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Flampouri E, Theodosi-Palimeri D, Kintzios S. Strobilurin fungicide kresoxim-methyl effects on a cancerous neural cell line: oxidant/antioxidant responses and in vitro migration. Toxicol Mech Methods 2018; 28:709-716. [PMID: 30064279 DOI: 10.1080/15376516.2018.1506848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In this paper we report the effects of the complex III inhibitor, strobilurin fungicide kresoxim-methyl, on the cellular homeostasis of a mammalian cancerous neural cell line. We examined whether exposure to subcytotoxic concentrations of kresoxim-methyl induce cellular and biochemical mechanisms of toxicity on the murine neuroblastoma N2a cells. Results revealed elevation of mitochondrial superoxide generation, decrease in mitochondrial transmembrane potential, losses on GPx enzyme activity, along with increased nitrite release. Fungicide exposure also induced impaired cellular migration. Our findings suggest that kresoxim-methyl, besides targeting the mitochondria in fungi, exerts its mode of action in mammalian cancer cells. Abbreviations: CAT: catalase; DMEM: Dulbecco's modified Eagle's medium; GPx: glutathione peroxidase; KM: kresoxym-methyl; N2a: mouse neuroblastoma cells; NO: nitric oxide.
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Affiliation(s)
- Evangelia Flampouri
- a Laboratory of Cell Technology, Department of Biotechnology, School of Food, Biotechnology and Development , Agricultural University of Athens , Athens , Greece
| | - Dimitra Theodosi-Palimeri
- a Laboratory of Cell Technology, Department of Biotechnology, School of Food, Biotechnology and Development , Agricultural University of Athens , Athens , Greece
| | - Spyridon Kintzios
- a Laboratory of Cell Technology, Department of Biotechnology, School of Food, Biotechnology and Development , Agricultural University of Athens , Athens , Greece
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Swathi P, Gana Manjusha K, Vivekanand M, Ramkishan A, Bhavani B. Effect of Morus alba against Hyperglycemic and Hyperlipidemic Activities in Streptozotocin Induced Diabetic Nephropathy. ACTA ACUST UNITED AC 2017. [DOI: 10.13005/bbra/2589] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ABSTRACT: The present study was designed to investigate the antihyperglycemic and hypolipidemic activities of ethanolic leaf extract of Morus alba (EMA) in Streptozotocin induced diabetic rats. Blood glucose, serum parameters such as glycated haemoglobin (HbA1c), bilirubin, albumin, creatinine, total protein, urea, lipid profile, and urine parameters such as urine protein, creatinine and volume and renal antioxidant enzymes like SOD, CAT, GSH and MDA were estimated at the end of 12 weeks study period. Kidney histopathology was also done. The treatment with EMA showed significant (p<0.05) reduction in the elevated blood glucose, HbA1c, kidney function parameters and lipid profile in STZ induced diabetic rats. Treatment with EMA exerted improvement in antioxidant enzymes as SOD, CAT, GSH and reduction in MDA level profile in STZ induced diabetic rats. Histopathology reveals, EMA showed marked amelioration of glomerulosclerosis caused by STZ. The activities of Morus alba might be due to the presence of antioxidant principles like terpenoids and sterols.
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Affiliation(s)
- P. Swathi
- A.U. College of Pharmaceutical Sciences, Andhra University, Visakhapatnam, India
| | - K. Gana Manjusha
- Vignan Institute of Pharmaceutical Technology, Visakhapatnam, India
| | - M. Vivekanand
- A.U. College of Pharmaceutical Sciences, Andhra University, Visakhapatnam, India
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Flampouri E, Mavrikou S, Mouzaki-Paxinou AC, Kintzios S. Alterations of cellular redox homeostasis in cultured fibroblast-like renal cells upon exposure to low doses of cytochrome bc1 complex inhibitor kresoxim-methyl. Biochem Pharmacol 2016; 113:97-109. [DOI: 10.1016/j.bcp.2016.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/01/2016] [Indexed: 12/18/2022]
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Mao S, Zhang A, Huang S. Serum levels of malondialdehyde, vitamin C and E in idiopathic nephrotic syndrome: a meta-analysis. Ren Fail 2014; 36:994-9. [PMID: 24665878 DOI: 10.3109/0886022x.2014.900430] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
It is well documented that oxidative stress is involved in the pathogenesis of idiopathic nephrotic syndrome (INS). Malondialdehyde (MDA) is a measurement of lipid oxidation; vitamin C and E are important components of antioxidants. However, the association between MDA, vitamin C or E levels and INS remains elusive. A meta-analysis was performed to investigate the alteration of serum levels of MDA, vitamin C and E in INS compared with controls. Eight studies were included in our meta-analysis according to predefined criteria. Active INS patients demonstrated significantly higher level of serum MDA (SMD: 2.13, 95% CI: 1.511 to 2.749, p < 10(-4)), markedly lower levels of serum vitamin C (SMD: -1.449, 95% CI: -2.616 to -0.281, p = 0.015) and E (SMD: -1.45, 95% CI: -2.544 to -0.356, p = 0.009) compared with those in controls. Active steroid-sensitive nephrotic syndrome (SSNS) patients showed comparable levels of serum vitamin C and E to those in controls. INS subjects in the remission stage demonstrated significantly higher level of serum MDA (SMD: 1.028, 95% CI: 0.438 to 1.617, p < 10(-4)), markedly lower level of serum vitamin C (SMD: -2.235, 95% CI: -3.048 to -1.421, p < 10(4)) and similar level of serum vitamin E compared with those in controls. No significant publication bias was observed. In conclusion, the disorder of MDA and vitamin C persists in the remission stage of INS. It seems that the serum levels of vitamin C and E is associated with the responsiveness of INS to steroids. However, more studies should be performed in the future.
