Tatsuya Nakatani

Silent Cerebral Infarction in Hemodialysis Patients

Background: Cerebrovascular diseases are very common in hemodialysis (HD) patients. Silent cerebral infarction (SCI) has not been investigated in HD patients although it may be a significant risk factor for cerebrovascular diseases. Hypothesis: Chronic renal failure may be an independent risk factor for SCI and cerebrovascular diseases. Methods: Cranial magnetic resonance imaging (MRI) was performed on 123 HD patients without symptomatic cerebrovascular disease and on 52 control subjects. We investigated the prevalence of SCI and performed cross-sectional study using multiple logistic analysis to assess the relationship between SCI and the risk factors. Results: The prevalence of SCI was significantly higher in HD patients than in the healthy control group (60 patients (48.8%) vs. 5 patients (9.6%), χ2 = 22.4, p < 0.0001). Multiple logistic regression analysis with all subjects showed that independent risk factors of SCI were chronic renal failure, hypertension, smoking and age (R2 = 0.468, p < 0.0001). In only the HD patient group, age and smoking were shown to be independent risk factors of SCI (R2 = 0.378, p < 0.0001) while HD duration and hypertension were not. Conclusions: The findings of the present study indicate that chronic renal failure maintained by hemodialysis increases the prevalence of SCI and that age and smoking habits are also significantly associated with SCI in HD patients.

Expression of peroxisome proliferator-activated receptors (PPARs) in human urinary bladder carcinoma and growth inhibition by its agonists.

Recent studies have demonstrated that peroxisome proliferator activator‐receptors(PPAR)‐γ is expressed in various cancer tissues and its ligand induces growth arrest of these cancer cells through apoptosis. In our study, we investigated the expression of PPAR‐α, β and γ in human bladder tumor (BT) and normal bladder (NB) tissues as well as the effects of PPAR‐γ ligands. Specimens were obtained from 170 patients with BT and 20 with NB. The expressions were investigated using RT‐PCR and immunohistochemical methods. We also investigated the inhibitory effect of PPAR‐γ ligands on BT‐derived cell line. Immunoreactive PPAR‐α and ‐β were significantly apparent in both BT and NB tissues. Although no marked expression of PPAR‐γ was observed in NB tissue, significant expression was found in BT tissue. The extent and intensity of immunoreactive PPAR‐γ polypeptides in BT cells were statistically much greater than those of NB cells. Correlation between PPAR‐γ expression and tissue type or progression of bladder cancer was observed; PPAR‐γ expression was higher in G3 of bladder cancer than in G1 and was higher in advanced than in early cancer. PPAR‐γ agonists, troglitazone and 15‐deoxy‐Δ12, 14‐prostaglandin J2 inhibited the growth of the BT cells. PPAR‐γ is expressed in bladder tumor, and results suggest that PPAR‐γ ligands may mediate potent antiproliferative effects against BT cells. Thus, PPAR‐γ has the ability to become a new target in treatment of bladder tumor.

Different risk factors for peripheral vascular calcification between diabetic and non-diabetic haemodialysis patients – importance of glycaemic control

Abstract Aim/hypothesis. Although derangements of calcium and phosphate control have been emphasized as important risk factors for vascular calcification in non-diabetic haemodialysis patients, similar risk factors for diabetic haemodialysis patients are not known. We compared factors affecting peripheral vascular calcification between haemodialysis patients with and without diabetes. Methods. We examined 421 patients on maintenance haemodialysis. There were 89 patients with Type II (non-insulin-dependent) diabetes mellitus (53 men and 36 women, 62±10 years old) and 332 patients without diabetes (192 men and 140 women, 59±13 years old). Hand roentgenography was carried out, and visible vascular calcification of the hand arteries was evaluated. Results. There were 42 diabetic patients and 45 non-diabetic patients with vascular calcification. The prevalence of vascular calcification in diabetic patients (47.1%) was higher than in non-diabetic patients (13.6%) (p<0.001). In multivariate logistic regression, the main factors affecting vascular calcification in non-diabetic patients were advanced age, longer duration of haemodialysis, increased phosphate concentrations, male gender, and lower predialysis diastolic pressure. In diabetic patients, predictors for vascular calcification were higher values of HbA1C and longer duration of haemodialysis. In diabetic patients, a 1% increase in HbA1C increased the risk of calcification by 2.1-fold (95% CI 1.282–3.575, p=0.0029). Conclusion/interpretation. We have shown that poor glycaemic control, rather than calcium and phosphate concentrations, is a predictor of peripheral vascular calcification in diabetic patients on haemodialysis. This study emphasizes that glycaemic control remains critical even in diabetic patients with end-stage renal disease.

