In the premise of vaccination and allergen-specific immunotherapy, transcutaneous formulations have an advantage over conventional subcutaneous injections in terms of convenience, simplicity of delivery, and painless administration into the skin. Additionally, since transcutaneous formulations can be rendered cold-chain free, they do not require expert handling during transportation, storage, and stockpiling, which enables reductions in costs and distribution to distant areas. Furthermore, transcutaneous formulations are effective for improving adherence in children with phobias toward injection needles and may help in persuading them to perform self-vaccination and home immunotherapy against allergies in the future. We have been promoting the development of innovative “patch-type formulations for vaccination and immunotherapy” which regard skin as an immune organ and utilize our original transcutaneous administration devices (hydrophilic gel patch and microneedle patch) for their delivery. We have confirmed the safety and efficacy of transcutaneous formulations not only in demonstration experiments using animals but also in physician-initiated clinical studies. Additionally, in order to elucidate the mechanism for the induction of immune responses by transcutaneous formulations, we analyzed the immunological events occurring in the skin and regional lymph nodes which accompanied the application of transcutaneous administration devices or the delivery of antigens (vaccines and allergens) to the skin surface layer. This review presents our results from basic to clinical research on the development of transcutaneous formulations for vaccines and allergen-specific immunotherapy.

Excessive generation of reactive oxygen species (ROS) has been implicated in the progression of tumors. Superoxide dismutase 3 (SOD3) is a copper-containing secretory antioxidative enzyme that plays a critical role in redox homeostasis, particularly in extracellular spaces. Considerable evidence suggests that SOD3 protein expression is significantly decreased or lost in several tumor tissues, and this loss results in tumor metastasis. On the other hand, epigenetic disturbances, including DNA hyper-/hypomethylation, histone de/acetylation, and histone de/methylation, may be involved in tumorigenesis and the progression of metastasis. However, regulation of SOD3 in the tumor microenvironment and the involvement of epigenetics in its expression remain unclear. To elucidate the molecular mechanisms underlying SOD3 expression, we investigated the involvement of epigenetics, including DNA methylation and histone modifications, in its regulation in tumor cells and macrophages. SOD3 expression in human monocytic THP-1 cells and human lung cancer A549 cells was silenced by DNA hypermethylation within the SOD3 promoter region. Furthermore, the DNA demethylase, ten-eleven translocation 1, was shown for the first time to play a key role in regulation of DNA methylation within that region. We also demonstrated that myocyte enhancer factor 2 functioned as one of the transcription factors of SOD3 expression in THP-1 cells. Collectively, these novel results will contribute to the elucidation of epigenetic redox regulation, and may provide important insights into tumorigenesis and tumor metastasis.

The number of patients with chronic liver diseases is expected to decline due to progress in antivirus therapy, including direct-acting antivirals for hepatitis C and nucleot(s)ide analogues for hepatitis B. On the other hand, the number of patients with nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH) in the setting of metabolic syndrome has been increasing worldwide. Hepatocellular carcinoma (HCC) arises in the setting of chronic hepatic inflammation and liver cirrhosis associated with NAFLD/NASH. However, the detailed clinical features of NAFLD/NASH and NAFLD/NASH-derived HCC prevalence have not yet been fully elucidated as there are two major problems in diagnosing definitive NAFLD/NASH: it is difficult to evaluate past alcoholic consumption history precisely and to obtain certain pathologic findings from all patients with fatty liver. Although previous studies clarified some of the genetic and pathophysiological aspects of NAFLD/NASH, basic knowledge of NAFLD/NASH mechanisms remains insufficient and the methods for predicting the risk of tumorigenesis and effective therapy for NAFLD/NASH are not well defined. The treatment of NAFLD/NASH comprises changes in lifestyle including eating habits and exercise leading to weight loss, and drug intake such as vitamin E. A number of new drugs for NAFLD/NASH patients have been under trial. Additional larger-scale studies are required to elucidate fully the clinical and basic landscape of NAFLD-HCC. This paper gives an overview of NAFLD/NASH management based on the most recent findings.

