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Phosphate, Microbiota and CKD. Nutrients 2021; 13:nu13041273. [PMID: 33924419 PMCID: PMC8070653 DOI: 10.3390/nu13041273] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 02/08/2023] Open
Abstract
Phosphate is a key uremic toxin associated with adverse outcomes. As chronic kidney disease (CKD) progresses, the kidney capacity to excrete excess dietary phosphate decreases, triggering compensatory endocrine responses that drive CKD-mineral and bone disorder (CKD-MBD). Eventually, hyperphosphatemia develops, and low phosphate diet and phosphate binders are prescribed. Recent data have identified a potential role of the gut microbiota in mineral bone disorders. Thus, parathyroid hormone (PTH) only caused bone loss in mice whose microbiota was enriched in the Th17 cell-inducing taxa segmented filamentous bacteria. Furthermore, the microbiota was required for PTH to stimulate bone formation and increase bone mass, and this was dependent on bacterial production of the short-chain fatty acid butyrate. We review current knowledge on the relationship between phosphate, microbiota and CKD-MBD. Topics include microbial bioactive compounds of special interest in CKD, the impact of dietary phosphate and phosphate binders on the gut microbiota, the modulation of CKD-MBD by the microbiota and the potential therapeutic use of microbiota to treat CKD-MBD through the clinical translation of concepts from other fields of science such as the optimization of phosphorus utilization and the use of phosphate-accumulating organisms.
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Letavernier E, Daudon M. [Effect of stiripentol on urine oxalate excretion]. Nephrol Ther 2021; 17S:S95-S99. [PMID: 33910706 DOI: 10.1016/j.nephro.2020.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 02/03/2020] [Indexed: 11/16/2022]
Abstract
Oxalate is a metabolite promoting the formation of calcium oxalate crystals in urine. Hyperoxaluria is a feature of genetic diseases, known as primary hyperoxaluria, leading to chronic kidney disease. Ethylene glycol poisoning induces the crystallization of calcium oxalate crystals in renal tubules, promoting acute renal failure. Urine oxalate results from glyoxylate transformation to oxalate in the liver, due to lactate dehydrogenase (LDH) activity, especially the LDH-5 isoenzyme. Genetic RNA interference therapy targeting lactate dehydrogenase lowers urine oxalate excretion in murine models. Stiripentol is a drug inhibiting neuronal LDH-5 isoenzyme activity. We hypothesized that stiripentol would also reduce hepatic oxalate production and urine oxalate excretion. In vitro Stiripentol decreases oxalate synthesis by hepatocytes. In vivo, stiripentol decreases urine oxalate excretion in rats and protects kidney tissue and function against ethylene glycol intoxication and hydroxyproline-induced calcium oxalate crystalline nephropathy. The use of stiripentol in clinical practice deserves further clinical studies.
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Affiliation(s)
- Emmanuel Letavernier
- Sorbonne Université, 4, rue de la Chine, 75020 Paris, France; Inserm, UMR S 1155 Maladies fréquentes et rares: des mécanismes moléculaires à la médecine personnalisée, 4, rue de la Chine, 75020 Paris, France; Service des explorations fonctionnelles multidisciplinaires, hôpital Tenon, 4, rue de la Chine, 75020 Paris France.
