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Deans R, Pittman J, Gerstl B, Haghighi K, Pleass H, KÄhler PD, Kvarnström N, Hseih W, Keung K, Luxton G, Yong K, Caldas R, Byun L, Loo C, Tippett J, Caponas G, Moses D, Wan KM, Arulpragasam K, Kiely N, Brännström M, Abbott J. The first Australian uterus transplantation procedure: A result of a long-term Australian-Swedish research collaboration. Aust N Z J Obstet Gynaecol 2023. [PMID: 37029932 DOI: 10.1111/ajo.13678] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/20/2023] [Indexed: 04/09/2023]
Abstract
AIMS The aim is to report the results of Australia's first uterus transplantation (UTx). METHODS Following long-standing collaboration between the Swedish and Australian teams, Human Research Ethics approval was obtained to perform six UTx procedures in a collaborative multi-site research study (Western Sydney Local District Health 2019/ETH13038), including Royal Hospital for Women, Prince of Wales Hospital, and Westmead Hospital in New Souh Wales. Surgeries were approved in both the live donor (LD) and deceased donor models in collaboration with the inaugural Swedish UTx team. RESULTS This is the first UTx procedure to occur in Australia, involving a mother donating her uterus to her daughter. The total operative time for the donor was 9 h 54 min. Concurrently, recipient surgery was synchronised to minimise graft ischaemic time, and the total operative time for the recipient was 6 h 12 min. Surgery was by laparotomy in the LD and recipient. The total warm ischaemic time of the graft was 1 h 53 min, and the cold ischaemic time was 2 h 17 min (total ischaemic time 4 h 10 min). The patient's first menstruation occurred 33 days after the UTx procedure. CONCLUSION Twenty-five years of Swedish and Australian collaboration has led to Australia's first successfully performed UTx surgery at The Royal Hospital for Women, Sydney, Australia.
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Affiliation(s)
- Rebecca Deans
- Department of Gynaecology, Royal Hospital for Women, New South Wales, Sydney, Australia
- Department of Gynaecology, University of New South Wales, New South Wales, Sydney, Australia
| | - Jana Pittman
- Department of Gynaecology, Royal Hospital for Women, New South Wales, Sydney, Australia
- Department of Gynaecology, University of New South Wales, New South Wales, Sydney, Australia
| | - Brigitte Gerstl
- Department of Gynaecology, University of New South Wales, New South Wales, Sydney, Australia
| | - Koroush Haghighi
- Department of Gynaecology, University of New South Wales, New South Wales, Sydney, Australia
- Department of Gynaecology, Prince of Wales Hospital, New South Wales, Sydney, Australia
| | - Henry Pleass
- Department of Gynaecology, Westmead Hospital, New South Wales, Sydney, Australia
- Department of Gynaecology, Sydney University, New South Wales, Sydney, Australia
| | - Pernilla Dahm KÄhler
- Department of Obstetrics and Gynaecology, Sahlgrenska Academy, Gothenburg, Sweden
- The Faculty of Medicine, University of Gothenburg, Sweden, Gothenburg, Sweden
| | - Niclas Kvarnström
- The Faculty of Medicine, University of Gothenburg, Sweden, Gothenburg, Sweden
| | - Wayne Hseih
- Department of Gynaecology, Royal Hospital for Women, New South Wales, Sydney, Australia
- Department of Gynaecology, University of New South Wales, New South Wales, Sydney, Australia
| | - Karen Keung
- Department of Gynaecology, Prince of Wales Hospital, New South Wales, Sydney, Australia
| | - Grant Luxton
- Department of Gynaecology, Prince of Wales Hospital, New South Wales, Sydney, Australia
| | - Kenneth Yong
- Department of Gynaecology, Prince of Wales Hospital, New South Wales, Sydney, Australia
| | - Rita Caldas
- Department of Gynaecology, Royal Hospital for Women, New South Wales, Sydney, Australia
| | - Lily Byun
- Department of Gynaecology, Royal Hospital for Women, New South Wales, Sydney, Australia
| | - Christine Loo
- Department of Gynaecology, Prince of Wales Hospital, New South Wales, Sydney, Australia
- Department of Clinical Pathology, South-Eastern Area Laboratory Services, New South Wales, Sydney, Australia
| | - John Tippett
- Department of Gynaecology, Royal Hospital for Women, New South Wales, Sydney, Australia
| | - George Caponas
- Department of Gynaecology, Royal Hospital for Women, New South Wales, Sydney, Australia
| | - Daniel Moses
- Department of Gynaecology, University of New South Wales, New South Wales, Sydney, Australia
- Department of Gynaecology, Prince of Wales Hospital, New South Wales, Sydney, Australia
| | - King-Man Wan
- Department of Gynaecology, Royal Hospital for Women, New South Wales, Sydney, Australia
