem, regardless of the pathology of APS or the type of antiphospholipid antibody, and it is thought that this completely new understanding of the mechanism will contribute greatly to comprehension of the pathology of APS.
  • [Discussion meeting on rheumatoid arthritis: progress in diagnosis and treatment].
    Takeuchi T, Atsumi T, Nagaoka S, Oribe M, Kikuchi J
    Nihon Naika Gakkai zasshi. The Journal of the Japanese Society of Internal Medicine 10 101 (10) 2926 - 2942 0021-5384 2012/10 [Refereed][Not invited]
  • Eri Hirakawa, Kazuyoshi Saito, Shintaro Hirata, Tatsuya Atsumi, Takao Koike, Yoshiya Tanaka
    MODERN RHEUMATOLOGY 5 22 (5) 769 - 773 1439-7595 2012/09 [Refereed][Not invited]
    A 16-year-old male with severe thrombocytopenia and progressive multiple organ infarctions was diagnosed as having catastrophic antiphospholipid syndrome (CAPS) complicated with systemic lupus erythematosus, and was successfully treated with combination of anticoagulants, corticosteroids, plasma exchange, and intravenous cyclophosphamide. Antibodies to phosphatidylserine/prothrombin (PS/PT) complex and cardiolipin (CL)/beta(2)-glycoprotein I (beta(2)GPI) were simultaneously detected, indicating that the different pathways of both PS/PT and CL/beta(2)GPI might be associated with the radical manifestation of CAPS.
  • Bill Giannakopoulos, Lu Gao, Miao Qi, Jason W. Wong, Demin M. Yu, Panayiotis G. Vlachoyiannopoulos, Harry M. Moutsopoulos, Tatsuya Atsumi, Takao Koike, Philip Hogg, Jian C. Qi, Steven A. Krilis
    JOURNAL OF AUTOIMMUNITY 39 (3) 121 - 129 0896-8411 2012/09 [Refereed][Not invited]
    Factor XI (FXI), a disulfide-linked covalent homodimer, circulates in plasma, and upon activation initiates the intrinsic/consolidation phase of coagulation. We present evidence that disulfide bonds in FXI are reduced to free thiols by oxidoreductases thioredoxin-1 (TRX-1) and protein disulfide isomerase (PDI). We identified that Cys362-Cys482 and Cys118-Cys147 disulfide bonds are reduced by TRX-1. The activation of TRX-1-treated FXI by thrombin, FXIIa or FXIa was significantly increased compared to non-reduced FXI, indicating that the reduced factor is more efficiently activated than the oxidized protein. Using a novel ELISA system, we compared the amount of reduced FXI in antiphospholipid syndrome (APS) thrombosis patients with levels in healthy controls, and found that APS patients have higher levels of reduced FXI. This may have implication for understanding the contribution of FXI to APS thrombosis, and the predisposition to thrombosis in patients with elevated plasma levels of reduced FXI. (c) 2012 Elsevier Ltd. All rights reserved.
  • Ryoko Sakai, Yukiko Komano, Michi Tanaka, Toshihiro Nanki, Ryuji Koike, Hayato Nagasawa, Koichi Amano, Atsuo Nakajima, Tatsuya Atsumi, Takao Koike, Atsushi Ihata, Yoshiaki Ishigatsubo, Kazuyoshi Saito, Yoshiya Tanaka, Satoshi Ito, Takayuki Sumida, Shigeto Tohma, Naoto Tamura, Takao Fujii, Takahiko Sugihara, Atsushi Kawakami, Noboru Hagino, Yukitaka Ueki, Akira Hashiramoto, Kenji Nagasaka, Nobuyuki Miyasaka, Masayoshi Harigai
    ARTHRITIS CARE & RESEARCH 64 (8) 1125 - 1134 2151-464X 2012/08 [Refereed][Not invited]
    Objective. To investigate associations between continuous treatments with tumor necrosis factor (TNF) antagonists and risk for developing serious infections (SIs) over 3 years in Japanese patients with rheumatoid arthritis (RA) enrolled in the Registry of Japanese RA Patients for Long-Term Safety (REAL) database. Methods. We analyzed 727 RA patients who had started either infliximab or etanercept (the anti-TNF group; 1,480.1 patient-years [PY]) and 571 RA patients who had started conventional nonbiologic disease-modifying antirheumatic drugs (the unexposed group; 1,104.1 PY) at the time of enrollment in the REAL. We assessed the occurrence of SIs within a 3-year observation period, including the period after switching to other TNF antagonists, and all SIs, unlimited to the first one in each patient as reported in other studies, to evaluate the real safety of TNF antagonists in daily practice. Results. The incidence rate of SIs per 100 PY was 5.54 (95% confidence interval [95% CI] 4.44-6.84) in the anti-TNF group and 2.72 (95% CI 1.87-3.83) in the unexposed group. Poisson regression analysis revealed that the relative risk (RR) of continuous use of TNF antagonists for SIs after adjusting for baseline and time-dependent covariates was significantly elevated both overall (1.97, 95% CI 1.25-3.19) and for the first year (2.40, 95% CI 1.20-5.03), but not for the second and third years combined (1.38, 95% CI 0.80-2.43). The adjusted RR for SIs of etanercept compared to infliximab was not significantly elevated. Conclusion. Continuous anti-TNF therapy was significantly associated with increased risks for developing SIs during, but not after, the first year.
  • Chikako Kiyohara, Masakazu Washio, Takahiko Horiuchi, Toyoko Asami, Saburo Ide, Tatsuya Atsumi, Gen Kobashi, Yoshifumi Tada, Hiroki Takahashi
    JOURNAL OF RHEUMATOLOGY 39 (7) 1363 - 1370 0315-162X 2012/07 [Refereed][Not invited]
    Objective. Cigarette smoking may be associated with increased risk of systemic lupus erythematosus (SLE), whereas the role of alcohol consumption is unknown. We examined the association between SLE risk and smoking or drinking. Methods. We investigated the relationship of smoking and drinking compared to SLE risk among 171 SLE cases and 492 healthy controls in female Japanese subjects. Unconditional logistic regression was used to compute OR and 95% Cl, with adjustments for several covariates. Results. Compared with nonsmoking, current smoking was significantly associated with increased risk of SLE (OR 3.06, 95% Cl 1.86-5.03). The higher the level of exposure to cigarette smoke, the higher the risk of SLE. Inhalation was also associated with increased SLE risk (OR 3.73, 95% Cl 1.46-9.94 for moderate inhalation; OR 3.06, 95% Cl 1.81-5.15 for deep inhalation). In contrast, light/moderate alcohol consumption had a protective effect on SLE risk (OR 0.38,95% CI 0.19-0.76). As for beer, the risks for non-beer drinkers and beer drinkers were similar. This also applies to alcoholic beverages other than beer. Conclusion. Our results suggest that smoking was positively associated with increased SLE risk whereas light/moderate alcohol consumption was inversely associated with SLE risk, irrespective of the type of alcoholic beverage. Additional studies are warranted to confirm these findings. (First Release May 15 2012; J Rheumatol 2012;39:1363-70; doi:10.3899/jrheum.111609)
  • Shoichi Ozaki, Tatsuya Atsumi, Taichi Hayashi, Akihiro Ishizu, Shigeto Kobayashi, Shunichi Kumagai, Yasuyuki Kurihara, Manae S. Kurokawa, Hirofumi Makino, Hiroko Nagafuchi, Kimimasa Nakabayashi, Norihiro Nishimoto, Machi Suka, Yasuhiko Tomino, Hidehiro Yamada, Kunihiro Yamagata, Masaharu Yoshida, Wako Yumura
    MODERN RHEUMATOLOGY 22 (3) 394 - 404 1439-7595 2012/06 [Refereed][Not invited]
    We (JMAAV [Japanese patients with MPO-ANCA-associated vasculitis] Study Group) performed a prospective, open-label, multi-center trial to evaluate the usefulness of severity-based treatment in Japanese patients with myeloperoxidase-anti-neutrophil cytoplasmic antibodies (MPO-ANCA)-associated vasculitis. Patients with MPO-ANCA-associated vasculitis received a severity-based regimen according to the appropriate protocol: low-dose corticosteroid and, if necessary, cyclophosphamide or azathioprine in patients with mild form; high-dose corticosteroid and cyclophosphamide in those with severe form; and the severe-form regimen plus plasmapheresis in those with the most severe form. We followed up the patients for 18 months. The primary end points were the induction of remission, death, and end-stage renal disease (ESRD). Fifty-two patients were registered, and 48 patients were enrolled in this study (mild form, n = 23; severe form, n = 23; most severe form, n = 2). Among the 47 patients who received the predefined therapies, 42 achieved remission within 6 months, 5 died, and 1 developed ESRD. Disease flared up in 8 of the 42 patients with remission during the 18-month follow-up period. The JMAAV trial is the first prospective trial for MPO-ANCA-associated vasculitis to be performed in Japan. The remission and death rates were comparable to those in several previous clinical trials performed in western counties. The regimen employed in this trial was tailor-made based on patients' disease severity and disease type, and it seems that standardization can be consistent with treatment choices made according to severity.
  • Shunsuke Noda, Masao Ogura, Akiko Tsutsumi, Tomohiro Udagawa, Koichi Kamei, Kentaro Matsuoka, Hiroshi Kitamura, Tatsuya Atsumi, Shuichi Ito
    PEDIATRIC NEPHROLOGY 27 (4) 681 - 685 0931-041X 2012/04 [Refereed][Not invited]
    Antiphospholipid syndrome (APS) is a rare disorder in children. More than half of childhood APS occurs as secondary APS complicated by systemic lupus erythematosus (SLE) and other autoimmune diseases. We encountered a boy with SLE who presented with thrombotic microangiopathy (TMA) due to APS. He was initially diagnosed with SLE and treated with methylprednisolone pulse therapy. However, his renal function rapidly deteriorated. Since poikilocytes were detected, we suspected that his condition was complicated by TMA or APS. Urgent plasma exchange, continuous hemodialysis, and intravenous cyclophosphamide saved the patient and his renal failure ameliorated. A renal biopsy performed at the onset of disease showed multiple microvascular thrombi, diffuse mesangiolysis, and cortical necrosis compatible with TMA. He was positive for anticardiolipin antibody, anti-beta 2-glycoprotein I antibody, and lupus anticoagulant as well as anti-phosphatidylserine-prothrombin complex IgG antibody (aPS/PT). Anti-a disintegrin-like and metalloproteinase with thrombospondin type 1 motifs 13 (ADAMTS13) antibody was negative and ADAMTS13 activity was normal. The aPS/PT is thrombogenic and is a newly discovered lupus anticoagulant. Childhood TMA due to APS has rarely been reported. To the best of our knowledge this is the first report of pediatric TMA due to APS with positive aPS/PT. Physicians need to be aware of aPS/PT in pediatric APS and/or SLE.
  • Improvement of the quality of life of a patient with colon ulceration of systemic lupus erythematosus by successful surgical treatment: report of a case.
    Noguchi K, Takahashi N, Homma S, Kataoka A, Kon Y, Atsumi T, Kamiyama T
    The American surgeon 4 78 (4) E209 - 10 0003-1348 2012/04 [Refereed][Not invited]
  • Kotaro Otomo, Tatsuya Atsumi, Olga Amengual, Yuichiro Fujieda, Masaru Kato, Kenji Oku, Tetsuya Horita, Shinsuke Yasuda, Takao Koike
    ARTHRITIS AND RHEUMATISM 64 (2) 504 - 512 0004-3591 2012/02 [Refereed][Not invited]
    Objective To define the antiphospholipid score (aPL-S) by testing multiple antiphospholipid antibodies (aPL) and to evaluate its efficacy for the diagnosis of antiphospholipid syndrome (APS) and predictive value for thrombosis. Methods. This study comprised 2 independent sets of patients with autoimmune diseases. In the first set of patients (n = 233), the aPL profiles were analyzed. Five clotting assays for testing lupus anticoagulant and 6 enzyme-linked immunosorbent assays (IgG/IgM anticardiolipin antibodies, IgG/IgM anti-beta(2)-glycoprotein I, and IgG/IgM phosphatidylserine-dependent antiprothrombin antibodies) were included. The association of the aPL-S with a history of thrombosis/ pregnancy morbidity was assessed. In the second set of patients (n = 411), the predictive value of the aPL-S for thrombosis was evaluated retrospectively. Two hundred ninety-six of these patients were followed up for > 2 years. The relationship between the aPL-S and the risk of developing thrombosis was analyzed. Results. In the first set of patients, the aPL-S was higher in those with thrombosis/pregnancy morbidity than in those without manifestations of APS (P < 0.00001). For the aPL-S, the area under the receiver operating characteristic curve value was 0.752. In the second set of patients, new thromboses developed in 32 patients. The odds ratio (OR) for thrombosis in patients with an aPL-S of > 30 was 5.27 (95% confidence interval [ 95% CI] 2.32-11.95, P < 0.0001). By multivariate analysis, an aPL-S of > 30 appeared to be an independent risk factor for thrombosis (hazard ratio 3.144 [ 95% CI 1.383-7.150], P = 0.006). Conclusion. The aPL-S is a useful quantitative index for diagnosing APS and may be a predictive marker for thrombosis in autoimmune diseases.
