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Steers NJ, Barasch J. Their last will and testament: dying immune cells protect the urinary system with extracellular DNA traps. Kidney Int 2023; 104:236-238. [PMID: 37479384 PMCID: PMC10950419 DOI: 10.1016/j.kint.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 07/23/2023]
Abstract
Like most epithelial organs, the bladder and kidney can be directly accessed by bacteria evolved for invasion. Epithelia and immune cells attempt to stymie this infection with biophysical and chemical mechanisms. Goldspink et al. connected the Na+ gradient in the kidney medulla with an immune defense mounted by dead cells (namely, the explosive death of neutrophils and macrophages), resulting in extracellular DNA traps. The pathway from Na+ concentration to immune death is depicted.
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Affiliation(s)
- Nicholas J Steers
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, USA.
| | - Jonathan Barasch
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, USA.
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2
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Goldspink A, Schmitz J, Babyak O, Brauns N, Milleck J, Breloh AM, Fleig SV, Jobin K, Schwarz L, Haller H, Wagenlehner F, Bräsen JH, Kurts C, von Vietinghoff S. Kidney medullary sodium chloride concentrations induce neutrophil and monocyte extracellular DNA traps that defend against pyelonephritis in vivo. Kidney Int 2023:S0085-2538(23)00265-X. [PMID: 37098380 DOI: 10.1016/j.kint.2023.03.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/10/2023] [Accepted: 03/17/2023] [Indexed: 04/27/2023]
Abstract
Urinary tract infections are common. Here, we delineate a role of extracellular DNA trap (ET) formation in kidney antibacterial defense and determine mechanisms of their formation in the hyperosmotic environment of the kidney medulla. ET of granulocytic and monocytic origin were present in the kidneys of patients with pyelonephritis along with systemically elevated citrullinated histone levels. Inhibition of the transcription coregulatory, peptidylarginine deaminase 4 (PAD4), required for ET formation, prevented kidney ET formation and promoted pyelonephritis in mice. ETs predominantly accumulated in the kidney medulla. The role of medullary sodium chloride and urea concentrations in ET formation was then investigated. Medullary-range sodium chloride, but not urea, dose-, time- and PAD4-dependently induced ET formation even in the absence of other stimuli. Moderately elevated sodium chloride promoted myeloid cell apoptosis. Sodium gluconate also promoted cell death, proposing a role for sodium ions in this process. Sodium chloride induced myeloid cell calcium influx. Calcium ion-free media or -chelation reduced sodium chloride-induced apoptosis and ET formation while bacterial lipopolysaccharide amplified it. Autologous serum improved bacterial killing in the presence of sodium chloride-induced ET. Depletion of the kidney sodium chloride gradient by loop diuretic therapy diminished kidney medullary ET formation and increased pyelonephritis severity. Thus, our data demonstrate that ETs may protect the kidney against ascending uropathogenic E. coli and delineate kidney medullary range sodium chloride concentrations as novel inducers of programmed myeloid cell death.
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Affiliation(s)
| | | | - Olena Babyak
- Institute of Experimental Immunology, University Clinic and Rheinische Friedrich-Wilhelms Universität Bonn, Bonn
| | - Nicolas Brauns
- Department of Internal Medicine, Division of Nephrology and Hypertension, Hannover Medical School, Hannover
| | | | - Anne M Breloh
- Department of Internal Medicine, Division of Nephrology and Hypertension, Hannover Medical School, Hannover
| | - Susanne V Fleig
- Nephrology Section, First Medical Clinic; Department of Geriatrics, University Hospital RWTH Aachen, Aachen
| | - Katarzyna Jobin
- Institute of Experimental Immunology, University Clinic and Rheinische Friedrich-Wilhelms Universität Bonn, Bonn; Würzburg Institute of Systems Immunology, Max Planck Research Group at the Julius-Maximilians-Universität, Würzburg
| | - Lisa Schwarz
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | - Hermann Haller
- Department of Internal Medicine, Division of Nephrology and Hypertension, Hannover Medical School, Hannover
| | - Florian Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | | | - Christian Kurts
- Institute of Experimental Immunology, University Clinic and Rheinische Friedrich-Wilhelms Universität Bonn, Bonn
| | - Sibylle von Vietinghoff
- Nephrology Section, First Medical Clinic; Department of Internal Medicine, Division of Nephrology and Hypertension, Hannover Medical School, Hannover.
