# Dissecting the role of dynamic epigenome prompting pathways leading to kidney allograft fibrosis

> **NIH NIH R01** · UNIVERSITY OF MARYLAND BALTIMORE · 2022 · $628,096

## Abstract

Late graft loss continues to be a major problem after kidney transplantation (KT), mainly as consequence of death
with a functioning graft and intrinsic allograft failure (or chronic allograft dysfunction (CAD)). CAD remains a
major cause of allograft attrition over time, resulting in reinstitution of end-stage renal disease care. CAD is
considered by many to be a variant of chronic kidney disease (CKD), with both immune and non-immune
mechanisms, contributing to the development of interstitial fibrosis, tubular atrophy (IFTA) and progressive loss
of graft function. Early development of graft fibrosis is predictive of late graft function. To study early factors
involved in kidney fibrosis progression, we established a cohort of 298 KT patients followed longitudinally, with
sequential genomic sampling of kidney allografts. Paired peripheral samples are also available. Utilizing this
unique resource, we have made these observations: a) Molecular activators of early graft injury among KT
recipients with kidney allografts progressing to fibrosis are independent of initial cause of injury, b) there is an
constant pro-inflammatory and oxidative stress proclivity in the allografts from patients progressing to CRAD, c)
specific DNA methylation (DNAm) patterns in donor kidney tissue associate with short- and long-term outcomes
post-KT, d) there are major DNAm pattern changes between cross-sectional kidney allograft biopsies with IFTA
and decline of graft function and kidney graft biopsies with normal histology and graft function (NFA) at > 2-years
post-KT, and e) preliminary data demonstrate that specific upstream epigenetic modifications are associated
with canonical gene pathways related to enhanced immune response and impaired allograft reparation. An
independent Cohort 2 (multicenter, five Institutions) will be used for validation and replication. Hereby, we
hypothesize that regardless of the initial insult after KT, inflammation and oxidative stress induce epigenetic
modifications of critical genes, resulting in an increased risk of fibrosis and progressive decline of kidney function.
These epigenetic modifications lead to secretion of specific cellular biomarkers into the circulation and urine that
predict the risk of kidney fibrosis and chronic allograft dysfunction. The specific aims (SA) include: SA1:
Determine post-KT epigenetic modifications sequentially from a longitudinal cohort of human renal allograft
biopsies. SA2: Develop predictive models to stratify the risk of developing fibrosis and function loss by integrating
the most predictive epigenetic, transcriptome, and clinical markers. SA3: Evaluate circulating small non-coding
RNA (sncRNA) profiles to identify biomarkers and correlate with gene expression changes in the renal allograft
with fibrosis and CAD. Evaluation of epigenetic changes in kidney grafts may provide new data about affected
pathways and regulators leading to graft injury, fibrosis, and loss of function. The proposed studi...

## Key facts

- **NIH application ID:** 10433992
- **Project number:** 5R01DK122682-04
- **Recipient organization:** UNIVERSITY OF MARYLAND BALTIMORE
- **Principal Investigator:** Valeria Raquel Mas
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $628,096
- **Award type:** 5
- **Project period:** 2019-07-01 → 2024-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10433992

## Citation

> US National Institutes of Health, RePORTER application 10433992, Dissecting the role of dynamic epigenome prompting pathways leading to kidney allograft fibrosis (5R01DK122682-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10433992. Licensed CC0.

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