| | - Michel Daudon
- Sorbonne Université, 4, rue de la Chine, 75020 Paris, France; Inserm, UMR S 1155 Maladies fréquentes et rares: des mécanismes moléculaires à la médecine personnalisée, 4, rue de la Chine, 75020 Paris, France; Service des explorations fonctionnelles multidisciplinaires, hôpital Tenon, 4, rue de la Chine, 75020 Paris France
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Saw JJ, Sivaguru M, Wilson EM, Dong Y, Sanford RA, Fields CJ, Cregger MA, Merkel AC, Bruce WJ, Weber JR, Lieske JC, Krambeck AE, Rivera ME, Large T, Lange D, Bhattacharjee AS, Romero MF, Chia N, Fouke BW. In Vivo Entombment of Bacteria and Fungi during Calcium Oxalate, Brushite, and Struvite Urolithiasis. KIDNEY360 2021; 2:298-311. [PMID: 35373025 PMCID: PMC8740987 DOI: 10.34067/kid.0006942020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/23/2020] [Indexed: 02/04/2023]
Abstract
Background Human kidney stones form via repeated events of mineral precipitation, partial dissolution, and reprecipitation, which are directly analogous to similar processes in other natural and manmade environments, where resident microbiomes strongly influence biomineralization. High-resolution microscopy and high-fidelity metagenomic (microscopy-to-omics) analyses, applicable to all forms of biomineralization, have been applied to assemble definitive evidence of in vivo microbiome entombment during urolithiasis. Methods Stone fragments were collected from a randomly chosen cohort of 20 patients using standard percutaneous nephrolithotomy (PCNL). Fourier transform infrared (FTIR) spectroscopy indicated that 18 of these patients were calcium oxalate (CaOx) stone formers, whereas one patient formed each formed brushite and struvite stones. This apportionment is consistent with global stone mineralogy distributions. Stone fragments from seven of these 20 patients (five CaOx, one brushite, and one struvite) were thin sectioned and analyzed using brightfield (BF), polarization (POL), confocal, super-resolution autofluorescence (SRAF), and Raman techniques. DNA from remaining fragments, grouped according to each of the 20 patients, were analyzed with amplicon sequencing of 16S rRNA gene sequences (V1-V3, V3-V5) and internal transcribed spacer (ITS1, ITS2) regions. Results Bulk-entombed DNA was sequenced from stone fragments in 11 of the 18 patients who formed CaOx stones, and the patients who formed brushite and struvite stones. These analyses confirmed the presence of an entombed low-diversity community of bacteria and fungi, including Actinobacteria, Bacteroidetes, Firmicutes, Proteobacteria, and Aspergillus niger. Bacterial cells approximately 1 μm in diameter were also optically observed to be entombed and well preserved in amorphous hydroxyapatite spherules and fans of needle-like crystals of brushite and struvite. Conclusions These results indicate a microbiome is entombed during in vivo CaOx stone formation. Similar processes are implied for brushite and struvite stones. This evidence lays the groundwork for future in vitro and in vivo experimentation to determine how the microbiome may actively and/or passively influence kidney stone biomineralization.
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Affiliation(s)
- Jessica J. Saw
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois
- Department of Molecular and Integrative Physiology, University of Illinois at Urbana-Champaign, Urbana, Illinois
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mayandi Sivaguru
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Elena M. Wilson
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois
- School of Molecular and Cellular Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Yiran Dong
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Robert A. Sanford
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois
- Department of Geology, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Chris J. Fields
- Roy J. Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Melissa A. Cregger
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois
- Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee
| | - Annette C. Merkel
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois
- School of Molecular and Cellular Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - William J. Bruce
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois
- School of Molecular and Cellular Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Joseph R. Weber
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois
- School of Molecular and Cellular Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - John C. Lieske
- Department of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Amy E. Krambeck
- Department of Urology, Mayo Clinic, Rochester, Minnesota
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Marcelino E. Rivera
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Timothy Large
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Dirk Lange
- The Stone Centre at Vancouver General Hospital, Department of Urologic Sciences, University of British Columbia, Jack Bell Research Centre, Vancouver, British Columbia, Canada
| | - Ananda S. Bhattacharjee
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Michael F. Romero
- Department of Individualized Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Nicholas Chia
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Bruce W. Fouke
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois
- School of Molecular and Cellular Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois
- Department of Geology, University of Illinois at Urbana-Champaign, Urbana, Illinois
- Roy J. Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Urbana, Illinois
- Department of Evolution, Ecology and Behavior, University of Illinois at Urbana-Champaign, Urbana, Illinois
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Abstract
PURPOSE OF REVIEW Oxalate is a metabolic end-product promoting the formation of calcium oxalate crystals in urine. Massive urine oxalate excretion occurs in genetic diseases, mainly primary hyperoxaluria type I and II, threatening renal function. Ethylene glycol poisoning may induce the precipitation of calcium oxalate crystals in renal tubules, leading to acute renal failure. In both cases, oxalate results from glyoxylate transformation to oxalate in the liver, by lactate dehydrogenase (LDH) enzymes, especially the LDH-5 isoenzyme. The purpose of the review is to highlight LDH as a potential therapeutic target according to recent publications. RECENT FINDINGS Genetic therapy targeting LDH metabolism decreases urine oxalate excretion in rodents. Stiripentol is an antiepileptic drug that has been shown recently to inhibit neuronal LDH-5 isoenzyme. Stiripentol was hypothesized to reduce hepatic oxalate production and urine oxalate excretion. In vitro, stiripentol decreases oxalate synthesis by hepatocytes. In vivo, stiripentol oral administration decreases urine oxalate excretion in rats and protects renal function and renal tissue against ethylene glycol intoxication and chronic calcium oxalate crystalline nephropathy. SUMMARY The use of stiripentol in-vitro and in-vivo highlights that targeting hepatic LDH by pharmacological or genetic tools may decrease oxalate synthesis, deserving clinical studies.