- Department of Gynaecology, University of New South Wales, New South Wales, Sydney, Australia
| | - Kaushalya Arulpragasam
- Department of Gynaecology, Royal Hospital for Women, New South Wales, Sydney, Australia
- Department of Gynaecology, University of New South Wales, New South Wales, Sydney, Australia
| | - Neill Kiely
- Department of Gynaecology, Royal Hospital for Women, New South Wales, Sydney, Australia
| | - Mats Brännström
- Department of Obstetrics and Gynaecology, Sahlgrenska Academy, Gothenburg, Sweden
- The Faculty of Medicine, University of Gothenburg, Sweden, Gothenburg, Sweden
| | - Jason Abbott
- Department of Gynaecology, Royal Hospital for Women, New South Wales, Sydney, Australia
- Department of Gynaecology, University of New South Wales, New South Wales, Sydney, Australia
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Tang J, Howell M, Lee VW, Guha C, Dominello A, Roger S, Keung K, Teixeira-Pinto A, Tong A, Wong G. Patients’ perspectives, factors and patterns of eHealth use in kidney transplant recipients. Kidney Int Rep 2023; 8:727-736. [PMID: 37069969 PMCID: PMC10105051 DOI: 10.1016/j.ekir.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 01/02/2023] [Accepted: 01/09/2023] [Indexed: 01/22/2023] Open
Abstract
Introduction eHealth supports the delivery of relevant health information and management of chronic disease. However, little is known about patients' perspectives and the determinants of eHealth use among kidney transplant recipients. Methods Kidney transplant recipients aged 18 years and older from 3 transplant units in Australia and the Better Evidence and Translation in Chronic Kidney Disease consumer network completed a survey with free-text responses relating to eHealth uptake. Multivariable regression modeling was used to determine the factors associated with eHealth use. Free-text responses were thematically analyzed. Results Of the 117 participants who were invited in person and who responded to the email, 91 completed the survey. Sixty-three participants (69%) were current eHealth users (active use of eHealth tools), and 91% had access to eHealth devices, including smartphones (81%) and computers (59%). Most (98%) reported that eHealth improves posttransplant care. Factors associated with increased eHealth use (odds ratio [95% confidence interval]) were higher eHealth literacy scale (eHEALS) score (1.21 [1.06-1.38]) and tertiary education (7.78 [2.19-27.7]). We identified the following 3 themes on eHealth determinants: (i) empowering self-management, (ii) enhancing health services, and (iii) technology burden. Conclusions Transplant recipients believe that eHealth interventions have the potential to improve their posttransplant care. eHealth interventions should meet the needs of all transplant recipients and be accessible to those with lower educational attainment.
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Chung EYM, Wang YM, Keung K, Hu M, McCarthy H, Wong G, Kairaitis L, Bose B, Harris DCH, Alexander SI. Membranous nephropathy: Clearer pathology and mechanisms identify potential strategies for treatment. Front Immunol 2022; 13:1036249. [PMID: 36405681 PMCID: PMC9667740 DOI: 10.3389/fimmu.2022.1036249] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/19/2022] [Indexed: 11/07/2022] Open
Abstract
Primary membranous nephropathy (PMN) is one of the common causes of adult-onset nephrotic syndrome and is characterized by autoantibodies against podocyte antigens causing in situ immune complex deposition. Much of our understanding of the disease mechanisms underpinning this kidney-limited autoimmune disease originally came from studies of Heymann nephritis, a rat model of PMN, where autoantibodies against megalin produced a similar disease phenotype though megalin is not implicated in human disease. In PMN, the major target antigen was identified to be M-type phospholipase A2 receptor 1 (PLA2R) in 2009. Further utilization of mass spectrometry on immunoprecipitated glomerular extracts and laser micro dissected glomeruli has allowed the rapid discovery of other antigens (thrombospondin type-1 domain-containing protein 7A, neural epidermal growth factor-like 1 protein, semaphorin 3B, protocadherin 7, high temperature requirement A serine peptidase 1, netrin G1) targeted by autoantibodies in PMN. Despite these major advances in our understanding of the pathophysiology of PMN, treatments remain non-specific, often ineffective, or toxic. In this review, we summarize our current understanding of the immune mechanisms driving PMN from animal models and clinical studies, and the implications on the development of future targeted therapeutic strategies.
