The fine-tuning of CXCL8 protects kidney against ischemia-reperfusion injury in mice lacking microRNA-146a

Les microARNs (miARN) sont de petits ARN régulant l’expression des gènes au niveau post-transcriptionnel. Ils sont impliqués dans la régulation de nombreux processus biologiques nécessaires au fonctionnement cellulaire, comme le contrôle de la réponse à l’inflammation. Dans ce travail, nous avons évalué l’implication des miARN dans la réponse tubulaire rénale à l’inflammation. Au cours d’un premier travail nous avons étudié par une approche globale le profil d’expression des miARN dans des cellules tubulaires proximales de la lignée HKJ2 exposées à des cytokines pro-inflammatoires. Nous avons ainsi identifié la forte induction de miR-146a en réponse au stimulus inflammatoire. Nous avons ensuite mis en évidence in vitro que l’induction de miR-146a par l’IL-1β dans les cellules HK-2 est secondaire à l’activation de la voie NF-κB, constitue un rétrocontrôle négatif de cette voie et régule l’expression de CXCL8 en aval. In vivo, l’étude du phénotype des souris invalidées pour miR-146a dans un modèle d’agression tubulaire rénale où l’inflammation joue un rôle significatif a mis en évidence une aggravation des lésions tubulaires, de l’infiltrat inflammatoire et de la fibrose interstitielle en réponse à l’ischémie-reperfusion. Le blocage de la signalisation induite par CXCL8 par la réparixine, un inhibiteur du récepteur de CXCL8 (CXCR1), permet de limiter le développement des lésions induites par l’ischémie-reperfusion chez les souris miR-146a-/-. Dans un second travail nous avons exploré le phénotype rénal des souris invalidées pour miR-146a, connues pour développer une auto-immunité.Independently of its cause, acute kidney injury leads to the development of tubular injury and interstitial inflammation that need to be controlled to avoid fibrosis development. We hypothesized that microRNAs (miRNAs) are involved in the regulation of the balance between lesions and adaptive repair. Using HK2 human proximal tubular epithelial cells, we studied in vitro the response to pro-inflammatory cytokines and the regulation of miR-146a. We explored its targets in HK2 cells after stimulation by IL-1β. In vivo we explored the effect of unilateral renal ischemia-reperfusion injury (IRI) in wild-type or miR-146a invalidated mice. In pro-inflammatory conditions, we identified miR-146a to be transcriptionally upregulated by ligands of the interleukin-1-toll-like receptor signaling in HK2 cells. IL-1β treatment induced miR-146a expression in a time- and concentration-dependent manner through the activation of NF-κB, as confirmed by siRNA and luciferase reporter vector experiments. MiR-146a acted as a negative feedback regulator of this critical pathway by targeting IRAK1, thus decreasing CXCL8/CXCL1 expression by injured tubular cells. In vivo, miR-146a was found to be induced in response to renal IRI in a mouse model of renal unilateral IRI seven days after the injury. In human, miR-146a was found to be induced in the renal allograft of patients who experienced acute tubular necrosis early after transplantation as compared to patients with normal allograft biopsy results (P<0.05). Mir-146a levels were also increased in urine samples collected ten days after renal transplantation in recipients of a deceased donor kidney as compared to recipients of a living donor kidney (P<0.01). In situ hybridization localized up-regulated miR-146a mostly in tubular cells after IRI. Fourteen days after unilateral IRI, miR-146a-/- mice had greater tubular injury, inflammatory infiltrate and fibrosis compared with wild-type mice. Inhibition of the CXCL8/CXCL1 signaling using reparixin, a CXCR2 inhibitor, prevented the development of tubular injury, inflammation and fibrosis after IRI in miR-146a-/- mice. In conclusion, these results highlight miR-146a as a key mediator of the renal response to injury by limiting the consequences of inflammation, a key process in the development of acute and chronic kidney diseases

MicroARN et maladies rénales

Les microARN (miARN) constituent une classe abondante de petits ARN naturels non codants. Ils jouent un rôle fondamental dans la régulation post-transcriptionnelle des gènes. Des données récentes suggèrent leur implication dans le développement de l’appareil urinaire et des cellules rénales et dans des processus impliqués dans la physiopathologie des maladies rénales comme la fibrogenèse, l’immunité innée et adaptative et les maladies dysimmunitaires ou le rejet du greffon rénal. Nous proposons une revue de la littérature sur l’implication des miARN en physiopathologie rénale

Prevalence of asymptomatic bacteriuria among kidney transplant recipients beyond two months post-transplant : a multicenter, prospective, cross-sectional study

