Clinical Effectiveness of SARS-CoV-2 Vaccination in Renal Transplant Recipients. Antibody Levels Impact in Pneumonia and Death.

BACKGROUND: Few studies have described the clinical impact of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines in renal transplant recipients (RTRs) in the context of omicron variant and the third vaccine dose. Antibody titer has been tried to relate to the prediction of outcomes related to SARS-CoV-2, but it results controversially in these populations. METHODS: All patients with positive SARS-CoV-2 polymerase chain reaction followed at a RTRs reference center from March 15, 2020, to March 15, 2022, were considered for analysis. Cases were analyzed by vaccination status. Breakthrough cases were then analyzed by nonantibodies (<20 arbitrary unit [AU]/mL), low (20-100 AU/mL), and high antibody titers (>100 AU/mL) against SARS-CoV-2 spike protein. Outcomes included pneumonia and mortality. We used logistic regression multivariable to assess for confounders. RESULTS: Among 186 RTRs with coronavirus disease 2019, 50.5% (n = 94) were vaccinated versus 49.5% (n = 92) unvaccinated. Of the vaccinated patients, 67.02% developed a high antibody titer (>100 AU/mL) but 14.89% achieved a low antibody titer and 18.08% nonantibodies. Pneumonia-free survival (day 20) was 95% in high antibody titer but 40% in unvaccinated RTRs. Survival in RTRs at day 60 was similar in the unvaccinated group compared with nonantibodies breakthrough cases (82%) but 92% in the low antibody titer group (relative risk, 0.027; 95% confidence interval, 0.002-0.479; P = 0.014). Only patients with >100 AU/mL showed a 100% survival on day 60 postinfection. CONCLUSIONS: Vaccinated RTRs who achieve at least a low antibody titer (>20 AU/mL) had better results in terms of pneumonia and mortality than unvaccinated RTRs. Antibody titer >100 AU/mL associate with even better results than patients with lower antibody titers.

Presence of T-275A and C-2152T Polymorphisms of the Promoter Region of Uridine Diphosphate-Glucuronosyltransferase 1A9 Increases Mortality From Digestive Tumors: Results After 10 Years of Follow-up in a Renal Transplant Population.

BACKGROUND: The aim of this study was to determine the distribution of uridine diphosphate-glucuronosyltransferase 1A9 (UGT1A9) promoter region T-275A and C-2152T single-nucleotide polymorphisms (SNPs) in stable transplant patients and to investigate the impact of these SNPs on the evolution of this population after 10 years of follow-up. METHODS: White renal transplant recipients (n = 873) were studied. The median time of follow-up was 91.8 months (P25-75 46-146). Amplification with specific "primers" to delimit the study area was performed for each polymorphism. Amplification was performed with the use of real-time polymerase chain reaction. RESULTS: T-275A promoter mutation was detected in 13% of patients and C-2152T in 12% of patients. Survival analysis was performed on 873 renal transplants, carried out between 2004 and 2013. We found a higher frequency of death from cancer among polymorphism carriers (P = .001). CONCLUSIONS: It appears that carriers of T-275A and C-2152T SNPs of the UGT1A9 gene promoter region show a greater incidence of death from cancer, with a significantly higher cumulative incidence of death from gastrointestinal tumors.

Embarazo en mujeres en diálisis crónica: revisión / Pregnancy in women on chronic dialysis: a review

La frecuencia de embarazos en mujeres en diálisis es extremadamente baja, aunque el porcentaje de gestaciones con éxito ha aumentado a lo largo de los años, siendo, según distintas series, superior al 70%. Estos embarazos no están exentos de complicaciones tanto para la madre como para el feto, el manejo de las cuales requiere el trabajo conjunto del nefrólogo, el ginecólogo, el enfermero y el nutricionista. A día de hoy no es posible encontrar un tratamiento sistemático nefrológico y ginecológico en este tipo de pacientes. Las principales medidas que se deberían adoptar incluirían: aumento del tiempo de diálisis, mantener bajos niveles de urea prediálisis, evitar hipotensiones e hipertensión materna, así como infecciones urinarias y fluctuaciones electrolíticas. Se requiere, además, una adecuada monitorización fetal (AU)

