Valproic Acid Protects Against Acute Kidney Injury in Hemorrhage and Trauma

RNA-binding protein biomarkers NR4A2 and NR4A3 in renal ischemia-reperfusion injury diagnosis

BACKGROUND

The diagnosis of renal ischemia and reperfusion injury (RIRI) is crucial for renal transplant recipients. RNA-binding proteins (RBPs) may have an impact on disease development. Therefore, this study explored the biomarkers associated with RBPs in RIRI.

METHODS

The RIRI related datasets, GSE37838 and GSE43974, and 3964 RBPs were employed in this research. The differential expression analysis was implemented for RIRI and control to gain differentially expressed genes in GSE37838. Then, differentially expressed genes were overlapped with RBPs to acquire intersection genes. Further, the machine learning, diagnostic analysis, and expression validation were executed to filtered biomarkers for RIRI. Additionally, pathway enrichment, molecular networks, and drug prediction were proceed.

RESULTS

The area under the curve values of NR4A2 and NR4A3 were >0.7, as well as the expression trend was consistent in both datasets, and all of them were remarkably highly expressed in RIRI. Therefore, they were considered as biomarkers of RIRI. Enrichment analyses revealed that they were both associated with neuroactive ligand-receptor interactions, among others. Further, the lncRNA-miRNA-mRNA and transcription factors (TF)-mRNA network was constructed, revealing that they were all regulated by noncoding RNAs and TF, such as SNHG5-hsa-mir-10b-5p-NR4A3, CREB1, TFAP2A, etc. In addition, a large number of biomarker-related drugs were predicted, among which cadmium acetate, potassium chromate (VI), etc were associated with NR4A2 and NR4A3.

CONCLUSION

In this study, we identified biomarkers associated with RBPs in RIRI, explored their associated pathways and drugs, which provided new insights into the clinical diagnosis and treatment of RIRI.

Near-infrared spectroscopy for kidney oxygen monitoring in a porcine model of hemorrhagic shock, hemodilution, and REBOA

Acute kidney injury is a common complication of trauma and hemorrhagic shock. In a porcine model of hemorrhagic shock, resuscitative endovascular balloon aortic occlusion (REBOA) and hemodilution, we hypothesized that invasive kidney oxygen concentration measurements would correlate more strongly with noninvasive near infra-red spectroscopy (NIRS) oxygen saturation measurements when cutaneous sensors were placed over the kidney under ultrasound guidance compared to placement over the thigh muscle and subcutaneous tissue. Eight anesthetized swine underwent hemorrhagic shock 4 of which were resuscitated with intravenous fluids prior to the return of shed blood (Hemodilution protocol) and 4 of which underwent REBOA prior to resuscitation and return of shed blood (REBOA protocol). There was a moderate correlation between the NIRS and kidney tissue oxygen measurements (r = 0.61 p < 0.001; r = 0.67 p < 0.001; r = 0.66 p < 0.001for left kidney, right kidney, and thigh NIRS respectively). When the animals were separated by protocol, the Hemodilution group showed a weak or nonsignificant correlation between NIRS and kidney tissue oxygen measurements (r = 0.10 p < 0.001; r = 0.01 p = 0.1007; r = 0.28 p < 0.001 for left kidney, right kidney, and thigh NIRS respectively). This contrasts with the REBOA group, where left and right kidney as well as thigh NIRS were moderately correlated with kidney tissue oxygen (r = 0.71 p < 0.001; r = 0.74 p < 0.001; r = 0.70 p < 0.001; for left kidney, right kidney, and thigh NIRS respectively). There was a strong correlation between both kidney NIRS signals and thigh NIRS measurements (r = 0.85 p < 0.001; r = 0.88 p < 0.001;for left kidney vs thigh and right kidney vs thigh respectively). There was also a strong correlation between left and right kidney NIRS (r = 0.90 p < 0.001). These relationships were maintained regardless of the resuscitation protocol. These results suggest that kidney NIRS measurements were more closely related to thigh NIRS measurements than invasive kidney tissue oxygen concentration.

Acute kidney injury associated with nephrotoxic drugs in critically ill patients: a multicenter cohort study using electronic health record data

Background

Nephrotoxic drugs frequently cause acute kidney injury (AKI) in adult intensive care unit (ICU) patients. However, there is a lack of large pharmaco-epidemiological studies investigating the associations between drugs and AKI. Importantly, AKI risk factors may also be indications or contraindications for drugs and thereby confound the associations. Here, we aimed to estimate the associations between commonly administered (potentially) nephrotoxic drug groups and AKI in adult ICU patients whilst adjusting for confounding.

