1
|
Saleh QW, Mohammadnejad A, Tepel M. FOXP3 full length splice variant is associated with kidney allograft tolerance. Front Immunol 2024; 15:1389105. [PMID: 38660296 PMCID: PMC11040551 DOI: 10.3389/fimmu.2024.1389105] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/29/2024] [Indexed: 04/26/2024] Open
Abstract
Background Progressive decline of allograft function leads to premature graft loss. Forkhead box P3 (FOXP3), a characteristic gene of T-regulatory cells, is known to be essential for auto-antigen tolerance. We assessed the hypothesis that low FOXP3 mRNA splice variant levels in peripheral blood cells early after transplantation are associated with progressive allograft injury. Methods Blood samples were prospectively collected from 333 incident kidney transplant recipients on the first and 29th postoperative day. We used quantitative polymerase chain reaction to determine transcripts of 3 isotypes of FOXP3 splice variants, including pre-mature FOXP3 and full length FOXP3 (FOXP3fl). We investigated the association between FOXP3 splice variant levels and the declines in estimated glomerular filtration rate (eGFR) of more than 5ml/min/1.73m2 within the first-year post-transplant using logistic regression. Results We observed lower FOXP3fl levels in recipients with declining eGFR (N = 132) than in recipients with stable eGFR (N = 201), (logarithmic value -4.13 [IQR -4.50 to -3.84] vs -4.00 [4.32 to -3.74], p=0.02). In ad hoc analysis pre-transplant FOXP3fl levels were similar in both groups. The association between FOXP3fl and declining eGFR was confirmed by multivariable analysis adjusted for potential confounding factors (Odds Ratio 0.51, 95% confidence interval 0.28 to 0.91: p=0.02). When stratifying FOXP3fl levels into quartiles, recipients with lower day1 FOXP3fl had the highest rate of declining eGFR (p=0.04). Conclusion Low FOXP3fl splice variant levels at the first postoperative day in kidney transplant recipients were associated with severe decline of eGFR, a well-known surrogate for hard endpoints.
Collapse
Affiliation(s)
- Qais W. Saleh
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- Cardiovascular and Renal Research, Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Afsaneh Mohammadnejad
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Martin Tepel
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- Cardiovascular and Renal Research, Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
2
|
Nagarajah S, Saleh QW, Rasmussen M, Tepel M. Long non-coding RNA MGAT3 in kidney transplant recipients with immunoglobulin A nephropathy. J Nephrol 2024:10.1007/s40620-023-01857-9. [PMID: 38194208 DOI: 10.1007/s40620-023-01857-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/28/2023] [Indexed: 01/10/2024]
Affiliation(s)
- Subagini Nagarajah
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- Institute of Molecular Medicine, and Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Qais W Saleh
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- Institute of Molecular Medicine, and Clinical Institute, University of Southern Denmark, Odense, Denmark
| | | | - Martin Tepel
- Department of Nephrology, Odense University Hospital, Odense, Denmark.
- Institute of Molecular Medicine, and Clinical Institute, University of Southern Denmark, Odense, Denmark.
| |
Collapse
|
3
|
Speedtsberg ES, Tepel M. Narrative review investigating the nephroprotective mechanisms of sodium glucose cotransporter type 2 inhibitors in diabetic and nondiabetic patients with chronic kidney disease. Front Endocrinol (Lausanne) 2023; 14:1281107. [PMID: 38174341 PMCID: PMC10761498 DOI: 10.3389/fendo.2023.1281107] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/16/2023] [Indexed: 01/05/2024] Open
Abstract
Background and aims Outcome trials using sodium glucose cotransporter type 2 inhibitors have consistently shown their potential to preserve kidney function in diabetic and nondiabetic patients. Several mechanisms have been introduced which may explain the nephroprotective effect of sodium glucose cotransporter type 2 inhibitors beyond lowering blood glucose. This current narrative review has the objective to describe main underlying mechanisms causing a nephroprotective effect and to show similarities as well as differences between proposed mechanisms which can be observed in patients with diabetic and nondiabetic chronic kidney disease. Methods We performed a narrative review of the literature on Pubmed and Embase. The research string comprised various combinations of items including "chronic kidney disease", "sodium glucose cotransporter 2 inhibitor" and "mechanisms". We searched for original research and review articles published until march, 2022. The databases were searched independently and the agreements by two authors were jointly obtained. Results Sodium glucose cotransporter type 2 inhibitors show systemic, hemodynamic, and metabolic effects. Systemic effects include reduction of blood pressure without compensatory activation of the sympathetic nervous system. Hemodynamic effects include restoration of tubuloglomerular feedback which may improve pathologic hyperfiltration observed in most cases with chronic kidney disease. Current literature indicates that SGLT2i may not improve cortical oxygenation and may reduce medullar oxygenation. Conclusion Sodium glucose cotransporter type 2 inhibitors cause nephroprotective effects by several mechanisms. However, several mediators which are involved in the underlying pathophysiology may be different between diabetic and nondiabetic patients.
Collapse
Affiliation(s)
- Emma S Speedtsberg
- Institute of Molecular Medicine, Cardiovascular and Renal Research, University of Southern Denmark, Odense, Denmark
- Institute of Clinical Medicine, University of Southern Denmark, Odense, Denmark
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Martin Tepel
- Institute of Molecular Medicine, Cardiovascular and Renal Research, University of Southern Denmark, Odense, Denmark
- Institute of Clinical Medicine, University of Southern Denmark, Odense, Denmark
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| |
Collapse
|
4
|
Luo Z, Zhang Y, Saleh QW, Zhang J, Zhu Z, Tepel M. Metabolic regulation of forkhead box P3 alternative splicing isoforms and their impact on health and disease. Front Immunol 2023; 14:1278560. [PMID: 37868998 PMCID: PMC10588449 DOI: 10.3389/fimmu.2023.1278560] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/25/2023] [Indexed: 10/24/2023] Open
Abstract
Forkhead Box P3 (FOXP3) is crucial for the development and suppressive function of human regulatory T cells (Tregs). There are two predominant FOXP3 splicing isoforms in healthy humans, the full-length isoform and the isoform lacking exon 2, with different functions and regulation mechanisms. FOXP3 splicing isoforms show distinct abilities in the cofactor interaction and the nuclear translocation, resulting in different effects on the differentiation, cytokine secretion, suppressive function, linage stability, and environmental adaptation of Tregs. The balance of FOXP3 splicing isoforms is related to autoimmune diseases, inflammatory diseases, and cancers. In response to environmental challenges, FOXP3 transcription and splicing can be finely regulated by T cell antigen receptor stimulation, glycolysis, fatty acid oxidation, and reactive oxygen species, with various signaling pathways involved. Strategies targeting energy metabolism and FOXP3 splicing isoforms in Tregs may provide potential new approaches for the treatment of autoimmune diseases, inflammatory diseases, and cancers. In this review, we summarize recent discoveries about the FOXP3 splicing isoforms and address the metabolic regulation and specific functions of FOXP3 splicing isoforms in Tregs.
Collapse
Affiliation(s)
- Zhidan Luo
- Department of Geriatrics, Chongqing General Hospital, Chongqing, China
- Cardiovascular and Renal Research, Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Yihua Zhang
- Department of Cardiology, Chongqing Fifth People’s Hospital, Chongqing, China
| | - Qais Waleed Saleh
- Cardiovascular and Renal Research, Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Jie Zhang
- Department of Geriatrics, Chongqing General Hospital, Chongqing, China
| | - Zhiming Zhu
- Department of Hypertension and Endocrinology, Daping Hospital, Chongqing, China
| | - Martin Tepel
- Cardiovascular and Renal Research, Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| |
Collapse
|
5
|
Saleh QW, Mohammadnejad A, Tepel M. Lower levels of FOXP3 are associated with prolonged inflammatory responses in kidney transplant recipients. Front Immunol 2023; 14:1252857. [PMID: 37771580 PMCID: PMC10525697 DOI: 10.3389/fimmu.2023.1252857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/31/2023] [Indexed: 09/30/2023] Open
Abstract
Background Immunosuppressive treatment of kidney transplant recipients is mainly aimed at pro-inflammatory T effector cells, yet they also target the immunosuppressive T regulatory cells. Here, we test the hypothesis that low levels of the master gene regulator of T regulatory cells, forkhead box P3 (FOXP3) splice variants, are associated with prolonged inflammatory responses to stimuli. Methods From blood samples obtained the first - and 29th day post-transplant, we extracted peripheral blood mononuclear cells and measured mRNA levels of Total FOXP3, pre-mature RNA FOXP3 (pre-mRNA FOXP3), full length FOXP3 (FOXP3fl) and, FOXP3 splice variant excluding exon two (FOXP3d2). We defined the primary outcome as the number of days in which C reactive protein (CRP) was above 50 mg/L. CRP levels were gathered in two periods, the first from the second to 29 days post-transplant, and the second from 30 to 57 days post-transplant. The association was tested using adjusted negative binomial regression. Results From 507 included kidney transplant recipients, 382 recipients had at least one CRP measurement >50 mg/L in the first period, median duration of elevated CRP was 4 days [interquartile range (IQR) 2 to 6]. In the second period, 69 recipients had at least one CRP measurement >50 mg/L, median duration of elevated CRP was 3 days [IQR 2 to 5]. In the first period, we found a significant association between lower levels of Total FOXP3 and prolonged duration of CRP elevation, incidence rate ratio 0.61 (95% confidence interval 0.46-0.80), p<0.01. Conclusion Lower levels of total FOXP3 mRNA levels in peripheral blood of kidney transplant recipients are associated with prolonged duration of inflammatory responses regardless of the underlying stimuli.
Collapse
Affiliation(s)
- Qais W. Saleh
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- Cardiovascular and Renal Research, Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Afsaneh Mohammadnejad
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Martin Tepel
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- Cardiovascular and Renal Research, Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
6
|
Sparding N, Genovese F, Rasmussen DGK, Karsdal MA, Krogstrup NV, Nielsen MB, Hornum M, Nagarajah S, Birn H, Jespersen B, Tepel M, Nørregaard R. Endotrophin Levels Are Associated with Allograft Outcomes in Kidney Transplant Recipients. Biomolecules 2023; 13:biom13050792. [PMID: 37238662 DOI: 10.3390/biom13050792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 04/29/2023] [Accepted: 04/30/2023] [Indexed: 05/28/2023] Open
Abstract
Early prediction of kidney graft function may assist clinical management, and for this, reliable non-invasive biomarkers are needed. We evaluated endotrophin (ETP), a novel non-invasive biomarker of collagen type VI formation, as a prognostic marker in kidney transplant recipients. ETP levels were measured with the PRO-C6 ELISA in the plasma (P-ETP) of 218 and urine (U-ETP/Cr) of 172 kidney transplant recipients, one (D1) and five (D5) days, as well as three (M3) and twelve (M12) months, after transplantation. P-ETP and U-ETP/Cr at D1 (P-ETP AUC = 0.86, p < 0.0001; U-ETP/Cr AUC = 0.70, p = 0.0002) were independent markers of delayed graft function (DGF) and P-ETP at D1 had an odds ratio of 6.3 (p < 0.0001) for DGF when adjusted for plasma creatinine. The results for P-ETP at D1 were confirmed in a validation cohort of 146 transplant recipients (AUC = 0.92, p < 0.0001). U-ETP/Cr at M3 was negatively associated with kidney graft function at M12 (p = 0.007). This study suggests that ETP at D1 can identify patients at risk of delayed graft function and that U-ETP/Cr at M3 can predict the future status of the allograft. Thus, measuring collagen type VI formation could aid in predicting graft function in kidney transplant recipients.
Collapse
Affiliation(s)
- Nadja Sparding
- Nordic Bioscience, 2730 Herlev, Denmark
- Biomedical Sciences, Faculty of Health and Medical Science, University of Copenhagen, 2200 Copenhagen, Denmark
| | | | | | | | | | - Marie Bodilsen Nielsen
- Department of Renal Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark
- Department of Biomedicine, Aarhus University, 8000 Aarhus, Denmark
| | - Mads Hornum
- Department of Nephrology, Rigshospitalet and Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Subagini Nagarajah
- Department of Nephrology, Odense University Hospital, 5000 Odense, Denmark
- Institute of Molecular Medicine, Cardiovascular and Renal Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Henrik Birn
- Department of Renal Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark
- Department of Biomedicine, Aarhus University, 8000 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark
| | - Bente Jespersen
- Department of Renal Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark
| | - Martin Tepel
- Department of Nephrology, Odense University Hospital, 5000 Odense, Denmark
- Institute of Molecular Medicine, Cardiovascular and Renal Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Rikke Nørregaard
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark
| |
Collapse
|
7
|
Finsen SH, Tepel M, Neland M, Rittig S, Thiesson HC. Successful low-dose immunotherapy after kidney transplantation in a 10-year-old girl with Schimke immuno-osseous dysplasia. Pediatr Transplant 2023:e14495. [PMID: 37051678 DOI: 10.1111/petr.14495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND This case report highlights a successful steroid-free, low-dose immunosuppressive protocol for renal transplantation in a pediatric patient with Schimke immuno-osseous dysplasia with excellent 7-year patient and graft survival. Schimke immuno-osseous dysplasia is a rare multisystem disorder involving the kidney. Renal transplantation is a therapeutic option, but posttransplant mortality is high due to severe infections and posttransplant lymphoproliferative disease. METHODS A 10-year-old girl diagnosed with Schimke immuno-osseous dysplasia and end-stage renal disease underwent an AB0-compatible living-related kidney transplantation, with no donor-specific antibodies. Our standard immunosuppression protocol was modified due to the risk of infection. Basiliximab was used as induction therapy, and a reduced dose of mycophenolate mofetil and tacrolimus was initiated following transplantation, maintaining the patient on a low tacrolimus target (3-5 μg/L). Mycophenolate mofetil was discontinued after 8 weeks due to neutropenia and the patient was kept on tacrolimus as monotherapy. Five years posttransplant the patient developed acute onset of neurological symptoms, consisting of ataxia, lack of voluntary coordination, balance, aphasia and dysphagia, and diplopia. She recovered without neurological deficits within 6 weeks. Extensive evaluation revealed no pathology. To avoid a possible a component of tacrolimus-induced cerebral vasoconstriction, the immunosuppressive therapy was changed to everolimus. RESULTS Seven years posttransplant, the patient has experienced no serious infections, no rejections, and had excellent graft function, and no de novo donor-specific antibodies. CONCLUSIONS The present results indicate that low-dose immunosuppressive therapy after renal transplantation with low immunological risk should be considered for patients with Schimke immuno-osseous dysplasia.
