Motoharu Tanaka

Angiotensin converting enzyme (ACE) in the kidney: contribution to blood pressure regulation and possible role of brush-border ACE.

With regard to the concept of the local action of the renin angiotensin system (RAS) involved in blood pressure regulation, the presence of angiotensin converting enzyme (ACE) in a variety of organs suggests that locally produced angiotensin II (ANG II) shares, at least to some extent, the actions of this peptide on respective target organs of ANG II. However, renal ACE is less well understood for its relationship between blood pressure and enzyme activity. In our present studies, with a single oral administration of enalapril to spontaneously hypertensive rats, the inhibition of renal cortical and aortic ACE, but not plasma ACE, coincided with a reduction in blood pressure. Development of high blood pressure in stroke-prone, spontaneously hypertensive rats (SHRSP) from 7 to 22 weeks of age was accompanied by an increase in ACE activity in the renal cortex. Aortic and pulmonary ACE also tended to increase with age, but was less prominent. Isolated brush-border membranes contained abundant ACE, both in Wistar-Kyoto rats and SHRSP, and the levels of ACE in renal cortical homogenates closely correlated to the levels of brush-border ACE. Thus, changes in renal cortical ACE activity in response to the ACE inhibition and in cases of SHRSP in relation to aging are apparently associated with changes in blood pressure. It is likely that renal cortical ACE activity reflects the enzyme activity in the brush borders. Thus, brush-border ACE should probably be taken into account when discussing possible roles of renal ACE.

Comparison of real-time quantitative polymerase chain reaction with three other assays for quantitation of hepatitis C virus.

Background and Aims: Evaluation of serum levels of hepatitis C virus (HCV) is important for predicting the response to interferon treatment and monitoring its therapeutic efficacy. The aim of this study was to evaluate real‐time quantitative polymerase chain reaction (PCR) as a method for the measurement of HCV‐RNA.

TT virus infection in patients with chronic liver disease of unknown etiology

The role of a novel virus, designated as TT virus (TTV), as a cause of chronic liver disease has not been well defined. We investigated the prevalence of TTV among 69 patients with chronic liver disease of unknown etiology and 50 volunteer blood donors with normal transaminase levels. TTV DNA was amplified by polymerase chain reaction (PCR) by using two different sets of primers: one based on the sequence of the original N22 clone within the open reading frame 1 (set A) and the other derived from the untranslated region (set B). The prevalence of TTV detected by PCR primers set A only, set B only, and in total (by either set A or B) was 11 (31%), 31 (86%), and 31 (86%) of 36 patients with chronic hepatitis; 2 (40%), 4 (80%), and 4 (80%) of 5 with cirrhosis; 11 (39%), 17 (61%), and 22 (79%) of 28 with hepatocellular carcinoma; and 9 (18%), 39 (78%), and 40 (80%) of 50 volunteer blood donors, respectively. Of the interpretable 25 PCR products amplified with primers set A, 9 were classified as genotype 1a, 10 as genotype 1b, 4 as genotype 2, 1 as genotype 3, and 1 as genotype 4. Molecular evolutionary analysis did not suggest any particular strains of TTV that might be associated with chronic liver disease. The nucleotide sequences of the untranslated region on which PCR primers set B were designed were highly conserved, and the interpretable 22 PCR products amplified with primers set B were not clearly divisible into distinct genotypes. Our findings provided no evidence that TTV is a causative agent of chronic liver disease. J. Med. Virol. 62:392–398, 2000.

AT1 receptor‐mediated stimulation by angiotensin II of rat aortic fibronectin gene expression in vivo

Fibronectin plays an important role in various vascular diseases. A subpressor (200 ng kg−I min−1) or pressor (1000 ng kg−1 min−1) dose of angiotensin II was continuously infused into rats by osmotic minipump for various times, to investigate the effects on aortic fibronectin gene expression. In rats infused with a subpressor dose of angiotensin II in which blood pressure was normal for 3 days, aortic fibronectin mRNA levels started to increase by 1.4 fold at 12 h and reached the maximal levels (increased by 3.1 fold) at 3 days. Treatment with TCV‐116 (3 mg kg−1 day−1), a non‐peptide selective AT1 receptor antagonist, completely inhibited the angiotensin II‐induced increase in aortic fibronectin mRNA, while hydralazine (10 mg kg−1 day−1) did not block this effect. Similar results were also obtained for a pressor dose of angiotensin II. Thus, angiotensin II directly stimulates aortic fibronectin gene expression in vivo, which is mediated by the AT1 receptor but not by blood pressure.

