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Medicine

Vurdering af urin nanokrystaller hos mennesker ved hjælp af calcium fluorophor mærkning og nanopartikel tracking analyse

Published: February 9, 2021 doi: 10.3791/62192

Summary

Formålet med denne undersøgelse var at afgøre, om nanopartikelsporingsanalyse (NTA) kunne påvise og kvantificere calciumholdige nanokrystaller i urinen fra raske voksne. Resultaterne fra den nuværende undersøgelse tyder på NTA kunne være et potentielt redskab til at estimere urin nanokrystaller under nyresten sygdom.

Abstract

Nyresten bliver mere udbredt på verdensplan hos voksne og børn. Den mest almindelige type nyresten består af calciumoxalat (CaOx) krystaller. Crystalluria opstår, når urinen bliver overmættet med mineraler (f.eks. calcium, oxalat, fosfat) og går forud for nyrestensdannelse. Standardmetoder til vurdering af krystallutri i stenformer omfatter mikroskopi, filtrering og centrifugering. Men disse metoder primært opdage mikrokrystaller og ikke nanokrystaller. Nanokrystaller er blevet foreslået at være mere skadelige for nyre epitelceller end mikrokrystaller in vitro. Her beskriver vi nanopartikelsporingsanalysens (NTA) evne til at detektere humane nanokrystaller i urinen. Raske voksne blev fodret med en kontrolleret oxalat kost før du drikker en oxalat belastning for at stimulere urin nanokrystaller. Urin blev indsamlet i 24 timer før og efter oxalatbelastningen. Prøverne blev behandlet og vasket med ethanol for at rense prøver. Urin nanokrystaller blev plettet med calcium bindende fluorophore, Fluo-4 AM. Efter farvning blev størrelsen og antallet af nanokrystaller bestemt ved hjælp af NTA. Resultaterne fra denne undersøgelse viser, at NTA effektivt kan detektere nanokrystallutri hos raske voksne. Disse fund tyder på, at NTA kan være en værdifuld metode til tidlig påvisning af nanokrystallutri hos patienter med nyrestenssygdom.

Introduction

Urinkrystaller form, når urinen bliver overmættet med mineraler. Dette kan forekomme hos raske personer, men er mere almindeligt hos personer med nyresten1. Tilstedeværelsen og akkumuleringen af urinkrystaller kan øge ens risiko for at udvikle en nyresten. Specifikt sker dette, når krystaller binder sig til Randalls plak, kerne, akkumuleres og vokser over tid2,3,4. Crystalluria går forud for nyresten dannelse og vurdering af crystalluria kan have prædiktiv værdi i nyresten tidligere3,5. Konkret er krystalluria blevet foreslået at være nyttig til at forudsige risikoen for sten gentagelse hos patienter med en historie af calciumoxalat indeholdende sten6,7.

Krystaller er blevet rapporteret til negativ indvirkning nyre epitel og cirkulerende immuncellefunktion8,9,10,11,12,13. Det er tidligere blevet rapporteret, at cirkulerende monocytter fra calciumoxalat (CaOx) nyrestens tidligere har undertrykt cellulære bioenergetics sammenlignet med raske personer14. Derudover reducerer CaOx-krystaller cellulære bioenergetics og forstyrrer redox homeostase i monocytter8. Indtagelse af måltider rig på oxalat kan forårsage krystalluri, som kan føre til nyre tubule skader og ændre produktionen og funktionen af urin makromolekyler, der beskytter mod nyrestendannelse 15,16. Flere undersøgelser har vist, at urinkrystaller kan variere i form og størrelse afhængigt af pH og temperaturen i urinen17,18,19. Desuden har urinproteiner vist sig at modulere krystaladfærd20. Daudon et al.19, foreslog, at crystalluria analyse kunne være nyttige i forvaltningen af patienter med nyresten sygdom og i vurderingen af deres reaktion på behandlinger. Et par konventionelle metoder, der i øjeblikket er tilgængelige til at evaluere tilstedeværelsen af krystaller, omfatter polariseret mikroskopi21,22, elektronmikroskopi23, partikeltællere3, urinfiltrering24, fordampning3,5 eller centrifugering21. Disse undersøgelser har givet værdifuld indsigt i nyresten feltet om krystalluri. En begrænsning af disse metoder har imidlertid været den manglende evne til at visualisere og kvantificere krystaller under 1 μm i størrelse. Krystaller af denne størrelse kan påvirke væksten af CaOx sten ved at knytte til Randall's plak.

