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Chen T, Cao Q, Wang R, Zheng G, Azmi F, Lee VW, Wang YM, Li H, Yu D, Rogers NM, Alexander SI, Harris DCH, Wang Y. Attenuation of renal injury by depleting cDC1 and by repurposing Flt3 inhibitor in anti-GBM disease. Clin Immunol 2023; 250:109295. [PMID: 36933629 DOI: 10.1016/j.clim.2023.109295] [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: 11/20/2022] [Accepted: 03/15/2023] [Indexed: 03/18/2023]
Abstract
Previous studies found cDC1s to be protective in early stage anti-GBM disease through Tregs, but pathogenic in late stage Adriamycin nephropathy through CD8+ T cells. Flt3 ligand is a growth factor essential for cDC1 development and Flt3 inhibitors are currently used for cancer treatment. We conducted this study to clarify the role and mechanisms of effects of cDC1s at different time points in anti-GBM disease. In addition, we aimed to utilize drug repurposing of Flt3 inhibitors to target cDC1s as a treatment of anti-GBM disease. We found that in human anti-GBM disease, the number of cDC1s increased significantly, proportionally more than cDC2s. The number of CD8+ T cells also increased significantly and their number correlated with cDC1 number. In XCR1-DTR mice, late (day 12-21) but not early (day 3-12) depletion of cDC1s attenuated kidney injury in mice with anti-GBM disease. cDC1s separated from kidneys of anti-GBM disease mice were found to have a pro-inflammatory phenotype (i.e. express high level of IL-6 and IL-12) in late but not early stage. In the late depletion model, the number of CD8+ T cells was also reduced, but not Tregs. CD8+ T cells separated from kidneys of anti-GBM disease mice expressed high levels of cytotoxic molecules (granzyme B and perforin) and inflammatory cytokines (TNF-α and IFN-γ), and their expression reduced significantly after cDC1 depletion with diphtheria toxin. These findings were reproduced using a Flt3 inhibitor in wild type mice. Therefore, cDC1s are pathogenic in anti-GBM disease through activation of CD8+ T cells. Flt3 inhibition successfully attenuated kidney injury through depletion of cDC1s. Repurposing Flt3 inhibitors has potential as a novel therapeutic strategy for anti-GBM disease.
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Affiliation(s)
- Titi Chen
- The University of Sydney, Camperdown, NSW 2006, Australia; The Westmead Institute for Medical Research, Hawkesbury Road, Westmead, NSW 2145, Australia; Department of Renal Medicine, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia.
| | - Qi Cao
- The University of Sydney, Camperdown, NSW 2006, Australia; The Westmead Institute for Medical Research, Hawkesbury Road, Westmead, NSW 2145, Australia
| | - Ruifeng Wang
- The University of Sydney, Camperdown, NSW 2006, Australia; The Westmead Institute for Medical Research, Hawkesbury Road, Westmead, NSW 2145, Australia; Department of Nephrology, The Second Hospital of Anhui Medical University, Anhui 230000, China
| | - Guoping Zheng
- The University of Sydney, Camperdown, NSW 2006, Australia; The Westmead Institute for Medical Research, Hawkesbury Road, Westmead, NSW 2145, Australia
| | - Farhana Azmi
- The University of Sydney, Camperdown, NSW 2006, Australia; The Westmead Institute for Medical Research, Hawkesbury Road, Westmead, NSW 2145, Australia
| | - Vincent W Lee
- The University of Sydney, Camperdown, NSW 2006, Australia; The Westmead Institute for Medical Research, Hawkesbury Road, Westmead, NSW 2145, Australia; Department of Renal Medicine, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia
| | - Yuan Ming Wang
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW 2145, Australia
| | - Hongqi Li
- The University of Sydney, Camperdown, NSW 2006, Australia; The Westmead Institute for Medical Research, Hawkesbury Road, Westmead, NSW 2145, Australia; The Department of Gerontology, Anhui Provincial Hospital, the first affiliated Hospital of University of Science and Technology of China, Hefei 230001, China
| | - Di Yu
- Faculty of Medicine, The University of Queensland Diamantina Institute, St Lucia, QLD 4072, Australia
| | - Natasha M Rogers
- The University of Sydney, Camperdown, NSW 2006, Australia; The Westmead Institute for Medical Research, Hawkesbury Road, Westmead, NSW 2145, Australia; Department of Renal Medicine, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia
| | - Stephen I Alexander
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW 2145, Australia
| | - David C H Harris
- The University of Sydney, Camperdown, NSW 2006, Australia; The Westmead Institute for Medical Research, Hawkesbury Road, Westmead, NSW 2145, Australia; Department of Renal Medicine, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia
| | - Yiping Wang
- The University of Sydney, Camperdown, NSW 2006, Australia; The Westmead Institute for Medical Research, Hawkesbury Road, Westmead, NSW 2145, Australia
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Chung EYM, Wang YM, Keung K, Hu M, McCarthy H, Wong G, Kairaitis L, Bose B, Harris DCH, Alexander SI. Membranous nephropathy: Clearer pathology and mechanisms identify potential strategies for treatment. Front Immunol 2022; 13:1036249. [PMID: 36405681 PMCID: PMC9667740 DOI: 10.3389/fimmu.2022.1036249] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 09/04/2022] [Accepted: 10/19/2022] [Indexed: 11/07/2022] Open
Abstract
Primary membranous nephropathy (PMN) is one of the common causes of adult-onset nephrotic syndrome and is characterized by autoantibodies against podocyte antigens causing in situ immune complex deposition. Much of our understanding of the disease mechanisms underpinning this kidney-limited autoimmune disease originally came from studies of Heymann nephritis, a rat model of PMN, where autoantibodies against megalin produced a similar disease phenotype though megalin is not implicated in human disease. In PMN, the major target antigen was identified to be M-type phospholipase A2 receptor 1 (PLA2R) in 2009. Further utilization of mass spectrometry on immunoprecipitated glomerular extracts and laser micro dissected glomeruli has allowed the rapid discovery of other antigens (thrombospondin type-1 domain-containing protein 7A, neural epidermal growth factor-like 1 protein, semaphorin 3B, protocadherin 7, high temperature requirement A serine peptidase 1, netrin G1) targeted by autoantibodies in PMN. Despite these major advances in our understanding of the pathophysiology of PMN, treatments remain non-specific, often ineffective, or toxic. In this review, we summarize our current understanding of the immune mechanisms driving PMN from animal models and clinical studies, and the implications on the development of future targeted therapeutic strategies.
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Affiliation(s)
- Edmund Y. M. Chung
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, NSW, Australia
- *Correspondence: Edmund Y. M. Chung,
| | - Yuan M. Wang
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, NSW, Australia
| | - Karen Keung
- Department of Nephrology, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Min Hu
- The Centre for Transplant and Renal Research, Westmead Institute of Medical Research, Westmead, NSW, Australia
| | - Hugh McCarthy
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, NSW, Australia
- Department of Nephrology, The Children’s Hospital at Westmead, Westmead, NSW, Australia
- Department of Nephrology, Sydney Children’s Hospital, Randwick, NSW, Australia
| | - Germaine Wong
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, NSW, Australia
- Department of Nephrology, Westmead Hospital, Westmead, NSW, Australia
| | - Lukas Kairaitis
- Department of Nephrology, Blacktown Hospital, Blacktown, NSW, Australia
| | - Bhadran Bose
- Department of Nephrology, Nepean Hospital, Kingswood, NSW, Australia
| | - David C. H. Harris
- The Centre for Transplant and Renal Research, Westmead Institute of Medical Research, Westmead, NSW, Australia
- Department of Nephrology, Westmead Hospital, Westmead, NSW, Australia
| | - Stephen I. Alexander
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, NSW, Australia
- Department of Nephrology, The Children’s Hospital at Westmead, Westmead, NSW, Australia
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3
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Wang R, Zhang J, Li D, Liu G, Fu Y, Li Q, Zhang L, Qian L, Hao L, Wang Y, Harris DCH, Wang D, Cao Q. Imbalance of circulating innate lymphoid cell subpopulations in patients with chronic kidney disease. Clin Immunol 2022; 239:109029. [PMID: 35525476 DOI: 10.1016/j.clim.2022.109029] [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: 07/22/2021] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 11/19/2022]
Abstract
Innate lymphoid cells (ILCs) are a newly identified heterogeneous family of innate immune cells. We conducted this study to investigate the frequency of circulating ILC subsets in various chronic kidney diseases (CKD). In DN, the proportion of total ILCs and certain ILC subgroups increased significantly. Positive correlations between proportion of total ILCs, ILC1s and body mass index, glycated hemoglobin were observed in DN. In LN, a significantly increased proportion of ILC1s was found in parallel with a reduced proportion of ILC2s. The proportions of total ILCs and ILC1s were correlated with WBC count and the level of C3. In all enrolled patients, the proportion of total ILCs and ILC1s was significantly correlated with the levels of ACR and GFR. In the present study, the proportion of circulating ILC subsets increased significantly in various types of CKD and correlated with clinico-pathological features, which suggests a possible role for ILCs in CKD.
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Affiliation(s)
- Ruifeng Wang
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia; Department of Nephrology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jingjing Zhang
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Dandan Li
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Guiling Liu
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yuqin Fu
- Department of Nephrology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qing Li
- The Central Laboratory of Medical Research Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Lei Zhang
- Department of Rheumatology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Long Qian
- Department of Rheumatology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Li Hao
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yiping Wang
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - David C H Harris
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Deguang Wang
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.
| | - Qi Cao
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia.
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Wang YM, Shaw K, Zhang GY, Chung EYM, Hu M, Cao Q, Wang Y, Zheng G, Wu H, Chadban SJ, McCarthy HJ, Harris DCH, Mackay F, Grey ST, Alexander SI. Interleukin-33 Exacerbates IgA Glomerulonephritis in Transgenic Mice Overexpressing B Cell Activating Factor. J Am Soc Nephrol 2022; 33:966-984. [PMID: 35387873 PMCID: PMC9063894 DOI: 10.1681/asn.2021081145] [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: 08/27/2021] [Accepted: 02/06/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The cytokine IL-33 is an activator of innate lymphoid cells 2 (ILC2s) in innate immunity and allergic inflammation. B cell activating factor (BAFF) plays a central role in B cell proliferation and differentiation, and high levels of this protein cause excess antibody production, including IgA. BAFF-transgenic mice overexpress BAFF and spontaneously develop glomerulonephritis that resembles human IgA nephropathy. METHODS We administered IL-33 or PBS to wild-type and BAFF-transgenic mice. After treating Rag1-deficient mice with IL-33, with or without anti-CD90.2 to preferentially deplete ILC2s, we isolated splenocytes, which were adoptively transferred into BAFF-transgenic mice. RESULTS BAFF-transgenic mice treated with IL-33 developed more severe kidney dysfunction and proteinuria, glomerular sclerosis, tubulointerstitial damage, and glomerular deposition of IgA and C3. Compared with wild-type mice, BAFF-transgenic mice exhibited increases of CD19+ B cells in spleen and kidney and ILC2s in kidney and intestine, which were further increased by administration of IL-33. Administering IL-33 to wild-type mice had no effect on kidney function or histology, nor did it alter the number of ILC2s in spleen, kidney, or intestine. To understand the role of ILC2s, splenocytes were transferred from IL-33-treated Rag1-deficient mice into BAFF-transgenic mice. Glomerulonephritis and IgA deposition were exacerbated by transfer of IL-33-stimulated Rag1-deficient splenocytes, but not by ILC2 (anti-CD90.2)-depleted splenocytes. Wild-type mice infused with IL-33-treated Rag1-deficient splenocytes showed no change in kidney function or ILC2 numbers or distribution. CONCLUSIONS IL-33-expanded ILC2s exacerbated IgA glomerulonephritis in a mouse model. These findings indicate that IL-33 and ILC2s warrant evaluation as possible mediators of human IgA nephropathy.
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Affiliation(s)
- Yuan Min Wang
- Centre for Kidney Research, The Children's Hospital at Westmead, The University of Sydney, Westmead, New South Wales, Australia
| | - Karli Shaw
- Centre for Kidney Research, The Children's Hospital at Westmead, The University of Sydney, Westmead, New South Wales, Australia
| | - Geoff Yu Zhang
- Centre for Kidney Research, The Children's Hospital at Westmead, The University of Sydney, Westmead, New South Wales, Australia
| | - Edmund Y M Chung
- Centre for Kidney Research, The Children's Hospital at Westmead, The University of Sydney, Westmead, New South Wales, Australia
| | - Min Hu
- Centre for Transplantation and Renal Research, University of Sydney at Westmead Millennium Institute, Westmead, New South Wales, Australia
| | - Qi Cao
- Centre for Transplantation and Renal Research, University of Sydney at Westmead Millennium Institute, Westmead, New South Wales, Australia
| | - Yiping Wang
- Centre for Transplantation and Renal Research, University of Sydney at Westmead Millennium Institute, Westmead, New South Wales, Australia
| | - Guoping Zheng
- Centre for Transplantation and Renal Research, University of Sydney at Westmead Millennium Institute, Westmead, New South Wales, Australia
| | - Huiling Wu
- Kidney Node Laboratory, The Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia.,Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Steven J Chadban
- Kidney Node Laboratory, The Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia.,Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Hugh J McCarthy
- Centre for Kidney Research, The Children's Hospital at Westmead, The University of Sydney, Westmead, New South Wales, Australia
| | - David C H Harris
- Centre for Transplantation and Renal Research, University of Sydney at Westmead Millennium Institute, Westmead, New South Wales, Australia
| | - Fabienne Mackay
- QIMR, University of Queensland, Brisbane, Queensland, Australia
| | - Shane T Grey
- Transplantation Immunology Group, Garvan Institute of Medical Research, Sydney, Australia
| | - Stephen I Alexander
- Centre for Kidney Research, The Children's Hospital at Westmead, The University of Sydney, Westmead, New South Wales, Australia
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Rangan GK, Wong ATY, Munt A, Zhang JQJ, Saravanabavan S, Louw S, Allman-Farinelli M, Badve SV, Boudville N, Chan J, Coolican H, Coulshed S, Edwards ME, Erickson BJ, Fernando M, Foster S, Gregory AV, Haloob I, Hawley CM, Holt J, Howard K, Howell M, Johnson DW, Kline TL, Kumar K, Lee VW, Lonergan M, Mai J, McCloud P, Pascoe E, Peduto A, Rangan A, Roger SD, Sherfan J, Sud K, Torres VE, Vilayur E, Harris DCH. Prescribed Water Intake in Autosomal Dominant Polycystic Kidney Disease. NEJM Evid 2022; 1:EVIDoa2100021. [PMID: 38319283 DOI: 10.1056/evidoa2100021] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Prescribed Water Intake in Autosomal Dominant Polycystic Kidney Disease The effect of increased water intake on kidney cyst growth in patients with polycystic kidney disease was compared for two groups randomly assigned to either prescribed or ad libitum water intake. Over 3 years, there was no difference in height-corrected total kidney volume between the groups.