Prevalence of TT virus in patients with fulminant hepatic failure in Japan

Abstract: A novel virus (TT virus) was isolated from patients with posttransfusion hepatitis of unknown etiology. We studied the prevalence of TT virus in 26 patients with fulminant hepatic failure without risk factors, including blood transfusion, and also examined 106 healthy blood donors as controls. We assayed serum TT virus DNA by seminested polymerase chain reactions and also examined the genotypes of this virus. Serum was obtained at admission from patients with fulminant hepatic failure. Serum samples at admission from seven (27%) of the 26 patients were positive for TT virus DNA. There were no differences in clinical findings, duration from onset to coma, or results of laboratory tests in patients with and without TT virus DNA. However, all 7 patients with TT virus died, whereas 9 of the 19 patients without TT virus died. The outcome for patients with fulminant hepatic failure and TT virus was significantly worse than for patients without the virus (P = 0.0227). TT virus was also detected in 29 (27%) of the 106 healthy blood donors. The genotype of the TT virus was mainly 1a in both groups. There were no differences in the rate of positivity and the genotypes of TT virus between patients with fulminant hepatic failure and healthy blood donors. TT virus infection may not cause severe hepatitis, such as fulminant hepatic failure, but it may indicate a poor outcome in such patients.

Lamivudine therapy for hepatitis B virus reactivation in a patient receiving intra-arterial chemotherapy for advanced hepatocellular carcinoma.

We describe a case of hepatitis B virus (HBV) reactivation that responded to lamivudine therapy in a 58-year-old man with advanced hepatocellular carcinoma (HCC). After seroconversion of hepatitis B e antigen to e antibodies by interferon therapy, the patient was found to have HCC with a portal tumor thrombus. A transarterial port was placed in the right femoral artery to permit infusion of epirubicin and cisplatin. After 3 months of arterial chemotherapy, the serum alpha-fetoprotein level had decreased and tumor staining diminished. Laboratory examinations suggested a flare-up of hepatitis B. Lamivudine was given to manage HBV reactivation. After 1 month, the serum HBV DNA level fell below the detection limit, and the alanine aminotransferase activity decreased to the normal range. With further arterial chemotherapy for HCC, no tumor staining was detected on computed tomography. Administration of lamivudine decreased serum HBV DNA levels for 7 months. Our findings suggest that HBV may be reactivated during chemotherapy for HCC, similar to other types of malignancies, and that lamivudine is effective for the management of HBV reactivation.

Changes in serum levels of hepatitis C virus genotype 1b monitored by real-time quantitative polymerase chain reaction as a predictor of long term response to interferon-α treatment

OBJECTIVE:The aim of this study was to find whether there is a relationship between the changes in the amounts of hepatitis C virus (HCV) at the start of interferon treatment and the long term response to therapy.METHODS:In 20 patients with HCV genotype 1b each given 880 MU of interferon-α, the changes in serum HCV RNA during the first 2 wk of therapy were monitored by real-time quantitative polymerase chain reaction (PCR).RESULTS:Real-time quantitative PCR detected HCV RNA at 101–108 copies/ml. Serum HCV RNA decreased rapidly between 8 and 24 h after the first administration (first phase) and more slowly thereafter (second phase), with median exponential decays of 2.14 and 0.11 log10/day, respectively. Four patients had sustained virological responses, nine patients had transient responses, and seven patients had no responses. The differences in the rate of first-phase viral decline among the three groups were not significant (p = 0.34), but the differences in the rate of second-phase viral decline were significant (p = 0.0004); the median viral decline (interquartile range) in the second phase was 0.48 (0.42–0.50) log10/day in patients with sustained responses, 0.16 (0.10–0.19) log10/day in patients with transient responses, and 0.026 (0.017–0.040) log10/day in patients with no responses.CONCLUSIONS:Changes in serum levels of HCV genotype 1b in the first 2 wk of interferon-α treatment, monitored by real-time quantitative PCR, can be used for prediction of the long term therapeutic response.

