Urine Exosomes: An Emerging Trove of Biomarkers.

Exosomes are released by most cells and can be isolated from all biofluids including urine. Exosomes are small vesicles formed as part of the endosomal pathway that contain cellular material surrounded by a lipid bilayer that can be traced to the plasma membrane. Exosomes are potentially a more targeted source of material for biomarker discovery than unfractionated urine, and provide diagnostic and pathophysiological information without an invasive tissue biopsy. Cytoplasmic contents including protein, mRNA, miRNA, and lipids have all been studied within the exosomal fraction. Many prospective urinary exosomal biomarkers have been successfully identified for a variety of kidney or genitourinary tract conditions; detection of systemic conditions may also be possible. Isolation and analysis of exosomes can be achieved by several approaches, although many require specialized equipment or involve lengthy protocols. The need for timely analysis in the clinical setting has driven considerable innovation with several promising options recently emerging. Consensus on exosome isolation, characterization, and normalization procedures would resolve critical clinical translational bottlenecks for existing candidate exosomal biomarkers and provide a template for additional discovery studies.

Exosomes from human saliva as a source of microRNA biomarkers.

OBJECTIVE: The aim of this study was to examine the presence of microRNAs (miRNAs) within exosomes isolated from human saliva and to optimize and test methods for successful downstream applications. DESIGN: Exosomes isolated from fresh and frozen glandular and whole human saliva were used as a source of miRNAs. The presence of miRNAs was validated with TaqMan quantitative PCR and miRNA microarrays. RESULTS: We successfully isolated exosomes from human saliva from healthy controls and a patient with Sjögren's syndrome. microRNAs extracted from the exosomal fraction were sufficient for quantitative PCR and microarray profiling. CONCLUSIONS: The isolation of miRNAs from easily and non-invasively obtained salivary exosomes with subsequent characterization of the miRNA expression patterns is promising for the development of future biomarkers of the diagnosis and prognosis of various salivary gland pathologies.

Setting the stage for acute-on-chronic kidney injury.

Acute-on-chronic kidney disease will be familiar to many nephrologists. Hsu et al. quantify the risk of acute-on-chronic disease across the stages of preexisting chronic kidney disease. Their study demonstrates the valuable insights that large epidemiological studies can bring to the field of acute kidney injury.

AP214, an analogue of alpha-melanocyte-stimulating hormone, ameliorates sepsis-induced acute kidney injury and mortality.

Sepsis remains a serious problem in critically ill patients with the mortality increasing to over half when there is attendant acute kidney injury. alpha-Melanocyte-stimulating hormone is a potent anti-inflammatory cytokine that inhibits many forms of inflammation including that with acute kidney injury. We tested whether a new alpha-melanocyte-stimulating hormone analogue (AP214), which has increased binding affinity to melanocortin receptors, improves sepsis-induced kidney injury and mortality using a cecal ligation and puncture mouse model. In the lethal cecal ligation-puncture model of sepsis, severe hypotension and bradycardia resulted and AP214 attenuated acute kidney injury of the lethal model with a bell-shaped dose-response curve. An optimum AP214 dose reduced acute kidney injury even when it was administered 6 h after surgery and it significantly improved blood pressure and heart rate. AP214 reduced serum TNF-alpha and IL-10 levels with a bell-shaped dose-response curve. Additionally; NF-kappaB activation in the kidney and spleen, and splenocyte apoptosis were decreased by the treatment. AP214 significantly improved survival in both lethal and sublethal models. We have shown that AP214 improves hemodynamic failure, acute kidney injury, mortality and splenocyte apoptosis attenuating pro- and anti-inflammatory actions due to sepsis.

Exosomal Fetuin-A identified by proteomics: a novel urinary biomarker for detecting acute kidney injury.

Urinary exosomes containing apical membrane and intracellular fluid are normally secreted into the urine from all nephron segments, and may carry protein markers of renal dysfunction and structural injury. We aimed to discover biomarkers in urinary exosomes to detect acute kidney injury (AKI), which has a high mortality and morbidity. Animals were injected with cisplatin. Urinary exosomes were isolated by differential centrifugation. Protein changes were evaluated by two-dimensional difference in gel electrophoresis and changed proteins were identified by mass spectrometry. The identified candidate biomarkers were validated by Western blotting in individual urine samples from rats subjected to cisplatin injection; bilateral ischemia and reperfusion (I/R); volume depletion; and intensive care unit (ICU) patients with and without AKI. We identified 18 proteins that were increased and nine proteins that were decreased 8 h after cisplatin injection. Most of the candidates could not be validated by Western blotting. However, exosomal Fetuin-A increased 52.5-fold at day 2 (1 day before serum creatinine increase and tubule damage) and remained elevated 51.5-fold at day 5 (peak renal injury) after cisplatin injection. By immunoelectron microscopy and elution studies, Fetuin-A was located inside urinary exosomes. Urinary Fetuin-A was increased 31.6-fold in the early phase (2-8 h) of I/R, but not in prerenal azotemia. Urinary exosomal Fetuin-A also increased in three ICU patients with AKI compared to the patients without AKI. We conclude that (1) proteomic analysis of urinary exosomes can provide biomarker candidates for the diagnosis of AKI and (2) urinary Fetuin-A might be a predictive biomarker of structural renal injury.

