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Oncel MY, Canpolat FE, Arayici S, Alyamac Dizdar E, Uras N, Oguz SS. Urinary markers of acute kidney injury in newborns with perinatal asphyxia (.). Ren Fail 2016; 38:882-8. [PMID: 27055689 DOI: 10.3109/0886022x.2016.1165070] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) affects up to 60% of severely asphyxiated neonates. The diagnosis of AKI can be and is further challenged by a lack of good biomarkers. We studied the role of novel markers for AKI, neutrophil gelatinase-associated lipocalin (NGAL), interleukin-8 (IL-18), Netrin-1 (NTN-1), and sodium hydrogen exchanger isoform 3 (NHE3) on development and early diagnosis of AKI in newborns with perinatal asphyxia (PA). METHODS Forty-one newborns with a diagnosis of PA (15 with AKI and 26 without AKI) and 20 healthy matched controls were involved to the study. Urinary samples were obtained on postnatal days 1 and 4 for patients with PA and on postnatal day 1 for the control subjects. AKI was defined using a serum creatinine-based modification of the acute kidney injury network criteria. RESULTS The levels of NGAL, NTN-1, NHE3, and IL-18 on the first postnatal day urine samples were higher in patients compared to controls (p < 0.001, p <0.001, p <0.02, p <0.001, respectively). In patients with AKI, the levels of NGAL and IL-18 were higher when compared to patients without AKI (p = 0.002, p <0.001, respectively). The levels of NTN-1 and NHE3 were similar in both groups. For the samples obtained on postnatal day 4, only NGAL levels were significantly higher in patients with AKI (p = 0.004) compared to those without AKI. CONCLUSION To our knowledge, this is the largest study, which evaluated the utility of urinary biomarkers in the diagnosis of AKI in newborns with PA. First day, urine NGAL and IL-18 levels have an important diagnostic power in such patients.
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Affiliation(s)
- Mehmet Yekta Oncel
- a Division of Neonatology , Zekai Tahir Burak Maternity Teaching Hospital , Ankara , Turkey
| | - Fuat Emre Canpolat
- a Division of Neonatology , Zekai Tahir Burak Maternity Teaching Hospital , Ankara , Turkey
| | - Sema Arayici
- a Division of Neonatology , Zekai Tahir Burak Maternity Teaching Hospital , Ankara , Turkey
| | - Evrim Alyamac Dizdar
- a Division of Neonatology , Zekai Tahir Burak Maternity Teaching Hospital , Ankara , Turkey
| | - Nurdan Uras
- a Division of Neonatology , Zekai Tahir Burak Maternity Teaching Hospital , Ankara , Turkey
| | - Serife Suna Oguz
- a Division of Neonatology , Zekai Tahir Burak Maternity Teaching Hospital , Ankara , Turkey
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Jankowski J, Schanstra JP, Mischak H. Body fluid peptide and protein signatures in diabetic kidney diseases. Nephrol Dial Transplant 2016. [PMID: 26209737 DOI: 10.1093/ndt/gfv091] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Body fluid protein-based biomarkers carry the hope of improving patient management in diabetes by enabling more accurate and earlier detection of diabetic kidney disease (DKD), but also of defining the most suitable therapeutic targets. We present the data on some of the best studied individual protein markers in body fluids and conclude that their potential in clinical application for assessing DKD is moderate. Proteome-based approaches aiming at the identification of panels of body fluid biomarkers might be a valid alternative. We discuss the past (first) clinical proteomics studies in DKD, stressing their drawbacks but also the lessons that could be learned from them, as well as the more recent studies that have a potential for actual clinical implementation. We also highlight relevant issues and current problems associated with clinical proteomics from discovery towards application, and give suggestions for solutions that may help guiding proteomic studies, thereby removing some of the current hurdles for implementation of potentially beneficial results.
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Affiliation(s)
- Joachim Jankowski
- Universitätsklinikum RWTH Aachen, Institute of Molecular Cardiovascular Research, Aachen, Germany
| | - Joost P Schanstra
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institute of Cardiovascular and Metabolic Disease, Toulouse, France Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Harald Mischak
- Mosaiques Diagnostics & Therapeutics, Hannover, Germany BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, Faculty of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Xia C, Li XQ, Zhou ZH, Chen HS. Identification of cytokines for early prediction of malignant middle cerebral artery infarction. Int J Neurosci 2016; 127:86-91. [DOI: 10.3109/00207454.2016.1146265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Nikiforova TA, Shchekochikhin DY, Kopylov FY, Syrkin AL. [Prognostic value of biomarkers in chronic heart failure with preserved left ventricular ejection fraction]. TERAPEVT ARKH 2016. [PMID: 28635812 DOI: 10.17116/terarkh2016889102-105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The paper reviews major biomarkers for determining the prognosis in patients with chronic heart failure and preserved ejection fraction. It also considers cystatin C, one of the novel and probably the most practically important biomarkers.
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Affiliation(s)
- T A Nikiforova
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - D Yu Shchekochikhin
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - F Yu Kopylov
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - A L Syrkin
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
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Cordaro M, Impellizzeri D, Bruschetta G, Siracusa R, Crupi R, Di Paola R, Esposito E, Cuzzocrea S. A novel protective formulation of Palmitoylethanolamide in experimental model of contrast agent induced nephropathy. Toxicol Lett 2016; 240:10-21. [DOI: 10.1016/j.toxlet.2015.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 10/02/2015] [Accepted: 10/09/2015] [Indexed: 10/22/2022]
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Schley G, Köberle C, Manuilova E, Rutz S, Forster C, Weyand M, Formentini I, Kientsch-Engel R, Eckardt KU, Willam C. Comparison of Plasma and Urine Biomarker Performance in Acute Kidney Injury. PLoS One 2015; 10:e0145042. [PMID: 26669323 PMCID: PMC4682932 DOI: 10.1371/journal.pone.0145042] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 11/29/2015] [Indexed: 12/22/2022] Open
Abstract
Background New renal biomarkers measured in urine promise to increase specificity for risk stratification and early diagnosis of acute kidney injury (AKI) but concomitantly may be altered by urine concentration effects and chronic renal insufficiency. This study therefore directly compared the performance of AKI biomarkers in urine and plasma. Methods This single-center, prospective cohort study included 110 unselected adults undergoing cardiac surgery with cardiopulmonary bypass between 2009 and 2010. Plasma and/or urine concentrations of creatinine, cystatin C, neutrophil gelatinase-associated lipocalin (NGAL), liver fatty acid-binding protein (L-FABP), kidney injury molecule 1 (KIM1), and albumin as well as 15 additional biomarkers in plasma and urine were measured during the perioperative period. The primary outcome was AKI defined by AKIN serum creatinine criteria within 72 hours after surgery. Results Biomarkers in plasma showed markedly better discriminative performance for preoperative risk stratification and early postoperative (within 24h after surgery) detection of AKI than urine biomarkers. Discriminative power of urine biomarkers improved when concentrations were normalized to urinary creatinine, but urine biomarkers had still lower AUC values than plasma biomarkers. Best diagnostic performance 4h after surgery had plasma NGAL (AUC 0.83), cystatin C (0.76), MIG (0.74), and L-FAPB (0.73). Combinations of multiple biomarkers did not improve their diagnostic power. Preoperative clinical scoring systems (EuroSCORE and Cleveland Clinic Foundation Score) predicted the risk for AKI (AUC 0.76 and 0.71) and were not inferior to biomarkers. Preexisting chronic kidney disease limited the diagnostic performance of both plasma and urine biomarkers. Conclusions In our cohort plasma biomarkers had higher discriminative power for risk stratification and early diagnosis of AKI than urine biomarkers. For preoperative risk stratification of AKI clinical models showed similar discriminative performance to biomarkers. The discriminative performance of both plasma and urine biomarkers was reduced by preexisting chronic kidney disease.
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Affiliation(s)
- Gunnar Schley
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Carmen Köberle
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Sandra Rutz
- Biomarker Assessments, Roche Diagnostics GmbH, Penzberg, Germany
| | - Christian Forster
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Weyand
- Department of Cardiac Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Ivan Formentini
- Biomarker & Experimental Medicine, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | - Kai-Uwe Eckardt
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Carsten Willam
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- * E-mail:
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Bao GH, Ho CT, Barasch J. The Ligands of Neutrophil Gelatinase-Associated Lipocalin. RSC Adv 2015; 5:104363-104374. [PMID: 27617081 DOI: 10.1039/c5ra18736b] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Neutrophil gelatinase associated lipocalin (NGAL), was originally identified in neutrophil granules as a heterodimer complex with gelatinase B (matrix metalloproteinase 9, MMP9), but more recently has been found to be secreted by damaged epithelial cells. Ngal is a member of the lipocalin family and subsequently named as lipocalin 2 on the basis of structural similarity with other members of the lipocalin family and its potential association with hydrophobic retinol and cholesterol oleate more strongly than their hydrophilic counterparts. In 2002, a landmark paper suggested that Ngal is a bacteriostatic agent which blocks iron acquisition by interacting with a number of bacterial siderophores, especially enterobactin. Since then, more siderophore-carrying functions have been reported than the possibility of hydrophobic ligand transport. In this setting, Ngal was renamed Siderocalin. Functions of siderocalin include not only bacteriostatic activity but potentially as a mediator of cell growth and differentiation; some of these functions appear to be referable to the holo siderocalin:siderophore:iron complex and recent work suggests that metabolic products may act as mammalian siderophores bound by Ngal. While still speculative, it may be that the mammalian siderophores can establish the missing link between Ngal and a number of its functions in vivo. This review provides an overview of the discoveries of the different ligands of Ngal and consequently related functions. Hydrophobic ligands, bacterial siderophores as well as their modified structures (synthetic siderophores), and mammalian siderophores are summarized.
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Affiliation(s)
- Guan-Hu Bao
- State Key Laboratory of Tea Plant Biology and Utilization, Biotechnology Building 214, Anhui Agricultural University, China
| | - Chi-Tang Ho
- State Key Laboratory of Tea Plant Biology and Utilization, Biotechnology Building 214, Anhui Agricultural University, China; Department of Food Science, Rutgers University, 65 Dudley Road, New Brunswick, New Jersey 08901-8520, United States
| | - Jonathan Barasch
- College of Physicians and Surgeons of Columbia University, New York, USA
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Abstract
Neonatal encephalopathy (NE) is a major contributor to neurodevelopmental deficits including cerebral palsy in term and near-term infants. The long-term neurodevelopmental outcome is difficult to predict with certainty in first few days of life. Multiorgan involvement is common but not part of the diagnostic criteria for NE. The most frequently involved organs are the heart, liver, kidneys and hematological system. Cerebral and organ involvement is associated with the release of organ specific biomarkers in cerebrospinal fluid, urine and blood. These biomarkers may have a role in the assessment of the severity of asphyxia and long-term outcome in neonates with NE.
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Affiliation(s)
- Saima Aslam
- Department of Paediatrics, National Maternity Hospital, Holles Street, Dublin, Ireland
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Patel ML, Sachan R, Misra R, Kamal R, Shyam R, Sachan P. Prognostic significance of urinary NGAL in chronic kidney disease. Int J Nephrol Renovasc Dis 2015; 8:139-44. [PMID: 26508883 PMCID: PMC4610878 DOI: 10.2147/ijnrd.s87423] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Chronic kidney disease (CKD) is a worldwide public health problem. Recently urinary NGAL (uNGAL) has been proven to be a useful (potentially ideal) biomarker for early detection of CKD. The aim of the present study was to examine the correlation of uNGAL with severity of renal impairment in CKD and to evaluate its prognostic value in these subjects. Methods This was a prospective study carried out over a period of 24 months in subjects with CKD due to primary chronic glomerulonephritis. New cases of CKD stage II, III, IV aged between 18 and 65 years were enrolled as per KDIGO (Kidney Disease: Improving Global Outcomes) guidelines 2012. A total of 90 subjects completed the study up to the end-point. The primary follow-up end-point was 18 months, or decreased glomerular filtration rate of less than 15 mL/min. Secondary follow-up end-point was the number of subjects who expired during this period. Results Multiple regression model of estimated glomerular filtration rate showed significant associations with log uNGAL (β=0.38, P<0.001), Ca×PO4 (β=0.60, P<0.001), hemoglobin (β=0.37, P<0.001), urine protein (β=0.34, P<0.001), serum albumin (β=0.48, P<0.001), and systolic blood pressure (β=0.76, P<0.001). Receiver operator curve for uNGAL considering the progression of CKD showed area under the curve for uNGAL was 0.878 (95% confidence interval: 0.68–0.96). Cut-off value for uNGAL was log 3.5 unit with a sensitivity of 93.08% and specificity of 71.43% for predicting the progression of CKD. Kaplan–Meier survival curve showed that patients with log uNGAL levels <3.51 unit had a survival rate of 71.4% while patients with NGAL level >3.51 unit had a renal survival rate of 14.7%. Conclusion Our study result showed that uNGAL has a positive correlation with disease severity which signifies the prognostic importance of uNGAL in CKD.