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Affiliation(s)
- Song Mao
- Department of Nephrology, Nanjing Children's Hospital, Affiliated to Nanjing Medical University , Nanjing , China
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5
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Serum paraoxonase activity and oxidative stress in patients with adult nephrotic syndrome. Atherosclerosis 2011; 218:243-6. [DOI: 10.1016/j.atherosclerosis.2011.05.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Revised: 05/24/2011] [Accepted: 05/30/2011] [Indexed: 11/17/2022]
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6
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Gilliam D, Valdez N, Branson S, Dixon A, Downing C. Maternal effects on ethanol teratogenesis in a cross between A/J and C57BL/6J mice. Alcohol 2011; 45:441-9. [PMID: 21641750 DOI: 10.1016/j.alcohol.2011.02.308] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 02/04/2011] [Accepted: 02/16/2011] [Indexed: 10/18/2022]
Abstract
Genetic factors influence adverse pregnancy outcome in both humans and animal models. Animal research reveals that both the maternal and fetal genetic profiles are important for determining the risk of physical birth defects and prenatal mortality. Using a reciprocal-cross breeding design, we investigated whether the mother's genes may be more important than fetal genes in determining risk for ethanol teratogenesis. Examination of possible synergistic genetic effects on ethanol teratogenesis was made possible by using two mouse strains known to be susceptible to specific malformations. Inbred A/J (A) and C57BL/6J (B6) mice were mated to produce four fetal genotype groups: the true-bred AċA and B6ċB6 genotypes and the genetically identical AċB6 and B6ċA genotypes (the F(1) genotype). Dams were administered either 5.8 g/kg ethanol or an isocaloric amount of maltose-dextrin on day 9 of pregnancy. Fetuses were removed by laparotomy on gestation day 18, weighed, and assessed for digit, vertebral, and kidney malformations. Digit malformations in the genetically identical F(1) ethanol-exposed litters showed a pattern consistent with a maternal genetic effect (AċB6 [2%] and B6ċA [30%]). In contrast, vertebral malformations were similar in all ethanol-exposed litters (AċA [26%], AċB6 [18%], B6ċA [22%], and B6ċB6 [33%]). The percentage of malformations did not differ between male and female fetuses, indicating sex-linked factors are not responsible for the maternal effect. Ethanol exposure decreased litter weights but did not affect litter mortality compared with maltose-exposed controls. This study supports the idea that genes influence malformation risk following in utero alcohol exposure. Specifically, maternal genes influence risk more than fetal genes for some teratogenic outcomes. No evidence supported synergistic genetic effects on ethanol teratogenesis. This research supports the conclusion that uterine environment contributes to determining risk of Fetal Alcohol Spectrum Disorder.
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Kim S, Lee SH, Kang S, Lee L, Park JD, Ryu DY. Involvement of c-Met- and Phosphatidylinositol 3-Kinase Dependent Pathways in Arsenite-Induced Downregulation of Catalase in Hepatoma Cells. Biol Pharm Bull 2011; 34:1748-52. [DOI: 10.1248/bpb.34.1748] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Soohee Kim
- College of Veterinary Medicine, Seoul National University
| | - Seung Heon Lee
- College of Veterinary Medicine, Seoul National University
| | - Sukmo Kang
- College of Veterinary Medicine, Seoul National University
| | - Lyon Lee
- College of Veterinary Medicine, Western University of Health Sciences
| | | | - Doug-Young Ryu
- College of Veterinary Medicine, Seoul National University
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Arozal W, Watanabe K, Veeraveedu PT, Ma M, Thandavarayan RA, Sukumaran V, Suzuki K, Kodama M, Aizawa Y. Telmisartan prevents the progression of renal injury in daunorubicin rats with the alteration of angiotensin II and endothelin-1 receptor expression associated with its PPAR-γ agonist actions. Toxicology 2011; 279:91-9. [DOI: 10.1016/j.tox.2010.09.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 09/22/2010] [Accepted: 09/22/2010] [Indexed: 12/24/2022]
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Bakr A, Abul Hassan S, Shoker M, Zaki M, Hassan R. Oxidant stress in primary nephrotic syndrome: does it modulate the response to corticosteroids? Pediatr Nephrol 2009; 24:2375-80. [PMID: 19644712 DOI: 10.1007/s00467-009-1246-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2009] [Revised: 05/24/2009] [Accepted: 06/08/2009] [Indexed: 10/20/2022]
Abstract
In order to assess the oxidative stress in newly diagnosed children with primary nephrotic syndrome (PNS), we serially measured serum total antioxidant capacity (TAC) and malondialdehyde (MDA) in 33 children with PNS and ten healthy matched controls. Patients were classified into two groups: those who had steroid-sensitive nephrotic syndrome (SSNS; n = 26) and those who had steroid-resistant nephrotic syndrome (SRNS; n = 7). Of the patients with SSNS, 15 were non-relapsers and 11 were relapsers. At the proteinuric phase, all patients had significantly higher MDA levels and lower TAC than the controls. These changes were more marked in patients with SRNS than in those with SSNS. During remission and still on corticosteroids, patients had higher TAC and similar MDA levels as in the proteinuric phase, but the TAC and MDA levels still significantly differed from those of the controls. More improvement in TAC and MDA levels occurred in patients following the weaning of corticosteroids, but TAC was still lower in the patients than in the controls. Moreover, TAC was higher in non-relapsers than in relapsers. Using a receiver operating characteristic curve, the initial response to corticosteroids could be predicted at serum TAC level > or =0.73 mM/L (sensitivity 89%, specificity 86%), while serum TAC levels < or = 1.14 mM/L after the weaning of corticosteroids could predict that the patient would not relapse (sensitivity 91%, specificity 80%). In conclusion, based on our results, PNS can be considered to be associated with oxidative stress even during remission. This stress may modulate the response to corticosteroids. Further prospective studies using larger numbers of patients are needed to validate these results.