  • Yukinori Okada, Kenichi Shimane, Yuta Kochi, Tomoko Tahira, Akari Suzuki, Koichiro Higasa, Atsushi Takahashi, Tetsuya Horita, Tatsuya Atsumi, Tomonori Ishii, Akiko Okamoto, Keishi Fujio, Michito Hirakata, Hirofumi Amano, Yuya Kondo, Satoshi Ito, Kazuki Takada, Akio Mimori, Kazuyoshi Saito, Makoto Kamachi, Yasushi Kawaguchi, Katsunori Ikari, Osman Wael Mohammed, Koichi Matsuda, Chikashi Terao, Koichiro Ohmura, Keiko Myouzen, Naoya Hosono, Tatsuhiko Tsunoda, Norihiro Nishimoto, Tsuneyo Mimori, Fumihiko Matsuda, Yoshiya Tanaka, Takayuki Sumida, Hisashi Yamanaka, Yoshinari Takasaki, Takao Koike, Takahiko Horiuchi, Kenshi Hayashi, Michiaki Kubo, Naoyuki Kamatani, Ryo Yamada, Yusuke Nakamura, Kazuhiko Yamamoto
    PLOS GENETICS 8 (1) e1002455  1553-7390 2012/01 [Refereed][Not invited]
    Systemic lupus erythematosus (SLE) is an autoimmune disease that causes multiple organ damage. Although recent genome-wide association studies (GWAS) have contributed to discovery of SLE susceptibility genes, few studies has been performed in Asian populations. Here, we report a GWAS for SLE examining 891 SLE cases and 3,384 controls and multi-stage replication studies examining 1,387 SLE cases and 28,564 controls in Japanese subjects. Considering that expression quantitative trait loci (eQTLs) have been implicated in genetic risks for autoimmune diseases, we integrated an eQTL study into the results of the GWAS. We observed enrichments of cis-eQTL positive loci among the known SLE susceptibility loci (30.8%) compared to the genome-wide SNPs (6.9%). In addition, we identified a novel association of a variant in the AF4/FMR2 family, member 1 (AFF1) gene at 4q21 with SLE susceptibility (rs340630; P = 8.3x10(-9), odds ratio = 1.21). The risk A allele of rs340630 demonstrated a cis-eQTL effect on the AFF1 transcript with enhanced expression levels (P<0.05). As AFF1 transcripts were prominently expressed in CD4(+) and CD19(+) peripheral blood lymphocytes, up-regulation of AFF1 may cause the abnormality in these lymphocytes, leading to disease onset.
  • Takashi Kurita, Hisako Nakagawa, Shinsuke Yasuda, Tetsuya Horita, Tatsuya Atsumi, Yasuko Nakagawa, Hiroshi Kataoka, Takao Koike
    Japanese Journal of Clinical Immunology 1 35 (1) 75 - 80 1349-7413 2012 [Refereed][Not invited]
    Sjögren's syndrome (SS) is a systemic autoimmune disorder characterized by profound lymphocytic infiltration into the lacrimal and salivary glands, thereby diminished secretory function. B cell hyper-activation is a predominant feature of SS related to hypergammaglobulinemia and production of autoantibodies. The adaptor molecule NF-kB activator 1 (Act1) plays an important role in the homeostasis of B cells by attenuating CD40 and B cell-activating factor belonging to the tumor necrosis factor family receptor (BAFFR) signaling. Act1-deficient mice develop autoimmune manifestations similar to SS, which are hypergammaglobulinemia, high levels of anti-SSA and anti-SSB autoantibodies. In this study, to investigate the role of Act1 in the pathogenesis of SS, we examined Act1mRNA expressions in B cells from patients with SS and discussed the association of Act1 with parameters and clinical manifestations of SS. We showed the low level of Act1mRNA expression in patients with SS and reciprocal association of Act1 with serum IgG level. Diminished Act1mRNA expression in SS may be associated with B cell hyperactivity and elevated immunoglobulin production in SS by uncontrolled B cell activation signal through CD40 and BAFFR. © 2012, The Japan Society for Clinical Immunology. All rights reserved.
  • Masaru Kato, Tatsuya Atsumi, Takashi Kurita, Toshio Odani, Yuichiro Fujieda, Kotaro Otomo, Tetsuya Horita, Shinsuke Yasuda, Takao Koike
    JOURNAL OF RHEUMATOLOGY 38 (10) 2209 - 2214 0315-162X 2011/10 [Refereed][Not invited]
    Objective. To evaluate the risk of reactivation of resolved hepatitis B virus (HBV) by immunosuppressive therapy in patients with autoimmune diseases. Methods. Thirty-five patients with autoimmune diseases were included in our study; all were hepatitis B surface antigen (HBsAg)-negative and antibody against hepatitis B core antigen-positive. They were followed for 8-124 weeks and clinical outcomes were analyzed, including serum levels of HBV-DNA and aminotransferase every 4 weeks during their immunosuppressive therapy for underlying autoimmune diseases. If HBV-DNA was detected during the immunosuppressive therapy. HBsAg, antibody against HBsAg (anti-HBs), hepatitis B e antigen (HBeAg), and antibody against HBeAg were also monitored every 4 weeks. Results. HBV-DNA was detected in 6 out of 35 patients. Anti-HBs titer was significantly lower in the patients in whom HBV-DNA was detected compared with the others at baseline: 2.83 (range 0.24-168.50) mIU/ml vs 99.94 (range 0.00-5342.98) mIU/ml, respectively (p = 0.036). Outcomes of the 6 patients with HBV reactivation were as follows: HBV-DNA turned negative in 2 patients without nucleic acid analog (NAA) and 1 with NAA; 2 died due to bacterial sepsis; and I died due to autoimmune hemolytic anemia. Significant elevation of aminotransferase was found in only 1 patient, but HBsAg converted to positive in 2 patients and HBeAg converted to positive in I patient. Conclusion. Reactivation of resolved HBV can occur during standard immunosuppressive therapy for autoimmune diseases. The low titer of baseline anti-HBs may carry its risk. (First Release Aug 15 2011; J Rheumatol 2011;38:2209-14; doi:10.3899/jrheum.110289)
  • [Treatment of rheumatic diseases: current status and future prospective. Topics: II. Immunosuppressant/antirheumatic drugs: 9. Mycophenolate mofetil].
    Kono M, Atsumi T
    Nihon Naika Gakkai zasshi. The Journal of the Japanese Society of Internal Medicine 10 100 (10) 2954 - 2959 0021-5384 2011/10 [Refereed][Not invited]
  • Yiannis Ioannou, Jing-Yun Zhang, Miao Qi, Lu Gao, Jian Cheng Qi, De-Min Yu, Herman Lau, Allan D. Sturgess, Panayiotis G. Vlachoyiannopoulos, Haralampos M. Moutsopoulos, Anisur Rahman, Charis Pericleous, Tatsuya Atsumi, Takao Koike, Stephane Heritier, Bill Giannakopoulos, Steven A. Krilis
    ARTHRITIS AND RHEUMATISM 9 63 (9) 2774 - 2782 0004-3591 2011/09 [Refereed][Not invited]
    Objective. Beta-2-glycoprotein I (beta(2)GPI) constitutes the major autoantigen in the antiphospholipid syndrome (APS), a common acquired cause of arterial and venous thrombosis. We recently described the novel observation that beta(2)GPI may exist in healthy individuals in a free thiol (biochemically reduced) form. The present study was undertaken to quantify the levels of total, reduced, and posttranslationally modified oxidized beta(2)GPI in APS patients compared to various control groups. Methods. In a retrospective multicenter analysis, the proportion of beta(2)GPI with free thiols in serum from healthy volunteers was quantified. Assays for measurement of reduced as well as total circulating beta(2)GPI were developed and tested in the following groups: APS (with thrombosis) (n = 139), autoimmune disease with or without persistent antiphospholipid antibodies (aPL) but without APS (n = 188), vascular thrombosis without APS or aPL (n = 38), and healthy volunteers (n = 91). Results. Total beta(2)GPI was significantly elevated in patients with APS (median 216.2 mu g/ml [interquartile range 173.3-263.8]) as compared to healthy subjects (median 178.4 mu g/ml [interquartile range 149.4-227.5] [P < 0.0002]) or control patients with autoimmune disease or vascular thrombosis (both P < 0.0001). The proportion of total beta(2)GPI in an oxidized form (i.e., lacking free thiols) was significantly greater in the APS group than in each of the 3 control groups (all P < 0.0001). Conclusion. This large retrospective multicenter study shows that posttranslational modification of beta(2)GPI via thiol-exchange reactions is a highly specific phenomenon in the setting of APS thrombosis. Quantification of posttranslational modifications of beta(2)GPI in conjunction with standard laboratory tests for APS may offer the potential to more accurately predict the risk of occurrence of a thrombotic event in the setting of APS.
  • Jun Fukae, Masato Isobe, Akemi Kitano, Mihoko Henmi, Fumihiko Sakamoto, Akihiro Narita, Takeya Ito, Akio Mitsuzaki, Masato Shimizu, Kazuhide Tanimura, Megumi Matsuhashi, Tamotsu Kamishima, Tatsuya Atsumi, Takao Koike
    ARTHRITIS CARE & RESEARCH 63 (9) 1247 - 1253 2151-464X 2011/09 [Refereed][Not invited]
    Objective. To investigate the relationship between synovial vascularity and progression of structural bone damage in each finger joint in patients with rheumatoid arthritis (RA) and to demonstrate synovial vascularity as a potential therapeutic marker. Methods. We studied 250 metacarpophalangeal (MCP) and 250 proximal interphalangeal (PIP) joints of 25 patients with active RA who were administered adalimumab or tocilizumab. Patients were examined with clinical and laboratory assessments. Power Doppler sonography was performed at baseline and at the fourth and eighth weeks. Synovial vascularity was evaluated according to quantitative measurement. Hand and foot radiography was performed at baseline and the twentieth week. Results. Clinical indices such as the 28-joint Disease Activity Score, the Clinical Disease Activity Index, and the Simplified Disease Activity Index were significantly decreased by biologic agents. The MCP and PIP joints with no response in synovial vascularity between baseline and the eighth week (vascularity improvement of <= 70% at the eighth week) showed a higher risk of radiographic progression compared with responsive joints (vascularity improvement of >70% at the eighth week; relative risk 2.33-9). Radiographic progression at the twentieth week was significantly lower in responsive joints than in nonresponsive joints. Conclusion. The improvement of synovial vascularity following treatment with biologic agents led to suppression of radiographic progression of RA in each finger joint. The alteration in synovial vascularity numerically reflected therapeutic efficacy. Using vascularity as a marker to determine the most suitable therapeutic approach would be beneficial for patients with active RA.
  • Olga Amengual, Tatsuya Atsumi, Takao Koike
    CURRENT VASCULAR PHARMACOLOGY 9 (5) 606 - 618 1570-1611 2011/09 [Refereed][Not invited]
    The antiphospholipid syndrome (APS) is an autoimmune disease in which recurrent vascular thrombosis, pregnancy morbidity or a combination of these events is associated with the persistent presence of circulating antiphospholipid antibodies (aPL). Evidence shows that the dominant antigenic targets for aPL in APS are phospholipid-binding plasma proteins such as beta 2glycoprotein I and prothrombin. The pathogenic role of aPL in thrombosis is widely accepted but the mechanisms by which these antibodies mediate disease are only partially understood. aPL may affect the normal procoagulant and anticoagulant reactions occurring on cell surface, and also may interact with certain cells, altering the expression and secretion of procoagulant substances. The intracellular signal transduction triggered by aPL has been a focus of intensive research and the p38 mitogen activated protein kinase (MAPK) pathway has been revealed as a major player in the aPL-mediated cell activation. In addition, some candidates as cell-receptor for phospholipid-binding plasma proteins have been identified. The recognition of the intracellular signaling triggered by aPL is a step forward in the design of new modalities of targeted therapies for thrombosis in APS including specific inhibitors of MAPK pathway or antagonists of the putative receptors. Furthermore, novel findings regarding the role of aPL in T-cells responses mark new advances in the understanding of the immunological reactions in APS and open new insights into possible therapeutic approaches to APS. In this article, we review the pathophysiological mechanisms of thrombosis and the specific new targeted therapies for the treatment in APS.