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Affiliation(s)
- Munna Lal Patel
- Department of Medicine, King George Medical University, Lucknow, India
| | - Rekha Sachan
- Department of Obstetrics and Gynaecology, King George Medical University, Lucknow, India
| | - Ravi Misra
- Department of Internal Medicine, King George Medical University, Lucknow, India
| | - Ritul Kamal
- Epidemiology Division, Council of Scientific and Industrial Research-Indian Institute of Toxicology Research (CSIR-IITR), Lucknow, India
| | - Radhey Shyam
- Department of Geriatric Intensive Care Unit, King George Medical University, Lucknow, India
| | - Pushpalata Sachan
- Department of Physiology, Career Institute of Medical Sciences, Lucknow, India
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Quintavalle C, Anselmi CV, De Micco F, Roscigno G, Visconti G, Golia B, Focaccio A, Ricciardelli B, Perna E, Papa L, Donnarumma E, Condorelli G, Briguori C. Neutrophil Gelatinase–Associated Lipocalin and Contrast-Induced Acute Kidney Injury. Circ Cardiovasc Interv 2015; 8:e002673. [DOI: 10.1161/circinterventions.115.002673] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Cristina Quintavalle
- From the Department of Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy (C.Q., E.P., G.C.); Institute of Genetics and Biomedical Research, Milan Unit, Milan, Italy (C.V.A., L.P.); Humanitas Research Hospital, Rozzano, Italy (C.V.A., L.P.); Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy (F.D.M., G.V., B.G., A.F., B.R., C.B.); Institute for Endocrinology and Experimental Oncology, National Research Council,
| | - Chiara Viviani Anselmi
- From the Department of Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy (C.Q., E.P., G.C.); Institute of Genetics and Biomedical Research, Milan Unit, Milan, Italy (C.V.A., L.P.); Humanitas Research Hospital, Rozzano, Italy (C.V.A., L.P.); Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy (F.D.M., G.V., B.G., A.F., B.R., C.B.); Institute for Endocrinology and Experimental Oncology, National Research Council,
| | - Francesca De Micco
- From the Department of Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy (C.Q., E.P., G.C.); Institute of Genetics and Biomedical Research, Milan Unit, Milan, Italy (C.V.A., L.P.); Humanitas Research Hospital, Rozzano, Italy (C.V.A., L.P.); Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy (F.D.M., G.V., B.G., A.F., B.R., C.B.); Institute for Endocrinology and Experimental Oncology, National Research Council,
| | - Giuseppina Roscigno
- From the Department of Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy (C.Q., E.P., G.C.); Institute of Genetics and Biomedical Research, Milan Unit, Milan, Italy (C.V.A., L.P.); Humanitas Research Hospital, Rozzano, Italy (C.V.A., L.P.); Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy (F.D.M., G.V., B.G., A.F., B.R., C.B.); Institute for Endocrinology and Experimental Oncology, National Research Council,
| | - Gabriella Visconti
- From the Department of Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy (C.Q., E.P., G.C.); Institute of Genetics and Biomedical Research, Milan Unit, Milan, Italy (C.V.A., L.P.); Humanitas Research Hospital, Rozzano, Italy (C.V.A., L.P.); Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy (F.D.M., G.V., B.G., A.F., B.R., C.B.); Institute for Endocrinology and Experimental Oncology, National Research Council,
| | - Bruno Golia
- From the Department of Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy (C.Q., E.P., G.C.); Institute of Genetics and Biomedical Research, Milan Unit, Milan, Italy (C.V.A., L.P.); Humanitas Research Hospital, Rozzano, Italy (C.V.A., L.P.); Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy (F.D.M., G.V., B.G., A.F., B.R., C.B.); Institute for Endocrinology and Experimental Oncology, National Research Council,
| | - Amelia Focaccio
- From the Department of Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy (C.Q., E.P., G.C.); Institute of Genetics and Biomedical Research, Milan Unit, Milan, Italy (C.V.A., L.P.); Humanitas Research Hospital, Rozzano, Italy (C.V.A., L.P.); Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy (F.D.M., G.V., B.G., A.F., B.R., C.B.); Institute for Endocrinology and Experimental Oncology, National Research Council,
| | - Bruno Ricciardelli
- From the Department of Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy (C.Q., E.P., G.C.); Institute of Genetics and Biomedical Research, Milan Unit, Milan, Italy (C.V.A., L.P.); Humanitas Research Hospital, Rozzano, Italy (C.V.A., L.P.); Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy (F.D.M., G.V., B.G., A.F., B.R., C.B.); Institute for Endocrinology and Experimental Oncology, National Research Council,
| | - Enzo Perna
- From the Department of Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy (C.Q., E.P., G.C.); Institute of Genetics and Biomedical Research, Milan Unit, Milan, Italy (C.V.A., L.P.); Humanitas Research Hospital, Rozzano, Italy (C.V.A., L.P.); Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy (F.D.M., G.V., B.G., A.F., B.R., C.B.); Institute for Endocrinology and Experimental Oncology, National Research Council,
| | - Laura Papa
- From the Department of Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy (C.Q., E.P., G.C.); Institute of Genetics and Biomedical Research, Milan Unit, Milan, Italy (C.V.A., L.P.); Humanitas Research Hospital, Rozzano, Italy (C.V.A., L.P.); Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy (F.D.M., G.V., B.G., A.F., B.R., C.B.); Institute for Endocrinology and Experimental Oncology, National Research Council,
| | - Elvira Donnarumma
- From the Department of Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy (C.Q., E.P., G.C.); Institute of Genetics and Biomedical Research, Milan Unit, Milan, Italy (C.V.A., L.P.); Humanitas Research Hospital, Rozzano, Italy (C.V.A., L.P.); Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy (F.D.M., G.V., B.G., A.F., B.R., C.B.); Institute for Endocrinology and Experimental Oncology, National Research Council,
| | - Gerolama Condorelli
- From the Department of Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy (C.Q., E.P., G.C.); Institute of Genetics and Biomedical Research, Milan Unit, Milan, Italy (C.V.A., L.P.); Humanitas Research Hospital, Rozzano, Italy (C.V.A., L.P.); Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy (F.D.M., G.V., B.G., A.F., B.R., C.B.); Institute for Endocrinology and Experimental Oncology, National Research Council,
| | - Carlo Briguori
- From the Department of Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy (C.Q., E.P., G.C.); Institute of Genetics and Biomedical Research, Milan Unit, Milan, Italy (C.V.A., L.P.); Humanitas Research Hospital, Rozzano, Italy (C.V.A., L.P.); Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy (F.D.M., G.V., B.G., A.F., B.R., C.B.); Institute for Endocrinology and Experimental Oncology, National Research Council,
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Moledina DG, Parikh CR, Garg AX, Thiessen-Philbrook H, Koyner JL, Patel UD, Devarajan P, Shlipak MG, Coca SG. Association of Perioperative Plasma Neutrophil Gelatinase-Associated Lipocalin Levels with 3-Year Mortality after Cardiac Surgery: A Prospective Observational Cohort Study. PLoS One 2015; 10:e0129619. [PMID: 26053382 PMCID: PMC4460181 DOI: 10.1371/journal.pone.0129619] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 05/11/2015] [Indexed: 01/15/2023] Open
Abstract
Background Higher levels of plasma neutrophil gelatinase-associated lipocalin (pNGAL) are an early marker of acute kidney injury and are associated with increased risk of short-term adverse outcomes. The independent association between pNGAL and long-term mortality is unknown. Methods In this prospective observational cohort study, we studied 1191 adults who underwent cardiac surgery between 2007 and 2009 at 6 centers in the TRIBE-AKI cohort. We measured the pNGAL on the pre-operative and first 3 post-operative days and assessed the relationship of peri-operative pNGAL concentrations with all-cause mortality. Results During a median follow-up of 3.0 years, 139 participants died (50/1000 person-years). Pre-operative levels of pNGAL were associated with 3-year mortality (unadjusted HR 1.96, 95% CI 1.34,2.85) and the association persisted after adjustment for pre-operative variables including estimated glomerular filtration rate (adjusted HR 1.48, 95% CI 1.04–2.12). After adjustment for pre- and intra-operative variables, including pre-operative NGAL levels, the highest tertiles of first post-operative and peak post-operative pNGAL were also independently associated with 3-year mortality risk (adjusted HR 1.31, 95% CI 1.0–1.7 and adjusted HR 1.78, 95% CI 1.2–2.7, respectively). However, after adjustment for peri-operative changes in serum creatinine, there was no longer an independent association between the first post-operative and peak post-operative pNGAL and long-term mortality (adjusted HR 0.98,95% CI 0.79–1.2 for first pNGAL and adjusted HR 1.19, 95% CI 0.87–1.61 for peak pNGAL). Conclusions Pre-operative pNGAL levels were independently associated with 3-year mortality after cardiac surgery. While post-operative pNGAL levels were also associated with 3-year mortality, this relationship was not independent of changes in serum creatinine. These findings suggest that while pre-operative pNGAL adds prognostic value for mortality beyond routinely available serum creatinine, post-operative pNGAL measurements may not be as useful for this purpose.
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Affiliation(s)
- Dennis G. Moledina
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
- VA CT Healthcare System, West Haven, Connecticut, United States of America
- Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Chirag R. Parikh
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
- VA CT Healthcare System, West Haven, Connecticut, United States of America
- Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
- * E-mail:
| | - Amit X. Garg
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | - Jay L. Koyner
- Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Uptal D. Patel
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Prasad Devarajan
- Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Michael G. Shlipak
- Division of General Internal Medicine, San Francisco VA Medical Center, University of California, San Francisco, California, United States of America
| | - Steven G. Coca
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
- VA CT Healthcare System, West Haven, Connecticut, United States of America
- Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
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Chia WJ, Tan FCK, Ong WY, Dawe GS. Expression and localisation of brain-type organic cation transporter (BOCT/24p3R/LCN2R) in the normal rat hippocampus and after kainate-induced excitotoxicity. Neurochem Int 2015; 87:43-59. [PMID: 26004810 DOI: 10.1016/j.neuint.2015.04.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 04/06/2015] [Accepted: 04/14/2015] [Indexed: 01/13/2023]
Abstract
The iron siderophore binding protein lipocalin 2 (LCN2, also known as 24p3, NGAL and siderocalin) may be involved in iron homeostasis, but to date, little is known about expression of its putative receptor, brain-type organic cation transporter (BOCT, also known as BOCT1, 24p3R, NGALR and LCN2R), in the brain during neurodegeneration. The present study was carried out to elucidate the expression of LCN2 and BOCT in hippocampus after excitotoxicity induced by the glutamate analog, kainate (KA) and a possible role of LCN2 in neuronal injury. As reported previously, a rapid and sustained induction in expression of LCN2 was found in the hippocampus after intracerebroventicular injection of KA. BOCT was expressed in neurons of the saline-injected control hippocampus, and immunolabel for BOCT protein was preserved in pyramidal neurons of CA1 at 1 day post-KA injection, likely due to the delayed onset of neurodegeneration after KA injection. At 3 days and 2 weeks after KA injections, loss of immunolabel was observed due to degenerated neurons, although remaining neurons continued to express BOCT, and induction of BOCT was found in OX-42 positive microglia. This resulted in an overall decrease in BOCT mRNA and protein expression after KA treatment. Increased expression of the pro-apoptotic marker, Bim, was found in both neurons and microglia after KA injection, but TUNEL staining indicating apoptosis was found primarily in Bim-expressing neurons, but not microglia. Interaction between LCN2 and BOCT was found by DuoLink assay in cultured hippocampal neurons. Apo-LCN2 without iron caused no significant differences in neuronal Bim expression or cell survival, whereas holo-LCN2 consisting of LCN2:iron:enterochelin complex increased Bim mRNA expression and decreased neuronal survival. Together, results suggest that LCN2 and BOCT may have a role in neuronal injury.
