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Wen Y, Yang C, Menez SP, Rosenberg AZ, Parikh CR. A Systematic Review of Clinical Characteristics and Histologic Descriptions of Acute Tubular Injury. Kidney Int Rep 2020; 5:1993-2001. [PMID: 33163720 PMCID: PMC7609907 DOI: 10.1016/j.ekir.2020.08.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/13/2020] [Accepted: 08/25/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The term "acute tubular injury" (ATI) represents histopathologic renal tubular injury and often manifests clinically as acute kidney injury (AKI). Studies systematically summarizing the clinical presentation and histological changes in human ATI are limited. METHODS We used a comprehensive search strategy to search human studies of ATI from 1936 to July 2019. We extracted study characteristics, clinical characteristics, and histologic descriptions of ATI by bright field, immunofluorescence, electron microscopy, and immunohistochemistry. We compared ATI histology as a function of tissue procurement type, timing, and etiologies. RESULTS We included 292 studies comprising a total of 1987 patients. The majority of studies (222 of 292, 76%) were single-center case reports. The mean age of included patients was 47 years. In native kidney biopsy cases, baseline, peak, and latest creatinine were 1.3 mg/dl, 7.19 mg/dl, and 1.85 mg/dl respectively, and biopsy was performed mostly after peak creatinine (86.7%, 391 of 451). We identified 16 histologic descriptions of tubular injury, including tubular cell sloughing (115 of 292, 39.4%), tubular epithelial flattening/simplification (110 of 292, 37.7%), tubular dilatation (109 of 292, 37.3%), and tubular cell necrosis (93 of 292, 31.8%). There was no difference in tubular injury histology among different tissue procurement types (native kidney biopsy, transplant kidney biopsy, and autopsy), among different etiologies, or between different tissue procurement timing (before or after creatinine peaks in native kidneys). Electron microscopy and immunohistochemistry were used in a minority of studies. CONCLUSION ATI manifests with diverse histologic changes. Efforts to establish protocols to harmonize biopsy practices, to handle kidney biopsy for tissue interrogation, and to report results across clinical practice are needed to improve our understanding of this complex disease.
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Affiliation(s)
- Yumeng Wen
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chen Yang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Steven P. Menez
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Avi Z. Rosenberg
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chirag R. Parikh
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Correspondence: Chirag R. Parikh, Division of Nephrology, Johns Hopkins University School of Medicine, 1830 E. Monument St., Suite 416, Baltimore, Maryland 21287, USA.
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2
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Xu-Dubois YC, Ahmadpoor P, Brocheriou I, Louis K, Arzouk Snanoudj N, Rouvier P, Taupin JL, Corchia A, Galichon P, Barrou B, Giraud S, Hauet T, Jouanneau C, Rodenas A, Placier S, Niasse A, Ouchelouche S, Naimi BY, Akil E, Hertig A, Buob D, Rondeau E. Microvasculature partial endothelial mesenchymal transition in early posttransplant biopsy with acute tubular necrosis identifies poor recovery renal allografts. Am J Transplant 2020; 20:2400-2412. [PMID: 32167213 DOI: 10.1111/ajt.15847] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 03/05/2020] [Accepted: 03/08/2020] [Indexed: 01/25/2023]
Abstract
Acute tubular necrosis (ATN), a frequent histopathological feature in the early post-renal transplant biopsy, affects long-term graft function. Appropriate markers to identify patients at risk of no or incomplete recovery after delayed graft function are lacking. In this study, we first included 41 renal transplant patients whose biopsy for cause during the first month after transplantation showed ATN lesions. Using partial microvasculature endothelial (fascin, vimentin) and tubular epithelial (vimentin) to mesenchymal transition markers, detected by immunohistochemistry, we found a significant association between partial endothelial to mesenchymal transition and poor graft function recovery (Spearman's rho = -0.55, P = .0005). Transforming growth factor-β1 was strongly expressed in these phenotypic changed endothelial cells. Extent of ATN was also correlated with short- and long-term graft dysfunction. However, the association of extensive ATN with long-term graft dysfunction (24 months posttransplant) was observed only in patients with partial endothelial to mesenchymal transition marker expression in their grafts (Spearman's rho = -0.64, P = .003), but not in those without. The association of partial endothelial to mesenchymal transition with worse renal graft outcome was confirmed on 34 other early biopsies with ATN from a second transplant center. Our results suggest that endothelial cell activation at the early phase of renal transplantation plays a detrimental role.
