X-linked Myotubular Myopathy Manifesting Carrier with Central and Peripheral Nervous System Involvement.

X-linked myotubular myopathy (XLMTM) is a rare genetic disorder caused by X-linked mutations in the MTM1 gene. Although heterozygous females are typically asymptomatic, affected cases have recently been reported. We herein report a case of XLMTM manifesting carrier of the pathogenic c.206dupG mutation in MTM1 with uncommon extramuscular symptoms. She developed gaze nystagmus and cognitive impairment in addition to muscle weakness. Electrophysiological studies and brain magnetic resonance imaging indicated the involvement of the central and peripheral nervous systems. XLMTM manifesting carriers may have a wider spectrum of clinical phenotypes than currently assumed. Appropriate follow-up of extramuscular and conventional muscular manifestations is important in such cases.

Undiagnosed myotonic dystrophy: A case report and literature review.

Myotonic dystrophy (MD) is an autosomal dominant disorder primarily characterized by myotonia. The present study describes the case of a 42-year-old woman who was transferred to the authors' department with acute abdomen and restrictive respiratory failure. Computed tomography revealed a 15-cm right ovarian tumor and atelectasis. An abdominal right salpingo-oophorectomy was performed under general anesthesia. She was then extubated after surgery; however, shortly thereafter she was re-incubated due to poor oxygenation and was then moved to the intensive care unit (ICU) for a further analysis of weaning failure. During her stay in the ICU, weaning was attempted twice, but failed both times. The patient underwent a tracheotomy 7 days after surgery. Consultation with a neurologist suggested possible MD. Following genetic testing, type I MD with ~700-1,100 cytosine-thymine-guanine repeats in the dystrophia myotonia protein kinase gene was confirmed. The patient was then transferred to a specialty hospital at 2 months after surgery. On the whole, the case described herein suggests that clinicians need to become familiar with this disease as a differential diagnosis for post-operative weaning failure.

Cerebrospinal Fluid Interleukin-6 in Immune Checkpoint Inhibitor-Induced Autoimmune Meningoencephalitis.

Immune checkpoint inhibitors (ICIs) have proven clinical benefits in various advanced cancers. However, despite their significant therapeutic efficacy, ICIs induce immune-related adverse events. Among these events, autoimmune meningoencephalitis often has severe effects on patients' outcomes, but its specific clinical features are still unclear. Here, we report two cases of ICI-associated meningoencephalitis with elevated interleukin-6 (IL-6) levels in the cerebrospinal fluid (CSF). A 47-year-old woman (Case 1) with renal cell carcinoma developed severe headache after a seventh nivolumab administration. A neurological examination revealed jolt accentuation signs and hyperreflexia in all extremities. CSF analysis revealed a high IL-6 value (6,620 pg/mL) with marked pleocytosis. A 70-year-old woman (Case 2) who received an initial administration of nivolumab plus ipilimumab for renal cell carcinoma developed alterations of consciousness. She presented with impaired consciousness, neck stiffness, and hyperreflexia in all extremities. CSF analysis demonstrated a high IL-6 value (49.3 pg/mL) with mild pleocytosis. Both patients were treated with steroid pulse therapy (methylprednisolone 1,000 mg/day, 3 days), followed by the administration of oral predonisolone. The symptoms and laboratory findings improved in both cases. CSF IL-6 values were proportional to the severity of meningoencephalitis and other clinical parameters. These findings may help elucidate the mechanisms of central nervous system complications that are caused by ICIs.

Thymoma-associated myasthenia gravis coexisting with myotonic dystrophy: a case report.

BACKGROUND: Myotonic dystrophy (dystrophia myotonica [DM]) is an autosomal-dominant inheritance, and myasthenia gravis (MG) is an autoimmune disease characterized by weakness of skeletal muscles. Cases of both DM and MG are extremely rare and distinguishing DM and MG symptoms is challenging. CASE PRESENTATION: We herein report a 49-year-old woman presenting with subacute dyspnea and muscle weakness. She had previously been diagnosed with DM 24 years earlier. Computed tomography (CT) revealed an anterior mediastinal 32-mm solid mass that was suspected of being thymoma. The clinical features and neurological examination findings confirmed the diagnosis of thymoma-associated MG coexisting with DM. Intensive treatment for MG, including surgery, resulted in an improvement in some of her neurological symptoms. CONCLUSIONS: The symptoms of DM usually progress slowly, so the sudden exacerbation of symptoms indicates the involvement of other factors. It is important to be aware of these associations, as an early diagnosis with proper treatment will result in a better outcome.

