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Ebrahimi S, Alalikhan A, Aghaee-Bakhtiari SH, Hashemy SI. The redox modulatory effects of SP/NK1R system: Implications for oxidative stress-associated disorders. Life Sci 2022; 296:120448. [PMID: 35247438 DOI: 10.1016/j.lfs.2022.120448] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/04/2022] [Accepted: 02/26/2022] [Indexed: 02/08/2023]
Abstract
Oxidative stress which refers to redox imbalance with increased generation of reactive oxygen species (ROS) has been associated with the pathophysiology of diverse disease conditions. Recently, a close, yet not fully understood, relation between oxidative stress and neuropeptides, in particular, substance P (SP), has been reported in certain conditions. SP has been shown to affect the cellular redox environment through activation of neurokinin-1receptor (NK1R). It seems that SP/NK1R system and oxidative stress can act either synergistically or antagonistically in a context-dependent manner, thereby, influencing the pathology of various clinical disorders either destructively or protectively. Importantly, the interactions between oxidative stress and SP/NK1R system can be pharmacologically targeted. Therefore, a better understanding of the redox modulatory properties of SP/NK1R signaling will pave the way for identifying new therapeutic possibilities for attenuating oxidative stress-mediated damage. Towards this end, we performed a comprehensive search through PubMed/Medline and Scopus databases and discussed all related existing literature regarding the interplay between oxidative stress and SP/NK1R system as well as their implication in various clinical disorders, to provide a clear view and hence better management of oxidative damage.
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Affiliation(s)
- Safieh Ebrahimi
- Department of Clinical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Alalikhan
- Department of Clinical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Hamid Aghaee-Bakhtiari
- Bioinformatics Research Group, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Medical Biotechnology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Isaac Hashemy
- Department of Clinical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Mascarenhas DD, Ravikumar P, Amento EP. N-modulin peptides attenuate respiratory distress in a scald-endotoxemia model. BURNS OPEN 2022. [DOI: 10.1016/j.burnso.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Covalent modification of nephrilin peptide with valproic acid increases its efficacy as a therapeutic in burn trauma. BURNS OPEN 2020; 4:85-89. [PMID: 35572093 PMCID: PMC9097890 DOI: 10.1016/j.burnso.2020.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Introduction: Nephrilin peptide, a designed inhibitor of Rictor complex, modulates systemic responses to trauma, alleviating clinically relevant variables in a rat scald model and sepsis mortality in a mouse model. This study explores the possibility that chemical conjugation of small molecules to the aminoterminus of nephrilin can modify its biological activity in the rat scald model. Methods: One of four molecules (valproic acid, decanoic acid, fenofibric acid and ibuprofen) was chemically attached to the amino terminus of nephrilin during synthesis. Animals were treated with each modified nephrilin by subcutaneous bolus injection on days 1–7 post-burn. Results: Compared to nephrilin, valproic acid-modified nephrilin showed significantly (all p < 0.05) improved systemic effects on kidney function (creatinine 0.17 ± 0.03 vs 0.31 ± 0.09 mg/dL), glycemic control (AUC 57.5 ± 40 vs 136.4 ± 69.2 mg.dL.hr), inflammation (IL-6 24 ± 9 vs 39 ± 8 pg/ml), pathological angiogenesis (1.46 ± 0.87 vs 6.53 ± 3.16 pct pixels) and weight gain (3.74 ± 0.31 vs 2.99 ± 0.53 slope), all variables previously shown to bear upon clinically relevant burn injury outcomes. Conclusion: Modification of nephrilin with valproic acid increases the efficacy of nephrilin peptide in burns.
