1
|
Greite R, Schott S, Wang L, Gohlke L, Kreimann K, Derlin K, Gutberlet M, Schmidbauer M, Leffler A, Tudorache I, Salman J, Ius F, Natanov R, Fegbeutel C, Haverich A, Lichtinghagen R, Hüsing AM, von Vietinghoff S, Schmitt R, Shushakova N, Rong S, Haller H, Schmidt‐Ott KM, Gram M, Vijayan V, Scheffner I, Gwinner W, Immenschuh S. Free heme and hemopexin in acute kidney injury after cardiopulmonary bypass and transient renal ischemia. Clin Transl Sci 2023; 16:2729-2743. [PMID: 37899696 PMCID: PMC10719480 DOI: 10.1111/cts.13667] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/13/2023] [Accepted: 10/09/2023] [Indexed: 10/31/2023] Open
Abstract
Free heme is released from hemoproteins during hemolysis or ischemia reperfusion injury and can be pro-inflammatory. Most studies on nephrotoxicity of hemolysis-derived proteins focus on free hemoglobin (fHb) with heme as a prosthetic group. Measurement of heme in its free, non-protein bound, form is challenging and not commonly used in clinical routine diagnostics. In contrast to fHb, the role of free heme in acute kidney injury (AKI) after cardiopulmonary bypass (CPB) surgery is unknown. Using an apo-horseradish peroxidase-based assay, we identified free heme during CPB surgery as predictor of AKI in patients undergoing cardiac valve replacement (n = 37). Free heme levels during CPB surgery correlated with depletion of hemopexin (Hx), a heme scavenger-protein. In mice, the impact of high levels of circulating free heme on the development of AKI following transient renal ischemia and the therapeutic potential of Hx were investigated. C57BL/6 mice were subjected to bilateral renal ischemia/reperfusion injury for 15 min which did not cause AKI. However, additional administration of free heme in this model promoted overt AKI with reduced renal function, increased renal inflammation, and reduced renal perfusion on functional magnetic resonance imaging. Hx treatment attenuated AKI. Free heme administration to sham operated control mice did not cause AKI. In conclusion, free heme is a predictor of AKI in CPB surgery patients and promotes AKI in transient renal ischemia. Depletion of Hx in CPB surgery patients and attenuation of AKI by Hx in the in vivo model encourage further research on Hx therapy in patients with increased free heme levels during CPB surgery.
Collapse
Affiliation(s)
- Robert Greite
- Department of Nephrology and HypertensionHannover Medical SchoolHannoverGermany
| | - Sebastian Schott
- Department of Nephrology and HypertensionHannover Medical SchoolHannoverGermany
| | - Li Wang
- Department of Nephrology and HypertensionHannover Medical SchoolHannoverGermany
| | - Lukas Gohlke
- Department of Nephrology and HypertensionHannover Medical SchoolHannoverGermany
| | - Kirill Kreimann
- Department of Nephrology and HypertensionHannover Medical SchoolHannoverGermany
| | - Katja Derlin
- Institute for Diagnostic and Interventional RadiologyHannover Medical SchoolHannoverGermany
| | - Marcel Gutberlet
- Institute for Diagnostic and Interventional RadiologyHannover Medical SchoolHannoverGermany
| | - Martina Schmidbauer
- Institute for Diagnostic and Interventional RadiologyHannover Medical SchoolHannoverGermany
| | - Andreas Leffler
- Department of Anesthesiology and Intensive Care MedicineHannover Medical SchoolHannoverGermany
| | - Igor Tudorache
- Department of Cardiac SurgeryUniversity Hospital DusseldorfDusseldorfGermany
| | - Jawad Salman
- Department of Cardiothoracic, Transplantation and Vascular SurgeryHannover Medical SchoolHannoverGermany
| | - Fabio Ius
- Department of Cardiothoracic, Transplantation and Vascular SurgeryHannover Medical SchoolHannoverGermany
| | - Ruslan Natanov
- Department of Cardiothoracic, Transplantation and Vascular SurgeryHannover Medical SchoolHannoverGermany
| | - Christine Fegbeutel
- Department of Cardiothoracic, Transplantation and Vascular SurgeryHannover Medical SchoolHannoverGermany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular SurgeryHannover Medical SchoolHannoverGermany
| | | | - Anne M. Hüsing
- Department of Nephrology and HypertensionHannover Medical SchoolHannoverGermany
| | - Sibylle von Vietinghoff
- Department of Nephrology and HypertensionHannover Medical SchoolHannoverGermany
- Nephrology Section, Medical Clinic 1University Hospital BonnBonnGermany
| | - Roland Schmitt
- Department of Nephrology and HypertensionHannover Medical SchoolHannoverGermany
| | - Nelli Shushakova
- Department of Nephrology and HypertensionHannover Medical SchoolHannoverGermany
| | - Song Rong
- Department of Nephrology and HypertensionHannover Medical SchoolHannoverGermany
| | - Hermann Haller
- Department of Nephrology and HypertensionHannover Medical SchoolHannoverGermany
| | - Kai M. Schmidt‐Ott
- Department of Nephrology and HypertensionHannover Medical SchoolHannoverGermany
| | - Magnus Gram
- Pediatrics, Department of Clinical Sciences LundSkane University Hospital, Lund UniversityLundSweden
| | - Vijith Vijayan
- Institute for Transfusion Medicine and Transplant EngineeringHannover Medical SchoolHannoverGermany
- Division of Critical Care Medicine, Department of PediatricsStanford University School of MedicineStanfordCaliforniaUSA
| | - Irina Scheffner
- Department of Nephrology and HypertensionHannover Medical SchoolHannoverGermany
| | - Wilfried Gwinner
- Department of Nephrology and HypertensionHannover Medical SchoolHannoverGermany
| | - Stephan Immenschuh
- Institute for Transfusion Medicine and Transplant EngineeringHannover Medical SchoolHannoverGermany
| |
Collapse
|
2
|
Greite R, Schmidt-Ott K. [What is confirmed in the treatment of chronic kidney disease?]. Inn Med (Heidelb) 2022; 63:1237-1243. [PMID: 36323846 PMCID: PMC9684262 DOI: 10.1007/s00108-022-01422-9] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
Chronic kidney disease (CKD) is defined as a relevant excretion of albumin into the urine or a reduction of the glomerular filtration rate (GFR) over a longer time period of ≥ 3 months. The causes of CKD are manifold, whereby the association with diabetes mellitus is the most frequent cause. Early stages of CKD affect approximately 10% of the total population. The frequency of cardiovascular events, the risk of dependency on dialysis and the all-cause mortality increase exponentially with a decrease in the GFR and an increase in albuminuria. The guidelines of the German College of General Practitioners and Family Physicians (DEGAM) and the organization Kidney Disease: Improving Global Outcomes (KDIGO) recommend referral to a nephrologist with a GFR of ≤ 30 or ≤ 60 ml/min/1.73 m2 in the presence of various cofactors. This means that the majority of CKD patients are treated by general internists or general practitioners. This article gives a concise summary of current data on the treatment of CKD and its associated complications in clinical practice. It refers to the current guidelines and also new study results which could perspectively expand the therapeutic repertoire.