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3
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Pfenning MB, Schmitz J, Scheffner I, Schulte K, Khalifa A, Tezval H, Weidemann A, Kulschewski A, Kunzendorf U, Dietrich S, Haller H, Kielstein JT, Gwinner W, Bräsen JH. High Macrophage Densities in Native Kidney Biopsies Correlate With Renal Dysfunction and Promote ESRD. Kidney Int Rep 2022; 8:341-356. [PMID: 36815108 PMCID: PMC9939427 DOI: 10.1016/j.ekir.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/21/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Macrophages and monocytes are main players in innate immunity. The relevance of mononuclear phagocyte infiltrates on clinical outcomes remains to be determined in native kidney diseases. Methods Our cross-sectional study included 324 patients with diagnostic renal biopsies comprising 17 disease entities and normal renal tissues for comparison. All samples were stained for CD68+ macrophages. Selected groups were further subtyped for CD14+ monocytes and CD163+ alternatively activated macrophages. Using precise pixel-based digital measurements, we quantified cell densities as positively stained areas in renal cortex and medulla as well as whole renal tissue. Laboratory and clinical data of all cases at the time of biopsy and additional follow-up data in 158 cases were accessible. Results Biopsies with renal disease consistently revealed higher CD68+-macrophage densities and CD163+-macrophage densities in cortex and medulla compared to controls. High macrophage densities correlated with impaired renal function at biopsy and at follow-up in all diseases and in diseases analyzed separately. High cortical CD68+-macrophage densities preceded shorter renal survival, defined as requirement of permanent dialysis. CD14+ monocyte densities showed no difference compared to controls and did not correlate with renal function. Conclusion Precise quantification of macrophage densities in renal biopsies may contribute to risk stratification to identify patients with high risk for end-stage renal disease (ESRD) and might be a promising therapeutic target in renal disease.
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Affiliation(s)
- Maren B. Pfenning
- Nephropathology Unit, Institute of Pathology, Hannover Medical School, Hannover, Lower Saxony, Germany,Medical Department I, Gastroenterology, Hepatology and Nephrology, Clinics Passau, Passau, Bavaria, Germany
| | - Jessica Schmitz
- Nephropathology Unit, Institute of Pathology, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Irina Scheffner
- Clinic for Kidney and Hypertension Diseases, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Kevin Schulte
- Clinic for Nephrology and Hypertension, Christian-Albrechts-University, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Schleswig-Holstein, Germany
| | - Abedalrazag Khalifa
- Nephropathology Unit, Institute of Pathology, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Hossein Tezval
- Department of Urology and Urological Oncology, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Alexander Weidemann
- Medical Clinic III – Nephrology and Dialysis, St. Vinzenz Hospital, Paderborn, North Rhine-Westphalia, Germany
| | - Anke Kulschewski
- Clinic for Nephrology and Hypertension, University Hospital Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Ulrich Kunzendorf
- Clinic for Nephrology and Hypertension, Christian-Albrechts-University, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Schleswig-Holstein, Germany
| | - Sebastian Dietrich
- Clinic for Nephrology and Hypertension, Christian-Albrechts-University, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Schleswig-Holstein, Germany
| | - Hermann Haller
- Clinic for Kidney and Hypertension Diseases, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Jan T. Kielstein
- Medical Clinic V, Nephrology, Rheumatology and Blood Purification, Academic Teaching Hospital Braunschweig, Braunschweig, Lower Saxony, Germany
| | - Wilfried Gwinner
- Clinic for Kidney and Hypertension Diseases, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Jan H. Bräsen
- Nephropathology Unit, Institute of Pathology, Hannover Medical School, Hannover, Lower Saxony, Germany,Correspondence: Jan Hinrich Bräsen, Nephropathology Unit, Institute of Pathology, Hannover Medical School, OE 5110, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
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4
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Gremke N, Kostev K, Kalder M. Association between antihypertensive medication and the risk of urinary tract infection (UTI) of outpatients: a retrospective cohort study. Infection 2022; 51:417-424. [PMID: 35906337 PMCID: PMC10042971 DOI: 10.1007/s15010-022-01895-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/22/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE The aim of this retrospective study was to investigate the impact of a broad spectrum of antihypertensive (AH) medications on urinary tract infections (UTI) of outpatients diagnosed in general practices in Germany. METHODS This study included a total of 367,960 patients aged ≥ 18 years newly a diagnosed with UTI in 1274 general practices in Germany between January 2010 and December 2019. The analysis was conducted for five groups representing five AH therapy classes (diuretics (DIU); beta blockers (BB); calcium channel blockers (CCB); ACE inhibitors (ACEi); angiotensin II receptor blockers (ARB)), each containing 73,592 patients. A Cox regression model was used to analyze the association between each antihypertensive drug class and UTI incidence as compared to all other antihypertensive drug classes (as a group). RESULTS The incidence of UTI diagnosis was slightly higher in patients treated with DIU (8.6%), followed by ACEi (8.1%), ARB (7.9%), and CCB (6.5%). Antibiotic therapy for UTI was given in 5.6% of DIU and 4.3% of CCB patients. The incidence of UTI and antibiotic therapy was much higher in women than in men across all therapy classes. No significant increase or decrease in UTI incidence or antibiotic therapy was observed in any of the AH therapy classes investigated. CONCLUSION The present study did not identify a significant increase or decrease of UTI incidence or antibiotic therapy in patients treated with ACEi, ACB, CCB, beta blockers or diuretics. Across all AH classes studied, the incidence of UTI and antibiotic therapy was higher in women than in men, although not significantly.
