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von Rauchhaupt E, Klaus M, Ribeiro A, Honarpisheh M, Li C, Liu M, Köhler P, Adamowicz K, Schmaderer C, Lindenmeyer M, Steiger S, Anders HJ, Lech M. GDF-15 Suppresses Puromycin Aminonucleoside-Induced Podocyte Injury by Reducing Endoplasmic Reticulum Stress and Glomerular Inflammation. Cells 2024; 13:637. [PMID: 38607075 PMCID: PMC11011265 DOI: 10.3390/cells13070637] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/22/2024] [Accepted: 03/30/2024] [Indexed: 04/13/2024] Open
Abstract
GDF15, also known as MIC1, is a member of the TGF-beta superfamily. Previous studies reported elevated serum levels of GDF15 in patients with kidney disorder, and its association with kidney disease progression, while other studies identified GDF15 to have protective effects. To investigate the potential protective role of GDF15 on podocytes, we first performed in vitro studies using a Gdf15-deficient podocyte cell line. The lack of GDF15 intensified puromycin aminonucleoside (PAN)-triggered endoplasmic reticulum stress and induced cell death in cultivated podocytes. This was evidenced by elevated expressions of Xbp1 and ER-associated chaperones, alongside AnnexinV/PI staining and LDH release. Additionally, we subjected mice to nephrotoxic PAN treatment. Our observations revealed a noteworthy increase in both GDF15 expression and secretion subsequent to PAN administration. Gdf15 knockout mice displayed a moderate loss of WT1+ cells (podocytes) in the glomeruli compared to wild-type controls. However, this finding could not be substantiated through digital evaluation. The parameters of kidney function, including serum BUN, creatinine, and albumin-creatinine ratio (ACR), were increased in Gdf15 knockout mice as compared to wild-type mice upon PAN treatment. This was associated with an increase in the number of glomerular macrophages, neutrophils, inflammatory cytokines, and chemokines in Gdf15-deficient mice. In summary, our findings unveil a novel renoprotective effect of GDF15 during kidney injury and inflammation by promoting podocyte survival and regulating endoplasmic reticulum stress in podocytes, and, subsequently, the infiltration of inflammatory cells via paracrine effects on surrounding glomerular cells.
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Affiliation(s)
- Ekaterina von Rauchhaupt
- Department of Medicine IV, Renal Division, Ludwig-Maximilians-University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (E.v.R.); (M.K.); (A.R.); (M.H.); (C.L.); (M.L.); (P.K.); (S.S.); (H.-J.A.)
| | - Martin Klaus
- Department of Medicine IV, Renal Division, Ludwig-Maximilians-University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (E.v.R.); (M.K.); (A.R.); (M.H.); (C.L.); (M.L.); (P.K.); (S.S.); (H.-J.A.)
| | - Andrea Ribeiro
- Department of Medicine IV, Renal Division, Ludwig-Maximilians-University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (E.v.R.); (M.K.); (A.R.); (M.H.); (C.L.); (M.L.); (P.K.); (S.S.); (H.-J.A.)
- Klinikum Rechts der Isar, Department of Nephrology, Technical University Munich, 81675 Munich, Germany;
| | - Mohsen Honarpisheh
- Department of Medicine IV, Renal Division, Ludwig-Maximilians-University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (E.v.R.); (M.K.); (A.R.); (M.H.); (C.L.); (M.L.); (P.K.); (S.S.); (H.-J.A.)
| | - Chenyu Li
- Department of Medicine IV, Renal Division, Ludwig-Maximilians-University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (E.v.R.); (M.K.); (A.R.); (M.H.); (C.L.); (M.L.); (P.K.); (S.S.); (H.-J.A.)
| | - Min Liu
- Department of Medicine IV, Renal Division, Ludwig-Maximilians-University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (E.v.R.); (M.K.); (A.R.); (M.H.); (C.L.); (M.L.); (P.K.); (S.S.); (H.-J.A.)
| | - Paulina Köhler
- Department of Medicine IV, Renal Division, Ludwig-Maximilians-University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (E.v.R.); (M.K.); (A.R.); (M.H.); (C.L.); (M.L.); (P.K.); (S.S.); (H.-J.A.)
| | - Karina Adamowicz
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology of Jagiellonian University, 30-387 Krakow, Poland;
| | - Christoph Schmaderer
- Klinikum Rechts der Isar, Department of Nephrology, Technical University Munich, 81675 Munich, Germany;
| | - Maja Lindenmeyer
- III Department of Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany;
| | - Stefanie Steiger
- Department of Medicine IV, Renal Division, Ludwig-Maximilians-University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (E.v.R.); (M.K.); (A.R.); (M.H.); (C.L.); (M.L.); (P.K.); (S.S.); (H.-J.A.)
| | - Hans-Joachim Anders
- Department of Medicine IV, Renal Division, Ludwig-Maximilians-University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (E.v.R.); (M.K.); (A.R.); (M.H.); (C.L.); (M.L.); (P.K.); (S.S.); (H.-J.A.)
| | - Maciej Lech
- Department of Medicine IV, Renal Division, Ludwig-Maximilians-University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (E.v.R.); (M.K.); (A.R.); (M.H.); (C.L.); (M.L.); (P.K.); (S.S.); (H.-J.A.)
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Ma S, Qiu Y, Zhang C. Cytoskeleton Rearrangement in Podocytopathies: An Update. Int J Mol Sci 2024; 25:647. [PMID: 38203817 PMCID: PMC10779434 DOI: 10.3390/ijms25010647] [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: 11/22/2023] [Revised: 12/14/2023] [Accepted: 01/01/2024] [Indexed: 01/12/2024] Open
Abstract
Podocyte injury can disrupt the glomerular filtration barrier (GFB), leading to podocytopathies that emphasize podocytes as the glomerulus's key organizer. The coordinated cytoskeleton is essential for supporting the elegant structure and complete functions of podocytes. Therefore, cytoskeleton rearrangement is closely related to the pathogenesis of podocytopathies. In podocytopathies, the rearrangement of the cytoskeleton refers to significant alterations in a string of slit diaphragm (SD) and focal adhesion proteins such as the signaling node nephrin, calcium influx via transient receptor potential channel 6 (TRPC6), and regulation of the Rho family, eventually leading to the disorganization of the original cytoskeletal architecture. Thus, it is imperative to focus on these proteins and signaling pathways to probe the cytoskeleton rearrangement in podocytopathies. In this review, we describe podocytopathies and the podocyte cytoskeleton, then discuss the molecular mechanisms involved in cytoskeleton rearrangement in podocytopathies and summarize the effects of currently existing drugs on regulating the podocyte cytoskeleton.
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Affiliation(s)
| | | | - Chun Zhang
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (S.M.); (Y.Q.)
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Hejazian SM, Ardalan M, Hosseiniyan Khatibi SM, Rahbar Saadat Y, Barzegari A, Gueguen V, Meddahi-Pellé A, Anagnostou F, Zununi Vahed S, Pavon-Djavid G. Biofactors regulating mitochondrial function and dynamics in podocytes and podocytopathies. J Cell Physiol 2023; 238:2206-2227. [PMID: 37659096 DOI: 10.1002/jcp.31110] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/25/2023] [Accepted: 08/14/2023] [Indexed: 09/04/2023]
Abstract
Podocytes are terminally differentiated kidney cells acting as the main gatekeepers of the glomerular filtration barrier; hence, inhibiting proteinuria. Podocytopathies are classified as kidney diseases caused by podocyte damage. Different genetic and environmental risk factors can cause podocyte damage and death. Recent evidence shows that mitochondrial dysfunction also contributes to podocyte damage. Understanding alterations in mitochondrial metabolism and function in podocytopathies and whether altered mitochondrial homeostasis/dynamics is a cause or effect of podocyte damage are issues that need in-depth studies. This review highlights the roles of mitochondria and their bioenergetics in podocytes. Then, factors/signalings that regulate mitochondria in podocytes are discussed. After that, the role of mitochondrial dysfunction is reviewed in podocyte injury and the development of different podocytopathies. Finally, the mitochondrial therapeutic targets are considered.
