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Hinze C, Lovric S, Halloran PF, Barasch J, Schmidt-Ott KM. Epithelial cell states associated with kidney and allograft injury. Nat Rev Nephrol 2024:10.1038/s41581-024-00834-0. [PMID: 38632381 DOI: 10.1038/s41581-024-00834-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 04/19/2024]
Abstract
The kidney epithelium, with its intricate arrangement of highly specialized cell types, constitutes the functional core of the organ. Loss of kidney epithelium is linked to the loss of functional nephrons and a subsequent decline in kidney function. In kidney transplantation, epithelial injury signatures observed during post-transplantation surveillance are strong predictors of adverse kidney allograft outcomes. However, epithelial injury is currently neither monitored clinically nor addressed therapeutically after kidney transplantation. Several factors can contribute to allograft epithelial injury, including allograft rejection, drug toxicity, recurrent infections and postrenal obstruction. The injury mechanisms that underlie allograft injury overlap partially with those associated with acute kidney injury (AKI) and chronic kidney disease (CKD) in the native kidney. Studies using advanced transcriptomic analyses of single cells from kidney or urine have identified a role for kidney injury-induced epithelial cell states in exacerbating and sustaining damage in AKI and CKD. These epithelial cell states and their associated expression signatures are also observed in transplanted kidney allografts, suggesting that the identification and characterization of transcriptomic epithelial cell states in kidney allografts may have potential clinical implications for diagnosis and therapy.
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Affiliation(s)
- Christian Hinze
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Svjetlana Lovric
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Philip F Halloran
- Alberta Transplant Applied Genomics Centre, Edmonton, Alberta, Canada
- Department of Medicine, Division of Nephrology and Transplant Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Jonathan Barasch
- Division of Nephrology, Columbia University, New York City, NY, USA
| | - Kai M Schmidt-Ott
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany.
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2
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Dahiya K, Prashant P, Dhankhar R, Dhankhar K, Kumar S, Vashist S. Lipocalin-2 as a biomarker for diabetic nephropathy. World J Meta-Anal 2023; 11:92-101. [DOI: 10.13105/wjma.v11.i4.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/11/2023] [Accepted: 03/29/2023] [Indexed: 04/14/2023] Open
Abstract
Diabetes is a major global public health issue. The prevalence of type 1 diabetes is comparatively static, as hereditary and genetic causes are involved, while type 2 diabetes (T2D) prevalence is increasing day by day. T2D is associated with chronic complications, including diabetic neuropathy (DN), nephropathy, retinopathy, and other complications like diabetic foot. DN is the main complication of both types of diabetes. DN can be diagnosed by routine laboratory tests, microalbuminuria > 300 mg/24 h, and a gradual decrease in glomerular filtration rate. As the appearance of microalbuminuria is a late manifestation, an early marker for renal damage is needed. Lipocalin-2, also known as neutrophil gelatinase-associated lipocalin (NGAL), is a small protein purified from neutrophil granules and a good marker for kidney disease. NGAL is a transporter protein responsible for many physiological processes, such as inflammation, generation of the immune response, and metabolic homeostasis. NGAL has been reported to depict the early changes in renal damage when urine microalbumin is still undetecable. Therefore, elucidating the role of NGAL in detecting DN and understanding its mechanism can help establish it as a potential early marker for DN.
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Affiliation(s)
- Kiran Dahiya
- Department of Biochemistry, Pt BD Sharma Post Graduate Institute of Medical Sciences, Rohtak 124001, Haryana, India
| | - Praveen Prashant
- Department of Biochemistry, Pt BD Sharma Post Graduate Institute of Medical Sciences, Rohtak 124001, Haryana, India
| | - Rakesh Dhankhar
- Department of Radiation Oncology, Pt BD Sharma Post Graduate Institute of Medical Sciences, Rohtak 124001, India
| | - Kumud Dhankhar
- Phase III, JSS Medical College, Mysuru 570015, Karnataka, India
| | | | - Sonia Vashist
- Department of Dermatology, Dr Sonia’s Dermatology Clinic, Rewari 123401, Haryana, India
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3
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Katz-Greenberg G, Malinchoc M, Broyles DL, Oxman D, Hamrahian SM, Maarouf OH. Urinary Neutrophil Gelatinase-Associated Lipocalin Predicts Intensive Care Unit Admission Diagnosis: A Prospective Cohort Study. KIDNEY360 2022; 3:1502-1510. [PMID: 36245663 PMCID: PMC9528386 DOI: 10.34067/kid.0001492022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/13/2022] [Indexed: 05/28/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is most commonly caused by tubular injury and is associated with a wide variety of critical illnesses. It is well known that urinary biomarkers can lead to the early identification of AKI. However, the ability of urinary biomarkers to distinguish between different types of critical illness has been less studied. METHODS In this prospective cohort study, urinary neutrophil gelatinase-associated lipocalin (uNGAL) was measured in 107 patients consecutively admitted to the ICUs in our tertiary medical center. uNGAL samples were collected within 3-6 hours of admission to an ICU and measured by ELISA. All data were analyzed using R statistical software, and univariate analysis was used to determine the correlations of uNGAL levels with AKI stage, admission diagnoses, and ICU course. RESULTS uNGAL level increased by a mean of 24-fold (SD 10-59) in ICU patients with AKI and demonstrated a significant correlation with the different AKI stages. uNGAL predicted the need for RRT, with values increased by more than 15-fold (P<0.05) in patients needing RRT, and remained a useful tool to predict AKI in ICU patients with a urinary tract infection. uNGAL level was correlated with certain ICU admitting diagnoses whereby uNGAL levels were lower in ICU patients with cardiogenic shock compared with other admission diagnoses (β=-1.92, P<0.05). CONCLUSIONS uNGAL can be used as an early predictor of AKI and its severity in patients admitted to the ICU, including the need for RRT. uNGAL may also help in distinguishing patients with cardiogenic shock from those with other critical illnesses and identifying those at risk for poor outcomes irrespective of the presence of AKI.
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Affiliation(s)
- Goni Katz-Greenberg
- Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Renal Division, Thomas Jefferson University Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | | | - David Oxman
- Pulmonary Division, Thomas Jefferson University Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Seyed M. Hamrahian
- Renal Division, Thomas Jefferson University Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Omar H. Maarouf
- Renal Division, Thomas Jefferson University Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
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4
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Seyahi NS, Ozcan SG. Application of New Acute Kidney Injury Biomarkers. Biomark Med 2022. [DOI: 10.2174/9789815040463122010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Kidney-related biomarkers can provide structural and functional information
about different parts of the nephron. These biomarkers can be used to evaluate
glomerular, tubular, or interstitial injury, inflammation, or repair, and glomerular or
tubular function. Furthermore, biomarkers can improve the acute kidney injury
diagnosis in various clinical conditions, including acute interstitial nephritis, acute
tubular injury, hepatorenal and cardiorenal syndrome, ischemic and nephrotoxic acute
kidney injury, and drug-induced acute kidney injury. Biomarkers might be used as an
additional precision medicine tool in managing patients with acute kidney injury; they
can help with clinical decision-making and impact patient outcomes. In this chapter, we
reviewed the utility of biomarkers used in acute kidney injury.
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Affiliation(s)
- Nurhan Seyahi Seyahi
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa,
Istanbul, Turkey
| | - Seyda Gul Ozcan
- Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University -
Cerrahpasa, Istanbul, Turkey
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5
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Shen TH, Stauber J, Xu K, Jacunski A, Paragas N, Callahan M, Banlengchit R, Levitman AD, Desanti De Oliveira B, Beenken A, Grau MS, Mathieu E, Zhang Q, Li Y, Gopal T, Askanase N, Arumugam S, Mohan S, Good PI, Stevens JS, Lin F, Sia SK, Lin CS, D’Agati V, Kiryluk K, Tatonetti NP, Barasch J. Snapshots of nascent RNA reveal cell- and stimulus-specific responses to acute kidney injury. JCI Insight 2022; 7:e146374. [PMID: 35230973 PMCID: PMC8986083 DOI: 10.1172/jci.insight.146374] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The current strategy to detect acute injury of kidney tubular cells relies on changes in serum levels of creatinine. Yet serum creatinine (sCr) is a marker of both functional and pathological processes and does not adequately assay tubular injury. In addition, sCr may require days to reach diagnostic thresholds, yet tubular cells respond with programs of damage and repair within minutes or hours. To detect acute responses to clinically relevant stimuli, we created mice expressing Rosa26-floxed-stop uracil phosphoribosyltransferase (Uprt) and inoculated 4-thiouracil (4-TU) to tag nascent RNA at selected time points. Cre-driven 4-TU-tagged RNA was isolated from intact kidneys and demonstrated that volume depletion and ischemia induced different genetic programs in collecting ducts and intercalated cells. Even lineage-related cell types expressed different genes in response to the 2 stressors. TU tagging also demonstrated the transient nature of the responses. Because we placed Uprt in the ubiquitously active Rosa26 locus, nascent RNAs from many cell types can be tagged in vivo and their roles interrogated under various conditions. In short, 4-TU labeling identifies stimulus-specific, cell-specific, and time-dependent acute responses that are otherwise difficult to detect with other technologies and are entirely obscured when sCr is the sole metric of kidney damage.
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Affiliation(s)
| | | | | | - Alexandra Jacunski
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Neal Paragas
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Sumit Mohan
- Department of Medicine, and
- Department of Epidemiology
| | | | | | | | | | - Chyuan-Sheng Lin
- Department of Pathology and Cell Biology, Columbia University, New York, New York, USA
| | - Vivette D’Agati
- Department of Pathology and Cell Biology, Columbia University, New York, New York, USA
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Lipocalin 2 stimulates bone fibroblast growth factor 23 production in chronic kidney disease. Bone Res 2021; 9:35. [PMID: 34334787 PMCID: PMC8326281 DOI: 10.1038/s41413-021-00154-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 03/23/2021] [Accepted: 04/20/2021] [Indexed: 12/15/2022] Open
Abstract
Bone-produced fibroblast growth factor 23 (FGF23) increases in response to inflammation and iron deficiency and contributes to cardiovascular mortality in chronic kidney disease (CKD). Neutrophil gelatinase-associated lipocalin (NGAL or lipocalin 2; LCN2 the murine homolog) is a pro-inflammatory and iron-shuttling molecule that is secreted in response to kidney injury and may promote CKD progression. We investigated bone FGF23 regulation by circulating LCN2. At 23 weeks, Col4a3KO mice showed impaired kidney function, increased levels of kidney and serum LCN2, increased bone and serum FGF23, anemia, and left ventricular hypertrophy (LVH). Deletion of Lcn2 in CKD mice did not improve kidney function or anemia but prevented the development of LVH and improved survival in association with marked reductions in serum FGF23. Lcn2 deletion specifically prevented FGF23 elevations in response to inflammation, but not iron deficiency or phosphate, and administration of LCN2 increased serum FGF23 in healthy and CKD mice by stimulating Fgf23 transcription via activation of cAMP-mediated signaling in bone cells. These results show that kidney-produced LCN2 is an important mediator of increased FGF23 production by bone in response to inflammation and in CKD. LCN2 inhibition might represent a potential therapeutic approach to lower FGF23 and improve outcomes in CKD.
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Yang B, Sylvius N, Luo J, Yang C, Da Z, Crotty C, Nicholson ML. Identifying Biomarkers from Transcriptomic Signatures in Renal Allograft Biopsies Using Deceased and Living Donors. Front Immunol 2021; 12:657860. [PMID: 34276651 PMCID: PMC8282197 DOI: 10.3389/fimmu.2021.657860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 06/07/2021] [Indexed: 12/02/2022] Open
Abstract
The survival of transplant kidneys using deceased donors (DD) is inferior to living donors (LD). In this study, we conducted a whole-transcriptome expression analysis of 24 human kidney biopsies paired at 30 minutes and 3 months post-transplantation using DD and LD. The transcriptome profile was found significantly different between two time points regardless of donor types. There were 446 differentially expressed genes (DEGs) between DD and LD at 30 minutes and 146 DEGs at 3 months, with 25 genes common to both time points. These DEGs reflected donor injury and acute immune responses associated with inflammation and cell death as early as at 30 minutes, which could be a precious window of potential intervention. DEGs at 3 months mainly represented the changes of adaptive immunity, immunosuppressive treatment, remodeling or fibrosis via different networks and signaling pathways. The expression levels of 20 highly DEGs involved in kidney diseases and 10 genes dysregulated at 30 minutes were found correlated with renal function and histology at 12 months, suggesting they could be potential biomarkers. These genes were further validated by quantitative polymerase chain reaction (qPCR) in 24 samples analysed by microarray, as well as in a validation cohort of 33 time point unpaired allograft biopsies. This analysis revealed that SERPINA3, SLPI and CBF were up-regulated at 30 minutes in DD compared to LD, while FTCD and TASPN7 were up-regulated at both time points. At 3 months, SERPINA3 was up-regulated in LD, but down-regulated in DD, with increased VCAN and TIMP1, and decreased FOS, in both donors. Taken together, divergent transcriptomic signatures between DD and LD, and changed by the time post-transplantation, might contribute to different allograft survival of two type kidney donors. Some DEGs including FTCD and TASPN7 could be novel biomarkers not only for timely diagnosis, but also for early precise genetic intervention at donor preservation, implantation and post-transplantation, in particular to effectively improve the quality and survival of DD.