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Affiliation(s)
- Gopala K Rangan
- Michael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, The University of Sydney, Westmead, New South Wales, Australia
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Westmead, New South Wales, Australia
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Annette T Y Wong
- Michael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, The University of Sydney, Westmead, New South Wales, Australia
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Westmead, New South Wales, Australia
| | - Alexandra Munt
- Michael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, The University of Sydney, Westmead, New South Wales, Australia
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Westmead, New South Wales, Australia
| | - Jennifer Q J Zhang
- Michael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, The University of Sydney, Westmead, New South Wales, Australia
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Westmead, New South Wales, Australia
| | - Sayanthooran Saravanabavan
- Michael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, The University of Sydney, Westmead, New South Wales, Australia
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Westmead, New South Wales, Australia
| | - Sandra Louw
- McCloud Consulting Group, Belrose, New South Wales, Australia
| | | | - Sunil V Badve
- Department of Renal Medicine, St. George Hospital, Kogarah, New South Wales, Australia
- The George Institute for Global Health, University of New South Wales, Sydney
| | - Neil Boudville
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Jessie Chan
- McCloud Consulting Group, Belrose, New South Wales, Australia
| | | | - Susan Coulshed
- North Shore Nephrology, Crows Nest, New South Wales, Australia
| | - Marie E Edwards
- Translational Polycystic Kidney Disease Center, Mayo Clinic, Rochester, MN
| | - Bradley J Erickson
- Translational Polycystic Kidney Disease Center, Mayo Clinic, Rochester, MN
| | - Mangalee Fernando
- Department of Renal Medicine, Prince of Wales Hospital, Eastern Sydney Health District Randwick, New South Wales, Australia
| | - Sheryl Foster
- Department of Radiology, Westmead Hospital, Western Sydney Local Health District, Westmead, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney
| | - Adriana V Gregory
- Translational Polycystic Kidney Disease Center, Mayo Clinic, Rochester, MN
| | - Imad Haloob
- Department of Renal Medicine, Bathurst Hospital, Bathurst, New South Wales, Australia
| | - Carmel M Hawley
- Australasian Kidney Trials Network, University of Queensland at Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Faculty of Medicine, Princess Alexandra Hospital Southside Clinical Unit, Brisbane, Queensland, Australia
| | - Jane Holt
- Department of Renal Medicine, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Kirsten Howard
- School of Public Health, The University of Sydney, Sydney
| | - Martin Howell
- School of Public Health, The University of Sydney, Sydney
| | - David W Johnson
- Australasian Kidney Trials Network, University of Queensland at Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Faculty of Medicine, Princess Alexandra Hospital Southside Clinical Unit, Brisbane, Queensland, Australia
| | - Timothy L Kline
- Translational Polycystic Kidney Disease Center, Mayo Clinic, Rochester, MN
| | - Karthik Kumar
- Gosford Nephrology, Gosford, New South Wales, Australia
| | - Vincent W Lee
- Michael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, The University of Sydney, Westmead, New South Wales, Australia
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Westmead, New South Wales, Australia
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney
- Department of Renal Medicine, Norwest Private Hospital, Bella Vista, New South Wales, Australia
| | - Maureen Lonergan
- Department of Renal Medicine, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Jun Mai
- Department of Renal Medicine, Liverpool Hospital, Southwestern Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Philip McCloud
- McCloud Consulting Group, Belrose, New South Wales, Australia
| | - Elaine Pascoe
- Australasian Kidney Trials Network, University of Queensland at Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Anthony Peduto
- Department of Radiology, Westmead Hospital, Western Sydney Local Health District, Westmead, New South Wales, Australia
| | - Anna Rangan
- Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Sydney
| | | | - Julie Sherfan
- Chemical Pathology Department, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney
| | - Kamal Sud
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Westmead, New South Wales, Australia
- Department of Renal Medicine, Nepean Hospital, Nepean Blue Mountains Local Health District, Sydney
- Nepean Clinical School, The University of Sydney Medical School, Kingswood, New South Wales, Australia
| | - Vicente E Torres
- Translational Polycystic Kidney Disease Center, Mayo Clinic, Rochester, MN
| | - Eswari Vilayur
- Department of Nephrology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - David C H Harris
- Michael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, The University of Sydney, Westmead, New South Wales, Australia
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Westmead, New South Wales, Australia
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
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Zheng G, Harris DCH. Editorial: TGF-β in Human Disease: Friend or Foe? Front Cell Dev Biol 2021; 9:739172. [PMID: 34660597 PMCID: PMC8514017 DOI: 10.3389/fcell.2021.739172] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/08/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Guoping Zheng
- Westmead Institute for Medical Research, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - David C H Harris
- Westmead Institute for Medical Research, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Westmead Hospital, Westmead, NSW, Australia
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7
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Dansie KB, Davies CE, Morton RL, Hawley CM, Johnson DW, Craig JC, Chapman JR, Cooper BA, Pollock CA, Harris DCH, McDonald SP. The IDEAL trial in Australia and New Zealand: Clinical and Economic impact. Nephrol Dial Transplant 2021; 37:168-174. [PMID: 34581810 DOI: 10.1093/ndt/gfab270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/05/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The impact of research findings on clinical practice usually remains uncertain and unmeasured. To address this problem, we examined the long term clinical and economic impact of the Initiating Dialysis Early and Late (IDEAL) study, using data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. METHODS We performed a registry-based study including all incident adult dialysis patients in Australia and New Zealand from July 2000-June 2018. A piecewise-linear regression model was used to examine differences in mean estimated Glomerular Filtration Rate (eGFR) at dialysis commencement for the years prior (2000-2010) and following (2010-2018) publication of the IDEAL results. The Return on Investment (ROI) was calculated using the total cost of performing the IDEAL study and the cost or savings accruing in Australia and New Zealand from change in dialysis initiation practice. RESULTS From July 2000-June 2010, mean eGFR at dialysis commencement increased at a rate of 0.21 mL/min/1.73m2 per year (95% CI 0.19 to 0.23). After IDEAL results were published, mean eGFR at dialysis commencement did not show any temporal change (-0.01 mL/min/1.73m2 per year, 95% CI -0.03 to 0.01). The ROI of the IDEAL study was AUD $35.70 per AUD $1 spent, an estimated saving to Australian and New Zealand health systems of up to AUD $84M per year. CONCLUSIONS The previous trend to higher eGFR at dialysis commencement changed following publication of IDEAL results to a steady eGFR which has continued for a decade, avoiding unnecessary dialysis treatments and accruing savings to Australian and New Zealand health systems.
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Affiliation(s)
- Kathryn B Dansie
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute, South Australia, Australia
| | - Christopher E Davies
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute, South Australia, Australia.,Adelaide Medical School, University of Adelaide, South Australia, Australia
| | - Rachael L Morton
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, New South Wales, Australia
| | - Carmel M Hawley
- Department of Nephrology, Princess Alexandra Hospital, Queensland, Australia.,Australasian Kidney Trials Network, University of Queensland, Queensland, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Queensland, Australia.,Australasian Kidney Trials Network, University of Queensland, Queensland, Australia.,Translational Research Institute, Brisbane, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - Jeremy R Chapman
- Westmead Clinical School, The Westmead Institute for Medical Research, New South Wales, Australia
| | - Bruce A Cooper
- Department of Renal Medicine, Royal North Shore Hospital, New South Wales, Australia
| | - Carol A Pollock
- Northern Clinical School, Kolling Institute of Medical Research, New South Wales, Australia
| | - David C H Harris
- Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, New South Wales
| | - Stephen P McDonald
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute, South Australia, Australia.,Adelaide Medical School, University of Adelaide, South Australia, Australia.,Royal Adelaide Hospital, South Australia, Australia
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8
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Abstract
The phenotypic heterogeneity and functional diversity of macrophages confer on them complexed roles in the development and progression of kidney diseases. After kidney injury, bone marrow-derived monocytes are rapidly recruited to the glomerulus and tubulointerstitium. They are activated and differentiated on site into pro-inflammatory M1 macrophages, which initiate Th1-type adaptive immune responses and damage normal tissues. In contrast, anti-inflammatory M2 macrophages induce Th2-type immune responses, secrete large amounts of TGF-β and anti-inflammatory cytokines, transform into αSMA+ myofibroblasts in injured kidney, inhibit immune responses, and promote wound healing and tissue fibrosis. Previous studies on the role of macrophages in kidney fibrosis were mainly focused on inflammation-associated injury and injury repair. Apart from macrophage-secreted profibrotic cytokines, such as TGF-β, evidence for a direct contribution of macrophages to kidney fibrosis is lacking. However, under inflammatory conditions, Wnt ligands are derived mainly from macrophages and Wnt signaling is central in the network of multiple profibrotic pathways. Largely underinvestigated are the direct contribution of macrophages to profibrotic signaling pathways, macrophage phenotypic heterogeneity and functional diversity in relation to kidney fibrosis, and on their cross-talk with other cells in profibrotic signaling networks that cause fibrosis. Here we aim to provide an overview on the roles of macrophage phenotypic and functional diversity in their contribution to pro-fibrotic signaling pathways, and on the therapeutic potential of targeting macrophages for the treatment of kidney fibrosis.
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Affiliation(s)
- Xiaoling Wang
- Shanxi Key Laboratory of Birth Defect and Cell Regeneration, Shanxi Medical University, Taiyuan, China
- Clinical Laboratory, Shanxi Academy of Traditional Chinese Medicine, Taiyuan, China
| | - Jianwei Chen
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Jun Xu
- Department of General Surgery, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jun Xie
- Shanxi Key Laboratory of Birth Defect and Cell Regeneration, Shanxi Medical University, Taiyuan, China
| | - David C. H. Harris
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Guoping Zheng
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
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9
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Luyckx VA, Harris DCH, Varghese C, Jha V. Bringing equity in access to quality dialysis. Lancet 2021; 398:10-11. [PMID: 33865498 DOI: 10.1016/s0140-6736(21)00732-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Valerie A Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - David C H Harris
- Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
| | | | - Vivekanand Jha
- The George Institute for Global Health, New Delhi, India; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; School of Public Health, Imperial College London, London, UK; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India.
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10
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Hole BD, Evans KM, Pyart R, Davids MR, Bedat CG, Hanafusa N, Harris DCH, Jager KJ, Jha V, Johansen KL, McDonald S, Masakane I, Rosa-Diez G, Saran R, Wetmore JB, Caskey FJ. International collaborative efforts to establish kidney health surveillance systems. Kidney Int 2021; 98:812-816. [PMID: 32998808 PMCID: PMC7526596 DOI: 10.1016/j.kint.2020.06.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/08/2020] [Accepted: 06/16/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Barnaby D Hole
- UK Renal Registry, Renal Association, Bristol, UK; Population Health Sciences, University of Bristol, Bristol, UK; Department of Renal Medicine, North Bristol NHS Trust, Bristol, UK
| | | | - Rhodri Pyart
- UK Renal Registry, Renal Association, Bristol, UK
| | - M Razeen Davids
- Division of Nephrology, Stellenbosch University, Cape Town, South Africa; Division of Nephrology, Tygerberg Hospital, Cape Town, South Africa; South African Renal Registry, Cape Town, South Africa; African Renal Registry, Cape Town, South Africa
| | | | - Norio Hanafusa
- Department of Blood Purification, Tokyo Women's Medical University, Tokyo, Japan; Japanese Society for Dialysis Therapy Renal Data Registry (JRDR), Tokyo, Japan
| | - David C H Harris
- The Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia; Western Sydney Renal Service, Westmead Hospital, Sydney, New South Wales, Australia
| | - Kitty J Jager
- European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry, Amsterdam University Medical Centers, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India; George Institute for Global Health, University of Oxford, Oxford, UK; Manipal Academy of Higher Education, Manipal, India
| | - Kirsten L Johansen
- Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA; Division of Nephrology, Hennepin County Medical Center, Minneapolis, Minnesota, USA; United States Renal Data System, Minneapolis, Minnesota, USA
| | - Stephen McDonald
- Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australia Health and Medical Research Institute, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia; Renal Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Ikuto Masakane
- Japanese Society for Dialysis Therapy Renal Data Registry (JRDR), Tokyo, Japan; Global Chronic Kidney Disease (CKD) Management Division, Yabuki Hospital, Yamagata, Japan
| | - Guillermo Rosa-Diez
- Latin American Dialysis & Renal Transplantation Registry, SLANH, Montevideo, Uruguay; Division of Nephrology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Rajiv Saran
- Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, Michigan, USA
| | - James B Wetmore
- Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA; Division of Nephrology, Hennepin County Medical Center, Minneapolis, Minnesota, USA; United States Renal Data System, Minneapolis, Minnesota, USA
| | - Fergus J Caskey
- Population Health Sciences, University of Bristol, Bristol, UK; Department of Renal Medicine, North Bristol NHS Trust, Bristol, UK.
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11
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Chen T, Cao Q, Wang R, Zheng G, Azmi F, Wang J, Lee VW, Wang YM, Yu H, Patel M, P'ng CH, Alexander SI, Rogers NM, Wang Y, Harris DCH. Conventional Type 1 Dendritic Cells (cDC1) in Human Kidney Diseases: Clinico-Pathological Correlations. Front Immunol 2021; 12:635212. [PMID: 34054804 PMCID: PMC8149958 DOI: 10.3389/fimmu.2021.635212] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background cDC1 is a subset of conventional DCs, whose most recognized function is cross-presentation to CD8+ T cells. We conducted this study to investigate the number and location of cDC1s in various human kidney diseases as well as their correlation with clinico-pathological features and CD8+ T cells. Methods We analyzed 135 kidney biopsies samples. Kidney diseases included: acute tubular necrosis (ATN), acute interstitial nephritis (AIN), proliferative glomerulonephritis (GN) (IgA nephropathy, lupus nephritis, pauci-immune GN, anti-GBM disease), non-proliferative GN (minimal change disease, membranous nephropathy) and diabetic nephropathy. Indirect immunofluorescence staining was used to quantify cDC1s, CD1c+ DCs, and CD8+ T cells. Results cDC1s were rarely present in normal kidneys. Their number increased significantly in ATN and proliferative GN, proportionally much more than CD1c+ DCs. cDC1s were mainly found in the interstitium, except in lupus nephritis, pauci-immune GN and anti-GBM disease, where they were prominent in glomeruli and peri-glomerular regions. The number of cDC1s correlated with disease severity in ATN, number of crescents in pauci-immune GN, interstitial fibrosis in IgA nephropathy and lupus nephritis, as well as prognosis in IgA nephropathy. The number of CD8+ T cells also increased significantly in these conditions and cDC1 number correlated with CD8+ T cell number in lupus nephritis and pauci-immune GN, with many of them closely co-localized. Conclusions cDC1 number correlated with various clinic-pathological features and prognosis reflecting a possible role in these conditions. Their association with CD8+ T cells suggests a combined mechanism in keeping with the results in animal models.
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Affiliation(s)
- Titi Chen
- School of Medicine, The University of Sydney, Camperdown, NSW, Australia.,Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia.,Department of Renal Medicine, Westmead Hospital, Westmead, NSW, Australia
| | - Qi Cao
- School of Medicine, The University of Sydney, Camperdown, NSW, Australia.,Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Ruifeng Wang
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Guoping Zheng
- School of Medicine, The University of Sydney, Camperdown, NSW, Australia.,Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Farhana Azmi
- School of Medicine, The University of Sydney, Camperdown, NSW, Australia.,Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Jeffery Wang
- School of Medicine, The University of Sydney, Camperdown, NSW, Australia.,Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Vincent W Lee
- School of Medicine, The University of Sydney, Camperdown, NSW, Australia.,Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia.,Department of Renal Medicine, Westmead Hospital, Westmead, NSW, Australia
| | - Yuan Min Wang
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Hong Yu
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Manish Patel
- School of Medicine, The University of Sydney, Camperdown, NSW, Australia.,Department of Urology, Westmead Hospital, Westmead, NSW, Australia
| | - Chow Heok P'ng
- Department of Anatomical Pathology, Westmead Hospital, Westmead, NSW, Australia
| | - Stephen I Alexander
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Natasha M Rogers
- School of Medicine, The University of Sydney, Camperdown, NSW, Australia.,Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia.,Department of Renal Medicine, Westmead Hospital, Westmead, NSW, Australia
| | - Yiping Wang
- School of Medicine, The University of Sydney, Camperdown, NSW, Australia.,Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - David C H Harris
- School of Medicine, The University of Sydney, Camperdown, NSW, Australia.,Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia.,Department of Renal Medicine, Westmead Hospital, Westmead, NSW, Australia
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12
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Ethier I, Johnson DW, Bello AK, Ye F, Osman MA, Levin A, Harris DCH, Kerr P, Liew A, Wong MG, Lunney M, Saad S, Zaidi D, Khan M, Jha V, Tonelli M, Okpechi IG, Viecelli AK. International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Oceania and South East Asia. Kidney Int Suppl (2011) 2021; 11:e86-e96. [PMID: 33981474 DOI: 10.1016/j.kisu.2021.01.004] [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: 10/02/2020] [Revised: 12/09/2020] [Accepted: 01/06/2021] [Indexed: 10/21/2022] Open
Abstract
Oceania and South East Asia (OSEA) is a socioeconomically, culturally, and ethnically diverse region facing a rising epidemic of noncommunicable diseases, including chronic kidney disease (CKD). The second iteration of the International Society of Nephrology Global Kidney Health Atlas aimed to provide a comprehensive evaluation of kidney care in OSEA. Of the 30 countries/territories in OSEA, 15 participated in the survey, representing 98.5% of the region's population. The median prevalence of treated kidney failure in OSEA was 1352 per million population (interquartile range, 966-1673 per million population), higher than the global median of 787 per million population. Although the general availability, access, and quality of kidney replacement therapy (i.e., dialysis and transplantation) was high in OSEA, inequalities in accessibility and affordability of kidney replacement therapy across the region resulted in variability between countries. According to the survey results, in a third of the participating countries (mostly lower-income countries), less than half the patients with kidney failure were able to access dialysis, whereas it was readily available to all with minimal out-of-pocket costs in high-income countries; similar variability in access to transplantation was also recorded. Limitations in workforce and resources vary across the region and were disproportionately worse in lower-income countries. There was little advocacy for kidney disease, moderate use of registries, restricted CKD detection programs, and limited availability of routine CKD testing in some high-risk groups across the region. International collaborations, as seen in OSEA, are important initiatives to help close the gaps in CKD care provision across the region and should continue receiving support from the global nephrology community.
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Affiliation(s)
- Isabelle Ethier
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - David W Johnson
- Department of Nephrology, Metro South and Ipswich Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Translation Research Institute, Brisbane, Queensland, Australia
| | - Aminu K Bello
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Feng Ye
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mohamed A Osman
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David C H Harris
- Centre for Transplantation and Renal Research, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia
| | - Peter Kerr
- Nephrology, Monash Medical Centre, Victoria, Australia
| | - Adrian Liew
- The Kidney & Transplant Practice, Mount Elizabeth Novena Hospital, Singapore
| | - Muh Geot Wong
- Department of Renal Medicine, Royal North Shore Hospital, University of Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, Australia
| | - Meaghan Lunney
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Syed Saad
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Deenaz Zaidi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Maryam Khan
- Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India.,School of Public Health, Imperial College, London, UK.,Manipal Academy of Higher Education, Manipal, India
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Pan-American Health Organization/World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Ikechi G Okpechi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.,Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Centre for Kidney Disease Research, University of Queensland, Brisbane, Queensland, Australia
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13
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Kelly DM, Anders HJ, Bello AK, Choukroun G, Coppo R, Dreyer G, Eckardt KU, Johnson DW, Jha V, Harris DCH, Levin A, Lunney M, Luyckx V, Marti HP, Messa P, Mueller TF, Saad S, Stengel B, Vanholder RC, Weinstein T, Khan M, Zaidi D, Osman MA, Ye F, Tonelli M, Okpechi IG, Rondeau E. International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Western Europe. Kidney Int Suppl (2011) 2021; 11:e106-e118. [PMID: 33981476 DOI: 10.1016/j.kisu.2021.01.007] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/09/2020] [Accepted: 01/06/2021] [Indexed: 01/08/2023] Open
Abstract
Populations in the high-income countries of Western Europe are aging due to increased life expectancy. As the prevalence of diabetes and obesity has increased, so has the burden of kidney failure. To determine the global capacity for kidney replacement therapy and conservative kidney management, the International Society of Nephrology conducted multinational, cross-sectional surveys and published the findings in the International Society of Nephrology Global Kidney Health Atlas. In the second iteration of the International Society of Nephrology Global Kidney Health Atlas, we aimed to describe the availability, accessibility, quality, and affordability of kidney failure care in Western Europe. Among the 29 countries in Western Europe, 21 (72.4%) responded, representing 99% of the region's population. The burden of kidney failure prevalence varied widely, ranging from 760 per million population (pmp) in Iceland to 1612 pmp in Portugal. Coverage of kidney replacement therapy from public funding was nearly universal, with the exceptions of Germany and Liechtenstein where part of the costs was covered by mandatory insurance. Fourteen (67%) of 21 countries charged no fees at the point of care delivery, but in 5 countries (24%), patients do pay some out-of-pocket costs. Long-term dialysis services (both hemodialysis and peritoneal dialysis) were available in all countries in the region, and kidney transplantation services were available in 19 (90%) countries. The incidence of kidney transplantation varied widely between countries from 12 pmp in Luxembourg to 70.45 pmp in Spain. Conservative kidney care was available in 18 (90%) of 21 countries. The median number of nephrologists was 22.9 pmp (range: 9.47-55.75 pmp). These data highlight the uniform capacity of Western Europe to provide kidney failure care, but also the scope for improvement in disease prevention and management, as exemplified by the variability in disease burden and transplantation rates.
