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Marton A, Saffari SE, Rauh M, Sun RN, Nagel AM, Linz P, Lim TT, Takase-Minegishi K, Pajarillaga A, Saw S, Morisawa N, Yam WK, Minegishi S, Totman JJ, Teo S, Teo LLY, Ng CT, Kitada K, Wild J, Kovalik JP, Luft FC, Greasley PJ, Chin CWL, Sim DKL, Titze J. Water Conservation Overrides Osmotic Diuresis During SGLT2 Inhibition in Patients With Heart Failure. J Am Coll Cardiol 2024; 83:1386-1398. [PMID: 38599715 DOI: 10.1016/j.jacc.2024.02.020] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Sodium-glucose cotransporter 2 inhibitors are believed to improve cardiac outcomes due to their osmotic diuretic potential. OBJECTIVES The goal of this study was to test the hypothesis that vasopressin-driven urine concentration overrides the osmotic diuretic effect of glucosuria induced by dapagliflozin treatment. METHODS DAPA-Shuttle1 (Hepato-renal Regulation of Water Conservation in Heart Failure Patients With SGLT-2 Inhibitor Treatment) was a single-center, double-blind, randomized, placebo-controlled trial, in which patients with chronic heart failure NYHA functional classes I/II and reduced ejection fraction were randomly assigned to receive dapagliflozin 10 mg daily or placebo (1:1) for 4 weeks. The primary endpoint was change from baseline in urine osmolyte concentration. Secondary endpoints included changes in copeptin levels and solute free water clearance. RESULTS Thirty-three randomized, sodium-glucose cotransporter 2 inhibitor-naïve participants completed the study, 29 of whom (placebo: n = 14; dapagliflozin: n = 15) provided accurate 24-hour urine collections (mean age 59 ± 14 years; left ventricular ejection fraction 31% ± 9%). Dapagliflozin treatment led to an isolated increase in urine glucose excretion by 3.3 mmol/kg/d (95% CI: 2.51-4.04; P < 0.0001) within 48 hours (early) which persisted after 4 weeks (late; 2.7 mmol/kg/d [95% CI: 1.98-3.51]; P < 0.0001). Dapagliflozin treatment increased serum copeptin early (5.5 pmol/L [95% CI: 0.45-10.5]; P < 0.05) and late (7.8 pmol/L [95% CI: 2.77-12.81]; P < 0.01), leading to proportional reductions in free water clearance (early: -9.1 mL/kg/d [95% CI: -14 to -4.12; P < 0.001]; late: -11.0 mL/kg/d [95% CI: -15.94 to -6.07; P < 0.0001]) and elevated urine concentrations (late: 134 mmol/L [95% CI: 39.28-229.12]; P < 0.01). Therefore, urine volume did not significantly increase with dapagliflozin (mean difference early: 2.8 mL/kg/d [95% CI: -1.97 to 7.48; P = 0.25]; mean difference late: 0.9 mL/kg/d [95% CI: -3.83 to 5.62]; P = 0.70). CONCLUSIONS Physiological-adaptive water conservation eliminated the expected osmotic diuretic potential of dapagliflozin and thereby prevented a glucose-driven increase in urine volume of approximately 10 mL/kg/d · 75 kg = 750 mL/kg/d. (Hepato-renal Regulation of Water Conservation in Heart Failure Patients With SGLT-2 Inhibitor Treatment [DAPA-Shuttle1]; NCT04080518).
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Affiliation(s)
- Adriana Marton
- Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore; Department of Internal Medicine 4-Nephrology and Hypertension, Paracelsus Private Medical School Nuremberg, Nuremberg, Germany.
| | | | - Manfred Rauh
- Research Laboratory, Division of Paediatrics, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Ruo-Ning Sun
- Clinical Imaging Research Centre, Centre for Translational Medicine, Singapore
| | - Armin M Nagel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany; German Cancer Research Center (DKFZ), Division of Medical Physics in Radiology, Heidelberg, Germany
| | - Peter Linz
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Tzy Tiing Lim
- Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore
| | | | | | - Sharon Saw
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Norihiko Morisawa
- Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore
| | - Wan Keat Yam
- Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore
| | - Shintaro Minegishi
- Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore
| | - John J Totman
- Clinical Imaging Research Centre, Centre for Translational Medicine, Singapore; Radiography and Medical Imaging Department, Fatima College of Health Sciences, Abu Dhabi, United Arab Emirates
| | - Serena Teo
- Clinical Imaging Research Centre, Centre for Translational Medicine, Singapore
| | - Louis L Y Teo
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Choon Ta Ng
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Kento Kitada
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Johannes Wild
- Center for Cardiology, Cardiology I, Johannes Gutenberg-University, Mainz, Germany
| | - Jean-Paul Kovalik
- Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore
| | - Friedrich C Luft
- Experimental and Clinical Research Center, Max-Delbrück Center for Molecular Medicine, Medical Faculty of the Charité, Berlin, Germany
| | - Peter J Greasley
- Early Discovery and Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Calvin W L Chin
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - David K L Sim
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Jens Titze
- Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore; III. Department of Medicine and Hamburg Center for Kidney Health (HCKH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Nephrology, Duke University Medical Center, Durham, North Carolina, USA.
