1
|
Salehi T, Montarello NJ, Juneja N, Stokes MB, Scherer DJ, Williams KF, King D, Macaulay E, Russell CH, Olakkengil SA, Carroll RP, Faull RJ, Teo KS, McDonald SP, Worthley MI, Coates PT, Rao NN. Long-Term Impact of Arteriovenous Fistula Ligation on Cardiac Structure and Function in Kidney Transplant Recipients: A 5-Year Follow-Up Observational Cohort Study. Kidney360 2021; 2:1141-1147. [PMID: 35368362 PMCID: PMC8786094 DOI: 10.34067/kid.0000692021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/06/2021] [Indexed: 02/04/2023]
Abstract
Background The long-term effects of arteriovenous fistula (AVF) ligation on cardiovascular structure following kidney transplantation remain uncertain. A prospective randomized, controlled trial (RCT) examined the effect of AVF ligation at 6 months on cardiovascular magnetic resonance imaging (CMR)-derived parameters in 27 kidney transplant recipients compared with 27 controls. A mean decrease in left ventricular mass (LVM) of 22.1 g (95% CI, 15.0 to 29.1) was observed compared with an increase of 1.2 g (95% CI, -4.8 to 7.2) in the control group (P<0.001). We conducted a long-term follow-up observational cohort study in the treated cohort to determine the evolution of CMR-derived parameters compared with those documented at 6 months post-AVF ligation. Methods We performed CMR at long-term follow-up in the AVF ligation observational cohort from our original RCT published in 2019. Results were compared with CMR at 6 months postintervention. The coprimary end point was the change in CMR-derived LVM and LVM index at long-term follow-up from imaging at 6 months postindex procedure. Results At a median of 5.1 years (interquartile range, 4.7-5.5 years), 17 patients in the AVF ligation group were studied with repeat CMR with a median duration to follow-up imaging of 5.1 years (IQR, 4.7-5.5 years). Statistically significant further reductions in LVM (-17.6±23.0 g, P=0.006) and LVM index (-10.0±13.0 g/m2, P=0.006) were documented. Conclusions The benefit of AVF ligation on LVM and LVM index regression appears to persist long term. This has the potential to lead to a significant reduction in cardiovascular mortality.
Collapse
Affiliation(s)
- Tania Salehi
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia,Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Nicholas J. Montarello
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia,Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Nishant Juneja
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Michael B. Stokes
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Daniel J. Scherer
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Kerry F. Williams
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - David King
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia
| | - Ewan Macaulay
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia
| | - Christine H. Russell
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia
| | - Santosh A. Olakkengil
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia
| | - Robert P. Carroll
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia,Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Randall J. Faull
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia,Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Karen S.L. Teo
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia,Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Stephen P. McDonald
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia,Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Matthew I. Worthley
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia,Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Patrick T. Coates
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia,Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Nitesh N. Rao
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, South Australia, Australia,Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
2
|
Toussaint ND, Pedagogos E, Lioufas NM, Elder GJ, Pascoe EM, Badve SV, Valks A, Block GA, Boudville N, Cameron JD, Campbell KL, Chen SSM, Faull RJ, Holt SG, Jackson D, Jardine MJ, Johnson DW, Kerr PG, Lau KK, Hooi LS, Narayan O, Perkovic V, Polkinghorne KR, Pollock CA, Reidlinger D, Robison L, Smith ER, Walker RJ, Wang AYM, Hawley CM. A Randomized Trial on the Effect of Phosphate Reduction on Vascular End Points in CKD (IMPROVE-CKD). J Am Soc Nephrol 2020; 31:2653-2666. [PMID: 32917784 PMCID: PMC7608977 DOI: 10.1681/asn.2020040411] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/14/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hyperphosphatemia is associated with increased fibroblast growth factor 23 (FGF23), arterial calcification, and cardiovascular mortality. Effects of phosphate-lowering medication on vascular calcification and arterial stiffness in CKD remain uncertain. METHODS To assess the effects of non-calcium-based phosphate binders on intermediate cardiovascular markers, we conducted a multicenter, double-blind trial, randomizing 278 participants with stage 3b or 4 CKD and serum phosphate >1.00 mmol/L (3.10 mg/dl) to 500 mg lanthanum carbonate or matched placebo thrice daily for 96 weeks. We analyzed the primary outcome, carotid-femoral pulse wave velocity, using a linear mixed effects model for repeated measures. Secondary outcomes included abdominal aortic calcification and serum and urine markers of mineral metabolism. RESULTS A total of 138 participants received lanthanum and 140 received placebo (mean age 63.1 years; 69% male, 64% White). Mean eGFR was 26.6 ml/min per 1.73 m2; 45% of participants had diabetes and 32% had cardiovascular disease. Mean serum phosphate was 1.25 mmol/L (3.87 mg/dl), mean pulse wave velocity was 10.8 m/s, and 81.3% had abdominal aortic calcification at baseline. At 96 weeks, pulse wave velocity did not differ significantly between groups, nor did abdominal aortic calcification, serum phosphate, parathyroid hormone, FGF23, and 24-hour urinary phosphate. Serious adverse events occurred in 63 (46%) participants prescribed lanthanum and 66 (47%) prescribed placebo. Although recruitment to target was not achieved, additional analysis suggested this was unlikely to have significantly affected the principle findings. CONCLUSIONS In patients with stage 3b/4 CKD, treatment with lanthanum over 96 weeks did not affect arterial stiffness or aortic calcification compared with placebo. These findings do not support the role of intestinal phosphate binders to reduce cardiovascular risk in patients with CKD who have normophosphatemia. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER Australian Clinical Trials Registry, ACTRN12610000650099.
Collapse
Affiliation(s)
- Nigel D Toussaint
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Eugenia Pedagogos
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
- Western Health, Melbourne, Victoria, Australia
| | - Nicole M Lioufas
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
- Western Health, Melbourne, Victoria, Australia
| | - Grahame J Elder
- School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Elaine M Pascoe
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Sunil V Badve
- St. George Hospital, Sydney, New South Wales, Australia
- Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrea Valks
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Neil Boudville
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - James D Cameron
- Monash Cardiovascular Research Centre, Monash Heart, Monash Health, Clayton, Victoria, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Katrina L Campbell
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | - Randall J Faull
- Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Central Northern Adelaide Renal and Transplantation Services, Adelaide, South Australia, Australia
| | - Stephen G Holt
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | | | - Meg J Jardine
- Concord Repatriation and General Hospital, Concord, New South Wales, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - David W Johnson
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
| | - Peter G Kerr
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Monash Health, Clayton, Victoria, Australia
| | - Kenneth K Lau
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Monash Health, Clayton, Victoria, Australia
| | | | - Om Narayan
- Monash Cardiovascular Research Centre, Monash Heart, Monash Health, Clayton, Victoria, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Vlado Perkovic
- Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Kevan R Polkinghorne
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Monash Health, Clayton, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Carol A Pollock
- Kolling Institute, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Donna Reidlinger
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Laura Robison
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Edward R Smith
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Robert J Walker
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Carmel M Hawley
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| |
Collapse
|
3
|
Zarrinkalam KH, Leavesley DI, Stanley JM, Atkins GJ, Faull RJ. Expression of Defensin Antimicrobial Peptides in the Peritoneal Cavity of Patients on Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080102100512] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To investigate the expression and regulation of defensins in the peritoneal cavity of peritoneal dialysis (PD) patients. Design The presence of defensins in the peritoneal cavity was assessed using reverse transcription polymerase chain reaction (RT-PCR). In vivo defensin expression was analyzed in human peritoneal membrane biopsies and in peritoneal cavity leukocytes isolated from spent dialysate. Defensin expression in vitro was assessed in cultured human peritoneal mesothelial cells (HPMC) and confirmed with PCR Southern blot and DNA sequencing. The effect of tumor necrosis factor alpha (TNFa) and epidermal growth factor (EGF) on b2 defensin expression in HPMC was analyzed by Northern blot analysis and RT-PCR respectively. Results Both a and b classes of defensins are expressed in the peritoneal cavity of PD patients. Messenger RNA for the a-defensin human neutrophil peptide 3 and for b-defensin-1 (hbD-1) were found in preparations containing predominantly peritoneal leukocytes, whereas b-defensin-2 (hbD-2) is expressed by HPMC. HPMC isolated from different individuals displayed variability in both basal hbD-2 expression and in response to stimulation by TNFa. Conversely, EGF consistently downregulated the level of hbD-2 message in HPMC. Conclusion a- and b-defensins are expressed in the peritoneal cavity, and hbD-2 is the main defensin present in the peritoneal membrane. Variable levels of expression of hbD-2 by mesothelial cells were seen, with evidence of regulation by cytokines and growth factors. This provides evidence for a previously unknown mechanism of innate immunity at that site.
