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Anai S, Nakayama Y, Gushiken H, Chinen S, Masuda K, Kamiya H, Ueno S, Maeda M, Kiyuna M, Sato Y, Matsumoto T. Diffuse alveolar hemorrhage and acute eosinophilic pneumonia: A rare form of amiodarone pulmonary toxicity diagnosed by bronchoalveolar lavage. J Cardiol Cases 2023; 27:93-96. [PMID: 36910038 PMCID: PMC9995651 DOI: 10.1016/j.jccase.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/07/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022] Open
Abstract
A 56-year-old man presented with fever, cough, and bloody sputum. He had undergone mitral valve replacement with mechanical prosthesis 14 months prior for mitral valve disease. Subsequently, the patient was taking warfarin and amiodarone. Chest imaging revealed dense, infiltrative shadows, and blood tests showed prolonged prothrombin time and eosinophilia. Warfarin was withdrawn, and antibiotics were started, but bloody sputum and respiratory failure persisted. Considering that eosinophilia was observed after the administration of amiodarone, the drug was discontinued, and bronchoalveolar lavage was performed. Cytology showed foam cells, eosinophils, and hemosiderin-laden macrophages; amiodarone-induced diffuse alveolar hemorrhage (DAH) and acute eosinophilic pneumonia (AEP) were diagnosed, and the patient was treated with corticosteroids. This report describes the first documented case of amiodarone-induced DAH and AEP. When a patient taking amiodarone presents with antibiotic-refractory pneumonia with bloody sputum and eosinophilia, amiodarone-induced DAH and AEP should be considered. Learning objective We report the first case of amiodarone-induced diffuse alveolar hemorrhage (DAH) and acute eosinophilic pneumonia (AEP) diagnosed by foam cells, eosinophils, and hemosiderin-laden macrophages on bronchoalveolar lavage cytology. When a patient taking amiodarone presents with antibiotic-refractory pneumonia with bloody sputum and eosinophilia, amiodarone-induced DAH and AEP should be considered.
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Affiliation(s)
- Satoshi Anai
- Division of Respiratory Medicine, Yuuai Medical Center, Tomishiro City, Okinawa, Japan
| | - Yuri Nakayama
- Division of Respiratory Medicine, Yuuai Medical Center, Tomishiro City, Okinawa, Japan
| | - Hiroki Gushiken
- Division of Respiratory Medicine, Yuuai Medical Center, Tomishiro City, Okinawa, Japan
| | - Shigeki Chinen
- Division of Respiratory Medicine, Yuuai Medical Center, Tomishiro City, Okinawa, Japan
| | - Keita Masuda
- Division of Respiratory Medicine, Yuuai Medical Center, Tomishiro City, Okinawa, Japan
| | - Hiroki Kamiya
- Division of Respiratory Medicine, Yuuai Medical Center, Tomishiro City, Okinawa, Japan
| | - Shiho Ueno
- Division of Respiratory Medicine, Yuuai Medical Center, Tomishiro City, Okinawa, Japan
| | - Minetaka Maeda
- Division of Cardiology, Yuuai Medical Center, Tomishiro City, Okinawa, Japan
| | - Masaya Kiyuna
- Division of Pathology, Yuuai Medical Center, Tomishiro City, Okinawa, Japan
| | - Yoko Sato
- Division of Respiratory Medicine, Yuuai Medical Center, Tomishiro City, Okinawa, Japan
| | - Tsuyoshi Matsumoto
- Division of Respiratory Medicine, Yuuai Medical Center, Tomishiro City, Okinawa, Japan
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Saeed J, Waqas QA, Khan UI, Abdullah HMA. Republished: Amiodarone-induced diffuse alveolar haemorrhage: a rare but potentially life-threatening complication of a commonly prescribed medication. Drug Ther Bull 2020; 58:107-111. [PMID: 32354726 DOI: 10.1136/dtb.2019.232149rep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
| | - Qazi Ahmed Waqas
- Internal Medicine, University of South Dakota Sanford, School of Medicine, Sioux Falls, South Dakota, USA
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Saeed J, Waqas QA, Khan UI, Abdullah HMA. Amiodarone-induced diffuse alveolar haemorrhage: a rare but potentially life-threatening complication of a commonly prescribed medication. BMJ Case Rep 2019; 12:12/10/e232149. [PMID: 31653638 DOI: 10.1136/bcr-2019-232149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Amiodarone is an antiarrhythmic agent that is used commonly in clinical practice. It is associated with many side effects, the most common being pulmonary manifestations. Interstitial pneumonitis is one of the most common complications, however rarely amiodarone can cause diffuse alveolar haemorrhage (DAH) too. We describe the case of a 73-year-old woman who presented with shortness of breath and haemoptysis 4 days after starting amiodarone. She was diagnosed with amiodarone-induced DAH based on imaging and bronchoalveolar lavage. She was treated with intravenous and then oral steroids, and amiodarone was discontinued. The patient made a significant clinical and radiological recovery. She was discharged 10 days after her presentation. This case highlights a rare but potentially life-threatening complication of a commonly used medication.