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2
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Loke RYJ, Chin CF, Liang G, Wong BH, Galam DLA, Tan BC, Chua GL, Minegishi S, Morisawa N, Sidorov I, Heijs B, Titze J, Wenk MR, Torta F, Silver DL. Mfsd2a-mediated lysolipid transport is important for renal recovery after acute kidney injury. J Lipid Res 2023; 64:100416. [PMID: 37467896 PMCID: PMC10424216 DOI: 10.1016/j.jlr.2023.100416] [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: 06/17/2023] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023] Open
Abstract
Acute kidney injury (AKI) is a global public health concern with high mortality and morbidity. In ischemic-reperfusion injury (IRI), a main cause of AKI, the brush border membrane of S3 proximal tubules (PT) is lost to the tubular lumen. How injured tubules reconstitute lost membrane lipids during renal recovery is not known. Here, we identified Mfsd2a, a sodium-dependent lysophosphatidylcholine (LPC) transporter, to be expressed specifically in the basolateral membrane of S3 PT. Using an in vivo activity probe for Mfsd2a, transport activity was found to be specific to the S3 PT. Mice with haploinsufficiency of Mfsd2a exhibited delayed recovery of renal function after acute IRI, with depressed urine osmolality and elevated levels of histological markers of damage, fibrosis, and inflammation, findings corroborated by transcriptomic analysis. Lipidomics revealed a deficiency in docosahexaenoic acid (DHA) containing phospholipids in Mfsd2a haploinsufficiency. Treatment of Mfsd2a haploinsufficient mice with LPC-DHA improved renal function and reduced markers of injury, fibrosis, and inflammation. Additionally, LPC-DHA treatment restored S3 brush border membrane architecture and normalized DHA-containing phospholipid content. These findings indicate that Mfsd2a-mediated transport of LPC-DHA is limiting for renal recovery after AKI and suggest that LPC-DHA could be a promising dietary supplement for improving recovery following AKI.
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Affiliation(s)
- Randy Y J Loke
- Signature Research Program in Cardiovascular and Metabolic Disorders, Duke-National University of Singapore (NUS) Medical School, Singapore
| | - Cheen Fei Chin
- Signature Research Program in Cardiovascular and Metabolic Disorders, Duke-National University of Singapore (NUS) Medical School, Singapore
| | - Gao Liang
- Singapore Lipidomics Incubator, Life Sciences Institute, NUS, Singapore; Department of Biochemistry, Yong Loo Lin School of Medicine, NUS, Singapore
| | - Bernice H Wong
- Signature Research Program in Cardiovascular and Metabolic Disorders, Duke-National University of Singapore (NUS) Medical School, Singapore
| | - Dwight L A Galam
- Signature Research Program in Cardiovascular and Metabolic Disorders, Duke-National University of Singapore (NUS) Medical School, Singapore
| | - Bryan C Tan
- Signature Research Program in Cardiovascular and Metabolic Disorders, Duke-National University of Singapore (NUS) Medical School, Singapore
| | - Geok-Lin Chua
- Signature Research Program in Cardiovascular and Metabolic Disorders, Duke-National University of Singapore (NUS) Medical School, Singapore
| | - Shintaro Minegishi
- Signature Research Program in Cardiovascular and Metabolic Disorders, Duke-National University of Singapore (NUS) Medical School, Singapore
| | - Norihiko Morisawa
- Signature Research Program in Cardiovascular and Metabolic Disorders, Duke-National University of Singapore (NUS) Medical School, Singapore
| | - Iulia Sidorov
- Center of Proteomics and Metabolomics, Leiden University Medical Center, Leiden, the Netherlands; The Novo Nordisk Foundation Center for Stem Cell Medicine (reNEW), Leiden University Medical Center, Leiden, the Netherlands
| | - Bram Heijs
- Center of Proteomics and Metabolomics, Leiden University Medical Center, Leiden, the Netherlands; The Novo Nordisk Foundation Center for Stem Cell Medicine (reNEW), Leiden University Medical Center, Leiden, the Netherlands
| | - Jens Titze
- Signature Research Program in Cardiovascular and Metabolic Disorders, Duke-National University of Singapore (NUS) Medical School, Singapore
| | - Markus R Wenk
- Singapore Lipidomics Incubator, Life Sciences Institute, NUS, Singapore; Department of Biochemistry, Yong Loo Lin School of Medicine, NUS, Singapore
| | - Federico Torta
- Singapore Lipidomics Incubator, Life Sciences Institute, NUS, Singapore; Department of Biochemistry, Yong Loo Lin School of Medicine, NUS, Singapore
| | - David L Silver
- Signature Research Program in Cardiovascular and Metabolic Disorders, Duke-National University of Singapore (NUS) Medical School, Singapore.
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3
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Hattori M, Rahman A, Kidoguchi S, Jahan N, Fujisawa Y, Morisawa N, Ohsaki H, Kobara H, Masaki T, Hossain A, Steeve A, Nishiyama A. Association of Antihypertensive Effects of Esaxerenone with the Internal Sodium Balance in Dahl Salt-Sensitive Hypertensive Rats. Int J Mol Sci 2022; 23:ijms23168915. [PMID: 36012182 PMCID: PMC9408866 DOI: 10.3390/ijms23168915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background: The nonsteroidal mineralocorticoid receptor blocker esaxerenone is effective in reducing blood pressure (BP). Objective: In this study, we investigated esaxerenone-driven sodium homeostasis and its association with changes in BP in Dahl salt-sensitive (DSS) hypertensive rats. Methods: In the different experimental setups, we evaluated BP by a radiotelemetry system, and sodium homeostasis was determined by an approach of sodium intake (food intake) and excretion (urinary excretion) in DSS rats with a low-salt diet (0.3% NaCl), high-salt diet (HSD, 8% NaCl), HSD plus 0.001% esaxerenone (w/w), and HSD plus 0.05% furosemide. Results: HSD-fed DSS rats showed a dramatic increase in BP with a non-dipper pattern, while esaxerenone treatment, but not furosemide, significantly reduced BP with a dipper pattern. The cumulative sodium excretion in the active period was significantly elevated in esaxerenone- and furosemide-treated rats compared with their HSD-fed counterparts. Sodium content in the skin, skinned carcass, and total body tended to be lower in esaxerenone-treated rats than in their HSD-fed counterparts, while these values were unchanged in furosemide-treated rats. Consistently, sodium balance tended to be reduced in esaxerenone-treated rats during the active period. Histological evaluation showed that esaxerenone, but not furosemide, treatment attenuated glomerulosclerosis, tubulointerstitial fibrosis, and urinary protein excretion induced by high salt loading. Conclusions: Collectively, these findings suggest that an esaxerenone treatment-induced reduction in BP and renoprotection are associated with body sodium homeostasis in salt-loaded DSS rats.