Collapse
Affiliation(s)
- Robert Greite
- Klinik für Nieren- und Hochdruckerkrankungen, Medizinische Hochschule Hannover (MHH), OE 6840, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - Kai Schmidt-Ott
- Klinik für Nieren- und Hochdruckerkrankungen, Medizinische Hochschule Hannover (MHH), OE 6840, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| |
Collapse
|
3
|
Vijayan V, Greite R, Schott S, Doricic J, Madyaningrana K, Pradhan P, Martens J, Blasczyk R, Janciauskiene S, Immenschuh S. Determination of free heme in stored red blood cells with an apo-horseradish peroxidase-based assay. Biol Chem 2022; 403:1091-1098. [PMID: 36054292 DOI: 10.1515/hsz-2022-0184] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/15/2022] [Indexed: 12/19/2022]
Abstract
Transfusion effectiveness of red blood cells (RBCs) has been associated with duration of the storage period. Storage-dependent RBC alterations lead to hemolysis and release of toxic free heme, but the increase of free heme levels over time is largely unknown. In the current study, an apo-horseradish peroxidase (apoHRP)-based assay was applied to measure levels of free heme at regular intervals or periodically in supernatants of RBCs until a maximum storage period of 42 days. Free heme levels increased with linear time-dependent kinetics up to day 21 and accelerated disproportionally after day 28 until day 42, as determined with the apoHRP assay. Individual time courses of free heme in different RBC units exhibited high variability. Notably, levels of free hemoglobin, an established indicator of RBC damage, and those of total heme increased with continuous time-dependent linear kinetics over the entire 42 day storage period, respectively. Supernatants from RBC units with high levels of free heme led to inflammatory activation of human neutrophils. In conclusion, determining free heme in stored RBCs with the applied apoHRP assay may become feasible for testing of RBC storage quality in clinical transfusion medicine.
Collapse
Affiliation(s)
- Vijith Vijayan
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany
| | - Robert Greite
- Department of Nephrology, Hannover Medical School, D-30625 Hannover, Germany
| | - Sebastian Schott
- Department of Nephrology, Hannover Medical School, D-30625 Hannover, Germany
| | - Julian Doricic
- Department of Nephrology, Hannover Medical School, D-30625 Hannover, Germany
| | - Kukuh Madyaningrana
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany.,Faculty of Biotechnology, Universitas Kristen Duta Wacana, 55224 Yogyakarta, Indonesia
| | - Pooja Pradhan
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany
| | - Jörg Martens
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany
| | - Rainer Blasczyk
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany
| | | | - Stephan Immenschuh
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany
| |
Collapse
|
4
|
Greite R, Wang L, Gohlke L, Schott S, Kreimann K, Doricic J, Leffler A, Tudorache I, Salman J, Natanov R, Ius F, Fegbeutel C, Haverich A, Lichtinghagen R, Chen R, Rong S, Haller H, Vijayan V, Gram M, Scheffner I, Gueler F, Gwinner W, Immenschuh S. Cell-Free Hemoglobin in Acute Kidney Injury after Lung Transplantation and Experimental Renal Ischemia/Reperfusion. Int J Mol Sci 2022; 23:ijms232113272. [PMID: 36362059 PMCID: PMC9657083 DOI: 10.3390/ijms232113272] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 10/15/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Cell-free hemoglobin (CFH), a pro-oxidant and cytotoxic compound that is released in hemolysis, has been associated with nephrotoxicity. Lung transplantation (LuTx) is a clinical condition with a high incidence of acute kidney injury (AKI). In this study, we investigated the plasma levels of CFH and haptoglobin, a CFH-binding serum protein, in prospectively enrolled LuTx patients (n = 20) with and without AKI. LuTx patients with postoperative AKI had higher CFH plasma levels at the end of surgery compared with no-AKI patients, and CFH correlated with serum creatinine at 48 h. Moreover, CFH levels inversely correlated with haptoglobin levels, which were significantly reduced at the end of surgery in LuTx patients with AKI. Because multiple other factors can contribute to AKI development in the complex clinical setting of LuTx, we next investigated the role of exogenous CFH administration in a mouse model of mild bilateral renal ischemia reperfusion injury (IRI). Exogenous administration of CFH after reperfusion caused overt AKI with creatinine increase, tubular injury, and enhanced markers of renal inflammation compared with vehicle-treated animals. In conclusion, CFH is a possible factor contributing to postoperative AKI after LuTx and promotes AKI in an experimental model of mild transient renal ischemia. Targeting CFH might be a therapeutic option to prevent AKI after LuTx.
Collapse
Affiliation(s)
- Robert Greite
- Department of Nephrology and Hypertension, Hannover Medical School, 30625 Hannover, Germany
- Correspondence:
| | - Li Wang
- Department of Nephrology and Hypertension, Hannover Medical School, 30625 Hannover, Germany
| | - Lukas Gohlke
- Department of Nephrology and Hypertension, Hannover Medical School, 30625 Hannover, Germany
| | - Sebastian Schott
- Department of Nephrology and Hypertension, Hannover Medical School, 30625 Hannover, Germany
| | - Kirill Kreimann
- Department of Nephrology and Hypertension, Hannover Medical School, 30625 Hannover, Germany
| | - Julian Doricic
- Department of Nephrology and Hypertension, Hannover Medical School, 30625 Hannover, Germany
| | - Andreas Leffler
- Anaesthesiology, Hannover Medical School, 30625 Hannover, Germany
| | - Igor Tudorache
- Cardiac Surgery, University of Dusseldorf, 40225 Dusseldorf, Germany
| | - Jawad Salman
- Cardiac Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Ruslan Natanov
- Cardiac Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Fabio Ius
- Cardiac Surgery, Hannover Medical School, 30625 Hannover, Germany
- German Center for Lung Research (DZL), 35392 Giessen, Germany
| | | | - Axel Haverich
- Cardiac Surgery, Hannover Medical School, 30625 Hannover, Germany
| | | | - Rongjun Chen
- Department of Nephrology and Hypertension, Hannover Medical School, 30625 Hannover, Germany
| | - Song Rong
- Department of Nephrology and Hypertension, Hannover Medical School, 30625 Hannover, Germany
| | - Hermann Haller
- Department of Nephrology and Hypertension, Hannover Medical School, 30625 Hannover, Germany
| | - Vijith Vijayan
- Pediatrics, Stanford University, Stanford, CA 94305, USA
| | - Magnus Gram
- Department of Pediatrics, Clinical Sciences Lund, Lund University, 22220 Lund, Sweden
| | - Irina Scheffner
- Department of Nephrology and Hypertension, Hannover Medical School, 30625 Hannover, Germany
| | - Faikah Gueler
- Department of Nephrology and Hypertension, Hannover Medical School, 30625 Hannover, Germany
| | - Wilfried Gwinner
- Department of Nephrology and Hypertension, Hannover Medical School, 30625 Hannover, Germany
| | - Stephan Immenschuh
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, 30625 Hannover, Germany
| |
Collapse
|
5
|
Derlin K, Hellms S, Gutberlet M, Peperhove M, Jang MS, Greite R, Hartung D, Derlin T, Fegbeutel C, Tudorache I, Jüttner B, Wiese B, Lichtinghagen R, Haller H, Haverich A, Wacker F, Warnecke G, Gueler F. Application of MR diffusion imaging for non-invasive assessment of acute kidney injury after lung transplantation. Medicine (Baltimore) 2020; 99:e22445. [PMID: 33285670 PMCID: PMC7717793 DOI: 10.1097/md.0000000000022445] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/06/2020] [Accepted: 08/16/2020] [Indexed: 01/07/2023] Open
