Molecular Bases and Phenotypic Determinants of Aromatase Excess Syndrome

Aromatase excess syndrome (AEXS) is a rare autosomal dominant disorder characterized by gynecomastia. This condition is caused by overexpression of CYP19A1 encoding aromatase, and three types of cryptic genomic rearrangement around CYP19A1, that is, duplications, deletions, and inversions, have been identified in AEXS. Duplications appear to have caused CYP19A1 overexpression because of an increased number of physiological promoters, whereas deletions and inversions would have induced wide CYP19A1 expression due to the formation of chimeric genes consisting of a noncoding exon(s) of a neighboring gene and CYP19A1 coding exons. Genotype-phenotype analysis implies that phenotypic severity of AEXS is primarily determined by the expression pattern of CYP19A1 and the chimeric genes and by the structural property of the fused exons with a promoter function (i.e., the presence or the absence of a natural translation start codon). These results provide novel information about molecular mechanisms of human genetic disorders and biological function of estrogens

アロマターゼ阻害剤による子宮筋腫・子宮内膜症の治療に関する基礎的・臨床的研究

金沢大学医学部附属病院本研究の成果は、以下の5点に集約される。1.子宮筋腫組織ではアロマターゼ発現が亢進しており、この亢進はGnRH analogueの投与により消失することを明らかにした。GnRH analogue投与は卵巣でのエストロゲン合成を低下させるが、今回の研究により子宮筋腫組織内でのエストロゲン(in situt estrogen)の合成を同時に低下させることを初めて明らかにした。GnRHanalogue投与では自然閉経に比較して子宮筋腫の縮小は急激かつ高度であるが、in situ estrogenの低下はこの理由を説明する可能性がある。2.子宮筋腫培養細胞にエストロゲン合成基質であるアンドロステンジオンを添加するとその増殖が促進される。この増殖促進効果はアロマターゼ阻害剤の添加により阻止することができる。3.ラットを用いた動物実験では、アロマターゼ阻害剤投与により無排卵状態が惹起されるが、投与中止により速やかに排卵周期が回復する。性周期回復後、妊孕性も速やかに回復しアロマターゼ阻害剤には長期効果はないことが確認された。4.学内倫理委員会の承認を得て、アロマターゼ阻害剤投与による子宮筋腫治療の臨床治験を開始した。閉経期に近いと考えられた患者では、子宮筋腫が著明に縮小して臨床症状が速やかに改善した。5.子宮内膜症細胞のアロマターゼは、転写因子SF-1/AD4BPにより局所的に発現が制御されているものと考えられた。その発現プロモーターPIIに結合するトランスエレメントは、顆粒膜細胞のそれとは異なるものであった。また、IL-1βにより制御される点で顆粒膜細胞における発現制御と異なっていた。Non steroidal anti-inframatory drugs(NSAIDs)やNF-kB阻害剤などによるプロモーター特異的発現抑制治療の可能性が示された。1. Leiomyoma of the uterus expresses estrogen synthetase (aromatase) and synthesize estrogen in situ. Preoperative GnRH agonist therapy abolishes aromatase expression in leiomyoma tissues in situ in addition to aromatase expression in the ovary. This combined suppression may explain why GnRH agonists induced shrinkage of leiomyoma more rapidly and more profoundly than natural menopause.2. Addition of androstenedione stimulates cell proliferation of leiomyoma cells in culture. This growth stimulatory action was completely canceled by the pretreatment with an aromatase inhibitor (fadrozole).3. Oral administration of fadrozole (1mg/kg/day,>1 weeks) induced anovulatory state in rats. Estrus cycles were recovered within 1 week after the discontinuation of fadrozole.4. Oral fadrozole (2mg/day) induced rapid and profound regression of leiomyoma and resolved bulk-related symptoms of a perimenopausal woman. The potential uses of aromatase inhibitors was demonstrated.5. AF-1/AD4BP binds to a nuclear half site of the most proximal promoter of aromatase (PII) and up-regulates the transcription of aromatase in endometriosis cells. Cis elements of PII promoter of aromatase, therefore its regulation, were quite different between endometriosis and the ovary, suggesting that tissues-specific and promoter-specific modulation of aromatase expression is possible.研究課題/領域番号:12557136, 研究期間(年度):2000 – 2002出典：「アロマターゼ阻害剤による子宮筋腫・子宮内膜症の治療に関する基礎的・臨床的研究」研究成果報告書　課題番号12557136（KAKEN：科学研究費助成事業データベース（国立情報学研究所））（https://kaken.nii.ac.jp/ja/report/KAKENHI-PROJECT-12557136/125571362002kenkyu_seika_hokoku_gaiyo/)を加工して作