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Affiliation(s)
- Mai Hattori
- Department of Pharmacology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Asadur Rahman
- Department of Pharmacology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
- Correspondence: (A.R.); (A.N.); Tel.: +81-87-891-2125 (A.R. & A.N.); Fax: +81-87-891-2126 (A.R. & A.N.)
| | - Satoshi Kidoguchi
- Department of Pharmacology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Nourin Jahan
- Department of Pharmacology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Yoshihide Fujisawa
- Life Science Research Center, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Norihiko Morisawa
- Department of Pharmacology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Hiroyuki Ohsaki
- Department of Medical Biophysics, Kobe University Graduate School of Health Sciences, 7-10-2, Tomogaoka, Suma-ku, Kobe 654-0142, Hyogo, Japan
| | - Hideki Kobara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Tsutomu Masaki
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Akram Hossain
- Department of Pharmacology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Akumwami Steeve
- Department of Pharmacology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
- Department of Anesthesiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Akira Nishiyama
- Department of Pharmacology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
- Correspondence: (A.R.); (A.N.); Tel.: +81-87-891-2125 (A.R. & A.N.); Fax: +81-87-891-2126 (A.R. & A.N.)
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4
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Zhang A, Nakano D, Morisawa N, Kitada K, Kittikulsuth W, Rahman A, Morikawa T, Konishi Y, Nishiyama A. Effects of molidustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor, on sodium dynamics in hypertensive subtotally nephrectomized rats. J Pharmacol Sci 2021; 146:98-104. [PMID: 33941326 DOI: 10.1016/j.jphs.2021.03.007] [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: 11/27/2020] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 11/16/2022] Open
Abstract
Hypoxia-inducible factor prolyl hydroxylase (HIF-PHD) inhibitors were developed for treatment of renal anemia. Patients applicable for HIF-PHD inhibitor treatment experience complications such as chronic kidney disease, whereby water and electrolyte homeostasis is disrupted. The effects of hypoxia-inducible factor stabilization on salt accumulation in the setting of reduced renal function remain unclear. In the present study, we investigated the effect of a HIF-PHD inhibitor, molidustat, on salt distribution and excretion in rats with subtotal nephrectomy-induced chronic kidney disease. Male Wistar rats were subjected to 5/6 nephrectomy. After confirming blood pressure elevation (>150 mmHg, at 4 weeks after surgery), rats were treated with molidustat. After 1 week of treatment, molidustat did not significantly improve blood cell volume or blood pressure. Distribution of sodium, potassium, and water in skin, carcass, and bone samples was not affected by molidustat. Furthermore, molidustat had no significant effect on urinary sodium excretion or concentration in response to acute oral salt loading (1 g/kg). In conclusion, molidustat did not affect distribution or excretion of salt in rats subjected to a model of nephron loss.
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Affiliation(s)
- Anqi Zhang
- Department of Pharmacology, Kagawa University, Kagawa, Japan
| | - Daisuke Nakano
- Department of Pharmacology, Kagawa University, Kagawa, Japan.
| | | | - Kento Kitada
- Department of Pharmacology, Kagawa University, Kagawa, Japan
| | | | - Asadur Rahman
- Department of Pharmacology, Kagawa University, Kagawa, Japan
| | - Takashi Morikawa
- Division of Nephrology and Hypertension, Osaka City General Hospital, Osaka, Japan
| | - Yoshio Konishi
- Division of Nephrology and Hypertension, Osaka City General Hospital, Osaka, Japan
| | - Akira Nishiyama
- Department of Pharmacology, Kagawa University, Kagawa, Japan
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5
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Kovarik JJ, Morisawa N, Wild J, Marton A, Takase‐Minegishi K, Minegishi S, Daub S, Sands JM, Klein JD, Bailey JL, Kovalik J, Rauh M, Karbach S, Hilgers KF, Luft F, Nishiyama A, Nakano D, Kitada K, Titze J. Adaptive physiological water conservation explains hypertension and muscle catabolism in experimental chronic renal failure. Acta Physiol (Oxf) 2021; 232:e13629. [PMID: 33590667 PMCID: PMC8244025 DOI: 10.1111/apha.13629] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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: 09/13/2020] [Revised: 02/11/2021] [Accepted: 02/11/2021] [Indexed: 12/22/2022]
Abstract
Aim We have reported earlier that a high salt intake triggered an aestivation‐like natriuretic‐ureotelic body water conservation response that lowered muscle mass and increased blood pressure. Here, we tested the hypothesis that a similar adaptive water conservation response occurs in experimental chronic renal failure. Methods In four subsequent experiments in Sprague Dawley rats, we used surgical 5/6 renal mass reduction (5/6 Nx) to induce chronic renal failure. We studied solute and water excretion in 24‐hour metabolic cage experiments, chronic blood pressure by radiotelemetry, chronic metabolic adjustment in liver and skeletal muscle by metabolomics and selected enzyme activity measurements, body Na+, K+ and water by dry ashing, and acute transepidermal water loss in conjunction with skin blood flow and intra‐arterial blood pressure. Results 5/6 Nx rats were polyuric, because their kidneys could not sufficiently concentrate the urine. Physiological adaptation to this renal water loss included mobilization of nitrogen and energy from muscle for organic osmolyte production, elevated norepinephrine and copeptin levels with reduced skin blood flow, which by means of compensation reduced their transepidermal water loss. This complex physiologic‐metabolic adjustment across multiple organs allowed the rats to stabilize their body water content despite persisting renal water loss, albeit at the expense of hypertension and catabolic mobilization of muscle protein. Conclusion Physiological adaptation to body water loss, termed aestivation, is an evolutionary conserved survival strategy and an under‐studied research area in medical physiology, which besides hypertension and muscle mass loss in chronic renal failure may explain many otherwise unexplainable phenomena in medicine.