Collapse
Affiliation(s)
- Stine Høyer Finsen
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Martin Tepel
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Mette Neland
- H.C. Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Søren Rittig
- Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | |
Collapse
|
8
|
Kremer D, Alkaff FF, Post A, Knobbe TJ, Tepel M, Thaunat O, Berger SP, van den Born J, Genovese F, Karsdal MA, Rasmussen DGK, Bakker SJL. Plasma endotrophin, reflecting tissue fibrosis, is associated with graft failure and mortality in KTR: results from two prospective cohort studies. Nephrol Dial Transplant 2022; 38:1041-1052. [PMID: 36535643 PMCID: PMC10064980 DOI: 10.1093/ndt/gfac332] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background
Fibrosis is a suggested cause of graft failure and mortality among kidney transplant recipients (KTR). Accumulating evidence suggests that collagen type VI is tightly linked to fibrosis, and may be a marker of systemic fibrosis and ageing. We studied whether plasma endotrophin, a pro-collagen type VI fragment, is associated with graft failure and mortality among KTR.
Methods
In cohort A, we measured plasma endotrophin in 690 prevalent KTR ≥ 1 year after transplantation (cohort A, 57% male, age 53 ± 13y). The non-overlapping cohort B included 500 incident KTR with serial endotrophin measurements before and after kidney transplantation, to assess trajectories and intra-individual variation of endotrophin.
Results
In cohort A, endotrophin was higher in KTR compared to healthy controls. Concentrations were positively associated with female sex, diabetes, cardiovascular disease, markers of inflammation and kidney injury. Importantly, endotrophin was associated with graft failure (HR per doubling: 1.87; 95%CI: 1.07 to 3.28) and mortality (HR per doubling: 2.59; 95%CI: 1.73 to 3.87) independent of potential confounders. Data from cohort B showed that endotrophin concentrations strongly decrease after transplantation, and remain stable during post-transplantation follow-up (intra-individual coefficient of variation: 5.0% [3.7%-7.6%]).
Conclusions
Plasma endotrophin is strongly associated with graft failure and mortality among KTR. These findings suggest a key role of abnormal extracellular matrix turnover and fibrosis in graft and patient prognosis among KTR, and highlight the need for (interventional) studies targeting the pro-fibrotic state of KTR. The intra-individual stability after transplantation indicates potential use of endotrophin as a biomarker and outcome measure of fibrosis.
Collapse
Affiliation(s)
- Daan Kremer
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Firas F Alkaff
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
- Division of Pharmacology and Therapy, Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine Universitas Airlangga , Surabaya, Indonesia
| | - Adrian Post
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Tim J Knobbe
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Martin Tepel
- Odense University Hospital, Department of Nephrology, Odense, Denmark, and University of Southern Denmark, Institute of Molecular Medicine , Cardiovascular and Renal Research, Odense , Denmark
| | - Olivier Thaunat
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Transplantation , Néphrologie et Immunologie Clinique, Lyon , France
| | - Stefan P Berger
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Jacob van den Born
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | | | | | | | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | | |
Collapse
|
9
|
Tepel M, Nagarajah S, Saleh Q, Thaunat O, Bakker SJL, van den Born J, Karsdal MA, Genovese F, Rasmussen DGK. Pretransplant characteristics of kidney transplant recipients that predict posttransplant outcome. Front Immunol 2022; 13:945288. [PMID: 35958571 PMCID: PMC9357871 DOI: 10.3389/fimmu.2022.945288] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 05/16/2022] [Accepted: 07/01/2022] [Indexed: 11/13/2022] Open
Abstract
Better characterization of the potential kidney transplant recipient using novel biomarkers, for example, pretransplant plasma endotrophin, will lead to improved outcome after transplantation. This mini-review will focus on current knowledge about pretransplant recipients’ characteristics, biomarkers, and immunology. Clinical characteristics of recipients including age, obesity, blood pressure, comorbidities, and estimated survival scores have been introduced for prediction of recipient and allograft survival. The pretransplant immunologic risk assessment include histocompatibility leukocyte antigens (HLAs), anti-HLA donor-specific antibodies, HLA-DQ mismatch, and non-HLA antibodies. Recently, there has been the hope that pretransplant determination of markers can further improve the prediction of posttransplant complications, both short-term and long-term outcomes including rejections, allograft loss, and mortality. Higher pretransplant plasma endotrophin levels were independently associated with posttransplant acute allograft injury in three prospective European cohorts. Elevated numbers of non-synonymous single-nucleotide polymorphism mismatch have been associated with increased allograft loss in a multivariable analysis. It is concluded that there is a need for integration of clinical characteristics and novel molecular and immunological markers to improve future transplant medicine to reach better diagnostic decisions tailored to the individual patient.
Collapse
Affiliation(s)
- Martin Tepel
- Department of Nephrology, Odense University Hospital, Odense, Denmark, and Cardiovascular and Renal Research, Institute of Molecular Medicine, Clinical Institute, University of Southern Denmark, Odense, Denmark
- *Correspondence: Martin Tepel,
| | - Subagini Nagarajah
- Department of Nephrology, Odense University Hospital, Odense, Denmark, and Cardiovascular and Renal Research, Institute of Molecular Medicine, Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Qais Saleh
- Department of Nephrology, Odense University Hospital, Odense, Denmark, and Cardiovascular and Renal Research, Institute of Molecular Medicine, Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Olivier Thaunat
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Transplantation, Néphrologie et Immunologie Clinique, Lyon, France
| | - Stephan J. L. Bakker
- Division of Nephrology, Department of Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Jacob van den Born
- Division of Nephrology, Department of Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | | | | |
Collapse
|
10
|
Saleh Q, Rasmussen M, Nagarajah S, Tepel M. MO943: Levels of Forkhead Box P3 (FOXP3) Transcripts in Kidney Transplant Recipients is Associated With Post-Transplant Cytomegalovirus Viremia. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac087.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
The forkhead box P3 (FOXP3) transcription factor is essential for the differentiation of T regulatory cells, which are major regulators of immune tolerance and immunologic activity. Quantification of the FOXP3 mRNA in peripheral blood might be clinically useful. Considering possible post-transcriptional regulation of FOXP3 mRNA, we tested the hypothesis that a low level of FOXP3 is associated with a higher risk of cytomegalovirus (CMV) viremia, in kidney transplant recipients (KTRs).
METHOD
Blood samples were collected the first day after transplantation from incident adult kidney transplant recipients. Ribonucleic acid was extracted from peripheral blood mononuclear cells and used in quantitative reverse transcription polymerase chain reaction. Levels of FOXP3 were measured using two primers differentiating mRNA FOXP3 and pre-mRNA FOXP3 (pre-FOXP3), both primers were normalized to the reference gene β-actin. We defined viremia with CMV as the finding of more than 1000 copies per mL of CMV DNA in plasma, at least once, within 3 months after transplantation. A ratio of FOXP3 to pre-FOXP3 was calculated and compared, using Mann–Whitney U-test according to CMV viremia status. Finally using receiver operating characteristics, we calculated are under the curve.
RESULTS
Of 340 patients enrolled, 24 experienced post-transplant CMV viremia. The median ratio of FOXP3 to pre-FOXP3 was lower in those diagnosed with post-transplant CMV viremia, compared to those who were not 6.8 [1.2–11.3] versus 12.2 [3.5–28.9] P < 0.01, respectively. Receiver operating characteristics yielded an area under the curve of 66.7% P < 0.01.
CONCLUSION
Our data shows an association between low levels of FOXP3 and risk for post-transplant CMV infection in kidney transplant recipients.
Collapse
Affiliation(s)
- Qais Saleh
- Odense University Hospital, Department of Nephrology, Odense, Denmark
- University of Southern Denmark, Institute of Molecular Medicine, Odense, Denmark
| | - Marianne Rasmussen
- Odense University Hospital, Department of Nephrology, Odense, Denmark
- University of Southern Denmark, Institute of Molecular Medicine, Odense, Denmark
| | - Subagini Nagarajah
- Odense University Hospital, Department of Nephrology, Odense, Denmark
- University of Southern Denmark, Institute of Molecular Medicine, Odense, Denmark
| | - Martin Tepel
- Odense University Hospital, Department of Nephrology, Odense, Denmark
- University of Southern Denmark, Institute of Molecular Medicine, Odense, Denmark
| |
Collapse
|
11
|
He C, Li Q, Cui Y, Gao P, Shu W, Zhou Q, Wang L, Li L, Lu Z, Zhao Y, Ma H, Chen X, Jia H, Zheng H, Yang G, Liu D, Tepel M, Zhu Z. Recurrent moderate hypoglycemia accelerates the progression of cognitive deficits through impairment of TRPC6/GLUT3 pathway in diabetic APP/PS1 mice. JCI Insight 2022; 7:154595. [PMID: 35077394 PMCID: PMC8983129 DOI: 10.1172/jci.insight.154595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/20/2022] [Indexed: 11/17/2022] Open
Abstract
Currently, the most effective strategy for dealing with Alzheimer’s disease (AD) is delaying the onset of dementia. Severe hypoglycemia is strongly associated with dementia; however, the effects of recurrent moderate hypoglycemia (RH) on the progression of cognitive deficits in patients with diabetes with genetic susceptibility to AD remain unclear. Here, we report that insulin-controlled hyperglycemia slightly aggravated AD-type pathologies and cognitive impairment; however, RH significantly increased neuronal hyperactivity and accelerated the progression of cognitive deficits in streptozotocin-induced (STZ-induced) diabetic APP/PS1 mice. Glucose transporter 3–mediated (GLUT3-mediated) neuronal glucose uptake was not significantly altered under hyperglycemia but was markedly reduced by RH, which induced excessive mitochondrial fission in the hippocampus. Overexpression of GLUT3, specifically in the dentate gyrus (DG) area of the hippocampus, enhanced mitochondrial function and improved cognitive deficits. Activation of the transient receptor potential channel 6 (TRPC6) increased GLUT3-mediated glucose uptake in the brain and alleviated RH-induced cognitive deficits, and inactivation of the Ca2+/AMPK pathway was responsible for TRPC6-induced GLUT3 inhibition. Taken together, RH impairs brain GLUT3-mediated glucose uptake and further provokes neuronal mitochondrial dysfunction by inhibiting TRPC6 expression, which then accelerates progression of cognitive deficits in diabetic APP/PS1 mice. Avoiding RH is essential for glycemic control in patients with diabetes, and TRPC6/GLUT3 represents potent targets for delaying the onset of dementia in patients with diabetes.
Collapse
Affiliation(s)
- Chengkang He
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing Institute for Brain and Intelligence, Chongqing, China
| | - Qiang Li
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing Institute for Brain and Intelligence, Chongqing, China
| | - Yuanting Cui
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing Institute for Brain and Intelligence, Chongqing, China
| | - Peng Gao
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing Institute for Brain and Intelligence, Chongqing, China
| | - Wentao Shu
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing Institute for Brain and Intelligence, Chongqing, China
| | - Qing Zhou
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing Institute for Brain and Intelligence, Chongqing, China
| | - Lijuan Wang
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing Institute for Brain and Intelligence, Chongqing, China
| | - Li Li
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing Institute for Brain and Intelligence, Chongqing, China
| | - Zongshi Lu
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing Institute for Brain and Intelligence, Chongqing, China
| | - Yu Zhao
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing Institute for Brain and Intelligence, Chongqing, China
| | - Huan Ma
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing Institute for Brain and Intelligence, Chongqing, China
| | - Xiaowei Chen
- Brain Research Center, Army Medical University, Chongqing Institute for Brain and Intelligence, Chongqing, China
| | - Hongbo Jia
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Hongting Zheng
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Gangyi Yang
- Endocrine Department, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Daoyan Liu
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing Institute for Brain and Intelligence, Chongqing, China
| | - Martin Tepel
- Odense University Hospital, Department of Nephrology, University of Southern Denmark, Institute for Molecular Medicine, Cardiovascular and Renal Research, Institute of Clinical Research, Odense, Denmark
| | - Zhiming Zhu
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing Institute for Brain and Intelligence, Chongqing, China
| |
Collapse
|
12
|
Saleh QW, Grønbæk L, Kronborg C, Lauridsen JT, Tepel M. Kidney function, future health costs, and quality-adjusted life-years in kidney transplant recipients transplanted during the SARS-Cov-2 lockdown in Denmark - An observational study. Heliyon 2021; 7:e08489. [PMID: 34849416 PMCID: PMC8619881 DOI: 10.1016/j.heliyon.2021.e08489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/01/2021] [Accepted: 11/24/2021] [Indexed: 01/08/2023] Open
Abstract
Background It is unknown whether lockdown due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may affect both clinical outcome in kidney transplant recipients and health care economics in Denmark. Methods We compared kidney transplant data at a tertiary university hospital before and during the lockdown period from March 13, 2020 until March 31, 2021, as well as kidney transplant data from Scandiatransplant for entire Denmark. Outcome variables included fall of plasma creatinine during the first postoperative day, and graft function three months posttransplant. We calculated the quality-adjusted life-years (QALYs) and costs which were caused by the lockdown recommendations. Findings The portion of living donation kidney transplantation was largely reduced during the lockdown period compared to before the lockdown: AB0-incompatible living donation declined from 14% to 7% (P < 0.01), and AB0-compatible living donation declined from 34% to 20% (p < 0.01). In entire Denmark during the lockdown period 78 living donor kidney transplants out of 268 kidney transplants (29%) were performed, whereas there were 878 living donor kidney transplants out of 2218 kidney transplants (39%) before the lockdown (P = 0.01). The observed reduction of living donor kidney transplants and consecutive reduction of graft survival will cause a loss of 5.04 QALYs. The additional costs in kidney transplant recipients who received a kidney transplant during the lockdown period will be 277,298 EUR. Interpretation SARS-CoV-2 lockdown period largely reduced living donation kidney transplants which will lead to reduced QALY as well as higher costs in kidney transplant recipients.