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Affiliation(s)
- Dearbhla M Kelly
- Wolfson Centre for the Prevention of Stroke and Dementia, University of Oxford, John Radcliffe Hospital, Oxford, UK.,Department of Nephrology, Beaumont Hospital, Dublin, Ireland
| | - Hans-Joachim Anders
- Division of Nephrology, Department of Internal Medicine IV, University Hospital of the Ludwig Maximilians University Munich, Munich, Germany
| | - Aminu K Bello
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Gabriel Choukroun
- Nephrology Dialysis Transplantation Department, CHU Amiens, MP3CV Research Unit, Amiens University, Amiens, France
| | - Rosanna Coppo
- Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy
| | - Gavin Dreyer
- Department of Nephrology, Barts Health National Health Service Trust, London, UK
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - David W Johnson
- Department of Nephrology, Metro South and Ipswich Nephrology and Transplant Services (MINTS), Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Translation Research Institute, Brisbane, Queensland, Australia
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India.,School of Public Health, Imperial College, London, UK.,Manipal Academy of Higher Education, Manipal, India
| | - David C H Harris
- Centre for Transplantation and Renal Research, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meaghan Lunney
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Valerie Luyckx
- Nephrology, Cantonal Hospital Graubunden, Chur, Switzerland.,Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Child Health and Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Hans-Peter Marti
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Division of Nephrology, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Piergiorgio Messa
- Nephrology, Dialysis and Renal Transplant Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Thomas F Mueller
- Nephrology Clinic, University Hospital Zurich, Zürich, Switzerland
| | - Syed Saad
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Benedicte Stengel
- Center for Research in Epidemiology and Population Health (CESP), National Institute of Health and Medical Research (INSERM), Villejuif, France.,University Paris Saclay, Villejuif, France
| | - Raymond C Vanholder
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium.,European Kidney Health Alliance, Brussels, Belgium
| | - Talia Weinstein
- Department of Nephrology, Tel Aviv Medical Center, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Maryam Khan
- Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
| | - Deenaz Zaidi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mohamed A Osman
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Feng Ye
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Pan-American Health Organization/World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Ikechi G Okpechi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.,Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Eric Rondeau
- Intensive Care Nephrology and Transplantation Department, Hopital Tenon, Assistance Publique-Hopitaux de Paris, Paris, France.,Sorbonne Université, Paris, France
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14
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Zakharova E, Gaipov A, Bello AK, Johnson DW, Jha V, Harris DCH, Levin A, Saad S, Khan M, Zaidi D, Osman MA, Ye F, Lunney M, Tonelli M, Okpechi IG, Zemchenkov A, Tchokhonelidze I. International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Newly Independent States and Russia. Kidney Int Suppl (2011) 2021; 11:e57-e65. [PMID: 33981471 DOI: 10.1016/j.kisu.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/02/2020] [Revised: 12/09/2020] [Accepted: 01/06/2021] [Indexed: 11/19/2022] Open
Abstract
The International Society of Nephrology Global Kidney Health Atlas analyzed the current state of kidney care in Newly Independent States and Russia. Our results demonstrated that the Newly Independent States and Russia region was not an exception and showed the same effect of chronic kidney disease on health and its outcomes, facing many difficulties and challenges in terms of improving kidney care across the countries. This work summarized and presented demographics, health information systems, statistics, and national health policy of the region, as well as characteristics of the burden of chronic kidney disease and kidney failure (KF) of participating countries. Besides significant economic advancement in the region, the collected data revealed existing shortage in KF care providers, essential medications, and health product access for KF care. Moreover, there was low reporting of kidney replacement therapy (dialysis and kidney transplantation) quality indicators and low capacity for long-term hemodialysis, peritoneal dialysis, and kidney transplantation. The financial issues and funding structures for KF care across the region needs strategic support for fundamental changes and further advancement. This article emphasizes the urgent need for further effective regional and international collaborations and partnership for establishment of universal health care systems for KF management.
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Affiliation(s)
- Elena Zakharova
- Department of Nephrology, Moscow City Hospital named after S.P. Botkin, Moscow, Russian Federation
- Department of Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
- Department of Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Abduzhappar Gaipov
- Department of Clinical Sciences, Nazarbayev University School of Medicine, Nur-Sultan, Kazakhstan
| | - Aminu K Bello
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - David W Johnson
- Department of Nephrology, Metro South and Ipswich Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translation Research Institute, Brisbane, Queensland, Australia
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
| | - David C H Harris
- Centre for Transplantation and Renal Research, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Syed Saad
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Maryam Khan
- Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
| | - Deenaz Zaidi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mohamed A Osman
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Feng Ye
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Meaghan Lunney
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Pan-American Health Organization/World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Ikechi G Okpechi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Alexander Zemchenkov
- Department of Internal Disease, Clinical Pharmacology and Nephrology, North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
- Department of Nephrology and Dialysis, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - Irma Tchokhonelidze
- High Technology Medical Center University Clinic, Tbilisi State Medical University, Tbilisi, Georgia
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15
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Amouzegar A, Abu-Alfa AK, Alrukhaimi MN, Bello AK, Ghnaimat MA, Johnson DW, Jha V, Harris DCH, Levin A, Tonelli M, Lunney M, Saad S, Khan M, Zaidi D, Osman MA, Ye F, Okpechi IG, Ossareh S. International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in the Middle East. Kidney Int Suppl (2011) 2021; 11:e47-e56. [PMID: 33981470 DOI: 10.1016/j.kisu.2021.01.002] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/09/2020] [Accepted: 01/06/2021] [Indexed: 10/21/2022] Open
Abstract
Kidney failure is the permanent impairment of kidney function associated with increased morbidity, hospitalization, and requirement for kidney replacement therapy. A total of 11 countries in the Middle East region (84.6%) responded to the survey. The prevalence of chronic kidney disease in the region ranged from 5.2% to 10.6%, whereas prevalence of treated kidney failure ranged from 152 to 826 per million population. Overall, the incidence of kidney transplantation was highest in Iran (30.9 per million population) and lowest in Oman and the United Arab Emirates (2.2 and 3.0 per million population, respectively). Long-term hemodialysis services were available in all countries, long-term peritoneal dialysis services were available in 9 (69.2%) countries, and transplantation services were available in most countries of the region. Public funding covered the costs of nondialysis chronic kidney disease care in two-thirds of countries, and kidney replacement therapy in nearly all countries. More than half of the countries had dialysis registries; however, national noncommunicable disease strategies were lacking in most countries. The Middle East is a region with high burden of kidney disease and needs cost-effective measures through effective health care funding to be available to improve kidney care in the region. Furthermore, well-designed and sustainable health information systems are needed in the region to address current gaps in kidney care in the region.
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Affiliation(s)
- Atefeh Amouzegar
- Division of Nephrology, Department of Medicine, Firoozgar Clinical Research Development Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali K Abu-Alfa
- Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Mona N Alrukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Aminu K Bello
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mohammad A Ghnaimat
- Nephrology Division, Department of Internal Medicine, The Specialty Hospital, Amman, Jordan
| | - David W Johnson
- Department of Nephrology, Metro South and Ipswich Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Translation Research Institute, Brisbane, Queensland, Australia
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India.,School of Public Health, Imperial College, London, UK.,Manipal Academy of Higher Education, Manipal, India
| | - David C H Harris
- Centre for Transplantation and Renal Research, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Pan-American Health Organization/World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Meaghan Lunney
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Syed Saad
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Maryam Khan
- Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
| | - Deenaz Zaidi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mohamed A Osman
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Feng Ye
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ikechi G Okpechi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.,Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Shahrzad Ossareh
- Division of Nephrology, Department of Medicine, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran
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16
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Wainstein M, Bello AK, Jha V, Harris DCH, Levin A, Gonzalez-Bedat MC, Rosa-Diez GJ, Ferreiro Fuentes A, Sola L, Pecoits-Filho R, Claure-Del Granado R, Madero M, Osman MA, Saad S, Zaidi D, Lunney M, Ye F, Katz IJ, Khan M, Shrapnel S, Tonelli M, Okpechi IG, Johnson DW. International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Latin America. Kidney Int Suppl (2011) 2021; 11:e35-e46. [PMID: 33981469 DOI: 10.1016/j.kisu.2021.01.005] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/09/2020] [Accepted: 01/06/2021] [Indexed: 11/16/2022] Open
Abstract
Latin America is a region with a widely variable socioeconomic landscape, facing a surge in noncommunicable diseases, including chronic kidney disease and kidney failure, exposing significant limitations in the delivery of care. Despite region-wide efforts to explore and address these limitations, much uncertainty remains as to the capacity, accessibility, and quality of kidney failure care in Latin America. Through this second iteration of the International Society of Nephrology Global Kidney Health Atlas, we aimed to report on these indicators to provide a comprehensive map of kidney failure care in the region. Survey responses were received from 18 (64.2%) countries, representing 93.8% of the total population in Latin America. The median prevalence and incidence of treated kidney failure in Latin America were 715 and 157 per million population, respectively, the latter being higher than the global median (142 per million population), with Puerto Rico, Mexico, and El Salvador experiencing much of this growing burden. In most countries, public and private systems collectively funded most aspects of kidney replacement therapy (dialysis and transplantation) care, with patients incurring at least 1% to 25% of out-of-pocket costs. In most countries, >90% of dialysis patients able to access kidney replacement therapy received hemodialysis (n = 11; 5 high income and 6 upper-middle income), and only a small minority began with peritoneal dialysis (1%-10% in 67% of countries; n = 12). Few countries had chronic kidney disease registries or targeted detection programs. There is a large variability in the availability, accessibility, and quality of kidney failure care in Latin America, which appears to be subject to individual countries' funding structures, underreliance on cheap kidney replacement therapy, such as peritoneal dialysis, and limited chronic kidney disease surveillance and management initiatives.
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Affiliation(s)
- Marina Wainstein
- National Health and Medical Research Council Chronic Kidney Disease Centre of Research Excellence and Chronic Kidney Disease in Queensland, University of Queensland, Brisbane, Queensland, Australia.,Kidney Health Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Aminu K Bello
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India.,School of Public Health, Imperial College, London, UK.,Manipal Academy of Higher Education, Manipal, India
| | - David C H Harris
- Centre for Transplantation and Renal Research, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maria C Gonzalez-Bedat
- Executive Board of the Latin American Dialysis and Transplantation Registry, Montevideo, Uruguay
| | - Guillermo J Rosa-Diez
- Division of Nephrology, Department of Medicine, University Institute Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.,Executive Board of the Latin American Dialysis and Transplantation Registry, Sociedad Latinoamericana de Nefrología e Hipertensión, Buenos Aires, Argentina
| | | | - Laura Sola
- Dialysis Unit, Centro Asistencial del Sindicato Médico del Uruguay Institución de Asistencia Médica Privada de Profesionales Sin Fines de Lucro, Montevideo, Uruguay
| | - Roberto Pecoits-Filho
- School of Medicine, Pontificia Universidade Catolica do Paraná, Curitiba, Brazil.,Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Rolando Claure-Del Granado
- Division of Nephrology, Department of Medicine, Hospital Obrero #2-Caja Nacional de Salud, Universidad Mayor de San Simon School of Medicine, Cochabamba, Bolivia
| | - Magdalena Madero
- Division of Nephrology, Department of Medicine, National Heart Institute, Mexico City, Mexico
| | - Mohamed A Osman
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Syed Saad
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Deenaz Zaidi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Meaghan Lunney
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Feng Ye
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ivor J Katz
- Division of Medicine, Department of Renal Medicine, St George and Sutherland Hospitals, University of New South Wales, Sydney, New South Wales, Australia
| | - Maryam Khan
- Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
| | - Sally Shrapnel
- School of Mathematics and Physics, University of Queensland, Brisbane, Queensland, Australia
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Pan-American Health Organization/World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Ikechi G Okpechi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.,Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - David W Johnson
- Department of Nephrology, Metro South and Ipswich Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Translation Research Institute, Brisbane, Queensland, Australia
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17
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Zhang L, Wang J, Yang CW, Tang SCW, Kashihara N, Kim YS, Togtokh A, Saad S, Ye F, Khan M, Zaidi D, Osman MA, Lunney M, Okpechi IG, Jha V, Harris DCH, Levin A, Tonelli M, Johnson DW, Bello AK, Zhao MH. International Society of Nephrology Global Kidney Health Atlas: structures, organization and services for the management of kidney failure in North and East Asia. Kidney Int Suppl (2011) 2021; 11:e77-e85. [PMID: 33981473 DOI: 10.1016/j.kisu.2021.01.011] [Citation(s) in RCA: 7] [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: 10/02/2020] [Revised: 12/10/2020] [Accepted: 01/06/2021] [Indexed: 12/28/2022] Open
Abstract
Kidney failure (KF) is a public health problem in all regions of the world. We aim to provide comprehensive information regarding the disease burden of KF and capacity for providing optimal care in the International Society of Nephrology North and East Asia region based on data from the International Society of Nephrology Global Kidney Health Atlas project. Seven of eight jurisdictions participated, and wide variation was found in terms of KF burden and care capacity. Prevalence of long-term dialysis ranged from 88.4 per million population in mainland China to 3251 per million population in Taiwan. Hemodialysis was the predominant modality of dialysis in all jurisdictions, except for Hong Kong, where peritoneal dialysis (PD) was much more prevalent than hemodialysis. All jurisdictions provided public funding for kidney replacement therapy (dialysis and transplantation). Although the frequency and duration of hemodialysis followed a standard pattern in all investigated jurisdictions, the density of nephrologists and kidney replacement therapy centers varied according to income level. Conservative care, whether medically advised or chosen by patients, was available in most jurisdictions. All jurisdictions had official registries for KF and recognized KF as a health priority. These comprehensive data provide information about the burden of KF and capacity to provide optimal care in North and East Asia, which varied greatly across jurisdictions in the region.
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Affiliation(s)
- Luxia Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Peking University Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, National Health and Family Planning Commission of China, Beijing, China.,Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education of China, Beijing, China.,Center for Data Science in Health and Medicine, Peking University, Beijing, China.,National Institute of Health Data Science at Peking University, Beijing, China.,Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Jinwei Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Peking University Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, National Health and Family Planning Commission of China, Beijing, China.,Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education of China, Beijing, China.,Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Chih-Wei Yang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Sydney Chi-Wai Tang
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Naoki Kashihara
- Department of Nephrology and Hypertension, Kawasaki Medical School, Okayama, Japan
| | - Yong-Soo Kim
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ariunaa Togtokh
- Division of Nephrology, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Syed Saad
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Feng Ye
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Maryam Khan
- Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
| | - Deenaz Zaidi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mohamed A Osman
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Meaghan Lunney
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Ikechi G Okpechi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.,Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India.,School of Public Health, Imperial College, London, UK.,Manipal Academy of Higher Education, Manipal, India
| | - David C H Harris
- Centre for Transplantation and Renal Research, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Pan-American Health Organization/World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - David W Johnson
- Department of Nephrology, Metro South and Ipswich Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Translation Research Institute, Brisbane, Queensland, Australia
| | - Aminu K Bello
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ming-Hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Peking University Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education of China, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Peking-Tsinghua Center for Life Sciences, Beijing, China
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18
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Zhang JQJ, Saravanabavan S, Chandra AN, Munt A, Wong ATY, Harris PC, Harris DCH, McKenzie P, Wang Y, Rangan GK. Up-Regulation of DNA Damage Response Signaling in Autosomal Dominant Polycystic Kidney Disease. Am J Pathol 2021; 191:902-920. [PMID: 33549515 DOI: 10.1016/j.ajpath.2021.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 01/05/2021] [Accepted: 01/14/2021] [Indexed: 12/19/2022]
Abstract
DNA damage and alterations in DNA damage response (DDR) signaling could be one of the molecular mechanisms mediating focal kidney cyst formation in autosomal dominant polycystic kidney disease (ADPKD). The aim of this study was to test the hypothesis that markers of DNA damage and DDR signaling are increased in human and experimental ADPKD. In the human ADPKD transcriptome, the number of up-regulated DDR-related genes was increased by 16.6-fold compared with that in normal kidney, and by 2.5-fold in cystic compared with that in minimally cystic tissue (P < 0.0001). In end-stage human ADPKD tissue, γ-H2A histone family member X (H2AX), phosphorylated ataxia telangiectasia and radiation-sensitive mutant 3 (Rad3)-related (pATR), and phosphorylated ataxia telangiectasia mutated (pATM) localized to cystic kidney epithelial cells. In vitro, pATR and pATM were also constitutively increased in human ADPKD tubular cells (WT 9-7 and 9-12) compared with control (HK-2). In addition, extrinsic oxidative DNA damage by hydrogen peroxide augmented γ-H2AX and cell survival in human ADPKD cells, and exacerbated cyst growth in the three-dimensional Madin-Darby canine kidney cyst model. In contrast, DDR-related gene expression was only transiently increased on postnatal day 0 in Pkd1RC/RC mice, and not altered at later time points up to 12 months of age. In conclusion, DDR signaling is dysregulated in human ADPKD and during the early phases of murine ADPKD. The constitutive expression of the DDR pathway in ADPKD may promote survival of PKD1-mutated cells and contribute to kidney cyst growth.
