Olfactory function is affected by demographic, cognitive, and genetic factors. In the present thesis, three empirical studies investigated individual differences in olfactory ability. Study I explored demographic and cognitive correlates in common olfactory tasks; odor detection, odor discrimination, and odor identification. The results indicated that old age influenced performance negatively in all tasks, and that semantic memory proficiency and executive functioning were related to odor discrimination and odor identification performance. No cognitive influence was observed for measurements of olfactory threshold. Using population-based data, Study II investigated a potential influence of the ApoE gene on olfactory identification after controlling for health status, semantic memory, and preclinical and clinical dementia. The main finding was that the ApoE- ɛ4 allele interacted with age, such that older ɛ4-carriers had an impaired odor identification performance relative to older non-carriers. Importantly, the negative ApoE- ɛ4 effect on olfactory proficiency was independent of clinical dementia conversion within five years. Study III investigated the effects of the BDNF val66met polymorphism on olfactory change over a five-year interval, in a community dwelling sample of young and old age cohorts. The results showed that age-related decline in olfactory identification was influenced by the BDNF val66met. In middle-aged subjects, no effect of BDNF val66met was observed although older val homozygote carriers showed a selectively larger olfactory decline than the older met carriers. Overall, results suggest that the relative influence of demographic and cognitive factors vary across different olfactory tasks and that two genes (ApoE and BDNF) impact age-related deficits in odor identification. Potential theoretical and practical implications of the findings are discussed as well as potential limitations of association studies in genomics research.

Thesis (Ph. D.)--University of Texas Health Science Center at Houston, School of Public Health, 2007. / Source: Dissertation Abstracts International, Volume: 68-10, Section: B, page: 6419. Advisers: Christopher I. Amos; Ralph F. Frankowski. Includes bibliographical references.

One of the objectives of the U.S. Food and Drug Administration is to protect the public health through post-marketing drug safety surveillance, also known as Pharmacovigilance. An inexpensive and efficient method to inspect post-marketing drug safety is to use data mining algorithms on electronic health records to discover associations between drugs and adverse events. The purpose of this study is two-fold. First, we review the methods and algorithms proposed in the literature for identifying association drug interactions to an adverse event and discuss their advantages and drawbacks. Second, we attempt to adapt some novel methods that have been used in comparable problems such as the genome-wide association studies and the market-basket problems. Most of the common methods in the drug-adverse event problem have univariate structure and thus are vulnerable to give false positive when certain drugs are usually co-prescribed. Therefore, we will study applicability of multivariate methods in the literature such as Logistic Regression and Regression-adjusted Gamma-Poisson Shrinkage Model for the association studies. We also adopted Random Forest and Monte Carlo Logic Regression from the genome-wide association study to our problem because of their ability to detect inherent interactions. We have built a computer program for the Regression-adjusted Gamma Poisson Shrinkage model, which was proposed by DuMouchel in 2013 but has not been made available in any public software package. A comparison study between popular methods and the proposed new methods is presented in this study.

O transtorno de déficit de atenção e hiperatividade (TDAH) é um dos transtornos psiquiátricos mais freqüentes da infância e adolescência, sendo caracterizado por sintomas de desatenção, hiperatividade e impulsividade. A contribuição genética na etiologia do TDAH é uma das mais altas já verificadas para transtornos psiquiátricos, com herdabilidade média estimada de 76%. Dentre os fatores genéticos que contribuiriam para o desenvolvimento da doença, genes que codificam componentes do sistema dopaminérgico estão entre os principais candidatos. Entre estes, o gene que codifica o receptor D4 de dopamina (DRD4) é o loco mais intensamente investigado nos estudos moleculares com o TDAH. O polimorfismo mais estudado no DRD4 é um VNTR de 48 pb localizado no exon 3; porém outros polimorfismos, localizados na região promotora do gene – uma duplicação de 120pb e os SNPs -521C>T e - 616C>G – também vêm sendo propostos como polimorfismos de suscetibilidade ao TDAH. Além desses, novas variantes em regiões regulatórias do gene, os SNPs rs11246227 e rs11246228, foram observados recentemente em associação com sintomas de desatenção do TDAH. O objetivo geral do presente trabalho foi aumentar a compreensão acerca da participação do gene DRD4 na etiologia do TDAH na nossa população Para tanto, foi testada inicialmente a possibilidade de associação do SNP rs11246227, sendo em seguida investigado o significado funcional dos SNPs rs11246227 e rs11246228, e sua possível relação com a doença, através de ferramentas de