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Huang H, Wan J, Ao X, Qu S, Jia M, Zhao K, Liang J, Zen K, Liang H. ECM1 and ANXA1 in urinary extracellular vesicles serve as biomarkers for breast cancer. Front Oncol 2024; 14:1408492. [PMID: 39040439 PMCID: PMC11260749 DOI: 10.3389/fonc.2024.1408492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/24/2024] [Indexed: 07/24/2024] Open
Abstract
Objective Although urinary extracellular vesicles (uEVs) have been extensively studied in various cancers, their involvement in breast cancer (BC) remains largely unexplored. The non-invasive nature of urine as a biofluid and its abundant protein content offer considerable potential for the early detection of breast cancer. Methods This study analyzed the proteomic profiles of uEVs from BC patients and healthy controls (HC). The dysregulation of ECM1 and ANXA1 in the uEVs was validated in a larger cohort of 128 BC patients, 25 HC and 25 benign breast nodules (BBN) by chemiluminescence assay (CLIA). The expression levels of ECM1 and ANXA1 were also confirmed in the uEVs of MMTV-PyMT transgenic breast cancer mouse models. Results LC-MS/MS analysis identified 571 dysregulated proteins in the uEVs of BC patients. ECM1 and ANXA1 were selected for validation in 128 BC patients, 25 HC and 25 BBN using CLIA, as their fold change showed a significant difference of more than 10 with p-value<0.05. Protein levels of ECM1 and ANXA1 in uEVs were significantly increased in BC patients. In addition, the protein levels of ECM1 and ANXA1 in the uEVs of MMTV-PyMT transgenic mice were observed to increase progressively with the progression of breast cancer. Conclusion We developed a simple and purification-free assay platform to isolate uEVs and quantitatively detect ECM1 and ANXA1 in uEVs by WGA-coupled magnetic beads and CLIA. Our results suggest that ECM1 and ANXA1 in uEVs could potentially serve as diagnostic biomarkers for breast cancer.
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Affiliation(s)
- Hai Huang
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Science, Nanjing University, Nanjing, China
- Department of Emergency, Nanjing Drum Tower Hospital, School of Life Science and Technology, China Pharmaceutical University, Nanjing, China
| | - Jingyu Wan
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Science, Nanjing University, Nanjing, China
| | - Xudong Ao
- Peking University Cancer Hospital, Affiliated Cancer Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Shuang Qu
- Department of Emergency, Nanjing Drum Tower Hospital, School of Life Science and Technology, China Pharmaceutical University, Nanjing, China
| | - Meng Jia
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Science, Nanjing University, Nanjing, China
| | - Keyu Zhao
- Department of Emergency, Nanjing Drum Tower Hospital, School of Life Science and Technology, China Pharmaceutical University, Nanjing, China
| | - Junqing Liang
- Peking University Cancer Hospital, Affiliated Cancer Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Ke Zen
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Science, Nanjing University, Nanjing, China
| | - Hongwei Liang
- Department of Emergency, Nanjing Drum Tower Hospital, School of Life Science and Technology, China Pharmaceutical University, Nanjing, China
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2
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Gu D, Ding Y, Jiang X, Shen B, Musante L, Holthofer H, Zou H. Diabetes with kidney injury may change the abundance and cargo of urinary extracellular vesicles. Front Endocrinol (Lausanne) 2023; 14:1085133. [PMID: 37077361 PMCID: PMC10107408 DOI: 10.3389/fendo.2023.1085133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/03/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Urinary extracellular vesicles (uEVs) are derived from epithelia facing the renal tubule lumen in the kidney and urogenital tract; they may carry protein biomarkers of renal dysfunction and structural injury. However, there are scarce studies focusing on uEVs in diabetes with kidney injury. MATERIALS AND METHODS A community-based epidemiological survey was performed, and the participants were randomly selected for our study. uEVs were enriched by dehydrated dialysis method, quantified by Coomassie Bradford protein assay, and adjusted by urinary creatinine (UCr). Then, they identified by transmission electron microscopy (TEM), nanoparticle track analysis (NTA), and western blot of tumor susceptibility gene 101. RESULTS Decent uEVs with a homogeneous distribution were finally obtained, presenting a membrane-encapsulated structure like cup-shaped or roundish under TEM, having active Brownian motion, and presenting the main peak between 55 and 110 nm under NTA. The Bradford protein assay showed that the protein concentrations of uEVs were 0.02 ± 0.02, 0.04 ± 0.05, 0.05 ± 0.04, 0.07 ± 0.08, and 0.11 ± 0.15 μg/mg UCr, respectively, in normal controls and in prediabetes, diabetes with normal proteinuria, diabetes with microalbuminuria, and diabetes with macroproteinuria groups after adjusting the protein concentration with UCr by calculating the vesicles-to-creatinine ratio. CONCLUSION The protein concentration of uEVs in diabetes with kidney injury increased significantly than the normal controls before and after adjusting the UCr. Therefore, diabetes with kidney injury may change the abundance and cargo of uEVs, which may be involved in the physiological and pathological changes of diabetes.
