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Biomedical subjects

Ryuji Nohara

Publications and source records attributed to Ryuji Nohara.

At least 19 recordsLinked to original sources

Activation of hypoxia-inducible factor 1 during macrophage differentiation.

Monocytes/macrophages of the myeloid lineage are the main cellular effectors of innate immunity. Hypoxia-inducible factor 1 (HIF-1) is essential for myeloid cell activation in response to inflammatory stimuli. However, it has not been established whether HIF-1 activity is induced during differentiation from monocyte to macrophage. We demonstrate that macrophage differentiation of THP-1 cells or monocytes from peripheral blood induces increased expression of both HIF-1alpha and HIF-1beta as well as increased HIF-1 transcriptional activity leading to increased expression of HIF-1 target genes. The increased HIF-1 activity in differentiated THP-1 cells resulted from the combined effect of increased HIF-1alpha mRNA levels and increased HIF-1alpha protein synthesis. Differentiation-induced HIF-1alpha protein and mRNA and HIF-1-dependent gene expression was blocked by treating cells with an inhibitor of the protein kinase C or MAP kinase signaling pathway. THP-1 cell differentiation was also associated with increased phosphorylation of the translational regulatory proteins p70 S6 kinase, S6 ribosomal protein, eukaryotic initiation factor 4E, and 4E binding protein 1, thus providing a possible mechanism for the modulation of HIF-1alpha protein synthesis. RNA interference studies demonstrated that HIF-1alpha is dispensable for macrophage differentiation but is required for functional maturation.

Alternative Splicing↗

A catheter-based intravascular radiation detector of vulnerable plaques.

UNLABELLED: Detection of vulnerable plaques before rupture is important in preventing acute coronary events such as myocardial infarction. Although therapeutic strategies such as percutaneous transluminal coronary angioplasty appear to prevent coronary occlusion and consequently may lead to improved prognosis in these patients, a method of detecting vulnerable plaques has not been established. A nuclear method that uses an intravascular radiation detector (IVRD) with the plaque-avid tracer (18)F-FDG is one of the most promising methods. The catheter-based IVRD consists of a catheter probe (a scintillator and flexible optic fibers), photomultipliers, a controller, and an automatic pullback unit and personal computer. A phantom study demonstrated that this detector was highly sensitive to (18)F and enabled the detection of (18)F point sources. However, details of the detection system in vivo remain unclear. METHODS: To evaluate vulnerable plaques in vivo, we investigated a canine femoral artery and coronary artery using this detector system. Our goal was to estimate the ability of this device to navigate through these arteries and to detect (18)F point sources fixed on their adventitia. RESULTS: In the study using a canine femoral artery, the IVRD could detect the point sources with good repeatability. In the study using an open-chest canine model, the catheter probe could easily be advanced into the left descending coronary artery, and the IVRD could detect target sources attached externally to the coronary artery (7- to 15-mm intervals) with good resolution. CONCLUSION: This newly developed catheter-based IVRD was able to detect, with good resolution, the slight radioactivity from (18)F point sources attached to the femoral artery and the coronary adventitia. These results show that catheter-based detection of coronary vulnerable plaques may be feasible.

Animals↗

[Exercise therapy for heart failure].

In chronic heart failure of CAD, therapeutic approach will be available either with drugs or exercise. With exercise, coronary risk factors such as BP, lipid, DM and obesity will be controlled. In addition, ischemia will also be controlled by decreasing oxygen demand related to BP and HR, and with increasing oxygen supply by increased ECNOS gene expression, collateral formation and regression of coronary stenosis. Infarct size is also reported to be decreased by increasing MnSOD in the cell by exercise. Prognosis of CHF is also good in various evidence of exercise therapy. Recent advances of molecular biology have revealed various mechanisms of exercise effect. Thus, exercise if properly prescribed without provoking ischemia will be basically and clinically effective therapy for patients with CHF.

Exercise Therapy↗

Myocardial metabolism of 123I-BMIPP under low-dose dobutamine infusion: implications for clinical SPECT imaging of ischemic heart disease.

