The University of Tokyo

Corrigendum to "Fatal anaphylaxis due to alpha-gal syndrome after initial cetuximab administration: The first forensic case report" [Legal Med. 51 (2021) 101878].

Phase II study of an oxaliplatin-based regimen for relapsed colon cancer patients treated with oxaliplatin-based adjuvant chemotherapy (INSPIRE study).

The aim of this study was to evaluate the efficacy and safety of first-line chemotherapy with re-introduction of oxaliplatin (OX) more than 6 months after adjuvant chemotherapy including OX. Stage II/III colon cancer patients with neuropathies of grade ≤ 1 who relapsed more than 6 months after adjuvant chemotherapy including OX were considered eligible. Eligible patients were treated with 5-fluorouracil, l-leucovorin and OX plus molecularly targeted agents or capecitabine and OX plus bevacizumab (BV) or S-1 and OX plus BV. The primary endpoint was the progression-free survival (PFS), and the secondary endpoints were the overall survival (OS), response rate (RR) and toxicity. A total of 50 patients were enrolled between September 2013 and May 2019. Twelve patients received 5-fluorouracil, l-leucovorin and OX (FOLFOX) plus BV, 21 patients received capecitabine and OX plus BV, 10 patients received S-1 and OX plus BV and 7 patients received FOLFOX plus cetuximab or panitumumab. The median PFS was 11.5 months (95% confidence interval [CI] 8.3-16.0), the median OS was 45.4 months (95% CI 37.4-NA), and the RR was 56.0% (95% CI 42.3-68.8). Adverse events of grade ≥ 3 that occurred in ≥ 5% of cases were neutropenia in 6 patients (12%), peripheral sensory neuropathy in 5 patients (10%), diarrhea in 4 patients (8%), hypertension in 4 patients (8%), anorexia in 3 patients (6%) and allergic reactions in 3 patients (6%). First-line chemotherapy with re-introduction of OX more than 6 months after adjuvant chemotherapy including OX can be used safely with expected efficacy for relapsed colon cancer patients.

Fatal anaphylaxis due to alpha-gal syndrome after initial cetuximab administration: The first forensic case report.

Cetuximab is mainly used for the treatment of advanced and metastatic colorectal cancer. Owing to the oligosaccharide galactose-α-1,3-galactose (α-gal) in its heavy chain, cetuximab can induce severe IgE-dependent anaphylaxis. α-Gal is also the antigen responsible for α-gal syndrome, known as mammalian meat allergy. Patients with α-gal syndrome may suffer from cetuximab-induced anaphylaxis at the first administration because of developed α-gal-specific IgE antibodies. A male patient in his 50 s with metastatic colon cancer was receiving chemotherapy involving scheduled cetuximab administration. However, he died soon after the first administration. Forensic autopsy confirmed rectal cancer, metastatic rectal cancer in the liver, and renal cancer. Laboratory blood tests revealed the presence of cetuximab- and beef-specific IgE antibodies before cetuximab administration and an extremely high level of tryptase after administration. Thus, we determined that the death was caused by cetuximab-induced anaphylaxis due to the preexisting α-gal syndrome. To the best of our knowledge, this is the first autopsy case report in forensic medicine of fatal anaphylaxis after initial cetuximab administration.

Quantitative structural characterization of local N-glycan microheterogeneity in therapeutic antibodies by energy-resolved oxonium ion monitoring.

Site-specific characterization of glycoform heterogeneity currently requires glycan structure assignment and glycopeptide quantification in two independent experiments. We present here a new method combining multiple reaction monitoring mass spectrometry with energy-resolved structural analysis, which we termed "energy-resolved oxonium ion monitoring". We demonstrated that monitoring the yields of oligosaccharide-derived fragment ions (oxonium ions) over a wide range of collision induced dissociation (CID) energy applied to a glycopeptide precursor exhibits a glycan structure-unique fragmentation pattern. In the analysis of purified immunoglobulin glycopeptides, the energy-resolved oxonium ion profile was shown to clearly distinguish between isomeric glycopeptides. Moreover, limit of detection (LOD) of glycopeptide detection was 30 attomole injection, and quantitative dynamic range spanned 4 orders magnitude. Therefore, both quantification of glycopeptides and assignment of their glycan structures were achieved by a simple analysis procedure. We assessed the utility of this method for characterizing site-specific N-glycan microheterogeneity on therapeutic antibodies, including validation of lot-to-lot glycoform variability. A significant change in the degree of terminal galactosylation was observed in different production lots of trastuzumab and bevacizumab. Cetuximab Fab glycosylation, previously known to cause anaphylaxis, was also analyzed, and several causative antigens including Lewis X motifs were quantitatively detected. The data suggests that energy-resolved oxonium ion monitoring could fulfill the regulatory requirement on the routine quality control analysis of forthcoming biosimilar therapeutics.

