Kazuyoshi Matsumura

Pathogenicity of IgG in patients with IgG4-related disease

Objective IgG4-related disease (IgG4-RD) is a systemic disease characterised by elevated serum IgG4 and IgG4-positive lymphoplasmacytic infiltration in the affected tissues. The pathogenic role of IgGs, including IgG4, in patients with IgG4-RD, however, is unknown. Design We examined the pathogenic activity of circulating IgGs in patients with IgG4-RD by injecting their IgGs into neonatal male Balb/c mice. Binding of patient IgGs to pancreatic tissue was also analysed in an ex vivo mouse organ culture model and in tissue samples from patients with autoimmune pancreatitis (AIP). Results Subcutaneous injection of patient IgG, but not control IgG, resulted in pancreatic and salivary gland injuries. Pancreatic injury was also induced by injecting patient IgG1 or IgG4, with more destructive changes induced by IgG1 than by IgG4. The potent pathogenic activity of patient IgG1 was significantly inhibited by simultaneous injection of patient IgG4. Binding of patient IgG, especially IgG1 and IgG4, to pancreatic tissue was confirmed in both the mouse model and AIP tissue samples. Conclusions IgG1 and IgG4 from patients with IgG4-RD have pathogenic activities through binding affected tissues in neonatal mice.

Rectal immunization with antigen-containing microspheres induces stronger Th2 responses than oral immunization: A new method for vaccination

The rectum as an effective site for induction of systemic and local immunity has received little attention. Rectal immunization with microspheres-containing ovalbumin (MS-OVA) was tested for its ability to elicit systemic and mucosal immune responses. Rectal immunization with MS-OVA enhanced both Th2 dominant OVA-specific IgG levels in the serum and OVA-specific IgA levels in fecal extracts more prominently than did oral immunization. Cytokine analysis of CD4(+) T cells indicated a predominant induction of Th2-type responses compared to Th1-type responses following rectal immunization compared to oral immunization. These results demonstrate that rectal immunization with microspheres could be an effective new vaccination method.

Hypocalcemia secondary to hypomagnesemia in a patient with Crohn's disease.

A 42-year-old female with Crohn’s disease who had previously undergone multiple surgical interventions developed marked hypocalcemia, which could not be resolved with calcium administration. Markedly reduced serum magnesium levels were also observed. After intravenous magnesium administration, serum calcium levels rapidly normalized. In addition, the plasma levels of intact parathyroid hormone increased immediately after magnesium administration. These data strongly suggest that hypocalcemia resulted from disturbance of appropriate parathyroid hormone secretion caused by hypomagnesemia. After introduction of infliximab therapy, her abdominal symptoms and endoscopic findings improved, and serum calcium and magnesium levels stabilized within the normal range without magnesium administration.