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Affiliation(s)
- Bin Yang
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.,Research and Innovation, University Hospitals of Leicester, Leicester, United Kingdom.,Nantong-Leicester Joint Institute of Kidney Science, Department of Nephrology, Affiliated Hospital of Nantong University, Nantong, China
| | - Nicolas Sylvius
- Genomics Core Facility, University of Leicester, Leicester, United Kingdom
| | - Jinli Luo
- Bioinformatics and Biostatistics Support Hub Leicester, University of Leicester, Leicester, United Kingdom
| | - Cheng Yang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Zhanyun Da
- Department of Rheumatology and Immunology, Affiliated Hospital of Nantong University, Nantong, China
| | - Charlottelrm Crotty
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.,Research and Innovation, University Hospitals of Leicester, Leicester, United Kingdom
| | - Michael L Nicholson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.,Research and Innovation, University Hospitals of Leicester, Leicester, United Kingdom.,Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
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8
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Kidney physiology and susceptibility to acute kidney injury: implications for renoprotection. Nat Rev Nephrol 2021; 17:335-349. [PMID: 33547418 DOI: 10.1038/s41581-021-00394-7] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 01/30/2023]
Abstract
Kidney damage varies according to the primary insult. Different aetiologies of acute kidney injury (AKI), including kidney ischaemia, exposure to nephrotoxins, dehydration or sepsis, are associated with characteristic patterns of damage and changes in gene expression, which can provide insight into the mechanisms that lead to persistent structural and functional damage. Early morphological alterations are driven by a delicate balance between energy demand and oxygen supply, which varies considerably in different regions of the kidney. The functional heterogeneity of the various nephron segments is reflected in their use of different metabolic pathways. AKI is often linked to defects in kidney oxygen supply, and some nephron segments might not be able to shift to anaerobic metabolism under low oxygen conditions or might have remarkably low basal oxygen levels, which enhances their vulnerability to damage. Here, we discuss why specific kidney regions are at particular risk of injury and how this information might help to delineate novel routes for mitigating injury and avoiding permanent damage. We suggest that the physiological heterogeneity of the kidney should be taken into account when exploring novel renoprotective strategies, such as improvement of kidney tissue oxygenation, stimulation of hypoxia signalling pathways and modulation of cellular energy metabolism.
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9
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Abdul K, De Silva PMC, Ekanayake E, Thakshila W, Gunarathna S, Gunasekara T, Jayasinghe S, Asanthi H, Chandana E, Chaminda G, Siribaddana S, Jayasundara N. Occupational Paraquat and Glyphosate Exposure May Decline Renal Functions among Rural Farming Communities in Sri Lanka. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3278. [PMID: 33810013 PMCID: PMC8005187 DOI: 10.3390/ijerph18063278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/12/2021] [Accepted: 03/18/2021] [Indexed: 01/21/2023]
Abstract
Extensive use of herbicides is common among rural agricultural workers in Sri Lanka. Recent studies have postulated their role in the development of chronic kidney disease of unknown etiology (CKDu). Paraquat and glyphosate are leading herbicides used by sugarcane farmers (SF), hence occupational exposure is inevitable. This study examined the expression of urinary paraquat, glyphosate and biomarkers among residential SF in CKDu emerging regions, Warunagama (WA) and Rahathangama (RH), in the Uva Province with non-endemic Matara (MA) in the Southern Province of Sri Lanka. Urinary glyphosate, Paraquat, kidney injury molecule -1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL) and β2-microglobulin (B2M) were determined using enzyme-linked immunosorbent assays (ELISA). Urinary creatinine, microalbumin, serum creatinine (SCr), serum cystatin C, estimated glomerular filtration rate (eGFR), and albumin creatinine ratio (ACR) were also assessed. Generally, herbicide residues and kidney injury biomarkers were higher in SF compared to the non-endemic MA. Creatinine-adjusted urinary glyphosate and paraquat levels were significantly higher in WA compared to MA. ACR in RH (median 14.9; IQR 5.4-393.1 mg/g) and WA (23.7; 11.5-64.6) was significantly higher than MA (4.3; 2.2-6.7). This study reports 39 individuals with impaired kidney function among SF in Sri Lanka for the first time. Urinary NGAL levels were significantly higher in both WA (median 2.14; IQR 1.28-6.15 ng/mg Cr) and RH (3.09; 1.15-9.09) compared to MA (1.28; 0.56-2.81). However, urinary KIM-1 levels in RH (3.2; 1.29-106.1 ng/g Cr) and WA (3.6; 1.94-115.1) were not significantly higher in MA (1.74; 0.76-116.9). Urinary NGAL (r = 0.493), eGFR (r = -0.147) and ACR (r = 0.171) significantly correlated with urinary glyphosate, but not with urinary paraquat levels. Urinary KIM-1 levels did not correlate with either urinary glyphosate or paraquat, while urinary B2M and serum cystatin C levels showed significant correlation with urinary glyphosate levels. The current study reports higher urinary herbicide levels among sugarcane farmers in WA and RH, and that is potentially linked to the subsequent decline in kidney function, as indicated by ACR, eGFR, and NGAL. We posit that these indicators may serve as markers to detect renal injury among herbicide-exposed SF in Rural Sri Lanka.
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Affiliation(s)
- K.S.M. Abdul
- Institute of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou 510006, China;
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara 81000, Sri Lanka; (E.M.D.V.E.); (W.A.K.G.T.); (S.D.G.); (T.D.K.S.C.G.)
| | - P. Mangala C.S. De Silva
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara 81000, Sri Lanka; (E.M.D.V.E.); (W.A.K.G.T.); (S.D.G.); (T.D.K.S.C.G.)
| | - E.M.D.V. Ekanayake
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara 81000, Sri Lanka; (E.M.D.V.E.); (W.A.K.G.T.); (S.D.G.); (T.D.K.S.C.G.)
- Department of Biomedical Sciences, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND 58203, USA
| | - W.A.K.G. Thakshila
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara 81000, Sri Lanka; (E.M.D.V.E.); (W.A.K.G.T.); (S.D.G.); (T.D.K.S.C.G.)
| | - S.D. Gunarathna
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara 81000, Sri Lanka; (E.M.D.V.E.); (W.A.K.G.T.); (S.D.G.); (T.D.K.S.C.G.)
| | - T.D.K.S.C. Gunasekara
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara 81000, Sri Lanka; (E.M.D.V.E.); (W.A.K.G.T.); (S.D.G.); (T.D.K.S.C.G.)
| | - S.S. Jayasinghe
- Department of Pharmacology, Faculty of Medicine, University of Ruhuna, Galle 80000, Sri Lanka;
| | - H.B. Asanthi
- Department of Limnology, Faculty of Fisheries and Marine Sciences and Technology, University of Ruhuna, Matara 81000, Sri Lanka;
| | - E.P.S. Chandana
- Department of Biosystems Technology, Faculty of Technology, University of Ruhuna, Matara 81000, Sri Lanka;
| | - G.G.T. Chaminda
- Department of Civil Engineering, Faculty of Engineering, University of Ruhuna, Hapugala 80000, Sri Lanka;
| | - S.H. Siribaddana
- Department of Medicine, Faculty of Medical & Allied Sciences, Rajarata University, Saliyapura 50008, Sri Lanka;
| | - Nishad Jayasundara
- The Nicholas School of the Environment, Duke University, Durham, NC 27708, USA;
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Obert LA, Elmore SA, Ennulat D, Frazier KS. A Review of Specific Biomarkers of Chronic Renal Injury and Their Potential Application in Nonclinical Safety Assessment Studies. Toxicol Pathol 2021; 49:996-1023. [PMID: 33576319 DOI: 10.1177/0192623320985045] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A host of novel renal biomarkers have been developed over the past few decades which have enhanced monitoring of renal disease and drug-induced kidney injury in both preclinical studies and in humans. Since chronic kidney disease (CKD) and acute kidney injury (AKI) share similar underlying mechanisms and the tubulointerstitial compartment has a functional role in the progression of CKD, urinary biomarkers of AKI may provide predictive information in chronic renal disease. Numerous studies have explored whether the recent AKI biomarkers could improve upon the standard clinical biomarkers, estimated glomerular filtration rate (eGFR), and urinary albumin to creatinine ratio, for predicting outcomes in CKD patients. This review is an introduction to alternative assays that can be utilized in chronic (>3 months duration) nonclinical safety studies to provide information on renal dysfunction and to demonstrate specific situations where these assays could be utilized in nonclinical drug development. Novel biomarkers such as symmetrical dimethyl arginine, dickkopf homolog 3, and cystatin C predict chronic renal injury in animals, act as surrogates for GFR, and may predict changes in GFR in patients over time, ultimately providing a bridge from preclinical to clinical renal monitoring.
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Affiliation(s)
- Leslie A Obert
- 549350GlaxoSmithKline (GSK), Nonclinical Safety, Collegeville, PA, USA
| | - Susan A Elmore
- Cellular and Molecular Pathology Branch, National Toxicology Program (NTP), 6857National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Daniela Ennulat
- 549350GlaxoSmithKline (GSK), Nonclinical Safety, Collegeville, PA, USA
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Wen Y, Yang C, Menez SP, Rosenberg AZ, Parikh CR. A Systematic Review of Clinical Characteristics and Histologic Descriptions of Acute Tubular Injury. Kidney Int Rep 2020; 5:1993-2001. [PMID: 33163720 PMCID: PMC7609907 DOI: 10.1016/j.ekir.2020.08.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/13/2020] [Accepted: 08/25/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The term "acute tubular injury" (ATI) represents histopathologic renal tubular injury and often manifests clinically as acute kidney injury (AKI). Studies systematically summarizing the clinical presentation and histological changes in human ATI are limited. METHODS We used a comprehensive search strategy to search human studies of ATI from 1936 to July 2019. We extracted study characteristics, clinical characteristics, and histologic descriptions of ATI by bright field, immunofluorescence, electron microscopy, and immunohistochemistry. We compared ATI histology as a function of tissue procurement type, timing, and etiologies. RESULTS We included 292 studies comprising a total of 1987 patients. The majority of studies (222 of 292, 76%) were single-center case reports. The mean age of included patients was 47 years. In native kidney biopsy cases, baseline, peak, and latest creatinine were 1.3 mg/dl, 7.19 mg/dl, and 1.85 mg/dl respectively, and biopsy was performed mostly after peak creatinine (86.7%, 391 of 451). We identified 16 histologic descriptions of tubular injury, including tubular cell sloughing (115 of 292, 39.4%), tubular epithelial flattening/simplification (110 of 292, 37.7%), tubular dilatation (109 of 292, 37.3%), and tubular cell necrosis (93 of 292, 31.8%). There was no difference in tubular injury histology among different tissue procurement types (native kidney biopsy, transplant kidney biopsy, and autopsy), among different etiologies, or between different tissue procurement timing (before or after creatinine peaks in native kidneys). Electron microscopy and immunohistochemistry were used in a minority of studies. CONCLUSION ATI manifests with diverse histologic changes. Efforts to establish protocols to harmonize biopsy practices, to handle kidney biopsy for tissue interrogation, and to report results across clinical practice are needed to improve our understanding of this complex disease.
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Affiliation(s)
- Yumeng Wen
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chen Yang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Steven P. Menez
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Avi Z. Rosenberg
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chirag R. Parikh
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Correspondence: Chirag R. Parikh, Division of Nephrology, Johns Hopkins University School of Medicine, 1830 E. Monument St., Suite 416, Baltimore, Maryland 21287, USA.
