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Kim YJ, Lee SW, Kim MS, Kim YJ, Choi JY, Cho JH, Kim CD, Kim YL, Yun WS, Huh S, Lim JH, Park SH. Anuria after kidney transplantation diagnosed as early recurrence of focal segmental glomerulosclerosis combined with acute calcineurin inhibitor nephrotoxicity: a case report and literature review. BMC Nephrol 2024; 25:123. [PMID: 38580974 PMCID: PMC10998363 DOI: 10.1186/s12882-024-03524-y] [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: 11/07/2023] [Accepted: 02/27/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Primary focal segmental glomerulosclerosis (FSGS) is a glomerular disease that sometimes recurs in patients after kidney transplantation (KT) and increases the risk of graft loss. Proteinuria is a common early sign of recurrent FSGS, but an abrupt decrease in urine volume is rare. Herein, we report a patient with early recurrence of FSGS with anuria following KT. CASE PRESENTATION A 55-year-old man with end-stage kidney disease caused by primary FSGS experienced anuria on postoperative day 2 following deceased donor KT. Laboratory results revealed that serum tacrolimus trough levels were consistently elevated at the time of anuria. At first, we considered acute calcineurin inhibitor (CNI) nephrotoxicity based on graft biopsy on light microscopy, laboratory findings, and clinical courses. However, the allograft function did not recover even after discontinuation of CNI, and recurrent FSGS was diagnosed 2 weeks later on electron microscopy. A total of 13 sessions of plasmapheresis and two administrations of rituximab (375 mg/m2) were required to treat recurrent FSGS. The patient achieved a partial response, and the spot urine protein-to-creatinine ratio decreased from 15.5 g/g creatinine to 5.2 g/g creatinine. At 5 months following KT, the serum creatinine level was stable at 1.15 mg/dL. CONCLUSIONS These findings highlight that anuria can occur in cases of early recurrence of FSGS combined with acute CNI nephrotoxicity.
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Affiliation(s)
- Yoon-Ju Kim
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, 41944, Daegu, South Korea
| | - Seong-Wook Lee
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, 41944, Daegu, South Korea
| | - Mee-Seon Kim
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, 41944, Daegu, South Korea
| | - Yong-Jin Kim
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, 41944, Daegu, South Korea
| | - Ji-Young Choi
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, 41944, Daegu, South Korea
| | - Jang-Hee Cho
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, 41944, Daegu, South Korea
| | - Chan-Duck Kim
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, 41944, Daegu, South Korea
| | - Yong-Lim Kim
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, 41944, Daegu, South Korea
| | - Woo-Sung Yun
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, 41944, Daegu, South Korea
| | - Seung Huh
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, 41944, Daegu, South Korea
| | - Jeong-Hoon Lim
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, 41944, Daegu, South Korea.
| | - Sun-Hee Park
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, 41944, Daegu, South Korea.
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Cheriyan AM, Ume AC, Francis CE, King KN, Linck VA, Bai Y, Cai H, Hoover RS, Ma HP, Gooch JL, Williams CR. Calcineurin A-α suppression drives nuclear factor-κB-mediated NADPH oxidase-2 upregulation. Am J Physiol Renal Physiol 2021; 320:F789-F798. [PMID: 33615888 PMCID: PMC8424558 DOI: 10.1152/ajprenal.00254.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 01/19/2021] [Accepted: 02/09/2021] [Indexed: 12/26/2022] Open
Abstract
Calcineurin inhibitors (CNIs) are vital immunosuppressive therapies in the management of inflammatory conditions. A long-term consequence is nephrotoxicity. In the kidneys, the primary, catalytic calcineurin (CnA) isoforms are CnAα and CnAβ. Although the renal phenotype of CnAα-/- mice substantially mirrors CNI-induced nephrotoxicity, the mechanisms downstream of CnAα are poorly understood. Since NADPH oxidase-2 (Nox2)-derived oxidative damage has been implicated in CNI-induced nephrotoxicity, we hypothesized that CnAα inhibition drives Nox2 upregulation and promotes oxidative stress. To test the hypothesis, Nox2 regulation was investigated in kidneys from CnAα-/-, CnAβ-/-, and wild-type (WT) littermate mice. To identify the downstream mediator of CnAα, nuclear factor of activated T cells (NFAT) and NF-κB regulation was examined. To test if Nox2 is transcriptionally regulated via a NF-κB pathway, CnAα-/- and WT renal fibroblasts were treated with the NF-κB inhibitor caffeic acid phenethyl ester. Our findings showed that cyclosporine A treatment induced Nox2 upregulation and oxidative stress. Furthermore, Nox2 upregulation and elevated ROS generation occurred only in CnAα-/- mice. In these mice, NF-κB but not NFAT activity was increased. In