1
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Sinha SK, Nicholas SB. Pathomechanisms of Diabetic Kidney Disease. J Clin Med 2023; 12:7349. [PMID: 38068400 PMCID: PMC10707303 DOI: 10.3390/jcm12237349] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/15/2023] [Accepted: 11/22/2023] [Indexed: 03/15/2024] Open
Abstract
The worldwide occurrence of diabetic kidney disease (DKD) is swiftly rising, primarily attributed to the growing population of individuals affected by type 2 diabetes. This surge has been transformed into a substantial global concern, placing additional strain on healthcare systems already grappling with significant demands. The pathogenesis of DKD is intricate, originating with hyperglycemia, which triggers various mechanisms and pathways: metabolic, hemodynamic, inflammatory, and fibrotic which ultimately lead to renal damage. Within each pathway, several mediators contribute to the development of renal structural and functional changes. Some of these mediators, such as inflammatory cytokines, reactive oxygen species, and transforming growth factor β are shared among the different pathways, leading to significant overlap and interaction between them. While current treatment options for DKD have shown advancement over previous strategies, their effectiveness remains somewhat constrained as patients still experience residual risk of disease progression. Therefore, a comprehensive grasp of the molecular mechanisms underlying the onset and progression of DKD is imperative for the continued creation of novel and groundbreaking therapies for this condition. In this review, we discuss the current achievements in fundamental research, with a particular emphasis on individual factors and recent developments in DKD treatment.
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Affiliation(s)
- Satyesh K. Sinha
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA;
- College of Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Susanne B. Nicholas
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA;
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2
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Moon S, Tsay JJ, Lampert H, Md Dom ZI, Kostic AD, Smiles A, Niewczas MA. Circulating short and medium chain fatty acids are associated with normoalbuminuria in type 1 diabetes of long duration. Sci Rep 2021; 11:8592. [PMID: 33883567 PMCID: PMC8060327 DOI: 10.1038/s41598-021-87585-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/30/2021] [Indexed: 11/08/2022] Open
Abstract
A substantial number of subjects with Type 1 Diabetes (T1D) of long duration never develop albuminuria or renal function impairment, yet the underlying protective mechanisms remain unknown. Therefore, our study included 308 Joslin Kidney Study subjects who had T1D of long duration (median: 24 years), maintained normal renal function and had either normoalbuminuria or a broad range of albuminuria within the 2 years preceding the metabolomic determinations. Serum samples were subjected to global metabolomic profiling. 352 metabolites were detected in at least 80% of the study population. In the logistic analyses adjusted for multiple testing (Bonferroni corrected α = 0.000028), we identified 38 metabolites associated with persistent normoalbuminuria independently from clinical covariates. Protective metabolites were enriched in Medium Chain Fatty Acids (MCFAs) and in Short Chain Fatty Acids (SCFAs) and particularly involved odd-numbered and dicarboxylate Fatty Acids. One quartile change of nonanoate, the top protective MCFA, was associated with high odds of having persistent normoalbuminuria (OR (95% CI) 0.14 (0.09, 0.23); p < 10-12). Multivariable Random Forest analysis concordantly indicated to MCFAs as effective classifiers. Associations of the relevant Fatty Acids with albuminuria seemed to parallel associations with tubular biomarkers. Our findings suggest that MCFAs and SCFAs contribute to the metabolic processes underlying protection against albuminuria development in T1D that are independent from mechanisms associated with changes in renal function.