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Mascarenhas DD. Transcriptional re-programming in rat central nervous system two weeks after burn trauma: the impact of nephrilin treatment on the expression of oxidative stress-related genes. Scars Burn Heal 2020; 6:2059513120939443. [PMID: 32850134 PMCID: PMC7425318 DOI: 10.1177/2059513120939443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Survivors of severe burns suffer lifetime neuroinflammatory consequences manifested by higher incidence of major depression and neurodegenerative disease. In a scald model, nephrilin peptide has previously been shown to protect rats from loss of lean body mass, kidney function and glycaemic control, complications that have also been shown to endure in burn patient populations. Nephrilin's mechanism of action has been suggested to involve protection from excessive oxidative stress. METHODS Using quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) amplification of transcripts in total RNA extracted from dorsal root ganglia of male rats 14 days after exposure to thermal insult, we query the relative levels of expression of 34 genes believed to be associated with oxidative stress biology in the central nervous system (CNS). We use these data to explore the central role of oxidative stress in astrogliosis, immunosuppression and mitochondrial homeostasis. RESULTS AND DISCUSSION Rats that received nephrilin treatment (4 mg/kg by subcutaneous bolus injection once daily for seven days after scald injury) showed significantly reduced elevations in gene expression of some key genes such as NOX2, GFAP, AQP4 and RAC1, but not of others such as NOX4, STEAP4, ARG1 and CCL2. CONCLUSION The implications of these data with reference to nephrilin's potential clinical utility for mitigating the enduring effects of burn trauma on the CNS are discussed. Nephrilin reduces the expression of some genes implicated in neurodegeneration after burn insult. LAY SUMMARY Nephrilin peptide is a novel treatment for short- and long-term systemic effects of burn trauma. This study measures the capability of nephrilin to address post-traumatic neurodegenerative disease by looking at the expression of genes in the central nervous system, in a rat scald model. Nephrilin appears to have beneficial effects by reducing the expression of some key genes known to be relevant in neurodegenerative processes, but not others.
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Affiliation(s)
- Desmond D Mascarenhas
- Mayflower Organization for Research & Education, Sunnyvale, CA, USA
- Transporin, Inc., Sunnyvale, CA, USA
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Mascarenhas DD, El Ayadi A, Ravikumar P, Kang GJ, Langer T, Moreno C, Amento EP. Positive effects of ferric iron on the systemic efficacy of nephrilin peptide in burn trauma. Scars Burn Heal 2020; 6:2059513120928494. [PMID: 32612853 PMCID: PMC7307390 DOI: 10.1177/2059513120928494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Nephrilin peptide is a designed inhibitor of Rictor complex (also known as mTORC2), an evolutionarily conserved assembly believed to modulate responses to cellular stress. We previously demonstrated the ability of nephrilin peptide to suppress neuroinflammation, loss of body mass, glycaemic control and kidney function in a rat scald model, as well as sepsis mortality in a mouse model. The present study explores the effect of nephrilin plus iron formulations on clinically relevant outcomes in the rat scald model. METHODS Animals were treated with nephrilin by subcutaneous bolus injection on post-burn days 1-7. Equimolar ferric iron in the formulation improved the positive systemic effects of nephrilin on kidney function, glycaemic control, oxidative stress, early hyperinflammation, late inflammasome activation, hyperangiogenesis and body mass, all variables previously shown to bear upon clinically relevant burn injury outcomes. The sparing effects of nephrilin-iron were demonstrated in both sexes. DISCUSSION Surprisingly, optimum daily treatment doses were in the range of 2-4 mg/kg, while 8 mg/kg was less effective, suggesting the possibility of marginal pro-oxidant effects from the 'free' iron fraction. Thus, although ferric iron in the nephrilin formulation is clearly helpful, care must be exercised to select an optimum treatment dose. CONCLUSION Iron increases the efficacy of nephrilin peptide in burns.
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Affiliation(s)
- Desmond D Mascarenhas
- Mayflower Organization for Research
& Education, Sunnyvale, CA, USA
- Transporin, Inc., Sunnyvale, CA,
USA
| | - Amina El Ayadi
- Department of Surgery, The University of
Texas Medical Branch, Galveston, TX, USA
- Shriners Hospitals for Children -
Galveston, Galveston, TX, USA
| | - Puja Ravikumar
- Molecular Medicine Research Institute,
Sunnyvale, CA, USA
| | | | - Tammy Langer
- Molecular Medicine Research Institute,
Sunnyvale, CA, USA
| | - Carlos Moreno
- Molecular Medicine Research Institute,
Sunnyvale, CA, USA
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Mascarenhas DD, Herndon DN, Arany I. Epigenetic memory of oxidative stress: does nephrilin exert its protective effects via Rac1? Biologics 2017; 11:97-106. [PMID: 28761330 PMCID: PMC5522666 DOI: 10.2147/btt.s136188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Aim Nephrilin peptide, a designed inhibitor of Rictor complex (mTORC2), exerts pleiotropic protective effects in metabolic, xenobiotic and traumatic stress models. Stress can generate enduring epigenetic changes in gene function. In this work we examine the possibility that nephrilin treatment protects against acute and enduring global changes in oxidative metabolism, with a focus on the Rictor-complex-mediated activation of Rac1, a subunit of NADPH oxidase (Nox) via PKCs, Prex1 and p66shc. Methods Given the wide range of animal models in which nephrilin peptide has previously demonstrated effectiveness in vivo, we chose three different experimental systems for this investigation: dermal fibroblasts, renal proximal tubule epithelial cells (PTECs), and kidney tissue and urine from an animal model of burn trauma in which nephrilin was previously shown to prevent loss of kidney function. Results (1) Nephrilin protects dermal fibroblasts from loss of viability and collagen synthesis after ultraviolet A (UV-A) or H2O2 insult. (2) Nephrilin reduces reactive oxygen species (ROS) formation by H2O2–treated (PTECs) with or without nicotine pretreatment. Using RNA arrays and pathway analysis we demonstrate that nicotine and H2O2-treated PTECs specifically induced Rac1 gene networks in these cells. (3) Using kidney tissue and urine from the burn trauma model we demonstrate significant elevations of [a] 8-aminoprostane in urine; [b] kidney tissue histone modification and DNA methylation; and [c] post-transcriptional phosphorylation events consistent with Rac1 activation in kidney tissue. Conclusion Nephrilin protects against oxidative stress, possibly by modulating the activation of Rac1.