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Affiliation(s)
- Jennifer Q J Zhang
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia; Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Sayanthooran Saravanabavan
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia; Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Ashley N Chandra
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia; Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Alexandra Munt
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia; Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Annette T Y Wong
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia; Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Peter C Harris
- Mayo Translational Polycystic Kidney Disease Center, Mayo Clinic, Rochester, Minnesota
| | - David C H Harris
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia; Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Paul McKenzie
- Department of Tissue Pathology, NSW Health Pathology, Royal Prince Alfred Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - Yiping Wang
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia; Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Gopala K Rangan
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia; Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia.
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19
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Wang R, Wang Y, Harris DCH, Cao Q. Innate lymphoid cells in kidney diseases. Kidney Int 2020; 99:1077-1087. [PMID: 33387602 DOI: 10.1016/j.kint.2020.11.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 08/24/2020] [Revised: 11/05/2020] [Accepted: 11/18/2020] [Indexed: 12/16/2022]
Abstract
It is well known that innate immune cells, including dendritic cells, macrophages, and natural killer cells, contribute to pathogenesis and protection in various kidney diseases. The understanding of innate immunity has been advanced recently by the discovery of a new group of innate lymphoid cells (ILCs), including ILC1, ILC2, and ILC3. ILCs lack adaptive antigen receptors, yet can be triggered by various pathogens and rapidly provide an abundant source of immunomodulatory cytokines to exert immediate immune reactions and direct subsequent innate and adaptive immune responses. ILCs play critical roles in immunity, tissue homeostasis, and pathological inflammation. In this review, we highlight the biological function of ILC subpopulations in the normal kidney, and their important roles in acute and chronic kidney diseases, thus demonstrating the emerging importance of ILC-regulated immunity in this special organ and providing insights for future research directions and therapeutic interventions.
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Affiliation(s)
- Ruifeng Wang
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Yiping Wang
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - David C H Harris
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia.
| | - Qi Cao
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia.
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20
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Thallas-Bonke V, Tan SM, Lindblom RS, Snelson M, Granata C, Jha JC, Sourris KC, Laskowski A, Watson A, Tauc M, Rubera I, Zheng G, Shah AM, Harris DCH, Elbatreek MH, Kantharidis P, Cooper ME, Jandeleit-Dahm K, Coughlan MT. Targeted deletion of nicotinamide adenine dinucleotide phosphate oxidase 4 from proximal tubules is dispensable for diabetic kidney disease development. Nephrol Dial Transplant 2020; 36:988-997. [PMID: 33367789 DOI: 10.1093/ndt/gfaa376] [Citation(s) in RCA: 9] [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: 09/09/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The nicotinamide adenine dinucleotide phosphate oxidase isoform 4 (Nox4) mediates reactive oxygen species (ROS) production and renal fibrosis in diabetic kidney disease (DKD) at the level of the podocyte. However, the mitochondrial localization of Nox4 and its role as a mitochondrial bioenergetic sensor has recently been reported. Whether Nox4 drives pathology in DKD within the proximal tubular compartment, which is densely packed with mitochondria, is not yet known. METHODS We generated a proximal tubular-specific Nox4 knockout mouse model by breeding Nox4flox/flox mice with mice expressing Cre recombinase under the control of the sodium-glucose cotransporter-2 promoter. Subsets of Nox4ptKO mice and their Nox4flox/flox littermates were injected with streptozotocin (STZ) to induce diabetes. Mice were followed for 20 weeks and renal injury was assessed. RESULTS Genetic ablation of proximal tubular Nox4 (Nox4ptKO) resulted in no change in renal function and histology. Nox4ptKO mice and Nox4flox/flox littermates injected with STZ exhibited the hallmarks of DKD, including hyperfiltration, albuminuria, renal fibrosis and glomerulosclerosis. Surprisingly, diabetes-induced renal injury was not improved in Nox4ptKO STZ mice compared with Nox4flox/flox STZ mice. Although diabetes conferred ROS overproduction and increased the mitochondrial oxygen consumption rate, proximal tubular deletion of Nox4 did not normalize oxidative stress or mitochondrial bioenergetics. CONCLUSIONS Taken together, these results demonstrate that genetic deletion of Nox4 from the proximal tubules does not influence DKD development, indicating that Nox4 localization within this highly energetic compartment is dispensable for chronic kidney disease pathogenesis in the setting of diabetes.
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Affiliation(s)
| | - Sih Min Tan
- Department of Diabetes, Central Clinical School, Monash University, Alfred Medical Research and Education Precinct, Melbourne, Victoria, Australia
| | - Runa S Lindblom
- Department of Diabetes, Central Clinical School, Monash University, Alfred Medical Research and Education Precinct, Melbourne, Victoria, Australia
| | - Matthew Snelson
- Department of Diabetes, Central Clinical School, Monash University, Alfred Medical Research and Education Precinct, Melbourne, Victoria, Australia
| | - Cesare Granata
- Department of Diabetes, Central Clinical School, Monash University, Alfred Medical Research and Education Precinct, Melbourne, Victoria, Australia.,Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
| | - Jay Chandra Jha
- Department of Diabetes, Central Clinical School, Monash University, Alfred Medical Research and Education Precinct, Melbourne, Victoria, Australia
| | - Karly C Sourris
- Department of Diabetes, Central Clinical School, Monash University, Alfred Medical Research and Education Precinct, Melbourne, Victoria, Australia
| | - Adrienne Laskowski
- Department of Diabetes, Central Clinical School, Monash University, Alfred Medical Research and Education Precinct, Melbourne, Victoria, Australia
| | - Anna Watson
- Department of Diabetes, Central Clinical School, Monash University, Alfred Medical Research and Education Precinct, Melbourne, Victoria, Australia
| | - Michel Tauc
- Laboratoire de Physiomédecine Moléculaire, LP2M, UMR-CNRS 7370, Université Côte d'Azur, Nice, France
| | - Isabelle Rubera
- Laboratoire de Physiomédecine Moléculaire, LP2M, UMR-CNRS 7370, Université Côte d'Azur, Nice, France
| | - Guoping Zheng
- Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Ajay M Shah
- King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, London, UK
| | - David C H Harris
- Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Mahmoud H Elbatreek
- Department of Pharmacology and Personalised Medicine, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | - Phillip Kantharidis
- Department of Diabetes, Central Clinical School, Monash University, Alfred Medical Research and Education Precinct, Melbourne, Victoria, Australia
| | - Mark E Cooper
- Department of Diabetes, Central Clinical School, Monash University, Alfred Medical Research and Education Precinct, Melbourne, Victoria, Australia
| | - Karin Jandeleit-Dahm
- Department of Diabetes, Central Clinical School, Monash University, Alfred Medical Research and Education Precinct, Melbourne, Victoria, Australia.,German Diabetes Centre, Leibniz Centre for Diabetes Research, Heinrich Heine University, Duesseldorf, Germany
| | - Melinda T Coughlan
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Department of Diabetes, Central Clinical School, Monash University, Alfred Medical Research and Education Precinct, Melbourne, Victoria, Australia
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21
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Abstract
The coronavirus disease 2019 pandemic presents significant challenges for health systems globally, including substantive ethical dilemmas that may pose specific concerns in the context of care for people with kidney disease. Ethical concerns may arise as changes in policy and practice affect the ability of all health professionals to fulfill their ethical duties toward their patients in providing best practice care. In this article, we briefly describe such concerns and elaborate on issues of particular ethical complexity in kidney care: equitable access to dialysis during pandemic surges; balancing the risks and benefits of different kidney failure treatments, specifically with regard to suspending kidney transplantation programs and prioritizing home dialysis, and barriers to shared decision-making; and ensuring ethical practice when using unproven interventions. We present preliminary advice on how to approach these issues and recommend urgent efforts to develop resources that will support health professionals and patients in managing them.
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Affiliation(s)
| | - Jordan A Parsons
- Bristol Medical School, University of Bristol, Bristol, UK; Instituts für Geschichte und Ethik der Medizin, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Fergus J Caskey
- Bristol Medical School, University of Bristol, Bristol, UK; The Richard Bright Renal Unit, Southmead Hospital, North Bristol National Health Service Trust, Bristol, UK
| | - David C H Harris
- Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia
| | - Vivekanand Jha
- George Institute for Global Health India, University of New South Wales (UNSW), New Delhi, India; School of Public Health, Imperial College, London, UK; Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
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22
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Tonelli M, Nkunu V, Varghese C, Abu-Alfa AK, Alrukhaimi MN, Bernieh B, Fox L, Gill J, Harris DCH, Hou FF, O'Connell PJ, Rashid HU, Niang A, Ossareh S, Tesar V, Zakharova E, Yang CW. Corrigendum to "Tonelli M, Nkunu V, Varghese C, et al. Framework for establishing integrated kidney care programs in low- and middle-income countries" Kidney Int Suppl. 2020;10:e19-e23. Kidney Int Suppl (2011) 2020; 10:e186. [PMID: 33304641 DOI: 10.1016/j.kisu.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
[This corrects the article DOI: 10.1016/j.kisu.2019.11.002.].
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Affiliation(s)
- Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Pan American Health Organization/World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Victoria Nkunu
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Ali K Abu-Alfa
- Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Mona N Alrukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Bassam Bernieh
- HHD for Home Dialysis, Al Ain, United Arab Emirates.,The Heart Medical Center, Al Ain, United Arab Emirates
| | | | - John Gill
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David C H Harris
- Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Fan Fan Hou
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Philip J O'Connell
- Renal Unit, University of Sydney at Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, The Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Harun Ur Rashid
- Department of Nephrology, Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Abdou Niang
- Department of Nephrology, Dalal Jamm Hospital, Cheikh Anta Diop University Teaching Hospital, Dakar, Senegal
| | - Shahrzad Ossareh
- Division of Nephrology, Department of Medicine, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran
| | - Vladimir Tesar
- Department of Nephrology, General University Hospital, Charles University, Prague, Czech Republic
| | - Elena Zakharova
- Department of Nephrology, Moscow City Hospital named after S.P. Botkin, Moscow, Russian Federation.,Department of Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation.,Department of Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Chih-Wei Yang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
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23
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Harris DCH, Davies SJ, Finkelstein FO, Jha V, Bello AK, Brown M, Caskey FJ, Donner JA, Liew A, Muller E, Naicker S, O'Connell PJ, Filho RP, Vachharajani T. Strategic plan for integrated care of patients with kidney failure. Kidney Int 2020; 98:S117-S134. [PMID: 33126957 DOI: 10.1016/j.kint.2020.07.023] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 12/14/2022]
Abstract
There is a huge gap between the number of patients worldwide requiring versus those actually receiving safe, sustainable, and equitable care for kidney failure. To address this, the International Society of Nephrology coordinated the development of a Strategic Plan for Integrated Care of Patients with Kidney Failure. Implementation of the plan will require engagement of the whole kidney community over the next 5-10 years.
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Affiliation(s)
- David C H Harris
- Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia.
| | - Simon J Davies
- Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | | | - Vivekanand Jha
- George Institute for Global Health India, University of New South Wales (UNSW), New Delhi, India; Manipal Academy of Higher Education (MAHE), Manipal, Kamataka, India
| | - Aminu K Bello
- Division of Nephrology and Immunity, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mark Brown
- Department of Renal Medicine, St. George Hospital and University of New South Wales, Sydney, New South Wales, Australia
| | - Fergus J Caskey
- UK Renal Registry, Learning and Research, Southmead Hospital, Bristol, UK; Population Health Sciences, University of Bristol, Bristol, UK; The Richard Bright Renal Unit, Southmead Hospital, North Bristol National Health Service Trust, Bristol, UK
| | - Jo-Ann Donner
- International Society of Nephrology, Brussels, Belgium
| | - Adrian Liew
- The Kidney & Transplant Practice, Mount Elizabeth Novena Hospital, Singapore
| | - Elmi Muller
- Transplant Unit, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Saraladevi Naicker
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Philip J O'Connell
- Renal Unit, University of Sydney at Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, The Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Roberto Pecoits Filho
- School of Medicine, Pontificia Universidade Catolica do Paraná, Curitiba, Brazil; Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Tushar Vachharajani
- Department of Nephrology & Hypertension, Glickman Urological & Kidney Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
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24
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Zhao Y, Qiao X, Wang L, Tan TK, Zhao H, Zhang Y, Zhang J, Rao P, Cao Q, Wang Y, Wang Y, Wang YM, Lee VWS, Alexander SI, Harris DCH, Zheng G. Correction to: Matrix metalloproteinase 9 induces endothelial-mesenchymal transition via Notch activation in human kidney glomerular endothelial cells. BMC Mol Cell Biol 2020; 21:72. [PMID: 33087059 PMCID: PMC7576858 DOI: 10.1186/s12860-020-00318-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ye Zhao
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, the University of Sydney, 176 Hawkesbury Road, Sydney, NSW, 2145, Australia.,The School of Biomedical Sciences, Chengdu Medical College, Chengdu, 610500, PR China
| | - Xi Qiao
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, the University of Sydney, 176 Hawkesbury Road, Sydney, NSW, 2145, Australia.,Department of Nephrology, Second Hospital of Shanxi Medical University, Shanxi Kidney Disease Institute, WuYi Road 382, Taiyuan, 030001, Shanxi, PR China
| | - Lihua Wang
- Department of Nephrology, Second Hospital of Shanxi Medical University, Shanxi Kidney Disease Institute, WuYi Road 382, Taiyuan, 030001, Shanxi, PR China
| | - Tian Kui Tan
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, the University of Sydney, 176 Hawkesbury Road, Sydney, NSW, 2145, Australia
| | - Hong Zhao
- Department of Biochemistry and Molecular Biology, Shanxi Medical University, Xinjian Road 56, Taiyuan, 030001, Shanxi, PR China
| | - Yun Zhang
- Experimental Centre of Science and Research, the First Clinical Hospital of Shanxi Medical University, Xinjian Road 382, Taiyuan, 030001, Shanxi, PR China
| | - Jianlin Zhang
- Department of Biochemistry and Molecular Biology, Shanxi Medical University, Xinjian Road 56, Taiyuan, 030001, Shanxi, PR China
| | - Padmashree Rao
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, the University of Sydney, 176 Hawkesbury Road, Sydney, NSW, 2145, Australia
| | - Qi Cao
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, the University of Sydney, 176 Hawkesbury Road, Sydney, NSW, 2145, Australia
| | - Yiping Wang
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, the University of Sydney, 176 Hawkesbury Road, Sydney, NSW, 2145, Australia
| | - Ya Wang
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, the University of Sydney, 176 Hawkesbury Road, Sydney, NSW, 2145, Australia
| | - Yuan Min Wang
- Centre for Kidney Research, Children's Hospital at Westmead, 212 Hawkesbury Road, Sydney, NSW, Australia
| | - Vincent W S Lee
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, the University of Sydney, 176 Hawkesbury Road, Sydney, NSW, 2145, Australia
| | - Stephen I Alexander
- Centre for Kidney Research, Children's Hospital at Westmead, 212 Hawkesbury Road, Sydney, NSW, Australia
| | - David C H Harris
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, the University of Sydney, 176 Hawkesbury Road, Sydney, NSW, 2145, Australia
| | - Guoping Zheng
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, the University of Sydney, 176 Hawkesbury Road, Sydney, NSW, 2145, Australia.
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25
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Martin DE, Harris DCH, Jha V, Segantini L, Demme RA, Le TH, McCann L, Sands JM, Vong G, Wolpe PR, Fontana M, London GM, Vanderhaegen B, Vanholder R. Ethical challenges in nephrology: a call for action. Nat Rev Nephrol 2020; 16:603-613. [PMID: 32587403 DOI: 10.1038/s41581-020-0295-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2020] [Indexed: 12/14/2022]
Abstract
The American Society of Nephrology, the European Renal Association-European Dialysis and Transplant Association and the International Society of Nephrology Joint Working Group on Ethical Issues in Nephrology have identified ten broad areas of ethical concern as priority challenges that require collaborative action. Here, we describe these challenges - equity in access to kidney failure care, avoiding futile dialysis, reducing dialysis costs, shared decision-making in kidney failure care, living donor risk evaluation and decision-making, priority setting in kidney disease prevention and care, the ethical implications of genetic kidney diseases, responsible advocacy for kidney health and management of conflicts of interest - with the aim of highlighting the need for ethical analysis of specific issues, as well as for the development of tools and training to support clinicians who treat patients with kidney disease in practising ethically and contributing to ethical policy-making.