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Affiliation(s)
| | | | | | | | - Abolfazl Barzegari
- Université Sorbonne Paris Nord, INSERM U1148, Laboratory for Vascular Translational Science, Cardiovascular Bioengineering, Villetaneuse, France
| | - Virginie Gueguen
- Université Sorbonne Paris Nord, INSERM U1148, Laboratory for Vascular Translational Science, Cardiovascular Bioengineering, Villetaneuse, France
| | - Anne Meddahi-Pellé
- Université Sorbonne Paris Nord, INSERM U1148, Laboratory for Vascular Translational Science, Cardiovascular Bioengineering, Villetaneuse, France
| | - Fani Anagnostou
- Université de Paris, CNRS UMR 7052 INSERM U1271, B3OA, Paris, France
| | | | - Graciela Pavon-Djavid
- Université Sorbonne Paris Nord, INSERM U1148, Laboratory for Vascular Translational Science, Cardiovascular Bioengineering, Villetaneuse, France
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4
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Shankland SJ, Jefferson JA, Wessely O. Repurposing drugs for diseases associated with podocyte dysfunction. Kidney Int 2023; 104:455-462. [PMID: 37290603 DOI: 10.1016/j.kint.2023.05.018] [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: 02/11/2023] [Revised: 04/02/2023] [Accepted: 05/11/2023] [Indexed: 06/10/2023]
Abstract
The majority of podocyte disorders are progressive in nature leading to chronic kidney disease and often kidney failure. The scope of current therapies is typically nonspecific immunosuppressant medications, which are accompanied by unwanted and serious side effects. However, many exciting clinical trials are underway to reduce the burden of podocyte diseases in our patients. Major advances and discoveries have recently been made experimentally in our understanding of the molecular and cellular mechanisms underlying podocyte injury in disease. This begs the question of how best to take advantage of these impressive strides. One approach to consider is the repurposing of therapeutics that have already been approved by the Food and Drug Administration, European Medicines Agency, and other regulatory agencies for indications beyond the kidney. The advantages of therapy repurposing include known safety profiles, drug development that has already been completed, and overall reduced costs for studying alternative indications for selected therapies. The purpose of this mini review is to examine the experimental literature of podocyte damage and determine if there are mechanistic targets in which prior approved therapies can be considered for repurposing to podocyte disorders.
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Affiliation(s)
- Stuart J Shankland
- Division of Nephrology, University of Washington, Seattle, Washington, USA; Institute for Stem Cell & Regenerative Medicine, University of Washington, Seattle, Washington, USA.
| | - J Ashley Jefferson
- Division of Nephrology, University of Washington, Seattle, Washington, USA
| | - Oliver Wessely
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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Vinogradov AA, Chebotareva NV, Bugrova AE, Brzhozovskiy AG, Krasnova TN, Nasibullina KZ, Kononikhin AS, Moiseev SV. [Study of urinary markers of different podocytopathies by proteomic analysis]. TERAPEVT ARKH 2023; 95:457-461. [PMID: 38158963 DOI: 10.26442/00403660.2023.06.202266] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/14/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Focal segmental glomerulosclerosis (FSGS) is a primary podocytopathy characterized by primary podocyte detection and high proteinuria. The search for biomarkers and factors associated with the progression of this disease is an important task nowdays. AIM To assess the proteomic profile of urine in patients with FSGS and to isolate urinary biomarkers of podocytopathies. MATERIALS AND METHODS The study included 41 patients diagnosed with chronic glomerulonephritis, 27 men and 14 women. According to the morphological study, 28 patients were diagnosed with FSGS, 9 with steroid-sensitive nephrotic syndrome and 14 with steroid-resistant nephrotic syndrome. The comparison group included 13 patients with membranous nephropathy. The study of the urinary proteome was carried out by targeted liquid chromatography-mass spectrometry using multiple reaction monitoring with synthetic stable isotope labelled peptide standards. RESULTS The main differences in the protein profile of urine were found in the subgroups of steroid-sensitive (SS) and steroid-resistant (SR) FSGS. In the FSGS SR group, at the onset of the disease, there was a high concentration of proteins reflecting damage to the glomerular filter (apo-lipoprotein A-IV, orosomucoid, cadherin, hemopexin, vitronectin), as well as proteins associated with tubulo-interstitial inflammation and accumulation of extracellular matrix (retinol- and vitamin D-binding proteins, kininogen-1, lumican and neurophilin-2). Compared with the membranous nephropathy group, FSGS patients had significantly higher urinary concentrations of carnosinase, orosomucoid, cadherin-13, tenascin X, osteopontin, and zinc-alpha-2-glycoprotein. CONCLUSION Thus, in patients with SR FSGS, the proteomic profile of urine includes more proteins at elevated concentrations, which reflects severe damage to various parts of the nephron compared with patients with SS FSGS and membranous nephropathy.
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Affiliation(s)
| | - N V Chebotareva
- Sechenov First Moscow State Medical University (Sechenov University)
| | | | | | - T N Krasnova
- Lomonosov Moscow State University
- Sechenov First Moscow State Medical University (Sechenov University)
| | - K Z Nasibullina
- Sechenov First Moscow State Medical University (Sechenov University)
| | | | - S V Moiseev
- Sechenov First Moscow State Medical University (Sechenov University)
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Vöing K, Michgehl U, Mertens ND, Picciotto C, Maywald ML, Goretzko J, Waimann S, Gilhaus K, Rogg M, Schell C, Klingauf J, Tsytsyura Y, Hansen U, van Marck V, Edinger AL, Vollenbröker B, Rescher U, Braun DA, George B, Weide T, Pavenstädt H. Disruption of the Rab7-Dependent Final Common Pathway of Endosomal and Autophagic Processing Results in a Severe Podocytopathy. J Am Soc Nephrol 2023; 34:1191-1206. [PMID: 37022133 PMCID: PMC10356157 DOI: 10.1681/asn.0000000000000126] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/03/2023] [Indexed: 04/07/2023] Open
Abstract
SIGNIFICANCE STATEMENT Endocytosis, recycling, and degradation of proteins are essential functions of mammalian cells, especially for terminally differentiated cells with limited regeneration rates and complex morphology, such as podocytes. To improve our understanding on how disturbances of these trafficking pathways are linked to podocyte depletion and slit diaphragm (SD) injury, the authors explored the role of the small GTPase Rab7, which is linked to endosomal, lysosomal, and autophagic pathways, using as model systems mice and Drosophila with podocyte-specific or nephrocyte-specific loss of Rab7, and a human podocyte cell line depleted for Rab7. Their findings point to maturation and fusion events during endolysosomal and autophagic maturation as key processes for podocyte homeostasis and function and identify altered lysosomal pH values as a putative novel mechanism for podocytopathies. BACKGROUND Endocytosis, recycling, and degradation of proteins are essential functions of mammalian cells, especially for terminally differentiated cells with limited regeneration rates, such as podocytes. How disturbances within these trafficking pathways may act as factors in proteinuric glomerular diseases is poorly understood. METHODS To explore how disturbances in trafficking pathways may act as factors in proteinuric glomerular diseases, we focused on Rab7, a highly conserved GTPase that controls the homeostasis of late endolysosomal and autophagic processes. We generated mouse and Drosophila in vivo models lacking Rab7 exclusively in podocytes or nephrocytes, and performed histologic and ultrastructural analyses. To further investigate Rab7 function on lysosomal and autophagic structures, we used immortalized human cell lines depleted for Rab7. RESULTS Depletion of Rab7 in mice, Drosophila , and immortalized human cell lines resulted in an accumulation of diverse vesicular structures resembling multivesicular bodies, autophagosomes, and autoendolysosomes. Mice lacking Rab7 developed a severe and lethal renal phenotype with early-onset proteinuria and global or focal segmental glomerulosclerosis, accompanied by an altered distribution of slit diaphragm proteins. Remarkably, structures resembling multivesicular bodies began forming within 2 weeks after birth, prior to the glomerular injuries. In Drosophila nephrocytes, Rab7 knockdown resulted in the accumulation of vesicles and reduced slit diaphragms. In vitro , Rab7 knockout led to similar enlarged vesicles and altered lysosomal pH values, accompanied by an accumulation of lysosomal marker proteins. CONCLUSIONS Disruption within the final common pathway of endocytic and autophagic processes may be a novel and insufficiently understood mechanism regulating podocyte health and disease.