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Affiliation(s)
- Dongfeng Gu
- Department of Nephrology and Transplantation Center, Zhengzhou People’s Hospital, Henan University of Chinese Medicine, Zhengzhou, China
| | - Yanan Ding
- Department of Nephrology and Transplantation Center, Zhengzhou People’s Hospital, Henan University of Chinese Medicine, Zhengzhou, China
| | - Xin Jiang
- Department of Nephrology and Transplantation Center, Zhengzhou People’s Hospital, Henan University of Chinese Medicine, Zhengzhou, China
| | - Beili Shen
- Department of Nephrology and Transplantation Center, Zhengzhou People’s Hospital, Henan University of Chinese Medicine, Zhengzhou, China
| | - Luca Musante
- Division of Nephrology and Center for Immunity, Inflammation and Regenerative Medicine, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Harry Holthofer
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hequn Zou
- Department of Nephrology, South China Hospital of Shenzhen University, Shenzhen, China
- *Correspondence: Hequn Zou,
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Müller RU, Messchendorp AL, Birn H, Capasso G, Cornec-Le Gall E, Devuyst O, van Eerde A, Guirchoun P, Harris T, Hoorn EJ, Knoers NVAM, Korst U, Mekahli D, Le Meur Y, Nijenhuis T, Ong ACM, Sayer JA, Schaefer F, Servais A, Tesar V, Torra R, Walsh SB, Gansevoort RT. An update on the use of tolvaptan for ADPKD: Consensus statement on behalf of the ERA Working Group on Inherited Kidney Disorders (WGIKD), the European Rare Kidney Disease Reference Network (ERKNet) and Polycystic Kidney Disease International (PKD-International). Nephrol Dial Transplant 2021; 37:825-839. [PMID: 35134221 PMCID: PMC9035348 DOI: 10.1093/ndt/gfab312] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Indexed: 12/02/2022] Open
Abstract
Approval of the vasopressin V2 receptor antagonist tolvaptan—based on the landmark TEMPO 3:4 trial—marked a transformation in the management of autosomal dominant polycystic kidney disease (ADPKD). This development has advanced patient care in ADPKD from general measures to prevent progression of chronic kidney disease to targeting disease-specific mechanisms. However, considering the long-term nature of this treatment, as well as potential side effects, evidence-based approaches to initiate treatment only in patients with rapidly progressing disease are crucial. In 2016, the position statement issued by the European Renal Association (ERA) was the first society-based recommendation on the use of tolvaptan and has served as a widely used decision-making tool for nephrologists. Since then, considerable practical experience regarding the use of tolvaptan in ADPKD has accumulated. More importantly, additional data from REPRISE, a second randomized clinical trial (RCT) examining the use of tolvaptan in later-stage disease, have added important evidence to the field, as have post hoc studies of these RCTs. To incorporate this new knowledge, we provide an updated algorithm to guide patient selection for treatment with tolvaptan and add practical advice for its use.
