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Rupprecht H, Catanese L, Amann K, Hengel FE, Huber TB, Latosinska A, Lindenmeyer MT, Mischak H, Siwy J, Wendt R, Beige J. Assessment and Risk Prediction of Chronic Kidney Disease and Kidney Fibrosis Using Non-Invasive Biomarkers. Int J Mol Sci 2024; 25:3678. [PMID: 38612488 PMCID: PMC11011737 DOI: 10.3390/ijms25073678] [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: 02/07/2024] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Effective management of chronic kidney disease (CKD), a major health problem worldwide, requires accurate and timely diagnosis, prognosis of progression, assessment of therapeutic efficacy, and, ideally, prediction of drug response. Multiple biomarkers and algorithms for evaluating specific aspects of CKD have been proposed in the literature, many of which are based on a small number of samples. Based on the evidence presented in relevant studies, a comprehensive overview of the different biomarkers applicable for clinical implementation is lacking. This review aims to compile information on the non-invasive diagnostic, prognostic, and predictive biomarkers currently available for the management of CKD and provide guidance on the application of these biomarkers. We specifically focus on biomarkers that have demonstrated added value in prospective studies or those based on prospectively collected samples including at least 100 subjects. Published data demonstrate that several valid non-invasive biomarkers of potential value in the management of CKD are currently available.
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Affiliation(s)
- Harald Rupprecht
- Department of Nephrology, Angiology and Rheumatology, Klinikum Bayreuth GmbH, 95445 Bayreuth, Germany; (H.R.); (L.C.)
- Department of Nephrology, Medizincampus Oberfranken, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Kuratorium for Dialysis and Transplantation (KfH) Bayreuth, 95445 Bayreuth, Germany
| | - Lorenzo Catanese
- Department of Nephrology, Angiology and Rheumatology, Klinikum Bayreuth GmbH, 95445 Bayreuth, Germany; (H.R.); (L.C.)
- Department of Nephrology, Medizincampus Oberfranken, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Kuratorium for Dialysis and Transplantation (KfH) Bayreuth, 95445 Bayreuth, Germany
| | - Kerstin Amann
- Department of Nephropathology, Institute of Pathology, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany;
| | - Felicitas E. Hengel
- III Department of Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (F.E.H.); (T.B.H.); (M.T.L.)
- Hamburg Center for Kidney Health (HCKH), University Medical Center Hamburg Eppendorf, 20246 Hamburg, Germany
| | - Tobias B. Huber
- III Department of Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (F.E.H.); (T.B.H.); (M.T.L.)
- Hamburg Center for Kidney Health (HCKH), University Medical Center Hamburg Eppendorf, 20246 Hamburg, Germany
| | | | - Maja T. Lindenmeyer
- III Department of Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (F.E.H.); (T.B.H.); (M.T.L.)
- Hamburg Center for Kidney Health (HCKH), University Medical Center Hamburg Eppendorf, 20246 Hamburg, Germany
| | - Harald Mischak
- Mosaiques Diagnostics GmbH, 30659 Hannover, Germany; (A.L.); (H.M.); (J.S.)
| | - Justyna Siwy
- Mosaiques Diagnostics GmbH, 30659 Hannover, Germany; (A.L.); (H.M.); (J.S.)
| | - Ralph Wendt
- Department of Nephrology, Hospital St. Georg, 04129 Leipzig, Germany;
| | - Joachim Beige
- Department of Nephrology, Hospital St. Georg, 04129 Leipzig, Germany;
- Kuratorium for Dialysis and Transplantation (KfH) Renal Unit, Hospital St. Georg, 04129 Leipzig, Germany
- Department of Internal Medicine II, Martin-Luther-University Halle/Wittenberg, 06108 Halle (Saale), Germany
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Rao VS, Ivey-Miranda JB, Cox ZL, Moreno-Villagomez J, Testani JM. Association of Urine Galectin-3 With Cardiorenal Outcomes in Patients With Heart Failure. J Card Fail 2024; 30:340-346. [PMID: 37301248 PMCID: PMC10947725 DOI: 10.1016/j.cardfail.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Approaches to distinguishing pathological cardiorenal dysfunction in heart failure (HF) from functional/hemodynamically mediated changes in serum creatinine are needed. We investigated urine galectin-3 as a candidate biomarker of renal fibrosis and a prognostic indicator of cardiorenal dysfunction phenotypes. METHODS We measured urine galectin-3 in 2 contemporary HF cohorts: the Yale Transitional Care Clinic (YTCC) cohort (n = 132) and the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial (n = 434). We assessed the association of urine galectin-3 with all-cause mortality in both cohorts and the association with an established marker of renal tissue fibrosis, urinary amino-terminal propeptide of type III procollagen (PIIINP) in TOPCAT. RESULTS In the YTCC cohort, there was significant effect modification between higher urine galectin-3 and lower estimated glomerular filtration rates (eGFRs) (Pinteraction = 0.046), such that low eGFR levels had minimal prognostic importance if urine galectin-3 levels were low, but they were important and indicated high risk if urine galectin-3 levels were high. Similar observations were noted in the TOPCAT study (Pinteraction = 0.002). In TOPCAT, urine galectin-3 also positively correlated with urine PIIINP at both baseline (r = 0.43; P < 0.001) and at 12 months (r = 0.42; P < 0.001). CONCLUSIONS Urine galectin-3 levels correlated with an established biomarker of renal fibrosis in 2 cohorts and was able to differentiate high- vs low-risk phenotypes of chronic kidney disease in HF. These proof-of-concept results indicate that additional biomarker research to differentiate cardiorenal phenotypes is warranted.
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Affiliation(s)
- Veena S Rao
- Division of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Juan B Ivey-Miranda
- Division of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA; Heart Failure and Heart Transplant Clinic, Hospital de Cardiologia, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Zachary L Cox
- Department of Pharmacy Practice, Lipscomb University College of Pharmacy, Nashville, TN, USA; Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Julieta Moreno-Villagomez
- Division of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jeffrey M Testani
- Division of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA.
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Alp A, Saruhan E, Doğan E, Genek DG, Huddam B. Time to Change Our Viewpoints to Assess Renal Risks in Patients with Solitary Kidneys beyond Traditional Approaches? J Clin Med 2023; 12:6885. [PMID: 37959350 PMCID: PMC10649944 DOI: 10.3390/jcm12216885] [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: 09/22/2023] [Revised: 10/26/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
Solitary functioning kidney (SFK) can be defined as the absence or hypofunction of a kidney due to acquired or congenital reasons. A congenital solitary functioning kidney (cSFK) is more common than is an acquired one (aSFK) and is characterized by the anatomical absence (agenesis) or hypofunction (hypoplasia; hypodysplasia) of one kidney from birth. Among the acquired causes, the most important is nephrectomy (Nx) (due to the donor, trauma or mass resection). Patients with SFK are at risk for the development of chronic kidney disease (CKD) in the long term. This risk potential is also significantly affected by hypertension. The relationship between hypertension and subclinical chronic inflammation is a connection that has not yet been fully clarified pathogenetically, but there are many studies highlighting this association. In recent years, studies examining different fibrosis and inflammation biomarkers in terms of the evaluation and prediction of renal risks have become increasingly popular in the literature. Oxidative stress is known to play an important role in homocysteine-induced endothelial dysfunction and has been associated with hypertension. In our study, we aimed to investigate the relationship between ambulatory blood pressure monitoring (ABPM) and urinary/serum fibrosis and inflammatory markers in patients with SFK. We prospectively investigated the relationship between ABPM results and soluble urokinase plasminogen activator receptor (suPAR), procollagen type III N-terminal peptide (PIIINP), homocysteine and other variables in 85 patients with SFK and compared them between cSFK and aSFK groups. In the etiology of SFK, a congenital or acquired origin may differ in terms of the significance of biomarkers. In particular, the serum homocysteine level may be associated with different clinical outcomes in patients with cSFK and aSFK.
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Affiliation(s)
- Alper Alp
- Department of Nephrology, Faculty of Medicine, Mugla Sıtkı Koçman University, 48000 Mugla, Turkey; (D.G.G.); (B.H.)
| | - Ercan Saruhan
- Department of Medical Biochemistry, Faculty of Medicine, Mugla Sıtkı Koçman University, 48000 Mugla, Turkey;
| | - Emrah Doğan
- Department of Radiology, Faculty of Medicine, Mugla Sıtkı Koçman University, 48000 Mugla, Turkey;
| | - Dilek Gibyeli Genek
- Department of Nephrology, Faculty of Medicine, Mugla Sıtkı Koçman University, 48000 Mugla, Turkey; (D.G.G.); (B.H.)
| | - Bülent Huddam
- Department of Nephrology, Faculty of Medicine, Mugla Sıtkı Koçman University, 48000 Mugla, Turkey; (D.G.G.); (B.H.)
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Klinkhammer BM, Boor P. Kidney fibrosis: Emerging diagnostic and therapeutic strategies. Mol Aspects Med 2023; 93:101206. [PMID: 37541106 DOI: 10.1016/j.mam.2023.101206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/25/2023] [Indexed: 08/06/2023]
Abstract
An increasing number of patients worldwide suffers from chronic kidney disease (CKD). CKD is accompanied by kidney fibrosis, which affects all compartments of the kidney, i.e., the glomeruli, tubulointerstitium, and vasculature. Fibrosis is the best predictor of progression of kidney diseases. Currently, there is no specific anti-fibrotic therapy for kidney patients and invasive renal biopsy remains the only option for specific detection and quantification of kidney fibrosis. Here we review emerging diagnostic approaches and potential therapeutic options for fibrosis. We discuss how translational research could help to establish fibrosis-specific endpoints for clinical trials, leading to improved patient stratification and potentially companion diagnostics, and facilitating and optimizing development of novel anti-fibrotic therapies for kidney patients.
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Affiliation(s)
| | - Peter Boor
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany; Electron Microscopy Facility, RWTH Aachen University Hospital, Aachen, Germany; Division of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany.
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5
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Yakupova EI, Abramicheva PA, Bocharnikov AD, Andrianova NV, Plotnikov EY. Biomarkers of the End-Stage Renal Disease Progression: Beyond the GFR. BIOCHEMISTRY. BIOKHIMIIA 2023; 88:1622-1644. [PMID: 38105029 DOI: 10.1134/s0006297923100164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 07/20/2023] [Accepted: 08/20/2023] [Indexed: 12/19/2023]
Abstract
Chronic kidney disease can progress to the end-stage renal disease (ESRD) characterized by a high risk of morbidity and mortality. ESRD requires immediate therapy or even dialysis or kidney transplantation, therefore, its timely diagnostics is critical for many patients. ESRD is associated with pathological changes, such as inflammation, fibrosis, endocrine disorders, and epigenetic changes in various cells, which could serve as ESRD markers. The review summarizes information on conventional and new ESRD biomarkers that can be assessed in kidney tissue, blood, and urine. Some biomarkers are specific to a particular pathology, while others are more universal. Here, we suggest several universal inflammatory, fibrotic, hormonal, and epigenetic markers indicative of severe deterioration of renal function and ESRD progression for improvement of ESRD diagnostics.
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Affiliation(s)
- Elmira I Yakupova
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, 119234, Russia.
| | - Polina A Abramicheva
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, 119234, Russia
| | - Alexey D Bocharnikov
- International School of Medicine of the Future, Sechenov First Moscow State Medical University, Moscow, 119992, Russia
| | - Nadezda V Andrianova
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, 119234, Russia
| | - Egor Y Plotnikov
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, 119234, Russia.
- Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Moscow, 117997, Russia
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Rende U, Guller A, Goldys EM, Pollock C, Saad S. Diagnostic and prognostic biomarkers for tubulointerstitial fibrosis. J Physiol 2023; 601:2801-2826. [PMID: 37227074 DOI: 10.1113/jp284289] [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: 01/09/2023] [Accepted: 05/23/2023] [Indexed: 05/26/2023] Open
Abstract
Renal fibrosis is the final common pathophysiological pathway in chronic kidney disease (CKD) regardless of the underlying cause of kidney injury. Tubulointerstitial fibrosis (TIF) is considered to be the key pathological predictor of CKD progression. Currently, the gold-standard tool to identify TIF is kidney biopsy, an invasive method that carries risks. Non-invasive diagnostics rely on an estimation of glomerular filtration rate and albuminuria to assess kidney function, but these fail to diagnose early CKD accurately or to predict progressive decline in kidney function. In this review, we summarize the current and emerging molecular biomarkers that have been studied in various clinical settings and in animal models of kidney disease and that are correlated with the degree of TIF. We examine the potential of these biomarkers to diagnose TIF non-invasively and to predict disease progression. We also examine the potential of new technologies and non-invasive diagnostic approaches in assessing TIF. Limitations of current and potential biomarkers are discussed and knowledge gaps identified.
