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REPORT
1Division of Nephrology and Hypertension, Childrens Hospital Medical Center, Department of Pediatrics, 2Department of Pathology and Laboratory Medicine, 3Division of Nephrology and Hypertension, Department of Medicine, University of Cincinnati College of Medicine, and 5Veteran Affairs Medical Center, Cincinnati, Ohio; and 4Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Submitted 25 October 2005 ; accepted in final form 18 January 2006
ABSTRACT
In kidneys subjected to ischemic reperfusion injury (IRI) stathmin, a tubulin-binding protein involved in the regulation of mitosis, is expressed in dedifferentiated and proliferating renal tubule cells during the recovery phase. To ascertain the role of stathmin in the recovery from ischemic kidney injury, stathmin-deficient (OP18/) and wild-type (WT) animals were subjected to experimental IRI. At 3, 7, and 14 days after reperfusion serum samples and kidneys were collected for the examination of parameters of renal function, morphology, and recovery. Our studies indicate that on day 14 after reperfusion OP18/ mice have significant renal failure, whereas the creatinine levels of WT animals have returned to baseline. Compared with WT animals OP18/ mice had more extensive tubular fibrosis. The examination of proliferating cell nuclear antigen expression indicated that OP18/ animals have increased proliferative or DNA repair activity for a more prolonged duration. The OP18/ animals also had an increased number of tubules with apoptotic cells. These results suggest that in stathmin-deficient mice subjected to IRI, the aberrant regulation of cell cycle progression, not observed under normal conditions, impairs or at least delays the process of tubular repair and recovery after acute renal injury.
acute renal failure; cell proliferation; renal function; fibrosis
Stathmin, an 18-kDa phosphoprotein, is expressed in cells that have reentered the cell cycle (1, 3, 5, 8, 40). Stathmin binds to tubulin and regulates microtubule dynamics (3335). The binding of stathmin to tubulin and its ability to disrupt the microtubules is modulated through its phosphorylation on multiple serine residues (2226). Inactivation of stathmin is a stepwise process that is primed by phosphorylation of Ser25 and 38 residues of stathmin by p38
and p34Cdc2 kinases (17). The inactivation of stathmins tubulin-binding capacity is then completed via phosphorylation of Ser16 and 63 (17). The Camp-dependent protein kinase and calcium/calmodulin-dependent kinaseGr have been implicated in the mediation of the latter phosphorylation reactions (17, 25, 26, 31). The expression levels and phosphorylation status of stathmin regulate cell division by increasing the instability of interphase microtubules, leading to their depolymerization (32). At the onset of mitosis, stathmin is phosphorylated and its capacity to bind to tubulin and induce microtubular catastrophe is lost. Inactivation of stathmin is among the necessary steps for the polymerization of microtubules and proper formation and functioning of the mitotic spindle (9, 12).
In previous studies, we demonstrated that the expression of stathmin increases in the proximal tubules of kidneys subjected to IRI. Stathmin was expressed by dedifferentiated (vimentin expressing), actively proliferating [proliferating-cell nuclear antigen (PCNA) positive] proximal tubule cells in the corticomedullary junction (46). Based on the location and distribution pattern of stathmin and its coexpression with PCNA and vimentin, which is expressed in the S3 segment in kidney IRI (45), it was concluded that stathmin is also expressed in the S3 segment of the proximal tubule (46). The ablation of stathmin gene in mice does not lead to any phenotypic abnormalities other than development of a mild late onset axonopathy, suggesting that there are redundancies in the system that can compensate for the absence of stathmin (20). However, the consequence of stathmin deficiency in conditions associated with tissue injury and physiological stress has not been examined. To test this hypothesis, we examined the effect of stathmin deficiency on the outcome of renal IRI.
