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Wang LJ, Ma XB, Xia HY, Sun X, Yu L, Yang Q, Hu ZQ, Zhao YH, Hu W, Ran JH. Identification of Biomarkers for Predicting Allograft Rejection following Kidney Transplantation Based on the Weighted Gene Coexpression Network Analysis. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9933136. [PMID: 34368360 PMCID: PMC8342162 DOI: 10.1155/2021/9933136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/03/2021] [Indexed: 12/02/2022]
Abstract
Kidney transplantation is the promising treatment of choice for chronic kidney disease and end-stage kidney disease and can effectively improve the quality of life and survival rates of patients. However, the allograft rejection following kidney transplantation has a negative impact on transplant success. Therefore, the present study is aimed at screening novel biomarkers for the diagnosis and treatment of allograft rejection following kidney transplantation for improving long-term transplant outcome. In the study, a total of 8 modules and 3065 genes were identified by WGCNA based on the GSE46474 and GSE15296 dataset from the Gene Expression Omnibus (GEO) database. Moreover, the results of Gene Ontology (GO) annotation and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis showed that these genes were mainly involved in the immune-related biological processes and pathways. Thus, 317 immune-related genes were selected for further analysis. Finally, 5 genes (including CD200R1, VAV2, FASLG, SH2D1B, and RAP2B) were identified as the candidate biomarkers based on the ROC and difference analysis. Furthermore, we also found that in the 5 biomarkers an interaction might exist among each other in the protein and transcription level. Taken together, our study identified CD200R1, VAV2, FASLG, SH2D1B, and RAP2B as the candidate diagnostic biomarkers, which might contribute to the prevention and treatment of allograft rejection following kidney transplantation.
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Affiliation(s)
- Li-Jun Wang
- Department of Urinary Surgery, The Affiliated Calmette Hospital of Kunming Medical University, The First People's Hospital of Kunming, Calmette Hospital, Kunming, Yunnan Province, China
| | - Xiao-Bo Ma
- Department of Clinical Laboratory, Yunnan Institute of Experimental Diagnosis, The First Affiliated Hospital of Kunming Medical University, Yunnan Key Laboratory of Laboratory Medicine, Kunming, Yunnan Province, China
| | - Hong-Ying Xia
- Department of Pharmacy, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, Yunnan Province, China
| | - Xun Sun
- Department of Urinary Surgery, The Affiliated Calmette Hospital of Kunming Medical University, The First People's Hospital of Kunming, Calmette Hospital, Kunming, Yunnan Province, China
| | - Lu Yu
- Department of Pathology, The Affiliated Calmette Hospital of Kunming Medical University, The First People's Hospital of Kunming, Calmette Hospital, Kunming, Yunnan Province, China
| | - Qian Yang
- Department of Pathology, The Affiliated Calmette Hospital of Kunming Medical University, The First People's Hospital of Kunming, Calmette Hospital, Kunming, Yunnan Province, China
| | - Zong-Qiang Hu
- Department of Hepatopancreatobiliary Surgery, The Affiliated Calmette Hospital of Kunming Medical University, The First People's Hospital of Kunming, Calmette Hospital, Kunming, Yunnan Province, China
| | - Yong-Heng Zhao
- Department of Urinary Surgery, The Affiliated Calmette Hospital of Kunming Medical University, The First People's Hospital of Kunming, Calmette Hospital, Kunming, Yunnan Province, China
| | - Wei Hu
- Department of Urinary Surgery, The Affiliated Calmette Hospital of Kunming Medical University, The First People's Hospital of Kunming, Calmette Hospital, Kunming, Yunnan Province, China
| | - Jiang-Hua Ran
- Department of Hepatopancreatobiliary Surgery, The Affiliated Calmette Hospital of Kunming Medical University, The First People's Hospital of Kunming, Calmette Hospital, Kunming, Yunnan Province, China
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Abstract
PURPOSE OF REVIEW To provide an update of the literature on the use of new biomarkers of rejection in kidney transplant recipients. RECENT FINDINGS The kidney allograft biopsy is currently considered the gold standard for the diagnosis of rejection. However, the kidney biopsy is invasive and could be indeterminate. A significant progress has been made in discovery of new biomarkers of rejection, and some of them have been introduced recently for potential use in clinical practice including measurement of serum donor-derived cell free DNA, allo-specific CD154 + T-cytotoxic memory cells, and gene-expression 'signatures'. The literature supports that these biomarkers provide fair and reliable diagnostic accuracy and may be helpful in clinical decision-making when the kidney biopsy is contraindicated or is inconclusive. SUMMARY The new biomarkers provide a promising approach to detect acute rejections in a noninvasive way.