Structural analysis of N-glycans from gull egg white glycoproteins and egg yolk IgG.

We previously showed that the expression of (Gal alpha 1-4Gal)-bearing glycoproteins among birds is related to their phylogeny. However, precise structures of (Gal alpha 1-4Gal)-containing N-glycans were only known for pigeon egg white glycoproteins and IgG. To compare structural features of (Gal alpha 1-4Gal)-containing N-glycans from other species, we analyzed N-glycans of gull egg white (GEW)-glycoproteins, ovomucoid, and ovotransferrin, and gull egg yolk IgG by HPLC, mass spectrometry (MS), and MS/MS analyses. GEW-glycoproteins included neutral, monosialyl, and disialyl N-glycans, and some of them contained Gal alpha 1-4Gal sequences. Bi-, tri-, and tetra-antennary oligosaccharides that lacked bisecting GlcNAc were the major core structures, and incomplete alpha-galactosylation and sialylation as well as the presence of diLacNAc on the branches generated microheterogeneity of the N-glycan structures. Moreover, unlike pigeon egg white glycoproteins, the major sialylation in GEW-glycoproteins is alpha2,3-, but not alpha2,6-linked sialic acids (NeuAc). In addition to the complex-type oligosaccharide, hybrid-type oligosaccharides that lack bisecting GlcNAc were also abundant in GEW-glycoproteins. Gull egg yolk IgG also contained Gal alpha 1-4Gal beta 1-4GlcNAc beta 1- sequences, but unlike pigeon IgG, no Gal alpha 1-4Gal beta 1-4Gal beta 1-4GlcNAc beta 1- sequence was detected. Bi- and tri-antennary complex-type oligosaccharides with bisecting GlcNAc and with core fucosylation as well as high-mannose-type oligosaccharides were the major structures in gull IgG. Our data indicated that some N-glycans from both GEW-glycoproteins and gull IgG contain the Gal alpha 1-4Gal beta 1-4GlcNAc beta 1- sequence, but the ratio of alpha-Gal-capped residues to non-alpha-Gal-capped residues in the nonreducing termini of N-glycans is much lower than that in those of pigeon glycoproteins.

Computationally and experimentally derived general rules for fragmentation of various glycosyl bonds in sodium adduct oligosaccharides.

Mechanisms of fragmentation of glycosyl bond linkages in various saccharides were investigated by using computational calculations to find general rules of fragmentation of sodiated oligosaccharides in mass spectrometry. The calculations revealed that alpha-Glc, alpha-Gal, beta-Man, alpha-Fuc, beta-GlcNAc, and beta-GalNAc linkages were cleaved more easily than beta-Glc, beta-Gal, and alpha-Man linkages because the transition states of the former were stabilized by the anomeric effect. The 1-6 linkage was more stable than the others, since saccharides with flexible 1-6 linkages were more stabilized in energy than the other linkages by the sodium cation. The sialyl linkage was the most labile of all the linkages investigated. Comparison of activation energies and binding affinities to the sodium cation revealed an increase in activation energy in proportion to the increment in binding affinity. The calculated stabilities of glycosyl bonds were: alpha-Man (Manalpha1-3Man, Manalpha1-4Man, Manalpha1-6Man) > beta-Gal (Galbeta1-4Gal) > alpha-GalNAc (GalNAcalpha1-4GalNAc) > beta-Man (Manbeta1-4GlcNAc) > alpha-Gal (Galalpha1-3Gal, Galalpha1-4Gal, Galalpha1-6Gal) > beta-Man (Manbeta1-4Man) > beta-GalNAc (GalNAcbeta1-4GalNAc) > alpha-Fuc (Fucalpha1-6GlcNAc) > alpha-Fuc (Fucalpha1-4GlcNAc) > beta-GlcNAc (GlcNAcbeta1-4GlcNAc) > alpha-Fuc (Fucalpha1-3GlcNAc) > alpha-NeuNAc (NeuNAcalpha2-3Gal, NeuNAcalpha2-6Gal); this result was close to the experimentally deduced trend. These theoretically and experimentally derived general rules for fragmentation should be useful for analyzing the experimentally obtained mass spectra of oligosaccharides.