Connective tissue growth factor is a biomarker and mediator of kidney allograft fibrosis.

Chronic allograft nephropathy (CAN) is a leading cause of kidney graft failure following transplantation. Its causes are complex and include both immunological and nonimmunological factors. Here we have studied the development of CAN in a mouse model of kidney transplantation comparing isografts and allografts. Unlike the normal histology and normal serum creatinine of the uninephrectomized, nonrejecting isografted mice (0.219 +/- 0.024 mg/dL), allografted mice demonstrated severe renal dysfunction (mean serum creatinine 0.519 +/- 0.061 mg/dL; p < 0.005) with progressive inflammation and fibrosis of the kidney. These animals also showed an increased expression of connective tissue growth factor (CTGF), both systemically and within the graft. CTGF was highly expressed in tubuloepithelial cells of allografts, along with alpha-smooth muscle actin, a marker of myofibroblasts, and transcriptionally associated with other markers of fibrosis. In vitro studies of tubular epithelium indicate that CTGF is capable of inducing EMT, independent of TGF-beta. Finally, in human transplant recipients, serum and urine CTGF levels are significantly elevated compared to naïve individuals. Urinary levels correlated with the histological presence of CAN. These studies suggest a critical role of CTGF in graft fibrogenesis, for both mouse and man. Thus, CTGF has potential as a biomarker of CAN, and also a therapeutic target in managing graft fibrosis.

Biomarker and drug-target discovery using proteomics in a new rat model of sepsis-induced acute renal failure.

Sepsis is one of the common causes of acute renal failure (ARF). The objective of this study was to identify new biomarkers and therapeutic targets. We present a new rat model of sepsis-induced ARF based on cecal ligation and puncture (CLP). We used this model to find urinary proteins which may be potential biomarkers and/or drug targets. Aged rats were treated with fluids and antibiotics after CLP. Urinary proteins from septic rats without ARF and urinary proteins from septic rats with ARF were compared by difference in-gel electrophoresis (DIGE). CLP surgery elevated interleukin (IL)-6 and IL-10 serum cytokines and blood nitrite compared with sham-operated rats. However, there was a range of serum creatinine values at 24 h (0.4-2.3 mg/dl) and only 24% developed ARF. Histology confirmed renal injury in these rats. Forty-nine percent of rats did not develop ARF. Rats without ARF also had less liver injury. The mortality rate at 24 h was 27% but was increased by housing the post-surgery rats in metabolic cages. Creatinine clearance and urine output 2-8 h after CLP was significantly reduced in rats which died within 24 h. Using DIGE we identified changes in a number of urinary proteins including albumin, brush-border enzymes (e.g., meprin-1-alpha) and serine protease inhibitors. The meprin-1-alpha inhibitor actinonin prevented ARF in aged mice. In summary, we describe a new rat model of sepsis-induced ARF which has a heterogeneous response similar to humans. This model allowed us to use DIGE to find changes in urinary proteins and this approach identified a potential biomarker and drug target - meprin-1-alpha.

Sepsis-induced organ failure is mediated by different pathways in the kidney and liver: acute renal failure is dependent on MyD88 but not renal cell apoptosis.