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Affiliation(s)
- Johannes J. Kovarik
- Programme in Cardiovascular and Metabolic DisordersDuke‐NUS Medical School Singapore Singapore
- Clinical Division of Nephrology and Dialysis Department of Internal Medicine III Medical University of Vienna Vienna Austria
| | - Norihiko Morisawa
- Department of Pharmacology Faculty of Medicine Kagawa University Kagawa Japan
| | - Johannes Wild
- Division for Cardiology 1 Centre for Cardiology Johannes Gutenberg‐University Mainz Mainz Germany
| | - Adriana Marton
- Programme in Cardiovascular and Metabolic DisordersDuke‐NUS Medical School Singapore Singapore
| | - Kaoru Takase‐Minegishi
- Programme in Cardiovascular and Metabolic DisordersDuke‐NUS Medical School Singapore Singapore
- Department of Stem Cell and Immune Regulation Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Shintaro Minegishi
- Programme in Cardiovascular and Metabolic DisordersDuke‐NUS Medical School Singapore Singapore
- Department of Medical Science and Cardiorenal Medicine Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Steffen Daub
- Division for Cardiology 1 Centre for Cardiology Johannes Gutenberg‐University Mainz Mainz Germany
| | - Jeff M. Sands
- Renal Division Department of Medicine Emory University Atlanta GA USA
| | - Janet D. Klein
- Renal Division Department of Medicine Emory University Atlanta GA USA
| | - James L. Bailey
- Renal Division Department of Medicine Emory University Atlanta GA USA
| | - Jean‐Paul Kovalik
- Programme in Cardiovascular and Metabolic DisordersDuke‐NUS Medical School Singapore Singapore
| | - Manfred Rauh
- Division of Paediatrics Research Laboratory Erlangen Germany
| | - Susanne Karbach
- Division for Cardiology 1 Centre for Cardiology Johannes Gutenberg‐University Mainz Mainz Germany
| | - Karl F. Hilgers
- Division of Nephrology and Hypertension University Clinic Erlangen Erlangen Germany
| | - Friedrich Luft
- Experimental and Clinical Research Center Max Delbrück Center for Molecular Medicine Berlin Germany
| | - Akira Nishiyama
- Department of Pharmacology Faculty of Medicine Kagawa University Kagawa Japan
| | - Daisuke Nakano
- Department of Pharmacology Faculty of Medicine Kagawa University Kagawa Japan
| | - Kento Kitada
- Programme in Cardiovascular and Metabolic DisordersDuke‐NUS Medical School Singapore Singapore
- JSPS Overseas Research Fellow Japan Society for the Promotion of Science Tokyo Japan
| | - Jens Titze
- Programme in Cardiovascular and Metabolic DisordersDuke‐NUS Medical School Singapore Singapore
- Division of Nephrology and Hypertension University Clinic Erlangen Erlangen Germany
- Division of Nephrology Duke University School of Medicine Durham NC USA
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6
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Li L, Nakano D, Zhang A, Kittikulsuth W, Morisawa N, Ohsaki H, Suzuki N, Yamamoto M, Nishiyama A. Effects of post-renal anemia treatment with the HIF-PHD inhibitor molidustat on adenine-induced renal anemia and kidney disease in mice. J Pharmacol Sci 2020; 144:229-236. [PMID: 33070842 DOI: 10.1016/j.jphs.2020.09.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/27/2020] [Accepted: 09/14/2020] [Indexed: 02/06/2023] Open
Abstract
The kidneys are the major organs for erythropoietin (EPO) production in adults, and thus, kidney damage results in reduced EPO levels and anemia. Inhibitors of Hypoxia-inducible factor-prolyl hydroxylase domain-containing protein (HIF-PHD) are awaited as new therapeutic options for renal anemia. It can be predicted that most patients who receive HIF-PHD inhibitors have renal dysfunction as a cause of anemia. Therefore, in the present study, we investigated the effects of the HIF-PHD inhibitor molidustat on anemia and renal dysfunction when initiated after the onset of renal anemia. Male C57BL/6J mice received adenine orally to induce nephropathy. After the onset of nephropathy, the mice were treated with either vehicle or molidustat. After 4 weeks of administration, vehicle-treated mice displayed significant anemia, and molidustat ameliorated this anemia. Vehicle-treated mice exhibited reduced creatinine clearance and body weight, increased blood urea nitrogen levels, histopathological changes, immune cell infiltration, and dehydration. Molidustat reversed immune cell infiltration, dehydration, and renal fibrosis without improving renal functional parameters. In conclusion, molidustat treatment initiated after the onset of nephropathy and renal anemia reversed anemia in mice. Molidustat improved some parameters of renal abnormality, but it did not restore renal function.
