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Miyazaki N, Murata I, Takemura G, Okada H, Kanamori H, Matsumoto-Miyazaki J, Yoshida G, Izumi K, Kashi H, Niimi K, Nishiwaki A, Miyazaki T, Ohno M, Ohashi H, Suzuki F, Minatoguchi S. Expression of prorenin receptor in renal biopsies from patients with IgA nephropathy. Int J Clin Exp Pathol 2014; 7:7485-7496. [PMID: 25550784 PMCID: PMC4270520] [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] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 11/01/2014] [Indexed: 06/04/2023]
Abstract
Prorenin receptor (PRR) has been implicated in the onset and progression of various renal diseases, though its possible association with immunoglobulin A (IgA) nephropathy remains unclear. In the present study, we tried to clarify expression and pathophysiological significance of PRR in IgA nephropathy. We immunohistochemically assessed PRR levels in renal biopsy specimens from 48 patients with IgA nephropathy and evaluated its relevance to the clinical and pathological features of the disease. PRR was detected mainly in renal tubular cells, which was confirmed at the subcellular level using immunoelectron microscopy. The PRR-positive area (%PRR area) correlated with daily urinary protein, which is known to reflect disease severity (r=0.286, P=0.049). PRR levels were weaker in tubular cells bordering areas of severe interstitial fibrosis, where α-smooth muscle actin-positive myofibroblasts were present. We also used immunohistochemical detection of microtubule-associated protein-1 light chain 3 (LC3) and electron microscopy to assess autophagy, a cytoprotective mechanism downstream of PRR. We noted an apparent coincidence between autophagy activation in tubular cells and PRR expression in the same cells. Taken together, our findings suggest that renal expression of PRR in IgA nephropathy may be a compensatory response slowing disease progression by preventing tubular cell death and subsequent fibrosis through activation of cytoprotective autophagic machinery. Further studies using different type of kidney diseases could draw conclusion if the present finding is a generalized observation beyond IgA nephropathy.
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Affiliation(s)
- Nagisa Miyazaki
- Second Department of Internal Medicine, Gifu University Graduate School of MedicineGifu, Japan
| | - Ichijiro Murata
- Second Department of Internal Medicine, Gifu University Graduate School of MedicineGifu, Japan
| | - Genzou Takemura
- Second Department of Internal Medicine, Gifu University Graduate School of MedicineGifu, Japan
- Department of Internal Medicine, Asahi UniversityMizuho, Gifu, Japan
| | - Hideshi Okada
- Second Department of Internal Medicine, Gifu University Graduate School of MedicineGifu, Japan
| | - Hiromitsu Kanamori
- Second Department of Internal Medicine, Gifu University Graduate School of MedicineGifu, Japan
| | - Jun Matsumoto-Miyazaki
- Second Department of Internal Medicine, Gifu University Graduate School of MedicineGifu, Japan
| | - Gakuro Yoshida
- Second Department of Internal Medicine, Gifu University Graduate School of MedicineGifu, Japan
| | - Kumiko Izumi
- Second Department of Internal Medicine, Gifu University Graduate School of MedicineGifu, Japan
- Division of Nephrology, Murakami Memorial Hospital Asahi UniversityGifu, Japan
| | - Hitomi Kashi
- Second Department of Internal Medicine, Gifu University Graduate School of MedicineGifu, Japan
| | - Kaori Niimi
- Second Department of Internal Medicine, Gifu University Graduate School of MedicineGifu, Japan
| | - Ayuko Nishiwaki
- Second Department of Internal Medicine, Gifu University Graduate School of MedicineGifu, Japan
| | | | - Michiya Ohno
- Division of Nephrology, Murakami Memorial Hospital Asahi UniversityGifu, Japan
| | - Hiroshige Ohashi
- Division of Nephrology, Murakami Memorial Hospital Asahi UniversityGifu, Japan
| | - Fumiaki Suzuki
- Department of Applied Life Science, Faculty of Applied Biological Sciences, Gifu UniversityGifu, Japan
| | - Shinya Minatoguchi
- Second Department of Internal Medicine, Gifu University Graduate School of MedicineGifu, Japan
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Higgins R, Zehnder D, Chen K, Lowe D, McKinnell J, Lam FT, Kashi H, Tan LC, Imray C, Fletcher S, Krishnan N, Hamer R, Briggs D. The histological development of acute antibody-mediated rejection in HLA antibody-incompatible renal transplantation. Nephrol Dial Transplant 2009; 25:1306-12. [DOI: 10.1093/ndt/gfp610] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Simforoosh N, Basiri A, Ziaee S, Danesh A, Tabibi A, Abdi H, Kashi H, Zare S. MP-06.01: Comparing Outcomes and Complications of Transvesical Prostatectomy Versus Transurethral Resection of Prostate. Urology 2009. [DOI: 10.1016/j.urology.2009.07.987] [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: 11/27/2022]
