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Xue R, Yiu WH, Chan KW, Lok SWY, Zou Y, Ma J, Li H, Chan LYY, Huang XR, Lai KN, Lan HY, Tang SCW. Long Non-coding RNA Neat1, NLRP3 Inflammasome, and Acute Kidney Injury. J Am Soc Nephrol 2024:00001751-990000000-00303. [PMID: 38687867 DOI: 10.1681/asn.0000000000000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 04/19/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is common in hospitalized patients and is associated with high mortality. Inflammation plays a key role in the pathophysiology of AKI. Long non-coding RNAs (lncRNAs) are increasingly recognized as regulators of the inflammatory and immune response, but its role in AKI remains unclear. METHODS We explored the role of lncRNA Neat1 in (1) a cross-sectional and a longitudinal cohort of AKI in human; (2) three murine models of septic and aseptic AKI and (3) cultured C1.1 mouse kidney tubular cells. RESULTS In human, hospitalized patients with AKI (n=66) demonstrated significantly increased lncRNA Neat1 levels in urinary sediment cells and buffy coat versus control participants (n=152) from a primary care clinic; and among 6 kidney transplant recipients, Neat1 levels were highest immediately after transplant surgery followed by a prompt decline to normal levels in parallel with recovery of kidney function. In mice with AKI induced by sepsis (via LPS injection or cecal ligation and puncture) and renal ischemia-reperfusion, kidney tubular Neat1 was increased versus sham-operated mice. Knockdown of Neat1 in the kidney using short hairpin RNA preserved kidney function, suppressed overexpression of the AKI biomarker NGAL, leukocyte infiltration and both intrarenal and systemic inflammatory cytokines IL-6, CCL-2 and IL-1β. In LPS-treated C1.1 cells, Neat1 was overexpressed via TLR4/NF-κB signaling, and translocated from the cell nucleus into the cytoplasm where it promoted activation of NLRP3 inflammasomes via binding with the scaffold protein Rack1. Silencing Neat1 ameliorated LPS-induced cell inflammation, whereas its overexpression upregulated IL-6 and CCL-2 expression even without LPS stimulation. CONCLUSIONS Our findings demonstrate a pathogenic role of Neat1 induction in human and mice during AKI with alleviation of kidney injury in 3 experimental models of septic and aseptic AKI after knockdown of Neat1. LPS/TLR4-induced Neat1 overexpression in tubular epithelial cells increases the inflammatory response by binding with the scaffold protein, Rack1, to activate NLRP3 inflammasomes.
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Affiliation(s)
- Rui Xue
- Division of Nephrology, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Wai Han Yiu
- Division of Nephrology, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Kam Wa Chan
- Division of Nephrology, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Sarah W Y Lok
- Division of Nephrology, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Yixin Zou
- Division of Nephrology, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Jingyuan Ma
- Division of Nephrology, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Hongyu Li
- Division of Nephrology, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Loretta Y Y Chan
- Division of Nephrology, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Xiao Ru Huang
- Department of Medicine and Therapeutics, and Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Kar Neng Lai
- Division of Nephrology, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Hui Yao Lan
- Department of Medicine and Therapeutics, and Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Sydney C W Tang
- Division of Nephrology, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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Lok SWY, Yiu WH, Zou Y, Xue R, Li H, Ma J, Chen J, Chan LYY, Lai KN, Tang SCW. Tubulovascular protection from protease-activated receptor-1 depletion during AKI-to-CKD transition. Nephrol Dial Transplant 2023; 38:2232-2247. [PMID: 36914214 DOI: 10.1093/ndt/gfad051] [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: 09/01/2022] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Thromboembolic events are prevalent in chronic kidney disease (CKD) patients due to increased thrombin generation leading to a hypercoagulable state. We previously demonstrated that inhibition of protease-activated receptor-1 (PAR-1) by vorapaxar reduces kidney fibrosis. METHODS We used an animal model of unilateral ischemia-reperfusion injury-induced CKD to explore the tubulovascular crosstalk mechanisms of PAR-1 in acute kidney injury (AKI)-to-CKD transition. RESULTS During the early phase of AKI, PAR-1-deficient mice exhibited reduced kidney inflammation, vascular injury, and preserved endothelial integrity and capillary permeability. During the transition phase to CKD, PAR-1 deficiency preserved kidney function and diminished tubulointerstitial fibrosis via downregulated transforming growth factor-β/Smad signaling. Maladaptive repair in the microvasculature after AKI further exacerbated focal hypoxia with capillary rarefaction, which was rescued by stabilization of hypoxia-inducible factor and increased tubular vascular endothelial growth factor A in PAR-1-deficient mice. Chronic inflammation was also prevented with reduced kidney infiltration by both M1- and M2-polarized macrophages. In thrombin-induced human dermal microvascular endothelial cells (HDMECs), PAR-1 mediated vascular injury through activation of NF-κB and ERK MAPK pathways. Gene silencing of PAR-1 exerted microvascular protection via a tubulovascular crosstalk mechanism during hypoxia in HDMECs. Finally, pharmacologic blockade of PAR-1 with vorapaxar improved kidney morphology, promoted vascular regenerative capacity, and reduced inflammation and fibrosis depending on the time of initiation. CONCLUSIONS Our findings elucidate a detrimental role of PAR-1 in vascular dysfunction and profibrotic responses upon tissue injury during AKI-to-CKD transition and provide an attractive therapeutic strategy for post-injury repair in AKI.
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Affiliation(s)
- Sarah W Y Lok
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Wai Han Yiu
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Yixin Zou
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Rui Xue
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Hongyu Li
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Jingyuan Ma
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Jiaoyi Chen
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Loretta Y Y Chan
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Kar Neng Lai
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Sydney C W Tang
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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Chan KW, Kwong ASK, Tan KCB, Lui SL, Chan GC, Ip TP, Yiu WH, Cowling BJ, Taam Wong V, Lao L, Feng Y, Lai KN, Tang SC. Add-on Rehmannia-6-Based Chinese Medicine in Type 2 Diabetes and CKD: A Multicenter Randomized Controlled Trial. Clin J Am Soc Nephrol 2023; 18:1163-1174. [PMID: 37307005 PMCID: PMC10564374 DOI: 10.2215/cjn.0000000000000199] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 12/22/2022] [Accepted: 06/03/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Diabetes is the leading cause of CKD and kidney failure. We assessed the real-world effectiveness of Rehmannia-6-based Chinese medicine treatment, the most used Chinese medicine formulation, on the change in eGFR and albuminuria in patients with diabetes and CKD with severely increased albuminuria. METHODS In this randomized, assessor-blind, standard care-controlled, parallel, multicenter trial, 148 adult patients from outpatient clinics with type 2 diabetes, an eGFR of 30-90 ml/min per 1.73 m 2 , and a urine albumin-to-creatinine ratio (UACR) of 300-5000 mg/g were randomized 1:1 to a 48-week add-on protocolized Chinese medicine treatment program (using Rehmannia-6-based formulations in the granule form taken orally) or standard care alone. Primary outcomes were the slope of change in eGFR and UACR between baseline and end point (48 weeks after randomization) in the intention-to-treat population. Secondary outcomes included safety and the change in biochemistry, biomarkers, and concomitant drug use. RESULTS The mean age, eGFR, and UACR were 65 years, 56.7 ml/min per 1.73 m 2 , and 753 mg/g, respectively. Ninety-five percent ( n =141) of end point primary outcome measures were retrievable. For eGFR, the estimated slope of change was -2.0 (95% confidence interval [CI], -0.1 to -3.9) and -4.7 (95% CI, -2.9 to -6.5) ml/min per 1.73 m 2 in participants treated with add-on Chinese medicine or standard care alone, resulting in a 2.7 ml/min per 1.73 m 2 per year (95% CI, 0.1 to 5.3; P = 0.04) less decline with Chinese medicine. For UACR, the estimated proportion in the slope of change was 0.88 (95% CI, 0.75 to 1.02) and 0.99 (95% CI, 0.85 to 1.14) in participants treated with add-on Chinese medicine or standard care alone, respectively. The intergroup proportional difference (0.89, 11% slower increment in add-on Chinese medicine, 95% CI, 0.72 to 1.10; P = 0.28) did not reach statistical significance. Eighty-five adverse events were recorded from 50 participants (add-on Chinese medicine versus control: 22 [31%] versus 28 [36%]). CONCLUSIONS Rehmannia-6-based Chinese medicine treatment stabilized eGFR on top of standard care alone after 48 weeks in patients with type 2 diabetes, stage 2-3 CKD, and severely increased albuminuria. CLINICAL TRIAL REGISTRY Semi-individualized Chinese Medicine Treatment as an Adjuvant Management for Diabetic Nephropathy (SCHEMATIC), NCT02488252 .
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Affiliation(s)
- Kam Wa Chan
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Alfred Siu Kei Kwong
- Department of Family Medicine and Primary Healthcare, Hong Kong West Cluster, Hospital Authority, Hong Kong SAR, China
| | - Kathryn Choon Beng Tan
- Division of Endocrinology & Metabolism, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Sing Leung Lui
- Department of Medicine, Tung Wah Hospital, Hong Kong SAR, China
| | - Gary C.W. Chan
- Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
| | - Tai Pang Ip
- Department of Medicine, Tung Wah Hospital, Hong Kong SAR, China
| | - Wai Han Yiu
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Benjamin John Cowling
- Division of Epidemiology and Biostatistics, School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - Vivian Taam Wong
- School of Chinese Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Lixing Lao
- School of Chinese Medicine, The University of Hong Kong, Hong Kong SAR, China
- Virginia University of Integrative Medicine, Fairfax, Virginia
| | - Yibin Feng
- School of Chinese Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kar Neng Lai
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Sydney C.W. Tang
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Lie DNW, Chan KW, Tang AHN, Chan ATP, Chan GCW, Lai KN, Tang SCW. Long-term outcomes of add-on direct renin inhibition in igA nephropathy: a propensity score-matched cohort study. J Nephrol 2023; 36:407-416. [PMID: 36630006 DOI: 10.1007/s40620-022-01530-7] [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: 08/25/2022] [Accepted: 11/20/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The long-term clinical outcomes in biopsy proven IgAN patients treated with aliskiren on top of a maximally tolerated dose of ACEi/ARB remain unknown. METHODS Patients with IgAN treated with a direct renin inhibitor and ACEi/ARB for at least 6 months were compared with a 1:1 propensityscore-matched cohort (including MEST-C score and the 12-months pre-exposure slope of eGFR matching) who received ACEi/ARB without aliskiren exposure to compute the hazard ratio of reaching the primary endpoint of a composite of 40% reduction in eGFR, initiation of KRT and all-cause mortality. Secondary outcome measures included changes in mean UPCR, blood pressure, eGFR, incidence of hyperkalemia and other adverse events during follow-up. RESULTS After a median follow-up of 2.5 years, 8/36 (22.2%) aliskiren-treated patients and 6/36 (16.7%) control patients reached the primary composite outcome (HR = 1.60; 95% CI 0.52-4.88; P = 0.412). Aliskiren treatment increased the risk of ≥ 40% eGFR decline (HR = 1.60; 95% CI 0.52-4.88; P = 0.412), and hyperkalemia (HR = 8.60; 95% CI 0.99-73.64; P = 0.050). At 10.8 years, renal composite outcome was reached in 69.4% vs 58.3% (HR = 2.16; 95% CI 1.18-3.98; P = 0.013) of patients in the aliskiren and control groups, respectively. The mean UPCR reduction between treatment and control was not statistically different (52.7% vs 42.5%; 95% CI 0.63-2.35; P = 0.556). The mean intergroup difference in eGFR decline over 60 months was 7.75 ± 3.95 ml/min/1.73 m2 greater in the aliskiren group (12.83 vs 5.08; 95% CI - 0.17 to 15.66; P = 0.055). CONCLUSION Among patients with IgAN, add-on aliskiren was associated with less favorable long-term kidney outcomes despite an initial anti-proteinuric effect.
