Hepatocyte growth factor ameliorates progression of interstitial fibrosis in rats with established renal injury

BACKGROUND

Hepatocyte growth factor (HGF) has been reported to prevent injury in several models of renal disease; however, whether HGF can also retard progression of established renal disease is not known.

METHODS

The aim of the present study was to examine the effects of HGF on progression of chronic renal disease in rats with remnant kidneys and established injury. Studies were performed in rats that underwent subtotal nephrectomy, were observed for two weeks without therapy, and then randomized to receive HGF or vehicle by continuous infusion for an additional two weeks.

RESULTS

HGF administration was associated with a reduction in morphologic evidence of interstitial, but not glomerular injury. The beneficial effects of HGF were not associated with reductions in the expression of transforming growth factor-beta (TGF-beta), or in the extent epithelial cell apoptosis or transdifferentiation. Rather, HGF appeared to induce fibrinolytic pathways by increasing expression of metalloproteinase-9 (MMP-9) and decreasing levels of plasminogen activator inhibitor-1 (PAI-1) and tissue inhibitor of metalloproteinase-1 (TIMP-2). HGF administration was also associated with an apparent increase in renal endothelin production and a significant reduction in glomerular capillary pressure.

CONCLUSION

These findings suggest that HGF can retard progression of chronic renal disease even after injury is already established, primarily by promoting matrix degradation.

Hepatocyte Growth Factor Modulates Matrix Metalloproteinases and Plasminogen Activator/Plasmin Proteolytic Pathways in Progressive Renal Interstitial Fibrosis

ABSTRACT. Evidence suggests that hepatocyte growth factor (HGF) ameliorates renal fibrosis in animal models of chronic renal disease by promoting extracellular matrix catabolism. This study examined the molecular mechanisms of HGF-induced alterations in matrix degradation bothin vitroandin vivo.In vitro, HGF increased the collagen catabolizing activity of human proximal tubular epithelial cells (HKC) that were treated with TGF-β1. Increased collagen catabolism was associated with enhanced activity of both matrix metalloproteinases (MMP) and plasminogen activators (PA)/plasmin proteolytic pathways. HGF abrogated TGF-β1–induced production of the profibrotic tissue inhibitor of metalloproteinase-2 (TIMP-2) and plasminogen activator inhibitor-1 (PAI-1). In addition, HGF induced the production of MMP-9.In vivo, continuous infusion of HGF in the rat remnant kidney model ameliorated renal fibrosis and tubulointerstitial collagen deposition. This was associated with increased tubular expression of MMP-9, enhancedin situgelatinolytic activity, partially restored plasmin activity and decreased expression of TIMP-2 and PAI-1 in tubular cells, and upregulation of renal TIMP-3 expression. Conversely, blocking of endogenous HGF by an anti-HGF neutralizing antibody increased renal fibrosis and interstitial collagen. This was accompanied by decreased tubular expression of MMP-9, lessin situproteolytic activity, and elevated expression of TIMP-2 and PAI-1 in tubular cells. Collectively, these findings demonstrate that HGF ameliorates renal fibrosis by enhancing extracellular matrix catabolism via both MMP and the PA/plasmin proteolytic pathways.

[Acquired mutation of type II transforming growth factor-beta receptor gene in glomerulosclerosis]

OBJECTIVE

To investigate the acquired mutation of type II transforming growth factor beta receptor TbetaR II gene plays a role in the process of glumerulosclerosis.

METHODS

Biopsy specimens of 32 patients with primary focal segmental glomerulosclerosis (FSGS) were examined. Microdissection was used to isolate the morphologically normal glumeruli, segmental sclerotic glomeruli (SSG) global sclerotic glomeruli (GSG), and in the same specimen, representing the sequence of glomerulosclerosis. DNA was extracted by one-step method. The A10 microsatellite instability (709 approximately 718) in TbetaRII gene was detected by high-fidelity PCR and strand length polymorphism. Scanning technique was used to calculate the mutation rate of TBRII gene A10 sequence.