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Affiliation(s)
- Niklas Gremke
- Department of Gynecology and Obstetrics, Philipps-University, Marburg, Germany.
| | | | - Matthias Kalder
- Department of Gynecology and Obstetrics, Philipps-University, Marburg, Germany
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Lee SY, Fierro J, Dipasquale J, Bastian A, Tran AM, Hong D, Chin B, Nguyen-Lee PJ, Mazal S, Espinal J, Thomas T, Dou H. Engineering Human Circulating Monocytes/Macrophages by Systemic Deliverable Gene Editing. Front Immunol 2022; 13:754557. [PMID: 35663976 PMCID: PMC9159279 DOI: 10.3389/fimmu.2022.754557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 03/25/2022] [Indexed: 11/17/2022] Open
Abstract
Delivery of plasmid DNA to transfect human primary macrophages is extremely difficult, especially for genetic engineering. Engineering macrophages is imperative for the treatment of many diseases including infectious diseases, cancer, neurological diseases, and aging. Unfortunately, plasmid does not cross the nuclear membranes of terminally differentiated macrophages to integrate the plasmid DNA (pDNA) into their genome. To address this issue, we have developed a core-shell nanoparticle (NP) using our newly created cationic lipid to deliver the anti-inflammatory cytokine IL-4 pDNA (IL-4pDNA-NPs). Human blood monocyte-derived macrophages (MDM) were effectively transfected with IL-4pDNA-NPs. IL-4pDNA-NPs were internalized in MDM within 30 minutes and delivered into the nucleus within 2 hours. Exogenous IL-4 expression was detected within 1 - 2 days and continued up to 30 days. Functional IL-4 expression led to M2 macrophage polarization in vitro and in an in vivo mouse model of inflammation. These data suggest that these NPs can protect pDNA from degradation by nucleases once inside the cell, and can transport pDNA into the nucleus to enhance gene delivery in macrophages in vitro and in vivo. In this research, we developed a new method to deliver plasmids into the nucleus of monocytes and macrophages for gene-editing. Introducing IL-4 pDNA into macrophages provides a new gene therapy solution for the treatment of various diseases.
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Affiliation(s)
- So Yoon Lee
- Department of Molecular and Translational Medicine of Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, United States
| | - Javier Fierro
- Department of Molecular and Translational Medicine of Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, United States
| | - Jake Dipasquale
- Department of Molecular and Translational Medicine of Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, United States
| | - Anthony Bastian
- Department of Molecular and Translational Medicine of Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, United States
| | - An M Tran
- Department of Molecular and Translational Medicine of Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, United States
| | - Deawoo Hong
- Biomedical Sciences Graduate School, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, United States
| | - Brandon Chin
- Biomedical Sciences Graduate School, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, United States
| | - Paul J Nguyen-Lee
- Department of Molecular and Translational Medicine of Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, United States
| | - Sarah Mazal
- Department of Molecular and Translational Medicine of Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, United States
| | - Jamil Espinal
- Biomedical Sciences Graduate School, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, United States
| | - Tima Thomas
- Department of Molecular and Translational Medicine of Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, United States
| | - Huanyu Dou
- Department of Molecular and Translational Medicine of Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, United States.,Biomedical Sciences Graduate School, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, United States
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Schmitz J, Brauns N, Hüsing AM, Flechsig M, Glomb T, Bräsen JH, Haller H, von Vietinghoff S. Renal medullary osmolytes NaCl and urea differentially modulate human tubular cell cytokine expression and monocyte recruitment. Eur J Immunol 2022; 52:1258-1272. [DOI: 10.1002/eji.202149723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/20/2022] [Accepted: 05/06/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Jessica Schmitz
