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Zhou Z, Gao P, Zhang T, Yang Y, Ding Q, Wu Z, Wang L. Functional analysis reveals calcium-sensing receptor gene regulating cell-cell junction in renal tubular epithelial cells. Int Urol Nephrol 2024; 56:2165-2177. [PMID: 38372840 DOI: 10.1007/s11255-024-03948-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/04/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE Calcium-sensing receptor (CASR) influences the expression pattern of multiple genes in renal tubular epithelial cells. The objective of this inquiry was to explore the molecular mechanisms of CASR in renal tubular epithelial cells and nephrolithiasis. METHODS HK-2 cells were transfected with lentiviruses carrying either CASR (named CASR) or an empty vector negative control (named NC), as well as shRNA intended to target CASR (named shCASR) or its corresponding negative control (named shNC). CCK-8 assay was used to detect the effect of CASR on the proliferation of HK-2 cells. RNA-Sequencing was applied to explore potential pathways regulated by CASR in HK-2 cells. RESULTS PCR and western blot results showed that CASR expression was significantly increased in CASR cells and was decreased in shCASR cells when compared to their corresponding negative control, respectively. CCK-8 assay revealed that CASR inhibited the proliferation of HK-2 cells. RNA-Sequencing results suggested that the shCASR HK-2 cells exhibited a significant up-regulation of 345 genes and a down-regulation of 366 genes. These differentially expressed genes (DEGs) were related to cell apoptosis and cell development. In CASR HK-2 cells, 1103 DEGs primarily functioned in mitochondrial energy metabolism, and amino acid metabolism. With the Venn diagram, 4 DEGs (Clorf116, ENPP3, IL20RB, and CLDN2) were selected as the hub genes regulated by CASR. Enrichment analysis revealed that these hub genes were involved in cell-cell junction, and epithelial cell development. CONCLUSIONS In summary, our investigation has the potential to offer novel perspectives on CASR regulating cell-cell junction in HK-2 cells.
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Affiliation(s)
- Zijian Zhou
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
- Clinical Research Center of Urolithiasis, Shanghai Medical College, Fudan University, Shanghai, 200040, People's Republic of China
| | - Peng Gao
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
- Clinical Research Center of Urolithiasis, Shanghai Medical College, Fudan University, Shanghai, 200040, People's Republic of China
| | - Tongtong Zhang
- Urology Centre, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200040, People's Republic of China
| | - Yuanyuan Yang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
- Clinical Research Center of Urolithiasis, Shanghai Medical College, Fudan University, Shanghai, 200040, People's Republic of China
| | - Qiang Ding
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
- Clinical Research Center of Urolithiasis, Shanghai Medical College, Fudan University, Shanghai, 200040, People's Republic of China
| | - Zhong Wu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China.
- Clinical Research Center of Urolithiasis, Shanghai Medical College, Fudan University, Shanghai, 200040, People's Republic of China.
| | - Lujia Wang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China.
- Clinical Research Center of Urolithiasis, Shanghai Medical College, Fudan University, Shanghai, 200040, People's Republic of China.
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Bourg S, Rakotozandriny K, Lucas IT, Letavernier E, Bonhomme C, Babonneau F, Abou-Hassan A. Confining calcium oxalate crystal growth in a carbonated apatite-coated microfluidic channel to better understand the role of Randall's plaque in kidney stone formation. LAB ON A CHIP 2024; 24:2017-2024. [PMID: 38407354 DOI: 10.1039/d3lc01050c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Effective prevention of recurrent kidney stone disease requires the understanding of the mechanisms of its formation. Numerous in vivo observations have demonstrated that a large number of pathological calcium oxalate kidney stones develop on an apatitic calcium phosphate deposit, known as Randall's plaque. In an attempt to understand the role of the inorganic hydroxyapatite phase in the formation and habits of calcium oxalates, we confined their growth under dynamic physicochemical and flow conditions in a reversible microfluidic channel coated with hydroxyapatite. Using multi-scale characterization techniques including scanning electron and Raman microscopy, we showed the successful formation of carbonated hydroxyapatite as found in Randall's plaque. This was possible due to a new two-step flow seed-mediated growth strategy which allowed us to coat the channel with carbonated hydroxyapatite. Precipitation of calcium oxalates under laminar flow from supersaturated solutions of oxalate and calcium ions showed that the formation of crystals is a substrate and time dependent complex process where diffusion of oxalate ions to the surface of carbonated hydroxyapatite and the solubility of the latter are among the most important steps for the formation of calcium oxalate crystals. Indeed when an oxalate solution was flushed for 24 h, dissolution of the apatite layer and formation of calcium carbonate calcite crystals occurred which seems to promote calcium oxalate crystal formation. Such a growth route has never been observed in vivo in the context of kidney stones. Under our experimental conditions, our results do not show any direct promoting role of carbonated hydroxyapatite in the formation of calcium oxalate crystals, consolidating therefore the important role that macromolecules can play in the process of nucleation and growth of calcium oxalate crystals on Randall's plaque.
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Affiliation(s)
- Samantha Bourg
- Laboratoire Physicochimie des Electrolytes et Nanosystèmes Interfaciaux (PHENIX), CNRS, Sorbonne Université, UMR 8234, Campus Jussieu, 4 place Jussieu, F-75005 Paris, France.
| | - Karol Rakotozandriny
- Laboratoire Physicochimie des Electrolytes et Nanosystèmes Interfaciaux (PHENIX), CNRS, Sorbonne Université, UMR 8234, Campus Jussieu, 4 place Jussieu, F-75005 Paris, France.