Collapse
Affiliation(s)
- Qais W. Saleh
- Odense University Hospital, Department of Nephrology, Odense, Denmark
- University of Southern Denmark, Institute of Molecular Medicine, Cardiovascular and Renal Research, Odense, Denmark
| | - Lone Grønbæk
- Department of Economics, University of Southern Denmark, Odense, Denmark
| | - Christian Kronborg
- Department of Economics, University of Southern Denmark, Odense, Denmark
| | | | - Martin Tepel
- Odense University Hospital, Department of Nephrology, Odense, Denmark
- University of Southern Denmark, Institute of Molecular Medicine, Cardiovascular and Renal Research, Odense, Denmark
- Corresponding author.
| |
Collapse
|
13
|
Chu C, Chen X, Hasan AA, Szakallova A, Krämer BK, Tepel M, Hocher B. Angiopoietin-2 predicts all-cause mortality in male but not female end-stage kidney disease patients on hemodialysis. Nephrol Dial Transplant 2021; 37:1348-1356. [PMID: 34792167 PMCID: PMC9217660 DOI: 10.1093/ndt/gfab332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background Angiopoietin-2 (Ang-2) plays a pivotal role in pathological vascular remodeling and angiogenesis. Both vascular mechanisms are active in patients with end-stage renal disease (ESRD) and may contribute to the high mortality in these patients. The aim of this multicenter prospective cohort study was to investigate baseline serum Ang-2 concentrations in ESRD patients on hemodialysis (HD) for their ability to predict all-cause mortality. Methods We conducted a prospective cohort study in 340 stable HD patients from different chronic dialysis centers in Berlin, Germany. The primary endpoint was all-cause mortality during a 5-year follow-up period. Blood samples and clinical data were collected at baseline. Serum Ang-2 was measured with a validated enzyme-linked immunosorbent assay (Biomedica, Vienna, Austria). Results A total of 313 HD patients (206 men and 107 women) were finally included in the study. Receiver operating characteristic (ROC) analysis of Ang-2 concentrations yielded an area under the curve (AUC) of 0.65 (P < 0.0001) for predicting all-cause mortality in the entire study population and was used to determine the optimal cut-off (111.0 pmol/L) for all-cause mortality. Kaplan–Meier survival analysis indicated that male but not female end-stage kidney disease patients on HD with higher Ang-2 concentrations had a significantly lower survival (log-rank test, P < 0.0001 and P = 0.380 for male and female patients, respectively). Multivariable Cox regression analyses adjusted for age, comorbidity, smoking, dialysis vintage, serum creatinine, hemoglobin, C-reactive protein, serum albumin, intact parathyroid hormone (iPTH), low-density lipoprotein (LDL) and Kt/V likewise indicated that elevated Ang-2 concentrations are associated with all-cause mortality in male {hazard ratio [HR] 3.294 [95% confidence interval (CI) 1.768–6.138]; P = 0.0002} but not in female end-stage kidney disease patients on HD [HR 1.084 (95% CI 0.476–2.467); P = 0.847]. Conclusion Ang-2 at baseline is independently associated with all-cause mortality in male ESRD patients on HD.
Collapse
Affiliation(s)
- Chang Chu
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology), University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.,Department of Nephrology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Xin Chen
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology), University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.,Department of Nephrology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Ahmed A Hasan
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology), University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Bernhard K Krämer
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology), University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.,European Center for Angioscience ECAS, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Martin Tepel
- Department of Nephrology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.,Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Berthold Hocher
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology), University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.,Institute of Medical Diagnostics, IMD Berlin-Potsdam, Berlin, Germany.,Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China.,Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
| |
Collapse
|
14
|
Wei X, Lu Z, Li L, Zhang H, Sun F, Ma H, Wang L, Hu Y, Yan Z, Zheng H, Yang G, Liu D, Tepel M, Gao P, Zhu Z. Reducing NADPH Synthesis Counteracts Diabetic Nephropathy through Restoration of AMPK Activity in Type 1 Diabetic Rats. Cell Rep 2021; 32:108207. [PMID: 32997989 DOI: 10.1016/j.celrep.2020.108207] [Citation(s) in RCA: 7] [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: 01/10/2020] [Revised: 07/11/2020] [Accepted: 09/09/2020] [Indexed: 01/14/2023] Open
Abstract
Diabetic nephropathy (DN) is a major complication of diabetes mellitus and a primary cause of end-stage renal failure. Clinical studies indicate that metabolic surgery improves DN; however, the mechanism remains unclear. Here, we report that Roux-en-Y Gastric Bypass (RYGB) surgery significantly blocked and reversed DN without affecting the insulin signaling pathway. This protective role of RYGB surgery is almost blocked by either inhibition or knockout of 5'AMP-activated protein kinase (AMPK) in podocytes. Furthermore, mRNA microarray data reveal that RYGB surgery obviously reduced the gene expression involved in nicotinamide adenine dinucleotide phosphate (NAPDH) synthesis. The expression of a key NADPH synthase, hexose-6-phosphate dehydrogenase (H6PD), was inhibited by the low plasma corticosterone level after surgery. In addition, blocking NAPDH synthesis by knocking down H6PD mimicked the beneficial role of RYGB surgery through activation of AMPK in podocytes. Therefore, this study demonstrates that reducing NADPH production is critical for renal AMPK activation in response to RYGB surgery.
Collapse
Affiliation(s)
- Xiao Wei
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing 400042, China
| | - Zongshi Lu
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing 400042, China
| | - Li Li
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing 400042, China
| | - Hexuan Zhang
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing 400042, China
| | - Fang Sun
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing 400042, China
| | - Huan Ma
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing 400042, China
| | - Lijuan Wang
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing 400042, China
| | - Yingru Hu
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing 400042, China
| | - Zhencheng Yan
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing 400042, China
| | - Hongting Zheng
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, Xinqiao Hospital, Army Medical University, Chongqing 400037, China
| | - Gangyi Yang
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University and Chongqing Clinical Research Center for Geriatrics, Chongqing 400010, China
| | - Daoyan Liu
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing 400042, China
| | - Martin Tepel
- Odense University Hospital, Department of Nephrology, University of Southern Denmark, Institute for Molecular Medicine, Cardiovascular and Renal Research, Institute of Clinical Research, Odense, Denmark
| | - Peng Gao
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing 400042, China.
| | - Zhiming Zhu
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing 400042, China.
| |
Collapse
|
15
|
Rasmussen DGK, Boesby L, Nielsen SH, Tepel M, Birot S, Karsdal MA, Kamper AL, Genovese F. Collagen turnover profiles in chronic kidney disease. Sci Rep 2019; 9:16062. [PMID: 31690732 PMCID: PMC6831687 DOI: 10.1038/s41598-019-51905-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 10/08/2019] [Indexed: 12/13/2022] Open
Abstract
Renal fibrosis is a hallmark of chronic kidney disease (CKD) caused by an imbalance between formation and degradation of extracellular matrix proteins. We investigated the collagen turnover profile of 81 non-dialysis CKD stage 2-5 patients by measuring peptides reflecting formation and degradation of collagen type (COL) I, III, IV, and VI. Based on the collagen turnover profile, we identified four clusters of patients. Cluster 1 contained one patient with prostate cancer, who had a distinct collagen turnover. The other clusters generally had severe (Cluster 2), moderate (Cluster 4), or mild CKD (Cluster 3). Cluster 4 patients were characterized by higher levels of COL III, COL IV, and COL VI (all p < 0.001) degradation fragments in plasma, while patients in Clusters 2 and 4 had higher levels of COL VI formation (p < 0.05). COL IV fragments in plasma were lower in Cluster 2 (p < 0.01). Urinary COL III fragments decreased from Cluster 3 to 4, and from Cluster 4 to 2 (both p < 0.001). We show that patients with similar kidney function have a different collagen remodeling profile, suggesting that different phenotypes exist with different disease activity and potentially disease progression. Biomarkers of collagen remodeling could provide additional information to traditional markers of renal function.
Collapse
Affiliation(s)
- Daniel Guldager Kring Rasmussen
- Nordic Bioscience, Herlev, Denmark.
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.
| | - Lene Boesby
- Department of Medicine, University Hospital Roskilde, Roskilde, Denmark
- Department of Nephrology, Herlev Hospital, Herlev, Denmark
| | - Signe Holm Nielsen
- Nordic Bioscience, Herlev, Denmark
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kgs, Lyngby, Denmark
| | - Martin Tepel
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| | | | | | | | | |
Collapse
|
16
|
Nagarajah S, Xia S, Rasmussen M, Tepel M. Endogenous intronic antisense long non-coding RNA, MGAT3-AS1, and kidney transplantation. Sci Rep 2019; 9:14743. [PMID: 31611608 PMCID: PMC6791892 DOI: 10.1038/s41598-019-51409-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 09/28/2019] [Indexed: 11/09/2022] Open
Abstract
β-1,4-mannosylglycoprotein 4-β-N-acetylglucosaminyltransferase (MGAT3) is a key molecule for the innate immune system. We tested the hypothesis that intronic antisense long non-coding RNA, MGAT3-AS1, can predict delayed allograft function after kidney transplantation. We prospectively assessed kidney function and MGAT3-AS1 in 129 incident deceased donor kidney transplant recipients before and after transplantation. MGAT3-AS1 levels were measured in mononuclear cells using qRT-PCR. Delayed graft function was defined by at least one dialysis session within 7 days of transplantation. Delayed graft function occurred in 22 out of 129 transplant recipients (17%). Median MGAT3-AS1 after transplantation was significantly lower in patients with delayed graft function compared to patients with immediate graft function (6.5 × 10−6, IQR 3.0 × 10−6 to 8.4 × 10−6; vs. 8.3 × 10−6, IQR 5.0 × 10−6 to 12.8 × 10−6; p < 0.05). The median preoperative MGAT3-AS1 was significantly lower in kidney recipients with delayed graft function (5.1 × 10−6, IQR, 2.4 × 10−6 to 6.8 × 10−6) compared to recipients with immediate graft function (8.9 × 10−6, IQR, 6.8 × 10−6 to 13.4 × 10−6; p < 0.05). Receiver-operator characteristics showed that preoperative MGAT3-AS1 predicted delayed graft function (area under curve, 0.83; 95% CI, 0.65 to 1.00; p < 0.01). We observed a positive predictive value of 0.57, and a negative predictive value of 0.95. Long non-coding RNA, MGAT3-AS1, indicates short-term outcome in patients with deceased donor kidney transplantation.
Collapse
Affiliation(s)
- Subagini Nagarajah
- Odense University Hospital, Department of Nephrology, Odense, Denmark.,University of Southern Denmark, Institute of Molecular Medicine, Cardiovascular and Renal Research, Institute of Clinical Research, Odense, Denmark
| | - Shengqiang Xia
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P.R. China
| | | | - Martin Tepel
- Odense University Hospital, Department of Nephrology, Odense, Denmark. .,University of Southern Denmark, Institute of Molecular Medicine, Cardiovascular and Renal Research, Institute of Clinical Research, Odense, Denmark.
| |
Collapse
|
17
|
Nagarajah S, Tepel M, Nielsen C, Assing K, Palarasah Y, Andersen LLT, Lange LB, Bistrup C. Reduced membrane attack complex formation in umbilical cord blood during Eculizumab treatment of the mother: a case report. BMC Nephrol 2019; 20:307. [PMID: 31390992 PMCID: PMC6686417 DOI: 10.1186/s12882-019-1469-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 07/19/2019] [Indexed: 02/07/2023] Open
Abstract
Background Atypical hemolytic uremic syndrome (aHUS) is a disorder of the microvasculature with hemolytic anemia, thrombocytopenia and acute kidney injury. Nowadays, aHUS is successfully treated with eculizumab, a humanized, chimeric IgG2/4 kappa antibody, which binds human complement C5 and blocks generation of C5a and membrane-attack-complex. Case presentation A 25-year-old woman with end stage renal disease due to relapsing atypical hemolytic uremic syndrome had a relapse of the disease during pregnancy. She was treated with eculizumab. We measured reduced formation of the membrane-attack complex in newborn’s umbilical cord vein blood using the sensitive and specific Palarasah-Nielsen-ELISA. Conclusions Eculizumab treatment of the mother with end stage renal disease may cause reduced innate immunity which could render newborns more susceptible to infections.
Collapse
Affiliation(s)
- Subagini Nagarajah
- Department of Nephrology, Odense University Hospital, 5000, Odense C, Denmark.,Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Martin Tepel
- Department of Nephrology, Odense University Hospital, 5000, Odense C, Denmark. .,Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark. .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Christian Nielsen
- Department of Immunology, Odense University Hospital, Odense, Denmark
| | - Kristian Assing
- Department of Immunology, Odense University Hospital, Odense, Denmark
| | - Yaseelan Palarasah
- Research Unit of Immunology and Microbiology, University of Southern Denmark, Odense, Denmark
| | | | - Lotte Borg Lange
- Department of Nephrology, Odense University Hospital, 5000, Odense C, Denmark
| | - Claus Bistrup
- Department of Nephrology, Odense University Hospital, 5000, Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
18
|
Kork F, Jankowski J, Goswami A, Weis J, Brook G, Yamoah A, Anink J, Aronica E, Fritz S, Huck C, Schipke C, Peters O, Tepel M, Noels H, Jankowski V. Golgin A4 in CSF and granulovacuolar degenerations of patients with Alzheimer disease. Neurology 2018; 91:e1799-e1808. [PMID: 30305446 DOI: 10.1212/wnl.0000000000006457] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 07/26/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To isolate and identify a new, as yet unknown molecule in CSF that could serve as marker for Alzheimer disease. METHODS We immunized mice with human CSF and fused hybridomas for monoclonal antibodies and screened these antibodies for their capacity to discriminate CSF of patients with Alzheimer disease from CSF of controls. We then chromatographically isolated the antigen to the best discriminating antibody and identified the antigen using mass spectrometric methods. Thereafter, we quantified the CSF concentration of the antigen in a new cohort of patients with Alzheimer disease and controls and performed immunohistochemistry of postmortem brain tissue derived from patients with Alzheimer disease and controls. RESULTS We generated >200 hybridomas and selected 1 antibody that discriminated CSF from patients with Alzheimer disease from that of controls. We identified golgin A4 as the antigen detected by this antibody. Golgin A4 concentration was significantly higher in CSF from patients with Alzheimer disease than in CSF of controls (145 [interquartile range 125-155] vs 115 [ 99-128] pg/mL, p < 0.001) and demonstrated a substantial discriminative power (area under the receiver operating characteristic curve 0.80, 95% confidence interval 0.67-0.94). Immunohistochemistry of postmortem brain sections from patients with Alzheimer disease revealed a significant accumulation of golgin A4 in granulovacuolar degeneration bodies (GVBs). CONCLUSIONS These results support the notion that golgin A4 could serve as a diagnostic marker in Alzheimer disease. For validation of this notion, prospective multicenter diagnostic studies will evaluate golgin A4 as diagnostic marker for Alzheimer disease. Furthermore, it has to be determined whether the association of golgin A4 with GVBs is an epiphenomenon or whether golgin A4 plays a more direct role in Alzheimer disease, allowing it to serve as a target in therapeutic treatment strategies. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that elevated CSF golgin A4 levels identify patients with Alzheimer disease.
