Outline Research Education Lectures & Courses Clinical Services & Other Works Clinical Performances
Home page URL http://www.tmd.ac.jp/med/ped/home.html

Staffs

Title Name Researcher information
Professor MORIO Tomohiro
Associate Professor TAKAGI Masatoshi
Junior Associate Professor ISODA Takeshi
Assistant Professor TAKASAWA Kei
Assistant Professor MORIOKA Chikako
Assistant Professor YAMASHITA Motoi
Assistant Professor UDAGAWA Tomohiro
Assistant Professor OZAKI Fumiko
Project Associate Professor IMAI Kohsuke
Graduate Student YAMAGUCHI Yohei
Graduate Student MIYAMOTO Satoshi
Graduate Student NISHIMURA Akira
Resident Gau Maki
KANEGANE Hirokazu
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Outline

Our department is providing advanced medical service for infants, children, adolescents and young adults. The specialties cover most pediatric diseases, including hematology-oncology, immunology, cardiology, neurology, endocrinology, nephrology, neonatology, allergy and rheumatology. On the other hand, our scientific and academic activities encompass a wide spectrum, from basic to clinical research. By focusing on innovative strategies for clarifying pathogenesis, diagnostic tests, and therapeutic interventions, we are looking at comprehensive resolution of the child’s health problems, improving their future.
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Research

Our research covers many specialties of pediatric diseases, and the research spans from bench to bedside. Our current main projects are
1. Identification of responsible genes for primary immunodeficiency (PID).
2. Development of therapeutic approach for PID

3. Research in autoimmune lymphoproliferative syndrome (ALPS) and RAS-associated ALPS like syndrome
4. Development of innovative techniques for ex vivo cell therapy after hematopoietic stem cell transplantation.
5. Multicenter Registry, Pediatric Idiopathic/heritable pulmonary arterial hypertension
6. Multicenter Registry, Congenital Heart Disease related pulmonary arterial hypertension
7. Effectiveness evaluation of live attenuated vaccines for patients using immunosuppresants
8. Multicenter Registry study on Kawasaki Disease with coronary aneurysm
9. Multicenter study for risk factors associated with disease severity of human metapneumovirus (hMPV) infection
10. Identifying the pathological mechanisms of periventricular leukomalacia and pulmonary damage using model rats
11. Elucidating the molecular mechanisms of gonadal development
12. Molecular pathology of congenital adrenal diseases and disorder of sex development
13. Molecular pathology of diabetes mellitus caused by mutations of the insulin receptor
14. Identifying pathological mechanisms of neurological diseases caused by defective DNA damage response
15. Investigation of molecule marker determine the prognosis of infant leukemia
16. Development of therapeutic strategy targeting homologous recombination repair
17. Genetic background of leukemia development
18. Genetic analysis and development of therapeutic approach for epilepsy syndrome
19. Developing data base of JIA (juvenile inflammatory arthritis), CoNinJa ((Children’s version of National Database of Rheumatic Diseases by iR-net in Japan)
20. Clarifying immunological profiles of the patients with autoimmune diseases
21. Developing a methodology for the diagnosis of atypical Kawasaki Disease by exploiting a novel biomarker
22. Development of newborn screening for treatable childhood diseases including spinal muscular atrophy
23. Kinetic and functional analysis of novel T and B cell subsets in patients with autoimmune disease
24. Clarifying prognostic predictor of nephritis /nephrotic syndrome

We are collaborating with Medical Research Institute at TMDU, Tokyo University, Institute of Medical Sci- ence, Hiroshima University, University of Queensland (Prof. Peter Koopman), Erasmus University (Prof. Jacques van Dongen), Yonsei University (Profs. H. Kim, and SK Lee), Sony Life Science Laboratories, National Institute for Longevity Sciences, National Research Institute for Child Health and Development, RIKEN Center for Integrative Medical Science, Kazusa DNA Research Institute, Tokyo Metropolitan Institute for Medical Science, Juntendo University, Kyoto University, Tokyo University and many other laboratories.