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Affiliation(s)
- Lei Li
- Department of Pharmacology, Kagawa University Medical School, Kagawa, Japan
| | - Daisuke Nakano
- Department of Pharmacology, Kagawa University Medical School, Kagawa, Japan.
| | - Anqi Zhang
- Department of Pharmacology, Kagawa University Medical School, Kagawa, Japan
| | | | - Norihiko Morisawa
- Department of Pharmacology, Kagawa University Medical School, Kagawa, Japan
| | - Hiroyuki Ohsaki
- Laboratory of Pathology, Department of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Norio Suzuki
- Division of Oxygen Biology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masayuki Yamamoto
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Akira Nishiyama
- Department of Pharmacology, Kagawa University Medical School, Kagawa, Japan
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7
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Morisawa N, Kitada K, Fujisawa Y, Nakano D, Yamazaki D, Kobuchi S, Li L, Zhang Y, Morikawa T, Konishi Y, Yokoo T, Luft FC, Titze J, Nishiyama A. Renal sympathetic nerve activity regulates cardiovascular energy expenditure in rats fed high salt. Hypertens Res 2020; 43:482-491. [PMID: 31932643 DOI: 10.1038/s41440-019-0389-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 12/08/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 01/20/2023]
Abstract
We recently reported that a 4% high-salt diet + saline for drinking (HS + saline) leads to a catabolic state, reduced heart rate, and suppression of cardiovascular energy expenditure in mice. We suggested that HS + saline reduces heart rate via the suppression of the sympathetic nervous system to compensate for the high salt intake-induced catabolic state. To test this hypothesis, we directly measured renal sympathetic nerve activity (RSNA) in conscious Sprague-Dawley (SD) rats using a radiotelemetry system. We confirmed that HS + saline induced a catabolic state. HS + saline decreased heart rate, while also reducing RSNA in SD rats. In contrast, Dahl salt-sensitive (DSS) rats exhibited no change in heart rate and increased RSNA during high salt intake. Renal denervation significantly decreased heart rate and attenuated the catabolic state independent of blood pressure in DSS rats fed HS + saline, suggesting that salt-sensitive animals were unable to decrease cardiovascular energy consumption due to abnormal renal sympathetic nerve activation during high salt intake. These findings support the hypothesis that RSNA mediates heart rate during high salt intake in SD rats. However, the insensitivity of heart rate and enhanced RSNA observed in DSS rats may be additional critical diagnostic factors for salt-sensitive hypertension. Renal denervation may benefit salt-sensitive hypertension by reducing its effects on catabolism and cardiovascular energy expenditure.
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Affiliation(s)
- Norihiko Morisawa
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan.,Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Kento Kitada
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan. .,Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore, Singapore.
| | - Yoshihide Fujisawa
- Life Science Research Center, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Daisuke Nakano
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Daisuke Yamazaki
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan.,Division of Nephrology and Hypertension, Osaka City General Hospital, Osaka, Japan
| | - Shuhei Kobuchi
- Division of Pharmacology, Department of Pharmacy, School of Pharmacy, Hyogo University of Health Sciences, Hyogo, Japan
| | - Lei Li
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yifan Zhang
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Takashi Morikawa
- Division of Nephrology and Hypertension, Osaka City General Hospital, Osaka, Japan
| | - Yoshio Konishi
- Division of Nephrology and Hypertension, Osaka City General Hospital, Osaka, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Friedrich C Luft
- Experimental & Clinical Research Center, a joint collaboration between Max-Delbrück Center for Molecular Medicine and Charité Universitätsmedizin, Berlin, Germany
| | - Jens Titze
- Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore, Singapore.,Division of Nephrology, Duke University Medical Center, Durham, NC, USA.,Division of Nephrology and Hypertension, University Clinic Erlangen, Erlangen, Germany
| | - Akira Nishiyama
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan
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8
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Yamazaki D, Kitada K, Morisawa N, Fujisawa Y, Nakano D, Hitomi H, Titze J, Nishiyama A. Abstract P169: Renal Denervation Attenuates a Catabolic State in Mice Fed High Salt. Hypertension 2019. [DOI: 10.1161/hyp.74.suppl_1.p169] [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: 11/16/2022]
Abstract
Introduction:
We recently reported that kidneys accumulate urea as an alternative osmolyte in the renal medulla to concentrate sodium into the urine during high salt intake. This urea-driven water conservation process is coupled with the energy-intensive nature of hepatic urea production, which leads to a catabolic state in mice fed high salt. In this study, we examined the effects of renal denervation on the salt-driven catabolic state since previous studies found that the renal sympathetic nervous system regulates urinary sodium excretion and energy metabolism of some organs such as liver and muscle.
Methods:
Sham-operated (sham) or renal denervated (RDX) male C57/B6J mice were fed on 0.3% NaCl diet with tap water (NS) or 4% NaCl high salt diet + 0.9% NaCl water to drink (HS) for 4 consecutive weeks (ad libitum), followed by 2 weeks of pair-feeding to match energy intake in all groups. We measured daily food intake and body weight, 24 hours urinary sodium excretion, body sodium content, and activity of liver arginase, a urea producing enzyme.
Results:
NS + sham and HS + sham mice showed similar body weight gain (NS + sham: +3.6 ± 0.2, HS + sham: +3.4 ± 0.2 g) during ad libitum feeding although HS significantly increased food intake (NS + sham: 3.1 ± 0.04, HS + sham: 3.3 ± 0.04 g/day). After the pair-feeding, HS mice significantly decreased their body weight (NS + sham: +0.9 ± 0.07, HS + sham: -0.6 ± 0.05 g) and increased liver arginase activity (NS + sham: 3792 ± 322, HS + sham: 5412 ± 499 units/L/tissue), confirming the high salt-induced catabolic hepatic urea production. On the other hand, HS did not increase food intake (NS + RDX: 3.2 ± 0.1, HS + RDX: 3.1 ± 0.01 g/day) and liver arginase activity (NS + RDX: 3599 ± 316, HS + RDX: 3363 ± 369 units/L/tissue) in RDX group. In addition, HS + RDX mice did not show pair feeding-induced body weight loss (NS + RDX: +0.6 ± 0.3, HS + RDX: +0.3 ± 0.3 g). HS + RDX mice did not alter 24 hours urinary sodium excretion (HS + sham: 135 ± 6.3, HS + RDX: 142 ± 13 mmol/d/kg) and body sodium content (HS + sham: 0.15 ± 0.003, HS + RDX: 0.15 ± 0.006 mmol/d/kg) compared with HS + sham mice.
