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Vascular access dysfunction is a cause of morbidity and mortality in chronic kidney disease (CKD) patients that require hemodialysis. The major cause of vascular access failure is venous stenosis due to neointimal hyperplasia (NH). Vascular smooth muscle cells (VSMC) are critical for the development of NH lesions, as they have the ability to modulate their phenotype from a "contractile" to a "synthetic" phenotype in the presence of uremia, through the regulation of sensor genes for uremia danger signals and VSMC-specific differentiation genes. Recent research indicates that Caspase-1 (casp-1) activation plays an essential role in sensing metabolic danger signal-associated molecular patterns and initiating vascular inflammation. Carbamylated LDL, a uremic toxin that has been shown to be found in higher levels in patients with CKD and in CKD murine models when compared to controls, and could play a role in casp-1 activation. Therefore, the goal of this project is to examine the role of cLDL/CKD-driven casp-1 activation in VSMC and CKD-related NH. We have established a CKD mouse model and published on CKD-associated vascular remodeling. We exposed wild type and caspase-1 knockout mice to our CKD model, analyzed and quantified the NH lesion formed. We also examined in vitro and ex-vivo changes in VSMC-specific differentiation genes when exposed to uremic serum and cLDL, in the presence or absence of caspase-1 inhibitor. We found that CKD serum induces with casp-1 activation and phenotypic changes in VSMCs from a "contractile" to a "synthetic" phenotype, which are reversed with casp-1 inhibition. In an ex-vivo model using relative quantification we found that VSMC contractile markers α -Actin, Calponin, SM-22, and Smoothelin gene expression of CKD mouse carotid VSMC were higher in casp-1 knockout mice when compared to wild-type (1.40, 1.28, 1.22, 1.41 respectively). Also using an in-vivo model, relative quantification of α-actin decreased from 1.0 to 0.329 when VSMCs were exposed to uremic serum and but increased back to 0.588 when Caspase-1 inhibitor is added. The relative quantification of Calponin also decreased from 1.0 to 0.394 when exposed to uremic serum and increased back to 0.601 with caspase-1 inhibitor. We also found that caspase-1 deficiency significantly reversed CKD-related vascular remodeling in casp-1 knockout mice and reduced NH volume by 50% from 1,440,023in wild-type mice to 71,069 µm2 in casp-1 knockouts (p-value 0.002). This evidence provides evidence that casp-1 plays a critical role in NH formation. Furthermore our results provide a novel insight over the therapeutic potential of casp-1 inhibitors for CKD induced NH and other inflammation induced vascular remodeling. / Public Health

Patients with chronic kidney disease (CKD) develop hyperhomocysteinemia (HHcy), have increased inflammatory monocytes (MC) and 10-times higher cardiovascular mortality than the general population. Here, we investigated HHcy-related MC differentiation in CKD. Twenty seven CKD and CVD, and 14 healthy subjects were recruited. CD40 was selected as a CKD-induced MC activation marker by mining for CKD-MC-mRNA screen database. We found that CD14++CD16+ MC, often denoted as inflammatory subset, soluble CD40 ligand (sCD40L), and TNFα/IL-6 levels were augmented in CVD and CKD subjects. CD40hiCD14++CD16+ MC, plasma homocysteine (Hcy) and S-adenosylhomocysteine (SAH) levels were increased in CVD and further elevated in CKD subjects. In cultured human peripheral blood mononuclear cells, CKD patient serum, Hcy, CD40L and TNFα/IL-6 induced CD40hiCD14++CD16+ MC differentiation, which was prevented by Hcy-lowering folic acid and neutralizing antibodies against TNFα and IL-6. Interestingly, CD14++CD16+ and CD40hiCD14++CD16+ MCs were negatively correlated with plasma S-adenosylmethionine/SAH (SAM/SAH) ratios, an indicator of methylation status, in CKD and CVD subjects. In white blood cells (WBC) isolated from CKD and CVD subjects with lower SAM/SAH ratios, hypomethylation was identified on the CG pair of NFκB consensus element in the core promoter located at the CpG island of CD40 gene by DNA methylation mapping using bisulfite converting pyrosequencing. Moreover, Hcy inhibited DNA methyltransferase-1 activity in cultured human blood MC. In conclusion, HHcy induces CD14++CD16+ and CD40hiCD14++CD16+ MC differentiation, at least in part, via sCD40L induction and CD40 DNA hypomethylation in CKD and CVD subjects. To study the role of CD40 in the development of kidney pathology and vascular disease, we then established mouse model of CKD-induced CVD (5/6 nephrectomy CKD model plus left carotid artery ligation) in CD40-/- mice. Bone marrow (BM)-derived cells were traced by the transplantation of BM cells from enhanced green fluorescent protein (EGFP) transgenic CD40+/+ mice after sublethal irradiation of the recipient CD40-/- mice. We demonstrated here that CKD accelerated carotid artery atherosclerosis, exacerbated metabolism, increased spleen weight and circulating CD40+ inflammatory MC, and further increased differentiation of mononuclear phagocytic cells (MPC); CD11b+F4/80- MC, CD11b+F4/80+ macrophage (Mϕ) and CD11c+CD11b+F4/80+ bone marrow-derived dendritic cell in the kidney and aorta, which were abolished by CD40-/- mice. We also found that CKD kidney elevated CD40 expression and induced MC chemotactic signals; CCL2, CCL12, and CCL5 chemokines, which were abolished in CD40-/- mice. In conclusion, our results suggest that CD40 induction in the chronic kidney disease mediates kidney chemokine production, which in turn contributes to acceleration of myeloid cell infiltration, MPC differentiation, and carotid artery atherosclerosis. / Pharmacology