RESULTS

A total of 192 sites of glomeruli from 32 patients were analyzed. The standard curve for mutant integrated pixel density (IPD) percentages (10% 32% 55% 75% 88%) versus DNA mutant ratios (17% 24% 53% 79% 95%) showed excellent linear correlation (r = 0.990 8). DNA from the glomeruli of NG, SSG, and GSG of all cases showed very low ratios of mutant allele (1 approximately 5%).

CONCLUSION

Mutation of TbetaRII gene A10 microsatellite sequence can not been detected during the progress of glomerulosclerosis.

Genetic variation of mannose-binding protein associated with glomerular immune deposition in IgA nephropathy

OBJECTIVE

To investigate the relationship between codon 54 gene polymorphism of the host defense molecule, mannose-binding protein (MBP), and the patterns of glomerular immune deposition in IgA nephropathy (IgAN).

METHODS

IgAN patients with different patterns of glomerular immune deposition were selected and divided into two groups. Group A consisted of 77 patients with glomerular IgA and C3 deposits, and Group AGM consisted of 70 patients with glomerular IgA, IgG, IgM, C3 and Clq deposits. Clinical features and laboratory relevant data of all patients were collected. One-hundred and forty healthy adults were recruited as normal controls. The MBP gene codon 54 GGC/GAC polymorphism was investigated by using polymerase chain reaction and restriction fragment length polymorphism.

RESULTS

The genotype frequency of GGC/GAC heterozygotes was significantly higher in Group AGM as compared with that of Group A (41.4% vs 19.5%, P < 0.01) or normal subjects (41.4% vs. 26.4%, P < 0.05), while no difference was found in the distribution of MBP genotypes between Group A and normal subjects. GAC allele frequency was also higher in Group AGM than that in Group A (0.24 vs. 0.14, P < 0.05) or normal subjects (0.24 vs. 0.15, P < 0.05). The variant allele (GAC) was markedly associated with Group AGM (OR = 1.95, 95% CI: 1.06 - 3.58). In both Group A and Group AGM, more patients carrying the variant allele had episodes of upper respiratory or gastrointestinal infections prior to the onset of IgAN than those with wild homozygotes (GGC/GGC).

CONCLUSIONS

Genetic variation of the host defense molecule, MBP, may be involved in the formation of the diverse patterns of glomerular immune deposition in IgAN. The variant allele of the MBP gene may partially account for abundant immune deposits in some IgAN patients.

[Genetic variations in plasminogen activator inhibitor-1 gene and beta fibrinogen gene associated with glomerular microthrombosis in lupus nephritis and the gene dosage effect]

OBJECTIVE

To explore the relationship of plasminogen activator inhibitor-1 (PAI-1) gene -675 4G/5G and beta fibrinogen gene -455 G/A variations to glomerular microthrombosis(T) in lupus nephritis(LN).

METHODS

One hundred and one patients with biopsy proven LN were divided into two groups according to the presence or absence of glomerular microthrombus, i.e. group LN+T(n=46) and group LN-T(n=55). The genotypes of PAI-1 gene and beta fibrinogen gene were profiled by polymerase chain reaction-sequence length polymorphism (PCR-SLP) and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) respectively. Clinical baseline data at the time of renal biopsy were collected. Normal controls consisted of 128 unrelated healthy adults. The etiologic fractions (EF) were calculated for estimating the contribution of risk genotypes of the two candidate genes to an increase in susceptibility to glomerular microthrombosis in LN patients.

RESULTS

Both the 4G/4G genotype and the 4G allele of PAI-1 gene occurred more frequently in group LN+T (47.83% and 0.685) than in group LN-T (23.64% and 0.507)(P<0.05) and normal controls (28.13% and 0.570) (P<0.05). The PAI-1 4G/4G genotype was significantly associated with microthrombosis (OR=2.96, 95%CI:1.26-6.92). Besides, the prevalence of the genotypes carrying the A allele of beta fibrinogen gene, i.e. G/A and A/A, as well as the prevalence of the A allele per se, was increased in group LN+T (47.83% and 0.261) versus group LN-T (27.27% and 0.145)(P<0.05). LN patients carrying the A allele had a high risk of glomerular thrombosis(OR=2.44, 95%CI:0.98-5.59). In addition, the presence of the PAI-1 4G/4G genotype together with the A allele of the beta fibrinogen gene was found to be a greater risk factor (OR=4.5, 95%CI: 1.34-15.12) for glomerular thrombosis in LN than the 4G/4G genotype or the A allele alone. The pooled EF (45.98%) for the risk genotypes of both PAI-1 gene and beta fibrinogen gene was also higher than that for the risk genotypes of either gene (31.67% and 28.23%).