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Affiliation(s)
- Yi-Chun Xu-Dubois
- Sorbonne Université, Institut national de la santé et de la recherche médicale (INSERM), Unité mixte de recherche (UMR), Paris, France.,Public Health, Assistance Publique-Hôpitaux de Paris (AP-HP), Tenon Hospital, Paris, France.,Kidney Transplantation, AP-HP, Tenon Hospital, Paris, France
| | | | | | - Kevin Louis
- Sorbonne Université, Institut national de la santé et de la recherche médicale (INSERM), Unité mixte de recherche (UMR), Paris, France
| | - Nadia Arzouk Snanoudj
- Department of Kidney Transplantation, AP-HP, Pitié Salpêtrière Hospital, Paris, France
| | - Philippe Rouvier
- Department of Pathology, AP-HP, Pitié Salpêtrière Hospital, Paris, France
| | - Jean-Luc Taupin
- Laboratoire d'Immunologie et Histocompatibilité Hôpital Saint-Louis, Paris, France.,Université Paris Diderot, INSERM UMR, Institut Universitaire d'Hématologie, Paris, France
| | - Anthony Corchia
- Sorbonne Université, Institut national de la santé et de la recherche médicale (INSERM), Unité mixte de recherche (UMR), Paris, France
| | - Pierre Galichon
- Sorbonne Université, Institut national de la santé et de la recherche médicale (INSERM), Unité mixte de recherche (UMR), Paris, France.,Kidney Transplantation, AP-HP, Tenon Hospital, Paris, France
| | - Benoit Barrou
- Department of Kidney Transplantation, AP-HP, Pitié Salpêtrière Hospital, Paris, France
| | - Sébastien Giraud
- Service de Biochimie, CHU de Poitiers, Pôle Biospharm, Poitiers, France.,INSERM UMR 1082 IRTOMIT, Poitiers, France
| | - Thierry Hauet
- Service de Biochimie, CHU de Poitiers, Pôle Biospharm, Poitiers, France.,INSERM UMR 1082 IRTOMIT, Poitiers, France.,Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
| | - Chantal Jouanneau
- Sorbonne Université, Institut national de la santé et de la recherche médicale (INSERM), Unité mixte de recherche (UMR), Paris, France
| | - Anita Rodenas
- Department of Pathology, AP-HP, Tenon Hospital, Paris, France
| | - Sandrine Placier
- Sorbonne Université, Institut national de la santé et de la recherche médicale (INSERM), Unité mixte de recherche (UMR), Paris, France
| | - Aissata Niasse
- Sorbonne Université, Institut national de la santé et de la recherche médicale (INSERM), Unité mixte de recherche (UMR), Paris, France
| | - Souhila Ouchelouche
- Sorbonne Université, Institut national de la santé et de la recherche médicale (INSERM), Unité mixte de recherche (UMR), Paris, France
| | | | | | - Alexandre Hertig
- Sorbonne Université, Institut national de la santé et de la recherche médicale (INSERM), Unité mixte de recherche (UMR), Paris, France.,Kidney Transplantation, AP-HP, Tenon Hospital, Paris, France.,Department of Kidney Transplantation, AP-HP, Pitié Salpêtrière Hospital, Paris, France
| | - David Buob
- Sorbonne Université, Institut national de la santé et de la recherche médicale (INSERM), Unité mixte de recherche (UMR), Paris, France.,Department of Pathology, AP-HP, Tenon Hospital, Paris, France
| | - Eric Rondeau
- Sorbonne Université, Institut national de la santé et de la recherche médicale (INSERM), Unité mixte de recherche (UMR), Paris, France.,Kidney Transplantation, AP-HP, Tenon Hospital, Paris, France
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A novel role of LRP5 in tubulointerstitial fibrosis through activating TGF-β/Smad signaling. Signal Transduct Target Ther 2020; 5:45. [PMID: 32345960 PMCID: PMC7188863 DOI: 10.1038/s41392-020-0142-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/10/2020] [Accepted: 02/19/2020] [Indexed: 02/07/2023] Open
Abstract
Previous studies by us and others demonstrated that activation of Wnt/β-catenin signaling plays a pathogenic role in chronic kidney diseases (CKD). Wnt co-receptor LRP5 variants are reported to associate with autosomal dominant polycystic kidney disease; but their exact roles in this disease and renal fibrosis have not been explored. Here, we observed the upregulation of LRP5 in the renal tubules of both type 1 and type 2 diabetic models and of an obstructive nephropathy model. In the obstructed kidneys, Lrp5 knockout significantly ameliorated tubulointerstitial fibrosis and tubular injury without changing Wnt/β-catenin signaling. Instead, decreased levels of TGF-β1 and TGF-β receptors (TβRs) were detected in Lrp5 knockout kidneys, followed by attenuated activation and nuclear translocation of Smad2/3 in the renal tubules, suggesting a regulatory effect of LRP5 on TGF-β/Smad signaling. In consistent with this hypothesis, LRP5 overexpression resulted in enhanced TGF-β/Smad signaling activation in renal tubule epithelial cells. Furthermore, LRP5 was co-immunoprecipitated with TβRI and TβRII, and its extracellular domain was essential for interacting with TβRs and for its pro-fibrotic activity. In addition to stabilizing TβRs, LRP5 increased the basal membrane presentation and TGF-β1-induced internalization of these receptors. Notably, TGF-β1 also induced LRP5 internalization. These findings indicate that LRP5 promotes tubulointerstitial fibrosis, at least partially, via direct modulation of TGF-β/Smad signaling, a novel, Wnt-independent function.
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4
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Vijayaraj P, Minasyan A, Durra A, Karumbayaram S, Mehrabi M, Aros CJ, Ahadome SD, Shia DW, Chung K, Sandlin JM, Darmawan KF, Bhatt KV, Manze CC, Paul MK, Wilkinson DC, Yan W, Clark AT, Rickabaugh TM, Wallace WD, Graeber TG, Damoiseaux R, Gomperts BN. Modeling Progressive Fibrosis with Pluripotent Stem Cells Identifies an Anti-fibrotic Small Molecule. Cell Rep 2019; 29:3488-3505.e9. [PMID: 31825831 PMCID: PMC6927560 DOI: 10.1016/j.celrep.2019.11.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 07/11/2019] [Accepted: 11/05/2019] [Indexed: 12/13/2022] Open
Abstract
Progressive organ fibrosis accounts for one-third of all deaths worldwide, yet preclinical models that mimic the complex, progressive nature of the disease are lacking, and hence, there are no curative therapies. Progressive fibrosis across organs shares common cellular and molecular pathways involving chronic injury, inflammation, and aberrant repair resulting in deposition of extracellular matrix, organ remodeling, and ultimately organ failure. We describe the generation and characterization of an in vitro progressive fibrosis model that uses cell types derived from induced pluripotent stem cells. Our model produces endogenous activated transforming growth factor β (TGF-β) and contains activated fibroblastic aggregates that progressively increase in size and stiffness with activation of known fibrotic molecular and cellular changes. We used this model as a phenotypic drug discovery platform for modulators of fibrosis. We validated this platform by identifying a compound that promotes resolution of fibrosis in in vivo and ex vivo models of ocular and lung fibrosis.