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Affiliation(s)
- Kristin Vöing
- Department of Internal Medicine and Nephrology, University Hospital of Münster, Medical Clinic D, Munster, Germany
| | - Ulf Michgehl
- Department of Internal Medicine and Nephrology, University Hospital of Münster, Medical Clinic D, Munster, Germany
| | - Nils David Mertens
- Department of Internal Medicine and Nephrology, University Hospital of Münster, Medical Clinic D, Munster, Germany
| | - Cara Picciotto
- Department of Internal Medicine and Nephrology, University Hospital of Münster, Medical Clinic D, Munster, Germany
| | - Mee-Ling Maywald
- Department of Internal Medicine and Nephrology, University Hospital of Münster, Medical Clinic D, Munster, Germany
| | - Jonas Goretzko
- Research Group Regulatory Mechanisms of Inflammation, Institute of Medical Biochemistry, Centre for Molecular Biology of Inflammation, University of Muenster, Muenster, Germany
| | - Sofie Waimann
- Department of Internal Medicine and Nephrology, University Hospital of Münster, Medical Clinic D, Munster, Germany
| | - Kevin Gilhaus
- Department of Internal Medicine and Nephrology, University Hospital of Münster, Medical Clinic D, Munster, Germany
| | - Manuel Rogg
- Institute of Surgical Pathology, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany
- Freiburg Institute for Advanced Studies (FRIAS), University of Freiburg, Freiburg, Germany
| | - Christoph Schell
- Institute of Surgical Pathology, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany
- Freiburg Institute for Advanced Studies (FRIAS), University of Freiburg, Freiburg, Germany
| | - Jürgen Klingauf
- Institute of Medical Physics and Biophysics, University of Muenster, Muenster, Germany
| | - Yaroslav Tsytsyura
- Institute of Medical Physics and Biophysics, University of Muenster, Muenster, Germany
| | - Uwe Hansen
- Institute for Musculoskeletal Medicine (IMM), University of Muenster, Muenster, Germany
| | - Veerle van Marck
- Department of Pathology, University Hospital Muenster Muenster, Germany
| | - Aimee L. Edinger
- Department of Developmental & Cell Biology, University of California, Irvine, California
| | - Beate Vollenbröker
- Department of Internal Medicine and Nephrology, University Hospital of Münster, Medical Clinic D, Munster, Germany
| | - Ursula Rescher
- Research Group Regulatory Mechanisms of Inflammation, Institute of Medical Biochemistry, Centre for Molecular Biology of Inflammation, University of Muenster, Muenster, Germany
| | - Daniela Anne Braun
- Department of Internal Medicine and Nephrology, University Hospital of Münster, Medical Clinic D, Munster, Germany
| | - Britta George
- Department of Internal Medicine and Nephrology, University Hospital of Münster, Medical Clinic D, Munster, Germany
| | - Thomas Weide
- Department of Internal Medicine and Nephrology, University Hospital of Münster, Medical Clinic D, Munster, Germany
| | - Hermann Pavenstädt
- Department of Internal Medicine and Nephrology, University Hospital of Münster, Medical Clinic D, Munster, Germany
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Windpessl M, Odler B, Bajema IM, Geetha D, Säemann M, Lee JM, Vaglio A, Kronbichler A. Glomerular Diseases Across Lifespan: Key Differences in Diagnostic and Therapeutic Approaches. Semin Nephrol 2023; 43:151435. [PMID: 37945450 DOI: 10.1016/j.semnephrol.2023.151435] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Glomerular diseases are common causes of chronic kidney disease in childhood, adolescence, and adulthood. The epidemiology of glomerular diseases differs between different age groups, with minimal change disease being the leading cause of nephrotic syndrome in childhood, while membranous nephropathy and focal segmental glomerulosclerosis are more common in adulthood. IgA vasculitis is also more common in childhood. Moreover, there is a difference in disease severity with more children presenting with a relapsing form of nephrotic syndrome and a more acute presentation of antineutrophil cytoplasmic antibody-associated vasculitis and concomitant glomerulonephritis, as highlighted by the higher percentage of cellular crescents on kidney biopsy specimens in comparison with older patients. There is also a female preponderance in antineutrophil cytoplasmic antibody-associated vasculitis and more children present with tracheobroncholaryngeal disease. This article aims to summarize differences in the presentation of different glomerular diseases that are encountered commonly by pediatric and adult nephrologists and potential differences in the management.
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Affiliation(s)
- Martin Windpessl
- Section of Nephrology, Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria; Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Balazs Odler
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, United Kingdom; Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ingeborg M Bajema
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; Department of Pathology and Medical Biology, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Duvuru Geetha
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Marcus Säemann
- 6th Medical Department, Nephrology and Dialysis, Clinic Ottakring, Vienna, Austria; Sigmund Freud University, Medical School, Vienna, Austria
| | - Jiwon M Lee
- Division of Rare Disease Management, Korea Disease Control and Prevention Agency, Cheongju-si, Republic of Korea
| | - Augusto Vaglio
- Department of Biomedical Experimental and Clinical Sciences "Mario Serio", University of Firenze, Nephrology Unit, Meyer Children's Hospital, Firenze, Italy
| | - Andreas Kronbichler
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, United Kingdom; Department of Internal Medicine IV, Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria.