Abstract
To assess whether MR diffusion imaging may be applied for non-invasive detection of renal changes correlating with clinical diagnosis of acute kidney injury (AKI) in patients after lung transplantation (lutx).Fifty-four patients (mean age 49.6, range 26-64 years) after lutx were enrolled in a prospective clinical study and underwent functional MR imaging of the kidneys in the early postoperative period. Baseline s-creatinine ranged from 39 to 112 μmol/L. For comparison, 14 healthy volunteers (mean age 42.1, range 24-59 years) underwent magnetic resonance imaging (MRI) using the same protocol. Renal tissue injury was evaluated using quantification of diffusion and diffusion anisotropy with diffusion-weighted (DWI) and diffusion-tensor imaging (DTI). Renal function was monitored and AKI was defined according to Acute-Kidney-Injury-Network criteria. Statistical analysis comprised one-way ANOVA and Pearson correlation.67% of lutx patients (36/54) developed AKI, 47% (17/36) had AKI stage 1, 42% (15/36) AKI stage 2, and 8% (3/36) severe AKI stage 3. Renal apparent diffusion coefficients (ADCs) were reduced in patients with AKI, but preserved in transplant patients without AKI and healthy volunteers (2.07 ± 0.02 vs 2.18 ± 0.05 vs 2.21 ± 0.03 × 10 mm/s, P < .05). Diffusion anisotropy was reduced in all lutx recipients compared with healthy volunteers (AKI: 0.27 ± 0.01 vs no AKI: 0.28 ± 0.01 vs healthy: 0.33 ± 0.02; P < .01). Reduction of renal ADC correlated significantly with acute loss of renal function after lutx (decrease of renal function in the postoperative period and glomerular filtration rate on the day of MRI).MR diffusion imaging enables non-invasive assessment of renal changes correlating with AKI early after lutx. Reduction of diffusion anisotropy was present in all patients after lutx, whereas marked reduction of renal ADC was observed only in the group of lutx recipients with AKI and correlated with renal function impairment.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Ralf Lichtinghagen
- Department of Clinical Chemistry, Hannover Medical School, Hannover, Germany
| | | | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery
| | | | - Gregor Warnecke
- Department of Cardiothoracic, Transplantation and Vascular Surgery
| | | |
Collapse
|
6
|
Greite R, Derlin K, Hensen B, Thorenz A, Rong S, Chen R, Hellms S, Jang MS, Bräsen JH, Meier M, Willenberg I, Immenschuh S, Haller H, Luft FC, Panigrahy D, Hwang SH, Hammock BD, Schebb NH, Gueler F. Early antihypertensive treatment and ischemia-induced acute kidney injury. Am J Physiol Renal Physiol 2020; 319:F563-F570. [PMID: 32799675 DOI: 10.1152/ajprenal.00078.2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Acute kidney injury (AKI) frequently complicates major surgery and can be associated with hypertension and progress to chronic kidney disease, but reports on blood pressure normalization in AKI are conflicting. In the present study, we investigated the effects of an angiotensin-converting enzyme inhibitor, enalapril, and a soluble epoxide hydrolase inhibitor, 1-trifluoromethoxyphenyl-3-(1-propionylpiperidin-4-yl)urea (TPPU), on renal inflammation, fibrosis, and glomerulosclerosis in a mouse model of ischemia-reperfusion injury (IRI)-induced AKI. Male CD1 mice underwent unilateral IRI for 35 min. Blood pressure was measured by tail cuff, and mesangial matrix expansion was quantified on methenamine silver-stained sections. Renal perfusion was assessed by functional MRI in vehicle- and TPPU-treated mice. Immunohistochemistry was performed to study the severity of AKI and inflammation. Leukocyte subsets were analyzed by flow cytometry, and proinflammatory cytokines were analyzed by quantitative PCR. Plasma and tissue levels of TPPU and lipid mediators were analyzed by liquid chromatography mass spectrometry. IRI resulted in a blood pressure increase of 20 mmHg in the vehicle-treated group. TPPU and enalapril normalized blood pressure and reduced mesangial matrix expansion. However, inflammation and progressive renal fibrosis were severe in all groups. TPPU further reduced renal perfusion on days 1 and 14. In conclusion, early antihypertensive treatment worsened renal outcome after AKI by further reducing renal perfusion despite reduced glomerulosclerosis.
Collapse
Affiliation(s)
- Robert Greite
- Nephrology, Hannover Medical School, Hannover, Germany
| | - Katja Derlin
- Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Bennet Hensen
- Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Anja Thorenz
- Nephrology, Hannover Medical School, Hannover, Germany
| | - Song Rong
- Nephrology, Hannover Medical School, Hannover, Germany
| | - Rongjun Chen
- Nephrology, Hannover Medical School, Hannover, Germany
| | - Susanne Hellms
- Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Mi-Sun Jang
- Nephrology, Hannover Medical School, Hannover, Germany
| | | | - Martin Meier
- Imaging Center, Institute of Laboratory Animal Sciences, Hannover Medical School, Hannover, Germany
| | - Ina Willenberg
- Faculty of Mathematics and Natural Sciences, University of Wuppertal, Wuppertal, Germany
| | | | | | - Friedrich C Luft
- Experimental and Clinical Research Center, Max-Delbrück Center/Charité, Berlin, Germany
| | - Dipak Panigrahy
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sung Hee Hwang
- Department of Entomology and Nematology, UC Davis Comprehensive Cancer Center, University of California, Davis, California
| | - Bruce D Hammock
- Department of Entomology and Nematology, UC Davis Comprehensive Cancer Center, University of California, Davis, California
| | - Nils Helge Schebb
- Faculty of Mathematics and Natural Sciences, University of Wuppertal, Wuppertal, Germany
| | - Faikah Gueler
- Nephrology, Hannover Medical School, Hannover, Germany
| |
Collapse
|
7
|
Kreimann K, Jang MS, Rong S, Greite R, von Vietinghoff S, Schmitt R, Bräsen JH, Schiffer L, Gerstenberg J, Vijayan V, Dittrich-Breiholz O, Wang L, Karsten CM, Gwinner W, Haller H, Immenschuh S, Gueler F. Ischemia Reperfusion Injury Triggers CXCL13 Release and B-Cell Recruitment After Allogenic Kidney Transplantation. Front Immunol 2020; 11:1204. [PMID: 32849490 PMCID: PMC7424013 DOI: 10.3389/fimmu.2020.01204] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 09/30/2019] [Accepted: 05/14/2020] [Indexed: 12/12/2022] Open
Abstract
Ischemia reperfusion injury (IRI) is linked with inflammation in kidney transplantation (ktx). The chemokine CXCL13, also known as B lymphocyte chemoattractant, mediates recruitment of B cells within follicles of lymphoid tissues and has recently been identified as a biomarker for acute kidney allograft rejection. The goal of this study was to explore whether IRI contributes to the up-regulation of CXCL13 levels in ktx. It is demonstrated that systemic levels of CXCL13 were increased in mouse models of uni- and bilateral renal IRI, which correlated with the duration of IRI. Moreover, in unilateral renal IRI CXCL13 expression in ischemic kidneys was up-regulated. Immunohistochemical studies revealed infiltration of CD22+ B-cells and, single-cell RNA sequencing analysis a higher number of cells expressing the CXCL13 receptor CXCR5, in ischemic kidneys 7 days post IRI, respectively. The potential relevance of these findings was also evaluated in a mouse model of ktx. Increased levels of serum CXCL13 correlated with the lengths of cold ischemia times and were further enhanced in allogenic compared to isogenic kidney transplants. Taken together, these findings indicate that IRI is associated with increased systemic levels of CXCL13 in renal IRI and ktx.