- Laboratoire de Chimie de la Matière Condensée de Paris (LCMCP), CNRS, Sorbonne Université, UMR 7574, Campus Jussieu, 4 place Jussieu, F-75005 Paris, France
| | - Ivan T Lucas
- Laboratoire Interfaces et Systèmes Electrochimiques (LISE), CNRS, Sorbonne Université, UMR 8235, Campus Jussieu, 4 place Jussieu, F-75005 Paris, France
| | - Emmanuel Letavernier
- AP-HP, Hôpital Tenon, Explorations Fonctionnelles Multidisciplinaires et Laboratoire des Lithiases, F-75020 Paris, France
| | - Christian Bonhomme
- Laboratoire de Chimie de la Matière Condensée de Paris (LCMCP), CNRS, Sorbonne Université, UMR 7574, Campus Jussieu, 4 place Jussieu, F-75005 Paris, France
| | - Florence Babonneau
- Laboratoire de Chimie de la Matière Condensée de Paris (LCMCP), CNRS, Sorbonne Université, UMR 7574, Campus Jussieu, 4 place Jussieu, F-75005 Paris, France
| | - Ali Abou-Hassan
- Laboratoire Physicochimie des Electrolytes et Nanosystèmes Interfaciaux (PHENIX), CNRS, Sorbonne Université, UMR 8234, Campus Jussieu, 4 place Jussieu, F-75005 Paris, France.
- Institut Universitaire de France (IUF), 75231 Paris Cedex 05, France
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Tamborino F, Cicchetti R, Mascitti M, Litterio G, Orsini A, Ferretti S, Basconi M, De Palma A, Ferro M, Marchioni M, Schips L. Pathophysiology and Main Molecular Mechanisms of Urinary Stone Formation and Recurrence. Int J Mol Sci 2024; 25:3075. [PMID: 38474319 DOI: 10.3390/ijms25053075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/16/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
Kidney stone disease (KSD) is one of the most common urological diseases. The incidence of kidney stones has increased dramatically in the last few decades. Kidney stones are mineral deposits in the calyces or the pelvis, free or attached to the renal papillae. They contain crystals and organic components, and they are made when urine is supersaturated with minerals. Calcium-containing stones are the most common, with calcium oxalate as the main component of most stones. However, many of these form on a calcium phosphate matrix called Randall's plaque, which is found on the surface of the kidney papilla. The etiology is multifactorial, and the recurrence rate is as high as 50% within 5 years after the first stone onset. There is a great need for recurrence prevention that requires a better understanding of the mechanisms involved in stone formation to facilitate the development of more effective drugs. This review aims to understand the pathophysiology and the main molecular mechanisms known to date to prevent recurrences, which requires behavioral and nutritional interventions, as well as pharmacological treatments that are specific to the type of stone.
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Affiliation(s)
- Flavia Tamborino
- Department of Medical Oral and Biotechnological Science, Università degli Studi "G. d'Annunzio" of Chieti, 66100 Chieti, Italy
| | - Rossella Cicchetti
- Department of Medical Oral and Biotechnological Science, Università degli Studi "G. d'Annunzio" of Chieti, 66100 Chieti, Italy
| | - Marco Mascitti
- Department of Medical Oral and Biotechnological Science, Università degli Studi "G. d'Annunzio" of Chieti, 66100 Chieti, Italy
| | - Giulio Litterio
- Department of Medical Oral and Biotechnological Science, Università degli Studi "G. d'Annunzio" of Chieti, 66100 Chieti, Italy
| | - Angelo Orsini
- Department of Medical Oral and Biotechnological Science, Università degli Studi "G. d'Annunzio" of Chieti, 66100 Chieti, Italy
| | - Simone Ferretti
- Department of Medical Oral and Biotechnological Science, Università degli Studi "G. d'Annunzio" of Chieti, 66100 Chieti, Italy
| | - Martina Basconi
- Department of Medical Oral and Biotechnological Science, Università degli Studi "G. d'Annunzio" of Chieti, 66100 Chieti, Italy
| | - Antonio De Palma
- Department of Medical Oral and Biotechnological Science, Università degli Studi "G. d'Annunzio" of Chieti, 66100 Chieti, Italy
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy
| | - Michele Marchioni
- Department of Medical Oral and Biotechnological Science, Università degli Studi "G. d'Annunzio" of Chieti, 66100 Chieti, Italy
| | - Luigi Schips
- Department of Medical Oral and Biotechnological Science, Università degli Studi "G. d'Annunzio" of Chieti, 66100 Chieti, Italy
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Taylor DZ, Smith GE, Wiener SV. Identification of Clinically Insignificant Renal Calculi on Sonography. Urology 2023; 176:55-62. [PMID: 37001825 DOI: 10.1016/j.urology.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/23/2023] [Accepted: 03/18/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE To determine factors predicting if a radiologists... report of a .. stone... on ultrasound (US) was not actually a clinically significant stone, based on subsequent computed tomogram (CT). US often overestimates stone size and various pathologic entities are also hyperechoic;.ßthus, a subsequent CT without a clinically significant stone may represent unnecessary radiation exposure. A decision-tree and nomogram were developed to predict when stones are unlikely on subsequent CT. METHODS Retrospective analysis of patients, of any age, receiving CT within 24.ßhours of a sonographic report documenting a single renal stone, during 2019...2020, in any phase of care, at one institution. Novel stone-likelihood-systems for US and CT (US-SLS, CT-SLS) were devised and validated to classify stones as clinically significant or insignificant, with CT as the gold standard. Binomial logistic regression predicting clinically significant stones was performed with sonographic and patient characteristics. RESULTS Eight hundred twenty patients had US followed by CT, 228 (27.8%) reported documented stones, 140 (17.1%) reported a single stone. Clinically significant stones were associated with larger stone size (P: .002), location (P: .002), hydronephrosis (P: .04), shadowing-artifact (P: .02) depth.ßto.ßstone (P: .008), and Body mass Index (BMI) (P: .01). US-SLS had higher sensitivity (95.4%) and negative-predictive-value (81.8%) compared to a multivariate model of significant variables. CONCLUSION US-SLS appears to exclude clinically irrelevant .. stones... better than established criteria including twinkle or shadow in this retrospective analysis. A diagnostic algorithm and nomogram are presented. US-SLS and the associated decision tree can assist providers in avoiding unnecessary radiation when clinically significant stones are unlikely.
