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Laster M, Pereira RC, Noche K, Gales B, Salusky IB, Albrecht LV. Sclerostin, Osteocytes, and Wnt Signaling in Pediatric Renal Osteodystrophy. Nutrients 2023; 15:4127. [PMID: 37836411 PMCID: PMC10574198 DOI: 10.3390/nu15194127] [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: 08/05/2023] [Revised: 09/07/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
The pathophysiology of chronic kidney disease-mineral and bone disorder (CKD-MBD) is not well understood. Specific factors secreted by osteocytes are elevated in the serum of adults and pediatric patients with CKD-MBD, including FGF-23 and sclerostin, a known inhibitor of the Wnt signaling pathway. The molecular mechanisms that promote bone disease during the progression of CKD are incompletely understood. In this study, we performed a cross-sectional analysis of 87 pediatric patients with pre-dialysis CKD and post-dialysis (CKD 5D). We assessed the associations between serum and bone sclerostin levels and biomarkers of bone turnover and bone histomorphometry. We report that serum sclerostin levels were elevated in both early and late CKD. Higher circulating and bone sclerostin levels were associated with histomorphometric parameters of bone turnover and mineralization. Immunofluorescence analyses of bone biopsies evaluated osteocyte staining of antibodies towards the canonical Wnt target, β-catenin, in the phosphorylated (inhibited) or unphosphorylated (active) forms. Bone sclerostin was found to be colocalized with phosphorylated β-catenin, which suggests that Wnt signaling was inhibited. In patients with low serum sclerostin levels, increased unphosphorylated "active" β-catenin staining was observed in osteocytes. These data provide new mechanistic insight into the pathogenesis of CKD-MBD and suggest that sclerostin may offer a potential biomarker or therapeutic target in pediatric renal osteodystrophy.
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Affiliation(s)
- Marciana Laster
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA; (M.L.); (R.C.P.); (K.N.); (B.G.)
| | - Renata C. Pereira
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA; (M.L.); (R.C.P.); (K.N.); (B.G.)
| | - Kathleen Noche
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA; (M.L.); (R.C.P.); (K.N.); (B.G.)
| | - Barbara Gales
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA; (M.L.); (R.C.P.); (K.N.); (B.G.)
| | - Isidro B. Salusky
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA; (M.L.); (R.C.P.); (K.N.); (B.G.)
| | - Lauren V. Albrecht
- Department of Pharmaceutical Sciences, School of Pharmacy, University of California, Irvine, CA 92697, USA
- Department of Developmental and Cell Biology, School of Biological Sciences, University of California, Irvine, CA 92697, USA
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Laster M, Kozman D, Norris KC. Addressing Structural Racism in Pediatric Clinical Practice. Pediatr Clin North Am 2023; 70:725-743. [PMID: 37422311 DOI: 10.1016/j.pcl.2023.03.010] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
Structural racism is the inequitable allocation of various social determinants of health to different communities. Exposure to this and other discrimination levied from intersectional identities is the primary driver of disproportionately adverse health outcomes for minoritized children and their families. Pediatric clinicians must vigilantly identify and mitigate racism in health care systems and delivery, assess for any impact of patient and family exposure to racism and direct them to appropriate health resources, foster an environment of inclusion and respect, and ensure that all care is delivered through a race-conscious lens with the utmost cultural humility and shared decision-making.
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Affiliation(s)
- Marciana Laster
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Division of Pediatric Nephrology, UCLA Department of Pediatrics, 10833 Le Conte Avenue, MDCC A2-383, Los Angeles, CA 90095-1752, USA
| | - Daniel Kozman
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA; UCLA Department of Medicine, Section of Medicine-Pediatrics & Preventive Medicine
| | - Keith C Norris
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Division of General Internal Medicine and Health Services Research, UCLA Department of Medicine, 1100 Glendon Avenue, Suite 710, Los Angeles, CA 90024, USA.
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Laster M, Norris KC. Equitable Transplantation: A Modifiable Risk Factor for Disparities in Mortality in ESKD. J Am Soc Nephrol 2022; 33:1240-1241. [PMID: 35365573 PMCID: PMC9257812 DOI: 10.1681/asn.2022030273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Marciana Laster
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Keith C Norris
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
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Seo-Mayer P, Ashoor I, Hayde N, Laster M, Sanderson K, Soranno D, Wigfall D, Brown D. Seeking justice, equity, diversity and inclusion in pediatric nephrology. Front Pediatr 2022; 10:1084848. [PMID: 36578658 PMCID: PMC9791125 DOI: 10.3389/fped.2022.1084848] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022] Open
Abstract
Inequity, racism, and health care disparities negatively impact the well-being of children with kidney disease. This review defines social determinants of health and describes how they impact pediatric nephrology care; outlines the specific impact of systemic biases and racism on chronic kidney disease care and transplant outcomes; characterizes and critiques the diversity of the current pediatric nephrology workforce; and aims to provide strategies to acknowledge and dismantle bias, address barriers to care, improve diversity in recruitment, and strengthen the pediatric nephrology community. By recognizing historical and current realities and limitations, we can move forward with strategies to address racism and bias in our field and clinical practices, thereby cultivating inclusive training and practice environments.