Conclusion:
These findings suggest that renal denervation attenuates the HS-induced body weight loss and catabolic urea production independently of urinary sodium excretion.
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Affiliation(s)
- Daisuke Yamazaki
- Dept of Pharmacology, Faculty of Medicine, Kagawa Univ, Kitagun, Japan
| | - Kento Kitada
- Cardiovascular and Metabolic Disorders, Duke-NUS Med Sch, College Rd, Singapore
| | - Norihiko Morisawa
- Div of Nephrology & Hypertension, Dept of Internal Medicine, Tokyo, Japan
| | - Yoshihide Fujisawa
- Life Science Rsch Cntr, Faculty of Medicine, Kagawa Univ, Kitagun, Japan
| | - Daisuke Nakano
- Dept of Pharmacology, Faculty of Medicine, Kagawa Univ, Kitagun, Japan
| | - Hirofumi Hitomi
- Dept of iPS Stem Cell Regenerative Medicine, Kansai Med Univ, Osaka, Japan
| | - Jens Titze
- Cardiovascular and Metabolic Disorders, Duke-NUS Med Sch, College Rd, Singapore
| | - Akira Nishiyama
- Dept of Pharmacology, Faculty of Medicine, Kagawa Univ, Kitagun, Japan
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9
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Kidoguchi S, Sugano N, Hayashi-Ishikawa N, Morisawa N, Tokudome G, Yokoo T. The characteristics of captopril challenge test-positive patients using various criteria. J Renin Angiotensin Aldosterone Syst 2019; 20:1470320319870891. [PMID: 31434530 PMCID: PMC6709445 DOI: 10.1177/1470320319870891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Indexed: 11/16/2022] Open
Abstract
Introduction: The captopril challenge test (CCT) is the major confirmatory test for primary
aldosteronism (PA), and frequently carried out because of its convenience.
However, it presents false-negative results with a certain probability, and
as there are many criteria for CCT, it is not concluded yet which criteria
to use. Materials and methods: A total of 71 PA patients were evaluated. We compared CCT-positive and
CCT-negative patients in the following three criteria: plasma
aldosterone/renin ratio (ARR) >200 after the CCT (criterion 1); plasma
aldosterone concentration (PAC) >120 pg/ml after the CCT (criterion 2);
and PAC suppression <30% of PAC before CCT (criterion 3). Results: The positive rate was 70.4%, 64.8% and 54.9% for criterion 1, criterion 2 and
criterion 3, respectively. With criterion 1, the baseline plasma renin
activity was lower, thus baseline ARR was higher in CCT-positive patients.
With criterion 2, PAC was higher and estimated sodium intake and K were
lower in CCT-positive patients. With criterion 3, K and PAC were lower in
CCT-positive patients. Although it was not significant, in the patients with
high sodium intake, the positive rate of criterion 1 was higher than that of
the other criteria. Conclusions: ARR>200 is the valuable criterion for the diagnosis of PA.
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Affiliation(s)
- Satoshi Kidoguchi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Naoki Sugano
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Naomi Hayashi-Ishikawa
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Norihiko Morisawa
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Goro Tokudome
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
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10
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Kidoguchi S, Sugano N, Takane K, Takahashi Y, Morisawa N, Yarita M, Hayashi-Ishikawa N, Tokudome G, Yokoo T. Azilsartan causes natriuresis due to its sympatholytic action in kidney disease. Hypertens Res 2019; 42:1507-1517. [PMID: 31138899 DOI: 10.1038/s41440-019-0271-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 11/01/2018] [Revised: 04/09/2019] [Accepted: 04/20/2019] [Indexed: 11/09/2022]
Abstract
The sympathoinhibitory mechanism of azilsartan was investigated in an adenine-induced chronic renal failure model. Azilsartan exerted an antihypertensive effect, though BP elevation induced by adenine was marginal. The creatinine value was significantly lower in the azilsartan group (AZ) than in the vehicle group (VEH); furthermore, proteinuria was suppressed, and sodium excretion was augmented in the AZ group. The low frequency (LF) of systolic BP was suppressed (VEH: 4.07 ± 2.67 mmHg2 vs. AZ: 3.32 ± 1.93 mmHg2 P < 0.001), and the spontaneous baroreflex gain (sBRG) was augmented (VEH: 1.04 ± 0.62ms/mmHg vs. AZ: 1.38 ± 0.69 ms/mmHg, P < 0.001) in AZ. There were no significant differences in ACE1 and ACE2 expression between the groups, which indicated that the action of azilsartan on these components of the intrarenal renin-angiotensin-aldosterone system was comparatively small. Although NHE3, NKCC, and ENaC expression was similar between the groups, NaCl cotransporter (NCC) expression was markedly suppressed by azilsartan (P < 0.05). Thus, in a mild chronic kidney disease (CKD) model with slight BP elevation, the sympatholytic effect of ARB might be expected, and azilsartan might exert its natriuretic effect by NCC suppression achieved by sympathoinhibitory activity.
