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Olney KC, de Ávila C, Todd KT, Tallant LE, Barnett JH, Gibson KA, Hota P, Pandiane AS, Durgun PC, Serhan M, Wang R, Lind ML, Forzani E, Gades NM, Thomas LF, Fryer JD. Commonly disrupted pathways in brain and kidney in a pig model of systemic endotoxemia. J Neuroinflammation 2024; 21:9. [PMID: 38178237 PMCID: PMC10765757 DOI: 10.1186/s12974-023-03002-6] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/19/2023] [Indexed: 01/06/2024] Open
Abstract
Sepsis is a life-threatening state that arises due to a hyperactive inflammatory response stimulated by infection and rarely other insults (e.g., non-infections tissue injury). Although changes in several proinflammatory cytokines and signals are documented in humans and small animal models, far less is known about responses within affected tissues of large animal models. We sought to understand the changes that occur during the initial stages of inflammation by administering intravenous lipopolysaccharide (LPS) to Yorkshire pigs and assessing transcriptomic alterations in the brain, kidney, and whole blood. Robust transcriptional alterations were found in the brain, with upregulated responses enriched in inflammatory pathways and downregulated responses enriched in tight junction and blood vessel functions. Comparison of the inflammatory response in the pig brain to a similar mouse model demonstrated some overlapping changes but also numerous differences, including oppositely dysregulated genes between species. Substantial changes also occurred in the kidneys following LPS with several enriched upregulated pathways (cytokines, lipids, unfolded protein response, etc.) and downregulated gene sets (tube morphogenesis, glomerulus development, GTPase signal transduction, etc.). We also found significant dysregulation of genes in whole blood that fell into several gene ontology categories (cytokines, cell cycle, neutrophil degranulation, etc.). We observed a strong correlation between the brain and kidney responses, with significantly shared upregulated pathways (cytokine signaling, cell death, VEGFA pathways) and downregulated pathways (vasculature and RAC1 GTPases). In summary, we have identified a core set of shared genes and pathways in a pig model of systemic inflammation.
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Affiliation(s)
- Kimberly C Olney
- Department of Neuroscience, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, USA
| | - Camila de Ávila
- Department of Neuroscience, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, USA
| | - Kennedi T Todd
- Department of Neuroscience, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, USA
| | - Lauren E Tallant
- Department of Neuroscience, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, USA
- Mayo Clinic Graduate School of Biomedical Sciences, Scottsdale, AZ, USA
| | - J Hudson Barnett
- Department of Neuroscience, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, USA
- Mayo Clinic Graduate School of Biomedical Sciences, Scottsdale, AZ, USA
- MD/PhD Training Program, Mayo Clinic, Scottsdale, AZ, USA
| | - Katelin A Gibson
- Department of Neuroscience, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, USA
| | - Piyush Hota
- Division of Nephrology & Hypertension, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, USA
| | | | - Pinar Cay Durgun
- School of Engineering of Matter, Transport & Energy, Arizona State University, Tempe, AZ, USA
| | - Michael Serhan
- School of Engineering of Matter, Transport & Energy, Arizona State University, Tempe, AZ, USA
| | - Ran Wang
- School of Engineering of Matter, Transport & Energy, Arizona State University, Tempe, AZ, USA
| | - Mary Laura Lind
- School of Engineering of Matter, Transport & Energy, Arizona State University, Tempe, AZ, USA
| | - Erica Forzani
- School of Engineering of Matter, Transport & Energy, Arizona State University, Tempe, AZ, USA
| | - Naomi M Gades
- Department of Comparative Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Leslie F Thomas
- Division of Nephrology & Hypertension, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, USA.
| | - John D Fryer
- Department of Neuroscience, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, USA.
- Mayo Clinic Graduate School of Biomedical Sciences, Scottsdale, AZ, USA.
- MD/PhD Training Program, Mayo Clinic, Scottsdale, AZ, USA.