CONCLUSION

The above findings indicated that genetic variations in PAI-1 and beta fibrinogen loci might represent risk factors for glomerular microthrombosis in LN. They may have synergetic impact and present gene dosage effect on the susceptibility to this pathological subphenotype.

Gene polymorphism in IL-1 receptor antagonist affects its production by monocytes in IgA nephropathy and Henoch-Schonlein nephritis

OBJECTIVE

To define the functional significance of IL-1 receptor antagonist (IL-1ra) gene polymorphism and to investigate, the production of IL-1ra by monocytes from individuals with different genotypes of IL-1.

METHODS

The genotype of IL-1ra was detected by polymerase chain reaction (PCR). Peripheral monocytes obtained from patients with immunoglobin A nephropathy (IgAN), Henoch-Schonlein purpura nephritis (HSPN) and normal subjects were matched in sex and age between the IL1RN-2 allele carriers and non-carriers. The secretion of IL-1ra, IL-1 alpha and IL-1 beta in the supernatant of GM-CSF (10 ng/ml) treated and untreated monocytes were measured by ELISA.

RESULTS

The secretion of IL-1ra by monocytes stimulated with GM-CSF was significantly higher in the IL1RN-2 allele non-carriers than those of carriers both in IgAN (21.55 +/- 3.08 vs 13.85 +/- 2.24 ng/ml, P < 0.001) and HSPN (23.72 +/- 6.68 vs 12.67 +/- 2.24 ng/ml, P < 0.01) as well as in normal controls (20.29 +/- 1.45 vs 10.51 +/- 2.3 ng/ml, P < 0.001). All showed no significant differences in monocyte secretion of IL-1 alpha and IL-1 beta by GM-CSF stimulation between the IL1RN-2 allele carriers and non-carriers.

CONCLUSIONS

These results indicate that a functional correlation of the IL1RN-2 allele and IL-1ra production is present in patients with IgAN and HSPN. This gene polymorphism control of IL-1ra production may contribute to the variety of clinical responses to inflammatory stimulation in individuals with different genotype of IL-1ra.

Computerized tomography pleurography: a new method for detecting minor pleural lesion

OBJECTIVES

To evaluate the ability of CT pleurography (CTP) in detecting minor pleural lesions in patients with pleural effusion and to assess its value in distinguishing malignant from benign pleural lesions.

METHODS

A prospective study of 50 patients with pleural effusion was conducted using conventional CT and CTP. CT scan was run after injecting an appropriate amount of contrast medium into the pleural cavity.

RESULTS

In 24 patients, all lesions detected by conventional CT were demonstrated by CTP. In 13 of 24 patients, CT pleurography detected additional lesions. In 20 of 26 patients with negative findings on conventional CT, CTP was capable of demonstrating the presence of pleural lesions. The sensitivity, specificity and accuracy of detecting pleural lesions were 25%, 100% and 30% for conventional CT, 86%, 100% and 87% for CTP, respectively.

CONCLUSION

CTP is superior to conventional CT in detecting and for the differential diagnosis benign and malignant pleural lesions.

[Establishment and implication of an assay for high density lipoprotein phospholipids in human serum]

OBJECTIVE

To develop an assay for high density lipoprotein phospholipids in human serum based on ascorbutate reduction method.

METHODS

HDLs were separated from apolipoprotein B-containing lipoproteins by precipitation of phosphotungstic acid and magnesium chloride. Phospholipids of HDL were extracted by ethanol/ether, and dried. After the dried phospholipids were digested by sulphuric acid and perchloric acid, the color was developed by adding ammonium molybdate in ascorbutate. The levels of high density lipoprotein phospholipids (HDL-PL) were measured by spectrophotometry at 700 nm.

