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Effects of Donor Age and Cell Senescence on Kidney Allograft Survival


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The biological processes responsible for somatic cell senescence contribute to organ aging and progression of chronic diseases, and this may contribute to kidney transplant outcomes. We examined the effect of pre-existing donor aging on the performance of kidney transplants, comparing mouse kidney isografts and allografts from old versus young donors. Before transplantation, old kidneys were histologically normal, but displayed an increased expression of senescence marker p16(INK4a). Old allografts at day 7 showed a more rapid emergence of epithelial changes and a further increase in the expression of p16(INK4a). Similar but much milder changes occurred in old isografts. These changes were absent in young allografts at day 7, but emerged by day 21. The expression of p16(INK4a) remained low in young kidney allografts at day 7, but increased with severe rejection at day 21. Isografts from young donors showed no epithelial changes and no increase in p16(INK4a). The measurements of the alloimmune response-infiltrate, cytology, expression of perforin, granzyme B, IFN-gamma and MHC-were not increased in old allografts. Thus, old donor kidneys display abnormal parenchymal susceptibility to transplant stresses and enhanced induction of senescence marker p16(INK4a), but were not more immunogenic. These data are compatible with a key role of somatic cell senescence mechanisms in kidney transplant outcomes by contributing to donor aging, being accelerated by transplant stresses, and imposing limits on the capacity of the tissue to proliferate.
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American Journal of Transplantation 2009; 9: 114–123
Wiley Periodicals Inc.
2009 The Authors
Journal compilation C
2009 The American Society of
Transplantation and the American Society of Transplant Surgeons
doi: 10.1111/j.1600-6143.2008.02500.x
Effects of Donor Age and Cell Senescence on Kidney
Allograft Survival
A. Melka
A. Vongwiwatanad,J.Urmson
d, L.-F. Zhue,
D. RaynerfandP.F.Halloran
Division of Pediatric Nephrology, Gastroenterology and
Metabolic Diseases, Children’s Hospital, Hannover
Medical School, Hannover, Germany
Department of Nephrology, Hannover Medical School,
Hannover, Germany
Division of Pediatric Nephrology, University of
Heidelberg, Heidelberg, Germany
Division of Nephrology and Transplantation Immunology,
Department of Medicine, University of Alberta,
Edmonton, Canada
Department of Surgery, University of Alberta, Edmonton,
Department of Laboratory Medicine and Pathology,
University of Alberta, Edmonton, Canada
Corresponding author: Anette Melk,
The biological processes responsible for somatic cell
senescence contribute to organ aging and progression
of chronic diseases, and this may contribute to kid-
ney transplant outcomes. We examined the effect of
pre-existing donor aging on the performance of kid-
ney transplants, comparing mouse kidney isografts
and allografts from old versus young donors. Before
transplantation, old kidneys were histologically nor-
mal, but displayed an increased expression of senes-
cence marker p16
. Old allografts at day 7 showed a
more rapid emergence of epithelial changes and a fur-
ther increase in the expression of p16
. Similar but
much milder changes occurred in old isografts. These
changes were absent in young allografts at day 7,
but emerged by day 21. The expression of p16
mained low in young kidney allografts at day 7, but
increased with severe rejection at day 21. Isografts
from young donors showed no epithelial changes and
no increase in p16
. The measurements of the al-
loimmune response—infiltrate, cytology, expression
of perforin, granzyme B, IFN-cand MHC—were not
increased in old allografts. Thus, old donor kidneys
display abnormal parenchymal susceptibility to trans-
plant stresses and enhanced induction of senescence
marker p16
, but were not more immunogenic.
These data are compatible with a key role of somatic
cell senescence mechanisms in kidney transplant out-
comes by contributing to donor aging, being acceler-
ated by transplant stresses, and imposing limits on the
capacity of the tissue to proliferate.
Key words: Donor age, kidney aging, p16
sion, senescence, transplantation
Received 17 September 2007, revised 18 September
2008 and accepted for publication 09 October 2008
The limitation in the supply of organs for transplantation
compels us to transplant organs from older donors, mak-
ing the biology of aging a key question in organ transplan-
tation. Old donor age impairs early and late graft function
and reduces survival of deceased donor kidney transplants
(1–5). In addition, older donor kidneys are often affected
by age-related diseases such as hypertension, diabetes
and arterial deterioration. Kidneys from older donors have
an increased incidence of delayed graft function, poorer
glomerular filtration rates (GFR) at all times, lower graft
survival and, in some studies, an increased frequency of
rejection (4,6). Indeed, concerns about old donor age are
a major reason for discarding organs. Kidneys from old
donors get more rejection, as defined by tubulitis in the
Banff system, suggesting that they evoke more vigorous
host alloimmune responses (7).
The effects of donor organ aging could be related to so-
matic cell senescence, the state of cells and tissues that
have lost their capacity for repair and replication. Somatic
cell senescence could be a unifying theme in organ trans-
plantation, reflecting the inherent limitations on survival,
repair and replication in somatic tissues (8,9). The hypoth-
esis is that each tissue has a finite capacity for survival,
repair and replication; capacity that is used up slowly by
age and rapidly by abnormal stresses from injury and dis-
ease. Thus, pre-existing aging reduces repair and survival
capacity, and peri- and posttransplant stresses use up more
of this capacity, leading to an earlier failure (8).
In vitro
there are two models of somatic cell senescence: replica-
tive senescence and stress- and aberrant signaling-induced
senescence (STASIS). Replicative senescence is caused
by telomere shortening and dysfunction and occurs only in
human fibroblasts but not in mouse embryonic fibroblasts
(10,11). Telomere shortening can be prevented by telom-
erase transfection (12). STASIS can be observed in both
cells from species and is associated with an increased
expression of cyclin-dependent kinase inhibitor p16
(13–17). STASIS is caused by extrinsic stresses, whereas
Donor Age, Cell Senescence and Allograft Survival
replicative senescence is an intrinsic consequence of cell
replication (18).
In vivo
, somatic cell senescence occurs in
kidneys with aging and probably contributes to the phe-
notype of organ aging and age-related diseases. Telom-
ere shortening occurs in human but not in rodent kidneys
(19,20), whereas increased p16
expression occurs in
both (21). In addition to its significant positive correlation
with the kidney age, p16
expression also correlated to
the histopathological changes seen in older kidneys (21).
Recent publications have added further support to the as-
sociation of p16
expression with a widespread impair-
ment in tissue regeneration in rodents (22–24). Because
of the existence of STASIS in both, human and rodent
senescence, we have focused on studying p16
pression as a central signaling protein in this senescence
The present mouse studies explored how the behavior
of kidney transplants from older and young mice differs
and examined both the parameters of rejection and the
parenchymal response to operative stress and rejection.
We chose to study 18-month-old CBA kidneys rather than
those of older mice to avoid the characteristic focal and
segmental glomerulosclerosis that spontaneously occurs
in mice and rats at later times. We assessed whether aging
alters the parenchymal response to immune and nonim-
mune stress and immunogenicity. To assess the evolution
of pathology, we used a previously described non-life-
supporting vascularized renal transplantation model in
mice across full MHC barriers (25–27). We investigated
how transplant stresses affect the morphology of the
epithelium and the expression of p16
mRNA and
Materials and Methods
Male CBA mice were obtained from the National Institute on Aging, aged
rodent colonies, at 3 (young) or 18 months (old) of age. C57Bl/6 (B6) mice
were purchased from Jackson Laboratory (Bar Harbor, ME). All animals
were kept in a facility that is barrier-maintained and specific pathogen-free.
The animals were transplanted within 1 week after arrival in our colony.
All experiments were performed according to the University of Alberta and
University of Heidelberg Animal Policy and Welfare Committee’s animal
care protocols.
Renal transplantation
The donor mice (CBA at age 3 or 18 months) were anaesthetized and the
abdomen was opened through a midline incision. The right kidney was ex-
cised, flushed and preserved in cold saline solution for 30 min. The host
mice (B6 for allogeneic and CBA for syngeneic grafts, at a weight of 21–
23 g and age of 2 months) were similarly anaesthetized and the right native
kidney excised. The donor kidney was anastomosed heterotopically to the
inferior aorta, vena cava and bladder on the right side, without removing
the host’s left kidney (non-life-supporting kidney transplantation). The mice
were allowed to recover and were killed by cervical dislocation at day 7
or 21 following anesthesia. None of the transplanted hosts received im-
munosuppressive therapy. All hosts received prophylactic antibiotics with a
cephalosporine (cefazolin sodium, Novopharm, Stouffville, Ontario, Canada)
at a dose of 100 mg/kg i.m. to prevent wound and urinary tract infection.
