Distal tubular epithelial cells of the kidney: Potential support for proximal tubular cell survival after renal injury

Gender difference and sex hormone production in rodent renal ischemia reperfusion injury and repair

BACKGROUND

Several lines of evidence suggest a protective effect of female sex hormones in several organs subjected to ischemia-reperfusion injury. The aim of the study was to investigate sex hormone production in male rats after a renal ischemia-reperfusion sequence and analyze the influence of gender differences on tissue remodelling during the recovery process.

METHOD

Age-matched sexually mature male and female rats were subjected to 60 min of renal unilateral ischemia by pedicle clamping with contralateral nephrectomy and followed for 1 or 5 days after reperfusion. Plasma creatinine, systemic testosterone, progesterone and estradiol levels were determined. Tubular injury, cell proliferation and inflammation, were evaluated as well as proliferating cell nuclear antigen, vimentin and translocator protein (TSPO) expressions by immunohistochemistry.

RESULTS

After 1 and 5 days of reperfusion, plasma creatinine was significantly higher in males than in females, supporting the high mortality in this group. After reperfusion, plasma testosterone levels decreased whereas estradiol significantly increased in male rats. Alterations of renal function, associated with tubular injury and inflammation persisted during the 5 days post-ischemia-reperfusion, and a significant improvement was observed in females at 5 days of reperfusion. Proliferating cell nuclear antigen and vimentin expression were upregulated in kidneys from males and attenuated in females, in parallel to injury development. TSPO expression was transiently increased in proximal tubules in male rats.

CONCLUSIONS

After ischemia, renal function recovery and tissue injury is gender-dependent. These differences are associated with a modulation of sex hormone production and a modification of tissue remodeling and proliferative cell processes.

Regenerative medicine of the kidney

End stage renal disease is a major health problem in this country and worldwide. Although dialysis and kidney transplantation are currently used to treat this condition, kidney regeneration resulting in complete healing would be a desirable alternative. In this review we focus our attention on current therapeutic approaches used clinically to delay the onset of kidney failure. In addition we describe novel approaches, like Tissue Engineering, Stem cell Applications, Gene Therapy, and Renal Replacement Therapy that may one day be possible alternative therapies for patients with the hope of delaying kidney failure or even stopping the progression of renal disease.

Adenovirus-mediated anti-sense ERK2 gene therapy inhibits tubular epithelial-mesenchymal transition and ameliorates renal allograft fibrosis

PURPOSE

Epithelial-mesenchymal transition (EMT) plays an important role in progress of renal allograft fibrosis. The adenovirus-mediated anti-sense extracellular signal-regulated kinase 2 (Adanti-ERK2) gene therapy was used to block ERK signaling pathway, and its effect on EMT and renal allograft fibrosis both in vivo and in vitro was explored.

METHODS

We first generated an in vitro EMT model by connective tissue growth factor (CTGF) stimulation in a HK-2 cell culture system, and then applied Adanti-ERK2 gene therapy on it. The transition of epithelial marker (E-cadherin) to mesenchymal markers (α-SMA, Vimentin) and the cell mobility function alteration were monitored for the observation of EMT progress. In vivo, a rat renal transplant model with Fisher-Lewis combination was employed and the Adanti-ERK2 gene therapy was given. The tubular EMT changes and pathology of allograft fibrosis were examined.

RESULTS

In vitro, Adanti-ERK2 gene therapy inhibited CTGF-induced tubular EMT and attenuated the cell motility function induced by CTGF. In vivo, Adanti-ERK2 gene therapy attenuated tubular EMT, modulated the infiltration of macrophages and CD8(+), CD4(+)T lymphocytes, and ameliorated fibrosis effectively in the renal allografts 24weeks after transplantation.

CONCLUSIONS

Adanti-ERK2 gene therapy inhibits tubular EMT and attenuates renal allograft fibrosis. It is possible to develop promising molecular drug(s) in the future based on ERK signaling pathway.

