1
|
Mortensen LA, Jespersen B, Helligsoe ASL, Tougaard B, Cibulskyte-Ninkovic D, Egfjord M, Boesby L, Marcussen N, Madsen K, Jensen BL, Petersen I, Bistrup C, Thiesson HC. Effect of Spironolactone on Kidney Function in Kidney Transplant Recipients: A Randomized Placebo-Controlled Clinical Trial. Clin J Am Soc Nephrol 2024:01277230-990000000-00360. [PMID: 38416033 DOI: 10.2215/cjn.0000000000000439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 02/21/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Long-term kidney allograft survival is hampered by progressive interstitial fibrosis and tubular atrophy. The SPIREN trial tested the hypothesis that the mineralocorticoid receptor antagonist spironolactone stabilizes kidney function and attenuates glomerular barrier injury in kidney transplant patients treated with calcineurin inhibitors. METHODS Randomized, placebo-controlled, double blind clinical trial including 188 prevalent kidney transplant patients. Patients were randomized to spironolactone or placebo for three years. Glomerular filtration rate was measured along with proteinuria and kidney fibrosis. The primary endpoint was change in measured glomerular filtration rate. Secondary outcomes were 24h proteinuria, kidney allograft fibrosis and cardiovascular events. Measured glomerular filtration rates, 24h proteinuria and blood pressure were determined yearly. Kidney biopsies were collected at baseline and after two years (n=48). Fibrosis was evaluated by quantitative stereology and classified according to Banff. RESULTS The groups were comparable at baseline except for slightly older allografts in the spironolactone group. Spironolactone reduced measured glomerular filtration rates (up to -7.6 (95% CI -10.9;-4.3) ml/min compared to placebo) independently of time since transplantation and blood pressure with no impact on the kidney function curve over time and reduced 24h proteinuria after one year. There was no significant effect of spironolactone on the development of interstitial fibrosis. CONCLUSION Spironolactone added to standard therapy for three years in kidney transplant patients did not improve kidney function, long-term proteinuria or interstitial fibrosis.
Collapse
Affiliation(s)
- Line A Mortensen
- Department of Nephrology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Bente Jespersen
- Department of Nephrology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Anne Sophie L Helligsoe
- Department of Nephrology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Birgitte Tougaard
- Department of Nephrology, Kolding Hospital, Sygehusvej 24, 6000 Kolding, Denmark
| | | | - Martin Egfjord
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 København Ø, Denmark
| | - Lene Boesby
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 København Ø, Denmark
| | - Niels Marcussen
- Department of Pathology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Kirsten Madsen
- Department of Pathology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
- Cardiovascular and Renal Research Unit, Institute of Molecular Medicine, University of Southern Denmark, Winsløwparken 21, 3. Sal, 5000 Odense C, Denmark
| | - Boye L Jensen
- Cardiovascular and Renal Research Unit, Institute of Molecular Medicine, University of Southern Denmark, Winsløwparken 21, 3. Sal, 5000 Odense C, Denmark
| | - Inge Petersen
- OPEN, Open Patient data Explorative Network, Odense University Hospital, Region of Southern Denmark
| | - Claus Bistrup
- Department of Nephrology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 3. Sal, 5000 Odense C, Denmark
| | - Helle C Thiesson
- Department of Nephrology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 3. Sal, 5000 Odense C, Denmark
| |
Collapse
|
2
|
Carvalho RF, do Canto LM, Cury SS, Frøstrup Hansen T, Jensen LH, Rogatto SR. Drug Repositioning Based on the Reversal of Gene Expression Signatures Identifies TOP2A as a Therapeutic Target for Rectal Cancer. Cancers (Basel) 2021; 13:5492. [PMID: 34771654 PMCID: PMC8583090 DOI: 10.3390/cancers13215492] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/21/2021] [Accepted: 10/28/2021] [Indexed: 12/12/2022] Open
Abstract
Rectal cancer is a common disease with high mortality rates and limited therapeutic options. Here we combined the gene expression signatures of rectal cancer patients with the reverse drug-induced gene-expression profiles to identify drug repositioning candidates for cancer therapy. Among the predicted repurposable drugs, topoisomerase II inhibitors (doxorubicin, teniposide, idarubicin, mitoxantrone, and epirubicin) presented a high potential to reverse rectal cancer gene expression signatures. We showed that these drugs effectively reduced the growth of colorectal cancer cell lines closely representing rectal cancer signatures. We also found a clear correlation between topoisomerase 2A (TOP2A) gene copy number or expression levels with the sensitivity to topoisomerase II inhibitors. Furthermore, CRISPR-Cas9 and shRNA screenings confirmed that loss-of-function of the TOP2A has the highest efficacy in reducing cellular proliferation. Finally, we observed significant TOP2A copy number gains and increased expression in independent cohorts of rectal cancer patients. These findings can be translated into clinical practice to evaluate TOP2A status for targeted and personalized therapies based on topoisomerase II inhibitors in rectal cancer patients.