Mice with technical complications or pyelonephritis were removed from the
study. We studied 15 young donors (n =7atday7andn=8 at day 21)
and 13 old donors (n =6atday7andn=7 at day 21) for allografts, and
8 young donors (n =4atday7andn=4 at day 21) and 7 old donors (n =
4atday7andn=3 at day 21) for isografts.
Tissue sections (2 lm) were stained with hematoxylin and eosin (H&E)
or with periodic acid-Schiff (PAS). Histopathologic changes were evaluated
based on the Banff classification for transplant pathology (28). The acute
lesions were scored from 0 to 3 based on the percentage of parenchymal
involvement, as described earlier. For interstitial infiltrate: 0 =representing
no or trivial (<10%) interstitial inflammation, 1 =representing 10–25%,
2=representing 26–50% and 3 =representing more than 50% of the total
parenchyma inflamed. For glomerulitis: 0 =representing no glomerulitis,
1=representing glomerulitis in up to 25% of glomeruli, 2 =represent-
ing glomerulitis in 26–75% of glomeruli and 3 =representing glomerulitis
in more than 75% of glomeruli. For tubulitis: 0 =no mononuclear cells
in tubules, 1 =representing foci with 1–4 cells per tubular cross-section,
2=representing foci with 5–10 cells per tubular cross-section and 3 =
representing more than 10 cells per tubular cross-section. Tubulitis was
assessed for nonatrophic and atrophic tubules separately. For vasculitis:
0=no arteritis, 1 =mild-to-moderate intimal arteritis in at least one arterial
cross-section, 2 =severe intimal arteritis with at least 25% luminal area lost
in at least one arterial cross-section and 3 =transmural arteritis and/or arte-
rial fibrinoid change and medial smooth muscle necrosis with lymphocyte
infiltrate in vessel. We also recorded the extent of graft necrosis, throm-
bosis, edema and cast formation as the percentage of total parenchyma
involved. The assessment of chronic changes included interstitial fibrosis
and tubular atrophy. These changes were scored based on the percentage
of parenchymal involvement. For interstitial fibrosis: 0 =representing inter-
stitial fibrosis in up to 5%, 1 =representing interstitial fibrosis in 6–25%,
2=representing interstitial fibrosis in 26–50% and 3 =representing inter-
stitial fibrosis in more than 50% of the cross-section. For tubular atrophy:
the percentage of tubules affected was assessed for the cortical area of
the complete cross-section. Vascular fibrous intimal thickening and arterio-
lar hyaline thickening did not occur in any of the mice and were therefore
not scored.
In addition, on PAS-stained slides, the number of nuclei per tubular cross-
section and the tubular diameter for nonatrophic and atrophic tubules were
assessed. No distinction was made between proximal and distal tubules;
medullary rays were avoided. Both assessments were done in 10 random
high-power fields (HPFs; 400×magnification). For the measurement of
the tubular diameter, pictures from randomly selected areas were taken
using a Nikon Eclipse-1000 digitizing microscope (Nikon, Melville, NY). The
resulting TIFF-files (size 25.6 ×20.48 inches) were processed using Adobe
Photoshop 5.0 (Adobe Systems Canada, Ottawa, Ontario, Canada) to reduce
their size (size 12.8 ×10.24 inches), making them suitable for ImageJ
software (free share software, NIH, Bethesda, MD). The tubular diameter
was measured in inches on these processed pictures.
Hybridoma cell lines were obtained from ATCC (Rockville, MD). Cell lines
producing monoclonal antibodies, 34–4-20S (anti H-2D), 11– (anti-
I-Ak), 11–4.1 (anti-H-2K) and 20–8-4S (anti-H-2KbDb) were maintained in
tissue culture in our laboratory. All other antibodies were purchased: anti
I-Ab(Serotec, Raleigh, NC), anti-mouse CD45 (Cedarlane, Hornby, ON), anti-
mouse CD3 (Serotec, Raleigh, NC), anti-mouse CD8 (Serotec, Raleigh, NC),
anti-mouse CD4 (BD Pharmingen, Mississauga, ON), anti-p16
Cruz Biotechnologies, Santa Cruz, CA) and Ki-67 (clone MIB-1, Dako, Mis-
sissauga, Ontario, Canada).
American Journal of Transplantation
2009; 9: 114–123 115
Melk et al.
Immunohistochemistry was performed either on frozen or on paraffin-
embedded biopsy sections. Fresh frozen sections were fixed in acetone
and then incubated with normal goat serum. Slides were then incubated
with rat anti-mouse CD45, CD3, CD4 and CD8. Control slides were treated
with PBS. Next, the slides were exposed to the affinity-purified goat anti-rat
IgG F(ab’)2fragment (ICN, Costa Mesa, CA). The slides were finally stained
with 3’3 diaminobenzidine tetrahydrochloride (DAB) and hydrogen perox-
ide for the peroxidase reaction and counterstained with hematoxylin. The
analysis was done by counting 10 random HPFs by a blinded observer.
Immunoperoxidase staining for p16
and Ki-67 was performed using
2-lm sections of paraffin-embedded tissue. Briefly, the sections were
deparaffinized and hydrated. In case of Ki-67 staining, antigen retrieval
was performed in citrate buffer. The sections were then immersed in 3%
H2O2:methanol to inactivate endogenous peroxidase and blocked with 20%
normal goat serum. The tissue sections were then incubated for 1 h at room
temperature with the primary antibody (mouse monoclonal antibody for ei-
ther p16
or Ki-67) or isotype control and rinsed with PBS. Following
30 min of incubation with the Envision monoclonal system (Dako), the sec-
tions were washed again in PBS. The visualization was performed using
the DAB substrate kit (Dako). The slides were counterstained with hema-
toxylin and were mounted. The percentage of positive nuclei was assessed
for tubules (for both p16
and Ki-67), glomeruli (only for p16
interstitium (only for p16
) by counting 10 random HPFs by a blinded
RNA isolation
Total RNA was extracted from tissue samples according to a modification of
the method described by Chirgwin et al. (29). Tissues were homogenized in
a polytron in 4 M guanidinium isothiocyanate, and the RNA was centrifuged
2cushion. RNA was isolated by phenol/chloroform extrac-
tion. Concentrations were determined by absorbance at 260 nm.
Reverse transcription (RT) and real-time polymerase chain
reaction (PCR)
Transcription into cDNA was done using Maloney murine leukemia virus
(MMLV) RT and random primers (Life Technologies, Burlington, Ontario,
Canada). The principle of real-time quantitative PCR has been described
by Heid et al. (30). cDNA was amplified in an ABI PRISM 7700 Sequence
Detector (Applied Biosystems, Foster City, CA). All samples were done in
duplicates and run in two separate experiments. Sequence-specific primers
and probe (Table S1) for IFN-c, perforin, granzyme B, p16
and hypox-
anthine phosphoribosyl transferase (HPRT) were designed using Primer
Express Software (Applied Biosystems). A relative quantification of gene
expression was performed using the Relative Standard Curve method, as
described in the User Bulletin #2 (Applied Biosystems). Briefly, the number
of PCR cycles that are needed to reach the fluorescence threshold is called
threshold cycle (Ct). The Ct value for each sample is proportional to the
logarithm of the initial amount of input cDNA. The calibrator used consisted
of cDNA derived from different tissues and age groups from normal and
transplanted mice. Standard curves were prepared by serial dilutions of the
calibrator for both the gene of interest and the housekeeping gene HPRT.
The dilutions were arbitrarily numbered 3, 1.5, 0.75, 0.375 and 0.1875. The
Ct values for all samples were then assigned an arbitrary value based on
the standard curves. The arbitrary values for the gene of interest and HPRT
were divided (gene/HPRT) in order to normalize to HPRT. Then, the mean
value for the duplicates is calculated. All values are given as a gene of
interest to HPRT ratio.
Statistical analysis
Data analyses were performed using SPSS (SPSS Inc., Chicago, IL). For
quantitative variables, the means among different groups were compared
using ANOVA, and
-tests with Bonferroni correction were used for multiple
pairwise comparisons. For ordinal observations, the different groups were
compared using the Kruskal–Wallis test, and pairwise comparisons were
performed using the Mann–Whitney
statistics. All values are given as
mean (M) ±standard deviation (SD).
