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Skrypnyk NI, Gist KM, Okamura K, Montford JR, You Z, Yang H, Moldovan R, Bodoni E, Blaine JT, Edelstein CL, Soranno DE, Kirkbride-Romeo LA, Griffin BR, Altmann C, Faubel S. IL-6-mediated hepatocyte production is the primary source of plasma and urine neutrophil gelatinase-associated lipocalin during acute kidney injury. Kidney Int 2019; 97:966-979. [PMID: 32081304 DOI: 10.1016/j.kint.2019.11.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 10/09/2019] [Accepted: 11/01/2019] [Indexed: 10/25/2022]
Abstract
Neutrophil gelatinase associated lipocalin (NGAL, Lcn2) is the most widely studied biomarker of acute kidney injury (AKI). Previous studies have demonstrated that NGAL is produced by the kidney and released into the urine and plasma. Consequently, NGAL is currently considered a tubule specific injury marker of AKI. However, the utility of NGAL to predict AKI has been variable suggesting that other mechanisms of production are present. IL-6 is a proinflammatory cytokine increased in plasma by two hours of AKI and mediates distant organ effects. Herein, we investigated the role of IL-6 in renal and extra-renal NGAL production. Wild type mice with ischemic AKI had increased plasma IL-6, increased hepatic NGAL mRNA, increased plasma NGAL, and increased urine NGAL; all reduced in IL-6 knockout mice. Intravenous IL-6 in normal mice increased hepatic NGAL mRNA, plasma NGAL and urine NGAL. In mice with hepatocyte specific NGAL deletion (Lcn2hep-/-) and ischemic AKI, hepatic NGAL mRNA was absent, and plasma and urine NGAL were reduced. Since urine NGAL levels appear to be dependent on plasma levels, the renal handling of circulating NGAL was examined using recombinant human NGAL. After intravenous recombinant human NGAL administration to mice, human NGAL in mouse urine was detected by ELISA during proximal tubular dysfunction, but not in pre-renal azotemia. Thus, during AKI, IL-6 mediates hepatic NGAL production, hepatocytes are the primary source of plasma and urine NGAL, and plasma NGAL appears in the urine during proximal tubule dysfunction. Hence, our data change the paradigm by which NGAL should be interpreted as a biomarker of AKI.
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Affiliation(s)
- Nataliya I Skrypnyk
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado, USA
| | - Katja M Gist
- Department of Cardiology, The Heart Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Kayo Okamura
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado, USA
| | - John R Montford
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado, USA; Renal Section, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
| | - Zhiying You
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado, USA
| | - Haichun Yang
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Radu Moldovan
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado, USA; Advanced Light Microscopy Core Facility, Aurora, Colorado, USA
| | - Evelyn Bodoni
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado, USA; Advanced Light Microscopy Core Facility, Aurora, Colorado, USA
| | - Judith T Blaine
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado, USA
| | - Charles L Edelstein
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado, USA
| | - Danielle E Soranno
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado, USA; Department of Pediatrics and Bioengineering, University of Colorado, Aurora, Colorado, USA
| | - Lara A Kirkbride-Romeo
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado, USA
| | - Benjamin R Griffin
- Department of Medicine, Division of Nephrology, University of Iowa, Iowa City, Iowa, USA
| | - Chris Altmann
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado, USA
| | - Sarah Faubel
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado, USA; Renal Section, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA.
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Altmann C, Ahuja N, Kiekhaefer CM, Andres Hernando A, Okamura K, Bhargava R, Duplantis J, Kirkbride-Romeo LA, Huckles J, Fox BM, Kahn K, Soranno D, Gil HW, Teitelbaum I, Faubel S. Early peritoneal dialysis reduces lung inflammation in mice with ischemic acute kidney injury. Kidney Int 2017; 92:365-376. [PMID: 28318621 DOI: 10.1016/j.kint.2017.01.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 01/10/2017] [Accepted: 01/12/2017] [Indexed: 01/18/2023]
Abstract
Although dialysis has been used in the care of patients with acute kidney injury (AKI) for over 50 years, very little is known about the potential benefits of uremic control on systemic complications of AKI. Since the mortality of AKI requiring renal replacement therapy (RRT) is greater than half in the intensive care unit, a better understanding of the potential of RRT to improve outcomes is urgently needed. Therefore, we sought to develop a technically feasible and reproducible model of RRT in a mouse model of AKI. Models of low- and high-dose peritoneal dialysis (PD) were developed and their effect on AKI, systemic inflammation, and lung injury after ischemic AKI was examined. High-dose PD had no effect on AKI, but effectively cleared serum IL-6, and dramatically reduced lung inflammation, while low-dose PD had no effect on any of these three outcomes. Both models of RRT using PD in AKI in mice reliably lowered urea in a dose-dependent fashion. Thus, use of these models of PD in mice with AKI has great potential to unravel the mechanisms by which RRT may improve the systemic complications that have led to increased mortality in AKI. In light of recent data demonstrating reduced serum IL-6 and improved outcomes with prophylactic PD in children, we believe that our results are highly clinically relevant.
