Tetsuji Takayama, Yasushi Sato and Naoki Muguruma : Role of Alcohol and Metabolic Diseases in Colorectal Carcinogenesis., Springer-Verlag, Singapore, 2019.
Masahiro Sogabe, Toshiya Okahisa, Koji Tsujigami, Yoshio Okita, Hiroshige Hayashi, Toshikatsu Taniki, Hiroshi Hukuno, Masahiko Nakasono, Naoki Muguruma, Seisuke Okamura and Susumu Ito : Ultrasonographic assesment of gastric motility in diabetic gastroparesis befor and after attaining glycemic control., Springer-Verlag, New York, Feb. 2005.
Tetsuji Takayama, Naoki Muguruma, Masanori Igarashi, shozo Ohsumi, Shiro Oka, Fumihiko Kakuta, Yoshiaki Kubo, Hideki Kumagai, Mika Sasaki, Tamotsu Sugai, Kokichi Sugao, Yuko Takeda, Hisashi Doyama, Kouji Bannno, Suguru Fukahori, Yoichi Furukawa, Takahiro Horimatsu, Ishikawa Hideki, Takeo Iawama, Yasushi Okazaki, Yutaka Saito, Nariaki Matsuura, Michihiro Mutoh, Naohiro Tomita, Takashi Akiyama, Toshiki Yamamoto, Hideyuki Ishida and Nakayama Yoshiko : Clinical Guidelines for Diagnosis and Management of Cowden Syndrome/PTEN Hamartoma Tumor Syndrome in Children and Adults-Secondary Publication., Journal of the Anus, Rectum and Colon, Vol.7, No.4, 284-300, 2023.
(要約)
Cowden syndrome (CS)/ hamartoma tumor syndrome (PHTS) is a rare autosomal dominantly inherited condition caused by germline pathogenesis. It is associated with multiple hamartomatous lesions occurring in various organs and tissues, including the gastrointestinal tract, skin, mucous membranes, breast, thyroid, endometrium, and brain. Macrocephaly or multiple characteristic mucocutaneous lesions commonly develop in individuals in their 20s. This syndrome is occasionally diagnosed in childhood due to the occurrence of multiple gastrointestinal polyps, autism spectrum disorders, and intellectual disability. CS/PHTS can be diagnosed taking the opportunity of multigene panel testing in patients with cancer. Appropriate surveillance for early diagnosis of associated cancers is required because patients have a high risk of cancers including breast, thyroid, colorectal, endometrial, and renal cancers. Under these circumstances, there is growing concern regarding the management of CS/PHTS in Japan, but there are no available practice guidelines. To address this situation, the guideline committee, which included specialists from multiple academic societies, was organized by the Research Group on Rare and Intractable Diseases granted by the Ministry of Health, Labour, and Welfare, Japan. The present clinical guidelines explain the principles in the diagnosis and management of CS/PHTS, together with four clinical questions and the corresponding recommendations, incorporating the concept of the Grading of Recommendations Assessment, Development, and Evaluation system. Herein, we present an English version of the guideline, some of which have been updated, to promote seamless implementation of accurate diagnosis and appropriate management of pediatric, adolescent, and adult patients with CS/PHTS.
1,3a,6a-Triazapentalene (TAP) is a compact fluorescent chromophore whose fluorescence properties vary greatly depending on the substituents on the TAP ring. This study investigated the photo-induced cytotoxicities of various TAP derivatives. Among the derivatives, 2-p-nitrophenyl-TAP showed significant cytotoxicity to HeLa cells under UV irradiation but no cytotoxicity without UV. In addition, the photo-induced cytotoxicity of 2-p-nitirophenyl-TAP was found to be cancer cell selective and effective against HeLa cells and HCT 116 cells. Under UV irradiation, 2-p-nitrophenyl-TAP generated reactive oxygen species (ROS) that induced an apoptosis and ferroptosis in cancer cells. Therefore, it was revealed that 2-p-nitrophenyl-TAP is the most compact dye that can generate ROS by photoirradiation.
Tetsu Tomonari, Joji Tani, Yasushi Sato, Hironori Tanaka, Takahiro Tanaka, Tatsuya Taniguchi, Akihiro Morishita, Koichi Okamoto, Masahiro Sogabe, Hiroshi Miyamoto, Naoki Muguruma, Tsutomu Masaki and Tetsuji Takayama : Initial therapeutic results of atezolizumab plus bevacizumab for unresectable advanced hepatocellular carcinoma and the importance of hepatic functional reserve., Cancer Medicine, Vol.12, No.3, 2646-2657, 2023.
(要約)
We analyzed the association between the modified albumin-bilirubin (mALBI) grade and therapeutic efficacy of atezolizumab plus bevacizumab (Atezo+Bev) for the treatment of unresectable hepatocellular carcinoma (u-HCC). In this retrospective observational study, we included 71 u-HCC patients treated with Atezo+Bev between September 2020 and September 2021. Patients were grouped corresponding to the mALBI grade at the start of treatment (mALBI 1+2a or mALBI 2b+3) and analyzed for therapeutic effect and the transition rate to secondary treatment. According to the Response Evaluation Criteria in Solid Tumors, the overall response rate was significantly higher for the mALBI 1+2a group, than for the mALBI 2b+3 group, with 26.2% and 3.4%, respectively. The progression-free survival (PFS) was significantly longer in the mALBI 1+2a group (10.5 months) than in the mALBI 2b+3 group (3.0 months). In the multivariate analysis, an mALBI of 1+2a was found to be an independent factor of PFS. The rate of second-line treatment with multi-targeted agents was also significantly higher in the mALBI 1+2a group. In real-world practice, Atezo+Bev treatment might have higher therapeutic efficacy in u-HCC patients with mALBI 1+2a.
Hironori Wada, Yasushi Sato, Shota Fujimoto, Koichi Okamoto, Masahiro Bando, Tomoyuki Kawaguchi, Hiroshi Miyamoto, Naoki Muguruma, Katsuhisa Horimoto, Yui Matsuzawa, Michihiro Mutoh and Tetsuji Takayama : Resveratrol inhibits development of colorectal adenoma via suppression of LEF1; comprehensive analysis with connectivity map., Cancer Science, Vol.113, No.12, 4374-4384, 2022.
(要約)
Although many chemopreventive studies on colorectal tumors have been reported, no effective and safe preventive agent is currently available. We searched for candidate preventive compounds against colorectal tumor comprehensively from United States Food and Drug Administration (FDA)-approved compounds by using connectivity map (CMAP) analysis coupled with in vitro screening with colorectal adenoma (CRA) patient-derived organoids (PDOs). We generated CRA-specific gene signatures based on the DNA microarray analysis of CRA and normal epithelial specimens, applied them to CMAP analysis with 1309 FDA-approved compounds, and identified 121 candidate compounds that should cancel the gene signatures. We narrowed them down to 15 compounds, and evaluated their inhibitory effects on the growth of CRA-PDOs in vitro. We finally identified resveratrol, one of the polyphenolic phytochemicals, as a compound showing the strongest inhibitory effect on the growth of CRA-PDOs compared with normal epithelial PDOs. When resveratrol was administered to Apc mice at 15 or 30 mg/kg, the number of polyps (adenomas) was significantly reduced in both groups compared with control mice. Similarly, the number of polyps (adenomas) was significantly reduced in azoxymethane-injected rats treated with 10 or 100 mg/resveratrol compared with control rats. Microarray analysis of adenomas from resveratrol-treated rats revealed the highest change (downregulation) in expression of LEF1, a key molecule in the Wnt signaling pathway. Treatment with resveratrol significantly downregulated the Wnt-target gene (MYC) in CRA-PDOs. Our data demonstrated that resveratrol can be the most effective compound for chemoprevention of colorectal tumors, the efficacy of which is mediated through suppression of LEF1 expression in the Wnt signaling pathway.
Fumika Nakamura, Yasushi Sato, Koichi Okamoto, Yasuteru Fujino, Yasuhiro Mitsui, kaizo kagemoto, Tomoyuki Kawaguchi, Hiroshi Miyamoto, Naoki Muguruma, Tomoko Sonoda, Koichi Tsuneyama and Tetsuji Takayama : Colorectal carcinoma occurring via the adenoma-carcinoma pathway in patients with serrated polyposis syndrome., Journal of Gastroenterology, Vol.57, No.4, 286-299, 2022.
(要約)
Although serrated polyposis syndrome (SPS) is associated with an increased colorectal cancer (CRC) risk, the carcinogenic mechanisms remain unknown. We investigated clinicopathological characteristics and genetic abnormalities in colorectal polyps and CRC to elucidate carcinogenic mechanisms in SPS. We retrospectively analyzed clinicopathological features of colorectal polyps in 44 SPS patients, and examined mutations of genes including APC, RAS, BRAF, and TP53, and microsatellite instability (MSI) in CRC tissues. Of the 44 patients, 25 (56%) fulfilled WHO criterion 1, 11 (25%) fulfilled criterion 2, and 8 (18%) fulfilled both. A total of 956 polyps were observed; 642 (67%) hyperplastic polyps (HP), 204 (21%) sessile serrated lesions (SSL), 10 (1%) traditional serrated adenoma (TSA), and 100 (11%) adenomas. The median numbers of polyps (/patient) were 10.5 (IQR 2.75-23) HPs, 4.0 (2.0-6.0) SSLs, 0 (0-0) TSA, and 1 (0-3.3) adenoma. SSL and HP located preferentially in the proximal and distal colon, respectively. Twenty-two CRCs were found in 18 patients. Based on the histological coexistence of SSL/TSA, BRAF mutation and MSI, 5 CRCs (26%) were classified as serrated-neoplasia pathway. Conversely, based on the coexistence of adenoma, APC/RAS and TP53 mutations, 11 CRCs (58%) were classified as adenoma-carcinoma pathway. The remaining three were unclassifiable. Most CRCs through adenoma-carcinoma pathway were located in the left-side colorectum and patients bearing those met criterion 2, characterized by many HP and advanced adenomas. Adenoma was a significant risk factor for CRC. Our results suggest that more than half of the CRCs, particularly those in the left-side colorectum, developed through the adenoma-carcinoma pathway in SPS patients. Adenoma was a risk factor for CRCs, suggesting its importance in colorectal carcinogenesis.
Noriaki Murayama, Koichi Okamoto, Tadahiko Nakagawa, Jinsei Miyoshi, Kensei Nishida, Tomoyuki Kawaguchi, kaizo kagemoto, Shinji Kitamura, Beibei Ma, Hiroshi Miyamoto, Naoki Muguruma, Mitsuyasu Yano, Koichi Tsuneyama, Takahiro Fujimori, Yasushi Sato and Tetsuji Takayama : miR-144-3p/miR-451a promotes lymphovascular invasion through repression of PTEN/p19 in rectal neuroendocrine tumors., Journal of Gastroenterology and Hepatology, Vol.37, No.5, 919-927, 2022.
(要約)
Although rectal neuroendocrine tumor (NET-G1) have potential metastatic capability, even among small tumors, no predictive biomarker for invasion and metastasis has been reported. We analyzed microRNA (miRNA) expression profiles in rectal NET-G1 tissues with and without lymphovascular invasion (LVI). Moreover, we then investigated their target genes to clarify the mechanism of invasion/metastasis in NET-G1. miRNA array analysis was performed using seven rectal NET-G1 tissues with LVI and seven without LVI. miRNA expression was confirmed by quantitative real-time PCR. A NET cell line H727 was transfected with miRNA mimic or target gene small interfering RNA, and migration and invasion assays were performed. The expression levels of miR-144-3p and miR-451a were significantly higher in NET-G1 with LVI versus without LVI, as determined by miRNA array analysis and RT-qPCR. A significant correlation was observed between miR-144-3p and miR-451a expression levels, strongly suggesting miR144/451 cluster overexpression in NET-G1 with LVI. Bioinformatic analysis of target genes revealed that miR-144-3p and miR-451a directly interact with PTEN and p19 mRNA, respectively. Immunohistochemistry revealed significantly lower expression of PTEN and p19 in NET-G1 tissues with LVI than in those without LVI. The miR-144-3p and miR-451a mimic significantly increased cell migration/invasion capability, respectively. Knockdown of PTEN and p19 induced significant augmentation of cell invasion and migration capability, respectively. Our data suggest that overexpression of miR-144/miR-451 cluster promotes LVI via repression of PTEN and p19 in rectal NET-G1 cells. miR-144/451 cluster may be a novel biomarker for predicting invasion/metastasis in rectal NET-G1.
Satoshi Teramae, Naoki Muguruma, Koichi Okamoto, Kumiko Oseto, Ryutaro Nishikawa, Takayuki Tanoue, Keiji Hirata, Shunichi Yanai, Takayuki Matsumoto, Seiji Shimizu, Jun Miwa, Yu Sakaki, Kazuo Yashima, Hiroyuki Ohnuma, Yasushi Sato, Yoshitaka Kitayama, Yoshio Ohda, Atsushi Yamauchi, Yoji Sanomura, Kumiko Tanaka, Yoshiaki Kubo, Hideki Ishikawa, Yoshimi Bando, TOmoko Sonoda and Tetsuji Takayama : Cancer risk and genotype-phenotype correlation in Japanese patients with Cowden syndrome., International Journal of Clinical Oncology, Vol.27, No.4, 639-647, 2022.
(要約)
Cowden syndrome (CS) is an autosomal-dominant hereditary disorder caused by a germline PTEN variant and characterized by multiple hamartomas and a high risk of cancers. However, no detailed data on CS in Asian patients nor genotype-phenotype correlation have been reported. We performed the first Japanese nationwide questionnaire survey on CS and obtained questionnaire response data on 49 CS patients. Patients included 26 females (median age 48 years). The incidence of breast, thyroid, endometrium, and colorectal cancer was 32.7%, 12.2%, 19.2% (among females), and 6.1%, respectively. The incidence of any cancers was relatively high among all patients (46.9%, 23/49), and particularly female patients (73.1%, 19/26), compared with previous reports from Western countries. Gastrointestinal (GI) polyps were more frequently found throughout the GI tract compared with previous studies. PTEN variants were detected in 95.6% (22/23) of patients; 12 in the N-terminal region (11 in phosphatase domain) and 10 in the C-terminal (C2 domain) region. The incidence of cancer in the C2 domain group was significantly higher than in the N-terminal region (phosphatase) group. All female patients with C2 domain variant had breast cancer. Our data suggest that Japanese patients with CS, particularly female patients and patients with C2 domain variant may have a high risk of cancers.
(キーワード)
Breast Neoplasms / Female / Genetic Association Studies / Hamartoma Syndrome, Multiple / Humans / Intestinal Polyps / Japan / Male / Middle Aged / PTEN Phosphohydrolase / Risk
Masanori Takehara, Hiroshi Miyamoto, Yasuteru Fujino, Tetsu Tomonari, Tatsuya Taniguchi, Shinji Kitamura, Koichi Okamoto, Masahiro Sogabe, Yasushi Sato, Naoki Muguruma, Yoshimi Bando and Tetsuji Takayama : Long-Term Survival due to Chemotherapy including Paclitaxel in a Patient with Metastatic Primary Splenic Angiosarcoma., Case Reports in Gastroenterology, Vol.15, No.3, 910-918, 2021.
(要約)
A primary splenic angiosarcoma is a rare type of soft tissue sarcoma and is associated with an extremely poor prognosis. In this study, we describe the case of a patient who was diagnosed with metastatic primary splenic angiosarcoma and survived for about 2 years. A 62-year-old female was referred to us for the treatment of splenic angiosarcoma with disseminated intravascular coagulation (DIC) and multiple liver and bone metastases. Paclitaxel therapy resulted in recovery from DIC and enabled her to continue sequential treatment through to sixth-line chemotherapy. We reviewed all splenic angiosarcoma case reports which were described as stage IV to date and compared with our case. From these data, we found that the median overall survival was 105 days, and the prognosis of splenic angiosarcoma of stage IV was worse than conventional case series. Splenectomy was performed in more patients than chemotherapy as a treatment. Moreover, various chemotherapeutic regimens were used. These data suggest that administering chemotherapy including paclitaxel to patients with splenic angiosarcoma might improve their prognosis.
The mechanism of resistance to sorafenib in hepatocellular carcinoma (HCC) remains unclear. We analyzed miRNA expression profiles in sorafenib-resistant HCC cell lines (PLC/PRF5-R1/R2) and parental cell lines (PLC/PRF5) to identify the miRNAs responsible for resistance. Drug sensitivity, migration/invasion capabilities, and epithelial-mesenchymal transition (EMT) properties were analyzed by biochemical methods. The clinical relevance of the target genes to survival in HCC patients were assessed using a public database. Four miRNAs were significantly upregulated in PLC/PRF5-R1/-R2 compared with PLC/PRF5. Among them, miR-125b-5p mimic-transfected PLC/PRF5 cells (PLC/PRF5-miR125b) and showed a significantly higher IC50 for sorafenib compared with controls, while the other miRNA mimics did not. PLC/PRF5-miR125b showed lower E-cadherin and higher Snail and vimentin expression-findings similar to those for PLC/PRF5-R2-which suggests the induction of EMT in those cells. PLC/PRF5-miR125b exhibited significantly higher migration and invasion capabilities and induced sorafenib resistance in an in vivo mouse model. Bioinformatic analysis revealed ataxin-1 as a target gene of miR-125b-5p. PLC/PRF5 cells transfected with ataxin-1 siRNA showed a significantly higher IC50, higher migration/invasion capability, higher cancer stem cell population, and an EMT phenotype. Median overall survival in the low-ataxin-1 patient group was significantly shorter than in the high-ataxin-1 group. In conclusion, miR-125b-5p suppressed ataxin-1 and consequently induced Snail-mediated EMT and stemness, leading to a poor prognosis in HCC patients.
Tetsu Tomonari, Yasushi Sato, Joji Tani, Akira Hirose, Chikara Ogawa, Akihiro Morishita, Hironori Tanaka, Takahiro Tanaka, Tatsuya Taniguchi, Koichi Okamoto, Masahiro Sogabe, Hiroshi Miyamoto, Naoki Muguruma, Kazushige Uchida, Tsutomu Masaki and Tetsuji Takayama : Comparison of therapeutic outcomes of Sorafenib and Lenvatinib as primary treatments for hepatocellular carcinoma with a focus on molecular-targeted agent sequential therapy: A propensity score-matched analysis., Hepatology Research, Vol.51, No.4, 472-481, 2021.
(要約)
The optimal choice between sorafenib (SOR) or lenvatinib (LEN) as the first-line treatment for unresectable hepatocellular carcinoma (u-HCC) remains debatable. Using propensity score matching, this study compares the outcomes of SOR and LEN in the molecular-targeted agent (MTA) sequential treatment of u-HCC patients. This retrospective, multicenter, observational study recruited 137 u-HCC patients who underwent primary treatment with LEN (n = 52) or SOR (n = 85) between June 2017 and June 2020 after regorafenib was approved as the secondary treatment for u-HCC. Propensity score matching was used to reduce confounding, resulting in the selection of 104 patients (n = 52 for the SOR and LEN cohorts). The median overall survival was 21.8 months for LEN and 20.4 months for SOR. LEN exhibited significantly greater therapeutic efficacy as compared to SOR (objective response rate: 3.8% [SOR] vs. 42.3% [LEN], P <0.01; progression-free survival: 10 months [LEN] vs. 5.1 months [SOR], P <0.01). No significant intergroup differences were noted in the rate of transition to secondary MTA treatments (SOR: 58.7%; LEN: 48.4%), adverse events (SOR: 86%; LEN: 95%), and maintenance of the Child-Pugh (CP) score during treatment. Compared to non-MTA treatments, secondary MTA treatment achieved a greater improvement in survival ( 4.3 months vs. 2.8 months, P=0.0047). Multivariate analysis demonstrated that the CP score (P <0.01) and alpha-fetoprotein level (P <0.01) were independent prognostic factors. Both SOR and LEN treatments showed a clinically comparable therapeutic efficacy as the first-line treatments for u-HCC patients in an MTA sequential therapy.
Hironori Tanaka, Yoshihito Saijyo, Tetsu Tomonari, Takahiro Tanaka, Tatsuya Taniguchi, Shusuke Yagi, Koichi Okamoto, Hiroshi Miyamoto, Masahiro Sogabe, Yasushi Sato, Naoki Muguruma, Koichi Tsuneyama, Masataka Sata and Tetsuji Takayama : An Adult Case of Congenital Extrahepatic Portosystemic Shunt Successfully Treated with Balloon-occluded Retrograde Transvenous Obliteration, Internal Medicine, Vol.60, No.12, 1839-1845, 2021.
(要約)
A 42-year-old woman visited our hospital due to syncope. Contrast-enhanced CT revealed portosystemic shunt, portal vein hypoplasia, and multiple liver nodules. The histological examination of a liver biopsy specimen exhibited portal vein hypoplasia and revealed that the liver tumor was positive for glutamine synthetase. The patient was therefore diagnosed with congenital extrahepatic portosystemic shunt type II, and with focal nodular hyperplasia (FNH)-like nodules. She had the complication of severe portopulmonary hypertension and underwent complete shunt closure by balloon-occluded retrograde transvenous obliteration (B-RTO). The intrahepatic portal vein was well developed at 1 year after B-RTO, and multiple liver nodules completely regressed. Her pulmonary hypertension also improved.
Sessile serrated adenomas/polyps (SSA/Ps) are a putative precursor lesion of colon cancer. Although the relevance of DNA hypermethylation in the SSA/P-cancer sequence is well documented, the role of DNA hypomethylation is unknown. We investigated the biological relevance of DNA hypomethylation in the SSA/P-cancer sequence by using 3-dimensional organoids of SSA/P. We first analyzed hypomethylated genes using datasets from our previous DNA methylation array analysis on 7 SSA/P and 2 cancer in SSA/P specimens. Expression levels of hypomethylated genes in SSA/P specimens were determined by RT-PCR and immunohistochemistry. We established 3-dimensional SSA/P organoids and performed knockdown experiments using a lentiviral shRNA vector. DNA hypomethylation at CpG sites of the gene was quantitated by MassARRAY analysis. The mean number of hypomethylated genes in SSA/P and cancer in SSA/P was 41.6 ± 27.5 and 214 ± 19.8, respectively, showing a stepwise increment in hypomethylation during the SSA/P-cancer sequence. S100P, S100α2, PKP3, and MUC2 were most commonly hypomethylated in SSA/P specimens. The mRNA and protein expression levels of S100P, S100α2, and MUC2 were significantly elevated in SSA/P compared with normal colon tissues, as revealed by RT-PCR and immunohistochemistry, respectively. Among these, mRNA and protein levels were highest for S100P. Knockdown of the S100P gene using a lentiviral shRNA vector in 3-dimensional SSA/P organoids inhibited cell growth by >50% (p < 0.01). The mean diameter of SSA/P organoids with S100P gene knockdown was significantly smaller compared with control organoids. MassARRAY analysis of DNA hypomethylation in the S100P gene revealed significant hypomethylation at specific CpG sites in intron 1, exon 1, and the 5'-flanking promoter region. These results suggest that DNA hypomethylation, including S100P hypomethylation, is supposedly associated with the SSA/P-cancer sequence. S100P overexpression via DNA hypomethylation plays an important role in promoting cell growth in the SSA/P-cancer sequence.
Tomoyuki Kawaguchi, Koichi Okamoto, Shota Fujimoto, Masahiro Bando, Hironori Wada, Hiroshi Miyamoto, Yasushi Sato, Naoki Muguruma, Katsuhisa Horiimoito and Tetsuji Takayama : Lansoprazole Inhibits the Development of Sessile Serrated Lesions by Inducing G1 Arrest via Skp2/p27 Signaling Pathway., Journal of Gastroenterology, Vol.59, No.1, 11-23, 2021.