Effect of long-term culture on the expression of antigens and adhesion molecule in single porcine pancreatic endocrine cells.

Changes in the expression of galactose (Gal) alpha1-3Gal, swine lymphocyte antigen (SLA) class II and intracellular adhesion molecule (ICAM)-1 of single porcine pancreatic endocrine (PE) cells during the culture period were investigated. Cultured porcine PE-cells were fixed in 10% buffered formalin for histological evaluation. At 1, 3, 6, 9 and 12 weeks of culture, mRNA was obtained from porcine PE-cells so that the expression of SLA class II and ICAM-1 genes could be examined by reverse transcriptase-polymerase chain reaction. The rates of Galalpha1-3Gal and SLA class II-positive cells did not decrease during the culture period, but the rates of Galalpha1-3Gal and SLA class II strongly positive cells significantly decreased. ICAM-1-positive cells were scarcely observed during the culture period. SLA class II and ICAM-1 mRNAs were detected at 1 and 3 weeks of culture, but were not detected after 6 weeks of culture. These results suggest that partial reduction in the expression of these antigens could be obtained by a long-term culture.

The neutralization of pseudorabies virus by anti-alpha-galactocyl natural antibody in normal serum.

Pseudorabies virus (PrV), a member of herpesviridae alphaherpes subfamily, can infect human cells in vitro. However, the transmission to Old World primates including humans is strongly restricted. In this study, we report the neutralizing activity of normal human serum against PrV grown in CPK cells derived from pig. PrV grown in all Old World primates-derived cells, which was tested in this study, were not neutralized by normal human serum. The virion of PrV grown in CPK cells harbored Galalpha1-3Galbeta1-4GlcNAc-R (alpha-gal epitope) on its surface, while PrV grown in Vero cells did not. Depletion of antibodies reacting to surface antigens of CPK cells negated the neutralization activity of human serum. Blockade of anti-alpha-gal antibodies by adding soluble Galalpha1-3Gal to normal human serum also prevent the inactivation of PrV grown in CPK cells. Although normal swine serum did not neutralize PrV grown in CPK cells, swine serum supplemented with exogenous anti-alpha-gal antibodies did. These results indicate that anti-alpha-gal antibodies in normal human serum contribute to the neutralization of PrV. Anti-alpha-gal antibodies in normal human serum may prevent transmission of PrV into humans.

Transplantation of cultured human corneal endothelial cells.

To investigate the feasibility of corneal reconstruction utilizing cultured human corneal endothelial cells (HCECs). We cultivated HCECs using culture dishes pre-coated with bovine corneal endothelial extracellular matrix. The effect of donor age on HCECs was investigated. We reconstructed corneas using cultured HCECs and human corneal stroma, then examined their functioning. The possibility of porcine corneal stroma as a carrier of cultured HCECs was investigated. The older the donor, the more frequently large senescent cells appeared in the passaged HCECs. The density of HCECs on the reconstructed cornea reached 2500 cells/mm2. The potential difference in the reconstructed and normal corneas was 0.30 mV and 0.40 mV, respectively; this indicates that the pump function of the reconstructed corneas is 75% of that of normal corneas. Porcine corneal stroma expressing little xenosugar antigen alpha-gal epitope induced no superacute rejection but mild cellular rejection when transplanted into corneas of animals possessing natural antibody to alpha-gal epitope. To reconstruct corneas that are the same as, or superior to, normal corneas, innovation is necessary in the methods used for culturing and seeding HCECs. Porcine corneal stroma is promising as a carrier of HCECs instead of human corneal stroma, the supply of which is limited. The validity of porcine corneal stroma, acellularized to prevent retrovirus infection, should be evaluated.

A role for arabinogalactan proteins in gibberellin-induced alpha-amylase production in barley aleurone cells.

Arabinogalactan proteins (AGPs) are plant proteoglycans that have been implicated in plant growth and development. The possible involvement of AGPs in the action of gibberellin (GA), a class of plant hormones, was examined by applying beta-glucosyl Yariv reagent (beta-Glc)3Y, a synthetic phenyl glycoside that interacts selectively with AGPs, to barley aleurone protoplasts. Gibberellin induces transcription and secretion of alpha-amylases in the protoplasts. Induction of alpha-amylase was clearly inhibited by (beta-Glc)3Y but not by (alpha-Gal)3Y, a negative control of the Yariv reagent that does not interact with AGPs. Transfection analysis, using an alpha-amylase promoter-GUS fusion gene in the protoplasts, indicated that the transcriptional activation of the alpha-amylase promoter was inhibited specifically by (beta-Glc)3Y. These observations are the first indication of an involvement of AGPs in a plant hormone function. The inhibitory effect of (beta-Glc)3Y was not observed when aleurone layers or half-seed grains were used. This result, together with the fact that protoplasts do not have cell walls, suggests that the AGPs that function in alpha-amylase induction reside at the plasma membrane. An aleurone-specific AGP was detected by reversed-phase HPLC, and supported the idea that an AGP may play an important role in aleurone-specific events. The possible mechanism of AGP function in gibberellin-induced alpha-amylase production is discussed.