- Nephropathology Unit Institute for Pathology University Clinic and Rheinische Friedrich‐Wilhelms Universität Bonn Bonn Germany
| | - Nicolas Brauns
- Department of Internal Medicine Division of Nephrology and Hypertension University Clinic and Rheinische Friedrich‐Wilhelms Universität Bonn Bonn Germany
| | - Anne M. Hüsing
- Department of Internal Medicine Division of Nephrology and Hypertension University Clinic and Rheinische Friedrich‐Wilhelms Universität Bonn Bonn Germany
| | - Martina Flechsig
- Department of Internal Medicine Division of Nephrology and Hypertension University Clinic and Rheinische Friedrich‐Wilhelms Universität Bonn Bonn Germany
| | - Thorsten Glomb
- Core Facility Transcriptomics Hannover Medical School Hannover Germany
| | - Jan Hinrich Bräsen
- Nephropathology Unit Institute for Pathology University Clinic and Rheinische Friedrich‐Wilhelms Universität Bonn Bonn Germany
| | - Hermann Haller
- Department of Internal Medicine Division of Nephrology and Hypertension University Clinic and Rheinische Friedrich‐Wilhelms Universität Bonn Bonn Germany
| | - Sibylle von Vietinghoff
- Department of Internal Medicine Division of Nephrology and Hypertension University Clinic and Rheinische Friedrich‐Wilhelms Universität Bonn Bonn Germany
- Nephrology Section First Medical Clinic University Clinic and Rheinische Friedrich‐Wilhelms Universität Bonn Bonn Germany
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7
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Abstract
Urinary tract infection (UTI) is the most common type of urogenital disease. UTI affects the urethra, bladder, ureter, and kidney. A total of 13.3% of women, 2.3% of men, and 3.4% of children in the United States will require treatment for UTI. Traditionally, bladder (cystitis) and kidney (pyelonephritis) infections are considered independently. However, both infections induce host defenses that are either shared or coordinated across the urinary tract. Here, we review the chemical and biophysical mechanisms of bacteriostasis, which limit the duration and severity of the illness. Urinary bacteria attempt to overcome each of these defenses, complicating description of the natural history of UTI.
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Affiliation(s)
| | - Anne-Catrin Uhlemann
- Department of Medicine and Pathology and Urology, Columbia University, New York, NY, USA;
| | - Jonathan Barasch
- Department of Medicine and Pathology and Urology, Columbia University, New York, NY, USA;
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8
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Anti-Inflammatory Activities of Captopril and Diuretics on Macrophage Activity in Mouse Humoral Immune Response. Int J Mol Sci 2021; 22:ijms222111374. [PMID: 34768805 PMCID: PMC8584063 DOI: 10.3390/ijms222111374] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 12/29/2022] Open
Abstract
Hypertension is accompanied by the over-activation of macrophages. Diuretics administered alone or in combination with hypotensive drugs may have immunomodulatory effects. Thus, the influence of tested drugs on mouse macrophage-mediated humoral immunity was investigated. Mice were treated intraperitoneally with captopril (5 mg/kg) with or without hydrochlorothiazide (10 mg/kg) or furosemide (5 mg/kg) by 8 days. Mineral oil-induced peritoneal macrophages were harvested to assess the generation of cytokines in ELISA, and the expression of surface markers was analyzed cytometrically. Macrophages were also pulsed with sheep red blood cells (SRBC) and transferred to naive mice for evaluation of their ability to induce a humoral immune response. Tested drugs increase the expression of surface markers important for the antigen phagocytosis and presentation. SRBC-pulsed macrophages from mice treated with captopril combined with diuretics increased the secretion of antigen-specific antibodies by recipient B cells, while macrophages of mice treated with hydrochlorothiazide or furosemide with captopril increased the number of antigen-specific B cells. Tested drugs alter the macrophage secretory profile in favor of anti-inflammatory cytokines. Our results showed that diuretics with or without captopril modulate the humoral response by affecting the function of macrophages, which has significant translational potential in assessing the safety of antihypertensive therapy.