(要約)
Although the serrated-neoplasia pathway reportedly accounts for 15-30% of colorectal cancer (CRC), no studies on chemoprevention of sessile serrated lesions (SSLs) have been reported. We searched for effective compounds comprehensively from a large series of compounds by employing Connectivity Map (CMAP) analysis of SSL-specific gene expression profiles coupled with in vitro screening using SSL patient-derived organoids (PDOs), and validated their efficacy using a xenograft mouse model of SSL. We generated SSL-specific gene signatures based on DNA microarray data, and applied them to CMAP analysis with 1309 FDA-approved compounds to select candidate compounds. We evaluated their inhibitory effects on SSL-PDOs using a cell viability assay. SSL-PDOs were orthotopically transplanted into NOG mice for in vivo evaluation. The signal transduction pathway was evaluated by gene expression profile and protein expression analysis. We identified 221 compounds by employing CMAP analysis of SSL-specific signatures, which should cancel the gene signatures, and narrowed them down to 17 compounds. Cell viability assay using SSL-PDOs identified lansoprazole as having the lowest IC50 value (47 µM) among 17 compounds. When SSL-PDO was orthotopically transplanted into murine intestinal tract, the tumor grew gradually. Administration of lansoprazole to mice inhibited the growth of SSL xenograft whereas the tumor in control mice treated with vehicle alone grew gradually over time. The Ki67 index in xenograft lesions from the lansoprazole group was significantly lower compared with the control group. Cell cycle analysis of SSL-PDOs treated with lansoprazole exhibited a significant increase in G1 phase cell population. Microarray and protein analysis revealed that lansoprazole downregulated Skp2 expression and upregulated p27 expression in SSL-PDOs. Our data strongly suggest that lansoprazole is the most effective chemopreventive agent against SSL, and that lansoprazole induces G1 cell cycle arrest by downregulating Skp2 and upregulating p27 in SSL cells.
Tamotsu Sagawa, Yasushi Sato, Masahiro Hirakawa, Kyoko Hamaguchi, Akira Fukuya, Koichi Okamoto, Hiroshi Miyamoto, Naoki Muguruma, Koshi Fujikawa, Yasuo Takahashi and Tetsuji Takayama : Clinical impact of primary tumour location, early tumour shrinkage, and depth of response in the treatment of metastatic colorectal cancer with first-line chemotherapy plus cetuximab or bevacizumab., Scientific Reports, Vol.10, No.1, 19815, 2020.
(要約)
The primary tumour location is an important prognostic factor for previously untreated metastatic colorectal cancer (mCRC). However, the predictive efficacies of primary tumour location, early tumour shrinkage (ETS), and depth of response (DpR) on mCRC treatment has not been fully evaluated. This study aimed to investigate the predictive efficacies of these traits in mCRC patients treated with first-line 5-fluorouracil-based chemotherapy plus biologic agents, namely, cetuximab and bevacizumab. This was a retrospective analysis of the medical records of 110 patients with pathology-documented unresectable mCRC. Patients with left-sided mCRC receiving any first-line regimen showed better overall survival (OS) than those with right-sided mCRC [33.3 vs 16.3 months; hazard ratio (HR) 0.44; 95% confidence interval (CI) 0.27-0.74; p < 0.001]. In patients with left-sided tumours, treatment with chemotherapy plus cetuximab yielded longer OS than chemotherapy plus bevacizumab (50.6 vs 27.8 months, HR 0.55; 95% CI 0.32-0.97; p = 0.0378). mCRC patients with ETS and high DpR showed better OS than those lacking ETS and with low DpR (33.5 vs 19.6 months, HR 0.50, 95% CI 0.32-0.79, p = 0.023 and 38.3 vs 19.0 months, HR 0.43, 95% CI 0.28-0.68, p < 0.001, respectively). Moreover, ETS and/or high DpR achieved in patients with right-sided mCRC receiving chemotherapy plus cetuximab were associated with significantly better OS than in those lacking ETS and with low DpR (34.3 vs 10.4 months, HR 0.19, 95% CI 0.04-0.94, p = 0.025 and 34.3 vs 10.4 months, HR 0.19, 95% CI 0.04-0.94, p = 0.0257, respectively). Taken together, our study demonstrates that primary tumour location is not only a well-known prognostic factor but also a relevant predictive factor in patients with mCRC receiving chemotherapy plus cetuximab. Additionally, both ETS and DpR could predict treatment outcomes and also potentially guide cetuximab treatment even in right-sided mCRCs.
Jun Okazaki, Toshihito Tanahashi, Yasushi Sato, Jinsei Miyoshi, Tadahiko Nakagawa, Tetsuo Kimura, Hiroshi Miyamoto, Yasuteru Fujino, Fumika Nakamura, Masanori Takehara, beibei ma, Masahiro Bando, Shinji Kitamura, Koichi Okamoto, Naoki Muguruma, Masahiro Sogabe and Tetsuji Takayama : MicroRNA-296-5p Promotes Cell Invasion and Drug Resistance by Targeting Bcl2-Related Ovarian Killer, Leading to a Poor Prognosis in Pancreatic Cancer., Digestion, Vol.101, No.6, 794-806, 2020.
(要約)
Pancreatic ductal adenocarcinoma (PDAC) is characterized by aggressive invasion, early metastasis, and resistance to chemotherapy, leading to a poor prognosis. To clarify the molecular mechanism of these malignant characteristics, we performed a genome-wide microRNA (miRNA) array analysis utilizing micro-cancer tissues from patients with unresectable PDAC (stage IV), obtained by endoscopic ultrasound-fine needle aspiration (EUS-FNA). The expression profiles of 2,042 miRNAs were determined using micro-cancer tissues from 13 patients with unresectable PDAC obtained by EUS-FNA. The relationship between individual miRNA levels and overall survival (OS) was analyzed. Possible target genes for miRNAs were bioinformatically analyzed using the online database miRDB. Pancreatic cancer cell lines PANC-1, MIA PaCa-2, and PK-8 were transfected with miRNA mimic or small interfering RNA, and cell invasion, epithelial-mesenchymal transition (EMT), and apoptosis markers were examined. miRNA and mRNA expressions were examined by quantitative polymerase chain reaction. Of 2,042 miRNAs, the 10 that exhibited the lowest correlation coefficient (p 0.005) between miRNA expression level and OS among the patients were identified. The miRDB and expression analysis in cancer cell lines for the 10 miRNAs identified miR-296-5p and miR-1207-5p as biomarkers predictive of shorter survival (p < 0.0005). Bioinformative target gene analysis and transfection experiments with miRNA mimics showed that Bcl2-related ovarian killer (BOK), a pro-apoptotic gene, is a target for miR296-5p in pancreatic cancer cells; transfection of miR-296-5p mimic into PANC-1, MIA PaCa-2, and PK-8 cells resulted in significant suppression of BOK mRNA and protein expression. These transfectants showed significantly higher invasion capability compared with control cells, and knock down of BOK in pancreatic cancer cells similarly enhanced invasion capability. Transfectants of miR-296-5p mimic also exhibited aberrant expression of EMT markers, including vimentin and N-cadherin. Moreover, these transfectants showed a significantly lower apoptosis rate in response to 5-fluorouracil and gemcitabine with a decrease of BOK expression, suggesting a role of miR-296-5p in drug resistance. These results suggest that miR-296-5p is a useful biomarker for a poor prognosis in patients with PDAC, and that the miR-296-5p/BOK signaling axis plays an important role in cell invasion, drug resistance, and EMT in PDACs.
Shota Fuimoto, Naoki Muguruma, Michiyasu Nakao, Hidenori ANDO, Takanori Kashihara, Yoshihiko Miyamoto, Koichi Okamoto, Shigeki Sano, Tatsuhiro Ishida, Yasushi Sato and Tetsuji Takayama : Indocyanine green-labeled dasatinib as a new fluorescent probe for molecular imaging of gastrointestinal stromal tumors., Journal of Gastroenterology and Hepatology, Vol.36, No.5, 1253-1262, 2020.
(要約)
It is difficult to differentiate gastrointestinal stromal tumors (GISTs) from other subepithelial lesions under gastrointestinal endoscopy. Because most GISTs express tyrosine kinase receptor c-KIT, fluorescence-labeled c-KIT-specific tyrosine kinase inhibitors seem to be useful agents for molecular imaging of GIST. We aimed to develop a near-infrared fluorescent imaging technology for GIST targeting c-KIT using the novel fluorescent probe indocyanine green-labeled dasatinib (ICG-dasatinib) and to investigate the antitumor effect of ICG-dasatinib on GIST cells. Indocyanine green-labeled dasatinib was synthesized by labeling linker-induced dasatinib with ICG derivative 3-indocyanine-green-acyl-1,3-thiazolidine-2-thione. Human GIST cell lines GIST-T1 and GIST-882M were incubated with ICG-dasatinib and observed by fluorescent microscopy. GIST cells were incubated with ICG-dasatinib, unlabeled dasatinib, or imatinib, and cell viabilities were evaluated. Subcutaneous GIST model mice or orthotopic GIST model rats were intravenously injected with ICG-dasatinib and observed using an IVIS Spectrum. Strong fluorescent signals of ICG-dasatinib were observed in both GIST cell lines in vitro. IC50 values for ICG-dasatinib, unlabeled dasatinib, and imatinib were 13.9, 1.17, and 16.2 nM in GIST-T1 and 26.6, 3.63, and 47.6 nM in GIST-882M cells, respectively. ICG-dasatinib accumulated in subcutaneous xenografts in mice. Fluorescent signals were also observed in liver and gallbladder, indicating biliary excretion; however, fluorescence intensity of tumors was significantly higher than that of intestine after washing. Strong fluorescent signals were observed in orthotopic xenografts through the covering normal mucosa in rats. Indocyanine green-labeled dasatinib could visualize GIST cells and xenografted tumors. The antitumor effect of ICG-dasatinib was preserved to the same degree as imatinib.
Tetsu Tomonari, Yasushi Sato, Hironori Tanaka, Takahiro Tanaka, Tatsuya Taniguchi, Masahiro Sogabe, Koichi Okamoto, Hiroshi Miyamoto, Naoki Muguruma, Yu Saitou, Satoru Imura, Yoshimi Bando, Mitsuo Shimada and Tetsuji Takayama : Conversion therapy for unresectable hepatocellular carcinoma after lenvatinib Three case reports., Medicine, Vol.99, No.42, e22782, 2020.
(要約)
Lenvatinib (LEN) is a novel potent multi-tyrosine kinase inhibitor, approved as first-line treatment for unresectable hepatocellular carcinoma (HCC). Considering its high objective response rate, LEN therapy could be expected to achieve downstaging of tumors and lead to conversion therapy with hepatectomy or ablation. However, the feasibility of conversion therapy after LEN treatment in unresectable HCC remains largely unknown. Here, we reported 3 cases of unresectable HCC: case 1, a 69-year-old man diagnosed with ruptured HCC; case 2, a 72-year-old woman with nonalcoholic steatohepatitis-based HCC; and case 3, a 73-year-old man with a history of alcoholic cirrhosis-based HCC. In all cases, cirrhosis was classified as Child-Pugh 5 and modified albumin-bilirubin grade 1 or 2a. HCC was diagnosed as Barcelona Clinic Liver Cancer (BCLC) stage B. In all cases, LEN was initiated after conventional-transcatheter arterial embolization enforcement, while maintaining liver function. In all cases, the main tumor size decreased after 6 months of LEN treatment and no satellite nodes were detected, indicating downstaging of HCC to BCLC stage A. Subsequently, conversion hepatectomy or ablation was performed. After successful conversion therapy, the general condition of the patients was good, without tumor recurrence during the observation period (median 10 months). This study demonstrated that LEN enables downstaging of HCC and thus represents a bridge to successful surgery or ablation therapy. In particular, LEN treatment may facilitate the possibility for conversion therapy of initially unresectable HCC, while maintaining the hepatic functional reserve.
Recently, immune checkpoint inhibitors(ICI)have been approved for use in advanced gastric cancer(AGC)based on the positive results of ATTRACTION‐2 trial in Japan. There has been accumulating evidence that the development of immune-related adverse events(irAE)may be associated with a response to ICI therapy, particularly in lung cancer, although little is known about these correlations in gastrointestinal cancer. To investigate the efficacy and irAE of ICI treatment and their correlation in AGC, we retrospectively examined 29 patients with AGC who received nivolumab therapy in our departments. Among them, 15 patients(52%)developed irAEs including 4 patients(14%)for grade 3 irAEs ; liver dysfunction(n＝2), type 1 diabetes mellitus(n＝2) and adrenal insufficiency(n＝1). The median overall survival was12．0months in the irAE group and 3．25 months in the non-irAE group(p＝0．164), which suggested the relationship between the effects and irAEs in ICI treatment of AGC. Further research is required to understand the implications of irAE characteristics on ICI response in GCA patients.
Recently, there have been some reports of electromagnetic interference during capsule endoscopy(CE)in regards to other medical devices and facility environment. These accidental events have not been analyzed sufficiently although academic societies and related ministries are proposing guidelines with cautious attention. Based on this, detailed analyses and development of solution are required. In this study, we review our experience with cases of accidental events during CE and assessed the causes and preventive solutions. A total of149CE cases(male :89, female :60, mean age :56±18 8)from January 2017 until December 2019 were analyzed retrospectively. Four cases(2%)with defective images were noted. Detailed events were as follows ;1 disorder of the sensor array, 2 recorder freezes, and 1 electromagnetic interference. These mechanical and electromagnetic troubles should be assessed and shared among medical staffs and manufacturers to propose possible solutions and perform CE safely.
Tetsu Tomonari, Yasushi Sato, Hironori Tanaka, Takahiro Tanaka, Tatsuya Taniguchi, Masahiro Sogabe, Koichi Okamoto, Hiroshi Miyamoto, Naoki Muguruma and Tetsuji Takayama : Sorafenib as second-line treatment option after failure of lenvatinib in patients with unresectable hepatocellular carcinoma, JGH Open, Vol.4, No.6, 1135-1139, 2020.
(要約)
Abstract Background and Aim Currently, there is no molecular-targeted agent that has demonstrated evidence of efficacy in patients with unresectable hepatocellular carcinoma (u-HCC) who have developed resistance to treatment with lenvatinib (LEN). In this real-world study, we aimed to investigate the therapeutic effect and safety of sorafenib (SOR) in patients with u-HCC after progression on treatment with LEN. Methods (Patients) and Results A total of 13 patients with u-HCC (12 males and 1 female), who were treated with SOR after progression on LEN, were enrolled in this retrospective study. Therapeutic efficacy was evaluated via contrast-enhanced computerized tomography at 8 weeks after the initiation of SOR therapy according to modified response evaluation criteria in solid tumors (mRECIST) and RECIST. According to mRECIST, the objective response rate (ORR) and disease control rate (DCR) were 15.3
Although pancreatic cancer often invades into peripancreatic adipose tissue, little is known about the cancer-adipocyte interaction. We first investigated the ability of adipocytes to de-differentiate to cancer-associated adipocytes (CAAs) by co-culturing with pancreatic cancer cells. We then examined the effects of CAA-conditioned media (CAA-CM) on the malignant characteristics of cancer cells, the mechanism underlying those effects, and their clinical relevance in pancreatic cancer. When 3T3-L1 adipocytes were co-cultured with pancreatic cancer cells (PANC-1) using Transwell system, adipocytes lost their lipid droplets and morphologically changed to fibroblast-like cells (CAA). Adipocyte-specific marker mRNA levels significantly decreased but those of fibroblast-specific markers appeared, characteristic findings of CAA, as revealed by real-time PCR. When PANC-1 cells were cultured with CAA-CM, significantly higher migration/invasion capability, chemoresistance, and epithelial-mesenchymal transition (EMT) properties were observed compared with control cells. To investigate the mechanism underlying these effects, we performed microarray analysis of PANC-1 cells cultured with CAA-CM, and found 78.5-fold higher expression of SAA1 compared with control cells. When SAA1 gene in PANC-1 cells was knocked down with SAA1 siRNA, migration/invasion capability, chemoresistance, and EMT properties were significantly attenuated compared with control cells. Immunohistochemical analysis on human pancreatic cancer tissues revealed positive SAA1 expression in 46/61 (75.4%). Overall survival in the SAA1-positive group was significantly shorter than in the SAA1-negative group (p=0.013). In conclusion, we demonstrated that pancreatic cancer cells induced de-differentiation in adipocytes toward CAA, and CAA promoted malignant characteristics of pancreatic cancer via SAA1 expression, suggesting that SAA1 is a novel therapeutic target in pancreatic cancer.
Hironori Tanaka, Koichi Okamoto, Yasushi Sato, Takahiro Tanaka, Tetsu Tomonari, Fumika Nakamura, Yasuteru Fujino, Yasuhiro Mitsui, Hiroshi Miyamoto, Naoki Muguruma, Akinori Morita, Hitoshi Ikushima and Tetsuji Takayama : Synergistic anti-tumor activity of miriplatin and radiation through PUMA-mediated apoptosis in hepatocellular carcinoma., Journal of Gastroenterology, Vol.55, No.11, 1072-1086, 2020.
(要約)
The prognosis for patients with unresectable advanced hepatocellular carcinoma (HCC) is poor. Miriplatin is a hydrophobic platinum compound that has a long retention time in lesions after transarterial chemoembolization (TACE). We investigated anti-tumor activity of miriplatin combined with irradiation on HCC cells, and its underlying mechanism of apoptosis. We also analyzed the effectiveness of miriplatin-TACE and radiotherapy for locally advanced HCC. Human HCC cell lines HepG2 and HuH-7 were treated with DPC (active form of miriplatin) and radiation, and synergy was evaluated using a combination index (CI). Apoptosis-related proteins and cell cycles were analyzed by western blotting and flowcytometry. We retrospectively analyzed treatment outcomes in 10 unresectable HCC patients with vascular/bile duct invasion treated with miriplatin-TACE and radiotherapy. DPC or X-ray irradiation decreased cell viability dose-dependently. DPC plus irradiation decreased cell viability synergistically in both cell lines (CI < 1, respectively). Cleaved PARP expression was induced much more strongly by DPC plus irradiation than by each treatment alone. Expression of p53 up-regulated modulator of apoptosis (PUMA) was significantly induced by the combination, and knockdown of PUMA with siRNA significantly decreased apoptosis in both cell lines. DPC plus irradiation caused sub-G1, G2/M, and S phase cell arrest in those cells. The combination of miriplatin-TACE and radiotherapy showed a high response rate for patients with locally advanced HCC despite small number of patients. Miriplatin plus irradiation had synergistic anti-tumor activity on HCC cells through PUMA-mediated apoptosis and cell cycle arrest. This combination may possibly be effective in treating locally advanced HCC.
Tetsu Tomonari, Yasushi Sato, Hironori Tanaka, Takahiro Tanaka, Yasuteru Fujino, Yasuhiro Mitsui, Akihiro Hirao, Tatsuya Taniguchi, Koichi Okamoto, Masahiro Sogabe, Hiroshi Miyamoto, Naoki Muguruma, Harumi Kagiwada, Masashi Kitazawa, Kazuhiro Fukui, Ktsuhisa Horimoto and Tetsuji Takayama : Potential use of lenvatinib for patients with unresectable hepatocellular carcinoma including after treatment with sorafenib: Real-world evidence and in vitro assessment via protein phosphorylation array., Oncotarget, Vol.11, No.26, 2531-2542, 2020.
(要約)
The efficacy and safety of lenvatinib (LEN) as a second/third-line treatment for unresectable hepatocellular carcinoma (HCC) after sorafenib (SOR) therapy remains unknown. We evaluated the outcomes of second/third-line LEN treatment, investigated the sensitivity of a SOR-resistant HCC cell line (PLC/PRF5-R2) to LEN, and assessed their signal transduction pathways by protein array analysis. We retrospectively enrolled 57 patients with unresectable HCC. Fifty-three radiologically evaluated patients comprised 34 molecular-targeted agent (MTA)-naive (first-line), nine intolerant to SOR (second-line), and 10 resistant to regorafenib (third-line). The objective response rates (ORRs) were 61.8% in first-line, 33.3% in second-line, and 20.0% in third-line groups. The overall survival (OS) in the first-line was significantly longer than that in the third-line group ( < 0.05). Patients with better liver functional reserves (child score, ALBI grade) exhibited higher ORR and longer OS. The IC of LEN against PLC/PRF5-R2 was significantly higher than that against PLC/PRF5. LEN significantly inhibited more LEN-related signal transduction pathways in PLC/PRF5 than in PLC/PRF5-R2 cells. This suggests that LEN is active and safe as a second/third-line treatment for unresectable HCC. LEN seems more effective for patients with HCC with better hepatic reserve functions or before MTA-resistance is acquired because of the partial cross-resistance to SOR.
Tadahiko Nakagawa, Yasushi Sato, Toshihito Tanahashi, Yasuhiro Mitsui, Yoshifumi Kida, Yasuteru Fujino, Misato Hirata, Shinji Kitamura, Hiroshi Miyamoto, Koichi Okamoto, Naoki Muguruma, Yoshimi Bando and Tetsuji Takayama : JMJD2A sensitizes gastric cancer to chemotherapy by cooperating with CCDC8., Gastric Cancer, Vol.23, No.3, 426-436, 2020.
(要約)
Jumonji domain-containing protein 2A (JMJD2A) of the JMJD2 family of histone lysine demethylases has been implicated in tumorigenesis. However, its expression and role in gastric cancer (GC) drug resistance remain unknown. Here, we investigated the role of JMJD2A in GC chemotherapeutic susceptibility and its clinical relevance in GC. We selected 12 relevant genes from previously identified gene signatures that can predict GC susceptibility to docetaxel, cisplatin, and S-1 (DCS) therapy. Each gene was knocked down using siRNA in GC cell lines, and cell viability assays were performed. JMJD2A expression in GC cell lines and tissues was assessed using qRT-PCR and immunohistochemistry, respectively. A JMJD2A downstream target related to drug susceptibility was examined using whole-gene expression array and immunoprecipitation. Among the 12 candidate genes, down-regulation of JMJD2A showed the maximum effect on GC susceptibility to anti-cancer drugs and increased the IC values for 5-FU, cisplatin, and docetaxel 15.3-, 2.7-, and 4.0-fold, respectively. JMJD2A was universally expressed in 12 GC cell lines, and its overexpression in GC tissue was positively correlated with tumor regression in 34 DCS-treated patients. A whole-gene expression array of JMJD2A-knockdown GC cells demonstrated a significant decrease in the expression of pro-apoptotic coiled-coil domain containing 8 (CCDC8), a downstream target of JMJD2A. Direct interaction between CCDC8 and JMJD2A was verified using immunoprecipitation. CCDC8 inhibition restored drug resistance to docetaxel, cisplatin, and S-1. Our results indicate that JMJD2A is a novel epigenetic factor affecting GC chemotherapeutic susceptibility, and JMJD2A/CCDC8 is a potential GC therapeutic target.
Yoshihiko Miyamoto, Naoki Muguruma, Shota Fujimoto, Yasuyuki Okada, Yoshifumi Kida, Fumika Nakamura, Kumiko Tanaka, Tadahiko Nakagawa, Shinji Kitamura, Koichi Okamoto, Hiroshi Miyamoto, Yasushi Sato and Tetsuji Takayama : Epidermal growth factor receptortargeted molecular imaging of colorectal tumors: Detection and treatment evaluation of tumors in animal models., Cancer Science, Vol.110, No.6, 1921-1930, 2019.
(要約)
To overcome the problem of overlooking colorectal tumors, a new and highly sensitive modality of colonoscopy is needed. Moreover, it is also important to establish a new modality to evaluate viable tumor volume in primary lesions of colorectal cancer (CRC) during chemotherapy. Therefore, we carried out molecular imaging of colorectal tumors targeting epidermal growth factor receptor (EGFR), which is highly expressed on tumor cells, for evaluating chemotherapeutic efficacy and for endoscopic detection of colorectal adenomas. We first attempted to image five CRC cell lines with various levels of EGFR expression using an Alexa Fluor-labeled anti-EGFR monoclonal antibody (AF-EGFR-Ab). A strong fluorescence signal was observed in the cells depending on the level of EGFR expression. When nude mice xenografted with LIM1215 CRC cells, which highly express EGFR, were i.v. injected with AF-EGFR-Ab, a strong fluorescence signal appeared in the tumor with a high signal to noise ratio, peaking at 48 hours after injection and then gradually decreasing, as shown using an IVIS Spectrum system. When the xenografted mice were treated with 5-fluorouracil, fluorescence intensity in the tumor decreased in proportion to the viable tumor cell volume. Moreover, when the colorectum of azoxymethane-treated rats was observed using a thin fluorescent endoscope with AF-EGFR-Ab, all 10 small colorectal adenomas (3 mm) were detected with a clear fluorescence signal. These preliminary results of animal experiments suggest that EGFR-targeted fluorescent molecular imaging may be useful for quantitatively evaluating cell viability in CRC during chemotherapy, and also for detecting small adenomas using a fluorescent endoscope.
Hiroshi Miyamoto, Kumiko Tanaka, Fumika Nakamura, Takahiro Ikeda, Shinji Kitamura, Tetsuo Kimura, Koichi Okamoto, Masahiro Sogabe, Naoki Muguruma, Yoshimi Bando and Tetsuji Takayama : Massive hemobilia following plastic stent removal in common bile duct cancer associated with primary sclerosing cholangitis (with video)., Clinical Journal of Gastroenterology, Vol.12, No.1, 2019.
