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Levitsky J, Baker TB, Jie C, Ahya S, Levin M, Friedewald J, Al-Saden P, Salomon DR, Abecassis MM. Plasma protein biomarkers enhance the clinical prediction of kidney injury recovery in patients undergoing liver transplantation. Hepatology 2014; 60:2017-26. [PMID: 25078558 DOI: 10.1002/hep.27346] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 07/28/2014] [Indexed: 12/23/2022]
Abstract
UNLABELLED Biomarkers predictive of recovery from acute kidney injury (AKI) after liver transplantation (LT) could enhance decision algorithms regarding the need for liver-kidney transplantation or renal sparing regimens. Multianalyte plasma/urine kidney injury protein panels were performed immediately before and 1 month post-LT in an initial test group divided by reversible pre-LT AKI (rAKI = post-LT renal recovery) versus no AKI (nAKI). This was followed by a larger validation set that included an additional group: irreversible pre-LT AKI (iAKI = no post-LT renal recovery). In the test group (n = 16), six pre-LT plasma (not urine) kidney injury proteins (osteopontin [OPN], neutrophil gelatinase-associated lipocalin, cystatin C, trefoil factor 3, tissue inhibitor of metalloproteinase [TIMP]-1, and β-2-microglobulin) were higher in rAKI versus nAKI (P < 0.05) and returned to normal values with renal recovery post-LT. In the validation set (n = 46), a number of proteins were significantly higher in both rAKI and iAKI versus nAKI. However, only pre-LT plasma OPN (P = 0.009) and TIMP-1 (P = 0.019) levels were significantly higher in rAKI versus iAKI. Logistic regression modeling was used to correlate the probability of post-LT rAKI, factoring in both pre-LT protein markers and clinical variables. A combined model including elevated OPN and TIMP-1 levels, age <57, and absence of diabetes had the highest area under the curve of 0.82, compared to protein-only and clinical variable-only models. CONCLUSION These data suggest that plasma protein profiles might improve the prediction of pre-LT kidney injury recovery after LT. However, multicenter, prospective studies are needed to validate these findings and ultimately test the value of such protein panels in perioperative management and decision making.
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Affiliation(s)
- Josh Levitsky
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL
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Kühnisch J, Seto J, Lange C, Stumpp S, Kobus K, Grohmann J, Elefteriou F, Fratzl P, Mundlos S, Kolanczyk M. Neurofibromin inactivation impairs osteocyte development in Nf1Prx1 and Nf1Col1 mouse models. Bone 2014; 66:155-62. [PMID: 24947449 DOI: 10.1016/j.bone.2014.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/06/2014] [Accepted: 06/09/2014] [Indexed: 12/18/2022]
Abstract
Neurofibromin has been identified as a critical regulator of osteoblast differentiation. Osteoblast specific inactivation of neurofibromin in mice results in a high bone mass phenotype and hyperosteoidosis. Here, we show that inactivation of the Nf1 gene also impairs osteocyte development. We analyzed cortical bone tissue in two conditional mouse models, Nf1Prx1 and Nf1Col1, for morphological and molecular effects. Backscattered electron microscopy revealed significantly enlarged osteocyte lacunae in Nf1Prx1 and Nf1Col1 mice (level E2: ctrl=1.90±0.52%, Nf1Prx1=3.40±0.95%; ctrl 1.60±0.47%, Nf1Col1 2.46±0.91%). Moreover, the osteocyte lacunae appeared misshaped in Nf1Prx1 and Nf1Col1 mice as indicated by increased Feret ratios. Strongest osteocyte and dendritic network disorganization was observed in proximity of muscle attachment sites in Nf1Prx1 humeri. In contrast to control cells, Nf1Prx1 osteocytes contained abundant cytosolic vacuoles and accumulated immature organic matrix within the perilacunar space, a phenotype reminiscent of the hyperosteoidosis shown Nf1 deficient mice. Cortical bone lysates further revealed approx. twofold upregulated MAPK signalling in osteocytes of Nf1Prx1 mice. This was associated with transcriptional downregulation of collagens and genes involved in mechanical sensing in Nf1Prx1 and Nf1Col1 bone tissue. In contrast, matrix gla protein (MGP), phosphate regulating endopeptidase homolog, X-linked (PHEX), and genes involved in lipid metabolism were upregulated. In line with previously described hyperactivation of Nf1 deficient osteoblasts, systemic plasma levels of the bone formation markers osteocalcin (OCN) and procollagen typ I N-propeptide (PINP) were approx. twofold increased in Nf1Prx1 mice. Histochemical and molecular analysis ascertained that osteocytes in Nf1Prx1 cortical bone were viable and did not undergo apoptosis or autophagy. We conclude that loss of neurofibromin is not only critical for osteoblasts but also hinders normal osteocyte development. These findings expand the effect of neurofibromin onto yet another cell type where it is likely involved in the regulation of mechanical sensing, bone matrix composition and mechanical resistance of bone tissue.
