E.A. Hwang

Acute Colitis Associated With Dengue Fever in a Renal Transplant Recipient

Dengue fever is a significant health problem for international travelers to all endemic area. Dengue fever is characterized by a sudden onset of fever, headache, rash, myalgia, and joint pain. Infection with the dengue virus is detrimental to a immunosuppressed renal transplant patients. Herein we report a 29-year-old woman living-related renal transplant recipient returning from Southeast Asia with dengue fever presenting as acute colitis. The patient traveled to Southeast Asia for 1 week. She developed watery diarrhea in the second week after the onset of symptoms of dengue fever. Laboratory findings were leukopenia, thrombocytopenia, and elevated serum transaminase levels. Sigmoidoscopic features showed nonspecific acute colitis. She improved after 10 days of hospitalization with intensive supportive care and continuous tacrolimus monotherapy. Altered clinical symptoms are manifested in immunologically naïve adults. Manifestation of unusual symptoms does not exclude dengue virus infection in renal transplant recipients.

Anti-wrinkle Compounds Isolated from the Seeds of Arctium lappa L.

This study was carried out to discover the skin wrinkle reducing components in the seeds of Arctium lappa. The isolation of a methylene chloride-soluble fraction of 70% ethanol extract from the seeds of Arctium lappa using a procollagen type-1 synthesis and MMP-1 activity resulted in the isolation and identification of four lignin compounds: arctiin, arctigenin, matairesinol, and diarctigenin. All structures were confirmed via NMR and MS spectroscopic data. To determine cell viability and procollagen type-1 synthesis, human dermal fibroblasts were treated with 10-100 μM. As a result, none of the four compounds showed cytotoxicity up to 50 μM. We also investigated their procollagen type-1 synthesis and MMP-1 inhibition activity and found that arctiin had the highest activity in terms of both procollagen synthesis and MMP-1 inhibition among all four compounds. Putting all the data together, we suggest that arctiin be used in cosmetics as an anti-wrinkle material.

A Study on the Depigmenting Effect of Carthamus tinctorius Seed, Cyperus rotundus and Schizonepeta tenuifolia Extracts

The objective of the present study was to evaluate the skin depigmentation effect of the extracts of three herbs, Carthamus tinctorius seed, Cyperus rotundus and Schizonepeta tenuifolia. Their effects on tyrosinase and melanin synthesis inhibitory action were assessed. We found that the C. tinctorius seed ethanol extracts reduced the tyrosinase activity and melanin formation of B16F10 melanoma cells. The C. tinctorius seed suppressed the expression in microphthalmia associated transcription factor (MITF), tyrosinase, tyrosinase related protein 1 (TRP-1), and tyrosinase related protein 2 (TRP-2) in B16F10 melanoma cells. These results show that C. tinctorius seed inhibited melanogenesis on the B16F10 melanoma cell. The underlying mechanism of C. tinctorius seed whitening activity may be the inhibition of tyrisinase, MITF, tyrosinase, TRP-1, and TRP-2 expression. The results suggested that C. tinctorius seed has considerable potential as a natural functional ingredient with a depigmentation effect.

Delayed Presentation of Arteriovenous Fistula and Pseudoaneurysms in a Renal Transplant Patient 10 Years After Percutaneous Allograft Biopsy

A 51-year-old man was admitted with microscopic hematuria at 10 years after living donor renal transplantation. In order to distinguish between acute tubular necrosis and acute rejection, a graft biopsy was performed under ultrasound guidance at 1 month posttransplantation. Doppler sonography revealed 3 pulsatile cystic masses and an arteriovenous fistula (AVF) in the lower kidney pole. Selective transplant renal angiography revealed 3 pseudoaneurysms with an AVF supplied by a lobular artery in the lower pole. The diagnosis was AVF with pseudoaneurysm, which developed secondary to percutaneous renal allograft biopsy. Interventional treatment was performed because of the high risk for pseudoaneurysm rupture. The AVF and pseudoaneurysms were treated successfully by percutaneous transluminal embolization; renal function remained stable after embolization.

