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Dehnadi A, Benedict Cosimi A, Neal Smith R, Li X, Alonso JL, Means TK, Arnaout MA. Prophylactic orthosteric inhibition of leukocyte integrin CD11b/CD18 prevents long-term fibrotic kidney failure in cynomolgus monkeys. Nat Commun 2017; 8:13899. [PMID: 28071653 PMCID: PMC5234083 DOI: 10.1038/ncomms13899] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/10/2016] [Indexed: 12/21/2022] Open
Abstract
Ischaemic acute kidney injury (AKI), an inflammatory disease process, often progresses to chronic kidney disease (CKD), with no available effective prophylaxis. This is in part due to lack of clinically relevant CKD models in non-human primates. Here we demonstrate that inhibition of the archetypal innate immune receptor CD11b/CD18 prevents progression of AKI to CKD in cynomolgus monkeys. Severe ischaemia-reperfusion injury of the right kidney, with subsequent periods of the left ureter ligation, causes irreversible right kidney failure 3, 6 or 9 months after AKI. Moreover, prophylactic inactivation of CD11b/CD18, using the orthosteric CD11b/CD18 inhibitor mAb107, improves microvascular perfusion and histopathology, reduces intrarenal pro-inflammatory mediators and salvages kidney function long term. These studies reveal an important early role of CD11b+ leukocytes in post-ischaemic kidney fibrosis and failure, and suggest a potential early therapeutic intervention to mitigate progression of ischaemic AKI to CKD in humans.
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Affiliation(s)
- Abbas Dehnadi
- Division of Transplant Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - A Benedict Cosimi
- Division of Transplant Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.,Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Rex Neal Smith
- Harvard Medical School, Boston, Massachusetts 02115, USA.,Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Xiangen Li
- Harvard Medical School, Boston, Massachusetts 02115, USA.,Leukocyte Biology and Inflammation Program, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.,Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - José L Alonso
- Harvard Medical School, Boston, Massachusetts 02115, USA.,Leukocyte Biology and Inflammation Program, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.,Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Terry K Means
- Harvard Medical School, Boston, Massachusetts 02115, USA.,Division of Rheumatology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - M Amin Arnaout
- Harvard Medical School, Boston, Massachusetts 02115, USA.,Leukocyte Biology and Inflammation Program, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.,Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.,Center For Regenerative Medicine, Medical Services, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
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Latchoumycandane C, Hanouneh M, Nagy LE, McIntyre TM. Inflammatory PAF Receptor Signaling Initiates Hedgehog Signaling and Kidney Fibrogenesis During Ethanol Consumption. PLoS One 2015; 10:e0145691. [PMID: 26720402 PMCID: PMC4697844 DOI: 10.1371/journal.pone.0145691] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 12/06/2015] [Indexed: 12/20/2022] Open
Abstract
Acute inflammation either resolves or proceeds to fibrotic repair that replaces functional tissue. Pro-fibrotic hedgehog signaling and induction of its Gli transcription factor in pericytes induces fibrosis in kidney, but molecular instructions connecting inflammation to fibrosis are opaque. We show acute kidney inflammation resulting from chronic ingestion of the common xenobiotic ethanol initiates Gli1 transcription and hedgehog synthesis in kidney pericytes, and promotes renal fibrosis. Ethanol ingestion stimulated transcription of TGF-ß, collagens I and IV, and alpha-smooth muscle actin with accumulation of these proteins. This was accompanied by deposition of extracellular fibrils. Ethanol catabolism by CYP2E1 in kidney generates local reactive oxygen species that oxidize cellular phospholipids to phospholipid products that activate the Platelet-activating Factor receptor (PTAFR) for inflammatory phospholipids. Genetically deleting this ptafr locus abolished accumulation of mRNA for TGF-ß, collagen IV, and α-smooth muscle actin. Loss of PTAFR also abolished ethanol-stimulated Sonic (Shh) and Indian hedgehog (Ihh) expression, and abolished transcription and accumulation of Gli1. Shh induced in pericytes and Ihh in tubules escaped to urine of ethanol-fed mice. Neutrophil myeloperoxidase (MPO) is required for ethanol-induced kidney inflammation, and Shh was not present in kidney or urine of mpo-/- mice. Shh also was present in urine of patients with acute kidney injury, but not in normal individuals or those with fibrotic liver cirrhosis We conclude neither endogenous PTAFR signaling nor CYP2E1-generated radicals alone are sufficient to initiate hedgehog signaling, but instead PTAFR-dependent neutrophil infiltration with myeloperoxidase activation is necessary to initiate ethanol-induced fibrosis in kidney. We also show fibrogenic mediators escape to urine, defining a new class of urinary mechanistic biomarkers of fibrogenesis for an organ not commonly biopsied.