Nonalcoholic steatohepatitis (NASH) is a lifestyle-related disease characterized by hepatic fibrosis with the accumulation of fat and inflammation and can progress to cirrhosis or hepatocellular carcinoma. However, effective pharmacotherapeutic strategies for hepatic fibrosis in NASH remain to be established. Among the initiators of inflammation, we have been investigating the possible involvement of group IVA phospholipase A₂ (IVA-PLA₂), which catalyzes the initial step in the generation of lipid mediators, including eicosanoids and lysophospholipids, in the progression of hepatic fibrosis. We have recently demonstrated that a lack of IVA-PLA₂ alleviates hepatic fibrosis in NASH model mice fed a high-fat and high-cholesterol diet and in CCl₄-treated mice. CCl₄-induced hepatic fibrosis was also prevented by the administration of an orally active, specific IVA-PLA₂ inhibitor even after hepatic fibrosis had developed. Based on these findings suggesting that IVA-PLA₂ mediates the cellular responses contributing to the progression of hepatic fibrosis, we have been exploring which types of cells in the liver are involved in IVA-PLA₂-mediated hepatic fibrosis using cell-specific IVA-PLA₂ knockout mice. The preliminary experimental results suggest that IVA-PLA₂ in endothelial cells, but not monocyte-derived cells, plays a role, in part, in the hepatic stellate cell-mediated progression of hepatic fibrosis. In this paper, we discuss the possibility that IVA-PLA₂ and/or its related molecules are candidate pharmacotherapeutic targets for NASH treatment.

Tissue expansion and chronic inflammation in adipose tissue (AT) are closely related to nonalcoholic steatohepatitis (NASH) pathology. Angiogenesis is initiated by the detachment of pericytes (PCs) from vessels in AT. This process is necessary for the development of AT in obesity. The detachment is caused by excessive platelet-derived growth factor B (PDGF-B) derived from M1-macrophages (Mφ) infiltrating obese AT. On the other hand, AT of tamoxifen-induced systemic PDGF receptor-β knockout mice showed decreased detachment of PCs from vessels in obesity, thereby attenuating hypertrophy of AT mediated by neoangiogenesis, resulting in protection from the development of chronic AT inflammation and systemic insulin resistance. The selective mineralocorticoid receptor (MR) inhibitor eplerenone (Ep) suppresses chronic inflammation in fat and the liver, improves glucose and lipid metabolism, and inhibits body weight and fat mass gain in mice fed a high-fat diet. As a novel mechanism, Ep increases energy expenditure and suppresses fat accumulation, thereby controlling the polarity of visceral AT Mφ from inflammatory M1 to anti-inflammatory M2 dominant. In addition, Ep directly inhibits the activation of signals 1 and 2 of NLRP3-inflammasomes in Mφ, which is an inflammatory mechanism closely involved in the development of NASH. Thus, we propose novel therapeutic approaches to NASH. Inhibition of PDGF receptor-β signaling prevents AT hypertrophy by regulating AT angiogenesis, and MR inhibitors directly suppress chronic inflammation in the AT and liver.

Nonalcoholic fatty liver disease (NAFLD) is characterized by the pathological accumulation of fat in the liver in the absence of any other disease related to liver steatosis, which includes a wide spectrum ranging from mild asymptomatic fatty liver to nonalcoholic steatohepatitis (NASH) and cirrhosis. However, the pathogenesis of NASH has not been established. In this study, we investigated the involvement of the G-protein-coupled receptor 120/free fatty acid receptor 4 (GPR120/FFAR4) in the pathogenesis of NASH. Mice fed a 0.1% methionine- and choline-deficient l-amino acid-defined, high-fat (CDAHF) diet showed a significant increase in plasma aspartate aminotransferase and alanine aminotransferase levels, fatty deposition, inflammatory cell infiltration, and slight fibrosis. Docosahexanoic acid (DHA, a GPR120/FFAR4 agonist) suppressed the inflammatory cytokines in hepatic tissues and prevented liver fibrosis. On the other hand, GPR120/FFAR4-deficient CDAHF-fed mice showed increments in the number of hepatic crown-like structures and immunoreactivity to F4/80-positive cells compared with wild-type mice. Furthermore, the levels of hepatic TNF-α mRNA expression increased in GPR120-deficient mice. These findings suggest that the GPR120/FFAR4-mediating system could be a key signaling pathway to prevent the development of NASH. In this review, we describe our recent data showing that GPR120/FFAR4 could be a therapeutic target in NASH/NAFLD.

While percent time within therapeutic range (%TTR) of international normalized ratio of prothrombin time (PT-INR) represents the quality of anticoagulation therapy with warfarin, it is often maintained less than 50% in patients with non-valvular atrial fibrillation (NVAF). We aimed to study if implementation of a multi-disciplinary ambulatory anticoagulation service (MAAS) may improve %TTR. Collaborating with cardiologists at Kanto Rosai Hospital, we conducted a MAAS for NVAF patients receiving warfarin from April 2013 to December 2015. Patients who agreed to utilize the service in addition to their appointments with cardiologists visited pharmacists to have counseling about diet, concomitant medications, and lifestyle. According to a protocol, pharmacists made dose adjustment proposals to cardiologists, if necessary. Upon approval by cardiologists, dose modifications were made. We retrospectively reviewed medical records of the patients who participated in the MAAS before and during the service. The study protocol was approved by the institutional review board. We identified 78 eligible patients (44 males and 34 females, aged 51 to 91 years). Their median %TTR increased significantly (p<0.05) from 57% during the pre-MAAS period to 77% during the MAAS period. In addition, the median percent time below therapeutic range (%TBTR) decreased significantly (p<0.05) from 35% during the baseline period to 11% during the MAAS period. The present study indicates that MAAS improves the quality of anticoagulation therapy with warfarin in ambulatory patients with NVAF. Further prospective, randomized studies with a greater number of patients are required to confirm the results of the present study.

