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Bullen AL, Katz R, Lee AK, Anderson CAM, Cheung AK, Garimella PS, Jotwani V, Haley WE, Ishani A, Lash JP, Neyra JA, Punzi H, Rastogi A, Riessen E, Malhotra R, Parikh CR, Rocco MV, Wall BM, Bhatt UY, Shlipak MG, Ix JH, Estrella MM. The SPRINT trial suggests that markers of tubule cell function in the urine associate with risk of subsequent acute kidney injury while injury markers elevate after the injury. Kidney Int 2019; 96:470-479. [PMID: 31262489 PMCID: PMC6650383 DOI: 10.1016/j.kint.2019.03.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 03/26/2019] [Accepted: 03/28/2019] [Indexed: 01/19/2023]
Abstract
Urine markers can quantify tubular function including reabsorption (α-1 microglobulin [α1m]) and β-2-microglobulin [β2m]) and protein synthesis (uromodulin). Individuals with tubular dysfunction may be less able to compensate to insults than those without, despite similar estimated glomerular filtration rate (eGFR) and albuminuria. Among Systolic Blood Pressure Intervention Trial (SPRINT) participants with an eGFR under 60 ml/min/1.73m2, we measured urine markers of tubular function and injury (neutrophil gelatinase-associated lipocalin [NGAL], kidney injury molecule-1 [KIM-1], interleukin-18 [IL-18], monocyte chemoattractant protein-1, and chitinase-3-like protein [YKL-40]) at baseline. Cox models evaluated associations with subsequent acute kidney injury (AKI) risk, adjusting for clinical risk factors, baseline eGFR and albuminuria, and the tubular function and injury markers. In a random subset, we remeasured biomarkers after four years, and compared changes in biomarkers in those with and without intervening AKI. Among 2351 participants, 184 experienced AKI during 3.8 years mean follow-up. Lower uromodulin (hazard ratio per two-fold higher (0.68, 95% confidence interval [0.56, 0.83]) and higher α1m (1.20; [1.01, 1.44]) were associated with subsequent AKI, independent of eGFR and albuminuria. None of the five injury markers were associated with eventual AKI. In the random subset of 947 patients with repeated measurements, the 59 patients with intervening AKI versus without had longitudinal increases in urine NGAL, IL-19, and YKL-40 and only 1 marker of tubule function (α1m). Thus, joint evaluation of tubule function and injury provided novel insights to factors predisposing to AKI, and responses to kidney injury.
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Affiliation(s)
- Alexander L Bullen
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Ronit Katz
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Alexandra K Lee
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, California, USA
| | - Cheryl A M Anderson
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA; Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California-San Diego, San Diego, California, USA
| | - Alfred K Cheung
- Division of Nephrology & Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA; Medical Service, Veterans Affairs, Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Pranav S Garimella
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Vasantha Jotwani
- Department of Medicine, San Francisco VA Medical Center, San Francisco, California, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - William E Haley
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, Florida, USA
| | - Areef Ishani
- Division of Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - James P Lash
- Division of Nephrology, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Javier A Neyra
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky Medical Center, Lexington, Kentucky, USA; Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern, Dallas, Texas, USA
| | - Henry Punzi
- UT Southwestern Medical Center, Carrollton, Texas, USA
| | - Anjay Rastogi
- Division of Pulmonary and Critical Care, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, California, USA
| | - Erik Riessen
- Medical Service, Veterans Affairs, Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Rakesh Malhotra
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Chirag R Parikh
- Department of Medicine, Section of Nephrology, Yale University, New Haven, Connecticut, USA
| | - Michael V Rocco
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Barry M Wall
- Division of Nephrology, Veterans Affairs Medical Center, Memphis, Tennessee, USA
| | - Udayan Y Bhatt
- Division of Nephrology, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | - Michael G Shlipak
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, California, USA; Department of Medicine, San Francisco VA Medical Center, San Francisco, California, USA
| | - Joachim H Ix
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA; Nephrology Section, Veterans Affairs, San Diego Healthcare System, La Jolla, California, USA
| | - Michelle M Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, California, USA; Department of Medicine, San Francisco VA Medical Center, San Francisco, California, USA.
