Publications by authors named "Mitoma H"
Article Synopsis
- Immune-mediated cerebellar ataxias (IMCAs) are disorders where the immune system primarily attacks the cerebellum, with various types like gluten ataxia and Miller Fisher syndrome identified, leading to insights into diagnosis and treatment.
- Specific autoantibodies help pinpoint some IMCA causes, but others require careful interpretation, as the relationships between them and the conditions are not always clear.
- New classifications such as primary autoimmune cerebellar ataxia (PACA) and latent autoimmune cerebellar ataxia (LACA) have emerged to improve early treatment and management, while recent studies are exploring how autoimmunity affects synapses and nervous system function.
Article Synopsis
- Prenatal alcohol exposure affects an estimated 2-5% of live births, leading to fetal alcohol spectrum disorder (FASD), which includes motor and cognitive deficits linked to specific brain regions like the cerebellum and cerebral cortex.
- Damage to the developing cerebellum can disrupt connections between cerebellar and cerebral circuits, resulting in cognitive issues such as problems with attention, memory, and social skills.
- Proposed therapies focus on repairing these disrupted cerebello-cerebral connections, emphasizing anti-inflammatory approaches and strategies to improve cerebellar myelination for better brain function.
Article Synopsis
- The cerebellum plays a crucial role in regulating motor, cognitive, social, and emotional functions by interacting with other brain structures to support automatic behaviors and predictive mechanisms across various tasks, including reward-related activities.
- It encodes important signals related to reward prediction and temporal changes, influenced by chemical changes in catecholamines, which assist in cognitive learning and complex behavior modulation.
- Recent research highlights the cerebellum's involvement in mood disorders and addiction, as it helps manage reward sensitivity and loss aversion, while also predicting behavioral outcomes based on past experiences, which can affect social interactions and impulse control.
Immune Ataxias: The Continuum of Latent Ataxia, Primary Ataxia and Clinical Ataxia.
J Integr Neurosci
April 2024
Article Synopsis
- Immune-mediated cerebellar ataxias (IMCAs) have been recognized as a clinical category that arises from immune attacks on the cerebellum, which houses a significant number of brain neurons and various antigens.
- IMCAs manifest in acute or subacute phases and include conditions such as gluten ataxia, post-infectious cerebellitis, and anti-GAD ataxia, presenting symptoms like vestibulocerebellar and motor syndromes.
- Latent autoimmune cerebellar ataxia (LACA) serves as a precursor stage for patients who are asymptomatic or exhibit mild symptoms, potentially allowing for therapeutic intervention to maintain neuronal health before progressing to more severe autoimmune disorders.
Article Synopsis
- The study aimed to categorize patients with adult-onset Still's disease (AOSD) and analyze differences in their prognosis based on various factors.
- A total of 153 patients were grouped into four clusters using characteristics like age, sex, clinical features, and lab results, revealing distinct profiles and outcomes for each group.
- Patients in Cluster 4, who were older and had more complications, showed the lowest survival rates and drug-free remission compared to the other clusters, indicating varying severities of AOSD.
Objectives: Understanding interpatient variation in CD4+T-cell responses is the bases for understanding the pathogenesis and management of rheumatoid arthritis (RA). We examined immune responses to SARS-CoV-2 vaccine in a cohort of patients with RA and determined factors associated with the responses.
Methods: Four hundred and thirty-one patients with RA having received two doses of BNT162b2, a messenger RNA-based vaccine for SARS-CoV-2, were included.
Article Synopsis
- The clinical category of immune-mediated cerebellar ataxias (IMCAs) has been identified after 30 years of research, highlighting the cerebellum's vulnerability to immune attacks due to its unique antigens.
- IMCAs encompass various disorders, including gluten ataxia and post-infectious cerebellitis, with known triggers like gluten sensitivity and infections.
- Recent advancements in understanding IMCAs have clarified their causes and treatment strategies, yet questions remain about how immune tolerance is disrupted and the mechanics of cerebellar damage.
Article Synopsis
- - The study aimed to assess care trends for patients with ANCA-associated vasculitis (AAV) over a decade, focusing on two specific types: granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA).