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Affiliation(s)
- Davina N W Lie
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 4/F Professorial Block, 102 Pokfulam Road, Hong Kong SAR, China
| | - Kam Wa Chan
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 4/F Professorial Block, 102 Pokfulam Road, Hong Kong SAR, China
| | - Alexander H N Tang
- Department of Pathology, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Anthony T P Chan
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 4/F Professorial Block, 102 Pokfulam Road, Hong Kong SAR, China
| | - Gary C W Chan
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 4/F Professorial Block, 102 Pokfulam Road, Hong Kong SAR, China
| | - Kar Neng Lai
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 4/F Professorial Block, 102 Pokfulam Road, Hong Kong SAR, China
| | - Sydney Chi-Wai Tang
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 4/F Professorial Block, 102 Pokfulam Road, Hong Kong SAR, China.
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Li H, Leung JCK, Yiu WH, Chan LYY, Li B, Lok SWY, Xue R, Zou Y, Lai KN, Tang SCW. Tubular β-catenin alleviates mitochondrial dysfunction and cell death in acute kidney injury. Cell Death Dis 2022; 13:1061. [PMID: 36539406 PMCID: PMC9768165 DOI: 10.1038/s41419-022-05395-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 10/29/2022] [Accepted: 11/01/2022] [Indexed: 12/24/2022]
Abstract
Mitochondria take part in a network of intracellular processes that regulate homeostasis. Defects in mitochondrial function are key pathophysiological changes during AKI. Although Wnt/β-catenin signaling mediates mitochondrial dysfunction in chronic kidney fibrosis, little is known of the influence of β-catenin on mitochondrial function in AKI. To decipher this interaction, we generated an inducible mouse model of tubule-specific β-catenin overexpression (TubCat), and a model of tubule-specific β-catenin depletion (TubcatKO), and induced septic AKI in these mice with lipopolysaccharide (LPS) and aseptic AKI with bilateral ischemia-reperfusion. In both AKI models, tubular β-catenin stabilization in TubCat animals significantly reduced BUN/serum creatinine, tubular damage (NGAL-positive tubules), apoptosis (TUNEL-positive cells) and necroptosis (phosphorylation of MLKL and RIP3) through activating AKT phosphorylation and p53 suppression; enhanced mitochondrial biogenesis (increased PGC-1α and NRF1) and restored mitochondrial mass (increased TIM23) to re-establish mitochondrial homeostasis (increased fusion markers OPA1, MFN2, and decreased fission protein DRP1) through the FOXO3/PGC-1α signaling cascade. Conversely, kidney function loss and histological damage, tubular cell death, and mitochondrial dysfunction were all aggravated in TubCatKO mice. Mechanistically, β-catenin transfection maintained mitochondrial mass and activated PGC-1α via FOXO3 in LPS-exposed HK-2 cells. Collectively, these findings provide evidence that tubular β-catenin mitigates cell death and restores mitochondrial homeostasis in AKI through the common mechanisms associated with activation of AKT/p53 and FOXO3/PGC-1α signaling pathways.
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Affiliation(s)
- Hongyu Li
- grid.194645.b0000000121742757Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Joseph C. K. Leung
- grid.194645.b0000000121742757Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Wai Han Yiu
- grid.194645.b0000000121742757Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Loretta Y. Y. Chan
- grid.194645.b0000000121742757Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Bin Li
- grid.194645.b0000000121742757Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Sarah W. Y. Lok
- grid.194645.b0000000121742757Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Rui Xue
- grid.194645.b0000000121742757Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Yixin Zou
- grid.194645.b0000000121742757Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Kar Neng Lai
- grid.194645.b0000000121742757Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Sydney C. W. Tang
- grid.194645.b0000000121742757Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, China
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Xue R, Han Yiu W, Chi Kam Leung J, Yuk Ying Chan L, Neng Lai K, Yao Lan H, Tang S. FC 119: Kidney-Specific Silencing of Neat1 Alleviates Diabetic Kidney Injury. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac125.001] [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: 11/14/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Long noncoding RNA Nuclear Enriched Abundant Transcript 1 (Neat1) not only serves as a key structural component of nuclear paraspeckle, but is also involved in a variety of pathophysiological processes. Our previous study shows that increased Neat1 expression is closely associated with the pathogenesis of acute kidney injury. Here, we investigate whether Neat1 plays a role in chronic kidney disease and diabetes (DKD).
METHOD
Neat1 expression on kidney biopsies of patients with DKD and other nondiabetic kidney disease was measured by in situ hybridization. Normal portions of kidney tissues removed from nephrectomy specimens for the treatment of renal carcinoma was used as control. In vivo, streptozotocin (STZ)-induced DKD was established in uninephrectomized C57BL/6 mice with low-dose STZ (50 mg/kg) injection for five consecutive days. Mice injected with citrate buffer were used as control. Neat 1 gene was subsequently knocked down in the kidney by shRNA gene silencing via ultrasound-mediated microbubble technique every 2 weeks. All mice were sacrificed at 10 weeks after STZ injection for renal histopathological examination, urine albumin-to-creatinine ratio (UACR) measurement and Neat 1 expression analysis.
RESULTS
Kidney Neat 1 expression was increased significantly in DKD patients compared with control and other kidney diseases (Figure 1). Similarly, Neat1 was induced in STZ-induced diabetic kidneys while its expression was markedly suppressed following shRNA knockdown as confirmed by real-time qPCR (Figure 2A, C and E). Compared with nondiabetic control, diabetic mice presented increased UACR with significant tubular dilatation and atrophy, while knockdown of Neat1 attenuated both proteinuria and kidney injury in the diabetic mice (Figure 2B, D and F).
CONCLUSION
Increased Neat 1 expression contributes to the pathogenesis of DKD and targeting Neat 1 may be a novel and potential therapeutic strategy for diabetic kidney injury.
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Affiliation(s)
- Rui Xue
- The University of Hong Kong, Medicine, Hong Kong, P.R. China
| | - Wai Han Yiu
- The University of Hong Kong, Medicine, Hong Kong, P.R. China
| | | | | | - Kar Neng Lai
- The University of Hong Kong, Medicine, Hong Kong, P.R. China
| | - Hui Yao Lan
- The Chinese University of Hong Kong, Hong Kong, P.R. China
| | - Sydney Tang
- The University of Hong Kong, Medicine, Hong Kong, P.R. China
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Chan KW, Yu KY, Yiu WH, Xue R, Lok SWY, Li H, Zou Y, Ma J, Lai KN, Tang SCW. Potential Therapeutic Targets of Rehmannia Formulations on Diabetic Nephropathy: A Comparative Network Pharmacology Analysis. Front Pharmacol 2022; 13:794139. [PMID: 35387335 PMCID: PMC8977554 DOI: 10.3389/fphar.2022.794139] [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: 11/01/2021] [Accepted: 02/10/2022] [Indexed: 11/14/2022] Open
Abstract
Background: Previous retrospective cohorts showed that Rehmannia-6 (R-6, Liu-wei-di-huang-wan) formulations were associated with significant kidney function preservation and mortality reduction among chronic kidney disease patients with diabetes. This study aimed to investigate the potential mechanism of action of common R-6 variations in a clinical protocol for diabetic nephropathy (DN) from a system pharmacology approach. Study Design and Methods: Disease-related genes were retrieved from GeneCards and OMIM by searching “Diabetic Nephropathy” and “Macroalbuminuria”. Variations of R-6 were identified from a published existing clinical practice guideline developed from expert consensus and pilot clinical service program. The chemical compound IDs of each herb were retrieved from TCM-Mesh and PubChem. Drug targets were subsequently revealed via PharmaMapper and UniProtKB. The disease gene interactions were assessed through STRING, and disease–drug protein–protein interaction network was integrated and visualized by Cytoscape. Clusters of disease–drug protein–protein interaction were constructed by Molecular Complex Detection (MCODE) extension. Functional annotation of clusters was analyzed by DAVID and KEGG pathway enrichment. Differences among variations of R-6 were compared. Binding was verified by molecular docking with AutoDock. Results: Three hundred fifty-eight genes related to DN were identified, forming 11 clusters which corresponded to complement and coagulation cascades and signaling pathways of adipocytokine, TNF, HIF-1, and AMPK. Five variations of R-6 were analyzed. Common putative targets of the R-6 variations on DN included ACE, APOE, CCL2, CRP, EDN1, FN1, HGF, ICAM1, IL10, IL1B, IL6, INS, LEP, MMP9, PTGS2, SERPINE1, and TNF, which are related to regulation of nitric oxide biosynthesis, lipid storage, cellular response to lipopolysaccharide, inflammatory response, NF-kappa B transcription factor activity, smooth muscle cell proliferation, blood pressure, cellular response to interleukin-1, angiogenesis, cell proliferation, peptidyl-tyrosine phosphorylation, and protein kinase B signaling. TNF was identified as the seed for the most significant cluster of all R-6 variations. Targets specific to each formulation were identified. The key chemical compounds of R-6 have good binding ability to the putative protein targets. Conclusion: The mechanism of action of R-6 on DN is mostly related to the TNF signaling pathway as a core mechanism, involving amelioration of angiogenesis, fibrosis, inflammation, disease susceptibility, and oxidative stress. The putative targets identified could be validated through clinical trials.
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Affiliation(s)
- Kam Wa Chan
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kam Yan Yu
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Wai Han Yiu
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Rui Xue
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Sarah Wing-Yan Lok
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Hongyu Li
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Yixin Zou
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Jinyuan Ma
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kar Neng Lai
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Tang SCW, Chan KW, Ip DKM, Yap DYH, Ma MKM, Mok MMY, Chan GCW, Tam S, Lai KN. Direct Renin Inhibition in Non-diabetic chronic Kidney disease (DRINK): a prospective randomized trial. Nephrol Dial Transplant 2021; 36:1648-1656. [PMID: 32617578 DOI: 10.1093/ndt/gfaa085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/26/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The potential long-term safety and efficacy of aliskiren in nondiabetic chronic kidney disease (CKD) are unknown. We sought to investigate the renoprotective effect of aliskiren on nondiabetic CKD patients. METHODS In this open-label, parallel, randomized controlled trial, nondiabetic CKD Stages 3-4 patients were randomized to receive aliskiren added to an angiotensin II receptor blocker (ARB) at the maximal tolerated dose, or ARB alone. Primary outcome was the rate of change in estimated glomerular filtration rate (eGFR). Secondary endpoints included rate of change in urine protein-to-creatinine ratio (UPCR), cardiovascular events and hyperkalemia. Composite renal outcomes of doubling of baseline serum creatinine or a 40% reduction in eGFR or incident end-stage renal disease or death were analyzed as post hoc analysis. RESULTS Seventy-six patients were randomized: 37 to aliskiren (mean age 55.1 ± 11.1 years) and 39 to control (mean age 55.0 ± 9.4 years). Their baseline demographics were comparable to eGFR (31.9 ± 9.0 versus 27.7 ± 9.0 mL/min/1.73 m2, P = 0.05) and UPCR (30.7 ± 12.6 versus 47.8 ± 2.8 mg/mmol, P = 0.33) for treatment versus control subjects. After 144 weeks of follow-up, there was no difference in the rate of eGFR change between groups. Six patients in the aliskiren group and seven in the control group reached the renal composite endpoint (16.2% versus 17.9%, P = 0.84). The cardiovascular event rate was 10.8% versus 2.6% (P = 0.217). The hyperkalemia rate was 18.9% versus 5.1% with an adjusted hazard ratio of 7.71 (95% confidence interval 1.14 to 52.3, P = 0.04) for the aliskiren arm. CONCLUSION Aliskiren neither conferred additional renoprotective benefit nor increased adverse events, except for more hyperkalemia in nondiabetic CKD patients.