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2
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Ghazi L, Pajewski NM, Rifkin DE, Bates JT, Chang TI, Cushman WC, Glasser SP, Haley WE, Johnson KC, Kostis WJ, Papademetriou V, Rahman M, Simmons DL, Taylor A, Whelton PK, Wright JT, Bhatt UY, Drawz PE. Effect of Intensive and Standard Clinic-Based Hypertension Management on the Concordance Between Clinic and Ambulatory Blood Pressure and Blood Pressure Variability in SPRINT. J Am Heart Assoc 2019; 8:e011706. [PMID: 31307270 PMCID: PMC6662121 DOI: 10.1161/jaha.118.011706] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Blood pressure ( BP ) varies over time within individual patients and across different BP measurement techniques. The effect of different BP targets on concordance between BP measurements is unknown. The goals of this analysis are to evaluate concordance between (1) clinic and ambulatory BP , (2) clinic visit-to-visit variability and ambulatory BP variability, and (3) first and second ambulatory BP and to evaluate whether different clinic targets affect these relationships. Methods and Results The SPRINT (Systolic Blood Pressure Intervention Trial) ambulatory BP monitoring ancillary study obtained ambulatory BP readings in 897 participants at the 27-month follow-up visit and obtained a second reading in 203 participants 293±84 days afterward. There was considerable lack of agreement between clinic and daytime ambulatory systolic BP with wide limits of agreement in Bland-Altman plots of -21 to 34 mm Hg in the intensive-treatment group and -26 to 32 mm Hg in the standard-treatment group. Overall, there was poor agreement between clinic visit-to-visit variability and ambulatory BP variability with correlation coefficients for systolic and diastolic BP all <0.16. We observed a high correlation between first and second ambulatory BP ; however, the limits of agreement were wide in both the intensive group (-27 to 21 mm Hg) and the standard group (-23 to 20 mm Hg). Conclusions We found low concordance in BP and BP variability between clinic and ambulatory BP and second ambulatory BP . Results did not differ by treatment arm. These results reinforce the need for multiple BP measurements before clinical decision making.
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Affiliation(s)
- Lama Ghazi
- 1 Division of Public Health Department of Epidemiology and Community Health University of Minnesota Minneapolis MN
| | - Nicholas M Pajewski
- 2 Division of Public Health Sciences Department of Biostatistical Sciences Wake Forest School of Medicine Winston-Salem NC
| | - Dena E Rifkin
- 3 Division of Nephrology Veterans Affairs Health System and University of California San Diego CA
| | - Jeffrey T Bates
- 4 Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine Houston TX
| | - Tara I Chang
- 5 Division of Nephrology Stanford University School of Medicine Palo Alto CA
| | - William C Cushman
- 6 Memphis Veterans Affairs Medical Center Memphis TN.,9 Department of Preventive Medicine University of Tennessee Health Science Center Memphis TN
| | - Stephen P Glasser
- 7 Division of Cardiology Department of Internal Medicine University of Kentucky College of Medicine Lexington KY
| | - William E Haley
- 8 Division of Nephrology and Hypertension Mayo Clinic Jacksonville FL
| | - Karen C Johnson
- 9 Department of Preventive Medicine University of Tennessee Health Science Center Memphis TN
| | - William J Kostis
- 10 Division of Cardiovascular Disease and Hypertension Rutgers Robert Wood Johnson Medical School New Brunswick NJ