Association of Modifiable Lifestyle Factors With Cortical Amyloid Burden and Cerebral Glucose Metabolism in Older Adults With Mild Cognitive Impairment.

Importance: Understanding the association of lifestyle factors with mild cognitive impairment enables the development of evidence-based interventions for delaying cognitive impairment. Objective: To explore whether objectively measured lifestyle factors, such as physical activity, conversation, and sleep, are associated with cortical amyloid burden and cerebral glucose metabolism in older adults with mild cognitive impairment. Design, Setting, and Participants: This cohort study included 855 community-dwelling adults in Usuki, Oita Prefecture, Japan, aged 65 years or older. Data were collected from August 2015 to December 2017. Participants were reviewed to examine risk and protective lifestyle factors for dementia. Data analysis was conducted in June 2019. Exposures: Wearable sensors, carbon-11 labeled Pittsburgh compound B positron emission tomography images, and fluorine-18 fluorodeoxyglucose positron emission tomography images. Main Outcomes and Measures: Wearable sensor data, such as walking steps, conversation time, and sleep, were collected from August 2015 to October 2017, and positron emission tomography images were collected from October 2015 to December 2017. A multiple regression model and change-point regression model were used to examine the association of lifestyle factors with mean amyloid or fluorodeoxyglucose uptake, assessed on the basis of a standardized uptake value ratio of the frontal lobes, temporoparietal lobes, and posterior cingulate gyrus with the cerebellar cortex as the reference region. The bootstrap method was used to obtain nonparametric 95% CIs on the associations of lifestyle factors with cognitive decline. Results: Of the 855 adults in the study, 118 (13.8%) were diagnosed with mild cognitive impairment, with a mean (SD) age of 75.7 (5.8) years and 66 (55.9%) women. Total sleep time was inversely associated with fluorodeoxyglucose uptake after adjusting for covariates (ß = -0.287; 95% CI, -0.452 to -0.121, P < .001). Change-point regression showed an inverse association between total sleep time and mean amyloid uptake when sleep duration was longer than 325 minutes (B = -0.0018; 95% CI, -0.0031 to -0.0007). Conclusions and Relevance: To our knowledge, this is the first study to demonstrate that total sleep time was associated with brain function in older adults with mild cognitive impairment. Sleep duration is a potentially modifiable risk factor for dementia at the mild cognitive impairment stage.

Relationship Between the Japanese Version of the Montreal Cognitive Assessment and PET Imaging in Subjects with Mild Cognitive Impairment.

BACKGROUND: The Montreal Cognitive Assessment (MoCA) test has high sensitivity and specificity for detecting mild cognitive impairment or early dementia. How the MoCA score relates to findings of positron emission tomography imaging, however, remains unclear. OBJECTIVE: This prospective study examined the relationship between the Japanese version of the MoCA (MoCA-J) test and brain amyloid deposition or cerebral glucose metabolism among subjects with mild cognitive impairment. METHODS: A total of 125 subjects with mild cognitive impairment underwent the MoCA-J test, and amyloid- and 18F-fluorodeoxyglucose- positron emission tomography. Linear correlation analysis and multiple linear regression analysis were conducted to investigate the relationship between the MoCA-J score and demographic characteristics, amyloid deposition, and cerebral glucose metabolism. Moreover, Statistical Parametric Mapping 8 was used for a voxel-wise regression analysis of the MoCA-J score and cerebral glucose metabolism. RESULTS: The MoCA-J score significantly correlated with age, years of education, and the Mini-Mental State Examination score. After adjusting for age, sex, and education, the MoCA-J score significantly correlated negatively with amyloid retention (ß= -0.174, p= 0.031) and positively with cerebral glucose metabolism (ß= 0.183, p= 0.044). Statistical Parametric Mapping showed that Japanese version of MoCA score correlated with glucose metabolism in the bilateral frontal and parietal lobes, and the left precuneus. CONCLUSION: The total MoCA-J score correlated with amyloid deposition and frontal and parietal glucose metabolism in subjects with mild cognitive impairment. Our findings support the usefulness of the MoCA-J test for screening subjects at high risk for Alzheimer's disease.

Modifiable Lifestyle Factors and Cognitive Function in Older People: A Cross-Sectional Observational Study.