●Hematology/Oncology/Immunology Group (Basic Research)
Immunology
We have explored inborn error of immunity (IEI) candidate genes using the whole-exome analysis (WES) method using next-generation sequencers and have identified several candidate mutations. Molecular characterization of these candidates has also been conducted parallelly. To date, we have performed WES for 136 cases of IEI and identified candidate genes in 36 cases (27%) (Okano). Imai et al reported novel disease concepts caused by APRIL mutation exhibiting attenuated plasmacyte differentiation. The etiology of OAS1 deficiency that exhibits pulmonary proteinosis has been revealed by the assay using iPS cells (Okano and Morio). Yamashita and Morio are analyzing the case with B cell deficiency and lymphoma using the Knock-in mouse model. Nishimura and Imai reported the summary of 42 IEI cases that underwent hematopoietic stem cell transplantation in our department. Also, we are working with domestic and overseas researchers to analyze the pathogenesis of IEI and to develop therapeutic methods. Imai is conducting a nationwide newborn screening for IEI using the TREC/KREC test. As adoptive immunotherapy to promote immunological reconstitution after transplantation, we have developed virus-specific T cell therapy for refractory viral infections and are pursuing the clinical trial (Kamiya and Morio).

Oncology
In the research for the diseases related to DNA damage response pathways, we have elucidated the usefulness of PARP inhibitors for neuroblastoma by targeting homologous recombination repair and lunched phase I physician-led clinical trials for refractory pediatric solid tumors. We have also developed a simple method to measure genomic copy number aberrations in neuroblastoma using digital PCR to classify the risk. We analyzed the cases of acute lymphocytic leukemia and submandibular adenocarcinoma caused by germline abnormalities of ETV6 and found that mutant ETV6 was located at cytoplasmic fraction and accelerated degradation of ETV6 led to a loss of function. (Takagi)

●Cardiology Group
We have three graduate school students. Yamaguchi is struggling to elucidate the mechanism of pulmonary arterial hypertension as a basic research, his current project is to examine the effect of dexmedetomidine for monocrotaline-induced pulmonary hypertension in rats. Ishii is engaged in a clinical research, he has two projects which are “Effect of Automated External Defibrillator (AED) for sudden cardiac death in young people” and “Effectiveness evaluation of live attenuated vaccines for patients using immunosuppresants”. In addition, Watanabe is a principal investigator of the project of “ Multicenter study for risk factors associated with disease severity of human metapneumovirus (hMPV) infection”.

●Neurology Group
< Basic research >
We are trying to establish the gene therapy using viral vectors for ataxia telangiectasia (AT), one of the major neurodegenerative diseases. Our another project is to establish diagnostic tools for early detection and early treatment of spinal muscular atrophy (SMA). We are also investigating the pathological mechanism of Moyamoya syndrome.
To Elucidate cytoprotective effect of astrocyte in oxygen-glucose deprivation condition, we have investigated the role of Nuclear Receptor 4A (NR4A) subfamily and another cytoprotective transcription factor associated with hypoxia-induced factor 1 alpha (HIF-1 α). Another study is to establish a rat neonatal white matter injury model. (collaborative project with Hiroshi Sakuma, Tokyo Metropolitan Institute of Medical Science).
< Clnical research >
“Genetic analysis and development of therapeutic approach for epilepsy syndrome”(collaboration with Showa University)
“Research for rare epilepsy syndrome” (collaboration with Institute of Epilepsy and Neurological Disorders) “Systematic measurement and functional analysis of autoantibody in immunologic neurological diseases” (col- laboration with Tokyo Metropolitan Institute of Medical Science)
“Evaluation of adrenocortical function in the patients with West syndrome treated with ACTH therapy”
“Development of newborn screening for treatable childhood diseases including spinal muscular atrophy”

●Endocrinology Group

Molecular mechanisms of gonadal development
To understand the pathophysiology of DSD, our current research is focusing on elucidating the molecular mechanisms of sex determination and gonadal development, especially in the aspect of the transcriptional network of sex determination and gonadal development. Another our target is to identify the precise functions of transcription factors, such as NR5A1 (SF1), FOXL2, and SOX9, in gonadal development.

Molecular analysis of pathological mechanisms in congenital adrenal hyperplasia (CAH)

One of our major tasks is supervising the CAH neonatal mass-screening in Tokyo. Currently, large number of CAH patients we treat, and clarifying the clinical details and we are focusing on clarifying the long term prognosis of the disease. In addition to adrenal insufficiency and androgen excess, metabolic syndrome during adulthood is reported to be another major concern of CAH. The precise pathophysiology is not known. We are looking at elucidating the molecular mechanisms of the metabolic syndrome in CAH patients by using mice model.

Identifying novel molecules of congenital endocrinological diseases
We aim to identify novel molecules responsible for development of congenital endocrine disorders such as insulin resistance. Current ongoing projects will be integrated systematically, and will be applicable to develop innovative approach for the treatment of congenital endocrine disorder, including regenerative medicine.