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Affiliation(s)
- Umut Rende
- School of Biomedical Engineering, The University of New South Wales, Sydney, NSW, Australia
| | - Anna Guller
- Macquarie Medical School, Faculty of Medicine, Health & Human Sciences, Macquarie University, NSW, Australia
| | - Ewa M Goldys
- School of Biomedical Engineering, The University of New South Wales, Sydney, NSW, Australia
| | - Carol Pollock
- Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Sonia Saad
- Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia
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7
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Rybi Szumińska A, Wasilewska A, Kamianowska M. Protein Biomarkers in Chronic Kidney Disease in Children-What Do We Know So Far? J Clin Med 2023; 12:3934. [PMID: 37373629 DOI: 10.3390/jcm12123934] [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: 04/03/2023] [Revised: 05/26/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Chronic kidney disease (CKD) in children is a major concern of medical care and public health as it is related to high morbidity and mortality due to progression to end-stage kidney disease (ESKD). It is essential to identify patients with a risk of developing CKD to implement therapeutic interventions. Unfortunately, conventional markers of CKD, such as serum creatinine, glomerular filtration rate (GFR) and proteinuria, have many limitations in serving as an early and specific diagnostic tool for this condition. Despite the above, they are still the most frequently utilized as we do not have better. Studies from the last decade identified multiple CKD blood and urine protein biomarkers but mostly assessed the adult population. This article outlines some recent achievements and new perspectives in finding a set of protein biomarkers that might improve our ability to prognose CKD progression in children, monitor the response to treatment, or even become a potential therapeutic target.
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Affiliation(s)
- Agnieszka Rybi Szumińska
- Department of Peadiatrics and Nephrology, Medical University of Bialystok, Waszyngtona 17, 15-297 Bialystok, Poland
| | - Anna Wasilewska
- Department of Peadiatrics and Nephrology, Medical University of Bialystok, Waszyngtona 17, 15-297 Bialystok, Poland
| | - Monika Kamianowska
- Department of Peadiatrics and Nephrology, Medical University of Bialystok, Waszyngtona 17, 15-297 Bialystok, Poland
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8
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Recent Developments in the Evaluation and Management of Cardiorenal Syndrome: A Comprehensive Review. Curr Probl Cardiol 2023; 48:101509. [PMID: 36402213 DOI: 10.1016/j.cpcardiol.2022.101509] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
Abstract
Cardiorenal syndrome (CRS) is an increasingly recognized diagnostic entity associated with high morbidity and mortality among acutely ill heart failure (HF) patients with acute and/ or chronic kidney diseases (CKD). While traditionally viewed as a state of decline in glomerular filtration rate (GFR) due to decreased renal perfusion, mainly due to therapeutic interventions to relieve congestive in HF, recent insights into the underlying pathophysiologic mechanisms of CRS led to a broader definition and further classification of CRS into 5 distinct types. In this comprehensive review, we discuss the classification of CRS, highlighting the underlying common pathogenetic pathways of heart failure and kidney injury, including increased congestion, neurohormonal dysregulation, oxidative stress as well as inflammation, and cytokine storm that are particularly evident in COVID-19 patients with multiorgan failure and also in those with other disorders including sepsis, systemic lupus erythematosus and amyloidosis. In this review we also present the recent advances in the diagnostic strategies of CRS including cardiac and renal biomarkers as well as advanced cardiac and renal imaging techniques that are available to aid in the diagnosis as well as in the prognostication of this disorder. Finally, we discuss the various therapeutic options available to-date, including fluid optimization, hemofiltration, renal replacement therapy as well as the role of SGLT2 inhibitors in light of recent data from RCTs. It is important to note that, CRS population are either excluded or underrepresented, at best, in major RCTs and therefore, therapeutic recommendations are largely extrapolated from HF and CKD clinical trials.
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Amatruda JG, Katz R, Sarnak MJ, Gutierrez OM, Greenberg JH, Cushman M, Waikar S, Parikh CR, Schelling JR, Jogalekar MP, Bonventre JV, Vasan RS, Kimmel PL, Shlipak MG, Ix JH. Biomarkers of Kidney Tubule Disease and Risk of End-Stage Kidney Disease in Persons With Diabetes and CKD. Kidney Int Rep 2022; 7:1514-1523. [PMID: 35812302 PMCID: PMC9263389 DOI: 10.1016/j.ekir.2022.03.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/18/2022] [Accepted: 03/28/2022] [Indexed: 12/21/2022] Open
Abstract
Introduction Tubulointerstitial damage in diabetes and chronic kidney disease (CKD) is poorly captured by estimated glomerular filtration rate (eGFR) and albuminuria. Urine biomarkers of kidney health may better elucidate disease progression in persons with diabetes and CKD. Methods Per case-cohort design, we randomly selected a subcohort of 560 study participants of the REasons for Geographic And Racial Differences in Stroke (REGARDS) study from 1092 adults with diabetes and baseline eGFR <60 ml/min per 1.73 m2 and registered a total of 161 end-stage kidney disease (ESKD) cases (n = 93 from the subcohort; n = 68 from outside the subcohort) during 4.3 ± 2.7 years mean follow-up. We measured urine biomarkers of kidney tubule injury (kidney injury molecule-1 [KIM-1]), inflammation and fibrosis (monocyte chemoattractant protein-1 [MCP-1]), repair (chitinase-3-like protein 1 [YKL-40]), and tubule function, including reabsorption (alpha-1-microglobulin [α1m]) and synthetic capacity (epidermal growth factor [EGF] and uromodulin [UMOD]). Weighted Cox regression models estimated ESKD risk adjusting for demographics, ESKD risk factors, and baseline eGFR and urine albumin. Least absolute shrinkage and selection operator (LASSO) regression identified a subset of biomarkers most strongly associated with ESKD. Results At baseline, subcohort participants had mean age of 70 ± 9 years, mean eGFR of 40 ±13 ml/min per 1.73 m2, and median urine albumin-to-creatinine ratio of 33 (interquartile range 10-213) mg/g. Adjusting for baseline eGFR and albuminuria, each 2-fold higher urine KIM-1 (hazard ratio = 1.43 [95% CI: 1.17-1.75]), α1m (hazard ratio = 1.47 [1.19-1.82]), and MCP-1 (hazard ratio = 1.27 [1.06-1.53]) were independently associated with ESKD. LASSO retained KIM-1 and α1m for associations with ESKD. Conclusion Among adults with diabetes and eGFR <60 ml/min per 1.73 m2, higher urine KIM-1, α1m, and MCP-1 are independently associated with incident ESKD, providing insight into kidney disease progression in persons with diabetes and CKD.
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Affiliation(s)
- Jonathan G. Amatruda
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, San Francisco, California, USA
| | - Ronit Katz
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
| | - Mark J. Sarnak
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Orlando M. Gutierrez
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jason H. Greenberg
- Section of Nephrology, Department of Pediatrics, Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Sushrut Waikar
- Section of Nephrology, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Chirag R. Parikh
- Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jeffrey R. Schelling
- Division of Nephrology, Department of Internal Medicine, MetroHealth System, Cleveland, Ohio, USA
- Department of Physiology and Biophysics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Manasi P. Jogalekar
- Division of Renal Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph V. Bonventre
- Division of Renal Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ramachandran S. Vasan
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Paul L. Kimmel
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael G. Shlipak
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, San Francisco, California, USA
- Department of Medicine, San Francisco VA Health Care System, San Francisco, California, USA
| | - Joachim H. Ix
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - CKD Biomarkers Consortium
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, San Francisco, California, USA
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Section of Nephrology, Department of Pediatrics, Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
- Section of Nephrology, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
- Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Nephrology, Department of Internal Medicine, MetroHealth System, Cleveland, Ohio, USA
- Department of Physiology and Biophysics, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Division of Renal Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
- Department of Medicine, San Francisco VA Health Care System, San Francisco, California, USA
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
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10
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Park S, Yang SH, Kim J, Cho S, Yang J, Min SI, Ha J, Jeong CW, Bhoo SH, Kim YC, Kim DK, Oh KH, Joo KW, Kim YS, Moon KC, Song EY, Lee H. Clinical Significances of Anti-Collagen Type I and Type III Antibodies in Antibody-Mediated Rejection. Transpl Int 2022; 35:10099. [PMID: 35634584 PMCID: PMC9131656 DOI: 10.3389/ti.2022.10099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 04/13/2022] [Indexed: 12/02/2022]
Abstract
It is important to determine the clinical significance of non-human leukocyte antigen (HLA) antibodies and their association with antibody-mediated rejection (ABMR) of kidney allografts. We collected post-transplant sera from 68 ABMR patients, 67 T-cell mediated rejection (TCMR) patients, and 83 control subjects without rejection, and determined the titers of 39 non-HLA antibodies including antibodies for angiotensin II receptor type I and MICA. We compared all these non-HLA antibody titers among the study groups. Then, we investigated their association with the risk of death-censored graft failure in ABMR cases. Among the antibodies evaluated, anti-collagen type I (p = 0.001) and type III (p < 0.001) antibody titers were significantly higher in ABMR cases than in both TCMR cases and no-rejection controls. Both anti-collagen type I [per 1 standard deviation (SD), adjusted odds ratio (OR), 11.72 (2.73-76.30)] and type III [per 1 SD, adjusted OR, 6.22 (1.91-31.75)] antibodies were significantly associated with the presence of ABMR. Among ABMR cases, a higher level of anti-collagen type I [per 1 SD, adjusted hazard ratio (HR), 1.90 (1.32-2.75)] or type III per 1 SD, [adjusted HR, 1.57 (1.15-2.16)] antibody was associated with a higher risk of death-censored graft failure. In conclusion, post-transplant anti-collagen type I and type III antibodies may be novel non-HLA antibodies related to ABMR of kidney allografts.
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Affiliation(s)
- Sehoon Park
- Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam-si, South Korea,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung-Hee Yang
- Kidney Research Institute, Seoul National University, Seoul, South Korea
| | - Jiyeon Kim
- Kidney Research Institute, Seoul National University, Seoul, South Korea
| | - Semin Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jaeseok Yang
- Transplantation Center, Department of Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Sang-Il Min
- Transplantation Center, Department of Surgery, Seoul National University Hospital, Seoul, South Korea,Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Jongwon Ha
- Transplantation Center, Department of Surgery, Seoul National University Hospital, Seoul, South Korea,Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, South Korea
| | - Seong Hee Bhoo
- Department of Genetic Engineering and Graduate School of Biotechnology, Kyung Hee University, Yongin-si, South Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea,Deparment of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Dong Ki Kim
- Kidney Research Institute, Seoul National University, Seoul, South Korea,Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea,Deparment of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea,Deparment of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Kwon Wook Joo
- Kidney Research Institute, Seoul National University, Seoul, South Korea,Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea,Deparment of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Yon Su Kim
- Kidney Research Institute, Seoul National University, Seoul, South Korea,Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea,Deparment of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung Chul Moon
- Department of Pathology, Seoul National University Hospital, Seoul, South Korea
| | - Eun Young Song
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, South Korea,*Correspondence: Eun Young Song, , orcid.org/0000-0003-1286-9611; Hajeong Lee, , orcid.org/0000-0002-1873-1587
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea,Deparment of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea,*Correspondence: Eun Young Song, , orcid.org/0000-0003-1286-9611; Hajeong Lee, , orcid.org/0000-0002-1873-1587
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11
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Kuźmiuk-Glembin I, Heleniak Z, Pięta R, Głyda M, Lizakowski S, Renke M, Konopa J, Chamienia A, Biedunkiewicz B, Rutkowski B, Tylicki L, Dębska-Ślizień A. Short-term Effects of Losartan on Cardiovascular Risk and Allograft Injury Biomarkers in Kidney Transplant Recipients. Transplant Proc 2022; 54:981-988. [PMID: 35346485 DOI: 10.1016/j.transproceed.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/03/2022] [Accepted: 02/18/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND There is a controversy over the renoprotective and cardioprotective effects of renin-angiotensin-aldosterone system blockade in kidney transplant recipients (KTRs). The aim of the study was to evaluate the short-term effects of losartan on allograft injury, cardiovascular risk biomarkers and safety of the treatment in KTRs. METHODS An interim analysis of a prospective, open, multicenter, controlled clinical trial CELART (Cardiovascular Effects of Losartan After Renal Transplantation) was performed. KTRs were allocated to losartan (L) 50 to 100 mg or standard hypotensive treatment (ST) group to reach target blood pressure (BP) <140/90 mm Hg. The short-term effects of the therapy were evaluated after 6 months: estimated glomerular filtration rate (eGFR), albuminuria, the intrarenal fibrosis biomarkers: urine excretion of transforming growth factor β-1 (TGFβ-1) and procollagen type III amino terminal propeptide (PIIINP), cardiac biomarker: serum concentration of N-terminal-pro-B-type natriuretic peptide (NT-proBNP), 24-hour ambulatory BP measurement, and hemoglobin and potassium concentrations. RESULTS At baseline the groups did not differ with respect to age, primary nephropathy, comorbidity, immunosuppressive therapy, albuminuria, and graft function. A total of 61 (L group) and 73 (ST group) patients reached the target BP and completed protocol at 6 months. After 6 months of therapy there were no significant differences in changes of eGFR, albuminuria, hemoglobin and potassium concentrations, urine excretion of PIIINP, and TGFβ-1 between groups. There was a trend in the L group to decrease the concentration of serum NT-proBNP. CONCLUSIONS Losartan shows minimal adverse effects and no influence on graft function and biomarkers of graft fibrosis. It may have a positive effect on cardiovascular risk in KTRs. Further interim analyses of the CELART study will be conducted.