Collapse
Affiliation(s)
- Felix Kork
- From the Institute for Molecular Cardiovascular Research (F.K., J.J., H.N., V.J.), Department of Anesthesiology (F.K.), and Institute of Neuropathology (A.G., J.W., G.B., A.Y.), Medical Faculty, RWTH Aachen University, Germany; School for Cardiovascular Diseases (J.J.), Maastricht University; Department of (Neuro) Pathology (J.A., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; mfd Diagnostics GmbH (S.F., C.H.), Wendelsheim; Charité-Universitätsmedizin Berlin (C.S., O.P.), corporate member of Freie Universität Berlin; Humboldt-Universität zu Berlin (C.S., O.P.); Berlin Institute of Health (C.S., O.P.), German Center for Neurodegenerative; Experimental and Clinical Research Center (C.S., O.P.), Memory Clinic, Berlin, Germany; and Department of Nephrology (M.T.), Odense University Hospital, Denmark
| | - Joachim Jankowski
- From the Institute for Molecular Cardiovascular Research (F.K., J.J., H.N., V.J.), Department of Anesthesiology (F.K.), and Institute of Neuropathology (A.G., J.W., G.B., A.Y.), Medical Faculty, RWTH Aachen University, Germany; School for Cardiovascular Diseases (J.J.), Maastricht University; Department of (Neuro) Pathology (J.A., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; mfd Diagnostics GmbH (S.F., C.H.), Wendelsheim; Charité-Universitätsmedizin Berlin (C.S., O.P.), corporate member of Freie Universität Berlin; Humboldt-Universität zu Berlin (C.S., O.P.); Berlin Institute of Health (C.S., O.P.), German Center for Neurodegenerative; Experimental and Clinical Research Center (C.S., O.P.), Memory Clinic, Berlin, Germany; and Department of Nephrology (M.T.), Odense University Hospital, Denmark
| | - Anand Goswami
- From the Institute for Molecular Cardiovascular Research (F.K., J.J., H.N., V.J.), Department of Anesthesiology (F.K.), and Institute of Neuropathology (A.G., J.W., G.B., A.Y.), Medical Faculty, RWTH Aachen University, Germany; School for Cardiovascular Diseases (J.J.), Maastricht University; Department of (Neuro) Pathology (J.A., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; mfd Diagnostics GmbH (S.F., C.H.), Wendelsheim; Charité-Universitätsmedizin Berlin (C.S., O.P.), corporate member of Freie Universität Berlin; Humboldt-Universität zu Berlin (C.S., O.P.); Berlin Institute of Health (C.S., O.P.), German Center for Neurodegenerative; Experimental and Clinical Research Center (C.S., O.P.), Memory Clinic, Berlin, Germany; and Department of Nephrology (M.T.), Odense University Hospital, Denmark
| | - Joachim Weis
- From the Institute for Molecular Cardiovascular Research (F.K., J.J., H.N., V.J.), Department of Anesthesiology (F.K.), and Institute of Neuropathology (A.G., J.W., G.B., A.Y.), Medical Faculty, RWTH Aachen University, Germany; School for Cardiovascular Diseases (J.J.), Maastricht University; Department of (Neuro) Pathology (J.A., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; mfd Diagnostics GmbH (S.F., C.H.), Wendelsheim; Charité-Universitätsmedizin Berlin (C.S., O.P.), corporate member of Freie Universität Berlin; Humboldt-Universität zu Berlin (C.S., O.P.); Berlin Institute of Health (C.S., O.P.), German Center for Neurodegenerative; Experimental and Clinical Research Center (C.S., O.P.), Memory Clinic, Berlin, Germany; and Department of Nephrology (M.T.), Odense University Hospital, Denmark
| | - Gary Brook
- From the Institute for Molecular Cardiovascular Research (F.K., J.J., H.N., V.J.), Department of Anesthesiology (F.K.), and Institute of Neuropathology (A.G., J.W., G.B., A.Y.), Medical Faculty, RWTH Aachen University, Germany; School for Cardiovascular Diseases (J.J.), Maastricht University; Department of (Neuro) Pathology (J.A., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; mfd Diagnostics GmbH (S.F., C.H.), Wendelsheim; Charité-Universitätsmedizin Berlin (C.S., O.P.), corporate member of Freie Universität Berlin; Humboldt-Universität zu Berlin (C.S., O.P.); Berlin Institute of Health (C.S., O.P.), German Center for Neurodegenerative; Experimental and Clinical Research Center (C.S., O.P.), Memory Clinic, Berlin, Germany; and Department of Nephrology (M.T.), Odense University Hospital, Denmark
| | - Alfred Yamoah
- From the Institute for Molecular Cardiovascular Research (F.K., J.J., H.N., V.J.), Department of Anesthesiology (F.K.), and Institute of Neuropathology (A.G., J.W., G.B., A.Y.), Medical Faculty, RWTH Aachen University, Germany; School for Cardiovascular Diseases (J.J.), Maastricht University; Department of (Neuro) Pathology (J.A., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; mfd Diagnostics GmbH (S.F., C.H.), Wendelsheim; Charité-Universitätsmedizin Berlin (C.S., O.P.), corporate member of Freie Universität Berlin; Humboldt-Universität zu Berlin (C.S., O.P.); Berlin Institute of Health (C.S., O.P.), German Center for Neurodegenerative; Experimental and Clinical Research Center (C.S., O.P.), Memory Clinic, Berlin, Germany; and Department of Nephrology (M.T.), Odense University Hospital, Denmark
| | - Jasper Anink
- From the Institute for Molecular Cardiovascular Research (F.K., J.J., H.N., V.J.), Department of Anesthesiology (F.K.), and Institute of Neuropathology (A.G., J.W., G.B., A.Y.), Medical Faculty, RWTH Aachen University, Germany; School for Cardiovascular Diseases (J.J.), Maastricht University; Department of (Neuro) Pathology (J.A., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; mfd Diagnostics GmbH (S.F., C.H.), Wendelsheim; Charité-Universitätsmedizin Berlin (C.S., O.P.), corporate member of Freie Universität Berlin; Humboldt-Universität zu Berlin (C.S., O.P.); Berlin Institute of Health (C.S., O.P.), German Center for Neurodegenerative; Experimental and Clinical Research Center (C.S., O.P.), Memory Clinic, Berlin, Germany; and Department of Nephrology (M.T.), Odense University Hospital, Denmark
| | - Eleonora Aronica
- From the Institute for Molecular Cardiovascular Research (F.K., J.J., H.N., V.J.), Department of Anesthesiology (F.K.), and Institute of Neuropathology (A.G., J.W., G.B., A.Y.), Medical Faculty, RWTH Aachen University, Germany; School for Cardiovascular Diseases (J.J.), Maastricht University; Department of (Neuro) Pathology (J.A., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; mfd Diagnostics GmbH (S.F., C.H.), Wendelsheim; Charité-Universitätsmedizin Berlin (C.S., O.P.), corporate member of Freie Universität Berlin; Humboldt-Universität zu Berlin (C.S., O.P.); Berlin Institute of Health (C.S., O.P.), German Center for Neurodegenerative; Experimental and Clinical Research Center (C.S., O.P.), Memory Clinic, Berlin, Germany; and Department of Nephrology (M.T.), Odense University Hospital, Denmark
| | - Stefan Fritz
- From the Institute for Molecular Cardiovascular Research (F.K., J.J., H.N., V.J.), Department of Anesthesiology (F.K.), and Institute of Neuropathology (A.G., J.W., G.B., A.Y.), Medical Faculty, RWTH Aachen University, Germany; School for Cardiovascular Diseases (J.J.), Maastricht University; Department of (Neuro) Pathology (J.A., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; mfd Diagnostics GmbH (S.F., C.H.), Wendelsheim; Charité-Universitätsmedizin Berlin (C.S., O.P.), corporate member of Freie Universität Berlin; Humboldt-Universität zu Berlin (C.S., O.P.); Berlin Institute of Health (C.S., O.P.), German Center for Neurodegenerative; Experimental and Clinical Research Center (C.S., O.P.), Memory Clinic, Berlin, Germany; and Department of Nephrology (M.T.), Odense University Hospital, Denmark
| | - Carmen Huck
- From the Institute for Molecular Cardiovascular Research (F.K., J.J., H.N., V.J.), Department of Anesthesiology (F.K.), and Institute of Neuropathology (A.G., J.W., G.B., A.Y.), Medical Faculty, RWTH Aachen University, Germany; School for Cardiovascular Diseases (J.J.), Maastricht University; Department of (Neuro) Pathology (J.A., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; mfd Diagnostics GmbH (S.F., C.H.), Wendelsheim; Charité-Universitätsmedizin Berlin (C.S., O.P.), corporate member of Freie Universität Berlin; Humboldt-Universität zu Berlin (C.S., O.P.); Berlin Institute of Health (C.S., O.P.), German Center for Neurodegenerative; Experimental and Clinical Research Center (C.S., O.P.), Memory Clinic, Berlin, Germany; and Department of Nephrology (M.T.), Odense University Hospital, Denmark
| | - Carola Schipke
- From the Institute for Molecular Cardiovascular Research (F.K., J.J., H.N., V.J.), Department of Anesthesiology (F.K.), and Institute of Neuropathology (A.G., J.W., G.B., A.Y.), Medical Faculty, RWTH Aachen University, Germany; School for Cardiovascular Diseases (J.J.), Maastricht University; Department of (Neuro) Pathology (J.A., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; mfd Diagnostics GmbH (S.F., C.H.), Wendelsheim; Charité-Universitätsmedizin Berlin (C.S., O.P.), corporate member of Freie Universität Berlin; Humboldt-Universität zu Berlin (C.S., O.P.); Berlin Institute of Health (C.S., O.P.), German Center for Neurodegenerative; Experimental and Clinical Research Center (C.S., O.P.), Memory Clinic, Berlin, Germany; and Department of Nephrology (M.T.), Odense University Hospital, Denmark
| | - Oliver Peters
- From the Institute for Molecular Cardiovascular Research (F.K., J.J., H.N., V.J.), Department of Anesthesiology (F.K.), and Institute of Neuropathology (A.G., J.W., G.B., A.Y.), Medical Faculty, RWTH Aachen University, Germany; School for Cardiovascular Diseases (J.J.), Maastricht University; Department of (Neuro) Pathology (J.A., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; mfd Diagnostics GmbH (S.F., C.H.), Wendelsheim; Charité-Universitätsmedizin Berlin (C.S., O.P.), corporate member of Freie Universität Berlin; Humboldt-Universität zu Berlin (C.S., O.P.); Berlin Institute of Health (C.S., O.P.), German Center for Neurodegenerative; Experimental and Clinical Research Center (C.S., O.P.), Memory Clinic, Berlin, Germany; and Department of Nephrology (M.T.), Odense University Hospital, Denmark
| | - Martin Tepel
- From the Institute for Molecular Cardiovascular Research (F.K., J.J., H.N., V.J.), Department of Anesthesiology (F.K.), and Institute of Neuropathology (A.G., J.W., G.B., A.Y.), Medical Faculty, RWTH Aachen University, Germany; School for Cardiovascular Diseases (J.J.), Maastricht University; Department of (Neuro) Pathology (J.A., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; mfd Diagnostics GmbH (S.F., C.H.), Wendelsheim; Charité-Universitätsmedizin Berlin (C.S., O.P.), corporate member of Freie Universität Berlin; Humboldt-Universität zu Berlin (C.S., O.P.); Berlin Institute of Health (C.S., O.P.), German Center for Neurodegenerative; Experimental and Clinical Research Center (C.S., O.P.), Memory Clinic, Berlin, Germany; and Department of Nephrology (M.T.), Odense University Hospital, Denmark
| | - Heidi Noels
- From the Institute for Molecular Cardiovascular Research (F.K., J.J., H.N., V.J.), Department of Anesthesiology (F.K.), and Institute of Neuropathology (A.G., J.W., G.B., A.Y.), Medical Faculty, RWTH Aachen University, Germany; School for Cardiovascular Diseases (J.J.), Maastricht University; Department of (Neuro) Pathology (J.A., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; mfd Diagnostics GmbH (S.F., C.H.), Wendelsheim; Charité-Universitätsmedizin Berlin (C.S., O.P.), corporate member of Freie Universität Berlin; Humboldt-Universität zu Berlin (C.S., O.P.); Berlin Institute of Health (C.S., O.P.), German Center for Neurodegenerative; Experimental and Clinical Research Center (C.S., O.P.), Memory Clinic, Berlin, Germany; and Department of Nephrology (M.T.), Odense University Hospital, Denmark
| | - Vera Jankowski
- From the Institute for Molecular Cardiovascular Research (F.K., J.J., H.N., V.J.), Department of Anesthesiology (F.K.), and Institute of Neuropathology (A.G., J.W., G.B., A.Y.), Medical Faculty, RWTH Aachen University, Germany; School for Cardiovascular Diseases (J.J.), Maastricht University; Department of (Neuro) Pathology (J.A., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; mfd Diagnostics GmbH (S.F., C.H.), Wendelsheim; Charité-Universitätsmedizin Berlin (C.S., O.P.), corporate member of Freie Universität Berlin; Humboldt-Universität zu Berlin (C.S., O.P.); Berlin Institute of Health (C.S., O.P.), German Center for Neurodegenerative; Experimental and Clinical Research Center (C.S., O.P.), Memory Clinic, Berlin, Germany; and Department of Nephrology (M.T.), Odense University Hospital, Denmark.
| |
Collapse
|
19
|
Nofer JR, Tepel M, Kehrel B, Walter M, Seedorf U, Assmann G, Zidek W. High Density Lipoproteins Enhance the Na+/H+ Antiport in Human Platelets. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1650335] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryIn the present study, we investigated the effect of high density lipoproteins 3 (HDL3) on Na+/H+ exchanger activity and cytosolic pH (pHi) in human platelets. HDL3 alone failed to affect pHi? but preincubation with HDL3 significantly enhanced the Na+/H+ antiport activation brought about by acidification with 100 mM sodium propionate or stimulation with 0.05 U/ml thrombin. The stimulatory effect of HDL3 was unaffected by indomethacin excluding a role for cyclooxygenase products. The HDL3 effect was not mediated by Ca2+/calmodulin-dependent protein kinase as HDL3 failed to increase cytosolic free calcium concentration. However, the potentiating effect of HDL3 was completely blocked in the presence of the protein kinase C inhibitor, bisindoylmaleimide and the phosphatidylcholine-specific phospholi-pase C inhibitor, D609. Furthermore, the effect of HDL3 was abolished after covalent modification of HDL3 with dimethylsuberimidate and was not observed in platelets from Glanzmann thrombasthenia type 1 which do not express GP IIb/IIIa, as well as in platelets preincubated with anti-GP Ilb/IIIa polyclonal antibodies. We conclude that HDL3 enhances the sodium propionate- and thrombin-induced Na+/H+ antiport activity in human platelets via binding to GP Ilb/IIIa and activation of protein kinase C and phosphatidylcholine-specific phospholipase C.