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Affiliation(s)
- Sydney C W Tang
- Division of Nephrology, Department of Medicine, The University of Hong Kong and Queen Mary Hospital, Hong Kong, China
| | - Kam Wa Chan
- Division of Nephrology, Department of Medicine, The University of Hong Kong and Queen Mary Hospital, Hong Kong, China
| | - Dennis K M Ip
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Desmond Y H Yap
- Division of Nephrology, Department of Medicine, The University of Hong Kong and Queen Mary Hospital, Hong Kong, China
| | - Maggie K M Ma
- Division of Nephrology, Department of Medicine, The University of Hong Kong and Queen Mary Hospital, Hong Kong, China
| | - Maggie M Y Mok
- Division of Nephrology, Department of Medicine, The University of Hong Kong and Queen Mary Hospital, Hong Kong, China
| | - Gary C W Chan
- Division of Nephrology, Department of Medicine, The University of Hong Kong and Queen Mary Hospital, Hong Kong, China
| | - Sidney Tam
- Department of Clinical Biochemistry, Queen Mary Hospital, Hong Kong, China
| | - Kar Neng Lai
- Division of Nephrology, Department of Medicine, The University of Hong Kong and Queen Mary Hospital, Hong Kong, China
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9
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Chan KW, Yu KY, Lee PW, Lai KN, Tang SCW. Global REnal Involvement of CORonavirus Disease 2019 (RECORD): A Systematic Review and Meta-Analysis of Incidence, Risk Factors, and Clinical Outcomes. Front Med (Lausanne) 2021; 8:678200. [PMID: 34113640 PMCID: PMC8185046 DOI: 10.3389/fmed.2021.678200] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/09/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction: The quantitative effect of underlying non-communicable diseases on acute kidney injury (AKI) incidence and the factors affecting the odds of death among coronavirus disease 2019 (COVID-19) AKI patients were unclear at population level. This study aimed to assess the association between AKI, mortality, underlying non-communicable diseases, and clinical risk factors. Methods: A systematic search of six databases was performed from January 1, 2020, until October 5, 2020. Peer-reviewed observational studies containing quantitative data on risk factors and incidence of renal manifestations of COVID-19 were included. Location, institution, and time period were matched to avoid duplicated data source. Incidence, prevalence, and odds ratio of outcomes were extracted and pooled by random-effects meta-analysis. History of renal replacement therapy (RRT) and age group were stratified for analysis. Univariable meta-regression models were built using AKI incidence as dependent variable, with underlying comorbidities and clinical presentations at admission as independent variables. Results: Global incidence rates of AKI and RRT in COVID-19 patients were 20.40% [95% confidence interval (CI) = 12.07-28.74] and 2.97% (95% CI = 1.91-4.04), respectively, among patients without RRT history. Patients who developed AKI during hospitalization were associated with 8 times (pooled OR = 9.03, 95% CI = 5.45-14.94) and 16.6 times (pooled OR = 17.58, 95% CI = 10.51-29.38) increased odds of death or being critical. At population level, each percentage increase in the underlying prevalence of diabetes, hypertension, chronic kidney disease, and tumor history was associated with 0.82% (95% CI = 0.40-1.24), 0.48% (95% CI = 0.18-0.78), 0.99% (95% CI = 0.18-1.79), and 2.85% (95% CI = 0.93-4.76) increased incidence of AKI across different settings, respectively. Although patients who had a kidney transplant presented with a higher incidence of AKI and RRT, their odds of mortality was lower. A positive trend of increased odds of death among AKI patients against the interval between symptom onset and hospital admission was observed. Conclusion: Underlying prevalence of non-communicable diseases partly explained the heterogeneity in the AKI incidence at population level. Delay in admission after symptom onset could be associated with higher mortality among patients who developed AKI and warrants further research.
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Affiliation(s)
- Kam Wa Chan
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Kam Yan Yu
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Pak Wing Lee
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kar Neng Lai
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Sydney Chi-Wai Tang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
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10
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Yiu WH, Chan KW, Chan LYY, Leung JCK, Lai KN, Tang SCW. Spleen Tyrosine Kinase Inhibition Ameliorates Tubular Inflammation in IgA Nephropathy. Front Physiol 2021; 12:650888. [PMID: 33790807 PMCID: PMC8006276 DOI: 10.3389/fphys.2021.650888] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/01/2021] [Indexed: 12/15/2022] Open
Abstract
Spleen tyrosine kinase (Syk) is a non-receptor tyrosine kinase involved in signal transduction in a variety of immune responses. It has been demonstrated that Syk plays a pathogenic role in orchestrating inflammatory responses and cell proliferation in human mesangial cells (HMC) in IgA nephropathy (IgAN). However, whether Syk is involved in tubular damage in IgAN remains unknown. Using human kidney biopsy specimens, we found that Syk was activated in renal tubules of biopsy-proven IgAN patients with an increase in total and phosphorylated levels compared to that from healthy control subjects. In vitro, cultured proximal tubular epithelial cells (PTECs) were stimulated with conditioned medium prepared from human mesangial cells incubated with polymeric IgA (IgA-HMC) from patients with IgAN or healthy control. Induction of IL-6, IL-8, and ICAM-1 synthesis from cultured PTECs incubated with IgA-HMC conditioned medium was significantly suppressed by treatment with the Syk inhibitor R406 compared to that from healthy control. Furthermore, R406 downregulated expression of phosphorylated p65 NF-κB and p-42/p-44 MAPK, and attenuated TNF-α-induced cytokine production in PTECs. Taken together, our findings suggest that Syk mediates IgA-HMC conditioned medium-induced inflammation in tubular cells via activation of NF-κB and p-42/p-44 MAPK signaling. Inhibition of Syk may be a potential therapeutic approach for tubulointerstitial injury in IgAN.
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Affiliation(s)
- Wai Han Yiu
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Kam Wa Chan
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Loretta Y Y Chan
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Joseph C K Leung
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Kar Neng Lai
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Sydney C W Tang
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
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11
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Yiu WH, Li Y, Lok SWY, Chan KW, Chan LYY, Leung JCK, Lai KN, Tsu JHL, Chao J, Huang XR, Lan HY, Tang SCW. Protective role of kallistatin in renal fibrosis via modulation of Wnt/β-catenin signaling. Clin Sci (Lond) 2021; 135:429-446. [PMID: 33458750 DOI: 10.1042/cs20201161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 09/11/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 12/31/2022]
Abstract
Kallistatin is a multiple functional serine protease inhibitor that protects against vascular injury, organ damage and tumor progression. Kallistatin treatment reduces inflammation and fibrosis in the progression of chronic kidney disease (CKD), but the molecular mechanisms underlying this protective process and whether kallistatin plays an endogenous role are incompletely understood. In the present study, we observed that renal kallistatin levels were significantly lower in patients with CKD. It was also positively correlated with estimated glomerular filtration rate (eGFR) and negatively correlated with serum creatinine level. Unilateral ureteral obstruction (UUO) in animals also led to down-regulation of kallistatin protein in the kidney, and depletion of endogenous kallistatin by antibody injection resulted in aggravated renal fibrosis, which was accompanied by enhanced Wnt/β-catenin activation. Conversely, overexpression of kallistatin attenuated renal inflammation, interstitial fibroblast activation and tubular injury in UUO mice. The protective effect of kallistatin was due to the suppression of TGF-β and β-catenin signaling pathways and subsequent inhibition of epithelial-to-mesenchymal transition (EMT) in cultured tubular cells. In addition, kallistatin could inhibit TGF-β-mediated fibroblast activation via modulation of Wnt4/β-catenin signaling pathway. Therefore, endogenous kallistatin protects against renal fibrosis by modulating Wnt/β-catenin-mediated EMT and fibroblast activation. Down-regulation of kallistatin in the progression of renal fibrosis underlies its potential as a valuable clinical biomarker and therapeutic target in CKD.
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Affiliation(s)
- Wai Han Yiu
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Ye Li
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Sarah W Y Lok
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Kam Wa Chan
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Loretta Y Y Chan
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Joseph C K Leung
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Kar Neng Lai
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - James H L Tsu
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Julie Chao
- Department of Biochemistry and Molecular Biology, Medical University of South Carolina, Charleston, SC, U.S.A
| | - Xiao-Ru Huang
- Department of Medicine and Therapeutics, and Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Hui Yao Lan
- Department of Medicine and Therapeutics, and Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Sydney C W Tang
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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12
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Abstract
During peritoneal dialysis, peritoneal cells are repeatedly exposed to a non-physiologic hypertonic environment with high glucose content and low pH. Current sterile dialysis solutions cause inflammation in the submesothelial compact zone, leading to fibrosis, angiogenesis, and, eventually, ultrafiltration failure. Although the normal interstitium separates the peritoneal microvasculature from the dialysis fluid and makes transperitoneal transport less efficient, changes in the submesothelial compact zone can result in progressive increases in solute transfer and ultrafiltration diminution. This peritoneal dysfunction will further be amplified with the development of an epithelial-to-mesenchymal transition of mesothelial cells and dissipation of the osmotic driving force through the increased area and solute transport that accompany neoangiogenesis of the submesothelial microvasculature. The alteration of the peritoneal membrane can be further aggravated by peritonitis, advanced glycation end-products, and glucose degradation products. Furthermore, new data are emerging to support a proinflammatory role for peritoneal adipocytes.
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Affiliation(s)
- Kar Neng Lai
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, PR China
| | - Sydney C.W. Tang
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, PR China
| | - Joseph C.K. Leung
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, PR China
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13
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Abstract
Background Kidney transplantation offers the best potential for full rehabilitation in patients with end-stage kidney disease who are treated with dialysis. However, due to organ shortage which is a universal phenomenon, most patients need to be maintained on a period of dialysis therapy before the prospect of transplantation. Peritoneal dialysis (PD) could be an ideal form of renal replacement therapy due to its favorable profile toward preservation of residual renal function, patient survival, lower overall burden on cardiovascular morbidity and infection risks. Methods With extensive experience in PD therapy from Hong Kong where PD-first is a mandatory health policy, we reviewed the literature and present current evidence that favors PD as an optimal form of bridging renal replacement therapy prior to kidney transplantation.
Results PD provides a viable and advantageous form of renal reaplcement particularly in terms of preservation of residual renal function, patient survival and quality of life, and cost among many other factors. Potential misconceptions that PD-related peritonitis and dialysis inadequacy are potentially deterrent factors for initiating PD therapy are clarified.
Conclusion PD is a practical and noninferior form of renal replacement that serves as an ideal bridge from conservative therapy to kidney transplantation.