The frequency of pregnancy in women on dialysis is extremely low, but the percentage of successful pregnancies in this context has increased over the years, with some studies placing the survival rate above 70%. These pregnancies are not exempt from both maternal and foetal complications, and so their management requires the joint efforts of nephrologists, gynaecologists, nurses, and nutritionists. Currently, we have been unable to establish consistent systematic treatment from both nephrological and gynaecological specialists in these patients. The main changes that need to be made are: increased time on dialysis, maintaining low levels of pre-dialysis urea, avoiding: maternal hypertension and hypotension, anaemia, urinary tract infections, and fluctuations in electrolytes. Adequate foetal monitoring is also necessary (AU)

Pregnancy in women on chronic dialysis: a review.

The frequency of pregnancy in women on dialysis is extremely low, but the percentage of successful pregnancies in this context has increased over the years, with some studies placing the survival rate above 70%. These pregnancies are not exempt from both maternal and foetal complications, and so their management requires the joint efforts of nephrologists, gynaecologists, nurses, and nutritionists. Currently, we have been unable to establish consistent systematic treatment from both nephrological and gynaecological specialists in these patients. The main changes that need to be made are: increased time on dialysis, maintaining low levels of pre-dialysis urea, avoiding: maternal hypertension and hypotension, anaemia, urinary tract infections, and fluctuations in electrolytes. Adequate foetal monitoring is also necessary.

Inadequate mycophenolic acid exposure and acute rejection in kidney transplantation.

INTRODUCTION: The clinical utility of predose levels of mycophenolic acid (MPA) monitoring among patients treated with mycophenolate mofetil (MMF) has been questioned. The aim of this study was to evaluate the impact of adequate MPA levels in the incidence of acute rejection episodes among a cohort of kidney transplant recipients. MATERIAL AND METHODS: In this retrospective study of 314 consecutive cases treated with tacrolimus, MMF, and steroids, evaluated 12-hour trough MPA samples during the first week as well as at 1, 3, 6, and 12 months as median values. RESULTS: During the first week, the median values of MPA were 1.6 microg/mL (p25-75 0.7-2.7 microg/mL) on mean doses of 1.84 +/- 0.38 g/d. The incidence of acute rejection was 28%. The mean MPA levels during the first week were significantly lower among patients who developed rejection than in nonrejectors (1.5 +/- 0.1 vs 2.1 +/- 0.1 microg/mL; P < .001). There were no significant differences in trough tacrolimus levels between rejectors and nonrejectors (11.2 +/- 0.4 vs 11.6 +/- 1.2 microg/mL; P < .78). Logistic regression analysis showed that one of the predictive factors of acute rejection was a 12-hour trough MPA <1.6 microg/mL (relative risk [RR] 2.6; CI [confidence interval] 95% 1.6-4.3; P < .001). CONCLUSIONS: Adequate MPA exposure is important to prevent acute rejection. Taking into account that the routine measurement of the area under the curve of MPA is impractical, at least the follow-up of trough MPA levels may help in the management of renal transplant recipients.

Graft outcome and mycophenolic acid trough level monitoring in kidney transplantation.

