Gastric Composite Tumor of Alpha Fetoprotein-Producing Carcinoma/Hepatoid Adenocarcinoma and Endocrine Carcinoma with Reference to Cellular Phenotypes

Alpha-fetoprotein-producing carcinoma (AFPC)/hepatoid adenocarcinoma (HAC) and neuroendocrine carcinoma (NEC) are uncommon in the stomach. Composite tumors consisting of these carcinomas and their histologic phenotypes are not well known. Between 2002 and 2007, to estimate the prevalence of composite tumors consisting of tubular adenocarcinoma, AFPC/HAC and NEC, we reviewed specimens obtained from 294 consecutive patients treated surgically for gastric cancer. We examined histological phenotype of tumors of AFPC or NEC containing the composite tumor by evaluating immunohistochemical expressions of MUC2, MUC5AC, MUC6, CDX2, and SOX2. Immunohistochemically, AFPC/HAC dominantly showed the intestinal or mixed phenotype, and NEC frequently showed the gastric phenotype. In the composite tumor, the tubular and hepatoid components showed the gastric phenotype, and the neuroendocrine component showed the mixed type. The unique composite tumor predominantly showed the gastric phenotype, and the hepatoid and neuroendocrine components were considered to be differentiated from the tubular component

Analysis of Risk Factors for High-dose Cisplatin-induced Renal Impairment in Head and Neck Cancer Patients

Background/Aim:Concurrent chemoradiotherapy with high-dose cisplatin (CDDP-RT) is the standard therapy for advanced head and neck cancer; however, due to CDDP-induced renal impairment, dose reduction or discontinuation is frequently required. Therefore, the identification of risk factors for renal impairment is of importance to improve the efficacy and safety of CDDP-RT.Patients and Methods: We retrospectively investigated risk factors for renal impairment in advanced head and neck cancer patients receiving CDDP-RT. Renal impairment was defined as a >25% decrease from baseline in estimated glomerular filtration rate within 14 days after CDDP administration in the first cycle.Results:Of the 82 patients analyzed in this study, 21 (26%) patients developed renal impairment. Multivariate logistic regression analysis showed that concomitant use of a calcium channel blocker or lower hemoglobin levels significantly contributed to the increased risk of CDDP-induced renal impairment (odds ratio=3.60, 95% confidence interval=1.04-12.40; odds ratio=0.71, 95% confidence interval=0.50-0.99, respectively), while concomitant use of proton pump inhibitors was a factor associated with a decreased risk of CDDP-induced renal impairment (odds ratio=0.20, 95% confidence interval=0.04-0.86).Conclusion:Renal function of patients receiving calcium channel blocker or patients with lower hemoglobin levels should be monitored cautiously when receiving CDDP-RT

Transcriptional Activation of Low-Density Lipoprotein Receptor Gene by DJ-1 and Effect of DJ-1 on Cholesterol Homeostasis

DJ-1 is a novel oncogene and also causative gene for familial Parkinson’s disease park7. DJ-1 has multiple functions that include transcriptional regulation, anti-oxidative reaction and chaperone and mitochondrial regulation. For transcriptional regulation, DJ-1 acts as a coactivator that binds to various transcription factors, resulting in stimulation or repression of the expression of their target genes. In this study, we found the low-density lipoprotein receptor (LDLR) gene is a transcriptional target gene for DJ-1. Reduced expression of LDLR mRNA and protein was observed in DJ-1-knockdown cells and DJ-1-knockout mice and this occurred at the transcription level. Reporter gene assays using various deletion and point mutations of the LDLR promoter showed that DJ-1 stimulated promoter activity by binding to the sterol regulatory element (SRE) with sterol regulatory element binding protein (SREBP) and that stimulating activity of DJ-1 toward LDLR promoter activity was enhanced by oxidation of DJ-1. Chromatin immunoprecipitation, gel-mobility shift and co-immunoprecipitation assays showed that DJ-1 made a complex with SREBP on the SRE. Furthermore, it was found that serum LDL cholesterol level was increased in DJ-1-knockout male, but not female, mice and that the increased serum LDL cholesterol level in DJ-1-knockout male mice was cancelled by administration with estrogen, suggesting that estrogen compensates the increased level of serum LDL cholesterol in DJ-1-knockout female mice. This is the first report that DJ-1 participates in metabolism of fatty acid synthesis through transcriptional regulation of the LDLR gene

DJ-1 degrades transthyretin and an inactive form of DJ-1 is secreted in familial amyloidotic polyneuropathy.