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Affiliation(s)
- Dominique E Martin
- School of Medicine, Deakin University, Geelong Waurn Ponds Campus, Geelong, VIC, Australia.
| | - David C H Harris
- University of Sydney at Westmead Hospital, Westmead, NSW, Australia
| | - Vivekanand Jha
- George Institute for Global Health, UNSW, New Delhi, India
- University of Oxford, Oxford, UK
- Manipal Academy of Higher Education, Manipal, India
| | - Luca Segantini
- International Society of Nephrology, Brussels, Belgium
- European Society for Organ Transplantation - ESOT c/o ESOT, Padova, Italy
| | - Richard A Demme
- Renal Division and Department of Medical Humanities and Bioethics, University of Rochester School of Medicine, Rochester, NY, USA
| | - Thu H Le
- Nephrology Division, Department of Medicine, University of Rochester School of Medicine, Rochester, NY, USA
| | - Laura McCann
- American Society of Nephrology, Washington, DC, USA
| | - Jeff M Sands
- Renal Division, Emory University School of Medicine, Atlanta, GA, USA
| | - Gerard Vong
- Center for Ethics, Emory University, Atlanta, GA, USA
| | | | - Monica Fontana
- European Renal Association - European Dialysis and Transplant Association, Parma, Italy
| | - Gerard M London
- Manhes Hospital, Nephrology Department GEPIR, Fleury-Mérogis, France
| | | | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine and Pediatrics, University Hospital, Corneel Heymanslaan 10, B9000, Gent, Belgium
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26
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Harris DCH, Davies SJ, Finkelstein FO, Jha V, Donner JA, Abraham G, Bello AK, Caskey FJ, Garcia GG, Harden P, Hemmelgarn B, Johnson DW, Levin NW, Luyckx VA, Martin DE, McCulloch MI, Moosa MR, O'Connell PJ, Okpechi IG, Pecoits Filho R, Shah KD, Sola L, Swanepoel C, Tonelli M, Twahir A, van Biesen W, Varghese C, Yang CW, Zuniga C. Increasing access to integrated ESKD care as part of universal health coverage. Kidney Int 2020; 95:S1-S33. [PMID: 30904051 DOI: 10.1016/j.kint.2018.12.005] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [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: 12/21/2018] [Accepted: 12/28/2018] [Indexed: 12/17/2022]
Abstract
The global nephrology community recognizes the need for a cohesive strategy to address the growing problem of end-stage kidney disease (ESKD). In March 2018, the International Society of Nephrology hosted a summit on integrated ESKD care, including 92 individuals from around the globe with diverse expertise and professional backgrounds. The attendees were from 41 countries, including 16 participants from 11 low- and lower-middle-income countries. The purpose was to develop a strategic plan to improve worldwide access to integrated ESKD care, by identifying and prioritizing key activities across 8 themes: (i) estimates of ESKD burden and treatment coverage, (ii) advocacy, (iii) education and training/workforce, (iv) financing/funding models, (v) ethics, (vi) dialysis, (vii) transplantation, and (viii) conservative care. Action plans with prioritized lists of goals, activities, and key deliverables, and an overarching performance framework were developed for each theme. Examples of these key deliverables include improved data availability, integration of core registry measures and analysis to inform development of health care policy; a framework for advocacy; improved and continued stakeholder engagement; improved workforce training; equitable, efficient, and cost-effective funding models; greater understanding and greater application of ethical principles in practice and policy; definition and application of standards for safe and sustainable dialysis treatment and a set of measurable quality parameters; and integration of dialysis, transplantation, and comprehensive conservative care as ESKD treatment options within the context of overall health priorities. Intended users of the action plans include clinicians, patients and their families, scientists, industry partners, government decision makers, and advocacy organizations. Implementation of this integrated and comprehensive plan is intended to improve quality and access to care and thereby reduce serious health-related suffering of adults and children affected by ESKD worldwide.
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Affiliation(s)
- David C H Harris
- Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia.
| | - Simon J Davies
- Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | | | - Vivekanand Jha
- George Institute for Global Health India, New Delhi, India; University of Oxford, Oxford, UK
| | - Jo-Ann Donner
- International Society of Nephrology, Brussels, Belgium
| | - Georgi Abraham
- Nephrology Division, Madras Medical Mission Hospital, Pondicherry Institute of Medical Sciences, Chennai, India
| | - Aminu K Bello
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Fergus J Caskey
- UK Renal Registry, Learning and Research, Southmead Hospital, Bristol, UK; Population Health Sciences, University of Bristol, Bristol, UK; The Richard Bright Renal Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Guillermo Garcia Garcia
- Servicio de Nefrologia, Hospital Civil de Guadalajara Fray Antonio Alcalde, University of Guadalajara Health Sciences Center, Hospital 278, Guadalajara, JAL, Mexico
| | - Paul Harden
- Oxford Kidney Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Brenda Hemmelgarn
- Departments of Community Health Sciences and Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David W Johnson
- Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia; Metro South and Ipswich Nephrology and Transplant Services (MINTS), Princess Alexandra Hospital, Brisbane, Australia
| | - Nathan W Levin
- Mount Sinai Icahn School of Medicine, New York, New York, USA
| | - Valerie A Luyckx
- Institute of Biomedical Ethics, University of Zurich, Zurich, Switzerland; Lecturer, Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Mignon I McCulloch
- Paediatric Intensive and Critical Unit, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Mohammed Rafique Moosa
- Division of Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Philip J O'Connell
- Renal Unit, University of Sydney at Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, The Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Ikechi G Okpechi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa; Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Roberto Pecoits Filho
- School of Medicine, Pontificia Universidade Catolica do Paraná, Curitiba, Brazil; Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | | | - Laura Sola
- Dialysis Unit, CASMU-IAMPP, Montevideo, Uruguay
| | - Charles Swanepoel
- Division of Nephrology and Hypertension, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ahmed Twahir
- Parklands Kidney Centre, Nairobi, Kenya; Department of Medicine, The Aga Khan University Hospital, Nairobi, Kenya
| | - Wim van Biesen
- Nephrology Department, Ghent University Hospital, Ghent, Belgium
| | | | - Chih-Wei Yang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Carlos Zuniga
- School of Medicine, Catholic University of Santisima Concepción, Concepcion, Chile
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27
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Wang R, Chen T, Wang C, Zhang Z, Wang XM, Li Q, Lee VWS, Wang YM, Zheng G, Alexander SI, Wang Y, Harris DCH, Cao Q. Flt3 inhibition alleviates chronic kidney disease by suppressing CD103+ dendritic cell-mediated T cell activation. Nephrol Dial Transplant 2020; 34:1853-1863. [PMID: 30590794 DOI: 10.1093/ndt/gfy385] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 06/17/2018] [Accepted: 11/16/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a global public health problem, which lacks effective treatment. Previously, we have shown that CD103+ dendritic cells (DCs) are pathogenic in adriamycin nephropathy (AN), a model of human focal segmental glomerulosclerosis (FSGS). Fms-like tyrosine kinase 3 (Flt3) is a receptor that is expressed with high specificity on tissue resident CD103+ DCs. METHODS To test the effect on CD103+ DCs and kidney injury of inhibition of Flt3, we used a selective Flt3 inhibitor (AC220) to treat mice with AN. RESULTS Human CD141+ DCs, homologous to murine CD103+ DCs, were significantly increased in patients with FSGS. The number of kidney CD103+ DCs, but not CD103- DCs or plasmacytoid DCs, was significantly decreased in AN mice after AC220 administration. Treatment with AC220 significantly improved kidney function and reduced kidney injury and fibrosis in AN mice. AC220-treated AN mice had decreased levels of inflammatory cytokines and chemokines, tumor necrosis factor-α, interleukin (IL)-1β, IL-6, CCL2 and CCL5 and reduced kidney infiltration of CD4 T cells and CD8 T cells. The protective effect of AC220 was associated with its suppression of CD103+ DCs-mediated CD8 T cell proliferation and activation in AN mice. CONCLUSION Flt3 inhibitor AC220 effectively reduced kidney injury in AN mice, suggesting that this inhibitor might be a useful pharmaceutical agent to treat CKD.
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Affiliation(s)
- Ruifeng Wang
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
- Department of Nephrology, The Second Hospital of Anhui Medical University, Hefei, China
| | - Titi Chen
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Chengshi Wang
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Zhiqiang Zhang
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Xin Maggie Wang
- Flow Cytometry Facility, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Qing Li
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Vincent W S Lee
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Yuan Min Wang
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Guoping Zheng
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Stephen I Alexander
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Yiping Wang
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - David C H Harris
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Qi Cao
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
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28
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Tonelli M, Nkunu V, Varghese C, Abu-Alfa AK, Alrukhaimi MN, Fox L, Gill J, Harris DCH, Hou FF, O'Connell PJ, Rashid HU, Niang A, Ossareh S, Tesar V, Zakharova E, Yang CW. Framework for establishing integrated kidney care programs in low- and middle-income countries. Kidney Int Suppl (2011) 2020; 10:e19-e23. [PMID: 32149006 DOI: 10.1016/j.kisu.2019.11.002] [Citation(s) in RCA: 21] [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: 06/26/2019] [Revised: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 12/17/2022] Open
Abstract
Secular increases in the burden of kidney failure is a major challenge for health systems worldwide, especially in low- and middle-income countries (LMICs) due to growing demand for expensive kidney replacement therapies. In LMICs with limited resources, the priority of providing kidney replacement therapies must be weighed against the prevention and treatment of chronic kidney disease, other kidney disorders such as acute kidney injury, and other noncommunicable diseases, as well as other urgent public health needs. Kidney failure is potentially preventable-not just through primary prevention of risk factors for kidney disease such as hypertension and diabetes, but also by timely management of established chronic kidney disease. Among people with established or incipient kidney failure, there are 3 key treatment strategies-conservative care, kidney transplantation, and dialysis-each of which has its own benefits. Joining up preventive care for people with or at risk for milder forms of chronic kidney disease with all 3 therapies for kidney failure (and developing synergistic links between the different treatment options) is termed "integrated kidney care" and has potential benefits for patients, families, and providers. In addition, because integrated kidney care implicitly considers resource use, it should facilitate a more sustainable approach to managing kidney failure than providing one or more of its components separately. There is currently no agreed framework that LMIC governments can use to establish and/or scale up programs to prevent and treat kidney failure or join up these programs to provide integrated kidney care. This review presents a suggested framework for establishing integrated kidney care programs, focusing on the anticipated needs of policy makers in LMICs.
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Affiliation(s)
- Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Pan American Health Organization/World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Victoria Nkunu
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Ali K Abu-Alfa
- Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Mona N Alrukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | | | - John Gill
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David C H Harris
- Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Fan Fan Hou
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Philip J O'Connell
- Renal Unit, University of Sydney at Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, The Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Harun Ur Rashid
- Department of Nephrology, Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Abdou Niang
- Department of Nephrology, Dalal Jamm Hospital, Cheikh Anta Diop University Teaching Hospital, Dakar, Senegal
| | - Shahrzad Ossareh
- Division of Nephrology, Department of Medicine, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran
| | - Vladimir Tesar
- Department of Nephrology, General University Hospital, Charles University, Prague, Czech Republic
| | - Elena Zakharova
- Department of Nephrology, Moscow City Hospital named after S.P. Botkin, Moscow, Russian Federation.,Department of Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation.,Department of Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Chih-Wei Yang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
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29
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Luyckx VA, Smyth B, Harris DCH, Pecoits-Filho R. Dialysis funding, eligibility, procurement, and protocols in low- and middle-income settings: results from the International Society of Nephrology collection survey. Kidney Int Suppl (2011) 2020; 10:e10-e18. [PMID: 32149005 DOI: 10.1016/j.kisu.2019.11.005] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/11/2019] [Accepted: 11/20/2019] [Indexed: 12/24/2022] Open
Abstract
Dialysis provisions and end-stage kidney disease (ESKD) care represents an important challenge, particularly in low-resource settings. The purpose of this project was to survey nephrologists from low- and lower middle-income countries about their experiences in the following domains: (i) Dialysis funding and eligibility; (ii) dialysis-procurement mechanisms; (iii) clinical protocols for dialysis; (iv) monitoring of dialysis outcomes; and (v) barriers to care for ESKD. One hundred and twenty responses from 31 low- and middle-income countries, from 8 ISN regions, were included in the analysis. When stratified by World Bank country income status, responses were received from 7 low-income countries, 12 lower middle-income countries, and 12 upper middle-income countries. Eighty-eight documents from 18 countries were uploaded, including country or institutional guidelines, protocols, and standard operating procedures. The International Society of Nephrology aims to develop a set of guidance documents that put forward a considered approach to dialysis provisions and ESKD care within resource limitations. As an initial step in this project, local practitioners from low-resource settings were surveyed about their experiences with dialysis funding, eligibility, procurement and their use of guidance documents, and how practices and procedures may have been developed with adaptations to the local circumstances. In this manuscript we describe the methodology and the main findings from the survey using an integrated quantitative and qualitative approach.
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Affiliation(s)
- Valerie A Luyckx
- Institute of Biomedical Ethics and the History of Medicine, University of Zurich, Zurich, Switzerland.,Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brendan Smyth
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney, Australia.,Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - David C H Harris
- Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Roberto Pecoits-Filho
- School of Medicine, Pontificia Universidade Catolica do Paraná, Curitiba, Brazil.,Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
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Chan CT, Blankestijn PJ, Dember LM, Gallieni M, Harris DCH, Lok CE, Mehrotra R, Stevens PE, Wang AYM, Cheung M, Wheeler DC, Winkelmayer WC, Pollock CA. Dialysis initiation, modality choice, access, and prescription: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2019; 96:37-47. [PMID: 30987837 DOI: 10.1016/j.kint.2019.01.017] [Citation(s) in RCA: 195] [Impact Index Per Article: 39.0] [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: 09/20/2018] [Revised: 12/21/2018] [Accepted: 01/04/2019] [Indexed: 02/06/2023]
Abstract
Globally, the number of patients undergoing maintenance dialysis is increasing, yet throughout the world there is significant variability in the practice of initiating dialysis. Factors such as availability of resources, reasons for starting dialysis, timing of dialysis initiation, patient education and preparedness, dialysis modality and access, as well as varied "country-specific" factors significantly affect patient experiences and outcomes. As the burden of end-stage kidney disease (ESKD) has increased globally, there has also been a growing recognition of the importance of patient involvement in determining the goals of care and decisions regarding treatment. In January 2018, KDIGO (Kidney Disease: Improving Global Outcomes) convened a Controversies Conference focused on dialysis initiation, including modality choice, access, and prescription. Here we present a summary of the conference discussions, including identified knowledge gaps, areas of controversy, and priorities for research. A major novel theme represented during the conference was the need to move away from a "one-size-fits-all" approach to dialysis and provide more individualized care that incorporates patient goals and preferences while still maintaining best practices for quality and safety. Identifying and including patient-centered goals that can be validated as quality indicators in the context of diverse health care systems to achieve equity of outcomes will require alignment of goals and incentives between patients, providers, regulators, and payers that will vary across health care jurisdictions.
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Affiliation(s)
| | - Peter J Blankestijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Laura M Dember
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maurizio Gallieni
- Department of Clinical and Biomedical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | | | - Charmaine E Lok
- University Health Network, University of Toronto, Ontario, Canada
| | - Rajnish Mehrotra
- Division of Nephrology, Kidney Research Institute and Harborview Medical Center, University of Washington, Seattle, Washington, USA
| | - Paul E Stevens
- Kent Kidney Care Centre, East Kent Hospitals, University NHS Foundation Trust, Canterbury, Kent, UK
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | | | | | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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31
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Chen T, Cao Q, Wang Y, Harris DCH. M2 macrophages in kidney disease: biology, therapies, and perspectives. Kidney Int 2019; 95:760-773. [PMID: 30827512 DOI: 10.1016/j.kint.2018.10.041] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [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: 08/17/2018] [Revised: 10/10/2018] [Accepted: 10/18/2018] [Indexed: 12/13/2022]
Abstract
Tissue macrophages are crucial players in homeostasis, inflammation, and immunity. They are characterized by heterogeneity and plasticity, due to which they display a continuum of phenotypes with M1/M2 presenting 2 extremes of this continuum. M2 macrophages are usually termed in the literature as anti-inflammatory and wound healing. Substantial progress has been made in elucidating the biology of M2 macrophages and their potential for clinical translation. In this review we discuss the current state of knowledge in M2 macrophage research with an emphasis on kidney disease. We explore their therapeutic potential and the challenges in using them as cellular therapies. Some new regulators that shape macrophage polarization and potential areas for future research are also examined.
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Affiliation(s)
- Titi Chen
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia; Center for Transplant and Renal Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia; Department of Renal Medicine, Westmead Hospital, Westmead, New South Wales, Australia.
| | - Qi Cao
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia; Center for Transplant and Renal Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Yiping Wang
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia; Center for Transplant and Renal Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - David C H Harris
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia; Center for Transplant and Renal Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia; Department of Renal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
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32
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Zhou JJ, Wang YM, Lee VWS, Zhang GY, Medbury H, Williams H, Wang Y, Tan TK, Harris DCH, Alexander SI, Durkan AM. DEC205-DC targeted DNA vaccine against CX3CR1 protects against atherogenesis in mice. PLoS One 2018; 13:e0195657. [PMID: 29641559 PMCID: PMC5895033 DOI: 10.1371/journal.pone.0195657] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 12/10/2017] [Accepted: 03/27/2018] [Indexed: 11/18/2022] Open
Abstract
Studies disrupting the chemokine pathway CX3CL1 (fractalkine)/ CX3CR1 have shown decreased atherosclerosis in animal models but the techniques used to interrupt the pathway have not been easily translatable into human trials. DNA vaccination potentially overcomes the translational difficulties. We evaluated the effect of a DNA vaccine, targeted to CX3CR1, on atherosclerosis in a murine model and examined possible mechanisms of action. DNA vaccination against CX3CR1, enhanced by dendritic cell targeting using DEC-205 single chain variable region fragment (scFv), was performed in 8 week old ApoE-/- mice, fed a normal chow diet. High levels of anti-CX3CR1 antibodies were induced in vaccinated mice. There were no apparent adverse reactions to the vaccine. Arterial vessels of 34 week old mice were examined histologically for atherosclerotic plaque size, macrophage infiltration, smooth muscle cell infiltration and lipid deposition. Vaccinated mice had significantly reduced atherosclerotic plaque in the brachiocephalic artery. There was less macrophage infiltration but no significant change to the macrophage phenotype in the plaques. There was less lipid deposition in the lesions, but there was no effect on smooth muscle cell migration. Targeted DNA vaccination to CX3CR1 was well tolerated, induced a strong immune response and resulted in attenuated atherosclerotic lesions with reduced macrophage infiltration. DNA vaccination against chemokine pathways potentially offers a potential therapeutic option for the treatment of atherosclerosis.