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Affiliation(s)
- Izabella Kuźmiuk-Glembin
- Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Zbigniew Heleniak
- Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Renata Pięta
- Department of Transplantology and Surgery, District Public Hospital, Poznań, Poland
| | - Maciej Głyda
- Department of Transplantology and Surgery, District Public Hospital, Poznań, Poland; Collegium Medicum In Bydgoszcz, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Sławomir Lizakowski
- Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Marcin Renke
- Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland; Division of Occupational, Metabolic, and Internal Diseases, National Centre for Maritime Medicine, Medical University of Gdańsk, Gdynia, Poland
| | - Joanna Konopa
- Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Andrzej Chamienia
- Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Bogdan Biedunkiewicz
- Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Bolesław Rutkowski
- Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Leszek Tylicki
- Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland.
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
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12
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Kongtasai T, Paepe D, Meyer E, Mortier F, Marynissen S, Stammeleer L, Defauw P, Daminet S. Renal biomarkers in cats: A review of the current status in chronic kidney disease. J Vet Intern Med 2022; 36:379-396. [PMID: 35218249 PMCID: PMC8965260 DOI: 10.1111/jvim.16377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 12/22/2022] Open
Abstract
Serum creatinine concentration, the classical biomarker of chronic kidney disease (CKD) in cats, has important limitations that decrease its value as a biomarker of early CKD. Recently, serum symmetric dimethylarginine concentration was introduced as a novel glomerular filtration rate biomarker for the early detection of CKD in cats. However, data on its specificity are still limited. The limitations of conventional biomarkers and the desire for early therapeutic intervention in cats with CKD to improve outcomes have prompted the discovery and validation of novel renal biomarkers to detect glomerular or tubular dysfunction. Changes in the serum or urinary concentrations of these biomarkers may indicate early kidney damage or predict the progression of kidney before changes in conventional biomarkers are detectable. This review summarizes current knowledge on renal biomarkers in CKD in cats, a field that has progressed substantially over the last 5 years.
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Affiliation(s)
- Thirawut Kongtasai
- Small Animal Department, Faculty of Veterinary Science, Ghent University, Merelbeke, Belgium.,Department of Clinical Sciences and Public Health, Faculty of Veterinary Science, Mahidol University, Nakhon Pathom, Thailand
| | - Dominique Paepe
- Small Animal Department, Faculty of Veterinary Science, Ghent University, Merelbeke, Belgium
| | - Evelyne Meyer
- Department of Pharmacology, Toxicology and Biochemistry, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Femke Mortier
- Small Animal Department, Faculty of Veterinary Science, Ghent University, Merelbeke, Belgium
| | - Sofie Marynissen
- Small Animal Department, Faculty of Veterinary Science, Ghent University, Merelbeke, Belgium
| | - Lisa Stammeleer
- Small Animal Department, Faculty of Veterinary Science, Ghent University, Merelbeke, Belgium
| | - Pieter Defauw
- Lumbry Park Veterinary Specialists, Alton, United Kingdom
| | - Sylvie Daminet
- Small Animal Department, Faculty of Veterinary Science, Ghent University, Merelbeke, Belgium
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13
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Abstract
Interstitial fibrosis with tubule atrophy (IF/TA) is the response to virtually any sustained kidney injury and correlates inversely with kidney function and allograft survival. IF/TA is driven by various pathways that include hypoxia, renin-angiotensin-aldosterone system, transforming growth factor (TGF)-β signaling, cellular rejection, inflammation and others. In this review we will focus on key pathways in the progress of renal fibrosis, diagnosis and therapy of allograft fibrosis. This review discusses the role and origin of myofibroblasts as matrix producing cells and therapeutic targets in renal fibrosis with a particular focus on renal allografts. We summarize current trends to use multi-omic approaches to identify new biomarkers for IF/TA detection and to predict allograft survival. Furthermore, we review current imaging strategies that might help to identify and follow-up IF/TA complementary or as alternative to invasive biopsies. We further discuss current clinical trials and therapeutic strategies to treat kidney fibrosis.Supplemental Visual Abstract; http://links.lww.com/TP/C141.
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14
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Thanaboonnipat C, Sutayatram S, Buranakarl C, Choisunirachon N. Renal ultrasonographic shear-wave elastography and urinary procollagen type III amino-terminal propeptide in chronic kidney disease dogs. Vet World 2020; 13:1955-1965. [PMID: 33132611 PMCID: PMC7566241 DOI: 10.14202/vetworld.2020.1955-1965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/04/2020] [Indexed: 12/20/2022] Open
Abstract
Background and Aim: Renal fibrosis is a well-established pathological alteration associated with chronic kidney disease (CKD) in several species and progresses as CKD advances. Although a renal biopsy is the gold standard for determining renal fibrosis, it is an invasive, impractical method for clinical practice. In humans, ultrasonographic shear-wave elastography (SWE), a novel advanced diagnostic imaging tool, can evaluate renal parenchyma stiffness, and urinary procollagen type III amino-terminal propeptide (uPIIINP), a promising renal fibrosis biomarker in humans, has increasingly been use applied to reduce the biopsies. This study compares renal tissue elasticity observed through SWE Young’s modulus (E) values between healthy dogs (HD) and those with CKD. Materials and Methods: The E value acquired by SWE, uPIIINP levels, and renal function were evaluated in 15 CKD dogs and 15 HD. Results: The renal cortical E values were significantly higher than the renal medullary E values in both groups (p<0.001). Renal cortical and medullary E values in CKD dogs were significantly higher than in HD (p<0.01). Cortical E values had greater significant correlations with renal functional parameters than the medullary E values and had a significant positive correlation with concentrations of plasma creatinine (Cr) (p<0.001); blood urea nitrogen (p<0.01); urine protein Cr ratio (p<0.01); and fractional excretions of sodium (p<0.05), potassium (p<0.05), chloride (p<0.05), and magnesium (p<0.001) while they had a negative correlation with urine specific gravity (p<0.05) and urine osmolality to plasma osmolality ratio (p<0.05). The uPIIINP to Cr (uPIIINP/Cr) ratios of CKD dogs were higher than those of HD (p<0.001). Moreover, the uPIIINP/Cr levels presented significant correlations with the renal cortical E values (p<0.01) and also the renal functional parameters. Conclusion: SWE offers a complementary, non-invasive diagnostic imaging tool for evaluating renal tissue stiffness in CKD dogs with renal function deterioration. In addition, uPIIINP levels are associated with renal function and structural changes in dogs. Therefore, the uPIIINP level might be a non-invasive, complementary, and promising biomarker for evaluating renal fibrosis in canine CKD.
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Affiliation(s)
- Chutimon Thanaboonnipat
- Department of Veterinary Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Saikaew Sutayatram
- Department of Veterinary Physiology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Chollada Buranakarl
- Department of Veterinary Physiology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Nan Choisunirachon
- Department of Veterinary Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, 10330, Thailand
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15
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Wang C, Brisson BK, Terajima M, Li Q, Hoxha K, Han B, Goldberg AM, Sherry Liu X, Marcolongo MS, Enomoto-Iwamoto M, Yamauchi M, Volk SW, Han L. Type III collagen is a key regulator of the collagen fibrillar structure and biomechanics of articular cartilage and meniscus. Matrix Biol 2019; 85-86:47-67. [PMID: 31655293 DOI: 10.1016/j.matbio.2019.10.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 02/07/2023]
Abstract
Despite the fact that type III collagen is the second most abundant collagen type in the body, its contribution to the physiologic maintenance and repair of skeletal tissues remains poorly understood. This study queried the role of type III collagen in the structure and biomechanical functions of two structurally distinctive tissues in the knee joint, type II collagen-rich articular cartilage and type I collagen-dominated meniscus. Integrating outcomes from atomic force microscopy-based nanomechanical tests, collagen fibril nanostructural analysis, collagen cross-link analysis and histology, we elucidated the impact of type III collagen haplodeficiency on the morphology, nanostructure and biomechanical properties of articular cartilage and meniscus in Col3a1+/- mice. Reduction of type III collagen leads to increased heterogeneity and mean thickness of collagen fibril diameter, as well as reduced modulus in both tissues, and these effects became more pronounced with skeletal maturation. These data suggest a crucial role of type III collagen in mediating fibril assembly and biomechanical functions of both articular cartilage and meniscus during post-natal growth. In articular cartilage, type III collagen has a marked contribution to the micromechanics of the pericellular matrix, indicating a potential role in mediating the early stage of type II collagen fibrillogenesis and chondrocyte mechanotransduction. In both tissues, reduction of type III collagen leads to decrease in tissue modulus despite the increase in collagen cross-linking. This suggests that the disruption of matrix structure due to type III collagen deficiency outweighs the stiffening of collagen fibrils by increased cross-linking, leading to a net negative impact on tissue modulus. Collectively, this study is the first to highlight the crucial structural role of type III collagen in both articular cartilage and meniscus extracellular matrices. We expect these results to expand our understanding of type III collagen across various tissue types, and to uncover critical molecular components of the microniche for regenerative strategies targeting articular cartilage and meniscus repair.
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Affiliation(s)
- Chao Wang
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA 19104, United States
| | - Becky K Brisson
- Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania, School of Veterinary Medicine, Philadelphia, PA, 19104, United States
| | - Masahiko Terajima
- Division of Oral and Craniofacial Health Sciences, University of North Carolina, Chapel Hill, NC, 27599, United States
| | - Qing Li
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA 19104, United States
| | - Kevt'her Hoxha
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA 19104, United States
| | - Biao Han
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA 19104, United States
| | - Abby M Goldberg
- Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania, School of Veterinary Medicine, Philadelphia, PA, 19104, United States
| | - X Sherry Liu
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, United States
| | - Michele S Marcolongo
- Department of Materials Science and Engineering, Drexel University, Philadelphia, PA, 19104, United States
| | - Motomi Enomoto-Iwamoto
- Department of Orthopaedics, School of Medicine, University of Maryland, Baltimore, MD, 21201, United States
| | - Mitsuo Yamauchi
- Division of Oral and Craniofacial Health Sciences, University of North Carolina, Chapel Hill, NC, 27599, United States
| | - Susan W Volk
- Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania, School of Veterinary Medicine, Philadelphia, PA, 19104, United States.
| | - Lin Han
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA 19104, United States.
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16
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Kim JY, Wee YM, Choi MY, Jung HR, Choi JY, Kwon HW, Jung JH, Cho YM, Go H, Han M, Kim YH, Han DJ, Shin S. Urinary transglutaminase 2 as a potent biomarker to predict interstitial fibrosis and tubular atrophy of kidney allograft during early posttransplant period in deceased donor kidney transplantation. Ann Surg Treat Res 2019; 97:27-35. [PMID: 31297350 PMCID: PMC6609414 DOI: 10.4174/astr.2019.97.1.27] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/26/2019] [Accepted: 05/14/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose Transglutaminase type 2 (TG2) is an extracellular matrix crosslinking enzyme with a pivotal role in kidney fibrosis. We tested whether quantification of urinary TG2 may represent a noninvasive method to estimate the severity of kidney allograft fibrosis. Methods We prospectively collected urine specimens from 18 deceased donor kidney transplant recipients at 1-day, 7-day, 1-month, 3-month, and 6-month posttransplant. In addition, kidney allograft tissue specimens at 0-day and 6-month posttransplant were sampled to analyze the correlation of urinary TG2 and kidney allograft fibrosis. Results Thirteen recipients had increased interstitial fibrosis and tubular atrophy (IFTA) scores at the 6-month protocol biopsy (IFTA group). The mean level of urinary TG2 in the IFTA group was higher compared to that of 5 other recipients without IFTA (no IFTA group). Conversely, the mean level of urinary syndecan-4 in the IFTA group was lower than levels in patients without IFTA. In the IFTA group, double immunofluorescent staining revealed that TG2 intensity was significantly upregulated and colocalizations of TG2/heparin sulfate proteoglycan and nuclear syndecan-4 were prominent, usually around tubular structures. Conclusion Urinary TG2 in early posttransplant periods is a potent biomarker for kidney allograft inflammation or fibrosis.