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Penniston KL, Knoll T. Diätetische Aspekte der Urolithiasis. Urolithiasis 2021. [DOI: 10.1007/978-3-662-62454-8_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Crivelli JJ, Mitchell T, Knight J, Wood KD, Assimos DG, Holmes RP, Fargue S. Contribution of Dietary Oxalate and Oxalate Precursors to Urinary Oxalate Excretion. Nutrients 2020; 13:nu13010062. [PMID: 33379176 PMCID: PMC7823532 DOI: 10.3390/nu13010062] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/23/2020] [Accepted: 12/25/2020] [Indexed: 02/07/2023] Open
Abstract
Kidney stone disease is increasing in prevalence, and the most common stone composition is calcium oxalate. Dietary oxalate intake and endogenous production of oxalate are important in the pathophysiology of calcium oxalate stone disease. The impact of dietary oxalate intake on urinary oxalate excretion and kidney stone disease risk has been assessed through large cohort studies as well as smaller studies with dietary control. Net gastrointestinal oxalate absorption influences urinary oxalate excretion. Oxalate-degrading bacteria in the gut microbiome, especially Oxalobacter formigenes, may mitigate stone risk through reducing net oxalate absorption. Ascorbic acid (vitamin C) is the main dietary precursor for endogenous production of oxalate with several other compounds playing a lesser role. Renal handling of oxalate and, potentially, renal synthesis of oxalate may contribute to stone formation. In this review, we discuss dietary oxalate and precursors of oxalate, their pertinent physiology in humans, and what is known about their role in kidney stone disease.
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Affiliation(s)
| | | | | | | | | | - Ross P. Holmes
- Correspondence: ; Tel.: +1-(205)-996-8765; Fax: +1-(205)-934-4933
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Stern JM, Burk RD, Asplin J, Krieger NS, Suadicani SO, Wang Y, Usyk M, Lee JA, Chen L, Becker J, Chan M, Bushinsky DA. Kidney stone formation and the gut microbiome are altered by antibiotics in genetic hypercalciuric stone-forming rats. Urolithiasis 2020; 49:185-193. [PMID: 33161469 DOI: 10.1007/s00240-020-01223-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
Antibiotics can alter the gut microbiome (GMB), which may be associated with stone disease. We sought to determine the effect that antibiotics have on the GMB, urine ion excretion and stone formation in genetic hypercalciuric stone-forming (GHS) rats. 116th generation GHS rats were fed a fixed amount of a normal calcium (1.2%) and phosphate (0.65%) diet, and divided into three groups (n = 10): control (CTL) diet, or supplemented with ciprofloxacin (Cipro, 5 mg/day) or Bactrim (250 mg/day). Urine and fecal pellets were collected over 6, 12 and 18 weeks. Fecal DNA was amplified across the 16S rRNA V4 region. At 18 weeks, kidney stone formation was visualized by Faxitron and blindly assessed by three investigators. After 18 weeks, urine calcium and oxalate decreased with Bactrim compared to CTL and Cipro. Urine pH increased with Bactrim compared to CTL and Cipro. Urine citrate increased with Cipro compared to CTL and decreased by half with Bactrim. Calcification increased with Bactrim compared to CTL and Cipro. Increased microbial diversity correlated with decreased urinary oxalate in all animals (R = - 0.46, p = 0.006). A potential microbial network emerged as significantly associated with shifts in urinary pH. Bactrim and Cipro differentially altered the GMB of GHS rats. The Bactrim group experienced a decrease in urine calcium, increased CaP supersaturation and increased calcification. The GMB is likely a contributing factor to changes in urine chemistry, supersaturation and stone risk. Further investigation is required to fully understand the association between antibiotics, the GMB and kidney stone formation.