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Keshavarz Shahbaz S, Pourrezagholi F, Nafar M, Ahmadpoor P, Barabadi M, Foroughi F, Hosseinzadeh M, Yekaninejad MS, Amirzargar A. Dynamic variation of kidney injury molecule-1 mRNA and protein expression in blood and urine of renal transplant recipients: a cohort study. Clin Exp Nephrol 2019; 23:1235-1249. [PMID: 31302846 DOI: 10.1007/s10157-019-01765-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 06/14/2019] [Indexed: 01/10/2023]
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Matz M, Lorkowski C, Fabritius K, Wu K, Rudolph B, Frischbutter S, Brakemeier S, Gaedeke J, Neumayer HH, Mashreghi MF, Budde K. The selective biomarker IL-8 identifies IFTA after kidney transplantation in blood cells. Transpl Immunol 2016; 39:18-24. [DOI: 10.1016/j.trim.2016.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/28/2016] [Accepted: 09/28/2016] [Indexed: 12/20/2022]
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Abstract
Kidney injury molecule-1(KIM-1) is a type I membrane protein, comprising an extracellular portion and a cytoplasmic portion, which is expressed at very low levels in the normal kidney. The extracellular portion can cleave and rapidly enter tubule lumens after kidney injury, and can then be detected in the urine. It has been confirmed that the urine KIM-1 level is closely related to tissue KIM-1 level and correlated with kidney tissue damage. Not only is KIM-1 proven to be an early biomarker of acute kidney injury but it also has a potential role in predicting long-term renal outcome. This review summarizes the relationships between KIM-1 and kidney injury, especially in chronic kidney disease.
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Affiliation(s)
- Caixia Yin
- a Department of Nephrology , The First Affiliated Hospital of Nanjing Medical University , Nanjing , Jiangsu Province , People's Republic of China
| | - Ningning Wang
- a Department of Nephrology , The First Affiliated Hospital of Nanjing Medical University , Nanjing , Jiangsu Province , People's Republic of China
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Hanaoka K, Kawato Y, Kubo K, Nakanishi T, Maeda M, Nakamura K, Hirose J, Noto T, Fukahori H, Fujikawa A, Miyoshi S, Takakura S, Morokata T, Higashi Y. A chronic renal rejection model with a fully MHC-mismatched rat strain combination under immunosuppressive therapy. Transpl Immunol 2016; 38:19-26. [DOI: 10.1016/j.trim.2016.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/05/2016] [Accepted: 08/17/2016] [Indexed: 12/21/2022]
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李 学, 李 旭, 段 世, 徐 雪, 刘 一, 李 金, 龚 建, 吴 皓. [Effect of inhibiting TIM-4 function in Kupffer cells on liver graft rejection in mice]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2016; 37:451-459. [PMID: 28446395 PMCID: PMC6744090 DOI: 10.3969/j.issn.1673-4254.2017.04.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the effects of inhibiting TIM-4 function in Kupffer cells (KCs) on liver graft rejection in mice and explore the underlying mechanism. METHODS Mouse models of orthotopic liver transplantation were treated with a control mAb group and TIM-4 mAb. The activated KCs were assayed with immunohistochemistry after operation. The expression of TIM-4 in KCs were assayed with Western blotting and RT-PCR and the levels of AST, ALT, TBIL, TNF-α, IFN-γ and CCL2 were assayed detected. The expression of TIM-4 in KCs was observed with laser confocal microscopy. HE staining was used to observe the microstructure of the liver tissues, and the number of CD25+Foxp3+T cells was determined using with flow cytometry; the proteins levels of p-P65and p-P38 were assayed with Western blotting. The donor mice were treated with clodronate liposomes to destroy the KCs in the liver before transplantation, and the liver grafts were examined for graft rejection. RESULTS The number of activated KCs in the liver graft increased progressively over time. Compared with the sham-operated group, the liver graft showed significantly increased TIM-4 protein and mRNA levels at 1, 3, and 