- - Researchers compared patients treated in two different timeframes (early vs. late) and found that the late group used more rituximab (RTX) and required lower doses of glucocorticoids (GC), resulting in better remission rates and fewer complications.
- - The findings suggest that advancements in treatment strategies for AAV have led to improved patient outcomes, including effective disease management and reduced reliance on glucocorticoids over time.
Article Synopsis
- Cerebellar reserve helps compensate for and restore lost functions due to cerebellar damage, relying on the brain's circuitry and requires both synaptic plasticity in the cerebellar cortex and healthy cerebellar nuclei for effectiveness.
- Recent studies indicate that the cerebellum uses a predictive internal model to control motor accuracy and maintain learning, which is essential for adapting movements.
- The proposed Kalman filter framework describes how the cerebellar cortex updates predictions while the nuclei refine these with real-time feedback, suggesting specific roles for different brain areas in preserving cerebellar functions despite damage.
Advances in cerebellar disorders: pre-clinical models, therapeutic targets, and challenges.
Expert Opin Ther Targets
November 2023
Article Synopsis
- Cerebellar ataxias (CAs) are complex neurological disorders with various causes and symptoms, and there are currently limited treatment options available.
- The discussion focuses on preclinical research models, the concept of cerebellar reserve, therapeutic strategies, and potential markers for monitoring treatment progress.
- Ongoing research is essential to develop effective therapies, considering the unique characteristics of each patient's condition, and to better understand how treatments for the cerebellum affect other brain areas.
Cerebellum: From the identification of the cerebellar motor syndrome to the internal models.
Handb Clin Neurol
August 2023
Article Synopsis
- Cerebellar circuitry is interconnected in loops with the cerebral cortex, leading to three main clinical syndromes of ataxia: cerebellar motor syndrome (CMS), vestibulocerebellar syndrome (VCS), and cerebellar cognitive affective syndrome/Schmahmann syndrome (CCAS/SS).
- Each syndrome displays unique symptoms ranging from motor and oculomotor issues to cognitive and emotional impairments, either occurring in isolation or together based on the underlying pathology.
- Dysmetria, a key feature of cerebellar deficits, results from prediction errors in the cerebellum's internal models, affecting motor coordination, eye movement, and cognitive processes, highlighting the cerebellum's role as a key player
Article Synopsis
- The cerebellum is crucial for motor, cognitive, and emotional functions; its decline in aging has led to increased scientific interest due to its role in timing and complex tasks like spatial navigation.
- Anatomical connections and interactions with the basal ganglia, cerebral cortex, and spinal cord suggest that the cerebellum creates internal models that aid in automatic behaviors; changes in its structure and function with age are linked to mobility and cognitive decline.
- Neuroimaging studies indicate that age-related cerebellar atrophy correlates with cognitive and motor performance issues, and in conditions like Alzheimer's, cerebellar function declines independently from the cerebral cortex's contributions.
Objectives: To evaluate the long-term impact of immunosuppressive therapeutic agents on antibody response to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) mRNA vaccination in patients with autoimmune rheumatic diseases (AIRD) in order to propose a strategy for annual vaccination.
Methods: This prospective multicentre cohort study evaluated the humoral response to second and third BNT162b2 and/or mRNA-1273 vaccines in 382 Japanese AIRD patients classified into 12 different medication groups and in 326 healthy controls (HCs). The third vaccination was administered six months after the second vaccination.
Article Synopsis
- * Well-known types of IMCAs include gluten ataxia, post-infectious cerebellitis, paraneoplastic cerebellar degeneration, opsoclonus myoclonus syndrome, anti-GAD ataxia, and primary autoimmune cerebellar ataxia, with some associated with autoimmune responses against various brain proteins.
- * Therapeutic approaches through immunotherapy can differ based on the underlying cause, and early treatment is crucial for maintaining cerebral function and recovery potential.
Article Synopsis
- Immune-mediated cerebellar ataxias (IMCAs) can vary in causes, leading to symptoms like gait ataxia that develop quickly.
- The authors introduce a concept called latent autoimmune cerebellar ataxia (LACA), likening it to latent autoimmune diabetes in adults (LADA), where symptoms progress slowly without clear autoimmunity markers.