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Affiliation(s)
| | - A Lianne Messchendorp
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Henrik Birn
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Departments of Clinical Medicine and Biomedicine, Aarhus University, Aarhus, Denmark
| | - Giovambattista Capasso
- Department of Translational Medical Sciences, Vanvitelli University, Naples, Italy
- Biogem Institute for Molecular Biology and Genetics, Ariano Irpino, Italy
| | | | - Olivier Devuyst
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- Division of Nephrology, UCL Medical School, Brussels, Belgium
| | - Albertien van Eerde
- Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Ewout J Hoorn
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nine V A M Knoers
- Department Genetics, University Medical Centre Groningen, Groningen, The Netherlands
| | - Uwe Korst
- PKD Familiäre Zystennieren e.V., Bensheim, Germany
| | - Djalila Mekahli
- PKD Research Group, Laboratory of Pediatrics, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Pediatric Nephrology and Organ Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Yannick Le Meur
- Department of Nephrology, Hemodialysis and Renal Transplantation, CHU and University of Brest, Brest, France
| | - Tom Nijenhuis
- Department of Nephrology, Radboud Institute for Molecular Life Sciences, Radboudumc Center of Expertise for Rare Kidney Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Albert C M Ong
- Academic Nephrology Unit, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, UK
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - John A Sayer
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Aude Servais
- Nephrology and Transplantation Department, Necker University Hospital, APHP, Paris, France
| | - Vladimir Tesar
- Department of Nephrology, 1st Faculty of Medicine, General University Hospital, Prague, Czech Republic
| | - Roser Torra
- Inherited Kidney Diseases Nephrology Department, Fundació Puigvert Instituto de Investigaciones Biomédicas Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- REDINREN, Barcelona, Spain
| | - Stephen B Walsh
- Department of Renal Medicine, University College London, London, UK
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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4
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García-Flores M, Sánchez-López CM, Ramírez-Calvo M, Fernández-Serra A, Marcilla A, López-Guerrero JA. Isolation and characterization of urine microvesicles from prostate cancer patients: different approaches, different visions. BMC Urol 2021; 21:137. [PMID: 34579682 PMCID: PMC8477576 DOI: 10.1186/s12894-021-00902-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 09/20/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Because of their specific and biologically relevant cargo, urine extracellular vesicles (EVs) constitute a valuable source of potential non-invasive biomarkers that could support the clinical decision-making to improve the management of prostate cancer (PCa) patients. Different EV isolation methods differ in terms of complexity and yield, conditioning, as consequence, the analytical result. METHODS The aim of this study was to compare three different isolation methods for urine EVs: ultracentrifugation (UC), size exclusion chromatography (SEC), and a commercial kit (Exolute® Urine Kit). Urine samples were collected from 6 PCa patients and 4 healthy donors. After filtered through 0.22 µm filters, urine was divided in 3 equal volumes to perform EVs isolation with each of the three approaches. Isolated EVs were characterized by spectrophotometric protein quantification, nanoparticle tracking analysis, transmission electron microscopy, AlphaScreen Technology, and whole miRNA Transcriptome. RESULTS Our results showed that UC and SEC provided better results in terms of EVs yield and purity than Exolute®, non-significant differences were observed in terms of EV-size. Interestingly, luminescent AlphaScreen assay demonstrated a significant enrichment of CD9 and CD63 positive microvesicles in SEC and UC methods compared with Exolute®. This heterogeneity was also demonstrated in terms of miRNA content indicating that the best correlation was observed between UC and SEC. CONCLUSIONS Our study highlights the importance of standardizing the urine EV isolation methods to guaranty the analytical reproducibility necessary for their implementation in a clinical setting.
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Affiliation(s)
- María García-Flores
- Laboratory of Molecular Biology, Fundación Instituto Valenciano de Oncología, 46009, Valencia, Spain.,IVO-CIPF Joint Research Unit of Cancer, Príncipe Felipe Research Center (CIPF), 46012, Valencia, Spain
| | - Christian M Sánchez-López
- Àrea de Parasitologia, Departament de Farmàcia i Tecnologia Farmacèutica i Parasitologia, Universitat de València, 46000, Burjassot, Valencia, Spain.,Joint Research Unit on Endocrinology, Nutrition and Clinical Dietetics, Health Research Institute La Fe, Universitat de Valencia, 46100, Valencia, Spain
| | - Marta Ramírez-Calvo
- Laboratory of Molecular Biology, Fundación Instituto Valenciano de Oncología, 46009, Valencia, Spain
| | - Antonio Fernández-Serra
- Laboratory of Molecular Biology, Fundación Instituto Valenciano de Oncología, 46009, Valencia, Spain
| | - Antonio Marcilla
- Àrea de Parasitologia, Departament de Farmàcia i Tecnologia Farmacèutica i Parasitologia, Universitat de València, 46000, Burjassot, Valencia, Spain. .,Joint Research Unit on Endocrinology, Nutrition and Clinical Dietetics, Health Research Institute La Fe, Universitat de Valencia, 46100, Valencia, Spain.
| | - José Antonio López-Guerrero
- Laboratory of Molecular Biology, Fundación Instituto Valenciano de Oncología, 46009, Valencia, Spain. .,IVO-CIPF Joint Research Unit of Cancer, Príncipe Felipe Research Center (CIPF), 46012, Valencia, Spain. .,Department of Pathology, School of Medicine, Catholic University of Valencia "San Vicente Mártir", 46001, Valencia, Spain.
