¥æ02 ACR Êó¹ð
±Ñ¸ì¤Îʹ¤¼è¤ê¤¬Æñ¤·¤¯¡¢Íý²ò¤Ç¤¤¿¤Î¤Ï3-4³äÄøÅ٤Ǥ·¤¿(±Ñ¸ì¤òÍý²ò¤·¤Æ¤¤¤¿¤È¤·¤Æ
¤â¡¢³§¤µ¤ó¤ËͱפÊÊó¹ð¤¬¤Ç¤¤ë¤«¤É¤¦¤«¤Ïµ¿Ìä¤Ç¤¹¤¬)¡£¤³¤Á¤é¤«¤éÀѶËŪ¤ËÏ䷳ݤ±¤Ê
¤«¤Ã¤¿°Ù¤«¡¢ÆâÍƤ¬minor¤Ê°Ù¤«¡¢»ä¤Î±éÂê¤Ë¤Ï¡¢³°¹ñ¤ÎÊý¤Ï¼ÁÌ䤷¤Æ¤¯¤ì¤Þ¤»¤ó¤Ç¤·¤¿¡£
ÆüËܿͤÎÊý¤¬¿ô̾Íè¤Æ²¼¤µ¤ê¡¢¥Õ¥í¥ê¥ÀÂç³Ø¤ÎSatohÀèÀ¸¤ÈÆüËܸì¤Çdiscussion¤·¤Þ¤·¤¿¡£
°Ê²¼¤Ë¤Ç¤¤ë¤À¤±¸íǧ»ö¹à¤ÎµºÜ¤òÈò¤±¤ë¤è¤¦¡¢Êó¹ð¤ËÅؤá¤Þ¤¹¡£
1 (ACR Medical Aspects of Rheumatic Diseases Lecture)
Hyperuricemia:speaker; Richard J Johnson, Baylor College of Medicine, Houston,
Texas
(JohnsonÀèÀ¸¤Ï¡¢¤â¤È¤ÏWashington University ¤Î¿Õ¡³Ø¤ÎCouserÀèÀ¸¤Î½ê¤Ë¤¤¤¿Êý¤Ç¡¢
¿Õ¡¤ÎʬÌî¤Ç¤Ï¸æ¹â̾¤ÊÀèÀ¸¤Ç¤¹¡£·²ÂçÂè3Æâ²Ê¤Î»ä¤ÎÀèÇÚ¤âα³Ø¤·¤Æ¤¤¤¿½ê¤Ç¤¹¡£)
(summary)
¹âÇ¢»À·ì¾Érat¤Ç¤Ïsalt independent¤Ë¼ý½Ì´ü·ì°µ¤¬¤¢¤¬¤ê¡¢alloprinolÅêÍ¿·²¤Ç¤Ï¼ý½Ì´ü
¾å¾º¤Ï¸«¤é¤ì¤Ê¤«¤Ã¤¿¡£¤½¤Î¥á¥«¥Ë¥º¥à¤Ï¡¢RA·Ï¤Î³èÀ²½¤ÈÍ¢ÆþºÙÆ°Ì®¤Ç¤ÎPDGF,COX-2¤Ê
¤É¤ò²ð¤·¤¿Ê¿³ê¶ÚºÙ˦¤ÎÁý¿£¤Î´ØÍ¿¤¬¹Í¤¨¤é¤ì¤¿¡£¤Þ¤¿¡¢¿Õ¹Å²½¥â¥Ç¥ë¤Ë¤ª¤¤¤Æ¤â
alloprinol¤Ï¹Å²½¤ÎÍÞÀ©¸ú²Ì¤ò¼¨¤·¤¿¡£
(¤â¤Ã¤È¾Ü¤·¤¯)
¹âÇ¢»À·ì¾É¤¬¹â·ì°µ¤½¤Î¤â¤Î¤Î´í¸±°ø»Ò¤È¤Ê¤ê¤¦¤ë¤È¤¤¤¦Î×¾²¸¦µæ¤¬ÆüËܤè¤êºÇ¶á¤À¤µ¤ì
