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Grenz A, Baier D, Petroktistis F, Wehrmann M, Köhle C, Schenk M, Sessler M, Gleiter CH, Fandrich F, Osswald H. Theophylline Improves Early Allograft Function in Rat Kidney Transplantation. J Pharmacol Exp Ther 2006; 317:473-9. [PMID: 16410406 DOI: 10.1124/jpet.105.096917] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Several previous studies have demonstrated a beneficial effect of the adenosine receptor (AdoR) antagonist theophylline in different forms of acute renal failure in laboratory animals and in humans. Therefore, we wanted to test whether theophylline can also improve impaired allograft function following ischemia reperfusion injury in experimental kidney transplantation (KT). Orthotopic transplantation of the left kidney was performed from Fisher 344 into Lewis rats. All transplanted rats received daily cyclosporine (5 mg/kg). The effect of theophylline treatment (10 mg/kg) on graft function was compared with appropriate controls on day 5 after KT by assessment of glomerular filtration rate (GFR) (inulin clearance). On day 5, GFR of allografts in control rats was 0.23 +/- 0.05 ml/min/g kidney weight (n = 10) compared with 0.50 +/- 0.09 ml/min/g in rats receiving theophylline (n = 9, p < 0.01), representing a 2-fold increase in GFR. Renal AdoR A(1) mRNA content was significantly increased in both KT groups compared with their respective control groups, whereas mRNA of AdoR A(2a), A(2b), and A(3) were found to be unchanged. Theophylline did not affect significantly interstitial infiltration of the graft by monocytes/macrophages and T-cells. Likewise, serum cytokines [interleukin (IL)-2, IL-6, IL-10, tumor necrosis factor-alpha] and erythropoietin plasma levels were not different among the allograft groups. The present study demonstrates that theophylline remarkably improved early renal allograft function in rats undergoing KT without influencing cytokine serum patterns or tissue inflammation. Since theophylline is a commonly used medication in humans, clinical studies in patients undergoing KT are warranted.
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Affiliation(s)
- Almut Grenz
- Institute of Pharmacology and Toxicology, Wilhelmstrasse 56, D-72074 Tuebingen, Germany
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Abstract
This review discusses the concept that nitric oxide synthase (NOS) may orchestrate both the inflammatory response to the renal allograft and anti-inflammatory defense in the graft itself. NO is produced by endothelial, epithelial, as well as inflammatory cells. In the setting of transplantation, the endothelium is the first lining to be subjected to the early response to injury. In turn, activated endothelial cells facilitate leukocyte recruitment, immune-mediated injury, and angiogenesis. On activation by inflammatory stimuli, endothelial cells up-regulate multiple vasoactive substances, oxygen radicals, cytokines, chemokines, and growth factors. Therefore, endothelial integrity, especially the expression of protecting vasoactive agents, such as NO, may be a key factor in resistance or sensitivity to transplantation-mediated injury. Thus, evaluating the mechanisms by which NO is involved in either protecting or injuring the transplanted allogeneic kidney is important for our understanding of renal allograft rejection. This review focuses on the role of NO in the inflammatory endothelial-leukocyte interactions, which are implicated in acute and chronic rejection of the transplanted kidney.
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Affiliation(s)
- Ingrid H C Vos
- Department of Pathobiology, Division of Physiology, Leiden University Medical Center, The Netherlands.
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Gourishankar S, Melk A, Halloran P. Nonimmune Mechanisms of Injury in Renal Transplantation. Transplant Rev (Orlando) 2002. [DOI: 10.1053/trre.2002.23263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Vos IHC, Rabelink TJ, Dorland B, Loos R, Middelaar BVAN, Gröne HJ, Joles JA. L-arginine supplementation improves function and reduces inflammation in renal allografts. J Am Soc Nephrol 2001; 12:361-367. [PMID: 11158227 DOI: 10.1681/asn.v122361] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Recovery from ischemia/reperfusion and immune-mediated injury in the renal transplant is associated with reduced renal hemodynamics and increased leukocyte infiltration. In diverse models of renal failure, L-arginine supplementation improved hemodynamics and reduced inflammation. However in a proinflammatory environment, L-arginine can worsen renal injury. This study investigated the therapeutic potential of L-arginine supplementation in allogeneic renal transplantation: Brown Norway rat kidneys were transplanted into Lewis rat recipients, with one native kidney remaining. Recipients received low-dose cyclosporin A (2.5 mg/kg per d subcutaneously) to obtain moderate vascular and interstitial rejection, with or without 1% L-arginine in drinking water for 7 d posttransplantation. Transplantation increased renal vasoconstriction (from 16.9 +/- 1.33 to 35.1 +/- 8.6 units; P: < 0.01), thereby reducing GFR (from 0.96 +/- 0.09 to 0.48 +/- 0.10 ml/min; P: < 0.05). Treatment with L-arginine restored renal graft function to levels found in normal donors (renal vascular resistance, 15.7 +/- 1.69 units; GFR, 0.80 +/- 0.06 ml/min). L-arginine significantly reduced vascular occlusion because of less inflammation, endothelial disruption, and thrombosis. L-arginine also decreased tubulitis, interstitial injury, and macrophage infiltration. These protective effects suggest that L-arginine might be useful as additive therapy to conventional immune suppression.