Collapse
Affiliation(s)
- Krystyna H. Zarrinkalam
- Department of Renal Medicine, Department of Orthopaedic Surgery and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - David I. Leavesley
- Department of Renal Medicine, Department of Orthopaedic Surgery and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jodie M. Stanley
- Department of Renal Medicine, Department of Orthopaedic Surgery and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Gerald J. Atkins
- Department of Renal Medicine, Department of Orthopaedic Surgery and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Randall J. Faull
- Department of Renal Medicine, Department of Orthopaedic Surgery and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| |
Collapse
|
4
|
Rao NN, Stokes MB, Rajwani A, Ullah S, Williams K, King D, Macaulay E, Russell CH, Olakkengil S, Carroll RP, Faull RJ, Teo KS, McDonald SP, Worthley MI, Coates PT. Effects of Arteriovenous Fistula Ligation on Cardiac Structure and Function in Kidney Transplant Recipients. Circulation 2019; 139:2809-2818. [DOI: 10.1161/circulationaha.118.038505] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Nitesh N. Rao
- Adelaide Medical School, University of Adelaide, Australia (N.N.R., S.U., R.P.C., S.P.M., M.I.W., P.T.C.)
- Central Northern Adelaide Renal and Transplantation Service (N.N.R., D.K., E.M., C.H.R., S.O., R.P.C., R.J.F., S.P.M., P.T.C.), Central Adelaide Local Health Network, Australia
- Lyell McEwin Hospital, Northern Adelaide Local Health Network, Australia (N.N.R.)
| | - Michael B. Stokes
- Department of Cardiology (M.B.S., A.R., K.W., K.S.L.T., M.I.W.), Central Adelaide Local Health Network, Australia
| | - Adil Rajwani
- Department of Cardiology (M.B.S., A.R., K.W., K.S.L.T., M.I.W.), Central Adelaide Local Health Network, Australia
- Department of Cardiology, Royal Perth Hospital, Australia (A.R.)
| | - Shahid Ullah
- Adelaide Medical School, University of Adelaide, Australia (N.N.R., S.U., R.P.C., S.P.M., M.I.W., P.T.C.)
- Australia and New Zealand Dialysis and Transplant Registry 1 (S.U., S.P.M.), South Australian Health and Medical Research Institute, Adelaide
| | - Kerry Williams
- Department of Cardiology (M.B.S., A.R., K.W., K.S.L.T., M.I.W.), Central Adelaide Local Health Network, Australia
| | - David King
- Central Northern Adelaide Renal and Transplantation Service (N.N.R., D.K., E.M., C.H.R., S.O., R.P.C., R.J.F., S.P.M., P.T.C.), Central Adelaide Local Health Network, Australia
- Department of Vascular Surgery (D.K., E.M.), Central Adelaide Local Health Network, Australia
| | - Ewan Macaulay
- Central Northern Adelaide Renal and Transplantation Service (N.N.R., D.K., E.M., C.H.R., S.O., R.P.C., R.J.F., S.P.M., P.T.C.), Central Adelaide Local Health Network, Australia
- Department of Vascular Surgery (D.K., E.M.), Central Adelaide Local Health Network, Australia
| | - Christine H. Russell
- Central Northern Adelaide Renal and Transplantation Service (N.N.R., D.K., E.M., C.H.R., S.O., R.P.C., R.J.F., S.P.M., P.T.C.), Central Adelaide Local Health Network, Australia
| | - Santosh Olakkengil
- Central Northern Adelaide Renal and Transplantation Service (N.N.R., D.K., E.M., C.H.R., S.O., R.P.C., R.J.F., S.P.M., P.T.C.), Central Adelaide Local Health Network, Australia
| | - Robert P. Carroll
- Adelaide Medical School, University of Adelaide, Australia (N.N.R., S.U., R.P.C., S.P.M., M.I.W., P.T.C.)
- Central Northern Adelaide Renal and Transplantation Service (N.N.R., D.K., E.M., C.H.R., S.O., R.P.C., R.J.F., S.P.M., P.T.C.), Central Adelaide Local Health Network, Australia
| | - Randall J. Faull
- Central Northern Adelaide Renal and Transplantation Service (N.N.R., D.K., E.M., C.H.R., S.O., R.P.C., R.J.F., S.P.M., P.T.C.), Central Adelaide Local Health Network, Australia
| | - Karen S.L. Teo
- Department of Cardiology (M.B.S., A.R., K.W., K.S.L.T., M.I.W.), Central Adelaide Local Health Network, Australia
| | - Stephen P. McDonald
- Adelaide Medical School, University of Adelaide, Australia (N.N.R., S.U., R.P.C., S.P.M., M.I.W., P.T.C.)
- Central Northern Adelaide Renal and Transplantation Service (N.N.R., D.K., E.M., C.H.R., S.O., R.P.C., R.J.F., S.P.M., P.T.C.), Central Adelaide Local Health Network, Australia
- Australia and New Zealand Dialysis and Transplant Registry 1 (S.U., S.P.M.), South Australian Health and Medical Research Institute, Adelaide
| | - Matthew I. Worthley
- Adelaide Medical School, University of Adelaide, Australia (N.N.R., S.U., R.P.C., S.P.M., M.I.W., P.T.C.)
- Department of Cardiology (M.B.S., A.R., K.W., K.S.L.T., M.I.W.), Central Adelaide Local Health Network, Australia
- Heart Health Theme (M.I.W.), South Australian Health and Medical Research Institute, Adelaide
| | - P. Toby Coates
- Adelaide Medical School, University of Adelaide, Australia (N.N.R., S.U., R.P.C., S.P.M., M.I.W., P.T.C.)
- Central Northern Adelaide Renal and Transplantation Service (N.N.R., D.K., E.M., C.H.R., S.O., R.P.C., R.J.F., S.P.M., P.T.C.), Central Adelaide Local Health Network, Australia
| |
Collapse
|
5
|
Warren JM, Irish GL, Purbrick B, Li JJ, Li X, Fitzpatrick DJ, Faull RJ. Developing the future Indigenous health workforce: The feasibility and impact of a student-led placement programme in remote Indigenous communities. Aust J Rural Health 2016; 24:306-311. [DOI: 10.1111/ajr.12281] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2015] [Indexed: 11/28/2022] Open
Affiliation(s)
| | | | | | - Joule J. Li
- University of Adelaide; Adelaide SA Australia
| | - Xi Li
- University of Adelaide; Adelaide SA Australia
| | | | | |
Collapse
|
6
|
Affiliation(s)
- Nitesh N. Rao
- Department of Renal Medicine; Royal Adelaide Hospital; Adelaide South Australia Australia
- University of Adelaide; Adelaide South Australia Australia
| | - Benjamin K. Dundon
- Monash Cardiovascular Research Centre; Monash HEART; Monash Health; Melbourne Victoria Australia
| | - Matthew I. Worthley
- Cardiovascular Research Centre at the Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Randall J. Faull
- Department of Renal Medicine; Royal Adelaide Hospital; Adelaide South Australia Australia
| |
Collapse
|
7
|
Dundon BK, Pisaniello AD, Nelson AJ, Maia M, Teo KS, Worthley SG, Coates PT, Russ GR, Faull RJ, Bannister K, Worthley MI. Dobutamine Stress Cardiac MRI for Assessment of Coronary Artery Disease Prior to Kidney Transplantation. Am J Kidney Dis 2015; 65:808-9. [DOI: 10.1053/j.ajkd.2015.02.319] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 02/10/2015] [Indexed: 11/11/2022]
|
8
|
Hakim H, Rao NN, Faull RJ, Coates PT. Nocardiosis presenting as a lung mass in a kidney transplant recipient. Nephrology (Carlton) 2015; 20 Suppl 1:6-9. [PMID: 25807850 DOI: 10.1111/nep.12420] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2014] [Indexed: 11/29/2022]
Abstract
Nocardiosis is a potentially life-threatening disease in renal transplant recipients. It is an uncommon infection with high lethality if left untreated. We report a case of a 67 year-old kidney transplant recipient who developed pulmonary nocardiosis and presented with pleural effusion along with an underlying lung mass, which was successfully treated with trimethoprim-sulphamethoxazole in conjunction with a reduction in immunosuppressive therapy. Five months later, graft function remains stable with complete regression of radiological abnormalities and absence of symptoms. Nocardiosis should be suspected in the presence of pulmonary symptoms in a transplant patient with unusual radiological presentation.