IL-17 production by γδ T cells is important for the antitumor effect of Mycobacterium bovis bacillus Calmette-Guérin treatment against bladder cancer.

Intravesical inoculation of Mycobacterium bovis bacillus Calmette‐Guérin (BCG) has been used for the treatment of bladder cancer. Recent studies implied the requirement of neutrophil infiltration for the antitumor effect. In this study, we found that IL‐17 was produced in the bladder after BCG treatment, preceding the infiltration of neutrophils. Neutrophils in the bladder after BCG treatment were reduced in IL‐17‐deficient mice, in which BCG‐induced antitumor effect against intravesically inoculated bladder cancer was abolished. Notably, the level of IL‐17 production and the number of neutrophils in BCG‐treated bladder was reduced in γδ T‐cell‐deficient mice but not in CD4‐depleted mice. Survival of bladder cancer‐inoculated γδ T‐cell‐deficient mice was not improved by BCG treatment. These results suggest that IL‐17‐producing γδ T cells play a key role in the BCG‐induced recruitment of neutrophils to the bladder, which is essential for the antitumor activity against bladder cancer.

Differential Contribution of Three Mitogen-Activated Protein Kinases to PDGF-BB-Induced Mesangial Cell Proliferation and Gene Expression

This study examined the role of mitogen-activated protein (MAP) kinase in PDGF-BB-induced proliferation and gene expression of human mesangial cells (MC). PDGF-BB stimulation of MC increased mRNA for transforming growth factor-beta1 (TGF-beta1), monocyte chemoattractant protein-1 (MCP-1), and plasminogen activator inhibitor-1 (PAI-1) and increased the cell numbers. To inhibit activation of extracellular signal-regulated kinase (ERK), c-Jun amino-terminal kinase (JNK), and p38, MC were infected with recombinant adenovirus containing dominant-negative mutants of ERK, JNK, and p38 (Ad-DN-ERK, Ad-DN-JNK, Ad-DN-p38, respectively), respectively. Infection of MC with Ad-DN-ERK or Ad-DN-JNK inhibited PDGF-BB-induced increase in [(3)H]thymidine incorporation and cell numbers, whereas Ad-DN-p38 did not. Ad-DN-ERK inhibited MCP-1 and PAI-1 mRNA expression in MC, but not TGF-beta1. Ad-DN-JNK and Ad-DN-p38 inhibited TGF-beta1 and MCP-1 mRNA expression, but not PAI-1. The inhibition of activator protein-1 (AP-1) in MC, by adenovirus containing dominant-negative mutant of c-Jun (Ad-DN-c-Jun), inhibited PDGF-BB-induced cell proliferation and TGF-beta1, MCP-1, and PAI-1 expressions. Furthermore, Ad-DN-JNK or Ad-DN-p38, but not Ad-DN-ERK, attenuated PDGF-BB-induced AP-1 activation in MC, indicating the involvement of JNK and p38 in AP-1 activation. Our results indicated that ERK and JNK, but not p38, participated in PDGF-BB-induced MC proliferation. PDGF-BB-induced expression of TGF-beta1 was mediated by JNK and p38, MCP-1 expression was through ERK, JNK, and p38, whereas PAI-1 expression was due to only ERK. AP-1 activation, which was partially due to JNK and p38 activations, was involved in MC proliferation and these three gene expressions. Thus, three MAP kinases seem to contribute to progression of glomerular disease via different molecular mechanisms.