  • Ryoko Sakai, Yukiko Komano, Michi Tanaka, Toshihiro Nanki, Ryuji Koike, Atsuo Nakajima, Tatsuya Atsumi, Shinsuke Yasuda, Yoshiya Tanaka, Kazuyoshi Saito, Shigeto Tohma, Takao Fujii, Atsushi Ihata, Naoto Tamura, Atsushi Kawakami, Takahiko Sugihara, Satoshi Ito, Nobuyuki Miyasaka, Masayoshi Harigai
    MODERN RHEUMATOLOGY 4 21 (4) 444 - 448 1439-7595 2011/08 [Refereed][Not invited]
  • Hideto Kameda, Katsuaki Kanbe, Eri Sato, Yukitaka Ueki, Kazuyoshi Saito, Shouhei Nagaoka, Toshihiko Hidaka, Tatsuya Atsumi, Michishi Tsukano, Tsuyoshi Kasama, Shunichi Shiozawa, Yoshiya Tanaka, Hisashi Yamanaka, Tsutomu Takeuchi
    JOURNAL OF RHEUMATOLOGY 38 (8) 1585 - 1592 0315-162X 2011/08 [Refereed][Not invited]
    Objective. The aim of the Efficacy and Safety of Etanercept on Active Rheumatoid Arthritis Despite Methotrexate Therapy in Japan (JESMR) study is to compare the efficacy of continuation versus discontinuation of methotrexate (MTX) when starting etanercept (ETN) in patients with active rheumatoid arthritis (RA). Methods. In total, 151 patients with active RA who had been taking MTX were randomized to either ETN 25 1112 twice a week with 6-8 mg/week MTX (the E+M group), or ETN alone (the E group). The primary endpoint at Week 52 was the radiographic progression assessed by van der Heijde-modified Sharp score. Results. The mean progression in total score at Week 52 was not significantly different, statistically, between the E+M group and the E group (0.8 vs 3.6, respectively; p = 0.06). However, a significant difference was observed in radiographic progression between Weeks 24 and 52 (0.3 vs 2.5; p = 0.03), and the mean progression of the erosion score was negative in the E+M group, which was significantly better than the E group at Week 52 (-0.2 vs 1.8; p = 0.02). Clinically, the cumulative probability plot of the American College of Rheumatology (ACR)-N values at Week 52 clearly demonstrated a superior response in the E+M group than in the E group. ACR20, 50, and 70 response rates at Week 52 in the E+M group (86.3%, 76.7%, and 50.7%) were significantly greater than those in the E group (63.8%; p = 0.003, 43.5%; p < 0.0001 and 29.0%; p = 0.01, respectively). Conclusion. MTX should be continued when starting ETN in patients with active RA. ( NCT00688103) (First Release May 15 2011; J Rheumatol 2011;38:1585-92; doi:10.3899/jrheum.110014)
  • Yukiko Komano, Michi Tanaka, Toshihiro Nanki, Ryuji Koike, Ryoko Sakai, Hideto Kameda, Atsuo Nakajima, Kazuyoshi Saito, Mitsuhiro Takeno, Tatsuya Atsumi, Shigeto Tohma, Satoshi Ito, Naoto Tamura, Takao Fujii, Tetsuji Sawada, Hiroaki Ida, Akira Hashiramoto, Takao Koike, Yoshiaki Ishigatsubo, Katsumi Eguchi, Yoshiya Tanaka, Tsutomu Takeuchi, Nobuyuki Miyasaka, Masayoshi Harigai
    JOURNAL OF RHEUMATOLOGY 38 (7) 1258 - 1264 0315-162X 2011/07 [Refereed][Not invited]
    Objective. To compare tumor necrosis factor-alpha (TNF-alpha) inhibitors to nonbiological disease-modifying antirheumatic drugs (DMARD) for the risk of serious infection in Japanese patients with rheumatoid arthritis (RA). Methods. Serious infections occurring within the first year of the observation period were examined using the records for patients recruited to the Registry of Japanese Rheumatoid Arthritis Patients for Longterm Safety (REAL), a hospital-based prospective cohort of patients with RA. The analysis included 1144 patients, 646 of whom were treated with either infliximab or etanercept [exposed group: 592.4 patient-years (PY)]. The remaining 498 patients received nonbiological DMARD with no biologics (unexposed group: 454.7 PY). Results. In the unexposed group, the incidence rate for all serious adverse events (SAE) was 9.02/100 PY and for serious infections, 2.64/100 PY. In the exposed group, SAE occurred in 16.04/100 PY and serious infections in 6.42/100 PY. The crude incidence rate ratio comparing serious infections in the exposed group with the unexposed group was 2.43 (95% Cl 1.27-4.65), a significant increase. A multivariate analysis revealed that the use of TNF inhibitors is a significant independent risk factor for serious infection (relative risk 2.37, 95% Cl 1.11-5.05, p = 0.026). Conclusion. Our study has provided the first epidemiological data on Japanese patients with RA for the safety of TNF inhibitors compared to nonbiological DMARD for up to 1 year of treatment. Anti-TNF therapy was associated with a significantly increased risk for serious infections, compared to treatment with nonbiological DMARD. (First Release April 15 2011; J Rheumatol 2011; 38:1258-64; doi:10.3899/jrheum.101009)
  • Tamotsu Kamishima, Kazuhide Tanimura, Masato Shimizu, Megumi Matsuhashi, Jun Fukae, Yujiro Kon, Hiromi Hagiwara, Akihiro Narita, Yuko Aoki, Naoki Kosaka, Tatsuya Atsumi, Hiroki Shirato, Satoshi Terae
    SKELETAL RADIOLOGY 40 (6) 745 - 755 0364-2348 2011/06 [Refereed][Not invited]
    To compare quantitative magnetic resonance imaging (MRI) and power Doppler ultrasonography (PDUS) with conventional measures of disease activity in rheumatoid arthritis (RA) patients treated with the anti-interleukin 6 (anti-IL 6) receptor antibody tocilizumab in terms of responsiveness at a few months to disease activity and ability to predict structural damage at 1 year. A cohort of patients with RA (n = 29) was evaluated clinically including disease activity score 28 (DAS28) and by semiquantitative (SQ-) and quantitative (Q-) PDUS (bilateral metacarpophalangeal joints) and MRI (one hand and wrist) at initiation of treatment with anti-IL 6 receptor antibody agents and after 2 and 5 months. Conventional radiography for both hands and wrists was performed at baseline and at 12 months. Responsiveness was assessed by standardized response means (SRM). Areas under the curve (AUC) for measures at baseline, 2 and 5 months were correlated with structural damage at 1 year. Among the laboratory and clinical parameters, DAS28-ESR was the most responsive with a large effect size of SRM. Structural damage progressions for radiography and MR erosion were correlated with AUC of MR bone erosion and Q-PDUS, respectively. In the evaluation of disease activity in RA patients in the first few months after starting anti-IL 6 receptor antibody tocilizumab treatment, the semiquantitative MR bone erosion score of the hand and quantitative value for power Doppler signal in the finger joint were both responsive and predictive of structural damage progression at 1 year.
  • Yuichiro Fujieda, Hiroshi Kataoka, Toshio Odani, Kotaro Otomo, Masaru Kato, Shinji Fukaya, Kenji Oku, Tetsuya Horita, Shinsuke Yasuda, Tatsuya Atsumi, Takao Koike
    MODERN RHEUMATOLOGY 21 (3) 276 - 281 1439-7595 2011/06 [Refereed][Not invited]
    To characterize reversible posterior leukoencephalopathy syndrome (RPLS) in systemic lupus erythematosus (SLE) in terms of treatments for resolution and its clinical course, we reviewed 28 cases of RPLS in SLE including our cases in view of the treatment. Of these, 15 cases improved with blood pressure control and 13 required immunosuppressive therapy for activity of SLE presenting neurological manifestations. Patients without immunosuppressants at onset of RPLS more frequently required immunosuppressive therapy to recover it than those precedingly using these agents [31% (4/13) versus 87% (13/15), p = 0.008, chi-square test]. Brain magnetic resonance imaging (MRI) is important for diagnosis of RPLS-SLE in the patient with SLE who develops neurological disturbance and rapidly increasing blood pressure. When 7-day therapy for hypertension and convulsion does not reverse the manifestations, immunosuppressive treatments would be recommended to reverse RPLS.
  • Miyuki Bohgaki, Masaki Matsumoto, Tatsuya Atsumi, Takeshi Kondo, Shinsuke Yasuda, Tetsuya Horita, Keiichi I. Nakayama, Fumihiko Okumura, Shigetsugu Hatakeyama, Takao Koike
    JOURNAL OF CELLULAR AND MOLECULAR MEDICINE 1 15 (1) 141 - 151 1582-1838 2011/01 [Refereed][Not invited]
    Antiphospholipid syndrome (APS) is characterized by thrombosis and the presence of antiphospholipid antibodies (aPL) that directly recognizes plasma beta(2)-glycoprotein I (beta(2)GPI). Tissue factor (TF), the major initiator of the extrinsic coagulation system, is induced on monocytes by aPL in vitro, explaining in part the pathophysiology in APS. We previously reported that the mitogen-activated protein kinase (MAPK) pathway plays an important role in aPL-induced TF expression on monocytes. In this study, we identified plasma gelsolin as a protein associated with beta(2)GPI by using immunoaffinity chromatography and mass spectrometric analysis. An in vivo binding assay showed that endogenous beta(2)GPI interacts with plasma gelsolin, which binds to integrin a(5)beta(1) through fibronectin. The tethering of beta(2)GPI to monoclonal anti-beta(2)GPI autoantibody on the cell surface was enhanced in the presence of plasma gelsolin. Immunoblot analysis demonstrated that p38 MAPK protein was phosphorylated by monoclonal anti-beta(2)GPI antibody treatment, and its phosphorylation was attenuated in the presence of anti-integrin a(5)beta(1) antibody. Furthermore, focal adhesion kinase, a downstream molecule of the fibronectin-integrin signalling pathway, was phosphorylated by anti-beta(2)GPI antibody treatment. These results indicate that molecules including gelsolin and integrin are involved in the anti-beta(2)GPI antibody-induced MAPK pathway on monocytes and that integrin is a possible therapeutic target to modify a prothrombotic state in patients with APS.
  • Toko Hashimoto, Shinsuke Yasuda, Hideyuki Koide, Hiroshi Kataoka, Tetsuya Horita, Tatsuya Atsumi, Takao Koike
    ARTHRITIS RESEARCH & THERAPY 13 (5) R154  1478-6354 2011 [Refereed][Not invited]
    Introduction: An unidentified population of peripheral blood mononuclear cells (PBMCs) express Ras guanine nucleotide releasing protein 4 (RasGRP4). The aim of our study was to identify the cells in human blood that express hRasGRP4, and then to determine if hRasGRP4 was altered in any patient with rheumatoid arthritis (RA). Methods: Monocytes and T cells were purified from PBMCs of normal individuals, and were evaluated for their expression of RasGRP4 mRNA/protein. The levels of RasGRP4 transcripts were evaluated in the PBMCs from healthy volunteers and RA patients by real-time quantitative PCR. The nucleotide sequences of RasGRP4 cDNAs were also determined. RasGRP4 protein expression in PBMCs/monocytes was evaluated. Recombinant hRasGRP4 was expressed in mammalian cells. Results: Circulating CD14(+) cells in normal individuals were found to express hRasGRP4. The levels of the hRasGRP4 transcript were significantly higher in the PBMCs of our RA patients relative to healthy individuals. Sequence analysis of hRasGRP4 cDNAs from these PBMCs revealed 10 novel splice variants. Aberrantly spliced hRasGRP4 transcripts were more frequent in the RA patients than in normal individuals. The presence of one of these abnormal splice variants was linked to RA. The levels of hRasGRP4 protein in PBMCs tended to be lower. As expected, the defective transcripts led to altered and/or nonfunctional protein in terms of P44/42 mitogen-activated protein (MAP) kinase activation. Conclusions: The identification of defective isoforms of hRasGRP4 transcripts in the PBMCs of RA patients raises the possibility that dysregulated expression of hRasGRP4 in developing monocytes plays a pathogenic role in a subset of RA patients.
  • Hideto Kameda, Yukitaka Ueki, Kazuyoshi Saito, Shouhei Nagaoka, Toshihiko Hidaka, Tatsuya Atsumi, Michishi Tsukano, Tsuyoshi Kasama, Shunichi Shiozawa, Yoshiya Tanaka, Tsutomu Takeuchi
    MODERN RHEUMATOLOGY 20 (6) 531 - 538 1439-7595 2010/12 [Refereed][Not invited]
    The superiority of the combination therapy of methotrexate (MTX) and anti-tumor necrosis factor (TNF) biological agents over anti-TNF monotherapy in MTX-na < ve patients with rheumatoid arthritis (RA) has been demonstrated. We investigated the efficacy and safety of continuation versus discontinuation of MTX at the commencement of etanercept (ETN) in patients with active RA despite MTX therapy. In total, 151 patients with active RA despite treatment with MTX were randomized to either ETN 25 mg twice a week and MTX 6-8 mg/week (the E + M group) or ETN alone (the E group). Co-primary endpoints included the European League Against Rheumatism (EULAR) good response rate and the American College of Rheumatology (ACR) 50 response rate at week 24. Demographic and clinical features between groups at baseline were similar. The EULAR good response rates were significantly higher in the E + M group (52%) than in the E group (33%) at week 24 (p = 0.0001). Although the ACR50 response rate, one of the co-primary endpoints, and the ACR70 response rate at week 24 were not significantly greater in the E + M group (64 and 38%, respectively) than in the E group (48 and 26%, respectively), the ACR20 response rate was significantly greater in the E + M group (90%) than in the E group (64%; p = 0.0002). Safety profiles were similar for the groups. Thus, MTX should be continued at the commencement of ETN therapy, even in RA patients who show an inappropriate response to MTX.
  • Tamotsu Kamishima, Yuichiro Fujieda, Tatsuya Atsumi, Rie Mimura, Takao Koike, Satoshi Terae, Hiroki Shirato
    AMERICAN JOURNAL OF ROENTGENOLOGY 195 (4) W287 - W292 0361-803X 2010/10 [Refereed][Not invited]
    OBJECTIVE. The purpose of this article is to examine the feasibility of whole-body joint MRI for detecting systemic joint synovitis and for analyzing the relationship between the hands and systemic joint involvement in patients with unclassified arthritis who later develop early rheumatoid arthritis (RA). MATERIALS AND METHODS. The study included 17 patients (five men and 12 women; median age, 65 years [range, 38-77 years]; median symptom duration, 3 months [range, 1-6 months]). MRI of the systemic joints was performed for patients with unclassified arthritis without radiographic evidence of RA and who were diagnosed as having RA according to 1987 revised classification criteria within 2 years. RESULTS. The chosen 4-point scale for image quality was moderate to excellent. MRI findings of systemic joints were in accordance with joint swelling and tenderness (chi-square test, p < 0.0001). Sixty percent (45/75) of hand joints and 67% (12/18) of systemic joints other than hands showed MR synovitis without swelling. With regard to the correlation of MRI findings between hands and joints other than hands, there was a statistically significant positive correlation in the joint count (r = 0.5514 and p = 0.0218) and semiquantitative value of hand synovitis (r = 0.5382 and p = 0.0258). CONCLUSION. Whole-body joint MRI in early RA is feasible in terms of image quality and agreement with the results of clinical examination. MRI may be more sensitive for depicting synovitis-positive joints than clinical examination. Estimation of the systemic burden of synovitis detected by MRI may be possible via MRI of the hands.