(要約)
Hemobilia is defined as bleeding into the biliary tract. Herein, we report a very rare case of massive hemobilia following plastic stent (PS) removal in common bile duct (CBD) cancer. A 72-year-old man with primary sclerosing cholangitis had undergone repeated insertion of a PS into the CBD. Biliary tract biopsy was performed based on suspicion of combined CBD cancer. Biopsy revealed poorly differentiated adenocarcinoma of the CBD. One month after the biliary tract biopsy, he was admitted for acute cholangitis, and endoscopic retrograde cholangiography was performed for the exchange of the PS. When one of the two biliary PSs was removed, spurting bleeding from the major papilla began abruptly. The massive bleeding caused the patient to be in a pre-shock state. A retrieval balloon catheter was compressed against the papilla for hemostasis. Although he was treated conservatively, the patient developed a bloody discharge. Upper gastrointestinal endoscopy revealed that the pulsatile bleeding beside the PSs started immediately after the removal of the coagula. Emergent contrast-enhanced computed tomography showed right hepatic artery aneurysm across the CBD. Therefore, transarterial embolization was performed. The patient's post-therapeutic course was uneventful. He received chemotherapy, but died about a half year after hemobilia occurred.
Yasushi Sato, Tamotsu Sagawa, Hiroyuki Ohnuma, Masahiro Hiarakawa, Yasuo Takahashi, Kyoko Hamaguchi, Koshi Fujikawa, Takayuki Nobuoka, Koichi Okamoto, Hiroshi Miyamoto, Naoki Muguruma, Ichiro Takemasa and Tetsuji Takayama : A dose-escalation study of docetaxel, oxaliplatin, and S-1 (DOS) as a first-line therapy for patients with unresectable metastatic gastric cancer., Cancer Chemotherapy and Pharmacology, Vol.83, No.1, 161-167, 2019.
(要約)
The aim of this study was to determine the recommended dose (RD) for a docetaxel/oxaliplatin/S-1 (DOS) regimen in patients with unresectable gastric cancer and to preliminarily evaluate its efficacy. Previously untreated patients with histologically proven unresectable metastatic gastric cancer were enrolled (n = 16). Docetaxel and oxaliplatin were administered intravenously on day 8 and S-1 was administered orally twice a day on days 1-14. Each cycle was repeated every 3 weeks. Dose-limiting toxicities (DLTs) were evaluated during the first treatment cycle. Three dose escalations of DOS were employed in this study: level 1 (50/100/80 mg/m), level 2 (50/130/80 mg/m), and level 3 (60/130/80 mg/m). According to the 3 + 3 dose-escalating schedule, we determined that the RD and maximum tolerated dose for this regimen were level 1 and level 2, respectively. The DLTs were grade 3 diarrhea and febrile neutropenia. The overall response rate was 78% (7/9) for patients with measurable lesions and consisted of two complete responses and five partial responses. Five patients underwent conversion surgery. The median follow-up time was 19 months with median survival time and progression-free survival being 19.6 months and 7.6 months, respectively. The results from this study demonstrated the safety and tolerability of DOS in unresectable metastatic gastric cancer patients and revealed promising preliminary efficacy with a high conversion rate. A phase II trial of DOS regimen using the identified RD is ongoing.
Kaizo Kagemoto, Koichi Okamoto, Tohshi Takaoka, Yasushi Sato, Shinji Kitamura, Tetsuo Kimura, Masahiro Sogabe, Hiroshi Miyamoto, Naoki Muguruma, Koichi Tsuneyama and Tetsuji Takayama : Detection of aberrant crypt foci with image-enhanced endoscopy., Endoscopy International Open, Vol.6, No.8, E924-E933, 2018.
(要約)
Conventional detection of aberrant crypt foci (ACF) with dye-spraying and magnifying observation is labor- and skill-intensive. We performed a prospective non-inferiority study to investigate the utility of image-enhanced endoscopy (IEE) for detection of ACF. Patients with a history of colorectal neoplasm were eligible. The number of ACF in the lower rectum was counted first using IEE magnification with narrow-band imaging (NBI) or blue-laser imaging (BLI), and subsequently using the methylene blue method. The primary endpoint was the ACF detection rate with IEE, i. e., the number of ACF detected with IEE relative to the number of ACF detected with methylene blue. The secondary endpoints were bowel preparation time, ACF detection time, and the detection rate with NBI or BLI. A total of 40 patients were enrolled (NBI 20 and BLI 20). The overall detection rate for ACF with IEE was 81.7 % (503/616; 95 %CI 78.8 - 84.6 %), meeting the primary endpoint. The detection rate for ACF with BLI (84.9 %, 258/304) was significantly higher than with NBI (78.5 %, 245/312; < 0.05). Both bowel preparation time and ACF detection time were significantly shorter with IEE versus the methylene blue method ( < 0.01, respectively). The detection rates for dysplastic and non-dysplastic ACF with IEE were 84.4 % (27/32) and 80.3 % (469/584), respectively. IEE is able to detect ACF during colonoscopy with sensitivity non-inferior to that of the conventional methylene blue method. IEE is simpler than the methylene blue method and is therefore a potentially useful new tool for ACF detection.
Yasuhiro Mitsui, Reiko Yokoyama, Shota Fujimoto, Kaizoh Kagemoto, Shinji Kitamura, Koichi Okamoto, Naoki Muguruma, Yoshimi Bando, Hidetaka Eguchi, Yasushi Okazaki, Hideyuki Ishida and Tetsuji Takayama : First report of an Asian family with gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS) revealed with the germline mutation of the APC exon 1B promoter region., Gastric Cancer, Vol.21, No.6, 1058-1063, 2018.
(要約)
A 48-year-old Japanese female with left hypochondralgia presented at our hospital. Esophagogastroduodenoscopy (EGD) revealed gastric cancers and carpeting fundic gland polyposis (FGPs) without Helicobacter pylori infection. Computed tomography showed multiple liver metastases. Total colonoscopy revealed a colonic tubular adenoma but not polyposis. She was diagnosed as having advanced gastric cancer with liver metastasis and received chemotherapy. Her mother had died from gastric cancer, and her elderly brother and niece had FGPs as revealed by EGD. Thus, the pedigree was diagnosed as gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS). Germline mutation analysis exhibited a point mutation in exon1B of the APC gene (c.-191T > C). Adenocarcinoma showed a gastric mucinous phenotype and was positive for a somatic mutation of p53, suggesting that p53 mutation may play a role in FGPs carcinogenesis. This is the first family with GAPPS in Asia in whom germline mutation of APC exon 1B has been detected.
Shota Fujimoto, Naoki Muguruma, Koichi Okamoto, Takeshi Kurihara, Yasushi Sato, Yoshihiko Miyamoto, Shinji Kitamura, Hiroshi Miyamoto, Takahiro Taguchi, Koichi Tsuneyama and Tetsuji Takayama : A Novel Theranostic Combination of Near-infrared Fluorescence Imaging and Laser Irradiation Targeting c-KIT for Gastrointestinal Stromal Tumors., Theranostics, Vol.8, No.9, 2313-2328, 2018.
(要約)
It is difficult to distinguish gastrointestinal stromal tumors (GISTs) from other types of submucosal tumors under conventional gastrointestinal endoscopy. We aimed to detect GISTs by molecular fluorescence imaging using a near-infrared (NIR) photosensitizer (IR700)-conjugated anti-c-KIT antibody and to treat GISTs by photoimmunotherapy with NIR irradiation as a non-invasive theranostic procedure. We also investigated the therapeutic mechanisms. Human GIST cell lines GIST-T1 and GIST-882M were incubated with IR700-conjugated anti-c-KIT antibody, IR700-12A8, and observed by confocal laser microscopy. Mice with GIST-T1 xenografts or rats with orthotopic xenografts were injected with IR700-12A8 or AF488-conjugated antibody, and observed under IVIS or autofluorescence imaging (AFI) endoscopy. GIST cells were treated with IR700-12A8 and NIR light and vivo, and cell viability, histology and apoptosis were evaluated. Strong red fluorescence of IR700-12A8 was observed on the cell membrane of GIST cells and was gradually internalized into the cytoplasm. Tumor-specific accumulation of IR700-12A8 was observed in GIST-T1 xenografts in mice. Under AFI endoscopy, a strong fluorescence signal was observed in orthotopic GIST xenografts in rats through the normal mucosa covering the tumor. The percentage of dead cells significantly increased in a light-dose-dependent manner and both acute necrotic and late apoptotic cell death was observed with annexin/PI staining. Cleaved PARP expression was significantly increased after IR700-12A8-mediated NIR irradiation, which was almost completely reversed by NaN. All xenograft tumors (7/7) immediately regressed and 4/7 tumors completely disappeared after IR700-12A8-mediated NIR irradiation. Histologic assessment and TUNEL staining revealed apoptosis in the tumors. NIR fluorescence imaging using IR700-12A8 and subsequent NIR irradiation could be a very effective theranostic technology for GIST, the underlying mechanism of which appears to involve acute necrosis and supposedly late apoptosis induced by singlet oxygen.
It has been reported that some single-nucleotide polymorphisms (SNPs) in lipid regulators such as apolipoproteins and cell surface molecules for hepatitis C virus (HCV) entry into hepatocytes are associated with HCV infection. However, it is unknown how HCV infection is affected by altered lipid metabolism resulting from the SNPs. We investigated the relationship between these SNPs and HCV infection status, and also analyzed the mechanism by which these SNPs mediate HCV infection via lipid metabolism alterations. Serum lipid and apolipoprotein profiles were tested in 158 HCV-positive and 220 HCV-negative subjects. We selected 22 SNPs in five lipid regulator genes which were related to HCV entry into hepatocytes and to lipid metabolism (APOA1, APOB, SR-B1, LDLR, and APOE), and their polymorphisms were analyzed using the PCR-sequence-specific oligonucleotide probe-Luminex method. An APOB N4311S (g.41553a > g) SNP, rs1042034, was significantly associated with HCV positivity; the HCV positivity rate for the minor allele AA genotype was significantly higher than for genotype AG + GG (P = 0.016). Other SNPs except for APOB P2712L SNP rs676210, which is in linkage disequilibrium with rs1042034, showed no significant difference in genotype distribution. The serum level of low density lipoprotein-cholesterol (LDL-C) in the genotype AA group was significantly lower than in the genotype non-AA group (P = 0.032), whereas the triglyceride (TG) level was significantly higher (P = 0.007). An APOB SNP, rs1042034, is closely associated with HCV infection through lipid metabolism alteration. The minor allele AA genotype might contribute to facilitating serum LDL uptake into hepatocytes via LDLR by modifying their affinity and interaction and may have an influence on HCV infection by their entry to the liver through the LDLR.
Although new image-enhanced endoscopy (IEE) technologies such as blue laser imaging (BLI), BLI-bright, and linked color imaging (LCI) have been developed, their utility for the detection of sessile serrated adenoma/polyps (SSA/Ps) is still unclear. This study aimed to evaluate the utility of BLI, BLI-bright, and LCI for SSA/P detection in still image examinations and in a prospective randomized controlled trial (RCT). A group of 6 expert and non-expert endoscopists read 200 endoscopic still images containing SSA/P lesions using white light image (WLI), BLI, BLI-bright, and LCI. Color differences were calculated using the color space method. A prospective RCT of tandem colonoscopy with WLI and LCI was performed. Patients with SSA/P and those with a history of SSA/P that had been endoscopically removed were enrolled and randomly allocated to WLI-LCI or LCI-WLI groups. Additional endoscopic detection rates for SSA/P were compared between the 2 groups. LCI showed the highest SSA/P detection rate among the 4 modes for both expert and non-expert endoscopists. The detection rate with LCI for the 6 expert endoscopists (mean 98.3 ± standard deviation 2.0 %) was significantly higher than that with WLI (86.7 ± 6.0 %, < 0.01). Likewise, the detection rate with LCI for the 6 non-expert endoscopists (92.3 ± 2.9 %) was significantly higher than that with WLI (72.7 ± 11.5 %, < 0.01). The color difference of SSA/P with LCI was the highest among the 4 modes, and was significantly higher than with WLI (median 15.9, (interquartile range 13.7 - 20.6) vs. 10.2, (7.6 - 14.2); < 0.0001). In the RCT, a total of 44 patients (WLI-LCI 22 vs. LCI-WLI 22) underwent colonoscopy. The additional detection rate for SSA/P in the second inspection in the WLI-LCI group (21.6 %, 8/37) was significantly higher than in the LCI-WLI group (3.2 %, 1/31; = 0.02). The small, flat, non-mucus and isochromatic SSA/Ps in the transverse colon were detected more frequently in the second inspection with LCI. LCI was the most sensitive mode for SSA/P detection among WLI, BLI, BLI-bright, and LCI in the still image examinations. Our RCT strongly suggests that LCI is superior to conventional WLI for SSA/P detection during colonoscopy. UMIN000017599.
Yasushi Sato, Masahiro Hirakawa, Hiroyuki Ohnuma, Minoru Takahashi, Tetsuro Okamoto, Koichi Okamoto, Hiroshi Miyamoto, Naoki Muguruma, Tomohisa Furuhata, Ichiro Takemasa, Junji Kato and Tetsuji Takayama : A triplet combination with capecitabine/oxaliplatin/irinotecan (XELOXIRI) plus cetuximab as first-line therapy for patients with metastatic colorectal cancer: a dose escalation study., Cancer Chemotherapy and Pharmacology, Vol.80, No.6, 1133-1139, 2017.
(要約)
The addition of cetuximab to triplet chemotherapy can increase treatment efficacy for patients with metastatic colorectal cancer (mCRC). We explored the dose-limiting toxicity and feasibility of a triweekly capecitabine, oxaliplatin, irinotecan, plus cetuximab (XELOXIRI plus cetuximab) regimen in patients with wild-type KRAS mCRC. Patients received oxaliplatin (100 mg/m, day 1), capecitabine (1700 mg/m per day from day 2 to 15), irinotecan (100, 120, and 150 mg/m for dose levels 1, 2, 3, respectively, on day 1), and cetuximab (400 mg/m, day 1 and, thereafter, 250 mg/m every week), repeated every 3 weeks. Dose-limiting toxicities (DLTs) were assessed in the first 2 treatment cycles to determine the maximum tolerated dose (MTD) and the recommended dose (RD). Twelve patients received a median of 7 cycles of therapy (range 2-10). The DLT was grade 4 neutropenia, observed in 1 of 6 patients at dose level 2. The MTD was not reached at dose level 3. Therefore, the RD of irinotecan was defined as 150 mg/m. Most common grade ≥ 3 toxicities were neutropenia (50%), diarrhea (17%), and febrile neutropenia (8%). The response rate was 83% (complete and partial response: 1 and 9 patient(s), respectively), including 4 conversion cases. The combination of XELOXIRI and cetuximab is feasible and has an acceptable toxicity profile; neutropenia was the DLT. The RD of irinotecan is 150 mg/m. The observed response rate was promising and warrants further investigation.
Yasuyuki Okada, Tetsuo Kimura, Tadahiko Nakagawa, Koichi Okamoto, Akira Fukuya, Takahiro Goji, Shota Fujimoto, Masahiro Sogabe, Hiroshi Miyamoto, Naoki Muguruma, Yasushi Tsuji, Toshiya Okahisa and Tetsuji Takayama : EGFR Down-regulation After anti-EGFR Therapy Predicts the Anti-tumor Effect in Colorectal Cancer., Molecular Cancer Research : MCR, Vol.15, No.10, 1445-1454, 2017.
(要約)
Anti-EGFR mAb is reported to induce EGFR internalization in colorectal cancer cells. However, the biological relevance of EGFR internalization with anti-EGFR mAb is unknown. Therefore, the relevance of EGFR downregulation with anti-EGFR mAb to antitumor activity in colorectal cancer cells was investigated. Quantification of EGFR on the cell surface before cetuximab treatment was assessed by flow cytometry, and its growth-inhibitory effects were measured by Trypan blue exclusion, in 10 wild-type colorectal cancer cell lines, but there was no significant correlation between EGFR number and its growth-inhibitory effect. However, a significant correlation existed between the percentage decrease in the number of EGFRs after cetuximab treatment and its growth-inhibitory effect in those cell lines. Treatment with TGFα, a ligand for EGFR, induced EGFR internalization in colorectal cancer cells, but most EGFRs subsequently recycled to the cell surface, consistent with previous studies. While cetuximab treatment induced EGFR internalization, most receptors subsequently translocated into the late endosome, leading to lysosomal degradation, as revealed by immunoblotting and double immunofluorescence. Cetuximab-sensitive colorectal cancer cells showed greater EGFR internalization, stronger cell growth inhibition, and more augmented apoptotic signals than nonsensitive cells. IHC for EGFR, performed using an EGFR pharmDx Kit (mouse anti-human EGFR mAb clone 2-18C9), in clinical specimens before and after anti-EGFR mAb therapy in 13 colorectal cancer patients showed a significant correlation between the response to anti-EGFR mAb and decreased staining after therapy. This report clearly demonstrates that anti-EGFR mAb facilitates internalization and subsequent degradation of EGFRs in lysosomes, which is an important determinant of the efficacy of anti-EGFR mAb treatment for colorectal cancer. .
Gastric xanthomas are frequently observed in the stomach as small yellowish plaques or nodules. A close relationship among Helicobacter pylori infection, atrophic gastritis, and xanthomas has been reported. We assessed the clinicopathological features of gastric cancer with or without xanthomas. A total of 91 patients who were diagnosed as having early gastric cancer were enrolled. We evaluated the gastritis status using scores for gastritis and atrophy, positivity of H. pylori infection, the prevalence rate of xanthomas, and the clinicopathological features of gastric cancer. Gastric xanthomas were observed in 72.5% of early gastric cancer cases. Scores for gastritis and atrophy were significantly higher in the xanthoma-positive group than those in the xanthoma-negative group. A higher prevalence of differentiated-type adenocarcinoma was found in the xanthoma-positive group. Among the cases with multiple gastric xanthomas, the prevalence of males was significantly higher than that of females. A high prevalence rate of gastric xanthomas in gastric cancer cases was shown. Xanthomas were highly associated with age, the severities of gastritis and atrophy, and differentiated-type adenocarcinoma. Regardless of the eradication of H. pylori, xanthomas may be useful predictive markers for the development of differentiated-type adenocarcinoma.
The rectal tonsil is a rare polypoid lesion exclusively found in the rectum and is considered a reactive proliferation of the lymphoid tissue. Although this lesion is benign, we recommend that it should be differentiated from carcinoid or polypoid type of mucosaassociated lymphoid tissue (MALT) lymphomas, based on gross findings. In this case report, we describe a case of rectal lesions with a unique appearance in a 41-year-old man. Colonoscopy revealed two 5-mm-sized nodules located opposite from each other on the left and right sides of the lower rectum. Endoscopic mucosal resection was conducted. Histopathologically, both lesions were mainly located in the submucosa and consisted of prominent lymphoid follicles with germinal centers of various sizes. No immunoreactivity of Bcl-2 was seen in the germinal centers. Immunohistochemical staining for kappa and lambda light chains revealed a polyclonal pattern. Therefore, these lesions were diagnosed as rectal tonsils.
Naoki Muguruma, Koichi Okamoto, Tadahiko Nakagawa, Katsutaka Sannomiya, Shota Fujimoto, Yasuhiro Mitsui, Tetsuo Kimura, Hiroshi Miyamoto, Jun Higashijima, Mitsuo Shimada, Yoko Horino, Shinya Matsumoto, Kenjiro Hanaoka, Tetsuo Nagano, Makoto Shibutani and Tetsuji Takayama : Molecular imaging of aberrant crypt foci in the human colon targeting glutathione S-transferase P1-1., Scientific Reports, Vol.7, No.1, 6536, 2017.
(要約)
Aberrant crypt foci (ACF), the earliest precursor lesion of colorectal cancers (CRCs), are a good surrogate marker for CRC risk stratification and chemoprevention. However, the conventional ACF detection method with dye-spraying by magnifying colonoscopy is labor- and skill-intensive. We sought to identify rat and human ACF using a fluorescent imaging technique that targets a molecule specific for ACF. We found that glutathione S-transferase (GST) P1-1 was overexpressed in ACF tissues in a screening experiment. We then synthesized the fluorogenic probe, DNAT-Me, which is fluorescently quenched but is activated by GSTP1-1. A CRC cell line incubated with DNAT-Me showed strong fluorescence in the cytosol. Fluorescence intensities correlated significantly with GST activities in cancer cell lines. When we sprayed DNAT-Me onto colorectal mucosa excised from azoxymethane-treated rats and surgically resected from CRC patients, ACF with strong fluorescent signals were clearly observed. The ACF number determined by postoperative DNAT-Me imaging was almost identical to that determined by preoperative methylene blue staining. The signal-to-noise ratio for ACF in DNAT-Me images was significantly higher than that in methylene blue staining. Thus, we sensitively visualized ACF on rat and human colorectal mucosa by using a GST-activated fluorogenic probe without dye-spraying and magnifying colonoscopy.
Masahiro Sogabe, Toshiya Okahisa, Masahiko Nakasono, Hiroshi Fukuno, Yoshihiko Miyamoto, Yasuyuki Okada, Jun Okazaki, Jinsei Miyoshi, Tetsu Tomonari, Tatsuya Taniguchi, Takahiro Goji, Shinji Kitamura, Hiroshi Miyamoto, Naoki Muguruma and Tetsuji Takayama : The differing influence of several factors on the development of fatty liver with elevation of liver enzymes between genders with metabolic syndrome: A cross-sectional study., PLoS ONE, Vol.12, No.6, e0177925, 2017.
(要約)
Nonalcoholic fatty liver disease (NAFLD) is known to be strongly associated with obesity, visceral fat, metabolic syndrome (MS), lifestyle, and lifestyle-related diseases in both males and females. However, the prevalence of NAFLD, MS, and clinical backgrounds is different between males and females. We conducted a cross-sectional study to examine the differing influence of lifestyle-related factors and visceral fat on fatty liver (FL) with elevation of liver enzymes between males and females with MS. We enrolled 42,134 persons who underwent a regular health check-up, and after excluding subjects who fulfilled excluding criteria, the remaining subjects were 2,110 persons with MS. We examined the differing influence of lifestyle-related factors and visceral fat on FL with elevation of alanine aminotransferase (ALT) (ALT elevation was defined as ALT level of ≥31 IU/l in the present study). The odds rations for FL with ALT elevation were as follows: WC, 1.83 (95% confidence interval (CI) 1.36-2.46); dyslipidemia, 1.89 (95% CI 1.34-2.68); hemoglobin A1c, 1.36 (95% CI 1.00-1.85); visceral fat type MS (V-type MS), 5.78 (95% CI 4.29-7.80); and light drinker, 0.56 (95% CI 0.41-0.78) in males with MS and BMI, 2.18 (95% CI 1.43-3.33); WC, 1.85 (95% CI 1.27-2.70); diastolic blood pressure, 1.69 (95% CI 1.16-2.45); triglyceride, 2.22 (95% CI 1.56-3.17); impaired glucose tolerance, 1.66 (95% CI 1.11-2.47); and V-type MS, 3.83 (95% CI 2.57-5.70) in females with MS. The prevalence of FL with ALT elevation and ALT was significantly higher in V-type MS than in the subcutaneous fat type MS in both males and females with MS (P < 0.001). Although V-type MS and WC is a common significant predictor of an increased prevalence of FL with ALT elevation in both males and females with MS, gender, lifestyle-related factors, and MS type in individuals with MS should be considered for the development of FL with ALT elevation.
S Bando, Takeshi Soeki, Tomomi Matsuura, Takeshi Tobiume, Takayuki Ise, Kenya Kusunose, Koji Yamaguchi, Shusuke Yagi, Daiju Fukuda, Takashi Iwase, Hirotsugu Yamada, Tetsuzo Wakatsuki, Michio Shimabukuro, Naoki Muguruma, Tetsuji Takayama, I Kishimoto, Kenji Kangawa and Masataka Sata : Plasma brain natriuretic peptide levels are elevated in patients with cancer, PLoS ONE, Vol.12, No.6, e0178607, 2017.