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Affiliation(s)
- Sydney C W Tang
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
| | - Kar Neng Lai
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China
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14
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Chan KW, Lee PW, Leung CPS, Chan GCW, Yiu WH, Cheung HM, Li B, Lok SWY, Li H, Xue R, Chan LYY, Leung JCK, Lam TP, Lai KN, Tang SCW. Patients' and clinicians' expectations on integrative medicine Services for Diabetes: a focus group study. BMC Complement Med Ther 2020; 20:205. [PMID: 32615961 PMCID: PMC7331247 DOI: 10.1186/s12906-020-02994-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/16/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Difference of perspective between patients and physicians over integrative medicine (IM) research and service provision remains unclear despite significant use worldwide. We observed an exceptionally low utilisation of IM and potential underreporting in diabetes. We aimed to explore the barriers and recommendations regarding service delivery and research of IM service among diabetes patients and physicians. METHODS A 10-group, 50-participant semi-structured focus group interview series was conducted. Twenty-one patients with diverse severity of disease, comorbidities and education levels; and 29 physicians (14 conventional medicine (ConM) and 15 Chinese medicine (CM)) with diverse clinical experience, academic background and affiliation were purposively sampled from private and public clinics. Their perspectives were qualitatively analysed by constant comparative method. RESULTS Seven subthemes regarding barriers towards IM service were identified including finance, service access, advice from medical professionals, uncertainty of service quality, uncertainty of CM effect, difficulty in understanding CM epistemology and access to medical records. Patients underreported the use of CM due to the concern over neutrality of medical advice among physicians. Inconvenience of service access, frequent follow-up, use of decoction and long-term financial burden were identified as key obstacles among patients. Regarding research design, ConM physicians emphasised standardisation and reproducibility while CM physicians emphasised personalisation. Some CM-related outcome measurements were suggested as non-communicable. Both physicians acknowledged the discordance in epistemology should be addressed by pragmatic approach. CONCLUSION Key obstacles of CAM clinical utilisation are different between patients. Further assessment on IM should be pragmatic to balance between standardisation, reproducibility and real-world practice. Evidence-based IM programs and research should merge with existing infrastructure.
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Affiliation(s)
- Kam Wa Chan
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Pak Wing Lee
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Crystal Pui Sha Leung
- Department of Family Medicine and Primary Healthcare, Hong Kong East Cluster, Hospital Authority, Hong Kong, Hong Kong SAR
| | - Gary Chi Wang Chan
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, Hong Kong, Hong Kong SAR
| | - Wai Han Yiu
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Hoi Man Cheung
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Bin Li
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Sarah Wing Yan Lok
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Hongyu Li
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Rui Xue
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Loretta Yuk Yee Chan
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Joseph Chi Kam Leung
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Tai Pong Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Kar Neng Lai
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Sydney Chi Wai Tang
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR.
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15
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CHAN KW, Lee PW, Leung CPS, Chan GCW, Chan LYY, Leung JCK, Lam TP, Lai KN, Tang S. P1045MISALIGNED EXPECTATIONS ON INTEGRATIVE MEDICAL SERVICE FOR DIABETES AND DIABETIC KIDNEY DISEASE: A COMPARATIVE FOCUS GROUP SERIES OF PATIENTS AND PHYSICIANS. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1045] [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: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Difference of perspective between patients and physicians over integrative medicine (IM) research and service provision remains unclear despite significant use worldwide. We sought to explore the barriers and recommendations regarding IM service among diabetes and diabetic kidney disease (DKD) patients and physicians.
Method
A 10-group, 50-participant semi-structured focus group interview series was conducted. Twenty-one patients with diverse severity of disease, comorbidities and education levels; and 29 physicians (14 western medicine (WM) and 15 Chinese medicine (CM)) with diverse clinical experience, academic background and affiliation were purposively sampled from private and public clinics. The perspectives were qualitatively analysed by constant comparative method with grounded theory approach.
Results
Seven subthemes regarding barriers towards IM service were identified including finance, service access, advice from medical professionals, uncertainty of service quality, uncertainty of CM effect, difficulty in understanding CM epistemology and access to medical records. Patients underreported the use of CM due to the concern over neutrality of medical advice among physicians. Practical issues including inconvenience of access to service, frequent follow-up, use of decoction and long-term financial burden were identified as key obstacles among patients. Regarding research design, WM physicians emphasized standardization and reproducibility while CM physicians emphasized personalization. Some CM-related outcome measurements were suggested as abstract and non-communicable. Both WM and CM physicians acknowledged the discordance in epistemology should be addressed by pragmatic approach.
Conclusion
Further assessment on IM should be pragmatic to balance between standardisation, reproducibility and real-world practice. Evidence-based IM programs and research should merge with existing infrastructure.
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Affiliation(s)
- Kam Wa CHAN
- The University of Hong Kong, Department of Medicine, Hong Kong, P.R. China
| | - Pak Wing Lee
- The University of Hong Kong, Department of Medicine, Hong Kong, P.R. China
| | - Crystal Pui Sha Leung
- Hospital Authority Hong Kong East Cluster, Department of Family Medicine and Primary Healthcare, Hong Kong, P.R. China
| | | | | | | | - Tai Pong Lam
- The University of Hong Kong, Department of Family Medicine and Primary Care, Hong Kong, P.R. China
| | - Kar Neng Lai
- The University of Hong Kong, Department of Medicine, Hong Kong, P.R. China
| | - Sydney Tang
- The University of Hong Kong, Department of Medicine, Hong Kong, P.R. China
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16
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Ma MKM, Yap DYH, Li CL, Mok MMY, Chan GCW, Kwan LPY, Lai KN, Tang SCW. Low-dose corticosteroid and mycophenolate for primary treatment of minimal change disease. QJM 2020; 113:399-403. [PMID: 31769845 DOI: 10.1093/qjmed/hcz297] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/31/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Mycophenolate has been shown to be effective in glomerular disease. However, the role of mycophenolate in the first-line treatment of adult-onset idiopathic minimal change disease (MCD) has not been systematically studied in a randomized fashion. AIM To evaluate the therapeutic efficacy of enteric-coated mycophenolate sodium combined with low-dose corticosteroid as first-line treatment for MCNS. DESIGN A prospective, open-label, randomized clinical trial. METHODS Twenty adult patients with biopsy proven MCD were recruited and randomly assigned to receive either enteric-coated Mycophenolate Sodium (EC-MPS) plus low-dose prednisolone (Group 1: Prednisolone 0.25 mg/kg/day, n = 10) or standard-dose prednisolone (Group 2: Prednisolone 1 mg/kg/day, n = 10). RESULTS After 24 weeks of therapy, eight patients in Group 1 vs. seven of patients in Group 2 achieved complete remission (P = 0.606). Both groups showed a significant reduction of urine protein excretion (P < 0.05) and increased serum albumin (P < 0.001) vs. baseline levels. However, no significant between-group differences were demonstrated. The relapse rate was also similar in both groups. Both treatment regimens were well tolerated but there were more patient reported adverse effects in the standard-dose prednisolone group. CONCLUSION EC-MPS plus low-dose prednisolone is non-inferior to standard-dose prednisolone therapy in inducing clinical remission and preventing relapse in adult-onset idiopathic MCD and is associated with better tolerability and less adverse effects. This trial is registered with the ClinicalTrials.gov number NCT01185197.
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Affiliation(s)
- M K M Ma
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - D Y H Yap
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - C L Li
- Renal Department, Centro Hospitalar Conde de São Januário, Macao, China
| | - M M Y Mok
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - G C W Chan
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - L P Y Kwan
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - K N Lai
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - S C W Tang
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
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17
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Abstract
The aquaporins (AQPs) constitute a large family of water channels that play a part in transcellular water movement in many tissues. They are particularly abundant and important in the kidney and the lung. Derangement of AQP structure or function leads to a variety of water-balance disorders. Aquaporin-1 (AQP1) is constitutively expressed in the endothelial cells of the capillaries and venules that provide the ultrasmall pores predicted by the three-pore model of water movement during peritoneal dialysis. The ultrasmall pores are critical for ultrafiltration. In addition, AQP1 and AQP3 are constitutively expressed in peritoneal mesothelial cells. The expression of those AQPs is upregulated by hyperosmolality. Reduced expression or function of AQP1 may be responsible for some cases of ultrafiltration failure, but further evidence is required to establish that link.
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Affiliation(s)
- Kar Neng Lai
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Man Fai Lam
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Joseph C. Leung
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
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18
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Li PKT, Chan TH, So WY, Wang AY, Leung CB, Lai KN. Comparisons of Y-Set Disconnect System (Ultraset) versus Conventional Spike System in Uremic Patients on Capd: Outcome and Cost Analysis. Perit Dial Int 2020. [DOI: 10.1177/089686089601601s70] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We conducted a single-blind, prospective randomized study on the use of the V -set disconnect system (Uttraset) (U) versus the conventional (C) spike system to assess the peritonitis rate, exit-site infection (ESt), clinical outcome, the resulting hospitalization rate, and recurrent costs. Forty new end-stage renal failure patients admitted to the dialysis program were recruited into the study and 20 each were randomly allocated to the U and C systems. They were studied for a period of 12 months. The mean number of days required to train patients for the U and C systems were 8.6 and 9.8 days, respectively. The peritonitis rates for the U and C systems were one episode every 17 and 11.4 patient-months, respectively. The ESI rates for the U and C systems were one episode every 26.4 and 21.6 patient-months, respectively. Four catheters were removed due to fungal peritonitis (three with the C system and one with the U system). As related to peritonitis, patients on the C system required 57 hospital-days while those on the U system required 28 days per year. On cost analysis, the extra cost required for the U system can be offset by the other expenses incurred for events related to more infections on the C system. It is concluded that for the similar cumulative costs required for the patients on the two systems, the Y-set disconnect has a better morbidity profile than the conventional spike system.
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Affiliation(s)
- Philip Kam Tao Li
- Department of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
| | - Tak Hin Chan
- Department of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
| | - Wing Yee So
- Department of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
| | - Angela Y.M. Wang
- Department of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
| | - Chi Bon Leung
- Department of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
| | - Kar Neng Lai
- Department of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
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19
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Li PKT, Ip M, Law MC, Szeto CC, Leung CB, Wong TY, Ho KK, Wang AY, Lui SF, Yu AW, Lyon DJ, Cheng AF, Lai KN. Use of Intraperitoneal Cefepime as Monotherapy in Treatment of CAPD Peritonitis. Perit Dial Int 2020. [DOI: 10.1177/089686080002000212] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Margaret Ip
- Department of Microbiology Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong, China
| | | | | | | | | | | | | | | | | | - Donald J. Lyon
- Department of Microbiology Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong, China
| | - Augustine F.B. Cheng
- Department of Microbiology Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong, China
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20
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Abstract
The socioeconomic statuses of Asian countries are diverse, and government reimbursement policies for renal replacement programs vary greatly from one country to another. Both factors affect not only the availability of treatment, but also the choice of dialysis modality. A close correlation is demonstrated between the dialysis treatment rate for end-stage renal disease (ESRO) and the gross domestic product (GOP) per capita income. A biphasic relationship with the GOP per capita income and the peritoneal dialysis (PO) utilization rate is observed, in that the countries with the highest and lowest treatment rates tend to have lower PO utilization rates, whereas countries with modest treatment rates tend to have higher PO utilization rates. In contrast, countries with high continuous ambulatory peritoneal dialysis (CAPO) utilization rates have the lowest automated peritoneal dialysis (APO) utilization rates. The low APO utilization rates are due to fact that, in most instances, patients themselves must purchase the APO machine, and the machines are relatively more expensive in Asian Pacific countries. Continuous cycling peritoneal dialysis (CCPO) is most frequently practiced. Generally, convenience for employment is the main indication for the utilization of APO. Other important indications are the convenience of treatment in young or elderly uremic patients. Contrary to the practice in CAPO treatment, detailed documentation of dialysis adequacy and nutritional status is not routinely done in patients undergoing APO treatment in most Asian Pacific countries. In conclusion, APO is an underdeveloped treatment modality in the renal replacement programs of Asian Pacific countries. The low utilization of APO is clearly influenced by non medical factors including government reimbursement policy and the cost of PO machines.
