Puncture approaches for ultrasound-guided kidney biopsy specimens: a pediatric model study using piglet kidneys
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A first-in-human study of quantitative ultrasound to assess transplant kidney fibrosis
Kidney transplantation is the optimal treatment for renal failure. In the United States, a biopsy at the time of organ procurement is often used to assess kidney quality to decide whether it should be used for transplant. This assessment is focused on renal fibrotic burden, because fibrosis is an important measure of irreversible kidney injury. Unfortunately, biopsy at the time of transplant is plagued by problems, including bleeding risk, inaccuracies introduced by sampling bias and rapid sample preparation, and the need for round-the-clock pathology expertise. We developed a quantitative algorithm, called renal H-scan, that can be added to standard ultrasound workflows to quickly and noninvasively measure renal fibrotic burden in preclinical animal models and human transplant kidneys. Furthermore, we provide evidence that biopsy-based fibrosis estimates, because of their highly localized nature, are inaccurate measures of whole-kidney fibrotic burden and do not associate with kidney function post-transplant. In contrast, we show that whole-kidney H-scan fibrosis estimates associate closely with post-transplant renal function. Taken together, our data suggest that the addition of H-scan to standard ultrasound workflows could provide a safe, rapid and easy-to-perform method for accurate quantification of transplant kidney fibrotic burden, and thus better prediction of post-transplant renal outcomes.
Evolving adeno-associated viruses for gene transfer to the kidney via cross-species cycling of capsid libraries
The difficulty of delivering genes to the kidney has limited the translation of genetic medicines, particularly for the more than 10% of the global population with chronic kidney disease. Here we show that new variants of adeno-associated viruses (AAVs) displaying robust and widespread transduction in the kidneys of mice, pigs and non-human-primates can be obtained by evolving capsid libraries via cross-species cycling in different kidney models. Specifically, the new variants, AAV.k13 and AAV.k20, were enriched from the libraries following sequential intravenous cycling through mouse and pig kidneys, ex vivo cycling in human organoid cultures, and ex vivo machine perfusion in isolated kidneys from rhesus macaques. The two variants transduced murine kidneys following intravenous administration, with selective tropism for proximal tubules, and led to markedly higher transgene expression than parental AAV9 vectors in proximal tubule epithelial cells within human organoid cultures and in autotransplanted pig kidneys. Following ureteral delivery, AAV.k20 efficiently transduced kidneys in pigs and macaques. The AAV.k13 and AAV.k20 variants are promising vectors for therapeutic gene-transfer applications in kidney diseases and transplantation.
ACOT12, a novel factor in the pathogenesis of kidney fibrosis, modulates ACBD5
Lipid metabolism, particularly fatty acid oxidation dysfunction, is a major driver of renal fibrosis. However, the detailed regulatory mechanisms underlying this process remain unclear. Here we demonstrated that acyl-CoA thioesterase 12 (Acot12), an enzyme involved in the hydrolysis of acyl-CoA thioesters into free fatty acids and CoA, is a key regulator of lipid metabolism in fibrotic kidneys. A significantly decreased level of ACOT12 was observed in kidney samples from human patients with chronic kidney disease as well as in samples from mice with kidney injuries. Acot12 deficiency induces lipid accumulation and fibrosis in mice subjected to unilateral ureteral obstruction (UUO). Fenofibrate administration does not reduce renal fibrosis in Acot12−/− mice with UUO. Moreover, the restoration of peroxisome proliferator-activated receptor α (PPARα) in Acot12−/−Pparα−/− kidneys with UUO exacerbated lipid accumulation and renal fibrosis, whereas the restoration of Acot12 in Acot12−/− Pparα−/− kidneys with UUO significantly reduced lipid accumulation and renal fibrosis, suggesting that, mechanistically, Acot12 deficiency exacerbates renal fibrosis independently of PPARα. In Acot12−/− kidneys with UUO, a reduction in the selective autophagic degradation of peroxisomes and pexophagy with a decreased level of ACBD5 was observed. In conclusion, our study demonstrates the functional role and mechanistic details of Acot12 in the progression of renal fibrosis, provides a preclinical rationale for regulating Acot12 expression and presents a novel means of preventing renal fibrosis.
Cyclic jetting enables microbubble-mediated drug delivery
The pursuit of targeted therapies capable of overcoming biological barriers, including the blood–brain barrier, has spurred the investigation of stimuli-responsive microagents that can improve therapeutic efficacy and reduce undesirable side effects. Intravenously administered, ultrasound-responsive microbubbles are promising agents with demonstrated potential in clinical trials, but the mechanism underlying drug absorption remains unclear. Here we show that ultrasound-driven single microbubbles puncture the cell membrane and induce drug uptake through stable cyclic microjets. Our theoretical models successfully reproduce the observed bubble and cell dynamic responses. We find that cyclic jets arise from shape instabilities, as opposed to classical inertial jets that are driven by pressure gradients, enabling microjet formation at mild ultrasound pressures below 100 kPa. We also establish a threshold for bubble radial expansion beyond which microjets form and facilitate cellular permeation and show that the stress generated by microjetting outperforms previously suggested mechanisms by at least an order of magnitude. Overall, this work elucidates the physics behind microbubble-mediated targeted drug delivery and provides the criteria for its effective and safe application.
A deep learning based ultrasound diagnostic tool driven by 3D visualization of thyroid nodules
Recognizing the limitations of computer-assisted tools for thyroid nodule diagnosis using static ultrasound images, this study developed a diagnostic tool utilizing dynamic ultrasound video, namely Thyroid Nodules Visualization (TNVis), by leveraging a two-stage deep learning framework that involved three-dimensional (3D) visualization. In this multicenter study, 4569 cases were included for framework development, and data from seven hospitals were employed for diagnostic validation. TNVis achieved a Dice similarity coefficient of 0.90 after internal testing. For the external validation, TNVis significantly improved radiologists’ performance, reaching an AUC of 0.79, compared to their diagnostic performance without the use of TNVis (AUC: 0.66; p < 0.001) and those with partial assistance (AUC: 0.72; p < 0.001). In conclusion, the TNVis-assisted diagnostic strategy not only significantly improves the diagnostic ability of radiologists but also closely imitates their clinical diagnostic procedures and provides them with an objective 3D representation of the nodules for precise and personalized diagnosis and treatment planning.
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