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Affiliation(s)
- Preethi Vijayaraj
- UCLA Children's Discovery and Innovation Institute, Mattel Children's Hospital UCLA, Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA; Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA 90095, USA
| | - Aspram Minasyan
- Department of Molecular & Medical Pharmacology, UCLA, Los Angeles, CA 90095, USA
| | - Abdo Durra
- UCLA Children's Discovery and Innovation Institute, Mattel Children's Hospital UCLA, Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA
| | - Saravanan Karumbayaram
- Department of Microbiology, Immunology, and Molecular Genetics, UCLA, Los Angeles, CA 90095, USA; Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA 90095, USA; Eli and Edythe Broad Stem Cell Research Center, UCLA, Los Angeles, CA 90095, USA
| | - Mehrsa Mehrabi
- UCLA Children's Discovery and Innovation Institute, Mattel Children's Hospital UCLA, Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA
| | - Cody J Aros
- UCLA Children's Discovery and Innovation Institute, Mattel Children's Hospital UCLA, Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA
| | - Sarah D Ahadome
- UCLA Children's Discovery and Innovation Institute, Mattel Children's Hospital UCLA, Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA
| | - David W Shia
- UCLA Children's Discovery and Innovation Institute, Mattel Children's Hospital UCLA, Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA
| | - Katherine Chung
- UCLA Children's Discovery and Innovation Institute, Mattel Children's Hospital UCLA, Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA
| | - Jenna M Sandlin
- UCLA Children's Discovery and Innovation Institute, Mattel Children's Hospital UCLA, Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA
| | - Kelly F Darmawan
- UCLA Children's Discovery and Innovation Institute, Mattel Children's Hospital UCLA, Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA
| | - Kush V Bhatt
- UCLA Children's Discovery and Innovation Institute, Mattel Children's Hospital UCLA, Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA
| | - Chase C Manze
- UCLA Children's Discovery and Innovation Institute, Mattel Children's Hospital UCLA, Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA
| | - Manash K Paul
- UCLA Children's Discovery and Innovation Institute, Mattel Children's Hospital UCLA, Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA
| | - Dan C Wilkinson
- Department of Materials Science and Engineering, UCLA, Los Angeles, CA 90095, USA
| | - Weihong Yan
- Department of Biology and Biochemistry, UCLA, Los Angeles, CA 90095, USA
| | - Amander T Clark
- Eli and Edythe Broad Stem Cell Research Center, UCLA, Los Angeles, CA 90095, USA; Molecular Cell and Developmental Biology, UCLA, Los Angeles, CA 90095, USA
| | - Tammy M Rickabaugh
- UCLA Children's Discovery and Innovation Institute, Mattel Children's Hospital UCLA, Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA
| | - W Dean Wallace
- Department of Pathology and Laboratory Medicine, UCLA, Los Angeles, CA 90095, USA
| | - Thomas G Graeber
- Department of Molecular & Medical Pharmacology, UCLA, Los Angeles, CA 90095, USA; California NanoSystems Institute, UCLA, Los Angeles, CA 90095, USA; Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA 90095, USA
| | - Robert Damoiseaux
- Department of Molecular & Medical Pharmacology, UCLA, Los Angeles, CA 90095, USA; California NanoSystems Institute, UCLA, Los Angeles, CA 90095, USA; Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA 90095, USA
| | - Brigitte N Gomperts
- UCLA Children's Discovery and Innovation Institute, Mattel Children's Hospital UCLA, Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA; Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA 90095, USA; Eli and Edythe Broad Stem Cell Research Center, UCLA, Los Angeles, CA 90095, USA; UCLA Molecular Biology Institute, UCLA, Los Angeles, CA 90095, USA.
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5
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Jensen MS, Mutsaers HAM, Tingskov SJ, Christensen M, Madsen MG, Olinga P, Kwon T, Nørregaard R. Activation of the prostaglandin E 2 EP 2 receptor attenuates renal fibrosis in unilateral ureteral obstructed mice and human kidney slices. Acta Physiol (Oxf) 2019; 227:e13291. [PMID: 31054202 PMCID: PMC6767420 DOI: 10.1111/apha.13291] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/15/2019] [Accepted: 04/26/2019] [Indexed: 12/18/2022]
Abstract
Aim Renal fibrosis plays a pivotal role in the development and progression of chronic kidney disease, which affects 10% of the adult population. Previously, it has been demonstrated that the cyclooxygenase‐2 (COX‐2)/prostaglandin (PG) system influences the progression of renal injury. Here, we evaluated the impact of butaprost, a selective EP2 receptor agonist, on renal fibrosis in several models of kidney injury, including human tissue slices. Methods We studied the anti‐fibrotic efficacy of butaprost using Madin‐Darby Canine Kidney (MDCK) cells, mice that underwent unilateral ureteral obstruction and human precision‐cut kidney slices. Fibrogenesis was evaluated on a gene and protein level by qPCR and Western blotting. Results Butaprost (50 μM) reduced TGF‐β‐induced fibronectin (FN) expression, Smad2 phosphorylation and epithelial‐mesenchymal transition in MDCK cells. In addition, treatment with 4 mg/kg/day butaprost attenuated the development of fibrosis in mice that underwent unilateral ureteral obstruction surgery, as illustrated by a reduction in the gene and protein expression of α‐smooth muscle actin, FN and collagen 1A1. More importantly, a similar anti‐fibrotic effect of butaprost was observed in human precision‐cut kidney slices exposed to TGF‐β. The mechanism of action of butaprost appeared to be a direct effect on TGF‐β/Smad signalling, which was independent of the cAMP/PKA pathway. Conclusion In conclusion, this study demonstrates that stimulation of the EP2 receptor effectively mitigates renal fibrogenesis in various fibrosis models. These findings warrant further research into the clinical application of butaprost, or other EP2 agonists, for the inhibition of renal fibrosis.
