1
|
Xu T, Herkens L, Jia T, Klinkhammer BM, Kant S, Krusche CA, Buhl EM, Hayat S, Floege J, Strnad P, Kramann R, Djudjaj S, Boor P. The role of desmoglein-2 in kidney disease. Kidney Int 2024; 105:1035-1048. [PMID: 38395410 DOI: 10.1016/j.kint.2024.01.037] [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: 11/08/2022] [Revised: 12/07/2023] [Accepted: 01/09/2024] [Indexed: 02/25/2024]
Abstract
Desmosomes are multi-protein cell-cell adhesion structures supporting cell stability and mechanical stress resilience of tissues, best described in skin and heart. The kidney is exposed to various mechanical stimuli and stress, yet little is known about kidney desmosomes. In healthy kidneys, we found desmosomal proteins located at the apical-junctional complex in tubular epithelial cells. In four different animal models and patient biopsies with various kidney diseases, desmosomal components were significantly upregulated and partly miss-localized outside of the apical-junctional complexes along the whole lateral tubular epithelial cell membrane. The most upregulated component was desmoglein-2 (Dsg2). Mice with constitutive tubular epithelial cell-specific deletion of Dsg2 developed normally, and other desmosomal components were not altered in these mice. When challenged with different types of tubular epithelial cell injury (unilateral ureteral obstruction, ischemia-reperfusion, and 2,8-dihydroxyadenine crystal nephropathy), we found increased tubular epithelial cell apoptosis, proliferation, tubular atrophy, and inflammation compared to wild-type mice in all models and time points. In vitro, silencing DSG2 via siRNA weakened cell-cell adhesion in HK-2 cells and increased cell death. Thus, our data show a prominent upregulation of desmosomal components in tubular cells across species and diseases and suggest a protective role of Dsg2 against various injurious stimuli.
Collapse
Affiliation(s)
- Tong Xu
- Institute of Pathology, RWTH Aachen University, Aachen, Germany; Department of Urology, the First Affiliated Hospital of Airforce Medical University, Xi'an, China
| | - Lea Herkens
- Institute of Pathology, RWTH Aachen University, Aachen, Germany
| | - Ting Jia
- Institute of Pathology, RWTH Aachen University, Aachen, Germany; Department of Nephrology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | | | - Sebastian Kant
- Institute of Molecular and Cellular Anatomy, RWTH Aachen University, Aachen, Germany
| | - Claudia A Krusche
- Institute of Molecular and Cellular Anatomy, RWTH Aachen University, Aachen, Germany
| | - Eva M Buhl
- Electron Microscopy Facility, RWTH Aachen University, Aachen, Germany
| | - Sikander Hayat
- Institute of Experimental Medicine and Systems Biology, RWTH Aachen University, Aachen, Germany
| | - Jürgen Floege
- Division of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany
| | - Pavel Strnad
- Department of Medicine III, Gastroenterology, Metabolic Diseases and Intensive Care, RWTH Aachen University, Aachen, Germany
| | - Rafael Kramann
- Institute of Experimental Medicine and Systems Biology, RWTH Aachen University, Aachen, Germany; Division of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany; Department of Internal Medicine, Nephrology and Transplantation, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Sonja Djudjaj
- Institute of Pathology, RWTH Aachen University, Aachen, Germany
| | - Peter Boor
- Institute of Pathology, RWTH Aachen University, Aachen, Germany; Electron Microscopy Facility, RWTH Aachen University, Aachen, Germany; Division of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany.
| |
Collapse
|
2
|
Hölscher DL, Goedertier M, Klinkhammer BM, Droste P, Costa IG, Boor P, Bülow RD. tRigon: an R package and Shiny App for integrative (path-)omics data analysis. BMC Bioinformatics 2024; 25:98. [PMID: 38443821 PMCID: PMC10916305 DOI: 10.1186/s12859-024-05721-w] [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: 11/21/2023] [Accepted: 02/26/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Pathomics facilitates automated, reproducible and precise histopathology analysis and morphological phenotyping. Similar to molecular omics, pathomics datasets are high-dimensional, but also face large outlier variability and inherent data missingness, making quick and comprehensible data analysis challenging. To facilitate pathomics data analysis and interpretation as well as support a broad implementation we developed tRigon (Toolbox foR InteGrative (path-)Omics data aNalysis), a Shiny application for fast, comprehensive and reproducible pathomics analysis. RESULTS tRigon is available via the CRAN repository ( https://cran.r-project.org/web/packages/tRigon ) with its source code available on GitLab ( https://git-ce.rwth-aachen.de/labooratory-ai/trigon ). The tRigon package can be installed locally and its application can be executed from the R console via the command 'tRigon::run_tRigon()'. Alternatively, the application is hosted online and can be accessed at https://labooratory.shinyapps.io/tRigon . We show fast computation of small, medium and large datasets in a low- and high-performance hardware setting, indicating broad applicability of tRigon. CONCLUSIONS tRigon allows researchers without coding abilities to perform exploratory feature analyses of pathomics and non-pathomics datasets on their own using a variety of hardware.
Collapse
Affiliation(s)
- David L Hölscher
- Institute of Pathology, RWTH Aachen University Clinic, Aachen, Germany
- Department of Nephrology and Immunology, RWTH Aachen University Clinic, Aachen, Germany
| | - Michael Goedertier
- Institute of Pathology, RWTH Aachen University Clinic, Aachen, Germany
- Institute for Computational Genomics, RWTH Aachen University Clinic, Aachen, Germany
| | | | - Patrick Droste
- Institute of Pathology, RWTH Aachen University Clinic, Aachen, Germany
- Department of Nephrology and Immunology, RWTH Aachen University Clinic, Aachen, Germany
| | - Ivan G Costa
- Institute for Computational Genomics, RWTH Aachen University Clinic, Aachen, Germany
| | - Peter Boor
- Institute of Pathology, RWTH Aachen University Clinic, Aachen, Germany
- Department of Nephrology and Immunology, RWTH Aachen University Clinic, Aachen, Germany
| | - Roman D Bülow
- Institute of Pathology, RWTH Aachen University Clinic, Aachen, Germany.
| |
Collapse
|
3
|
Moellmann J, Krueger K, Wong DWL, Klinkhammer BM, Buhl EM, Dehairs J, Swinnen JV, Noels H, Jankowski J, Lebherz C, Boor P, Marx N, Lehrke M. 2,8-Dihydroxyadenine-induced nephropathy causes hexosylceramide accumulation with increased mTOR signaling, reduced levels of protective SirT3 expression and impaired renal mitochondrial function. Biochim Biophys Acta Mol Basis Dis 2024; 1870:166825. [PMID: 37536502 DOI: 10.1016/j.bbadis.2023.166825] [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: 03/13/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/05/2023]
Abstract
AIM Chronic kidney disease (CKD) is accompanied by increased cardiovascular risk and heart failure (HF). In rodents, 2,8-dihydroxyadenine (DHA)-induced nephropathy is a frequently used CKD model. Cardiac and kidney tubular cells share high energy demand to guarantee constant contractive force of the heart or reabsorption/secretion of primary filtrated molecules and waste products by the kidney. Here we analyze time-dependent mechanisms of kidney damage and cardiac consequences under consideration of energetic pathways with the focus on mitochondrial function and lipid metabolism in mice. METHODS AND RESULTS CKD was induced by alternating dietary adenine supplementation (0.2 % or 0.05 % of adenine) in C57BL/6J mice for 9 weeks. Progressive kidney damage led to reduced creatinine clearance, kidney fibrosis and renal inflammation after 3, 6, and 9 weeks. No difference in cardiac function, mitochondrial respiration nor left ventricular fibrosis was observed at any time point. Investigating mechanisms of renal damage, protective SirT3 was decreased in CKD, which contrasted an increase in protein kinase B (AKT) expression, mechanistic target of rapamycin (mTOR) downstream signaling, induction of oxidative and endoplasmic reticulum (ER) stress. This occurred together with impaired renal mitochondrial function and accumulation of hexosylceramides (HexCer) as an established mediator of inflammation and mitochondrial dysfunction in the kidney. CONCLUSIONS 2,8-DHA-induced CKD results in renal activation of the mTOR downstream signaling, endoplasmic reticulum stress, tubular injury, fibrosis, inflammation, oxidative stress and impaired kidney mitochondrial function in conjunction with renal hexosylceramide accumulation in C57BL/6J mice.
Collapse
Affiliation(s)
- Julia Moellmann
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Katja Krueger
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Dickson W L Wong
- Institute of Pathology, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Barbara M Klinkhammer
- Institute of Pathology, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Eva M Buhl
- Institute of Pathology, University Hospital Aachen, RWTH Aachen University, Aachen, Germany; Department of Nephrology, RWTH Aachen University, Aachen, Germany; Electron Microscopy Facility, RWTH Aachen University, Aachen, Germany
| | - Jonas Dehairs
- Laboratory of Lipid Metabolism and Cancer, Department of Oncology, LKI - Leuven Cancer Institute, KU Leuven - University of Leuven, Leuven, Belgium
| | - Johan V Swinnen
- Laboratory of Lipid Metabolism and Cancer, Department of Oncology, LKI - Leuven Cancer Institute, KU Leuven - University of Leuven, Leuven, Belgium
| | - Heidi Noels
- Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University, Aachen, Germany
| | - Joachim Jankowski
- Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University, Aachen, Germany
| | - Corinna Lebherz
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Peter Boor
- Institute of Pathology, University Hospital Aachen, RWTH Aachen University, Aachen, Germany; Department of Nephrology, RWTH Aachen University, Aachen, Germany
| | - Nikolaus Marx
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Michael Lehrke
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany.
| |
Collapse
|
4
|
Droste P, Wong DWL, Hohl M, von Stillfried S, Klinkhammer BM, Boor P. Semiautomated pipeline for quantitative analysis of heart histopathology. J Transl Med 2023; 21:666. [PMID: 37752535 PMCID: PMC10523682 DOI: 10.1186/s12967-023-04544-2] [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: 05/26/2023] [Accepted: 09/19/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Heart diseases are among the leading causes of death worldwide, many of which lead to pathological cardiomyocyte hypertrophy and capillary rarefaction in both patients and animal models, the quantification of which is both technically challenging and highly time-consuming. Here we developed a semiautomated pipeline for quantification of the size of cardiomyocytes and capillary density in cardiac histology, termed HeartJ, by generating macros in ImageJ, a broadly used, open-source, Java-based software. METHODS We have used modified Gomori silver staining, which is easy to perform and digitize in high throughput, or Fluorescein-labeled lectin staining. The latter can be easily combined with other stainings, allowing additional quantitative analysis on the same section, e.g., the size of cardiomyocyte nuclei, capillary density, or single-cardiomyocyte protein expression. We validated the pipeline in a mouse model of cardiac hypertrophy induced by transverse aortic constriction, and in autopsy samples of patients with and without aortic stenosis. RESULTS In both animals and humans, HeartJ-based histology quantification revealed significant hypertrophy of cardiomyocytes reflecting other parameters of hypertrophy and rarefaction of microvasculature and enabling the analysis of protein expression in individual cardiomyocytes. The analysis also revealed that murine and human cardiomyocytes had similar diameters in health and extent of hypertrophy in disease confirming the translatability of our murine cardiac hypertrophy model. HeartJ enables a rapid analysis that would not be feasible by manual methods. The pipeline has little hardware requirements and is freely available. CONCLUSIONS In summary, our analysis pipeline can facilitate effective and objective quantitative histological analyses in preclinical and clinical heart samples.
Collapse
Affiliation(s)
- Patrick Droste
- LaBooratory of Nephropathology, Institute of Pathology, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Division of Nephrology and Clinical Immunology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Dickson W L Wong
- LaBooratory of Nephropathology, Institute of Pathology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Mathias Hohl
- Department of Internal Medicine III, University Hospital, Saarland University, Homburg, Germany
| | - Saskia von Stillfried
- LaBooratory of Nephropathology, Institute of Pathology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Barbara M Klinkhammer
- LaBooratory of Nephropathology, Institute of Pathology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Peter Boor
- LaBooratory of Nephropathology, Institute of Pathology, Medical Faculty, RWTH Aachen University, Aachen, Germany.
- Division of Nephrology and Clinical Immunology, Medical Faculty, RWTH Aachen University, Aachen, Germany.
| |
Collapse
|
5
|
Ermert K, Buhl EM, Klinkhammer BM, Floege J, Boor P. Reduction of Endothelial Glycocalyx on Peritubular Capillaries in Chronic Kidney Disease. Am J Pathol 2023; 193:138-147. [PMID: 36414084 DOI: 10.1016/j.ajpath.2022.11.003] [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] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/07/2022] [Accepted: 11/03/2022] [Indexed: 11/20/2022]
Abstract
In chronic kidney disease (CKD), peritubular capillaries undergo anatomic and functional alterations, such as rarefaction and increased permeability. The endothelial glycocalyx (EG) is a carbohydrate-rich gel-like mesh, which covers the luminal surface of endothelial cells. It is involved in many regulatory functions of the endothelium, including vascular permeability. Herein, we investigated ultrastructural alterations of the EG in different murine CKD models. Fluorescence staining using different lectins with high affinity to components of the renal glycocalyx revealed a reduced binding to the endothelium in CKD in the animal models, and there were similar finding in human kidney specimens. Lanthanum Dysprosium Glycosamino Glycan adhesion staining technique was used to visualize the ultrastructure of the glycocalyx in transmission electron microscopy. This also enabled quantitative analyses, showing a significant reduction of the EG thickness and density. In addition, mRNA expression of proteins involved in glycocalyx biology, synthesis, and turnover (ie, syndecan 1 and glypican 1), which are main components of the glycocalyx, and exostosin 2, involved in the synthesis of the glycocalyx, were significantly up-regulated in endothelial cells isolated from murine CKD models. Visualization of glycocalyx using specific transmission electron microscopy analyses allows qualitative and quantitative analyses and revealed significant pathologic alterations in peritubular capillaries in CKD.