Adult human CD133/1(+) kidney cells isolated from papilla integrate into developing kidney tubules

Approximately 60,000 patients in the United States are waiting for a kidney transplant due to genetic, immunologic and environmentally caused kidney failure. Adult human renal stem cells could offer opportunities for autologous transplant and repair of damaged organs. Current data suggest that there are multiple progenitor types in the kidney with distinct localizations. In the present study, we characterize cells derived from human kidney papilla and show their capacity for tubulogenesis. In situ, nestin(+) and CD133/1(+) cells were found extensively intercalated between tubular epithelia in the loops of Henle of renal papilla, but not of the cortex. Populations of primary cells from the renal cortex and renal papilla were isolated by enzymatic digestion from human kidneys unsuited for transplant and immuno-enriched for CD133/1(+) cells. Isolated CD133/1(+) papillary cells were positive for nestin, as well as several human embryonic stem cell markers (SSEA4, Nanog, SOX2, and OCT4/POU5F1) and could be triggered to adopt tubular epithelial and neuronal-like phenotypes. Isolated papillary cells exhibited morphologic plasticity upon modulation of culture conditions and inhibition of asymmetric cell division. Labeled papillary cells readily associated with cortical tubular epithelia in co-culture and 3-dimensional collagen gel cultures. Heterologous organ culture demonstrated that CD133/1(+) progenitors from the papilla and cortex became integrated into developing kidney tubules. Tubular epithelia did not participate in tubulogenesis. Human renal papilla harbor cells with the hallmarks of adult kidney stem/progenitor cells that can be amplified and phenotypically modulated in culture while retaining the capacity to form new kidney tubules. This article is part of a Special Issue entitled: Polycystic Kidney Disease.

Tamm-Horsfall protein-deficient thick ascending limbs promote injury to neighboring S3 segments in an MIP-2-dependent mechanism

Tamm-Horsfall protein (THP) is a glycoprotein expressed exclusively in thick ascending limbs (TAL) of the kidney. We recently described a novel protective role of THP against acute kidney injury (AKI) via downregulation of inflammation in the outer medulla. Our current study investigates the mechanistic relationships among the status of THP, inflammation, and tubular injury. Using an ischemia-reperfusion model in wild-type and THP-/- mice, we demonstrate that it is the S3 proximal segments but not the THP-deficient TAL that are the main targets of tubular injury during AKI. The injured S3 segments that are surrounded by neutrophils in THP-/- mice have marked overexpression of neutrophil chemoattractant MIP-2 compared with wild-type counterparts. Neutralizing macrophage inflammatory protein-2 (MIP-2) antibody rescues S3 segments from injury, decreases neutrophil infiltration, and improves kidney function in THP-/- mice. Furthermore, using immunofluorescence volumetric imaging of wild-type mouse kidneys, we show that ischemia alters the intracellular translocation of THP in the TAL cells by partially shifting it from its default apical surface domain to the basolateral domain, the latter being contiguous to the basolateral surface of S3 segments. Concomitant with this is the upregulation, in the basolateral surface of S3 segments, of the scavenger receptor SRB-1, a putative receptor for THP. We conclude that TAL affects the susceptibility of S3 segments to injury at least in part by regulating MIP-2 expression in a THP-dependent manner. Our findings raise the interesting possibility of a direct role of basolaterally released THP on regulating inflammation in S3 segments.

Stem cell marker TRA-1-60 is expressed in foetal and adult kidney and upregulated in tubulo-interstitial disease

The kidney has an intrinsic ability to repair itself when injured. Epithelial cells of distal tubules may participate in regeneration. Stem cell marker, TRA-1-60 is linked to pluripotency in human embryonic stem cells and is lost upon differentiation. TRA-1-60 expression was mapped and quantified in serial sections of human foetal, adult and diseased kidneys. In 8- to 10-week human foetal kidney, the epitope was abundantly expressed on ureteric bud and structures derived therefrom including collecting duct epithelium. In adult kidney inner medulla/papilla, comparisons with reactivity to epithelial membrane antigen, aquaporin-2 and Tamm-Horsfall protein, confirmed extensive expression of TRA-1-60 in cells lining collecting ducts and thin limb of the loop of Henle, which may be significant since the papillae were proposed to harbour slow cycling cells involved in kidney homeostasis and repair. In the outer medulla and cortex there was rare, sporadic expression in tubular cells of the collecting ducts and nephron, with positive cells confined to the thin limb and thick ascending limb and distal convoluted tubules. Remarkably, in cortex displaying tubulo-interstitial injury, there was a dramatic increase in number of TRA-1-60 expressing individual cells and in small groups of cells in distal tubules. Dual staining showed that TRA-1-60 positive cells co-expressed Pax-2 and Ki-67, markers of tubular regeneration. Given the localization in foetal kidney and the distribution patterns in adults, it is tempting to speculate that TRA-1-60 may identify a population of cells contributing to repair of distal tubules in adult kidney.