●Rheumatology group
We are establishing an evidence based guideline of pediatric rheumatoid diseases including juvenile idiopathic arthritis: JIA. Developing a novel database system, CoNinJa(Children’s version of National Database of Rheumatic Diseases by iR-net in Japan), clarifying immunological profiles of the patients with autoimmune diseases, developing a methodology for the diagnosis of atypical Kawasaki Disease by exploiting a novel biomarker, and Kinetic and functional analysis of novel T and B cell subsets in patients with autoimmune disease are other our current projects. In addition, in joint research with the department of rheumatology, we are analyzing the current status and effectiveness of treatment for childhood and adult onset of collagen disease.

●Neonatology group
We are examining changes of profile in umbilical cord-derived mesenchymal stem cells due to the intrauterine environment in humans through joint clinical research with related hospitals.
We are trying to elucidate the mechanism and effect of umbilical cord-derived mesenchymal stem cell therapy for diseases in preterm infant and the involvement of mesenchymal stem cells in the establishment of diseases. We aim to identify predictive biomarkers for preterm complications by intrauterine environment using umbilical cord-derived mesenchymal stem cells.

As a preliminary step before starting clinical trials of dental pulp stem cell administration for chronic phase of cerebral palsy, we are establishing the chronic phase of cerebral palsy in rat and examining the therapeutic effect of dental pulp stem cell administration on the chronic phase of cerebral palsy as a four-party joint research with Nagoya University Pediatrics, Tokyo Metropolitan Institute of Medical Sciences, and Gene Technoscience.

●Allergy Group
One of our main project goals is to elucidate the immunological mechanisms of food allergy such as that against milk and eggs. In addition, we carry out immunological and epidemiological studies on therapeutic effects of oral immunotherapy against food allergy.
In collaboration with the Japanese Society of Pediatric Allergy and Clinical Immunology, we are conducting sev- eral clinical studies to refine pharmacologic therapy listed in the Japanese pediatric guideline for the treatment and management of asthma.

●Nephrology Group
We aim to clarifying predictor of nephritic and/or idiopathic nephrotic syndrome for improving the therapeutic protocols of them through joint clinical research with related hospitals.
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Education

Block Lecture
The systematic lecture was performed for M4 students. One third of lectures “were performed using an active
-learning” style. The number of frames of the active-learning from nine frames in the previous fiscal year to 12 frames. Two frames of team -based learning (TBL) were also provided. Although one frame of active-learning alone cannot cover the whole area of pediatrics, about 85% of students reach the passing point in the final test covering the whole area of pediatrics by student self-study. At this point, we believe that the usefulness of active learning has been demonstrated.
Project semester
This provides the opportunities of basic research for the 4th grade students for half a year. This year, one student was committed to the research of our department and presented at a scientific meeting.
Pre-clinical clerkship (PCC).
We proposed 6 programs providing the opportunities to learn the logical skills of clinical practice.
After the curriculum, The students undertake the examination of clinical practice, i.e., OSCE , CBT.
Clinical clerkship (CC)
Clinical clerkship (CC) for 5th-year medical students in pediatrics was shortened from 1 month (4 weeks) to 2 weeks due to the pandemic of COVID-19. Each student spent two weeks in one of the two groups (hematology, immunology, cardiology, neurology, endocrinology, nephrology, Rheumatology, neonatology).
Lectures were given to all students on Mondays and Fridays (diagnostics, congenital heart disease, neonates, infusion, EEG, endocrinology, leukemia, immunodeficiency infections, and the role of the Child Life Specialist in pediatrics), and student conferences were held every Friday for further understanding of the clinical practice program.
During the period when ward practice was interrupted due to COVID-19, miniCEX based problem-solving lectures were performed to each assigned medical group every day using web conferencing tools to promote their self-study, and two to three lectures were given to all students per week.

The number of 6th-year medical students accepted for clinical training in pediatrics was increased by one student to two this year, and they will continue to practice for two weeks in a medical group of their choice as an advanced program.

In terms of post-graduate education, at least one month of basic clinical education was provided to the first and second year of clinical residents at on-campus or off-campus facilities (Soka Municipal Hospital, Tokyo North Medical Center, Tsuchiura Kyodo General Hospital). On the other hand, for early clinical residents who chose pediatrics for at least two months, specialized clinical education was mainly provided on TMDU campus. For the second semester clinical residents at the university, we provided a wide range of more specialized clinical education to prepare them to become pediatric specialists.
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Lectures & Courses