[Transplantation of corneal endothelial cells].

Though conventional corneal transplantation has achieved great success, it still has several drawbacks including limited availability of donor corneas, recurrent allograft rejection, and subsequent graft failure in certain cases. Reconstructing clinically usable corneas by applying the technology of regenerative medicine can offer a solution to these problems, as well as making corneal transplantation a non-emergency surgery and enabling the usage of banked corneal cells. In the present study, we focused on corneal endothelium that is critical for corneal transparency and investigated the reconstruction of cornea utilizing cultured human corneal endothelial cells (HCECs). We succeeded in steadily culturing HCECs by using culture dishes pre-coated with extracellular matrix produced by calf corneal endothelial cells and culture media that contained basic fibroblast growth factor and fetal bovine serum. We performed the following analysis utilizing these cultured HCECs. The older the donor was, the more frequently large senescent cells appeared in the passaged HCECs. The telomeres of HCECs were measured as terminal restriction fragments (TRF) by Southern blotting. HCECs, in vivo from donors in their seventies had a long TRFs of over 12 kilobases. Passaging shortened the TRFs but there was no difference in TRFs among donors of various ages. These results indicated that shortening of telomere length is not related to senescence of HCECs. We investigated the role of advanced glycation end products (AGEs) in the senescence of in vivo HCECs. The results indicated that AGE-protein in the aqueous humor is endocytosed into HCECs via AGE receptors expressed on the surface of HCECs and damages HCECs by producing reactive oxygen species and inducing apoptosis, suggesting that AGEs, at least partly, cause the senescence of HECEs. HCECs were cultured using adult human serum instead of bovine serum to get rid of bovine material that can be infected with prions. Primary and passage culture of HCECs was possible using adult human serum. We reconstructed the cornea using cultured HCECs and human corneal stroma. The corneal stroma, on which the cell suspension of HCECs was poured, was mildly centrifuged to enhance the HCECs attachment to the stroma. The cell density of HCECs on the reconstructed cornea reached 2,500 cells/mm2. The pump function of the reconstructed cornea was measured with an Ussing chamber. The potential difference in the reconstructed cornea and normal cornea was 0.30 mV and 0.40 mV, respectively; indicating that the pump function of the reconstructed cornea is 75% of that of the normal cornea. The reconstructed cornea was transplanted to a rabbit eye and stayed transparent for 6 months after the operation. Fluorescein labeled cultured HCECs remained on the graft 1 month after the transplantation, indicating that transplanted HCECs contributed to the transparency of the graft. The possibility of using artificial stroma or porcine corneal stroma as a carrier of cultured HCECs was investigated. The artificial stroma made of alkaline-treated collagen could not be sutured but showed good transparency, biocompatibility, and cell-attachability. Porcine corneal stroma, expressing little xeno-sugar antigen alpha-gal epitope, induced no super acute rejection but mild cellular rejection when transplanted in the cornea of animals possessing natural antibody to alpha-gal epitope. The cornea reconstructed with porcine corneal stroma and HCECs had an average cell density of 1721/mm2 and had approximately 60% of the pump function of a normal cornea. As new technologies in corneal transplantation, the application of self immature cells and the direct delivery of cultured HCECs into the anterior chamber were investigated. Part of rat mononuclear cells that were obtained from the bone marrow and injected into the rat anterior chamber transformed into corneal endothelium-like cells, suggesting that self immature cells can transform into corneal endothelial cells. Cultured rabbit corneal endothelial cells that endocytosed iron were injected into the anterior chamber of rabbits whose corneal endothelium was cryo-injured, and were pulled to Descemet's membrane by putting a magnet on the eyelid. In these rabbits, corneal edema decreased more quickly than in the control group and no intraocular pressure rise was observed during 8 weeks after the operation, suggesting that the direct delivery of cultured HCECs into the anterior chamber can be an alternative method of choice. The following obstacles should be addressed to make the transplantation of cultured corneal endothelial cells clinically applicable. 1. To reconstruct a cornea that is the same as or superior to the normal cornea, more innovation is necessary in the method of culturing and seeding HCECs. We should consider utilizing HCECs obtained from fetuses after clearing ethical issues. Moreover, we need to develop a method to enhance the cell density and the cell functions. 2. Porcine corneal stroma is promising as a carrier of HCECs instead of human corneal stroma, which is in very limited supply. The usefulness of porcine corneal stroma acellularized to prevent retrovirus infection should be evaluated. 3. To make the self immature cells applicable to corneal transplantation, we should elucidate the corneal endothelial cell specific markers and the factors that are necessary to induce self immature cells to become corneal endothelial cells. 4. The direct delivery of cultured HCECs into the anterior chamber can be an alternative method of choice when its long-term safety is confirmed.