MATERIALS AND METHODS
IRI. Animals used for the generation of heterozygote stathmin knockout breeding pairs were the litters of the 14th back cross of heterozygote (OP18+/) and C57BL/6 wild-type (WT) mice. Mice used for the studies described here were stathmin-deficient (OP18/) and WT littermates derived from mating of OP18+/ animals from the aforementioned back cross. Bilateral IRI was induced in WT and OP18/ animals (2830 g, n = 6/group) by occluding the renal pedicles with microvascular clamps (45 min) under anesthesia. Completeness of ischemia was verified by blanching of the kidneys, signifying the stoppage of blood flow. The blood flow to the kidneys was reestablished by removal of the clamps (reperfusion) with visual verification of blood return. Animals subjected to sham operation (identical treatment except the renal pedicles were not clamped) were used as controls. During the procedure, animals were well hydrated and their body temperature was controlled at around 94°C using an adjustable heating pad. After ischemia, animals were kept under the veterinarians observation. At 3, 7, and 14 days postischemia, animals were killed and blood and kidneys were harvested. Blood samples were centrifuged, and the serum was collected for creatinine measurement. The kidneys were fixed in paraformaldehyde for histopathology and immunohistochemical studies. All studies involving animals were performed according to protocols submitted to and approved by the institutional animal care and use committee at the University of Cincinnati.
Examination of kidney function. Serum creatinine levels were measured to determine the integrity of renal function. Blood was collected from animals at the time of death (3, 7, and 14 days). Whole blood was centrifuged at 25°C for 10 min at 10,000 g. Serum was collected and used for creatinine measurement. Creatinine assays were performed on a Roche Cobas Fara automated system (Roche, Nutly, NJ) using the Creatinine 557 kit (Sigma, St. Louis, MO).
Histological assessment of the kidneys. At 3, 7, and 14 days, the kidneys were removed and fixed in paraformaldehyde for 24 h. Kidney sections were paraffin embedded, 5-µm sections were cut and stained with hemotoxillin and eosin (H&E) or trichrome stains. Tissue sections were examined under low power (x40 magnification) for tubular dilatation, cast formation, calcification, interstitial inflammation, and fibrosis. All these morphological changes were scored semiquantitatively on a 0 to 3+ scale (0 = no lesion, 1+ = <25% of parenchyma affected by the lesion, 2+ = >25 to 50% of parenchyma affected by the lesion, 3+ = >50% of parenchyma affected by the lesion). The numerical values from these studies were expressed as means ± SE and analyzed for statistical significance.
Feulgen staining for determination of cellular DNA content. For quantitation of nuclear DNA content 5-µm tissue sections were stained using Feulgen stain protocol. Briefly, tissue sections were depurinated with concentrated HCl followed by staining with Schiffs reagent (aqueous solution of crystal violet and sulfurous acid). The extent of blue nuclear staining by this staining protocol is directly proportional to the nuclear DNA content.
Immunohistochemical assessment of the kidney sections. Paraformaldehyde fixed paraffin embedded kidney sections were washed twice in PBS (pH 7.4) and blocked with 10% rabbit serum/0.3% Triton X-100 in PBS for 1 h. Tissue sections were incubated with polyclonal rabbit anti-stathmin (Calbiochem, San Diego, CA) or mouse monoclonal anti-PCNA IgG (Santa Cruz Biotechnology Santa Cruz, CA). Sections were washed and then incubated with the appropriate secondary antibody (goat anti-rabbit or mouse IgG conjugated with FITC or Alexa Fluor 568 Dye) for 2 h at room temperature. Sections were examined and images acquired on a Nikon PCM 2000 laser confocal scanning microscope as 0.5-µm "optical sections" of the stained cells. Red dye was excited with the 543.5-nm single-line output of the helium-neon laser. The PCM 2000 standard red channel long-pass 565-nm filter was used as the emission filter for the red dye. Digital images were acquired through a single illumination and detection pinhole and analyzed. The quantitation of PCNA expression was performed by examining five independent fields per section at x100 magnification. Expression of PCNA per field was scored according to the following grading: tubules were assigned a score of 0 = No expression, 1 = at least one positive cell per tubule, 2 = at least two positive cells per tubule, and 3 = at least three positive cells per tubule. The cumulative numerical values for each section was calculated by adding the population of tubules per group multiplied by its numerical grade divided by the number of fields counted. The numerical values from these studies were expressed as means ± SE and analyzed for statistical significance.