Collapse
Affiliation(s)
- Jerzy-Roch Nofer
- The Institut für Klinische Chemie und Laboratoriumsmedizin, Zentrallaboratorium, Münster, Germany
| | - Martin Tepel
- Medizinische Poliklinik, Westfälische Wilhelms-Universitat, Münster, Germany
| | - Beate Kehrel
- Experimented Hämostaseforschung, Medizinische Klinik und Poliklinik, Innere Medizin A, Münster, Münster, Germany
| | - Michael Walter
- The Institut für Klinische Chemie und Laboratoriumsmedizin, Zentrallaboratorium, Münster, Germany
- Institut für Arterioskleroseforschung an der Universität Münster, Münster, Germany
| | - Udo Seedorf
- Institut für Arterioskleroseforschung an der Universität Münster, Münster, Germany
| | - Gerd Assmann
- The Institut für Klinische Chemie und Laboratoriumsmedizin, Zentrallaboratorium, Münster, Germany
- Institut für Arterioskleroseforschung an der Universität Münster, Münster, Germany
| | - Walter Zidek
- Medizinische Poliklinik, Westfälische Wilhelms-Universitat, Münster, Germany
| |
Collapse
|
20
|
Rasmussen DGK, Hansen TW, von Scholten BJ, Nielsen SH, Reinhard H, Parving HH, Tepel M, Karsdal MA, Jacobsen PK, Genovese F, Rossing P. Higher Collagen VI Formation Is Associated With All-Cause Mortality in Patients With Type 2 Diabetes and Microalbuminuria. Diabetes Care 2018; 41:1493-1500. [PMID: 29643059 DOI: 10.2337/dc17-2392] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/26/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Type 2 diabetes is a common risk factor for the development of chronic kidney disease (CKD). Enhanced de novo collagen type VI (COL VI) formation has been associated with renal fibrosis and CKD. We investigated the hypothesis that PRO-C6, a product specifically generated during COL VI formation, is prognostic for adverse outcomes in patients with type 2 diabetes and microalbuminuria. RESEARCH DESIGN AND METHODS In a prospective, observational study, we measured PRO-C6 in the serum (S-PRO-C6) and urine (U-PRO-C6) of 198 patients with type 2 diabetes and microalbuminuria without symptoms of coronary artery disease. Patients were followed for a median of 6.5 years, and end points were a composite of cardiovascular events (n = 38), all-cause mortality (n = 26), and reduction of estimated glomerular filtration rate (eGFR) of >30% (disease progression [n = 42]). Cox models were unadjusted and adjusted for the conventional risk factors of sex, age, BMI, systolic blood pressure, LDL cholesterol, smoking, HbA1c, plasma creatinine, and urinary albumin excretion rate. RESULTS Doubling of S-PRO-C6 increased hazards for cardiovascular events (hazard ratio 3.06 [95% CI 1.31-7.14]), all-cause mortality (6.91 [2.96-16.11]), and disease progression (4.81 [1.92-12.01]). Addition of S-PRO-C6 to a model containing conventional risk factors improved relative integrated discrimination by 22.5% for cardiovascular events (P = 0.02), 76.8% for all-cause mortality (P = 0.002), and 53.3% for disease progression (P = 0.004). U-PRO-C6 was not significantly associated with any of the outcomes. CONCLUSIONS S-PRO-C6 generated during COL VI formation predicts cardiovascular events, all-cause mortality, and disease progression in patients with type 2 diabetes and microalbuminuria.
Collapse
Affiliation(s)
- Daniel G K Rasmussen
- Nordic Bioscience, Herlev, Denmark .,Institute of Molecular Medicine, Cardiovascular and Renal Research, University of Southern Denmark, Odense, Denmark
| | | | | | - Signe H Nielsen
- Nordic Bioscience, Herlev, Denmark.,Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | | | | | - Martin Tepel
- Institute of Molecular Medicine, Cardiovascular and Renal Research, University of Southern Denmark, Odense, Denmark.,Department of Nephrology, Odense University Hospital, Odense, Denmark
| | | | | | | | - Peter Rossing
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
21
|
Nagarajah S, Rasmussen M, Tepel M. SP762CHANGE OF LONG NON-CODING RNA, MGAT3-AS1, IN PATIENTS BEFORE AND AFTER KIDNEY TRANSPLANTATION. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Subagini Nagarajah
- Institute of Molecular Medicine, University of Sourthern Denmark, Odense, Denmark
| | | | - Martin Tepel
- Nephrology, Odense University Hospital, Odense, Denmark
| |
Collapse
|
22
|
Svenningsen P, Tepel M. SP709ELEVATED URINARY EXTRACELLULAR VESICLE EXCRETION IN PATIENTS WITH DELAYED GRAFT FUNCTION AFTER DECEASED KIDNEY TRANSPLANTATION. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Per Svenningsen
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Martin Tepel
- Nephrology, Odense University Hospital, Odense, Denmark
| |
Collapse
|
23
|
Beck HC, Tepel M. FP721COMPLOSOME AFFECTS THE OUTCOME AFTER INCIDENT KIDNEY TRANSPLANTATION. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.fp721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hans Christian Beck
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Martin Tepel
- Nephrology, Odense University Hospital, Odense, Denmark
| |
Collapse
|
24
|
Rasmussen DGK, Fenton A, Jesky M, Ferro C, Boor P, Tepel M, Karsdal MA, Genovese F, Cockwell P. Urinary endotrophin predicts disease progression in patients with chronic kidney disease. Sci Rep 2017; 7:17328. [PMID: 29229941 PMCID: PMC5725589 DOI: 10.1038/s41598-017-17470-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 11/27/2017] [Indexed: 12/21/2022] Open
Abstract
Renal fibrosis is the central pathogenic process in progression of chronic kidney disease (CKD). Collagen type VI (COL VI) is upregulated in renal fibrosis. Endotrophin is released from COL VI and promotes pleiotropic pro-fibrotic effects. Kidney disease severity varies considerably and accurate information regarding CKD progression may improve clinical decisions. We tested the hypothesis that urinary endotrophin derived during COL VI deposition in fibrotic human kidneys is a marker for progression of CKD in the Renal Impairment in Secondary Care (RIISC) cohort, a prospective observational study of 499 CKD patients. Endotrophin localised to areas of increased COL VI deposition in fibrotic kidneys but was not present in histologically normal kidneys. The third and fourth quartiles of urinary endotrophin:creatinine ratio (ECR) were independently associated with one-year disease progression after adjustment for traditional risk factors (OR (95%CI) 3.68 (1.06–12.83) and 8.65 (2.46–30.49), respectively). Addition of ECR quartiles to the model for disease progression increased prediction as seen by an increase in category-free net reclassification improvement (0.45, 95% CI 0.16–0.74, p = 0.002) and integrated discrimination improvement (0.04, 95% CI 0.02–0.06, p < 0.001). ECR was associated with development of end-stage renal disease (ESRD). It is concluded that ECR predicts disease progression of CKD patients.
Collapse
Affiliation(s)
- Daniel Guldager Kring Rasmussen
- Nordic Bioscience, Herlev, Denmark. .,University of Southern Denmark, Institute of Molecular Medicine, Cardiovascular and Renal Research, Odense, Denmark.
| | - Anthony Fenton
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, UK.,College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Mark Jesky
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, UK.,College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Charles Ferro
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, UK.,College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Peter Boor
- Division of Nephrology, RWTH University of Aachen, Aachen, Germany.,Institute of Pathology, RWTH University of Aachen, Aachen, Germany
| | - Martin Tepel
- University of Southern Denmark, Institute of Molecular Medicine, Cardiovascular and Renal Research, Odense, Denmark.,Department of Nephrology, Odense University Hospital, Odense, Denmark
| | | | | | - Paul Cockwell
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, UK.,College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| |
Collapse
|
25
|
Shen J, Rasmussen M, Dong QR, Tepel M, Scholze A. Expression of the NRF2 Target Gene NQO1 Is Enhanced in Mononuclear Cells in Human Chronic Kidney Disease. Oxid Med Cell Longev 2017; 2017:9091879. [PMID: 28785379 PMCID: PMC5530440 DOI: 10.1155/2017/9091879] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/03/2017] [Accepted: 05/11/2017] [Indexed: 12/12/2022]
Abstract
Reduced nuclear factor erythroid 2-related factor 2 (NRF2) pathway activity was reported in models of chronic kidney disease (CKD). Pharmacological activation of NRF2 is supposed to improve renal function, but data concerning the NRF2 activity in human CKD are lacking. We investigated the NRF2 target NAD(P)H:quinone oxidoreductase 1 (NQO1) as a readout parameter for NRF2 activity in monocytes of CKD patients (n = 63) compared to those of healthy controls (n = 16). The NQO1 gene expression was quantified using real-time PCR and the protein content by in-cell Western assays. We found a 3-4-fold increase in NQO1 gene expression in CKD 1-5 (n = 29; 3.5 for NQO1/ribosomal protein L41; p < 0.001). This was accompanied by a 1.1-fold increase in NQO1 protein (p = 0.06). Cardiovascular disease prevalence was higher in CKD 1-5 patients with higher compared to those with lower NQO1 gene expression (p = 0.02). In advanced uremia, in dialysis patients (n = 34), NQO1 gene expression was less robustly upregulated than that in CKD 1-5, while NQO1 protein was not upregulated. We conclude that in mononuclear cells of CKD patients, the NRF2 pathway is activated by coexisting pathogenic mechanisms, but in advanced uremia, the effectiveness of this upregulation is reduced. Both processes could interfere with pharmacological NRF2 activation.
Collapse
Affiliation(s)
- Jianlin Shen
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Molecular Medicine, Cardiovascular and Renal Research, University of Southern Denmark, Odense, Denmark
| | | | - Qi-Rong Dong
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Martin Tepel
- Institute of Molecular Medicine, Cardiovascular and Renal Research, University of Southern Denmark, Odense, Denmark
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Alexandra Scholze
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
26
|
Rasmussen D, Genovese F, Fenton A, Boor P, Tepel M, Ferro C, Jesky M, Karsdal M, Cockwell P. SP274URINARY ENDOTROPHIN (PRO-C6), A DYNAMIC PRODUCT OF TYPE VI COLLAGEN FORMATION, PREDICTS DISEASE PROGRESSION AND MORTALITY IN PATIENTS WITH CHRONIC KIDNEY DISEASE. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx145.sp274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
27
|
Nagarajah S, Xia S, Thilo F, Tepel M. SP063LONG NON-CODING RNA, MGAT3-AS1, IN KIDNEY DISEASE AND PREDICTION OF ALLOGRAFT FUNCTION. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx140.sp063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
28
|
Xia S, Thilo F, Tepel M. MO045LONG NONCODING RNA IN PATIENTS AFTER RENAL TRANSPLANTATION. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw138.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
29
|
Xia S, Thilo F, Tepel M. MP733COMPLEMENT 5A RECEPTOR TRANSCRIPTS AFTER KIDNEY TRANSPLANTATION. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw200.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
30
|
Goldager DK, Genovese F, Karsdal M, Xia S, Tepel M. MP694RECOVERY OF KIDNEY ALLOGRAFT FUNCTION AFFECTS MARKERS FOR COLLAGEN TYPE III and VI TURNOVER. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw200.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
31
|
Xia S, Liu Y, Li X, Thilo F, Tepel M. Insulin Increases Expression of TRPC6 Channels in Podocytes by a Calcineurin-Dependent Pathway. Cell Physiol Biochem 2016; 38:659-69. [PMID: 26849622 DOI: 10.1159/000438658] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Insulin signaling to podocytes is relevant for the function of the glomerulus. Now, we tested the hypothesis that insulin increases the surface expression of canonical transient receptor potential canonical type 6 (TRPC6) channels in podocytes by a calcineurin-dependent pathway. METHODS We used quantitative RT-PCR, immunoblotting, immunofluorescence and fluorescence spectrophotometry in cultured podocytes. Activation of Nuclear Factor of Activated T-cells (NFATc1) was measured using a specific calorimetric assay. RESULTS Insulin increased the expression of TRPC6 transcripts and protein in podocytes. Insulin increased TRPC6 transcripts in a time and dose-dependent manner. The insulin-induced elevation of TRPC6 transcripts was blocked in the presence of tacrolimus, cyclosporine A, and NFAT-inhibitor (each p < 0.01 by ANOVA and Bonferroni's multiple comparison test). Transcripts of NOX4, another target gene of the calcineurin-NFAT pathway, were affected in a similar way. Immunoblotting showed that the administration of 100 nmol/L insulin increased TRPC6-proteins 2-fold within 48 hours. Insulin increased the activity of NFATc1 in nuclear extracts (p < 0.001) whereas tacrolimus, cyclosporine A, and NFAT-inhibitor blocked that insulin effect (p < 0.001; two way ANOVA). Immunofluorescence showed that insulin increased TRPC6-expression on the cell surface. Fluorescence-spectrophotometry and manganese quench experiments indicated that the increased TRPC6-expression after insulin administration was accompanied by an elevated transplasmamembrane cation influx. Insulin-stimulated surface expression of TRPC6 as well as transplasmamembrane cation influx could be reduced by pretreatment with tacrolimus. CONCLUSION Insulin increases the expression of TRPC6 channels in podocytes by activation of the calcineurin-dependent pathway.