| | | | - Mahboob Rahman
- 12 Case Western Reserve University University Hospitals Cleveland Medical Center Louis Stokes Cleveland VA Medical Center Cleveland OH
| | - Debra L Simmons
- 13 Department of Internal Medicine University of Utah Salt Lake City UT.,14 George E. Wahlen Veterans Affairs Medical Center Salt Lake City UT
| | - Addison Taylor
- 4 Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine Houston TX
| | - Paul K Whelton
- 15 Tulane University School of Public Health and Tropical Medicine New Orleans LA
| | - Jackson T Wright
- 16 Clinical Hypertension Program Division of Nephrology and Hypertension University Hospitals Cleveland Medical Center Cleveland OH
| | - Udayan Y Bhatt
- 17 Division of Nephrology The Ohio State University, Wexner Medical Center Columbus OH
| | - Paul E Drawz
- 18 Division of Renal Diseases and Hypertension University of Minnesota Minneapolis MN
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Ginsberg C, Craven TE, Chonchol MB, Cheung AK, Sarnak MJ, Ambrosius WT, Killeen AA, Raphael KL, Bhatt UY, Chen J, Chertow GM, Freedman BI, Oparil S, Papademetriou V, Wall BM, Wright CB, Ix JH, Shlipak MG. PTH, FGF23, and Intensive Blood Pressure Lowering in Chronic Kidney Disease Participants in SPRINT. Clin J Am Soc Nephrol 2018; 13:1816-1824. [PMID: 30425104 PMCID: PMC6302330 DOI: 10.2215/cjn.05390518] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 09/06/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated that intensive BP lowering reduced the risk of cardiovascular disease, but increased eGFR decline. Serum parathyroid hormone (PTH) and fibroblast growth factor-23 (FGF23) concentrations are elevated in CKD and are associated with cardiovascular disease. We evaluated whether intact PTH or intact FGF23 concentrations modify the effects of intensive BP control on cardiovascular events, heart failure, and all-cause mortality in SPRINT participants with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We measured PTH and FGF23 in 2486 SPRINT participants with eGFR<60 ml/min per 1.73 m2 at baseline. Cox models were used to evaluate whether serum PTH and FGF23 concentrations were associated with cardiovascular events, heart failure, and all-cause mortality, and whether PTH and FGF23 modified the effects of intensive BP control. RESULTS The mean age of this subcohort was 73 years, 60% were men, and mean eGFR was 46±11 ml/min per 1.73 m2. Median PTH was 48 (interquartile range [IQR], 35-67) pg/ml and FGF23 was 66 (IQR, 52-88) pg/ml. There were 261 composite cardiovascular events, 102 heart failure events, and 179 deaths within the subcohort. The adjusted hazard ratio (HR) per doubling of PTH concentration for cardiovascular events, heart failure, and all-cause mortality were 1.29 (95% confidence interval [95% CI], 1.06 to 1.57), 1.32 (95% CI, 0.96 to 1.83), and 1.04 (95% CI, 0.82 to 1.31), respectively. There were significant interactions between PTH and BP arm for both the cardiovascular (P-interaction=0.01) and heart failure (P-interaction=0.004) end points. Participants with a PTH above the median experienced attenuated benefits of intensive BP control on cardiovascular events (adjusted HR, 1.02; 95% CI, 0.72 to 1.42) compared with participants with a PTH below the median (adjusted HR, 0.67; 95% CI, 0.45 to 1.00). FGF23 was not independently associated with any outcome and did not modify the effects of the intervention. CONCLUSIONS SPRINT participants with CKD and a high serum PTH received less cardiovascular protection from intensive BP therapy than participants with a lower serum PTH.