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Affiliation(s)
- Wan-Jie Chia
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 10 Medical Drive, Singapore 117597; National University of Singapore Graduate School for Integrative Sciences and Engineering, Centre for Life Sciences, National University of Singapore, 28 Medical Drive, Singapore 117456; Neurobiology and Ageing Programme, Life Sciences Institute, Centre for Life Sciences, National University of Singapore, 28 Medical Drive, Singapore 117456
| | - Francis Chee Kuan Tan
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 10 Medical Drive, Singapore 117597; Neurobiology and Ageing Programme, Life Sciences Institute, Centre for Life Sciences, National University of Singapore, 28 Medical Drive, Singapore 117456; Singapore Institute for Neurotechnology (SINAPSE), Centre for Life Sciences, 28 Medical Drive, Singapore 117456
| | - Wei-Yi Ong
- Neurobiology and Ageing Programme, Life Sciences Institute, Centre for Life Sciences, National University of Singapore, 28 Medical Drive, Singapore 117456; Department of Anatomy, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 4 Medical Drive, Singapore 117597.
| | - Gavin S Dawe
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 10 Medical Drive, Singapore 117597; National University of Singapore Graduate School for Integrative Sciences and Engineering, Centre for Life Sciences, National University of Singapore, 28 Medical Drive, Singapore 117456; Neurobiology and Ageing Programme, Life Sciences Institute, Centre for Life Sciences, National University of Singapore, 28 Medical Drive, Singapore 117456; Singapore Institute for Neurotechnology (SINAPSE), Centre for Life Sciences, 28 Medical Drive, Singapore 117456.
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64
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Evseeva MV, Karetnikova VN, Barbarash OL. [Renal dysfunction in patients with myocardial infarction concurrent with type 2 diabetes mellitus]. TERAPEVT ARKH 2015; 87:105-108. [PMID: 25823278 DOI: 10.17116/terarkh2015871105-108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Carbohydrate metabolic disturbances are an independent risk factor for not only the development, but also poor course of cardiovascular diseases, particularly those concurrent with renal dysfunction (RD). This factor acquires particular relevance due to the fact that the incidence of type 2 diabetes mellitus significantly continues to rise worldwide. The review considers the main mechanisms and common components of the pathogenesis of RD, as well as the constituents forming its basis in the presence of carbohydrate metabolic disturbances. Moreover, it highlights the timely detection of RD, a search for new biomarkers of prognostic value for cardiovascular events, and the early diagnosis of RD. The review unveils the present view of optimal diagnostic and management tactics for patients with myocardial infarction concurrent with background diseases.
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Affiliation(s)
- M V Evseeva
- Kemerovo State Medical Academy, Ministry of Health of Russia, Kemerovo, Russia
| | - V N Karetnikova
- Kemerovo State Medical Academy, Ministry of Health of Russia, Kemerovo, Russia; Research Institute for Complex Issues of Cardiovascular Diseases, Siberian Branch, Russian Academy of Medical Sciences, Kemerovo, Russia
| | - O L Barbarash
- Kemerovo State Medical Academy, Ministry of Health of Russia, Kemerovo, Russia; Research Institute for Complex Issues of Cardiovascular Diseases, Siberian Branch, Russian Academy of Medical Sciences, Kemerovo, Russia
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65
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Rucci N, Capulli M, Piperni SG, Cappariello A, Lau P, Frings-Meuthen P, Heer M, Teti A. Lipocalin 2: a new mechanoresponding gene regulating bone homeostasis. J Bone Miner Res 2015; 30:357-68. [PMID: 25112732 DOI: 10.1002/jbmr.2341] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 07/29/2014] [Accepted: 08/05/2014] [Indexed: 12/20/2022]
Abstract
Mechanical loading represents a crucial factor in the regulation of skeletal homeostasis. Its reduction causes loss of bone mass, eventually leading to osteoporosis. In a previous global transcriptome analysis performed in mouse calvarial osteoblasts subjected to simulated microgravity, the most upregulated gene compared to unit gravity condition was Lcn2, encoding the adipokine Lipocalin 2 (LCN2), whose function in bone metabolism is poorly known. To investigate the mechanoresponding properties of LCN2, we evaluated LCN2 levels in sera of healthy volunteers subjected to bed rest, and found a significant time-dependent increase of this adipokine compared to time 0. We then evaluated the in vivo LCN2 regulation in mice subjected to experimentally-induced mechanical unloading by (1) tail suspension, (2) muscle paralysis by botulin toxin A (Botox), or (3) genetically-induced muscular dystrophy (MDX mice), and observed that Lcn2 expression was upregulated in the long bones of all of them, whereas physical exercise counteracted this increase. Mechanistically, in primary osteoblasts transfected with LCN2-expression-vector (OBs-Lcn2) we observed that Runx2 and its downstream genes, Osterix and Alp, were transcriptionally downregulated, and alkaline phosphatase (ALP) activity was less prominent versus empty-vector transduced osteoblasts (OBs-empty). OBs-Lcn2 also exhibited an increase of the Rankl/Opg ratio and IL-6 mRNA, suggesting that LCN2 could link poor differentiation of osteoblasts to enhanced osteoclast stimulation. In fact, incubation of purified mouse bone marrow mononuclear cells with conditioned media from OBs-Lcn2 cultures, or their coculture with OBs-Lcn2, improved osteoclastogenesis compared to OBs-empty, whereas treatment with recombinant LCN2 had no effect. In conclusion, our data indicate that LCN2 is a novel osteoblast mechanoresponding gene and that its regulation could be central to the pathological response of the bone tissue to low mechanical forces.
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Affiliation(s)
- Nadia Rucci
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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66
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Kim JD, Chee HK, Shin JK, Kim JS, Lee SA, Kim YH, Lee WS, Kim HY. Novel Early Predictor of Acute Kidney Injury after Open Heart Surgery under Cadiopulmonary Bypass Using Plasma Neutrophil Gelatinase-Associated Lipocalin. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2014; 47:240-8. [PMID: 25207221 PMCID: PMC4157474 DOI: 10.5090/kjtcs.2014.47.3.240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 11/20/2013] [Accepted: 11/24/2013] [Indexed: 11/19/2022]
Abstract
Background Open heart surgery using cardiopulmonary bypass (CPB) is considered one of the most frequent surgical procedures in which acute kidney injury (AKI) is a frequent and serious complication. The aim of the present study was to evaluate the efficiency of neutrophil gelatinase-associated lipocalin (NGAL) as an early AKI biomarker after CPB in cardiac surgery (CS). Methods Thirty-seven adult patients undergoing CS with CPB were included in this retrospective study. They had normal preoperative renal function, as assessed by the creatinine (Cr) level, NGAL level, and estimated glomerular filtration rate. Serial evaluation of serum NGAL and Cr levels was performed before, immediately after, and 24 hours after the operation. Patients were divided into two groups: those who showed normal immediate postoperative serum NGAL levels (group A, n=30) and those who showed elevated immediate postoperative serum NGAL levels (group B, n=7). Statistical analysis was performed using Statistical Package for the Social Sciences version 18. Results Of the 37 patients, 6 (6/37, 16.2%) were diagnosed with AKI. One patient belonged to group A (1/30, 3.3%), and 5 patients belonged to group B (5/7, 71.4%). Two patients in group B (2/7, 28.5%) required further renal replacement therapy. Death occurred in only 1 patient (1/37, 2.7%), who belonged to group B. Conclusion The results of this study suggest that postoperative plasma NGAL levels can be used as an early biomarker for the detection of AKI following CS using CPB. Further studies with a larger sample size are needed to confirm our results.
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Affiliation(s)
- Jong Duk Kim
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Seoul Hospital, Konkuk University School of Medicine, Korea
| | - Hyun Keun Chee
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Seoul Hospital, Konkuk University School of Medicine, Korea
| | - Je Kyoun Shin
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Seoul Hospital, Konkuk University School of Medicine, Korea
| | - Jun Seok Kim
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Seoul Hospital, Konkuk University School of Medicine, Korea
| | - Song Am Lee
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Seoul Hospital, Konkuk University School of Medicine, Korea
| | - Yo Han Kim
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Chungju Hospital, Konkuk University School of Medicine, Korea
| | - Woo Surng Lee
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Chungju Hospital, Konkuk University School of Medicine, Korea
| | - Hye Young Kim
- Department of Anesthesia and Pain Medicine, Konkuk University Chungju Hospital, Konkuk University School of Medicine, Korea
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Lippi G, Meschi T, Nouvenne A, Mattiuzzi C, Borghi L. Neutrophil gelatinase-associated lipocalin in cancer. Adv Clin Chem 2014; 64:179-219. [PMID: 24938019 DOI: 10.1016/b978-0-12-800263-6.00004-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Neutrophil gelatinase-associated lipocalin (NGAL), also known as lipocalin-2, is a 178-amino acid protein which exists in three molecular forms, including a 25-kDa monomer, a 45-kDa homodimer, and a 135-kDa heterodimer complexed with matrix metalloproteinase 9 (MMP-9). Polymorphonuclear neutrophils and tubular cells of the kidney are the most representative cellular sources. As such, NGAL is now considered the biochemical gold standard for early diagnosis of acute kidney injury. Recent evidence suggests, however, that ectopic or enhanced expression of NGAL may occur in many other pathologic conditions including cancer. Several epidemiologic studies, as reviewed in this chapter, showed that a variety of malignant tumors consistently overexpressed NGAL with increased concentration in blood, urine, and other biologic fluids. In addition, NGAL was frequently associated with tumor size, stage, and invasiveness. These features thus make it a potential biomarker for malignancy. A number of experimental studies also demonstrated that the ability to bind MMP-9, to scavenge iron into cancer cells along with the effect on subcellular localization of transmembrane proteins such as cadherins and catenins, confers this protein the potential to enhance can cer aggressiveness and makes it an appealing target of future anticancer research.
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Alge JL, Arthur JM. Biomarkers of AKI: a review of mechanistic relevance and potential therapeutic implications. Clin J Am Soc Nephrol 2014; 10:147-55. [PMID: 25092601 DOI: 10.2215/cjn.12191213] [Citation(s) in RCA: 210] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AKI is a common clinical condition associated with a number of adverse outcomes. More timely diagnosis would allow for earlier intervention and could improve patient outcomes. The goal of early identification of AKI has been the primary impetus for AKI biomarker research, and has led to the discovery of numerous novel biomarkers. However, in addition to facilitating more timely intervention, AKI biomarkers can provide valuable insight into the molecular mechanisms of this complex and heterogeneous disease. Furthermore, AKI biomarkers could also function as molecular phenotyping tools that could be used to direct clinical intervention. This review highlights the major studies that have characterized the diagnostic and prognostic predictive power of these biomarkers. The mechanistic relevance of neutrophil gelatinase-associated lipocalin, kidney injury molecule 1, IL-18, liver-type fatty acid-binding protein, angiotensinogen, tissue inhibitor of metalloproteinase-2, and IGF-binding protein 7 to the pathogenesis and pathobiology of AKI is discussed, putting these biomarkers in the context of the progressive phases of AKI. A biomarker-integrated model of AKI is proposed, which summarizes the current state of knowledge regarding the roles of these biomarkers and the molecular and cellular biology of AKI.