Collapse
Affiliation(s)
- Shengqiang Xia
- Odense University Hospital, Department of Nephrology, and University of Southern Denmark, Institute for Molecular Medicine, Cardiovascular and Renal Research, Institute of Clinical Research, Odense, Denmark
| | | | | | | | | |
Collapse
|
32
|
Tepel M, Beck HC, Tan Q, Borst C, Rasmussen LM. The 82-plex plasma protein signature that predicts increasing inflammation. Sci Rep 2015; 5:14882. [PMID: 26445912 PMCID: PMC4597208 DOI: 10.1038/srep14882] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 09/10/2015] [Indexed: 12/22/2022] Open
Abstract
The objective of the study was to define the specific plasma protein signature that predicts the increase of the inflammation marker C-reactive protein from index day to next-day using proteome analysis and novel bioinformatics tools. We performed a prospective study of 91 incident kidney transplant recipients and quantified 359 plasma proteins simultaneously using nano-Liquid-Chromatography-Tandem Mass-Spectrometry in individual samples and plasma C-reactive protein on the index day and the next day. Next-day C-reactive protein increased in 59 patients whereas it decreased in 32 patients. The prediction model selected and validated 82 plasma proteins which determined increased next-day C-reactive protein (area under receiver-operator-characteristics curve, 0.772; 95% confidence interval, 0.669 to 0.876; P < 0.0001). Multivariable logistic regression showed that 82-plex protein signature (P < 0.001) was associated with observed increased next-day C-reactive protein. The 82-plex protein signature outperformed routine clinical procedures. The category-free net reclassification index improved with 82-plex plasma protein signature (total net reclassification index, 88.3%). Using the 82-plex plasma protein signature increased net reclassification index with a clinical meaningful 10% increase of risk mainly by the improvement of reclassification of subjects in the event group. An 82-plex plasma protein signature predicts an increase of the inflammatory marker C-reactive protein.
Collapse
Affiliation(s)
- Martin Tepel
- Department of Nephrology, Odense University Hospital, and University of Southern Denmark, Institute of Molecular Medicine, Cardiovascular and Renal Research, Institute of Clinical Research
| | - Hans C Beck
- Department of Clinical Biochemistry and Pharmacology, Centre for Individualized Medicine in Arterial Diseases (Odense University Hospital), and Centre for Clinical Proteomics (Odense University Hospital/University of Southern Denmark)
| | - Qihua Tan
- Department of Epidemiology, Biostatistics and Biodemography, Institute of Public Health; Unit of Human Genetics, Institute of Clinical Research, University of Southern Denmark
| | - Christoffer Borst
- Department of Nephrology, Odense University Hospital, and University of Southern Denmark, Institute of Molecular Medicine, Cardiovascular and Renal Research, Institute of Clinical Research
| | - Lars M Rasmussen
- Department of Clinical Biochemistry and Pharmacology, Centre for Individualized Medicine in Arterial Diseases (Odense University Hospital), and Centre for Clinical Proteomics (Odense University Hospital/University of Southern Denmark)
| |
Collapse
|
33
|
Skarphedinsson S, Thiesson HC, Shakar SA, Tepel M. Factors predicting kidney damage in Puumala virus infected patients in Southern Denmark. Eur J Clin Microbiol Infect Dis 2015. [PMID: 26205664 DOI: 10.1007/s10096-015-2446-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In Europe, infections with Puumala hantavirus cause nephropathia epidemica. Presently the risk factors predicting severe kidney damage after Puumala virus infection are not well known. The objective of the study was to investigate environmental and individual factors predicting severe kidney damage caused by serologically established Puumala infections. In a nationwide cohort study we investigated all serologically established Puumala infections in Southern Denmark from 1996 to 2012. A total of 184 patients had serologically verified Puumala virus infection. In patients with Puumala virus infections the decrease of platelet counts preceded acute kidney failure. Multivariable logistic regression demonstrated that recent activities in the forest, platelet counts, and flu-like symptoms predicted estimated glomerular filtration rates less than 30 mL/min/1.73 m(²), but not age, gender, fever, nor abdominal pain. Severe kidney damage in Puumala infections in Southern Denmark is associated with the risk of recent activities in the forest.
Collapse
Affiliation(s)
- S Skarphedinsson
- Clinical Center of Emerging and Vectorborne Infections, Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - H C Thiesson
- Department of Nephrology, Odense University Hospital, Odense, Denmark.,Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - S A Shakar
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - M Tepel
- Department of Nephrology, Odense University Hospital, Odense, Denmark. .,Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark. .,Institute for Molecular Medicine, Cardiovascular and Renal Research, Institute of Clinical Research, Odense University Hospital and University of Southern Denmark, Winsløwparken 21.3, 5000, Odense C, Denmark.
| |
Collapse
|
34
|
Tepel M, Beck HC, Xia S, Rasmussen LM. SP826PLASMA PROTEOME CHARACTERIZES THE INFLAMMATORY RESPONSE IN PATIENTS AFTER INCIDENT KIDNEY TRANSPLANTATION. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv202.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
35
|
Xia S, Tepel M. FP859GENDER-DEPENDENT EXPRESSION OF CHEMOKINE RECEPTOR CX3CR1 IN INCIDENT KIDNEY TRANSPLANT PATIENTS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv185.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
36
|
Borst C, Xia S, Bistrup C, Tepel M. Interleukin-8 transcripts in mononuclear cells determine impaired graft function after kidney transplantation. PLoS One 2015; 10:e0117315. [PMID: 25689147 PMCID: PMC4331279 DOI: 10.1371/journal.pone.0117315] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 08/15/2014] [Accepted: 12/20/2014] [Indexed: 12/29/2022] Open
Abstract
Objective Interleukin-8 (IL-8) has been associated with ischemia reperfusion injury after renal allograft transplantation. Impaired allograft function may cause major impact on patient morbidity and health care costs. We investigated whether transcript levels in mononuclear cells including IL-8 on the first postoperative day may be involved in immediate allograft dysfunction as defined by reduced relative change in plasma creatinine at the first postoperative day. Methods We performed a single center, prospective-cohort study of 113 patients receiving kidney transplants. Peripheral blood mononuclear cells were harvested within 24 hours after transplantation. Transcripts were measured using quantitative RT-PCR. Results Transcript levels of IL-8 and S100A8 were significantly lower in patients with relative change in plasma creatinine less than 10% at the first postoperative day. Receiver-operator characteristic curves showed that IL-8 predicted the relative change in plasma creatinine less than 10% (area under curve (AUC), 0.80; P = 0.0007). Multivariate analyses showed that lower IL-8 transcripts, longer time on dialysis, higher recipient body mass index and deceased donor type were associated with relative change in plasma creatinine at the first postoperative day less than 10%. Conclusion Reduced levels of IL-8 transcripts in peripheral mononuclear cells predict immediate graft dysfunction and delayed graft function.
Collapse
Affiliation(s)
- Christoffer Borst
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Institute of Molecular Medicine, Cardiovascular and Renal Research, Institute of Clinical Research, Odense, Denmark
| | - Shengqiang Xia
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Institute of Molecular Medicine, Cardiovascular and Renal Research, Institute of Clinical Research, Odense, Denmark
| | - Claus Bistrup
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Martin Tepel
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Institute of Molecular Medicine, Cardiovascular and Renal Research, Institute of Clinical Research, Odense, Denmark
- * E-mail:
| |
Collapse
|
37
|
Chen L, Kaßmann M, Sendeski M, Tsvetkov D, Marko L, Michalick L, Riehle M, Liedtke WB, Kuebler WM, Harteneck C, Tepel M, Patzak A, Gollasch M. Functional transient receptor potential vanilloid 1 and transient receptor potential vanilloid 4 channels along different segments of the renal vasculature. Acta Physiol (Oxf) 2015; 213:481-91. [PMID: 25069877 DOI: 10.1111/apha.12355] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 05/26/2014] [Accepted: 07/22/2014] [Indexed: 12/19/2022]
Abstract
AIM Transient receptor potential vanilloid 1 (TRPV1) and vanilloid 4 (TRPV4) cation channels have been recently identified to promote endothelium-dependent relaxation of mouse mesenteric arteries. However, the role of TRPV1 and TRPV4 in the renal vasculature is largely unknown. We hypothesized that TRPV1/4 plays a role in endothelium-dependent vasodilation of renal blood vessels. METHODS We studied the distribution of functional TRPV1/4 along different segments of the renal vasculature. Mesenteric arteries were studied as control vessels. RESULTS The TRPV1 agonist capsaicin relaxed mouse mesenteric arteries with an EC50 of 25 nm, but large mouse renal arteries or rat descending vasa recta only at >100-fold higher concentrations. The vasodilatory effect of capsaicin in the low-nanomolar concentration range was endothelium-dependent and absent in vessels of Trpv1 -/- mice. The TRPV4 agonist GSK1016790A relaxed large conducting renal arteries, mesenteric arteries and vasa recta with EC50 of 18, 63 nm and ~10 nm respectively. These effects were endothelium-dependent and inhibited by a TRPV4 antagonist, AB159908 (10 μm). Capsaicin and GSK1016790A produced vascular dilation in isolated mouse perfused kidneys with EC50 of 23 and 3 nm respectively. The capsaicin effects were largely reduced in Trpv1 -/- kidneys, and the effects of GSK1016790A were inhibited in Trpv4 -/- kidneys. CONCLUSION Our results demonstrate that two TRPV channels have unique sites of vasoregulatory function in the kidney with functional TRPV1 having a narrow, discrete distribution in the resistance vasculature and TRPV4 having more universal, widespread distribution along different vascular segments. We suggest that TRPV1/4 channels are potent therapeutic targets for site-specific vasodilation in the kidney.
Collapse
Affiliation(s)
- L. Chen
- Experimental and Clinical Research Center (ECRC); Charité Medical Faculty and the Max Delbrück Center for Molecular Medicine (MDC); Berlin Germany
- Xiamen Zhongshan Hospital; Xiamen University; Xiamen China
| | - M. Kaßmann
- Experimental and Clinical Research Center (ECRC); Charité Medical Faculty and the Max Delbrück Center for Molecular Medicine (MDC); Berlin Germany
| | - M. Sendeski
- Institute of Vegetative Physiology; Charité University Medicine Berlin; Berlin Germany
| | - D. Tsvetkov
- Experimental and Clinical Research Center (ECRC); Charité Medical Faculty and the Max Delbrück Center for Molecular Medicine (MDC); Berlin Germany
| | - L. Marko
- Experimental and Clinical Research Center (ECRC); Charité Medical Faculty and the Max Delbrück Center for Molecular Medicine (MDC); Berlin Germany
| | - L. Michalick
- German Heart Center Berlin; Institute of Physiology; Charité University Medicine Berlin; Berlin Germany
| | - M. Riehle
- Department of Pharmacology and Experimental Therapy; Institute of Experimental and Clinical Pharmacology and Toxicology; Eberhard Karls University Hospitals and Clinics; Interfaculty Center of Pharmacogenomics and Drug Research; University of Tübingen; Tübingen Germany
| | - W. B. Liedtke
- Department of Neurology and Neurobiology; Center for Translational Neuroscience; Duke University Medical Center; Durham NC USA
| | - W. M. Kuebler
- German Heart Center Berlin; Institute of Physiology; Charité University Medicine Berlin; Berlin Germany
| | - C. Harteneck
- Department of Pharmacology and Experimental Therapy; Institute of Experimental and Clinical Pharmacology and Toxicology; Eberhard Karls University Hospitals and Clinics; Interfaculty Center of Pharmacogenomics and Drug Research; University of Tübingen; Tübingen Germany
| | - M. Tepel
- Department of Cardiovascular and Renal Research; Department of Nephrology; University of Southern Denmark; Odense Denmark
| | - A. Patzak
- Institute of Vegetative Physiology; Charité University Medicine Berlin; Berlin Germany
| | - M. Gollasch
- Experimental and Clinical Research Center (ECRC); Charité Medical Faculty and the Max Delbrück Center for Molecular Medicine (MDC); Berlin Germany
- Medical Clinic for Nephrology and Internal Intensive Care; Charité Campus Virchow; Berlin Germany
| |
Collapse
|
38
|
Tepel M, Borst C, Bistrup C, Marcussen N, Pagonas N, Seibert FS, Arndt R, Zidek W, Westhoff TH. Urinary calprotectin and posttransplant renal allograft injury. PLoS One 2014; 9:e113006. [PMID: 25402277 PMCID: PMC4234472 DOI: 10.1371/journal.pone.0113006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 08/14/2014] [Accepted: 10/17/2014] [Indexed: 11/18/2022] Open
Abstract
Objective Current methods do not predict the acute renal allograft injury immediately after kidney transplantation. We evaluated the diagnostic performance of urinary calprotectin for predicting immediate posttransplant allograft injury. Methods In a multicenter, prospective-cohort study of 144 incipient renal transplant recipients, we postoperatively measured urinary calprotectin using an enzyme-linked immunosorbent assay and estimated glomerular filtration rate (eGFR) after 4 weeks, 6 months, and 12 months. Results We observed a significant inverse association of urinary calprotectin concentrations and eGFR 4 weeks after transplantation (Spearman r = −0.33; P<0.001). Compared to the lowest quartile, patients in the highest quartile of urinary calprotectin had an increased risk for an eGFR less than 30 mL/min/1.73 m2 four weeks after transplantation (relative risk, 4.3; P<0.001; sensitivity, 0.92; 95% CI, 0.77 to 0.98; specificity, 0.48; 95% CI, 0.31 to 0.66). Higher urinary calprotectin concentrations predicted impaired kidney function 4 weeks after transplantation, as well as 6 months and 12 months after transplantation. When data were analyzed using the urinary calprotectin/creatinine-ratio similar results were obtained. Urinary calprotectin was superior to current use of absolute change of plasma creatinine to predict allograft function 12 months after transplantation. Urinary calprotectin predicted an increased risk both in transplants from living and deceased donors. Multivariate linear regression showed that higher urinary calprotectin concentrations and older donor age predicted lower eGFR four weeks, 6 months, and 12 months after transplantation. Conclusions Urinary calprotectin is an early, noninvasive predictor of immediate renal allograft injury after kidney transplantation.