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Affiliation(s)
- Dylan Z Taylor
- SUNY Upstate Medical University College of Medicine, Syracuse, NY.
| | - Garrett E Smith
- SUNY Upstate Medical University, Department of Urology, Syracuse, NY.
| | - Scott V Wiener
- SUNY Upstate Medical University, Department of Urology, Syracuse, NY.
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Dong C, Song C, He Z, Liao W, Song Q, Xiong Y, Meng L, Yang S. An overview of global research landscape in etiology of urolithiasis based on bibliometric analysis. Urolithiasis 2023; 51:71. [PMID: 37067622 DOI: 10.1007/s00240-023-01447-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/05/2023] [Indexed: 04/18/2023]
Abstract
The high incidence, recurrence and treatment costs of urolithiasis have a serious impact on patients and society. For a long time, countless scholars have been working tirelessly on studies related to the etiology of urolithiasis. A comprehensive understanding of the current status will be beneficial to the development of this field. We collected all literature about the etiology of urolithiasis from 1990 to 2022 using the Web of Science (WoS) database. VOSviewer, Bibliometrix and CiteSpace software were used to quantitatively analyze and visualize the data as well. The query identified 3177 articles for final analysis, of which related to the etiology of urolithiasis. The annual number of publications related to urolithiasis research has steadily increased during the latest decade. United States (1106) and China (449) contributed the most publications. University of Chicago (92) and Indiana University (86) have the highest number of publications. Urolithiasis and Journal of Urology have published the most articles in the field. Coe FL is the most productive author (63 articles), whose articles have obtained the most citations in all (4141 times). The keyword, such as hypercalciuria, hyperoxaluria, citrate, oxidative stress, inflammation, Randall's plaque, are the most attractive targets for the researchers. Our review provides a global landscape of studies related to the etiology of urolithiasis, which can serve as a reference for future studies in this field.
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Affiliation(s)
- Caitao Dong
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, People's Republic of China
| | - Chao Song
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, People's Republic of China
| | - Ziqi He
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, People's Republic of China
| | - Wenbiao Liao
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, People's Republic of China
| | - Qianlin Song
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, People's Republic of China
| | - Yunhe Xiong
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, People's Republic of China
| | - Lingchao Meng
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, People's Republic of China.
| | - Sixing Yang
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, People's Republic of China.
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6
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Abstract
Sarcoidosis is a systemic inflammatory disease of unknown etiology. The pathogenesis rests on an aberrant T cell response to unidentified antigens in individuals predisposed by genetic and environmental factors. Increased expression of polarized macrophages and disequilibrium between effector and regulator T cells contribute to the formation of noncaseating granulomas, that are frequently found in affected organs. The main kidney abnormalities in sarcoidosis are granulomatous interstitial nephritis (GIN) and hypercalcemia-related disorders. The clinical diagnosis is difficult. The outcome is variable, ranging from spontaneous remission to end-stage kidney disease (ESKD). Early diagnosis and prompt treatment with corticosteroids can improve the prognosis. Hypercalcemia may be responsible for acute kidney injury (AKI) caused by vasoconstriction of afferent arterioles. Complications of persistent hypercalcemia include nephrocalcinosis and renal stones. In patients with ESKD, dialysis and transplantation can offer results comparable to those observed in patients with other causes of kidney failure. Based on a review of the literature, we present an overview of the etiopathogenesis, the renal manifestations of sarcoidosis and their complications, management and prognosis.
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7
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Jia Q, Huang Z, Wang G, Sun X, Wu Y, Yang B, Yang T, Liu J, Li P, Li J. Osteopontin: An important protein in the formation of kidney stones. Front Pharmacol 2022; 13:1036423. [PMID: 36452224 PMCID: PMC9703462 DOI: 10.3389/fphar.2022.1036423] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/26/2022] [Indexed: 09/10/2024] Open
Abstract
The incidence of kidney stones averages 10%, and the recurrence rate of kidney stones is approximately 10% at 1 year, 35% at 5 years, 50% at 10 years, and 75% at 20 years. However, there is currently a lack of good medicines for the prevention and treatment of kidney stones. Osteopontin (OPN) is an important protein in kidney stone formation, but its role is controversial, with some studies suggesting that it inhibits stone formation, while other studies suggest that it can promote stone formation. OPN is a highly phosphorylated protein, and with the deepening of research, there is growing evidence that it promotes stone formation, and the phosphorylated protein is believed to have adhesion effect, promote stone aggregation and nucleation. In addition, OPN is closely related to immune cell infiltration, such as OPN as a pro-inflammatory factor, which can activate mast cells (degranulate to release various inflammatory factors), macrophages (differentiated into M1 macrophages), and T cells (differentiated into T1 cells) etc., and these inflammatory cells play a role in kidney damage and stone formation. In short, OPN mainly exists in the phosphorylated form in kidney stones, plays an important role in the formation of stones, and may be an important target for drug therapy of kidney stones.