We studied how pre-existing aging may alter the evolu-
tion of rejection on the renal parenchyma and the effect of
stress of the transplantation procedure. The old kidneys
were evaluated in our previously described renal trans-
plant model (25–27). We used a donor–recipient combina-
tion either fully mismatched for MHC and non-MHC anti-
gens (CBA into B6, allogeneic) or fully matched for MHC
and non-MHC antigens (CBA into CBA, syngeneic), with
no immunosuppression. The left host kidney remained in
place to maintain the survival (non-life-supporting trans-
plant model) and health of the host, with no incidental loss
of subjects due to death from uremia and hyperkalemia.
This provided us with the ability to assess the evolution of
pathologic lesions over time.
Normal CBA mice:
Young CBA mice lacked features of
aging or renal disease (Figure 1A and B). Four of the 18
old CBA showed mild patchy tubular atrophy, affecting less
Figure 1: Tubular cross sections in (A) normal young CBA
mice, (B) Normal old CBA mice, (C) young CBA donor kid-
ney 7 days after allogeneic transplantation, (D) old CBA donor
kidney 7 days after allogeneic transplantation, (E) young CBA
donor kidney 21 days after allogeneic transplantation and (F)
old CBA donor kidney 7 days after allogeneic transplantation.
Original magnification 400×.
American Journal of Transplantation
2009; 9: 114–123
Donor Age, Cell Senescence and Allograft Survival
Ta b l e 1 : Basement membrane wrinkling, tubular diameter and cell number for kidneys from CBA mice
Tubular diameter Nuclei per tubular cross section (No.)
Kidney Tubular Interstitial TBM
weight (mg) atrophy (%) fibrosis wrinkling (%) All Wrinkled Normal All Wrinkled Normal
NCBA Young 236 ±54 0 0 0 1.4 ±0.08 NA 1.4 ±0.08 3.9 ±0.9 NA 3.9 ±0.9
Old 325 ±77 0 0 0 1.3 ±0.1 NA 1.3 ±0.1 4.1 ±0.8 NA 4.1 ±0.8
Allografts D7 Young 313 ±60 0 0 3.5 ±5.4 1.4 ±0.2 NA 1.4 ±0.2 4.5 ±0.7 NA 4.5 ±0.7
Old 394 ±73 12.7 ±15.5 0 60.4 ±27.91,71.0 ±0. 091,70.9 ±0.0912 1.1 ±0.12,13 3.6 ±0.523.3 ±0.712 3.9 ±0.3
Allografts D21 Young 335 ±70 31.8 ±33.5 1.0 ±0.6144.2 ±41.191.0 ±0.2 1.0 ±0.05 1.2 ±0.2 4.2 ±0.2 3.7 ±0.2 4.9 ±0.8
Old 427 ±129 43.7 ±31.8 1.1 ±0.710 63.9 ±31.370.9 ±0.0660.8 ±0. 0641.1 ±0.1 2.6 ±0.781.9 ±1.153.9 ±2.0
Isografts D7 Young 202 ±21 0 0 0 1.5 ±0.1 NA 1.5 ±0.1 5.2 ±0.4 NA 5.2 ±0.4
Old 289 ±34 3.6 ±3.3 0 33.6 ±8.03,61.2 ±0.2 1.1 ±0.2 1.3 ±0.1 4.3 ±0.5 3.8 ±0.5 4.7 ±0.7
Isografts D21 Young 189 ±12 0 0 0 1.4 ±0.1 NA 1.4 ±0.1 4.7 ±0.4 NA 4.7 ±0.4
Old 253 ±56 12.9 ±15.8 0.4 ±0.9 16.2 ±7.48,13 1.2 ±0.111 0.8 ±0.4 1.3 ±0.1 4.1 ±0.413 3.2 ±1.5 4.6 ±0.5
Data are shown for normal mice prior to transplantation (NCBA) as well as 7 days (D7) and 21 days (D21) after transplantation.
TBM =tubular basement membrane; ‘all’ =diameters or nuclei for all tubules in the 10 HPFs assessed were used to calculate the mean value for either diameter or number of
nuclei; ‘wrinkled’ =diameters or nuclei for tubules that appeared to be wrinkled in the 10 HPFs assessed were used to calculate the mean value for either diameter or number of
nuclei; ‘normal’ =diameters or nuclei for tubules that appeared to be normal in the 10 HPFs assessed were used to calculate the mean value for either diameter or number of
1p<0.005 when compared with young allografts D7.
2p<0.05 when compared with young allografts D7.
3p<0.05 when compared with young isografts D7.
4p<0.005 when compared with young allografts D21.
5p<0.05 when compared with young allografts D21.
6p<0.001 when compared with normal old.
7p<0.01 when compared with normal old.
8p<0.05 when compared with normal old.
9p<0.05 when compared with normal young.
10p<0.005 when compared with old allografts D7.
11p<0.01 when compared with old allografts D21.
12p<0.05 when compared with old allografts D21.
13p<0.05 when compared with old isografts D7.
American Journal of Transplantation
2009; 9: 114–123 117
Melk et al.
CBA D7 D21
/HPRT ratio
normalized to young normal CBA
(CBA in C57BL6)
D7 D21
(CBA in CBA)
D7 D21
(CBA in CBA)
*p<.005 vs. D7 young
**p<.005 vs. D7 old
#p<.01vs. normal
old controls
#Figure 2: P16
mRNA expres-
sion for CBA kidneys prior to and af-
ter allogeneic and syngeneic trans-
plantation. Normal CBA =prior to
transplantation; D7 =7 days after
transplantation; D21 =21 days af-
ter transplantation. Values are given
as fold difference compared with nor-
mal young CBA mice. Significant dif-
ferences are indicated.
than 0.5% of the area of cortical tubules, as expected for
age (Figure 1B). None of the old CBA mice displayed focal
and segmental glomerulosclerosis or other features of re-
nal disease. Young and old kidneys displayed no significant
differences in the tubular diameter or number of nuclei per
tubular cross-section (Table 1).
At day 7, allografts from old donor mice
showed greater tubular basement membrane (TBM) wrin-
kling and tubular mass loss, compared with allografts of
young donor mice (Table 1) (Figure 1C and D). TBM wrin-
kling was more frequent in old allografts (60%) compared
with young allografts (4%). Old allografts also showed
tubular atrophy (12.7% vs. 0% in young allografts), a re-
duced tubular diameter (1.0 vs. 1.4 in young D7 allografts)
and a lower number of nuclei per tubular cross-section
(3.6 vs. 4.5 in young D7 allografts) (Table 1).
At day 21, old allografts showed TBM wrinkling in 64%
of tubules and young allografts in 44% of tubules; the
difference was no longer significant (Figure 1E and F;
Table 1). Both groups manifested interstitial fibrosis when
compared with D7 allografts (old D21: p <0.005; young
D21: p <0.005). The number of tubules meeting the cri-
teria for tubular atrophy increased further in old D21 al-
lografts (44%) and became detectable in young D21 allo-
grafts transplants (32%). There was no significant differ-
ence in the amount of interstitial fibrosis or tubular atrophy
between old and young allografts at day 21. The number
of cells per tubular cross-section and the tubular diameter
further decreased in old D21 allografts (Table 1). Old D21
allografts had significantly fewer tubular cells (2.6 vs. 4.2 in
young D21 allografts; p <0.005), and the tubular diameter
tended to be smaller (0.9 vs. 1.2 in young D21 allografts;
p=0.06), particularly in tubules with wrinkled TBM
(0.8 vs. 1.0 in young D21 allografts; p <0.005).
The histology of young isografts at day 7 was
normal. Old isografts showed TBM wrinkling in 34% and
tubular atrophy in 4% of the tubular cross-sections. The
tubular diameter and tubular cells did not change in iso-
grafts when compared with normal young and old CBA
kidneys (Table 1).
At day 21, TBM wrinkling was not present in any young iso-
grafts, and was present in only one of the old isografts, af-
fecting 16% of the tubular cross-sections. Young isografts
did not show any tubular atrophy, whereas in old isografts,
13% of the tubular cross-sections showed tubular atrophy.
The tubular diameter and tubular cells did not change in
isografts when compared with normal young and old CBA
Normal CBA mice:
Normal kidneys from old nor-
mal CBA expressed significantly higher p16
(Figure 2) compared with young kidneys (37-fold; p <
0.001). P16
staining was assessed in the nuclei of prox-
imal and distal tubules and collecting duct (tubular staining),
podocytes and parietal epithelium of glomeruli (glomerular
staining) and interstitial cells (interstitial staining). Old nor-
mal CBA kidneys had significantly more p16
nuclei than young normal CBA mice for tubular (p <0.005;
Figure 3A), glomerular (p <0.05; Figure 3B) and interstitial
cells (p <0.05; Figure 3C).
