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Collier ARY, Pernicone E, Zsengeller Z, Salahuddin S, Khankin E, Karumanchi SA. 309: Placental sFlt1 and complement activation in preeclampsia and HELLP syndrome. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.10.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Peña JR, Cardarelli F, Khankin E, Pavlakis M. P119 Single-center experience in routine post-transplant antibody testing of kidney transplant recipients without pre-existing donor specific anti-HLA antibodies. Hum Immunol 2016. [DOI: 10.1016/j.humimm.2016.07.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Arany Z, Patten I, Rana S, Shahul S, Rowe G, Jang C, Liu L, Hacker M, Rhee J, Mitchell J, Mahmood F, Hess P, Farrell C, Koulisis N, Khankin E, Burke S, Tudorache I, Bauersachs J, del Monte F, Hilfiker-Kleiner D, Karumanchi A. Abstract 219: Cardiac Angiogenic Imbalance Leads to Peripartum Cardiomyopathy. Circ Res 2012. [DOI: 10.1161/res.111.suppl_1.a219] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Peri-partum cardiomyopathy (PPCM) is a frequently fatal disease that affects women near delivery, and occurs more frequently in women with pre-eclampsia and/or multiple gestation. The etiology of PPCM, or why it associates with pre-eclampsia, remains unknown. We show here that PPCM is associated with a systemic angiogenic imbalance, accentuated by pre-eclampsia. Mice that lack cardiac PGC-1α, a powerful regulator of angiogenesis, develop profound PPCM. Importantly, the PPCM is entirely rescued by pro-angiogenic therapies. In humans, the placenta in late gestation secretes VEGF inhibitors like soluble Flt1 (sFlt1), and this is accentuated by multiple gestation and pre-eclampsia. This anti-angiogenic environment is accompanied by sub-clinical cardiac dysfunction, the extent of which correlates with circulating levels of sFlt1. Exogenous sFlt1 alone caused diastolic dysfunction in wildtype mice, and profound systolic dysfunction in mice lacking cardiac PGC-1α. Finally, plasma samples from women with PPCM contained abnormally high levels of sFlt1. These data strongly suggest that PPCM is in large part a vascular disease, caused by excess anti-angiogenic signaling in the peri-partum period. The data also explain how late pregnancy poses a threat to cardiac homeostasis, and why pre-eclampsia and multiple gestation are important risk factors for the development of PPCM.
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Osol G, Khankin E, Karumanchi A. P10.01 EFFECTS OF VEGFR-1 (FLT-1) INHIBITION DURING PREGNANCY ON THE UTERINE CIRCULATION OF THE MOUSE. Artery Res 2011. [DOI: 10.1016/j.artres.2011.10.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Thadhani R, Powe CE, Tjoa ML, Khankin E, Ye J, Ecker J, Schneyer A, Karumanchi SA. First-trimester follistatin-like-3 levels in pregnancies complicated by subsequent gestational diabetes mellitus. Diabetes Care 2010; 33:664-9. [PMID: 20007937 PMCID: PMC2827528 DOI: 10.2337/dc09-1745] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether maternal levels of follistatin-like-3 (FSTL3), an inhibitor of activin and myostatin involved in glucose homeostasis, are altered in the first trimester of pregnancies complicated by subsequent gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS This was a nested case-control study of subjects enrolled in a prospective cohort of pregnant women with and without GDM (> or =2 abnormal values on a 100-g glucose tolerance test at approximately 28 weeks of gestation). We measured FSTL3 levels in serum collected during the first trimester of pregnancy. Logistic regression analyses were used to determine the risk of GDM. RESULTS Women who developed GDM (n = 37) had lower first-trimester serum levels of FSTL3 compared with women who did not (n = 127) (median 10,789 [interquartile range 7,013-18,939] vs. 30,670 [18,370-55,484] pg/ml, P < 0.001). When subjects were divided into tertiles based on FSTL3 levels, women with the lowest levels demonstrated a marked increase in risk for developing GDM in univariate (odds ratio 11.2 [95% CI 3.6-35.3]) and multivariate (14.0 [4.1-47.9]) analyses. There was a significant negative correlation between first-trimester FSTL3 levels and approximately 28-week nonfasting glucose levels (r = -0.30, P < 0.001). CONCLUSIONS First-trimester FSTL3 levels are associated with glucose intolerance and GDM later in pregnancy.
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Affiliation(s)
- Ravi Thadhani
- Division of Nephrology, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts, USA.
