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Thomas CP. Screening of Living Kidney Donors for Genetic Diseases: CON. Kidney360 2024:02200512-990000000-00310. [PMID: 38748490 DOI: 10.34067/kid.0000000000000353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 01/04/2024] [Indexed: 05/19/2024]
Affiliation(s)
- Christie P Thomas
- Department of Internal Medicine and Iowa Institute of Human Genetics, University of Iowa Carver College of Medicine, Iowa City
- VA Medical Center, Iowa City, Iowa
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Ruiz MA, Zhang X, Mansilla MA, Zahr RS, Thomas CP, Smith RJ, Gordeuk VR, Saraf SL. Prevalence of kidney health genetic variants in adults with sickle cell nephropathy. Br J Haematol 2024. [PMID: 38735682 DOI: 10.1111/bjh.19525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/30/2024] [Indexed: 05/14/2024]
Abstract
The pathophysiology and genetic risk for sickle cell disease (SCD)-related chronic kidney disease (CKD) are not well understood. In 70 adults with SCD-related CKD and without APOL1 inherited in a high-risk pattern, 24 (34%) had pathogenic variants in candidate genes using KidneySeq™. A moderate impact INF2 variant was observed in 20 (29%) patients and those with 3 versus 0-2 pathogenic or moderate impact glomerular genetic variants had higher albuminuria and lower estimated glomerular filtration rate (adjusted p ≤ 0.015). Using a panel of preselected genes implicated in kidney health, we observed several variants in people with sickle cell nephropathy.
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Affiliation(s)
- Maria Armila Ruiz
- Division of Hematology and Oncology, Sickle Cell Center, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Xu Zhang
- Division of Hematology and Oncology, Sickle Cell Center, University of Illinois at Chicago, Chicago, Illinois, USA
| | - M Adela Mansilla
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Rima S Zahr
- Division of Pediatric Nephrology and Hypertension, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Christie P Thomas
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Richard J Smith
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Victor R Gordeuk
- Division of Hematology and Oncology, Sickle Cell Center, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Santosh L Saraf
- Division of Hematology and Oncology, Sickle Cell Center, University of Illinois at Chicago, Chicago, Illinois, USA
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Ma M, Ganapathi M, Zheng Y, Tan KL, Kanca O, Bove KE, Quintanilla N, Sag SO, Temel SG, LeDuc CA, McPartland AJ, Pereira EM, Shen Y, Hagen J, Thomas CP, Galván NTN, Pan X, Lu S, Rosenfeld JA, Calame DG, Wangler MF, Lupski JR, Pehlivan D, Hertel PM, Chung WK, Bellen HJ. Homozygous missense variants in YKT6 result in loss of function and are associated with developmental delay, with or without severe infantile liver disease and risk for hepatocellular carcinoma. Genet Med 2024:101125. [PMID: 38522068 DOI: 10.1016/j.gim.2024.101125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024] Open
Abstract
PURPOSE YKT6 plays important roles in multiple intracellular vesicle trafficking events but has not been associated with Mendelian diseases. METHODS We report three unrelated individuals with rare homozygous missense variants in YKT6 who exhibited neurological disease with or without a progressive infantile liver disease. We modeled the variants in Drosophila. We generated wild-type and variant genomic rescue constructs (GRs) of the fly ortholog dYkt6 and compared their ability in rescuing the loss-of-function phenotypes in mutant flies. We also generated a dYkt6KozakGAL4 allele to assess the expression pattern of dYkt6. RESULTS Two individuals are homozygous for YKT6 [NM_006555.3:c.554A>G p.(Tyr185Cys)] and exhibited normal prenatal course followed by failure to thrive, developmental delay and progressive liver disease. Haplotype analysis identified a shared homozygous region flanking the variant, suggesting a common ancestry. The third individual is homozygous for YKT6 [NM_006555.3:c.191A>G p.(Tyr64Cys)] and exhibited neurodevelopmental disorders and optic atrophy. Fly dYkt6 is essential and is expressed in the fat body (analogous to liver) and central nervous system. Wild-type GR can rescue the lethality and autophagic flux defects whereas the variants are less efficient in rescuing the phenotypes. CONCLUSION The YKT6 variants are partial loss-of-function alleles and the p.(Tyr185Cys) is more severe than p.(Tyr64Cys).
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Affiliation(s)
- Mengqi Ma
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, TX 77030, USA
| | - Mythily Ganapathi
- Department of Pathology and Cell Biology, Columbia University Irving Medical center, New York, NY 10032, USA
| | - Yiming Zheng
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, TX 77030, USA; Present affiliation: School of Life Science, Xiamen University, Xiamen, Fujian Province 361102, China
| | - Kai-Li Tan
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, TX 77030, USA; Present affiliation: Emergent Biosolutions, 5901 E Lombard St, Baltimore, MD 21202, USA
| | - Oguz Kanca
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, TX 77030, USA
| | - Kevin E Bove
- Department of Pathology & Laboratory Medicine, Cincinnati Childrens hospital Medical center, Cincinnati, OH 45229, USA
| | - Norma Quintanilla
- Department of Pathology and Immunology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030, USA
| | - Sebnem O Sag
- Department of Medical Genetics, Faculty of Medicine, Uludag University, Bursa 16220, Turkey
| | - Sehime G Temel
- Department of Medical Genetics, Faculty of Medicine, Uludag University, Bursa 16220, Turkey
| | - Charles A LeDuc
- Department of Pediatrics, Columbia University, New York, NY 10032, USA
| | | | - Elaine M Pereira
- Department of Pediatrics, Columbia University, New York, NY 10032, USA
| | - Yufeng Shen
- Department of Systems Biology, Columbia University Medical Center, New York, NY 10032, USA
| | - Jacob Hagen
- Department of Systems Biology, Columbia University Medical Center, New York, NY 10032, USA
| | - Christie P Thomas
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Nhu Thao Nguyen Galván
- Division of Abdominal Transplantation, Baylor College of Medicine, Houston, TX 77030, USA
| | - Xueyang Pan
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, TX 77030, USA
| | - Shenzhao Lu
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, TX 77030, USA
| | - Jill A Rosenfeld
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Baylor Genetics Laboratories, Houston, TX 77021, USA
| | - Daniel G Calame
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Division of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; Texas Children's Hospital, Houston, TX 77030, USA
| | - Michael F Wangler
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, TX 77030, USA
| | - James R Lupski
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Texas Children's Hospital, Houston, TX 77030, USA; Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Davut Pehlivan
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, TX 77030, USA; Division of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; Texas Children's Hospital, Houston, TX 77030, USA
| | - Paula M Hertel
- Texas Children's Hospital, Houston, TX 77030, USA; Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Wendy K Chung
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
| | - Hugo J Bellen
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, TX 77030, USA.
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Lee BK, Thomas CP. Genetic testing in the evaluation of recipient candidates and living kidney donors. Curr Opin Nephrol Hypertens 2024; 33:4-12. [PMID: 37823847 DOI: 10.1097/mnh.0000000000000934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
PURPOSE OF REVIEW The aim of this study is to provide an overview of the role of genetic testing in the evaluation of kidney transplant candidates and living donors who may be at risk for heritable kidney disease. We focus our discussion on monogenic diseases, excluding renal diseases that have complex polygenic influences. Adoption of new technologies such as next-generation sequencing (NGS) with comprehensive gene panels has greatly enabled access to genetic testing recently; yet transplant professionals rarely receive adequate training in clinical genetics. In addition to a broad discussion of genetic testing, we hope to illustrate the thought processes and resources used in clinical genetic evaluation of recipient candidates and donors. RECENT FINDINGS Targeted renal genetic panels, whole exome and genome sequencing have greatly expanded our ability to test for pathogenic variants. Testing methods, analytic tools and the subsequent interpretation by the testing laboratory and treating physician impacts patient management and clinicians may lack the resources to practice in this new era of genomic medicine. SUMMARY The expansion of genomics into transplant medicine can provide improved diagnosis in transplant candidates and potentially disease prediction in living donors. Transplant professionals need to be familiar with emerging trends, promises and limitations of NGS-based testing.
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Affiliation(s)
- Brian K Lee
- Kidney/Pancreas Transplant Center, Dell Seton Medical Center, University of Texas at Austin, Austin, Texas
| | - Christie P Thomas
- Department of Internal Medicine and Iowa Institute of Human Genetics, University of Iowa Carver College of Medicine, Iowa City
- VA Medical Center, Iowa City, Iowa, USA
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Thomas CP, Wynn JJ, Stratta RJ. Lost in translation: Misguided application of a laudable and well-intentioned policy. Am J Transplant 2023; 23:1274-1275. [PMID: 37088142 DOI: 10.1016/j.ajt.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/10/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Affiliation(s)
- Christie P Thomas
- Division of Nephrology, Department of Medicine, University of Iowa Carver College of Medicine and VA Medical Center, Iowa City, Iowa, USA
| | - James J Wynn
- Division of Transplant and Hepatobiliary Surgery, Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA.
| | - Robert J Stratta
- Department of Surgery, Section of Transplantation, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
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Rheault MN, Amaral S, Bock M, Chambers ET, Chavers B, Ters ME, Garro R, Gbadegesin R, Govil A, Harshman L, Amer H, Hooper DK, Israni AK, Riad S, Sageshima J, Shapiro R, Seifert M, Smith J, Sung R, Thomas CP, Wang Q, Verghese PS. A randomized controlled trial of preemptive rituximab to prevent recurrent focal segmental glomerulosclerosis post-kidney transplant (PRI-VENT FSGS): protocol and study design. Front Nephrol 2023; 3:1181076. [PMID: 37675355 PMCID: PMC10479749 DOI: 10.3389/fneph.2023.1181076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/17/2023] [Indexed: 09/08/2023]
Abstract
Background Focal segmental glomerulosclerosis (FSGS) is a common cause of end-stage kidney disease requiring kidney transplantation and can recur in the allograft in 30-80% of recipients resulting in reduced graft survival. Plasmapheresis has shown efficacy in treating some cases of recurrent FSGS but isolated plasmapheresis has not demonstrated efficacy in preventing recurrent FSGS. Rituximab has had anecdotal success in preventing recurrence in a single center study but has not been studied in combination with plasmapheresis for preventing FSGS recurrence. Methods We are conducting a randomized, controlled, multicenter clinical trial of adult and pediatric kidney transplant recipients with primary FSGS to assess whether plasmapheresis in combination with rituximab prevents recurrent disease post-transplantation. Discussion Rituximab combined with plasmapheresis is a promising, novel therapy to prevent recurrent FSGS, a disease with limited therapeutic options and no consensus guidelines for prevention or treatment. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT03763643, identifier NCT03763643.