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Affiliation(s)
- Salina Moon
- Research Division, Joslin Diabetes Center, One Joslin Place, Boston, MA, 02215, USA
| | - John J Tsay
- Research Division, Joslin Diabetes Center, One Joslin Place, Boston, MA, 02215, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Medicine, Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - Heather Lampert
- Research Division, Joslin Diabetes Center, One Joslin Place, Boston, MA, 02215, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Family Medicine, Brown University, Providence, RI, USA
| | - Zaipul I Md Dom
- Research Division, Joslin Diabetes Center, One Joslin Place, Boston, MA, 02215, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Aleksandar D Kostic
- Research Division, Joslin Diabetes Center, One Joslin Place, Boston, MA, 02215, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Microbiology, Harvard Medical School, Boston, MA, USA
| | - Adam Smiles
- Research Division, Joslin Diabetes Center, One Joslin Place, Boston, MA, 02215, USA
| | - Monika A Niewczas
- Research Division, Joslin Diabetes Center, One Joslin Place, Boston, MA, 02215, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
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3
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Label-Free Protein Detection by Micro-Acoustic Biosensor Coupled with Electrical Field Sorting. Theoretical Study in Urine Models. SENSORS 2021; 21:s21072555. [PMID: 33917374 PMCID: PMC8038679 DOI: 10.3390/s21072555] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/30/2021] [Accepted: 04/03/2021] [Indexed: 12/20/2022]
Abstract
Diagnostic devices for point-of-care (POC) urine analysis (urinalysis) based on microfluidic technology have been actively developing for several decades as an alternative to laboratory based biochemical assays. Urine proteins (albumin, immunoglobulins, uromodulin, haemoglobin etc.) are important biomarkers of various pathological conditions and should be selectively detected by urinalysis sensors. The challenge is a determination of different oligomeric forms of the same protein, e.g., uromodulin, which have similar bio-chemical affinity but different physical properties. For the selective detection of different types of proteins, we propose to use a shear bulk acoustic resonator sensor with an additional electrode on the upper part of the bioliquid-filled channel for protein electric field manipulation. It causes modulation of the protein concentration over time in the near-surface region of the acoustic sensor, that allows to distinguish proteins based on their differences in diffusion coefficients (or sizes) and zeta-potentials. Moreover, in order to improve the sensitivity to density, we propose to use structured sensor interface. A numerical study of this approach for the detection of proteins was carried out using the example of albumin, immunoglobulin, and oligomeric forms of uromodulin in model urine solutions. In this contribution we prove the proposed concept with numerical studies for the detection of albumin, immunoglobulin, and oligomeric forms of uromodulin in urine models.
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4
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Edwards A, Christensen EI, Unwin RJ, Norden AGW. Predicting the protein composition of human urine in normal and pathological states: Quantitative description based on Dent1 disease (
CLCN5
mutation). J Physiol 2020; 599:323-341. [DOI: 10.1113/jp280740] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/16/2020] [Indexed: 01/25/2023] Open
Affiliation(s)
- Aurélie Edwards
- Department of Biomedical Engineering Boston University Boston MA USA
| | | | - Robert J. Unwin
- Department of Renal Medicine Royal Free Campus University College London London UK
| | - Anthony G. W. Norden
- Department of Renal Medicine Royal Free Campus University College London London UK
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5
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Luchsinger V, Lizama L, Garmendia ML, Tempio F, Ruiz M, Pizarro R, Rossi P, Huenchur L, Moreno C, López M, Ampuero S, Larrañaga C, Avendaño LF. Immunoglobulins concentration and B cell counts as severity markers in adult community-acquired pneumonia: Cross sectional study. Medicine (Baltimore) 2020; 99:e22390. [PMID: 33157914 PMCID: PMC7647610 DOI: 10.1097/md.0000000000022390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Community-acquired pneumonia (CAP) is a worldwide cause of morbidity and mortality. Immunoglobulins (Igs) and B cells quantification studies in CAP are few and show discrepancies. Serum IgA acts as a powerful natural anti-inflammatory factor, but its role in the CAP has not yet been defined. The highly sensitive xMAP Luminex technique allows better immunoglobulins quantification. The aim of this study was to analyze the relation between clinical severity and circulating Igs and B cells in adults with CAP.Igs (M, A, G1, G2, G3, and G4) and B cells were quantified in peripheral blood of 190 Chilean patients ≥18 years old hospitalized for CAP and in 21 adults without respiratory disease, using xMAP Luminex and flow cytometry, respectively. Clinical history was recorded and PSI and CURB-65 scores were calculated for evaluation of clinical severity.The total IgM, IgG2 and total IgG levels were lower in CAP than in asymptomatic adults (P < .05). No significant differences of Igs levels were found between patients classified as severe and mild by PSI and CURB-65 scores. Fatal cases had higher levels of IgA (P < .05). No differences in CD19 B cells frequency was found between CAP and asymptomatic adults (P = .40). In PSI severe cases, CD19 B cells were significantly lower than in mild cases (P = .008). No differences were found in CURB-65 severe and mild groups (P = .11). In fatal cases (11/82) group, CD19 B cells frequency was lower than in 71 survivors (P = .2). No differences in memory B lymphocytes were detected between asymptomatic and CAP adults, severe and mild patients, survivors and fatal cases (P > .05).Serum IgA levels were significantly higher in fatal CAP cases, raising it as a potential biomarker for severe disease considering its relatively universal availability. In PSI severe patients, B cells showed lower levels and could have a role on its physiopathology. Finding new markers rooted in physiopathology could improve the possibility of scoring severe CAP cases. Luminex technology showed promising quantification serum Igs.