bioinformática. O estudo de associação foi realizado em uma amostra composta por 478 pacientes com TDAH, diagnosticados segundo os critérios do DSM-IV, e seus pais biológicos. O rs112466227 foi investigado por abordagens baseada em família (FBAT) e dimensional (PBAT, ANOVA). A possibilidade de desequilíbrio de ligação (DL) com polimorfismos previamente investigados na presente amostra foi estimada pelo programa MLocus. A análise in silico foi realizada utilizando diferentes bases de dados genômicos e programas de predição de sítios alvo para miRNAs e de funcionalidade. A análise pelo FBAT mostrou um desvio significativo da transmissão do alelo C nos pacientes do subtipo desatento. Foram observadas evidências de DL com a duplicação de 120bp e com o VNTR do exon 3. As análises de bioinformática mostraram que os SNPs rs11246227 e rs11246228 estão localizadas na região 3’ do gene DRD4, e não na região 5’, como previamente descrito. Diferenças entre os alelos, com perda ou ganho de sítios de ligação para diferentes miRNAs, foram detectados em ambos os SNPs pelos programas MicroInspector, 5 smiRNAdb e miRecords, e apenas no rs11246227 pelos programas Human miRNA Target e Mirò. A grande variabilidade e a complexidade genética marcante do gene DRD4 aliada à heterogeneidade fenotípica do TDAH provavelmente contribuíram para nossos resultados de associação, divergentes dos descritos na literatura, os quais necessitam de replicação em estudos futuros. Nossos achados em bioinformática sugerem um possível envolvimento dos SNPs investigados com a ligação de miRNAs relacionados aos processos de neurogênese e neuroplasticidade. Genes envolvidos com estes processos vêm sendo identificados nos genome-wide association studies realizados com o TDAH, o que apóia nossos resultados in silico. Entretanto, mais estudos funcionais são necessários, tanto in silico como in vitro, para esclarecer o envolvimento dos polimorfismos analisados na regulação da expressão do gene DRD4 via miRNAs e, consequentemente, do possível efeito desses elementos na etiologia da doença. / Attention-deficit/hyperactivity disorder (ADHD) is one of the most common psychiatric disorders of childhood and adolescence, characterized by inattentive, hyperactive and impulsive symptoms. Genetic contribution to ADHD etiology is one of the highest ever recorded for psychiatric disorders, with a mean heritability of 76%. Among genetic factors that could contribute to disorder development, genes encoding components from dopaminergic system are the main candidate. Of these, the dopamine D4 receptor gene (DRD4) is the most extensively investigated locus in molecular studies of ADHD. The most studied polymorphism in DRD4 gene is a variable number of tandem repeats (VNTR) of 48bp, located at exon 3, although other polymorphisms, located in promoter region – a 120bp duplication and the SNPs -521C> T and-616C> G – have also been proposed as susceptibility polymorphisms for ADHD. In addition, new variants in regulatory regions, the SNPs rs11246227 and rs11246228, have recently been associated with inattentive symptoms of the disorder. The overall objective of this study was to increase the understanding on the involvement of DRD4 gene in ADHD etiology in our population For this purpose, the possibility of association with the SNP rs11246227 was initially tested, being afterwards investigated the functional effect of both rs11246227 and rs11246228 and their possible relation to ADHD through bioinformatics approach. The association study was performed in a sample composed by 478 ADHD patients, diagnosed according to DSM-IV criteria, and their biological parents. The rs112466227 was investigated by both family-based (FBAT) and dimensional (PBAT, ANOVA) approaches. The possibility of linkage disequilibrium (LD) with polymorphisms previously investigated in the present sample was estimated by MLocus software. In silico analysis was conducted using different genomic databases and programs to predict miRNA target sites and functionality. FBAT analysis showed a significant excess of C allele transmission in inattentive subtype patients. Evidences of LD with both 120bp tandem duplication and exon 3 VNTR were observed. Bioinformatics analyses showed that both SNPs rs11246227 and rs11246228 are located in the 3' region of DRD4 gene, and not at 5’ region, as previously described. Differences between alleles, with loss or gain of binding sites, were detected in both SNPs by MicroInspector, smiRNAdb and miRecords, and only in rs11246227 by Human miRNA Targets and miRò DRD4 huge variability and marked genetic complexity allied to ADHD phenotypic heterogeneity might have contributed to our 7 association results, distinct from the ones reported in literature, what needs to be replicated in future studies. Our bioinformatics findings suggest a possible involvement of investigated SNPs in binding properties of miRNAs related to processes of neurogenesis and neuronal plasticity. Genes involved in these processes have been identified in ADHD genome-wide association studies, reinforcing our in silico results. However, new functional studies, using both in silico and in vitro approaches, are needed to clarify the involvement of the investigated polymorphisms in DRD4 expression control mediated by miRNAs and, consequently, the possible effect of these elements in ADHD etiology.