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Flythe JE, Assimon MM, Tugman MJ, Chang EH, Gupta S, Shah J, Sosa MA, Renaghan AD, Melamed ML, Wilson FP, Neyra JA, Rashidi A, Boyle SM, Anand S, Christov M, Thomas LF, Edmonston D, Leaf DE. Characteristics and Outcomes of Individuals With Pre-existing Kidney Disease and COVID-19 Admitted to Intensive Care Units in the United States. Am J Kidney Dis 2021; 77:190-203.e1. [PMID: 32961244 PMCID: PMC7501875 DOI: 10.1053/j.ajkd.2020.09.003] [Citation(s) in RCA: 135] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/15/2020] [Indexed: 12/13/2022]
Abstract
RATIONALE & OBJECTIVE Underlying kidney disease is an emerging risk factor for more severe coronavirus disease 2019 (COVID-19) illness. We examined the clinical courses of critically ill COVID-19 patients with and without pre-existing chronic kidney disease (CKD) and investigated the association between the degree of underlying kidney disease and in-hospital outcomes. STUDY DESIGN Retrospective cohort study. SETTINGS & PARTICIPANTS 4,264 critically ill patients with COVID-19 (143 patients with pre-existing kidney failure receiving maintenance dialysis; 521 patients with pre-existing non-dialysis-dependent CKD; and 3,600 patients without pre-existing CKD) admitted to intensive care units (ICUs) at 68 hospitals across the United States. PREDICTOR(S) Presence (vs absence) of pre-existing kidney disease. OUTCOME(S) In-hospital mortality (primary); respiratory failure, shock, ventricular arrhythmia/cardiac arrest, thromboembolic events, major bleeds, and acute liver injury (secondary). ANALYTICAL APPROACH We used standardized differences to compare patient characteristics (values>0.10 indicate a meaningful difference between groups) and multivariable-adjusted Fine and Gray survival models to examine outcome associations. RESULTS Dialysis patients had a shorter time from symptom onset to ICU admission compared to other groups (median of 4 [IQR, 2-9] days for maintenance dialysis patients; 7 [IQR, 3-10] days for non-dialysis-dependent CKD patients; and 7 [IQR, 4-10] days for patients without pre-existing CKD). More dialysis patients (25%) reported altered mental status than those with non-dialysis-dependent CKD (20%; standardized difference=0.12) and those without pre-existing CKD (12%; standardized difference=0.36). Half of dialysis and non-dialysis-dependent CKD patients died within 28 days of ICU admission versus 35% of patients without pre-existing CKD. Compared to patients without pre-existing CKD, dialysis patients had higher risk for 28-day in-hospital death (adjusted HR, 1.41 [95% CI, 1.09-1.81]), while patients with non-dialysis-dependent CKD had an intermediate risk (adjusted HR, 1.25 [95% CI, 1.08-1.44]). LIMITATIONS Potential residual confounding. CONCLUSIONS Findings highlight the high mortality of individuals with underlying kidney disease and severe COVID-19, underscoring the importance of identifying safe and effective COVID-19 therapies in this vulnerable population.
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Affiliation(s)
- Jennifer E Flythe
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina (UNC) Kidney Center, UNC School of Medicine, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC.
| | - Magdalene M Assimon
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina (UNC) Kidney Center, UNC School of Medicine, Chapel Hill, NC
| | - Matthew J Tugman
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina (UNC) Kidney Center, UNC School of Medicine, Chapel Hill, NC
| | - Emily H Chang
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina (UNC) Kidney Center, UNC School of Medicine, Chapel Hill, NC
| | - Shruti Gupta
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Jatan Shah
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Marie Anne Sosa
- Division of Nephrology, Department of Medicine, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, FL
| | - Amanda DeMauro Renaghan
- Division of Nephrology, Department of Medicine, University of Virginia Health System, Charlottesville, VA
| | - Michal L Melamed
- Department of Medicine/Nephrology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - F Perry Wilson
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT; Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, CT
| | - Javier A Neyra
- Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington, KY
| | - Arash Rashidi
- Division of Nephrology and Hypertension, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Suzanne M Boyle
- Section of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Shuchi Anand
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Marta Christov
- Division of Nephrology, Department of Medicine, Westchester Medical Center, Valhalla, NY
| | - Leslie F Thomas
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic in Arizona, Scottsdale, AZ
| | - Daniel Edmonston
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Renal Section, Durham VA Medical Center, Durham, NC
| | - David E Leaf
