Engineering of Extracellular Vesicles Based on Payload Changes for Tissue Regeneration

In the field of tissue regeneration and tissue engineering, many years ago, various nano to macroscopic-sized materials have been used to reduce inflammation and restore damaged tissue. Whether it is safe to study the regeneration of all tissues based on the biological mechanisms of an organism composed of cells is still debated, and studies using extracellular vesicles derived from cells have become popular in the past decade. It has been reported that exosomes with a size of 100 nm or less, which plays an important role in cell–cell communication, contain various factors, such as proliferation, anti-inflammatory, and growth factors. In addition, the payload of exosomes varies depending on the parent cell and the recipient cell, and a technology to differentiate the selective payload must treat specific diseases. In this review, we examined the current trends in research using exosomes derived from cells or tissues and analyzed various research reports on factors that can affect tissue regeneration.

Engineering of Extracellular Vesicles Based on Payload Changes for Tissue Regeneration

In the field of tissue regeneration and tissue engineering, many years ago, various nano to macroscopic-sized materials have been used to reduce inflammation and restore damaged tissue. Whether it is safe to study the regeneration of all tissues based on the biological mechanisms of an organism composed of cells is still debated, and studies using extracellular vesicles derived from cells have become popular in the past decade. It has been reported that exosomes with a size of 100 nm or less, which plays an important role in cell–cell communication, contain various factors, such as proliferation, anti-inflammatory, and growth factors. In addition, the payload of exosomes varies depending on the parent cell and the recipient cell, and a technology to differentiate the selective payload must treat specific diseases. In this review, we examined the current trends in research using exosomes derived from cells or tissues and analyzed various research reports on factors that can affect tissue regeneration.

Drug-induced nephrotoxicity

Drugs are a common cause of acute and chronic kidney disease and contribute to patient morbidity and increased healthcare utilization. Drug-induced nephrotoxicity is approximately 14% to 26% in adults and tends to increase among certain patients and/or with complex clinical conditions. Unfortunately, apart from conservative management, including drug withdrawal, no effective treatment is known for this condition. Therefore, in order to reduce the frequency of drug-induced nephrotoxicity, early recognition of renal toxicity and appropriate prevention strategies, such as understanding the exact mechanisms of renal injury, patient and drug-related risk factors, and preemptive measures are needed. In this review, we will present the mechanisms of drug-induced nephrotoxicity and general preventive strategies for clinical physicians.

Drug-induced nephrotoxicity

Drugs are a common cause of acute and chronic kidney disease and contribute to patient morbidity and increased healthcare utilization. Drug-induced nephrotoxicity is approximately 14% to 26% in adults and tends to increase among certain patients and/or with complex clinical conditions. Unfortunately, apart from conservative management, including drug withdrawal, no effective treatment is known for this condition. Therefore, in order to reduce the frequency of drug-induced nephrotoxicity, early recognition of renal toxicity and appropriate prevention strategies, such as understanding the exact mechanisms of renal injury, patient and drug-related risk factors, and preemptive measures are needed. In this review, we will present the mechanisms of drug-induced nephrotoxicity and general preventive strategies for clinical physicians.

Drug-induced nephrotoxicity

Drugs are a common cause of acute and chronic kidney disease and contribute to patient morbidity and increased healthcare utilization. Drug-induced nephrotoxicity is approximately 14% to 26% in adults and tends to increase among certain patients and/or with complex clinical conditions. Unfortunately, apart from conservative management, including drug withdrawal, no effective treatment is known for this condition. Therefore, in order to reduce the frequency of drug-induced nephrotoxicity, early recognition of renal toxicity and appropriate prevention strategies, such as understanding the exact mechanisms of renal injury, patient and drug-related risk factors, and preemptive measures are needed. In this review, we will present the mechanisms of drug-induced nephrotoxicity and general preventive strategies for clinical physicians.