BACKGROUND: Large inter- and intrapatient variabilities have been observed in the pharmacokinetics of mycophenolic acid (MPA). As a consequence, the efficacy and safety of mycophenolate mofetil (MMF) may be optimized with individualized doses based on therapeutic drug monitoring. MATERIALS AND METHODS: In this retrospective study we analyzed; 7536 12-hour trough MPA samples obtained during the first year posttransplantation among 314 kidney recipients treated with tacrolimus, MMF, and corticosteroids. RESULTS: Despite taking similar MMF doses, patients with delayed graft function (DGF) showed lower 12-hour trough MPA levels than patients without DGF 1.4 +/- 0.1 vs 2.1 +/- 0.1 microg/mL; P = .001). There was a significant correlation between 12-hour trough MPA levels and creatinine clearance (r = .32; P < .001). Logistic regression analysis showed that creatinine clearance was a predictive factor of adequate 12-hour trough MPA levels (>1.6 microg/mL) at 7 days posttransplantation. Twelve-hour trough MPA levels at 7 days posttransplantation were lower among patients who developed an acute rejecton episode (1.5 +/- 0.1 vs 2.1 +/- 0.1 microg/mL; P < .001), whereas those with gastrointestinal side effects showed high levels (4.1 +/- 0.5 microg/mL). CONCLUSIONS: In patients with delayed or poor graft function, MMF doses greater than 2 g/d may be necessary to achieve adequate MPA levels. Therapeutic drug monitoring of MPA may be useful to prevent acute rejection episodes or toxicity.

Effects of raloxifene therapy on circulating osteoprotegerin and RANK ligand levels in post-menopausal osteoporosis.

Previous in vitro studies suggest that the anti-resorptive effect of raloxifene might be mediated by changes in several cytokines involved in the bone remodeling process. In this context, the osteoprotegerin (OPG)- receptor activator of NF kappa B ligand (RANKL) system is considered a key component in the osteoclastogenesis regulation. The aim of this study was to determine the effects of raloxifene treatment on serum concentrations of OPG, receptor RANKL and its relationship with biochemical markers of bone turnover and bone mineral density (BMD) in previously untreated women with post-menopausal osteoporosis. We selected 47 post-menopausal women (mean age 63+/-7 yr) with densitometric criteria of osteoporosis. We determined at baseline, 3, 6, and 12 months anthropometric parameters, biochemical markers of bone turnover, serum levels of 25(OH) D, serum levels of OPG and RANKL. BMD (dual-energy x-ray absorptiometry) in lumbar spine (LS) femoral neck and total hip was measured at baseline and 12 months after raloxifene (60 mg/day) treatment. Serum levels of OPG decreased in the 3rd and 6th month of treatment (p<0.001) and returned to basal levels in the 12th month. There was a significant decrease of RANKL levels and OPG/RANKL ratio after 1 yr of raloxifene treatment. In addition, BMD in LS increased significantly (2.5%) in the 12th month of treatment (p=0.031). Finally, the biochemical markers of bone turnover (total alkaline phosphatase, bone alkaline phosphatase, osteocalcin, tartrate-resistant acid phosphatase, urine cross-linked carboxi-terminal telopeptide of type I collagen) decreased significantly from the 3rd month of treatment. In conclusion, our results support the hypothesis that raloxifene may inhibit osteoclast activity, at least partly modulating the OPG-RANKL system.

Serine dehydratase and tyrosine aminotransferase activities increased by long-term starvation and recovery by refeeding in rainbow trout (Oncorhynchus mykiss).

Here, we study a cycle of long-term starvation followed by refeeding in relation to the kinetics of serine dehydratase (SerDH) and tyrosine aminotransferase (TyrAT) in rainbow trout (Oncorhynchus mykiss). We determine SerDH- and TyrAT- specific activity at different substrate concentrations in liver and white muscle of juvenile trout starved for 70 days and then refed for 6 hr, 32 hr, 4 days, and 9 days. SerDH showed a hyperbolic kinetic with a K(m) for L-serine of 77.07+/-8.78 mM in the liver of control trout. After 70 days of starvation, the SerDH activity at saturate substrate concentration rose 100% over control. No significant changes were found in the K(m) values of the enzyme. After refeeding, the SerDH activity declined to control values. TyrAT also showed a hyperbolic kinetic with a K(m) for L-tyrosine of 1.86+/-0.12 and 2.55+/-0.57 mM in liver and white muscle, respectively. In starved trout, TyrAT activity in liver and white muscle was about 64 and 267%, respectively, higher than control. After 9 days of refeeding, the control values recovered, although, at 6 hr of refeeding, hepatic TyrAT activity was higher than that for starvation. This work shows that SerDH and TyrAT are present in rainbow trout and that the two enzymes have regulatory functions in the catabolism of their respective amino acids in this species.