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Affiliation(s)
- Joshua M Stern
- Albert Einstein College of Medicine, 1300 Morris Park Ave. Bronx, New York, NY, 10461, USA.
| | - Robert D Burk
- Albert Einstein College of Medicine, 1300 Morris Park Ave. Bronx, New York, NY, 10461, USA
| | - John Asplin
- Litholink, Laboratory Corporation of America® Holdings, Chicago, IL, USA
| | | | - Sylvia O Suadicani
- Albert Einstein College of Medicine, 1300 Morris Park Ave. Bronx, New York, NY, 10461, USA
| | - Yi Wang
- Albert Einstein College of Medicine, 1300 Morris Park Ave. Bronx, New York, NY, 10461, USA
| | - Mykhaylo Usyk
- Albert Einstein College of Medicine, 1300 Morris Park Ave. Bronx, New York, NY, 10461, USA
| | - Justin A Lee
- Albert Einstein College of Medicine, 1300 Morris Park Ave. Bronx, New York, NY, 10461, USA
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Abstract
The prevalence of urolithiasis in humans is increasing worldwide; however, non-surgical treatment and prevention options remain limited despite decades of investigation. Most existing laboratory animal models for urolithiasis rely on highly artificial methods of stone induction and, as a result, might not be fully applicable to the study of natural stone initiation and growth. Animal models that naturally and spontaneously form uroliths are an underused resource in the study of human stone disease and offer many potential opportunities for improving insight into stone pathogenesis. These models include domestic dogs and cats, as well as a variety of other captive and wild species, such as otters, dolphins and ferrets, that form calcium oxalate, struvite, uric acid, cystine and other stone types. Improved collaboration between urologists, basic scientists and veterinarians is warranted to further our understanding of how stones form and to consider possible new preventive and therapeutic treatment options.
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Manna L, Rizzi E, Bafile E, Macchi C, Ruscica M, Salini R, Rossi E, Panebianco C, Pazienza V, Federici F. Impact of Phyllantus niruri and Lactobacillus amylovorus SGL 14 in a mouse model of dietary hyperoxaluria. Benef Microbes 2020; 11:547-559. [PMID: 33032472 DOI: 10.3920/bm2020.0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Hyperoxaluria is a pathological condition which affects long-term health of kidneys. The present study evaluates the impact of the combination of Lactobacillus amylovorus SGL 14 and the plant extract Phyllantus niruri (namely Phyllantin 14™) on dietary hyperoxaluria. Safety and efficacy of Phyllantin 14 have been evaluated in vivo. Mice C57BL6 fed a high-oxalate diet were compared to mice fed the same diet administered with Phyllantin 14 by gavage for 6 weeks. Control mice were fed a standard diet without oxalate. No adverse effects were associated to Phyllantin 14 supplementation, supporting its safety. Mice fed a high-oxalate diet developed significant hyperoxaluria and those administered with Phyllantin 14 showed a reduced level of urinary oxalate and a lower oxalate-to-creatinine ratio. Soluble and insoluble caecal oxalate were significantly lower in treated group, a finding in agreement with the colonisation study, i.e. mice were colonised with SGL 14 after 3 weeks. Microbiota analysis demonstrated that both oxalate diet and Phyllantin 14 can differently modulate the microbiota. In conclusion, our findings suggest that Phyllantin 14 supplementation represents a potential supportive approach for reducing urinary oxalate and/or for enhancing the efficacy of existing treatments.