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Affiliation(s)
- Kar Neng Lai
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Sing Leung Lui
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Daniel T.M. Chan
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
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Lui SL, Yip T, Tse KC, Lam MF, Lai KN, Lo WK. Treatment of Refractory Pseudomonas Aeruginosa Exit-Site Infection by Simultaneous Removal and Reinsertion of Peritoneal Dialysis Catheter. Perit Dial Int 2020. [DOI: 10.1177/089686080502500611] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Patients on continuous ambulatory peritoneal dialysis (CAPD) with Pseudomonas aeruginosa exit-site infection (ESI) refractory to antibiotic treatment often require replacement of their peritoneal dialysis catheter (PDC). The optimal interval between removal and reinsertion of the PDC is not known. There are relatively few data on the feasibility of simultaneous removal and reinsertion of dialysis catheters for the treatment of P. aeruginosa ESI. Methods We retrospectively reviewed the short- and long-term outcomes of all CAPD patients who had undergone simultaneous removal and reinsertion of their PDC for the treatment of refractory P. aeruginosa ESI in our hospital between January 1994 and December 2003. During the operation, the old catheter was removed first and a new catheter was inserted into the opposite side of the abdomen. All patients received 7 days of antibiotic therapy postoperatively. CAPD was resumed after 2 weeks of intermittent peritoneal dialysis. Results Over a 10-year period, 37 CAPD patients underwent the operation. Mean age of the patients was 59.5 ± 10.9 years. The interval between the diagnosis of ESI and the operation was 16.7 ± 6.9 weeks. The patients received 7.6 ± 2.5 weeks of antibiotic treatment before the procedure. Early postoperative complications were uncommon. None of the patients developed ESI within 4 weeks after the operation. At 1 year after the operation, 3 patients (8%) had developed recurrence of P. aeruginosa ESI 24 – 40 weeks postoperatively. Peritonitis due to P. aeruginosa was not observed. Conclusions We conclude that simultaneous removal and reinsertion of the PDC is feasible in eradicating refractory ESI due to P. aeruginosa. This procedure alleviates the need for temporary hemodialysis and allows continuation of peritoneal dialysis.
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Affiliation(s)
- Sing Leung Lui
- Division of Nephrology, University Department of Medicine, Tung Wah Hospital, Hong Kong SAR, People's Republic of China
| | - Terence Yip
- Division of Nephrology, University Department of Medicine, Tung Wah Hospital, Hong Kong SAR, People's Republic of China
| | - Kai Chung Tse
- Division of Nephrology, University Department of Medicine, Tung Wah Hospital, Hong Kong SAR, People's Republic of China
| | - Man Fai Lam
- Division of Nephrology, University Department of Medicine, Tung Wah Hospital, Hong Kong SAR, People's Republic of China
| | - Kar Neng Lai
- Division of Nephrology, University Department of Medicine, Tung Wah Hospital, Hong Kong SAR, People's Republic of China
| | - Wai Kei Lo
- Division of Nephrology, University Department of Medicine, Tung Wah Hospital, Hong Kong SAR, People's Republic of China
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Abstract
The socioeconomic statuses of Asian countries are diverse and government reimbursement policies for renal replacement programs vary greatly from one country to another. Both factors affect not only the availability of treatment but also the choice of dialysis modality. Despite the economic growth of Hong Kong over the past three decades, the resources spent by our government on health services are less than other developed countries. The National Health Service, which is run on a tight budget, supports almost 95% of the patients on renal replacement programs. Due to the cost-effectiveness and reimbursement from the government, 79% of patients with end-stage renal failure in Hong Kong are treated with continuous ambulatory peritoneal dialysis (CAPD). All new patients entering the renal replacement program run by the National Health Service are offered CAPD as the first-line dialytic treatment. Due to budgetary constraint, over the past 10 years dialysis centers in Hong Kong have adopted a small-volume regime of 3 x 2-L daily exchanges as the initial dialysis prescription. This dialysis prescription will be considered to be suboptimal by Western standards, but the survival of these patients was comparable to, or even better than, other areas despite a lower Kt/V. These preliminary studies suggest small-volume dialysis may be an acceptable compromise in Asian populations with their smaller body size, given the financial constraints. These issues are especially important in Asia, where financial resources for renal replacement therapy are still limited in most countries and many patients have to continue working to pay for their renal replacement treatment. Using this small-volume dialytic regime, more patients may be treated with the limited financial resources. Furthermore, our experience raises the question of the importance of nutritional status in patient survival.
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Affiliation(s)
- Kar Neng Lai
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Wai Kei Lo
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
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Lam MF, Tang C, Wong AK, Tong KL, Yu AW, Li CS, Cheung KO, Lai KN. ASPD: A Prospective Study of Adequacy in Asian Patients on Long Term, Small Volume, Continuous Ambulatory Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080602600411] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The impact of small solute clearance on patient survival in continuous ambulatory peritoneal dialysis (CAPD) is not yet solidified. Previously, we demonstrated that CAPD using small volume (6 L) daily exchanges provides adequate dialysis for most Asian patients. Methods We conducted a prospective, long-term observational study to determine the optimal dialysis adequacy that may provide better patient survival for Asian patients who receive small-volume CAPD. We recruited 294 patients. The initial CAPD regime was 3 x 2-L exchanges daily. The same regime was maintained unless there was significant loss of ultrafiltration or fluid retention despite the use of hypertonic dialysate. Results Median study period was 38.9 (range 5 – 76.5) months, with 81% and 27% of patients remaining in the study at 24 and 48 months respectively. The overall survival rates at 2 and 4 years were 94.0% and 74.8% respectively. Our long-term data revealed that survival rate was related to Kt/V values. Survival rates were significantly higher for patients with total Kt/V > 2.0 than for patients with Kt/V < 1.7 ( p = 0.02). The former group had lower body mass index and higher residual renal function and peritoneal Kt/V than the latter group. On analysis using Cox proportional hazards regression models, cardiovascular disease (CVD), lower urine volume, and higher body mass index were independent predictors of mortality. Patients with higher renal Kt/V had a significantly lower risk of mortality (RR = 0.018, p = 0.01) after adjusting for the effects of CVD and diabetes mellitus. Conclusion Our data recommend that 1.7 be the minimal target for total Kt/V in patients on long-term CAPD. Patients with high body mass index, low residual urine volume, and significant CVD need close monitoring.
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Affiliation(s)
- Man Fai Lam
- Renal Units, Department of Medicine, Queen Mary Hospital, Hong Kong
| | - Colin Tang
- Renal Units, Department of Medicine, Queen Mary Hospital, Hong Kong
| | | | | | - Alex W. Yu
- Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | | | | | - Kar Neng Lai
- Renal Units, Department of Medicine, Queen Mary Hospital, Hong Kong
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Lam MF, Tang BSF, Tse KC, Chan TM, Lai KN. Ampicillin–Sulbactam and Amikacin Used as Second-Line Antibiotics for Patients with Culture-Negative Peritonitis. Perit Dial Int 2020. [DOI: 10.1177/089686080802800520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Man Fai Lam
- Nephrology Division Queen Mary Hospital University of Hong Kong Hong Kong
| | - Bone Siu Fai Tang
- Department of Medicine Department of Microbiology Queen Mary Hospital University of Hong Kong Hong Kong
| | - Kai Chung Tse
- Nephrology Division Queen Mary Hospital University of Hong Kong Hong Kong
| | - Tak Mao Chan
- Nephrology Division Queen Mary Hospital University of Hong Kong Hong Kong
| | - Kar Neng Lai
- Nephrology Division Queen Mary Hospital University of Hong Kong Hong Kong
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Yip T, Tse KC, Lam MF, Cheng SW, Lui SL, Tang S, Ng M, Chan TM, Lai KN, Lo WK. Risks and Outcomes of Peritonitis after Flexible Colonoscopy in CAPD Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080702700517] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective The ISPD 2005 guidelines for peritonitis recommend antibiotic prophylaxis for patients undergoing colonoscopy with polypectomy while on continuous ambulatory peritoneal dialysis (CAPD) but there is little literature to support this recommendation. This study aimed to look into the risks and outcomes of peritonitis after colonoscopy in CAPD patients. Patients and Methods All records of flexible colonoscopy performed on our CAPD patients from January 1994 to January 2006 were retrieved. Demographic and clinical data, use of antibiotics before colonoscopy, endoscopic findings, procedure performed, and peritonitis data were analyzed. Results 77 CAPD patients underwent 97 colonoscopies. No peritonitis developed in the 18 cases where antibiotics were given before colonoscopy. Among those without antibiotic prophylaxis, 4 episodes of peritonitis occurred within 24 hours after the procedure and 1 occurred 5 days later. All responded to intraperitoneal antibiotics. Colonic biopsy and polypectomy were not associated with more peritonitis (2 in 41 with biopsy vs 3 in 38 without biopsy, p = 0.67; 1 in 30 with polypectomy vs 4 in 49 without polypectomy, p = 0.64). Conclusion The risk of peritonitis after colonoscopy without antibiotic prophylaxis was 6.3%. All peritonitis episodes responded to intraperitoneal antibiotics. Colonic biopsy or polypectomy did not appear to increase the risk of peritonitis. Although statistically not significant when compared with patients without antibiotic prophylaxis, we observed no peritonitis after colonoscopy in patients that were given antibiotics for prophylactic purposes or for other reasons. The efficacy of prophylactic antibiotics would be better defined by large randomized trials.
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Affiliation(s)
- Terence Yip
- Department of Medicine, Tung Wah Hospital, University of Hong Kong, Hong Kong
| | - Kai Chung Tse
- Department of Medicine, Tung Wah Hospital, University of Hong Kong, Hong Kong
| | - Man Fai Lam
- Department of Medicine, Tung Wah Hospital, University of Hong Kong, Hong Kong
| | - Suk Wai Cheng
- Department of Medicine, Tung Wah Hospital, University of Hong Kong, Hong Kong
| | - Sing Leung Lui
- Department of Medicine, Tung Wah Hospital, University of Hong Kong, Hong Kong
| | - Sydney Tang
- Department of Medicine, Tung Wah Hospital, University of Hong Kong, Hong Kong
| | - Matthew Ng
- Department of Medicine, Tung Wah Hospital, University of Hong Kong, Hong Kong
| | - Tak Mao Chan
- Department of Medicine, Tung Wah Hospital, University of Hong Kong, Hong Kong
| | - Kar Neng Lai
- Department of Medicine, Tung Wah Hospital, University of Hong Kong, Hong Kong
| | - Wai Kei Lo
- Department of Medicine, Tung Wah Hospital, University of Hong Kong, Hong Kong
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Affiliation(s)
- Sydney C.W. Tang
- Department of Medicine Department of Medicine The University of Hong Kong Queen Mary Hospital Hong Kong, China
| | - Kar Neng Lai
- Division of Nephrology Department of Medicine The University of Hong Kong Queen Mary Hospital Hong Kong, China
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Yiu WH, Li RX, Wong DWL, Wu HJ, Chan KW, Chan LYY, Leung JCK, Lai KN, Sacks SH, Zhou W, Tang SCW. Complement C5a inhibition moderates lipid metabolism and reduces tubulointerstitial fibrosis in diabetic nephropathy. Nephrol Dial Transplant 2019; 33:1323-1332. [PMID: 29294056 DOI: 10.1093/ndt/gfx336] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/07/2017] [Indexed: 02/06/2023] Open
Abstract
Background Complement C5 mediates pro-inflammatory responses in many immune-related renal diseases. Given that the C5a level is elevated in diabetes, we investigated whether activation of C5a/C5aR signalling plays a pathogenic role in diabetic nephropathy (DN) and the therapeutic potential of C5a inhibition for renal fibrosis. Methods Human renal biopsies from patients with DN and control subjects were used for immunohistochemical staining of complement C5 components. Renal function and tubulointerstitial injury were compared between db/m mice, vehicle-treated mice and C5a inhibitor-treated db/db mice. A cell culture model of tubule epithelial cells (HK-2) was used to demonstrate the effect of C5a on the renal fibrotic pathway. Results Increased levels of C5a, but not of its receptor C5aR, were detected in renal tubules from patients with DN. The intensity of C5a staining was positively correlated with the progression of the disease. In db/db mice, administration of a novel C5a inhibitor, NOX-D21, reduced the serum triglyceride level and attenuated the upregulation of diacylglycerolacyltransferase-1 and sterol-regulatory element binding protein-1 expression and lipid accumulation in diabetic kidney. NOX-D21-treated diabetic mice also had reduced serum blood urea nitrogen and creatinine levels with less glomerular and tubulointerstitial damage. Renal transforming growth factor beta 1 (TGF-β1), fibronectin and collagen type I expressions were reduced by NOX-D21. In HK-2 cells, C5a stimulated TGF-β production through the activation of the PI3K/Akt signalling pathway. Conclusions Blockade of C5a signalling by NOX-D21 moderates altered lipid metabolism in diabetes and improved tubulointerstitial fibrosis by reduction of lipid accumulation and TGF-β-driven fibrosis in diabetic kidney.