Effect of antisense ribozyme to pig alpha (1,3) galactosyl transferase gene on the expression of Gal alpha (1,3)Gal epitope.

A precise structural analysis of a fertilization-associated carbohydrate-rich glycopeptide isolated from the fertilized eggs of euryhaline killi fish (Fundulus heteroclitus). Novel penta-antennary N-glycan chains with a bisecting N-acetylglucosaminyl residue.

A novel carbohydrate-rich sialoglycopeptide of apparent molecular mass approximately 6 kDa was isolated from the fertilized eggs of Fundulus heteroclitus (euryhaline killi fish). This glycopeptide is a member of the L-hyosophorin family, characterized by its high content of carbohydrate (80-90% by weight) and formed by depolymerization of the precursor glycopoly-protein (H-hyosophorin) upon fertilization. The structures of the N-glycan chains were unambiguously established by a combination of compositional analysis, methylation analysis, selective chemical degradation (periodate oxidation-Smith degradation and hydrazinolysis-nitrous acid deamination), enzymatic (peptide:N-glycosidase F, several beta-galactosidases, beta-hexosaminidase and alpha-galactosidase) digestions and instrumental analyses (1H-NMR and fast atom bombardment mass spectrometry) to have the novel and unique carbohydrate sequences, Gal alpha 1-->3(Gal beta 1-->4)Gal beta 1-->4GlcNAc beta 1--> and Gal alpha 1-->3(+/- GalNAc beta 1-->4GlcNAc beta 1-->3Gal beta 1-->4)Gal beta 1-->4GlcNAc beta 1-->. This study represents the first detailed investigation of the nature of bulky complex asparagine-linked penta-antennary glycans with a bisecting GlcNAc residue in glycoproteins. Expression of such bulky multiantennary glycan units on proteins may be essential during early embryogenesis.

Significant increase in the antibody to Gal alpha 1-3Gal structure in sera of patients with hepatocellular carcinoma after transcatheter arterial embolization.

Sera from the patients with chronic liver diseases and hepatocellular carcinoma (HCC) were tested for reactivity with neutral glycosphingolipids extracted from rabbit liver plasma membrane by enzyme-linked immunosorbent assay and thin-layer chromatography immunostaining. IgG class antibody to neutral glycosphingolipids was detected in 29.6% (8 of 27), 6.3% (1 of 16), 0% (0 of 8), 0% (0 of 25), and 6.9% (2 of 29) in the sera of patients with HCC, liver cirrhosis, autoimmune chronic active hepatitis, chronic hepatitis, and normal individuals, respectively. Using the serum positive for the antibody to neutral glycosphingolipids, the target antigen glycolipid was isolated. Negative ion fast atom bombardment mass spectrometry, exoglycosidases treatment, and permethylation analysis revealed that the main target antigen was IV3 alpha Gal-nLc4Cer. In enzyme-linked immunosorbent assay, IgG class antibody to IV3 alpha Gal-nLc4Cer was detected in 33.3% (9 of 27), 18.8% (3 of 16), 25% (2 of 8), 4% (1 of 25), and 6% (3 of 50) in the sera of patients with HCC, liver cirrhosis, autoimmune chronic active hepatitis, chronic hepatitis, and normal individuals, respectively. Of 9 HCC patients positive for the antibody, 6 had received transcatheter arterial embolization (TAE) therapy. Six of 10 patients who received TAE therapy had the antibody, whereas only 3 of 17 patients without TAE therapy had the antibody. This antibody may be a heterophile antibody, which recognizes Gal alpha 1-3Gal structure at the nonreducing terminal of the antigen. Since the occurrence of this antibody was closely related with TAE therapy, the necrosis of HCC induced by TAE therapy may stimulate the production of the antibody.