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Affiliation(s)
- Charles Ginsberg
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California
- Division of Nephrology-Hypertension, University of California, San Diego, San Diego, California
| | | | - Michel B. Chonchol
- Division of Renal Diseases and Hypertension, University of Anschutz Medical Center, Aurora, Colorado
| | - Alfred K. Cheung
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah
| | - Mark J. Sarnak
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | | | - Anthony A. Killeen
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Kalani L. Raphael
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah
| | - Udayan Y. Bhatt
- Division of Nephrology, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Jing Chen
- Nephrology and Hypertension Section, Tulane University School of Medicine, New Orleans, Louisiana
| | - Glenn M. Chertow
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Barry I. Freedman
- Nephrology Section, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Suzanne Oparil
- Division of Cardiovascular Disease, University of Alabama School of Medicine, Birmingham, Alabama
| | | | - Barry M. Wall
- Division of Nephrology, Veterans Affairs Medical Center, Memphis, Tennessee
| | | | - Joachim H. Ix
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California
- Division of Nephrology-Hypertension, University of California, San Diego, San Diego, California
| | - Michael G. Shlipak
- Kidney Health Research Collaborative, Veterans Affairs Medical Center, San Francisco, California; and
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - for the SPRINT Research Group
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California
- Division of Nephrology-Hypertension, University of California, San Diego, San Diego, California
- Department of Biostatistical Sciences and
- Nephrology Section, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Division of Renal Diseases and Hypertension, University of Anschutz Medical Center, Aurora, Colorado
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
- Division of Nephrology, The Ohio State University, Wexner Medical Center, Columbus, Ohio
- Nephrology and Hypertension Section, Tulane University School of Medicine, New Orleans, Louisiana
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
- Division of Cardiovascular Disease, University of Alabama School of Medicine, Birmingham, Alabama
- Division of Cardiology, Georgetown University Medical Center, Washington, DC
- Division of Nephrology, Veterans Affairs Medical Center, Memphis, Tennessee
- Department of Neurology, University of Miami, Miami, Florida
- Kidney Health Research Collaborative, Veterans Affairs Medical Center, San Francisco, California; and
- Department of Medicine, University of California, San Francisco, San Francisco, California
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Von Visger JR, Gunay Y, Andreoni KA, Bhatt UY, Nori US, Pesavento TE, Elkhammas EA, Winters HA, Nadasdy T, Singh N. The risk of recurrent IgA nephropathy in a steroid-free protocol and other modifying immunosuppression. Clin Transplant 2014; 28:845-54. [PMID: 24869763 DOI: 10.1111/ctr.12389] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2014] [Indexed: 12/17/2022]
Abstract
Recurrent glomerulonephritis is an important cause of kidney allograft failure. The effect of immunosuppression on recurrent IgA nephropathy (IgAN) is unclear. We analyzed the impact of steroids and other immunosuppression on the risk of recurrent IgAN post-kidney transplantation. Between June 1989 and November 2008, 3311 kidney transplants were performed at our center. IgAN was the primary disease in 124 patients; of these, 75 (60.5%) patients received steroid-based immunosuppression (15 undergoing late steroid withdrawal), and 49 (39.5%) were maintained on steroid-free immunosuppression. Recurrent IgAN was diagnosed in 27 of 124 (22%) patients in clinically indicated kidney allograft biopsies over a median follow-up of 6.86 ± 5.4 yr. On cox proportional hazards model multivariate analysis, the hazard risk (HR) of IgAN recurrence was significantly higher in patients managed with steroid-free (HR 8.59: 3.03, 24.38, p < 0.001) and sirolimus-based (HR = 3.00:1.16, 7.75, p = 0.024) immunosuppression without antilymphocyte globulin induction (HR = 4.5: 1.77, 11.73, p = 0.002). Mycophenolate use was associated with a lower risk (HR = 0.42: 0.19, 0.95, p = 0.036), whereas cyclosporine did not have a significant impact on the risk of IgAN recurrence (p = 0.61). These results warrant future prospective studies regarding the role of steroids and other immunosuppression drugs in reducing recurrence of IgAN and other glomerulonephritis post-transplant.