RESULTS

The coefficients of variation (CV) were 3.6% and 3.7% within two batches of assays. Recovery of isolated HDL-PL added to serum ranged from 98% to 107%, averagely 103%. The established assay for human serum HDL-PL was used to measure the serum levels of 30 hypercholesterolemic subjects, 30 hypertriglyceridemic subjects, 30 combined hyperlipidemic subjects, and 30 normolipidemic subjects. The hypertriglyceridemic subjects had lower HDL-PL level than normolipidemic subjects and hypercholesterolemic subjects (The P values are 0.005 and 0.007 respectively).

CONCLUSION

A simple and specific method for assay of HDL-phos-pholipids in human serum has been developed. The above data collected by the use of this method demonstrate the closer relationship between human HDL-PL metabolism and triglyceride metabolism, suggesting that lower HDL-PL level might serve as an index in the assay for type IV hyperlipidemia.

Cloning, expression patterns, and chromosome localization of three human and two mouse homologues of GABA(A) receptor-associated protein

Type A receptors of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter, contain alpha, beta, delta, gamma, and rho subunits. The gamma subunit has four subtypes: gamma1, gamma2, gamma3, andgamma4. GABA(A) receptor-associated protein (GABARAP) was previously demonstrated to act as a linker protein between microtubules and the gamma2 subunit of GABA(A) receptors. However, no other linker proteins have been identified as mediating the linkage of microtubules and the remaining subunits of GABA(A) receptors. In this study we identified three human paralogues (GABARAPL1, GABARAPL2, and GABARAPL3) and two mouse orthologues (Gabarapl1 and Gabarapl2) of human GABARAP, all of which encoded 117 amino acids, as does Gabarapl. The expression patterns of GABARAPL1, GABARAPL2, and GABARAP in 16 adult tissues showed that they were expressed ubiquitously. The expression levels of GABARAPL1 as a 2.3-kb transcript were very high in brain, heart, peripheral blood leukocytes, liver, kidney, placenta, and skeletal muscle, very low in thymus and small intestine, and moderate in other tissues tested. The unique 1.35-kb transcript of GABARAPL2 was expressed at high levels in heart, brain, testis, prostate, ovary, spleen, and skeletal muscle, at very low levels in lung, thymus, and small intestine, and moderately in other tissues tested. For GABARAP, a 1.3-kb transcript was abundantly expressed in all tested tissues with small variation. The expression patterns of Gabarapl1 and Gabarapl2 were similar to those of their counterparts in human. In addition, GABARAPL1 was localized to human chromosome 12p12.3 and GABARAPL2 to 16q22.3-q24.1 by RH mapping, while GABARAP and GABARAPL3 were found to be localized at chromosomes 17p13.2 and 15q25.1, respectively, by searching the related databases. Sequence comparison of the cDNAs and their corresponding genomic sequences shows that GABARAP, GABARAPL1, and GABARAPL2 are composed of four exons each, while GABARAPL3 is distributed only at one exon.

Mannose-binding lectin gene polymorphism associated with the patterns of glomerular immune deposition in IgA nephropathy

OBJECTIVE

To elucidate the genetic background underlying the diversity of mesangial immune deposition in IgA nephropathy (IgAN), we investigated the distribution of mannose-binding lectin (MBL) gene codon 54 polymorphism and serum MBL levels in IgAN patients.

METHODS

Seventy-seven IgAN patients with glomerular IgA and C3 deposits (Group A) and 70 with glomerular IgA, IgG, IgM, C3 and Clq deposits (Group AGM) were included in the present study. Control group consisted of 140 normal adults. MBL genotypes were investigated by polymerase chain reaction and restriction fragment length polymorphism. Serum MBL levels with different genotypes were also assayed in some subjects.

RESULTS

The variant allele (GAC) was markedly associated with Group AGM (OR = 1.95, 95% C.I.: 1.06-3.58). In both Group A and Group AGM, more patients carrying the variant allele had episodes of upper respiratory or gastrointestinal infections prior to onset or exacerbation of IgAN than wild homozygotes (GGC/GGC). In addition, a significant difference in serum MBL level was also observed between wild homozygotes and heterozygotes (GGC/GAC) (GGC/GGC > GGC/GAC) (p<0.0001) in all groups, while there was no difference for subjects with the same genotypes among the three groups (p > 0.05). Serum MBL levels of the rare variant homozygotes approached zero.