PURPOSE: 123I-(p-iodophenyl)-3-(R,S)-methylpentadecanoic acid (123I-BMIPP) is a fatty acid analog for single-photon emission computed tomography (SPECT) imaging that is mainly stored in the triglyceride pool. Low-dose dobutamine infusion has been reported to improve BMIPP uptake in the stunned myocardium, but the mechanism underlying this effect remains unclear. The purpose of this study was therefore to investigate the myocardial metabolism of 123I-BMIPP in the stunned myocardium under low-dose dobutamine infusion, and to elucidate the mechanism by which dobutamine improves BMIPP uptake. METHODS: Using open-chest dogs, stunned myocardium was induced by occlusion of the left anterior descending artery (LAD) for 30 min, with subsequent reperfusion (ischemia group, n=6). After direct injection of BMIPP into the LAD, myocardial extraction and retention were examined and metabolites evaluated (using high-performance liquid chromatography) during dobutamine infusion. The results in the ischemia group were compared with findings obtained in a control group under dobutamine infusion (n=6). RESULTS: Dobutamine infusion significantly increased both the rapid extraction (within 30 s) of BMIPP into the myocardium (control vs ischemia group: 48+/-19% vs 66+/-14%, p<0.05) and its subsequent retention (73+/-13% vs 85+/-8%, p<0.05). The metabolites from the myocardium consisted of back diffusion of nonmetabolized BMIPP, the alpha-oxidation metabolite, intermediate metabolites, and the full-oxidation metabolite. Among these metabolites, the full-oxidation metabolite decreased significantly (from 34.0+/-20.0% to 15.8+/-9.3%, p<0.05) in the stunned regions, though back diffusion of nonmetabolized BMIPP increased (from 51.3+/-21.9% to 71.3+/-10.1%, p<0.05). CONCLUSION: These results indicate that increased uptake of BMIPP in stunned myocardium is mainly due to decreased beta-oxidation in tissue and increased shunt retention of BMIPP in the triglyceride pool, and thereby provide further insight into the pathophysiology of stunned myocardium.

Animals↗

A catheter-based radiation detector for endovascular detection of atheromatous plaques.

PURPOSE: Although various radiopharmaceuticals have been developed for the detection of atheromas, external imaging techniques have limitations when it comes to the detection of small plaques. In this study, we developed a charged particle-sensitive detector for the endovascular detection of small plaques. METHODS: The device consists of a probe, an automatic pullback unit and a controller. The probe, which consists of a plastic scintillator and flexible optical fibres, is 1.0 mm in diameter. The probe was inserted into a catheter placed on (18)F point sources, and then the radioactivity was measured as the probe was pulled out stepwise. RESULTS: The sensitivity for (18)F was 9.3 cps/kBq, and there was a close linear correlation between the peak counts and source dose until at least 0.8 MBq. Furthermore, this device showed low background counts (<0.1 cps) and a low detection limit (0.21 kBq). To investigate the effect of background radioactivity on the measurement at the point sources, a ball phantom was prepared and five (18)F point sources were set on the ball's surface. Even though 298 MBq of (18)F-fluorodeoxyglucose was injected into the ball, the point sources located every 10 mm on the ball's surface were detectable separately. CONCLUSION: The data gathered suggest that a catheter-based radiation detector in combination with charged particle-emitting radiopharmaceuticals is useful for the endovascular detection of small lesions such as coronary plaques.

Animals↗

Expression of MHC-beta and MCT1 in cardiac muscle after exercise training in myocardial-infarcted rats.

To evaluate the hypothesis that increasing the potential for glycolytic metabolism would benefit the functioning of infarcted myocardium, we investigated whether mild exercise training would increase the activities of oxidative enzymes, expression of carbohydrate-related transport proteins (monocarboxylate transporter MCT1 and glucose transporter GLUT4), and myosin heavy chain (MHC) isoforms. Myocardial infarction (MI) was produced by occluding the proximal left coronary artery in rat hearts for 30 min. After the rats performed 6 wk of run training on a treadmill, the wall of the left ventricle was dissected and divided into the anterior wall (AW; infarcted region) and posterior wall (PW; noninfarcted region). MI impaired citrate synthase and 3-hydroxyacyl-CoA dehydrogenase activities in the AW (P < 0.01) but not in the noninfarcted PW. No differences in the expression of MCT1 were found in either tissues of AW and PW after MI, whereas exercise training significantly increased the MCT1 expression in all conditions, except AW in the MI rats. Exercise training resulted in an increased expression of GLUT4 protein in the AW in the sham rats and in the PW in the MI rats. The relative amount of MHC-beta was significantly increased in the AW and PW in MI rats compared with sham rats. However, exercise training resulted in a significant increase of MHC-alpha expression in both AW and PW in both sham and MI rats (P < 0.01). These findings suggest that mild exercise training enhanced the potential for glycolytic metabolism and ATPase activity of the myocardium, even in the MI rats, ensuring a beneficial role in the remodeling of the heart.

