Treatment for Churg-Strauss Syndrome: Induction of Remission and Efficacy of Intravenous Immunoglobulin Therapy

ABSTRACTChurg-Strauss syndrome (CSS) is characterized by the presence of asthma, eosinophilia, and small-vessel vasculitis with granuloma. It is a distinct entity, as determined from all classifications of systemic vasculitis. The poor prognostic factors in CSS are renal insufficiency, cardiomyopathy, severe gastrointestinal (GI) tract, and central nervous systems (CNS) involvement. The initial management of CSS should include a high dose of a corticosteroid: prednisone at 1 mg/kg/day or its equivalent for methylprednisolone with tapering over 6 months. In patients with severe or rapidly progressing CSS, the administration of methylprednisolone pulse at 1 g/body/day for 3 days is recommended. When corticosteroid therapy does not induce remission, or when patients have poor prognostic factors, immunosuppressive cytotoxic therapy is indicated. However, some patients with severe CSS often show resistance to conventional treatment. We think that IVIG therapy is a hopeful candidate for second-line treatment for CSS patients, particularly in the case of neuropathy and/or cardiomyopathy, which are resistant to conventional therapy. However, there is not much evidence supporting the effectiveness of IVIG in CSS, and the mechanisms underlying the action of IVIG remain unclear. Now we are performing clinical trials of IVIG therapy for CSS patients who are resistant to conventional treatment, through a nationwide double-blinded placebo-controlled study in Japan

High Energy Particle Measurements during Long Discharge in LHD

The spatial resolved energy spectra can be observed during a long discharge of NBI plasma bycontinuously scanning the neutral particle analyzer. In these discharges, the plasmas are initiated by the ECH heating, after that NBI#2 (Co-injection) sustains the plasma during 40-60 seconds. The scanned pitch angle is from 44 degrees to 74 degrees. The injected neutral beam (hydrogen) energy of NBI#2 is only 130 keV because the original ion source polarity is negative. The shape of spectra is almost similar from 44 degrees to 53 degrees. However the spectra from 55 degrees are strongly varied. It reflects the injection pitch angle of the beam according to the simulation (53 degrees ot R* = 3.75 m in simulation). The beam keeps the pitch angle at incidence until the beam energy becomes to the energy, which the pitch angle scattering is occurred by the energy loss due to the electron collision. The low flux region can be observed around 10-15 keV, which is 15 times of the electron temperature. The energy region may be equal to the energy at which the pitch angle scattering is occurred. At the energy, the particle is scattered by the collision with the plasma ions and some of particles may run away from the plasma because they have a possibility to enter the loss cone. According to the simulation, the loss cone can be expected at the 10 keV with the small angular dependence. The depth of the loss cone is deep at the small pitch angle. The hollow in the spectrum may be concluded to be the loss cone as the tendency is almost agreed with the experimental result

Integrating Statistical Predictions and Experimental Verifications for Enhancing Protein-Chemical Interaction Predictions in Virtual Screening

Predictions of interactions between target proteins and potential leads are of great benefit in the drug discovery process. We present a comprehensively applicable statistical prediction method for interactions between any proteins and chemical compounds, which requires only protein sequence data and chemical structure data and utilizes the statistical learning method of support vector machines. In order to realize reasonable comprehensive predictions which can involve many false positives, we propose two approaches for reduction of false positives: (i) efficient use of multiple statistical prediction models in the framework of two-layer SVM and (ii) reasonable design of the negative data to construct statistical prediction models. In two-layer SVM, outputs produced by the first-layer SVM models, which are constructed with different negative samples and reflect different aspects of classifications, are utilized as inputs to the second-layer SVM. In order to design negative data which produce fewer false positive predictions, we iteratively construct SVM models or classification boundaries from positive and tentative negative samples and select additional negative sample candidates according to pre-determined rules. Moreover, in order to fully utilize the advantages of statistical learning methods, we propose a strategy to effectively feedback experimental results to computational predictions with consideration of biological effects of interest. We show the usefulness of our approach in predicting potential ligands binding to human androgen receptors from more than 19 million chemical compounds and verifying these predictions by in vitro binding. Moreover, we utilize this experimental validation as feedback to enhance subsequent computational predictions, and experimentally validate these predictions again. This efficient procedure of the iteration of the in silico prediction and in vitro or in vivo experimental verifications with the sufficient feedback enabled us to identify novel ligand candidates which were distant from known ligands in the chemical space

DOCK2 is involved in the host genetics and biology of severe COVID-19

「コロナ制圧タスクフォース」COVID-19疾患感受性遺伝子DOCK2の重症化機序を解明 --アジア最大のバイオレポジトリーでCOVID-19の治療標的を発見--. 京都大学プレスリリース. 2022-08-10.Identifying the host genetic factors underlying severe COVID-19 is an emerging challenge. Here we conducted a genome-wide association study (GWAS) involving 2, 393 cases of COVID-19 in a cohort of Japanese individuals collected during the initial waves of the pandemic, with 3, 289 unaffected controls. We identified a variant on chromosome 5 at 5q35 (rs60200309-A), close to the dedicator of cytokinesis 2 gene (DOCK2), which was associated with severe COVID-19 in patients less than 65 years of age. This risk allele was prevalent in East Asian individuals but rare in Europeans, highlighting the value of genome-wide association studies in non-European populations. RNA-sequencing analysis of 473 bulk peripheral blood samples identified decreased expression of DOCK2 associated with the risk allele in these younger patients. DOCK2 expression was suppressed in patients with severe cases of COVID-19. Single-cell RNA-sequencing analysis (n = 61 individuals) identified cell-type-specific downregulation of DOCK2 and a COVID-19-specific decreasing effect of the risk allele on DOCK2 expression in non-classical monocytes. Immunohistochemistry of lung specimens from patients with severe COVID-19 pneumonia showed suppressed DOCK2 expression. Moreover, inhibition of DOCK2 function with CPYPP increased the severity of pneumonia in a Syrian hamster model of SARS-CoV-2 infection, characterized by weight loss, lung oedema, enhanced viral loads, impaired macrophage recruitment and dysregulated type I interferon responses. We conclude that DOCK2 has an important role in the host immune response to SARS-CoV-2 infection and the development of severe COVID-19, and could be further explored as a potential biomarker and/or therapeutic target

