Japanese Journal of Clinical Immunology
Online ISSN : 1349-7413
Print ISSN : 0911-4300
ISSN-L : 0911-4300
Volume 34, Issue 3
Displaying 1-7 of 7 articles from this issue
Review Articles
  • Satoshi FUKUSHIMA, Hironobu IHN, Yasuharu NISHIMURA, Satoru SENJU
    2011 Volume 34 Issue 3 Pages 113-120
    Published: 2011
    Released on J-STAGE: June 30, 2011
    JOURNAL FREE ACCESS
      It was recently revealed that ES-cell like pluripotent stem cells, designated as iPS cells, can be generated from somatic cells. iPS cells could be used as not only a source of regeneration medicine, but also a source of cell vaccine. Pluripotent stem cells are characterized by pluripotency and infinite propagation capacity. Non-virus-mediated methods for gene transfer have been established. Genetic modification of pluripotent stem cells and subsequent in vitro differentiation to dendritic cells would be an attractive strategy. Here we describe the previous studies about cancer immunotherapy by utilizing dendritic cells derived from pluripotent stem cells.
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  • Shigeru KOTAKE, Yuki NANKE
    2011 Volume 34 Issue 3 Pages 121-130
    Published: 2011
    Released on J-STAGE: June 30, 2011
    JOURNAL FREE ACCESS
      Spondyloarthritis (SpA) includes reactive arthritis (ReA) and enteropathic arthritis (EA), which are clinically important but often misdiagnosed. ReA, sterile inflammatory arthritis, arises after certain genitourinary or gastrointestinal infections. Chlamydia are the most common pathogens causing ReA; ReA due to Chlamydia infection is called Chlamydia-associated arthritis (Chl-AA). Recently, Chlamydia trachomatis was detected in the synovial tissue from patients with ReA by electronmicroscopy. In addition, mRNA as well as DNA has been detected in the synovial tissue, suggesting that Chlamydia are viable in inflamed joints. Thus, the notion that ReA is a sterile inflammation should be reconsidered. Chl-AA patients, especially women, often show no symptoms and signs of genitourinary infection. Thus, Chl-AA should be suspected in patients with inflammatory arthritides that is difficult to diagnose. EA is accompanied by inflammatory bowel diseases (IBD). In Japan, over 130,000 individuals have IBD; IBD is diagnosed in 6,500 individuals every year. Around 10% IBD patients develop arthritis, suggesting that 13,000 patients develop arthritis every year. SpA includes peripheral and axial arthritis; axial arthritis includes spondylitis and sacroiliac arthritis. Sacroiliac joint tests need to be performed to diagnose sacroiliac arthritis. Rheumatologists should be aware of the pathogenesis of Chl-AA and EA and diagnose and treat these diseases appropriately.
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  • Yasuto ARAKI
    2011 Volume 34 Issue 3 Pages 131-137
    Published: 2011
    Released on J-STAGE: June 30, 2011
    JOURNAL FREE ACCESS
      Evidence including genome-wide analyses have uncovered that epigenetic mechanisms regulate differentiation and effector functions in CD8 T cells. Gene expression profiles change when CD8 T cells differentiate from naïve T cells to memory T cells. It has been shown that this programmed differentiation is regulated by epigenetic mechanisms. Upon antigen stimulation, CD8 T cells activate and acquire effector functions to target cells. Effector molecule gene expressions are upregulated by epigenetic mechanisms in CD8 T cells. It is suggested that memory T cells respond more rapidly to antigens because chromatin structures of effector molecule genes are open and their gene transcriptions are poised for activation.
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  • Kaichi KANEKO, Shinichi KAWAI
    2011 Volume 34 Issue 3 Pages 138-148
    Published: 2011
    Released on J-STAGE: June 30, 2011
    JOURNAL FREE ACCESS
      Mechanisms of glucocorticoid-induced osteoporosis (GIOP) are categorized into local and systemic effects. In the local mechanisms, direct inhibitory effect of glucocorticoid on bone formation is thought to be one of the important mechanisms of GIOP. In contrast, secondary hyperparathyroidism induced by negative balance of calcium due to inhibition of absorption and increase of excretion is an important systemic mechanism of GIOP. Other mechanisms of GIOP are also shown in this review. From clinical points of view, serum markers for evaluation of GIOP have been discussed. Osteocalcin, procollagen type I N-terminal peptide, and bone-specific alkaline phosphatase as markers of bone formation are decreased in GIOP. Collagen I N-terminal telopeptide and tartrate resistent acid phosphatase isoform 5b as markers of bone resorption are increased in GIOP.
