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Huang Y, Ning X, Ahrari S, Cai Q, Rajora N, Saxena R, Yu M, Zheng J. Physiological principles underlying the kidney targeting of renal nanomedicines. Nat Rev Nephrol 2024; 20:354-370. [PMID: 38409369 DOI: 10.1038/s41581-024-00819-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2024] [Indexed: 02/28/2024]
Abstract
Kidney disease affects more than 10% of the global population and is associated with considerable morbidity and mortality, highlighting a need for new therapeutic options. Engineered nanoparticles for the treatment of kidney diseases (renal nanomedicines) represent one such option, enabling the delivery of targeted therapeutics to specific regions of the kidney. Although they are underdeveloped compared with nanomedicines for diseases such as cancer, findings from preclinical studies suggest that renal nanomedicines may hold promise. However, the physiological principles that govern the in vivo transport and interactions of renal nanomedicines differ from those of cancer nanomedicines, and thus a comprehensive understanding of these principles is needed to design nanomedicines that effectively and specifically target the kidney while ensuring biosafety in their future clinical translation. Herein, we summarize the current understanding of factors that influence the glomerular filtration, tubular uptake, tubular secretion and extrusion of nanoparticles, including size and charge dependency, and the role of specific transporters and processes such as endocytosis. We also describe how the transport and uptake of nanoparticles is altered by kidney disease and discuss strategic approaches by which nanoparticles may be harnessed for the detection and treatment of a variety of kidney diseases.
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Affiliation(s)
- Yingyu Huang
- Department of Chemistry and Biochemistry, The University of Texas at Dallas, Richardson, TX, USA
| | - Xuhui Ning
- Department of Chemistry and Biochemistry, The University of Texas at Dallas, Richardson, TX, USA
| | - Samira Ahrari
- Department of Chemistry and Biochemistry, The University of Texas at Dallas, Richardson, TX, USA
| | - Qi Cai
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nilum Rajora
- Department of Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ramesh Saxena
- Department of Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mengxiao Yu
- Department of Chemistry and Biochemistry, The University of Texas at Dallas, Richardson, TX, USA.
| | - Jie Zheng
- Department of Chemistry and Biochemistry, The University of Texas at Dallas, Richardson, TX, USA.
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Holtz LR, Nix BD, Akuse SE, Hall-Moore C, Newberry RD, Ciorba MA, Deepak P, Zulfiqar M, Shieh JJ, Johnson JR, Riley IR, Dorshow RB. First-in-Human Assessment of Gut Permeability in Crohn's Disease Patients Using Fluorophore Technology. GASTRO HEP ADVANCES 2024; 3:491-497. [PMID: 38813093 PMCID: PMC11129951 DOI: 10.1016/j.gastha.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/09/2024] [Indexed: 05/31/2024]
Abstract
Background and Aims The dual sugar absorption test as a classic measure of human intestinal permeability has limited clinical utility due to lengthy and cumbersome urine collection, assay variability, and long turnaround. We aimed to determine if the orally administered fluorophore MB-102 (relmapirazin) (molecular weight [MW] = 372) compares to lactulose (L) (MW = 342) and rhamnose (R) (MW = 164)-based dual sugar absorption test as a measure of gut permeability in people with a spectrum of permeability including those with Crohn's disease (CD). Methods We performed a single-center, randomized, open-label, crossover study comparing orally administered MB-102 (1.5 or 3.0 mg/kg) to L (1000 mg) and R (200 mg). Adults with active small bowel CD on magnetic resonance enterography (cases) and healthy adults (controls) were randomized to receive either MB-102 or L and R on study day 1, and the other tracer 3 to 7 days later. Urine was collected at baseline and 1, 2, 4, 6, 8, 10, and 12 hours after tracer ingestion to calculate the cumulative urinary percent excretion of MB-102 and L and R. Results Nine cases and 10 controls completed the study without serious adverse events. Urinary recovery of administered MB-102 correlated with recovery of lactulose (r-squared = 0.83) for all participants. MB-102 urine recovery was also tracked with the L:R ratio urine recovery (r-squared = 0.57). In controls, the percentages of L and MB-102 recovered were similar within a narrow range, unlike in CD patients. Conclusion This first-in-human study of an orally administered fluorophore to quantify gastrointestinal permeability in adults with CD demonstrates that MB-102 is well tolerated, and its recovery in urine mirrors that of percent L and the L:R ratio.