At day 7 of rejection, p16
mRNA expres-
sion increased significantly in old allografts (p <0.01;
Figure 2) but not in young allografts (p =1.000) com-
pared with either normal old or young controls. Thus, the
rejecting old kidneys displayed higher p16
mRNA ex-
pression than the rejecting young kidneys at day 7 (P <
0.005), reflecting both higher basal expression and greater
American Journal of Transplantation
2009; 9: 114–123
Donor Age, Cell Senescence and Allograft Survival
positive nuclei
in tubules (%)
NCBA D7 post tx D21 post tx
positive nuclei
in glomeruli (%)
NCBA D7 post tx D21 post tx
positive nuclei
in interstitium (%)
NCBA D7 post tx D21 post tx
Figure 3: P16
protein expression in (A) tubular cells (B)
glomeruli and (C) interstitial cells in renal cortex of CBA kid-
neys. Normal CBA (NCBA) =prior to transplantation; D7 =7 days
after transplantation; D21 =21 days after transplantation. Values
are given as the percentage of positive nuclei for each of the three
cellular compartments. Significant differences are indicated.
induced expression. The percentage p16
-positive nu-
clei increased by day 7: the increase was significant for
glomerular cells in old allografts (p <0.005; Figure 3B) and
for interstitial cells in both old and young allografts (p <
0.05 and p <0.001, respectively; Figure 3C). The percent-
age of p16
-positive nuclei was significantly higher in
old than young kidneys for tubular (p <0.05), glomerular
(p <0.01) and interstitial cells (p <0.01).
At day 21, p16
mRNA expression further increased
in allografts from old donors (p <0.005 when compared
with D7 allografts; Figure 2). In addition, p16
expression increased in young allografts (p <0.005 for day
21 compared with day 7; Figure 2), thus eliminating the
CBA D7 D21
(CBA in C57BL6)
Ki-67 positive nuclei in tubules (%)
Figure 4: Ki-67 expression in tubular cells in renal cortex of
CBA kidneys. Normal CBA =prior to transplantation; D7 =7 days
after transplantation; D21 =21 days after transplantation. Values
are given as the percentage of positive nuclei from the total tubular
nuclei. Significant differences are indicated.
difference in p16
mRNA expression between old and
young allografts by day 21. In all investigated cell types, the
percentage of p16
-positive nuclei in old allografts was
significantly higher compared to normal controls (tubules:
p<0.05, glomeruli: p <0.05, interstitium: p <0.05 vs.
normal CBA; Figure 3A–C). The increase in young allografts
versus normal young kidneys was statistically significant
for glomerular and interstitial cells (p <0.05 and p <0.001
vs. normal CBA, respectively; Figure 3B and C), although
not for tubules. Thus, there was no difference in p16
expression between old and young allografts at day 21.
Isografts at days 7 and 21:
mRNA and protein
expression for old and young isografts was similar to the
expression found in normal CBA mice (Figures 2 and 3).
The proliferative response of tubular cells was measured
by Ki-67 staining.
Normal CBA mice:
The rate of proliferation measurable
in tubular cells was, regardless of age, very low. Old normal
CBA kidneys had a tendency toward less Ki-67-positive
tubular cells when compared with young normal CBA mice
(Figure 4).
At day 7 of rejection, Ki-67 expression in-
creased significantly in old and young allografts (vs. old
American Journal of Transplantation
2009; 9: 114–123 119
Melk et al.
normal CBA: p =0.001; vs. young normal CBA: p <0.001),
but was significantly lower in old allografts compared with
young allografts (p <0.01; Figure 4). There was no further
increase in Ki-67-positive tubular cells by day 21 for either
group. The difference between transplants from old and
young donors remained significant (p <0.005).
Immune response
The immune response was assessed by histologic markers
of rejection, the amount and type of infiltrate as well as
the expression of MHC, IFN-cand cytotoxic T-cell genes
(granzyme B and perforin).
Both age groups developed lesions charac-
teristic of rejecting transplants at day 7 and day 21. There
were no significant differences for any of the acute features
at days 7 and 21 between young and old donor kidneys,
respectively (Table 2). The number of infiltrating cells, mea-
sured as CD45- (total lymphocytes), CD3- (T cells), CD4-
(T helper cells) and CD8- (cytotoxic T cells) positive cells,
was similar in both old and young transplants at day 7 and
day 21 (Table 3). No differences were seen for donor (CBA)
and recipient (B6) classes I and II (Table 4) expression be-
tween old and young transplants at days 7 and 21 after
transplantation. mRNA expression for two cytotoxic T-cell
genes (granzyme B and perforin) and IFN-c(Figure S1) was
similar in allografts from old and young donors at days 7
and 21 after transplantation.
As expected, none of the isografts from both
age groups developed lesions of rejection at day 7 or 21.
None of the kidneys showed acute tubular necrosis. One
of the old transplants showed features of mild acute tubu-
lar injury at day 7, but the others did not. There was no
interstitial infiltrate, even in the kidney with mild tubular
injury. None of the isografts at day 21 in both age groups
showed any signs of acute tubular injury.
In the present studies, a principal difference in old donor
tissue is the earlier deterioration of old tissues with trans-
plant stress and no increase in rejection compared with
young donor tissue. Allografts from old donor kidneys
showed signs of progressive tubular atrophy and tubular
loss, whereas the number of tubular cells remained con-
sistent in young donor allografts. Transplantation also in-
duced p16
, the cell cycle regulator typical of somatic
cell senescence, at the mRNA and protein level. The basal
levels of p16
were present in old native donor kidneys,
and p16
was induced in allografts from old donor kid-
neys soon after transplantation (day 7). In contrast, young
nontransplanted kidneys showed very little basal expres-
sion of p16
, with an increased expression not until later
after transplantation (day 21). Isografts did not have an ef-
fect on p16
expression. A proliferative response was
induced in both age groups after transplantation, but was
significantly lower in transplants from old donors. Thus, the
Ta b l e 2 : Acute histopathologic features of rejection in kidneys from CBA mice
Tubulitis in Tubulitis in Interstitial
nonatrophic tubules atrophic tubules infiltrate Glomerulitis Vasculitis Necrosis Thrombosis Edema Casts
Allografts D7 Young 0.6 ±0.5 0 2.4 ±0.5 0.7 ±0.5 0.6 ±0.5 0 0 0 0
Old 1.0 ±0.0 1.2 ±0.4 2.8 ±0.4 1.0 ±0.6 0.5 ±0.6 1.7 ±2.6 0 0 0
Allografts D21 Young 1.9 ±0.7 2.3 ±0.7 2.6 ±0.7 0.9 ±0.6 1.5 ±0.5 2.5 ±3.8 0 7.5 ±7.6 3.8 ±5.2
Old 1.1 ±0.4 1.7 ±0.5 2.7 ±0.5 1.0 ±0.0 1.6 ±0.5 1.4 ±2.4 0 7.7 ±8.4 0
Isografts D7 Young 0 0 0 0 0 0 0 0 0
Old 0 0 0 0 0 0 0 0 0
Isografts D21 Young 0 0 0 0 0 0 0 0 0
Old 0 0 0 0 0 0 0 0 0
Data are shown for mice 7 days (D7) and 21 days (D21) after transplantation.
Tubulitis, interstitial infiltrate, glomerulitis and vasculitis were assessed according to the Banff classification (28) (for details, see Materials and Methods section). The extent of graft
necrosis, thrombosis, edema and cast formation were recorded as the percentage of total parenchyma involved.
American Journal of Transplantation
2009; 9: 114–123
Donor Age, Cell Senescence and Allograft Survival
Ta b l e 3 : Cytology and cell counts for infiltrating lymphocytes
Young Old Young Old Young Old
CD45 2 ±34±8 148 ±80 138 ±86 38 ±530±7
CD3 1 ±40±1 117 ±68 111 ±79 44 ±643±10
CD4 0 ±10 47±38 54 ±61 3 ±34±3
CD8 1 ±21±2 113 ±77 88 ±67 20 ±621±8
Data are shown for normal mice prior to transplantation (NCBA)
as well as 7 days (D7) and 21 days (D21) after transplantation.
stress of transplantation induces features of cell senes-
cence in both old and young donor kidneys, and these oc-
cur earlier and to a greater extent in old donor tissues. Con-
sistent with the increase in cell senescence, we found a
reduced proliferation in response to transplantation stress.