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Higgins R, Zehnder D, Chen K, Fletcher S, Kashi H, Tan LC, Imray C, Lam FT, Hamer R, Krishnan N. TREATMENT OF ACUTE ANTIBODY-MEDIATED REJECTION; SPECIFIC ANTI-T LYMPHOCYTE THERAPY IS EFFECTIVE, WHILE SPECIFIC ANTI-B LYMPHOCYTE THERAPY IS NOT. Transplantation 2008. [DOI: 10.1097/01.tp.0000331112.79328.8a] [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]
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Krishnan NS, Higgins RM, Lam FT, Kashi H, Jobson S, Ramaiyan K, Rahman M, Morris A. HA-1 Mismatch Has Significant Effect in Chronic Allograft Nephropathy in Clinical Renal Transplantation. Transplant Proc 2007; 39:1439-45. [PMID: 17580157 DOI: 10.1016/j.transproceed.2007.02.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2006] [Revised: 10/10/2006] [Accepted: 02/05/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND The minor histocompatibility antigen HA-1 occurs in two allelic forms: H and R. The HA-1(H) form presented in the context of HLA A2 can elicit specific cytotoxic lymphocyte (CTL) responses and can cause graft-versus-host disease in marrow transplants. However, its significance in solid organ transplants is unknown. We determined whether incompatibility of the HA-1 resulted in enhanced rejection and whether HA-1 specific CTLs were generated. MATERIALS AND METHODS HLA A2-matched donor/recipient pairs were selected and typed for HA-1 antigens by polymerase chain reaction. Nineteen of 81 pairs were mismatched for HA-1. Peripheral blood mononuclear leucocytes from five recipients, HLA A2 DR-matched with donors, were stimulated for 3 days with third-party donor, matched for HLA A2 DR but mismatched for HA-1. Cells were stained for surface markers, HA-1(H)-specific tetramer reagent, and analyzed by flow cytometry. Controls were unstimulated cells; PBML from two patients never exposed to HA-1(H); immunoglobulin G isotype-matched controls. For all patients, acute rejection rates posttransplant was ascertained. Long-term data was available for 36 patients. RESULTS AND CONCLUSIONS There was no difference in acute rejection rates between the HA-1-matched and -mismatched groups, but there was a significant difference in chronic rejection rates, evidenced by increased graft failures during the follow-up period (P = .0024). Lymphocytes from five HA-1-mismatched recipients were stimulated in vitro with cells from HLA-A2 and DR-matched but HA-1-mismatched surrogate donor. Though there seemed to be an excess of tetramer-positive cells, anti-HA-1-specific CTL responses were not conclusively elicited in vitro.
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Affiliation(s)
- N S Krishnan
- Renal Unit, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, England, UK.
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Higgins RM, Raymond NT, Krishnan NS, Veerasamy M, Rahmati M, Lam FT, Kashi H, West N. Acute rejection after renal transplantation is reduced by approximately 50% by prior therapeutic blood transfusions, even in tacrolimus-treated patients. Transplantation 2004; 77:469-71. [PMID: 14966430 DOI: 10.1097/01.tp.0000111756.83834.a7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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
BACKGROUND The authors investigated the relationship between therapeutic blood transfusion before renal transplantation and rejection rates in cyclosporine- and tacrolimus-treated patients. METHODS In one center, 265 consecutive recipients were studied. Protocol induction was with azathioprine, prednisolone, and cyclosporine or tacrolimus; 37% had biopsy-proven acute rejection in the first 6 months and 46% had received zero to two units of blood before transplantation. RESULTS Lower risk of rejection was associated with tacrolimus induction (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.29-0.95; P=0.049), prior transfusion of three or more units of blood (OR, 0.54; 95% CI, 0.33-0.90; P=0.024), and older age at transplantation (mean, 44.23 +/- 12.56 [+/- SD] years vs. 38.96 +/- 12.37 years; P=0.001). Multiple logistic regression modeling showed the effect of three or more prior transfusions on acute rejection was as follows: OR, 0.49; 95% CI, 0.29 to 0.83; P=0.008. CONCLUSIONS Induction immunosuppression should take account of the higher risk of rejection in patients coming to transplantation who have previously received zero to two units of blood.