Growth, protein-turnover rates and nucleic-acid concentrations in the white muscle of rainbow trout during development.

We have studied the growth rate, nucleic-acid concentration, protein-accumulation rate (K(G)), and several other parameters relating to protein turnover, such as the protein-synthesis (K(S)), and protein-degradation rates (K(D)), protein-synthesis capacity (C(S)), protein-synthesis efficiency (K(RNA)), protein-synthesis rate per DNA unit (K(DNA)) and protein-retention efficiency (PRE), in the white muscle of rainbow trout during development. Both growth rate and relative food intake decreased significantly with age and weight, as did the food-efficiency ratio (FER) and protein-efficiency ratio (PER). Although absolute RNA and DNA contents increased with age, their relative concentrations decreased. The RNA/DNA ratio increased sharply from 14 to 28 weeks but afterwards decreased towards initial values. Hypertrophy increased rapidly to the 28-week stage but henceforth increased much more slowly. Hyperplasia, on the other hand, continued to increase linearly, resulting in a significant four- to fivefold predominance in this type of growth at the end of the 96-week experimental period. K(G) decreased significantly with age, as did K(S), and C(S), whereas at the 14-week stage, K(D) was significantly lower than at other ages. K(RNA) increased until 28 weeks. K(DNA) increased significantly in juvenile fish compared to both fingerlings and adults, where it showed similar lower values. PRE remained high at all ages.

Carbohydrate deprivation reduces NADPH-production in fish liver but not in adipose tissue.

Little is known about the way in which carnivorous fish such as salmonids mobilise and metabolise dietary carbohydrates, which are essential to lipid metabolism. Thus we have studied changes caused by the absence of dietary carbohydrates to the kinetics and molecular behaviour of the four cellular NADPH-production systems [glucose 6-phosphate dehydrogenase (G6PDH); 6-phosphogluconate dehydrogenase (6PGDH); malic enzyme (ME); and isocitrate dehydrogenase NADP-dependent (NADP-IDH)] in the liver and adipose tissue of rainbow trout (Oncorhynchus mykiss). We used spectrophotometry to study enzyme kinetics and nucleic acid concentrations, and immunoblot analysis to determine specific protein concentrations. The absence of carbohydrate reduced specific enzyme activity, maximum rate and catalytic efficiency by almost 65% in G6PDH and 6PGDH, by more than 50% in ME, and by almost 25% in NADP-IDH but caused no significant changes in the K(m) values or activity ratios in any of these hepatic enzymes. Molecular analysis clearly showed that this kinetic behaviour reflected concomitant changes in intracellular enzyme concentrations, produced by protein-induction/repression processes rather than changes in the activity of pre-existing enzymes. We conclude that the absence of carbohydrates significantly reduces intracellular concentrations of G6PDH, ME and NADP-IDH in trout liver in percentages similar to those recorded for enzyme activity. We found no such variations in the concentrations of any of these enzymes in adipose tissue and no change in the levels of their activity, suggesting that the liver and adipose tissues are subject to different regulation systems with regard to carbohydrates and play distinct roles in lipid metabolism.

Dietary alterations in protein, carbohydrates and fat increase liver protein-turnover rate and decrease overall growth rate in the rainbow trout (Oncorhynchus mykiss).