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8
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Boeckhaus J, Mohr L, Dihazi H, Tönshoff B, Weber LT, Pape L, Latta K, Fehrenbach H, Lange-Sperandio B, Kettwig M, Staude H, König S, John-Kroegel U, Gellermann J, Hoppe B, Galiano M, Haffner D, Rhode H, Gross O. Ratio of Urinary Proteins to Albumin Excretion Shifts Substantially during Progression of the Podocytopathy Alport Syndrome, and Spot Urine Is a Reliable Method to Detect These Pathologic Changes. Cells 2023; 12:cells12091333. [PMID: 37174733 PMCID: PMC10177071 DOI: 10.3390/cells12091333] [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] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/12/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
The urinary albumin- and protein-to-creatinine ratios (UACR and UPCR, respectively) are key endpoints in most clinical trials assessing risk of progression of chronic kidney disease (CKD). For the first time, the current study compares the UACR versus the UPCR head-to-head at early stages of CKD, taking use of the hereditary podocytopathy Alport syndrome (AS) as a model disease for any CKD. Urine samples originated from the prospective randomized, controlled EARLY PRO-TECT Alport trial (NCT01485978). Urine samples from 47 children with confirmed diagnoses of AS at very early stages of CKD were divided according to the current stage of AS: stage 0 (UACR < 30 mg/g), stage 1 (30-300 mg/g) or stage 2 (>300 mg/g). The range of estimated glomerular filtration rate was 75-187.6 mL/min. The mean age was 10.4 ± 4.5 years. In children at stage 0, proteinuria in spot urine, confirmed in 24 h urine, was almost ten times higher than albuminuria (106.4 ± 42.2 vs. 12.5 ± 9.7; p < 0.05); it was "only" about three times higher in stage 1 (328.5 ± 210.1 vs. 132.3 ± 80.5; p < 0.05) and almost equal in stage 2 (1481.9 ± 983.4 vs. 1109.7 ± 873.6; p = 0.36). In 17 children, UACRs and UPCRs were measured simultaneously in 24 h urine and spot urine in the same study visit. Interestingly, the UACR (and UPCR) in 24 h urine vs. in spot urine varied by less than 10% (266.8 ± 426.4 vs. 291.2 ± 530.2). In conclusion, our study provides the first evidence that in patients with normal glomerular filtration rate (GFR) and low amounts of albuminuria, especially in children with podocytopathies such as AS, measuring the UACR and UPCR in spot urine is a reliable and convenient alternative to 24 h urine collection. Our study advocates both the UACR and the UPCR as relevant diagnostic biomarkers in future clinical trials in children with glomerular diseases because the UPCR seems to be a very significant parameter at very early stages of podocytopathies. The German Federal Ministry of Education and Research funded this trial (01KG1104).
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Affiliation(s)
- Jan Boeckhaus
- Clinic for Nephrology and Rheumatology, University Medical Center Goettingen, 37075 Goettingen, Germany
| | - Lea Mohr
- Clinic for Nephrology and Rheumatology, University Medical Center Goettingen, 37075 Goettingen, Germany
| | - Hassan Dihazi
- Clinic for Nephrology and Rheumatology, University Medical Center Goettingen, 37075 Goettingen, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Lutz T Weber
- Pediatric Nephrology, Children's and Adolescents' Hospital, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Lars Pape
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany
- Department of Pediatrics II, University Childrens' Hospital, University of Duisburg-Essen, 45147 Essen, Germany
| | - Kay Latta
- Clementine Kinderhospital Frankfurt, 60316 Frankfurt, Germany
| | - Henry Fehrenbach
- Pediatric Nephrology, Children's Hospital, 87700 Memmingen, Germany
| | | | - Matthias Kettwig
- Clinic of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Hagen Staude
- Pediatric Nephrology, University Children's Hospital Rostock, 18057 Rostock, Germany
| | - Sabine König
- University Children's Hospital Münster, 48149 Münster, Germany
| | - Ulrike John-Kroegel
- Division of Pediatric Nephrology, University Children's Hospital, 07743 Jena, Germany
| | - Jutta Gellermann
- Pediatric Nephrology, Charité Children's Hospital, 10117 Berlin, Germany
| | - Bernd Hoppe
- Division of Pediatric Nephrology, Department of Pediatrics, University of Bonn, 53121 Bonn, Germany
| | - Matthias Galiano
- Department of Pediatrics and Adolescent Medicine, University Hospital, Friedrich-Alexander-University Erlangen, 91054 Erlangen, Germany
| | - Dieter Haffner
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany
| | - Heidrun Rhode
- Department of Internal Medicine I, Cardiology, Angiology, Intensive Medical Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Oliver Gross
- Clinic for Nephrology and Rheumatology, University Medical Center Goettingen, 37075 Goettingen, Germany
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9
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Ursu R, Sopel N, Ohs A, Tati R, Buvall L, Nyström J, Schiffer M, Müller-Deile J. Glomerular Endothelial Cell-Derived miR-200c Impairs Glomerular Homeostasis by Targeting Podocyte VEGF-A. Int J Mol Sci 2022; 23. [PMID: 36499397 DOI: 10.3390/ijms232315070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/27/2022] [Accepted: 11/29/2022] [Indexed: 12/04/2022] Open
Abstract
Deciphering the pathophysiological mechanisms of primary podocytopathies that can lead to end-stage renal disease and increased mortality is an unmet need. Studying how microRNAs (miRs) interfere with various signaling pathways enables identification of pathomechanisms, novel biomarkers and potential therapeutic options. We investigated the expression of miR-200c in urine from patients with different renal diseases as a potential candidate involved in podocytopathies. The role of miR-200c for the glomerulus and its potential targets were studied in cultured human podocytes, human glomerular endothelial cells and in the zebrafish model. miR-200c was upregulated in urine from patients with minimal change disease, membranous glomerulonephritis and focal segmental glomerulosclerosis and also in transforming growth factor beta (TGF-β) stressed glomerular endothelial cells, but not in podocytes. In zebrafish, miR-200c overexpression caused proteinuria, edema, podocyte foot process effacement and glomerular endotheliosis. Although zinc finger E-Box binding homeobox 1/2 (ZEB1/2), important in epithelial to mesenchymal transition (EMT), are prominent targets of miR-200c, their downregulation did not explain our zebrafish phenotype. We detected decreased vegfaa/bb in zebrafish overexpressing miR-200c and could further prove that miR-200c decreased VEGF-A expression and secretion in cultured human podocytes. We hypothesize that miR-200c is released from glomerular endothelial cells during cell stress and acts in a paracrine, autocrine, as well as context-dependent manner in the glomerulus. MiR-200c can cause glomerular damage most likely due to the reduction of podocyte VEGF-A. In contrast, miR-200c might also influence ZEB expression and therefore EMT, which might be important in other conditions. Therefore, we propose that miR-200c-mediated effects in the glomerulus are context-sensitive.
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10
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Ravaglia F, Melica ME, Angelotti ML, De Chiara L, Romagnani P, Lasagni L. The Pathology Lesion Patterns of Podocytopathies: How and why? Front Cell Dev Biol 2022; 10:838272. [PMID: 35281116 PMCID: PMC8907833 DOI: 10.3389/fcell.2022.838272] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 12/17/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Podocytopathies are a group of proteinuric glomerular disorders driven by primary podocyte injury that are associated with a set of lesion patterns observed on kidney biopsy, i.e., minimal changes, focal segmental glomerulosclerosis, diffuse mesangial sclerosis and collapsing glomerulopathy. These unspecific lesion patterns have long been considered as independent disease entities. By contrast, recent evidence from genetics and experimental studies demonstrated that they represent signs of repeated injury and repair attempts. These ongoing processes depend on the type, length, and severity of podocyte injury, as well as on the ability of parietal epithelial cells to drive repair. In this review, we discuss the main pathology patterns of podocytopathies with a focus on the cellular and molecular response of podocytes and parietal epithelial cells.