¤Æ¤¤¤ë¤¬(Iseki et al. J Hypertens 2001)¡¢¼Â¸³Åª¤Ë¹âÇ¢»À·ì¾É¤È¹â·ì°µ¤È¤Î´Ø·¸¤ò¸¡¾Ú
¤·¤¿ËÉÙ¤Êdata¤òÄ󼨤·¤Æ¤¤¤¿¡£NaCl¤Î±Æ¶Á¤ò½ü³°¤¹¤ë¤¿¤á¡¢low salt diet (°Ê²¼LS)¤Ë
¤·¤¿rat¤Ëoxonic acid(uricase inhibitor)(°Ê²¼OA)¤òÅêÍ¿¤·¤Æ¹âÇ¢»À¤Î¾õÂ֤ˤ¹¤ë¤È¡¢2
½µ´ÖÄø¤Ç¼ý½Ì´ü·ì°µ¤¬¾å¾º¤·¤Æ¤¯¤ë¡£Æ±»þ¤Ëalloprinol¤òÅêÍ¿¤·¤¿·²¤Ç¤Ï·ì°µ¤Ï¾å¤¬¤é¤Ê
¤«¤Ã¤¿¡£¤³¤Î¥é¥Ã¥È¤Ç¤Ï¡¢¿Õ¡´Ö¼Á¤Ë¡¢Ã±³Ëµå¿»½á¤È¡¢De GalanthaÀ÷¿§¤Ç¡¢Ç¢»À°ì¥Ê¥È¥ê
¥¦¥à¤ÎCrystal¤¬¸«¤é¤ì¤¿¡£Ç¢»À¤¬¹â·ì°µ¤ò¤ª¤³¤¹¥á¥«¥Ë¥º¥à¤È¤·¤Æ¡¢LS+OA+rat¤Ç¤Ï»åµå
ÂÎÆâ¤Î¥ì¥Ë¥ó¤Îȯ¸½¤¬Ð¶¿Ê¤·¤Æ¤ª¤ê¡¢R-A·Ï¤Î³èÀ²½¤Ë¤è¤ë¡¢Ç¢ºÙ´É¤«¤é¤ÎNaºÆµÛ¼ýж¿Ê
¤È¡¢GFR¤ÎÄã²¼¤¬¤¢¤²¤é¤ì¤ë¡£¹¹¤Ë¡¢¤³¤ÎLS+OA+rat¤Ë¤Ï¡¢Í¢ÆþºÙÆ°Ì®¥ì¥Ù¥ë¤ÎÊ¿³ê¶ÚºÙ˦
(SMC)¤ÎÁý¿£¤¬Ç§¤á¤é¤ì¤¿¡£¤³¤ÎÊѲ½¤Ïessential hypertention¤Ë¤Ï¤ß¤é¤ì¤Ê¤¤¡£¼ÂºÝ¡¢in
vitro¤Îdata¤Ï¡¢Ç¢»À¤¬SMC¤ÎMAPK¤äCOX2¤äPDGF¤Îȯ¸½¤òж¿Ê¤µ¤»¡¢SMC¤ÎÁý¿£¤òÂ¥¿Ê¤µ¤»
¤¿¡£¤Þ¤¿¡¢¤³¤ÎÁý¿£¤Ïprobenecid¤äMAPK inhibitor, COX-2 inhibitor¤¬ÍÞÀ©¤·¤¿¡£¤³¤Î¤³
¤È¤Ï¡¢LS+OA+rat¤Ë¤ª¤¤¤ÆÍ¢ÆþºÙÆ°Ì®¥ì¥Ù¥ë¤ÎÊ¿³ê¶ÚºÙ˦(SMC)¤ÎÁý¿£¤¬¡¢¹â·ì°µ¤Ë´ØÍ¿¤¹
¤ë»ö¤ò¼¨¤·¤Æ¤¤¤ë¡£¹¹¤Ë¡¢¿Õµ¡Ç½¤ÎÄã²¼¤·¤¿¾õÂÖ¤ÇOA¤òÅêÍ¿¤·¡¢»åµåÂιŲ½¤ËÂФ¹¤ë±Æ¶Á