CnAα-/- renal fibroblasts, NF-κB inhibition prevented Nox2 upregulation and reactive oxygen species (ROS) generation. In conclusion, these findings indicate that 1) CnAα loss stimulates Nox2 upregulation, 2) NF-κB is a novel CnAα-regulated transcription factor, and 3) NF-κB mediates CnAα-induced Nox2 and ROS regulation. Our results demonstrate that CnAα plays a key role in Nox2 and ROS generation. Furthermore, these novel findings provide evidence of divergent CnA isoform signaling pathways. Finally, this study advocates for CnAα-sparing CNIs, ultimately circumventing the CNI nephrotoxicity.NEW & NOTEWORTHY A long-term consequence of calcineurin inhibitors (CNIs) is oxidative damage and nephrotoxicity. This study indicates that NF-κB is a novel calcineurin-regulated transcription factor that is activated with calcineurin inhibition, thereby driving oxidative damage in CNI nephropathy. These findings provide additional evidence of divergent calcineurin signaling pathways and suggest that selective CNIs could improve the long-term outcomes of patients by mitigating renal side effects.
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Affiliation(s)
- Aswathy M Cheriyan
- Division of Nephrology, Department of Medicine, and Department of Physiology, Emory University, Atlanta, Georgia
| | - Adaku C Ume
- Department of Neuroscience, Cell Biology and Physiology, Wright State University, Dayton, Ohio
| | - Cynthia E Francis
- Department of Pharmaceutical Sciences, School of Pharmacy, Philadelphia College of Osteopathic Medicine, Suwanee, Georgia
| | - Keyona N King
- Division of Nephrology, Department of Medicine, and Department of Physiology, Emory University, Atlanta, Georgia
| | - Valerie A Linck
- Division of Nephrology, Department of Medicine, and Department of Physiology, Emory University, Atlanta, Georgia
| | - Yun Bai
- Department of Pharmaceutical Sciences, School of Pharmacy, Philadelphia College of Osteopathic Medicine, Suwanee, Georgia
| | - Hui Cai
- Division of Nephrology, Department of Medicine, and Department of Physiology, Emory University, Atlanta, Georgia
- Research Service, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Robert S Hoover
- Division of Nephrology, Department of Medicine, and Department of Physiology, Emory University, Atlanta, Georgia
- Research Service, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Heping P Ma
- Division of Nephrology, Department of Medicine, and Department of Physiology, Emory University, Atlanta, Georgia
| | - Jennifer L Gooch
- Division of Nephrology, Department of Medicine, and Department of Physiology, Emory University, Atlanta, Georgia
- Department of Pharmaceutical Sciences, School of Pharmacy, Philadelphia College of Osteopathic Medicine, Suwanee, Georgia
- Research Service, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Clintoria R Williams
- Division of Nephrology, Department of Medicine, and Department of Physiology, Emory University, Atlanta, Georgia
- Department of Neuroscience, Cell Biology and Physiology, Wright State University, Dayton, Ohio
- Research Service, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
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Zhang J, Qiu J, Chen GD, Wang CX, Wang C, Yu SJ, Chen LZ. Etiological analysis of graft dysfunction following living kidney transplantation: a report of 366 biopsies. Ren Fail 2018; 40:219-225. [PMID: 29619905 PMCID: PMC6014316 DOI: 10.1080/0886022x.2018.1455592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/03/2018] [Accepted: 03/15/2018] [Indexed: 11/18/2022] Open
Abstract
AIM The aim of this study is to investigate the clinical features of graft dysfunction following living kidney transplantation and to assess its causes. METHODS We retrospectively analyzed a series of 366 living kidney transplantation indication biopsies with a clear etiology and diagnosis from July 2003 to June 2016 at our center. The classifications and diagnoses were performed based on clinical and pathological characteristics. All biopsies were evaluated according to the Banff 2007 schema. RESULTS Acute rejection (AR) occurred in 85 cases (22.0%), chronic rejection (CR) in 62 cases (16.1%), borderline rejection (BR) in 12 cases (3.1%), calcineurin inhibitor (CNI) toxicity damage in 41 cases (10.6%), BK virus-associated nephropathy (BKVAN) in 43 cases (11.1%), de novo or recurrent renal diseases in 134 cases (34.7%), and other causes in nine cases (2.3%); additionally, 20 cases had two simultaneous causes. The 80 cases with IgA nephropathy (IgAN) had the highest incidence (59.7%) of de novo or recurrent renal diseases. After a mean ± SD follow up of 3.7 ± 2.3 years, the 5-year graft cumulative survival rates of AR, CR, CNI toxicity, BKVAN, and de novo or recurrent renal diseases were 60.1%, 31.2%, 66.6%, 66.9%, and 67.1%, respectively. CONCLUSIONS A biopsy is helpful for the diagnosis of graft dysfunction. De novo or recurrent renal disease, represented by IgAN, is a major cause of graft dysfunction following living kidney transplantation.
