title: Aristolochic acid nephropathy: Harbinger of a global iatrogenic disease.
abstract: This review constitutes an overview of our investigations of aristolochic acid nephropathy, a chronic kidney disease associated with carcinomas of the upper urinary tract. Our studies began by confirming the hypothesis that chronic dietary poisoning by aristolochic acid was responsible for endemic (Balkan) nephropathy. A unique TP53 mutational signature in urothelial tumors and the presence of aristolactam-DNA adducts in the renal cortex, defined in the course of this research, proved to be robust biomarkers of exposure to this potent nephrotoxin and human carcinogen. Armed with this information, we used molecular epidemiologic approaches and novel mechanistic information to establish the causative role of aristolochic acid in upper urinary tract carcinoma in Taiwan, where one-third of the population had been prescribed herbal remedies containing Aristolochia, and the recorded incidence of upper urinary tract cancers is the highest in the world. As traditional Chinese medicine is practiced similarly in Taiwan and China, it is likely that upper urinary tract carcinomas and their attendant aristolochic acid nephropathy are prevalent in China and other Asian countries where Aristolochia herbs have been used for centuries in the treatment and prevention of disease, creating a potential public health problem of considerable magnitude.
authors.affiliation: Laboratory of Chemical Biology, Department of Pharmacological Sciences, Stony Brook University, Stony Brook, New York 11794, USA. apg@pharm.stonybrook.edu
authors.forename: Arthur P
authors.initials: AP
authors.lastname: Grollman
mesh_terms: D034341:Aristolochic Acids / Q000009:adverse effects*; D001449:Balkan Nephropathy / Q000453:epidemiology / Q000209:etiology*; D018736:DNA Adducts; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D007672:Kidney Cortex; D007674:Kidney Diseases / Q000453:epidemiology / Q000209:etiology*; D008516:Medicine, Chinese Traditional / Q000009:adverse effects; D009154:Mutation; D013624:Taiwan / Q000453:epidemiology; D016159:Tumor Suppressor Protein p53 / Q000235:genetics; D014571:Urologic Neoplasms / Q000453:epidemiology / Q000235:genetics / Q000378:metabolism*
chemical_list: D034341:Aristolochic Acids; D018736:DNA Adducts; D016159:Tumor Suppressor Protein p53; C000228:aristolochic acid I