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Affiliation(s)
- Lori R. Holtz
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - B. Darren Nix
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Sewuese E. Akuse
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Carla Hall-Moore
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Rodney D. Newberry
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew A. Ciorba
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Parakkal Deepak
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Maria Zulfiqar
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
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Shieh JJ, Riley IR, Rogers TE, Dorshow RB. Novel Chiral High-Performance Liquid Chromatographic (HPLC) Determination of MB-102, A New Fluorescent Tracer Agent Enabling the Measurement of Point-of-Care Glomerular Filtration Rate. ANAL LETT 2022. [DOI: 10.1080/00032719.2022.2102645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Bugaj JE, Dorshow RB. Evaluation of Developmental and Reproductive Toxicity in Rabbits for MB-102, a Fluorescent Tracer Agent Designed for Real-Time Measurement of Glomerular Filtration Rate. Int J Toxicol 2022; 41:380-388. [PMID: 35758830 DOI: 10.1177/10915818221111331] [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: 11/15/2022]
Abstract
The fluorescent tracer, MB-102, has been designed for the direct, real-time measurement of glomerular filtration rate. Previous studies, both in vitro and in vivo (rats, rabbits and dogs), were conducted to assess potential toxicity including single dose toxicity, mutation assay, chromosomal aberration assay, phototoxicity, local tolerance study, micronuclease assay, hERG channel changes, CNS and cardiovascular safety. The results of these studies led to a safety/toxicology profile for this agent deemed sufficient by the FDA to conduct Phase I and Phase II human clinical studies. In this paper we report on maternal toxicity and the potential effects on embryo-fetal development and the toxicokinetics of MB-102 administered daily via intravenous (bolus) injection into pregnant rabbits during the period of organogenesis gestation day 7-19. Assessment of toxicity was based on mortality, clinical observations, body weight, food consumption, reproductive performance and necropsy and cesarean section findings. Blood samples were collected for toxicokinetic evaluation. No test article findings were noted in any of these studies. The only clinical findings observed were the discoloration of skin, eyes or pelage in the 2 higher dose groups, which were considered related to the color and fluorescent properties of MB-102 and were deemed non-adverse. Exposure, as assessed by Cmax and AUC(0-6) increased in a dose dependent manner from 4.5 to 113 mg/kg/day. No accumulation of the test article was noted after multiple doses were administered. Thus, intravenous administration of MB-102 was not associated with any adverse developmental or reproductive toxicities in pregnant rabbits.
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Bugaj JE, Dorshow RB. Absence of developmental or reproductive toxicity in rats for MB-102, a fluorescent tracer agent for point-of-care measurement of glomerular filtration rate. Regul Toxicol Pharmacol 2022; 131:105158. [DOI: 10.1016/j.yrtph.2022.105158] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/13/2022] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
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Real-time glomerular filtration rate: improving sensitivity, accuracy and prognostic value in acute kidney injury. Curr Opin Crit Care 2021; 26:549-555. [PMID: 33002974 DOI: 10.1097/mcc.0000000000000770] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Acute kidney injury (AKI) is common and associated with high patient mortality, and accelerated progression to chronic kidney disease. Our ability to diagnose and stratify patients with AKI is paramount for translational progress. Unfortunately, currently available methods have major pitfalls. Serum creatinine is an insensitive functional biomarker of AKI, slow to register the event and influenced by multiple variables. Cystatin C, a proposed alternative, requires long laboratory processing and also lacks specificity. Other techniques are either very cumbersome (inuline, iohexol) or involve administration of radioactive products, and are therefore, not applicable on a large scale. RECENT FINDINGS The development of two optical measurement techniques utilizing novel minimally invasive techniques to quantify kidney function, independent of serum or urinary measurements is advancing. Utilization of both one and two compartmental models, as well as continuous monitoring, are being developed. SUMMARY The clinical utility of rapid GFR measurements in AKI patients remains unknown as these disruptive technologies have not been tested in studies exploring clinical outcomes. However, these approaches have the potential to improve our understanding of AKI and clinical care. This overdue technology has the potential to individualize patient care and foster therapeutic success in AKI.