Background: The development of evidence-based interventions for delaying or preventing cognitive impairment is an important challenge. Most previous studies using self-report questionnaires face problems with reliability and consistency due to recall bias or misclassification among older people. Therefore, objective measurement of lifestyle components is needed to confirm the relationships between lifestyle factors and cognitive function. Aims: The current study examined the relationship between lifestyle factors collected with wearable sensors and cognitive function among community-dwelling older people using machine learning. Methods: In total, 855 participants (mean age: 73.8 years) wore a wristband sensor for 7.8 days on average every 3 months. Various lifestyle parameters were measured, including walking steps, conversation time, total sleep time (TST), sleep efficiency, time awake after sleep onset, awakening count, napping time, and heart rate. Random forest (RF) regression analysis was used to examine the relationships between total daily sensing data and Mini-Mental State Examination (MMSE) scores. Confounding factor analysis was conducted with models that were adjusted and unadjusted for demographic and vascular risk factors, and selected variables were assessed as risk and protective factors using partial dependence plots (PDPs). Results: Lifestyle data were collected for 31.3 ± 7.1 days per year using wristband sensors. RF regression analysis adjusted for age, gender, and education levels selected four variables, including number of walking steps, conversation time, TST, and heart rate. Moreover, walking steps, conversation time, and heart rate remained after RF regression analysis adjusted for demographic and vascular risk factors. Number of walking steps, conversation time, and heart rate were categorized as protective factors, whereas TST was categorized as a risk factor for cognitive function. Although PDPs of number of walking steps and heart rate revealed continuously increased MMSE scores, those of conversation time and TST and revealed that the tendency in the graph was reversed at the boundary of a particular threshold (321.1 min for conversation time, 434.1 min for TST). Conclusions: Lifestyle factors, such as physical activity, sleep, and social activity appear to be associated with cognitive function among older people. Physical activity and appropriate durations of sleep and conversation are important for cognitive function.

[Ross syndrome presenting with asymptomatic tonic pupils].

A 66-year-old woman presented with asymptomatic tonic pupils and areflexia when she was admitted to our hospital due to vertigo. She had also noticed heat intolerance and decreased sweating on her right side since she was approximately 10 years old. Both sides of each eye contracted in the pilocarpine eye drop test, while sweating on the face and left chest decreased. She was thus diagnosed with Ross syndrome. When acethylcholine was administered intracutaneously, sweating of the left subclavian and left peri-umbilical areas decreased. During an electrogastrogram, the average muscle contraction frequency was decreased and the incidence of bradygastria increased. Blood flow of the skin of the left forefinger (but not right) increased at rest and the reaction in the blood flow on deep breathing decreased. A skin biopsy of the left upper arm showed atrophy of pilosebaceous and sweat glands. Despite treatment with intravenous immunoglobulin, the patient's deficits did not improve. The lesions typical of Ross syndrome may be associated with many parts of the autonomic nervous system.

[Pathophysiology of oxystress-induced tissue damage in cerebrovascular disease].

The electron transport system required for energy transduction in mitochondria releases free electrons to generate superoxide, which is converted to hydrogen peroxide either spontaneously or by superoxide dismutase (SOD). In the presence of catalase and/or peroxidases, hydrogen peroxide is converted to water and hypochlorite (when metabolized by myeloperoxidase). In the absence of SOD, hydrogen peroxide can be converted to highly toxic hydroxyl radicals, in particular, in the presence of transition metals such as the free form of iron. Superoxide also reacts rapidly with nitric oxide (NO) to form peroxynitrite, thereby regulating the biological activities of NO. Oxidative stress caused by such reactive species functions as redox regulator for cells as well as hazardous metabolites, which oxidize a wide variety of cellular constituents, including critical amino acid residues (cysteine, histidine, tyrosine, tryptophan, etc.) in proteins and low-molecular weight constituents. Thus, oxidative stress functions as a double-edged sword in living organisms, including mammals. The present work describes the pathophysiological roles of oxidative stress in and around blood vessels and in the etiology of vasogenic brain injury.

Mitochondria determine the efficacy of anticancer agents that interact with DNA but not the cytoskeleton.