Collapse
Affiliation(s)
- Harris Hakim
- Central Northern Adelaide Renal and Transplant Service, Adelaide, South Australia, Australia
| | | | | | | |
Collapse
|
9
|
Dundon BK, Torpey K, Nelson AJ, Wong DT, Duncan RF, Meredith IT, Faull RJ, Worthley SG, Worthley MI. The deleterious effects of arteriovenous fistula-creation on the cardiovascular system: a longitudinal magnetic resonance imaging study. Int J Nephrol Renovasc Dis 2014; 7:337-45. [PMID: 25258554 PMCID: PMC4172192 DOI: 10.2147/ijnrd.s66390] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Aim Arteriovenous fistula-formation remains critical for the provision of hemodialysis in end-stage renal failure patients. Its creation results in a significant increase in cardiac output, with resultant alterations in cardiac stroke volume, systemic blood flow, and vascular resistance. The impact of fistula-formation on cardiac and vascular structure and function has not yet been evaluated via “gold standard” imaging techniques in the modern era of end-stage renal failure care. Methods A total of 24 patients with stage 5 chronic kidney disease undergoing fistula-creation were studied in a single-arm pilot study. Cardiovascular magnetic resonance imaging was undertaken at baseline, and prior to and 6 months following fistula-creation. This gold standard imaging modality was used to evaluate, via standard brachial flow-mediated techniques, cardiac structure and function, aortic distensibility, and endothelial function. Results At follow up, left ventricular ejection fraction remained unchanged, while mean cardiac output increased by 25.0% (P<0.0001). Significant increases in left and right ventricular end-systolic volumes (21% [P=0.014] and 18% [P<0.01]), left and right atrial area (11% [P<0.01] and 9% [P<0.01]), and left ventricular mass were observed (12.7% increase) (P<0.01). Endothelial-dependent vasodilation was significantly decreased at follow up (9.0%±9% vs 3.0%±6%) (P=0.01). No significant change in aortic distensibility was identified. Conclusion In patients with end-stage renal failure, fistula-formation is associated with an increase in cardiac output, dilation of all cardiac chambers and deterioration in endothelial function.
Collapse
Affiliation(s)
- Benjamin K Dundon
- Cardiology Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia ; Monash Cardiovascular Research Centre, MonashHEART, Monash Health, Melbourne, Vic, Australia ; Central Northern Renal and Transplantation Service, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Kim Torpey
- Central Northern Renal and Transplantation Service, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Adam J Nelson
- Cardiology Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Dennis Tl Wong
- Cardiology Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia ; Monash Cardiovascular Research Centre, MonashHEART, Monash Health, Melbourne, Vic, Australia
| | - Rae F Duncan
- Cardiology Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Ian T Meredith
- Monash Cardiovascular Research Centre, MonashHEART, Monash Health, Melbourne, Vic, Australia
| | - Randall J Faull
- Cardiology Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia ; Central Northern Renal and Transplantation Service, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Stephen G Worthley
- Cardiology Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia ; South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Matthew I Worthley
- Cardiology Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia ; South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| |
Collapse
|
10
|
Dundon BK, Torpey DK, Nelson AJ, Wong DTL, Duncan RF, Meredith IT, Faull RJ, Worthley SG, Worthley MI. Beneficial cardiovascular remodeling following arterio-venous fistula ligation post-renal transplantation: a longitudinal magnetic resonance imaging study. Clin Transplant 2014; 28:916-25. [DOI: 10.1111/ctr.12402] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Benjamin K. Dundon
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
- Monash Cardiovascular Research Centre; Monash HEART; Monash Health; Melbourne Vic. Australia
| | - David K. Torpey
- Department of Renal Medicine; Royal Adelaide Hospital; Adelaide SA Australia
| | - Adam J. Nelson
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
| | - Dennis T. L. Wong
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
- Monash Cardiovascular Research Centre; Monash HEART; Monash Health; Melbourne Vic. Australia
| | - Rae F. Duncan
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
| | - Ian T. Meredith
- Monash Cardiovascular Research Centre; Monash HEART; Monash Health; Melbourne Vic. Australia
| | - Randall J. Faull
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
- Department of Renal Medicine; Royal Adelaide Hospital; Adelaide SA Australia
| | - Stephen G. Worthley
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
| | - Matthew I. Worthley
- Cardiovascular Research Centre at the Royal Adelaide Hospital; University of Adelaide; Adelaide SA Australia
| |
Collapse
|
11
|
Black CL, Foster-Smith E, Lewis ID, Faull RJ, Sidhu SK. Post-transplant plasmablastic lymphoma of the skin. Australas J Dermatol 2012; 54:277-82. [DOI: 10.1111/j.1440-0960.2012.00939.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 06/23/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Catherine L. Black
- Department of Dermatology; Royal Adelaide Hospital; Adelaide South Australia Australia
| | | | - Ian D. Lewis
- Department of Haematology; SA Pathology; Adelaide South Australia Australia
| | - Randall J. Faull
- Department of Renal Medicine; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Shireen K. Sidhu
- Department of Dermatology; Royal Adelaide Hospital; Adelaide South Australia Australia
| |
Collapse
|
12
|
|
13
|
Jeffs LS, Hurtado PR, Faull RJ, Peh CA. Antineutrophil cytoplasmic antibody-associated vasculitis with renal involvement: the evidence for treatment. INT J EVID-BASED HEA 2011; 8:18-27. [PMID: 21495440 DOI: 10.1111/j.1744-1609.2010.00149.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Antineutrophil cytoplasmic antibody-associated vasculitis is an autoimmune disease involving small to medium blood vessels. It is an uncommon illness, but can have devastating consequences, particularly on kidney function and other vital organs. Exciting progress has been made in the treatment of the disease largely because of international collaboration in randomised clinical trials. Patient survival has improved dramatically with advancements in disease diagnosis and medical treatment. The long-term morbidity from the disease, although improving, remains substantial with up to 10% of survivors requiring dialysis or kidney transplantation. Clinical trials are underway using more specifically targeted immunosuppressants in the hope to improve the long-term patient outcomes. Advancements are also being made in understanding the pathogenesis of the disease and this will further assist disease treatment and outcomes in the future.
Collapse
Affiliation(s)
- Lisa S Jeffs
- Renal Unit, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, Australia.
| | | | | | | |
Collapse
|
14
|
Lau DH, Mackenzie L, Kelly DJ, Psaltis PJ, Brooks AG, Worthington M, Rajendram A, Kelly DR, Zhang Y, Kuklik P, Nelson AJ, Wong CX, Worthley SG, Rao M, Faull RJ, Edwards J, Saint DA, Sanders P. Hypertension and atrial fibrillation: evidence of progressive atrial remodeling with electrostructural correlate in a conscious chronically instrumented ovine model. Heart Rhythm 2010; 7:1282-90. [PMID: 20466075 DOI: 10.1016/j.hrthm.2010.05.010] [Citation(s) in RCA: 143] [Impact Index Per Article: 10.2] [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: 03/25/2010] [Accepted: 05/05/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hypertension accounts for more atrial fibrillation (AF) than any other predisposing factor. OBJECTIVE The purpose of this study was to characterize the time course, extent, and electrostructural correlation of atrial remodeling in chronic hypertension. METHODS Thirty-two sheep were studied: 21 with induced "one-kidney, one-clip" hypertension and 11 controls. Sequential closed-chest electrophysiologic studies were performed in 12 conscious animals (6 hypertensive, 6 controls) to evaluate progressive remodeling over 15 weeks. Additional atrial structural/functional analyses were performed in 5 controls and at 5, 10, and 15 weeks of hypertension (five per time point) via histology/cardiac magnetic resonance imaging to correlate with open-chest electrophysiologic parameters. RESULTS The hypertensive group developed a progressive increase in mean arterial pressure (P <.001). Mean effective refractory periods were uniformly higher at all time points (P <.001). Progressive biatrial hypertrophy (P = .003), left atrial dysfunction (P <.05) and greater AF inducibility were seen early with increased inflammation from 5 weeks of hypertension. In contrast, significant conduction slowing (P <.001) with increased heterogeneity (P <.001) along with increased interstitial fibrosis resulted in longer and more fractionated AF episodes only from 10 weeks of hypertension. Significant electrostructural correlation was seen in conduction abnormalities and AF inducibility with both atrial inflammation and fibrosis. CONCLUSION Hypertension is associated with early and progressive changes in atrial remodeling. Atrial remodeling occurs at different time domains in chronic hypertension with significant electrostructural correlation of the remodeling cascade. Early institution of antihypertensive treatment may prevent formation of substrate capable of maintaining AF.