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Affiliation(s)
- Vivian Luchsinger
- Programa de Virología, ICBM: Programa de Virología, ICBM, Facultad de Medicina
| | - Luis Lizama
- Programa de Virología, ICBM: Programa de Virología, ICBM, Facultad de Medicina
| | | | - Fabián Tempio
- Programa de Inmunología, ICBM: Programa de Virología, ICBM, Facultad de Medicina
- Instituto Milenio de Inmunología e Inmunoterapia, Facultad de Medicina
| | | | | | | | | | - Cristian Moreno
- Programa de Virología, ICBM: Programa de Virología, ICBM, Facultad de Medicina
| | - Mercedes López
- Programa de Inmunología, ICBM: Programa de Virología, ICBM, Facultad de Medicina
- Instituto Milenio de Inmunología e Inmunoterapia, Facultad de Medicina
| | - Sandra Ampuero
- Programa de Virología, ICBM: Programa de Virología, ICBM, Facultad de Medicina
| | - Carmen Larrañaga
- Programa de Virología, ICBM: Programa de Virología, ICBM, Facultad de Medicina
| | - Luis Fidel Avendaño
- Programa de Virología, ICBM: Programa de Virología, ICBM, Facultad de Medicina
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Della Ventura B, Gelzo M, Battista E, Alabastri A, Schirato A, Castaldo G, Corso G, Gentile F, Velotta R. Biosensor for Point-of-Care Analysis of Immunoglobulins in Urine by Metal Enhanced Fluorescence from Gold Nanoparticles. ACS APPLIED MATERIALS & INTERFACES 2019; 11:3753-3762. [PMID: 30609355 DOI: 10.1021/acsami.8b20501] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Biosensors are easy-to-use and cost-effective devices that are emerging as an attractive tool, not only in settling diagnosis or in disease monitoring, but also in mass screening tests, a timely topic that impacts on daily life of the whole society. Nanotechnologies lend themselves to the development of highly sensitive devices whose realization has become a very interdisciplinary topic. Relying on the enhancement of the fluorescence signal detected at the surface of patterned gold nanoparticles, we report the behavior of an analytical device in detecting immunoglobulins in real urine samples that shows a limit of detection of approximately 8 μg/L and a linear range of 10-100 μg/L well below the detection limit of nephelometric method, which is the reference method for this analysis. These performances have been reached thanks to an effective surface functionalization technique and can be improved even more if superydrophobic features of the substrate we produce will be exploited. Since the analyte recognition is realized by antibodies the specificity is very high and, in fact, no interference has been detected by other compounds also present in the real urine samples. The device has been assessed on serum samples by comparing IgG concentrations values obtained by the biosensor with those provided by a nephelometer. In this step we found that our approach allows the analysis of the whole blood without any pretreatment; moreover, it is inherently extendable to the analysis of most biochemical markers in biological fluids.