Nanokrystaller har vist sig at forårsage omfattende skade på nyreceller sammenlignet med større mikrokrystaller25. Tilstedeværelsen af nanokrystaller er blevet rapporteret i urinen ved hjælp af en nanopartikelanalysator26,27. Nylige undersøgelser har anvendt fluorescerende mærkede bisfosfatsonder (alendronat-fluorescein/alendronat-Cy5) til at undersøge nanokrystaller ved hjælp af nanoskala flow cytometry28. Begrænsningen af dette farvestof er, at det ikke er specifikt og vil binde sig til næsten alle typer sten undtagen cystein. En nøjagtig vurdering af tilstedeværelsen af nanokrystaller hos enkeltpersoner kan således være et effektivt redskab til at diagnosticere krystallutri og/eller forudsige stenrisiko. Formålet med denne undersøgelse var at påvise og kvantificere calciumholdige nanokrystaller (< 1 μm i størrelse) ved hjælp af nanopartikelsporingsanalyse (NTA). For at opnå dette blev NTA-teknologi brugt i kombination med en calciumbinding fluorophore, Fluo-4 AM til at detektere og kvantificere calcium indeholdende nanokrystaller i urinen hos raske voksne.

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Protocol

Alle eksperimenter, der er skitseret i dette arbejde, blev godkendt af University of Alabama i Birmingham (UAB) Institutional Review Board. Raske voksne (33,6 ± 3,3 år; n =10) blev indskrevet i undersøgelsen, hvis de havde et normalt blod omfattende metabolisk panel, ikke-tobaksbrugere, ikke-gravide, et BMI mellem 20-30 kg / m2, og fri for kroniske medicinske tilstande eller akutte sygdomme. Raske deltagere underskrev en skriftlig informeret samtykkeformular inden undersøgelsens start.

1. Klinisk protokol og urinindsamling

  1. Har deltagerne forbruge en lav oxalat kost udarbejdet af UAB Center for Clinical and Translational Sciences Bionutrition Core i 3 dage og hurtigt natten før indsamling af deres urin (24-timers prøve).
  2. Den følgende dag, har deltagerne returnere deres 24-timers urinprøve (præ-oxalat), før de indtager en oxalat belastning (smoothie indeholder frugt og grøntsager, ~ 8 mM oxalat). Få deltagerne til efterfølgende at indsamle deres urin i 24 timer (postoksalatprøve) og returnere deres urin den følgende dag.
  3. Alle urinprøver opbevares ved stuetemperatur (RT) inden forarbejdningen som beskrevet nedenfor og vist i figur 1.

2. Urinbehandling

BEMÆRK: Alle anvendte materialer og udstyr er anført i Materialeoversigten.
ADVARSEL: Brug altid personlige værnemidler, mens du håndterer kliniske prøver og reagenser. Specifikt handsker, ansigts- og øjenskjolde, åndedrætsværn og beskyttelsesbeklædning.

  1. Mål og registrer urin pH og volumen. Bland grundigt, før der tilsættes 50 mL urin i et mærket sterilt 50 mL konisk rør.
  2. Centrifugeprøve ved 1200 x g i 10 min ved RT ved hjælp af en bænktopcentrifuge.
    BEMÆRK: Hold prøven på RT for at forhindre yderligere krystaldannelse, da køligere temperaturer kan fremme krystallisering.
  3. Supernatanten kasseres og vaskes og genbruges pellet igen med 5 mL 100% ethanol. Prøven centrifuges ved 1200 x g i 10 minutter ved RT ved hjælp af en centrifuge på bænken.
  4. Supernatanten kasseres og genbruges pellet i 1 mL af 100% ethanol. Prøven opbevares ved -20 °C til senere forarbejdning eller plette prøven som beskrevet nedenfor.
    BEMÆRK: Der er ingen signifikant forskel i datapunkter (dvs. partikelstørrelse/koncentration) mellem lagrede eller nyplettede prøver.