Protective effect of quercetin on hydrogen peroxide-induced tight junction disruption

Tight junction is a crucial structure in the control of paracellular transport across epithelial/endothelial barriers. This study investigated the protective effect of quercetin against hydrogen peroxide (H(2)O(2))-induced tight junction disruption and hyperpermeability in ECV304 monolayers. Nonlethal concentration of H(2)O(2) (100 micromol/L; 4 hours) decreased expression of the tight junction proteins zonular occudens (ZO)-1 and occludin as well as disrupted the junction structure at the cell border. Concurrently, the increased activities of extracellular signal-regulated kinase (ERK)1/2 and p38 mitogen-activated protein kinase (MAPK) were observed. Pretreatment with quercetin (10 micromol/L; 30 minutes) prior to H(2)O(2) prevented the loss of ZO-1 and occludin. In addition, the level of phosphorylated p38 MAPK, but not that of the phosphorylated ERK1/2, decreased in quercetin-pretreated group. These findings suggested that the protective effect of quercetin involved the inhibition of phosphorylated p38 MAP activity. Furthermore, quercetin could also preserve the functional integrity of ECV304 monolayers from H(2)O(2) exposure.

Kidney regeneration

Neonephrogenesis, the capacity to regenerate renal tissue, is a distinctive feature of fish but not usually of mammals. However, evidence exists for kidney repair in response to insulting agents for animals and human beings. Studies have therefore been designed in the past few years to clarify the cellular and molecular basis of renal repair, with the aim to investigate the potential regenerative capacity of animal and human kidneys. Three main questions are being addressed by this research: whether terminally differentiated cells in adult animal kidneys have regenerative capacity; whether multipotent progenitor cells exist in kidneys; and whether renal repair can be favoured or accelerated by cells of extrarenal origin migrating to the kidney in response to injury. In this Review, we describe evidence of cellular and molecular pathways related to renal repair and regeneration, and review data from animal and human studies that show that the kidney might have regenerative capacity.

Ethylene glycol induced hyperoxaluria increases plasma and renal tissue asymmetrical dimethylarginine in rats: a new pathogenetic link in hyperoxaluria induced disorders

PURPOSE

The pathogenesis of kidney stones remains elusive. There is some evidence that hyperoxaluria may effect vascular endothelium and many studies link renal stones to atherosclerosis. Also, renal vascular endothelial cells regulate proximal tubular epithelial cell function. We determined the effect of hyperoxaluria on plasma and tissue levels of asymmetrical dimethylarginine. The secondary aim was to determine the effect of verapamil on asymmetrical dimethylarginine.

MATERIALS AND METHODS

A total of 42 Sprague-Dawley rats were included in the study. In groups 1A, 1B and 1C hyperoxaluria was induced with ethylene glycol for 2 weeks. Groups 2A, 2B and 2C received ethylene glycol for 14 days and verapamil for 28 days. Control group 3 received no specific medication but distilled water. Blood samples were obtained at 24 hours and at study end, and kidney samples were obtained at 24 hours, and 7 and 28 days for histopathological evaluation.

RESULTS

Plasma asymmetrical dimethylarginine increased early in the hyperoxaluric group (p = 0.0002). The effect was retained at the end of the study period (p = 0.01). There was no increase in asymmetrical dimethylarginine in the verapamil group on short-term and long-term followup. Hyperoxaluria induced a significantly dense staining pattern in renal tissue asymmetrical dimethylarginine vs controls (p = 0.01). Asymmetrical dimethylarginine staining did not differ in the control and verapamil groups.

CONCLUSIONS

Increased systemic and local tissue asymmetrical dimethylarginine may help explain the pathogenetic mechanisms of hyperoxaluria induced disorders such as nephrolithiasis and atherosclerosis.

