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Packialakshmi B, Limerick E, Ackerman HC, Lin X, Nekhai S, Oliver JD, Stewart IJ, Knepper MA, Fitzhugh C, Zhou X. Proteomic analyses of urinary exosomes identify novel potential biomarkers for early diagnosis of sickle cell nephropathy, a sex-based study. Front Physiol 2024; 15:1300667. [PMID: 38426210 PMCID: PMC10901968 DOI: 10.3389/fphys.2024.1300667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/26/2024] [Indexed: 03/02/2024] Open
Abstract
Sickle cell nephropathy (SCN) is a leading cause of morbidity and mortality in sickle cell disease (SCD). Early intervention is crucial for mitigating its effects. However, current diagnostic methods rely on generic tests and may not detect SCN until irreversible renal damage occurs. Therefore, specific biomarkers for early diagnosis of SCN are needed. Urinary exosomes, membrane-bound vesicles secreted by renal podocytes and epithelial cells, contain both common and cell type-specific membrane and cytosolic proteins, reflecting the physiologic and pathophysiologic states of the kidney. Using proteomics, we analyzed the proteomes of urinary exosomes from humanized SCD mice at 2 months (without albuminuria) and 4 months (with albuminuria) of age. Excretion of 164 proteins were significantly increased and 176 proteins was significantly decreased in the exosomes when mice developed albuminuria. Based on the relevance to SCD, chronic kidney disease and Western blot confirmation in mice, we analyzed protein abundance of heparanase, cathepsin C, α2-macroglobulin and sarcoplasmic endoplasmic Ca2+ ATPase-3 (SERCA3) in the urinary exosomes and urine of 18 SCD subjects without albuminuria and 12 subjects with albuminuria using Western blot analyses. Both male and female subjects increased or tended to increase the excretion of these proteins in their urinary exosomes upon developing albuminuria, but female subjects demonstrated stronger correlations between the excretion of these proteins and urine albumin creatinine ratio (UACR) compared to male subjects. In contrast, exosomal excretion of Tamm-Horsfall protein, β-actin and SHP-1 was independent of albuminuria. These findings provide a foundation for a time-course study to determine whether increases in the levels of these proteins precede the onset of albuminuria in patients, which will help determine the potential of these proteins as biomarkers for early detection of SCN.
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Affiliation(s)
- Balamurugan Packialakshmi
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD, United States
| | - Emily Limerick
- Cellular and Molecular Therapeutic Branch, National Heart Lung and Blood Institute, Bethesda, MD, United States
| | - Hans C. Ackerman
- Physiology Unit, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, Rockville, MD, United States
| | - Xionghao Lin
- Department of Medicine, Howard University, Washington, DC, United States
| | - Sergei Nekhai
- Department of Medicine, Howard University, Washington, DC, United States
| | - James D. Oliver
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD, United States
- Nephrology Service, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Ian J. Stewart
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD, United States
| | - Mark A. Knepper
- System Biology Center, National Heart Lung and Blood Institute, Bethesda, MD, United States
| | - Courtney Fitzhugh
- Cellular and Molecular Therapeutic Branch, National Heart Lung and Blood Institute, Bethesda, MD, United States
| | - Xiaoming Zhou
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD, United States
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de Berny Q, Saint-Jacques C, Santin A, Mattioni S, Steichen O, Chieze R, Frochot V, Letavernier E, Lionnet F, Haymann JP. Urine concentration impairment in sickle cell anemia: genuine nephrogenic diabetes insipidus or osmotic diuresis? Am J Physiol Renal Physiol 2024; 326:F278-F284. [PMID: 38059298 PMCID: PMC11207532 DOI: 10.1152/ajprenal.00313.2023] [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: 10/09/2023] [Revised: 11/16/2023] [Accepted: 12/03/2023] [Indexed: 12/08/2023] Open
Abstract
The urine concentration impairment responsible for hyposthenuria in sickle cell nephropathy is currently thought to be a consequence of renal medulla lesions, which lead to nephrogenic diabetes insipidus. The objective of the present study was to investigate the mechanism of hyposthenuria in patients with sickle cell anemia. We performed an observational study of patients with homozygous SS sickle cell anemia and data available on the fasting plasma antidiuretic hormone (ADH) concentration. A total of 55 patients were analyzed. The fasting plasma ADH values ranged from 1.2 to 15.4 pg/mL, and 82% of the patients had elevated ADH values and low fasting urine osmolality (<505 mosmol/kgH2O). Plasma ADH was positively associated with plasma tonicity and natremia (P < 0.001). None of the patients experienced polyuria and fasting free water clearance was negative in all cases, thus, ruling out nephrogenic diabetes insipidus. The tertile groups did not differ with regard to fasting urine osmolality, plasma renin level, mGFR, or several hemolysis biomarkers. The negative fasting free water clearance in all cases and the strong association between 24-h osmolal clearance and 24-h diuresis favors the diagnosis of osmotic diuresis due to an impaired medullary gradient, rather than lesions to collecting tubule.NEW & NOTEWORTHY The urine concentration impairment in sickle cell anemia is an osmotic diuresis related to an impaired renal medullary gradient leading to an ADH plateau effect. The fasting plasma ADH was high in the context of a basic state of close-to-maximal urine concentration probably driven by short nephrons maintaining a cortex-outer medullary gradient (about 400 milliosmoles). The patients had a low daily osmoles intake without evidence of thirst dysregulation so no one experienced polyuria.