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12
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Stevens JS, Xu K, Corker A, Gopal TS, Sayan OR, Geraghty EP, Yaeh AM, Kosuri YD, Burton JR, Lincoln SV, Callahan MP, Breheney RK, Beenken AS, Gamino JN, Felman AE, Gehani A, Giordano HA, Gozali A, Guerrero Herrera EF, Hatcher BA, Kheir LA, Li Y, Mitsui EK, Nha JI, Sayan AT, Spaiser SJ, Arumugam S, Sia SK, King KL, Mohan S, Barasch J. Rule Out Acute Kidney Injury in the Emergency Department With a Urinary Dipstick. Kidney Int Rep 2020; 5:1982-1992. [PMID: 33163719 PMCID: PMC7609964 DOI: 10.1016/j.ekir.2020.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/24/2020] [Accepted: 09/01/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction The identification of acute injury of the kidney relies on serum creatinine (SCr), a functional marker with poor temporal resolution as well as limited sensitivity and specificity for cellular injury. In contrast, urinary biomarkers of kidney injury have the potential to detect cellular stress and damage in real time. Methods To detect the response of the kidney to injury, we have tested a lateral flow dipstick that measures a urinary protein called neutrophil gelatinase-associated lipocalin (NGAL). Analysis of urine was performed in a prospective cohort of 479 patients (final cohort N = 426) entering an emergency department in New York City and subsequently admitted for inpatient care. Results Colorimetric development had high interrater reliability (88% concordance rate) and correlated with traditional enzyme-linked immunosorbent assay (ELISA) measurements (ρ = 0.732, P < .0001). Of the 14% of the cohort who met Acute Kidney Injury Network (AKIN) SCr criteria for acute kidney injury (AKI), 67% demonstrated transient (<2 days) and 33% demonstrated sustained (>2 days) elevation of SCr. Comparing the outcomes of patients with sustained versus transient or undetectable changes in SCr revealed that the urinary NGAL (uNGAL) dipstick had high specificity and negative predictive value (NPV) (high- vs. low-intermediate readings, sensitivity = 0.55, specificity = 0.91, positive predictive value = 0.24, NPV = 0.97, χ2 = 20.39, P < 0.001). Conclusion We show that the introduction of a bedside uNGAL dipstick permits accurate triage by identifying individuals who do not have tubular injury. In an era of shortening length of stay and rapid decisions based on isolated SCr measurements, real-time exclusion of kidney injury by a dipstick will be particularly useful to overcome the retrospective, insensitive, and nonspecific attributes of SCr.
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Affiliation(s)
- Jacob S Stevens
- Division of Nephrology, Columbia University Irving Medical Center, New York, New York, USA
| | - Katherine Xu
- Division of Nephrology, Columbia University Irving Medical Center, New York, New York, USA
| | - Alexa Corker
- Division of Nephrology, Columbia University Irving Medical Center, New York, New York, USA
| | - Tejashree S Gopal
- Division of Nephrology, Columbia University Irving Medical Center, New York, New York, USA
| | - Osman R Sayan
- Emergency Department, Columbia University Irving Medical Center, New York, New York, USA
| | - Erin P Geraghty
- Internal Medicine Residency, Columbia University Irving Medical Center, New York, New York, USA
| | - Andrew M Yaeh
- Internal Medicine Residency, Columbia University Irving Medical Center, New York, New York, USA
| | - Yaagnik D Kosuri
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - John R Burton
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Saul V Lincoln
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Miriam P Callahan
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Rebecca K Breheney
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Andrew S Beenken
- Division of Nephrology, Columbia University Irving Medical Center, New York, New York, USA
| | - Juliana N Gamino
- Emergency Department, Columbia University Irving Medical Center, New York, New York, USA
| | - Ariel E Felman
- Division of Nephrology, Columbia University Irving Medical Center, New York, New York, USA
| | - Anjali Gehani
- Division of Nephrology, Columbia University Irving Medical Center, New York, New York, USA
| | - Hayley A Giordano
- Emergency Department, Columbia University Irving Medical Center, New York, New York, USA
| | - Aileen Gozali
- Emergency Department, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Britney A Hatcher
- Emergency Department, Columbia University Irving Medical Center, New York, New York, USA
| | - Lena A Kheir
- Emergency Department, Columbia University Irving Medical Center, New York, New York, USA
| | - Yuanji Li
- Division of Nephrology, Columbia University Irving Medical Center, New York, New York, USA
| | - Erika K Mitsui
- Emergency Department, Columbia University Irving Medical Center, New York, New York, USA
| | - Jae I Nha
- Division of Nephrology, Columbia University Irving Medical Center, New York, New York, USA
| | - Alexander T Sayan
- Division of Nephrology, Columbia University Irving Medical Center, New York, New York, USA
| | - Samuel J Spaiser
- Emergency Department, Columbia University Irving Medical Center, New York, New York, USA
| | - Siddarth Arumugam
- Biomedical Engineering, Columbia University, New York, New York, USA
| | - Samuel K Sia
- Biomedical Engineering, Columbia University, New York, New York, USA
| | - Kristen L King
- Division of Nephrology, Columbia University Irving Medical Center, New York, New York, USA
| | - Sumit Mohan
- Division of Nephrology, Columbia University Irving Medical Center, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Jonathan Barasch
- Division of Nephrology, Columbia University Irving Medical Center, New York, New York, USA
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13
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Choi YH, Lee DH, Lee JH. The title: serum neutrophil Gelatinase-associated Lipocalin at 3 hours after return of spontaneous circulation in patients with cardiac arrest and therapeutic hypothermia: early predictor of acute kidney injury. BMC Nephrol 2020; 21:389. [PMID: 32894077 PMCID: PMC7487645 DOI: 10.1186/s12882-020-02054-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/02/2020] [Indexed: 03/20/2023] Open
Abstract
Background Serum neutrophil gelatinase-associated lipocalin (NGAL) could be used as a predictive marker of acute kidney injury (AKI) in patients with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) who are managed with targeted temperature management (TTM). However, the NGAL measurement timepoints vary from immediately after ROSC to several days later. The primary objective of this study was to determine an association between AKI and NGAL, both immediately (ROSC-NGAL) and 3 h after ROSC (3 h-NGAL), in OHCA patients with TTM. The secondary objective was to ascertain the association between NGAL levels in the early post-ROSC phase and the neurologic outcomes at discharge. Methods This prospective observational study was conducted between January 2016 and December 2018 and enrolled adult OHCA patients (≥18 years) with TTM after ROSC. The serum NGAL level was measured both immediately and 3 h after ROSC. Univariate and multivariate analyses were performed to identify the associations between AKI, poor neurologic outcome, and NGAL. Results Among 861 OHCA patients, 89 patients were enrolled. AKI occurred in 48 (55.1%) patients. On multivariate logistic regression analysis, 3 h-NGAL was significantly associated with AKI (odds ratio [OR] 1.022; 95% confidence interval [CI] 1.009–1.035; p = 0.001). The area under the receiver operating characteristic curve of 3 h-NGAL for AKI was 0.910 (95% CI 0.830–0.960), and a cut-off value of 178 ng/mL was identified. Both ROSC-NGAL and 3 h-NGAL were not significantly associated with poor neurologic outcome on multivariate logistic regression analysis (ROSC-NGAL; OR 1.017; 95% CI 0.998–1.036; p = 0.084, 3 h-NGAL; OR 0.997; 95% CI 0.992–1.001; p = 0.113). Conclusions The serum NGAL concentration measured 3 h after ROSC is an excellent early predictive marker for AKI in OHCA patients treated with TTM. Future research is needed to identify the optimal measurement timepoint to establish NGAL as a predictor of neurologic outcome and to validate the findings of this research.
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Affiliation(s)
- Yoon Hee Choi
- Department of Emergency Medicine, College of Medicine, Ewha Womans University Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, South Korea
| | - Dong Hoon Lee
- Department of Emergency Medicine, Chung-Ang University, College of Medicine, Seoul, South Korea
| | - Jae Hee Lee
- Department of Emergency Medicine, College of Medicine, Ewha Womans University Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, South Korea.
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14
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Abstract
The current unidimensional paradigm of kidney disease detection is incompatible with the complexity and heterogeneity of renal pathology. The diagnosis of kidney disease has largely focused on glomerular filtration, while assessment of kidney tubular health has notably been absent. Following insult, the kidney tubular cells undergo a cascade of cellular responses that result in the production and accumulation of low-molecular-weight proteins in the urine and systemic circulation. Modern advancements in molecular analysis and proteomics have allowed the identification and quantification of these proteins as biomarkers for assessing and characterizing kidney diseases. In this review, we highlight promising biomarkers of kidney tubular health that have strong underpinnings in the pathophysiology of kidney disease. These biomarkers have been applied to various specific clinical settings from the spectrum of acute to chronic kidney diseases, demonstrating the potential to improve patient care.
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Affiliation(s)
- William R Zhang
- Kidney Health Research Collaborative, University of California San Francisco School of Medicine, San Francisco, California 94121, USA
| | - Chirag R Parikh
- Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA;
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15
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Karaolanis G, Williams ZF, Bakoyiannis C, Hadjis D, Cox MW, Moris D. The Clinical Utility and Assessment of Renal Biomarkers in Acute Kidney Injury After Abdominal Endovascular Aneurysm Repair. A Systematic Review. Curr Pharm Des 2019; 25:4695-4701. [PMID: 31814549 DOI: 10.2174/1381612825666191209122804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/02/2020] [Indexed: 11/22/2022]
Abstract
The widespread adoption of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAA) is due to the obvious advantages of the procedure compared to the traditional open repair. However, these advantages have to be weighed against the increased risk of renal dysfunction with EVAR. The evaluation of the perioperative renal function after EVAR has been hampered by the lack of sensitive and specific biochemical markers of acute kidney injury (AKI). The purpose of this study was to summarize all novel renal biomarkers and to evaluate their clinical utility for the assessment of the kidney function after EVAR. A systematic review of the current literature, as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines, was performed to identify relevant studies with novel renal biomarkers and EVAR. Pubmed and Scopus databases were systemically searched. Studies reporting on thoracic endovascular aortic repair (TEVAR), case reports, case series, letters to the editor, and systematic reviews were excluded. Neutrophil-Gelatinase-Associated Lipocalin, Cystatin C, Liver-type fatty-acid-binding protein were the most common among the eligible studies while Interleukin-18, Retinol binding protein, N-acetyle-b-D-glucosaminidase and microalbumin have a sparse appearance in the literature. These biomarkers have been assessed in plasma as well as urine samples with each sample material having its own advantages and drawbacks. Which of these biomarkers has the most potential for assessing postoperative renal failure after EVAR, remains to be proved. The few studies presented in the literature show the potential clinical utility of these biomarkers, but larger studies with longer follow-up are required to determine the precise relationship between these biomarkers and postoperative acute kidney injury.
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Affiliation(s)
- Georgios Karaolanis
- Vascular Unit, Department of Surgery, University of Ioannina and School of Medicine, University of Ioannina, 45110, Ioannina, Greece
| | - Zachary F Williams
- Duke Surgery, Duke University Medical Center, Durham, NC, 27708, United States
| | - Chris Bakoyiannis
- First Department of Surgery, Division of Vascular Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Hadjis
- Vascular Unit, Department of Surgery, University of Ioannina and School of Medicine, University of Ioannina, 45110, Ioannina, Greece
| | - Mitchell W Cox
- Duke Surgery, Duke University Medical Center, Durham, NC, 27708, United States
| | - Dimitrios Moris
- Duke Surgery, Duke University Medical Center, Durham, NC, 27708, United States
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16
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Desanti De Oliveira B, Xu K, Shen TH, Callahan M, Kiryluk K, D'Agati VD, Tatonetti NP, Barasch J, Devarajan P. Molecular nephrology: types of acute tubular injury. Nat Rev Nephrol 2019; 15:599-612. [PMID: 31439924 PMCID: PMC7303545 DOI: 10.1038/s41581-019-0184-x] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2019] [Indexed: 12/29/2022]
Abstract
The acute loss of kidney function has been diagnosed for many decades using the serum concentration of creatinine - a muscle metabolite that is an insensitive and non-specific marker of kidney function, but is now used for the very definition of acute kidney injury (AKI). Fortunately, myriad new tools have now been developed to better understand the relationship between acute tubular injury and elevation in serum creatinine (SCr). These tools include unbiased gene and protein expression analyses in kidney, urine and blood, the localization of specific gene transcripts in pathological biopsy samples by rapid in-situ RNA technology and single-cell RNA-sequencing analyses. However, this molecular approach to AKI has produced a series of unexpected problems, because the expression of specific kidney-derived molecules that are indicative of injury often do not correlate with SCr levels. This discrepancy between kidney injury markers and SCr level can be reconciled by the recognition that many separate subtypes of AKI exist, each with distinct patterning of molecular markers of tubular injury and SCr data. In this Review, we describe the weaknesses of isolated SCr-based diagnoses, the clinical and molecular subtyping of acute tubular injury, and the role of non-invasive biomarkers in clinical phenotyping. We propose a conceptual model that synthesizes molecular and physiological data along a time course spanning from acute cellular injury to organ failure.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Prasad Devarajan
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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17
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Abstract
The molecular mechanisms in acute tubular injury (ATI) are complex and enigmatic. Moreover, we currently lack validated tissue injury markers that can be integrated into the kidney biopsy analysis to guide nephrologists in their patient's management of AKI. Although recognizing the ATI lesion by light microscopy is fairly straightforward, the staging of tubular lesions in the context of clinical time course and etiologic mechanism currently is not adapted to the renal pathology practice. To the clinician, the exact time point when an ischemic or toxic injury has occurred often is not known and cannot be discerned from the review of the biopsy sample. Moreover, the assessment of the different types of organized necrosis as the underlying cell death mechanism, which can be targeted using specific inhibitors, has not yet reached clinical practice. The renal pathology laboratory is uniquely qualified to assess the time course and etiology of ATI using established analytic techniques, such as immunohistochemistry and electron microscopy. Recent advances in the understanding of pathophysiological mechanisms of ATI and the important role that certain types of tubular cell organelles play in different stages of the ATI lesions may allow differentiation of early versus late ATI. Furthermore, the determination of respective cell injury pathways may help to differentiate ischemic versus toxic etiology in a reliable fashion. In the future, such a kidney biopsy-based classification system of ATI could guide the nephrologist's management of patients in regard to treatment modality and drug choice.
