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Wu R, Li J, Tu G, Su Y, Zhang X, Luo Z, Rong R, Zhang Y. Comprehensive Molecular and Cellular Characterization of Acute Kidney Injury Progression to Renal Fibrosis. Front Immunol 2021; 12:699192. [PMID: 34777334 PMCID: PMC8586649 DOI: 10.3389/fimmu.2021.699192] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 10/01/2021] [Indexed: 02/05/2023] Open
Abstract
Acute kidney injury (AKI) and chronic kidney disease (CKD) represent different stages of renal failure; thus, CKD can be regarded as a result of AKI deterioration. Previous studies have demonstrated that immune cell infiltration, oxidative stress, and metabolic mentalism can support renal fibrosis progression in AKI cases. However, the most important triggers and cell types involved in this pathological progression remain unclear. This study was conducted to shed light into the underlying cellular and molecular features of renal fibrosis progression through the analysis of three mouse whole kidney and one human single-cell RNA-sequencing datasets publicly available. According to the different causes of AKI (ischemia reperfusion injury [IRI] or cisplatin), the mouse samples were divided into the CIU [control-IRI-unilateral ureteral obstruction (UUO)] and CCU (control-cisplatin-UUO) groups. Comparisons between groups revealed eight different modules of differentially expressed genes (DEGs). A total of 1,214 genes showed the same expression pattern in both CIU and CCU groups; however, 1,816 and 1,308 genes were expressed specifically in the CCU and CIU groups, respectively. Further assessment of the DEGs according to the Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment pathway and Gene Ontology (GO) showed that T-cell activation, fatty acid metabolic process, and arachidonic acid metabolism were involved in the fibrosis progression in CIU and CCU. Single-cell RNA-sequencing data along with the collected DEGs information also revealed that the T-cell activation mainly happened in immune cells, whereas the fatty acid metabolic process and arachidonic acid metabolism occurred in tubule cells. Taken together, these findings suggest that the fibrosis process differed between the CIU and CCU stages, in which immune and tubule cells have different functions. These identified cellular and molecular features of the different stages of fibrosis progression may pave the way for exploring novel potential therapeutic strategies in the clinic.
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Affiliation(s)
- Renyan Wu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Immunology, Department of Immunology and Microbiology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiawei Li
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Guowei Tu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ying Su
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xuepeng Zhang
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhe Luo
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Yi Zhang, ; Ruiming Rong, ; Zhe Luo,
| | - Ruiming Rong
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
- *Correspondence: Yi Zhang, ; Ruiming Rong, ; Zhe Luo,
| | - Yi Zhang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
- Biomedical Research Center, Institute for Clinical Sciences, Zhongshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Yi Zhang, ; Ruiming Rong, ; Zhe Luo,
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Alshogran OY. Warfarin Dosing and Outcomes in Chronic Kidney Disease: A Closer Look at Warfarin Disposition. Curr Drug Metab 2019; 20:633-645. [PMID: 31267868 DOI: 10.2174/1389200220666190701095807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/02/2019] [Accepted: 06/12/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Chronic Kidney Disease (CKD) is a prevalent worldwide health problem. Patients with CKD are more prone to developing cardiovascular complications such as atrial fibrillation and stroke. This warrants the use of oral anticoagulants, such as warfarin, in this population. While the efficacy and safety of warfarin in this setting remain controversial, a growing body of evidence emphasizes that warfarin use in CKD can be problematic. This review discusses 1) warfarin use, dosing and outcomes in CKD patients; and 2) possible pharmacokinetic mechanisms for altered warfarin dosing and response in CKD. METHODS Structured search and review of literature articles evaluating warfarin dosing and outcomes in CKD. Data and information about warfarin metabolism, transport, and pharmacokinetics in CKD were also analyzed and summarized. RESULTS The literature data suggest that changes in warfarin pharmacokinetics such as protein binding, nonrenal clearance, the disposition of warfarin metabolites may partially contribute to altered warfarin dosing and response in CKD. CONCLUSION Although the evidence to support warfarin use in advanced CKD is still unclear, this synthesis of previous findings may help in improving optimized warfarin therapy in CKD settings.