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9
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Merveille O, Lampert T, Schmitz J, Forestier G, Feuerhake F, Wemmert C. An automatic framework for fusing information from differently stained consecutive digital whole slide images: A case study in renal histology. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 208:106157. [PMID: 34091100 DOI: 10.1016/j.cmpb.2021.106157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 05/02/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This article presents an automatic image processing framework to extract quantitative high-level information describing the micro-environment of glomeruli in consecutive whole slide images (WSIs) processed with different staining modalities of patients with chronic kidney rejection after kidney transplantation. METHODS This four-step framework consists of: 1) approximate rigid registration, 2) cell and anatomical structure segmentation 3) fusion of information from different stainings using a newly developed registration algorithm 4) feature extraction. RESULTS Each step of the framework is validated independently both quantitatively and qualitatively by pathologists. An illustration of the different types of features that can be extracted is presented. CONCLUSION The proposed generic framework allows for the analysis of the micro-environment surrounding large structures that can be segmented (either manually or automatically). It is independent of the segmentation approach and is therefore applicable to a variety of biomedical research questions. SIGNIFICANCE Chronic tissue remodelling processes after kidney transplantation can result in interstitial fibrosis and tubular atrophy (IFTA) and glomerulosclerosis. This pipeline provides tools to quantitatively analyse, in the same spatial context, information from different consecutive WSIs and help researchers understand the complex underlying mechanisms leading to IFTA and glomerulosclerosis.
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Affiliation(s)
- Odyssee Merveille
- ICube, University of Strasbourg, CNRS (UMR 7357), Strasbourg, France; Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1294, F-69100, LYON, France.
| | - Thomas Lampert
- ICube, University of Strasbourg, CNRS (UMR 7357), Strasbourg, France
| | | | | | - Friedrich Feuerhake
- Institute of Pathology, Hannover Medical School, Germany; University Clinic, Freiburg, Germany
| | - Cédric Wemmert
- ICube, University of Strasbourg, CNRS (UMR 7357), Strasbourg, France
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10
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Suárez Fernández ML, Ridao Cano N, Álvarez Santamarta L, Gago Fraile M, Blake O, Díaz Corte C. A Current Review of the Etiology, Clinical Features, and Diagnosis of Urinary Tract Infection in Renal Transplant Patients. Diagnostics (Basel) 2021; 11:diagnostics11081456. [PMID: 34441390 PMCID: PMC8392421 DOI: 10.3390/diagnostics11081456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/26/2021] [Accepted: 08/05/2021] [Indexed: 12/23/2022] Open
Abstract
Urinary tract infection (UTI) represents the most common infection after kidney transplantation and remains a major cause of morbidity and mortality in kidney transplant (KT) recipients, with a potential impact on graft survival. UTIs after KT are usually caused by Gram-negative microorganisms. Other pathogens which are uncommon in the general population should be considered in KT patients, especially BK virus since an early diagnosis is necessary to improve the prognosis. UTIs following kidney transplantation are classified into acute simple cystitis, acute pyelonephritis/complicated UTI, and recurrent UTI, due to their different clinical presentation, prognosis, and management. Asymptomatic bacteriuria (ASB) represents a frequent finding after kidney transplantation, but ASB is considered to be a separate entity apart from UTI since it is not necessarily a disease state. In fact, current guidelines do not recommend routine screening and treatment of ASB in KT patients, since a beneficial effect has not been shown. Harmful effects such as the development of multidrug-resistant (MDR) bacteria and a higher incidence of Clostridium difficile diarrhea have been associated with the antibiotic treatment of ASB.
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Affiliation(s)
- María Luisa Suárez Fernández
- Unidad de Gestión Clínica de Nefrología, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (N.R.C.); (L.Á.S.); (M.G.F.); (C.D.C.)
- Correspondence:
| | - Natalia Ridao Cano
- Unidad de Gestión Clínica de Nefrología, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (N.R.C.); (L.Á.S.); (M.G.F.); (C.D.C.)
| | - Lucia Álvarez Santamarta
- Unidad de Gestión Clínica de Nefrología, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (N.R.C.); (L.Á.S.); (M.G.F.); (C.D.C.)
| | - María Gago Fraile
- Unidad de Gestión Clínica de Nefrología, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (N.R.C.); (L.Á.S.); (M.G.F.); (C.D.C.)
| | | | - Carmen Díaz Corte
- Unidad de Gestión Clínica de Nefrología, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (N.R.C.); (L.Á.S.); (M.G.F.); (C.D.C.)