Collapse
Affiliation(s)
- Kirill Kreimann
- Department of Nephrology, Hannover Medical School (MHH), Hannover, Germany
| | - Mi-Sun Jang
- Department of Nephrology, Hannover Medical School (MHH), Hannover, Germany
| | - Song Rong
- Department of Nephrology, Hannover Medical School (MHH), Hannover, Germany
| | - Robert Greite
- Department of Nephrology, Hannover Medical School (MHH), Hannover, Germany
| | | | - Roland Schmitt
- Department of Nephrology, Hannover Medical School (MHH), Hannover, Germany
| | - Jan Hinrich Bräsen
- Nephropathology Unit, Institute of Pathology, Hannover Medical School (MHH), Hannover, Germany
| | - Lena Schiffer
- Department of Nephrology, Hannover Medical School (MHH), Hannover, Germany
| | | | - Vijith Vijayan
- Institute for Transfusion Medicine, Hannover Medical School (MHH), Hannover, Germany
| | | | - Li Wang
- Department of Nephrology, Hannover Medical School (MHH), Hannover, Germany
| | - Christian M Karsten
- Institute for Systemic Inflammation Research, University of Lübeck, Lübeck, Germany
| | - Wilfried Gwinner
- Department of Nephrology, Hannover Medical School (MHH), Hannover, Germany
| | - Hermann Haller
- Department of Nephrology, Hannover Medical School (MHH), Hannover, Germany
| | - Stephan Immenschuh
- Institute for Transfusion Medicine, Hannover Medical School (MHH), Hannover, Germany
| | - Faikah Gueler
- Department of Nephrology, Hannover Medical School (MHH), Hannover, Germany
| |
Collapse
|
8
|
Störmer J, Gueler F, Rong S, Jang MS, Shushakova N, Schmidt S, Haller H, Greite R. P0558DICLOFENAC ENHANCES RENAL INFLAMMATION IN EXPERIMENTAL SUBCLINICAL ACUTE KIDNEY INJURY (AKI). Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Diclofenac is frequently used for pain control. In a previous study, we showed that already a single oral dose of diclofenac could reduce renal perfusion in healthy individuals. To investigate the influence of oral diclofenac administration on renal inflammation in the setting of pre-existing renal damage, we used a mouse model of subclinical acute kidney injury (AKI) induced by renal ischemia-reperfusion injury (IRI) followed by diclofenac administration.
Method
Male CD1 mice (7-8 weeks old) underwent unilateral renal pedicle clamping for 15min to induce subclinical AKI. After reperfusion mice received a single oral dose of 100 or 200mg/kg diclofenac via oral gavage. Vehicle treated mice with unilateral IRI served as control. At day 1, mice were placed into metabolic cages to collect urine. Histology was performed on day 1 and 14 for renal morphology. Inflammation and fibrosis were investigated by immunohistochemistry and qPCR.
Results
Diclofenac treated mice showed reduced urine production. Morphologically, signs of AKI were more pronounced in diclofenac treated kidneys which also showed more Cox-2 positive tubuli in the cortex. On mRNA expression level the pro-inflammatory markers IL-6 and CXCL2, the chemoattractant for neutrophils, were elevated in the diclofenac group. Early upregulation of the pro-fibrotic markers CTGF and PAI-1 was detected already on d1 after IRI in the diclofenac group and tubular atrophy was pronounced after two weeks.
Conclusion
Already, a single oral dose of diclofenac causes aggravation of renal inflammation and progressive renal fibrosis in the setting of pre-existing subclinical acute kidney injury.
Collapse
Affiliation(s)
| | - Faikah Gueler
- Hannover Medical School, Nephrology, Hannover, Germany
| | - Song Rong
- Hannover Medical School, Nephrology, Hannover, Germany
| | - Mi-Sun Jang
- Hannover Medical School, Nephrology, Hannover, Germany
| | | | | | | | - Robert Greite
- Hannover Medical School, Nephrology, Hannover, Germany
| |
Collapse
|
9
|
Jang MS, Kreimann K, Greite R, Rong S, Von Vietinghoff S, Schmitt R, Dittrich-Breiholz O, Bräsen JH, Vijayan V, Haller H, Immenschuh S, Gueler F. P1608CXCL13 IS STRONGLY INDUCED BY RENAL ISCHEMIA REPERFUSION INJURY AND CORRELATES WITH SEVERITY OF RENAL INFLAMMATION. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Ischemia reperfusion injury (IRI) is a strong trigger of inflammation and is tightly linked to renal allograft damage and function. CXCL13 or B lymphocyte chemoattractant (BLC) is a chemokine that controls B cell organization in lymphoid tissues and has recently been described as a biomarker for B cell involvement in acute kidney allograft rejection.
Method
To show, that CXCL13 is already induced by IRI alone we used renal IRI models in mice with different ischemia times and a kidney transplantation model. We measured serum CXCL13 and characterized cell infiltrates by immunohistochemistry and performed single cell RNA sequencing. Allogenic and isogenic kidney transplantation (KTX) in mice was done to evaluate these findings in the transplant setting.
Results
Systemic CXCL13 levels increased within hours after surgery in a time dependent manner, both after induction of IRI and KTX. Levels of CXCL13 increased with duration of ischemia time and were higher in allogenic than isogenic transplantation with equal duration of ischemia. CXCR5, the receptor for CXCL13, is mainly expressed on B lymphocytes but also on a subset of T lymphocytes and macrophages. CXCR5 positive infiltrates were detected in IRI kidneys seven days after injury. In kidney allografts interstitial B cell infiltrates were observed as early as seven days and increased further towards three weeks after KTX.
Conclusion
The current findings indicate that IRI is a strong trigger of CXCL13 expression in the kidney and release into the circulation, which is followed by B lymphocyte infiltration into damaged tissue in ischemic and renal allografts.
Collapse
Affiliation(s)
- Mi-Sun Jang
- Hannover Medical School, Department of Nephrology, Hannover, Germany
| | - Kirill Kreimann
- Hannover Medical School, Department of Nephrology, Hannover, Germany
| | - Robert Greite
- Hannover Medical School, Department of Nephrology, Hannover, Germany
| | - Song Rong
- Hannover Medical School, Department of Nephrology, Hannover, Germany
| | | | - Roland Schmitt
- Hannover Medical School, Department of Nephrology, Hannover, Germany
| | | | | | - Vijith Vijayan
- Hannover Medical School, Transfusion medicine, Hannover, Germany
| | - Hermann Haller
- Hannover Medical School, Department of Nephrology, Hannover, Germany
| | | | - Faikah Gueler
- Hannover Medical School, Department of Nephrology, Hannover, Germany
| |
Collapse
|
10
|
Rund KM, Nolte F, Doricic J, Greite R, Schott S, Lichtinghagen R, Gueler F, Schebb NH. Clinical blood sampling for oxylipin analysis - effect of storage and pneumatic tube transport of blood on free and total oxylipin profile in human plasma and serum. Analyst 2020; 145:2378-2388. [PMID: 32037406 DOI: 10.1039/c9an01880h] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Quantitative analysis of oxylipins in blood samples is of increasing interest in clinical studies. However, storage after sampling and transport of blood might induce artificial changes in the apparent oxylipin profile due to ex vivo formation/degradation by autoxidation or enzymatic activity. In the present study we investigated the stability of free (i.e. non-esterified) and total oxylipins in EDTA-plasma and serum generated under clinical conditions assessing delays in sample processing and automated transportation: Free cytochrome P450 monooxygenase and 5-lipoxygenase (LOX) formed oxylipins as well as autoxidation products were marginally affected by storage of whole blood up to 4 h at 4 °C, while total (i.e. the sum of free and esterified) levels of these oxylipins were stable up to 24 h and following transport. Cyclooxygenase (COX) products (TxB2, 12-HHT) and 12-LOX derived hydroxy-fatty acids were prone to storage and transport induced changes due to platelet activation. Total oxylipin patterns were generally more stable than the concentration of free oxylipins. In serum, coagulation induced higher levels of COX and 12-LOX products showing a high inter-individual variability. Overall, our results indicate that total EDTA-plasma oxylipins are the most stable blood oxylipin marker for clinical samples. Here, storage of blood before further processing is acceptable for a period up to 24 hours at 4 °C. However, levels of platelet derived oxylipins should be interpreted with caution regarding potential ex vivo formation.