Despite the success of vaccines in routine use worldwide, there are substantial challenges hampering our ability to develop vaccines against extant diseases including malaria and tuberculosis. Novel approaches are urgently required to help us understand immunological correlates of protection against disease and facilitate our understanding of the impact of human genetic variation on the success of diverse vaccines. To identify host genetic factors responsible for variation in antibody responses against vaccine antigens delivered routinely to infants worldwide I performed a genome-wide association study (GWAS) involving 2,499 infants recruited from three diverse sites across Africa. I identified strong genetic associations between variants in the class II major histocompatibility complex (MHC) locus and responses against five antigens: pertussis toxin (PT), filamentous haemagglutinin (FHA) and pertactin; diphtheria toxin (DT); and hepatitis B surface antigen. To characterise these associations at the gene and allelic level I developed a large, high-resolution (6-digit 'G') population-specific human leukocyte antigen (HLA) imputation reference panel including 697 individuals from the vaccine GWAS typed at 11 genes, highlighting the diversity of HLA across the African continent. Using this panel I imputed HLA into the remaining GWAS dataset to fine-map the associations to specific HLA alleles, amino acid and single nucleotide polymorphism sites; some of which were found to be African specific. I then used these HLA association findings observed with PT response to correlate, through genetics, this trait with susceptibility to whooping cough in an independently recruited and analysed set of cohorts from the UK. I further used these genetic correlations to demonstrate the relevance of levels of PT-specific circulating follicular helper T-cells and TRBV29-1 T-cell receptor gene expression levels in the development of this protective immune response against PT. By using HLA-peptide binding studies I also demonstrate the diversity of mechanisms that are involved in HLA-disease association, showing that the breadth and affinity of DT-peptide binding are increased with HLA-DRB1 alleles associated with increased DT antibody responses. Taken together, these data represent the first comprehensive genetic association study of multiple vaccine responses undertaken in African infants. These results highlight the importance of human genetics in modulating protective responses against vaccine antigens and demonstrate how such associations can be harnessed to understand biological mechanisms of protective efficacy in greater detail that may in turn facilitate future vaccine development.

Comme pour toute pathologie, la survenue d’un cancer du sein est conditionnée par l’association de facteurs génétiques héréditaires et de facteurs environnementaux acquis. Les facteurs génétiques connus comprennent à la fois des mutations pathogènes rares induisant un risque élevé de développer un cancer du sein et des variants génétiques fréquents (single nucleotides polymorphisms - SNP) responsables d’une faible augmentation du risque. L’ensemble des résultats de ce manuscrit plaide en faveur d’un impact majeur des facteurs génétiques constitutionnels à la fois en ce qui concerne le risque de développer un cancer du sein mais aussi en tant que déterminants du type de cancer du sein, voire du pronostic. La survenue d’un cancer du sein exprimant les récepteurs aux estrogènes et HER2-négatif est associée à 4 SNP introniques du gène FGFR2. Le pronostic des cancers du sein n’est pas associé aux variants impliquant un risque de développer un cancer. Quatre SNP indépendants sont associés à une évolution péjorative des cancers du sein triple-négatifs.La séquence d’événements qui mène du génome du patient à celui de la tumeur reste complexe, mal connue et probablement spécifique à chaque cancer comme l’illustrent les deux cas liés à des mutations germinales BRCA1/2 étudiés en deuxième partie de manuscrit. Le dernier travail permet de faire un lien vers la pratique clinique et rapporte une prévalence des mutations germinales BRCA1/2 d’environ 3% dans une cohorte