Masako Ogawa

Successful treatment of reactive arthritis with a humanized anti–interleukin‐6 receptor antibody, tocilizumab

Reactive arthritis is a disease with the clinical triad of arthritis, urethritis, and conjunctivitis (1). The onset of the disease is often preceded by bacterial infections of Campylobacter, Chlamydia, Salmonella, Shigella, or Yersinia, either in the urogenital or gastrointestinal tract (2,3). HLA–B27 is strongly associated with reactive arthritis, so that this disease is considered as one of the HLA–B27positive spondylarthropathies. Although the pathogenesis of reactive arthritis remains imperfectly understood, bacterial infections trigger systemic immunoreactions, and overproduction of proinflammatory cytokines has been shown to contribute to sterile joint inflammation (1–4). Several kinds of drugs are used for the management of reactive arthritis, including nonsteroidal antiinflammatory drugs (NSAIDs); disease-modifying antirheumatic drugs (DMARDs) such as sulfasalazine, methotrexate, and leflunomide; corticosteroids; and immunosuppressive drugs, including azathioprine and cyclosporine, whereas the use of antibiotics remains controversial (1–4). Infliximab, a chimeric anti–tumor necrosis factor (anti-TNF ) antibody, and etanercept, a 75-kd TNF receptor fusion protein, reportedly ameliorated symptoms in patients with reactive arthritis (5–8), as well as other HLA–B27-positive spondylarthropathies (9). However, to our knowledge, there have been no reports regarding the efficacy of the humanized anti–interleukin-6 (IL-6) receptor antibody, tocilizumab (10), for reactive arthritis. Here we report a case of reactive arthritis treated successfully with tocilizumab.

Preventative Effect of a Flavonoid, Enzymatically Modified Isoquercitrin on Ocular Symptoms of Japanese Cedar Pollinosis

BACKGROUND Flavonoids are nutrients that exert anti-allergic effects. We investigated the preventative effect of enzymatically modified isoquercitrin (EMIQ), a flavonoid, to relieve the symptoms of Japanese cedar pollinosis. METHODS In a parallel-group, double-blind placebo-controlled study design, 24 subjects with Japanese cedar pollinosis took 100mg EMIQ or a placebo for 8 weeks, starting 4 weeks prior to the onset of pollen release. Subjective symptoms, ADL scores and the usage of drugs were recorded daily, and the QOL score was obtained every 4 weeks. Blood sampling was performed before and after the study to measure serum levels of IgE and flavonoids. RESULTS During the entire study period, ocular symptom + medication score for the EMIQ group was significantly lower (p < 0.05) than that of the placebo group. When limited to the period, ocular symptom scores (p < 0.05, weeks 5-6), and ocular congestion scores (p < 0.05, weeks 5-6) for the EMIQ group was significantly lower than that for the placebo group while other scores for the EMIQ group, such as ocular itching scores (p = 0.09, weeks 4-5), lacrimation scores (p = 0.07, weeks 5-6), and ocular congestion scores (p = 0.06, weeks 4-5), all tended to be lower. However no significant differences were found in nasal symptoms between the two groups. Serum concentrations of IgE were not significantly downregulated but the serum concentrations of quercetin and its derivatives were elevated significantly by the intake of EMIQ. CONCLUSIONS Intake of the quercetin glycoside EMIQ proved to be effective for the relief of ocular symptoms caused by Japanese cedar pollinosis.

Integrative assessment of potential effects of dioxins and related compounds in wild Baikal seals (Pusa sibirica): application of microarray and biochemical analyses.

We have previously indicated that accumulation of chlorinated dioxins and related compounds (DRCs) induced cytochrome P450 (CYP) 1A1, 1A2 and 1B1 isozymes in the liver of wild Baikal seals (Pusa sibirica). Here we attempt to assess the potential effects of DRCs triggered by the induction of these CYP1 isozymes in this species, using an integrative approach, combining gene expression monitoring and biochemical assays. To screen genes that may potentially respond to the exposure of DRCs, we constructed a custom cDNA oligo array that can target mRNAs in Baikal seals, and monitored hepatic mRNA expression levels in the wild population. Correlation analyses between the hepatic total 2,3,7,8-tetrachlorodibenzo-p-dioxin toxic equivalents (TEQs) and mRNA levels supported our previous findings that high accumulation of DRCs induces the transcription of CYP1A1, CYP1A2 and CYP1B1 genes. In addition, our integrative assessment indicated that the chronic exposure to DRCs may alter the hepatic transcript levels of genes related to oxidative stress, Fe ion homeostasis, and inflammatory responses. The expression levels of CYP1A2 showed significant positive correlations with levels of malondialdehyde, a biomarker of lipid peroxidation, and of etheno-dA, a DNA adduct, suggesting that the lipid peroxidation may be enhanced through the production of reactive oxygen species (ROS) triggered by CYP1A2 induction. Moreover, there was a positive correlation between heme oxygenase activities and malondialdehyde levels, suggesting the prompted heme degradation by ROS. Fetuin-A levels, which are suppressed by inflammation, showed a significant negative correlation with TEQ levels, and hepcidin levels, which are conversely increased by inflammation, had significant positive correlations with malondialdehyde and etheno-dA levels, implying the progression of inflammation by DRC-induced oxidative stress. Taken together, we propose here that wild Baikal seals may suffer from effects of chronic exposure to DRCs on the induction of CYP1 isozymes, followed by increased oxidative stress, heme degradation and inflammation.