(要約)
Natriuretic peptides have been proposed as biomarkers of cardiovascular disease, especially heart failure. Brain natriuretic peptide (BNP) has also been shown to be upregulated at the transcriptional and translational levels by pro-inflammatory cytokines in cardiac myocytes. Although we often measure plasma BNP levels in cancer patients, it remains unknown whether cancer-related inflammation affects the plasma BNP levels. We investigated the relationship between the BNP and human cancers. We retrospectively studied 2,923 patients in whom the plasma BNP levels and serum C-reactive protein (CRP) were measured and echocardiography was performed. Patients with clinically evident heart failure (NYHA II or higher), heart disease requiring medical treatment or surgery, renal dysfunction, and inflammatory disease were excluded. There were 234 patients in the final analysis. Blood sampling was performed before surgery and chemotherapy. In addition, we evaluated the relationship between the inflammation and plasma BNP levels in mouse models of colon cancer. Of the 234 patients, 80 were diagnosed with cancer. Both the plasma BNP and serum CRP levels were significantly higher in cancer patients than those without. There were no significant differences in the echocardiographic parameters. There was a significant positive correlation between the plasma BNP and serum CRP levels in cancer patients (r = 0.360, P<0.01) but not in those without. In cancer patients, only the CRP correlated with the BNP independent of the age, creatinine level, hypertension, and body mass index. In addition, in nude mice with subcutaneous colon cancer, the plasma BNP level was elevated compared with that in non-cancer mice, and there was a significant relationship between the plasma BNP and serum levels of the inflammatory markers. In cancer patients, as well as colon cancer model mice, the plasma BNP levels were elevated, possibly due to cancer-related inflammation. The effect of cancer on the BNP levels should be considered when using BNP as an indicator of heart failure in cancer patients.
Jun Okazaki, Naoki Muguruma, Shinji Kitamura, Tetsuo Kimura, Koichi Okamoto, Hiroshi Miyamoto, Kazuhiro Kishi, Yoshimi Bando, Takeshi Kondo, Itsuro Endo, Masahiro Abe and Tetsuji Takayama : Paraneoplastic hypocalcemia developed in gastric cancer accompanied by osteoblastic metastasis, Internal Medicine, Vol.56, No.11, 1345-1349, 2017.
(要約)
Paraneoplastic syndromes are generally defined as clinical disorders associated with malignant diseases, and hypocalcemia associated with cancer is a rare condition. A woman in her 60s was referred to our hospital for the further examination of massive ascites due to carcinoma of unknown primary origin. She complained of numbness around her lips, and marked hypocalcemia of 5.0 mg/dL was noted. After two courses of chemotherapy, computed tomography showed a decrease in the ascites, and her serum calcium level increased. Although hypocalcemia is a very rare condition in patients with gastric cancer, serum calcium values should be evaluated when neurological symptoms are observed.
Shinji Kitamura, Toshihito Tanahashi, Eriko Aoyagi, Tadahiko Nakagawa, Koichi Okamoto, Tetsuo Kimura, Hiroshi Miyamoto, Yasuhiro Mitsui, Kazuhito Rokutan, Naoki Muguruma and Tetsuji Takayama : Response Predictors of S-1, Cisplatin, and Docetaxel Combination Chemotherapy for Metastatic Gastric Cancer: Microarray Analysis of Whole Human Genes., Oncology, Vol.93, No.2, 127-135, 2017.
(要約)
The aim of this study was to identify biomarkers for predicting the efficacy of docetaxel, cisplatin, and S-1 (DCS) therapy for advanced gastric cancer using microarrays of biopsy specimens before chemotherapy. Nineteen samples were taken from 19 patients with unresectable metastatic gastric cancer who received DCS as a first-line therapy. Laser capture microdissection was performed, and total cellular RNA was extracted from each microdissected sample. Whole-gene expression was analyzed by microarray, and the difference in mRNA expression observed with the microarrays was confirmed by quantitative real-time PCR. Immunohistochemical staining was performed using clinical tissue sections obtained by endoscopic biopsy. Eleven patients were identified as early responders and 8 patients as nonresponders to DCS therapy. Twenty-nine genes showed significant differences in relative expression ratios between tumor and normal tissues. A classifier set of 29 genes had high accuracy (94.7%) for distinguishing gene expression between 11 early responders and 8 nonresponders. Decreasing the size of the classifier set to 4 genes (PDGFB, PCGF3, CISH, and ANXA5) increased the accuracy to 100%. Expression levels by real-time PCR for validation were well correlated with those 4 genes in microarrays. The genes identified may serve as efficient biomarkers for personalized cancer-targeted therapy.
Koichi Okamoto, Naoki Muguruma, Kaizo Kagemoto, Yasuhiro Mitsui, Daisaku Fujimoto, Shinji Kitamura, Tetsuo Kimura, Masahiro Sogabe, Hiroshi Miyamoto and Tetsuji Takayama : Efficacy of hybrid endoscopic submucosal dissection (ESD) as a rescue treatment in difficult colorectal ESD cases., Digestive Endoscopy, Vol.29, No.suppl.2, 45-52, 2017.
(要約)
Endoscopic submucosal dissection (ESD), which provides a higher en bloc resection rate than conventional endoscopic mucosal resection (EMR), is considered to be a useful treatment option for large colorectal tumors. However, colorectal ESD is not widely used because of its technical difficulty, risk of complications and time required. To overcome these drawbacks, a simpler modified technique, ESD with snaring (hybrid ESD), has been developed. The aim of the present study was to retrospectively compare the safety and efficacy of hybrid ESD and conventional ESD for colorectal tumors. Between September 2008 and June 2016, ESD was carried out on 137 lesions and hybrid ESD on 27 lesions. All hybrid ESD cases were carried out as a rescue treatment in difficult ESD cases. We retrospectively investigated procedure time, and the rates of en bloc resection, perforation, bleeding, and local recurrence. In the hybrid ESD group, procedure time was shorter compared with the ESD group (108 ± 59.5 min vs 122 ± 72.2 min), but the en bloc resection rate was lower (66.7% vs 94.2%). However, there were no significant differences in procedure time, or in rates of en bloc resection, perforation and bleeding between the two groups. Local recurrence did not develop in any of our cases. Hybrid ESD as a rescue treatment in difficult ESD cases may be less effective for en bloc resection of large colorectal tumors. Indication for hybrid ESD may be limited to scheduled treatment from the outset and emergency cases with patients who present unstable vital signs during ESD.
Although des-gamma-carboxy prothrombin (DCP) is a well-known tumor marker for hepatocellular carcinoma (HCC), the mechanism of DCP production is unclear. This study aimed to investigate the mechanism how DCP is produced in HCC cells. Levels of mRNA and DCP were analyzed by real-time polymerase chain reaction and electro-chemiluminescence immunoassay respectively. Secreted alkaline phosphatase (SEAP) expression vectors including deletion mutants of the prothrombin gene promoter were constructed for reporter gene assay. The transcription factors bound to DNA fragments were analyzed by mass spectrometry. An electrophoretic mobility shift assay (EMSA) was performed using a biotin end-labeled DNA. The prothrombin mRNA levels in all 5 DCP producing cell lines were appreciably high. However, those in 2 DCP non-producing cell lines were below detectable levels. A SEAP vector with -2985 to +27 showed a very high transcription activity in DCP-producing Huh-1 cells. However, transcription abruptly decreased when the vector with -2955 to +27 was transfected, and then remained at the similar levels with larger deletion mutants, indicating the existence of a cis-element at -2985 to -2955 (31-bp). Mass spectrometry analysis identified the protein that bound to the 31-bp DNA as poly-(ADP-ribose) polymerase-1 (PARP-1). Knockdown of the PARP-1 gene by small interfering RNA in Huh-1 cells induced marked inhibition of prothrombin gene transcription. The EMSA clearly showed that PARP-1 specifically binds to the 31-bp DNA fragment in the prothrombin gene promoter. Our data suggest that PARP-1 activates prothrombin gene transcription and that the excessive prothrombin gene transcription induces DCP production in DCP-producing HCC cells.
Naoki Muguruma, Kumiko Tanaka, satoshi teramae and Tetsuji Takayama : Colon capsule endoscopy: toward the future., Clinical Journal of Gastroenterology, Vol.10, No.1, 1-6, 2017.
(要約)
Colon capsule endoscopy is a wireless and minimally invasive technique for visualization of the whole colon. With recent improvements of technical features in second-generation systems, a more important role for colon capsule endoscopy is rapidly emerging. Although several limitations and drawbacks are yet to be resolved, its usefulness as a tool for colorectal cancer screening and monitoring disease activity in inflammatory bowel diseases has become more apparent with increased use. Further investigations, including multicenter trials, are required to evaluate the substantial role of the colon capsule in managing colorectal diseases.
(キーワード)
Capsule Endoscopes / Capsule Endoscopy / Colonic Diseases / Colonic Polyps / Colonoscopy / Colorectal Neoplasms / Early Detection of Cancer / Equipment Design / Humans / Inflammatory Bowel Diseases
Yuri Matsumoto, Hiroshi Miyamoto, Akira Fukuya, Fumika Nakamura, Takahiro Goji, Shinji Kitamura, Tetsuo Kimura, Koichi Okamoto, Masahiro Sogabe, Naoki Muguruma, Mitsuo Shimada, Yoshimi Bando and Tetsuji Takayama : Hemosuccus pancreaticus caused by a mucinous cystic neoplasm of the pancreas., Clinical Journal of Gastroenterology, Vol.10, No.2, 185-190, 2017.
(要約)
Hemosuccus pancreaticus is a gastrointestinal hemorrhage through the main pancreatic duct. Here, we report a rare case of hemosuccus pancreaticus due to a mucinous cystic neoplasm of the pancreas. A 62-year-old woman who had been followed for a branch duct intraductal papillary mucinous neoplasm visited our emergency room due to severe abdominal pain and bloody discharge. Computed tomography revealed that the pancreatic cyst increased the tension of the wall and a high-density area indicative of bleeding into the cyst was observed. Endoscopy showed opening of and hemorrhaging from the papilla of Vater. The patient was diagnosed with hemosuccus pancreaticus caused by hemorrhaging into the cyst from the branch duct intraductal papillary mucinous neoplasm. Based on this diagnosis, elective distal pancreatectomy was performed. The histopathological diagnosis was a mucinous cystic neoplasm with intermediate-grade dysplasia based upon the pathological findings that fibrous ovarian-type stroma existed abundantly and the stroma cells were positive for progesterone receptor and inhibin. Hemosuccus pancreaticus caused by a mucinous cystic neoplasm is extremely rare and there has been only one case reported to date. In conclusion, it should be recognized that pancreatic cystic neoplasms including mucinous cystic neoplasms may cause hemosuccus pancreaticus.
Yasuteru Fujino, Shunsaku Takeishi, Kensei Nishida, Koichi Okamoto, Naoki Muguruma, Tetsuo Kimura, Shinji Kitamura, Hiroshi Miyamoto, Akiko Fujimoto, Jun Higashijima, Mitsuo Shimada, Kazuhito Rokutan and Tetsuji Takayama : Downregulation of miR-100/miR-125b is associated with lymph node metastasis in early colorectal cancer with submucosal invasion., Cancer Science, Vol.108, No.3, 390-397, 2017.
(要約)
A majority of early colorectal cancers (CRCs) with submucosal invasion undergo surgical operation, despite a very low incidence of lymph node metastasis. Our study aimed to identify microRNAs (miRNAs) specifically responsible for lymph node metastasis in submucosal CRCs. MicroRNA microarray analysis revealed that miR-100 and miR-125b expression levels were significantly lower in CRC tissues with lymph node metastases than in those without metastases. These results were validated by quantitative real-time PCR in a larger set of clinical samples. The transfection of a miR-100 or miR-125b inhibitor into colon cancer HCT116 cells significantly increased cell invasion, migration, and MMP activity. Conversely, overexpression of miR-100 or miR-125b mimics significantly attenuated all these activities but did not affect cell growth. To identify target mRNAs, we undertook a gene expression array analysis of miR-100-silenced HCT116 cells as well as negative control cells. The Ingenuity Pathway Analysis, TargetScan software analyses, and subsequent verification of mRNA expression by real-time PCR identified mammalian target of rapamycin (mTOR) and insulin-like growth factor 1 receptor (IGF1R) as direct, and Fas and X-linked inhibitor-of-apoptosis protein (XIAP) as indirect candidate targets for miR-100 involved in lymph node metastasis. Knockdown of each gene by siRNA significantly reduced the invasiveness of HCT116 cells. These data clearly show that downregulation of miR-100 and miR-125b is closely associated with lymph node metastasis in submucosal CRC through enhancement of invasion, motility, and MMP activity. In particular, miR-100 may promote metastasis by upregulating mTOR, IGF1R, Fas, and XIAP as targets. Thus, miR-100 and miR-125b may be novel biomarkers for lymph node metastasis of early CRCs with submucosal invasion.
Koichi Okamoto, Shinji Kitamura, Tetsuo Kimura, Tadahiko Nakagawa, Masahiro Sogabe, Hiroshi Miyamoto, Naoki Muguruma and Tetsuji Takayama : Clinicopathological Characteristics of Serrated Polyps as Precursors to Colorectal Cancer: Current Status and Management., Journal of Gastroenterology and Hepatology, Vol.32, No.2, 358-367, 2017.
(要約)
Serrated polyps have long been thought to lack malignant potential in the human colorectum. However, identification of the serrated pathway to colorectal cancer based on molecular biology has improved our understanding of the pathogenesis of colorectal cancers. Accordingly, serrated polyps such as traditional serrated adenoma and sessile serrated adenoma/polyps (SSA/P) are now considered to be precursor lesions of the serrated pathway. Recently, serrated polyps were classified into three subtypes, consisting of hyperplastic polyp, SSA/P, and traditional serrated adenoma, according to the World Health Organization classification. It has been suggested that SSA/P in the proximal colon are a precursor lesion of pathogenesis of colorectal cancer and are characterized by BRAF mutation and a CpG island methylator phenotype with or without microsatellite instability. However, SSA/P is more challenging to detect by colonoscopy and is likely to account for some interval cancers, particularly in the proximal colon because it presents flat or sessile, isochroous appearance, and occasionally has a mucous cap. Furthermore, the possibility has been raised that pathologists misclassify SSA/P as hyperplastic polyp. It is important for gastroenterologists to recognize the endoscopic features of serrated polyps to facilitate their detection and removal and also to establish postpolypectomy surveillance guidelines. In this review, we discuss the recent classification of serrated polyps; the molecular characteristics of the serrated pathway; appropriate diagnostic methods using endoscopy, including a new image-enhanced endoscopic technique; and management of these lesions.
Tetsuo Kimura, Hiroshi Miyamoto, Akira Fukuya, Shinji Kitamura, Koichi Okamoto, Masako Kimura, Naoki Muguruma, Tetsuya Ikemoto, Mitsuo Shimada, Akiko Yoneda, Yoshimi Bando, Makoto Takishita and Tetsuji Takayama : Neuroendocrine carcinoma of the pancreas with similar genetic alterations to invasive ductal adenocarcinoma., Clinical Journal of Gastroenterology, Vol.9, No.4, 261-265, 2016.
(要約)
Neuroendocrine carcinoma (NEC) of the pancreas is very rare, and its origin is not fully elucidated. Here, we present a case of a small-size NEC of the pancreas that is genetically similar to invasive ductal adenocarcinoma (IDA). A 65-year-old man was referred to our hospital due to obstructive jaundice and found to have a 12-mm solid tumor in the pancreas head. The tumor exhibited low vascularity on enhanced computed tomography, and endoscopic retrograde pancreatographic imaging revealed an irregular obstruction in a branch duct of the pancreas. The patient was thereby diagnosed with a pancreatic ductal cancer, and stomach-preserving pancreaticoduodenectomy with regional lymph node resection was performed. Histochemical analysis of the resected tumor showed that the neoplastic cells with scanty cytoplasm and hyperchromatic nuclei strongly expressed chromogranin A and synaptophysin. The Ki-67 index was 40 % in the most proliferative tumor regions, and the tumor was diagnosed as a NEC of the pancreas. However, in the analysis of genetic alterations of the tumor tissue, the neoplastic cells showed altered KRAS, TP53, and SMAD4/DPC4, suggesting that the NEC in our case is genetically related to IDA. Our data suggest that poorly differentiated IDAs may transform into NECs.
Masahiro Sogabe, Toshiya Okahisa, Tetsuo Kimura, Koichi Okamoto, Hiroshi Miyamoto, Naoki Muguruma and Tetsuji Takayama : Influence of metabolic syndrome on upper gastrointestinal disease., Clinical Journal of Gastroenterology, Vol.9, No.4, 191-202, 2016.
(要約)
A recent increase in the rate of obesity as a result of insufficient physical exercise and excess food consumption has been seen in both developed and developing countries throughout the world. Additionally, the recent increased number of obese individuals with lifestyle-related diseases associated with abnormalities in glucose metabolism, dyslipidemia, and hypertension, defined as metabolic syndrome (MS), has been problematic. Although MS has been highlighted as a risk factor for ischemic heart disease and arteriosclerotic diseases, it was also recently shown to be associated with digestive system disorders, including upper gastrointestinal diseases. Unlike high body weight and high body mass index, abdominal obesity with visceral fat accumulation is implicated in the onset of various digestive system diseases because excessive visceral fat accumulation may cause an increase in intra-abdominal pressure, inducing the release of various bioactive substances, known as adipocytokines, including tumor necrosis factor-α, interleukin-6, resistin, leptin, and adiponectin. This review article focuses on upper gastrointestinal disorders and their association with MS, including obesity, visceral fat accumulation, and the major upper gastrointestinal diseases.
Yoshihiko Miyamoto, Naoki Muguruma, Tetsuo Kimura, Koichi Okamoto, Masahiro Sogabe, Hiroshi Miyamoto, Seiya Kohno, Masahiko Nakasono, Hiroshige Hayashi, Yoshimi Bando and Tetsuji Takayama : Protein-losing enteropathy in a patient with familial adenomatous polyposis and advanced colon cancer., Clinical Journal of Gastroenterology, Vol.9, No.3, 134-139, 2016.
(要約)
A 29-year-old female visited a hospital because of increasingly severe lower leg edema. She was diagnosed as having multiple polyps in the stomach and colon by gastroscopy and sigmoidoscopy as well as multiple liver tumors by abdominal CT. She was referred to our hospital for further examination. Total colonoscopy revealed a type 2 tumor in the transverse colon and more than 200 polyps distributed throughout the colorectum. Biopsies of the tumor and polyps showed histological characteristics of adenocarcinoma and tubulovillous adenoma, respectively. Thus, she was diagnosed as having metastatic colon cancer derived from familial adenomatous polyposis (FAP). Laboratory tests showed a marked hypoalbuminemia of 1.1 g/dl. The fecal alpha-1 anti-trypsin test showed abnormal clearance (62.1 ml/day), and scintigraphy using 99mTc-human serum albumin revealed protein loss in the whole colon. Multiple ligation probe amplification analysis of the APC gene identified a germline duplication of exons 11-13. Direct sequencing of the reverse transcription PCR products of APC mRNA revealed a deletion of 25 base pairs and a tandem duplication of exons 11-13. This case was considered to be protein-losing enteropathy resulting from numerous colonic tubulovillous adenomas and advanced colon cancer in a FAP patient with unusual mutational events in APC.
Miwako Kagawa, Yasuteru Fujino, Naoki Muguruma, Noriaki Murayama, Koichi Okamoto, Shinji Kitamura, Tetsuo Kimura, Kazuhiro Kishi, Hiroshi Miyamoto, Hisanori Uehara and Tetsuji Takayama : Localized amyloidosis of the stomach mimicking a superficial gastric cancer., Clinical Journal of Gastroenterology, Vol.9, No.3, 109-113, 2016.
(要約)
A 73-year-old man was referred to our hospital for further examination of a depressed lesion in the stomach found by cancer screening gastroscopy. A barium upper gastrointestinal series showed an area of irregular mucosa measuring 15 mm on the anterior wall of the gastric body. Esophagogastroduodenoscopy revealed a 15 mm depressed lesion on the anterior wall of the lower gastric body. We suspected an undifferentiated adenocarcinoma from the appearance and took some biopsies. However, histology of the specimens revealed amyloidal deposits in the submucosal layer without malignant findings. Congo red staining was positive for amyloidal protein and green birefringence was observed under polarized light microscopy. Congo red staining with prior potassium permanganate incubation confirmed the light chain (AL) amyloid type. There were no amyloid deposits in the colon or duodenum. Computed tomography of the chest, abdomen, and pelvis showed no remarkable findings. Thus, this case was diagnosed as a localized gastric amyloidosis characterized by AL type amyloid deposition in the mucosal or submucosal layer. As the clinical outcome of gastric AL amyloidosis seems favorable, this case is scheduled for periodic examination to recognize potential disease progression and has been stable for 2 years.
Masahiro Sogabe, Toshiya Okahisa, Tadahiko Nakagawa, Hiroshi Fukuno, Masahiko Nakasono, Tetsu Tomonari, Takahiro Tanaka, Hironori Tanaka, Tatsuya Taniguchi, Naoki Muguruma and Tetsuji Takayama : Influence of light alcohol consumption on lifestyle-related diseases: a predictor of fatty liver with liver enzyme elevation in Japanese females with metabolic syndrome., BMC Gastroenterology, Vol.16, No.1, 17, 2016.
(要約)
Although heavy drinking is known to lead to liver injury, some recent studies have reported that light alcohol consumption (LAC) may play a protective role against fatty liver in the general population, and may even play a protective role against non-alcoholic fatty liver disease (NAFLD) in males with metabolic syndrome (MS). However, the association between LAC and fatty liver with liver enzyme elevation in females with MS is unclear. Participants of this study were 20,853 females who underwent a regular health check-up between April 2008 and March 2012 at our hospital. Enrolled subjects were 1141 females with MS, who underwent all necessary tests and drank less than 20 g/day of alcohol. We investigated the presence of fatty liver with liver enzyme elevation, defined in this study as alanine aminotransferase (ALT) levels ≧31 IU/I, and the association between LAC and fatty liver with ALT elevation. There was no significant difference in the prevalence of fatty liver and ALT between light drinkers and non-drinkers. The prevalence of individuals receiving a treatment for dyslipidemia and impaired glucose tolerance (IGT) was significantly lower in light drinkers than in non-drinkers. Body mass index (BMI), waist circumference (WC), diastolic blood pressure (DBP), triglyceride (TG), uric acid (UA), IGT, and visceral fat type MS (V-type MS) were significant predictors of the prevalence of fatty liver with ALT elevation in logistic regression analysis. The odds ratio [OR] (95 % confidence interval [CI], p value) for fatty liver with ALT elevation were as follows: BMI, 2.181 (1.445-3.293, p <0.001); WC, 1.853 (1.280-2.684, p <0.01); DBP, 1.604 (1.120-2.298, p <0.05); TG, 2.202 (1.562-3.105, p <0.001); UA, 2.959 (1.537-5.698, p <0.01); IGT, 1.692 (1.143-2.506, p <0.01); and V-type MS, 3.708 (2.529-5.437, p <0.001). There was no significant difference in the prevalence of fatty liver with ALT elevation in females with MS between light drinkers and non-drinkers, suggesting that other factors such as BMI, WC, V-type MS, and lifestyle-related disease may be more important than LAC for the prevalence of fatty liver with ALT elevation.
Tetsu Tomonari, Shunsaku Takeishi, Tatsuya Taniguchi, Takahiro Tanaka, Hironori Tanaka, Shota Fujimoto, Tetsuo Kimura, Koichi Okamoto, Hiroshi Miyamoto, Naoki Muguruma and Tetsuji Takayama : MRP3 as a novel resistance factor for sorafenib in hepatocellular carcinoma, Oncotarget, Vol.7, No.6, 7207-7215, 2016.
(要約)
The mechanism of resistance of hepatocellular carcinoma (HCC) to sorafenib is unknown and no useful predictive biomarker for sorafenib treatment has been reported. Accordingly, we established sorafenib-resistant HCC cells and investigated the underlying mechanism of resistance to sorafenib. Sorafenib-resistant cell lines were established from the HCC cell line PLC/PRF5 by cultivation under continuous exposure to increasing concentration of sorafenib. The IC50 values of the 2 resistant clones PLC/PRF5-R1 and PLC-PRF5-R2 were 9.2±0.47 M (1.8-fold) and 25±5.1 M (4.6-fold) respectively, which were significantly higher than that of parental PLC/PRF5 cells (5.4±0.17 M) (p < 0.01 respectively), as determined by MTT assay. Western blot analysis of signal transduction-related proteins showed no significant differences in expression of AKT/pAKT, mTOR/pmTOR, or ERK/pERK between the 2 resistant clones versus parent cells, suggesting no activation of an alternative signal transduction pathway. Likewise, when expression of membrane transporter proteins was determined, there were no significant differences in expression levels of BSEP, MDR1, MRP2, BCRP, MRP4 and OCT1 between resistant clones and parent cells. However, the expression levels of MRP3 in the 2 resistant clones were significantly higher than that of parent cells. When MRP3 gene was knocked down by siRNA in PLC-PRF5-R2 cells, the sensitivity of the cells to sorafenib was restored. In the analysis of gene mutation, there was no mutation in the activation segment of Raf1 kinase in the resistant clones. Our data clearly demonstrate that the efflux transporter MRP3 plays an important role in resistance to sorafenib in HCC cells.