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Affiliation(s)
| | - Qazi Ahmed Waqas
- Internal Medicine, University of South Dakota Sanford, School of Medicine, Sioux Falls, South Dakota, USA
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Gu L, Deng H, Ren Z, Zhao Y, Yu S, Guo Y, Dai J, Chen X, Li K, Li R, Wang G. Dynamic Changes in the Microbiome and Mucosal Immune Microenvironment of the Lower Respiratory Tract by Influenza Virus Infection. Front Microbiol 2019; 10:2491. [PMID: 31736922 PMCID: PMC6838016 DOI: 10.3389/fmicb.2019.02491] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/16/2019] [Indexed: 02/05/2023] Open
Abstract
Influenza is a major public health concern, and the high mortality rate is largely attributed to secondary bacterial infections. There are several mechanisms through which the virus increases host susceptibility to bacterial colonization, but the micro-environment in lower respiratory tract (LRT) of host, infected with influenza virus, is unclear. To this end, we analyzed the LRT microbiome, transcriptome of lung and metabolome of bronchoalveolar lavage fluid (BALF) in mice inoculated intra-nasally with H1N1 to simulate human influenza, and we observed significant changes in the composition of microbial community and species diversity in the acute (7 days post inoculation or dpi), convalescent (14 dpi) and the recovery (28 dpi) periods. The dominant bacterial class shifted from Alphaproteobacteria to Gammaproteobacteria and Actinobacteria in the infected mice, with a significant increase in the relative abundance of anaerobes and facultative anaerobes like Streptococcus and Staphylococcus. The dysbiosis in the LRT of infected mice was not normalized even in the recovery phase of the infection. In addition, the infected lung transcriptome showed significant differences in the expression levels of genes associated with bacterial infection and immune responses. Finally, the influenza virus infection also resulted in significant changes in the metabolome of the BALF. These alterations in the microbiome, transcriptome, and metabolome of infected lungs were not only appeared at the acute period, but also observed at the recovery period. Furthermore, the infection of influenza virus induced a long-term effect in LRT micro-environmental homeostasis, which may give a chance for the invasion of potential pathogens.
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Affiliation(s)
- Liming Gu
- Department of Microbiology and Immunology, Shantou University Medical College, Shantou, China
- Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou, China
| | - Huixiong Deng
- Department of Microbiology and Immunology, Shantou University Medical College, Shantou, China
- Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou, China
| | - Zhihui Ren
- Department of Microbiology and Immunology, Shantou University Medical College, Shantou, China
- Department of Anesthesiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ying Zhao
- Department of Microbiology and Immunology, Shantou University Medical College, Shantou, China
- Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou, China
| | - Shun Yu
- Department of Microbiology and Immunology, Shantou University Medical College, Shantou, China
- Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou, China
| | - Yingzhu Guo
- Department of Microbiology and Immunology, Shantou University Medical College, Shantou, China
- Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou, China
| | - Jianping Dai
- Department of Microbiology and Immunology, Shantou University Medical College, Shantou, China
- Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou, China
| | - Xiaoxuan Chen
- Department of Microbiology and Immunology, Shantou University Medical College, Shantou, China
- Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou, China
| | - Kangsheng Li
- Department of Microbiology and Immunology, Shantou University Medical College, Shantou, China
- Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou, China
| | - Rui Li
- Department of Microbiology and Immunology, Shantou University Medical College, Shantou, China
- Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou, China
- *Correspondence: Rui Li,
| | - Gefei Wang
- Department of Microbiology and Immunology, Shantou University Medical College, Shantou, China
- Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou, China
- Gefei Wang,
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Fasler K, Traber GL, Jaggi GP, Landau K. Amiodarone-associated Optic Neuropathy-A Clinical Criteria-based Diagnosis? Neuroophthalmology 2018; 42:2-10. [PMID: 29467802 DOI: 10.1080/01658107.2017.1340961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 06/05/2017] [Accepted: 06/07/2017] [Indexed: 10/19/2022] Open
Abstract
Amiodarone-associated optic neuropathy (AAON) is a controversial diagnosis with possible impact on vital cardiac therapy decisions. This retrospective case series aims for application of distinguishing features of AAON versus non-arteritic ischaemic optic neuropathy (NAION): Bilaterality, mode of onset, degree of optic nerve dysfunction, structure of uninvolved disc (unilateral cases), and systemic toxic effects. Applying these criteria to patients with disc swelling under amiodarone, the authors identified four unilateral disc swellings, one with NAION-typical features only and three with one or more NAION-atypical features. All three sequential and six bilateral cases showed one or more NAION-atypical features. The 12 cases highlight the persisting diagnostic dilemma arising from diversity of presentation, lack of plausible pathomechanism, and controversial existence of the entity itself.