Although chemotherapy is an important method for the treatment of patients with cancer, its efficacy is limited because of different sensitivities of tumor cells to anticancer agents and/or side effects on normal tissues. The present work demonstrates that mitochondria play a crucial role in the apoptosis of cancer cells induced by anticancer agents that interact with DNA but not with the cytoskeleton. Agents that interact with DNA selectively enhanced generation of reactive oxygen species (ROS) in mitochondria, released cytochrome c, and activated caspase-9 and caspase-3 to induce apoptosis of mesothelioma H2052 cells but not their ρ(0) cells, which lack mitochondrial DNA (mtDNA). The sensitivity of a variety of cells to the agents showed positive correlation with the amounts of their mitochondria. In contrast, agents that selectively affect the cytoskeleton activated caspase-8 and caspase-3 and equally induced apoptosis of both H2052 and their ρ(0) cells by a mitochondria-independent mechanism. The results suggest that mtDNA is a potential target for the anticancer agents that interact with DNA to induce ROS-dependent apoptosis of cancer cells, whereas agents that affect the cytoskeleton induce cell death by a mitochondria- and ROS-independent mechanism. The present observation is important for the selection of medicine for chemotherapy of patients with cancer.

Ultraviolet-A irradiation to the eye modulates intestinal mucosal functions and properties of mast cells in the mouse.

We previously reported that topical irradiation of the eye by ultraviolet-B (UVB) activated hypothalamo-pituitary-adrenal axis (HPA-A) of the mouse to increase 3, 4-dihydroxyphenylalanine (DOPA)-positive melanocytes in the skin by an inducible nitric oxide synthase (iNOS)-dependent mechanism. This work demonstrates that irradiation of the eye by ultraviolet-A (UVA) specifically increased DOPA-positive cells in the mucosa of the jejunum and colon of C57BL/6J mice by some HPA- and iNOS-independent mechanism. UVA-induced increase in DOPA-positive cells in the intestine was inhibited by the administration of hexamethonium or prazosin plus propranolol, blockers for the sympathetic nervous system. UVA irradiation of the eye increased DOPA- and histidine decarboxylase (HDC)-positive cells in the intestinal mucosa of both C57BL/6J and WBB6F1/J mice but not in the mutant strain W/Wv of the latter that lack mast cells. UVA irradiation of the eye suppressed the intestinal peristalsis of control, hypophysectomized or iNOS(-/-) C57BL/6J mice by the mechanism that was inhibited by hexamethonium or prazosin plus propranolol. These observations suggest that UVA irradiation of the eye stimulated the sympathetic nervous system to increase the mucosal DOPA- and HDC-positive mast cells and suppressed the peristalsis of the small intestine of the mouse.

Effect of oxidative stress during repeated ovulation on the structure and functions of the ovary, oocytes, and their mitochondria.

We previously reported that superoxide generated in the ovary induces apoptosis of granulosa cells to break down follicular walls, thereby supporting ovulation in rodents, and suggested that oxidative stress underlies the mechanism of ovarian aging. To test this hypothesis, we successfully induced ovulation repeatedly in mice by sequentially administrating pregnant mare serum gonadotropin, human chorionic gonadotropin, and prostaglandin F2alpha. Kinetic analysis revealed that the number of ovulated oocytes decreased significantly with repeated cycles of ovulation with a concomitant decrease in the gene expression of mitochondrial transcription factor A and nuclear respiratory factor 1 and an increase in oocytes having abnormally distributed mitochondria. Repeated ovulation decreased the amounts of mitochondrial DNA and increased 8-hydroxydeoxyguanosine in oocytes. Cell culture analysis of the in vivo fertilized oocytes revealed that their maturation from two cells to blastocyst was inhibited significantly by repeated ovulation. All these events induced by repeated ovulation were suppressed by oral administration of L-carnitine. These results suggest that oxidative stress associated with ovulation underlies the mechanism of ovarian aging and that L-carnitine may have therapeutic potential in patients with infertility and increased incidence of aneuploidy and to suppress impaired maturation of zygotes frequently observed in childbearing at an advanced age.

Alpha-melanocyte-stimulating hormone plays an important role in the onset of pollinosis in a pollen allergy mouse model.