Expression of LECAM-1 and LFA-1 on PRE-B lymphoma cells but not on preneoplastic pre-B cells in SL/Kh mice

The pre-B lymphoma-prone inbred strain SL/Kh mice showed a polyclonal expansion of BP-1+ pre-B cells in bone marrow early in life. Preneoplastic pre-B cells did not express adhesion molecules LECAM-1 and LFA-1, whereas neoplastic pre-B cells consistently expressed both molecules. There were two types of pre-B lymphomas in SL/Kh with distinct in vivo behavior. One infiltrated lymph nodes and spleen and another, predominantly bone marrow. However, lymphoma cells of both types expressed BP-1, LECAM-1 and LFA-1. Expression of these adhesion molecules on BP-1+ cells, therefore, may represent an important consequence of pre-B lymphomagenesis in SL/Kh strain, but is not sufficient to explain the in vivo behavior of the pre-B lymphoma cells.

DNA Damage in Rheumatoid Arthritis: An Age-Dependent Increase in the Lipid Peroxidation-Derived DNA Adduct, Heptanone-Etheno-2′-Deoxycytidine

Objective. To evaluate what types of DNA damages are detected in rheumatoid arthritis (RA). Methods. The DNA adducts such as 8-oxo-hydroxy-7,8-dihydro-2′-deoxyguanosine (8-oxo-dG), 1,N6-etheno-2′-deoxyadenosine (εdA), and heptanone-etheno-2′-deoxycytidine (HεdC) in genomic DNAs, derived from whole blood cells from 46 RA patients and 31 healthy controls, were analyzed by high-performance liquid chromatography tandem mass spectrometry, and their levels in RA patients and controls were compared. In addition, correlation between DNA adducts and clinical parameters of RA was analyzed. Results. Compared with controls, the levels of HεdC in RA were significantly higher (P < 0.0001) and age dependent (r = 0.43, P < 0.01), while there was no significant difference in 8-oxo-dG and εdA accumulation between RA patients and controls. HεdC levels correlated well with the number of swollen joints (r = 0.57, P < 0.0001) and weakly with the number of tender joints (r = 0.26, P = 0.08) of RA patients, while they did not show a significant association with serological markers such as C-reactive protein and matrix metalloproteinase 3. Conclusion. These findings indicate that HεdC may have some influence on the development of RA and/or its complications.

Germline transcripts of the immunoglobulin heavy-chain and T cell receptor genes in a murine hematopoietic stem cell line LyD9 and its derivative cell lines

We compared germline transcript levels of immunoglobulin heavy chain and T cell receptor (TcR) genes in a murine hematopoietic stem cell line, LyD9, and its derivative cell lines. LyD9 cells can be induced to differentiate into at least three lineages, namely, B lymphocyte, macrophage, and granulocyte lineages. Although C mu transcripts were found in stem cells to B lymphocytes, other myeloid-committed cells also expressed significant amounts of C mu transcripts. Germline TcR transcripts did not show good correlation with differentiation potential and stages of hematopoietic cells. During this search we identified a novel germline transcript containing the JH-C microliter sequence in LyD9 and some of its derivative cells. Expression of mRNAs for immunoglobulin- and TcR-associated molecules (lambda 5, MB1 and CD3 delta) was widespread except for lambda 5 mRNA. Among three mRNAs encoding putative recombinase proteins, RAG-1 and RAG-2 mRNAs were not expressed in any cell lines tested, while RBP-2 mRNA was expressed ubiquitously.

346 Clinical Effects of Tocilizumab, a Humanized Anti-interleukin-6 Receptor Antibody, on Patients with Autoimmune and Allergic Diseases.

Background A humanized anti-interleukin-6 receptor, tocilizumab, has been approved as a biological drug for the treatment of rheumatoid arthritis, systemic juvenile idiopathic arthritis and Castlemans disease. Since dysregulation of IL-6 production also plays a pathologic role in other various autoimmune and allergic diseases, we tested whether tocilizumab might have beneficial effect on refractory autoimmune or allergic diseases to conventional treatment regimens. Methods After informed consent by patients and approval by the Ethics Committee of Osaka University Hospital were obtained, patients were treated with tocilizumab at 8 mg/kg every 4 weeks. Results The diseases for which off-label use of tocililizumab was performed included amyloid A amyloidosis, relapsing polychondritis, systemic sclerosis, HLA-B27 positive spondyloarthritis such as reactive arthritis and psoriatic arthritis, polymyalgia rheumatica and polymyositis. After 3 injections of tocilizumab amyloid fibril deposits in the colon disappeared in a patient with gastrointestinal AA amyloidosis, who was resistant to anti-TNF drugs and disease-modifying antirheumatic drugs. In 2 patients with refractory relapsing polychondritis, the continuous tocilizumab treatment for more than 3 years could ameliorate clinical symptoms related to upper and lower airways and stabilize the disease activity. The skin sclerosis of 2 patients with systemic sclerosis became softened with reductions of 52 and 23% in the modified Rodnan total skin score by the tocilizumab treatment. Two administrations of tocilizumab led to the disappearance of joint swelling, pain and complete resolution of symptoms in a patient with refractory reactive arthritis to several therapeutic regimens for 4 years, whereas 2 patients with severe psoriatic arthritis did hardly respond to tocilizumab. In a patient with polymyalgia rheumatica, the tocilizumab treatment caused a reduction of the disease activity score (PMR-AS) from 22.14 to 0.74, indicating remission. Creatine phosphokinase normalized by 2 patients with polymyositis who had been resistant to corticosteroids and immunosuppressive drugs, in association with the disappearance of the high intensity zones in the thigh muscles on MR images. Conclusions These clinical effects of tocilizumab suggest that it may be an optional treatment for refractory autoimmune or allergic diseases although further clinical trails will be essential.