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Affiliation(s)
- Bartolomeo Della Ventura
- Dipartimento di Fisica Ettore Pancini , Università di Napoli Federico II , Via Cintia, 26 Ed. 6 , 80126 Napoli , Italy
| | - Monica Gelzo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche , Università di Napoli Federico II , Via Pansini 5 , 80131 Napoli , Italy
- CEINGE-Biotecnologie avanzate s.c. a r.l., Via Gaetano Salvatore 486 , 80145 Napoli , Italy
| | - Edmondo Battista
- Centro di Ricerca Interdipartimentale sui Biomateriali , Università degli Studi di Napoli "Federico II" , Ple Tecchio 80 , 80125 Napoli , Italy
| | - Alessandro Alabastri
- Electrical and Computer Engineering Department , Rice University , 6100 Main Street , Houston , Texas 77005 , United States
| | - Andrea Schirato
- Dipartimento di Fisica , Politecnico di Milano , Piazza L. da Vinci 32 , 20133 Milano , Italy
| | - Giuseppe Castaldo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche , Università di Napoli Federico II , Via Pansini 5 , 80131 Napoli , Italy
- CEINGE-Biotecnologie avanzate s.c. a r.l., Via Gaetano Salvatore 486 , 80145 Napoli , Italy
| | - Gaetano Corso
- Dipartimento di Medicina Clinica e Sperimentale , Università di Foggia , 70122 Viale Pinto , Foggia , Italy
| | - Francesco Gentile
- Dipartimento di Ingegneria Elettrica e Tecnologie dell'Informazione , Università di Napoli Federico II , via Claudio 21 , 80125 Napoli , Italy
| | - Raffaele Velotta
- Dipartimento di Fisica Ettore Pancini , Università di Napoli Federico II , Via Cintia, 26 Ed. 6 , 80126 Napoli , Italy
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7
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Qin Y, Zhang S, Shen X, Zhang S, Wang J, Zuo M, Cui X, Gao Z, Yang J, Zhu H, Chang B. Evaluation of urinary biomarkers for prediction of diabetic kidney disease: a propensity score matching analysis. Ther Adv Endocrinol Metab 2019; 10:2042018819891110. [PMID: 31832131 PMCID: PMC6887810 DOI: 10.1177/2042018819891110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 11/04/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the diagnostic value of six urinary biomarkers for prediction of diabetic kidney disease (DKD). METHODS The cross-sectional study recruited 1053 hospitalized patients with type 2 diabetes mellitus (T2DM), who were categorized into the diabetes mellitus (DM) with normoalbuminuria (NA) group (n = 753) and DKD group (n = 300) according to 24-h urinary albumin excretion rate (24-h UAE). Data on the levels of six studied urinary biomarkers [transferrin (TF), immunoglobulin G (IgG), retinol-binding protein (RBP), β-galactosidase (GAL), N-acetyl-beta-glucosaminidase (NAG), and β2-microglobulin (β2MG)] were obtained. The propensity score matching (PSM) method was applied to eliminate the influences of confounding variables. RESULTS Patients with DKD had higher levels of all six urinary biomarkers. All indicators demonstrated significantly increased risk of DKD, except for GAL and β2MG. Single RBP yielded the greatest area under the curve (AUC) value of 0.920 compared with the other five markers, followed by TF (0.867) and IgG (0.867). However, GAL, NAG, and β2MG were shown to have a weak prognostic ability. The diagnostic values of the different combinations were not superior to the single RBP. CONCLUSIONS RBP, TF, and IgG could be used as reliable or good predictors of DKD. The combined use of these biomarkers did not improve DKD detection.
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Affiliation(s)
- Yongzhang Qin
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin, China
- Department of Endocrinology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Shuang Zhang
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin, China
- Tianjin Women’s and Children’s Health Center, Tianjin, China
| | - Xiaofang Shen
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin, China
| | - Shunming Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Jingyu Wang
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin, China
| | - Minxia Zuo
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin, China
| | - Xiao Cui
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin, China
| | - Zhongai Gao
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin, China
| | - Juhong Yang
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin, China
| | - Hong Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
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8
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Papadopoulou-Marketou N, Kanaka-Gantenbein C, Marketos N, Chrousos GP, Papassotiriou I. Biomarkers of diabetic nephropathy: A 2017 update. Crit Rev Clin Lab Sci 2017; 54:326-342. [DOI: 10.1080/10408363.2017.1377682] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Nektaria Papadopoulou-Marketou
- Diabetes Centre of the Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, Athens, Greece
- Department of Endocrinology, Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden
| | - Christina Kanaka-Gantenbein
- Diabetes Centre of the Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | | | - George P. Chrousos
- Diabetes Centre of the Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Ioannis Papassotiriou
- Department of Clinical Biochemistry, “Aghia Sophia” Children’s Hospital, Athens, Greece
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9