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Affiliation(s)
| | | | | | | | | | - Peter Olinga
- Department of Pharmaceutical Technology and Biopharmacy University of Groningen Groningen the Netherlands
| | - Tae‐Hwan Kwon
- Department of Biochemistry and Cell Biology, School of Medicine Kyungpook National University Daegu Korea
| | - Rikke Nørregaard
- Department of Clinical Medicine Aarhus University Aarhus Denmark
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6
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Yoo KH, Yim HE, Bae ES, Hong YS. Angiotensin inhibition in the developing kidney; tubulointerstitial effect. Pediatr Res 2019; 85:724-730. [PMID: 30700837 DOI: 10.1038/s41390-019-0288-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/01/2018] [Accepted: 11/09/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Renin-angiotensin system (RAS) blockade during nephrogenesis causes a broad range of renal mal-development. Here, we hypothesized that disruption of renal lymphangiogenesis may contribute to tubulointerstitial alterations after RAS blockade during kidney maturation. METHODS Newborn rat pups were treated with enalapril (30 mg/kg/day) or vehicle for 7 days after birth. Lymphangiogenesis was assessed via immunostaining and/or immunoblots for vascular endothelial growth factor (VEGF)-C, VEGF receptor (VEGFR)-3, Podoplanin, and Ki-67. The intrarenal expression of fibroblast growth factor (FGF)-1, FGF-2, FGF receptor (R)-1, α-smooth muscle actin (α-SMA), and fibroblast-specific protein (FSP)-1 was also determined. Sirius Red staining was performed to evaluate interstitial collagen deposition. RESULTS On postnatal day 8, renal lymphangiogenesis was disrupted by neonatal enalapril treatment. The expression of podoplanin and Ki-67 decreased in enalapril-treated kidneys. While the expression of VEGF-C was decreased, the levels of VEGFR-3 receptor increased following enalapril treatment. Enalapril treatment also reduced the renal expression of FGF-1, FGF-2, and FGFR-1. Enalapril-treated kidneys exhibited profibrogenic properties with increased expression of α-SMA and FSP-1 and enhanced deposition of interstitial collagen. CONCLUSION Enalapril treatment during postnatal renal maturation can disrupt renal lymphangiogenesis along with tubulointerstitial changes, which may result in a pro-fibrotic environment in the developing rat kidney.
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Affiliation(s)
- Kee Hwan Yoo
- Department of Pediatrics, College of Medicine, Korea University, Seoul, 02841, Korea
| | - Hyung Eun Yim
- Department of Pediatrics, College of Medicine, Korea University, Seoul, 02841, Korea.
| | - Eun Soo Bae
- Department of Pediatrics, College of Medicine, Korea University, Seoul, 02841, Korea
| | - Young Sook Hong
- Department of Pediatrics, College of Medicine, Korea University, Seoul, 02841, Korea
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Abstract
The molecular mechanisms in acute tubular injury (ATI) are complex and enigmatic. Moreover, we currently lack validated tissue injury markers that can be integrated into the kidney biopsy analysis to guide nephrologists in their patient's management of AKI. Although recognizing the ATI lesion by light microscopy is fairly straightforward, the staging of tubular lesions in the context of clinical time course and etiologic mechanism currently is not adapted to the renal pathology practice. To the clinician, the exact time point when an ischemic or toxic injury has occurred often is not known and cannot be discerned from the review of the biopsy sample. Moreover, the assessment of the different types of organized necrosis as the underlying cell death mechanism, which can be targeted using specific inhibitors, has not yet reached clinical practice. The renal pathology laboratory is uniquely qualified to assess the time course and etiology of ATI using established analytic techniques, such as immunohistochemistry and electron microscopy. Recent advances in the understanding of pathophysiological mechanisms of ATI and the important role that certain types of tubular cell organelles play in different stages of the ATI lesions may allow differentiation of early versus late ATI. Furthermore, the determination of respective cell injury pathways may help to differentiate ischemic versus toxic etiology in a reliable fashion. In the future, such a kidney biopsy-based classification system of ATI could guide the nephrologist's management of patients in regard to treatment modality and drug choice.
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Affiliation(s)
- Gilbert W Moeckel
- Renal Pathology and Electron Microscopy Laboratory, Department of Pathology, Yale School of Medicine, New Haven, CT.
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Qi R, Yang C. Renal tubular epithelial cells: the neglected mediator of tubulointerstitial fibrosis after injury. Cell Death Dis 2018; 9:1126. [PMID: 30425237 PMCID: PMC6233178 DOI: 10.1038/s41419-018-1157-x] [Citation(s) in RCA: 150] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/06/2018] [Accepted: 10/18/2018] [Indexed: 02/07/2023]
Abstract
Renal fibrosis, especially tubulointerstitial fibrosis, is the inevitable outcome of all progressive chronic kidney diseases (CKDs) and exerts a great health burden worldwide. For a long time, interests in renal fibrosis have been concentrated on fibroblasts and myofibroblasts. However, in recent years, growing numbers of studies have focused on the role of tubular epithelial cells (TECs). TECs, rather than a victim or bystander, are probably a neglected mediator in renal fibrosis, responding to a variety of injuries. The maladaptive repair mechanisms of TECs may be the key point in this process. In this review, we will focus on the role of TECs in tubulointerstitial fibrosis. We will follow the fate of a tubular cell and depict the intracellular changes after injury. We will then discuss how the repair mechanism of tubular cells becomes maladaptive, and we will finally discuss the intercellular crosstalk in the interstitium that ultimately proceeds tubulointerstitial fibrosis.
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Affiliation(s)
- Ruochen Qi
- Department of Urology, Zhongshan Hospital, Fudan University, 200032, Shanghai, P. R. China
- Shanghai Medical College, Fudan University, 200032, Shanghai, P.R. China
| | - Cheng Yang
- Department of Urology, Zhongshan Hospital, Fudan University, 200032, Shanghai, P. R. China.