We have determined the protein-turnover rates and nucleic-acid concentrations in the liver of trout (Oncorhynchus mykiss) fed on two different isocaloric diets: low-protein/high-fat and non-carbohydrate/high-fat. Compared to controls, the partial replacement of protein with fat significantly decreased the protein accumulation rate and protein-retention efficiency in the liver whilst increasing the fractional protein-synthesis and protein-degradation rates as well as protein-synthesis efficiency. The complete replacement of carbohydrates with fat significantly lowered the protein-accumulation rate and protein-retention efficiency, but enhanced both the protein-synthesis and protein-degradation rates as well as protein-synthesis capacity. The protein:DNA and RNA:DNA ratios decreased considerably on both diets. Total DNA decreased in fish on a low-protein/high-fat diet but did not change in those on a non-carbohydrate/high-fat diet. The absolute protein-synthesis rate registered no significant change under any of the nutritional conditions. Both the experimental diets did however raise the fractional protein-synthesis rate significantly, due to enhanced protein-synthesis efficiency when protein was partially replaced with fat and to enhanced protein-synthesis capacity when carbohydrates were completely replaced with fat. Our results show the capacity of the liver to adapt its turnover rates and conform to different nutritional conditions. They also point to the possibility of controlling fish growth by dietary means.

Protein nutrition in fish: protein/energy ratio and alternative protein sources to fish meal.

Those interested in the design and manufacture of feeds for intensive fish farming face the basic concern of formulating mixtures for the best yield at the lowest costs. Of the macronutrients in the feed, protein has and continues to receive special consideration because fish present high and specific needs for this constituent. Traditionally, protein has been supplied primarily by fish meals. This paper presents a synthesis of the efforts made and the lines explored to achieve an effective reduction of the amount of fish meal in the feeds for fish, following two strategies: reduction of the protein in the feeds and the use of new raw materials to replace fish meal.

Selective changes in the protein-turnover rates and nature of growth induced in trout liver by long-term starvation followed by re-feeding.

We report upon the effects of a cycle of long-term starvation followed by re-feeding on the liver-protein turnover rates and nature of protein growth in the rainbow trout (Oncorhynchus mykiss). We determined the protein-turnover rate and its relationship with the nucleic-acid concentrations in the livers of juvenile trout starved for 70 days and then re-fed for 9 days. During starvation the total hepatic-protein and RNA contents decreased significantly and the absolute protein-synthesis rate (A(S)) also fell, whilst the fractional protein-synthesis rate (K(S)) remained unchanged and the fractional protein-degradation rate (K(D)) increased significantly. Total DNA content, an indicator of hyperplasia, and the protein:DNA ratio, an indicator of hypertrophy, both fell considerably. After re-feeding for 9 days the protein-accumulation rates (K(G), A(G)) rose sharply, as did K(S), A(S), K(D)), protein-synthesis efficiency (K(RNA)) and the protein-synthesis rate/DNA unit (K(DNA)). The total hepatic protein and RNA contents increased but still remained below the control values. The protein:DNA and RNA:DNA ratios increased significantly compared to starved fish. These changes demonstrate the high response capacity of the protein-turnover rates in trout liver upon re-feeding after long-term starvation. Upon re-feeding hypertrophic growth increased considerably whilst hyperplasia remained at starvation levels.

Long-term nutritional effects on the primary liver and kidney metabolism in rainbow trout. Adaptive response to starvation and a high-protein, carbohydrate-free diet on glutamate dehydrogenase and alanine aminotransferase kinetics.

In fish, metabolic changes and qualitative responses during different nutritional situations are highly controversial in the scientific literature, and for this reason the objective of this work has been to probe deeper into the adaptive behaviour of two important amino acid-metabolising enzymes, glutamate dehydrogenase (GDH) and alanine aminotransferase (AAT) of liver and kidney in trout. In the present study, we examined the long-term effects of endogenous or exogenous proteins--generated, respectively, by a prolonged starvation or by feeding a high-protein diet--on the kinetics of liver and kidney GDH and AAT. Feeding on a high-protein diet significantly increased the liver (100%) and kidney (49%) GDH Vmax and catalytic efficiency; the same kinetic parameters of AAT increased by 65% only in the liver enzyme, without changing the Km and activity ratio values. Starvation registered a significant increase of both enzymes, Vmax and catalytic efficiency in the liver, but activity was unaltered in the kidney. In addition, no significant changes were found in the Km or activity ratio. All enzyme kinetics showed a Michaelian behaviour without any evidence of sigmoidicity. The experimental results show strong adaptive responses in the kinetic behaviour of the enzymes of both tissues. With the exception of renal AAT, the remainder of the enzymes presented a marked influence in their kinetic parameters by an excess of protein. The results are discussed in terms of the possible adaptive role of enzyme kinetics to amino acid availability.

