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Czopek A, Moorhouse R, Gallacher PJ, Pugh D, Ivy JR, Farrah TE, Godden E, Hunter RW, Webb DJ, Tharaux PL, Kluth DC, Dear JW, Bailey MA, Dhaun N. Endothelin blockade prevents the long-term cardiovascular and renal sequelae of acute kidney injury in mice. Sci Transl Med 2022; 14:eabf5074. [PMID: 36516266 DOI: 10.1126/scitranslmed.abf5074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Acute kidney injury (AKI) is common and associated with increased risks of cardiovascular and chronic kidney disease. Causative molecular/physiological pathways are poorly defined. There are no therapies to improve long-term outcomes. An activated endothelin system promotes cardiovascular and kidney disease progression. We hypothesized a causal role for this in the transition of AKI to chronic disease. Plasma endothelin-1 was threefold higher; urine endothelin-1 was twofold higher; and kidney preproendothelin-1, endothelin-A, and endothelin-B receptor message up-regulated in patients with AKI. To show causality, AKI was induced in mice by prolonged ischemia with a 4-week follow-up. Ischemic injury resulted in hypertension, endothelium-dependent and endothelium-independent macrovascular and microvascular dysfunction, and an increase in circulating inflammatory Ly6Chigh monocytes. In the kidney, we observed fibrosis, microvascular rarefaction, and inflammation. Administration of endothelin-A antagonist, but not dual endothelin-A/B antagonist, normalized blood pressure, improved macrovascular and microvascular function, and prevented the transition of AKI to CKD. Endothelin-A blockade reduced circulating and renal proinflammatory Ly6Chigh monocytes and B cells, and promoted recruitment of anti-inflammatory Ly6Clow monocytes to the kidney. Blood pressure reduction alone provided no benefits; blood pressure reduction alongside blockade of the endothelin system was as effective as endothelin-A antagonism in mitigating the long-term sequelae of AKI in mice. Our studies suggest up-regulation of the endothelin system in patients with AKI and show in mice that existing drugs that block the endothelin system, particularly those coupling vascular support and anti-inflammatory action, can prevent the transition of AKI to chronic kidney and cardiovascular disease.
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Affiliation(s)
- Alicja Czopek
- Edinburgh Kidney, University/BHF Centre of Research Excellence, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Rebecca Moorhouse
- Edinburgh Kidney, University/BHF Centre of Research Excellence, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Peter J Gallacher
- Edinburgh Kidney, University/BHF Centre of Research Excellence, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Dan Pugh
- Edinburgh Kidney, University/BHF Centre of Research Excellence, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK.,Department of Renal Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK
| | - Jessica R Ivy
- Edinburgh Kidney, University/BHF Centre of Research Excellence, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Tariq E Farrah
- Edinburgh Kidney, University/BHF Centre of Research Excellence, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK.,Department of Renal Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK
| | - Emily Godden
- Edinburgh Kidney, University/BHF Centre of Research Excellence, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Robert W Hunter
- Edinburgh Kidney, University/BHF Centre of Research Excellence, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK.,Department of Renal Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK
| | - David J Webb
- Edinburgh Kidney, University/BHF Centre of Research Excellence, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Pierre-Louis Tharaux
- Paris Cardiovascular Research Centre (PARCC), Institut National de la Santé et de la Recherche Médicale (INSERM), 75015 Paris, France
| | - David C Kluth
- Edinburgh Kidney, University/BHF Centre of Research Excellence, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - James W Dear
- Edinburgh Kidney, University/BHF Centre of Research Excellence, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Matthew A Bailey
- Edinburgh Kidney, University/BHF Centre of Research Excellence, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Neeraj Dhaun
- Edinburgh Kidney, University/BHF Centre of Research Excellence, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK.,Department of Renal Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK.,Paris Cardiovascular Research Centre (PARCC), Institut National de la Santé et de la Recherche Médicale (INSERM), 75015 Paris, France
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Bohorquez H, Seal JB, Cohen AJ, Kressel A, Bugeaud E, Bruce DS, Carmody IC, Reichman TW, Battula N, Alsaggaf M, Therapondos G, Bzowej N, Tyson G, Joshi S, Nicolau-Raducu R, Girgrah N, Loss GE. Safety and Outcomes in 100 Consecutive Donation After Circulatory Death Liver Transplants Using a Protocol That Includes Thrombolytic Therapy. Am J Transplant 2017; 17:2155-2164. [PMID: 28276658 DOI: 10.1111/ajt.14261] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/14/2017] [Accepted: 02/22/2017] [Indexed: 02/06/2023]
Abstract
Donation after circulatory death (DCD) liver transplantation (LT) reportedly yields inferior survival and increased complication rates compared with donation after brain death (DBD). We compare 100 consecutive DCD LT using a protocol that includes thrombolytic therapy (late DCD group) to an historical DCD group (early DCD group n = 38) and a cohort of DBD LT recipients (DBD group n = 435). Late DCD LT recipients had better 1- and 3-year graft survival rates than early DCD LT recipients (92% vs. 76.3%, p = 0.03 and 91.4% vs. 73.7%, p = 0.01). Late DCD graft survival rates were comparable to those of the DBD group (92% vs. 93.3%, p = 0.24 and 91.4% vs. 88.2%, p = 0.62). Re-transplantation occurred in 18.4% versus 1% for the early and late DCD groups, respectively (p = 0.001). Patient survival was similar in all three groups. Ischemic-type biliary lesions (ITBL) occurred in 5%, 3%, and 0.2% for early DCD, late DCD, and DBD groups, respectively, but unlike in the early DCD group, in the late DCD group ITBL was endoscopically managed and resolved in each case. Using a protocol that includes a thrombolytic therapy, DCD LT yielded patient and graft survival rates comparable to DBD LT.
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Affiliation(s)
- H Bohorquez
- Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA.,School of Medicine, University of Queensland, New Orleans, LA
| | - J B Seal
- Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA.,School of Medicine, University of Queensland, New Orleans, LA
| | - A J Cohen
- Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA.,School of Medicine, University of Queensland, New Orleans, LA
| | - A Kressel
- Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA
| | - E Bugeaud
- Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA
| | - D S Bruce
- Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA
| | - I C Carmody
- Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA.,School of Medicine, University of Queensland, New Orleans, LA
| | - T W Reichman
- Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA
| | - N Battula
- Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA
| | - M Alsaggaf
- School of Medicine, University of Queensland, New Orleans, LA
| | - G Therapondos
- Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA.,School of Medicine, University of Queensland, New Orleans, LA
| | - N Bzowej
- Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA.,School of Medicine, University of Queensland, New Orleans, LA
| | - G Tyson
- Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA.,School of Medicine, University of Queensland, New Orleans, LA
| | - S Joshi
- Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA.,School of Medicine, University of Queensland, New Orleans, LA
| | - R Nicolau-Raducu
- Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA
| | - N Girgrah
- Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA.,School of Medicine, University of Queensland, New Orleans, LA
| | - G E Loss
- Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA.,School of Medicine, University of Queensland, New Orleans, LA
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