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Affiliation(s)
- Jirko Kühnisch
- Institute for Medical Genetics and Human Genetics, Charité, Universitätsmedizin Berlin, Berlin, Germany; FG Development & Disease, Max Planck Institute for Molecular Genetics, Berlin, Germany.
| | - Jong Seto
- Department of Biomaterials, Max Planck Institute for Colloids and Interfaces, Potsdam, Germany; Department of Chemistry, École Normale Superiéure, 24 rue Lhomond, Paris 75005, France
| | - Claudia Lange
- Department of Biomaterials, Max Planck Institute for Colloids and Interfaces, Potsdam, Germany; Institut für Physiologische Chemie, MTZ, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Sabine Stumpp
- Institute for Medical Genetics and Human Genetics, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Karolina Kobus
- FG Development & Disease, Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - Julia Grohmann
- FG Development & Disease, Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - Florent Elefteriou
- Department of Medicine, Pharmacology and Cancer Biology, Center for Bone Biology, Vanderbilt University Medical Center, Nashville TN, USA
| | - Peter Fratzl
- Department of Biomaterials, Max Planck Institute for Colloids and Interfaces, Potsdam, Germany; Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany
| | - Stefan Mundlos
- Institute for Medical Genetics and Human Genetics, Charité, Universitätsmedizin Berlin, Berlin, Germany; FG Development & Disease, Max Planck Institute for Molecular Genetics, Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany
| | - Mateusz Kolanczyk
- Institute for Medical Genetics and Human Genetics, Charité, Universitätsmedizin Berlin, Berlin, Germany; FG Development & Disease, Max Planck Institute for Molecular Genetics, Berlin, Germany.
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Kühnisch J, Seto J, Lange C, Schrof S, Stumpp S, Kobus K, Grohmann J, Kossler N, Varga P, Osswald M, Emmerich D, Tinschert S, Thielemann F, Duda G, Seifert W, el Khassawna T, Stevenson DA, Elefteriou F, Kornak U, Raum K, Fratzl P, Mundlos S, Kolanczyk M. Multiscale, converging defects of macro-porosity, microstructure and matrix mineralization impact long bone fragility in NF1. PLoS One 2014; 9:e86115. [PMID: 24465906 PMCID: PMC3897656 DOI: 10.1371/journal.pone.0086115] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 12/05/2013] [Indexed: 01/01/2023] Open
Abstract
Bone fragility due to osteopenia, osteoporosis or debilitating focal skeletal dysplasias is a frequent observation in the Mendelian disease Neurofibromatosis type 1 (NF1). To determine the mechanisms underlying bone fragility in NF1 we analyzed two conditional mouse models, Nf1Prx1 (limb knock-out) and Nf1Col1 (osteoblast specific knock-out), as well as cortical bone samples from individuals with NF1. We examined mouse bone tissue with micro-computed tomography, qualitative and quantitative histology, mechanical tensile analysis, small-angle X-ray scattering (SAXS), energy dispersive X-ray spectroscopy (EDX), and scanning acoustic microscopy (SAM). In cortical bone of Nf1Prx1 mice we detected ectopic blood vessels that were associated with diaphyseal mineralization defects. Defective mineral binding in the proximity of blood vessels was most likely due to impaired bone collagen formation, as these areas were completely devoid of acidic matrix proteins and contained thin collagen fibers. Additionally, we found significantly reduced mechanical strength of the bone material, which was partially caused by increased osteocyte volume. Consistent with these observations, bone samples from individuals with NF1 and tibial dysplasia showed increased osteocyte lacuna volume. Reduced mechanical properties were associated with diminished matrix stiffness, as determined by SAM. In line with these observations, bone tissue from individuals with NF1 and tibial dysplasia showed heterogeneous mineralization and reduced collagen fiber thickness and packaging. Collectively, the data indicate that bone fragility in NF1 tibial dysplasia is partly due to an increased osteocyte-related micro-porosity, hypomineralization, a generalized defect of organic matrix formation, exacerbated in the regions of tensional and bending force integration, and finally persistence of ectopic blood vessels associated with localized macro-porotic bone lesions.