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
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Gilbert W, Thomas LF, Coyne L, Rushton J. Review: Mitigating the risks posed by intensification in livestock production: the examples of antimicrobial resistance and zoonoses. Animal 2020; 15:100123. [PMID: 33573940 DOI: 10.1016/j.animal.2020.100123] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 07/07/2020] [Revised: 10/27/2020] [Accepted: 11/03/2020] [Indexed: 12/16/2022] Open
Abstract
Major shifts in how animals are bred, raised and slaughtered are involved in the intensification of livestock systems. Globally, these changes have produced major increases in access to protein-rich foods with high levels of micronutrients. Yet the intensification of livestock systems generates numerous externalities including environmental degradation, zoonotic disease transmission and the emergence of antimicrobial resistance (AMR) genes. Where the process of intensification is most advanced, the expertise, institutions and regulations required to manage these externalities have developed over time, often in response to hard lessons, crises and challenges to public health. By exploring the drivers of intensification, the foci of future intensification can be identified. Low- and middle-income (LMICs) countries are likely to experience significant intensification in livestock production in the near future; however, the lessons learned elsewhere are not being transferred rapidly enough to develop risk mitigation capacity in these settings. At present, fragmentary approaches to address these problems present an incomplete picture of livestock populations, antimicrobial use, and disease risks in LMIC settings. A worldwide improvement in evidence-based zoonotic disease and AMR management within intensifying livestock production systems demands better information on the burden of livestock-associated disease, antimicrobial use and resistance and resources allocated to mitigation.
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Affiliation(s)
- W Gilbert
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, UK
| | - L F Thomas
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, UK.; International Livestock Research Institute, Nairobi, Kenya
| | - L Coyne
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, UK
| | - J Rushton
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, UK..
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de Glanville WA, Thomas LF, Cook EAJ, Bronsvoort BMDC, Wamae NC, Kariuki S, Fèvre EM. Household socio-economic position and individual infectious disease risk in rural Kenya. Sci Rep 2019; 9:2972. [PMID: 30814567 PMCID: PMC6393457 DOI: 10.1038/s41598-019-39375-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 01/22/2019] [Indexed: 11/21/2022] Open
Abstract
The importance of household socio-economic position (SEP) in shaping individual infectious disease risk is increasingly recognised, particularly in low income settings. However, few studies have measured the extent to which this association is consistent for the range of pathogens that are typically endemic among the rural poor in the tropics. This cross-sectional study assessed the relationship between SEP and human infection within a single community in western Kenya using a set of pathogens with diverse transmission routes. The relationships between household SEP and individual infection with Plasmodium falciparum, hookworm (Ancylostoma duodenale and/or Necator americanus), Entamoeba histolytica/dispar, Mycobacterium tuberculosis, and HIV, and co-infections between hookworm, P. falciparum and E. histolytica/dispar, were assessed using multivariable logistic and multinomial regression. Individuals in households with the lowest SEP were at greatest risk of infection with P. falciparum, hookworm and E. histolytica/dispar, as well as co-infection with each pathogen. Infection with M. tuberculosis, by contrast, was most likely in individuals living in households with the highest SEP. There was no evidence of a relationship between individual HIV infection and household SEP. We demonstrate the existence of a household socio-economic gradient within a rural farming community in Kenya which impacts upon individual infectious disease risk. Structural adjustments that seek to reduce poverty, and therefore the socio-economic inequalities that exist in this community, would be expected to substantially reduce overall infectious disease burden. However, policy makers and researchers should be aware that heterogeneous relationships can exist between household SEP and infection risk for different pathogens in low income settings.
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Affiliation(s)
- W A de Glanville
- Centre for Immunity, Infection and Evolution, Institute for Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Ashworth Laboratories, West Mains Road, Edinburgh, EH9 3JT, UK.
- International Livestock Research Institute, Old Naivasha Road, PO BOX 30709, 00100, Nairobi, Kenya.