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Kolbach-Mandel AM, Mandel NS, Hoffmann BR, Kleinman JG, Wesson JA. Stone former urine proteome demonstrates a cationic shift in protein distribution compared to normal. Urolithiasis 2017; 45:337-346. [PMID: 28314883 PMCID: PMC5511579 DOI: 10.1007/s00240-017-0969-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 02/08/2017] [Indexed: 11/25/2022]
Abstract
Many urine proteins are found in calcium oxalate stones, yet decades of research have failed to define the role of urine proteins in stone formation. This urine proteomic study compares the relative amounts of abundant urine proteins between idiopathic calcium oxalate stone forming and non-stone forming (normal) cohorts to identify differences that might correlate with disease. Random mid-morning urine samples were collected following informed consent from 25 stone formers and 14 normal individuals. Proteins were isolated from urine using ultrafiltration. Urine proteomes for each sample were characterized using label-free spectral counting mass spectrometry, so that urine protein relative abundances could be compared between the two populations. A total of 407 unique proteins were identified with the 38 predominant proteins accounting for >82% of all sample spectral counts. The most highly abundant proteins were equivalent in stone formers and normals, though significant differences were observed in a few moderate abundance proteins (immunoglobulins, transferrin, and epidermal growth factor), accounting for 13 and 10% of the spectral counts, respectively. These proteins contributed to a cationic shift in protein distribution in stone formers compared to normals (22% vs. 18%, p = 0.04). Our data showing only small differences in moderate abundance proteins suggest that no single protein controls stone formation. Observed increases in immunoglobulins and transferrin suggest increased inflammatory activity in stone formers, but cannot distinguish cause from effect in stone formation. The observed cationic shift in protein distribution would diminish protein charge stabilization, which could lead to protein aggregation and increased risk for crystal aggregation.
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Affiliation(s)
- Ann M Kolbach-Mandel
- Division of Nephrology, Department of Medicine, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI, 53226, USA
| | - Neil S Mandel
- Mandel International Stone and Molecular Analysis Center, Zablocki VA Medical Center, 5000 W. National Avenue, Milwaukee, WI, 53295, USA
- Division of Nephrology, Department of Medicine, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI, 53226, USA
| | - Brian R Hoffmann
- Department of Biomedical Engineering, Cardiovascular Center, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI, 53226, USA
| | - Jack G Kleinman
- Division of Nephrology, Department of Medicine, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI, 53226, USA
| | - Jeffrey A Wesson
- Nephrology Section, Consultant Care Division, Zablocki Department of Veterans Affairs Medical Center, 5000 W. National Avenue (111K), Milwaukee, WI, 53295, USA.
- Division of Nephrology, Department of Medicine, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI, 53226, USA.
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10
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Niewczas MA, Mathew AV, Croall S, Byun J, Major M, Sabisetti VS, Smiles A, Bonventre JV, Pennathur S, Krolewski AS. Circulating Modified Metabolites and a Risk of ESRD in Patients With Type 1 Diabetes and Chronic Kidney Disease. Diabetes Care 2017; 40:383-390. [PMID: 28087576 PMCID: PMC5319475 DOI: 10.2337/dc16-0173] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 12/17/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Patients with type 1 diabetes (T1D) with impaired renal function are at increased risk for end-stage renal disease (ESRD). Although the rate of progression varies, determinants and mechanisms of this variation are unknown. RESEARCH DESIGN AND METHODS We examined serum metabolomic profiles associated with variation in renal function decline in participants with T1D (the Joslin Kidney Study prospective cohort). One hundred fifty-eight patients with proteinuria and chronic kidney disease stage 3 were followed for a median of 11 years to determine estimated glomerular filtration rate slopes from serial measurements of serum creatinine and to ascertain time to onset of ESRD. Baseline serum samples were subjected to global metabolomic profiling. RESULTS One hundred ten amino acids and purine and pyrimidine metabolites were detected in at least 80% of participants. Serum levels of seven modified metabolites (C-glycosyltryptophan, pseudouridine, O-sulfotyrosine, N-acetylthreonine, N-acetylserine, N6-carbamoylthreonyladenosine, and N6-acetyllysine) were associated with renal function decline and time to ESRD (P < 0.001) independent of the relevant clinical covariates. The significant metabolites correlated with one another and with the indices of tubular injury. CONCLUSIONS This prospective cohort study in participants with T1D, proteinuria, and impaired renal function at baseline demonstrated that patients with increased circulating levels of certain modified metabolites experience faster renal function decline, leading to ESRD. Whether some of these candidate metabolites are risk factors or just prognostic biomarkers of progression to ESRD in T1D needs to be determined.