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Affiliation(s)
- Ashraf Bakr
- Pediatric Nephrology, Mansoura Faculty of Medicine, Mansoura University Children's Hospital, Mansoura, Egypt.
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Choi SI, Kim TI, Kim KS, Kim BY, Ahn SY, Cho HJ, Lee HK, Cho HS, Kim EK. Decreased catalase expression and increased susceptibility to oxidative stress in primary cultured corneal fibroblasts from patients with granular corneal dystrophy type II. THE AMERICAN JOURNAL OF PATHOLOGY 2009; 175:248-61. [PMID: 19497990 DOI: 10.2353/ajpath.2009.081001] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Granular corneal dystrophy type II (GCD II) is an autosomal dominant disorder characterized by age-dependent progressive accumulation of transforming growth factor-beta-induced protein (TGFBIp) deposits in the corneal stroma. Several studies have suggested that corneal fibroblasts may decline with age in response to oxidative stress. To investigate whether oxidative stress is involved in the pathogenesis of GCD II, we assayed antioxidant enzymes, oxidative damage, and susceptibility to reactive oxygen species-induced cell death in primary cultured corneal fibroblasts (PCFs) from GCD II patients and healthy subjects. We found elevated protein levels of Mn-superoxide dismutase, Cu/Zn-superoxide dismutase, glutathione peroxidase, and glutathione reductase, as well as increased CAT mRNA and decreased catalase protein in GCD II PCFs. Furthermore, catalase is down-regulated in normal PCFs transfected with transforming growth factor-beta-induced gene-h3. We also observed an increase in not only intracellular reactive oxygen species and H(2)O(2) levels, but also malondialdehyde, 4-hydroxynonenal, and protein carbonyls levels in GCD II PCFs. Greater immunoreactivity for malondialdehyde was observed in the corneal tissue of GCD II patients. In addition, we observed a decrease in Bcl-2 and Bcl-xL levels and an increase in Bax and Bok levels in GCD II PCFs. Finally, GCD II PCFs are more susceptible to H(2)O(2)-induced cell death. Together, these results suggest that oxidative damage induced by decreased catalase is involved in GCD II pathogenesis, and antioxidant agents represent a possible treatment strategy.
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Affiliation(s)
- Seung-il Choi
- Department of Ophthalmology, Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Balakumar P, Vishal Arvind Chakkarwar, Kumar V, Jain A, Reddy J, Singh M. Experimental models for nephropathy. J Renin Angiotensin Aldosterone Syst 2008; 9:189-95. [DOI: 10.1177/1470320308098343] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Nephropathy is a leading cause of morbidity and mortality and its prevalence is continuously increasing in industrialised nations. Nephropathy is characterised to varying degrees by nodular glomerulosclerosis, glomerular basement membrane thickness and mesangial expansion, leading to a decline in glomerular filtration rate, persistent elevated albuminuria, elevated arterial blood pressure and fluid retention. Hyperglycaemia, hyperlipidaemia and hypertension are considered to be the major risk factors implicated in the progression of nephropathy.Various signalling systems, such as vasoconstrictor peptides, inflammatory mediators, growth factors and adhesion molecules, are involved in the pathogenesis of nephropathy.At present, no promising therapy is available to treat patients with nephropathy due to lack of understanding of signalling culprits involved in the pathogenesis of nephropathy. Animal models are being developed to better understand the disease pathogenesis and develop drugs for nephropathy. In the present review, we have discussed various animal models for nephropathy, which may open vistas for developing new drugs to treat nephropathy.
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Affiliation(s)
| | | | - Vijay Kumar
- Department of Pharmacy, Lovely Professional University, Jalandhar, India
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El-Melegy NT, Mohamed NA, Sayed MM. Oxidative modification of low-density lipoprotein in relation to dyslipidemia and oxidant status in children with steroid sensitive nephrotic syndrome. Pediatr Res 2008; 63:404-9. [PMID: 18356747 DOI: 10.1203/pdr.0b013e3181647af5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
It has been proposed that nephrotic syndrome is a consequence of an imbalance between oxidant/antioxidant statuses. The present study aimed to assess oxidant and antioxidant status in relation to dyslipidemia in children during remission and relapse phases of steroid sensitive nephrotic syndrome (SSNS). The study dealt with 40 children diagnosed as SSNS. They were categorized into two subgroups. The first subgroup included 25 children during remission stage. The second subgroup included 15 children during relapse. Control group consisted of age and gender-matched 15 healthy children. Significantly higher serum levels of malondialdehyde, oxidized LDL, total cholesterol, LDL cholesterol, triglycerides, apolipoprotein A-I, and apolipoprotein-B were observed in patients with SSNS especially in the relapsers. The serum levels of albumin, glutathione peroxidase activity, vitamin C, A, and E, and HDL cholesterol were significantly lower in patients especially among relapsers. In conclusion, a strong relationship between the oxidant/antioxidant status and dyslipidemia is documented in patients with SSNS, especially among relapsers. No normalization of the biochemical indices was observed despite the use of glucocorticoids. Therefore, the combined use of steroid, antioxidant therapy, and lipid lowering therapy can be recommended in such children.