  • Eriko Suzuki, Olga Amengual, Tatsuya Atsumi, Kenji Oku, Toko Hashimoto, Hiroshi Kataoka, Tetsuya Horita, Shinsuke Yasuda, Masahiro Ieko, Kazuaki Fukushima, Takao Koike
    JOURNAL OF RHEUMATOLOGY 37 (8) 1639 - 1645 0315-162X 2010/08 [Refereed][Not invited]
    Objective. A high incidence of thromboembolic events has been reported in patients with systemic lupus erythematosus (SLE). Phosphatidylserine (PS) is normally sequestered in the inner leaflet of cell membranes. Externalization of PS during cell activation is mediated by phospholipid scramblase 1 (PLSCR1) and has a central role in promoting blood coagulation. We investigated the underlying pathogenic status of thrombophilia in SLE by analyzing PLSCR1 expression on monocytes from patients with SLE. Methods. Sixty patients with SLE were evaluated. Twenty-three patients had antiphospholipid syndrome (APS/SLE). Plasma D-dimer levels were measured as a marker of fibrin turnover. The cDNA encoding human PLSCR1 was cloned from the total RNA extract from monocytes, and independent clones were sequenced. PLSCR1 mRNA expression in CD14+ cells was determined by real-time polymerase chain reaction. PS exposure on CD14+ cell surface was analyzed by flow cytometry. Results. Elevated D-dimer levels were found in plasma from SLE patients. Three splice variants of PLSCR1 mRNA were identified in all subjects, and levels of full-length PLSCR1 mRNA were significantly increased in SLE compared to healthy controls (2.9 +/- 1.5 vs 1.3 +/- 0.4, respectively; p < 0.0001). Flow-cytometry analysis showed relative enhancement of PS exposure in the surface of CD14+ cells in SLE patients compared to healthy controls. Conclusion. Novel PLSCR1 splice variants were identified. Monocytes in SLE patients had enhanced PLSCR1 mRNA expression, as well as increased fibrin turnover and cell-surface PS exposure, indicating that PLSCR1 may, in part, contribute to the prothrombotic tendency in SLE. (First Release June 1 2010; J Rheumatol 2010;37:1639-45; doi:10.3899/jrheum.091420)
  • Keiko Myouzen, Yuta Kochi, Kenichi Shimane, Keishi Fujio, Tomohisa Okamura, Yukinori Okada, Akari Suzuki, Tatsuya Atsumi, Satoshi Ito, Kazuki Takada, Akio Mimori, Shiro Ikegawa, Ryo Yamada, Yusuke Nakamura, Kazuhiko Yamamoto
    HUMAN MOLECULAR GENETICS 19 (11) 2313 - 2320 0964-6906 2010/06 [Refereed][Not invited]
    Systemic lupus erythematosus (SLE) is an autoimmune disease induced by the combinations of environmental and genetic factors. Recently, mice in which the early growth response 2 (EGR2) gene, a zinc-finger transcription factor, is conditionally knocked out in CD2(+) T cells have been shown to develop a lupus-like autoimmune disease. Here, we evaluated if polymorphisms in the EGR2 gene influence SLE susceptibility in humans. We first analyzed the effect of SNPs in the EGR2 region on EGR2 expression, and a significant positive correlation with expression was identified in an SNP located at the 5' flanking region of EGR2 (rs10761670, R=0.23, P=0.00072). We then performed a case-control association study using three sets of SLE cohorts by genotyping 14 tag SNPs in the EGR2 gene region. A peak of association with SLE susceptibility was observed for rs10761670 [Pooled: OR = 1.23 (95% CI 1.10-1.37), P=0.00023). This SNP was also associated with susceptibility to rheumatoid arthritis (RA) [OR = 1.15 (95% CI 1.05-1.26), P = 0.0019), suggesting that EGR2 is a common risk factor for SLE and RA. Among the SNPs in complete linkage disequilibrium with rs10761670 (r(2) = 1.0), two SNPs (rs1412554 and rs1509957) affected the binding of transcription factors and transcriptional activity in vitro, suggesting that they may be candidates of causal regulatory variants in this region. Therefore, EGR2 is a genetic risk factor for SLE, in which increased gene expression may contribute to SLE pathogenesis.
  • Masahiro Ieko, Mika Yoshida, Sumiyoshi Naito, Toru Nakabayashi, Kaoru Kanazawa, Kazuhiro Mizukami, Masaya Mukai, Tatsuya Atsumi, Takao Koike
    INTERNATIONAL JOURNAL OF HEMATOLOGY 91 (5) 776 - 783 0925-5710 2010/06 [Refereed][Not invited]
    The causes of thrombosis in antiphospholipid syndrome (APS) remain unknown, though several hypotheses in regard to hypofibrinolysis have been proposed. To clarify the mechanism, we measured plasma levels of thrombin-activatable fibrinolysis inhibitor (TAFI) in APS patients. Both the TAFI antigen (TAFI:Ag) level measured with an ELISA, and thrombin-thrombomodulin-dependent TAFI activity (TAFI:Ac) were elevated in 68 APS patients as compared with those in 66 healthy controls, though they were lower than those in 46 patients with autoimmune diseases. As for the influence of antiphospholipid antibodies (aPL) on TAFI levels, the mean TAFI:Ac level in 39 SLE patients positive for APS was significantly lower than that in 27 SLE patients without APS, whereas there was no difference in TAFI:Ag between those groups. Furthermore, purified IgG from patients positive for aPL, and monoclonal aPL (EY2C9 and 23-1D) inhibited the activation of TAFI in a concentration dependent manner. These results suggest that aPL inhibits TAFI activation by affecting the function of thrombomodulin-thrombin complex through phospholipids. Although TAFI in plasma is elevated in autoimmune diseases including APS, we concluded that an elevated level is not likely a risk factor for thrombosis in APS patients, because of the inhibition of TAFI activation by aPL.
  • Jun Fukae, Yujiro Kon, Mihoko Henmi, Fumihiko Sakamoto, Akihiro Narita, Masato Shimizu, Kazuhide Tanimura, Megumi Matsuhashi, Tamotsu Kamishima, Tatsuya Atsumi, Takao Koike
    ARTHRITIS CARE & RESEARCH 62 (5) 657 - 663 2151-464X 2010/05 [Refereed][Not invited]
    Objective. To investigate the relationship between synovial vascularity assessed by quantitative power Doppler sonography (PDS) and progression of structural bone damage in a single finger joint in patients with rheumatoid arthritis (RA). Methods. We studied 190 metacarpophalangeal (MCP) joints and 190 proximal interphalangeal (PIP) joints of 19 patients with active RA who had initial treatment with disease-modifying antirheumatic drugs (DMARDs). Patients were examined by clinical and laboratory assessments throughout the study. Hand and foot radiography was performed at baseline and the twentieth week. Magnetic resonance imaging (MRI) was performed at baseline. PDS was performed at baseline and the eighth week. Synovial vascularity was evaluated according to both quantitative and semiquantitative methods. Results. Quantitative PDS was significantly correlated with the enhancement rate of MRI in each single finger joint. Comparing quantitative synovial vascularity and radiographic change in single MCP or PIP joints, the level of vascularity at baseline showed a significant positive correlation with radiographic progression at the twentieth week. The change of vascularity in response to DMARDs, defined as the percentage change in vascularity by the eighth week from baseline, was inversely correlated with radiographic progression in each MCP joint. The quantitative PDS method was more useful than the semiquantitative method for the evaluation of synovial vascularity in a single finger joint. Conclusion. The change of synovial vascularity in a single finger joint determined by quantitative PDS could numerically predict its radiographic progression. Using vascularity as a guide to consider a therapeutic approach would have benefits for patients with active RA.
  • Kenichi Shimane, Yuta Kochi, Tetsuya Horita, Katsunori Ikari, Hirofumi Amano, Michito Hirakata, Akiko Okamoto, Ryo Yamada, Keiko Myouzen, Akari Suzuki, Michiaki Kubo, Tatsuya Atsumi, Takao Koike, Yoshinari Takasaki, Shigeki Momohara, Hisashi Yamanaka, Yusuke Nakamura, Kazuhiko Yamamoto
    ARTHRITIS AND RHEUMATISM 62 (2) 574 - 579 0004-3591 2010/02 [Refereed][Not invited]
    Objective. Genome-wide association (GWA) studies in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) in Caucasian populations have independently identified risk variants in and near the tumor necrosis factor alpha (TNF alpha)-induced protein 3 gene (TNFAIP3), which is crucial for the regulation of TNF-mediated signaling and Toll-like receptor signaling. The aim of this study was to assess the role of TNFAIP3 in the development of SLE and RA in Japanese subjects. Methods. We selected 2 single-nucleotide polymorphisms (SNPs) from previous GWA studies. Rs2230926 is a nonsynonymous SNP in TNFAIP3 and is associated with SLE, while rs10499194 is an intergenic SNP associated with RA. We then performed 2 independent sets of SLE case-control comparisons (717 patients and 1,362 control subjects) and 3 sets of RA case-control comparisons (3,446 patients and 2,344 control subjects) using Japanese subjects. We genotyped SNPs using TaqMan assays. Results. We observed a significant association between rs2230926 and an increased risk of SLE and RA in the Japanese population (for SLE, odds ratio [OR] 1.92, 95% confidence interval [95% CI] 1.53-2.41, P = 1.9 x 10(-8); for RA, OR 1.35, 95% CI 1.18-1.56, P = 2.6 x 10(-5)). The intergenic SNP rs10499194 was also associated with SLE and RA, while the risk allele for RA in Caucasians was protective against the diseases in our population. Conclusion. We demonstrated a significant association between the nonsynonymous variant in TNFAIP3 and the risk for SLE and RA in the Japanese population. TNFAIP3, similar to STAT4 and IRF5, may be a common genetic risk factor for SLE and RA that is shared between the Caucasian and Japanese populations.
  • Hideto Yamada, Tatsuya Atsumi, Olga Amengual, Takao Koike, Itsuko Furuta, Kaori Ohta, Gen Kobashi
    JOURNAL OF REPRODUCTIVE IMMUNOLOGY 84 (1) 95 - 99 0165-0378 2010/01 [Refereed][Not invited]
    The aim of this study was to evaluate whether anti-beta 2 glycoprotein-I antibody (anti-beta 2GPI) of the IgG or IgM classes is associated with the development of pregnancy-induced hypertension (PIH) or preeclampsia in the Japanese population. In a case-controlled cohort study, peripheral blood was obtained at 8-14 weeks of gestation from a consecutive series of 1155 women. The case group comprised 36 patients who later developed PIH during the pregnancy. Of the 36 PIH patients, 13 had severe PIH, 18 had preeclampsia and 11 had severe preeclampsia. One hundred and eleven age- and parity-matched women whose pregnancies ended in normal delivery without obstetric complications were selected as controls. We found that a titer of anti-beta 2GPI IgG >= 1.0 U/ml was a risk factor for severe PIH (P = 0.023, OR 5.7 95%CI 1.4-22.8). In addition, titers of anti-beta 2GPI IgM >= 1.2 U/ml was found to be a risk factor for PIH (P = 0.001, OR 8.8 95%CI 1.6-47.5). In women positive for anti-beta 2GPI but negative for lupus anticoagulant, anti-cardiolipin, phosphatidylserine-dependent anti-prothrombin, or kininogen-dependent anti-phosphatidylethanolamine antibodies, the presence of anti-beta 2GPI was not a significant risk factor for development of PIH or preeclampsia. In conclusion, the presence of anti-beta 2GPI antibody represents a risk factor for developing PIH and severe PIH. This finding Supports the utility of anti-beta 2GPI determination as one of the laboratory criteria for anti-phospholipid syndrome classification. The usefulness of anti-beta 2GPI measurement among women without other anti-phospholipid antibodies requires further study. (C) 2009 Elsevier Ireland Ltd. All rights reserved.
  • Shigeki Shimada, Hideto Yamada, Tatsuya Atsumi, Takashi Yamada, Noriaki Sakuragi, Hisanori Minakami
    Reproductive Medicine and Biology 9 (4) 217 - 221 1447-0578 2010 [Refereed][Not invited]
    We encountered a woman who had a history of repeated fetal losses and positive tests for lupus anticoagulant, phosphatidylserine-dependent antiprothrombin (aPS/PT) IgG, IgM and kininogen-dependent antiphosphatidylethanolamine (aPE) IgG, IgM. Her previous pregnancy had ended in intrauterine fetal death at 24 weeks of gestation despite a therapy of low-dose aspirin, prednisolone and danaparoid. During the present pregnancy, she was treated with repeated intravenous infusions of immunoglobulin (IVIg) together with low-dose aspirin, prednisolone and heparin. When thrombocytopenia developed, she delivered a female baby weighing 2,152 g at 34 weeks of gestation by cesarean section. Titers of aPS/PT IgM and aPE IgM were reduced or maintained at low levels by repeated IVIg therapies. The IVIg therapy might be effective for aspirin-heparinoid-resistant antiphospholipid syndrome. © 2010 Japan Society for Reproductive Medicine.