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Affiliation(s)
- Michelle N. Rheault
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Sandra Amaral
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Margret Bock
- Department of Pediatrics, Children’s Hospital of Colorado, Denver, CO, United States
| | | | - Blanche Chavers
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Mireile El Ters
- Department of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States
| | - Rouba Garro
- Department of Pediatrics, Emory University, Atlanta, GA, United States
| | | | - Amit Govil
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Lyndsay Harshman
- Department of Pediatrics, University of Iowa, Iowa, IA, United States
| | - Hatem Amer
- Department of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States
| | - David K. Hooper
- Division of Nephrology and Hypertension, Cincinnati Children’s Hospital, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Ajay K. Israni
- The Kidney Center at Hennepin Healthcare, Hennepin Health, Minneapolis, MN, United States
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Samy Riad
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Junichiro Sageshima
- Department of Surgery, University of California, Davis, Davis, CA, United States
| | - Ron Shapiro
- Department of Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY, United States
| | - Michael Seifert
- Heersink School of Medicine, Department of Pediatrics, School of Medicine, University of Alabama, Birmingham, AL, United States
| | - Jodi Smith
- Department of Pediatrics, Seattle Children’s Hospital, Seattle, WA, United States
| | - Randall Sung
- Department of Surgery, University of Michigan Health, Ann, Arbor, MI, United States
| | - Christie P. Thomas
- Department of Internal Medicine, University of Iowa, Iowa City, IA, United States
| | - Qi Wang
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, United States
| | - Priya S. Verghese
- Department of Pediatrics, Northwestern University, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, United States
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Thomas CP, Daloul R, Lentine KL, Gohh R, Anand PM, Rasouly HM, Sharfuddin AA, Schlondorff JS, Rodig NM, Freese ME, Garg N, Lee BK, Caliskan Y. Genetic evaluation of living kidney donor candidates: a review and recommendations for best practices. Am J Transplant 2023; 23:597-607. [PMID: 36868514 DOI: 10.1016/j.ajt.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/25/2023] [Accepted: 02/20/2023] [Indexed: 03/05/2023]
Abstract
The growing accessibility and falling costs of genetic sequencing techniques has expanded the utilization of genetic testing in clinical practice. For living kidney donation, genetic evaluation has been increasingly used to identify genetic kidney disease in potential candidates, especially in those of younger ages. However, genetic testing on asymptomatic living kidney donors remains fraught with many challenges and uncertainties. Not all transplant practitioners are aware of the limitations of genetic testing, are comfortable with selecting testing methods, comprehending test results, or providing counsel, and many do not have access to a renal genetic counselor or a clinical geneticist. Although genetic testing can be a valuable tool in living kidney donor evaluation, its overall benefit in donor evaluation has not been demonstrated and it can also lead to confusion, inappropriate donor exclusion, or misleading reassurance. Until more published data become available, this practice resource should provide guidance for centers and transplant practitioners on the responsible use of genetic testing in the evaluation of living kidney donor candidates.
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Affiliation(s)
- Christie P Thomas
- Department of of Internal Medicine and Iowa Institute of Human Genetics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; VA Medical Center, Iowa City, Iowa, USA.
| | - Reem Daloul
- Division of Nephrology, Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Krista L Lentine
- Saint Louis University Transplant Center, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Reginald Gohh
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Prince M Anand
- Mid-Carolinas Transplant Center, Medical University of South Carolina, Lancaster, South Carolina, USA
| | - Hila Milo Rasouly
- Center for Precision Medicine and Genomics, Department of Medicine, Columbia University, New York City, New York, USA
| | - Asif A Sharfuddin
- Division of Nephrology and Transplant, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Johannes S Schlondorff
- Department of Internal Medicine, Ohio State University Medical Center, Columbus, Ohio, USA
| | - Nancy M Rodig
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Margaret E Freese
- Department of of Internal Medicine and Iowa Institute of Human Genetics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Neetika Garg
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Brian K Lee
- Kidney/Pancreas Transplant Center, Dell Seton Medical Center, University of Texas at Austin, Austin, Texas, USA
| | - Yasar Caliskan
- Saint Louis University Transplant Center, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
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Sambharia M, Freese ME, Donato F, Bathla G, Abukhiran IMM, Dantuma MI, Mansilla MA, Thomas CP. Suspected Autosomal Recessive Polycystic Kidney Disease but Cerebellar Vermis Hypoplasia, Oligophrenia Ataxia, Coloboma, and Hepatic Fibrosis (COACH) Syndrome in Retrospect, A Delayed Diagnosis Aided by Genotyping and Reverse Phenotyping: A Case Report and A Review of the Literature. Nephron Clin Pract 2023; 148:264-272. [PMID: 36617405 DOI: 10.1159/000527991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/20/2022] [Indexed: 01/07/2023] Open
Abstract
The clinical features of cerebellar vermis hypoplasia, oligophrenia, ataxia, coloboma, and hepatic fibrosis (COACH) characterize the rare autosomal recessive multisystem disorder called COACH syndrome. COACH syndrome belongs to the spectrum of Joubert syndrome and related disorders (JSRDs) and liver involvement distinguishes COACH syndrome from the rest of the JSRD spectrum. Developmental delay and oculomotor apraxia occur early but with time, these can improve and may not be readily apparent or no longer need active medical management. Congenital hepatic fibrosis and renal disease, on the other hand, may develop late, and the temporal incongruity in organ system involvement may delay the recognition of COACH syndrome. We present a case of a young adult presenting late to a Renal Genetics Clinic for evaluation of renal cystic disease with congenital hepatic fibrosis, clinically suspected to have autosomal recessive polycystic kidney disease. Following genetic testing, a reevaluation of his medical records from infancy, together with reverse phenotyping and genetic phasing, led to a diagnosis of COACH syndrome.
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Affiliation(s)
- Meenakshi Sambharia
- Division of Nephrology, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Margaret E Freese
- Division of Nephrology, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Francisco Donato
- Department of Radiology, University of Iowa, Iowa City, Iowa, USA
| | - Girish Bathla
- Department of Radiology, University of Iowa, Iowa City, Iowa, USA
| | | | - Maisie I Dantuma
- The Iowa Institute of Human Genetics, University of Iowa, Iowa City, Iowa, USA
| | - M Adela Mansilla
- The Iowa Institute of Human Genetics, University of Iowa, Iowa City, Iowa, USA
| | - Christie P Thomas
- Division of Nephrology, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
- The Iowa Institute of Human Genetics, University of Iowa, Iowa City, Iowa, USA
- Department of Pediatrics, College of Medicine, University of Iowa, Iowa City, Iowa, USA
- Veterans Affairs Medical Center, Iowa City, Iowa, USA
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Lam NN, Muiru AN, Tietjen A, Hays RE, Xiao H, Garg AX, McNatt G, Howey R, Thomas CP, Sarabu N, Wooley C, Kasiske BL, Lentine KL. Associations of Lack of Insurance and Other Sociodemographic Traits With Follow-up After Living Kidney Donation. Am J Kidney Dis 2022; 80:683-685. [PMID: 35301049 DOI: 10.1053/j.ajkd.2022.01.427] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/14/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Ngan N Lam
- University of Calgary, Calgary, Alberta, Canada
| | | | | | - Rebecca E Hays
- University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | | | | | - Gwen McNatt
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Sambharia M, Rastogi P, Thomas CP. Monogenic focal segmental glomerulosclerosis: A conceptual framework for identification and management of a heterogeneous disease. Am J Med Genet C Semin Med Genet 2022; 190:377-398. [PMID: 35894442 PMCID: PMC9796580 DOI: 10.1002/ajmg.c.31990] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/31/2022] [Accepted: 06/30/2022] [Indexed: 01/29/2023]
Abstract
Focal segmental glomerulosclerosis (FSGS) is not a disease, rather a pattern of histological injury occurring from a variety of causes. The exact pathogenesis has yet to be fully elucidated but is likely varied based on the type of injury and the primary target of that injury. However, the approach to treatment is often based on the degree of podocyte foot process effacement and clinical presentation without sufficient attention paid to etiology. In this regard, there are many monogenic causes of FSGS with variable presentation from nephrotic syndrome with histological features of primary podocytopathy to more modest degrees of proteinuria with limited evidence of podocyte foot process injury. It is likely that genetic causes are largely underdiagnosed, as the role and the timing of genetic testing in FSGS is not established and genetic counseling, testing options, and interpretation of genotype in the context of phenotype may be outside the scope of practice for both nephrologists and geneticists. Yet most clinicians believe that a genetic diagnosis can lead to targeted therapy, limit the use of high-dose corticosteroids as a therapeutic trial, and allow the prediction of the natural history and risk for recurrence in the transplanted kidney. In this manuscript, we emphasize that genetic FSGS is not monolithic in its presentation, opine on the importance of genetic testing and provide an algorithmic approach to deployment of genetic testing in a timely fashion when faced with a patient with FSGS.
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Affiliation(s)
- Meenakshi Sambharia
- Division of Nephrology, Department of Internal MedicineUniversity of IowaIowa CityIowaUSA
| | - Prerna Rastogi
- Department of PathologyUniversity of IowaIowa CityIowaUSA
| | - Christie P. Thomas
- Division of Nephrology, Department of Internal MedicineUniversity of IowaIowa CityIowaUSA,Department of PediatricsUniversity of IowaIowa CityIowaUSA,The Iowa Institute of Human GeneticsUniversity of IowaIowa CityIowaUSA,Medical ServiceVeterans Affairs Medical CenterIowa CityIowaUSA
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Sambharia M, Gattineni J, Noureddine L, Mansilla MA, Thomas CP. Familial hyperkalemic hypertension: hyperkalemia not hypertension defines dominant KLHL3 disease and may permit earlier recognition and tailored therapy. J Nephrol 2022; 35:1737-1742. [PMID: 35000137 DOI: 10.1007/s40620-021-01217-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/28/2021] [Indexed: 01/16/2023]
Affiliation(s)
- Meenakshi Sambharia
- Division of Nephrology, Department of Internal Medicine, SE419 GH, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Jyothsna Gattineni
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Lama Noureddine
- Division of Nephrology, Department of Internal Medicine, SE419 GH, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - M Adela Mansilla
- The Iowa Institute of Human Genetics, University of Iowa, Iowa City, IA, 52242, USA
| | - Christie P Thomas
- Division of Nephrology, Department of Internal Medicine, SE419 GH, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242, USA. .,Department of Pediatrics, University of Iowa, Iowa City, IA, 52242, USA. .,Veterans Affairs Medical Center, Iowa City, IA, 52242, USA.
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Kumar A, Bonnell LN, Eberlein M, Thomas CP. The U-shaped association of post-lung transplant mortality with pre-transplant eGFR underscores possible limitations of creatinine-based estimation equations for risk stratification. J Heart Lung Transplant 2022; 41:1277-1284. [DOI: 10.1016/j.healun.2022.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 05/10/2022] [Accepted: 05/30/2022] [Indexed: 12/01/2022] Open
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Thomas CP, Gupta S, Freese ME, Chouhan KK, Dantuma MI, Holanda DG, Katz DA, Darbro BW, Mansilla MA, Smith RJ. Sequential genetic testing of living-related donors for inherited renal disease to promote informed choice and enhance safety of living donation. Transpl Int 2021; 34:2696-2705. [PMID: 34632641 DOI: 10.1111/tri.14133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 01/09/2023]
Abstract
Living kidney donors (LKDs) with a family history of renal disease are at risk of kidney disease as compared to LKDs without such history suggesting that some LKDs may be pre-symptomatic for monogenic kidney disease. LKDs with related transplant candidates whose kidney disease was considered genetic in origin were selected for genetic testing. In each case, the transplant candidate was first tested to verify the genetic diagnosis. A genetic diagnosis was confirmed in 12 of 24 transplant candidates (ADPKD-PKD1: 6, ALPORT-COL4A3: 2, ALPORT-COL4A5: 1: nephronophthisis-SDCCAG8: 1; CAKUT-HNF1B and ADTKD-MUC1: 1 each) and 2 had variants of unknown significance (VUS) in phenotype-relevant genes. Focused genetic testing was then done in 20 of 34 LKDs. 12 LKDs screened negative for the familial variant and were permitted to donate; seven screened positive and were counseled against donation. One, the heterozygous carrier of a recessive disorder was also cleared. Six of seven LKDs with a family history of ADPKD were under 30 years and in 5, by excluding ADPKD, allowed donation to safely proceed. The inclusion of genetic testing clarified the diagnosis in recipient candidates, improving safety or informed decision-making in LKDs.