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Affiliation(s)
- Desmond D Mascarenhas
- Mayflower Organization for Research & Education, Sunnyvale, CA.,Transporin, Inc., Sunnyvale, CA
| | - David N Herndon
- Department of Surgery, The University of Texas Medical Branch, and Shriners Hospitals for Children, Galveston, TX
| | - Istvan Arany
- Department of Pediatrics, Division of Pediatric Nephrology, University of Mississippi Medical Center, Jackson, MS, USA
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Mascarenhas DD, Ayadi AE, Wetzel M, Prasai A, Mifflin R, Jay J, Herndon DN, Finnerty CC. Effects of the nephrilin peptide on post-burn glycemic control, renal function, fat and lean body mass, and wound healing. INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2016; 6:44-50. [PMID: 28078180 PMCID: PMC5218868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/14/2016] [Indexed: 06/06/2023]
Abstract
The mechanisms underlying the effects of severe burn trauma are not well understood. We previously demonstrated the ability of nephrilin peptide (an iron-binding peptide believed to enter cells through iron-uptake pathways) to suppress aspects of the neuroinflammatory response in a rat scald model, as well as sepsis mortality in a mouse model. This study explores the effect of nephrilin on other clinically relevant outcomes in the rat scald model. In a rat scald model, animals were treated with nephrilin either in week 1 or week 2 post-burn. Measurements were made of serum glucose and creatinine as well as wound area by planimetry and body composition by DEXA. Given the potential role of iron, results were analyzed both for the entire cohort of animals and for the normoferremic (>100 ug/dL serum iron) subset of animals. Nephrilin improved body composition, wound healing, kidney function, and glycemic control. The first two effects were significant in normoferremic but not in hypoferremic animals suggesting an effect of iron status on burn injury outcomes. Nephrilin treatment modulates a number of relevant variables in the rat scald model.
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Affiliation(s)
- Desmond D Mascarenhas
- Mayflower Organization for Research & EducationSunnyvale, CA 94085, USA
- Transporin, Inc.Sunnyvale, CA 94085, USA
| | - Amina El Ayadi
- Department of Surgery, The University of Texas Medical BranchUSA
- Shriners Hospitals for Children - GalvestonGalveston, TX 77550, USA
| | - Michael Wetzel
- Shriners Hospitals for Children - GalvestonGalveston, TX 77550, USA
- Cell Biology Graduate Program, The University of Texas Medical BranchGalveston, TX 77555, USA
| | - Anesh Prasai
- Shriners Hospitals for Children - GalvestonGalveston, TX 77550, USA
- Cell Biology Graduate Program, The University of Texas Medical BranchGalveston, TX 77555, USA
| | - Randy Mifflin
- Department of Surgery, The University of Texas Medical BranchUSA
- Shriners Hospitals for Children - GalvestonGalveston, TX 77550, USA
| | - Jayson Jay
- Shriners Hospitals for Children - GalvestonGalveston, TX 77550, USA
- The Institute for Translational Sciences and The Sealy Center for Molecular Medicine, The University of Texas Medical BranchGalveston, TX 77550, USA
| | - David N Herndon
- Department of Surgery, The University of Texas Medical BranchUSA
- Shriners Hospitals for Children - GalvestonGalveston, TX 77550, USA
- The Institute for Translational Sciences and The Sealy Center for Molecular Medicine, The University of Texas Medical BranchGalveston, TX 77550, USA
| | - Celeste C Finnerty
- Department of Surgery, The University of Texas Medical BranchUSA
- Shriners Hospitals for Children - GalvestonGalveston, TX 77550, USA
- The Institute for Translational Sciences and The Sealy Center for Molecular Medicine, The University of Texas Medical BranchGalveston, TX 77550, USA