Toll-like receptors (TLRs) are important in sepsis. Myeloid differentiation factor 88 (MyD88) is a key molecule involved in signal transduction by multiple TLRs. The objective of this study was to investigate the contribution of TLR4 and MyD88 to acute renal failure (ARF) induced by polymicrobial sepsis. Liver dysfunction and apoptosis in the spleen contribute to sepsis severity after cecal ligation and puncture (CLP). Therefore, we also investigated liver injury and splenic apoptosis. We used a mouse model of sepsis-induced ARF using CLP to generate polymicrobial sepsis. Despite fluid and antibiotic resuscitation the mice developed multi-organ failure, including ARF, which resembles human sepsis. We investigated the role of the TLR4 receptor by comparing C3H/HeJ mice (which lack TLR4) with C3H/He0UJ normal controls. The role of MyD88 was investigated by comparing MyD88 knockout mice (MyD88(-/-)) with wild-type controls. Following CLP, mice lacking TLR4 and wild-type mice both developed comparable ARF. However, MyD88(-/-) mice did not develop ARF compared to wild-type controls. In contrast, MyD88(-/-) mice developed liver injury comparable to wild type. After CLP, MyD88(-/-) mice had significantly reduced apoptosis in the spleen compared with wild type. Apoptosis was not detected in the kidney of wild-type or MyD88(-/-) mice after CLP. In summary, ARF induced by polymicrobial sepsis is dependent on MyD88, but not TLR4. The absence of MyD88 dissociates ARF from liver injury; liver injury is MyD88-independent. There was MyD88-dependent apoptosis in the spleen, but no apoptosis in the kidney. MyD88 may be a good drug target for some, but not all, organ dysfunctions following sepsis.

Simvastatin improves sepsis-induced mortality and acute kidney injury via renal vascular effects.

Acute kidney injury (AKI) occurs in about half of patients in septic shock and the mortality of AKI with sepsis is extremely high. An effective therapeutic intervention is urgently required. Statins are 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors that also have pleiotropic actions. They have been reported to increase the survival of septic or infectious patients. But the effect of simvastatin, a widely used statin, on sepsis-induced AKI is unknown. The effects of simvastatin and tumor necrosis factor (TNF)-alpha neutralizing antibody were studied in a clinically relevant model of sepsis-induced AKI using cecal ligation and puncture (CLP) in elderly mice. Simvastatin significantly improved CLP-induced mortality and AKI. Simvastatin attenuated CLP-induced tubular damage and reversed CLP-induced reduction of intrarenal microvascular perfusion and renal tubular hypoxia at 24 h. Simvastatin also restored towards normal CLP-induced renal vascular protein leak and serum TNF-alpha. Neither delayed simvastatin therapy nor TNF-alpha neutralizing antibody improved CLP-induced AKI. Simvastatin improved sepsis-induced AKI by direct effects on the renal vasculature, reversal of tubular hypoxia, and had a systemic anti-inflammatory effect.

Collection, storage, preservation, and normalization of human urinary exosomes for biomarker discovery.

Urinary exosomes containing apical membrane and intracellular fluid are normally secreted into the urine from all nephron segments, and may carry protein markers of renal dysfunction and structural injury. We studied methods for collection, storage, and preservation of urinary exosomal proteins. We collected urine from healthy volunteers, added protease inhibitors, and stored urine samples at 4, -20, and -80 degrees C for 1 week or 7 months. Samples were thawed with and without extensive vortexing, and three fractions were isolated: urinary sediment, supernatant, and exosome fraction. Protein concentration, electrophoresis patterns, and abundance of seven exosome-associated proteins were measured. Exosome-associated proteins were not detected in sediment or supernatant fractions. Protease inhibitors prevented degradation of exosome-associated proteins. Freezing at -20 degrees C caused a major loss in exosomes compared to fresh urine. In contrast, recovery after freezing at -80 degrees C was almost complete. Extensive vortexing after thawing markedly increased exosome recovery in urine frozen at -20 or -80 degrees C, even if frozen for 7 months. The recovery from first and second morning urine was similar. The abundance of cytosolic exosome-associated proteins did not decrease during long-term storage. We concluded: (1) protease inhibitors are essential for preservation; (2) storage at -80 degrees C with extensive vortexing after thawing maximizes the recovery of urinary exosomes; (3) the difference between first and second morning urine exosome-associated protein was small, suggesting minimal protein degradation in the urinary tract/bladder; (4) urinary exosomes remain intact during long-term storage. These urine collection, storage, and processing conditions may be useful for future biomarker discovery efforts.

RNA: a method to specifically inhibit PCR amplification of known members of a multigene family by degenerate primers.

The polymerase chain reaction (PCR) is a versatile method to amplify specific DNA with oligonucleotide primers. By designing degenerate PCR primers based on amino acid sequences that are highly conserved among all known gene family members, new members of a multigene family can be identified. The inherent weakness of this approach is that the degenerate primers will amplify previously identified, in addition to new, family members. To specifically address this problem, we synthesized a specific RNA for each known family member so that it hybridized to one strand of the template, adjacent to the 3'-end of the primer, allowing the degenerate primer to bind yet preventing extension by DNA polymerase. To test our strategy, we used known members of the soluble, nitric oxide-sensitive guanylyl cyclase family as our templates and degenerate primers that discriminate this family from other guanylyl cyclases. We demonstrate that amplification of known members of this family is effectively and specifically inhibited by the corresponding RNAs, alone or in combination. This robust method can be adapted to any application where multiple PCR products are amplified, as long as the sequence of the desired and the undesired PCR product(s) is sufficiently distinct between the primers.