Assessment of the kidney sections for apoptosis. To confirm and quantify apoptosis, paraffin-embedded 5-µm kidney sections were subjected to terminal deoxynucleotidedyl transferase (TUNEL) assay using the ApoAlert Apoptosis Assay Kit (Clontech). Apoptotic nuclei were detected by visualization with a fluorescent microscope. Tissue sections were examined at x320 magnification. A minimum of 15 fields from at least of 3 tissue sections sections from 3 to 5 animals per time point were examined. Only cells that displayed the characteristic nuclear morphology of apoptosis, including nuclear fragmentation, nuclear condensation, and intensely fluorescent nuclei by TUNEL assay, were counted as apoptotic. Cells with TUNEL-positive nuclei, in the absence of the above morphological criteria, were not considered apoptotic. The results indicate the average number of tubules with at least one apoptotic cell per field for five independent fields from at least three different kidneys. The numerical values from these studies are expressed as means ± SE and analyzed for statistical significance.
Statistical analyses. Values are expressed as means ± SE. The significance of difference between mean values was examined using ANOVA. A P <0.05 was considered statistically significant.
RESULTS
Expression of stathmin after IRI. Expression of stathmin increases and reaches its peak levels by 72 h after the induction of IRI (46). Since the studies outlined in this manuscript examine the effect of stathmin deficiency over a period of 14 days after injury, we examined the expression of stathmin on days 3, 7, and 14 after reperfusion. Our results (Fig. 1) indicate that stathmin expression is highly elevated in renal tubules in the corticomedullary region of the kidney on day 3 (Fig. 1b) after IRI. Stathmin expression on days 7 and 14 (Fig. 1, c and d) are below that of day 3, yet are still substantially above that of the sham-operated animals (Fig. 1a).
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The renal function of the WT and OP18/ animals were examined at 3, 7, and 14 days after IRI by determining the serum creatinine levels (Fig. 2). Our results indicate that the serum creatinine levels increase by day 3 in both OP18/ and WT animals subjected to IRI (0.5 ± 0.04 to 1.3 ± 0.2 in OP18/ and 0.4 ± 0.1 to 1.7 ± 0.6 mg/dl in WT). On day 7, the serum creatinine remained elevated in both WT (0.9 ± 0.1 mg/dl) and OP18/ (1.0 ± 0.1 mg/dl) animals. On day 14 OP18/ animals had significantly elevated levels of serum creatinine (1.1 ± 0.1 mg/dl); in comparison, the serum creatinine levels of WT animals had returned to near normal (0.5 ± 0.03 mg/dl). The comparison of serum creatinine levels of sham operated WT and OP18/ animals (0.4 ± 0.1 and 0.5 ± 0.04) indicate that in the absence of renal injury the serum creatinine levels of these animals are practically identical. Our results suggest that during the early time points of injury (days 3 and 7) the renal function of WT and OP18/ animals are similarly affected. However, by day 14 when the renal function of WT animals is back to normal the renal function of the OP18/ mice is worsening and serum creatinine levels of OP18/ (1.1 ± 0.1 mg/dl) are significantly higher than the WT (0.5 ± 0.03 mg/dl) animals (Fig. 2).
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In previous studies, we demonstrated that the expression of stathmin increases during the recovery phase in kidneys subjected to IRI (46). Stathmin is primarily expressed in the proximal tubular epithelium by cells that also express vimentin and PCNA (46). These results indicate that stathmin is a marker of cells that have dedifferentiated, reentered the cell cycle and may be involved in the recovery process. Stathmin is a tubulin-binding phosphoprotein that plays an important role in the regulation of spindle formation and mitosis (14, 15, 18, 19, 32). It needs to be deactivated via phosphorylation of its serine residues in order for the cells to progress through mitosis. Overexpression of WT or nonphosphorylatable stathmin leads to reduced growth rate and in case of the latter to G2 to M blockage (14, 15, 18, 19). Paradoxically, a reduction in stathmin levels also leads to abnormal formation of the mitotic spindle and accumulation of cells in the G2 to M phase (12, 23, 32). These dichotomous results may be explained by the role of stathmin in the regulation of microtubule dynamics and formation of mitotic spindle (12, 32).