Magnesium supplementation prevents experimental chronic cyclosporine a nephrotoxicity via renin-angiotensin system independent mechanism.

Background. We have previously shown that correction of hypomagnesemia by magnesium (Mg) supplementation ameliorates chronic cyclosporine A (CsA) nephropathy via inhibiting gene expression of fibrogenic molecules. Experiments were conducted to further elucidate upstream mechanism of the beneficial effects upon CsA nephrotoxicity. Methods. CsA (15 mg/kg/day, subcutaneous [SC]) was administered daily to rats maintained on low sodium diet for 7, 14, and 28 days. Because blockade of renin-angiotensin system improves chronic CsA nephropathy, the effects of Mg supplementation and those of angiotensin-converting enzyme inhibitor (ACEI) were compared on renal function, renal histology, mononuclear cell infiltration, and gene expression profile. Results. CsA induced a decline in glomerular filtration and developed characteristic striped fibrosis that were mostly evident at day 28. Mg attenuated CsA-induced impaired renal function, whereas ACEI did not. Interstitial inflammation as evidenced by monocyte/macrophage infiltration preceded the renal fibrosis and increased progressively with the CsA treatment period. Concomitantly, CsA markedly up-regulated expression of chemoattractant proteins, osteopontin, and monocyte chemoattractant protein-1. These changes were abolished by Mg but were only partially affected with ACEI. CsA promoted renal mRNA expression of fibrogenic molecules and extracellular matrices that were almost completely abolished by Mg but partially suppressed by ACEI. Similarly, CsA-induced chronic fibrotic lesion was markedly attenuated by Mg supplementation but was partially attenuated by ACEI. Conclusion. Mg supplementation abolished CsA-induced precedent interstitial inflammation possibly via inhibition of chemoattractants expression and consequently attenuated tubulointerstitial fibrosis. In this protective mechanism, factors independent of the renin-angiotensin system appears to be mainly involved.

Role of hypomagnesemia in chronic cyclosporine nephropathy

BACKGROUND Hypomagnesemia is a common finding of cyclosporine (CsA)-treated patients and has been proposed as both a cause and a consequence of CsA-induced nephrotoxicity. This experiment was conducted to elucidate the role of hypomagnesemia in the pathogenesis of chronic CsA nephropathy. METHODS CsA (15 mg/kg/day subcutaneously) was administered to rats maintained on a low-sodium diet for 1, 2, and 4 weeks, and the effects of magnesium (Mg) supplementation on renal function, renal histology, and renal gene expression profile of fibrogenic molecules and vasoconstrictors was examined. RESULTS CsA elicited hypomagnesemia and induced a progressive decline in glomerular filtration. At 28 day, renal tubular atrophy and cortical striped interstitial fibrosis were evident with CsA treatment. Dietary supplementation of Mg ameliorated CsA-induced hypomagnesemia and almost completely abolished CsA-induced chronic fibrotic lesions. Neither CsA nor Mg supplementation affected blood pressure. Renal cortical mRNA of transforming growth factor beta, plasminogen activator inhibitor (PAI)-1, and extracellular matrix started to increase at 14 days and elevated further at 28 days. In contrast, the increase in mRNA of tissue inhibitor of matrix metalloproteinase-1 and renin was evident early at 7 days and reached peak at 14 days. These mRNA increases, except that of renin, were almost abolished when hypomagnesemia was corrected. Magnesium supplementation also improved glomerular dysfunction, at least in part, through inhibition of up-regulated mRNA of endothelin-1. CONCLUSION CsA-induced hypomagnesemia contributes to chronic renal fibrotic lesions seen during CsA treatment through up-regulation of fibrogenic molecules, most notably early activation of tissue inhibitor of matrix metalloproteinase-1 expression.

Tissue factor antisense oligonucleotides prevent renal ischemia-reperfusion injury.