¤ò¸«¤¿¼Â¸³(Rat¤ÎÊÒÊý¤Î¿Õ¤Î·ìή¤ò¼×ÃÇ¡¢»Ä¿Õ¤ËÂФ·¤Æ¤â¡¢´ö¤Ä¤«Æ°Ì®¤ò·ë姤·¤¿¤â¤Î¤Ë
OA¤òÅêÍ¿¤·¤¿¡£)¤Ç¤Ï¡¢alloprinolÅêÍ¿·²¤Ç¡¢»åµåÂιŲ½¤¬·Ú¸º¤·¤¿¡£¤³¤³¤Ç¤âSMC¤Ë¤ª¤±
¤ëCOX-2ȯ¸½¤Îж¿Ê¤òǧ¤á¤¿¡£
>>COX-2 inhibitor¤Ç·ì°µ¤¬¤µ¤¬¤ë¡©
¤½¤Î¾¡¢Ripsky¤ÎB-cell lecture, ¤Þ¤¿¡¢T-cell lecture, dendritic cell (DC)lecture
¤¬¤¢¤ê¡¢Èó¾ï¤ËÊÙ¶¯¤Ë¤Ê¤ê¤Þ¤·¤¿¡£ÆäË(´ðËÜŪ¤Ê»ö¤Ç¤¢¤ë¤«¤âÃΤì¤Þ¤»¤ó¤¬)immature DC
¤Ï¡¢ÌȱַϤËÂФ·¤ÆÍÞÀ©Åª¤ËƯ¤¯»ö¡¢¤Þ¤¿¡¢DC¤Ë¤Ïmyeloid DC¤Èplasmacytoid DC¤È¤¢¤Ã¤Æ
Ìò³ä¤¬°ã¤¦»ö¡¢DC¤ò°ìö³°¤Ë½Ð¤·¤Æ¡¢peptide¤È¶¦¤ËÇÝÍܤ·¡¢¤Þ¤¿ÂÎÆâ¤ËÌᤷ¤Æ¥ï¥¯¥Á¥ó¼£
ÎŤò¹Ô¤¦»ö¤Ê¤É¡¢½é¤á¤ÆÃΤê¤Þ¤·¤¿¡£¤³¤ì¤é¤Îlecture¤Î¥¹¥é¥¤¥É¤Î°ìÉô¤òJPG²èÁü¤ÇÊݸ
¤·¤Æ¤¤¤Þ¤¹¡£¸æ´õ˾¤ÎÊý¤Ï¸æÏ¢Íí¤¯¤À¤µ¤¤¡£
2 CRP¤ÈFcR-
CRP¤ÏÀ¸ÂÎÆâ¤Ç¡¢±ê¾ÉÈ¿±þ¤Î·ë²ÌÀ¸¤¸¤¿¥´¥ß¤Î½üµî¤Ê¤É¡¢¤¤¤í¤ó¤ÊÌò³ä¤ò¤â¤Ã¤Æ¤¤¤ë¤¬¡¢¤³
¤Îlecture¤Ç¤Ï¡¢CRP¤¬Fc¦ÃR¤Î¥ê¥¬¥ó¥É¤È¤·¤ÆƯ¤¡¢Fc¦ÃRȯ¸½ºÙ˦µ¡Ç½¤ò³èÀ²½¤·¤¿¤ê¡¢
ÍÞÀ©¤·¤¿¤ê¤·¤Æ¤¤¤ë¤³¤È¤Ë´Ø¤¹¤ëdata¤¬¼¨¤µ¤ì¤¿¡£Fc¦ÃRª¡,ª£a¤Ë·ë¹ç¤¹¤ë¤È¡¢±ê¾ÉÀ¤ÎÊÑ
²½¤ò¡¢Fc¦Ãª¢b¤Ï¹³±ê¾ÉÀ¤ÎÊѲ½¤ò¤â¤¿¤é¤¹ÍÍƯ¤¯¡£¥¨¥ó¥É¥È¥¥·¥ó¥·¥ç¥Ã¥¯¤Î¥â¥Ç¥ë¤Ë¡¢
CRP¤òÅêÍ¿¤¹¤ë¤È¡¢normal mice¤Ç¤Ïmortality¤¬²þÁ±¤¹¤ë¤¬¡¢Fc¦Ãª¢bKO mice¤Ïmortality