Collapse
Affiliation(s)
- Robson Francisco Carvalho
- Department of Clinical Genetics, University Hospital of Southern Denmark, 7100 Vejle, Denmark;
- Institute of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark
- Department of Functional and Structural Biology—Institute of Bioscience, São Paulo State University (UNESP), Botucatu 18618-689, Brazil;
| | - Luisa Matos do Canto
- Department of Clinical Genetics, University Hospital of Southern Denmark, 7100 Vejle, Denmark;
- Institute of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Sarah Santiloni Cury
- Department of Functional and Structural Biology—Institute of Bioscience, São Paulo State University (UNESP), Botucatu 18618-689, Brazil;
| | - Torben Frøstrup Hansen
- Department of Oncology, University Hospital of Southern Denmark, 7100 Vejle, Denmark; (T.F.H.); (L.H.J.)
- Danish Colorectal Cancer Center South, 7100 Vejle, Denmark
| | - Lars Henrik Jensen
- Department of Oncology, University Hospital of Southern Denmark, 7100 Vejle, Denmark; (T.F.H.); (L.H.J.)
- Danish Colorectal Cancer Center South, 7100 Vejle, Denmark
| | - Silvia Regina Rogatto
- Department of Clinical Genetics, University Hospital of Southern Denmark, 7100 Vejle, Denmark;
- Institute of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark
- Danish Colorectal Cancer Center South, 7100 Vejle, Denmark
| |
Collapse
|
3
|
von Huth S, Thingholm LB, Kofoed PE, Bang C, Rühlemann MC, Franke A, Holmskov U. Intestinal protozoan infections shape fecal bacterial microbiota in children from Guinea-Bissau. PLoS Negl Trop Dis 2021; 15:e0009232. [PMID: 33657123 PMCID: PMC7959362 DOI: 10.1371/journal.pntd.0009232] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 03/15/2021] [Accepted: 02/11/2021] [Indexed: 12/24/2022] Open
Abstract
Intestinal parasitic infections, caused by helminths and protozoa, are globally distributed and major causes of worldwide morbidity. The gut microbiota may modulate parasite virulence and host response upon infection. The complex interplay between parasites and the gut microbiota is poorly understood, partly due to sampling difficulties in remote areas with high parasite burden. In a large study of children in Guinea-Bissau, we found high prevalence of intestinal parasites. By sequencing of the 16S rRNA genes of fecal samples stored on filter paper from a total of 1,204 children, we demonstrate that the bacterial microbiota is not significantly altered by helminth infections, whereas it is shaped by the presence of both pathogenic and nonpathogenic protozoa, including Entamoeba (E.) spp. and Giardia (G.) lamblia. Within-sample diversity remains largely unaffected, whereas overall community composition is significantly affected by infection with both nonpathogenic E. coli (R2 = 0.0131, P = 0.0001) and Endolimax nana (R2 = 0.00902, P = 0.0001), and by pathogenic E. histolytica (R2 = 0.0164, P = 0.0001) and G. lamblia (R2 = 0.00676, P = 0.0001). Infections with multiple parasite species induces more pronounced shifts in microbiota community than mild ones. A total of 31 bacterial genera across all four major bacterial phyla were differentially abundant in protozoan infection as compared to noninfected individuals, including increased abundance of Prevotella, Campylobacter and two Clostridium clades, and decreased abundance of Collinsella, Lactobacillus, Ruminococcus, Veillonella and one Clostridium clade. In the present study, we demonstrate that the fecal bacterial microbiota is shaped by intestinal parasitic infection, with most pronounced associations for protozoan species. Our results provide insights into the interplay between the microbiota and intestinal parasites, which are valuable to understand infection biology and design further studies aimed at optimizing treatment strategies.
Collapse
Affiliation(s)
- Sebastian von Huth
- Cancer and Inflammation Research, Department of Molecular Medicine, University of Southern Denmark, Denmark
| | - Louise B. Thingholm
- Institute of Clinical Molecular Biology, Christian Albrechts University of Kiel, Germany
| | - Poul-Erik Kofoed
- Department of Pediatrics, Kolding Hospital, Denmark
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Corinna Bang
- Institute of Clinical Molecular Biology, Christian Albrechts University of Kiel, Germany
| | - Malte C. Rühlemann
- Institute of Clinical Molecular Biology, Christian Albrechts University of Kiel, Germany
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian Albrechts University of Kiel, Germany
| | - Uffe Holmskov
- Cancer and Inflammation Research, Department of Molecular Medicine, University of Southern Denmark, Denmark
- * E-mail:
| |
Collapse
|