Collapse
Affiliation(s)
- Katharina M Rund
- Chair of Food Chemistry, Faculty of Mathematics and Natural Sciences, University of Wuppertal, Wuppertal, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Wang L, Vijayan V, Jang MS, Thorenz A, Greite R, Rong S, Chen R, Shushakova N, Tudorache I, Derlin K, Pradhan P, Madyaningrana K, Madrahimov N, Bräsen JH, Lichtinghagen R, van Kooten C, Huber-Lang M, Haller H, Immenschuh S, Gueler F. Labile Heme Aggravates Renal Inflammation and Complement Activation After Ischemia Reperfusion Injury. Front Immunol 2019; 10:2975. [PMID: 31921212 PMCID: PMC6933315 DOI: 10.3389/fimmu.2019.02975] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/04/2019] [Indexed: 01/02/2023] Open
Abstract
Background: Ischemia reperfusion injury (IRI) plays a major role in solid organ transplantation. The length of warm ischemia time is critical for the extent of tissue damage in renal IRI. In this experimental study we hypothesized that local release of labile heme in renal tissue is triggered by the duration of warm ischemia (15 vs. 45 min IRI) and mediates complement activation, cytokine release, and inflammation. Methods: To induce IRI, renal pedicle clamping was performed in male C57BL/6 mice for short (15 min) or prolonged (45 min) time periods. Two and 24 h after experimental ischemia tissue injury labile heme levels in the kidney were determined with an apo-horseradish peroxidase assay. Moreover, renal injury, cytokines, and C5a and C3a receptor (C5aR, C3aR) expression were determined by histology, immunohistochemistry and qPCR, respectively. In addition, in vitro studies stimulating bone marrow-derived macrophages with LPS and the combination of LPS and heme were performed and cytokine expression was measured. Results: Inflammation and local tissue injury correlated with the duration of warm ischemia time. Labile heme concentrations in renal tissue were significantly higher after prolonged (45 min) as compared to short (15 min) IRI. Notably, expression of the inducible heme-degrading enzyme heme oxygenase-1 (HO-1) was up-regulated in kidneys after prolonged, but not after short IRI. C5aR, the pro-inflammatory cytokines IL-6 and TNF-α as well as pERK were up-regulated after prolonged, but not after short ischemia times. Consecutively, neutrophil infiltration and up-regulation of pro-fibrotic cytokines such as CTGF and PAI were more pronounced in prolonged IRI in comparison to short IRI. In vitro stimulation of macrophages with LPS revealed that IL-6 expression was enhanced in the presence of heme. Finally, administration of the heme scavenger human serum albumin (HSA) reduced the expression of pro-inflammatory cytokines, C3a receptor and improved tubular function indicated by enhanced alpha 1 microglobulin (A1M) absorption after IRI. Conclusions: Our data show that prolonged duration of warm ischemia time increased labile heme levels in the kidney, which correlates with IRI-dependent inflammation and up-regulation of anaphylatoxin receptor expression.
Collapse
Affiliation(s)
- Li Wang
- Department of Nephrology, Hannover Medical School, Hanover, Germany
| | - Vijith Vijayan
- Institute for Transfusion Medicine, Hannover Medical School, Hanover, Germany
| | - Mi-Sun Jang
- Department of Nephrology, Hannover Medical School, Hanover, Germany
| | - Anja Thorenz
- Department of Nephrology, Hannover Medical School, Hanover, Germany
| | - Robert Greite
- Department of Nephrology, Hannover Medical School, Hanover, Germany
| | - Song Rong
- Department of Nephrology, Hannover Medical School, Hanover, Germany
| | - Rongjun Chen
- Department of Nephrology, Hannover Medical School, Hanover, Germany
| | - Nelli Shushakova
- Department of Nephrology, Hannover Medical School, Hanover, Germany
| | - Igor Tudorache
- Department of Cardiothoracic Surgery, Hannover Medical School, Hanover, Germany
| | - Katja Derlin
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hanover, Germany
| | - Pooja Pradhan
- Institute for Transfusion Medicine, Hannover Medical School, Hanover, Germany
| | - Kukuh Madyaningrana
- Institute for Transfusion Medicine, Hannover Medical School, Hanover, Germany
| | - Nodir Madrahimov
- Department of Cardiothoracic Surgery, Hannover Medical School, Hanover, Germany
| | | | - Ralf Lichtinghagen
- Department of Laboratory Medicine, Hannover Medical School, Hanover, Germany
| | - Cees van Kooten
- Department of Nephrology, Leiden University Medical Centre, Leiden, Netherlands
| | - Markus Huber-Lang
- Institute of Clinical and Experimental Trauma-Immunology, University Hospital of Ulm, Ulm, Germany
| | - Hermann Haller
- Department of Nephrology, Hannover Medical School, Hanover, Germany
| | - Stephan Immenschuh
- Institute for Transfusion Medicine, Hannover Medical School, Hanover, Germany
| | - Faikah Gueler
- Department of Nephrology, Hannover Medical School, Hanover, Germany
| |
Collapse
|
12
|
Rund KM, Peng S, Greite R, Claaßen C, Nolte F, Oger C, Galano JM, Balas L, Durand T, Chen R, Gueler F, Schebb NH. Dietary omega-3 PUFA improved tubular function after ischemia induced acute kidney injury in mice but did not attenuate impairment of renal function. Prostaglandins Other Lipid Mediat 2019; 146:106386. [PMID: 31698142 DOI: 10.1016/j.prostaglandins.2019.106386] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/09/2019] [Accepted: 08/28/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is an important complication after major surgery and solid organ transplantation. Here, we present a dietary omega-3 polyunsaturated fatty acid (n3-PUFA) supplementation study to investigate whether pre-treatment can reduce ischemia induced AKI in mice. METHODS Male 12-14 week old C57BL/6 J mice received a linoleic acid rich sunflower oil based standard diet containing 10 % fat (STD) or the same diet enriched with n3-PUFA (containing 1 % EPA and 1 % DHA) (STD + n3). After 14 days of feeding bilateral 30 min renal ischemia reperfusion injury (IRI) was conducted to induce AKI and mice were sacrificed at 24 h. Serum creatinine and blood urea nitrogen (BUN) as well as liver enzyme elevation were measured. Kidney damage was analyzed by histology and immunohistochemistry. Furthermore, pro-inflammatory cytokines (IL-6, MCP-1) were determined by qPCR. FA and oxylipin pattern were quantified in blood and kidneys by GC-FID and LC-MS/MS, respectively. RESULTS n3-PUFA supplementation prior to renal IRI increased systemic and renal levels of n3-PUFA. Consistently, eicosanoids and other oxylipins derived from n3-PUFA including precursors of specialized pro-resolving mediators were elevated while n6-PUFA derived mediators such as pro-inflammatory prostaglandins were decreased. Feeding of n3-PUFA did not attenuate renal function impairment, morphological renal damage and inflammation characterized by IL-6 and MCP-1 elevation or neutrophil infiltration. However, the tubular transport marker alpha-1 microglobulin (A1M) was significantly higher expressed in proximal tubular epithelial cells of STD + n3 compared to STD fed mice. This indicates a better integrity of proximal tubular epithelial cells and thus significant protection of tubular function. In addition, heme oxygenase-1 (HO-1) which protects tubular function was also up-regulated in the treatment group receiving n3-PUFA supplemented chow. DISCUSSION We showed that n3-PUFA pre-treatment did not affect overall renal function or renal inflammation in a mouse model of moderate ischemia induced AKI, but tubular transport was improved. In conclusion, dietary n3-PUFA supplementation altered the oxylipin levels significantly but did not protect from renal function deterioration or attenuate ischemia induced renal inflammation.