Collapse
Affiliation(s)
- Dennis H Lau
- Cardiovascular Research Centre, Department of Cardiology, Royal Adelaide Hospital and Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Lau DH, Mackenzie L, Rajendram A, Psaltis PJ, Kelly DR, Spyropoulos P, Zhang Y, Olakkengil SA, Russell CH, Brooks AG, Faull RJ, Saint DA, Kelly DJ, Rao MM, Worthley SG, Sanders P. Characterization of cardiac remodeling in a large animal “one-kidney, one-clip” hypertensive model. Blood Press 2010; 19:119-25. [DOI: 10.3109/08037050903576767] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
16
|
Lau DH, Mackenzie L, Kelly DJ, Psaltis PJ, Worthington M, Rajendram A, Kelly DR, Nelson AJ, Zhang Y, Kuklik P, Brooks AG, Worthley SG, Faull RJ, Rao M, Edwards J, Saint DA, Sanders P. Short-term hypertension is associated with the development of atrial fibrillation substrate: a study in an ovine hypertensive model. Heart Rhythm 2009; 7:396-404. [PMID: 20185115 DOI: 10.1016/j.hrthm.2009.11.031] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [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: 10/22/2009] [Accepted: 11/28/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Hypertension is frequently complicated by the development of atrial fibrillation (AF). However, the mechanisms of this link remain poorly understood. In addition, whether short-term hypertension can result in a substrate for AF is not known. OBJECTIVE The purpose of this study was to characterize the atrial substrate predisposing to AF due to short-duration hypertension. METHODS Sixteen sheep were studied: 10 had induced hypertension for 7 +/- 4 weeks via the "one-kidney, one-clip" model, and six were controls. Cardiac magnetic resonance imaging was used to assess functional changes. Open-chest electrophysiological study was performed using a custom-made 128-electrode epicardial plaque applied to both right (RA) and left atria (LA), including the Bachmann's bundle, to determine effective refractory periods (ERPs) and conduction velocity at four pacing cycle lengths from six sites. Tissue specimens were harvested for structural analysis. RESULTS The hypertensive group demonstrated the following compared with controls: higher blood pressure (P <.0001), enlarged LA (P <.05), reduced LA ejection fraction (P <.05), uniformly higher mean ERP (P <.001), slower mean conduction velocity (P <.001), higher conduction heterogeneity index (P <.0001), greater AF inducibility (P = .03), and increased AF durations (P = .04). Picrosirius red staining of atrial tissues revealed increased interstitial fibrosis (P <.0001). There was also evidence of increased inflammatory cell infiltrates (P <.0001). CONCLUSION Short-duration hypertension is associated with significant atrial remodeling characterized by atrial enlargement/dysfunction, interstitial fibrosis, inflammation, slowed/heterogeneous conduction, increased ERP, and greater propensity for AF.
Collapse
Affiliation(s)
- Dennis H Lau
- Cardiovascular Research Centre, Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Reuter SE, Faull RJ, Ranieri E, Evans AM. Endogenous plasma carnitine pool composition and response to erythropoietin treatment in chronic haemodialysis patients. Nephrol Dial Transplant 2008; 24:990-6. [PMID: 18987259 DOI: 10.1093/ndt/gfn588] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Anaemia is a common complication associated with haemodialysis and is usually managed by treatment with recombinant human erythropoietin (rHuEPO). However, many patients remain hyporesponsive to rHuEPO treatment despite adequate iron therapy. The effect of L-carnitine administration on rHuEPO dose and/or haematocrit in haemodialysis patients has been previously reported with equivocal results. This study examined the relationship between endogenous carnitine pool composition and rHuEPO requirements in long-term haemodialysis patients. METHODS Pre-dialysis blood samples were collected from 87 patients and analysed for plasma L-carnitine and individual acylcarnitine levels by LCMS/MS. As an indication of rHuEPO responsiveness, erythropoietin resistance index (ERI) was calculated as rHuEPO dose/kg/week normalized for haemoglobin levels. RESULTS A significant negative correlation between L-carnitine levels and ERI was found (P = 0.0421). All patients categorized as high ERI (>0.02 microg/kg/week/gHb) exhibited subnormal L-carnitine levels (<30 microM); conversely, patients with normal L-carnitine levels (>30 microM) displayed low ERI values (<0.02 microg/kg/week/gHb). More importantly, the ratio of non-acetyl acylcarnitines/total carnitine was significantly positively correlated with ERI (P = 0.0062). CONCLUSIONS These data illustrate the relationship between carnitine levels and response to rHuEPO treatment in haemodialysis patients, in particular, the importance of the proportion of long-chain acylcarnitines within the plasma carnitine pool. This proportion may be more indicative of the response to L-carnitine supplementation than absolute L-carnitine levels alone.
Collapse
Affiliation(s)
- Stephanie E Reuter
- Sansom Institute, University of South Australia, Adelaide, SA, Australia
| | | | | | | |
Collapse
|
18
|
Galluccio ST, Faull RJ, Ghali J. Extreme hyperkalaemia and hypernatraemia in a renal-transplant recipient: where two wrongs make a right? Nephrology (Carlton) 2008; 13:448-9. [PMID: 18844835 DOI: 10.1111/j.1440-1797.2008.00947.x] [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: 11/29/2022]
Affiliation(s)
- Steven T Galluccio
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | | |
Collapse
|
19
|
Abstract
It has been widely established that patients with end-stage renal disease undergoing chronic haemodialysis therapy exhibit low endogenous levels of L-carnitine and elevated acylcarnitine levels; however, the clinical implication of this altered carnitine profile is not as clear. It has been suggested that these disturbances in carnitine homeostasis may be associated with a number of clinical problems common in this patient population, including erythropoietin-resistant anaemia, cardiac dysfunction, and dialytic complications such as hypotension, cramps and fatigue. In January 2003, the Centers for Medicare and Medicaid Services (USA) implemented coverage of intravenous L-carnitine for the treatment of erythropoietin-resistant anaemia and/or intradialytic hypotension in patients with low endogenous L-carnitine concentrations. It has been estimated that in the period of 1998-2003, 3.8-7.2% of all haemodialysis patients in the USA received at least one dose of L-carnitine, with 2.7-5.2% of patients receiving at least 3 months of supplementation for one or both of these conditions. The use of L-carnitine within Australia is virtually non-existent, which leads us to the question: Are Australian haemodialysis patients missing out? This review examines the previous research associated with L-carnitine administration to chronic dialysis patients for the treatment of anaemia, cardiac dysfunction, dyslipidaemia and/or dialytic symptoms, and discusses whether supplementation is warranted within the Australian setting.
Collapse
Affiliation(s)
- Stephanie E Reuter
- Sansom Institute, University of South Australia, and Department of Renal Medicine, Royal Adelaide Hospital, South Australia, Australia
| | | | | |
Collapse
|
20
|
Affiliation(s)
- Mohammed O Kaisar
- Renal Unit, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, Australia
| | | | | |
Collapse
|
21
|
Abstract
The linkage between bone parameters (calcium, phosphate, parathyroid hormone) and cardiovascular death in dialysis patients has led to a major resurgence in interest in this area of nephrological practice. Two major groups have recently published extensive guidelines for clinical practice in this area--the National Kidney Foundation's Kidney Disease Outcomes and Quality Initiative from the United States, and the Caring for Australasians with Renal Impairment group from Australia and New Zealand. There are some important differences in their recommendations, which reflect variations in local clinical practice, reimbursement systems, and interpretation of the medical literature. Two areas of divergence are highlighted in this editorial--use of vitamin D and its analogs, and use of phosphate binders. Readers of guidelines such as these need to be careful to interpret such recommendations in the context of the realities of their local clinical practice and availability of therapies.