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Borsting E, Patel SV, Declèves AE, Lee SJ, Rahman QM, Akira S, Satriano J, Sharma K, Vallon V, Cunard R. Tribbles homolog 3 attenuates mammalian target of rapamycin complex-2 signaling and inflammation in the diabetic kidney. J Am Soc Nephrol 2014; 25:2067-78. [PMID: 24676635 DOI: 10.1681/asn.2013070811] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The endoplasmic reticulum (ER) stress response is activated in the diabetic kidney and functions to reduce ER protein accumulation and improve cellular function. We previously showed that tribbles homolog 3 (TRB3), an ER stress-associated protein, is upregulated in the diabetic kidney. Here, we investigated whether absence of TRB3 alters outcomes in diabetic nephropathy. Type 1 diabetes was induced in TRB3 wild-type and knockout ((-/-)) mice by low-dose streptozotocin, and the mice were followed for 12 weeks. Diabetic TRB3(-/-) mice developed higher levels of albuminuria and increased expression of inflammatory cytokine and chemokine mRNA in renal cortices relative to wild-type littermates, despite similar hyperglycemia. Diabetic TRB3(-/-) mice also expressed higher levels of ER stress-associated molecules in both the renal cortices and glomeruli. This change was associated with higher renal cortical phosphorylation of AKT at serine 473 (Ser(473)), which is the AKT site phosphorylated by mammalian target of rapamycin complex-2 (mTORC2). We show in renal tubular cells that TRB3 binds to mTOR and the rapamycin-insensitive companion of mTOR (Rictor), a protein specific to mTORC2. Finally, we demonstrate in murine tubular cells that TRB3 can inhibit secretion of IL-6. Thus, TRB3 reduces albuminuria and inflammatory gene expression in diabetic kidney disease by a mechanism that may involve inhibition of the mTORC2/AKT pathway and may prove to be a novel therapeutic target.
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Affiliation(s)
- Emily Borsting
- Research Service and Division of Nephrology-Hypertension, Veterans Affairs San Diego Healthcare System, Veterans Medical Research Foundation, San Diego, California
| | - Shalin V Patel
- Research Service and Division of Nephrology-Hypertension, Veterans Affairs San Diego Healthcare System, Veterans Medical Research Foundation, San Diego, California
| | - Anne-Emilie Declèves
- Center for Renal Translational Medicine, Department of Medicine, University of California San Diego, La Jolla, California; and
| | - Sarah J Lee
- Research Service and Division of Nephrology-Hypertension, Veterans Affairs San Diego Healthcare System, Veterans Medical Research Foundation, San Diego, California
| | - Qazi M Rahman
- Research Service and Division of Nephrology-Hypertension, Veterans Affairs San Diego Healthcare System, Veterans Medical Research Foundation, San Diego, California
| | - Shizuo Akira
- Laboratory of Host Defense, WPI Immunology Frontier Research Center, Osaka University, Osaka, Japan
| | - Joe Satriano
- Research Service and Division of Nephrology-Hypertension, Veterans Affairs San Diego Healthcare System, Veterans Medical Research Foundation, San Diego, California; Center for Renal Translational Medicine, Department of Medicine, University of California San Diego, La Jolla, California; and
| | - Kumar Sharma
- Research Service and Division of Nephrology-Hypertension, Veterans Affairs San Diego Healthcare System, Veterans Medical Research Foundation, San Diego, California; Center for Renal Translational Medicine, Department of Medicine, University of California San Diego, La Jolla, California; and
| | - Volker Vallon
- Research Service and Division of Nephrology-Hypertension, Veterans Affairs San Diego Healthcare System, Veterans Medical Research Foundation, San Diego, California; Center for Renal Translational Medicine, Department of Medicine, University of California San Diego, La Jolla, California; and
| | - Robyn Cunard
- Research Service and Division of Nephrology-Hypertension, Veterans Affairs San Diego Healthcare System, Veterans Medical Research Foundation, San Diego, California; Center for Renal Translational Medicine, Department of Medicine, University of California San Diego, La Jolla, California; and
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Mascarenhas DD, ElAyadi A, Singh BK, Prasai A, Hegde SD, Herndon DN, Finnerty CC. Nephrilin peptide modulates a neuroimmune stress response in rodent models of burn trauma and sepsis. INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2013; 3:190-200. [PMID: 24273694 PMCID: PMC3828741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 09/15/2013] [Indexed: 06/02/2023]
Abstract