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Affiliation(s)
- Nagla T El-Melegy
- Department of Biochemistry, Faculty of Medicine, Assiut University, Assiut 71515, Egypt.
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Koçer G, Şentürk ÜK, Kuru O, Gündüz F. Potential sources of oxidative stress that induce postexercise proteinuria in rats. J Appl Physiol (1985) 2008; 104:1063-8. [DOI: 10.1152/japplphysiol.00581.2007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Exercise-induced proteinuria is a common consequence of physical activity and is caused predominantly by alterations in renal hemodynamics. Although it has been shown that exercise-induced oxidative stress can also contribute to the occurrence of postexercise proteinuria, the sources of reactive oxygen species that promote it are unknown. We investigated the enzymes nicotinamide adenine dinucleotide phosphate (NADPH) oxidase and xanthine oxidase (XO) as possible sources of oxidative stress in postexercise proteinuria. First, we evaluated the effect of blocking the NADPH oxidase enzyme on postexercise proteinuria. We found a significant increase in urinary protein level, kidney thiobarbituric acid-reactive substances (TBARS), and protein carbonyl content after exhaustive exercise, and NADPH oxidase activity was induced by exercise. Rats that were treated with an NADPH oxidase inhibitor for 4 days before exhaustive exercise showed no increase in kidney TBARS or protein carbonyl derivative level and no proteinuria or NADPH oxidase activation. In the next set of experiments, we investigated the effect of XO blockage on postexercise proteinuria. Oxypurinol, an XO inhibitor was administered to rats for 3 days before exercise. Although XO inhibition significantly decreased kidney TBARS levels and protein carbonyl content in exercised rats, the inhibition did not prevent exercise-induced proteinuria. However, plasma and kidney XO activity was not induced by exercise, but rather it was suppressed under oxypurinol treatment. These results suggest that increased NADPH oxidase activity induced by exhaustive exercise is an important source of elevated oxidative, stress during exercise, which contributes to the occurrence of postexercise proteinuria.
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Sentürk UK, Kuru O, Koçer G, Gündüz F. Biphasic Pattern of Exercise-Induced Proteinuria in Sedentary and Trained Men. ACTA ACUST UNITED AC 2006; 105:p22-32. [PMID: 17179735 DOI: 10.1159/000097953] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2005] [Accepted: 10/03/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Exercise-induced proteinuria is a common consequence of physical activity, although its mechanism is not clear. Oxidant stress has been proposed as one of different factors involved in postexercise proteinuria in rats. In this study we investigated whether reactive oxygen radicals generated during exercise play a role in exercise-induced proteinuria in sedentary and trained men. METHODS The validity of oxidant stress following stepwise maximal exercise on proteinuria was investigated in sedentary and trained subjects before and after antioxidant vitamin treatment (A, C, and E) for 2 months. While protein carbonyl content in serum and thiobarbituric acid reactive substances (TBARS) in erythrocytes and urine were used as oxidant stress markers, total protein, albumin, beta(2)-microglobulin in urine were assayed for proteinuria in five consecutive specimens after exercise. Urines were collected before exercise, then 30 min, 2, 8 and 24 h postexercise. RESULTS Increased urinary protein levels and mixed type proteinuria were determined after 30 min of exercise in sedentary and trained subjects. Proteinuria was normalized at 2 and 8 h specimens. However, glomerular type proteinuria was identified at 24 h specimen in both groups. Oxidant stress markers were significantly elevated in sedentary and trained subjects. Antioxidant treatment prevented the increase in oxidant stress markers, urinary protein levels and the occurrence of glomerular type proteinuria after exhaustive exercise at 24 h in both groups. CONCLUSIONS These findings suggest that the exercise-induced oxidant stress may contribute to exercise-induced proteinuria in sedentary and trained men.
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Affiliation(s)
- Umit Kemal Sentürk
- Akdeniz University, Faculty of Medicine, Department of Physiology, Antalya, Turkey.
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Vielhauer V, Berning E, Eis V, Kretzler M, Segerer S, Strutz F, Horuk R, Gröne HJ, Schlöndorff D, Anders HJ. CCR1 blockade reduces interstitial inflammation and fibrosis in mice with glomerulosclerosis and nephrotic syndrome. Kidney Int 2005; 66:2264-78. [PMID: 15569315 DOI: 10.1111/j.1523-1755.2004.66038.x] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND CC chemokines mediate leukocyte infiltration into inflamed tissue. We have recently shown that blockade of the CC chemokine receptor CCR1 reduces interstitial inflammation and fibrosis in murine obstructive nephropathy. However, it is not known whether CCR 1 blockade is protective in progressive renal injury associated with severe proteinuria. We therefore studied the effect of the small-molecule CCR1 antagonist BX471 in a murine model of adriamycin-induced focal segmental glomerulosclerosis (FSGS) with nephrotic syndrome and progressive interstitial inflammation and fibrosis. METHODS Adriamycin nephropathy with persistent proteinuria was induced in male BALB/c mice by two intravenous injections of adriamycin (13 mg/kg) at day 0 and 14. BX471 treatment was started at day 14 when proteinuria and interstitial inflammation had developed. At 6 weeks, renal histology was studied by morphometry and immunohistochemistry. RESULTS At week 6, adriamycin-treated mice showed FSGS, associated with tubulointerstitial injury consisting of tubular dilation and atrophy, interstitial leukocyte infiltration, and fibrosis. The mRNA expression of CCR1 and CC chemokines, including the CCR1 ligands CCL3 (MIP-1alpha) and CCL5 (RANTES), was up-regulated in diseased kidneys, with a prominent interstitial expression of CCL5. Compared to vehicle-treated controls BX471 significantly reduced the amount of macrophages and T lymphocytes in interstitial lesions by 51% and 22%, respectively. Markers of renal fibrosis such as interstitial fibroblasts (48%) and interstitial volume (23%) were significantly reduced by BX471 treatment. In contrast, the extent of proteinuria and glomerular sclerosis was not affected by BX471 treatment. CONCLUSION Blockade of CCR1 substantially reduced interstitial leukocyte accumulation and the subsequent renal fibrosis in a murine model of nephrotic syndrome and FSGS. These findings support a role for CCR1 in interstitial leukocyte recruitment and suggest that CCR1 blockade might be a new therapeutic strategy in progressive nephropathies such as FSGS.