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Affiliation(s)
- Katrin Fasler
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
| | - Ghislaine L Traber
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
| | - Gregor Peter Jaggi
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
| | - Klara Landau
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
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Amiodarone-Induced Retinal Neuronal Cell Apoptosis Attenuated by IGF-1 via Counter Regulation of the PI3k/Akt/FoxO3a Pathway. Mol Neurobiol 2016; 54:6931-6943. [PMID: 27774572 DOI: 10.1007/s12035-016-0211-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 10/11/2016] [Indexed: 01/07/2023]
Abstract
Amiodarone (AM) is the most effective antiarrhythmic agent currently available. However, clinical application of AM is limited by its serious toxic adverse effects including optic neuropathy. The purpose of this study was to explore the effects of AM and to assess if insulin-like growth factor-1 (IGF-1) could protect retinal neuronal cells from AM-induced apoptosis, and to determine the molecular mechanisms underlying the effects. Accordingly, the phosphorylation/activation of Akt and FoxO3a were analyzed by Western blot while the possible pathways involved in the protection of IGF-1 were investigated by application of various pathway inhibitors. The full electroretinogram (FERG) was used to evaluate in vivo effect of AM and IGF-1 on rat retinal physiological functions. Our results showed that AM concentration dependently caused an apoptosis of RGC-5 cells, while IGF-1 protected RGC-5 cells against this effect by AM. The protective effect of IGF-1 was reversed by PI3K inhibitors LY294002 and wortmannin as well as the Akt inhibitor VIII. AM decreased p-Akt and p-FoxO3a while increased the nuclear localization of FoxO3a in the RGC-5 cells. IGF-1 reversed the effect of AM on the p-Akt and p-FoxO3a and the nuclear translocation of FoxO3a. Similar results were obtained in primary cultured retinal ganglia cells. Furthermore, FERG in vivo recording in rats showed that AM decreased a-wave and b-wave of FERG while IGF-1 reversed the effects of AM. These data show that AM induced apoptosis of retinal neuronal cells via inhibiting the PI3K/Akt/FoxO3a pathway while IGF-1 protected RGC-5 cells against AM-induced cell apoptosis by stimulating this pathway.
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Metabolomics screening identifies reduced L-carnitine to be associated with progressive emphysema. Clin Sci (Lond) 2016; 130:273-87. [DOI: 10.1042/cs20150438] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 11/12/2015] [Indexed: 01/29/2023]
Abstract
The progression of emphysema, a severe chronic lung disease, was found to be associated with reduced lung tissue-specific L-carnitine in a clinically relevant mouse model. Furthermore, supplementing mice with this metabolite improved lung function and impaired disease progression.