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Affiliation(s)
- Patricia Seo-Mayer
- Division of Pediatric Nephrology, Inova Children's Hospital, University of Virginia School of Medicine-Inova Campus, Fairfax, VA, United States
| | - Isa Ashoor
- Division of Pediatric Nephrology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Nicole Hayde
- Division of Pediatric Nephrology, Children's Hospital of Montefiore, Albert Einstein College of Medicine, New York, NY, United States
| | - Marciana Laster
- Division of Pediatric Nephrology, University of California Los Angeles Mattel Children's Hospital, Los Angeles, CA, United States
| | - Keia Sanderson
- Division of Pediatric Nephrology, University of North Carolina, Chapel Hill, NC, United States
| | - Danielle Soranno
- Division of Pediatric Nephrology, Indiana University, Indianapolis, IN, United States
| | - Delbert Wigfall
- Division of Pediatric Nephrology, Duke University School of Medicine, Durham, NC, United States
| | - Denver Brown
- Division of Pediatric Nephrology, Children's National Hospital, George Washington School of Medicine, Washington, DC, United States
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Laster M, Denburg M, Okuda Y, Kumar J, Furth S, Warady B, Kalantar-Zadeh K, Norris K, Salusky IB. Race and Ethnicity Predict Bone Markers and Fracture in Pediatric Patients With Chronic Kidney Disease. J Bone Miner Res 2021; 36:298-304. [PMID: 32960469 PMCID: PMC8893169 DOI: 10.1002/jbmr.4182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 01/17/2023]
Abstract
Studies in healthy children have shown racial-ethnic differences in bone markers and bone outcomes including fractures. At present, limited studies have evaluated the impact of race and ethnicity on bone markers and fractures within the pediatric chronic kidney disease (CKD) population. In a cohort study of 762 children between the ages of 1.5 years and 18 years, with CKD stages 1 to 4 from the CKD in children (CKiD) cohort, the relationship between racial-ethnic group and bone markers (parathyroid hormone [PTH], 25-hydroxyvitamin D [25-OHD], 1,25-dihydroxyvitamin D [1,25(OH)2 D], and C-terminal fibroblast growth factor [FGF23]) was determined using linear mixed models. Additionally, logistic regression was used to evaluate racial-ethnic differences in prevalent fracture upon study entry. Black race was associated with 23% higher PTH levels (confidence interval [CI], 2.5% to 47.7%; p = .03), 33.1% lower 25-OHD levels (CI, -39.7% to -25.7%; p < .0001), and no difference in C-terminal FGF23 or 1,25(OH)2 D levels when compared to whites. Hispanic ethnicity was associated with 15.9% lower C-terminal FGF23 levels (CI, -28.3% to -1.5%; p = .03) and 13.8% lower 25-OHD levels (CI, -22.2% to -4.5%; p = .005) when compared to whites. Black and Hispanic children had 74% (odds ratio [OR] 0.26; CI, 0.14 to 0.49; p = .001) and 66% (OR 0.34; CI, 0.17 to 0.65; p < .0001) lower odds of any fracture than white children at study entry, respectively. Race and ethnicity are associated with differences in bone markers and despite lower 25-OHD levels, both black and Hispanic children with CKD reported a lower prevalent fracture history than white children. The current findings in the CKD population are similar to racial-ethnic differences described in healthy children. Additional studies are needed to better understand how these differences might impact the management of pediatric CKD-MBD. © 2020 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Marciana Laster
- Department of Pediatrics, Division of Nephrology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Michelle Denburg
- The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Yusuke Okuda
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan.,Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension and Kidney Transplantation, University of California, Irvine, Irvine, CA, USA
| | - Juhi Kumar
- Weill Cornell Medical College, New York, NY, USA
| | - Susan Furth
- The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Bradley Warady
- Division of Nephrology, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension and Kidney Transplantation, University of California, Irvine, Irvine, CA, USA
| | - Keith Norris
- Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Isidro B Salusky
- Department of Pediatrics, Division of Nephrology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
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Okuda Y, Streja E, Rhee CM, Tantisattamo E, Reddy U, Laster M, Tang Y, Rajpoot D, Molnar MZ, Ichii H, Obi Y, Kalantar-Zadeh K. Association of age with risk of first and subsequent allograft failure and mortality among young kidney transplant recipients in the USA - a retrospective cohort study. Transpl Int 2020; 33:1503-1515. [PMID: 32779214 DOI: 10.1111/tri.13717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/21/2020] [Revised: 03/20/2020] [Accepted: 08/05/2020] [Indexed: 11/30/2022]
Abstract
Adolescent age may be a high-risk period for kidney allograft failure. However, the knowledge on this topic is limited mostly to the first transplant. Among 20 960 patients aged ≤21 years at the first kidney transplantation from the US Renal Data System, we evaluated the association of age at the first kidney transplant with risk for the first and subsequent graft failures (1st, 2nd, and 3rd) using the conditional risk set model for recurrent time-to-event data. The median age was 15 (interquartile range: 9-18) years, and 18% received transplants twice or more during a median follow-up of 9.7 years. The risk for graft failures was highest in 16 to <18 years old with an adjusted hazard ratio (aHR) of 1.93 (95% CI, 1.73-2.15; reference: <3 years). When separately analyzed, the highest risk was observed in 17, 19, and 21 years old for the first, second, and third transplant, respectively. Those 16 to <18 years were also strongly associated with the highest risk for death after returning to dialysis (aHR, 4.01; 95% CI, 2.82-5.71). Adolescent recipients remain at high risk for allograft failure for a long time, which may result in high mortality risk, even though they surpass this high-risk period soon after the first transplant.
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Affiliation(s)
- Yusuke Okuda
- Division of Nephrology and Hypertension, School of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, CA, USA.,Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, JAPAN
| | - Elani Streja
- Division of Nephrology and Hypertension, School of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, CA, USA
| | - Connie M Rhee
- Division of Nephrology and Hypertension, School of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, CA, USA
| | - Ekamol Tantisattamo
- Division of Nephrology and Hypertension, School of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, CA, USA
| | - Uttam Reddy
- Division of Nephrology and Hypertension, School of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, CA, USA
| | - Marciana Laster
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Division of Pediatric Nephrology, Mattel Children's Hospital at UCLA, Los Angeles, CA, USA
| | - Ying Tang
- Division of Nephrology and Hypertension, School of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, CA, USA.,Department of Pediatric Nephrology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Deepak Rajpoot
- Miller Children Hospital, Long Beach, CA, USA.,Department of Pediatrics, School of Medicine, University of California Irvine, Orange, CA, USA
| | - Miklos Z Molnar
- James D Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary.,Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Hirohito Ichii
- Department of Surgery, University of California Irvine, Orange, CA, USA
| | - Yoshitsugu Obi
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, School of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, CA, USA
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Okuda Y, Soohoo M, Ishikura K, Tang Y, Obi Y, Laster M, Rhee CM, Streja E, Kalantar-Zadeh K. Primary causes of kidney disease and mortality in dialysis-dependent children. Pediatr Nephrol 2020; 35:851-860. [PMID: 32020338 PMCID: PMC8876253 DOI: 10.1007/s00467-019-04457-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/09/2019] [Accepted: 12/13/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Congenital anomalies of the kidney and urinary tract (CAKUT) is associated with a slower progression to end-stage renal disease (ESRD) in pre-dialysis patients. However, little is known about the associated mortality risks after transitioning to dialysis. METHODS This retrospective cohort study included 0-21 year-old incident dialysis patients from the United States Renal Data System starting dialysis between 1995 and 2016. We examined the association of CAKUT vs. non-CAKUT with all-cause mortality, using Cox regression adjusted for case mix variables. We also examined the mortality risk associated with 14 non-CAKUT vs. CAKUT ESRD etiologies and under stratification by estimated glomerular filtration rate (eGFR). RESULTS Among 25,761 patients, the median (interquartile range) age was 17 (11-19) years, and 4780 (19%) had CAKUT. CAKUT was associated with lower mortality, with an adjusted hazard ratio (aHR) of 0.72 (95%CI, 0.64-0.81) (reference: non-CAKUT). In age-stratified analyses, CAKUT vs. non-CAKUT aHRs (95%CI) were 0.66 (0.54-0.80), 0.56 (0.39-0.80), 0.66 (0.50-0.86), and 0.97 (0.80-1.18) among patients < 6, 6-< 13, 13-< 18, and ≥ 18 years at dialysis initiation, respectively. Among non-CAKUT ESRD etiologies, the risk of mortality associated with primary glomerulonephritis (aHR, 0.93; 95%CI 0.80-1.09) and focal segmental glomerulosclerosis (aHR, 0.89; 95%CI, 0.75-1.04) were comparable or slightly lower compared to CAKUT, whereas most other primary causes were associated with higher mortality risk. While the CAKUT group had lower mortality risk compared to the non-CAKUT group patients with eGFR ≥5 mL/min/1.73m2, CAKUT was associated with higher mortality in patients with eGFR < 5 mL/min/1.73 m2. CONCLUSIONS CAKUT is associated with lower mortality among children < 18 years old, but showed comparable mortality with non-CAKUT among patients ≥ 18 years old. ESRD etiology should be considered in risk assessment for children initiating dialysis.