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MESH Headings
- Animals
- Antibiotics, Antineoplastic
- Chemokines/metabolism
- Doxorubicin
- Fibrosis
- Glomerulosclerosis, Focal Segmental/drug therapy
- Glomerulosclerosis, Focal Segmental/metabolism
- Glomerulosclerosis, Focal Segmental/pathology
- Kidney/pathology
- Leukocytes/pathology
- Male
- Mice
- Mice, Inbred BALB C
- Nephritis, Interstitial/drug therapy
- Nephritis, Interstitial/metabolism
- Nephritis, Interstitial/pathology
- Nephrotic Syndrome/drug therapy
- Nephrotic Syndrome/metabolism
- Nephrotic Syndrome/pathology
- Phenylurea Compounds/pharmacology
- Piperidines/pharmacology
- Proteinuria/drug therapy
- Proteinuria/metabolism
- Proteinuria/pathology
- Receptors, CCR1
- Receptors, Chemokine/antagonists & inhibitors
- Receptors, Chemokine/metabolism
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Affiliation(s)
- Volker Vielhauer
- Nephrologisches Zentrum, Medizinische Poliklinik Innenstadt, Ludwig-Maximilians-University, Munich, Germany.
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Gündüz F, Sentürk UK. The effect of reactive oxidant generation in acute exercise-induced proteinuria in trained and untrained rats. Eur J Appl Physiol 2003; 90:526-32. [PMID: 12905046 DOI: 10.1007/s00421-003-0888-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2003] [Indexed: 10/26/2022]
Abstract
Exercise-induced proteinuria is a common consequence of physical activity, although its mechanism is not clear. We investigated whether free radicals generated during exercise play a role in post-exercise proteinuria in sedentary and treadmill-running trained rats, separately. Sedentary and trained rats were randomly divided into four sub-groups: control, antioxidant treatment, exhaustive exercise and an exhaustive exercise plus antioxidant treatment group. Antioxidant therapy was applied by intragastric catheter for 4 weeks with vitamin C (ascorbic acid, 50 mg x kg(-1) x day(-1)) and vitamin E (alpha-tocopherol, 20 mg x kg(-1).day(-1)). Twenty-four-hour urine samples were used for measuring protein levels and protein electrophoresis. Thiobarbituric acid (TBARS) and glutathione (GSH) levels, superoxide dismutase (SOD) and catalase (CAT) activities were assayed in blood and tissues. Increased urinary protein levels and mixed type proteinuria in electrophoresis were identified after exhaustive exercise in sedentary rats. Erythrocyte, kidney and muscle TBARS levels were significantly elevated in this group. Antioxidant treatment prevented the increase in urinary protein levels, TBARS levels and the occurrence of mixed type proteinuria after exhaustive exercise in sedentary rats. Exhaustive exercise in trained rats resulted in elevation of urine protein levels and mixed type proteinuria although kidney TBARS levels were not changed compared to those of the trained controls. Antioxidant therapy in trained and exhausted-trained animals resulted in decreased TBARS levels in the kidney but it did not affect urinary-increased protein levels or electrophoresis in exhausted animals. This findings suggest that the exercise-induced oxidant stress may contribute to post-exercise proteinuria in sedentary rats. However, this mechanism may not be responsible for proteinuria in trained rats.
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Affiliation(s)
- Filiz Gündüz
- Department of Physiology, Medical Faculty, Akdeniz University, Kampus, 07070 Antalya, Turkey
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17
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Özalp-Yaman Ş, Önal AM, Türker L. Electrochemical and quantum chemical studies on mitomycin and adriamycin. J Mol Struct 2003. [DOI: 10.1016/s0022-2860(03)00176-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Lee GT, Ha H, Lee HC, Cho YD. Agmatine reduces hydrogen peroxide in mesangial cells under high glucose conditions. JOURNAL OF BIOCHEMISTRY AND MOLECULAR BIOLOGY 2003; 36:251-7. [PMID: 12787478 DOI: 10.5483/bmbrep.2003.36.3.251] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Agmatine, an amine and organic cation, reduced H(2)O(2) that was generated by hyperglycemia, and transcription factors such as NF-kappaB and AP-1 activity in the mesangial cells that were exposed to high glucose. However, spermine which shares a strong nucleophilic structure with agmatine decreased the H(2)O(2) levels and AP-1, but not the NF-kappaB activity. Possible roles for agmatine and spermine in decreasing fibronectin are discussed, and the signaling pathway for agmatine-reduced fibronectin accumulation is presented.
