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Greite R, Schott S, Wang L, Gohlke L, Kreimann K, Derlin K, Gutberlet M, Schmidbauer M, Leffler A, Tudorache I, Salman J, Ius F, Natanov R, Fegbeutel C, Haverich A, Lichtinghagen R, Hüsing AM, von Vietinghoff S, Schmitt R, Shushakova N, Rong S, Haller H, Schmidt‐Ott KM, Gram M, Vijayan V, Scheffner I, Gwinner W, Immenschuh S. Free heme and hemopexin in acute kidney injury after cardiopulmonary bypass and transient renal ischemia. Clin Transl Sci 2023; 16:2729-2743. [PMID: 37899696 PMCID: PMC10719480 DOI: 10.1111/cts.13667] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/13/2023] [Accepted: 10/09/2023] [Indexed: 10/31/2023] Open
Abstract
Free heme is released from hemoproteins during hemolysis or ischemia reperfusion injury and can be pro-inflammatory. Most studies on nephrotoxicity of hemolysis-derived proteins focus on free hemoglobin (fHb) with heme as a prosthetic group. Measurement of heme in its free, non-protein bound, form is challenging and not commonly used in clinical routine diagnostics. In contrast to fHb, the role of free heme in acute kidney injury (AKI) after cardiopulmonary bypass (CPB) surgery is unknown. Using an apo-horseradish peroxidase-based assay, we identified free heme during CPB surgery as predictor of AKI in patients undergoing cardiac valve replacement (n = 37). Free heme levels during CPB surgery correlated with depletion of hemopexin (Hx), a heme scavenger-protein. In mice, the impact of high levels of circulating free heme on the development of AKI following transient renal ischemia and the therapeutic potential of Hx were investigated. C57BL/6 mice were subjected to bilateral renal ischemia/reperfusion injury for 15 min which did not cause AKI. However, additional administration of free heme in this model promoted overt AKI with reduced renal function, increased renal inflammation, and reduced renal perfusion on functional magnetic resonance imaging. Hx treatment attenuated AKI. Free heme administration to sham operated control mice did not cause AKI. In conclusion, free heme is a predictor of AKI in CPB surgery patients and promotes AKI in transient renal ischemia. Depletion of Hx in CPB surgery patients and attenuation of AKI by Hx in the in vivo model encourage further research on Hx therapy in patients with increased free heme levels during CPB surgery.
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Affiliation(s)
- Robert Greite
- Department of Nephrology and HypertensionHannover Medical SchoolHannoverGermany
| | - Sebastian Schott
- Department of Nephrology and HypertensionHannover Medical SchoolHannoverGermany
| | - Li Wang
- Department of Nephrology and HypertensionHannover Medical SchoolHannoverGermany
| | - Lukas Gohlke
- Department of Nephrology and HypertensionHannover Medical SchoolHannoverGermany
| | - Kirill Kreimann
- Department of Nephrology and HypertensionHannover Medical SchoolHannoverGermany
| | - Katja Derlin
- Institute for Diagnostic and Interventional RadiologyHannover Medical SchoolHannoverGermany
| | - Marcel Gutberlet
- Institute for Diagnostic and Interventional RadiologyHannover Medical SchoolHannoverGermany
| | - Martina Schmidbauer
- Institute for Diagnostic and Interventional RadiologyHannover Medical SchoolHannoverGermany
| | - Andreas Leffler
- Department of Anesthesiology and Intensive Care MedicineHannover Medical SchoolHannoverGermany
| | - Igor Tudorache
- Department of Cardiac SurgeryUniversity Hospital DusseldorfDusseldorfGermany
| | - Jawad Salman
- Department of Cardiothoracic, Transplantation and Vascular SurgeryHannover Medical SchoolHannoverGermany
| | - Fabio Ius
- Department of Cardiothoracic, Transplantation and Vascular SurgeryHannover Medical SchoolHannoverGermany
| | - Ruslan Natanov
- Department of Cardiothoracic, Transplantation and Vascular SurgeryHannover Medical SchoolHannoverGermany
| | - Christine Fegbeutel