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Pirie CG, Rogers TE, Dorshow RB. Effectiveness of MB-102, a novel fluorescent tracer agent, for conducting ocular angiography in dogs. Am J Vet Res 2020; 81:428-436. [PMID: 32343181 DOI: 10.2460/ajvr.81.5.428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of a novel fluorescence tracer agent, MB-102, for conducting ocular angiography in dogs. ANIMALS 10 ophthalmologically normal dogs (2 to 4 years old) and 10 dogs with retinal degeneration or primary open-angle glaucoma (< 6 years old). PROCEDURES While anesthetized, all dogs received sodium fluorescein (20 mg/kg, IV) or MB-102 (20 or 40 mg/kg, IV) first and then the other dye in a second treatment session 2 days later in a randomized crossover design. Anterior fluorescence angiography was performed on one eye and posterior fluorescence angiography on the other. Imaging was performed with a full-spectrum camera and camera adaptor system. Filter sets that were tailored to match the excitation and emission characteristics of each angiographic fluorescent agent were used. RESULTS All phases and phase intervals during anterior and posterior segment angiography were identified, regardless of the dye used. However, agent fluorescence and visualization of the iridal blood vessels were hindered in some dogs, irrespective of agent, owing to the degree of iridal pigmentation present. No significant difference was noted between the 2 dyes in any phase or phase interval, and slight improvement in image contrast was observed with MB-102 during the venous phases owing to a reduction of vessel wall staining in both normal and diseased eyes. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that MB-102 would be useful for conducting ocular angiography in dogs.
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Abstract
PURPOSE OF REVIEW Hypertension (HTN) and chronic kidney disease (CKD) are significant problems. With recent advances in technologies, biosensors have shown a great potential to provide better home monitoring in hypertension (HTN), medication compliance, diagnostic device for kidney disease, CKD/end-stage renal disease (ESRD) care, and post kidney transplant management. RECENT FINDINGS Multiple devices/biosensors have been developed related to HTN, kidney function including real-time glomerular filtration rate, CKD/end-stage renal disease, and transplant care. In recent advances in wearable biosensors, point of care monitoring system could provide more integrated care to the patients via telenephrology. SUMMARY This review focuses on the recent advances in biosensors which may be useful for HTN and nephrology. We will discuss future potential clinical implication of these biosensors.
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Shieh JJ, Riley IR, Rogers TE, Kao LF, Dorshow RB. Characterization of MB-102, a New Fluorescent Tracer Agent for Point-of-Care Renal Function Monitoring. J Pharm Sci 2020; 109:1191-1198. [DOI: 10.1016/j.xphs.2019.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 10/13/2019] [Accepted: 11/01/2019] [Indexed: 10/25/2022]
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Kashani K, Rosner MH, Ostermann M. Creatinine: From physiology to clinical application. Eur J Intern Med 2020; 72:9-14. [PMID: 31708357 DOI: 10.1016/j.ejim.2019.10.025] [Citation(s) in RCA: 141] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/05/2019] [Accepted: 10/22/2019] [Indexed: 12/22/2022]
Abstract
Estimating static kidney function accurately and detecting changes in kidney function in a timely fashion are challenging but critically important tasks. Serum creatinine is the most widely used functional biomarker of the kidney. However, its use is associated with substantial shortcomings. Understanding these shortcomings is critical in allowing accurate interpretation of creatinine values and translating them into changes in kidney function. In this review, the pathways involved in creatinine generation and metabolism as well as the techniques involved in measuring creatinine concentrations are discussed. This allows for the discussion of the value and pitfalls in using creatinine as a marker of kidney function. In addition, information regarding alternative functional biomarkers of the kidney is provided.