- Shanghai Key Laboratory of Organ Transplantation, 200032, Shanghai, P. R. China.
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9
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Galichon P, Xu-Dubois YC, Buob D, Tinel C, Anglicheau D, Benbouzid S, Dahan K, Ouali N, Hertig A, Brocheriou I, Rondeau E. Urinary transcriptomics reveals patterns associated with subclinical injury of the renal allograft. Biomark Med 2018; 12:427-438. [PMID: 29697267 DOI: 10.2217/bmm-2017-0330] [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] [Indexed: 11/21/2022] Open
Abstract
AIM Subclinical pathological features in renal allograft biopsies predict poor outcomes, and noninvasive biomarkers are wanted. RNA quantification in urine predicts overt rejection. We hypothesized that a whole transcriptome analysis would be informative, even for discrete injury. PATIENTS & METHODS We performed an mRNA microarray with an optimized normalization method on 26 urinary cell pellets to study renal partial epithelial to mesenchymal transition (pEMT) in stable kidney allografts. RESULTS & CONCLUSION Unbiased pathway analysis revealed immune response as the main underlying biological process. In a subgroup of pristine biopsies, isolated pEMT was associated with reduced metabolic functions. Thus, pEMT translates into specific urinary mRNA patterns, in other words, increased inflammation and decreased metabolic functions. Deposited in Gene Expression Omnibus (GSE89652).
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Affiliation(s)
- Pierre Galichon
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S1155, Paris, France.,Institut National de la Santé et de la Recherche Médicale, UMR_S1155, Paris, France.,Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, APHP, Paris, France
| | - Yi-Chun Xu-Dubois
- Institut National de la Santé et de la Recherche Médicale, UMR_S1155, Paris, France.,Service de Santé Publique, Hôpital Tenon, APHP, Paris, France
| | - David Buob
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S1155, Paris, France.,Institut National de la Santé et de la Recherche Médicale, UMR_S1155, Paris, France.,Service d'Anatomie Pathologique, Hôpital Tenon, APHP, Paris, France
| | - Claire Tinel
- Service de Néphrologie et Transplantation Adulte, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Dany Anglicheau
- Service de Néphrologie et Transplantation Adulte, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,RTRS « Centaure », Labex « Transplantex », Paris, France
| | | | - Karine Dahan
- Néphrologie et Dialyses, Hôpital Tenon, APHP, Paris, France
| | - Nacera Ouali
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, APHP, Paris, France
| | - Alexandre Hertig
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S1155, Paris, France.,Institut National de la Santé et de la Recherche Médicale, UMR_S1155, Paris, France.,Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, APHP, Paris, France
| | - Isabelle Brocheriou
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S1155, Paris, France.,Institut National de la Santé et de la Recherche Médicale, UMR_S1155, Paris, France.,Service d'Anatomie Pathologique, Hôpital de la Pitié-Salpêtrière, APHP, Paris, France
| | - Eric Rondeau
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S1155, Paris, France.,Institut National de la Santé et de la Recherche Médicale, UMR_S1155, Paris, France.,Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, APHP, Paris, France
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10
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Gibier JB, Hémon B, Fanchon M, Gaudelot K, Pottier N, Ringot B, Van Seuningen I, Glowacki F, Cauffiez C, Blum D, Copin MC, Perrais M, Gnemmi V. Dual role of MUC1 mucin in kidney ischemia-reperfusion injury: Nephroprotector in early phase, but pro-fibrotic in late phase. Biochim Biophys Acta Mol Basis Dis 2017; 1863:1336-1349. [DOI: 10.1016/j.bbadis.2017.03.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 03/14/2017] [Accepted: 03/29/2017] [Indexed: 11/15/2022]
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11
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Prunotto M, Chaykovska L, Bongiovanni M, Frattini M, Cagarelli T, Weibel F, Bruschi M, de Herreros AG, Moll S. Tubular Cytoplasmic Expression of Zinc Finger Protein SNAI1 in Renal Transplant Biopsies: A Sign of Diseased Epithelial Phenotype? THE AMERICAN JOURNAL OF PATHOLOGY 2016; 187:55-69. [PMID: 27863213 DOI: 10.1016/j.ajpath.2016.09.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 09/02/2016] [Accepted: 09/12/2016] [Indexed: 11/19/2022]
Abstract
The aim of the present study was to analyze in vivo the role of zinc finger protein SNAI1 (SNAI1) on renal fibrosis. Unilateral ureteral obstruction injury was induced in Snai1 knockout mice. Snai1 gene deletion was, however, only partial and could therefore not be correlated to reduced fibrosis. Expression of SNAI1 protein and epithelial-mesenchymal transformation markers was then assessed in human chronic allograft nephropathy biopsy specimens. Significant up-regulation of SNAI1 protein was detected within cytoplasm of proximal tubules localized, for some of them, near foci of fibrosis and tubular atrophy. No concomitant epithelial-mesenchymal transformation could, however, be demonstrated analyzing the expression of the fibroblast markers vimentin, α-smooth muscle actin, and S100A4. SNAI1 cytoplasmic up-regulation was particularly evident in biopsy specimens obtained from calcineurin inhibitor-treated patients, which might be because of, as suggested by in vitro experiments, a decrease of the proteasome chimotrypsin activity. Deeper analysis on chronic allograft nephropathy biopsy specimens suggested that SNAI1 cytoplasmic up-regulation was preceded by a transient increase of phosphorylated heat shock protein 27, p38 mitogen-activated protein kinase, and glycogen synthase kinase 3β. Concomitant down-regulation of the polyubuquitinylated conjugates was detected in SNAI1+ tubules. Altogether, these results might suggest that calcineurin inhibitor-induced tubular SNAI1 protein cytoplasmic accumulation, possibly because of impaired SNAI1 proteasomal degradation and nuclear translocation, might be a sign of a diseased profibrotic epithelial phenotype.