Collapse
Affiliation(s)
- Katja Ermert
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany; Division of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany
| | - Eva M Buhl
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany; Division of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany; Electron Microscopy Facility, RWTH Aachen University Hospital, Aachen, Germany
| | - Barbara M Klinkhammer
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany; Division of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany
| | - Jürgen Floege
- Division of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany
| | - Peter Boor
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany; Division of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany; Electron Microscopy Facility, RWTH Aachen University Hospital, Aachen, Germany.
| |
Collapse
|
6
|
Hölscher DL, Bouteldja N, Joodaki M, Russo ML, Lan YC, Sadr AV, Cheng M, Tesar V, Stillfried SV, Klinkhammer BM, Barratt J, Floege J, Roberts ISD, Coppo R, Costa IG, Bülow RD, Boor P. Next-Generation Morphometry for pathomics-data mining in histopathology. Nat Commun 2023; 14:470. [PMID: 36709324 PMCID: PMC9884209 DOI: 10.1038/s41467-023-36173-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/16/2023] [Indexed: 01/29/2023] Open
Abstract
Pathology diagnostics relies on the assessment of morphology by trained experts, which remains subjective and qualitative. Here we developed a framework for large-scale histomorphometry (FLASH) performing deep learning-based semantic segmentation and subsequent large-scale extraction of interpretable, quantitative, morphometric features in non-tumour kidney histology. We use two internal and three external, multi-centre cohorts to analyse over 1000 kidney biopsies and nephrectomies. By associating morphometric features with clinical parameters, we confirm previous concepts and reveal unexpected relations. We show that the extracted features are independent predictors of long-term clinical outcomes in IgA-nephropathy. We introduce single-structure morphometric analysis by applying techniques from single-cell transcriptomics, identifying distinct glomerular populations and morphometric phenotypes along a trajectory of disease progression. Our study provides a concept for Next-generation Morphometry (NGM), enabling comprehensive quantitative pathology data mining, i.e., pathomics.
Collapse
Affiliation(s)
- David L Hölscher
- Institute of Pathology, RWTH Aachen University Clinic, Aachen, Germany
| | - Nassim Bouteldja
- Institute of Pathology, RWTH Aachen University Clinic, Aachen, Germany
| | - Mehdi Joodaki
- Institute for Computational Genomics, RWTH Aachen University Clinic, Aachen, Germany
| | | | - Yu-Chia Lan
- Institute of Pathology, RWTH Aachen University Clinic, Aachen, Germany
| | | | - Mingbo Cheng
- Institute for Computational Genomics, RWTH Aachen University Clinic, Aachen, Germany
| | - Vladimir Tesar
- Department of Nephrology, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | | | | | - Jonathan Barratt
- John Walls Renal Unit, University Hospital of Leicester National Health Service Trust, Leicester, United Kingdom
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Jürgen Floege
- Department of Nephrology and Immunology, RWTH Aachen University Clinic, Aachen, Germany
| | - Ian S D Roberts
- Department of Cellular Pathology, Oxford University Hospitals National Health Services Foundation Trust, Oxford, United Kingdom
| | - Rosanna Coppo
- Fondazione Ricerca Molinette, Torino, Italy
- Regina Margherita Children's University Hospital, Torino, Italy
| | - Ivan G Costa
- Institute for Computational Genomics, RWTH Aachen University Clinic, Aachen, Germany
| | - Roman D Bülow
- Institute of Pathology, RWTH Aachen University Clinic, Aachen, Germany
| | - Peter Boor
- Institute of Pathology, RWTH Aachen University Clinic, Aachen, Germany.
- Department of Nephrology and Immunology, RWTH Aachen University Clinic, Aachen, Germany.
| |
Collapse
|
7
|
Moellmann J, Mann PA, Kappel BA, Kahles F, Klinkhammer BM, Boor P, Kramann R, Ghesquiere B, Lebherz C, Marx N, Lehrke M. The sodium-glucose co-transporter-2 inhibitor ertugliflozin modifies the signature of cardiac substrate metabolism and reduces cardiac mTOR signalling, endoplasmic reticulum stress and apoptosis. Diabetes Obes Metab 2022; 24:2263-2272. [PMID: 35801343 DOI: 10.1111/dom.14814] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/25/2022] [Accepted: 07/01/2022] [Indexed: 11/30/2022]
Abstract
AIM To investigate cardiac signalling pathways connecting substrate utilization with left ventricular remodelling in a murine pressure overload model. METHODS Cardiac hypertrophy was induced by transverse aortic constriction surgery in 20-week-old C57BL/6J mice treated with or without the sodium-glucose co-transporter 2 (SGLT2) inhibitor ertugliflozin (225 mg kg-1 chow diet) for 10 weeks. RESULTS Ertugliflozin improved left ventricular function and reduced myocardial fibrosis. This occurred simultaneously with a fasting-like response characterized by improved glucose tolerance and increased ketone body concentrations. While cardiac insulin signalling was reduced in response to SGLT2 inhibition, AMP-activated protein kinase (AMPK) signalling was increased with induction of the fatty acid transporter cluster of differentiation 36 and phosphorylation of acetyl-CoA carboxylase (ACC). Further, enzymes responsible for ketone body catabolism (β-hydroxybutyrate dehydrogenase, succinyl-CoA:3-oxoacid-CoA transferase and acetyl-CoA acetyltransferase 1) were induced by SGLT2 inhibition. Ertugliflozin led to more cardiac abundance of fatty acids, tricarboxylic acid cycle metabolites and ATP. Downstream mechanistic target of rapamycin (mTOR) pathway, relevant for protein synthesis, cardiac hypertrophy and adverse cardiac remodelling, was reduced by SGLT2 inhibition, with alleviation of endoplasmic reticulum (ER) stress and unfolded protein response (UPR) providing a potential mechanism for abundant reduced left ventricular apoptosis and fibrosis. CONCLUSION SGLT2 inhibition reduced left ventricular fibrosis in a murine model of cardiac hypertrophy. Mechanistically, this was associated with reduced cardiac insulin and increased AMPK signalling as a potential mechanism for less cardiac mTOR activation with alleviation of downstream ER stress, UPR and apoptosis.
Collapse
Affiliation(s)
- Julia Moellmann
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Pascal A Mann
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Ben A Kappel
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Florian Kahles
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Barbara M Klinkhammer
- Institute of Pathology, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Peter Boor
- Institute of Pathology, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
- Department of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany
| | - Rafael Kramann
- Department of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany
- Institute of Experimental Medicine and Systemsbiology, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Bart Ghesquiere
- VIB Metabolomics Expertise Center, VIB Center for Cancer Biology, Leuven, Belgium
- KU Leuven Metabolomics Expertise Center, Department of Oncology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Corinna Lebherz
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Nikolaus Marx
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Michael Lehrke
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| |
Collapse
|
8
|
Bouteldja N, Klinkhammer BM, Schlaich T, Boor P, Merhof D. Improving unsupervised stain-to-stain translation using self-supervision and meta-learning. J Pathol Inform 2022; 13:100107. [PMID: 36268068 PMCID: PMC9577059 DOI: 10.1016/j.jpi.2022.100107] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background In digital pathology, many image analysis tasks are challenged by the need for large and time-consuming manual data annotations to cope with various sources of variability in the image domain. Unsupervised domain adaptation based on image-to-image translation is gaining importance in this field by addressing variabilities without the manual overhead. Here, we tackle the variation of different histological stains by unsupervised stain-to-stain translation to enable a stain-independent applicability of a deep learning segmentation model. Methods We use CycleGANs for stain-to-stain translation in kidney histopathology, and propose two novel approaches to improve translational effectivity. First, we integrate a prior segmentation network into the CycleGAN for a self-supervised, application-oriented optimization of translation through semantic guidance, and second, we incorporate extra channels to the translation output to implicitly separate artificial meta-information otherwise encoded for tackling underdetermined reconstructions. Results The latter showed partially superior performances to the unmodified CycleGAN, but the former performed best in all stains providing instance-level Dice scores ranging between 78% and 92% for most kidney structures, such as glomeruli, tubules, and veins. However, CycleGANs showed only limited performance in the translation of other structures, e.g. arteries. Our study also found somewhat lower performance for all structures in all stains when compared to segmentation in the original stain. Conclusions Our study suggests that with current unsupervised technologies, it seems unlikely to produce “generally” applicable simulated stains.
Collapse
Affiliation(s)
- Nassim Bouteldja
- Institute of Imaging and Computer Vision, RWTH Aachen University, Aachen, Germany
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany
- Corresponding author at: University Hospital Aachen, Pauwelsstr. 16, 52074 Aachen, Germany
| | | | - Tarek Schlaich
- Institute of Imaging and Computer Vision, RWTH Aachen University, Aachen, Germany
| | - Peter Boor
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany
- Department of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany
| | - Dorit Merhof
- Institute of Imaging and Computer Vision, RWTH Aachen University, Aachen, Germany
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| |
Collapse
|
9
|
Kers J, Bülow RD, Klinkhammer BM, Breimer GE, Fontana F, Abiola AA, Hofstraat R, Corthals GL, Peters-Sengers H, Djudjaj S, von Stillfried S, Hölscher DL, Pieters TT, van Zuilen AD, Bemelman FJ, Nurmohamed AS, Naesens M, Roelofs JJTH, Florquin S, Floege J, Nguyen TQ, Kather JN, Boor P. Deep learning-based classification of kidney transplant pathology: a retrospective, multicentre, proof-of-concept study. Lancet Digit Health 2021; 4:e18-e26. [PMID: 34794930 DOI: 10.1016/s2589-7500(21)00211-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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: 04/07/2021] [Revised: 08/10/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Histopathological assessment of transplant biopsies is currently the standard method to diagnose allograft rejection and can help guide patient management, but it is one of the most challenging areas of pathology, requiring considerable expertise, time, and effort. We aimed to analyse the utility of deep learning to preclassify histology of kidney allograft biopsies into three main broad categories (ie, normal, rejection, and other diseases) as a potential biopsy triage system focusing on transplant rejection. METHODS We performed a retrospective, multicentre, proof-of-concept study using 5844 digital whole slide images of kidney allograft biopsies from 1948 patients. Kidney allograft biopsy samples were identified by a database search in the Departments of Pathology of the Amsterdam UMC, Amsterdam, Netherlands (1130 patients) and the University Medical Center Utrecht, Utrecht, Netherlands (717 patients). 101 consecutive kidney transplant biopsies were identified in the archive of the Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany. Convolutional neural networks (CNNs) were trained to classify allograft biopsies as normal, rejection, or other diseases. Three times cross-validation (1847 patients) and deployment on an external real-world cohort (101 patients) were used for validation. Area under the receiver operating characteristic curve (AUROC) was used as the main performance metric (the primary endpoint to assess CNN performance). FINDINGS Serial CNNs, first classifying kidney allograft biopsies as normal (AUROC 0·87 [ten times bootstrapped CI 0·85-0·88]) and disease (0·87 [0·86-0·88]), followed by a second CNN classifying biopsies classified as disease into rejection (0·75 [0·73-0·76]) and other diseases (0·75 [0·72-0·77]), showed similar AUROC in cross-validation and deployment on independent real-world data (first CNN normal AUROC 0·83 [0·80-0·85], disease 0·83 [0·73-0·91]; second CNN rejection 0·61 [0·51-0·70], other diseases 0·61 [0·50-0·74]). A single CNN classifying biopsies as normal, rejection, or other diseases showed similar performance in cross-validation (normal AUROC 0·80 [0·73-0·84], rejection 0·76 [0·66-0·80], other diseases 0·50 [0·36-0·57]) and generalised well for normal and rejection classes in the real-world data. Visualisation techniques highlighted rejection-relevant areas of biopsies in the tubulointerstitium. INTERPRETATION This study showed that deep learning-based classification of transplant biopsies could support pathological diagnostics of kidney allograft rejection. FUNDING European Research Council; German Research Foundation; German Federal Ministries of Education and Research, Health, and Economic Affairs and Energy; Dutch Kidney Foundation; Human(e) AI Research Priority Area of the University of Amsterdam; and Max-Eder Programme of German Cancer Aid.