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11
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Jobin K, Müller DN, Jantsch J, Kurts C. Sodium and its manifold impact on our immune system. Trends Immunol 2021; 42:469-479. [PMID: 33962888 DOI: 10.1016/j.it.2021.04.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 12/19/2022]
Abstract
The Western diet is rich in salt, and a high salt diet (HSD) is suspected to be a risk factor for cardiovascular diseases. It is now widely accepted that an experimental HSD can stimulate components of the immune system, potentially exacerbating certain autoimmune diseases, or alternatively, improving defenses against certain infections, such as cutaneous leishmaniasis. However, recent findings show that an experimental HSD may also aggravate other infections (e.g., pyelonephritis or systemic listeriosis). Here, we discuss the modulatory effects of a HSD on the microbiota, metabolic signaling, hormonal responses, local sodium concentrations, and their effects on various immune cell types in different tissues. We describe how these factors are integrated, resulting either in immune stimulation or suppression in various tissues and disease settings.
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Affiliation(s)
- Katarzyna Jobin
- Institute of Molecular Medicine and Experimental Immunology, University of Bonn, Bonn, Germany; Würzburg Institute of Systems Immunology, Max-Planck Research Group, University of Würzburg, Würzburg, Germany
| | - Dominik N Müller
- Experimental and Clinical Research Center (ECRC), a cooperation of Charité-Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, and Max Delbruck Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany; Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Jonathan Jantsch
- Institute of Clinical Microbiology and Hygiene, University Hospital of Regensburg and University of Regensburg, Regensburg, Germany.
| | - Christian Kurts
- Institute of Molecular Medicine and Experimental Immunology, University of Bonn, Bonn, Germany; Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Victoria, Australia.
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12
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Tian H, Wu J, Ma M. Implications of macrophage polarization in corneal transplantation rejection. Transpl Immunol 2020; 64:101353. [PMID: 33238187 DOI: 10.1016/j.trim.2020.101353] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/20/2020] [Accepted: 11/20/2020] [Indexed: 02/07/2023]
Abstract
Corneal transplantation rejection remains an urgent problem threatening the success rate of high-risk patients. Macrophages are involved in the rejection of corneal transplants. Macrophages have M1 and M2 phenotypes, classified according their response to external stimuli. Macrophage polarization, through which these distinct forms are activated, is not only involved in the occurrence and development of inflammation, tumors, and autoimmune and other diseases, but also participates in graft rejection. This study provides an overview of the types of macrophages and mechanisms of their polarization, and review current knowledge regarding their involvement in corneal transplantation and potential therapeutic applications. Consideration of the relationship between the direction of macrophage polarization and the determination of graft survival and how it can be modified, is important for the development of novel corneal anti-rejection therapies.
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Affiliation(s)
- Huiwen Tian
- Department of Ophthalmology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Jing Wu
- Department of Huiqiao Medical Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
| | - Ming Ma
- Department of Ophthalmology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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Tantisattamo E, Molnar MZ, Ho BT, Reddy UG, Dafoe DC, Ichii H, Ferrey AJ, Hanna RM, Kalantar-Zadeh K, Amin A. Approach and Management of Hypertension After Kidney Transplantation. Front Med (Lausanne) 2020; 7:229. [PMID: 32613001 PMCID: PMC7310511 DOI: 10.3389/fmed.2020.00229] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/04/2020] [Indexed: 12/14/2022] Open
Abstract
Hypertension is one of the most common cardiovascular co-morbidities after successful kidney transplantation. It commonly occurs in patients with other metabolic diseases, such as diabetes mellitus, hyperlipidemia, and obesity. The pathogenesis of post-transplant hypertension is complex and is a result of the interplay between immunological and non-immunological factors. Post-transplant hypertension can be divided into immediate, early, and late post-transplant periods. This classification can help clinicians determine the etiology and provide the appropriate management for these complex patients. Volume overload from intravenous fluid administration is common during the immediate post-transplant period and commonly contributes to hypertension seen early after transplantation. Immunosuppressive medications and donor kidneys are associated with post-transplant hypertension occurring at any time point after transplantation. Transplant renal artery stenosis (TRAS) and obstructive sleep apnea (OSA) are recognized but common and treatable causes of resistant hypertension post-transplantation. During late post-transplant period, chronic renal allograft dysfunction becomes an additional cause of hypertension. As these patients develop more substantial chronic kidney disease affecting their allografts, fibroblast growth factor 23 (FGF23) increases and is associated with increased cardiovascular and all-cause mortality in kidney transplant recipients. The exact relationship between increased FGF23 and post-transplant hypertension remains poorly understood. Blood pressure (BP) targets and management involve both non-pharmacologic and pharmacologic treatment and should be individualized. Until strong evidence in the kidney transplant population exists, a BP of <130/80 mmHg is a reasonable target. Similar to complete renal denervation in non-transplant patients, bilateral native nephrectomy is another treatment option for resistant post-transplant hypertension. Native renal denervation offers promising outcomes for controlling resistant hypertension with no significant procedure-related complications. This review addresses the epidemiology, pathogenesis, and specific etiologies of post-transplant hypertension including TRAS, calcineurin inhibitor effects, OSA, and failed native kidney. The cardiovascular and survival outcomes related to post-transplant hypertension and the utility of 24-h blood pressure monitoring will be briefly discussed. Antihypertensive medications and their mechanism of actions relevant to kidney transplantation will be highlighted. A summary of guidelines from different professional societies for BP targets and antihypertensive medications as well as non-pharmacological interventions, including bilateral native nephrectomy and native renal denervation, will be reviewed.