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Affiliation(s)
- R M Higgins
- Renal Transplant Unit, University Hospitals Coventry and Warwickshire, Coventry, UK.
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Ponticelli C, Yussim A, Cambi V, Legendre C, Rizzo G, Salvadori M, Kahn D, Kashi H, Salmela K, Fricke L, Heemann U, Garcia-Martinez J, Lechler R, Prestele H, Girault D. A randomized, double-blind trial of basiliximab immunoprophylaxis plus triple therapy in kidney transplant recipients. Transplantation 2001; 72:1261-7. [PMID: 11602853 DOI: 10.1097/00007890-200110150-00014] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND A double-blind, placebo-controlled, randomized study was performed to assess whether immunoprophylaxis with basiliximab (Simulect) could reduce the incidence of acute rejection in kidney transplant recipients treated with cyclosporine (Neoral), steroids, and azathioprine. METHODS Three hundred forty patients received either placebo or basiliximab at a dose of 20 mg, given intravenously on days 0 and 4. All patients received cyclosporine, steroids, and azathioprine. The primary endpoint was the incidence of acute rejection at 6 months. Secondary endpoints included the safety and tolerability of basiliximab and placebo, 1-year patient and graft survival, and significant medical events up to 12 months. RESULTS During the first 6 months posttransplantation, acute rejection occurred in 20.8% of patients given basiliximab versus 34.9% of patients administered placebo (P=0.005). Similarly, there was a reduction in biopsy-proven acute rejection at 6 months in the patients receiving basiliximab (P=0.023). One-year patient survival was 97.6% with basiliximab and 97.1% with placebo, graft survival was 91.5% versus 88.4%, respectively (NS). The adverse-events profile of patients treated with basiliximab was indistinguishable from that of patients treated with placebo. The number of patients with infections was similar (65.5% for basiliximab vs. 65.7% for placebo), including cytomegalovirus infections (17.3% vs. 14.5%, P=0.245). Nine neoplasms (three in the basiliximab group, six in the placebo arm) were recorded up to 1 year from transplantation. CONCLUSIONS Basiliximab in combination with cyclosporine, steroids, and azathioprine triple therapy was highly effective in reducing the incidence of acute renal allograft rejection without increasing the incidence of infections and other side effects.
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Affiliation(s)
- C Ponticelli
- Divisione Nefrologia e Dialisi, IRCCS Ospedale Maggiore Policlinico, Via Commenda 15, 20122, Milano, Italy
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Higgins RM, Hart P, Lam FT, Kashi H. Conversion from tacrolimus to cyclosporin in stable renal transplant patients: safety, metabolic changes, and pharmacokinetic comparison. Transplantation 2000; 70:199-202. [PMID: 10919600] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND Conversion from tacrolimus to cyclosporin has not previously been reported as routine clinical practice, but only as indicated by rejection or adverse effects. METHODS The safety and metabolic outcome of elective conversion from tacrolimus to cyclosporin was examined in 19 recipients of cadaver renal transplants. Conversion was performed in stable patients at 3-6 months after transplantation. RESULTS Patient and graft survival was 100% at 3 months after conversion, with no rejection episodes. Three patients have been subsequently converted back to tacrolimus, two for rejection and one for hirsutism. There were no significant changes in creatinine, urate, or blood sugar levels after conversion, but the mean plasma magnesium rose from 0.73 (0.63-0.97) to 0.82 (0.65-1) mmol/liter (P=0.037), and the mean plasma cholesterol rose from 5.2 (3.4-6.8) to 5.5 (3.8-7.6) mmol/liter (P=0.033). Pharmacokinetic profiles were measured before and after conversion, and showed that cyclosporin (Neoral) exhibited significantly less interpatient and intrapatient variability than tacrolimus, for area under the curve (AUC), maximum concentration postdose (Cmax), minimum concentration postdose (Cmin), time to maximum concentration (Tmax). CONCLUSION This is the first study that has examined the outcome of conversion from tacrolimus- to cyclosporin-based immunosuppression in stable patients after renal transplantation. This conversion was performed without early immunological hazard, but there was a small rise in blood cholesterol levels after conversion. Pharmacokinetic studies showed cyclosporin in the form of Neoral showed less inter- and intrapatient variability than tacrolimus, although this is of uncertain clinical significance.