Background. Tissue factor (TF) expression is induced on macrophages and endothelial cells during the immune response. We designed an antisense (AS) phosphorothioate oligodeoxynucleotide (ODN) to specifically inhibit the expression of rat TF to study the effects of the AS ODN on renal ischemia-reperfusion injury in the rat. Method. AS-1 ODN for TF was delivered intravenously to inhibit the expression of TF in endothelial cells. After 8 hr, the right kidney was harvested and the left renal artery and vein were clamped. The kidney was reperfused after 90 min of ischemia, and rats were killed at 0, 1.5, 5, 12, and 24 hr after reperfusion. TF expression was analyzed by immunohistochemical staining using monoclonal antibody. Results. In the untreated ischemic group, 0 of 20 rats survived beyond day 3. However, treatment with AS-1/TF led to 12 of 20 rats surviving beyond day 4. TF was detected on distal tubular epithelial cells, endothelial cells, and blood vessels but not on necrotic and proximal tubular epithelial cells. The necrotic area extended and encompassed nearly all of the ischemic kidney within 12 hr after reperfusion. The necrotic area and the grade of TF staining were more significantly reduced in the AS-1/TF-treated group than in the control group. Furthermore, fluorescein isothiocyanate-labeled AS-1/TF was significantly intense in tubular epithelial cells 8 hr after intravenous administration. Conclusions. The results indicate that AS-1/TF inhibited the ischemia-reperfusion injury of the kidney. Microcirculatory incompetence resulting from microthrombus may cause the formation and development of necrosis.

Cyclooxygenase-1 and -2 in human testicular tumours

In this study, we investigated the expression of cyclooxygenase (COX)-1 and -2 in human testicular cancer (TC) and normal testis (NT) tissues, as well as the effects of COX ligands on viability and proliferation. Tumour specimens were obtained from 72 patients with TC and 20 patients with NT. RT-PCR and immunohistochemical methods were used to determine COX expression. While COX expression was not noted in any of the NT tissues, a marked expression was observed in the TC samples. The extent and intensity of immunoreactive COX-1 and -2 polypeptides in the TC tissues was statistically greater than the expression in the NT tissues. The synthetic COX inhibitors inhibited the growth of the TC cells. Both COX-1 and COX-2 are induced in testicular cancer, and these results indicate that both COX-1 and COX-2 are essential for the growth of TC cells.

Expression of peroxisome proliferator-activated receptors in human testicular cancer and growth inhibition by its agonists

OBJECTIVES To investigate the expression of peroxisome proliferator activator-receptor (PPAR)-alpha, beta, and gamma in human testicular cancer (TC) and normal testicular (NT) tissues, as well as the effects of the PPAR-gamma ligand. Recent studies have demonstrated that PPAR-gamma is expressed in various cancer tissues and its ligand induces growth arrest of these cancer cells through apoptosis. However, the expression of PPARs and the effects of PPAR-gamma ligand in testis have not been examined. METHODS Tumor specimens were obtained from 72 patients with TC. Specimens were obtained from 20 patients with NT tissue. The expressions were investigated using reverse transcriptase-polymerase chain reaction and immunohistochemical methods. We also investigated the inhibitory effect of the PPAR-gamma ligand on the TC-derived cell line. RESULTS Immunoreactive PPAR-alpha and beta were significantly apparent in TC tissues. Marked expression of PPAR-alpha and beta was also detected in the NT group. However, very weak or no expression of immunoreactive PPAR-gamma was found in the NT cases. In contrast, we found significant expression of immunoreactive PPAR-gamma in the cancer cells in the TC group. The synthetic PPAR-gamma agonists thiazolidinedione compounds and the endogenous PPAR-gamma ligand, 15-deoxy-Delta-prostaglandin J(2), inhibited the growth of the TC cells. CONCLUSIONS PPAR-gamma is induced in TC, and the results suggest that PPAR-gamma ligands may mediate potent antiproliferative effects against TC cells through differentiation. Thus, PPAR-gamma may become a new target in the treatment of TC.