7 days after transplantation (P<0.05) and increased levels of AST, ALT, TBIL, TNF-α, IFN-γ and CCL2 at 7 days (P<0.05). The graft in TIM-4 mAb group showed mild pathological changes with a mean RAI score of 2.67∓0.75, which was significantly lower than that in control mAb group (P<0.05). The mean survival time of the recipient mice was 53.8∓6.4 days in TIM-4 mAb group, significantly longer than that in the control mAB group (14.5∓2.9 days, P<0.05). Donor treatment with clodronate liposomes resulted in comparable RAI scores in TIM-4 mAb and control mAb groups (8.01∓0.64 vs 7.93∓0.56, P>0.05). The protein levels of p-P65 and p-P38 in TIM-4 mAb group were significantly lower than those in control mAb group (P<0.05), and CD25+Foxp3+T cells in the liver graft increased significantly in TIM-4 mAb group. CONCLUSION Inhibition of TIM-4 function in KCs reduces the production of inflammatory factors after liver transplantation possibly by inhibiting the NF-κB and MAPK signaling pathways and promoting the proliferation of Foxp3+Treg cells to induce allograft tolerance.
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Affiliation(s)
- 学强 李
- 重庆市九龙坡区人民医院西城院区普外科,重庆 401329Department of General Surgery, West People's Hospital of Jiulongpo District, Chongqing 401329, China
| | - 旭宏 李
- 重庆三峡中心医院百安分院普外科,重庆 404000Department of General Surgery, Bai'an Branch of Chongqing Three Gorges Central Hospital, Chongqing 404000, China
| | - 世刚 段
- 重庆重庆市第九人民医院普外科,重庆 400799Department of General Surgery, Ninth People's Hospital of Chongqing, Chongqing 400799, China
| | - 雪松 徐
- 重庆医科大学附属第二医院肝胆外科,重庆 400010Department of Hepatobiliary Surgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - 一鸣 刘
- 重庆医科大学附属第二医院肝胆外科,重庆 400010Department of Hepatobiliary Surgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - 金政 李
- 重庆医科大学附属第二医院肝胆外科,重庆 400010Department of Hepatobiliary Surgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - 建平 龚
- 重庆医科大学附属第二医院肝胆外科,重庆 400010Department of Hepatobiliary Surgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - 皓 吴
- 重庆医科大学附属第二医院肝胆外科,重庆 400010Department of Hepatobiliary Surgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
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A head-to-head comparison of homocysteine and cystatin C as pre-procedure predictors for contrast-induced nephropathy in patients undergoing coronary computed tomography angiography. Clin Chim Acta 2015; 444:86-91. [PMID: 25687162 DOI: 10.1016/j.cca.2015.02.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 02/05/2015] [Accepted: 02/05/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Homocysteine is a potential predictor for contrast-induced nephropathy (CIN). We aimed to compare homocysteine with cystatin C as pre-procedure predictors for CIN in patients undergoing coronary computed tomography angiography (CCTA). METHODS A total of 580 consecutive patients were enrolled. Concentrations of plasma homocysteine and serum cystatin C were measured before CCTA. CIN is defined as an elevation of creatinine by ≥ 25% or ≥ 0.5mg/dl from baseline within 48h. Receiver operating characteristic curves, Pearson correlation coefficients and logistic regression analysis were used to evaluate the efficiency of potential predictors. RESULTS Fifty-seven (9.83%) patients developed CIN. Concentrations of homocysteine (19.35 ± 4.32 μmol/l vs. 13.42 ± 3.96 μmol/l, p<0.001) and cystatin C (1.20 ± 0.21 mg/dl vs. 0.99 ± 0.15 mg/dl, p<0.001) increased significantly in CIN subjects. CIN was predicted by homocysteine (AUC 0.829, p<0.001) and cystatin C (AUC 0.774, p<0.001), while creatinine was not predictive. Both homocysteine and cystatin C had positive correlation with ΔCreatinine48h-0 (p<0.001) and negative correlation with ΔeGFR48h-0 (p<0.001). Regression analysis confirmed that increased baseline homocysteine [OR: 1.262 (1.123, 2.554), p<0.001] and cystatin C [OR: 1.565 (1.380, 1.775), p<0.001] were independent predictors for CIN. CONCLUSIONS Homocysteine, with similar predictive value compared to cystatin C, was an independent biomarker for predicting CIN before CCTA examination.