Endoplasmic reticulum (ER) stress, which results from the aggregation of misfolded proteins in the ER, has been implicated in many forms of kidney injury, including hypertensive nephrosclerosis. ER stress induction increases levels of active TGFβ1, a pro-fibrotic cytokine, which can lead to epithelial-to-mesenchymal transition (EMT) in renal proximal tubular cells. EMT occurs when epithelial cells undergo phenotypic changes, which can be prevented by inhibiting ER stress. Further, the ER stress protein TDAG51 is essential for the development of TGFβ1-mediated fibrosis. The low molecular weight chemical chaperone 4-phenylbutyrate (4-PBA) can protect against ER stress-mediated kidney injury. It acts directly on the kidney, and can prevent ER stress, renal tubular damage, and acute tubular necrosis. In a tunicamycin-mediated model of kidney injury, this damage is prevented primarily through repression of the pro-apoptotic ER stress protein CHOP. Along with providing renoprotective effects, 4-PBA can inhibit endothelial dysfunction and elevated blood pressure in a rat model of essential hypertension. In addition to lowering blood pressure, 4-PBA reduces contractility, augments endothelial-dependent vasodilation, and normalizes media-to-lumen ratio in mesenteric arteries from spontaneously hypertensive rats. Further, ER stress leads to reactive oxygen species generation, which is reduced with 4-PBA. Dahl salt-sensitive rats given 4-PBA are protected from hypertension, proteinuria, albuminuria, and renal pathology. Rats provided with vasodilatory medications demonstrate that lowering blood pressure alone is not renoprotective. In fact, endothelial dysfunction, as demonstrated by an impaired myogenic response, is culpable in the breakdown of the glomerular filtration barrier and subsequent renal damage. As such, alleviating ER stress using 4-PBA serves as a viable therapeutic strategy to preserve renal function and prevent ER stress-mediated endothelial dysfunction, renal fibrosis, glomerular filtration barrier destruction, and progression of hypertensive nephrosclerosis. / Thesis / Doctor of Philosophy (PhD) / Chronic kidney disease is characterized by progressive loss of kidney function, and is a major public health problem. Kidney cells make proteins that help the kidney function properly. However, if the proteins are made improperly, the kidney does not function as well. This can lead to poor filtration and protein in the urine, damage to important kidney structures, and kidney scarring. High blood pressure, a risk factor for kidney disease, is often accused of causing kidney damage. This thesis shows that malfunctioning blood vessels can cause kidney injury, and lowering blood pressure may not prevent this. However, there are pharmacological molecules that can protect the kidney from damage. These molecules help the cells make proteins properly, preventing blood vessel malfunction and kidney damage. Our findings suggest that helping blood vessels and kidney cells create properly functioning proteins is more protective for the kidney than lowering blood pressure alone.

Encephalitozoon cuniculi, Toxoplasma gondii and Sarcocystis neurona are intracellular parasites that infect a wide range of mammalian host species including domestic cats. The prevalence of antibodies to these parasites in cats was examined using an indirect immunofluorescence antibody assay. E. cuniculi targets the kidneys of rabbits but the prevalence of disease in cats is unknown. Chronic kidney disease (CKD) is a common cause of illness in cats. T. gondii is a widespread parasite of cats; however, it is not considered a major causative agent of CKD. The first hypothesis was that E. cuniculi and T. gondii are unrecognized causes of chronic kidney disease in domestic cats. Serum and plasma samples were examined for protozoal antibodies from 232 feline patients at the VMRCVM Teaching Hospital. Thirty-six of the 232 samples met the IRIS criteria for CKD. Antibodies to E. cuniculi were found in 15 samples, 4 of which came from cats with CKD. Antibodies to T. gondii were found in 63 samples; 10 cats of the 63 had CKD. These were not significantly different from cats with no CKD and the null hypothesis was rejected. Domestic cats, armadillos, raccoons and skunks are intermediate hosts (IH) for S. neurona while opossums are the definitive host (DH). The seroprevalence of S. neurona was examined in domestic cats from Virginia and Pennsylvania. The second hypothesis was that domestic cats are important IH for S. neurona transmission. A low seroprevalence was found in 32 of the 441 cats and the null hypothesis was rejected. / Master of Science in Life Sciences