Prevention of chronic renal allograft rejection in rats with an oral endothelin A receptor antagonist.
BACKGROUND
Chronic rejection is the most common cause of graft loss in renal transplantation. The pathomechanisms underlying chronic rejection are poorly understood, and no treatment has yet successfully been established. We hypothesized that, in analogy to models of reduced renal mass, the administration of a selective endothelin (ET) A receptor antagonist could improve the course of chronic rejection in renal allografts.


METHODS
Experiments were performed in the Fisher-to-Lewis rat model of chronic rejection. Lewis-->Lewis isografts served as controls. Animals were treated with either the oral selective ET-A receptor antagonist LU135252 (50 mg/kg/day) or vehicle. Animal survival, blood pressure, creatinine clearance, proteinuria, and urinary ET excretion were investigated for 24 weeks. Kidneys were removed for light microscopical evaluation, determination of ET mRNA expression and tissue protein concentration, and immunohistochemical assessment of cell surface markers.


RESULTS
Rats with chronic rejection showed an increase in renal ET mRNA synthesis and ET protein content. Treatment with LU135252 resulted in a significant improvement in survival after 24 weeks (0.92 vs. 0.38, P<0.01 by log-rank test). Creatinine clearance was higher in animals treated with the selective ET-A receptor antagonist (P<0.05). LU135252 had no influence on blood pressure and proteinuria. Selective ET-A blockade was associated with significantly less morphological changes and a significant reduction of expression of cell surface markers for macrophages (ED1), T cells (R73), and MHC II (F17-23-2).


CONCLUSIONS
The renal ET-A system plays an important role in the pathomechanisms underlying chronic renal allograft rejection, because the treatment with a selective ET-A receptor antagonist dramatically improves the course of chronic renal failure after allograft transplantation. These results offer a novel therapeutical option for treatment of chronic renal allograft rejection, for which so far no therapy is known.
Braun
C
C
V. Department of Medicine (Nephrology/Endocrinology), University Hospital Mannheim, Germany.
Conzelmann
T
T
Vetter
S
S
Schaub
M
M
Back
W E
WE
Yard
B
B
Kirchengast
M
M
Tullius
S G
SG
Schnülle
P
P
van der Woude
F J
FJ
Rohmeiss
P
P
D000284:Administration, Oral; D000818:Animals; D065128:Endothelin Receptor Antagonists; D019332:Endothelin-1 / Q000235:genetics; D016232:Endothelins / Q000652:urine; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival / Q000187:drug effects; D007674:Kidney Diseases / Q000517:prevention & control; D007678:Kidney Glomerulus / Q000187:drug effects; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D010666:Phenylpropionates / Q000627:therapeutic use; D011743:Pyrimidines / Q000627:therapeutic use; D012333:RNA, Messenger / Q000378:metabolism; D051381:Rats; D011916:Rats, Inbred F344; D011917:Rats, Inbred Lew; D044022:Receptor, Endothelin A; D017466:Receptors, Endothelin / Q000008:administration & dosage
D065128:Endothelin Receptor Antagonists; D019332:Endothelin-1; D016232:Endothelins; D010666:Phenylpropionates; D011743:Pyrimidines; D012333:RNA, Messenger; D044022:Receptor, Endothelin A; D017466:Receptors, Endothelin; C107831:darusentan