Dominant negative mutants of guanylyl cyclase: probes for global functions and intramolecular mechanisms.

Dominant negative mutants are unique tools to define functions of a protein, not only within complex cellular and organismal contexts, but also mechanistically within a protein. Guanylyl cyclases are amenable to studies with dominant negative mutants, with their own sets of opportunities for insight and pitfalls to overcome. Membrane and soluble forms of guanylyl cyclase represent self-contained signal transduction modules that recognize, transduce, and amplify an external signal to give a carefully controlled response. Beginning with recognition of peptide hormones versus nitric oxide, membrane and soluble guanylyl cyclases are considerably different, except that their catalytic domains are closely related. Studies on these catalytic domains and their counterparts in adenylyl cyclases have raised an integral question of whether one or two domains form a catalytic site, which remains unresolved. Regardless of which model is correct, guanylyl cyclases appear to require an oligomeric state to function properly. The inferred relationship between protein-protein interaction and function is the basis for developing dominant negative mutants, which can be designed without prior structural information. Soluble guanylyl cyclases exist in a heterodimeric state, whereas membrane guanylyl cyclases are homodimeric, or possibly higher-order oligomers. These properties dictate that dominant negative mutants of membrane and soluble guanylyl cyclases be approached in fundamentally different ways, with regard to their design, their functional consequences, and their limitations. Using dominant negative mutants as specific inhibitors in complex systems, such as transgenic animals, represents a significant advance, and continuing improvements are just an inkling of the extraordinary potential of this approach. For example, the function of a protein can be obscured because it is expressed in multiple cell types; by restricting its pattern of expression, a cell-specific promoter, coupled to a dominant negative mutant, can pinpoint this function. As more sophisticated methods are developed, dominant negative mutants will provide additional opportunities to unveil new regulatory mechanisms, new signaling pathways, or even new therapeutic approaches.

Accuracy in external dosimetry of ionizing radiation.

A new approach to defining and calculating accuracy and uncertainty in external dosimetry is described. It is more comprehensive and mathematically rigorous than other approaches currently in use, while at the same time being practical to implement. The type testing required to demonstrate the performance of a dosimeter is described, and an example of the calculation of accuracy and uncertainty is given. The paper concludes with some recommendations concerning performance testing and independent testing.

Skin dose from radionuclide contamination on clothing.

Skin dose due to radionuclide contamination on clothing is calculated by Monte Carlo simulation of electron and photon radiation transport. Contamination due to a hot particle on some selected clothing geometries of cotton garment is simulated. The effect of backscattering in the surrounding air is taken into account. For each combination of source-clothing geometry, the dose distribution function in the skin, including the dose at tissue depths of 7 mg cm(-2) and 1,000 mg cm(-2), is calculated by simulating monoenergetic photon and electron sources. Skin dose due to contamination by a radionuclide is then determined by proper weighting of the monoenergetic dose distribution functions. The results are compared with the VARSKIN point-kernel code for some radionuclides, indicating that the latter code tends to underestimate the dose for gamma and high energy beta sources while it overestimates skin dose for low energy beta sources.

Type testing of the Siemens Plessey electronic personal dosemeter.

This paper presents the results of a laboratory assessment of the performance of a new type of personal dosimeter, the Electronic Personal Dosemeter made by Siemens Plessey Controls Limited. Twenty pre-production dosimeters and a reader were purchased by Ontario Hydro for the assessment. Tests were performed on radiological performance, including reproducibility, accuracy, linearity, detection threshold, energy response, angular response, neutron response, and response time. There were also tests on the effects of a variety of environmental factors, such as temperature, humidity, pulsed magnetic and electric fields, low- and high-frequency electromagnetic fields, light exposure, drop impact, vibration, and splashing. Other characteristics that were tested were alarm volume, clip force, and battery life. The test results were compared with the relevant requirements of three standards: an Ontario Hydro standard for personal alarming dosimeters, an International Electrotechnical Commission draft standard for direct reading personal dose monitors, and an International Electrotechnical Commission standard for thermoluminescence dosimetry systems for personal monitoring. In general, the performance of the Electronic Personal Dosemeter was found to be quite acceptable: it met most of the relevant requirements of the three standards. However, the following deficiencies were found: slow response time; sensitivity to high-frequency electromagnetic fields; poor resistance to dropping; and an alarm that was not loud enough. In addition, the response of the electronic personal dosimeter to low-energy beta rays may be too low for some applications. Problems were experienced with the reliability of operation of the pre-production dosimeters used in these tests.