新生仔期のデヒドロエピアンドロステロン・アセテ-ト投与の雌ラット生殖機能に及ぼす影響に関する研究

取得学位 : 博士（医学）, 学位授与番号 : 医博乙第1267号,学位授与年月日：平成6年2月16日,学位授与年：199

エストロゲン合成酵素の遺伝子多型が酵素活性および乳癌の発生率に及ぼす影響

金沢大学附属病院乳癌およびその周囲の脂肪組織では健常組織に比較しエストロゲン合成酵素(アロマターゼ)が高発現しており、局所でのエストロゲンが産生が亢進している。このエストロゲンは乳癌の発育・進展に深く関わっている。本研究では、このアロマターゼ発現量を規定する遺伝因子の関与について検討した。5\u27-RACE法により乳癌粗織からアロマターゼの新規発現プロモーター(I.7)をクローニングした。RT-PCR法による半定量では、乳癌組織のアロマターゼcDNAの39-54%がこの新規promoterからの転写によるものと推定された。このプロモーターの発現は、乳癌の周囲の脂肪組織にもみられたがその発現量は乳癌に比して低かった。さらに、このプロモーターにあるGATA binding siteにGATA-2がおもに結合し、転写を正に調節していることを、各種のプロモーターコンストラクトを用いたtransfection、DNA footprintingおよびelectromobility shift assayにより確認した。従って、この新規プロモーターはおもに上皮細胞に発現する転写因子により調節されており、この新規プロモーターはがん周囲の間葉由来の細胞ではなく、上皮由来の乳癌細胞に特異的に発現するプロモーターと考えられた。がん細胞自身が合成したエストロゲンは、周囲の脂肪細胞で合成され拡散により運ばれてくるエストロゲンに比し効率よくがん細胞自身の発育を促進すると考えられることから、今後はこの新規プロモーターを中心にがん細胞自身のアロマターゼ発現について検討する必要があると考えられた。そこでこのプロモーター領域の再シークエンスを行いSNP侯補領域を同定した。現在、Light cyclerを用いてこれらの部位のSNPを検索するためのシステムを開発している。また、倫理委員会の承認を受けて、連結可能匿名化をおこなった乳癌患者および対照者の血液サンプル(おのおの100名をめざしている)を収集中である。この遺伝子多型と乳癌との関連について現在検討中である。さらに、遺伝的にアロマターゼ発現が亢進している家系の遺伝子解析を行い、アロマターゼ遺伝子近傍の染色体微少逆位によって本症が生じたものであることを明らかにした。研究課題/領域番号:14031209, 研究期間(年度):2002出典：「エストロゲン合成酵素の遺伝子多型が酵素活性および乳癌の発生率に及ぼす影響」研究成果報告書　課題番号14031209（KAKEN：科学研究費助成事業データベース（国立情報学研究所））（https://kaken.nii.ac.jp/ja/grant/KAKENHI-PROJECT-14031209/)を加工して作

Colonization by Clostridium difficile of neonates in a hospital, and infants and children in three day-care facilities of Kanazawa, Japan

The intestinal-carriage rates of i>Clostridium difficile in neonates hospitalized in the University Hospital’s Center for Perinatal and Reproductive Health and in infants and children enrolled in two day-nurseries and a kindergarten were examined. Swab samples from the floors of these facilities were also analyzed to determine the extent of environmental contamination by this organism. C. difficile was found in the stool of only one of 40 neonates during the normal 1-week stay in the hospital after delivery. The isolate from the neonate was identical to that of her mother, as determined by PCR ribotyping, pulsed-field gel electrophoresis analysis, and toxin gene type, suggesting that the C. difficile-positive neonate acquired the organism from her mother rather than from the environment. By contrast, 47 (48.0%) of the 98 infants and children, comprising 50 enrolled in two daynurseries who were ≤3 years old and 48 enrolled in a kindergarten who were 2–5 years old, carried C. difficile. The carriage rate in infants under 2 years of age was much higher (84.4%) than in children 2 years old and older (30.3%). When analyzed according to age group, the carriage rates were 100, 75.0, 45.5, 24.0, 38.5, and 23.5% in infants and children 0, 1, 2, 3, 4, and 5 years old, respectively. The observation that several children were colonized with the same type of C. difficile strain in each day-care facility, and that the floors of day-nursery A and kindergarten C were contaminated with C. difficile strains identical to those colonizing the intestines of children enrolled in those facilities suggests that cross-infection of C. difficile among children occurs through C. difficile-carrying children or their contaminated environments. [Int Microbiol 2005; 8(1):43-48