¤¬°²½¤¹¤ë¡£Normal mice¤ËCRPÅêÍ¿¤¹¤ë¤ÈIL-10¤Î»ºÀ¸¤¬Â¥¿Ê¤µ¤ì¤ë¡£¤Þ¤¿¡¢Fc¦Ãª¢bKO
mice¤ËCRP¤òÅêÍ¿¤¹¤ë¤È¡¢TNF-alpha¤äIL1-12¤È¤¤¤Ã¤¿proinflammatory cytokines¤Î»ºÀ¸¤¬
ж¿Ê¤¹¤ë¡£
3 NMDA antagonist¤ÎDextromethorphan¤¬ fibromyalgia¤Îthermal-wind up¤òÍÞÀ©¤¹¤ë¡£>>
FM¤Î¼£ÎŤËDextromethorphan¤¬»È¤¨¤ë¡©¤¢¤Þ¤ê¤è¤¯Íý²ò¤Ç¤¤Þ¤»¤ó¤Ç¤·¤¿¡£
4À¸ÊªÀ½ºÞ²ÖÀ¹¤ê
RA- #463-464 ; CTLA4Ig¤Ë´Ø¤¹¤ëstudy
#465 ; MTX¤Î¶ÚÃí¤Çdose¤òÁý¤ä¤·¤Æ¤â¡¢¼À´µ³èÆ°À¤Ï¥³¥ó¥È¥í¡¼¥ë¤Ç¤¤Ê
¤¤¡£
#467-468 ; Adalimumab(D2E7-´°Á´¥Ò¥È·¿²½¹³TNFalfa¹³ÂÎ)¤Ë´Ø¤¹¤ëstudy
#Infliximub ¥ßinfliximub¤Ï¤â¤¦¤¹¤Ã¤«¤êRA¤Ë¤Ï¿»Æ©¤·¤Æ¤ª¤ê¡¢º£²ó¤ÎACR
¤Ç¤Ï¡¢RA°Ê³°¤ÎÉÂÂ֤ؤαþÍѤÎÊó¹ð¤¬Â¿¤¯¡¢Wegener¥æs glanulomatosis,
ankylosing spondylitis, lupus nephsitis(#441), RA¤Ë¤è¤ëAA amyloidosis(#82,
#83)¤Ê¤É¤ÎÊó¹ð¤¬Í¤ê¤Þ¤·¤¿¡£
¤¢¤È¡¢Ripsky¤Î¹ÖµÄ¤Ë¤â¤Ç¤Æ¤¤Þ¤·¤¿¤¬¡¢Rituximub(antiCD20monoclonal antibody-Lº¿¤È
Hº¿¤Îmouse variable region¤È human IgGk¤Îconstant region¤Î¥¥á¥é¹³ÂÎ)¤Ë¤è¤ëRA¤Î¼£
¸³¤Îdata¤â¤¢¤ê¤Þ¤·¤¿¡£CD20¤Ï¡¢¤Û¤È¤ó¤É¤ÎBºÙ˦¤äBcell·Ï¤Îmaligant cell¤Ëȯ¸½¤¹¤ëËì
´ÓÄÌ·¿¥ê¥óÃÁÇò¤Ç¡¢natural ligand¤äÀ¸ÍýŪ¤Êµ¡Ç½¤Ï¤Þ¤Àʬ¤«¤Ã¤Æ¤¤¤Ê¤¤¡Ö¡ª¡×¤¬¡¢¹³ÂÎ