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Affiliation(s)
- Edmund Y. M. Chung
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, NSW, Australia
- *Correspondence: Edmund Y. M. Chung,
| | - Yuan M. Wang
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, NSW, Australia
| | - Karen Keung
- Department of Nephrology, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Min Hu
- The Centre for Transplant and Renal Research, Westmead Institute of Medical Research, Westmead, NSW, Australia
| | - Hugh McCarthy
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, NSW, Australia
- Department of Nephrology, The Children’s Hospital at Westmead, Westmead, NSW, Australia
- Department of Nephrology, Sydney Children’s Hospital, Randwick, NSW, Australia
| | - Germaine Wong
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, NSW, Australia
- Department of Nephrology, Westmead Hospital, Westmead, NSW, Australia
| | - Lukas Kairaitis
- Department of Nephrology, Blacktown Hospital, Blacktown, NSW, Australia
| | - Bhadran Bose
- Department of Nephrology, Nepean Hospital, Kingswood, NSW, Australia
| | - David C. H. Harris
- The Centre for Transplant and Renal Research, Westmead Institute of Medical Research, Westmead, NSW, Australia
- Department of Nephrology, Westmead Hospital, Westmead, NSW, Australia
| | - Stephen I. Alexander
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, NSW, Australia
- Department of Nephrology, The Children’s Hospital at Westmead, Westmead, NSW, Australia
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Chung EYM, Blazek K, Teixeira-Pinto A, Sharma A, Kim S, Lin Y, Keung K, Bose B, Kairaitis L, McCarthy H, Ronco P, Alexander SI, Wong G. Predictive Models for Recurrent Membranous Nephropathy After Kidney Transplantation. Transplant Direct 2022; 8:e1357. [PMID: 35935023 PMCID: PMC9355108 DOI: 10.1097/txd.0000000000001357] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022] Open
Abstract
Recurrent membranous nephropathy (MN) posttransplantation affects 35% to 50% of kidney transplant recipients (KTRs) and accounts for 50% allograft loss 5 y after diagnosis. Predictive factors for recurrent MN may include HLA-D risk alleles, but other factors have not been explored with certainty.
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Affiliation(s)
- Edmund Y M Chung
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Katrina Blazek
- School of Population Health, University of New South Wales, Kensington, NSW, Australia
| | | | - Ankit Sharma
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia.,Department of Renal Medicine, Westmead Hospital, Westmead, NSW, Australia
| | - Siah Kim
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia.,Department of Renal Medicine, Westmead Hospital, Westmead, NSW, Australia
| | - Yingxin Lin
- School of Mathematics and Statistics, The University of Sydney, Camperdown, NSW, Australia
| | - Karen Keung
- Department of Renal Medicine, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Bhadran Bose
- Department of Renal Medicine, Nepean Hospital, Kingswood, NSW, Australia
| | - Lukas Kairaitis
- Department of Renal Medicine, Blacktown Hospital, Blacktown, NSW, Australia
| | - Hugh McCarthy
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia.,Department of Renal Medicine, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Pierre Ronco
- Sorbonne Université, Université Pierre et Marie Curie, Paris, France.,Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche, Paris, France.,Department of Nephrology, Centre Hospitalier du Mans, Le Mans, France
| | - Stephen I Alexander
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Germaine Wong
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia.,School of Public Health, The University of Sydney, Camperdown, NSW, Australia.,Department of Renal Medicine, Westmead Hospital, Westmead, NSW, Australia
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5
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Yi Z, Salem F, Menon MC, Keung K, Xi C, Hultin S, Haroon Al Rasheed MR, Li L, Su F, Sun Z, Wei C, Huang W, Fredericks S, Lin Q, Banu K, Wong G, Rogers NM, Farouk S, Cravedi P, Shingde M, Smith RN, Rosales IA, O'Connell PJ, Colvin RB, Murphy B, Zhang W. Deep learning identified pathological abnormalities predictive of graft loss in kidney transplant biopsies. Kidney Int 2021; 101:288-298. [PMID: 34757124 DOI: 10.1016/j.kint.2021.09.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/12/2021] [Accepted: 09/09/2021] [Indexed: 10/19/2022]
Abstract
Interstitial fibrosis, tubular atrophy, and inflammation are major contributors to kidney allograft failure. Here we sought an objective, quantitative pathological assessment of these lesions to improve predictive utility and constructed a deep-learning-based pipeline recognizing normal vs. abnormal kidney tissue compartments and mononuclear leukocyte infiltrates. Periodic acid- Schiff stained slides of transplant biopsies (60 training and 33 testing) were used to quantify pathological lesions specific for interstitium, tubules and mononuclear leukocyte infiltration. The pipeline was applied to the whole slide images from 789 transplant biopsies (478 baseline [pre-implantation] and 311 post-transplant 12-month protocol biopsies) in two independent cohorts (GoCAR: 404 patients, AUSCAD: 212 patients) of transplant recipients