我が国における糖尿病患者は約740万人であり, 死因の39%は心血管合併症である。腎症は30～40%でみられ, 合併症対策が最も重要である。特に腎症は他の大血管合併症を併発し, その対策は大切な課題である。末期腎不全で透析導入される患者は毎年増加しており 25万人以上の透析患者になっている。その原因疾患として糖尿病腎症が急激な増加を示しており約40%を占める。その透析導入後の予後も悪く, 5年生存率が約50%である。

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リゾリン脂質メディエーターであるリゾホスファチジン酸 (lysophosphatidic acid: LPA) およびスフィンゴシン1-リン酸 (sphingosine 1-phosphate: SIP) は多彩な生理活性を有し, 受容体の存在も解明され, さらに血漿中濃度がその作用発現濃度に近いため, 加伽oでの役割が注目されている。本稿では, この二つのリゾリン脂質メディエーターの肝臓病における意義を明らかにすべく今までの知見につき紹介する。in vitroおよびin vivoのデータからはLPAとSIPは, ともに肝臓の再生および線維化に関連していることが示唆され, これらの作用の修飾による治療学の確立も期待される。

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Background Anti-cytokine therapy is an effective therapy for rheumatoid arthritis. To know the kinetics of cytokine expression, we investigated mice with arthritis induced by anti-type II collagen monoclonal antibody (anti-CII Abs) plus lipopolysaccharide (LPS).
Methods BALB/c mice (7 weeks' age) were injected i. v. with anti-CII Abs 2mg/mouse and 3 days later injected i. p.with 50μg of LPS. Mice developed arthritis, and the cytokine expressions in extracted legs were determined by RT-PCR. Serum cytokine concentrations were measured using ELISA. In addition, both sets of data were compared with those of TNF gene-deficient mice.
Results After induction of arthritis in wild-type mice, mRNA expression of TNF-α increased early, followed by IL-18. IL-1β and IL-6 mRNA expressions rose comparatively later. TNF-α, IL-1β and IL-6 concentrations in the serum reflected the level of their mRNA expressions. Interestingly, serum IL-18 level showed two distinct peaks, at early and later phase. In contrast, arthritis did not develop in TNF-α-deficient mice, and no elevation of IL-1β or IL-6 in either serum or tissue mRNA was observed at any time point. Further, no increase in tissue mRNA levels was seen in TNF-α-deficient mice, however, there was a significant increase in serum IL-18 concentrations in the later phase.
Conclusion This study demonstrates that mRNA levels of TNF-α and IL-18 in both serum and joint tissue are increased, in the early phase with different patterns in mice with arthritis induced by anti-CII Abs plus LPS; IL-1β and IL-6 levels also increased in the later phase. The results using TNF-α-deficient mice indicate that TNF-α might play a crucial role as a key upstream molecule in the cytokine network of early inflammatory arthritis, and that TNF-αmight trigger the synthesis of several other cytokines.

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われわれは, ノイラミニダーゼ処理とプロテアーゼ処理を行った試料を用いてALPのアガロースゲル電気泳動を行い, 骨型ALP (BAP) 分画活性値を求めた。その結果, 高分子小腸型ALP (HLAP) はBAP分画と重なる位置に検出された。また, HIAPを含む検体をプロテアーゼ処理するとα₂β位のBAPが減少し, β位の低分子サイズの通常の小腸型ALPが増加したことから, アイソザイム検査に用いる試料をプロテアーゼ処理することが必須であると考えられた。なお, プロテアーゼ処理試料を用いたアガロースゲル電気泳動法から求めたBAP分画活性値は, ELISA法より求めたBAP活性値と高い相関 (r=0.982) があったことから, 臨床評価に充分耐えられる方法と考えられた。

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This guideline describes the procedure of reliability evaluation on hemoglobin Alc (HbAlc) measurement to meet the traceability chain in HbAlc reference systern in Japan. The accuracy of routine measurement procedures shall be validated by manufacturers according to manufacturer's standard operating procedures. Routine laboratories shall maintain accuracy of measurement based on the manufacturer's validation.
The accuracy of measurement is expressed by uncertainty estimated according to ISO Guide 33. Performance evaluation of routine measurement procedures should be based on the measurements which are composed of ten runs of measurement a day or two runs of measurements per day and continue to ten days against the evaluation material in this guideline. The material to be used for the performanceevaluation for HbAlc measurement (QRM HbAlc) is prepared and distributed by HECTEF Standard Reference Center. This material has five concentration levels and assigned values by using JSCC reference measurement procedure using KO500 method calibrated by JCCLS CRM-004.
Validation criterion is determined for each evaluation procedure. These criteria suggest how manufacturer's validation should maintain traceability to the working reference material (JCCLS CRM-004). The internal quality control system in the routine measurement laboratory is required to maintain ±0.2% (JDS value) as an uncertainty.

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Japan has been hit by many food safety and false labeling scandals based on dishonesty and/or falsehood. The nature of the Japanese public as “being too trusting” tends to make matters worse and accelerates a mindset of abnormal precaution as food scandals shatter the “food safety myth. ” In fact, this leads people to pursue a zero-risk attitude towards food safety which is scientifically unobtainable. Other food concerns involve ethical issues of food distribution. For example, the over-importing of food from developing nations puts a strain on the developing nation to feed its own people. Another example would be health damage (nausea and/or diarrhea) caused after trying a poorly researched diet as aired on one of Japan's health food TV programs. Clinical chemists have worked together and contributed much to the realm of food safety together with clinicians, but their role should be expanded to include not only the field of analytical chemistry, but to also include the sociological and philosophical aspects of food and food distribution. This requires the proposal of a new term “ESCAOLOGY. ” The concept of a Virtual Institute for Escaology is also proposed in order for clinical chemists to work together in full cooperation.

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