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| 1.
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論文
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Kometani, Mitsuhiro ; Yoneda, Takashi ; Demura, Masashi ; Koide, Hiroshi ; Nishimoto, Koshiro ; Mukai, Kuniaki ; Gomez-Sanchez, Celso E. ; Akagi, Tadayuki ; Yokota, Takashi ; Horike, Shin-ichi ; Karashima, Shigehiro ; Miyamori, Isamu ; Yamagishi, Masakazu ; Takeda, Yoshiyu ; 米田, 隆 ; 赤木, 紀之 ; 横田, 崇 ; 堀家, 慎一 ; 唐島, 成宙 ; 宮森, 勇 ; 山岸, 正和 ; 武田, 仁勇
概要:
金沢大学医薬保健研究域医学系<br />Adrenocortical hormone excess, due to primary aldosteronism (PA) or hypercortisolemia, causes hypert
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ension and cardiovascular complications. In PA, hypomethylation of aldosterone synthase (CYP11B2) is associated with aldosterone overproduction. However, in hypercortisolemia, the role of DNA methylation of 11β-hydroxylase (CYP11B1), which catalyzes cortisol biosynthesis and is highly homologous to CYP11B2, is unclear. The aims of our study were to determine whether the CYP11B1 expression was regulated through DNA methylation in hypercortisolemia with cortisol-producing adenoma (CPA), and to investigate a possible relationship between DNA methylation and somatic mutations identified in CPA. Methylation analysis showed that the CYP11B1 promoter was significantly less methylated in CPA than in adjacent unaffected adrenal tissue and white blood cells. Furthermore, in CPA with somatic mutations in either the catalytic subunit of protein kinase A (PRKACA) or the guanine nucleotide-binding protein subunit alpha (GNAS) gene, the CYP11B1 promoter was significantly hypomethylated. In addition, DNA methylation reduced CYP11B1 promoter activity using a reporter assay. Our study results suggest that DNA methylation at the CYP11B1 promoter plays a role in the regulation of CYP11B1 expression and cortisol production in CPA, and that somatic mutations associated with CPA reduce DNA methylation at the CYP11B1 promoter. © 2017 The Author(s).
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| 2.
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Oka, Rie ; Nomura, Akihiro ; Yasugi, Ayaka ; Kometani, Mitsuhiro ; Gondoh, Yuko ; Yoshimura, Kenichi ; Yoneda, Takashi ; 大家, 理恵 ; 野村, 章洋 ; 米谷, 充弘 ; 吉村, 健一 ; 米田, 隆
概要:
金沢大学附属病院代謝内科<br />Nutritional intervention is effective in improving glycemic control in patients with type 2 diabetes b
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ut requires large inputs of manpower. Recent improvements in photo analysis technology facilitated by artificial intelligence (AI) and remote communication technologies have enabled automated evaluations of nutrient intakes. AI- and mobile-supported nutritional intervention is expected to be an alternative approach to conventional in-person nutritional intervention, but with less human resources, although supporting evidence is not yet complete. The aim of this study is to test the hypothesis that AI-supported nutritional intervention is as efficacious as the in-person, face-to-face method in terms of improving glycemic control in patients with type 2 diabetes.
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| 3.
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Wakabayashi, Yusuke ; Oka, Rie ; Nakaya, Masako ; Karashima, Shigehiro ; Kometani, Mitsuhiro ; Sakurai, Masaru ; Yoshimura, Kenichi ; Yoneda, Takashi ; 大家, 理恵 ; 唐島, 成宙 ; 米谷, 充弘 ; 櫻井, 勝 ; 吉村, 健一 ; 米田, 隆
概要:
金沢大学附属病院代謝内科<br />Objective. Individuals with multiple metabolic risk factors often experience concomitant sleep-disorde
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red breathing (SDB). We aimed to determine the associations of SDB with individual components of metabolic syndrome independent of obesity. Methods. A cross-sectional study was conducted in 1137 employees aged 30–64 years. Apnea-hypopnea index (AHI) was assessed using a portable monitor for obstructive sleep apnea by admission. Of these, 451 participants took an oral glucose tolerance test to assess homeostatic model assessment of insulin resistance (HOMA-IR) and Matsuda insulin sensitivity index (ISI). Results. The odds ratio (OR) of the highest category of the AHI (≥15 episodes per hour) compared to the lowest one (<5 episodes per hour) was significantly elevated for hypertension, for hypertriglyceridemia, and for low HDL-cholesterolemia when adjusted for age, sex, and alcohol and smoking status (). After further adjustment for body mass index (BMI) or waist circumference, the associations for hypertension still remained statistically significant () while those for hypertriglyceridemia and low HDL-cholesterolemia were no longer significant. The association between higher insulin resistance as assessed by HOMA-IR and Matsuda ISI and higher categories of the AHI was also lost after adjustment for BMI. Conclusion. Obesity was a strong confounding factor in the association between SDB and most metabolic risk factors including insulin resistance, except for hypertension. Further longitudinal study is needed to examine the temporal or causal relationships between SDB and metabolic risk factors. This trial is registered with UMIN-CTR UMIN000028067.