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Affiliation(s)
- Jirko Kühnisch
- Institute for Medical Genetics and Human Genetics, Charité - Universitätsmedizin Berlin, Berlin, Germany
- FG Development & Disease, Max Planck Institute for Molecular Genetics, Berlin, Germany
- * E-mail: (JK); (MK)
| | - Jong Seto
- Department of Biomaterials, Max Planck Institute for Colloids and Interfaces, Potsdam, Germany
- Department of Chemistry, Universität Konstanz, Konstanz, Germany
| | - Claudia Lange
- Department of Biomaterials, Max Planck Institute for Colloids and Interfaces, Potsdam, Germany
- Institut für Physiologische Chemie, MTZ, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Susanne Schrof
- Julius Wolff Institute & Brandenburg School of Regenerative Therapies, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sabine Stumpp
- Institute for Medical Genetics and Human Genetics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Karolina Kobus
- FG Development & Disease, Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - Julia Grohmann
- FG Development & Disease, Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - Nadine Kossler
- FG Development & Disease, Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - Peter Varga
- Julius Wolff Institute & Brandenburg School of Regenerative Therapies, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Monika Osswald
- FG Development & Disease, Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - Denise Emmerich
- Institute for Medical Genetics and Human Genetics, Charité - Universitätsmedizin Berlin, Berlin, Germany
- FG Development & Disease, Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - Sigrid Tinschert
- Division für Humangenetik, Medizinische Universität Innsbruck, Innsbruck, Austria
- Institut für Klinische Genetik, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Falk Thielemann
- Klinik für Orthopädie, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Georg Duda
- Julius Wolff Institute & Brandenburg School of Regenerative Therapies, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin-Brandenburg Center for Regenerative Therapies, Berlin, Germany
| | - Wenke Seifert
- Institute for Vegetative Anatomy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thaqif el Khassawna
- Laboratory of Experimental Trauma Surgery Giessen, Justus-Liebig University Giessen, Giessen, Germany
| | - David A. Stevenson
- University of Utah, Department of Pediatrics, Division of Medical Genetics, Salt Lake City, Utah, United States of America
| | - Florent Elefteriou
- Department of Medicine, Pharmacology and Cancer Biology, Center for Bone Biology, Vanderbilt University - Medical Center, Nashville, Tennessee, United States of America
| | - Uwe Kornak
- Institute for Medical Genetics and Human Genetics, Charité - Universitätsmedizin Berlin, Berlin, Germany
- FG Development & Disease, Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - Kay Raum
- Julius Wolff Institute & Brandenburg School of Regenerative Therapies, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Fratzl
- Department of Biomaterials, Max Planck Institute for Colloids and Interfaces, Potsdam, Germany
- Berlin-Brandenburg Center for Regenerative Therapies, Berlin, Germany
| | - Stefan Mundlos
- Institute for Medical Genetics and Human Genetics, Charité - Universitätsmedizin Berlin, Berlin, Germany
- FG Development & Disease, Max Planck Institute for Molecular Genetics, Berlin, Germany
- Berlin-Brandenburg Center for Regenerative Therapies, Berlin, Germany
| | - Mateusz Kolanczyk
- Institute for Medical Genetics and Human Genetics, Charité - Universitätsmedizin Berlin, Berlin, Germany
- FG Development & Disease, Max Planck Institute for Molecular Genetics, Berlin, Germany
- * E-mail: (JK); (MK)
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Chappard D, Baslé MF, Legrand E, Audran M. New laboratory tools in the assessment of bone quality. Osteoporos Int 2011; 22:2225-40. [PMID: 21347743 DOI: 10.1007/s00198-011-1573-6] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 01/31/2011] [Indexed: 01/22/2023]
Abstract
Bone quality is a complex set of intricated and interdependent factors that influence bone strength. A number of methods have emerged to measure bone quality, taking into account the organic or the mineral phase of the bone matrix, in the laboratory. Bone quality is a complex set of different factors that are interdependent. The bone matrix organization can be described at five different levels of anatomical organization: nature (organic and mineral), texture (woven or lamellar), structure (osteons in the cortices and arch-like packets in trabecular bone), microarchitecture, and macroarchitecture. Any change in one of these levels can alter bone quality. An altered bone remodeling can affect bone quality by influencing one or more of these factors. We have reviewed here the main methods that can be used in the laboratory to explore bone quality on bone samples. Bone remodeling can be evaluated by histomorphometry; microarchitecture is explored in 2D on histological sections and in 3D by microCT or synchrotron. Microradiography and scanning electron microscopy in the backscattered electron mode can measure the mineral distribution; Raman and Fourier-transformed infra-red spectroscopy and imaging can simultaneously explore the organic and mineral phase of the matrix on multispectral images; scanning acoustic microscopy and nanoindentation provide biomechanical information on individual trabeculae. Finally, some histological methods (polarization, surface staining, fluorescence, osteocyte staining) may also be of interest in the understanding of quality as a component of bone fragility. A growing number of laboratory techniques are now available. Some of them have been described many years ago and can find a new youth; others having benefited from improvements in physical and computer techniques are now available.
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Affiliation(s)
- D Chappard
- INSERM, U922-IRIS-IBS Institut de Biologie en Santé, CHU d'Angers, 49933, Angers, France.
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