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Affiliation(s)
- Christie P Thomas
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.,Department of Pediatrics, University of Iowa, Iowa City, IA, USA.,Veterans Affairs Medical Center, Iowa City, IA, USA
| | - Sonali Gupta
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Margaret E Freese
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Maisie I Dantuma
- Iowa Institute of Human Genetics, University of Iowa, Iowa City, IA, USA
| | | | - Daniel A Katz
- Department of Surgery, University of Iowa, Iowa City, IA, USA
| | - Benjamin W Darbro
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA.,Iowa Institute of Human Genetics, University of Iowa, Iowa City, IA, USA
| | - Maria A Mansilla
- Iowa Institute of Human Genetics, University of Iowa, Iowa City, IA, USA
| | - Richard J Smith
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.,Department of Pediatrics, University of Iowa, Iowa City, IA, USA.,Iowa Institute of Human Genetics, University of Iowa, Iowa City, IA, USA
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14
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Doshi MD, Gordon EJ, Freedman BI, Glover C, Locke JE, Thomas CP. Integrating APOL1 Kidney-risk Variant Testing in Live Kidney Donor Evaluation: An Expert Panel Opinion. Transplantation 2021; 105:2132-2134. [PMID: 33534524 PMCID: PMC8994118 DOI: 10.1097/tp.0000000000003641] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Mona D. Doshi
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Elisa J. Gordon
- Department of Surgery-Transplantation, Northwestern University, Chicago, IL
| | - Barry I. Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC
| | | | - Jayme E. Locke
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Christie P. Thomas
- Department of Medicine, University of Iowa, Iowa City, IA
- Department of Medicine, University of Iowa, Iowa City, IA
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15
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Kumar A, Bonnell LN, Thomas CP. Impact of changing renal function, while waiting for a heart transplant, on post-transplant mortality and development of end stage kidney disease. Transpl Int 2021; 34:1044-1051. [PMID: 33884675 DOI: 10.1111/tri.13889] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/31/2021] [Accepted: 04/16/2021] [Indexed: 11/30/2022]
Abstract
Heart transplantation is a viable option for end stage heart disease but long-term complications such as chronic kidney disease are being increasingly recognized. We sought to investigate the effect of change in estimated glomerular filtration rate (eGFR) during the heart transplant waitlist period on post-transplant mortality and end stage kidney disease (ESKD). We analysed the United Network of Organ Sharing heart transplant database from 2000 to 2017. Multivariable Cox regression with restricted cubic splines and cumulative incidence competing risk (CICR) methods were used to compare the effects of change in eGFR on mortality and ESKD, respectively. A total of 19 412 patients met our inclusion criteria. Mortality increased with increasing loss of eGFR (adjusted hazard ratio increased from 1.02 [confidence interval (CI) 1.01-1.04, P = 0.008] for 10% loss to 1.15 (CI 1.06-1.26, P = 0.001) for 50% loss of eGFR. Similarly, risk of ESKD also increased monotonically with increasing loss of renal function [subdistribution hazard ratio increased from 1.12 (CI 1.09-1.14, P < 0.001) to 2.0 (CI 1.74-2.3, P < 0.001)] as loss of eGFR increased from 10% to 50%. Overall, we found that loss of >10% of eGFR resulted in higher risk of mortality and higher risk of ESKD.
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Affiliation(s)
- Abhishek Kumar
- Department of Internal Medicine, University of Vermont, Burlington, VT, USA
| | - Levi N Bonnell
- Department of General Internal Medicine Research, University of Vermont, Burlington, VT, USA
| | - Christie P Thomas
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.,Veterans Affairs Medical Center, Iowa City, IA, USA
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16
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Mansilla MA, Sompallae RR, Nishimura CJ, Kwitek AE, Kimble MJ, Freese ME, Campbell CA, Smith RJ, Thomas CP. Targeted broad-based genetic testing by next-generation sequencing informs diagnosis and facilitates management in patients with kidney diseases. Nephrol Dial Transplant 2021; 36:295-305. [PMID: 31738409 PMCID: PMC7834596 DOI: 10.1093/ndt/gfz173] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/23/2019] [Indexed: 12/15/2022] Open
Abstract
Background The clinical diagnosis of genetic renal diseases may be limited by the overlapping spectrum of manifestations between diseases or by the advancement of disease where clues to the original process are absent. The objective of this study was to determine whether genetic testing informs diagnosis and facilitates management of kidney disease patients. Methods We developed a comprehensive genetic testing panel (KidneySeq) to evaluate patients with various phenotypes including cystic diseases, congenital anomalies of the kidney and urinary tract (CAKUT), tubulointerstitial diseases, transport disorders and glomerular diseases. We evaluated this panel in 127 consecutive patients ranging in age from newborns to 81 years who had samples sent in for genetic testing. Results The performance of the sequencing pipeline for single-nucleotide variants was validated using CEPH (Centre de’Etude du Polymorphism) controls and for indels using Genome-in-a-Bottle. To test the reliability of the copy number variant (CNV) analysis, positive samples were re-sequenced and analyzed. For patient samples, a multidisciplinary review board interpreted genetic results in the context of clinical data. A genetic diagnosis was made in 54 (43%) patients and ranged from 54% for CAKUT, 53% for ciliopathies/tubulointerstitial diseases, 45% for transport disorders to 33% for glomerulopathies. Pathogenic and likely pathogenic variants included 46% missense, 11% nonsense, 6% splice site variants, 23% insertion–deletions and 14% CNVs. In 13 cases, the genetic result changed the clinical diagnosis. Conclusion Broad genetic testing should be considered in the evaluation of renal patients as it complements other tests and provides insight into the underlying disease and its management.
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Affiliation(s)
- M Adela Mansilla
- Iowa Institute of Human Genetics, University of Iowa, Iowa City, IA, USA
| | | | - Carla J Nishimura
- Iowa Institute of Human Genetics, University of Iowa, Iowa City, IA, USA
| | - Anne E Kwitek
- Physiology, Medical College of Wisconsin, Iowa City, IA, USA
| | - Mycah J Kimble
- Iowa Institute of Human Genetics, University of Iowa, Iowa City, IA, USA
| | | | - Colleen A Campbell
- Iowa Institute of Human Genetics, University of Iowa, Iowa City, IA, USA
| | - Richard J Smith
- Iowa Institute of Human Genetics, University of Iowa, Iowa City, IA, USA.,Internal Medicine, University of Iowa, Iowa City, IA, USA.,Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Christie P Thomas
- Internal Medicine, University of Iowa, Iowa City, IA, USA.,Pediatrics, University of Iowa, Iowa City, IA, USA.,Veterans Affairs Medical Center, Iowa City, IA, USA
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17
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Story MT, Sanders ML, Bashir AA, Longo JM, Abel SL, Dollard SC, Grodstein EI, Thomas CP, Katz DA. Infiltrating Kaposi sarcoma presenting as acute kidney injury: An unexpected consequence of deliberate hepatitis C-positive organ transplantation. Transpl Infect Dis 2021; 23:e13481. [PMID: 33012057 DOI: 10.1111/tid.13481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 08/06/2020] [Accepted: 09/20/2020] [Indexed: 11/30/2022]
Abstract
Kaposi sarcoma (KS) following kidney transplantation can result from recipient reactivation of latent human herpesvirus 8 (HHV-8) infection or activation of donor-acquired HHV-8 infection. Post-transplant KS typically manifests with cutaneous pathology, but rare cases of renal allograft involvement have been reported. We describe two cases of donor-derived HHV-8 infection in two hepatitis C (HCV) viremia-negative transplant recipients who each received a kidney from a donor with HCV viremia. One recipient did not develop KS while the other presented with acute kidney injury caused by extensive KS infiltration of the renal parenchyma and metastatic disease. This report reviews the literature for cases of KS involving the renal allograft and highlights an unexpected consequence of deliberate HCV-positive organ transplantation.
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Affiliation(s)
- Maria T Story
- Department Medicine, Division of Nephrology, University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA, USA
| | - M Lee Sanders
- Department Medicine, Division of Nephrology, University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA, USA
- Iowa City VA Health Care System, Iowa City, IA, USA
| | - Amani A Bashir
- Department of Pathology, University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA, USA
| | - Jude M Longo
- Iowa City VA Health Care System, Iowa City, IA, USA
- Department of Radiology, University of Iowa Roy and Lucille Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Stacy L Abel
- Iowa City VA Health Care System, Iowa City, IA, USA
| | | | - Elliot I Grodstein
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Christie P Thomas
- Department Medicine, Division of Nephrology, University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA, USA
- Iowa City VA Health Care System, Iowa City, IA, USA
| | - Daniel A Katz
- Iowa City VA Health Care System, Iowa City, IA, USA
- Department of Surgery, University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA, USA
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18
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Mashmoushi A, Choudhary A, Thomas CP, Wolf MT. A rare case of hyporeninemic hypertension: Questions. Pediatr Nephrol 2021; 36:567-568. [PMID: 32607770 PMCID: PMC7772231 DOI: 10.1007/s00467-020-04658-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/09/2020] [Indexed: 11/28/2022]
Abstract
Not required for clinical quiz
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Affiliation(s)
- Ahmad Mashmoushi
- Pediatric Nephrology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Abha Choudhary
- Pediatric Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Christie P. Thomas
- Division of Nephrology, Department of Internal Medicine, University of Iowa Health Care, Iowa City, IA, USA
| | - Matthias T.F. Wolf
- Pediatric Nephrology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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19
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Mashmoushi A, Choudhary A, Thomas CP, Wolf MT. A rare case of hyporeninemic hypertension: Answers. Pediatr Nephrol 2021; 36:569-573. [PMID: 32607771 PMCID: PMC7772256 DOI: 10.1007/s00467-020-04667-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/09/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Ahmad Mashmoushi
- Pediatric Nephrology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Abha Choudhary
- Pediatric Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Christie P. Thomas
- Division of Nephrology, Department of Internal Medicine, University of Iowa Health Care, Iowa City, IA, USA
| | - Matthias T.F. Wolf
- Pediatric Nephrology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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20
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Dollard SC, Annambhotla P, Wong P, Meneses K, Amin MM, La Hoz RM, Lease ED, Budev M, Arrossi AV, Basavaraju SV, Thomas CP. Donor-derived human herpesvirus 8 and development of Kaposi sarcoma among 6 recipients of organs from donors with high-risk sexual and substance use behavior. Am J Transplant 2021; 21:681-688. [PMID: 32633035 PMCID: PMC7891580 DOI: 10.1111/ajt.16181] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 01/25/2023]
Abstract
Kaposi sarcoma (KS) can develop following organ transplantation through reactivation of recipient human herpesvirus 8 (HHV-8) infection or through donor-derived HHV-8 transmission. We describe 6 cases of donor-derived HHV-8 infection and KS investigated from July 2018 to January 2020. Organs from 6 donors, retrospectively identified as HHV-8-positive, with a history of drug use disorder, were transplanted into 22 recipients. Four of 6 donors had risk factors for HHV-8 infection reported in donor history questionnaires. Fourteen of 22 organ recipients (64%) had evidence of posttransplant HHV-8 infection. Lung recipients were particularly susceptible to KS. Four of the 6 recipients who developed KS died from KS or associated complications. The US opioid crisis has resulted in an increasing number and proportion of organ donors with substance use disorder, and particularly injection drug use history, which may increase the risk of HHV-8 transmission to recipients. Better awareness of the risk of posttransplant KS for recipients of organs from donors with HHV-8 infection risk could be useful for recipient management. Testing donors and recipients for HHV-8 is currently challenging with no validated commercial serology kits available. Limited HHV-8 antibody testing is available through some US reference laboratories and the Centers for Disease Control and Prevention.