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Affiliation(s)
- L Manna
- Sintal Dietetics s.r.l., Via Tevere 18, 64020 Castelnuovo Vomano, Teramo, Italy
| | - E Rizzi
- Sintal Dietetics s.r.l., Via Tevere 18, 64020 Castelnuovo Vomano, Teramo, Italy
| | - E Bafile
- Sintal Dietetics s.r.l., Via Tevere 18, 64020 Castelnuovo Vomano, Teramo, Italy
| | - C Macchi
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Via Balzaretti 9, 20122 Milan, Italy
| | - M Ruscica
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Via Balzaretti 9, 20122 Milan, Italy
| | - R Salini
- Istituto Zooprofilattico Sperimentale, dell'Abruzzo e del Molise 'G. Caporale', Via Campo Boario, 64100 Teramo, Italy
| | - E Rossi
- Istituto Zooprofilattico Sperimentale, dell'Abruzzo e del Molise 'G. Caporale', Via Campo Boario, 64100 Teramo, Italy
| | - C Panebianco
- Unità di Gastroenterologia, IRCCS 'Casa Sollievo della Sofferenza' Hospital, Viale dei Cappuccini 1, 71013 San Giovani Rotondo, Foggia, Italy
| | - V Pazienza
- Unità di Gastroenterologia, IRCCS 'Casa Sollievo della Sofferenza' Hospital, Viale dei Cappuccini 1, 71013 San Giovani Rotondo, Foggia, Italy
| | - F Federici
- Sintal Dietetics s.r.l., Via Tevere 18, 64020 Castelnuovo Vomano, Teramo, Italy
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Dietary Oxalate Intake and Kidney Outcomes. Nutrients 2020; 12:nu12092673. [PMID: 32887293 PMCID: PMC7551439 DOI: 10.3390/nu12092673] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/25/2020] [Accepted: 08/30/2020] [Indexed: 12/16/2022] Open
Abstract
Oxalate is both a plant-derived molecule and a terminal toxic metabolite with no known physiological function in humans. It is predominantly eliminated by the kidneys through glomerular filtration and tubular secretion. Regardless of the cause, the increased load of dietary oxalate presented to the kidneys has been linked to different kidney-related conditions and injuries, including calcium oxalate nephrolithiasis, acute and chronic kidney disease. In this paper, we review the current literature on the association between dietary oxalate intake and kidney outcomes.
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Liu Y, Jin X, Hong HG, Xiang L, Jiang Q, Ma Y, Chen Z, Cheng L, Jian Z, Wei Z, Ai J, Qi S, Sun Q, Li H, Li Y, Wang K. The relationship between gut microbiota and short chain fatty acids in the renal calcium oxalate stones disease. FASEB J 2020; 34:11200-11214. [PMID: 32645241 DOI: 10.1096/fj.202000786r] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/20/2020] [Accepted: 06/16/2020] [Indexed: 02/05/2023]
Abstract
The relationship of gut microbiota and calcium oxalate stone has been limited investigated, especially with no study of gut microbiota and short chain fatty acids (SCFAs) in nephrolithiasis. We provided Sprague Dawley rats of renal calcium oxalate stones with antibiotics and examined the renal crystals deposition. We also performed a case-control study by analyzing 16S rRNA microbial profiling, shotgun metagenomics and SCFAs in 153 fecal samples from non-kidney stone (NS) controls, patients with occasional renal calcium oxalate stones (OS) and patients with recurrent stones (RS). Antibiotics reduced bacterial load in feces and could promote the formation of renal calcium crystals in model rats. In addition, both OS and RS patients exhibited higher fecal microbial diversity than NS controls. Several SCFAs-producing gut bacteria, as well as metabolic pathways associated with SCFAs production, were considerably lower in the gut microbiota among the kidney stone patients compared with the NS controls. Representation of genes involved in oxalate degradation showed no significance difference among groups. However, fecal acetic acid concentration was the highest in RS patients with high level of urinary oxalate, which was positively correlated with genes involvement in oxalate synthesis. Administration of SCFAs reduced renal crystals. These results shed new light on bacteria and SCFAs, which may promote the development of treatment strategy in nephrolithiasis.
