title: Decreased mineralocorticoid receptor expression in blood cells of kidney transplant recipients undergoing immunosuppressive treatment: cost efficient determination by quantitative PCR.
abstract: OBJECTIVE
  Electrolyte imbalances caused by impaired ion transport are a frequent side effect of immunosuppressive treatment in renal transplant recipients. Clinical symptoms resemble features of hypoaldosteronism, although concentrations of aldosterone are in the normal range. Because immunosuppression might affect the hormone receptor status of cells, mineralocorticoid receptor (hMR) expression by peripheral blood leucocytes (PBL) was studied in these patients.
  
  
  METHODS
  Twenty one renal transplant recipients being treated with cyclosporine A and 19 healthy controls were tested. hMR expression was quantified by means of competitive reverse transcription polymerase chain reaction (cRT-PCR) and compared with receptor binding studies with subsequent Scatchard plot analysis carried out previously on 20 renal transplant recipients and 25 controls. Advantages of PCR were summarised and compared with Scatchard plot analysis.
  
  
  RESULTS
  Cyclosporine A caused a 37% decrease in hMR molecules on PBL in 75% of renal transplant recipients, and this effect was attributable to the downregulation of hMR transcription. PCR was 99% specific for the detection of hMR in PBL and highly reproducible.
  
  
  CONCLUSIONS
  Decreases in hMR protein and RNA in PBL of transplant recipients revealed an inhibitory effect of cyclosporine A on hMR transcription. Because hMR acts as a transcription factor, the expression of several genes involved in electrolyte homeostasis is affected, leading to signs of nephrotoxicity that require therapeutic adjustments. Because of the small volume of blood, the assay can be repeated during treatment and is therefore useful for measuring treatment outcomes. Lower costs and the absence of radioactive challenge are further advantages of the PCR method.
authors.affiliation: Department of Medicine III, Solingen General Hospital, University of Cologne, 42653 Solingen, Germany. heering@klinikumsolingen.de
authors.forename: P J
authors.initials: PJ
authors.lastname: Heering
authors.forename: N
authors.initials: N
authors.lastname: Klein-Vehne
authors.forename: K
authors.initials: K
authors.lastname: Fehsel
mesh_terms: D003362:Cost-Benefit Analysis; D016572:Cyclosporine / Q000494:pharmacology*; D018076:DNA, Complementary / Q000235:genetics; D016903:Drug Monitoring / Q000379:methods; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology*; D016030:Kidney Transplantation / Q000502:physiology*; D011182:Postoperative Care / Q000379:methods; D018161:Receptors, Mineralocorticoid / Q000097:blood / Q000187:drug effects* / Q000235:genetics; D020133:Reverse Transcriptase Polymerase Chain Reaction / Q000191:economics
chemical_list: D018076:DNA, Complementary; D007166:Immunosuppressive Agents; D018161:Receptors, Mineralocorticoid; D016572:Cyclosporine