CONCLUSIONS

Our findings provide evidence that the host defense molecule, MBL, may be involved in the formation of the diversity of glomerular immune deposition in IgAN. Genetic deficiency of MBL may partially account for abundant immune deposits in some IgAN patients.

[Mannose-binding protein gene polymorphism influences the patterns of glomerular immune deposition in IgA nephropathy]

OBJECTIVE

To investigate the relationship between mannose-binding protein(MBP) gene codon 54 (GGC/GAC) polymorphism and the patterns of glomerular immune deposition in IgA nephropathy (IgAN) and explore its functional significance.

METHODS

IgAN patients were divided into two groups according to the pattern of glomerular immune deposition. Group A included 77 patients with glomerular IgA and C3 deposits. Group AGM consisted of 70 patients with glomerular IgA, IgG, IgM, C3 and Clq deposits. One hundred and forty healthy adults were used as normal controls. MBP genotypes were investigated by PCR-RFLP. Serum MBP levels of some subjects with different genotypes were also assayed by ELISA simultaneously.

RESULTS

The genotype frequency of GAC heterozygotes was significantly higher in group AGM than in group A (41.4% vs. 19.5%, P<0.01) or normal subjects (41.4% vs. 26.4%, P<0.05), while no difference was found in the distribution of MBP genotypes between group A and normal subjects. The allele frequency of GAC mutation was also higher in group AGM than in group A (0.236 vs. 0.136, P<0.05) or normal subjects (0.236 vs. 0.146, P<0.05). The variant allele (GAC) was markedly associated with group AGM (OR=1.95, 95%CI: 1.06-3.58). In both group A and group AGM, more patients carrying the variant allele had episodes of upper respiratory or gastrointestinal infections prior to the onset or exacerbation of IgAN than wild homozygotes. In addition, a significant difference in serum MBP level was also observed among the three genotypes (GGC/GGC>GGC/GAC>GAC/GAC) (P<0.0001) for all groups, while there were no differences in serum MBP levels for subjects with the same genotypes among the three groups (P>0.05).

CONCLUSION

The above findings provide evidence that IgAN patients with abundant immune deposits in glomeruli show a higher frequency of MBP gene variation which is associated with a high frequency of infection and a low serum MBP level. This genetic deficiency may lead to an impaired first-line defense and a less effective clearance of immune complex than those without this mutation and thereafter accelerate glomerular immune deposition during the process of disease.

Cloning and tissue expressional characterization of a full-length cDNA encoding human neuronal protein P17.3

A full-length cDNA of 595 bp was isolated from a human fetal brain cDNA library. It contains an open reading frame encoding 153 amino acids, with an 18-bp 5'UTR and a 118-bp 3'UTR in which there is an atypical polyadenylation signal (ATTAAA). The calculated molecular weight of the deduced protein is 17.3 kU. The predicted isoelectric point is 4.89. On account of its high homology to mouse neuronal protein NP15.6 (81.2% identity), the deduced protein was named neuronal protein 17.3 (NP17.3). When its secondary structure was examined by the GGBSM program of PCGENE software, it was found that 32.6 and 15.0% of its amino acids are involved in forming alpha-helices and beta-sheets, respectively. Examined with the PESTFIND program, a typical PEST region found in rapidly degraded proteins was found between residue 48 and residue 68.

[Isolation of isoforms of apolipoprotein CIII from human serum by chromatofocusing]

This study aimed to isolate isoforms of apolipoprotein (apo) C III from human serum. 24-hour fasting serum from normal and hyperlipidemic subjects was pooled and subjected to ultracentrifugation at plasma density for 20 hours. Very low density lipoprotein (VLDL) was collected at density of d < 1.006 g/ml, and it was delipidated by ethanol and ether. The delipidated apo-VLDL was dissolved in a solution containing 7.2 mol/L urea and 20 mmol/L dithiothreitol. The insoluble apo B was removed by centrifugation. The soluble apo-VLDL was applied to PBE94 column, and eluted with elution buffer containing polybuffer 74 and 8 mol/L urea (1:8, pH4.0). After pooled, the eluted peaks of apolipoproteins were applied to column chromatography of hydroxylapatite to remove the polybuffer. The purified isoforms of apoC III and the purified apo C I, C II and E, were characterized by isoelectrofocusing and west blot. The results showed that the purified apoC III1, C III2, and C II were pure.