Collapse
Affiliation(s)
- Katharina M Rund
- Chair of Food Chemistry, Faculty of Mathematics and Natural Sciences, University of Wuppertal, Wuppertal, Germany
| | - Shu Peng
- Nephrology, Hannover Medical School, Hannover, Germany; Department of Thoracic surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
| | - Robert Greite
- Nephrology, Hannover Medical School, Hannover, Germany
| | - Cornelius Claaßen
- Chair of Food Chemistry, Faculty of Mathematics and Natural Sciences, University of Wuppertal, Wuppertal, Germany
| | - Fabian Nolte
- Chair of Food Chemistry, Faculty of Mathematics and Natural Sciences, University of Wuppertal, Wuppertal, Germany
| | - Camille Oger
- Institut des Biomolécules Max Mousseron (IBMM), UMR 5247 CNRS, Université de Montpellier, ENSCM, France
| | - Jean-Marie Galano
- Institut des Biomolécules Max Mousseron (IBMM), UMR 5247 CNRS, Université de Montpellier, ENSCM, France
| | - Laurence Balas
- Institut des Biomolécules Max Mousseron (IBMM), UMR 5247 CNRS, Université de Montpellier, ENSCM, France
| | - Thierry Durand
- Institut des Biomolécules Max Mousseron (IBMM), UMR 5247 CNRS, Université de Montpellier, ENSCM, France
| | - Rongjun Chen
- Nephrology, Hannover Medical School, Hannover, Germany
| | - Faikah Gueler
- Nephrology, Hannover Medical School, Hannover, Germany.
| | - Nils Helge Schebb
- Chair of Food Chemistry, Faculty of Mathematics and Natural Sciences, University of Wuppertal, Wuppertal, Germany.
| |
Collapse
|
13
|
Greite R, Tudorache I, Vijayan V, Doricic J, Kreimann K, Leffler A, Fegbeutel C, Haverich A, Lichtinghagen R, Haller H, Gwinner W, Immenschuh S, Gueler F. FP289ACUTE KIDNEY INJURY AFTER MAJOR CARDIAC SURGERY CORRELATES WITH TRANSFUSION OF PACKED RED BLOOD CELLS AND THEIR DEGRADATION PRODUCTS. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
14
|
Kreimann K, Greite R, Tudorache I, Schiffer L, Lichtinghagen R, Rong S, Jang MS, Bräsen JH, Doricic J, Sarisin A, Vondran F, Vijayan V, Gwinner W, Fegbeutel C, Haverich A, Leffler A, Haller H, Immenschuh S, Gueler F. SaO055CREATININE INDEPENDENT SYSTEMIC BIOMARKER FOR SEVERITY OF ACUTE KIDNEY INJURY AFTER MAJOR SURGERY AND TRANSPLANTATION. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz101.sao055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | | | - Song Rong
- Hannover Medical School, Hannover, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Hellms S, Gueler F, Gutberlet M, Schebb NH, Rund K, Kielstein JT, VoChieu V, Rauhut S, Greite R, Martirosian P, Haller H, Wacker F, Derlin K. Single-dose diclofenac in healthy volunteers can cause decrease in renal perfusion measured by functional magnetic resonance imaging. ACTA ACUST UNITED AC 2019; 71:1262-1270. [PMID: 31131893 DOI: 10.1111/jphp.13105] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 02/12/2019] [Accepted: 04/22/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES We investigated changes of renal perfusion after topical and oral diclofenac administration in healthy volunteers using functional magnetic resonance imaging (MRI) with arterial spin labelling (ASL). METHODS Twenty-four healthy human participants (21-51 years) underwent 1.5T MRI before and 1 h after a single oral dose of diclofenac (50 mg). Twelve of 24 participants underwent an additional MRI examination following 3-day topical diclofenac administration. For renal perfusion imaging, a flow-sensitive alternating inversion-recovery TrueFISP ASL sequence was applied. Plasma concentrations of diclofenac and serum concentrations of thromboxane were determined. KEY FINDINGS After oral diclofenac application, large interindividual differences in plasma concentrations were observed (range <3-4604 nm). Topical diclofenac application did not result in relevant systemic diclofenac levels (range 5-75 nm). MRI showed a significant reduction of renal perfusion in individuals with diclofenac levels ≥225 nm (baseline: 347 ± 7 vs diclofenac: 323 ± 8 ml/min/100 g, P < 0.01); no significant differences were observed in participants with diclofenac levels <225 nm. Diclofenac levels correlated negatively with thromboxane B2 levels pointing towards target engagement. CONCLUSIONS Single-dose diclofenac caused a decrease in renal perfusion in participants with diclofenac levels ≥225 nm. We demonstrated that even a single dose of diclofenac can impair renal perfusion, which could be detrimental in patients with underlying chronic kidney disease or acute kidney injury.
Collapse
Affiliation(s)
- Susanne Hellms
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Faikah Gueler
- Nephrology Hannover Medical School, Hannover, Germany
| | - Marcel Gutberlet
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Nils Helge Schebb
- Institute for Food Toxicology and Analytical Chemistry, University of Veterinary Medicine Hannover, Hannover, Germany.,Food Chemistry, Faculty of Mathematics and Natural Sciences, University of Wuppertal, Wuppertal, Germany
| | - Katharina Rund
- Institute for Food Toxicology and Analytical Chemistry, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Jan T Kielstein
- Medical Clinic V (Nephrology, Rheumatology, Blood Purification), Academic Teaching Hospital Braunschweig, Braunschweig, Germany
| | - VanDai VoChieu
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | | | - Robert Greite
- Nephrology Hannover Medical School, Hannover, Germany
| | - Petros Martirosian
- Section on Experimental Radiology, University of Tuebingen, Tübingen, Germany
| | | | - Frank Wacker
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Katja Derlin
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| |
Collapse
|
16
|
Schiffer L, Wiehler F, Bräsen JH, Gwinner W, Greite R, Kreimann K, Thorenz A, Derlin K, Teng B, Rong S, von Vietinghoff S, Haller H, Mengel M, Pape L, Lerch C, Schiffer M, Gueler F. Chemokine CXCL13 as a New Systemic Biomarker for B-Cell Involvement in Acute T Cell-Mediated Kidney Allograft Rejection. Int J Mol Sci 2019; 20:ijms20102552. [PMID: 31137652 PMCID: PMC6567305 DOI: 10.3390/ijms20102552] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/13/2019] [Accepted: 05/19/2019] [Indexed: 12/31/2022] Open
Abstract
The presence of B-cell clusters in allogenic T cell-mediated rejection (TCMR) of kidney allografts is linked to more severe disease entities. In this study we characterized B-cell infiltrates in patients with TCMR and examined the role of serum CXCL-13 in these patients and experimentally. CXCL-13 serum levels were analyzed in 73 kidney allograft recipients at the time of allograft biopsy. In addition, four patients were evaluated for CXCL13 levels during the first week after transplantation. ELISA was done to measure CXCL-13 serum levels. For further mechanistic understanding, a translational allogenic kidney transplant (ktx) mouse model for TCMR was studied in BalbC recipients of fully mismatched transplants with C57BL/6 donor kidneys. CXCL-13 serum levels were measured longitudinally, CD20 and CD3 composition and CXCL13 mRNA in tissue were examined by flow cytometry and kidneys were examined by histology and immunohistochemistry. We found significantly higher serum levels of the B-cell chemoattractant CXCL13 in patients with TCMR compared to controls and patients with borderline TCMR. Moreover, in patients with acute rejection within the first week after ktx, a >5-fold CXCL13 increase was measured and correlated with B-cell infiltrates in the biopsies. In line with the clinical findings, TCMR in mice correlated with increased systemic serum-CXCL13 levels. Moreover, renal allografts had significantly higher CXCL13 mRNA expression than isogenic controls and showed interstitial CD20+ B-cell clusters and CD3+ cell infiltrates accumulating in the vicinity of renal vessels. CXCL13 blood levels correlate with B-cell involvement in TCMR and might help to identify patients at risk of a more severe clinical course of rejection.
Collapse
Affiliation(s)
- Lena Schiffer
- Nephrology, Hannover Medical School, 30625 Hannover, Germany.