Adaptation, Physiological↗

Improvement of oxygen metabolism in ischemic myocardium as a result of enhanced external counterpulsation with heparin pretreatment for patients with stable angina.

Enhanced external counterpulsation (EECP) is noninvasive, safe, and effective for stable angina. We have reported that the development of functional collateral vessels is one of the mechanisms of EECP therapy using ammonia positron emission tomography (PET). The efficacy of heparin treatment on collateral growth is shown in several clinical studies. We evaluated whether EECP combined with intravenous heparin injection is effective for exercise capacity and oxygen metabolism of ischemic myocardium in stable angina. Eleven patients with stable angina were treated with conventional EECP therapy (C group). Seven patients with stable angina were treated with EECP therapy with 5000 IU heparin pretreatment (H group). At baseline and after the completion of treatment H, 7 patients underwent [(11)C] acetate PET to examine the change in regional myocardial oxygen metabolism. Although the total treadmill exercise time was prolonged after treatment in both groups, the extent of the improvements was significantly greater in the H group compared with the C group. Although k mono, the index of regional myocardial oxygen metabolism, in the nonischemic region remained unchanged, k mono in the ischemic region increased significantly ( P << 0.05) from 0.038 +/- 0.004 to 0.053 +/- 0.007. In conclusion, EECP with heparin pretreatment appears to be a new treatment remedy for patients with stable angina.

Angina Pectoris↗

Successful allogeneic bone marrow transplantation for acute myelogenous leukemia after drug-induced cardiomyopathy.

Anthracycline derivatives often induce cardiomyopathy. Patients with seriously decreased cardiac function due to chemotherapeutic drugs cannot usually receive allogeneic hematopoietic stem cell transplantation (SCT) for hematologic disorders. We successfully performed allogeneic bone marrow transplantation (BMT) in a patient with severe cardiomyopathy. An 18-year-old woman with relapsed acute myelogenous leukemia had cardiomyopathy due to previous anthracycline administration. She underwent allogeneic BMT from her HLA-identical brother. Her preconditioning regimen was cytosine arabinoside, etoposide, total body irradiation, and high-dose cyclophosphamide. Congestive heart failure (CHF) was not present before BMT. Right heart pressures were monitored by a pulmonary arterial balloon catheter system (Swan-Ganz catheter). After BMT, she had severe CHF, which was controlled using pimobendan and amrinone. Patients with cardiomyopathy can receive allogeneic SCT under strict hemodynamic management.

Adolescent↗

LOX-1 pathway affects the extent of myocardial ischemia-reperfusion injury.

Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) was originally identified as a receptor for oxidized low-density lipoprotein predominantly expressed in endothelial cells. LOX-1 expression can be induced in cardiomyocytes and that activation of LOX-1 is involved in apoptosis. To investigate possible roles of LOX-1 in myocardial ischemia-reperfusion injury, rats were subjected to coronary artery ligation for 1h followed by reperfusion for 2h. Immunohistochemistry revealed that expression of LOX-1 in cardiac myocytes was induced following ischemia-reperfusion but not ischemia alone. Administration of anti-LOX-1 monoclonal antibody resulted in a nearly 50% reduction in myocardial infarction size compared with that of normal IgG or saline (P<0.05). These findings suggest that activation of the LOX-1 pathway is involved in determining the extent of myocardial ischemia-reperfusion injury and that inhibition of the LOX-1 pathway may provide a novel strategy for treatment of acute myocardial infarction in humans.

Animals↗

Relationship between natural killer activity and anger expression in patients with coronary heart disease.

Recently, the contribution of the immune system in the development and progression of arteriosclerosis has been suggested. Moreover, psychological stress has also been reported to affect the immune response. Thus, psychological factors are considered to influence the immune response, and an excessive immune response promotes the progression of arteriosclerosis, resulting in the development of coronary heart disease (CHD). In this study, the relationship between the immune response and psychological factors was investigated in CHD patients (n = 74) and normal controls (n = 64). Natural killer (NK) activity was significantly higher in the CHD group than the normal control (CHD vs normal: 8151.39 vs 6653.06, P < 0.05), and was significantly elevated by the suppression of anger and negative emotions (P < 0.05). These results indicate that the characteristic process of psychological response in CHD patients is related to an overresponse of NK activity. We speculate that this linkage significantly influences the development of CHD.

Adult↗

Use of exercise cardiac rehabilitation after acute myocardial infarction.