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Affiliation(s)
- Yusuke Okuda
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA,Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Melissa Soohoo
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA
| | - Kenji Ishikura
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Ying Tang
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA
| | - Yoshitsugu Obi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA
| | - Marciana Laster
- David Geffen School of Medicine at UCLA, Los Angeles, CA,Division of Pediatric Nephrology, Mattel Children’s Hospital at UCLA, Los Angeles, CA
| | - Connie M. Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, 101 The City Drive South, City Tower, Suite 400, Orange, CA, 92868, USA.
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Laster M, Pereira RC, Salusky IB. Unraveling the osteocyte in CKD-MBD post-renal transplantation. Kidney Int 2019; 96:1059-1061. [PMID: 31648693 DOI: 10.1016/j.kint.2019.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 07/18/2019] [Accepted: 07/26/2019] [Indexed: 12/01/2022]
Abstract
Changes in indices of mineral metabolism, bone protein expression, and bone turnover were assessed between pre- and post-renal transplant bone biopsies obtained 12 months apart. Circulating sclerostin and fibroblast growth factor 23 (FGF-23) levels decreased, and a low bone turnover state was highly prevalent on follow-up. In contrast, bone sclerostin expression increased, whereas FGF-23 bone expression was unchanged/decreased. These findings underscore the limitations of circulating biomarkers and the critical role of bone biopsy to understand osteocyte biology in chronic kidney disease-mineral bone disorder.
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Affiliation(s)
- Marciana Laster
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Renata C Pereira
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Isidro B Salusky
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
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Laster M, Pereira RC, Salusky IB. Racial differences in bone histomorphometry in children and young adults treated with dialysis. Bone 2019; 127:114-119. [PMID: 31181383 PMCID: PMC6708779 DOI: 10.1016/j.bone.2019.06.004] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 05/22/2019] [Accepted: 06/06/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Healthy African-Americans are known to have greater bone mineral density and decreased risk of fracture when compared to Caucasians. In fact, comparisons of bone histomorphometry in healthy South African children and adults reveal greater cortical thickness in Black subjects as compared to White. How these differences are reflected in the bone of American children and young adults on dialysis is unknown. METHODS Using tetracycline-labeled, iliac crest bone biopsies obtained in prior research protocols in pediatric and young adult dialysis patients, we compared trabecular and cortical parameters between non-Hispanic African-American subjects and non-Hispanic Caucasian subjects matched by age and gender. A linear regression model controlled for trabecular turnover and mineralization was used to further investigate the association of race with cortical thickness. RESULTS The matched cohort consisted of 52 subjects-26 African-American and 26 Caucasian. Turnover, mineralization and volume parameters in trabecular bone did not show significant differences between racial groups. Characterizing subjects by renal osteodystrophy type did not show a statistically significant difference although Caucasian patients had double the prevalence of mineralization defects. Consistent with this was a trend toward better mineralization parameters in African-Americans including shorter osteoid maturation time and lower osteoid volume. A sub-cohort of patients with cortical measures demonstrated greater median (IQR) cortical thickness in African-Americans (541 μm [354, 694]) than in Caucasians (371 μm [336, 446], p = 0.08). In a linear regression model controlling for trabecular turnover and mineralization, African-American subjects had 36.2% (95% CI 0.28 to 85.1%, p = 0.048) greater cortical thickness as compared to White subjects. There was no significant difference in cortical porosity. CONCLUSIONS Although likely limited by sample size, our findings suggest that, similar to findings in populations of normal children, African-American race in pediatric and young adults on dialysis is associated with greater cortical thickness. Additionally, there was a trend toward greater mineralization defects in Caucasian children. Both findings require further exploration with larger patient samples in order to thoroughly explore these racial differences and the implications on CKD-MBD treatment.
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Affiliation(s)
- Marciana Laster
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America.
| | - Renata C Pereira
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Isidro B Salusky
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
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Okuda Y, Soohoo M, Tang Y, Obi Y, Laster M, Rhee CM, Streja E, Kalantar-Zadeh K. Estimated GFR at Dialysis Initiation and Mortality in Children and Adolescents. Am J Kidney Dis 2019; 73:797-805. [PMID: 30833086 DOI: 10.1053/j.ajkd.2018.12.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 09/18/2018] [Accepted: 12/17/2018] [Indexed: 12/27/2022]
Abstract
RATIONALE & OBJECTIVE The association of estimated glomerular filtration rate (eGFR) at dialysis therapy initiation with mortality among adult dialysis patients has been greatly debated, with some studies showing no benefit from early dialysis therapy initiation. However, this association has not been well investigated in pediatric dialysis patients. The objective of this study was to evaluate the mortality risk associated with eGFR at dialysis therapy initiation in children and adolescents with kidney failure. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS 9,963 incident dialysis patients aged 1 to 17 years in the US Renal Data System registry (1995-2016). PREDICTOR eGFRs at dialysis therapy initiation calculated using the pediatric-specific bedside Schwartz equation (<5, 5-<7, 7-<9, 9-<12, and ≥12mL/min/1.73m2). OUTCOME Time to all-cause death. ANALYTICAL APPROACH Cox proportional hazards regression adjusted for case-mix variables, height, body mass index, hemoglobin level, and serum albumin level. RESULTS Median eGFR was 7.8 (IQR, 5.6-10.5) mL/min/1.73m2 and median age was 13 (IQR, 9-16) years. 696 deaths were observed during the median follow-up of 1.4 (IQR, 0.7-2.7) years, and overall crude mortality rate was 31 per 1,000 patient-years. There appeared to be a trend toward higher mortality risk across higher eGFRs at dialysis therapy initiation. Compared with eGFRs of 7 to <9mL/min/1.73m2, eGFRs <5 and ≥12mL/min/1.73m2 were associated with lower and higher mortality, with adjusted HRs of 0.57 (95% CI, 0.43-0.74) and 1.31 (95% CI, 1.05-1.65), respectively. In age-stratified analysis, there were consistent relationships among patients 6 years and older while the eGFR-mortality association was attenuated among patients younger than 6 years (Pinteraction = 0.002). LIMITATIONS Possible errors in eGFRs due to methods for serum creatinine measurement. Unmeasured confounders related to eGFR at dialysis therapy initiation. CONCLUSIONS Higher eGFR at dialysis therapy initiation was associated with higher mortality risk. Further studies of eGFR at initiation are needed in pediatric dialysis patients, especially among those younger than 6 years.
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Affiliation(s)
- Yusuke Okuda
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA
| | - Melissa Soohoo
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA
| | - Ying Tang
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA; Department of Pediatric Nephrology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yoshitsugu Obi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA
| | - Marciana Laster
- David Geffen School of Medicine at UCLA, Los Angeles, CA; Division of Pediatric Nephrology, Mattel Children's Hospital at UCLA, Los Angeles, CA
| | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA.