Expression and modulation of translocator protein and its partners by hypoxia reoxygenation or ischemia and reperfusion in porcine renal models

Translocator protein (TSPO), formerly known as the peripheral-type benzodiazepine receptor, is an 18-kDa drug- and cholesterol-binding protein localized to the outer mitochondrial membrane and implicated in a variety of cell and mitochondrial functions. To determine the role of TSPO in ischemia-reperfusion injury (IRI), we used both in vivo and in vitro porcine models: an in vivo renal ischemia model where different conservation modalities were tested and an in vitro model where TSPO-transfected porcine proximal tubule LLC-PK(1) cells were exposed to hypoxia and oxidative stress. The expression of TSPO and its partners in steroidogenic cells, steroidogenic acute regulatory protein (StAR) and cytochrome P-450 side chain cleavage CYP11A1, as well as the impact of TSPO overexpression and exposure to TSPO ligands in vitro in hypoxia-ischemia conditions were investigated. Hypoxia induced caspase activation, reduction of ATP content, and LLC-PK(1) cell death. Transfection and overexpression of TSPO rescued the cells from the detrimental effects of hypoxia and reoxygenation. Moreover, TSPO overexpression was accompanied by a reduction of H(2)O(2)-induced necrosis. TSPO drug ligands did not affect TSPO-mediated functions. In vivo, TSPO expression was modulated by IRI and during regeneration particularly in proximal tubule cells, which do not express this protein at the basal level. Under the same conditions, StAR and CYP11A1 protein and gene expression was reduced without apparent relation to TSPO changes. Pregnenolone was identified and measured in the pig kidney. Pregnenolone synthesis was not affected by the experimental conditions used. Taken together, these results indicate that changes in TSPO expression in kidney regenerating tissue could be important for renal protection and maintenance of kidney function.

Angiotensin II induces DNA damage in the kidney

Increased activity of the renin angiotensin system with enhanced levels of angiotensin II leads to oxidative stress with endothelial dysfunction, hypertension, and atherosclerosis. Epidemiologic studies revealed a higher cancer mortality and an increased kidney cancer incidence in hypertensive patients. Because elevated angiotensin II levels might contribute to carcinogenesis, we tested whether angiotensin II induces DNA damage in the kidney. In isolated perfused mouse kidneys, as little as 1 nmol/L angiotensin II caused a significant increase in DNA strand breaks, measured with the comet assay. This damage was independent of the hemodynamic effect of angiotensin II and mediated by the angiotensin II type 1 receptor. Angiotensin II also caused double-strand breaks in the cells of the isolated perfused kidney, detected with an antibody against the double-strand break marker gamma-H2AX. Studies in cell culture allowed further characterization of the DNA damage induced by angiotensin II. Single- and double-strand breaks, abasic sites, and 7,8-dihydro-8-oxo-guanine, all types of oxidative DNA lesions, were detected in angiotensin II-treated renal cells. The majority of detected strand breaks was repaired within 1 hour, but double-strand breaks increased and persisted for at least 24 hours.

When less is more: apoptosis during acute kidney injury

The paper by Ma and Devarajan suggests that the subtle apoptotic events that occur in the distal nephron after acute kidney injury might have a greater than expected impact on the adjacent proximal tubules and kidney function. Understanding these events might facilitate development of therapeutic means to ameliorate acute kidney injury.

Silymarin attenuates the renal ischemia/reperfusion injury-induced morphological changes in the rat kidney

OBJECTIVES

Renal ischemia/reperfusion (I/R) injury is associated with increased mortality and morbidity rates due to acute renal failure (ARF). Oxidative stress induced with renal I/R injury directly affects glomerular and tubular epithelium through reactive oxygen species. Several studies have been directed to the treatment of renal I/R injury. The aim of this study was to test the attenuation with silymarin (SM) treatment of renal I/R injury-induced morphological changes in the rat kidney.

METHODS

A total of 32 adult male Sprague-Dawley rats were evaluated in four groups. Group I (sham), Group II (renal I/R), Group III (renal I/R injury + SM 50 mg per kg) and Group IV (renal I/R injury + SM 100 mg per kg) were designed to evaluate the dose-dependent effects of SM on the morphological changes of renal I/R injury. Renal I/R injury were induced with left renal pedicle occlusion for 45 min followed with reperfusion for 6 h under anesthesia. After induction of I/R injury, left nephrectomies were performed for histopathological examinations.

RESULTS

After renal I/R injury, significant tubular dilatation, tubular vacuolization, pelvic inflammation, interstitial inflammation, perirenal adipose infiltration, tubular necrosis and glomerular necrosis (cortical necrosis) were observed. However, even with low dose SM in Group III (50 mg per kg SM), histopathological changes due to I/R injury were prevented.