Cytokine Array After Cyclosporine Treatment in Rats

OBJECTIVES Long-term treatment with cyclosporine (CsA) results in chronic nephrotoxicity, which is known to be mediated by several cytokines including transforming growth factor-betal. Cytokines are known to play an important role in innate immunity, apoptosis, angiogenesis, cell growth, and differentiation. They are known to be involved in most disease processes, including cancer, cardiac disease, and nephrotoxicity. To evaluate changes of cytokines in a rat model of CsA-induced chronic nephrotoxicity, we performed a cytokine array. METHODS Experiments were performed on two groups of rats; normal control group and CsA-treated group. Cytokine array in rat serum was performed using Cytokine Antibody Array I kit from RayBiotech. RESULTS Serum creatinine, urine creatinine, and creatinine clearance increased in the CsA-treated group. Among the several cytokines, the expressions of the lipopolysaccharide-induced CXC chemokine (LIX), monocyte chemoattractant protein 1 (MCP-1), nerve growth factor (beta-NGF), and tissue inhibitor of metalloproteinase-1 (TIMP-1) in the CsA-treated group were increased above that of cytokines in the control group. The density of the LIX in controls was 0.62, and in the CsA-treated group was 1.24. The density of the MCP-1 in controls was 0.68, and in CsA-treated, 1.43. The density of the beta-NGF in controls was 0.62, and that in CsA-treated, 1.24. The density of the TIMP-1 in controls 1.13, and in CsA-treated, 1.40. CONCLUSIONS Our data suggested that among several cytokines elevated levels of the LIX, MCP-1, beta-NGF, and TIMP-1 are the contributing factors to CsA-induced nephropathy.

Elevated Fibroblast Growth Factor 23 Levels As a Cause of Early Post-Renal Transplantation Hypophosphatemia

BACKGROUND Hypophosphatemia is a common complication after renal transplantation. Hyperparathyroidism has long been thought to be the cause, but hypophosphatemia can persist after high parathyroid hormone (PTH) levels normalize. Furthermore, calcitriol levels remain inappropriately low after transplantation, suggesting that mechanisms other than PTH contribute. Fibroblast growth factor 23 (FGF-23) induces phosphaturia, inhibits calcitriol synthesis, and accumulates in chronic kidney disease. We performed prospective study to investigate if FGF-23 early after renal transplantation contributes to hypophosphatemia. METHODS We measured FGF-23 levels before and at 1, 2, 4, and 12 weeks after transplantation in 20 renal transplant recipients. Serum creatinine, calcium (Ca), phosphate (Pi), intact PTH (PTH), and 1,25-dihydroxy vitamin D (1,25(OH)(2)VitD) were measured at the same time. RESULTS FGF-23 levels decreased by 97% at 4 weeks after renal transplantation (PRT) (7,471 ± 11,746 vs 225 ± 295 pg/mL; P < .05) but were still above normal. PTH and Pi levels also decreased significantly after renal transplantation, and Ca and 1,25(OH)(2)VitD slightly increased. PRT hypophosphatemia of <2.5 mg/dL developed in 15 (75%) and 12 (60%) patients at 4 weeks and 12 weeks respectively. Compared with nonhypophosphatemic patients, the levels of FGF-23 of hypophosphatemic patients were higher (303 ± 311 vs 10 ± 6.9 pg/mL; P = .02) at 4 weeks PRT. FGF-23 levels were inversely correlated with Pi (r(2) = 0.406; P = .011); PTH was not independently associated with Pi (r(2) = 0.132; P = .151). CONCLUSIONS FGF-23 levels decrease dramatically after renal transplantation. During the early PRT period, Pi rapidly decreased, suggesting that FGF-23 is cleared by the kidney, but residual FGF-23 may contribute to the PRT hypophosphatemia. FGF-23, but not PTH levels, was independently associated with PRT hypophosphatemia.

Basiliximab does not reduce the early rejection incidence in high-risk kidney recipients under tacrolimus-based immunosuppression.

This study sought to evaluate the benefit of addition of basiliximab to tacrolimus-based immunosuppression among high-risk renal transplantations. We retrospectively analyzed the clinical data of the basiliximab induction group (n = 55) and a risk-matched control group (n = 57). Graft survivals rates at 1, 3, and 5 years were 100%, 98.1%, and 91.8%, respectively, for the control and 96.2%, 93.9%, and 76.4%, respectively, for the basiliximab group (P = .083). Patient survivals rates at 1, 3, and 5 years were 98.3%, 98.3%, and 98.3%, respectively, for the control group and 98.2%, 94.2%, and 94.2%, respectively, for the basiliximab group (P = .277). Biopsy-proven acute rejection (AR) within 12 months occurred among 24.6% and 18.2% for the control and induction groups, respectively (P = .492). Serum creatinine levels at 1, 3, 6, and 12 months were 1.23 +/- 0.30, 1.38 +/- 0.41, 1.47 +/- 0.61, and 1.44 +/- 0.67 mg/dL, respectively, among the control and 1.24 +/- 0.28, 1.40 +/- 0.38, 1.40 +/- 0.36, and 1.63 +/- 1.62 mg/dL, respectively, among the induction group. In conclusion, this study showed that the addition of basiliximab to tacrolimus-based immunosuppression did not further improve the results of high-risk kidney transplantations in terms of reducing AR, prolonging graft survival, or improving renal function.