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Kidney injury molecule-1 expression in human kidney transplants with interstitial fibrosis and tubular atrophy. BMC Nephrol 2015; 16:19. [PMID: 25884518 PMCID: PMC4359521 DOI: 10.1186/s12882-015-0011-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 01/30/2015] [Indexed: 12/22/2022] Open
Abstract
Background Kidney injury molecule-1 (KIM-1) is expressed in tubular epithelial cells after injury and may have a role in the development of renal graft fibrosis. In this study we evaluated the molecular and protein expressions of KIM-1 in dysfunctional allografts and also mRNA KIM-1 expression in urine as potential biomarkers of graft fibrosis. Methods Protein and mRNA levels in renal tissue and urinary sediment cells of 69 kidney transplant recipients that undertook for-cause graft biopsies were evaluated by immunohistochemistry and real-time polymerase chain reaction. The histopathology was classified according to the 2007 Banff schema. Results KIM-1 protein expression was increased in biopsies with interstitial fibrosis and tubular atrophy (IF/TA) compared with biopsies showing acute calcineurin inhibitor nephrotoxicity (CIN) (P <0.05). Kidney tissue KIM-1 mRNA signaling (in) was increased in biopsies with IF/TA compared with all other groups (P <0.05). In the urine cells KIM-1 mRNA was also increased in patients with IF/TA compared with patients with acute CIN (P <0.05). Significant correlations were found between KIM-1 protein and mRNA levels in tissue, between mRNA expressions in tissue and urine and between protein tissue expression and gene expression in the urine. Conclusions KIM-1 seems to be a marker of kidney graft fibrosis. Urinary KIM-1 mRNA may become a useful non-invasive biomarker of the injuries that can trigger intra-graft fibrotic processes, such as interstitial fibrosis and tubular atrophy.
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Fernando M, Peake PW, Endre ZH. Biomarkers of calcineurin inhibitor nephrotoxicity in transplantation. Biomark Med 2014; 8:1247-62. [DOI: 10.2217/bmm.14.86] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Over 35 years of use has demonstrated the revolutionary therapeutic benefits of calcineurin inhibitors (CNI) in not only preventing transplant rejection, but also the renal and nonrenal toxicity of CNI. Acute reversible and insidious irreversible forms of CNI nephrotoxicity have been identified, with ischemia from an imbalance between vasoconstrictors and vasodilators playing an important role. The ongoing search to define toxicity pathways has been enriched by ‘Omics’ studies. Changes in proteins including those involved in activation of pro-inflammatory responses, oxidative stress, ER stress and the unfolded protein response have been identified, and these may serve as biomarkers of toxicity. However, the current standard of CNI toxicity, histology, lacks specificity, which creates challenges for biomarker validation. This review focuses on progress in nephrotoxic pathway identification of CNI and biomarker validation.