  • Chikako Kiyohara, Masakazu Washio, Takahiko Horiuchi, Yoshifumi Tada, Toyoko Asami, Saburo Ide, Tatsuya Atsumi, Gen Kobashi, Hiroki Takahashi
    JOURNAL OF RHEUMATOLOGY 36 (10) 2195 - 2203 0315-162X 2009/10 [Refereed][Not invited]
    Objective. Recent studies have identified signal transducer and activator of transcription 4 (STAT4) as a Susceptibility gene for systemic lupus erythematosus (SLE) in different populations. Similarly, tumor necrosis factor receptor superfamily, member 1B (TNFRSF1B) has been reported to be associated with SLE risk in Japanese populations. Along with environmental factors Such as smoking, both polymorphisms may modulate an individual's susceptibility to SLE. We investigated these relationships in it case-control study to evaluate risk factors for SLE among Japanese women. Methods. We investigated the relationship of the STAT4 rs7574865 and TNFRSF1B rs1061622 polymorphisms to SLE risk with special reference to their combination and interaction with cigarette smoking among 152 SLE cases and 427 controls. Results. The TT genotype of STAT4 rs7574865 was significantly associated with increased risk of SLE (OR 2.21, 95% CI 1.10-4.68). Subjects with at least one G allele of TNFRSF1B rs 1061622 had an increased risk of SLE (OR 1.56 95% CI 0.99-2.47). The attributable proportion due to the interaction between the TNFRSF1B rs 1061622 genotypes and smoking was estimated to be 0.49 (95% CI 0.07-0.92), indicating that 49% of the excess risk for SLE in smokers with at least one G allele was due to an additive interaction. A lack of significant associations of STAT4 with smoking was observed. No significant gene-gene interactions were found among polymorphisms of STAT4 and TNFRSF1B. Conclusion. Our findings suggest that the association between cigarette smoking and SLE could be differentiated by the TNFRSF1B rs 1061622 T allele among female Japanese subjects. This preliminary exploratory result should be confirmed in it larger study. (First Release August 15 2009: J Rheumatol 2009;36:2195-203; doi: 10.3899/jrheum.090181)
  • Atsumi T
    [Rinsho ketsueki] The Japanese journal of clinical hematology 10 50 (10) 1427 - 1433 0485-1439 2009/10 [Refereed][Not invited]
  • Hisako Nakagawa, Shinsuke Yasuda, Eiji Matsuura, Kazuko Kobayashi, Masahiro Ieko, Hiroshi Kataoka, Tetsuya Horita, Tatsuya Atsumi, Takao Koike
    BLOOD 114 (12) 2553 - 2559 0006-4971 2009/09 [Refereed][Not invited]
    Angiostatin was first discovered as a plasminogen fragment with antitumor/antiangiogenic property. One of the angiostatin isoforms, that is, angiostatin 4.5 (AS4.5), consisting of plasminogen kringle 1 to 4 and a most part of kringle 5, is produced by autoproteolysis and present in human plasma. beta 2-glycoprotein I (beta 2GPI) is proteolytically cleaved by plasmin in its domain V (nicked beta 2GPI), resulting in binding to plasminogen. Antiangiogenic properties have been recently reported in nicked beta 2GPI as well as in intact beta 2GPI at higher concentrations. In the present study, we found significant binding of nicked beta 2GPI to AS4.5 (K(D) = 3.27 x 10(6) M(-1)). Via this binding, nicked beta 2GPI attenuates the antiangiogenic functions of AS4.5 in the proliferation of arterial/venous endothelial cells, in the extracellular matrix invasion and the tube formation of venous endothelial cells, and in vivo angiogenesis. In contrast, intact beta 2GPI does not bind to AS4.5 or inhibit its antiangiogenic activity. Thus, nicked beta 2GPI exerts dual effects on angiogenesis, that is, nicked beta 2GPI promotes angiogenesis in the presence of AS4.5, whereas nicked beta 2GPI inhibits angiogenesis at concentrations high enough to neutralize AS4.5. Our data suggest that plasmin-nicked beta 2GPI promotes angiogenesis by interacting with plasmin-generated AS4.5 in sites of increased fibrinolysis such as thrombus. (Blood. 2009; 114: 2553-2559)
  • Ryuji Koike, Masayoshi Harigai, Tatsuya Atsumi, Koichi Amano, Shinichi Kawai, Kazuyoshi Saito, Tomoyuki Saito, Masahiro Yamamura, Tsukasa Matsubara, Nobuyuki Miyasaka
    MODERN RHEUMATOLOGY 19 (4) 351 - 357 1439-7595 2009/08 [Refereed][Not invited]
    The introduction of biological agents targeting tumor necrosis factor-alpha (TNF-alpha) has brought about a paradigm shift in the treatment of rheumatoid arthritis (RA). Although these anti-TNF agents have excellent efficacy against RA, a substantial number of patients still show inadequate responses. In Western countries, such patients are already being treated with new classes of antirheumatic drugs such as abatacept and rituximab. Tocilizumab (TCZ) is a humanized monoclonal antibody developed in Japan against the human interleukin-6 (IL-6) receptor. TCZ does not only alleviate the signs and symptoms of RA but also seems to prevent progressive bone and joint destruction. However, there is a concern that TCZ might increase the risk of adverse events such as infections since IL-6 plays a pivotal role in the immune system. Calculating the relative risks of specific adverse outcomes with TCZ use remains difficult, due to insufficient patient numbers enrolled in clinical trials to date. This review presents tentative guidelines for the use of TCZ for RA patients prepared by the Japan College of Rheumatology and based on results of clinical trials in Japan and Western countries. The guidelines are intended as a guide for postmarketing surveillance and clinical practice, and will be revised periodically based on the surveillance.
  • Yoshie Sakai, Tatsuya Atsumi, Masahiro Ieko, Olga Amengual, Shin Furukawa, Akira Furusaki, Miyuki Bohgaki, Hiroshi Kataoka, Tetsuya Horita, Shinsuke Yasuda, Takao Koike
    ARTHRITIS AND RHEUMATISM 60 (8) 2457 - 2467 0004-3591 2009/08 [Refereed][Not invited]
    Objective. Antibodies to prothrombin (APTs) and to beta(2)-glycoprotein I are the major autoantibodies responsible for lupus anticoagulant (LAC) activity. APTs comprise antibodies against prothrombin alone as well as antibodies against phosphatidylserine/prothrombin complex (anti-PS/PT), the latter being highly associated with the anti phospholipid syndrome (APS). The effect of anti-PS/PT on thrombin generation has not been elucidated, and the paradoxical effect of LAC (an anticoagulant in vitro, but a procoagulant in vivo) remains an enigma. The purpose of this study was to investigate the effects of anti-PS/PT on thrombin generation and to examine the LAC paradox. Methods. We evaluated 36 anti-PS/PT-positive APS patients and 127 healthy subjects. Markers of in vivo thrombin/fibrin generation, including prothrombin fragment F(1+2), thrombin-antithrombin III complex, soluble fibrin monomer, D-dimer, and fibrin degradation products, were measured. Mouse monoclonal anti-PS/PT antibody 231D was established, and its effects on in vitro thrombin generation were investigated by chromogenic assay. Results. Significantly elevated levels of markers thrombin/fibrin generation were observed in anti-PS/PT-positive patients, regardless of the presence or absence of anticardiolipin antibodies, as compared with healthy subjects. In the presence of low concentrations of human activated factor V (FVa), monoclonal antibody 231D increased thrombin generation in a dose-dependent manner. In contrast, when high concentrations of FVa were added, monoclonal antibody 231D decreased thrombin generation. Under a constant concentration of FVa a high concentration of human FXa enhanced the effect of 231D. Conclusion. The presence of anti-PS/PT greatly correlated with increased thrombin generation in APS patients. The in vitro effects of monoclonal antibody 231D on thrombin generation are "biaxial" according to the FVa/FXa balance. These data may serve as a clue to understanding the LAC paradox and the thrombogenic properties of anti-PS/PT.
  • Toshiyuki Bohgaki, Tatsuya Atsumi, Miyuki Bohgaki, Akira Furusaki, Makoto Kondo, Kazuko C. Sato-Matsumura, Riichiro Abe, Hiroshi Kataoka, Tetsuya Horita, Shinsuke Yasuda, Yoshiharu Amasaki, Mitsufumi Nishio, Ken-Ichi Sawada, Hiroshi Shimizu, Takao Koike
    JOURNAL OF RHEUMATOLOGY 36 (6) 1240 - 1248 0315-162X 2009/06 [Refereed][Not invited]
    Objective. To analyze the relationship between clinical benefits and immunological changes in patients with systemic sclerosis (SSc) treated with autologous hematopoietic stern cell transplantation (HSCT). Methods. Ten patients with SSc were treated with high-dose cyclophosphamide followed by highly purified CD34+ cells (n = 5) or unpurified grafts (n = 5). Two groups of patients were retrospectively constituted based on their clinical response (good responders, 11 = 7; and poor responders, n = 3). As well as clinical findings, immunological reconstitution through autologous HSCT was assessed by fluorescence-activated cell sorter analysis, quantification of signal joint T cell receptor rearrangement excision circles (sjTREC), reflecting the thymic function, and foxp3 a key gene of regulatory T cells, mRNA levels. Results. Patients' clinical and immunological findings were similar between good and poor responders, or CD34-purified and Unpurified groups at inclusion. The sjTREC values were significantly suppressed at 3 months after autologous HSCT in good responders compared with poor responders (p = 0.0152). Reconstitution of CD4+CD45RO- naive T cells was delayed in good responders compared with poor responders. The phenotype of other lymphocytes, cytokine production in T cells, and foxp3 gene expression levels after autologous HSCT did not correlate with clinical response in good or poor responders. Clinical and immunological findings after autologous HSCT were similar between CD34-purified and Unpurified groups. Conclusion. Our results suggest that immunosuppression intensity, sufficient to induce transient suppression of thymic function, is attributable to the feasible clinical response in patients with SSc treated with autologous HSCT Appropriate monitoring of sjTREC values may predict clinical benefits in transplanted SSc patients after autologous HSCT. (First Release May 15 2009; J Rheumatol 2009;36:1240-8; doi: 10.3899/jrheum.081025)
  • Hideto Yamada, Tatsuya Atsumi, Gen Kobashi, Chikako Ota, Emi H. Kato, Noriko Tsuruga, Kaori Ohta, Shinsuke Yasuda, Takao Koike, Hisanori Minakami
    JOURNAL OF REPRODUCTIVE IMMUNOLOGY 79 (2) 188 - 195 0165-0378 2009/01 [Refereed][Not invited]
    Antiphospholipid antibody (aPL) is associated with thromboembolism. There is scant evidence of a relationship between the aPL profile and serious adverse pregnancy outcome. The aim of this study was to assess whether aPL measurements during early pregnancy were useful in predicting a serious adverse pregnancy outcome. In this prospective study, we measured aPLs, including lupus anticoagulant (LA), IgG, IgM, IgA anticardiolipin antibody (aCL), IgG, IgM phosphatidylserine-dependent antiprothrombin antibody, and IgG kininogen-dependent antiphosphatidylethanolamine antibody (aPE) during the first trimester in a consecutive series of 1155 women. The 99th percentile cut-off values in each aPL were determined using samples from 105 women who did not exhibit any pregnancy morbidity. We assessed the predictive risk of a serious adverse pregnancy outcome adjusted for confounding factors. We found that IgG aCL was asssociated with developing pregnancy-induced hypertension (PIH) (odds ratio 11.4, 95% CI 2.7-48); IgG aPE with PIH (8.3, 2.4-29), severe PIH (20.4, 4.5-91), and premature delivery (PD) (12.7, 3.1-50); and LA with PD (11.0, 2.8-44) and low birth weight (8.0, 2.1-31). The combinations of IgG aPE plus IgG aCL (17.5, 4.7-66.7) or IgG aPE plus LA (22.2, 5.4-909) measurements predicted severe PIH with 30.8% sensitivity and 99.2% specificity. We conclude that aPL measurements during early pregnancy may be useful in predicting adverse pregnancy outcome. (C) 2009 Elsevier Ireland Ltd. All rights reserved.
  • Kenji Oku, Tatsuya Atsumi, Olga Amengual, Takao Koike
    SEMINARS IN THROMBOSIS AND HEMOSTASIS 34 (4) 335 - 339 0094-6176 2008/06 [Refereed][Not invited]
    Anticardiolipin antibody (aCL), anti-beta 2 glycoprotein I antibodies, and lupus anticoagulant (LA) are the only laboratory tests considered within the revised criteria for the classification of the antiphospholipid syndrome (APS). Recently, antibodies against phosphatidylserine-prothrombin complex (aPS/PT) have been detected, and these antibodies, rather than antibodies against prothrombin alone, are closely associated with APS and LA. The sensitivity and specificity of aPS/PT for the diagnosis of APS were assessed in a population of patients with a variety of autoimmune disorders. aCL and aPS/PT have similar diagnostic value for APS, therefore aPS/PT should be further explored, not only for research purposes but also as a candidate for one of the laboratory criteria for the classification of the APS.
  • [Study on usefulness of different APTT test kit in variable coagulopathy].
    Naito S, Ieko M, Yoshida M, Tarumi T, Nakabayashi T, Nishio H, Atsumi T
    Rinsho byori. The Japanese journal of clinical pathology 3 56 (3) 195 - 202 0047-1860 2008/03 [Refereed][Not invited]
  • Hiroshi Kataoka, Tatsuya Atsumi, Toko Hashimoto, Tetsuya Horita, Shinsuke Yasuda, Takao Koike
    MODERN RHEUMATOLOGY 18 (1) 105 - 108 1439-7595 2008/02 [Refereed][Not invited]
    Polymyalgia rheumatica (PMR) frequently occurs with giant cell arteritis (GCA). We report here two cases of PMR with aortitis in the absence of diminished pulse and manifestations related to GCA. Contrasted CT, MR angiography, and F-18-deoxyglucose positron emission tomography showed aortitis without stenosis that is not classified into any of large vasculitides. It should be acknowledged that aortitis might present as PMR and imaging studies are recommended.
  • Tatsuya Atsumi, Tetsuya Horita, Tsuneyo Mimori, Takao Koike
    Arthritis and Rheumatism 58 (2) S140 - S142 0004-3591 2008/02 [Refereed][Not invited]
  • Toshiyuki Bohgaki, Tatsuya Atsumi, Takao Koike
    AUTOIMMUNITY REVIEWS 7 (3) 198 - 203 1568-9972 2008/01 [Refereed][Not invited]
    Hematopoietic stem cell transplantation (HSCT) is an effective treatment for refractory autoimmune diseases. The safety and long-term outcome have been also acceptable. Infectious diseases under immune suppressive state after autologous HSCT are common transplantation related complications whereas autoimmune diseases are uncommon. Organ specific autoimmune diseases, such as immune mediated thrombocytopenia and thyroid dysfunction, are the most common after autologous HSCT. Systemic autoimmune diseases can also develop after autologous HSCT in patients with hematological disorders with genetic predisposition to autoimmune diseases. Although the mechanism of autoimmunity after HSCT is not well-known, long-term follow-up is essential in patients with autoimmune diseases treated with autologous HSCT. (C) 2007 Elsevier B.V. All rights reserved.
  • Toshiyuki Bohgaki, Tatsuya Atsumi, Takao Koike
    NEW ENGLAND JOURNAL OF MEDICINE 357 (26) 2734 - 2736 0028-4793 2007/12 [Refereed][Not invited]
  • Ikeda D, Tsujino I, Sakaue S, Ohira H, Itoh N, Kamigaki M, Ishimaru S, Atsumi T, Nishimura M
    Circulation journal : official journal of the Japanese Circulation Society 11 71 (11) 1829 - 1831 1346-9843 2007/11 [Refereed][Not invited]
  • Defective expression of Ras guanyl nucleotide-releasing protein 1 in a subset of patients with systemic lupus erythematosus.
    Yasuda S, Stevens RL, Terada T, Takeda M, Hashimoto T, Fukae J, Horita T, Kataoka H, Atsumi T, Koike T
    Journal of immunology (Baltimore, Md. : 1950) 7 179 (7) 4890 - 4900 0022-1767 2007/10 [Refereed][Not invited]
  • [Clinical significance of antiphospholipid antibody in diagnosis of collagen diseases].