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Affiliation(s)
- Jimmy Jianheng Zhou
- Centre for Kidney Research, Children’s Hospital at Westmead, Westmead, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
| | - Yuan Min Wang
- Centre for Kidney Research, Children’s Hospital at Westmead, Westmead, NSW, Australia
| | - Vincent W. S. Lee
- University of Sydney, Sydney, NSW, Australia
- Centre for Transplantation and Renal Research, University of Sydney at Westmead Institute of Medical Research, Westmead, NSW, Australia
| | - Geoff Yu Zhang
- Centre for Kidney Research, Children’s Hospital at Westmead, Westmead, NSW, Australia
| | - Heather Medbury
- Vascular Biology Research Centre, Surgery, University of Sydney, Westmead Hospital, University of Sydney, Westmead, NSW, Australia
| | - Helen Williams
- Vascular Biology Research Centre, Surgery, University of Sydney, Westmead Hospital, University of Sydney, Westmead, NSW, Australia
| | - Ya Wang
- Centre for Transplantation and Renal Research, University of Sydney at Westmead Institute of Medical Research, Westmead, NSW, Australia
| | - Thian Kui Tan
- Centre for Transplantation and Renal Research, University of Sydney at Westmead Institute of Medical Research, Westmead, NSW, Australia
| | - David C. H. Harris
- University of Sydney, Sydney, NSW, Australia
- Centre for Transplantation and Renal Research, University of Sydney at Westmead Institute of Medical Research, Westmead, NSW, Australia
| | - Stephen I. Alexander
- Centre for Kidney Research, Children’s Hospital at Westmead, Westmead, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
| | - Anne M. Durkan
- Centre for Kidney Research, Children’s Hospital at Westmead, Westmead, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
- * E-mail:
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Cao Q, Wang Y, Wang C, Wang XM, Lee VWS, Zheng G, Zhao Y, Alexander SI, Harris DCH. Therapeutic potential of regulatory macrophages generated from peritoneal dialysate in adriamycin nephropathy. Am J Physiol Renal Physiol 2018; 314:F561-F571. [PMID: 29357438 DOI: 10.1152/ajprenal.00538.2017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cell therapy using macrophages requires large amounts of cells, which are difficult to collect from patients. Patients undergoing peritoneal dialysis (PD) discard huge numbers of peritoneal macrophages in dialysate daily. Macrophages can be modulated to become regulatory macrophages, which have shown great promise as a therapeutic strategy in experimental kidney disease and human kidney transplantation. This study aimed to examine the potential of using peritoneal macrophages (PMs) from peritoneal dialysate to treat kidney disease. Monocytes/macrophages accounted for >40% of total peritoneal leukocytes in both patients and mice undergoing PD. PMs from patients and mice undergoing PD were more mature than peripheral monocytes/macrophages, as shown by low expression of C-C motif chemokine receptor 2 (CCR2) and morphological changes during in vitro culture. PMs from patients and mice undergoing PD displayed normal macrophage function and could be modulated into a regulatory (M2) phenotype. In vivo, adoptive transfer of peritoneal M2 macrophages derived from PD mice effectively protected against kidney injury in mice with adriamycin nephropathy (AN). Importantly, the transfused peritoneal M2 macrophages maintained their M2 phenotype in kidney of AN mice. In conclusion, PMs derived from patients and mice undergoing PD exhibited conventional macrophage features. Peritoneal M2 macrophages derived from PD mice are able to reduce kidney injury in AN, suggesting that peritoneal macrophages from patients undergoing PD may have the potential for clinical therapeutic application.
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Affiliation(s)
- Qi Cao
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Yiping Wang
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Changqi Wang
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Xin M. Wang
- Flow Cytometry Facility, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Vincent W. S. Lee
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Guoping Zheng
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Ye Zhao
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Stephen I. Alexander
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - David C. H. Harris
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
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Wong ATY, Mannix C, Grantham JJ, Allman-Farinelli M, Badve SV, Boudville N, Byth K, Chan J, Coulshed S, Edwards ME, Erickson BJ, Fernando M, Foster S, Haloob I, Harris DCH, Hawley CM, Hill J, Howard K, Howell M, Jiang SH, Johnson DW, Kline TL, Kumar K, Lee VW, Lonergan M, Mai J, McCloud P, Peduto A, Rangan A, Roger SD, Sud K, Torres V, Vilayur E, Rangan GK. Randomised controlled trial to determine the efficacy and safety of prescribed water intake to prevent kidney failure due to autosomal dominant polycystic kidney disease (PREVENT-ADPKD). BMJ Open 2018; 8:e018794. [PMID: 29358433 PMCID: PMC5780847 DOI: 10.1136/bmjopen-2017-018794] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Maintaining fluid intake sufficient to reduce arginine vasopressin (AVP) secretion has been hypothesised to slow kidney cyst growth in autosomal dominant polycystic kidney disease (ADPKD). However, evidence to support this as a clinical practice recommendation is of poor quality. The aim of the present study is to determine the long-term efficacy and safety of prescribed water intake to prevent the progression of height-adjusted total kidney volume (ht-TKV) in patients with chronic kidney disease (stages 1-3) due to ADPKD. METHODS AND ANALYSIS A multicentre, prospective, parallel-group, open-label, randomised controlled trial will be conducted. Patients with ADPKD (n=180; age ≤65 years, estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m2) will be randomised (1:1) to either the control (standard treatment+usual fluid intake) or intervention (standard treatment+prescribed fluid intake) group. Participants in the intervention arm will be prescribed an individualised daily fluid intake to reduce urine osmolality to ≤270 mOsmol/kg, and supported with structured clinic and telephonic dietetic review, self-monitoring of urine-specific gravity, short message service text reminders and internet-based tools. All participants will have 6-monthly follow-up visits, and ht-TKV will be measured by MRI at 0, 18 and 36 months. The primary end point is the annual rate of change in ht-TKV as determined by serial renal MRI in control vs intervention groups, from baseline to 3 years. The secondary end points are differences between the two groups in systemic AVP activity, renal disease (eGFR, blood pressure, renal pain), patient adherence, acceptability and safety. ETHICS AND DISSEMINATION The trial was approved by the Human Research Ethics Committee, Western Sydney Local Health District. The results will inform clinicians, patients and policy-makers regarding the long-term safety, efficacy and feasibility of prescribed fluid intake as an approach to reduce kidney cyst growth in patients with ADPKD. TRIAL REGISTRATION NUMBER ANZCTR12614001216606.
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Affiliation(s)
- Annette T Y Wong
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | - Carly Mannix
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | - Jared J Grantham
- The Kidney Institute, Division of Nephrology and Hypertension, Kansas University Medical Center, Kansas City, Kansas, USA
| | - Margaret Allman-Farinelli
- School of Life and Environmental Sciences, The Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Sunil V Badve
- Department of Renal Medicine, St. George Hospital, Sydney, Australia
| | - Neil Boudville
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands and the Harry Perkins Institute of Medical Research, University of Western Australia, Sydney, Australia
| | - Karen Byth
- Research and Education Network, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | | | | | - Marie E Edwards
- Translational Polycystic Kidney Disease Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Bradley J Erickson
- Translational Polycystic Kidney Disease Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Mangalee Fernando
- Department of Renal Medicine, Prince of Wales Hospital, Eastern Sydney Health District and the University of New South Wales, Randwick, Australia
| | - Sheryl Foster
- Department of Radiology, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Imad Haloob
- Department of Renal Medicine, Bathurst Base Hospital, Bathurst, Australia
| | - David C H Harris
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | - Carmel M Hawley
- Australasian Kidney Trials Network, University of Queensland at Princess Alexandra Hospital, Woolloongabba, Australia
| | - Julie Hill
- McCloud Consulting Group, Gordon, Australia
| | - Kirsten Howard
- School of Public Health, University of Sydney, Sydney, Australia
| | - Martin Howell
- School of Public Health, University of Sydney, Sydney, Australia
| | - Simon H Jiang
- Department of Renal Medicine, Canberra Hospital, Garran, Australia
- Department of Immunology and Infectious Diseases, John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - David W Johnson
- Australasian Kidney Trials Network, University of Queensland at Princess Alexandra Hospital, Woolloongabba, Australia
| | - Timothy L Kline
- Translational Polycystic Kidney Disease Center, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Vincent W Lee
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
- Department of Renal Medicine, Norwest Private Hospital, Sydney, Australia
| | - Maureen Lonergan
- Department of Renal Medicine, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Jun Mai
- Department of Renal Medicine, Liverpool Hospital, Southwestern Sydney Local Health District, Liverpool, Australia
| | | | - Anthony Peduto
- Department of Radiology, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | - Anna Rangan
- School of Life and Environmental Sciences, The Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | | | - Kamal Sud
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
- Department of Renal Medicine, Nepean Hospital, Nepean Blue Mountains Local Health District, Sydney, Australia
- Nepean Clinical School, The University of Sydney Medical School, Sydney, Australia
| | - Vincent Torres
- Translational Polycystic Kidney Disease Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Eswari Vilayur
- Department of Nephrology, John Hunter Hospital, Newcastle, Australia
| | - Gopala K Rangan
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
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Zhao Y, Qiao X, Tan TK, Zhao H, Zhang Y, Liu L, Zhang J, Wang L, Cao Q, Wang Y, Wang Y, Wang YM, Lee VWS, Alexander SI, Harris DCH, Zheng G. Matrix metalloproteinase 9-dependent Notch signaling contributes to kidney fibrosis through peritubular endothelial-mesenchymal transition. Nephrol Dial Transplant 2018; 32:781-791. [PMID: 27566305 PMCID: PMC5427520 DOI: 10.1093/ndt/gfw308] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 10/30/2015] [Accepted: 07/12/2016] [Indexed: 11/28/2022] Open
Abstract
Background: Endothelial cells are known to contribute to kidney fibrosis via endothelial–mesenchymal transition (EndoMT). Matrix metalloproteinase 9 (MMP-9) is known to be profibrotic. However, whether MMP-9 contributes to kidney fibrosis via EndoMT is unknown. Methods: Primary mouse renal peritubular endothelial cells (MRPECs) were isolated and treated by recombinant human transforming growth factor beta 1 (rhTGF-β1) with or without MMP-9 inhibitor or by recombinant human MMP-9 (rhMMP-9) alone. Kidney fibrosis was induced by unilateral ureteral obstruction (UUO) in MMP-9 knockout (KO) and wide-type (WT) control mice. The effects of MMP-9 on EndoMT of MRPECs and kidney fibrosis were examined. Results: We showed that MRPECs underwent EndoMT after rhTGF-β1 treatment or in UUO kidney as evidenced by decreased expression of endothelial markers, vascular endothelial cadherin (VE-cadherin) and CD31, and increased levels of mesenchymal markers, α-smooth muscle actin (α-SMA) and vimentin. The expression of fibrosis markers was also up-regulated significantly after rhTGF-β1 treatment in MRPECs. The EndoMT and fibrosis markers were significantly less in rhTGF-β1-treated MMP-9 KO MRPECs, whereas MMP-9 alone was sufficient to induce EndoMT in MRPECs. UUO kidney of MMP-9 KO mice showed significantly less interstitial fibrosis and EndoMT in MRPECs. Notch signaling shown by Notch intracellular domain (NICD) was increased, while Notch-1 was decreased in rhTGF-β1-treated MRPECs of MMP-9 WT but not MMP-9 KO mice. Inhibition of MMP-9 or Notch signaling prevented rhTGF-β1- or rhMMP-9-induced α-SMA and NICD upregulation in MRPECs. UUO kidney of MMP-9 KO mice had less staining of Notch signaling transcription factor Hey-1 in VE-cadherin-positive MRPECs than WT controls. Conclusions: Our results demonstrate that MMP-9-dependent Notch signaling plays an important role in kidney fibrosis through EndoMT of MRPECs.
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Affiliation(s)
- Ye Zhao
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia.,The School of Biomedical Sciences, Chengdu Medical College, Chengdu, People's Republic of China
| | - Xi Qiao
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia.,Department of Nephrology, Second Hospital of Shanxi Medical University, Shanxi Kidney Disease Institute, Taiyuan, Shanxi, People's Republic of China
| | - Thian Kui Tan
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Hong Zhao
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia.,Department of Biochemistry and Molecular Biology, Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China
| | - Yun Zhang
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia.,Experimental Centre of Science and Research, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China
| | - Lixin Liu
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia.,Experimental Centre of Science and Research, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China
| | - Jianlin Zhang
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia.,Department of Biochemistry and Molecular Biology, Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China
| | - Lihua Wang
- Department of Nephrology, Second Hospital of Shanxi Medical University, Shanxi Kidney Disease Institute, Taiyuan, Shanxi, People's Republic of China
| | - Qi Cao
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Yiping Wang
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Ya Wang
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Yuan Min Wang
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Vincent W S Lee
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Stephen I Alexander
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - David C H Harris
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Guoping Zheng
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
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Cao Q, Wang Y, Niu Z, Wang C, Wang R, Zhang Z, Chen T, Wang XM, Li Q, Lee VWS, Huang Q, Tan J, Guo M, Wang YM, Zheng G, Yu D, Alexander SI, Wang H, Harris DCH. Potentiating Tissue-Resident Type 2 Innate Lymphoid Cells by IL-33 to Prevent Renal Ischemia-Reperfusion Injury. J Am Soc Nephrol 2018; 29:961-976. [PMID: 29295873 DOI: 10.1681/asn.2017070774] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [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: 07/16/2017] [Accepted: 11/23/2017] [Indexed: 12/21/2022] Open
Abstract
The IL-33-type 2 innate lymphoid cell (ILC2) axis has an important role in tissue homeostasis, inflammation, and wound healing. However, the relative importance of this innate immune pathway for immunotherapy against inflammation and tissue damage remains unclear. Here, we show that treatment with recombinant mouse IL-33 prevented renal structural and functional injury and reduced mortality in mice subjected to ischemia-reperfusion injury (IRI). Compared with control-treated IRI mice, IL-33-treated IRI mice had increased levels of IL-4 and IL-13 in serum and kidney and more ILC2, regulatory T cells (Tregs), and anti-inflammatory (M2) macrophages. Depletion of ILC2, but not Tregs, substantially abolished the protective effect of IL-33 on renal IRI. Adoptive transfer of ex vivo-expanded ILC2 prevented renal injury in mice subjected to IRI. This protective effect associated with induction of M2 macrophages in kidney and required ILC2 production of amphiregulin. Treatment of mice with IL-33 or ILC2 after IRI was also renoprotective. Furthermore, in a humanized mouse model of renal IRI, treatment with human IL-33 or transfer of ex vivo-expanded human ILC2 ameliorated renal IRI. This study has uncovered a major protective role of the IL-33-ILC2 axis in renal IRI that could be potentiated as a therapeutic strategy.
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Affiliation(s)
- Qi Cao
- Centre for Transplant and Renal Research and .,Henan Key Laboratory of Immunology and Targeted Therapy, and.,Henan Collaborative Innovation Center of Molecular Diagnosis and Laboratory Medicine, Xinxiang Medical University, Xinxiang, China
| | - Yiping Wang
- Centre for Transplant and Renal Research and
| | - Zhiguo Niu
- Henan Key Laboratory of Immunology and Targeted Therapy, and.,Henan Collaborative Innovation Center of Molecular Diagnosis and Laboratory Medicine, Xinxiang Medical University, Xinxiang, China
| | | | | | | | - Titi Chen
- Centre for Transplant and Renal Research and
| | - Xin Maggie Wang
- Flow Cytometry Facility, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Qing Li
- Centre for Transplant and Renal Research and
| | | | - Qingsong Huang
- Henan Key Laboratory of Immunology and Targeted Therapy, and.,Henan Collaborative Innovation Center of Molecular Diagnosis and Laboratory Medicine, Xinxiang Medical University, Xinxiang, China
| | - Jing Tan
- Department of Nephrology, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Minghao Guo
- Department of Nephrology, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Yuan Min Wang
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, New South Wales, Australia; and
| | | | - Di Yu
- Department of Immunology and Infectious Disease, John Curtin School of Medical Research, The Australian National University, Canberra, Australia
| | - Stephen I Alexander
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, New South Wales, Australia; and
| | - Hui Wang
- Henan Key Laboratory of Immunology and Targeted Therapy, and .,Henan Collaborative Innovation Center of Molecular Diagnosis and Laboratory Medicine, Xinxiang Medical University, Xinxiang, China
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Qiao X, Rao P, Zhang Y, Liu L, Pang M, Wang H, Hu M, Tian X, Zhang J, Zhao Y, Wang XM, Wang C, Yu H, Guo F, Cao Q, Wang Y, Wang YM, Zhang GY, Lee VW, Alexander SI, Zheng G, Harris DCH. Redirecting TGF- β Signaling through the β-Catenin/Foxo Complex Prevents Kidney Fibrosis. J Am Soc Nephrol 2017; 29:557-570. [PMID: 29180394 DOI: 10.1681/asn.2016121362] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [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: 12/25/2016] [Accepted: 10/25/2017] [Indexed: 01/09/2023] Open
Abstract
TGF-β is a key profibrotic factor, but targeting TGF-β to prevent fibrosis also abolishes its protective anti-inflammatory effects. Here, we investigated the hypothesis that we can redirect TGF-β signaling by preventing downstream profibrotic interaction of β-catenin with T cell factor (TCF), thereby enhancing the interaction of β-catenin with Foxo, a transcription factor that controls differentiation of TGF-β induced regulatory T cells (iTregs), and thus, enhance anti-inflammatory effects of TGF-β In iTregs derived from EL4 T cells treated with recombinant human TGF-β1 (rhTGF-β1) in vitro, inhibition of β-catenin/TCF transcription with ICG-001 increased Foxp3 expression, interaction of β-catenin and Foxo1, binding of Foxo1 to the Foxp3 promoter, and Foxo transcriptional activity. Moreover, the level of β-catenin expression positively correlated with the level of Foxo1 binding to the Foxp3 promoter and Foxo transcriptional activity. T cell fate mapping in Foxp3gfp Ly5.1/5.2 mice revealed that coadministration of rhTGF-β1 and ICG-001 further enhanced the expansion of iTregs and natural Tregs observed with rhTGF-β1 treatment alone. Coadministration of rhTGF-β1 with ICG-001 also increased the number of Tregs and reduced inflammation and fibrosis in the kidney fibrosis models of unilateral ureteric obstruction and ischemia-reperfusion injury. Notably, ICG-001 prevented the fibrosis in distant organs (lung and liver) caused by rhTGF-β1. Together, our results show that diversion of β-catenin from TCF- to Foxo-mediated transcription inhibits the β-catenin/TCF-mediated profibrotic effects of TGF-β while enhancing the β-catenin/Foxo-mediated anti-inflammatory effects. Targeting β-catenin/Foxo may be a novel therapeutic strategy in the treatment of fibrotic diseases that lead to organ failure.
