European Heart Journal Advance Access published online on May 8, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn197
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Contrast agents and renal cell apoptosis
1 Department of Cellular and Molecular Biology and Pathology, ‘Federico II’ University of Naples, Via Pansini, 5, I-80121 Naples, Italy
2 Fondazione SDN, Naples, Italy
3 Laboratory of Interventional Cardiology, Department of Cardiology, Clinica Mediterranea, Via Orazio, 2, I-80121 Naples, Italy
4 Laboratory of Interventional Cardiology, ‘Vita e Salute’ University School of Medicine, San Raffaele Hospital, Milan, Italy
5 University School of Molecular Medicine, University of Milan, Milan, Italy
Received 25 December 2007; revised 14 April 2008; accepted 18 April 2008.
* Corresponding authors. Tel: +39 081 7259 764, Fax: +39 081 7259 777, Email: briguori.carlo{at}hsr.it or carlo.briguori{at}hsr.it (C.B.); Tel: +39 081 7464416, Fax: +39 081 7701016, Email: gecondor{at}unina.it (G.C.)
Aims: Contrast media (CM) induce a direct toxic effect on renal tubular cells. This toxic effect may have a role in the pathophysiology of contrast nephropathy.
Methods and results: We evaluated (i) the cytotoxicity of CM [both low-osmolality (LOCM) and iso-osmolality (IOCM)], of iodine alone, and of an hyperosmolar solution (mannitol 8%) on human embryonic kidney (HEK 293), porcine proximal renal tubular (LLC-PK1), and canine Madin–Darby distal tubular renal (MDCK) cells; and (ii) the effectiveness of various antioxidant compounds [N-acetylcysteine (NAC), ascorbic acid and sodium bicarbonate] in preventing CM cytotoxicity. The cytotoxicity of CM was assessed at different time points, with different methods: cell viability, DNA laddering, flow cytometry, and caspase activation.
Both LOCM and IOCM produced a concentration- and time-dependent increase in cell death as assessed by the different methods. On the contrary, iodine alone and hyperosmolar solution did not induce any significant cytotoxic effect. There was not any significant difference in the cytotoxic effect between LOCM and IOCM. Furthermore, both LOCM and IOCM caused a marked increase in caspase-3 and -9 activities and poly(ADP-ribose) fragmentation, while no effect on caspase-8/-10 was observed, thus indicating that the CM activated apoptosis mainly through the intrinsic pathway. Both CM induced an increase in protein expression levels of pro-apoptotic members of the Bcl2 family (Bim and Bad). NAC and ascorbic acid but not sodium bicarbonate had a dose-dependent protective effect on renal cells after 3 h incubation with high dose (200 mg iodine/mL) of both LOCM and IOCM.
Conclusion: Both LOCM and IOCM induce a dose-dependent renal cell apoptosis. NAC and ascorbic acid but not sodium bicarbonate prevent this contrast-induced apoptosis.
Key Words: Contrast media • Kidney • Apoptosis • Prevention
The first two authors contributed equally to this work.
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