Collapse
Affiliation(s)
- Martin Tepel
- Department of Nephrology, Odense University Hospital, and University of Southern Denmark, Institute of Molecular Medicine, Cardiovascular and Renal Research, Institute of Clinical Research, Odense, Denmark
| | - Christoffer Borst
- Department of Nephrology, Odense University Hospital, and University of Southern Denmark, Institute of Molecular Medicine, Cardiovascular and Renal Research, Institute of Clinical Research, Odense, Denmark
| | - Claus Bistrup
- Department of Nephrology, Odense University Hospital, and University of Southern Denmark, Institute of Molecular Medicine, Cardiovascular and Renal Research, Institute of Clinical Research, Odense, Denmark
| | - Niels Marcussen
- Department of Pathology, Odense University Hospital, and University of Southern Denmark, Odense, Denmark
| | - Nikolaos Pagonas
- Department of Nephrology, Charité, Campus Benjamin Franklin, Berlin, Germany
- Medizinische Klinik I, Univ.-Klinik Marienhospital Herne, Ruhr-University Bochum, Bochum, Germany
| | - Felix S. Seibert
- Department of Nephrology, Charité, Campus Benjamin Franklin, Berlin, Germany
- Medizinische Klinik I, Univ.-Klinik Marienhospital Herne, Ruhr-University Bochum, Bochum, Germany
| | - Robert Arndt
- Department of Nephrology, Charité, Campus Benjamin Franklin, Berlin, Germany
| | - Walter Zidek
- Department of Nephrology, Charité, Campus Benjamin Franklin, Berlin, Germany
| | - Timm H. Westhoff
- Department of Nephrology, Charité, Campus Benjamin Franklin, Berlin, Germany
- Medizinische Klinik I, Univ.-Klinik Marienhospital Herne, Ruhr-University Bochum, Bochum, Germany
- * E-mail:
| |
Collapse
|
39
|
Genovese F, Karsdal MA, Leeming DJ, Scholze A, Tepel M. Association of versican turnover with all-cause mortality in patients on haemodialysis. PLoS One 2014; 9:e111134. [PMID: 25354390 PMCID: PMC4212982 DOI: 10.1371/journal.pone.0111134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 07/22/2014] [Accepted: 09/22/2014] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Cardiovascular diseases are among the most common causes of mortality in renal failure patients undergoing haemodialysis. A high turnover rate of the proteoglycan versican, represented by the increased presence of its fragmentation products in plasma, has previously been associated with cardiovascular diseases. The objective of the study was to investigate the association of versican turnover assessed in plasma with survival in haemodialysis patients. METHODS A specific matrix metalloproteinase-generated neo-epitope fragment of versican (VCANM) was measured in plasma of 364 haemodialysis patients with a 5-years follow-up, using a robust competitive enzyme-linked immunosorbent assays. Association between VCANM plasma concentration and survival was assessed by Kaplan-Meier analysis and adjusted Cox model. RESULTS Haemodialysis patients with plasma VCANM concentrations in the lowest quartile had increased risk of death (odds ratio, as compared to the highest quartile: 7.1, p<0.001), with a reduced survival of 152 days compared to 1295 days for patients with plasma VCANM in the highest quartile. Multivariate analysis showed that low VCANM (p<0.001) and older age (p<0.001) predicted death in haemodialysis patients. CONCLUSIONS Low concentrations of the versican fragment VCANM in plasma were associated with higher risk of death among haemodialysis patients. A possible protective role for the examined versican fragment is suggested.
Collapse
Affiliation(s)
- Federica Genovese
- Nordic Bioscience, Fibrosis Biology and Biomarkers, Herlev, Denmark
- * E-mail:
| | | | - Diana J. Leeming
- Nordic Bioscience, Fibrosis Biology and Biomarkers, Herlev, Denmark
| | - Alexandra Scholze
- Odense University Hospital, Department of Nephrology, Institute for Molecular Medicine, Cardiovascular and Renal Research, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Martin Tepel
- Odense University Hospital, Department of Nephrology, Institute for Molecular Medicine, Cardiovascular and Renal Research, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
40
|
Schulz AM, Terne C, Jankowski V, Cohen G, Schaefer M, Boehringer F, Tepel M, Kunkel D, Zidek W, Jankowski J. Modulation of NADPH oxidase activity by known uraemic retention solutes. Eur J Clin Invest 2014; 44:802-11. [PMID: 25041433 DOI: 10.1111/eci.12297] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 06/24/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Uraemia and cardiovascular disease appear to be associated with an increased oxidative burden. One of the key players in the genesis of reactive oxygen species (ROS) is nicotinamide adenine dinucleotide phosphate (NADPH) oxidase. Based on initial experiments demonstrating a decreased inhibitory effect on NADPH oxidase activity in the presence of plasma from patients with CKD-5D after dialysis compared with before dialysis, we investigated the effect of 48 known and commercially available uraemic retention solutes on the enzymatic activity of NADPH oxidase. METHODS Mononuclear leucocytes isolated from buffy coats of healthy volunteers were isolated, lysed and incubated with NADH in the presence of plasma from healthy controls and patients with CKD-5D. Furthermore, the leucocytes were lysed and incubated in the presence of uraemic retention solute of interest and diphenyleneiodonium chloride (DPI), an inhibitor of NADPH oxidase. The effect on enzymatic activity of NADPH oxidase was quantified within an incubation time of 120 min. RESULTS Thirty-nine of the 48 uraemic retention solutes tested had a significant decreasing effect on NADPH oxidase activity. Oxalate has been characterized as the strongest inhibitor of NADPH oxidase (90% of DPI inhibition). Surprisingly, none of the uraemic retention solutes we investigated was found to increase NADPH oxidase activity. Furthermore, plasma from patients with CKD-5D before dialysis caused significantly higher inhibitory effect on NADPH oxidase activity compared with plasma from healthy subjects. However, this effect was significantly decreased in plasma from patients with CKD-5D after dialysis. CONCLUSIONS The results of this study show that uraemic retention solutes modulated the activity of the NADPH oxidase. The results of this study might be the basis for the development of inhibitors applicable as drug in the situation of increased oxidative stress.
Collapse
Affiliation(s)
- Anna Marta Schulz
- Charité-Universitätsmedizin Berlin (CBF), Medizinische Klinik IV, Berlin, Germany
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Thilo F, Lee M, Xia S, Zakrzewicz A, Tepel M. High glucose modifies transient receptor potential canonical type 6 channels via increased oxidative stress and syndecan-4 in human podocytes. Biochem Biophys Res Commun 2014; 450:312-7. [DOI: 10.1016/j.bbrc.2014.05.116] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 05/24/2014] [Indexed: 12/31/2022]
|
42
|
Shiohira S, Yoshida T, Sugiura H, Nishida M, Nitta K, Tsuchiya K, Grampp S, Goppelt-Strube M, Eckardt KU, Schodel J, Kang SW, Kim Y, Seo SK, Kim T, Ong S, Yang WS, Han NJ, Lee JM, Baek CH, Park SK, Kemter E, Aigner B, Wanke R, Troyano Suarez N, Olmos Centenero G, Mora I, Griera M, Cano JL, Martin P, Zamora J, Ruiz-Torres MP, Falke LL, Leask A, Lyons K, Nguyen TQ, Goldschmeding R, Park SK, Kim D, Lee AS, Jung YJ, Yang KH, Lee S, Kim W, Kim W, Kang KP, Garcia-Jerez A, Luengo-Rodriguez A, Ramirez-Chamond R, Carracedo J, Medrano-Andres D, Rodriguez-Puyol D, Calleros L, Kim HW, Park SK, Yang WS, Lee SK, Chang JW, Seo JW, Lee CT, Chou CA, Lee YT, Ng HY, Sanchez-Nino MD, Fernandez-Fernandez B, Perez-Gomez MV, Poveda J, Sanz AB, Cannata-Ortiz P, Egido J, Selgas R, Ortiz A, Ma SK, Kim IJ, Kim CS, Bae EH, Kim SW, Kokeny G, Boo'Si M, Fazekas K, Rosivall L, Mozes MM, Mijuskovic M, Ulrich C, Berger H, Trojanowicz B, Kohler F, Wolf A, Seibert E, Fiedler R, Markau S, Glomb M, Girndt M, Lajdova I, Spustova V, Oksa A, Chorvat D, Marcek Chorvatova A, Choi SO, Kim JS, Han BG, Yang JW, Liu S, Lv J, Chang R, Su F, Liang W, Zawada AM, Rogacev KS, Hundsdorfer J, Sester U, Fliser D, Heine GH, Chen JS, Cheng CW, Chang LC, Wu CZ, Novaes AS, Borges FT, Boim MA, Tramonti G, Romiti N, Chieli E, Hamahata S, Nagasawa Y, Kawabe M, Kida A, Yahiro M, Nanami M, Hasuike Y, Kuragano T, Nakasho K, Ohyama H, Nakanishi T, Tanaka S, Yano S, Sugimoto T, Bae E, Stevens KK, Hillyard DZ, Delles C, Jardine AG, Burke M, Morais C, Soyer P, Sinnya S, Winterford C, Oliver K, Lambie D, Staatz C, Carroll R, Campbell S, Isbel N, Felaco P, Pesce M, Patruno A, Sirolli V, Speranza L, Amoroso L, Franceschelli S, Bonomini M, Thilo F, Zakrzewicz A, Tepel M, Thilo F, Zakrzewicz A, Tepel M, Liu S, Li Y, Liang W, Su F, Wang B. CELL SIGNALLING AND APOPTOSIS. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
43
|
Heisterkamp M, Titze S, Lorenzen J, Eckardt KU, Koettgen A, Kielstein JT, Bouquegneau A, Vidal-Petiot E, Vrtovsnik F, Cavalier E, Krzesinski JM, Flamant M, Delanaye P, Anguiano L, Riera M, Pascual J, Barrios C, Betriu A, Valdivielso JM, Fernandez E, Soler MJ, Denys MA, Viaene A, Goessaert AS, Delanghe J, Everaert K, Kim YS, Choi MJ, Deok JY, Kim SG, Bevc S, Hojs N, Hojs R, Ekart R, Gorenjak M, Puklavec L, Bevc S, Hojs N, Hojs R, Ekart R, Gorenjak M, Puklavec L, Piskunowicz M, Hofmann L, Zurcher E, Bassi I, Zweiacker C, Stuber M, Narkiewicz K, Vogt B, Burnier M, Pruijm M, Rusu E, Zilisteanu D, Atasie T, Circiumaru A, Carstea F, Ecobici M, Rosca M, Tanase C, Mihai S, Voiculescu M, Kim YS, Jeon YD, Choi MJ, Kim SG, Polenakovic M, Pop-Jordanova N, Hung SC, Tarng DC, Tuta L, Stanigut A, Mesiano P, Rollino C, Ferro M, Beltrame G, Massara C, Quattrocchio G, Borca M, Bazzan M, Roccatello D, Maksudova A, Urasaeva LI, Khalfina TN, Zilisteanu D, Rusu E, Atasie T, Ecobici M, Circiumaru A, Carstea F, Rosca M, Tanase C, Mihai S, Voiculescu M, Tekce H, Kin Tekce B, Aktas G, Alcelik A, Sengul E, Lindic J, Purg D, Skamen J, Krsnik M, Skoberne A, Pajek J, Kveder R, Bren A, Kovac D, Kin Tekce B, Tekce H, Aktas G, Delgado G, Drechsler C, Wanner C, Blouin K, Pilz S, Tomaschitz A, Kleber ME, Willmes C, Krane V, Marz W, Ritz E, Van Gilst WH, Van Der Harst P, De Boer RA, Scholze A, Petersen L, Hocher B, Rasmussen LM, Tepel M, De Paula EA, Vanelli CP, Caminhas MS, Soares BC, Bassoli FA, Da Costa DMN, Lanna CMM, Galil AGS, Colugnati FAB, Costa MB, Bastos MG, De Paula RB, Santoro D, Zappulla Z, Alibrandi A, Tomasello Andulajevic M, Licari M, Baldari S, Buemi M, Cernaro V, Campenni A, Pallet N, Chauvet S, Levi C, Meas-Yedid V, Beaune P, Thevet E, Karras A, Santos S, Malheiro J, Campos A, Pedroso S, Santos J, Cabrita A, Mayor MM, Ayala R, Ramos C, Franco S, Guillen R, Kim JS, Yang JW, Han BG, Choi SO, Tudor MN, Navajas Martinez MF, Vaduva C, Maria DT, Mota E, Clari R, Mongilardi E, Vigotti FN, Consiglio V, Scognamiglio S, Nazha M, Roggero S, Piga A, Piccoli G, Mukhopadhyay P, Patar K, Chaterjee N, Ganguly K. CKD LAB METHODS, PROGRESSION & RISK FACTORS 1. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
44
|
Scholze A, Liu Y, Pedersen L, Xia S, Roth HJ, Hocher B, Rasmussen LM, Tepel M. Soluble α-klotho and its relation to kidney function and fibroblast growth factor-23. J Clin Endocrinol Metab 2014; 99:E855-61. [PMID: 24606097 DOI: 10.1210/jc.2013-4171] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Relations between fibroblast growth factor-23 (FGF-23), soluble α-klotho (s-α-klotho), and kidney function in chronic kidney disease (CKD) are still unclear. Especially the role of s-α-klotho requires further study. OBJECTIVES Our objectives were to analyze the relation of s-α-klotho to estimated glomerular filtration rate (eGFR), FGF-23, and other parameters of calcium-phosphate metabolism and to investigate the response of s-α-klotho to cholecalciferol. PATIENTS, DESIGN, AND SETTING Twenty-four CKD (stage 1-5) patients participated in this 8-week randomized controlled trial (vitamin D and chronic renal insufficiency). INTERVENTIONS Interventions included 40 000 IU cholecalciferol or placebo weekly. MAIN OUTCOME MEASURE S-α-klotho was determined by ELISA with antihuman klotho antibodies 67G3 and 91F1. RESULTS For all patients, s-α-klotho concentrations did not differ between CKD stages. When patients were subdivided based on FGF-23 concentrations, a positive association of s-α-klotho with eGFR became apparent in patients with lower than median FGF-23 concentrations but not in those above median value. Patients with s-α-klotho below 204 pg/mL showed higher age, lower phosphate clearance, and lower bone-specific alkaline phosphatase compared with patients with higher s-α-klotho. Treatment with cholecalciferol significantly increased 1,25-dihydroxyvitamin D. The increase of FGF-23 had only borderline significance. There was no significant effect of high-dose cholecalciferol administration for 8 weeks on plasma s-α-klotho. CONCLUSIONS CKD patients with s-α-klotho below 204 pg/mL had higher age, lower phosphate clearance, and lower bone-specific alkaline phosphatase. An association of s-α-klotho with eGFR was observed only in the presence of close to normal, but not high, FGF-23 concentrations. Cholecalciferol treatment did not change s-α-klotho concentrations.