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Affiliation(s)
- Joseph L Alge
- Division of Nephrology, Medical University of South Carolina, Charleston, South Carolina; and
| | - John M Arthur
- Division of Nephrology, Medical University of South Carolina, Charleston, South Carolina; and Medical Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
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Halabian R, Roudkenar MH, Jahanian-Najafabadi A, Hosseini KM, Tehrani HA. Co-culture of bone marrow-derived mesenchymal stem cells overexpressing lipocalin 2 with HK-2 and HEK293 cells protects the kidney cells against cisplatin-induced injury. Cell Biol Int 2014; 39:152-63. [PMID: 25049146 DOI: 10.1002/cbin.10344] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 06/25/2014] [Indexed: 12/16/2022]
Abstract
Conditioned medium of mesenchymal stem cells (MSCs) is now being used for its cytoprotective effects, especially when the cells are equipped with cytoprotective factors to strengthen them against unfavorable microenvironments. Overexpression of Lcn2 in MSCs mimics in vivo kidney injury. Hence, unraveling how Lcn2-engineered MSCs affect kidney cells has been investigated. Cisplatin treated HK-2 or HEK293 kidney cells were co-cultivated with Lcn2 overexpressing MSCs in upper and lower chambers of transwell plates. Proliferation, apoptosis, and expression of growth factors and cytokines were assessed in the kidney cells. Co-cultivation with the MSCs-Lcn2 not only inhibited cisplatin-induced cytotoxicity in the HK-2 and HEK293 cells, but increased proliferation rate, prevented cisplatin-induced apoptosis, and increased expression of growth factors and the amount of antioxidants in the kidney cells. Thus Lcn2-engineered MSCs can ameliorate and repair injured kidney cells in vitro, which strongly suggests there are beneficial effects of the MSCs-Lcn2 in cell therapy of kidney injury.
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Affiliation(s)
- Raheleh Halabian
- Department of Medical Biotechnology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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70
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Wang G, Liu X, Meng L, Liu S, Wang L, Li J, Cui C, Meng J, Hu S, Wei Y. Up-regulated lipocalin-2 in pulmonary hypertension involving in pulmonary artery SMC resistance to apoptosis. Int J Biol Sci 2014; 10:798-806. [PMID: 25076856 PMCID: PMC4115200 DOI: 10.7150/ijbs.9470] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 06/16/2014] [Indexed: 12/20/2022] Open
Abstract
A key feature of pulmonary hypertension (PH) is the remodeling of small pulmonary arteries due to abnormal pulmonary artery smooth muscle cell (PASMC) proliferation and resistance to apoptosis. However, the cellular mechanisms underlying how PASMCs in the pathological condition of pulmonary hypertension become resistant to apoptosis remain unknown. It was recently reported that lipocalin 2 (Lcn2) is up-regulated in a wide array of malignant conditions, which facilitates tumorigenesis partly by inhibiting cell apoptosis. In this study, we observed that the expression levels of Lcn2 were significantly elevated in a rat PH model induced with monocrotaline and in patients with congenital heart disease-associated PH (CHD-PH) when compared with respective control. Therefore, we hypothesize that Lcn2 could regulate human PASMC (HPASMC) apoptosis through a mechanism. By the detection of DNA fragmentation using the TUNEL assay, the detection of Annexin V/PI-positive cells using flow cytometry, and the detection of cleaved caspase-3 and caspase-3 activity, we observed that Lcn2 significantly inhibited HPASMC apoptosis induced by serum withdrawal and H2O2 treatment. We also observed that Lcn2 down-regulated the proapoptotic protein Bax, decreased the levels of cellular ROS, and up-regulated the expression of superoxide dismutases (SOD1 and SOD2). In conclusion, Lcn2 significantly inhibits HPASMC apoptosis induced by oxidative stress via decreased intracellular ROS and elevated SODs. Up-regulation of Lcn2 in a rat PH model and CHD-PH patients may be involved in the pathological process of PH.
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Affiliation(s)
- Guoliang Wang
- 1. State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Xiaoyan Liu
- 2. Medical Research Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
| | - Liukun Meng
- 1. State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Shenghua Liu
- 1. State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Li Wang
- 1. State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Jun Li
- 1. State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Chuanjue Cui
- 1. State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Jian Meng
- 1. State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Shengshou Hu
- 1. State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Yingjie Wei
- 1. State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
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Bayram M, Ezelsoy M, Usta E, Oral K, Saraçoğlu A, Bayramoğlu Z, Yıldırım Ö. Rapid Detection of Acute Kidney Injury by Urinary Neutrophil Gelatinase-Associated Lipocalin in Patients Undergoing Cardiopulmonary Bypass. Turk J Anaesthesiol Reanim 2014; 42:239-44. [PMID: 27366429 DOI: 10.5152/tjar.2014.65668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 11/25/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Acute kidney injury (AKI) is common following cardiopulmonary bypass (CPB). The aim of this study is to determine the accuracy of urinary neutrophil gelatinase-associated lipocalin (NGAL) levels following cardiac surgery to establish the severity of renal impairment as compared to serum creatinine levels. METHODS A total number of 28 patients undergoing elective cardiopulmonary bypass were included. Diagnostic criteria of AKI was established in case of a percentage increase in serum creatinine concentration of >50%. Serum creatinine levels were recorded in the preoperative period before induction and in the postoperative period at 24, 48, and 72 hours. Urinary NGAL measurement was performed before induction and in the 4(th) postoperative hour. The duration of CPB surgery, hospital stay, and cross-clamp time were recorded. RESULTS Based on AKI criteria, subjects were grouped as AKI (n=11) and no AKI (n=19). Postoperative urinary NGAL levels were significantly higher in the group with AKI (11.8 ng mL(-1) vs. 104.0 ng mL(-1), p=0.003). In the AKI group, CPB time bypass (111.9 min vs. 82.7 min) and cross-clamp time (76.9 min vs. 59.1 min) were significantly higher. A cut-off of 25.5 ng mL(-1) yielded a sensitivity of 81.82% and a specificity of 94.12% at the postoperative 4(th) hour with an AUC of 0.947 for predication of AKI. CONCLUSION Urine NGAL rose significantly much earlier as compared to serum creatinine levels in the early postoperative period. Although larger case series are needed, we are of the opinion that urinary NGAL measurements may be used as an early clinical marker of AKI following CPB.
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Affiliation(s)
- Muhammed Bayram
- Department of Cardiovascular Surgery, Bilim University Faculty of Medicine, İstanbul, Turkey
| | - Mehmet Ezelsoy
- Department of Cardiovascular Surgery, Bilim University Faculty of Medicine, İstanbul, Turkey
| | - Emrah Usta
- Department of Cardiology, Bilim University Faculty of Medicine, İstanbul, Turkey
| | - Kerem Oral
- Department of Cardiovascular Surgery, Bilim University Faculty of Medicine, İstanbul, Turkey
| | - Ayten Saraçoğlu
- Department of Anaesthesiology, Bilim University Faculty of Medicine, İstanbul, Turkey
| | - Zehra Bayramoğlu
- Department of Cardiovascular Surgery, Bilim University Faculty of Medicine, İstanbul, Turkey
| | - Özgür Yıldırım
- Department of Cardiovascular Surgery, Bilim University Faculty of Medicine, İstanbul, Turkey
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Malyszko J, Bachorzewska-Gajewska H, Dobrzycki S. Biomarkers of Contrast-Induced Nephropathy: Which Ones and What Is Their Clinical Relevance? Interv Cardiol Clin 2014; 3:379-391. [PMID: 28582223 DOI: 10.1016/j.iccl.2014.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Contrast-induced nephropathy, or contrast-induced acute kidney injury (AKI), is an acute impairment of renal function as manifested by an increase in serum creatinine. Different urinary and serum proteins have been intensively investigated as possible biomarkers for the early diagnosis of AKI. Promising candidate biomarkers have the ability to detect an early and graded increase in tubular epithelial cell injury and to distinguish prerenal causes of AKI from acute tubular necrosis. In this article new, emerging biomarkers of contrast-induced AKI are presented and described, of which serum neutrophil gelatinase-associated lipocalin appears to be the most promising.
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Affiliation(s)
- Jolanta Malyszko
- 2nd Department of Nephrology, Medical University, M. Sklodowska-Curie 24a, Bialystok 15-276, Poland.
| | | | - Slawomir Dobrzycki
- Department of Invasive Cardiology, Medical University, M. Sklodowska-Curie 24a, Bialystok 15-276, Poland
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Zang X, Zheng F, Hong HJ, Jiang Y, Song Y, Xia Y. Neutrophil gelatinase-associated lipocalin protects renal tubular epithelial cells in hypoxia–reperfusion by reducing apoptosis. Int Urol Nephrol 2014; 46:1673-9. [DOI: 10.1007/s11255-014-0749-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 05/16/2014] [Indexed: 10/25/2022]
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Pronschinske KB, Qiu S, Wu C, Kato TS, Khawaja T, Takayama H, Naka Y, Templeton DL, George I, Farr MA, Mancini DM, Schulze PC. Neutrophil gelatinase-associated lipocalin and cystatin C for the prediction of clinical events in patients with advanced heart failure and after ventricular assist device placement. J Heart Lung Transplant 2014; 33:1215-22. [PMID: 25049066 DOI: 10.1016/j.healun.2014.06.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 06/09/2014] [Accepted: 06/18/2014] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Progressive renal dysfunction develops in patients with advanced HF. We evaluated neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C compared with established markers of renal function in patients with heart failure (HF) because they might improve prognostic assessment of patients with HF. METHODS Serum samples were collected from 40 patients with stable HF (age: 58 ± 8 years, body mass index [BMI]: 28.4 ± 6.4 kg/m(2)), 40 HF patients undergoing ventricular assist device (VAD) implantation (age: 53 ± 11 years, BMI: 26.8 ± 5.5 kg/m(2)), 40 patients undergoing VAD removal at cardiac transplantation, and 24 controls (age: 48 ± 7 years, BMI: 29.4 ± 4.2 kg/m(2)). Clinical data were collected from institutional medical records. NGAL and cystatin C levels were measured by enzyme-linked immunosorbent assay and estimated glomerular filtration rate (eGFR) calculated using the Modification of Diet in Renal Disease formula. RESULTS Patients with stable HF showed elevated NGAL and cystatin C levels compared with controls (NGAL: 114.9 ± 48.3 ng/mL vs 72.0 ± 36.6 ng/mL, p < 0.0001; cystatin C: 1490.4 ± 576.1 ng/mL vs 954.7 ± 414.2 ng/mL, p = 0.0026). Unlike cystatin C, NGAL increased in advanced HF patients requiring VAD implantation (158.7 ± 74.8 ng/mL, p < 0.001). On VAD support, NGAL levels decreased (127.1 ± 80.4 ng/mL, p = 0.034). NGAL was higher in patients who developed right ventricular failure (187.8 ± 66.0 vs 130.9 ± 67.0 ng/mL, p = 0.03) and irreversible renal dysfunction (190.0 ± 73.8 ng/mL vs 133.8 ± 54.2 ng/mL, p < 0.05), whereas cystatin C, creatinine, and eGFR were not different. NGAL correlated with eGFR (r = -0.2188, p = 0.01). CONCLUSIONS NGAL levels correlate with HF severity and hemodynamic improvement after VAD placement. Our findings suggest a role of this novel biomarker as a marker of severity and prognosis in patients with HF.