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Affiliation(s)
| | - Maria Elena Melica
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Maria Lucia Angelotti
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Letizia De Chiara
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Paola Romagnani
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
- Nephrology Unit, Meyer Children’s Hospital, Florence, Italy
| | - Laura Lasagni
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
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11
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Rubel D, Boulanger J, Craciun F, Xu EY, Zhang Y, Phillips L, Callahan M, Weber W, Song W, Ngai N, Bukanov NO, Shi X, Hariri A, Husson H, Ibraghimov-Beskrovnaya O, Liu S, Gross O. Anti-microRNA-21 Therapy on Top of ACE Inhibition Delays Renal Failure in Alport Syndrome Mouse Models. Cells 2022; 11:cells11040594. [PMID: 35203245 PMCID: PMC8869926 DOI: 10.3390/cells11040594] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 12/05/2021] [Revised: 01/28/2022] [Accepted: 02/03/2022] [Indexed: 02/01/2023] Open
Abstract
Col4a3−/− Alport mice serve as an animal model for renal fibrosis. MicroRNA-21 (miR-21) expression has been shown to be increased in the kidneys of Alport syndrome patients. Here, we investigated the nephroprotective effects of Lademirsen anti-miR-21 therapy. We used a fast-progressing Col4a3−/− mouse model with a 129/SvJ background and an intermediate-progressing F1 hybrid mouse model with a mixed genetic background, with angiotensin-converting enzyme inhibitor (ACEi) monotherapy in combination with anti-miR-21 therapy. In the fast-progressing model, the anti miR-21 and ACEi therapies showed an additive effect in the reduction in fibrosis, the decline of proteinuria, the preservation of kidney function and increased survival. In the intermediate-progressing F1 model, the anti-miR-21 and ACEi therapies individually improved kidney pathology. Both also improved kidney function and survival; however, the combination showed a significant additive effect, particularly for survival. RNA sequencing (RNA-seq) gene expression profiling revealed that the anti-miR-21 and ACEi therapies modulate several common pathways. However, anti-miR-21 was particularly effective at normalizing the expression profiles of the genes involved in renal tubulointerstitial injury pathways. In conclusion, significant additive effects were detected for the combination of anti-miR-21 and ACEi therapies on kidney function, pathology and survival in Alport mouse models, as well as a strong differential effect of anti-miR-21 on the renal expression of fibrotic factors. These results support the addition of anti-miR-21 to the current standard of care (ACEi) in ongoing clinical trials in patients with Alport syndrome.
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Affiliation(s)
- Diana Rubel
- Clinic for Nephrology and Rheumatology, University Medical Center Goettingen, 37075 Goettingen, Germany; (D.R.); (Y.Z.)
| | | | - Florin Craciun
- Sanofi-Genzyme Research and Development, Framingham, MA 02118, USA; (F.C.); (E.Y.X.); (L.P.); (M.C.); (W.W.); (W.S.); (N.N.); (N.O.B.); (X.S.); (H.H.); (O.I.-B.)
| | - Ethan Y. Xu
- Sanofi-Genzyme Research and Development, Framingham, MA 02118, USA; (F.C.); (E.Y.X.); (L.P.); (M.C.); (W.W.); (W.S.); (N.N.); (N.O.B.); (X.S.); (H.H.); (O.I.-B.)
- Excision BioTherapeutics, San Francisco, CA 94111, USA
| | - Yanqin Zhang
- Clinic for Nephrology and Rheumatology, University Medical Center Goettingen, 37075 Goettingen, Germany; (D.R.); (Y.Z.)
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - Lucy Phillips
- Sanofi-Genzyme Research and Development, Framingham, MA 02118, USA; (F.C.); (E.Y.X.); (L.P.); (M.C.); (W.W.); (W.S.); (N.N.); (N.O.B.); (X.S.); (H.H.); (O.I.-B.)
- Abbvie Bioresearch Center, Worcester, MA 01605, USA
| | - Michelle Callahan
- Sanofi-Genzyme Research and Development, Framingham, MA 02118, USA; (F.C.); (E.Y.X.); (L.P.); (M.C.); (W.W.); (W.S.); (N.N.); (N.O.B.); (X.S.); (H.H.); (O.I.-B.)
| | - William Weber
- Sanofi-Genzyme Research and Development, Framingham, MA 02118, USA; (F.C.); (E.Y.X.); (L.P.); (M.C.); (W.W.); (W.S.); (N.N.); (N.O.B.); (X.S.); (H.H.); (O.I.-B.)
- Takeda Pharmaceuticals, Cambridge, MA 02139, USA
| | - Wenping Song
- Sanofi-Genzyme Research and Development, Framingham, MA 02118, USA; (F.C.); (E.Y.X.); (L.P.); (M.C.); (W.W.); (W.S.); (N.N.); (N.O.B.); (X.S.); (H.H.); (O.I.-B.)
| | - Nicholas Ngai
- Sanofi-Genzyme Research and Development, Framingham, MA 02118, USA; (F.C.); (E.Y.X.); (L.P.); (M.C.); (W.W.); (W.S.); (N.N.); (N.O.B.); (X.S.); (H.H.); (O.I.-B.)
| | - Nikolay O. Bukanov
- Sanofi-Genzyme Research and Development, Framingham, MA 02118, USA; (F.C.); (E.Y.X.); (L.P.); (M.C.); (W.W.); (W.S.); (N.N.); (N.O.B.); (X.S.); (H.H.); (O.I.-B.)
- Janssen Pharmaceuticals, Boston, MA 02115, USA
| | - Xingyi Shi
- Sanofi-Genzyme Research and Development, Framingham, MA 02118, USA; (F.C.); (E.Y.X.); (L.P.); (M.C.); (W.W.); (W.S.); (N.N.); (N.O.B.); (X.S.); (H.H.); (O.I.-B.)
- Novartis Institute for BioMedical Research, Boston, MA 02139, USA
| | - Ali Hariri
- Sanofi-Genzyme, Clinical Development, Cambridge, MA 02142, USA; (A.H.); (S.L.)
- Eloxx Pharmaceuticals, Watertown, MA 02140, USA
| | - Hervé Husson
- Sanofi-Genzyme Research and Development, Framingham, MA 02118, USA; (F.C.); (E.Y.X.); (L.P.); (M.C.); (W.W.); (W.S.); (N.N.); (N.O.B.); (X.S.); (H.H.); (O.I.-B.)
| | - Oxana Ibraghimov-Beskrovnaya
- Sanofi-Genzyme Research and Development, Framingham, MA 02118, USA; (F.C.); (E.Y.X.); (L.P.); (M.C.); (W.W.); (W.S.); (N.N.); (N.O.B.); (X.S.); (H.H.); (O.I.-B.)
- Dyne Therapeutics, Waltham, MA 02451, USA
| | - Shiguang Liu
- Sanofi-Genzyme, Clinical Development, Cambridge, MA 02142, USA; (A.H.); (S.L.)
| | - Oliver Gross
- Clinic for Nephrology and Rheumatology, University Medical Center Goettingen, 37075 Goettingen, Germany; (D.R.); (Y.Z.)