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Affiliation(s)
- Gilbert W Moeckel
- Renal Pathology and Electron Microscopy Laboratory, Department of Pathology, Yale School of Medicine, New Haven, CT.
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18
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Hassan SS, Rizk A, Thomann C, Motawie A, Abdelfattah S, Ahmad Z. Preconditioning with atorvastatin against renal ischemia-reperfusion injury in nondiabetic versus diabetic rats. Can J Physiol Pharmacol 2018; 97:1-14. [PMID: 30412424 DOI: 10.1139/cjpp-2018-0228] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Acute renal failure complicates renal ischemia-reperfusion (I/R) owing to reactive oxygen species production. Atorvastatin (ATO) has anti-inflammatory and antioxidant properties. The current study investigated whether ATO alleviated damage induced by renal I/R injury in nondiabetic versus diabetic rat models. Thirty-six rats were equally divided into 6 groups: group A1 (nondiabetic sham), group A2 (nondiabetic I/R), group A3 (nondiabetic ATO + I/R), group B1 (diabetic sham), group B2 (diabetic I/R), and group B3 (diabetic ATO + I/R). All groups experienced 45 min of bilateral renal ischemia followed by 24 h of reperfusion. Groups A3 and B3 were treated with single intraperitoneal doses of ATO (10 mg/kg) 30 min before ischemia. Histological analysis of kidney tissues, kidney function tests, and analyses of caspase-3 and CD44 expression and oxidative stress markers were performed to assess tubular injury. Histological analysis revealed marked tubular damage in groups A2 and B2 but improvement in groups A3 and B3. Improvements were also found in groups A3 and B3 for caspase-3 and CD44 expression, kidney function tests, and oxidative stress markers. Our results suggest ATO may ameliorate renal I/R injury differently between nondiabetic and diabetic rats.
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Affiliation(s)
- Sherif S Hassan
- a Department of Medical Education, California University of Science and Medicine, School of Medicine, San Bernardino, CA 92408, USA.,b Department of Anatomy and Embryology, Faculty of Medicine, Cairo University, El-Manial Street, Cairo, Egypt
| | - Ayman Rizk
- b Department of Anatomy and Embryology, Faculty of Medicine, Cairo University, El-Manial Street, Cairo, Egypt
| | - Charity Thomann
- a Department of Medical Education, California University of Science and Medicine, School of Medicine, San Bernardino, CA 92408, USA.,c School of Psychology, Fielding Graduate University, Santa Barbara, CA 93105, USA
| | - Ahmed Motawie
- b Department of Anatomy and Embryology, Faculty of Medicine, Cairo University, El-Manial Street, Cairo, Egypt
| | - Shereen Abdelfattah
- b Department of Anatomy and Embryology, Faculty of Medicine, Cairo University, El-Manial Street, Cairo, Egypt
| | - Zulfiqar Ahmad
- d Department of Biochemistry, A.T. Still University-Kirksville College of Osteopathic Medicine, Kirksville, MO 63501, USA
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19
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Abdelsalam M, Elmorsy E, Abdelwahab H, Algohary O, Naguib M, El Wahab AA, Eldeeb A, Eltoraby E, Abdelsalam A, Sabry A, El-Metwally M, Akl M, Anber N, El Sayed Zaki M, Almutairi F, Mansour T. Urinary biomarkers for early detection of platinum based drugs induced nephrotoxicity. BMC Nephrol 2018; 19:219. [PMID: 30180818 PMCID: PMC6123931 DOI: 10.1186/s12882-018-1022-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 08/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nephrotoxicity is a major hazard complicating the use of platinum based drugs (PBD), which can hinder using higher doses protocols to maximize the therapeutic gain. Shortage of serum creatinine level as an accurate biomarker for acute kidney injuries (AKI) necessitates searching for novel biomarkers with better sensitivity and specificity in patients on PBD. METHODS In a prospective cohort design, 132 patients receiving PBD were selected for the study. AKI was diagnosed by continuous follow up of serum creatinine level according to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines 2012. Serum creatinine and urinary biomarkers (KIM-1, NGAL and cystatin C) was measured in the day of treatment and for 3 days after PBD cycle. RESULTS AKI occurred in 35 patients (26.52% of patients). KIM-1, Cystatin C, and NGAL showed significant increase in samples collected in the day of AKI in comparison to their corresponding basal levels (P < 0.0001). In addition, significant increase in urinary levels of the biomarkers in samples collected 1 day before AKI in comparison to their basal levels (P < 0.0001, P < 0.0001, and P = 0.013 for KIM-1, NGAL and Cystatin C respectively). Furthermore KIM-1 data showed a significant increase 2 days before serum creatinine rise in comparison to the corresponding KIM-1 levels in patients who developed AKI (P = 0.001). CONCLUSIONS Urinary KIM-1, Cystatin C and NGAL can predict PBD induced AKI in earlier stages than serum createnine. KIM-1 is the most sensitive biomarker for early detection of AKI in patients receiving PBD.
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Affiliation(s)
- Mostafa Abdelsalam
- Mansoura Nephrology and dialysis Unit, Internal Medicine Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ekramy Elmorsy
- Department of Forensic Medicine and Clinical Toxicology, Mansoura faculty of Medicine, Mansoura, Egypt
| | - Hassan Abdelwahab
- Mansoura Nephrology and dialysis Unit, Internal Medicine Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Osman Algohary
- Mansoura Nephrology and dialysis Unit, Internal Medicine Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mahmoud Naguib
- Mansoura Nephrology and dialysis Unit, Internal Medicine Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Abd El Wahab
- Mansoura Nephrology and dialysis Unit, Internal Medicine Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Eldeeb
- Mansoura Nephrology and dialysis Unit, Internal Medicine Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ehab Eltoraby
- Internal Medicine Departments, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Adel Abdelsalam
- Internal Medicine Departments, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Alaa Sabry
- Mansoura Nephrology and dialysis Unit, Internal Medicine Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed El-Metwally
- Internal Medicine Departments, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Akl
- Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Nahla Anber
- Fellow of Biochemistry, Emergency Hospital, Mansoura University, Mansoura, Egypt
| | | | - Fahad Almutairi
- Department of Biochemistry, Faculty of Science, University of Tabuk, Tabuk, Kingdom of Saudi Arabia
| | - Tamer Mansour
- Clinical Pathology Department, Mansoura faculty of Medicine, Mansoura, Egypt
- Department of Population Health and Reproduction, University of California, Davis, California, USA
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20
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Wu B, Gong X, Kennedy WA, Brooks JD. Identification of transcripts associated with renal damage due to ureteral obstruction as candidate urinary biomarkers. Am J Physiol Renal Physiol 2018; 315:F16-F26. [PMID: 29488389 DOI: 10.1152/ajprenal.00382.2017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Renal obstruction is a common cause of renal failure in adults and children and is suspected when hydronephrosis is detected on imaging. Because not all cases of hydronephrosis are associated with renal damage, biomarkers are needed to guide intervention to relieve obstruction. We performed gene expression profiling on the kidneys from adult mice over a detailed time course after obstruction and compared these data with a neonatal model of bilateral high-grade obstruction induced by conditional deletion of the calcineurin β1 gene. Having identified a set of 143 transcripts modulated in both adult and neonatal obstruction, we tested their expression in a model of short-term obstruction (1 day), where renal damage is transient and reversible, and long-term obstruction (5 days), where significant renal damage is permanent. A significant number of transcripts increased early after obstruction, and later normalized, while 26 transcripts remained elevated 10 and 28 days after relief of 5 days of ureteral obstruction. With the use of qPCR, elevated levels of several of these candidate RNA biomarkers of renal damage were detected in urine from obstructed mice. In addition, several of these candidate RNA biomarkers of damage resulting from obstruction were detectable in catheterized urine samples from children undergoing surgery for ureteropelvic junction obstruction. Measurement of urinary transcripts modulated in response to renal obstruction could serve as biomarkers of renal damage with important clinical applications.
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Affiliation(s)
- Bo Wu
- Department of Urology, Stanford University , Stanford, California
| | - Xue Gong
- Department of Urology, Stanford University , Stanford, California
| | | | - James D Brooks
- Department of Urology, Stanford University , Stanford, California
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21
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22
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Liu J, Kumar S, Dolzhenko E, Alvarado GF, Guo J, Lu C, Chen Y, Li M, Dessing MC, Parvez RK, Cippà PE, Krautzberger AM, Saribekyan G, Smith AD, McMahon AP. Molecular characterization of the transition from acute to chronic kidney injury following ischemia/reperfusion. JCI Insight 2017; 2:94716. [PMID: 28931758 PMCID: PMC5612583 DOI: 10.1172/jci.insight.94716] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 08/10/2017] [Indexed: 12/16/2022] Open
Abstract
Though an acute kidney injury (AKI) episode is associated with an increased risk of chronic kidney disease (CKD), the mechanisms determining the transition from acute to irreversible chronic injury are not well understood. To extend our understanding of renal repair, and its limits, we performed a detailed molecular characterization of a murine ischemia/reperfusion injury (IRI) model for 12 months after injury. Together, the data comprising RNA-sequencing (RNA-seq) analysis at multiple time points, histological studies, and molecular and cellular characterization of targeted gene activity provide a comprehensive profile of injury, repair, and long-term maladaptive responses following IRI. Tubular atrophy, interstitial fibrosis, inflammation, and development of multiple renal cysts were major long-term outcomes of IRI. Progressive proximal tubular injury tracks with de novo activation of multiple Krt genes, including Krt20, a biomarker of renal tubule injury. RNA-seq analysis highlights a cascade of temporal-specific gene expression patterns related to tubular injury/repair, fibrosis, and innate and adaptive immunity. Intersection of these data with human kidney transplant expression profiles identified overlapping gene expression signatures correlating with different stages of the murine IRI response. The comprehensive characterization of incomplete recovery after ischemic AKI provides a valuable resource for determining the underlying pathophysiology of human CKD.
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Affiliation(s)
- Jing Liu
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Sanjeev Kumar
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.,Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Egor Dolzhenko
- Molecular and Computational Biology, Division of Biological Sciences, University of Southern California, Los Angeles, California, USA
| | - Gregory F Alvarado
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Jinjin Guo
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Can Lu
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Yibu Chen
- Norris Medical Library, University of Southern California, Los Angeles, California
| | - Meng Li
- Norris Medical Library, University of Southern California, Los Angeles, California
| | - Mark C Dessing
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Riana K Parvez
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Pietro E Cippà
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - A Michaela Krautzberger
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Gohar Saribekyan
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Andrew D Smith
- Molecular and Computational Biology, Division of Biological Sciences, University of Southern California, Los Angeles, California, USA
| | - Andrew P McMahon
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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Barasch J, Zager R, Bonventre JV. Acute kidney injury: a problem of definition. Lancet 2017; 389:779-781. [PMID: 28248160 PMCID: PMC5460771 DOI: 10.1016/s0140-6736(17)30543-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 11/21/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Jonathan Barasch
- Department of Medicine, Columbia University, New York, NY 10032, USA.
| | - Richard Zager
- Fred Hutchinson Cancer Center, University of Washington, Washington, DC, USA
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Malas TB, Formica C, Leonhard WN, Rao P, Granchi Z, Roos M, Peters DJM, 't Hoen PAC. Meta-analysis of polycystic kidney disease expression profiles defines strong involvement of injury repair processes. Am J Physiol Renal Physiol 2017; 312:F806-F817. [PMID: 28148532 DOI: 10.1152/ajprenal.00653.2016] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/30/2017] [Accepted: 01/30/2017] [Indexed: 12/25/2022] Open
Abstract
Polycystic kidney disease (PKD) is a major cause of end-stage renal disease. The disease mechanisms are not well understood and the pathogenesis toward renal failure remains elusive. In this study, we present the first RNASeq analysis of a Pkd1-mutant mouse model in a combined meta-analysis with other published PKD expression profiles. We introduce the PKD Signature, a set of 1,515 genes that are commonly dysregulated in PKD studies. We show that the signature genes include many known and novel PKD-related genes and functions. Moreover, genes with a role in injury repair, as evidenced by expression data and/or automated literature analysis, were significantly enriched in the PKD Signature, with 35% of the PKD Signature genes being directly implicated in injury repair. NF-κB signaling, epithelial-mesenchymal transition, inflammatory response, hypoxia, and metabolism were among the most prominent injury or repair-related biological processes with a role in the PKD etiology. Novel PKD genes with a role in PKD and in injury were confirmed in another Pkd1-mutant mouse model as well as in animals treated with a nephrotoxic agent. We propose that compounds that can modulate the injury-repair response could be valuable drug candidates for PKD treatment.