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Affiliation(s)
- Katherine B Pronschinske
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Sylvia Qiu
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Christina Wu
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Tomoko S Kato
- Department of Cardiovascular Medicine and Organ Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tuba Khawaja
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Hiroo Takayama
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York
| | - Yoshifumi Naka
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York
| | - Danielle L Templeton
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Isaac George
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Maryjane A Farr
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Donna M Mancini
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York
| | - P Christian Schulze
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
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Mussap M, Noto A, Fanos V, Van Den Anker JN. Emerging biomarkers and metabolomics for assessing toxic nephropathy and acute kidney injury (AKI) in neonatology. BIOMED RESEARCH INTERNATIONAL 2014; 2014:602526. [PMID: 25013791 PMCID: PMC4071811 DOI: 10.1155/2014/602526] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 03/25/2014] [Indexed: 01/07/2023]
Abstract
Identification of novel drug-induced toxic nephropathy and acute kidney injury (AKI) biomarkers has been designated as a top priority by the American Society of Nephrology. Increasing knowledge in the science of biology and medicine is leading to the discovery of still more new biomarkers and of their roles in molecular pathways triggered by physiological and pathological conditions. Concomitantly, the development of the so-called "omics" allows the progressive clinical utilization of a multitude of information, from those related to the human genome (genomics) and proteome (proteomics), including the emerging epigenomics, to those related to metabolites (metabolomics). In preterm newborns, one of the most important factors causing the pathogenesis and the progression of AKI is the interaction between the individual genetic code, the environment, the gestational age, and the disease. By analyzing a small urine sample, metabolomics allows to identify instantly any change in phenotype, including changes due to genetic modifications. The role of liquid chromatography-mass spectrometry (LC-MS), proton nuclear magnetic resonance (1H NMR), and other emerging technologies is strategic, contributing basically to the sudden development of new biochemical and molecular tests. Urine neutrophil gelatinase-associated lipocalin (uNGAL) and kidney injury molecule-1 (KIM-1) are closely correlated with the severity of kidney injury, representing noninvasive sensitive surrogate biomarkers for diagnosing, monitoring, and quantifying kidney damage. To become routine tests, uNGAL and KIM-1 should be carefully tested in multicenter clinical trials and should be measured in biological fluids by robust, standardized analytical methods.
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Affiliation(s)
- M. Mussap
- Department of Laboratory Medicine, IRCCS San Martino-IST, University Hospital, National Institute for Cancer Research, Largo Rosanna Benzi 10, 16132 Genoa, Italy
| | - A. Noto
- Department of Pediatrics and Clinical Medicine, Section of Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, Azienda Mista and University of Cagliari, 09042 Cagliari, Italy
| | - V. Fanos
- Department of Pediatrics and Clinical Medicine, Section of Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, Azienda Mista and University of Cagliari, 09042 Cagliari, Italy
| | - J. N. Van Den Anker
- Division of Pediatric Clinical Pharmacology, Children's National Medical Center, Washington, DC 20010, USA
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Kaucsár T, Révész C, Godó M, Krenács T, Albert M, Szalay CI, Rosivall L, Benyó Z, Bátkai S, Thum T, Szénási G, Hamar P. Activation of the miR-17 family and miR-21 during murine kidney ischemia-reperfusion injury. Nucleic Acid Ther 2014; 23:344-54. [PMID: 23988020 DOI: 10.1089/nat.2013.0438] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Ischemia-reperfusion (I/R) is the main cause of acute kidney injury (AKI) in patients. We investigated renal microRNA (miRNA) expression profiles and the time course of changes in selected miRNA expressions after renal I/R to characterize the miRNA network activated during development and recovery from AKI. METHODS AND RESULTS One day after lethal (30 minutes) and sublethal (20 minutes) renal ischemia, AKI was verified by renal histology (tubular necrosis, regeneration), blood urea nitrogen (BUN) level, renal mRNA expression, and plasma concentration of neutrophil gelatinase-associated lipocalin (NGAL) in C57BL/6J mice. On the first day after 30-minute, lethal I/R miR-21, miR-17-5p, and miR-106a were elevated out of the 21 miRNAs successfully profiled on the Luminex multiplex assay. After 20-minute, sublethal I/R, renal miR-17-5p and miR-106a expressions were elevated on the first and second days of reperfusion, while miR-21 expression increased later and lasted longer. Renal miR-17-5p and miR-21 expressions correlated with each other. Renal function returned to normal on the fourth day after sublethal I/R. CONCLUSIONS Our results demonstrate that besides miR-21, miR-17-5p, and miR-106a are additionally activated during the maintenance and recovery phases of renal I/R injury. Furthermore, a correlation between renal miR-17-5p and miR-21 expressions warrants further investigation of how they may influence each other and the outcome of renal ischemia-reperfusion injury.
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Affiliation(s)
- Tamás Kaucsár
- Institute of Pathophysiology, Semmelweis University, Budapest, Hungary
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Yen MH, Lee JJ, Yeh CF, Wang KC, Chiang YW, Chiang LC, Chang JS. Yakammaoto inhibited human coxsackievirus B4 (CVB4)-induced airway and renal tubular injuries by preventing viral attachment, internalization, and replication. JOURNAL OF ETHNOPHARMACOLOGY 2014; 151:1056-1063. [PMID: 24361333 DOI: 10.1016/j.jep.2013.11.049] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 11/05/2013] [Accepted: 11/27/2013] [Indexed: 06/03/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Yakammaoto is a prescription of traditional Chinese medicine (TCM) containing nine ingredients, including Ephedra sinica, Pinellia ternate, Zingiber officinale, Tussilago farfara, Aster tataricus, Ziziphus jujube, Belamcanda chinensis, Asarum sieboldii, and Schisandra chinensis. Yakammaoto has been used against flu-like symptoms for more than two thousand years in China and Japan. Coxsackievirus B4 (CVB4) causes not only flu-like symptoms but life-threatening diseases, such as pneumonia, acute kidney injury, and so forth with severe morbidity and mortality. There is no effective therapeutic modality against CVB4 infection. It is unknown whether yakammaoto is effective against CVB4 infection. We tested the hypothesis that yakammaoto can effectively inhibit CVB4-induced plaque formation in human airway and renal tubular cell lines by preventing viral attachment, internalization, and replication. MATERIALS AND METHODS The fingerprint of yakammaoto was assessed by HPLC. Effects of yakammaoto on CVB4 infection were tested by plaque reduction assay, reverse transcription polymerase chain reaction (RT-PCR), and enzyme-linked immunosorbent assay (ELISA). RESULTS Yakammaoto dose-dependently inhibited CVB4-induced plaque formation in HK-2, A549, and HEp-2 cells (p<0.0001). Yakammaoto was both effective when supplemented prior to and after viral inoculation (p<0.0001) by preventing viral attachment (p<0.0001), internalization (p<0.0001), and replication (p<0.0001). Yakammaoto could decrease NGAL secretion before cytolysis to protect against viral injury. CONCLUSIONS Yakammaoto had antiviral activity against CVB4-induced cellular injuries in airway mucosa and renal tubular epithelia by preventing viral attachment, internalization, and replication. The current study provides a basic support of its potential use against CVB4-induced airway and concomitant renal injuries.
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Affiliation(s)
- Ming Hong Yen
- School of Pharmacy and Graduate Institute of Natural Products, College of Pharmacy, Kaohsiung Medical University, Taiwan
| | - Jia Jung Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan
| | - Chia Feng Yeh
- Department of Renal Care, College of Medicine, Kaohsiung Medical University, Taiwan
| | - Kuo Chih Wang
- Department of Renal Care, College of Medicine, Kaohsiung Medical University, Taiwan
| | - Ya Wen Chiang
- Department of Renal Care, College of Medicine, Kaohsiung Medical University, Taiwan
| | - Lien Chai Chiang
- Department of Microbiology, School of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan
| | - Jung San Chang
- Department of Renal Care, College of Medicine, Kaohsiung Medical University, Taiwan; Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 807, Taiwan.
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Zughaier SM, Kandler JL, Shafer WM. Neisseria gonorrhoeae modulates iron-limiting innate immune defenses in macrophages. PLoS One 2014; 9:e87688. [PMID: 24489950 PMCID: PMC3905030 DOI: 10.1371/journal.pone.0087688] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 01/01/2014] [Indexed: 11/19/2022] Open
Abstract
Neisseria gonorrhoeae is a strict human pathogen that causes the sexually transmitted infection termed gonorrhea. The gonococcus can survive extracellularly and intracellularly, but in both environments the bacteria must acquire iron from host proteins for survival. However, upon infection the host uses a defensive response by limiting the bioavailability of iron by a number of mechanisms including the enhanced expression of hepcidin, the master iron-regulating hormone, which reduces iron uptake from the gut and retains iron in macrophages. The host also secretes the antibacterial protein NGAL, which sequesters bacterial siderophores and therefore inhibits bacterial growth. To learn whether intracellular gonococci can subvert this defensive response, we examined expression of host genes that encode proteins involved in modulating levels of intracellular iron. We found that N. gonorrhoeae can survive in association (tightly adherent and intracellular) with monocytes and macrophages and upregulates a panel of its iron-responsive genes in this environment. We also found that gonococcal infection of human monocytes or murine macrophages resulted in the upregulation of hepcidin, NGAL, and NRAMP1 as well as downregulation of the expression of the gene encoding the short chain 3-hydroxybutyrate dehydrogenase (BDH2); BDH2 catalyzes the production of the mammalian siderophore 2,5-DHBA involved in chelating and detoxifying iron. Based on these findings, we propose that N. gonorrhoeae can subvert the iron-limiting innate immune defenses to facilitate iron acquisition and intracellular survival.
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Affiliation(s)
- Susu M. Zughaier
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia, United States of America
- * E-mail:
| | - Justin L. Kandler
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - William M. Shafer
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Laboratories of Microbial Pathogenesis, Department of Veterans Affairs Medical Center, Decatur, Georgia, United States of America
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79
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Tasanarong A, Hutayanon P, Piyayotai D. Urinary Neutrophil Gelatinase-Associated Lipocalin predicts the severity of contrast-induced acute kidney injury in chronic kidney disease patients undergoing elective coronary procedures. BMC Nephrol 2013; 14:270. [PMID: 24305547 PMCID: PMC4234212 DOI: 10.1186/1471-2369-14-270] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 11/26/2013] [Indexed: 11/25/2022] Open
Abstract
Background Contrast-induced acute kidney injury (CI-AKI) particularly in high risk patients with chronic kidney disease (CKD), increases morbidity and mortality. Neutrophil gelatinase-associated lipocalin (NGAL) is a protein excreted by the kidney during AKI. There are no urine (u) NGAL data as an early CI-AKI marker in CKD patients undergoing coronary procedures. Methods This prospective study enrolled 130 patients with estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 undergoing elective coronary procedures. Serial urine samples, obtained at baseline and 3, 6, 12, 18, and 24 h post contrast administration were analyzed by NGAL ELISA kit. AKI was defined as an increase in serum creatinine (SCr) of ≥ 0.3 mg/dl or ≥ 1.5 times baseline SCr within 48 h per 2012 KDIGO guidelines. Receiver operator characteristic curve analyses identified optimal uNGAL and delta of uNGAL values for diagnosing CI-AKI. Results The uNGAL was significantly and inverse correlated with eGFR (R = 0.25, P < 0.005). CI-AKI developed in 16/130 (12.31%) patients: 13 and 3 in CI-AKI stages I and II, respectively. uNGAL and delta of uNGAL were significantly higher in the CI-AKI group when compared with the No CI-AKI group (P < 0.05). The best uNGAL cut-off for optimal sensitivity 94%, specificity 78%, and area under the curve 0.84 for predicting CI-AKI was 117 ng/mL at 6 h, respectively. Corresponding values for predicting CI-AKI stage II were 100%, 87% and 0.9 when using an uNGAL of 264 ng/mL at 6 h. Conclusions Monitoring of uNGAL levels not only provide the early detecting CI-AKI but also predict the severity of CI-AKI in CKD patients undergoing elective coronary procedures.
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Affiliation(s)
- Adis Tasanarong
- Nephrology Unit, Department of Medicine, Faculty of Medicine, Thammasat University (Rangsit Campus), Khlong Nueng, Khlong Luang, Pathum Thani 12121, Thailand.