Collapse
Affiliation(s)
- Jesper Kers
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Department of Pathology, Leiden Transplant Center, Leiden University Medical Center, Leiden, Netherlands; Van 't Hoff Institute for Molecular Sciences, University of Amsterdam, Amsterdam, Netherlands.
| | - Roman D Bülow
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany
| | | | - Gerben E Breimer
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Francesco Fontana
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Nephrology and Dialysis Unit, University Hospital of Modena, Modena, Italy
| | - Adeyemi Adefidipe Abiola
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Department of Morbid Anatomy and Forensic Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Rianne Hofstraat
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Van 't Hoff Institute for Molecular Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Garry L Corthals
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Van 't Hoff Institute for Molecular Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Hessel Peters-Sengers
- Center for Experimental and Molecular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Sonja Djudjaj
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany
| | | | - David L Hölscher
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany
| | - Tobias T Pieters
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands
| | - Arjan D van Zuilen
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands
| | - Frederike J Bemelman
- Renal Transplant Unit, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Azam S Nurmohamed
- Renal Transplant Unit, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Maarten Naesens
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | - Joris J T H Roelofs
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Sandrine Florquin
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Jürgen Floege
- Department of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany
| | - Tri Q Nguyen
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jakob N Kather
- Department of Medicine III, RWTH Aachen University Hospital, Aachen, Germany; Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Boor
- Department of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany; Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany.
| |
Collapse
|
10
|
Klinkhammer BM, Lammers T, Mottaghy FM, Kiessling F, Floege J, Boor P. Non-invasive molecular imaging of kidney diseases. Nat Rev Nephrol 2021; 17:688-703. [PMID: 34188207 PMCID: PMC7612034 DOI: 10.1038/s41581-021-00440-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 02/05/2023]
Abstract
In nephrology, differential diagnosis or assessment of disease activity largely relies on the analysis of glomerular filtration rate, urinary sediment, proteinuria and tissue obtained through invasive kidney biopsies. However, currently available non-invasive functional parameters, and most serum and urine biomarkers, cannot capture intrarenal molecular disease processes specifically. Moreover, although histopathological analyses of kidney biopsy samples enable the visualization of pathological morphological and molecular alterations, they only provide information about a small part of the kidney and do not allow longitudinal monitoring. These limitations not only hinder understanding of the dynamics of specific disease processes in the kidney, but also limit the targeting of treatments to active phases of disease and the development of novel targeted therapies. Molecular imaging enables non-invasive and quantitative assessment of physiological or pathological processes by combining imaging technologies with specific molecular probes. Here, we discuss current preclinical and clinical molecular imaging approaches in nephrology. Non-invasive visualization of the kidneys through molecular imaging can be used to detect and longitudinally monitor disease activity and can therefore provide companion diagnostics to guide clinical trials, as well as the safe and effective use of drugs.
Collapse
Affiliation(s)
| | - Twan Lammers
- Institute for Experimental Molecular Imaging, RWTH Aachen University Hospital, Aachen, Germany,Department of Pharmaceutics, Utrecht University, The Netherlands,Department of Targeted Therapeutics, University of Twente, Enschede, The Netherlands
| | - Felix M. Mottaghy
- Department of Nuclear Medicine, University Hospital RWTH Aachen, Germany,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Fabian Kiessling
- Institute for Experimental Molecular Imaging, RWTH Aachen University Hospital, Aachen, Germany,Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Jürgen Floege
- Department of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany
| | - Peter Boor
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany,Department of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany,Electron Microscopy Facility, RWTH Aachen University Hospital, Aachen, Germany,
| |
Collapse
|
11
|
Wong DWL, Klinkhammer BM, Djudjaj S, Villwock S, Timm MC, Buhl EM, Wucherpfennig S, Cacchi C, Braunschweig T, Knüchel-Clarke R, Jonigk D, Werlein C, Bülow RD, Dahl E, von Stillfried S, Boor P. Multisystemic Cellular Tropism of SARS-CoV-2 in Autopsies of COVID-19 Patients. Cells 2021; 10:1900. [PMID: 34440669 PMCID: PMC8394956 DOI: 10.3390/cells10081900] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 12/18/2022] Open
Abstract
Multiorgan tropism of SARS-CoV-2 has previously been shown for several major organs. We have comprehensively analyzed 25 different formalin-fixed paraffin-embedded (FFPE) tissues/organs from autopsies of fatal COVID-19 cases (n = 8), using histopathological assessment, detection of SARS-CoV-2 RNA using polymerase chain reaction and RNA in situ hybridization, viral protein using immunohistochemistry, and virus particles using transmission electron microscopy. SARS-CoV-2 RNA was mainly localized in epithelial cells across all organs. Next to lung, trachea, kidney, heart, or liver, viral RNA was also found in tonsils, salivary glands, oropharynx, thyroid, adrenal gland, testicles, prostate, ovaries, small bowel, lymph nodes, skin and skeletal muscle. Viral RNA was predominantly found in cells expressing ACE2, TMPRSS2, or both. The SARS-CoV-2 replicating RNA was also detected in these organs. Immunohistochemistry and electron microscopy were not suitable for reliable and specific SARS-CoV-2 detection in autopsies. These findings were validated using in situ hybridization on external COVID-19 autopsy samples (n = 9). Apart from the lung, correlation of viral detection and histopathological assessment did not reveal any specific alterations that could be attributed to SARS-CoV-2. In summary, SARS-CoV-2 and its replication could be observed across all organ systems, which co-localizes with ACE2 and TMPRSS2 mainly in epithelial but also in mesenchymal and endothelial cells. Apart from the respiratory tract, no specific (histo-)morphologic alterations could be assigned to the SARS-CoV-2 infection.
Collapse
Affiliation(s)
- Dickson W. L. Wong
- Institute of Pathology, RWTH Aachen University Hospital, 52074 Aachen, Germany; (D.W.L.W.); (B.M.K.); (S.D.); (S.V.); (M.C.T.); (E.M.B.); (S.W.); (C.C.); (T.B.); (R.K.-C.); (R.D.B.); (E.D.)
| | - Barbara M. Klinkhammer
- Institute of Pathology, RWTH Aachen University Hospital, 52074 Aachen, Germany; (D.W.L.W.); (B.M.K.); (S.D.); (S.V.); (M.C.T.); (E.M.B.); (S.W.); (C.C.); (T.B.); (R.K.-C.); (R.D.B.); (E.D.)
| | - Sonja Djudjaj
- Institute of Pathology, RWTH Aachen University Hospital, 52074 Aachen, Germany; (D.W.L.W.); (B.M.K.); (S.D.); (S.V.); (M.C.T.); (E.M.B.); (S.W.); (C.C.); (T.B.); (R.K.-C.); (R.D.B.); (E.D.)
| | - Sophia Villwock
- Institute of Pathology, RWTH Aachen University Hospital, 52074 Aachen, Germany; (D.W.L.W.); (B.M.K.); (S.D.); (S.V.); (M.C.T.); (E.M.B.); (S.W.); (C.C.); (T.B.); (R.K.-C.); (R.D.B.); (E.D.)
| | - M. Cherelle Timm
- Institute of Pathology, RWTH Aachen University Hospital, 52074 Aachen, Germany; (D.W.L.W.); (B.M.K.); (S.D.); (S.V.); (M.C.T.); (E.M.B.); (S.W.); (C.C.); (T.B.); (R.K.-C.); (R.D.B.); (E.D.)
| | - Eva M. Buhl
- Institute of Pathology, RWTH Aachen University Hospital, 52074 Aachen, Germany; (D.W.L.W.); (B.M.K.); (S.D.); (S.V.); (M.C.T.); (E.M.B.); (S.W.); (C.C.); (T.B.); (R.K.-C.); (R.D.B.); (E.D.)
- Electron Microscopy Facility, RWTH Aachen University Hospital, 52074 Aachen, Germany
| | - Sophie Wucherpfennig
- Institute of Pathology, RWTH Aachen University Hospital, 52074 Aachen, Germany; (D.W.L.W.); (B.M.K.); (S.D.); (S.V.); (M.C.T.); (E.M.B.); (S.W.); (C.C.); (T.B.); (R.K.-C.); (R.D.B.); (E.D.)
| | - Claudio Cacchi
- Institute of Pathology, RWTH Aachen University Hospital, 52074 Aachen, Germany; (D.W.L.W.); (B.M.K.); (S.D.); (S.V.); (M.C.T.); (E.M.B.); (S.W.); (C.C.); (T.B.); (R.K.-C.); (R.D.B.); (E.D.)
| | - Till Braunschweig
- Institute of Pathology, RWTH Aachen University Hospital, 52074 Aachen, Germany; (D.W.L.W.); (B.M.K.); (S.D.); (S.V.); (M.C.T.); (E.M.B.); (S.W.); (C.C.); (T.B.); (R.K.-C.); (R.D.B.); (E.D.)
| | - Ruth Knüchel-Clarke
- Institute of Pathology, RWTH Aachen University Hospital, 52074 Aachen, Germany; (D.W.L.W.); (B.M.K.); (S.D.); (S.V.); (M.C.T.); (E.M.B.); (S.W.); (C.C.); (T.B.); (R.K.-C.); (R.D.B.); (E.D.)
| | - Danny Jonigk
- Institute of Pathology, Hannover Medical School, 30625 Hannover, Germany;
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), 30625 Hannover, Germany;
| | - Christopher Werlein
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), 30625 Hannover, Germany;
| | - Roman D. Bülow
- Institute of Pathology, RWTH Aachen University Hospital, 52074 Aachen, Germany; (D.W.L.W.); (B.M.K.); (S.D.); (S.V.); (M.C.T.); (E.M.B.); (S.W.); (C.C.); (T.B.); (R.K.-C.); (R.D.B.); (E.D.)
| | - Edgar Dahl
- Institute of Pathology, RWTH Aachen University Hospital, 52074 Aachen, Germany; (D.W.L.W.); (B.M.K.); (S.D.); (S.V.); (M.C.T.); (E.M.B.); (S.W.); (C.C.); (T.B.); (R.K.-C.); (R.D.B.); (E.D.)
| | - Saskia von Stillfried
- Institute of Pathology, RWTH Aachen University Hospital, 52074 Aachen, Germany; (D.W.L.W.); (B.M.K.); (S.D.); (S.V.); (M.C.T.); (E.M.B.); (S.W.); (C.C.); (T.B.); (R.K.-C.); (R.D.B.); (E.D.)
| | - Peter Boor
- Institute of Pathology, RWTH Aachen University Hospital, 52074 Aachen, Germany; (D.W.L.W.); (B.M.K.); (S.D.); (S.V.); (M.C.T.); (E.M.B.); (S.W.); (C.C.); (T.B.); (R.K.-C.); (R.D.B.); (E.D.)
- Electron Microscopy Facility, RWTH Aachen University Hospital, 52074 Aachen, Germany
- Department of Nephrology and Immunology, RWTH Aachen University Hospital, 52074 Aachen, Germany
| |
Collapse
|
12
|
von Stillfried S, Villwock S, Bülow RD, Djudjaj S, Buhl EM, Maurer A, Ortiz‐Brüchle N, Celec P, Klinkhammer BM, Wong DW, Cacchi C, Braunschweig T, Knüchel‐Clarke R, Dahl E, Boor P. SARS-CoV-2 RNA screening in routine pathology specimens. Microb Biotechnol 2021; 14:1627-1641. [PMID: 33993637 PMCID: PMC8209898 DOI: 10.1111/1751-7915.13828] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 01/03/2021] [Accepted: 04/27/2021] [Indexed: 12/18/2022] Open
Abstract
Virus detection methods are important to cope with the SARS-CoV-2 pandemics. Apart from the lung, SARS-CoV-2 was detected in multiple organs in severe cases. Less is known on organ tropism in patients developing mild or no symptoms, and some of such patients might be missed in symptom-indicated swab testing. Here, we tested and validated several approaches and selected the most reliable RT-PCR protocol for the detection of SARS-CoV-2 RNA in patients' routine diagnostic formalin-fixed and paraffin-embedded (FFPE) specimens available in pathology, to assess (i) organ tropism in samples from COVID-19-positive patients, (ii) unrecognized cases in selected tissues from negative or not-tested patients during a pandemic peak, and (iii) retrospectively, pre-pandemic lung samples. We identified SARS-CoV-2 RNA in seven samples from confirmed COVID-19 patients, in two gastric biopsies, one small bowel and one colon resection, one lung biopsy, one pleural resection and one pleural effusion specimen, while all other specimens were negative. In the pandemic peak cohort, we identified one previously unrecognized COVID-19 case in tonsillectomy samples. All pre-pandemic lung samples were negative. In conclusion, SARS-CoV-2 RNA detection in FFPE pathology specimens can potentially improve surveillance of COVID-19, allow retrospective studies, and advance our understanding of SARS-CoV-2 organ tropism and effects.