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Affiliation(s)
- Tareq B Malas
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands; and
| | - Chiara Formica
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands; and
| | - Wouter N Leonhard
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands; and
| | | | | | - Marco Roos
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands; and
| | - Dorien J M Peters
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands; and
| | - Peter A C 't Hoen
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands; and
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Xu K, Rosenstiel P, Paragas N, Hinze C, Gao X, Huai Shen T, Werth M, Forster C, Deng R, Bruck E, Boles RW, Tornato A, Gopal T, Jones M, Konig J, Stauber J, D'Agati V, Erdjument-Bromage H, Saggi S, Wagener G, Schmidt-Ott KM, Tatonetti N, Tempst P, Oliver JA, Guarnieri P, Barasch J. Unique Transcriptional Programs Identify Subtypes of AKI. J Am Soc Nephrol 2016; 28:1729-1740. [PMID: 28028135 DOI: 10.1681/asn.2016090974] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/12/2016] [Indexed: 01/07/2023] Open
Abstract
Two metrics, a rise in serum creatinine concentration and a decrease in urine output, are considered tantamount to the injury of the kidney tubule and the epithelial cells thereof (AKI). Yet neither criterion emphasizes the etiology or the pathogenetic heterogeneity of acute decreases in kidney excretory function. In fact, whether decreased excretory function due to contraction of the extracellular fluid volume (vAKI) or due to intrinsic kidney injury (iAKI) actually share pathogenesis and should be aggregated in the same diagnostic group remains an open question. To examine this possibility, we created mouse models of iAKI and vAKI that induced a similar increase in serum creatinine concentration. Using laser microdissection to isolate specific domains of the kidney, followed by RNA sequencing, we found that thousands of genes responded specifically to iAKI or to vAKI, but very few responded to both stimuli. In fact, the activated gene sets comprised different, functionally unrelated signal transduction pathways and were expressed in different regions of the kidney. Moreover, we identified distinctive gene expression patterns in human urine as potential biomarkers of either iAKI or vAKI, but not both. Hence, iAKI and vAKI are biologically unrelated, suggesting that molecular analysis should clarify our current definitions of acute changes in kidney excretory function.
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Affiliation(s)
- Katherine Xu
- Departments of *Medicine, Division of Nephrology
| | | | - Neal Paragas
- Department of Medicine, Division of Nephrology, University of Washington, Seattle, Washington
| | | | - Xiaobo Gao
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Max Werth
- Departments of *Medicine, Division of Nephrology
| | - Catherine Forster
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Rong Deng
- Departments of *Medicine, Division of Nephrology
| | - Efrat Bruck
- Departments of *Medicine, Division of Nephrology
| | | | | | | | | | - Justin Konig
- Departments of *Medicine, Division of Nephrology
| | | | | | - Hediye Erdjument-Bromage
- Department of Biochemistry and Molecular Pharmacology, New York University Langone Medical Center, New York, New York
| | - Subodh Saggi
- Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, New York
| | | | | | | | - Paul Tempst
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Paolo Guarnieri
- Systems Biology, Columbia University Medical Center, New York, New York;
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Renal Ischemia/Reperfusion Injury in Diabetic Rats: The Role of Local Ischemic Preconditioning. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8580475. [PMID: 26925416 PMCID: PMC4746276 DOI: 10.1155/2016/8580475] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/22/2015] [Accepted: 01/04/2016] [Indexed: 11/17/2022]
Abstract
Background. The aim of this study was to evaluate the effects of local ischemic preconditioning using biochemical markers and histopathologically in the diabetic rat renal IR injury model. Methods. DM was induced using streptozotocin. Rats were divided into four groups: Group I, nondiabetic sham group (n = 7), Group II, diabetic sham group (n = 6), Group III, diabetic IR group (diabetic IR group, n = 6), and Group IV, diabetic IR + local ischemic preconditioning group (diabetic IR + LIPC group, n = 6). Ischemic renal injury was induced by clamping the bilateral renal artery for 45 min. 4 h following ischemia, clearance protocols were applied to assess biochemical markers and histopathologically in rat kidneys. Results. The histomorphologic total cell injury scores of the nondiabetic sham group were significantly lower than diabetic sham, diabetic IR, and diabetic IR + LIPC groups. Diabetic IR group scores were not significantly different than the diabetic sham group. But diabetic IR + LIPC group scores were significantly higher than the diabetic sham and diabetic IR groups. Conclusion. Local ischemic preconditioning does not reduce the risk of renal injury induced by ischemia/reperfusion in diabetic rat model.
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Abella V, Scotece M, Conde J, Gómez R, Lois A, Pino J, Gómez-Reino JJ, Lago F, Mobasheri A, Gualillo O. The potential of lipocalin-2/NGAL as biomarker for inflammatory and metabolic diseases. Biomarkers 2015; 20:565-71. [PMID: 26671823 PMCID: PMC4819811 DOI: 10.3109/1354750x.2015.1123354] [Citation(s) in RCA: 169] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Lipocalin-2 (LCN2), also known as neutrophil gelatinase-associated lipocalin (NGAL), is a secreted glycoprotein that belongs to a group of transporters of small lipophilic molecules in circulation. LCN2 has been recently characterized as an adipose-derived cytokine. This adipokine is believed to bind small substances, such as steroids and lipopolysaccharides, and has been reported to have roles in the induction of apoptosis in hematopoietic cells, transport of fatty acids and iron, modulation of inflammation, and metabolic homeostasis. Recently, LCN2 has emerged as a useful biomarker and rheumatic diseases. This review provides an overview of LCN2 in inflammation, immunity, and metabolism.
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Affiliation(s)
- Vanessa Abella
- a SERGAS (Servizo Galego de Saude), Research Laboratory 9, NEIRID Lab (Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases), Institute of Medical Research (IDIS), Santiago University Clinical Hospital , Santiago de Compostela , Spain .,b Departamento de Bioloxía Celular e Molecular , Facultade de Ciencias, Universidade Da Coruña (UDC) , Campus de A Coruña , Spain
| | - Morena Scotece
- a SERGAS (Servizo Galego de Saude), Research Laboratory 9, NEIRID Lab (Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases), Institute of Medical Research (IDIS), Santiago University Clinical Hospital , Santiago de Compostela , Spain
| | - Javier Conde
- a SERGAS (Servizo Galego de Saude), Research Laboratory 9, NEIRID Lab (Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases), Institute of Medical Research (IDIS), Santiago University Clinical Hospital , Santiago de Compostela , Spain
| | - Rodolfo Gómez
- a SERGAS (Servizo Galego de Saude), Research Laboratory 9, NEIRID Lab (Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases), Institute of Medical Research (IDIS), Santiago University Clinical Hospital , Santiago de Compostela , Spain
| | - Ana Lois
- a SERGAS (Servizo Galego de Saude), Research Laboratory 9, NEIRID Lab (Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases), Institute of Medical Research (IDIS), Santiago University Clinical Hospital , Santiago de Compostela , Spain
| | - Jesús Pino
- c SERGAS, Division of Orthopaedics Surgery and Traumatology, Santiago University Clinical Hospital , Santiago de Compostela , Spain
| | - Juan J Gómez-Reino
- a SERGAS (Servizo Galego de Saude), Research Laboratory 9, NEIRID Lab (Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases), Institute of Medical Research (IDIS), Santiago University Clinical Hospital , Santiago de Compostela , Spain
| | - Francisca Lago
- d SERGAS (Servizo Galego de Saude), Research Laboratory 7, Molecular and Cellular Cardiology Laboratory, Institute of Medical Research (IDIS), Santiago University Clinical Hospital , Santiago de Compostela , Spain
| | - Ali Mobasheri
- e The D-BOARD European Consortium for Biomarker Discovery, Department of Veterinary Preclinical Sciences, School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey , Guildford , UK .,f Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Arthritis Research UK Pain Centre, Medical Research Council and Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Nottingham, Queen's Medical Centre , Nottingham , UK , and.,g Center of Excellence in Genomic Medicine Research (CEGMR), King Fahd Medical Research Center (KFMRC), Faculty of Applied Medical Sciences, King AbdulAziz University , Jeddah , Kingdom of Saudi Arabia
| | - Oreste Gualillo
- a SERGAS (Servizo Galego de Saude), Research Laboratory 9, NEIRID Lab (Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases), Institute of Medical Research (IDIS), Santiago University Clinical Hospital , Santiago de Compostela , Spain
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Maghsoudi O, Mirjalili SH, Dolatabadi M, Joshaghani MF, Zarea M, Yahaghi E, Mokarizadeh A. Investigations of renal function using the level of neutrophil gelatinase-associated lipocalin associated with single-dose of cisplatin during chemotherapy. Diagn Pathol 2015; 10:98. [PMID: 26170013 PMCID: PMC4501214 DOI: 10.1186/s13000-015-0338-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/27/2015] [Indexed: 12/31/2022] Open
Abstract
Background Neutrophil gelatinase-associated lipocalin (NGAL) is known as a primary indicator of acute and chronic renal and can be effective in chronic kidney injury (CKI) with kidney tumors cisplatin (CP) chemotherapy. The aim of this study was to evaluate serum and urinary biomarker including NGAL (sNGAL and uNGAL) in canine with solid renal tumors who suffered from cisplatin after short and long-term chemotherapy. Methods In this study, in treatment and control groups, canine (n = 10 and n = 5) were administered cisplatin at 1.2 mg/kg/day (i.v.) for five consecutive days with CKI and without CKI, respectively. Serum and urine NGAL levels (ng/mL) were evaluated at 0, 1, 5, 9, 13, 17, 21, 25 and 29 days after drug injection versus baseline in treated and control groups. Results Canine in treatment group had shown symptoms of toxicity of cisplatin. The results indicated the higher concentrations of serum, sNGAL and uNGAL (P = 0.024; P = 0.011) compared with control group (P = 0.701, P = 0.612), (Table 2, Figs. 1 and 2). Indeed, our results showed that canine with CKI were associated with higher levels of sNGAL and uNGAL compared with control group without CKI. Moreover, the highest level of uNGAL was seen in comparison with sNGAL, after a high dose (1.2 mg/kg) administration of CP. Conclusion Our data suggested that U-NGAL may be useful for monitoring of renal injury in CKI patients that exposed with cisplatin. Furthermore, a primary elevate in urinary NGAL expulsion may help in identifying cases at danger of cisplatin-induced CKI that might profit from innovative remedies to prevent cisplatin nephrotoxicity.
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Affiliation(s)
- Omid Maghsoudi
- Doctor of Veterinary Medicine (DVM), Faculty of Veterinary Medicine, Islamic Azad University, Karaj Branch, Karaj, Iran
| | | | | | - Mostafa Fallah Joshaghani
- Under graduate of Veterinary Medicine, Faculty of Veterinary Medicine, Islamic Azad University, Karaj Branch, Karaj, Iran
| | - Mojtaba Zarea
- Center for Chemical Biology, Indian Institute of Chemical Technology (iict), Tarnaka, Hyderabad, India
| | - Emad Yahaghi
- Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Aram Mokarizadeh
- Cellular & Molecular Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran.
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Rhee H, Shin N, Shin MJ, Yang BY, Kim IY, Song SH, Lee DW, Lee SB, Kwak IS, Seong EY. High serum and urine neutrophil gelatinase-associated lipocalin levels are independent predictors of renal progression in patients with immunoglobulin A nephropathy. Korean J Intern Med 2015; 30:354-61. [PMID: 25995666 PMCID: PMC4438290 DOI: 10.3904/kjim.2015.30.3.354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 08/26/2014] [Accepted: 09/05/2014] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND/AIMS Tubulointerstitial injury plays an important role in the progression of immunoglobulin A nephropathy (IgAN), and neutrophil gelatinase-associated lipocalin (NGAL) is among the most sensitive tubular biomarkers. We investigated whether serum or urine NGAL predicts prognosis in patients with IgAN. METHODS The present study enrolled patients with biopsy-proven IgAN from January 2005 to December 2010, whose serum and urine samples at the time of kidney biopsy were preserved by freezing. We retrospectively reviewed patient clinical data and followed patients until October 2012. Serum and urine NGAL levels were measured using an enzyme-linked immunosorbent assay kit. Renal progression was defined as an estimated glomerular filtration rate decline by > 50% or progression to end-stage renal disease. RESULTS There were 121 patients enrolled in this study. During the median follow-up period of 41.49 months, renal progression was found in nine patients (7.4%). Serum or urine NGAL alone could not predict renal progression; however, when serum and urine NGAL levels were combined, belonging to the high NGAL group independently predicted renal progression (hazard ratio [HR], 5.56; 95% confidence interval [CI], 1.42 to 21.73; p = 0.014), along with tubular damage graded according to the Oxford classification as T2 (HR, 8.79; 95% CI, 2.01 to 38.51; p = 0.004). In addition, a Kaplan-Meier curve of renal survival showed significantly higher renal progression in patients in the high NGAL group (log rank, p = 0.004). CONCLUSIONS In patients with IgAN, high serum and urine NGAL levels at the time of kidney biopsy predict renal progression.