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Affiliation(s)
| | | | - Phili Wong
- Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Katherine Meneses
- Liver Transplant DepartmentUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Minal M. Amin
- Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Ricardo M. La Hoz
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Erika D. Lease
- Division of Pulmonary Critical Care and Sleep MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Maria Budev
- Department of Pulmonary MedicineCleveland Clinic FoundationClevelandOhioUSA
| | | | | | - Christie P. Thomas
- Department of Internal MedicineUniversity of Iowa Carver College of MedicineIowa CityIowaUSA,Veterans Affairs Medical CenterIowa CityIowaUSA
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21
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Yamada M, Rastogi P, Ince D, Thayyil A, Adela Mansilla M, Smith RJH, Kuppachi S, Thomas CP. Minimal Change Disease With Nephrotic Syndrome Associated With Coronavirus Disease 2019 After Apolipoprotein L1 Risk Variant Kidney Transplant: A Case Report. Transplant Proc 2020; 52:2693-2697. [PMID: 32972761 PMCID: PMC7440148 DOI: 10.1016/j.transproceed.2020.08.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/18/2020] [Indexed: 02/07/2023]
Abstract
Kidney injury is a well-known complication in people with coronavirus disease 2019 (COVID-19). In kidney transplant recipients with COVID-19, presentation with nephrotic syndrome has not been well described. We report on a 49-year-old black female kidney transplant recipient who presented 25 years after transplant with clinical features of nephrotic syndrome following a diagnosis of COVID-19. Histologic examination showed acute tubular injury with unremarkable glomeruli on light microscopy and diffuse foot process effacement of podocytes on electron microscopy, consistent with minimal change-like podocyte injury. Apolipoprotein L1 (APOL1) genetic testing confirmed 2 high-risk APOL1 alleles in the kidney donor. We speculate that COVID-19-induced systemic or local cytokine release could serve as a second hit in the presence of APOL1 risk alleles and mediate a podocytopathy manifesting as nephrotic syndrome. The presented case with minimal change-like disease, occurring in the context of the donor high-risk APOL1 genotype, extends the spectrum of clinical manifestations in COVID-19-associated nephropathy.
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Affiliation(s)
- Masaaki Yamada
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa; VA Medical Center, Iowa City, Iowa
| | - Prerna Rastogi
- Department of Pathology, University of Iowa, Iowa City, Iowa
| | - Dilek Ince
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Abdullah Thayyil
- Department of Pathology, East Carolina University, Greenville, North Carolina; Department of Pathology, Vidant Medical Center, Greenville, North Carolina
| | - M Adela Mansilla
- Iowa Institute of Human Genetics, University of Iowa, Iowa City, Iowa
| | - Richard J H Smith
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa; Iowa Institute of Human Genetics, University of Iowa, Iowa City, Iowa
| | - Sarat Kuppachi
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa.
| | - Christie P Thomas
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa; VA Medical Center, Iowa City, Iowa
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22
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Thomas CP, Freese ME, Ounda A, Jetton JG, Holida M, Noureddine L, Smith RJ. Correction: Initial experience from a renal genetics clinic demonstrates a distinct role in patient management. Genet Med 2020; 23:2017-2019. [PMID: 33024316 PMCID: PMC8486658 DOI: 10.1038/s41436-020-01000-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Christie P Thomas
- Departments of Internal Medicine, University of Iowa, Iowa City, IA, USA. .,Departments of Pediatrics, University of Iowa, Iowa City, IA, USA. .,Veterans Affairs Medical Center, Iowa City, IA, USA.
| | - Margaret E Freese
- Departments of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Agnes Ounda
- Departments of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Myrl Holida
- Departments of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Lama Noureddine
- Departments of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Richard J Smith
- Departments of Internal Medicine, University of Iowa, Iowa City, IA, USA.,Departments of Pediatrics, University of Iowa, Iowa City, IA, USA.,The Iowa Institute of Human Genetics, University of Iowa, Iowa City, IA, USA
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23
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Mandelbrot DA, Reese PP, Garg N, Thomas CP, Rodrigue JR, Schinstock C, Doshi M, Cooper M, Friedewald J, Naik AS, Kaul DR, Ison MG, Rocco MV, Verbesey J, Hladunewich MA, Ibrahim HN, Poggio ED. KDOQI US Commentary on the 2017 KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Am J Kidney Dis 2020; 75:299-316. [PMID: 32007233 DOI: 10.1053/j.ajkd.2019.10.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 12/27/2022]
Abstract
Living kidney donation is widely practiced throughout the world. During the past 2 decades, various groups have provided guidance about the evaluation and care of living donors. However, during this time, our knowledge in the field has advanced substantially and many agreed on the need for a comprehensive, unifying document. KDIGO (Kidney Disease: Improving Global Outcomes) addressed this issue at an international level with the publication of its clinical practice guideline on the evaluation and care of living kidney donors. The KDIGO work group extensively reviewed the available literature and wrote a series of guideline recommendations using various degrees of evidence when available. As has become recent practice, NKF-KDOQI (National Kidney Foundation-Kidney Disease Outcomes Quality Initiative) convened a work group to provide a commentary on the KDIGO guideline, with a focus on how these recommendations apply in the context of the United States. In the United States, the United Network for Organ Sharing (UNOS) guides and regulates the practice of living kidney donation. While the KDIGO guideline for the care of living kidney donors and UNOS policy are similar in most aspects of the care of living kidney donors, several important areas are not consistent or do not align with common practice by US transplantation programs in areas in which UNOS has not set specific policy. For the time being, and recognizing the value of the KDIGO guidelines, US transplantation programs should continue to follow UNOS policy.
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Affiliation(s)
| | - Peter P Reese
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Neetika Garg
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | | | - Carrie Schinstock
- Division of Nephrology and Hypertension, William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Mona Doshi
- Division of Nephrology, University of Michigan, Ann Arbor, MI
| | - Matthew Cooper
- Georgetown University School of Medicine, MedStar Georgetown Transplant Institute, Washington, DC
| | - John Friedewald
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Abhijit S Naik
- Division of Nephrology, University of Michigan, Ann Arbor, MI
| | | | - Michael G Ison
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Jennifer Verbesey
- MedStar Georgetown Transplant Institute and Children's National Health System, Washington, DC
| | - Michelle A Hladunewich
- Division of Nephrology, Department of Medicine, Nanji Family Kidney Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Emilio D Poggio
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
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24
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Crow LD, Jambusaria‐Pahlajani A, Chung CL, Baran DA, Lowenstein SE, Abdelmalek M, Ahmed RL, Anadkat MJ, Arcasoy SM, Berg D, Bibee KP, Billingsley E, Black WH, Blalock TW, Bleicher M, Brennan DC, Brodland DG, Brown MR, Carroll BT, Carucci JA, Chang TW, Chaux G, Cusack CA, Dilling DF, Doyle A, Emtiazjoo AM, Ferguson NH, Fosko SW, Fox MC, Goral S, Gray AL, Griffin JR, Hachem RR, Hall SA, Hanlon AM, Hayes D, Hickey GW, Holtz J, Hopkins RS, Hu J, Huang CC, Brian Jiang SI, Kapnadak SG, Kraus ES, Lease ED, Leca N, Lee JC, Leitenberger JJ, Lim MA, Longo MI, Malik SM, Mallea JM, Menter A, Myers SA, Neuburg M, Nijhawan RI, Norman DJ, Otley CC, Paek SY, Parulekar AD, Patel MJ, Patel VA, Patton TJ, Pugliano‐Mauro M, Ranganna K, Ravichandran AK, Redenius R, Roll GR, Samie FH, Shin T, Singer JP, Singh P, Soon SL, Soriano T, Squires R, Stasko T, Stein JA, Taler SJ, Terrault NA, Thomas CP, Tokman S, Tomic R, Twigg AR, Wigger MA, Zeitouni NC, Arron ST. Initial skin cancer screening for solid organ transplant recipients in the United States: Delphi method development of expert consensus guidelines. Transpl Int 2019; 32:1268-1276. [DOI: 10.1111/tri.13520] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/25/2019] [Accepted: 09/02/2019] [Indexed: 12/25/2022]
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25
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Tietjen A, Hays R, McNatt G, Howey R, Lebron-Banks U, Thomas CP, Lentine KL. Billing for living kidney donor care: Balancing cost recovery, regulatory compliance, and minimized donor burden. Curr Transplant Rep 2019; 6:155-166. [PMID: 31214485 PMCID: PMC6580854 DOI: 10.1007/s40472-019-00239-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To provide standardized guidance for transplant programs to maximize financial reimbursement related to living donor care, and to minimize financial consequences of evaluation, surgical and follow-up care to living donor candidates and donors. RECENT FINDINGS In 2014, the American Society for Transplantation (AST) Live Donor Community of Practice (LDCOP) "Consensus Conference on Best Practices in Live Kidney Donation" identified inconsistencies in billing practices as a barrier to living donor financial neutrality, and issued a strong recommendation that the transplant community actively pursue strategies and policies to make living donation a financially neutral act, within the framework of federal law. The LDCOP convened a multidisciplinary group of experts to review and synthesize current Medicare regulations and commercial payer practices related to billing for living donor care, and the implications for transplant programs and patients. We developed guidance for transplant program staff related to strategies to consistently and appropriately obtain reimbursement via the Medicare Cost Report by utilizing organ acquisition; coordinate available coverage for donor pretesting, evaluation, hospitalization, follow-up care, and complications; coordinate charges in kidney paired donation; and maximize coverage through private insurance contracting. We also offer recommendations to protect donor confidentiality in the context of billing, and to educate and prepare donor candidates and donors about any remaining gaps in coverage related to donation. SUMMARY Best practices in billing for living donation-related care should focus on balancing cost recovery, regulatory compliance, and minimized donor burden. Herein we offer 9 recommendations for best practice. We also offer a platform of 7 recommendations for research & advocacy efforts to better understand the climate of living donor medical costs, and to optimize billing practices that support provision of living donor transplant services to all patients who can benefit and to achieve financial neutrality for living donors.
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Affiliation(s)
- Andrea Tietjen
- American Society of Transplantation (AST) Living Donor Community of Practice (LDCOP)
- Saint Barnabas Medical Center, Livingston, NJ
| | - Rebecca Hays
- American Society of Transplantation (AST) Living Donor Community of Practice (LDCOP)
- University of Wisconsin Hospital and Clinics, Division of Surgery, Madison, WI
| | - Gwen McNatt
- American Society of Transplantation (AST) Living Donor Community of Practice (LDCOP)
- Kovler Organ Transplantation Center, Northwestern Memorial Hospital, Chicago, IL
| | - Robert Howey
- American Society of Transplantation (AST) Living Donor Community of Practice (LDCOP)
- Toyon Associates, Concord, CA
| | - Ursula Lebron-Banks
- American Society of Transplantation (AST) Living Donor Community of Practice (LDCOP)
- New York-Presbyterian Hospital, New York, NY
| | - Christie P. Thomas
- American Society of Transplantation (AST) Living Donor Community of Practice (LDCOP)
- University of Iowa Transplant Institute, Iowa City, IA
| | - Krista L. Lentine
- American Society of Transplantation (AST) Living Donor Community of Practice (LDCOP)
- Saint Louis University Center for Abdominal Transplantation, St. Louis, MO
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Bu F, Zhang Y, Wang K, Borsa NG, Jones MB, Taylor AO, Takanami E, Meyer NC, Frees K, Thomas CP, Nester C, Smith RJH. Genetic Analysis of 400 Patients Refines Understanding and Implicates a New Gene in Atypical Hemolytic Uremic Syndrome. J Am Soc Nephrol 2018; 29:2809-2819. [PMID: 30377230 DOI: 10.1681/asn.2018070759] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 09/12/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Genetic variation in complement genes is a predisposing factor for atypical hemolytic uremic syndrome (aHUS), a life-threatening thrombotic microangiopathy, however interpreting the effects of genetic variants is challenging and often ambiguous. METHODS We analyzed 93 complement and coagulation genes in 400 patients with aHUS, using as controls 600 healthy individuals from Iowa and 63,345 non-Finnish European individuals from the Genome Aggregation Database. After adjusting for population stratification, we then applied the Fisher exact, modified Poisson exact, and optimal unified sequence kernel association tests to assess gene-based variant burden. We also applied a sliding-window analysis to define the frequency range over which variant burden was significant. RESULTS We found that patients with aHUS are enriched for ultrarare coding variants in the CFH, C3, CD46, CFI, DGKE, and VTN genes. The majority of the significance is contributed by variants with a minor allele frequency of <0.1%. Disease-related variants tend to occur in specific complement protein domains of FH, CD46, and C3. We observed no enrichment for multiple rare coding variants in gene-gene combinations. CONCLUSIONS In known aHUS-associated genes, variants with a minor allele frequency >0.1% should not be considered pathogenic unless valid enrichment and/or functional evidence are available. VTN, which encodes vitronectin, an inhibitor of the terminal complement pathway, is implicated as a novel aHUS-associated gene. Patients with aHUS are not enriched for multiple rare variants in complement genes. In aggregate, these data may help in directing clinical management of aHUS.