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Affiliation(s)
- Satoshi Kidoguchi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Naoki Sugano
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Koki Takane
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yasuhito Takahashi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Norihiko Morisawa
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Miki Yarita
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Naomi Hayashi-Ishikawa
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Goro Tokudome
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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11
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Morisawa N, Kitada K, Yamazaki D, Nakano D, Fujisawa Y, Titze J, Nishiyama A. Abstract P220: High Salt Intake Induces Catabolism Accompanied by Hepatic Urea Osmolyte Production and Decreases Renal Sympathetic Nerve Activity. Hypertension 2018. [DOI: 10.1161/hyp.72.suppl_1.p220] [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: 11/16/2022]
Abstract
Introduction:
We have recently reported that high salt intake induces the energy-intensive nature of hepatic urea osmolyte production that accompanied the decrease in heart rate (HR). These findings suggest that high salt intake decreases sympathetic nerve activity to reduce cardiovascular energy expenditure for the hepatic urea production. Therefore, we examined the effects of high salt intake on renal sympathetic nerve activity (RSNA) by using a radiotelemetry system in rats.
Methods:
We inserted the radiotelemetry system into male Sprague Dawley (SD) rats for recording RSNA and HR. After 2 weeks recovery, we fed the rats 0.3% NaCl diet (NS) with tap water to drink (NS + tap), 4% NaCl diet with tap water (HS + tap), and 4% NaCl diet with saline (HS + saline) for 4 days in this order, and kept monitoring their HR and RSNA. In the separate experiment, we also fed male SD rats NS + tap or HS + saline for 6 consecutive weeks to confirm a catabolic state in HS + saline rats.
Results:
Rats exhibited marked reductions in RSNA and HR during HS + saline phase compared with other phases. HS + saline rats significantly decreased body weight (369±35 g) compared with NS + tap rats (405±48 g) despite of the similar daily food intake (18.5±1.3 vs. 19.2±1.6 g/day). And HS + saline rats increased liver arginase, a urea producing enzyme, activity (1561±121 units/L/mg) compared with NS + tap rats (1337±131 units/L/mg) at 6 weeks after the feeding.
Conclusion:
High salt intake decreased RSNA accompanied by the catabolic urea production in rats. These findings suggest that the sympathetic nervous system is one of the key regulators to reduce cardiovascular energy expenditure, which could support the energy-intensive nature of hepatic urea production in high salt-fed rats.
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Affiliation(s)
- Norihiko Morisawa
- Div of Nephrology & Hypertension, Dept of Internal Medicine, Jikei Univ Sch of Medicine, Tokyo, Japan
| | - Kento Kitada
- Cardiovascular and Metabolic Disorders, Duke-NUS Med Sch, Singapore, Singapore
| | - Daisuke Yamazaki
- Dept of Pharmacology, Faculty of Medicine, Kagawa Univ, Kagawa, Japan
| | - Daisuke Nakano
- Dept of Pharmacology, Faculty of Medicine, Kagawa Univ, Kagawa, Japan
| | | | - Jens Titze
- Cardiovascular and Metabolic Disorders, Duke-NUS Med Sch, Singapore, Singapore
| | - Akira Nishiyama
- Dept of Pharmacology, Faculty of Medicine, Kagawa Univ, Kagawa, Japan
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12
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Morisawa N, Koshima Y, Kuriyama S, Matsuyama M, Hayashi N, Satoh JI, Amemiya M, Yokoo T. Effectiveness of a fixed combination formula of ombitasvir/paritaprevir/ritonavir for hepatitis C virus infection in patients on maintenance haemodialysis. Nephrology (Carlton) 2018. [PMID: 28621007 DOI: 10.1111/nep.13011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
A fixed-dose formula that combines Ombitasvir (OBV), Paritaprevir (PTV) and Ritonavir (RTV) has been launched into the field of anti-HCV therapy in Japan for patients infected with HCV genotypes 1 and 2 in 2015. However, little is yet known as to the efficacy and safety of this novel therapy in patients on maintenance haemodialysis (HD). The present report describes a preliminary experience in 10 patients (five males and five females) who underwent maintenance HD. All of them had HCV genotype 1b, without having the resistance-associated variants at Y93 or L31 in the nonstructural proteins 5A (NS5A) region. After the treatment, eight patients successfully achieved virus eradication and sustained a virological response at 12 weeks (SVR12). In addition, mac-2 binding protein glycosylation isomer (M2BPGi), a biomarker for liver fibrosis, was reduced after the therapy. Two patients withdrew from the therapy due to the development of erythema multiforme and a strong drowsiness, respectively. These results suggest that triple therapy combining OBV, PTV and RTV is effective in achieving SVR12 in most of the HCV-infected patients on HD. In addition, this combination therapy contributed to retard the progression of liver fibrosis. However, we suggest that further trial will be required to establish its clinical efficacy and safety.