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Affiliation(s)
- Marco Prunotto
- Discovery Technologies, Roche Innovation Center Basel, Roche Pharma Research and Early Development, Basel, Switzerland.
| | - Lyubov Chaykovska
- Clinics for Cardiovascular Surgery, Zurich University Hospital, Zurich, Switzerland
| | - Massimo Bongiovanni
- Division of Clinical Pathology, Department of Pathology and Immunology, University Hospital Geneva, Geneva, Switzerland
| | | | - Thomas Cagarelli
- Division of Clinical Pathology, Department of Pathology and Immunology, University Hospital Geneva, Geneva, Switzerland
| | - Franziska Weibel
- Discovery Technologies, Roche Innovation Center Basel, Roche Pharma Research and Early Development, Basel, Switzerland
| | - Maurizio Bruschi
- Laboratory of Uremia Pathophysiology, Giannina Gaslini Hospital, Genova, Italy
| | | | - Solange Moll
- Division of Clinical Pathology, Department of Pathology and Immunology, University Hospital Geneva, Geneva, Switzerland; Institute of Clinical Pathology, University Hospital Lausanne, Lausanne, Switzerland
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12
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Mutsaers HAM, Stribos EGD, Glorieux G, Vanholder R, Olinga P. Chronic Kidney Disease and Fibrosis: The Role of Uremic Retention Solutes. Front Med (Lausanne) 2015; 2:60. [PMID: 26380262 PMCID: PMC4553389 DOI: 10.3389/fmed.2015.00060] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/17/2015] [Indexed: 12/20/2022] Open
Abstract
Chronic kidney disease (CKD) is a major global health concern, and the uremic state is highly associated with fibrogenesis in several organs and tissues. Fibrosis is characterized by excessive production and deposition of extracellular matrix proteins with a detrimental impact on organ function. Another key feature of CKD is the retention and subsequent accumulation of solutes that are normally cleared by the healthy kidney. Several of these uremic retention solutes, including indoxyl sulfate and p-cresyl sulfate, have been suggested to be CKD-specific triggers for the development and perpetuation of fibrosis. The purpose of this brief review is to gather and discuss the current body of evidence linking uremic retention solutes to the fibrotic response during CKD, with a special emphasis on the pathophysiological mechanisms in the kidney.
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Affiliation(s)
- Henricus A M Mutsaers
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen , Groningen , Netherlands
| | - Elisabeth G D Stribos
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen , Groningen , Netherlands ; Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen , Groningen , Netherlands
| | - Griet Glorieux
- Renal Division, Department of Internal Medicine, Ghent University Hospital , Ghent , Belgium
| | - Raymond Vanholder
- Renal Division, Department of Internal Medicine, Ghent University Hospital , Ghent , Belgium
| | - Peter Olinga
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen , Groningen , Netherlands
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13
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Simon N, Hertig A. Alteration of Fatty Acid Oxidation in Tubular Epithelial Cells: From Acute Kidney Injury to Renal Fibrogenesis. Front Med (Lausanne) 2015; 2:52. [PMID: 26301223 PMCID: PMC4525064 DOI: 10.3389/fmed.2015.00052] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 07/17/2015] [Indexed: 12/11/2022] Open
Abstract
Renal proximal tubular cells are the most energy-demanding cells in the body. The ATP that they use is mostly produced in their mitochondrial and peroxisomal compartments, by the oxidation of fatty acids. When those cells are placed under a biological stress, such as a transient hypoxia, fatty acid oxidation (FAO) is shut down for a period of time that outlasts injury, and carbohydrate oxidation does not take over. Facing those metabolic constraints, surviving tubular epithelial cells exhibit a phenotypic switch that includes cytoskeletal rearrangement and production of extracellular matrix proteins, most probably contributing to acute kidney injury-induced renal fibrogenesis, thence to the development of chronic kidney disease. Here, we review experimental evidence that dysregulation of FAO profoundly affects the fate of tubular epithelial cells, by promoting epithelial-to-mesenchymal transition, inflammation, and eventually interstitial fibrosis. Restoring physiological production of energy is undoubtedly a possible therapeutic approach to unlock the mesenchymal reprograming of tubular epithelial cells in the kidney. In this respect, the benefit of the use of fibrates is uncertain, but new drugs that could specifically target this metabolic pathway, and, hopefully, attenuate renal fibrosis merit future research.
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Affiliation(s)
- Noémie Simon
- IMSERM UMR_S1155, Rare and Common Kidney Diseases, Remodeling and Tissue Repair, Hôpital Tenon , Paris , France
| | - Alexandre Hertig
- IMSERM UMR_S1155, Rare and Common Kidney Diseases, Remodeling and Tissue Repair, Hôpital Tenon , Paris , France ; UMR S 1155, UPMC Sorbonne Université Paris 06 , Paris , France
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14
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Louis K, Hertig A. How tubular epithelial cells dictate the rate of renal fibrogenesis? World J Nephrol 2015; 4:367-373. [PMID: 26167460 PMCID: PMC4491927 DOI: 10.5527/wjn.v4.i3.367] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 04/21/2015] [Accepted: 05/18/2015] [Indexed: 02/06/2023] Open
Abstract
The main threat to a kidney injury, whatever its cause and regardless of whether it is acute or chronic, is the initiation of a process of renal fibrogenesis, since fibrosis can auto-perpetuate and is of high prognostic significance in individual patients. In the clinic, a decrease in glomerular filtration rate correlates better with tubulointerstitial damage than with glomerular injury. Accumulation of the extracellular matrix should not be isolated from other significant cellular changes occurring in the kidney, such as infiltration by inflammatory cells, proliferation of myofibroblasts, obliteration of peritubular capillaries and atrophy of tubules. The aim of this review is to focus on tubular epithelial cells (TEC), which, necessarily involved in the repair process, eventually contribute to accelerating fibrogenesis. In the context of injury, TEC rapidly exhibit phenotypic and functional changes that recall their mesenchymal origin, and produce several growth factors known to activate myofibroblasts. Because they are high-demanding energy cells, TEC will subsequently suffer from the local hypoxia that progressively arises in a microenvironment where the matrix increases and capillaries become rarified. The combination of hypoxia and metabolic acidosis may induce a vicious cycle of sustained inflammation, at the center of which TEC dictate the rate of renal fibrogenesis.