A new method for computerized tomography diagnosis of early transtentorial hernia

OBJECTIVE

To evaluate a new scanning method designed for the diagnosis of early transtentorial hernia as compared with the routine scanning method (parallel to orbitomeatal line).

METHODS

102 patients with unilateral high intracranial pressure and 100 volunteers without any cranial symptoms and signs were scanned on (1) the plane perpendicular to the plane of clivus and (2) the plane parallel to orbitomeatal line, a line joining the apex of the dorsum sellae and the lowest point of the clivus.

RESULTS

Vertical-to-clivus scanning method directly demonstrated the temporal transtentorial hernia in 48 of 102 patients with unilateral high intracranial pressure, but the orbitomeatal line scanning method was not able to show this direct finding. The projected tissue of the temporal lobe could be obviously shown and the degree of the hernia could be judged directly on the CT imaging with the vertical-to-clivus scanning method. Therefore, the CT diagnosis criterion of the hernia was suggested as follows: the hernia would be determined if the downward shift of the temporal lobe was more than 3 mm and suspected if less than 3 mm with ipsilateral high intracranial pressure.

CONCLUSION

This new method presented a superiority in showing the temporal transtentorial hernia for the patients with a cranial emergency.

Comparison of hypertonic saline solutions and dextran in dialysis-induced hypotension

The efficacy of three hypertonic saline solutions for treating dialysis-induced hypotension in a randomized, blinded, crossover clinical trial of 10 patients (a minimum of three cycles per solution) was compared. Dialysis-induced hypotension, defined as a decrease in systolic blood pressure of at least 10 mm Hg or systolic blood pressure less than 100 mm Hg, was treated with an iv bolus of either 10 mL of 23% saturated hypertonic saline, 30 mL of 7.5% hypertonic saline, or 30 mL of 7.5% saline with 6% dextran 70, each containing similar osmolar loads of 80, 80, and 100 mosM, respectively. All three solutions raised systolic blood pressure within 5 min (mean pretreatment systolic blood pressure, 87 mm Hg; mean posttreatment systolic blood pressure, 101 mm Hg; P < 0.05). The magnitude of the increase was greater with saturated hypertonic saline (15 mm Hg) and dextran 70 (17 mm Hg) compared with that with hypertonic saline (9 mm Hg; P < 0.05). At 10 min, dialysis-induced hypotension was less frequent with saturated hypertonic saline (incidence, 9%) compared with hypertonic saline (45%). Beyond 10 min, however, there was a trend toward a lower incidence of further dialysis-induced hypotension with dextran 70. There were no side effects. Given equal osmole loads, the more concentrated solution produced a greater increase in systolic blood pressure. The addition of an oncotic agent such as dextran may prolong the blood pressure response beyond 10 min. It was concluded that hypertonic saline solutions safely and effectively treat dialysis-induced hypotension.

Knotting and entanglement of multiple central venous catheters

A 53-yr-old black male was admitted with peripheral vascular disease and septic shock. Appropriate cardiopulmonary resuscitation and operative intervention required the placement of multiple central venous lines. These included two subclavicular central venous pressure (CVP) catheters and one Swan-Ganz catheter (SGC). During manipulation of the SGC, it formed a knot with the two CVP catheters entangled in it. After consideration of the variety of strategies that could be employed, the CVP catheters were manually disengaged from the knot and the knot was surgically removed. The increasing frequency and multiple central angioaccess catheters will result in a finite increase in the nature and complexity of the clinical challenges. The insistence on the use of multiple single-channel catheters for separate therapeutic functions and the duration of stay of pulmonary catheters should be reconsidered.