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Laster M, Soohoo M, Streja E, Elashoff R, Jernigan S, Langman CB, Norris KC, Salusky IB, Kalantar-Zadeh K. Racial-ethnic differences in chronic kidney disease-mineral bone disorder in youth on dialysis. Pediatr Nephrol 2019; 34:107-115. [PMID: 30267239 PMCID: PMC6420309 DOI: 10.1007/s00467-018-4048-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 07/02/2018] [Accepted: 08/07/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Studies in healthy pediatric populations and adults treated with dialysis demonstrate higher parathyroid hormone (PTH) and lower 25-hydroxyvitamin D levels in African-Americans. Despite these findings, African-Americans on dialysis demonstrate greater bone strength and a decreased risk of fracture compared to the Caucasian dialysis population. The presence of such differences in children and young adult dialysis patients is unknown. METHODS Differences in the markers of mineral and bone metabolism (MBM) were assessed in 661 incident dialysis patients (aged 1 month to < 21 years). Racial-ethnic differences in PTH, calcium, phosphate, and total alkaline phosphatase (AP) activity were analyzed over the first year of dialysis using multivariate linear mixed models. RESULTS African-American race predicted 23% higher serum PTH (95% CI, 4.7-41.3%) when compared to Caucasian patients, while Hispanic ethnicity predicted 17.5% higher PTH (95% CI, 2.3-38%). Upon gender stratification, the differences in PTH were magnified in African-American and Hispanic females: 38% (95% CI, 14.8-69.8%) and 28.8% (95% CI, 4.7-54.9%) higher PTH compared to Caucasian females. Despite higher PTH values, African-American females persistently demonstrated up to 10.9% lower serum AP activity (95% CI, - 20.6-- 0.7%). CONCLUSIONS There are racial-ethnic differences in the markers of MBM. Higher PTH is seen in African-American and Hispanic children and young adults on dialysis with a magnification of this difference amongst the female population. There is a need to consider how factors like race, ethnicity, and gender impact the goal-targeted treatment of MBM disorders.
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Affiliation(s)
- Marciana Laster
- Division of Pediatric Nephrology, David Geffen School of Medicine at UCLA, 10833 Le Conte, Box 951752, Los Angeles, CA, 90095-1752, USA
- Division of Pediatric Nephrology, Mattel Children's Hospital at UCLA, Los Angeles, CA, USA
| | - Melissa Soohoo
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Robert Elashoff
- Division of Pediatric Nephrology, David Geffen School of Medicine at UCLA, 10833 Le Conte, Box 951752, Los Angeles, CA, 90095-1752, USA
| | - Stephanie Jernigan
- Division of Pediatric Nephrology, Emory University School of Medicine, Atlanta, GA, USA
| | - Craig B Langman
- Feinberg School of Medicine, Northwestern University and the Anne and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Keith C Norris
- Division of Pediatric Nephrology, David Geffen School of Medicine at UCLA, 10833 Le Conte, Box 951752, Los Angeles, CA, 90095-1752, USA
| | - Isidro B Salusky
- Division of Pediatric Nephrology, David Geffen School of Medicine at UCLA, 10833 Le Conte, Box 951752, Los Angeles, CA, 90095-1752, USA.
- Division of Pediatric Nephrology, Mattel Children's Hospital at UCLA, Los Angeles, CA, USA.
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA
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Abstract
PURPOSE OF REVIEW We will review non-renal-related mechanisms of fibroblast growth factor 23 (FGF23) pathophysiology. RECENT FINDINGS FGF23 production and metabolism may be affected by many bone, mineral, and kidney factors. However, it has recently been demonstrated that other factors, such as iron status, erythropoietin, and inflammation, also affect FGF23 production and metabolism. As these non-mineral factors are especially relevant in the setting of chronic kidney disease (CKD), they may represent emerging determinants of CKD-associated elevated FGF23 levels. Moreover, FGF23 itself may promote anemia and inflammation, thus contributing to the multifactorial etiologies of these CKD-associated comorbidities. CKD-relevant, non-mineral-related, bidirectional relationships exist between FGF23 and anemia, and between FGF23 and inflammation. Iron deficiency, anemia, and inflammation affect FGF23 production and metabolism, and FGF23 itself may contribute to anemia and inflammation, highlighting complex interactions that may affect aspects of CKD pathogenesis and treatment.
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Affiliation(s)
- Mark R Hanudel
- UCLA Department of Pediatrics, Division of Pediatric Nephrology, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, MDCC A2-383, Los Angeles, CA, 90095-1752, USA.
| | - Marciana Laster
- UCLA Department of Pediatrics, Division of Pediatric Nephrology, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, MDCC A2-383, Los Angeles, CA, 90095-1752, USA
| | - Isidro B Salusky
- UCLA Department of Pediatrics, Division of Pediatric Nephrology, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, MDCC A2-383, Los Angeles, CA, 90095-1752, USA
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13
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Abstract
End-stage kidney disease and earlier stages of chronic kidney disease (CKD) represent one of the most dramatic examples of racial/ethnic disparities in health in our nation. African Americans are 3 times more likely to require renal replacement therapy then their non-Hispanic white counterparts. This article describes CKD-related disparities linked to a variety of clinical, socioeconomic, and cultural factors, as well as to select social determinants of health that are defined by social positioning and often by race within the United States. Our advancing understanding of these issues has led to improvements in patient outcomes and is narrowing the gap in disparities across most aspects of CKD and CKD risk factors. There are also extensive data indicating similar improvements in quality measures for patients on dialysis therapy. This article also reviews the state of CKD in African Americans from a population perspective and provides recommendations for the way forward.
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Affiliation(s)
- Marciana Laster
- Division of Nephrology, Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, CA
| | - Jenny I Shen
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA; Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Keith C Norris
- Division of Nephrology and Hypertension, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA; Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA.