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15
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Rostaing L, Hertig A, Albano L, Anglicheau D, Durrbach A, Vuiblet V, Moulin B, Merville P, Hazzan M, Lang P, Touchard G, Hurault deLigny B, Quéré S, Di Giambattista F, Dubois YC, Rondeau E. Fibrosis progression according to epithelial-mesenchymal transition profile: a randomized trial of everolimus versus CsA. Am J Transplant 2015; 15:1303-12. [PMID: 25808994 DOI: 10.1111/ajt.13132] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 11/12/2014] [Accepted: 11/30/2014] [Indexed: 01/25/2023]
Abstract
Markers of epithelial-mesenchymal transition (EMT) may identify patients at high risk of graft fibrogenesis who could benefit from early calcineurin inhibitor (CNI) withdrawal. In a randomized, open-label, 12-month trial, de novo kidney transplant patients received cyclosporine, enteric-coated mycophenolate sodium (EC-MPS) and steroids to month 3. Patients were stratified as EMT+ or EMT- based on month 3 biopsy, then randomized to start everolimus with half-dose EC-MPS (720 mg/day) and cyclosporine withdrawal (CNI-free) or continue cyclosporine with standard EC-MPS (CNI). The primary endpoint was progression of graft fibrosis (interstitial fibrosis/tubular atrophy [IF/TA] grade increase ≥1 between months 3-12) in EMT+ patients. 194 patients were randomized (96 CNI-free, 98 CNI); 153 (69 CNI-free, 84 CNI) were included in histological analyses. Fibrosis progression occurred in 46.2% (12/26) CNI-free EMT+ patients versus 51.6% (16/31) CNI EMT+ patients (p = 0.68). Biopsy-proven acute rejection (BPAR, including subclinical events) occurred in 25.0% and 5.1% of CNI-free and CNI patients, respectively (p < 0.001). In conclusion, early CNI withdrawal with everolimus initiation does not prevent interstitial fibrosis. Using this CNI-free protocol, in which everolimus exposure was relatively low and administered with half-dose EC-MPS, CNI-free patients were overwhelmingly under-immunosuppressed and experienced an increased risk of BPAR.
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Affiliation(s)
- L Rostaing
- Department of Nephrology, Dialysis and Transplantation, Hôpital de Rangueil, Toulouse, France
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16
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Bloch J, Hazzan M, Van der Hauwaert C, Buob D, Savary G, Hertig A, Gnemmi V, Frimat M, Perrais M, Copin MC, Broly F, Noël C, Pottier N, Cauffiez C, Glowacki F. Donor ABCB1 genetic polymorphisms influence epithelial-to-mesenchyme transition in tacrolimus-treated kidney recipients. Pharmacogenomics 2014; 15:2011-24. [DOI: 10.2217/pgs.14.146] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Aim: The contribution of epithelial–mesenchymal transition (EMT) has been suggested in renal transplant recipients receiving calcineurin inhibitors and developing nephrotoxicity. Materials & methods: We assessed whether interindividual variability in tacrolimus pharmacokinetics is associated with the occurrence in tubular cells of two EMT markers (vimentin, β-catenin) detected at 3‐month in 140 allograft biopsies. We investigated whether genetic polymorphisms affecting CYP3A5 and ABCB1 influence EMT and kidney fibrosis. Results: In univariate analysis, the donor CYP3A5*1 allele was significantly associated with a lower vimentin expression. In multivariate analysis, grafts carrying ABCB1 3435T allele(s) developed significantly less EMT and less interstitial fibrosis. Conclusion: Donor SNPs significantly influence the epithelial program in the context of kidney transplantation, and the epithelial metabolism of tacrolimus is one key to understand graft fibrogenesis.
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Affiliation(s)
- Julie Bloch
- EA4483, Faculté de Médecine H Warembourg, Pôle Recherche, Université de Lille, France
- Service de Néphrologie, Hôpital Huriez, CHRU, Lille, France
| | - Marc Hazzan
- Service de Néphrologie, Hôpital Huriez, CHRU, Lille, France
| | | | - David Buob
- Institut de Pathologie, Centre de Biologie Pathologie Génétique, CHRU, Lille, France
| | - Grégoire Savary
- EA4483, Faculté de Médecine H Warembourg, Pôle Recherche, Université de Lille, France
| | - Alexandre Hertig
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, AP-HP, Paris, France
| | - Viviane Gnemmi
- Institut de Pathologie, Centre de Biologie Pathologie Génétique, CHRU, Lille, France
| | - Marie Frimat
- Service de Néphrologie, Hôpital Huriez, CHRU, Lille, France
| | - Michaël Perrais
- Institut National de la Santé et de la Recherche Médicale, U837, Jean-Pierre Aubert Research Center, Equipe 5 "Mucines, Différenciation et Cancérogenèse Épithéliales", Lille, France
| | - Marie-Christine Copin
- Institut de Pathologie, Centre de Biologie Pathologie Génétique, CHRU, Lille, France
| | - Franck Broly
- EA4483, Faculté de Médecine H Warembourg, Pôle Recherche, Université de Lille, France
| | - Christian Noël
- Service de Néphrologie, Hôpital Huriez, CHRU, Lille, France
| | - Nicolas Pottier
- EA4483, Faculté de Médecine H Warembourg, Pôle Recherche, Université de Lille, France
| | - Christelle Cauffiez
- EA4483, Faculté de Médecine H Warembourg, Pôle Recherche, Université de Lille, France
| | - François Glowacki
- EA4483, Faculté de Médecine H Warembourg, Pôle Recherche, Université de Lille, France
- Service de Néphrologie, Hôpital Huriez, CHRU, Lille, France
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17
