PubMed · 10830673
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C Keyes, F Federico. 2000. Preventing medication errors.. https://doi.org/10.1093/intqhc%2F12.2.159
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Early transplant dysfunction and failure because of immunological and nonimmunological factors still presents a significant clinical problem for transplant recipients. A critical unmet need is the noninvasive detection and prediction of immune injury such that acute injury can be reversed by proactive immunosuppression titration. In this study, we used iTRAQ -based proteomic discovery and targeted ELISA validation to discover and validate candidate urine protein biomarkers from 262 renal allograft recipients with biopsy-confirmed allograft injury. Urine samples were randomly split into a training set of 108 patients and an independent validation set of 154 patients, which comprised the clinical biopsy-confirmed phenotypes of acute rejection (AR) (n = 74), stable graft (STA) (n = 74), chronic allograft injury (CAI) (n = 58), BK virus nephritis (BKVN) (n = 38), nephrotic syndrome (NS) (n = 8), and healthy, normal control (HC) (n = 10). A total of 389 proteins were measured that displayed differential abundances across urine specimens of the injury types (p < 0.05) with a significant finding that SUMO2 (small ubiquitin-related modifier 2) was identified as a "hub" protein for graft injury irrespective of causation. Sixty-nine urine proteins had differences in abundance (p < 0.01) in AR compared with stable graft, of which 12 proteins were up-regulated in AR with a mean fold increase of 2.8. Nine urine proteins were highly specific for AR because of their significant differences (p < 0.01; fold increase >1.5) from all other transplant categories (HLA class II protein HLA-DRB1, KRT14, HIST1H4B, FGG, ACTB, FGB, FGA, KRT7, DPP4). Increased levels of three of these proteins, fibrinogen beta (FGB; p = 0.04), fibrinogen gamma (FGG; p = 0.03), and HLA DRB1 (p = 0.003) were validated by ELISA in AR using an independent sample set. The fibrinogen proteins further segregated AR from BK virus nephritis (FGB p = 0.03, FGG p = 0.02), a finding that supports the utility of monitoring these urinary proteins for the specific and sensitive noninvasive diagnosis of acute renal allograft rejection.
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Mercuric chloride (HgCl(2)) is known to be a nephrotoxicant. When HgCl(2) is administered into rats, acute renal failure (ARF) is induced. Heme oxygenase-1 (HO-1) is antioxidative enzyme and is known to play a protective role against the oxidative injury. To elucidate the cytoprotective role of HO-1 against the nephrotoxicant-induced ARF, we examined the effect of hemin, HO-1 inducer, on HgCl(2)-induced ARF. Subcutaneous administration of hemin (30 mg/kg body weight) into rats once a day for two successive days obviously induced HO-1 protein in the kidneys at 24 h after the last injection. Under this situation, when HgCl(2) (1 mg/kg body weight) was intraperitoneally injected into rats at 24 h after the last injection of hemin improved the serum creatinine (SCr) and blood urea nitrogen (BUN) levels, markers for renal injury, at 24 h after the HgCl(2) injection as compared with the control rats without hemin pretreatment (HgCl(2) treatment alone). This result was further confirmed by histopathological analysis. These findings strongly suggest that the preinduction of HO-1 ameliorates the subsequent HgCl(2)-induced acute renal injury.