3. Nanopartikelsporingsanalyse (NTA)

  1. Prøveforberedelse
    1. Guld nanopartikler: Brug guld nanopartikler til at optimere indstillingerne på instrumentet. Fortynd 100 nm størrelse guld nanopartikler 1:1000 i ultrapure vand.
    2. Human urin: Fortynd urinprøver 20 gange i vand før farvning med 5 mM Fluo-4 AM (en calcium fluorescens farvestof) i 30 min i mørke. Analyser prøverne ved hjælp af NTA.
    3. Forbered Calcium Oxalat (CaOx) krystaller som tidligere beskrevet29. 10 mM stamopløsning fortyndes (14,6 mg i 10 ml vand) til 50 μM i vand, og de fortyndede prøver plettes med 5 mM Fluo-4 AM i 30 minutter i mørke inden analysen.
    4. Calciumphosphatkrystaller (CaP): Fortynd 10 mM stamopløsning (50,4 mg i 10 ml vand) til 50 μM i vand og plette de fortyndede prøver med 5 mM Fluo-4 AM i 30 minutter i mørke før NTA-analyse.
  2. Opsætning af instrument, kameraindstillinger og dataindsamling
    BEMÆRK: Den computer- og instrumentopsætning, der bruges til denne metode, er vist i figur 2.
    1. Tænd computeren og derefter instrumentet. Åbn softwaren, og tænd kameraet.
    2. Når softwarevinduet er åbent, skal du klikke på hentningsikonet i øverste venstre hjørne af vinduet for at starte hentningstilstanden. Kamerainitialiseringen tager et par sekunder.
    3. Rengør platformen ved først at pumpe luft ind i den ved hjælp af en 1 mL sprøjte, indtil platformen ser ren ud. Tilsæt forsigtigt vand til apparatet 2-3 gange ved hjælp af en anden 1 mL sprøjte for at fjerne eventuelle luftbobler.
      BEMÆRK: Se efter luftbobler i platformen såvel som i slangen. Det er vigtigt ikke at have bobler i hele apparatet før og under kørslen af prøver. Hvis der er bobler til stede, skal platformen rengøres igen med luft og vand.
    4. Når platformen er ren, tilsæt vand for at kontrollere for enhver forurening på overfladen ved at se kameraet. Dernæst tilsættes guld nanopartikler som en kontrol til prøven lastning pumpe injektor til at oprette instrumentet.
    5. Juster kameraniveauet på skærmen eller på knappen til højre side af instrumentet, indtil billedet begynder at vise farvede pixel og derefter reducere kameraniveauet.
    6. Juster derefter skærmen for at optimere billedet. Venstreklik på museknappen på videobilledet. Hold venstre museknap nede, og træk billedet op og ned for at få hele visningen.
      BEMÆRK: Den normale kameralinse og filter bruges til at vurdere guld nanopartikler og unstained prøver.
    7. Opsæt infusionshastigheden, og fokuser kameraet, så guldnananopartiklerne er synlige på kameraskærmen. Infusionshastigheden indstilles til høj (dvs. 500 μL/min) for den indledende opsætning for at sikre, at guldnanopartiklerne opdages. Når hastigheden er registreret, reduceres den til 50 μL/min.
    8. Juster kameraniveauet for at visualisere partiklerne. For ikke-indgroede prøver skal du justere skærmforøgelsen på niveau 5 for at opnå kamerafokus og indstille kameraniveauet til 8. Når fokus er indstillet, skal du registrere prøven (dvs. kun 1 måling i 60 sekunder).
      BEMÆRK: Fokus og kontinuerlig strømningshastighed er vigtige for at opnå klare og skarpe billeder af partiklerne til optælling.
    9. Efter optimering rengøres apparatet igen med vand, før prøverne vurderes. Se kameraet for at sikre, at slangen er ren, og at partiklerne ikke er til stede.
      BEMÆRK: Vask kammeret mellem hver prøve, indtil kameraet ikke har fundet partikler.
    10. Hvis du vil analysere farvede prøver, skal du justere kameraet til den filterposition, der indeholder det passende fluorescerende filter. Fortyndede og farvede prøver på prøveindlæsningspumpens injektor indlæses, og hastigheden reduceres til 20 μL/min. til analyse af prøven.
    11. Juster derefter skærmforøgelsen og kameraniveauet, da disse er vigtige parametre. For farvede (fluorescerende) prøver skal du indstille skærmforstærkning til 5 og kameraniveauet på niveau 13.
      BEMÆRK: Disse parametre varierer afhængigt af eksempeltypen, og hver prøve skal optimeres for at få fokus.
    12. Brug standardmåling til at måle prøverne for 5 indfangninger pr. prøve, hvor en opsamlingsvarighed er i 60 sekunder.
    13. Gem og gem data efter hver måling. Softwaren gemmer billed- og videofiler til hver måling. Softwaren leverer outputdata (f.eks. krystalstørrelse: 10 nM - 1000 nM og koncentration) i både Excel- og pdf-formater.
    14. Det gennemsnitlige antal nanopartikler for alle 5 aflæsninger for hver enkelt prøve beregnes. Analyser dataene ved hjælp af standardafvigelse eller standardfejl i middelværdien, og brug t-test til parret analyse.