The pramipexole extended-release (long acting) tablet, a D2 receptor agonist commonly used for the treatment of Parkinson's disease, has increasingly demonstrated usability for patients with long acting performance and patient adherence improvements. As a generic drug it is sold by six companies while a brand name drug is also marketed. As these formulations are hygroscopic it is described as such in package inserts so that tablets will only be removed from the press-through package (PTP) immediately before ingestion. It is often dispensed in one-dose packaging (ODP) as determined by a patient's physical functions and symptom characteristics. With ODP, quality control and ease of removal from the PTP are important factors. In this study we examined the stability of tablets in the ODP (25℃ RH75%) while also comparing the ease of handling of the seven products currently marketed in Japan. In the tablets' ODP, changes such as swelling and decreases in tablets hardness were observed in six formulations. Differences were found among the products in comparison of packaging material, required tablet extrusion strength, and ease of removal. Given the differences in PTP materials and hygroscopicity it is suggested that pharmacists must not only consider the drug formulations of products but also contribute to improvements in medication adherence for patients with poor hand-finger function.

In this study, we attempted to improve the non-aqueous titration method using N,N-dimethylformamide (DMF) in the Japanese Pharmacopoeia seventeenth edition (JP XVII) for advancement in experimental safety. As an alternative solvent for DMF, we demonstrate titrations using dimethyl sulfoxide (DMSO), which has similar properties as and much higher safety than DMF. Five drugs (i.e., acetohexamide, glibenclamide, sulfamethoxazole, tranilast, and furosemide) listed in JP XVII use DMF as a solvent for titrations with sodium hydroxide standard solution. For these drugs, we examined whether DMF can be replaced with DMSO in quantitative analyses. As a result, a quantification similar to that of the Pharmacopoeia protocol is possible by simply replacing DMF with DMSO or using a mixed solvent of DMSO and water.

Long-term practical training in the 6-year course of pharmaceutical education is a program for students after acquiring basic knowledge on pharmaceutical sciences and preclinical training. However, it remains unproved whether practical training affects students' robust acquisition and reconstruction of pharmaceutical expertise which they had learned before starting practical training. To address this issue, we administered survey questionnaires to 5th-year students (n=149) of Keio University in 2016 both before and after practical training. From the viewpoint of self-efficacy, psychological approach was applied to evaluate respondents' psychological state “to do well” on a 7-point Likert scale (1=disagree, 4=neither, 7=agree) for specific subjects C1-C18 (18 core units of pharmaceutical expertise in the current Model Core Curriculum for Pharmaceutical Education), mainly including basic pharmaceutical sciences, public health, clinical pharmacology and pharmacotherapy. C1-C18 total score values, which reflect the strength of certainty to acquire expertise, were significantly higher after the first term of practical training compared to before training, regardless of the pharmacy and the hospital (p<0.001), but not after the second term. Specific factors associated with increased score values for “to do well” were not extracted from other questionnaire answers concerning students' mentors or their self-learning during practical training. These results demonstrated that practical training at least partly reinforced students' feeling of “to do well”, contributing to their robust acquisition and reconstruction of pharmaceutical expertise. Giving students recognition individually of their learning process themselves encourages more effective practical training toward their development of resources as a pharmacist.

Corticosteroid insensitive airway inflammation is one of major barrier to effective managements of chronic airway diseases, such as chronic obstructive pulmonary disease (COPD) and severe asthma. The role of nonreceptor tyrosine kinase Src is important in airway inflammation in mice models of atopic asthma and COPD. Thus, in this study, we determined the effects of Src inhibitor, dasatinib, on airway inflammation induced by repeated intranasal exposure to lipopolysaccharide (LPS). Male mice (A/J strain, 5 weeks old) were intranasally exposed to LPS twice daily for 3 d, and dasatinib was intranasally treated 2 h prior to each LPS exposure. A day after the last stimulation, lungs and bronchoalveolar lavage fluid (BALF) were collected. Dasatinib attenuated the accumulation of inflammatory cells in lungs, and the increase in the numbers of inflammatory cells and the accumulation of cytokines/chemokines in BALF in a dose dependent manner. Therefore, this study suggested that targeting the Src can provide a new therapeutic approach for corticosteroid insensitive pulmonary diseases.