1. Chronic Kidney Disease Increases Cerebral Microbleeds in Mouse and Man
- Author
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Lau, Wei Ling, Nunes, Ane CF, Vasilevko, Vitaly, Floriolli, David, Lertpanit, Long, Savoj, Javad, Bangash, Maria, Yao, Zhihui, Shah, Krunal, Naqvi, Sameen, Paganini-Hill, Annlia, Vaziri, Nosratola D, Cribbs, David H, and Fisher, Mark
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Aging ,Neurosciences ,Kidney Disease ,Cerebrovascular ,2.1 Biological and endogenous factors ,Renal and urogenital ,Actin Cytoskeleton ,Animals ,Cells ,Cultured ,Cerebral Hemorrhage ,Disease Models ,Animal ,Endothelial Cells ,Female ,Humans ,Male ,Mice ,Inbred C57BL ,Middle Aged ,Renal Insufficiency ,Chronic ,Tight Junctions ,Chronic kidney disease ,Microbleeds ,Mouse model ,Endothelial cell culture ,Brain MRI ,Endothelium ,Kidney ,Stroke ,adenine ,claudin 5 ,creatinine ,nitrogen ,occludin ,tight junction protein ,urea ,von Willebrand factor ,actin filament ,animal cell culture ,animal experiment ,animal model ,animal tissue ,Article ,bEnd.3 cell line ,blood brain barrier ,blood pressure ,brain hemorrhage ,chronic kidney failure ,cohort analysis ,comparative study ,controlled study ,creatinine blood level ,cystinosis ,diabetic nephropathy ,disease burden ,disease exacerbation ,end stage renal disease ,endothelium cell ,follow up ,hemodialysis ,human ,hypertension ,immunofluorescence test ,immunoglobulin A nephropathy ,immunohistochemistry ,interstitial nephritis ,lupus erythematosus nephritis ,male ,medical record review ,mouse ,nephrectomy ,nonhuman ,nuclear magnetic resonance imaging ,priority journal ,protein expression ,retrospective study ,survival ,tight junction ,urea nitrogen blood level ,uremia ,animal ,C57BL mouse ,cell culture ,complication ,disease model ,female ,middle aged ,pathology ,pathophysiology ,Public Health and Health Services ,Clinical sciences - Abstract
Brain microbleeds are increased in chronic kidney disease (CKD) and their presence increases risk of cognitive decline and stroke. We examined the interaction between CKD and brain microhemorrhages (the neuropathological substrate of microbleeds) in mouse and cell culture models and studied progression of microbleed burden on serial brain imaging from humans. Mouse studies: Two CKD models were investigated: adenine-induced tubulointerstitial nephritis and surgical 5/6 nephrectomy. Cell culture studies: bEnd.3 mouse brain endothelial cells were grown to confluence, and monolayer integrity was measured after exposure to 5-15% human uremic serum or increasing concentrations of urea. Human studies: Progression of brain microbleeds was evaluated on serial MRI from control, pre-dialysis CKD, and dialysis patients. Microhemorrhages were increased 2-2.5-fold in mice with CKD independent of higher blood pressure in the 5/6 nephrectomy model. IgG staining was increased in CKD animals, consistent with increased blood-brain barrier permeability. Incubation of bEnd.3 cells with uremic serum or elevated urea produced a dose-dependent drop in trans-endothelial electrical resistance. Elevated urea induced actin cytoskeleton derangements and decreased claudin-5 expression. In human subjects, prevalence of microbleeds was 50% in both CKD cohorts compared with 10% in age-matched controls. More patients in the dialysis cohort had increased microbleeds on follow-up MRI after 1.5 years. CKD disrupts the blood-brain barrier and increases brain microhemorrhages in mice and microbleeds in humans. Elevated urea alters the actin cytoskeleton and tight junction proteins in cultured endothelial cells, suggesting that these mechanisms explain (at least in part) the microhemorrhages and microbleeds observed in the animal and human studies.
- Published
- 2020