    Atsumi T
    Nihon Naika Gakkai zasshi. The Journal of the Japanese Society of Internal Medicine 10 96 (10) 2138 - 2143 0021-5384 2007/10 [Refereed][Not invited]
  • Olga Amengual, Tatsuya Atsumi, Yukiko Komano, Hiroshi Kataoka, Tetsuya Horita, Shinsuke Yasuda, Takao Koike
    ARTHRITIS AND RHEUMATISM 56 (8) 2803 - 2805 0004-3591 2007/08 [Refereed][Not invited]
  • [Infliximab].
    Yoshida N, Hashimoto T, Atsumi T, Koike T
    Nihon rinsho. Japanese journal of clinical medicine 7 65 (7) 1251 - 1258 0047-1852 2007/07 [Refereed][Not invited]
  • Takao Koike, Miyuki Bohgaki, Olga Amengual, Tatsuya Atsumi
    JOURNAL OF AUTOIMMUNITY 28 (2-3) 129 - 133 0896-8411 2007/03 [Refereed][Not invited]
    Antiphospholipid antibodies (aPL) are an heterogeneous group of circulating immunoglobulins arising in a wide range of infectious and autoimmune diseases. Since the early 80 s, the interest on anticardiolipin antibodies (aCL) has exponentially increased due to their association with thrombosis. The antiphospholipid syndrome (APS) was defined as a clinical disorder characterized by thrombosis and pregnancy morbidity associated to the persistent presence of aCL and/or lupus anticoagulant (LA). Thrombosis is the major manifestation in patients with aPL, but the spectrum of symptoms and signs associated with aPL has considerably broadened, and other manifestations such as thrombocytopenia, nonthrombotic neurological syndromes, psychiatric manifestations, livedo reticularis, skin ulcers, haemolytic anemia, pulmonary hypertension, cardiac valve abnormality and atherosclerosis have also been related to the presence of those antibodies. Numerous mechanisms have been proposed to explain the thrombotic tendency of patients with aPL, but the pathogenesis seems to be multifactorial. (C) 2007 Elsevier Ltd. All rights reserved.
  • Takao Koike, Tatsuya Atsumi
    ARTHRITIS AND RHEUMATISM 56 (2) 393 - 394 0004-3591 2007/02 [Refereed][Not invited]
  • [Phosphatidylserine-dependent anti-prothrombin antibody as a new marker for the diagnosis of antiphospholipid syndrome].
    Ieko M, Nakabayashi T, Tarumi T, Yoshida M, Naito S, Atsumi T, Koike T
    Rinsho byori. The Japanese journal of clinical pathology 3 54 (3) 256 - 262 0047-1860 2006/03 [Refereed][Not invited]
  • H Kasahara, E Matsuura, K Kaihara, D Yamamoto, K Kobayashi, J Inagaki, K Ichikawa, A Tsutsumi, S Yasuda, T Atsumi, T Yasuda, T Koike
    INTERNATIONAL IMMUNOLOGY 17 (12) 1533 - 1542 0953-8178 2005/12 [Refereed][Not invited]
    beta 2-Glycoprotein I (beta 2-GPI) is a major antigen for anti-cardiolipin antibodies and their epitopes are cryptic. Conformation of each domain of beta 2-GPI was optimized from its crystal structure by energy minimization and by molecular dynamics simulation. Three electrostatic interactions, i.e. D-193-K-246, D-222-K-317 and E-228-K-308, were observed between domains IV and V in the optimized structure that was constructed based on the consensus sequences obtained by the phage-displayed random peptide library. Antigenic structures determined by the epitope mapping mainly consisted of hydrophobic amino acids located on two discontinuous sequences in domain IV. These amino acid clusters, as an epitope, were covered by domain V and were of a hidden nature. A similar but incomplete counterpart to the epitopic clusters was found in domain I but was not in domains II or III. Binding of anti-beta 2-GPI auto-antibodies to solid-phase beta 2-GPI was significantly reduced either by L replacement for W-235, a common amino acid component for the epitopes, or by V replacement for all of D-193, D-222 and E-228. Structural analysis indicated a hypothesis that these electrostatic interactions between domains IV and V retained exposure to W-235 and that epitope spreading occurred in the region surrounding W-235. Thus, epitopic structures recognized by anti-beta 2-GPI auto-antibodies are cryptic and inter-domain electrostatic interactions are involved in their in exposure.
  • J Fukae, Y Amasaki, Y Yamashita, T Bohgaki, S Yasuda, S Jodo, T Atsumi, T Koike
    ARTHRITIS AND RHEUMATISM 52 (9) 2697 - 2707 0004-3591 2005/09 [Refereed][Not invited]
    Objective. To study the capacity of butyrate to inhibit production of tumor necrosis factor alpha (TNF alpha) in macrophage-like synoviocytes (MLS) from patients with rheumatoid arthritis (RA), in human peripheral monocytes, and in murine RAW264.7 macrophages. Methods. The concentrations of TNFa in culture supernatants of these cells were measured using enzyme-linked immunosorbent assay. The expression levels of various messenger RNAs (mRNA), such as those for TNFa, the mRNA-binding protein TIS11B, and luciferase, were measured using real-time quantitative polymerase chain reaction. The in vitro effects of butyrate on transcriptional regulation were evaluated by transfection with various reporter plasmids in RAW264.7 macrophages. The effects of TIS11B on TNF alpha expression were examined using an overexpression model of TIS11B in RAW264.7 cells. Results. Butyrate suppressed TNF alpha protein and mRNA production in MLS and monocytes, but paradoxically enhanced transactivation of the TNFa promoter. Expression of the AU-rich element (ARE)-binding protein TIS11B was up-regulated by butyrate. Induction of TNFa mRNA by lipopolysaccharide was significantly inhibited when TIS11B was overexpressed. Butyrate facilitated the degradation of luciferase transcripts containing the 3'-untranslated region (3'-UTR) of TNF alpha, and this effect was dependent on the ARE in the 3'-UTR that is known to be involved in the regulation of mRNA degradation. Conclusion. These results indicate that butyrate suppresses TNFa expression by facilitating mRNA degradation mediated through a cis-acting ARE. Butyrate has the ability to regulate TNFa at the mRNA level and is therefore a potential therapeutic drug for RA patients.
  • T Atsumi, O Amengual, S Yasuda, E Matsuura, T Koike
    AUTOIMMUNITY 38 (5) 377 - 381 0891-6934 2005/08 [Refereed][Not invited]
    beta 2-Glycoprotein I (beta 2GPI), a phospholipid-binding protein, is one of the major target antigens for antiphospholipid antibodies (aPL) found in patients with antiphospholipid syndrome (APS). Thrombophilic disorders in APS patients are strongly associated with aPL, and their pathogenic properties depend on the presence of beta 2GPI. Procoagulant cell stimulation by aPL, via beta 2GPI, is one of the most plausible mechanisms of thrombosis in APS, and p38 mitogen activated protein kinase (MAPK) pathway plays a crucial role in such activation. beta 2GPI is proteolytically cleaved in domain V by activated factor X or plasmin, leading to the generation of the nicked form of beta 2GPI. Recently, increasing attention is focused on the role of nicked-beta 2GPI as a regulator of extrinsic fibrinolysis pathway.
  • Vertebral fracture and bone mineral density in women receiving high dose glucocorticoids for treatment of autoimmune diseases
    S Kumagai, S Kawano, T Atsumi, S Inokuma, Y Okada, Y Kanai, J Kaburaki, H Kameda, A Suwa, H Hagiyama, S Hirohata, H Makino, H Hashimoto
    JOURNAL OF RHEUMATOLOGY 32 (5) 863 - 869 0315-162X 2005/05 [Refereed][Not invited]
    Objective. To evaluate the factors influencing the occurrence of vertebral fracture in patients receiving high dose glucocorticoids (GC). Methods. A cross-sectional study was performed on women who had received at least 0.5 mg/kg of oral glucocorticoid for the treatment of autoimmune diseases for more than 1 month between 1998 and 2003. Logistic regression analysis and chi-square test were used to examine the effects of glucocorticoid dose and other factors on vertebral fractures. Receiver-operating characteristics curve (ROC) analysis was used to determine the bone mineral density (BMD) cutoff value for the risk of vertebral fracture. Results. The study population comprised 160 women, including 35 with vertebral fractures. In ROC analysis, the BMD threshold of the risk of fracture for postmenopausal women (0.787 g/cm(2), T score -2.1) was lower than that for premenopausal women (0.843 g/cm(2), T score -1.7). Among patients with fractures, 7 of 16 premenopausal patients had normal BMD values (T score > -1), whereas only one of 19 postmenopausal patients showed a comparable level of BMD. Additionally, vertebral fracture was more frequent for patients with high total cholesterol values (> 280 mg/dl) than for those with normal total cholesterol values (< 220 mg/dl). Moreover, patients with high total cholesterol values had lower BMD values than those with normal total cholesterol values. Conclusion. The fact that vertebral fracture frequently occurred in premenopausal patients with normal BMD and evidence that hyperlipidemia correlated with fracture suggest the pathology of vertebral fracture secondary to high dose glucocorticoid therapy is multifactorial and possibly involves lipid metabolism.
  • [Antiphospholipid syndrome].
    Atsumi T, Koike T
    Nihon rinsho. Japanese journal of clinical medicine 63 Suppl 5 484 - 489 0047-1852 2005/05 [Refereed][Not invited]
  • ML Bertolaccini, T Atsumi, T Koike, GRV Hughes, MA Khamashta
    THROMBOSIS AND HAEMOSTASIS 93 (2) 289 - 297 0340-6245 2005/02 [Refereed][Not invited]
    We evaluated the clinical significance of aPT and aPS-PT by testing for the presence of these antibodies in 2 12 SLE patients and in 100 healthy individuals. Results show that anti-prothrombin antibodies were found in 47% of the patients (aPT in 31% and aPS-PT in 31%). Their presence did not correlate with that of aCL, anti-beta2GPI, LA and/or anti-protein S. IgG but not IgM aPT were more frequently found in patients with thrombosis than in those without. IgG and IgM aPS-PT were also more frequent in patients with thrombosis (venous and/or arterial) than in those without. Levels of IgG aPT and IgG and IgM aPS-PT were higher in patients with thrombosis than in those without. Although aPT and aPS-PT were more frequently found in women with adverse obstetric history than in those without,the differences were not statistically significant. More significantly, 48% of the patients with aPL-related clinical features who were negative for standard tests had antiprothrombin antibodies. We can conclude that aPT and aPS-PT are frequently found in SLE. Their presence is associated with thrombosis, making these antibodies potential markers for the APS. Testing for these antibodies could be of clinical benefit in patients who are negative for the routinely used tests.
  • ML Bertolaccini, T Atsumi, T Koike, GRV Hughes, MA Khamashta
    THROMBOSIS AND HAEMOSTASIS 93 (2) 289 - 297 0340-6245 2005/02 [Refereed][Not invited]
    We evaluated the clinical significance of aPT and aPS-PT by testing for the presence of these antibodies in 2 12 SLE patients and in 100 healthy individuals. Results show that anti-prothrombin antibodies were found in 47% of the patients (aPT in 31% and aPS-PT in 31%). Their presence did not correlate with that of aCL, anti-beta2GPI, LA and/or anti-protein S. IgG but not IgM aPT were more frequently found in patients with thrombosis than in those without. IgG and IgM aPS-PT were also more frequent in patients with thrombosis (venous and/or arterial) than in those without. Levels of IgG aPT and IgG and IgM aPS-PT were higher in patients with thrombosis than in those without. Although aPT and aPS-PT were more frequently found in women with adverse obstetric history than in those without,the differences were not statistically significant. More significantly, 48% of the patients with aPL-related clinical features who were negative for standard tests had antiprothrombin antibodies. We can conclude that aPT and aPS-PT are frequently found in SLE. Their presence is associated with thrombosis, making these antibodies potential markers for the APS. Testing for these antibodies could be of clinical benefit in patients who are negative for the routinely used tests.
  • S Yasuda, T Atsumi, E Matsuura, K Kaihara, D Yamamoto, K Ichikawa, T Koike
    ARTHRITIS AND RHEUMATISM 52 (1) 212 - 218 0004-3591 2005/01 [Refereed][Not invited]
    Objective. To clarify the consequences of the valise/leucine polymorphism at position 247 of the beta(2)-glycoprotein I (beta(2)GPI) gene in patients with antiphospholipid syndrome (APS), by investigating the correlation between genotypes and the presence of anti-beta(2)GPI antibody. The reactivity of anti-beta(2)GPI antibodies was characterized using recombinant Val(247) and Leu(247) beta(2)GPI. Methods. Sixty-five Japanese patients with APS and/or systemic lupus erythematosus who were positive for antiphospholipid antibodies and 61 controls were analyzed for the presence of the Val/Leu(247) polymorphism of beta(2)GPI. Polymorphism assignment was determined by polymerase chain reaction followed by restriction enzyme digestion. Recombinant Val(247) and Leu(247) beta(2)GPI were established to compare the reactivity of anti-beta(2)GPI antibodies to beta(2)GPI between these variants. The variants were prepared on polyoxygenated plates or cardiolipin-coated plates, and the reactivity of a series of anti-beta(2)GPI antibodies (immunized anti-human beta(2)GPI monoclonal antibodies [Cof-19-21] and autoimmune anti-beta(2)GPI monoclonal antibodies [EYIC8, EY2C9, and TMIG2]) and IgGs purified from patient sera was investigated. Results. A positive correlation between the Val(247) allele and the presence of anti-beta(2)GPI antibodies was observed in the patient group. Human monoclonal/polyclonal anti-beta(2)GPI autoantibodies showed higher binding to recombinant Val(247) beta(2)GPI than to Leu(247) beta(2)GPI, although no difference in the reactivity of the immunized anti-beta(2)GPI between these variants was observed. Conformational optimization showed that the replacement of Leu(247) by Val(247) led to a significant alteration in the tertiary structure of domain V and/or the domain IV-V interaction. Conclusion. The Val(247) beta(2)GPI allele was associated with both a high frequency of anti-beta(2)GPI antibodies and stronger reactivity with anti-beta(2)GPI antibodies compared with the Leu(247) beta(2)GPI allele, suggesting that the Val(247) beta(2)GPI allele may be one of the genetic risk factors for development of APS.