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Affiliation(s)
- Monika A Niewczas
- Research Division, Joslin Diabetes Center, Boston, MA .,Department of Medicine, Harvard Medical School, Boston, MA
| | - Anna V Mathew
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | | | - Jaeman Byun
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Melissa Major
- Research Division, Joslin Diabetes Center, Boston, MA
| | | | - Adam Smiles
- Research Division, Joslin Diabetes Center, Boston, MA
| | - Joseph V Bonventre
- Department of Medicine, Harvard Medical School, Boston, MA.,Renal Division, Brigham and Women's Hospital, Boston, MA
| | - Subramaniam Pennathur
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Andrzej S Krolewski
- Research Division, Joslin Diabetes Center, Boston, MA.,Department of Medicine, Harvard Medical School, Boston, MA
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11
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Increased plasma kidney injury molecule-1 suggests early progressive renal decline in non-proteinuric patients with type 1 diabetes. Kidney Int 2017; 89:459-67. [PMID: 26509588 PMCID: PMC4848189 DOI: 10.1038/ki.2015.314] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/29/2015] [Accepted: 08/20/2015] [Indexed: 11/08/2022]
Abstract
Progressively decreasing glomerular filtration rate (GFR), or renal decline, is seen in patients with type 1 diabetes (T1D) and normoalbuminuria or microalbuminuria. Here we examined the associations of kidney injury molecule-1 (KIM-1) in plasma and urine with the risk of renal decline and determine whether those associations are independent of markers of glomerular damage. The study group comprised patients with T1D from the 2nd Joslin Kidney Study of which 259 had normoalbuminuria and 203 had microalbuminuria. Serial measurements over 4 to 10 years of follow-up (median 8 years) of serum creatinine and cystatin C were used jointly to estimate eGFRcr-cys slopes and time of onset of CKD stage 3 or higher. Baseline urinary excretion of IgG2 and albumin were used as markers of glomerular damage, and urinary excretion of KIM-1 and its plasma concentration were used as markers of proximal tubular damage. All patients had normal renal function at baseline. During follow-up, renal decline (eGFRcr-cys loss 3.3% or more per year) developed in 96 patients and 62 progressed to CKD stage 3. For both outcomes, the risk rose with increasing baseline levels of plasma KIM-1. In multivariable models, elevated baseline plasma KIM-1 was strongly associated with risk of early progressive renal decline, regardless of baseline clinical characteristics, serum TNFR1 or markers of glomerular damage. Thus, damage to proximal tubules may play an independent role in the development of early progressive renal decline in non-proteinuric patients with T1D.
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Musante L, Tataruch D, Gu D, Liu X, Forsblom C, Groop PH, Holthofer H. Proteases and protease inhibitors of urinary extracellular vesicles in diabetic nephropathy. J Diabetes Res 2015; 2015:289734. [PMID: 25874235 PMCID: PMC4383158 DOI: 10.1155/2015/289734] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 02/23/2015] [Indexed: 12/14/2022] Open
Abstract
Diabetic nephropathy (DN) is one of the major complications of diabetes mellitus (DM), leads to chronic kidney disease (CKD), and, ultimately, is the main cause for end-stage kidney disease (ESKD). Beyond urinary albumin, no reliable biomarkers are available for accurate early diagnostics. Urinary extracellular vesicles (UEVs) have recently emerged as an interesting source of diagnostic and prognostic disease biomarkers. Here we used a protease and respective protease inhibitor array to profile urines of type 1 diabetes patients at different stages of kidney involvement. Urine samples were divided into groups based on the level of albuminuria and UEVs isolated by hydrostatic dialysis and screened for relative changes of 34 different proteases and 32 protease inhibitors, respectively. Interestingly, myeloblastin and its natural inhibitor elafin showed an increase in the normo- and microalbuminuric groups. Similarly, a characteristic pattern was observed in the array of protease inhibitors, with a marked increase of cystatin B, natural inhibitor of cathepsins L, H, and B as well as of neutrophil gelatinase-associated Lipocalin (NGAL) in the normoalbuminuric group. This study shows for the first time the distinctive alterations in comprehensive protease profiles of UEVs in diabetic nephropathy and uncovers intriguing mechanistic, prognostic, and diagnostic features of kidney damage in diabetes.