Based on our previous studies (46), evidence showing that stathmin is involved in the regulation of mitosis (14, 15, 18, 19, 32) and the established role of coordinated regulation of cell cycle in recovery from renal injury (10, 36, 37, 42), we hypothesized that the absence of stathmin adversely affects the tubular repair and recovery process subsequent to renal IRI. To test our hypothesis, WT and OP18/ mice were subjected to kidney IRI. Our results indicate that OP18/ and WT animals subjected to renal IRI have similar mortality rates. The examinations of functional and morphological changes in the kidneys indicate that: 1) stathmin-deficient animals develop a more prolonged disease compared with WT animals; 2) the proliferative and apoptotic response of OP18/ animals is prolonged compared with WT animals; and 3) creatinine levels of WT animals after an initial increase on days 3 and 7 return to normal levels by day 14; in contrast, the serum creatinine levels of OP18/ animals remain elevated through out the 14 days of these studies (Fig. 2). These results are consistent with a delayed or impaired tubular repair process and the prolongation of renal dysfunction in stathmin-deficient mice during the recovery phase of IRI.
The most salient features of these studies are the histological abnormalities in kidneys of stathmin-deficient mice at 14 days after reperfusion. Our results indicate that while the normal histology of the kidneys has been restored in WT animals by day 14, the kidneys of OP18/ animals show increased interstitial fibrosis and deposition of calcium in coticomedullary tubules (Figs. 3H and 4), indicative of severe cell injury and consistent with the persistence of damage in kidney tubules. The onset of fibrosis and presence of renal failure at 14 days of reperfusion (Fig. 3) support the conclusion that the ability of stathmin-deficient animals to recover from kidney IRI is impaired. As previously mentioned, stathmin plays an important role in regulation of the G2-to-M transition. Stathmin deficiency may therefore disrupt the proper progression of proliferating cells through the cell cycle during tubular repair. Studies examining the effect of p21, a regulator of the cell cycle, indicate that its deficiency leads to elevated numbers of polyploid cells with enlarged nuclei (29). Our results indicate an increased number of tubular cells with enlarged nuclei but not an elevated number of polyploid cells. Also of interest are the differences in the patterns of PCNA expression and apoptosis in the WT and OP18/ animals, where the latter show a more prolonged duration of PCNA expression (Fig. 6) and apoptotic response (Fig. 6). As a cofactor in the polymerase
complex, PCNA is required not only for the synthesis of the leading strand during replication (S phase) but also plays an important role in nucleotide excision repair (6, 13, 21, 38, 39). The latent increase in PCNA levels may indicate a delayed proliferative response associated with DNA replication and repair in the tubular repair process. Alternatively, based on the effect of stathmin dysregulation on cell cycle progression (14, 15, 18, 19, 32), it could be hypothesized that the absence of stathmin, which may function as an effecter protein that is downstream of Cdc2, could lead to the elimination of a G2-to-M transition block (23). The disruption of this regulatory point may contribute to genomic instability by allowing cells with damaged DNA to complete the cell cycle. These damaged cells, which need to undergo DNA repair, may account for the increase in the numbers of enlarged nuclei, and enhanced expression levels of PCNA observed in the kidneys of OP18/ animals during the later stages of IRI. A preponderance of irreversibly damaged cells may also manifest itself as an increase in the number of apoptotic cells in the injured kidneys of OP18/ animals. Our results showing that the number of tubules with apoptotic cells is increased in OP18/ animals on day 14 seem to support this. A concomitant increase in PCNA expression and the number of apoptotic cells in the kidneys of OP18/ mice could also be suggestive of the presence of an imbalance in the proliferative and apoptotic response that may contribute to delayed or lack of recovery from IRI. It is plausible that impaired tubulogenesis due to the absence of stathmin may result in aberrant recovery and persistence of injury in the renal tubules of OP18/ mice after IRI.
