title: A comparison of the ability of levels of urinary biomarker proteins and exosomal mRNA to predict outcomes after renal transplantation.
abstract: BACKGROUND
  mRNA for biomarkers of kidney injury extracted from urinary exosomes may reflect or predict levels of the corresponding protein after transplantation and clinical outcomes.
  
  
  METHODS
  Urinary exosomes were isolated from patients following renal transplantation, from healthy controls, and patients with CKD. Expression of exosomal mRNA for the injury biomarkers neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), kidney injury molecule-1 (KIM-1), and cystatin C was compared with the concentrations of corresponding urinary proteins, 18S RNA and serum creatinine.
  
  
  RESULTS
  All biomarker protein concentrations increased after transplantation, and urinary NGAL and IL-18 at 24 and 168 h correlated with the day 7 creatinine reduction ratio (CRR). Exosomal18S RNA increased after transplantation, but exosomal mRNA for NGAL, IL-18 and cystatin C did not correlate with the day 7 CRR, or urinary biomarker concentrations at any time after transplantation. Exosomal NGAL mRNA was lower 4 h after transplantation than in control exosomes. In contrast, exosomal mRNA for cystatin C was unchanged after transplantation and in CKD, although urinary cystatin C temporarily increased following transplantation. Urinary KIM-1 increased after transplantation, but exosomal mRNA for KIM-1 remained undetectable. In CKD 18S RNA was raised, and exosomal mRNA for NGAL, IL-18 and cystatin C was detected in all patients. While urinary NGAL was greater in CKD than control subjects, exosomal NGAL mRNA was unchanged. Exosomal IL-18 mRNA was increased in CKD, but not IL-18 protein.
  
  
  CONCLUSIONS
  After renal transplantation, urinary NGAL and IL-18 levels reflect the day 7 CRR. However, while mRNA for these biomarkers is present in exosomes, their levels do not reflect or predict urinary biomarker levels or the CRR. This likely reflects the fact that packaging of mRNA in exosomes is selective, and is not necessarily representative of mRNA in the parent cells responsible for biomarker production.
authors.affiliation: Department of Nephrology, Prince of Wales Hospital, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
authors.forename: Philip W
authors.initials: PW
authors.lastname: Peake
authors.affiliation: Department of Nephrology, Prince of Wales Hospital, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Pianta
authors.affiliation: Department of Nephrology, Prince of Wales Hospital, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
authors.forename: Lena
authors.initials: L
authors.lastname: Succar
authors.affiliation: Department of Nephrology, Prince of Wales Hospital, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
authors.forename: Mangalee
authors.initials: M
authors.lastname: Fernando
authors.affiliation: Department of Nephrology, Prince of Wales Hospital, Sydney, Australia.
authors.forename: Debbie J
authors.initials: DJ
authors.lastname: Pugh
authors.affiliation: Department of Nephrology, Prince of Wales Hospital, Sydney, Australia.
authors.forename: Kathleen
authors.initials: K
authors.lastname: McNamara
authors.affiliation: Department of Nephrology, Prince of Wales Hospital, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
authors.forename: Zoltan H
authors.initials: ZH
authors.lastname: Endre
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000235:genetics / Q000628:therapy* / Q000652:urine; D000209:Acute-Phase Proteins / Q000235:genetics / Q000652:urine*; D000328:Adult; D015415:Biomarkers / Q000032:analysis / Q000652:urine; D055354:Exosomes / Q000235:genetics*; D005260:Female; D006801:Humans; D020382:Interleukin-18 / Q000235:genetics / Q000652:urine*; D016030:Kidney Transplantation; D000071068:Lipocalin-2; D054834:Lipocalins / Q000235:genetics / Q000652:urine*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000235:genetics / Q000652:urine*; D012333:RNA, Messenger / Q000032:analysis* / Q000235:genetics; D016896:Treatment Outcome
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D020382:Interleukin-18; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D012333:RNA, Messenger