Interferon-free treatment for hepatitis C virus infection induces normalization of extrahepatic type I interferon signaling

BACKGROUND/AIMS: Hepatitis C virus (HCV) replicates in the peripheral blood mononuclear cells (PBMCs), leading to the production of type I interferons (IFNs). It is well known that the gene expression profile of PBMC is similar to that of the liver. The present study explored the dynamic gene expression profile of PBMCs collected from HCV-infected patients undergoing direct-acting antiviral (DAA) therapy. METHODS: A prospective cohort comprising 27 patients under DAA therapy was formed. Expression level of IFN-β and its downstream interferon-stimulated genes (ISGs) was measured in PBMCs before and after DAA treatment. Furthermore, immunoblotting was performed to identify the signaling molecules involved in the expression of ISGs. RESULTS: The pretreatment expression level of interferon-induced protein 44 (IFI44) and C-X-C motif chemokine ligand 10 (CXCL10) correlated with the pretreatment expression level of IFN-β. After DAA treatment, a significant decrease in the expression levels of IFN-β, IFI44, and CXCL10 was observed in the PBMCs. Furthermore, the pretreatment expression level of IFN-β and ISGs correlated with the level of signal transducer and activator of transcription 1 (STAT1) phosphorylation, and DAA treatment abrogated STAT1 phosphorylation. CONCLUSIONS: Pretreatment activation of IFN-β response is rapidly normalized after DAA treatment. The present study suggests that the decreased type I IFN response by the clearance of HCV might contribute to DAA-induced alleviation of extrahepatic manifestation of chronic HCV infection.

Analysis of lysosomal membrane proteins exposed to melanin in HeLa cells

OBJECTIVES: There have been developed to use targeting ability for antimicrobial, anticancerous, gene therapy and cosmetics through analysis of various membrane proteins isolated from cell organelles. METHODS: It was examined about the lysosomal membrane protein extracted from lysosome isolated from HeLa cell treated by 100 ppm melanin for 24 hours in order to find associated with targeting ability to melanin using by 2-dimensional electrophoresis. RESULTS: The result showed 14 up-regulated (1.5-fold) and 13 down-regulated (2.0-fold) spots in relation to melanin exposure. CONCLUSIONS: It has been found that lysosomal membrane proteins are associated with melanin to decolorize and quantity through cellular activation of lysosome.

Usefulness of Extracorporeal Treatment for Combined Intoxication with Controlled-Release Carbamazepine and Topiramate

Controlled-release carbamazepine (CBZ) could be more harmful than the regular form in special situations due to their respective biochemical characteristics. When primary treatment is not effective in acute intoxication, extracorporeal treatment (ECTR) could be an option. We recently applied ECTR to a patient with combined intoxication of topiramate and controlled-release CBZ who deteriorated despite receiving primary treatment. The patient improved after administering ECTR. Early ECTR intervention may be beneficial for the treatment of CBZ intoxication, especially of the controlled-release form.

A Case of Oliguric Mannitol Induced Acute Kidney Injury Early Treated by Continuous Renal Replacement Therapy / 고신대학교의과대학학술지

We report oliguric mannitol-induced acute kidney injury (AKI) early treated by continuous renal replacement therapy. A 70-year-old woman was admitted to the Department of Neurology with diagnosis of acute intracranial hemorrhage. Mannitol was infused for intracranial pressure control. At admission third day, urine output was abruptly decreased to 57 ml during first 6 hours and blood urea nitrogen (BUN) and serum creatinine was increased to 54.2 mg/dL and 5.3 mg/dL respectively. Plasma osmolality was 340 mOsm/kg and osmolar gap was 70. Mannitol was immediately withdrawn and continuous renal replacement therapy (CRRT) was performed to remove mannitol rapidly. Urine output was increased 6 hours later after continuous veno-veno hemodiafiltration (CVVHDF) start. BUN and creatinine was decreased to 21.4 and 1.2 mg/dL at admission ninth day. Mannitol can develop oliguric AKI and CRRT may be of more benefit than conventional hemodialysis in the case of increased intracranial pressure.

Neuron-Like Differentiation of Bone Marrow-Derived Mesenchymal Stem Cells

PURPOSE: Mesenchymal stem cells (MSCs) are multipotent and give rise to distinctly differentiated cells from all three germ layers. Neuronal differentiation of MSC has great potential for cellular therapy. We examined whether the cluster of mechanically made, not neurosphere, could be differentiated into neuron-like cells by growth factors, such as epidermal growth factor (EGF), hepatocyte growth factor (HGF), and vascular endothelial growth factor (VEGF). MATERIALS AND METHODS: BMSCs grown confluent were mechanically separated with cell scrapers and masses of separated cells were cultured to form cluster BMSCs. As described here cluster of BMSCs were differentiated into neuron-like cells by EGF, HGF, and VEGF. Differentiated cells were analyzed by means of phase-contrast inverted microscopy, reverse transcriptase-polymerase chain reaction (RT-PCR), immunofluorescence, and immunocytochemistry to identify the expression of neural specific markers. RESULTS: For the group with growth factors, the shapes of neuron-like cells was observable a week later, and two weeks later, most cells were similar in shape to neuron-like cells. Particularly, in the group with chemical addition, various shapes of filament structures were seen among the cells. These culture conditions induced MSCs to exhibit a neural cell phenotype, expressing several neuro-glial specific markers. CONCLUSION: bone marrow-derived mesenchymal stem cells (BMSCs) could be easily induced to form clusters using mechanical scraping, not neurospheres, which in turn could differentiate further into neuron-like cells and might open an attractive possibility for clinical cell therapy for neurodegenerative diseases. In the future, we consider that neuron-like cells differentiated from clusters of BMSCs are needed to be compared and analyzed on a physiological and molecular biological level with preexisting neuronal cells, and studies on the possibility of their transplantation and differentiation capability in animal models are further required.