The purpose of this study was to determine the rate of participation of patients after acute myocardial infarction (AMI) in phase II cardiac rehabilitation with exercise training (ie, exercise cardiac rehabilitation, ECR) in Japan. Forty-six hospitals treating patients with AMI were surveyed for their implementation of phase II ECR after AMI in 1996-98. Of the 46 hospitals, 19 were approved and 27 were not approved for health insurance payment for ECR. A total of 13685 patients with AMI were admitted to the 46 hospitals. There were no differences between approved and non-approved hospitals in the annual number of patients with AMI (Approved, 117+61 vs Non-approved, 86+71 patients per hospital, NS), the rate of performance of emergency coronary angioplasty (63+16 vs 65+20%, NS), or the rate of emergency coronary stenting (31+16 vs 34+22%, NS). However, ECR was performed routinely in 84.2% (16/19 hospitals) of the approved hospitals, but in only 22.2% (6/27 hospitals) of the non-approved hospitals (p<0.001). Although the participation rate of AMI patients in ECR was 21.0% (2875/13685 patients) overall, it was markedly lower in the non-approved hospitals (8.0%, 557/6999 patients) than in the approved hospitals (34.7%, 2318/6686 patients, p<0.0001). Based on the present result, the overall rate of participation of AMI patients in ECR in Japan was estimated at 4.8-11.7%. Despite similar patient volumes and acute phase interventional treatment of AMI between the hospitals approved and not approved for health insurance payment for ECR, ECR was markedly underused in the non-approved hospitals in Japan. To promote ECR for all AMI patients in Japan, the number of hospitals approved for ECR should be substantially increased.

Economics, Hospital↗

Neurohormonal determinants of peak oxygen uptake in patients with chronic heart failure.

Chronic heart failure (CHF) is characterized by the activation of neurohormones and cytokines. This study determined whether peak oxygen uptake (VO2) can be predicted by the degree of neurohormonal and cytokine activations in CHF. Plasma norepinephrine. epinephrine, renin-angiotensin system activity, ANP, BNP, and serum interleukin-6 (IL-6) and tumor necrosis factor (TNF)-alpha were measured in 84 CHF patients (age, 59 +/- 1 years, LVEF, 36 +/- 1%) and 34 controls. Maximal cardiopulmonary exercise testing was performed. Peak VO2 (Controls vs CHF: 27.8 +/- 1.3 vs 18.2 +/- 0.5 mL/min/kg, P < 0.0001) was lower in CHF. Patients with CHF had increased plasma norepinephrine (211 +/- 11 vs 315 +/- 24 pg/mL), renin activity (1.2 +/- 0.2 vs 6.2 +/- 1.1 ng/mL/hr), ANP (22 +/- 3 vs 72 +/- 7 pg/mL), and BNP levels (18 +/- 3 vs 200 +/- 25 pg/mL) (all P < 0.01). Serum IL-6 (1.1 0.1 vs 2.4 +/- 0.3 pg/mL) and TNF-alpha (2.7 +/- 0.2 vs 4.0 +/- 0.3 pg/mL) levels were higher in CHF (both P < 0.001). Univariate analysis revealed that age (P < 0.001), cardiothoracic ratio (P < 0.001), norepinephrine (P < 0.0001), ANP (P < 0.001), BNP (P < 0.01), and log IL-6 (P < 0.05) were significantly related with peak VO2. Stepwise regression analysis indicated that plasma norepinephrine and ANP emerged as significant determinants of peak VO2, independent of patient age (overall R = 0.61, P < 0.0001). In summary, patients with CHF exhibited activation of neurohormones and proinflammatory cytokines. Among the elevated hormonal and cytokine markers, plasma norepinephrine and ANP levels were independent predictors of exercise capacity.

Atrial Natriuretic Factor↗

[Use of beta-blockers in heart failure].

Recently, a number of clinical trials showed that beta-blockers reduce morbidity and mortality in patients with heart failure. Possible mechanisms for this effect of beta-blockers include protection from catecholamine myocyte toxicity, upregulation of beta-adrenergic signaling, attenuation of apoptosis, reduction in myocardial oxygen demand, and antiarrhythmic effect. Metoprolol, bisoprolol, and carvedilol are proved to have substantial benefit in the treatment of heart failure by large-scale studies. In patients with moderate to severe heart failure, these drugs have to be started slowly and to be uptitrated gradually while watching for deterioration of heart failure. Cardiac contraindications include severe bradycardia, high-degree heart block, and decompensated heart failure. In spite of those adverse effects, beta-blocker should be actively adopted in the treatment of heart failure.

Adrenergic beta-Antagonists↗