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An 87-year-old man had been treated under a diagnosis of idiopathic dilated cardiomyopathy and sick sinus syndrome since 1996. His heart failure was worsened by atrial fibrillation in August 2004. He received amiodarone from October 2004. He was admitted to our hospital with shortness of breath in February 2005. Chest radiography revealed a diffuse reticular shadow in the right lung field and pleural effusion. The diagnosis was interstitial pneumonitis induced by amiodarone. However, 10 days after the discontinuation of amiodarone, the serum sodium concentration fell to 114mEq/l. The blood and urine chemical data were consistent with syndrome of inappropriate antidiuretic hormone secretion (SIADH). The serum sodium concentration improved with fluid restriction. Clinicians should be aware that SIADH may occur during amiodarone therapy.

New immunosuppressive agents have significantly improved early survival after organ transplantation for patients with end-stage organ failure. However, a major problem in transplantation is continued to be graft rejection. Chronic allograft rejection threatens the long-term survival of organ transplant recipients. Therefore, induction of donor specific tolerance is very important for improving long-term survival after transplantation. The costimulatory pathways are crucial in regulating T cell activation and donor specific tolerance. The costimulatory pathways are potential therapeutic targets for inducing donor specific tolerance and improving long-term survival after transplantation.

A 54-year-old woman had been treated under a diagnosis of cardiac sarcoidosis since 1998. She was admitted to our department because of recurrent heart failure in April 2002. A DDD pacemaker was implanted because of complete AV block in 2000, but she had always suffered from > or = New York Heart Association (NYHA) class III heart failure. To prevent recurrent heart failure, biventricular pacing was performed. The left ventricular epicardial pacing lead was newly inserted into the great cardiac vein via the left subclavian vein, and connected with the previously implanted generator. The QRS duration decreased from 200 to 140 msec. Serum brian natriuretic peptide level decreased from 321 to 226 pg/ml. Cardiac index increased from 1.93 to 2.20. Her functional class improved from NYHA class III to class II.

Recent progress in DNA technology, such as antisense oligodeoxynucleotides (ODNs) to regulate the transcription of disease-related genes, has important roles in therapeutic applications. Recently, transfection of cis-element double-stranded DNA, named as 'decoy', has been reported to be a useful method for gene therapy. This 'decoy' strategy has been not only a useful method for the experimental studies of endogenous gene regulation but also a novel clinical strategy for gene therapy. In this article, we reviewed (1) experimental results from the several disease models, (2) the ongoing clinical trials including coronary angioplasty, arthritis, and dermatitis in Japan.