- Department of Cardiothoracic, Transplantation and Vascular SurgeryHannover Medical SchoolHannoverGermany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular SurgeryHannover Medical SchoolHannoverGermany
| | | | - Anne M. Hüsing
- Department of Nephrology and HypertensionHannover Medical SchoolHannoverGermany
| | - Sibylle von Vietinghoff
- Department of Nephrology and HypertensionHannover Medical SchoolHannoverGermany
- Nephrology Section, Medical Clinic 1University Hospital BonnBonnGermany
| | - Roland Schmitt
- Department of Nephrology and HypertensionHannover Medical SchoolHannoverGermany
| | - Nelli Shushakova
- Department of Nephrology and HypertensionHannover Medical SchoolHannoverGermany
| | - Song Rong
- Department of Nephrology and HypertensionHannover Medical SchoolHannoverGermany
| | - Hermann Haller
- Department of Nephrology and HypertensionHannover Medical SchoolHannoverGermany
| | - Kai M. Schmidt‐Ott
- Department of Nephrology and HypertensionHannover Medical SchoolHannoverGermany
| | - Magnus Gram
- Pediatrics, Department of Clinical Sciences LundSkane University Hospital, Lund UniversityLundSweden
| | - Vijith Vijayan
- Institute for Transfusion Medicine and Transplant EngineeringHannover Medical SchoolHannoverGermany
- Division of Critical Care Medicine, Department of PediatricsStanford University School of MedicineStanfordCaliforniaUSA
| | - Irina Scheffner
- Department of Nephrology and HypertensionHannover Medical SchoolHannoverGermany
| | - Wilfried Gwinner
- Department of Nephrology and HypertensionHannover Medical SchoolHannoverGermany
| | - Stephan Immenschuh
- Institute for Transfusion Medicine and Transplant EngineeringHannover Medical SchoolHannoverGermany
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Hüsing AM, Wulfmeyer VC, Gaedcke S, Fleig SV, Rong S, DeLuca D, Haller H, Schmitt R, von Vietinghoff S. Myeloid CCR2 Promotes Atherosclerosis after AKI. J Am Soc Nephrol 2022; 33:1487-1500. [PMID: 35537780 PMCID: PMC9342642 DOI: 10.1681/asn.2022010048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/10/2021] [Accepted: 04/10/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The risk of cardiovascular events rises after AKI. Leukocytes promote atherosclerotic plaque growth and instability. We established a model of enhanced remote atherosclerosis after renal ischemia-reperfusion (IR) injury and investigated the underlying inflammatory mechanisms. METHODS Atherosclerotic lesions and inflammation were investigated in native and bone marrow-transplanted LDL receptor-deficient (LDLr-/- ) mice after unilateral renal IR injury using histology, flow cytometry, and gene expression analysis. RESULTS Aortic root atherosclerotic lesions were significantly larger after renal IR injury than in controls. A gene expression screen revealed enrichment for chemokines and their cognate receptors in aortas of IR-injured mice in early atherosclerosis, and of T cell-associated genes in advanced disease. Confocal microscopy revealed increased aortic macrophage proximity to T cells. Differential aortic inflammatory gene regulation in IR-injured mice largely paralleled the pattern in the injured kidney. Single-cell analysis identified renal cell types that produced soluble mediators upregulated in the atherosclerotic aorta. The analysis revealed a marked early increase in Ccl2, which CCR2+ myeloid cells mainly expressed. CCR2 mediated myeloid cell homing to the post-ischemic kidney in a cell-individual manner. Reconstitution with Ccr2-/- bone marrow dampened renal post-ischemic inflammation, reduced aortic Ccl2 and inflammatory macrophage marker CD11c, and abrogated excess aortic atherosclerotic plaque formation after renal IR. CONCLUSIONS Our data introduce an experimental model of remote proatherogenic effects of renal IR and delineate myeloid CCR2 signaling as a mechanistic requirement. Monocytes should be considered as mobile mediators when addressing systemic vascular sequelae of kidney injury.