to correlate composite lesion features with graft loss. Our model accurately recognized kidney tissue compartments and mononuclear leukocytes. The digital features significantly correlated with revised Banff 2007 scores but were more sensitive to subtle pathological changes below the thresholds in the Banff scores. The Interstitial and Tubular Abnormality Score (ITAS) in baseline samples was highly predictive of one-year graft loss, while a Composite Damage Score in 12-month post-transplant protocol biopsies predicted later graft loss. ITASs and Composite Damage Scores outperformed Banff scores or clinical predictors with superior graft loss prediction accuracy. High/intermediate risk groups stratified by ITASs or Composite Damage Scores also demonstrated significantly higher incidence of estimated glomerular filtration rate decline and subsequent graft damage. Thus, our deep-learning approach accurately detected and quantified pathological lesions from baseline or post-transplant biopsies and demonstrated superior ability for prediction of post-transplant graft loss with potential application as a prevention, risk stratification or monitoring tool.
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Affiliation(s)
- Zhengzi Yi
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Fadi Salem
- Pathology Division, Department of Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Madhav C Menon
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Nephrology Division, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Karen Keung
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia; Department of Nephrology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Caixia Xi
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sebastian Hultin
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - M Rizwan Haroon Al Rasheed
- Pathology Division, Department of Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Li Li
- Pathology Division, Department of Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Fei Su
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zeguo Sun
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Chengguo Wei
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Weiqing Huang
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samuel Fredericks
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Qisheng Lin
- Nephrology Division, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Khadija Banu
- Nephrology Division, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Germaine Wong
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Natasha M Rogers
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Samira Farouk
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Paolo Cravedi
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Meena Shingde
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - R Neal Smith
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ivy A Rosales
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Philip J O'Connell
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Department of Nephrology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Robert B Colvin
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Barbara Murphy
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Weijia Zhang
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Hu M, Hawthorne WJ, Nicholson L, Burns H, Qian YW, Liuwantara D, Jimenez Vera E, Chew YV, Williams L, Yi S, Keung K, Watson D, Rogers N, Alexander SI, O'Connell PJ. Low-Dose Interleukin-2 Combined With Rapamycin Led to an Expansion of CD4 +CD25 +FOXP3 + Regulatory T Cells and Prolonged Human Islet Allograft Survival in Humanized Mice. Diabetes 2020; 69:1735-1748. [PMID: 32381646 DOI: 10.2337/db19-0525] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 05/27/2019] [Accepted: 05/03/2020] [Indexed: 11/13/2022]
Abstract
Islet transplantation is an emerging therapy for type 1 diabetes and hypoglycemic unawareness. However, a key challenge for islet transplantation is cellular rejection and the requirement for long-term immunosuppression. In this study, we established a diabetic humanized NOD-scidIL2Rγnull (NSG) mouse model of T-cell-mediated human islet allograft rejection and developed a therapeutic regimen of low-dose recombinant human interleukin-2 (IL-2) combined with low-dose rapamycin to prolong graft survival. NSG mice that had received renal subcapsular human islet allografts and were transfused with 1 × 107 of human spleen mononuclear cells reconstituted human CD45+ cells that were predominantly CD3+ T cells and rejected their grafts with a median survival time of 27 days. IL-2 alone (0.3 × 106 IU/m2 or 1 × 106 IU/m2) or rapamycin alone (0.5-1 mg/kg) for 3 weeks did not prolong survival. However, the combination of rapamycin with IL-2 for 3 weeks significantly prolonged human islet allograft survival. Graft survival was associated with expansion of CD4+CD25+FOXP3+ regulatory T cells (Tregs) and enhanced transforming growth factor-β production by CD4+ T cells. CD8+ T cells showed reduced interferon-γ production and reduced expression of perforin-1. The combination of IL-2 and rapamycin has the potential to inhibit human islet allograft rejection by expanding CD4+FOXP3+ Tregs in vivo and suppressing effector cell function and could be the basis of effective tolerance-based regimens.