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Affiliation(s)
- Mangalee Fernando
- Department of Nephrology, Prince of Wales Hospital, Barker St., Randwick, Sydney, NSW, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Philip W Peake
- Department of Nephrology, Prince of Wales Hospital, Barker St., Randwick, Sydney, NSW, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Zoltan H Endre
- Department of Nephrology, Prince of Wales Hospital, Barker St., Randwick, Sydney, NSW, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
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Li X, Zhuang S. Recent advances in renal interstitial fibrosis and tubular atrophy after kidney transplantation. FIBROGENESIS & TISSUE REPAIR 2014; 7:15. [PMID: 25285155 PMCID: PMC4185272 DOI: 10.1186/1755-1536-7-15] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 08/29/2014] [Indexed: 01/05/2023]
Abstract
Although kidney transplantation has been an important means for the treatment of patients with end stage of renal disease, the long-term survival rate of the renal allograft remains a challenge. The cause of late renal allograft loss, once known as chronic allograft nephropathy, has been renamed “interstitial fibrosis and tubular atrophy” (IF/TA) to reflect the histologic pattern seen on biopsy. The mechanisms leading to IF/TA in the transplanted kidney include inflammation, activation of renal fibroblasts, and deposition of extracellular matrix proteins. Identifying the mediators and factors that trigger IF/TA may be useful in early diagnosis and development of novel therapeutic strategies for improving long-term renal allograft survival and patient outcomes. In this review, we highlight the recent advances in our understanding of IF/TA from three aspects: pathogenesis, diagnosis, and treatment.
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Affiliation(s)
- Xiaojun Li
- Department of Nephrology, Tongji University School of Medicine, Shanghai East Hospital, Shanghai, China
| | - Shougang Zhuang
- Department of Nephrology, Tongji University School of Medicine, Shanghai East Hospital, Shanghai, China ; Department of Medicine, Alpert Medical School of Brown University, Rhode Island Hospital, Middle House 301, 593 Eddy Street, Providence, RI 02903, USA
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Abstract
Contrast-induced nephropathy (CIN) is a serious complication of angiographic procedures resulting from the administration of contrast media (CM). It is the third most common cause of hospital acquired acute renal injury and represents about 12% of the cases. CIN is defined as an elevation of serum creatinine (Scr) of more than 25% or ≥0.5 mg/dl (44 μmol/l) from baseline within 48 h. More sensitive markers of renal injury are desired, therefore, several biomarkers of tubular injury are under evaluation. Multiple risk factors may contribute to the development of CIN; these factors are divided into patient- and procedure-related factors. Treatment of CIN is mainly supportive, consisting mainly of careful fluid and electrolyte management, although dialysis may be required in some cases. The available treatment option makes prevention the corner stone of management. This article will review the recent evidence concerning CIN incidence, diagnosis, and prevention strategies as well as its treatment and prognostic implications.
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Affiliation(s)
- Nazar M A Mohammed
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Mahfouz
- Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Katafan Achkar
- Department of Nephrology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ihsan M Rafie
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Rachel Hajar
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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A comparison of the ability of levels of urinary biomarker proteins and exosomal mRNA to predict outcomes after renal transplantation. PLoS One 2014; 9:e98644. [PMID: 24918752 PMCID: PMC4053318 DOI: 10.1371/journal.pone.0098644] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 05/06/2014] [Indexed: 12/27/2022] Open
Abstract
Background mRNA for biomarkers of kidney injury extracted from urinary exosomes may reflect or predict levels of the corresponding protein after transplantation and clinical outcomes. Methods Urinary exosomes were isolated from patients following renal transplantation, from healthy controls, and patients with CKD. Expression of exosomal mRNA for the injury biomarkers neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), kidney injury molecule-1 (KIM-1), and cystatin C was compared with the concentrations of corresponding urinary proteins, 18S RNA and serum creatinine. Results All biomarker protein concentrations increased after transplantation, and urinary NGAL and IL-18 at 24 and 168 h correlated with the day 7 creatinine reduction ratio (CRR). Exosomal18S RNA increased after transplantation, but exosomal mRNA for NGAL, IL-18 and cystatin C did not correlate with the day 7 CRR, or urinary biomarker concentrations at any time after transplantation. Exosomal NGAL mRNA was lower 4 h after transplantation than in control exosomes. In contrast, exosomal mRNA for cystatin C was unchanged after transplantation and in CKD, although urinary cystatin C temporarily increased following transplantation. Urinary KIM-1 increased after transplantation, but exosomal mRNA for KIM-1 remained undetectable. In CKD 18S RNA was raised, and exosomal mRNA for NGAL, IL-18 and cystatin C was detected in all patients. While urinary NGAL was greater in CKD than control subjects, exosomal NGAL mRNA was unchanged. Exosomal IL-18 mRNA was increased in CKD, but not IL-18 protein. Conclusions After renal transplantation, urinary NGAL and IL-18 levels reflect the day 7 CRR. However, while mRNA for these biomarkers is present in exosomes, their levels do not reflect or predict urinary biomarker levels or the CRR. This likely reflects the fact that packaging of mRNA in exosomes is selective, and is not necessarily representative of mRNA in the parent cells responsible for biomarker production.