Defatted safflower seed extract inhibits adipogenesis in 3T3-L1 preadipocytes and improves lipid profiles in C57BL/6J ob/ob mice fed a high-fat diet.

In the present study, we hypothesized that defatted safflower seed which is known to be rich in polyphenols might influence adipogenesis and obesity-related disorders, and therefore the anti-adipogenic and hypolipidemic effects of ethanol extract from defatted safflower (Cathamus tinctorius L.) seeds (CSE) were investigated both in cultured 3T3-L1 preadipocytes and in C57BL/6J ob/ob mice fed a high-fat diet. CSE inhibited adipocyte differentiation of 3T3-L1 preadipocytes and decreased expression of the adipogenic transcription factors, SREBP1c and PPARγ, and their target genes. Six-week-old obese (ob/ob) mice were fed a high-fat diet and treated with CSE (50 or 100 mg/kg/day) by oral gavage for 6 weeks. Body fat mass (epididymal and perirenal white adipose tissues) in the CSE-treated groups was significantly lower than that in the high-fat diet control (HFD) group, whereas average daily food intake was not significantly different among the groups. Plasma and hepatic triglyceride levels and plasma low-density lipoprotein cholesterol level were also significantly lower in the CSE groups compared to the HFD group. These results suggest that CSE which decreases body fat mass and improves lipid profiles in plasma and liver, represents a potential treatment option for obesity and associated metabolic disorders, including hyperlipidemia.

Effects of Tacrolimus on Antioxidant Status and Oxidative Stress in Glioma Cells

OBJECTIVES After organ transplantation, some patients suffer from mild neurologic symptoms, ranging from tremor to severe complications, including seizures and encephalopathy. Among the immunosuppressants, tacrolimus can cause neurologic side effects. However, the mechanisms of encephalopathy by tacrolimus are not fully understood. We measured the antioxidant status, hydrogen peroxide level, and malondialdehyde level in glioma cells after tacrolimus treatment. METHODS The production of hydrogen peroxide was determined by the modified xylenol orange method. The amount of malondialdehyde was measured by the thiobarbituric acid assay, which is based on malondialdehyde reaction with thiobarbituric acid to give a red species absorbing at 535 nm. Total antioxidant status (TAS) was measured using TAS kits (NX2332). RESULTS Tacrolimus resulted in dose- and time-dependent increases in the production of hydrogen peroxide by glioma cells. The antioxidant status decreased in the glioma cells after tacrolimus treatment. Malondialdehyde level was unchanged in the glioma cells after tacrolimus treatment. CONCLUSIONS Increased production of reactive oxygen species and decreased antioxidant status by tacrolimus in glioma cells may contribute to neurologic side effects.

Comparison of Peritoneal Dialysis and Hemodialysis After Kidney Transplant Failure

BACKGROUND Patients with a failed kidney transplant represent a unique chronic kidney disease population that is increasing in number and is at high risk of morbidity and mortality. Among transplant-naïve patients, those treated with peritoneal dialysis (PD) show an early survival advantage compared with those treated with hemodialysis (HD). But any advantage of PD after allograft failure is unknown. The aim of this study was to investigate the clinical outcomes of patients with failed allografts according to the type of dialysis modality. METHOD We reviewed medical records of patients who initiated dialysis after kidney transplant failure from November 1982 to May 2011. Demographics features, clinical data, and survival outcomes were compared between PD and HD patients who had experienced allograft failure. RESULTS The 182 patients with failed allografts showed the most common cause to be chronic rejection. The median duration of function before allograft failure was 74.0 months. After allograft failure, 145 (79.7%) patients returned to HD and 37 (20.3%) to PD. Twenty-three patients (12.6%) died over the median 69.1 months duration of follow-up. During the observation period, 16 HD (11%) and 7 PD (8.9%) patients died. The survival rates of PD patients at 1 year were 91.2% and 84.4%, respectively, at 1 and 3 years, and those of HD patients 94.8% and 88.9%. There was no significant difference in the survivals of the 2 groups. CONCLUSIONS The study suggests that the outcome of patients starting PD after kidney transplant failure was similar to those starting HD. Therefore, PD can be regarded to be a good treatment option for patients returning to dialysis after kidney transplant failure.