Methods

In this multicenter retrospective observational study, we included adult ICU admissions to 13 Dutch ICUs. We measured exposure to 44 predefined (potentially) nephrotoxic drug groups. The outcome was AKI during ICU admission. The association between each drug group and AKI was estimated using etiological cause-specific Cox proportional hazard models and adjusted for confounding. To facilitate an (independent) informed assessment of residual confounding, we manually identified drug group-specific confounders using a large drug knowledge database and existing literature.

Results

We included 92 616 ICU admissions, of which 13 492 developed AKI (15%). We found 14 drug groups to be associated with a higher hazard of AKI after adjustment for confounding. These groups included established (e.g. aminoglycosides), less well established (e.g. opioids) and controversial (e.g. sympathomimetics with α- and β-effect) drugs.

Conclusions

The results confirm existing insights and provide new ones regarding drug associated AKI in adult ICU patients. These insights warrant caution and extra monitoring when prescribing nephrotoxic drugs in the ICU and indicate which drug groups require further investigation.

[Role of Histone Modifications in Acute Kidney Injury Progressing to Chronic Kidney Disease]

Acute kidney injury (AKI), a clinical syndrome caused by various factors, is characterized by a rapid decline in kidney function in a short period of time. AKI affects the short-term prognosis of patients and may also induce chronic kidney disease (CKD). However, the current treatment options for AKI mainly focus on symptom management. Specific therapeutic measures available for the prevention of transition from AKI to CKD are very limited in number. Histones are basic proteins that intricately bind the DNA in chromosomes. After translation, histones undergo various modifications on their amino-terminal tails, such as methylation, acetylation, phosphorylation, ubiquitination, and lactylation, collectively forming the "histone code", which affects the expression of genes mainly by regulating the elastic structure of chromatin or recruiting specific proteins. Extensive research conducted in recent years on histone post-translational modifications (PTMs) has also sparked continuous interest in their association with the AKI-to-CKD transition. Therefore, this paper highlights the significant role of PTMs in the process of AKI developing and progressing to CKD, with a view to finding new approaches to preventing the progression of AKI to CKD.

Elamipretide mitigates ischemia-reperfusion injury in a swine model of hemorrhagic shock

ischemia-reperfusion injury (IRI) after hemorrhage is potentiated by aortic occlusion or resuscitative endovascular balloon occlusion of the aorta (REBOA). Given the central role of mitochondrial injury in shock, we hypothesized that Elamipretide, a peptide that protects mitochondria, would mitigate IRI after hemorrhagic shock and REBOA. Twelve pigs were subjected to hemorrhagic shock and 45 min of REBOA. After 25 min of REBOA, animals received either saline or Elamipretide. Animals were transfused with autologous blood during balloon deflation, and pigs were resuscitated with isotonic crystalloids and norepinephrine for 4.25 h. Elamipretide-treated animals required less crystalloids than the controls (62.5 [50-90] and 25 [5-30] mL/kg, respectively), but similar amounts of norepinephrine (24.7 [8.6-39.3] and 9.7 [2.1-12.5] mcg/kg, respectively). Treatment animals had a significant reduction in serum creatinine (control: 2.7 [2.6-2.8]; Elamipretide: 2.4 [2.4-2.5] mg/dL; p = 0.04), troponin (control: 3.20 [2.14-5.47] ng/mL, Elamipretide: 0.22 [0.1-1.91] ng/mL; p = 0.03), and interleukin-6 concentrations at the end of the study. There were no differences in final plasma lactate concentration. Elamipretide reduced fluid requirements and protected the kidney and heart after profound IRI. Further understanding the subcellular consequences of REBOA and mitochondrial rescue will open new therapeutic avenues for patients suffering from IRI after hemorrhage.

Evaluation of surgical outcomes in elderly patients with rib fractures: A single-centre propensity score matching study

Background

Rib fractures are the most common injuries in chest trauma. Compared with younger patients, elderly patients with rib fracture have a higher incidence of complications and mortality. A retrospective study was conducted to investigate the effect of internal fixation compared with conservative treatment on the outcome of rib fracture in elderly patients.