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4. Insulin Secretion and Risk for Future Diabetes in Subjects with a Nonpositive Insulinogenic Index
Aono, Daisuke ; Oka, Rie ; Kometani, Mitsuhiro ; Takeda, Yoshimichi ; Karashima, Shigehiro ; Yoshimura, Kenichi ; Takeda, Yoshiyu ; Yoneda, Takashi ; 青野, 大輔 ; 大家, 理恵 ; 米谷, 充弘 ; 武田, 仁裕 ; 唐島, 成宙 ; 吉村, 健一 ; 武田, 仁勇 ; 米田, 隆
概要:
金沢大学附属病院代謝内科<br />Aim. To characterize subjects with a nonpositive insulinogenic index and longitudinally observe change
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s in their glucose tolerance. Subjects and Methods. A historical cohort study was conducted using data from the medical checkups of public school workers. Indices of insulin secretion and insulin sensitivity derived from oral glucose tolerance test (OGTT) and the incidences of diabetes and impaired glucose tolerance (IGT) were compared among subgroups of subjects with different insulinogenic index (change in insulin/change in glucose over the first 30 min on the OGTT). Results. Of the 1464 nondiabetic subjects at baseline, 72 (4.9%) subjects had a nonpositive insulinogenic index: 42 of those subjects had a nonpositive glucose response (ΔGlu0–30 ≤ 0) and 30 had a nonpositive insulin response (ΔIns0–30 ≤ 0). Compared with subjects who had normal glucose tolerance (NGT) with insulinogenic index ≥ 0.4, subjects with a nonpositive glucose response had a higher first-phase Stumvoll and lower incidences of diabetes and IGT based on a log-rank test (), whereas subjects with a nonpositive insulin response had lower indices of insulin secretion and a higher incidence of diabetes (). Conclusions. These results demonstrate that in the first 30 min on the OGTT, subjects with a nonpositive insulinogenic index due to a nonpositive glucose response (ΔGlu0–30 ≤ 0) had a lower risk for future diabetes and that subjects with nonpositive insulin response (ΔIns0–30 ≤ 0) had a higher risk for future one.
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| 5.
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蘇馬, 由衣 ; 大家, 理恵 ; 藤井, 寿美枝 ; 伊藤, 直子 ; 米谷, 充弘 ; 唐島, 成宙 ; 武田, 仁勇 ; 米田, 隆 ; 浅野, 昭道 ; Soma, Yui ; Oka, Rie ; Fujii, Sumie ; Ito, Naoko ; Kometani, Mitsuhiro ; Karashima, Shigehiro ; Takeda, Yoshiyu ; Yoneda, Takashi ; Asano, Akimichi
概要:
金沢大学附属病院代謝内科<br />Aim: The Japan Diabetes Society (JDS)/Japan Geriatrics Society (JGS) Joint Committee reported 'Glycemi
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c Targets for Elderly Patients with Diabetes' in 2016. Based on this recommendation, we aimed to clarify 1) the achievement status of glycemic targets in the elderly and 2) the presence of hypoglycemia in real life among elderly individuals with an HbA1c below the lower limit.Subjects and Methods: [Analysis I] In 326 elderly with diabetes ≥65 years of age visiting the outpatient department specializing in diabetes, the proportions of patients with HbA1c values below the lower limit and the use of drugs potentially associated with severe hypoglycemia (e.g. insulin formulations, sulfonylureas, glinides) were investigated. [Analysis II] Of the patients with HbA1c values below the lower limit, seven were tested for hypoglycemia in real