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Affiliation(s)
- Fengxiao Bu
- Medical Genetics Center, Southwest Hospital, Chongqing, China; and.,Molecular Otolaryngology and Renal Research Laboratories
| | - Yuzhou Zhang
- Molecular Otolaryngology and Renal Research Laboratories
| | | | | | | | | | - Erika Takanami
- Molecular Otolaryngology and Renal Research Laboratories
| | - Nicole C Meyer
- Molecular Otolaryngology and Renal Research Laboratories
| | - Kathy Frees
- Molecular Otolaryngology and Renal Research Laboratories
| | - Christie P Thomas
- Division of Nephrology, Department of Internal Medicine, Carver College of Medicine, and
| | - Carla Nester
- Molecular Otolaryngology and Renal Research Laboratories.,Division of Nephrology, Department of Internal Medicine, Carver College of Medicine, and.,Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Richard J H Smith
- Molecular Otolaryngology and Renal Research Laboratories, .,Division of Nephrology, Department of Internal Medicine, Carver College of Medicine, and.,Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa
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27
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Raikwar NS, Shibuya M, Thomas CP. VEGF-A selectively inhibits FLT1 ectodomain shedding independent of receptor activation and receptor endocytosis. Am J Physiol Cell Physiol 2018; 315:C214-C224. [PMID: 29719170 PMCID: PMC6139503 DOI: 10.1152/ajpcell.00247.2017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 03/28/2018] [Accepted: 04/11/2018] [Indexed: 11/22/2022]
Abstract
Ectodomain shedding and regulated intracellular proteolysis can determine the fate or function of cell surface proteins. Fms-related tyrosine kinase (FLT) or VEGF receptor 1 is a high-affinity cell surface VEGF-A receptor tyrosine kinase that is constitutively cleaved to release an NH2-terminal VEGF-A binding ectodomain that, once shed, can antagonize the effects of VEGF-A in the extracellular milieu. We evaluated the effect of VEGF-A on FLT1 cleavage in native cells and in transient and stable expression systems. We demonstrate that VEGF-A inhibits FLT1 ectodomain cleavage in a time- and dose-dependent manner, whereas VEGF-A knockdown in HEK293 cells increases ectodomain shedding. Although kinase insert domain receptor (KDR) or VEGF receptor 2, analogous to FLT1, is also subject to extracellular and intracellular cleavage, VEGF-A does not inhibit KDR cleavage. VEGF-A inhibition of FLT1 cleavage is not dependent on FLT1 tyrosine kinase activity or the intracellular FLT1 residues. N-acetylleucylleucylnorleucinal (ALLN), a proteasomal inhibitor; bafilomycin A, an inhibitor of endosomal acidification; and dynasore, a dynamin inhibitor, all increase the abundance of FLT1 and the shed ectodomain, indicating that FLT1 is subject to dynamin-mediated endocytosis and susceptible to proteasomal and lysosomal degradation. VEGF-A inhibition of cleavage is not reversed by ALLN, bafilomycin A, or dynasore. However, a 30 AA deletion in the extracellular immunoglobulin 7 domain leads to enhanced cleavage of Flt1 with a significant reduction of the VEGF inhibitory effect. Our results indicate that the inhibition of FLT1 ectodomain cleavage by VEGF-A is dependent neither on receptor activation nor on internalization nor a consequence of receptor degradation and likely represents a direct inhibitory effect on receptor cleavage.
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Affiliation(s)
- Nandita S Raikwar
- Department of Internal Medicine, University of Iowa Carver College of Medicine , Iowa City, Iowa
| | - Masabumi Shibuya
- Institute of Physiology and Medicine, Jobu University, Takasaki, Gunma, Japan
| | - Christie P Thomas
- Department of Internal Medicine, University of Iowa Carver College of Medicine , Iowa City, Iowa
- Department of Pediatrics, University of Iowa Carver College of Medicine , Iowa City, Iowa
- Department of Obstetrics, University of Iowa Carver College of Medicine , Iowa City, Iowa
- Graduate Program in Molecular Medicine, University of Iowa Carver College of Medicine , Iowa City, Iowa
- Veterans Affairs Medical Center , Iowa City, Iowa
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28
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Zepeda-Orozco D, Wen HM, Hamilton BA, Raikwar NS, Thomas CP. EGF regulation of proximal tubule cell proliferation and VEGF-A secretion. Physiol Rep 2017; 5:5/18/e13453. [PMID: 28963126 PMCID: PMC5617933 DOI: 10.14814/phy2.13453] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 07/31/2017] [Accepted: 08/17/2017] [Indexed: 11/24/2022] Open
Abstract
Proximal tubule cell (PTC) proliferation is critical for tubular regeneration and recovery from acute kidney injury. Epidermal growth factor (EGF) and vascular endothelial growth factor (VEGF‐A) are important for the maintenance of tubulointerstitial integrity and can stimulate PTC proliferation. We utilized HK‐2 cells, an immortalized human PTC line, to characterize the EGF‐dependent regulation of VEGF‐A secretion and proliferation in PTCs. We demonstrate that EGF stimulates VEGF‐A secretion via the EGF receptor (EGFR) and stimulates cell proliferation via activation of the VEGF receptor, VEGFR‐2. EGFR activation promotes MAPK (ERK1/2) activation and HIF‐1α expression, which are required for basal and EGF‐stimulated VEGF‐A secretion. EGF also stimulates the phosphorylation of P70S6 kinase (P70S6K), the downstream target of mTORC1. Rapamycin decreased basal and EGF stimulated HIF‐1α and enhanced MAPK (ERK1/2) activation, while MAPK (ERK/12) inhibition downregulated HIF‐1α expression and the phosphorylation of p70S6K. EGF stimulation of p70S6K was also independent of p‐AKT. Inhibition of the mTORC1 pathway with rapamycin abolished phosphorylation of p70S6K but had no effect on VEGF‐A secretion, indicating that EGF‐stimulated VEGF‐A secretion did not require mTORC1 pathway activation. We demonstrate evidence of a complex crosstalk between the MAPK/ERK and mTORC1 pathways, wherein MAPK (ERK1/2) activation stimulates p‐P70S6K, while p‐P70S6K activation seems to inhibit MAPK (ERK1/2) in EGF‐treated HK‐2 cells. Our results suggest that EGF stimulates MAPK (ERK1/2) in HK‐2 cells, which in turn increases HIF‐1α expression and VEGF‐A secretion, indicating that VEGF‐A mediates EGF‐stimulated cell proliferation as an autocrine proximal tubular epithelial cell growth factor.
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Affiliation(s)
- Diana Zepeda-Orozco
- Division of Pediatric Nephrology, Stead Family Department of Pediatrics, Dialysis and Transplantation, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Hsiang M Wen
- Division of Pediatric Nephrology, Stead Family Department of Pediatrics, Dialysis and Transplantation, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Bradley A Hamilton
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Nandita S Raikwar
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Christie P Thomas
- Division of Pediatric Nephrology, Stead Family Department of Pediatrics, Dialysis and Transplantation, University of Iowa Carver College of Medicine, Iowa City, Iowa.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.,VA Medical Center, Iowa City, Iowa
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29
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Kalil RS, Smith RJ, Rastogi P, Katz DA, Thomas CP. Late Reoccurrence of Collapsing FSGS After Transplantation of a Living-Related Kidney Bearing APOL 1 Risk Variants Without Disease Evident in Donor Supports the Second Hit Hypothesis. Transplant Direct 2017; 3:e185. [PMID: 28795137 PMCID: PMC5540623 DOI: 10.1097/txd.0000000000000697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/05/2017] [Indexed: 11/26/2022] Open
Affiliation(s)
- Roberto S. Kalil
- 1 Kidney Transplant Program, Iowa City VAMC, Iowa City, IA
- 2 Department of Internal Medicine, Division of Nephrology, Carver College of Medicine, Iowa City, IA
| | - Richard J. Smith
- 2 Department of Internal Medicine, Division of Nephrology, Carver College of Medicine, Iowa City, IA
- 3 The Iowa Institute of Human Genetics, University of Iowa, Iowa City, IA
- 4 Department of Otolaryngology, Carver College of Medicine, Iowa City, IA
| | - Prerna Rastogi
- 5 Department of Pathology, Carver College of Medicine, Iowa City, IA
| | - Daniel A. Katz
- 1 Kidney Transplant Program, Iowa City VAMC, Iowa City, IA
- 6 Department of Surgery, Organ Transplant Center, Carver College of Medicine, Iowa City, IA
| | - Christie P. Thomas
- 1 Kidney Transplant Program, Iowa City VAMC, Iowa City, IA
- 2 Department of Internal Medicine, Division of Nephrology, Carver College of Medicine, Iowa City, IA
- 3 The Iowa Institute of Human Genetics, University of Iowa, Iowa City, IA
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30
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Raikwar NS, Thomas CP. Aldosterone regulates a 5' variant sgk1 transcript via a shared hormone response element in the sgk1 5' regulatory region. Physiol Rep 2017; 5:5/7/e13221. [PMID: 28408636 PMCID: PMC5392512 DOI: 10.14814/phy2.13221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 02/20/2017] [Accepted: 02/21/2017] [Indexed: 11/24/2022] Open
Abstract
We previously identified a 5ʹ variant alternate transcript of Sgk1 (Sgk1_v3) encoding an NH2‐terminal variant Sgk1 isoform, Sgk1_i3 that, like Sgk1, is expressed in the distal convoluted tubule, connecting tubule and collecting duct and can stimulate epithelial Na+ transport (Am J Physiol Renal Physiol 303: F1527–F1533, 2012). We now demonstrate that, similar to Sgk1, aldosterone and glucocorticoids stimulate Sgk1_v3 expression in cell lines from the collecting duct and airway epithelia. In mice, short term aldosterone infusion and maneuvers that increase endogenous aldosterone secretion including dietary Na+ deprivation and K+ loading increases distal nephron Sgk1_v3 expression in vivo. Although Sgk1_v3 has a different 5ʹ proximal regulatory region from Sgk1, the transcription start sites are less than 1000 bp apart. We cloned the 5ʹ regulatory region for Sgk1 and Sgk_v3 upstream of a luciferase gene and by deletion and reporter gene analysis we localized the corticosteroid regulatory region for Sgk1_v3 to a glucocorticoid response element (GRE) that had previously been identified for Sgk1 (Am J Physiol Endo Metab 283: E971–E979, 2002). We tested this element with MR in an MR‐null cell line and demonstrate that aldosterone stimulates Sgk1 and Sgk1_v3 via this GRE. We conclude that corticosteroids stimulate Sgk1 and Sgk1_v3 expression in epithelial cells via activation of a common conserved GRE in the 5ʹ flanking region of Sgk1.