Sepsis occurs three times more often in burns than in other types of trauma, suggesting an overlap or synergy between underlying immune mechanisms in burn trauma and sepsis. Nephrilin peptide, a designed inhibitor of mTORC2, has previously been shown to modulate a neuroimmune stress response in rodent models of xenobiotic and metabolic stress. Here we investigate the effect of nephrilin peptide administration in different rodent models of burn trauma and sepsis. In a rat scald burn model, daily subcutaneous bolus injection of 4 mg/kg nephrilin significantly reduced the elevation of kidney tissue substance P, S100A9 gene expression, PMN infiltration and plasma inflammatory markers in the acute phase, while suppressing plasma CCL2 and insulin C-peptide, kidney p66shc-S36 phosphorylation and PKC-beta and CGRP in dorsal root ganglia at 14 days (chronic phase). In the mouse cecal ligation and puncture model of sepsis, nephrilin fully protected mice from mortality between surgery and day 7, compared to 67% mortality in saline-treated animals, while significantly reducing elevated CCL2 in plasma. mTORC2 may modulate important neuroimmune responses in both burn trauma and sepsis.
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Affiliation(s)
- Desmond D Mascarenhas
- Mayflower Organization for Research & EducationSunnyvale, CA 94085, USA
- Protigen Inc.Sunnyvale, CA 94085, USA
| | - Amina ElAyadi
- Department of Surgery, The University of Texas Medical Branch, and Shriners Hospitals for ChildrenGalveston, TX 77550, USA
| | | | - Anesh Prasai
- Department of Surgery, The University of Texas Medical Branch, and Shriners Hospitals for ChildrenGalveston, TX 77550, USA
| | - Sachin D Hegde
- Department of Surgery, The University of Texas Medical Branch, and Shriners Hospitals for ChildrenGalveston, TX 77550, USA
| | - David N Herndon
- Department of Surgery, The University of Texas Medical Branch, and Shriners Hospitals for ChildrenGalveston, TX 77550, USA
| | - Celeste C Finnerty
- Department of Surgery, The University of Texas Medical Branch, and Shriners Hospitals for ChildrenGalveston, TX 77550, USA
- The Institute for Translational Sciences and The Sealy Center for Molecular Medicine, The University of Texas Medical BranchGalveston TX 77550, USA
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Cunard R. Mammalian tribbles homologs at the crossroads of endoplasmic reticulum stress and Mammalian target of rapamycin pathways. SCIENTIFICA 2013; 2013:750871. [PMID: 24490110 PMCID: PMC3892554 DOI: 10.1155/2013/750871] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 11/20/2013] [Indexed: 05/03/2023]
Abstract
In 2000, investigators discovered Tribbles, a Drosophila protein that coordinates morphogenesis by inhibiting mitosis. Further work has delineated Xenopus (Xtrb2), Nematode (Nipi-3), and mammalian homologs of Drosophila tribbles, which include TRB1, TRB2, and TRB3. The sequences of tribbles homologs are highly conserved, and despite their protein kinase structure, to date they have not been shown to have kinase activity. TRB family members play a role in the differentiation of macrophages, lymphocytes, muscle cells, adipocytes, and osteoblasts. TRB isoforms also coordinate a number of critical cellular processes including glucose and lipid metabolism, inflammation, cellular stress, survival, apoptosis, and tumorigenesis. TRB family members modulate multiple complex signaling networks including mitogen activated protein kinase cascades, protein kinase B/AKT signaling, mammalian target of rapamycin, and inflammatory pathways. The following review will discuss metazoan homologs of Drosophila tribbles, their structure, expression patterns, and functions. In particular, we will focus on TRB3 function in the kidney in podocytes. This review will also discuss the key signaling pathways with which tribbles proteins interact and provide a rationale for developing novel therapeutics that exploit these interactions to provide better treatment options for both acute and chronic kidney disease.
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Affiliation(s)
- Robyn Cunard
- Research Service and Division of Nephrology-Hypertension, Veterans Affairs San Diego Healthcare System, Veterans Medical Research Foundation, Mail Code 151, 3350 La Jolla Village Drive, San Diego, CA 92161, USA
- Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA
- *Robyn Cunard:
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