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Affiliation(s)
- Ingrid H C Vos
- Department of Nephrology and Hypertension, University Medical Center, Utrecht, the Netherlands
| | - Ton J Rabelink
- Department of Vascular Medicine, University Medical Center, Utrecht, the Netherlands
| | - Bert Dorland
- Department of Laboratory of Metabolic Diseases, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Remko Loos
- Department of Laboratory of Metabolic Diseases, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Ben VAN Middelaar
- Department of Nephrology and Hypertension, University Medical Center, Utrecht, the Netherlands
| | - Hermann-Josef Gröne
- Department of Department of Cellular and Molecular Pathology, German Cancer Research Center, Heidelberg, Germany
| | - Jaap A Joles
- Department of Nephrology and Hypertension, University Medical Center, Utrecht, the Netherlands
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Kim YS, Lim CS, Kim S, Lee JS, Lee S, Kim ST, Kim HJ, Chae DW. Cadaveric renal allograft at the time of implantation has the similar immunological features with the rejecting allograft. Transplantation 2000; 70:1080-5. [PMID: 11045646 DOI: 10.1097/00007890-200010150-00015] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Compared to living donations, cadaveric transplants have a poorer outcome, and the immunologic status of renal tissues at the time of transplantation might influence the final outcome of the renal allograft. PATIENTS AND METHODS We used quantitative RT-PCR to evaluate the differential expression of cytokine genes from 37 implantation tissues [18 cadaveric tissues (CI), 19 specimens from living donors (LI)]. We compared them with 17 acutely rejecting allograft (AR). RESULTS Acute rejection within 6 months after transplantation occurred 8 times in patients with cadaveric allograft, but the living-donor recipients experienced 4 episodes (P<0.05). Proinflammatory cytokines were co-expressed more frequently in CI than in LI. The levels of IFN-gamma, TNF-alpha and IL-10 mRNA were also higher in CI. We compared the profiles of several cytokine expressions of CI with those of AR. The messages for IL-6 were more abundant in the CI, IFN-gamma was more expressed in AR, and the other cytokine expression levels were similar in both types. However, when comparing LI and AR, all the cytokine messages except IL-6 were up-regulated in AR than in LI. In CI, the levels of cytokine gene expressions were similar despite various cold ischemic time except IL-10 that were elevated for those cases where the operation was done within 4 hr of nephrectomy. CONCLUSIONS The numbers and levels of gene transcription of inflammatory cytokines were higher in the tissues from a cadaver, and were not different from those of AR. This immunologic hostility at the time of implantation would contribute to the poorer outcome of cadaveric allograft.