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14
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Laster M, Soohoo M, Hall C, Streja E, Rhee CM, Ravel VA, Reddy U, Norris KC, Salusky IB, Kalantar-Zadeh K. Racial-ethnic disparities in mortality and kidney transplant outcomes among pediatric dialysis patients. Pediatr Nephrol 2017; 32:685-695. [PMID: 27796622 PMCID: PMC5392236 DOI: 10.1007/s00467-016-3530-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/05/2016] [Accepted: 09/25/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Previous studies in adult hemodialysis patients have shown that African-American and Hispanic patients have a lower risk of mortality in addition to a lower likelihood of kidney transplantation. However, studies of the association between race and outcomes in pediatric dialysis are sparse and often do not examine outcomes in Hispanic children. The objective was to determine if racial-ethnic disparities in mortality and kidney transplantation outcomes exist in pediatric dialysis patients. METHODS This was a retrospective cohort analysis of 2,697 pediatric dialysis patients (aged 0-20 years) from a large national dialysis organization (entry period 2001-2011) of non-Hispanic white, African-American, and Hispanic race-ethnicity. Associations between race-ethnicity with mortality and kidney transplantation outcomes were examined separately using competing risks methods. Logistic regression analyses were used to examine the association between race-ethnicity, with outcomes within 1 year of dialysis initiation. RESULTS Of the 2,697 pediatric patients in this cohort, 895 were African-American, 778 were Hispanic, and 1,024 were non-Hispanic white. After adjusting for baseline demographics, competing risk survival analysis revealed that compared with non-Hispanic whites, African-Americans had a 64 % higher mortality risk (hazards ratio [HR] = 1.64; 95 % CI 1.24-2.17), whereas Hispanics had a 31 % lower mortality risk (HR = 0.69; 95 % CI 0.47-1.01) that did not reach statistical significance. African-Americans also had higher odds of 1-year mortality after starting dialysis (odds ratio [OR] = 2.08; 95 % CI 0.95-4.58), whereas both African-Americans and Hispanics had a lower odds of receiving a transplant within 1 year of starting dialysis (OR = 0.28; 95 % CI 0.19-0.41 and OR = 0.43; 95 % CI 0.31-0.59 respectively). CONCLUSION In contrast to adults, African-American pediatric dialysis patients have worse survival than their non-Hispanic white counterparts, whereas Hispanics have a similar to lower mortality risk. Both African-American and Hispanic pediatric dialysis patients had a lower likelihood of kidney transplantation than non-Hispanic whites, similar to observations in the adult dialysis population.
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Affiliation(s)
- Marciana Laster
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Melissa Soohoo
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, School of Medicine, University of California Irvine, 101 The City Drive South, City Tower, Suite 400, ZOT: 4088, Orange, CA, 92868-3217, USA
| | - Clinton Hall
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, School of Medicine, University of California Irvine, 101 The City Drive South, City Tower, Suite 400, ZOT: 4088, Orange, CA, 92868-3217, USA
| | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, School of Medicine, University of California Irvine, 101 The City Drive South, City Tower, Suite 400, ZOT: 4088, Orange, CA, 92868-3217, USA
- Division of Nephrology and Hypertension, School of Medicine, University of California Irvine, Orange, CA, USA
| | - Vanessa A Ravel
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, School of Medicine, University of California Irvine, 101 The City Drive South, City Tower, Suite 400, ZOT: 4088, Orange, CA, 92868-3217, USA
| | - Uttam Reddy
- Division of Nephrology and Hypertension, School of Medicine, University of California Irvine, Orange, CA, USA
| | - Keith C Norris
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Kamyar Kalantar-Zadeh
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, School of Medicine, University of California Irvine, 101 The City Drive South, City Tower, Suite 400, ZOT: 4088, Orange, CA, 92868-3217, USA.
- Division of Nephrology and Hypertension, School of Medicine, University of California Irvine, Orange, CA, USA.
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15
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Affiliation(s)
| | - Keith C Norris
- Department of Medicine, Division of Nephrology and Hypertension and .,Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, California
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16
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Laster M, Im D, Ahn A, Ho CH. A 12-year-old boy with dyspnea, hypertension, hematuria, and proteinuria. Hosp Pediatr 2015; 5:348-351. [PMID: 26034167 DOI: 10.1542/hpeds.2014-0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
| | | | | | - Cynthia H Ho
- Departments of Pediatrics, and Internal Medicine, Los Angeles County + University of Southern California Medical Center, Keck School of Medicine, Los Angeles, California
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17
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Anis Y, Leshem O, Reuveni H, Wexler I, Ben Sasson R, Yahalom B, Laster M, Raz I, Ben Sasson S, Shafrir E, Ziv E. Antidiabetic effect of novel modulating peptides of G-protein-coupled kinase in experimental models of diabetes. Diabetologia 2004; 47:1232-1244. [PMID: 15235770 DOI: 10.1007/s00125-004-1444-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2003] [Accepted: 04/19/2004] [Indexed: 11/26/2022]
Abstract
AIMS/HYPOTHESIS G-protein-coupled receptor kinases (GRKs) play a key role in agonist-induced desensitisation of G-protein-coupled receptors (GPCRs) that are involved in metabolic regulation and glucose homeostasis. Our aim was to examine whether small peptides derived from the catalytic domain of GRK2 and -3 would ameliorate Type 2 diabetes in three separate animal models of diabetes. METHODS Synthetic peptides derived from a kinase-substrate interaction site in GRK2/3 were initially screened for their effect on in vitro melanogenesis, a GRK-mediated process. The most effective peptides were administered intraperitoneally, utilising a variety of dosing regimens, to Psammomys obesus gerbils, Zucker diabetic fatty (ZDF) rats, or db/db mice. The metabolic effects of these peptides were assessed by measuring fasting and fed blood glucose levels and glucose tolerance. RESULTS Two peptides, KRX-683(107) and KRX-683(124), significantly reduced fed-state blood glucose levels in the diabetic Psammomys obesus. In animals treated with KRX-683(124) at a dose of 12.5 mg/kg weekly for 7 weeks, ten of eleven treated animals responded with mean blood glucose significantly lower than controls (4.7+/-0.4 vs 16.8+/-0.8 mmol/l, p</=0.0001). Significant reductions in blood glucose compared with controls were also seen in ZDF rats administered KRX-683(124) and in db/db mice, which had significantly reduced fasting and 2-hour postprandial glucose levels after the treatment. CONCLUSIONS/INTERPRETATION Sequence-based peptides derived from GRK2/3 have an antidiabetic effect demonstrated in three different animal models of Type 2 diabetes. By modulating GRK2/3 activity, these peptides enhance GPCR-initiated signal transduction, resulting in improved glucose homeostasis. Sequence-based peptide modulation of GRK could prove useful in the treatment of Type 2 diabetes.
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Affiliation(s)
- Y Anis
- Keryx Biopharmaceuticals, Jerusalem, Israel
| | - O Leshem
- Keryx Biopharmaceuticals, Jerusalem, Israel
| | - H Reuveni
- Keryx Biopharmaceuticals, Jerusalem, Israel
| | - I Wexler
- Keryx Biopharmaceuticals, Jerusalem, Israel
- Department of Pediatrics, Hadassah University Hospital, Jerusalem, Israel
| | - R Ben Sasson
- Diabetes Research Center, Department of Medicine, Hadassah University Hospital, Jerusalem 91120, Israel
| | - B Yahalom
- Keryx Biopharmaceuticals, Jerusalem, Israel
| | - M Laster
- Keryx Biopharmaceuticals, Jerusalem, Israel
| | - I Raz
- Diabetes Research Center, Department of Medicine, Hadassah University Hospital, Jerusalem 91120, Israel
| | - S Ben Sasson
- Department of Experimental Medicine & Cancer Research, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - E Shafrir
- Diabetes Research Center, Department of Medicine, Hadassah University Hospital, Jerusalem 91120, Israel
| | - E Ziv
- Diabetes Research Center, Department of Medicine, Hadassah University Hospital, Jerusalem 91120, Israel.