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Affiliation(s)
- Wai Han Yiu
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong
| | - Rui Xi Li
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong
| | - Dickson W L Wong
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong
| | - Hao Jia Wu
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong
| | - Kam Wa Chan
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong
| | - Loretta Y Y Chan
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong
| | - Joseph C K Leung
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong
| | - Kar Neng Lai
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong
| | - Steven H Sacks
- Medical Research Council Centre for Transplantation, King's College London, Guy's Hospital, London, UK
| | - Wuding Zhou
- Medical Research Council Centre for Transplantation, King's College London, Guy's Hospital, London, UK
| | - Sydney C W Tang
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong
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Li B, Leung JCK, Chan LYY, Yiu WH, Li Y, Lok SWY, Liu WH, Chan KW, Tse HF, Lai KN, Tang SCW. Amelioration of Endoplasmic Reticulum Stress by Mesenchymal Stem Cells via Hepatocyte Growth Factor/c-Met Signaling in Obesity-Associated Kidney Injury. Stem Cells Transl Med 2019; 8:898-910. [PMID: 31054183 PMCID: PMC6708066 DOI: 10.1002/sctm.18-0265] [Citation(s) in RCA: 28] [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: 11/14/2018] [Accepted: 03/24/2019] [Indexed: 12/12/2022] Open
Abstract
Recent advances in the understanding of lipid metabolism suggest a critical role of endoplasmic reticulum (ER) stress in obesity‐induced kidney injury. Hepatocyte growth factor (HGF) is a pleiotropic cytokine frequently featured in stem cell therapy with distinct renotropic benefits. This study aims to define the potential link between human induced pluripotent stem cell‐derived mesenchymal stem cells (iPS‐MSCs)/bone marrow‐derived MSCs (BM‐MSCs) and ER stress in lipotoxic kidney injury induced by palmitic acid (PA) in renal tubular cells and by high‐fat diet (HFD) in mice. iPS‐MSCs or BM‐MSCs alleviated ER stress (by preventing induction of Bip, chop, and unfolded protein response), inflammation (Il6, Cxcl1, and Cxcl2), and apoptosis (Bax/Bcl2 and terminal deoxynucleotidyl transferase‐mediated dUTP‐biotin nick end labeling‐positive cells) in renal cortex of animals exposed to HFD thus mitigating histologic damage and albuminuria, via activating HGF/c‐Met paracrine signaling that resulted in enhanced HGF secretion in the glomerular compartment and c‐Met expression in the tubules. Coculture experiments identified glomerular endothelial cells (GECs) to be the exclusive source of glomerular HGF when incubated with either iPS‐MSCs or BM‐MSCs in the presence of PA. Furthermore, both GEC‐derived HGF and exogenous recombinant HGF attenuated PA‐induced ER stress in cultured tubular cells, and this effect was abrogated by a neutralizing anti‐HGF antibody. Taken together, this study is the first to demonstrate that MSCs ameliorate lipotoxic kidney injury via a novel microenvironment‐dependent paracrine HGF/c‐Met signaling mechanism to suppress ER stress and its downstream pro‐inflammatory and pro‐apoptotic consequences. stem cells translational medicine2019;8:898&910
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Affiliation(s)
- Bin Li
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, People's Republic of China
| | - Joseph C K Leung
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, People's Republic of China
| | - Loretta Y Y Chan
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, People's Republic of China
| | - Wai Han Yiu
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, People's Republic of China
| | - Ye Li
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, People's Republic of China
| | - Sarah W Y Lok
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, People's Republic of China
| | - Wing Han Liu
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, People's Republic of China
| | - Kam Wa Chan
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, People's Republic of China
| | - Hung Fat Tse
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, People's Republic of China
| | - Kar Neng Lai
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, People's Republic of China
| | - Sydney C W Tang
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, People's Republic of China
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Chan KW, Kwong ASK, Chan GCW, Leung CPS, Yiu WH, Lui SL, Ip TP, Cowling BJ, Wong DWL, Li B, Li Y, Feng Y, Chan LY, Leung JC, Tan KCB, Wong Taam VCW, Lai KN, tang SCW. Semi-individualised Chinese Medicine Treatment for Diabetic Kidney Disease – From users’ perspectives to SCHEMATIC trial interim result and potential mechanisms. Advances in Integrative Medicine 2019. [DOI: 10.1016/j.aimed.2019.03.033] [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: 10/27/2022]
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Abstract
IgA nephropathy (IgAN), a common primary glomerulonephritis worldwide, is associated with a substantial risk of progression to end-stage renal failure. The disease runs a highly variable clinical course with frequent involvement of tubulointerstitial damage. A subgroup of IgAN with proximal tubular epithelial cells (PTECs) and tubulointerstitial damage often is associated with rapid progression to end-stage renal failure. Human mesangial cell-derived mediators lead to podocyte and tubulointerstitial injury via mesangial-podocytic-tubular cross-talk. Although mesangial-podocytic communication plays a pathogenic role in podocytic injury, the implication of a podocyte-PTEC cross-talk pathway in the progression of tubulointerstitial injury in IgAN should not be underscored. We review the role of mesangial-podocytic-tubular cross-talk in the progression of IgAN. We discuss how podocytopathy in IgAN promotes subsequent PTEC dysfunction and whether tubulointerstitial injury affects the propagation of podocytic injury in IgAN. A thorough understanding of the cross-talk mechanisms among mesangial cells, podocytes, and PTECs may lead to better design of potential therapeutic options for IgAN.
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Affiliation(s)
- Joseph C K Leung
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong..
| | - Kar Neng Lai
- Nephrology Center, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong
| | - Sydney C W Tang
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong
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Chan GC, Wu HJ, Chan KW, Yiu WH, Zou A, Huang XR, Lan HY, Lai KN, Tang SC. N-acetyl-seryl-aspartyl-lysyl-proline mediates the anti-fibrotic properties of captopril in unilateral ureteric obstructed BALB/C mice. Nephrology (Carlton) 2018; 23:297-307. [DOI: 10.1111/nep.13000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 12/18/2016] [Accepted: 01/08/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Gary C.W. Chan
- Division of Nephrology, Department of Medicine; The University of Hong Kong
| | - Hao Jia Wu
- Division of Nephrology, Department of Medicine; The University of Hong Kong
| | - Kam Wa Chan
- Division of Nephrology, Department of Medicine; The University of Hong Kong
| | - Wai Han Yiu
- Division of Nephrology, Department of Medicine; The University of Hong Kong
| | - Ailis Zou
- Division of Nephrology, Department of Medicine; The University of Hong Kong
| | - Xiao Ru Huang
- Department of Medicine and Therapeutics, and Li Ka Shing Institute of Health Sciences; The Chinese University of Hong Kong
| | - Hui Yao Lan
- Department of Medicine and Therapeutics, and Li Ka Shing Institute of Health Sciences; The Chinese University of Hong Kong
| | - Kar Neng Lai
- Division of Nephrology, Department of Medicine; The University of Hong Kong
| | - Sydney C.W. Tang
- Division of Nephrology, Department of Medicine; The University of Hong Kong
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Ma MK, Yap DY, Li CL, Mok MM, Chan GC, Kwan LP, Lai KN, Tang SC. WITHDRAWN: Enteric coated mycophenolate sodium combined with lowdose steroid as first line therapy in minimal change nephrotic syndrome: an open label randomized controlled study. Oncotarget 2018. [DOI: 10.18632/oncotarget.23838] [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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Yiu WH, Wong DWL, Wu HJ, Li RX, Yam I, Chan LYY, Leung JCK, Lan HY, Lai KN, Tang SCW. Kallistatin protects against diabetic nephropathy in db/db mice by suppressing AGE-RAGE-induced oxidative stress. Kidney Int 2017; 89:386-98. [PMID: 26536000 DOI: 10.1038/ki.2015.331] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 09/05/2015] [Accepted: 09/10/2015] [Indexed: 01/03/2023]
Abstract
Kallistatin is a serine protease inhibitor with anti-inflammatory, anti-angiogenic, and anti-oxidative properties. Since oxidative stress plays a critical role in the pathogenesis of diabetic nephropathy, we studied the effect and mechanisms of action of kallistatin superinduction. Using ultrasound-microbubble-mediated gene transfer, kallistatin overexpression was induced in kidney tubules. In db/db mice, kallistatin overexpression reduced serum creatinine and BUN levels, ameliorated glomerulosclerosis and tubulointerstitial injury, and attenuated renal fibrosis by inhibiting TGF-β signaling. Additionally, downstream PAI-1 and collagens I and IV expression were reduced and kallistatin partially suppressed renal inflammation by inhibiting NF-κB signaling and decreasing tissue kallikrein activity. Kallistatin lowered blood pressure and attenuated oxidative stress as evidenced by suppressed levels of NADPH oxidase 4, and oxidative markers (nitrotyrosine, 8-hydroxydeoxyguanosine, and malondialdehyde) in diabetic renal tissue. Kallistatin also inhibited RAGE expression in the diabetic kidney and AGE-stimulated cultured proximal tubular cells. Reduced AGE-induced reactive oxygen species generation reflected an anti-oxidative mechanism via the AGE-RAGE-reactive oxygen species axis. These results indicate a renoprotective role of kallistatin against diabetic nephropathy by multiple mechanisms including suppression of oxidative stress, anti-fibrotic and anti-inflammatory actions, and blood pressure lowering.