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Affiliation(s)
- Jee Yeon Kim
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yu-Mee Wee
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Monica Young Choi
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hey Rim Jung
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yoon Choi
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Wook Kwon
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joo Hee Jung
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Mee Cho
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Heounjeong Go
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Minkyu Han
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Korea
| | - Young Hoon Kim
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duck Jong Han
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Shin
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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17
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Taranta-Janusz K, Moczulska A, Nosek H, Michaluk-Skutnik J, Klukowski M, Wasilewska A. Urinary procollagen III aminoterminal propeptide and β-catenin - New diagnostic biomarkers in solitary functioning kidney? Adv Med Sci 2019; 64:189-194. [PMID: 30738287 DOI: 10.1016/j.advms.2018.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 08/20/2018] [Accepted: 10/04/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE We aimed at evaluating urinary levels of procollagen III aminoterminal propeptide (PIIINP) and β-catenin and the relationship between these markers and clinical and laboratory variables in children with a solitary functioning kidney (SFK). PATIENTS AND METHODS The study group consisted of 98 (M/F: 62/36) children with an SFK with a median age of 8 years. An age-matched control group contained 54 healthy peers. Urinary levels of procollagen III aminoterminal propeptide and β-catenin were measured using a commercially available immunoassay kit. RESULTS The urinary values of PIIINP (UPIIINP) were significantly increased in patients with SFK versus controls (p < 0.01). Our analysis revealed no significant differences in urinary β-catenin levels between the SFK patients and control subjects (p > 0.05). Only urinary PIIINP levels were correlated to renal function tests, such as serum creatinine, urea, uric acid, and estimated glomerular filtration rate (p<0.05). CONCLUSIONS An increased urinary level of PIIINP may indicate early kidney impairment in children with SFK. Urinary β-catenin does not seem to play any important role as a marker of renal function in children with SFK. Further long-term studies are required in order to evaluate the clinical usefulness of these markers and their predictive value of chronic kidney disease (CKD) progression.
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Affiliation(s)
| | - Anna Moczulska
- Department of Pediatric Nephrology, Jagiellonian University Medical College, Cracow, Poland
| | - Hanna Nosek
- Department of Pediatric Gastroenterology and Nutrition, Regional Specialized Children's Hospital in Olsztyn, Poland
| | | | - Mark Klukowski
- Department of Pediatrics, Gastroenterology and Allergology, Medical University of Bialystok, Poland
| | - Anna Wasilewska
- Department of Pediatrics and Nephrology, Medical University of Bialystok, Poland
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18
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Thanaboonnipat C, Sutayatram S, Buranakarl C, Choisunirachon N. Renal shear wave elastography and urinary procollagen type III amino-terminal propeptide (uPIIINP) in feline chronic kidney disease. BMC Vet Res 2019; 15:54. [PMID: 30744640 PMCID: PMC6371591 DOI: 10.1186/s12917-019-1801-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 01/29/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is one of the most common diseases occurring in cats. It is characterized by renal fibrosis, which is strongly correlated with impairment of renal function. Since renal biopsy is not performed routinely in clinical practice, the non-invasive method of ultrasonographic shear-wave elastography (SWE) was used to determine renal parenchymal stiffness. Currently, urinary procollagen type III amino-terminal propeptide (uPIIINP) is a renal fibrosis biomarker in humans. Moreover, PIIINP is increasingly applied for identification of fibrosis in various organs in animals. RESULTS The Young's modulus (E) value on SWE, uPIIINP, and renal function were evaluated in 23 CKD cats and 25 healthy cats (HC). The renal cortical E values were significantly higher than those of the renal medulla in both groups (P < 0.001). The E values of the renal cortex and medulla were significantly higher in CKD cats than in HC (P < 0.001 and P < 0.01, respectively). The E values, especially of the cortex, showed a significant positive correlation with concentrations of plasma creatinine (P < 0.001), blood urea nitrogen (P < 0.05), while they had a negative correlation with urine specific gravity (P < 0.001) and urine osmolality per plasma osmolality ratio (P < 0.01). The uPIIINP to creatinine ratios (uPIIINP/Cr) were significantly higher in CKD cats than in HC (P < 0.01) and were highly correlated with renal cortical E values (P < 0.001). CONCLUSIONS SWE might be an additively useful and non-invasive diagnostic imaging tool to evaluate renal parenchymal stiffness, which correlates with renal functional impairment in CKD cats. Moreover, the uPIIINP/Cr might be a promissing biomarker for adjunctive assessing the renal fibrosis in feline CKD.
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Affiliation(s)
- Chutimon Thanaboonnipat
- Department of Veterinary Physiology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand.,Department of Veterinary Surgery, Faculty of Veterinary Science, Chulalongkorn University, 39 Henri-Dunant Road, Wangmai, Pathumwan, Bangkok, 10330, Thailand
| | - Saikaew Sutayatram
- Department of Veterinary Physiology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Chollada Buranakarl
- Department of Veterinary Physiology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Nan Choisunirachon
- Department of Veterinary Surgery, Faculty of Veterinary Science, Chulalongkorn University, 39 Henri-Dunant Road, Wangmai, Pathumwan, Bangkok, 10330, Thailand.
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19
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Cellular and molecular mechanisms of kidney fibrosis. Mol Aspects Med 2018; 65:16-36. [PMID: 29909119 DOI: 10.1016/j.mam.2018.06.002] [Citation(s) in RCA: 280] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 06/12/2018] [Indexed: 12/14/2022]
Abstract
Renal fibrosis is the final pathological process common to any ongoing, chronic kidney injury or maladaptive repair. It is considered as the underlying pathological process of chronic kidney disease (CKD), which affects more than 10% of world population and for which treatment options are limited. Renal fibrosis is defined by excessive deposition of extracellular matrix, which disrupts and replaces the functional parenchyma that leads to organ failure. Kidney's histological structure can be divided into three main compartments, all of which can be affected by fibrosis, specifically termed glomerulosclerosis in glomeruli, interstitial fibrosis in tubulointerstitium and arteriosclerosis and perivascular fibrosis in vasculature. In this review, we summarized the different appearance, cellular origin and major emerging processes and mediators of fibrosis in each compartment. We also depicted and discussed the challenges in translation of anti-fibrotic treatment to clinical practice and discuss possible solutions and future directions.
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20
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Abstract
Chronic kidney disease (CKD) has become a significant public health concern, as it is associated with substantial morbidity. Prior research has evaluated multiple novel CKD biomarkers to supplement serum creatinine and proteinuria. The ultimate goal of this research is to find biomarkers that can be used to accurately predict CKD progression and to better time outpatient follow-up, and referral for transplant. Also, an optimal panel of biomarkers can augment the predictive value of proteinuria and serum creatinine by enriching patient enrollment in clinical trials. In this review, we discuss salient findings on 12 candidate plasma and urine biomarkers and their reported association with CKD. We explore the common pathways of CKD progression and the pathophysiologic processes of tubulointerstitial injury, inflammation, repair, and fibrosis that are potentially classified by specific biomarkers. We describe both pediatric and adult findings and highlight the paucity of pediatric research in CKD progression. It will be important for cohorts with longitudinal follow-up to evaluate these CKD biomarkers for potential use in pediatric clinical trials and routine CKD management.
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21
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Jotwani V, Katz R, Ix JH, Gutiérrez OM, Bennett M, Parikh CR, Cummings SR, Sarnak MJ, Shlipak MG. Urinary Biomarkers of Kidney Tubular Damage and Risk of Cardiovascular Disease and Mortality in Elders. Am J Kidney Dis 2018; 72:205-213. [PMID: 29602632 DOI: 10.1053/j.ajkd.2017.12.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 12/23/2017] [Indexed: 01/07/2023]
Abstract
RATIONALE & OBJECTIVE Novel urinary biomarkers have enabled earlier detection of kidney tubular damage, but their prognostic value for adverse cardiovascular outcomes is uncertain. We hypothesized that tubular damage, measured by urine α1-microglobulin (A1M), amino-terminal propeptide of type III procollagen (PIIINP), and neutrophil gelatinase-associated lipocalin (NGAL), would be associated with higher risks for cardiovascular events and mortality among elders. STUDY DESIGN Case-cohort study. SETTING & PARTICIPANTS This study included a randomly selected subcohort (n=502), cardiovascular disease (CVD) cases (n=245), and heart failure cases (n=220) from the Health, Aging, and Body Composition (Health ABC) Study. PREDICTORS Baseline urine A1M, PIIINP, and NGAL concentrations. OUTCOMES Incident CVD, heart failure, and all-cause mortality. ANALYTICAL APPROACH Cox proportional hazards models were used to evaluate biomarker associations with each outcome. RESULTS At baseline, mean age was 74 years and estimated glomerular filtration rate was 73mL/min/1.73m2. After adjustment for demographics, estimated glomerular filtration rate, albumin-creatinine ratio, and other cardiovascular risk factors, each doubling in biomarker concentration was associated with the following adjusted HRs for CVD: A1M, 1.51 (95% CI, 1.16-1.96); PIIINP, 1.21 (95% CI, 1.00-1.46); and NGAL, 1.12 (95% CI, 1.05-1.20). There were 248 deaths in the subcohort during a median follow-up of 12.4 years. Adjusted associations of each biomarker (HR per doubling) with all-cause mortality were: A1M, 1.29 (95% CI, 1.10-1.51); PIIINP, 1.05 (95%, 0.94-1.18); and NGAL, 1.07 (95% CI, 1.02-1.12). Biomarker concentrations did not have statistically significant associations with heart failure after multivariable adjustment. LIMITATIONS Urine biomarkers were measured at a single time point; no validation cohort available. CONCLUSIONS Kidney tubular damage is an independent risk factor for CVD and death among elders. Future studies should investigate mechanisms by which kidney tubular damage may adversely affect cardiovascular risk.
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Affiliation(s)
- Vasantha Jotwani
- Division of Nephrology, Department of Medicine, San Francisco VA Medical Center, San Francisco, CA; Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, CA.
| | - Ronit Katz
- Kidney Research Institute, University of Washington, Seattle, WA
| | - Joachim H Ix
- Division of Nephrology-Hypertension, Department of Medicine, University of California, San Diego, CA; Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Orlando M Gutiérrez
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, AL
| | - Michael Bennett
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Chirag R Parikh
- Section of Nephrology, Department of Medicine, Yale University, New Haven, CT; Program of Applied Translational Research, Yale University, New Haven, CT
| | - Steven R Cummings
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - Mark J Sarnak
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA
| | - Michael G Shlipak
- Division of Nephrology, Department of Medicine, San Francisco VA Medical Center, San Francisco, CA; Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, CA
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22
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Park M, Katz R, Shlipak MG, Weiner D, Tracy R, Jotwani V, Hughes-Austin J, Gabbai F, Hsu CY, Pfeffer M, Bansal N, Bostom A, Gutierrez O, Sarnak M, Levey A, Ix JH. Urinary Markers of Fibrosis and Risk of Cardiovascular Events and Death in Kidney Transplant Recipients: The FAVORIT Trial. Am J Transplant 2017; 17:2640-2649. [PMID: 28371433 PMCID: PMC5620109 DOI: 10.1111/ajt.14284] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 03/13/2017] [Accepted: 03/18/2017] [Indexed: 01/25/2023]
Abstract
Cardiovascular risk remains high in kidney transplant recipients (KTRs) despite improved kidney function after transplant. Urinary markers of kidney fibrosis and injury may help to reveal mechanisms of this risk. In a case-cohort study among stable KTRs who participated in the FAVORIT trial, we measured four urinary proteins known to correlate with kidney tubulointerstitial fibrosis on biopsy (urine alpha 1 microglobulin [α1m], monocyte chemoattractant protein-1 [MCP-1], procollagen type I [PINP] and type III [PIIINP] N-terminal amino peptide) and evaluated associations with cardiovascular disease (CVD) events (n = 300) and death (n = 371). In adjusted models, higher urine α1m (hazard ratio [HR] per doubling of biomarker 1.40 [95% confidence interval [CI] 1.21, 1.62]), MCP-1 (HR 1.18 [1.03, 1.36]), and PINP (HR 1.13 [95% CI 1.03, 1.23]) were associated with CVD events. These three markers were also associated with death (HR per doubling α1m 1.51 [95% CI 1.32, 1.72]; MCP-1 1.31 [95% CI 1.13, 1.51]; PINP 1.11 [95% CI 1.03, 1.20]). Higher concentrations of urine α1m, MCP-1, and PINP may identify KTRs at higher risk for CVD events and death. These markers may identify a systemic process of fibrosis involving both the kidney and cardiovascular system, and give new insights into mechanisms linking the kidney with CVD.
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Affiliation(s)
- M Park
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, California,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - R Katz
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington
| | - M G Shlipak
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California,General Internal Medicine Section, San Francisco Veterans Affairs Hospital, San Francisco, California,Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - D Weiner
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - R Tracy
- Department of Pathology, University of Vermont, Burlington, Vermont
| | - V Jotwani
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - J Hughes-Austin
- Division of Preventive Medicine, Department of Preventive Medicine and Public Health, University of California San Diego, San Diego, California
| | - F Gabbai
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, California,Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California
| | - CY Hsu
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - M Pfeffer
- Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - N Bansal
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington
| | - A Bostom
- Rhode Island Hospital, Providence, Rhode Island
| | - O Gutierrez
- Departments of Medicine and Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - M Sarnak
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - A Levey
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - J H Ix
- Division of Preventive Medicine, Department of Preventive Medicine and Public Health, University of California San Diego, San Diego, California,Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, California,Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California
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23
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Brief Report: Cumulative Tenofovir Disoproxil Fumarate Exposure is Associated With Biomarkers of Tubular Injury and Fibrosis in HIV-Infected Men. J Acquir Immune Defic Syndr 2017; 73:177-81. [PMID: 27088295 DOI: 10.1097/qai.0000000000001027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Tenofovir disoproxil fumarate (TDF) can cause kidney damage, but current clinical tests are insensitive for detecting toxicity. Among 884 HIV-infected men enrolled in the Multicenter AIDS Cohort Study, we measured urine biomarkers specific for tubular damage (interleukin-18, kidney injury molecule-1, procollagen type III N-terminal propeptide) and albuminuria. In adjusted analyses, each year of TDF exposure was independently associated with 3.3% higher interleukin-18 (95% CI: 0.8% to 5.8%), 3.4% higher kidney injury molecule-1 (1.1% to 5.7%), and 3.1% higher procollagen type III N-terminal propeptide (0.8% to 5.5%), but not with albuminuria (2.8%; -0.6% to 6.2%). Biomarkers of tubular damage may be more sensitive than albuminuria for detecting toxicity from TDF and other medications.