      Clinical guidelines have recommended that bisphosphonate is the first choice for the treatment of GIOP. Teriparatide is recombinant human parathyroid hormone 1-34, which should be considered as a therapeutic option for those at high risk of bone fracture. Denosumab, an anti receptor activator of nuclear factor-β ligand approved as a drug for postmenopausal osteoporosis was also effective for GIOP in clinical trials.
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Original Article
  • Daisuke SUZUKI, Osamu KIMOTO, Jin SAWADA, Kumiko SHIMOYAMA, Masanori K ...
    2011 Volume 34 Issue 3 Pages 149-153
    Published: 2011
    Released on J-STAGE: June 30, 2011
    JOURNAL FREE ACCESS
      Background. MZB is a purine analog, and is used as a disease modifying anti-rheumatic drug (DMARD). We conducted an open label uncontrolled clinical trial to evaluate the efficacy and safety of combination therapy with methotrexate (MTX) and mizoribine (MZB).
      Methods. Thirty one RA patients (9 males, 22 females, 68±12 year-old) who fulfilled ACR criteria of RA and did not show sufficient clinical response to MTX were included. MZB (150 mg/day, once a day) were added to MTX. DAS28-CRP was measured at day 0 and 1, 3, 6, and 12 months after the treatment. Adverse events were recorded.
      Results. Overall DAS28-CRP was significantly decreased from 4.4±1.0 to 3.1±1.3 at 3 months (p<0.01), 2.7±0.68 at 6 months (p<0.01), 2.4±1.4 at 12 months (p<0.01). Seventeen patients (55%) achieved significant improvement of DAS28-CRP. Number of swollen joints of responders before the treatment was significantly fewer than that of non-responders. Improvement of DAS28-CRP was significantly different between the responders (0.91±0.74) and non-responders (0.18±0.66) at 1 month (p<0.01). Nine patients (29%) could achieve remission Four patients experienced adverse events.
      Conclusions. MTX and MZB combination therapy was effective and relatively safety.
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Case Reports
  • Mai KONISHI, Syuichi KOARADA, Ken YAMAGUCHI, Satoko TASHIRO, Sachiko S ...
    2011 Volume 34 Issue 3 Pages 154-161
    Published: 2011
    Released on J-STAGE: June 30, 2011
    JOURNAL FREE ACCESS
      We report a case of microscopic polyangiitis (mPA) and giant cell arteritis (GCA) (polyangiitis overlap syndrome) after influenza vaccination. A 67-year-old female with chronic kidney disease, who had been observed by a physician, presented fever and headache after immunization of influenza vaccine. She was diagnosed as having with mPA and GCA based on symptoms, worsening of renal function, biopsy of temporal artery (giant cell arteritis) and skin (microscopic polyangiitis), pulmonary involvement and the presence of myeloperoxidase-specific anti-neutrophil cytoplasmic antibodies (MPO-ANCA). She was treated with prednisolone (PSL) and the symptoms were improved. However, two months later she was presented with general physical weariness. She was diagnosed as having with pneumocystis pneumonia, cytomegalovirus infection and cryptococcosis. Despite intensive treatment, she was died and autopsy was performed. The present case suggests that the influenza vaccination may cause different types of vasculitis, mPA and GCA, through the common mechanism in pathophysiology. This patient is also the first case of mPA and GCA proven by histological examination.
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  • Hayato YAMAZAKI, Yoshishige MIYABE, Junzo TOMOISHI, Shigeo KAWAI, Eisa ...
    2011 Volume 34 Issue 3 Pages 162-167
    Published: 2011
    Released on J-STAGE: June 30, 2011
    JOURNAL FREE ACCESS
      A 63-year-old man was admitted to our hospital because of persistent fever, weight loss, painful foot, and purpura on his extremities. He had lower extremity peripheral neuropathy, and skin biopsy of the purpura revealed vasculitis. Serum tests for myeloperoxidase−antineutrophil cytoplasmic antibody (MPO-ANCA), proteinase 3-ANCA, and ANCA (indirect fluorescent antibody method) were all negative. Computed tomography revealed a 6-cm large, irregularly shaped lesion in the right kidney, while the nasal sinuses and lungs were intact. Based on these findings, a diagnosis of suspected systemic vasculitis associated with renal cell carcinoma was made. Thus, right nephrectomy was performed. However, the pathological findings showed a large infarct with necrotizing vasculitis of the arcuate, interlobular, and perinephric small arteries and a crescent formation in the glomerulus. Based on these findings, he was diagnosed with microscopic polyangiitis. Due to rapidly worsening symptoms of purpura and neuropathy, treatment with a high dose of corticosteroid was initiated on postoperative day 2, which led to improvement of his symptoms. Vasculitis accompanied with a mass-like lesion is occasionally confused with malignancy. The lesion in our patient was considered to have originated by asymptomatic renal infarction. This case suggests that a renal mass-like lesion with vasculitis should be diagnosed with care.
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