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Affiliation(s)
- Ekamol Tantisattamo
- Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA, United States.,Nephrology Section, Department of Medicine, Tibor Rubin Veterans Affairs Medical Center, VA Long Beach Healthcare System, Long Beach, CA, United States.,Section of Nephrology, Department of Internal Medicine, Multi-Organ Transplant Center, William Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, MI, United States
| | - Miklos Z Molnar
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, United States.,Methodist University Hospital Transplant Institute, Memphis, TN, United States.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Bing T Ho
- Division of Nephrology and Hypertension, Department of Medicine, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Uttam G Reddy
- Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA, United States.,Nephrology Section, Department of Medicine, Tibor Rubin Veterans Affairs Medical Center, VA Long Beach Healthcare System, Long Beach, CA, United States
| | - Donald C Dafoe
- Division of Transplantation, Department of Surgery, University of California Irvine School of Medicine, Orange, CA, United States
| | - Hirohito Ichii
- Division of Transplantation, Department of Surgery, University of California Irvine School of Medicine, Orange, CA, United States
| | - Antoney J Ferrey
- Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA, United States.,Nephrology Section, Department of Medicine, Tibor Rubin Veterans Affairs Medical Center, VA Long Beach Healthcare System, Long Beach, CA, United States
| | - Ramy M Hanna
- Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA, United States
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA, United States.,Nephrology Section, Department of Medicine, Tibor Rubin Veterans Affairs Medical Center, VA Long Beach Healthcare System, Long Beach, CA, United States
| | - Alpesh Amin
- Department of Medicine, University of California Irvine School of Medicine, Orange, CA, United States
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14
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Jobin K, Stumpf NE, Schwab S, Eichler M, Neubert P, Rauh M, Adamowski M, Babyak O, Hinze D, Sivalingam S, Weisheit C, Hochheiser K, Schmidt SV, Meissner M, Garbi N, Abdullah Z, Wenzel U, Hölzel M, Jantsch J, Kurts C. A high-salt diet compromises antibacterial neutrophil responses through hormonal perturbation. Sci Transl Med 2020; 12:12/536/eaay3850. [DOI: 10.1126/scitranslmed.aay3850] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 02/12/2020] [Indexed: 12/11/2022]
Abstract
The Western diet is rich in salt, which poses various health risks. A high-salt diet (HSD) can stimulate immunity through the nuclear factor of activated T cells 5 (Nfat5)–signaling pathway, especially in the skin, where sodium is stored. The kidney medulla also accumulates sodium to build an osmotic gradient for water conservation. Here, we studied the effect of an HSD on the immune defense against uropathogenic E. coli–induced pyelonephritis, the most common kidney infection. Unexpectedly, pyelonephritis was aggravated in mice on an HSD by two mechanisms. First, on an HSD, sodium must be excreted; therefore, the kidney used urea instead to build the osmotic gradient. However, in contrast to sodium, urea suppressed the antibacterial functionality of neutrophils, the principal immune effectors against pyelonephritis. Second, the body excretes sodium by lowering mineralocorticoid production via suppressing aldosterone synthase. This caused an accumulation of aldosterone precursors with glucocorticoid functionality, which abolished the diurnal adrenocorticotropic hormone–driven glucocorticoid rhythm and compromised neutrophil development and antibacterial functionality systemically. Consistently, under an HSD, systemic Listeria monocytogenes infection was also aggravated in a glucocorticoid-dependent manner. Glucocorticoids directly induced Nfat5 expression, but pharmacological normalization of renal Nfat5 expression failed to restore the antibacterial defense. Last, healthy humans consuming an HSD for 1 week showed hyperglucocorticoidism and impaired antibacterial neutrophil function. In summary, an HSD suppresses intrarenal neutrophils Nfat5-independently by altering the local microenvironment and systemically by glucocorticoid-mediated immunosuppression. These findings argue against high-salt consumption during bacterial infections.