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Nakhoul F, Khankin E, Yaccob A, Kawachi H, Karram T, Awaad H, Nakhoul N, Hoffman A, Abassi Z. Eplerenone potentiates the antiproteinuric effects of enalapril in experimental nephrotic syndrome. Am J Physiol Renal Physiol 2008; 294:F628-37. [DOI: 10.1152/ajprenal.00524.2007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Nephrotic syndrome (NS) is a clinical state characterized by massive proteinuria and edema. It is believed that nephrin and podocin are involved in the development of proteinuria. The proteinuria and effects of eplerenone alone or combined with enalapril on nephrin/podocin abundance in rats with NS have not yet been studied. Therefore, the present study was designed to examine the early (beginning 2 days before NS induction) and late (beginning 2 wk after NS induction) effects of eplerenone and enalapril, alone or combined, on proteinuria and nephrin/podocin abundance in rats with adriamycin-induced NS. Adriamycin caused a significant increase in daily protein excretion (UprV; from 26.96 ± 3.43 to 958.57 ± 56.7 mg/day, P < 0.001) and cumulative proteinuria [from 900.33 ± 135.5 to 22,490.62 ± 931.26 mg ( P < 0.001)] during 6 wk. Early treatment with enalapril significantly decreased UprV from 958.6 ± 56.7 to 600.31 ± 65.13 mg/day ( P < 0.001) and cumulative proteinuria to 12,842.37 ± 1,798.17 mg/6 wk ( P < 0.001). Similarly, early treatment with eplerenone produced a profound antiproteinuric effect: UprV decreased from 958.57 ± 56.7 to 593.38 ± 21.83 mg/day, P < 0.001, and cumulative proteinuria to 16,601.84 ± 1,334.31 mg/6 wk; P < 0.001. An additive effect was obtained when enalapril and eplerenone were combined: UprV decreased from 958.57 ± 56.69 to 424.17 ± 38.54 mg/day, P < 0.001, and cumulative protein excretion declined to 10,252.88 ± 1,011.3 mg/6 wk, P < 0.001. These antiproteinuric effects were associated with substantial preservation of glomerular nephrin and podocin. In contrast, late treatment with either enalapril or eplerenone alone or combined mildly decreased UprV and cumulative proteinuria. Thus pretreatment with eplerenone or enalapril is effective in reducing daily and cumulative protein excretion and preservation of nephrin/podocin. More profound antiproteinuric effects were obtained when enalapril and eplerenone were combined.
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Blum S, Nakhoul F, Khankin E, Abassi Z. Renal slit diaphragm--the open zipper and the failing heart. Isr Med Assoc J 2007; 9:107-11. [PMID: 17348483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Inherited forms of proteinuria constitute a rare and heterogeneous group of diseases, the most prominent of which is glomerular dysfunction, which leads to proteinuria. Investigation of the genetic background underlying these diseases has provided significant data on the normal operation of the glomerular filter. Among the different components of the glomerulus, the podocyte slit diaphragm is considered the main source for genetically derived protein alteration, which leads in turn to proteinuria. Investigation of the different proteins revealed that the lack of nephrin and podocin is the leading cause of several inherited forms of proteinuria. It was also proposed that the lack of podocin is linked to cardiac anomalies. This review suggests that the absence of slit diaphragm proteins and the open zipper phenomenon are associated with cardiac anomalies.
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Affiliation(s)
- Shany Blum
- Laboratory of Vascular Medicine, Rappaport Family Institute for Research in the Medical Sciences, Haifa, Israel.
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Abassi Z, Nakhoul F, Khankin E, Reisner SA, Yigla M. Pulmonary hypertension in chronic dialysis patients with arteriovenous fistula: pathogenesis and therapeutic prospective. Curr Opin Nephrol Hypertens 2006; 15:353-60. [PMID: 16775448 DOI: 10.1097/01.mnh.0000232874.27846.37] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW End-stage renal disease patients receiving chronic haemodialysis via arteriovenous access often develop various cardiovascular complications, including vascular calcification, cardiac-vascular calcification and atherosclerotic coronary disease. This review describes recently published studies that demonstrate a high incidence of pulmonary hypertension among patients with end-stage renal disease receiving long-term haemodialysis via a surgical arteriovenous fistula. Both end-stage renal disease and long-term haemodialysis via arteriovenous fistula may be involved in the pathogenesis of pulmonary hypertension by affecting pulmonary vascular resistance and cardiac output. RECENT FINDINGS Morbidity and mortality from cardiovascular disease are greatly increased in patients on maintenance haemodialysis therapy. Using Doppler echocardiography, we found a significant increase in cardiac output in 40% of chronic haemodialysis patients, probably related to the large arteriovenous access or altered vascular resistance as a result of the local vascular tone and function expressed by the imbalance between vasodilators such as nitric oxide, and vasoconstrictors such as endothelin-1. SUMMARY We propose different potential mechanisms as explanations for the development of pulmonary hypertension. Hormonal and metabolic derangement associated with end-stage renal disease might lead to pulmonary arterial vasoconstriction and an increase in pulmonary vascular resistance. Pulmonary arterial pressure may be further increased by high cardiac output resulting from the arteriole-venous access itself, worsened by commonly occurring anaemia and fluid overload.