life using a continuous glucose monitoring system (CGM).Results: [Analysis I] Among the 326 subjects, 235 (72.1%) were using drugs potentially associated with severe hypoglycemia, and 63 (19.3%) had an HbA1c value below the lower limit. [Analysis II] In the seven patients examined using CGM, hypoglycemia was detected in five, all of whom were unaware.Conclusions: A considerable number of elderly patients were taking drugs associated with hypoglycemic risks and had an HbA1c value below the lower limit, some of whom actually had hypoglycemia as detected by CGM. Using tools such as CGM, preventive measures against hypoglycemia should be taken.<br />目的：「高齢者糖尿病の治療向上のための日本糖尿病学会と日本老年医学会の合同委員会」は2016年5月に「高齢者糖尿病の血糖コントロール目標（HbA1c値）」ガイドラインを発表した．本ガイドラインに基づいて，1）糖尿病専門外来に通院する高齢者におけるHbA1c目標達成状況，2）HbA1c下限値未満の高齢者での実生活での低血糖の有無について明らかにしたいと考えた．対象と方法：【分析I】K病院糖尿病専門外来通院中の65歳以上の高齢糖尿病患者326人を対象として，“重症低血糖が危惧される薬剤（インスリン，SU薬，グリニド薬）”使用中の患者の割合，及びHbA1c下限値未満の割合を調査した．【分析II】分析IのHbA1c下限値未満の患者のうち7名において持続的血糖モニタリング（CGM）で実生活での低血糖がないかを検査した．結果：【分析I】研究対象者326人のうち，“重症低血糖が危惧される薬剤”使用中の割合は235人（72.1％）であり，このうち63人（19.3％）がHbA1c下限値未満であった．【分析II】HbA1c下限値未満であった63人のうち7名にCGMを施行したところ，5例に低血糖が検出され，いずれも自覚症状を欠いていた．結論：K病院糖尿病専門外来通院中の高齢糖尿病患者において，低血糖が危惧される薬剤を使用し，HbA1c下限値未満の患者が相当数見られ，一部はCGMで実際に低血糖が確認された．CGMなどのツールを用いて，実生活での低血糖に対する予防策を講じつつ投薬管理にあたる必要がある．<br />出版者照会後に全文公開
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| 6.
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米田, 隆 ; Yoneda, Takashi
概要:
取得学位 : 博士（医学）, 学位授与番号 : 医博甲第1107号, 学位授与年月日：平成6年3月25日,学位授与年：1994
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| 7.
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Oka, Rie ; Shibata, Kyoko ; Sakurai, Masaru ; Kometani, Mitsuhiro ; Yamagishi, Masakazu ; Yoshimura, Kenichi ; Yoneda, Takashi ; 大家, 理恵 ; 柴田, 恭子 ; 櫻井, 勝 ; 米谷, 充弘 ; 山岸, 正和 ; 吉村, 健一 ; 米田, 隆
概要:
金沢大学附属病院研修医・専門医総合教育センター<br />We aimed to clarify how the trajectories of 1-hour postload plasma glucose (PG) and 2-hour
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PG were different in the development of type 2 diabetes. Using data of repeated health checkups in Japanese workers from April 2006 to March 2016, longitudinal changes of fasting, 1-hour, and 2-hour PG on the oral glucose tolerance test were analyzed with a linear mixed effects model. Of the 1464 nondiabetic subjects at baseline, 112 subjects progressed to type 2 diabetes during the observation period (progressors). In progressors, 1-hour PG and 2-hour PG showed gradual increases with slopes of 1.33 ± 0.2 and 0.58 ± 0.2 mg/dL/year, respectively, followed by a steep increase by which they attained diabetes. Until immediately before the diabetes transition, age- and sex-adjusted mean level of 2-hour PG was 149 ± 2.7 mg/dL, 34 ± 2.7 (30%) higher compared to nonprogressors, while that of 1-hour PG was 206 ± 4.1 mg/dL, 60 ± 4.3 mg/dL (41%) higher compared to nonprogressors. In conclusion, diabetes transition was preceded by a mild elevation of 2-hour PG for several years or more. The elevation in 1-hour PG was larger than that of 2-hour PG until immediately before the transition to diabetes. © 2017 Rie Oka et al.<br />Embargo Period 12 months
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| 8.