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Affiliation(s)
- Xi Qiao
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia.,Department of Nephrology, Shanxi Kidney Disease Institute and
| | - Padmashree Rao
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Yun Zhang
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia.,Experimental Centre of Science and Research and
| | - Lixin Liu
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia.,Experimental Centre of Science and Research and
| | - Min Pang
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia.,Department of Respiratory Medicine, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China
| | - Hailong Wang
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia.,Department of Biochemistry and Molecular Biology, Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China
| | - Min Hu
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Xinrui Tian
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia.,Department of Respiratory Medicine, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China
| | - Jianlin Zhang
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia.,Department of Biochemistry and Molecular Biology, Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China
| | - Ye Zhao
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Chengshi Wang
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Hong Yu
- Cell Imaging Facility, The Westmead Institute for Medical Research, Westmead, New South Wales, Australia; and
| | - Fei Guo
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Qi Cao
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Yiping Wang
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Yuan Min Wang
- Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, New South Wales, Australia
| | - Geoff Yu Zhang
- Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, New South Wales, Australia
| | - Vincent W Lee
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Stephen I Alexander
- Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, New South Wales, Australia
| | - Guoping Zheng
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia;
| | - David C H Harris
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
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Li X, Yu D, Yu N, Wang X, Li X, Harris DCH, Wang Y. B7-H4 deficiency in salivary gland of patients with primary Sjögren's syndrome impairs the regulatory effect on T cells. Int J Rheum Dis 2017; 20:474-480. [PMID: 28217953 DOI: 10.1111/1756-185x.13041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
AIM Our previous study confirmed the defect of B7-H4 expression in peripheral blood and salivary glands of patients with primary Sjögren's syndrome (pSS). The aim of this study was to analyze the effect of the deficit expression of B7-H4 on CD4+ T cells. METHODS CD4+ T cells were purified by magnetic-activated cell sorting MACS. The proliferation and cytokine production of CD4+ T cells co-cultured with purified salivary gland epithelial cells (SGECs) from pSS or non-SS sicca syndrome were detected. RESULTS By co-culturing the gland cells with CD4+ T cells, we found the proliferation of CD4+ T cells was significantly suppressed. The effect was weaker when SGECs from pSS patients were used compared to that from non-pSS sicca syndrome controls. Simultaneously, the productions of cytokines interleukin (IL)-5, IL-13, IL-17A, IL-6 in supernatant were reduced and also SGECs from pSS patients decreased them less than that from non-SS controls. CONCLUSIONS The decrease of B7-H4 expression in salivary glands of SS patients contributes to the defect of negatively regulating the inflammation caused by CD4+ T cells, thereby providing new insights into the role of B7-H4 in the inflammatory process of salivary glands in SS.
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Affiliation(s)
- Xiaomei Li
- Department of Rheumatology and Immunology, Affiliated Anhui Provincial Hospital, Anhui Medical University, Hefei, Anhui
| | - Daliang Yu
- Department of Rheumatology and Immunology, Affiliated Anhui Provincial Hospital, Anhui Medical University, Hefei, Anhui.,Department of Nephrology, Renmin Hospital of Three Gorges University, Yichang, China
| | - Ning Yu
- Department of Rheumatology and Immunology, Affiliated Anhui Provincial Hospital, Anhui Medical University, Hefei, Anhui
| | - Ximei Wang
- Department of Rheumatology and Immunology, Affiliated Anhui Provincial Hospital, Anhui Medical University, Hefei, Anhui
| | - Xiangpei Li
- Department of Rheumatology and Immunology, Affiliated Anhui Provincial Hospital, Anhui Medical University, Hefei, Anhui
| | - David C H Harris
- Centre for Transplantation and Renal Research, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Yiping Wang
- Centre for Transplantation and Renal Research, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
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Hu M, Wang YM, Wang Y, Zhang GY, Zheng G, Yi S, O'Connell PJ, Harris DCH, Alexander SI. Regulatory T cells in kidney disease and transplantation. Kidney Int 2016; 90:502-14. [PMID: 27263492 DOI: 10.1016/j.kint.2016.03.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [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: 10/15/2015] [Revised: 03/06/2016] [Accepted: 03/17/2016] [Indexed: 01/03/2023]
Abstract
Regulatory T cells (Tregs) have been shown to be important in maintaining immune homeostasis and preventing autoimmune disease, including autoimmune kidney disease. It is also likely that they play a role in limiting kidney transplant rejection and potentially in promoting transplant tolerance. Although other subsets of Tregs exist, the most potent and well-defined Tregs are the Foxp3 expressing CD4(+) Tregs derived from the thymus or generated peripherally. These CD4(+)Foxp3(+) Tregs limit autoimmune renal disease in animal models, especially chronic kidney disease, and kidney transplantation. Furthermore, other subsets of Tregs, including CD8 Tregs, may play a role in immunosuppression in kidney disease. The development and protective mechanisms of Tregs in kidney disease and kidney transplantation involve multiple mechanisms of suppression. Here we review the development and function of CD4(+)Foxp3(+) Tregs. We discuss the specific application of Tregs as a therapeutic strategy to prevent kidney disease and to limit kidney transplant rejection and detail clinical trials in this area of transplantation.
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Affiliation(s)
- Min Hu
- Centre for Transplantation and Renal Research, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, University of Sydney, Westmead, New South Wales, Australia
| | - Yuan Min Wang
- Centre for Kidney Research, The Children's Hospital at Westmead, University of Sydney, Westmead, New South Wales, Australia
| | - Yiping Wang
- Centre for Transplantation and Renal Research, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia
| | - Geoff Y Zhang
- Centre for Kidney Research, The Children's Hospital at Westmead, University of Sydney, Westmead, New South Wales, Australia
| | - Guoping Zheng
- Centre for Transplantation and Renal Research, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia
| | - Shounan Yi
- Centre for Transplantation and Renal Research, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia
| | - Philip J O'Connell
- Centre for Transplantation and Renal Research, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia
| | - David C H Harris
- Centre for Transplantation and Renal Research, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia
| | - Stephen I Alexander
- Centre for Kidney Research, The Children's Hospital at Westmead, University of Sydney, Westmead, New South Wales, Australia.
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40
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Zheng G, Zhang J, Zhao H, Wang H, Pang M, Qiao X, Lee SR, Hsu TT, Tan TK, Lyons JG, Zhao Y, Tian X, Loebel DAF, Rubera I, Tauc M, Wang Y, Wang Y, Wang YM, Cao Q, Wang C, Lee VWS, Alexander SI, Tam PPL, Harris DCH. α3 Integrin of Cell-Cell Contact Mediates Kidney Fibrosis by Integrin-Linked Kinase in Proximal Tubular E-Cadherin Deficient Mice. Am J Pathol 2016; 186:1847-1860. [PMID: 27182643 DOI: 10.1016/j.ajpath.2016.03.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 02/15/2016] [Accepted: 03/17/2016] [Indexed: 01/25/2023]
Abstract
Loss of E-cadherin marks a defect in epithelial integrity and polarity during tissue injury and fibrosis. Whether loss of E-cadherin plays a causal role in fibrosis is uncertain. α3β1 Integrin has been identified to complex with E-cadherin in cell-cell adhesion, but little is known about the details of their cross talk. Herein, E-cadherin gene (Cdh1) was selectively deleted from proximal tubules of murine kidney by Sglt2Cre. Ablation of E-cadherin up-regulated α3β1 integrin at cell-cell adhesion. E-cadherin-deficient proximal tubular epithelial cell displayed enhanced transforming growth factor-β1-induced α-smooth muscle actin (α-SMA) and vimentin expression, which was suppressed by siRNA silencing of α3 integrin, but not β1 integrin. Up-regulation of transforming growth factor-β1-induced α-SMA was mediated by an α3 integrin-dependent increase in integrin-linked kinase (ILK). Src phosphorylation of β-catenin and consequent p-β-catenin-Y654/p-Smad2 transcriptional complex underlies the transcriptional up-regulation of ILK. Kidney fibrosis after unilateral ureteric obstruction or ischemia reperfusion was increased in proximal tubule E-cadherin-deficient mice in comparison to that of E-cadherin intact control mice. The exacerbation of fibrosis was explained by the α3 integrin-dependent increase of ILK, β-catenin nuclear translocation, and α-SMA/proximal tubular-specific Cre double positive staining in proximal tubular epithelial cell. These studies delineate a nonconventional integrin/ILK signaling by α3 integrin-dependent Src/p-β-catenin-Y654/p-Smad2-mediated up-regulation of ILK through which loss of E-cadherin leads to kidney fibrosis.
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Affiliation(s)
- Guoping Zheng
- Centre for Transplantation and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney, Australia.
| | - Jianlin Zhang
- Centre for Transplantation and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney, Australia; Department of Biochemistry and Molecular Biology, Shanxi Medical University, Taiyuan, People's Republic of China
| | - Hong Zhao
- Centre for Transplantation and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney, Australia; Department of Biochemistry and Molecular Biology, Shanxi Medical University, Taiyuan, People's Republic of China
| | - Hailong Wang
- Centre for Transplantation and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney, Australia; Department of Biochemistry and Molecular Biology, Shanxi Medical University, Taiyuan, People's Republic of China
| | - Min Pang
- Centre for Transplantation and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney, Australia; Department of Respiratory Medicine, the First Hospital of Shanxi Medical University, Taiyuan, People's Republic of China
| | - Xi Qiao
- Centre for Transplantation and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney, Australia; Department of Renal Medicine, the Second Hospital of Shanxi Medical University, Taiyuan, People's Republic of China
| | - So R Lee
- Centre for Transplantation and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney, Australia
| | - Tzu-Ting Hsu
- Centre for Transplantation and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney, Australia
| | - Thian K Tan
- Centre for Transplantation and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney, Australia
| | - J Guy Lyons
- Sydney Head and Neck Cancer Institute, Sydney Cancer Centre, Royal Prince Alfred Hospital, Centenary Institute and Department of Dermatology, University of Sydney, Sydney, Australia
| | - Ye Zhao
- Centre for Transplantation and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney, Australia
| | - Xinrui Tian
- Department of Respiratory Medicine, the Second Hospital of Shanxi Medical University, Taiyuan, People's Republic of China
| | - David A F Loebel
- Embryology Unit, Children's Medical Research Institute, and Sydney Medical School, University of Sydney, Sydney, Australia
| | - Isabella Rubera
- Laboratory of Molecular Physio-Medicine, National Centre for Scientific Research, University of Nice-Sophia Antipolis, Parc Valrose, Nice, France
| | - Michel Tauc
- Laboratory of Molecular Physio-Medicine, National Centre for Scientific Research, University of Nice-Sophia Antipolis, Parc Valrose, Nice, France
| | - Ya Wang
- Centre for Transplantation and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney, Australia
| | - Yiping Wang
- Centre for Transplantation and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney, Australia
| | - Yuan M Wang
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, Australia
| | - Qi Cao
- Centre for Transplantation and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney, Australia
| | - Changqi Wang
- Centre for Transplantation and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney, Australia
| | - Vincent W S Lee
- Centre for Transplantation and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney, Australia
| | - Stephen I Alexander
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, Australia
| | - Patrick P L Tam
- Embryology Unit, Children's Medical Research Institute, and Sydney Medical School, University of Sydney, Sydney, Australia
| | - David C H Harris
- Centre for Transplantation and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney, Australia
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41
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Pang M, Wang H, Rao P, Zhao Y, Xie J, Cao Q, Wang Y, Wang YM, Lee VW, Alexander SI, Harris DCH, Zheng G. Autophagy links β-catenin and Smad signaling to promote epithelial-mesenchymal transition via upregulation of integrin linked kinase. Int J Biochem Cell Biol 2016; 76:123-34. [PMID: 27177845 DOI: 10.1016/j.biocel.2016.05.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [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: 11/17/2015] [Revised: 03/26/2016] [Accepted: 05/08/2016] [Indexed: 10/21/2022]
Abstract
TGF-β1 induces epithelial-mesenchymal transition (EMT) and autophagy in a variety of cells. However, the role of autophagy in TGF-β1-induced EMT has not been clearly elucidated and the underlying mechanisms are unclear. In the present study, we found that TGF-β1 induced both autophagy and EMT in mouse tubular epithelial C1.1 cells. Inhibition of autophagy by 3-methyladenine or siRNA knockdown of Beclin 1 reduced TGF-β1-induced increase of vimentin and decreased E-cadherin expression. In contrast, rapamycin-associated enhancement of TGF-β1-induced autophagy increased EMT of C1.1 cells. Serum rescue inhibited autophagy followed by reversal of EMT. Blocking of autophagosome-lysosomal but not proteosomal degradation reduced the decrease of E-cadherin, demonstrating a role for autophagy in degradation of E-cadherin during EMT. Autophagy promoted the activation of Src and Src-associated phosphorylation of β-catenin at Y-654 leading to pY654-β-catenin/p-Smad2 complex formation. Chromatin immunoprecipitation assay demonstrated binding by the pY654-β-catenin/p-Smad2 complex to ILK promoter thus increasing ILK expression. Taken together, our results demonstrate that TGF-β1-induced autophagy links β-catenin and Smad signaling to promote EMT in C1.1 cells through a novel pY654-β-catenin/p-Smad2/ILK pathway. The pathway delineated links disruption of E-cadherin/β-catenin-mediated cell-cell contact to induction of EMT via upregulation of ILK.
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Affiliation(s)
- Min Pang
- Centre for Transplantation and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney NSW 2145, Australia; Dept. of Respiratory Medicine, First Hospital of Shanxi Medical University, Taiyuan 030001, PR China
| | - Hailong Wang
- Centre for Transplantation and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney NSW 2145, Australia; Dept. of Biochemistry and Molecular Biology, Shanxi Medical University, Taiyuan 030001, PR China
| | - Padmashree Rao
- Centre for Transplantation and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney NSW 2145, Australia
| | - Ye Zhao
- Centre for Transplantation and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney NSW 2145, Australia
| | - Jun Xie
- Dept. of Biochemistry and Molecular Biology, Shanxi Medical University, Taiyuan 030001, PR China
| | - Qi Cao
- Centre for Transplantation and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney NSW 2145, Australia
| | - Yiping Wang
- Centre for Transplantation and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney NSW 2145, Australia
| | - Yuan Min Wang
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney NSW 2145, Australia
| | - Vincent W Lee
- Centre for Transplantation and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney NSW 2145, Australia
| | - Stephen I Alexander
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney NSW 2145, Australia
| | - David C H Harris
- Centre for Transplantation and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney NSW 2145, Australia
| | - Guoping Zheng
- Centre for Transplantation and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney NSW 2145, Australia; Dept. of Biochemistry and Molecular Biology, Shanxi Medical University, Taiyuan 030001, PR China.
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42
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Zhao Y, Qiao X, Wang L, Tan TK, Zhao H, Zhang Y, Zhang J, Rao P, Cao Q, Wang Y, Wang Y, Wang YM, Lee VWS, Alexander SI, Harris DCH, Zheng G. Matrix metalloproteinase 9 induces endothelial-mesenchymal transition via Notch activation in human kidney glomerular endothelial cells. BMC Cell Biol 2016; 17:21. [PMID: 27130612 PMCID: PMC4850690 DOI: 10.1186/s12860-016-0101-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [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: 11/14/2015] [Accepted: 04/22/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Endothelial-mesenchymal transition (EndoMT) is a major source of myofibroblast formation in kidney fibrosis. Our previous study showed a profibrotic role for matrix metalloproteinase 9 (MMP-9) in kidney fibrosis via induction of epithelial-mesenchymal transition (EMT). Inhibition of MMP-9 activity reduced kidney fibrosis in murine unilateral ureteral obstruction. This study investigated whether MMP-9 also plays a role in EndoMT in human glomerular endothelial cells. RESULTS TGF-β1 (10 or 20 ng/ml) induced EndoMT in HKGECs as shown by morphological changes. In addition, VE-cadherin and CD31 were significantly downregulated, whereas α-SMA, vimentin, and N-cadherin were upregulated. RT-PCR revealed that Snail, a known inducer of EMT, was upregulated. The MMP inhibitor GM6001 abrogated TGF-β1-induced EndoMT. Zymography indicated that MMP-9 was also upregulated in TGF-β1-treated HKGECs. Recombinant MMP-9 (2 μg/ml) induced EndoMT in HKGECs via Notch signaling, as evidenced by increased formation of the Notch intracellular domain (NICD) and decreased Notch 1. Inhibition of MMP-9 activity by its inhibitor showed a dose-dependent response in preventing TGF-β1-induced α-SMA and NICD in HKGECs, whereas inhibition of Notch signaling by γ-secretase inhibitor (GSI) blocked rMMP-9-induced EndoMT. CONCLUSIONS Taken together, our results demonstrate that MMP-9 plays an important role in TGF-β1-induced EndoMT via upregulation of Notch signaling in HKGECs.