Late Adverse Reaction to Iodixanol (Visipaque(R)) / 대한내과학회지

Late adverse reactions to iodinated contrast medium are defined as reactions occurring 1 hour to 1 week after contrast medium injection. The majority of late adverse reactions are cutaneous reactions, and include itching, maculopapular rash, urticaria, erythematous patches, and angioedema. We report a patient with an iodixanol (Visipaque(R))-induced late adverse reaction. She was admitted for evaluation of nephrotic range proteinuria and edema. Abdomen and chest enhanced computed tomography was performed as a malignancy work-up. Sixteen hours after radiocontrast exposure, her entire body felt itchy. A maculopapular rash was first detected on her back and abdomen 24 hours after exposure, and spread over her entire body, including her face. Her skin lesions resolved completely in 5 days after administering steroid and antihistamine. We should consider late adverse reactions of iodinated contrast medium when we detect skin lesions late after radiocontrast use.

Late Adverse Reaction to Iodixanol (Visipaque(R)) / 대한내과학회지

Late adverse reactions to iodinated contrast medium are defined as reactions occurring 1 hour to 1 week after contrast medium injection. The majority of late adverse reactions are cutaneous reactions, and include itching, maculopapular rash, urticaria, erythematous patches, and angioedema. We report a patient with an iodixanol (Visipaque(R))-induced late adverse reaction. She was admitted for evaluation of nephrotic range proteinuria and edema. Abdomen and chest enhanced computed tomography was performed as a malignancy work-up. Sixteen hours after radiocontrast exposure, her entire body felt itchy. A maculopapular rash was first detected on her back and abdomen 24 hours after exposure, and spread over her entire body, including her face. Her skin lesions resolved completely in 5 days after administering steroid and antihistamine. We should consider late adverse reactions of iodinated contrast medium when we detect skin lesions late after radiocontrast use.

Treatment of Pseudoaneurysm Caused by Insertion of Dual Lumen Catheter for Hemodialysis: A Case Report / 대한신장학회지

In patients with end-stage renal disease, cannulation of the central venous system with large-bore dual-lumen catheters is often necessary until a functioning vascular access can be created. However, the technique of placing a dual-lumen catheter can make complication. The right internal jugular vein is the preferred site of hemodialysis catheter placement because its complication rate was lower compared with the subclavian and left internal jugular veins. Common complications include severe bleeding, hematoma formation, pneumothorax and hemothorax, atrial or ventricular arrhythmias, malposition of the catheter, air embolism, secondary infections, and intraarterial placement of the catheter. We report an unusual case of pseudoaneurysm of the superior thyroidal artery complicating an attempt of internal jugular-vein catheterization which was successfully treated by endovascular coil embolization.

Renal Pelvic Hematoma Induced by Delayed Re-bleeding After Renal Biopsy / 대한신장학회지

Renal biopsy is a useful method for the diagnosis of kidney disease. Complications may occur and are usually associated with bleeding. However, delayed recurrent bleeding is so rare. We report a case of renal pelvic hematoma and hydronephrosis occurred by delayed re-bleeding after percutaneous needle renal biopsy. A 42-year-old woman was admitted to our institution via emergency room with gross hematuria and left flank pain, which had started on that day. Renal biopsy had been done 8 days earlier. Computed tomography (CT) angiography revealed left hydronephrosis caused by pelvic hematoma and we observed bloody urine in the left ureteral orifice on cystoscopy. Hydration, diuresis and double J stent insertion restored hydronephrosis and hematuria was disappeared. Even though renal pelvic hematoma by delayed bleeding occurs rarely after percutaneous needle kidney biopsy, we should consider this complication when delayed recurrent gross hematuria occurs after kidney biopsy.

