@article{MallyJarzina2022,
  author    = {Mally, Angela and Jarzina, Sebastian},
  title     = {Mapping adverse outcome pathways for kidney injury as a basis for the development of mechanism-based animal-sparing approaches to assessment of nephrotoxicity},
  series = {Frontiers in Toxicology},
  volume    = {4},
  journal   = {Frontiers in Toxicology},
  issn      = {2673-3080},
  doi       = {10.3389/ftox.2022.863643},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-284405},
  year      = {2022},
  abstract  = {In line with recent OECD activities on the use of AOPs in developing Integrated Approaches to Testing and Assessment (IATAs), it is expected that systematic mapping of AOPs leading to systemic toxicity may provide a mechanistic framework for the development and implementation of mechanism-based in vitro endpoints. These may form part of an integrated testing strategy to reduce the need for repeated dose toxicity studies. Focusing on kidney and in particular the proximal tubule epithelium as a key target site of chemical-induced injury, the overall aim of this work is to contribute to building a network of AOPs leading to nephrotoxicity. Current mechanistic understanding of kidney injury initiated by 1) inhibition of mitochondrial DNA polymerase γ (mtDNA Polγ), 2) receptor mediated endocytosis and lysosomal overload, and 3) covalent protein binding, which all present fairly well established, common mechanisms by which certain chemicals or drugs may cause nephrotoxicity, is presented and systematically captured in a formal description of AOPs in line with the OECD AOP development programme and in accordance with the harmonized terminology provided by the Collaborative Adverse Outcome Pathway Wiki. The relative level of confidence in the established AOPs is assessed based on evolved Bradford-Hill weight of evidence considerations of biological plausibility, essentiality and empirical support (temporal and dose-response concordance).},
  language  = {en}
}
@article{JarzinaDiFioreEllingeretal.2022,
  author    = {Jarzina, Sebastian and Di Fiore, Stefano and Ellinger, Bernhard and Reiser, Pia and Frank, Sabrina and Glaser, Markus and Wu, Jiaqing and Taverne, Femke J. and Kramer, Nynke I. and Mally, Angela},
  title     = {Application of the adverse outcome pathway concept to in vitro nephrotoxicity assessment: kidney injury due to receptor-mediated endocytosis and lysosomal overload as a case study},
  series = {Frontiers in Toxicology},
  volume    = {4},
  journal   = {Frontiers in Toxicology},
  issn      = {2673-3080},
  doi       = {10.3389/ftox.2022.864441},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-284796},
  year      = {2022},
  abstract  = {Application of adverse outcome pathways (AOP) and integration of quantitative in vitro to in vivo extrapolation (QIVIVE) may support the paradigm shift in toxicity testing to move from apical endpoints in test animals to more mechanism-based in vitro assays. Here, we developed an AOP of proximal tubule injury linking a molecular initiating event (MIE) to a cascade of key events (KEs) leading to lysosomal overload and ultimately to cell death. This AOP was used as a case study to adopt the AOP concept for systemic toxicity testing and risk assessment based on in vitro data. In this AOP, nephrotoxicity is thought to result from receptor-mediated endocytosis (MIE) of the chemical stressor, disturbance of lysosomal function (KE1), and lysosomal disruption (KE2) associated with release of reactive oxygen species and cytotoxic lysosomal enzymes that induce cell death (KE3). Based on this mechanistic framework, in vitro readouts reflecting each KE were identified. Utilizing polymyxin antibiotics as chemical stressors for this AOP, the dose-response for each in vitro endpoint was recorded in proximal tubule cells from rat (NRK-52E) and human (RPTEC/TERT1) in order to (1) experimentally support the sequence of key events (KEs), to (2) establish quantitative relationships between KEs as a basis for prediction of downstream KEs based on in vitro data reflecting early KEs and to (3) derive suitable in vitro points of departure for human risk assessment. Time-resolved analysis was used to support the temporal sequence of events within this AOP. Quantitative response-response relationships between KEs established from in vitro data on polymyxin B were successfully used to predict in vitro toxicity of other polymyxin derivatives. Finally, a physiologically based kinetic (PBK) model was utilized to transform in vitro effect concentrations to a human equivalent dose for polymyxin B. The predicted in vivo effective doses were in the range of therapeutic doses known to be associated with a risk for nephrotoxicity. Taken together, these data provide proof-of-concept for the feasibility of in vitro based risk assessment through integration of mechanistic endpoints and reverse toxicokinetic modelling.},
  language  = {en}
}
@article{HartrampfWeinzierlSerflingetal.2022,
  author    = {Hartrampf, Philipp E. and Weinzierl, Franz-Xaver and Serfling, Sebastian E. and Pomper, Martin G. and Rowe, Steven P. and Higuchi, Takahiro and Seitz, Anna Katharina and K{\"u}bler, Hubert and Buck, Andreas K. and Werner, Rudolf A.},
  title     = {Hematotoxicity and nephrotoxicity in prostate cancer patients undergoing radioligand therapy with [\(^{177}\)Lu]Lu-PSMA I\&T},
  series = {Cancers},
  volume    = {14},
  journal   = {Cancers},