- Correspondence: ; Tel.: +49-551-39-60488
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12
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Sopel N, Ohs A, Schiffer M, Müller-Deile J. A Tight Control of Non-Canonical TGF-β Pathways and MicroRNAs Downregulates Nephronectin in Podocytes. Cells 2022; 11:149. [PMID: 35011710 DOI: 10.3390/cells11010149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/22/2021] [Accepted: 01/01/2022] [Indexed: 02/01/2023] Open
Abstract
Nephronectin (NPNT) is an extracellular matrix protein in the glomerular basement membrane that is produced by podocytes and is important for the integrity of the glomerular filtration barrier. Upregulated transforming growth factor β (TGF-β) and altered NPNT are seen in different glomerular diseases. TGF-β downregulates NPNT and upregulates NPNT-targeting microRNAs (miRs). However, the pathways involved were previously unknown. By using selective inhibitors of the canonical, SMAD-dependent, and non-canonical TGF-β pathways, we investigated NPNT transcription, translation, secretion, and regulation through miRs in podocytes. TGF-β decreased NPNT mRNA and protein in cultured human podocytes. TGF-β-dependent regulation of NPNT was meditated through intracellular signaling pathways. Under baseline conditions, non-canonical pathways predominantly regulated NPNT post-transcriptionally. Podocyte NPNT secretion, however, was not dependent on canonical or non-canonical TGF-β pathways. The canonical TGF-β pathway was also dispensable for NPNT regulation after TGF-β stimulation, as TGF-β was still able to downregulate NPNT in the presence of SMAD inhibitors. In contrast, in the presence of different non-canonical pathway inhibitors, TGF-β stimulation did not further decrease NPNT expression. Moreover, distinct non-canonical TGF-β pathways mediated TGF-β-induced upregulation of NPNT-targeting miR-378a-3p. Thus, we conclude that post-transcriptional fine-tuning of NPNT expression in podocytes is mediated predominantly through non-canonical TGF-β pathways.
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Boeckhaus J, Gross O. Sodium-Glucose Cotransporter-2 Inhibitors in Patients with Hereditary Podocytopathies, Alport Syndrome, and FSGS: A Case Series to Better Plan a Large-Scale Study. Cells 2021; 10:1815. [PMID: 34359984 DOI: 10.3390/cells10071815] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/13/2021] [Accepted: 07/16/2021] [Indexed: 12/30/2022] Open
Abstract
Hereditary diseases of the glomerular filtration barrier are characterized by a more vulnerable glomerular basement membrane and dysfunctional podocytes. Recent clinical trials have demonstrated the nephroprotective effect of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in chronic kidney disease (CKD). SGLT2-mediated afferent arteriole vasoconstriction is hypothesized to correct the hemodynamic overload of the glomerular filtration barrier in hereditary podocytopathies. To test this hypothesis, we report data in a case series of patients with Alport syndrome and focal segmental glomerulosclerosis (FSGS) with respect of the early effect of SGLT2i on the kidney function. Mean duration of treatment was 4.5 (±2.9) months. Mean serum creatinine before and after SGLT-2i initiation was 1.46 (±0.42) and 1.58 (±0.55) mg/dL, respectively, with a median estimated glomerular filtration rate of 64 (±27) before and 64 (±32) mL/min/1.73 m2 after initiation of SGLT2i. Mean urinary albumin-creatinine ratio in mg/g creatinine before SGLT-2i initiation was 1827 (±1560) and decreased by almost 40% to 1127 (±854) after SGLT2i initiation. To our knowledge, this is the first case series on the effect and safety of SGLT2i in patients with hereditary podocytopathies. Specific large-scale trials in podocytopathies are needed to confirm our findings in this population with a tremendous unmet medical need for more effective, early on, and safe nephroprotective therapies.
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Savas B, Astarita G, Aureli M, Sahali D, Ollero M. Gangliosides in Podocyte Biology and Disease. Int J Mol Sci 2020; 21:E9645. [PMID: 33348903 PMCID: PMC7766259 DOI: 10.3390/ijms21249645] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 11/23/2020] [Revised: 12/07/2020] [Accepted: 12/14/2020] [Indexed: 02/07/2023] Open
Abstract
Gangliosides constitute a subgroup of glycosphingolipids characterized by the presence of sialic acid residues in their structure. As constituents of cellular membranes, in particular of raft microdomains, they exert multiple functions, some of them capital in cell homeostasis. Their presence in cells is tightly regulated by a balanced expression and function of the enzymes responsible for their biosynthesis, ganglioside synthases, and their degradation, glycosidases. The dysregulation of their abundance results in rare and common diseases. In this review, we make a point on the relevance of gangliosides and some of their metabolic precursors, such as ceramides, in the function of podocytes, the main cellular component of the glomerular filtration barrier, as well as their implications in podocytopathies. The results presented in this review suggest the pertinence of clinical lipidomic studies targeting these metabolites.
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Affiliation(s)
- Berkan Savas
- INSERM, IMRB, Univ Paris Est Créteil, F-94010 Créteil, France; (B.S.); (D.S.)
| | - Giuseppe Astarita
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University, 20007 Washington, DC, USA;
| | - Massimo Aureli
- Department of Medical Biotechnology and Translational Medicine, University of Milano, Milano Italy, 20090 Segrate (Milano), Italy;
| | - Dil Sahali
- INSERM, IMRB, Univ Paris Est Créteil, F-94010 Créteil, France; (B.S.); (D.S.)
- Service Néphrologie, AP-HP, Hôpital Henri Mondor, F-94010 Créteil, France
| | - Mario Ollero
- INSERM, IMRB, Univ Paris Est Créteil, F-94010 Créteil, France; (B.S.); (D.S.)
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15
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Sipovsky VG, Nevorotin AI, Avsiewitsch IV, Smirnov AV. [Ultrastructural study of podocyte alterations in non proliferative glomerulopathy]. Arkh Patol 2019; 81:51-58. [PMID: 31317931 DOI: 10.17116/patol20198103151] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ultrastructural changes in podocytes are an important diagnostic and prognostic marker for nephropathies. However, the biomedical understanding of detected submicroscopic changes in podocytes remains controversial. OBJECTIVE To investigate the relationship between the ultrastructural changes of podocytes (fusion of cytopodia and denudation of the basement membrane as a result of their desquamation) with a number of clinical and laboratory indicators of kidney dysfunction in case of non-proliferative glomerulopathies (NPGP). Thirty-seven patients (23 men, 14 women) with NPGP, including 8 with focal segmental glomerulosclerosis (FSGS), 17 with membranous nephropathy (MN), and 12 with minimal change disease (MCD), were examined. SUBJECT AND METHODS All the patients underwent standard laboratory and instrumental studies: determinations of the levels of total serum cholesterol (mmol/l), total serum protein (g/l); serum albumin (g/l); CKD-EPI glomerular filtration rate (GFR) (ml/min/1.73 m2), and daily protein loss (g/day). Light optical changes were measured; completely sclerotic and/or focally segmentally sclerotic glomeruli were taken into account. Quantitative ultrastructural stereological analysis was carried out estimating the cytopodium width (CPW) and the degree of glomerular basement membrane denudation (GBMD) (%). RESULTS NPGP cases showed the largest number of sclerotic glomeruli in FSGS, which was accompanied by the lowest level of daily proteinuria and GFR. Quantitative values of CPW were associated with the level of daily protein loss (r=0.47; p < 0.05) and serum albumin (r=-0.57; p <0.05) in patients with nephrotic syndrome. In MN, the absolute value of CPW was larger than that in the other two patient groups. A correlation analysis of CPW and GBMD values among patients with NPGP revealed a statistically insignificant negative relation between these morphometric parameters. However, when a subgroup of patients with podocytopathies (only MCD and FSGS) was identified in the study group, this relationship was found to be significant (r=-0.54; p=0.012). CONCLUSION The patients with NPGP exhibited a relationship between the severity of nephrotic syndrome and proteinuria/hypoalbuminemia, on the one hand, and CPW, on the other. The established negative relationship between CPW and the percentage of GBMD in the subgroup of patients with podocytopathies may be due to the early stages of podocyte injury, which are accompanied by transient GBMD.