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Affiliation(s)
- Luca Musante
- Centre for Bioanalytical Sciences (CBAS), Dublin City University, Dublin 9, Ireland
- *Luca Musante: and
| | - Dorota Tataruch
- Centre for Bioanalytical Sciences (CBAS), Dublin City University, Dublin 9, Ireland
| | - Dongfeng Gu
- Centre for Bioanalytical Sciences (CBAS), Dublin City University, Dublin 9, Ireland
| | - Xinyu Liu
- Centre for Bioanalytical Sciences (CBAS), Dublin City University, Dublin 9, Ireland
| | - Carol Forsblom
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, 00100 Helsinki, Finland
- Department of Medicine, Division of Nephrology, Helsinki University Central Hospital, 00100 Helsinki, Finland
- Diabetes and Obesity, Research Program Unit, University of Helsinki, 00100 Helsinki, Finland
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, 00100 Helsinki, Finland
- Department of Medicine, Division of Nephrology, Helsinki University Central Hospital, 00100 Helsinki, Finland
- Diabetes and Obesity, Research Program Unit, University of Helsinki, 00100 Helsinki, Finland
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
| | - Harry Holthofer
- Centre for Bioanalytical Sciences (CBAS), Dublin City University, Dublin 9, Ireland
- *Harry Holthofer:
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Al-Malki AL. Assessment of urinary osteopontin in association with podocyte for early predication of nephropathy in diabetic patients. DISEASE MARKERS 2014; 2014:493736. [PMID: 24876663 PMCID: PMC4024407 DOI: 10.1155/2014/493736] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 04/15/2014] [Accepted: 04/16/2014] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Microalbuminuria has been clinically used for noninvasive evaluation of renal dysfunctions. However, it is a nonspecific marker of diabetic nephropathy (DN). METHODS This study was conducted from March 2012 to April 2013 at Biochemistry Unit, King Fahd Medical Research Center (KFMRC). In this study, urinary osteopontin, podocytes number, and levels of immunoglobulin M (IgM) were determined in 60 patients (diabetic normoalbuminuria, diabetic microalbuminuria, and nephritic syndrome) compared with healthy subjects. RESULTS It was found that in diabetic microalbuminuria patients have a highly significant increase in urinary IgM, osteopontin, and podocyte levels as compared to other groups. Nephrotic syndrome patients showed a moderate significant elevation of these parameters compared to control subjects. At a given specificity of 97%, podocytes yielded the highest sensitivity of all markers, 95.5%. The sensitivity was considerably higher compared to IgM and osteopontin. Podocyte number was positively correlated with serum IgM and osteopontin (r = 0.63 and 0.56), respectively. Its cutoff corresponding to the 10% coefficient of variation was most appropriate for early diagnosis of DN. CONCLUSION Monitoring urinary podocyte may provide a noninvasive tool that is a sensitive, accurate, and specific biomarker of glomerular injury and can be used in combination with osteopontin and IgM to more reliably detect and monitor prognosis.
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Affiliation(s)
- Abdulrahman L. Al-Malki
- Biochemistry Department, Faculty of Science, King Abdulaziz University, P.O. Box 80203, Jeddah 21589, Saudi Arabia
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IgG4-related membranous nephropathy with high blood and low urine IgG4/IgG ratio: a case report and review of the literature. Clin Rheumatol 2013; 33:145-8. [PMID: 24105363 DOI: 10.1007/s10067-013-2406-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 09/18/2013] [Indexed: 12/24/2022]
Abstract
Membranous nephropathy (MN) is a rare manifestation of IgG4-related disease. Interestingly, the significance of IgG4 has also been documented in idiopathic MN (IMN). Previous studies reported that urine IgG4/IgG ratios were significantly higher in IMN compared with other kinds of nephropathy, indicating that impairment of charge selectivity barrier seemed to be an obvious characteristic of IMN. Although high blood concentration of IgG4 is very common in IgG4-related MN, no study about the urine IgG4 has been described before. Here, we present a 55-year-old male with IgG4-related MN. Complete remission of proteinuria was promptly achieved by glucocorticoid treatment without immunosuppressant. Consistent with previous reports, the serum antibody against M-type phospholipase A2 receptor was negative. Surprisingly, although the blood concentration of IgG4/IgG reached as high as 36 %, the urine concentration of IgG4/IgG was only 5 %. The calculated ratio of the renal clearance of IgG4 to IgG of this patient (0.15) was obviously lower than that of five patients with IMN (0.53∼0.81). We speculated that this phenomenon might be a clue of the different pathogenesis between IgG4-related MN and IMN.