Aspergillus flavus Peritonitis Detected by Fungal Balls in the Blood Culture Bottles: A Case Report / 대한신장학회지

Fungal peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients is rare. But, it is a serious complication of CAPD because of high morbidity and mortality. It is very important to diagnose and treat such infections promptly, as otherwise it has a poor prognosis. We experienced a case of peritonitis in a CAPD patient that was caused by Aspergillus flavus detected by fungal balls in blood culture bottles and treated successfully by administering anti-fungal agents and removing the peritoneal dialysis catheter.

A case of peritonitis caused by Pantoea agglomerans in a patient undergoing continuous ambulatory peritoneal dialysis / 대한내과학회지

Microorganisms belonging to the genus Pantoea rarely cause infection in normal hosts, but are common in hospitalized or immunocompromised patients. Pantoea agglomerans has frequently been associated with exogenous sources such as plants, soil, water, and foodstuffs. Until now, only one case of P. agglomerans associated peritonitis has been reported in an adult patient undergoing continuous ambulatory peritoneal dialysis (CAPD). We report a case of peritonitis due to P. agglomerans in a 55 year old man with maintenance CAPD. Antibiotic therapy with intraperitoneal cefazolin and gentamicin led to clinical improvement.

Peritonitis and Intra-abdominal Abscess by Trichoderma longibrachiatum in a Patient Undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD) / 대한신장학회지

Peritonitis by Trichoderma longibrachiatum in patients undergoing CAPD has been reported rarely in the literature. We describe a case of peritonitis and intra-abodominal abscess caused by an unusual fungus, Trichoderma longibrachiatum, in a patient undergoing CAPD. The patient was successfully treated with catheter removal, anti-fungal agents and appropriate drainage.

Transaxillary Renal Artery Angioplasty and Stenting in a Single-Kidney Patient with Leriches Syndrome / 대한신장학회지

We report a case of renovascular hypertension (RVH) by severe left renal artery stenosis (RAS) that was successfully treated by percutaneous intervention in a single-kidney patient with Leriches syndrome. A 51-year-old man was admitted to our hospital due to uncontrolled hypertension on medications with maximal doses. CT angiography showed complete occlusion of the infrarenal abdominal aorta, the absence of the right kidney and the approximately 80% stenosis of the proximal left renal artery. The proximal left RAS was considered as an important factor in uncontrolled secondary hypertension and aggravation of his renal function. We made an attempt to relieve the RAS by transaxillary renal artery angioplasty and stenting because of the total occlusion of the bilateral iliac artery. His renal function was remarkably improved and his hypertension was well controlled with less antihypertensive medications after the procedure.

Abdominal Actinomycosis Associated with a Sigmoid Colon Perforation in a Patient with a Ventriculoperitoneal Shunt

Abdominal actinomycosis causing hydronephrosis in a patient with a ventriculoperitoneal shunt is very rare. A 27- year-old female patient was admitted complaining of lower abdominal pain. She had undergone ventriculoperitoneal shunt surgery 10 years ago. Abdominal Ultrasonography and a CT scan demonstrated an inflammatory mass in the lower left quadrant of the abdomen causing obstructive hydroureter and hydronephrosis. Laparotomy revealed a diffusely infiltrating mass involving the small bowel, mesentery, and sigmoid colon, and a 1cm perforation in the sigmoid colon. Actinomycosis was diagnosed upon histological examination. After treatment with antibiotics and surgery, the patient's condition improved.

Acute Bilateral Renal Cortical Necrosis Associated with Diclofenac Sodium / 대한신장학회잡지

Acute bilateral renal cortical necrosis is relatively unusual cause of acute renal failure (ARF). We report a rare case of acute bilateral renal cortical necrosis associated with diclofenac sodium. A 57-year-old man visited to our hospital with progressive oligoanuria for three days. Four days earlier, after diclofenac sodium 150 mg was injected intramuscularly at local hospital, he experienced anaphylactic shock. Our laboratory findings revealed the existence of fibrin split, thrombocytopenia, coagulopathy, and microangiopathic hemolytic anemia (MAHA). These findings were compatible with disseminated intravascular coagulation (DIC). The radiocontrast enhancement CT scan showed a bilateral lack of enhancement of the renal cortex after contrast infusion, enhancement of renal medulla, and the absence of renal excretion of the contrast dye. Renal biopsy showed a cortical necrosis with congested acellular glomuruli and necrotic tubules. Empiric treatment including hemodialysis was commenced. Although his renal function was not completely recovered, he is now being followed up at this hospital without dialysis.