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Affiliation(s)
- Kianoush Kashani
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States.
| | - Mitchell H Rosner
- Division of Nephrology, University of Virginia Health System, Charlottesville, VA, United States
| | - Marlies Ostermann
- King's College London, Guy's & St Thomas' Hospital, London, United Kingdom
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Next tier in vitro and in vivo nonclinical studies further elucidating the safety and toxicity profile of MB-102, a novel fluorescent tracer agent for measurement of glomerular filtration rate. Regul Toxicol Pharmacol 2019; 107:104417. [DOI: 10.1016/j.yrtph.2019.104417] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/14/2019] [Accepted: 07/01/2019] [Indexed: 11/18/2022]
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McKinlay J, Tyson E, Forni LG. Renal complications of anaesthesia. Anaesthesia 2019; 73 Suppl 1:85-94. [PMID: 29313905 DOI: 10.1111/anae.14144] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2017] [Indexed: 12/15/2022]
Abstract
Peri-operative acute kidney injury is common, accounting for 30-40% of all in-hospital cases of acute kidney injury. It is associated with clinically significant morbidity and mortality even with what was hitherto regarded as relatively trivial increases in serum creatinine, and carries over a 12-fold relative risk of death following major abdominal surgery. Comorbid conditions such as diabetes, hypertension, liver disease and particularly pre-existing chronic kidney disease, as well as the type and urgency of surgery, are major risk factors for the development of postoperative acute kidney injury. As yet, there are no specific treatment options for the injured kidney, although there are several modifiable risk factors of which the anaesthetist should be aware. As well as the avoidance of potential nephrotoxins and appropriate volume balance, optimal anaesthetic management should aim to reduce the risk of postoperative renal complications. This may include careful ventilatory management and blood pressure control, as well as appropriate analgesic strategies. The choice of anaesthetic agent may also influence renal outcomes. Rather than concentrate on the classical management of acute kidney injury, this review focuses on the potential development of acute kidney injury peri-operatively, and the means by which this may be ameliorated.
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Affiliation(s)
- J McKinlay
- Surrey Peri-operative Anaesthesia and Critical Care Collaborative Research Group and Department of Intensive Care Medicine, University of Surrey, Surrey, UK
| | - E Tyson
- Department of Intensive Care Medicine, Royal Surrey County Hospital, University of Surrey, Surrey, UK
| | - L G Forni
- Surrey Peri-operative Anaesthesia and Critical Care Collaborative Research Group and Department of Intensive Care Medicine, University of Surrey, Surrey, UK.,Surrey Peri-operative Anaesthesia and Critical Care Collaborative Research Group and Department of Clinical and Experimental Medicine, Faculty of Health Care Sciences, University of Surrey, Surrey, UK
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Abstract
PURPOSE OF REVIEW Measurement of glomerular filtration rate is an essential tool for determining the health or dysfunction of the kidney. The glomerular filtration rate is a dynamic function that can change almost instantaneously in response to stressors. Despite its central role in nephrology, there are no techniques available to the clinician for monitoring glomerular filtration rate in real time. Recent advances in technology to measure fluorescent compounds through the skin are providing a new approach for real-time monitoring of glomerular filtration rate. This review frames these technologies within how such measurements might be used in clinical medicine. RECENT FINDINGS Fluorescent molecules that act as ideal filtration markers are now available. Using transdermal sensors, the plasma disappearance rate of these exogenous markers can be measured rather than their steady state concentration. This eliminates the delay inherent in using an endogenous marker of filtration and permits continuous monitoring of GFR. SUMMARY These new technologies provide enhanced opportunities for diagnosis of kidney dysfunction and therapeutic monitoring. Accurate assessment of measured GFR will eliminate the erroneous diagnosis of chronic kidney disease (CKD) from many patients. Assessment of renal reserve will provide a new risk factor for progression of CKD. Real-time monitoring of GFR in critically ill patients will allow for earlier diagnosis of acute kidney injury and a dynamic metric to guide therapeutics. These are but a few of the many opportunities that this new technology will provide in both the clinical and research arenas.
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Debreczeny MP, Dorshow RB. Transdermal optical renal function monitoring in humans: development, verification, and validation of a prototype device. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-9. [PMID: 29752796 DOI: 10.1117/1.jbo.23.5.057003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 04/26/2018] [Indexed: 06/08/2023]
Abstract
A prototype medical device for monitoring kidney function by transdermal measurement of the clearance rate of the exogenous fluorescent tracer agent MB-102 (administered intravenously) was developed. Verification of the device with an in vitro protocol is described. The expected renal clearance of the agent was mimicked by preparing a dilution series of MB-102 in the presence of a scattering agent. The slope of a linear fit to the logarithm of fluorescence intensity as a function of dilution step agreed with predictions within 5%, a level of accuracy that would be adequate in assessment of GFR to prevent misdiagnosis of kidney disease. Transdermal measurement was validated using a rat model. A two-compartment pharmacokinetic dependence was observed, with equilibration of the fluorescent agent between the vascular space into which it was injected and the extracellular space into which it subsequently diffused. The best observed signal-to-noise ratios were about 150, allowing determination of the renal clearance time with 5% precision using a 10-min fitting window. Based on the verification and validation methods for transdermal fluorescence detection described herein, the instrument has been approved by the FDA for a first-in-human clinical study, and a first transdermal clearance curve in a human is presented herein.