Collapse
Affiliation(s)
| | - Sophia Villwock
- Institute of PathologyRWTH Aachen University HospitalAachenGermany
| | - Roman D. Bülow
- Institute of PathologyRWTH Aachen University HospitalAachenGermany
| | - Sonja Djudjaj
- Institute of PathologyRWTH Aachen University HospitalAachenGermany
| | - Eva M. Buhl
- Institute of PathologyRWTH Aachen University HospitalAachenGermany
- Electron Microscopy FacilityRWTH Aachen University HospitalAachenGermany
| | - Angela Maurer
- Institute of PathologyRWTH Aachen University HospitalAachenGermany
| | | | - Peter Celec
- Institute of VirologyBiomedical Research CenterSlovak Academy of SciencesBratislavaSlovakia
- Institute of PathophysiologyFaculty of MedicineComenius UniversityBratislavaSlovakia
- Department of Molecular BiologyFaculty of Natural SciencesComenius UniversityBratislavaSlovakia
| | | | | | - Claudio Cacchi
- Institute of PathologyRWTH Aachen University HospitalAachenGermany
| | | | | | - Edgar Dahl
- Institute of PathologyRWTH Aachen University HospitalAachenGermany
- RWTH Centralized Biomaterial Bank (RWTH cBMB)RWTH Aachen University HospitalAachenGermany
| | - Peter Boor
- Institute of PathologyRWTH Aachen University HospitalAachenGermany
- Electron Microscopy FacilityRWTH Aachen University HospitalAachenGermany
- Department of NephrologyRWTH Aachen University HospitalAachenGermany
- Department of ImmunologyRWTH Aachen University HospitalAachenGermany
| |
Collapse
|
13
|
Solagna F, Tezze C, Lindenmeyer MT, Lu S, Wu G, Liu S, Zhao Y, Mitchell R, Meyer C, Omairi S, Kilic T, Paolini A, Ritvos O, Pasternack A, Matsakas A, Kylies D, zur Wiesch JS, Turner JE, Wanner N, Nair V, Eichinger F, Menon R, Martin IV, Klinkhammer BM, Hoxha E, Cohen CD, Tharaux PL, Boor P, Ostendorf T, Kretzler M, Sandri M, Kretz O, Puelles VG, Patel K, Huber TB. Pro-cachectic factors link experimental and human chronic kidney disease to skeletal muscle wasting programs. J Clin Invest 2021; 131:135821. [PMID: 34060483 PMCID: PMC8159690 DOI: 10.1172/jci135821] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 12/20/2019] [Accepted: 04/21/2021] [Indexed: 02/06/2023] Open
Abstract
Skeletal muscle wasting is commonly associated with chronic kidney disease (CKD), resulting in increased morbidity and mortality. However, the link between kidney and muscle function remains poorly understood. Here, we took a complementary interorgan approach to investigate skeletal muscle wasting in CKD. We identified increased production and elevated blood levels of soluble pro-cachectic factors, including activin A, directly linking experimental and human CKD to skeletal muscle wasting programs. Single-cell sequencing data identified the expression of activin A in specific kidney cell populations of fibroblasts and cells of the juxtaglomerular apparatus. We propose that persistent and increased kidney production of pro-cachectic factors, combined with a lack of kidney clearance, facilitates a vicious kidney/muscle signaling cycle, leading to exacerbated blood accumulation and, thereby, skeletal muscle wasting. Systemic pharmacological blockade of activin A using soluble activin receptor type IIB ligand trap as well as muscle-specific adeno-associated virus-mediated downregulation of its receptor ACVR2A/B prevented muscle wasting in different mouse models of experimental CKD, suggesting that activin A is a key factor in CKD-induced cachexia. In summary, we uncovered a crosstalk between kidney and muscle and propose modulation of activin signaling as a potential therapeutic strategy for skeletal muscle wasting in CKD.
Collapse
Affiliation(s)
- Francesca Solagna
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Caterina Tezze
- Veneto Institute of Molecular Medicine, Padua, Italy
- Department of Biomedical Sciences, University of Padova, Padua, Italy
| | - Maja T. Lindenmeyer
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Shun Lu
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Guochao Wu
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Shuya Liu
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yu Zhao
- Institute of Medical Systems Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robert Mitchell
- School of Biological Sciences, University of Reading, Reading, United Kingdom
| | - Charlotte Meyer
- Renal Division, Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Saleh Omairi
- College of Medicine, University of Wasit, Kut, Iraq
| | - Temel Kilic
- Renal Division, Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Andrea Paolini
- School of Biological Sciences, University of Reading, Reading, United Kingdom
| | - Olli Ritvos
- Department of Physiology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Arja Pasternack
- Department of Physiology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Antonios Matsakas
- Molecular Physiology Laboratory, Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, Hull, United Kingdom
| | - Dominik Kylies
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Jan-Eric Turner
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicola Wanner
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Viji Nair
- Michigan Medicine, Ann Arbor, Michigan, USA
| | | | | | - Ina V. Martin
- Department of Nephrology and Clinical Immunology and
| | | | - Elion Hoxha
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Clemens D. Cohen
- Nephrological Center, Medical Clinic and Polyclinic IV, University of Munich, Munich, Germany
| | - Pierre-Louis Tharaux
- Paris Centre de Recherche Cardiovasculaire, INSERM, Université de Paris, Paris, France
| | - Peter Boor
- Department of Nephrology and Clinical Immunology and
- Institute of Pathology, University Hospital RWTH Aachen, Aachen, Germany
| | | | | | - Marco Sandri
- Veneto Institute of Molecular Medicine, Padua, Italy
- Department of Biomedical Sciences, University of Padova, Padua, Italy
| | - Oliver Kretz
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victor G. Puelles
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Anatomy and Developmental Biology, Monash University, Melbourne, Australia
| | - Ketan Patel
- School of Biological Sciences, University of Reading, Reading, United Kingdom
- Freiburg Institute for Advanced Studies and Center for Biological System Analysis, University of Freiburg, Freiburg, Germany
| | - Tobias B. Huber
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Freiburg Institute for Advanced Studies and Center for Biological System Analysis, University of Freiburg, Freiburg, Germany
| |
Collapse
|
14
|
Bouteldja N, Klinkhammer BM, Bülow RD, Droste P, Otten SW, Freifrau von Stillfried S, Moellmann J, Sheehan SM, Korstanje R, Menzel S, Bankhead P, Mietsch M, Drummer C, Lehrke M, Kramann R, Floege J, Boor P, Merhof D. Deep Learning-Based Segmentation and Quantification in Experimental Kidney Histopathology. J Am Soc Nephrol 2021; 32:52-68. [PMID: 33154175 PMCID: PMC7894663 DOI: 10.1681/asn.2020050597] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [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: 05/06/2020] [Accepted: 09/09/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Nephropathologic analyses provide important outcomes-related data in experiments with the animal models that are essential for understanding kidney disease pathophysiology. Precision medicine increases the demand for quantitative, unbiased, reproducible, and efficient histopathologic analyses, which will require novel high-throughput tools. A deep learning technique, the convolutional neural network, is increasingly applied in pathology because of its high performance in tasks like histology segmentation. METHODS We investigated use of a convolutional neural network architecture for accurate segmentation of periodic acid-Schiff-stained kidney tissue from healthy mice and five murine disease models and from other species used in preclinical research. We trained the convolutional neural network to segment six major renal structures: glomerular tuft, glomerulus including Bowman's capsule, tubules, arteries, arterial lumina, and veins. To achieve high accuracy, we performed a large number of expert-based annotations, 72,722 in total. RESULTS Multiclass segmentation performance was very high in all disease models. The convolutional neural network allowed high-throughput and large-scale, quantitative and comparative analyses of various models. In disease models, computational feature extraction revealed interstitial expansion, tubular dilation and atrophy, and glomerular size variability. Validation showed a high correlation of findings with current standard morphometric analysis. The convolutional neural network also showed high performance in other species used in research-including rats, pigs, bears, and marmosets-as well as in humans, providing a translational bridge between preclinical and clinical studies. CONCLUSIONS We developed a deep learning algorithm for accurate multiclass segmentation of digital whole-slide images of periodic acid-Schiff-stained kidneys from various species and renal disease models. This enables reproducible quantitative histopathologic analyses in preclinical models that also might be applicable to clinical studies.
Collapse
Affiliation(s)
- Nassim Bouteldja
- Institute of Imaging and Computer Vision, RWTH Aachen University, Aachen, Germany
| | - Barbara M. Klinkhammer
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany,Department of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany
| | - Roman D. Bülow
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany
| | - Patrick Droste
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany
| | - Simon W. Otten
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany
| | | | - Julia Moellmann
- Department of Cardiology and Vascular Medicine, RWTH Aachen University Hospital, Aachen, Germany
| | | | | | - Sylvia Menzel
- Department of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany
| | - Peter Bankhead
- Edinburgh Pathology, University of Edinburgh, Edinburgh, United Kingdom,Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Matthias Mietsch
- Laboratory Animal Science Unit, German Primate Center, Goettingen, Germany
| | - Charis Drummer
- Platform Degenerative Diseases, German Primate Center, Goettingen, Germany
| | - Michael Lehrke
- Department of Cardiology and Vascular Medicine, RWTH Aachen University Hospital, Aachen, Germany
| | - Rafael Kramann
- Department of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany,Department of Internal Medicine, Nephrology and Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jürgen Floege
- Department of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany
| | - Peter Boor
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany,Department of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany
| | - Dorit Merhof
- Institute of Imaging and Computer Vision, RWTH Aachen University, Aachen, Germany,Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| |
Collapse
|
15
|
Sato Y, Boor P, Fukuma S, Klinkhammer BM, Haga H, Ogawa O, Floege J, Yanagita M. Developmental stages of tertiary lymphoid tissue reflect local injury and inflammation in mouse and human kidneys. Kidney Int 2020; 98:448-463. [PMID: 32473779 DOI: 10.1016/j.kint.2020.02.023] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [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: 10/01/2018] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 12/12/2022]
Abstract
Tertiary lymphoid tissues (TLTs) are inducible ectopic lymphoid tissues in chronic inflammatory states and function as sites of priming local immune responses. We previously demonstrated that aged but not young mice exhibited multiple TLTs after acute kidney injury and that TLTs were also detected in human aged and diseased kidneys. However, the forms of progression and the implication for kidney injury remain unclear. To clarify this we analyzed surgically resected kidneys from aged patients with or without chronic kidney disease as well as kidneys resected for pyelonephritis, and classified TLTs into three distinct developmental stages based on the presence of follicular dendritic cells and germinal centers. In injury-induced murine TLT models, the stages advanced with the extent of kidney injury, and decreased with dexamethasone accompanied with improvement of renal function, fibrosis and inflammation. Kidneys from aged patients with chronic kidney disease consistently exhibited more frequent and advanced stages of TLTs than those without chronic kidney disease. Kidneys of patients with pyelonephritis exhibited more frequent TLTs with more advanced stages than aged kidneys. Additionally, TLTs in both cohorts shared similar locations and components, suggesting that TLT formation may not be a disease-specific phenomenon but rather a common pathological process. Thus, our findings provide the insights into biological features of TLT in the kidney and implicate TLT stage as a potential marker reflecting local injury and inflammation.
Collapse
Affiliation(s)
- Yuki Sato
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Medical Innovation Center TMK Project, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Peter Boor
- Institute of Pathology, Rhenish-Westphalian Technical University of Aachen, Aachen, Germany; Department of Nephrology, Rhenish-Westphalian Technical University of Aachen, Aachen, Germany
| | - Shingo Fukuma
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Barbara M Klinkhammer
- Institute of Pathology, Rhenish-Westphalian Technical University of Aachen, Aachen, Germany; Department of Nephrology, Rhenish-Westphalian Technical University of Aachen, Aachen, Germany
| | - Hironori Haga
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Osamu Ogawa
- Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Jürgen Floege
- Department of Nephrology, Rhenish-Westphalian Technical University of Aachen, Aachen, Germany
| | - Motoko Yanagita
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Institute for the Advanced Study of Human Biology (ASHBi), Kyoto University, Kyoto, Japan.
| |
Collapse
|
16
|
Sun Q, Baues M, Klinkhammer BM, Ehling J, Djudjaj S, Drude NI, Daniel C, Amann K, Kramann R, Kim H, Saez-Rodriguez J, Weiskirchen R, Onthank DC, Botnar RM, Kiessling F, Floege J, Lammers T, Boor P. Elastin imaging enables noninvasive staging and treatment monitoring of kidney fibrosis. Sci Transl Med 2020; 11:11/486/eaat4865. [PMID: 30944168 DOI: 10.1126/scitranslmed.aat4865] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 11/28/2018] [Accepted: 03/11/2019] [Indexed: 12/13/2022]
Abstract
Fibrosis is the common endpoint and currently the best predictor of progression of chronic kidney diseases (CKDs). Despite several drawbacks, biopsies remain the only available means to specifically assess the extent of renal fibrosis. Here, we show that molecular imaging of the extracellular matrix protein elastin allows for noninvasive staging and longitudinal monitoring of renal fibrosis. Elastin was hardly expressed in healthy mouse, rat, and human kidneys, whereas it was highly up-regulated in cortical, medullar, and perivascular regions in progressive CKD. Compared to a clinically relevant control contrast agent, the elastin-specific magnetic resonance imaging agent ESMA specifically detected elastin expression in multiple mouse models of renal fibrosis and also in fibrotic human kidneys. Elastin imaging allowed for repetitive and reproducible assessment of renal fibrosis, and it enabled longitudinal monitoring of therapeutic interventions, accurately capturing anti-fibrotic therapy effects. Last, in a model of reversible renal injury, elastin imaging detected ensuing fibrosis not identifiable via routine assessment of kidney function. Elastin imaging thus has the potential to become a noninvasive, specific imaging method to assess renal fibrosis.