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Affiliation(s)
- V G Sipovsky
- Acad. I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, Saint-Petersburg, Russia
| | - A I Nevorotin
- Acad. I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, Saint-Petersburg, Russia
| | - I V Avsiewitsch
- Acad. I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, Saint-Petersburg, Russia
| | - A V Smirnov
- Acad. I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, Saint-Petersburg, Russia
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16
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Lepori N, Zand L, Sethi S, Fernandez-Juarez G, Fervenza FC. Clinical and pathological phenotype of genetic causes of focal segmental glomerulosclerosis in adults. Clin Kidney J 2018; 11:179-190. [PMID: 29644057 PMCID: PMC5888331 DOI: 10.1093/ckj/sfx143] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [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: 10/15/2017] [Accepted: 11/17/2017] [Indexed: 02/07/2023] Open
Abstract
Focal segmental glomerulosclerosis (FSGS) is a histologic lesion resulting from a variety of pathogenic processes that cause injury to the podocytes. Recently, mutations in more than 50 genes expressed in podocyte or glomerular basement membrane were identified as causing genetic forms of FSGS, the majority of which are characterized by onset in childhood. The prevalence of adult-onset genetic FSGS is likely to be underestimated and its clinical and histological features have not been clearly described. A small number of studies of adult-onset genetic FSGS showed that there is heterogeneity in clinical and histological findings, with a presentation ranging from sub-nephrotic proteinuria to full nephrotic syndrome. A careful evaluation of adult-onset FSGS that do not have typical features of primary or secondary FSGS (familial cases, resistance to immunosuppression and absence of evident cause of secondary FSGS) should include a genetic evaluation. Indeed, recognizing genetic forms of adult-onset FSGS is of the utmost importance, given that this diagnosis will have major implications on treatment strategies, selecting of living-related kidney donor and renal transplantation success.
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Affiliation(s)
- Nicola Lepori
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
- Division of Nephrology and Dialysis, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Ladan Zand
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Sanjeev Sethi
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
| | - Gema Fernandez-Juarez
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
- Nephrology Division, Hospital Universitario Fundacion Alcorcon, Madrid, Spain
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17
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Trautmann A, Schnaidt S, Lipska-Ziętkiewicz BS, Bodria M, Ozaltin F, Emma F, Anarat A, Melk A, Azocar M, Oh J, Saeed B, Gheisari A, Caliskan S, Gellermann J, Higuita LMS, Jankauskiene A, Drozdz D, Mir S, Balat A, Szczepanska M, Paripovic D, Zurowska A, Bogdanovic R, Yilmaz A, Ranchin B, Baskin E, Erdogan O, Remuzzi G, Firszt-Adamczyk A, Kuzma-Mroczkowska E, Litwin M, Murer L, Tkaczyk M, Jardim H, Wasilewska A, Printza N, Fidan K, Simkova E, Borzecka H, Staude H, Hees K, Schaefer F. Long-Term Outcome of Steroid-Resistant Nephrotic Syndrome in Children. J Am Soc Nephrol 2017; 28:3055-3065. [PMID: 28566477 PMCID: PMC5619960 DOI: 10.1681/asn.2016101121] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 04/17/2017] [Indexed: 02/05/2023] Open
Abstract
We investigated the value of genetic, histopathologic, and early treatment response information in prognosing long-term renal outcome in children with primary steroid-resistant nephrotic syndrome. From the PodoNet Registry, we obtained longitudinal clinical information for 1354 patients (disease onset at >3 months and <20 years of age): 612 had documented responsiveness to intensified immunosuppression (IIS), 1155 had kidney biopsy results, and 212 had an established genetic diagnosis. We assessed risk factors for ESRD using multivariate Cox regression models. Complete and partial remission of proteinuria within 12 months of disease onset occurred in 24.5% and 16.5% of children, respectively, with the highest remission rates achieved with calcineurin inhibitor-based protocols. Ten-year ESRD-free survival rates were 43%, 94%, and 72% in children with IIS resistance, complete remission, and partial remission, respectively; 27% in children with a genetic diagnosis; and 79% and 52% in children with histopathologic findings of minimal change glomerulopathy and FSGS, respectively. Five-year ESRD-free survival rate was 21% for diffuse mesangial sclerosis. IIS responsiveness, presence of a genetic diagnosis, and FSGS or diffuse mesangial sclerosis on initial biopsy as well as age, serum albumin concentration, and CKD stage at onset affected ESRD risk. Our findings suggest that responsiveness to initial IIS and detection of a hereditary podocytopathy are prognostic indicators of favorable and poor long-term outcome, respectively, in children with steroid-resistant nephrotic syndrome. Children with multidrug-resistant sporadic disease show better renal survival than those with genetic disease. Furthermore, histopathologic findings may retain prognostic relevance when a genetic diagnosis is established.
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Affiliation(s)
- Agnes Trautmann
- Division of Pediatric Nephrology, University Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | - Sven Schnaidt
- Institute of Medical Biometry and Informatics, University of Heidelberg, Germany
| | | | - Monica Bodria
- Dipartimento di Medicina Clinica e Sperimentale, University of Studies of Parma, Parma, Italy
- Division of Nephrology, Dialysis and Transplantation, IRCCS Giannina Gaslini, Genoa, Italy
| | - Fatih Ozaltin
- Department of Pediatric Nephrology, Nephrogenetics Laboratory and Center for Biobanking and Genomics, Hacettepe University, Ankara, Turkey
| | - Francesco Emma
- Nephrology and Dialysis Unit, Children's Hospital Bambino Gesù, Istitutio di Ricovero e Cura a Carattere Scientificio (IRCCS), Rome, Italy
| | - Ali Anarat
- Pediatric Nephrology Department, Cukurova University Medical Faculty, Adana, Turkey
| | - Anette Melk
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Marta Azocar
- Pediatric Nephrology, Hospital Luis Calvo Mackenna-Facultad de Chile, Santiago, Chile
| | - Jun Oh
- Department of Pediatric Nephrology, University Children's Hospital, Hamburg, Germany
| | - Bassam Saeed
- Department of Pediatric Nephrology, Kidney Hospital of Damascus, Damascus, Syria
| | - Alaleh Gheisari
- Pediatric Nephrology Department, Isfahan University of Medical Science, St. Al Zahra Hospital, Isfahan, Iran
| | - Salim Caliskan
- Pediatric Nephrology Department, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Jutta Gellermann
- Clinic for Pediatric Nephrology, Charite Hospital, Berlin, Germany
| | | | | | - Dorota Drozdz
- Department of Pediatric Nephrology, Jagiellonian University Medical College, Krakow, Poland
| | - Sevgi Mir
- Department of Pediatric Nephrology, Ege University Medical Faculty, Izmir, Turkey
| | - Ayse Balat
- Department of Pediatric Nephrology, Gaziantep University Medical Faculty, Gaziantep, Turkey
| | - Maria Szczepanska
- Department of Pediatrics, Division of Dentistry, School of Medicine, Zabrze, Poland
| | - Dusan Paripovic
- Department of Pediatric Nephrology, University Children's Hospital, Belgrade, Serbia
| | | | - Radovan Bogdanovic
- Department of Pediatric Nephrology, Institute of Mother Child and Healthcare of Serbia, Belgrade, Serbia
| | - Alev Yilmaz
- Department of Pediatric Nephrology, Istanbul Medical Faculty, Istanbul, Turkey
| | - Bruno Ranchin
- Pediatric Nephrology Unit, Hôpital Femme Mere Enfant, Hospices Civils de Lyon, Lyon, France
| | - Esra Baskin
- Department of Pediatric Nephrology, Baskent University Hospital, Ankara, Turkey
| | - Ozlem Erdogan
- Department of Pediatric Nephrology, Sami Ulus Children's Hospital, Ankara, Turkey
| | - Giuseppe Remuzzi
- Clinical Research Center for Rare Diseases Aldo & Cele Daccò, IRCCS, Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy
- Unit of Nephrology and Dialysis, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
- Department of Biomedical and Clinical Science L. Sacco, University of Milan, Milan, Italy