Material and methods

We used a 1:1 propensity score matching method to perform a retrospective analysis of 703 elderly patients with rib fractures treated in the Thoracic Surgery Department of Beijing Jishuitan Hospital between 2013 and 2020. After matching, the length of hospital stay, death, symptom relief and rib fracture healing were compared between the surgery and the control group.

Results

The study included 121 patients receiving SSRF in the surgery group and 121 patients receiving conservative treatment in the control group. The length of hospital stay in the surgery group was significantly longer than that in the conservative group (11.39d vs. 9.48d, p = 0.000). After 9 months of follow-up, the fracture healing rate in the surgery group was significantly higher than that in the control group (96.67% vs. 88.89%, p = 0.020). The fracture healing time (p = 0.000), improvement in pain score (p = 0.000) and duration of pain medication use (p = 0.000) were also significantly better in the surgery group than in the control group.

Conclusion

Compared with conservative treatment, surgical treatment can prolong hospital stay to some extent. However, it has the advantages of more rapid healing and lessened pain. For rib fractures in elderly individuals, surgical treatment is a safe and effective option under strict surgical indications and is recommended.

Valproic Acid During Hypotensive Resuscitation In Pigs With Trauma And Hemorrhagic Shock Does Not Improve Survival

BACKGROUND

Valproic acid (VPA) has been extensively used for treatment of anxiety and seizure. Recent studies have shown that VPA has cellular protective effects in preclinical models following severe hemorrhage. This study investigated the effects of VPA on coagulation and survival in pigs after traumatic hemorrhage and hypotensive resuscitation.

METHODS

Following baseline measurements, femur fracture was performed in 20 anesthetized and instrumented pigs (41 ± 2 kg), followed by hemorrhage of 55% of the estimated blood volume and a 10 min shock period. Pigs were then resuscitated over 30 min with: normal saline alone (NS group, n = 10, 4 ml/kg) or VPA solution (VPA group, n = 10, 90 mg/kg, 2 ml/kg of 45 mg VPA/ml, plus 2 ml NS/kg). All pigs were then monitored for 2 hrs or until death. Hemodynamics were recorded and blood samples were taken for blood and coagulation analysis (Rotem®) at baseline, after hemorrhage, resuscitation, and 2 hrs or death.

RESULTS

Femur fracture and hemorrhage caused similar reductions in mean arterial pressure (MAP) and cardiac output and increase in heart rate in both groups. Resuscitation with NS or VPA did not return these measurements to baseline. No differences were observed in hematocrit, pH, lactate, base excess, or total protein between the groups. Compared to NS, resuscitation with VPA decreased platelet counts and prolonged aPTT, with no differences in fibrinogen levels, PT, or any of the Rotem® measurements between the two groups. Neither survival rates (NS: 7 of 10 pigs and VPA: 7 of 10 pigs) nor survival times after resuscitation (NS: 97 ± 40 min and VPA: 98 ± 43 min) differed between the groups.

CONCLUSIONS

Following traumatic hemorrhage and hypotensive resuscitation in pigs, VPA provides no benefit towards improving coagulation function or survival times.

LEVELS OF RELEVANCE

N/A.

Propofol Reduces Renal Ischemia Reperfusion-mediated Necroptosis by Up-regulation of SIRT1 in Rats

Propofol (Pro) is well known to regulate the asleep-awake-asleep technique. Increasing indication recommends that Pro also has promising properties such as anti-oxidant and anti-inflammation belongings in several disease models. It has been described that Pro has beneficial properties against renal ischemia/reperfusion (rI/R)-mediated acute lung injury (ALI). Nevertheless, pathogenesis underlying the beneficial action of Pro on the remote ALI mediated by rI/R remains unwell unstated. In this research, we displayed that Pro administration remarkably inhibits rI/R-mediated pro-inflammatory cytokines production. Increased levels of oxidative stress were mainly decreased by Pro. Pro administration ameliorated apoptosis-related caspase-3 activation. Furthermore, the levels of crucial necroptosis-associated protein were reduced by Pro. Sirtuin 1 (SIRT1) inhibitor attenuated the aforementioned changes of Pro. In conclusion, these results propose that Pro attenuates rI/R-induced inflammation, oxidative stress, apoptosis, and necroptosis by up-regulation of SIRT1 in rats. Our findings disclose an original pathogenesis underlying the beneficial effect of Pro against rI/R-mediated ALI and reinforce the knowledge that Pro might be a hopeful beneficial agent for the rI/R-mediated ALI.