Collapse
Affiliation(s)
- Qinxue Sun
- Institute of Pathology, RWTH Aachen University Hospital, 52074 Aachen, Germany.,Department of Radiology, Ningbo Medical Center Li Huili Hospital, 315040 Ningbo, China
| | - Maike Baues
- Institute for Experimental Molecular Imaging, RWTH Aachen University Hospital, 52074 Aachen, Germany
| | - Barbara M Klinkhammer
- Institute of Pathology, RWTH Aachen University Hospital, 52074 Aachen, Germany.,Department of Nephrology and Immunology, RWTH Aachen University Hospital, 52074 Aachen, Germany
| | - Josef Ehling
- Institute for Experimental Molecular Imaging, RWTH Aachen University Hospital, 52074 Aachen, Germany
| | - Sonja Djudjaj
- Institute of Pathology, RWTH Aachen University Hospital, 52074 Aachen, Germany
| | - Natascha I Drude
- Institute for Experimental Molecular Imaging, RWTH Aachen University Hospital, 52074 Aachen, Germany.,Department for Nuclear Medicine, RWTH Aachen University Hospital, 52074 Aachen, Germany
| | - Christoph Daniel
- Institute of Pathology and Department of Nephropathology, University Erlangen, 91054 Erlangen, Germany
| | - Kerstin Amann
- Institute of Pathology and Department of Nephropathology, University Erlangen, 91054 Erlangen, Germany
| | - Rafael Kramann
- Department of Nephrology and Immunology, RWTH Aachen University Hospital, 52074 Aachen, Germany
| | - Hyojin Kim
- Joint Research Center for Computational Biomedicine, RWTH Aachen University Hospital, 52074 Aachen, Germany.,Institute of Computational Biomedicine, Heidelberg University, 69120 Heidelberg, Germany
| | - Julio Saez-Rodriguez
- Joint Research Center for Computational Biomedicine, RWTH Aachen University Hospital, 52074 Aachen, Germany.,Institute of Computational Biomedicine, Heidelberg University, 69120 Heidelberg, Germany
| | - Ralf Weiskirchen
- Institute of Molecular Pathobiochemistry, Experimental Gene Therapy and Clinical Chemistry, RWTH Aachen University Hospital, 52074 Aachen, Germany
| | | | - Rene M Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, WC2R 2LS London, UK
| | - Fabian Kiessling
- Institute for Experimental Molecular Imaging, RWTH Aachen University Hospital, 52074 Aachen, Germany
| | - Jürgen Floege
- Department of Nephrology and Immunology, RWTH Aachen University Hospital, 52074 Aachen, Germany
| | - Twan Lammers
- Institute for Experimental Molecular Imaging, RWTH Aachen University Hospital, 52074 Aachen, Germany. .,Department of Targeted Therapeutics, University of Twente, 7522 NB Enschede, Netherlands
| | - Peter Boor
- Institute of Pathology, RWTH Aachen University Hospital, 52074 Aachen, Germany. .,Department of Nephrology and Immunology, RWTH Aachen University Hospital, 52074 Aachen, Germany.,Electron Microscopy Facility, RWTH Aachen University Hospital, 52074 Aachen, Germany.,Institute of Molecular Biomedicine, Comenius University, 81972 Bratislava, Slovakia
| |
Collapse
|
17
|
Moellmann J, Klinkhammer BM, Droste P, Kappel B, Haj-Yehia E, Maxeiner S, Artati A, Adamski J, Boor P, Schütt K, Lopaschuk GD, Verma S, Marx N, Lehrke M. Empagliflozin improves left ventricular diastolic function of db/db mice. Biochim Biophys Acta Mol Basis Dis 2020; 1866:165807. [PMID: 32353614 DOI: 10.1016/j.bbadis.2020.165807] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/09/2020] [Accepted: 04/15/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Investigation of the effect of SGLT2 inhibition by empagliflozin on left ventricular function in a model of diabetic cardiomyopathy. BACKGROUND SGLT2 inhibition is a new strategy to treat diabetes. In the EMPA-REG Outcome trial empagliflozin treatment reduced cardiovascular and overall mortality in patients with diabetes presumably due to beneficial cardiac effects, leading to reduced heart failure hospitalization. The relevant mechanisms remain currently elusive but might be mediated by a shift in cardiac substrate utilization leading to improved energetic supply to the heart. METHODS We used db/db mice on high-fat western diet with or without empagliflozin treatment as a model of severe diabetes. Left ventricular function was assessed by pressure catheter with or without dobutamine stress. RESULTS Treatment with empagliflozin significantly increased glycosuria, improved glucose metabolism, ameliorated left ventricular diastolic function and reduced mortality of mice. This was associated with reduced cardiac glucose concentrations and decreased calcium/calmodulin-dependent protein kinase (CaMKII) activation with subsequent less phosphorylation of the ryanodine receptor (RyR). No change of cardiac ketone bodies or branched-chain amino acid (BCAA) metabolites in serum was detected nor was cardiac expression of relevant catabolic enzymes for these substrates affected. CONCLUSIONS In a murine model of severe diabetes empagliflozin-dependent SGLT2 inhibition improved diastolic function and reduced mortality. Improvement of diastolic function was likely mediated by reduced spontaneous diastolic sarcoplasmic reticulum (SR) calcium release but independent of changes in cardiac ketone and BCAA metabolism.
Collapse
Affiliation(s)
- Julia Moellmann
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Barbara M Klinkhammer
- Institute of Pathology, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Patrick Droste
- Institute of Pathology, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Ben Kappel
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Elias Haj-Yehia
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Sebastian Maxeiner
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Anna Artati
- Research Unit Molecular Endocrinology and Metabolism, Helmholtz Centrum Munich, German Research Center for Environmental Health (GmbH), Munich-Neuherberg, Germany
| | - Jerzy Adamski
- Research Unit Molecular Endocrinology and Metabolism, Helmholtz Centrum Munich, German Research Center for Environmental Health (GmbH), Munich-Neuherberg, Germany; Chair of Experimental Genetics, Technical University of Munich, Freising-Weihenstephan, Germany; German Center for Diabetes Research (DZD e.V.), Munich-Neuherberg, Germany; Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Peter Boor
- Institute of Pathology, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Katharina Schütt
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Gary D Lopaschuk
- Cardiovascular Research Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
| | - Nikolaus Marx
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany.
| | - Michael Lehrke
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany.
| |
Collapse
|
18
|
Buhl EM, Djudjaj S, Klinkhammer BM, Ermert K, Puelles VG, Lindenmeyer MT, Cohen CD, He C, Borkham‐Kamphorst E, Weiskirchen R, Denecke B, Trairatphisan P, Saez‐Rodriguez J, Huber TB, Olson LE, Floege J, Boor P. Dysregulated mesenchymal PDGFR-β drives kidney fibrosis. EMBO Mol Med 2020; 12:e11021. [PMID: 31943786 PMCID: PMC7059015 DOI: 10.15252/emmm.201911021] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 12/08/2019] [Accepted: 12/09/2019] [Indexed: 12/21/2022] Open
Abstract
Kidney fibrosis is characterized by expansion and activation of platelet-derived growth factor receptor-β (PDGFR-β)-positive mesenchymal cells. To study the consequences of PDGFR-β activation, we developed a model of primary renal fibrosis using transgenic mice with PDGFR-β activation specifically in renal mesenchymal cells, driving their pathological proliferation and phenotypic switch toward myofibroblasts. This resulted in progressive mesangioproliferative glomerulonephritis, mesangial sclerosis, and interstitial fibrosis with progressive anemia due to loss of erythropoietin production by fibroblasts. Fibrosis induced secondary tubular epithelial injury at later stages, coinciding with microinflammation, and aggravated the progression of hypertensive and obstructive nephropathy. Inhibition of PDGFR activation reversed fibrosis more effectively in the tubulointerstitium compared to glomeruli. Gene expression signatures in mice with PDGFR-β activation resembled those found in patients. In conclusion, PDGFR-β activation alone is sufficient to induce progressive renal fibrosis and failure, mimicking key aspects of chronic kidney disease in humans. Our data provide direct proof that fibrosis per se can drive chronic organ damage and establish a model of primary fibrosis allowing specific studies targeting fibrosis progression and regression.
Collapse
Affiliation(s)
- Eva M Buhl
- Institute of PathologyRWTH University of AachenAachenGermany
- Division of NephrologyRWTH University of AachenAachenGermany
- Electron Microscopy FacilityRWTH University of AachenAachenGermany
| | - Sonja Djudjaj
- Institute of PathologyRWTH University of AachenAachenGermany
| | | | - Katja Ermert
- Institute of PathologyRWTH University of AachenAachenGermany
| | - Victor G Puelles
- Division of NephrologyRWTH University of AachenAachenGermany
- III. Department of MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Department of NephrologyMonash Health, and Center for Inflammatory DiseasesMonash UniversityMelbourneVic.Australia
| | - Maja T Lindenmeyer
- III. Department of MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Clemens D Cohen
- Nephrological CenterMedical Clinic and Policlinic IVUniversity of MunichMunichGermany
| | - Chaoyong He
- Cardiovascular Biology ProgramOklahoma Medical Research FoundationOklahoma CityOKUSA
- State Key Laboratory of Natural MedicinesDepartment of PharmacologyChina Pharmaceutical UniversityNanjingChina
| | - Erawan Borkham‐Kamphorst
- Institute of Molecular Pathobiochemistry, Experimental Gene Therapy and Clinical ChemistryRWTH University of AachenAachenGermany
| | - Ralf Weiskirchen
- Institute of Molecular Pathobiochemistry, Experimental Gene Therapy and Clinical ChemistryRWTH University of AachenAachenGermany
| | - Bernd Denecke
- Interdisciplinary Center for Clinical Research (IZKF)RWTH University of AachenAachenGermany
| | - Panuwat Trairatphisan
- Faculty of MedicineInstitute for Computational BiomedicineHeidelberg University, and Heidelberg University HospitalHeidelbergGermany
| | - Julio Saez‐Rodriguez
- Faculty of MedicineInstitute for Computational BiomedicineHeidelberg University, and Heidelberg University HospitalHeidelbergGermany
| | - Tobias B Huber
- III. Department of MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Lorin E Olson
- Cardiovascular Biology ProgramOklahoma Medical Research FoundationOklahoma CityOKUSA
| | - Jürgen Floege
- Division of NephrologyRWTH University of AachenAachenGermany
| | - Peter Boor
- Institute of PathologyRWTH University of AachenAachenGermany
- Division of NephrologyRWTH University of AachenAachenGermany
| |
Collapse
|
19
|
Shi C, Kim T, Steiger S, Mulay SR, Klinkhammer BM, Bäuerle T, Melica ME, Romagnani P, Möckel D, Baues M, Yang L, Brouns SLN, Heemskerk JWM, Braun A, Lammers T, Boor P, Anders HJ. Crystal Clots as Therapeutic Target in Cholesterol Crystal Embolism. Circ Res 2020; 126:e37-e52. [PMID: 32089086 DOI: 10.1161/circresaha.119.315625] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
RATIONALE Cholesterol crystal embolism can be a life-threatening complication of advanced atherosclerosis. Pathophysiology and molecular targets for treatment are largely unknown. OBJECTIVE We aimed to develop a new animal model of cholesterol crystal embolism to dissect the molecular mechanisms of cholesterol crystal (CC)-driven arterial occlusion, tissue infarction, and organ failure. METHODS AND RESULTS C57BL/6J mice were injected with CC into the left kidney artery. Primary end point was glomerular filtration rate (GFR). CC caused crystal clots occluding intrarenal arteries and a dose-dependent drop in GFR, followed by GFR recovery within 4 weeks, that is, acute kidney disease. In contrast, the extent of kidney infarction was more variable. Blocking necroptosis using mixed lineage kinase domain-like deficient mice or necrostatin-1s treatment protected from kidney infarction but not from GFR loss because arterial obstructions persisted, identifying crystal clots as a primary target to prevent organ failure. CC involved platelets, neutrophils, fibrin, and extracellular DNA. Neutrophil depletion or inhibition of the release of neutrophil extracellular traps had little effects, but platelet P2Y12 receptor antagonism with clopidogrel, fibrinolysis with urokinase, or DNA digestion with recombinant DNase I all prevented arterial occlusions, GFR loss, and kidney infarction. The window-of-opportunity was <3 hours after CC injection. However, combining Nec-1s (necrostatin-1s) prophylaxis given 1 hour before and DNase I 3 hours after CC injection completely prevented kidney failure and infarcts. In vitro, CC did not directly induce plasmatic coagulation but induced neutrophil extracellular trap formation and DNA release mainly from kidney endothelial cells, neutrophils, and few from platelets. CC induced ATP release from aggregating platelets, which increased fibrin formation in a DNase-dependent manner. CONCLUSIONS CC embolism causes arterial obstructions and organ failure via the formation of crystal clots with fibrin, platelets, and extracellular DNA as critical components. Therefore, our model enables to unravel the pathogenesis of the CC embolism syndrome as a basis for both prophylaxis and targeted therapy.