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Affiliation(s)
- Harin Rhee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Nari Shin
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Pathology, Pusan National University School of Medicine, Busan, Korea
| | - Min Ji Shin
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Byung Yun Yang
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Il Young Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Sang Heon Song
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Dong Won Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Soo Bong Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Ihm Soo Kwak
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Eun Young Seong
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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Ghorbel MT, Patel NN, Sheikh M, Angelini GD, Caputo M, Murphy GJ. Changes in renal medulla gene expression in a pre-clinical model of post cardiopulmonary bypass acute kidney injury. BMC Genomics 2014; 15:916. [PMID: 25331815 PMCID: PMC4210505 DOI: 10.1186/1471-2164-15-916] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 10/08/2014] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a common and serious complication of cardiac surgery using cardiopulmonary bypass (CPB). The pathogenesis is poorly understood and the study of AKI in rodent models has not led to improvements in clinical outcomes. We sought to determine the changes in renal medullary gene expression in a novel and clinically relevant porcine model of CPB-induced AKI. RESULTS Adult pigs (n = 12 per group) were randomised to undergo sham procedure, or 2.5 hours CPB. AKI was determined using biochemical (Cr51 EDTA clearance, CrCl, urinary IL-18 release) and histological measures. Transcriptomic analyses were performed on renal medulla biopsies obtained 24 hours post intervention or from sham group. Microarray results were validated with real-time polymerase chain reaction and Western Blotting.Of the transcripts examined, 66 were identified as differentially expressed in CPB versus Sham pig's kidney samples, with 19 (29%) upregulated and 47 (71%) down-regulated. Out of the upregulated and downregulated transcripts 4 and 16 respectively were expression sequence tags (EST). The regulated genes clustered into three classes; Immune response, Cell adhesion/extracellular matrix and metabolic process. Upregulated genes included Factor V, SLC16A3 and CKMT2 whereas downregulated genes included GST, CPE, MMP7 and SELL. CONCLUSION Post CPB AKI, as defined by clinical criteria, is characterised by molecular changes in renal medulla that are associated with both injury and survival programmes. Our observations highlight the value of large animal models in AKI research and provide insights into the failure of findings in rodent models to translate into clinical progress.
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Affiliation(s)
- Mohamed T Ghorbel
- Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Level 7, Bristol Royal Infirmary; Upper Maudlin Street, Bristol BS2 8HW, UK.
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Abstract
The mammalian kidney has an intrinsic ability to repair after significant injury. However, this process is inefficient: patients are at high risk for the loss of kidney function in later life. No therapy exists to treat established acute kidney injury (AKI) per se: strategies to promote endogenous repair processes and retard associated fibrosis are a high priority. Whole-organ gene expression profiling has been used to identify repair responses initiated with AKI, and factors that may promote the transition from AKI to chronic kidney disease. Transcriptional profiling has shown molecular markers and potential regulatory pathways of renal repair. Activation of a few key developmental pathways has been reported during repair. Whether these are comparable networks with similar target genes with those in earlier nephrogenesis remains unclear. Altered microRNA profiles, persistent tubular injury responses, and distinct late inflammatory responses highlight continuing kidney pathology. Additional insights into injury and repair processes will be gained by study of the repair transcriptome and cell-specific translatome using high-resolution technologies such as RNA sequencing and translational profiling tailored to specific cellular compartments within the kidney. An enhanced understanding holds promise for both the identification of novel therapeutic targets and biomarker-based evaluation of the damage-repair process.
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Affiliation(s)
- Sanjeev Kumar
- Department of Stem Cell Biology and Regenerative Medicine, Eli and Edythe Broad-California Institute of Regenerative Medicine (CIRM) Center for Regenerative Medicine and Stem Cell Research, The Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Jing Liu
- Department of Stem Cell Biology and Regenerative Medicine, Eli and Edythe Broad-California Institute of Regenerative Medicine (CIRM) Center for Regenerative Medicine and Stem Cell Research, The Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Andrew P McMahon
- Department of Stem Cell Biology and Regenerative Medicine, Eli and Edythe Broad-California Institute of Regenerative Medicine (CIRM) Center for Regenerative Medicine and Stem Cell Research, The Keck School of Medicine of the University of Southern California, Los Angeles, CA.
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Torres-Salido MT, Cortes-Hernandez J, Vidal X, Pedrosa A, Vilardell-Tarres M, Ordi-Ros J. Neutrophil gelatinase-associated lipocalin as a biomarker for lupus nephritis. Nephrol Dial Transplant 2014; 29:1740-9. [DOI: 10.1093/ndt/gfu062] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Filiopoulos V, Biblaki D, Vlassopoulos D. Neutrophil gelatinase-associated lipocalin (NGAL): a promising biomarker of contrast-induced nephropathy after computed tomography. Ren Fail 2014; 36:979-86. [PMID: 24673459 DOI: 10.3109/0886022x.2014.900429] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Contrast-induced nephropathy (CIN) is a common cause of hospital-acquired acute kidney injury (AKI) and a source of significantly increased short- and long-term mortality. Studies of large cohorts have revealed that more than half of these cases are in subjects undergoing cardiac catheterization and intra-arterial coronary angiography, and nearly a third follow computed tomography (CT) scans. Neutrophil gelatinase-associated lipocalin (NGAL) represents an early predictive troponin-like biomarker for AKI. Its role in the timely diagnosis of CIN has already been examined in adults and children undergoing coronary angiography and a meta-analysis revealed a very good performance of plasma or urine NGAL in the prediction of CIN. Much of these data have been extrapolated to patients receiving intravenous (IV) contrast agent for CT scans, although major differences in patient populations, contrast volume administered and intra-procedural complications between the two settings exist. In this context, a recent prospective study by our group evaluated plasma NGAL, measured using standardized Τriage® NGAL test (Biosite Incorporated, San Diego, CA) at baseline and 6-h post-procedure, for early detection of CIN among hospitalized patients undergoing elective contrast-enhanced CT. CIN, defined as an increase in serum creatinine (SCr) of >25% or >0.5 mg/dL from baseline within 48-h post-procedure, was found in 8.51% of subjects. In contrast, significant elevation of plasma NGAL was found at 6-h post-procedure with excellent performance characteristics. This review presents the current status of NGAL in the prediction of CIN after IV contrast administration among hospitalized patients undergoing elective contrast-enhanced CT.
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Affiliation(s)
- Vassilis Filiopoulos
- Department of Nephrology, Sismanogleion-Amalia Fleming General Hospital , Athens , Greece
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Grgic I, Krautzberger AM, Hofmeister A, Lalli M, DiRocco DP, Fleig SV, Liu J, Duffield JS, McMahon AP, Aronow B, Humphreys BD. Translational profiles of medullary myofibroblasts during kidney fibrosis. J Am Soc Nephrol 2014; 25:1979-90. [PMID: 24652793 DOI: 10.1681/asn.2013101143] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Myofibroblasts secrete matrix during chronic injury, and their ablation ameliorates fibrosis. Development of new biomarkers and therapies for CKD will be aided by a detailed analysis of myofibroblast gene expression during the early stages of fibrosis. However, dissociating myofibroblasts from fibrotic kidney is challenging. We therefore adapted translational ribosome affinity purification (TRAP) to isolate and profile mRNA from myofibroblasts and their precursors during kidney fibrosis. We generated and characterized a transgenic mouse expressing an enhanced green fluorescent protein (eGFP)-tagged L10a ribosomal subunit protein under control of the collagen1α1 promoter. We developed a one-step procedure for isolation of polysomal RNA from collagen1α1-eGFPL10a mice subject to unilateral ureteral obstruction and analyzed and validated the resulting transcriptional profiles. Pathway analysis revealed strong gene signatures for cell proliferation, migration, and shape change. Numerous novel genes and candidate biomarkers were upregulated during fibrosis, specifically in myofibroblasts, and we validated these results by quantitative PCR, in situ, and Western blot analysis. This study provides a comprehensive analysis of early myofibroblast gene expression during kidney fibrosis and introduces a new technique for cell-specific polysomal mRNA isolation in kidney injury models that is suited for RNA-sequencing technologies.
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Affiliation(s)
- Ivica Grgic
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Internal Medicine and Nephrology, Philipps-University, Marburg, Germany
| | - A Michaela Krautzberger
- Department of Stem Cell Biology and Regenerative Medicine, W.M. Keck School of Medicine of the University of Southern California, Los Angeles, California; Eli and Edythe Broad Center for Regenerative Medicine and Stem Cell Research, Los Angeles, California
| | - Andreas Hofmeister
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Internal Medicine and Nephrology, Philipps-University, Marburg, Germany
| | - Matthew Lalli
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Derek P DiRocco
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Susanne V Fleig
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Nephrology, Hannover Medical School, Hannover, Germany
| | - Jing Liu
- Department of Stem Cell Biology and Regenerative Medicine, W.M. Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Jeremy S Duffield
- Division of Nephrology and Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
| | - Andrew P McMahon
- Department of Stem Cell Biology and Regenerative Medicine, W.M. Keck School of Medicine of the University of Southern California, Los Angeles, California; Eli and Edythe Broad Center for Regenerative Medicine and Stem Cell Research, Los Angeles, California
| | - Bruce Aronow
- University of Cincinnati Department of Pediatrics, Cincinnati, Ohio; and
| | - Benjamin D Humphreys
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Kidney Group, Harvard Stem Cell Institute, Cambridge, Massachusetts
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Liu J, Krautzberger AM, Sui SH, Hofmann OM, Chen Y, Baetscher M, Grgic I, Kumar S, Humphreys BD, Hide WA, McMahon AP. Cell-specific translational profiling in acute kidney injury. J Clin Invest 2014; 124:1242-54. [PMID: 24569379 DOI: 10.1172/jci72126] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 12/05/2013] [Indexed: 02/01/2023] Open
Abstract
Acute kidney injury (AKI) promotes an abrupt loss of kidney function that results in substantial morbidity and mortality. Considerable effort has gone toward identification of diagnostic biomarkers and analysis of AKI-associated molecular events; however, most studies have adopted organ-wide approaches and have not elucidated the interplay among different cell types involved in AKI pathophysiology. To better characterize AKI-associated molecular and cellular events, we developed a mouse line that enables the identification of translational profiles in specific cell types. This strategy relies on CRE recombinase-dependent activation of an EGFP-tagged L10a ribosomal protein subunit, which allows translating ribosome affinity purification (TRAP) of mRNA populations in CRE-expressing cells. Combining this mouse line with cell type-specific CRE-driver lines, we identified distinct cellular responses in an ischemia reperfusion injury (IRI) model of AKI. Twenty-four hours following IRI, distinct translational signatures were identified in the nephron, kidney interstitial cell populations, vascular endothelium, and macrophages/monocytes. Furthermore, TRAP captured known IRI-associated markers, validating this approach. Biological function annotation, canonical pathway analysis, and in situ analysis of identified response genes provided insight into cell-specific injury signatures. Our study provides a deep, cell-based view of early injury-associated molecular events in AKI and documents a versatile, genetic tool to monitor cell-specific and temporal-specific biological processes in disease modeling.
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Cianciolo R, Yoon L, Krull D, Stokes A, Rodriguez A, Jordan H, Cooper D, Falls JG, Cullen J, Kimbrough C, Berridge B. Gene expression analysis and urinary biomarker assays reveal activation of tubulointerstitial injury pathways in a rodent model of chronic proteinuria (Doxorubicin nephropathy). Nephron Clin Pract 2013; 124:1-10. [PMID: 24248038 DOI: 10.1159/000355542] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 09/08/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Tubular atrophy and interstitial fibrosis are well-recognized sequelae of chronic proteinuria; however, little is known regarding the molecular pathways activated within tubulointerstitium in chronic proteinuric nephropathies. METHODS To investigate the molecular mechanisms of proteinuria-associated tubulointerstitial (TI) disease, doxorubicin nephropathy was induced in rats. Progression of disease was monitored with weekly urinary biomarker assays. Because histopathology revealed multifocal TI injury, immunodirected laser capture microdissection was used to identify and isolate injured proximal tubules, as indicated by kidney injury molecule-1 immunolabeling. Adjacent interstitial cells were harvested separately. Gene expression microarray, manual annotation of gene lists, and Gene Set Enrichment Analysis were performed. A subset of the regulated transcripts was validated by quantitative PCR and immunohistochemistry. RESULTS Severe proteinuria preceded tubular injury biomarkers by 1 week. Histology revealed multifocal, mild TI damage at 3 weeks, which progressed in severity at 5 weeks. Affymetrix microarray analysis revealed tissue-specific regulation of gene expression. Manual annotation of gene lists, gene set enrichment analysis, and urinary biomarker assays revealed similarities to pathways activated in direct TI injuries. This suggests commonalities amongst the molecular mechanisms of TI injury secondary to proteinuria, ischemia-reperfusion, and nephrotoxicity. © 2013 S. Karger AG, Basel.