Jinsei Miyoshi, Hiroshi Miyamoto, Takahiro Goji, Tatsuya Taniguchi, Tetsu Tomonari, Masahiro Sogabe, Tetsuo Kimura, Shinji Kitamura, Koichi Okamoto, Yasuteru Fujino, Naoki Muguruma, Toshiya Okahisa and Tetsuji Takayama : Serum diamine oxidase activity as a predictor of gastrointestinal toxicity and malnutrition due to anticancer drugs., Journal of Gastroenterology and Hepatology, Vol.30, No.11, 1582-1590, 2015.
(要約)
Objective evaluation of intestinal mucosal damage due to anticancer drugs is generally difficult. Serum diamine oxidase (DAO) activity is reported to reflect the integrity and maturity of the small intestinal mucosa. Therefore, we investigated whether serum DAO activity is an indicator of gastrointestinal toxicity or nutritional status in patients receiving chemotherapy. We prospectively enrolled 20 patients with unresectable metastatic gastric cancer who received oral S-1 (80 mg/m(2) ) on days 1-14, and intravenous cisplatin (60 mg/m(2) ) and docetaxel (50 mg/m(2) ) on day 8 every 3 weeks. Serum DAO activity was measured by colorimetry. Gastrointestinal toxicity was evaluated by CTCAE v4.0. Endoscopic examination and biopsy of duodenal mucosa assessed mucosal damage. Malnutrition was evaluated by measuring serum total protein and albumin levels. Serum DAO activity decreased step-by-step significantly during anticancer drug treatment and recovered after drug holidays. In all 14 patients who experienced diarrhea, serum DAO activity significantly decreased prior to diarrhea onset. Percent decrease in DAO activity was significantly correlated with severity of diarrhea. Significant correlation was observed between percent decrease in DAO activity and percent decrease in duodenal villus height or surface area from baseline. There were also significant correlations between percent decrease in serum DAO activity at day 14 and percent decrease in serum total protein or albumin levels at day 21 from baseline. Serum DAO activity sensitively indicates gastrointestinal damage prior to symptom onset and can be a useful predictor of intestinal mucosal damage and nutritional status in patients receiving chemotherapy.
Takahiro Goji, Tetsuo Kimura, Hiroshi Miyamoto, Masanori Takehara, kaizo Kagamoto, Yasuyuki Okada, Jun Okazaki, Yoshifumi Takaoka, Yoshihiko Miyamoto, Yasuhiro Mitsui, Tatsunao Sueuchi, Kumiko Tanaka, Yasuteru Fujino, Sayo Matsumoto, Toshi Takaoka, Shinji Kitamura, Koichi Okamoto, Masako Kimura, Masahiro Sogabe, Naoki Muguruma, Toshiya Okahisa, Yasuhiro Sato, Tamotsu Sagawa, Koji Fujikawa, Yasushi Sato, Hitoshi Ikushima and Tetsuji Takayama : A Phase I/II Study of Fixed-dose-rate Gemcitabine and S-1 with Concurrent Radiotherapy for Locally Advanced Pancreatic Cancer, Cancer Chemotherapy and Pharmacology, Vol.76, No.3, 615-620, 2015.
(要約)
This study was conducted to identify the maximum-tolerated dose (MTD) of fixed-dose-rate gemcitabine (FDR-gem) administered concurrently with S-1 and radical radiation for locally advanced pancreatic cancer (LAPC) and to provide efficacy and safety data. Patients with unrespectable pancreatic cancer confined to the pancreatic region were treated with FDR-gem (300-400 mg/m(2), 5 mg/m(2)/min) on days 1, 8, 22, and 29 and 60 mg/m(2) of S-1 orally on days 1-14, 22-35. A total radiation dose of 50.4 Gy (1.8 Gy/day, 28 fractions) was delivered concurrently. Twenty-five patients were enrolled; all were evaluable for toxicity assessment. In phase I, eight patients were treated in sequential cohorts of three to five patients per dose level. The MTD was reached at level 2, and dose-limiting toxicities were neutropenia and thrombocytopenia. The recommended doses were 300 mg/m(2) of gemcitabine and 60 mg/m(2) of S-1 daily. The overall response rate was 25% and disease control rate (partial response plus stable disease) was 92%. The progression-free survival was 11.0 months. The median overall survival and 1-year survival rates were 16.0 months and 73%, respectively. The combination of FDR-gem and S-1 with radiation is a feasible regimen that shows favorable antitumor activity with an acceptable safety profile in patients with LAPC.
Masahiro Sogabe, Toshiya Okahisa, Masahiko Nakasono, Yasuteru Fujino, Yasuhiro Mitsui, Yoshihumi Takaoka, Tetsuo Kimura, Koichi Okamoto, Naoki Muguruma and Tetsuji Takayama : Investigation of Gastroduodenal Mucosal Injury in Japanese Asymptomatic Antiplatelet Drug Users, Medicine, Vol.94, No.26, e1047, 2015.
(要約)
Antiplatelet drugs are widely used for the prevention of cardiovascular disease and cerebral vascular disorders. Although there have been several studies on gastroduodenal mucosal injury with gastrointestinal (GI) symptoms such as GI bleeding, in antiplatelet drug users (including low-dose aspirin (LDA)), there have been few reports on the association between antiplatelet drug use and gastroduodenal mucosal injury in asymptomatic antiplatelet drug users. This study was a cross-sectional study elucidating the association between antiplatelet drug use and gastroduodenal mucosal injury in asymptomatic antiplatelet drug users.Subjects were 186 asymptomatic Japanese antiplatelet drug users who underwent a regular health checkup. Subjects were divided into those with and without gastroduodenal mucosal injury endoscopically, and the association between gastroduodenal mucosal injury and other data in asymptomatic antiplatelet drug users was investigated.The prevalence of males and drinkers were significantly higher in subjects with gastroduodenal mucosal injury than in those without. In addition, the prevalence of proton pump inhibitor (PPI) users was significantly lower in subjects with gastroduodenal mucosal injury than in subjects without gastroduodenal mucosal injury. Logistic regression analysis showed PPI (odds ratios: 0.116; 95% confidence intervals: 0.021-0.638; P < 0.05) was a significant predictor of a decreased prevalence of gastroduodenal mucosal injury and closed-type (C-type) atrophy (3.172; 1.322-7.609; P < 0.01) was a significant predictor of an increased prevalence of severe gastroduodenal mucosal injury in asymptomatic antiplatelet drug users.Gender and lifestyle, such as drinking, may have an impact on risk of gastroduodenal mucosal injury in asymptomatic subjects taking antiplatelet drugs. Although PPI is a significant predictor of a decreased prevalence of gastroduodenal mucosal injury, including in asymptomatic antiplatelet drug users, status of gastric atrophy should also be considered against severe gastroduodenal mucosal injury.
(キーワード)
Adult / Aged / Aged, 80 and over / Endoscopy, Gastrointestinal / Female / Gastric Mucosa / Humans / Male / Middle Aged / Platelet Aggregation Inhibitors / Retrospective Studies / Stomach Diseases / Young Adult
Naoki Muguruma, Shinji Kitamura, Tetsuo Kimura, Hiroshi Miyamoto and Tetsuji Takayama : Endoscopic Management of Nonvariceal Upper Gastrointestinal Bleeding: State of the Art., Clinical Endoscopy, Vol.48, No.2, 96-101, 2015.
(要約)
Nonvariceal upper gastrointestinal (GI) bleeding is one of the most common reasons for hospitalization and a major cause of morbidity and mortality worldwide. Recently developed endoscopic devices and supporting apparatuses can achieve endoscopic hemostasis with greater safety and efficiency. With these advancements in technology and technique, gastroenterologists should have no concerns regarding the management of acute upper GI bleeding, provided that they are well prepared and trained. However, when endoscopic hemostasis fails, endoscopy should not be continued. Rather, endoscopists should refer patients to radiologists and surgeons without any delay for evaluation regarding the appropriateness of emergency interventional radiology or surgery.
A 60-year-old male presented to our hospital for further investigation of abnormal findings on an upper gastrointestinal series. Esophagogastroduodenoscopy demonstrated atrophic gastritis and a submucosal tumor (SMT) at the anterior wall of the antrum. The patient was positive for serum anti-Helicobacter pylori (H. pylori) antibody and H. pylori eradication therapy was performed. Five months later, the SMT showed a remarkable morphological change in that an ulcer had developed on its apex, and partial gastrectomy was performed. Pathological examination suggested an inflammatory fibroid polyp (IFP), and genetic analysis revealed no mutation in the platelet-derived growth factor receptor alpha gene. This case suggests that H. pylori infection plays an important role in the etiology of IFPs.
Satoshi Teramae, Hiroshi Miyamoto, Naoki Muguruma, Yasuyuki Okada, Takahiro Goji, Shinji Kitamura, Tetsuo Kimura, Masako Kimura, Yoshimi Bando and Tetsuji Takayama : Insulin-like growth factor II-producing metastatic colon cancer with recurrent hypoglycemia., Clinical Journal of Gastroenterology, Vol.8, No.1, 35-40, 2015.
(要約)
A 45-year-old man was referred to our hospital and found to have a tubular adenocarcinoma of the descending colon with multiple liver metastases. During hospitalization, the patient suffered recurrent hypoglycemic attacks that required intravenous 50% glucose infusion. He was diagnosed with non-islet cell tumor hypoglycemia (NICTH) because the colon cancer tissue obtained by biopsy was strongly stained for insulin-like growth factor-II (IGF-II) by immunohistochemistry. He received chemotherapy with oxaliplatin, 5-FU and leucovorin (FOLFOX) plus bevacizumab (Bmab), and showed a partial response. As the metastatic lesions decreased in size, the hypoglycemic attacks gradually disappeared. Subsequently, he received outpatient chemotherapy and maintained a high quality of life for about 10 months. Western blot analysis of IGF-II in serum at the time of admission showed a high-molecular-weight form of IGF-II, which was considered to have caused hypoglycemia. This patient presents a very rare case of colorectal cancer associated with NICTH syndrome due to production of high-molecular-weight IGF-II by cancer cells. It is important to investigate IGF-II expression in cancer tissues for establishing the diagnosis of NICTH in cases with intractable hypoglycemia complicated by advanced cancer.
(キーワード)
Adenocarcinoma / Blotting, Western / Colonic Neoplasms / Humans / Hypoglycemia / Immunohistochemistry / Insulin-Like Growth Factor II / Liver Neoplasms / Male / Middle Aged / Recurrence
Atsushi Inoue, Koichi Okamoto, Yasuteru Fujino, Tadahiko Nakagawa, Naoki Muguruma, Katsutaka Sannomiya, Yasuhiro Mitsui, Toshi Takaoka, Shinji Kitamura, Hiroshi Miyamoto, Toshiya Okahisa, Takahiro Fujimori, Issei Imoto and Tetsuji Takayama : B-RAF mutation and accumulated gene methylation in aberrant crypt foci (ACF),sessile serrated adenoma/polyp (SSA/P) and cancer in SSA/P., British Journal of Cancer, Vol.112, No.2, 403-412, 2015.
(要約)
Sessile serrated adenomas/polyps (SSA/Ps) are a putative precursor of colon cancer with microsatellite instability (MSI). However, the developmental mechanism of SSA/P remains unknown. We performed genetic analysis and genome-wide DNA methylation analysis in aberrant crypt foci (ACF), SSA/P, and cancer in SSA/P specimens to show a close association between ACF and the SSA/P-cancer sequence. We also evaluated the prevalence and number of ACF in SSA/P patients. ACF in the right-side colon were observed in 36 patients with SSA/Ps alone, 2 with cancers in SSA/P, and 20 normal subjects and biopsied under magnifying endoscopy. B-RAF mutation and MSI were analysed by PCR-restriction fragment length polymorphism (RFLP) and PCR-SSCP, respectively, in 15 ACF, 20 SSA/P, and 2 cancer specimens. DNA methylation array analysis of seven ACF, seven SSA/P, and two cancer in SSA/P specimens was performed using the microarray-based integrated analysis of methylation by isochizomers (MIAMI) method. B-RAF mutations were frequently detected in ACF, SSA/P, and cancer in SSA/P tissues. The number of methylated genes increased significantly in the order of ACF<SSA/P<cancer. The most commonly methylated genes in SSA/P were PQLC1, HDHD3, RASL10B, FLI1, GJA3, and SLC26A2. Some of these genes were methylated in ACF, whereas all genes were methylated in cancers. Immunohistochemistry revealed their silenced expression. Microsatellite instability and MLH1 methylation were observed only in cancer. The prevalence and number of ACF were significantly higher in SSA/P patients than in normal subjects. A significant correlation was seen between the numbers of SSA/P and ACF in SSA/P patients. Our results suggest that ACF are precursor lesions of the SSA/P-cancer sequence in patients with SSA/P, where ACF arise by B-RAF mutation and methylation of some of the six identified genes and develop into SSA/Ps through accumulated methylation of these genes.
Yasuteru Fujino, Naoki Muguruma, Shinji Kitamura, Yasuhiro Mitsui, Tetsuo Kimura, Hiroshi Miyamoto, Hisanori Uehara, Koichi Kataoka and Tetsuji Takayama : Perineurioma in the sigmoid colon diagnosed and treated by endoscopic resection, Clinical Journal of Gastroenterology, Vol.7, No.5, 392-396, 2014.
(要約)
Perineuriomas are rare benign peripheral nerve sheath tumors in the gastrointestinal tract. We recently encountered a submucosal lesion in the sigmoid colon that was resected by endoscopic mucosal resection and was then diagnosed as perineurioma by immunohistochemistry. A 51-year-old female with a positive test for fecal occult blood was referred to our hospital for screening colonoscopy. Colonoscopy identified a submucosal lesion, approximately 15 mm in diameter, in the sigmoid colon. Endoscopic ultrasound showed a 15-mm tumor with a strong acoustic shadow. Endoscopic mucosal resection was performed in order to make a precise diagnosis as well as removal. The specimen revealed spindle cell proliferation without atypia, and immunostaining revealed that the spindle cells were positive for collagen type IV and glut-1, and the lesion was diagnosed as a colonic perineurioma with no malignancy. Gastroenterologists as well as pathologists should be aware of this type of submucosal lesion, and immunohistochemical evaluation is highly recommended when an unusual mesenchymal tumor is found.
Miyamoto Yoshihiko, Naoki Muguruma, Seisuke Okamura, Okada Yasuyuki, Shinji Kitamura, Koichi Okamoto, Takahiro Goji, Yoneda Akiko, Noriko Kagawa and Tetsuji Takayama : A pedunculated submucosal lesion in the stomach with inverted downgrowth, Internal Medicine, Vol.53, No.15, 1625-1628, 2014.
(要約)
A 70-year-old man with a gastric lesion was referred to our hospital because of an unusual pedunculated lesion in the gastric body. Endoscopic ultrasound showed scattered cystic lesions within a heterogeneous area confined to the submucosal layer. Endoscopic mucosal resection was performed to obtain a precise diagnosis, as well as for removal. The lesion was histopathologically diagnosed as a heterotopic submucosal gland. We herein describe this rare type of gastric polyp and provide a literature review.
Hirao Akihiro, Tetsu Tomonari, Tanaka Hironori, Kumiko Tanaka, Kagawa Miwako, Tanaka Takahiro, Tatsuya Taniguchi, Harada Rie, Momoko Sato, Naoki Muguruma and Tetsuji Takayama : Development of a renal subcapsular hematoma during angiography for diagnosis and subsequent treatment of hepatocellular carcinoma, Clinical Journal of Gastroenterology, Vol.7, No.2, 185-188, 2014.
(要約)
A renal subcapsular hematoma rarely occurs without a history of trauma. It has been reported as a complication of urological interventions and also reported to occur spontaneously in patients with renal malignancies. However, there are no previous reports of renal subcapsular hematomas occurring in connection with abdominal angiography. We report here a case of a renal subcapsular hematoma that developed and was recognized during abdominal angiography for treatment of hepatocellular carcinoma (HCC). An 80-year-old male was referred to our hospital for transarterial embolization for multiple HCCs. His past medical history included hypertension. His laboratory data showed slightly decreased number of platelets and hepaplastin test due to liver cirrhosis. When computed tomography angiography was performed, a 7-cm subcapsular hematoma developed and was recognized over the right kidney during the procedure. He was successfully managed supportively with blood transfusion, tranexamic acid and antibiotics. Since thrombocytopenia and hypertension are reportedly risk factors for hematoma formation, careful manipulation is required during angiography in HCC patients with liver cirrhosis and hypertension. It must be kept in mind that rare complications, such as a renal subcapsular hematoma, can happen during abdominal angiography for diagnostic and interventional treatment of HCC.
Shinji Kitamura, Naoki Muguruma, Koichi Okamoto, Fumika Nakamura, Yasuyuki Okada, Tetsuo Kimura, Hiroshi Miyamoto and Tetsuji Takayama : Endoscopic submucosal dissection through a gastrostomy for early gastric cancer in patients with pharyngeal stenosis., Gastrointestinal Endoscopy, Vol.79, No.2, 206-207, 2014.
Momoko Sato, Naoki Muguruma, Nakagawa Tadahiko, Koichi Okamoto, Tetsuo Kimura, Shinji Kitamura, Hiromi Yano, Sannomiya Katsutaka, Takahiro Goji, Hiroshi Miyamoto, Toshiya Okahisa, Hiroaki Mikasa, Wada Satoshi, Iwata Masao and Tetsuji Takayama : High antitumor activity of pladienolide B and its derivative in gastric cancer, Cancer Science, Vol.105, No.1, 110-116, 2014.
(要約)
The antitumor activity of pladienolide B, a novel splicing inhibitor, against gastric cancer is totally unknown and no predictive biomarker of pladienolide B efficacy has been reported. We investigated the antitumor activity of pladienolide B and its derivative on gastric cancer cell lines and primary cultured cancer cells from carcinomatous ascites of gastric cancer patients. The effect of pladienolide B and its derivative on six gastric cancer cell lines was investigated using a MTT assay and the mean IC50 values determined to be 1.6 ± 1.2 (range, 0.6-4.0) and 1.2 ± 1.1 (range, 0.4-3.4) nM, respectively, suggesting strong antitumor activity against gastric cancer. The mean IC50 value of pladienolide B derivative against primary cultured cells from 12 gastric cancer patients was 4.9 ± 4.7 nM, indicative of high antitumor activity. When 18 SCID mice xenografted with primary cultured cells from three patients were administered the pladienolide B derivative intraperitoneally, all tumors completely disappeared within 2 weeks after treatment. Histological examination revealed a pathological complete response for all tumors. In the xenograft tumors after treatment with pladienolide B derivative, immature mRNA were detected and apoptotic cells were observed. When the expressions of cell-cycle proteins p16 and cyclin E in biopsied gastric cancer specimens were examined using immunohisctochemistry, positivities for p16 and cyclin E were significantly and marginally higher, respectively, in the low-IC50 group compared with the high-IC50 group, suggesting the possibility that they might be useful as predictive biomarkers for pladienolide B. In conclusion, pladienolide B was very active against gastric cancer via a mechanism involving splicing impairment and apoptosis induction.
(キーワード)
Aged / Aged, 80 and over / Animals / Antineoplastic Agents / Apoptosis / Cell Line, Tumor / Cyclin E / Cyclin-Dependent Kinase Inhibitor p16 / Epoxy Compounds / Female / Humans / Macrolides / Male / Mice / Mice, SCID / Middle Aged / RNA Splicing / Random Allocation / Stomach Neoplasms / Xenograft Model Antitumor Assays
Toshihiro Omoya, Masako Shiba, Shingo Hibino, Rika Aoki, Shinji Kitamura, Naoki Muguruma and Tetsuji Takayama : Twig tea impaction in the colon causing abdominal pain, Clinical Journal of Gastroenterology, Vol.6, No.6, 438-441, 2013.
(要約)
We describe a case of lower abdominal pain caused by a twig tea impaction at the rectosigmoid junction after inadvertent ingestion. The foreign body was detected and successfully dislodged from the colonic wall with grasping forceps during colonoscopy. The post-procedural course was uneventful, and the patient was discharged 10 days after the removal. Colonic injury, including perforation due to foreign body ingestion, must be considered in patients presenting with unexplained symptoms and findings, even when they do not recall any foreign body ingestion.
(キーワード)
abdominal pain / foreign body / endoscopic removal
Naoki Muguruma, Hiroshi Miyamoto, Toshiya Okahisa and Tetsuji Takayama : Endoscopic Molecular Imaging: Status and Future Perspective., Clinical Endoscopy, Vol.46, No.6, 603-610, 2013.
(要約)
During the last decade, researchers have made great progress in the development of new image processing technologies for gastrointestinal endoscopy. However, diagnosis using conventional endoscopy with white light optical imaging is essentially limited, and ultimately, we still rely on the histopathological diagnosis from biopsy specimens. Molecular imaging represents the most novel imaging methods in medicine, and the future of endoscopic diagnosis is likely to be impacted by a combination of biomarkers and technology. Endoscopic molecular imaging can be defined as the visualization of molecular characteristics with endoscopy. These innovations will allow us not only to locate a tumor or dysplastic lesion but also to visualize its molecular characteristics and the activity of specific molecules and biological processes that affect tumor behavior and/or its response to therapy. In the near future, these promising technologies will play a central role in endoluminal oncology.
Koichi Okamoto, Takaoka Toshi, Naoki Muguruma, Tetsuji Takayama and Niitsu Yoshiro : Endoscopy of aberrant crypt foci: the expert approach, Video Journal and Encyclopedia of GI Endoscopy, Vol.1, 357-358, 2013.
Miho Tsuda, Koichi Okamoto, Naoki Muguruma, Katsutaka Sannomiya, Tadahiko Nakagawa, Hiroshi Miyamoto, Shinji Kitamura, Takahiro Goji, Tetsuo Kimura, Toshiya Okahisa, Keisuke Izumi and Tetsuji Takayama : Suppressive effect of RAS inhibitor manumycin A on aberrant crypt foci formation in the azoxymethane-induced rat colorectal carcinogenesis model., Journal of Gastroenterology and Hepatology, Vol.28, No.10, 1616-1623, 2013.
(要約)
The mean number of ACF in the 8-week manumycin A group (72.9 ± 20.1) was significantly lower than in the vehicle group (155.6 ± 56.7, P < 0.01), and it was significantly lower even in the 4-week manumycin A group than in the vehicle group (92.2 ± 13.0 vs 222.3 ± 83.3, P < 0.01). The positive rate for phosphorylated ERK in the manumycin A group (13.5 ± 19.2%) was significantly lower than in the vehicle group (50.2 ± 19.8%, P < 0.01). The positive rate for Ki-67 in the manumycin A group (2.2 ± 3.4%) was significantly lower than in the vehicle group (14.7 ± 8.2%, P < 0.01). There were significantly more terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling-positive cells in tissue samples from the manumycin A group versus the vehicle group (8.6 ± 9.7% vs 2.9 ± 2.0%, P < 0.05).
Shinji Kitamura, Mitsugi Yasuda, Naoki Muguruma, Koichi Okamoto, Hisashi Takeuchi, Yoshimi Bando, Hiroshi Miyamoto, Toshiya Okahisa, Mitsuyasu Yano, Ryusuke Torisu and Tetsuji Takayama : Prevalence and characteristics of nodular gastritis in Japanese elderly., Journal of Gastroenterology and Hepatology, Vol.28, No.7, 1154-1160, 2013.
(要約)
NG was found in 62 cases (0.94%) out of 6623 patients who underwent endoscopy, with a mean age of 47.3 ± 13.3 years. Female patients were present at a significantly higher rate in the elderly group (P < 0.001). The grade of neutrophil infiltration in the greater curvature of the upper gastric body was recognized at a significantly higher rate in the elderly group (P < 0.05). PG II was present at a higher rate and PG I/II at a lower rate in the elderly group (P < 0.05). The odds ratio for the risk of gastric cancer in patients with NG was 2.1 (95% confidence interval 0.3-15.3) in the elderly group.