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18
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Honigman A, Zeira E, Ohana P, Abramovitz R, Tavor E, Bar I, Zilberman Y, Rabinovsky R, Gazit D, Joseph A, Panet A, Shai E, Palmon A, Laster M, Galun E. Imaging transgene expression in live animals. Mol Ther 2001; 4:239-49. [PMID: 11545615 DOI: 10.1006/mthe.2001.0437] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Monitoring the expression of therapeutic genes in targeted tissues in disease models is important to assessing the effectiveness of systems of gene therapy delivery. We applied a new light-detection cooled charged-coupled device (CCCD) camera for continuous in vivo assessment of commonly used gene therapy delivery systems (such as ex vivo manipulated cells, viral vectors, and naked DNA), without the need to kill animals. We examined a variety of criteria related to real-time monitoring of luciferase (luc) gene expression in tissues including bone, muscle, salivary glands, dermis, liver, peritoneum, testis, teeth, prostate, and bladder in living mice and rats. These criteria included determination of the efficiency of infection/transfection of various viral and nonviral delivery systems, promoter specificity, and visualization of luciferase activity, and of the ability of luciferin to reach various organs. The exposure time for detection of luc activity by the CCCD camera is relatively short (approximately 2 minutes) compared with the intensified CCD camera photon-counting method (approximately 15 minutes). Here we transduce a variety of vectors (such as viruses, transfected cells, and naked DNA) by various delivery methods, including electroporation, systemic injection of viruses, and tail-vein, high-velocity-high-volume administration of DNA plasmids. The location, intensity, and duration of luc expression in different organs were determined. The distribution of luciferin is most probably not a barrier for the detection of in vivo luciferase activity. We showed that the CCCD photon detection system is a simple, reproducible, and applicable method that enables the continuous monitoring of a gene delivery system in living animals.
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Affiliation(s)
- A Honigman
- Department of Virology, Faculty of Medicine, Hebrew University, Jerusalem, Israel
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19
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Goldenberg-Furmanov M, Stein I, Pikarsky E, Catane R, Vigoda M, Laster M, Corn B, Ben-Sasson S. A designer inhibitor of a novel protein-kinase causes regression of human hormone refractory prostate cancer xenografts in nude mice. Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)81292-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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Abdul-Ghani R, Ohana P, Matouk I, Ayesh S, Ayesh B, Laster M, Bibi O, Giladi H, Molnar-Kimber K, Sughayer MA, de Groot N, Hochberg A. Use of transcriptional regulatory sequences of telomerase (hTER and hTERT) for selective killing of cancer cells. Mol Ther 2000; 2:539-44. [PMID: 11124054 DOI: 10.1006/mthe.2000.0196] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.0] [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: 11/22/2022] Open
Abstract
Telomerase (hTER and hTERT) plays a crucial role in cellular immortalization and carcinogenesis. Telomerase activity can be detected in about 85% of different malignant tumors, but is absent in most normal cells. In situ hybridization analysis showed that high levels of hTER and hTERT expression are present in bladder cancer, while no signal was detected in normal tissue. Therefore, in this work we propose to use hTER and hTERT transcriptional regulatory sequences to control the expression of a cytotoxic gene in bladder tumor cells, resulting in the selective destruction of this cell population. Expression vectors containing the diphtheria toxin A-chain (DT-A) gene were linked to hTER and hTERT transcriptional regulatory sequences, respectively. Inhibition of protein synthesis occurred in bladder and hepatocellular carcinoma cells transfected with the plasmids containing the DT-A gene under the control of the hTER or hTERT promoters in correlation with their activity. These studies support the feasibility of using hTER and hTERT transcriptional regulatory sequences for targeted patient-oriented gene therapy of human cancer.
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Affiliation(s)
- R Abdul-Ghani
- Department of Biological Chemistry, University of Pennsylvania Medical Center, Jerusalem, Pennsylvania 91904, Israel
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21
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Banet G, Bibi O, Matouk I, Ayesh S, Laster M, Kimber KM, Tykocinski M, de Groot N, Hochberg A, Ohana P. Characterization of human and mouse H19 regulatory sequences. Mol Biol Rep 2000; 27:157-65. [PMID: 11254105 DOI: 10.1023/a:1007139713781] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [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: 11/12/2022]
Abstract
H19 is expressed in a large percentage of bladder tumors, but not expressed in healthy bladder tissue. The aim of this study is to define H19 optimal transcriptional regulatory sequences in tumor cells, which can potentially be used to control expression of a toxin gene in constructs to be used in bladder cancer gene therapy trials in mice and human. Transient expression assays revealed that elements responsible for promoter activity are contained within the 85 bp upstream region. The transcriptional activity of this region was strongly inhibited by the methylation of the Hpa II sites. A modest cell specificity is conferred by the upstream sequences. The human and murine promoter activities were significantly increased by the human H19 4.1 kb enhancer sequence. The 85 bp H19 upstream region contains all the elements to interact with the enhancer. We showed that the human H19 promoter is highly active in a murine bladder carcinoma cell line, justifying its use to drive the expression of a cytotoxin gene in gene therapy trials in mice.
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Affiliation(s)
- G Banet
- University of Pennsylvania Medical Center, Department of Pathology and Laboratory Medicine, Philadelphia 19104, USA
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22
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Ohana P, Kopf E, Bibi O, Ayesh S, Schneider T, Laster M, Tykocinski M, de Groot N, Hochberg A. The expression of the H19 gene and its function in human bladder carcinoma cell lines. FEBS Lett 1999; 454:81-4. [PMID: 10413100 DOI: 10.1016/s0014-5793(99)00780-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [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: 11/19/2022]
Abstract
The human H19 gene is a paternally imprinted oncofetal gene, highly expressed in several fetal tissues, down-regulated in nearly all adult tissues but re-expressed in carcinomas of tissues which express the gene in fetal life. It has no known protein product and till today, no function could be designated to H19 RNA. Cells derived from bladder carcinomas and hepatocellular carcinomas were transfected with plasmids carrying a luciferase reporter gene under the control of a 800 nucleotides long promoter region of the H19 gene either alone or together with different parts of a 5 kb downstream region, previously shown to possess enhancer activity. Our results provide evidence that three regions of the 3' downstream sequence can independently stimulate the H19 promoter activity in a tissue and cell specific manner. The growth rate of two cell populations, both derived from the same bladder carcinoma cell line and which differ in their H19 RNA content, were compared. The cells with a high H19 RNA level stopped their proliferation after 48 h when cultivated in a low serum containing media while the cells lacking H19 RNA continued their proliferation for at least an additional 48 h period.
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Affiliation(s)
- P Ohana
- Department of Biological Chemistry, Institute of Life Sciences, Hebrew University, Jerusalem, Israel
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23
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Abstract
From January 1987 to April 1993, 25 multiply injured patients were treated with closed intramedullary Ender nail fixation of the humeral shaft. Criteria for the procedure were humeral diaphyseal fractures with associated multiple injuries. Seventeen distal and mid-shaft fractures were treated via a modified anterograde approach in which the rotator cuff is not violated. Eight proximal third fractures were treated via the standard retrograde approach. Postoperative follow-up averaged 36 months. Full range of motion was attained 17 of the 25 patients. Of the eight remaining patients, three with a slightly limited range of motion achieved full range of motion following nail removal; three had preoperative radial nerve palsy which resolved within 1 year, and two patients required follow-on plating. In 92 per cent (23 of 25) there were no incidences of infection or non-union. Flexible nails avoid complications of reaming. The modified anterograde approach allows excellent shoulder motion since it does not violate the rotator cuff. Ender nails provide excellent fixation and clinical outcome in the multiply injured patient and are cost effective compared with interlocking nails.