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Affiliation(s)
- Yu Liu
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Xi Jin
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Hyokyoung G Hong
- Department of Statistics and Probability, Michigan State University, East Lansing, MI, USA
| | - Liyuan Xiang
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Qingyao Jiang
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yucheng Ma
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Zude Chen
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Liang Cheng
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhongyu Jian
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhitao Wei
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jianzhong Ai
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Shiqian Qi
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qun Sun
- Key Laboratory of Bio-Resources and Eco-Environment of the Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, China
| | - Hong Li
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Li
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Kunjie Wang
- Department of Urology, Laboratory of Reconstructive Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
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Ormanji MS, Rodrigues FG, Heilberg IP. Dietary Recommendations for Bariatric Patients to Prevent Kidney Stone Formation. Nutrients 2020; 12:nu12051442. [PMID: 32429374 PMCID: PMC7284744 DOI: 10.3390/nu12051442] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/09/2020] [Accepted: 05/13/2020] [Indexed: 12/12/2022] Open
Abstract
Bariatric surgery (BS) is one of the most common and efficient surgical procedures for sustained weight loss but is associated with long-term complications such as nutritional deficiencies, biliary lithiasis, disturbances in bone and mineral metabolism and an increased risk of nephrolithiasis, attributed to urinary metabolic changes resultant from low urinary volume, hypocitraturia and hyperoxaluria. The underlying mechanisms responsible for hyperoxaluria, the most common among all metabolic disturbances, may comprise increased intestinal oxalate absorption consequent to decreased calcium intake or increased dietary oxalate, changes in the gut microbiota, fat malabsorption and altered intestinal oxalate transport. In the current review, the authors present a mechanistic overview of changes found after BS and propose dietary recommendations to prevent the risk of urinary stone formation, focusing on the role of dietary oxalate, calcium, citrate, potassium, protein, fat, sodium, probiotics, vitamins D, C, B6 and the consumption of fluids.
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Affiliation(s)
- Milene S. Ormanji
- Nephrology Division, Universidade Federal de São Paulo, São Paulo 04023-062, Brazil; (M.S.O.); (F.G.R.)
| | - Fernanda G. Rodrigues
- Nephrology Division, Universidade Federal de São Paulo, São Paulo 04023-062, Brazil; (M.S.O.); (F.G.R.)
- Department of Nutrition, Universidade Federal de São Paulo, São Paulo 04023-062, Brazil
| | - Ita P. Heilberg
- Nephrology Division, Universidade Federal de São Paulo, São Paulo 04023-062, Brazil; (M.S.O.); (F.G.R.)
- Department of Nutrition, Universidade Federal de São Paulo, São Paulo 04023-062, Brazil
- Correspondence: ; Tel.: +55-(11)-5576-4848 (ext. 2465)
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Jiang T, Chen W, Cao L, He Y, Zhou H, Mao H. Abundance, Functional, and Evolutionary Analysis of Oxalyl-Coenzyme A Decarboxylase in Human Microbiota. Front Microbiol 2020; 11:672. [PMID: 32390974 PMCID: PMC7190790 DOI: 10.3389/fmicb.2020.00672] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 03/24/2020] [Indexed: 11/13/2022] Open
Abstract
Oxalic acid and its oxalate salts have been linked to kidney stones and other health problems and about 80% kidney stones are made up of calcium oxalate. Oxalyl coenzyme A decarboxylase (OXC) is a key enzyme in the catabolism of oxalate. In this study, we performed bioinformatic and biochemical analysis of OXC. First, we mined the OXC sequences from a public protein database and collected 1396 putative OXC sequences. These sequences were widely spread and mainly distributed in Actinobacteria, Alphaproteobacteria, Gammaproteobacteria, and Betaproteobacteria and classified into seven clusters. The phylogenetic relationship and evolutionary rate of the 7 clusters showed that OXC are highly conserved. Second, the abundance of the different clusters of OXC was explored in 380 human microbiome datasets, which showed that OXCs in Cluster 1 were relatively high in the gut while OXCs in Clusters 2-4 were relatively enriched in the vagina. Third, we measured the activity of one OXC from Mycobacterium mageritense (OXCmm) in Cluster 3, in which there was no experimentally characterized enzymes. Mutation analysis showed that OXCmm shared the same active sites with the OXC from Oxalobacter formigenes. Taken together, this analysis provides a better insight into the distribution and catalysis of OXC and further potential alternative application of OXC active bacteria as probiotics in the management of kidney stone disease.