BACKGROUND: alpha-Melanocyte-stimulating hormone (alpha-MSH) is a neuropeptide that controls melanogenesis in pigmentary cells. In addition, its potent immunomodulatory activity has been recently described in cutaneous inflammatory disorders. However the mechanism of such pollen allergies remains to be elucidated. The purpose of this study was to investigate the role of alpha-MSH in a murine model of pollen allergy. METHODS: Eight-week-old male BDF-1 mice were sensitized with Cry j I. After the last intranasal antigen, the number of sneezes was counted for 5 min. In addition, the serum levels of IgE and neuronal hormones were measured by ELISA. The expression of IgA, melanocortin receptor 1 (MC1R) and MC5R in the trachea were also observed by immunohistochemistry. RESULTS: Both the concentration of alpha-MSH and adrenocorticotropin in plasma increase in pollen allergy model mice. Furthermore, MC5R increased in the trachea; however, MC1R did not increase in the trachea. In addition, the changes in sneezing and IgA expression in the pollen allergy model mice were suppressed by alpha-MSH antibody treatment, but they remained unchanged after MC1R antagonist (agouti) treatment. CONCLUSIONS: These results indicate that sneezing due to pollen allergy is associated with an increased concentration of alpha-MSH and the expression of MC5R.

Prevention of scattered light-induced asthenopia and fatigue by a polarized filter.

BACKGROUND: It has been well documented that a long-time irradiation of the eye by a strong light elicits eyestrain and fatigue. To elucidate the mechanism for the induction of light-induced fatigue and asthenopia, changes in the mouse were analyzed after white light-irradiation to the eye. METHODS: C57BL/6j male mice were irradiated with white light in a specially designed room equipped with four mirrors covering all areas of its four walls to elicit diffused reflected light, and changes in their plasma levels of cortisol, INF-gamma, interleukin-10 (IL-10) and transforming growth factor-beta (TGF-beta) were analyzed. RESULTS: Irradiation of mice with scattered white light significantly decreased the motional activity of animals, suggesting the occurrence of fatigue. Biochemical analysis and enzyme-immunoassay revealed that the irradiation of mice significantly elevated the plasma levels of cortisol, IFN-gamma, IL-10 and TGF-beta. All these changes were not observed with mice irradiated with the light in a similar room not equipped with mirrors. These changes were successfully inhibited by a polarized glass filter but not by a non-polarized filter with a similar absorbance. CONCLUSIONS: These observations suggest that irradiation of the eye by scattered reflected light stimulated a stress response via hypothalamo-pituitary-adrenal axis to enhance the secretion of cortisol from the adrenal grand and increase the plasma levels of cytokines.

Role of hydrogen generation by Klebsiella pneumoniae in the oral cavity.

Some gastrointestinal bacteria synthesize hydrogen (H(2)) by fermentation. Despite the presence of bactericidal factors in human saliva, a large number of bacteria also live in the oral cavity. It has never been shown that oral bacteria also produce H(2) or what role H(2) might play in the oral cavity. It was found that a significant amount of H(2) is synthesized in the oral cavity of healthy human subjects, and that its generation is enhanced by the presence of glucose but inhibited by either teeth brushing or sterilization with povidone iodine. These observations suggest the presence of H(2)-generating bacteria in the oral cavity. The screening of commensal bacteria in the oral cavity revealed that a variety of anaerobic bacteria generate H(2). Among them, Klebsiella pneumoniae (K. pneumoniae) generated significantly large amounts of H(2) in the presence of glucose. Biochemical analysis revealed that various proteins in K. pneumoniae are carbonylated under standard culture conditions, and that oxidative stress induced by the presence of Fe(++) and H(2)O(2) increases the number of carbonylated proteins, particularly when their hydrogenase activity is inhibited by KCN. Inhibition of H(2) generation markedly suppresses the growth of K. pneumoniae. These observations suggest that H(2) generation and/or the reduction of oxidative stress is important for the survival and growth of K. pneumoniae in the oral cavity.

Dynamic aspects of ascorbic acid metabolism in the circulation: analysis by ascorbate oxidase with a prolonged in vivo half-life.