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24
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Duprez DA, Gross MD, Sanchez OA, Kizer JR, Ix JH, Lima J, Tracy RP, Jacobs DR. Collagen Turnover Markers in Relation to Future Cardiovascular and Noncardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis. Clin Chem 2017; 63:1237-1247. [PMID: 28515098 DOI: 10.1373/clinchem.2016.270520] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/31/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Sustained remodeling of extracellular matrix can compromise organs and tissues. Procollagen type III N-terminal propeptide (PIIINP) and collagen type I carboxy-terminal telopeptide (ICTP) reflect collagen synthesis and degradation. We studied their predictive value for future death and disease. METHODS A total of 3068 men and women in the Multi-Ethnic Study of Atherosclerosis who were free of cardiovascular disease (CVD) and in generally good health had a baseline blood sample taken for ICTP and PIIINP. Median follow-up was 13.0 years. Among 4 primary outcomes, CVD events (n = 697) were adjudicated, death (n = 571) was by death certificate, and chronic inflammatory-related severe hospitalization and death (ChrIRD, n = 726) and total cancer (n = 327) were classified using International Classification of Diseases codes. We used Poisson regression to study baseline ICTP and PIIINP relative to these outcomes. RESULTS Mean (SD) PIIINP was 5.47 (1.95) μg/L and ICTP was 3.37 (1.70) μg/L. PIIINP and ICTP were highly correlated with each other and with estimated glomerular filtration rate (eGFR). Adjustment for age and eGFR attenuated relative risks, remaining 20%-30% per SD of both PIIINP and ICTP in prediction for total death and ChrIRD, and of PIIINP for cancer, with little additional attenuation by adjusting for risk factors and inflammatory biomarkers. CVD outcome was generally unrelated to PIIINP but became marginally inversely related to ICTP in the most adjusted model. CONCLUSIONS The collagen biomarkers PIIINP and ICTP, in part through pathophysiologically parallel associations with renal function, predicted ChrIRD and total death. Moreover, PIIINP predicted future cancer. These collagen markers may help differentiate healthy from unhealthy aging.
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Affiliation(s)
| | | | - Otto A Sanchez
- Nephrology Division, School of Medicine, University of Minnesota, Minneapolis, MN
| | - Jorge R Kizer
- Division of Cardiology, Department of Medicine, and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Joachim H Ix
- Nephrology Division, University of California San Diego, San Diego, CA
| | - Joao Lima
- Cardiovascular Division, John Hopkins University, Baltimore, MD
| | - Russell P Tracy
- Department of Pathology & Laboratory Medicine and Department of Biochemistry, University of Vermont College of Medicine, Colchester, VT
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
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25
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Stribos EGD, Nielsen SH, Brix S, Karsdal MA, Seelen MA, van Goor H, Bakker SJL, Olinga P, Mutsaers HAM, Genovese F. Non-invasive quantification of collagen turnover in renal transplant recipients. PLoS One 2017; 12:e0175898. [PMID: 28430784 DOI: 10.1371/journal.pone.0175898] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 04/02/2017] [Indexed: 12/17/2022] Open
Abstract
Kidney allograft failure due to chronic injury/rejection remains the main cause of graft loss in renal transplant recipients (RTR). Here, we investigated whether specific biomarkers of extracellular matrix (ECM) turnover are associated with allograft function and chronic kidney disease (CKD) stage in RTR. Seventy-eight patients who attended the University Medical Center Groningen for a routine check-up after kidney transplantation were enrolled in the study. Plasma and/or 24h-urine samples were collected and specific matrix-metalloproteinase-generated neo-epitope fragments of collagens were measured by enzyme-linked immunosorbent assay. Our results demonstrated that urinary levels of C3M, a marker for collagen type III degradation, correlated with estimated glomerular filtration rate (eGFR; r = 0.58, p<0.0001), with lower levels detected in the urine of patients with advanced CKD. In addition, plasma levels of Pro-C6, a marker for collagen type VI formation, significantly increased with disease progression and correlated with eGFR (r = -0.72, p<0.0001). Conversely, plasma C3M and urinary Pro-C6 levels showed no correlation with renal function. We identified two neo-epitope biomarkers of tissue turnover associated with ECM remodeling and fibrosis that can stratify patients by CKD stage. This is as promising first step towards non-invasive monitoring of ECM turnover in the kidneys.
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Affiliation(s)
- Elisabeth G D Stribos
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen Research Institute of Pharmacy, Groningen, The Netherlands
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Signe Holm Nielsen
- Nordic Bioscience A/S, Herlev, Denmark
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
| | - Susanne Brix
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
| | | | - Marc A Seelen
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harry van Goor
- Department of Pathology and Medical Biology, Division of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter Olinga
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen Research Institute of Pharmacy, Groningen, The Netherlands
| | - Henricus A M Mutsaers
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen Research Institute of Pharmacy, Groningen, The Netherlands
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26
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Ix JH, Katz R, Bansal N, Foster M, Weiner DE, Tracy R, Jotwani V, Hughes-Austin J, McKay D, Gabbai F, Hsu CY, Bostom A, Levey AS, Shlipak MG. Urine Fibrosis Markers and Risk of Allograft Failure in Kidney Transplant Recipients: A Case-Cohort Ancillary Study of the FAVORIT Trial. Am J Kidney Dis 2017; 69:410-419. [PMID: 28024930 PMCID: PMC7321838 DOI: 10.1053/j.ajkd.2016.10.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 10/05/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Kidney tubulointerstitial fibrosis marks risk for allograft failure in kidney transplant recipients, but is poorly captured by estimated glomerular filtration rate (eGFR) or urine albumin-creatinine ratio (ACR). Whether urinary markers of tubulointerstitial fibrosis can noninvasively identify risk for allograft failure above and beyond eGFR and ACR is unknown. STUDY DESIGN Case-cohort study. SETTING & PARTICIPANTS The FAVORIT (Folic Acid for Vascular Outcome Reduction in Transplantation) Trial was a randomized double-blind trial testing vitamin therapy to lower homocysteine levels in stable kidney transplant recipients. We selected a subset of participants at random (n=491) and all individuals with allograft failure during follow-up (cases; n=257). PREDICTOR Using spot urine specimens from the baseline visit, we measured 4 urinary proteins known to correlate with tubulointerstitial fibrosis on biopsy (urine α1-microglobulin [A1M], monocyte chemoattractant protein 1 [MCP-1], and procollagen type III and type I amino-terminal amino pro-peptide). OUTCOME Death-censored allograft failure. RESULTS In models adjusted for demographics, chronic kidney disease risk factors, eGFR, and ACR, higher concentrations of urine A1M (HR per doubling, 1.73; 95% CI, 1.43-2.08) and MCP-1 (HR per doubling, 1.60; 95% CI, 1.32-1.93) were strongly associated with allograft failure. When additionally adjusted for concentrations of other urine fibrosis and several urine injury markers, urine A1M (HR per doubling, 1.76; 95% CI, 1.27-2.44]) and MCP-1 levels (HR per doubling, 1.49; 95% CI, 1.17-1.89) remained associated with allograft failure. Urine procollagen type III and type I levels were not associated with allograft failure. LIMITATIONS We lack kidney biopsy data, BK titers, and HLA antibody status. CONCLUSIONS Urine measurement of tubulointerstitial fibrosis may provide a noninvasive method to identify kidney transplant recipients at higher risk for future allograft failure, above and beyond eGFR and urine ACR.
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Affiliation(s)
- Joachim H Ix
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, CA; Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA; Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA.
| | - Ronit Katz
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, WA
| | - Nisha Bansal
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, WA
| | - Meredith Foster
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA
| | - Daniel E Weiner
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA
| | - Russell Tracy
- Department of Pathology, University of Vermont, Burlington, VT
| | - Vasantha Jotwani
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Jan Hughes-Austin
- Department of Orthopedic Surgery, University of California San Diego, San Diego, CA
| | - Dianne McKay
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, CA
| | - Francis Gabbai
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, CA; Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Chi-Yuan Hsu
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA
| | | | - Andrew S Levey
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA
| | - Michael G Shlipak
- General Internal Medicine Section, San Francisco Veterans Affairs Hospital, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA; Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA
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27
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Yılmaz R, Yıldırım T, Baydar D, Altun B, Erdem Y. Urinary Type III Procollagen Is Associated With Chronic Allograft Dysfunction and Predicts Graft Survival. Transplant Proc 2017; 49:281-287. [DOI: 10.1016/j.transproceed.2016.11.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/31/2016] [Accepted: 11/16/2016] [Indexed: 12/13/2022]
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Mansour SG, Puthumana J, Coca SG, Gentry M, Parikh CR. Biomarkers for the detection of renal fibrosis and prediction of renal outcomes: a systematic review. BMC Nephrol 2017; 18:72. [PMID: 28219345 PMCID: PMC5319065 DOI: 10.1186/s12882-017-0490-0] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 02/14/2017] [Indexed: 11/28/2022] Open
Abstract
Background Fibrosis is the unifying pathway leading to chronic kidney disease. Identifying biomarkers of fibrosis may help predict disease progression. Methods We performed a systematic review to evaluate the reliability of blood and urine biomarkers in identifying fibrosis on biopsy as well as predicting renal outcomes. Using MEDLINE and EMBASE, a two-stage search strategy was implemented. Stage I identified a library of biomarkers correlating with fibrosis on biopsy. Stage II evaluated the association between biomarkers identified in stage I, and renal outcomes. Only biomarkers with moderate positive correlation with fibrosis (r > 0.40) or acceptable area under the curve (AUC >0.65) advanced to stage II. Results Stage I identified 17 studies and 14 biomarkers. Five biomarkers met criteria to advance to stage II, but only three were independently associated with renal outcomes. Transforming growth factor β (TGF-β) correlated with fibrosis (r = 0.60), and was associated with 1.7–3.9 times the risk of worsening renal function in 426 patients. Monocyte chemoattractant protein-1 (MCP-1) diagnosed fibrosis with AUC of 0.66 and was associated with 2.3–11.0 times the risk of worsening renal function in 596 patients. Matrix metalloproteinase-2 (MMP-2) correlated with fibrosis (r = 0.41), and was associated with 2.5 times the risk of worsening renal function. Conclusions Given the heterogeneity of the data due to diverse patient populations along with differing renal outcomes, a meta-analysis could not be conducted. Nonetheless we can conclude from the published data that TGF-β, MCP-1 and MMP-2 may identify patients at risk for renal fibrosis and hence worse renal outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s12882-017-0490-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sherry G Mansour
- Program of Applied Translational Research, Department of Medicine, Yale University, School of Medicine, New Haven, CT, USA.,Section of Nephrology, Yale University School of Medicine, 60 Temple Street, Suite 6C, New Haven, CT, 06510, USA
| | - Jeremy Puthumana
- Program of Applied Translational Research, Department of Medicine, Yale University, School of Medicine, New Haven, CT, USA
| | - Steven G Coca
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mark Gentry
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA
| | - Chirag R Parikh
- Program of Applied Translational Research, Department of Medicine, Yale University, School of Medicine, New Haven, CT, USA. .,Section of Nephrology, Yale University School of Medicine, 60 Temple Street, Suite 6C, New Haven, CT, 06510, USA. .,Veterans Affairs Connecticut Healthcare System, New Haven, CT, USA.