(キーワード)
Age Factors / Aged / Aged, 80 and over / Asian Continental Ancestry Group / Gastritis / Gastroscopy / Humans / Japan / Prevalence / Risk Factors / Stomach Neoplasms
Koichi Okamoto, Naoki Muguruma, Shinji Kitamura, Masako Shiba and Tetsuji Takayama : Lessons from imperfect endoscopic submucosal dissection of rectal tumor., Digestive Endoscopy, Vol.25, No.Suppl 2, 31-36, 2013.
(要約)
Endoscopic mucosal resection (EMR) is a standard endoscopic treatment for gastrointestinal tumors, but resections done in a piecemeal fashion are difficult to diagnose pathologically as curative resections, and the local recurrence rate is relatively high. Recently, endoscopic submucosal dissection (ESD) for colorectal tumors, which provides a higher complete resection rate than conventional EMR, has rapidly come into widespread use in Japan. However, colorectal ESD is still technically difficult and has complications such as perforation, and the procedure time is longer than that of conventional EMR. We report herein a case in which a rectal tumor was resected with an inappropriate specimen due to imperfect ESD. This lesion had severe fibrosis in the submucosal layer because the lesion had been injected with a solution for EMR in another hospital, which resulted in non-lifting signs, and had been subjected to many biopsies. During the ESD in our hospital, the submucosal layer was not clearly identified, and a small injury was caused in the specimen. A precise diagnosis based on histopathological findings could not be made because of the inappropriate specimen. Thus, expertise in both the diagnostic and the therapeutic aspects is required before treating large colorectal tumors.
Koichi Okamoto, Seisuke Okamura, Naoki Muguruma, Shinji Kitamura, Tetsuo Kimura, Yoshitaka Imoto, Hiroshi Miyamoto, Toshiya Okahisa and Tetsuji Takayama : Endoscopic submucosal dissection for early gastric cancer using a cross-counter technique., Surgical Endoscopy, Vol.26, No.12, 3676-3681, 2012.
(要約)
Endoscopic submucosal dissection (ESD) in early gastric cancer has rapidly come into widespread use. However, since complications such as bleeding and perforation often occur, and the procedure time is longer for ESD than endoscopic mucosal resection (EMR), development of safer and more reliable technique is required. The subjects comprised 45 patients with lesions diagnosed histologically as early gastric cancer. They were divided into three groups: cross-counter technique group (CC, n = 15), peroral traction-assisted ESD with suture material group (PT, n = 15), and no-traction group (NT, n = 15). ESD was carried out by two endoscopists who had experienced fewer than 30 cases of ESD. To compare safety and efficacy of a new traction method (CC group) for ESD in early gastric cancer with other methods (PT group and NT group), procedure time, dissected area per unit time, complete resection rate, perforation rate, and bleeding rate were evaluated. There was no significant difference among these three groups in terms of complications, complete resection rate or procedure time. The dissection area per unit time was 22.4, 15.7, and 13.5 mm(2)/min in the CC, PT, and NT groups, respectively, and there was a significant difference between the CC and NT groups (p = 0.007). The cross-counter technique shortened the treatment time for endoscopists without abundant experience in gastric ESD, and it is considered a useful method to institute in order to introduce ESD.
(キーワード)
Aged / Aged, 80 and over / Early Medical Intervention / Equipment Design / Female / Gastric Mucosa / Gastroscopes / Gastroscopy / Humans / Male / Middle Aged / Stomach Neoplasms
Naoki Muguruma, Seisuke Okamura, Y Imoto, T Sueuchi, Koichi Okamoto, H Fujimoto, K Arita, Takanori Hirose and Tetsuji Takayama : Perineurioma: an uncommon lesion in the gastrointestinal tract., Endoscopy, Vol.44, No.Suppl 2 UCTN, E182-3, 2012.
Koichi Okamoto, Naoki Muguruma, Shinji Kitamura, Tetsuo Kimura and Tetsuji Takayama : Endoscopic submucosal dissection for large colorectal tumors using a cross-counter technique and a novel large-diameter balloon overtube., Digestive Endoscopy, Vol.24, No.Suppl.1, 96-99, 2012.
(要約)
Endoscopic submucosal dissection (ESD) in early gastric cancer (EGC), which provides a higher complete resection rate than conventional endoscopic mucosal resection (EMR), has rapidly come into widespread use. However, colorectal ESD is not widely used because of its technical difficulty and complications such as perforation, and the procedure time is longer than that of conventional EMR. Development of safer and more reliable devices as well as technique modifications are therefore required. The aim of our study is to compare safety and efficacy of a new traction method, the cross-counter technique, for large colorectal tumors combined with a balloon overtube. A total of 30 patients with large colorectal tumors were analyzed retrospectively; 15 patients for the cross-counter technique group (CC group) and 15 patients for the no-traction group (NT group). Procedure time, complete resection rate, perforation rate and bleeding rate were assessed. The procedure time was 126 ± 42.2 min and 165 ± 61.3 min in the CC and NT groups, respectively, and there was a significant difference between the two groups (P < 0.05). There were no significant differences in complete resection rate, perforation rate and bleeding rate between the two groups. The cross-counter technique shortened the treatment time in colorectal ESD without any complication.
We compared high-sensitivity KRAS mutation testing with direct sequencing for predicting the efficacy of antiepidermal growth factor receptor antibodies in patients with metastatic colorectal cancer (mCRC). We analyzed the KRAS status in 61 tumors from cetuximab-treated mCRC patients by both direct sequencing and a high-sensitivity method: 2-step PCR restriction fragmentation length polymorphism (RFLP). Therapeutic effects in each mutational status were evaluated. The incidences of KRAS mutations determined by direct sequencing and 2-step PCR RFLP were 34.4 and 52.5%, respectively (p = 0.02). Patients were categorized into 3 groups [W/W, wild-type by both methods (n = 29); W/M, wild-type by direct sequencing, detected mutation by 2-step PCR RFLP (n = 11); M/M, mutant-type by both methods (n = 21)]. The response rate for cetuximab in the W/M group (0%) was the same as that in the M/M group, and was significantly lower than in the W/W group (41.4%) (p < 0.001). Progression-free survival in the W/M group (11.0 weeks) was similar to that in the M/M group (8.0 weeks), and was significantly shorter than in the W/W group (18.0 weeks) (p < 0.002). High-sensitivity KRAS mutation testing is useful for selecting true responders to cetuximab.
Naoki Muguruma, Koichi Okamoto, Tetsuo Kimura, Kazuhiro Kishi, Toshiya Okahisa, Seisuke Okamura and Tetsuji Takayama : Endoscopic ablation therapy for gastrointestinal superficial neoplasia., Digestive Endoscopy, Vol.24, No.3, 139-149, 2011.
(要約)
In Japan, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have been widely accepted and standardized for the treatment of gastrointestinal superficial neoplasia. In contrast, mucosal ablation techniques are more common in Western countries and a variety of endoscopic ablation modalities, including argon plasma coagulation (APC), photodynamic therapy (PDT) and lasers, are used. Recently developed modalities such as radiofrequency ablation (RFA) and cryotherapy are also available for the treatment of superficial lesions such as dysplasia of Barrett's esophagus. Although we should understand that the completeness of destruction of neoplastic tissue can only be judged at follow up, endoscopic ablation is a viable alternative to endoscopic resection for dysplasia and early-stage malignancies, especially for poor candidates of surgery or endoscopic resection.
Naoki Muguruma and Susumu Ito : Labeled anti-mucin antibody detectable by infrared-fluorescence endoscopy., Cancer Biomarkers, Vol.4, No.6, 321-328, 2008.
(要約)
The goal of our study was to develop a method for molecular imaging of the gastrointestinal tract using an infrared fluorescence endoscope (IRFE) and antibodies labeled with an indocyanine green (ICG) derivative to detect cancerous tissue. The IRFE comprised an infrared endoscope equipped with excitation (710-790 nm) and barrier (810-920 nm) filters. We developed ICG-N-hydroxysulfosuccinimide ester (ICG-sulfo-OSu) and 3-ICG-acyl-1,3-thiazolidine-2-thione (ICG-ATT) as infrared fluorescent-labeling reagents, and anti-human carcinoembryonic antigen (CEA) antibody and MUC1 antibody were labeled with the ICG-derivatives. Freshly resected specimens of gastric cancer were observed by IRFE after reaction with ICG-derivative-labeled antibodies. Positive fluorescence was observed at the tumor location by IRFE, and the immunofluorescent images correlated well with the tumor sites. The immunofluorescence studies suggested that the intensity of the infrared fluorescence of the ICG-ATT-labeled MUC1 antibody is stronger than the ICG-sulfo-OSu-labeled MUC1 antibody. We concluded that specific antibodies for gastrointestinal cancer labeled with an ICG-derivative accompanied by a reinforcing agent and an optimal electronic device can generate a strong enough fluorescent signal to visualize cancer proteins.
Sogabe Masahiro, Kimura Yoshitaka, Iwaki Hiroshi, Okita Yoshio, Hibino Shingo, Sawda Seizo, Toshiya Okahisa, Okamoto Koichi, Tsujigami Koji, Hayashi Hiroshige, Hukui Yasuo, Nakamura Toshio, Taniki Toshikatsu, Nakasono Masahiko, Naoki Muguruma, Seisuke Okamura and Susumu Ito : Ultrasonographic comparison of gastric motility between diabetic gastroparesis patients with and without metabolic syndrome., Journal of Gastroenterology and Hepatology, Vol.23, No.7 Pt 2, e17-22, 2007.
(要約)
Diabetic patients with poor glycemic control or long standing disease often have impaired gastric motility. Recently, metabolic factors such as blood glucose have been reported as influencing gastric motility independently of autonomic neuropathy. Many diabetic patients have metabolic syndrome, which is strongly associated with coronary and other diseases. We investigated whether metabolic syndrome influences diabetic gastroparesis patients. We observed gastric motility ultrasonographically in diabetic gastroparesis patients including nine with and nine without metabolic syndrome. Both groups complained of upper abdominal symptoms when hospitalized to improve blood sugar control. All patients underwent upper gastrointestinal endoscopy to rule out gastric and duodenal lesions. All had autonomic neuropathy. Gastric motility was evaluated within 3 days after admission by transabdominal ultrasonography after a test meal. Gastric emptying was 45.0 +/- 13.7% in patients with and 39.1 +/- 11.9% in patients without metabolic syndrome, which was not statistically significant. Frequency of gastric contractions was 8.33 +/- 2.78 per 3 min in patients with metabolic syndrome and 7.44 +/- 2.13 per 3 min in the others, which was not statistically significant. The motility index, which involves antral contractility, was 3.21 +/- 2.18 in patients with metabolic syndrome and 2.80 +/- 1.87 in the others, which was not statistically significant. Metabolic syndrome did not appear to contribute to delayed gastric motility in diabetic gastroparesis.
Yoshitaka Imoto, Naoki Muguruma, Tetsuo Kimura, Eriko Aoyagi, Koichi Okamoto, Seisuke Okamura, Susumu Ito, Nobuya Sano and Mitsuo Shimada : Relationship between mucin expression and preoperatie bile juice cytology in biliary tract carcinoma, The Journal of Medical Investigation : JMI, Vol.54, No.1-2, 41-47, 2007.
(要約)
The present study evaluated correlations between preoperative bile juice cytology and mucin expression of surgical specimens in biliary tract carcinoma. Twenty-five patients with biliary tract carcinoma surgically treated at our hospital, whose bile juice cytology had been evaluated before operation, were allocated to this study. Biliary cytology was classified into three categories based on the Papanicolaou classification. Immunohistochemical staining of tissues was performed using MUC1 and MUC2 monoclonal antibodies. Lesions showing MUC1 expression of ++ or higher and MUC2 expression of - were classified as Group A, and the remaining lesions as Group B. According to the epithelial site, preoperative cytology was highly correlated in Group A, while it was negative in Group B (p<0.05). In the advanced site of carcinomas, preoperative cytology tended to highly be positive in Group A, while it tended to be negative in Group B (p<0.05). These results suggest that the bile juice cytology results are affected by characteristics of mucin expression in the tissue. Based on the possibility that mucin expression correlates with the prognosis of each carcinoma, a positive cytological result suggests a poor prognosis for the carcinoma, which may be informative for predicting the post-operative courses and choosing treatments.
Yoko Tadatsu, Naoki Muguruma, Susumu Ito, Masaya Tadatsu, Yoshihiro Kusaka, Koichi Okamoto, Yoshitaka Imoto, Hiromi Taue, Shigeki Sano and Yoshimitsu Nagao : Optimal Labeling Condition of Antibodies Available for Immunofluorescence Endoscopy, The Journal of Medical Investigation : JMI, Vol.53, No.1/2, 52-60, 2006.
(要約)
In recent years, labeled antibodies have been used for diagnostic imaging in many studies. In this study, we investigated the mode of binding in antibodies labeled with ICG derivatives newly developed for the diagnosis of microcarcinomas, and evaluated the optimal binding molar ratio between the labeling compounds and antibody. MUC 1 antibody and ICG derivatives (ICG-ATT and ICG-sulfo-OSu) were used. ICG derivatives non-covalently bound to the antibody were removed with ethyl acetate, and the ratio of ICG derivatives covalently bound to the labeled antibody was confirmed. During purification of the labeled antibody, the amount of each labeling compound reacting with 1 molecule of the antibody varied as follows: 4, 8, 16, and 32 molar equivalents. Subsequently, the intensity of fluorescence was evaluated by spectroscopy and infrared fluoroscopy. The ratio of residual ICG derivative labeling the antibody was 67.4% for ICG-ATT and 65.0% for ICG-sulfo-OSu. When fluorescent antibody labeled with ICG-ATT at an F/P ratio of 2.94 or 4.18 was used, specific and clear fluorescent images of the antigen were obtained. When ICG-ATT-labeled antibody at an F/P ratio of 6.50 or 6.75 was used, the fluorescence intensity decreased and the fluorescent images of antigen became unclear. It was found that the ICG-ATT-labeled antibody was a more specific and sensitive marker than ICG-sulfo-OSu-labeled antibody, and that lower binding molar ratios of ICG-ATT were more useful for labeling the antibody.
Masahiko Nakasono, Naoki Muguruma, Seisuke Okamura, Susumu Ito, Akiko Iga, Satoshi Wada, Michiyo Okazaki, Takahiro Horie, Tamotsu Fukuda and Toshiaki Sano : Colonic pseudolipomatosis, microscopically classified into two groups, Journal of Gastroenterology and Hepatology, Vol.21, No.1 Pt 1, 65-70, 2006.
(要約)
Colonic pseudolipomatosis is rare and the pathogenesis is controversial. The purpose of the present paper was to clarify endoscopic and histological characteristics of colonic pseudolipomatosis and to discuss the etiology. A total of 15 lesions from 14 patients was reviewed. They were able to be histologically classified into two groups on the basis of variety in size of the vacuoles: Group A, the ratio of largest vacuole to smallest vacuole in size is less than three, Group B, the ratio is more than four. Four of 15 lesions were group A, and were endoscopically polypoid or flat lesions covered with normal-looking mucosa. They were microscopically characterized by (i) predominant location in the upper portion of the lamina propria; (ii) no submucosal involvement; (iii) less variation in vacuolar size; and (iv) no association with lymph follicles. The vacuoles of group A contained proteinaceous materials in two of four lesions. Group B (11 lesions) had small elevated mucosa with normal-looking surface or non-elevated reddish mucosa. Microscopically, the lesions were mainly located in the lower portion of the lamina propria, occasionally also in the submucosa, had variable-sized vacuoles, and were related to lymph follicles. It is suggested that the vacuoles in group A contain fluid, and may indicate an abnormal stagnation of interstitial fluid. Microscopic appearance of group B is essentially similar to that of pneumatosis coli. It is thought that group B probably results from penetration of gas from the crypts into the mucosa during colonoscopy. It is unclear why group B had a preference for ileocecal valve and an association with lymph follicles.
Naoki Muguruma, Yoshitaka Imoto, Tetsuo Kimura, Seisuke Okamura and Susumu Ito : Adenomyomatosis of the Gallbladder as a Potential Risk Factor for Gallbladder Carcinoma, International Medical Journal, Vol.13, No.2, 91-94, 2006.
Duodenal lymphangitis carcinomatosa has been sporadically described, but so far little attention has been paid to duodenal lymphangitis carcinomatosa. Four cases with duodenal lymphangitis carcinomatosa were endoscopically and histologically examined. The four cases exhibited multiple polypoid lesions along the Kerckring's folds and/or were covered by characteristically granular, non-ulcerated mucosa upon thickening. The granularity seems to been caused by dilated lymph vessels containing the carcinoma cells. The lesions were microscopically characterized by: (i) involvement of lymph vessels located in the upper portion of the lamina propria; (ii) no inflammatory changes; and (iii) no desmoplastic changes. Primary sites were thought to be the stomach in case 1, the pancreas in cases 2 and 4, and unknown in case 3. All patients died within 6 months after admission or endoscopic examination. As duodenal lymphangitis carcinomatosis shows characteristic endoscopic appearance, endoscopic diagnosis is not difficult. We should realize that the lesion represents extremely poor prognosis, and it should be distinguished from ordinary metastatic duodenal carcinoma.
Mayuko Takagawa, Naoki Muguruma, Kaori Oguri, Yoshitaka Imoto, Koichi Okamoto, Kunio II and Susumu Ito : Prediction of Prognosis in Gallbladder Carcinoma by Mucin and p53 Immunohistochemistry, Digestive Diseases and Sciences, Vol.50, No.8, 1410-1413, 2005.
(要約)
Mucin core proteins are known to be present in various organs and are specifically expressed with carcinogenesis and closely associated with the prognoses of various malignant tumors in the digestive tract such as colorectal cancer. The present study evaluated correlations between mucin and p53 expression and prognosis of gallbladder cancer using surgically resected tissue specimens from 26 patients with gallbladder carcinoma surgically treated at our hospital. Immunohistochemical staining was performed using MUC 1, MUC2, and p53 monoclonal antibody. The level of antigen expression in the lesion was classified into four stages: none(-), slight(+), moderate (++), and severe (+ + +). According to the UICC classification, histopathological grading, levels of T, N, and M factors, and tumor stages were compared with regard to the correlations with mucin and p53 expression. All cases were classified into two groups according to the results of mucin immunohistochemistry: group A (MUC1, > or = ++; and MUC2, < or = +) and group B (MUC1, < ++; or MUC2, > +). Postoperative survival periods were compared between the two groups and p53-positive and -negative groups. Neither histological grading nor T factor correlated with mucin or p53 expression, respectively. Moreover, neither N factor nor M factor correlated with mucin or p53 expression. Furthermore, stage grouping did not correlate with mucin or p53 expression. However, when the correlation between the postoperative survival period and mucin expression was evaluated, the mean postoperative surgical period was significantly shorter in Group A than in Group B (1.02 years in Group A vs 2.92 years in Group B; P = 0.016). There was no relationship between postoperative survival period and p53 positivity. Mucin expression was independent of various tumor growth factors and clearly reflected the prognosis of gallbladder cancer. Because the relative malignancy of gallbladder cancer could be evaluated by examining the level of glycoprotein expression in tumor tissue, mucin could be a more important marker than p53 for predicting prognosis in gallbladder carcinoma using surgically resected tissue specimens.
Akemi Tsutsui, Seisuke Okamura, Naoki Muguruma, Koji Tsujigami, Soichi Ichikawa, Susumu Ito and Kazunori Umino : Three-Dimensional Reconstruction of ENdosonographic Images of Gastric Lesions: Preliminary Experience, Journal of Clinical Ultrasound, Vol.33, No.3, 112-118, 2005.
(要約)
This study was conducted to assess the ability of the endoluminal sonographic probes to image upper gastrointestinal lesions detected with conventional endoscopy and to reconstruct 3-dimensional (3D) images. Sonographic images were obtained from 25 gastrointestinal lesions in 22 patients using a sonographic miniprobe manually drawn at a set speed across lesions detected during conventional endoscopy. 3D images were then reconstructed using an in-house software program. In 16 lesions (64%), the 3D sectional images were evaluated as good, and all 25 lesions (100%) could be visualized both transversely and longitudinally. In 12 lesions (48%), the 3D display of the endosonographic surface image corresponded to the endoscopic appearance. In all 11 cases of gastric cancer, the depth of tumor invasion measured using the 3D image was consistent with the histologic diagnosis (100% accuracy). When videotaped sonographic images were stored on a hard disk, it took an average of 3.5 minutes to obtain and display 3D images of the targeted area. 3D sonographic reconstructions of digestive lesions were useful in diagnosis, and we believe that further improvements should enhance the clinical usefulness of 3D endosonography.
Susumu Ito, Koichi Okamoto, Naoki Muguruma, T. Kimura, H. Yano, Y. Imoto, M. Kaji, R. Aoki and Seisuke Okamura : A Novel Diagnostic Method for Evaluation of Vascular Lesions in the Digestive Tract Using Infrared Fluorescence Endoscopy, Endoscopy, Vol.37, No.1, 52-57, 2005.
(要約)
We have developed an infrared fluorescence endoscope to evaluate gastrointestinal vascular lesions. Infrared endoscopy (IRE) after intravenous administration of indocyanine green (ICG) is used at present to examine vascular lesions such as esophageal varices. However, no previous study has compared the sensitivity of infrared fluorescence endoscopy (IRFE) with that of IRE. In this study, we compared the usefulness of IRFE and IRE. For IRFE we used an infrared endoscope equipped with excitation and barrier filters and an intensified charge-coupled device camera. In preliminary experiments, the observable tissue depth was assessed by wrapping increasing numbers of layers of commercially available pork around a syringe containing a uniform concentration of ICG or by changing the concentration of ICG in a syringe covered by a piece of pork of uniform thickness. In the clinical part of the study, ICG was administered intravenously at different concentrations to patients with esophageal varices and the resulting infrared fluorescent images were evaluated. The preliminary experiments revealed that the depth of tissue that could be visualized was significantly greater in IRFE than it was in IRE (11.2 mm in IRFE vs. approximately 3.2 mm in IRE). Clear infrared fluorescence was obtained by IRFE at lower concentrations of ICG than the concentrations required to obtain clear images using IRE. In the clinical part of the study, clear infrared fluorescence was observed in a region where esophageal varices had been detected by conventional endoscopy when ICG was administered in doses of 0.005 mg/kg to 0.01 mg/kg, which was lower than the doses used in IRE. Compared with conventional IRE, IRFE facilitated the observation of deeper layers, and esophageal varices were observed by IRFE following the intravenous administration of a markedly reduced dose of ICG. IRFE, in combining the characteristics of reflected infrared light and fluorescence, may be a useful novel procedure in the diagnosis of vascular lesions in the gastrointestinal tract.
Koichi Okamoto, Naoki Muguruma, Rika Aoki, Yasunori Sato, Jiro Nakamoto, Yoshitaka Imoto, Seisuke Okamura, Susumu Ito, Hiroshi Okitsu and Toshiaki Sano : A Treatment Using ST1571 for Jejunal Gastrointestinal Stromal Tumor (GIST) Accompanied with Liver Metastas and Peritoneal Dissemination, Internal Medicine, Vol.43, No.12, 1151-1156, 2004.
(要約)
A 64-year-old man with a chief complaint of melena visited our emergency outpatient clinic. After several examinations, he was diagnosed as a gastrointestinal stromal tumor (GIST) with liver metastasis. Surgical resection of the jejunal lesion and postoperative adjuvant therapy with STI571 for one year was performed. Due to recent immunohistological studies and introduction of STI571, the diagnosis, treatment, and prognosis of GIST are about to change profoundly. Further accumulation of cases is necessary to investigate the diagnosis, treatment, and prognosis of GIST.