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Affiliation(s)
- Anne M. Hüsing
- Division of Nephrology and Hypertension, Department of Internal Medicine, Hannover Medical School, Hannover, Germany
| | - Vera C. Wulfmeyer
- Division of Nephrology and Hypertension, Department of Internal Medicine, Hannover Medical School, Hannover, Germany
| | - Svenja Gaedcke
- German Centre for Lung Research, Hannover Medical School, Hannover, Germany
| | - Susanne V. Fleig
- Division of Nephrology and Hypertension, Department of Internal Medicine, Hannover Medical School, Hannover, Germany,Nephrology Section, Medical Clinic 1, University Hospital Bonn, Rheinische Friedrich Wilhelm University of Bonn, Bonn, Germany
| | - Song Rong
- Division of Nephrology and Hypertension, Department of Internal Medicine, Hannover Medical School, Hannover, Germany
| | - David DeLuca
- German Centre for Lung Research, Hannover Medical School, Hannover, Germany
| | - Hermann Haller
- Division of Nephrology and Hypertension, Department of Internal Medicine, Hannover Medical School, Hannover, Germany
| | - Roland Schmitt
- Division of Nephrology and Hypertension, Department of Internal Medicine, Hannover Medical School, Hannover, Germany
| | - Sibylle von Vietinghoff
- Division of Nephrology and Hypertension, Department of Internal Medicine, Hannover Medical School, Hannover, Germany,Nephrology Section, Medical Clinic 1, University Hospital Bonn, Rheinische Friedrich Wilhelm University of Bonn, Bonn, Germany
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4
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Fleig S, Kapanadze T, Bernier-Latmani J, Lill JK, Wyss T, Gamrekelashvili J, Kijas D, Liu B, Hüsing AM, Bovay E, Jirmo AC, Halle S, Ricke-Hoch M, Adams RH, Engel DR, von Vietinghoff S, Förster R, Hilfiker-Kleiner D, Haller H, Petrova TV, Limbourg FP. Loss of vascular endothelial notch signaling promotes spontaneous formation of tertiary lymphoid structures. Nat Commun 2022; 13:2022. [PMID: 35440634 PMCID: PMC9018798 DOI: 10.1038/s41467-022-29701-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 03/21/2022] [Indexed: 12/20/2022] Open
Abstract
Tertiary lymphoid structures (TLS) are lymph node-like immune cell clusters that emerge during chronic inflammation in non-lymphoid organs like the kidney, but their origin remains not well understood. Here we show, using conditional deletion strategies of the canonical Notch signaling mediator Rbpj, that loss of endothelial Notch signaling in adult mice induces the spontaneous formation of bona fide TLS in the kidney, liver and lung, based on molecular, cellular and structural criteria. These TLS form in a stereotypical manner around parenchymal arteries, while secondary lymphoid structures remained largely unchanged. This effect is mediated by endothelium of blood vessels, but not lymphatics, since a lymphatic endothelial-specific targeting strategy did not result in TLS formation, and involves loss of arterial specification and concomitant acquisition of a high endothelial cell phenotype, as shown by transcriptional analysis of kidney endothelial cells. This indicates a so far unrecognized role for vascular endothelial cells and Notch signaling in TLS initiation. Loss of canonical Notch signaling in vascular endothelial cells induces spontaneous formation of proto-typical tertiary lymphoid structures in mouse kidney, liver and lungs, which form around central arteries that acquire a high endothelial cell signature
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Affiliation(s)
- Susanne Fleig
- Vascular Medicine Research, Hannover Medical School, 30625, Hannover, Germany.,Department of Nephrology and Hypertension, Hannover Medical School, 30625, Hannover, Germany.,Department of Geriatric Medicine (Medical Clinic VI), RWTH Aachen University Hospital, 52074, Aachen, Germany
| | - Tamar Kapanadze
- Vascular Medicine Research, Hannover Medical School, 30625, Hannover, Germany.,Department of Nephrology and Hypertension, Hannover Medical School, 30625, Hannover, Germany
| | - Jeremiah Bernier-Latmani
- Vascular and Tumor Biology Laboratory, Department of Oncology UNIL CHUV and Ludwig Institute for Cancer Research, Lausanne, Switzerland
| | - Julia K Lill
- Department of Immunodynamics, Institute for Experimental Immunology and Imaging, Medical Research Centre, University Hospital Essen, 45147, Essen, Germany
| | - Tania Wyss
- Vascular and Tumor Biology Laboratory, Department of Oncology UNIL CHUV and Ludwig Institute for Cancer Research, Lausanne, Switzerland.,SIB Swiss Institute of Bioinformatics, Lausanne, 1015, Switzerland
| | - Jaba Gamrekelashvili
- Vascular Medicine Research, Hannover Medical School, 30625, Hannover, Germany.,Department of Nephrology and Hypertension, Hannover Medical School, 30625, Hannover, Germany
| | - Dustin Kijas
- Vascular Medicine Research, Hannover Medical School, 30625, Hannover, Germany.,Department of Nephrology and Hypertension, Hannover Medical School, 30625, Hannover, Germany
| | - Bin Liu
- Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Anne M Hüsing