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Affiliation(s)
- M Liebergall
- Hadassah University Hospital at Ein Kerem, Department of Orthopedic Surgery, Jerusalem, Israel
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24
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Gould F, Anderson A, Jones A, Sumerford D, Heckel DG, Lopez J, Micinski S, Leonard R, Laster M. Initial frequency of alleles for resistance to Bacillus thuringiensis toxins in field populations of Heliothis virescens. Proc Natl Acad Sci U S A 1997; 94:3519-23. [PMID: 11038613 PMCID: PMC20471 DOI: 10.1073/pnas.94.8.3519] [Citation(s) in RCA: 218] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The risk of rapid pest adaptation to an insecticide is highly dependent on the initial frequency of resistance alleles in field populations. Because we have lacked empirical estimates of these frequencies, population-genetic models of resistance evolution have relied on a wide range of theoretical estimates. The recent commercialization of genetically engineered cotton that constitutively produces an insecticidal protein derived from the biocontrol agent, Bacillus thuringiensis (Bt) has raised concern that we lack data needed to quantify the risk of insect pests such as Heliothis virescens rapidly adapting to this ecologically valuable class of toxins. By individually mating over 2,000 male H. virescens moths collected in four states to females of a Bt toxin-resistant laboratory strain, and screening F1 and F2 offspring for tolerance of the toxic protein, we were able to directly estimate the field frequency of alleles for resistance as 1.5 x 10(-3). This high initial frequency underscores the need for caution in deploying transgenic cotton to control insect pests. Our single-pair mating technique greatly increases the efficiency of detecting recessive resistance alleles. Because alleles that decrease target site sensitivity to Bt toxins and other insecticides are often recessive, this technique could be useful in estimating resistance allele frequencies in other insects exposed to transgenic insecticidal crops or conventional insecticides.
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Affiliation(s)
- F Gould
- Department of Entomology, North Carolina State University, Raleigh, NC 27695, USA
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25
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Galun E, Ilan Y, Livni N, Ketzinel M, Nahor O, Pizov G, Nagler A, Eid A, Rivkind A, Laster M. Hepatitis B virus infection associated with hematopoietic tumors. Am J Pathol 1994; 145:1001-7. [PMID: 7977632 PMCID: PMC1887425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Hepatitis B virus (HBV) infection and replication have been linked to the development of hepatocellular carcinoma. Bone marrow-derived cells, as well as mesenchymal and epithelial cells, were recently shown to support HBV replication. We hypothesize that the mechanism that links HBV infection and liver tumors might also promote tumor development in tissues permissive for HBV replication. Between 1980 and 1993 we retrospectively identified 22 patients who were hepatitis B surface antigen (HBsAg) carriers and had extra-hepatic malignancies. These patients had 25 tumors, of which 22 were bone marrow derived. HBsAg was detected by immunohistochemistry in bone marrow cells of leukemia patient and of 3 of 10 lymphoma patients. In addition, in 4 of 10 patients with lymphoma, including 2 patients in which HBsAg stained bone marrow cells, HBsAg was also detected in the endothelial cells of blood vessels of the tumor tissue. These results suggest that the identification of an HBV gene product in endothelial cells might point to a role of HBV infection in the development of certain hematopoietic tumors, possibly through activation of cytokines or growth factors, which may eventually lead to bone marrow cell proliferation.
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Affiliation(s)
- E Galun
- Liver Unit, Hadassah University Hospital, Ein-Kerem, Jerusalem, Israel
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Weiskopf RB, Eger EI, Ionescu P, Yasuda N, Cahalan MK, Freire B, Peterson N, Lockhart SH, Rampil IJ, Laster M. Desflurane does not produce hepatic or renal injury in human volunteers. Anesth Analg 1992; 74:570-4. [PMID: 1554124 DOI: 10.1213/00000539-199204000-00018] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We examined the potential toxicity of desflurane in 13 young 25.0 +/- 2.3 (mean +/- SD) yr-old men, given 7.35 +/- 0.81 MAC-hours of desflurane anesthesia. Hepatic and renal function tests, serum electrolytes, and standard urine and hematologic tests were performed before, during, and after anesthesia. No toxicity was found. There were no changes in tests of hepatocellular integrity (plasma alanine transferase activity), synthetic function (serum albumin, prothrombin time, partial thromboplastin time), or renal function (serum creatinine concentration, blood urea nitrogen concentration). Decreases in red blood cell count, hematocrit, and blood hemoglobin concentration during and immediately after anesthesia were attributed to blood sampling and infusion of intravenous electrolyte solution. These values returned by 4 days after anesthesia to values not different from those before anesthesia. Increased white blood cell counts and blood glucose concentrations noted during anesthesia with other inhaled anesthetics were also seen in these volunteers. Desflurane appears to have no greater toxicity than currently used inhaled anesthetics and, because of its lesser metabolism, may have lesser or not toxicity.
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Affiliation(s)
- R B Weiskopf
- Department of Anesthesia, University of California, San Francisco 94143-0648
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Weiskopf RB, Cahalan MK, Ionescu P, Eger EI, Yasuda N, Lockhart SH, Rampil IJ, Laster M, Freire B, Peterson N. Cardiovascular actions of desflurane with and without nitrous oxide during spontaneous ventilation in humans. Anesth Analg 1991; 73:165-74. [PMID: 1854031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We investigated the cardiovascular actions of desflurane (formerly I-653) during spontaneous ventilation. We gave 0.8-0.9, 1.2-1.3, and 1.6-1.7 MAC desflurane in oxygen (n = 6) and in 60% nitrous oxide, balance oxygen (n = 6) to unmedicated healthy male volunteers. Both anesthetic regimens decreased ventilation, increased partial pressure of arterial carbon dioxide, and produced similar cardiovascular changes. In comparison with values obtained when the volunteers were conscious, desflurane anesthesia with spontaneous ventilation decreased systemic vascular resistance and mean arterial blood pressure. Cardiac index, heart rate, stroke volume index, and central venous blood pressure increased. Left ventricular ejection fraction increased at 0.83 MAC desflurane in oxygen, and otherwise did not differ from the conscious value. The velocity of ventricular circumferential fiber shortening, estimated by echocardiography, increased with desflurane in oxygen but did not change with desflurane in nitrous oxide. Oxygen consumption increased during desflurane and oxygen anesthesia, but not when nitrous oxide plus oxygen was the background gas. Desflurane increased oxygen transport, the ratio of oxygen transport to oxygen consumption, mixed venous partial pressure of oxygen, and oxyhemoglobin saturation. The cardiovascular changes with desflurane during spontaneous ventilation differ from those during controlled ventilation. With both background gases, spontaneous ventilation, in comparison with controlled ventilation, increased cardiac index, stroke volume, central venous pressure, left ventricular ejection fraction, velocity of circumferential fiber shortening, oxygen transport, and the ratio of oxygen transport to oxygen consumption but did not change mean arterial blood pressure except at 1.66 MAC desflurane in oxygen (when it was higher with spontaneous than with controlled ventilation).