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Chan KW, Ip TP, Kwong ASK, Lui SL, Chan GCW, Cowling BJ, Yiu WH, Wong DWL, Liu Y, Feng Y, Tan KCB, Chan LYY, Leung JCK, Lai KN, Tang SCW. Semi-individualised Chinese medicine treatment as an adjuvant management for diabetic nephropathy: a pilot add-on, randomised, controlled, multicentre, open-label pragmatic clinical trial. BMJ Open 2016; 6:e010741. [PMID: 27496229 PMCID: PMC4986085 DOI: 10.1136/bmjopen-2015-010741] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Diabetes mellitus and diabetic nephropathy (DN) are prevalent and costly to manage. DN is the leading cause of end-stage kidney disease. Conventional therapy blocking the renin-angiotensin system has only achieved limited effect in preserving renal function. Recent observational data show that the use of Chinese medicine (CM), a major form of traditional medicine used extensively in Asia, could reduce the risk of end-stage kidney disease. However, existing clinical practice guidelines are weakly evidence-based and the effect of CM remains unclear. This trial explores the effect of an existing integrative Chinese-Western medicine protocol for the management of DN. OBJECTIVE To optimise parameters and assess the feasibility for a subsequent phase III randomised controlled trial through preliminary evaluation on the effect of an adjuvant semi-individualised CM treatment protocol on patients with type 2 diabetes with stages 2-3 chronic kidney disease and macroalbuminuria. METHODS AND ANALYSIS This is an assessor-blind, add-on, randomised, controlled, parallel, multicentre, open-label pilot pragmatic clinical trial. 148 patients diagnosed with DN will be recruited and randomised 1:1 to a 48-week additional semi-individualised CM treatment programme or standard medical care. Primary end points are the changes in estimated glomerular filtration rate and spot urine albumin-to-creatinine ratio between baseline and treatment end point. Secondary end points include fasting blood glucose, glycated haemoglobin, brain natriuretic peptide, fasting insulin, C peptide, fibroblast growth factor 23, urinary monocyte chemotactic protein-1, cystatin C, nephrin, transforming growth factor-β1 and vascular endothelial growth factor. Adverse events are monitored through self-completed questionnaire and clinical visits. Outcomes will be analysed by regression models. Enrolment started in July 2015. ETHICS AND REGISTRATION This protocol is approved by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (reference number UW 14-301). TRIAL REGISTRATION NUMBER NCT02488252.
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Affiliation(s)
- Kam Wa Chan
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Tai Pang Ip
- Department of Medicine, Tung Wah Hospital, Hong Kong, Hong Kong
| | - Alfred Siu Kei Kwong
- Department of Family Medicine and Primary Healthcare, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Sing Leung Lui
- Department of Medicine, Tung Wah Hospital, Hong Kong, Hong Kong
| | - Gary Chi Wang Chan
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Benjamin John Cowling
- Division of Epidemiology and Biostatistics, School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | - Wai Han Yiu
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Dickson Wai Leong Wong
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Yang Liu
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Yibin Feng
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Kathryn Choon Beng Tan
- Division of Endocrinology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Loretta Yuk Yee Chan
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Joseph Chi Kam Leung
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Kar Neng Lai
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Sydney Chi Wai Tang
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
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Tse KC, Li FK, Tang S, Tang CSO, Lai KN, Chan TM. Angiotensin inhibition or blockade for the treatment of patients with quiescent lupus nephritis and persistent proteinuria. Lupus 2016; 14:947-52. [PMID: 16425574 DOI: 10.1191/0961203305lu2249oa] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [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: 11/05/2022]
Abstract
Angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) reduces proteinuria and the rate of renal function deterioration in diabetic nephropathy and other glomerular diseases, but its role in quiescent lupus nephritis has not been established. We conducted a retrospective study to investigate the effects of ACEI/ARB on proteinuria and renal function in patients with persistent proteinuria (>1 g/day) despite resolution of acute lupus nephritis following immunosuppressive treatment. Fourteen out of 92 patients were included. The duration of treatment with ACEI/ARB was 52.1 ± 35.7 months. The levels of proteinuria, serum albumin, serum creatinine, systolic and diastolic blood pressure were 1.10 to 6.90 g/day, 35.8 ± 3.6 g/L, 102.54 ± 34.48 μmol/L, 137.6 ± 10.9 and 81.9 ± 9.2 mmHg at baseline. Proteinuria and serum albumin showed significant sustained improvements after 6 and 24 months of treatment. Comparison of slopes for serial proteinuria, albumin and reciprocal of serum creatinine before and after treatment showed significant improvements in six (43%), eight (57%) and two patients, respectively. At last follow-up proteinuria remained significantly lower (0.36 g/day, P = 0.043) and albumin higher (41.3 ± 2.2 g/L, P = 0.023). Eleven (78.6%) patients had proteinuria improved by >50%, and five had insignificant proteinuria at last follow-up. Systolic blood pressure was significantly reduced from 6 months onwards, but this did not correlate with proteinuria reduction. Diastolic blood pressure, serum creatinine, creatinine clearance, anti-dsDNA, C3 and haemoglobin were not altered. We conclude that ACEI/ARB effectively reduces proteinuria and improves serum albumin in patients with persistent proteinuria despite quiescent lupus nephritis.
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Affiliation(s)
- K C Tse
- Nephrology Division, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
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Abstract
We investigated the expression profile of inflammatory cytokines in the lung of lupus-prone MRL/lpr mice and evaluated the therapeutic potential of mycophenolate mofetil (MMF) in reducing pulmonary cytokines in active lupus. Eight-week old female MRL/lpr mice ( n = 20) were treated with MMF in vehicle by oral gavage. Disease control MRL/lpr mice ( n = 30) or normal control MRL mice ( n = 20) received vehicle alone. The mice were sacrificed after eight or 12 weeks of treatment. Gene expression and protein synthesis of IL-1β, MCP-1 and TGF-β1 in lung tissues were determined. We found an increase in the gene expression of IL-1β, MCP-1 and TGF-β1 in lung tissues of untreated MRL/lpr mice compared with MRL mice at either 16 weeks or 20 weeks of age. MMF treatment significantly prolonged the survival of MRL/lpr mice, down-regulated the gene expression of IL-1β, MCP-1 and TGF-β1 in lung tissues at the end of eight or 12 weeks of treatment. Protein synthesis of TGF-b1 was decreased following eight weeks of MMF treatment. We conclude that MMF treatment can reduce the TGF-b1 gene expression and protein synthesis in lung tissues of lupus-prone mice. Our findings provide experimental data suggesting a beneficial potential of MMF therapy in pulmonary involvement of lupus.
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Affiliation(s)
- H Guo
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong
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38
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Abstract
Diabetic nephropathy is the commonest cause of end-stage renal disease in most developed economies. Current standard of care for diabetic nephropathy embraces stringent blood pressure control via blockade of the renin-angiotensin-aldosterone system and glycemia control. Recent understanding of the pathophysiology of diabetic nephropathy has led to the development of novel therapeutic options. This review article focuses on available data from landmark studies on the main therapeutic approaches and highlights some novel management strategies.
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Affiliation(s)
- Sydney C W Tang
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Gary C W Chan
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Kar Neng Lai
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; Nephrology Department, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong
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Chan GC, Lam B, Yap DY, Ip MS, Lai KN, Tang SC. Proteinuria is associated with sleep apnea in chronic kidney disease. Nephrol Dial Transplant 2016; 31:772-779. [DOI: 10.1093/ndt/gfv306] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Abstract
Since its first description in 1968, IgA nephropathy has remained the most common form of primary glomerulonephritis leading to chronic kidney disease in developed countries. The clinical progression varies, and consequent end-stage renal disease occurs in 30% to 40% of patients 20 to 30 years after the first clinical presentation. Current data implicate overproduction of aberrantly glycosylated IgA1 as being pivotal in the induction of renal injury. Effective and specific treatment is still lacking, and new therapeutic approaches will be developed after better understanding the disease pathogenesis.
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Affiliation(s)
- Kar Neng Lai
- Nephrology Department, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong; Nephrology Division Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Joseph C K Leung
- Nephrology Division Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Sydney C W Tang
- Nephrology Division Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
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Leung JCK, Chan LYY, Saleem MA, Mathieson PW, Tang SCW, Lai KN. Combined blockade of angiotensin II and prorenin receptors ameliorates podocytic apoptosis induced by IgA-activated mesangial cells. Apoptosis 2016; 20:907-20. [PMID: 25808596 PMCID: PMC7101871 DOI: 10.1007/s10495-015-1117-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Glomerulo-podocytic communication plays an important role in the podocytic injury in IgA nephropathy (IgAN). In this study, we examine the role of podocytic angiotensin II receptor subtype 1 (AT1R) and prorenin receptor (PRR) in podocytic apoptosis in IgAN. Polymeric IgA (pIgA) was isolated from patients with IgAN and healthy controls. Conditioned media were prepared from growth arrested human mesangial cells (HMC) incubated with pIgA from patients with IgAN (IgA-HMC media) or healthy controls (Ctl-HMC media). A human podocyte cell line was used as a model to examine the regulation of the expression of AT1R, PRR, TNF-α and CTGF by IgA-HMC media. Podocytic nephrin expression, annexin V binding and caspase 3 activity were used as the functional readout of podocytic apoptosis. IgA-HMC media had no effect on AngII release by podocytes. IgA-HMC media significantly up-regulated the expression of AT1R and PRR, down-regulated nephrin expression and induced apoptosis in podocytes. Mono-blockade of AT1R, PRR, TNF-α or CTGF partially reduced podocytic apoptosis. IgA-HMC media activated NFκB, notch1 and HEY1 expression by podocytes and dual blockade of AT1R with PRR, or anti-TNF-α with anti-CTGF, effectively rescued the podocytic apoptosis induced by IgA-HMC media. Our data suggests that pIgA-activated HMC up-regulates the expression of AT1R and PRR expression by podocytes and the associated activation of NFκB and notch signalling pathways play an essential role in the podocytic apoptosis induced by glomerulo-podocytic communication in IgAN. Simultaneously targeting the AT1R and PRR could be a potential therapeutic option to reduce the podocytic injury in IgAN.
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Affiliation(s)
- Joseph C K Leung
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Room 301, Professorial Block, 102 Pokfulam Road, Pokfulam, Hong Kong, China,
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Affiliation(s)
- K N Lai
- Department of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin
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Abstract
BACKGROUND IgA nephropathy (IgAN) is a very common glomerulonephritis worldwide. Nevertheless, treatment options for primary IgAN are still largely based on opinion or weak evidence. There is a lack of large randomized controlled trials (RCT) that provide a definitive immunosuppressive protocol for IgAN. The recent KDIGO Clinical Practice Guidelines for Glomerulonephritis have assigned low levels of evidence for almost all recommendations and suggestions related to this nephropathy. SUMMARY In this article, we review different treatment options and emphasize that the key to therapeutic decision-making is the assessment of an individual's prognosis. The risk of disease progression is closely related to clinical parameters such as proteinuria, hypertension, and impaired glomerular filtration rate. For patients with minor urinary abnormalities, the mainstay of treatment is long-term regular follow-up to detect renal progression and hypertension. Optimized supportive care aiming to maintain proteinuria <1 g/day is preferred in the typical patient presenting with microhematuria, significant but nonnephrotic proteinuria, hypertension, and variable degrees of renal failure. The atypical patient with overt nephritic syndrome or rapidly progressive kidney injury that represents a vasculitic form of IgAN should be treated with immunosuppression. Finally, the variant of overlapping syndrome of IgAN and lipoid nephrosis that runs a good prognosis should be treated as lipoid nephrosis. KEY MESSAGE The treatment of IgAN should be structured according to the clinical scenario.
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Affiliation(s)
- Kar Neng Lai
- Nephrology Center, Hong Kong Sanatorium and Hospital, University of Hong Kong, Hong Kong, SAR, China; Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, China
| | - Joseph C K Leung
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, China
| | - Sydney C W Tang
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, China
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Abstract
Diabetic nephropathy (DN) is a major cause of uremia in developed societies. Inflammation is emerging as an important mechanism for its pathogenesis and progression. Herein, we review 4 recently described cellular receptors that have been shown to mediate diabetic interstitial kidney disease. Peroxisome proliferator-activated receptor-γ attenuates STAT-1 activation and has shown promise in renoprotection. Its clinical utility is limited mainly by fluid retention through upregulation of sodium-hydrogen exchanger-3 and aquaporin-1 channels in the proximal tubule. The bradykinin receptor 2 of the kallikrein-kinin system has been shown to mediate diabetic kidney injury and its blockade conferred renoprotective effects in animal models of DN. The related protease-activated receptor, especially receptor 4, has recently been shown to participate in DN. Further studies are required to confirm its role. Finally, the toll-like receptor, especially TLR4 and TLR2, has been verified in multiple models to be a significant sensor of and reactor to hyperglycemia and other diabetic substrates that orchestrate interstitial inflammation in DN.