- Department of Nephrology and Hypertension, Hannover Medical School, 30625, Hannover, Germany
| | - Esther Bovay
- Max-Planck-Institute for Molecular Biomedicine, 48149, Muenster, Germany
| | - Adan Chari Jirmo
- Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany.,Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Stephan Halle
- Institute of Immunology, Hannover Medical School, 30625, Hannover, Germany
| | - Melanie Ricke-Hoch
- Department of Cardiology and Angiology, Hannover Medical School, 30625, Hannover, Germany
| | - Ralf H Adams
- Max-Planck-Institute for Molecular Biomedicine, 48149, Muenster, Germany
| | - Daniel R Engel
- Department of Immunodynamics, Institute for Experimental Immunology and Imaging, Medical Research Centre, University Hospital Essen, 45147, Essen, Germany
| | - Sibylle von Vietinghoff
- Department of Nephrology and Hypertension, Hannover Medical School, 30625, Hannover, Germany.,Division of Medicine I, Nephrology section, UKB Bonn University Hospital, Bonn, Germany
| | - Reinhold Förster
- Institute of Immunology, Hannover Medical School, 30625, Hannover, Germany
| | - Denise Hilfiker-Kleiner
- Department of Cardiology and Angiology, Hannover Medical School, 30625, Hannover, Germany.,Department of Cardiovascular Complications of Oncologic Therapies, Medical Faculty of the Philipps University Marburg, 35037, Marburg, Germany
| | - Hermann Haller
- Department of Nephrology and Hypertension, Hannover Medical School, 30625, Hannover, Germany
| | - Tatiana V Petrova
- Vascular and Tumor Biology Laboratory, Department of Oncology UNIL CHUV and Ludwig Institute for Cancer Research, Lausanne, Switzerland
| | - Florian P Limbourg
- Vascular Medicine Research, Hannover Medical School, 30625, Hannover, Germany. .,Department of Nephrology and Hypertension, Hannover Medical School, 30625, Hannover, Germany.
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5
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Helmke A, Hüsing AM, Gaedcke S, Brauns N, Balzer MS, Reinhardt M, Hiss M, Shushakova N, de Luca D, Prinz I, Haller H, von Vietinghoff S. Peritoneal dialysate-range hypertonic glucose promotes T-cell IL-17 production that induces mesothelial inflammation. Eur J Immunol 2020; 51:354-367. [PMID: 32926407 DOI: 10.1002/eji.202048733] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 05/04/2020] [Revised: 08/04/2020] [Accepted: 09/11/2020] [Indexed: 12/25/2022]
Abstract
Peritoneal dialysis (PD) employs hypertonic glucose to remove excess water and uremic waste. Peritoneal membrane failure limits its long-term use. T-cell cytokines promote this decline. T-cell differentiation is critically determined by the microenvironment. We here study how PD-range hypertonic glucose regulates T-cell polarization and IL-17 production. In the human peritoneal cavity, CD3+ cell numbers increased in PD. Single cell RNA sequencing detected expression of T helper (Th) 17 signature genes RORC and IL23R. In vitro, PD-range glucose stimulated spontaneous and amplified cytokine-induced Th17 polarization. Osmotic controls l-glucose and d-mannose demonstrate that induction of IL-17A is a substance-independent, tonicity dose-dependent process. PD-range glucose upregulated glycolysis and increased the proportion of dysfunctional mitochondria. Blockade of reactive-oxygen species (ROS) prevented IL-17A induction in response to PD-range glucose. Peritoneal mesothelium cultured with IL-17A or IL17F produced pro-inflammatory cytokines IL-6, CCL2, and CX3CL1. In PD patients, peritoneal IL-17A positively correlated with CX3CL1 concentrations. PD-range glucose-stimulated, but neither identically treated Il17a-/- Il17f-/- nor T cells cultured with the ROS scavenger N-acetylcysteine enhanced mesothelial CX3CL1 expression. Our data delineate PD-range hypertonic glucose as a novel inducer of Th17 polarization in a mitochondrial-ROS-dependent manner. Modulation of tonicity-mediated effects of PD solutions may improve membrane survival.
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Affiliation(s)
- Alexandra Helmke
- Division of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Anne M Hüsing
- Division of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Svenja Gaedcke
- German Center for Lung Research, Hannover Medical School, Hannover, Germany
| | - Nicolas Brauns
- Division of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Michael S Balzer
- Division of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Martin Reinhardt
- Division of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Marcus Hiss
- Division of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Nelli Shushakova
- Division of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - David de Luca
- German Center for Lung Research, Hannover Medical School, Hannover, Germany
| | - Immo Prinz
- Hannover Medical School, Institute for Immunology, Hannover, Germany
| | - Hermann Haller
- Division of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
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