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Affiliation(s)
- Qingxia Jia
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China
| | - Ziye Huang
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Guang Wang
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xia Sun
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yuyun Wu
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Bowei Yang
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Tongxin Yang
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jianhe Liu
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Pei Li
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jiongming Li
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
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8
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Goldberga I, Patris N, Chen CH, Thomassot E, Trébosc J, Hung I, Gan Z, Berthomieu D, Métro TX, Bonhomme C, Gervais C, Laurencin D. First Direct Insight into the Local Environment and Dynamics of Water Molecules in the Whewellite Mineral Phase: Mechanochemical Isotopic Enrichment and High-Resolution 17O and 2H NMR Analyses. THE JOURNAL OF PHYSICAL CHEMISTRY. C, NANOMATERIALS AND INTERFACES 2022; 126:12044-12059. [PMID: 35928237 PMCID: PMC9340807 DOI: 10.1021/acs.jpcc.2c02070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Calcium oxalate minerals of the general formula CaC2O4 . xH2O are widely present in nature and usually associated with pathological calcifications, constituting up to 70-80% of the mineral component of renal calculi. The monohydrate phase (CaC2O4 .H2O, COM) is the most stable form, accounting for the majority of the hydrated calcium oxalates found. These mineral phases have been studied extensively via X-ray diffraction and IR spectroscopy and, to a lesser extent, using 1H, 13C, and 43Ca solid-state NMR spectroscopy. However, several aspects of their structure and reactivity are still unclear, such as the evolution from low- to high-temperature COM structures (LT-COM and HT-COM, respectively) and the involvement of water molecules in this phase transition. Here, we report for the first time a 17O and 2H solid-state NMR investigation of the local structure and dynamics of water in the COM phase. A new procedure for the selective 17O- and 2H-isotopic enrichment of water molecules within the COM mineral is presented using mechanochemistry, which employs only microliter quantities of enriched water and leads to exchange yields up to ∼30%. 17O NMR allows both crystallographically inequivalent water molecules in the LT-COM structure to be resolved, while 2H NMR studies provide unambiguous evidence that these water molecules are undergoing different types of motions at high temperatures without exchanging with one another. Dynamics appear to be essential for water molecules in these structures, which have not been accounted for in previous structural studies on the HT-COM structure due to lack of available tools, highlighting the importance of such NMR investigations for refining the overall knowledge on biologically relevant minerals like calcium oxalates.
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Affiliation(s)
- Ieva Goldberga
- ICGM,
Univ Montpellier, CNRS, ENSCM, 34293 Montpellier, France
| | - Nicolas Patris
- HydroSciences
Montpellier, UMR 5151, CNRS, IRD, Université
de Montpellier, 34090 Montpellier, France
| | - Chia-Hsin Chen
- ICGM,
Univ Montpellier, CNRS, ENSCM, 34293 Montpellier, France
| | - Emilie Thomassot
- Université
de Lorraine, CRPG, CNRS UMR 7358, 54500 Vandœuvre-lès-Nancy, France
| | - Julien Trébosc
- Université
de Lille, CNRS, INRAE, Centrale Lille, Université d’Artois
FR2638−IMEC−Institut Michel Eugène Chevreul, 59000 Lille, France
| | - Ivan Hung
- National
High Magnetic Field Laboratory (NHMFL), Tallahassee, Florida 32310, United States
| | - Zhehong Gan
- National
High Magnetic Field Laboratory (NHMFL), Tallahassee, Florida 32310, United States
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9
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He R, Chou C, Chen L, Stoller M, Kang M, Ho SP. Insights Into Pulp Biomineralization in Human Teeth. FRONTIERS IN DENTAL MEDICINE 2022. [DOI: 10.3389/fdmed.2022.883336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
IntroductionMineralized pulp (MP) compromises tooth function and its causation is unknown. The hypothesis of this study is that pulp mineralization is associated with pulpal tissue adaptation, increased mineral densities, and decreased permeabilities of tubular dentin and cementum. Methods will include correlative spatial mapping of physicochemical and biochemical characteristics of pulp, and contextualize these properties within the dentin-pulp complex (DPC) to reveal the inherent vunerabilities of pulp.MethodsSpecimens (N = 25) were scanned using micro X-ray computed tomography (micro-XCT) to visualize MP and measure mineral density (MD). Elemental spatial maps of MP were acquired using synchrotron X-ray fluorescence microprobe (μXRF) and energy dispersive X-ray spectroscopy (EDX). Extracted pulp tissues were sectioned for immunolabelling and the sections were imaged using a light microscope. Microscale morphologies and nanoscale ultrastructures of MP were imaged using scanning electron (SEM) and scanning transmission electron microscopy (STEM) techniques.ResultsHeterogeneous distribution of MD from 200 to 2,200 mg/cc, and an average MD of 892 (±407) mg/cc were observed. Highly mineralized pulp with increased number of occluded tubules, reduced pore diameter in cementum, and decreased connectivity in lateral channels were observed. H&E, trichrome, and von Kossa staining showed lower cell and collagen densities, and mineralized regions in pulp. The biomolecules osteopontin (OPN), osteocalcin (OCN), osterix (OSX), and bone sialoprotein (BSP) were immunolocalized around PGP 9.5 positive neurovascular bundles in MP. SEM and STEM revealed a wide range of nano/micro particulates in dentin tubules and spherulitic mineral aggregates in the collagen with intrafibrillar mineral surrounding neurovascular bundles. EDX and μXRF showed elevated counts of Ca, P, Mg, and Zn inside pulp and at the dentin-pulp interface (DPI) in the DPC.ConclusionColocalization of physical and chemical, and biomolecular compositions in MP suggest primary and secondary biomineralization pathways in pulp and dentin at a tissue level, and altered fluid dynamics at an organ level. Elevated counts of Zn at the mineralizing front in MP indicated its role in pulp biomineralization. These observations underpin the inherent mechano- and chemo-responsiveness of the neurovascular DPC and help elucidate the clinical subtleties related to pulpitis, dentin-bridge, and pulp stone formation.