| | | | | | - Mieczyslaw Litwin
- Department of Pediatric Nephrology, Centrum Zdrowia Dziecka, Warsaw, Poland
| | - Luisa Murer
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Women's and Child's Health, Hospital of Padua, Padua, Italy
| | - Marcin Tkaczyk
- Pediatric Nephrology Division, Polish Mothers Memorial Hospital Research Institute, Lodz, Poland
| | - Helena Jardim
- Department of Pediatric Nephrology, Centre Hospitalar, Porto, Portugal
| | - Anna Wasilewska
- Department of Pediatric Nephrology, University Hospital, Bialystok, Poland
| | - Nikoleta Printza
- First Pediatric Department, Hippokration General Hospital, Aristotle University, Thessaloniki, Greece
| | - Kibriya Fidan
- Pediatric Nephrology Department, Gazi University Hospital, Ankara, Turkey
| | - Eva Simkova
- Department of Pediatric Nephrology, Dubai Hospital, Dubai, United Arab Emirates
| | - Halina Borzecka
- Department of Pediatric Nephrology, Medical University, Lublin, Poland; and
| | - Hagen Staude
- Department of Pediatric Nephrology, University Children's Hospital, Rostock, Germany
| | - Katharina Hees
- Institute of Medical Biometry and Informatics, University of Heidelberg, Germany
| | - Franz Schaefer
- Division of Pediatric Nephrology, University Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany;
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18
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Trautmann A, Bodria M, Ozaltin F, Gheisari A, Melk A, Azocar M, Anarat A, Caliskan S, Emma F, Gellermann J, Oh J, Baskin E, Ksiazek J, Remuzzi G, Erdogan O, Akman S, Dusek J, Davitaia T, Özkaya O, Papachristou F, Firszt-Adamczyk A, Urasinski T, Testa S, Krmar RT, Hyla-Klekot L, Pasini A, Özcakar ZB, Sallay P, Cakar N, Galanti M, Terzic J, Aoun B, Caldas Afonso A, Szymanik-Grzelak H, Lipska BS, Schnaidt S, Schaefer F. Spectrum of steroid-resistant and congenital nephrotic syndrome in children: the PodoNet registry cohort. Clin J Am Soc Nephrol 2015; 10:592-600. [PMID: 25635037 PMCID: PMC4386250 DOI: 10.2215/cjn.06260614] [Citation(s) in RCA: 166] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 12/22/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Steroid-resistant nephrotic syndrome is a rare kidney disease involving either immune-mediated or genetic alterations of podocyte structure and function. The rare nature, heterogeneity, and slow evolution of the disorder are major obstacles to systematic genotype-phenotype, intervention, and outcome studies, hampering the development of evidence-based diagnostic and therapeutic concepts. To overcome these limitations, the PodoNet Consortium has created an international registry for congenital nephrotic syndrome and childhood-onset steroid-resistant nephrotic syndrome. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Since August of 2009, clinical, biochemical, genetic, and histopathologic information was collected both retrospectively and prospectively from 1655 patients with childhood-onset steroid-resistant nephrotic syndrome, congenital nephrotic syndrome, or persistent subnephrotic proteinuria of likely genetic origin at 67 centers in 21 countries through an online portal. RESULTS Steroid-resistant nephrotic syndrome manifested in the first 5 years of life in 64% of the patients. Congenital nephrotic syndrome accounted for 6% of all patients. Extrarenal abnormalities were reported in 17% of patients. The most common histopathologic diagnoses were FSGS (56%), minimal change nephropathy (21%), and mesangioproliferative GN (12%). Mutation screening was performed in 1174 patients, and a genetic disease cause was identified in 23.6% of the screened patients. Among 14 genes with reported mutations, abnormalities in NPHS2 (n=138), WT1 (n=48), and NPHS1 (n=41) were most commonly identified. The proportion of patients with a genetic disease cause decreased with increasing manifestation age: from 66% in congenital nephrotic syndrome to 15%-16% in schoolchildren and adolescents. Among various intensified immunosuppressive therapy protocols, calcineurin inhibitors and rituximab yielded consistently high response rates, with 40%-45% of patients achieving complete remission. Confirmation of a genetic diagnosis but not the histopathologic disease type was strongly predictive of intensified immunosuppressive therapy responsiveness. Post-transplant disease recurrence was noted in 25.8% of patients without compared with 4.5% (n=4) of patients with a genetic diagnosis. CONCLUSIONS The PodoNet cohort may serve as a source of reference for future clinical and genetic research in this rare but significant kidney disease.
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MESH Headings
- Adolescent
- Age Distribution
- Age of Onset
- Biopsy
- Child
- Child, Preschool
- DNA Mutational Analysis
- Europe/epidemiology
- Female
- Genetic Markers
- Genetic Predisposition to Disease
- Glomerulonephritis, Membranoproliferative/diagnosis
- Glomerulonephritis, Membranoproliferative/epidemiology
- Glomerulonephritis, Membranoproliferative/genetics
- Glomerulonephritis, Membranoproliferative/therapy
- Glomerulosclerosis, Focal Segmental/diagnosis
- Glomerulosclerosis, Focal Segmental/epidemiology
- Glomerulosclerosis, Focal Segmental/genetics
- Glomerulosclerosis, Focal Segmental/therapy
- Humans
- Immunosuppressive Agents/therapeutic use
- Infant
- Infant, Newborn
- Kidney Transplantation
- Latin America/epidemiology
- Male
- Middle East/epidemiology
- Mutation
- Nephrosis, Lipoid/diagnosis
- Nephrosis, Lipoid/epidemiology
- Nephrosis, Lipoid/genetics
- Nephrosis, Lipoid/therapy
- Nephrotic Syndrome/congenital
- Nephrotic Syndrome/diagnosis
- Nephrotic Syndrome/epidemiology
- Nephrotic Syndrome/genetics
- Nephrotic Syndrome/therapy
- Phenotype
- Prospective Studies
- Recurrence
- Registries
- Remission Induction
- Retrospective Studies
- Risk Factors
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Agnes Trautmann
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Monica Bodria
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Fatih Ozaltin
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Alaleh Gheisari
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Anette Melk
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Marta Azocar
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Ali Anarat
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Salim Caliskan
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Francesco Emma
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Jutta Gellermann
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Jun Oh
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Esra Baskin
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Joanna Ksiazek
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Giuseppe Remuzzi
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Ozlem Erdogan
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Sema Akman
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Jiri Dusek
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Tinatin Davitaia
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Ozan Özkaya
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Fotios Papachristou
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Agnieszka Firszt-Adamczyk
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Tomasz Urasinski
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Sara Testa
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Rafael T Krmar
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Lidia Hyla-Klekot
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Andrea Pasini
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Z Birsin Özcakar
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Peter Sallay
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Nilgun Cakar
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Monica Galanti
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Joelle Terzic
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Bilal Aoun
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Alberto Caldas Afonso
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Hanna Szymanik-Grzelak
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Beata S Lipska
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Sven Schnaidt
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Franz Schaefer
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
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