CONCLUSIONS

The results of this study have demonstrated that SM significantly prevents renal I/R injury-induced renal tubular changes in the rat. SM in 50 mg/kg was observed to be sufficient to significantly prevent renal tubular necrosis. Further, to our literature knowledge, this is the first specific study to demonstrate the preventive effect of SM on renal I/R injury.

Human renal cells from the thick ascending limb and early distal tubule: characterization of primary isolated and cultured cells by reverse transcription polymerase chain reaction

AIM

Human renal tubular cells of well-defined nephron origin are an important basis in the research of various physiological and pathophysiological mechanisms in the kidney. Whereas an exceeding amount of data has been obtained on proximal tubular cells, only limited data of cells of the human thick ascending limb and the early distal tubule (TALDC) are available.

METHODS

TALDC have been isolated immunomagnetically according to their specific antigen expression of Tamm-Horsfall glycoprotein (THG). Cells were either directly processed for analysis or cultured under normal cell culture conditions. Differentiation of primary isolates and cultured cells was assessed by reverse transcription polymerase chain reaction using characteristic markers. As controls, we used RNA from whole human kidney and cultured HK-2 cells. Additional characterizations were made by morphological analysis and western blotting.

RESULTS

Primary isolated TALDC express the characteristic markers epidermal growth factor receptor, Na-K-2Cl transporter 2, epithelial calcium canal, and THG but were negative for Pax-2, aquaporin-2 and -3. Cultured TALDC were positive for epidermal growth factor receptor and Na-K-2Cl transporter 2 but have lost their epithelial calcium canal and THG expression and started to express Pax-2. All probes were positive for the specific markers kidney-specific cadherin and cytokeratin-8. Furthermore, differentiation of cultured TALDC was shown by cell morphology and their characteristic protein expression pattern.

CONCLUSION

Our results highlight the purity of primary isolates and the differentiation of cultured TALDC, and show that they can be used as an in vitro system studies of the human thick ascending limb of Henle's loop and early distal tubule.

Acute kidney injury: stimulation of repair

PURPOSE OF REVIEW

The kidney has the ability to restore the structural and functional integrity of the proximal tubule, which undergoes extensive epithelial cell death via necrosis and apoptosis after a prolonged ischaemic insult. This review focuses on the recent advances in this area, and discusses the possible therapeutic interventions that might be derived from these insights.

RECENT FINDINGS

Interest has recently been focused on the possible role of bone marrow originating stem cells in endogenous repair of the injured tubule, the identification of a resident population of progenitor cells in the kidney, and the potential therapeutic role of growth factors including erythropoietin and hepatocyte growth factor to stimulate these processes.

SUMMARY

Advances in the understanding of the early processes that initiate and control the proliferation of surviving tubular epithelium and vascular structures are ready to be translated into clinical trials in acute kidney injury.

Role of apoptosis in the kidney after reperfusion

A szervtranszplantáció klinikai megvalósulása a 20. század orvostudományának egyik legfontosabb vívmánya. Az ischaemiareperfúzió befolyást gyakorol a transzplantált szerv azonnali és hosszú távú működésére. A szervtranszplantáció az ischaemiareperfúzió klinikai modelljének tekinthető. Célkitűzés: Az ischaemiareperfúzió során létrejött károsodások megelőzési lehetőségeinek vizsgálata, melyben az apoptosis kulcsfontosságú szerepet játszik. Módszerek: Humán vesetranszplantációban vizsgálták az apoptosist. Állatkísérletben átmeneti ischaemiát követően elemezték az apoptosis kialakulását, és megkísérelték kalciumantagonisták: verapamil, nifedipin, bepridil, fendilin, valamint a B-típusú monoamino-oxidáz irreverzíbilis szelektív inhibitor (–)-deprenyl (MAO-B) adásával megelőzni kialakulását. Eredmények: Transzplantált humán vesében mind apoptoticus, mind necroticus sejtek előfordulnak, regenerációs sejtproliferációs jelekkel kísérve. Patkányvesében a kalciumantagonisták csökkentették az apoptosis előfordulását. A (–)-deprenylnek preventív hatása volt a renalis tubularis sejtek ischaemiareperfúziót követő apoptosisának kialakulásában. Következtetések: A tubulussejtek funkcionális kapacitása szignifikánsan hozzájárul az adekvát veseműködéshez. A tubularis sejtek apoptosisának csökkentése feltehetően javíthatná a transzplantált vese funkcióját.