Collapse
Affiliation(s)
- Chongxu Shi
- From the Medizinische Klinik und Poliklinik IV, Klinikum der Universität, LMU München, Germany (C.S., T.K., S.S., S.R.M., L.Y., H.-J.A.)
| | - Tehyung Kim
- From the Medizinische Klinik und Poliklinik IV, Klinikum der Universität, LMU München, Germany (C.S., T.K., S.S., S.R.M., L.Y., H.-J.A.)
| | - Stefanie Steiger
- From the Medizinische Klinik und Poliklinik IV, Klinikum der Universität, LMU München, Germany (C.S., T.K., S.S., S.R.M., L.Y., H.-J.A.)
| | - Shrikant R Mulay
- From the Medizinische Klinik und Poliklinik IV, Klinikum der Universität, LMU München, Germany (C.S., T.K., S.S., S.R.M., L.Y., H.-J.A.)
| | - Barbara M Klinkhammer
- Department of Nephrology, Institute of Pathology (B.M.K, P.B.), RWTH Aachen University Hospital, Germany
| | - Tobias Bäuerle
- Preclinical Imaging Platform Erlangen, Institute of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany (T.B.)
| | - Maria Elena Melica
- Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (M.E.M., P.R.), University of Florence, Italy.,Department of Experimental and Clinical Biomedical Sciences "Mario Serio" (M.E.M., P.R.), University of Florence, Italy
| | - Paola Romagnani
- Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (M.E.M., P.R.), University of Florence, Italy.,Department of Experimental and Clinical Biomedical Sciences "Mario Serio" (M.E.M., P.R.), University of Florence, Italy.,Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, Italy (P.R.)
| | - Diana Möckel
- Institute for Experimental Molecular Imaging (D.M., M.B., T.L.), RWTH Aachen University Hospital, Germany
| | - Maike Baues
- Institute for Experimental Molecular Imaging (D.M., M.B., T.L.), RWTH Aachen University Hospital, Germany
| | - Luying Yang
- From the Medizinische Klinik und Poliklinik IV, Klinikum der Universität, LMU München, Germany (C.S., T.K., S.S., S.R.M., L.Y., H.-J.A.)
| | - Sanne L N Brouns
- Department of Biochemistry, CARIM, Maastricht University, The Netherlands (S.L.N.B., J.W.M.H.)
| | - Johan W M Heemskerk
- Department of Biochemistry, CARIM, Maastricht University, The Netherlands (S.L.N.B., J.W.M.H.)
| | - Attila Braun
- Walther-Straub-Institute for Pharmacology and Toxicology, Ludwig-Maximilians University Munich, German Center for Lung Research, Germany (A.B.)
| | - Twan Lammers
- Institute for Experimental Molecular Imaging (D.M., M.B., T.L.), RWTH Aachen University Hospital, Germany
| | - Peter Boor
- Department of Nephrology, Institute of Pathology (B.M.K, P.B.), RWTH Aachen University Hospital, Germany
| | - Hans-Joachim Anders
- From the Medizinische Klinik und Poliklinik IV, Klinikum der Universität, LMU München, Germany (C.S., T.K., S.S., S.R.M., L.Y., H.-J.A.)
| |
Collapse
|
20
|
Gadermayr M, Gupta L, Appel V, Boor P, Klinkhammer BM, Merhof D. Generative Adversarial Networks for Facilitating Stain-Independent Supervised and Unsupervised Segmentation: A Study on Kidney Histology. IEEE Trans Med Imaging 2019; 38:2293-2302. [PMID: 30762541 DOI: 10.1109/tmi.2019.2899364] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
A major challenge in the field of segmentation in digital pathology is given by the high effort for manual data annotations in combination with many sources introducing variability in the image domain. This requires methods that are able to cope with variability without requiring to annotate a large amount of samples for each characteristic. In this paper, we develop approaches based on adversarial models for image-to-image translation relying on unpaired training. Specifically, we propose approaches for stain-independent supervised segmentation relying on image-to-image translation for obtaining an intermediate representation. Furthermore, we develop a fully-unsupervised segmentation approach exploiting image-to-image translation to convert from the image to the label domain. Finally, both approaches are combined to obtain optimum performance in unsupervised segmentation independent of the characteristics of the underlying stain. Experiments on patches showing kidney histology proof that stain-translation can be performed highly effectively and can be used for domain adaptation to obtain independence of the underlying stain. It is even capable of facilitating the underlying segmentation task, thereby boosting the accuracy if an appropriate intermediate stain is selected. Combining domain adaptation with unsupervised segmentation finally showed the most significant improvements.
Collapse
|
21
|
Puelles VG, Fleck D, Ortz L, Papadouri S, Strieder T, Böhner AM, van der Wolde JW, Vogt M, Saritas T, Kuppe C, Fuss A, Menzel S, Klinkhammer BM, Müller-Newen G, Heymann F, Decker L, Braun F, Kretz O, Huber TB, Susaki EA, Ueda HR, Boor P, Floege J, Kramann R, Kurts C, Bertram JF, Spehr M, Nikolic-Paterson DJ, Moeller MJ. Novel 3D analysis using optical tissue clearing documents the evolution of murine rapidly progressive glomerulonephritis. Kidney Int 2019; 96:505-516. [DOI: 10.1016/j.kint.2019.02.034] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 01/23/2019] [Accepted: 02/28/2019] [Indexed: 12/17/2022]
|
22
|
Buchtler S, Grill A, Hofmarksrichter S, Stöckert P, Schiechl-Brachner G, Rodriguez Gomez M, Neumayer S, Schmidbauer K, Talke Y, Klinkhammer BM, Boor P, Medvinsky A, Renner K, Castrop H, Mack M. Cellular Origin and Functional Relevance of Collagen I Production in the Kidney. J Am Soc Nephrol 2018; 29:1859-1873. [PMID: 29777019 PMCID: PMC6050926 DOI: 10.1681/asn.2018020138] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [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: 02/08/2018] [Accepted: 04/23/2018] [Indexed: 01/13/2023] Open
Abstract
Background Interstitial fibrosis is associated with chronic renal failure. In addition to fibroblasts, bone marrow-derived cells and tubular epithelial cells have the capacity to produce collagen. However, the amount of collagen produced by each of these cell types and the relevance of fibrosis to renal function are unclear.Methods We generated conditional cell type-specific collagen I knockout mice and used (reversible) unilateral ureteral obstruction and adenine-induced nephropathy to study renal fibrosis and function.Results In these mouse models, hematopoietic, bone marrow-derived cells contributed to 38%-50% of the overall deposition of collagen I in the kidney. The influence of fibrosis on renal function was dependent on the type of damage. In unilateral ureteral obstruction, collagen production by resident fibroblasts was essential to preserve renal function, whereas in the chronic model of adenine-induced nephropathy, collagen production was detrimental to renal function.Conclusions Our data show that hematopoietic cells are a major source of collagen and that antifibrotic therapies need to be carefully considered depending on the type of disease and the underlying cause of fibrosis.
Collapse
Affiliation(s)
- Simone Buchtler
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - Alexandra Grill
- Institute of Physiology, University of Regensburg, Regensburg, Germany
| | | | - Petra Stöckert
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | | | | | - Sophia Neumayer
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - Kathrin Schmidbauer
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - Yvonne Talke
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - Barbara M Klinkhammer
- Department of Pathology and
- Department of Nephrology, RWTH Aachen University, Aachen, Germany; and
| | - Peter Boor
- Department of Pathology and
- Department of Nephrology, RWTH Aachen University, Aachen, Germany; and
| | - Alexander Medvinsky
- Institute for Stem Cell Research, Medical Research Council Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Kerstin Renner
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - Hayo Castrop
- Institute of Physiology, University of Regensburg, Regensburg, Germany
| | - Matthias Mack
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany;
| |
Collapse
|
23
|
Döring Y, Noels H, van der Vorst EPC, Neideck C, Egea V, Drechsler M, Mandl M, Pawig L, Jansen Y, Schröder K, Bidzhekov K, Megens RTA, Theelen W, Klinkhammer BM, Boor P, Schurgers L, van Gorp R, Ries C, Kusters PJH, van der Wal A, Hackeng TM, Gäbel G, Brandes RP, Soehnlein O, Lutgens E, Vestweber D, Teupser D, Holdt LM, Rader DJ, Saleheen D, Weber C. Vascular CXCR4 Limits Atherosclerosis by Maintaining Arterial Integrity: Evidence From Mouse and Human Studies. Circulation 2017; 136:388-403. [PMID: 28450349 DOI: 10.1161/circulationaha.117.027646] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/17/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The CXCL12/CXCR4 chemokine ligand/receptor axis controls (progenitor) cell homeostasis and trafficking. So far, an atheroprotective role of CXCL12/CXCR4 has only been implied through pharmacological intervention, in particular, because the somatic deletion of the CXCR4 gene in mice is embryonically lethal. Moreover, cell-specific effects of CXCR4 in the arterial wall and underlying mechanisms remain elusive, prompting us to investigate the relevance of CXCR4 in vascular cell types for atheroprotection. METHODS We examined the role of vascular CXCR4 in atherosclerosis and plaque composition by inducing an endothelial cell (BmxCreERT2-driven)-specific or smooth muscle cell (SMC, SmmhcCreERT2- or TaglnCre-driven)-specific deficiency of CXCR4 in an apolipoprotein E-deficient mouse model. To identify underlying mechanisms for effects of CXCR4, we studied endothelial permeability, intravital leukocyte adhesion, involvement of the Akt/WNT/β-catenin signaling pathway and relevant phosphatases in VE-cadherin expression and function, vascular tone in aortic rings, cholesterol efflux from macrophages, and expression of SMC phenotypic markers. Finally, we analyzed associations of common genetic variants at the CXCR4 locus with the risk for coronary heart disease, along with CXCR4 transcript expression in human atherosclerotic plaques. RESULTS The cell-specific deletion of CXCR4 in arterial endothelial cells (n=12-15) or SMCs (n=13-24) markedly increased atherosclerotic lesion formation in hyperlipidemic mice. Endothelial barrier function was promoted by CXCL12/CXCR4, which triggered Akt/WNT/β-catenin signaling to drive VE-cadherin expression and stabilized junctional VE-cadherin complexes through associated phosphatases. Conversely, endothelial CXCR4 deficiency caused arterial leakage and inflammatory leukocyte recruitment during atherogenesis. In arterial SMCs, CXCR4 sustained normal vascular reactivity and contractile responses, whereas CXCR4 deficiency favored a synthetic phenotype, the occurrence of macrophage-like SMCs in the lesions, and impaired cholesterol efflux. Regression analyses in humans (n=259 796) identified the C-allele at rs2322864 within the CXCR4 locus to be associated with increased risk for coronary heart disease. In line, C/C risk genotype carriers showed reduced CXCR4 expression in carotid artery plaques (n=188), which was furthermore associated with symptomatic disease. CONCLUSIONS Our data clearly establish that vascular CXCR4 limits atherosclerosis by maintaining arterial integrity, preserving endothelial barrier function, and a normal contractile SMC phenotype. Enhancing these beneficial functions of arterial CXCR4 by selective modulators might open novel therapeutic options in atherosclerosis.
Collapse
Affiliation(s)
| | - Heidi Noels
- From Institute for Cardiovascular Prevention (IPEK), LMU Munich, Germany (Y.D., E.P.C.v.d.V., C.N., V.E., M.D., M.M., Y.J., K.B., R.T.A.M., C.R., O.S., E.T., C.W.); Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University, Germany (H.N., L.P., W.T.); Institute for Cardiovascular Physiology, Vascular Research Centre, Goethe University, Frankfurt am Main, Germany (K.S., R.P.B.); Division of Nephrology and Immunology, RWTH Aachen University Hospital, Germany (B.M.K., P.B.); Cardiovascular Research Institute Maastricht (CARIM), Department of Biochemistry, Maastricht University, the Netherlands (R.T.A.M., R.v.G., T.M.H., C.W.); Academic Medical Center, Department of Pathology and Department of Medical Biochemistry, Amsterdam University, the Netherlands (P.J.H.K., A.v.D.W., E.T.); Department of Vascular and Endovascular Surgery, LMU Munich, Germany (G.G.); DZHK (German Centre for Cardiovascular Research), partner site Frankfurt am Main, Germany (R.P.B.); DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Germany (O.S., C.W.); Department of Physiology and Pharmacology, Karolinksa Institutet, Stockholm, Sweden (O.S.); Max-Plank-Institute for Molecular Biomedicine, Münster, Germany (D.V.); Institute for Laboratory Medicine, LMU Munich, Germany (D.T., L.M.H.); and Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (D.J.R., D.S.)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Klinkhammer BM, Goldschmeding R, Floege J, Boor P. Treatment of Renal Fibrosis-Turning Challenges into Opportunities. Adv Chronic Kidney Dis 2017; 24:117-129. [PMID: 28284377 DOI: 10.1053/j.ackd.2016.11.002] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 11/03/2016] [Indexed: 12/19/2022]
Abstract
Current treatment modalities are not effective in halting the progression of most CKD. Renal fibrosis is a pathological process common to all CKD and thereby represents an excellent treatment target. A large number of molecular pathways involved in renal fibrosis were identified in preclinical studies, some of them being similar among different organs and some with available drugs in various phases of clinical testing. Yet only few clinical trials with antifibrotic drugs are being conducted in CKD patients. Here we review those clinical trials, focusing on agents with direct antifibrotic effects, with particular focus on pirfenidone and neutralizing antibodies directed against profibrotic growth factors and cell connection proteins. We discuss the potential reasons for the poor translation in treatment of renal fibrosis and propose possible approaches and future developments to improve it, eg, patient selection and companion diagnostics, specific and sensitive biomarkers as novel end points for clinical trials, and drug-targeting and theranostics.