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Miettinen J, Helin H, Pakarinen M, Jalanko H, Lauronen J. Histopathology and biomarkers in prediction of renal function in children after kidney transplantation. Transpl Immunol 2014; 31:105-11. [PMID: 24801206 DOI: 10.1016/j.trim.2014.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 04/24/2014] [Accepted: 04/25/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Early detection of chronic allograft injury is a major challenge after kidney transplantation (RTx) in adults and children. We correlated the expression of four immunohistochemical biomarkers, P-selectin glycoprotein ligand-1 (PSGL-1), vimentin, α-smooth muscle actin (α-SMA) and collagen IV, to the kidney graft histology and function in pediatric RTx patients. METHODS We analyzed the histopathology and immunohistochemical stainings of 165 biopsies from 56 patients. Histopathology was scored according to Banff '05 classification and biomarker expression semiquantitatively. Glomerular filtration rate (GFR) was measured annually by (51)Cr-EDTA clearance. RESULTS In protocol biopsies, the expression of all four biomarkers correlated with the interstitial fibrosis and tubular atrophy (IF/TA) changes, which increased during the first 36months after RTx. At the time of 18month biopsy, we observed the deterioration of GFR in patients with high (≥2) IF/TA score (50 vs. 68ml/min/1.73m(2), p=0.004) or collagen IV expression (45 vs. 65ml/min/1.73m(2), p=0.016). Intense stainings of IF/TA, collagen IV and vimentin are also associated with poor GFR at 36 and 48months, however, the biomarker scores revealed no additional predictive value for concomitant or late GFR compared to IF/TA score. Patients with high and low biomarker expressions showed no significant differences in annual deterioration of GFR, which declined on average 2.2ml/min/1.73m(2)/year over the 7years follow-up. CONCLUSIONS Overall, the results suggest that traditional histopathology is a sufficient predictor for graft function, and the routine use of these histochemical markers as surrogates for graft function deterioration is questioned.
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Affiliation(s)
- Jenni Miettinen
- Department of Pediatric Nephrology and Transplantation, Children's Hospital, University of Helsinki and Helsinki University Central Hospital, PL 281, 00029 HUS, Helsinki, Finland.
| | - Heikki Helin
- Division of Pathology and Genetics, HUSLAB, Helsinki University Central Hospital, PL 400, 00029 HUS, Helsinki, Finland
| | - Mikko Pakarinen
- Department of Pediatric Surgery, Children's Hospital, University of Helsinki and Helsinki University Central Hospital, PL 281, 00029 HUS, Helsinki, Finland
| | - Hannu Jalanko
- Department of Pediatric Nephrology and Transplantation, Children's Hospital, University of Helsinki and Helsinki University Central Hospital, PL 281, 00029 HUS, Helsinki, Finland
| | - Jouni Lauronen
- Histocompatibility Laboratory, Finnish Red Cross Blood Service, Kivihaantie 7, 00310 Helsinki, Finland
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18
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Xu-Dubois YC, Hertig A, Lebranchu Y, Hurault de Ligny B, Thervet E, Jauréguy M, Touchard G, Le Pogamp P, Le Meur Y, Toupance O, Heng AE, Bayle F, Girardot-Seguin S, Servais A, Meas-Yedid V, Rondeau E. Progression of pulse pressure in kidney recipients durably exposed to CsA is a risk factor for epithelial phenotypic changes: an ancillary study of the CONCEPT trial. Transpl Int 2014; 27:344-52. [PMID: 24279707 DOI: 10.1111/tri.12253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 06/23/2013] [Accepted: 11/24/2013] [Indexed: 11/29/2022]
Abstract
In this ancillary study of the CONCEPT trial, we studied the role of CsA withdrawal at 3 months (3M) post-transplant on the intensity of epithelial phenotypic changes (EPC, an early marker for kidney fibrogenesis) on the 12 M surveillance biopsy. Although conversion from CsA to sirolimus (SRL) at 3M was reported to have improved mean graft function at 12 M, it did not reduce the score of EPC (1.73 ± 1.15 in the SRL group vs. 1.87 ± 1 in the CsA group, P = 0.61). Acute rejection, which had occurred twice more frequently in SRL-converted patients included here, was associated with 12 M EPC. Interestingly, we observed that the patients durably exposed to CsA and who developed 12 M EPC had a significant progression of blood pulse pressure (pp) from 1 to 6M post-transplantation (Δpp = +12.3 mmHg, P = 0.0035). Pulse pressure at 4, 6, and 9 M and pp progression from 1 to 6M were significantly associated with the development of EPC at 12 M in renal grafts. Logistic regression analysis revealed that a high 6M pp (≥ 60 mmHg) was an independent risk factor for 12 M EPC with an odds ratio of 2.25 per additional 10 mmHg pp (95%CI: 1.14-4.4, P = 0.02) after adjustment with recipient's and donor's age, acute rejection incidence and immunosuppressive regimen. A post hoc analysis of the data collected in the whole population CONCEPT study revealed that pp was significantly higher at 6 months in patients maintained on CsA and that at this time point pp correlated negatively with GFR at 1 year.
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Affiliation(s)
- Yi-Chun Xu-Dubois
- Département de Santé Publique, APHP, Hôpital Tenon, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR_S1155, Paris, France
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Xu-Dubois YC, Galichon P, Brocheriou I, Baugey E, Morichon R, Jouanneau C, Ouali N, Rondeau E, Hertig A. Expression of the transcriptional regulator snail1 in kidney transplants displaying epithelial-to-mesenchymal transition features. Nephrol Dial Transplant 2013; 29:2136-44. [DOI: 10.1093/ndt/gft279] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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