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, G12 8QQ, United Kingdom.
| | - L F Thomas
- Centre for Immunity, Infection and Evolution, Institute for Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Ashworth Laboratories, West Mains Road, Edinburgh, EH9 3JT, UK
- International Livestock Research Institute, Old Naivasha Road, PO BOX 30709, 00100, Nairobi, Kenya
| | - E A J Cook
- Centre for Immunity, Infection and Evolution, Institute for Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Ashworth Laboratories, West Mains Road, Edinburgh, EH9 3JT, UK
- International Livestock Research Institute, Old Naivasha Road, PO BOX 30709, 00100, Nairobi, Kenya
| | - B M de C Bronsvoort
- The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Roslin, Midlothian, EH25 9RG, UK
- Roslin Institute, The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Roslin, Midlothian, EH25 9RG, UK
| | - N C Wamae
- School of Pharmacy and Health Sciences, United States International University-Africa, PO Box 14634-01000, Nairobi, Kenya
| | - S Kariuki
- Centre for Microbiology Research, Kenya Medical Research Institute, PO Box 19464-00200, Nairobi, Kenya
| | - E M Fèvre
- International Livestock Research Institute, Old Naivasha Road, PO BOX 30709, 00100, Nairobi, Kenya.
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Neston, CH64 7TE, UK.
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Firth C, Harris LA, Smith ML, Thomas LF. A Case Report of Cronkhite-Canada Syndrome Complicated by Membranous Nephropathy. Case Rep Nephrol Dial 2019; 8:261-267. [PMID: 30643792 PMCID: PMC6323406 DOI: 10.1159/000494714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/19/2018] [Indexed: 11/19/2022] Open
Abstract
Cronkhite-Canada syndrome (CCS) is a very rare disorder with less than 500 reported cases. It is characterized by extensive gastrointestinal polyposis and ectodermal anomalies including alopecia, cutaneous hyperpigmentation, and onychodystrophy. Only 3 cases of associated kidney disease (membranous nephropathy [MN]) have been reported. A 71-year-old male with CCS was referred for further evaluation of proteinuria. The patient initially presented with abdominal discomfort, weight loss, dysgeusia, skin hyperpigmentation, alopecia, and dystrophic nails. Endoscopic evaluation showed widespread gastrointestinal nodular inflammation and polyps. Histopathology was consistent with CCS. Initial treatment was with prednisone, azathioprine, and ranitidine. He had moderate clinical improvement but developed nephrotic-range proteinuria. Renal biopsy showed MN, and cyclosporine was started. The patient had significant improvement in his CCS manifestations; however, his proteinuria and renal function worsened. Rituximab was added to his regimen of cyclosporine and azathioprine, which resulted in remission of his MN, marked improvement in his polyposis, and near resolution of his cutaneous symptoms. This case represents a unique presentation of CCS associated with MN treated with rituximab. The excellent clinical response observed for both CCS and MN advocates consideration of this treatment, especially for refractory disease.
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Affiliation(s)
- Christine Firth
- Department of Internal Medicine, Mayo Clinic in Arizona, Scottsdale, Arizona, USA
| | - Lucinda A Harris
- Division of Gastroenterology, Mayo Clinic in Arizona, Scottsdale, Arizona, USA
| | - Maxwell L Smith
- Department of Anatomic Pathology, Mayo Clinic in Arizona, Scottsdale, Arizona, USA
| | - Leslie F Thomas
- Division of Nephrology and Hypertension, Mayo Clinic in Arizona, Scottsdale, Arizona, USA
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Makau DN, Gitau GK, Muchemi GK, Thomas LF, Cook EAJ, Wardrop NA, Fèvre EM, de Glanville WA. Environmental predictors of bovine Eimeria infection in western Kenya. Trop Anim Health Prod 2017; 49:409-416. [PMID: 28054227 PMCID: PMC5253148 DOI: 10.1007/s11250-016-1209-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 12/05/2016] [Indexed: 11/24/2022]
Abstract
Eimeriosis is caused by a protozoan infection affecting most domestic animal species. Outbreaks in cattle are associated with various environmental factors in temperate climates but limited work has been done in tropical settings. The objective of this work was to determine the prevalence and environmental factors associated with bovine Eimeria spp. infection in a mixed farming area of western Kenya. A total of 983 cattle were sampled from 226 cattle-keeping households. Faecal samples were collected directly from the rectum via digital extraction and analysed for the presence of Eimeria spp. infection using the MacMaster technique. Individual and household level predictors of infection were explored using mixed effects logistic regression. The prevalence of individual animal Eimeria infection was 32.8% (95% CI 29.9-35.9). A positive linear relationship was found between risk of Eimeria infection and increasing temperature (OR = 1.4, 95% CI 1.06-1.86) and distance to areas at risk of flooding (OR = 1.49, 95% CI 1.17-1.91). There was weak evidence of non-linear relationship between Eimeria infection and the proportion of the area around a household that was classified as swamp (OR = 1.12, 95% CI 0.87-1.44; OR (quadratic term) = 0.85, 95% CI 0.73-1.00), and the sand content of the soil (OR = 1.18, 95% CI 0.91-1.53; OR (quadratic term) = 1.1, 95% CI 0.99-1.23). The risk of animal Eimeria spp. infection is influenced by a number of climatic and soil-associated conditions.