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Wang C, Li C, Gong W, Lou T. New urinary biomarkers for diabetic kidney disease. Biomark Res 2013; 1:9. [PMID: 24252392 PMCID: PMC4177619 DOI: 10.1186/2050-7771-1-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 01/04/2013] [Indexed: 11/10/2022] Open
Abstract
Diabetic kidney disease is the leading cause of end-stage renal disease in developed and developing countries. Microalbuminuria is the gold standard for detection and prediction of diabetic kidney disease and cardiovascular risk disease in clinical practice. However, microalbuminuria has several limitations, such as lower sensitive, larger variability. It is urgent to explore higher sensitivity and specificity for earlier detection of diabetic kidney disease and more accurate prediction of the progression to end stage renal disease. We reviewed some new and important urinary biomarkers, such as: transferrin, immunoglobulin G, immunoglobulin M, Cystanic C, podocytes, type IV collagen, 8-oxo-7, 8-dihydro-2'-deoxyguanosine, ceruloplasmin, monocyte chemoattractant protein-1 and so on. We need good quality, long-term, large longitudinal trials to validate published biomarkers and find new biomarkers, considering biomarkers reviewed here are from small cross-sectional studies.
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Affiliation(s)
- Cheng Wang
- Division of Nephrology, Department of Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, 510630, China.
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Dufresne SF, Datta K, Li X, Dadachova E, Staab JF, Patterson TF, Feldmesser M, Marr KA. Detection of urinary excreted fungal galactomannan-like antigens for diagnosis of invasive aspergillosis. PLoS One 2012; 7:e42736. [PMID: 22900046 PMCID: PMC3416763 DOI: 10.1371/journal.pone.0042736] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 07/12/2012] [Indexed: 02/06/2023] Open
Abstract
Mortality associated with invasive aspergillosis (IA) remains high, partly because of delayed diagnosis. Detection of microbial exoantigens, released in serum and other body fluids during infection, may help timely diagnosis. In course of IA, Aspergillus galactomannan (GM), a well established polysaccharide biomarker, is released in body fluids including urine. Urine is an abundant, safely collected specimen, well-suited for point-of-care (POC) testing, which could play an increasing role in screening for early disease. Our main objective was to demonstrate GM antigenuria as a clinically relevant biological phenomenon in IA and establish proof-of-concept that it could be translated to POC diagnosis. Utilizing a novel IgM monoclonal antibody (MAb476) that recognizes GM-like antigens from Aspergillus and other molds, we demonstrated antigenuria in an experimental animal IA model (guinea pig), as well as in human patients. In addition, we investigated the chemical nature of the urinary excreted antigen in human samples, characterized antigen detection in urine by immunoassays, described a putative assay inhibitor in urine, and indicated means of alleviation of the inhibition. We also designed and used a lateral flow immunochromatographic assay to detect urinary excreted antigen in a limited number of IA patient urine samples. In this study, we establish that POC diagnosis of IA based on urinary GM detection is feasible. Prospective studies will be necessary to establish the performance characteristics of an optimized device and define its optimal clinical use.
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Affiliation(s)
- Simon F. Dufresne
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Département de Microbiologie et Immunologie, Université de Montréal, Montréal, Quebec, Canada
| | - Kausik Datta
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Xinming Li
- Albert Einstein College of Medicine, Bronx, New York, United States of America
- China Medical University, Shenyang, People's Republic of China
| | - Ekaterina Dadachova
- Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Janet F. Staab
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Thomas F. Patterson
- University of Texas Health Science Center and South Texas Veterans Healthcare System, San Antonio, Texas, United States of America
| | - Marta Feldmesser
- Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Kieren A. Marr
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States of America
- * E-mail:
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