  • [Immunological and serological tests for diagnosis of rheumatoid arthritis: anti-agalactosyl IgG antibody].
    Atsumi T
    Nihon rinsho. Japanese journal of clinical medicine 63 Suppl 1 328 - 331 0047-1852 2005/01 [Refereed][Not invited]
  • S Yasuda, M Bohgaki, T Atsumi, T Koike
    IMMUNOBIOLOGY 210 (10) 775 - 780 0171-2985 2005 [Refereed][Not invited]
    Antiphospholipid syndrome (APS) is characterized by recurrent thrombosis or pregnancy morbidity associated with antiphospholipid antibodies (aPL). Impaired fibrinolysis is a contributing factor for the development of thrombosis, and the effect of aPL in the fibrinolytic system has been investigated. Impaired release of tPA and enhanced release of PAI-1 after endothelial activation is reported in patients with APS. Elevated Lipoprotein (a) levels have been found in APS, which results in inhibition of fibrinolytic activity. Phospholipid-bound beta(2)-glycoprotein I (beta(2)GPI) is a major autoantigen for aPLs. beta(2)GPI exerts both anti-coagulant and procoagulant properties mainly by interacting with other phospholipid-binding proteins such as coagulation factors and protein C. Dramatic increase in the affinity Of beta(2)GPI to the cell surface is induced by binding of pathogenic anti-beta(2)GPI antibodies, which may modify the physiological function Of beta(2)GPI and may affect the coagulation/fibrinolysis balance on the cell surface. Using chromogenic assays for measuring fibrinolytic activity, we demonstrated that addition of monoclonal anticardiolipin antibody (aCL) decreases the activity of extrinsic/intrinsic fibrinolysis. Significantly lower activity of intrinsic fibrinolysis was also demonstrated in the euglobulin fractions from APS patients. Endothelial cells and monocytes are activated by aPLs in vitro, resulting in production of tissue factor (TF), a major initiator of the coagulation system. Recently, aPLs are reported to induce thrombocytes to produce thromboxane. The importance of apoE receptor 2 on platelets for the binding of artificially dimerized beta(2)GPI was suggested. By investigating aPL-inducible genes in peripheral blood mononuclear cells, we found that the mitogen-activated protein kinase (MAPK) pathway was up-regulated. Using a monocyte cell line, phosphorylation of p38 MAPK, NF-kappa B translocation to the nuclear fraction, and up-regulated TF mRNA expression were demonstrated after treatment with monoclonal aCL. These phenomena were observed only in the presence Of beta(2)GPI. Moreover, a specific p38 MAPK inihibitor SB203580 decreased aCL/beta(2)GPI-induced TF mRNA expression. Thus, aCL/beta(2)GPI plays dual roles in the pathogenesis of APS, firstly by deranging the fibrinolytic system and secondly by activating monocytes, endothelial cells and thrombocytes to produce TF or thromboxane. (C) 2005 Elsevier GmbH. All rights reserved.
  • M Bohgaki, T Atsumi, Y Yamashita, S Yasuda, Y Sakai, A Furusaki, T Bohgaki, O Amengual, Y Amasaki, T Koike
    INTERNATIONAL IMMUNOLOGY 16 (11) 1633 - 1641 0953-8178 2004/11 [Refereed][Not invited]
    The anti-phospholipid syndrome (APS) is characterized by thrombosis and the presence of anti-phospholipid antibodies (aPL). Tissue factor (TF), the major initiator of the coagulation system, is induced on monocytes by aPL in vitro, explaining, in part, the pathophysiology in this syndrome. However, little is known regarding the nature of the aPL-induced signal transduction pathways leading to TF expression. In this study, we investigated aPL-inducible genes in PBMC using cDNA array system and real-time PCR. Our results indicated that the mitogen-activated protein kinase (MAPK) pathway was related to TF expression when PBMCs were treated, in the presence of beta(2)Glycoprotein I (beta(2)GPI), with human monoclonal anti-beta(2)GPI antibodies [beta(2)GPI-dependent anti-cardiolipin antibodies (aCL/beta(2)GPI)]. Western blotting studies using monocyte cell line (RAW264.7) demonstrated that p38 MAPK protein was phosphorylated with nuclear factor kappaB (NF-kappaB) activation by monoclonal aCL/beta(2)GPI treatment, and that SB203580, a specific p38 MAPK inhibitor, decreased the aCL/beta(2)GPI-induced TF mRNA expression. The p38 MAPK phosphorylation, NF-kappaB translocation and TF mRNA expression triggered by aCL/beta(2)GPI were abolished in the absence of beta(2)GPI. These results demonstrated that the p38 MAPK signaling pathway plays an important role in aPL-induced TF expression on monocytes and suggest that the p38 MAPK may be a possible therapeutic target to modify a pro-thrombotic state in patients with APS.
  • Sugiura-Ogasawara M, Atsumi T, Ozaki Y, Koike T, Suzumori K
    Fertility and sterility 5 82 (5) 1440 - 1442 0015-0282 2004/11 [Refereed][Not invited]
  • Hashimoto T, Jodo S, Furusaki A, Kon Y, Amasaki Y, Atsumi T, Komatsu H, Shimokawa J, Yonezawa K, Koike T
    Internal medicine (Tokyo, Japan) 10 43 (10) 1000 - 1004 0918-2918 2004/10 [Refereed][Not invited]
  • O Amengual, T Atsumi, T Koike
    CLINICAL IMMUNOLOGY 112 (2) 144 - 149 1521-6616 2004/08 [Refereed][Not invited]
    The preliminary classification criteria for definite anti phospholipid syndrome (APS) include the presence of anticardiolipin antibodies (aCL) and/or lupus anticoagulant (LA) as laboratory criteria. However, antiphospholipid antibodies (aPL) are a heterogeneous group of antibodies comprising also antibodies against phospholipid-binding proteins or their complexes with phospholipids. Prothrombin is one of the antigen recognized by aPL. In the last decade, there has been increasing interest in antibodies against prothrombin alone and those against phosphatidylserine-prothrombin complex. The latter, phosphatidylserine-dependent antiprothrombin antibodies (aPT), have been closely associated with APS and LA. In this paper, we review the properties of anti prothrombin antibodies. (C) 2004 Elsevier Inc. All rights reserved.
  • H Das, T Atsumi, Y Fukushima, H Shibuya, K Ito, Y Yamada, Y Amasaki, K Ichikawa, O Amengual, T Koike
    CLINICAL RHEUMATOLOGY 23 (3) 218 - 222 0770-3198 2004/06 [Refereed][Not invited]
    Our objective in this study was to explore the diagnostic value of antiagalactosyl IgG antibodies in rheumatoid arthritis (RA). The study comprised 266 Japanese patients with systemic autoimmune diseases, including 60 with RA. Human agalactosyl IgG was prepared enzymatically, and the serum levels of antiagalactosyl IgG antibodies were determined using a lectin enzyme immunoassay. Serum IgG and IgM rheumatoid factors (RF) were measured using laser nephelometry for IgM (LN-RF) and an enzyme-linked immunosorbent assay for IgG (IgG-RF). Antiagalactosyl IgG antibodies were significantly more common in patients with RA than in those without (78% vs. 18%, odds ratio (OR) 16.51, 95% confidence interval (CI) 8.12-33.58, p<0.0001). Patients with RA also had a higher frequency of LN-RF than those without RA (75% vs. 28%, OR 7.81, 95% CI 3.91-15.58, p< 0.001). The specificity of antiagalactosyl IgG antibodies for RA was significantly higher than that of LN-RF (82% vs. 72%, p<0.0011). There was a significant correlation between titers of antiagalactosyl IgG antibodies and C-reactive protein levels. Antiagalactosyl IgG antibodies are more specific markers for RA than conventional LN-RF, and may provide useful information for the diagnosis of RA.
  • S Yasuda, T Atsumi, M Ieko, E Matsuura, K Kobayashi, J Inagaki, H Kato, H Tanaka, M Yamakado, M Akino, H Saitou, Y Amasaki, S Jodo, O Amengual, T Koike
    BLOOD 103 (10) 3766 - 3772 0006-4971 2004/05 [Refereed][Not invited]
    beta(2)-Glycoprotein I (beta(2)-GPI) is proteolytically cleaved by plasmin in domain V (nicked beta(2)-GPI), being unable to bind to phospholipids. This cleavage may occur in vivo and elevated plasma levels of nicked P2-GPI were detected in patients with massive plasmin generation and fibrinolysis turnover. In this study, we report higher prevalence of elevated ratio of nicked P2-GPI against total beta(2)-GPI in patients with ischemic stroke (63%) and healthy subjects with lacunar infarct (27%) when compared to healthy subjects with normal findings on magnetic resonance imaging (8%), suggesting that nicked beta(2)-GPI might have a physiologic role beyond that of its parent molecule in patients with thrombosis. Several inhibitors of extrinsic fibrinolysis are known, but a negative feedback regulator has not been yet documented. We demonstrate that nicked beta(2)-GPI binds to Glu-plasminogen with K-D Of 0.37 x 10(-6) M, presumably mediated by the interaction between the fifth domain of nicked beta2-GPI and the fifth kringle domain of Glu-plasminogen. Nicked beta(2-)GPI also suppressed plasmin generation up to 70% in the presence of tissue plasminogen activator, plasminogen, and fibrin. Intact beta2-GPI lacks these properties. These data suggest that beta(2)-GPI/plasmin-nicked beta(2)-GPI controls extrinsic fibrinolysis via a negative feedback pathway loop. (C) 2004 by The American Society of Hematology.
  • N Li, K Nakamura, Y Jiang, H Tsurui, S Matsuoka, M Abe, M Ohtsuji, H Nishimura, K Kato, T Kawai, T Atsumi, T Koike, T Shirai, H Ueno, S Hirose
    HUMAN MOLECULAR GENETICS 13 (2) 171 - 179 0964-6906 2004/01 [Refereed][Not invited]
    Systemic lupus erythematosus (SLE), a complex multigenic disease, is a typical antibody-mediated autoimmune disease characterized by production of autoantibodies against a variety of autoantigens and immune complex-type tissue inflammation, most prominently in the kidney. Evidence suggests that genetic factors predisposing to aberrant proliferation/maturation of self-reactive B cells initiate and propagate the disease. In SLE-prone New Zealand Black (NZB) mice and their F-1 cross with New Zealand White (NZW) mice, B cell abnormalities can be ascribed mainly to self-reactive CD5(+) B1 cells. Our genome-wide scans to search for susceptibility genes for aberrant activation of B1 cells in these mice showed evidence that the gene, Ltk, encoding leukocyte tyrosine kinase (LTK), is a possible candidate. LTK is a receptor-type protein tyrosine kinase, belonging to the insulin receptor superfamily, and is mainly expressed in B lymphocyte precursors and neuronal tissues. Sequence and functional analyses of the gene revealed that NZB has a gain-of-function polymorphism in the LTK kinase domain near YXXM, a binding motif of the p85 subunit of phosphatidylinositol 3-kinase (PI3K). SLE patients also had this type of Ltk polymorphism with a significantly higher frequency compared with the healthy controls. Our findings suggest that these polymorphic LTKs cause up-regulation of the PI3K pathway and possibly form one genetic component of susceptibility to abnormal proliferation of self-reactive B cells in SLE.
  • Yasuda S, Atsumi T, Ieko M, Koike T
    Thrombosis research 5-6 114 (5-6) 461 - 465 0049-3848 2004 [Refereed][Not invited]
  • Atsumi T, Amengual O, Yasuda S, Koike T
    Thrombosis research 5-6 114 (5-6) 533 - 538 0049-3848 2004 [Refereed][Not invited]
  • H Yamada, T Atsumi, EH Kato, S Shimada, M Morikawa, H Minakami
    FERTILITY AND STERILITY 80 (5) 1276 - 1278 0015-0282 2003/11 [Refereed][Not invited]
  • [Clinical significance of antiphospholipid antibody analysis in diagnosis of collagen diseases].
    Atsumi T
    Nihon Naika Gakkai zasshi. The Journal of the Japanese Society of Internal Medicine 10 92 (10) 1948 - 1955 0021-5384 2003/10 [Refereed][Not invited]
  • [Antiphospholipid syndrome: new criteria and management of the patients].
    Atsumi T
    Ryumachi. [Rheumatism] 3 43 (3) 528 - 537 0300-9157 2003/06 [Refereed][Not invited]
  • K Kobayashi, M Kishi, T Atsumi, ML Bertolaccini, H Makino, N Sakairi, Yamamoto, I, T Yasuda, MA Khamashta, GRV Hughes, T Koike, DR Voelker, E Matsuura
    JOURNAL OF LIPID RESEARCH 44 (4) 716 - 726 0022-2275 2003/04 [Refereed][Not invited]
    beta(2)-glycoprotein I (beta(2)-GPI) is a major antigen for antiphospholipid antibodies (Abs, aPL) present in patients with antiphospholipid syndrome (APS). We recently reported (I. Lipid Res., 42: 697, 200 1; J Lipid Res., 43: 1486, 2002) that beta(2)-GPI specifically binds to Cu2+-oxidized LDL (oxLDL) and that the beta(2)-GPI ligands are omega-carboxylated 7-ketocholesteryl esters. In the present study, we demonstrate that oxLDL forms stable and nondissociable complexes with beta(2)-GPI in serum, and that high serum levels of the complexes are associated with arterial thrombosis in APS. A conjugated ketone function at the 7-position of cholesterol as well as the omega-carboxyl function of the beta(2)-GPI ligands was necessary for beta(2)-GPI binding. The ligand-mediated noncovalent interaction of beta(2)-GPI and oxLDL undergoes a temperature- and time-dependent conversion to much more stable but readily dissociable complexes in vitro at neutral pH. In contrast, stable and nondissociable beta(2)-GPI-oxLDL complexes were frequently detected in sera from patients with APS and/or systemic lupus erythematodes. Both the presence Of beta(2)-GPI-oxLDL complexes and IgG Abs recognizing these complexes were strongly associated with arterial thrombosis. Further, these same Abs correlated with IgG immune complexes containing beta(2)-GPI or LDL.jlr Thus, the beta(2)-GPI-oxLDL complexes acting as an autoantigen are closely associated with autoimmune-mediated atherogenesis.