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Affiliation(s)
- D N Makau
- Department of Public Health Pharmacology and Toxicology, Faculty of Veterinary Medicine, University of Nairobi, Nairobi, PO BOX 29053-00625, Kenya.
| | - G K Gitau
- Department of Clinical Studies, Faculty of Veterinary Medicine, University of Nairobi, Nairobi, PO BOX 29053-00625, Kenya
| | - G K Muchemi
- Department of Public Health Pharmacology and Toxicology, Faculty of Veterinary Medicine, University of Nairobi, Nairobi, PO BOX 29053-00625, Kenya
| | - L F Thomas
- International Livestock Research Institute, Old Naivasha Road, PO Box 30709-00100, Nairobi, Kenya
- Centre for Immunity, Infection and Evolution, Institute for Immunology and Infection Research, School of Biological Sciences, Kings Buildings, University of Edinburgh, West Mains Road, Edinburgh, EH9 3JT, UK
| | - E A J Cook
- International Livestock Research Institute, Old Naivasha Road, PO Box 30709-00100, Nairobi, Kenya
- Centre for Immunity, Infection and Evolution, Institute for Immunology and Infection Research, School of Biological Sciences, Kings Buildings, University of Edinburgh, West Mains Road, Edinburgh, EH9 3JT, UK
| | - N A Wardrop
- Geography and Environment, University of Southampton, Highfield Campus, University Road, Southampton, SO17 1BJ, UK
| | - E M Fèvre
- International Livestock Research Institute, Old Naivasha Road, PO Box 30709-00100, Nairobi, Kenya
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Neston, CH64 7TE, UK
| | - W A de Glanville
- International Livestock Research Institute, Old Naivasha Road, PO Box 30709-00100, Nairobi, Kenya.
- Centre for Immunity, Infection and Evolution, Institute for Immunology and Infection Research, School of Biological Sciences, Kings Buildings, University of Edinburgh, West Mains Road, Edinburgh, EH9 3JT, UK.
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Batra RK, Heilman RL, Smith ML, Thomas LF, Khamash HA, Katariya NN, Hewitt WR, Singer AL, Mathur AK, Huskey J, Chakkera HA, Moss A, Reddy KS. Rapid Resolution of Donor-Derived Glomerular Fibrin Thrombi After Deceased Donor Kidney Transplantation. Am J Transplant 2016; 16:1015-20. [PMID: 26689853 DOI: 10.1111/ajt.13561] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 08/16/2015] [Revised: 09/11/2015] [Accepted: 09/29/2015] [Indexed: 01/25/2023]
Abstract
The aim of this study was to determine the clinical and histologic outcomes related to transplanting kidneys from deceased donors with glomerular fibrin thrombi (GFT). We included all cases transplanted between October 2003 and October 2014 that had either a preimplantation biopsy or an immediate postreperfusion biopsy showing GFT. The study cohort included 61 recipients (9.9%) with GFT and 557 in the control group without GFT. Delayed graft function occurred in 49% of the GFT group and 39% in the control group (p = 0.14). Serum creatinine at 1, 4, and 12 months and estimated GFR at 12 months were similar in the two groups. Estimated 1-year graft survival was 93.2% in the GFT group and 95.1% in the control group (p = 0.22 by log-rank). Fifty-two of the 61 patients in the GFT group (85%) had a 1-month protocol biopsy, and only two biopsies (4%) showed residual focal glomerular thrombi. At the 1-year protocol biopsy, the prevalence of moderate to severe interstitial fibrosis and tubular atrophy was 24% in the GFT group and 30% in the control group (p = 0.42). We concluded that GFT resolves rapidly after transplantation and that transplanting selected kidneys from deceased donors with GFT is a safe practice.