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29
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Jotwani V, Scherzer R, Estrella MM, Jacobson LP, Witt MD, Palella F, Ho K, Bennett M, Parikh CR, Ix JH, Shlipak M. Association of HIV infection with biomarkers of kidney injury and fibrosis in the Multicenter AIDS Cohort Study. Antivir Ther 2017; 22:421-429. [PMID: 28054933 PMCID: PMC5498264 DOI: 10.3851/imp3124] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is common among HIV-infected individuals but serum creatinine is insensitive for detecting kidney damage at early stages. We hypothesized that HIV infection would be associated with elevations in subclinical markers of kidney injury and fibrosis in a contemporary cohort of men. METHODS In this cross-sectional study, we measured urine levels of interleukin-18 (IL-18), kidney injury molecule-1 (KIM-1), pro-collagen type III N-terminal pro-peptide (PIIINP) and albumin-creatinine ratio (ACR) in 813 HIV-infected and 331 uninfected men enrolled in the Multicenter AIDS Cohort Study. RESULTS Median eGFR was 95 ml/min/1.73 m2 among African-Americans (n=376) and 87 ml/min/1.73 m2 among Caucasians (n=768). Among HIV-infected men, the median CD4 lymphocyte count was 572 cells/mm3 and 76% of men had undetectable HIV RNA levels. After multivariable adjustment for traditional CKD risk factors including eGFR, HIV infection was associated with 52% higher urine IL-18 (95% CI, 33%, 73%), 44% higher KIM-1 (27%, 64%), 30% higher PIIINP (15%, 47%) and 84% higher ACR (54%, 120%), with similar effect sizes among African-Americans and Caucasians (P>0.2 for tests of interaction by race). These associations remained statistically significant in analyses that excluded persons with detectable HIV RNA levels and in models that adjusted for cumulative exposure to tenofovir disoproxil fumarate. CONCLUSIONS Compared with uninfected men, HIV-infected men had more extensive glomerular and tubulointerstitial damage, as assessed by urine biomarkers. Future studies should evaluate whether combinations of biomarkers can be used to monitor stages of kidney injury and to predict CKD risk in HIV-infected individuals.
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Affiliation(s)
- Vasantha Jotwani
- Department of Medicine, San Francisco VA Medical Center, San Francisco, CA, USA
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, CA, USA
| | - Rebecca Scherzer
- Department of Medicine, San Francisco VA Medical Center, San Francisco, CA, USA
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, CA, USA
| | - Michelle M Estrella
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lisa P Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mallory D Witt
- Division of HIV Medicine, Department of Medicine, Harbor-UCLA Medical Center and the Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA
| | - Frank Palella
- Division of Infectious Diseases, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Ken Ho
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael Bennett
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Chirag R Parikh
- Section of Nephrology, Department of Medicine, Yale University, New Haven, CT, USA
- Program of Applied Translational Research, Yale University, New Haven, CT, USA
| | - Joachim H Ix
- Division of Nephrology-Hypertension, Department of Medicine, University of California, San Diego, CA, USA
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Michael Shlipak
- Department of Medicine, San Francisco VA Medical Center, San Francisco, CA, USA
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, CA, USA
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Rosenbloom J, Ren S, Macarak E. New frontiers in fibrotic disease therapies: The focus of the Joan and Joel Rosenbloom Center for Fibrotic Diseases at Thomas Jefferson University. Matrix Biol 2016; 51:14-25. [PMID: 26807756 DOI: 10.1016/j.matbio.2016.01.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Fibrotic diseases constitute a world-wide major health problem, but research support remains inadequate in comparison to the need. Although considerable understanding of the pathogenesis of fibrotic reactions has been attained, no completely effective therapies exist. Although fibrotic disorders are diverse, it is universally appreciated that a particular cell type with unique characteristics, the myofibroblast, is responsible for replacement of functioning tissue with non-functional scar tissue. Understanding the cellular and molecular mechanisms responsible for the creation of myofibroblasts and their activities is central to the development of therapies. Critical signaling cascades, initiated primarily by TGF-β, but also involving other cytokines which stimulate pro-fibrotic reactions in the myofibroblast, offer potential therapeutic targets. However, because of the multiplicity and complex interactions of these signaling pathways, it is very unlikely that any single drug will be successful in modifying a major fibrotic disease. Therefore, we have chosen to examine the effectiveness of administration of several drug combinations in a mouse pneumoconiosis model. Such treatment proved to be effective. Because fibrotic diseases that tend to be chronic, are difficult to monitor, and are patient variable, implementation of clinical trials is difficult and expensive. Therefore, we have made efforts to identify and validate non-invasive biomarkers found in urine and blood. We describe the potential utility of five such markers: (i) the EDA form of fibronectin (Fn(EDA)), (ii) lysyl oxidase (LOX), (iii) lysyl oxidase-like protein 2 (LoxL2), (iv) connective tissue growth factor (CTGF, CCNII), and (v) the N-terminal propeptide of type III procollagen (PIIINP).
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Affiliation(s)
- Joel Rosenbloom
- Joan and Joel Rosenbloom Research Center for Fibrotic Diseases, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, United States; Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, United States.
| | - Shumei Ren
- Joan and Joel Rosenbloom Research Center for Fibrotic Diseases, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, United States; Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Edward Macarak
- Joan and Joel Rosenbloom Research Center for Fibrotic Diseases, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, United States; Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, United States
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Bellavia D, Cataliotti A, Clemenza F, Baravoglia CH, Luca A, Traina M, Gridelli B, Bertani T, Burnett JC, Scardulla C. Long-Term Structural and Functional Myocardial Adaptations in Healthy Living Kidney Donors: A Pilot Study. PLoS One 2015; 10:e0142103. [PMID: 26556804 PMCID: PMC4640880 DOI: 10.1371/journal.pone.0142103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 10/16/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND AIMS Compensatory renal hypertrophy following unilateral nephrectomy (UNX) occurs in the remaining kidney. However, the long-term cardiac adaptive process to UNX remains poorly defined in humans. Our goal was to characterize myocardial structure and function in living kidney donors (LKDs), approximately 12 years after UNX. METHODS AND RESULTS Cardiac function and structure in 15 Italian LKDs, at least 5 years after UNX (median time from donation = 8.4 years) was investigated and compared to those of age and sex matched U.S. citizens healthy controls (n = 15). Standard and speckle tracking echocardiography (STE) was performed in both LKDs and controls. Plasma angiotensin II, aldosterone, atrial natriuretic peptide (ANP), N terminus pro B-type natriuretic peptide (NT-proBNP), cyclic guanylyl monophosphate (cGMP), and amino-terminal peptide of procollagen III (PIIINP) were also collected. Median follow-up was 11.9 years. In LKDs, LV geometry and function by STE were similar to controls, wall thickness and volumes were within normal limits also by CMR. In LKDs, CMR was negative for myocardial fibrosis, but apical rotation and LV torsion obtained by STE were impaired as compared to controls (21.4 ± 7.8 vs 32.7 ± 8.9 degrees, p = 0.04). Serum creatinine and PIIINP levels were increased [1.1 (0.9-1.3) mg/dL, and 5.8 (5.4-7.6)] μg/L, respectively), while urinary cGMP was reduced [270 (250-355) vs 581 (437-698) pmol/mL] in LKDs. No LKD developed cardiovascular or renal events during follow-up. CONCLUSIONS Long-term kidney donors have no apparent structural myocardial abnormalities as assessed by contrast enhanced CMR. However, myocardial deformation of the apical segments, as well as apical rotation, and LV torsion are reduced. The concomitant increase in circulating PIIINP level is suggestive of fibrosis. Further studies, focused on US and EU patients are warranted to evaluate whether these early functional modifications will progress to a more compromised cardiac function and structure at a later time.
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Affiliation(s)
- Diego Bellavia
- Division of Cardiovascular Diseases, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
- Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Alessandro Cataliotti
- Institute of Clinical Medicine and Institute for Experimental Medical Research, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Francesco Clemenza
- Division of Cardiovascular Diseases, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Cesar Hernandez Baravoglia
- Division of Cardiovascular Diseases, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Angelo Luca
- Department of Radiology, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Marcello Traina
- Sport and Exercise Sciences "DISMOT" Research Unit, University of Palermo, Palermo, Italy
| | - Bruno Gridelli
- Division of Cardiovascular Diseases, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Tullio Bertani
- Division of Nephrology, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - John C. Burnett
- Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Cesare Scardulla
- Division of Cardiovascular Diseases, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
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Ix JH, Biggs ML, Mukamal K, Djousse L, Siscovick D, Tracy R, Katz R, Delaney JA, Chaves P, Rifkin DE, Hughes-Austin JM, Garimella PS, Sarnak MJ, Shlipak MG, Kizer JR. Urine Collagen Fragments and CKD Progression-The Cardiovascular Health Study. J Am Soc Nephrol 2015; 26:2494-503. [PMID: 25655067 PMCID: PMC4587692 DOI: 10.1681/asn.2014070696] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 12/22/2014] [Indexed: 11/03/2022] Open
Abstract
Tubulointerstitial fibrosis is common with ageing and strongly prognostic for ESRD but is poorly captured by eGFR or urine albumin to creatinine ratio (ACR). Higher urine levels of procollagen type III N-terminal propeptide (PIIINP) mark the severity of tubulointerstitial fibrosis in biopsy studies, but the association of urine PIIINP with CKD progression is unknown. Among community-living persons aged ≥65 years, we measured PIIINP in spot urine specimens from the 1996 to 1997 Cardiovascular Health Study visit among individuals with CKD progression (30% decline in eGFR over 9 years, n=192) or incident ESRD (n=54) during follow-up, and in 958 randomly selected participants. We evaluated associations of urine PIIINP with CKD progression and incident ESRD. Associations of urine PIIINP with cardiovascular disease, heart failure, and death were evaluated as secondary end points. At baseline, mean age (±SD) was 78±5 years, mean eGFR was 63±18 ml/min per 1.73 m(2), and median urine PIIINP was 2.6 (interquartile range, 1.4-4.2) μg/L. In a case-control study (192 participants, 231 controls), each doubling of urine PIIINP associated with 22% higher odds of CKD progression (adjusted odds ratio, 1.22; 95% confidence interval, 1.00 to 1.49). Higher urine PIIINP level was also associated with incident ESRD, but results were not significant in fully adjusted models. In a prospective study among the 958 randomly selected participants, higher urine PIIINP was significantly associated with death, but not with incident cardiovascular disease or heart failure. These data suggest higher urine PIIINP levels associate with CKD progression independently of eGFR and ACR in older individuals.
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Affiliation(s)
- Joachim H Ix
- Division of Nephrology-Hypertension, University of California San Diego and Veterans Affairs San Diego Healthcare System, San Diego, California;
| | - Mary L Biggs
- Department of Biostatistics, School of Public Health and Community Medicine, University of Washington, Seattle, Washington
| | - Kenneth Mukamal
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Luc Djousse
- Division of Aging, Brigham and Women's Hospital and Boston Veterans Affairs Healthcare System, Boston, Massachusetts
| | | | - Russell Tracy
- Department of Pathology, University of Vermont, Burlington, Vermont
| | - Ronit Katz
- Division of Nephrology, University of Washington, Seattle, Washington
| | - Joseph A Delaney
- Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, Washington
| | - Paulo Chaves
- Department of Medicine, Florida International University, Miami, Florida
| | - Dena E Rifkin
- Division of Nephrology-Hypertension, University of California San Diego and Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Jan M Hughes-Austin
- Department of Family and Preventive Medicine, University of California San Diego, San Diego, California
| | | | - Mark J Sarnak
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Michael G Shlipak
- Department of Medicine, University of California San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, California; and
| | - Jorge R Kizer
- Departments of Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
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Turnover of type III collagen reflects disease severity and is associated with progression and microinflammation in patients with IgA nephropathy. Nephrol Dial Transplant 2015; 31:472-9. [DOI: 10.1093/ndt/gfv301] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 07/06/2015] [Indexed: 01/06/2023] Open
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Boor P, Floege J. Renal allograft fibrosis: biology and therapeutic targets. Am J Transplant 2015; 15:863-86. [PMID: 25691290 DOI: 10.1111/ajt.13180] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 11/30/2014] [Accepted: 12/19/2014] [Indexed: 01/25/2023]
Abstract
Renal tubulointerstitial fibrosis is the final common pathway of progressive renal diseases. In allografts, it is assessed with tubular atrophy as interstitial fibrosis/tubular atrophy (IF/TA). IF/TA occurs in about 40% of kidney allografts at 3-6 months after transplantation, increasing to 65% at 2 years. The origin of renal fibrosis in the allograft is complex and includes donor-related factors, in particular in case of expanded criteria donors, ischemia-reperfusion injury, immune-mediated damage, recurrence of underlying diseases, hypertensive damage, nephrotoxicity of immunosuppressants, recurrent graft infections, postrenal obstruction, etc. Based largely on studies in the non-transplant setting, there is a large body of literature on the role of different cell types, be it intrinsic to the kidney or bone marrow derived, in mediating renal fibrosis, and the number of mediator systems contributing to fibrotic changes is growing steadily. Here we review the most important cellular processes and mediators involved in the progress of renal fibrosis, with a focus on the allograft situation, and discuss some of the challenges in translating experimental insights into clinical trials, in particular fibrosis biomarkers or imaging modalities.