  • O Amengual, T Atsumi, T Koike
    ARTHRITIS AND RHEUMATISM 48 (4) 886 - 895 0004-3591 2003/04 [Refereed][Not invited]
  • Sakai Y, Atsumi T, Itoh T, Koike T
    Lancet 9360 361 (9360) 834  0140-6736 2003/03 [Refereed][Not invited]
  • Shin Furukawa, Tatsuya Atsumi, Takao Koike
    Japanese Journal of Clinical Immunology 26 (5) 267 - 273 1349-7413 2003 [Refereed][Not invited]
  • R Takeuchi, T Atsumi, M Ieko, Y Amasaki, K Ichikawa, T Koike
    BRITISH JOURNAL OF HAEMATOLOGY 119 (3) 781 - 788 0007-1048 2002/12 [Refereed][Not invited]
    beta2- glycoprotein I (beta2GPI) bears the epitope( s) for autoimmune anticardiolipin antibodies ( aCL) frequently present in patients with antiphospholipid syndrome ( APS). b2GPI is involved in coagulation and fibrinolytic systems, including inhibition of contact activation. Coagulation factor XII is an initiator of intrinsic coagulation and also of intrinsic fibrinolysis. We investigated the effect of aCL (= anti-beta2GPI antibodies), regarding intrinsic fibrinolysis using autoimmune monoclonal anti-beta2GPI antibodies derived from a patient with APS or from an NZW/ BXSB- F1 mouse. We developed a chromogenic assay system to determine intrinsic fibrinolytic activity. The reaction was activated by kaolin in the euglobulin fraction. Exogenous betaGPI slightly suppressed intrinsic fibrinolytic activity of the euglobulin fraction from normal plasma. Human monoclonal anti-beta2GPI antibody ( EY2C9) and mouse monoclonal anti-beta2GPI antibody ( WBCAL- 1) in the presence of beta2GPI decreased the activity. In this system, the suppression remained significant in the presence of an excess of exogenous activated factor XII. Euglobulin fractions from APS patients' plasma paralleled low activities of intrinsic fibrinolysis compared with those from healthy subjects. Our results suggest that beta2GPI and anti-beta2GPI antibodies suppress intrinsic fibrinolytic activities. This suppression was not only due to inhibition of factor XII activation but was also related to function of activated factor XII ( XIIa). These phenomena partly explain the mechanisms of thrombosis in APS.
  • Anti-beta(2)-glycoprotein I antibodies in children with atopic dermatitis
    A Ambrozic, T Avicin, K Ichikawa, T Kveder, E Matsuura, M Hojnik, T Atsumi, B Rozman, T Koike
    INTERNATIONAL IMMUNOLOGY 14 (7) 823 - 830 0953-8178 2002/07 [Refereed][Not invited]
    beta(2)-Glycoprotein I (beta(2)GPI) appears to be the major antigen for antiphospholipid antibodies (aPL) in patients with antiphospholipid syndrome (APS). In early infancy, virtually all children initiate transient immune response to non-pathogenic nutritional antigens, which fails to terminate in children with atopic diseases. To examine the possibility that a prolonged immune response to beta(2)GPI could also spread to the human protein, antibodies against human beta(2)GPI (anti-beta(2)GPI) were determined in 93 randomly selected children with different allergic diseases. A high frequency (42%) of IgG anti-beta(2)GPI was found in children with atopic dermatitis (AD), but not in those with other allergic diseases. Anti-beta(2)GPI in children with AD were exclusively of the IgG1 subclass and bound to bovine beta(2)GPI as well, but not to either beta(2)GPI combined with the phospholipid cardiolipin. The epitopes were identified in domain V of beta(2)GPI and the antibody binding was abolished upon the specific proteolytic cleavage of the phospholipid-binding C-terminal loop in domain V of beta(2)GPI. These results indicated that the epitopes for anti-beta(2)GPI in children with AD most likely resided in close vicinity of the phospholipid-binding site of beta(2)GPI. The epitopic difference from anti-beta(2)GPI in APS may explain presumed non-thrombogenicity of anti-beta(2)GPI in children with AD.
  • Gene polymorphisms of tissue plasminogen activator and plasminogen activator inhibitor-1 in patients with antiphospholipid antibodies
    S Yasuda, A Tsutsumi, T Atsumi, ML Bertolaccini, K Ichikawa, MA Khamashta, GRV Hughes, T Koike
    JOURNAL OF RHEUMATOLOGY 29 (6) 1192 - 1197 0315-162X 2002/06 [Refereed][Not invited]
    Objective. Impaired fibrinolytical outcomes may be one of the pathogenic factors for thrombotic events in patients with antiphospholipid antibodies (aPL). We investigated the consequences of the gene polymorphisms of tissue plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1) in patients positive for aPL. Methods. Seventy-seven Japanese and 82 British patients with aPL were examined for Alu-repeat insertion (I)/deletion (D) polymorphism of the tPA gene by polymerase chain reaction (PCR), and 4G/5G polymorphism in the PAI-1 promoter gene by site-directed mutagenesis-PCR and restriction fragment length polymorphism analysis. Correlations between these polymorphisms and clinical symptoms of antiphospholipid syndrome (APS) (arterial thrombosis, venous thrombosis, miscarriage) were analyzed. Results. Significant differences in the allele frequencies of these genes did not exist between patients and controls. There was no significant correlation between these gene polymorphisms and clinical symptoms of APS in patients with aPL. Conclusion. Polymorphisms of the tPA or PAI-1 genes probably do not significantly influence the risk of arterial thrombosis, venous thrombosis, or pregnancy morbidity in patients with aPL.
  • Atsumi T, Koike T
    Autoimmunity reviews 1-2 1 (1-2) 49 - 53 1568-9972 2002/02 [Refereed][Not invited]

Books etc

Conference Activities & Talks

  • International Medicine Department in Hokkaido University Hospital.  [Not invited]
    ATSUMI Tatsuya
    Sapporo, Japan, 2nd HUH-SNUH Joint Symposium  2014/12
  • New guidelines in APS diagnosis.  [Not invited]
    ATSUMI Tatsuya
    8th Congress of Asia Pacific Society of Thrombosis and Haemostasis.  2014/10
  • International multi-centre study in Phosphatidylserine-dependent-antiprothrombin antibodies (aPS/PT) for the diagnosis of antiphospholipid syndrome.  [Not invited]
    ATSUMI Tatsuya
    0th Annual Meeting of the Scientific and Standardization Committee (SSC) of the International Society on Thrombosis and Haemostasis (ISTH).  2014/06
  • Methotrexate-related tolerability: Is it really of concern? in “Understanding the synergy between methotrexate andbDMARDs in rheumatoid arthritis  [Invited]
    ATSUMI Tatsuya
    6th Asia Pacific League of associations for rheumatology congress  2014/03
  • ATSUMI Tatsuya
    9th International Congress on Autoimmunity.  2014/03  Nice、France
  • 抗リン脂質抗体症候群の臨床と検査  [Not invited]
    渥美 達也
    日本抗リン脂質抗体標準化ワークショップ第1回学術集会  2014/02  東京
  • リウマチは発病から2年、遅くても3年以内に診断する  [Not invited]
    渥美 達也
    平成25年度厚生労働省難治性疾患等克服研究推進事業リウマチ・アレルギーシンポジウム  2014/02  東京
  • 関節リウマチの診断と治療の進歩  [Invited]
    渥美 達也
    江別医師会新年記念講演会  2014/01  江別市
  • ATSUMI Tatsuya
    1st HUH-SNUH Joint Symposium  2013/12  Seoul, South Korea
  • MIND THE GAP! 日常臨床におけるT2T実践  [Invited]
    渥美 達也
    第28回日本臨床リウマチ学会  2013/11  幕張市
  • 日常生活をとりもどすための関節リウマチ治療(労働生産性を中心に)  [Invited]
    渥美 達也
    第41回日本臨床免疫学会総会  2013/11  下関市
  • ATSUMI Tatsuya
    4th International Congress on Antiphospholipid Antibodies  2013/09  14th International Congress on Antiphospholipid Antibodies
  • ATSUMI Tatsuya
    14th International Congress on Antiphospholipid Antibodies  2013/09  Rio de Janeiro, Brazil
  • 関節リウマチ治療の進歩: もはや「難病」ではない  [Invited]
    渥美 達也
    千歳市市民公開講座I  2013/08  千歳市
  • 関節リウマチの早期診断  [Invited]
    渥美 達也
    市民公開講座 正しく知ろう、リウマチ治療の現在  2013/05  札幌
  • 渥美 達也
    第57回日本リウマチ学会学術集会  2013/04  京都
  • ループス腎炎ガイドラインと免疫抑制剤  [Invited]
    渥美 達也
    第57回日本リウマチ学会学術集会  2013/04  京都
  • 渥美 達也
    第57回日本リウマチ学会学術集会  2013/04  京都
  • 関節リウマチ治療の進歩  [Invited]
    渥美 達也
    釧路市民公開講座 道東リウマチ医療講演会  2013/04  釧路市
  • ATSUMI Tatsuya
    58th Annual Scientific and Standardization Committee Meeting, International Society on Thrombosis and Haemostasis  2012/06  Liverpool, UK.
  • Tastuya Atsumi
    The 5th Asian Congress on Autoimmunity  2011/11  シンガポール
  • ATSUMI Tatsuya
    57th Annual Scientific and Standardization Committee Meeting  2011/07  Kyoto,Japan

Educational Activities

Teaching Experience

  • 研究発表技法Ⅰ
    開講年度 : 2018
    課程区分 : 修士課程
    開講学部 : 医学院
  • Advanced Social and behavioral Sciences
    開講年度 : 2018
    課程区分 : 修士課程
    開講学部 : 医学院
    キーワード : 健康増進科学、健康増進活動、栄養、食生活、運動、身体活動
  • 研究発表技法Ⅱ
    開講年度 : 2018
    課程区分 : 修士課程
    開講学部 : 医学院
  • Master's Thesis Research in Medical Sciences
    開講年度 : 2018
    課程区分 : 修士課程
    開講学部 : 医学院
    キーワード : 免疫、代謝・内分泌、腎 Rheumatology, Endocrinology, Nephrology
  • 研究発表技法Ⅰ
    開講年度 : 2018
    課程区分 : 博士後期課程
    開講学部 : 医学研究科
  • Basic Principles of Medicine
    開講年度 : 2018
    課程区分 : 修士課程
    開講学部 : 医学院
    キーワード : 免疫、代謝・内分泌、腎 Rheumatology, Endocrinology, Nephrology
  • 研究発表技法Ⅱ
    開講年度 : 2018
    課程区分 : 博士後期課程
    開講学部 : 医学研究科
  • Principles of Medicine
    開講年度 : 2018
    課程区分 : 博士後期課程
    開講学部 : 医学院
    キーワード : 免疫、代謝・内分泌、腎 Rheumatology, Endocrinology, Nephrology
  • 基盤医学研究Ⅱ
    開講年度 : 2018
    課程区分 : 博士後期課程
    開講学部 : 医学研究科
  • Dissertation Research in Medical Sciences
    開講年度 : 2018
    課程区分 : 博士後期課程
    開講学部 : 医学院
    キーワード : 免疫、代謝・内分泌、腎 Rheumatology, Endocrinology, Nephrology
  • 基盤医学研究Ⅰ
    開講年度 : 2018
    課程区分 : 博士後期課程
    開講学部 : 医学研究科
  • Dissertation Research in Clinical Medicine
    開講年度 : 2018
    課程区分 : 博士後期課程
    開講学部 : 医学院
    キーワード : 免疫、代謝・内分泌、腎 Rheumatology, Endocrinology, Nephrology
  • 臨床医学研究Ⅱ
    開講年度 : 2018
    課程区分 : 博士後期課程
    開講学部 : 医学研究科
  • Integrated・Endocrinology and Metabolism
    開講年度 : 2018
    課程区分 : 学士課程
    開講学部 : 医学部
    キーワード : ホルモン、視床下部、脳下垂体、甲状腺、副甲状腺、性腺、糖尿病、脂質異常症、肥満、高尿酸血症、痛風
  • 臨床医学研究Ⅰ
    開講年度 : 2018
    課程区分 : 博士後期課程
    開講学部 : 医学研究科
  • Integrated・Rheumatology and Allergology
    開講年度 : 2018
    課程区分 : 学士課程
    開講学部 : 医学部
  • 医学総論
    開講年度 : 2018
    課程区分 : 博士後期課程
    開講学部 : 医学研究科
  • 研究発表技法Ⅰ
    開講年度 : 2018
    課程区分 : 博士後期課程
    開講学部 : 医学院
  • 研究発表技法Ⅱ
    開講年度 : 2018
    課程区分 : 博士後期課程
    開講学部 : 医学院
  • 選択実習Ⅰ
    開講年度 : 2018
    課程区分 : 学士課程
    開講学部 : 医学部
  • 選択実習Ⅱ
    開講年度 : 2018
    課程区分 : 学士課程
    開講学部 : 医学部
  • 統合・膠原病・アレルギー学
    開講年度 : 2018
    課程区分 : 学士課程
    開講学部 : 医学部
  • 統合・内分泌・代謝学
    開講年度 : 2018
    課程区分 : 学士課程
    開講学部 : 医学部
  • 全科臨床実習
    開講年度 : 2018
    課程区分 : 学士課程
    開講学部 : 医学部
  • 診療参加型選択科臨床実習
    開講年度 : 2018
    課程区分 : 学士課程
    開講学部 : 医学部

Campus Position History

  • 2015年4月1日 
  • 2017年1月1日 
  • 2019年4月1日 

Position History

  • 2015年4月1日 
  • 2017年1月1日 
  • 2019年4月1日 

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