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Affiliation(s)
- Nandita S Raikwar
- Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa
| | - Christie P Thomas
- Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa .,The Graduate Program in Molecular Biology, University of Iowa College of Medicine, Iowa City, Iowa.,The Veterans Affairs Medical Center, Iowa City, Iowa
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31
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Kuppachi S, Holanda D, Eberlein M, Alexiev B, Tyler AJ, Wissel MC, Kleiboeker SB, Thomas CP. An Unexpected Surge in Plasma BKPyV Viral Load Heralds the Development of BKPyV-Associated Metastatic Bladder Cancer in a Lung Transplant Recipient With BKPyV Nephropathy. Am J Transplant 2017; 17:813-818. [PMID: 27647675 DOI: 10.1111/ajt.14057] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 08/19/2016] [Accepted: 09/10/2016] [Indexed: 01/25/2023]
Abstract
We report a lung transplant recipient who developed BK polyoma virus (BKPyV) DNAemia and BKPyV nephropathy. With careful management of his immunosuppression he achieved significant reduction in BKPyV DNAemia and stabilization of his kidney function. He later developed a high-grade bladder cancer and shortly thereafter he experienced a major upsurge in the level of BKPyV DNAemia that coincided with the discovery of hepatic metastasis. Retrospectively, the bladder cancer and the hepatic secondary tumor stained uniformly for SV40 large T antigen, and the BKPyV DNA sequences identified in plasma corresponded to BKPyV DNA within hepatic tissue, indicating that the spike in BKPyV load was likely derived from the circulating tumor cells or cell-free tumor DNA following metastases of a BKV-associated cancer. To the best of our knowledge, this is the first description of a surge in BKPyV load in a patient with controlled BKPyVN that heralded the appearance of a metastatic urothelial malignancy. This report discusses the literature on BKPyV-associated malignancies and the possibility that unexplained increases in BKPyV DNAemia may be a biomarker for metastatic BKPyV-related urothelial cancer.
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Affiliation(s)
- S Kuppachi
- Division of Nephrology, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - D Holanda
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA
| | - M Eberlein
- Division of Pulmonary, Critical Care and Occupational Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - B Alexiev
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - A J Tyler
- Viracor-IBT Laboratories, Lee's Summit, MO
| | - M C Wissel
- Viracor-IBT Laboratories, Lee's Summit, MO
| | | | - C P Thomas
- Division of Nephrology, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.,Division of Internal Medicine, VA Medical Center, Iowa City, IA.,Graduate Program in Molecular and Cellular Biology, University of Iowa Carver College of Medicine, Iowa City, IA
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32
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Zvauya R, Oyebode F, Day EJ, Thomas CP, Jones LA. A comparison of stress levels, coping styles and psychological morbidity between graduate-entry and traditional undergraduate medical students during the first 2 years at a UK medical school. BMC Res Notes 2017; 10:93. [PMID: 28193287 PMCID: PMC5307866 DOI: 10.1186/s13104-017-2395-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 01/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stress levels and psychological morbidity are high among undergraduate medical students (UGs), but there is a lack of research into the psychological health of UK graduate-entry medical students (GEs). GEs are likely to experience different (perhaps more severe) stressors and to cope with stress differently. We compared stress levels, psychological morbidity and coping styles in GE versus UG medical students studying at the same UK medical school in the same academic year. A cross-sectional self-rated questionnaire study of all first- and second-year GE and UG medical students was conducted. Perceived stress, psychological morbidity, recent adverse life events, stress-related personality traits and coping styles were assessed using standard questionnaires. RESULTS 75% GEs and 46% UGs responded to the questionnaire. Both groups reported equally high levels, and similar profiles of, perceived stress and psychological morbidity. Levels of recent adverse life events and stress-related personality traits were similar in both groups. Compared to UGs, GEs were more likely to use active coping (p = 0.02) and positive reframing (p = 0.03), but were also more likely to use substances (alcohol and other drugs; p < 0.001) to help them cope. Unlike UGs, second-year GEs showed less perceived stress (p = 0.007) and psychological morbidity (p = 0.006) than first-year GEs although levels of both were still high. CONCLUSION Our results show that both GE students and their younger UG counterparts on a traditional medical course have similar profiles of stress symptoms. They do, however, cope with stress differently. GEs are more likely to use active problem-focused coping strategies, and they are also more likely to cope by using substances (alcohol or other drugs). GE students need interventions to prevent maladaptive coping styles and encourage adaptive coping that are tailored to their needs. Such interventions should be targeted at first-year students. It is vital that these students develop positive coping skills to benefit them during training and in a future career that is inherently stressful.
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Affiliation(s)
- R Zvauya
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. .,Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
| | - F Oyebode
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - E J Day
- National Addiction Centre, King's College London, London, UK
| | - C P Thomas
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - L A Jones
- Department of Psychological Medicine, University of Worcester, Worcester, UK
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Kuppachi S, Holanda D, Thomas CP. Light Chain Deposition Disease After Kidney Transplantation With Long Graft Survival: Case Report. Transplant Proc 2016; 48:255-8. [PMID: 26915878 DOI: 10.1016/j.transproceed.2015.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 12/07/2015] [Indexed: 11/19/2022]
Abstract
Light Chain Deposition Disease (LCDD) is a monoclonal immunoglobulin deposition disease that commonly affects kidneys among other organs. It leads to end-stage renal disease and has a high disease recurrence rate after kidney transplantation. This has led some authors to advise against transplantation in view of the poor long-term graft and patient outcomes. Recent literature has shown improvement/stabilization of native kidney disease following the use of bortezomib. We present 2 cases of LCDD after transplantation with graft dysfunction. They were both treated with different therapeutic agents to induce remission. Because sustained remission was not achieved they received bortezomib following which they have experienced a prolonged period of stable renal function with no clinically detectable disease. These unique cases highlight the possibility to achieve long-term stable graft function and disease remission after renal transplantation for LCDD.
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Affiliation(s)
- S Kuppachi
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
| | - D Holanda
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - C P Thomas
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA; Department of Internal Medicine, VA Medical Center, Iowa City, Iowa, USA
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Kuppachi S, Kaur D, Holanda DG, Thomas CP. BK polyoma virus infection and renal disease in non-renal solid organ transplantation. Clin Kidney J 2015; 9:310-8. [PMID: 26985385 PMCID: PMC4792618 DOI: 10.1093/ckj/sfv143] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 11/25/2015] [Indexed: 12/12/2022] Open
Abstract
BK virus (BKV) is a non-enveloped DNA virus of the polyomaviridae family that causes an interstitial nephritis in immunosuppressed patients. BKV nephropathy is now a leading cause of chronic kidney disease and early allograft failure following kidney transplantation. It is also known to cause renal disease with a progressive decline in kidney function in non-renal solid organ transplant (NRSOT) recipients, although the disease may not be recognized nor its impact appreciated in this patient population. In this report, we review the existing literature to highlight our current understanding of its incidence in NRSOT populations, the approaches to diagnosis and the potential treatment options.
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Affiliation(s)
- Sarat Kuppachi
- Department of Internal Medicine , University of Iowa, Carver College of Medicine , Iowa City, IA , USA
| | - Deepkamal Kaur
- Department of Internal Medicine , University of Iowa, Carver College of Medicine , Iowa City, IA , USA
| | - Danniele G Holanda
- Department of Pathology , University of Iowa, Carver College of Medicine , Iowa City, IA , USA
| | - Christie P Thomas
- Department of Internal Medicine, University of Iowa, Carver College of Medicine, Iowa City, IA, USA; VA Medical Center, Iowa City, IA, USA
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Warnock DG, Thomas CP, Vujkovac B, Campbell RC, Charrow J, Laney DA, Jackson LL, Wilcox WR, Wanner C. Antiproteinuric therapy and Fabry nephropathy: factors associated with preserved kidney function during agalsidase-beta therapy. J Med Genet 2015; 52:860-6. [PMID: 26490103 PMCID: PMC4717450 DOI: 10.1136/jmedgenet-2015-103471] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 09/25/2015] [Indexed: 12/14/2022]
Abstract
Background Nephropathy is an important feature of classical Fabry disease, which results in alpha-galactosidase A deficiency and cellular globotriaosylceramide accumulation. We report the safety and efficacy of antiproteinuric therapy with ACE inhibitors or angiotensin II receptor blockers (ARBs) in a study of classical Fabry patients receiving recombinant agalsidase-beta therapy. Methods and design The goal was maintenance of urine protein to creatinine ratio (UPCR) <0.5 g/g or a 50% reduction in baseline UPCR for 24 patients at eight study sites. The change in estimated glomerular filtration rate (eGFR) was assessed over 21 months of treatment. Results 18 out of 24 patients achieved the UPCR goal with eGFR slopes that were significantly better than six patients who did not achieve the UPCR goal (−3.6 (−4.8 to −1.1) versus −7.0 (−9.0 to −5.6) mL/min/1.73 m2/year, respectively, p=0.018). Despite achieving the UPCR goal, 67% (12/18 patients) still progressed with an eGFR slope <−2 mL/min/1.73 m2/year. Regression analysis showed that increased age at initiation of agalsidase-beta therapy was significantly associated with worsened kidney outcome. Hypotension and hyperkalaemia occurred in seven and eight patients, respectively, which required modification of antiproteinuric therapy but was not associated with serious adverse events. Conclusions This study documents the effectiveness of agalsidase-beta (1 mg/kg/2 weeks) and antiproteinuric therapy with ACE inhibitors and/or ARB in patients with severe Fabry nephropathy. Patients had preservation of kidney function if agalsidase-beta treatment was initiated at a younger age, and UPCR maintained at or below 0.5 g/g with antiproteinuric therapy. Trial registration number NCT00446862.
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Affiliation(s)
- David G Warnock
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christie P Thomas
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | | | - Ruth C Campbell
- Department of Medicine, Medical University of South Caroline, Charleston, South Carolina, USA
| | - Joel Charrow
- Departments of Pediatrics-Genetics, Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Dawn A Laney
- Department of Human Genetics, Emory University, Atlanta, Georgia, USA
| | - Leslie L Jackson
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - William R Wilcox
- Department of Human Genetics, Emory University, Atlanta, Georgia, USA
| | - Christoph Wanner
- Department of Nephrology, University Klinik Würzburg, Würzburg, Germany
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36
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Thomas CP, Nester CM, Phan AC, Sharma M, Steele AL, Lenert PS. Eculizumab for rescue of thrombotic microangiopathy in PM-Scl antibody-positive autoimmune overlap syndrome. Clin Kidney J 2015; 8:698-701. [PMID: 26613027 PMCID: PMC4655803 DOI: 10.1093/ckj/sfv101] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 09/14/2015] [Indexed: 11/14/2022] Open
Abstract
A 46-year-old female with interstitial lung disease presented with proximal muscle weakness, worsening hypertension, microangiopathic hemolysis, thrombocytopenia and deteriorating renal function. She had no sclerodactyly, but had abnormal capillaroscopy. She tested positive for PM-Scl antibodies, and a renal biopsy showed an acute thrombotic microangiopathy consistent with scleroderma renal crisis (SRC). She failed to respond to corticosteroids, plasmapheresis and renin–angiotensin pathway inhibitors. She recovered quickly with the anti-C5 antibody, eculizumab. She had no genetic abnormalities associated with atypical hemolytic uremic syndrome except a DNA variant of unknown significance in C3. This case suggests that eculizumab may be effective for SRC.