  number    = {3},
  issn      = {2072-6694},
  doi       = {10.3390/cancers14030647},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-254825},
  year      = {2022},
  abstract  = {(1) Background: Prostate-specific membrane antigen (PSMA)-directed radioligand therapy (RLT) has shown remarkable results in patients with advanced prostate cancer. We aimed to evaluate the toxicity profile of the PSMA ligand [\(^{177}\)Lu]Lu-PSMA I\&T. (2) Methods: 49 patients with metastatic, castration-resistant prostate cancer treated with at least three cycles of [\(^{177}\)Lu]Lu-PSMA I\&T were evaluated. Prior to and after RLT, we compared leukocytes, hemoglobin, platelet counts, and renal functional parameters (creatinine, eGFR, n = 49; [\(^{99m}\)Tc]-MAG3-derived tubular extraction rate (TER), n = 42). Adverse events were classified according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 and KDIGO Society. To identify predictive factors, we used Spearman's rank correlation coefficient. (3) Results: A substantial fraction of the patients already showed impaired renal function and reduced leukocyte counts at baseline. Under RLT, 11/49 (22\%) patients presented with nephrotoxicity CTCAE I or II according to creatinine, but 33/49 (67\%) according to eGFR. Only 5/42 (13\%) showed reduced TER, defined as <70\% of the age-adjusted mean normal values. Of all renal functional parameters, absolute changes of only 2\% were recorded. CTCAE-based re-categorization was infrequent, with creatinine worsening from I to II in 2/49 (4.1\%; GFR, 1/49 (2\%)). Similar results were recorded for KDIGO (G2 to G3a, 1/49 (2\%); G3a to G3b, 2/49 (4.1\%)). After three cycles, follow-up eGFR correlated negatively with age (r = -0.40, p = 0.005) and the eGFR change with Gleason score (r = -0.35, p < 0.05) at baseline. Leukocytopenia CTCAE II occurred only in 1/49 (2\%) (CTCAE I, 20/49 (41\%)) and CTCAE I thrombocytopenia in 7/49 (14\%), with an absolute decrease of 15.2\% and 16.6\% for leukocyte and platelet counts. Anemia CTCAE II occurred in 10/49 (20\%) (CTCAE I, 36/49 (73\%)) with a decrease in hemoglobin of 4.7\%. (4) Conclusions: After PSMA-targeted therapy using [\(^{177}\)Lu]Lu-PSMA I\&T, no severe (CTCAE III/IV) toxicities occurred, thereby demonstrating that serious adverse renal or hematological events are unlikely to be a frequent phenomenon with this agent.},
  language  = {en}
}
@phdthesis{Mueller2012,
  author    = {M{\"u}ller, Stephanie},
  title     = {Identification of early molecular changes associated with Fumonisin B1-induced carcinogenesis in vivo and in vitro},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-71336},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2012},
  abstract  = {Fumonisin B1 (FB1) is a mycotoxin produced by various Fusarium species and constitutes a major contaminant of maize worldwide. A 2-year carcinogenicity study of the National Toxicology Program (NTP) in Fischer N344 rats showed that male rats were most susceptible to FB1-induced tumor formation in the kidney. Histopathologically, a rare and highly malignant tumor type originating from the proximal tubules of rat kidney with increased potential for invasion and metastasis was identified. However, mechanisms underlying the FB1-induced carcinogenesis in kidneys of male rats are still not clear. Previous studies have shown that FB1-mediated disruption of sphingolipid metabolism via inhibition of ceramide synthase is a primary key event in FB1 toxicity. The disruption of sphingolipid metabolism may cause time- and dose-related changes in the relative balance of various bioactive intermediates. Furthermore, the ability of FB1 to induce renal cell death and subsequent compensatory cell proliferation is well known, but it does not completely explain the invasive growth characteristics and exceptionally high metastatic potential of FB1-induced tumors. Considering the complexity of sphingolipid metabolism and the fact that various sphingolipids (e.g. ceramide, sphingoid bases and their respective 1-phosphates) act on opposing signaling pathways, it is hypothesized that the balance between individual sphingolipids and thus the overall cellular response to FB1 may shift with time and by continuing FB1 exposure, resulting in the disruption of specific cell signaling pathways, which may promote tumor formation in kidney. To identify early FB1-induced gene expression patterns in the kidney, which may be associated with sphingolipid-mediated signaling pathways in cancer, a short-term i.p. study on FB1 in male Sprague Dawley rats was performed and changes in gene expression were analyzed using a qRT-PCR array that comprises 84 relevant genes of 6 pathways pivotally involved in the formation of cancer. Furthermore, apoptosis and cell proliferation as well as changes in specific sphingolipids were investigated in FB1-treated kidneys. As shown by classical histopathology (H\&E) and (immuno)-histochemical staining (TUNEL and BrdU), FB1 caused a time- and dose-dependent increase in tubular apoptosis in the cortex and OSOM of the kidney, which was compensated by the induction of proliferation in the affected areas. HPLC-MS/MS analysis of bioactive sphingolipids demonstrated that FB1 induced a marked elevation of the pro-apoptotic sphingoid bases sphinganine and sphingosine, which paralleled the time- and dose-dependent increase in renal tubular apoptosis. With prolonged exposure to FB1, increased metabolic conversion of