Collapse
Affiliation(s)
- Alexandra Scholze
- Clinical Research Unit (A.S., M.T.), Department of Nephrology, and Centre for Individualized Medicine in Arterial Diseases (L.P., L.M.R.), Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, 5000 Odense C, Denmark; Institute of Clinical Research (A.S., M.T.) and Institute of Molecular Medicine (Y.L., S.X., M.T.), Cardiovascular and Renal Research, University of Southern Denmark, 5000 Odense C, Denmark; Labor Dr Limbach und Kollegen (H.J.R.), Medizinisches Versorgungszentrum, 69126 Heidelberg, Germany; and Institute of Nutritional Science (B.H.), University of Potsdam, 14558 Nuthetal/Potsdam, Germany
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Abstract
A 32-year-old woman with known stage-4 chronic kidney disease due to lupus nephritis presented with twin pregnancy after in vitro fertilization at a gestational age of 24 weeks + 3 days because of imminent preterm labour. Repeated ultrasound evaluations confirmed intrauterine growth restriction in both twins and polyhydramnios as the cause of imminent preterm labour. After initiation of haemodialysis treatment, ultrasound evaluation showed a significant decrease in amniotic fluids, and also reduction in blood urea nitrogen and in clinical complaints could be observed. At a gestational age of 28 weeks + 4 days, delivery was performed by Caesarean section. This case study shows that effective treatment of elevated uraemic toxins significantly reduced the morbidity risks of the twins.
Collapse
Affiliation(s)
- Ann-Maria Gramkow
- Department of Nephrology , Odense University Hospital , Odense , Denmark
| | - Michael Aarup
- Department of Nephrology , Odense University Hospital , Odense , Denmark
| | | | - Martin Tepel
- Department of Nephrology , Odense University Hospital , Odense , Denmark ; Institute of Molecular Medicine, Cardiovascular and Renal Research , University of Southern Denmark , Odense , Denmark
| |
Collapse
|
46
|
Tepel M, Armbruster FP, Grön HJ, Scholze A, Reichetzeder C, Roth HJ, Hocher B. Nonoxidized, biologically active parathyroid hormone determines mortality in hemodialysis patients. J Clin Endocrinol Metab 2013; 98:4744-51. [PMID: 24171919 DOI: 10.1210/jc.2013-2139] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND It was shown that nonoxidized PTH (n-oxPTH) is bioactive, whereas the oxidation of PTH results in a loss of biological activity. METHODS In this study we analyzed the association of n-oxPTH on mortality in hemodialysis patients using a recently developed assay system. RESULTS Hemodialysis patients (224 men, 116 women) had a median age of 66 years. One hundred seventy patients (50%) died during the follow-up period of 5 years. Median n-oxPTH levels were higher in survivors (7.2 ng/L) compared with deceased patients (5.0 ng/L; P = .002). Survival analysis showed an increased survival in the highest n-oxPTH tertile compared with the lowest n-oxPTH tertile (χ², 14.3; P = .0008). Median survival was 1702 days in the highest n-oxPTH tertile, whereas it was only 453 days in the lowest n-oxPTH tertile. Multivariable-adjusted Cox regression showed that higher age increased odds for death, whereas higher n-oxPTH reduced the odds for death. Another model analyzing a subgroup of patients with intact PTH (iPTH) concentrations at baseline above the upper normal range of the iPTH assay (70 ng/L) revealed that mortality in this subgroup was associated with oxidized PTH but not with n-oxPTH levels. CONCLUSIONS The predictive power of n-oxPTH and iPTH on the mortality of hemodialysis patients differs substantially. Measurements of n-oxPTH may reflect the hormone status more precisely. The iPTH-associated mortality is most likely describing oxidative stress-related mortality.
Collapse
Affiliation(s)
- Martin Tepel
- MD, PhD, Institute of Nutritional Science, University of Potsdam, 14558 Nuthetal, Potsdam, Germany.
| | | | | | | | | | | | | |
Collapse
|
47
|
Claessen H, Strassburger K, Tepel M, Waldeyer R, Chernyak N, Jülich F, Albers B, Bächle C, Rathmann W, Meisinger C, Thorand B, Hunger M, Schunk M, Stark R, Rückert IM, Peters A, Huth C, Stöckl D, Giani G, Holle R, Icks A. Medication costs by glucose tolerance stage in younger and older women and men: results from the population-based KORA survey in Germany. Exp Clin Endocrinol Diabetes 2013; 121:614-23. [PMID: 24122240 DOI: 10.1055/s-0033-1354357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To estimate medication costs in individuals with diagnosed diabetes, undetected diabetes, impaired glucose regulation and normal blood glucose values in a population-based sample by age and sex.Using the KORA F4 follow-up survey, conducted in 2006-2008 (n=2611, age 40-82 years), we identified individuals' glucose tolerance status by means of an oral glucose tolerance test. We assessed all medications taken regularly, calculated age-sex specific medication costs and estimated cost ratios for total, total without antihyperglycemic drugs, and cardiovascular medication, using multiple 2-part regression models.Compared to individuals with normal glucose values, costs were increased in known diabetes, undetected diabetes and impaired glucose regulation, which was more pronounced in participants aged 40-59 years than in those aged 60-82 years (cost ratios for all medications: 40-59 years: 2.85; 95%-confidence interval: 1.78-4.54, 2.00; 1.22-3.29 and 1.53; 1.12-2.09; 60-82 years: 2.04; 1.71-2.43, 1.17; 0.90-1.51 and 1.09; 0.94-1.28). Compared to individuals with diagnosed diabetes, costs were significantly lower among individuals with impaired glucose regulation across all age and sex strata, also when antihyperglycemic medication was excluded (40-59 years: 0.60; 0.36-0.98, 60-82 years: 0.74; 0.60-0.90; men: 0.72; 0.56-0.93; women: 0.72; 0.54-0.96).We could quantify age- and sex-specific medication costs and cost ratios in individuals with diagnosed diabetes, undetected diabetes and impaired glucose regulation compared to those with normal glucose values, using data of a population-based sample, with oral glucose tolerance test-based identification of diabetes states. These results may help to validly estimate cost-effectiveness of screening and early treatment or prevention of diabetes.
Collapse
Affiliation(s)
- H Claessen
- Institute of Biometrics and Epidemiology, German Diabetes Center at the Heinrich-Heine-University, Leibniz-Center for Diabetes Research, Duesseldorf, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Henze A, Raila J, Scholze A, Zidek W, Tepel M, Schweigert FJ. Does N-acetylcysteine modulate post-translational modifications of transthyretin in hemodialysis patients? Antioxid Redox Signal 2013; 19:1166-72. [PMID: 23249342 DOI: 10.1089/ars.2012.5125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
It is assumed that effects of the thiol antioxidant N-acetylcysteine (NAC) are mediated by interaction with protein-associated cysteine residues, however, information on protein level in vivo are missing. Therefore, we analyzed NAC-induced modifications of the protein transthyretin (TTR) in plasma of hemodialysis patients in a randomized, placebo-controlled study. TTR was selected due to its low molecular weight and the free cysteine residue in the polypeptide chain, which is known to be extensively modified by formation of mixed disulfides. The intravenous application of NAC during a hemodialysis session resulted in a substantial increase of native TTR from median 15% (range 8.8%-30%) to median 40% (37-50) and reduction of S-cysteinylated TTR [51% (44-60) vs. 6.6% (2.4-10)]. Additionally the pronounced formation of a TTR-NAC adduct was detected. However, all these modifications seemed to be reversible. Additionally, in vitro incubation of plasma with NAC confirmed the in vivo results and indicated that changes in post-translational modification pattern of TTR were a function of NAC concentration. Based on these observations and the essential metabolic and biochemical role of protein-associated cysteine residues we hypothesize that the interaction of NAC with proteins may explain altered protein functions due to modification of cysteine residues.
Collapse
Affiliation(s)
- Andrea Henze
- 1 Institute of Nutritional Science, University of Potsdam , Nuthetal, Germany
| | | | | | | | | | | |
Collapse
|
49
|
Chen L, Kaßmann M, Marko L, Tepel M, Gollasch M. Abstract 509: Role of TRPV1 and TRPV4 Channels in the Renal Vasculature. Hypertension 2013. [DOI: 10.1161/hyp.62.suppl_1.a509] [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
Transient receptor potential vanilloid 1 (TRPV1) and vanilloid 4 (TRPV4) cation channels have been recently identified to promote endothelium-dependent relaxation of small mesenteric arteries of mice, with calcium sparklets providing elementary calcium influx through single TRPV4 channels. The role of TRPV1 and TRPV4 in the renal vasculature is largely unknown. We hypothesized that TRPV1 and TRPV4 play an important role in endothelium-dependent vasodilation of renal blood vessels. We performed myography experiments on isolated renal arteries and perfused isolated kidneys of C57BL/6J mice. Isolated mesenteric arteries served as control vessels. The TRPV1 agonist capsaicin relaxed mesenteric arteries with an EC
50
of ~9 nM, but not large renal arteries (EC
50
>10 μM). This relaxation was inhibited by the TRPV1 antagonist capsazepine (10 μM). The capsaicin effect was absent in vessels of TRPV1 knock-out mice. Cytochrome P450 (CYP) 4A- and CYP4F-derived hydroxyeicosatetraenoic acid (20-HETE), which is a proinflammatory mediator of endotoxin-induced acute systemic inflammation, activated TRPV1 channels in patch clamp studies. The TRPV4 agonist GSK1016790A relaxed renal and mesenteric arteries with EC
50
of ~12 nM and 70 nM, respectively. These effects were inhibited by a specific TRPV4 antagonist, AB159908 (10 μM). Capsaicin
and GSK1016790A produced vascular dilation in isolated kidneys with EC
50
of ~11 nM and ~2 nM, respectively. The capsaicin effects were absent in kidneys of TRPV1 knock-out mice, whereas the effects of
GSK1016790A were also observed in TRPV1 knock-out mice. Our results demonstrate that TRPV4 channels are capable to promote endothelial relaxation in large and small renal arteries, whereas TRPV1 channels play a specific vasodilatory role in small arteries of the kidney. We suggest that specific activation of TRPV1 and TRPV4 may be a novel promising strategy for treatment of sepsis-associated renal vasoconstriction.
Collapse
Affiliation(s)
- Lan Chen
- Charité Univ Berlin, Berlin, Germany
| | | | | | | | | |
Collapse
|
50
|
Leeming DJ, Karsdal MA, Rasmussen LM, Scholze A, Tepel M. Association of systemic collagen type IV formation with survival among patients undergoing hemodialysis. PLoS One 2013; 8:e71050. [PMID: 23990924 PMCID: PMC3750054 DOI: 10.1371/journal.pone.0071050] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [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: 04/14/2013] [Accepted: 06/24/2013] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The 7S domain of collagen type IV (P4NP_7S) assessed in plasma represents systemic collagen type IV formation. The objective of the study was to investigate the association of systemic collagen type IV formation with survival among patients undergoing hemodialysis. METHODS We performed an observational cohort study of 371 hemodialysis patients. Plasma P4NP_7S was analyzed using a specific enzyme-linked immunosorbent assay detecting the amino-terminal propeptide of type IV procollagen. Association between categories of plasma P4NP_7S concentrations and survival was initially assessed by Kaplan-Meier analysis, then in an adjusted Cox model. RESULTS For hemodialysis patients in the highest category of systemic collagen type IV formation, i.e. plasma P4NP_7S concentrations more than 775 pg/L, an increased risk for death was observed (highest P4NP_7S category vs all other categories, hazard ratio, 1.934; 95% confidence interval, 1.139 to 3.285). Survival analysis showed an increased risk of death in the highest P4NP_7S category compared to the other categories (Chi square 6.903; P = 0.032). Median survival was only 105 days in the highest P4NP_7S category whereas it was 629 days in the medium category, and 905 days in the lowest category. Multivariable-adjusted Cox regression showed increased odds for death with higher age and higher P4NP_7S categories. Systemic collagen type IV formation was associated with plasma concentrations of the collagen IV degradation product C4M (Spearman r = 0.764; P<0.0001) confirming extracellular matrix turnover. CONCLUSION Among hemodialysis patients elevated systemic collagen type IV formation suggesting accelerating systemic fibrosis was associated with increased risk of death.
Collapse
Affiliation(s)
| | | | - Lars M. Rasmussen
- Odense University Hospital, Department of Clinical Biochemistry and Pharmacology, Odense, Denmark
| | - Alexandra Scholze
- Odense University Hospital, Department of Nephrology, Institute for Molecular Medicine, Cardiovascular and Renal Research, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Martin Tepel
- Odense University Hospital, Department of Nephrology, Institute for Molecular Medicine, Cardiovascular and Renal Research, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|