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Dorshow RB, Hall-Moore C, Shaikh N, Talcott MR, Faubion WA, Rogers TE, Shieh JJ, Debreczeny MP, Johnson JR, Dyer RB, Singh RJ, Tarr PI. Measurement of gut permeability using fluorescent tracer agent technology. Sci Rep 2017; 7:10888. [PMID: 28883476 PMCID: PMC5589723 DOI: 10.1038/s41598-017-09971-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 07/31/2017] [Indexed: 12/27/2022] Open
Abstract
The healthy gut restricts macromolecular and bacterial movement across tight junctions, while increased intestinal permeability accompanies many intestinal disorders. Dual sugar absorption tests, which measure intestinal permeability in humans, present challenges. Therefore, we asked if enterally administered fluorescent tracers could ascertain mucosal integrity, because transcutaneous measurement of differentially absorbed molecules could enable specimen-free evaluation of permeability. We induced small bowel injury in rats using high- (15 mg/kg), intermediate- (10 mg/kg), and low- (5 mg/kg) dose indomethacin. Then, we compared urinary ratios of enterally administered fluorescent tracers MB-402 and MB-301 to urinary ratios of sugar tracers lactulose and rhamnose. We also tested the ability of transcutaneous sensors to measure the ratios of absorbed fluorophores. Urinary fluorophore and sugar ratios reflect gut injury in an indomethacin dose dependent manner. The fluorophores generated smooth curvilinear ratio trajectories with wide dynamic ranges. The more chaotic sugar ratios had narrower dynamic ranges. Fluorophore ratios measured through the skin distinguished indomethacin-challenged from same day control rats. Enterally administered fluorophores can identify intestinal injury in a rat model. Fluorophore ratios are measureable through the skin, obviating drawbacks of dual sugar absorption tests. Pending validation, this technology should be considered for human use.
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Affiliation(s)
| | - Carla Hall-Moore
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Nurmohammad Shaikh
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Michael R Talcott
- Division of Comparative Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - William A Faubion
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Roy B Dyer
- Immunochemical Core Laboratory, Mayo Clinic, Rochester, MN, USA
| | | | - Phillip I Tarr
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
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Huang J, Gretz N. Light-Emitting Agents for Noninvasive Assessment of Kidney Function. ChemistryOpen 2017; 6:456-471. [PMID: 28794936 PMCID: PMC5542756 DOI: 10.1002/open.201700065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Indexed: 02/03/2023] Open
Abstract
The noninvasive assessment of kidney function and diagnosis of kidney disease have long been challenges. Traditional methods are not routinely available, because the existing protocols are cumbersome, time consuming, and invasive. In the past few years, significant progress in the area of diagnosing kidney function and disease on the basis of light-emitting agents has been made. Herein, we briefly review light-emitting agents, including organic fluorescent agents and inorganic renal clearable luminescent nanoparticles for the noninvasive and real-time monitoring of kidney function and disease. Moreover, some significant requirements and strategies regarding the design of ideal glomerular filtration rate agents and renal clearable nanoparticles are discussed. Finally, we discuss future challenges in expediting clinical translation of these developed light-emitting agents, along with considerations of the efforts that need to be made to develop new agents and diagnosing kidney disease.