Collapse
Affiliation(s)
- Randall J Faull
- Renal Unit, Royal Adelaide Hospital and the Department of Medicine, University of Adelaide, South Australia, Australia.
| |
Collapse
|
22
|
Abstract
AIM The aim of this pilot study was to test the effect of pravastatin on serum levels of high-sensitivity CRP (hs-CRP), IL-6 and the soluble adhesion molecules sVCAM-1, sICAM-1 and sE-selectin in chronic dialysis patients. METHODS At the commencement of the study, serum levels of lipids, liver function tests and endothelial markers (CRP, IL-6, sICAM-1, sVCAM-1, sE-selectin) were measured. Patients then commenced 1 month of 10 mg of pravastatin per day, and if tolerated, then 4 months of 40 mg of pravastatin per day. Serum levels of lipids, liver function tests and endothelial markers were repeated after the total of 5 months of pravastatin therapy. RESULTS Thirty-nine patients were enrolled, and 25 (male/female 17/8; 21 haemodialysis, 4 peritoneal dialysis) patients completed the study. Pravastatin therapy significantly improved the patients' lipid profiles, but had no significant effect on the levels of CRP, IL-6, sICAM-1, sVCAM-1, or sE-selectin. CONCLUSION Short-term (5 months) treatment with pravastatin in patients receiving chronic dialysis improved their lipid profile, but had no significant effect on surrogate markers of endothelial activation.
Collapse
Affiliation(s)
- Lisa S Jeffs
- Department of Renal Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
| | | | | | | | | |
Collapse
|
23
|
Reuter SE, Evans AM, Faull RJ, Chace DH, Fornasini G. Impact of haemodialysis on individual endogenous plasma acylcarnitine concentrations in end-stage renal disease. Ann Clin Biochem 2005; 42:387-93. [PMID: 16168195 DOI: 10.1258/0004563054889954] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with end-stage renal disease (ESRD) undergoing long-term haemodialysis exhibit low L-carnitine and elevated acylcarnitine concentrations. This study evaluated endogenous concentrations of an array of acylcarnitines (carbon chain length up to 18) in healthy individuals and ESRD patients receiving haemodialysis, and examined the impact of a single haemodialysis session on acylcarnitine concentrations. METHODS Blood samples were collected from 60 healthy subjects and 50 ESRD patients undergoing haemodialysis (pre- and post-dialysis samples). Plasma samples were analysed for individual acylcarnitine concentrations by electrospray MS/MS. RESULTS Of the 31 acylcarnitines, 29 were significantly (P<0.05) elevated in ESRD patients compared with healthy controls; in particular, C5 and C8:1 concentrations were substantially elevated. For acylcarnitines with a carbon chain length less than eight, plasma acylcarnitine concentrations decreased significantly over the course of a single dialysis session; however, post-dialysis concentrations invariably remained significantly higher than those in healthy subjects. Dialytic removal of acylcarnitines diminished once the acyl chain length exceeded eight carbons. CONCLUSIONS The accumulation of acylcarnitines during long-term haemodialysis suggests that removal by haemodialysis is less efficient than removal from the body by the healthy kidney. Removal is significantly correlated to acyl chain length, most likely due to the increased molecular weight and lipophilicity that accompanies increased chain length.
Collapse
Affiliation(s)
- Stephanie E Reuter
- Centre for Pharmaceutical Research, University of South Australia, North Terrace, Adelaide, SA 5000, Australia
| | | | | | | | | |
Collapse
|
24
|
Abstract
BACKGROUND Lymphoproliferative disease is a common and serious complication of organ transplantation. It is well documented that the risk of its development increases with the level of immunosuppression. Less is known about its incidence, prevalence, timing, and prognosis. METHODS The authors conducted a retrospective review of all patients with lymphoproliferative disease after renal transplantation documented in the Australia and New Zealand Dialysis and Transplant Registry from 1970 to March 2003. RESULTS One hundred ninety-seven cases of lymphoproliferative disease occurred in 15,930 allografts in 13,516 recipients. There has been a steady increase in its incidence and prevalence each decade since 1970. Cases cluster into an early group (<2 years after transplantation) and a late group (5-10 years after transplantation). Risk factors include exposure to a calcineurin inhibitor, but there was no increased risk in those treated with anti-T-lymphocyte antibodies. Patient survival was poor: 51% at 1 year and 39% at 5 years. CONCLUSIONS Lymphoproliferative disease is an increasingly common problem after renal transplantation, and the outcome is poor. Measures to reduce its incidence might include reduction of long-term immunosuppression exposure. Established disease has a high short-term mortality, and new treatment options, such as anti-B-lymphocyte monoclonal antibodies, should be aggressively pursued.
Collapse
Affiliation(s)
- Randall J Faull
- Renal Unit, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, Australia.
| | | | | |
Collapse
|
25
|
Mathew TH, Faull RJ, Snelling PL. The shortage of kidneys for transplantation in Australia. Med J Aust 2005. [DOI: 10.5694/j.1326-5377.2005.tb06901.x] [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: 11/17/2022]
|
26
|
Abstract
Progressive peritoneal membrane fibrosis, and associated loss of ultrafiltration and dialysis capacity, is an increasingly limiting problem with time on peritoneal dialysis. The primary culprit is the composition of the peritoneal dialysate, although episodes of peritonitis can hasten the process. At a molecular level, there is increasing evidence that several growth factors play key roles in the development of peritoneal membrane fibrosis. Transforming growth factor (TGF)-beta is widely implicated in pathological fibrosis, and a considerable body of evidence favours a similar role in the peritoneal membrane. Connective tissue growth factor (CTGF), a downstream mediator of TGF-beta-induced fibrosis, has more recently been implicated in peritoneal membrane scarring. In contrast to the pleiotropic effects of TGF-beta, CTGF more specifically targets the fibrosis pathway, and so is an attractive candidate for inhibiting the damage to the membrane. Heparin-binding epidermal growth factor-like growth factor (HB-EGF) has also been found in the peritoneal cavity, but its effect on peritoneal mesothelial cells suggests that it has a positive role in guiding membrane repair and avoiding pathological fibrosis. In the future, it is hoped that changes in peritoneal dialysis technology will create a better balance between the bad and good effects of these growth factors, which in turn will lead to more successful long-term outcomes for this major renal replacement therapy.
Collapse
Affiliation(s)
- Randall J Faull
- Renal Unit, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, Australia.
| |
Collapse
|
27
|
Evans AM, Faull RJ, Nation RL, Prasad S, Elias T, Reuter SE, Fornasini G. Impact of hemodialysis on endogenous plasma and muscle carnitine levels in patients with end-stage renal disease. Kidney Int 2004; 66:1527-34. [PMID: 15458447 DOI: 10.1111/j.1523-1755.2004.00916.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND End-stage renal disease (ESRD) patients undergoing hemodialysis treatment have reduced plasma L-carnitine levels; however, the relationship between dialysis age and carnitine status is poorly understood. This study examined the relationship between duration of dialysis and plasma and skeletal muscle concentrations of L-carnitine and its esters in ESRD patients. METHODS Blood samples were collected from 21 patients at baseline and throughout the first 12 months of hemodialysis. In 5 patients, muscle samples were obtained after 0, 6, and 12 months of hemodialysis. Blood and muscle samples were collected from an additional 20 patients with a mean dialysis age of 5.10 years. L-carnitine, acetyl-L-carnitine, and total L-carnitine were measured by high-performance liquid chromatography (HPLC). RESULTS The mean +/- SD plasma L-carnitine concentration in ESRD patients who had not yet started hemodialysis was 50.6 +/- 20.0 micromol/L. Significantly lower concentrations were observed after 12 months (29.7 +/- 10.5 micromol/L) and >12 months (22.0 +/- 5.4 micromol/L) of hemodialysis treatment. Acetyl-L-carnitine also declined with dialysis age, while plasma nonacetylated acylcarnitines continued to increase with the progression of hemodialysis therapy. An inverse relationship between dialysis age and muscle L-carnitine concentrations was observed. CONCLUSION Long-term hemodialysis treatment is associated with a significant reduction in endogenous plasma and muscle L-carnitine levels and a significant increase in plasma acylcarnitines. The majority of the change in plasma L-carnitine concentrations occurs within the first few months of hemodialysis, while muscle levels continue to decline after 12 months of treatment.