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Affiliation(s)
- R M Higgins
- Renal Transplant Unit, Walsgrave Hospital NHS Trust, Coventry, UK
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Higgins RM, Hart P, Lam FT, Kashi H. Conversion from tacrolimus to cyclosporine in stable renal transplant patients: safety, metabolic changes, and pharmacokinetic comparison. Transplantation 2000; 69:1736-9. [PMID: 10836393 DOI: 10.1097/00007890-200004270-00038] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [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: 11/25/2022]
Abstract
BACKGROUND Although conversion between tacrolimus and cyclosporine has been performed when indicated for rejection or adverse effects, the safety and metabolic outcome of elective conversion from tacrolimus to cyclosporine has not previously been examined. METHODS Conversion from tacrolimus to cyclosporine was performed in 19 recipients of cadaver renal transplants at 3-6 months after transplantation. Pharmacokinetic profiles and biochemical studies were performed three times, in steady state, before, and after conversion. RESULTS Patient and graft survival was 100% at 3 months after conversion, with no rejection episodes. Three patients have been subsequently converted back to tacrolimus, two for rejection and one for hirsutism. There were no significant changes in creatinine, urate, or blood sugar levels after conversion, but the mean plasma magnesium rose from 0.73 (0.63-0.97) to 0.82 (0.65-1) mmol/L (P=0.037), and the mean plasma cholesterol rose from 5.2 (3.4-6.8) to 5.5 (3.8-7.6) mmol/L (P=0.033). Pharmacokinetic profiles were measured before and after conversion, and showed that cyclosporine (Neoral) exhibited significantly less interpatient and intrapatient variability than tacrolimus, for area under the curve (AUC), maximum concentration after dose (Cmax), minimum concentration after dose (Cmin), and time to maximum concentration (Tmax). CONCLUSION This is the first study that has examined the outcome of conversion from tacrolimus- to cyclosporine-based immunosuppression in stable patients after renal transplantation. This conversion was performed without early immunological hazard, but there was a small rise in blood cholesterol levels after conversion. Pharmacokinetic studies showed that cyclosporine in the form of Neoral exhibited less inter- and intrapatient variability than tacrolimus, although this is of uncertain clinical significance.
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Affiliation(s)
- R M Higgins
- Renal Transplant Unit, Walsgrave Hospital NHS Trust, Coventry, United Kingdom
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Higgins RM, Morlidge C, Magee P, McDiarmaid-Gordon A, Lam FT, Kashi H. Conversion between cyclosporin and tacrolimus--30-fold dose prediction. Nephrol Dial Transplant 1999; 14:1609. [PMID: 10383044 DOI: 10.1093/ndt/14.6.1609] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Higgins RM, West N, Edmunds ME, Dukes DC, Kashi H, Jurewicz A, Lam FT. Effect of a strict HLA matching policy on distribution of cadaveric kidney transplants to Indo-Asian and white European recipients: regional study. BMJ 1997; 315:1354-5. [PMID: 9402778 PMCID: PMC2127850 DOI: 10.1136/bmj.315.7119.1354] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- R M Higgins
- Dialysis Unit, Walsgrave Hospital, Coventry.
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Ahmad N, Kashi H, Helmy H, Hadingham J, Potts DJ, Lodge JP. Renal preservation with phosphate buffered sucrose: comparison with hyperosmolar citrate in a prospective trial. Transplant Proc 1997; 29:355-6. [PMID: 9123036 DOI: 10.1016/s0041-1345(96)00305-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- N Ahmad
- Department of Organ Transplantation, St. James's University Hospital, Leeds, United Kingdom
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Kashi H, Lam FT, Giles GR. Recurrent pyogenic cholangiohepatitis. Ann R Coll Surg Engl 1989; 71:387-9. [PMID: 2604348 PMCID: PMC2499042] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Three cases of complicated oriental cholangiohepatitis are described in patients of Asian origin. The development of high biliary strictures in two patients required liver resection; in the third patient the process was complicated by a presumed bile duct malignancy. Oriental cholangiohepatitis may be expected in UK surgical practice given the increased frequency of migration from Asia.
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Affiliation(s)
- H Kashi
- University Department of Surgery, St James's University Hospital, Leeds
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