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Affiliation(s)
- P Boor
- Division of Nephrology and Clinical Immunology, RWTH University of Aachen, Aachen, Germany; Department of Pathology, RWTH University of Aachen, Aachen, Germany; Institute of Molecular Biomedicine, Bratislava, Slovakia
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35
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Papasotiriou M, Genovese F, Klinkhammer BM, Kunter U, Nielsen SH, Karsdal MA, Floege J, Boor P. Serum and urine markers of collagen degradation reflect renal fibrosis in experimental kidney diseases. Nephrol Dial Transplant 2015; 30:1112-21. [PMID: 25784725 DOI: 10.1093/ndt/gfv063] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 02/19/2015] [Indexed: 01/24/2023] Open
Affiliation(s)
- Marios Papasotiriou
- Institute of Pathology, RWTH University of Aachen, Aachen, NRW, Germany Department of Nephrology, RWTH University of Aachen, Aachen, NRW, Germany Department of Nephrology, University Hospital of Patras, Patras, Greece
| | | | | | - Uta Kunter
- Department of Nephrology, RWTH University of Aachen, Aachen, NRW, Germany
| | | | | | - Jürgen Floege
- Department of Nephrology, RWTH University of Aachen, Aachen, NRW, Germany
| | - Peter Boor
- Institute of Pathology, RWTH University of Aachen, Aachen, NRW, Germany Department of Nephrology, RWTH University of Aachen, Aachen, NRW, Germany
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Jianguo W, Zhenzhen L, Xianghua L, Zhanzheng Z, Suke S, Suyun W. Serum and urinary procollagen III aminoterminal propeptide as a biomarker of obstructive nephropathy in children. Clin Chim Acta 2014; 434:29-33. [PMID: 24768785 DOI: 10.1016/j.cca.2014.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 04/11/2014] [Accepted: 04/16/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ureteropelvic junction obstruction (UPJO) is the most common cause of chronic renal failure in children. Rapid diagnosis is important to preserve function and/or to slow down renal injury. This study was to examine serum and urinary procollagen III aminoterminal propeptide (sPIIINP/uPIIINP) protein as potential biomarkers of obstruction in hydronephrosis. METHODS The study included 29 children with unilateral UPJO who underwent pyeloplasty (Group 1), 30 children with mild, nonobstructive hydronephrosis (Group 2), and 30 healthy children. In Group 1, serum and voided urine samples were obtained at preoperative, 3 days, and 3, 6 and 12 months after pyeloplasty, respectively. Meanwhile, additional urine from the affected pelvis was collected at surgery. Serum and voided urine were evaluated for PIIINP in each group using immunoenzymatic enzyme-linked immunosorbent assay (ELISA) commercial kits and were expressed in picograms per milligram creatine (cr.). RESULTS The preoperative sPIIINP and uPIIINP levels were significantly greater in Group 1 than in other 2 groups. Three months after pyeloplasty, sPIIINP and uPIIINP levels had decreased significantly in Group 1 together with significant improvement of split renal function. Receiver operator characteristic (ROC) analyses revealed a good diagnostic profile for uPIIINP/cr. in identifying children with abnormal split renal function (<40%) [area under the curve (AUC) 0.789]. CONCLUSIONS Increasing uPIIINP levels are associated with worsening obstruction. Additional studies are required to confirm a potential application uPIIINP as a useful biomarker for the diagnosis and progression of congenital obstructive nephropathy.
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Affiliation(s)
- Wen Jianguo
- The Institute of Clinical Medicine, Henan, China; Urology Department Pediatric Urodynamic Center, Henan, China
| | - Li Zhenzhen
- The Institute of Clinical Medicine, Henan, China; Nephrology Department of the First Affiliated Hospital of Zhengzhou University, Henan, China.
| | - Liu Xianghua
- Pathological Experiment Center of Henan University of Traditional Chinese Medicine, China
| | - Zhao Zhanzheng
- Nephrology Department of the First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Sun Suke
- The Institute of Clinical Medicine, Henan, China
| | - Wang Suyun
- The Institute of Clinical Medicine, Henan, China
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The extracellular matrix in the kidney: a source of novel non-invasive biomarkers of kidney fibrosis? FIBROGENESIS & TISSUE REPAIR 2014; 7:4. [PMID: 24678881 PMCID: PMC3986639 DOI: 10.1186/1755-1536-7-4] [Citation(s) in RCA: 249] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 02/27/2014] [Indexed: 02/06/2023]
Abstract
Interstitial fibrosis is the common endpoint of end-stage chronic kidney disease (CKD) leading to kidney failure. The clinical course of many renal diseases, and thereby of CKD, is highly variable. One of the major challenges in deciding which treatment approach is best suited for a patient but also in the development of new treatments is the lack of markers able to identify and stratify patients with stable versus progressive disease. At the moment renal biopsy is the only means of diagnosing renal interstitial fibrosis. Novel biomarkers should improve diagnosis of a disease, estimate its prognosis and assess the response to treatment, all in a non-invasive manner. Existing markers of CKD do not fully and specifically address these requirements and in particular do not specifically reflect renal fibrosis. The aim of this review is to give an insight of the involvement of the extracellular matrix (ECM) proteins in kidney diseases and as a source of potential novel biomarkers of renal fibrosis. In particular the use of the protein fingerprint technology, that identifies neo-epitopes of ECM proteins generated by proteolytic cleavage by proteases or other post-translational modifications, might identify such novel biomarkers of renal fibrosis.
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Cholecalciferol Supplementation Does Not Protect Against Renal Allograft Structural and Functional Deterioration: A Retrospective Study. Transplantation 2011; 91:207-12. [DOI: 10.1097/tp.0b013e318200ba37] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Ghoul BE, Squalli T, Servais A, Elie C, Meas-Yedid V, Trivint C, Vanmassenhove J, Grünfeld JP, Olivo-Marin JC, Thervet E, Noël LH, Prié D, Fakhouri F. Urinary procollagen III aminoterminal propeptide (PIIINP): a fibrotest for the nephrologist. Clin J Am Soc Nephrol 2010; 5:205-10. [PMID: 20089486 DOI: 10.2215/cjn.06610909] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Kidney biopsy (KB), to date the only tool for the evaluation of renal fibrosis, carries specific risks, and its relevance is limited by the small size of renal parenchyma assessed. Thus, a noninvasive alternative to KB is required. Collagen type III amino-terminal propeptide (PIIINP) is a degradation product of collagen type III, the increase of which may reflect an ongoing fibrotic process. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In a prospective study including 199 patients with various stages of chronic kidney disease (CKD), the association between urinary PIIINP/creatinine ratio (UPIIINP/Cr), patients' characteristics, and renal fibrosis was assessed. RESULTS A total of 118 of the patients had UPIIINP/Cr measured simultaneously with the performance of a KB. In patients, median UPIIINP/Cr was 290 ng/mmol versus 93.7 ng/mmol in controls. In univariate analysis, UPIIINP/Cr was correlated with serum creatinine, estimated GFR, CKD stage, presence of coronary artery disease, and nephropathy type (glomerulonephritis versus other types). In multivariate analysis, only estimated GFR and nephropathy type were correlated with UPIIINP/Cr. UPIIINP/Cr was closely correlated with the extent of interstitial fibrosis in KB assessed using two different methods. Moreover, UPIIINP/Cr >800 ng/mmol had a negative predictive value of 94% to detect patients in whom KB will eventually prove "noninformative" (KB leading neither to a definite diagnosis of nephropathy nor to specific treatment). CONCLUSIONS UPIIINP/Cr is a promising fibro-test for the kidney and may alleviate the need for KB in some patients with CKD. Its predictive value for CKD progression deserves evaluation in prospective studies.
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Affiliation(s)
- Balsam El Ghoul
- Department of Nephrology, Université Paris Descartes, Hôpital Necker, Paris, France
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Tylicki L, Renke M, Rutkowski P, Larczyński W, Aleksandrowicz E, Lysiak-Szydlowska W, Rutkowski B. Dual blockade of the renin-angiotensin-aldosterone system with high-dose angiotensin-converting enzyme inhibitor for nephroprotection: an open, controlled, randomized study. ACTA ACUST UNITED AC 2009; 42:381-8. [PMID: 19230172 DOI: 10.1080/00365590801905943] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Despite the proven effectiveness of combination therapy with an angiotensin I-converting enzyme inhibitor (ACEI) and angiotensin II-receptor blockers (ARBs) for the prevention and treatment of kidney disease, it has not proved possible to inhibit the progress of chronic nephropathies completely. To improve renal outcome one may consider using increased dosages of ACEI above those usually recommended for hypertension. MATERIAL AND METHODS A randomized, open, controlled study was conducted to evaluate the influence of two combination therapies on proteinuria, markers of tubular injury and renal fibrosis. A total of 18 patients with a creatinine level of 109+/-36 micromol/l and proteinuria of 0.97+/-0.76 g/24 h were enrolled in the study. In the 8-week run-in period, an ACEI (cilazapril 5 mg once-daily) and an ARB (telmisartan 80 mg once-daily) were administered to achieve the target blood pressure of < or = 130/80 mmHg. Next, the patients were randomly assigned to either an increased dose of cilazapril (10 mg) or the previous dose (5 mg) in two active-treatment periods, each lasting 8 weeks. RESULTS A significant increase in renin activity was observed after administration of cilazapril 10 mg (6.46+/-1.12 vs 4.67+/-0.7 ng/ml/h; p=0.028). Proteinuria, urine excretion of N-acetyl-beta-D-glucosaminidase, and alpha1-microglobulin and amino-terminal propeptide of type III procollagen were unchanged. CONCLUSION An increased dosage of cilazapril (twice the maximum recommended dose) in addition to combination therapy with telmisartan was associated with increased blockade of the renin-angiotensin-aldosterone system, with no additional effect on proteinuria, markers of tubular injury or renal fibrosis.
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Affiliation(s)
- Leszek Tylicki
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland.
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Tylicki L, Rutkowski P, Renke M, Larczyński W, Aleksandrowicz E, Lysiak-Szydlowska W, Rutkowski B. Triple Pharmacological Blockade of the Renin-Angiotensin-Aldosterone System in Nondiabetic CKD: An Open-Label Crossover Randomized Controlled Trial. Am J Kidney Dis 2008; 52:486-93. [DOI: 10.1053/j.ajkd.2008.02.297] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Accepted: 02/14/2008] [Indexed: 01/27/2023]
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Abstract
Recent advancements in immunobiology have introduced several new diagnostic tools for monitoring kidney transplant recipients. These have been added to more established tests that, although imperfect, remain important benchmarks of diagnostic utility. Both new and old tests can be characterized with regard to their practicality, and as to whether they detect aberrant function or define the cause of dysfunction. Unfortunately, no current test is both practical and specific to a particular disease entity. Accordingly, the diagnosis of graft dysfunction remains dependent on the proper use and interpretation of many studies. This article reviews the current assays that have been evaluated in the clinic for the diagnosis of renal allograft-related diseases. These are limited to assays based on routinely obtainable samples such as blood, biopsy tissue, and urine. Newer studies are presented, along with more mundane assays, to highlight the practical use of studies regardless of their degree of mechanistic sophistication.
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Affiliation(s)
- Raffaele Girlanda
- Transplantation Branch, National Institutes of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA
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Nakamura A, Ishii A, Ohata C, Komurasaki T. Early induction of osteoactivin expression in rat renal tubular epithelial cells after unilateral ureteral obstruction. ACTA ACUST UNITED AC 2007; 59:53-9. [PMID: 17588730 DOI: 10.1016/j.etp.2007.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Accepted: 03/29/2007] [Indexed: 10/23/2022]
Abstract
In this study, we examined the expression of osteoactivin in the rat kidney after unilateral ureteral obstruction. Male Wistar rats were sacrificed at 6h, and on days 1, 2, 3 and 7 after the obstruction. The renal tubular lumens gradually dilated, and marked interstitial fibrosis was confirmed histologically on day 3 after the obstruction. The expressions of osteoactivin and collagen type III were examined by quantitative real-time RT-PCR. An 8-fold increase in osteoactivin mRNA expression as compared with that in the sham-operated group was observed at 6h after the obstruction, whereas no elevation of collagen type III mRNA expression was observed at this early stage. Furthermore, semi-quantitative RT-PCR was performed to identify upregulation of expression of matrix metalloproteinase-13 mRNA relative to that in the sham-operated control, and normalized to the expression level of beta-actin. Intense osteoactivin expression localized in the dilated tubular epithelium and interstitial fibroblasts in the obstructive kidney was detected by immunohistochemistry and by in situ hybridization. These results suggested that the early-phase upregulation of osteoactivin expression in the tubular epithelium in response to renal injury might play a role in triggering renal interstitial fibrosis via activation of matrix metalloproteinase expression and collagen remodeling in rats.
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Affiliation(s)
- Atsushi Nakamura
- Medicinal Research Laboratories, Taisho Pharmaceutical Co LTD, Saitama-Shi, Saitama, Japan.