Primary care of pediatrics covers a wide spectrum of health care and clinical problems in children, and all pediatricians should be well trained in those subjects. Further, Tokyo Medical and Dental University is one of the top raked national medical universities in Japan, and achieving cutting edge research is another social

responsibility. For students, we provide educational programs to learn primary pediatric care, management of the diseases in every organ during neonatal period childhood, and basic science. For residents, our educational program is mainly focused on producing physician scientists who possess the skills of pediatrics for primary care, of physician specialist and of basic researcher.
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Clinical Services & Other Works

●Hematology/Oncology/Immunology Group
Treating children with primary immunodeficiency, hematological malignancies, hematological disorders, and malignant solid tumors.
Collaboration with other professional facilities including St. Luke’s International Hospital and Juntendo University Hospital. Joint clinical conference and trainee exchange program are regularly held in the collaborating system.
Medical care
By collaborating with national co-operative clinical research group, such as the Tokyo Children’s Cancer Study Group (TCCSG) and Japanese Children’s Cancer Study Group (JCCG), we offer our patients opportunities to participate in the latest clinical trials, contributing to establishment of both standard and novel therapies for childhood cancers and other non-malignant diseases.
In FY2020, we performed HCT for 13 (12 allo-HCT and 1 auto-HCT) , and 9 cases were for PID patients. For IEI (9 cases), 1 Related bone marrow cell transplantation, 1related peripheral blood stem cell transplantation, 2 unrelated bone marrow transplantations, 1 cord blood transplantation, and 5 HLA haplo-matched transplantations were performed.
For malignancies (4 cases), 3 HLA haplo-matched transplantations were performed. Autologous peripheral blood stem cell transplantation was performed for advanced malignancy (1 case).
Our experience of HCT exceeds 230 cases including more than 100 cases with primary immunodeficiency diseases, so far.
Clinical trial
Three doctor-initiated clinical trials led by the pediatric department of Tokyo Medical and Dental University are ongoing.
”Phase I Clinical Study of Oral Olaparib in Pediatric Patients with Refractory Solid Tumors ”.
” Multi-virus (Cytomegalovirus, EB virus, Adenovirus, BK virus, and HHV-6) specific Cytotoxic T-Lymphocytes from HLA-haploidentical or more HLA-matched relative donor to persistent viral infection after hematopoietic cell transplantation (multi-center, prospective phase I/II study) ”
” Clinical Phase II Study of hematopoietic stem cell transplantation for ataxia telangiectasia and related dis- eases ” is carried out.

●Cardiology Group
We provide medical care in a wide range of pediatric cardiovascular diseases. Especially, our department is one of the major center hospitals providing medical care of pediatric pulmonary hypertension.
In 2019, the number of inpatients was 97, which consisted of 56 congenital heart disease, 17 pulmonary hypertension, 10 Kawasaki Disease, 8arrhythmia, 2 cardiomyopathy and 4others. Cardiac catheterizations were performed in 48 patients and cardiac surgery was performed in 18 patients (16 open-heart surgery), which consisted of 8 VSDs, 5 ASDs, 1 TOF+PA+MAPCA reRastelli, 1 DORV, 1 PDA. The number of outpatients was 1,793, echocardiogram was performed in 612, Treadmill exercise-induced electrocardiogram was performed in 63, and Holter 24hr electrocardiogram was performed in 58 patients.

●Neurology Group
We provide medical care in a wide range of pediatric nerologic diseases.
In particular, collaborating with the department of neurosurgery, we run an epilepsy center, providing advanced medical care for pediatric patients with intractable epilepsy.
The medical services in our department are long-term video EEG monitoring, high magnetic field MRI/PET, ACTH therapy, ketogenic diet, vagus nerve stimulation and surgical operation, such as focal brain resection and callosotomy. We also provide nucleic acid drug and gene therapy for patients with spinal muscular atrophy. We focus on diagnosis, genetic analysis and treatment for rare neurologic diseases.

●Endocrinology Group
We provide comprehensive diagnostic and treatment services for children with endocrinological abnormality and diabetes, such as disorders of growth, pubertal development, Ca/P metabolism (including skeletal dysplasia), gonadal development and adrenal cortex function. Especially, we are focusing on providing advanced medical service for congenital adrenal hyperplasia (CAH) and disorders of sex development (DSD). Our institute is one of the DSD central facilities approved by the Japanese Society for Pediatric Endocrinology (JSPE). For social contribution, we supervise the neonatal screening system for CAH in Tokyo metropolitan city and peer support group of type 1 diabetes, “Tokyo Wakamatsu-kai”.

●Nephrology Group
Nephrology Group provides diagnosis and treatment for patients with various kidney diseases. We perform kidney biopsy (30/year) and imaging examination.
We performed peritoneal dialysis for low-body-weight children and provided acute hemodialysis for children who developed acute kidney injury and for children with collagen diseases.