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Affiliation(s)
- Min Hu
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
- Westmead Clinical Schools, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Wayne J Hawthorne
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - Leigh Nicholson
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - Heather Burns
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - Yi Wen Qian
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - David Liuwantara
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - Elvira Jimenez Vera
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - Yi Vee Chew
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - Lindy Williams
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - Shounan Yi
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - Karen Keung
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - Debbie Watson
- Molecular Horizons and School of Chemistry and Molecular Bioscience, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Natasha Rogers
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - Stephen I Alexander
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Philip J O'Connell
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
- Westmead Clinical Schools, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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7
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Wei C, Banu K, Garzon F, Basgen JM, Philippe N, Yi Z, Liu R, Choudhuri J, Fribourg M, Liu T, Cumpelik A, Wong J, Khan M, Das B, Keung K, Salem F, Campbell KN, Kaufman L, Cravedi P, Zhang W, O'Connell PJ, He JC, Murphy B, Menon MC. SHROOM3-FYN Interaction Regulates Nephrin Phosphorylation and Affects Albuminuria in Allografts. J Am Soc Nephrol 2018; 29:2641-2657. [PMID: 30341149 PMCID: PMC6218856 DOI: 10.1681/asn.2018060573] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 06/01/2018] [Accepted: 09/14/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We previously showed that the presence of a CKD-associated locus in SHROOM3 in a donor kidney results in increased expression of SHROOM3 (an F-actin-binding protein important for epithelial morphogenesis, via rho-kinase [ROCK] binding); this facilitates TGF-b signaling and allograft fibrosis. However, other evidence suggests Shroom3 may have a protective role in glomerular development. METHODS We used human data, Shroom3 knockdown podocytes, and inducible shRNA-mediated knockdown mice to study the role of Shroom3 in adult glomeruli. RESULTS Expression data from the Nephroseq database showed glomerular and nonglomerular SHROOM3 had opposing associations with renal function in CKD biopsy samples. In human allografts, homozygosity at rs17319721, the SHROOM3 locus linked with lower GFR, was associated with reduced albuminuria by 2 years after transplant. Although our previous data showed reduced renal fibrosis with tubular Shroom3 knockdown, this study found that glomerular but not tubular Shroom3 knockdown induced albuminuria. Electron microscopy revealed diffuse foot process effacement, and glomerular RNA-sequencing showed enrichment of tyrosine kinase signaling and podocyte actin cytoskeleton pathways in knockdown mice. Screening SHROOM3-interacting proteins identified FYN (a src-kinase) as a candidate.We confirmed the interaction of endogenous SHROOM3 with FYN in human podocytes via a critical Src homology 3-binding domain, distinct from its ROCK-binding domain. Shroom3-Fyn interaction was required in vitro and in vivo for activation of Fyn kinase and downstream nephrin phosphorylation in podocytes. SHROOM3 knockdown altered podocyte morphology, cytoskeleton, adhesion, and migration. CONCLUSIONS We demonstrate a novel mechanism that may explain SHROOM3's dichotomous associations in glomerular versus nonglomerular compartments in CKD.
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Affiliation(s)
- Chengguo Wei
- Division of Nephrology, Department of Medicine and
| | - Khadija Banu
- Division of Nephrology, Department of Medicine and
| | | | - John M Basgen
- Morphometry and Stereology Laboratory, Charles R. Drew University of Medicine and Science, Los Angeles, California
| | | | - Zhengzi Yi
- Division of Nephrology, Department of Medicine and
| | - Ruijie Liu
- Division of Nephrology, Department of Medicine and
| | | | - Miguel Fribourg
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tong Liu
- Center for Advanced Proteomics, Department of Biochemistry and Molecular Biology, New Jersey Medical School, Newark, New Jersey; and
| | | | - Jenny Wong
- Division of Nephrology, Department of Medicine and
| | - Mubeen Khan
- Division of Nephrology, Department of Medicine and
| | - Bhaskar Das
- Division of Nephrology, Department of Medicine and
| | - Karen Keung
- Renal Unit, University of Sydney at Westmead Hospital, Sydney, Australia
| | - Fadi Salem
- Division of Nephrology, Department of Medicine and
| | | | | | | | - Weijia Zhang
- Division of Nephrology, Department of Medicine and
| | - Philip J O'Connell
- Renal Unit, University of Sydney at Westmead Hospital, Sydney, Australia
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