Extension of the operational regime of the LHD towards a deuterium experiment

As the finalization of a hydrogen experiment towards the deuterium phase, the exploration of the best performance of hydrogen plasma was intensively performed in the large helical device. High ion and electron temperatures, Ti and Te, of more than 6 keV were simultaneously achieved by superimposing high-power electron cyclotron resonance heating onneutral beam injection (NBI) heated plasma. Although flattening of the ion temperature profile in the core region was observed during the discharges, one could avoid degradation by increasing the electron density. Another key parameter to present plasma performance is an averaged beta value $\left\langle \beta \right\rangle$ . The high $\left\langle \beta \right\rangle$ regime around 4% was extended to an order of magnitude lower than the earlier collisional regime. Impurity behaviour in hydrogen discharges with NBI heating was also classified with a wide range of edge plasma parameters. The existence of a no impurity accumulation regime, where the high performance plasma is maintained with high power heating  >10 MW, was identified. Wide parameter scan experiments suggest that the toroidal rotation and the turbulence are the candidates for expelling impurities from the core region

日本睡眠歯科学会口腔内装置診療ガイドライン作成委員会の活動報告

Oral appliance therapy was approved by national health insurance in Japan in 2004 and oral appliances（OAs）have since been widely used in the treatment of obstructive sleep apnea（OSA）. We herein described the process of making clinical practice guidelines by the task force of the Japanese Academy of Dental Sleep Medicine as a work report. In Japan, OAs are covered by national health insurance. In consideration of the balance between medical treatment fees and the price of technical materials, we used a single-piece（monoblock）OA that advanced the mandible forward and limited mouth opening in OSA patients in Japan. The Japanese Academy of Dental Sleep Medicine（JADSM）focused on OAs frequently used for the treatment of OSA in Japan, and considered an evaluation of their effects to benecessary. Clinical practice guidelines were developed using the Grading of Recommendations, Assessment, Development, and Evaluation（GRADE）system. We recommend OAs that advanced the mandible forward and limited mouth opening for patients with OSA.However, CPAP should be used by patients for whom it has been indicated. OAs are desirable for those who cannot use CPAP（GRADE 1B, strong recommendation/quality of evidence, “Moderate quality”）. The long-term effects and side effects, OSA severity, and comorbidities of OA therapy were not examined, which represented a limitation to the present study. In future studies, the Japanese Academy of Dental Sleep Medicine plan to update clinical practice guidelines for oral appliances used in OSA

Anti-inflammatory and bronchoprotective roles of endogenous prostaglandin E2

Prostaglandin E2 (PGE2) is produced by resident cells in the airway, such as airway epithelial cells, airway smooth muscle cells and alveolar macrophages, and is always present in the airway. Various exogenous and endogenous stimuli cause immediate increases in PGE2 from several-fold to multiples of 10-fold. Prostaglandin E2 controls the function of cells that contribute to immune and inflammatory responses, such as lymphocytes, eosinophils, mast cells, macrophages and polymorphonuclear cells, and exhibits suppressor activity in the initial and advanced stages of allergic airway inflammation (establishment of sensitization, induction of early asthmatic response, chemotaxis of inflammatory cells and continuation of the late asthmatic response). Therefore, if the endogenous protective effects of PGE2 are weakened or absent, inflammation and hypersensitive responses readily occur in the airway. Although the effects of PGE2 remain to be clarified, the possibility of the involvement of decreased PGE2 activity in the pathogenesis of asthma exists. However, in aspirin-induced asthma the role of PGE2 as a protective factor, through an as yet undetermined mechanism, is marked. It is thought that, in this type of asthma, symptoms may be induced by the elimination of the protective action of PGE2 by non-steroidal anti-inflammatory drugs (NSAID). It is possible that PGE2 agonists that produce little airway irritation and drugs that raise the endogenous PGE2 level have potential as new types of anti-inflammatory or anti-asthma drugs

Selective Consumption of Fish Oil at End of the Day Increases the Physiological Fatty Acid Compositions of Eicosapentaenoic Acid and Docosahexaenoic Acid in Mice

Diets with high daily fat consumption are associated with excess weight. However, the effects of fat type and consumption timing on excess weight remain unclear. We investigated the selection of a 30% (w/w) fat diet of soybean oil (SOY), lard (LARD), and fish oil (FISH) on the metabolic parameters of mice. Male C57BL/6 mice were divided into the double SOY-box (w-SOY), SOY-box/LARD-box (SOY-vs-LARD), or SOY-box/FISH-box (SOY-vs-FISH) groups and allowed to selectively consume for 8 weeks. The total energy intake was similar for all groups, but the mice selectively chose to consume LARD over SOY and SOY over FISH. Body weight in the SOY-vs-LARD group was significantly higher than that in the w-SOY and SOY-vs-FISH groups. Additionally, minimal but selective consumption of an omega-3 fatty-acid-rich FISH diet at the end of the active period increased the physiological fatty acid compositions of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in the SOY-vs-FISH group; their metabolic parameters were also lower than the SOY-vs-LARD group. In conclusion, selectively consuming small amounts of fish oil at the end of the day may prevent excess weight compared with LARD consumption