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Affiliation(s)
- Katarzyna Jobin
- Institute of Experimental Immunology, University Hospital of Bonn, Rheinische Friedrich Wilhelm University, 53127 Bonn, Germany
- Institute for Systems Immunology, Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Natascha E. Stumpf
- Institute of Experimental Immunology, University Hospital of Bonn, Rheinische Friedrich Wilhelm University, 53127 Bonn, Germany
| | - Sebastian Schwab
- Institute of Experimental Immunology, University Hospital of Bonn, Rheinische Friedrich Wilhelm University, 53127 Bonn, Germany
- Medizinische Klinik I, University Hospital of Bonn, Rheinische Friedrich Wilhelm University, 53127 Bonn, Germany
| | - Melanie Eichler
- Institute of Experimental Immunology, University Hospital of Bonn, Rheinische Friedrich Wilhelm University, 53127 Bonn, Germany
| | - Patrick Neubert
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Manfred Rauh
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Loschgestraβe 15, 91054 Erlangen, Germany
| | - Marek Adamowski
- Institute of Experimental Immunology, University Hospital of Bonn, Rheinische Friedrich Wilhelm University, 53127 Bonn, Germany
| | - Olena Babyak
- Institute of Experimental Immunology, University Hospital of Bonn, Rheinische Friedrich Wilhelm University, 53127 Bonn, Germany
| | - Daniel Hinze
- Institute of Experimental Oncology, University Hospital of Bonn, Rheinische Friedrich Wilhelm University, Bonn, Germany
| | - Sugirthan Sivalingam
- Institute of Experimental Oncology, University Hospital of Bonn, Rheinische Friedrich Wilhelm University, Bonn, Germany
| | - Christina Weisheit
- Institute of Experimental Immunology, University Hospital of Bonn, Rheinische Friedrich Wilhelm University, 53127 Bonn, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Bonn, Rheinische Friedrich Wilhelm University, 53127 Bonn, Germany
| | - Katharina Hochheiser
- Institute of Experimental Immunology, University Hospital of Bonn, Rheinische Friedrich Wilhelm University, 53127 Bonn, Germany
| | - Susanne V. Schmidt
- Institute of Innate Immunity, University Hospital of Bonn, Rheinische Friedrich Wilhelm University, 53127 Bonn, Germany
| | - Mirjam Meissner
- Institute of Experimental Immunology, University Hospital of Bonn, Rheinische Friedrich Wilhelm University, 53127 Bonn, Germany
| | - Natalio Garbi
- Institute of Experimental Immunology, University Hospital of Bonn, Rheinische Friedrich Wilhelm University, 53127 Bonn, Germany
| | - Zeinab Abdullah
- Institute of Experimental Immunology, University Hospital of Bonn, Rheinische Friedrich Wilhelm University, 53127 Bonn, Germany
| | - Ulrich Wenzel
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Michael Hölzel
- Institute of Experimental Oncology, University Hospital of Bonn, Rheinische Friedrich Wilhelm University, Bonn, Germany
| | - Jonathan Jantsch
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Christian Kurts
- Institute of Experimental Immunology, University Hospital of Bonn, Rheinische Friedrich Wilhelm University, 53127 Bonn, Germany
- Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, VIC 3010, Australia
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15
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Fehrenbach DJ, Mattson DL. Inflammatory macrophages in the kidney contribute to salt-sensitive hypertension. Am J Physiol Renal Physiol 2020; 318:F544-F548. [PMID: 31984790 DOI: 10.1152/ajprenal.00454.2019] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This review will highlight recent studies that have investigated the relationship between Na+, renal macrophage polarization, and renal damage. A hyperosmotic environment drives the macrophage toward a proinflammatory phenotype and away from an anti-inflammatory phenotype. Animal models of salt-sensitive hypertension demonstrate a characteristic infiltration of macrophages into the kidney that is greatly reduced when blood pressure is lowered. Because general immunosuppression or macrophage depletion leads to a host of adverse side effects, more recent studies have modulated the interaction of specific signaling molecules, including NOD-like receptor family pyrin domain-containing 3, chemokine (C-X-C motif) ligand 16, and VEGF, to prevent the end-organ renal damage that accumulates in salt-sensitive disease.
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Affiliation(s)
- Daniel J Fehrenbach
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Physiology, Augusta University and the Medical College of Georgia, Augusta, Georgia
| | - David L Mattson
- Department of Physiology, Augusta University and the Medical College of Georgia, Augusta, Georgia
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