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Affiliation(s)
- R K Batra
- Department of Surgery, Mayo Clinic, Phoenix, AZ
| | - R L Heilman
- Department of Medicine, Mayo Clinic, Phoenix, AZ
| | - M L Smith
- Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ
| | - L F Thomas
- Department of Medicine, Mayo Clinic, Phoenix, AZ
| | - H A Khamash
- Department of Medicine, Mayo Clinic, Phoenix, AZ
| | | | - W R Hewitt
- Department of Surgery, Mayo Clinic, Phoenix, AZ
| | - A L Singer
- Department of Surgery, Mayo Clinic, Phoenix, AZ
| | - A K Mathur
- Department of Surgery, Mayo Clinic, Phoenix, AZ
| | - J Huskey
- Department of Medicine, Mayo Clinic, Phoenix, AZ
| | - H A Chakkera
- Department of Medicine, Mayo Clinic, Phoenix, AZ
| | - A Moss
- Department of Surgery, Mayo Clinic, Phoenix, AZ
| | - K S Reddy
- Department of Surgery, Mayo Clinic, Phoenix, AZ
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Fervenza FC, Canetta PA, Barbour SJ, Lafayette RA, Rovin BH, Aslam N, Hladunewich MA, Irazabal MV, Sethi S, Gipson DS, Reich HN, Brenchley P, Kretzler M, Radhakrishnan J, Hebert LA, Gipson PE, Thomas LF, McCarthy ET, Appel GB, Jefferson JA, Eirin A, Lieske JC, Hogan MC, Greene EL, Dillon JJ, Leung N, Sedor JR, Rizk DV, Blumenthal SS, Lasic LB, Juncos LA, Green DF, Simon J, Sussman AN, Philibert D, Cattran DC. A Multicenter Randomized Controlled Trial of Rituximab versus Cyclosporine in the Treatment of Idiopathic Membranous Nephropathy (MENTOR). Nephron Clin Pract 2015; 130:159-68. [PMID: 26087670 DOI: 10.1159/000430849] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 04/17/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Idiopathic membranous nephropathy remains the leading cause of nephrotic syndrome in Caucasian adults. Immunosuppressive therapy with cyclosporine (CSA) is often successful in reducing proteinuria, but its use is associated with a high relapse rate. Rituximab, a monoclonal antibody that specifically targets CD20 on the surface of B-cells, is effective in achieving a complete remission of proteinuria in patients with idiopathic membranous nephropathy. However, whether rituximab is as effective as CSA in inducing and maintaining complete or partial remission of proteinuria in these patients is unknown. The membranous nephropathy trial of rituximab (MENTOR) hypothesizes that B-cell targeting with rituximab is non-inferior to CSA in inducing long-term remission of proteinuria. METHODS AND DESIGN Patients with idiopathic membranous nephropathy, proteinuria ≥5 g/24 h, and a minimum of 3 months of Angiotensin-II blockade will be randomized into a 12-month treatment period with i.v. rituximab, 1,000 mg (2 infusions, 14 days apart; repeated at 6 months if a substantial reduction in proteinuria (equal to or >25%) is seen at 6 months) or oral CSA 3.5-5 mg/kg/day for 6 months (continued for another 6 months if a substantial reduction in proteinuria (equal to or >25%) is seen at 6 months). The efficacy of treatment will be assessed by the remission status (based on changes in proteinuria) at 24 months from randomization. Patient safety will be assessed via collection of adverse event data and evaluation of pre- and posttreatment laboratory data. At the 6-month post-randomization visit, patients who have been randomized to either CSA or rituximab but who do not have a reduction in proteinuria ≥25% (confirmed on repeat measurements within 2 weeks) will be considered treatment failures and exit the study. DISCUSSION This study will test for the first time whether treatment with rituximab is non-inferior to CSA in inducing long-term remission (complete or partial) of proteinuria in patients with idiopathic membranous nephropathy.