Because AA (L-ascorbic acid) scavenges various types of free radicals to form MDAA (monodehydroascorbic acid) and DAA (dehydroascorbic acid), its regeneration from the oxidized metabolites is critically important for humans and other animals that lack the ability to synthesize this antioxidant. To study the dynamic aspects of AA metabolism in the circulation, a long acting AOase (ascorbate oxidase) derivative was synthesized by covalently linking PEG [poly(ethylene glycol)] to the enzyme. Fairly low concentrations of the modified enzyme (PEG-AOase) rapidly decreased AA levels in isolated fresh plasma and blood samples with a concomitant increase in their levels of MDAA and DAA. In contrast, relatively high doses of PEG-AOase were required to decrease the circulating plasma AA levels of both normal rats and ODS (osteogenic disorder Shionogi) rats that lack the ability to synthesize AA. Administration of 50 units of PEG-AOase/kg of body weight rapidly decreased AA levels in plasma and the kidney without affecting the levels in other tissues, such as the liver, brain, lung, adrenal grand and skeletal muscles. PEG-AOase slightly, but significantly, decreased glutathione (GSH) levels in the liver without affecting those in other tissues. Suppression of hepatic synthesis of GSH by administration of BSO [L-buthionin-(S,R)-sulfoximine] enhanced the PEG-AOase-induced decrease in plasma AA levels. These and other results suggest that the circulating AA is reductively regenerated from MDAA extremely rapidly and that hepatic GSH plays important roles in the regeneration of this antioxidant.

Ultraviolet A irradiation of the eye induces immunomodulation of skin and intestine in mice via hypothalomo-pituitary-adrenal pathways.

Irradiation by ultraviolet A (UVA) initiates the suppression of skin contact hypersensitivity. However, the change in the whole body immunity by UVA irradiation of the eye is still unknown. The mice used in this study were separated into four groups namely: a control, UVA irradiation of the eye, UVA irradiation of the ear, UVA irradiation of the eye + a glucocorticoid receptor antagonist (RU-486) administrated, UVA irradiation of the eye with an adrenalectomy and non-irradiation + cortisol administrated groups. The eye or ear was locally exposed to UVA after covering the remaining body surface with aluminum foil at a dose of 110 kJ/m(2) using a FL20SBLB-A lamp. Plasma adrenocorticotropic hormone, cortisol, and interleukin-10 (IL-10) content increased by UVA irradiation of the eye. In addition, UVA irradiation of the eye induced down-regulation of the epidermal Langerhans cells in the ear and the up-regulation of the mucosal immunoglobulin A (IgA) in the intestine. However, the changes in the epidermal Langerhans cells and mucosal IgA of UVA irradiation of the eye are not induced either by the RU-486 treatment or an adrenalectomy. These results clearly indicate that the signal evoked by UVA irradiation of the eye, through the hypothalamo-pituitary-adrenal pathway, up-regulated the production of glucocorticosterone. This hormone controls immunity, and the possibility that it performed a living body defense for UVA exposure was thus suggested.

Fasting differentially modulates the immunological system: its mechanism and sex difference.

The immunological properties and hormonal metabolism in rodents are affected by physical and psychological stress more strongly in males than in females. To elucidate the mechanism and physiological significance of the sex difference in the susceptibility of animal to stresses, changes in the immunological system in plasma and intestine and hormonal status in plasma were compared among 8-week-old male and female ICR mice before and after fasting. During the fasting of animals, the expression of immunoglobulin A in intestinal mucosa, and cortisol, interleukin-10 and interferon-gamma in plasma increased. These changes occurred more apparently in males than in females. Under identical conditions, the plasma levels of testosterone decreased markedly with concomitant occurrence of apoptosis in the testis, while the plasma levels of estradiol decreased calmly, and no appreciable apoptosis occurred in the ovary. These results indicate that testosterone enhances the stress-induced modulation of the immune system by some mechanism that was antagonized by estradiol.

Effect of starvation on the survival of male and female mice.

We previously observed that female mice survived significantly longer than male mice under fasting conditions. To elucidate the mechanism underlying the sex different effect of fasting, we analyzed various events induced in male and female mice. Kinetic analysis revealed that fasting elicited hypothermia and decreased muscle weight more apparently in male than in female mice. The life-time of male was increased by administration of estradiol while that of female was decreased by ovariectomy. Although plasma levels of estradiol were below detectable levels in male mice, those in female were significantly high and remained unchanged for a fairly long time. Generation of ketone bodies was enhanced more markedly in female than in male animals. The increased generation of ketone bodies in female was strongly inhibited by ovariectomy while that in male animals was increased by administration of estradiol. Expression of uncoupling protein-1 (UCP-1) in brown adipose tissue increased markedly in female mice while it was low in male animals. These results suggest that estrogen is a major factor that increases the life-time of animals under fasting conditions by increasing fatty acid oxidation, ketone body production and heat generation that support the energy metabolism and homeostasis required for the survival of animals.