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Affiliation(s)
- Quentin de Berny
- Service de Néphrologie, Dialyse et Transplantation Rénale, Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - Camille Saint-Jacques
- Service d'Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, UMR-S 1155, Médecine Sorbonne Université, Paris, France
| | - Aline Santin
- Service de Médecine Interne, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Médecine Sorbonne Université, Paris, France
| | - Sarah Mattioni
- Service de Médecine Interne, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Médecine Sorbonne Université, Paris, France
| | - Olivier Steichen
- Service de Médecine Interne, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Médecine Sorbonne Université, Paris, France
| | - Rémi Chieze
- Service d'Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, UMR-S 1155, Médecine Sorbonne Université, Paris, France
| | - Vincent Frochot
- Service d'Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, UMR-S 1155, Médecine Sorbonne Université, Paris, France
| | - Emmanuel Letavernier
- Service d'Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, UMR-S 1155, Médecine Sorbonne Université, Paris, France
| | - François Lionnet
- Service de Médecine Interne, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Médecine Sorbonne Université, Paris, France
| | - Jean-Philippe Haymann
- Service d'Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, UMR-S 1155, Médecine Sorbonne Université, Paris, France
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Lebensburger JD, Derebail VK. Sickle Cell Disease and the Kidney. Hematol Oncol Clin North Am 2022; 36:1239-1254. [DOI: 10.1016/j.hoc.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Safdar OY, Baghdadi RM, Alahmadi SA, Fakieh BE, Algaydi AM. Sickle cell nephropathy: A review of novel biomarkers and their potential roles in early detection of renal involvement. World J Clin Pediatr 2022; 11:14-26. [PMID: 35096543 PMCID: PMC8771312 DOI: 10.5409/wjcp.v11.i1.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 08/12/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
Whether the underlying mutations are homozygous, heterozygous, or co-inherited with other hemoglobinopathies, sickle cell disease is known to afflict the kidneys, leading to the clinical entity known as sickle cell nephropathy (SCN). Although common, SCN remains diagnostically elusive. Conventional studies performed in the context of renal disorders often fail to detect early stage SCN. This makes the quest for early diagnosis and treatment more challenging, and it increases the burden of chronic kidney disease-related morbidity among patients. Novel diagnostic tools have been employed to overcome this limitation. In this study, we discuss various biomarkers of SCN, including those employed in clinical practice and others recently identified in experimental settings, such as markers of vascular injury, endothelial dysfunction, tubulo-glomerular damage, and oxidative stress. These include kidney injury molecule-1, monocyte chemoattractant protein-1, N-acetyl-B-D-glucosaminidase, ceruloplasmin, orosomucoid, nephrin, and cation channels, among others. Furthermore, we explore the potential of novel biomarkers for refining diagnostic and therapeutic approaches and describe some obstacles that still need to be overcome. We highlight the importance of a collaborative approach to standardize the use of promising new biomarkers. Finally, we outline the limitations of conventional markers of renal damage as extensions of the pathogenic process occurring at the level of the organ and its functional subunits, with a discussion of the expected pattern of clinical and biochemical progression among patients with SCN.
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Affiliation(s)
- Osama Y Safdar
- Department of Pediatric, King Abdulaziz University, JEDDAH 21414, Saudi Arabia
| | - Rana M Baghdadi
- College of Medicine, King Abdulaziz University, JEDDAH 21422, Saudi Arabia
| | - Sereen A Alahmadi
- College of Medicine, King Abdulaziz University, JEDDAH 21422, Saudi Arabia
| | - Bana E Fakieh
- College of Medicine, King Abdulaziz University, JEDDAH 21422, Saudi Arabia
| | - Amaal M Algaydi
- College of Medicine, King Abdulaziz University, JEDDAH 21422, Saudi Arabia
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Poplawska M, Dutta D, Jayaram M, Salifu M, Chong NS, Lim SH. Intestinal pathophysiological abnormalities in steady state and after vaso-occlusive crisis in murine sickle cell disease. Br J Haematol 2021; 196:777-780. [PMID: 34632582 DOI: 10.1111/bjh.17889] [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] [Received: 08/09/2021] [Revised: 09/15/2021] [Accepted: 09/27/2021] [Indexed: 11/30/2022]
Abstract
We showed in the present study that, not unlike in adult patients with sickle cell disease (SCD), Townes mice exhibit increases in serum intestinal fatty acid binding proteins and lipopolysaccharides (LPS), together with a breach in the intestinal barrier. These abnormalities increased rapidly after the induction of vaso-occlusive crisis (VOC). We also confirmed higher intestinal microbial density in SCD. These findings support the concept that SCD and/or its complications, and not hospitalisation or medications, are responsible for the intestinal pathophysiological changes. The present results provide the basis for use of Townes mice to further elucidate the mechanistic relationship between intestinal pathophysiology and VOC.
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Affiliation(s)
- Maria Poplawska
- Division of Hematology and Oncology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Dibyendu Dutta
- Division of Hematology and Oncology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Manjunath Jayaram
- Department of Chemistry, Middle Tennessee State University, Murfreesboro, TN, USA
| | - Moro Salifu
- Division of Hematology and Oncology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Ngee S Chong
- Department of Chemistry, Middle Tennessee State University, Murfreesboro, TN, USA
| | - Seah H Lim
- Division of Hematology and Oncology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
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