Rejection parameters such as the Banff scores, MHC ex-
pression, cellular infiltrate and the expression of cytotoxic
T-cell genes and IFN-cwere similar in allografts from old
and young donor kidneys, both early and later after trans-
plant, suggesting that donor age does not alter immuno-
genicity. Taken together, these results show that older
donor age is an important determinant of a kidney’s re-
action to transplantation and rejection stress, but has little
effect on the magnitude of the immune response. The re-
sults establish that at least some features of aging are
induced in an accelerated fashion by stresses surrounding
The augmented development of histopathological features
of atrophy, cell loss and p16
expression in isografts and
allografts from old donors indicates an increased suscep-
tibility of old allografts to damage through peri- and post-
transplant stresses. We show that acute rejection has a
greater impact in old allografts, which was not attributable
to the differences in recipient’s immune response toward
the old organ or donor’s immunogenicity. In addition, gene
array studies currently in progress in our laboratory sup-
port this finding on a much larger scale of investigated
genes. These findings are in contrast to some human data
that suggest a greater frequency of rejection and impact of
acute rejection due to higher immunogenicity of old donors
(7). The difference is that tubulitis is a late stage of epithe-
lial deterioration, with the loss of the ability to exclude
Ta b l e 4 : Donor (CBA) and recipient (B6) MHC class I and class II expression
Young Old Young Old Young Old
Donor MHC
Class I 0.67 ±1.40 0.14 ±0.36 1.9 ±1.8 2.0 ±1.7 0.5 ±1.4 1.8 ±1.5
Class II 0.17 ±0.38 0.08 ±0.27 2.9 ±2.0 2.2 ±1.7 0.5 ±1.4 1.5 ±1.6
Recipient MHC
Class I 0 0 3.4 ±1.1 3.5 ±0.8 2.8 ±1.0 3.5 ±0.8
Class II 0 0 2.3 ±0.5 2.2 ±1.2 3.1 ±1.1 3.7 ±0.8
Data are shown for normal mice prior to transplantation (NCBA) as well as 7 days (D7) and 21 days (D21) after transplantation. Donor
MHC expression was assessed in tubules and recipient MHC in interstitium.
lymphocytes (31). Thus, the old epithelium permits more
tubulitis with the same level of the immune response, and
the conclusion that old kidneys are more immunogeneic is
probably incorrect.
Thus, the principal problem of old donor tissues is not that
they are more immunogenic but that the parenchyma pos-
sess greater fragility, leaving it susceptible to deterioration
and atrophy and irreversible cell cycle arrest when rejec-
tion occurs. The reason for poorer outcomes in old donors
is intrinsic to the donor and is a combination of under-
lying features of somatic cell deterioration and developing
chronic features together with the loss of tubular cells. The
resulting decreased capacity of old donor tissues to repair
peritransplant injuries and maintain organ mass may be a
prototype for a general feature of old tissue. Even though
our data point toward a central role of the epithelium within
this process, we cannot exclude the possibility that older
animals may have had fewer peritubular capillaries going
into surgery, which could have led to tubular injury through
Not only are some mechanisms of cellular senescence
pre-established in organs from older donors but these pro-
cesses are also accelerated by the transplantation process,
in both young and old tissues. The increases in p16
probably reflect both the response to the peri- and post-
transplant environmental stresses and the need for in-
creased replication followed by signals for cell cycle inhibi-
tion. The induction of p16
in old donor allografts at day 7
was about 7-fold higher compared with induction in young
donor kidneys and was additive to the pre-existing higher
expression in old normal CBA mice kidney. The
changes at day 7 reflect the damage caused by acute re-
jection, and possibly by ischemia-reperfusion and stresses
of the surger y itself. It must be noted, however, that the
kidneys had minimal ischemia (as seen in the isografts), as
is the case for living donation. Since p16
-positive cells
are irreversibly arrested in the cell cycle and are no longer
are capable of replication (17), these data suggest that, 7
days after transplantation, old donor kidneys possess a sig-
nificantly lower ability to withstand stresses and to repair,
which is supported by the Ki-67 data showing a reduced
proliferative response in old transplants. Twenty-one days
after transplantation, p16
was increased in both old
American Journal of Transplantation
2009; 9: 114–123 121
Melk et al.
and young donor transplants, consistent with the idea that
ongoing acute rejection with increased need for replication
will exhaust the replicative potential in young donors.
The survival of an organ is limited by senescence mecha-
nisms. We believe that somatic cell senescence changes
contribute to collapse of tissue integrity and—if success-
fully bypassed—will prolong tissue survival and enhance
performance of allografts. Further studies have to investi-
gate how kidneys lacking p16
will perform and which
cellular compartment is limiting for transplant survival.
This study was funded by Roche Organ Transplant Research Foundation,
Canadian Institutes of Health Research, Kidney Foundation of Canada, The
Muttart Foundation and The Royal Canadian Legion.
1. Terasaki PI, Cecka JM, Gjertson DW. Impact analysis: A method
for evaluating the impact of factors in clinical renal transplantation.
In: Cecka JM, Terasaki PI, eds. Clinical Transplants. Los Angeles,
CA: UCLA Tissue Typing Laboratory, 1998: 437–441.
2. Gjertson DW. Determinants of long-term survival of adult kidney
transplants. In: Terasaki P, Cecka JM, eds. Clinical Transplants.
Los Angeles, CA: UCLA Immunogenetics Center, 2000: 341–
3. Cicciarelli J, Iwaki Y, Mendenz R. The influence of donor age
on kidney graft survival in the 1990s. In: Cecka JM, Terasaki PI,
eds. Clinical Transplants. Los Angeles, CA: UCLA Tissue Typing
Laboratory, 1999: 335–340.
4. Prommool S, Jhangri GS, Cockfield SM, Halloran PF. Time de-
pendency of factors affecting renal allograft survival. J Am Soc
Nephrol 2000; 11: 565–573.
5. Toma H, Tanabe K, Tokumoto T, Shimizu T, Shimmura H. Time-
dependent risk factors influencing the long-term outcome in living
renal allografts: Donor age is a crucial risk factor for long-term graft
survival more than 5 years after transplantation. Transplantation
2001; 72: 940–947.
6. Gourishankar S, Hunsicker LG, Jhangri GS, Cockfield SM, Halloran
PF. The stability of the glomerular filtration rate after renal trans-
plantation is improving. J Am Soc Nephrol 2003; 14: 2387–2394.
7. de Fijter JW, Mallat MJ, Doxiadis II et al. Increased immunogenic-
ity and cause of graft loss of old donor kidneys. J Am Soc Nephrol
2001; 12: 1538–1546.
8. Halloran PF, Melk A, Barth C. Rethinking chronic allograft
nephropathy: The concept of accelerated senescence. J Am Soc
Nephrol 1999; 10: 167–181.
9. Halloran PF, Melk A. Renal senescence, cellular senescence, and
their relevance to nephrology and transplantation. Adv Nephrol
Necker Hosp 2001; 31: 273–283.
10. Harley CB, Futcher AB, Greider CW. Telomeres shorten during
ageing of human fibroblasts. Nature 1990; 345: 458–460.
11. Wright WE, Shay JW. Telomere dynamics in cancer progression
and prevention: Fundamental differences in human and mouse
telomere biology. Nat Med 2000; 6: 849–851.
12. Bodnar AG, Ouellette M, Frolkis M et al. Extension of life-span
by introduction of telomerase into normal human cells. Science
1998; 279: 349–352.
13. Zindy F, Quelle DE, Roussel MF, Sherr CJ. Expression of the
p16INK4a tumor suppressor versus other INK4 family members
during mouse development and aging. Oncogene 1997; 15: 203–
14. Palmero I, McConnell B, Parry D et al. Accumulation of p16INK4a
in mouse fibroblasts as a function of replicative senescence and
not of retinoblastoma gene status. Oncogene 1997; 15: 495–
15. Quelle DE, Zindy F, Ashmun RA, Sherr CJ. Alternative reading
frames of the INK4a tumor suppressor gene encode two unre-
lated proteins capable of inducing cell cycle arrest. Cell 1995; 83:
16. Carnero A, Hudson JD, Price CM, Beach DH. p16(INK4A) and
p19(ARF) act in overlapping pathways in cellular immortalization.
Nat Cell Biol 2000; 2: 148–155.
17. Beausejour CM, Krtolica A, Galimi F et al. Reversal of human
cellular senescence: Roles of the p53 and p16 pathways. EMBO
J 2003; 22: 4212–4222.
18. Wright WE, Shay JW. Historical claims and current interpretations
of replicative aging. Nat Biotechnol 2002; 20: 682–688.