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10
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Leroy C, Bonhomme-Coury L, Gervais C, Tielens F, Babonneau F, Daudon M, Bazin D, Letavernier E, Laurencin D, Iuga D, Hanna J, Smith M, Bonhomme C. A novel multinuclear solid-state NMR approach for the characterization of kidney stones. MAGNETIC RESONANCE (GOTTINGEN, GERMANY) 2021; 2:653-671. [PMID: 37905220 PMCID: PMC10539836 DOI: 10.5194/mr-2-653-2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/15/2021] [Indexed: 11/01/2023]
Abstract
The spectroscopic study of pathological calcifications (including kidney stones) is extremely rich and helps to improve the understanding of the physical and chemical processes associated with their formation. While Fourier transform infrared (FTIR) imaging and optical/electron microscopies are routine techniques in hospitals, there has been a dearth of solid-state NMR studies introduced into this area of medical research, probably due to the scarcity of this analytical technique in hospital facilities. This work introduces effective multinuclear and multidimensional solid-state NMR methodologies to study the complex chemical and structural properties characterizing kidney stone composition. As a basis for comparison, three hydrates (n = 1 , 2 and 3) of calcium oxalate are examined along with nine representative kidney stones. The multinuclear magic angle spinning (MAS) NMR approach adopted investigates the 1 H , 13 C , 31 P and 31 P nuclei, with the 1 H and 13 C MAS NMR data able to be readily deconvoluted into the constituent elements associated with the different oxalates and organics present. For the first time, the full interpretation of highly resolved 1 H NMR spectra is presented for the three hydrates, based on the structure and local dynamics. The corresponding 31 P MAS NMR data indicates the presence of low-level inorganic phosphate species; however, the complexity of these data make the precise identification of the phases difficult to assign. This work provides physicians, urologists and nephrologists with additional avenues of spectroscopic investigation to interrogate this complex medical dilemma that requires real, multitechnique approaches to generate effective outcomes.
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Affiliation(s)
- César Leroy
- Laboratoire Chimie de la Matière Condensée de Paris, LCMCP, Sorbonne Université, CNRS, 75005 Paris, France
- Institut Charles Gerhardt Montpellier, CNRS, ENSCM, Université de Montpellier, Montpellier, France
| | - Laure Bonhomme-Coury
- Laboratoire Chimie de la Matière Condensée de Paris, LCMCP, Sorbonne Université, CNRS, 75005 Paris, France
| | - Christel Gervais
- Laboratoire Chimie de la Matière Condensée de Paris, LCMCP, Sorbonne Université, CNRS, 75005 Paris, France
| | - Frederik Tielens
- Laboratoire Chimie de la Matière Condensée de Paris, LCMCP, Sorbonne Université, CNRS, 75005 Paris, France
- General Chemistry (ALGC) – Materials Modelling Group, Vrije
Universiteit Brussel (Free University Brussels – VUB), Pleinlaan 2, 1050
Brussels, Belgium
| | - Florence Babonneau
- Laboratoire Chimie de la Matière Condensée de Paris, LCMCP, Sorbonne Université, CNRS, 75005 Paris, France
| | - Michel Daudon
- AP-HP, Hôpital Tenon, Explorations Fonctionnelles
Multidisciplinaires et INSERM UMRS 1155, Sorbonne Université, Hôpital Tenon, Paris, France
| | - Dominique Bazin
- Institut de Chimie Physique, UMR CNRS 8000, Bâtiment 350,
Université Paris Saclay, 91405 Orsay CEDEX, France
- Laboratoire de Physique des Solides, UMR CNRS 8502, Bâtiment 510, Université Paris-Sud, 91405 Orsay CEDEX, France
| | - Emmanuel Letavernier
- AP-HP, Hôpital Tenon, Explorations Fonctionnelles
Multidisciplinaires et INSERM UMRS 1155, Sorbonne Université, Hôpital Tenon, Paris, France
| | - Danielle Laurencin
- Institut Charles Gerhardt Montpellier, CNRS, ENSCM, Université de Montpellier, Montpellier, France
| | - Dinu Iuga
- Department of Physics, University of Warwick, Gibbet Hill Road,
Coventry CV4 7AL, United Kingdom
| | - John V. Hanna
- Department of Physics, University of Warwick, Gibbet Hill Road,
Coventry CV4 7AL, United Kingdom
| | - Mark E. Smith
- Department of Chemistry, University of Southampton, Southampton SO17 1BJ, United Kingdom
| | - Christian Bonhomme
- Laboratoire Chimie de la Matière Condensée de Paris, LCMCP, Sorbonne Université, CNRS, 75005 Paris, France
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11
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Sivaguru M, Saw JJ, Wilson EM, Lieske JC, Krambeck AE, Williams JC, Romero MF, Fouke KW, Curtis MW, Kear-Scott JL, Chia N, Fouke BW. Human kidney stones: a natural record of universal biomineralization. Nat Rev Urol 2021; 18:404-432. [PMID: 34031587 DOI: 10.1038/s41585-021-00469-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 02/04/2023]
Abstract
GeoBioMed - a new transdisciplinary approach that integrates the fields of geology, biology and medicine - reveals that kidney stones composed of calcium-rich minerals precipitate from a continuum of repeated events of crystallization, dissolution and recrystallization that result from the same fundamental natural processes that have governed billions of years of biomineralization on Earth. This contextual change in our understanding of renal stone formation opens fundamentally new avenues of human kidney stone investigation that include analyses of crystalline structure and stratigraphy, diagenetic phase transitions, and paragenetic sequences across broad length scales from hundreds of nanometres to centimetres (five Powers of 10). This paradigm shift has also enabled the development of a new kidney stone classification scheme according to thermodynamic energetics and crystalline architecture. Evidence suggests that ≥50% of the total volume of individual stones have undergone repeated in vivo dissolution and recrystallization. Amorphous calcium phosphate and hydroxyapatite spherules coalesce to form planar concentric zoning and sector zones that indicate disequilibrium precipitation. In addition, calcium oxalate dihydrate and calcium oxalate monohydrate crystal aggregates exhibit high-frequency organic-matter-rich and mineral-rich nanolayering that is orders of magnitude higher than layering observed in analogous coral reef, Roman aqueduct, cave, deep subsurface and hot-spring deposits. This higher frequency nanolayering represents the unique microenvironment of the kidney in which potent crystallization promoters and inhibitors are working in opposition. These GeoBioMed insights identify previously unexplored strategies for development and testing of new clinical therapies for the prevention and treatment of kidney stones.