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Lipocalin2 enhances the matrix metalloproteinase-9 activity and invasion of extravillous trophoblasts under hypoxia. Placenta 2013; 34:1036-43. [DOI: 10.1016/j.placenta.2013.08.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 07/24/2013] [Accepted: 08/06/2013] [Indexed: 11/21/2022]
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Cobrin AR, Blois SL, Kruth SA, Abrams-Ogg ACG, Dewey C. Biomarkers in the assessment of acute and chronic kidney diseases in the dog and cat. J Small Anim Pract 2013; 54:647-55. [PMID: 24152019 DOI: 10.1111/jsap.12150] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In both human and veterinary medicine, diagnosing and staging renal disease can be difficult. Measurement of glomerular filtration rate is considered the gold standard for assessing renal function but methods for its assessment can be technically challenging and impractical. The main parameters used to diagnose acute and chronic kidney disease include circulating creatinine and urea concentrations, and urine-specific gravity. However, these parameters can be insensitive. Therefore, there is a need for better methods to diagnose and monitor patients with renal disease. The use of renal biomarkers is increasing in human and veterinary medicine for the diagnosis and monitoring of acute and chronic kidney diseases. An ideal biomarker would identify site and severity of injury, and correlate with renal function, among other qualities. This article will review the advantages and limitations of renal biomarkers that have been used in dogs and cats, as well as some markers used in humans that may be adapted for veterinary use. In the future, measuring a combination of biomarkers will likely be a useful approach in the diagnosis of kidney disorders.
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Affiliation(s)
- A R Cobrin
- Ontario Veterinary College Department of Clinical Studies, University of Guelph, Guelph, Ontario, Canada, N1G 2W1
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82
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Daure E, Belanger MC, Beauchamp G, Lapointe C. Elevation of neutrophil gelatinase-associated lipocalin (NGAL) in non-azotemic dogs with urinary tract infection. Res Vet Sci 2013; 95:1181-5. [PMID: 24074691 DOI: 10.1016/j.rvsc.2013.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 08/07/2013] [Accepted: 09/02/2013] [Indexed: 01/07/2023]
Abstract
Neutrophil gelatinase-associated lipocalin (NGAL) is a promising biomarker in humans and dogs with kidney disease. This protein is expressed by many cells including renal tubular cells and neutrophils. The aim of this study was to evaluate the effect of urinary tract infection (UTI) on urinary NGAL (uNGAL) concentration in dogs. Urine culture and measurement of uNGAL level were performed in 80 non-azotemic dogs suspected of UTI and 19 healthy dogs. Dogs were divided in three groups: 19 healthy dogs, 25 dogs with positive culture and 55 dogs suspected of UTI but with negative culture. uNGAL and uNGAL/Creatinine was significantly higher (P < 0.0001) in dogs with UTI (14.22 ng/mL;19.74 μg/g) compared to Healthy (0.24 ng/mL;0.11 μg/g) and Negative (1.13 ng/mL;1.28 μg/g) dogs. A uNGAL value <3.38 ng/mL had a negative predictive value for UTI of 87%. Presence of UTI has to be considered when uNGAL is used to detect kidney disease.
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Affiliation(s)
- Evence Daure
- Internal Medicine Service, DMV Veterinary Center, 2300, 54th Avenue, Montreal (Lachine), QC H8T 3R2, Canada.
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83
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Kim H, Hur M, Cruz DN, Moon HW, Yun YM. Plasma neutrophil gelatinase-associated lipocalin as a biomarker for acute kidney injury in critically ill patients with suspected sepsis. Clin Biochem 2013; 46:1414-8. [PMID: 23747960 DOI: 10.1016/j.clinbiochem.2013.05.069] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 05/28/2013] [Accepted: 05/29/2013] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the diagnostic utility of plasma neutrophil gelatinase-associated lipocalin (NGAL) as an early objective biomarker to predict acute kidney injury (AKI) in critically ill patients with suspected sepsis, for whom procalcitonin (PCT) was used for the diagnosis and staging of sepsis. DESIGN AND METHODS Plasma NGAL was measured using the Triage NGAL Test (Alere, Inc., San Diego, CA, USA) in 231 samples obtained from patients with suspected sepsis. The results of NGAL were compared with those of Elecsys BRAHMS PCT (Roche Diagnostics, Basel, Switzerland). Renal failure was assessed using the renal subscore of Sepsis-related Organ Failure Assessment (SOFA) score. AKI was defined according to the Acute Kidney Injury Network criteria. RESULTS The concentrations of plasma NGAL were significantly different according to the five groups of PCT concentration (P<0.0001) and the renal subscore of SOFA score (P<0.0001). Plasma NGAL was significantly increased in the patients with AKI compared with those without AKI (416.5 ng/mL vs. 181.0 ng/mL, P=0.0223). CONCLUSION Plasma NGAL seems to be a highly sensitive and objective predictor of AKI in patients with sepsis. Plasma NGAL can be added for the diagnosis and staging of renal failure in sepsis.
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Affiliation(s)
- Hanah Kim
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
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84
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Singer E, Markó L, Paragas N, Barasch J, Dragun D, Müller DN, Budde K, Schmidt-Ott KM. Neutrophil gelatinase-associated lipocalin: pathophysiology and clinical applications. Acta Physiol (Oxf) 2013; 207:663-72. [PMID: 23375078 DOI: 10.1111/apha.12054] [Citation(s) in RCA: 161] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 11/13/2012] [Accepted: 12/06/2012] [Indexed: 12/22/2022]
Abstract
Neutrophil gelatinase-associated lipocalin (NGAL), a 25 kDa protein produced by injured nephron epithelia, is one of the most promising new markers of renal epithelial injury. In contrast to serum creatinine and urinary output, which are the measures of kidney function, NGAL is specifically induced in the damaged nephron and then released into blood and urine, where it can be readily measured. Careful proof-of-concept studies using defined animal models have uncovered the sources and trafficking of NGAL in acute kidney injury (AKI) and have addressed the contributions of renal and non-renal sources. Clinical studies indicate that NGAL, unlike creatinine, is a marker responsive to tissue stress and nephron injury, but less so to adaptive hemodynamic responses. In certain clinical settings, NGAL is an earlier marker compared with serum creatinine. In addition, clinical studies have shown that NGAL is a powerful predictor of poor clinical outcomes, which can be used to risk stratify patients when combined with serum creatinine. NGAL has important limitations, including its responsiveness in systemic inflammation, which is partially uncoupled from its response to kidney injury and which needs to be considered when interpreting NGAL results clinically. This review covers the biology and pathophysiology of NGAL and summarizes the results of the growing body of clinical studies that have addressed the utility of NGAL in the early diagnosis of AKI, in the distinction of intrinsic AKI and in the prognostic assessment of broad patient populations.
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Affiliation(s)
- E. Singer
- Department of Nephrology; Campus Mitte; Charité - Universitätsmedizin Berlin; Berlin; Germany
| | - L. Markó
- Experimental and Clinical Research Center; a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine; Berlin; Germany
| | - N. Paragas
- Department of Medicine; Columbia University College of Physicians and Surgeons; New York; NY; USA
| | - J. Barasch
- Department of Medicine; Columbia University College of Physicians and Surgeons; New York; NY; USA
| | - D. Dragun
- Department of Nephrology and Intensive Care Medicine Campus Virchow Klinikum; Charité - Universitätsmedizin Berlin; Berlin; Germany
| | - D. N. Müller
- Experimental and Clinical Research Center; a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine; Berlin; Germany
| | - K. Budde
- Department of Nephrology; Campus Mitte; Charité - Universitätsmedizin Berlin; Berlin; Germany
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Sweetman DU, Molloy EJ. Biomarkers of acute kidney injury in neonatal encephalopathy. Eur J Pediatr 2013; 172:305-16. [PMID: 23138391 DOI: 10.1007/s00431-012-1890-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 10/24/2012] [Indexed: 01/11/2023]
Abstract
Acute kidney injury (AKI) is a common complication of neonatal encephalopathy (NE). The accurate diagnosis of neonatal AKI, irrespective of the cause, relies on suboptimal methods such as identification of rising serum creatinine, decreased urinary output and glomerular filtration rate. Studies of AKI biomarkers in adults and children have shown that biomarkers can improve the early diagnosis of AKI. Hypoxia-ischaemia is the proposed aetiological basis of AKI in both NE and cardiopulmonary bypass (CPB). However, there is a paucity of studies examining the role of AKI biomarkers specifically in NE. Urinary cystatin C (CysC), neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18, kidney injury molecule-1, liver-type fatty acid-binding protein, serum CysC and serum NGAL all show good ability to predict early AKI in a heterogeneous critically ill neonatal population including infants post-CPB. Moreover, serum and urinary NGAL and urinary CysC are early predictors of AKI secondary to NE. These findings are promising and open up the possibility of biomarkers playing a significant role in the early diagnosis and treatment of NE-related AKI. There is an urgent need to explore the role of AKI biomarkers in infants with NE as establishing the diagnosis of AKI earlier may allow more timely intervention with potential for improving long-term outcome.
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Affiliation(s)
- D U Sweetman
- Department of Neonatology, National Maternity Hospital, Holles Street, Dublin, Ireland.
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86
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Kim SM, Park JS, Norwitz ER, Jung HJ, Kim BJ, Park CW, Jun JK. Circulating levels of neutrophil gelatinase-associated lipocalin (NGAL) correlate with the presence and severity of preeclampsia. Reprod Sci 2013; 20:1083-9. [PMID: 23439619 DOI: 10.1177/1933719113477480] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Neutrophil gelatinase-associated lipocalin (NGAL) has emerged as a reliable marker of acute renal injury and is produced at the maternal-fetal interface but its role in preeclampsia has not been systematically examined. This study investigated whether plasma NGAL concentrations changed in patients with preeclampsia at diagnosis compared to normotensive controls. STUDY DESIGN A case-control study was performed. Plasma was collected from women with preeclampsia and normotensive controls matched for age, gestational age, and body mass index. Plasma NGAL concentrations were measured by specific enzyme-linked immunosorbent assay. RESULTS Patients with preeclampsia had significantly higher NGAL concentrations than controls (median [range]: 203.8 ng/mL [66.1-575.4] vs. 122.8 ng/mL [7.0-669.7]; P = .047). In subgroup analysis, patients with severe preeclampsia had significantly higher NGAL concentrations than those with mild preeclampsia. Plasma NGAL concentrations were positively correlated with the amount of proteinuria in women with preeclampsia (P = .003). CONCLUSIONS Plasma NGAL concentrations were significantly elevated in women with preeclampsia versus normotensive controls, and concentrations appear to be associated with the severity of the disease.
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Affiliation(s)
- Sun Min Kim
- Department of Obstetrics & Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Borkham-Kamphorst E, van de Leur E, Zimmermann HW, Karlmark KR, Tihaa L, Haas U, Tacke F, Berger T, Mak TW, Weiskirchen R. Protective effects of lipocalin-2 (LCN2) in acute liver injury suggest a novel function in liver homeostasis. Biochim Biophys Acta Mol Basis Dis 2013; 1832:660-73. [PMID: 23376114 DOI: 10.1016/j.bbadis.2013.01.014] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 01/10/2013] [Accepted: 01/16/2013] [Indexed: 12/29/2022]
Abstract
Lipocalin-2 is expressed under pernicious conditions such as intoxication, infection, inflammation and other forms of cellular stress. Experimental liver injury induces rapid and sustained LCN2 production by injured hepatocytes. However, the precise biological function of LCN2 in liver is still unknown. In this study, LCN2(-/-) mice were exposed to short term application of CCl4, lipopolysaccharide and Concanavalin A, or subjected to bile duct ligation. Subsequent injuries were assessed by liver function analysis, qRT-PCR for chemokine and cytokine expression, liver tissue Western blot, histology and TUNEL assay. Serum LCN2 levels from patients suffering from liver disease were assessed and evaluated. Acute CCl4 intoxication showed increased liver damage in LCN2(-/-) mice indicated by higher levels of aminotransferases, and increased expression of inflammatory cytokines and chemokines such as IL-1β, IL-6, TNF-α and MCP-1/CCL2, resulting in sustained activation of STAT1, STAT3 and JNK pathways. Hepatocytes of LCN2(-/-) mice showed lipid droplet accumulation and increased apoptosis. Hepatocyte apoptosis was confirmed in the Concanavalin A and lipopolysaccharide models. In chronic models (4weeks bile duct ligation or 8weeks CCl4 application), LCN2(-/-) mice showed slightly increased fibrosis compared to controls. Interestingly, serum LCN2 levels in diseased human livers were significantly higher compared to controls, but no differences were observed between cirrhotic and non-cirrhotic patients. Upregulation of LCN2 is a reliable indicator of liver damage and has significant hepato-protective effect in acute liver injury. LCN2 levels provide no correlation to the degree of liver fibrosis but show significant positive correlation to inflammation instead.