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Lu J, Miyakawa K, Roth RA, Ganey PE. Tumor necrosis factor-alpha potentiates the cytotoxicity of amiodarone in Hepa1c1c7 cells: roles of caspase activation and oxidative stress. Toxicol Sci 2012; 131:164-78. [PMID: 23042730 DOI: 10.1093/toxsci/kfs289] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Amiodarone (AMD), a class III antiarrhythmic drug, causes idiosyncratic hepatotoxicity in human patients. We demonstrated previously that tumor necrosis factor-alpha (TNF-α) plays an important role in a rat model of AMD-induced hepatotoxicity under inflammatory stress. In this study, we developed a model in vitro to study the roles of caspase activation and oxidative stress in TNF potentiation of AMD cytotoxicity. AMD caused cell death in Hepa1c1c7 cells, and TNF cotreatment potentiated its toxicity. Activation of caspases 9 and 3/7 was observed in AMD/TNF-cotreated cells, and caspase inhibitors provided minor protection from cytotoxicity. Intracellular reactive oxygen species (ROS) generation and lipid peroxidation were observed after treatment with AMD and were further elevated by TNF cotreatment. Adding water-soluble antioxidants (trolox, N-acetylcysteine, glutathione, or ascorbate) produced only minor attenuation of AMD/TNF-induced cytotoxicity and did not influence the effect of AMD alone. On the other hand, α-tocopherol (TOCO), which reduced lipid peroxidation and ROS generation, prevented AMD toxicity and caused pronounced reduction in cytotoxicity from AMD/TNF cotreatment. α-TOCO plus a pancaspase inhibitor completely abolished AMD/TNF-induced cytotoxicity. In summary, activation of caspases and oxidative stress were observed after AMD/TNF cotreatment, and caspase inhibitors and a lipid-soluble free-radical scavenger attenuated AMD/TNF-induced cytotoxicity.
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Affiliation(s)
- Jingtao Lu
- Department of Biochemistry and Molecular Biology, Michigan State University, East Lansing, Michigan 48824, USA
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Hernández Voth AR, Catalán JS, Benavides Mañas PD, Avila Martínez RJ, Peñalver Paolini CL, Díaz de Atauri Rodríguez MJ. A 73-year-old man with interstitial lung disease due to dronedarone. Am J Respir Crit Care Med 2012; 186:201-2. [PMID: 22798421 DOI: 10.1164/ajrccm.186.2.201] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Mulder JE, Brien JF, Racz WJ, Takahashi T, Massey TE. Mechanisms of Amiodarone and Desethylamiodarone Cytotoxicity in Nontransformed Human Peripheral Lung Epithelial Cells. J Pharmacol Exp Ther 2010; 336:551-9. [DOI: 10.1124/jpet.110.173120] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Palermo V, Falcone C, Calvani M, Mazzoni C. Acetyl-L-carnitine protects yeast cells from apoptosis and aging and inhibits mitochondrial fission. Aging Cell 2010; 9:570-9. [PMID: 20550520 DOI: 10.1111/j.1474-9726.2010.00587.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In this work we report that carnitines, in particular acetyl-l-carnitine (ALC), are able to prolong the chronological aging of yeast cells during the stationary phase. Lifespan extension is significantly reduced in yca1 mutants as well in rho(0) strains, suggesting that the protective effects pass through the Yca1 caspase and mitochondrial functions. ALC can also prevent apoptosis in pro-apoptotic mutants, pointing to the importance of mitochondrial functions in regulating yeast apoptosis and aging. We also demonstrate that ALC attenuates mitochondrial fission in aged yeast cells, indicating a correlation between its protective effect and this process. Our findings suggest that ALC, used as therapeutic for stroke, myocardial infarction and neurodegenerative diseases, besides the well-known anti-oxidant effects, might exert protective effects also acting on mitochondrial morphology.