prospective de patientes présentant un cancer du sein métastatique, non sélectionnées en fonction de leur âge, type de cancer ou antécédents familiaux. / As in any disease, the development of breast cancer depends on genetic hereditary factors and environmental acquired factors. Genetic factors of breast cancer involve rare pathogenic mutations with high risk of developing a breast cancer and frequent genetic variants (single nucleotides polymorphisms - SNP) responsible for a low increase in the risk of cancer. The works presented in this manuscript show that germline genetic factors strongly determine the risk of developing a breast cancer, but also the subtype of breast cancer and may impact the prognosis. Estrogen-positive, HER2-negative breast cancer development is associated with 4 intronic SNP in FGFR2 gene. Breast cancer prognosis is not associated with variants conferring a risk of developing a breast cancer. Four independent SNP are associated with bad outcomes in triple-negative breast cancers.The way that leads from patient genome to tumor genome is complex, mainly unknown and probably different for each case, as illustrated in the two case reports involving BRCA1/2 germline mutations described in the second part of the manuscript. Last work is a clinical research trial and shows a prevalence of BRCA1/2 mutations of around 3%, in a prospective cohort with metastatic breast cancer patients unselected on their age, cancer type or family history.

O transtorno de déficit de atenção e hiperatividade (TDAH) é um dos transtornos psiquiátricos mais freqüentes da infância e adolescência, sendo caracterizado por sintomas de desatenção, hiperatividade e impulsividade. A contribuição genética na etiologia do TDAH é uma das mais altas já verificadas para transtornos psiquiátricos, com herdabilidade média estimada de 76%. Dentre os fatores genéticos que contribuiriam para o desenvolvimento da doença, genes que codificam componentes do sistema dopaminérgico estão entre os principais candidatos. Entre estes, o gene que codifica o receptor D4 de dopamina (DRD4) é o loco mais intensamente investigado nos estudos moleculares com o TDAH. O polimorfismo mais estudado no DRD4 é um VNTR de 48 pb localizado no exon 3; porém outros polimorfismos, localizados na região promotora do gene – uma duplicação de 120pb e os SNPs -521C>T e - 616C>G – também vêm sendo propostos como polimorfismos de suscetibilidade ao TDAH. Além desses, novas variantes em regiões regulatórias do gene, os SNPs rs11246227 e rs11246228, foram observados recentemente em associação com sintomas de desatenção do TDAH. O objetivo geral do presente trabalho foi aumentar a compreensão acerca da participação do gene DRD4 na etiologia do TDAH na nossa população Para tanto, foi testada inicialmente a possibilidade de associação do SNP rs11246227, sendo em seguida investigado o significado funcional dos SNPs rs11246227 e rs11246228, e sua possível relação com a doença, através de ferramentas de bioinformática. O estudo de associação foi realizado em uma amostra composta por 478 pacientes com TDAH, diagnosticados segundo os critérios do DSM-IV, e seus pais biológicos. O rs112466227 foi investigado por abordagens baseada em família (FBAT) e dimensional (PBAT, ANOVA). A possibilidade de desequilíbrio de ligação (DL) com polimorfismos previamente investigados na presente amostra foi estimada pelo programa MLocus. A análise in silico foi realizada utilizando diferentes bases de dados genômicos e programas de predição de sítios alvo para miRNAs e de funcionalidade. A análise pelo FBAT mostrou um desvio significativo da transmissão do alelo C nos pacientes do subtipo desatento. Foram observadas evidências de DL com a duplicação de 120bp e com o VNTR do exon 3. As análises de bioinformática mostraram que os SNPs rs11246227 e rs11246228 estão localizadas na região 3’ do gene DRD4, e não na região 5’, como previamente descrito. Diferenças entre os alelos, com perda ou ganho de sítios de ligação para diferentes miRNAs, foram detectados em ambos os SNPs pelos programas MicroInspector, 5 smiRNAdb e miRecords, e apenas no rs11246227 pelos programas Human miRNA Target e Mirò. A