19. Melk A, Ramassar V, Helms LMH et al. Telomere shorten-
ing in kidneys with age. J Am Soc Nephrol 2000; 11: 444–
20. Melk A, Kittikowit W, Sandhu I et al. Cell senescence in rat kidneys
in vivo increases with growth and age despite lack of telomere
shortening. Kidney Int 2003; 63: 2134–2143.
21. Melk A, Schmidt BM, Takeuchi O, Sawitzki B, Rayner DC, Hallo-
ran PF. Expression of p16INK4a and other cell cycle regulator and
senescence associated genes in aging human kidney. Kidney Int
2004; 65: 510–520.
22. Krishnamurthy J, Ramsey MR, Ligon KL et al. p16INK4a induces
an age-dependent decline in islet regenerative potential. Nature
2006; 443: 453–457.
23. Molofsk yAV, Slutsky SG, Joseph NM et al. Increasing p16INK4a ex-
pression decreases forebrain progenitors and neurogenesis dur-
ing ageing. Nature 2006; 443: 448–452.
24. Janzen V, Forkert R, Fleming HE et al. Stem-cell ageing modified
by the cyclin-dependent kinase inhibitor p16INK4a. Nature 2006;
443: 421–426.
25. Afrouzian M, Ramassar V, Urmson J, Zhu LF, Halloran PF. Tran-
scription factor IRF-1 in kidney transplants mediates resistance
to graft necrosis during rejection. J Am Soc Nephrol 2002; 13:
26. Jabs WJ, Sedelmeyer A, Ramassar V et al. Heterogeneity in
the evolution and mechanisms of the lesions of kidney al-
lograft rejection in mice. Am J Transplant 2003; 3: 1501–
27. Halloran PF, Urmson J, Ramassar V et al. The lesions of T cell-
mediated kidney allograft rejection in mice do not require per-
forin or granzyme A and B. Am J Transplant 2004; 4: 1600–
28. Racusen LC, Solez K, Colvin RB et al. The Banff 97 working clas-
sification of renal allograft pathology. Kidney Int 1999; 55: 713–
29. Chirgwin JM, Pryzybyla AE, MacDonald RJ, Rutter WJ. Isolation
of biologically active ribonucleic acid from sources enriched in
ribonuclease. Biochemistry 1979; 18: 5294–5299.
30. Heid CA, Stevens J, Livak KJ, Williams PM. Real time quantitative
PCR. Genome Res 1996; 6: 986–994.
31. Einecke G, Broderick G, Sis B, Halloran PF. Early loss of renal
transcripts in kidney allografts: Relationship to the development
of histologic lesions and alloimmune effector mechanisms. Am J
Transplant 2007; 7: 1121–1130.
American Journal of Transplantation
2009; 9: 114–123
Donor Age, Cell Senescence and Allograft Survival
Supporting Information
The following supporting information is available for this
Figure S1. (A)Granzyme B, (B)perforin and (C)IFN-c
mRNA expression for CBA kidneys. Normal CBA =prior
to transplantation; D7 =7 days after transplantation; D21
=21 days after transplantation; Yg =Young. Values are
given as gene of interest/HPRT ratio. Old kidneys (), SD
up; young kidneys (), SD down. Significant differences are
Ta b l e S 1 : Sequences for primers and probes used in real-
time PCR studies
Please note: Wiley-Blackwell is not responsible for the con-
tent or functionality of any supporting informations sup-
plied by the authors. Any queries (other than missing ma-
terial) should be directed to the corresponding author for
the article.
American Journal of Transplantation
2009; 9: 114–123 123
... 7 For example, in humans, this manifests as decreased recovery from acute kidney injury in the elderly and decreased success with transplantation of kidneys from older donors. [7][8][9][10][11] Unsurprisingly, the concept of renal aging has significant implications for the development of CKD, and in human medicine there is debate as to what constitutes renal aging vs disease. 2,6 CKD is common in older cats and results in similar histopathologic lesions; thus, these questions are undoubtedly applicable to feline patients. ...
... 30 The accumulation of senescent cells with age can have a negative effect on the kidney's ability to regenerate effectively and can also promote fibrosis. 7,8,30 Senescence plays a role in aging in the feline kidney, as p16-mediated renal senescence is positively Figure 4 Frequency of renal histopathologic lesions (0 = 0%; 1 <5%; 2 = 5-15%; 3 = 16-25%; 4 = 26-50%; 5 = 51-75%; 6 >75%) in the renal corticomedullary junction from different age groups. (a) Glomerulosclerosis, (b) inflammation, (c) tubular atrophy and (d) fibrosis increases with age in the renal cortex of cats without chronic kidney disease. ...
Objectives In humans, renal aging is associated with an increased frequency of glomerulosclerosis, interstitial fibrosis, inflammation and tubular atrophy. The purpose of this study was to describe the frequency of renal histopathologic lesions in cats without kidney disease. Methods A cross-sectional study of archival kidney tissue from 74 cats without kidney disease (serum creatinine <1.6 mg/dl; urine specific gravity >1.035) was carried out: 0–4 years (young, n = 18); 5–9 years (mature, n = 16); 10–14 years (senior, n = 34), 15+ years (geriatric, n = 6). Glomerulosclerosis, tubular atrophy, interstitial inflammation and fibrosis, and the presence or absence of lipid in the interstitium and tubules were scored by a pathologist masked to clinical data. Statistical analyses were performed as appropriate. Results Geriatric cats had significantly more glomerulosclerosis than mature ( P = 0.01) and young cats ( P = 0.004). Senior cats had significantly more glomerulosclerosis than young cats ( P = 0.006). Glomerulosclerosis was weakly positively correlated with age ( r = 0.48; P <0.0001). Geriatric cats had significantly more tubular atrophy than mature ( P = 0.02) and young cats ( P <0.0001). Senior cats had significantly more tubular atrophy than young cats ( P <0.0001). Geriatric cats had significantly more inflammation than senior cats ( P = 0.02), mature cats ( P = 0.01) and young cats ( P <0.0001). Senior cats had significantly more inflammation than young cats ( P = 0.004). Geriatric and senior cats had significantly more fibrosis than young cats ( P = 0.01 and P = 0.04, respectively). Frequency of tubular lipid increased with age (young: 28%; mature: 56%; senior: 79%; geriatric: 100%) as did the frequency of interstitial lipid (young: 22%, mature: 56%, senior: 85%, geriatric: 100%). Conclusions and relevance Evidence of renal aging exists in cats. These changes imply that the aging kidney may be more susceptible to injury and impaired healing.
... 2 Furthermore, we and others have linked p16 INK4a and other senescence markers in human transplant biopsies to the development of interstitial fibrosis, tubular atrophy, and allograft dysfunction. [3][4][5][6] Importantly, ablation of senescent cells (often referred to as senolysis) by transgenic or pharmacological means, led to better integrity, and function during kidney aging. 7,8 Recently, it was demonstrated that senolysis can rescue age-associated maladaptive repair of damaged kidneys after acute and chronic ischemic injury. ...
... An advantage of ferroptotic senolysis could be the dominating elimination of senescent tubular cells. We have previously shown that the majority of senescent cells in failing transplants are tubular cells and we now demonstrate that these cells are characterized by a unique sensitivity to ferroptosis.3,5 ...
The accumulation of senescent cells is an important contributor to kidney aging, chronic renal disease and poor outcome after kidney transplantation. Approaches to eliminate senescent cells with senolytic compounds have been proposed as novel strategies to improve marginal organs. While most existing senolytics induce senescent cell clearance by apoptosis, we observed that ferroptosis, an iron catalyzed subtype of regulated necrosis, might serve as an alternative way to ablate senescent cells. We found that murine kidney tubular epithelial cells became sensitized to ferroptosis when turning senescent. This was linked to increased expression of pro‐ferroptotic lipoxygenase‐5 and reduced expression of anti‐ferroptotic glutathione peroxidase 4 (GPX4). In tissue slice cultures from aged kidneys low dose application of the ferroptosis‐inducer RSL3 selectively eliminated senescent cells while leaving healthy tubular cells unaffected. Similar results were seen in a transplantation model, in which RSL3 reduced the senescent cell burden of aged donor kidneys and caused a reduction of damage and inflammatory cell infiltration during the early post‐transplantation period. In summary, these data reveal an increased susceptibility of senescent tubular cells to ferroptosis with the potential to be exploited for selective reduction of renal senescence in aged kidney transplants.
... Renal ageing and senescence lead to renal pathophysiological changes and systemic geriatric phenotypes, which are similar to those of CKD. It should be noted that renal senescence can also occur in sick children and may reduce their renal regeneration potential (Melk et al., 2009). ...