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Affiliation(s)
- Mayandi Sivaguru
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA. .,Carl Zeiss Labs@Location Partner, Carl R. Woese Institute for Genomic Biology University of Illinois at Urbana-Champaign, Urbana, IL, USA.
| | - Jessica J Saw
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.,Department of Molecular and Integrative Physiology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.,Mayo Clinic School of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Elena M Wilson
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.,School of Molecular and Cellular Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Amy E Krambeck
- Department of Urology, Mayo Clinic, Rochester, MN, USA.,Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - James C Williams
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael F Romero
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.,Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Kyle W Fouke
- Jackson School of Geosciences, University of Texas at Austin, Austin, TX, USA
| | - Matthew W Curtis
- Carl Zeiss Microscopy LLC, One North Broadway, White Plains, NY, USA
| | | | - Nicholas Chia
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Individualized Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bruce W Fouke
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA. .,Carl Zeiss Labs@Location Partner, Carl R. Woese Institute for Genomic Biology University of Illinois at Urbana-Champaign, Urbana, IL, USA. .,School of Molecular and Cellular Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA. .,Department of Geology, University of Illinois at Urbana-Champaign, Urbana, IL, USA. .,Department of Microbiology, University of Illinois at Urbana-Champaign, Urbana, IL, USA. .,Roy J. Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
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12
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Du Y, Roger VB, Mena J, Kang M, Stoller ML, Ho SP. Structural and chemical heterogeneities of primary hyperoxaluria kidney stones from pediatric patients. J Pediatr Urol 2021; 17:214.e1-214.e11. [PMID: 33495102 PMCID: PMC8709938 DOI: 10.1016/j.jpurol.2020.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Calcium oxalate stones are the most common type among stone-forming patients and in some cases result from predisposed genetic conditions. In this work, we examined the differences in structure and chemical composition between oxalate stones from patients from three groups: 1) pediatric patients that were genetically predisposed (primary hyperoxaluria) to form stones (PPH); 2) control pediatric patients that did not have such genetic predisposition (PN-PH); 3) adult patients that formed oxalate stones without the genetic predisposition (A-CaOx). A variety of instrumental analyses were conducted to identify physicochemical properties of stones characteristic of predisposed pediatric (PPH), pediatric hyperoxaluria (PN-PH), and adult (A-CaOx) patient populations. METHODS Genetic variants of 16 stone-forming patients were determined using whole-exome gene sequencing. Components of stones from PPH (n = 6), PN-PH (n = 5), and A-CaOx (n = 5) groups were identified using Fourier transform infrared (FTIR) spectroscopy. Stone morphology and density were evaluated using high resolution X-ray computed tomography (micro-XCT). Stone microstructure and elemental composition were mapped with scanning electron microscopy (SEM) and energy dispersive X-ray (EDX) spectroscopy, respectively. RESULTS Calcium oxalate bipyramidal crystals were found on stones from all groups. Stones from PPH patients with PH types I and II were composed of calcium oxalate monohydrate (COM) with relatively uniform mineral density (1224 ± 277 mg/cc) and distinct smooth surfaces. By contrast, micro-spherical calcium phosphate particles were found only on PN-PH stones, which also showed a broader range of mineral densities (1266 ± 342 mg/cc). Stones from the PN-PH group also contained phosphorus (P), which was absent in NP-PH stones. A-CaOx stones were of significantly lower mineral density (645 ± 237 mg/cc) than pediatric stones and were more heterogeneous in their elemental composition. CONCLUSION Unique structural and compositional characteristics were identified in stones from pediatric patients with primary hyperoxaluria. These include the absence of phosphorus, a narrower mineral density distribution, and a uniform elemental composition compared to stones from pediatric patients without the genetic predisposition. Thus, characterization of stones at the macro- and micro-scales in combination with genetic testing of patients can provide insights and accurate diagnosis to develop a treatment plan for effective patient care.
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Affiliation(s)
- Yuan Du
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Vincent Blay Roger
- Division of Preclinical Education, Biomaterials & Engineering, School of Dentistry, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Jorge Mena
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Misun Kang
- Division of Preclinical Education, Biomaterials & Engineering, School of Dentistry, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Marshall L Stoller
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Sunita P Ho
- Division of Preclinical Education, Biomaterials & Engineering, School of Dentistry, University of California San Francisco, San Francisco, CA, 94143, USA; Department of Urology, School of Medicine, University of California San Francisco, San Francisco, CA, 94143, USA.
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13
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Du Y, Kang M, Mena J, Stoller ML, Ho SP, Li J. Structure and elemental composition of Ceftriaxone induced pediatric nephrolithiasis. Urolithiasis 2021; 49:309-320. [PMID: 33587147 DOI: 10.1007/s00240-020-01231-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/14/2020] [Indexed: 11/30/2022]
Abstract
Ceftriaxone is a widely used antibiotic because to its broad-spectrum gram-negative coverage, safety, and biological half life (5-9 h) permit dose once-daily administration. It is specifically used in pediatric patients in developing countries. Ceftriaxone forms insoluble sludge/stone when combined with calcium in the urinary system. In this study, Ceftriaxone induced sludge/stones from pediatric patients were collected to identify its microstructure and composition to gather insights into the mechanism of Ceftriaxone induced sludge/stone formation. The results illustrated that Ceftriaxone induced stones formed rapidly following antibiotic administration. Ceftriaxone calcium salt crystals could easily be broken with minimal intervention. However, Ceftriaxone combined with calcium phosphate formed an insoluble stone aggregate.