grande variabilidade e a complexidade genética marcante do gene DRD4 aliada à heterogeneidade fenotípica do TDAH provavelmente contribuíram para nossos resultados de associação, divergentes dos descritos na literatura, os quais necessitam de replicação em estudos futuros. Nossos achados em bioinformática sugerem um possível envolvimento dos SNPs investigados com a ligação de miRNAs relacionados aos processos de neurogênese e neuroplasticidade. Genes envolvidos com estes processos vêm sendo identificados nos genome-wide association studies realizados com o TDAH, o que apóia nossos resultados in silico. Entretanto, mais estudos funcionais são necessários, tanto in silico como in vitro, para esclarecer o envolvimento dos polimorfismos analisados na regulação da expressão do gene DRD4 via miRNAs e, consequentemente, do possível efeito desses elementos na etiologia da doença. / Attention-deficit/hyperactivity disorder (ADHD) is one of the most common psychiatric disorders of childhood and adolescence, characterized by inattentive, hyperactive and impulsive symptoms. Genetic contribution to ADHD etiology is one of the highest ever recorded for psychiatric disorders, with a mean heritability of 76%. Among genetic factors that could contribute to disorder development, genes encoding components from dopaminergic system are the main candidate. Of these, the dopamine D4 receptor gene (DRD4) is the most extensively investigated locus in molecular studies of ADHD. The most studied polymorphism in DRD4 gene is a variable number of tandem repeats (VNTR) of 48bp, located at exon 3, although other polymorphisms, located in promoter region – a 120bp duplication and the SNPs -521C> T and-616C> G – have also been proposed as susceptibility polymorphisms for ADHD. In addition, new variants in regulatory regions, the SNPs rs11246227 and rs11246228, have recently been associated with inattentive symptoms of the disorder. The overall objective of this study was to increase the understanding on the involvement of DRD4 gene in ADHD etiology in our population For this purpose, the possibility of association with the SNP rs11246227 was initially tested, being afterwards investigated the functional effect of both rs11246227 and rs11246228 and their possible relation to ADHD through bioinformatics approach. The association study was performed in a sample composed by 478 ADHD patients, diagnosed according to DSM-IV criteria, and their biological parents. The rs112466227 was investigated by both family-based (FBAT) and dimensional (PBAT, ANOVA) approaches. The possibility of linkage disequilibrium (LD) with polymorphisms previously investigated in the present sample was estimated by MLocus software. In silico analysis was conducted using different genomic databases and programs to predict miRNA target sites and functionality. FBAT analysis showed a significant excess of C allele transmission in inattentive subtype patients. Evidences of LD with both 120bp tandem duplication and exon 3 VNTR were observed. Bioinformatics analyses showed that both SNPs rs11246227 and rs11246228 are located in the 3' region of DRD4 gene, and not at 5’ region, as previously described. Differences between alleles, with loss or gain of binding sites, were detected in both SNPs by MicroInspector, smiRNAdb and miRecords, and only in rs11246227 by Human miRNA Targets and miRò DRD4 huge variability and marked genetic complexity allied to ADHD phenotypic heterogeneity might have contributed to our 7 association results, distinct from the ones reported in literature, what needs to be replicated in future studies. Our bioinformatics findings suggest a possible involvement of investigated SNPs in binding properties of miRNAs related to processes of neurogenesis and neuronal plasticity. Genes involved in these processes have been identified in ADHD genome-wide association studies, reinforcing our in silico results. However, new functional studies, using both in silico and in vitro approaches, are needed to clarify the involvement of the investigated polymorphisms in DRD4 expression control mediated by miRNAs and, consequently, the possible effect of these elements in ADHD etiology.