Impact of starvation-refeeding on kinetics and protein expression of trout liver NADPH-production systems.

Herein we report on the kinetic and protein expression of glucose-6-phosphate dehydrogenase (G6PDH), 6-phosphogluconate dehydrogenase, and malic enzyme (ME) in the liver of the trout (Oncorhynchus mykiss) during a long-term starvation-refeeding cycle. Starvation significantly depressed the activity of these enzymes by almost 60%, without changing the Michaelis constant. The time response to this nutritional stimulus increased with fish weight. The sharp decline in G6PDH and ME activities was due to a specific protein-repression phenomenon, as demonstrated by molecular and immunohistochemical analyses. Also, the dimeric banding pattern of liver G6PDH shifted from the fully reduced and partially oxidized forms, predominant in control, to a fully oxidized form, more sensitive to proteolytic inactivation. Refeeding caused opposite effects in both protein concentration and enzyme activities of about twice the control values in the first stages, later reaching the normal enzyme activity levels. Additionally, the partially oxidized form of G6PDH increased. The kinetics of these enzymes were examined in relation to the various metabolic roles of NADPH. These results clearly indicate that trout liver undergoes protein repression-induction processes under these two contrasting nutritional conditions.

A microcomputer-controlled demand feeder for the study of feeding behavior in fish.

This paper describes an easy-to-make, low-cost demand feeder. The electromechanical design ensures a single-pellet delivery for each demand. The feeder, activated by a fish pressing a bar, is driven by a solenoid. A variety of pellet shapes and sizes can be used, offering broad experimental versatility. The feeder is also suitable for microcomputer control.

[Effects of partial hepatectomy on various blood and hepatic parameters in the rainbow trout (Salmo gairdnerii, Rich.)]. / Efectos de la hepatectomía parcial sobre algunos parámetros sanguíneos y hepáticos en la trucha arco iris (Salmo gairdnerii, Rich.).

After 36% of hepatic mass removal , rainbow trout recovered its initial liver weight in 20-30 days, i.e., with a regeneration rate clearly lower than in mammals. During early regeneration process hematocrit index and hemoglobin content were slightly decreased, but both parameters rapidly reached their normal values. The evolution of both glycaemia and hepatic glycogen content supported the idea of the existence of a late regeneration wave, which, in this case, could begin at about the 20th post-operative day.

Hormonal effects on gluconeogenesis from (U-14C)glutamate in rainbow trout (Salmo gairdneri).

Blood glucose was significantly decreased by insulin (4 I.U./kg). Glucagon (1 mg/kg) and Cortisol (5 mg/kg) administration produced a significant hyperglycaemia. Insulin administration did not modify liver glycogen levels. Glucagon showed a marked liver glycogen mobilization. Cortisol stimulated liver glycogen deposition. Insulin and Glucagon showed a significant inverse effect on gluconeogenesis from (U-14C)glutamate, decreasing and increasing 14C-glucose formation respectively. Hormonal treatments did not influence the very low levels of incorporation of (U-14C)glutamate into liver and muscle glycogen.

Some functional consequences of partial hepatectomy in rainbow trout (Salmo gairdnerii).

A partial hepatectomy (an average of 36% of hepatic mass removed) was performed in rainbow trout. Thirty days after this partial hepatic removal, the liver had recovered its initial weight. During regeneration the remaining liver was unable to maintain normal blood levels of protein, cholesterol and, partially, lipids which decrease after surgery. The results obtained show that functional and liver weight regeneration proceed at different rates throughout a given time course, weight recovering faster than complete functional restoration.