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Affiliation(s)
- Calivarathan Latchoumycandane
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, United States of America
| | - Mohamad Hanouneh
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Laura E Nagy
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, United States of America
| | - Thomas M McIntyre
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, United States of America
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Parekh DJ, Weinberg JM, Ercole B, Torkko KC, Hilton W, Bennett M, Devarajan P, Venkatachalam MA. Tolerance of the human kidney to isolated controlled ischemia. J Am Soc Nephrol 2013; 24:506-17. [PMID: 23411786 DOI: 10.1681/asn.2012080786] [Citation(s) in RCA: 149] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Tolerance of the human kidney to ischemia is controversial. Here, we prospectively studied the renal response to clamp ischemia and reperfusion in humans, including changes in putative biomarkers of AKI. We performed renal biopsies before, during, and after surgically induced renal clamp ischemia in 40 patients undergoing partial nephrectomy. Ischemia duration was >30 minutes in 82.5% of patients. There was a mild, transient increase in serum creatinine, but serum cystatin C remained stable. Renal functional changes did not correlate with ischemia duration. Renal structural changes were much less severe than observed in animal models that used similar durations of ischemia. Other biomarkers were only mildly elevated and did not correlate with renal function or ischemia duration. In summary, these data suggest that human kidneys can safely tolerate 30-60 minutes of controlled clamp ischemia with only mild structural changes and no acute functional loss.
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Affiliation(s)
- Dipen J Parekh
- Department of Urology, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA.
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Endre ZH, Pickering JW, Walker RJ. Clearance and beyond: the complementary roles of GFR measurement and injury biomarkers in acute kidney injury (AKI). Am J Physiol Renal Physiol 2011; 301:F697-707. [PMID: 21753074 DOI: 10.1152/ajprenal.00448.2010] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Acute kidney injury (AKI) is a common and frequently fatal illness in critically ill patients. The reliance on daily measurements of serum creatinine as a surrogate of glomerular filtration rate (GFR) not only delays diagnosis and development of successful therapies but also hinders insight into the pathophysiology of human AKI. Measurement of GFR under non-steady-state conditions remains an elusive gold standard against which biomarkers of renal injury need to be judged. Approaches to the rapid (near real-time) measurement of GFR are explored. Even if real-time GFR was available, absent baseline information will always limit diagnosis of AKI based on GFR or serum creatinine to a detection of change. Biomarkers of renal cellular injury have provided new strategies to facilitate detection and early intervention in AKI. However, the diagnostic and predictive performance of urinary biomarkers of injury vary, depending on both the time after renal injury and on the preinjury GFR. Progress in understanding the role of each novel biomarker in the causal pathways of AKI promises to enhance their diagnostic potential. We predict that combining rapid measures of GFR with biomarkers of renal injury will yield substantive progress in the treatment of AKI.
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Affiliation(s)
- Zoltán H Endre
- Christchurch Kidney Research Group, Department of Medicine, University of Otago, Christchurch, New Zealand.
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Accurate, fast, and convenient measurement of glomerular filtration rate in potential renal transplant donors. Transplantation 2010; 90:510-7. [PMID: 20595931 DOI: 10.1097/tp.0b013e3181e9139d] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Measurement of glomerular filtration rate (GFR) is essential in the risk evaluation of potential kidney donors. The optimal method of measuring GFR involves using clearance techniques. However, clearance techniques are technically complex and time consuming. The goal of this study is to evaluate a different method of measuring GFR, one that retains the accuracy of a clearance technique and adds the convenience of a plasma creatinine measurement. METHODS Fifty subjects, including both normal and patients with different degrees of renal dysfunction, were included in the initial validation study. GFR was measured simultaneously using a continuous infusion of I-iothalamate and external radioactivity measurement after a single intravenous injection of Tc-labeled diethylenetriaminepentaacetic acid (Tc-DTPA). After validation, the renal function of 80 potential renal transplant donors was measured using only external radiation detection. RESULTS External radioactivity decreases versus time with first-order kinetics. The rate of clearance of Tc-DTPA was measured as the slope (kappa) of the natural logarithm of external radioactivity corrected for radioactive decay versus time. There was an excellent correlation between kappa and simultaneous GFR measurements done with I-iothalamate. Nonlinear regression analysis of kappa GFR values obtained in potential renal transplant donors versus frequencies indicates a mean value and variance similar to normal reported values obtained with clearance techniques. Estimated GFR and 24-hr plasma creatinine clearance underestimate GFR with greater variance. CONCLUSIONS Measurements of external whole tissue radioactivity after intravenous injection of Tc-DTPA represents an accurate, fast, and convenient way to measure total and individual kidney GFR, addressing an important concern during the risk evaluation of potential renal transplant donors.
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