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Affiliation(s)
- Osama Y Alshogran
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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Barnette DA, Johnson BP, Pouncey DL, Nshimiyimana R, Desrochers LP, Goodwin TE, Miller GP. Stereospecific Metabolism of R- and S-Warfarin by Human Hepatic Cytosolic Reductases. Drug Metab Dispos 2017; 45:1000-1007. [PMID: 28646078 PMCID: PMC5539582 DOI: 10.1124/dmd.117.075929] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 06/06/2017] [Indexed: 01/10/2023] Open
Abstract
Coumadin (rac-warfarin) is the most commonly used anticoagulant in the world; however, its clinical use is often challenging because of its narrow therapeutic range and interindividual variations in response. A critical contributor to the uncertainty is variability in warfarin metabolism, which includes mostly oxidative but also reductive pathways. Reduction of each warfarin enantiomer yields two warfarin alcohol isomers, and the corresponding four alcohols retain varying levels of anticoagulant activity. Studies on the kinetics of warfarin reduction have often lacked resolution of parent-drug enantiomers and have suffered from coelution of pairs of alcohol metabolites; thus, those studies have not established the importance of individual stereospecific reductive pathways. We report the first steady-state analysis of R- and S-warfarin reduction in vitro by pooled human liver cytosol. As determined by authentic standards, the major metabolites were 9R,11S-warfarin alcohol for R-warfarin and 9S,11S-warfarin alcohol for S-warfarin. R-warfarin (Vmax 150 pmol/mg per minute, Km 0.67 mM) was reduced more efficiently than S-warfarin (Vmax 27 pmol/mg per minute, Km 1.7 mM). Based on inhibitor phenotyping, carbonyl reductase-1 dominated R-and S-warfarin reduction, followed by aldo-keto reductase-1C3 and then other members of that family. Overall, the carbonyl at position 11 undergoes stereospecific reduction by multiple enzymes to form the S alcohol for both drug enantiomers, yet R-warfarin undergoes reduction preferentially. This knowledge will aid in assessing the relative importance of reductive pathways for R- and S-warfarin and factors influencing levels of pharmacologically active parent drugs and metabolites, thus impacting patient dose responses.
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Affiliation(s)
- Dustyn A Barnette
- Department of Biochemistry and Molecular Biology, University of Arkansas for Medical Sciences, Little Rock (D.A.B., D.L.P., G.P.M.), Department of Chemistry, University of Central Arkansas, Conway (B.P.J.), and Department of Chemistry, Hendrix College, Conway (R.N., L.P.D., T.E.G.), Arkansas
| | - Bryce P Johnson
- Department of Biochemistry and Molecular Biology, University of Arkansas for Medical Sciences, Little Rock (D.A.B., D.L.P., G.P.M.), Department of Chemistry, University of Central Arkansas, Conway (B.P.J.), and Department of Chemistry, Hendrix College, Conway (R.N., L.P.D., T.E.G.), Arkansas
| | - Dakota L Pouncey
- Department of Biochemistry and Molecular Biology, University of Arkansas for Medical Sciences, Little Rock (D.A.B., D.L.P., G.P.M.), Department of Chemistry, University of Central Arkansas, Conway (B.P.J.), and Department of Chemistry, Hendrix College, Conway (R.N., L.P.D., T.E.G.), Arkansas
| | - Robert Nshimiyimana
- Department of Biochemistry and Molecular Biology, University of Arkansas for Medical Sciences, Little Rock (D.A.B., D.L.P., G.P.M.), Department of Chemistry, University of Central Arkansas, Conway (B.P.J.), and Department of Chemistry, Hendrix College, Conway (R.N., L.P.D., T.E.G.), Arkansas
| | - Linda P Desrochers
- Department of Biochemistry and Molecular Biology, University of Arkansas for Medical Sciences, Little Rock (D.A.B., D.L.P., G.P.M.), Department of Chemistry, University of Central Arkansas, Conway (B.P.J.), and Department of Chemistry, Hendrix College, Conway (R.N., L.P.D., T.E.G.), Arkansas
| | - Thomas E Goodwin
- Department of Biochemistry and Molecular Biology, University of Arkansas for Medical Sciences, Little Rock (D.A.B., D.L.P., G.P.M.), Department of Chemistry, University of Central Arkansas, Conway (B.P.J.), and Department of Chemistry, Hendrix College, Conway (R.N., L.P.D., T.E.G.), Arkansas
| | - Grover P Miller
- Department of Biochemistry and Molecular Biology, University of Arkansas for Medical Sciences, Little Rock (D.A.B., D.L.P., G.P.M.), Department of Chemistry, University of Central Arkansas, Conway (B.P.J.), and Department of Chemistry, Hendrix College, Conway (R.N., L.P.D., T.E.G.), Arkansas
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