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Predicting and Defining Steroid Resistance in Pediatric Nephrotic Syndrome using Plasma Metabolomics

ABSTRACT: Paired citrate plasma samples were collected from 27 steroid-sensitive and 14 steroid-resistant nephrotic syndrome participants prior to beginning treatment and after an average of 7 weeks (range 3-19 wks) of treatment with a corticosteroid.

ORGANISM(S): Human Homo Sapiens

TISSUE(S): Blood

DISEASE(S): Pediatric Nephrotic Syndrome

SUBMITTER: Susan Sumner

PROVIDER: ST000939 | MetabolomicsWorkbench | Thu Mar 01 00:00:00 GMT 2018

REPOSITORIES: MetabolomicsWorkbench

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Project description:Steroid-refractory acute rejection is a risk factor for inferior renal allograft outcome. We aimed to gain insight into the mechanisms underlying steroid resistance by identifying novel molecular markers of steroid-refractory acute rejection. Eighty-three kidney transplant recipients (1995-2005), who were treated with methylprednisolone during a first acute rejection episode, were included in this study. Gene expression patterns were investigated in a discovery cohort of 36 acute rejection biopsies, and verified in a validation cohort of 47 acute rejection biopsies. In the discovery set, expression of metallothioneins (MT) was significantly (P<0.000001) associated with decreased response to steroid treatment. Multivariate analysis resulted in a predictive model containing MT-1 as an independent covariate (AUC=0.88, P<0.0000001). In the validation set, MT-1 expression was also significantly associated with steroid resistance (P=0.029). Metallothionein expression was detected in macrophages and tubular epithelial cells. Parallel to the findings in patients, in vitro experiments of peripheral blood mononuclear cells from 11 donors showed that non-response to methylprednisolone treatment is related to highly elevated MT levels. High expression of metallothioneins in renal allografts is associated with resistance to steroid treatment. Metallothioneins regulate intracellular concentrations of zinc, through which they may diminish the zinc-requiring anti-inflammatory effect of the glucocorticoid receptor. Transcriptional profiles of 40 renal allograft biopsy samples were analyzed using Illumina HumanRef-8 v3.0 BeadChips (Illumina, San Diego, CA). Expression profiles were investigated in total RNA isolated from biopsy samples of 18 patients with steroid responsive acute rejection and 18 patients with steroid resistant acute rejection. Four biopsies, taken during acute decrease of graft function but with no histomorphologic indication of rejection, were included as controls.

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Predicting and Defining Steroid Resistance in Pediatric Nephrotic Syndrome using Plasma Metabolomics

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