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Affiliation(s)
- Jin Zhang
- Department of Organ Transplant, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiang Qiu
- Department of Organ Transplant, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Guo-Dong Chen
- Department of Organ Transplant, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chang-Xi Wang
- Department of Organ Transplant, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chang Wang
- Department of Organ Transplant, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shuang-Jin Yu
- Department of Organ Transplant, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Li-Zhong Chen
- Department of Organ Transplant, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Raeisi S, Ghorbanihaghjo A, Argani H, Dastmalchi S, Ghasemi B, Ghazizadeh T, Rashtchizadeh N, Nemati M, Mesgari Abbasi M, Bargahi N, Mota A, Vatankhah AM. Effects of Angiotensin II Receptor Blockade on Soluble Klotho and Oxidative Stress in Calcineurin Inhibitor Nephrotoxicity in Rats. Iran J Kidney Dis 2016; 10:358-363. [PMID: 27903993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 06/03/2016] [Accepted: 06/06/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Calcineurin inhibitor nephrotoxicity is major problem after organ transplantation. It is multifactorial, but oxidative stress may have an important role in this process. It has been shown that angiotensin II receptor blockers have renoprotective effects but their molecular mechanism is largely unknown. Antioxidative effect is an important role of the recently known anti-aging protein, klotho. This study aimed to evaluate effect of valsartan in alleviation of cyclosporine A nephrotoxicity via a probable increase in serum klotho levels or decreasing oxidative stress. MATERIALS AND METHODS Thirty-two Sprague-Dawley rats were divided into 4 groups to receive 1 mL/kg/d of olive oil as control; 30 mg/kg/d of cyclosporine; 30 mg/kg/d of cyclosporine and 50 mg/kg/d of valsartan; and 50 mg/kg/d of valsartan. After the 6 weeks of administration period, serum levels of klotho and 8-hydroxydeoxyguanosine were measured using an enzyme-linked immunosorbent assay. Serum malondialdehyde level was measured spectrophotometrically. RESULTS The mean serum level of klotho was significantly lower in the cyclosporine group compared with control and valsartan groups. Klotho level in the valsartan group was significantly higher than those in the other groups. The cyclosporine group was detected to have significantly higher serum 8-hydroxydeoxyguanosine and malondialdehyde levels compared with the other study groups. The levels of klotho were negatively correlated with 8-hydroxydeoxyguanosine and malondialdehyde levels. CONCLUSIONS Administration of valsartan may lead to attenuation of the nephrotoxic side effect of cyclosporine via enhancing klotho and decreasing oxidative stress levels.