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Affiliation(s)
- Geun Taek Lee
- Department of Biochemistry, College of Science, Yonsei University, Seoul 120-749, Korea
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Kuin A, Kruse JJ, Stewart FA. Proteinuria and vascular changes after renal irradiation: the role of reactive oxygen species (ROS) and vascular endothelial growth factor (Vegf). Radiat Res 2003; 159:174-81. [PMID: 12537522 DOI: 10.1667/0033-7587(2003)159[0174:pavcar]2.0.co;2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Proteinuria occurs in all degrees of radiation nephropathy and can be present without other symptoms. In this study, radiation-induced proteinuria in C3H mice demonstrated a clear dose-response relationship and was apparent before the onset of significant structural vascular changes and decreases in renal function. This suggests that proteinuria is not a secondary event due to loss of the vascular structure. In an attempt to ameliorate radiation-induced proteinuria and progressive renal failure, two factors were studied. The influence of reactive oxygen species (ROS), which are generated by infiltrating neutrophils and mediate proteinuria in models of acute glomerular injury, was the first to be investigated. Short-term administration of the reactive oxygen scavengers superoxide dismutase (SOD) and catalase did not reverse an established radiation-induced proteinuria. Continuous administration of the antioxidant N-acetylcysteine (NAC) also failed to inhibit this proteinuria. However, since no direct assessment of the impact of these interventions on renal redox status was made, the putative role of ROS in radiation-induced proteinuria and nephropathy remains undefined. The second factor studied was vascular endothelial growth factor (Vegf), which is suggested to be involved in glomerular vessel permeability and the development of proteinuria in some models of renal disease. Northern blot analysis of mRNA from whole kidneys did not demonstrate any increased expression of Vegf after irradiation. There was also no change in the ratio of the different Vegf isoforms (PCR analysis), either in the whole kidney or in isolated glomeruli. No significant role for Vegf was identified for radiation-induced vascular changes or proteinuria, although post-transcriptional changes cannot be excluded.
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Affiliation(s)
- Annemieke Kuin
- Division of Experimental Therapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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20
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Dziegiel P, Suder E, Surowiak P, Jethon Z, Rabczyński J, Januszewska L, Sopel M, Zabel M. Role of exogenous melatonin in reducing the nephrotoxic effect of daunorubicin and doxorubicin in the rat. J Pineal Res 2002; 33:95-100. [PMID: 12153443 DOI: 10.1034/j.1600-079x.2002.02902.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The aim of these studies was to examine the nephroprotective effect of melatonin following the anthracycline administration [daunorubicin (DNR); doxorubicin (DOX)] in rats. Application of these drugs in chemotherapy is limited because of their cardiotoxicity and nephrotoxicity. Rats of the Buffalo strain were divided into groups according to the cytostatic drug used, its dose and sequence of administration [DNR or DOX single (i.v.) dose of 10 mg/kg b.w., i.e. acute intoxication and 3 mg/kg b.w. (i.v.) weekly for 3 wk, subchronic intoxication]. Melatonin was administered subcutaneously before and after every injection of a cytostatic drug at a dose of 10 mg/kg b.w. The severity of renal alterations was examined both biochemically [levels of lipid peroxidation markers, malonyldialdehyde (MDA) and 4-hydroxyalkenals (4-HDA)], or histologically. A statistically significant decrease in renal damage was noted after melatonin administration to acutely or subchronically intoxicated DNR-treated and DOX-treated rats. Biochemical assays revealed significant decreases in MDA and 4-HDA levels following application of melatonin during subchronic DNR or DOX intoxication. In summary, melatonin was found to exert a protective effect on the kidney, which was particularly evident after subchronic DOX and DNR intoxication, using both histological or biochemical methods.
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Affiliation(s)
- Piotr Dziegiel
- Department of Histology and Embryology, Wrocław Medical University, Chałubińskiego 6a, Wrocław, Poland.
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22
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Ohtake T, Kimura M, Takemura H, Hishida A. Effects of dietary lipids on daunomycin-induced nephropathy in mice: comparison between cod liver oil and soybean oil. Lipids 2002; 37:359-66. [PMID: 12030316 DOI: 10.1007/s1145-002-0903-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although it is well known that dietary lipids affect the course of glomerulonephritis in rats and humans, the precise mechanisms involved have not been fully elucidated. The aim of this study was to investigate the effects of different types of dietary lipids (fish oil and vegetable oil) on daunomycin (DM)-induced nephropathy in mice fed on soybean oil (SO) or cod liver oil (CLO). Urinary protein excretion, serum albumin, creatinine, total cholesterol, and TG were measured, and glomerular histological changes were evaluated. Antioxidant enzymes were also measured, along with the levels of lipid peroxide, GSH, thromboxane (Tx) B2, and 6-keto prostaglandin F1alpha in renal cortical tissue. Dietary CLO significantly reduced urinary albumin excretion and ameliorated the histological changes induced by DM. The increase of tissue lipid peroxide levels seen in SO-fed mice was suppressed in CLO-fed mice, whereas CLO-fed mice showed higher GSH levels than SO-fed mice throughout the experiment. In addition, renal tissue GSH peroxidase activity was significantly higher at 72 h after DM injection in CLO-DM mice than in SO-DM mice. Both renal cortical TxB2 and 6-keto PGF1alpha levels were significantly lower in CLO-DM mice than in SO-DM mice. These results suggest that inhibition of oxidative damage by dietary CLO played an important role in the prevention of DM nephropathy in this mouse model. The effect of CLO was closely associated with the inhibition of Tx synthesis.