Full-text available
Chronic kidney disease (CKD) is an increasingly serious public health problem in the world, but the effective therapeutic approach is quite limited at present. Cellular senescence is characterized by the irreversible cell cycle arrest, senescence-associated secretory phenotype (SASP) and senescent cell anti-apoptotic pathways (SCAPs). Renal senescence shares many similarities with CKD, including etiology, mechanism, pathological change, phenotype and outcome, however, it is difficult to judge whether renal senescence is a trigger or a consequence of CKD, since there is a complex correlation between them. A variety of cellular signaling mechanisms are involved in their interactive association, which provides new potential targets for the intervention of CKD, and then extends the researches on senotherapy. Our review summarizes the common features of renal senescence and CKD, the interaction between them, the strategies of senotherapy, and the open questions for future research.
... Moreover, there are some characteristics in favor of pediatric kidneys over adult organs, protecting against hyperfiltration. In children undergoing unilateral nephrectomy, the remaining kidney is perfectly adaptable, demonstrating that the growth potential must be retained in pediatric kidneys [40]; kidneys from pediatric donors show superior "functional reserve" contributing to the adaptation of these organs to the recipients [41]; and pediatric kidneys have a higher number of functioning nephrons and are less susceptible to somatic cell senescence mechanisms that can limit the performance of an aging graft [42]. ...
Background The use of small pediatric kidneys as single grafts for transplantation is controversial, due to the potential risk for graft thrombosis and insufficient nephron mass.Methods Aiming to test the benefits of transplanting these kidneys, 375 children who underwent kidney transplantation in a single center were evaluated: 49 (13.1%) received a single graft from a small pediatric donor (≤ 15 kg, SPD group), 244 (65.1%) from a bigger pediatric donor (> 15 kg, BPD group), and 82 (21.9%) from adult living donors (group ALD).ResultsGroups had similar baseline main characteristics. After 5 years of follow-up, children from the SPD group were comparable to children from BPD and ALD in patient survival (94%, 96%, and 98%, respectively, p = 0.423); graft survival (89%, 88%, and 93%, respectively, p = 0.426); the frequency of acute rejection (p = 0.998); the incidence of post-transplant lymphoproliferative disease (p = 0.671); the odds ratio for severely increased proteinuria (p = 0.357); the rates of vascular thrombosis (p = 0.846); and the necessity for post-transplant surgical intervention prior to discharge (p = 0.905). The longitudinal evolution of eGFR was not uniform among groups. The three groups presented a decrease in eGFR, but the slope of the curve was steeper in ALD children. At 5 years, the eGFR of the ALD group was 10 ml/min/1.73m2 inferior to the others. At that time, the eGFR from the SPD group was statistically similar to the BPD group (p = 0.952).Conclusion In a specialized transplant center, the use of a single small pediatric donor kidney for transplantation is as successful as bigger pediatric or adult living donors, after 5 years of follow-up.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information.
... Similarly, after cardiac IRI, the removal of senescent cells improved cardiac function and vascularization, decreased scar size by attenuating biological processes associated with inflammation and fibrosis and increased the survival rate (Dookun et al., 2020;Walaszczyk et al., 2019). In addition, the process of organ transplantation involves IRI, and cellular senescence either present in the donor organ or induced in the host during the procedure is associated with impaired functionality of the transplant and increased mortality (McGlynn et al., 2009;Melk et al., 2008;Naesens, 2011;Slegtenhorst et al., 2014;Tullius et al., 2010). Clearance of senescent cells or inhibition of senescence conversely improves transplant function and transplantation outcome (Braun et al., 2012;Iske et al., 2020). ...
Full-text available
Lipid-based signalling modulates several cellular processes and intercellular communication during wound healing and tissue regeneration. Bioactive lipids include but are not limited to the diverse group of eicosanoids, phospholipids, and extracellular vesicles and mediate the attraction of immune cells, initiation of inflammatory responses, and their resolution. In aged individuals, wound healing and tissue regeneration are greatly impaired, resulting in a delayed healing process and non-healing wounds. Senescent cells accumulate with age in vivo, preferably at sites implicated in age-associated pathologies and their elimination was shown to alleviate many age-associated diseases and disorders. In contrast to these findings, the transient presence of senescent cells in the process of wound healing exerts beneficial effects and limits fibrosis. Hence, clearance of senescent cells during wound healing was repeatedly shown to delay wound closure in vivo. Recent findings established a dysregulated synthesis of eicosanoids, phospholipids and extracellular vesicles as part of the senescent phenotype. This intriguing connection between cellular senescence, lipid-based signalling, and the process of wound healing and tissue regeneration prompts us to compile the current knowledge in this review and propose future directions for investigation.
Although age difference between donor and recipient was not associated with serum creatinine at 5 or 10 years or death-censored graft failure (Ferrari et al., Nephrol Dial Transplant 26:702–708, 2011), different findings exhibited a significant impact of donor-recipient age mismatch on renal allograft function and worse short-term or long-term transplant outcome (Basar et al., Transplantation 67:1191–1193, 1999; Lim et al., Nephrol Dial Transplant 25:3082–3089, 2010). A recent clinical study of 6317 renal transplant patients manifested that engraftment of older living kidney grafts could cause an inferior allograft outcomes compared with younger living donors (Lim et al., Nephrol Dial Transplant 25:3082–3089, 2010). Nevertheless, the effect of age difference between donor and recipient remains obscure, and further experimental investigations were required.
Cellular senescence is a state of irreversible cell cycle arrest that often emerges after tissue damage and in age‐related diseases. Through the production of a multicomponent secretory phenotype (SASP), senescent cells can impact the regeneration and function of tissues. However, the effects of senescent cells and their SASP are very heterogeneous and depend on the tissue environment and type as well as the duration of injury, the degree of persistence of senescent cells, and the organism's age. While the transient presence of senescent cells is widely believed to be beneficial, recent data suggest that it is detrimental for tissue regeneration after acute damage. Further, although senescent cell persistence is typically associated with the progression of age‐related chronic degenerative diseases, it now appears to be also necessary for correct tissue function in the elderly. Here, we discuss what is currently known about the roles of senescent cells and their SASP in tissue regeneration in aging and age‐related diseases, highlighting their (negative and/or positive) contributions. We provide insight for future research, including the possibility of senolytic‐based therapies and cellular reprogramming, with aims ranging from enhancing tissue repair to extending a healthy lifespan.
Full-text available
Interstitial fibrosis and tubular atrophy, a major cause of kidney allograft dysfunction, has been linked to premature cellular senescence. The mTOR inhibitor Rapamycin protects from senescence in experimental models, but its antiproliferative properties have raised concern early after transplantation particularly at higher doses. Its effect on senescence has not been studied in kidney transplantation, yet. Rapamycin was applied to a rat kidney transplantation model (3 mg/kg bodyweight loading dose, 1.5 mg/kg bodyweight daily dose) for 7 days. Low Rapamycin trough levels (2.1-6.8 ng/mL) prevented the accumulation of p16INK4a positive cells in tubules, interstitium, and glomerula. Expression of the cytokines MCP-1, IL-1β, and TNF-α, defining the proinflammatory senescence-associated secretory phenotype, was abrogated. Infiltration with monocytes/macrophages and CD8+ T-lymphocytes was reduced and tubular function was preserved by Rapamycin. Inhibition of mTOR was not associated with impaired structural recovery, higher glucose levels, or weight loss. mTOR inhibition with low-dose Rapamycin in the immediate posttransplant period protected from premature cellular senescence without negative effects on structural and functional recovery from preservation/reperfusion damage, glucose homeostasis, and growth in a rat kidney transplantation model. Reduced senescence might maintain the renal regenerative capacity rendering resilience to future injuries resulting in protection from interstitial fibrosis and tubular atrophy.
Kidney transplantation is the gold standard for treating patients with end-stage kidney disease. Organ shortage forces the utilization of marginal or expanded criteria donors leading to inferior outcomes. Cellular senescence has been proposed essential for the impaired regenerative capacities seen in older donor organs. The impact of cellular senescence for transplantation goes surely beyond these effects regarding tissue quality. Cellular senescence has been shown to play a role in transplant-related injuries and becomes thereby crucial even for transplant organs from younger donors. Senotherapeutic strategies have been shown to positively affect kidney structure and function and thereby provide great opportunities for the transplantation setting. In addition to treatment of donor and/or recipient, the ex situ phase provides a window of opportunity to interfere with existing senescence or to condition the kidney in a way to make it less vulnerable toward transplant-related stresses.