- Pediatric Nephrology, Hannover Medical School, 30625 Hannover, Germany.
| | - Flavia Wiehler
- Nephrology, Hannover Medical School, 30625 Hannover, Germany.
| | | | | | - Robert Greite
- Nephrology, Hannover Medical School, 30625 Hannover, Germany.
| | - Kirill Kreimann
- Nephrology, Hannover Medical School, 30625 Hannover, Germany.
| | - Anja Thorenz
- Nephrology, Hannover Medical School, 30625 Hannover, Germany.
| | - Katja Derlin
- Radiology, Hannover Medical School, 30625 Hannover, Germany.
| | - Beina Teng
- Nephrology, Hannover Medical School, 30625 Hannover, Germany.
| | - Song Rong
- Nephrology, Hannover Medical School, 30625 Hannover, Germany.
| | | | - Hermann Haller
- Nephrology, Hannover Medical School, 30625 Hannover, Germany.
| | - Michael Mengel
- Laboratory Medicine & Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada.
| | - Lars Pape
- Pediatric Nephrology, Hannover Medical School, 30625 Hannover, Germany.
| | - Christian Lerch
- Pediatric Nephrology, Hannover Medical School, 30625 Hannover, Germany.
| | - Mario Schiffer
- Nephrology, Hannover Medical School, 30625 Hannover, Germany.
- Nephrology and Hypertension, University Hospital Erlangen, 91054 Erlangen, Gerrmany.
| | - Faikah Gueler
- Nephrology, Hannover Medical School, 30625 Hannover, Germany.
| |
Collapse
|
17
|
Greite R, Deutsch K, Bräsen JH, von Vietinghoff S. Erratum: Azathioprine hypersensitivity syndrome in anti-myeloperoxidase anti-neutrophil cytoplasmic antibody-associated vasculitis. Clin Kidney J 2019; 12:311. [PMID: 30976415 PMCID: PMC6452184 DOI: 10.1093/ckj/sfy092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
18
|
Greite R, Deutsch K, Bräsen JH, von Vietinghoff S. Azathioprine hypersensitivity syndrome in anti-myeloperoxidase anti-neutrophil cytoplasmic antibody-associated vasculitis. Clin Kidney J 2018; 12:89-91. [PMID: 30746133 PMCID: PMC6366126 DOI: 10.1093/ckj/sfy038] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/02/2018] [Indexed: 11/14/2022] Open
Abstract
Two patients with anti-neutrophil cytoplasmic antibody–associated vasculitis (AAV) and rapid onset of high fever, tachycardia and systemic hypotension accompanied by elevated laboratory markers of infection were diagnosed with azathioprine hypersensitivity syndrome only after repeat exposure. Azathioprine hypersensitivity can closely mimic sepsis and/or vasculitis activity and should be considered in AAV, a condition with frequent use of this drug. We discuss the pitfalls in diagnosis and the possible pathophysiologic background.
Collapse
Affiliation(s)
- Robert Greite
- Department of Internal Medicine, Division of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Konstantin Deutsch
- Department of Internal Medicine, Division of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | | | - Sibylle von Vietinghoff
- Department of Internal Medicine, Division of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
- Correspondence and offprint requests to: Sibylle von Vietinghoff; E-mail:
| |
Collapse
|
19
|
Greite R, Thorenz A, Chen R, Jang MS, Rong S, Brownstein MJ, Tewes S, Wang L, Baniassad B, Kirsch T, Bräsen JH, Lichtinghagen R, Meier M, Haller H, Hueper K, Gueler F. Renal ischemia-reperfusion injury causes hypertension and renal perfusion impairment in the CD1 mice which promotes progressive renal fibrosis. Am J Physiol Renal Physiol 2018; 314:F881-F892. [DOI: 10.1152/ajprenal.00519.2016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Renal ischemia-reperfusion injury (IRI) is a severe complication of major surgery and a risk factor for increased morbidity and mortality. Here, we investigated mechanisms that might contribute to IRI-induced progression to chronic kidney disease (CKD). Acute kidney injury (AKI) was induced by unilateral IRI for 35 min in CD1 and C57BL/6 (B6) mice. Unilateral IRI was used to overcome early mortality. Renal morphology, NGAL upregulation, and neutrophil infiltration as well as peritubular capillary density were studied by immunohistochemistry. The composition of leukocyte infiltrates in the kidney after IRI was investigated by flow cytometry. Systemic blood pressure was measured with a tail cuff, and renal perfusion was quantified by functional magnetic resonance imaging (fMRI). Mesangial matrix expansion was assessed by silver staining. Following IRI, CD1 and B6 mice developed similar morphological signs of AKI and increases in NGAL expression, but neutrophil infiltration was greater in CD1 than B6 mice. IRI induced an increase in systemic blood pressure of 20 mmHg in CD1, but not in B6 mice; and CD1 mice also had a greater loss of renal perfusion and kidney volume than B6 mice ( P < 0.05). CD1 mice developed substantial interstitial fibrosis and decreased peritubular capillary (PTC) density by day 14 while B6 mice showed only mild renal scarring and almost normal PTC. Our results show that after IRI, CD1 mice develop more inflammation, hypertension, and later mesangial matrix expansion than B6 mice do. Subsequently, CD1 animals suffer from CKD due to impaired renal perfusion and pronounced permanent loss of peritubular capillaries.
Collapse
Affiliation(s)
- Robert Greite
- Nephrology, Hannover Medical School, Hannover, Germany
| | - Anja Thorenz
- Nephrology, Hannover Medical School, Hannover, Germany
| | - Rongjun Chen
- Nephrology, Hannover Medical School, Hannover, Germany
| | - Mi-Sun Jang
- Nephrology, Hannover Medical School, Hannover, Germany
| | - Song Rong
- Nephrology, Hannover Medical School, Hannover, Germany
- The Transplantation Center of the Affiliated Hospital, Zunyi Medical College, Zunyi, China
| | | | - Susanne Tewes
- Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Li Wang
- Nephrology, Hannover Medical School, Hannover, Germany
| | | | | | | | | | - Martin Meier
- Imaging Center, Institute of Laboratory Animal Sciences, Hannover Medical School, Hannover, Germany
| | | | - Katja Hueper
- Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Faikah Gueler
- Nephrology, Hannover Medical School, Hannover, Germany
| |
Collapse
|
20
|
Greite R, Hensen B, Rong S, Bräsen JH, Meier M, Hammock B, Panigrahy D, Lee S, Haller H, Hueper K, Gueler F. FP240FUNCTIONAL MRI DETECTS PRONOUNCED RENAL PERFUSION IMPAIRMENT AFTER BLOOD PRESSURE NORMALIZATION FOLLOWING ACUTE KIDNEY INJURY IN MICE. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.fp240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Robert Greite
- Nephrology, Hannover Medical School, Hannover, Germany
| | - Bennet Hensen
- Nephrology, Hannover Medical School, Hannover, Germany
| | - Song Rong
- Nephrology, Hannover Medical School, Hannover, Germany
| | | | - Martin Meier
- Nephrology, Hannover Medical School, Hannover, Germany
| | - Bruce Hammock
- Entomology, University of California Davis, Davis, CA, United States
| | - Dipak Panigrahy
- Pathology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Sing Lee
- Entomology, University of California, Davis, Davis, CA, United States
| | | | - Katja Hueper
- Radiology, Hannover Medical School, Hannover, Germany
| | - Faikah Gueler
- Nephrology, Hannover Medical School, Hannover, Germany
| |
Collapse
|
21
|
Greite R, Chen R, Rong S, Thorenz A, Braesen JH, Hensen B, Meier M, Schebb N, Hammock B, Lee S, Panigrahy D, Haller H, Hueper K, Gueler F. MO008EARLY ANTI HYPERTENSIVE THERAPY IN A MOUSE MODEL OF ACUTE KIDNEY INJURY IS DELETETERIOUS. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw130.03] [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: 11/14/2022] Open
|
22
|