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Representative Results

Resultaterne fra denne undersøgelse viser, at NTA effektivt kan påvise gennemsnitsstørrelsen og koncentrationen af calciumholdige nanokrystaller i urinen hos mennesker. Dette blev opnået ved hjælp af fluorophore, Fluo-4 AM og nanopartikelsporingsanalyse. Fluo-4 AM var i stand til at binde sig til både CaOx og CaP krystaller. Som vist i figur 3Ablev CaOx-krystaller bestemt til at være mellem 50-270 nm i størrelse og har en gennemsnitlig koncentration på 1,26 x 109 partikler/mL. CaP-krystallerne var mellem 30-225 nm i størrelse og havde en gennemsnitlig koncentration på 2,22 x 109 partikler/mL (Figur 3B). For at afgøre, om NTA kunne vurdere nanokrystaller i human urin, blev raske voksne bedt om at indtage en kontrolleret oxalatdiæt efterfulgt af en høj oxalatbelastning. 24 timers urinprøver før og efter belastningen blev indsamlet for at vurdere urin nanokrystallernes størrelse og koncentration. Urinprøverne før oxalat indeholdt nogle nanokrystaller i urinen (1,65 x 108 ± 3,29 x 107 partikler/mL) mellem 110 og 300 nm (figur 4). I modsætning hertil var der en betydelig stigning (p<0.0001) i nanokrystaller i urinen i postokseprøver (7,05 x 108 ± 1,08 x 108 partikler/mL; 100-320 nm) (Figur 4). For at bekræfte metodens reproducerbarhed blev prøverne målt tre gange, og der var ingen signifikant variation i tekniske replikater (figur 5).

Figure 1
Figur 1: Protokol for isolering og farvning af nanokrystaller fra mennesker.

Figure 2
Figur 2: Beskrivelse af nanopartikelsporingsanalyse (NTA). (B) Prøverne sprøjtes ind i en indspærring med en sprøjtepumpe i et kontinuerligt tempo, inden den optiske overflade fyldes. Prøver observeres derefter af den objektive linse og fanges af kameraet, da prøver strømmer gennem platformen, før de kommer ud gennem udløbsrøret for at blive kasseret. Klik her for at se en større version af dette tal.

Figure 3
Figur 3: NTA registrerer Fluo-4 AM mærket calciumoxalat (CaOx) og calciumphosphat (CaP) krystaller. Repræsentative grafer over (A) CaOx og (B) CaP-krystaller, der viser størrelsesfordeling og koncentration. Klik her for at se en større version af dette tal.

Figure 4
Figur 4: NTA registrerer Fluo-4 AM mærket 24-timers humane nanokrystaller i urinen. Repræsentativ graf af Fluo-4 AM mærket urin nanokrystaller i 24-timers præ-oxalat og post-oxalat prøver fra en sund voksen på en kontrolleret oxalat kost. Klik her for at se en større version af dette tal.

Figure 5
Figur 5: Tekniske replikater af humane nanokrystaller i 24-timers urinindsamlinger ved hjælp af NTA. Tekniske replikater af Fluo-4 AM mærket urin nanokrystaller i 24-timers (A) præ-oxalat og (B) post-oxalat prøver fra en sund voksen på en kontrolleret oxalat kost. Klik her for at se en større version af dette tal.

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Discussion

NTA er blevet brugt i denne undersøgelse til at vurdere nanokrystaller i human urin ved hjælp af en calciumbindingssonde, Fluo-4 AM. Der findes ingen standardmetode til påvisning af nanokrystaller i urinen. Nogle forskergrupper har opdaget nanokrystaller i urinen og påberåbt sig brugen af omfattende protokoller eller metoder, der er begrænset i deres evne til at kvantificere prøverne27,28. Denne undersøgelse viser en specifik og følsom metode til påvisning af calciumholdige nanokrystaller i urinen hos mennesker, der deltog i en diætfodringsundersøgelse, der bestod i indtagelse af en høj oxalatbelastning. Mængden af oxalat, der forbruges, svarede til det virkelige forbrug af oxalat (f.eks. 1/2 spinatsalat).