Dynamics of Hepatitis C Virus Monitored by Real-Time Quantitative Polymerase Chain Reaction During First 2 Weeks of IFN-β Treatment Are Predictive of Long-Term Therapeutic Response

The relation between the change in hepatitis C virus (HCV) RNA levels at the start of interferon-beta (IFN-beta) treatment and the long-term therapeutic response remains poorly defined. In 20 patients with chronic hepatitis C who received IFN-beta (total dose 126-756 MU), the changes in serum HCV RNA during the first 2 weeks of therapy were monitored by real-time quantitative polymerase chain reaction (PCR). The serum HCV RNA level decreased rapidly during the first 24 h of therapy (first phase) and more slowly thereafter (second phase), with a mean exponential decay rate of 1.17 log10/day and 0.37 log10/day, respectively. Three patients had a sustained virologic response, 10 patients had a transient response, and 7 patients had no response. The differences in the rate of first-phase viral decline among the three groups were not significant (p = 0.21), but the differences in the rate of second-phase viral decline were significant (p = 0.0021). The mean decay rate between the end of the first 24 h and day 14 was 0.96 +/- 0.43 log10/day in sustained responders, 0.39 +/- 0.30 log10/day in transient responders, and 0.13 +/- 0.09 log10/day in nonresponders. We conclude that during the first 2 weeks of therapy, changes in serum HCV RNA levels as monitored by real-time quantitative PCR can be used to predict the long-term response to treatment with IFN-beta.

Changes in hypervariable region 1 in patients with chronic hepatitis C of genotype 1b with biochemical response to interferon

BACKGROUND/AIMS: The outcome of interferon (IFN) therapy of hepatitis C virus (HCV) infection can be classified as a complete viral response (CR), biochemical response (BR), or no response (NR). Why alanine aminotransferase (ALT) activity decreases in patients with BR despite viral persistence is unknown. METHODS: Of 158 patients infected with HCV genotype 1b, all 20 patients with BR and 20 of the 114 patients with NR, matched for viral load to the BR group, were studied. We sequenced nucleotides in the hypervariable region (HVR) of serum HCV RNA, and analyzed quasispecies of this region by the polymerase chain reaction and single-strand conformation polymorphism (PCR-SSCP). RESULTS: In HVR 1, SSCP patterns differed after therapy; the major clone before therapy disappeared with therapy in eight of the 20 BR patients, but in none of the 20 NR patients (P=0.0033; Fishers exact test). PCR products of HVR 1 from six patients were cloned before and after therapy, and 40 clones from each patient were sequenced each time. Results of cloning and sequencing were generally consistent with those of SSCP. For the six patients, a major clone could be identified both before and after therapy. In two patients with BR, there were many changes in the amino acid sequence of the major clone after IFN; in one patient with NR, mutations were not found. CONCLUSION: Changes in the major viral clone with IFN treatment may be related to the decrease in ALT activity in some patients, in spite of the continued presence of HCV RNA.

Association of HLA alleles with response (especially biochemical response) to interferon therapy in Japanese patients with chronic hepatitis C.

The response of chronic hepatitis C to interferon (IFN) treatment is classified as complete response (CR), biochemical response (BR), or no response (NR). Several studies have found no difference in prevention of hepatocellular carcinoma by IFN therapy between patients with CR and those with BR. We investigated whether specific human leukocyte antigen (HLA) alleles were associated with response to IFN, especially BR, in 138 patients with chronic hepatitis C. Comparing patients with and without CR, male, a low viral titer, genotype 2a or 2b, HLA-B55, and HLA-DRB1-0803 were more common in the group with CR. Multivariate analysis showed that age (adjusted odds ratio [OR], 0.95 by every year [95% confidence interval [CI] 0.90 - 0.99], p = 0.028), genotype 2a or 2b (5.21 [95% CI 1.63 - 16.6], p = 0.005), and low viral titer (8.58 (2.66 - 27.7), p < 0.001) were associated with CR. Comparing patients with BR and NR, the pretreatment alanine aminotransferase (ALT) level was lower in the BR group (p < 0.001). Both HLA-B7 and HLA-DRB1-0101 were more common in this group (p = 0.002). As the alleles HLA-B7 and HLA-DRB1-0101 were in linkage disequilibrium, the HLA-B7-DRB1-0101 haplotype may be associated with BR. Multivariate analysis indicated that a low ALT level (0.98 by every 1 IU/L [95% CI 0.98 - 0.99], p = 0.001) and HLA-B7-DRB1-0101 haplotype (32.3 [95% CI 1.50 - 693.1], p = 0.026) contributed significantly to BR. This study suggested that host HLA expression, but not viral factors, can influence BR.