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Affiliation(s)
- Chris Altmann
- University of Colorado Denver, Internal Medicine, Renal, Aurora, Colorado, USA
| | - Nilesh Ahuja
- University of Colorado Denver, Internal Medicine, Renal, Aurora, Colorado, USA
| | - Carol M Kiekhaefer
- University of Colorado Denver, Internal Medicine, Renal, Aurora, Colorado, USA
| | - Ana Andres Hernando
- University of Colorado Denver, Internal Medicine, Renal, Aurora, Colorado, USA
| | - Kayo Okamura
- University of Colorado Denver, Internal Medicine, Renal, Aurora, Colorado, USA
| | - Rhea Bhargava
- University of Colorado Denver, Internal Medicine, Renal, Aurora, Colorado, USA
| | - Jane Duplantis
- University of Colorado Denver, Internal Medicine, Renal, Aurora, Colorado, USA
| | | | - Jill Huckles
- University of Colorado Denver, Internal Medicine, Renal, Aurora, Colorado, USA
| | - Benjamin M Fox
- University of Colorado Denver, Internal Medicine, Renal, Aurora, Colorado, USA
| | - Kashfi Kahn
- University of Colorado Denver, Internal Medicine, Renal, Aurora, Colorado, USA
| | - Danielle Soranno
- Department of Pediatrics and Bioengineering, University of Colorado Denver, Aurora, Colorado, USA
| | - Hyo-Wook Gil
- University of Colorado Denver, Internal Medicine, Renal, Aurora, Colorado, USA; Department of Internal Medicine, Soonchunhyang University, Cheonan Hospital, Cheonan, Republic of Korea
| | - Isaac Teitelbaum
- University of Colorado Denver, Internal Medicine, Renal, Aurora, Colorado, USA
| | - Sarah Faubel
- University of Colorado Denver, Internal Medicine, Renal, Aurora, Colorado, USA.
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Andres-Hernando A, Okamura K, Bhargava R, Kiekhaefer CM, Soranno D, Kirkbride-Romeo LA, Gil HW, Altmann C, Faubel S. Circulating IL-6 upregulates IL-10 production in splenic CD4 + T cells and limits acute kidney injury-induced lung inflammation. Kidney Int 2017; 91:1057-1069. [PMID: 28214022 DOI: 10.1016/j.kint.2016.12.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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: 03/21/2016] [Revised: 11/21/2016] [Accepted: 12/01/2016] [Indexed: 12/16/2022]
Abstract
Although it is well established that acute kidney injury (AKI) is a proinflammatory state, little is known about the endogenous counter-inflammatory response. IL-6 is traditionally considered a pro-inflammatory cytokine that is elevated in the serum in both human and murine AKI. However, IL-6 is known to have anti-inflammatory effects. Here we sought to investigate the role of IL-6 in the counter-inflammatory response after AKI, particularly in regard to the anti-inflammatory cytokine IL-10. Ischemic AKI was induced by bilateral renal pedicle clamping. IL-10-deficient mice had increased systemic and lung inflammation after AKI, demonstrating the role of IL-10 in limiting inflammation after AKI. We then sought to determine whether IL-6 mediates IL-10 production. Wild-type mice with AKI had a marked upregulation of splenic IL-10 that was absent in IL-6-deficient mice with AKI. In vitro, addition of IL-6 to splenocytes increased IL-10 production in CD4+ T cells, B cells, and macrophages. In vivo, CD4-deficient mice with AKI had reduced splenic IL-10 and increased lung myeloperoxidase activity. Thus, IL-6 directly increases IL-10 production and participates in the counter-inflammatory response after AKI.
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Affiliation(s)
- Ana Andres-Hernando
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado, USA
| | - Kayo Okamura
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado, USA
| | - Rhea Bhargava
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado, USA
| | - Carol M Kiekhaefer
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado, USA
| | - Danielle Soranno
- Department of Pediatrics and Bioengineering, University of Colorado, Aurora, Colorado, USA
| | - Lara A Kirkbride-Romeo
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado, USA
| | - Hyo-Wook Gil
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado, USA; Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Chris Altmann
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado, USA
| | - Sarah Faubel
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado, USA.
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