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Nelson E, Shadbolt C, Bunzli S, Cochrane A, Choong P, Dowsey M. The effect of animated consent material on participants' willingness to enrol in a placebo-controlled surgical trial: a protocol for a randomised feasibility study. Pilot Feasibility Stud 2021; 7:46. [PMID: 33557951 PMCID: PMC7869245 DOI: 10.1186/s40814-021-00782-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/26/2021] [Indexed: 11/21/2022] Open
Abstract
Background Placebo-controlled surgical trials are recognised as the gold standard way to test the efficacy of a surgical procedure. Despite a rise in arthroscopic subacromial decompression (ASD) surgeries for the treatment of shoulder pain, only two placebo-controlled surgical trials have been conducted. These trials encountered significant recruitment challenges, threatening the external validity of findings. Difficulties with recruitment are common in clinical trials and likely to be amplified in placebo-controlled surgical trials. This mixed method feasibility trial aims to address the following questions: (i) Feasibility: What proportion of patients who have consented to undergo ASD report that they would be willing to enrol in a placebo-controlled trial for this procedure? (ii) Optimisation: Can patients’ willingness to enrol in, or understanding of, such a trial be improved by supplementing written consent materials with a brief visual animation that outlines the details of the trial? And (iii) exploration: What factors influence patients stated willingness to enrol in such a trial, and how do they believe the recruitment process could be improved? Methods This study aims to recruit 80 patients on the waiting list for ASD. Participants will be randomised (1:1) to either view a brief video animation explaining the hypothetical placebo-controlled trial in addition to written information or to written information only. Participants in both groups will be required to state if they would be willing to opt-in to the hypothetical ASD trial after immediately being presented with the consent material and again 1 week after completion of the consent process. Patients in both groups will also be required to complete a measure of trial literacy. Twenty participants will be purposively sampled to take part in an embedded qualitative study exploring understanding of trial concepts and factors contributing to willingness to opt-in. Discussion This feasibility study will provide evidence for optimising participant recruitment into a placebo-controlled trial of ASD by consenting patients using animated trial information in addition to written information. This pilot and feasibility data may also be relevant to placebo-controlled surgical trials more broadly, which are characterised by recruitment challenges. Trial registration ANZCTR, ACTRN12620001132932, date October 30, 2020 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00782-7.
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Affiliation(s)
- Elizabeth Nelson
- The University of Melbourne Department of Surgery, St. Vincent's Hospital, Level 2 Clinical Sciences Building, 29 Regent Street, Fitzroy, Melbourne, VIC, 3065, Australia
| | - Cade Shadbolt
- The University of Melbourne Department of Surgery, St. Vincent's Hospital, Level 2 Clinical Sciences Building, 29 Regent Street, Fitzroy, Melbourne, VIC, 3065, Australia
| | - Samantha Bunzli
- The University of Melbourne Department of Surgery, St. Vincent's Hospital, Level 2 Clinical Sciences Building, 29 Regent Street, Fitzroy, Melbourne, VIC, 3065, Australia
| | - Angela Cochrane
- Department of Orthopaedics, St. Vincent's Hospital, Level 3 Daly Wing, 35 Victoria Parade, Fitzroy, Melbourne, 3065, VIC, Australia
| | - Peter Choong
- The University of Melbourne Department of Surgery, St. Vincent's Hospital, Level 2 Clinical Sciences Building, 29 Regent Street, Fitzroy, Melbourne, VIC, 3065, Australia.,Department of Orthopaedics, St. Vincent's Hospital, Level 3 Daly Wing, 35 Victoria Parade, Fitzroy, Melbourne, 3065, VIC, Australia
| | - Michelle Dowsey
- The University of Melbourne Department of Surgery, St. Vincent's Hospital, Level 2 Clinical Sciences Building, 29 Regent Street, Fitzroy, Melbourne, VIC, 3065, Australia. .,Department of Orthopaedics, St. Vincent's Hospital, Level 3 Daly Wing, 35 Victoria Parade, Fitzroy, Melbourne, 3065, VIC, Australia.