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Affiliation(s)
- Y S Kim
- Department of Internal Medicine and Clinical Research Institute, Seoul National University College of Medicine, Korea
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Vos IH, Joles JA, Schurink M, Weckbecker G, Stojanovic T, Rabelink TJ, Gröne HJ. Inhibition of inducible nitric oxide synthase improves graft function and reduces tubulointerstitial injury in renal allograft rejection. Eur J Pharmacol 2000; 391:31-8. [PMID: 10720632 DOI: 10.1016/s0014-2999(00)00021-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Increased levels of nitric oxide (NO) are found in rejecting renal allografts. Inducible NO synthase (iNOS) in infiltrating monocytes/macrophages could lead to NO bursts. NO may modulate the inflammatory response of early rejection due to its high reactivity with superoxide to yield peroxynitrite. To define the role of iNOS in acute renal allograft, rejection effects of the specific iNOS blockers iminoethyl-lysine and 7-butylhexahydro-1H-azepin-2-imine, monohydrochloride on renal function and morphology were investigated in renal allografts. Lewis rats received Brown Norway grafts with one kidney left in situ. All recipients were treated with low dose cyclosporine-A (2.5 mg/kg BW/day s.c.) to allow moderate rejection. In addition, one group received iminoethyl-lysine (10 mg/kg BW/day gavage) and one group received butylhexahydro-azepin-imine (3.4 mg/kg BW/day i.p.). Sham operated Brown Norway donor rats served as baseline controls. Compared to controls, low dose cyclosporine-A decreased glomerular filtration rate (P<0.05) and numerically increased renal vascular resistance. Adding iminoethyl-lysine to cyclosporine-A improved renal hemodynamics. Adding butylhexahydro-azepin-imine to cyclosporine-A practically restored glomerular filtration rate and renal vascular resistance (P<0.05) to control levels. Grafts treated with cyclosporine-A alone showed vascular, glomerular and tubulointerstitial lesions. Adding iminoethyl-lysine or butylhexahydro-azepin-imine to cyclosporine-A did not significantly reduce vascular and glomerular injury, but diminished tubulointerstitial injury as well as nitrotyrosine staining in tubular epithelium (P<0.05). Thus, adding the iNOS blockers iminoethyl-lysine or butylhexahydro-azepin-imine to cyclosporine-A improved graft function and reduced tubulointerstitial lesions.
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Affiliation(s)
- I H Vos
- Department of Nephrology and Hypertension, University Medical Center, Utrecht, The Netherlands
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Oei FB, Welters MJ, Bonthuis F, Vaessen LM, Marquet RL, Zondervan PE, Weimar W, Bogers AJ. A size-matching heterotopic aortic valve implantation model in the rat. J Surg Res 1999; 87:239-44. [PMID: 10600355 DOI: 10.1006/jsre.1999.5763] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Structural failure of cardiac valve allografts may be related to technical factors such as size mismatch, resulting in early intimal proliferation and fibrosis or immunological reactions against the transplanted valves, featuring lymphocytic infiltration. OBJECTIVE To develop a heterotopic aortic valve implantation model in the rat to study the immunological factors leading to graft failure in the setting of a technical adaptation for size mismatch. METHODS Syngeneic (WAG-WAG or DA-DA) and allogeneic (WAG-BN or WAG-DA) rat strain combinations were used to study the effect of the allogeneic response on valve properties. An end-to-side anastomosis was made between the U-shaped aortic root graft and the recipient's abdominal aorta to resolve the problems of size matching. RESULTS No animals suffered from ischemic or neurological complications during the study period. One hundred percent survival and patency of the aortic grafts were achieved at the end of a 21-day observation period. In the syngeneic group 9 of 10 valves were still competent when assessed during retrograde injection. In contrast, 2 of 10 allogeneic valve grafts were competent on postoperative Day 21. Microscopic evaluation revealed no fibrosis or intimal thickening in the syngeneic valve grafts while the allogeneic valve grafts demonstrated rejection-like morphology. CONCLUSION The absence of fibrosis and intimal thickening in the syngeneic transplanted valve grafts indicates that this implantation model is not influenced by nonimmunological-based structural changes. Therefore, this new model enables us to study the association between donor-directed immune responses and allograft degeneration in a technically unbiased manner.
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Affiliation(s)
- F B Oei
- Department of Thoracic Surgery, University Hospital Rotterdam-Dijkzigt, Rotterdam, The Netherlands.