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Nakamura A, Sakai Y, Ohata C, Komurasaki T. Expression and significance of a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS)-1 in an animal model of renal interstitial fibrosis induced by unilateral ureteral obstruction. ACTA ACUST UNITED AC 2007; 59:1-7. [PMID: 17583485 DOI: 10.1016/j.etp.2007.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Accepted: 01/11/2007] [Indexed: 11/16/2022]
Abstract
To evaluate the pathological roles of a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS)-1 in rat renal interstitial fibrosis, we examined the expression, localization and effect on growth of ADAMTS-1 in a normal rat kidney cell line (NRK-49F). Increased ADAMTS-1 mRNA expression was observed in the kidney by in situ hybridization after induction of unilateral ureteral obstruction (UUO) in male Wistar rats, the mRNA was localized in the renal tubular epithelial cells in the outer stripe of the outer medulla in the UUO kidney. On the other hand, no positive signals were observed in the sham-operated-kidney. Western-blot analysis of stable human embryonic kidney 293 (HEK293) transformant cells expressing rat ADAMTS-1 containing the V5 tag using anti-V5 tag monoclonal antibody revealed the presence of two post-translationally processed bands in the cells: an 87-kDa band with a metalloproteinase motif and 65-kDa band with a thrombospondin motifs. On the other hand, secretion of the 65-kDa protein into the culture supernatants from the transformant cells was confirmed. Treatment with the culture supernatant of the transformant cells potently reduced the uptake of 3H-thymidine in the NRK-49F cells, no such inhibitory effect was observed with the culture medium of the HEK293 cells. These results suggest that the UUO-induced expression of ADAMTS-1 in the rat renal tubular epithelial cells may actively contribute to the inhibition of DNA synthesis in the renal interstitial fibroblasts via the 65-kDa moiety with thrombospondin motifs.
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Affiliation(s)
- Atsushi Nakamura
- Medicinal Research Laboratories, Taisho Pharmaceutical Co LTD, Saitama-Shi 331-9530, Saitama, Japan.
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Lin YH, Liu CP, Hsu RB, Lee CM, Wang SS, Kao HL, Chao CL, Shiau YC, Hung CS, Liao LC, Ho YL. Association of amino-terminal propeptide of type III procollagen and acute myocardial rejection in male patients receiving heart transplantation. ACTA ACUST UNITED AC 2007; 45:1004-8. [PMID: 17867989 DOI: 10.1515/cclm.2007.196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The amino-terminal propeptides of type I and III procollagens (PINP and PIIINP) are markers reflecting the status of collagen turnover. We hypothesized that measurement of these serum procollagen propeptides could be used to non-invasively assess acute rejection in heart transplant recipients. METHODS In heart transplant recipients, endomyocardial biopsy specimens taken at 6 and 12 months after surgery were used for study. PINP and PIIINP were measured postoperatively at 3, 6, and 12 months. RESULTS A total of 20 male heart transplant patients and seven male control subjects were enrolled. Five patients showed rejection 6 months after transplantation (group 1), while 15 patients showed no rejection (group 2). In group 2 patients, serum PINP and PIIINP levels decreased significantly 6 months after transplantation. In contrast, elevation of serum PINP and PIIINP levels persisted in group 1 patients 6 months after transplantation. At 6 months after transplantation, group 1 patients had significantly higher PIIINP levels than group 2 patients (p=0.025) and controls (p=0.003). After immunosuppressive therapy, all group 1 patients were free of rejection 12 months after transplantation and serial serum PIIINP levels decreased significantly in these patients. CONCLUSIONS Serum PIIINP levels represent a non-invasive method to reflect the occurrence and resolution of acute rejection.
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Affiliation(s)
- Yen-Hung Lin
- Department of Internal Medicine, Division of Cardiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Tylicki L, Biedunkiewicz B, Chamienia A, Wojnarowski K, Zdrojewski Z, Aleksandrowicz E, Lysiak-Szydlowska W, Rutkowski B. Renal allograft protection with angiotensin II type 1 receptor antagonists. Am J Transplant 2007; 7:243-8. [PMID: 17227571 DOI: 10.1111/j.1600-6143.2006.01588.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The renal benefits of agents inhibiting the renin-angiotensin-aldosterone system in renal transplant recipients, i.e. preventing the development of chronic graft nephropathy, are supposed but not finally proven. In a double-blind, placebo-controlled, cross-over study, we evaluated the influence of losartan on surrogate markers of tubular injury, urine excretion of transforming growth factor beta-1 (TGF-beta1) and amino-terminal propeptide of type III procollagen (PIIINP) in 16 patients after transplantation. The patients received randomly either losartan (50-100 mg daily) or the beta-blocker carvedilol (12.5-25 mg) for 8 weeks, allowing a placebo washout between treatments. The target office through blood pressure (BP) was below 130/85 mmHg. The BP did not differ in the treatment periods. Losartan significantly decreased N-acetyl-beta-d-glucosaminidase and alfa-1 microglobulin excretion relative to placebo and carvedilol. Urine excretion of TGF-beta1 and PIIINP was significantly lower after losartan. In conclusion, losartan reduces urine excretion of proteins associated with tubular damage and graft fibrosis.
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Affiliation(s)
- L Tylicki
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, Poland
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Kim CD, Cho YJ, Park SH, Ha SW, Lee EG, Kim YJ, Kwon TH, Kim IS, Kim YL. Urinary Transforming Growth Factor-β–Induced Gene-h3 (βig-h3) as a Sensitive Predictor in Chronic Cyclosporine Nephrotoxicity. Transplant Proc 2006; 38:1314-9. [PMID: 16797290 DOI: 10.1016/j.transproceed.2006.02.070] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2005] [Indexed: 11/24/2022]
Abstract
Transforming growth factor (TGF)-beta is involved in the pathogenesis of chronic cyclosporine nephrotoxicity (CyAN). Since the expression of TGF-beta induced gene h3 (betaig-h3) is up-regulated by TGF-beta, we evaluated the potential role of betaig-h3 as a sensitive urinary marker to monitor the progression/regression of chronic CyAN. Urinary betaig-h3 levels were determined using an enzyme-linked immunosorbent assay in nine patients with chronic CyAN and 13 patients with stable graft function. We scored the extent of tubulointerstitial fibrosis (TIF) and using immunoperoxidase labeling, determined betaig-h3 expression in renal tissues of patients with chronic CyAN. Urinary betaig-h3 excretion was higher in chronic CyAN compared to control subjects (173.4+/-26.0 vs 62.6+/-5.0 ng/mg creatinine, P<.01). In chronic CyAN, the degree of TIF correlated with increased urinary betaig-h3 levels (r=.785, P<.05). In kidneys with chronic CyAN, betaig-h3 labeling was more prominent at the basement membranes (BM) of the tubules where inflammatory cells had infiltrated the surrounding interstitium. Moreover, the BM of the atrophied tubules and their surrounding interstitium were strongly labeled. Urinary betaig-h3 levels decreased from 173.4+/-26.0 to 64.9+/-14.4 ng/mg creatinine at 1 month after discontinuation of CyA or reduction in CyA dosage (P<.01) despite unchanged serum creatinine levels. Urinary betaig-h3 levels increased in patients with chronic CyAN and decreased after discontinuation or reduction of CyA dosage. Our results suggested that urinary betaig-h3 levels could be used as a sensitive urinary marker to monitor the progression or regression of chronic CyAN.
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Affiliation(s)
- C-D Kim
- Kyungpook National University School of Medicine, Department of Internal Mediicne, Daegu, Republic of Korea.
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48
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Schuller S, Valentin S, Remy B, Jespers P, Foulon S, Van Israël N, Clercx C, McEntee K. Analytical, physiologic, and clinical validation of a radioimmunoassay for measurement of procollagen type III amino terminal propeptide in serum and bronchoalveolar lavage fluid obtained from dogs. Am J Vet Res 2006; 67:749-55. [PMID: 16649905 DOI: 10.2460/ajvr.67.5.749] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To validate a radioimmunoassay for measurement of procollagen type III amino terminal propeptide (PIIINP) concentrations in canine serum and bronchoalveolar lavage fluid (BALF) and investigate the effects of physiologic and pathologic conditions on PIIINP concentrations. SAMPLE POPULATION Sera from healthy adult (n = 70) and growing dogs (20) and dogs with chronic renal failure (CRF; 10), cardiomyopathy (CMP; 12), or degenerative valve disease (DVD; 26); and sera and BALF from dogs with chronic bronchopneumopathy (CBP; 15) and healthy control dogs (10 growing and 9 adult dogs). PROCEDURE A radioimmunoassay was validated, and a reference range for serum PIIINP (S-PIIINP) concentration was established. Effects of growth, age, sex, weight, CRF, and heart failure on S-PIIINP concentration were analyzed. In CBP-affected dogs, S-PIIINP and BALF-PIIINP concentrations were evaluated. RESULTS The radioimmunoassay had good sensitivity, linearity, precision, and reproducibility and reasonable accuracy for measurement of S-PIIINP and BALF-PIIINP concentrations. The S-PIIINP concentration reference range in adult dogs was 8.86 to 11.48 mug/L. Serum PIIINP concentration correlated with weight and age. Growing dogs had significantly higher S-PIIINP concentrations than adults, but concentrations in CRF-, CMP-, DVD-, or CBP-affected dogs were not significantly different from control values. Mean BALF-PIIINP concentration was significantly higher in CBP-affected dogs than in healthy adults. CONCLUSIONS AND CLINICAL RELEVANCE In dogs, renal or cardiac disease or CBP did not significantly affect S-PIIINP concentration; dogs with CBP had high BALF-PIIINP concentrations. Data suggest that the use of PIIINP as a marker of pathologic fibrosis might be limited in growing dogs.
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Affiliation(s)
- Simone Schuller
- Department of Small Animal Clinical Sciences, University of Liège, 4000 Liège, Belgium
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49
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Rogier E, Durrbach A, Abecassis L, Ferlicot S, Snanoudj R, Baudreuil S, Arzouk N, Vazquez A, Charpentier B, Bourgeade MF. A novel biological assay to detect the active form of TGF-beta in urine to monitor renal allograft rejection. Kidney Int 2005; 68:1875-83. [PMID: 16164666 DOI: 10.1111/j.1523-1755.2005.00607.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transforming growth factor-beta (TGF-beta) plays an important role in renal fibrosis. Measurement of the concentration of the active form of TGF-beta particularly in urine may help our understanding of the mechanism of chronic allograft nephropathy and could be used as a diagnostic tool. However, TGF-beta release and activation are complex and, consequently, there is currently no accurate way to measure TGF-beta activity. METHODS TGF-beta-sensitive BL41 cells were stably transfected with a reporter plasmid harboring a synthetic TGF-beta-inducible DNA sequence upstream from the luciferase gene. Cells were incubated with urine samples from normal donors or transplanted recipients with or without patent nephropathy, and the active form of TGF-beta was determined as luciferase activity. RESULTS We have established a cell line which expresses luciferase activity in response to active TGF-beta in a dose-dependent manner. Moreover, the use of a histone deacetylase inhibitor greatly increased sensitivity to TGF-beta and also stabilized luciferase inductibility. This test is highly specific to active TGF-beta. Detectable levels of TGF-beta were found in urine from patients with renal dysfunction due to acute or chronic renal allograft rejection (P < 0.001), but not in that from patients with stable, correctly functional kidneys. CONCLUSION We describe a highly sensitive and specific assay for active TGF-beta. We also show that, in cases of renal allograft, TGF-beta expression is highly and significantly correlated with acute or chronic rejections.
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Affiliation(s)
- Edith Rogier
- INSERM Unité 542, Hôpital Paul Brousse, Villejuif, France
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Eikmans M, Ijpelaar DHT, Baelde HJ, de Heer E, Bruijn JA. The use of extracellular matrix probes and extracellular matrix-related probes for assessing diagnosis and prognosis in renal diseases. Curr Opin Nephrol Hypertens 2005; 13:641-7. [PMID: 15483455 DOI: 10.1097/00041552-200411000-00010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Scarring in the kidney results from excessive local synthesis and exogenous accumulation of extracellular matrix components. Once chronic damage is present in the biopsy, therapeutic intervention for the renal patient encounters severe limitations. It is therefore essential to determine clinical outcome preferably at a time point before the development of overt scarring. Clinical parameters and morphologic alterations in the biopsy are currently used as tools for the diagnosis of the renal disease entity and for assessment of the patient's prognosis. Expression levels of extracellular matrix and matrix-related components may serve as additive and even superior prognostic indicators to conventional parameters. We will elaborate on studies supporting this concept. RECENT FINDINGS Several investigators have shown in experimental models for renal disease that extracellular matrix probes and related probes reflect disease progression and predict outcome. In this review, we will provide an update on the most recent studies of human renal biopsies showing that expression of extracellular matrix components, regulators of matrix degradation, and cytokines affecting matrix deposition may be employed for discrimination of diagnostic groups and predicting prognosis. SUMMARY Molecular techniques are expected to be used more and more for diagnostic and prognostic purposes in nephrological practice to supplement the histopathological analysis of the renal biopsy. Assessment of expression of matrix molecules, matrix-regulating cytokines, and metalloproteinases in renal kidney biopsies is helpful to distinguish patients who are at risk of developing progressive renal failure from patients who are likely to recover from renal tissue injury by natural remodeling mechanisms.
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Affiliation(s)
- Michael Eikmans
- Department of Pathology, Leiden University Medical Center, Building 1, L1-Q, PO Box 9600, 2300 RC, Leiden, The Netherlands.
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