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Affiliation(s)
- Yuan Du
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, 95 Yong An Road, Xi Cheng District, Beijing, 100050, China
| | - Misun Kang
- Division of Preclinical Education, Biomaterials and Engineering, School of Dentistry, University of California, 707 Parnassus Avenue, D 3212, San Francisco, CA, 94143, USA
| | - Jorge Mena
- Department of Urology, School of Medicine, University of California, 400 Parnassus Avenue, San Francisco, CA, 94143-0330, USA
| | - Marshall L Stoller
- Department of Urology, School of Medicine, University of California, 400 Parnassus Avenue, San Francisco, CA, 94143-0330, USA.
| | - Sunita P Ho
- Division of Preclinical Education, Biomaterials and Engineering, School of Dentistry, University of California, 707 Parnassus Avenue, D 3212, San Francisco, CA, 94143, USA. .,Department of Urology, School of Medicine, University of California, 400 Parnassus Avenue, San Francisco, CA, 94143-0330, USA.
| | - Jun Li
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, 95 Yong An Road, Xi Cheng District, Beijing, 100050, China.
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14
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Srirangapatanam S, Wiener S, Stoller ML. Role of core body temperature in nephrolithiasis. BJU Int 2020; 126:620-624. [PMID: 32750202 DOI: 10.1111/bju.15185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the role of core body temperature in urinary stone formation using a large clinical dataset. PATIENTS AND METHODS We retrospectively collected 14 519 039 individual temperature measurements from 580 416 patients with medical history, laboratory values and medication history between 2013 and 2018 at a single institution. After exclusions and matching 2:1 (controls:cases) to account for confounding variables, 7104 patients with a history of urinary stones were identified. RESULTS Patients with a history of urinary stones (cases) had an elevated mean (SD) oral temperature compared to matched controls, at 36.666 (0.17) vs 36.659 (0.20)°C (P = 0.012). Logistic regression of matched samples showed that higher core body temperature was predictive of a history of nephrolithiasis (odds ratio 1.21, 95% confidence interval 1.04-1.4; P = 0.015). CONCLUSION Core body temperature was significantly higher in patients with a history of urinary stones compared to matched controls, contrary to the anticipated thermodynamic considerations leading to crystal aggregation. Given that the core body temperature is elevated, rather than decreased, thermodynamic process driving stone formation is unlikely.
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Affiliation(s)
| | - Scott Wiener
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY, USA
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15
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Curry JN, Saurette M, Askari M, Pei L, Filla MB, Beggs MR, Rowe PS, Fields T, Sommer AJ, Tanikawa C, Kamatani Y, Evan AP, Totonchi M, Alexander RT, Matsuda K, Yu AS. Claudin-2 deficiency associates with hypercalciuria in mice and human kidney stone disease. J Clin Invest 2020; 130:1948-1960. [PMID: 32149733 PMCID: PMC7108907 DOI: 10.1172/jci127750] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 01/08/2020] [Indexed: 12/29/2022] Open
Abstract
The major risk factor for kidney stone disease is idiopathic hypercalciuria. Recent evidence implicates a role for defective calcium reabsorption in the renal proximal tubule. We hypothesized that claudin-2, a paracellular cation channel protein, mediates proximal tubule calcium reabsorption. We found that claudin-2-null mice have hypercalciuria due to a primary defect in renal tubule calcium transport and papillary nephrocalcinosis that resembles the intratubular plugs in kidney stone formers. Our findings suggest that a proximal tubule defect in calcium reabsorption predisposes to papillary calcification, providing support for the vas washdown hypothesis. Claudin-2-null mice were also found to have increased net intestinal calcium absorption, but reduced paracellular calcium permeability in the colon, suggesting that this was due to reduced intestinal calcium secretion. Common genetic variants in the claudin-2 gene were associated with decreased tissue expression of claudin-2 and increased risk of kidney stones in 2 large population-based studies. Finally, we describe a family in which males with a rare missense variant in claudin-2 have marked hypercalciuria and kidney stone disease. Our findings indicate that claudin-2 is a key regulator of calcium excretion and a potential target for therapies to prevent kidney stones.