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Dodd SM. Chronic allograft nephropathy: the inevitable outcome of renal transplantation? CURRENT TOPICS IN PATHOLOGY. ERGEBNISSE DER PATHOLOGIE 1999; 92:37-60. [PMID: 9919806 DOI: 10.1007/978-3-642-59877-7_3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- S M Dodd
- Department of Morbid Anatomy and Histopathology, St. Bartholomew's, London, UK
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Kouwenhoven EA, Marquet RL, Bonthuis F, IJzermans JN, de Bruin RW. The role of alloantigen-independent factors in transplant arteriosclerosis. Transplant Proc 1997; 29:1721-2. [PMID: 9142246 DOI: 10.1016/s0041-1345(97)00029-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- E A Kouwenhoven
- Dept of Surgery, Erasmus University, Rotterdam, The Netherlands
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Macchiarini P, Mazmanian GM, de Montpréville VT, Dulmet EM, Chapelier AL, Dartevelle PG. Maximal preservation time of tracheal allografts. The Paris-Sud University Lung Transplantation Group. Ann Thorac Surg 1995; 60:1597-604. [PMID: 8787449 DOI: 10.1016/0003-4975(95)00811-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Our objective was to study the maximal preservation time of directly revascularized tracheal allografts in immunosuppressed piglets. METHODS Donor grafts were flushed with Euro-Collins solution (65 mL/kg at 4 degrees C) by simultaneous inferior thyroid artery and bronchial artery perfusion through a 15-cm aortic segment and heterotopically implanted on their own vascular pedicle after 3 (group 1), 6 (group 2), 15 (group 3), and 24 (group 4) hours of static storage in Euro-Collins solution at 4 degrees C (n = 5 each). The animals were observed for 4 weeks after transplantation and then sacrificed. Histologic evaluation of the tracheal allografts was routinely done using specimens from open biopsies. RESULTS The overall length of tracheal grafts was 12.4 +/- 0.6 cm, and this variable was not significantly different between the four groups. Graft exocrine (mucous secretion) function began 1.3 +/- 0.5 days after transplantation in groups 1 through 3 but was absent in all group 4 grafts (p < 0.0001). All grafts in groups 1 through 3 were viable at the time of sacrifice and showed little discernible intergroup and intragroup histologic and functional (tracheal smooth muscle contraction and relaxation) variations except for a significantly higher (p < 0.001) incidence of rejection in group 3 allografts. In contrast, all grafts in group 4 became completely necrotic 4 days after transplantation (p < 0.001) despite full patency of all the vascular anastomoses. CONCLUSIONS These results demonstrate that tracheal allografts may be safely preserved for as long as 15 hours and that longer periods of ischemia are likely to result in irreversible allograft damage.
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Affiliation(s)
- P Macchiarini
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, Le Plessis Robinson, Paris-Sud University, France
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Paul LC. Aspects of allograft rejection, III: Clinical assessment of renal allograft rejection. Transplant Rev (Orlando) 1995. [DOI: 10.1016/s0955-470x(95)80022-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Although chronic rejection remains the most crucial cause of organ graft loss over the long term, its etiology is not well defined. Early injury to graft endothelial cells caused by alloantigen-independent factors, such as ischemia or reperfusion, as well as alloantigen-dependent events, such as acute rejection, have been implicated. Macrophages and their products, peptide growth factors and adhesion molecules are all thought to play an important role in this process via the cytokine-adhesion molecule cascade. Although new immunosuppressive agents, including RS61443 or rapamycin, may be effective in preventing antigen-driven components of this condition, risk factors for initial non-immune injury must also be considered and, if possible, countered.
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Affiliation(s)
- H Azuma
- Surgical Research Laboratory, Harvard Medical School, Boston, Massachusetts
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Tullius SG, Heemann U, Hancock WW, Azuma H, Tilney NL. Long-term kidney isografts develop functional and morphologic changes that mimic those of chronic allograft rejection. Ann Surg 1994; 220:425-32; discussion 432-5. [PMID: 7944655 PMCID: PMC1234410 DOI: 10.1097/00000658-199410000-00002] [Citation(s) in RCA: 131] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE This study examined antigen-independent factors in the pathogenesis of chronic rejection of organ transplants. SUMMARY BACKGROUND DATA In addition to alloantigen-dependent events, antigen-independent factors can influence chronic rejection of organ allografts. Initial injury, including early ischemia and acute rejection, may contribute. METHODS Kidney isografts were transplanted orthotopically into bilaterally nephrectomized rat recipients and studied functionally, morphologically and immunohistologically, at serial intervals up to 72 weeks after transplantation. Controls included chronically rejecting kidney allografts using a well-established model, non-nephrectomized and uninephrectomized animals with a native kidney that had undergone initial ischemia and uninephrectomized rats whose remaining kidney had been manipulated operatively. RESULTS Allograft recipients developed progressive proteinuria after 12 weeks, with gradual renal failure ultimately leading to death. At the same time, morphologic changes, including progressive arteriosclerosis and glomerulosclerosis, tubular atrophy, and interstitial fibrosis, developed. Immunohistologically, macrophages infiltrated glomeruli during this period and cytokines became upregulated. Comparable changes occurred in isografts, but later, beginning after week 24 and progressing thereafter. The single ischemic kidney in uninephrectomized controls also developed the same lesions; no comparable changes were noted in other control kidneys. CONCLUSIONS Antigen-independent functional and morphologic changes occur in long-term kidney isografts that resemble those appearing considerably earlier in allografts that reject chronically. Initial injury and extent of functioning renal mass may be important factors for such late changes.
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Affiliation(s)
- S G Tullius
- Surgical Research Laboratory, Harvard Medical School, Boston, Massachusetts
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