Renal epithelial cells in regenerating tubules undergo dedifferentiation, reenter the cell cycle, reestablish an intact epithelium and redifferentiate during recovery from acute tubular injury (11, 45). Studies indicate that proper progression through the cell cycle is of paramount importance to the recovery process after renal injury (10, 36, 37, 42). This is supported by a number of studies that show enhanced expression of cell cycle regulatory molecules such as p53, p21 and 143-3 in the proximal tubule epithelium of kidneys subjected to ischemic or toxic acute renal injury (16, 29, 30). Further evidence for the role of proper cell cycle progression in recovery from renal injury comes from the examination of the effect of deficiency of p21 and 143-3, a scaffolding molecule that organizes various signal transducers into signaling modules (44), on the pathology and outcome of IRI. The deficiency of cell cycle regulators such as p21 in renal IRI leads to increased mortality, prolonged renal dysfunction and more severe renal pathology (29, 30). It is possible that the induction of cell cycle regulators in response to acute renal injury is involved in slowing down the proliferative response to allow reversibly damaged cells to undergo repair before completing the cell cycle (29).
Stathmin is involved in the regulation of microtubule dynamics and plays a pivotal role in the regulation of cell division (14, 15, 18, 19, 32). Inactivation of stathmins tubulin-binding capacity depends on its serine phosphorylation, and the modulation of stathmin activity is necessary for proper formation and function of the mitotic spindle (17, 25, 26, 31). Serine phosphorylation and inactivation of stathmin are partially dependent on the activity of Cdc2 which in turn is regulated by p21 (27, 28, 43). It is therefore plausible that stathmin functions as an effecter protein downstream of Cdc2, and its absence may short-circuit the regulation of the cell cycle. We propose that the delayed recovery and prolongation of renal dysfunction in OP18/ animals may be due to dysregulation of the G2-to-M transition in cell division, allowing the severely damaged cells to continue to grow. The death of these damaged cells during the tubular repair process may lead to exacerbation of renal injury and development of fibrosis, therefore hampering the recovery process. The functional and histological alterations in the kidneys of OP18/ animals subjected to IRI support the hypothesis that stathmin deficiency disrupts or delays the process of tubular repair and regeneration subsequent to renal injury. Based on these studies we suggest that an imbalance in cell proliferation and cell loss contributes to delayed tubular repair, development of fibrotic response and prolonged loss of renal function in stathmin-deficient mice following IRI. It is plausible that downregulation of proteins such as stathmin or p21, which are involved in cell cycle regulation, in kidneys of patients with acute renal failure may result in delayed recovery or prolonged worsening of kidney function and development of chronic renal insufficiency subsequent to acute ischemic insult. Whether the absence of stathmin leads to the development of permanent and chronic renal failure following IRI is not clear. Studies examining the long-term outcome of IRI in stathmin null animals should answer that question.
GRANTS
These studies were supported by National Institutes of Health Grants DK-66589 (M. Soleimani), DK-061458 (J. J. Bissler), and DK-54770 (H. Rabb), and a Merit Review Award (M. Soleimani) from the Veterans Affairs Administration.
ACKNOWLEDGMENTS
We thank Dr. U. K. Schubart and G. P. Shumyatsky for kindly providing the OP18/ mice and Dr. P. Devarajan for critical review and constructive suggestions in preparing this manuscript.
FOOTNOTES
Address for reprint requests and other correspondence: K. Zahedi, Division of Nephrology and Hypertension, Childrens Hospital Medical Research Foundation, 3333 Burnet Ave., Cincinnati, OH 45229-3039 (e-mail: Kamyar.Zahedi{at}cchmc.org) or M. Soleimani, Division of Nephrology and Hypertension, Dept. of Medicine, Univ. of Cincinnati College of Medicine, 231 Albert Sabin Way, MSB 259G, Cincinnati, OH 45267 (e-mail: Manoocher.Soleimani{at}uc.edu)
The costs of publication of this article were defrayed in part by the payment of page charges. The article must therefore be hereby marked "advertisement" in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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