Little attention has been paid to colorectal xanthoma. To clarify the clinical and pathological features of colorectal xanthoma, we report 28 colorectal xanthomas biopsied from 25 patients. All were composed of typical xanthoma cells and showed polypoid configuration. Median age of the patients was 64 years and there were 15 men and 10 women. Diabetes mellitus, constipation, and hyperlipidemia were found in two, one, and seven patients, respectively. Seventeen (60.7%) of the 28 polyps were located in the sigmoid colon and the remaining 11 in the rectum. Twenty-three polyps (82.1%) were sessile. Twelve (60.0%) of twenty polyps that were recorded were reddish in color. Only two polyps revealed a yellowish tone. Microscopically, foamy cells were present in the lamina propria, but the submucosa did not contain foamy cells. Immunohistochemically, the foamy cells invariably expressed extensive positivity for CD68. The colonic glands showed a deformity in the case with moderate to intense density of the foamy cells. The surface epithelium showed a hyperplastic change in 22 (78.6%) xanthomas. The colonic glands in four xanthomas were also associated with hyperplastic changes. The basement membrane of the surface epithelium was often thickened. Cell debris and proliferation of the capillaries were observed just below the surface epithelium in 19 (67.9%) and 22 (78.6%) xanthomas, respectively. Previous mucosal minute injury was suggested as the pathogenesis of colorectal xanthomas. Colorectal xanthomas were not identical to gastric and esophageal xanthoma, endoscopically or microscopically. We prefer the term "xanthomatous polyp" rather than xanthoma in the colorectal region. They may be regarded as a novel type of colorectal non-neoplastic polyp.
Masaya Tadatsu, Susumu Ito, Naoki Muguruma, Yoshihiro Kusaka, Kumi Inayama, Termi Bando, Yoko Tadatsu, Koichi Okamoto, Kunio Ii, Yoshimitsu Nagao, Shigeki Sano and Hiromi Taue : A New Infrared Fluorescent-Labeling Agent and Labeled Antibody for Diagnosing Microcancers, Bioorganic & Medicinal Chemistry, Vol.11, No.15, 3289-3294, 2003.
(要約)
We have developed infrared fluorescent labeling agents and infrared-ray fluorescence endoscopes to establish a novel diagnostic technique. Since the fluorescence intensity of the initial labeled antibody (ICG-sulfo-OSu-labeled antibody) was not sufficient for practical use, we synthesized indocyanine green acylthiazolidinethione (ICG-ATT), which was expected to label various target molecules having amino groups efficiently. To confirm imaging of infrared fluorescence intensity of ICG-ATT- and ICG-sulfo-OSu-labeled anti-MUC1 antibodies, cotton thread was soaked in various concentrations of the antibody solution in 0.1M PBS, and observed under the epi-illumination infrared fluorescence microscope. Localization and the intensity of infrared fluorescence and DAB coloring was compared in paraffin sections of human gastric mucosa. In the study of cotton threads, both labeled antibodies showed relatively clear infrared fluorescence, and significant difference was not observed between the two antibodies. ICG-ATT-labeled anti-MUC1 antibody produced stronger staining than that by ICG-sulfo-OSu-labeled antibody. Localization pattern of infrared fluorescent staining was in good agreement with that by the conventional method with oxidized DAB staining. ICG-ATT is useful as a fluorescent-labeling agent for diagnosis of microcancers by infrared fluorescence endoscopes.
K Inayama, Susumu Ito, Naoki Muguruma, Yoshihiro Kusaka, T Bando, Y Tadatsu, M Tadatsu, Kunio Ii, S Shibamura and K Takesako : Basic study of an agent for reinforcement of near-infrared fluorescence on tumor tissue, Digestive and Liver Disease, Vol.35, No.2, 88-93, 2003.
(要約)
An indocyanine green derivative (ICG-sulfo-OSu) and agents for reinforcement of infrared fluorescence, which can be used as an infrared fluorescent labeling substance suitable for detection of microlesions by an IR fluorescence endoscope, have been developed. The study aims were to confirm the ability of a reinforcement agent, as well as imaging processing, to intensify fluorescence from the labeled antibody on immunohistochemical staining. ICG-sulfo-OSu-labeled MUC1 antibody and an IR fluorescence imaging system were employed in the present study. Paraffin sections of gastric cancer were stained with anti-MUC1 antibody by the avidin-biotinylated peroxidase complex method. Among the positive specimens, three cases were used for IR imaging analysis. Octylglucoside was used as a reinforcement agent. The incubation of paraffin sections with ICG-sulfo-OSu-labeled MUC1 antibody resulted in positive staining of the tumor sites by an IR fluorescence imaging system, and the intensity of fluorescence was increased depending on the concentration of octylglucoside and grade of imaging processing. A reinforcement agent, and image processing, intensify a labeled antibody excitable by infrared fluorescence in tumor sections and can generate a strong enough fluorescent signal to detect small cancers when examined with an infrared fluorescence endoscope.
Hiroko Matsunaga, Hirohito Honda, Kenichiro Kubo, Katsutaka Sannomiya, Xuezhi Cui, Yoshio Toyota, Toshifumi Mori, Naoki Muguruma, Toshiya Okahisa, Seisuke Okamura, Ichiro Shimizu and Susumu Ito : Clinical value of the determination of serum guanase activity in patients with chronic hepatitis type C, The Journal of Medical Investigation : JMI, Vol.50, No.1-2, 64-71, 2003.
(要約)
The study examines the clinical significance of guanase (GU) measurement in patients with hepatitis C. 688 patients in whom either ALT was abnormal, or in whom HBsAg or HCVAb was detected in the serum, were enrolled into this study. The percentage of cases in which normal ALT while elevated GU was compared among the different disease groups. Then, the percentage of cases with normal ALT but elevated GU was compared between HBV and HCV groups. For the entire population, a significant correlation was observed between ALT and GU (r=0.872). The overall percentage of cases with normal ALT but elevated GU activity was 11.4%. In HCV group, 449 cases had normal ALT. Of these cases, 20.3% had elevated GU, while ALT was normal. Before 1989, no test to check donated blood for HCV antibody was available. However, screening of donated blood for high GU was associated with a reduced incidence of post-transfusion hepatitis. This is probably because following the screening, blood donated by patients with hepatitis C who had normal ALT but elevated GU was rejected. After the introduction of HCV antibody measurement, GU measurement is still useful to reveal the pathophysiological condition in-patients with chronic hepatitis type C.
(キーワード)
Alanine Transaminase / Biological Markers / Blood Donors / Comorbidity / Guanine Deaminase / Hepatitis B Surface Antigens / Hepatitis B, Chronic / Hepatitis C Antibodies / Hepatitis C, Chronic / Humans / Incidence / Japan / Mass Screening / Prospective Studies / Sensitivity and Specificity
Yoshio Toyota, Hirohito Honda, Toshihiro Omoya, Kumi Inayama, Masaharu Suzuki, Kenichiro Kubo, Masahiko Nakasono, Naoki Muguruma, Seisuke Okamura, Ichiro Shimizu, Kunio Ii and Susumu Ito : Usefulness of a hemoglobin index determined by electronic endoscopy in the diagnosis of Helicobacter pylori gastritis, Digestive Endoscopy, Vol.14, No.4, 156-162, 2002.
Masako Kamamura, Hirohito Honda, Hiroshi Inoue, Hirohiko Shinomiya, Kenichiro Kobo, Akemi Tsutsui, Naoki Muguruma, Hiroshi Shibata, Ichiro Shimizu and Susumu Ito : Study of causes of higher mortality rates from chronic liver diseases in Tokushima Prefecture, The Journal of Medical Investigation : JMI, Vol.49, No.3-4, 163-171, 2002.
(要約)
Mortality rates from chronic liver diseases (CLD) such as liver cirrhosis and hepatocellular carcinoma have been reported to be higher in Tokushima prefecture, although its causes remain unclear. To clarify the causes of CLD in Tokushima prefecture, we evaluated the positive rates of HBs antigen and anti-HCV antibody and the mortality rates from CLD in patients with liver diseases and blood donors after dividing the entire Tokushima prefecture into 8 district boundaries of health centers. In addition, to evaluate the causes of the higher frequency of CLD and the relationship between the development of CLD and viruses, medical examinations were performed in 2 mountain villages in Tokushima prefecture where the drift of population was limited and the mortality rates from CLD differed from each other. As a result, it was found that HCV infection was the major cause of the higher mortality rates from CLD in Tokushima prefecture. Although there were marked regional differences in the mortality rates from CLD, they were mainly due to different rates of HCV infection.
(キーワード)
Adult / Aged / Blood Donors / Carcinoma, Hepatocellular / Chronic Disease / Female / Hepatitis B Antibodies / Hepatitis B Surface Antigens / Hepatitis B, Chronic / Hepatitis C Antibodies / Hepatitis C, Chronic / Humans / Japan / Liver Cirrhosis / Liver Diseases / Liver Function Tests / Liver Neoplasms / Male / Middle Aged / Population Dynamics / Rural Population / Seroepidemiologic Studies
(文献検索サイトへのリンク)
● PubMed @ National Institutes of Health, US National Library of Medicine (PMID): 12323006
Terumi Bando, Naoki Muguruma, Susumu Ito, Yoko Musashi, Kumi Inayama, Yoshihiro Kusaka, Masaya Tadatsu, Kunio Ii, Tatsuro Irimura, Seiichi Shibamura and Kazuhiro Takesako : Basic studies on a labeled anti-mucin antibody detectable by infrared-fluorescence endoscopy, Journal of Gastroenterology, Vol.37, No.4, 260-269, 2002.
(要約)
We developed a fluorescent dye, indocyanine green (ICG)-sulfo-OSu, which was excited by infrared rays and conjugated to various antibodies. We attempted to clarify the staining patterns of antisulfomucin and anti-MUC1 antibodies in gastrointestinal cancer. We then evaluated the potential of the dye as a fluorescent label for antibodies specific to cancer, to be used as a diagnostic method for microcancer, with infrared fluorescence endoscopy. Paraffin sections of samples collected from 10 patients with esophageal cancer, 30 patients with gastric cancer, and 20 patients with colorectal cancer were immunohistologically stained using an anti-sulfomucin antibody and an anti-MUC1 antibody, and the staining patterns were examined. If a section had a high staining intensity, it was reacted with the ICG-suflo-OSu-labeled antibody and evaluated with infrared fluorescence imaging. The staining patterns with the antibodies varied depending on the organs and the histological types and depth of the cancers, but the staining was generally good and the staining on the mucosal surface of cancer tissues was retained. Good images of cancer cells could be obtained by infrared fluorescence observation using the ICG-sulfo-OSu-labeled anti-MUC1 antibody. The anti-MUC1 antibody stained gastrointestinal cancer cells well, and nearly specific infrared fluorescence in cancer tissues was observed using the labeled anti-MUC1 antibody. The ICG-sulfo-OSu-labeled anti-MUC1 antibody has possible usefulness for the screening of cancer via infrared fluorescence endoscopy.
S Ichikawa, Seisuke Okamura, K Tujigami, Y Kusaka, M Tadatsu, Y Okita, A Tsutsui, Naoki Muguruma, Toshiya Okahisa, Hiroshi Shibata, Ichiro Shimizu, Susumu Ito and K Umino : Quantitative Analysis of Red Color Sign in the Endoscopic Evaluation of Esophageal Varices, Endoscopy, Vol.33, No.9, 747-753, 2001.
(要約)
Bleeding due to esophageal variceal rupture is associated with an extremely high mortality rate. Variceal bleeding is frequent in patients who have a red color sign on endoscopy. However, the red color sign is subjectively evaluated on the basis of color tone and the shape of the varices. To allow standardization and facilitate consensus, an objective method of assessing the red color sign is needed. In this study, a system was established for quantifying the red color sign during endoscopic evaluation. Between July 1995 and February 1997, 55 untreated patients with portal hypertension and esophageal varices identified on upper gastrointestinal endoscopy were enrolled in the study. Images obtained about 5 cm oral to the esophagogastric junction during endoscopy were stored on magnetic optical disks using an endoscopic image processor. The still images were transmitted to a computer and analyzed using computer software. The RGB components (R, red; G, green; B, blue) were measured at points showing flare consistent with the red color sign. The endoscopic assessment was based on the Japanese Research Society for Portal Hypertension's general rules for recording endoscopic findings in esophagogastric varices. The ratio of the red color area to the variceal area increased with increasing red color grade. There were significant positive correlations between the R and G, and G and B components. This suggests that comparing the R components alone would allow assessment of the color differences in the red color area and in the varices. The R value was significantly higher in the red color area (115 +/- 20) than in the varices (57 +/- 19). An R value of 90 was found at the boundary between the two parts (P < 0.001). The red color area can be automatically calculated and quantified using the analysis program. Improvements in data storage methods may allow real-time evaluation during endoscopy in the future.
(キーワード)
Aged / Color / Endoscopy, Digestive System / Esophageal and Gastric Varices / Female / Follow-Up Studies / Gastrointestinal Hemorrhage / Humans / Hypertension, Portal / Japan / Liver Cirrhosis / Male / Middle Aged
Hitoshi Miyajima, Masahiro Nomura, Naoki Muguruma, Toshiya Okahisa, Seisuke Okamura, Hirohito Honda, Ichiro Shimizu, Masafumi Harada, Ken Saito, Yutaka Nakaya and Susumu Ito : Relationship among gastric motility,autonomic activity,and portal hemodynamics in patients with liver cirrhosis, Journal of Gastroenterology and Hepatology, Vol.16, No.6, 647-659, 2001.
(要約)
We examined the effects of the autonomic nervous function and the volume of portal blood flow to clarify the mechanism of the abnormal gastric motility in patients with liver cirrhosis. Heart rate variability, electrogastrogram (EGG), and volume of portal blood flow were measured before and after a meal in 27 patients with liver cirrhosis (LC group) and in 20 normal subjects (N group). Autonomic nervous function was evaluated by using spectral analysis of heart rate variability. We used the cine phase-contrast (PC) method, using magnetic resonance imaging (MRI) to measure the portal flow, while the peak frequency and spectral power of the EGG were measured at pre- and postprandial change. The ratio of low frequency power to high frequency power (LF/HF) was significantly higher, and the HF power was significantly lower in the LC group than in the N group both before and after a meal. In both groups, the electrogastrographic peak power ratio before and after a meal showed a positive correlation with the HF ratio, and an inverse correlation with the LF/HF ratio. In addition, portal blood flow volume was significantly decreased in the LC group than in the N group. However, the increased rate of portal blood flow after a meal correlated positively with the increased rate of electrogastrographic peak power. Moreover, gastric motility was positively correlated with esophageal varices and coma scale with the use of multivariate analysis. Parasympathetic hypofunction, sympathetic hyperfunction and portal hemodynamics were closely related with gastric motility in cirrhotic patients. In addition, gastric motility was decreased, at least in part, by the ingestion of food in cirrhotic patients because of abnormalities in autonomic functions and portal blood flow following a meal.
(キーワード)
Aged / Autonomic Nervous System / Electrophysiology / Female / Gastrointestinal Motility / Heart Rate / Hemodynamics / Humans / Liver Cirrhosis / Magnetic Resonance Imaging / Male / Middle Aged / Portal System
Naoki Muguruma, Seisuke Okamura, Soichi Ichikawa, Koji Tsujigami, Suzuki Masaharu, Masahiko Nakasono, Yoshihiro Kusaka, Masaya Tadatsu, Yoshio Okita and Susumu Ito : Asymptomatic case of congenital absence of the gallbladder, The Journal of Medical Investigation : JMI, Vol.48, No.1-2, 118-121, 2001.
(要約)
Congenital absence of the gallbladder is rare among biliary abnormalities, and its preoperative diagnosis has been considered very difficult. We encountered a patient with congenital absence of the gallbladder and suggest a possible preoperative diagnosis of the abnormality, as well as reviewing the literature.
Susumu Ito, Naoki Muguruma, Yoshiko Kusaka, Masaya Tadatsu, Mikio Yano, Terumi Bando, Hirohito Honda, Ichiro Shimizu and Kunio Ii : Detection of human gastric cancer of resected specimens using a novel infrared fluorescent anti-human carcinoembryonic antigen antibody with an infrared fluorescence endoscope in vitro., Endoscopy, Vol.33, No.10, 849-853, 2001.
(要約)
An indocyanine green derivative (ICG-sulfo-OSu) that can be used as an infrared fluorescent labeling substance suitable for detecting microlesions with an infrared fluorescence endoscope has been developed. The aims of the present study were to develop an infrared fluorescence endoscope and to demonstrate its usefulness in detecting cancerous tissue using an antibody coupled with ICG-sulfo-OSu. ICG-sulfo-OSu-labeled mouse anti-human carcinoembryonic antigen (CEA) antibody and an infrared fluorescence endoscope were used in this study. Biopsy specimens of gastric cancer were stained with anti-CEA antibody using the avidin-biotinylated peroxidase complex method. The positive specimens used for the infrared imaging analysis were freshly resected stomachs from three patients. Treatment of freshly resected stomach specimens with ICG-sulfo-OSu-labeled-anti-CEA antibody complex resulted in positive staining of the tumor sites on infrared fluorescence endoscopy, and the infrared fluorescent images correlated well with the tumor sites. An anti-CEA antibody with affinity for cancerous lesions and labeled with ICG-sulfo-OSu can therefore be imaged using this infrared fluorescence endoscope. Specific antibodies tagged with ICG-sulfo-OSu can label cancer cells and can generate a strong enough fluorescent signal to detect small cancers when examined with an infrared fluorescence endoscope.
Yoshihiro Kusaka, Susumu Ito, Naoki Muguruma, Masaya Tadatsu, Terumi Bando, Kunio Ii, Tatsuro Irimura and Seiichi Shibamura : Vital immunostaining of human gastric and colorectal cancers grafted intro nude mice : a preclinical assessment of a potential adjunct to videoendoscopy, Journal of Gastroenterology, Vol.35, No.10, 748-752, 2000.
123.
Susumu Ito, Naoki Muguruma, Shigehito Hayashi, Satoko Taoka, Terumi Bando, Yoshiko Kusaka, Soichi Ichikawa, Aya Hiasa, Toshihiro Omoya, Hirohito Honda, Ichiro Shimizu, Kunio Ii and Yoko Goto : Visualization of human gastric cancer with a novel infrared fluorescent labeling marker of anticarcinoembryonic antigen antibody in vitro., Digestive Endoscopy, Vol.12, No.1, 33-36, 2000.
Shigehito Hayashi, Naoki Muguruma, Terumi Bando, Satoko Taoka, Susumu Ito and Kunio Ii : Vital immunohistochemical staining for a novel method of diagnosing micro-cancer-examination of immunohistochemical staining of non-fixed fresh tissue-, The Journal of Medical Investigation : JMI, Vol.46, No.3-4, 178-185, 1999.
(要約)
It becomes possible to establish a novel diagnostic method for micro-cancer by modulating the signals from the lesion, if lesions can be labeled with substances which can be detected by video endoscopy. The authors have already succeeded in synthesizing indocyanine green (ICG) derivatives for a fluorescent labeling substance which emits near-infrared rays. Before the antibodies labeled by these substances can be used, it is necessary to establish a method of vital immunohistochemical staining. So, we investigated the responses of antibodies exposed to non-fixed fresh tissue specimens as a basic study on vital immunohistochemical staining. The responses of fresh esophageal and gastric specimens (biopsied or surgically resected) to immunohistochemical staining with anti-epithelial membrane antigen (EMA) antibodies under various conditions using the ABC method were examined. These tissue specimens were stained immunohistochemically, and incubated with anti-EMA antibodies for 10 and 30 minutes (esophagus), and for 60 and 120 minutes (stomach) at 37 degrees C. These results suggest that vital immunohistochemical staining is possible under optimum conditions. If an infrared fluorescent endoscopy catching this excited fluorescence can be developed, it will be possible to establish a new endoscopic diagnostic method on the basis of vital immunohistochemical staining.
Naoki Muguruma, Seisuke Okamura, Toshiya Okahisa, Hiroshi Shibata, Susumu Ito and Keiko Yagi : Endoscopic sonography in the diagnosis of xanthogranulomatous cholecystitis, Journal of Clinical Ultrasound, Vol.27, No.6, 347-350, 1999.
(要約)
Xanthogranulomatous cholecystitis (XGC) is an unusual inflammatory disease of the gallbladder that may simulate gallbladder cancer. We report the findings with conventional sonography, endoscopic sonography (EUS), and CT in 3 cases of XGC. EUS could visualize hyperechoic nodules in the gallbladder wall, probably representing xanthogranulomas, but loss of the multilayered structure of the gallbladder wall and infiltration into adjacent organs make differentiating XGC from gallbladder cancer difficult with EUS alone.
Tatsuro Ogata, Ichiro Shimizu, Takahiro Horie, Koji Yamamoto, Arata Iuchi, Masaya Tadatsu, Naoki Muguruma, Toshiya Okahisa, Seisuke Okamura and Susumu Ito : A case of a giant lipoma of the duodenal bulb., Endosc, Vol.11, No.4, 345-349, 1999.
129.
Seisuke Okamura, Akemi Tsutsui, Naoki Muguruma, Soichi Ichkawa, Masahiro Sogabe, Yoshio Okita, Tamotsu Fukuda, Shigehito Hayashi, Toshiya Okahisa, Susumu Ito and Toshiaki Sano : The utility and limitations of an ultrasonic miniprobe in the staging of gastric cancer, The Journal of Medical Investigation : JMI, Vol.46, No.1, 49-53, 1999.
(要約)
To determine the utility and limitations of an ultrasonic miniprobe (UMP) in the staging of gastric cancer, we evaluated 46 patients who underwent endoscopic ultrasonography (EUS) using an UMP and who were histologically determined to have gastric cancers. In every case, UMP findings were compared with histopathological findings after treatment. The total accuracy of UMP relative to the depth of tumor invasion was 71.7% (33/46 cases). Accuracy with respect to T1-m tumor diagnosis was 75.7% (22/29 cases), and for T1-sm, 76.9% (10/13 cases), but accuracy for T2 tumor diagnosis was low, due to ultrasound attenuation. When the analysis was carried out based on the size of tumor, the accuracy for UMP was 50.0% (9/18 cases) for all tumors over 20 mm and 85.7% (24/28 cases) for all tumors smaller than 20 mm. We conclude that UMP is suitable for investigation of tumor extension when the lesion is superficial and/or small gastric cancers which do not cause ultrasonic attenuation, but not when the tumor is large or located in certain sites, although conventional EUS is useful in some of these cases.
(キーワード)
Aged / Endosonography / Female / Humans / Male / Neoplasm Staging / Sensitivity and Specificity / Stomach Neoplasms
Naoki Muguruma, Susumu Ito, T Bando, S Taoka, Y Kusaka, S Hayashi, S Ichikawa, Y Matsunaga, Y Tada, S Okamura, K Ii, K Imaizumi, K Nakamura, K Takesako and S Shibamura : Labeled carcinoembryonic antigen antibodies excitable by infrared rays : a novel diagnostic method for micro cancers in the digestive tract, Internal Medicine, Vol.38, No.7, 537-542, 1999.
131.
Naoki Muguruma, Susumu Ito, Shigehito Hayashi, Satoko Taoka, Hiromasa Kakehashi, Kunio Ii, Seiichi Shibamura and Kazuhiro Takesako : Antibodies labeled with fluorescence-agent excitable by infrared rays, Journal of Gastroenterology, Vol.33, No.4, 467-471, 1998.
132.
Naoki Muguruma, Seisuke Okamura, Toshiya Okahisa, M Yasuda, S Hayashi, H Shibata and Susumu Ito : Electrohydraulic lithotripsy treatment for persimmon bezoars., Digestive Endoscopy, Vol.30, No.5, S60, 1998.
133.
Susumu Ito, Naoki Muguruma, Shigehito Hayashi, Satoko Taoka, Terumi Bando, Kumi Inayama, Masahiro Sogabe, Toshiya Okahisa, Seisuke Okamura, Hiroshi Shibata, Tatsuro Irimura, Kazuhiro Takesako and Seiichi Shibamura : Development of agents for reinforcement of fluorescence on near-infrared ray excitation for immunohistological staining, Bioorganic & Medicinal Chemistry, Vol.6, No.5, 613-618, 1998.
134.
Junya Inoi, Ichiro Shimizu, Yasuhiro Tsuji, Naoki Muguruma and Susumu Ito : Effect of administration of ursodeoxycholic acid at bedtime on cholesterol saturation of hepatic bile in Japanese patients with gallstone, The Journal of Medical Investigation : JMI, Vol.45, No.1,4, 115-122, 1998.