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Affiliation(s)
- Sydney C W Tang
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.
| | - Wai Han Yiu
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Miao Lin
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Kar Neng Lai
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
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Lim AI, Chan LYY, Tang SCW, Lai KN, Leung JCK. Albumin and glycated albumin activate KIM-1 release in tubular epithelial cells through distinct kinetics and mechanisms. Inflamm Res 2014; 63:831-9. [DOI: 10.1007/s00011-014-0757-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 07/05/2014] [Accepted: 07/08/2014] [Indexed: 01/06/2023] Open
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Lim AI, Chan LYY, Tang SCW, Yiu WH, Li R, Lai KN, Leung JCK. BMP-7 represses albumin-induced chemokine synthesis in kidney tubular epithelial cells through destabilization of NF-κB-inducing kinase. Immunol Cell Biol 2014; 92:427-35. [PMID: 24418819 DOI: 10.1038/icb.2013.106] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 10/30/2013] [Revised: 11/28/2013] [Accepted: 12/12/2013] [Indexed: 01/28/2023]
Abstract
Protein overload activates proximal tubule epithelial cells (PTECs) to release chemokines. Bone morphogenetic protein-7 (BMP-7) reduces infiltrating cells and tissue damage in acute and chronic renal injuries. The present study examines the inhibitory effect and related molecular mechanism of BMP-7 on chemokine and adhesion molecule synthesis by PTECs activated with human serum albumin (HSA). The expression profiles of chemokines and adhesion molecules in cultured human PTECs were screened by PCR array. Expression of CXCL1, CXCL2 and vascular cell adhesion protein 1 (VCAM-1) by PTECs was significantly upregulated by HSA and reduced by BMP-7. HSA activated both the canonical and noncanonical nuclear factor (NF)-κB pathways in PTECs, as indicated by the increased nuclear translocation of NF-κB p50 and p52 subunits. The nuclear translocation of NF-κB p52 was completely abrogated by BMP-7, whereas NF-κB p50 activation was only partially repressed. BMP-7 increased the expression of cellular inhibitor of apoptosis 1 (cIAP1), tumor necrosis factor receptor-associated factor (TRAF)2 and TRAF3, but not of NF-κB-inducing kinase (NIK) that was significantly upregulated by HSA. Silencing NIK recapitulated the partial inhibitory effect on HSA-induced chemokine synthesis by BMP-7. Complete abolishment of the chemokine synthesis was only achieved by including additional blockade of the NF-κB p65 translocation on top of NIK silencing. Our data suggest that BMP-7 represses the NIK-dependent chemokine synthesis in PTECs activated with HSA through blocking the noncanonical NF-κB pathway and partially interfering with the canonical NF-κB pathway.
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Affiliation(s)
- Ai Ing Lim
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong
| | - Loretta Y Y Chan
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong
| | - Sydney C W Tang
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong
| | - Wai Han Yiu
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong
| | - Ruixi Li
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong
| | - Kar Neng Lai
- Nephrology Center, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong
| | - Joseph C K Leung
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong
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Wu HJ, Yiu WH, Li RX, Wong DWL, Leung JCK, Chan LYY, Zhang Y, Lian Q, Lin M, Tse HF, Lai KN, Tang SCW. Mesenchymal stem cells modulate albumin-induced renal tubular inflammation and fibrosis. PLoS One 2014; 9:e90883. [PMID: 24646687 PMCID: PMC3960109 DOI: 10.1371/journal.pone.0090883] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [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: 11/08/2013] [Accepted: 02/05/2014] [Indexed: 02/07/2023] Open
Abstract
Bone marrow-derived mesenchymal stem cells (BM-MSCs) have recently shown promise as a therapeutic tool in various types of chronic kidney disease (CKD) models. However, the mechanism of action is incompletely understood. As renal prognosis in CKD is largely determined by the degree of renal tubular injury that correlates with residual proteinuria, we hypothesized that BM-MSCs may exert modulatory effects on renal tubular inflammation and epithelial-to-mesenchymal transition (EMT) under a protein-overloaded milieu. Using a co-culture model of human proximal tubular epithelial cells (PTECs) and BM-MSCs, we showed that concomitant stimulation of BM-MSCs by albumin excess was a prerequisite for them to attenuate albumin-induced IL-6, IL-8, TNF-α, CCL-2, CCL-5 overexpression in PTECs, which was partly mediated via deactivation of tubular NF-κB signaling. In addition, albumin induced tubular EMT, as shown by E-cadherin loss and α-SMA, FN and collagen IV overexpression, was also prevented by BM-MSC co-culture. Albumin-overloaded BM-MSCs per se retained their tri-lineage differentiation capacity and overexpressed hepatocyte growth factor (HGF) and TNFα-stimulating gene (TSG)-6 via P38 and NF-κB signaling. Albumin-induced tubular CCL-2, CCL-5 and TNF-α overexpression were suppressed by recombinant HGF treatment, while the upregulation of α-SMA, FN and collagen IV was attenuated by recombinant TSG-6. Neutralizing HGF and TSG-6 abolished the anti-inflammatory and anti-EMT effects of BM-MSC co-culture in albumin-induced PTECs, respectively. In vivo, albumin-overloaded mice treated with mouse BM-MSCs had markedly reduced BUN, tubular CCL-2 and CCL-5 expression, α-SMA and collagen IV accumulation independent of changes in proteinuria. These data suggest anti-inflammatory and anti-fibrotic roles of BM-MSCs on renal tubular cells under a protein overloaded condition, probably mediated via the paracrine action of HGF and TSG-6.
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Affiliation(s)
- Hao Jia Wu
- Nephrology Division, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Wai Han Yiu
- Nephrology Division, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Rui Xi Li
- Nephrology Division, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Dickson W. L. Wong
- Nephrology Division, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Joseph C. K. Leung
- Nephrology Division, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Loretta Y. Y. Chan
- Nephrology Division, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Yuelin Zhang
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Qizhou Lian
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
- Department of Ophthalmology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Miao Lin
- Nephrology Division, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Hung Fat Tse
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Kar Neng Lai
- Nephrology Division, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Sydney C. W. Tang
- Nephrology Division, The University of Hong Kong, Queen Mary Hospital, Hong Kong
- * E-mail:
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Yiu WH, Wong DWL, Chan LYY, Leung JCK, Chan KW, Lan HY, Lai KN, Tang SCW. Tissue kallikrein mediates pro-inflammatory pathways and activation of protease-activated receptor-4 in proximal tubular epithelial cells. PLoS One 2014; 9:e88894. [PMID: 24586431 PMCID: PMC3931644 DOI: 10.1371/journal.pone.0088894] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 01/13/2014] [Indexed: 12/11/2022] Open
Abstract
Tissue kallikrein (KLK1) expression is up-regulated in human diabetic kidney tissue and induced by high glucose (HG) in human proximal tubular epithelial cells (PTEC). Since the kallikrein-kinin system (KKS) has been linked to cellular inflammatory process in many diseases, it is likely that KLK1 expression may mediate the inflammatory process during the development of diabetic nephropathy. In this study, we explored the role of KLK1 in tubular pro-inflammatory responses under the diabetic milieu. Recombinant KLK1 stimulated the production of inflammatory cytokines in PTEC via the activation of p42/44 and p38 MAPK signaling pathways. Molecular knockdown of endogenous KLK1 expression by siRNA transfection in PTEC attenuated advanced glycation end-products (AGE)-induced IL-8 and ICAM-1 productions in vitro. Interestingly, exposure of PTEC to KLK1 induced the expression of protease-activated receptors (PARs). There was a 2.9-fold increase in PAR-4, 1.4-fold increase in PAR-1 and 1.2-fold increase in PAR-2 mRNA levels. Activation of PAR-4 by a selective agonist was found to elicit the pro-inflammatory and pro-fibrotic phenotypes in PTEC while blockade of the receptor by specific antagonist attenuated high glucose-induced IL-6, CCL-2, CTGF and collagen IV expression. Calcium mobilization by the PAR-4 agonist in PTEC was desensitized by pretreatment with KLK1. Consistent with these in vitro findings, there was a markedly up-regulation of tubular PAR-4 expression in human diabetic renal cortical tissues. Together, these results suggest that up-regulation of KLK1 in tubular epithelial cells may mediate pro-inflammatory pathway and PAR activation during diabetic nephropathy and provide a new therapeutic target for further investigation.
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Affiliation(s)
- Wai Han Yiu
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Dickson W. L. Wong
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Loretta Y. Y. Chan
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Joseph C. K. Leung
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Kwok Wah Chan
- Department of Pathology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Hui Yao Lan
- Department of Medicine and Therapeutics, and Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Kar Neng Lai
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Sydney C. W. Tang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
- * E-mail:
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Yap DYH, Lai KN. The role of cytokines in the pathogenesis of systemic lupus erythematosus - from bench to bedside. Nephrology (Carlton) 2013; 18:243-55. [PMID: 23452295 DOI: 10.1111/nep.12047] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2013] [Indexed: 12/23/2022]
Abstract
The pathogenesis of systemic lupus erythematosus (SLE) entails a complex interaction between the different arms of the immune system. While autoantibodies production and immune complex deposition are cornered as hallmark features of SLE, there is growing evidence to propose the pathogenic role of cytokines in this disease. Examples of these cytokines include BLys, interleukin-6, interleukin-17, interleukin-18, type I interferons and tumour necrosis factor alpha. These cytokines all assume pivotal functions to orchestrate the differentiation, maturation and activation of various cell types, which would mediate local inflammatory process and tissue injury. The knowledge on these cytokines not only fosters our understanding of the disease, but also provides insights in devising biomarkers and targeted therapies. In this review, we focus on cytokines which have substantial pathogenic significance and also highlight the possible clinical applications of these cytokines.
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Affiliation(s)
- Desmond Yat Hin Yap
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR
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50
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Lim AI, Tang SCW, Lai KN, Leung JCK. Kidney injury molecule-1: more than just an injury marker of tubular epithelial cells? J Cell Physiol 2013; 228:917-24. [PMID: 23086807 DOI: 10.1002/jcp.24267] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 10/12/2012] [Indexed: 12/25/2022]
Abstract
Regardless of the original causes and etiology, the progression to renal function declines follows a final common pathway associated with tubulointerstitial injury, in which the proximal tubular epithelial cells (PTEC) are instrumental. Kidney injury molecule-1 (KIM-1) is an emerging biomarker, and its expression and release are induced in PTEC upon injury. KIM-1 plays the role as a double-edged sword and implicates in the process of kidney injury and healing. Expression of KIM-1 is also associated with tubulointerstitial inflammation and fibrosis. More importantly, KIM-1 expressing PTEC play the role as the residential phagocytes, contribute to the removal of apoptotic cells and facilitate the regeneration of injured tubules. The precise mechanism of KIM-1 and its sheded ectodomain on restoration of tubular integrity after injury is not fully understood. Other than PTEC, macrophages (Mø) also implicate in tubular repair. Understanding the crosstalk between Mø and the injured PTEC is essential for designing appropriate methods for controlling the sophisticated machinery in tubular regeneration and healing. This article will review the current findings of KIM-1, beginning with its basic structure, utility as a biomarker, and possible functions, with focus on the role of KIM-1 in regeneration and healing of injured PTEC.
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Affiliation(s)
- Ai Ing Lim
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong
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