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Affiliation(s)
| | - Amir Ghorbanihaghjo
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Kim BS, Cho Y, Lee H, Joo DJ, Huh KH, Kim MS, Kim YS. Comparative Proteomic Analysis of Rapamycin Versus Cyclosporine Combination Treatment in Mouse Podocytes. Transplant Proc 2016; 48:1297-301. [PMID: 27320608 DOI: 10.1016/j.transproceed.2016.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/25/2015] [Revised: 01/13/2016] [Accepted: 01/21/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND The mechanism of podocyte injury observed with the use of rapamycin (RPM) remains unclear. The conversion from calcineurin inhibitors (CNIs) to RPM in kidney transplant recipients has been associated with a higher incidence of proteinuria and renal injury. In this study, we performed proteomic analyses to investigate the alteration of protein expression in mouse podocytes treated with RPM in comparison with CNI/RPM combination. METHODS Immortalized mouse podocytes were treated with 20 nmol/L RPM or 20 nmol/L RPM + 1 μg/mL cyclosporine. Podocyte proteins were separated by 2-dimensional polyacrylamide gel electrophoresis (2DE) and identified by matrix-assisted laser desorption time-of-flight (MALDI-TOF) mass spectrometry and peptide fingerprinting. Selected proteins were analyzed by means of Western blot assay. RESULTS We identified 36 differently expressed proteins after isolated RPM or CNI/RPM combination treatment in cultured mouse podocytes. There are 3 distinct patterns of protein expression: (1) potentiated down- or upregulation of proteins by CNI/RPM treatment compared with isolated RPM treatment (n = 4); (2) partial offset of down-regulation by CNI/RPM in comparison with RPM treatment (n = 25); (3) no difference in down-regulation between RPM and CNI/RPM treatment (n = 5). We found a significant interplay between RPM and CNI on the expression of the selected proteins in mouse podocytes. This might explain the higher incidence of proteinuria by CNI/RPM combination in clinical settings. CONCLUSIONS Further study is required to elucidate the target protein associated with RPM-induced podocyte injury.
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Affiliation(s)
- B S Kim
- Division of Nephrology, Department of Internal Medicine, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea; The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Y Cho
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - H Lee
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - D J Joo
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - K H Huh
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - M S Kim
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Y S Kim
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
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Jiménez C, López MO, Ros A, Aguilar A, Menendez D, Rivas B, Santana MJ, Vaca MA, Escuin F, Madero R, Selgas R. The Natural History of Kidney Graft Cortical Microcirculation Determined by Real-Time Contrast-Enhanced Sonography (RT-CES). PLoS One 2016; 11:e0150384. [PMID: 26949940 PMCID: PMC4780790 DOI: 10.1371/journal.pone.0150384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 02/12/2016] [Indexed: 01/05/2023] Open
Abstract
Background Kidney transplantation is the therapy of choice for end-stage kidney disease. Graft’s life span is shorter than expected due in part to the delayed diagnosis of various complications, specifically those related to silent progression. It is recognized that serum creatinine levels and proteinuria are poor markers of mild kidney lesions, which results in delayed clinical information. There are many investigation looking for early markers of graft damage. Decreasing kidney graft cortical microcirculation has been related to poor prognosis in kidney transplantation. Cortical capillary blood flow (CCBF) can be measured by real-time contrast-enhanced sonography (RT-CES). Our aim was to describe the natural history of CCBF over time under diverse conditions of kidney transplantation, to explore the influence of donor conditions and recipient events, and to determine the capacity of CCBF for predicting renal function in medium term. Patients and Methods RT-CES was performed in 79 consecutive kidney transplant recipients during the first year under regular clinical practice. Cortical capillary blood flow was measured. Clinical variables were analyzed. The influence of CCBF has been determined by univariate and multivariate analysis using mixed regression models based on sequential measurements for each patient over time. We used a first-order autoregression model as the structure of the covariation between measures. The post-hoc comparisons were considered using the Bonferroni correction. Results The CCBF values varied significantly over the study periods and were significantly lower at 48 h and day 7. Brain-death donor age and CCBF levels showed an inverse relationship (r: -0.62, p<0.001). Living donors showed higher mean CCBF levels than brain-death donors at each point in the study. These significant differences persisted at month 12 (54.5 ± 28.2 vs 33.7 ± 30 dB/sec, living vs brain-death donor, respectively, p = 0.004) despite similar serum creatinine levels (1.5 ± 0.3 and 1.5 ± 0.5 mg/dL). A sole rejection episode was associated with lower overall CCBF values over the first year. CCBF defined better than level of serum creatinine the graft function status at medium-term. Conclusion RT-CES is a non-invasive tool that can quantify and iteratively estimate cortical microcirculation. We have described the natural history of cortical capillary blood flow under regular clinical conditions.