(要約)
The administration of a single, daily 600 mg dose of ursodeoxycholic acid (UDCA) at bedtime and 3-200 mg doses per day at mealtime was conducted for 6 patients with gallstone and choledocholithiasis who were undergoing biliary drainage for the purpose of improving jaundice. Hepatic bile was collected from a drainage tube after a lapse of time in order to compare the bile acid compositions and cholesterol saturation index (SI) in bile for the 2 protocols. A significant increase in UDCA levels in hepatic bile was observed after both UDCA administration at bedtime and mealtime, but the effect of bedtime administration was significantly greater than that of mealtime administration. Whereas levels of cholic acid and chenodeoxycholic acid (CDCA) decreased for the case of bedtime administration, this was not detected for mealtime administration, although no significant differences among the mean interval values were observed. A significant in difference decreased SI was observed during UDCA bedtime administration, but not during mealtime administration, compared to the SI before administration. This suggests a decreased cholesterol excretion into the bile. Based on these findings and from the point of view of compliance, bedtime administration of UDCA appears to be an effective method.
(キーワード)
Adult / Aged / Bile / Bile Acids and Salts / Cholagogues and Choleretics / Cholelithiasis / Cholesterol / Drug Administration Schedule / Eating / Female / Gallstones / Humans / Male / Middle Aged / Ursodeoxycholic Acid
Terukage Hirata, Hiromi Kogiso, Kenji Morimoto, Satoshi Miyamoto, Hiromi Taue, Shigeki Sano, Naoki Muguruma, Susumu Ito and Yoshimitsu Nagao : Synthesis and Reactivities of 3-Indocyanine-green-acyl-1,3-thiazolidine-2-thione (ICG-ATT) as a New Near-Infrared Fluorescent-labeling Reagent, Bioorganic & Medicinal Chemistry, Vol.6, No.11, 2179-2184, 1998.
136.
Susumu Ito, Naoki Muguruma, Shigehito Hayashi, Satoko Taoka, Akemi Tsutsui, Tamotsu Fukuta, Toshiya Okahisa, Yoshio Ohkita and Ichiro Shimizu : Development of an imaging system using fluorescent labeling substances excited by infrared rays., Digestive Endoscopy, Vol.9, No.4, 278-282, 1997.
137.
Ichiro Shimizu, Susumu Ito, Takeshi Takaoka, Naoki Muguruma, Toshimasa Fukuda, Tatsuhiko Okabe, Minoru Horikita, Singo Hibino, Hiroshige Hayashi and Hirohito Honda : Prevention of posttransfusional non-A, non-B hepatitis by a screen test for hepatitis C virus antibody of donor bloods., The Tokushima Journal of Experimental Medicine, Vol.38, No.1, 19-23, 1991.
学術論文(紀要・その他):
1.
T Goji, Seisuke Okamura, H Takeuchi, Tetsuo Kimura, Shinji Kitamura, Katsuyoshi Tamaki, Koichi Okamoto, Masako Kaji, Naoki Muguruma, Toshiya Okahisa, J Shunto and Tetsuji Takayama : Migrated Endoclip and Stone Formation after Cholecystectomy: A Case Treated by Endoscopic Sphincterotomy, Internal Medicine, Vol.48, No.23, 2015-2017, 2009.
(要約)
Endoclip migration into the common bile duct following laparoscopic cholecystectomy (LC) is an extremely rare complication. Migrated endoclip into the common bile duct can cause obstruction, serve as a nidus for stone formation, and cause cholangitis. We report a case of cholangitis due to a migrated endoclip and consequent choledocholithiasis 6 years after LC, which was successfully treated by endoscopic extraction.
(キーワード)
Aged / Cholecystectomy / Common Bile Duct / Foreign-Body Migration / Gallstones / Humans / Male / Postoperative Complications / Sphincterotomy, Endoscopic / Surgical Instruments
Naoki Muguruma and Tetsuji Takayama : Endoscopic Sclerotherapy with Aluminum Potassium Sulfate and Tannic Acid: An Effective and Less Invasive Strategy for Internal Hemorrhoids, Clinical Endoscopy, Vol.52, No.6, 521-522, 2019.
Takanori Kashihara, Naoki Muguruma, Shota Fujimoto, Yoshihiko Miyamoto, Yasushi Sato and Tetsuji Takayama : Recent Advances in Molecular Imaging of Colorectal Tumors., Digestion, Vol.102, No.1, 57-64, Dec. 2020.
(要約)
Recent endoscopic studies have revealed that small colorectal tumors are often overlooked during colonoscopy, indicating that more sensitive detection methods are needed. Molecular imaging has received considerable attention as a new endoscopic technique with high sensitivity. It generally employs a fluorescence-labeled compound that specifically binds to a molecule on the tumor. Fluorescent probes for molecular imaging are largely classified as 2 types: a fluorescence-labeled antibody targeting a molecule specifically expressed on the tumor cell surface such as epidermal growth factor receptor or vascular endothelial growth factor (VEGF); and a fluorescence-labeled small molecule compound targeting a molecule specifically expressed in tumor cells including c-Met, glutathione S-transferase, γ-glutamyltranspeptidase, cathepsin, or endothelin A receptor. These probes successfully detected colorectal tumors in several animal studies. Moreover, 3 recent human clinical trials evaluating endoscopic molecular imaging for colorectal tumors have been reported. In one study, a Cy5-labeled synthetic peptide against c-Met was developed, and fluorescent endoscopic observation with this probe detected a greater number of colorectal adenomas than with white light observation. Another trial used IR800-labeled anti-VEGF antibody, which sensitively detected human colorectal adenomas by fluorescent endoscopy. Last, a fluorescent probe with synthetic peptide against BRAF-positive cells was able to visualize sessile serrated lesions. The fluorescent probes accumulated at very high levels in colorectal tumor cells but at lower levels in surrounding nonneoplastic mucosa. Key Messages: We expect that molecular imaging techniques with fluorescent probes will soon lead to the establishment of a highly sensitive endoscopic method for colorectal tumor detection.
Susumu Ito, Naoki Muguruma, Tetsuo Kimura, Hiromi Yano, Yoshitaka Imoto, Koichi Okamoto, Masako Kaji, Shigeki Sano and Yoshimitsu Nagao : Principle and Clinical Usefulness of the Infrared Fluorescence Endoscopy, The Journal of Medical Investigation : JMI, Vol.53, No.1/2, 1-8, Feb. 2006.
(要約)
Since there is no infrared fluorescence materials in the living body, infrared fluorescence labeling materials are very useful for making a diagnosis of a micro cancer. We have developed an infrared fluorescence endoscope (IRFE) and indocyanin green (ICG)-derivative as infrared fluorescence labeling materials to evaluate gastrointestinal neoplastic lesions. The study aims were to apply an IRFE and to demonstrate its usefulness in detecting cancerous tissue using an antibody coupled with ICG-derivative. IRFE consisted of an infrared endoscope equipped with excitation (710-790 nm) and barrier (810-920 nm) filters and an intensified CCD camera. We have developed ICG N-hydroxy sulfo succinimide ester (ICG-sulfo-OSu) and 3-ICG-acyl-1, 3-thiazolidine-2-thione (ICG-ATT) as an infrared fluorescent-labeling reagent. ICG-derivative-labeled mouse anti-human carcinoembryonic antigen (CEA) antibody and MUC1 antibody were employed in this study. Moreover, we examined the ability of a reinforcement agent, octylglucoside, to intensity fluorescence from the labeled antibody. Biopsy specimens of gastric cancer were stained with anti-CEA antibody by the avidin-biotinylated peroxidase complex method. Among the positive specimens, freshly resected stomach from three cases were used for the infrared (IR) imaging analysis. The incubation of freshly resected stomach specimens with ICG-anti-CEA antibody-complex resulted in positive staining of the tumor sites by IRFE, and the IR fluorescent images correlated well with the tumor sites. The immunohistochemical studies suggested that the intensity of IR fluorescence of ICG-ATT-MUC1 was stronger than that of ICG-sulfo-OSu. In tumor sections, the reinforcement agent intensified fluorescence, ever at low antibody concentrations. Therefore, we conclude that an anti-CEA (and/or MUC1) antibody with affinity for cancerous lesions and labeled with ICG-derivative can be imaged with this IRFE. Specific antibodies tagged with ICG-derivative with the reinforcement agent can label cancer cells and generate a strong enough fluorescent signal to detect small cancers when examined with an IR fluorescence endoscope.
Naoki Muguruma, Fujimoto Daisaku, Yasuteru Fujino, Kashihara Takanori, Kazuyoshi Noda, Fukuya Akira, Takehara Masanori, Hirao Akihiro, Hironori Tanaka, Takahiro Tanaka, Tetsu Tomonari and Tetsuji Takayama : Linked Color Imaging System in the Endoscopic Detection of Sessile Serrated Adenoma/Polyp, Korea International Digestive Endoscopy Congress 2019, Aug. 2019.
(キーワード)
Image-enhanced endoscopy / Linked color imaging / Sessile serrated adenoma/polyp
9.
Naoki Muguruma, Koichi Okamoto and Tetsuji Takayama : Advanced Endoscopic Imaging in Colorectal Lesions, Korea International Digestive Endoscopy Congress 2019, Aug. 2019.
(キーワード)
Colorectal cancer / Image-enhanced endoscopy / Molecular imaging
10.
Hironori Tanaka, Tetsu Tomonari, Takahiro Tanaka, Akihiro Hirao, Fumika Nakamura, Kumiko Tanaka, Koichi Okamoto, Yasushi Sato, Masahiro Sogabe, Hiroshi Miyamoto, Naoki Muguruma and Tetsuji Takayama : Therapeutic efficacy of chemoradiotherapy with Miriplatin for hepatocellular carcinoma., digestive disease week2019, San Diego, May 2019.
11.
Jinsei Miyoshi, Noriaki Murayama, Kumiko Tanaka, Takahiro Tanaka, Fumika Nakamura, Yasuteru Fujino, Keiichiro Matsumura, Miwako Kagawa, Tetsu Tomonari, Shinji Kitamura, Koichi Okamoto, Hiroshi Miyamoto, Yasushi Sato, Naoki Muguruma and Tetsuji Takayama : Development of a Novel Mirna-Based Signature to Predict Invasion and Metastasis in Rectal Neuroendocrine Tumors., digestive disease week2019, Vol.156, No.6, 133, San Diego, May 2019.
Naoki Muguruma, Koichi Okamoto, Shota Fujimoto, Tadahiko Nakagawa, Katsutaka Sannomiya, Yasuhiro Mitsui, Tetsuo Kimura, Hiroshi Miyamoto, Mitsuo Shimada, Yoko Horino, Shinya Matsumoto, Kenjiro Hanaoka and Tetsuji Takayama : Optical Molecular Imaging of Aberrant Crypt Foci in the Human Colon by Glutathione S-Transferase-Activated Fluorogenic Probe., Digestive Disease Week2017, Chicago, May 2017.
21.
Shota Fujimoto, Naoki Muguruma, Koichi Okamoto, Misaki Miwa, Yoshihiko Miyamoto, Yoshifumi Takaoka, Koichi Tsuneyama and Tetsuji Takayama : A New Theranostic Combination of Fluorescent Molecular Imaging and Laser Therapy Targeting C-Kit in Gastrointestinal Stromal Tumors., Digestive Disease Week2017, Chicago, May 2017.
22.
Masanori Takehara, Naoki Muguruma, Koichi Okamoto, Kazuyoshi Noda, Kaizo Kagemoto, Yuri Matsumoto, Tadahiko Nakagawa, Shunsaku Takeishi, Jun Okazaki, Daisaku Fujimoto, Shinji Kitamura, Tetsuo Kimura, Hiroshi Miyamoto and Tetsuji Takayama : Endoscopic Resection is safe and effective for rectal carcinoid tumors., The First World Congress of Gastrointestinal Endoscopy,, Hyderabad, Feb. 2017.
23.
Tomoyuki Kawaguchi, Naoki Muguruma, Koichi Okamoto, Kumiko Tanaka, Satoshi Teramae, Yasuhiro Mitsui, Yoshifumi Takaoka, Tatsunao Sueuchi, Takahiro Goji, Shinji Kitamura, Masako Kimura, Tetsuo Kimura, Hiroshi Miyamoto and Tetsuji Takayama : Assessment of small bowel capsule endoscopy and APC gene mutation in familial adenomatous polyposis., The First World Congress of Gastrointestinal Endoscopy, Hyderabad, Feb. 2017.
24.
Masahiro Sogabe, Toshiya Okahisa, Tadahiko Nakagawa, Noriaki Murayama, Masanori Takehara, Kaizo Kagemoto, Yoshifumi Takaoka, Tetsu Tomonari, Tatsuya Taniguchi, Tetsuo Kimura, Naoki Muguruma and Tetsuji Takayama : Influence of Lifestyle and Lifestyle-Related Disease on Nonalcoholic Fatty Liver Disease in Japanese With Metabolic Syndrome, Digestive Disease Week2016, San Diego, May 2016.
25.
Tatsuya Taniguchi, Hironori Tanaka, Takahiro Tanaka, Tetsu Tomonari, Kazuhiro Kishi, Hiroshi Miyamoto, Naoki Muguruma, Masahiro Sogabe, Tadahiko Nakagawa and Tetsuji Takayama : Des-g-carboxy Prothrombin (DCP) Is Produced by Overexpression of Prothrombin Gene in Hepatocellular Carcinoma, Digestive Disease Week2016, San Diego, May 2016.
26.
Tetsu Tomonari, Shunsaku Takeishi, Tatsuya Taniguchi, Takahiro Tanaka, Hironori Tanaka, Tetsuo Kimura, Koichi Okamoto, Hiroshi Miyamoto, Naoki Muguruma and Tetsuji Takayama : MRP3 As a Novel Resistance Factor for Sorafenib in Hepatocellular Carcinoma, Digestive Disease Week2016, San Diego, May 2016.
27.
Yoshihiko Miyamoto, Naoki Muguruma, Shota Fujimoto, Tadahiko Nakagawa, Shinji Kitamura, Tetsuo Kimura, Koichi Okamoto, Masahiro Sogabe, Toshiya Okahisa and Tetsuji Takayama : Molecular Imaging Targeting Epidermal Growth Factor Receptor in Detection and Evaluation of Therapeutic Efficacy for Colorectal Cancer, Digestive Disease Week2016, San Diego, May 2016.
28.
Tetsuji Takayama, Naoki Muguruma and Koichi Okamoto : Chemoprevention for Colorectal Cancer targeting Aberrant Crypt Foci, The 5th International Forum,The 102nd General Meeting of the Japanese Society of Gastroenterology, Tokyo, Apr. 2016.
Naoki Muguruma, Miyamoto Yoshihiko, Fujimoto Shota, Okada Yasuyuki, Shinji Kitamura, Tetsuo Kimura, Koichi Okamoto, Hiroshi Miyamoto and Tetsuji Takayama : Optical Molecular Imaging and Assessment of Therapeutic Response of Colorectal Cancer Targeting Epidermal Growth Factor Receptor, World Congress of Molecular Imaging 2014, Sep. 2014.
33.
Kagawa Miwako, Toshiya Okahisa, Takaoka yoshifumi, Yasuteru Fujino, Jinsei Miyoshi, Takaoka Toshi, Tetsu Tomonari, Shinji Kitamura, Okada Yasuyuki, Kagemoto Kaizo, Takehara Masanori, Kumiko Tanaka, Matsumoto Sayo, Teramae Tomofumi, Hiroshi Miyamoto, Naoki Muguruma, Tetsuji Takayama and Takaoka Toshi : Angiogenesis-Related Factors At the Residual Inflammation in Patients With Ulcerative Colitis in Clinical Remission Stage, Digestive Disease Week2014, Chicago, May 2014.
34.
Akina Nakanishi, Toshiya Okahisa, Emi Umezu, Tadahiko Nakagawa, Miwako Kagawa, Toshi Takaoka, Takahiro Goji, Hiromi Yano, Shinji Kitamura, Takahiro Goji, Hiroshi Miyamoto, Naoki Muguruma and Tetsuji Takayama : Expression of Thymidline EMT via ERK 1/2 Signal Patway in Ulcerative Colitis, DDW2013,Orland, Orange County Convention Center, Orlando, May 2013.
35.
Yasuteru Fujino, Koichi Okamoto, Naoki Muguruma, Jun Okazaki, Yasuyuki Okada, Hironori Tanaka, Jinsei Miyoshi, Toshi Takaoka, Shinji Kitamura, Hiroshi Miyamoto, Toshiya Okahisa and Tetsuji Takayama : Usefulness of a new sphincterotome for the endoscopic submucosal dissection of colorectal neoplasms, DDW2013, Orlando, May 2013.
36.
Naoki Muguruma, Kwon Kwang-an, Al-Quarshobi Issa, Donnellan Fergal, Swan P. Michael, Streutker Catherine, Cirocco Maria, May R. Gary, Kandel Gabor, Kortan P. Paul and Marcon E. Norman : The Role of Endoscopic Resection in the Diagnosis and Treatment of Gastric Inflammatory Fibroid Polyp, DDW 2010, New Orleans, May 2010.
37.
H Takeuchi, Seisuke Okamura, T Kimura, T Itagaki, K Okamoto, M Kaji, H Miyamoto, Naoki Muguruma and Susumu Ito : Simple and appropriate pretreatment for nasal endoscopy: Usefulness of vasoconstrictor nose drop, Digestive disease Week 2007, Washington, D.C., May 2007.
38.
Masahiro Sogabe, Toshiya Okahisa, Koji Tsujigami, Yoshio Okita, Hirokazu Hayashi, Toshikatsu Taniki, Hiroshi Hukuno, Masahiko Nakasono, Naoki Muguruma, Seisuke Okamura and Susumu Ito : Ultrasonographic assessment of gastric motility in diabetic gastroparesis before and after attaining glycemic control., Journal of Gastroenterology, Vol.40, No.6, 583-590, Jul. 2005.
(要約)
Glycemic control is important for maintaining gastric motility in diabetic patients, but gastric motility has not yet been studied ultrasonographically in relation to glycemic control. We made such observations before and after establishing glycemic control in diabetic patients with gastroparesis. We studied 30 diabetic patients with upper abdominal digestive symptoms who were hospitalized for correction of poor blood sugar control and who underwent upper digestive tract endoscopy to rule out structural causes such as gastric/duodenal lesions. Gastric motility was evaluated by transabdominal ultrasonography, using a test meal, before and after attainment of glycemic control (within 3 days after admission and 3 days before discharge). Also, upper abdominal digestive symptoms present on admission and at discharge were compared. After glycemic control was established, contractions of the antral region were more frequent than before the attainment of control (8.93 +/- 1.17/3 min vs 7.63 +/- 2.22/3 min, respectively; P < 0.001). Glycemic control also significantly improved gastric emptying (before glycemic control, 49.2 +/- 14.8%; after, 67.1 +/- 11.5%; P < 0.001). This was also true for the motility index, concerning antral gastric contractility (before control, 2.97 +/- 1.57; after, 3.75 +/- 1.09; P < 0.05). Upper abdominal symptom scores were also significantly lower after attainment of control than before (0.47 +/- 0.78 vs 3.17 +/- 2.00, respectively; P < 0.001). These findings suggest that attaining glycemic control improves gastric motility and attainments upper abdominal symptoms in diabetic patients with gastroparesis.
(キーワード)
Adult / Aged / Aged, 80 and over / Blood Glucose / Diabetes Mellitus, Type 1 / Diabetes Mellitus, Type 2 / Female / Follow-Up Studies / Gastric Emptying / Gastroparesis / Humans / Male / Middle Aged / Severity of Illness Index
U Eiko, Masahiro Nomura, Kohzou Uehara, Naoki Muguruma, Seisuke Okamura, Yutaka Nakaya and Susumu Ito : , Influence in gastrointestinal endoscopy on circulatory dynamics: Relation with pulse wave velocity, The 7th Asia/Oceania Regional Congress of Gerontology, Tokyo, 2003.
40.
Hitoshi Miyajima, Masahiro Nomura, Tomomi Nada, Naoki Muguruma, Toshiya Okahisa, Hiroshi Shibata, Seisuke Okamura, Hirohito Honda, Ichiro Shimizu, Susumu Ito and Yutaka Nakaya : Abnormal gastric motility in liver cirrhosis: Effect of autonomic nervous function and volume of portal blood flow, The 7th United European Gastroenterology Week, Roma,Italy, 1999.
41.
Ken Saito, Yutaka Nakaya, Masahiro Nomura, N Takeuchi, Naoki Muguruma, Fumiko Kishi, Hirokazu Miyoshi and Hiromu Nishitani : Study on the excitation process during ventricular depolarization in normal subjects by magnetocardiogram, The 9th International Conference on Biomagnetism, Wien, 1993.
Akinari Kasai, Jinsei Miyoshi, Akihiro Haga, Takashi Kawanaka, Koichi Okamoto, Naoki Muguruma, Yasushi Sato and Tetsuji Takayama : CT-based AI radiomics model for predicting complete response and progression free survival of chemoradiothearapy in ESCC., 第80回日本癌学会学術総会, Oct. 2021.
14.
Beibei Ma, Hiroyuki Ueda, Naoki Muguruma, Koichi Okamoto, Tomoyuki Kawaguchi, Akira Fukuya, Yoshifumi Kida, Yasuyuki Okada, Tatsuya Taniguchi, Yasushi Sato and Tetsuji Takayama : Activation of EGFR signaling pathway in the left-side colorectal cancerLeft-side vs. right-side cancer organoids., 第80回日本癌学会学術総会, Sep. 2021.
Recently, immune checkpoint inhibitors(ICI)have been approved for use in advanced gastric cancer(AGC)based on the positive results of ATTRACTION‐2 trial in Japan. There has been accumulating evidence that the development of immune-related adverse events(irAE)may be associated with a response to ICI therapy, particularly in lung cancer, although little is known about these correlations in gastrointestinal cancer. To investigate the efficacy and irAE of ICI treatment and their correlation in AGC, we retrospectively examined 29 patients with AGC who received nivolumab therapy in our departments. Among them, 15 patients(52%)developed irAEs including 4 patients(14%)for grade 3 irAEs ; liver dysfunction(n＝2), type 1 diabetes mellitus(n＝2) and adrenal insufficiency(n＝1). The median overall survival was12．0months in the irAE group and 3．25 months in the non-irAE group(p＝0．164), which suggested the relationship between the effects and irAEs in ICI treatment of AGC. Further research is required to understand the implications of irAE characteristics on ICI response in GCA patients.
Tetsuji Takayama, Koichi Okamoto and Naoki Muguruma : Surrogate marker for chemoprevention study on colorectal cancer Molecular imaging of aberrant crypt foci., 第78回日本癌学会学術総会, Sep. 2019.
37.
Tadahiko Nakagawa, Toshihito Tanahashi, yoshihiko miyamoto, Jun Okazaki, masanori takehara, noriaki murayama, Jinsei Miyoshi, Tatsuya Taniguchi, Yoshimi Bando, Koichi Okamoto, Yasushi Sato, Naoki Muguruma and Tetsuji Takayama : JMJD2A (KDM4A) sensitizes metastatic gastric cancer to chemotherapy by cooperating CCDC8., 第78回日本癌学会学術総会, Sep. 2019.
38.
yoshihiko miyamoto, Naoki Muguruma, yasuyuki okada, Hironori Tanaka, Jun Okazaki, Koichi Okamoto, Yasushi Sato and Tetsuji Takayama : EGFR-targeted molecular imaging for detection and treatment evaluation of colorectal tumors in animal model., 第78回日本癌学会学術総会, Sep. 2019.
39.
Hironori Tanaka, Koichi Okamoto, 岡田 泰行, 宮本 佳彦, Yasuhiro Mitsui, Fumika Nakamura, Jinsei Miyoshi, Yasuteru Fujino, Takahiro Tanaka, Tetsu Tomonari, Shinji Kitamura, Hiroshi Miyamoto, Naoki Muguruma, Yasushi Sato and Tetsuji Takayama : Therapeutic efficacy of miriplatin in combination with radiotherapy for advanced hepatocellular carcinoma., 第17回日本臨床腫瘍学会学術集会, Jul. 2019.
Yasuhiro Mitsui, Shinji Kitamura, Koichi Okamoto, Yasushi Sato, Naoki Muguruma and Tetsuji Takayama : Clinicopathological characteristics of Gastric adenocarcinoma with proximal polyposis of the stomach., 第91回日本胃癌学会総会, Mar. 2019.
Daisaku Fujimoto, Naoki Muguruma and Tetsuji Takayama : Usefulness of linked color imaging in endoscopic diagnosis of SSA/P: A novel image enhancment technique., 第24回日本消化器関連学会週間, Nov. 2016.
Tetsuo Kimura, Naoki Muguruma and Tetsuji Takayama : Suppressive effect of the farnesyltransferase inhibitor for aberrant crypt foci as a precursor of colorectal cancer., 第56回日本消化器病学会大会(JDDW2014), Oct. 2014.