Collapse
|
25
|
Bábíčková J, Klinkhammer BM, Buhl EM, Djudjaj S, Hoss M, Heymann F, Tacke F, Floege J, Becker JU, Boor P. Regardless of etiology, progressive renal disease causes ultrastructural and functional alterations of peritubular capillaries. Kidney Int 2016; 91:70-85. [PMID: 27678159 DOI: 10.1016/j.kint.2016.07.038] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [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: 04/15/2016] [Revised: 07/15/2016] [Accepted: 07/28/2016] [Indexed: 12/28/2022]
Abstract
Progressive renal diseases are associated with rarefaction of peritubular capillaries, but the ultrastructural and functional alterations of the microvasculature are not well described. To study this, we analyzed different time points during progressive kidney damage and fibrosis in 3 murine models of different disease etiologies. These models were unilateral ureteral obstruction, unilateral ischemia-reperfusion injury, and Col4a3-deficient mice, we analyzed ultrastructural alterations in patient biopsy specimens. Compared with kidneys of healthy mice, we found a significant and progressive reduction of peritubular capillaries in all models analyzed. Ultrastructurally, compared with the kidneys of control mice, focal widening of the subendothelial space and higher numbers of endothelial vacuoles and caveolae were found in fibrotic kidneys. Quantitative analysis showed that peritubular capillary endothelial cells in fibrotic kidneys had significantly and progressively reduced numbers of fenestrations and increased thickness of the cell soma and lamina densa of the capillary basement membrane. Similar ultrastructural changes were also observed in patient's kidney biopsy specimens. Compared with healthy murine kidneys, fibrotic kidneys had significantly increased extravasation of Evans blue dye in all 3 models. The extravasation could be visualized using 2-photon microscopy in real time in living animals and was mainly localized to capillary branching points. Finally, fibrotic kidneys in all models exhibited a significantly greater degree of interstitial deposition of fibrinogen. Thus, peritubular capillaries undergo significant ultrastructural and functional alterations during experimental progressive renal diseases, independent of the underlying injury. Analyses of these alterations could provide read-outs for the evaluation of therapeutic approaches targeting the renal microvasculature.
Collapse
Affiliation(s)
- Janka Bábíčková
- Institute of Pathology, RWTH University of Aachen, Aachen, Germany; Division of Nephrology, RWTH University of Aachen, Aachen, Germany; Institute of Molecular Biomedicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia; Institute for Clinical and Translational Research, Biomedical Research Center SAS, Bratislava, Slovakia
| | | | - Eva M Buhl
- Institute of Pathology, RWTH University of Aachen, Aachen, Germany; Division of Nephrology, RWTH University of Aachen, Aachen, Germany
| | - Sonja Djudjaj
- Institute of Pathology, RWTH University of Aachen, Aachen, Germany
| | - Mareike Hoss
- Institute of Pathology, RWTH University of Aachen, Aachen, Germany; Electron Microscopy Facility, RWTH University of Aachen, Aachen, Germany
| | - Felix Heymann
- Division of Gastroenterology, RWTH University of Aachen, Aachen, Germany
| | - Frank Tacke
- Division of Gastroenterology, RWTH University of Aachen, Aachen, Germany
| | - Jürgen Floege
- Division of Nephrology, RWTH University of Aachen, Aachen, Germany
| | - Jan U Becker
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | - Peter Boor
- Institute of Pathology, RWTH University of Aachen, Aachen, Germany; Division of Nephrology, RWTH University of Aachen, Aachen, Germany.
| |
Collapse
|
26
|
Klinkhammer BM, Djudjaj S, Kunter U, Hoss M, Floege J, Boor P. TO032CONSEQUENCES AND FATE OF INTRARENAL CRYSTALS IN ADENINE NEPHROPATHY. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw148.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
27
|
Buhl EM, Djudjaj S, Klinkhammer BM, Borkham-Kamphorst E, Weiskirchen R, Olson LE, Floege J, Boor P. SP277CONSTITUTIVE ACTIVATION OF PDGFR-β IN RENAL MESENCHYMAL CELLS DRIVES RENAL FIBROSIS. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw164.21] [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: 11/12/2022] Open
|
28
|
Klinkhammer BM, Möllmann J, Stöhr R, Lebherz C, Marx N, Lehrke M, Boor P. SO018EFFECTS OF GLP-1 ON METABOLIC KIDNEY AND HEART DISEASE. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw120.01] [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
|
29
|
Ehling J, Klinkhammer BM, Sun Q, Baues M, Kiessling F, Floege J, Lammers T, Boor P. MO025NON-INVASIVE MOLECULAR IMAGING OF KIDNEY FIBROSIS. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw134.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
30
|
Buhl EM, Djudjaj S, Babickova J, Klinkhammer BM, Folestad E, Borkham-Kamphorst E, Weiskirchen R, Hudkins K, Alpers CE, Eriksson U, Floege J, Boor P. The role of PDGF-D in healthy and fibrotic kidneys. Kidney Int 2016; 89:848-61. [DOI: 10.1016/j.kint.2015.12.037] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/20/2015] [Accepted: 12/11/2015] [Indexed: 02/04/2023]
|
31
|
Djudjaj S, Lue H, Rong S, Papasotiriou M, Klinkhammer BM, Zok S, Klaener O, Braun GS, Lindenmeyer MT, Cohen CD, Bucala R, Tittel AP, Kurts C, Moeller MJ, Floege J, Ostendorf T, Bernhagen J, Boor P. Macrophage Migration Inhibitory Factor Mediates Proliferative GN via CD74. J Am Soc Nephrol 2015; 27:1650-64. [PMID: 26453615 DOI: 10.1681/asn.2015020149] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [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: 02/10/2015] [Accepted: 08/24/2015] [Indexed: 01/09/2023] Open
Abstract
Pathologic proliferation of mesangial and parietal epithelial cells (PECs) is a hallmark of various glomerulonephritides. Macrophage migration inhibitory factor (MIF) is a pleiotropic cytokine that mediates inflammation by engagement of a receptor complex involving the components CD74, CD44, CXCR2, and CXCR4. The proliferative effects of MIF may involve CD74 together with the coreceptor and PEC activation marker CD44. Herein, we analyzed the effects of local glomerular MIF/CD74/CD44 signaling in proliferative glomerulonephritides. MIF, CD74, and CD44 were upregulated in the glomeruli of patients and mice with proliferative glomerulonephritides. During disease, CD74 and CD44 were expressed de novo in PECs and colocalized in both PECs and mesangial cells. Stress stimuli induced MIF secretion from glomerular cells in vitro and in vivo, in particular from podocytes, and MIF stimulation induced proliferation of PECs and mesangial cells via CD74. In murine crescentic GN, Mif-deficient mice were almost completely protected from glomerular injury, the development of cellular crescents, and the activation and proliferation of PECs and mesangial cells, whereas wild-type mice were not. Bone marrow reconstitution studies showed that deficiency of both nonmyeloid and bone marrow-derived Mif reduced glomerular cell proliferation and injury. In contrast to wild-type mice, Cd74-deficient mice also were protected from glomerular injury and ensuing activation and proliferation of PECs and mesangial cells. Our data suggest a novel molecular mechanism and glomerular cell crosstalk by which local upregulation of MIF and its receptor complex CD74/CD44 mediate glomerular injury and pathologic proliferation in GN.
Collapse
Affiliation(s)
- Sonja Djudjaj
- Department of Pathology, Department of Nephrology and Immunology, and
| | - Hongqi Lue
- Institute of Biochemistry and Molecular Cell Biology, RWTH Aachen University, Aachen, Germany
| | - Song Rong
- Department of Nephrology and Immunology, and
| | | | | | | | - Ole Klaener
- Department of Pathology, Department of Nephrology and Immunology, and
| | | | - Maja T Lindenmeyer
- Division of Nephrology and Institute of Physiology, University of Zürich, Zürich, Switzerland
| | - Clemens D Cohen
- Division of Nephrology and Institute of Physiology, University of Zürich, Zürich, Switzerland
| | - Richard Bucala
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Andre P Tittel
- Institute of Molecular Medicine and Experimental Immunology, University of Bonn, Bonn, Germany; and
| | - Christian Kurts
- Institute of Molecular Medicine and Experimental Immunology, University of Bonn, Bonn, Germany; and
| | | | | | | | - Jürgen Bernhagen
- Institute of Biochemistry and Molecular Cell Biology, RWTH Aachen University, Aachen, Germany;
| | - Peter Boor
- Department of Pathology, Department of Nephrology and Immunology, and Institute of Molecular Biomedicine, Comenius University, Bratislava, Slovakia
| |
Collapse
|
32
|
Ehling J, Bábíčková J, Gremse F, Klinkhammer BM, Baetke S, Knuechel R, Kiessling F, Floege J, Lammers T, Boor P. Quantitative Micro-Computed Tomography Imaging of Vascular Dysfunction in Progressive Kidney Diseases. J Am Soc Nephrol 2015. [PMID: 26195818 DOI: 10.1681/asn.2015020204] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Progressive kidney diseases and renal fibrosis are associated with endothelial injury and capillary rarefaction. However, our understanding of these processes has been hampered by the lack of tools enabling the quantitative and noninvasive monitoring of vessel functionality. Here, we used micro-computed tomography (µCT) for anatomical and functional imaging of vascular alterations in three murine models with distinct mechanisms of progressive kidney injury: ischemia-reperfusion (I/R, days 1-56), unilateral ureteral obstruction (UUO, days 1-10), and Alport mice (6-8 weeks old). Contrast-enhanced in vivo µCT enabled robust, noninvasive, and longitudinal monitoring of vessel functionality and revealed a progressive decline of the renal relative blood volume in all models. This reduction ranged from -20% in early disease stages to -61% in late disease stages and preceded fibrosis. Upon Microfil perfusion, high-resolution ex vivo µCT allowed quantitative analyses of three-dimensional vascular networks in all three models. These analyses revealed significant and previously unrecognized alterations of preglomerular arteries: a reduction in vessel diameter, a prominent reduction in vessel branching, and increased vessel tortuosity. In summary, using µCT methodology, we revealed insights into macro-to-microvascular alterations in progressive renal disease and provide a platform that may serve as the basis to evaluate vascular therapeutics in renal disease.
Collapse
Affiliation(s)
- Josef Ehling
- Institute for Experimental Molecular Imaging, Helmholtz Institute for Biomedical Engineering, Medical Faculty, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University, Aachen, Germany; Institute of Pathology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Janka Bábíčková
- Institute of Pathology, Medical Faculty, RWTH Aachen University, Aachen, Germany; Institute of Molecular Biomedicine, Comenius University, Bratislava, Slovakia
| | - Felix Gremse
- Institute for Experimental Molecular Imaging, Helmholtz Institute for Biomedical Engineering, Medical Faculty, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University, Aachen, Germany
| | | | - Sarah Baetke
- Institute for Experimental Molecular Imaging, Helmholtz Institute for Biomedical Engineering, Medical Faculty, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University, Aachen, Germany
| | - Ruth Knuechel
- Institute of Pathology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Fabian Kiessling
- Institute for Experimental Molecular Imaging, Helmholtz Institute for Biomedical Engineering, Medical Faculty, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University, Aachen, Germany
| | - Jürgen Floege
- Department of Nephrology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Twan Lammers
- Institute for Experimental Molecular Imaging, Helmholtz Institute for Biomedical Engineering, Medical Faculty, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University, Aachen, Germany; Department of Targeted Therapeutics, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands; and Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Peter Boor
- Institute of Pathology, Medical Faculty, RWTH Aachen University, Aachen, Germany; Institute of Molecular Biomedicine, Comenius University, Bratislava, Slovakia; Department of Nephrology, Medical Faculty, RWTH Aachen University, Aachen, Germany;
| |
Collapse
|
33
|
Braun GS, Nagayama Y, Maruta Y, Heymann F, van Roeyen CR, Klinkhammer BM, Boor P, Villa L, Salant DJ, Raffetseder U, Rose-John S, Ostendorf T, Floege J. IL-6 Trans-Signaling Drives Murine Crescentic GN. J Am Soc Nephrol 2015; 27:132-42. [PMID: 26041841 DOI: 10.1681/asn.2014111147] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [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: 11/26/2014] [Accepted: 03/20/2015] [Indexed: 01/07/2023] Open
Abstract
The role of IL-6 signaling in renal diseases remains controversial, with data describing both anti-inflammatory and proinflammatory effects. IL-6 can act via classic signaling, engaging its two membrane receptors gp130 and IL-6 receptor (IL-6R). Alternatively, IL-6 trans-signaling requires soluble IL-6R (sIL-6R) to act on IL-6R-negative cells that express gp130. Here, we characterize the role of both pathways in crescentic nephritis. Patients with crescentic nephritis had significantly elevated levels of IL-6 in both serum and urine. Similarly, nephrotoxic serum-induced nephritis (NTN) in BALB/c mice was associated with elevated serum IL-6 levels. Levels of serum sIL-6R and renal downstream signals of IL-6 (phosphorylated signal transducer and activator of transcription 3, suppressor of cytokine signaling 3) increased over time in this model. Simultaneous inhibition of both IL-6 signaling pathways using anti-IL-6 antibody did not have a significant impact on NTN severity. In contrast, specific inhibition of trans-signaling using recombinant sgp130Fc resulted in milder disease. Vice versa, specific activation of trans-signaling using a recombinant IL-6-sIL-6R fusion molecule (Hyper-IL-6) significantly aggravated NTN and led to increased systolic BP in NTN mice. This correlated with increased renal mRNA synthesis of the Th17 cell cytokine IL-17A and decreased synthesis of resistin-like alpha (RELMalpha)-encoding mRNA, a surrogate marker of lesion-mitigating M2 macrophage subtypes. Collectively, our data suggest a central role for IL-6 trans-signaling in crescentic nephritis and offer options for more effective and specific therapeutic interventions in the IL-6 system.