Collapse
Affiliation(s)
- Allan M Evans
- Centre for Pharmaceutical Research, School of Pharmaceutical, Molecular and Biomedical Sciences, University of South Australia, Adelaide, South Australia, Australia.
| | | | | | | | | | | | | |
Collapse
|
28
|
Zarrinkalam KH, Stanley JM, Gray J, Oliver N, Faull RJ. Connective tissue growth factor and its regulation in the peritoneal cavity of peritoneal dialysis patients. Kidney Int 2003; 64:331-8. [PMID: 12787426 DOI: 10.1046/j.1523-1755.2003.00069.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Connective tissue growth factor (CTGF) is a fibrogenic cytokine that is highly expressed in wound healing and fibrotic lesions. The role of transforming growth factor-beta (TGF-beta) in fibrosis is well documented, and the emerging understanding that its fibrogenic actions are mediated through CTGF has provided an attractive target molecule for the modulation of matrix overproduction in fibrotic disease. The involvement of CTGF in the pathogenesis of peritoneal membrane fibrosis in peritoneal dialysis (PD) patients has not been investigated, and so the aim of this study was to ascertain whether CTGF is produced in the peritoneal cavity of PD patients and to investigate its regulation by cytokines. METHODS Reverse transcription-polymerase chain reaction (RT-PCR), Northern blotting, and Western blotting were used to study CTGF expression by cultured human peritoneal mesothelial cells (HPMC) from peritoneal dialysis patients. Western blotting was used to detect CTGF expression in spent peritoneal dialysate from patients with and without peritonitis. RESULTS RT-PCR analysis demonstrated the expression of CTGF mRNA in cultured primay HPMCs isolated from spent peritoneal effluent. The production of the major 36 to 38 kD CTGF protein doublet by HPMC in addition to a 23 to 25 kD proteolytically processed form was confirmed by Western blotting. Several molecular weight forms of CTGF (18 to 38 kD) were also detected by Western blotting in peritoneal dialysate, with levels markedly elevated during episodes of peritonitis. Northern and Western blot analysis revealed that CTGF mRNA and protein production by HPMC was up-regulated by TGF-beta, with mRNA levels significantly increasing above the control (P < 0.01). In contrast, platelet-derived growth factor (PDGF), epidermal growth factor (EGF), and tumor necrosis factor-alpha (TNF-alpha) had no measurable effects on CTGF mRNA expression. CONCLUSION These results are the first to demonstrate the production of CTGF by HPMC and its presence in the peritoneal cavity of PD patients. The marked increase in CTGF levels by factors implicated in the development of peritoneal membrane fibrosis suggests its involvement in the underlying pathophysiologic mechanism(s).
Collapse
|
29
|
Keller LS, Peh CA, Nolan J, Bannister KM, Clarkson AR, Faull RJ. BK transplant nephropathy successfully treated with cidofovir. Nephrol Dial Transplant 2003; 18:1013-4. [PMID: 12686681 DOI: 10.1093/ndt/gfg061] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lisa S Keller
- Department of Renal Medicine, Royal Adelaide Hospital, North Terrace, Adelaide, SA 3000, Australia.
| | | | | | | | | | | |
Collapse
|
30
|
Abstract
BACKGROUND Since 1994 we have placed all peritoneal dialysis (Tenckhoff) catheters at our hospital laparoscopically using a technique that incorporates suture fixation into the pelvis. The purpose of this study was to determine the long-term outcome of this approach. METHOD Perioperative and follow-up data for all patients undergoing placement of a peritoneal dialysis catheter at the Royal Adelaide Hospital were collected prospectively and managed on unit specific and hospital wide computerized databases. A total of 148 procedures were carried out in 123 patients from March 1994 to November 2001. Follow-up ranged from 3 to 68 months (median, 42 months). All procedures were undertaken or supervised by one surgeon, and catheters were routinely sutured into the pelvis at laparoscopy. RESULTS There was no perioperative mortality in this series, and only one catheter could not be placed laparoscopically. This was in a patient with extensive intra-abdominal adhesions. Mean operative time was 27 min (range, 10-100 min), and mean postoperative stay was 2.8 days (range, 1-12 days). Seven (5%) patients experienced peri/postoperative haemorrhage, and four of these underwent surgical re-exploration. Twenty-five (17%) catheters are still used for dialysis. Thirty-four (23%) catheters were removed when the recipient received a subsequent renal transplant, and 42 (28%) patients died during follow-up. Forty-six (31%) patients required catheter revision or removal because of technical problems; 26 (18%) recurrent peritonitis or exit site infection; and 20 (14%) catheter blockage. Twenty-eight reinsertion procedures were carried out in 25 patients. Ten (7%) patients developed port site hernias at late follow-up, and required hernioplasty. Catheter migration leading to malfunction (poor drainage) occurred in eight (5%) patients only. CONCLUSIONS Laparoscopic placement of peritoneal dialysis catheters is a safe and effective procedure. The majority of patients will dialyse successfully using this technique. Suturing the catheter tip into the pelvis is associated with a low rate of catheter migration.
Collapse
Affiliation(s)
- Cu T Lu
- The University of Adelaide, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | | | | | | | | |
Collapse
|
31
|
Zarrinkalam KH, Leavesley DI, Stanley JM, Atkins GJ, Faull RJ. Expression of defensin antimicrobial peptides in the peritoneal cavity of patients on peritoneal dialysis. Perit Dial Int 2001; 21:501-8. [PMID: 11757835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVE To investigate the expression and regulation of defensins in the peritoneal cavity of peritoneal dialysis (PD) patients. DESIGN The presence of defensins in the peritoneal cavity was assessed using reverse transcription polymerase chain reaction (RT-PCR). In vivo defensin expression was analyzed in human peritoneal membrane biopsies and in peritoneal cavity leukocytes isolated from spent dialysate. Defensin expression in vitro was assessed in cultured human peritoneal mesothelial cells (HPMC) and confirmed with PCR Southern blot and DNA sequencing. The effect of tumor necrosis factor alpha (TNFalpha) and epidermal growth factor (EGF) on beta2 defensin expression in HPMC was analyzed by Northern blot analysis and RT-PCR respectively. RESULTS Both alpha and beta classes of defensins are expressed in the peritoneal cavity of PD patients. Messenger RNA for the alpha-defensin human neutrophil peptide 3 and for beta-defensin-1 (hbetaD-1) were found in preparations containing predominantly peritoneal leukocytes, whereas beta-defensin-2 (hbetaD-2) is expressed by HPMC. HPMC isolated from different individuals displayed variability in both basal hbetaD-2 expression and in response to stimulation by TNFalpha. Conversely, EGF consistently downregulated the level of hbetaD-2 message in HPMC. CONCLUSION Alpha- and beta-defensins are expressed in the peritoneal cavity, and hbetaD-2 is the main defensin present in the peritoneal membrane. Variable levels of expression of hbetaD-2 by mesothelial cells were seen, with evidence of regulation by cytokines and growth factors. This provides evidence for a previously unknown mechanism of innate immunity at that site.
Collapse
Affiliation(s)
- K H Zarrinkalam
- Department of Renal Medicine, Royal Adelaide Hospital, South Australia, Australia
| | | | | | | | | |
Collapse
|
32
|
Abstract
BACKGROUND The mesothelial cell monolayer lining the peritoneal membrane needs constant repair in response to peritonitis and to the toxicity of peritoneal dialysate. In many continuous ambulatory peritoneal dialysis (CAPD) patients, the repair process progressively fails, and membrane dysfunction and fibrosis occur. Heparin-binding epidermal growth factor-like growth factor (HB-EGF) has an important role in wound repair and is also fibrogenic, and thus may be involved in these processes in the peritoneal cavity. METHODS The presence of HB-EGF, its receptors, and its associated proteins was determined in peritoneal membrane biopsies, cultured human peritoneal mesothelial cells (HPMCs), and peritoneal macrophages from CAPD patients by reverse transcription-polymerase chain reaction, flow cytometry, and immunofluorescence immunocytochemistry with confocal microscopy. HB-EGF effects on HPMC adhesion were measured by a static adhesion assay, on integrin expression by flow cytometry, and on migration by wound healing and chemotaxis assays. RESULTS HB-EGF, its receptors HER-1 and HER-4, and the associated proteins CD9, CD44, and integrin alpha(3)beta(1) were expressed by HPMCs and peritoneal macrophages. HB-EGF colocalized with HER-1 and HER-4 in HPMCs and induced their adhesion to collagen type I, expression of beta 1 integrins, and migration. CONCLUSIONS HB-EGF is produced by cells in the peritoneal cavity of CAPD patients and has functional effects on HPMCs that would facilitate repair of the mesothelial layer.