- For early diagnosis and intervention of LACA, it’s essential to identify a critical time-window before severe neuronal damage occurs, emphasizing the need for effective biomarkers.
Objectives: Recently, the involvement of basophils and IgE-type autoantibodies in the pathogenesis of SLE has been elucidated using mouse models; however, few studies have been conducted in humans. In this study, the role of basophils and anti-double-stranded DNA (dsDNA) IgE in SLE was examined using human samples.
Methods: The correlation between disease activity and serum levels of anti-dsDNA IgE in SLE was evaluated using enzyme-linked immunosorbent assay.
Article Synopsis
- * A consortium of neurologists developed the "Scale for Ocular Motor Disorders in Ataxia" (SODA) to assess the extent of eye movement deficits, making it accessible for non-specialist healthcare providers.
- * Validation studies showed SODA effectively measures specific eye movement abnormalities, yet its scores don't correlate with existing ataxia scales, suggesting that traditional measures may not adequately address ocular motor dysfunction.
Background: Systemic sclerosis (SSc) is a multiple-organ disease characterized by vascular damage, autoimmunity, and tissue fibrosis. Organ injuries such as interstitial lung diseases (ILD), resulting from inflammatory and fibrosis processes, lead to poor prognosis. Although autoantibodies are detected in the serum of patients with SSc, the mechanisms by which immune cells are involved in tissue inflammation and fibrosis is not fully understood.
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- * This reserve develops around age 12, influenced by both enhanced cerebellar functions and existing neural connections, but it can be hindered by injury during critical growth periods.
- * Factors like vulnerability to injury and the potential for growth impact how well the cerebellum can build this reserve, emphasizing the need for more research on its resilience and recovery capabilities.
Article Synopsis
- The cerebellum is vulnerable to immune attacks, leading to conditions known as immune-mediated cerebellar ataxias (IMCAs), which include various syndromes like gluten ataxia and Miller Fisher syndrome.
- These ataxias can result from autoimmunity against a range of neurological proteins and manifest with various clinical symptoms, making them a significant area of concern.
- The review discusses recent advancements in understanding IMCAs, emphasizes the need for better diagnosis of rare immune ataxias, and highlights the potential for effective treatment if identified early.
Objectives: We aim to clarify the efficacy and safety of switching immunosuppressive drugs and to identify the predictive factors for treatment failure after switching in patients with systemic lupus erythematosus (SLE).
Methods: We retrospectively evaluated patients with SLE who switched immunosuppressive drugs for any reason in our hospital between 2015 and 2020. The efficacy endpoints were the change in SLE Disease Activity Index 2000 score, prednisolone dose, and disease status over 12 months, as well as treatment continuation rates.
Article Synopsis
- Freezing of gait (FOG) is a major issue for Parkinson's disease (PD) patients affecting daily life, but its underlying causes are not well understood.
- *The study examined 53 newly diagnosed, untreated PD patients and classified them into "freezers" and "nonfreezers" based on their FOG symptoms, looking at various clinical factors.
- *Results indicated that FOG was present in 15% of participants, with freezers showing more severe apathy and motor symptoms, but there were no significant differences in cognitive abilities or depressive symptoms between the groups.*
Article Synopsis
- A nationwide survey in Japan examined how economic factors and location influence high school students' applications to medical schools, highlighting significant disparities based on socioeconomic status and urban versus rural living.
- Over 1,000 responses from teachers indicated that many believe students from economically disadvantaged backgrounds face challenges in aspiring to become medical professionals, with 66.8% agreeing it's difficult for them to enroll.
- The findings reveal that private schools, which often have higher tuition, and urban schools have more students successfully entering medical programs, suggesting a systemic bias against lower-income and rural students in medical school admissions.
Background: Mizoribine (MZR) is an immunosuppressive agent that selectively inhibits inosine monophosphate dehydrogenase; its actions are considerably similar to those of mycophenolate mofetil (MMF). This study aimed to clarify whether MZR can be a good treatment option for systemic lupus erythematosus (SLE) and to compare the efficacy and safety of MZR and MMF in patients with active SLE.
Methods: We retrospectively compared the efficacy, continuation rate, and safety of MZR (52 patients) and MMF (31 patients) after adjusting for stabilized inverse probability of treatment weighting based on propensity scores.