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Berndt T, Thomas LF, Craig TA, Sommer S, Li X, Bergstralh EJ, Kumar R. Evidence for a signaling axis by which intestinal phosphate rapidly modulates renal phosphate reabsorption. Proc Natl Acad Sci U S A 2007; 104:11085-90. [PMID: 17566100 PMCID: PMC1891094 DOI: 10.1073/pnas.0704446104] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.1] [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] [Indexed: 12/16/2022] Open
Abstract
The mechanisms by which phosphorus homeostasis is preserved in mammals are not completely understood. We demonstrate the presence of a mechanism by which the intestine detects the presence of increased dietary phosphate and rapidly increases renal phosphate excretion. The mechanism is of physiological relevance because it maintains plasma phosphate concentrations in the normal range after ingestion of a phosphate-containing meal. When inorganic phosphate is infused into the duodenum, there is a rapid increase in the renal fractional excretion of phosphate (FE Pi). The phosphaturic effect of intestinal phosphate is specific for phosphate because administration of sodium chloride does not elicit a similar response. Phosphaturia after intestinal phosphate administration occurs in thyro-parathyroidectomized rats, demonstrating that parathyroid hormone is not essential for this effect. The increase in renal FE Pi in response to the intestinal administration of phosphate occurs without changes in plasma concentrations of phosphate (filtered load), parathyroid hormone, FGF-23, or secreted frizzled related protein-4. Denervation of the kidney does not attenuate phosphaturia elicited after intestinal phosphate administration. Phosphaturia is not elicited when phosphate is instilled in other parts of the gastrointestinal tract such as the stomach. Infusion of homogenates of the duodenal mucosa increases FE Pi, which demonstrates the presence of one or more substances within the intestinal mucosa that directly modulate renal phosphate reabsorption. Our experiments demonstrate the presence of a previously unrecognized phosphate gut-renal axis that rapidly modulates renal phosphate excretion after the intestinal administration of phosphate.
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Affiliation(s)
- Theresa Berndt
- *Division of Nephrology and Hypertension, Department of Internal Medicine
| | - Leslie F. Thomas
- *Division of Nephrology and Hypertension, Department of Internal Medicine
| | - Theodore A. Craig
- *Division of Nephrology and Hypertension, Department of Internal Medicine
| | - Stacy Sommer
- *Division of Nephrology and Hypertension, Department of Internal Medicine
| | - Xujian Li
- Division of Biostatistics, Department of Health Sciences Research, and
| | | | - Rajiv Kumar
- *Division of Nephrology and Hypertension, Department of Internal Medicine
- Department of Biochemistry and Molecular Biology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905
- To whom correspondence should be addressed. E-mail:
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Meyn RE, Hewitt RR, Thomas LF, Humphrey RM. Effects of ultraviolet irradiation on the rate and sequence of DNA replication in synchronized Chinese hamster cells. Biophys J 1976; 16:517-25. [PMID: 1276380 PMCID: PMC1334872 DOI: 10.1016/s0006-3495(76)85706-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The effects of ultraviolet light (UV) irradiation on the rate of DNA replication in synchronized Chinese hamster ovary (CHO) cells were investigated. A technique for measuring semiconservative DNA replication was employed that involved growing the cells in medium containing 5-bromodeoxyuridine and subsequently determining the amount of DNA that acquired hybrid buoyant density in CsCl density gradients. One of the advantages of this technique was that it allowed a characterization of the extent of DNA replication as well as rate after irradiation. It was found that while there was a dose-dependent reduction in the rate of DNA replication following UV-irradiation, doses of up to 10 J/m2 (which produce many dimers per replication) did not prevent the ultimate replication of the entire genome. Hence, we conclude that dimers cannot be absolute blocks to DNA replication. In order to account for the total genome replication observed, a mechanism must exist that allows genome replication between dimers. The degree of reduction in the rate of replication by UV was the same whether the cells were irradiated at the G1-S boundary or 1 h into S-phase. Previous work had shown that cells in early S-phase are considerably more sensitive to UV than cells at the G1-S boundary. Experiments specifically designed to test for reiterative replication showed that UV does not induce a second round of DNA replication within the same S-phase.
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