Collapse
Affiliation(s)
- R J Faull
- Renal Laboratory, Royal Adelaide Hospital, Adelaide, South Australia.
| | | | | | | | | |
Collapse
|
33
|
Elias TJ, Bannister KM, Clarkson AR, Russ GR, Mathew TH, Barratt LJ, Faull RJ. Excellent long-term graft survival in low risk, primary renal allografts treated with prednisolone-avoidance immunosuppression. Clin Transplant 2000; 14:157-61. [PMID: 10770422 DOI: 10.1034/j.1399-0012.2000.140210.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Primary avoidance of oral corticosteroids for renal transplant recipients is uncommon. The South Australian renal transplant service used a double therapy (DT) regimen of cyclosporin and azathioprine from August 1986 to July 1996 for low risk (first graft, PRA < 50%) allografts. Oral corticosteroid, prednisolone (P), was reserved for severe rejection or two mild rejection episodes, but could be later withdrawn at the physician's discretion. This regimen is associated with more early acute rejection (Russ et al., Clin Transplant 1990: 4: 26). We have now analysed long-term patient survival (PS) and graft survival (GS) for this group. Of 448 transplants in South Australia between August 1986 and July 1996, 295 commenced DT regimen. Ninety-four (31.8%) never received P at any stage post-transplantation (group 1), 96 (32.5%) were placed on P and later weaned (group 2), and 97 (33%) remained on long-term P (group 3). Technical losses, eight (2.7%), within 30 d of transplantation, were excluded from sub-group analysis. PS for the total DT cohort at 1, 5 and 9 yr post-transplantation was 97, 88 and 74%, respectively. GS over the same time period was 88, 75 and 55%, respectively. There was no statistically significant difference in survival compared to other 'low risk' grafts in the rest of Australia during the same time period. Mean serum creatinine concentration (CrC) for the DT group at 3 and 6 months and 1, 3, 5 and 10 yr was not significantly different to the rest of the Australian 'low risk' grafts. In the DT cohort, there were 334 acute rejections ( < 90 d) in 206 patients (70%), but only 42 (12.5%) required anti-lymphocyte antibody therapy (OKT3 or ATG) for rejection. PS at 9 yr was not statistically significantly different between groups 1 and 2, but both groups survived better than group 3 (p < 0.0043). GS for group 1 at 1, 5 and 9 yr post-transplantation was 90, 81 and 73%, respectively; for group 2, 98, 87 and 66%, respectively; and for group 3, 84, 63 and 29%, respectively. Statistical significance was reached in group 1 versus 3 (p < 0.001) and group 2 versus 3 (p < 0.001). In summary, a DT regimen in low risk, first renal allografts gives excellent long-term patient and GS and minimises long-term P, despite a high rate of early acute rejection.
Collapse
Affiliation(s)
- T J Elias
- Renal Unit, Royal Adelaide Hospital, SA, Australia
| | | | | | | | | | | | | |
Collapse
|
34
|
Walker PC, Bannister KM, Clarkson AR, Faull RJ. Hypercalcaemia following renal transplantation: A common problem of limited clinical consequence? Nephrology (Carlton) 2000. [DOI: 10.1046/j.1440-1797.2000.00509.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
35
|
Affiliation(s)
- R J Faull
- Renal Unit, Royal Adelaide Hospital, Australia.
| |
Collapse
|
36
|
Abstract
Drug hypersensitivity reactions commonly cause acute interstitial nephritis (AIN). Clozapine, a new antipsychotic, can cause fatal bone-marrow toxicity. We report clozapine-induced AIN as another serious adverse drug reaction.
Collapse
|
37
|
Leavesley DI, Stanley JM, Faull RJ. Epidermal growth factor modifies the expression and function of extracellular matrix adhesion receptors expressed by peritoneal mesothelial cells from patients on CAPD. Nephrol Dial Transplant 1999; 14:1208-16. [PMID: 10344363 DOI: 10.1093/ndt/14.5.1208] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Efficient peritoneal dialysis depends on an intact layer of mesothelial cells that line the peritoneal membrane. This layer is disrupted in patents on continuous ambulatory peritoneal dialysis during episodes of peritonitis (acute injury) and replaced by fibrous tissue during extended dialysis (chronic injury). Little is understood of human peritoneal mesothelial cell (HPMC) responses to wounding and episodes of peritonitis. METHODS HPMC were harvested from spent peritoneal dialysis effluent and maintained under defined in vitro conditions. Adhesive interactions with extracellular matrix (ECM) molecules and chemotactic and wound-healing responses were measured in vitro using purified ECM molecules. RESULTS HPMC express multiple functional cell receptors recognizing and binding to ECM molecules, including several members of the integrin family. HPMC exhibit directed migration in wound healing and chemotaxis assays with ECM molecules. Epidermal growth factor (EGF) stimulates a reversible change to a fibroblastic phenotype, accompanied by increased expression of beta1 integrins, particularly alpha2beta1, increased adhesion to type I collagen, and significantly greater HPMC migration on type I collagen in wound healing and chemotaxis assays. CONCLUSIONS HPMC possess the migratory capacity to contribute to the efficient repair of damaged peritoneal membrane after acute injury, and growth factors, such as EGF, facilitate peritoneal membrane healing by augmenting cell adhesion and migration.
Collapse
Affiliation(s)
- D I Leavesley
- Renal Unit, Royal Adelaide Hospital, South Australia, Australia
| | | | | |
Collapse
|
38
|
|
39
|
Faull RJ, Bannister KM, Russ GR, Mathew TH, Clarkson AR. Excellent long-term survival of low-risk, first renal allografts using cyclosporine/azathioprine double therapy. Transplant Proc 1999; 31:1155-6. [PMID: 10083516 DOI: 10.1016/s0041-1345(98)01943-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- R J Faull
- Renal Units, Royal Adelaide Hospital, South Australia, Australia
| | | | | | | | | |
Collapse
|
40
|
Jose MD, Bannister KM, Clarkson AR, Faull RJ. Renal biopsy precipitating catastrophic antiphospholipid syndrome, complicated by protein S deficiency and acute adrenal failure. Aust N Z J Med 1999; 29:105-6. [PMID: 10200832 DOI: 10.1111/j.1445-5994.1999.tb01607.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
41
|
Gares SL, Giannakopoulos N, MacNeil D, Faull RJ, Pilarski LM. During human thymic development, beta 1 integrins regulate adhesion, motility, and the outcome of RHAMM/hyaluronan engagement. J Leukoc Biol 1998; 64:781-90. [PMID: 9850161 DOI: 10.1002/jlb.64.6.781] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
During human thymic differentiation, interactions between fibronectin (Fn)/beta1 integrins and hyaluronan (HA)/RHAMM control motility and Fn/beta1 integrins mediate spontaneous Fn-dependent adhesion. Multinegative (MN, CD3-4-8-) thymocytes exhibit strong spontaneous adherence to Fn (75%) that was efficiently inhibited by anti-alpha5beta1 and only weakly inhibited by anti-alpha4beta1. The relatively weak adherence of unfractionated thymocytes to Fn required both alpha4beta1 and alpha5beta1. Video time-lapse microscopy indicates that a subset of thymocytes also undergo spontaneous Fn-dependent motility mediated by alpha5beta1, alpha4beta1, and the HA-receptor RHAMM, but not by CD44. The loss of motility after hyaluronidase treatment of thymocytes indicated that motility is strongly dependent on HA. Of motile cells, 55% were DP, 19% were DN, and 24% were CD4+SP, but only 1% were CD8+SP. Overall, for MN thymocytes, beta1 integrin mediated Fn-adhesion, but after expression of CD4/CD8, beta1 integrins mediated Fn-dependent motility. Treatment with the activating anti-beta1 mAb QE.2E5 inhibited thymic motility and converted otherwise nonadherent thymocytes to an adherent state. High-avidity interactions via integrins appear to supercede the motogenicity of RHAMM and HA, suggesting that integrin avidity may regulate RHAMM. During thymic development, changes in adhesion or motility appear to be mediated by integrin avidity modulation.