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Affiliation(s)
- Erawan Borkham-Kamphorst
- Institute of Clinical Chemistry and Pathobiochemistry, RWTH Aachen University Hospital, Germany.
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Jang E, Lee S, Kim J, Kim J, Seo J, Lee W, Mori K, Nakao K, Suk K. Secreted protein lipocalin‐2 promotes microglial M1 polarization. FASEB J 2012. [DOI: 10.1096/fj.12-222257] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Eunha Jang
- Department of PharmacologyBrain Science and Engineering InstituteCell and Matrix Research Institute (CMRI)Kyungpook National University School of MedicineDaeguKorea
| | - Shinrye Lee
- Department of PharmacologyBrain Science and Engineering InstituteCell and Matrix Research Institute (CMRI)Kyungpook National University School of MedicineDaeguKorea
| | - Jong‐Heon Kim
- Department of PharmacologyBrain Science and Engineering InstituteCell and Matrix Research Institute (CMRI)Kyungpook National University School of MedicineDaeguKorea
| | - Jae‐Hong Kim
- Department of PharmacologyBrain Science and Engineering InstituteCell and Matrix Research Institute (CMRI)Kyungpook National University School of MedicineDaeguKorea
| | - Jung‐Wan Seo
- Department of PharmacologyBrain Science and Engineering InstituteCell and Matrix Research Institute (CMRI)Kyungpook National University School of MedicineDaeguKorea
| | - Won‐Ha Lee
- School of Life Sciences and BiotechnologyKyungpook National UniversityDaeguKorea
| | - Kiyoshi Mori
- Department of Medicine and Clinical ScienceKyoto University Graduate School of MedicineKyotoJapan
| | - Kazuwa Nakao
- Department of Medicine and Clinical ScienceKyoto University Graduate School of MedicineKyotoJapan
| | - Kyoungho Suk
- Department of PharmacologyBrain Science and Engineering InstituteCell and Matrix Research Institute (CMRI)Kyungpook National University School of MedicineDaeguKorea
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Neutrophil gelatinase-associated lipocalin is a sensitive biomarker for the early diagnosis of acute rejection after living-donor kidney transplantation. Int Urol Nephrol 2012; 45:1159-67. [DOI: 10.1007/s11255-012-0321-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 10/22/2012] [Indexed: 12/21/2022]
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90
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Schroll A, Eller K, Feistritzer C, Nairz M, Sonnweber T, Moser PA, Rosenkranz AR, Theurl I, Weiss G. Lipocalin-2 ameliorates granulocyte functionality. Eur J Immunol 2012; 42:3346-57. [PMID: 22965758 DOI: 10.1002/eji.201142351] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 08/01/2012] [Accepted: 09/06/2012] [Indexed: 11/10/2022]
Abstract
Attraction of neutrophils to sites of infection or tissue injury is an essential prerequisite for an efficient innate immune response. Herein, we provide novel evidence that the antimicrobial protein, neutrophil gelatinase associated lipocalin (24p3 or lipocalin-2, Lcn2) is a central regulator of this process. Lcn2 is produced by several cell types but high amounts are released by neutrophils. Using human and murine neutrophils, we found that the addition of recombinant Lcn2 significantly stimulated their migration, which was independent of IL-8/keratinocyte chemokine formation. Mechanistically, this could be traced back to Lcn2-mediated changes of Erk1/2 signaling. Accordingly, the i.p. injection of Lcn2 into C57BL/6 mice stimulated the mobilization of neutrophils while we found a significantly reduced neutrophil chemotactic activity of cells obtained from Lcn2 KO mice. This observation transmitted to a reduced accumulation of neutrophils in intra-dermal lesions infected with Salmonella typhimurium in Lcn2 KO mice as compared to WT mice. This was not only due to a reduced chemotaxis but also to an impaired cellular adhesion of neutrophils in the absence of Lcn2. We herein describe a novel role of Lcn2 as an important paracrine chemoattractant and an indispensable factor for neutrophil function in inflammation.
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Affiliation(s)
- Andrea Schroll
- Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Medical University Innsbruck, Innsbruck, Austria
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91
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Shrestha K, Shao Z, Singh D, Dupont M, Tang WHW. Relation of systemic and urinary neutrophil gelatinase-associated lipocalin levels to different aspects of impaired renal function in patients with acute decompensated heart failure. Am J Cardiol 2012; 110:1329-35. [PMID: 22835414 DOI: 10.1016/j.amjcard.2012.06.035] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 06/08/2012] [Accepted: 06/08/2012] [Indexed: 12/17/2022]
Abstract
Both urine and serum neutrophil gelatinase-associated lipocalin (NGAL) reflect active chronic kidney disease and predict acute kidney injury. However, a direct comparison of these markers in acute decompensated heart failure has not been performed. We prospectively evaluated 93 patients admitted with acute decompensated heart failure and treated with intravenous furosemide and measured both systemic (serum) and urine NGAL levels and their corresponding markers of estimated glomerular filtration rate, natriuresis (urine sodium), and diuretic response (net output, urine sodium/furosemide ratio). In our study cohort, the median urine and serum NGAL level was 34 ng/ml (interquartile range 24 to 86) and 252 ng/ml (interquartile range 175 to 350), respectively. The urine and serum NGAL levels correlated modestly (r = 0.37, p <0.001). Higher urine (but not systemic) NGAL correlated with the markers of impaired natriuresis and reduced diuresis (p <0.005 for all). In contrast, higher serum NGAL demonstrated a stronger relation with reduced glomerular filtration function (p <0.0001). Both markers predicted acute kidney injury (urine NGAL, odds ratio 1.7, p = 0.035; serum NGAL, odds ratio 1.9, p = 0.009). In conclusion, in patients with acute decompensated heart failure, urine NGAL levels reflect renal distal tubular injury with impaired natriuresis and diuresis, and systemic NGAL levels demonstrate a stronger association with glomerular filtration function. Both systemic and urine NGAL predict worsening renal function.
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Affiliation(s)
- Kevin Shrestha
- Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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92
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Jiang C, Qi C, Sun K, Xia L, Xue W, Huang Y. Diagnostic value of N-acetyl-β-D-glucosaminidase for the early prediction of acute kidney injury after percutaneous nephrolithotripsy. Exp Ther Med 2012; 5:197-200. [PMID: 23251267 PMCID: PMC3524284 DOI: 10.3892/etm.2012.737] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 09/19/2012] [Indexed: 01/31/2023] Open
Abstract
The present observational study was undertaken in order to evaluate the diagnostic value of urinary N-acetyl-β-D-glucosaminidase (NAG) for the prediction of acute kidney injury (AKI) in patients after percutaneous nephrolithotripsy (PNL). Pre- and post-operative patient data were collected for 90 patients who underwent PNL between September 2008 and December 2010. The patients included 64 males and 26 females with an average age of 52.8±9.7 years. Pre- and post-operative urinary NAG was measured by colorimetric assay and serum creatinine levels were determined for comparative analysis. Urinary NAG levels significantly increased after PNL compared to pre-operative levels (P<0.05). AKI occurred in 11 cases after surgery. A comparison of the AKI and non-AKI groups revealed no significant differences in age, gender ratio or baseline creatinine levels (P>0.05); however, there were significant differences between the groups as regards surgical duration, post-operative infection rate, C-reactive protein levels and number of hospital days (P<0.05). NAG levels were significantly higher in the AKI compared to the non-AKI group after surgery (P<0.05). The diagnostic utility of the increase in urinary NAG 24 h after surgery was assessed by receiver operating characteristic (ROC) analysis. For an increase in NAG of 235.44%, the area under the ROC curve was 0.878 (P<0.01) and the sensitivity and specificity for AKI diagnosis were 81.8 and 91.1%, respectively. Urinary NAG significantly increased in patients suffering from AKI after surgery. This parameter is more sensitive than serum creatinine and can reflect the impairment of kidney function at an earlier stage. The surgical duration and post-operative infection rate are possible risk factors for AKI. Urinary NAG may have some clinical value in the early diagnosis of AKI after surgery.
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Affiliation(s)
- Chen Jiang
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, P.R. China
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93
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McWilliam SJ, Antoine DJ, Sabbisetti V, Turner MA, Farragher T, Bonventre JV, Park BK, Smyth RL, Pirmohamed M. Mechanism-based urinary biomarkers to identify the potential for aminoglycoside-induced nephrotoxicity in premature neonates: a proof-of-concept study. PLoS One 2012; 7:e43809. [PMID: 22937100 PMCID: PMC3427159 DOI: 10.1371/journal.pone.0043809] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 07/26/2012] [Indexed: 11/30/2022] Open
Abstract
Premature infants are frequently exposed to aminoglycoside antibiotics. Novel urinary biomarkers may provide a non-invasive means for the early identification of aminoglycoside-related proximal tubule renal toxicity, to enable adjustment of treatment and identification of infants at risk of long-term renal impairment. In this proof-of-concept study, urine samples were collected from 41 premature neonates (≤32 weeks gestation) at least once per week, and daily during courses of gentamicin, and for 3 days afterwards. Significant increases were observed in the three urinary biomarkers measured (Kidney Injury Molecule-1 (KIM-1), Neutrophil Gelatinase-associated Lipocalin (NGAL), and N-acetyl-β-D-glucosaminidase (NAG)) during treatment with multiple courses of gentamicin. When adjusted for potential confounders, the treatment effect of gentamicin remained significant only for KIM-1 (mean difference from not treated, 1.35 ng/mg urinary creatinine; 95% CI 0.05–2.65). Our study shows that (a) it is possible to collect serial urine samples from premature neonates, and that (b) proximal tubule specific urinary biomarkers can act as indicators of aminoglycoside-associated nephrotoxicity in this age group. Further studies to investigate the clinical utility of novel urinary biomarkers in comparison to serum creatinine need to be undertaken.
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Affiliation(s)
- Stephen J. McWilliam
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - Daniel J. Antoine
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
- Department of Medicine, Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Venkata Sabbisetti
- Department of Medicine, Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Mark A. Turner
- Department of Women’s and Children’s Health, Neonatal Unit, Liverpool Women’s Hospital, University of Liverpool, Liverpool, United Kingdom
| | - Tracey Farragher
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Joseph V. Bonventre
- Department of Medicine, Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - B. Kevin Park
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - Rosalind L. Smyth
- Institute of Child Health, Department of Women’s and Children’s Health, University of Liverpool, Liverpool, United Kingdom
| | - Munir Pirmohamed
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
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94
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Chakraborty S, Kaur S, Guha S, Batra SK. The multifaceted roles of neutrophil gelatinase associated lipocalin (NGAL) in inflammation and cancer. BIOCHIMICA ET BIOPHYSICA ACTA 2012; 1826:129-69. [PMID: 22513004 PMCID: PMC3362670 DOI: 10.1016/j.bbcan.2012.03.008] [Citation(s) in RCA: 280] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 03/06/2012] [Accepted: 03/08/2012] [Indexed: 02/06/2023]
Abstract
Neutrophil gelatinase associated lipocalin (NGAL), also known as oncogene 24p3, uterocalin, siderocalin or lipocalin 2, is a 24kDa secreted glycoprotein originally purified from a culture of mouse kidney cells infected with simian virus 40 (SV-40). Subsequent investigations have revealed that it is a member of the lipocalin family of proteins that transport small, hydrophobic ligands. Since then, NGAL expression has been reported in several normal tissues where it serves to provide protection against bacterial infection and modulate oxidative stress. Its expression is also dysregulated in several benign and malignant diseases. Its small size, secreted nature and relative stability have led to it being investigated as a diagnostic and prognostic biomarker in numerous diseases including inflammation and cancer. Functional studies, conducted primarily on lipocalin 2 (Lcn2), the mouse homologue of human NGAL have revealed that Lcn2 has a strong affinity for iron complexed to both bacterial siderophores (iron-binding proteins) and certain human proteins like norepinephrine. By sequestering iron-laden siderophores, Lcn2 deprives bacteria of a vital nutrient and thus inhibits their growth (bacteriostatic effect). In malignant cells, its proposed functions range from inhibiting apoptosis (in thyroid cancer cells), invasion and angiogenesis (in pancreatic cancer) to increasing proliferation and metastasis (in breast and colon cancer). Ectopic expression of Lcn2 also promotes BCR-ABL induced chronic myelogenous leukemia in murine models. By transporting iron into and out of the cell, NGAL also regulates iron responsive genes. Further, it stabilizes the proteolytic enzyme matrix metalloprotease-9 (MMP-9) by forming a complex with it, and thereby prevents its autodegradation. The factors regulating NGAL expression are numerous and range from pro-inflammatory cytokines like interleukins, tumor necrosis factor-α and interferons to vitamins like retinoic acid. The purpose of this review article is to examine the expression, structure, regulation and biological role of NGAL and critically assess its potential as a novel diagnostic and prognostic marker in both benign and malignant human diseases.