●Rheumatology group
Medical treatment and treatment of children with collagen disease and rheumatic diseases in general, but not limited to these cases, undiagnosed cases such as unknown fever and joint pain, and autoinflammatory syndrome represented by periodic fever. Is going. In addition, the current status of pediatric rheumatic diseasesThe emphasis is on the issues and challenges of transitional care in adulthood for pediatric rheumatic diseases, depending on the situation and the actual situation.
The medical treatment started in July 2015, and the number of outpatients in 2019 exceeded 1600 mainly for referrals. The total number of hospitalized patients in one year is 157, all of which are increasing year by year.

●Neonatology group
Collaborating with other medical departments or special care groups in pediatrics, we are treating preterm in- fants (≧ 27 weeks gestation, birth weight ≧ 800 g), neonates with complications and babys born from mothers with complication.

●Allergy Group
The qualified allergists of the group attend both inpatient and outpatient care units for allergic diseases in the allergy medical center of our university and extramural, affiliated hospitals, where not only the standard medical services following clinical guidelines for allergic diseases are provided, but also highly advanced treatment such as oral immunotherapy for food allergy as well.
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Clinical Performances

●Hematology-Oncology/ Immunology Group
Hematology-Oncology/ Immunology Group provides diagnosis, treatment and pathological analysis of hemato- logical malignancies and primary immunodeficiency diseases. We perform hematopoietic stem cell transplan- tation for refractory diseases. Specifically, we treat the largest number of primary immunodeficiency disease patients in Japan. We participate in multi-center cooperative clinical research to establish both standard and novel therapies for childhood cancers, and also participate in the approval of industry-based clinical trials for drugs (such as anticancer drugs).

●Cardiology Group
Cardiology group performs diagnosis, evaluation of treatment and decision of treatment strategy for pediatric pulmonary hypertension patients. We actively treat severe idiopathic/hereditary pulmonary arterial hypertension (IPAH/HPAH) patients by upfront combination therapy (uCT) with two or three kinds of disease targeted drugs including continuous venous infusion of epoprostenol. We made considerable achievements of treatment in severe IPAH/HPAH patients with epoprostenol/treprostinil.

●Neurology Group
Neurology group provide highly specialized diagnostic approach and medical care for neurological disorders such as incractable epilepsy, cerebellar ataxia, immune-mediated neurological disease, spinal muscular atrophy, involuntary movement, perinatal brain damage, infection of nervous system, acute encephalopathy/encephalitis, neurodegenerative disease.

●Endocrinology Group
The leader of our endocrinology group is a supervisor of congenital adrenal hyperplasia (CAH) newborn screen- ing in Tokyo. We treat substantial number of CAH (21-OHD) patients and performed couples of clinical studies. We also focus on disorder of sex development (DSD) and long-term follow-up for childhood cancer survivors (CSS). We are organizing a Type 1 DM patients’ association (Wakamatsu-kai) and have the summer camp for diabetic children every year.

●Nephrology Group
We treat various pediatric kidney diseases, such as congenital nephrotic syndrome, refractory nephrotic syn- drome, IgA nephropathy, etc. Kidney biopsy is performed to more than 40 patients. We provide acute hemodial- ysis treatment and peritoneal dialysis for low-body-weight patients (under 10kg) in cooperation with department of blood purification.

●Rheumatology group
Clinically, our target is not only pediatric collagen and rheumatic disease, but also inflammatory diseases which require biopharmaceutical medicine, such as periodic fever unknown origin, and repeated arthritis affecting mul- tiple joints. We are also actively involved in the expansion and standardization of treatment indications through participation in clinical trials and formulation of guidelines. Further, for developing a therapeutic approach, we are planning to register international clinical trials of a novel biopharmaceutical medicine, such as belimumab for pediatric SLE.

●Neonatology Group
Our NICU provides intensive care for preterm infants and critically ill newborns. As a designated perinatal medical center in Tokyo, we accept maternal and neonatal transfer from various areas in Tokyo and contribute to perinatal medicine in Tokyo.

●Allergy Group
We focus on clinical care of severe and complicated allergic diseases such as food allergy-induced anaphylaxis, food-dependent exercise-induced anaphylaxis, food protein-induced enterocolitis syndrome and oral allergy syn- drome induced by cross-reactivity between food, inhalant and contact allergens. We extensively perform food challenge tests not only for correct diagnosis of food allergy but for preparation of oral immunotherapy in cooperation with the affiliated hospitals. We introduce new biological medicines to the long-term management for sever persistent asthma patients.
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