Homologous and heterologous desensitization of a guanylyl cyclase-linked nitric oxide receptor in cultured rat medullary interstitial cells.

Selected studies of nitroglycerin tolerance have demonstrated desensitization of the nitric oxide-stimulated guanylyl cyclase. To define the mechanism by which the response to nitric oxide becomes desensitized, we studied the effects of activating both nitric oxide and atrial natriuretic peptide-stimulated guanylyl cyclases in rat medullary interstitial cells. Cells were pretreated with the nitric oxide agonists nitroprusside (SNP) and SIN-1 for 18 hr before measuring SNP- or SIN-1-stimulated cyclic GMP (cGMP) accumulation in the presence of 3-isobutyl-1-methylxanthine. Pretreatment with SNP decreased SNP- and SIN-1-stimulated cGMP accumulation without altering the EC50 for SNP. Pretreatment with SIN-1 also inhibited SNP and SIN-1-stimulated cGMP accumulation. To rule out a nonspecific metabolic effect of SNP, we showed that SNP pretreatment decreased SIN-1-stimulated soluble guanylyl cyclase activity, but had no significant effect on forskolin-stimulated cyclic AMP accumulation. Pretreatment with SNP also decreased the mRNA abundance of the alpha 1- and beta 1-subunits of guanylyl cyclase. Pretreatment with either atrial natriuretic peptide or 8-chlorophenylthio-cGMP inhibited SNP-stimulated cGMP. We conclude that the soluble guanylyl cyclase-linked nitric oxide receptor exhibits homologous and heterologous desensitization in rat medullary interstitial cells. The site of regulation is unknown, but homologous desensitization may involve decreased abundance of soluble guanylyl cyclase.

Dominant negative mutants of nitric oxide-sensitive guanylyl cyclase.

Since a nitric oxide-sensitive form of guanylyl cyclase exists as a heterodimer, mutations disrupting catalysis but not heterodimer formation could serve as dominant negative mutations. Two mutations within the catalytic region of the alpha subunit (alpha 1D513A, alpha 1D529A) caused complete losses of basal and sodium nitroprusside-stimulated guanylyl cyclase activity; however, the mutant alpha subunits continued to form heterodimers with wild-type beta-subunit. Rat insulinoma cells, which contain the alpha 1 beta 1 form of guanylyl cyclase, were stably transfected with alpha 1D513A or alpha 1D529A. The response to sodium nitroprusside, which exceeded 200-fold in the presence of wild-type alpha 1, was markedly reduced by the expression of either mutant subunit. In contrast, the mutant subunits failed to inhibit heat-stable enterotoxin-induced cGMP elevations; the bacterial peptide elevated insulinoma cell cGMP approximately 100-fold. The two point mutations, therefore, result in dominant negative proteins that can effectively and specifically block the NO/cGMP signaling pathway. These are also the first studies to show that, although both the alpha and beta subunits contain regions homologous to putative cyclase catalytic regions, a point mutation in just one of the subunits can completely inhibit cyclase activity.

Differential expression of mRNA for guanylyl cyclase-linked endothelium-derived relaxing factor receptor subunits in rat kidney.

Endothelium-derived relaxing factor (EDRF) has profound effects on the renal vasculature, the glomerular mesangium, and also affects renal salt excretion. EDRF stimulates guanylyl cyclases, which are thought to be heterodimers comprised of alpha and beta subunits. Two alpha and two beta isoforms have been identified thus far. However, the molecular composition of in vivo guanylyl cyclase-linked EDRF receptors is unknown. We used polymerase chain reaction to clone a portion of the rat alpha 2 subunit. Guanylyl cyclase-linked EDRF receptor mRNA was detected in microdissected renal structures using a reverse transcription/polymerase chain reaction assay. The interlobular artery/afferent arteriole contained mRNA for the alpha 1, alpha 2, and beta 1 subunits; a faint beta 2 band was found in 29% of experiments. In contrast, the cortical collecting duct contained mRNA only for alpha 1 and beta 2 subunits. We conclude that guanylyl cyclase-linked EDRF receptor subunit isoforms are independently and heterogeneously expressed in the renal vasculature and cortical collecting duct, suggesting that several different EDRF receptors exist in vivo. These data suggest that the tubule receptor is composed of alpha 1/beta 2. The vasculature may contain at least two different EDRF receptors (alpha 1/beta 1 and alpha 2/beta 1). Some beta 2 may also be expressed, allowing for even greater heterogeneity.