当科の柏崎大奈先生が18F-FDG PETを用いて解き明かした「不安定頚動脈プラークと脾臓の炎症はカップリングしている」なる論文がJournal of Stroke and Cerebrovascular Diseases誌に掲載されました。
われわれがかねてより主張しているコンセプトである「頚動脈狭窄症における慢性全身炎症」の存在を強く示唆する論文です。全力投球で執筆させていただきました。われわれのこの新しいコンセプトを理解していただくには、いろいろと紆余曲折があって少々時間を要しましたが、既知の事実を追認するだけの研究に止まらず、これからもフロンティア・スピリットに満ちた研究を進めていきたいと考えています。
この「頚動脈狭窄症と炎症」のコンセプトを共有する仲間とともに、新たな研究会「プラーク・クラブ」を設立しました。第一回研究会を本年11月24日（土）午後、東京にて開催します。ご興味のある先生は、ぜひご参集ください。発起人は以下の通りです。
川崎医科大学脳神経外科 宇野昌明
岩手医科大学脳神経外科 小笠原邦昭
富山大学脳神経外科 黒田 敏
九州大学脳神経外科 飯原弘二
京都大学脳神経外科 吉田和道（敬称略・年齢順）
A Voyage to Depth of Neuroscience Vol. 51
Inflammation Coupling Between Unstable Carotid Plaque and Spleen-A 18F-Fluorodeoxyglucos Positron Emission Tomography Study.
Kashiwazaki D, Yamamoto S, Akioka N, Kuwayama N, Noguchi K, Kuroda S.
J Stroke Cerebrovasc Dis. 2018 Aug 4. [Epub ahead of print]
Abstract
BACKGROUND AND PURPOSE:
This study was aimed to assess the hypothesis that unstable plaque formation in the carotid artery is one of phenotypes of chronic and systemic inflammation.
METHODS:
This study included 8 symptomatic patients with internal carotid stenosis (ICS) and 7 healthy controls. All subjects underwent 18F-fluorodeoxyglucos positron emission tomography (18F-FDG PET) of whole body. Plaque vulnerability was evaluated on magnetic resonance imaging (MRI). On 18F-FDG PET, the maximum standardized uptake (SUVmax) value was measured in the carotid plaque, aorta, spleen, liver, and bone marrow. The SUVmax ratio of the spleen or bone marrow to the liver was also calculated. These values were compared between 2 groups. All 8 patients in ICS group underwent carotid endarterectomy, and surgical specimens were subjected to immunohistochemistry.
RESULTS:
All 8 patients in ICS group had unstable plaque on MRI. The mean SUVmax of carotid plaque was 2.5 ± .2 in ICS group. The SUVmax of spleen was significantly higher in ICS group than in the controls (3.20 ± .25 and 2.51 ± .40, respectively; P = .003). The SUVmax ratio (spleen/liver) was also significantly higher in ICS group than in the controls (1.12 ± .06 and .85 ± .12, respectively; P = .001). The SUVmax of aorta was also significantly higher in ICS group than in the controls (2.16 ± .27 and 1.48 ± .15, respectively; P = .001). However, there were no significant differences in the SUVmax in the bone marrow and SUVmax ratio (bone marrow/liver) between the 2 groups (P = .811 and P = .731, respectively). Histological examination showed that the plaque strongly expressed endothelial progenitor cells, microvessels, and M1 macrophages.
CONCLUSIONS:
These data strongly suggest the inflammation coupling between the spleen and unstable carotid plaque, and may be useful to develop novel therapeutic strategies against systemic inflammation in patients with ICS.