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MESH Headings
- Adult
- Aged
- Blood Pressure
- Calcinosis/etiology
- Calcinosis/metabolism
- Calcinosis/mortality
- Calcinosis/pathology
- Calcinosis/therapy
- Cardiac Output
- Echocardiography, Doppler/methods
- Endothelin-1/metabolism
- Female
- Humans
- Hypertension, Pulmonary/etiology
- Hypertension, Pulmonary/metabolism
- Hypertension, Pulmonary/mortality
- Hypertension, Pulmonary/pathology
- Hypertension, Pulmonary/therapy
- Kidney Failure, Chronic/complications
- Kidney Failure, Chronic/metabolism
- Kidney Failure, Chronic/mortality
- Kidney Failure, Chronic/pathology
- Kidney Failure, Chronic/therapy
- Male
- Middle Aged
- Nitric Oxide/metabolism
- Pulmonary Artery/metabolism
- Pulmonary Artery/physiopathology
- Renal Dialysis/adverse effects
- Time Factors
- Vascular Resistance
- Vasoconstrictor Agents/metabolism
- Vasodilator Agents/metabolism
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Affiliation(s)
- Zaid Abassi
- Department of Physiology and Biophysics, Rappaport Family Institute for Research in the Medical Sciences, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Technion City, Israel
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Nakhoul F, Ramadan R, Khankin E, Yaccob A, Kositch Z, Lewin M, Assady S, Abassi Z. Glomerular abundance of nephrin and podocin in experimental nephrotic syndrome: different effects of antiproteinuric therapies. Am J Physiol Renal Physiol 2005; 289:F880-90. [PMID: 15942045 DOI: 10.1152/ajprenal.00451.2004] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Nephrotic syndrome (NS) is a clinical state characterized by massive proteinuria, hypoalbuminemia, and eventual edema formation. Although the mechanisms underlying this phenomenon are not yet fully clarified, it is well accepted that nephrin and podocin are involved in the development of proteinuria. The effects of early treatment with various antiproteinuric therapies on proteinuria and glomerular staining of nephrin and podocin in rats with experimental NS have not been previously studied. Proteinuria and glomerular nephrin and podocin immunofluorescence were examined in rat kidneys with adriamycin-induced NS and the effects of antiproteinuric drug therapies during 5 wk with enalapril, losartan, alone or in combination, omapatrilat, and mycophenolate mofetil on these parameters were assessed. Injection of adriamycin caused a significant increase in daily (from 21.8 ± 1.4 to 983.1 ± 45.8 mg/day, P < 0.01) and cumulative protein excretion (from negligible values to 22,490 ± 931 mg, P < 0.001) during 5 wk. Early treatment with enalapril significantly decreased the daily (641.7 ± 82.4 mg/day, P < 0.0023) and cumulative proteinuria (15,727 ± 2,204 mg, P < 0.001). A similar effect, although to a lesser extent, was obtained after omapatrilat treatment: cumulative proteinuria was reduced to 18,706 ± 1,042 mg, P < 0.001. In contrast, losartan treatment did not significantly influence the cumulative proteinuria that remained comparable (20,351 ± 1,360 mg, P > 0.05) to that observed in untreated NS rats. Unexpectedly, when losartan was given in combination with enalapril, it abolished the beneficial effects of the latter. Pretreatment with mycophenolate mofetil exerted a moderate antiproteinuric effect, which appeared only during the last week of the experimental treatment. Nephrotic rats exhibited severe disruption of slit diaphragm structure as seen by rapid and profound loss of nephrin and podocin. Beneficial effects of enalapril, omapatrilat, and mycophenolate mofetil paralleled the preservation of nephrin, as determined immunohistochemically, and enabled prediction of significant antiproteinuric responses. Enalapril alone or in combination with losartan resulted in significant preservation of podocin. Pretreatment with enalapril, and to a lesser extent omapatrilat, is superior to losartan in reducing proteinuria in NS rats. A combination of ACE inhibitors with ANG II receptor blockers does not provide any advantageous antiproteinuric therapy in these animals. Nephrin loss is an indication of proteinuria in NS and the antiproteinuric effects of ACE inhibitors, vasopeptidase inhibitors, and mycophenolate mofetil attenuate this reduction. Not all the drugs which restore podocin reduce urinary protein in NS.
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Affiliation(s)
- Farid Nakhoul
- Dept. of Physiology and Biophysics, Faculty of Medicine, Technion, P.O. Box 9649, Haifa, 31096, Israel
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Armaly Z, Khankin E, Ramadan R, Ben-Itzhak O, Guralnik L, Green J, Nakhoul F. Two cases of renal mucormycosis in renal transplanted patients. Clin Nephrol 2002; 58:247-9. [PMID: 12356197 DOI: 10.5414/cnp58247] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Nakhoul F, Gelman R, Green J, Khankin E, Baruch Y. Lamivudine therapy for severe acute hepatitis B virus infection after renal transplantation: case report and literature review. Transplant Proc 2001; 33:2948-9. [PMID: 11543804 DOI: 10.1016/s0041-1345(01)02265-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- F Nakhoul
- Department of Nephrology and Molecular Medicine, Rambam Medical Center, Haifa, Israel
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