| Project/Area Number |
17K08741
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Multi-year Fund |
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| Section | 一般 |
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| Research Field |
Human pathology
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| Research Institution | Kobe City Medical Center General Hospital(First Clinical Division, Second Clinical Division, Third (2018-2019)
Kobe University (2017) |
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Principal Investigator |
Hara Shigeo 地方独立行政法人神戸市民病院機構神戸市立医療センター中央市民病院(第1診療部、第2診療部、第3診療部, 中央市民病院, 部長 (10590648)
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| Project Period (FY) |
2017-04-01 – 2020-03-31
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| Project Status |
Completed (Fiscal Year 2019)
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| Budget Amount *help |
¥4,810,000 (Direct Cost: ¥3,700,000、Indirect Cost: ¥1,110,000)
Fiscal Year 2019: ¥910,000 (Direct Cost: ¥700,000、Indirect Cost: ¥210,000)
Fiscal Year 2018: ¥1,950,000 (Direct Cost: ¥1,500,000、Indirect Cost: ¥450,000)
Fiscal Year 2017: ¥1,950,000 (Direct Cost: ¥1,500,000、Indirect Cost: ¥450,000)
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| Keywords | 膜性腎症 / THSD7A / 悪性腫瘍 / IgGサブクラス / PLA2R / レクチン経路 / IgG / 特発性 / 病理学 |
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| Outline of Final Research Achievements |
Among 469 consecutive cases of pathologically confirmed MN, 14 cases were confirmed positive for THSD7A by immunohistochemistry (3.0%). The prevalence of THSD7A-associated MN tended to be higher in northern Japan. In two patients,cancer was detected at the time of renal biopsy (small-cell carcinoma of the lung and prostatic adenocarcinoma with neuroendocrine differentiation). Pathological analysis of kidney biopsy tissue revealed minor changes except for one case with spike formation. IF studies demonstrated that IgG subclass was mainly IgG4-dominant/codominant (12/13, 92% cases), while the case with prostatic cancer was IgG2-dominant.Of 10 cases with known clinical follow-up data, 6 demonstrated reduced serum creatinine and 8 presented reduced proteinuria. In 38 malignancy cases, 3 (1, gastric cancer; 2, colon cancer) cases were positive for THSD7A.THSD7A was negative in lymph node metastasis. Urinary test was negative for proteinuria.
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| Academic Significance and Societal Importance of the Research Achievements |
本邦におけるTHSD7A陽性膜性腎症の臨床病理学的特徴を明らかにした初の研究である。THSD7A陽性膜性腎症には癌合併があることも併せて示し、膜性腎症で悪性腫瘍合併の積極的なスクリーニングとしてTHSD7A免疫染色が有用であることを示した。頻度は膜性腎症の約3%であり海外報告と同程度であるが、地域によって頻度が異なる点については、THSD7A陽性膜性腎症の発症に何らかの環境因子が関与していることが示唆される。
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