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Affiliation(s)
- Christie P Thomas
- Division of Nephrology, Department of Internal Medicine , Carver College of Medicine, The University of Iowa , Iowa City, IA , USA ; Stead Department of Pediatrics, Carver College of Medicine , The University of Iowa , Iowa City, IA , USA ; The VA Medical Center , Iowa City, IA , USA
| | - Carla M Nester
- Division of Nephrology, Department of Internal Medicine , Carver College of Medicine, The University of Iowa , Iowa City, IA , USA ; Stead Department of Pediatrics, Carver College of Medicine , The University of Iowa , Iowa City, IA , USA
| | - Andrew C Phan
- Division of Immunology, Department of Internal Medicine , Carver College of Medicine, The University of Iowa , Iowa City, IA , USA ; Present address: St Joseph Heritage Group in Orange , Orange, CA , USA
| | - Manisha Sharma
- Division of Immunology, Department of Internal Medicine , Carver College of Medicine, The University of Iowa , Iowa City, IA , USA
| | - Amanda L Steele
- Division of Immunology, Department of Internal Medicine , Carver College of Medicine, The University of Iowa , Iowa City, IA , USA ; Present address: Park Nicollet Rheumatology in Minneapolis , Minneapolis , MN , USA
| | - Petar S Lenert
- Division of Immunology, Department of Internal Medicine , Carver College of Medicine, The University of Iowa , Iowa City, IA , USA
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Gharbi M, Moore LSP, Gilchrist M, Thomas CP, Bamford K, Brannigan ET, Holmes AH. Forecasting carbapenem resistance from antimicrobial consumption surveillance: Lessons learnt from an OXA-48-producing Klebsiella pneumoniae outbreak in a West London renal unit. Int J Antimicrob Agents 2015; 46:150-6. [PMID: 25979640 PMCID: PMC4526541 DOI: 10.1016/j.ijantimicag.2015.03.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 03/12/2015] [Accepted: 03/12/2015] [Indexed: 11/28/2022]
Abstract
This study aimed to forecast the incidence rate of carbapenem resistance and to assess the impact of an antimicrobial stewardship intervention using routine antimicrobial consumption surveillance data. Following an outbreak of OXA-48-producing Klebsiella pneumoniae (January 2008-April 2010) in a renal cohort in London, a forecasting ARIMA model was derived using meropenem consumption data [defined daily dose per 100 occupied bed-days (DDD/100OBD)] from 2005-2014 as a predictor of the incidence rate of OXA-48-producing organisms (number of new cases/year/100,000OBD). Interrupted times series assessed the impact of meropenem consumption restriction as part of the outbreak control. Meropenem consumption at lag -1 year (the preceding year), highly correlated with the incidence of OXA-48-producing organisms (r=0.71; P=0.005), was included as a predictor within the forecasting model. The number of cases/100,000OBD for 2014-2015 was estimated to be 4.96 (95% CI 2.53-7.39). Analysis of meropenem consumption pre- and post-intervention demonstrated an increase of 7.12 DDD/100OBD/year (95% CI 2.97-11.27; P<0.001) in the 4 years preceding the intervention, but a decrease thereafter. The change in slope was -9.11 DDD/100OBD/year (95% CI -13.82 to -4.39). Analysis of alternative antimicrobials showed a significant increase in amikacin consumption post-intervention from 0.54 to 3.41 DDD/100OBD/year (slope +0.72, 95% CI 0.29-1.15; P=0.01). Total antimicrobials significantly decreased from 176.21 to 126.24 DDD/100OBD/year (P=0.05). Surveillance of routinely collected antimicrobial consumption data may provide a key warning indicator to anticipate increased incidence of carbapenem-resistant organisms. Further validation using real-time data is needed.
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Affiliation(s)
- M Gharbi
- The National Centre for Infection Prevention and Management, Imperial College London, Du Cane Road, London W12 ONN, UK.
| | - L S P Moore
- The National Centre for Infection Prevention and Management, Imperial College London, Du Cane Road, London W12 ONN, UK; Imperial College Healthcare NHS Trust, Du Cane Road, London W12 OHS, UK
| | - M Gilchrist
- The National Centre for Infection Prevention and Management, Imperial College London, Du Cane Road, London W12 ONN, UK; Imperial College Healthcare NHS Trust, Du Cane Road, London W12 OHS, UK
| | - C P Thomas
- Imperial College Healthcare NHS Trust, Du Cane Road, London W12 OHS, UK
| | - K Bamford
- The National Centre for Infection Prevention and Management, Imperial College London, Du Cane Road, London W12 ONN, UK; Imperial College Healthcare NHS Trust, Du Cane Road, London W12 OHS, UK
| | - E T Brannigan
- The National Centre for Infection Prevention and Management, Imperial College London, Du Cane Road, London W12 ONN, UK; Imperial College Healthcare NHS Trust, Du Cane Road, London W12 OHS, UK
| | - A H Holmes
- The National Centre for Infection Prevention and Management, Imperial College London, Du Cane Road, London W12 ONN, UK; Imperial College Healthcare NHS Trust, Du Cane Road, London W12 OHS, UK
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Li C, Raikwar NS, Santillan MK, Santillan DA, Thomas CP. Aspirin inhibits expression of sFLT1 from human cytotrophoblasts induced by hypoxia, via cyclo-oxygenase 1. Placenta 2015; 36:446-53. [PMID: 25638730 DOI: 10.1016/j.placenta.2015.01.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 12/29/2014] [Accepted: 01/08/2015] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Elevated circulating soluble FLT1 (sFLT1) levels seen in preeclampsia may play a role in its development. Aspirin is recommended for prevention of preeclampsia. We hypothesized that aspirin may inhibit the production of sFlt1. METHODS Placentas from women with and without preeclampsia were collected. Primary cytotrophoblasts (CTBs) were cultured from normal placentas and treated with aspirin, sc-560, a COX1 inhibitor or celecoxib, a COX2 inhibitor. The expression of sFLT1, FLT1, COX1 and COX2 was studied. The effect of aspirin on sFlt1 expression was also studied in HEK293 cells and in HTR-8/SVNeo cells. RESULTS The expression of sFLT1 was increased in preeclamptic placentas compared to control placentas and the expression and release of sFLT1 increased in CTBs exposed to 2% O2 compared to controls. Aspirin at 3 and 12 mM concentration reduced the expression and release of sFLT1 in CTBs. Aspirin also inhibited sFlt1 expression from HTR-8/SVNeo and HEK293 cells. Sc-560, but not celecoxib, reduced sFLT1 expression and release from CTBs. Aspirin and sc-560 also reduced hypoxia-induced FLT1 mRNA expression and inhibited COX1 mRNA in CTBs. DISCUSSION This study confirms that sFLT1 expression is increased in preeclamptic placentas and in CTBs exposed to hypoxia. Aspirin inhibits the production sFLT1 in CTBs and in HTR-8/SVNeo. Sc-560 recapitulated the effects of aspirin on sFLT1 expression and release in CTBs suggesting that the aspirin effect may be mediated via inhibition of COX1. The study increases our understanding of the mechanisms regulating sFlt1 expression and provides a plausible explanation for the effect of aspirin to prevent preeclampsia.
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Affiliation(s)
- C Li
- Department of Obstetrics and Gynecology, Iowa City, IA, USA
| | - N S Raikwar
- Division of Nephrology, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - M K Santillan
- Department of Obstetrics and Gynecology, Iowa City, IA, USA
| | - D A Santillan
- Department of Obstetrics and Gynecology, Iowa City, IA, USA
| | - C P Thomas
- Department of Obstetrics and Gynecology, Iowa City, IA, USA; Division of Nephrology, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Department of Veterans Affairs Medical Center, Iowa City, IA, USA.
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Tohme FA, Kalil RS, Thomas CP. Conversion to a sirolimus-based regimen is associated with lower incidence of BK viremia in low-risk kidney transplant recipients. Transpl Infect Dis 2015; 17:66-72. [PMID: 25582442 DOI: 10.1111/tid.12347] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 09/16/2014] [Accepted: 11/03/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND BK viral nephropathy is an increasingly recognized cause of early allograft loss in kidney transplantation. This study aimed to determine whether a sirolimus (Sir)-based calcineurin inhibitor-sparing regimen is associated with a lower incidence of BK viremia. METHODS This was a single-center retrospective study. Patients were either on tacrolimus (Tac)-based or on Sir-based immunosuppression. Conversion from Tac to Sir occurred at or after 3 months if patients were <62 years of age, had calculated panel reactive antibodies of <20%, and did not have acute early rejection. RESULTS Incidence of clinically significant BK viremia was 17.9% in the Tac group and 4.3% in the Sir group. Cox regression multivariate analysis showed that male gender (hazard ratio [HR] = 2.87) and switch to Sir (HR = 0.333) impacted the incidence of BK viremia. Kaplan-Meier analysis showed a higher BK-free survival in the Sir group. A trend was seen toward shorter time to resolution of BK viremia and lower peak viremia in the Sir group. Patients on Sir had a higher estimated glomerular filtration rate at each time point; 34% of patients discontinued Sir because of side effects. CONCLUSION Conversion to Sir-based maintenance immunosuppression at or about 3 months after kidney transplantation correlates with a lower incidence of BK viremia.
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Affiliation(s)
- F A Tohme
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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Raikwar NS, Liu KZ, Thomas CP. N-terminal cleavage and release of the ectodomain of Flt1 is mediated via ADAM10 and ADAM 17 and regulated by VEGFR2 and the Flt1 intracellular domain. PLoS One 2014; 9:e112794. [PMID: 25387128 PMCID: PMC4227870 DOI: 10.1371/journal.pone.0112794] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 10/20/2014] [Indexed: 11/25/2022] Open
Abstract
Flt is one of the cell surface VEGF receptors which can be cleaved to release an N-terminal extracellular fragment which, like alternately transcribed soluble Flt1 (sFlt1), can antagonize the effects of VEGF. In HUVEC and in HEK293 cells where Flt1 was expressed, metalloprotease inhibitors reduced Flt1 N-terminal cleavage. Overexpression of ADAM10 and ADAM17 increased cleavage while knockdown of ADAM10 and ADAM17 reduced N-terminal cleavage suggesting that these metalloproteases were responsible for Flt1 cleavage. Protein kinase C (PKC) activation increased the abundance and the cleavage of Flt1 but this did not require any residues within the intracellular portion of Flt1. ALLN, a proteasomal inhibitor, increased the abundance of Flt1 which was additive to the effect of PKC. Removal of the entire cytosolic region of Flt1 appeared to stimulate cleavage of Flt1 and Flt1 was no longer sensitive to ALLN suggesting that the cytosolic region contained a degradation domain. Knock down of c-CBL, a ring finger ubiquitin ligase, in HEK293 cells increased the expression of Flt1 although it did not appear to require a previously published tyrosine residue (1333Y) in the C-terminus of Flt1. Increasing VEGFR2 expression increased VEGF-stimulated sFlt1 expression and progressively reduced the cleavage of Flt1 with Flt1 staying bound to VEGFR2 as a heterodimer. Our results imply that secreted sFlt1 and cleaved Flt1 will tend to have local effects as a VEGF antagonist when released from cells expressing VEGFR2 and more distant effects when released from cells lacking VEGFR2.