the accumulated sphinganine to the sphinganine-1-phosphate, a second messenger with anti-apoptotic and proliferative properties, was observed in kidney. This finding was compliant with the increased regenerative cell proliferation in the cortex and OSOM. In addition to effects on sphingoid bases and their 1-phosphate metabolites, this study, for the first time, demonstrated reduced levels of specific ceramides in rat kidney after FB1 exposure. In particular, C16-ceramide, which is a widespread constituent of membrane-bound complex sphingolipids involved in cell adhesion, was time- and dose-dependently decreased after treatment with FB1. Besides its role as component of the cell membrane, C16-ceramide functions as a signaling molecule for the initiation of apoptosis in response to various stress stimuli. Under conditions of chronic FB1 exposure, a significant reduction in pro-apoptotic C16-ceramide together with markedly increased levels of anti-apoptotic and proliferation-promoting sphingoid base 1-phosphates may thus favor resistance to stress-induced apoptosis and facilitate the survival of abnormal cells with potential to initiate tumor formation. Our study also revealed that early exposure to FB1 resulted in increased expression of a plethora of genes involved in tumor initiation as well as tumor progression. While single FB1 exposure was demonstrated to predominately induce gene expression of proto-oncogenic transcription factors (e.g. Fos, Jun, Myc) and apoptotis-related genes (e.g. members of the tumor-necrosis factor family), repeated exposure resulted in marked upregulation of genes mediating cell survival and cell proliferation (e.g. Bcl-XL, Bcl-2, Nfκb1 and Egfr). Moreover, continued exposure to FB1 initiated increased expression of genes critically involved in tumor migration, adhesion, invasion and metastasis. A close correlation was established between gene expression changes in response to FB1 and known signaling pathways mediated by extracellular or intracellular action of sphingoid base 1-phosphates - bioactive lipids that were markedly increased after FB1 treatment. In particular, genes encoding components of the plasminogen activator system were abundantly upregulated. These mediate invasion and metastasis in response to So1P, and may hence particularly promote the formation of highly aggressive and invasive tumors in kidney as observed after chronic exposure to FB1. Thus, it is conceivable that upregulation of a majority of genes in response to FB1 may be a direct or indirect consequence of increased So1P signaling. Another aim of this study was to identify differences in the organ-specific susceptibility for tumor formation by comparing FB1-mediated effects on apoptosis, cell proliferation, sphingolipids, and selected cancer-related genes in kidney and liver. Collectively, the present results revealed that kidney and liver showed marked differences in several endpoints of FB1 toxicity, which seemed to be primarily associated with their different susceptibility to FB1-mediated alterations in sphingolipid metabolism. The strong correlation between histopathological lesions and alterations in sphingolipid metabolism as well as sphingoid base 1-phosphate accumulation and concomitant S1P receptor expression suggested that tumor formation and progression to highly malignant carcinomas seems to be rather favored in kidney compared to liver. However, genes mostly deregulated by FB1 treatment in kidney (PAI-1, Thbs1 and Itga2) were also found to be induced in liver. To verify FB1-induced gene expression in kidney, normal rat tubular epithelial (NRK-52E) cells were analyzed for FB1-induced expression changes of the same cancer-related genes as in vivo. The results of qRT-PCR analysis revealed that gene expression changes in NRK-52E cells after FB1 treatment strongly correlated with those found in rat kidney and paralleled the marked alterations in sphingolipid metabolism. Furthermore, a good correlation between FB1-induced expression changes of cancer-related genes obtained in vivo and in vitro and those known to be mediated by bioactive sphingoid base 1-phosphates in cancer was established. Moreover, experiments modeling the invasive behavior of NRK-52E cells showed that FB1 may enhance cell invasion, which also correlated with both the increase in invasion- and metastasis-associated genes and bioactive sphingoid base 1-phophates. Importantly, NRK-52E cells basally expressed the S1P receptors S1P2 and S1P3, which are known to be involved in tumor migration and invasion. Since these receptors were also identified as most abundant S1PRs in kidneys of male Sprague Dawley rats, they may present important mediators of gene expression and invasion in response to FB1 in vivo. In summary, FB1-mediated disruption of sphingolipid metabolism and subsequent time- and dose-related increase in intermediates, such as bioactive sphingoid base 1-phosphates, correlate with early changes in genes and signaling pathways that may mediate loss of growth control, replication, evasion of apoptosis, cell motility and invasion, and thus favor renal tumor formation in response to FB1. However, to clarify whether the obtained gene expression changes in cancer-related genes in kidney are specific to the biological action of sphingoid base 1-phosphates and their respective receptors, further mechanistic studies are necessary.},
  subject      = {Nephrotoxizit{\"a}t},
  language  = {en}
}