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Affiliation(s)
- Takayasu Ohtake
- Department of Medicine, Fujinomiya City General Hospital, Japan
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23
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Wang Y, Wang Y, Feng X, Bao S, Yi S, Kairaitis L, Tay YC, Rangan GK, Harris DC. Depletion of CD4(+) T cells aggravates glomerular and interstitial injury in murine adriamycin nephropathy. Kidney Int 2001; 59:975-84. [PMID: 11231352 DOI: 10.1046/j.1523-1755.2001.059003975.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND CD4(+) T cells play an important role in various types of immunologic renal disease, including lupus nephritis, IgA nephropathy, and crescentic glomerulonephritis. CD4(+) T cells are also major infiltrating lymphocytes in chronic tubulointerstitial inflammation associated with nonimmunological renal diseases. We suspected that CD4(+) T cells might contribute to disease progression and loss of renal function in chronic proteinuric renal disease (CPRD). To investigate this possibility, the effect of monoclonal antibody against CD4(+) lymphocytes (anti-CD4) was studied in a murine model (adriamycin nephropathy) of CPRD. METHODS Adriamycin nephropathy was produced in male BALB/c mice by a single intravenous injection of adriamycin (11 mg/kg). Anti-CD4 was given by intraperitoneal injection following the development of proteinuria at days 5, 6, 7, 21, and 37 after adriamycin. After six weeks, renal function and histology were studied by histomorphometry, immunohistochemistry, and flow cytometry. RESULTS Flow cytometric analysis showed a marked decrease in the number of CD4(+) T cells in blood and spleen of the antibody-treated animals (N = 7, P < 0.01). Adriamycin plus CD4(+) depletion mice had significantly greater mesangial expansion, glomerular sclerosis, and interstitial expansion than the mice on adriamycin alone. Interstitial infiltration with macrophages and CD8(+) cells was significantly increased in adriamycin plus CD4(+) depletion mice. Creatinine clearance (17.5 +/- 0.54 vs. 29.2 +/- 0.89 microL/min, P < 0.001) was significantly worse in the adriamycin plus CD4(+) depletion mice than in adriamycin alone mice and correlated with histologic change in glomeruli and interstitium. CONCLUSIONS Depletion of CD4(+) T cells promotes glomerular and interstitial injury in mice with established adriamycin nephropathy. These findings suggest that CD4(+) T cells have a protective role against the progression of adriamycin nephropathy.
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Affiliation(s)
- Y Wang
- Department of Renal Medicine, The University of Sydney at Westmead Hospital, Westmead, New South Wales, Australia.
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24
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Pedraza-Chaverrí J, Granados-Silvestre MD, Medina-Campos ON, Maldonado PD, Olivares-Corichi IM, Ibarra-Rubio ME. Post-transcriptional control of catalase expression in garlic-treated rats. Mol Cell Biochem 2001; 216:9-19. [PMID: 11216869 DOI: 10.1023/a:1011050619406] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Regulation of catalase (CAT) expression, a major antioxidant enzyme that detoxifies H2O2, is very complex. Garlic is effective to prevent or ameliorate oxidative stress probably through its intrinsic antioxidant properties and/or to its ability to modify antioxidant enzyme expression. In this paper we studied the effect of a 2% garlic diet on the renal and hepatic CAT expression (mRNA levels, and enzyme activity, content, synthesis, and degradation). The study was made 2 weeks after feeding rats with a 2% garlic diet. CAT activity and content were measured by a spectrophotometric method and Western blot, respectively. CAT mRNA levels and CAT synthesis (k(s)) and degradation (kD) in vivo were measured by Northern blot and kinetic of reappearance of CAT activity after aminotriazole injection, respectively. Garlic-treatment decreased CAT activity and content, and CAT mRNA levels were unchanged in both tissues. k(s) decreased and kD remained unchanged in kidney and liver. The decrease in k(s) without changes in kD and CAT mRNA levels could explain the low CAT expression in garlic-fed rats. In vivo H2O2 generation in kidney and liver was markedly decreased in garlic-fed rats which could be due to a direct antioxidant effect of garlic. This may be the initial event in the garlic-fed rats that leads to the decreased CAT expression. Our data strongly suggest that the diminished renal and hepatic CAT expression in garlic-fed rats is mediated by post-transcriptional changes (mainly low translational efficiency) which could be an adaptation to the low H2O2.
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Affiliation(s)
- J Pedraza-Chaverrí
- Department of Biology, Faculty of Chemistry, National Autonomous University of Mexico UNAM, México
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Gwinner W, Gröne HJ. Role of reactive oxygen species in glomerulonephritis. Nephrol Dial Transplant 2000; 15:1127-32. [PMID: 10910434 DOI: 10.1093/ndt/15.8.1127] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- W Gwinner
- Department of Nephrology, Medical School, Hannover, Germany
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Pedraza-Chaverri J, Granados-Silvestre MD, Medina-Campos ON, Hernández-Pando R. Effect of the in vivo catalase inhibition on aminonucleoside nephrosis. Free Radic Biol Med 1999; 27:245-53. [PMID: 10468195 DOI: 10.1016/s0891-5849(99)00023-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Reactive oxygen species have been involved in the pathophysiology of puromycin aminonucleoside (PAN)-nephrosis. The role of H2O2 in these rats may be studied modulating the amount or activity of catalase, which breakdowns H2O2 to water and oxygen. To explore the role of H2O2 in this experimental model, we studied the effect of the in vivo catalase inhibiton with 3-amino-1,2,4-triazole (ATZ) on the course of PAN-nephrosis. Four groups of rats were studied: control rats (CT group), PAN-injected rats (PAN group), ATZ-injected rats (ATZ group), and ATZ- and PAN-injected rats (ATZPAN group). Rats were placed in metabolic cages to collect 24 h urine along the study, ATZ (1 g/kg) was given 24 h before PAN injection (75 mg/kg), and the proteinuria was measured on days 0, 2, 4, 6, 8, and 10. Proteinuria started before (day 4) and was significantly higher on days 6, 8, and 10 in the ATZPAN group than in the PAN group. On day 10, hypercholesterolemia was significantly higher in the ATZPAN group than in the PAN group. These data indicate that the in vivo catalase inhibition magnifies PAN-nephrosis, suggesting that H2O2 is produced in vivo and involved in the renal damage in this experimental disease.