¤Çligation¤·¤Æ¤â¡¢ºÙ˦Æâ¤Ë¼è¤ê¹þ¤Þ¤ì¤¿¤ê¡¢ºÙ˦¤«¤éshedding¤·¤¿¤ê¤·¤Ê¤¤¤È¤¤¤¦»ö
¤Ç¡¢Bcell depletion therapy¤È¤·¤ÆÎ×¾²»î¸³¤ò¤·¤Æ¤¤¤ë¤Î¤À¤í¤¦¤¬¡¢¤¤¤¤¤Î¤À¤í¤¦
¤«.....¡£ºÙ¤«¤¤protocol¤Ï»ä¤¬JPG²èÁü¤ÇÊݸ¤·¤Æ¤ª¤ê¤Þ¤¹¡£
¤Þ¤¿¡¢ÆüÍËÆü¤ÎÌë¤Ë¡¢Centocore¤ÎTNFarfaÀ½ºÞ¤Ë´Ø¤¹¤ëWorld Class Discussion¤¬
Sheraton¤Ç¤¢¤ê¤Þ¤·¤¿¡£¤³¤³¤ËRituximub¤â¤Ç¤Æ¤¤Þ¤¹¡£¶ñÂÎŪ¤ÊÆâÍƤϡ¢¶á¤¤¤¦¤Á
Centocore¤Î¥Û¡¼¥à¥Ú¡¼¥¸¤«CD-ROM¤Ç¤ß¤ë¤³¤È¤¬¤Ç¤¤ë¤è¤¦¤Ë¤Ê¤ë¤½¤¦¤Ç¤¹¡£
SLE ¥ßRituximub-U Penn , epratuzumab (antiCD22)-NIAMS¤Ç³Æ¡¹Î×¾²¼£¸³¤¬¿Ê¹ÔÃæ¡£
#5¤½¤Î¾¡§
*RA¤Îȯ¾ÉÁ°¤«¤éÍÛÀ¤Ë¤Ê¤ë¼«¸Ê¹³ÂΡ¡¹³cyclic citrullinated peptide¹³ÂÎ(¦ÁCCP)
*²È²ÀÃÏÃ泤Ǯ(FMF) ¥ß MEFV gene ( ¤³¤Îgene product¤Ïpyrin ¤È¤¤¤¤¡¢ðùγµå¡¢Ã±µå¤Ë
ȯ¸½¤·¤Æ¤ª¤ê¡¢cytoskelton¤Ë¤¯¤Ã¤Ä¤¯)¤¬¡¢¤³¤ÎMEFV gene¤Îmutation¤¬FMF¤Ç¤¢¤ë¤³¤È¤¬
ʬ¤«¤Ã¤¿¡£pyrin¤Ï¡¢IL-4, IL-10¤Çȯ¸½¤¬¤Õ¤¨¤ëantiinflammatory protein¤Ç¡¢septic
shock model¤Îdeath rate¤Ïpyrin homo KO mice¤Ç¾å¾º¤¹¤ë¡£
*hispanic SLE¤Ç¤Ï¡¢Ç¢ÃÁÇò½Ð¤ä¤¹¤¤¡£(OR 2.73 P 0.035)
*colchicin¤ÎÏ¢ÆüÆâÉþ¤Ç¸þ¤³¤¦6¥ö·î¤ÎÄËÉ÷ȯºî¤òÍÞÀ©¤·¤¿¡£
[2002ǯ11·î4Æü 15»þ42ʬ28ÉÃ]