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Affiliation(s)
- Tao Jiang
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wenwei Chen
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Linsheng Cao
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yanfeng He
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Huiliang Zhou
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Houping Mao
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Denburg MR, Koepsell K, Lee JJ, Gerber J, Bittinger K, Tasian GE. Perturbations of the Gut Microbiome and Metabolome in Children with Calcium Oxalate Kidney Stone Disease. J Am Soc Nephrol 2020; 31:1358-1369. [PMID: 32381601 DOI: 10.1681/asn.2019101131] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/22/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The relationship between the composition and function of gut microbial communities and early-onset calcium oxalate kidney stone disease is unknown. METHODS We conducted a case-control study of 88 individuals aged 4-18 years, which included 44 individuals with kidney stones containing ≥50% calcium oxalate and 44 controls matched for age, sex, and race. Shotgun metagenomic sequencing and untargeted metabolomics were performed on stool samples. RESULTS Participants who were kidney stone formers had a significantly less diverse gut microbiome compared with controls. Among bacterial taxa with a prevalence >0.1%, 31 taxa were less abundant among individuals with nephrolithiasis. These included seven taxa that produce butyrate and three taxa that degrade oxalate. The lower abundance of these bacteria was reflected in decreased abundance of the gene encoding butyryl-coA dehydrogenase (P=0.02). The relative abundance of these bacteria was correlated with the levels of 18 fecal metabolites, and levels of these metabolites differed in individuals with kidney stones compared with controls. The oxalate-degrading bacterial taxa identified as decreased in those who were kidney stone formers were components of a larger abundance correlation network that included Eggerthella lenta and several Lactobacillus species. The microbial (α) diversity was associated with age of stone onset, first decreasing and then increasing with age. For the individuals who were stone formers, we found the lowest α diversity among individuals who first formed stones at age 9-14 years, whereas controls displayed no age-related differences in diversity. CONCLUSIONS Loss of gut bacteria, particularly loss of those that produce butyrate and degrade oxalate, associates with perturbations of the metabolome that may be upstream determinants of early-onset calcium oxalate kidney stone disease.
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Affiliation(s)
- Michelle R Denburg
- Division of Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kristen Koepsell
- Division of Pediatric Urology, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jung-Jin Lee
- Division of Gastroenterology, Department of Pediatrics, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jeffrey Gerber
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Division of Infectious Diseases, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kyle Bittinger
- Division of Gastroenterology, Department of Pediatrics, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Gregory E Tasian
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania .,Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Division of Pediatric Urology, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Nutrients, vitamins, probiotics and herbal products: an update of their role in urolithogenesis. Urolithiasis 2020; 48:285-301. [DOI: 10.1007/s00240-020-01182-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/15/2020] [Indexed: 12/15/2022]
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Calcium Oxalate Nephrolithiasis and Gut Microbiota: Not just a Gut-Kidney Axis. A Nutritional Perspective. Nutrients 2020; 12:nu12020548. [PMID: 32093202 PMCID: PMC7071363 DOI: 10.3390/nu12020548] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/14/2020] [Accepted: 02/18/2020] [Indexed: 12/13/2022] Open
Abstract
Recent studies have shown that patients with kidney stone disease, and particularly calcium oxalate nephrolithiasis, exhibit dysbiosis in their fecal and urinary microbiota compared with controls. The alterations of microbiota go far beyond the simple presence and representation of Oxalobacter formigenes, a well-known symbiont exhibiting a marked capacity of degrading dietary oxalate and stimulating oxalate secretion by the gut mucosa. Thus, alterations of the intestinal microbiota may be involved in the pathophysiology of calcium kidney stones. However, the role of nutrition in this gut-kidney axis is still unknown, even if nutritional imbalances, such as poor hydration, high salt, and animal protein intake and reduced fruit and vegetable intake, are well-known risk factors for kidney stones. In this narrative review, we provide an overview of the gut-kidney axis in nephrolithiasis from a nutritional perspective, summarizing the evidence supporting the role of nutrition in the modulation of microbiota composition, and their relevance for the modulation of lithogenic risk.
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Gut microbiome and kidney stone disease: not just an Oxalobacter story. Kidney Int 2019; 96:25-27. [DOI: 10.1016/j.kint.2019.03.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 02/05/2023]
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