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Coelho S, Ortíz F, Gelpi R, Koskinen P, Porta N, Bestard O, Melilli E, Taco O, Torras J, Honkanen E, Grinyó JM, Cruzado JM. Sterile leukocyturia is associated with interstitial fibrosis and tubular atrophy in kidney allograft protocol biopsies. Am J Transplant 2014; 14:908-15. [PMID: 24517324 DOI: 10.1111/ajt.12639] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 12/13/2013] [Accepted: 12/29/2013] [Indexed: 01/25/2023]
Abstract
Kidney allograft interstitial fibrosis and tubular atrophy (IF/TA) is associated with a poorer renal function and outcome. In the current clinical practice, an early diagnosis can only be provided by invasive tests. We aimed to investigate the association of sterile leukocyturia with Banff criteria histological findings in kidney allograft protocol biopsies. We studied 348 allograft biopsies from two different European countries performed at 8.5 + 3.5 months after transplantation. In these cases, the presence of sterile leukocyturia (Leuc+, n = 70) or no leukocyturia (Leuc-, n = 278) was analyzed and related to Banff elementary lesions. Only IF/TA was significantly different between Leuc+ and Leuc- groups. IF/TA was present in 85.7% of Leuc+ and 27.7% of Leuc- patients (p < 0.001). IF/TA patients had higher serum creatinine and presence of proteinuria (p < 0.05). Independent predictors of IF/TA were donor age, donor male sex, serum creatinine and Leuc+ (hazard ratio 18.2; 95% confidence interval, 8.1-40.7). The positive predictive value of leukocyturia for predicting IF/TA was 85.7% whereas the negative predictive value was 72.3%. These studies suggest that leukocyturia is a noninvasive and low-cost test to identify IF/TA. An early diagnosis may allow timely interventional measures directed to minimize its impact and improve graft outcome.
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Affiliation(s)
- S Coelho
- Department of Nephrology, Hospital Fernando da Fonseca, Lisbon, Portugal
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Kim SC, Page EK, Knechtle SJ. Urine proteomics in kidney transplantation. Transplant Rev (Orlando) 2013; 28:15-20. [PMID: 24321302 DOI: 10.1016/j.trre.2013.10.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 10/21/2013] [Indexed: 12/13/2022]
Abstract
The transplanted kidney, through its urinary output, provides a medium through which the molecular constitution can provide insight into either the healthy function or developing dysfunction of a newly transplanted organ. An assay that would detect the aberration of early biomarkers of allograft injury using only urine samples from patients would provide many advantages over the current use of creatinine and tissue biopsies, as these means are either relatively non-specific or very invasive. Several urine biomarkers have been correlated with allograft injury, including CXCL9, CXCL10, CCL2, NGAL, IL-18, cystatin C, KIM-1 and Tim-3. The recent results of the CTOT-01 trial serve to validate the predictive value of the CXCL9 biomarker as a non-invasive biomarker for rejection and a prognostic indicator of graft function. There is now a preponderance of evidence showing a value of urinary monitoring of CXCL9 and CXCL10 with respect to detection of acute kidney allograft rejection. The value of the assay has been validated as a means of reducing the need for kidney transplant biopsy and applying biopsy in a more targeted manner. Additional goals for non-invasive monitoring would include predictive value prior to creatinine elevation that in turn would permit earlier, preemptive treatment of rejection.
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Affiliation(s)
- Steven C Kim
- Emory University Hospital, Department of Surgery, Atlanta, GA, 30322
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