BackgroundDuring routine post-kidney transplant care, most European transplant physicians screen patients for asymptomatic bacteriuria. The usefulness of this strategy is debated. To make screening cost-effective, asymptomatic bacteriuria should be prevalent enough to justify the expense, and antibiotics should improve patient outcomes significantly if asymptomatic bacteriuria is detected. Regrettably, the prevalence of asymptomatic bacteriuria among kidney transplant recipients is not well defined.MethodsTo determine the prevalence of asymptomatic bacteriuria among kidney transplant recipients, we did a cross-sectional study among kidney transplant recipients undergoing routine surveillance in three outpatient transplant clinics in Belgium and France. We excluded patients who were in the first two months post-transplantation and/or had a urinary catheter. Asymptomatic participants who had a urine culture with one organism isolated at ≥ 105 CFU/mL were asked to provide a confirmatory urine specimen. Asymptomatic bacteriuria was defined per Infectious Diseases Society of America guidelines.ResultsWe screened 500 consecutive kidney transplant recipients. Overall, the prevalence of asymptomatic bacteriuria was 3.4% (17/500 patients). It was similarly low among kidney transplant recipients who were between 2 and 12 months after transplantation (1.3%, 1/76 patients) and those who were farther after transplantation (3.8%, 16/424 patients: p = 0.49). Asymptomatic bacteriuria was significantly associated with female gender (risk ratio 3.7, 95% CI 1.3-10.3, p = 0.007) and older age (mean age: 61 ± 12 years [bacteriuric participants], versus 53 ± 15 years [non-bacteriuric participants], p = 0.03). One participant's colistin-resistant Escherichia coli isolate carried the globally disseminated mcr-1 gene.ConclusionsAmong kidney transplant recipients who are beyond the second month post-transplant, the prevalence of asymptomatic bacteriuria is low. Further studies are needed to ascertain the cost-effectiveness of a screen-and-treat strategy for asymptomatic bacteriuria in this population

A Validated LC-MS/MS Method for Performing Belatacept Drug Monitoring in Renal Transplantation

Belatacept, a CTLA4-Ig, was designed to prevent rejection and graft loss in kidney transplant recipients. This immunotherapy showed a long-term clinical benefit mainly on renal function and better glycemic control but was also associated with a higher number of severe infectious diseases, particularly CMV disease, and lymphoproliferative disease. Therapeutic drug monitoring usually guides the benefit–risk assessment of long-term immunosuppression. In this study, an analytical method by LC-MS/MS was developed in 20 microL of plasma for the belatacept quantification. Intra- and inter-assay precision and accuracy were lower than 20% for the limit of quantification, and 15% for higher concentrations. The method was implemented in our lab and provided data about the inter-variability (N = 108) and intra-variability (N = 33) of belatacept concentrations in kidney transplant recipients with a stable renal function, after conversion from a CNI- to a belatacept-based regimen

Severe relapse of SARS‐CoV‐2 infection in a kidney transplant recipient with negative nasopharyngeal SARS‐CoV‐2 RT‐PCR after rituximab

International audienceImmunocompromised patients may experience prolonged viral shedding after their initial SARS-CoV-2 infection, however, symptomatic relapses after remission currently remain rare. We herein describe a severe COVID-19 relapse case of a kidney transplant recipient (KTR) following rituximab therapy, 3 months after a moderate COVID-19 infection, despite viral clearance after recovery of the first episode. During the clinical relapse, the diagnosis was established on a broncho-alveolar lavage specimen (BAL) by RT-PCR. The infectivity of the BAL sample was confirmed on a cell culture assay. Whole genome sequencing confirmed the presence of an identical stain (Clade 20A). However, it had an acquired G142D mutation and a larger deletion of 3-amino-acids at position 143-145. These mutations located within the N-terminal domain are suggested to play a role in viral entry. The diagnosis of a COVID-19 relapse should be considered in the setting of unexplained persistent fever and/or respiratory symptoms in KTRs (especially for those after rituximab therapy), even in patients with previous negative naso-pharyngeal SARS-CoV-2 PCR

Development and validation of an optimized integrative model using urinary chemokines for noninvasive diagnosis of acute allograft rejection.

The urinary chemokines CXCL9 and CXCL10 are promising noninvasive diagnostic markers of acute rejection (AR) in kidney recipients, but their levels might be confounded by urinary tract infection (UTI) and BK-virus reactivation. Multiparametric model development and validation addressed these confounding factors in a training set of 391 samples, optimizing the diagnostic performance of urinary chemokines. CXCL9/creatinine increased in UTI and BKV viremia with or without nephropathy (BKVN) (no UTI/leukocyturia/UTI: -0.10/1.61/2.09, P=0.0001 and no BKV/viremia/BKVN: -0.10/1.90/2.29, P<0.001) as well as CXCL10/creatinine (1.17/2.09/1.98, P<0.0001 and 1.13/2.21/2.51, P<0.001, respectively). An optimized 8-parameter model (recipient age, sex, eGFR, DSAs, UTI, BKV blood viral load, CXCL9 and CXCL10) diagnosed AR with high accuracy (AUC: 0.85, 95% CI: 0.80-0.89) and remained highly accurate at the time of screening (AUC: 0.81, 95% CI: 0.48-1) or indication biopsies (AUC: 0.85, 95% CI: 0.81-0.90) and within the first year (AUC: 0.86, 95% CI: 0.80-0.91) or later (AUC: 0.90, 95% CI: 0.84-0.96), achieving AR diagnosis with an AUC of 0.85 and 0.92 (P<0.0001) in two external validation cohorts. Decision curve analyses demonstrated the clinical utility of the model. Considering confounding factors rather than excluding them, we optimized a noninvasive multiparametric diagnostic model for AR of kidney allografts with unprecedented accuracy