Collapse
Affiliation(s)
- Gerald S Braun
- Division of Nephrology and Immunology, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University, Aachen Germany; Institute of Biochemistry and Molecular Biology, RWTH Aachen University, Aachen, Germany;
| | - Yoshikuni Nagayama
- Division of Nephrology and Immunology, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University, Aachen Germany; Division of Nephrology, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Yuichi Maruta
- Division of Nephrology and Immunology, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University, Aachen Germany; Division of Nephrology, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Felix Heymann
- Division of Gastroenterology, Metabolic Diseases and Intensive Care, RWTH Aachen University, Aachen, Germany
| | - Claudia R van Roeyen
- Division of Nephrology and Immunology, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University, Aachen Germany
| | - Barbara M Klinkhammer
- Division of Nephrology and Immunology, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University, Aachen Germany; Institute of Pathology, RWTH Aachen University, Aachen, Germany
| | - Peter Boor
- Division of Nephrology and Immunology, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University, Aachen Germany; Institute of Pathology, RWTH Aachen University, Aachen, Germany; Institute of Molecular Biomedicine, Comenius University, Bratislava, Slovakia
| | - Luigi Villa
- Division of Nephrology and Immunology, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University, Aachen Germany
| | - David J Salant
- Department of Medicine, Section of Nephrology, Boston University School of Medicine, Boston, MA; and
| | - Ute Raffetseder
- Division of Nephrology and Immunology, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University, Aachen Germany
| | - Stefan Rose-John
- Institute of Biochemistry, Christian-Albrechts-University, Kiel, Germany
| | - Tammo Ostendorf
- Division of Nephrology and Immunology, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University, Aachen Germany
| | - Jürgen Floege
- Division of Nephrology and Immunology, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University, Aachen Germany
| |
Collapse
|
34
|
Papasotiriou M, Genovese F, Klinkhammer BM, Kunter U, Nielsen SH, Karsdal MA, Floege J, Boor P. FP221SERUM AND URINE MARKERS OF COLLAGEN DEGRADATION REFLECT RENAL FIBROSIS IN EXPERIMENTAL KIDNEY DISEASES. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv173.03] [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: 11/12/2022] Open
|
35
|
Papasotiriou M, Genovese F, Klinkhammer BM, Kunter U, Nielsen SH, Karsdal MA, Floege J, Boor P. Serum and urine markers of collagen degradation reflect renal fibrosis in experimental kidney diseases. Nephrol Dial Transplant 2015; 30:1112-21. [PMID: 25784725 DOI: 10.1093/ndt/gfv063] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 02/19/2015] [Indexed: 01/24/2023] Open
Affiliation(s)
- Marios Papasotiriou
- Institute of Pathology, RWTH University of Aachen, Aachen, NRW, Germany Department of Nephrology, RWTH University of Aachen, Aachen, NRW, Germany Department of Nephrology, University Hospital of Patras, Patras, Greece
| | | | | | - Uta Kunter
- Department of Nephrology, RWTH University of Aachen, Aachen, NRW, Germany
| | | | | | - Jürgen Floege
- Department of Nephrology, RWTH University of Aachen, Aachen, NRW, Germany
| | - Peter Boor
- Institute of Pathology, RWTH University of Aachen, Aachen, NRW, Germany Department of Nephrology, RWTH University of Aachen, Aachen, NRW, Germany
| |
Collapse
|
36
|
Nagayama Y, Braun GS, Jakobs CM, Maruta Y, van Roeyen CR, Klinkhammer BM, Boor P, Villa L, Raffetseder U, Trautwein C, Görtz D, Müller-Newen G, Ostendorf T, Floege J. Gp130-dependent signaling in the podocyte. Am J Physiol Renal Physiol 2014; 307:F346-55. [PMID: 24899055 DOI: 10.1152/ajprenal.00620.2013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Renal inflammation, in particular glomerular, is often characterized by increased IL-6 levels. The in vivo relevance of IL-6 signaling in glomerular podocytes, which play central roles in most glomerular diseases, is unknown. Here, we show that in normal mice, podocytes express gp130, the common signal-transducing receptor subunit of the IL-6 family of cytokines. Following systemic IL-6 or LPS injection in mice, podocyte IL-6 signaling was evidenced by downstream STAT3 phosphorylation. Next, we generated mice deficient for gp130 in podocytes. Expectedly, these mice exhibited abrogated IL-6 downstream signaling in podocytes. At the age of 40 wk, they did not show spontaneous renal pathology or abnormal renal function. The mice were then challenged using two LPS injury models as well as nephrotoxic serum to induce crescentic nephritis. Under all conditions, circulating IL-6 levels increased markedly and the mice developed the pathological hallmarks of the corresponding injury models such as proteinuria and development of glomerular crescents, respectively. However, despite the capacity of normal podocytes to transduce IL-6 family signals downstream, there were no significant differences between mice bearing the podocyte-specific gp130 deletion and their control littermates in any of these models. In conclusion, under the different conditions tested, gp130 signaling was not a critical component of the (patho-)biology of the podocyte in vivo.
Collapse
Affiliation(s)
- Yoshikuni Nagayama
- Division of Nephrology and Immunology, RWTH Aachen University, Aachen Germany; Division of Nephrology, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Gerald S Braun
- Division of Nephrology and Immunology, RWTH Aachen University, Aachen Germany; Institute of Biochemistry and Molecular Biology, RWTH Aachen University, Aachen, Germany;
| | - Christina M Jakobs
- Division of Nephrology and Immunology, RWTH Aachen University, Aachen Germany
| | - Yuichi Maruta
- Division of Nephrology and Immunology, RWTH Aachen University, Aachen Germany; Division of Nephrology, Showa University Fujigaoka Hospital, Yokohama, Japan
| | | | | | - Peter Boor
- Division of Nephrology and Immunology, RWTH Aachen University, Aachen Germany; Institute of Pathology, RWTH Aachen University, Aachen, Germany; Institute of Molecular Biomedicine, Comenius University, Bratislava, Slovakia; and
| | - Luigi Villa
- Division of Nephrology and Immunology, RWTH Aachen University, Aachen Germany
| | - Ute Raffetseder
- Division of Nephrology and Immunology, RWTH Aachen University, Aachen Germany
| | - Christian Trautwein
- Division of Gastroenterology, Metabolic Diseases, and Intensive Care, RWTH Aachen University, Aachen, Germany
| | - Dieter Görtz
- Institute of Biochemistry and Molecular Biology, RWTH Aachen University, Aachen, Germany
| | - Gerhard Müller-Newen
- Institute of Biochemistry and Molecular Biology, RWTH Aachen University, Aachen, Germany
| | - Tammo Ostendorf
- Division of Nephrology and Immunology, RWTH Aachen University, Aachen Germany
| | - Jürgen Floege
- Division of Nephrology and Immunology, RWTH Aachen University, Aachen Germany
| |
Collapse
|
37
|
Kramann R, Kunter U, Brandenburg VM, Leisten I, Ehling J, Klinkhammer BM, Knüchel R, Floege J, Schneider RK. Osteogenesis of heterotopically transplanted mesenchymal stromal cells in rat models of chronic kidney disease. J Bone Miner Res 2013; 28:2523-34. [PMID: 23703894 DOI: 10.1002/jbmr.1994] [Citation(s) in RCA: 22] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 04/29/2013] [Accepted: 05/09/2013] [Indexed: 12/21/2022]
Abstract
The current study is based on the hypothesis of mesenchymal stromal cells (MSCs) contributing to soft-tissue calcification and ectopic osteogenesis in chronic kidney disease (CKD). Rat MSCs were transplanted intraperitoneally in an established three-dimensional collagen-based model in healthy control animals and two rat models of CKD and vascular calcification: (1) 5/6 nephrectomy + high phosphorus diet; and (2) adenine nephropathy. As internal controls, collagen gels without MSCs were transplanted in the same animals. After 4 and 8 weeks, MSCs were still detectable and proliferating in the collagen gels (fluorescence-activated cell sorting [FACS] analysis and confocal microscopy after fluorescence labeling of the cells). Aortas and MSC-containing collagen gels in CKD animals showed distinct similarities in calcification (micro-computed tomography [µCT], energy-dispersive X-ray [EDX] analysis, calcium content), induction of osteogenic markers, (ie, bone morphogenic protein 2 [BMP-2], Runt related transcription factor 2 [Runx2], alkaline phosphatase [ALP]), upregulation of the osteocytic marker sclerostin and extracellular matrix remodeling with increased expression of osteopontin, collagen I/III/IV, fibronectin, and laminin. Calcification, osteogenesis, and matrix remodeling were never observed in healthy control animals and non-MSC-containing collagen gels in all groups. Paul Karl Horan 26 (PKH-26)-labeled, 3G5-positive MSCs expressed Runx2 and sclerostin in CKD animals whereas PKH-26-negative migrated cells did not express osteogenic markers. In conclusion, heterotopically implanted MSCs undergo osteogenic differentiation in rat models of CKD-induced vascular calcification, supporting our hypothesis of MSCs as possible players in heterotopic calcification processes of CKD patients.
Collapse
Affiliation(s)
- Rafael Kramann
- Division of Nephrology and Clinical Immunology, Medical Faculty Rheinisch-Westfaelische Technische Hochschule (RWTH) Aachen University, Aachen, Germany; Institute of Pathology, Medical Faculty Rheinisch-Westfaelische Technische Hochschule (RWTH) Aachen University, Aachen, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Gaisa NT, Reinartz A, Schneider U, Klaus C, Heidenreich A, Kaemmerer E, Klinkhammer BM, Knuechel R, Gassler N. Abstract 1904: Acyl-coenzyme A synthetase 5 levels in urothelial cellines and bladder cancer tissues reflect cellular differentiation and senescence. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-1904] [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: 11/16/2022]
Abstract
Abstract
Introduction:
Metabolic components like fatty acids and acyl-Coenzyme A (acyl-CoA) thioesters have been implicated in the pathogenesis of various tumours. The activation of fatty acids to acyl-CoAs is catalysed by long chain acyl-CoA synthetases (ACSL), and impairment of ACSL expression levels has been associated with tumourigenesis and progression in intestinal and uterine cancers. The presented study aims to characterize ACSL expression and acyl-CoA synthesis in normal/neoplastic bladder tissues and cell lines.
Experimental procedures:
Expression of ACSL isoforms 1, 3, 4 and 5 were analysed by qRT-PCR, western blot analysis and immunohistochemistry in bladder cell lines (Urotsa, RT4, RT112 and J82) and n=21 matched pairs of non-neoplastic urothelium and urothelial cancer samples. Senescence was investigated by senescence-associated-ß-galactosidase (sa-β-gal) enzymhistochemistry. Additionally, lipid mass spectrometry was performed on fresh tissue samples (n=3) to measure synthesis of acyl-CoAs.
Summary of the new, unpublished data:
In normal urothelium expression of ACSL1, 3, 4 and 5, with highest levels of ACSL isoform 5 (13.3 fold increase in normal urothelium and 7.3 in tumours) was found. Highest rates of significant up- or downregulations (p<0.05) were also detected for ACSL5 expression (88.89% significant up- or downregulations). However, ACSL5 expression was reduced in corresponding neoplastic tissues (61.1%, 11/18). Expression was also decreased in urothelial carcinoma cell lines depending on their degree of differentiation. Additionally, high expression of ACSL5 correlated with increased β-galactosidase activity (p=0.03) and positive Uroplakin III (p=0.015) staining in tumours. In contrast, synthesis of acyl-CoAs was enhanced in neoplastic bladder tissues compared to normal urothelium, pointing towards further additional regulatory mechanisms.
Conclusions:
These results confirm an expression of ACSLs, especially isoform 5, in human urothelium, prove enzymatic/lipidomic changes in bladder cancer tissues, and suggest an involvement of ACSL5 in cellular maturation and/or senescence with possible effects on induction of tumour formation or progression.
Further work shall identify responsible pathway alterations. The attempt to re-balance the metabolic equilibrium of the urothelium may offer a further opportunity for tumour treatment and prevention.
Citation Format: Nadine T. Gaisa, Andrea Reinartz, Ursula Schneider, Christina Klaus, Axel Heidenreich, Elke Kaemmerer, Barbara M. Klinkhammer, Ruth Knuechel, Nikolaus Gassler. Acyl-coenzyme A synthetase 5 levels in urothelial cellines and bladder cancer tissues reflect cellular differentiation and senescence. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1904. doi:10.1158/1538-7445.AM2013-1904
Collapse
Affiliation(s)
- Nadine T. Gaisa
- 1Institute of Pathology, RWTH Aachen University, Aachen, Germany
| | - Andrea Reinartz
- 1Institute of Pathology, RWTH Aachen University, Aachen, Germany
| | - Ursula Schneider
- 1Institute of Pathology, RWTH Aachen University, Aachen, Germany
| | - Christina Klaus
- 1Institute of Pathology, RWTH Aachen University, Aachen, Germany
| | - Axel Heidenreich
- 2Department of Urology, University Hospital RWTH Aachen University, Aachen, Germany
| | - Elke Kaemmerer
- 1Institute of Pathology, RWTH Aachen University, Aachen, Germany
| | - Barbara M. Klinkhammer
- 3Department of Internal Medicine II, Nephrology and Immunology, University Hospital RWTH Aachen, Aachen, Germany
| | - Ruth Knuechel
- 1Institute of Pathology, RWTH Aachen University, Aachen, Germany
| | - Nikolaus Gassler
- 1Institute of Pathology, RWTH Aachen University, Aachen, Germany
| |
Collapse
|