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Extracellular vesicle-transferred long noncoding RNAs in bladder cancer. Clin Chim Acta 2021; 516:34-45. [PMID: 33450212 DOI: 10.1016/j.cca.2021.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 12/11/2022]
Abstract
Extracellular vesicles (EVs) secreted by a variety of cells, including cancer cells, in the tumor microenvironment play crucial roles in cancer progression by transferring molecular cargos. Emerging evidence indicates that long noncoding RNAs (lncRNAs) are important biomolecules that can be transferred by EVs to modulate cancer development. The potential clinical application of EV-transferred lncRNAs in biological fluids for cancer diagnosis has also been verified. Over the past decade, research on the biological roles and applications of EVs and their contents in human cancers has reached new heights. Therefore, a detailed discussion of the roles of EV-transferred lncRNAs in various cancers, including bladder cancer (BC), will provide a novel strategy for cancer diagnosis and therapy. In this review, we summarized and discussed the current studies on the detection technologies of EV-transferred lncRNAs. The diagnostic values of EV-transferred lncRNAs in various biological fluids, including urine, serum, and plasma, for BC diagnosis and prognosis were compared. Moreover, the biofunctional roles and clinical applications of these EV-transferred lncRNAs in BC were further discussed. In addition, we also highlighted the research directions and suggestions for future research on BC-associated EV-transferred lncRNAs. In conclusion, BC-associated EV-transferred lncRNAs show significant potential as noninvasive biomarkers or therapeutic targets for BC diagnosis and treatment.
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7
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Fujitaka K, Murakami T, Takeuchi M, Kakimoto T, Mochida H, Arakawa K. mRNAs in urinary nano-extracellular vesicles as potential biomarkers for non-invasive kidney biopsy. Biomed Rep 2020; 14:11. [PMID: 33235726 PMCID: PMC7678616 DOI: 10.3892/br.2020.1387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/16/2020] [Indexed: 12/17/2022] Open
Abstract
Urinary nano-extracellular vesicles (NVs), including exosomes and microvesicles, are considered potential biomarkers for kidney diseases using liquid biopsies. However, clinical application of urinary NVs has not yet been validated. In the present study, the levels of mRNAs in urinary NVs in animal models of kidney disease were assessed. Urine samples were collected from the animal models and urinary NVs were isolated by ultracentrifugation. Gene expression levels of kidney injury markers in urinary NVs and renal tissue were quantified by reverse transcription-quantitative PCR. The mRNA levels of desmin, a podocyte injury marker, in urinary NVs was markedly increased in the puromycin aminonucleoside (PAN) nephritis model, in parallel with enhanced desmin expression in kidney tissues. The expression of regulator of calcineurin 1 and the podocin to nephrin ratio (PNR) were also increased in the PAN nephritis model. Treatment with prednisolone mitigated these changes in gene expression as well as proteinuria. PNR, which is considered a predictive marker of glomerular dysfunction, in urinary NVs was highly correlated with urinary protein excretion (P<0.01). Furthermore, PNR in urinary NVs of Zucker diabetic fatty rats, a diabetic kidney disease model, was correlated with urinary albumin excretion (P<0.01). These results suggest that changes in mRNA levels of urinary NVs reflect the disease status of kidney tissues and their functional alterations. Collectively, mRNA analysis of urinary NVs may be used as a liquid biopsy tool for improved classification and performance of risk prediction to determine the severity of kidney diseases.
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Affiliation(s)
- Keisuke Fujitaka
- Research Unit/Frontier, Sohyaku Innovative Research Division, Mitsubishi Tanabe Pharma Corporation, Fujisawa-shi, Kanagawa 251-8555, Japan.,Graduate School of Life and Environmental Sciences, University of Tsukuba, Tsukuba, Ibaraki 305-0005, Japan
| | - Taku Murakami
- Hitachi Chemical Co. America, Ltd., R&D Center, Irvine, CA 92617, USA
| | - Masato Takeuchi
- Medical Affairs Department, Ikuyaku Integrated Value Development Division, Mitsubishi Tanabe Pharma Corporation, Osaka 541-8505, Japan
| | - Tetsuhiro Kakimoto
- Research Unit/Frontier, Sohyaku Innovative Research Division, Mitsubishi Tanabe Pharma Corporation, Fujisawa-shi, Kanagawa 251-8555, Japan
| | - Hideki Mochida
- Research Unit/Frontier, Sohyaku Innovative Research Division, Mitsubishi Tanabe Pharma Corporation, Fujisawa-shi, Kanagawa 251-8555, Japan
| | - Kenji Arakawa
- Medical Intelligence Department, Ikuyaku Integrated Value Development Division, Mitsubishi Tanabe Pharma Corporation, Tokyo 103-8405, Japan
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