DJ-1 plays roles in transcriptional regulation and anti-oxidative stress, and loss of its function is thought to result in the onset of Parkinson's disease. DJ-1 has a protease-like structure and transthyretin (TTR), a protein causing familial amyloidotic polyneuropathy (FAP), was identified as a substrate for DJ-1 protease in this study. Both TTR and DJ-1 were secreted into the culture medium under normal conditions, and secreted TTR was not aggregated. Under oxidative conditions, TTR but not DJ-1 was secreted into the culture medium, resulting in aggregation. Mirror images of both the expression patterns and solubility of DJ-1 and TTR were observed in tissues of FAP patients, and an unoxidized form of DJ-1, an inactive form, was secreted into the serum of FAP patients. These results suggest that oxidative stress to cells abrogates secretion of DJ-1 and that secreted DJ-1 degrades aggregated TTR to protect against the onset of FAP

小児期の近位型脊髄性筋萎縮症の臨床像と分子遺伝学的診断

脊髄性筋萎縮症(SMA)は脊髄の前角細胞の変性,脱落により,筋萎縮や筋力低下を呈する常染色体性劣性の遺伝病である.本疾患は発症年齢,最高到達運動能力,経過により3つの型に分類される.分子遺伝学的には,1990年に3型ともに5q13に存在することが証明され,さらに1995年SMAの候補遺伝子としてSMN(survival motor neuron)遺伝子とNAIP(neuronal apoptosis inhibitory protein)遺伝子が報告された.本研究ではSMA患者を臨床的に分類し,SMN遺伝子,NAIP遺伝子について解析した.また,臨床型と遺伝子学的解析結果の関係を検討した.対象はSMA患者39名と精神遅滞,心肥大を各々伴つたatypical SMA2名である.1990年のInternational SMA Collaboration Workshop Reportの臨床型分類をもとに39名を分類した.この分類における発症年齢,最高到達運動能力,経過の3つの基準のすべてを満たし,臨床型に分類できたのは39例中20例であった.発症年齢,運動能力,経過のそれぞれについて分類した結果,発症年齢,経過では幅拡い臨床像を示し,臨床的に分類するのには最高到達運動能力および経過が有用であった.また,遺伝子解析の結果,全体の85%(33/39:I型90%,II型100%,III型54%)においてSMN遺伝子のexon 7のみ,またはexon 7および8のホモ接合性の欠失を認めた.また,I型の2名(5% 2/39)においてSMN遺伝子の欠失と同時にNAIP遺伝子のexon 5および欠失が認められた.両遺伝子の認められた2例ともに1型の重症例であったが,その他のSMN遺伝子のみの欠失した症例は臨床症状にかなりの幅が認めれていた.いずれの欠失も認められなかつた7例のうち5例は皿型であった.以上より臨床的重症度と遺伝子の欠失サイズの相関が示唆された.atypical SMAのうち1例にSMN遺伝子の欠失が認められた.また,精神遅滞をともなつた1例は欠失が認められず,異なる疾患の可能性も考えられた.Spinal muscular atrophy (SMA) is an autosomal recessive disorder characterized by degenration of anterior horn cells in the spinal cord, leading to symmetrical proximal muscle weakness and atrophy. Affected individuals are classified into three types depending on the onset age, highest motor functional ability and clinical course. In 1990, the gene for SMA was mapped to chromosome region 5g13 for all three types of SMA. In 1995, the SMN (survival motor neuron) and NAIP (neuronal apoptosis inhibitory protein) genes were reported as candidate genes for SMA. In this study, we analyzed clinical features of SMA patients and deletions of these two candidate genes. The subjects included 39 SMA patients and two atypical SMA cases, one with mental retardation and the other with cardiomegaly. We classified 39 SMA cases based on the classification devised by the International SMA Consortium Meeting Report. Twenty cases satisfied all three criteria of this classification, and could clearly be classified as one of the three types. Our results of classifying cases according to each criterion suggested that clinical features of SMA constitute a broad spectrum encompassing the three types. Thus, it is most useful to classify patients according to their highest motor functional ability. Thirty-three cases of typical SMA (85% of all, 90% of type I, 100% of type II and 54% of type III) showed deletions of exons 7 and 8 or only exon 7 of the SMN gene. Two of type I (5% of all) showed deletions of exon 5 and 6 of the NAIP gene with deletions of the SMA genes. The other cases (2 of type I and 5 of type III) had no deletions of these genes. Involvement of the SMN and NAIP genes appears to be related to the severity of SMA. The one atypical case showed deletion of the SMN gene. The other one with mental retardation may be heterogeneous