Les variétés modernes de canne à sucre sont d'origine bispécifique et possèdent une structure génétique complexe, aneuploïde et hautement polyploïde rendant difficile les études de résistance génétique. La feuille jaune de la canne a sucre est une maladie dont l'agent causal est le sugarcane yellow leaf virus (scylv). Ce virus a une large diversité. Seuls trois génotypes viraux, différenciables par rtpcr, ont été trouves en Guadeloupe. Les objectifs de l'étude sont d'évaluer: l/la possibilité de marquer la résistance de la plante au scylv grâce a une étude d'association pan-génomique 2/l'impact de la diversité de l'agent pathogène sur la résistance de la canne a sucre au scylv. Les études d'association ont été menées avec plus de 4000 marqueurs aflp et d'art sur quatre types de données phénotypiques (intensité et densité virale dans les feuilles et les tiges). Les phénotypes ont été mesures sur 189 variétés de cannes à sucre dans deux essais successifs dans un dispositif en trois blocs randomises. De ces variétés, 40 ont été sélectionnées et ont permis d'obtenir 10 croisements biparentaux. Les descendances obtenues ont été suivies sur deux essais. L'incidence et la diversité du scylv ont été évaluées pour les 40 variétés et les descendances. L'héritabilité au sens strict de la résistance aux scylv a été déterminée. Six marqueurs de résistance au scylv ont été identifies ainsi que deux gènes ayant potentiellement un rôle dans la résistance au virus. L'étude montre également que la résistance de la plante est variable en fonction du génotype du scylv et que cette résistance est en partie transmise aux descendances. Créer des variétés résistantes au scylv est donc possible. / Modern varieties of sugarcane have a bispecific origin and a complex genetic structure, aneuploid and highly polyploid, maklng genetic resistance study uneasy to perform. Yellow leaf of sugarcane is a viral disease whose causal agent is the sugarcane yellow leaf virus (scylv). This virus has a wide range of diversity. Only three viral genotypes, distinguishable by rt-pcr, were found in guadeloupe. The objectives of this srudy are to assess: l/the possibility to find markers associated with plant resistance to scylv through a genome wide association study 2 1 the impact of the pathogen diversity on the resistance of sugarcane to scylv. Association studies have been conducted with more than 4000 aflp and dart markers on four types of phenotypic data (virus intensity and density in leaves and canes). Phenotypes were measured on 189 varieties of sugarcane in two successive trials in a three randomized complete block design. From these varieties, 40 were selected and allowed to obtain 10 biparental crosses. The offspring were followed during two trials. The incidence and the diversity of scylv were evaluated in the 40 varieties and the offspring. The narrow sense heritability of the resistance to the scylvs was determined. Six markers of the resistance to the scylv and two genes, with potential contribution in virus resistance, have been identified. The study also shows that the resistance of the plant is variable depending on the scylv genotype and that this resistance is partly transmitted to the offspring. Breeding for scylv resistance is practicable.

Genetic heterogeneity, lifestyle factors, gene-gene or gene-environment interactions are the determinants of T2D which puts Hispanics and populations with African ancestry at higher risk of developing T2D. In this dissertation, the genetic associations of PPARGC1A polymorphisms with T2D and its related phenotypes (metabolic markers) in Haitian Americans (cases=110, controls=116), African Americans (cases=120, controls=124) and Cuban Americans (cases=160, controls=181) of South Florida were explored. Five single nucleotide polymorphisms of gene PPARGC1A were evaluated in each ethnicity for their disease association. In Haitian Americans, rs7656250 (OR= 0.22, pp=0.03) had significant protective association with T2D but had risk association in African Americans for rs7656250 (OR=1.02, p=0.96) and rs4235308 (OR=2.53, p=0.03). We found that in Haitian American females, both rs7656250 (OR=0.23, pp=0.03) had protective association with T2D. In African American females, rs7656250 (OR=1.14, p=0.78) had risk association whereas in males, it had significant protective effect (OR=0.37, p=0.04). However, the risk association exhibited by rs4235308 was stronger in African American females (OR=2.69, p=0.03) than males (OR=1.16, p=0.72). In Cuban Americans, only rs7656250 showed significant risk association with T2D (OR=6.87, p=0.02) which was stronger in females alone (OR=7.67, p=0.01). We also observed significant differences among correlations of PPARGC1A SNPs and T2D phenotypes. Positive correlation was observed for log Hs-CRP with rs3774907 (pp=0.03) in Cuban Americans respectively. Correlation of log A1C with rs7656250 (p=0.02) was positive in Cuban Americans while it was negative for rs3774907 in Haitian Americans (ppPPARGC1A correlations with T2D and its phenotypes among the three ethnicities studied (ii) the associations of PPARGC1A SNPs showed significant effect modification by sex. The findings suggest that variations in effects of PPARGC1A gene polymorphisms among three ethnicities and between sexes may have biomedical implications for the development of T2D as well as the phenotypes related to T2D.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第22344号 / 医博第4585号 / 新制||医||1042(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 藤渕 航, 教授 渡邊 直樹, 教授 玉木 敬二 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM