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Burfeind KG, Funahashi Y, Munhall AC, Eiwaz M, Hutchens MP. Natural Killer Lymphocytes Mediate Renal Fibrosis Due to Acute Cardiorenal Syndrome. KIDNEY360 2024; 5:8-21. [PMID: 38037228 PMCID: PMC10833608 DOI: 10.34067/kid.0000000000000305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/26/2023] [Indexed: 12/02/2023]
Abstract
Key Points Natural killer cells infiltrate the kidney after cardiac arrest and medial renal fibrosis Granzyme A is produced by natural killer cells and causes mesenchymal cell expansion and fibrosis in type 1 cardiorenal syndrome Background The AKI to CKD transition presents an opportunity for intervention to prevent CKD. Our laboratory developed a novel murine model of AKI-CKD transition and cardiac arrest/cardiopulmonary resuscitation (CA/CPR), in which all animals develop CKD at 7 weeks. The purpose of this study was to identify potential immune drivers of fibrosis after CA/CPR. Methods Cardiac arrest was induced by potassium chloride, and mice were resuscitated with chest compressions and epinephrine. The kidney immune landscape after CA/CPR was profiled using 11-color flow cytometry analysis and immunofluorescence. Immune cell-derived mediators of fibrosis were identified by analyzing data from three previously published single-cell or single-nuclear RNA sequencing studies. NRK49F fibroblasts were treated with granzyme A (GzA) in vitro , and then cell proliferation was quantified using 5-ethynyl-2′-deoxyuridine. GzA was pharmacologically inhibited both in vitro and in vivo . Results Immune cells infiltrated the kidney after CA/CPR, consisting primarily of innate immune cells, including monocytes/macrophages, neutrophils, and natural killer (NK) cells. NK cell infiltration immediately preceded mesenchymal cell expansion, which occurred starting 7 days after CA/CPR. Immune cells colocalized with mesenchymal cells, accumulating in the areas of fibrosis. Analysis of previously published single-cell or single-nuclear RNA sequencing data revealed GzA as a potential mediator of immune to mesenchymal communication. GzA administration to fibroblasts in vitro induced cell growth and proliferation. Pharmacologic blockade of GzA signaling in vivo attenuated fibrosis and improved renal function after CA/CPR. Conclusions Renal inflammation occurs during cardiorenal syndrome, which correlates with mesenchymal cell expansion. GzA, produced by NK cells, presents a novel therapeutic target to prevent the transition to CKD after AKI.
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Affiliation(s)
- Kevin G. Burfeind
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon
| | | | | | - Mahaba Eiwaz
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon
- Portland VA Medical Center, Portland, Oregon
| | - Michael P. Hutchens
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon
- Portland VA Medical Center, Portland, Oregon
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2
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Nelson JW, Ortiz-Melo DI, Mattocks NK, Emathinger JM, Prescott J, Xu K, Griffiths RC, Wakasaki R, Piehowski PD, Hutchens MP, Coffman TM, Gurley SB. Soluble ACE2 Is Filtered into the Urine. KIDNEY360 2022; 3:2086-2094. [PMID: 36591353 PMCID: PMC9802553 DOI: 10.34067/kid.0001622022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 08/01/2022] [Indexed: 02/01/2023]
Abstract
Background ACE2 is a key enzyme in the renin-angiotensin system (RAS) capable of balancing the RAS by metabolizing angiotensin II (AngII). First described in cardiac tissue, abundance of ACE2 is highest in the kidney, and it is also expressed in several extrarenal tissues. Previously, we reported an association between enhanced susceptibility to hypertension and elevated renal AngII levels in global ACE2-knockout mice. Methods To examine the effect of ACE2 expressed in the kidney, relative to extrarenal expression, on the development of hypertension, we used a kidney crosstransplantation strategy with ACE2-KO and WT mice. In this model, both native kidneys are removed and renal function is provided entirely by the transplanted kidney, such that four experimental groups with restricted ACE2 expression are generated: WT→WT (WT), KO→WT (KidneyKO), WT→KO (SystemicKO), and KO→KO (TotalKO). Additionally, we used nanoscale mass spectrometry-based proteomics to identify ACE2 fragments in early glomerular filtrate of mice. Results Although significant differences in BP were not detected, a major finding of our study is that shed or soluble ACE2 (sACE2) was present in urine of KidneyKO mice that lack renal ACE2 expression. Detection of sACE2 in the urine of KidneyKO mice during AngII-mediated hypertension suggests that sACE2 originating from extrarenal tissues can reach the kidney and be excreted in urine. To confirm glomerular filtration of ACE2, we used micropuncture and nanoscale proteomics to detect peptides derived from ACE2 in the Bowman's space. Conclusions Our findings suggest that both systemic and renal tissues may contribute to sACE2 in urine, identifying the kidney as a major site for ACE2 actions. Moreover, filtration of sACE2 into the lumen of the nephron may contribute to the pathophysiology of kidney diseases characterized by disruption of the glomerular filtration barrier.
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Affiliation(s)
- Jonathan W. Nelson
- Division of Nephrology & Hypertension, Department of Medicine, Oregon Health & Science University, Portland, Oregon
| | - David I. Ortiz-Melo
- Division of Nephrology, Department of Medicine, Duke University and Durham VA Health Care Centers, Durham, North Carolina
| | - Natalie K. Mattocks
- Division of Nephrology, Department of Medicine, Duke University and Durham VA Health Care Centers, Durham, North Carolina
| | - Jacqueline M. Emathinger
- Division of Nephrology & Hypertension, Department of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Jessica Prescott
- Division of Nephrology, Department of Medicine, Duke University and Durham VA Health Care Centers, Durham, North Carolina
| | - Katherine Xu
- Division of Nephrology, Department of Medicine, Duke University and Durham VA Health Care Centers, Durham, North Carolina
| | - Robert C. Griffiths
- Division of Nephrology, Department of Medicine, Duke University and Durham VA Health Care Centers, Durham, North Carolina
| | - Rumie Wakasaki
- Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon
| | - Paul D. Piehowski
- Environmental and Biological Services Division, Pacific Northwest National Laboratory, Richland, Washington
| | - Michael P. Hutchens
- Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon
| | - Thomas M. Coffman
- Division of Nephrology, Department of Medicine, Duke University and Durham VA Health Care Centers, Durham, North Carolina,Program in Cardiovascular and Metabolic Disorders, Duke–NUS Medical School, Singapore
| | - Susan B. Gurley
- Division of Nephrology & Hypertension, Department of Medicine, Oregon Health & Science University, Portland, Oregon,Division of Nephrology, Department of Medicine, Duke University and Durham VA Health Care Centers, Durham, North Carolina
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3
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Funahashi Y, Ikeda M, Wakasaki R, Chowdhury S, Groat T, Zeppenfeld D, Hutchens MP. Renal injury in cardiorenal syndrome type 1 is mediated by albumin. Physiol Rep 2022; 10:e15173. [PMID: 35150207 PMCID: PMC8838648 DOI: 10.14814/phy2.15173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/22/2021] [Accepted: 01/02/2022] [Indexed: 11/24/2022] Open
Abstract
Cardiorenal syndrome type 1 (CRS‐1) acute kidney injury (AKI) is a critical complication of acute cardiovascular disease but is poorly understood. AKI induces acute albuminuria. As chronic albuminuria is associated with worsening kidney disease and albumin has been implicated in tubular epithelial injury, we investigated whether albumin participates in CRS‐1, and whether CRS‐1 alters renal albumin handling. We report the role of albumin in in vivo and in vitro CRS‐1 models. An established translational model, cardiac arrest and cardiopulmonary resuscitation (CA/CPR) induced severe acute albuminuria which correlated with tubular epithelial cell death. In vivo microscopy demonstrated CA/CPR‐induced glomerular filtration of exogenous albumin, while administration of exogenous albumin after CA/CPR worsened AKI compared to iso‐oncotic control. Increased albumin signal was observed in the proximal tubules of CA/CPR mice compared to sham. Comparison of albumin flux from tubular lumen to epithelial cells revealed saturated albumin transport within minutes of albumin injection after CA/CPR. In vitro, HK2 cells (human kidney tubular epithelial cells), exposed to oxygen‐glucose deprivation were injured by albumin in a dose dependent fashion. This interference was unchanged by the tubular endocytic receptor megalin. In conclusion, CRS‐1 alters albumin filtration and tubular uptake, leading to increased tubular exposure to albumin, which is injurious to tubular epithelial cells, worsening AKI. Our findings shed light on the pathophysiology of renal albumin and may guide interventions such as albumin resuscitation to improve CRS‐1 outcomes. This investigation may have important translational relevance for patients that receive exogenous albumin as part of their CRS‐1 treatment regimen.
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Affiliation(s)
- Yoshio Funahashi
- Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Mizuko Ikeda
- Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Rumie Wakasaki
- Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Sheuli Chowdhury
- Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Tahnee Groat
- Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Douglas Zeppenfeld
- Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Michael P Hutchens
- Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA.,Operative Care Division, Portland Veterans Affairs Medical Center, Portland, Oregon, USA
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4
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Matsushita K, Mori K, Saritas T, Eiwaz MB, Funahashi Y, Nickerson MN, Hebert JF, Munhall AC, McCormick JA, Yanagita M, Hutchens MP. Cilastatin Ameliorates Rhabdomyolysis-induced AKI in Mice. J Am Soc Nephrol 2021; 32:2579-2594. [PMID: 34341182 PMCID: PMC8722809 DOI: 10.1681/asn.2020030263] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/17/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Rhabdomyolysis, the destruction of skeletal muscle, is a significant cause of AKI and death in the context of natural disaster and armed conflict. Rhabdomyolysis may also initiate CKD. Development of specific pharmacologic therapy is desirable because supportive care is nearly impossible in austere environments. Myoglobin, the principal cause of rhabdomyolysis-related AKI, undergoes megalin-mediated endocytosis in proximal tubule cells, a process that specifically injures these cells. METHODS To investigate whether megalin is protective in a mouse model of rhabdomyolysis-induced AKI, we used male C57BL/6 mice and mice (14-32 weeks old) with proximal tubule-specific deletion of megalin. We used a well-characterized rhabdomyolysis model, injection of 50% glycerol in normal saline preceded by water deprivation. RESULTS Inducible proximal tubule-specific deletion of megalin was highly protective in this mouse model of rhabdomyolysis-induced AKI. The megalin knockout mice demonstrated preserved GFR, reduced proximal tubule injury (as indicated by kidney injury molecule-1), and reduced renal apoptosis 24 hours after injury. These effects were accompanied by increased urinary myoglobin clearance. Unlike littermate controls, the megalin-deficient mice also did not develop progressive GFR decline and persistent new proteinuria. Administration of the pharmacologic megalin inhibitor cilastatin to wild-type mice recapitulated the renoprotective effects of megalin deletion. This cilastatin-mediated renoprotective effect was dependent on megalin. Cilastatin administration caused selective proteinuria and inhibition of tubular myoglobin uptake similar to that caused by megalin deletion. CONCLUSIONS We conclude that megalin plays a critical role in rhabdomyolysis-induced AKI, and megalin interference and inhibition ameliorate rhabdomyolysis-induced AKI. Further investigation of megalin inhibition may inform translational investigation of a novel potential therapy.
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Affiliation(s)
- Katsuyuki Matsushita
- Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon
| | - Kiyoshi Mori
- School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Turgay Saritas
- Division of Nephrology & Hypertension, Oregon Health & Science University, Portland, Oregon,Division of Nephrology & Hypertension, University Hospital RWTH Aachen, Aachen, Germany
| | - Mahaba B. Eiwaz
- Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon
| | - Yoshio Funahashi
- Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon
| | - Megan N. Nickerson
- Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon
| | - Jessica F. Hebert
- Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon
| | - Adam C. Munhall
- Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon
| | - James A. McCormick
- Division of Nephrology & Hypertension, Oregon Health & Science University, Portland, Oregon
| | - Motoko Yanagita
- Department of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan,Institute for Advanced Study of Human Biology, Kyoto University, Kyoto, Japan
| | - Michael P. Hutchens
- Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon,Portland Veterans Affairs Medical Center, Operative Care Division, Portland, Oregon,Correspondence: Dr. Michael P. Hutchens, Operative Care Division, Portland Veterans Affairs Medical Center R&D, 5 3710 SW US Veterans Hospital Road, Portland, OR 97239.
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5
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Guan Y, Nakano D, Li L, Zheng H, Nishiyama A, Tian Y, Zhang L. Protease-Activated Receptor 1 Contributes to Microcirculation Failure and Tubular Damage in Renal Ischemia-Reperfusion Injury in Mice. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6665714. [PMID: 33681367 PMCID: PMC7925038 DOI: 10.1155/2021/6665714] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 01/25/2021] [Accepted: 02/08/2021] [Indexed: 12/11/2022]
Abstract
Ischemia-reperfusion- (IR-) induced kidney injury is difficult to avoid during renal transplantation and robot-assisted partial nephrectomy. Renal IR injury is characterized by tubular damage, microcirculation failure, and inflammation, which coordinately augment renal injury; however, no specific treatment is available for these conditions. Protease-activated receptor-1 (PAR-1) and its ligand, thrombin, are involved in coagulation and were shown to be associated with epithelial cell injury. Here, we hypothesized that PAR-1 exaggerated renal IR-induced tubular cell damage and microcirculation failure and that pharmacological inhibition of PAR-1 by Q94 could prevent these injuries. Renal warm IR increased the expression of PAR-1 in the renal tubules. Q94 attenuated renal IR-induced changes and histopathological damage. Microcirculation failure analyzed by congestion in the histopathology and blood cell flow examined by intravital multiphoton microscopy were suppressed by Q94 treatment. Q94 also dramatically increased tubular cell proliferation despite the lower renal damage. Thrombin suppressed cell proliferation and induced apoptosis in the tubules; these effects were prevented by Q94 treatment. Taken together, PAR-1 was associated with renal IR injury. Inhibition of PAR-1 ameliorated injury possibly by improving renal microcirculation and tubular cell survival/proliferation.
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Affiliation(s)
- Yu Guan
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Daisuke Nakano
- Department of Pharmacology, Kagawa University, Kagawa, Japan
| | - Lei Li
- Division of Kidney Transplantation, Department of Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Haofeng Zheng
- Division of Kidney Transplantation, Department of Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Akira Nishiyama
- Department of Pharmacology, Kagawa University, Kagawa, Japan
| | - Ye Tian
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lei Zhang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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6
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Terker AS, Sasaki K, Arroyo JP, Niu A, Wang S, Fan X, Zhang Y, Nwosisi S, Zhang MZ, Harris RC. Activation of hypoxia-sensing pathways promotes renal ischemic preconditioning following myocardial infarction. Am J Physiol Renal Physiol 2021; 320:F569-F577. [PMID: 33522414 DOI: 10.1152/ajprenal.00476.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Ischemic heart disease is the leading cause of death worldwide and is frequently comorbid with chronic kidney disease. Physiological communication is known to occur between the heart and the kidney. Although primary dysfunction in either organ can induce dysfunction in the other, a clinical entity known as cardiorenal syndrome, mechanistic details are lacking. Here, we used a model of experimental myocardial infarction (MI) to test effects of chronic cardiac ischemia on acute and chronic kidney injury. Surprisingly, chronic cardiac damage protected animals from subsequent acute ischemic renal injury, an effect that was accompanied by evidence of chronic kidney hypoxia. The protection observed post-MI was similar to protection observed in a separate group of healthy animals housed in ambient hypoxic conditions prior to kidney injury, suggesting a common mechanism. There was evidence that chronic cardiac injury activates renal hypoxia-sensing pathways. Increased renal abundance of several glycolytic enzymes following MI suggested that a shift toward glycolysis may confer renal ischemic preconditioning. In contrast, effects on chronic renal injury followed a different pattern, with post-MI animals displaying worsened chronic renal injury and fibrosis. These data show that although chronic cardiac injury following MI protected against acute kidney injury via activation of hypoxia-sensing pathways, it worsened chronic kidney injury. The results further our understanding of cardiorenal signaling mechanisms and have implications for the treatment of heart failure patients with associated renal disease.NEW & NOTEWORTHY Experimental myocardial infarction (MI) protects from subsequent ischemic acute kidney injury but worsens chronic kidney injury. Observed protection from ischemic acute kidney injury after MI was accompanied by chronic kidney hypoxia and increased renal abundance of hypoxia-inducible transcripts. These data support the idea that MI confers protection from renal ischemic injury via chronic renal hypoxia and activation of downstream hypoxia-inducible signaling pathways.
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Affiliation(s)
- Andrew S Terker
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt Center for Kidney Disease, Nashville, Tennessee
| | - Kensuke Sasaki
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt Center for Kidney Disease, Nashville, Tennessee
| | - Juan Pablo Arroyo
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt Center for Kidney Disease, Nashville, Tennessee
| | - Aolei Niu
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt Center for Kidney Disease, Nashville, Tennessee
| | - Suwan Wang
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt Center for Kidney Disease, Nashville, Tennessee
| | - Xiaofeng Fan
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt Center for Kidney Disease, Nashville, Tennessee
| | - Yahua Zhang
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt Center for Kidney Disease, Nashville, Tennessee
| | - Sochinweichi Nwosisi
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt Center for Kidney Disease, Nashville, Tennessee
| | - Ming-Zhi Zhang
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt Center for Kidney Disease, Nashville, Tennessee
| | - Raymond C Harris
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt Center for Kidney Disease, Nashville, Tennessee.,Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, Tennessee
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7
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Funahashi Y, Chowdhury S, Eiwaz MB, Hutchens MP. Acute Cardiorenal Syndrome: Models and Heart-Kidney Connectors. Nephron Clin Pract 2020; 144:629-633. [PMID: 32814315 DOI: 10.1159/000509353] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/10/2020] [Indexed: 11/19/2022] Open
Abstract
Cardiorenal syndrome type 1 (CRS-1) is an acute kidney injury (AKI) due to acute worsening of cardiac function. More than 20% of patients with acute heart failure develop AKI, and AKI predicts poor outcome. Although a number of potential pathways have been suggested as heart-kidney connectors which might drive the syndrome, there are significant barriers to investigation, such as a paucity of animal models, a lack of specific biomarkers, and an inconsistent temporal and causal relationship between changes in cardiac flow and development of renal dysfunction. Thus, mechanisms of heart-kidney interaction are still unclear, and there is no specific or effective therapy for CRS-1. This review, therefore, focuses on mitigating these challenges in the investigation of CRS-1. We review the available models and focus on mechanistic insights gained from those models. In particular, we focus on non-flow and endocrine mediators of CRS-1 such as heart-derived messengers which alter renal function and which may represent targetable pathways in this syndrome. As precise connectors of heart-kidney interaction remain unclear, the establishment of animal and relevant cell-culture models and further investigation are required.
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Affiliation(s)
- Yoshio Funahashi
- Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA,
| | - Sheuli Chowdhury
- Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Mahaba B Eiwaz
- Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Michael P Hutchens
- Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA.,Portland Veterans Affairs Medical Center, Operative Care Division, Portland, Oregon, USA
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8
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Terker AS, de Caestecker M. Modeling human disease: a mouse model of acute kidney injury to chronic kidney disease progression after cardiac arrest. Kidney Int 2020; 97:22-24. [PMID: 31901349 PMCID: PMC7197020 DOI: 10.1016/j.kint.2019.09.017] [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: 08/17/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 10/25/2022]
Abstract
Matsushita et al. describe a model of acute kidney injury to chronic kidney disease progression in mice surviving cardiac arrest: mice develop severe acute kidney injury that initially recovers but is followed by the onset of impaired renal function on longer-term follow-up. These findings suggest that distinct cardiorenal toxicities and/or injury dynamics are operative in this cardiac arrest model that do not occur in traditional models of acute kidney injury, providing new opportunities for therapeutic and biomarker discovery for an important clinical problem.
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Affiliation(s)
- Andrew Scott Terker
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mark de Caestecker
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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9
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The acute kidney injury to chronic kidney disease transition in a mouse model of acute cardiorenal syndrome emphasizes the role of inflammation. Kidney Int 2019; 97:95-105. [PMID: 31623859 DOI: 10.1016/j.kint.2019.06.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 12/18/2022]
Abstract
Acute cardiorenal syndrome is a common complication of acute cardiovascular disease. Studies of acute kidney injury (AKI) to chronic kidney disease (CKD) transition, including patients suffering acute cardiovascular disease, report high rates of CKD development. Therefore, acute cardiorenal syndrome associates with CKD, but no study has established causation. To define this we used a murine cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) model or sham procedure on male mice. CA was induced with potassium chloride while CPR consisted of chest compressions and epinephrine eight minutes later. Two weeks after AKI was induced by CA/CPR, the measured glomerular filtration rate (GFR) was not different from sham. However, after seven weeks the mice developed CKD, recapitulating clinical observations. One day, and one, two, and seven weeks after CA/CPR, the GFR was measured, and renal tissue sections were evaluated for various indices of injury and inflammation. One day after CA/CPR, acute cardiorenal syndrome was indicated by a significant reduction of the mean GFR (649 in sham, vs. 25 μL/min/100g in CA/CPR animals), KIM-1 positive tubules, and acute tubular necrosis. Renal inflammation developed, with F4/80 positive and CD3-positive cells infiltrating the kidney one day and one week after CA/CPR, respectively. Although there was functional recovery with normalization of GFR two weeks after CA/CPR, deposition of tubulointerstitial matrix proteins α-smooth muscle actin and fibrillin-1 progressed, along with a significantly reduced mean GFR (623 in sham vs. 409 μL/min/100g in CA/CPR animals), proteinuria, increased tissue transforming growth factor-β, and fibrosis establishing the development of CKD seven weeks after CA/CPR. Thus, murine CA/CPR, a model of acute cardiorenal syndrome, causes an AKI-CKD transition likely due to prolonged renal inflammation.
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