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Affiliation(s)
- Carlos Jiménez
- Department of Nephrology, Research Unit, University Hospital La Paz, IdiPAZ, IRSIN, REDinREN, Madrid, Spain
- * E-mail:
| | - María Ovidia López
- Department of Nephrology, Research Unit, University Hospital La Paz, IdiPAZ, IRSIN, REDinREN, Madrid, Spain
| | - Amaia Ros
- Department of Nephrology, University Hospital Donostia. Donostia. Spain
| | - Ana Aguilar
- Department of Nephrology, Research Unit, University Hospital La Paz, IdiPAZ, IRSIN, REDinREN, Madrid, Spain
| | - David Menendez
- Department of Nephrology, Research Unit, University Hospital La Paz, IdiPAZ, IRSIN, REDinREN, Madrid, Spain
| | - Begoña Rivas
- Department of Nephrology, Research Unit, University Hospital La Paz, IdiPAZ, IRSIN, REDinREN, Madrid, Spain
| | - María José Santana
- Department of Nephrology, Research Unit, University Hospital La Paz, IdiPAZ, IRSIN, REDinREN, Madrid, Spain
| | - Marco Antonio Vaca
- Department of Nephrology, Research Unit, University Hospital La Paz, IdiPAZ, IRSIN, REDinREN, Madrid, Spain
| | - Fernando Escuin
- Department of Nephrology, Research Unit, University Hospital La Paz, IdiPAZ, IRSIN, REDinREN, Madrid, Spain
| | - Rosario Madero
- Department of Biostatistics, University Hospital La Paz, Madrid, Spain
| | - Rafael Selgas
- Department of Nephrology, Research Unit, University Hospital La Paz, IdiPAZ, IRSIN, REDinREN, Madrid, Spain
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Takasu C, Vaziri ND, Li S, Robles L, Vo K, Takasu M, Pham C, Liu S, Farzaneh SH, Foster CE, Stamos MJ, Ichii H. Treatment With Dimethyl Fumarate Attenuates Calcineurin Inhibitor-induced Nephrotoxicity. Transplantation 2015; 99:1144-50. [PMID: 25710612 PMCID: PMC4452388 DOI: 10.1097/tp.0000000000000647] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cyclosporine A (CsA) is an immunosuppressive drug which has been widely used to prevent rejection after organ transplantation. However, its therapeutic use is limited by nephrotoxicity, in part mediated by oxidative stress. The present study aims to investigate the protective effects of dimethyl fumarate (DMF) on CsA-induced nephrotoxicity by enhancing the antioxidant defense system. METHODS Male Sprague-Dawley rats were treated with CsA (n = 8, 20 mg/kg per day intraperitoneally) or CsA + DMF (n = 7, 50 mg/kg per day orally) for 28 days. Renal function, histopathology, malondialdehyde (MDA), myeloperoxidase levels, and antioxidant enzyme expression were determined. RESULTS The DMF cotreatment ameliorated CsA-induced renal dysfunction as evidenced by significant decrease in serum creatinine (CsA 0.79 ± 0.02 mg/dL vs CsA + DMF 0.62 ± 0.04 mg/dL, P = 0.001) and urea (CsA 66.9 ± 0.4 mg/dL vs CsA + DMF 53.3 ± 2.6 mg/dl, P < 0.0001) levels, as well as improvement of creatinine clearance. Dimethyl fumarate also significantly decreased serum MDA and renal tissue MDA and myeloperoxidase contents. The protein expression of NAD(P)H quinone oxidoreductase-1, a major cellular antioxidant and detoxifying enzyme, was significantly enhanced by DMF administration in kidney. CONCLUSIONS Administration of DMF has a protective potential against CsA nephrotoxicity. The protection afforded by DMF is mediated in part through inhibiting oxidative stress and inflammation and enhancing the antioxidant capacity.
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Affiliation(s)
- Chie Takasu
- Department of Surgery, University of California, Irvine, CA, USA
| | | | - Shiri Li
- Department of Surgery, University of California, Irvine, CA, USA
| | - Lourdes Robles
- Department of Surgery, University of California, Irvine, CA, USA
| | - Kelly Vo
- Department of Surgery, University of California, Irvine, CA, USA
| | - Mizuki Takasu
- Department of Surgery, University of California, Irvine, CA, USA
| | - Christine Pham
- Department of Surgery, University of California, Irvine, CA, USA
| | - Shuman Liu
- Department of Medicine, University of California, Irvine, CA, USA
| | | | | | - Michael J Stamos
- Department of Surgery, University of California, Irvine, CA, USA
| | - Hirohito Ichii
- Department of Surgery, University of California, Irvine, CA, USA
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