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Affiliation(s)
- Joshua N Curry
- Department of Molecular and Integrative Physiology and
- Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Matthew Saurette
- Department of Pediatrics and
- Membrane Protein Disease Research Group, University of Alberta, Edmonton, Alberta, Canada
| | - Masomeh Askari
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Academic Center for Education, Culture and Research (ACECR), Tehran, Iran
| | - Lei Pei
- Division of Nephrology and Hypertension, Department of Internal Medicine, and
| | - Michael B Filla
- Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas, USA
- Division of Nephrology and Hypertension, Department of Internal Medicine, and
| | - Megan R Beggs
- Department of Pediatrics and
- Membrane Protein Disease Research Group, University of Alberta, Edmonton, Alberta, Canada
| | - Peter Sn Rowe
- Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas, USA
- Division of Nephrology and Hypertension, Department of Internal Medicine, and
| | - Timothy Fields
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Andre J Sommer
- Department of Chemistry and Biochemistry, Miami University, Oxford, Ohio, USA
| | - Chizu Tanikawa
- Laboratory of Genome Technology, Human Genome Center, Institute of Medical Science, Graduate School of Frontier Sciences, University of Tokyo, Tokyo, Japan
| | - Yoichiro Kamatani
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Kanagawa, Japan
| | - Andrew P Evan
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Mehdi Totonchi
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Academic Center for Education, Culture and Research (ACECR), Tehran, Iran
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - R Todd Alexander
- Membrane Protein Disease Research Group, University of Alberta, Edmonton, Alberta, Canada
- Department of Physiology, University of Alberta, Edmonton, Alberta, Canada
| | - Koichi Matsuda
- Laboratory of Genome Technology, Human Genome Center, Institute of Medical Science, Graduate School of Frontier Sciences, University of Tokyo, Tokyo, Japan
- Laboratory of Clinical Genome Sequencing, Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, University of Tokyo, Tokyo, Japan
| | - Alan Sl Yu
- Department of Molecular and Integrative Physiology and
- Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas, USA
- Division of Nephrology and Hypertension, Department of Internal Medicine, and
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16
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Abstract
The process of kidney stone formation is complex and still not completely understood. Supersaturation and crystallization are the main drivers for the etiopathogenesis of uric acid, xanthine and cystine stones but this physicochemical concept fails to adequately explain the formation of calcium-based nephrolithiasis, which represents the majority of kidney stones. Contemporary concepts of the pathogenesis of calcium-based nephrolithiasis focus on a nidus-associated stone formation of calcium-based nephrolithiasis on Randall's plaques or on plugs of Bellini's duct. Randall's plaques originate from the interaction of interstitial calcium supersaturation in the renal papilla, vascular and interstitial inflammatory processes and mineral deposits of calcifying nanoparticles on the basal membrane of the thin ascending branch of the loop of Henle; however, plugs of Bellini's duct are assumed to be caused by mineral deposits on the wall of the collecting ducts. Aggregation and overgrowth are influenced by the interaction of matrix proteins with calcium supersaturated urine, by an imbalance between promoters and inhibitors of stone formation in the calyceal urine. Current research has elucidated many factors contributing to stone formation by revealing novel insights into the physiology of nephron and papilla, by analyzing vascular, inflammatory and calcifying processes in the renal medulla, by examining the proteome, the microbiome, promoters and inhibitors of stone formation in the urine and by conducting the first genome-wide association studies; however, more future research is mandatory to fill the gap of knowledge and hopefully, to obtain novel prophylactic, therapeutic and metaphylactic tools beyond the current state of knowledge.
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17
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Re: Geobiology Reveals How Human Kidney Stones Dissolve In Vivo. Eur Urol 2019; 75:532. [DOI: 10.1016/j.eururo.2018.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 11/01/2018] [Indexed: 11/21/2022]
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18
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Wiener SV, Chen L, Shimotake AR, Kang M, Stoller ML, Ho SP. Novel insights into renal mineralization and stone formation through advanced imaging modalities. Connect Tissue Res 2018; 59:102-110. [PMID: 29745818 PMCID: PMC6120852 DOI: 10.1080/03008207.2017.1409219] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED Purpose/Aim: The most common kidney stone composed of calcium oxalate forms on interstitial calcium phosphate mineral known as a Randall's plaque (RP). Due to limited information about events leading to the initial deposition of nanometer size interstitial calcium phosphate pre-clusters, there continues to be a debate on the initial site of calcium phosphate deposition and factors leading to stone formation. MATERIALS AND METHODS High-resolution X-ray micro-computed tomography (CT), and light and electron microscopy techniques were used to characterize human renal pyramids and five representative kidney stones with identifiable stems. Mineral densities of mineralized aggregates within these specimens were correlated with micro- and ultra-structures as seen using light and electron microscopy techniques. RESULTS The earliest detectable biominerals in the human renal papilla were proximal intratubular plate-like calcium phosphate deposits. Unoccluded tubules in stems connected to calcium phosphate stones were observed by electron microscope and X-ray micro-CT. These tubules were similar in diameter (30-100 μm) and shape to those observed in the distal regions of the renal papilla. CONCLUSIONS Observations were patterned through a novel and unified theory of stepwise-architecture guided biomineralization (a combination of smaller structures leading to a larger but similar structural framework). A plausible stepwise progression in renal biomineralization is proposed; proximal intratubular calcium phosphate deposits can lead to interstitial yet calcium phosphate rich RP and mature into a stem on which a calcium oxalate stone grows within the collecting system of a kidney.
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Affiliation(s)
- Scott V. Wiener
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Ling Chen
- University of California San Francisco Division of Biomaterials and Bioengineering, Preventive and Restorative Dental Sciences, California, San Francisco, USA
| | - Alex R. Shimotake
- University of California San Francisco Division of Biomaterials and Bioengineering, Preventive and Restorative Dental Sciences, California, San Francisco, USA
| | - Misun Kang
- University of California San Francisco Division of Biomaterials and Bioengineering, Preventive and Restorative Dental Sciences, California, San Francisco, USA
| | - Marshall L. Stoller
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Sunita P. Ho
- Department of Urology, University of California San Francisco, San Francisco, California, USA
- University of California San Francisco Division of Biomaterials and Bioengineering, Preventive and Restorative Dental Sciences, California, San Francisco, USA
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19
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Abstract
PURPOSE OF REVIEW The pathophysiological mechanisms in kidney stone formation are insufficiently understood. In order to achieve a better understanding of the complexity of stone formation, studies evaluating anatomical variations in the renal papillae have been performed. This review intends to illuminate recent findings. Moreover, new techniques to improve the understanding and interpretation of crystallization mechanisms are reviewed. RECENT FINDINGS Due to improvements of digital ureteroscopes, detailed endoscopic mapping of renal papillae is now possible. Connections between papillary morphology and histopathological changes in different subsets of stone formers have been documented. The formation of kidney stones seems to take place in relation to Randall's plaques, Ducts of Bellini or by free formation. Additionally, theories of kidney stone formation because of vascular injury or inflammatory events in the papillae have been suggested. SUMMARY Novel techniques including improved digital endoscopic visualization, microcomputed tomography (CT), electron microscopy and energy dispersive compositional analyses of kidney stones seem essential in the search for effective and reliable methods to understand stone forming processes, which ultimately should result in effective measures for more personalized stone prevention strategies in the future.
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