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Affiliation(s)
- Jiaguo Huang
- Medical Research Center, Medical Faculty MannheimUniversity of HeidelbergTheodor-Kutzer-Ufer 1–368167MannheimGermany
| | - Norbert Gretz
- Medical Research Center, Medical Faculty MannheimUniversity of HeidelbergTheodor-Kutzer-Ufer 1–368167MannheimGermany
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Molitoris BA. Rethinking CKD Evaluation: Should We Be Quantifying Basal or Stimulated GFR to Maximize Precision and Sensitivity? Am J Kidney Dis 2017; 69:675-683. [PMID: 28223001 PMCID: PMC5403623 DOI: 10.1053/j.ajkd.2016.11.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 11/14/2016] [Indexed: 12/20/2022]
Abstract
Chronic kidney disease (CKD) is an increasing clinical problem. Although clinical risk factors and biomarkers for the development and progression of CKD have been identified, there is no commercial surveillance technology to definitively diagnose and quantify the severity and progressive loss of glomerular filtration rate (GFR) in CKD. This has limited the study of potential therapies to late stages of CKD when FDA-registerable events are more likely. Because patient outcomes, including the rate of CKD progression, correlate with disease severity and effective therapy may require early intervention, being able to diagnose and stratify patients by their level of decreased kidney function early on is key for translational progress. In addition, renal reserve, defined as the increase in GFR following stimulation, may improve the quantification of GFR based solely on basal levels. Various groups are developing and characterizing optical measurement techniques using new minimally invasive or noninvasive approaches for quantifying basal and stimulated kidney function. This development has the potential to allow widespread individualization of therapy at an earlier disease stage. Therefore, the purposes of this review are to suggest why quantifying stimulated GFR, by activating renal reserve, may be advantageous in patients and to review fluorescent technologies to deliver patient-specific GFR.
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Affiliation(s)
- Bruce A Molitoris
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indiana Center for Biological Microscopy, Rouderbush VA, Indianapolis, IN.
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Huang J, Gretz N, Weinfurter S. Filtration markers and determination methods for the assessment of kidney function. Eur J Pharmacol 2016; 790:92-98. [DOI: 10.1016/j.ejphar.2016.06.060] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/02/2016] [Accepted: 06/30/2016] [Indexed: 12/01/2022]
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Huang J, Weinfurter S, Pinto PC, Pretze M, Kränzlin B, Pill J, Federica R, Perciaccante R, Ciana LD, Masereeuw R, Gretz N. Fluorescently Labeled Cyclodextrin Derivatives as Exogenous Markers for Real-Time Transcutaneous Measurement of Renal Function. Bioconjug Chem 2016; 27:2513-2526. [DOI: 10.1021/acs.bioconjchem.6b00452] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jiaguo Huang
- Medical
Research Center, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Stefanie Weinfurter
- Medical
Research Center, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Pedro Caetano Pinto
- Division
of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - Marc Pretze
- Molecular
Imaging and Radiochemistry, Department of Clinical Radiology and Nuclear
Medicine, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Bettina Kränzlin
- Medical
Research Center, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Johannes Pill
- Medical
Research Center, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | | | | | | | - Rosalinde Masereeuw
- Division
of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - Norbert Gretz
- Medical
Research Center, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
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Improved kinetic model for the transcutaneous measurement of glomerular filtration rate in experimental animals. Kidney Int 2016; 90:1377-1385. [PMID: 27665115 DOI: 10.1016/j.kint.2016.07.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 07/13/2016] [Accepted: 07/14/2016] [Indexed: 02/06/2023]
Abstract
Transcutaneous measurement of the glomerular filtration rate (tGFR) is now frequently used in animal studies. tGFR allows consecutive measurements on the same animal, including multiple measurements on a daily basis, because no blood sampling is required. Here we derive and validate a novel kinetic model for the description of transcutaneously measured FITC-Sinistrin excretion kinetics. In contrast to standard 1- to 3-compartment models, our model covers the complete kinetic, including injection and distribution of the tracer in the plasma compartment. Because the model describes the complete progression of the measurement, it allows further refinement by correcting for baseline shifts observed occasionally during measurement. Possible reasons for shifts in the background signal include photo bleaching of the skin, autofluorescence, changes of physiological state of the animals during the measurements, or effects arising from the attachment of the measurement device. Using the new 3-compartment kinetic model with modulated baseline (tGFR3cp.b.m), tGFR measurements in rats can reach comparable precision as those from GFR measurements assessed using a gold standard technique based on constant infusion of a tracer. Moreover, the variability of simultaneous (parallel) measurements, as well as repeated tGFR measurements in the same animals, showed higher precision when tGFR3cp.b.m was compared with the 1-compartment tGFR1cp model.
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