[Multicenter Survey on Phantom Entrance Surface Air Kerma of Angiography and IVR in Japan].

PURPOSE: In DRLs 2020, the entrance surface air kerma (Ka,e) was set to 17 mGy/min as the reference dose rate in fluoroscopy. But, Ka,e in fluoroscopy for different regions and Ka,e in exposure was not set. A multicenter survey was conducted to evaluate Ka,e by each area. METHODS: Ka,e for each area was analyzed for 79 facilities attending this survey (274 machines and 461 protocols). When the protocols were changed by the difference in disease, angiography, or IVR, the difference rate of Ka,e was evaluated. Ka,e before and after modifying the incident air kerma at the patient entrance reference point (Ka,r) and air kerma area product (PKA) difference rate were calculated when protocols were changed, considering the DRLs 2020. RESULTS: There were dose differences in Ka,e by each area. Compared to DRLs 2020, 36 protocols from 13 facilities modified their protocols, all of which reduced Ka,e. CONCLUSION: Although reducing Ka,e does not necessarily reduce Ka,r, and PKA, comparison of Ka,e by each area is expected to optimize medical exposure protection, including evaluation of quality control.

Syntheses of 25-Adamantyl-25-alkyl-2-methylidene-1α,25-dihydroxyvitamin D3 Derivatives with Structure-Function Studies of Antagonistic and Agonistic Active Vitamin D Analogs.

The active form of vitamin D3, 1α,25-dihydroxyvitamin D3 [1,25(OH)2D3], is a major regulator of calcium homeostasis through activation of the vitamin D receptor (VDR). We have previously synthesized vitamin D derivatives with large adamantane (AD) rings at position 24, 25, or 26 of the side chain to study VDR agonist and/or antagonist properties. One of them-ADTK1, with an AD ring and 23,24-triple bond-shows a high VDR affinity and cell-selective VDR activity. In this study, we synthesized novel vitamin D derivatives (ADKM1-6) with an alkyl group substituted at position 25 of ADTK1 to develop more cell-selective VDR ligands. ADKM2, ADKM4, and ADKM6 had VDR transcriptional activity comparable to 1,25(OH)2D3 and ADTK1, although their VDR affinities were weaker. Interestingly, ADKM2 has selective VDR activity in kidney- and skin-derived cells-a unique phenotype that differs from ADTK1. Furthermore, ADKM2, ADKM4, and ADKM6 induced osteoblast differentiation in human dedifferentiated fat cells more effectively than ADTK1. The development of vitamin D derivatives with bulky modifications such as AD at position 24, 25, or 26 of the side chain is useful for increased stability and tissue selectivity in VDR-targeting therapy.

Combination of triple bond and adamantane ring on the vitamin D side chain produced partial agonists for vitamin D receptor.

Vitamin D receptor (VDR) ligands are therapeutic agents that are used for the treatment of psoriasis, osteoporosis, and secondary hyperparathyroidism and have immense potential as therapeutic agents for autoimmune diseases, cancers, and cardiovascular diseases. However, the major side effect of VDR ligands, the development of hypercalcemia, limits their expanded use. To develop tissue-selective VDR modulators, we have designed vitamin D analogues with an adamantane ring at the side chain terminal, which would interfere with helix 12, the activation function 2, and modulate the VDR potency. Here we report 25- or 26-adamantyl-23,23,24,24-tetradehydro-19-norvitamin D derivatives (ADTK1-4, 4b,a and 5a,b). These compounds showed high VDR affinities (90% at maximum), partial agonistic activities (EC50 10(-9)-10(-8) M with 40-80% efficacy) in transactivation, and tissue-selective activity in target gene expressions. We investigate the structure-activity relationships of these compounds on the basis of their X-ray crystal structures.