NTA er et godt karakteriseret højopløsningsværktøj, der bruger Brownian-bevægelse til at måle partikler i opløsning30. Det er blevet brugt til at vurdere biologiske nanopartikler i en række biologiske prøver31,32,33. Derudover kan NTA nøjagtigt forudsige størrelsen såvel som koncentrationen af partikler i enhver type biologisk prøve. Denne metode kræver ingen mærkning. Mærkning kan dog anvendes til påvisning af specifikke partikler. Fluo-4 AM blev brugt i denne undersøgelse til effektivt og specifikt at opdage calcium indeholdende nanokrystaller i urinprøver. Calciumfluorescerende sonder blev oprindeligt brugt til at måle gratis cytosolic calcium34. Fluo-4 er en analog af Fluo-3, hvis fluorescens øges >100 gange ved binding til fri calcium35. Derudover har Fluo-4 vist sig at vurdere calciumpartikler i synovialvæsken hos patienter med gigt ved hjælp af flowcytometri36. Således brugte vi Fluo-4 AM til disse undersøgelser.

Alle prøver blev løbende injiceret i platformen for nøjagtig detektion. Bestemmelse af koncentrationen og partikelstørrelsen afhænger af strømningshastigheden, da en høj strømningshastighed (dvs. 50 μL/min. ) kan påvirke nøjagtig vurdering af koncentrationen samt partikelstørrelsen sammenlignet med en statisk indstilling og en lavere strømningshastighed (dvs. 20 μL/min.37. Således giver en konstant langsom strømningshastighed nøjagtig måling af antallet af partikler, der er til stede i prøverne. Andre vigtige parametre, der kan påvirke partikeltællingen og -størrelsen, omfatter kameraniveau, detektionstærskel og fokus38,39,40. En konsistent partikelmåling i prøver (CV ca. 20%) blev observeret i den aktuelle undersøgelse, som var i overensstemmelse med resultaterne fra en anden undersøgelse39. Endelig er tilstedeværelsen af nanokrystaller i urinen hos mennesker blevet bekræftet ved hjælp af elektronmikroskopi29. Denne forskning viser NTA kan med succes måle urin nanokrystaller fra mennesker.

En fordel ved denne protokol er brugen af Fluo-4 AM til at evaluere calciumholdige partikler i opløsning. En anden fordel er den minimale variation, der observeres ved påvisning af nanokrystaller i prøver. En begrænsning af NTA i denne indstilling er den manglende evne til at skelne mellem nanokrystallers morfologi. Men denne metode kan være gavnligt at opdage crystalluria for at forudsige sten risiko hos personer med en historie af calcium indeholdende nyresten. Denne protokol kan ikke erstatte de nuværende metoder, men kan give ny indsigt i nanokrystaller i urinen. Brugen af NTA til at vurdere urin calcium indeholdende krystaller er en ny tilgang, der bør fremhæve betydningen af nanokrystallutri ud over standard mikroskopi og metoder, der er nævnt ovenfor. Yderligere undersøgelser er berettiget til at undersøge pålideligheden af denne metode i nyresten befolkning.

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Disclosures

Forfatterne erklærer ingen interessekonflikter.

Acknowledgments

Forfatterne takker alle deltagere i undersøgelsen og UAB CCTS Bionutrition Core og UAB High Resolution Imaging Service Center for deres bidrag. Dette arbejde blev støttet af NIH grants DK106284 og DK123542 (TM) og UL1TR003096 (National Center for Advancing Translational Sciences).

Materials

Name Company Catalog Number Comments
Benchtop Centrifuge Jouan Centrifuge CR3-12
Calcium Oxalate monohydrate Synthesized in the lab as previously described29. Store at RT; Stock 10 mM
Calcium Phosphate crystals (hydroxyapatite nanopowder) Sigma 677418 Store at RT; Stock 10 mM
Ethanol Fischer Scientific AC615095000 Store at RT; Stock 100%
Fluo-4 AM* AAT Bioquest, Inc. 20550 Store at Freezer (-20°C); Stock 5 mM
Gold Nanoparticles Sigma 742031 Store at 2-8°C
NanoSight Instrument Malvern Instruments, UK NS300
Syringe pump Harvard Apparatus 98-4730
Virkon Disinfectant LanXESS Energizing Company, Germany LSP
*Fluorescence dyes are light sensitive; stock and aliquots should be stored in the dark at -20°C.

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Medicin Problem 168 Oxalat nyresten nanokrystallutri Nanopartikelsporingsanalyse calcium
Vurdering af urin nanokrystaller hos mennesker ved hjælp af calcium fluorophor mærkning og nanopartikel tracking analyse
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Kumar, P., Bell, A., Mitchell, T.More

Kumar, P., Bell, A., Mitchell, T. Estimation of Urinary Nanocrystals in Humans using Calcium Fluorophore Labeling and Nanoparticle Tracking Analysis. J. Vis. Exp. (168), e62192, doi:10.3791/62192 (2021).

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