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Affiliation(s)
- Subhankar Chakraborty
- Department of Biochemistry and Molecular Biology, The UT MD Anderson Cancer Center, Houston, Texas
| | - Sukhwinder Kaur
- Department of Biochemistry and Molecular Biology, The UT MD Anderson Cancer Center, Houston, Texas
| | - Sushovan Guha
- Departments of Gastroenterology, Hepatology, and Nutrition, The UT MD Anderson Cancer Center, Houston, Texas
| | - Surinder K. Batra
- Department of Biochemistry and Molecular Biology, The UT MD Anderson Cancer Center, Houston, Texas
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
- Eppley Institute for Cancer Research, Department of Surgery, University of Nebraska Medical Center, Omaha, NE
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95
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Fadel FI, Abdel Rahman AM, Mohamed MF, Habib SA, Ibrahim MH, Sleem ZS, Bazaraa HM, Soliman MM. Plasma neutrophil gelatinase-associated lipocalin as an early biomarker for prediction of acute kidney injury after cardio-pulmonary bypass in pediatric cardiac surgery. Arch Med Sci 2012; 8:250-5. [PMID: 22661997 PMCID: PMC3361037 DOI: 10.5114/aoms.2012.28552] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 09/05/2011] [Accepted: 09/23/2011] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Cardiopulmonary bypass (CPB) surgery is considered one of the most frequent surgical procedures in which acute kidney injury (AKI) represents a frequent and serious complication. The aim of the present study was to evaluate the efficiency of neutrophil gelatinase-associated lipocalin (NGAL) as an early AKI biomarker after CPB in pediatric cardiac surgery. MATERIAL AND METHODS The study included forty children aged 2 to 78 months undergoing CPB. They were divided into group I: patients who suffered AKI grades II and III; and group II: patients who did not develop AKI or at risk. Peripheral venous blood was withdrawn pre- and post-operatively for serial measurements of NGAL and creatinine. Statistical analysis was performed using Statistical Package for Social Sciences version 14. RESULTS Mean plasma NGAL levels showed highly significant elevations in group I patients at 2, 12, and 24 h after surgery (p < 0.0001) compared to group II. Significant correlations were found between NGAL and creatinine at different time intervals. Highly significant correlations (p < 0.0001) were found between plasma NGAL and AKI at 2, 12 and 24 h after surgery. A cut-off level of 100 ng/ml at 2 h, and 125 ng/ml at 12 h post-operatively both recorded the highest accuracy, being 95% accurate, with sensitivity of 100% and 89.5% respectively, and specificity of 90.5% and 100% respectively. CONCLUSIONS This study showed that plasma NGAL could be used as an early biomarker for detection of AKI following CPB. We recommend further studies on a wider scale to validate the current study results.
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Affiliation(s)
| | | | | | - Sonia A. Habib
- Department of Pediatrics, National Research Centre, Egypt
| | - Mona H. Ibrahim
- Department of Clinical Pathology, National Research Centre, Egypt
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96
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Bhavsar NA, Köttgen A, Coresh J, Astor BC. Neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule 1 (KIM-1) as predictors of incident CKD stage 3: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Kidney Dis 2012; 60:233-40. [PMID: 22542304 DOI: 10.1053/j.ajkd.2012.02.336] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 02/24/2012] [Indexed: 01/08/2023]
Abstract
BACKGROUND Identifying individuals at risk of chronic kidney disease (CKD) is critical for timely treatment initiation to slow progression of the disease. Neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule 1 (KIM-1) are known biomarkers of acute kidney injury, but it is unknown whether these markers are associated with incident CKD stage 3 in the general population. STUDY DESIGN Matched case-control study. SETTING & PARTICIPANTS African American and white participants from the Atherosclerosis Risk in Communities (ARIC) Study who at baseline had an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m(2) and urinary albumin-creatinine ratio ≤30 mg/g. 143 controls were matched for age, sex, and race to 143 cases of incident CKD stage 3 after 8.6 years of follow-up. PREDICTORS Quartile of NGAL and KIM-1. OUTCOMES & MEASUREMENTS Incident CKD stage 3 (eGFR <60 mL/min/1.73 m(2) at follow-up and a decrease in eGFR from baseline to follow-up ≥25%). RESULTS Both NGAL (P = 0.05) and KIM-1 levels (P < 0.001) were correlated positively with baseline urinary albumin-creatinine ratio; neither was associated with baseline eGFR. Participants with NGAL concentrations in the fourth quartile had more than 2-fold higher odds (adjusted OR, 2.11; 95% CI, 0.96-4.64) of incident CKD stage 3 compared with participants in the first quartile after multivariable adjustment (P-trend = 0.03). Adjustment for urinary creatinine and albumin levels resulted in a nonsignificant association (highest quartile adjusted OR, 1.52; 95% CI, 0.64-3.58; P = 0.2). No significant association between KIM-1 level and incident CKD was observed in crude or adjusted models. LIMITATIONS The relatively small sample size of the study limits precision and power to detect weak associations. CONCLUSIONS Higher NGAL, but not KIM-1, levels were associated with incident CKD stage 3. Adjustment for urinary creatinine and albumin concentration attenuated this association. Additional studies are needed to confirm these findings and assess the utility of urinary NGAL as a marker of CKD risk.
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Affiliation(s)
- Nrupen A Bhavsar
- Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD, USA
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97
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Gong L, Yu H, ZhuGe Y, Yu Q. Neutrophil Gelatinase-Associated Lipocalin Protects Renal Tubular Epithelial Cell in Ischemic/Reperfusion Injury Rats via Apoptosis-Regulating Proteins. Ren Fail 2012; 34:777-83. [DOI: 10.3109/0886022x.2012.678173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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98
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Dupont M, Shrestha K, Singh D, Awad A, Kovach C, Scarcipino M, Maroo AP, Tang WHW. Lack of significant renal tubular injury despite acute kidney injury in acute decompensated heart failure. Eur J Heart Fail 2012; 14:597-604. [PMID: 22505396 DOI: 10.1093/eurjhf/hfs039] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
AIMS Acute kidney injury (AKI) is a strong predictor of adverse events with an incompletely understood pathophysiology. Neutrophil gelatinase-associated lipocalin (NGAL) is proposed as an early marker of renal tubular injury. Our aim is to determine whether AKI during treatment of acute decompensated heart failure (ADHF) is accompanied by renal tubular injury. METHODS AND RESULTS Urinary NGAL (uNGAL) and urinary creatinine (uCreat) levels were measured in 141 consecutive patients hospitalized for ADHF and followed for 180 days for death or re-hospitalization. AKI was defined as a rise in serum creatinine ≥0.3 mg/dl in a 48 h period. Median uNGAL/uCreat levels on Day 1 (baseline) were similar between patients who did and did not develop AKI [22.8 (12.5-106.8) μg/g vs. 20.6 (12.4-52.0) μg/g, P = 0.55]. On Day 2 and beyond, the difference between the AKI and no AKI cohorts increased, but was only significant on Day 3 [36.2 (21.7-131.8) μg/g vs. 29.4 (11.4-54.6) μg/g, P = 0.02]. The area under the receiver operating characteristic curve for Day 2 uNGAL/uCreat (≥ or <32 µg/g) to predict AKI was 0.61. There was no difference in diuretic response between 'uNGAL/uCreat + ' (≥ 27 µg/g) and 'uNGAL/uCreat-' (<27 µg/g) patients. However 'uNGAL/uCreat + ' patients had more adverse events after 180 days (66% vs. 52%, P = 0.02). CONCLUSIONS In patients with ADHF who develop AKI following diuretic therapy, a minor rise in uNGAL precedes AKI. However, the degree of renal tubular insult was much lower than that observed in other forms of AKI.
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Affiliation(s)
- Matthias Dupont
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH 44195, USA
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99
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Zekey F, Senkul T, Ates F, Soydan H, Yilmaz O, Baykal K. Evaluation of the impact of shock wave lithotripsy on kidneys using a new marker: how do neutrophil gelatinese-associated lypocalin values change after shock wave lithotripsy? Urology 2012; 80:267-72. [PMID: 22503759 DOI: 10.1016/j.urology.2012.02.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 01/24/2012] [Accepted: 02/10/2012] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine possible acute kidney injury with new marker neutrophil gelatinase-associated lipocalin (NGAL) in urine and to show the relationship between changes of this marker and conventional markers in patients undergoing shock wave lithotripsy (SWL). METHODS In patients with kidney stones, serum urea, creatinine, urine microalbumin, and NGAL levels were determined before SWL and at the first, second, and seventh days after SWL. In addition, patients who had undergone SWL were evaluated with Technetium-99m (Tc99m)-dimercaptosuccinic acid (DMSA) and Tc99m-diethylenetriaminepenta acetate renal scintigraphy 1 week before and 3 months after SWL. RESULTS AND LIMITATIONS Forty patients were included in the study. All patients had a single stone in the kidney with an average size of 9.25 mm (range 5-15). No statistical change was found in the levels of average serum urea and creatinine levels, urine microglobulin, and NGAL levels, which were measured before SWL and after SWL. No significant difference was identified in urine NGAL and microalbumin levels of the groups, which were separated by shock wave number and shock energy amount on the first, second, and seventh days after SWL. In the high-energy SWL group, 3 patients had a statistical decrease in their differential kidney function measured with Tc99m difference between differential function rates of the kidney before and after SWL (DMSA) after 3 months after SWL. CONCLUSION Our study found that, using both new and conventional parameters in the acute stage and 3 months later, SWL treatment does not cause acute kidney damage.
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Affiliation(s)
- Fatih Zekey
- Department of Urology, GATA Haydarpasa Teaching Hospital, Istanbul, Turkey
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100
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Abstract
Understanding of chronic heart failure (HF) has progressed from a syndrome of disordered hemodynamics caused by alterations in the structure of the heart to one that involves intertwined molecular pathways in disarray. Accordingly, the assessment and treatment of patients with chronic HF has shifted from a focus on hemodynamics to modification of maladaptive molecular processes. Accumulating evidence shows that molecular biomarkers of disease could provide a unique window into the pathophysiology of chronic HF, potentially improving our ability to predict adverse outcomes, provide novel drug targets, and even help gauge therapeutic efficacy. The more 'traditional' biomarkers such as cardiac troponin, natriuretic peptides, and C-reactive protein have been studied in large cohorts of patients with chronic HF and have relatively established clinical applications. In this Review, we summarize the properties, clinical data, and potential applications of some emerging biomarkers that could uniquely indicate the level of biomechanical stretch, inflammation, ventricular remodeling, myocardial injury, and renal dysfunction that occurs in chronic HF. We will also discuss the potential role for these biomarkers within a multimarker-based strategy that could, in the future, lead to better care for these patients.
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