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Affiliation(s)
- J Pedraza-Chaverri
- Department of Biology, Faculty of Chemistry, National Autonomous University of Mexico, México, D.F.
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Rangan GK, Wang Y, Tay YC, Harris DC. Inhibition of nuclear factor-kappaB activation reduces cortical tubulointerstitial injury in proteinuric rats. Kidney Int 1999; 56:118-34. [PMID: 10411685 DOI: 10.1046/j.1523-1755.1999.00529.x] [Citation(s) in RCA: 142] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Protein-induced chemokine expression in proximal tubular cells is mediated by the transcription factor nuclear factor-kappa B (NF-kappaB). We hypothesized that in vivo inhibition of renal NF-kappaB activation would reduce interstitial monocyte infiltration in a rat model of nonimmune proteinuric tubulointerstitial inflammation. METHODS Male Wistar rats received a single intravenous injection of doxorubicin hydrochloride [adriamycin (ADR), 7.5 mg/kg] and were studied 7, 14, 21, and 28 days later. In a second study, inhibitors of NF-kappaB [N-acetylcysteine (NAC; 150 mg/kg, b.i.d., i.p.), pyrrolidine dithiocarbamate (PDTC, 50 mg/kg, b. i.d., i.p.)] or vehicle were commenced on day 14 after the onset of proteinuria and were continued until day 30. RESULTS Rats injected with ADR had increased proteinuria (UpV, day 28, 474 +/- 57; control, 18 +/- 2 mg/day; P < 0.01) and cortical tubulointerstitial injury [tubule cell atrophy, interstitial volume, and monocyte/macrophage (ED-1) infiltration]. Electrophoretic mobility shift assay of nuclear extracts from whole cortex of ADR rats demonstrated that NF-kappaB activation (p50/65, p50/c-Rel) increased from day 7 (4.7 +/- 0.2 fold-increase above control; P < 0.01) was maximal at day 28 (6.2 +/- 0.7; P < 0.01) and correlated with UpV (r = 0.63; P < 0.05) and interstitial ED-1 infiltration (r = 0.67; P < 0.01). Chronic treatment of ADR rats with PDTC suppressed NF-kappaB activation (by 73%; P < 0.05) without any effect on UpV. NF-kappaB inhibition with PDTC was accompanied by a reduction in tubule cell atrophy (59%; P < 0.01), interstitial volume (49%; P < 0.05) and ED-1 infiltration (48%; P < 0.01), and cortical lipid peroxidation (41%; P < 0.05) compared with vehicle-treated ADR rats. In contrast NAC had no effect on NF-kappaB activation, tubulointerstitial injury, or UpV in ADR rats. CONCLUSION The activation of NF-kappaB may have an important role in mediating cortical interstitial monocyte infiltration and tubular injury in nonimmune proteinuric tubulointerstitial inflammation.
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Affiliation(s)
- G K Rangan
- Department of Renal Medicine, University of Sydney at Westmead Hospital, Australia
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Matsushima H, Yonemura K, Ohishi K, Hishida A. The role of oxygen free radicals in cisplatin-induced acute renal failure in rats. THE JOURNAL OF LABORATORY AND CLINICAL MEDICINE 1998; 131:518-26. [PMID: 9626987 DOI: 10.1016/s0022-2143(98)90060-9] [Citation(s) in RCA: 211] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We examined the role of oxygen free radicals in cisplatin-induced acute renal failure (ARF). The intravenous injection of cisplatin (5 mg/kg body weight) induced an increase in serum creatinine and tubular damage in the outer stripe of the outer medulla in rats. The renal content of malondialdehyde (MDA) transiently increased. Treatment with the free radical scavengers dimethylthiourea (DMTU) or lecithinized superoxide dismutase (L-SOD) attenuated the increase in serum creatinine. The beneficial effect of DMTU, a hydroxyl radical scavenger, was associated with less accumulation of MDA, less tubular damage, and enhanced expression of proliferating cell nuclear antigen (PCNA) in the damaged tubular cells, but not with improvement of reduced renal blood flow (RBF). On the other hand, the beneficial effect of L-SOD, a superoxide anion scavenger, was associated with preservation of RBF and increased urinary guanosine 3',5'-cyclic monophosphate excretion but not with modification of tubular damage or PCNA expression. These results suggest that (1) cisplatin-induced nephrotoxicity was associated with lipid peroxidation, (2) the hydroxyl radical scavenger prevented ARF through both attenuation of tubular damage and enhanced regenerative response of the damaged tubular cells, and (3) the superoxide anion scavenger did the same through preservation of RBF. It follows that oxygen free radicals may play an important role in cisplatin-induced ARF by reducing RBF and inducing tubular damage.
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Affiliation(s)
- H Matsushima
- First Department of Medicine, Hamamatsu University School of Medicine, Japan
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