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Affiliation(s)
- J R Von Visger
- Division of Nephrology, Department of Internal Medicine, The Ohio State University College of Medicine and Public Health, Columbus, OH, USA
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Parikh S, Nijmeh R, Van Cleef S, Timmerman S, Bhatt UY, Agarwal AK. Catheter Outcomes in the Short-term Inpatient Setting: A Controlled Quality Improvement Study Comparing Citrate and Heparin Lock. Semin Dial 2011; 25:351-6. [DOI: 10.1111/j.1525-139x.2011.00966.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hebert PL, Nori US, Bhatt UY, Hebert LA. A modest proposal for improving the accuracy of creatinine-based GFR-estimating equations. Nephrol Dial Transplant 2011; 26:2426-8. [PMID: 21447760 DOI: 10.1093/ndt/gfr151] [Citation(s) in RCA: 4] [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] [Indexed: 11/14/2022] Open
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7
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Brodsky SV, Nadasdy T, Rovin BH, Satoskar AA, Nadasdy GM, Wu HM, Bhatt UY, Hebert LA. Warfarin-related nephropathy occurs in patients with and without chronic kidney disease and is associated with an increased mortality rate. Kidney Int 2011; 80:181-9. [PMID: 21389969 DOI: 10.1038/ki.2011.44] [Citation(s) in RCA: 211] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
An acute increase in the international normalized ratio (INR; a comparison of prothrombin time to monitor the effects of warfarin) over 3 in patients with chronic kidney disease (CKD) is often associated with an unexplained acute increase in serum creatinine (SC) and an accelerated progression of CKD. Kidney biopsy in a subset of these patients showed obstruction of the renal tubule by red blood cell casts, and this appears to be the dominant mechanism of the acute kidney injury. We termed this warfarin-related nephropathy (WRN), and previously reported cases of WRN only in patients with CKD. We now assess whether this occurs in patients without CKD, its risk factors, and consequences. In 15,258 patients who initiated warfarin therapy during a 5-year period, 4006 had an INR over 3 and SC measured at the same time; however, the large data set precluded individual patient clinical assessment. A presumptive diagnosis of WRN was made if the SC increased by over 0.3 mg/dl within 1 week after the INR exceeded 3 with no record of hemorrhage. WRN occurred in 20.5% of the entire cohort, 33.0% of the CKD cohort, and 16.5% of the no-CKD cohort. Other risk factors included age, diabetes mellitus, hypertension, and cardiovascular disease. The 1-year mortality was 31.1% with compared with 18.9% without WRN, an increased risk of 65%. Thus, WRN may be a common complication of warfarin therapy in high-risk patients and CKD doubles this risk. The mechanisms of these risks are unclear.
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Affiliation(s)
- Sergey V Brodsky
- Department of Pathology, Ohio State University, Columbus, Ohio 43210, USA.
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Bhatt UY, Sferra TJ, Johnson A, Williams C, Shirey K, Venema T, Nuovo GJ, Nahman NS. Glomerular beta-galactosidase expression following transduction with microsphere-adenoviral complexes. Kidney Int 2002; 61:S68-72. [PMID: 11841616 DOI: 10.1046/j.1523-1755.2002.0610s1068.x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aortic injection of adenoviral-microsphere complexes is a useful technique for in vivo gene transfer (transduction) to the glomerulus. In this approach, the appearance of the foreign transprotein in the glomerulus may result from glomerular cell gene transfer and local synthesis or hepatic cell transduction followed by synthesis, secretion, and deposition in the glomerulus. We postulated that glomerular expression of the foreign transgene was the result of glomerular cell transduction. To test this question, male SD rats underwent aortic injections with adenovirus containing the LacZ expression cassette [expressing beta-galactosidase (betagal)] coupled to 16 microm diameter microspheres. After 48 hours, histologic staining confirmed glomerular expression of the betagal transprotein and reverse transcription in situ polymerase chain reaction demonstrated the presence of the betagal transgene in the glomerulus. In addition, hepatic expression of the betagal transprotein was minimal and substantially less than that observed in the glomeruli. These data support the contention that adenoviral-microsphere complexes result in glomerular cell transduction with the desired transgene, followed by local transprotein synthesis. This approach may prove useful for facilitating glomerular gene transfer in the development of gene therapy for glomerulonephritis.
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Affiliation(s)
- Udayan Y Bhatt
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio 43210, USA
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9
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Nahman, Jr. NS, Drost WT, Bhatt UY, Sferra TJ, Johnson A, Gamboa P, Hinkle GH, Haynam A, Bergdall V, Hickey C, Bonagura JD, Brannon-peppas L, Ellison JS, Mansfield A, Shie S, Shen N. Biomed Microdevices 2002; 4:189-195. [DOI: 10.1023/a:1016044313036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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