Identification of a Predictive Biomarker for the Beneficial Effect of Keishibukuryogan, a Kampo (Japanese Traditional) Medicine, on Patients with Climacteric Syndrome

Keishibukuryogan (KBG; Guizhi-Fuling-Wan in Chinese) is one of the Kampo (Japanese traditional) medicines used to treat patients with climacteric syndrome. KBG can be used by patients who cannot undergo hormone replacement therapy due to a history of breast cancer. We evaluated whether cytosine-adenine (CA) repeat polymorphism of the estrogen receptor β gene can be a predictor of the beneficial effect of KBG on climacteric syndrome. We also investigated the relationship between CA repeat polymorphism, the patients’ profiles, and the therapeutic effect. We found that CA was an SS, SL, or LL genotype according to the number of repeats. We studied 39 consecutive patients with climacteric disorders who took KBG for 12 weeks. The diagnosis of climacteric disorders was made on the basis of the Kupperman index. KBG significantly improved the patients’ climacteric symptoms (i.e., vasomotor symptoms in the patients with the LL genotype and melancholia in the patients with the SL genotype). No relationship between the patients’ profiles and CA repeat polymorphism was recognized. CA repeat polymorphism could thus be a potential biomarker to predict the efficacy of KBG in climacteric syndrome, and its use will help to reduce the cost of treating this syndrome by focusing the administration of KBG on those most likely to benefit from it

Antenatal antiarrhythmic treatment for fetal tachyarrhythmias: a study protocol for a prospective multicentre trial

Introduction Several retrospective or single-centrestudies demonstrated the efficacy of transplacentaltreatment of fetal tachyarrhythmias. Our retrospectivenationwide survey showed that the fetal therapy willbe successful at an overall rate of 90%. For fetuseswith hydrops, the treatment success rate will be 80%.However, standard protocol has not been established.The objective of this study is to evaluate the efficacy andsafety of the protocol-defined transplacental treatment offetal tachyarrhythmias. Participant recruitment began inOctober 2010.Methods and analysis The current study is a multicentre,single-arm interventional study. A total of 50 fetuseswill be enrolled from 15 Japanese institutions. Theprotocol-defined transplacental treatment is performed forsingletons with sustained fetal tachyarrhythmia ≥180 bpm,with a diagnosis of supraventricular tachycardia or atrialflutter. Digoxin, sotalol, flecainide or a combination is usedfor transplacental treatment. The primary endpoint isdisappearance of fetal tachyarrhythmias. The secondaryendpoints are fetal death related to tachyarrhythmia,proportion of preterm birth, rate of caesarean sectionattributable to fetal arrhythmia, improvement in fetalhydrops, neonatal arrhythmia, neonatal central nervoussystem disorders and neonatal survival. Maternal, fetal andneonatal adverse events are evaluated at 1 month afterbirth. Growth and development are also evaluated at 18and 36 months of corrected age.Ethics and dissemination The Institutional Review Boardof the National Cerebral and Cardiovascular Center ofJapan has approved this study. Our findings will be widelydisseminated through conference presentations and peerreviewedpublications

Small primary adenocarcinoma in adenomyosis with nodal metastasis: a case report

<p>Abstract</p> <p>Background</p> <p>Malignant transformation of adenomyosis is a very rare event. Only about 30 cases of this occurrence have been documented till now.</p> <p>Case presentation</p> <p>The patient was a 57-year-old woman with a slightly enlarged uterus, who underwent total hysterectomy and unilateral adnexectomy. On gross inspection, the uterine wall displayed a single nodule measuring 5 cm and several small gelatinous lesions. Microscopic examination revealed a common leiomyoma and multiple adenomyotic foci. A few of these glands were transformed into a moderately differentiated adenocarcinoma. The endometrium was completely examined and tumor free. The carcinoma was, therefore, considered to be an endometrioid adenocarcinoma arising from adenomyosis. Four months later, an ultrasound scan revealed enlarged pelvic lymph nodes: a cytological diagnosis of metastatic adenocarcinoma was made.</p> <p>Immunohistochemical studies showed an enhanced positivity of the tumor site together with the neighbouring adenomyotic foci for estrogen receptors, aromatase, p53 and COX-2 expression when compared to the distant adenomyotic glands and the endometrium. We therefore postulate that the neoplastic transformation of adenomyosis implies an early carcinogenic event involving p53 and COX-2; further tumor growth is sustained by an autocrine-paracrine loop, based on a modulation of hormone receptors as well as aromatase and COX-2 local expression.</p> <p>Conclusion</p> <p>Adenocarcinoma in adenomyosis may be affected by local hormonal influence and, despite its small size, may metastasize.</p