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Demura, Masashi ; Wang, Fen ; Yoneda, Takashi ; Karashima, Shigehiro ; Mori, Shunsuke ; Oe, Masashi ; Kometani, Mitsuhiro ; Sawamura, Toshitaka ; Cheng, Yuan ; Maeda, Yuji ; Namiki, Mikio ; Ino, Hidekazu ; Fujino, Noboru ; Uchiyama, Katsuharu ; Tsubokawa, Toshinari ; Yamagishi, Masakazu ; Nakamura, Yasuhiro ; Ono, Katsuhiko ; Sasano, Hironobu ; Demura, Yoshiki ; Takeda, Yoshiyu
概要:
金沢大学医薬保健研究域医学系<br />Objective: Nuclear receptors are involved in a wide variety of functions, including aldosteronogenes
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is. Nuclear receptor families NR4A [nerve growth factor-induced clone B (NGFIB), Nur-related factor 1 (NURR1) and neuron-derived orphan receptor 1 (NOR1)] and NR2F [chicken ovalbumin upstream promoter-transcription factor 1 (COUP-TFI), COUP-TFII and NR2F6) activate, whereas NR5A1 [steroidogenic factor 1 (SF1)] represses CYP11B2 (aldosterone synthase) gene transcription. The present study was undertaken to elucidate the mechanism of differential regulation of nuclear receptors between cardiovascular and adrenal tissues. Methods: We collected tissues of artery (n = 9), cardiomyopathy muscle (n = 9), heart muscle (noncardiomyopathy) (n = 6), adrenal gland (n = 9) and aldosterone-producing adenoma (APA) (n = 9). 5′-rapid amplification of cDNA ends (RACE) identified transcription start sites. Multiplex reverse-transcription PCR (RT-PCR) determined use of alternative noncoding exons 1 (ANEs). Results: In adrenocortical H295R cells, angiotensin II, KCl or cAMP, all stimulated CYP11B2 transcription and NR4A was upregulated, whereas NR2F and NR5A1 were downregulated. 5′-RACE and RT-PCR revealed four ANEs of NGFIB (NR4A1), three of NURR1 (NR4A2), two of NOR1 (NR4A3) and two of SF1 (NR5A1) in cardiovascular and adrenal tissues. Quantitative multiplex RT-PCR showed NR4A and NR5A1 differentially employed multiple ANEs in a tissue-specific manner. The use of ANEs of NGFIB and NURR1 was significantly different between APA and artery. Changes in use of ANEs of NGFIB and NOR1 were observed between cardiomyopathy and noncardiomyopathy. The NR4A mRNA levels in artery were high compared with cardiac and adrenal tissues, whereas the NR5A1 mRNA level in adrenal tissues was extremely high compared with cardiovascular tissues. Conclusion: NR4A and NR5A1 genes are complex in terms of alternative promoter use. The use of ANEs may be associated with the pathophysiology of the heart and adrenal gland. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.
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| 9.
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Karashima, Shigehiro ; Yoneda, Takashi ; Kometani, Mitsuhiro ; Ohe, Masashi ; Mori, Shunsuke ; Sawamura, Toshitaka ; Furukawa, Kenji ; Seta, Takashi ; Yamagishi, Masakazu ; Takeda, Yoshiyu
概要:
The mineralocorticoid receptor (MR) is expressed in the kidneys and in adipose tissue, and primary aldosteronism (PA) is
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associated with metabolic syndrome. This study assessed the effects of MR blockade by eplerenone (EPL) and spironolactone (SPL) on blood pressure (BP) and metabolic factors in patients with PA. Fifty-four patients with PA were treated with one of two MRAs, EPL (25-100 mg daily, n=27) or SPL (12.5-100 mg daily, n=27) for 12 months. Visceral (VAT) and subcutaneous adipose tissue were quantified using CT and FatScan imaging analysis software. Body mass index, homeostasis model assessment-insulin resistance (HOMA-IR), serum creatinine, potassium and lipids, urinary albumin excretion (UAE) and plasma aldosterone concentration (PAC) and plasma renin activity (PRA) were measured before and after treatment. EPL and SPL decreased BP and increased serum potassium levels to similar degrees. PAC and PRA did not differ between the two groups. Although treatment with the MRAs did not change HOMA-IR or serum lipids, they significantly decreased UAE and VAT (P<0.05). These results suggest that EPL and SPL are effective and safe for the treatment of PA. The long-term metabolic and renal effects of these MRAs should be further investigated. © 2016 The Japanese Society of Hypertension. All rights reserved.<br />Embargo Period 6 months
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| 10.
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Kometani, Mitsuhiro ; Yoneda, Takashi ; Demura, Masashi ; Karashima, Shigehiro ; Mori, Shunsuke ; Oe, Masashi ; Sawamura, Toshitaka ; Okuda, Rika ; Yamagishi, Masakazu ; Takeda, Yoshiyu
概要:
Primary aldosteronism (PA) is a major cause of secondary hypertension, divided into two subtypes: unilateral and bilater
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al. Unilateral PA (u-PA) is surgically-curable. Medical treatment with mineralocorticoid receptors antagonists is recommended as a second-line treatment when the patients are not candidate for surgical treatment. The present case was a 39-year-old woman with u-PA, who had refused surgery, had suffered from adverse effects of medical treatment. She was treated with transcatheter adrenal arterial embolization (TAAE). Her blood pressure had been well controlled without progression of cardiorenovascular damage for 12 years. TAAE can be the third treatment option for u-PA patients. © 2016 The Japanese Society of Internal Medicine.
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