Tewes S, Greite R, Hartung D, Chen R, Rong S, Bräsen J, Meier M, Jang M, Gutberlet M, Hensen B, Wacker F, Güler F, Hüper K. Diffusionsbildgebung und T2 mapping können renale Pathologien im Rahmen eines akuten Nierenversagens charakterisieren und eine Vorhersage zum renalen Outcome geben. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581886] [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: 10/22/2022]
|
23
|
Ostermann AI, Herbers J, Willenberg I, Chen R, Hwang SH, Greite R, Morisseau C, Gueler F, Hammock BD, Schebb NH. Oral treatment of rodents with soluble epoxide hydrolase inhibitor 1-(1-propanoylpiperidin-4-yl)-3-[4-(trifluoromethoxy)phenyl]urea (TPPU): Resulting drug levels and modulation of oxylipin pattern. Prostaglandins Other Lipid Mediat 2015; 121:131-7. [PMID: 26117215 DOI: 10.1016/j.prostaglandins.2015.06.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 06/03/2015] [Accepted: 06/09/2015] [Indexed: 11/29/2022]
Abstract
Epoxides from polyunsaturated fatty acids (PUFAs) are potent lipid mediators. In vivo stabilization of these epoxides by blockade of the soluble epoxide hydrolase (sEH) leads to anti-inflammatory, analgesic and normotensive effects. Therefore, sEH inhibitors (sEHi) are a promising new class of drugs. Herein, we characterized pharmacokinetic (PK) and pharmacodynamic properties of a commercially available potent sEHi 1-(1-propanoylpiperidin-4-yl)-3-[4-(trifluoromethoxy)phenyl]urea (TPPU). Cell culture studies suggest its high absorption and metabolic stability. Following administration in drinking water to rats (0.2, 1, and 5mg TPPU/L with 0.2% PEG400), TPPU's blood concentration increased dose dependently within the treatment period to reach an almost steady state after 8 days. TPPU was found in all the tissues tested. The linoleic epoxide/diol ratios in most tissues were dose dependently increased, indicating significant sEH inhibition. Overall, administration of TPPU with the drinking water led to systemic distribution as well as high drug levels and thus makes chronic sEH inhibition studies possible.
Collapse
Affiliation(s)
- Annika I Ostermann
- University of Veterinary Medicine Hannover, Institute for Food Toxicology and Analytical Chemistry, Bischofsholer Damm 15, 30173 Hannover, Germany
| | - Jan Herbers
- University of Veterinary Medicine Hannover, Institute for Food Toxicology and Analytical Chemistry, Bischofsholer Damm 15, 30173 Hannover, Germany
| | - Ina Willenberg
- University of Veterinary Medicine Hannover, Institute for Food Toxicology and Analytical Chemistry, Bischofsholer Damm 15, 30173 Hannover, Germany
| | - Rongjun Chen
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Sung Hee Hwang
- Department of Entomology and Nematology, and UC Davis Comprehensive Cancer Center, University of California, Davis, CA 95616, USA
| | - Robert Greite
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Christophe Morisseau
- Department of Entomology and Nematology, and UC Davis Comprehensive Cancer Center, University of California, Davis, CA 95616, USA
| | - Faikah Gueler
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Bruce D Hammock
- Department of Entomology and Nematology, and UC Davis Comprehensive Cancer Center, University of California, Davis, CA 95616, USA
| | - Nils Helge Schebb
- University of Veterinary Medicine Hannover, Institute for Food Toxicology and Analytical Chemistry, Bischofsholer Damm 15, 30173 Hannover, Germany; University of Wuppertal, Institute of Food Chemistry, Wuppertal, Germany.
| |
Collapse
|
24
|
Greite R, Chen R, Rong S, Wang L, Jang MS, Haller H, Bräsen JH, Meier M, Hueper K, Gueler F. SP289HYPERTENSION AGGRAVATES ACUTE KIDNEY INJURY (AKI) AND ACCELERATES PROGRESSION TO CHRONIC KIDNEY DISEASE (CKD) IN CD1 MICE. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv191.09] [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: 11/14/2022] Open
|
25
|
Greite R, Chen R, Baniassad B, Rong S, Thorenz A, Meier M, Tewes S, Hüper K, Güler F. RAAS Activation Aggravates Ischemia Reperfusion Injury and Accelerates Progression to Chronic Kidney Disease. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.1048.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
26
|
Rong S, Hueper K, Kirsch T, Greite R, Klemann C, Mengel M, Meier M, Menne J, Leitges M, Susnik N, Meier M, Haller H, Shushakova N, Gueler F. Renal PKC-ε deficiency attenuates acute kidney injury and ischemic allograft injury via TNF-α-dependent inhibition of apoptosis and inflammation. Am J Physiol Renal Physiol 2014; 307:F718-26. [DOI: 10.1152/ajprenal.00372.2013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Acute kidney injury (AKI) increases the risk of morbidity and mortality after major surgery and transplantation. We investigated the effect of PKC-ε deficiency on AKI and ischemic allograft damage after kidney transplantation. PKC-ε-deficient and wild type (WT) control mice were subjected to 35 min of renal pedicle clamping to induce AKI. PKC-ε deficiency was associated with a marked improvement in survival and an attenuated loss of kidney function. Furthermore, functional MRI experiments revealed better renal perfusion in PKC-ε-deficient mice than in WT mice one day after IRI. Acute tubular necrosis and neutrophil infiltration were markedly reduced in PKC-ε-deficient mice. To determine whether this resistance to ischemia-reperfusion injury resulted from changes in local renal cells or infiltrating leukocytes, we studied a life-supporting renal transplant model of ischemic graft injury. We transplanted kidneys from H2b PKC-ε-deficient mice (129/SV) and their corresponding WT littermates into major histocompatibility complex-incompatible H2d recipients (BALB/c) and induced ischemic graft injury by prolonged cold ischemia time. Recipients of WT allografts developed severe renal failure and died within 10 days of transplantation. Recipients of PKC-ε-deficient allografts had better renal function and survival; they had less generation of ROS and upregulation of proinflammatory proteins (i.e., ICAM-1, inducible nitric oxide synthase, and TNF-α) and showed less tubular epithelial cell apoptosis and inflammation in their allografts. These data suggest that local renal PKC-ε expression mediates proapoptotic and proinflammatory signaling and that an inhibitor of PKC-ε signaling could be used to prevent hypoxia-induced AKI.
Collapse
Affiliation(s)
- Song Rong
- Department of Nephrology, Hannover Medical School, Hannover, Germany
- The Transplantation Center, Affiliated Hospital, Zunyi Medical College, Zunyi, China
| | - Katja Hueper
- Institute for Diagnostic and Interventional Radiology, Medical School Hannover, Hannover, Germany
| | - Torsten Kirsch
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Robert Greite
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Christian Klemann
- Centre for Paediatrics and Adolescent Medicine, Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Michael Mengel
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - Matthias Meier
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Jan Menne
- Department of Nephrology, Hannover Medical School, Hannover, Germany
- Phenos GmbH, Hannover, Germany
| | - Michael Leitges
- Department of Nephrology, Hannover Medical School, Hannover, Germany
- The Biotechnology Centre of Oslo, University of Oslo, Oslo, Norway
| | - Nathan Susnik
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Martin Meier
- Imaging Center, Institute for Animal Science, Medical School Hannover, Hannover, Germany; and
| | - Hermann Haller
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Nelli Shushakova
- Department of Nephrology, Hannover Medical School, Hannover, Germany
- Phenos GmbH, Hannover, Germany
| | - Faikah Gueler
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| |
Collapse
|