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Affiliation(s)
- R B Weiskopf
- Department of Anesthesia, University of California, San Francisco 94143-0648
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Litt L, Lockhart S, Cohen Y, Yasuda N, Kim F, Freire B, Laster M, Peterson N, Taheri S, Chang LH. In vivo 19F nuclear magnetic resonance brain studies of halothane, isoflurane, and desflurane. Rapid elimination and no abundant saturable binding. Ann N Y Acad Sci 1991; 625:707-24. [PMID: 2058918 DOI: 10.1111/j.1749-6632.1991.tb33904.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- L Litt
- Department of Anesthesia, University of California, San Francisco 94143-0648
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Abstract
Desflurane is a potent inhaled anesthetic associated with a dose-dependent depression of cortical electrical activity. Recently, it has been suggested that the burst suppression pattern seen in dogs given moderately high doses (2.0 MAC) of desflurane may spontaneously subside. This observation suggests the development of acute tolerance to at least some of the anesthetic effects of this drug. No other volatile anesthetic has been found to produce acute tolerance. We attempted to replicate these findings in domestic swine. Five juvenile swine (25-30 kg) were anesthetized with desflurane in oxygen and during normocapnia were exposed to two doses of desflurane sufficient to induce burst suppression (1.5 and 1.7 MAC) for 35 min at each dose, with a period of EEG recovery (0.6 MAC) before, between (in 3 of 5 animals), and after the high doses. Frontoparietal EEG was continuously recorded and the burst suppression ratio continuously calculated. Suppression was more complete at 1.7 MAC than at 1.5 MAC (98.24 +/- 1.75 vs. 90.80 +/- 3.05%, respectively, mean +/- standard deviation). The degree of burst suppression activity did not change over time at either 1.5 (P greater than 0.33) or 1.7 MAC desflurane (P greater than 0.41). There was no EEG evidence of tolerance to desflurane anesthesia in swine.
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Affiliation(s)
- I J Rampil
- Department of Anesthesia, University of California, San Francisco 94143-0648
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Yasuda N, Lockhart SH, Eger EI, Weiskopf RB, Liu J, Laster M, Taheri S, Peterson NA. Comparison of kinetics of sevoflurane and isoflurane in humans. Anesth Analg 1991; 72:316-24. [PMID: 1994760 DOI: 10.1213/00000539-199103000-00007] [Citation(s) in RCA: 181] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The low solubility of sevoflurane in blood suggests that this agent should enter and leave the body more rapidly than isoflurane. However, the closeness of sevoflurane and isoflurane tissue/blood partition coefficients suggests that the rates of equilibration with and elimination from tissues should be similar. We tested both predictions, comparing sevoflurane with isoflurane and nitrous oxide in seven volunteers. We measured the rate at which the alveolar (end-tidal) (FA) concentration of nitrous oxide increased toward an inspired (FI) concentration of 65%-70%, then measured the concurrent rise in FA and mixed expired concentrations (FM) of sevoflurane and isoflurane at respective FI values of 1.0% sevoflurane and 0.6% isoflurane for 30 min. Minute ventilation (VE) was measured concurrently with the measurements of anesthetic concentrations. For the potent agents, we also measured VE, FA, and FM for 6-7 days of elimination. FA/FI values at 30 min of administration were as follows: nitrous oxide, 0.986 +/- 0.003 (mean +/- SD); sevoflurane, 0.850 +/- 0.018; and isoflurane, 0.733 +/- 0.027. FA/FA0 (FA0 = the last FA during administration) values after 5 min of elimination were as follows: sevoflurane, 0.157 +/- 0.020; isoflurane, 0.223 +/- 0.024. Recovery (volume of anesthetic recovered during elimination/volume taken up) of sevoflurane (101% +/- 7%) equaled recovery of isoflurane (101% +/- 6%). Time constants for a five-compartment mammillary model for sevoflurane were smaller than those for isoflurane for the lungs but were not different from isoflurane for the other compartments.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- N Yasuda
- Department of Anesthesia, University of California, San Francisco 94143-0464
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Lockhart SH, Yasuda N, Peterson N, Laster M, Taheri S, Weiskopf RB, Eger EI. Comparison of percutaneous losses of sevoflurane and isoflurane in humans. Anesth Analg 1991; 72:212-5. [PMID: 1985506 DOI: 10.1213/00000539-199102000-00013] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We studied the percutaneous losses of sevoflurane and isoflurane during administration and elimination in seven healthy male volunteers. Anesthesia was induced and maintained with fentanyl, midazolam, and/or thiopental, and nitrous oxide for 30 min, after which 1% sevoflurane and 0.4% isoflurane in 65% nitrous oxide were administered for 30 min. Inspired, end-tidal, and mixed-expired gas samples were collected during administration and for 5-7 days of elimination. To measure percutaneous loss, each subject's arm was enclosed in a glass cylinder sealed at both ends and with two ports, one for flushing with nitrogen and one for obtaining gas samples during the 30 min of administration and the first 150 min of elimination. Anesthetic concentrations in all samples were determined using gas chromatography. The surface area of the arm was measured and the total surface area was calculated. During administration and elimination, percutaneous loss of isoflurane was significantly greater than that of sevoflurane (P less than 0.05). For both volatile agents, losses during elimination were greater than during administration (P less than 0.05), but even when combined, these losses were too small to affect kinetic or metabolic studies based on mass balance.
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Affiliation(s)
- S H Lockhart
- Department of Anesthesia, University of California, San Francisco 94143-0464
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Weiskopf RB, Cahalan MK, Yasuda N, Eger EI, Ionescu P, Rampil IJ, Lockhart S, Caldwell J, Holmes MA, Freire B, Johnson BH, Laster M, Kelley S. CARDIOVASCULAR ACTIONS OF DESFLURANE (1-653) IN HUMANS. Anesth Analg 1990. [DOI: 10.1213/00000539-199002001-00426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Cahalan MK, Weiskopf RB, Yasuda N, Eger EI, Ionescu P, Rampil IJ, Lockhart S, Caldwell J, Holmes MA, Freire B, Johnson BH, Laster M, Kelley S, Peterson N. Cardiovascular Effects of Desflurane and Nitrous Oxide in Humans. Anesth Analg 1990. [DOI: 10.1213/00000539-199002001-00046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Weiskopf RB, Cahalan MK, Yasuda N, Eger EI, Ionescu P, Rampil IJ, Lockhart S, Caldwell J, Holmes MA, Freire B, Johnson BH, Laster M, Kelley S. DURATION OF ANESTHESIA INFLUENCES THE CARDIOVASCULAR ACTIONS OF DESFLURANE (I-653). Anesth Analg 1990. [DOI: 10.1213/00000539-199002001-00427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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