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Affiliation(s)
- Vanessa Palermo
- Department of Cell and Developmental Biology, University of Rome, Rome, Italy
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Maeda A, Yano T, Itoh Y, Kakumori M, Kubota T, Egashira N, Oishi R. Down-regulation of RhoA is involved in the cytotoxic action of lipophilic statins in HepG2 cells. Atherosclerosis 2010; 208:112-8. [DOI: 10.1016/j.atherosclerosis.2009.07.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Revised: 07/07/2009] [Accepted: 07/15/2009] [Indexed: 12/25/2022]
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Han Y, Miller A, Mangada J, Liu Y, Swistowski A, Zhan M, Rao MS, Zeng X. Identification by automated screening of a small molecule that selectively eliminates neural stem cells derived from hESCs but not dopamine neurons. PLoS One 2009; 4:e7155. [PMID: 19774075 PMCID: PMC2743191 DOI: 10.1371/journal.pone.0007155] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Accepted: 08/25/2009] [Indexed: 12/15/2022] Open
Abstract
Background We have previously described fundamental differences in the biology of stem cells as compared to other dividing cell populations. We reasoned therefore that a differential screen using US Food and Drug Administration (FDA)-approved compounds may identify either selective survival factors or specific toxins and may be useful for the therapeutically-driven manufacturing of cells in vitro and possibly in vivo. Methodology/Principal Findings In this study we report on optimized methods for feeder-free culture of hESCs and hESC-derived neural stem cells (NSCs) to facilitate automated screening. We show that we are able to measure ATP as an indicator of metabolic activity in an automated screening assay. With this optimized platform we screened a collection of FDA-approved drugs to identify compounds that have differential toxicity to hESCs and their neural derivatives. Nine compounds were identified to be specifically toxic for NSCs to a greater extent than for hESCs. Six of these initial hits were retested and verified by large-scale cell culture to determine dose-responsive NSC toxicity. One of the compounds retested, amiodarone HCL, was further tested for possible effects on postmitotic neurons, a likely target for transplant therapy. Amiodarone HCL was found to be selectively toxic to NSCs but not to differentiated neurons or glial cells. Treated and untreated NSCs and neurons were then interrogated with global gene expression analysis to explore the mechanisms of action of amiodarone HCl. The gene expression analysis suggests that activation of cell-type specific cationic channels may underlie the toxicity of the drug. Conclusions/Significance In conclusion, we have developed a screening strategy that allows us to rapidly identify clinically approved drugs for use in a Chemistry, Manufacture and Control protocol that can be safely used to deplete unwanted contaminating precursor cells from a differentiated cell product. Our results also suggest that such a strategy is rich in the potential of identifying lineage specific reagents and provides additional evidence for the utility of stem cells in screening and discovery paradigms.
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Affiliation(s)
- Yi Han
- Buck Institute for Aging Research, Novato, California, United States of America
| | - Aaron Miller
- Buck Institute for Aging Research, Novato, California, United States of America
| | - Julie Mangada
- Buck Institute for Aging Research, Novato, California, United States of America
| | - Ying Liu
- Invitrogen, Carlsbad, California, United States of America
| | - Andrzej Swistowski
- Buck Institute for Aging Research, Novato, California, United States of America
| | - Ming Zhan
- National Institute of Aging, Baltimore, Maryland, United States of America
| | - Mahendra S. Rao
- Buck Institute for Aging Research, Novato, California, United States of America
- Invitrogen, Carlsbad, California, United States of America
| | - Xianmin Zeng
- Buck Institute for Aging Research, Novato, California, United States of America
- * E-mail:
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Amphotericin B-induced renal tubular cell injury is mediated by Na+ Influx through ion-permeable pores and subsequent activation of mitogen-activated protein kinases and elevation of intracellular Ca2+ concentration. Antimicrob Agents Chemother 2009; 53:1420-6. [PMID: 19139282 DOI: 10.1128/aac.01137-08] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Amphotericin B (AMB) is one of the most effective antifungal agents; however, its use is often limited by the occurrence of adverse events, especially nephrotoxicity. The present study was designed to determine the possible mechanisms underlying the nephrotoxic action of AMB. The exposure of a porcine proximal renal tubular cell line (LLC-PK1 cells) to AMB caused cell injury, as assessed by mitochondrial enzyme activity, the leakage of lactate dehydrogenase, and tissue ATP depletion. Propidium iodide uptake was enhanced, while terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling was not affected by AMB, suggesting a lack of involvement of apoptosis in AMB-induced cell injury. The cell injury was inhibited by the depletion of membrane cholesterol with methyl-beta-cyclodextrin, which lowered the extracellular Na(+) concentration or the chelation of intracellular Ca(2+). The rise in the intracellular Ca(2+) concentration may be mediated through the activation of the ryanodine receptor (RyR) on the endoplasmic reticulum and the mitochondrial Na(+)-Ca(2+) exchanger, since cell injury was attenuated by dantrolene (an RyR antagonist) and CGP37157 (an Na(+)-Ca(2+) exchanger inhibitor). Moreover, AMB-induced cell injury was reversed by PD169316 (a p38 mitogen-activated protein [MAP] kinase inhibitor), c-Jun N-terminal kinase inhibitor II, and PD98059 (a MEK1/2 inhibitor). The phosphorylations of these MAP kinases were enhanced by AMB in a calcium-independent manner, suggesting the involvement of MAP kinases in AMB-induced cell injury. These findings suggest that Na(+) entry through membrane pores formed by the association of AMB with membrane cholesterol leads to the activation of MAP kinases and the elevation of the intracellular Ca(2+) concentration, leading to renal tubular cell injury.
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