Collapse
Affiliation(s)
- S L Gares
- Department of Oncology and The Cross Cancer Institute, University of Alberta, Edmonton, Canada
| | | | | | | | | |
Collapse
|
42
|
Jose MD, Bannister KM, Clarkson AR, Whitehead FJ, Faull RJ. Mesangiocapillary glomerulonephritis in a patient with Nocardia pneumonia. Nephrol Dial Transplant 1998; 13:2628-9. [PMID: 9794572 DOI: 10.1093/ndt/13.10.2628] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M D Jose
- Department of Renal Medicine, Royal Adelaide Hospital, SA, Australia
| | | | | | | | | |
Collapse
|
43
|
Affiliation(s)
- M D Jose
- Department of Renal Medicine, Royal Adelaide Hospital, South Australia, Australia
| | | | | | | |
Collapse
|
44
|
Affiliation(s)
- C G Chew
- Renal Unit, Royal Adelaide Hospital, South Australia
| | | | | |
Collapse
|
45
|
Faull RJ, Wang J, Leavesley DI, Puzon W, Russ GR, Vestweber D, Takada Y. A novel activating anti-beta1 integrin monoclonal antibody binds to the cysteine-rich repeats in the beta1 chain. J Biol Chem 1996; 271:25099-106. [PMID: 8810264 DOI: 10.1074/jbc.271.41.25099] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The functional status of an integrin depends on the conformation of its extracellular domain, which is controlled by the cell expressing that receptor. The transmission of regulatory signals from within the cell is considered to be via propagated conformational changes from the receptor's cytoplasmic tails to the extracellular ligand binding "pocket." The end result is increased accessibility of the ligand binding pocket in the high affinity ("active") form of integrins. We report a novel monoclonal antibody (QE.2E5) that binds within the cysteine-rich repeats in the integrin beta1 chain and induces high affinity binding of fibronectin to the integrin alpha5beta1. The QE.2E5 epitope is located approximately 200 residues both from the predicted binding site for fibronectin and from the epitopes recognized by other activating anti-beta1 monoclonal antibodies. It is also expressed on beta1 integrins from a number of nonhuman species. Although they have the same functional effects, the binding of QE.2E5 and another activating antibody (8A2) to the receptor have contrasting effects on the expression of an activation-dependent epitope in the beta1 chain. We propose that the cysteine-rich repeats contain a regulatory region that is distinct from those previously described in the integrin beta1 chain.
Collapse
Affiliation(s)
- R J Faull
- Renal Unit, Royal Adelaide Hospital, North Terrace, Adelaide 5000, South Australia, Australia
| | | | | | | | | | | | | |
Collapse
|
46
|
Faull RJ, Wang J, Stavros W. Changes in the expression of adhesion molecules as peripheral blood monocytes differentiate into peritoneal macrophages. Nephrol Dial Transplant 1996; 11:2037-44. [PMID: 8918719 DOI: 10.1093/oxfordjournals.ndt.a027093] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Peritoneal macrophages, derived from peripheral blood monocytes, are the chief cellular defenders against invasion of the peritoneal cavity by infectious organisms. Monocyte migration into the peritoneal cavity depends upon a coordinated series of adhesive events, utilizing cell surface receptors known as adhesion molecules. In order to better understand the mechanisms of leucocyte infiltration of the peritoneum during peritonitis, we studied the relative expression of adhesion molecules on monocytes and peritoneal macrophages from patients on continuous ambulatory peritoneal dialysis (CAPD). Peripheral blood and spent peritoneal dialysis fluid were obtained from patients undergoing CAPD, and the level of expression of various adhesion molecules on the monocytes/macrophages analysed by flow cytometry using receptor-specific monoclonal antibodies. Monocytes were also purified from the peripheral blood of volunteer donors, cultured in vitro for varying periods, and analysed in the same manner. Consistent differences in expression of certain adhesion molecules were found between monocytes and peritoneal macrophages, and similar changes occurred on monocytes cultured in vitro. Concurrent infection had no clear effect. Several receptors (integrins alpha 4 beta 1, alpha 6 beta 1, alpha L beta 2 and alpha IIb beta 3, and platelet endothelial cell adhesion molecule-1) were significantly decreased on peritoneal macrophages, while only the integrin alpha v beta 5 increased. It is concluded that monocyte differentiation into peritoneal macrophages is accompanied by characteristic alterations in the adhesion molecule repertoire on the cell surface, emphasizing the different adhesive requirements of these two cell types.
Collapse
Affiliation(s)
- R J Faull
- Renal Unit, Royal Adelaide Hospital, Australia
| | | | | |
Collapse
|
47
|
Abstract
Rapid and yet precisely controlled changes in cell adhesion are a hallmark of a number of basic physiological processes. Many of these processes directly impact upon nephrology, including: (1) cell migration, which occurs during leukocyte infiltration into inflammatory sites (e.g., in glomerulonephritis, interstitial nephritis, and renal transplant rejection) and during embryogenesis (e.g., in development of the genitourinary system): and (2) platelet aggregation at sites of clot formation (e.g., in glomerulonephritis). The integrins are a family of adhesion molecules whose function is controlled by the cells that express them, and this properly makes them eminently suitable receptors for those situations that demand flexibility of the cellular adhesive phenotype. The control of integrin function occurs via regulatory signals that originate within the cell cytoplasm and are then transmitted to the external ligand-binding domain of the receptor. The generation and transmission of these "inside-out" signals are the subjects of intensive research that will be summarized in this review article.
Collapse
Affiliation(s)
- R J Faull
- Renal Unit, Royal Adelalde Hospital, South Australia
| | | |
Collapse
|
48
|
|
49
|
Abstract
Dynamic regulation of receptor function is a distinguishing feature of the integrin family of adhesion molecules and makes a significant contribution to alterations in cellular adhesive properties. The best characterized example is that of the platelet receptor alpha IIb beta 3 (glycoprotein IIb-IIIa), which does not bind soluble fibrinogen on resting platelets. Following platelet activation, the alpha IIb beta 3 binds soluble fibrinogen with moderately high affinity and platelet aggregation ensues. Similar regulation of receptor function has also been directly demonstrated for alpha 5 beta 1 and alpha M beta 2, and it is likely that it is a general property of all members of the family. The altered ligand binding affinity is due to a change in the conformation of the external domain of the receptor, in response to intracellular signals that are transmitted the length of the molecule. The cytoplasmic tails of the integrins are active participants in this regulation, and they also mediate interactions with the cytoskeleton. A number of anti-integrin monoclonal antibodies have been described which induce high affinity ligand binding, and certain of these preferentially bind to the high affinity conformation of the receptor. The alteration in conformation allows better access for macromolecular ligands to the ligand binding pocket, which has been mapped (in alpha IIb beta 3) to the amino terminal globular head of the receptor. The precise mechanism by which the activating signal is transferred from within the cell to the distal external domain remains the subject of active research.
Collapse
Affiliation(s)
- R J Faull
- Department of Renal Medicine, St. George Hospital, Kogarah, NSW, Australia
| | | |
Collapse
|
50
|
Faull RJ, Kovach NL, Harlan JM, Ginsberg MH. Stimulation of integrin-mediated adhesion of T lymphocytes and monocytes: two mechanisms with divergent biological consequences. J Exp Med 1994; 179:1307-16. [PMID: 7511685 PMCID: PMC2191445 DOI: 10.1084/jem.179.4.1307] [Citation(s) in RCA: 118] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
We show that the adhesion of T lymphoid cells to immobilized fibronectin can be increased by two distinct mechanisms. The first is by increasing the affinity of the fibronectin receptor/ligand interaction using the anti-beta 1 integrin monoclonal antibody 8A2. The second is by treating the cells with phorbol 12-myristate 13-acetate (PMA), which alters events that occur after receptor occupancy (e.g., cell spreading) without affecting receptor affinity. The effects of these two mechanisms on adhesion in the presence of physiological concentrations of soluble fibronectin suggest that they have different biological consequences. Under these conditions, the net effect of increasing the affinity of the fibronectin receptors is to decrease cell adhesion, whereas the increase in adhesion induced by PMA is unaffected. This suggests that the high affinity receptors are not primarily available for cell adhesion under these circumstances, and that they have an alternative function. We further show that high affinity binding of soluble fibronectin can be induced by either differentiation of the monocytic cell line THP-1 or by cross-linking the T cell receptor complexes on the T lymphoid cell line HUT-78. The differentiated monocytic cells express two populations of fibronectin receptors: a minority in a high affinity state, and the majority in a low affinity state. Thus they will both continue to adhere in the presence of physiological concentrations of soluble fibronectin and bind significant amounts of soluble fibronectin at the cell surface.
Collapse
Affiliation(s)
- R J Faull
- Committee on Vascular Biology, Scripps Research Institute, La Jolla, California 92037
| | | | | | | |
Collapse
|