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Affiliation(s)
- Nandita S. Raikwar
- Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, IA, United States of America
| | - Kang Z. Liu
- Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, IA, United States of America
| | - Christie P. Thomas
- Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, IA, United States of America
- Department of Pediatrics, University of Iowa College of Medicine, Iowa City, IA, United States of America
- Department of Obstetrics, University of Iowa College of Medicine, Iowa City, IA, United States of America
- Department of Molecular and Cellular Biology, University of Iowa College of Medicine, Iowa City, IA, United States of America
- Veterans Affairs Medical Center, Iowa City, IA, United States of America
- * E-mail:
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Bu F, Maga T, Meyer NC, Wang K, Thomas CP, Nester CM, Smith RJH. Comprehensive genetic analysis of complement and coagulation genes in atypical hemolytic uremic syndrome. J Am Soc Nephrol 2013; 25:55-64. [PMID: 24029428 DOI: 10.1681/asn.2013050453] [Citation(s) in RCA: 159] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Atypical hemolytic uremic syndrome (aHUS) is a thrombotic microangiopathy caused by uncontrolled activation of the alternative pathway of complement at the cell surface level that leads to microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney failure. In approximately one half of affected patients, pathogenic loss-of-function variants in regulators of complement or gain-of-function variants in effectors of complement are identified, clearly implicating complement in aHUS. However, there are strong lines of evidence supporting the presence of additional genetic contributions to this disease. To identify novel aHUS-associated genes, we completed a comprehensive screen of the complement and coagulation pathways in 36 patients with sporadic aHUS using targeted genomic enrichment and massively parallel sequencing. After variant calling, quality control, and hard filtering, we identified 84 reported or novel nonsynonymous variants, 22 of which have been previously associated with disease. Using computational prediction methods, 20 of the remaining 62 variants were predicted to be deleterious. Consistent with published data, nearly one half of these 42 variants (19; 45%) were found in genes implicated in the pathogenesis of aHUS. Several genes in the coagulation pathway were also identified as important in the pathogenesis of aHUS. PLG, in particular, carried more pathogenic variants than any other coagulation gene, including three known plasminogen deficiency mutations and a predicted pathogenic variant. These data suggest that mutation screening in patients with aHUS should be broadened to include genes in the coagulation pathway.
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Raikwar NS, Liu KZ, Thomas CP. Protein kinase C regulates FLT1 abundance and stimulates its cleavage in vascular endothelial cells with the release of a soluble PlGF/VEGF antagonist. Exp Cell Res 2013; 319:2578-87. [PMID: 23911939 DOI: 10.1016/j.yexcr.2013.07.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 06/25/2013] [Accepted: 07/09/2013] [Indexed: 01/18/2023]
Abstract
FLT1 and its soluble form (sFLT1) arise as alternate transcripts from the same gene and sFLT1 can antagonize the effect of vascular endothelial growth factor (VEGF) on its cognate receptors. We investigated the effect of VEGF and protein kinase C (PKC) activation on sFLT1 abundance. We demonstrated that VEGF stimulates sFLT1 and FLT1 mRNA and protein levels in vascular endothelial cells via VEGFR2 and PKC. Using an FLT1 expression vector with N and C-terminal epitope tags, we show that PKC activation increases the cleavage of FLT1 into an N-terminal extracellular fragment and a C-terminal intracellular fragment with the cleavage occurring adjacent to the transmembrane domain. The trafficking and glycosylation inhibitors brefeldin, monensin and tunicamycin substantially reduced cleavage and release of the N-terminal ectodomain of FLT1 and inhibited secretion of the isoforms of sFLT1. The shed FLT1 ectodomain can bind VEGF and PlGF and inhibit VEGF-induced vascular tube formation thus confirming that it is functionally equivalent to the alternately spliced and secreted sFLT1 isoforms.
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Affiliation(s)
- Nandita S Raikwar
- Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, IA, USA
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Xie L, Nester CM, Reed AI, Zhang Y, Smith RJ, Thomas CP. Tailored eculizumab therapy in the management of complement factor H-mediated atypical hemolytic uremic syndrome in an adult kidney transplant recipient: a case report. Transplant Proc 2013. [PMID: 23195022 DOI: 10.1016/j.transproceed.2012.07.141] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Atypical hemolytic uremic syndrome (aHUS) is characterized by thrombocytopenia, microangiopathic hemolytic anemia, and acute kidney injury (AKI) which frequently progresses to end-stage renal disease (ESRD). In 50% of affected patients, mutations in complement regulatory proteins cause inappropriate complement activation with endothelial injury. Complement factor H (CFH) mutations cause 25% of aHUS cases; these patients have an 80% recurrence risk after kidney transplantation. Eculizumab, an anti-C5 antibody, is effective in limiting hemolysis episodes in patients with aHUS, but less is known about preventing recurrence after kidney transplantation. Herein we report the use of prophylactic eculizumab in an adult with aHUS who underwent kidney transplantation. A 31-year-old female presented with aHUS and progressive AKI associated with low complement 3 level leading to ESRD despite plasmapheresis and corticosteroids. She had a heterozygous nonsense mutation in CFH and reduced plasma CFH levels. She was given preoperative plasmapheresis and eculizumab and underwent living unrelated renal transplantation. Postoperatively, eculizumab was dosed to achieve low functional complement 5 levels and low soluble membrane attack complex levels and she has maintained excellent graft function without aHUS recurrence. We propose that eculizumab with titrated dosing should be used in CFH-mediated aHUS patients who are at a high risk of recurrence.
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Affiliation(s)
- L Xie
- Department of Internal Medicine, University of Iowa, Iowa City, IA 52242, USA
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Raikwar NS, Liu KZ, Thomas CP. Post‐translational cleavage of Flt1 occurs very close to transmembrane domain releasing extracellular N‐terminal fragment which binds to PlGF. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.688.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nandita S Raikwar
- Internal MedicineUniversity of Iowa Carver College of MedicineIowa CityIA
| | - Kang Z Liu
- Internal MedicineUniversity of Iowa Carver College of MedicineIowa CityIA
| | - Christie P Thomas
- Internal MedicineUniversity of Iowa Carver College of MedicineIowa CityIA
- VA Medical CenterIowa CityIA
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Tohme FA, Katz DA, Holanda DG, Thomas CP. Quiz page April 2013: recurrent episodes of acute kidney injury in a kidney transplant recipient. Am J Kidney Dis 2013; 61:A22-4. [PMID: 23497770 DOI: 10.1053/j.ajkd.2012.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 12/17/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Fadi A Tohme
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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Raikwar NS, Liu KZ, Thomas CP. A regulated NH2-terminal Sgk1 variant with enhanced function is expressed in the collecting duct. Am J Physiol Renal Physiol 2012; 303:F1527-33. [PMID: 23034940 DOI: 10.1152/ajprenal.00191.2012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Sgk1 is a relatively unstable kinase that regulates epithelial Na(+) transport in the distal nephron of the kidney. We identified a 5' variant alternate transcript of human Sgk1 (Sgk1_v3) that is expressed in the connecting tubule and collecting duct, is regulated by aldosterone and insulin, and is predicted to encode an NH(2)-terminal variant Sgk1 isoform, Sgk1_i3. Sgk1_i3 contains a polybasic motif, KKR, in its NH(2) terminus that regulates ubiquitination and stability of the expressed protein in HEK293 cells. In Fisher rat thyroid, and mpkCCD(c14) cells, Sgk1_i3 had a significantly greater effect on Na(+) transport compared with Sgk1 and its stimulatory effect was dependent on the kinase domain. Sgk1_i3 increased the abundance of cleaved epithelial Na(+) channel (ENaC) subunits at the cell surface, which was inhibited by coexpression of Nedd4-2. Together, the data demonstrate that a renally expressed Sgk1 isoform, Sgk1_i3, shows improved stability, is regulated by insulin and aldosterone, and stimulates ENaC activity when heterologously expressed in collecting duct cells.
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Stewart ZA, Collins TE, Schlueter AJ, Raife TI, Holanda DG, Nair R, Reed AI, Thomas CP. Case report: Eculizumab rescue of severe accelerated antibody-mediated rejection after ABO-incompatible kidney transplant. Transplant Proc 2012. [PMID: 23195021 DOI: 10.1016/j.transproceed.2012.03.053] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
ABO-incompatible (ABOI) living donor kidney transplantation has become a well-accepted practice with standard protocols using perioperative antibody-depleting therapies to lower blood group titers to an acceptable threshold for transplantation. However, a subset of patients will experience accelerated antibody-mediated rejection (AMR) after ABOI kidney transplantation and require aggressive intervention to prevent allograft loss. Here in we report the successful use of terminal complement inhibition with eculizumab to rescue an ABOI kidney allograft with accelerated AMR refractory to salvage splenectomy and daily plasmapheresis. This case emphasizes the fact that, despite close postoperative surveillance and aggressive intervention, graft loss from accelerated AMR after ABOI kidney transplantation remains a very real risk. Eculizumab may offer a graft-saving therapeutic option for isolated cases of severe AMR after ABOI kidney transplantation refractory to standard treatment.
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Affiliation(s)
- Z A Stewart
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
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Raikwar NS, Liu KZ, Thomas CP. VEGFR‐1/FLT‐1 is induced by protein kinase C and its Ectodomain Cleavage is regulated by glycosylation and metalloproteases. FASEB J 2012. [DOI: 10.1096/fasebj.26.1_supplement.750.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nandita S Raikwar
- Department of Internal MedicineUniversity of Iowa College of MedicineIowa CityIA
| | - Kang Z Liu
- Department of Internal MedicineUniversity of Iowa College of MedicineIowa CityIA
| | - Christie P Thomas
- Department of Internal MedicineUniversity of Iowa College of MedicineIowa CityIA
- VA Medical CenterIowa CityIA
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Philibert RA, Sears RA, Powers LS, Nash E, Bair T, Gerke AK, Hassan I, Thomas CP, Gross TJ, Monick MM. Coordinated DNA methylation and gene expression changes in smoker alveolar macrophages: specific effects on VEGF receptor 1 expression. J Leukoc Biol 2012; 92:621-31. [PMID: 22427682 DOI: 10.1189/jlb.1211632] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Cigarette smoking is implicated in numerous diseases, including emphysema and lung cancer. The clinical expression of lung disease in smokers is not well explained by currently defined variations in gene expression or simple differences in smoking exposure. Alveolar macrophages play a critical role in the inflammation and remodeling of the lung parenchyma in smoking-related lung disease. Significant gene expression changes in alveolar macrophages from smokers have been identified. However, the mechanism for these changes remains unknown. One potential mechanism for smoking-altered gene expression is via changes in cytosine methylation in DNA regions proximal to gene-coding sequences. In this study, alveolar macrophage DNA from heavy smokers and never smokers was isolated and methylation status at 25,000 loci determined. We found differential methylation in genes from immune-system and inflammatory pathways. Analysis of matching gene expression data demonstrated a parallel enrichment for changes in immune-system and inflammatory pathways. A significant number of genes with smoking-altered mRNA expression had inverse changes in methylation status. One gene highlighted by this data was the FLT1, and further studies found particular up-regulation of a splice variant encoding a soluble inhibitory form of the receptor. In conclusion, chronic cigarette smoke exposure altered DNA methylation in specific gene promoter regions in human alveolar macrophages.
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Bhatt AP, Neppalli VT, Kelley EA, Schlueter AJ, Thomas CP. Dextran Removal by Plasmapheresis in a Kidney-Pancreas Transplant Recipient With Dextran 40–Induced Osmotic Nephrosis. Am J Kidney Dis 2011; 57:621-3. [DOI: 10.1053/j.ajkd.2010.10.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 10/08/2010] [Indexed: 11/11/2022]
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