小児期の近位型脊髄性筋萎縮症の臨床像と分子遺伝学的診断

脊髄性筋萎縮症(SMA)は脊髄の前角細胞の変性,脱落により,筋萎縮や筋力低下を呈する常染色体性劣性の遺伝病である.本疾患は発症年齢,最高到達運動能力,経過により3つの型に分類される.分子遺伝学的には,1990年に3型ともに5q13に存在することが証明され,さらに1995年SMAの候補遺伝子としてSMN(survival motor neuron)遺伝子とNAIP(neuronal apoptosis inhibitory protein)遺伝子が報告された.本研究ではSMA患者を臨床的に分類し,SMN遺伝子,NAIP遺伝子について解析した.また,臨床型と遺伝子学的解析結果の関係を検討した.対象はSMA患者39名と精神遅滞,心肥大を各々伴つたatypical SMA2名である.1990年のInternational SMA Collaboration Workshop Reportの臨床型分類をもとに39名を分類した.この分類における発症年齢,最高到達運動能力,経過の3つの基準のすべてを満たし,臨床型に分類できたのは39例中20例であった.発症年齢,運動能力,経過のそれぞれについて分類した結果,発症年齢,経過では幅拡い臨床像を示し,臨床的に分類するのには最高到達運動能力および経過が有用であった.また,遺伝子解析の結果,全体の85%(33/39:I型90%,II型100%,III型54%)においてSMN遺伝子のexon 7のみ,またはexon 7および8のホモ接合性の欠失を認めた.また,I型の2名(5% 2/39)においてSMN遺伝子の欠失と同時にNAIP遺伝子のexon 5および欠失が認められた.両遺伝子の認められた2例ともに1型の重症例であったが,その他のSMN遺伝子のみの欠失した症例は臨床症状にかなりの幅が認めれていた.いずれの欠失も認められなかつた7例のうち5例は皿型であった.以上より臨床的重症度と遺伝子の欠失サイズの相関が示唆された.atypical SMAのうち1例にSMN遺伝子の欠失が認められた.また,精神遅滞をともなつた1例は欠失が認められず,異なる疾患の可能性も考えられた.Spinal muscular atrophy (SMA) is an autosomal recessive disorder characterized by degenration of anterior horn cells in the spinal cord, leading to symmetrical proximal muscle weakness and atrophy. Affected individuals are classified into three types depending on the onset age, highest motor functional ability and clinical course. In 1990, the gene for SMA was mapped to chromosome region 5g13 for all three types of SMA. In 1995, the SMN (survival motor neuron) and NAIP (neuronal apoptosis inhibitory protein) genes were reported as candidate genes for SMA. In this study, we analyzed clinical features of SMA patients and deletions of these two candidate genes. The subjects included 39 SMA patients and two atypical SMA cases, one with mental retardation and the other with cardiomegaly. We classified 39 SMA cases based on the classification devised by the International SMA Consortium Meeting Report. Twenty cases satisfied all three criteria of this classification, and could clearly be classified as one of the three types. Our results of classifying cases according to each criterion suggested that clinical features of SMA constitute a broad spectrum encompassing the three types. Thus, it is most useful to classify patients according to their highest motor functional ability. Thirty-three cases of typical SMA (85% of all, 90% of type I, 100% of type II and 54% of type III) showed deletions of exons 7 and 8 or only exon 7 of the SMN gene. Two of type I (5% of all) showed deletions of exon 5 and 6 of the NAIP gene with deletions of the SMA genes. The other cases (2 of type I and 5 of type III) had no deletions of these genes. Involvement of the SMN and NAIP genes appears to be related to the severity of SMA. The one atypical case showed deletion of the SMN gene. The other one with mental retardation may be heterogeneous