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Affiliation(s)
- Rachel Cianciolo
- Safety Assessment, GlaxoSmithKline, Research Triangle Park, N.C., USA
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Grigoryev DN, Cheranova DI, Heruth DP, Huang P, Zhang LQ, Rabb H, Ye SQ. Meta-analysis of molecular response of kidney to ischemia reperfusion injury for the identification of new candidate genes. BMC Nephrol 2013; 14:231. [PMID: 24152794 PMCID: PMC4016589 DOI: 10.1186/1471-2369-14-231] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 10/11/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accumulated to-date microarray data on ischemia reperfusion injury (IRI) of kidney represent a powerful source for identifying new targets and mechanisms of kidney IRI. In this study, we conducted a meta-analysis of gene expression profiles of kidney IRI in human, pig, rat, and mouse models, using a new scoring method to correct for the bias of overrepresented species. The gene expression profiles were obtained from the public repositories for 24 different models. After filtering against inclusion criteria 21 experimental settings were selected for meta-analysis and were represented by 11 rat models, 6 mouse models, and 2 models each for pig and human, with a total of 150 samples. Meta-analysis was conducted using expression-based genome-wide association study (eGWAS). The eGWAS results were corrected for a rodent species bias using a new weighted scoring algorithm, which favors genes with unidirectional change in expression in all tested species. RESULTS Our meta-analysis corrected for a species bias, identified 46 upregulated and 1 downregulated genes, of which 26 (55%) were known to be associated with kidney IRI or kidney transplantation, including LCN2, CCL2, CXCL1, HMOX1, ICAM1, ANXA1, and TIMP1, which justified our approach. Pathway analysis of our candidates identified "Acute renal failure panel" as the most implicated pathway, which further validates our new method. Among new IRI candidates were 10 novel (<5 published reports related to kidney IRI) and 11 new candidates (0 reports related to kidney IRI) including the most prominent candidates ANXA2, CLDN4, and TYROBP. The cross-species expression pattern of these genes allowed us to generate three workable hypotheses of kidney IRI, one of which was confirmed by an additional study. CONCLUSIONS Our first in the field kidney IRI meta-analysis of 150 microarray samples, corrected for a species bias, identified 10 novel and 11 new candidate genes. Moreover, our new meta-analysis correction method improved gene candidate selection by identifying genes that are model and species independent, as a result, function of these genes can be directly extrapolated to the disease state in human and facilitate translation of potential diagnostic or therapeutic properties of these candidates to the bedside.
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Affiliation(s)
- Dmitry N Grigoryev
- Division of Experimental and Translational Genetics, Department of Pediatrics, Children's Mercy Hospitals and Clinics, University of Missouri School of Medicine, Kansas City, MO, USA.
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Fuchs TC, Mally A, Wool A, Beiman M, Hewitt P. An Exploratory Evaluation of the Utility of Transcriptional and Urinary Kidney Injury Biomarkers for the Prediction of Aristolochic Acid–Induced Renal Injury in Male Rats. Vet Pathol 2013; 51:680-94. [DOI: 10.1177/0300985813498779] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The predictive value of different urinary and transcriptional biomarkers was evaluated in a proof-of-principle toxicology study in rats using aristolochic acid (AA), a known nephrotoxic agent. Male Wistar rats were orally dosed with 0.1, 1, or 10 mg/kg for 12 days. Urine was collected on days 1, 5, and 12 over 24 hours. Gene expression analysis was also conducted using quantitative real-time polymerase chain reaction and Illumina whole-genome chips. Protein biomarkers (Kim-1, Timp-1, vascular endothelial growth factor, osteopontin, clusterin, cystatin C, calbindin D-28K, β2-microglobulin, α–glutathione S-transferase, GSTY1b, RPA-1, and neutrophil gelatinase-associated lipocalin) were measured in these urine samples. Treatment with AA resulted in a slight dose- and/or time-dependent increase in urinary β2-microglobulin, lipocalin 2, and osteopontin before an increase in serum creatinine or serum urea nitrogen was observed. A strong decrease in urinary calbindin D-28K was also detected. The Compugen Ltd. prediction model scored both the 1- and 10-mg/kg AA dose groups as positive for nephrotoxicity despite the absence of renal histopathological changes. In addition, several previously described transcriptional biomarkers were identified as early predictors of renal toxicity as they were detected before morphological alterations had occurred. Altogether, these findings demonstrated the predictive values of renal biomarkers approved by the Food and Drug Administration, European Medicines Agency, and Pharmaceuticals & Medical Devices Agency in AA-induced renal injury in rats and confirmed the utility of renal transcriptional biomarkers for detecting progression of compound-induced renal injury in rats. In addition, several transcriptional biomarkers identified in this exploratory study could present early predictors of renal tubular epithelium injury in rats.
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Affiliation(s)
- T. C. Fuchs
- Merck Serono, Non-Clinical Safety, Darmstadt, Germany
| | - A. Mally
- Department of Toxicology, University of Wuerzburg, Wuerzburg, Germany
| | - A. Wool
- Compugen Ltd., Tel Aviv, Israel
| | | | - P. Hewitt
- Merck Serono, Non-Clinical Safety, Darmstadt, Germany
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Transcriptome analysis of renal ischemia/reperfusion injury and its modulation by ischemic pre-conditioning or hemin treatment. PLoS One 2012; 7:e49569. [PMID: 23166714 PMCID: PMC3498198 DOI: 10.1371/journal.pone.0049569] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 10/10/2012] [Indexed: 01/06/2023] Open
Abstract
Ischemia/reperfusion injury (IRI) is a leading cause of acute renal failure. The definition of the molecular mechanisms involved in renal IRI and counter protection promoted by ischemic pre-conditioning (IPC) or Hemin treatment is an important milestone that needs to be accomplished in this research area. We examined, through an oligonucleotide microarray protocol, the renal differential transcriptome profiles of mice submitted to IRI, IPC and Hemin treatment. After identifying the profiles of differentially expressed genes observed for each comparison, we carried out functional enrichment analysis to reveal transcripts putatively involved in potential relevant biological processes and signaling pathways. The most relevant processes found in these comparisons were stress, apoptosis, cell differentiation, angiogenesis, focal adhesion, ECM-receptor interaction, ion transport, angiogenesis, mitosis and cell cycle, inflammatory response, olfactory transduction and regulation of actin cytoskeleton. In addition, the most important overrepresented pathways were MAPK, ErbB, JAK/STAT, Toll and Nod like receptors, Angiotensin II, Arachidonic acid metabolism, Wnt and coagulation cascade. Also, new insights were gained about the underlying protection mechanisms against renal IRI promoted by IPC and Hemin treatment. Venn diagram analysis allowed us to uncover common and exclusively differentially expressed genes between these two protective maneuvers, underscoring potential common and exclusive biological functions regulated in each case. In summary, IPC exclusively regulated the expression of genes belonging to stress, protein modification and apoptosis, highlighting the role of IPC in controlling exacerbated stress response. Treatment with the Hmox1 inducer Hemin, in turn, exclusively regulated the expression of genes associated with cell differentiation, metabolic pathways, cell cycle, mitosis, development, regulation of actin cytoskeleton and arachidonic acid metabolism, suggesting a pleiotropic effect for Hemin. These findings improve the biological understanding of how the kidney behaves after IRI. They also illustrate some possible underlying molecular mechanisms involved in kidney protection observed with IPC or Hemin treatment maneuvers.
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Taub PR, Borden KC, Fard A, Maisel A. Role of biomarkers in the diagnosis and prognosis of acute kidney injury in patients with cardiorenal syndrome. Expert Rev Cardiovasc Ther 2012; 10:657-67. [PMID: 22651841 DOI: 10.1586/erc.12.26] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cardiac and renal disease frequently coexist but have long been difficult to diagnose in a timely manner and treat effectively. Noninvasive and cost-effective biomarkers are needed to help identify cardiac patients who are at risk of acute kidney injury early in the course of disease. Biomarkers can provide insights into underlying mechanisms and lead to a better understanding of complex disease states such as the cardiorenal syndrome, which can lead to better therapies and, ultimately, to improved patient outcomes. The natriuretic peptides are established biomarkers in heart failure and have set the standard for how a well-validated biomarker can be useful for diagnosis/prognosis, monitoring response to therapy and chronic disease management. For patients with acute kidney injury in the setting of cardiac disease, new biomarkers such as neutrophil gelatinase-associated lipocalin, cystatin C, kidney injury molecule-1 and IL-18 are emerging as early signals of renal dysfunction prior to any elevations in serum creatinine. Other promising candidate biomarkers for the early diagnosis of acute kidney injury include osteopontin, N-acetyl-b-d-glucosaminidase, stromal cell-derived factor-1 and exosomes. More research with all of these novel biomarkers is needed; however, the early results are very promising.
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Affiliation(s)
- Pam R Taub
- University of California San Diego, UCSD Medical Center, Division of Cardiology, 200 West Arbor Drive, San Diego, CA 92103-8411, USA.
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Koltsova SV, Trushina Y, Haloui M, Akimova OA, Tremblay J, Hamet P, Orlov SN. Ubiquitous [Na+]i/[K+]i-sensitive transcriptome in mammalian cells: evidence for Ca(2+)i-independent excitation-transcription coupling. PLoS One 2012; 7:e38032. [PMID: 22666440 PMCID: PMC3362528 DOI: 10.1371/journal.pone.0038032] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 04/29/2012] [Indexed: 12/21/2022] Open
Abstract
Stimulus-dependent elevation of intracellular Ca2+ ([Ca2+]i) affects the expression of numerous genes – a phenomenon known as excitation-transcription coupling. Recently, we found that increases in [Na+]i trigger c-Fos expression via a novel Ca2+i-independent pathway. In the present study, we identified ubiquitous and tissue-specific [Na+]i/[K+]i-sensitive transcriptomes by comparative analysis of differentially expressed genes in vascular smooth muscle cells from rat aorta (RVSMC), the human adenocarcinoma cell line HeLa, and human umbilical vein endothelial cells (HUVEC). To augment [Na+]i and reduce [K+]i, cells were treated for 3 hrs with the Na+,K+-ATPase inhibitor ouabain or placed for the same time in the K+-free medium. Employing Affymetrix-based technology, we detected changes in expression levels of 684, 737 and 1839 transcripts in HeLa, HUVEC and RVSMC, respectively, that were highly correlated between two treatments (p<0.0001; R2>0.62). Among these Na+i/K+i-sensitive genes, 80 transcripts were common for all three types of cells. To establish if changes in gene expression are dependent on increases in [Ca2+]i, we performed identical experiments in Ca2+-free media supplemented with extracellular and intracellular Ca2+ chelators. Surprisingly, this procedure elevated rather than decreased the number of ubiquitous and cell-type specific Na+i/K+i-sensitive genes. Among the ubiquitous Na+i/K+i-sensitive genes whose expression was regulated independently of the presence of Ca2+ chelators by more than 3-fold, we discovered several transcription factors (Fos, Jun, Hes1, Nfkbia), interleukin-6, protein phosphatase 1 regulatory subunit, dual specificity phosphatase (Dusp8), prostaglandin-endoperoxide synthase 2, cyclin L1, whereas expression of metallopeptidase Adamts1, adrenomedulin, Dups1, Dusp10 and Dusp16 was detected exclusively in Ca2+-depleted cells. Overall, our findings indicate that Ca2+i-independent mechanisms of excitation-transcription coupling are involved in transcriptomic alterations triggered by elevation of the [Na+]i/[K+]i ratio. There results likely have profound implications for normal and pathological regulation of mammalian cells, including sustained excitation of neuronal cells, intensive exercise and ischemia-triggered disorders.