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Affiliation(s)
- Norihiko Morisawa
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.,Division of Nephrology, Department of Internal Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Yohei Koshima
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Satoru Kuriyama
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Momoko Matsuyama
- Division of Nephrology, Department of Internal Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Naomi Hayashi
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.,Division of Nephrology, Department of Internal Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Jun-Ichi Satoh
- Division of Nephrology, Department of Internal Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Morimasa Amemiya
- Division of Nephrology, Department of Internal Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
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13
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Morisawa N, Sugano N, Yamakawa T, Kuriyama S, Yokoo T. Successful long-term effects of direct renin inhibitor aliskiren in a patient with atherosclerotic renovascular hypertension. CEN Case Rep 2017; 6:66-73. [DOI: 10.1007/s13730-016-0246-x] [Citation(s) in RCA: 2] [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: 09/26/2016] [Accepted: 12/24/2016] [Indexed: 11/24/2022] Open
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14
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Morisawa N, Satoh H, Matsuyama M, Hayashi N, Adachi A, Satoh JI, Yokoo T, Amemiya M. [Usefulness of the treatment with corticosteroids and ciclosporin A for TAFRO syndrome]. Nihon Naika Gakkai Zasshi 2016; 105:2432-2439. [PMID: 30646443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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15
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Abstract
The presence of nodal metastasis in patients with urogenital malignancies is an important factor for prognosis, and radiologic identification of enlarged nodes greatly affects treatment choices. Radiologic evaluation for nodal metastases is usually performed with computed tomography, but magnetic resonance imaging is also useful in evaluating primary and nodal metastases in pelvic tumors. On these cross-sectional modalities, nodal metastases are usually suspected according to location and size criteria. Although there has been no general consensus on the criteria, a short axis diameter of 8 to 10 mm is generally applied. However, radiologic evaluation does not always provide sufficient accuracy for nodal staging because of an inability to diagnose smaller metastatic lymph nodes. The clinical significance of a radiologic recognition of enlarged nodes also differs by cancer type in relation to differences in staging systems and treatment. The presence of regional lymphadenopathy in patients with renal cell carcinoma often alters surgical methods, whereas the presence of regional lymphadenopathy is an indication of systemic chemotherapy in patients with cancers of the urinary tract, prostate, and testicles. In this report, preferential sites and staging of nodal metastasis and contributions of radiologic imaging are reviewed for each urogenital cancer.
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Affiliation(s)
- N Morisawa
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan
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16
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Madarame H, Yaegashi R, Fukunaga N, Matsukuma M, Mutoh K, Morisawa N, Sasaki Y, Tsubaki S, Hasegawa Y, Takai S. Pathogenicity of Rhodococcus equi strains possessing virulence-associated 15- to 17-kDa and 20-kDa antigens: experimental and natural cases in pigs. J Comp Pathol 1998; 119:397-405. [PMID: 9839201 DOI: 10.1016/s0021-9975(98)80034-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The pathogenic role of Rhodococcus equi in pigs remains controversial. Small numbers of pigs were inoculated intravenously (i.v.), or intramuscularly (i.m.) around the mouth, with a virulent, an intermediately virulent, or an avirulent strain of R. equi and killed 14 days later. None showed clinical signs other than transient fever and weight loss. The virulent and intermediately virulent strains were recovered in culture from various organs and lymph nodes of pigs inoculated i.v., but only from the mandibular lymph nodes of pigs inoculated i.m. The avirulent strain was not recovered from any site. None of the pigs developed macroscopically visible lesions, but they showed reactive hyperplasia of the mandibular lymph nodes. The latter contained scattered phagocytic cells, which were labelled immunohistochemically for virulence-associated antigens (15- to 17-kDa antigens or 20-kDa antigen). Intermediately virulent and virulent strains of R. equi were isolated from mandibular lymph nodes of 5.5% of apparently healthy abattoir pigs (n = 1615). Virulence-associated antigens were detected in phagocytic cells of culture-positive nodes, but the latter showed no lesions other than reactive lymphoid hyperplasia. The results would seem to question the pathogenic role of R. equi in pigs, and it is speculated that the organism survives in the lymph nodes without causing pathognomonic lesions.
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Affiliation(s)
- H Madarame
- Laboratory of Experimental Animal Science, School of Veterinary Medicine and Animal Sciences, Kitasato University, Aomori, Japan
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17
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Madarame H, Takai S, Morisawa N, Fujii M, Hidaka D, Tsubaki S, Hasegawa Y. Immunohistochemical detection of virulence-associated antigens of Rhodococcus equi in pulmonary lesions of foals. Vet Pathol 1996; 33:341-3. [PMID: 8740709 DOI: 10.1177/030098589603300312] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [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: 02/01/2023]
Abstract
Rhodococcus equi was isolated from the lungs of six foals with bronchopneumonia. All isolates expressed 15-17-kd antigens by immunoblot analysis and contained a virulence-associated plasmid of 85 or 90 kb. Immunohistochemically, R. equi from all pulmonary lesions showed the expression of 15-17-kd antigens mainly in the phagocytic cells. The specific monoclonal antibody to 15-17-kd antigens of R. equi (MAb 10G5) may be an aid in the diagnosis of R. equi-induced pneumonia.
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Affiliation(s)
- H Madarame
- Department of Laboratory Animal Science, School of Veterinary Medicine and Animal Sciences, Kitasato University, Japan
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18
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Morisawa N. [Point of contact of the patient having diagnostic tests. Nurse's role in diagnostic tests]. Kango 1977; 29:12-9. [PMID: 586380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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19
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Ishikawa T, Watanabe Y, Morisawa N, Tanaka A, Inui H. [Clinical evaluation of KPC by the double blind test against infection and postoperative inflammation in oral surgery (author's transl)]. Nihon Koku Geka Gakkai Zasshi 1976; 22:110-30. [PMID: 796506 DOI: 10.5794/jjoms.22.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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20
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Ishikawa T, Watanabe Y, Tanaka A, Morisawa N, Inui H. [A case of papillary hyperplasia at the tip of uvula and its etiologic consideration (author's transl)]. Nihon Koku Geka Gakkai Zasshi 1976; 22:36-41. [PMID: 1087661 DOI: 10.5794/jjoms.22.36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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21
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Ishikawa T, Kawamura J, Tanaka A, Morisawa N, Kamiya K. [A case of congenital mucous retention cyst at the inferior part of the mandibular angle (author's transl)]. Nihon Koku Geka Gakkai Zasshi 1974; 20:375-80. [PMID: 4549814 DOI: 10.5794/jjoms.20.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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