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Affiliation(s)
- Ye Zhao
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, the University of Sydney, 176 Hawkesbury Road, Sydney, NSW, 2145, Australia.,The School of Biomedical Sciences, Chengdu Medical College, Chengdu, 610500, PR China
| | - Xi Qiao
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, the University of Sydney, 176 Hawkesbury Road, Sydney, NSW, 2145, Australia.,Department of Nephrology, Second Hospital of Shanxi Medical University, Shanxi Kidney Disease Institute, WuYi Road 382, Taiyuan, 030001, Shanxi, PR China
| | - Lihua Wang
- Department of Nephrology, Second Hospital of Shanxi Medical University, Shanxi Kidney Disease Institute, WuYi Road 382, Taiyuan, 030001, Shanxi, PR China
| | - Tian Kui Tan
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, the University of Sydney, 176 Hawkesbury Road, Sydney, NSW, 2145, Australia
| | - Hong Zhao
- Department of Biochemistry and Molecular Biology, Shanxi Medical University, Xinjian Road 56, Taiyuan, 030001, Shanxi, PR China
| | - Yun Zhang
- Experimental Centre of Science and Research, the First Clinical Hospital of Shanxi Medical University, Xinjian Road 382, Taiyuan, 030001, Shanxi, PR China
| | - Jianlin Zhang
- Department of Biochemistry and Molecular Biology, Shanxi Medical University, Xinjian Road 56, Taiyuan, 030001, Shanxi, PR China
| | - Padmashree Rao
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, the University of Sydney, 176 Hawkesbury Road, Sydney, NSW, 2145, Australia
| | - Qi Cao
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, the University of Sydney, 176 Hawkesbury Road, Sydney, NSW, 2145, Australia
| | - Yiping Wang
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, the University of Sydney, 176 Hawkesbury Road, Sydney, NSW, 2145, Australia
| | - Ya Wang
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, the University of Sydney, 176 Hawkesbury Road, Sydney, NSW, 2145, Australia
| | - Yuan Min Wang
- Centre for Kidney Research, Children's Hospital at Westmead, 212 Hawkesbury Road, Sydney, NSW, Australia
| | - Vincent W S Lee
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, the University of Sydney, 176 Hawkesbury Road, Sydney, NSW, 2145, Australia
| | - Stephen I Alexander
- Centre for Kidney Research, Children's Hospital at Westmead, 212 Hawkesbury Road, Sydney, NSW, Australia
| | - David C H Harris
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, the University of Sydney, 176 Hawkesbury Road, Sydney, NSW, 2145, Australia
| | - Guoping Zheng
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, the University of Sydney, 176 Hawkesbury Road, Sydney, NSW, 2145, Australia.
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Abstract
Macrophages are found in normal kidney and in increased numbers in diseased kidney, where they act as key players in renal injury, inflammation, and fibrosis. Macrophages are highly heterogeneous cells and exhibit distinct phenotypic and functional characteristics in response to various stimuli in the local microenvironment in different types of kidney disease. In kidney tissue necrosis and/or infection, damage- and/or pathogen-associated molecular patterns induce pro-inflammatory macrophages, which contribute to further tissue injury, inflammation, and subsequent fibrosis. Apoptotic cells and anti-inflammatory factors in post-inflammatory tissues induced anti-inflammatory macrophages, which can mediate kidney repair and regeneration. This review summarizes the role of macrophages with different phenotypes in kidney injury, inflammation, and fibrosis in various acute and chronic kidney diseases. Understanding alterations of kidney microenvironment and the factors that control the phenotype and functions of macrophages may offer an avenue for the development of new cellular and cytokine/growth factor-based therapies as alternative treatment options for patients with kidney disease.
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Affiliation(s)
- Qi Cao
- Centre for Transplant and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney, New South Wales, Australia
| | - David C H Harris
- Centre for Transplant and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Yiping Wang
- Centre for Transplant and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney, New South Wales, Australia
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Sun Y, Wang Y, Cao Q, Yu H, Zheng D, Wang Y, Harris DCH. Expression and Role of CD166 in the Chronic Kidney Disease. Iran J Pediatr 2015; 25:e543. [PMID: 26495101 PMCID: PMC4610341 DOI: 10.5812/ijp.543] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 02/05/2015] [Accepted: 02/16/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND CD166, an adhesion molecule of the immunoglobulin superfamily, is one of the crucial effectors that traffic lymphocytes into tissues. Till now, the expression and role of CD166 in the chronic kidney disease remains unknown. OBJECTIVES In the present study, we are to examine the expression of CD166 in the chronic kidney disease, and to explore its function with CD4+ T cells. MATERIALS AND METHODS CD166 expression was tested by Flow Cytometry (FACS) in the primary macrophages stimulated with LPS. In vivo, the expression of CD166 and CD4 were examined in the kidney tissues of adriamycin-induced nephropathy (AN) mice by immnohistochemistry. Macrophages and lymphocytes were co-cultured, the interaction between CD166 and CD4 was tested by immunofluorescent staining. Furthermore, the effects of CD166 on the activation and proliferation of T cells were explored. RESULTS In this study, CD166 expression was found to be upregulated on activated macrophages and glomerular endothelia in the adriamycin-induced nephropathy (AN) mice and CD4+ T cells were increased with CD166 expression in the AN mice. The interaction between macrophages and CD4+ T cells indicated that CD166 played a key role in the recruitment of lymphocytes in the chronic kidney disease, and neither proliferation nor activation of T cells was affected by CD166. CONCLUSIONS CD166 expressed on macrophages and endothelia in AN kidney, and the function was related to the recruitment of CD4+ T cells into inflamed kidney, indicating that CD166 may be a potential target for reducing the inflammatory infiltrates in the chronic kidney disease.
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Affiliation(s)
- Yan Sun
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
- Corresponding author: Yan Sun, Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China. Tel: +86-15168889589, E-mail:
| | - Yiping Wang
- Centre for Transplantation and Renal Research, University of Sydney at Westmead Millennium Institute, Sydney, Australia
| | - Qi Cao
- Centre for Transplantation and Renal Research, University of Sydney at Westmead Millennium Institute, Sydney, Australia
| | - Hong Yu
- The High Tech Centre, Westmead Millennium Institute, University of Sydney Westmead, Sydney, Australia
| | - Dong Zheng
- Centre for Transplantation and Renal Research, University of Sydney at Westmead Millennium Institute, Sydney, Australia
| | - Ya Wang
- Centre for Transplantation and Renal Research, University of Sydney at Westmead Millennium Institute, Sydney, Australia
| | - David C. H. Harris
- Centre for Transplantation and Renal Research, University of Sydney at Westmead Millennium Institute, Sydney, Australia
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Cao Q, Lu J, Li Q, Wang C, Wang XM, Lee VWS, Wang C, Nguyen H, Zheng G, Zhao Y, Alexander SI, Wang Y, Harris DCH. CD103+ Dendritic Cells Elicit CD8+ T Cell Responses to Accelerate Kidney Injury in Adriamycin Nephropathy. J Am Soc Nephrol 2015; 27:1344-60. [PMID: 26376858 DOI: 10.1681/asn.2015030229] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 07/31/2015] [Indexed: 12/22/2022] Open
Abstract
CD103(+) dendritic cells (DCs) in nonlymphoid organs exhibit two main functions: maintaining tolerance by induction of regulatory T cells and protecting against tissue infection through cross-presentation of foreign antigens to CD8(+) T cells. However, the role of CD103(+) DCs in kidney disease is unknown. In this study, we show that CD103(+) DCs are one of four subpopulations of renal mononuclear phagocytes in normal kidneys. CD103(+) DCs expressed DC-specific surface markers, transcription factors, and growth factor receptors and were found in the kidney cortex but not in the medulla. The number of kidney CD103(+) DCs was significantly higher in mice with adriamycin nephropathy (AN) than in normal mice, and depletion of CD103(+) DCs attenuated kidney injury in AN mice. In vitro, kidney CD103(+) DCs preferentially primed CD8(+) T cells and did not directly induce tubular epithelial cell apoptosis. Adoptive transfer of CD8(+) T cells significantly exacerbated kidney injury in AN SCID mice, whereas depletion of CD103(+) DCs in these mice impaired activation and proliferation of transfused CD8(+) T cells and prevented the exacerbation of kidney injury associated with this transfusion. In conclusion, kidney CD103(+) DCs display a pathogenic role in murine CKD via activation of CD8(+) T cells.
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Affiliation(s)
- Qi Cao
- Centre for Transplant and Renal Research and
| | - Junyu Lu
- Emergency Department, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China; and
| | - Qing Li
- Centre for Transplant and Renal Research and
| | | | - Xin Maggie Wang
- Flow Cytometry Facility, Westmead Millennium Institute, University of Sydney, Sydney, New South Wales, Australia
| | | | | | - Hanh Nguyen
- Centre for Transplant and Renal Research and
| | | | - Ye Zhao
- Centre for Transplant and Renal Research and
| | - Stephen I Alexander
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Yiping Wang
- Centre for Transplant and Renal Research and
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Abstract
Human membranous nephritis is a major cause of end-stage kidney disease. Active Heymann nephritis (HN) is an auto-immune model of membranous nephritis induced in Lewis rats by immunization with a crude renal tubular antigen (Fx1A) or megalin (gp330). The pathogenesis of HN is through the binding of anti-Fx1A autoantibodies to the auto-antigen expressed on glomerular epithelial cells, resulting in severe glomerular injury and proteinuria. The pathological features of HN include immune deposits in glomeruli and infiltration of glomeruli and the tubulointerstitium by macrophages and T cells. This unit describes the method of the preparation of Fx1A and the induction of HN in Lewis rats by immunization with Fx1A.
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Affiliation(s)
- Yuan Min Wang
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Vincent W S Lee
- Centre for Transplant and Renal Research, Westmead Millennium Institute, University of Sydney at Westmead Hospital, Sydney, New South Wales, Australia
| | - Huiling Wu
- Collaborative Transplant Research Group, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - David C H Harris
- Centre for Transplant and Renal Research, Westmead Millennium Institute, University of Sydney at Westmead Hospital, Sydney, New South Wales, Australia
| | - Stephen I Alexander
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Abstract
Chronic proteinuric renal injury is a major cause of end stage renal disease. Adriamycin nephropathy (AN) is a murine model of chronic proteinuric renal disease whereby chemical injury is followed by immune and structural changes that mimic human disease. This unit describes the method of AN induced by a single injection of adriamycin (ADR) in BALB/c mice. After the initial toxic injury, an immune-mediated chronic proteinuric renal disease that resembles human focal segmental glomerulosclerosis develops. The clinic pathological features of AN are nephrotic syndrome, focal glomerulosclerosis, tubular injury, and interstitial compartment expansion with mononuclear cell infiltrates that are composed largely of macrophages and T cells.
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Affiliation(s)
- Yuan Min Wang
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, Australia
| | - Yiping Wang
- Centre for Transplant and Renal Research, Westmead Millennium Institute, University of Sydney at Westmead Hospital, Sydney, Australia
| | - David C H Harris
- Centre for Transplant and Renal Research, Westmead Millennium Institute, University of Sydney at Westmead Hospital, Sydney, Australia
| | - Stephen I Alexander
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, Australia
| | - Vincent W S Lee
- Centre for Transplant and Renal Research, Westmead Millennium Institute, University of Sydney at Westmead Hospital, Sydney, Australia
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Ta MHT, Rao P, Korgaonkar M, Foster SF, Peduto A, Harris DCH, Rangan GK. Pyrrolidine dithiocarbamate reduces the progression of total kidney volume and cyst enlargement in experimental polycystic kidney disease. Physiol Rep 2014; 2:2/12/e12196. [PMID: 25501440 PMCID: PMC4332200 DOI: 10.14814/phy2.12196] [Citation(s) in RCA: 13] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Heterocyclic dithiocarbamates have anti‐inflammatory and anti‐proliferative effects in rodent models of chronic kidney disease. In this study, we tested the hypothesis that pyrrolidine dithiocarbamate (PDTC) reduces the progression of polycystic kidney disease (PKD). Male Lewis polycystic kidney (LPK) rats (an ortholog of Nek8/NPHP9) received intraperitoneal injections of either saline vehicle or PDTC (40 mg/kg once or twice daily) from postnatal weeks 4 until 11. By serial magnetic resonance imaging at weeks 5 and 10, the relative within‐rat increase in total kidney volume and cyst volume were 1.3‐fold (P =0.01) and 1.4‐fold (P < 0.01) greater, respectively, in LPK + Vehicle compared to the LPK + PDTC(40 mg/kg twice daily) group. At week 11 in LPK rats, PDTC attenuated the increase in kidney weight to body weight ratio by 25% (P < 0.01) and proteinuria by 66% (P < 0.05 vs. LPK + Vehicle) but did not improve renal dysfunction. By quantitative whole‐slide image analysis, PDTC did not alter interstitial CD68+ cell accumulation, interstitial fibrosis, or renal cell proliferation in LPK rats at week 11. The phosphorylated form of the nuclear factor (NF)‐κB subunit, p105, was increased in cystic epithelial cells of LPK rats, but was not altered by PDTC. Moreover, PDTC did not significantly alter nuclear expression of the p50 subunit or NF‐κB (p65)‐DNA binding. Kidney enlargement in LPK rats was resistant to chronic treatment with a proteasome inhibitor, bortezomib. In conclusion, PDTC reduced renal cystic enlargement and proteinuria but lacked anti‐inflammatory effects in LPK rats. Lewis polycystic kidney rats were treated with pyrrolidine dithiocarbamate (PDTC) from weeks 4 to 11. Quantitative analysis of serial magnetic resonance images indicated that over time, the change in total kidney volume was 1.3‐fold higher in PDTC‐treated than in vehicle‐treated rats. PDTC treatment also decreased kidney weight to body weight ratio, renal cystic volume, and proteinuria.
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Affiliation(s)
- Michelle H T Ta
- Michael Stern Laboratory for Polycystic Kidney Disease, Centre for Transplant and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Padmashree Rao
- Michael Stern Laboratory for Polycystic Kidney Disease, Centre for Transplant and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Mayuresh Korgaonkar
- Brain Dynamics Centre, Westmead Millennium Institute, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Sheryl F Foster
- Department of Radiology, Westmead Hospital and The University of Sydney, Sydney, New South Wales, Australia
| | - Anthony Peduto
- Department of Radiology, Westmead Hospital and The University of Sydney, Sydney, New South Wales, Australia
| | - David C H Harris
- Michael Stern Laboratory for Polycystic Kidney Disease, Centre for Transplant and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Gopala K Rangan
- Michael Stern Laboratory for Polycystic Kidney Disease, Centre for Transplant and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney, New South Wales, Australia
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Abstract
Macrophages (MΦ) are highly heterogeneous cells that exhibit distinct phenotypic and functional characteristics depending on their microenvironment and the disease type and stage. MΦ are distributed throughout normal and diseased kidney tissue, where they have been recognized as key factors in renal fibrosis. Recent studies have identified switch of phenotype and diverse roles for MΦ in several murine models of kidney disease. In this review, we discuss macrophage heterogeneity and their involvement in renal fibrosis.
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Affiliation(s)
- Qi Cao
- Centre for Transplant and Renal Research, Westmead Millennium Institute at University of Sydney , Sydney, New South Wales, Australia
| | - Yiping Wang
- Centre for Transplant and Renal Research, Westmead Millennium Institute at University of Sydney , Sydney, New South Wales, Australia
| | - David C H Harris
- Centre for Transplant and Renal Research, Westmead Millennium Institute at University of Sydney , Sydney, New South Wales, Australia
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Cao Q, Wang Y, Wang XM, Lu J, Lee VWS, Ye Q, Nguyen H, Zheng G, Zhao Y, Alexander SI, Harris DCH. Renal F4/80+ CD11c+ mononuclear phagocytes display phenotypic and functional characteristics of macrophages in health and in adriamycin nephropathy. J Am Soc Nephrol 2014; 26:349-63. [PMID: 25012165 DOI: 10.1681/asn.2013121336] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Conventional markers of macrophages (Mфs) and dendritic cells (DCs) lack specificity and often overlap, leading to confusion and controversy regarding the precise function of these cells in kidney and other diseases. This study aimed to identify the phenotype and function of renal mononuclear phagocytes (rMPs) expressing key markers of both Mфs and DCs. F4/80(+)CD11c(+) cells accounted for 45% of total rMPs in normal kidneys and in those from mice with Adriamycin nephropathy (AN). Despite expression of the DC marker CD11c, these double-positive rMPs displayed the features of Mфs, including Mф-like morphology, high expression of CD68, CD204, and CD206, and high phagocytic ability but low antigen-presenting ability. F4/80(+)CD11c(+) cells were found in the cortex but not in the medulla of the kidney. In AN, F4/80(+)CD11c(+) cells displayed an M1 Mф phenotype with high expression of inflammatory mediators and costimulatory factors. Adoptive transfer of F4/80(+)CD11c(+) cells separated from diseased kidney aggravated renal injury in AN mice. Furthermore, adoptive transfer of common progenitors revealed that kidney F4/80(+)CD11c(+) cells were derived predominantly from monocytes, but not from pre-DCs. In conclusion, renal F4/80(+)CD11c(+) cells are a major subset of rMPs and display Mф-like phenotypic and functional characteristics in health and in AN.
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Affiliation(s)
- Qi Cao
- Centre for Transplant and Renal Research and
| | - Yiping Wang
- Centre for Transplant and Renal Research and
| | - Xin Maggie Wang
- Flow Cytometry Facility, Westmead Millennium Institute, University of Sydney, Sydney, New South Wales, Australia; and
| | - Junyu Lu
- Centre for Transplant and Renal Research and
| | | | - Qianling Ye
- Centre for Transplant and Renal Research and
| | - Hanh Nguyen
- Centre for Transplant and Renal Research and
| | | | - Ye Zhao
- Centre for Transplant and Renal Research and
| | - Stephen I Alexander
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, New South Wales, Australia
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