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Affiliation(s)
- Svetlana V. Koltsova
- Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM) – Technopôle Angus, Montreal, PQ, Canada
- Institute of General Pathology and Pathophysiology, Russian Academy of Medical Sciences, Moscow, Russia
| | - Yulia Trushina
- Faculty of Biology, M.V. Lomonosov Moscow State University, Moscow, Russia
| | - Mounsif Haloui
- Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM) – Technopôle Angus, Montreal, PQ, Canada
| | - Olga A. Akimova
- Institute of General Pathology and Pathophysiology, Russian Academy of Medical Sciences, Moscow, Russia
- Faculty of Biology, M.V. Lomonosov Moscow State University, Moscow, Russia
| | - Johanne Tremblay
- Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM) – Technopôle Angus, Montreal, PQ, Canada
- Department of Medicine, Université de Montréal, Montreal, PQ, Canada
| | - Pavel Hamet
- Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM) – Technopôle Angus, Montreal, PQ, Canada
- Department of Medicine, Université de Montréal, Montreal, PQ, Canada
| | - Sergei N. Orlov
- Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM) – Technopôle Angus, Montreal, PQ, Canada
- Department of Medicine, Université de Montréal, Montreal, PQ, Canada
- * E-mail:
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Slocum JL, Heung M, Pennathur S. Marking renal injury: can we move beyond serum creatinine? Transl Res 2012; 159:277-89. [PMID: 22424431 PMCID: PMC3308350 DOI: 10.1016/j.trsl.2012.01.014] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 01/12/2012] [Accepted: 01/13/2012] [Indexed: 02/07/2023]
Abstract
Acute kidney injury (AKI) is a prevalent and devastating condition associated with significant morbidity and mortality. Despite marked improvements in clinical care, the outcomes for subjects with AKI have shown limited improvement in the past 50 years. A major factor inhibiting clinical progress in this field has been the inability to accurately predict and diagnose early kidney dysfunction. The current gold standard clinical and biochemical criteria for diagnosis of AKI, Risk Injury Failure Loss End-stage renal disease, and its modification, Acute Kidney Injury Network criteria, rely on urine output and serum creatinine, which are insensitive, nonspecific, and late markers of disease. The recent development of a variety of analytic mass spectrometry-based platforms have enabled separation, characterization, detection, and quantification of proteins (proteomics) and metabolites (metabolomics). These high-throughput platforms have raised hopes of identifying novel protein and metabolite markers, and recent efforts have led to several promising novel markers of AKI. However, substantial challenges remain, including the need to systematically evaluate incremental performance of these markers over and beyond current clinical and biochemical criteria for AKI. We discuss the basic issues surrounding AKI biomarker development, highlight the most promising markers currently under development, and discuss the barriers toward widespread clinical implementation of these markers.
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Affiliation(s)
- Jessica L Slocum
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48105, USA
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Clerico A, Galli C, Fortunato A, Ronco C. Neutrophil gelatinase-associated lipocalin (NGAL) as biomarker of acute kidney injury: a review of the laboratory characteristics and clinical evidences. Clin Chem Lab Med 2012; 50:1505-17. [PMID: 22962216 DOI: 10.1515/cclm-2011-0814] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 01/19/2012] [Indexed: 11/15/2022]
Abstract
Acute kidney injury (AKI) is a common and serious condition, currently diagnosed by functional biomarkers, such as serum creatinine measurements. Unfortunately, creatinine increase is a delayed and unreliable indicator of AKI. The lack of early biomarkers of structural kidney injury has hampered our ability to translate promising experimental therapies to human AKI. The recent discovery, translation and validation of neutrophil gelatinase-associated lipocalin (NGAL), possibly the most promising novel AKI biomarker, is reviewed here. NGAL may be measured by several methods both in plasma and urine for the early diagnosis of AKI and for the prediction of clinical outcomes, such as dialysis requirement and mortality, in several common clinical scenarios, including in the intensive care unit, cardiac surgery and renal damage due the exposition to toxic agent and drugs, and renal transplantation. Furthermore, the predictive properties of NGAL, may play a critical role in expediting the drug development process. A systematic review of literature data indicates that further studies are necessary to establish accurate reference population values according to age, gender and ethnicity, as well as reliable and specific decisional values concerning the more common clinical settings related to AKI. Furthermore, proper randomized clinical trials on renal and systemic outcomes comparing the use of NGAL vs. standard clinical practice are still lacking and accurate cost-benefit and/or cost-utility analyses for NGAL as biomarker of AKI are also needed. However, it is important to note that NGAL, in the absence of diagnostic increases in serum creatinine, is able to detect some patients affected by subclinical AKI who have an increased risk of adverse outcomes. These results also suggest that the concept and definition of AKI might need to be reassessed.
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Affiliation(s)
- Aldo Clerico
- Fondazione G. Monasterio CNR-Regione Toscana and Scuola Superiore Sant'Anna, Pisa, Italy.
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Kim TM, Ramírez V, Barrera-Chimal J, Bobadilla NA, Park PJ, Vaidya VS. Gene expression analysis reveals the cell cycle and kinetochore genes participating in ischemia reperfusion injury and early development in kidney. PLoS One 2011; 6:e25679. [PMID: 21980527 PMCID: PMC3181346 DOI: 10.1371/journal.pone.0025679] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 09/08/2011] [Indexed: 01/04/2023] Open
Abstract
Background The molecular mechanisms that mediate the ischemia-reperfusion (I/R) injury in kidney are not completely understood. It is also largely unknown whether such mechanisms overlap with those governing the early development of kidney. Methodology/Principal Findings We performed gene expression analysis to investigate the transcriptome changes during regeneration after I/R injury in the rat (0 hr, 6 hr, 24 hr, and 120 hr after reperfusion) and early development of mouse kidney (embryonic day 16 p.c. and postnatal 1 and 7 day). Pathway analysis revealed a wide spectrum of molecular functions that may participate in the regeneration and developmental processes of kidney as well as the functional association between them. While the genes associated with cell cycle, immunity, inflammation, and apoptosis were globally activated during the regeneration after I/R injury, the genes encoding various transporters and metabolic enzymes were down-regulated. We also observed that these injury-associated molecular functions largely overlap with those of early kidney development. In particular, the up-regulation of kinases and kinesins with roles in cell division was common during regeneration and early developmental kidney as validated by real-time PCR and immunohistochemistry. Conclusions In addition to the candidate genes whose up-regulation constitutes an overlapping expression signature between kidney regeneration and development, this study lays a foundation for studying the functional relationship between two biological processes.
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Affiliation(s)
- Tae-Min Kim
- Center for Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Victoria Ramírez
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zúbiran, Mexico City, Mexico
| | - Jonatan Barrera-Chimal
- Molecular Physiology Unit, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zúbiran, Mexico City, Mexico
| | - Norma A. Bobadilla
- Molecular Physiology Unit, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zúbiran, Mexico City, Mexico
| | - Peter J. Park
- Center for Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Vishal S. Vaidya
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
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Shemin D, Dworkin LD. Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for early acute kidney injury. Crit Care Clin 2011; 27:379-89. [PMID: 21440207 DOI: 10.1016/j.ccc.2010.12.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Based on information to date, although limitations in the accuracy of NGAL in predicting AKI persist, the preponderance of published studies demonstrate that NGAL, when measured in the plasma and in the urine, is a reliable biomarker for the subsequent development of clinically apparent AKI. If very early detection of AKI, via the measurement of plasma or urinary NGAL, can be followed by effective treatment to abort the development or limit the severity of AKI, and therefore decrease the rate of RRT, length of hospitalization stay, and/or mortality risk, NGAL measurement will become a critically important diagnostic tool in critical care medicine, pediatrics, and surgery.
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Affiliation(s)
- Douglas Shemin
- Division of Kidney Diseases and Hypertension, Rhode Island Hospital, Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI 02903, USA.
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Wu QQ, Wang Y, Senitko M, Meyer C, Wigley WC, Ferguson DA, Grossman E, Chen J, Zhou XJ, Hartono J, Winterberg P, Chen B, Agarwal A, Lu CY. Bardoxolone methyl (BARD) ameliorates ischemic AKI and increases expression of protective genes Nrf2, PPARγ, and HO-1. Am J Physiol Renal Physiol 2011; 300:F1180-92. [PMID: 21289052 DOI: 10.1152/ajprenal.00353.2010] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Ischemic acute kidney injury (AKI) triggers expression of adaptive (protective) and maladaptive genes. Agents that increase expression of protective genes should provide a therapeutic benefit. We now report that bardoxolone methyl (BARD) ameliorates ischemic murine AKI as assessed by both renal function and pathology. BARD may exert its beneficial effect by increasing expression of genes previously shown to protect against ischemic AKI, NF-E2-related factor 2 (Nrf2), peroxisome proliferator-activated receptor-γ (PPARγ), and heme oxygenase 1 (HO-1). Although we found that BARD alone or ischemia-reperfusion alone increased expression of these genes, the greatest increase occurred after the combination of both ischemia-reperfusion and BARD. BARD had a different mode of action than other agents that regulate PPARγ and Nrf2. Thus we report that BARD regulates PPARγ, not by acting as a ligand but by increasing the amount of PPARγ mRNA and protein. This should increase ligand-independent effects of PPARγ. Similarly, BARD increased Nrf2 mRNA; this increased Nrf2 protein by mechanisms in addition to the prolongation of Nrf2 protein half-life previously reported. Finally, we localized expression of these protective genes after ischemia and BARD treatment. Using double-immunofluorescence staining for CD31 and Nrf2 or PPARγ, we found increased Nrf2 and PPARγ on glomerular endothelia in the cortex; Nrf2 was also present on cortical peritubular capillaries. In contrast, HO-1 was localized to different cells, i.e., tubules and interstitial leukocytes. Although Nrf2-dependent increases in HO-1 have been described, our data suggest that BARD's effects on tubular and leukocyte HO-1 during ischemic AKI may be Nrf2 independent. We also found that BARD ameliorated cisplatin nephrotoxicity.
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Affiliation(s)
- Qing Qing Wu
- Department of Internal Medicine, Nephrology Division, UT Southwestern Medical Center, Dallas, TX 75390-8856, USA
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Abstract
PURPOSE OF REVIEW Acute kidney injury is increasingly recognized in acute care settings in more recent years. Proper diagnosis and risk stratification for acute kidney injury is necessary for carrying out appropriate and cost-effective treatments in patients with acute kidney injury. Kidney markers serve as diagnostic and prognostic tools to give physicians a more complete perspective of renal insult. The aim of this review is to highlight some of the evidence from recent studies, involving kidney markers and provide current opinion on the accuracy of these markers. RECENT FINDINGS Recent studies demonstrate that novel kidney markers such as cystatin C, interleukin-18, kidney injury molecule 1, and neutrophil gelatinase-associated lipocalin serve as more accurate markers for acute kidney injury as compared with the more traditional marker, creatinine. Additionally, there seems to be a correlation between the concentrations of each marker and the level of deterioration of kidneys, patient recovery time, length of hospital stay, and hospital costs. SUMMARY Each individual kidney marker possesses its own strengths and weaknesses in determining the onset and severity of acute kidney injury. However, in combination, a panel of kidney markers may serve as powerful tools in diagnosing kidney injury with high accuracy.
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Devarajan P. Review: neutrophil gelatinase-associated lipocalin: a troponin-like biomarker for human acute kidney injury. Nephrology (Carlton) 2010; 15:419-28. [PMID: 20609093 DOI: 10.1111/j.1440-1797.2010.01317.x] [Citation(s) in RCA: 269] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Acute kidney injury (AKI) is a common and serious condition, the diagnosis of which currently depends on functional markers such as serum creatinine measurements. Unfortunately, creatinine is a delayed and unreliable indicator of AKI. The lack of early biomarkers of structural kidney injury (akin to troponin in acute myocardial injury) has hampered our ability to translate promising experimental therapies to human AKI. Fortunately, understanding the early stress response of the kidney to acute injuries has revealed a number of potential biomarkers. The discovery, translation and validation of neutrophil gelatinase-associated lipocalin (NGAL), possibly the most promising novel AKI biomarker, is reviewed. NGAL is emerging as an excellent stand-alone troponin-like structural biomarker in the plasma and urine for the early diagnosis of AKI, and for the prediction of clinical outcomes such as dialysis requirement and mortality in several common clinical scenarios. The approach of using NGAL as a trigger to initiate and monitor therapies for AKI, and as a safety biomarker when using potentially nephrotoxic agents, is also promising. In addition, it is hoped that the use of sensitive and specific biomarkers such as NGAL as endpoints in clinical trials will result in a reduction in required sample sizes, and hence the cost incurred. Furthermore, predictive biomarkers like NGAL may play a critical role in expediting the drug development process. However, given the complexity of AKI, additional biomarkers (perhaps a panel of plasma and urinary biomarkers) may eventually need to be developed and validated for optimal progress to occur.
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Affiliation(s)
- Prasad Devarajan
- Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, Ohio 45229-3039, USA.
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Devarajan P. Neutrophil gelatinase-associated lipocalin: a promising biomarker for human acute kidney injury. Biomark Med 2010; 4:265-80. [PMID: 20406069 DOI: 10.2217/bmm.10.12] [Citation(s) in RCA: 216] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Acute kidney injury (AKI) is a common and serious condition, the diagnosis of which depends on serum creatinine measurements. Unfortunately, creatinine is a delayed and unreliable indicator of AKI. The lack of early biomarkers has crippled our ability to translate promising experimental therapies to human AKI. Fortunately, understanding the early stress response of the kidney to acute injuries has revealed a number of potential biomarkers. The discovery, translation and validation of neutrophil gelatinase-associated lipocalin, arguably the most promising novel AKI biomarker, are reviewed in this article. Neutrophil gelatinase-associated lipocalin is emerging as an excellent standalone troponin-like biomarker in the plasma and urine for the prediction of AKI, monitoring clinical trials in AKI and for the prognosis of AKI in several common clinical scenarios.
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Affiliation(s)
- Prasad Devarajan
- Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH 45229-3039, USA.
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Ahn JI, Baik SY, Ko MJ, Shin HJ, Chung HJ, Jeong HS. Effects of Mercuric Chloride on Gene Expression in NRK-52E Cells. Genomics Inform 2010. [DOI: 10.5808/gi.2010.8.1.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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