Senescent cells, characterized typically by irreversible cell cycle arrest coupled with marked transcriptional changes and a pro-inflammatory secretome, are proposed as key drivers of kidney fibrosis with the epithelial cells of the renal tubule playing a central role. In this chapter, we discuss the accumulating evidence that senescence is associated with aging and a number of renal diseases in humans and that this is associated with worsened kidney function and outcome. We also review the insights gained from studies using a variety of animal models and discuss how these have informed our knowledge of the processes underlying cellular senescence and fibrosis in the kidney.
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The terminus of a DNA helix has been called its Achilles' heel. Thus to prevent possible incomplete replication and instability of the termini of linear DNA, eukaryotic chromosomes end in characteristic repetitive DNA sequences within specialized structures called telomeres. In immortal cells, loss of telomeric DNA due to degradation or incomplete replication is apparently balanced by telomere elongation, which may involve de novo synthesis of additional repeats by novel DNA polymerase called telomerase. Such a polymerase has been recently detected in HeLa cells. It has been proposed that the finite doubling capacity of normal mammalian cells is due to a loss of telomeric DNA and eventual deletion of essential sequences. In yeast, the est1 mutation causes gradual loss of telomeric DNA and eventual cell death mimicking senescence in higher eukaryotic cells. Here, we show that the amount and length of telomeric DNA in human fibroblasts does in fact decrease as a function of serial passage during ageing in vitro and possibly in vivo. It is not known whether this loss of DNA has a causal role in senescence.
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We have developed a novel "real time" quantitative PCR method. The method measures PCR product accumulation through a dual-labeled fluorogenic probe (i.e., TaqMan Probe). This method provides very accurate and reproducible quantitation of gene copies. Unlike other quantitative PCR methods, real-time PCR does not require post-PCR sample handling, preventing potential PCR product carry-over contamination and resulting in much faster and higher throughput assays. The real-time PCR method has a very large dynamic range of starting target molecule determination (at least five orders of magnitude). Real-time quantitative PCR is extremely accurate and less labor-intensive than current quantitative PCR methods.
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Four INK4 proteins can prevent cell proliferation by specifically inhibiting cyclin D-dependent kinases. Both p18INK4c and p19INK4d were widely expressed during mouse embryogenesis, but p16INK4a and p15INK4b were not readily detected prenatally. Although p15INK4b, p18INK4c and p19INK4d were demonstrated in many tissues by 4 weeks after birth, p16INK4a protein expression was restricted to the lung and spleen of older mice, with increased, more widespread mRNA expression during aging. Transcripts encoding the INK4a alternative reading frame product p19ARF were not detected before birth but were ubiquitous postnatally. Expression of p16INK4a and p15INK4b was induced when mouse embryos were disrupted and cultured as mouse embryo 'fibroblasts' (MEFs). The levels of p16INK4a and p18INK4c, but not p15INK4b or p19INK4d, further increased as MEFs approached senescence. Following crisis and establishment, three of four independently-derived cell lines became polyploid and expressed higher levels of functional p16INK4a. In contrast, one MEF line that sustained bi-allelic deletions of INK4a initially remained diploid. Therefore, loss of p16INK4a and other events predisposing to polyploidy may represent alternative processes contributing to cell immortalization. Whereas p18INK4c and p19INK4d may regulate pre- and postnatal development, p16INK4a more likely plays a checkpoint function during cell senescence that underscores its selective role as a tumor suppressor.
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Viral transformation of mouse and human fibroblasts has very different effects on the composition of cyclin-dependent kinase (Cdk) complexes. In human cells transformed by the large T-antigen of simian virus 40 (SV40 T-Ag) and human tumour cell lines that lack a functional retinoblastoma gene product (pRb) no cyclin D1-Cdk4 complexes can be detected because all the available Cdk4 is associated with the Cdk-inhibitor p16INK4a. In contrast, SV40-transformed mouse cells and fibroblasts from Rh1-nullizygous mouse embryos contain normal levels of cyclin D1-Cdk4 complexes. To investigate this species difference, we have compared the biochemical properties and expression of mouse p16INK4a with that of its human counterpart. There is a marked increase in p16 RNA and protein levels as primary embryo fibroblasts approach their finite lifespan in culture, but mouse p16 expression does not appear to be influenced by the status of pRb. Transformed or spontaneously immortalized mouse cells therefore do not achieve the very high levels of p16 characteristic of pRb-negative human cell lines. We suggest that these differences may be related to the different frequencies with which mouse and human cells can be immortalized in culture.
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Normal human cells undergo a finite number of cell divisions and ultimately enter a nondividing state called replicative senescence. It has been proposed that telomere shortening is the molecular clock that triggers senescence. To test this hypothesis, two telomerase-negative normal human cell types, retinal pigment epithelial cells and foreskin fibroblasts, were transfected with vectors encoding the human telomerase catalytic subunit. In contrast to telomerase-negative control clones, which exhibited telomere shortening and senescence, telomerase-expressing clones had elongated telomeres, divided vigorously, and showed reduced staining for β-galactosidase, a biomarker for senescence. Notably, the telomerase-expressing clones have a normal karyotype and have already exceeded their normal life-span by at least 20 doublings, thus establishing a causal relationship between telomere shortening and in vitro cellular senescence. The ability to maintain normal human cells in a phenotypically youthful state could have important applications in research and medicine.
Background. Most investigations have revealed that the improvement in early graft survival has not resulted in a corresponding improvement in long-term graft survival. The risk factors for long-term graft survival should be clarified. Methods. A single-center experience of 1100 consecutive renal transplant recipients who received kidneys from living donors from 1983 to 1998 was reviewed to clarify the time dependency of risk factors for long-term graft survival. We examined various possible risk factors, including HLA-AB and -DR mismatches, ABO-blood group incompatibility, graft weight, donor age and sex, recipient age and sex, and the presence or absence of acute rejection by using the time-dependent, nonproportional Cox’s hazards model. Results. Acute rejection episode, donor age, HLA-AB 4-antigen mismatches, ABO-incompatible transplantation, smaller kidney weight compared with the patient’s body weight (Kw/Bw ratio less than 2.67), and transplantation from an unrelated living donor were risk factors for long-term graft outcome. Multivariate analysis for time-dependent risk factors showed that donor age of more than 60 years was the most important risk factor for long-term graft failure after 5 years posttransplantation (hazard ratio: 2.57). In contrast, acute rejection, ABO incompatibility, and nonrelated donors were significant risk factors for short-term graft failure within 5 years after kidney transplantation (hazard ratios: 2.68, 1.57, and1.69, respectively). Conclusions. Donor age of more than 60 years was a crucial risk factor affecting long-term graft survival. In contrast, acute rejection, ABO incompatibility, and nonrelated donors were significant risk factors for short-term graft failure.
The Banff Classification of renal allograft pathology is an international standard for the classification and interpretation of renal allograft biopsies. The Banff Classification was developed in 1991 and published in 1993. The classification is the subject of meetings held every tow years; in 1997, it was modified and strengthened. Current topics of discussion that are likely to influence the Banff Classification in 1999 and beyond include sublinical rejection, post-transplant lymphoproliferative disorder, thrombotic microangiopathy and peritubula capillary alterations. The extension of similar concepts to the classification of changes in the native kidney and in other solid organ transplants is likely.
Intact ribonucleic acid (RNA) has been prepared from tissues rich in ribonuclease such as the rat pancreas by efficient homogenization in a 4 M solution of the potent protein denaturant guanidinium thiocyanate plus 0.1 M 2-mercaptoethanol to break protein disulfide bonds. The RNA was isolated free of protein by ethanol precipitation or by sedimentation through cesium chloride. Rat pancreas RNA obtained by these means has been used as a source for the purification of alpha-amylase messenger ribonucleic acid.
The INK4a (MTS1, CDKN2) gene encodes an inhibitor (p16INK4a) of the cyclin D-dependent kinases CDK4 and CDK6 that blocks them from phosphorylating the retinoblastoma protein (pRB) and prevents exit from the G1 phase of the cell cycle. Deletions and mutations involving INK4a occur frequently in cancers, implying that p16INK4a, like pRB, suppresses tumor formation. An unrelated protein (p19ARF) arises in major part from an alternative reading frame of the mouse INK4a gene, and its ectopic expression in the nucleus of rodent fibroblasts induces G1 and G2 phase arrest. Economical reutilization of coding sequences in this manner is practically without precedent in mammalian genomes, and the unitary inheritance of p16INK4a and p19ARF may underlie their dual requirement in cell cycle control.